Skin conditions

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Cysts

What are cysts?

An epidermoid cyst is a fluid-filled pocket under the surface of your skin. It looks and feels like a lump or bump on your skin.

Many people call epidermal inclusion cysts “sebaceous cysts.” The term “sebaceous cyst” is misleading because the cyst isn’t filled with sebum. Sebum is an oily substance created by your sebaceous glands that keeps your skin moist. Instead, a keratin (a protein) and cell debris fill epidermal inclusion cysts.

Who gets cysts?

Although they can appear at any age, epidermal inclusion cysts most frequently occur between ages 20 to 60. Epidermal cysts rarely appear before puberty. They’re more common in men than women.

Some rare genetic conditions and other conditions can lead to the development of multiple epidermal inclusion cysts.

What are the treatments for cysts?

Uncomplicated cysts do not need treatment but may be a cosmetic concern.

Complications of an epidermal cysts may include:

Inflamed cyst: The cyst is swollen and tender.

Infected cyst: Your body is fighting harmful bacteria within the cyst, which causes swelling, pain and skin discoloration.

Ruptured cyst: The cyst breaks open, which causes swelling, pain, skin discoloration and yellow (often stinky) fluid drainage.

In many cases, a healthcare provider may recommend monitoring a simple cyst and not treating it if it doesn’t cause symptoms.

If the cyst swells and/or causes discomfort, use a warm compress over the cyst to reduce symptoms at home. If your symptoms continue or get worse, contact a provider. They may recommend antibiotics

Epidermal cyst (sebaceous cyst) removal

A dermatologist or surgeon may remove the epidermal cyst with the following procedures:

Incision and drainage:

Your provider will make a small opening over the cyst and release the collection of fluid within the cyst. This procedure won’t resolve the cyst, since your provider won’t remove the cyst capsule (the outer portion of the cyst). It can help with inflammation and swelling.

Punch extrusion:

A surgical procedure that may remove the cyst. This procedure uses a local anesthetic (you won’t be asleep and you won’t feel pain). A small hole is made into the cyst and the contents squeezed out. Once empty, the surgeon pulls out the lining of the cyst through the small hole.

Surgical excision:

A surgical procedure that removes the cyst. This procedure uses a local anesthetic (you won’t be asleep and you won’t feel pain). A large cut is made in the skin and the surgeon explores under the cyst which is then removed in its entirety. The removal of the capsule (the outer portion of the cyst) prevents the cyst from growing back.

Granuloma annulare

What is granuloma annulare?

Granuloma annulare is a benign skin condition characterized by small, raised bumps that form a ring with a normal or sunken centre. The cause of granuloma annulare is unknown and it is found in patients of all ages. The condition tends to be seen in otherwise healthy people. Sometimes it is associated with diabetes or thyroid disease.

Who gets granuloma annulare?

It's not clear what causes granuloma annulare. Sometimes it's triggered by:

  • Animal or insect bites
  • Infections, such as hepatitis
  • Tuberculin skin tests
  • Vaccinations
  • Sun exposure
  • Minor skin injuries
  • Medicines

 

Granuloma annulare is not contagious. Granuloma annulare can be related to diabetes or thyroid disease, most often when it is extensive. It may, rarely, be related to cancer, especially in older people whose granuloma annulare is severe, doesn't respond to treatment or returns after cancer treatment.

What is the treatment for granuloma annulare?

Because granuloma annulare usually causes no symptoms and clears up by itself, you may not need treatment (except for cosmetic reasons). It is not contagious. If you do receive treatment, it may include corticosteroids (cream, tape, or injections). Other treatments, such as antibiotics, dapsone, retinoids, and niacinamide, may be considered for widespread granuloma annulare. Most granuloma annulare rashes resolve without treatment within 2 years. However, it is not uncommon to have new rings appear years later.

Infantile Haemangiomas

What are infantile haemangiomas?

An infantile hemangioma is a type of birthmark often called a strawberry birthmark. It happens when a tangled group of blood vessels grows in or under a baby's skin. The birthmark grows rapidly in the first three months of life, especially at 5-8 weeks. Growth is usually complete by 6 months. This is followed by a plateau period of no growth and then gradual involution usually after the child is 1. Most haemangiomas will have completed regression by the time the child is 11 years old. But some can leave a mark or loose skin.

Who gets infantile haemangiomas?

Infantile haemangiomas occur more frequently in female and premature infants, and those of low birth weight (<1 kg). The risk is increased during pregnancy in women who have pre-eclampsia, advanced maternal age, multiple gestation pregnancies, progesterone therapy in pregnancy, amniocentesis, and chorionic villus sampling.

