Skin Diseases

Itchy, Red, and Blotchy

A briefer on skin allergies

By Carmela Agustin-Kasala, MD FPPS FPSAAI  

ALLERGIC diseases are caused by an over reactive immune system which is a complex network of cellular, biochemical, and anatomic interactions leading to the defense against what the body may perceive as foreign organisms. Generally, allergies occur in genetically predisposed individuals. Worldwide, the incidence of allergic diseases has been increasing and now probably affects about a quarter of the population. These diseases are among the most common chronic disorders affecting people.   

       Allergies may occur anywhere in the body, be it in the skin, eyes, nose, lungs, and more.

But the skin is the largest organ of the body so is it any wonder that allergies may seem to manifest a lot on the skin?  

        Commonly, skin allergies are perceived as itchy, red, and blotchy conditions in the skin. Pruritus is an itching and unpleasant sensation that provokes a desire to scratch, which in the end makes matters worse. But there are many times when the desire to itch somehow is more than the will not to scratch. There is even a saying that goes, “To itch is human, to scratch… simply divine…” 

        More often than not, we hear of asthma of the skin. Just exactly what is this condition? 

Is this related to Bronchial Asthma which is a condition characterized by difficulty of breathing and wheezing sounds in the patient?  Asthma of the skin is layman’s term for what should properly be addressed as Atopic Dermatitis or Eczema.  

        Atopic Dermatitis is a relapsing skin condition with dry skin and red patches which are associated with extreme itchiness and a strong family history for allergies. Frequently seen in babies and young children, it may also develop in young adults and may continue to adult life. In infants, it’s more commonly seen in the cheeks, chest, trunk, scalp, outer arms, and legs with the diaper area being spared. 

In older children and adults, however, the areas most affected are the skin fold of the elbows, back of the knees, eyelids, hands, and soles.  

        Urticaria is another common skin allergy condition more commonly known in the vernacular as pantal or tagulabay. This is a condition characterized by itchy, raised red bumps of various sizes and shapes that appear on the skin. They are also called hives or wheals. This condition may occur at any age, typically fleeting for a few minutes or hours to some instances that may last longer. If the condition lasts within six weeks, then it is called an Acute Urticaria. More than the six weeks, it is Chronic Urticaria.  

       Angioedema, on the other hand, is a deeper swelling similar to hives that is non-itchy but sometimes has a burning or tingling sensation. Urticaria and Angioedema may be caused by a whole lot of things including:  drugs, food, insects, and even physical agents such as sweat, pressure, and hot or cold temperature.  

        Allergic Contact Dermatitis is an inflammatory reaction to substances that come in contact with the skin. These irritating substances may include cosmetics, hair dye, jewelry, metals, topical medications, dental materials, and even plants. It is typically seen as a well-demarcated red rash and swelling with itchy, red, closely- spaced vesicles, papules, and/or blisters in affected skin areas. It is usually located on the area of skin exposed to the offending substance but may have some spreading to surrounding areas. The area with the greatest exposure reacts more severely.  

       Although there may be no initial reaction, regular use (nail polish remover, preservatives in contact lens solutions, or repeated contact with metals in earring posts and the metal backs of watches) may eventually cause sensitivity and reaction to the product. Some products cause a reaction only when they come in contact with the skin and are exposed to sunlight (photosensitivity). These include shaving lotions, sunscreens, sulfa ointments, some perfumes, coal tar products, and oil from the skin of a lime. A few airborne allergens, such as pollen or insecticide spray, may also cause contact dermatitis. 

       Diagnosis of skin allergies would always depend on a good history and physical examination. More often than not, a strong family history for allergies would be elicited. Also, in some, a stressful family or work condition may be noted. Allergy skin testing may be done to find out if any airborne, food, or insect allergen may be the cause of the reactions.

        In instances wherein allergy skin testing is not feasible, like if the patient’s condition leaves no part of the skin available for skin testing or patient’s condition doesn’t allow an antihistamine free period or patient has had prior anaphylaxis, the Immunocap Test may be done for a limited number of allergens.

This, however, is definitely more expensive than the allergy skin testing. Patch Testing may be done for patients who have Contact Dermatitis problems to find out what substance may be the culprit to the problem. These tests may be done at medical centers or clinics where allergists hold their clinics.

        Treatment for skin allergies, in general, would include:

• Antihistamines. Given to combat the itchiness that patients feel.

• Anti-inflammatory agents, both steroidal and non-steroidal types. Meant to combat the ongoing swelling and inflammation.

• Skin care. To ensure proper skin hydration.

• Removal of identified offending agent.  For Contact Dermatitis.

• Avoidance of identified food/drug allergen. For food and drug allergies.

       If you feel or suspect you are suffering from any of these skin problems, it is best to consult a board-certified allergist in your area. For information on allergies and how to find an allergist anywhere in the Philippines, just log on to the official website of the Philippine Society of Allergy, Asthma and Immunology (PSAAI), www.psaai.com.  

Home Remedies for Skin Allergies

• If an area on the skin is itchy, apply mashed papaya seeds or papaya skin on it. Aside from reducing the skin’s itch, this helps in treating other facial problems like acne.

• Take lots of water, as well as fresh fruits and vegetables that have high water content in them to prevent all kinds of skin allergies.

• To relieve skin of irritation, swelling, and redness, soak a washcloth in a cold water and apply it on the inflamed area of the skin.

• Soothe itchy skin by taking a warm oatmeal bath. Take a handful of rolled oats and place them in a blender or food grinder. Add the powder to your bath and soak in the tub for at least 20 minutes.

Dr. Kasala is a pediatrician and an allergy specialist trained to see both adults and children with allergies. She is a Member of the Board of Directors of the PSAAI.  She holds clinic at The Medical City Medical Arts Tower Room 802.