What is atopic eczema?

Atopic eczema (often called atopic dermatitis) is one of a group of related, inherited conditions that also includes asthma and hay fever. It can make the skin dry, itchy, red, broken and sore. It sometimes makes the skin darker or lighter for a while. People of all ages can get atopic eczema, but it usually starts in early childhood. It usually improves with age, but some people will have the condition into adulthood.


What are Topical corticosteroids?

Topical corticosteroids are topical treatments that reduce skin inflammation. This slows the production of skin cells and helps reduce itching. They usually come as creams and ointments but are also available as a mousse or shampoo for use on the scalp. Topical corticosteroids are normally used once or twice a day. 

Topical corticosteroids vary in strength; they can be mild, moderate, potent and very potent.


What is psoriasis?

Psoriasis is a skin disease in which normal skin cells are produced faster than they are shed. This results in a build-up of cells seen as patches of raised, red, flaky, skin covered with silvery scales (known as plaques). The skin can also become inflamed (red and swollen). The severity of psoriasis varies greatly, and for many people it has a big impact on their lives. Psoriasis is usually a lifelong condition. At times it might clear up completely but it will normally return. Psoriasis can start at any age, but it is less common in children. The disease can contribute to low self-esteem, anxiety, embarrassment and depression, much like other chronic conditions but this may be overlooked by healthcare professionals. For example, over a third of people who have psoriasis report clinically significant anxiety and depression.Some people with psoriasis also develop joint disease called psoriatic arthritis.

The condition can also affect a person's participation in social and physical activities, employment and education.


What are Coal tar preparations?

Coal tar preparations are one of the topical treatments used in psoriasis they can reduce scales, inflammation and itchiness. They are available in various formulations, such as lotions, creams, shampoos and products for use in the bath or shower.


What is Dithranol?

Dithranol is a topical medication that slows the production of skin cells. It is often used for 'short-contact' treatment, which means that it is applied for short period of time then washed off or removed with oil. There is a lassars paste which can be left on the psoriasis plaques for a longer period up to 24 hours.

Dithranol can cause burning or irritation of normal skin so is only applied to the psoriasis plaques. It is also messy to use and can cause staining.


Treatment using phototherapy

Phototherapy uses ultraviolet (UV) light to treat certain skin conditions. It can be used alone or with drugs called psoralens, which make the skin more sensitive to light (as also known as PUVA). Phototherapy should be used periodically and it is not suitable for long-term use to control your psoriasis.

Your healthcare professional should offer you phototherapy if you have psoriasis that cannot be controlled with topical treatment alone. Treatment is usually given 3 or 2 times a week.


You may be offered topical treatment as well as phototherapy if:

•    you have plaques that do not respond to phototherapy, are on parts of the body that are difficult to treat or are covered with hair and need treatment (such as flexures and the scalp) or

•    you are not able or do not want to take systemic drugs. 


Phototherapy and risk of skin cancer

Exposure to UV light during phototherapy can increase your risk of skin cancer so your treatment should be carefully monitored.

Some people are at especially high risk of skin cancers (for example, people with xeroderma pigmentosum or familial melanoma or who have already received a lot of phototherapy). If you have one of these conditions, phototherapy is not likely to be suitable for you.


When considering PUVA treatment, your healthcare professional should first discuss with you:

•    other possible treatment options

•    the risks of skin cancer, explaining that the risk increases with the number of treatments.