Professor Chris Bunker: dermatologist in North London

Angioma

What are angiomas? Angiomas are tumours which are non-cancerous (benign), made up of small blood vessels. They appear on the surface of the skin and can be located on any part of the body. There are different types of angioma including cherry angioma, spider angioma, and angiokeratomas. These tumours are harmless but patients may wish to have them removed for aesthetic reasons. What are the symptoms of angioma? Angioma can occur on any part of the body, and they look different depending on the type. Cherry angioma: Usually purple, blue, black, or red coloured Are on top of the skin as a growth Come in single form or in clusters Can grow to ¼ of an inch in size If struck, they bleed considerably Spider angioma: Are more common in childhood and pregnancy Can be frequently food on the neck, face, arms, fingers, and back of hands Are below the surface of the skin and have a single red spot with extensions coming from it (thus the name ‘spider angioma’) Angiokeratoma Creates small marks on the skin which are red and blue Often look like warts Feel hard and do not fade when compressed What causes angiomas? The exact cause is unknown, but certain people may be more likely to get them because of genetic disposition. They are often connected with age, and they are also linked to chemical exposure, particular medical conditions, and some arise in pregnancy. Cherry angiomas are associated with ageing, and seem to appear more in individuals over 30, becoming more common in older age. How are angiomas treated? Because angiomas are benign, treatment isn’t particularly necessary, but some people do choose to have angiomas removed for cosmetic reasons. If the angioma is in a position which causes it to bleed frequently because it is knocked, this means it may need to be removed. There are several treatment options for angiomas, including freezing the lesion, burning the angioma, having laser surgery performed, or having the angioma removed through excision. In some cases surgery may be an option to cut out the angioma. Depending on the size of the angioma you may need more than one treatment session. Surgery or treatment can leave behind bruising or scarring, but this clears up after a while. How can angiomas be prevented? The cause of angiomas is not known, so prevention is not really considered. Angiomas are also not cancerous, so they are nothing to worry about if you do develop one. You may decide to have them removed, but this is easily achieved and a dermatologist or expert in aesthetic medicine can easily advise the best course of treatment. ...

Atopic dermatitis

What is atopic dermatitis? Atopic dermatitis (or atopic eczema) is a chronic inflammation of the skin that results in an itchy rash. It is more common in children than adults. This condition is “atopic” because it does not affect a specific area; it can affect several different areas of the body and is not necessarily where the skin is in direct contact with an allergen. Prognosis: Atopic dermatitis is a long-term condition. There is no decisive cure as of yet, however, with adequate treatment, the symptoms can be controlled. In some cases, the condition goes away on its own during puberty. If the condition becomes chronic - that is, you still suffer from it when you are an adult, its symptoms may become more severe with time. What are the symptoms of atopic dermatitis? When atopic dermatitis starts showing its first symptoms, a child may have: Dry skin; Erythema, blisters, crusting and eczema on the skin. If the condition becomes chronic in adults, the symptoms will be more severe and you may also suffer from: Hyperkeratosis (thickening of the skin); Papules on the skin; Intense itching; Anal fissures, sometimes with blood; Increased sensitivity to skin infections. How is it diagnosed? A dermatologist will analyse your rashes with: A physical examination; A patch test (some allergens are placed on your skin to see if there is a reaction to them); Biopsy (in rarer cases, this is done to exclude other potential, more severe conditions related to atopic dermatitis); Allergen-specific immunoglobulin E (IgE) test; Skin-prick testing; Screening tests for breathing problems, such as asthma, rhinitis and rhino-conjunctivitis, which may lead to developing atopic dermatitis. What causes atopic dermatitis? Atopic dermatitis is a multi-causal disease, that is, a condition caused by several concurrent factors. The most common causes include: Genetic predisposition; An anomaly in the activity of the enzymes that make the natural hydro-lipid film which protects the skin; Stress; Exposure to allergens or irritants; Sweating. How can atopic dermatitis be prevented? It is rather hard to prevent atopic dermatitis. However, you can prevent it from becoming chronic in children and you can take a number of steps to reduce its symptoms (however severe it may be and regardless of your age): Choose delicate products for washing and taking care of your skin; Wear loose clothes, made of cotton, linen or other natural fibres; Be very careful when choosing cosmetics and make-up, making sure they are allergen- and fragrance-free. How is atopic dermatitis treated? Your dermatologist may prescribe: Topical corticosteroids; Emollient creams or ointments, which can help with ongoing rashes; Antihistamines, antibiotics or antiviral medications; Phototherapy (if it could help you); As we have mentioned, many of these treatments will help in reducing the symptoms, however, adults with chronic atopic dermatitis will probably never cure it completely. Which doctor should I talk to? To diagnose and treat this condition, you will need to see a dermatologist. ...

Couperose

What is couperose skin? Couperose skin is a condition caused by weakened blood vessels in the face, usually on the cheeks and nose. When we are exposed to heat, the cold, different emotions of stimulants (e.g. alcohol), our skin responds by dilating the blood vessels in our face. This allows blood to flow through them and then closing when needed. However, if these vessels are weakened, they can struggle to close causing longer-lasting redness. What are the symptoms of couperose skin? The main symptom of couperose skin is the appearance of small dilated capillaries, which on the face form a kind of spider web in characteristic red tones. Alongside these visible blood vessels, people with couperose skin may also have red spots on their face, tight, dry skin. What causes couperose skin? The causes of this skin condition are not fully known. However, medical specialists point out that there are certain risk factors that favour their appearance as: Abrupt temperature changes Stress Menopause Consumption of corticosteroids Tobacco and alcohol Sunburn Gender (women are more likely to be prone to couperose skin) Can couperose skin be prevented? To prevent couperose skin it can help to avoid abrupt temperature changes. It is important to moisturise your skin well and to always use sunscreen, even in winter. What is the treatment for couperose skin? The best treatment for couperose skin has been found to be intense pulsed light (IPL). IPL is the same treatment used for treating rosacea and removing hair. A special gel is applied to the skin and the IPL machine moves over the treatment area. The laser light passes through the skin without damaging it. The effect of the laser heat reaches the veins to be treated, causing blood to clot and close. This way, the gradual elimination of the dilated blood vessels is achieved. ...

