Inflammatory and Allergic Skin Diseases

Psoriasis is a chronic inflammatory skin disease in which overactivation of the immune system causes skin cells to renew much faster than normal. This accelerated cycle leads to thick, raised plaques covered with silvery-white scales. It most commonly affects the elbows, knees, scalp and lower back and is not contagious.

The disease usually follows a course of flare-ups and quieter periods. In some people it can affect not only the skin but also the nails and joints, causing psoriatic arthritis. Because visible plaques and itching can affect quality of life, accurate diagnosis and ongoing follow-up are important.

Symptoms

• Well-defined, raised red plaques covered with silvery-white scales
• Common involvement of the elbows, knees, scalp, lower back and around the navel
• Itching, tightness or occasional burning sensation
• Nail pitting, thickening or separation from the nail bed
• A tendency for pinpoint bleeding when scales are removed

Types

Plaque psoriasis is the most common form. Other types include guttate psoriasis, which may develop after throat infections and appears as small drop-like lesions; inverse (flexural) psoriasis, which affects skin folds; pustular psoriasis, characterized by inflammatory pustules; and erythrodermic psoriasis, which affects extensive areas of the body.

Possible causes and triggers

Genetic predisposition and immune-system dysregulation play central roles. Factors that may trigger flare-ups include stress, infections—especially throat infections—skin trauma and irritation, certain medications, smoking, alcohol and cold, dry weather.

Everyday considerations

Regular moisturization, avoiding vigorous rubbing and irritating products, not forcibly removing scales and managing personal triggers may help reduce flare-ups. Moderate sun exposure may be beneficial for some people, although the approach should be individualized.

When should you see a specialist?

Dermatologic evaluation is recommended for widespread or persistent plaques, severe itching, nail changes, or accompanying joint pain and swelling. Early assessment is particularly important when joint involvement is suspected.

How does treatment change according to severity?

Topical treatments may be sufficient for limited plaques, whereas phototherapy or systemic treatments may be considered for extensive involvement, joint symptoms or disease that significantly affects quality of life. Treatment selection is based not only on the percentage of body surface involved but also on special sites such as the scalp, face, hands and feet, and genital area.

Why are joint symptoms important?

In some people, psoriasis may be accompanied by joint pain, morning stiffness, swollen fingers or heel pain. These symptoms require assessment for psoriatic arthritis. Early diagnosis is important for helping prevent permanent joint damage.

During breastfeeding

Dermatologic evaluation and appropriately selected psoriasis treatment can generally be carried out during breastfeeding. The physician selects topical or systemic medications from options considered appropriate for the breastfeeding period.

Why is long-term follow-up necessary?

Psoriasis is a chronic disease that may alternate between flare-ups and quieter periods. When symptoms improve, treatment may not always be stopped completely; depending on the individual, preventive skin care or intermittent treatment may be needed. Required laboratory monitoring is performed for systemic medications, and associated conditions such as obesity, hypertension and metabolic disorders are also considered as part of comprehensive follow-up.

Atopic dermatitis (eczema) is a chronic inflammatory skin disease characterized by severe itching, dryness and redness and often begins in childhood. It is closely associated with a weakened skin barrier and an allergic tendency known as atopy and may occur together with conditions such as asthma and allergic rhinitis. It is not contagious.

The disease progresses with periods of flare-up and remission. Itching is often the dominant symptom and can affect sleep and daily life. Because scratching can create a cycle in which itching becomes more intense, keeping the skin moisturized and protected is important.

Symptoms

• Severe itching and pronounced skin dryness
• Red, scaly areas that may sometimes ooze or crust
• In infants, commonly on the face and cheeks; in children and adults, often in flexural areas such as the inner elbows, behind the knees and the neck
• Thickening and hardening of the skin due to persistent scratching (lichenification)

Possible causes and triggers

Genetic weakness of the skin barrier and dysregulation of the immune response play central roles. Triggers may include dryness, soaps and detergents, sweating, wool or synthetic fabrics, allergens such as dust mites and pollen, temperature changes and stress.

Everyday considerations

Frequent and generous moisturization, short lukewarm showers, fragrance-free gentle cleansers, cotton clothing and avoidance of known triggers may help reduce symptoms. Avoiding scratching helps protect the skin.

When should you see a specialist?

Dermatologic evaluation is recommended for persistent or widespread itching, symptoms that disrupt sleep, signs of infection such as oozing or crusting, or disease that does not improve with basic skin care.

Why is the skin barrier central to treatment?

In atopic dermatitis, the skin barrier is more prone to water loss and penetration by external irritants. For this reason, regular moisturizer use remains important even when symptoms have settled, rather than using treatment only during flare-ups. Short lukewarm showers, fragrance-free cleansers and soft textiles may reduce irritation.

The itch-redness cycle

Scratching further damages the skin barrier and increases inflammation, while increased inflammation intensifies itching. Breaking this cycle requires both control of inflammation and regular moisturization. If nighttime itching is prominent, sleep quality should also be considered in the treatment plan.

During breastfeeding

Dermatologic evaluation and appropriately selected eczema treatment can generally be carried out during breastfeeding. Creams or systemic medications are selected by the physician from options considered appropriate for breastfeeding.

Contact dermatitis is an inflammatory skin condition caused by direct contact with a substance and is characterized by redness, itching and irritation. Symptoms are usually limited to the area of contact and may form a pattern corresponding to the source of exposure, such as jewelry, gloves or a cosmetic product.

There are two main types: irritant contact dermatitis, caused by the direct damaging effect of an irritating substance, and allergic contact dermatitis, which occurs when the immune system becomes sensitized to a particular substance. Irritant contact dermatitis is more common.

