Top 10 Skin Problems

Transcription

1 THE UK GUIDE Top 10 Skin Problems Learn how a Dermatologist can solve your frustrating challenges with skin, scalp, hair and nails Jennifer Crawley MBChB, BSc (Hons), MRCP (Derm) BAD British Association of Dermatologists Ophthalmology BSMD British Society for Medical Dermatologyy BSPD British Society of Paediatric Dermatology IAD Irish Association of Dermatologists

2 Table of contents Introduction 2 Learn how to treat 3 Acne 4 Atopic Eczema 6 Psoriasis 10 Rosacea 13 Seborrhoeic Dermatitis 16 Skin Cancer: Malignant Melanoma 18 Skin Cancer: Basal Cell Carcinoma 21 Skin Cancer: Squamous Cell Carcinoma 24 Skin Cancer: Bowen s Disease 26 Actinic Keratoses 29 Keloids 31 Final words 33 Download all of our guides! 34

3 Introduction My name is Jennifer Crawley and I am a Consultant Dermatologist at Clinica London on Harley Street. The treatments in this guide are primarily concerned with finding and treating diseases and cosmetic problems of the skin, scalp, hair and nails. I ve tried to outline the most common skin conditions that I see in clinical practice so you can better understand your particular situation. The most serious conditions usually require my help before a patient can be free of all their symptoms. I ve also included information with regards to self-care that you can take advantage of before we see each other. My special expertise is in dermatology for both adults and children. I perform a range of surgical and non-surgical procedures, including surgical excision of melanoma and non-melanoma skin cancers, incisional biopsies, shave excisions and curettage and cautery. I look forward to meeting you to discuss your skin concerns and treatment options in the coming months. This guide was created out of conversations I ve had with patients. I ve recently sat down and answered similar questions on video so I could share this information online as well as here in written form. I hope you like the conversational and straight forward nature of this guide. Best regards, Jennifer Crawley, MBChB, BSc (Hons), MRCP (Derm) Call us with any questions on:

4 Learn how to treat On the pages that follow you will find a series of symptom and treatment overviews for the most common conditions I see in my clinics. The best thing to do if you have a concern is give us a quick call and we can let you know if you should come in or not. Call us with any questions on:

5 Acne Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). Acne signs and symptoms It usually starts at puberty and varies in severity. It ranges from a few spots on the face, neck, back and chest to a more significant problem that may cause scarring and impact on self-confidence. For the majority, it tends to resolve by the late teens or early twenties, but it can persist for longer in some people. Acne can develop for the first time in people in their late twenties or even in their thirties. It can run in families, but most cases are sporadic and occur for unknown reasons. Call us with any questions on:

6 We aim our treatment of acne at prevention of new spots and reduction in the risk of scarring. Acne self-care We suggest you use make-up products that are oil-free or water- based. Choose products that are non-comedogenic. Cleanse your skin and remove makeup with a mild soap or a gentle cleanser and water, or an oil-free soap substitute. Scrubbing too hard can irritate the skin and make your acne worse. Contact us for an acne treatment consultation During your consultation at Clinica London, we ll take a full history and perform a full assessment of your skin. We'll give you a treatment plan, based on the severity of your acne and then review at the correct time to assess your progress. Acne treatment Acne treatments fall into the following broad groups: Topical treatments: those that we apply directly to the skin Oral therapy: including antibiotics and Isotretinoin therapy Most treatments take two to four months to produce their greatest effect. Call us with any questions on:

7 Atopic Eczema Atopic eczema is an extremely common inflammatory condition of the skin. It may start at any age but is most common in children, affecting 1 in every 5 children in the UK at some stage. We use the term atopic to describe a group of conditions which include asthma, eczema and hay fever. These conditions are linked to an increased activity of the allergy component of the immune system. Many factors appear important for its development. These include defects in the skin barrier and abnormalities in the normal inflammatory and allergic responses. A tendency to atopic conditions often runs in families. Call us with any questions on:

8 Eczema signs and symptoms Atopic eczema usually starts in the first months of life but it may also develop for the first time in adulthood. The main symptom is an itch. Scratching in response to itch may cause many of the changes seen on the skin. Itch can be severe enough to interfere with sleep, causing tiredness and irritability. Eczema self-care Moisturise your skin as often as possible, ideally at least 2-3 times each day. Wear gloves to protect your hands if they come into contact with irritants, such as when doing housework. Rinse well after swimming, and apply plenty of moisturiser after drying. Wear comfortable clothes made of materials such as cotton, and avoid wearing wool next to your skin. Try to resist the temptation to scratch. It may relieve your itch briefly, but it will make your skin itchier in the long term. Smooth a moisturiser onto the itchy skin. Avoid close contact with anyone who has an active cold sore as patients with eczema are at risk of getting a widespread cold sore infection. Do not keep pets to which there is an obvious allergy. Call us with any questions on:

9 Keep cool. Overheating can make eczema itch more. Treat eczema early - the more severe eczema becomes, the more difficult it is to control. Many factors in a person s environment can make eczema worse. These include: heat dust wool pets irritants, such as soap and detergents infections foods Contact us for an eczema consultation During your consultation at Clinica London, we'll take a full history and perform a skin assessment of your eczema. We'll give you a treatment plan based on the severity of your eczema, which may include a variety of treatments as discussed above. Sometimes we need to take a skin biopsy if the diagnosis is uncertain. We carry this out under local anaesthetic in the minor ops room at Clinica London. We send this sample to histopathology for analysis. It is important that we follow up with you at appropriate time points to ensure an improvement in your rash. Call us with any questions on:

10 Eczema treatment Most eczema treatments are topical. With more severe eczema, some people need to take oral medication as well. Regular emollient therapy is the mainstay and most important part of treatment for all patients with eczema. This includes the: Other treatments in the therapeutic ladder include the application of topical steroids, topical calcineurin inhibitors and oral therapy. Call us with any questions on:

11 Psoriasis Psoriasis is a common inflammatory skin disease affecting 2% of the population. It occurs equally in men and women, can appear at any age, and tends to come and go unpredictably. It is not infectious. Although psoriasis is a long-term condition, there are many effective treatments available to keep it under good control. We see numerous sub-types of psoriasis. Psoriasis can affect the nails and the joints as well as the skin. Both inherited and environmental factors play a role in the development of psoriasis. Psoriasis tends to run in families. Call us with any questions on:

12 Psoriasis signs and symptoms Skin affected by psoriasis is red and scaly. The outer layer of skin (the epidermis) contains skin cells, which are continuously being replaced. This process normally takes between three and four weeks. In psoriasis, the rate of turnover is dramatically increased so that cells are formed and shed in as little as three or four days. For many individuals, factors such infections, stress, alcohol and/or smoking can trigger flares of psoriasis. Certain medications such as beta-blockers (used to treat high blood pressure and angina), lithium tablets (used to treat malaria) can also cause psoriasis to flare. Contact us for a psoriasis consultation During your consultation at Clinica London, we'll take a full history and perform a full skin assessment. Usually, we can diagnose psoriasis after a clinical examination of your skin, yet, there are times when a skin biopsy is helpful. A biopsy involves injecting a local anaesthetic and taking a very small sample of skin to look at under the microscope. We can do this in the minor procedure room at Clinica London. We'll give you a treatment plan based on the type and severity of psoriasis. It is important that we follow up with you at appropriate time points to ensure improvement in your rash. Call us with any questions on:

13 Psoriasis treatment There is no cure for psoriasis but there are several effective treatments available. Treatment of psoriasis varies and largely depends on severity. Hierarchy of therapy includes: topical therapy phototherapy oral systemic agents or injection therapy Call us with any questions on:

14 Rosacea Rosacea is a common rash usually occurring on the face. It predominantly affects middle-aged and fair-skinned people. It is more common in women but tends to be more severe in men. It is a chronic condition and, in any individual, the severity tends to come and go. The cause of rosacea is unknown, but the factors that trigger rosacea cause inflammation and readiness of the blood vessels in the skin of the face to dilate. Alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress can trigger and make rosacea worse. It can be worsened by natural sunlight. Call us with any questions on:

15 Rosacea signs and symptoms Rosacea tends to affect the cheeks, forehead, chin and nose, and is characterised by flushing and redness, dilated blood vessels, small red bumps and pus-filled spots known as papules and pustules. There may also be uncomfortable inflammation of the surface of the eyes and eyelids. Some people with rosacea have eye symptoms (including red, itchy, sore eyes and eyelids, a gritty feeling and sensitivity to light). A few patients with rosacea may develop more serious eye problems, such as painful inflammation involving the front part of the eye (rosacea keratitis) and this may cause blurred vision. It is important that you consult your doctor if you develop symptoms affecting the eyes. Contact us for a rosacea consultation During your consultation at Clinica London a full history, including potential triggers, will be taken and a full clinical assessment of your skin is performed. A treatment plan based on the treatments above will be given. The treatment options will be based on the severity of the rosacea and you will be reviewedperiodically to ensure improvement in your symptoms. Call us with any questions on:

16 Rosacea treatment The inflammation that accompanies rosacea can be treated with preparations applied to the skin or taken by mouth; however, these will not help the redness or blushing that may be associated with rosacea. Topical applications of metronidazole or azelaic acid are helpful. In addition, an oral antibiotic may be helpful. A sunblock is also advised. An eye specialist should manage more severe types of eye involvement. There are eye specialists at Clinica London who are specialists in the eye complications of rosacea. Call us with any questions on:

17 Seborrhoeic Dermatitis Seborrhoeic dermatitis or seborrhoeic eczema is a red, itchy, flaky rash commonly seen on the: Face: eyebrows, nasolabial folds, eyelids Scalp Chest: central chest and upper back Ears Skin folds Seborrhoeic dermatitis affects 4% of the population. The flaking can be a cause of a great deal of social embarrassment. Seborrhoeic dermatitis can start at any time after puberty and is slightly more common in men. Babies can also get a short lived type Call us with any questions on:

18 of seborrhoeic dermatitis on the scalp (cradle cap) and nappy area, which usually clears after a few months. It is not hereditary. Seborrhoeic dermatitis signs and symptoms Seborrhoeic dermatitis can be difficult to distinguish from other kinds of dermatitis when certain areas such as the eyelid or genital area are affected or if it is very widespread. Severe scalp seborrhoeic dermatitis can resemble psoriasis. Contact us for a seborrhoeic dermatitis consultation During your consultation at Clinica London, we'll take a full history and perform a full assessment of your skin. We'll give you a treatment plan based on the severity of your symptoms. Seborrhoeic dermatitis treatment Seborrhoeic dermatitis treatment is usually needed on a long-term basis. The choice depends on which areas of the body are affected and whether there is a lot of irritation. We manage seborrhoeic dermatitis with treatment that reduces the level of skin yeast these include creams and shampoo, which you can safely use on a long-term basis. We might also use mild steroid creams for short periods to settle any irritation. Call us with any questions on:

19 Skin Cancer: Malignant Melanoma Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin. In a melanoma skin cancer, the melanocytes become malignant and multiply excessively. Malignant melanoma causes One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight. The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma. Call us with any questions on:

20 Melanoma is the most serious type of skin cancer because it is more likely to spread (metastasise) from the skin to other parts of the body than other types of skin cancer. If melanoma has spread to other parts of the body, those deposits are known as secondary melanoma (secondaries/metastases). Malignant melanoma risk factors Risk factors for melanoma include: fair skin that burns easily in the sun multiple freckles history of severe sunburn history of excess sunbed use previous and family history of melanoma multiple atypical naevi a very large dark birthmark a weakened immune system Malignant melanoma prognosis Although a diagnosis of melanoma can be serious, we catch most melanomas at an early stage so they do not cause any further problem. If we don't catch lesions at the early stages then there is a higher risk of the melanoma spreading, which can reduce life expectancy. Call us with any questions on:

21 Contact us for a malignant melanoma consultation During your appointment at Clinica London, we'll perform a full and thorough history including potential risk factors for melanoma. In addition, we will perform a detailed examination of your mole, including dermatoscopy. Dermatoscopy involves looking at the mole with a special instrument called a dermatoscope. This allows in-depth inspection of skin lesions to help us decide if they are benign or cancerous. We can examine all parts of the body, including the torso, limbs, face, hands and feet with this method. Malignant Melanoma Treatment Treatment for a suspected melanoma is surgical excision. Most patients do not need either radiotherapy or chemotherapy. You'll need close follow-up following diagnosis. If the mole, under dermoscopy, concerns us, we'll perform a skin biopsy or excision in the minor procedure room at Clinica London. This involves injecting local anaesthetic and removing or sampling the area. We then send this to the histopathology laboratory for analysis. We would then bring you back to discuss all the results and what further treatment you may need. We also perform sequential photography of moles so we can compare if there are any changes over time. This is extremely useful for monitoring moles and lesions especially if there are many moles on the skin. Call us with any questions on:

22 Skin Cancer: Basal Cell Carcinoma A basal cell carcinoma (BCC) is a type of non-melanoma skin cancer. It is the most common type (greater than 80%) of all skin cancer in the UK. Basal cell carcinomas are sometimes referred to as rodent ulcers. The commonest cause is exposure to ultraviolet (UV) light from the sun or from sunbeds. Basal cell carcinoma can occur anywhere on the body, but we find them most on sun-exposed areas such as your face, head, neck and ears. Risk factors include fair skin, a tendency to burn rather than tan, and previous history. Call us with any questions on:

23 We can cure basal cell carcinoma in almost every case. Treatment can be more complicated if the basal cell carcinoma has been neglected for a long time, or if it occurs in an awkward place, such as close to the eye or on the nose or ear. Basal cell carcinomas rarely spread to other parts of the body. Although it is a type of skin cancer, it is almost never life-threatening. Basal cell carcinoma self-care Treatment will be much easier if we detect your basal cell carcinoma early. Basal cell carcinomas can vary in their appearance, but it is advisable to see your doctor if you have any concern. Protection from UV light is crucial. Contact us for a basal cell carcinoma consultation During your appointment at Clinica London, we'll perform a full and thorough history. In addition, we'll perform a detailed examination of the lesion, including examination by dermatoscopy. This involves looking at the lesion with a special instrument called a dermatoscope. This consists of a magnifier and light source and allows in-depth inspection of skin lesions to help decide if it is benign or cancerous. We can examine all parts of the body, including the torso, limbs, face, neck, hands and feet with this method. Call us with any questions on:

24 As part of the investigation and management of a basal cell carcinoma, we'll perform a skin biopsy or skin excision in the minor procedure room at Clinica London. This involves injecting a local anaesthetic to the area and removing or sampling the area. We then send this to the histopathology laboratory for analysis. We would then bring you back to discuss all the results and what treatment you may need. Basal cell carcinoma treatment The commonest treatment for basal cell carcinoma is surgery. We can also use some other, but less common, treatment modalities. For example, we may use topical therapy for certain sub-types of basal cell carcinoma. Surgical excision is the preferred treatment, but the choice of other treatments depends on: the site and size of the basal cell carcinoma the condition of the surrounding skin the number of basal cell carcinomas to be treated (some people have multiple) as well as the overall state of health of each person to be treated. Call us with any questions on:

25 Skin Cancer: Squamous Cell Carcinoma Squamous cell carcinoma is a non-melanoma skin cancer (NMSC), and the second most common type of skin cancer in the UK. NMSC accounts for 20% of all cancers and 90% of all skin cancers. Squamous cell carcinoma accounts for 23% of all non-melanoma skin cancers. The most important cause of squamous cell carcinoma is too much exposure to ultraviolet light from the sun or other sources. Risk factors include pale skin and past history of skin cancer. Areas exposed to the sun are the areas most commonly affected. A skin biopsy can help to confirm the diagnosis. Call us with any questions on:

26 The vast majority of squamous cell carcinomas are low-risk skin cancers and we can cure them. A small number can recur locally and/or spread (metastasise) to the lymph nodes or to other parts of the body. Squamous cell carcinoma treatment Surgery is usually the recommended treatment. Treatment of areas of scaly sun damage (actinic keratosis and Bowen s disease) may reduce your risk of an squamous cell carcinoma. Contact us for a squamous cell carcinoma treatment During your appointment at Clinica London we'll perform a full and thorough history. In addition, we'll perform a detailed examination of your lesion. Sometimes we'll need to examine the lesion by dermatoscopy. As part of the investigation and management, the worrisome lesion will need a skin biopsy or skin excision. We perform this in the minor procedure room at Clinica London. The procedure involves injecting a local anaesthetic to the area and removing or sampling the area. We then send this to the histopathology laboratory for analysis. We would then bring you back to discuss all the results and what treatment you may need. Call us with any questions on:

27 Skin Cancer: Bowen s Disease Squamous cell carcinoma in situ, often called Bowen s disease, is a growth of cancerous cells that is confined to the outer layer of the skin. It is not a serious condition, and its importance rests on the fact that, very occasionally, it can progress into an invasive skin cancer known as squamous cell carcinoma. For this reason, dermatologists usually treat, or at least monitor, Bowen's disease. Most cases of Bowen s disease develop as a result of long-term sun exposure, and it is more likely in those receiving long-term immunosuppression medication. Call us with any questions on:

28 Areas affected include sun-exposed sites such as the face, scalp, neck, hands and lower legs. Contact us for a Bowen's disease consultation During your consultation, we will discuss the various options available depending on the size, site and area involved. A skin biopsy is often helpful in diagnosis. This involves injecting a local anaesthetic to the area and removing or sampling the area. We then send this to the histopathology laboratory for analysis. We would then bring you back to discuss all the results and what treatment you may need. Bowen's disease treatment Bowen's disease therapies include: Freezing with liquid nitrogen or cryotherapy Curettage Excision 5-fluorouracil cream Cryotherapy involves the removal of some skin lesions by freezing them with liquid nitrogen in the clinic room. No special preparation is needed. We apply the cold liquid nitrogen directly onto the skin with a special spray gun. Call us with any questions on:

29 Although you might feel slight local and temporary pain, cryotherapy does not normally need a local anaesthetic. The procedure only takes a matter of seconds. Depending on the nature of the lesion, more than one treatment may be necessary. This is usually repeated at regular intervals in the clinic. We will discuss this during your consultation. Another treatment option we provide at Clinica London is curettage and cautery. Curettage involves surgical scraping of the area concerned, following application of local anaesthetic, and then using an electrical current to stop any bleeding. We carry this out in the procedure room. The sample is then sent to histopathology for detailed analysis. We can also use a cream therapy to treat the affected area. This can cause some reddening of the skin for the weeks that it is being applied. Call us with any questions on:

30 Actinic Keratoses Actinic keratoses are areas of sun-damaged skin found predominantly on sun-exposed parts of the body. We find them particularly on the backs of the hands and forearms, the face and ears, the scalp in balding men and the lower legs in women. They may also occur on the lips. Excessive sun exposure over many years (from sunbathing, sunbed use, and outdoor work or recreational activities) can cause actinic keratoses. It is more common in older people. and fair-skinned, blueeyed, red- or blonde-haired individuals, who burn easily in the sun but tan poorly. Actinic keratoses often causes little trouble. Call us with any questions on:

31 Actinic keratoses self-care Protecting your skin from the sun will reduce the number of new actinic keratoses you get, and also reduce the risk of getting a suninduced skin cancer. Actinic keratoses treatment Actinic keratoses therapies include cryotherapy curettage topical therapy, including 5-fluorouracil or imiquimod It is advisable to protect the skin from further sun damage. Call us with any questions on:

32 Keloids A keloid is a special type of scar. All wounds heal with a scar but a keloid scar is one that grows too much and can even become larger than the original wound. It can occur after minor skin damage and involve the areas outside the scar itself. It may last permanently. Risk factors include darker skin, young age, past history, wounds under tension. Common areas include upper chest, shoulders and earlobes. Call us with any questions on:

33 Keloid treatment Treatment is difficult and not always successful. Possible lines of treatments include the following: Injections of a steroid (triamcinolone) into a keloid may help to flatten small and early ones. Steroid-impregnated tape applied for 12 to 24 hours a day may help to flatten keloids. Putting a silicone sheet over them at night for several months helps some keloids to flatten. Silicone in gel form is also available. Laser treatment makes keloids less red but does not make them smaller. Keloid treatment with intralesional steroid injection This is a procedure involving the injection of a steroid solution into the abnormal skin, with the aim of improving its appearance or reducing symptoms such as itch or pain. We perform intralesional injection of a steroid in the procedure room at Clinica London. No special preparation is required and a local anaesthetic is not needed. Depending on the size of the area to be treated, you may need several injections. There are some side effects to this type of therapy, which we discuss before the treatment. Call us with any questions on:

34 Final words I know from experience that it is not always easy to choose which dermatology treatment is best for your particular skin. If you have any strange rashes, scars, spots, moles or other concerns, it s best to have someone review your skin and then make a professional recommendation as to which treatment options are best for you. In order to simplify your decision to arrange an initial appointment, I want to conclude with 10 reasons to call Clinica London: 1. I am a Consultant Dermatologist at Clinica London 2. I have a further special special interest in dermatology 3. I have access to the top cutting-edge technology at Clinica London to restore skin 4. Many fees are fully covered by insurance and we have transparent pricing models for self paying patients 5. I have 10 years of Consultant experience in London 6. You'll receive the best care, as an individual 7. My patients provide enthusiastic testimonials about their skin treatment Call us to set up an appointment to discuss your facial rejuvenation options on: We'll explore the best treatment options for your skin to restore it to a more youthful and rejuvenated state. Call us with any questions on:

35 Download all of our guides! The UK Guide to Eyelid Surgery Understand the things you need to know when pursuing Private Eyelid Surgery Click to download this patient guide The UK Guide to Aesthetic Treatments Understand the things you need to know about Aesthetic Treatments Click to download this patient guide The UK Guide to Cataract Surgery Understand the things you need to know when pursuing Private Cataract Surgery Click to download this patient The UK Guide to AMD Treatment Understand the things you need to know when pursuing Private AMD Treatment The UK Guide to Glaucoma Treatment Understand the things you need to know when pursuing Private Glaucoma Treatment The UK Guide to Diabetic Retinopathy Understand the things you need to know about Diabetic Retinopathy Click to download this patient Click to download this patient Click to download this patient guide guide guide Call us with any questions on: