Acne

Acne Medical Skin Treatments Dr Justin Lim Professor Yoland Lim Dr Selina Lim Laser Cosmetic

Acne (pimples) is a very common skin condition usually appearing during the teenage years (during puberty) but can also appear during adulthood[1]. Although there are multiple factors and conditions that lead to acne, there are two types which are the most common onsets: 

1) Acne vulgaris and 

2) Acne rosacea[2]


Acne vulgaris is the most common type that causes pimples in adolescents whereas acne rosacea presents itself in adulthood. Affecting 85% of Australians aged between 15-24 years old, acne vulgaris develops when the oil glands or pores in the skin get blocked[3]. This blockage is prevalent during puberty as increased levels of androgens (normal sex hormones) create an increase in the size and sebum (oil) production of glands. Increased production of oil ultimately result in irritation and lead to redness, swelling and tenderness of the pimple. 


Unfortunately the onset of acne especially during adolescence can result in psychological consequences. Due to acne being a visible skin condition, studies have found and proven acne can be responsible for depression and low self-esteem[4]. Luckily there are multiple effective and successful treatments available for acne including over-the-counter treatments, lifestyle changes, prescription medications and even acupuncture[5],[6], 

    

References:

[1] Better Health Victoria (2018, April) Acne betterhealth.vic.gov.au/health/conditionsandtreatments/acne 

[2] ABC Health & Wellbeing (2017, August) When acne isn’t just a teenage phase abc.net.au/news/health/2017-08-09/when-acne-isnt-just-a-teenage-phase/8687240

[3] All about acne (2018, August) Hormones acne.org.au/acne-whats-to-blame

[4] Revol O et al (2015, July) Psychological impact of acne on 21st-centry adolescents: decoding for better care. doi: 10.1111/bjd.13749 

[5] Health Direct (2019, October) Acne healthdirect.gov.au/acne

[6] Mansu et al (2018, March) Acupuncture for Acne Vulgaris: A Systematic Review and Meta-Analysis. Doi: 10.1155/2018/480

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Bags Under Eyes

Bags under eyes is a typical occurrence where the tissue around the eyes become weaken and sag[1]. Due to the loss of skin tone around the eyes, the fat around the eyes shifts to the lower eyelids causing a puffy and swollen look. Apart from ageing, other factors which may cause bags under eyes include allergies, not getting enough sleep and smoking tobacco. 


Summary of Causes:

  • Fluid retention, especially upon waking or after a salty meal
  • Lack of sleep
  • Allergies
  • Smoking
  • Heredity — under-eye bags can run in families[2]


Remedies and treatments for bags under eyes depend on the cause[3]. For example, if bags under eyes were solely due to an ageing factor, a cosmetic solution such as plastic surgery may be most appropriate. Bags under eyes as a consequence of allergies may be treated using medications[4], however prior to taking any medications it is recommended to consult your medical practitioner to ensure the correct cause is found. 


References:

[1] American Academy of Ophthalmology (2018, November) Bags Under the Eyes haao.org/eye-health/tips-prevention/bags-under-eyes

[2] Mayo Clinic: Patient Care & Health Information, Diseases & Conditions, mayoclinic.org/diseases-conditions/bags-under-eyes/symptoms-causes/syc-20369927

[3] All about vision. How to get rid of bags under your eyes. allaboutvision.com/conditions/bags-under-eyes/ 

[4] John Hopkins Medicine. How to get rid of bags under your eyes. hopkinsmedicine.org/health/treatment-tests-and-therapies/how-to-get-rid-of-bags-under-your-eyes 

Eczema (atopic dermatitis)

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Eczema (atopic dermatitis) is a chronic inflammatory skin condition whereby the skin does not retain moisture very well resulting in dry skin causing the skin to become vulnerable to allergens and irritants[1] resulting in the characteristic itchiness. This then leads to a vicious cycle where the allergens and irritants cause itching leading to more chemicals in the skin to be released. Although, the culprit of what causes eczema is unknown, it is thought to be due to a genetic mutation causing an inability to repair the damage to the skin barrier[2]. 


Common symptoms of eczema include red, dry, scaly and itchy skin and are more often found behind the knees, neck, wrists and elbows[3]. Unfortunately there is no cure for eczema from a western medicine perspective but there are a variety of potentially effective strategies for management such as ensuring the skin is always moisturised, staying cool, avoiding irritants such as detergents and toothpastes and applying cool towels to the itchy area for immediate relief[4].

