Acne
What is acne?
Acne is a very common skin condition characterised by comedones (blackheads and whiteheads) and pus-filled spots (pustules). It usually starts at puberty and varies in severity from a few spots on the face, back and chest, which most adolescents will have at some time, to a more serious problem that may be embarrassing, sap self-confidence and cause scarring. For the majority it tends to resolve by the late teens or early twenties but can persist for longer in some people. Acne can develop for the first time in people in their late twenties or even the thirties. It occasionally occurs in young children.
What causes acne?
The sebaceous (oil-producing) glands of people who get acne are particularly sensitive to normal blood levels of a hormone called testosterone, which is present in both men and women. This causes the glands to produce an excess of oil. At the same time, the dead skin cells lining the pores are not shed properly and clog up the follicles. These two effects result in a build-up of oil producing blackheads (where a darkened plug of oil is visible) and whiteheads.
The acne bacterium (known as Propionibacterium acnes) lives on everyone’s skin, usually causing no problems, but, in those prone to acne, the build up of oil creates an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots.
Is acne hereditary?
Acne can run in families, but this does not necessarily mean that if your parents had acne you will get it too.
What does acne look like and what does it feel like?
The typical appearance of acne is a mixture of the following: an oily skin, blackheads and whiteheads, red spots and yellow pus-filled pimples, and scars. Occasionally, large, tender spots or cysts may develop which can either eventually burst and discharge their contents or may heal up without bursting.
How is acne diagnosed?
Acne is easily recognised by the appearance of the spots and by their distribution on the face, neck, chest or back. However there are several varieties of acne and your doctor will be able to tell you which type you have after examining your skin. The most common type is “acne vulgaris”.
Can acne be cured?
At present there is no ‘cure’ for acne, although the available treatments can be very effective in preventing the formation of new spots and scarring.
Eczema (Atopic Eczema)
What is atopic eczema?
Atopic eczema is an inflammatory condition of the skin. Atopic is the term used to describe conditions such as eczema, asthma, seasonal rhinitis and hay fever, which often have a genetic basis. Eczema is the term used to describe changes in the upper layer of the skin that include redness, blistering, oozing, crusting, scaling, thickening and sometimes pigmentation (although not all of these changes will necessarily occur together). The words eczema and dermatitis are interchangeable and mean the same thing: thus atopic eczema is the same as atopic dermatitis. For simplicity we shall use atopic eczema in this leaflet.
Atopic eczema affects both sexes equally and usually starts in the first weeks or months of life. It is most common in children, affecting at least 10% of infants at some stage. It usually disappears during childhood, although it can carry on into adult life or come back in the teenage or early adult years. It may occasionally develop for the first time in adulthood.
What causes atopic eczema?
This is still not fully understood. A tendency to atopic conditions often runs in families (see below) and is part of your genetic make-up. In people with atopic eczema, the function of their skin as a barrier to the outside world does not work well, so that irritant and allergy-inducing substance enter their skin, and may cause dryness and inflammation. Atopic eczema is not catching.
Is atopic eczema hereditary?
Yes. Atopic eczema (as well as asthma and hay fever) tends to run in families. If one or both parents suffer from eczema, asthma or hay fever, it is more likely that their children will suffer from them too. In addition, there is a tendency for these conditions to run true to type within each family: in other words, in some families most of the affected members will have eczema, and, in others, asthma or hay fever will predominate.
What are the symptoms of atopic eczema?
The main symptom is itch. Scratching in response to itch may be the cause for many of the changes seen on the skin. Itching can be bad enough to interfere with sleep, causing tiredness and irritability.
What does atopic eczema look like?
Atopic eczema can affect any part of the skin, including the face, but the areas most commonly affected are the bends of the elbows and knees, and around the wrists and neck (a flexural pattern). Other common appearances of atopic eczema include discrete coin-sized areas of inflammation (a discoid pattern), and numerous small bumps that coincide with the hair follicles (a follicular pattern).
If you have eczema, it is likely your skin will be red and dry, and scratch marks (and bleeding) are common. When the eczema is very active (during a ‘flare-up’) you may develop small water blisters on the hands and feet, or the affected areas of your skin may become moist and weepy. In areas that are repeatedly scratched, the skin may thicken up (a process known as lichenification), and become even more itchy.
What makes atopic eczema flare up?
Many factors in a person’s environment can make eczema worse. These include;
- Heat, dust and contact with irritants such as soap or detergents
- Being unwell: for example having a common cold can make eczema flare
- Infections with bacteria or viruses can make eczema worse. Bacterial infection (usually with a bug called Staphylococcus) makes the affected skin yellow, crusty and inflamed, and may need treatment with antibiotics. An infection with the virus that causes cold sores (herpes simplex virus) can cause a painful widespread (and occasionally dangerous) flare of eczema, and may need treatment with antiviral tablets
- Dryness of the skin
- Perhaps stress
How is atopic eczema diagnosed?
It is usually easy for health care professionals, such as health visitors, practice nurses and general practitioners, to diagnose eczema when they look at the skin. However, sometimes the pattern of eczema in older children and adults is different, and the help of a hospital specialist may be needed. Blood tests and skin tests are usually not necessary. Occasionally the skin may need to be swabbed (by rubbing a sterile cotton bud on it) to check for bacterial or viral infections.
Can atopic eczema be cured?
No, it cannot be cured, but there are many ways of controlling it. Most children with atopic eczema improve as they get older (75% clear by their teens). However, many of those who have had eczema continue to have dry skin and need to avoid irritants such as soaps or bubble baths. Eczema may persist in adults, but it should be controllable with the right treatment. Atopic eczema may be troublesome for people in certain jobs that bring them into contact with irritant materials, such as catering, hairdressing or nursing.
Contact Dermatitis
What is contact dermatitis?
The words ‘dermatitis’ and ‘eczema’ are interchangeable and mean the same thing. Contact dermatitis, therefore, is the same thing as contact eczema. For simplicity we will stick to the word ‘dermatitis’ in this leaflet.
Dermatitis means an inflammation of the skin. The term ‘contact dermatitis’ is used when this inflammation is caused by contact with something in the environment.
What causes contact dermatitis?
Two main groups of things in the environment cause contact dermatitis: irritants and allergens.
Irritants are substances like detergents and solvents that strip the skin of its natural oils, and cause dermatitis to develop if contacted frequently and without skin protection. When this happens, the skin changes are known as an irritant contact dermatitis. The most important factor in causing this type of contact dermatitis is the amount of irritants to which you are exposed. It is particularly common in people who do a lot of wet work, for example nurses, hairdressers, those who work in bars, and those in the catering trade.
Allergens are things to which your immune system can develop a specific reaction after you have come into contact with them. Examples include substances such as nickel, rubber, and perfumes or preservatives used in some creams and cosmetics. This type of dermatitis is called an allergic contact dermatitis. It is not known why some people who are exposed to these allergens develop it while others do not.
Sometimes substances such as proteins in fruit and vegetables can cause an immediate allergic reaction leading to itchy skin swellings known as contact urticaria (hives), which in turn can aggravate your dermatitis.
Contact dermatitis cannot be caught from nor spread to other people.
Is contact dermatitis hereditary?
People with a tendency to asthma, eczema and hay fever develop irritant contact dermatitis more easily than others, and this tendency does run in families.
What are the symptoms of contact dermatitis?
Itching of the skin is the commonest symptom, and this can be intense. Sometimes the skin becomes sore, and painful cracks can develop over the backs of the fingers when dermatitis affects the hands.
What does contact dermatitis look like?
The commonest areas on which contact dermatitis occurs are the hands, arms, face and legs. During a flare, contact dermatitis inflames the skin surface making it look red and scaly. Sometimes, tiny water blisters develop and these leak fluid when scratched. When the contact dermatitis is less active, the skin looks thick and dry, and painful little cracks can form over joints.
How will it be diagnosed?
Irritant contact dermatitis is diagnosed simply by knowing which irritant substances your skin is exposed to, and how often this occurs.
Allergic contact dermatitis is diagnosed by a procedure available in specialist dermatology departments known as patch testing. This involves putting sticky patches containing different substances on your back. The patches are taken off 2 days later, and the doctor or patch test nurse will then look at your back to see which ones have reacted. They will need to look again after a further 48 hours to see if there are further reactions.
Can contact dermatitis be cured?
Yes - if you can greatly reduce your contact with irritants, then your irritant contact dermatitis will improve or clear.
If patch testing shows that you are allergic to a specific allergen, then avoiding that allergen will usually lead to a big improvement or even complete clearance of your allergic contact dermatitis.
Herpes Simplex
What is herpes simplex?
Herpes simplex is an infection of the skin with the herpes simplex virus. This can be caught from another person after direct skin-to-skin contact, mouth contact, or sexual contact. The first time the virus is caught, it does not always show up on the skin, but can lie dormant within special parts of the sensory nerves (the sensory nerve ganglia). Later in life, the virus can become active again and appear as herpes simplex on the skin. The commonest areas to be affected by herpes simplex are the lips (as cold sores) and the genital area (as genital herpes).
Is herpes simplex hereditary?
No.
What does herpes simplex feel like and what does it look like?
The very first infection is often un-noticed as it may only produce a short-lived redness of the skin. Sometimes, however, a first infection can make a person feel very unwell with a temperature, swollen lymph glands and soreness and blisters in the mouth and on the lips or elsewhere on the skin.
When the herpes simplex virus infection becomes active again, the first symptom is a burning or stinging pain at the affected site, followed by pink bumps and small blisters. The blisters quickly dry and crust over, and the areas usually heal over within a few days. Repeated attacks usually occur in roughly the same place each time.
If Herpes simplex virus infects the eye it causes pain, sensitivity to light and discharge and can cause scarring.
How is herpes simplex diagnosed?
Usually the appearance of skin affected by herpes simplex is enough to make a diagnosis. Sometimes a surface swab is taken, but getting the result usually takes a few days. If you think you have herpes in the genital area, you can be seen quickly at your local Genito-Urinary Medicine (GUM) or Sexual Health clinic.
Can herpes simplex be cured?
Symptoms clear in a few days or weeks, with or without treatment, though the virus will remain in a dormant state in the body. In a majority of patients, recurrent symptoms are mild and infrequent, or do not happen at all. For a minority, troublesome recurrences can usually be prevented by using oral anti-viral drugs or adopting lifestyle changes.
Things that encourage the virus to be more active are:
- Other infections such as colds or ‘flu.
- Getting tired and run-down.
- Sunburn
- A skin injury, such as an operation or a graze, at the place where the virus shows itself at the surface
http://www.britishskinfoundation.org.uk/SkinInformation/AtoZofSkindisease/Ichthyosis.aspx
