SKIN CONDITIONS TREATED

 

ACNE VULGARIS

 

Acne info 

Acne vulgaris is a chronic, inflammatory disorder of the sebaceous (oil) gland in the skin. It occurs when the pores (hair follicles) become clogged with dead skin cells, bacteria and excess sebum. Both blackheads and pustules can form. The oil and bacteria continue to build up behind the blockage and cause papules and pustules which appear as red lumps, often with the appearance of a whitehead. Acne can typically be found on the face, chest and back, although can occur in other areas such as the buttocks. Typically, if acne lesions are found on more than one area (e.g face and back), medication would be recommended.

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Why do I have Acne?

Acne affects around 80% of people at some point in their lives. Typically, it can be brought on by several factors including hormone changes, stress, excessive sweating and it can also be hereditary. This is mainly due to a sensitivity to androgens, such as testosterone. This sensitivity changes the rate of cell turnover, meaning that acne sufferers have an overload of skin cells which can’t naturally shed quickly enough. This causes a thickening of the top layer of skin (epidermis) and results in the pore becoming clogged.

On the skins surface live natural bacteria, which feed off surface oils to create a healthy barrier function. However, when the pores get blocked this causes the bacteria to become trapped in the skin, where there is more sebum for them to thrive on. In this environment the bacteria quickly multiple and cause an inflammatory response, this creates a red lump called a papule.

The papule can become a pustule if pus forms.

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Four Reasons Why Acne Occurs

1. Increase in cell turnover

2. Increase in sebum production

3. Increase in P.Acne bacteria

4. Inflammation

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There are a couple of crucial ingredients you should use on your skin to combat these 4 factors: Salicylic acid and Glycolic acid retinol.

 

Common Myths about Acne

"Acne is a different condition from spots." - In fact, there is no difference between these two words. Acne is the medical term for breakouts. The severity of the condition, however, can range from comedones to cystic acne.

"Acne is for teenagers." - Acne occurs in both teenagers and adults. Hormonal conditions/imbalances, stress and emotional trauma are the main triggers to cause acne at any age.

"Acne is caused by unclean skin." - In fact most acne sufferers tend to over clean their skin as they think this will help. You should wash/cleanse your skin twice a day ONLY as over-cleansing makes the skin raw and promotes the skin to start producing more sebum (oil).

"Acne is contagious." - Acne is not contagious and can’t be spread from person to person. P.Acne bacteria cannot be transmitted like most bacterial infections.

"You should avoid wearing makeup if you have Acne" - There is absolutely no reason to completely avoid makeup, but do ensure you use an oil free foundation. Always remember to remove makeup correctly, and never sleep with makeup on.

 

Mild Acne

If your acne is determined to be mild, you may benefit from a personalised treatment plan with a combination of in clinic facial treatments and home care products.  Obagi offers a superb home treatment regimen to tackle acne.   This, alongside clinic based treatment peels with Obagi Blue Radiance administered by Dr Benning, can produce excellent results.

 

Moderate Acne

For Moderate Acne you may be required to have a combination of topical prescribed creams, antibiotics and/or in clinic treatments and regular reviews with Dr Benning.

 

Topical treatments - These are usually the first choice for those with mild to moderate acne. There are a variety of active anti-acne agents, such as benzoyl peroxide, antibiotics (e.g. erythromycin, tetracycline and clindamycin), retinoids (e.g. tretinoin, isotretinoin and adapalene), azelaic acid and nicotinamide (also known as niacinamide). 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.

 

Oral antibiotic treatment your doctor may recommend a course of antibiotic tablets, usually erythromycin or a type of tetracycline, which is often taken in combination with a suitable topical treatment. Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement. Typical courses last three to six months

 

Severe Acne

Rarely, in clinic treatments for acne are not enough.  If this becomes the case, then Dr Benning would advise onward referral to a consultant dermatologist  for consideration of oral isotretinoin. 

 

ROSACEA

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What is rosacea?

Rosacea is a chronic rash involving the central face, the nose and cheeks, that most often starts between the age of 30 and 60 years. It is common in those with fair skin, blue eyes and is more common in women. It is unrelated to acne but is sometimes called ‘acne rosacea’

 

There are several theories regarding the cause of rosacea, including genetic, environmental, vascular and inflammatory factors. Skin damage due to chronic exposure to ultraviolet radiation plays a part.

 

The skin's innate immune response appears to be important, as high concentrations of antimicrobial peptides such as cathelicidins have been observed in rosacea.

 

Cathelicidins are part of the skin's normal defence against microbes.

Cathelicidins promote infiltration of neutrophils in the dermis and dilation of blood vessels.

Neutrophils release nitric oxide also promoting vasodilation.

Fluid leaks out of these dilated blood vessels causing swelling (oedema); and proinflammatory cytokines leak into the dermis, increasing the inflammation.

Matrix metalloproteinases (MMPs) such as collagenase and elastase also appear important in rosacea.

 

These enzymes remodel normal tissue and help in wound healing and production of blood vessels (angiogenesis).

In rosacea, they are in high concentration and may contribute to cutaneous inflammation and thickened, hardened skin.

MMPs may also activate cathelicidins contributing to inflammation.

Hair follicle mites (Demodex folliculorum) are sometimes observed within rosacea papules but their role is unclear.

 

An increased incidence of rosacea has been reported in those who carry the stomach bacterium Helicobacter pylori, but most dermatologists do not believe it to be the cause of rosacea.

 

Rosacea may be aggravated by facial creams or oils, and especially by topical steroids (see steroid rosacea).

 

What are the clinical features of rosacea?

Rosacea results in red spots (papules) and sometimes pustules. They are dome-shaped rather than pointed and unlike acne, there are no blackheads, whiteheads or nodules. Rosacea may also result in red areas (erythematotelangiectatic rosacea), scaling (rosacea dermatitis) and swelling (phymatous rosacea).

 

Characteristics of rosacea

Frequent blushing or flushing

A red face due to persistent redness and/or prominent blood vessels – telangiectasia (the first stage or erythematotelangiectatic rosacea)

Red papules and pustules on the nose, forehead, cheeks and chin often follow (inflammatory or papulopustular rosacea); rarely, the trunk and upper limbs may also be affected

Dry and flaky facial skin

Aggravation by sun exposure and hot and spicy food or drink (anything that reddens the face)

Sensitive skin: burning and stinging, especially in reaction to make-up, sunscreens and other facial creams

Red, sore or gritty eyelid margins including papules and styes (posterior blepharitis), and sore or tired eyes (conjunctivitis, keratitis, episcleritis) – ocular rosacea

Enlarged unshapely nose with prominent pores (sebaceous hyperplasia) and fibrous thickening – rhinophyma

Firm swelling of other facial areas including the eyelids – blepharophyma

Persistent redness and swelling or solid oedema of the upper face due to lymphatic obstruction – Morbihan disease

Persistent yellow-brown papules and nodules due to granulomatous rosacea.

 

What is the differential diagnosis of rosacea?

Rosacea may occasionally be confused with or accompanied by other facial rashes.

 

How is rosacea diagnosed?

In most cases, no investigations are required and the diagnosis of rosacea is made clinically.

Central redness in a characteristic pattern

Papules and pustules

Flushing

Telangiectasia

Burning or stinging

Oedema

Dry appearance

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What is the treatment for rosacea?

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General measures

Where possible, reduce factors causing facial flushing.

Avoid oil-based facial creams. Use water-based make-up.

Never apply a topical steroid to the rosacea as although short-term improvement may be observed (vasoconstriction and anti-inflammatory effect), it makes the rosacea more severe over the next weeks (possibly by increased production of nitric oxide).

Protect yourself from the sun. Use light oil-free facial sunscreens. SPF 50 – take with oral vitamin D supplementation.

Keep your face cool to reduce flushing: minimise your exposure to hot or spicy foods, alcohol, hot showers and baths and warm rooms.

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Oral antibiotics for rosacea

Tetracycline antibiotics including doxycycline and minocycline are commonly used to treat rosacea

They reduce the redness, papules, pustules and eye symptoms.

The antibiotics are usually prescribed for 6–12 weeks, with the duration and dose depending on the severity of the rosacea.

Further courses are often needed from time to time, as antibiotics don't cure the disorder.

