What's spoiling your skin? From eczema to acne, cold sores to cancer, read our expert guide to the causes and best treatments...

Redness, rashes, bumps and break-outs can be at best embarrassing, and at worst really quite debilitating. 

But brilliant developments in doctors’ understanding of how to prevent and treat skin conditions means the outlook for patients is looking much brighter.

In this, the final part of our unique HOW TO BEAT series, we have worked closely with experts in each field of dermatology to bring you cutting-edge information about your complaint and the newest treatments available. It could be life-transforming.

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Brilliant developments in doctors¿ understanding of how to prevent and treat skin conditions means the outlook for patients is looking much brighter

Brilliant developments in doctors’ understanding of how to prevent and treat skin conditions means the outlook for patients is looking much brighter

ECZEMA

Dermatitis (or eczema) affects one in ten adults and one in five children, causing patches of dry, scaly, red and itchy skin.

In some cases, an unknown allergy to substances such as perfumes, creams, hair dyes or nickel jewellery can be enough to prompt the body to mount a defence, triggering an inflammatory reaction in the skin.

But most eczema is atopic eczema, an inherited condition that is linked to other sensitivities such as hay fever and asthma. The distinctive, red, itchy patches of skin are a sign that your immune system has over-reacted to harmless allergens and has triggered the inflammatory process in its defence.

The usual cause is an inherited gene that leads to a deficiency in a protein that’s supposed to keep the skin moist and act as its barrier, explains Professor Hywel Williams, director of the Centre for Evidence-based Dermatology at the University of Nottingham. ‘This deficiency means the skin dries out, becomes itchy and inflamed and — if scratched — red and sore.’

Other inherited genes can trigger the body to mount an abnormal immune response in the skin to allergens such as house mites or even certain foods.

Very often eczema sufferers have to endure a combination of the two: the deficient skin barrier and an abnormal response to allergens.

DON'T SCRATCH THAT ITCH, IT'LL PROLONG THE AGONY 

Scratching produces more inflammation so must be avoided, doctors warn 

Scratching produces more inflammation so must be avoided, doctors warn 

While scratching that itch may feel fantastic, it can very often prolong the problem. 

‘When skin is inflamed it is a sign that inflammatory cells have gathered beneath its surface,’ explains Dr Joanna Gach, consultant dermatologist at BMI Meriden in Coventry and University Hospital Coventry. 

‘These cells stimulate the release histamine - a natural chemical the body produces in response to an allergen – which causes the itching. Scratching produces more inflammation, more histamine and more itch.’

She recommends trying a non-soap cleanser such as Dermol 500 (£11.94 from Lloyds pharmacy) and frequent use of preservative and fragrance free emollient creams such as E45 cream, Aveeno, Cetraben or Olaten (see products below).

‘Never ignore itching skin,’ warns Dr Gach. ‘In extreme cases it could be a sign of iron deficiency, diabetes, thyroid, kidney or liver disease so always see your GP if the itching persists.’ 

Itching can also be caused by a fungal infection - characterised by a flaky round and itchy wound - which can be treated with oral anti-fungal agents. 

Hives - a raised itchy rash which may be triggered by allergy to insect bites, medications or general anaesthetics – or an infection can be treated with antihistamines (in higher doses than those taken for hay fever).

However, the rogue genes might never be switched on until the person is exposed to specific environmental triggers, such as low temperatures or low humidity, which dry the skin to the point that brings on eczema.

SO WHAT WORKS?

The latest thinking in eczema treatment focuses on protecting the skin barrier first with emollients (moisturising oils, creams and ointments) and then dampening down the immune system (with steroid creams) when red, itchy skin inflammation occurs.

However, continuous and over-use of steroid creams can cause skin-thinning — the steroid appears to reduce the production of collagen, a protein that helps supports the top levels of skin. 

So Professor Williams advises judicious use: ‘Once the initial “attack” phase is under control, we often put people on “weekend therapy”, using the creams only on a Saturday and Sunday night,’ he says. ‘This rarely causes skin-thinning and dramatically reduces the number of flare-ups.’

Specialists are excited by newer topical anti-inflammatory ointments, called tacrolimus or pimecrolimus, which can be prescribed by your GP and which won’t cause skin-thinning.

