• Skin Examination
• Acne & Acne Scars
• Psoriasis
• Hair Loss
• Eczema
• Rosacea
• Herpes
• Bacterial and Fungal Infections
• Mole Remover
• Sun Damage
• Skin Cancer

 

Skin Examination

Dr. Hala Fadli is constantly educating her patients about skin cancer. Ultraviolet light from the sun is the most common cause of skin cancer. Therefore, everyone should have a complete skin exam at least once a year by a specialist dermatologist. Those who have a history of skin cancer should be examined more frequently.

Acne & Acne Scars

Treatments for acne depend on how much scarring of the skin is being caused by the acne and also how much the person is affected by the acne. The doctor has to establish both of these facts as the treatments for acne are long term and need commitment from both the doctor and patient. Acne can cause psychological suffering which does not necessarily reflect the acne severity.

Treatment of acne, even if it is mild, is therefore important as a person may be greatly affected by mild acne whereas another person who has very severe acne may not be self conscious at all.

This is very much down to the individual as the face is particularly sensitive an area to be affected during teenage years. Acne can lead to reduced confidence and low self esteem and this should be recognised by healthcare professionals.

The treatments of acne have the following actions:

• keratolytic
• antibacterial
• anti- inflammatory
• reduce sebum production

 

Keratolytics

The keratolytics reduce the blockage in the duct of the hair and sebaceous gland allowing the sebum to flow more freely out of the gland.

Antibacterial

 
The antibacterial treatments can be applied topically or as antibiotics taken by mouth. They reduce the amount of bacteria in the sebaceous glands thereby reducing the amount of chemicals that they produce that can cause inflammation.

Anti- inflammatory

The anti- inflammatory treatments reduce the amount of inflammation directly.

Sebum reducers

No topical treatments reduce the amount of sebum produced, but isotretinoin which is a systemic treatment is very effective at doing this.

Treatments for scarring

The physical scarring that is caused by acne can be red or purple in colour and be raised or leave deep pock marks. The scars improve with time over a period of 18 months or more with them becoming flatter and the colour returning to the normal skin colour.

Laser treatments, dermabrasion, chemical peels and other treatments have been suggested for acne scarring though none has the ability to remove all traces of scarring and their effect is very hard to measure.

Psoriasis

Psoriasis is a chronic skin condition that usually presents with thick, red, shiny scales and patches. While some minor cases afford patients no concern whatsoever, some cases are so extensive that they can be debilitating. The treatment options for psoriasis have grown by leaps and bounds in the last few years and even the most severe psoriasis cases are now very treatable.

There are many treatments that improve psoriasis and even clear the plaques. However, it must be recognised there is no cure for psoriasis whilst at present the exact causes are not even known. Be very sceptical if someone claims to have the cure for psoriasis.
The many treatments need careful and dedicated use to allow them to work and they are summarised below.

Topical treatments

These include tar preparations, dithranol, topical steroids, vitamin D analogue creams, and retinoid applications. Some of these treatments leave stains on the skin and clothing and some are very smelly and as such are regarded as cosmetically unacceptable. Some have been used for decades and shown to largely be very effective.

More recent treatments such as the vitamin D analogues have been shown to be simple and less messy to use and very effective if used correctly.
Moisturisers are the mainstay to combat the dryness and should be used in large amounts and regularly.

Physical treatments

These include the use of ultraviolet B light (UVB) and also ultraviolet A light (UVA). Psoralens are used with UVA called PUVA. This would involve one, two or three visits per week to a dermatology department to receive the light treatment. This is usually by standing in a light cabinet for the correct amount of time.

Systemic treatments

These are prescribed under specialist supervision. These treatments are taken in tablet form or occasionally by injection.
They include methotrexate, cyclosporin, acitretin, hydroxyurea and many other different types of drugs. These need to be monitored to watch for side effects.

Hair Loss

Once considered a sign of vanity, caring for one’s hair is of great importance to many individuals and hair loss, in many cases, can be devastating. Hair loss may be a sign of underlying disease or may be completely normal – either way, many treatment options now exist to help keep the hair you have and re-grow what you’ve lost!

 

The causes of hair loss are varied and a correct diagnosis is essential to enable successful treatment. Androgenetic alopecia (the common balding process, male or female pattern hair loss) is the most common form of hair loss in men and women for which there are scientifically proven treatments which can slow down, stop or reverse the process. Generally the earlier treatment is instigated the better the results.

Alopecia areata affects 1% of the population at some time in their lives and usually presents as patchy hair loss.  Whilst the course of this condition can be unpredictable there are effective treatments to encourage regrowth.

Eczema

Eczema is a form of dermatitis, or inflammation of the upper layers of the skin. The term eczema is broadly applied to a range of persistent skin conditions. These include dryness and recurring skin rashes which are characterized by one or more of these symptoms: redness, skin edema, itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. Areas of temporary skin discoloration may appear and are sometimes due to healed lesions, although scarring is rare.