Cryo-sclerotherapy

What is liquid cryo-sclerotherapy? Liquid cryo-sclerotherapy is a technique that promotes the gradual elimination of micro varicose veins and capillaries from the legs. Why is it performed? Liquid cryo-sclerotherapy is a simple and quick technique that removes micro varicose veins safely and effectively. However, it not only improves the aesthetic appearance of varicose veins, but also reduces pressure on the circulatory system, minimises pain, and the sensation of heavy legs. What does it involve? It consists of introducing a sclerosing product into the blood capillary at a temperature of around -40⁰. The low temperature irritates the capillary wall, thus causing a hardening of the capillary, a process known as sclerosis. This results in the disappearance of the micro varicose vein. During the procedure, you may notice a slight stinging sensation and redness of the area due to the cold, which will disappear within 24-48 hours. This procedure offers good results and prevents the subsequent appearance of pigmentation that may occur with other sclerosing procedures. The syringe used for the procedure has two compartments: the inner compartment contains the sclerosing product and the outer compartment contains the carbonic snow that provides the cold necessary for the sclerosing liquid to remain at -40⁰ throughout the session. How to prepare for it No special preparation is necessary for liquid cryosclerosis. Post-treatment care No specific care is necessary after liquid cryo-sclerotherapy. However, you should avoid sun exposure, so it is best to have the cryo-sclerotherapy treatment in winter or when you are not planning to sunbathe. The treatment is generally well tolerated. Any redness or stinging sensation will disappear within 24-48 hours, and you may notice a purplish colour appear during the 15 days following treatment, which will disappear within a few days. In any case, all you need to do is apply a cream. ...

Dandruff and seborrhea

What is dandruff? Dandruff is a common scalp disorder characterised by excessive peeling and flaking of the skin on your head. Dandruff is usually easily managed and is not contagious. What are the symptoms of dandruff? The main symptoms of dandruff are: White flakes or scales of dead skin in the hair near the scalp An itchy scalp Seborrhoea (excessively oily scalp) What causes dandruff? Sometimes dandruff can be associated with other skin problems of the scalp, such as seborrheic dermatitis (irritated, oily skin which in babies is called cradle cap) or psoriasis. Other causes can be: Eczema Allergic contact dermatitis (e.g. sensitivity to certain shampoos and hair products) Dry skin Not shampooing your hair enough (oils and skin cells can build up) Tinea capitis (a fungal infection, also known as scalp ringworm) Can dandruff be prevented? Whilst dandruff can be treated, in terms of preventing its recurrence you should: Avoid scratching your scalp When shampooing your hair, do so gently, without scratching the scalp Brush your hair daily Wash your hair regularly (at least 2-3 times a week) Avoid using colouring products on your hair Avoid using styling products (gels, mousses) which can build up oils on your scalp Expose your hair to the sun every so often What is the treatment for dandruff? The treatment of dandruff varies according to the severity of each case but includes: Using medicated shampoos that contain either zinc pyrithione, coal tar, ketoconazole, salicylic acid or selenium sulphide two to three times a week or every other day until the dandruff is under control (usually within one month). For more severe cases of dandruff, a dermatologist may have to prescribe a prescription-strength shampoo or steroid lotion. ...

Eczema

What is eczema? Eczema, also known as dermatitis, encompasses a set of skin conditions that usually cause a rash and inflammation. In most cases, the skin reddens, itches, and may peel or even form blisters. The severity varies depending on the patient. Eczema can be divided into several types, the most common being atopic eczema and contact eczema. Atopic eczema Atopic eczema (the most common variant) is characterized by the presence of scaly and reddish lesions, often located in the creases of the elbows and knees, although it is not uncommon to appear in other places, such as the hands. Babies may develop atopic eczema on their scalp or cheeks. “Atopic” refers to a group of allergic conditions that are thought to have a genetic component, which often occur together in the same individual, particularly during childhood. The other two common atopic conditions are asthma and hay fever (allergic rhinitis). Contact eczema Contact eczema appears in the form of scaly patches, blisters, hives and redness caused by irritation due to harmful substances or by an allergy to certain substances that have come into contact with the skin. What are the symptoms of eczema? Almost all cases of eczema feature the following symptoms: Redness Itching A rash In the case of atopic eczema, the following can also occur: Small bumps, which may leak fluid when scratched The skin may appear lighter or darker where affected by the rash The skin can become infected if scratched Contact eczema may display the following symptoms: Itching, burning and stinging sensations Hives (small, itchy bumps) Fluid-filled blisters Thick, scaly, or leathery skin may develop over time. There are other, rarer forms of eczema, such as nummular eczema and stasis dermatitis, which may cause other symptoms, such as round patches of scaly skin (nummular), or swelling in the legs (stasis). Causes of eczema Factors that can cause eczema include other diseases, contact with irritants, allergens and individual genetic constitution. As an allergic condition, the symptoms are the result of the body’s immune system reacting abnormally to an external substance. Atopic eczema is likely the result of a combination of Genetic factors A flaw in the immune system Dry skin An environmental trigger Contact eczema is usually the result of touching a toxic substance or irritant, or an allergic reaction to something you have touched. Common triggers include: Detergent Latex Certain metals (e.g. in jewellery) Soap Perfume Make-up or skin-care products Solvents Paint Bleach Toxic plants (e.g. poison ivy) Can eczema be prevented? The main measures to prevent the flare-ups of eczema involve avoiding contact with substances that irritate the skin. Limiting contact with water is also recommended, for instance, by taking shorter baths and showers, using warm, rather than hot water, and wearing gloves when washing up. Measure such as moisturising the skin regularly, and only using gentle soaps are also beneficial. What is the treatment for eczema? There are a number of ways to treat eczema, depending on the individual case. The recommended treatment for allergic contact eczema will be mainly to avoid being surrounded by the trigger substance and to avoid scratching the rash. Once the trigger is detected and eliminated, corticosteroid drugs or creams, antihistamines, moisturizing creams and antibiotics may be prescribed. Some doctors may recommend therapies such as biofeedback, light therapy, or the application of wet dressings for atopic dermatitis. Even after the eczema disappears, it is recommended to continue with the indicated treatment for a few more days. ...