Although Professor Williams says it’s too early to know if they are safe long term, evidence shows they seem to be highly effective. In extreme cases light therapy (see next page) can help.

Soap is too harsh for eczema sufferers, he says, and avoid any skincare products containing preservatives or washes containing sodium laurel sulphate, which can irritate eczema.

Instead, ‘a simple emulsifying ointment from the chemist can be mixed with water as a cream soap and used as a direct application cream,’ he suggests. Or try Dermol Shower Emollient, £6.65.

The experts’ favourite products: Try Avene XeraCalm AD (a range of creams, cleansing oils and lotions for varying degrees of dryness which contains compounds that can help restore the skin’s barrier), from £5.50 to £35, suggests Dr Anthony Bewley, consultant dermatologist at Bart’s and the London NHS Trust.

Aveeno moisturising cream, £8.93, contains oatmeal, which is anti-itch and helps restore the skin barrier, says Dr Nick Lowe, a dermatologist and former senior lecturer at University College London’s school of medicine.

TOWIE star Jess Wright suffers from psoriasis

PSORIASIS

This skin condition — characterised by raised flaking, itching red patches on various parts of the body — affects around 1.8 million people in Britain, most of them first affected before their 40th birthday.

It is an immune condition that causes the body to produce too many new skin cells. The extra cells accumulate and cluster in red, inflamed patches, thickening the skin, which often has a ‘silvery scale’ appearance.

A virus or infection such as tonsillitis — when the immune system is weakened — can trigger the condition in those with a genetic predisposition, as can a stressful event, says Christopher Griffiths, professor of dermatology at the University of Manchester and a world expert on psoriasis.

Around 30 per cent of people with psoriasis get painful joints — sometimes the joint pain comes before the skin condition appears — because the immune system targets the joints, triggering psoriatic arthritis.

SO WHAT WORKS?

The old and trusted methods of treating psoriasis are fast falling out of favour and there is new hope on the horizon in the form of a powerful injection and, in a year’s time, a once-a-day tablet that could halt symptoms in their tracks.

For the past 100 years products containing coal tar, a thick, heavy oil with a strong smell have been used for psoriasis. 

They are still used today in some centres alongside a treatment called PUVA, which combines light therapy with psoralen tablets (psoralens are synthetic versions of compounds found in plants that increase the skin’s sensitivity to UV light).

This triggers a chemical reaction that slows down the production of skin cells. But coal tar can be unpleasant to use (it is smelly and can be messy) and PUVA has been linked with skin cancer.

‘When PUVA was introduced 40 years ago, the risks hadn’t been determined and though it was highly effective, people used it too often,’ says Professor Griffiths. ‘It not only increased wrinkles and brown spots but also the incidence of skin cancer.’

PUVA is still offered on the NHS but treatments are limited to one a year. Instead, specialists increasingly favour UV treatment (see laser box) which has a lower risk of skin cancer.

Mild cases of psoriasis can now be treated using gels containing vitamin D — which slows the over-active build-up of the top layer of skin — combined with a corticosteroid, which can dampen down the immune response. 

And for severe cases — particularly where patients also have psoriatic arthritis — regular treatment with new ‘biologic’ injections can make a significant difference. 

MOISTURISER THAT MAKES SKIN WORSE 

For decades, it’s been routinely recommended and prescribed by GPs as a gentle moisturiser, but using aqueous cream in this way can make skin conditions worse.

One study found that 56 per cent of children developed an irritant reaction to it, while many complained that it made their skin sting.

‘There is also some evidence to show it might dry out the skin barrier further,’ says dermatologist Professor Hywel Williams. ‘It is great as a wash product, but it shouldn’t be used as a moisturiser, as it cannot repair your skin.

The treatment helps block the chemicals that lead to the immune response. ‘This new treatment has transformed the lives of patients with severe psoriasis in the past decade,’ says Professor Griffiths.

The injections are administered by the patient — just as someone with diabetes injects insulin — once a week or once every 12 weeks, depending on the type of treatment.

Four different biological therapies have been approved by the National Institute for Health and Care Excellence (NICE) and, according to Professor Williams, one more which promises to be even more effective is due for approval within 12 months. 

‘Thirty years ago these patients would have been having significant amounts of PUVA, spending time in hospital and increasing their skin cancer risk — but now we can give them back normal lives,’ says Professor Griffiths.

The drugs are, however, expensive, so dermatologists use them only as a last resort, and come with the possibilities of side-effects such as increased risk of infection, rashes and, in very rare cases, neurological symptoms (such as seizures and inflammation of the nerves of the eyes) .

Another ground-breaking treatment, a new once-a-day tablet called apremilast, could become available in the UK in the next year. It works by inhibiting an enzyme in immune cells, causing an anti-inflammatory effect.

Trials on the drug in the U.S. have been promising and NICE is currently reviewing it as a treatment. Professor Griffiths has been conducting clinical trials of the drug in the UK. 

‘So far, the results have been promising,’ he says. ‘If the drug is approved by NICE, it could further revolutionise the treatment of psoriasis.’

Light therapy can help a number of skin conditions such as eczema and psoriasis 

Light therapy can help a number of skin conditions such as eczema and psoriasis 

Being overweight is associated with a higher incidence of skin problems including psoriasis. As Neil Walker, a consultant dermatologist at the Lister Hospital, London, explains: ‘The science of this isn’t fully understood — we don’t know whether it’s being overweight that causes psoriasis or whether having psoriasis makes it more likely you will gain weight.’

The experts’ favourite products: For a moisturiser try La Roche Posay’s Iso-Urea Anti-Flake Body Milk, £14.

It contains humectants — substances that increase the moisture levels in the skin and also acts to gently remove surface skin cells, says Dr Joanna Gach, consultant dermatologist at University Hospital Coventry and BMI Meriden in Coventry. Dr Bewley suggests simple washes and creams and E45 moisturisers, £5.50.

ROSACEA

The ruddy faced flushing and blushing that characterises rosacea is an extremely common problem in middle age.

It’s caused when the blood vessels in the face expand excessively in response to various triggers (from spicy food to alcohol, or even stress) causing increased blood flow to the area.

A 2011 study found that almost half of all UK adults report some symptoms. Though rosacea does run in families, it isn’t inevitable, and it is increasingly treatable.

SO WHAT WORKS?

Steroid creams are no longer prescribed — many specialists believe they make the condition worse — but GPs can prescribe a new gel called brimonidine, which restricts the dilation of blood vessels that causes redness. ‘This is an effective treatment and the only one available right now that treats the flushing of the skin’, says Professor Griffiths.

However, he warns some patients get a ‘rebound’ effect, which means the redness comes back more intensely when they stop using it.

Clinique¿s anti-redness range, especially Daily Protective Base Cream, £19
E45 cream
Avene¿s Eau Thermale Anti-Redness Rich Moisturising Cream, £13.50

The experts’ favourite products: For mild cases, Dr Gach suggests Clinique’s anti-redness range, especially Daily Protective Base Cream, £19; Dr Bewley recommends simple washes and creams and E45 moisturisers, £5.50, and Avene’s Eau Thermale Anti-Redness Rich Moisturising Cream, £13.50

If your skin flushes red frequently, or stays red between flushing episodes, your GP can prescribe an anti-inflammatory ointment (azelaic acid) or low doses of an oral antibiotic (tetracycline), which can help reduce inflammation. ‘Antibiotics have an additional benefit of getting rid of bacteria in the inflamed hair follicles that are also implicated in rosacea,’ says Dr Bewley.

Some patients find laser treatments can help. A new, if controversial, theory is that rosacea sufferers have more bacteria on their skin — specifically, bacteria produced by a mite called Demodex.

We all have this mite on our skin, but studies have found levels in rosacea sufferers can be ten times greater, which is thought to lead to higher levels of inflammation. As a result, some pharmaceutical companies are looking at ways to control the Demodex mite as a way of controlling rosacea.

‘Studies looking at the role of Demodex in rosacea have been small,’ says Dr Bewley. ‘If it plays a role at all it’s certainly not in all cases and the research isn’t brilliant.’

The experts’ favourite products: For mild cases, Dr Gach suggests Clinique’s anti-redness range, especially Daily Protective Base Cream, £19; Dr Bewley recommends Avene’s Eau Thermale Anti-Redness Rich Moisturising Cream, £13.50.

