Dr Melanie Wynne-Jones tells us how we can sort out skin problems and help our skin fight a range of common complaints
Skin problems can be a sign of internal health issues.
Skin is a vital barrier to protect us from infection, but it can come under attack.
This can run in families. You’ll notice dry or weeping red, itchy areas, often on the insides of knees and elbows, although it can appear anywhere. Flare-ups can be triggered by foods, heat or cold, irritants (clothing, soaps), house dust, pets, infection, hormones or stress.
Treat it by not scratching, removing known triggers and using emollients (strong moisturising creams/washing products) several times a day; keep trying different pharmacy or prescription brands until you find one to suit.
Steroid creams (from mild hydrocortisone to very powerful Dermovate) will help to settle the inflammation, but overuse can lead to skin thinning and redness, so follow the instructions carefully. Severe flare-ups may need a short course of steroid tablets or antibiotics.
This common condition increases skin ‘turnover’ so new cells pile up, producing itchy red scaly patches and thickened silvery plaques. The scalp, nails, palms and soles may be affected and joints may become inflamed, too.
It can run in families and appear in the teens or later life. Flare-ups may be triggered by stress, infections, trauma and hormones.
It’s treated with moisturisers, creams containing steroids, tar, or chemicals related to vitamin D, with ultraviolet light, or, occasionally, stronger immune-system drugs such as methotrexate (although these can affect the blood or liver so require careful monitoring).
This ‘midlife acne’ affects sebaceous (oil-producing) glands in the face, causing redness, thread veins, lumpiness, pustules and flushing; eyes may feel gritty too.
Reduce flushing by avoiding hot and windy environments, stress, coffee, alcohol and/or spicy foods.
Flare-ups may be linked to steroid creams, cosmetics or medicines. Rosacea can be treated with emollients, and antibiotic lotions or tablets for several months; you may need to see a specialist.
This inflammation affects sebaceous glands, producing a dry red scaly rash on the face, eyelids, eyebrows, scalp (like dandruff), ears, neck and/or chest.
It can be made worse by stress, medical conditions, medication or a yeast infection.
It often improves with creams/shampoos containing anti-yeast ketoconazole, but you may need stronger tablets from your GP. Remove eyelid scales with a cotton-wool bud dipped in diluted baby shampoo.
Lumps, bumps, moles & sores
A blocked sebaceous gland can form a skin-coloured cyst that can be removed using local anaesthetic if it causes problems. If it becomes infected (red, swollen and painful) you’ll need antibiotics or drainage to remove pus.
Lipomas are fatty lumps under the skin; larger ones occasionally become cancerous so should be removed.
Skin tags and seborrhoeic warts (raised brown warty growths that look stuck on) are common as we get older, and can be removed if troublesome.
Actinic keratoses (pink or brown scaly patches) are an early sign of sun damage and should be frozen off or treated with prescription cream to prevent skin cancer.
Squamous cell carcinomas and malignant melanomas are the most serious form of skin cancer, although new research suggests that a genetically modified herpes virus can activate the body’s immune system, target melanoma cells and improve survival.
Never try to diagnose a new lump, bump, mole or ulcer yourself, and if existing ones ulcerate or change (for example their size, shape, colour or surface), show your GP promptly.
Our skin protects us against the environment, but is vulnerable to trauma and other threats
Sunshine helps the skin to make vitamin D, but too much can cause short- and long-term damage and accelerate ageing changes. Sunburn produces redness, soreness, blistering and peeling, and increases skin-cancer risks (see lumps and bumps).
Always use sun protection (sunscreen that protects against UVA and UVB), cover up, and/or head for the shade. Photosensitivity resembles sunburn, but skin creases (for example, around the nose) often escape.
It can be triggered by using perfume, creams, medication (antibiotics, quinine), chemicals, plants such as parsley, and by medical conditions, such as lupus. It can also worsen eczema, producing chronic actinic dermatitis.
Polymorphic light eruption produces a red itchy rash starting in spring and recurring each year. The cause isn’t known, but it often affects young women and settles after the menopause. If sunscreen fails, moisturisers or hydrocortisone cream will help to soothe it.
Bacteria can enter through tiny breaks in the skin, or infect glands and hair follicles. You may notice spreading redness and soreness (cellulitis), a painful red lump containing pus (boil/abscess), sticky yellow scabs (impetigo), or occasionally a more serious infection with fever and aching. You’ll probably need antibiotics, so visit your GP.
The wart virus causes flat, lumpy or fronded warts, and ingrowing verrucas. They can
take years to disappear naturally, so you may want to see a pharmacist for a suitable wart treatment (rub off the overlying skin with a pumice stone or emery board so the treatment can penetrate well).
See your GP if you’re not certain it’s a wart, or if warts affect your face, nail bed or genitals.
Cold sores are caused by the herpes simplex virus; pharmacies stock various treatments for this. But herpes zoster (shingles) produces a patch of multiple blisters on the face or body, and can be very painful (or affect vision if near the eye). See your GP, who will probably prescribe antiviral tablets.
Fungal infections can produce itchy, scaly red patches (ringworm), athlete’s foot or thickened and flaky discoloured nails; thrush produces itching and redness in skin folds, such as under the breasts.
Keep the area clean and dry, and use an antifungal cream or nail paint, such as clotrimazole, terbinafine or amorolfine (from the pharmacy), or ask your GP about tablets.
Allergies and sensitivities can look like eczema, and be caused by many substances, including water, detergents, household/work chemicals, hair dye, cosmetics, and nickel (jewellery/jeans studs).
Your GP may refer you for patch testing to see what makes you react. Cope by avoiding the cause, keeping your hands out of water (add cotton lining gloves if you use rubber gloves), drying thoroughly, and moisturising; you may also need a steroid cream.
What to watch for at every age
In Your Thirties
The skin starts to dry out at this age so use a daily moisturiser and sun protection, and do regular self-checks for changes/possible skin cancer (do all these in every decade).
In Your Forties
You’ve probably noticed your first wrinkles have appeared by now! Slow down their progress by not smoking, staying well hydrated and continuing to use sun protection.
In Your Fifties
Oestrogen levels fall after the menopause, so your skin may become thinner, less elastic and more oily, with downy facial hair. Good skincare and a healthy balanced diet are even more important now. If you need hormone replacement therapy to relieve hot flushes and sweats, it may have a bonus effect on your skin,
In Your Sixties And Beyond
Problems that appear now are often due to medication or UV damage. Coarser skin (or thinning hair) can be a sign your thyroid gland is slowing down; you may need a blood test. Don’t forget to keep checking for changes to your skin.
Skin Vital Statistics
* Surface area is up to two square metres
* Forms around a sixth of our body weight
* Thinnest on our eye lids (0.5mm), thickest on the soles of our feet (4mm)
* Keeps moisture both in and out
* Helps to regulate body temperature (by dilating/shrinking blood vessels and sweating)
* New cells form at the bottom of the outer layer (epidermis), gradually rise to the surface and flake off (around 30 days)
* The inner layer (dermis) contains supportive collagen tissue, nerve cells, melanocytes (pigment/colour), oil/sweat glands and hair follicles