 

Moisturizing is one of the most important self-care treatments for sufferers of eczema. Keeping the affected area moistened can promote skin healing and relief of symptoms. Soaps and harsh detergents should not be used on affected skin because they can strip natural skin oils and lead to excessive dryness. Instead, the use of moisturizing body wash, or an emollient like aqueous cream, will maintain natural skin oils and may reduce some of the need to moisturize the skin.

Treatment of eczema includes the use of corticosteroids, immunomodulators, antibiotics, light therapy or immunosuppressants.

Rosacea

Rosacea is a common inflammatory condition of the skin of the face that causes redness that looks like a flush or blush. It is initially characterised by outbreaks and periods of improvement. Rosacea is sometimes called acne rosacea, which is misleading because rosacea and acne are two totally different conditions, although they can appear together.

Rosacea often progresses from intermittent to persistent facial redness with pimples without blackheads and telangiectasia (red lines where the tiny blood vessels of the cheeks, nose, chin and forehead become quite prominent).
Rosacea occurs in both men and women and, and although it may occur at any age, onset usually begins after the age of 30.

People with rosacea often find that certain lifestyle and environmental factors trigger a flare-up or aggravate their individual conditions. Common triggers include certain foods (especially hot or spicy foods) and drink, (especially alcohol and caffeine), exercise, temperature changes, exposure to the sun, rain or wind, and stress.
Rosacea responds to treatment but cannot be cured. Left untreated, the redness becomes more permanent and the tiny blood vessels may become more visible. Pimples often develop and in a few people, especially older men, the nose may become bumpy, red and swollen (Rhinophyma).

 

A topical antibiotic, metronidazole is commonly given as a gel or cream for the treatment of mild rosacea.

Antibiotic tablets or capsules, taken by mouth (orally), are used if your skin does not respond to topical metronidazole or if you have a more severe form of the condition.

 

Eye problems

If you develop eyelid inflammation (blepharitis) or any eye discomfort or stickiness, you should see your GP for the most appropriate treatment. Regular eyelid hygiene is the most important part of treatment and prevention of blepharitis. Eye problems are unlikely to occur in patients taking antibiotic tablets for rosacea.

 

Redness and flushing

Medicines used to treat pustules do not clear the redness or reduce the appearance of dilated blood vessels below the skin. Clonidine is sometimes used as a non-hormonal treatment for facial flushing during and around the menopause and so may help to reduce flushing attacks in rosacea during this period. However, there is little evidence to support its usefulness in the treatment of flushing in rosacea.

 

Laser treatment for telangiectasia

Lasers use light energy, which is absorbed by the haemoglobin in blood and converted to heat, which causes the dilated red veins to shrink.

Surgery for rhinophyma

Rhinophyma can be treated surgically. The nose can be planed and shaped under anaesthetic. The nose is then dressed and forms a new layer of skin. A carbon dioxide laser can also be used to shrink the rhinophyma tissue.

Herpes

Herpes is a viral infection that manifests itself in a variety of ways including cold sores or fever blisters as well as genital sores. Never curable but very treatable, herpes is so stigmatized that many patients are embarrassed to discuss it with their doctor. Studies to improve treatment methods or eliminate outbreaks entirely, continue.

Bacterial and Fungal Infections

Our skin usually does a phenomenal job of protecting us from environmental hazards. However, there are occasions when infections do occur. Bacterial and fungal infections should be diagnosed and treated promptly to avoid further complications.

Mole Remover

Removal of a mole often depends on the size and location on the body.
Moles that may need to be removed as a treatment for a health condition, such as skin cancer or depression. Moles that are in a place where they are likely to get damaged, such as the shaving area on the face, may also be removed to avoid irritation and further harm to the mole.

 

How is a mole removed?

 

A mole is removed using a local anaesthetic. This means that you will be awake during removal, but the affected area will be numb.

There are several ways a mole can be removed, such as:

 

• Freezing it with a liquid gas.
• Shaving the mole close to the skin using a surgical blade.
• Using a chemical, like salicylic acid.
• Punch biopsy, using an instrument like an apple corer to remove the mole.
• Surgery, where a margin of healthy skin around the mole is also removed to avoid the risk of a possible melanoma affecting neighbouring skin.

 

Aftercare

 

Generally, the larger a mole is, the harder it is to remove. Removal may leave a scar once the wound has healed. Moles on the face are treated very carefully to ensure scarring is kept to a minimum.
Once a mole has been removed, it should be protected by using a sunscreen that has SPF (sun protection factor) 30 or above for at least six months afterwards. The higher the SPF, the more protection you will have from sunburn and the sun's damaging UVA and UVB rays.
It is also vital that the wound site is kept clean and covered to avoid infection while it heals.

 

Keeping an eye on your moles

 

Monitoring moles is very important because they can change shape and colour. This could be the sign of a melanoma (skin cancer) forming.

Look out for changes in your mole, such as:

 

• getting bigger,
• bleeding,
• changing shape,
• itching, or
• changing colour or becoming patchy.

 

If a mole shows any of these signs, see your dermatologist immediately.