What is the treatment for infantile haemangioma?

Most infantile haemangiomas are small, harmless, and resolve without treatment.
Treatment is indicated for lesions that have potential to affect vision, breathing, feeding, or by compression of internal organs), ulceration, or cosmetic disfigurement. Treatment is often oral propranolol for 6-12 months. Since treatment should be started as soon as possible, ideally before the rapid growth occurs, urgent referral to dermatology should be made.

Skin infections eg fungal, warts, scabies

What are skin infections?

A skin infection occurs when parasites, fungi, or germs such as bacteria penetrate the skin and spread. This can cause pain, itching, swelling, and skin colour changes.

Skin infections are different from rashes. A rash is an area of swollen or irritated skin. While rashes can be symptoms of some skin infections, a person with a rash does not necessarily have an infection.

Who gets skin infections?

You are more likely to get a skin infection if you:

  • Have poor circulation
  • Have diabetes
  • Are older
  • Have an immune system disease, such as HIV
  • Have a weakened immune system because of chemotherapy or other medicines that suppress your immune system
  • Have to stay in one position for a long time, such as if you are sick and have to stay in bed for a long time or you are paralysed
  • Are malnourished
  • Have excessive skinfolds, which can happen if you have obesity

Skin infections are different from rashes. A rash is an area of swollen or irritated skin. While rashes can be symptoms of some skin infections, a person with a rash does not necessarily have an infection.

Skin infections are caused by different kinds of germs. For example:

  • Bacteria cause cellulitis, impetigo, and staphylococcal (staph) infections
  • Viruses cause shingles, warts, and herpes simplex
  • Fungi cause athlete's foot and yeast infections
  • Parasites cause body lice, head lice, and scabies

 

 

What are the treatments for skin infections?

The treatment depends on the type of infection and how serious it is. Some infections will go away on their own. When you do need treatment, it may include a cream or lotion to put on the skin. Other possible treatments include medicines and a procedure to drain pus.
Sometimes close contacts will also need treatment to prevent re-infection.

Alopecia areata

What is alopecia areata?

Alopecia areata is an autoimmune disease that causes patchy hair loss anywhere on your body, but it most commonly affects the hair on the skin that covers your head (scalp). “Alopecia” is a medical term for hair loss and “areata” means that it occurs in small, random areas.

Who gets alopecia areata?

Anyone can develop alopecia areata. But your chances of having alopecia areata are greater if:

  • you’re a child
  • you have a family history of alopecia areata
  • you or your family members have an autoimmune disorder, including type 1 diabetes, pernicious anaemia, vitiligo, lupus or thyroid disease.

Alopecia areata is an autoimmune disease that causes your immune system to attack your body. Your immune system mistakenly attacks your hair follicles because it thinks they’re foreign invaders — bacteria, viruses, parasites or fungi — that cause infection, illness and disease.

When this happens, your hair begins to fall out, often in clumps the size and shape of a quarter. The extent of the hair loss varies. In some cases, it’s only in a few spots. In others, the hair loss may be more significant, including total hair loss.

There are many different classifications of alopecia areata. The classifications depend on the amount of hair you’ve lost and where you’ve lost it on your body.

  • Alopecia areata totalis: You’ve lost all your hair on your scalp.
  • Alopecia areata universalis: You’ve lost all your hair on your scalp and all your body hair.
  • Diffuse alopecia areata: Your hair is thinning rather than falling out in patches.
  • Ophiasis alopecia areata: You’ve lost a band of hair on the bottom back sides of your scalp (occipitotemporal scalp).

Alopecia areata causes your hair to fall out in patches. The patches are usually small and round — about the size of a quarter — but the shape and amount of hair you lose may be bigger or smaller. Nails may also develop dents or pits (cupuliform depressions). They may make your nails feel coarse or gritty, like sandpaper.

Alopecia areata doesn’t typically affect your physical health. However, it can affect you psychosocially (how society and social groups affect your thoughts and emotions) and psychologically (how you think about yourself and your behaviour). You may experience stress, anxiety and depression.

 

What are the treatments for alopecia areata?

Treatment options include:

Corticosteroids

Anti-inflammatory drugs are often used to treat autoimmune diseases. Corticosteroids are injected into your scalp or other areas, taken orally as a pill or applied topically (rubbed into your skin) as an ointment, cream or foam. Your body’s response to corticosteroids may be slow and the hair loss may come back when the treatment is stopped.
Minoxidil (Rogaine®): Minoxidil is a topical drug that treats male and female pattern baldness. It usually takes about 12 weeks of treatment before your hair begins to grow. Some side effects include headache, scalp irritation and unusual hair growth.