Symptoms

• Redness, itching and burning in the area of contact
• Dryness, scaling and cracks
• Small fluid-filled blisters (vesicles) and oozing in some cases
• A localized pattern corresponding to the shape of the contacting object

Common causes

Common irritants include soaps and detergents, frequent handwashing, solvents and certain chemicals. Common allergens include nickel in jewelry, buttons and buckles, fragrance and perfume ingredients, hair dyes, latex and some topical products.

Everyday considerations

The most important step is identifying the responsible substance and stopping contact with it. Protective gloves, gentle cleansing and moisturizing or barrier creams may help protect the skin. In allergic contact dermatitis, patch testing may help identify the responsible allergen.

When should you see a specialist?

Dermatologic evaluation is recommended when the condition recurs, persists, spreads or the trigger cannot be identified, and also when allergic contact dermatitis or patch testing needs to be investigated.

How are allergic and irritant contact dermatitis distinguished?

Irritant contact dermatitis may develop after direct irritating effects such as detergents, frequent handwashing or chemical exposure. In allergic contact dermatitis, the immune system has become sensitized to a specific substance. Because the two conditions can look similar, the history and distribution of contact are important, and recurrent cases may require patch testing.

Avoiding contact is part of treatment

Using cream alone will not provide a lasting solution if exposure to the responsible substance continues. Cosmetics, hair dyes, metal accessories, cleaning products and occupational chemicals should be reviewed in detail. Protective gloves and barrier creams may be useful for certain occupational exposures.

During breastfeeding

Dermatologic evaluation and appropriately selected treatment for contact dermatitis can generally be carried out during breastfeeding. Topical medications and skin-care products are selected by the physician.

Urticaria (hives) is characterized by the sudden appearance of itchy, raised wheals that usually disappear or move to another area within 24 hours. Individual lesions may come and go quickly, while new lesions can continue to develop for days. In some cases, deeper swelling known as angioedema may occur in areas such as the lips and eyelids.

If it lasts for less than six weeks, it is called acute urticaria; if it persists longer, it is considered chronic urticaria. In chronic urticaria, a clear trigger often cannot be identified.

Symptoms

• Itchy, raised wheals of varying sizes, usually pink-red with a paler center
• Individual lesions disappearing within a short time and reappearing elsewhere
• Possible involvement of any area of the body
• Deeper swelling of areas such as the lips and eyelids (angioedema)

Possible triggers

Infections, certain foods, medications such as some painkillers and antibiotics, insect stings, physical stimuli including pressure, cold, heat, sunlight and friction, and stress may act as triggers. In chronic urticaria, a specific cause is often not found.

Everyday considerations

Avoiding recognized triggers, reducing overheating and friction, and keeping a symptom diary noting when episodes occur may make assessment easier.

When should you see a specialist?

Dermatologic evaluation is recommended for recurrent symptoms or symptoms lasting longer than six weeks. If shortness of breath, swelling of the tongue, lips or throat, difficulty swallowing, or dizziness accompanies the rash, this may be an emergency and immediate assessment at the nearest emergency department is required.

What is the difference between acute and chronic urticaria?

Urticaria lasting less than six weeks is considered acute, while symptoms that continue or recur beyond this period are considered chronic. In acute cases, triggers such as infection, medication or food may be more apparent, whereas a single cause may not be identified in chronic urticaria. Rather than performing unnecessarily broad allergy testing, evaluation is targeted according to the history.

Which symptoms are emergencies?

Rapid swelling of the lips, tongue or throat, shortness of breath, wheezing, dizziness or a feeling of fainting may be part of a more serious allergic reaction. If these symptoms occur, a routine outpatient appointment should not be awaited and urgent medical evaluation is required.

During breastfeeding

Dermatologic evaluation and appropriately selected urticaria treatment can generally be carried out during breastfeeding. Antihistamines or other medications are selected by the physician from options considered suitable for breastfeeding.

Pityriasis rosea is a widespread rash seen most often in young adults that usually resolves on its own, generally within 6–8 weeks. It often begins with a single larger “herald patch,” followed several days later by smaller oval lesions on the trunk.

When lesions on the trunk follow the natural skin lines, they may produce a “Christmas tree” pattern on the back. Mild itching commonly accompanies the rash, and it usually heals without scarring. Although a viral association has been proposed, it is not generally considered clearly contagious in everyday practice.

Symptoms

• An initial single, oval, mildly scaly and larger lesion known as the herald patch
• Smaller oval pink-brown scaly lesions appearing on the trunk afterward
• A “Christmas tree” distribution along skin lines on the back
• Usually mild itching; the face is generally spared

Course

The condition is self-limited and usually heals without scarring within 6–8 weeks. Temporary color changes may remain after the rash resolves.

Everyday considerations

Gentle cleansing, moisturization and avoiding overheating and irritation may help reduce itching.

When should you see a specialist?

Dermatologic evaluation is useful to confirm the diagnosis because the appearance may resemble other conditions such as fungal infections. Specialist advice is recommended if itching is severe, the course is unusual or there are important hormonal changes.

Why is diagnosis important?

Although pityriasis rosea is often recognized by its typical appearance, it can resemble fungal infections, drug eruptions and some other skin diseases. Dermatologic assessment is particularly useful if the eruption occurs in unusual areas, lasts much longer than expected or the typical herald patch is absent.

How can itching be reduced?

Because the condition usually resolves spontaneously, treatment is primarily aimed at reducing discomfort. Lukewarm showers, fragrance-free moisturizer and avoiding sweating and very hot environments may help relieve itching. If itching is severe, the physician may recommend an appropriate topical or oral treatment.

During breastfeeding

Dermatologic evaluation and appropriately selected treatment for symptoms can generally be carried out during breastfeeding. Creams or medications are selected by the physician from suitable options.