The advent of powerful systemic therapies have revolutionized treatment outcomes : Skin eruptions? | Sunday Observer

The advent of powerful systemic therapies have revolutionized treatment outcomes : Skin eruptions?

Almost all of us have experienced a skin ailment in the course of our lives from infancy to old age. From cradle cap, to nappy rash infants, to sunburn, psoriasis and eczemas and other diseases which range from “rash” to “eruption”, in adults, skin diseases can be both distressing and embarrassing .Many still consider them to be a taboo subject, to be discussed only within closed doors.

However, there is no need to be ashamed of being a victim to these diseases since many of them are treatable, and often caused by a lack of certain vitamins, or exposure to ultra violet rays, or weather related, due to sudden changes in weather patterns from hot to cold in a single day.

Simple remedies: avoiding harsh chemical compounds, can speed healing of wounds and skin eruptions, says an eminent Skin specialist.

Consultant Dermatologist, Lady Ridgeway Hospital, and Chairman , Board of Study in Dermatology, Postgraduate Institute of Medicine, University of Colombo, Dr Jayamini Seneviratne draws on his vast knowledge in the field in which he has earned the distinction of being a front runner. Here, he talks to the Sunday Observer on how skin ailments are triggered, how they should be treated, and underlines the importance of public awareness raising to overcome myths and misconceptions on common preventable diseases that if treated early could prevent complications.

Excerpts …

Q. Dr Seneviratne , skin ailments have surged in recent years across Sri Lanka. Although everyone of us are familiar with experiencing at least one skin ailment in our lifetime, most of us are still ignorant of what they are. Or for that matter, the role of the skin as an organ in the human body. Tell us more about what the skin is and how it protects the body from adverse internal and external impacts. Firstly, since you have made Dermatology your field of study, tell us what it involves.

A. Dermatology is the study of skin diseases and their treatment. However, it also broadly covers hair and nail diseases, skin care and beauty care.

Dr Jayamini Seneviratne

Skin is a vital organ of the human body. It has a number of important functions. It’s primarily an organ of protection. It protects the vulnerable “milieu interior”, meaning internal environment, from a multitude of biological, chemical and physical agents. For example, protecting the DNA (genetic material) from ultraviolet radiation, which is of paramount importance for the survival of the species. Lack of protection provided by the skin may lead to wounds, infections, burns and sunburns, to cite a few simple examples. Among its other functions are Vitamin D synthesis, temperature regulation and its psycho-sensual functions. For the latter, the hair and nails contribute significantly.

Q. What is it made up of?

A. The skin is basically a bi-layered structure. The topmost layer, the epidermis, can be compared to a brick wall. The cells are the bricks and the intercellular substances the cement.

The bottom layer, known as the dermis supports and maintains the epidermis, while giving strength to the skin. It also supports the hair, nails and a variety of skin glands known as appendages. The dermis is made of cells, an extra-cellular matrix, blood vessels and nerves. These structures are also found in other organs. This explains, at least partly, the basis of skin involvement in diseases of other organs.

Q. All humans suffer from at least one skin disease in their life. Do you agree? If so why?

A. There are many reasons for this. Firstly, the skin is the largest organ. Secondly, it is constantly in contact with an environment which is ever-changing. Modern humans are not restricted to one place as did our ancestors. In time to come, this will extend even beyond the earth’s atmosphere. Modern humans, a majority of them, if not all, use a variety of applications on their skin, hair and nails. They range from hair oils and shampoos to creams, lotions and makeup products, though safe for the majority of the people.

Q. Can you categorize skin ailments?

A. Skin diseases are known to afflict the seven ages of man. This can be used as a basis of classification, e.g. neonatal skin diseases. They can also be classified as inherited and acquired. Inherited diseases could result from a defect in one gene, multiple genes (polygenic) or abnormalities in chromosomes (numeric or structural).

Acquired diseases can be classified according to their origin, e.g. infection, autoimmune, metabolic, nutritional and even drug-induced, etc. Often in practice, there can be considerable overlap, e.g. drug eruptions are often inflammatory.