Topical immunotherapy

Your healthcare provider rubs an allergen into your skin to create an allergic reaction (contact dermatitis), which produces hair growth. Some side effects include scalp irritation, swollen lymph nodes (lymphadenopathy), eczema and skin discoloration.

JAK kinase inhibitor

Ritlecitinib (Litfulo) is an oral treatment that can be used for severe alopecia areata in people aged over 12. Severe is defined as when 50% of the scalp hair is lost. This medicine should be used with caution at risk of heart disease. There are possible severe side effects such as clots or affects on the immune system that might increase the risk of cancer.

Styling techniques

If your body doesn’t respond to other treatment options, you may be able to obscure or hide your hair loss with certain hairstyles, wigs or hair weaves.


Alopecia areata can be unpredictable. In some people, their hair grows back but falls out again later. In others, their hair grows back and never falls out again. Each case of alopecia areata is unique. Even if someone loses all of their hair, there is always a chance that it’ll grow back even without any treatment. Treatments may take up 12 weeks to start working.

Vitiligo

What is vitiligo?

Vitiligo is a skin condition that causes your skin to lose its colour or pigment. This causes your skin to appear lighter than your natural skin tone or turn white. If you have vitiligo on a part of your body that has hair, your hair may turn white or silver.

The condition occurs when your body’s immune system destroys melanocytes. Melanocytes are skin cells that produce melanin, the chemical that gives skin its colour or pigmentation.

Who gets vitiligo?

Vitiligo affects all races and sexes equally. It’s more visible in people with darker skin tones. Although vitiligo can develop in anyone at any age, it usually become apparent before age 30.

You might be at a higher risk of developing vitiligo if you have certain autoimmune conditions like:

  • Addison’s disease
  • Pernicious anaemia
  • Diabetes (Type 1)
  • Lupus
  • Psoriasis
  • Rheumatoid arthritis
  • Thyroid disease

 

What are the treatments for vitiligo?

Treatment for vitiligo isn’t necessary, as the condition isn’t harmful to your body, but may cause cosmetic concerns. There are various treatment options by either attempting to restoring colour (repigmentation) to the white areas or by eliminating the remaining colour (depigmentation) in your skin.

About 10% to 20% of people who have vitiligo fully regain their skin colour. This is most common among people who develop early vitiligo, experience the peak of the condition spreading within six months or less, have facial vitiligo. It’s less likely that you’ll regain your pigment if you develop vitiligo symptoms after age 20 or have vitiligo on your lips, limbs or hands.

Common treatments for vitiligo include:

Medications

There isn’t a specific medication to stop vitiligo from affecting your skin, but there are certain drugs that can slow the speed of pigmentation loss, help melanocytes regrow or bring color back to your skin. Medications to treat vitiligo could include:

  • corticosteroids
  • topical Janus kinase inhibitors (ruxolitinib-not currently NICE approved for use in Jersey and UK)
  • calcineurin inhibitors (eg Protopic).

Light therapy

Light therapy or phototherapy is the treatment to help return colour to your skin. Your provider will use light boxes, ultraviolet B (UVB) lights for a short amount of time. It can take several light therapy sessions to see results on your skin.

Combining oral psoralen medication and ultraviolet A light (PUVA) treats large areas of skin with vitiligo. This treatment is effective for people with vitiligo on their head, neck, trunk, upper arms and legs.

Depigmentation therapy

Depigmentation therapy removes the colour of your natural skin tone to match areas of your skin affected with vitiligo. Depigmentation therapy uses the drug monobenzone. You can apply this medication to pigmented patches of your skin. This will turn your skin white to match the areas of your skin with vitiligo.

Counselling

Some people diagnosed with vitiligo find counselling or visiting a mental health professional beneficial to help improve their self-esteem, anxiety or depression that can be associated with changes to their skin. Vitiligo can cause psychological distress and can affect a person’s outlook and social interactions. If this happens, your caregiver may suggest that you meet with a counsellor or attend a support group.

Skin cancers

What is skin cancer?

Skin cancer is a disease that involves the growth of abnormal cells in your skin tissues. Normally, as skin cells grow old and die, new cells form to replace them. When this process doesn’t work as it should — like after exposure to ultraviolet (UV) light from the sun — cells grow more quickly. These cells may be noncancerous (benign), which don’t spread or cause harm. Or they may be cancerous.

