Acne

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Acne (pimples) is a very common skin condition usually peaking during the teenage years (during puberty) but can also appear during adulthood[1]. 

In a study from Harvard Medical School, it showed that acne had affected 55% of all women, with 28% having mild acne, and 27% having clinical acne. It affects:

• 45% of women aged 21-30
• 26% aged 31-40, and 
• 12% aged 41-50. 

Inflammatory acne is seen more in younger cohorts than those with comedonal acne[2].

Although there are multiple factors and conditions that lead to acne, there are two types which are the most common: 

1) Acne vulgaris and 

2) Acne rosacea[3]

Acne vulgaris is the most common type that causes pimples in adolescents whereas acne rosacea presents itself in adulthood. Affecting 85% of all Australians aged between 15-24 years old, acne vulgaris develops when the oil glands or pores in the skin get blocked[4]. 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. 

Acne was also associated with:

• facial hirsutism
• large pores, and 
• sebum excretion.

Additionally smokers had more, primarily ‘comedonal’ acne than nonsmokers[5].

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[6]. There are multiple effective and successful treatments available for acne including over-the-counter treatments, lifestyle changes, prescription medications and even acupuncture[7],[8].

References:

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

[2] J Womens Health (Larchmt). 2012 Feb;21(2):223-30. doi: 10.1089/jwh.2010.2722. Epub 2011 Dec 15. Acne vulgaris in women: prevalence across the life span. Perkins AC1, Maglione J, Hillebrand GG, Miyamoto K, Kimball AB.

Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.

[3] 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

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

[5] J Womens Health (Larchmt). 2012 Feb;21(2):223-30. doi: 10.1089/jwh.2010.2722. Epub 2011 Dec 15. Acne vulgaris in women: prevalence across the life span. Perkins AC1, Maglione J, Hillebrand GG, Miyamoto K, Kimball AB.

Department of Dermatology, Harvard Medical School, Boston, Massachusetts, USA.

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

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

[8] Mansu et al (2018, March) Acupuncture for Acne Vulgaris: A Systematic Review and Meta-Analysis. Doi: 10.1155/2018/4806734 

Skin inflammation medically referred to as dermatitis is defined as inflammatory changes to the surface layer of the skin known as the epidermis. Although the term dermatitis and eczema are often used interchangeably, dermatitis refers to a group of skin conditions whereas eczema is a type of skin condition. 

As such, there are different types of dermatitis such as[1]:

• Atopic dermatitis (or eczema) 
• Contact dermatitis 
• Dyshidrotic dermatitis
• Seborrheic dermatitis

Despite the several types of dermatitis, generally the symptoms are the same. However, it is important to note symptoms of dermatitis will look different depending on the kind of dermatitis, where the dermatitis occurs on different body parts and the symptoms can range from mild to severe[2]. 

Common symptoms include:

• Blisters
• Itchy skin
• Redness
• Swelling
• Rashes
• Dry, cracked skin

Treatment of dermatitis consists of both lifestyle changes as well as medical interventions. For example, substituting standard soap with soap-free cleansers, wearing soft smooth clothes and protecting your skin from dust, water and detergents are all lifestyle changes which can alleviate symptoms[3]. In addition, topical steroids, antihistamines or antibiotics as prescribed by your healthcare professional may also provide benefit in managing symptoms. 

References

[1] DePietro (2018, October) What Is Dermatitis? healthline.com/health/dermatitis

[2] Mayo clinic. Dermatitis mayoclinic.org/diseases-conditions/dermatitis-eczema/symptoms-causes/syc-20352380

[3] Oakley. Dermatitis dermnetnz.org/topics/dermatitis/

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

 Herpes Labialis (cold sores) are small blisters that typically form on the lips and skin around the mouth, nose and the chin. As cold sores are contagious the moment you feel a tingling sensation, it is important to adhere to good prevention strategies such as not sharing items that come into contact with the cold sore and refraining from kissing whilst having a cold sore. 

Cold sores are caused by the herpes simplex virus and the infection persists throughout life normally in a dormant state[1]. However, there are multiple factors which contribute in causing the virus to become active again. These include[2]:

• A break in the skin near the affected area
• Emotional upset or stress
• Periods
• Tiredness and fatigue
• Colds, flu or fever 

One of the worst sensations with cold sores are the persistent tingling and uncomfortable nature of the lesions, along with the social stigma associated with them.

Treatment of cold sores include topical agents and in some cases oral antiviral therapy[3]after review by your medical practitioner. In order to relieve any pain or discomfort, health care professionals suggest cold compresses on the affected area, intake of cold foods and drinks and ensuring pain relief[4]. 

References

[1] Better Health Victoria (2017, July) Cold sores betterhealth.vic.gov.au/health/conditionsandtreatments/cold-sores

[2] Health Direct (2018, August) Cold sores healthdirect.gov.au/cold-sores

[3] SA Health – Government of South Australia. Cold sores (herpes simplex type 1) – including symptoms, treatment and prevention sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Health+topics/Health+conditions+prevention+and+treatment/Infectious+diseases/Cold+sores+Herpes+simplex+type+1/Cold+sores+herpes+simplex+type+1+-+including+symptoms+treatment+and+prevention

[4] Kids Health (2019, February) Cold Sores (HSV-1) kidshealth.org/en/teens/cold-sores.html

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 

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

As we age, our skin changes – it becomes thinner, veins become more visible and it no longer looks as smooth as it once did. 

Our skin is made up of multiple layers and throughout life; the uppermost layer (the epidermis) constantly renews itself. The layer beneath the epidermis, the dermis, contains blood and lymph vessels, nerves, sweat glands and oil glands and is made up of elastin and collagen. During healthy ageing, the epidermis slows its rate of all production resulting in a thinner epidermis causing the skin to become more susceptible to wrinkles[1]. 

More so, as we age, the dermis produces less elastin and collagen causing the skin to sag and droop. Although ageing and the effects of skin are inevitable, there are strategies that you can do to protect your skin and make it feel and look better. More costly options include facelifts and surgical skin tightening. Alternative non-invasive and subtle tightening strategies include[2]:

• Skin-firming creams and lotions (a subtle effect). It is important to note that creams and lotions containing collagen and elastin cannot lift sagging skin as it does not penetrate the skin deeply enough
• Ultrasounds. This procedure sends heat deep into the skin causing the body to produce more collagen
• Laser treatment 
• Radiofrequency

Sagging skin is not only a consequence of ageing but can also originate from major weight loss[3]. During weight gain, to accommodate for the increased growth, the skin expands. This expansion causes the skin to be stretched and the collagen and elastin fibres become damaged (reduced ability to retract)[4].

References

[1] Better Health Channel (2018, April) Healthy ageing – the skin betterhealth.vic.gov.au/health/conditionsandtreatments/healthy-ageing-the-skin

[2] American Academy of Dermatology. Many ways to firm sagging skin aad.org/public/cosmetic/younger-looking/firm-sagging-skin

[3] Better Health Channel (2019, January) Body contouring surgery betterhealth.vic.gov.au/health/conditionsandtreatments/body-contouring-surgery

[4] Spritzler (2016, October) How to Tighten Loose Skin After Losing Weight healthline.com/nutrition/loose-skin-after-weight-loss

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 and is predisposed in 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/shingles

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

Hair is a significant feature which serves to keep us warm, protect sensitive areas such as the nose from dust particles and contributes to maintaining self-image[1]. Approximately five million hair follicles are found across the entire skin surface except for the palms of the hand, soles of the feet and lips. Normal hair growth occurs in cycles with each follicle producing hair for a period of months to years. Approximately one centimetre of hair is grown every month. 

There are two main stages during hair growth: an anagen phase (or the growing phase) and a telogen phase (or the resting phase). During the hair growth cycle, about 85-90% of the hairs on our heads are in the anagen phase and the remaining in the telogen phase[2]. Typically, on average we lose about 100 hairs a day. 

Hair loss is a common condition with varying types and is defined as a change in the number of hair follicles that are growing hair[3]. One type of hair loss condition is known as telogen effluvium (TE). TE is the second most common form of hair loss and is characterised by an increase in the number of hair follicles in the telogen phase. Because of this, as there are more dormant hair follicles, TE first appears as thinning of hair on the scalp. Approximately 300 hairs are lost in individuals who are affected by TE. 

Multiple causes may trigger TE such as[4]:

• Major physical trauma 
• Extreme weight loss 
• Thyroid problems (hyper- and hypothyroidism)
• Extreme changes to diet
• Sudden hormonal changes
• Major psychological stress
• Certain medications such as antidepressants

Currently there are no effective western medical treatments for TE. However, understanding the underlying cause will provide benefit in correcting the disorder[5]. For example, if hair loss began after commencement of a new medication, discuss the situation with your medical practitioner where an alternative management plan may be advised. 

References

[1] Hunt and McHale (2005, October) The psychological impact of alopecia DOI: 10.1136/bmj.331.7522.951

[2] Harvard Medical School (2019, April) Telogen Effluvium health.harvard.edu/a_to_z/telogen-effluvium-a-to-z

[3] Healthline (2017, January) Telogen Effluvium: What Is It and What Can I Do? healthline.com/health/telogen-effluvium

[4] Mounsey et al (2009, April) Diagnosing and Treating Hair Loss aafp.org/afp/2009/0815/p356.html

[5] Australian Family PhyscianMale baldness Volume 45, No.4, April 2016 Pages 186-188 racgp.org.au/afp/2016/april/male-baldness/