Cameron Diaz has previously discussed how her love of junk food triggered acne

Cameron Diaz has previously discussed how her love of junk food triggered acne

ACNE

More than half of all women over the age of 25 suffer some form of facial acne and as with teen acne, it is triggered by hormonal changes. In both age groups, high levels of the hormone testosterone cause the oil glands to pump out excess oil, blocking pores and causing pimples. Acne sufferers also appear to have more propionic bacterium (p. acnes) on their skin, which colonises the hair follicles leading to the blockages that cause the acne breakouts.

SO WHAT WORKS?

The first step is over-the-counter acne treatments containing benzoyl peroxide, a mild bleach which removes the top layer of skin, unblocking pores and has an antiseptic effect on the surface bacteria that cause acne (try Quinoderm, Panoxyl and Acnecide, from around £2).

Washes and creams containing salicylic acid (such as the Proactiv + range from Boots, from £19.99) slow the shedding of cells inside the pores which cause clogging and pimples. Repeated studies have found that products containing salicylic acid at concentrations of 2.5 per cent can be effective against acne spots.

For many decades antibiotics have been prescribed for acne, to destroy the bacteria on the skin. However concerns about antibiotic resistance mean GPs are more likely to prescribe higher strength benzoyl peroxide in combination with a mild topical antibiotic or vitamin A cream, which help remove the top layer of the skin so unblocking pores.

Women can be prescribed the contraceptive pill Yasmin or Dianette which can block the increased testosterone that causes acne, but the spots frequently reappear when they later come off the Pill.

Dermatologist Dr Nick Lowe says a newer drug called spironolactone, used mainly as an anti-blood pressure medication has been found to have the same testosterone-blocking effects on acne, without the risks. This is available on the NHS, but only to women (it has ‘feminising effects’ such as reducing hair growth on the body), and is usually prescribed when acne appears as a consequence of Polycystic Ovarian Syndrome — a hormonal disorder where women’s bodies produce too much testosterone.

Another option is light therapy (see box , right). For severe acne and as a last resort, a dermatologist can prescribe strong medication called isotretinoin (perhaps best known by the brand name Roaccutane) which reduces the action of the oil glands and the bacteria that cause acne, and which can also help reduce the formation of scarring.

WHAT WILL GET RID OF THE SCARS?

¿Scarring usually gets better on its own within two years,¿ says dermatologist Dr Anthony Bewley

‘Scarring usually gets better on its own within two years,’ says dermatologist Dr Anthony Bewley

Most acne treatments take eight to 12 weeks for skin to respond, but if you are worried about scars, talk to your GP.

‘Scarring usually gets better on its own within two years,’ says dermatologist Dr Anthony Bewley. 

‘However, creams containing retinoids can work to change the structure of the skin cells in a scar and thus reduce it.’

If you are willing to pay a private dermatologist, you could consider ‘Punch treatment’.

This is where under a local anaesthetic, a round, sharp instrument called a ‘punch’ tool is used to cut or punch out the scars and the area is then stitched together. 

This produces a softer scar that eventually fades.

Laser resurfacing and dermabrasion that removes the top layer of the skin may also help scarring, says Dr Bewley.

However none of these treatments are available on the NHS.

However, side-effects can include back pain, extreme drying out of the skin, lips and scalp, muscle pain, hair loss and in rare cases psychiatric problems; women taking the drug must also take the Pill to avoid pregnancy as the drug can cause birth defects.

‘For about 95 per cent of patients who go onto isotetinion, their acne will clear,’ says Dr Anthony Bewley, consultant dermatologist at Bart’s and the London NHS Trust. Some doctors are now using lower doses for four to six months to ensure the side-effects are not too severe, monitoring patients with the option to put them on a further dose later on if required. It might also be worth thinking about your diet.

‘We used to say diet was irrelevant in acne but that advice has changed recently,’ says Dr Neil Walker, a consultant dermatologist at the Stratum Clinic, Oxford and Lister Hospital, London. ‘But a substantial number of studies now show diets with a high glycaemic index (sugary foods that are absorbed into the bloodstream quickly) and a diet high in dairy may have an influence after all.

A review published last year by New York University of 50 years of studies, suggested eating foods with a high GI and drinking milk not only aggravated acne but in some cases triggered it, possibly because they trigger hormonal fluctuations.

