PART 4 OF 5: Inflammatory skin infections are common dermatologic conditions for which massage practitioners should be familiar. 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, and contact dermatitis.
Eczema (Atopic Dermatitis): Eczema is the most common inflammatory skin condition. It is not contagious. Eczema is more common in children and most often found on the hands, wrists, scalp, face, nape of the neck, upper chest, creases of the elbows and knees, ankles, feet, and in infants, the face and scalp. Between 25% and 30% of children have at least one episode of eczema by age 5. Adult cases tend to be more chronic and recurrent with periods of exacerbation. Exacerbations are frequently related to stress, anxiety, and sudden or extreme changes in temperature and high humidity. Eczema is also called eczematous dermatitis. Eczema has no known cause, but it may be related to allergies and can be hereditary. Between 75% and 80% of affected individuals have a personal or family history of asthma or hay fever (allergic rhinitis). In children, food allergies may play a role in causing eczema. Eczema is characterized by dry, scaly, leathery, or crusty skin. The skin may be moist and red in skin folds. Affected areas may itch or burn; itching is more severe at night. Skin can become raw, sensitive, and swollen from scratching. The itch-scratch cycle can cause poor sleep quality. Skin may be lighter or darker in color than normal. Some lesions crack, ooze clear fluid, and may bleed.
Massage and Eczema: Eczema is a local contraindication if it contains broken skin. Before massaging affected areas that do not contain broken skin, obtain verbal consent. Some clients with disfiguring eczema may feel self-conscious. If consent is granted, ask the client how sensitive the affected area is and adjust the pressure accordingly. Use highly emollient lubricants to combat dry skin and avoid products containing alcohol or essential oils as the latter was found to worsen eczema in children, especially with repeated use (Anderson et al, 2000). Some clients do best with a hypoallergenic product. Affected skin should never be rubbed vigorously. The National Eczema Association (2015) recommends that parents of children with eczema massage moisturizers into to their skin (rather than simply applying moisturizers).
Research: Eczema improved in young children with a 20-minute massage given daily by their parents for 1 month (Schachner et al, 1998). Improvements were reductions in pruritus (itching), redness, in the thickened, leathery quality of affected skin called lichenification. The children’s mood and activity levels significantly improved, and their parent’s anxiety levels decreased immediately after the massage sessions.
Psoriasis: Psoriasis a chronic inflammatory skin condition in which the proliferation rate of skin cells accelerate, causing them to buildup in thick patches. Instead of skin renewing approximately every 28 days, it occurs every few days. Psoriasis typically affects the scalp and skin over the elbows, knees, back, chest, and buttocks. Psoriasis may spread to nails, causing pitting, discoloration, and nail separation. Psoriasis affects between 1% and 3% of the U.S. population. It can occur at any age but is more common between the ages of 10 and 30 and again between the ages of 57 and 60. Psoriatic arthritis is a form of arthritis that develops in approximately 30% of people with moderate to severe psoriasis. Both psoriasis and psoriatic arthritis are marked by periods of exacerbation alternating with periods of remission; exacerbations are related to trauma and psychosocial stress.
Massage and Psoriasis: Psoriasis is a local contraindication if it contains broken skin. Avoid affected areas containing broken skin. Before massaging affected areas that do not contain broken skin, obtain verbal consent. Some clients with disfiguring psoriasis may feel self-conscious. If consent is granted, ask the client how sensitive the affected area is and adjust the pressure accordingly. Use highly emollient lubricants to combat dry skin; some clients do best with a hypoallergenic product. Affected skin should never be rubbed vigorously. Because emotional stress was found to play a role in the onset and exacerbation of psoriasis (Devrimci-Ozguven et al, 2000), massage using techniques which promote relaxation are indicated.
For clients with psoriatic arthritis, avoid swollen or tender areas (i.e., fingers and toes), or use only light pressure. An example of light pressure is 3 on a 10-point pressure scale or level 1-2 on the Walton pressure scale. Avoid aggressively applied passive range-of-motion on affected joints.