Who gets skin cancer?

Ultraviolet light, also called UV light, causes most of the DNA changes in skin cells. UV light can come from sunlight, tanning lamps and tanning beds. But sun exposure doesn't explain skin cancers that develop on skin that's not typically exposed to sunlight. Other factors can contribute to the risk and development of some skin cancer. The exact cause is not always clear. A report from 2020 showed that skin cancer is the most common cancer in Jersey, accounting for more than 40% of all cancer cases.

Risk factors

Factors that may increase the chances of getting skin cancer include:

  • Being in the sun too much. A lot of time spent in the sun or using tanning beds raises the risk of skin cancer. Getting severe sunburns also raises the risk.
  • Having skin that sunburns easily. Anyone of any skin colour can get nonmelanoma skin cancer, but it's more common in people who have low levels of melanin in their skin. Melanin is a substance that gives colour to skin. It also helps protect the skin from damaging UV light.

People with darker skin have more melanin than people with white skin. The risk of non-melanoma skin cancer is highest in people who have blond or red hair, have blue eyes, lots of freckles or sunburn easily.

  • A personal or family history of skin cancer. People who have had skin cancer before have a higher risk of developing it again. Those with a family history of skin cancer also may have a higher risk of developing skin cancer.
  • Medicines to control the immune system. Medicines that work by suppressing the immune system raise the risk of skin cancers significantly. Medicines that work in this way include those used after an organ transplant to prevent rejection.
  • Radiation therapy. Radiation therapy to treat acne or other skin conditions may raise the risk of skin cancer at the previous treatment sites on the skin.
  • Increasing age. The risk of some types of skin cancer goes up as people get older.
  • Inherited syndromes that cause skin cancer. Some rare genetic diseases can raise the risk of skin cancer.

 

What are the treatments for skin cancer?

Skin cancer can spread to nearby tissue or other areas in your body if it’s not caught early. Fortunately, if skin cancer is identified and treated in early stages, most are cured.

There are many types of skin cancer. The most common types are basal cell carcinoma, squamous cell carcinoma and melanoma.

Basal cell carcinomas (BCCs)

BCCs are abnormal, uncontrolled growths that arise from the skin’s basal cells in the outermost layer of skin (epidermis). BCCs are the most common form of skin cancer and most often develop on skin areas typically exposed to the sun, especially the face, ears, neck, scalp, shoulders and back. Most BCCs are caused by the combination of intermittent, intense exposure and cumulative, long-term exposure to UV radiation from the sun.
BCCs can be locally destructive if not detected and treated early, but are slow growing and do not generally spread around the body (do not metastasize). They can be treated with creams, cryotherapy (freezing), scraping or cutting away completely (excision) depending on size, thickness, location and preference. They tend to present with a slow growing non-healing scab or lump on the skin, that sometimes bleeds, or ulcerates and scabs. They are generally not painful.

Squamous cell carcinoma

Squamous cell carcinoma (SCC) is an uncontrolled growth of abnormal cells arising from the squamous cells in the outmost layer of skin (epidermis). They are the second most common type of skin cancer. SCCs are common on sun-exposed areas such as the ears, face, scalp, neck and hands. These are places where the skin often reveals signs of sun damage, including wrinkles and age spots. They are caused by cumulative, long-term exposure to UV radiation from the sun and tanning beds causes most SCCs. SCCs can sometimes grow rapidly and metastasize if not detected and treated early. They often present as a tender rapidly growing tender or painful lump on sun-exposed skin.

Melanoma

Melanoma is a cancer that develops from melanocytes, the skin cells that produce melanin pigment, which gives skin its colour. Melanomas often resemble moles and sometimes may arise from them. They can appear on any area of the body, even in areas that are not typically exposed to the sun. Melanoma is often triggered by the kind of intense, intermittent sun exposure that leads to sunburn. Tanning bed use also increases risk for melanoma.

How many people get it? In 2025, an estimated 212,200 new cases of melanoma are expected to occur in the U.S. Of those, 107,240 cases will be in situ (noninvasive), confined to the epidermis (the top layer of skin), and 104,960 cases will be invasive, penetrating the epidermis into the skin’s second layer (the dermis).

How serious is it? Melanoma is the most dangerous of the three most common forms of skin cancer. Melanomas can be curable when caught and treated early. In 2025, melanoma is projected to cause about 8,430 deaths.

