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Monday, November 08, 2004
Skin asthma
By Kristine B. Nograles, MD
Tinky
ASTHMATICS are found everywhere. It's not surprising when somebody is labeled hikain. This condition runs in families, so children of asthmatics are more often than not expected to suffer the same lung condition as their parent or parents.
The same is true for those with allergic rhinitis. These are the "sneezers". They inhale pollen, or dust, and they have an attack of the sneezies. You can identify them by their swollen lower lids and their red noses marked with a horizontal line at the bridge resulting from the constant rubbing. Again, this runs in the family.
It is often a surprise, though, for parents with a lahi of asthma and allergic rhinitis to bring in a child to the dermatologist and be told that the child has "skin asthma".
"Pwede pala yan doc?" is often the common reaction. These conditions are cousins, so to speak. Asthma, allergic rhinitis, and atopic dermatitis (a.k.a. skin asthma), are related. If a family member has one of these, the rest may suffer from any of the two.
Although this is does not occur 100 percent. A relative may be free of all three. More and more children are diagnosed with skin asthma these days. Some are even identified by their 4th month of life. These children may outgrow the condition by the time they are 10, similar to the course of lung asthma. And like lung asthma, the condition comes in waves or attacks.
People with skin asthma have very dry skin. During attacks, the dry skin becomes even thicker and drier, sometimes even visibly cracked. These little cracks in the skin are avenues for entry of germs that infect the skin causing more problems. Aside from the dryness, skin asthmatics also have very itchy skin. So they tend to scratch a lot. The scratching causes the darkening and thickening of the skin, especially in areas behind the knee and in the crease of the arm. Scratching can also cause more cracks and breaks in the skin, again providing an entry point for bacteria and fungi.
This is the point at which a dermatologist is consulted who usually gives the patient antibiotics, anti-itch medications, and various creams and lotions to apply. But as I said, the attacks come and go. So the important thing to do is to prevent or at least minimize these attacks.
Moisturize
First rule of atopic dermatitis: moisturize often. These people have very dry skin. So the trick is to provide moisture. Seal the cracks to prevent skin infection.
Moisturize often during the day. Moisturize always after bath when the skin is still damp so that you trap the water.
The best moisturizer is petroleum jelly. But this is very uncomfortable and may be unbearable warm. A more water-based form is Aquaphor, which is available abroad, for those of you with relatives in the U.S. Other good moisturizers are Cetaphil cream, Nutraderm, Balneum, Jergen's ultra-healing lotion. Recently, I have placed some of my patients on extra virgin coconut oil and they claim that they are well moisturized and are less itchy. You'll have to deal with the slight tropical smell, though. Also, coconut oil does not have studies to back these testimonials, but personally, I think it's worth a try.
Use "mild" products
Skin asthmatics also have very sensitive, allergic skin. So the use of very mild products is mandatory. The trick is to use "baby" products. I highly recommend using "fragrance-free" products because perfumes cause so many allergic reactions. Bath soaps should be very mild. Avoid perfumes on the skin.
The food issue
Many ask if there are foods that are not supposed to be eaten. Some patients, and their relatives, notice that certain foods trigger the attacks. While there are commonly cited culprits, like chicken, eggs, peanuts and chocolate, my personal stand in this issue is that it is a case-to-case decision.
I usually start off by putting the patient on a "hypoallergenic diet" wherein these foods are avoided and, when the skin is calm, slowly reintroduce a food item one by one to see which one triggers a reaction. It's more time-consuming but it is more specific and allows the person to enjoy his food more. Most patients outgrow the attacks by the age of 12. But they will always have dry and sensitive skin. So these tips will be useful to follow for life.
Email me at tinkynogralesmd@yahoo.com for comments, suggestions and questions.
(November 8, 2004 issue)
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