‘There is evidence a low glycaemic load diet (wholegrains and vegetables) may significantly improve the number of spots,’ says Dr Walker.

The experts’ favourite products: For mild to moderate acne Dr Gach recommends La Roche Posay’s Effaclar Duo, £15.50 (an everyday moisturising cream with salicylic acid to reduce the build up of dead skin); Dr Bewley suggests Clearasil Ultra Rapid Action Treatment Cream (with salicylic acid) £4.26 as a spot treatment, morning and night.

CASE STUDY: BLUE LIGHT CLEARED UP MY EMBARRASSING SPOTS 

Paralympic champion Hannah Cockcroft, 22, suffered from acne from the age of 12

Paralympic champion Hannah Cockcroft, 22, suffered from acne from the age of 12

Paralympic champion Hannah Cockcroft, 22, has suffered from acne since the age of 12 and her joy after winning two gold medals in 2012 was well and truly dampened by comments about her skin.

‘Over the years I went back and forth to the GP,’ she says, ‘I tried all sorts of over-the counter products and prescriptions creams.’ 

Then Hannah was given a handheld device that transmits blue light and used it on the worst affected areas every day for an hour: ‘

After six to eight weeks the difference was incredible. 

I had virtually no spots and my skin looked calm and clear. 

It was painless and there were so side-effects.’

Dermatologist Dr Nick Lowe explains: ‘The visible blue light helps reduce the acne bacteria by targeting and activating a chemical, known as porphyrin, which then kills the bacteria.’

■ Lustre Pure Light £225, fromlustrepurelight.com. Another option is Lumie Clear Acne Treatment Light, £149, boots.com 

 

NATURAL REMEDIES FOR A CLEAR COMPLEXION

‘Popping a supplement to improve your skin is gaining more credibility among dermatologists,’ says Dr Neil Walker, a consultant dermatologist at the Stratum Clinic, Oxford, and Lister Hospital, London.

For acne and eczema: Try fish oils. ‘Omega 3 fish oil supplements can be beneficial in patients with acne, because they reduce inflammation and help unblock blackheads and whiteheads,’ says Dr Walker. 

‘I have seen some dramatic improvements in patients who take fish oil capsules, but they don’t work for everyone. A fish oil supplement can also be useful for patients with seborrhoeic dermatitis, a common scaling rash associated with surface yeasts, as it reduces inflammation.’

Take one to two (500mg) capsules daily. Try Super Strength Omega 3 with 200mg DHA and 300mg EPA, £15.95 for 180 capsules from healthspan.co.uk.

Omega 3 fish oil supplements (right) can be beneficial in patients with acne. Lycopene, extracted from tomatoes, is thought to suppress free radicals - molecules that are believed to be responsible for cell damage and ageing in the skin caused by the sun

For psoriasis: Try Vitamin D3. Research conducted by the University of Verona and published in the British Journal of Dermatology in 2011 found that vitamin D deficiency is very common in psoriasis sufferers, affecting 80 per cent of patients in winter and 50 per cent in summer.

‘We know that creams made with vitamin D derivatives can work very well on psoriasis,’ says Dr Walker. ‘What scientists don’t understand yet are the precise mechanisms involved, and whether taking vitamin supplements will have the same effect as creams containing vitamin D.’

Take 2000 international units (iu) daily in the winter, 1000iu in the summer. Try Super Strength Vitamin D3, £10.95 for 240 tablets from healthspan.co.uk.

For sun protection: Try lycopene. Extracted from tomatoes, lycopene is thought to suppress free radicals — molecules that are believed to be responsible for cell damage and ageing in the skin caused by the sun.

‘I take this for a week prior to and during holidays in the sun, and recommend all my patients do the same,’ says Dr Nick Lowe, a dermatologist and former senior lecturer at University College London.

Take two to three lycopene capsules daily: £14.95 for 60 capsules from healthspan.co.uk.

 

WARD OFF A COLD SORE BEFORE YOUR BIG EVENT  

COLD SORES

Worrying about having a cold sore for a big event like a wedding for instance may actually be a trigger

Worrying about having a cold sore for a big event like a wedding for instance may actually be a trigger

These small blisters develop around the lips and mouth after contact with the herpes simplex virus. 