 

Topical treatment of rosacea

Antibiotic metronidazole cream or gel can be used intermittently or long-term on its own for mild inflammatory rosacea and in combination with oral antibiotics for more severe cases.

Azelaic acid cream or lotion is also effective for mild inflammatory rosacea, applied twice daily to affected areas.

Brimonidine gel can allow constriction of dilated blood vessels reduce facial redness temporarily.

Ivermectin cream can be used in the treatment of papulopustular rosacea. It controls demodex mites and is anti-inflammatory.

Isotretinoin

When antibiotics are ineffective or poorly tolerated, topical tretinoin oral isotretinoin may be very effective. Although isotretinoin is often curative for acne, it may be needed in low dose long-term for rosacea, sometimes for years. It has important side effects and is not suitable for everyone.  If it is determined that this is the best next step – Dr Benning can organise onward referral to a private dermatologist.

 

Vascular laser

Persistent telangiectasia can be successfully improved with vascular laser or intense pulsed light treatment. Where these are unavailable, cautery, diathermy (electrosurgery) or sclerotherapy (strong saline injections) may be helpful. Papulopustular rosacea may also improve with laser treatment or radiofrequency.

 

MILIA

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Milia Removal

Milia are very small, raised, pearly-white or yellowish bumps on the skin. They are most often seen on the skin around the cheeks, nose, eyes and eyelids, forehead and chest. However, they can occur anywhere on the body. Milia are very common in new-born babies but can affect people of any age. In babies, milia clear by themselves and no treatment is needed. In other people, they may take longer to clear. In persistent cases, treatment may be suggested. The cysts occur when keratin becomes trapped beneath the surface of the skin. Keratin is a strong protein that is typically found in skin tissues, hair, and nail cells.

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FAQS

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What causes Milia?

In older children and adults, milia are typically associated with some type of damage to the skin, such as:

 

• blistering due to a skin condition

• burns

• blistering injuries, such as poison ivy

• skin resurfacing procedures, such as dermabrasion or laser resurfacing

• long-term use of steroid creams

• long-term sun damage

• ageing and dehydrated skin

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How are Milium/Milia removed?

The most common type of milia removal is performed using a needle. Once the skin with milia has been cleaned, a sterile needle is then used to create a tiny incision in the skin covering the cyst. The contents of the milia are then carefully extracted so as not to cause any trauma to the skin.

 

Some types of milia may be more suitable for removal using a Hyfrecator. A Hyfrecator uses tiny electrical pulses to cauterize the skin covering the milia, allowing the contents to then be extracted.

 

In other cases, you may be prescribed a topical medication to treat the milia, but this is only for certain types of milia.

 

Who is suitable for treatment?

Anyone who suffers from milia whether it’s just a single one or many, regardless of size.

 

Contra-indications to treatment include:

Hepatitis B (highly infectious, virus not easily destroyed)

Blood disorders (Haemophilia)

Heart conditions, especially when taking blood thinners such as warfarin.

High blood pressure (can only treat when controlled or lowered)

Skin diseases and allergies (fungus infections, broken skin, active eczema or psoriasis)

Diabetic (skin is slower to heal)

Sun burn

Anti-coagulant drugs

Pregnancy (some disorders arise during pregnancy but can disappear after birth)

Keloid scarring (after injury there may be overgrowth of skin. Further keloids may develop after treatment).

General ill health (this can affect skin healing time)

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How does it feel to have Milium removed?

There will be a mild sensation similar to a stinging nettle on the skin when the Milia is cauterised. This sensation may remain for a few minutes after the procedure. To alleviate any discomfort, we can use a local anaesthetic before the treatment, so the treatment should be pain-free or cause very minimal pain in most cases.

 

Are there any side effects/downtime after treatment?

The area will look like mosquito bites after treatment, the skin will have been irritated due to contents of the milia being squeezed out. There will also be redness which can take a few days to completely reside. Although unlikely there is a possibility that scabs may form in the treated area; this will heal completely in 10 days.

 

How many treatments are needed?

In most cases 1 treatment is sufficient to remove the milia. If there are large numbers of milia present you may need several sessions to clear the area. If more treatment is needed, an interval of 2 weeks is advised between treatments to ensure skin healing.