Examining skin complaints

Despite the fact that half of the population suffers from some sort of skin condition, there are still social stigmas attached, as Jill Eckersley explains


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.”