They are contracted by skin to skin contact — kissing for instance — or drinking from an infected cup and lie dormant in the body, flaring up in response to sunlight or when the immune system is challenged, for instance, when you’re stressed or ill..

‘Worrying about having a cold sore for a big event like a wedding for instance may actually be a trigger, so for those with recurrent problems we may prescribe a preventative oral treatment for two weeks before,’ says Paul Griffiths, professor of virology at University College London Medical School and the Royal Free Hospital, London.

‘The creams acyclovir and penciclovir, available on prescription and over the counter, have been shown in randomised controlled trials to stop a cold sore developing if they are taken as soon as a patient feels the tell-tale tingling caused by the virus reactivating in the nervous system.’ (Acyclovir pills are also effective in preventing attacks but are available only on prescription). 

Professor Griffiths says acyclovir and penciclovir creams have also been shown to reduce the duration of cold sore attack.

He recommends a lip salve containing sun block as sunlight is a common trigger — especially on summer holidays or skiing trips.

‘Unfortunately it has proved very challenging to develop a vaccine against the virus — the best we can offer those with recurrent attacks of more than six a year is to take oral aciclovir for a year continuously. Sometimes when they stop the protection seems to continue and they get fewer attacks, perhaps because their anxiety triggers have been reduced,’ says Professor Griffiths.

German trials showed a herbal lemon balm cream is effective if applied early enough (Lomaherpan £6 for 5g from herpes.org.uk/acatalog/Creams.html)

WARTS AND VERUCCAS

Warts are small, rough growths caused by the human papillomavirus. A verruca is simply a wart on the sole of the foot. ‘Most are harmless and will go away on their own, usually within two years,’ says Adam Friedmann, a consultant dermatologist at the Whittington Hospital, London and the Harley Street Dermatology Clinic.

TOP VERRUCA TIP  

Apply nail varnish to your verruca to give it a waterproof seal and prevent it infecting others, recommends podiatrist Emma Supple. 

Home-treatments (using salicylic acid to remove skin cells or liquid nitrogen which freezes and destroys the affected skin cells are most effective if the wart or verruca is caught early, says Dr Friedmann. 

He says an older painless treatment that has come back into fashion is diphencyprone (DCP) which can be painted on the warts by a specialist at a limited number of NHS centres or privately every two to four weeks. ‘It provokes an allergic reaction which boosts the body’s natural immune response and seems to be 80-90 percent effective on old, big and painful warts’ he says.

A newer treatment imiquimod (Aldara) works by attracting the attention of the immune system so it attacks the wart and destroys it (available on prescription).

Dr Tariq Khan, a consultant podiatrist at the Royal London Hospital for Integrated Medicine, recommends boosting the immune system with a dose of zinc (15mg of zinc citrate daily). He also says he has successfully trialed a herbal extract of marigold which has antiviral and keratolytic properties (it thins the skin causing the wart to shed the top layers) with a 90 per cent success rate over 12 weeks compared to placebo. Four hundred podiatrists have been trained in its use. Contact tariq.khan@uclh.nhs.uk.

 

BLAST AWAY THOSE BLOTCHES AND UGLY VEINS

From acne and scars to eczema and psoriasis, various forms of light and laser treatments are showing very positive results.

UV Light Therapy: Ultra violet rays similar to those in sunlight have been used for decades to help treat conditions such as eczema and psoriasis. The rays appear to dampen the overactive immune response that causes both conditions.

Although any UV exposure brings an increased risk of skin cancer, the dose is measured, and the patient is exposed to only a small part of the UV light spectrum, keeping the risk low. In severe eczema cases, a patient may be prescribed (on the NHS) a course of UV sessions three times a week for three months.

Ultra violet rays similar to those in sunlight have been used for decades to help treat conditions such as eczema and psoriasis

Ultra violet rays similar to those in sunlight have been used for decades to help treat conditions such as eczema and psoriasis

Laser therapy: Here a single focused wavelength of light is used to heat up specific structures beneath the skin without damaging surrounding tissue. It is used for a range of complaints, from thread veins, to rosacea, sun spots and acne scarring (but not eczema).

Some lasers use a continuous beam, while others use rapid pulses of energy. The light energy is converted into heat within the skin, which creates a sensation like being pinged by an elastic band. A 20cm patch of skin might take 15 minutes to treat and some conditions may require up to six treatments — others get a good result after just one.

