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To tame angry skin, you need the right diagnosis. Here's how to identify and relieve rosacea, psoriasis, and eczema

tHE AVERAGE ADULT has 20 square feet of skin. This shell constantly protects against bacteria, dirt, and the elements. In return, it gets burned by the sun, starved by dehydration, and bombarded by stress.

No wonder your skin gets mad sometimes — and not just by breaking out. Conditions such as rosacea, eczema, and psoriasis cause serious trouble for almost 100 million Americans each year. Indeed, more than 3 million workdays are lost each year due to these and other skin diseases, according to the American Academy of Dermatology. But there's no need to suffer in silence: Remedies — ranging from dietary changes to topical creams to supplements — abound.

Rosacea
Easily recognizable among the 14 million Americans it affects, rosacea causes redness and swelling on the face. It often begins as a tendency to blush easily and then progresses to persistent redness that can include the nose, cheeks, forehead, and chin. Small, broken blood vessels and tiny pimples often appear in the midst of the red patches. The condition typically affects fair-skinned women between the ages of 30 and 50, although it can appear at any age and affect any skin type. (In men, rosacea can be particularly severe.) And it can be quite painful — particularly on windy days, when the rush of air stings inflamed skin.

The cause: Although there is no conclusive cause of rosacea, there are plenty of theories. It may be a component of a more generalized blood-vessel abnormality or gastro intestinal inflammation, says Alan Dattner, M.D., a holistic dermatologist in New Rochelle, N.Y., and a Natural Health advisory board member. "Still others suspect it's an inflammatory response to an infection caused by a type of fungus, bacteria, or a microscopic mitelike organism called Demodex," says Wilma Bergfeld, M.D., a board-certified dermatologist at the Cleveland Clinic Foundation in Ohio. The relief: Minimize the inflammation with a variety of lifestyle changes, advises Bergfeld.

Use a mild (fragrance-free) cleanser like Cetaphil, says Bergfeld. "Antidandruff shampoos with zinc are also effective as facial rinse."
Apply a mild water-based moisturizer (they tend not to clog pores), preferably containing antioxidants, after washing, says Bergfeld. Topical creams containing oatmeal or the herb feverfew may also help reduce redness, she adds. If you need something stronger, a prescription cream, like MetroGel (metronidazole) or Finacea (azelaic acid), or an oral antibiotic, such as tetracycline, can help suppress underlying inflammation.
Avoid eating foods that can cause redness or flushing in the face area. Alcohol, spicy foods, and even tomatoes are three common culprits.
Take a multivitamin that contains anti-inflammatory antioxidants like vitamins C and E.
Rule out underlying food allergies to dairy, wheat, citrus, or soy, says Angila Jaeggli, N.D., a naturopathic physician at Sastyr University in Seattle. A three-week elimination diet, guided by a dietitian, may help pinpoint an offending ingredient.
Consider supplementing your diet with omega-3 fatty acids. "They act as a systemic anti-inflammatory," says Jaeggli, who advises two grams per day. (Omega-3 fatty acid supplements can inhibit blood clotting, so always check with your doctor before supplementing, especially if you're taking garlic, ginseng, or any blood-thinning medications.)
Pay attention to your digestion. Decreased production of hydrochloric acid in the stomach may contribute to rosacea, says Jaeggli. Digestive supplements — either betaine hydrochloride or herbal bitters, depending on the GI abnormality — may help, says Dattner, who also cautions that these supplements should only be taken under medical supervision. (A variety of laboratory tests, including stool assays, are necessary to determine a digestive cause, he explains.)
Consider taking a prescription antihistamine. For persistently red-faced patients, Bergfeld usually prescribes Allegra (fexofenadine) or Zyrtec (cetirizine).
Look into laser treatments. They target redness and can improve your appearance, says Doris J. Day, clinical assistant professor of dermatology at New York University. According to a report published this year in the Journal of Drugs and Dermatology, long-pulsed dye lasers and intense-pulsed light devices are effective. However, keep in mind that, depending on the severity of your condition, you may need regular maintenance therapy — which could be costly — to control redness overtime.
If your eyes are affected, see your doctor immediately, warns Day. "Prescription eyedrops containing cortisone or antibiotics may be needed to prevent blindness," she explains. Oral antibiotics may also be prescribed.
Eczema
Technically a general term for any type of dermatitis or inflammation of the skin, eczema affects about 3 percent of Americans, usually starting in childhood and tapering off by one's 30s. The most common form, atopic dermatitis, can be identified by red, scaly, itchy patches that may blister and can become infected. Patches occur on the face, hands, and feet as well as the elbows and backs of the knees.

The cause: Eczema is believed to be caused by an abnormal immune response to some irritating substance. Genetics may also play a role, and allergies, asthma, hay fever, or an upper respiratory infection can trigger the condition. For some sufferers, contact with irritating surfaces or environmental irritants can cause a flare-up; others find that certain soaps, fruits, and even pet dander can bring on a bout of itching. Stress is another common culprit.

The relief: "One of the biggest triggers for eczema is dry skin," says Day. "So one of the best ways to get relief is to hydrate and lock the moisture in."