 

References

[1]Australian Society of Clinical Immunology and Allergy (2019) Eczema (Atopic Dermatitis). allergy.org.au/patients/skin-allergy/eczema

[2] Better Health Channel (2018, April) Eczema (atopic dermatitis) betterhealth.vic.gov.au/health/ConditionsAndTreatments/eczema-atopic-dermatitis

[3] Health Direct (2017, December) Eczema healthdirect.gov.au/eczema

[4] The Royal Children’s Hospital Melbourne (2018, March) rch.org.au/kidsinfo/fact_sheets/Eczema

Keloid Scarring

Keloid scarring or keloids are a type of scar caused by abnormal wound healing in response to injury such as trauma, burns, vaccinations, surgery, skin piercings and acne[1], on a background of a predisposition to this.


Normal and healthy wound healing consists of three stages: 

1. Inflammatory

2. Fibroblastic

3. Maturation 


In cases where keloids are formed, there is an overactivity of the fibroblastic stage causing an overproduction of collagen and cytokines. This then results in the appearance of shiny, smooth and rounded skin elevations that may be itchy, tender or uncomfortable[2]. It is thought the cause of this to be due to both genetic and environmental factors[3]. 


Although affecting all ethnic populations, higher incident rates are observed in darker skinned individuals of African and Asian descent[3]. Development of keloids are commonly found on the upper back, chest and shoulders but can also form anywhere[3]. There are a variety of methods to treat keloids including conventional surgery, corticosteroid injections, laser therapy, radiation therapy, cryosurgery and compression to reduce the size of the keloid. According to Harvard it is important to note the optimal results may involve a combination of these methods[2]. 


References

[1] Larson et al (2011) Scarring and scarless wound healing. Advanced Wound Repair Therapies 77-111. 

[2] Health Harvard (2019, April) health.harvard.edu/a_to_z/keloids-a-to-z

[3] McGinty and Siddiqui (2019, March) Keloid. StatPearls 

Onychomycosis (fungal toe nail infections)

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Onychomycosis (fungal toe nail infections) are common infections of the toenail resulting in discoloured and thick nails[1]. For some patients it appears as yellow, mustard colour, or even grey and black colours. 


Fungal toe nails can happen to anyone but may be commoner in people who have/had:

  • nail or toe surgery 
  • athletes foot
  • diabetes
  • a weakened immune system or 
  • blood circulation disorder


For some patients the abnormal shape and look of their nails can make them feel down, and potentially impact their social life, affecting what clothes and footwear they wear as they are hyperaware of their nails.


Depending on the severity of the condition, treatment of onychomycosis may involve the chemical or surgical removal of the infected nail, topical treatments, or a combination of treatments[2]. It is important this condition is treated as deformed nails can lead to surrounding tissue damage resulting in secondary bacterial infection[3]. 

    

References

[1] Center for Disease Control and Prevention (2017, January) Fungal Nail Infections cdc.gov/fungal/nail-infections.html

[2] Ghannoum and Isham (2014) Fungal Nail Infections (Onychomycosis): A Never- Ending Story? doi: 10.1371/journal.ppat.1004105

[3] Shirwaikar et al (2008) Treatment for Onychomycosis: An Update doi: 10.4103/0250-474X.49088

Psoriasis

Psoriasis is a common inflammatory skin condition thought to be attributed to dysfunction of the immune system. 


Typically, psoriasis affects the outside of the:

  • elbows
  • knees
  • nails
  • scalp[1] 


There are numerous kinds of psoriasis such as:

  • pustular psoriasis
  • guttate psoriasis
  • flexural psoriasis
  • napkin psoriasis 
  • plaque psoriasis- the commonest form[2]


Although psoriasis causes different symptoms in those affected, common symptoms include red, dry and raised patches of skin known as plaques2. In mild cases, topical agents are generally used to treat psoriasis such as moisturisers, corticosteroid creams and ointments[3]. In some cases, ultraviolet light therapy can be used to help slow down the production of skin cells. 


