Looking after your skin - NENC
Please refer the below Advice and Guidance for more information.
When should you worry?
Advice and Guidance
Acne
Acne is a common skin condition that affects most people at some point.
Acne is a common inflammatory skin condition. It is usually seen in younger people, and often clears up on its own. For some (12% woman and 3% men) it can continue into adulthood. Treatment is sometimes needed to improve how the skin looks, to prevent scarring, and to avoid psychological damage. The main aims of treatment are reduction of oil (sebum), soften up the skin to prevent blocked pores, and treat any bacteria overgrowing in blocked pores. In general, most treatments take two to four months to produce their maximum effect. Sometimes a number of treatments need to be tried before things settle down.
Acne treatments fall into the following categories:
- Topical treatments, i.e. those that are applied directly to the skin like creams or gels
- Oral antibiotics, i.e. tablets taken by mouth (these are anti inflammatory and fight off bacteria)
- Oral contraceptive pills (hormonal medications)
- Isotretinoin (Roaccutane) capsules
Topical Treatments
These are usually the first choice for those with mild to moderate acne. There are different products that can work, such as benzoyl peroxide, antibiotics (e.g. erythromycin, tetracycline and clindamycin), retinoids (e.g. tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide. Some of these can be bought over the counter, and some are prescribed by a doctor.They should be applied to the entire affected area of the skin (e.g. all of the face) and not just to individual spots, usually every night or twice daily depending on the treatment. Most topical treatments are initially irritating to the skin, so often you will be advised to use smaller amounts less often, to build up tolerance.
Oral antibiotic treatment
Your doctor may recommend a course of antibiotic tablets. Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement, for at least six months. Often the doctor will suggest continuing a single topical cream (ie not one with antibiotic in it) along with an antibiotic tablet.
Oral contraceptive treatments
Combined hormone contraceptive pills can help girls or women who have acne; they can reduce the amount of oil the skin produces. It usually takes at least three to four months for the benefits to show. Your doctor will discuss whether you are eligible for these medications; as there are some risk factors in your personal or family history which may prevent this being an option such as clots in the legs or lungs.
Isotretinoin
This is a powerful and highly effective treatment for acne which continues to benefit most patients for up to two years after a course of treatment. However, can cause a number of side effects and can only be prescribed under the supervision of a consultant dermatologist. Isotretinoin can harm an unborn child and so there are strict rules about how it is prescribed and monitored.
Women (including teenagers) enrol in a pregnancy prevention programme and need to have a negative pregnancy test prior to starting treatment. Pregnancy tests will be repeated every month during treatment and five weeks after completing the course of treatment. Effective contraception must be used for at least four weeks before treatment, whilst on treatment, and for at least four weeks afterwards.
In a small number of patients isotretinoin may cause depression and suicidal feelings. Acne itself often makes people feel depressed so this can be complicated. Details about any personal and family history of depression or other mental illness should be discussed with your own doctor and dermatologist prior to considering treatment with isotretinoin.
Most courses of isotretinoin last for four months during which time the skin usually becomes dry, particularly around the lips. Regular application of a lip moisturiser is usually helpful. Often, acne becomes a little worse for a few weeks before improvement occurs.
It should be emphasised that many thousands of people have benefited from treatment with isotretinoin without serious side effects.
Eczema (young people)
Eczema, also called dermatitis, is the name for a common group of skin conditions which cause dry itchy skin
The most commonly affected areas are the creases at the elbows and knees, as well as wrists and neck. It can cause coin-sized areas of inflammation and small bumps that coincide with your hair follicles. The skin can appear dry, red or can have little water blisters if on the edges of the fingers or toes.
Bacterial infection makes affected skin yellow, crusty and inflamed. Cold sores can cause sudden flare-ups.
Dealing with eczema
Eczema often improves and then gets worse again, it can be a longer term condition which is known as chronic, that means it can come and go. Many things can make it worse - heat, dust, woollen clothes, pets, food allergens, stress (like exams), as well as soaps, detergents and chemicals.
What can I do?
- Treat it early – the worse it gets, the harder it is to control.
- Moisturise, ideally at least 2-3 times a day. Use the most greasy, non-perfumed moisturiser your skin can tolerate.
- Wash with a moisturiser - avoid bubble bath, shower gel and detergents.
- Keep cool, and bathe in lukewarm water. Avoid washing more than once daily.
- Moisturise before swimming, rinse well afterwards and apply plenty of moisturiser after drying.
- Avoid wool next to your skin.
- Try not to scratch. Smooth a moisturiser on instead.
- Use non-biological washing powder and a double rinse cycle. Do washing at 60°C to kill dust mites.
- Avoid perfumed products, like deodorants, shampoos and cleaning products.
- If you shave, use an emollient instead of shaving cream.
- Avoid close contact with anyone who has a cold sore.
- Use dust mite covers on the beds
- Avoid thick clothing on a nightime, wear loose cotton
Find out more at www.eczema.org.
How can atopic eczema be treated?
‘Topical’ means ‘applied to the skin surface’. Most eczema treatments are topical, although for more severe eczema some people need to take ‘oral’ medication (by mouth) as well.
‘Complete emollient therapy’ is the mainstay of treatment for all patients with eczema -this means regular use of a moisturiser (also known as an emollient) and washing with a moisturiser instead of soap (known as a soap substitute).
Antibiotics and antiseptics:
If your skin becomes wet, weepy and crusted, it may be infected and a course of antibiotics may be needed. Antiseptics, when applied to the skin alone or as part of a moisturising preparation, can be helpful in stopping the infection. Incorrect use of antiseptics can, however, irritate the skin and make eczema worse. Antiseptics should not be used continuously because this can result in excessive drying of the skin.
