Examining skin complaints

The skin is the body’s largest organ and the aver­age adult has a stag­ger­ing two square metres of it, weigh­ing 3.2 kilos. The skin has sev­er­al vital func­tions; it pro­tects from injury and envi­ron­men­tal dam­age, reg­u­lates tem­per­a­ture, detects infec­tions and is a vital sen­so­ry organ. It con­sists of three lay­ers, the deep­est of which con­stant­ly pro­duces new skin cells so that the whole skin is replaced rough­ly every four weeks.

Skin reflects your gen­er­al health, which is why many peo­ple get spots when they are stressed or run­down. The ene­mies of skin health include UV light from the sun, smok­ing, poor diet and bad sleep habits. Cen­tral heat­ing and air con­di­tion­ing can also cause con­cerns because they dry the skin out.

Con­di­tions such as acne, rosacea, eczema and pso­ri­a­sis are not life-threat­en­ing, but they are life-affect­ing, main­ly because they are so obvi­ous. The effects are both phys­i­cal – itch­ing, pain, dis­com­fort – and psy­cho­log­i­cal – loss of con­fi­dence and self-esteem. Even in nurs­ery school, chil­dren often don’t want to touch oth­ers with rough, red­dened or scaly skin and this does not improve in adult life. Hav­ing severe eczema or pso­ri­a­sis can affect the num­ber of careers open to you as well as the way you are able to live your every­day life.

ACNE

Angry bumps and pimples

Acne affects most peo­ple at some point in their lives. About 80 per cent of teenagers have acne while 1 per cent of men and 5 per cent of women aged over 25 are still affect­ed, a num­ber that has been ris­ing in recent years.

It is caused by chang­ing hor­mone lev­els and specif­i­cal­ly male hor­mones, such as testos­terone, hence its preva­lence dur­ing puber­ty. Sebum, the oily sub­stance that lubri­cates the skin, is pro­duced in increased quan­ti­ties at this time and blocks the hair fol­li­cles pro­duc­ing the char­ac­ter­is­tic bumps and pim­ples.

A com­mon mis­con­cep­tion is that peo­ple with acne live on junk food, although diet does play a part. Con­sul­tant der­ma­tol­o­gist Dr Sher­naz Wal­ton, of the British Asso­ci­a­tion of Der­ma­tol­o­gists, says: “A diet high in pro­tein and low-GI car­bo­hy­drates seems to improve acne break­outs where­as high-GI carbs may influ­ence the devel­op­ment and sever­i­ty of acne.”

It is impor­tant to keep the skin clean, but only gen­tle prod­ucts should be used. Over-the-counter treat­ments con­tain­ing anti-bac­te­ri­als, such as ben­zoyl per­ox­ide, can be rec­om­mend­ed by your phar­ma­cist. If they have no effect, then talk to your GP.

Con­di­tions such as acne, rosacea, eczema and pso­ri­a­sis are not life-threat­en­ing, but they are life-affect­ing, main­ly because they are so obvi­ous

Var­i­ous top­i­cal treat­ments are avail­able on pre­scrip­tion, includ­ing retinoids, aze­la­ic acid and antibi­otics. Women some­times find that hor­mone treat­ments, such as the com­bined con­tra­cep­tive pill, can help. Dr Wal­ton adds: “Blue light treat­ment is a non-inva­sive pro­ce­dure which uses light in the wave­length range of 405–420nm to kill skin bac­te­ria. It can be used alone or in con­junc­tion with a pho­to-sen­si­tis­ing agent and, in small stud­ies, has been shown to be effec­tive.”

Severe acne on the face, back and chest can leave scars, but cam­ou­flage make-up can min­imise these. Dr Wal­ton advis­es: “Try not to pick or squeeze spots as this may cause scar­ring. Take action as soon as spots appear and expect to use your treat­ments for at least two months before you see much improve­ment. Make sure you under­stand how to use them cor­rect­ly.”

ROSACEA

Burning, stinging sensation

Rosacea is a com­mon, though poor­ly under­stood, skin con­di­tion affect­ing about one in ten peo­ple, espe­cial­ly those of fair-skinned north­ern-Euro­pean ori­gin. It can look like sun­burn, except that it is per­ma­nent. It may begin with episodes of flush­ing, fol­lowed by a burn­ing, sting­ing sen­sa­tion, which results in per­ma­nent red­ness, spots and vis­i­ble blood ves­sels on the cheeks, nose and chin. It can also result in sore, blood­shot eyes.

The cause of rosacea is not known, but sug­ges­tions have includ­ed an abnor­mal­i­ty in the blood ves­sels, tiny mites called Demod­ex, which live on the skin, H. pylori infec­tion or genet­ic sus­cep­ti­bil­i­ty. Peo­ple find that cer­tain things trig­ger an episode – heat and sun­shine, spicy food and alco­hol being com­mon trig­gers. It’s impor­tant to iden­ti­fy your own trig­gers and avoid them.

Treat­ment can include metron­ida­zole cream or gel. Laser or IPL (intense pulsed light) treat­ment can be used to coun­ter­act the red­ness. Con­sul­tant der­ma­tol­o­gist Dr Bav Shergill says: “Next year we should see a new kind of rosacea cream, based on a class of drugs called alpha 2 ago­nists, which can sig­nif­i­cant­ly reduce red­ness and flush­ing. It’s hard to say whether rosacea has become more com­mon or whether increas­ing aware­ness that treat­ment is avail­able has led to an increase in diag­no­sis.

