Skin Conditions

Acne

Acne is a common skin condition that affects most people at some point. It causes spots to develop on the skin, usually on the face, back and chest. The spots can range from surface blackheads and whiteheads – which are often mild – to deep, inflamed, pus-filled pustules and cysts, which can be severe and long-lasting and lead to scarring.

Keeping your skin clean is important, but will not prevent new spots developing. Wash the affected area twice a day with a mild soap or cleanser, but do not scrub the skin too hard to avoid irritating it. If your skin is dry, use a moisturiser (emollient). Most of these are now tested so they don't cause spots (non-comedogenic).

If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription. See your GP if you cannot control your acne with over-the-counter medication or if it is causing you distress and making you feel unhappy.Also see your GP if you develop nodules or cysts, as they will need to be treated properly to avoid scarring.  

Acne is very common in teenagers and younger adults. About 80% of people between the ages of 11 and 30 will be affected by acne. It is most common between the ages of 14 and 17 in girls, and boys between 16 and 19. Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties. In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.

It affects the grease-producing glands next to the hair follicles in the skin. Certain hormones cause these glands to produce larger amounts of oil (abnormal sebum). This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus. There is no evidence that diet, poor hygiene or sexual activity play a role in acne.

Ringworm

Ringworm is a common and highly infectious skin infection that causes a ring-like red rash on the skin.

The rash can appear almost anywhere on the body, with the scalp, feet and groin being common sites. The condition, medically known as "tinea", isn't serious and is usually easily treated using creams sold by the pharmacy. However, ringworm is highly contagious and easily spread among people.nebDespite its name, it doesn't have anything to do with worms. It's an infection of the skin caused by a fungus.

You need to see your GP if you or your child have ringworm of the scalp. This type of ringworm is treated with antifungal tablets only available on prescription. Other types of ringworm are generally treated with antifungal cream from the pharmacy and you don't need to see a doctor unless the infection persists. However, pharmacists often prefer children to see a GP to confirm a diagnosis.

Ringworm is passed between people through direct skin contact and by sharing objects such as towels, hairbrushes and bedding. Pets such as dogs and cats can have ringworm, which they can pass on to people they come into contact with.

Ringworm is common. It's estimated that 10-20% of people will have a fungal skin infection at some point during their lifetime. People of all ages can be affected by ringworm, but children are particularly susceptible to it.

It's really important, where possible, to prevent spreading the infection. You should avoid sharing towels, bedding or clothes with anyone diagnosed with ringworm. If you think your pet has ringworm, take it to the vet. If your pet is treated quickly, you will be less likely to catch the infection from it. If your child has ringworm, they do not need to stay off school. However, you should inform the school your child has the condition. In addition to treatment, your child should maintain a good level of personal hygiene to prevent the infection spreading.

Psoriasis. 

Psoriasis is a condition on the skin that causes red, flaky, crusty patches of skin covered with silvery scales. 

These patches normally appear on your elbows, knees, scalp and lower back but can appear anywhere on your body. 

Most people are only affected in small patches. 

In some cases, the patches can be itchy or very sore.

Psoriasis only affects around 2% of people in the UK. 

It can start at any age, but most often develops in adults under 35 years old. 

For some people, it is just a minor irritation, for others it has a major impact on their quality of life. Many people's psoriasis symptoms start or become worse because of a certain event, known as a trigger. 

Knowing your triggers may help you to avoid a flare-up. 

Common triggers include:

an injury to your skin such as a cut, scrape, insect bite or sunburn 

drinking excessive amounts of alcohol

smoking

stress

hormonal changes, particularly in women (for example during puberty and the menopause)

certain medicines such as lithium, some antimalarial medicines, anti-inflammatory medicines 

ACE inhibitors (used to treat high blood pressure)

beta blockers (used to treat congestive heart failure)

throat infections 

other immune disorders, such as HIV.

Psoriasis is not contagious so it cannot be spread from person to person. There is no cure for psoriasis, but treatment will usually help keep the condition under control.

Most people with psoriasis can be treated by their GP. 

Your GP may refer you to a skin specialist (dermatologist) and their team in a hospital if your symptoms are particularly severe or did not respond well to other treatments. 

Your doctor will probably start with a mild treatment, such as topical creams (which are applied to the skin), and then move on to stronger treatments if necessary.

A wide range of treatments are available for psoriasis, but identifying which treatment is most effective can be difficult. 

Talk to your doctor if you feel a treatment is not working or you have uncomfortable side effects.

Treatments fall into three categories:

topical - creams and ointments that are applied to your skin

phototherapy - your skin is exposed to certain types of ultraviolet light

systemic - oral and injected medications that work throughout the entire body 

Often, different types of treatment are used in combination.Your treatment for psoriasis may need to be reviewed regularly. Most cases of psoriasis go through cycles, causing problems for a few weeks or months before easing or stopping. There are several different types of psoriasis. Many people have only one form of psoriasis at a time, although two different types can occur together. One type may change into another type or may become more severe.

There are many different types of psoriasis including; plaque psoriasis, scalp psoriasis and nail psoriasis.

Eczema. 

It mainly affects children, but can continue into adulthood.

Eczema is a condition that causes the skin to become itchy, red, dry and cracked. 

It is a long-term, or chronic, condition.

Eczema commonly occurs in areas with folds of skin, such as:

behind the knees

the inside of the elbows

on the side of the neck

around the eyes and ears

Eczema can vary in severity and most people are only mildly affected. 

Severe symptoms include cracked, sore and bleeding skin.

People with eczema usually have periods when symptoms are less noticeable, as well as flare-ups when symptoms become more severe, needing additional treatment. Symptoms include itchy, dry and red skin that may be broken or cracked.

Eczema can occur in small patches all over the body and is most common:

in infants – on the face and scalp, and on the arms and legs

in adults and children – on the hands or around joints on the arms and legs, such as the inside of the elbows or the backs of the knees

The symptoms of eczema vary according to how severely you or your child are affected by the condition.

People with mild eczema normally have only small areas of dry skin that are occasionally itchy. In more severe cases, eczema can cause widespread dry skin, constant itching and oozing fluid. 

Scratching can disrupt your sleep and make your skin bleed. It can also make itching worse, and a cycle of itching and regular scratching may develop. In children, this can lead to sleepless nights and difficulty concentrating at school. During a flare-up symptoms become worse and you or your child may need stronger treatment when this happens. 

During a flare-up, your skin may be:

extremely itchy, red, hot, dry and scaly

wet, weeping and swollen

infected with bacteria. There is no single cause of eczema. It probably has a mixture of inherited and environmental causes that act together at different times.

You may be born with an increased likelihood of developing eczema, which you inherit from your parents. 

Some of the most common allergens that can cause eczema include:

house dust mites

pet fur

pollen

Eczema can sometimes be caused by food allergens, especially before the age of one. Foods that typically cause allergic reactions include:

cows milk

eggs

nuts

soya

wheat

Some studies of children and young people with atopic eczema found that one-third to nearly two-thirds also had a food allergy.

Allergies do not always play a role. There are many other things likely to bring out eczema, including:  

cold weather

dampness

harsh soaps

washing too much

rough clothing 

Although there is no cure for eczema, treatments can ease the symptoms.Children with eczema normally find their symptoms naturally improve over time.

Medications used to treat eczema most commonly include:

emollients – used all the time for dry skin

topical corticosteroids – used to reduce swelling and redness during flare-ups

Your GP will prescribe emollients for dry skin and the weakest effective topical corticosteroid. 

Different strengths are needed for different parts of the body.

As long as the eczema is not infected, certain dressings or bandages – known as dry wraps, wet wraps and occlusive dressings – may also be applied by a healthcare professional.

They work by reducing itchiness, preventing scratching and helping to stop the skin from drying out.

Other medicines used to ease the symptoms of eczema include:

antihistamines

oral corticosteroids

antibiotics

topical immunosuppresants

IMPETIGO

Impetigo is a common and highly contagious skin infection that causes sores and blisters. It's not usually serious and often improves within a week of treatment.

There are two types of impetigo:

non-bullous impetigo, which typically affects the skin around the nose and mouth, causing sores to develop that quickly burst to leave a yellow-brown crust

bullous impetigo, which typically affects the central part of the body between the waist and neck, causing fluid-filled blisters to develop that burst after a few days to leave a yellow crust

Both types of impetigo may leave behind some red marks when the crusts have cleared up, but these will usually improve over the following days or weeks.

Speak to your GP if you think you or your child may have symptoms of impetigo.

Impetigo is not usually serious, but it can sometimes have similar symptoms to more serious conditions such as cellulitis (an infection of the deeper layers of skin) so it's important to get a correct diagnosis.

Your GP can also prescribe treatment to help clear up the infection more quickly than if it was left untreated.

Impetigo is caused by bacteria infecting the outer layers of skin.

The bacteria can infect the skin in two main ways:

through a break in otherwise healthy skin, such as a cut, insect bite or other injury

through skin damaged by another underlying skin condition, such as scabies or eczema.

The infection can be spread easily through close contact, such as through direct physical contact, or by sharing towels or flannels. Impetigo can affect people at any age but children more often than adults. Every year in the UK, around one in every 35 children up to four years of age and around one in every 60 children between four and 15 years of age will develop impetigo.

Non-bullous impetigo is the most common type of impetigo, accounting for more than 70% of cases. Bullous impetigo is most common in babies, although it can affect older children and adults too.

How impetigo is treated

Impetigo usually gets better without treatment in around two to three weeks, but treatment is often recommended because it can reduce the length of the illness to around seven to 10 days and can lower the risk of the infection being spread.

The main treatments prescribed are antibiotic creams or antibiotic tablets. These usually have to be used for around a week.

During treatment, it's important to take precautions to minimise the risk of impetigo spreading to other people or other areas of the body, such as by:

not touching the sores whenever possible

washing your hands regularly 

not sharing flannels, sheets or towels

staying away from work, school, nursery or playgroup until the sores have dried up or treatment has been continuing for at least 48 hours 

Most people are no longer contagious after 48 hours of treatment or once their sores have dried and healed.

Potential complications

Impetigo is rarely serious, but in some cases the infection can spread to other areas of the body and cause problems such as cellulitis and scarlet fever.

In very rare cases, impetigo may lead to some scarring, particularly if you scratch at the blisters, crusts or sores.

VITILIGO

Vitiligo is a long-term condition that causes pale, white patches to develop on the skin due to lack of a chemical called melanin.

Vitiligo can affect any area of your skin, but most commonly occurs on skin exposed to the sun, such as your face, neck and hands.

The condition varies from person to person. Some people only get a few small, white patches that progress no further. Other people get bigger white patches that join up across large areas of their skin.

There is no way of predicting how much of your skin will be affected. The white patches are usually permanent.

Why does vitiligo occur?

Vitiligo occurs due to a lack of melanin in the affected areas of skin. Melanin gives your skin its colour and protects it from the sun. It is not exactly clear what causes this lack of melanin, but it has been linked to problems with the immune system and nerve endings in the skin. Certain things can increase your chances of developing vitiligo, such as a family history of the condition or having another autoimmune problem, like an overactive thyroid gland. Vitiligo is not caused by an infection and you cannot catch it from contact with someone who has it. In the UK, about 1 in 100 people develop vitiligo. It usually starts to appear at around 20 years of age, although it can occur at any age. Women and men are equally likely to be affected. 

Diagnosis

Vitiligo can usually be identified by a GP after a physical examination. You may also be asked questions about your family's medical history and if the problem is affecting your confidence. In some cases, an ultraviolet lamp, may be shone on your skin to examine it in more detail and rule out other skin conditions. You may also be checked for symptoms of other autoimmune conditions, such as diabetes. Sometimes, blood tests are taken to check how well your thyroid gland is functioning.

How is vitiligo treated?

The white patches caused by vitiligo are usually permanent, although there are treatment options to improve the appearance of your skin.

If the patches are relatively small, skin camouflage cream may be used to cover them up.

In general, combination treatments, such as phototherapy (treatment with light) and medication, give the best results.

In some cases, treatment may restore pigment to your patches but the effect does not usually last. Unfortunately, there is nothing that can stop the condition from spreading.

Complications

Vitiligo can sometimes cause other problems. Due to a lack of melanin, your skin will be more vulnerable to the effects of the sun. If it is not protected with a strong sun cream, then sunburn is likely.  Vitiligo may also lead to a lack of pigmentation in your eyes and a partial loss of hearing. Problems with confidence and self-esteem are common in people with vitiligo, particularly if the condition affects areas of frequently exposed skin. Support groups can often help by putting you in contact with other people who have vitiligo. Your GP may suggest a group in your area. Charities such as The Vitiligo Society may be able to help.