Prevention

Most skin cancers can be prevented by protecting yourself from the sun. To lower the risk of skin cancer you can:

  • Stay out of the sun during the middle of the day. In Jersey and the UK, the sun's rays are strongest between about 10 a.m. and 3 p.m. Plan outdoor activities at other times of the day. When outside, stay in shade as much as possible.
  • Wear sunscreen year-round. Use a broad-spectrum sunscreen with an SPF of at least 30, even on cloudy days. Apply sunscreen generously. Apply again every two hours, or more often if you're swimming or sweating.
  • Wear protective clothing. Wear dark, tightly woven clothes that cover your arms and legs. Wear a wide-brimmed hat that shades your face and ears. Don't forget sunglasses.
  • Don't use tanning beds. The lights in tanning beds give off ultraviolet light. Using tanning beds increases the risk of skin cancer. Some countries such as Australia have made tanning beds illegal.
  • Check your skin often and report changes to your healthcare team. Look at your skin often for new growths. Look for changes in moles, freckles, bumps and birthmarks. Use mirrors to check your face, neck, ears and scalp.

Look at your chest and trunk and the tops and undersides of your arms and hands. Look at the front and back of your legs and your feet. Look at the bottom of the feet and the spaces between your toes. Also check your genital area and between your buttocks.

What is the treatment for skin cancer?

Treatment depends on the type of cancer. Some can be treated with creams, cryotherapy (freezing), scraping, but others need to be cut away completely (excision).

 

 

Support

After diagnosis of skin cancer, you will be provided with the contact details for a dedicated skin cancer specialist nurse. Further support can be provided in person from the Macmillan centre in Jersey General Hospital or on-line:
https://www.macmillan.org.uk/cancer-information-and-support/skin-cancer

 

Hives or urticaria

What are hives?

Hives is also known as 'urticaria' or 'nettle rash'. This skin rash can have a range of triggers, most commonly an allergic reaction. Other triggers include medicines or infections. In urticaria that has been going on for a long time, the cause is often unknown.

Who gets urticaria?

One in five children or adults has an episode of acute urticaria during their lifetime. It affects all races and both sexes.

Acute urticaria in children is usually caused by infection, even if afebrile. In older children food, medication, and inhaled allergens are also important causes. In adults, urticaria is usually idiopathic and spontaneous.

Chronic spontaneous urticaria affects 0.5–2% of the population; in some series, two-thirds are women. Chronic inducible urticaria is however more common. There are genetic and autoimmune associations.

Chronic urticaria is not an allergy. In some cases the origin may be autoimmune, which is why antibodies are detected that chronically stimulate mast cells that release histamine. In many other cases no triggering cause is identified.

What are the treatments for urticaria?

The main treatment of all forms of urticaria in adults and children is with an oral second-generation H1-antihistamine such as cetirizine or loratidine. If the standard dose (eg, 10 mg for cetirizine) is not effective, the dose can be increased up to fourfold (eg, 40 mg cetirizine daily). They are stopped when the acute urticaria has settled down. The addition of a second antihistamine is not thought to be helpful but other agents such as monteleukast may be added at this stage.

Patients with chronic urticaria that has failed to respond to maximum-dose second-generation oral antihistamines taken for four weeks should be referred to a dermatologist. Other medication such as omalizumab may be considered.

Acute urticaria resolves in hours to days but is often recurrent. Although chronic urticaria clears up in most cases, 15% continue to wheals at least twice weekly after two years.

Psoriasis

What is psoriasis?

Psoriasis is classed as an immune-mediated inflammatory condition which simply means that the immure system is not functioning correctly. Immune cells called T-cells become over active producing inflammatory chemicals called cytokines. This causes symptoms on the skin and can sometimes affect the joints.

In psoriasis the normal skin replacement process speeds up, taking just a few days to replace skin cells that usually take 21-28 days. This causes a build-up of immature skin cells seen as raised patches of flaky skin covered with silvery scales (known as ‘plaques’) which can also be itchy.

Psoriasis can occur on any area of the body, including the scalp, hands, feet and genitals, although different types tend to occur on different areas.

Who gets psoriasis?

Psoriasis affects between 2% and 3% of the UK population - up to 1.8 million people and it affects males and females equally.

Psoriasis can occur at any age, although there seem to be two ‘peaks’; from the late teens to early thirties, and between the ages of around 50 and 60.

Some people with psoriasis may also get psoriatic arthritis - a type of arthritis associated with the skin condition but this doesn’t affect everyone who has psoriasis.