References

[1] National Psoriasis Foundation (2019, October). Psoriasis. psoriasis.org/about-psoriasis

[2] Better Health Channel (2018, April) Psoriasis. betterhealth.vic.gov.au/health/ConditionsAndTreatments/psoriasis

[3] Health Direct (2019, March) Psoriasis. healthdirect.gov.au/psoriasis

Rosacea

Rosacea or acne rosacea is a common and non-contagious skin condition exclusively affecting the face. Although there are four subtypes of rosacea each displaying different signs and symptoms, it is typically characterised by:

  • redness
  • flushing and 
  • possibly pimples on the face[1]


The exact cause of rosacea is unknown but it is thought that it occurs due to sensitivity to a microscopic parasite that naturally lives on human skin known as the Demodex folliculorum mite[2]. Envrionmental factors which can also trigger the onset of rosacea include:

  • Alcohol
  • Overexposure to sunlight
  • Emotional stress
  • Spicy foods
  • Hot drinks such as tea and coffee
  • Anxiety 


Common treatment strategies for rosacea consist of[3]: 

  • Application of topical creams and gels containing antibiotics or azelaic acid
  • Antibiotic pills 
  • Laser treatment 


As a consequence of patient dissatisfaction post medicine and surgery for rosacea, complementary treatment options such as acupuncture have been closely studied. One study found the beneficial effects of acupuncture on rosacea with significant improvements after 3 sessions of acupuncture treatment[4].


References

[1] American Academy of Dermatology. Rosacea: Overview haad.org/public/diseases/rosacea/what-is/overview

[2] Better Health Victoria (2018, April) Rosacea betterhealth.vic.gov.au/health/conditionsandtreatments/rosacea

[3] Health Direct (2019, January) Rosacea healthdirect.gov.au/rosacea

[4] Gao et al (2018) Treatment of Rosacea using acupuncture for improving the local skin microcirculation doi: 10.1097/MD.0000000000011931

Seborrhoeic keratosis

Seborrhoeic keratosis is a common and benign tumour found on the skin particularly on the face, neck, hands, chest and shoulders. Typically, seborrhoeic keratosis is asymptomatic and usually appears as multiple flat, small and raised growths that range in colour[1]. 

Seborrhoeic Keratosis is caused by proliferation of immature skin cells that produce keratin known as keratinocytes[2]. As this may present with morphological features similar to that of malignant skin lesions, it is important and essential to consult a medical practitioner for a thorough history and examination. As most seborrhoeic keratosis is harmless, treatment is generally not needed[3]. However, referral for treatments such as surgical removal, cryotherapy, electrosurgery and curettage may be considered after seeing your doctor. 

    

References:

[1] National Centre for Advancing Translational Sciences – Genetic and Rare Diseases Information Centre (2017) Seborrheic Keratosis – Summary. rarediseases.info.nih.gov/diseases/3108/seborrheic-keratosis 

[2] Greco et al (2019) Seborrheic Keratosis ncbi.nlm.nih.gov/books/NBK545285/

[3] American Academy of Dermatology. Seborrheic Keratoses: Diagnosis and Treatment aad.org/public/diseases/a-z/seborrheic-keratoses-treatment

Shingles

Shingles also known as herpes zoster is a painful skin rash caused by the varicella-zoster virus (the same virus that causes chickenpox). Common symptoms include:

  • tiredness
  • photophobia (sensitivity to light) 
  • tender and painful skin[1]


Shingles can occur at any age predominantly affecting older adults but is only predisposed to individuals who have had chickenpox in the past. During the onset of shingles, the chickenpox virus becomes active again. Although it is unclear why shingles develop, it is thought to be due to a multitude of factors such as:

  • experiencing physical and emotional stress
  • a weakened immune system from medical treatment (such as chemotherapy)
  • recently undergoing organ/bone-marrow transplants[2]


A common treatment for shingles involves antiviral medicine, and is indicated for treatment within 72 hours of onset of symptoms, which reduces the severity as well as reduces the risk of ongoing pain lasting for longer than 3 months known as post-herpetic neuralgia. 


References

[1] Health Direct (2019, March) Shingles. healthdirect.gov.au/shingle

[2] Better Health Channel. Shingles betterhealth.vic.gov.au/health/conditionsandtreatments/shingles

Sunburn

In Australia, one in five adolescents and one in eight adults get sunburnt on a summer weekend in the outdoors[1]. Sunburn is defined as the damage to the skin caused by exposure to ultraviolet (UV) radiation from the sun[2]. There are three types of UV radiation but only two are involved in sunburn: UVA radiation and UVB radiation. When the skin is exposed to either UVA or UVB radiation, more melanin (a pigment produced by skin cells) is produced causing the skin to tan. From this, the skin responds by releasing chemicals that dilate blood vessels causing fluid leakage and inflammation- ie sunburn[3]. 


