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Skin problems FAQs

This page includes the FAQs on acne, eczema, psoriasis, rosacea and shaving problems. If you're concerned about moles or skin cancer, click here. For hyperhidrosis (excessive sweating), click here.

Acne

What is acne?

Acne is an inflammatory condition that occurs in the tiny hair roots and their associated oil or sebaceous glands in the skin. It can range in severity from occasional spots and blackheads to severe pus filled nodules that will lead to scarring of the skin. It's most common on the face, neck, back and shoulders — it occurs at the sites of greatest activity of the sebaceous glands

What are the main symptoms?

The main symptoms include:

reddened, inflamed bumps called papules
whiteheads and blackheads — the non-inflammed spots, also known as comedones
pus filled spots or pustules
deep tender nodules under the skin.

What's the risk?

It's estimated that around 80 to 90% of adolescents and young adults develop acne. In 70% of individuals, acne subsides spontaneously after 4 to 5 years. In 30% it will persists for longer with an incidence of 1% of men at 40 years of age, having acne that requires treatment.

The most common time for acne to start is around puberty. It is not necessarily hereditary, although it does seem that if your parents suffered from acne when they were young, you may be more likely to develop it too.

What causes it?

The onset of acne is thought to be related to the dramatic increase in the levels of the sex hormone testosterone which occurs around puberty. The spots and pustules develop because of a change in the hair follicles and sebaceous glands in the skin.

The sebaceous glands become oversensitive even to normal levels of testosterone, producing more sebum (oil), which reaches the skin through the hair follicles and leading to a greasy skin. The next and most important change is a change of growth of the skin cells lining the hair follicle, which become sticky when they die and build up as a partial blockage in the follicle. This leads to a build up of oil in the follicle which solidifies with the formation of the blackhead and whitehead. Bacteria, particularly Propionibacterium acnes, present in the follicle, react to the build up of oil by multiplying and producing chemicals that lead to inflammation of the follicle.

Eventually, the body reacts to the bacteria by bringing in white blood cells to kill the bacteria, which leads to pus formation and the development of the pustule. If the inflammation is deep in the follicle it can lead to rupture of the follicle with deep inflammation developing in the skin and the formation of a nodule.

How can I prevent it?

It isn't possible to prevent acne if you are prone to the condition. It is a myth that acne is related to diet or to personal hygiene. It is, however, possible to prevent the damage acne can do to the skin and your psychological wellbeing by getting treatment as soon as possible.

Should I see a doctor?

Mild to moderate acne can often be effectively controlled using over-the-counter preparations, such as creams and lotions containing benzoyl peroxide. (Ask a pharmacist to recommend some suitable products.) .) If these do not work after a period of 2 months, or if your condition is more severe, see your doctor.

What are the main treatments?

Over-the counter-preparations are useful for mild cases of acne. These kill the bacteria in the skin which are responsible for the inflammation. They must be applied over the entire surface of the affected area, not just the spots. Most need to be used for at least two months before you notice any benefit.
Topical antibiotic lotions or creams, such as Clindamycin, help to reduce the number of bacteria on the skin and ease inflammation. They are not as useful for blackheads and whiteheads.
Oral antibiotics work in much the same way as topical ones. Those most commonly prescribed are tetracycline, erythromycin and minocycline. You may notice benefits within six weeks though it is important to take the antibiotics for at least six months. It is important to take the antibiotics carefully as some are affected by food in the stomach.
Derivatives of vitamin A are the major agents that will unblock the follicle and clear blackheads and whiteheads. They work by normalising the growth of skin cells in the follicle, preventing blockages from developing. These agents should thus be used in all patients with acne. Topical preparations - Tretinoin (Retin A), Isotretinoin (Isotrex) and Adapaline (Differin) - can all be obtained from your doctor on prescription.
Isotretinoin (Roaccutane) is used for severe or persistent cases. Also a synthetic derivative of vitamin A, it is used in tablet form and has a very high success rate. It reduces sebum production significantly, clears blockages from skin follicles and reduces inflammation. Side effects are unpredictable but most are due to the drying of the skin with the most common side effect being dry, chapped lips. More severe side effects can occur and your doctor will explain these in detail before he or she prescribes them to you. One side effect that has recently been highlighted is that of depression, which can be severe.
Light treatments. Sunlight is thought to help improve moderate acne in about 60% of cases. Ultraviolet light treatment can also be used, and a new treatment using red and blue light has been found to be effective at healing mild to moderate acne.

How can I help myself?

If you are susceptible to acne a number of factors have been found to make the condition worse.