Keep your showers short (10 to 15 minutes) and the water lukewarm, says Day. Hot water strips skin of natural oils and encourages dry patches.
Prevent the itch by applying an over-the-counter hydrocortisone cream with 0.5 percent to 10 percent concentration. Or try over-the-counter antihistamines like Claritin (loratadine) or Benadryl (diphenhydramine).
Moisturize. "As soon as you step out, pat dry and moisturize with something emollient, like a product containing shea butter. A cream or an ointment, rather than a lotion, also tends to be extra moisturizing," advises Day.
Rule out dairy allergies, suggests Jaeggli. (A dietitian-monitored three-week elimination diet can help.) Be sure to take a calcium supplement with vitamin D to replace these missing nutrients.
Consider taking supplements. Jaeggli recommends two grams of fish oil a day, which some studies indicate may help minimize dry skin. Quercetin — a natural antihistamine widely marketed as a treatment for allergic conditions like asthma, hay fever, hives, and eczema — may also provide relief. "Start with about 200 milligrams three times a day, before meals," suggests Jaeggli.
Check your zinc intake. Eczema is one symptom of zinc deficiency, so make sure you're getting the RDA of 15 mg a day, including what's in your multivitamin.
Visit an herbologist For eczema, the Traditional Chinese Medicine (TCM) formula Xiao Feng San is usually prescribed, says Weiyi Ding, LAc, associate professor of acupuncture and Oriental medicine at Bastyr University. Six to 10 grams a day, taken in two or three doses, is the usual prescription, says Ding, who also advises seeking out a practitioner certified by the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM).
Psoriasis
There are several forms of psoriasis, a chronic skin disorder that affects more than 6 million Americans. Typically, people have only one type at a time, but multiple types can occasionally flare up simultaneously, and some types can change form in response to certain triggers. Plaque psoriasis — characterized by raised red lesions topped by a silvery scale and found on the scalp, elbows, knees and lower back — is the most prevalent. Other forms of psoriasis include guttate (small red bumps), inverse (appearing in the armpits and groin area), pustular (with blisters), and erythrodermic (which covers large areas of the skin and requires immediate medical treatment). Approximately 10 percent to 30 percent of people with psoriasis can develop psoriatic arthritis, which causes stiffening and swelling in and around joints.

The cause: Psoriasis is an autoimmune disorder characterized by rapid overproduction of skin cells, explains Day. Stress is a likely contributor to flare-ups, but certain drugs — including Eskalith (lithium), which is used to treat manic depression; Inderal (propranolol), a blood pressure medication; and Indocin (indomethacin), a nonsteroidal anti-inflammatory prescribed for arthritis — can aggravate the condition. Pregnancy worsens psoriasis in about 18 percent of cases; some studies show that it can also flare up with a vengeance within four months of delivery.

The relief: While there's no cure, there are more available treatment options than ever.

Keep the affected areas clean. Psoriasis scales can harbor bacteria, says Bergfeld; choose a mild body wash. For shampoos, Bergfeld suggests using a tar-based product, such as Neutrogena T/Gel. Nizoral, an antidandruff shampoo now available without a prescription, may also provide scalp relief.
Consider a prescription-strength hydrocortisone cream. According to Bergfeld, over-the-counter hydrocortisone creams may provide relief for mild cases, but others may need extra protection.
Inquire about pharmaceuticals. "A class of drugs called biologies suppress the immune response — in a controlled way — that triggers the psoriasis," says Day. Two medications — Enbrel (etanercept) and Humira (adalimumab) — that were first used for rheumatoid arthritis are now prescribed to treat psoriasis.
Lower your stress levels by incorporating a daily relaxation regimen. According to the National Psoriasis Foundation (NPF), stress can trigger or aggravate psoriasis. Massage therapy, yoga, and meditation are all good anti-stress measures to try. Stress-relieving options are most effective when used in conjunction with more traditional therapies, according to the NPF.
Investigate hypnotherapy. A small (11 patients) randomized, controlled, 1999 pilot study from The Johns Hopkins School of Medicine found that hypnosis could be useful in moderating plaque psoriasis.
Try a mahonia-based topical treatment. Mahonia aquifolium, a berry that grows wild in Europe, was initially used as a folk remedy for inflammatory skin diseases, including psoriasis. A 2006 double-blind, placebo-controlled study published in the American Journal of Therapeuticals tested the efficacy of Relieva, a topical cream laced with a proprietary mahonia extract; the cream provided significant relief to patients with mild to moderate plaque psoriasis, with few side effects.
Seek out herbal solutions. Si Wu Tang or Tao Hong Si Wu Tang (6-10grams daily) are two TCM formulas often prescribed for psoriasis, says Ding. Consult an NCCAOM-certified specialist for the correct dose.
Topical creams with oatmeal or the herb feverfew may help reduce the redness of rosacea.

After bathing, soothe eczema symptoms with a cream rich in super emollient shea butter.

To reduce stress, which can trigger or aggravate psoriasis, incorporate a daily relaxation regimen such as yoga, meditation, or massage therapy.

PHOTO (COLOR): TOWEL OFF: Don't be embarassed by troubled skin.

PHOTO (COLOR): RICH REWARD: Water-based moisturizers help quell rosacea.

PHOTO (COLOR): COOL DOWN: To ease eczema, take short, lukewarm showers.

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By Kathleen Doheny

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