Some people will have a family history of the condition, but others may not. A flare-up of psoriasis can be triggered by a number of factors, such as stress or anxiety, injury to skin, hormonal changes, or certain infections or medications.

What are the treatments for psoriasis?

Most people with psoriasis start their treatment under the guidance of a General Practitioner (GP). Psoriasis treatment usually starts with topical (applied to the skin) treatments, which can come in different formulations (creams, ointments, gels, etc) and have different active ingredients.

  • Moisturisers and emollients
  • Vitamin D based topicals
  • Topical steroids
  • Coal tar preparations
  • Dithranol preparations
  • Calcineurin inhibitors

Treatments from a Dermatologist

If psoriasis is severe, or if various types of topical treatments don’t work, a GP should provide a referral to a Dermatologist.

These may include:

  • Ultraviolet light therapy
  • Systemic treatments eg methotrexate, acitretin, ciclosporin, apremilast.
  • Biologic treatments eg adalimumab, secukinumab, risankinumab, geselkumab, ustekinumab.

Seborrhoeic dermatitis

What is Seborrhoeic dermatitis?

Seborrhoeic dermatitis is a common, chronic or relapsing form of eczema/dermatitis that mainly affects the sebaceous gland-rich regions of the scalp, face, and trunk. It affects 5% of the population. The of seborrhoeic eczema is not fully understood, but the yeast Malassezia ovale is known to play a role perhaps using the skin oils or sebum and producing unsaturated fatty acids which breach the skin's barrier function causing the inflammatory reaction.

Who gets Seborrhoeic dermatitis?

It is most commonly seen in men aged 18 to 40 but can occur at any age. Seborrhoeic dermatitis often occurs in otherwise healthy patients. However, the following factors are sometimes associated with severe adult seborrhoeic dermatitis:

  • Oily skin
  • Family history seborrhoeic dermatitis or a family history of psoriasis
  • Immunosuppression
  • Neurological and psychiatric conditions (eg Parkinson’s disease, tardive dyskinesia, depression, epilepsy, facial nerve palsy, spinal cord injury, Down syndrome)
  • Use of neuroleptic medications
  • Treatment for psoriasis with psoralen and ultraviolet A (PUVA) therapy
  • Lack of sleep
  • Stressful events

What is the treatment for Seborrhoeic dermatitis?

Treatment of seborrhoeic dermatitis often involves several of the following options.

  • Keratolytics: used to remove scale when necessary, e.g. salicylic acid, lactic acid, urea, propylene glycol.
  • Topical antifungal agents: applied to reduce the yeast Malassezia e.g. ketoconazole shampoo and/or cream.
  • Mild topical corticosteroids: for 1–3 weeks to reduce the inflammation of an acute flare.
  • Topical calcineurin inhibitors: (pimecrolimus cream, tacrolimus ointment) are indicated if topical corticosteroids are needing to be used frequently, as they have fewer adverse effects on facial skin with long term use.
  • In resistant cases in adults, oral itraconazole, tetracycline antibiotics, or phototherapy may be recommended. Low-dose oral isotretinoin has also been shown to be effective for severe or moderate disease.

 

Eczema

What is Eczema?

Eczema is a condition that causes dry skin, itchiness, rashes, scaly patches, blisters and skin infections. There are seven types of eczema that affect the skin. There is no cure for eczema but there are many treatments available to help you manage it.

Who gets eczema?

Many people with eczema use the phrase “flare” to describe a phase of eczema that can last many days or even several weeks when they are experiencing one or more exacerbated eczema symptoms or side effects from prolonged itchiness. Severe eczema can come with additional complications beyond itchy skin and rashes, such as infections that can lead to hospitalization if left untreated. Both genetic and environmental factors play a role.

Atopic dermatitis usually occurs in people who have an 'atopic tendency'. This means they may develop any or all of three closely linked conditions; atopic dermatitis, asthma and hay fever (allergic rhinitis). Often these conditions run within families with a parent, child or sibling also affected.

Current evidence points to mutations in the filaggrin gene being likely to underlie almost half the cases of atopic eczema. Filaggrin is needed for maintaining the outermost barrier layer of the skin. So, the starting point to what causes eczema is the primary defect in the skin barrier function. Later changes are probably because the skin is a poor barrier so the skin becomes sensitised to environmental triggers such as the dust mite or weeds, trees and grass pollens. The relevance of this finding is that it reinforces the importance of the regular use of emollients to help manage eczema.

