Psoriasis and eczema, two skin diseases with similar symptoms, can now be distinguished on a genetic level. Some forms of the inflammatory skin disorders appear so similar that even doctors find it hard to tell them apart.
The finding may save patients time, money, and aggravation on the road to a final diagnosis, and will allow doctors to treat patients promptly with the right types of medication. The new study was published today in Science Translational Medicine.
The research team the Entrepreneurial University (TUM) in Munich, Germany compared the genes of 24 patients ages 18 to 60 who had either psoriasis or eczema. The team found that psoriasis resembles a wound healing reaction with an over-activated immune response in the upper layer of the skin. This is what causes the scaly skin markings that characterize psoriasis.
Eczema, on the other hand, involves other immune cell subtypes that obstruct the skin barrier and block the skin’s immune response. Eczema skin reactions are commonly associated with bacteria, viruses, or fungi, which can make inflammation worse.
Cases on the Borderline
“Our results help people suffering from a phenotype of psoriasis or eczema that cannot be clearly teased apart from the other condition,” said Dr. Kilian Eyerich, a researcher who worked on the study. “In those cases, we might in fact be able to diagnose more precisely and earlier, thus providing the best possible therapy to the patient sooner.”
Dr. Steven R. Feldman, a dermatology professor at the Wake Forest University School of Medicine, said it’s typically easy to tell the diseases apart. In the event that psoriasis and eczema cannot be distinguished, it may be because their inflammatory paths have crossed.
“At the border, it can be hard to tell,” he said.
He would like to see the study results replicated to prove that the test is reliable and accurate. Feldman added that it could be useful in situations where a patient can't see a specialist but still wants an accurate diagnosis.
Wet-Wraps Help Alleviate Kids’ Eczema
In related news, another new study has shown that wet-wrapping can provide medication-free relief from eczema in children.
Wet-wrapping involves soaking the skin in lukewarm water for about 20 minutes, then applying a lotion or medicated ointment to areas that are inflamed. The child is then dressed in wet clothing or wrapped in wet strips of cloth to seal in the moisture, and a dry layer of clothing goes on top for about two hours.
Dr. Mark Boguniewicz, a pediatric allergist and immunologist at National Jewish Health in Denver, conducted research on wet-wrapping as part of a study published in the Journal of Allergy and Clinical Immunology: In Practice.
In his study, 72 children who used the wrapping technique saw a 71 percent reduction in skin symptoms, maintained healthy skin for one month after a short course of inpatient treatment, and did not need steroid medication to maintain their skin health. They were wet-wrapped two to three times a day, and treatment was tapered down to just the affected areas of skin throughout the two-week study period.
The researchers measured and tracked the severity of the children's eczema throughout the study, using the SCORAD (Scoring Atopic Dermatitis) and ADQ (AD Quickscore) clinical scales. The most serious cases were rated 50 or higher on the scales.
“When these children arrived their mean score was right around 50, so they were severe cases,” said Boguniewicz in a press statement. “When they left, their mean score was less than 15. That kind of improvement, in just a short amount of time, was very, very dramatic. Over roughly four days we saw dramatic improvements.”
He cautions parents not to try the treatment at home, though.
“You can't just try this on your own because overuse can do more harm than good,” he said. “You first want to familiarize yourself with the concept at our website and talk to a specialist about it. We have a lot of material that can help you determine if this is the right approach for your child.”