Skin is a complex structure and rashes of many sorts can become evident readily. Rashes are not to be underestimated. Rashes are often belittled by others who don’t appreciate the significance and we as Dermatologists appreciate the terrible affect they can have on quality of life.
Rashes can cause disfiguring changes in appearance, as well as itch, pain, blisters, ulcers, hair loss and even reduced function of temperature control and fluid balance.
Conditions can include eczema (dermatitis), psoriasis, infections, allergies, drug reactions, viral reactions, autoimmune conditions and many other rare processes. The identification of the cause of the problem and an understanding of the process and potential treatments are the key to improved control or even cure. In New Zealand dermatologists only complete training after years of internal medicine experience and then specialist examinations followed by at least 4 more years of dermatology advanced training. This means they have the unique knowledge and experience to help with the myriad causes of skin rashes.
Very often dermatologists are the only ones capable of confirming a diagnosis and / or instituting the optimal treatment. Although dermatology is a broad speciality with many aspects (surgical, cosmetic, allergy etc) Dr Barker, Dr Coutts and Dr Snow reserve considerable time for the management of complex skin rashes. Sometimes the diagnosis will be apparent to us in moments, sometimes we may need to complete investigations eg skin biopsy, blood tests, skin scrapings. We see patients of all ages.
Eczema is common in New Zealand. There are many types. In some cases more than one type of eczema exists. However the commonest sort is “ atopic eczema”. This may be inherited or sporadic and changes through life. It is itchy, red and may be painful and inhibit sleep and disrupt concentration. We have regimens that can optimize management and give a plan for exacerbations and for maintenance treatment. Allergy can make “atopic eczema” worse in some cases. We have the facilities for comprehensive allergy testing.
Once the patient has seen the consultant we can offer a Special Nurse Clinic session for reinforcement of the treatment regimen and learnings. This has been shown in trials to give a superior long term control for the patient.
Other causes of eczema include “irritant”, “ allergic contact” and “drug induced”.
Psoriasis is another common rash in New Zealand. It affects about 4 in 100 people. It can seriously affect quality of life. There is also increasing evidence that it may have an association with cardiovascular health, mental health, and general well being. There is a strong association with joint inflammation. Traditionally management has been topical (creams) but in recent years, newer tablet or even injection based treatment have improved control. In New Zealand we now have access to the “biologic drugs” which have provided an exciting new option and given many people much better control and a new lease on life. Not infrequently Dr Barker, Dr Coutts and Dr Snow see people who may not have seen a dermatologist regarding the psoriasis for several years. Things are changing so quickly now with psoriasis that these people may be missing out on better / safer management.