Excessive sweating or being in a humid climate can cause acne to flare up. Try to avoid this.
Certain medications may worsen acne. Discuss this with your doctor.
Anything you put on your skin, such as sun cream or moisturiser, can affect acne. Again, discuss this with your doctor so you can find suitable alternatives.
Be especially careful when shaving, as this can irritate the skin. Try using a razor for sensitive skin or an electric shaver — the shave may not be as close, but you will be less likely to nick or cut your skin.
Avoid excessive cleansing. Acne is not caused by dirt and lack of hygiene, and too much cleansing can dry the skin making it too sensitive for the use of topical treatments that would otherwise be very useful.
Don't pick at your spots. This can lead to scarring or pitting, which is permanent.
Apply acne medications over the entire affected area, not just on individual spots.
Keep your hair off your face, especially if it is greasy too, and avoid touching your face too often.

What's the outlook?

Acne is a self-limiting condition. It does disappear on its own, but it may take a number of years. The treatments listed above can help to control the condition or prevent it from recurring.

How can I remove scars?

If you have severe acne, or if you have picked at your spots, you may be left with pitting and scarring when the spots heal. This is permanent, but can be improved by a number of cosmetic treatments.

Dermabrasion literally planes away the top layer of scarred skin. It can be messy and the results may be uneven.
Laser treatment is used plane away the top layer of the skin in much the same way as dermabrasion, but causes less trauma to the skin and is more sensitive.
Collagen injections are sometimes used to fill out the scars from severe acne. The results are not permanent, and are not as effective for ice pick scars.

Eczema

What is eczema?

Eczema is a group of skin conditions which produces inflammation, itching and sometimes scaling or blisters.

What are the main symptoms?

The main symptoms include:

flaking and itching
redness and swelling
broken and blistered skin
irritation and inflammation
thickening and drying of the skin
crusty, flaky skin on the scalp, eyebrows and folds on the side of the nose

What's the risk?

It is estimated that up to one-fifth of all children of school age have eczema, along with about one in twelve of the adult population. One form of eczema, atopic eczema, primarily affects babies and young children. About 75% of children with this type of eczema develop it in their first year of life.

Seborrhoeic eczema can affect babies, when it is often called cradle cap. Adult seborrhoeic eczema can begin at any age, but most often affects adults in their 20s and 30s. It occurs more frequently in men than in women.

What causes it?

The causes of eczema depend on the particular type of eczema involved.

Atopic eczema is thought to be hereditary. It may start as an allergic reaction to food or house dust.
Contact eczema occurs when you come into direct contact with an irritant, such as chemicals, soaps, detergents, rubber, nickel or cement. In some cases these irritants are so strong they would cause a reaction in most people; in others the eczema develops because it provokes a skin reaction due to an allergy.
Seborrhoeic eczema is thought to be caused by an overgrowth of yeast.

How can I prevent it?

Eczema cannot be prevented, but can be controlled. Depending on the type of eczema, this may involve avoiding any triggers, such as not coming into contact with harsh chemicals.

Should I see a doctor?

See your doctor if you develop any signs of eczema. There are various treatments available and the sooner help is obtained the sooner the condition can be kept under control.

What are the main treatments?

There is no cure for eczema, and treatment depends on the type of eczema. In most instances it involves a skin care regime to reduce the symptoms.

Emollients are used to maintain skin hydration. Emollients help reduce dryness and reduce itching. Some are applied directly to the skin, while others are used as soap substitutes or added to the bath.
Topical steroids can be applied to the skin to reduce inflammation. It is important to use these sparingly and to use them for the shortest period possible. In some more severe cases oral steroids and other tablets are prescribed to reduce inflammation.
There are also now non-steroidal ointments and creams available which can control inflammation at the first sign of a flare-up. These can be applied as often as you like and on sensitive areas such as the face.
Antibiotics are used in cream or tablet for to control secondary infection, which commonly occurs in eczema. If the infection is not controlled it can make the eczema worse.
Anti-fungal creams may be needed for adult seborrhoeic eczema.
Complementary therapies such as Chinese herbs have helped some people.

How can I help myself?

There are a number of things you can do to reduce the discomfort caused by eczema.

Avoid wool and synthetic fibres, which can irritate inflamed skin. Go for cotton and other soft, natural fibres.
Avoid overheating, as this increases skin irritation. Turn down the central heating and avoid overdressing or heavy bedcovers.
Try to determine what triggers your eczema. Avoid these foods or chemicals where possible.
If you have atopic eczema, reduce house dust mites where possible. Remove heavy carpets and curtains, and wash bedding frequently at high temperatures.
Some forms of eczema become worse when you are under stress. Try to relax, and learn some relaxation techniques if possible.
Avoid overwashing, as this can dry out the skin. Always apply cream or moisturiser after washing to seal in moisture, and avoid very hot baths, as the heat can dry the skin.
Wear rubber gloves when cleaning or doing housework. This reduces exposure to chemicals.

