How to Know When It's Time to See a Dermatologist for Eczema and Psoriasis

From allure.com

Chronic skin conditions can be treated over-the-counter, but in some cases, you'll want to get an appointment with your doctor, stat. Here's what to expect from medical treatment

Beauty, as we know it, has changed. In the last decade alone, an industry that was once obsessive about surface-level physicality has turned inward to focus on once-technical categories reserved for sterile doctor's offices, like dermatology, mental health, and nutrition. It's not that applying a pristine cat-eye liner isn't as valuable a skill (and it is a skill) now as it was in the early-aughts. It's just that today, the sector is placing a premium on beauty from the inside out.

For those with certain skin conditions like eczema and psoriasis, this includes working with medical specialists to treat the symptoms that may leave the body's largest organ in need of some extra-special TLC. And although there's no cure (yet, anyway) for these itchy, inflamed skin conditions, over-the-counter options abound for those looking to get mild cases under control. Trusted dermatologists can be of great service, too, especially in instances when the drugstore aisle just won't cut it.

While eczema and psoriasis tend to manifest with uncomfortable topical symptoms (think scaly patches of red, raised skin), the conditions often stem from internal factors that can be better served by medications than slathered in creams. This is true all throughout the beauty industry, after all: Why simply cover up your acne, for example, when you can work to clear up what's causing your breakouts from within?

In mild, localized occurrences that appear in, say, the nooks of elbows or knees, topical treatments can indeed be effective, explains Joshua Zeichner, a board-certified dermatologist in New York City. But medications go one step further, targeting the systems that make you have an inflammatory response in the first place. However, patients shouldn't write off over-the-counter treatments altogether: It's when medication is combined with the right cleaners and moisturizers that Zeichner finds the most success in treating moderate to severe cases.

"If patients have large body surface areas that cannot practically be covered using a topical treatment, systemic therapies are often a better option," adds Zeichner. "Systemic options are also used in localized cases in which topical treatments aren't clearing the skin."

So, what “systemic options” — i.e., medications — are we talking? Dermatologists, Zeichner included, are especially into biologics, drug products that are either made from living organisms or contain components of living organisms. Because biologics are derived from a myriad of natural sources, including blood and viruses, their applications are wide-ranging. And for skin conditions, their potential is enormous — especially for psoriasis, in which skin cells build up and form itchy, dry blotches.

"Psoriasis is by far the most common skin condition that we use biologics for currently," says Robert Finney, a board-certified dermatologist in New York City. "This is because we were able to identify and effectively target inflammatory pathways that are unregulated in psoriasis. We have long-term data that demonstrate their efficacy in this condition, and typically, side effects are minimal."

Biologics, as Finney notes, have been “life-changing” for many of his patients, as older treatment options had a kind of triple-whammy of medical frustrations: They weren't as successful, required frequent lab monitoring, and had many unwanted side effects that biologics don't. The difference with biologics is that they help address skin conditions at their root, rather than simply dulling physical symptoms. As Zeichner explains, biologics act on specific targets in the immune system that have been shown to be causing factors in skin conditions, lowering the extra inflammation created by our immune systems as a result.

Both eczema and psoriasis are chronic, meaning that they're long-term conditions that require ongoing medical attention. Which means that, no, biologics aren't exactly a silver-bullet solution to conditions that have no cure. But dermatologists agree: They're an incredibly viable option for those with modern, extreme, or otherwise stubborn cases for which over-the-counter solutions are no match.

"Typically, prescription medications are required in the case of psoriasis and involve a combination of topical steroids and topical vitamin D analogs, which work by increasing vitamin D levels in the body and help the body absorb more calcium," says Finney. "If a patient has moderate disease or worse, biologics are the gold standard."

For those with milder symptoms, patients may be able to get away with what they already have at home. That is, as long as products are moisturizing enough to restore the fragile, but crucial skin barrier, which defends your body and its precious water balance.

"The right cleanser can help your skin condition, but the wrong one can make things worse," says Zeichner, who likes to recommend Dove's Deep Moisture Body Wash. "Stick to gentle, nonstop cleansers that hydrate the skin without disrupting the outer skin layer."

The right moisturizer is critical, too: Look for light, easy-to-spread formulas that help repair the skin barrier, such as Vaseline's Intensive Care Essential Healing lotion. The dermatologist-favourite comes chock-full of rich, healing ingredients that treat or prevent dry, rough skin, like triple-purified petrolatum and colloidal oatmeal.

This isn't just A-plus advice for those experiencing a recent eczema or psoriasis flare-up. We could all stand to commit to a little extra nourishment, be that by way of our complexions or a nutrient-rich diet. And for those who need a little extra help along the way, never fear: Medical professionals are here to help guide you down the path to true beauty — first inside, then out.

https://www.allure.com/story/when-to-see-a-dermatologist-for-eczema-psoriasis