Spontaneous flare-ups are often the result of triggers, which commonly include:

  • Soap and detergents
  • Overheating / rough clothing
  • Stress
  • Skin infection
  • Other triggers only affect certain people, these include:
  • Animal dander (fur, hair) and saliva - if resulting from a pet, symptoms often improve when patients spend time in a different environment for a few days
  • House-dust mites and their droppings - sensitised patients may notice a worsening of facial eczema when they wake up
  • Food - primarily in infants and young children
  • Aero-allergens (pollens) - reactions to airborne allergens may cause a worsening of symptoms (often facial) over spring / summer in those sensitised. This is most commonly seen in older children and adults.

 

 

What are the treatments for eczema?

Treatment overview

Complete emollient therapy to the whole skin every day - the correct use of moisturisers and avoiding all soap by using soap substitutes

Steroid creams / ointments for a flare (red/itchy areas of skin) - apply thinly to affected areas of skin. Often 2 strengths of steroids should be kept at home, one mild and a stronger. The milder treatment is used for mild flares, and on thinner areas of skin (eg face, skin folds and lower legs), the stronger treatment can be used for short spells during more troublesome flares and on thicker areas of skin

The weekend steroid regime, frequent flares often benefit from applying steroid creams/ointments on two consecutive days a week once a flare has settled.

Topical calcineurin inhibitors - should be considered on areas of thin skin (eg the face) if too much steroid cream has been needed.

In both children and adults it is more effective and safer to 'hit hard' using more potent treatments for a few days than it is to use less potent treatments for longer periods of time. This involves use of a moderate to potent topical steroid eg Betnovate ® or Elocon ® OD until things settle down

Where there is marked sleep disturbance a short-term use of a sedating anti-histamine at night eg adults - Atarax ® (hydroxyzine) 25-50 mg, and children - Piriton ® (chlorpheniramine) 5-15 mg can be used. This is not part of the long term treatment of eczema.

Skin swabs should be considered if the eczema does not respond to the above measures.

Moisturisers

The most important factor is to find a cream that you like and are happy to use. Ointments are less likely to cause contact allergic dermatitis as they do not contain preservatives but are more poorly tolerated as they may feel ‘heavy’ on the skin.

Frequent and liberal emollient use can reduce the chances of a flare of eczema. They need to be applied downward in the direction of the hairs to lessen the risk of folliculitis (pus spots). All emollients may sting if applied to inflamed skin.

Order of application - if topical steroids are also being used, moisturisers can be applied first and allowed to dry for 15-20 minutes before applying the topical steroid. Take care to wash hands before applying emollients to infants and very young children as there there is some evidence that this may reduce the risk of peanut and various other food allergies.

 

Topical steroids

Use the lowest appropriate potency and only apply thinly to inflamed skin

  • Allow moisturisers to dry into skin for 20 minutes before applying the steroid
  • Avoid using combined steroid / antibiotic preparations on a regular basis (eg Fucibet® and Fucidin-H ® cream) as it will increase the risk of antibiotic resistance
  • Strength of steroid to be determined by the age of patient, site and severity:
  • Child face: mild potency eg 1% hydrocortisone
  • Child trunk and limbs: moderate potency eg Eumovate ® (clobetasone butyrate 0.05%) or Betnovate-RD ® (betamethasone valerate 0.025%)
  • Adult face: mild or moderate potency eg Eumovate ®
  • Adult trunk and limbs: potent eg Betnovate ® (betamethasone valerate 0.1%), Elocon ® (mometasone)
  • Palms and soles: potent or very potent eg Dermovate ® (clobetasol propionate 0.05%)

If used appropriately it is uncommon to develop steroid atrophy.

 

For more frequent flares

You may be asked to start a weekender regime - Betnovate ® or Elocon ® should be applied thinly to inflamed areas OD for two weeks and then alternate days for a further two weeks. Once the eczema is under control, it is used on two consecutive days (eg Saturday and Sunday) of each week to the areas that tend to flare. The treatment must be applied even if the skin in not inflamed - the aim is to reduce the frequency of flare-ups (a preventative regime).

An alternative to using topical steroids is to use Protopic ® ointment - as above the eczema first needs to be brought under control by more frequent use of the Protopic and then reduced down to twice a week

In general, antibiotics have a limited role in eczema, however, if the eczema continues to flare swab the skin and treat if results are relevant.

 

Severe eczema

Severe eczema which is poorly controlled despite these measures may need referral to a dermatologist for systemic medication (tablets or injections). The new treatments such as dupilumab are only used for severe eczema after more established treatments such as ciclosporin or methotrexate have been used.

Rosacea

What is rosacea?

Rosacea is a common chronic inflammatory skin condition affecting 1 in 10 people in the UK, mainly affecting the central face and most often starts between the age of 30–60 years.

Rosacea is common and is characterised by persistent facial redness with or without spots. It typically has a relapsing and remitting course.

Who gets rosacea?

Rosacea is estimated to affect around 5% of adults worldwide. It affects men and women equally but men are thought to be less likely to ask for medical treatment for this.

Rosacea typically presents after the age of 30 and becomes more prevalent with age. Although rosacea can affect anyone, it is more common in those with fair skin, blue eyes, and those of Celtic or North European descent. Typically there is a history of ‘sensitive’ skin.

What is the treatment for rosacea?

Although there is no cure for rosacea, symptoms can be managed with the following lifestyle measures, medical, and procedural interventions.

General Measures

Lifestyle advice

Consider keeping a diary to record a symptoms to aid the identification of triggers:

Common triggers include spicy food, hot/cold temperatures (hot baths), exercise, sun exposure, cosmetic products, medications (those that cause vasodilation), alcohol, fruits and vegetables, dairy, marinated meat products and avoid the triggers identified.

Moisturise frequently and use gentle over-the-counter cleansers such as Cetaphil®.

Physical sunscreens (ie, zinc oxide/titanium oxide) with SPF ≥ 30 provide a broad-spectrum of UV radiation and visible light protection and may be better tolerated than chemical sunscreens which irritate the sensitive skin associated with rosacea. Avoid skin irritants such as exfoliants and alcohol-based topical products. Topical steroids are a known trigger for rosacea and use should be avoided on the face in anyone predisposed to rosacea as they may aggravate the condition

Cosmetics with a green tint such as Rosalique 3:1®  are useful to minimise the appearance of redness and may have soothing other ingredients to settle inflammation.

Specific measures

Existing treatments for rosacea can be very effective — however, they often target only one feature. A combination of therapies may be required where patients present with multiple features and in severe rosacea.

Transient erythema (flushing)

  • Alpha-adrenergic agonists eg topical brimonidine (Mirvaso®) — they are often used infrequently for special occasions only, as persistent use may result in rebound flushing on discontinuation
  • Oral beta-blockers (carvedilol)
  • Oral clonidine may reduce flushing

Persistent erythema

  • Alpha-adrenergic agonists (topical brimonidine, topical oxymetazoline, as above)
  • Intense pulsed light therapy
  • Vascular laser

Inflammatory papules/pustules

  • Topical azelaic acid (for mild/moderate only)
  • Topical ivermectin
  • Topical metronidazole (for mild/moderate only)
  • Topical erythromycin
  • Oral tetracyclines (oxytetracycline, lymecycline, doxycycline)
  • Oral macrolides (erythromycin, azithromycin)
  • Oral metronidazole
  • Oral isotretinoin often at low dose, long courses (if other measures ineffective)

Telangiectasia

  • Electrodesiccation
  • Intense pulsed light therapy
  • Vascular laser

 

Acne

Acne

What is acne?

Acne is a common chronic disorder affecting the hair follicle and sebaceous gland, in which there is expansion and blockage of the follicle and inflammation.

Who gets acne?

Acne affects males and females of all races and ethnicities. It is found most commonly in adolescents and young adults, with 85% of 16 to 18 year-olds affected. However, it may sometimes occur in children and adults of all ages. There is commonly another peak in women who are middle aged. There is some evidence that acne is becoming more common in the UK.

 

 

What are the treatments for acne?

Mild acne can be treated with topical treatments such as benzoyl peroxide (purchased over the counter as Acnecide®), retinoids, antibiotics or azelaic acid (over the counter as Skinoren®).

Moderate acne can be treated as for mild acne, but with the addition of courses of antibiotics such as lymecycline, doxycycline or erythromycin. Low dose oral contraceptives or spironolactone (blood pressure tablet with anti-male hormone properties) may be used in women. If the acne does not respond to these measures or if there is scarring then isotretinoin (Roaccutane®)may be considered.

Severe acne

Where there is severe acne, such as deep nodules or cysts or scarring, referral to a dermatologist should be undertaken for consideration of isotretinoin. Severe acne can cause generalised symptoms such as fever and tiredness in which case the need to see a dermatologist is urgent.

The main principle of acne treatment is to try to prevent acne scarring occurring.

Support

There is widespread misinformation about acne. To counter some of the myths and provide evidence based information the British Association of Dermatologists has created the website https://www.acnesupport.org.uk/