Melanoma

Melanoma is a type of skin cancer that forms from the skin cells called melanocytes, which give the skin its pigment. This type of skin cancer can also be called malignant melanoma and is the most dangerous form of skin cancer, with a mortality rate of around 20% if the cancer goes undetected. What causes melanoma? Melanoma is most often caused by over-exposure to the sun’s harmful ultraviolet (UV) rays. It is more common in older people due to the cumulative effect of years of exposure to the sun, and is especially common in areas of the body that are more exposed to the sun such as the face, back of the neck, hands and arms. Due to this, melanoma is also more common in people with a fair complexion, and with people that have been sunburnt as a child. Having said that, it is a myth that people with darker skin are not affected, as they also carry a risk if not protected from the sun. Where they commonly develop in areas that receive a lot of sun exposure in fair coloured skin, in darker skin types they more commonly develop on the soles of the feet, palms of the hand and in the finger nail beds, and can easily go unnoticed. Melanoma can also be genetic, with around 5% of cases of melanoma thought to be genetically passed on. What are the symptoms of melanoma? Melanomas are often noticed by the person rather than diagnosed by a doctor. A sign of a melanoma is a mole that changes shape or size, or that the border of the outline changes and becomes more blurred. Another symptom is when a new mole, or pigmented section of skin appears where there was nothing before. The key for checking a mole to look for signs of melanoma is the ABCDE acronym for the characteristics of melanoma: Asymmterical shape such as two halves of a mole having a different shape irregular Border when the mole has a ‘notched’ outline Change in colour such as uneven colours or multiple colours Diameter when the size changes, or when a mole is bigger than 6 millimeters in diameter. Evolving If the mole changes overtime, or develops other symptoms such as itchiness or bleeding. Melanoma treatments The treatment of the melanoma depends on the type of melanoma, the severity and the position on the body, and whether the cancer has spread. Some of the options available to your doctor include surgery, with different methods available to remove the melanoma. Radiotherapy may be considered if the cancer has spread, or it may be decided that a melanoma vaccine is the best option, which aims to kill the cells using the body’s own defence mechanisms. This form of treatment is still being developed. If you are concerned you may have a melanoma, and would like to be diagnosed. Make an appointment with a specialist here: https://www.topdoctors.co.uk/melanoma ...

Melasma

What is melasma? Melasma, also known as cholasma, is a skin condition where patches of skin on the face take on a light or dark brown colour. It’s more noticeable in the summer, because these patches tend to tan more than the parts which are not affected. Melasma is a common condition, affecting women much more than men , and women who are pregnant in particular. Is melasma a serious condition? Melasma is not contagious, and it doesn’t develop into skin cancer or other health conditions. However, there is no cure for melasma, though there are a number of treatments (see below). If melasma occurs during pregnancy, the condition is likely to disappear again after a few months. Symptoms of melasma Melasma appears as darker patches of the face, usually the cheeks and nose. Patches might be small at first but grow larger over time. Unlike moles, they are flat, not raised. In some cases, you might get patches of dark skin on the neck and arms. There is no itchiness or soreness, or any pain from melasma – the only symptom is the cosmetic difference it makes to your skin. Medical tests to diagnose melasma Melasma is usually straightforward to diagnose simply by looking at the pigmentation of the skin and the pattern made by the patches. In some cases, however, a dermatologist might recommend taking a small sample of skin to examine. This operation should be quick and will involve the use of local anaesthetic. What are the causes of melasma? What causes melasma is unknown. However, there are a lot of things that can increase your chances of developing the condition: having a darker skin type pregnancy use of contraceptive medication a family history of the condition sun exposure Treatments for melasma There is a certain amount that you can do yourself to manage melasma and improve the appearance of your skin. A dermatologist can also offer some options for treatment if these strategies haven’t worked. What can I do? Protect yourself from the sun – sun protection is important not only to manage melasma but to reduce your chances of developing skin cancer. You can reduce your exposure to the sun by using a high-factor suncream (30 and above), wearing a hat when it’s sunny outside, and avoiding the use of tanning salons. Skin lightening creams – some skin lightening creams can be purchased over the counter, but might not be as effective as those prescribed by a dermatologist (see below). Cover-up makeup – some brands of makeup are designed to cover up darker marks, and you might be able to get a recommendation from a dermatologist. What can a dermatologist offer? Prescription skin-lightening creams – these often contain a chemical called hydroquinone which prevents skin cells from producing melanin. There are side effects to the use of this cream, including skin irritation, and it does not work for everyone, so you can only get this cream on prescription from a doctor. Surgical procedures – a number of procedures can treat melasma, including microneedling, chemical peels, and laser therapy. Each type of procedure has associated risks and could make the condition worse, so it should be performed by an experienced specialist. Skin camouflage – a skin camouflage service can provide a cream that matches your skin type and covers up any dark patches on your skin. There are around 80 skin camouflage clinics in the UK offering advice and skin products for a range of skin conditions. ...

Molluscum contagiosum

What is molluscum contagiosum? Molluscum contagiosum (MC) is a viral skin infection that causes papules or nodules with a pearly appearance on the skin. It can affect both children and adults and is contagious, being spread in a number of ways. People with weakened immune systems, such as those affected by HIV, have a higher risk of acquiring this virus. What are the symptoms of molluscum contagiosum? This disease first manifests as a small painless papule with a dimple in the centre, usually measuring between two and five millimetres, but are sometimes larger. They may itch and some patients experience red, dry and sometimes cracked skin around them. They most commonly appear in the armpit, behind the knee or around the groin. The spots are usually pink or red in colour and may occasionally have a tiny white or yellow head in the middle, which, if ruptured, releases a highly infectious yellow-white fluid. This should be avoided if possible, as it increased the chance of the spots spreading to other parts of the body. What causes molluscum contagiosum? MC is caused by infection with the molluscum contagiosum virus. This is highly contagious and can be caught by: Physical contact with the skin of another infected individual Touching an object contaminated with the virus – towels, flannels, clothes, and toys that a patient has been in contact with can all pass the virus on to others Sexual contact, including intimate physical contact as well as full intercourse. Due to this, it is often confused with herpes or genital warts. Can molluscum contagiosum be prevented? To prevent this infection, you should avoid coming into physical contact with infected individuals, particularly their spots, as well as not sharing personal items such as razors, makeup or towels. Keep areas of infected skin covered with clothing or a waterproof bandage when swimming. One should be aware of the risk of sexual transmission. If you are infected with molluscum contagiosum, you should inform the people you live with and any romantic partners about your condition and avoid passing the condition on if possible. Treatment of molluscum contagiosum Treatment isn’t usually necessary as the virus only causes a few minor symptoms (spots and sometimes itching) and tends to clear up within 6-18 months. As long as the patient leaves the spots alone and doesn’t scratch or burst them, they are unlikely to leave scars. Treatment may sometimes be recommended if the spots are unsightly and affecting the patient’s quality of life or if the patient has a weakened immune system. Treatment can take the form of: Topical creams Cryotherapy (freezing the spots) Diathermy (using heat to destroy the spots) Curettage (scraping the infected cells away) Laser treatment ...

Pemphigus

What is pemphigus? Pemphigus is a set of rare diseases that affect the immune system. It manifests as blisters on the skin and in the mucous membranes of the mouth, nose, throat or genitals. It is not a contagious disease. There are several different types of pemphigus: Pemphigus vulgaris: Blisters first appear in the mouth and can be painful but do not cause itching or scars. This form is one of the most common. Pemphigus foliaceus: Blisters first appear on the face and the scalp and then to the chest and the back. Flakes on the skin that break off easily can also arise. In this type of Pemphigus the blisters do cause itching, but they are not painful or appear in the mouth. Vegetative pemphigus: In this form of pemphigus, the sores appear in the groin and armpits. Pemphigus IgA: This type of pemphigus is caused by the antibody IgA and is the most dangerous. The blisters may contain pus. Paraneoplastic pemphigus: This is the least common type of oemphigus and usually affects people with some forms of cancer. It causes painful sores in the mouth, cuts and scars around the eyelids, blisters on the skin and problems in the lungs. What are the symptoms of pemphigus? The symptoms vary depending on the type of pemphigus, but in general they usually manifest as blisters on different parts of the body. In some cases, they are painful and sore and in other cases they can may cause itching or be filled with pus. What are the causes of pemphigus? The immune system produces antibodies to attack viruses and harmful bacteria. In pemphigus, the immune system and its antibodies attack the healthy cells of the skin and mucous membranes instead. As a result of this attack, the skin cells separate, and fluid accumulates in the layers of the skin, producing blisters. The cause of the immune system attack is unknown. Pemphigus treatment After your GP or dermatologist has diagnosed pemphigus, it will be treated through medication. Normally high doses of anti-inflammatories are administered to control the immune system, either orally or by injection. The dermatologist can also prescribe immunosuppressive drugs and antibiotics in case of an infection. ...

Psoriasis

What is psoriasis? Psoriasis is a condition that affects the skin, causing patches of red rash, and flaky patches of silvery skin, which can sometimes be itchy or sore. The condition can present anywhere, but is most common on the scalp, elbows, knees and lower back. It can affect men and women of any age, but is more common in adults under 35 years old. It is non-contagious and the severity differs between people, with some only affected a little, and others affected greatly. Psoriasis is a chronic condition, meaning that it lasts a long time. It usually has periods with mild or no symptoms, followed by periods of more severe symptoms. What are the different types? The most common types of psoriasis are as follows: Plaque psoriasis The most common form of psoriasis, and shows as raised, red patches of skin covered with silvery patches of dry skin, known as plaques. Plaques can appear anywhere, but usually appear on elbows, knees, lower back and scalp. The plaques can be sore and itchy, and may crack and bleed in some cases. Nail psoriasis The nails are affected in around half of the people with psoriasis. Small dents may appear, and the nails may become discoloured or grow abnormally. The nails can become loose and separate from the nail bed, and in severe cases the nails may crumble. Guttate psoriasis This form often starts in childhood, and appears in the form of small, dot like lesions. It is the second most common form of psoriasis. This form often starts after a throat infection, but in most cases will disappear after a few weeks. Inverse psoriasis Folds of the skin such as elbows, knees, groin, buttocks and under the breasts are usually affected by this form. It appears as large, red smooth patches, and becomes worse by friction and sweating. Pustular psoriasis This is characterised by small, white blisters surrounded by red skin. It is not an infection, or contagious and can affect any part of the body, particularly the hands and feet. What are the causes of psoriasis? The cause of psoriasis is unknown, but is due to the skin cells being replaced more quickly than usual, which is possibly a problem with the immune system. The normal process for skin cell production is the production of the new cell in the deeper layers of the skin, the new cells gradually move up through the layers, until they reach the top layer, where they then die and flake off. This usually takes around three to four weeks. With psoriasis, the process only takes three to seven days, causing a build-up of skin cells that are not ready to flake off. Psoriasis can sometimes be triggered due to injury, stress, smoking, drinking alcohol and certain medications. What is the treatment for psoriasis? Mild psoriasis can be treated with skin creams. These can reduce swelling, soreness, itching and reduce the rate of skin cell growth. These may include steroid creams, moisturisers, and coal tar especially in the form of a psoriasis shampoo. More severe forms of psoriasis may be treated with phototherapy. The treatment exposes your skin to ultraviolet light which helps to treat the condition. You may be prescribed a medicine to help cure problems with your immune system that may be leading to psoriasis. ...

Rash

Rashes are irritations that appear on the skin. There are different types, depending on the colour and the texture that they present as well as the causes. The most common are contact dermatitis, which appears as a reaction of skin contact with certain products (from soaps, to materials such as latex or rubber); seborrheic dermatitis, a harmless rash that manifests itself with red areas and flaking, especially on the face and torso, usually caused by stress or the use of lotions or soaps that contain alcohol. In addition, there are numerous conditions that show skin rashes as symptoms: childhood diseases such as chickenpox or measles; herpes zoster virus; psoriasis and eczema; insect bites or reactions to certain medications. Treatment for skin rashes depends on the causes, and can range from creams to oral medications. ...

Rosacea

What is rosacea? Rosacea is a chronic skin condition that causes a facial rash, which may include red blotches, telangiectasia (spider veins), pimples or spots, and possibly a burning sensation on the skin of the cheeks, nose, chin and forehead. It is a long-term pathology that appears more frequently in middle-aged people and can vary in intensity. What are the symptoms of rosacea? Rosacea can manifest as several symptoms, including: Redness of the face (often giving the appearance of blushing) Bumps or pimples on the skin Patches of rough, dry skin Swelling, particularly around the nose and eyes (a bulbous red nose is a common indicator of severe rosacea) A burning or stinging sensation Telangiectasia (spider veins – thin and reddish lines form under the skin because the blood vessels under the skin are enlarged. Eye problems, including itching, dryness, swelling, light-sensitivity, bloodshot or watery appearance, etc. Different patients may experience a different selection of symptoms, the most common being the unexplained redness of the face, which often bears a resemblance to acne (although the two are distinct conditions). Rosacea tends to flare up in cycles, with patients suffering symptoms for a period of weeks or months, before the symptoms disappear for a similar period. What are the causes of rosacea? The cause of rosacea is unknown but there are several factors that are thought to contribute to or worsen it. For example excessive consumption of alcohol, caffeine or hot and spicy food is thought to trigger episodes, as can intense physical activity. Other factors include: Age – rosacea occurs most commonly in people between 30 and 50 years of age. Skin type – fair-skinned people seem to be more susceptible (especially those with blond hair and blue eyes). Genetics – family history of the condition means you are more likely to suffer from rosacea. It it also more common in people of Celtic and Scandinavian ancestry. Hormonal changes (e.g. the menopause) Sudden changes in temperature Exposure to sun or wind Stress Some medications Certain bacteria, e.g. helicobacter pylori Can rosacea be prevented? Rosacea is not a pathology that can be prevented, but you can still avoid severe episodes by starting treatment as soon as possible when symptoms flare up, and keeping your skin hydrated. Other tips include identifying and avoiding the things that a flare-up, avoiding products that irritate the skin, and generally taking care of your skin, by using sun cream, make-up suited to our skin type, and gentle shampoos and gels to avoid further irritation. What is the treatment for rosacea? Although there is no cure, the symptoms can be managed. Rosacea can triggered by different things in different patients, so treatment differs accordingly. The doctor may prescribe drugs, such as antibiotics and tetracycline derivatives, topical preparations, or laser or intense pulsed light therapies. ...

Seborrheic dermatitis

Seborrheic dermatitis is a skin disease characterised mainly by the appearance of white or yellowish scales on the body parts where more fat tissue can be found, such as the face, scalp or inside the ear. If seborrheic dermatitis affects babies, it is called cradle cap. Currently there is no known cause of seborrheic dermatitis. It seems to be hereditary but can also be caused by hormone levels, weak immune system, lack of nutrients or a fungus called Malassezia. ...

Sexually transmitted infections (STIs)

What are sexually transmitted infections (STIs)? Sexually transmitted infections (STIs) are a set of infectious diseases that are transmitted from one person to another through sexual contact (vaginally, anally or orally). There are numerous types of STIs, including: Chlamydia Gonorrhoea Genital herpes HIV Genital warts HPV (human papillomavirus) Syphilis Trichomoniasis Pubic lice (‘crabs’) What symptoms do STIs present? Sexually transmitted infections can cause symptoms, although not always. Some patients may experience the following symptoms: Pain when peeing Unusual discharge from the vagina, penis or anus A rash Itchy genitals Vaginal bleeding Blisters or sores around the genitals Flu-like symptoms Skin growths around the genitals What causes sexually transmitted infections? The cause of sexually transmitted infections is either bacteria, parasites, fungi or viruses. Can STIs be prevented? Abstinence is the only way to completely prevent STIs, however, making sexual contact safer will also reduce the possibility of contracting an STI. If used properly, condoms can provide effective protection against many STIs. However, whilst condoms protect you from contact with fluids (semen or blood), they may not protect you from skin-to-skin transmission. It is also a good idea to have regular STI health checks if you are sexually active, to allow for early diagnosis and treatment and to stop the spread of STIs among the population. It is also a good idea to have the HPV vaccine, which is currently offered to girls at school. What is the treatment for STIs? Not all sexually transmitted infections can be cured. Those that are caused by bacteria, such as chlamydia, are treated with antibiotics. However, those that are caused by a virus, such as genital herpes, treatment is limited to alleviating the symptoms. STIs such as lice or trichomoniasis can be treated with topical medications. ...