Contact Dermatitis: Contact dermatitis is inflammation of the skin. The two main types of contact dermatitis are irritant dermatitis and allergic dermatitis. The characteristic rash develops at the site of contact with the causative agent within minutes to hours of contact exposure and can last 2 to 4 weeks. These rashes are not contagious, but are uncomfortable. Contact dermatitis is caused by contact with either an irritant (causing irritant dermatitis) or an allergen (causing allergic dermatitis). Irritant dermatitis accounts for 80% of cases, and allergic dermatitis accounts for 20%. The most common sign of contact dermatitis is an uncomfortable rash often limited to the area of contact. The rash is characterized by redness, swelling, and small vesicular lesions that ooze, itch, burn, or sting. The area may also feel warm and tender to the touch. The location of the rash provides clues to the source.
Massage and Contact Dermatitis: Avoid the affected area during the massage because it is often hypersensitive; contact dermatitis cannot be transmitted by contact. The practitioner should always consider the client’s skin reaction to products used. Inquire about past skin reactions from chemicals in laundry detergents and eliminate contact with linens washed in the detergent identified, if applicable. Also, inquire about allergies to latex and wool. If the client is allergic to these, he or she may have allergic reactions to shea butter or lanolin, respectively. In these cases, avoid products containing these ingredients and use a hypoallergenic product. Avoid latex gloves on clients who have latex allergies.
Latex allergies have been linked to shea butter hypersensitivity because of cross-reactivity (Grier, 2012). Also, essential oils used in massage products have been linked to contact dermatitis (Lakshmi, 2014) including laurel (Adişen & Onder, 2007) and turmeric (Lopez-Villafuerte & Clores, 2016), as well as ayurvedic oils, particularly Dhanwantharam tailam and Eladi tailam (Eladi coconut oil); so caution is warranted.
Practitioners who use essential oils in their practice are at increased risk for occupational contact dermatitis (Crawford et al, 2004; Trattner et al, 2008). Crawford et al (2004) found 15-23% of massage practitioners had contact dermatitis on their hands and risks were greater among practitioners with a history of eczema or atopic dermatitis.
Adişen, E., Onder, M. (2007). Allergic contact dermatitis from Laurus nobilis oil induced by massage. Contact Dermatitis, 56(6), 360-361.
Anderson, C., Lis-Balchin, M., Kirk-Smith, M. (2000). Evaluation of massage with essential oils on childhood atopic eczema. Phytother Res, 14(6), 452-456.
Crawford, G.H., Katz, K.A., Ellis, E., James, W.D. (2004). Use of aromatherapy products and increased risk of hand dermatitis in massage therapists. Arch Dermatol, 140(8), 991-996.
Devrimci-Ozguven, H., Kundakci, T.N., Kumbasar, H., Boyvat, A. (2000). The depression, anxiety, life satisfaction and affective expression levels in psoriasis patients. J Eur Acad Dermatol Venereol, 14(4), 267-271.
Grier, T. (2012). Is there cross-reactivity between shea butter and natural rubber latex? http://www.latexallergyresources.org/sites/default/files/newsletter-attachments/The%20ALERT%20Dec%202012.pdf.
Lakshmi, C. (2014). Allergic contact dermatitis (type IV hypersensitivity) and type I hypersensitivity following aromatherapy with ayurvedic oils (Dhanwantharam thailum, Eladi coconut oil) presenting as generalized erythema and pruritus with flexural eczema. Indian J Dermatol, 59(3), 283-286.
Lopez-Villafuerte, L., Clores, K.H. (2016). Contact dermatitis caused by turmeric in a massage oil. Contact Dermatitis, 75(1), 52-53.\
National Eczema Association. (2015). Natural and alternative treatments for eczema, what works, what doesn’t. Retrieved from https://nationaleczema.org/alternative-treatments/
Schachner, L., Field, T., Hernandez-Reif, M., Duarte, A.M., Krasnegor, J. (1998). Atopic dermatitis symptoms decreased in children following massage therapy. Pediatr Dermatol, 15(5), 390-395.
Trattner, A., David, M., Lazarov, A. (2008). Occupational contact dermatitis due to essential oils. Contact Dermatitis, 58(5), 282-284.
Dr. Susan Salvo is a massage therapist, author, educator, researcher, explorer, and perpetual student. To learn more, check out the “About Susan” tab. You can contact Susan at email@example.com.