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Dry Skin &
Inflammation

There are a number of dry skin conditions which are prone to inflammation, such as plaque psoriasis, guttate psoriasis, atopic eczema, varicose eczema, incontinence-associated dermatitis, hand dermatitis and contact dermatitis (allergic and irritant).

Eczema

Eczema, or dermatitis, includes a range of related inflammatory dry skin conditions where there is damage to the skin barrier, such as atopic eczema, contact dermatitis and varicose eczema. In all cases the skin is characteristically dry and often inflamed. When the skin is itchy, scratching can cause further damage to the skin and further inflammation.

The causes of the different types of eczema are varied and may include environmental factors. Both genetic and environmental factors are implicated in atopic eczema.

Flare-ups, characterised by areas of hot, red, inflamed skin, are a common feature of atopic eczema which affect part or most of the body. According to the NICE Atopic Eczema in Children Costing Report 2008, children with moderate atopic eczema suffer on average 8.7 flares per year1 and, within this period, mild to moderate atopic eczema patients are likely to have experienced at least one flare requiring a step up in treatment to either a topical corticosteroid or a topical calcineurin inhibitor.

It is important for patients to try to recognise the triggers which may lead to a flare of their eczema.

Common triggers include:-

  • Washing with soap based products
  • Some washing powders and detergents
  • Animal dander (fur, hair) and saliva
  • Pollen
  • House-dust mites and their droppings
  • Stress
  • Food – infants and young children may be particularly affected

Emollients are the mainstay of treatment for atopic eczema and should continue to be used during flares and when the skin appears normal to help maintain the condition of the skin barrier.

Psoriasis

Psoriasis is a systemic, immune-mediated disorder, characterized by inflammatory skin and joint manifestations. The inflamed ‘salmon pink’ coloured plaques, covered in silvery dry skin scales are characteristic of psoriasis.

NICE acknowledge the widespread use of emollients as part of the management of psoriasis, to moisturise dry skin. This helps to make the skin more comfortable by reducing itching and dryness and reducing the amount of scale. In addition, emollients may have an anti-proliferative effect in psoriasis and may be the only treatment needed in mild psoriasis.2

Treating Dry and Inflamed Skin Conditions

Emollients will always remain the mainstay of treating dry skin. However, for those whose skin is prone to inflammation, additional intervention may be required through the concomitant use of topical corticosteroids or immunomodulators, either during ‘flares,’ or sometimes for longer, because the severity of their baseline condition is not adequately controlled using emollients alone.

Combination therapy, typically involving supplementing emollient use with an additional anti‑inflammatory medicine, such as a topical corticosteroid or immunomodulator (also referred to as calcineurin inhibitor), is established standard care.

Topical corticosteroids are available in a variety of different potencies. Patients may sometimes be required to use a range of different strengths of topical corticosteroid when the severity of their skin condition changes, as well as for different parts of the body. It is always important to ensure that patients fully understand their treatment plans.

Combination treatment plans therefore need to be both customised to the differing needs of individual patients and closely monitored by a healthcare professional.

Adex Gel emollient as part of a different treatment regimen for dry skin prone to inflammation

Adex Gel offers a useful treatment option to manage dry skin conditions predisposed to flare-ups.

Adex Gel combines an emollient with an ancillary anti-inflammatory medicinal substance together in a single preparation, offering patients and healthcare professionals a simple and convenient treatment regimen.

Adex Gel can be used routinely in circumstances where ancillary anti-inflammatory action may be beneficial, or intermittently e.g. during flares.

Adex gel

Adex Gel as part of a treatment plan - adapted from NICE Clinical Guideline 57- Atopic Eczema in Children3

Below is a useful patient resource on dry, inflamed skin which can be downloaded free of charge.

Managing dry, inflamed skin, a guide for patients

Adex gel management

Other useful information resources

More information on the treatment of eczema and psoriasis can be found in the NICE links below.

References
  1. https://www.nice.org.uk/guidance/cg57/resources/cg57-atopic-eczema-in-children-evidence-tables2
  2. https://bnf.nice.org.uk/treatment-summary/psoriasis.html
  3. National Institute for Health and Care Excellence. Atopic eczema in children: Management of atopic eczema in children from birth up to the age of 12 (CG57). 2007. London: National Institute for Health and Care Excellence.
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