TOPICAL CALCINEURIN INHIBITORS
Calcineurin inhibitors, tacrolimus ointment and pimecrolimus cream, may be used when Eczema is not responding to topical steroids, or in skin sites which are more susceptible to the side effects of steroids, such as the face, eyelids and armpits and groin. The most common side effect is stinging on application but this normally disappears after a few applications. They are associated with an increased risk of skin infections and should not be applied to infected (weeping, crusted) skin.
Antihistamines:
Antihistamine tablets can be helpful in some patients particularly if there is an allergy trigger. Antihistamines that make people sleepy can be useful when used at night. They have no effect on the inflammation of eczema and are helpful largely as a result of their sedating effects, reducing sleep disruption.
Bandaging (dressings):
Cotton bandages and cotton or silk vests/leggings worn on top of creams can help keep creams from rubbing off and stop scratching. For some patients the use of medicated paste bandages may be helpful, as they are soothing and provide a physical barrier to scratching. It is important to be taught how to use the dressings correctly. Your doctor or nurse will advise you regarding the suitability of the various bandages and dressings available.
Avoidance of Allergens:
Atopic people often have allergies: Air borne allergens from cats, dogs, pollen, grass or the house dust-mite, can cause flares of Eczema in some patients.
Most eczema is not due to a specific allergy. It is important to seek medical advice before excluding any foods from your diet so you can ensure you are not missing any nutrients from your diet.
Latex (rubber) allergy is more common in people who are atopic. The symptoms may, consist only of itching of the skin after contact with rubber products.
Other treatments:
Ultraviolet light: Some people with chronic eczema benefit from ultraviolet light treatment, which is usually given in a specialist hospital department. People with severe or widespread atopic eczema not responding to topical treatments may need oral treatments (taken by mouth). These work by dampening down the immune system and are given under the close supervision of a dermatologist.
Eczema can significantly impact on your confidence, sleep, how you feel and cope with daily life, your ability to form friendships and how you apply your treatments. Some people also need wellbeing and psychology support to help them.
Psoriasis
Psoriasis is a skin condition that causes flaky patches of skin which form scales.
Psoriasis is a common, inflammatory skin condition, it affects around 3% of the population. It causes skin to turn over more quickly than normal. This leads to dull-red, scaly plaques forming on the skin; often the knees, elbows and scalp. Psoriasis is most commonly chronic, which means it can always be present or can happen on and off over time. We do not know what causes psoriasis, although we do know it can be linked to the genes in your family, and made worse at times of stress, or with alcohol and smoking. There are different types of psoriasis which can affected the nails, joints or other parts of the skin.
Does psoriasis have to be treated?
You may not need treatment if your psoriasis is not causing you any problems. Your doctor can discuss the options with you.
When is the treatment applied?
Moisturisers (emollients) are best to be used regularly. Active treatment is not usually required if the psoriasis is no longer raised up. Sometimes smooth red, paler or darker skin can remain in an area after psoriasis has cleared. This is called post inflammatory skin change and will fade over time so does not need active treatments. These areas do not need to be treated unless the psoriasis comes back again (with scaly dry patches).
Can I use sunlight to help my skin?
Sun light can help improve psoriasis and many people find their psoriasis can improve after being in the sun. Being active outside when it is sunny is good and will make you feel better. However it is important to avoid getting sun burnt as this is painful and has risks for your skin both now and when you are older.
How is Psoriasis treated?
Treatment will depend on the type of psoriasis, how extensive it is, how much it is concerning you and which part of your body is affected. Treatments will be used to decrease the inflammation, scaliness and itchiness of the skin. There are many options and no one treatment works for everyone. Your doctor or nurse will discuss the best treatments for you.
What topical treatments (applied to skin like creams) are used in psoriasis?
Moisturisers often called emollients can help if your skin feels dry. There are a number of treatment creams such as steroid creams, vitamin D creams and combinations. Many of these active treatments are used ‘off licence’ in children and young adults under 18 years. This is common for treatments in children and young adults. Being off-license does not mean that they are not safe.
What can be done if the topical treatments are not helping me enough?
If psoriasis is severe, widespread (covering a lot of skin) and not controlled with topical (putting creams and ointments on) treatments then other treatments may be considered. These include light treatments (UVB in the dermatology department), tablets (methotrexate, acitretin, ciclosporin for example) or occasionally injections (‘biologic’ medications) which can be needed in severe psoriasis.
Some people may try several different treatments before finding the treatment which works best for them.
What can you expect?
Treatments can control psoriasis for some, but it is likely that areas of psoriasis will come and go.
Having psoriasis should not stop you living your life to the full and doing anything you want to do.
Moles
- If you have a lot of moles, check regularly for any changing, bleeding or scabbing – or just looking different. You might need to photograph them to keep track.
- Protect yourself from too much sun, and avoid sunbeds. In strong sun, protect your skin with good clothing, a hat, sunglasses and sunscreen.
- Skin cancer is not common in young people. It normally presents as a spot, freckle or mole that's different to the skin around it. Most skin cancers can be successfully treated if found early.
Signs a mole could be cancerous
Some moles can be a sign of melanoma, a type of skin cancer see nhs melanoma skin cancer page for further information.
Sometimes they may bleed, itch, or be crusty or raised.
They often have uneven edges.
Melanomas may change colour over time or have more than 2 colours.
Check if your mole could be cancerous
Signs of harmless moles
Most harmless moles are round or oval-shaped, with a smooth edge.
They are usually darker on brown and black skin.
They can be flat or raised and may feel smooth or rough.
Sometimes they have hair growing from them.
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