Help me face up to this dry skin problem
Q I’VE
been told I have dermatitis – dry, red, itchy and flaky skin on my nose and between my eyebrows. Over the years, I have used various lotions and potions, some prescribed, which all work for a while, then, for some reason, fail.
It is so embarrassing as it is in the middle of my face and there is nothing I can do to hide it, and it really affects my confidence. My doctor didn’t seem to think there was much problem with me using a steroid cream, but I am concerned about long-term effects and the fact that I may need to use more and more as time goes by. I am 55.
A SKIN inflammation, specifically around the nose and eyebrow area, is usually a condition called seborrheic dermatitis. It is particularly prone in areas where there is more oil in the skin, and is thought to be worsened by a yeast species known as melassezia which normally sits harmlessly on the skin but causes problems for some people, for reasons we don’t quite understand.
It is seen as patches of red, scaly, greasy skin, often with yellowish crusts. Because it affects the face, it is highly visible and distressing psychologically. This is worsened by the misconception that it is caused by a lack of hygiene. Treatment for this type of dermatitis involves anti-fungal creams to target the yeast, as well as steroid creams to control the inflammation.
It is difficult to treat as the oily areas of skin are an ideal spot for the yeast to recur, so once it is cleared, sufferers find it often comes back. To add to this difficulty, steroid creams are not meant for long-term use due to their side effects, so a solution can seem elusive.
The condition can be kept at bay by regular treatments with anti-fungal creams, shampoos and even tablets which could result in reduced use of steroids in the long term. Other treatments can include light therapy. It is worth noting that as with other skin conditions, seborrheic dermatitis is known to worsen with emotional stress, so proactive relaxation techniques may go some way to improving the condition.
QI HAVE been diagnosed with the early stages of emphysema and so I am naturally interested in any advances in treatment of the condition. Although I have read – often in The Mail on Sunday – about surgical and other treatment options, my GP tells me he’s never heard of them and continues to prescribe inhalers, which have minimal effect. Can you explain why this is?
A CHRONIC obstructive pulmonary disease (COPD) is thought to affect more than a million people in the UK – one in ten Britons over the age of 50 – and accounts for 25,000 deaths a year.
These lung diseases, most commonly emphysema and chronic bronchitis, are usually a result of smoking and cause coughs, breathlessness and excessive sputum production.
Like many chronic, incurable conditions, COPD can be treated solely by a GP without specialist input, particularly in patients in the milder stages of a condition. This would typically mean inhalers and may go on to include specific oral medication. There are very strict guidelines about onward referral to specialists.
The National Institute for Health and Care Excellence (NICE) recommends that a specialist team get involved only if primary care treatments are not working and therapy has minimal effect.
If someone feels this is the case with their COPD, referral to a respiratory physician should be the normal procedure so other treatments can be explored and offered in a hospital setting.
Many of these specialist treatments may not be familiar to a GP, particularly those that are experimental therapies, but will be well known to the specialists.
For example, one procedure, called endobronchial lung volume reduction, which helps release air trapped in the lungs, has approval from NICE but is still very much under their review in terms of safety and effectiveness: currently it can be offered only by a trained specialist working with a thoracic team.
More time is needed to build up a body of evidence to prove that it is indeed a successful, safe treatment.