Classification of skin diseases are often descriptive, e.g. scaly lesions are known as “papulosquamous” and red lesions are known broadly as “erythematous”. Fortunately, a majority of skin diseases are trivial in nature. Therefore, dermatology has remained an out-patient department (OPD) specialty worldwide. However, the more serious skin conditions require hospitalization.

Q. Have the names of skin diseases changed over the years?

A. The names of most human diseases have not changed over the years, an example being diabetes. The same applies for skin diseases; psoriasis and eczemas are the most common examples. Skin diseases are also called by a variety of names, which range from “rash” to “eruption”.

Dermatology has evolved over many centuries. Many people from a number of countries have significantly contributed to the specialty. Even now, a wide variety of terms and names are used.

This can, at times, lead to confusion. The International League of Dermatological Societies(ILDS) has recently addressed the issue. It is hoped that international agreement can be reached in the use of terms and definitions.

Q. There are still many myths and misconceptions regarding these ailments. What are the most common?

A. For generations, humans have been baffled by the sudden appearance of a rash. The rapidity with which it spreads can also be alarming. The disfiguration that often follow some skin diseases can be devastating. People often wrongly attribute skin diseases to say, for instance heaty food.

Similarly, a drug that the patient is consuming or a vaccine that the child has recently received is often held responsible. However, this is rarely the case.

Q. How do you diagnose skin diseases?

A. The type and amount of skin diseases in any community reflects the genetic and racial constitution of its members, nutrition and their hygienic standards. They are immensely influenced by their cultural practices, customs and occupations. Climatic influences may alter the skin disease. Diagnosis of an illness rests on a tripod of symptoms, signs and investigations.

Q. What are the symptoms to look out for?

A Symptoms are mostly subjective than the details provided by the patient. As lay people without any medical knowledge, they tell the doctor what they think is important. At times, people convey their interpretations rather than what they actually feel.

Signs, on the other hand are more objective, and therefore, higher in scientific value. However, generally, signs need to be elicited and interpreted in relation to the symptoms of the patient.

Q. What are they?

A. Patients with skin diseases often complain of a rash. The main symptom, common to most skin diseases is itching (pruritus) - a feeling of itching leading to scratching. It can be mild, moderate or severe. The latter can be intractible and very troublesome. To make matters worse, in many skin diseases, itching grows worse in the night. In certain diseases like eczemas, itching could lead to worsening of the rash. This is especially seen in young children. Itching in the night, if severe, can lead to the slowing of growth.

Q. What about pain?

A. Another less common symptom is pain. Pain, in relation to a skin rash, occurs in inflammatory conditions like infections. It may also occur if skin nerves or blood vessels are involved.

The mainstay of diagnosis of a dermatological disorder rests on a dermatologist’s ability to elicit and interpret the components of a rash. The specialty has remained a visual specialty. The precise identification of a rash will depend on the dermatologist’s ability to recognize various patterns in appearance and evolution .A dermatologist attempts to identify the primary structure involved, the type of disease and its impact on the physical and psychological wellbeing of the patient. In no branch of medicine other than psychiatry do psychological factors loom so large as in dermatology.

Q. What kind of treatment procedures do you follow?

A. As the skin is accessible, almost all skin diseases require local applications. For minor, localized diseases, a single type of application is often enough. For widespread rashes, a number of applications may be required. To control symptoms like itching, a wide variety of systemic drugs are used. Systemic drugs are also used to control and stop the progression of the disease.

As the skin is an organ of immense regenerative potential, a state conducive to healing needs to be achieved. Rest, an adequate amount of sleep, good nutrition and avoidance of harmful compounds like some soaps, is of vital importance.

Q. There has been several advances in the detection, and treatment of skin diseases, globally. Does Sri Lanka have access to these hi tech methods? Can patients with skin ailments be able to look forward to a future when they could have more effective and positive outcomes from such methods?

A. The advent of powerful systemic therapies have revolutionized treatment outcomes. A wide variety of physical agents, e.g. lasers, are also now available.