What's the outlook?

Some forms of eczema will clear up on their own, though this may take some time. Others may come back once treatment is stopped.

Psoriasis

What is psoriasis?

A skin disease producing patches of inflamed, red skin often with silvery scales.

What are the main symptoms?

Patches of skin, called plaques, that appear red and inflamed.
Thick silvery scales.
Dryness and occasionally irritation.

Psoriasis most often affects the scalp and hairline, the knees and elbows, and the small of the back. It can range in severity from the occasional mild patch to plaques covering a wide area of the body.

What's the risk?

Psoriasis can strike anyone at anytime, though it is very rare in young children — especially before the age of about four. There are two peak times when the condition is most likely to develop: in the late teens to mid twenties, and in middle age. Men and women are affected equally, and it seems to be more common in cooler climates.

Experts are uncertain exactly why psoriasis develops. There is strong evidence of a genetic link, and about one-third of people with psoriasis have a family history of the disease. If both your parents had psoriasis you have around a 50% chance of developing it at some time in your life. If you have acquired the tendency to develop psoriasis from your parents it still requires a trigger - infection, injury, stress - to activate it and bring it out on the skin.

What causes it?

Psoriasis is an immunological disease which results in an upset in the turnover of skin cells. Normally skin cells take around 21-40 days to mature and rise to the surface, where dead cells are constantly being shed. With psoriasis, the skin cells in the top layer of the skin reproduce so quickly - often in two or three days - that the live cells reach the surface and accumulate along with the dead cells to form thick visible layers.

How can I prevent it?

Although it cannot be prevented, there are a number of factors that trigger an attack. Common triggers include:

throat infections
medications — drugs such as beta-blockers, which are used to treat high blood pressure, or NSAIDs (non-steroidal anti-inflammatory drugs) can sometimes cause an attack of psoriasis
the weather — psoriasis tends to worsen during the winter, possibly because there is less sunlight and partly due to increased skin dryness caused by the cold weather and overheating
stress — both physical and emotional stress play an important part in triggering attacks

Should I see a doctor?

You should see a doctor even if the initial attack is minor. It is important to get a proper diagnosis and treatment, and to help ensure the condition is kept under control. Psoriasis can be severe and require hospital treatment, or cause complications such as psoriatic arthritis.

What are the main treatments?

There are a number of effective treatments to control, but not cure, psoriasis. They are available in the form of creams, lotions, ointments and shampoos.

Emollients and skin softeners are one of the mainstays of treatment. They help keep the skin soft and moist, and stop any scaly patches becoming too dry and itchy. Some emollients also help to remove the thick surface layers of psoriasis patches. They will not eliminate psoriasis by themselves.
Vitamin D creams and ointments are generally the first line treatment for psoriasis. They are pleasant to use and do not smell or mark clothing. They work by reducing the immunological changes that cause psoriasis and also slow down growth of the skin cells.
Coal tar is one of the oldest treatments. Though effective, some of the formulations are strong smelling and messy to use, and can stain the skin and clothing.
Dithranol is useful for chronic psoriasis as it slows the rate at which the skin cells divide and reproduce. It is available in creams and ointments of various strengths. You must use it with care, because it can burn normal skin and temporarily stain skin as well as permanently staining clothing.
Corticosteroid creams and lotions are also effective, and do not cause staining. They must be used sparingly as overuse for long periods can thin the skin.
A topical retinoid drug - Tazarotene - can help with mild to moderate psoriasis. One of the newer forms of treatment, this slows the replacement of the skin cells and helps to reduce inflammation. The use of this drug is limited by irritancy that many users experience when applying it.
Phototherapy (ultraviolet light therapy) is used in severe cases because it helps slow the overgrowth of the skin and reduce inflammation.
Oral drugs can be valuable for severe psoriasis that is resistant to other methods. Methotrexate is used in cancer therapy to stop the division of malignant cells — in psoriasis it has the same effect on skin cells. Because such drugs are toxic, they are reserved for the seriously affected and administered under close supervision from a specialist.

How can I help myself?

Keep your skin moisturised
Reduce your stress levels

What's the outlook?

About 10% of people experience only one or two episodes and never get another attack of psoriasis. The majority of sufferers have only small patches that improve on their own or with a little treatment. About 5—8% of sufferers develop the very severe forms of psoriasis that may require specialist hospital treatment.

