PART 4 OF 5: Inflammatory skin infections are common dermatologic conditions. Causes range from allergies, contact with various agents, autoimmunity, and aging. Some conditions are chronic while others are episodic. Pathologies featured in this article include eczema, psoriasis, contact dermatitis, and scleroderma.
Eczema: Eczema is the most common inflammatory skin condition. Eczema is most often found on the hands, scalp, face, nape of the neck, creases of the elbows and knees, and ankles and feet. Eczema is characterized by dry skin that is scaly, leathery, or crusty. Skin may be lighter or darker in color than normal. Some lesions ooze clear fluid or may bleed.
Massage Therapy and Eczema: Avoid affected areas containing broken skin. Massage improved eczema by reducing skin itching, redness, and decreased the thickened, leathery quality of affected skin called lichenification (1). Affected individuals were also less anxious after massage (1). Before massaging the affected area, obtain verbal consent. If consent is granted, ask the client how sensitive the affected area is and adjust pressure accordingly. Use a highly emollient lubricant to combat dry skin; some clients do best with a hypoallergenic product. Be sure the lubricant does not contain essential oils, because some were found to worsen eczema (2).
Psoriasis: Psoriasis is a chronic inflammatory skin condition in which the proliferation rate of epidermal cells is greatly accelerated. Instead of skin renewing approximately every 28 days, it occurs every few days. When this happens, skin cells build up in thick patches. Psoriasis typically affects the scalp and skin over the elbows, knees, back, chest, and buttocks. Psoriasis is marked by periods of exacerbation; exacerbations are related to trauma and psychosocial stress.
Massage Therapy and Psoriasis: Like eczema, avoid affected areas containing broken skin. Before massaging the affected area, obtain verbal consent. Some clients with disfiguring psoriasis may feel self-conscious while they are on the massage table. If consent is granted, ask the client how sensitive the affected area is and adjust the pressure accordingly. Use a highly emollient lubricant to combat dry skin; some clients do best with a hypoallergenic product. Because emotional stress was found to play a role in the onset and exacerbation of psoriasis (3), massage using techniques that promote relaxation is indicated.
NOTE: Prescriptive topical agents are often used to manage skin conditions such as eczema and psoriasis. If prescription drug administration is not clearly listed in your state laws, you do not have the authority to apply the drug on your client’s skin. Numerous laws dictate which people holding state licenses may administer prescription drugs in accordance with the Federal Drug Administration or FDA. Massage therapists who administer drugs may be in violation of state and federal laws.
Contact Dermatitis: Contact dermatitis is inflammation of the skin. Signs and symptoms develop at the site of contact with the causative agent within 24 to 48 hours, sometimes sooner. Two main types of contact dermatitis are irritant and allergic. Irritant dermatitis accounts for 80% of cases, and allergic dermatitis accounts for 20%.
Massage Therapy and Contact Dermatitis: Avoid the affected area during the massage. Ask about latex and wool allergies. If your client is allergic to latex or wool, s/he may have an allergic reaction to shea butter or lanolin, respectively. In these cases, lubricants containing these ingredients should be avoided and a hypoallergenic lubricant used. Latex allergies have been linked to shea butter hypersensitivity because of cross-reactivity (4). Research also suggests that therapists who use essential oils in their practice may be increasing their risk of developing contact dermatitis on their own hands (5, 6). This risk is even greater in therapists who have a history of dermatitis (5).
Scleroderma: Scleroderma is a chronic disease characterized by thickening and hardening of the skin and connective tissues. Scleroderma is caused by overproduction of collagen, which leads to fibrosis accompanied by inflammation. Fibrosis may remain localized to the dermis and superficial fascia, or it may extend to the deep fascia, become systemic, and affect internal organs. When the latter occurs, the individual may experience cardiac arrhythmias, respiratory failure, kidney failure, or esophageal or intestinal obstruction.
Massage Therapy and Scleroderma: Massage is indicated and improved hand function (7, 8), hand strength, skin pliability (7), joint motion (8), and reduced contractures (7). Manual lymphatic drainage improved hand function and perceived quality of life and decreased edema (9). Before massaging the affected area, obtain verbal consent. If consent is granted, ask how sensitive the affected area is and adjust pressure accordingly. Use a highly emollient lubricant to combat dry skin; some clients do best with a hypoallergenic product. If the client is weak or medically fragile, a gentle massage is indicated that may include techniques of light and even pressure (3 on a 10-point pressure scale) and slower speed.
Articles and Journals Referenced:
- Schachner L, et al: Atopic dermatitis symptoms decreased in children following massage therapy, Pediatr Dermatol 15:390–395, 1998.
- Anderson C, Lis-Balchin M, Kirk-Smith M: Evaluation of massage with essential oils on childhood atopic eczema, Phytother Res 14:452–456, 2000.
Devrimci-Ozguven, H., Kundakci, N., Kumbasar, H., & Boyvat, A: The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. Journal of the European Academy of Dermatology and Venereology,14(4), 267-271
- Grier T: Is there cross-reactivity between shea butter and natural rubber latex? 2012. http://www.latexallergyresources.org/sites/default/files/newsletter-attachments/The%20ALERT%20Dec%202012.pdf
- Crawford GH, et al: Use of aromatherapy products and increased risk of hand dermatitis in massage therapists, Arch Dermatol 140:991–996, 2004.
- Trattner A, David M, Lazarov A: Occupational contact dermatitis due to essential oils, Contact Dermatitis 58(5):282–284, 2008.
- Askew LJ, et al: Objective evaluation of hand function in scleroderma patients to assess effectiveness of physical therapy, Br J Rheum 22:224–232, 1983.
- Poole JL: Musculoskeletal rehabilitation in the person with scleroderma: musculoskeletal rehabilitation in the person with scleroderma, Curr Opin Rheumatol 22(2):205–212, 2010.
- Bongi SM, et al: Manual lymph drainage improving upper extremity edema and hand function in patients with systemic sclerosis in edematous phase, Arthritis Care Res (Hoboken) 63(8):1134–1141, 2011.
Susan Salvo is a board certified massage therapist with 30+ years of experience. Susan is passionate about massage therapy and massage education. You can contact her at firstname.lastname@example.org.