Treatment of sunburn involves time and patience and recommendations to help alleviate the symptoms include staying hydrated, avoiding soaps that may irritate your skin, keeping out of the sun, applying moisturiser and applying cold compresses. As exposing your skin to UV radiation increases the risk of developing skin cancer, it is important to practice effective prevention strategies such as the well known, age old “Slip, Slop, Slap”. 

    

References:

[1] Cancer Council Australia (2016, October)Sunburn wiki.cancer.org.au/skincancerstats/Sunburn 

[2] Health Direct (2019, August) Sunburn and sun protection healthdirect.gov.au/sunburn

[3] Better Health Victoria (2016, April) Sunburn betterhealth.vic.gov.au/health/conditionsandtreatments/sunburn

Urticaria

Urticaria, commonly known as hives is a type of skin rash characterised by the appearance of: 

  • raised lumps or 
  • wheals


Hives display a similar appearance like mosquito bites and range from a few millimetres to several centimetres with symptoms lasting anywhere between minutes to hours[1]. Furthermore, unlike mosquito bites, hives can appear on any area of the body, may change shape, move around and disappear and reappear over short periods of time[2]. Additionally, when pressing the centre of hives, it turns white -this is known as blanching. 


Occurring in 1 in 5 individuals, urticaria is caused by the release of a protein, known as histamine, which the body produces and stores in mast cells[3]. When histamine is released into the skin, it causes the blood vessels to expand triggering redness, swelling and an itch. 


Treatment of urticaria typically involves an oral dose of antihistamines, avoiding spicy foods and alcohol and staying out of the heat[4]. According to current evidence, acupuncture has been shown to have positive effects in relieving symptoms in urticaria cases[5].


References

[1] Allergy and Anaphylaxis Australia (2018, September) Urticaria (Hives) and Angioedema hallergyfacts.org.au/allergy-anaphylaxis/urticaria-hives 

[2] American College of Allergy, Asthma & Immunology. Hives (Urticaria) acaai.org/allergies/types-allergies/hives-urticaria

[3] Australasian Society of Clinical Immunology and Allergy (2019, May) Hives (Urticaria) allergy.org.au/patients/skin-allergy/urticaria-hives

[4] Health Direct (2019, August) Hives healthdirect.gov.au/hives

[5] Yao et al (2016) The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: A Systematic Review doi.org/10.1155/2016/5191729 

Warts

Dr Justin Lim Professor Yoland Lim Best Acupuncture Melbourne Skin Cosmetic Acupuncture Weight Loss

Warts are small skin growths caused by human papillomavirus (HPV). Once infected with HPV, it may take as long as one year before warts become visible. The growths of warts are most common during childhood[1]. Not only can warts spread on your body, it can also spread to others through direct measures such as skin-to-skin contact as well as indirect measures such as in public showers and swimming pools[2]. 


To date, there are more than 100 types of HPV. Consequently this results in multiple different kinds of warts. These include and are not limited to[3]:  

  • Common warts- typically appear as a group and mainly occur on the knuckles and the back of the hands and knees
  • Flat warts- face and the back of the hands and are flat-topped
  • Plantar warts- soles of the feet
  • Genital warts- on genitals of both males and females
  • Filiform warts- generally long and thin shaped and are found on the eyelids, armpits or neck


Although warts may go away without any treatment, your general practitioner may trial treatment options available such as[4]:

  • Covering the wart to prevent spreading (such as by using tape)
  • Applying topical creams or gels with salicylic acid or lactic acid 
  • Cryotherapy treatment 
  • Burning/laser treatment 
  • Immunotherapy 

However these treatment modalities may not always yield satisfying results.


References

[1] Better Health Victoria (2018, April) Warts betterhealth.vic.gov.au/health/conditionsandtreatments/warts

[2] The Royal Children’s Hospital Melbourne (2018, May) Warts rch.org.au/kidsinfo/fact_sheets/Warts/

[3] American Osteopathic College of Dermatology. Warts aocd.org/page/Warts

[4] Health Direct (2019, September) How to treat warts healthdirect.gov.au/wart-treatments