Shingles (herpes zoster)

What is shingles? Shingles is a viral infection that causes a tender and painful rash which most commonly presents either on the right or left hand side of the torso. You can also get shingles on your face, eyes and genitals. Shingles is not life-threatening, but it can cause a lot of pain and discomfort. What are the symptoms of shingles? The first signs of shingles is usually a pain felt in the area of skin, a headache and generally feeling unwell. A few days after these symptoms, a rash will present. The shingles rash is red, blotchy and appears on just one side of your body. The red blotches turn into small, itchy blisters that ooze fluid. Eventually these blisters dry out and form little scabs. Even after the rash has gone, the area of skin affected can remain painful. The rash can take up to 4 weeks to heal. Other symptoms experienced with shingles include: fatigue sensitivity to light fever What causes shingles? Shingles is caused by the varicella-zoster virus, which is the same virus that causes the chickenpox. Anyone who has had chickenpox can develop shingles as the virus stays in your nervous system, remaining dormant for years. If the virus reactivates, it moves along the nerve pathways resulting in shingles. Shingles is not contagious to people who have had chickenpox. For people who not had the chickenpox, exposure to shingles can cause them to come down with the chickenpox. This can be dangerous in older people, pregnant women, newborns and people with weakened immune systems. How can shingles be prevented? There are two vaccines that can help avoid shingles. The first is the chickenpox vaccine which is usually given to adults who have never had the chickenpox. This vaccine cannot guarantee you against the chickenpox, but it can significantly reduce your chances. The second preventative measure is the shingles vaccine. This is available in the UK to people over the age of 70 or 78. This vaccine proved to be ineffective on people aged over 80 however. Even if you do contract shingles after the vaccine, the symptoms will be much milder. For people with shingles, they should avoid work or school until the rash scabs over. How is shingles treated? To treat shingles, there are some techniques to relieve the discomfort, including: over-the-counter painkillers wearing loose-fitting clothing use cooling creams use a cool compress wrapped in a towel a few times a day There are also a couple of measures to avoid: do not let plasters pr dressings stick to the rash do not use antibiotic cream as this slows the healing process Although there is no cure for shingles, you can take anti-viral medication to reduce the risk of complications and to help the healing process. For people experiencing severe pain, prescription painkillers will be considered. ...

Skin allergies

Skin allergies are an immune reaction that is produced by the presence or contact with certain substances or products (allergens). Reactions can vary depending on the product that causes the allergy to the person: perfumes, lotions, cosmetics, flowers, foods. In addition, there are different types of skin allergies: food allergy, contact dermatitis, and atopy. The common symptoms that cause skin allergies are skin rashes, inflammation, redness, burning, pruritus or itching, but severe complications may occur depending on the case. It is therefore important to consult with a specialist when these symptoms appear and which are often sudden and sometimes can cause suffocation or choking and put the patient's health at risk. The treatment usually involves taking antihistamines to attack the allergy and its symptoms as a first step. But then it is recommended to perform allergy tests to identify the allergen that causes that reaction in the body and to be able to treat it directly. In most cases, avoiding the substances that cause the allergy is enough. ...

Skin fungus

What is skin fungus? Skin fungi are microorganisms that can cause several skin conditions. We all have fungi on our dermis and epidermis. They usually don’t usually cause any issues to our body, but sometimes they do. In some cases fungi can become infectious agents, thus posing a threat to our health. This can occur as a result of an impaired immune system, when the fungi can grow a colony on your skin. This fungal growth can lead to other conditions. That is why skin fungal infections are more common during the summer with high humidity, heat as well as in crowded places. There are two main sub-groups of skin fungi: Superficial mycoses (or cutaneous mycoses): they affect the surface of the skin, nails or mucosae; Subcutaneous mycoses: they extend deeper into the dermis. The most common types of skin fungi are: Dermatophytosis: it affects the nail and body hair (keratinised areas); Candidiasis: this fungus grows in the body’s most humid areas (groin, armpits or in between the fingers); Pityriasis versicolor: it causes flaky discoloured patches to appear on the neck, shoulders, chest, stomach, arms and face. What are the symptoms caused by skin fungus? The most common symptoms include: Dyschromia, or any disorder causing skin discolouration (ash-like and scaly white, red or brown patches); Alopecia areata; Itchy skin; Inflammation and irritation. How are skin fungus conditions diagnosed? Skin fungus can be diagnosed with: Dermatological visit with a specialist (this is often enough to get an accurate diagnosis); Should the diagnosis from the dermatologist be confirmed, the specialist will gather a sample from your skin, body hair or nails and send them to a laboratory for further testing; Lamp examination: a particular type of UV light determines the specific fluorescence of fungi. What causes them? Fungal infections can be caused by several factors, although they are often associated with impaired immune defences: Unhealthy diet; Poor hygiene; Stress; Hot temperatures; Excessive sweating; Wearing tight clothes; Taking immunosuppressants, antibiotics or corticosteroids for a long period of time; Suffering from an immune system compromising condition. How can skin fungus infections be prevented? Here are some steps you can take to prevent a fungal infection: Ensure you wear clean, breathable underwear made with natural fibres (e.g. cotton); Wear flip flops if you shower at the gym or at a public pool; Thoroughly dry yourself after showering and be extra careful with the most humid areas of the body; Avoid taking medications for too long. How are skin fungus problems treated? Treatments largely depend on what kind of fungal infection you have and how severe it is. The most common treatments are: Antifungal medications, to be applied directly on to the area of irritation; Oral antifungal medication, in the case of persistent infections; Corticosteroids, to help with the itching. Which doctor should I talk to? You should see a dermatologist as soon as possible, in order to accurately diagnose and adequately treat a fungal skin infection. ...

Skin infections

Cutaneous infections are skin diseases that are caused by the attack of different types of germs, which provoke a local reaction in which different cells and microorganisms present in the skin are destroyed. Initially, the affected area becomes inflamed and presents a reddish, stinging and burning sensation, which usually ends up causing an abscess and an ulcer on the skin, or a fistula. The most frequent infections can be classified according to their origin: bacterial, like staphylococcus or impetigo; viral, such as warts, molluscum contagiosum or herpes simplex; those caused by fungi, such as candida infections; or those caused by skin parasites such as scabies or lice. The treatment of cutaneous infections depends on the causes, although in most cases it will be necessary to clean the lesion with hydrogen peroxide or alcohol, and apply creams that contain antibiotics or take the antibiotics orally, as determined by the specialist. ...

Skin patches

What are skin blemishes? Human skin is prone to all kinds of spots and stains. Most of the time these are harmless, but it’s important to be able to identify them, to know what they are, and to take action if necessary. Dark stains on the skin are known as hyperpigmentation. Some people may find them distressing if they can’t be hidden or disguised on areas where they tend to appear: the face, hands and other parts exposed to the sun. Hyperpigmentation occurs when the body produces an excess of melanin in certain areas of the skin. This results in flat patches of skin that have a darker colour, ranging from light brown to black, and which can vary in size and shape. There are many different types, but the most common ones are: Pigment stains (such as age spots) à These are small, dark patches caused mainly by exposure to the sun, and therefore appear on exposed areas: face, hands and arms. Melasma or chloasma (‘mask of pregnancy’) à Appears in the form of dark, irregular patches on the face or arms. It affects 90% of pregnant women, and women taking the contraceptive pill, due to hormonal changes. Inflammatory hyperpigmentation à Appears when a skin injury heals and leaves a flat stain with an altered colour. It is common in people with acne and may also be caused by cosmetic procedures. Signs of skin stains The main sign of skin blemishes or patches is a change in the colour of some areas of skin. These are painless, as already mentioned, and can have many causes. They are usually harmless, but a dermatology specialist should take a close look at them nonetheless. What causes skin stains? Hyperpigmentation of the skin is the response to an overproduction of melanin (a pigment that gives the skin, hair and eyes their natural colour). Stains on the skin appear in the form of patches and can be triggered by a variety of factors. The most common causes of stains are sun exposure, genetic factors, age, hormonal changes, and skin injury or infection. Can they be prevented? Some stains can be prevented, but others are unavoidable. To prevent the appearance of certain stains, you should avoid too much exposure to the sun and should use a high sun protection factor. Any potential hormonal effects caused by medications can be discussed with a specialist. What does treatment involve? There are two commonly-used treatments: chemical peel and laser therapy. The former consists of applying an acid solution to the affected area to remove the superficial layers of the skin. The chemical solution causes the skin to blister, and then peel, resulting in the appearance of new, uniform skin. The second treatment, laser therapy, has almost the same effect as the chemical peel but is more precise, since the dermatologist has more control over the procedure. Laser therapy involves ‘hitting’ the affected areas with a high intensity light. Some treatments are mild, acting only on the skin's epidermis or superficial layer, and others are more intense, penetrating the deeper layers of the skin. Although they are widely used, these treatments are slightly invasive, to a greater or lesser extent depending on your skin type. They may irritate, inflame or burn the skin, causing post-inflammatory hyperpigmentation. New treatments have emerged in recent years using hydroquinone, arbutin, kojic acid, vitamin C derivatives, retinoic acid derivatives, azelaic acid, B-resorcinol or butylresorcinol, as well as jojoba oil or lemon juice, or following a sugar-free diet. All of these are effective ways to treat hyperpigmentation. ...

Studies of skin types

What are skin type studies? Skin type studies determine whether we have mixed, oily, dry, sensitive or normal skin. This is carried out by a dermatologist. Why skin type studies performed? The passage of time, or external factors such as sun exposure, environmental impact, some diseases, hormonal changes, certain medications or food, affect the skin. A skin study can be performed to find out what type of skin you have, as each person requires a personalised treatment based on the characteristics of their skin. The study provides information about the skin’s level of hydration, elasticity, thickness and sebaceous secretion. The classification includes four basic types: Dry skin which suffers greater water loss and is less protected against potential damage Oily skin with high sebaceous secretion Sensitive skin which is highly reactive to stimuli Normal skin which has a good balance of water and sebum levels. You can learn which type of skin you have by going to a specialist and having a skin type study performed. This will help prevent future skin problems and you will learn which creams, shampoos and soaps are best for your skin type. How to prepare for a skin type study: No specific preparation is necessary. However, for the specialist to be able to analyse the skin correctly, the face must be well washed and free of make-up and other cosmetic products. What do you feel during a skin type study? The test is completely painless with no discomfort. What about abnormal results? It is unlikely you will have abnormal results. However, if the dermatologist discovers any kind of skin lesion, they will advise you of any action you need to take. ...

Sun allergy

What is photosensitivity? Photosensitivity, commonly known as sun allergy, is the skin’s reaction to sun exposure. Symptoms may be different to other dermatological issues. Among the most common reactions, the following stand out: Polymorphic light eruption (PLE); is more common in women and people who are fair, but it can affect men and people with dark skin. It appears as lumps and bumps a few hours after having sunbathed, it is most common on the face and neckline, but can also affect the back of the arms and the legs. Solar urticaria; less common that the previous one, it tends to appear as large hives, similar to an insect bite. It affects both men and women and can appear on any area of the body. It appears minutes after exposure to natural sunlight or artificial light. Actinic prurigo; is a rare reaction to sunlight in which the skin thickens, it tends to affect the elderly. What are the symptoms? The main symptoms of sun allergy are itching, pain, and skin redness that tend to appear a few hours or days after exposure. Some less common symptoms may appear, such as; headache, nausea, or chills. Causes of photosensitivity The causes for photosensitivity remain unknown, although it is known that symptoms appear when there is prolonged exposure to UVA and / or UVB rays (particularly in spring and summer). It is one of the main primary idiopathic photodermatoses. How can it be prevented? To prevent sun allergy it is very important to protect your skin with sunscreen and wear appropriate clothing. People with sensitive skin are recommended to avoid using perfumes, deodorant, and cosmetics when in the sun. What is the treatment? Treatment for photosensitivity mainly focuses on protecting yourself from the sun, although in more severe cases you may be prescribed antihistamines, corticosteroids, or antimalarials. ...

Vascular malformations

This is a congenital malformation of the blood vessel and can appear in the veins, capillaries, arteries and lymph vessels. There are different types of vascular malformations that differ in accordance with which blood vessel is affected. They are present from birth and increase in size with age. ...

Vitiligo

What is vitiligo? Vitiligo is a condition that consists of a progressive depigmentation of the skin in different areas of the body causing white spots. The depigmented areas of the skin can manifest themselves in different ways – either spread over the body or in specific locations (for example, only on one side of the body). Its appearance can arise at any age. What are the symptoms of vitiligo? The main and visible symptoms of vitiligo are white spots on the skin. These are more common in those areas more exposed to the sun such as hands, feet, arms, face or lips. Other areas may include the armpits, groin, eyes, nostrils, navel, genitals and rectal areas. Often people with this condition have grey hair prematurely and those with dark skin may notice a loss of colour inside their mouth. What causes vitiligo? This disease is caused by the destruction of certain cells known as melanocytes which are responsible for the creation of melanin, a pigment in the skin. Though the causes are not clear, vitiligo is associated with conditions of an autoimmune origin, such as Addison's disease or diabetes. Can vitiligo be prevented? Due to the lack of conclusive studies about the cause of vitiligo, there is no absolute way to prevent this disease. One way to try and prevent vitiligo is to avoid sun exposure, especially at times when the heat intensity is high. Applying sun lotion may help too. What is the treatment for vitiligo? Depending on the severity of each case - the number of spots, the rate of spread and the patient's preferences, the treatment will vary. Not all treatments are appropriate for all patients. A large number of treatment options may involve unexpected side effects, or may be prolonged and sometimes, without the desired results being achieved. There are certain medications that can be applied directly to the skin or taken orally oral, which can be combined with ultraviolet light to remove the white spots. Surgical treatments include skin grafts taken from the patient's own tissue. Tattoos have been used as well, especially for those who have small affected areas. Thirdly, using sun lotions can help, and using makeup or dyes to cover the white spots. ...

Warts

What are warts? Warts are hard growths that can occur in various areas of the body, caused by a viral infection. They are more frequent in children and teenagers and are usually benignant formations (not cancerous ones). Warts aren’t normally painful. Healing takes from a few weeks to six months with adequate treatment. There are several types of warts. The most common ones are: Common warts: these usually occur on the fingers, hands, elbows, and knees; Flat warts: most common on the face, arms, and knees; Plantar warts: they are usually found on the soles of the feet. Plantar warts can be painful, as they are continuously rubbed and under pressure; Mosaic warts: these commonly occur under the toes; Filiform warts: thread- or finger-like warts often occurring on the face; Condylomas or genital warts: sexually transmitted warts, most common in the genital area. Prognosis Warts are usually innocuous and heal after a couple of weeks. However, in some cases they should be removed to avoid potential complications (such as skin melanoma). What are the symptoms? Warts can appear weeks or months after contagion. They are usually rough and fairly small growths of variable shape. In some cases, small and dark dots can be seen within a wart. Although is not common, warts can cause pain, itching and bleeding. How are they diagnosed? A dermatological examination with a specialist is usually enough to confirm the presence of warts. Your doctor may also request a skin biopsy: in that case, the wart is removed and sent to a laboratory for analysis. What causes them? Warts are caused by the human papilloma virus (HPV). There’s a higher chance of contagion if your skin is damp or wet, or if you have a small lesion (such as a cut) on your skin. Warts can be transmitted in the following ways: Contact with the skin of somebody who has HPV; Contact with contaminated surfaces (the floor of a pool, common showers, at the gym); Sharing personal hygiene objects, such as towels or razors; If you already have a wart, you may spread it to other areas of your body by touching it. How can they be prevented? You should: Use rubber flip flops in the changing room and common showers at the gym; Thoroughly disinfect lesions of the skin; Wash your hands multiple times a day. If you have a wart, you should cover it with a plaster when going to higher-risk places (such as the pool or the gym) to avoid spreading it to other areas of your body or to other people. You should also avoid touching the wart and sharing your personal hygiene objects. How are they treated? Warts usually disappear on themselves in 6 to 24 months, especially in children. However, this is not always the case for adults, so if you have a wart you may need to have it removed, because autonomous healing could take much longer. The following treatments are not always conclusive, as the wart could be recurrent or occur in other areas of your body. Should new warts appear, even if you’ve been treating them, this could mean that the viral cells of the old warts have spread to other parts of your body. In this case, you should see your dermatologist again. The most common treatments are: Cryotherapy: liquid nitrogen is used to freeze the warts. This procedure can be carried out at home, with products that can be bought at your local pharmacy; Cantharidin: by applying this compound directly on the wart, it will die out and the doctor will remove it after a couple of days; Electrodesiccation: electricity is used to heat up the affected area until the wart dies. This procedure is often associated with curettage, which consists in removing the wart by cutting it with a scalpel or by scraping it off with a spoon-like instrument; Laser treatment: this procedure ensures a highly precise intervention on the affected area, without compromising neighbouring tissues; Keratolysis: this exfoliation method destroys the wart, by using specific medications which can also be applied at home. Which doctor should I talk to? Dermatologists are generally the specialists who treat and remove warts. ...

Professor Chris Bunker
Dermatology
North London

Professor Chris Bunker

Dermatologist in
London

FRCPsych

Professor Chris Bunker areas of expertise:

Professional statement

Diseases, Medical Tests and Treatments

Dermatopathology

HIV

Acne

Alopecia