Sun Damage

Sun damage of the skin, also known as photo damage can be either acute, as in a sunburn or more commonly, chronic, seen as gradual changes in the skin caused by an accumulation of sun exposure throughout one's life. Chronic photo damage results in either a cosmetic change in the skin's appearance called photo aging, or changes that are of medical and health concerns such as pre-cancerous lesions and skin cancers. The evidence is very strong that ultra-violet light is the cause of most of the changes that we consider to be associated with aging of the skin.

What does sun damaged skin look like?

Fine and coarse wrinkles are seen on sun damaged skin. There is a roughness to the skin and a laxity or looseness in advanced damage, patchy or mottled darker patches of increased pigmentation are seen also. Sometimes these patches become irregular and produce what are known as lentigos. In areas around the back of the neck a leathery texture and coarseness with deep lines is frequently seen, the skin may feel dry and scaly. Chronic sun exposure will in many produce a thickened layer in the upper dermis known as solar elastosis, which gives a yellowish chicken skin look.

Protecting your skin from sun damage

Sun avoidance and regular sunscreen use are widely promoted by organizations and individuals interested in skin cancer prevention. A sunburn is caused by exposing your skin to too much ultraviolet (UV) light from the sun, that is, lightwaves that measure approximately 200-400nm.

Treatment for sun damaged skin

There are a number of products and treatments available to try to reverse some of the signs of sun damage. The use of products containing alpha hydroxy acids such as glycolic acid and lactic acid may have a smoothing effect on the skin. We also know that vitamin C preparations will also have modest effects on reversing the appearance of sun damage

Skin Cancer

There are two main types of skin cancer - malignant melanoma and non-melanoma.

Malignant melanoma

 

It is the most dangerous form and affects more women than men. The disease is rare in children under 14, but its incidence increases with age.

 

There are two main types of non-melanoma skin cancer:

Basal cell cancer
The most common type of skin cancer, which develops from basal cells, the deepest layer of skin. It's more common in people in middle or old age. It doesn't usually spread to other parts of the body.

Squamous cell skin cancer
Develops in the upper layer of the skin. This type of cancer can spread to the deeper layers of the skin and occasionally to nearby lymph nodes and other organs.

Other rarer types of skin cancer include merkel cell carcinoma, Kaposi's sarcoma and sarcoma.

 

Causes

 

It's not entirely clear why skin cancers develop, but overexposure to UV radiation is a major risk. Skin type is also a factor.

Overexposure to UV radiation in childhood and teenage years - even for short periods - can lead to malignant melanoma in later life. Children in particular must be well protected.
Repeated exposure to low levels of UV radiation is believed to be important in causing non-melanoma skin cancer.

Although a tan might be considered fashionable and a sign of healthy skin, it isn't healthy at all. On the contrary, it's a sign of damage - your skin turns darker because it's been burned. The sun also ages your skin, making you look older and wrinkly sooner.

 

Those most at risk of skin cancer are people with light or fair skin, freckles, who burn lobster red in the sun, already have moles and/or spend too long in the sun without protection. Brown- or black-skinned people rarely get skin cancer, but everyone should be careful.

 

Prevention

 

Skin cancer is mostly avoidable if sensible precautions are taken:

 

• Avoid sunbeds.
• Stay in the shade between 11am and 3pm, when the sun is at its strongest.
• Use a high-factor sunscreen of at least SPF15 that filters out UVB and UVA and reapply it every two hours.
• Wear protective clothing - a wide-brimmed hat, sunglasses (BS2724:1987) and loose, tightly woven clothing.

You don't have to be sunbathing to get burned - so remember to cover up whenever you go out in the sun.
Your location and the time of day are factors too. UV radiation is at its most intense in the middle of the day between April and September, and is strongest closer to the equator and at higher altitudes.

You can still get burned under light cloud cover. UV rays are also reflected off light-coloured surfaces such as snow and sand.
Our bodies do need sunlight, though, to make vitamin D. Experts suggest 20 minutes exposure a day is enough and it's best to get it during the safer periods of the day - early morning or late afternoon.

Symptoms

 

Many moles aren't cancerous, but it's vital to keep an eye on them. If you're worried about a mole or notice any of the following in one, ask your doctor's advice:

 

• change in size (for example, getting larger)
• change in shape (for example, irregular outline)
• change in colour (for example, mixed shades of brown and black)
• change in sensation (for example, painful, itchy)
• bleeding, oozing or crusting
• redness or inflammation around the edge
• being bigger than other moles.

If skin cancers are treated early, they should cause no further problems.

 

Diagnosis and treatment

 

As it's not always possible to differentiate between skin cancers and benign skin conditions by examination alone, you may need to have a biopsy. The doctor will remove all or part of the suspected mole or skin and send it to the laboratory for analysis.

If it's confirmed as cancer, it'll be removed by surgery or radiotherapy, depending on its size and type. Chemotherapy is often used in addition to surgery when treating malignant melanoma.

Enjoy the sun, but take it easy!