The Most Common Skin Conditions, Explained
We tend to focus on the idea of “perfect” skin, whether that involves filtering selfies or struggling to embrace a breakout. Those that have skin conditions and choose to challenge that ideal are constantly faced with the associated stigma, despite the fact that skin conditions are actually extremely common. According to the American Academy of Dermatology (AAD), more than 85 million Americans are affected by skin diseases each year. But, because of that stigma, there’s not a lot of common knowledge about the even the most prevalent disorders, outside of acne (which tops that list. To help change that, we spoke with a dermatologist to break down the key facts about four common skin conditions: psoriasis, eczema, rosacea, and seborrheic dermatitis. The derms we spoke with focused on causes and treatment, there's one more piece to the puzzle you should always keep in mind — practicing self-care and appreciating your skin. And if you need some inspiration when it comes to putting those ideas into practice, check out these Instagrammers speaking out against stigmatized skin conditions.
Psoriasis Psoriasis is an immune system disorder that causes the body to grow excess skin cells, which can create red, scaly rashes on the body and face. While it’s often passed down genetically, that’s not always the case. In fact, according to the AAD, psoriasis is an incredibly common disorder that affects an estimated 7.5 million people in the United States.
The skin patches characteristic of psoriasis, which can sometimes feel itchy, are “usually located in the scalp, elbows, and knees,” Shilesh Iyer, M.D., a board-certified dermatologist with the New York Dermatology Group, tells Teen Vogue. “It can also affect the nails and, in more extensive cases, it can affect other parts of the body.”
Depending on the severity of the symptoms, it may not be immediately clear to you that you have psoriasis — which is where a professional opinion comes in handy. “[Psoriasis] can be confused with other kinds of rashes that come and go,” Dr. Iyer says. “[But] if there’s a persistent type of rash, it’s best to have it evaluated by a dermatologist so we can help diagnose what the condition is and help guide the treatment options.” He says those treatment options typically include topical creams that you apply to the affected areas, light and laser therapy (which, according to the National Psoriasis Foundation, slows the growth of the excess skin cells), or oral medications (including biologics, which Dr. Iyer says “target specific molecules that are involved in producing psoriasis”) for advanced cases.
People with more mild cases of psoriasis may be able to get by with over-the-counter treatments, including topical steroids, anti-dandruff shampoos, and coal tar — but Dr. Iyer recommends seeing a dermatologist for guidance regardless.
Dr. Iyer notes that psoriases tends to “wax and wane.” He adds, “There may be episodes where it’s worse, and then it gets better on its own. When it’s bad, we usually treat it more aggressively...and there may be periods of time [when] it’s in remission or very quiet.”
Eczema Eczema, or atopic dermatitis, is another immune disorder. “It manifests in the skin as itchy rashes that can typically affect the face, neck, eyelids, and the folds of the arms and legs,” Dr. Iyer says, noting that it’s often found in people who have a history of allergies, like hives, asthma, or seasonal allergies. In fact, while eczema is often genetic, that could simply mean that someone in your family has a history of those allergies, rather than eczema specifically.
Eczema affects an estimated 31.6 million Americans, 3% of adults worldwide, and 20% of children worldwide. Indeed, according to the National Eczema Association, babies are most prone to eczema. “It generally gets better [over time], but there’s always a risk that it can come back in certain areas,” Dr. Iyer says. People who are diagnosed with eczema as children can have flare-ups throughout adulthood — though, as with psoriasis, it may come and go.
But while eczema can be confused with psoriasis, Dr. Iyer says there are some key differences — namely the fact that it tends to be itchier, its distribution on the body, and the connection to a history of allergies. “Those three things would be good clues to clue you in to whether it’s eczema over psoriasis,” he says. “But...it [can] be tricky to differentiate. If you see a dermatologist, they can sometimes [do so] based on the way it looks. In cases where it’s a little more tricky to diagnose, we could do a biopsy if needed.” The biopsy [involves] testing a patch of skin in a lab, according to NYU Langone. The procedure is a minor one, though, and only done as a last diagnostic resort.
As far as treatment goes, Dr. Iyer says it often involves topical steroid or anti-inflammatory creams, but that there are more advanced options — such as light treatments and the aformentioned biologics — available as well. “There’s a whole range of options to treat it; but just like with psoriasis, if it’s a very mild, minimal case, you can start with trying to use over-the-counter [such as] Cortaid, [a hydrocortisone cream],” he says. “Generally with eczema patients, we tell them to be very careful with dry skin care — moisturize [and] don’t use overly drying soaps or detergents, because dryness can trigger flares of eczema.”
There are plenty of over-the-counter skincare products that people afflicted with eczema swear by, but as everyone’s skin is different, it could be a bit of trial and error. “If it’s getting worse or there are periods where it’s really flaring, we do have to consider whether [you’re] getting allergic reactions to products that [you’re] using,” Dr. Iyer says.
Rosacea Rosacea is characterized primarily by redness in the cheeks, though it can progress beyond that. “In the beginning it may manifest as just easy flushing and blushing,” Dr. Iyer says. “But sometimes it will progress [to the point] where patients may start to get breakouts, or feel that their skin is uneven or splotchy, usually on the center of the face — so the cheeks and nose.” Though it typically manifests in early adulthood, he notes that patients often have a history of redness dating back to childhood or adolescence.
Aside from the redness, visible blood vessels (which occurs due to swelling, according to Johns Hopkins Medicine), and potential pimples, Dr. Iyer says people with rosacea may also feel skin sensitivity, tingling, or burning.
And it’s those symptoms that often lead to a diagnosis of rosacea versus simply a tendency to blush. “If it gets to the point where the patient is complaining of breakouts, splotchy skin, dry patches, excess sensitivity, tingling, [or] burning then we would probably start treating it as rosacea,” Dr. Iyer says.
In mild cases, he usually recommends a gentle skin care regimen, with moisturizers, cleansers, and sunscreens that are “tolerable to the patient.” Per the AAD, it’s also helpful for patients to learn and avoid their own triggers (such as spicy foods), and be vigilant about sun protection, as people with rosacea tend to be particularly sensitive to those rays. But “if it’s a little bit more advanced, we usually add topical medications,” Dr. Iyer says. “And in even more advanced cases, where there [are] actually pimples and breakouts, there are oral medications we can use. In addition to topical and oral medications, we frequently use laser treatments to tone down the redness and broken capillaries if they appear.”
“People who have a propensity toward rosacea will always have that propensity,” Dr. Iyer adds. “So the more effectively managed it is, [that] will prevent it from progressing.”
Seborrheic Dermatitis Seborrheic Dermatitis is essentially a more advanced form of dandruff, which manifests in the form of flaky patches, redness, and oily areas of the skin. While it largely affects the scalp, Dr. Iyer says it can also appear on the eyebrows and sides of the nose; and Mayo Clinic notes that it may affect the ears, eyelids, and chest as well.
While it can be mistaken for dandruff, the more persistent symptoms tend to be what get people to the dermatologist and, ultimately, to a diganosis. “A lot of times patients will come in seeking treatment because [their skin] is dry, and flaky, and a little splotchy, and it can be itchy,” Dr. Iyer says.
Once it is diagnosed, he says seborrheic dermatitis is often treated with prescription topical medications, but dermatologists may sometimes pair prescriptions with over-the-counter treatments, like dandruff shampoos. When going the over-the-counter route, resist the instinct to oil up your scalp — contrary to what it may seem, this condition is actually linked to excess oil. It’s also a good idea to avoid hairsprays, gels, and fragranced products, as they can lead to fungal growth and increased irritation.
When it comes to all of these conditions, Dr. Iyer stresses that they “can be a little tricky to diagnose,” so if you experience any symptoms, your best bet is to make an appointment with a specialist. “A board-certified dermatologist will get you the fastest diagnoses and most effective treatments,” he says. “It should be known to patients that there are treatment options and seeing a dermatologist can be very helpful.”
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