“Rosacea is a dis­ease that can wax and wane for years before burn­ing out. It can affect the eyes and lead to ocu­lar com­pli­ca­tions, so see your GP if you expe­ri­ence eye irri­ta­tion. Don’t give up on your treat­ment – your der­ma­tol­o­gist will sup­port you.”

ECZEMA

Redness and constant itching 

Eczema affects as many as one in five chil­dren and one in twelve adults in the UK. The caus­es are part­ly genet­ic and part­ly envi­ron­men­tal and, like many aller­gic con­di­tions, the inci­dence has increased con­sid­er­ably over the last 30 or 40 years. Symp­toms include red­ness, dry­ness, flak­ing skin, intol­er­a­ble itch­ing, sore­ness and cracked, bro­ken skin, which may bleed and lead to seri­ous infec­tions.

There are sev­er­al types of eczema, the most com­mon being atopic eczema, an aller­gic con­di­tion relat­ed to asth­ma and hay fever, which often runs in fam­i­lies. The name der­mati­tis is often used to describe the type of eczema which results from con­tact with chem­i­cals, deter­gents, some plants and min­er­als. Diet alone is not thought to cause eczema except, some­times, in babies or very young chil­dren.

Treat­ments for eczema include emol­lient creams and lotions, some of which can be bought over the counter on the advice of your phar­ma­cist. They can be added to bath­wa­ter or applied direct­ly on to affect­ed skin. In very severe cas­es, emol­lients can be cov­ered with first wet and then dry ban­dages to obtain relief from the con­stant itch­ing.

Top­i­cal steroids can only be pre­scribed by a doc­tor and come in var­i­ous poten­cies. They are used to bring severe flare-ups under con­trol. It can be help­ful to be referred to a skin clin­ic to learn how best to use both emol­lients and steroids. Con­sul­tant der­ma­tol­o­gist Dr Andrew Wright, of the British Asso­ci­a­tion of Der­ma­tol­o­gists, points out that non-adher­ence to treat­ment is com­mon and a major cause of treat­ment fail­ure. Apply­ing emol­lients can be time-con­sum­ing, chil­dren are often resis­tant and par­ents wor­ry about the effect of potent steroid creams on young skin.

Some peo­ple find that lifestyle changes – keep­ing the home cool, wear­ing only cot­ton cloth­ing, avoid­ing con­tact with pets, remov­ing soft fur­nish­ings – can help. Oth­ers turn to com­ple­men­tary treat­ments, such as herbal and home­o­path­ic med­i­cines. If you choose this route, make sure your prac­ti­tion­er is a mem­ber of the appro­pri­ate reg­u­la­to­ry body.

Dr Wright adds: “Eczema is a mul­ti-fac­to­r­i­al con­di­tion; there­fore, it’s impor­tant to take a holis­tic approach to its man­age­ment. Treat­ing the var­i­ous fac­tors with ade­quate amounts of mois­turis­ers and the cor­rect strength of top­i­cal steroid is essen­tial. It’s true that these creams can thin the skin if the wrong one is used on the wrong area of the body for too long, but they are very safe if used prop­er­ly. Stronger ones may be used on the body and limbs; weak­er ones on the face.” 

PSORIASIS

Scaly, red, flaky skin

Pso­ri­a­sis is a con­di­tion in which the skin’s nor­mal replace­ment process speeds up, leav­ing plaques of scaly, red, flaky skin. It affects about 2 per cent of the pop­u­la­tion, both men and women. It is thought there is a genet­ic ele­ment with the con­di­tion run­ning in fam­i­lies, and flare-ups can be caused by envi­ron­men­tal trig­gers, stress, injury, hor­mon­al changes and infec­tion.

Pso­ri­a­sis is an auto-immune dis­ease with the T cells in the immune sys­tem becom­ing over-active and more skin cells being cre­at­ed too quick­ly. It is linked to a con­di­tion called pso­ri­at­ic arthri­tis, an inflam­ma­to­ry joint dis­ease, and research is cur­rent­ly tak­ing place into a pos­si­ble link with coro­nary heart dis­ease, stroke ill­ness and high blood pres­sure in lat­er life.

As with oth­er skin con­di­tions, treat­ments vary from top­i­cal creams and sham­poos to whole-body treat­ments in the form of strong drugs, such as methotrex­ate, cyclosporin and acitretin, which is relat­ed to vit­a­min A.

Pro­fes­sor Chris Grif­fiths, of Man­ches­ter Uni­ver­si­ty, says that new­er ther­a­pies called “bio­log­ics”, which tar­get key parts of the immune sys­tem, can now be giv­en, either via a drip or by injec­tion, to patients who have not respond­ed to more tra­di­tion­al treat­ments. As with eczema, com­ple­men­tary treat­ments may also be used, but again only rep­utable prac­ti­tion­ers should be con­sult­ed.

Pro­fes­sor Grif­fiths advis­es: “Don’t let the dis­ease con­trol your life. It’s advis­able to take reg­u­lar exer­cise, have a healthy diet and keep an eye on your blood pres­sure. Cut down on smok­ing and alco­hol, and con­sid­er con­tact­ing oth­ers through a sup­port group. Stress man­age­ment may be help­ful. Always use the treat­ments pre­scribed for you, even though it can take weeks for improve­ments to be seen. See your doc­tor reg­u­lar­ly so that you can find the best treat­ment for you.”