Depending on your condition (if it is causing ‘severe psychological distress) and your postcode (funding varies from region to region), your laser treatment may be covered by the NHS. If not, ask your GP to refer you to a dermatologist. Sessions might cost upwards of £300 a time.

Thread veins, spider veins, rosacea and port wine stains: Here laser heat clots the blood, causing the blood vessels to shrink, reducing the appearance of surface redness.

Sun spots: The darker patches of skin (natural pigment or tattoo ink) are heated up, causing the pigment to break into smaller particles. These are seen as foreign matter by the body’s immune system, which, over a few weeks, will eliminate them.

Scarring: Laser heat stimulates the fibroblasts — cells responsible for making collagen and elastin, which make skin springy — to produce more of these proteins, which plump up in the indentation left by the scar.


Talking therapies such as CBT have been shown to improve skin conditions such as psoriasis, eczema and acne

Talking therapies such as CBT have been shown to improve skin conditions such as psoriasis, eczema and acne

TALKING CAN HELP THE PROBLEM DISAPPEAR 

Therapies such as relaxation therapy, mindfulness — a form of meditation — and Cognitive Behavioural Therapy (CBT) have been shown to improve skin conditions such as psoriasis, eczema and acne.

This is because stress and anxiety are thought not only to trigger many long-term skin problems, but up to 40 per cent of patients who have a problem with their skin also suffer anxiety or depression because of their condition.

‘The skin and the nervous system originate from the same tissue in the foetus,’ explains Dr Christopher Bridgett, a London-based psychiatrist who specialises in psychodermatology, as this field is known. ‘The tissue, known as the ectoderm, forms the skin and then curls inwards at the top to form the brain.’

As a result, whatever affects your brain also, in turn affects your skin. Furthermore, when we’re stressed, our body releases cortisol and adrenaline, hormones which can cause rashes or similar skin responses if the stress is intense or prolonged.

Though psychological approaches are used in tandem with other therapies, and often control rather than cure the conditions, Dr Reena Shah, a clinical psychologist specialising in dermatology at the Royal London Hospital, says effects are often remarkable.

Patients formerly unable to leave their homes due to anxiety or depression or trapped in a frustrating pattern of scratching leave her care with improved confidence — and much better skin. ‘It can really change lives,’ she says.

Studies have found that CBT can improve psoriasis and that meditation during light therapy can speed treatment by up to four times.

With only seven dedicated psychodermatology clinics in the UK, NHS availability is limited, but ask your GP to refer you to a dermatologist with an interest in this field.

■ For more information see:

Guys & St Thomas’ NHS Trust, in association with The Department of Psychological Medicine at King’s College London, has produced worksheets and podcasts on mindfulness for psoriasis and meditation for persistent itching at kcl.ac.uk/iop/depts/pm/research/imparts/Self-help-materials.aspx

Dr Bridgett’s habit reversal techniques, which he’s successfully used to stop people with eczema from scratching, can be found at atopicskindisease.com

Look out for a new psychodermatology website is being launched in the spring by the British Association of Dermatologists. It will be called atskinandmind.co.uk

 

SKIN CANCER

Skin cancer can be a frightening diagnosis, but the vast majority of skin cancers are not life-threatening.

There are a number of different types of skin cancers, which require different approaches and treatment.

Skin cancer can be a frightening diagnosis, but the vast majority of skin cancers are not life-threatening

Skin cancer can be a frightening diagnosis, but the vast majority of skin cancers are not life-threatening

NON-MELAMONA SKIN CANCERS 

This is the most common and least serious type — usually spotted in older people and unlikely to spread, except in rare cases. Non-melanoma skin cancers fall into two categories:

Basal cell carcinomas (BCCs or ‘rodent ulcers’)

Look out for: A small lump that gets bigger, the edges may have a shiny or pearly look, with a sunken or ulcerated centre. Often, they crust, bleed and never seem to heal (a BCC is rarely itchy). They mainly develop in areas exposed to the sun, such as the face, back, or lower legs. BCCs are the most common form of non-melanoma skin cancer. They affect the basal cells in the deepest layer of the skin.

Treatment: If left untreated, the more infiltrating type of BCC can be very destructive, particularly around the ears, noses and eyes, warns Dr Justine Hextall, consultant dermatologist at the Western Sussex NHS Trust. However, she says, a BCC is highly unlikely to spread elsewhere in the body.

‘We surgically remove the cancer under local anaesthetic, or use local radiotherapy (a beam of electrons, which only penetrate as far as the skin to avoid damage to surrounding tissues) to destroy the cancer.

‘If the cancer is superficial, it may be treated with chemotherapy creams or photodynamic therapy, which uses strong light to activate creams which destroy cancerous cells and not surrounding healthy tissue.’

Squamous cell carcinomas (SCC) 

Look out for: A rapidly growing, often painful lump or area of thickening in skin. One in five skin cancers are SCCs. They develop in cells called keratinocytes in the upper layers of the skin.

Like BCCs, they mainly occur in areas of skin exposed to the sun: the head, neck, upper lip, forearms and lower legs, but can also grow around the vulva and anus.

WEAR SUN CREAM IN THE CAR 

It’s not just sun worshippers who may be at risk of skin cancer, say dermatologists. This is because you can get it just from spending time walking the dog, running or gardening, says Dr Bav Shergill, a consultant dermatologist from West Sussex.

He says you can also get sun damage through a windscreen or an office window — UVA rays can penetrate glass and while they won’t cause sunburn, they can cause cancer in the long term. Studies have suggested that some truck drivers and office workers who sit near windows may be at greater risk.

It’s also important to apply enough suncream. The official advice is to apply sunscreen 20 minutes before leaving the house and then again ten minutes after you have gone outside, and technically this applies from March to October, when UV levels have increased, although some dermatologists believe you should use suncream all year round.

Professor John Hawk, a spokesperson for the British Skin Foundation. ‘You need two teaspoons for your head, neck and arms, and two tablespoons for the rest of your body. 

Reapply every couple of hours or after swimming or sea. 

Treatment: Although this type of skin cancer is still unlikely to spread beyond the skin, it can be more aggressive, and requires prompt surgical removal.

Dr Hextall warns: ‘The lips and ears are a high-risk site for SCCs — they are more likely to spread to lymph nodes, so prompt surgical treatment is key.’

 

MALIGNANT MELANOMAS 

Look out for: New moles, or changes in existing moles (specifically asymmetry, an irregular border, uneven colour or changes in colour, inflammation or increasing size). ‘Some malignant moles will stand out from the rest, but more than 70 per cent are completely flat and not raised off the skin,’ says Dr Hextall.

Malignant melanomas affect the melanocytes (cells that give colour or pigment to skin). A third of all cases originate from a pre-existing mole, but most appear in ordinary, non-mole skin.

‘The most dangerous type of skin cancer, this is the second most common cancer in people aged from 15 to 34.

Malignant melanoma claims 2,000 lives a year in the UK. This type of skin cancer is, thankfully, rare and only accounts for 2 per cent of all skin cancer cases,’ says Dr Hextall.

Treatment: Surgical removal (by a dermatologist), which usually takes a wider portion of skin around the cancer site to ensure no cancer cells are left behind.

If the cancer has spread to lymph nodes and other parts of the body. new drug treatments, including ipilimumab (which has recently become available), are showing good results, says Dr Hextall.

Sun spots/liver spots

Look out for: Sun spots, or liver spots, are flat, brown spots or patches of skin that appear on areas most exposed to sun, typically backs of hands, face, forearms, forehead and shoulders.

Sun spots are common in the over-40s, and are caused by the sun’s rays, which damage the DNA in the melanocytes (the cells that produce the brown pigment). This makes the melanocytes enlarge and cluster together.

Liver spots are usually benign, if well-defined with an even light to moderate brown pigmentation. ‘But, if they are irregular, have different shades of pigmentation, or an irregular edge, they could be malignant,’ warns Dr Hextall.

Treatment: Dr Hextall says suspect liver spots should be examined by an experienced doctor and, if necessary, biopsied before considering laser or freezing treatments to remove them.

Seven people die every day from skin cancer in the UK. Help the British Skin Foundation lead the fight against the disease and fund vital research by creating a fundraising team or donating at www.ittakesseven.org.uk

 

 

 

 

 

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