Rosacea

What is rosacea?

Rosacea is an inflammatory skin condition that affects the central areas of the face, causing reddening.

What are the main symptoms?

A prolonged flushing that eventually develops into permanent redness of the skin on the face. It most often occurs on the nose, forehead, cheeks, eyelids or chin. More rarely it can affect the trunk, arms or legs.
The redness may be accompanied by spots or pustules that resemble acne — which is why rosacea is often mistakenly called adult acne. You do not develop whiteheads or blackheads.
Spider veins (telangiectasia) may develop on the face. These are tiny visible red veins near the skin's surface.
If the condition is severe or left untreated, rosacea can cause tissue overgrowth on the nose, a condition known as rhinophyma. This makes the nose red and bulbous, and because the sebaceous glands overreact, the nose is especially greasy. Rhinophyma occurs more frequently in men than in women.
25% of people with rosacea develop eye complications which can be mild with redness of the eye, or severe with scarring and impaired vision

What's the risk?

Rosacea occurs more often in women than in men, although men are more vulnerable to rhinophyma. There are two peaks of incidence, one in the early to mid twenties and one in the 50s to 60s. It appears that there is a genetic predisposition to rosacea, and the tendency can run in families. It is more common in fair-skinned people.

What causes it?

The exact cause is unknown. It may develop because the blood vessels under the skin become overly sensitive to normal stimulae.

How can I prevent it?

There is no way to prevent rosacea, though you can prevent the long term side effects from developing.

Should I see a doctor?

It is important to see your doctor so you can obtain a proper diagnosis. Your doctor will also want to rule out other conditions that produce similar symptoms.

What are the main treatments?

The inflamed pusy spots will respond to topical or systemic antibiotics. This usually involves a topical antibiotic cream, such as metronidazole, or oral tetracycline. This is long-term treatment. Once the condition is under control the dosage is gradually reduced, and eventually stopped. The flushing attacks and redness of the skin can be treated with low doses of a drug called clonidine. If antibiotics are ineffective your doctor may prescribe isotretinoin, which is also used for severe cases of acne.

How can I help myself?

The best way of helping yourself is to avoid any triggers that cause flushing. Each person will have different trigger factors and it is important not to go on to a blanket exclusion regime. Factors such as alcohol, hot foods or drinks, spicy foods, or overheated environments can cause flushing. If you find one of these triggers flushing try to avoid it.

What's the outlook?

Rosacea is a self-limiting condition (i.e. it eventually gets better on its own) but there is no way of predicting when it will disappear. Treatment will help to prevent the long-term problems that could develop with rosacea.

Shaving problems

What are shaving problems?

Every man who shaves is prone to the occasional cut or sore patch. But there are some other shaving-related shaving conditions that can produce more serious and uncomfortable symptoms. The main symptoms are red, raised bumps and ingrown hairs, irritation, or rashes.

What's the risk?

Although anyone can develop shaving problems, they are most common in men who have very curly facial hair, especially those of African-Caribbean descent. It is estimated that up to 80% of African-Caribbean men suffer from shaving problems.

What causes them?

The bumps may have a number of causes.

"Barber's rash", medically known as folliculitis, is caused when the hair follicles become infected with the bacteria Staphylococcus aureus. This bug lives in the nasal passages and can be introduced to the follicles during shaving. The infection leads to redness, itching, and small, pus-filled blisters.
"Razor bumps", medically called pseudofolliculitis barbae, occur when the hair curls and grows back into the skin. This hair may then be attacked by the body's immune system, leading to redness, inflammation and increased susceptibility to infection. It may also develop into full-blown folliculitis.
Ingrown hairs can also develop when the hair is cut too short, below the surface of the skin.

How can I prevent them?

The best way of preventing shaving problems is to learn to shave correctly.

Should I see a doctor?

Initially it is unnecessary to see the doctor. If developing good shaving habits does not help, a doctor can provide a proper diagnosis and also any medical treatment that may be necessary. For problems that are severe or difficult to treat, ask for a referral to a dermatologist (skin specialist).

What are the main treatments?

The primary treatment is to shave correctly. If shaving still causes problems, a dermatologist may prescribe a topical antibiotic solution called Dalacin T solution which is used as an after shave and has been shown to be effective in a large percentage of individuals with this problem. If this does not work by itself, combination with a topical vitamin A derivative may be of value.

How can I help myself?

Aside from learning correct shaving techniques, and caring for your skin, there is little that can be done.

What's the outlook?

In most cases shaving problems will clear up. However, in men with very curly hair it may be a problem that comes and goes.