Love the skin you’re in
Dr Sarah offers her advice for acne, eczema and more
Avisible skin problem can damage your confidence and, according to the General Medical Council, a quarter of the population are affected by a condition that would benefit from medical care. So, if that’s you, it’s time to take action. Visit your doctor, even if you’ve been in the past, as new treatments are launched regularly. National guidelines now recommend people with troublesome skin conditions are referred for specialist advice.
Too old for spots?
Everyone gets spots, but acne is associated with persistent blockage and inflammation of hair follicles and their oil glands to form blackheads, whiteheads, lumps and spots. Acne affects eight out of 10 teenagers, but up to 12% of women and 3% of men are affected in midlife. Acne is linked with oversensitivity to androgen hormones. Although men make more of these hormones, women also produce small amounts. Androgens stimulate oil production and cause skin cells to stick together rather than being shed, which blocks oil ducts. Skin bacteria then triggers inflammation and immune reactions to the chemicals they release.
SELF-HELP STEPS
Diet can influence the activity of the skin’s oil glands, as well as the stickiness of the skin cells that block the glands and form blackheads. It also influences the degree of inflammation. A wholefood diet full of antioxidant-rich fruit and vegetables, nuts, seeds and oily fish will help. Cut back on sugar, which triggers the release of insulinlike growth factor (IGF-1) and causes skin cells to proliferate to promote blackheads. Milk contains sugars, growth factors and hormones, and some people benefit from cutting back on dairy. If you do, ensure you get enough calcium from nuts, seeds, leafy vegetables and supplements.
Benzoyl peroxide is the most effective topical treatment available over the counter.
If oral antibiotics are needed, a probiotic supplement containing friendly digestive bacteria will reduce intestinal side effects.
MEDICAL TREATMENT
Acne must be treated properly to prevent scarring. Treatments can take eight weeks or more to work and may irritate the skin at first, so persevere. First-line treatments are usually topical creams, lotions or gels, such as benzoyl peroxide and azelaic acid, or topical antibiotics. Oral antibiotics are mainly used when acne is moderate to severe, or where large areas of the body are affected. The oral contraceptive pill can reduce the severity of acne for women who also need contraception.
Scaly patches
Psoriasis is an inflammatory disease where skin cells multiply around 10 times faster than normal and do not mature properly. They push up to the surface and form raised, red patches covered with fine, silvery scales anywhere on the body, including the scalp. Nails are affected in nine out of 10 people with psoriasis, causing pits and flaking, while a form of arthritis occurs in up to 30% of people. Psoriasis is linked with genetic, environmental and immune factors, and affects around one in 50 adults.
SELF-HELP STEPS
Omega-3 fish oils can improve itching, scaling and redness. Some
people benefit from avoiding red meats, dairy products, gluten and refined sugars. Only follow a restricted diet with nutritional supervision to avoid deficiencies.
Dead Sea mud and salts contain minerals that help to normalise skin cell production, as can Mahonia ointment (made from the Oregon grape extract), and indigo cream. Try Indigo Skin Repair Cream (£14.95 for 150ml, skinshop.co.uk/ indigo-skin-repair-cream).
MEDICAL TREATMENT
Emollients help to soften skin, remove scales and reduce inflammation. Prescribed creams or gels containing vitamin D derivatives (calcipotriol, tacalcitol) or vitamin A derivatives (tazarotene) can slow skin cell production. But treatments take several weeks to start working, so don’t give up too soon. Corticosteroid creams and ointments may be prescribed for treating localised areas of psoriasis.
You will be referred to a specialist if the condition does not improve, or if you develop joint pain, which could be a sign of psoriatic arthritis. If so, treatment is needed as soon as possible. Specialists can prescribe a wide range of immune drugs that reduce cell division, including pimecrolimus (also used for eczema), acitretin, and antibody treatments (for example, ixekizumab, secukinumab, ustekinumab, brodalumab). Specialist centres can also offer phototherapy with ultraviolet light. Referral to a clinical psychologist is recommended if psoriasis is affecting your emotional wellbeing.