Skin Problems

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Your skin is your body's largest and fastest-growing organ. It covers and protects your body by maintaining an even body temperature, keeping harmful microbes out, and by helping you feel things through the nerves in your skin like heat, cold, and pain. Anything that irritates, clogs, or inflames your skin can cause symptoms such as redness, swelling, burning, and itching.

This section explores some of the most common skin problems – acne, eczema, skin cancer, psoriasis, and rosacea – and provides up-to-date information about medical treatments available for each.

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Acne is a skin disorder that causes pimples when the passageway that connects the skin’s pores to the oil glands becomes blocked with an oily, waxy substance known as sebum. Acne, which appears most often on the face, neck, shoulders, chest and back, can come in many forms. Whiteheads and blackheads are the most commonly known; nodular and cystic acne are more severe because they form deep in the skin and can cause scars.

A common problem in adolescence, acne may also appear for the first time or worsen in midlife for reasons not fully understood. According to Harvard Health , hormonal fluctuations associated with menstruation and menopause make women more susceptible to adult acne.

Treatments

  • Over-the-counter topical treatments: If you have mild acne that's not inflamed, treatment with over-the-counter lotions that contains benzoyl peroxide, sulfur and salicylic acid will help keep pores open and inhibit bacterial growth.
  • Topical treatments available by prescription: If your acne doesn't respond to over-the-counter treatments, consider seeing a doctor or dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available, which work by killing excess skin bacteria.
  • Antibiotics: For moderate to severe acne, a short course of prescription oral antibiotics may be required to reduce bacteria and fight inflammation. In most cases, dermatologists will recommend the use of topical medications and oral antibiotics together. Potential side effects of antibiotics include an upset stomach, dizziness or skin discolouration. These drugs also increase your skin's sun sensitivity and may reduce the effectiveness of oral contraceptives.
  • Isotretinoin:  Isotretinoin (Accutane) is a very effective oral medication for severe acne that doesn’t respond to other treatments. However, people who take it need close monitoring by a dermatologist because of the possibility of severe side effects. Isotretinoin commonly causes side effects such as dry eyes, mouth, lips, nose and skin, as well as itching, hair thinning, nosebleeds, muscle aches, sun sensitivity and impaired night vision. The drug is known to cause severe birth defects and must not be taken during pregnancy. In addition, isotretinoin may be associated with an increased risk of depression and suicide, although this causal relationship has not been proved.
  • Oral contraceptives: Estrogen-dominant oral contraceptives can improve acne in adult women. However, oral contraceptives may cause other undesirable side effects such as nausea, headaches, breast tenderness, and depression. 
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According to the American Academy of Dermatology , eczema (also called dermatitis) is a general term used it to describe conditions that can cause the skin to swell and discolour. Short-term symptoms of eczema include itchy skin, redness and tiny bumps or blisters. If these symptoms remain untreated, the skin can become thick, scaly and dry.

The most common type of eczema is atopic dermatitis and is seen most often in children. Atopic dermatitis appears as irritated, red, dry, crusted patches on the skin – usually in the crux of the elbows or behind the knees. If the skin becomes infected, it may develop a wet, weeping look.

Treatment

  • Corticosteroid ointments or creams:  Your doctor may prescribe a corticosteroid ointment or cream to ease scaling and relieve itching. Side effects of long-term or repeated use can include skin irritation or discolouration, thinning of the skin, infections, and stretch marks.
  • Oral antihistamines: If itching is severe due to allergic contact dermatitis, oral antihistamines may help. Diphenhydramine (Benadryl, others) can make you sleepy and may be especially helpful at bedtime.
  • Antibiotics: If there are signs of bacterial skin infection, oral antibiotics are usually needed. Your doctor may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on your skin and to prevent recurrent infections.
  • Oral or injected corticosteroids: For more severe cases, your doctor may prescribe a short course of oral corticosteroids to reduce inflammation and control symptoms. While these medications are effective, they can't be used long term because of potential serious side effects, which include cataracts, loss of bone mineral, muscle weakness, decreased resistance to infection, high blood pressure and thinning of the skin.
  • Immunosuppressants: Immunosuppressants, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help reduce eczema flares and maintain normal skin texture. Due to possible concerns about the effect of these medications on the immune system when used for prolonged periods, this medication is often only approved for children over the age of 2, and should be used only when other treatments are not an option.
  • Light therapy: Also known as phototherapy, this treatment exposes your skin to controlled amounts of natural or artificial light. Though effective, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer. 
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Psoriasis is a common skin disease that causes cells to build up rapidly on the surface of the skin, forming thick silvery scales and itchy, dry, red patches that are sometimes painful. The most common areas affected are the scalp, elbows, knees, and lower back, although any skin surface may be involved. It can also occur in the nails and body folds.

Treatment

According to Mayo Clinic , psoriasis treatments can be divided into three main types: topical treatments, light therapy and medications.

  • Topical treatments: These are creams and ointments applied directly to the skin, and are effective in treating mild to moderate psoriasis.
    • Topical corticosteroids: Low-potency corticosteroid ointments are often recommended for areas of delicate skin such as the face and may be prescribed in medium and high-strength forms for stubborn plaques on the hands, feet, arms, legs and trunk.
    • Vitamin D analogues: These synthetic forms of vitamin D, such as Calcipotriol (Dovonex,) slow down the growth of skin cells.  
    • Tazarotene (Tazorac): This is a synthetic vitamin A derivative, which normalises DNA activity in skin cells and may decrease inflammation.
    • Coal tar: A thick, black byproduct of the manufacture of petroleum products and coal, coal tar can reduce scaling, itching and inflammation.
    • Salicylic acid: Available both over-the-counter and by prescription, salicylic acid promotes sloughing of dead skin cells and reduces scaling.
  • Light therapy: Also known as phototherapy, light therapy may treat widespread psoriasis. This form of treatment uses ultraviolet B or ultraviolet A, alone or in combination with coal tar.
  • Medications: If your psoriasis is resistant to other types of treatment, your doctor may prescribe oral or injected drugs. Because of severe side effects, some of these medications are used for only brief periods and may be alternated with other forms of treatment. Medications can include Vitamin A derivatives, immunosuppressants, antineoplastic agents or biologic therapies.
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Rosacea is a common disorder that mainly affects skin on the face. It causes redness on the nose, chin, cheeks, and forehead, and often produces small, red, pus-filled bumps. Blood vessels may also become visible. Although rosacea can occur in anyone, it most commonly affects middle-aged women who have fair skin. Left untreated, this condition tends to worsen over time. While there's no cure for rosacea, treatments are available to control and reduce symptoms.

Treatment

Treatment for rosacea most often involves medications – either for topical use, to be taken orally, or both. Surgical and other procedures may also be used to treat symptoms of rosacea.

  • Antibiotics: Antibiotics used for rosacea may come in the form of creams, gels or lotions to spread on the affected skin or in pills that you swallow. These can help reduce inflammation and treat pimples. It can take at least a month to see results from topical antibiotics. While oral antibiotics are generally more effective in the short term, they can also cause more side effects.
  • Acne drugs: If antibiotics are unhelpful, your doctor might recommend a more powerful drug, isotretinoin (Amnesteem, Claravis, others). It is most commonly used for severe cystic acne, but can often clear up acne-like lesions of rosacea as well. This drug should not be used during pregnancy.
  • Surgical and other procedures: Doctors often recommend medical procedures to reduce the visibility of blood vessels – a common symptom of rosacea. Certain procedures, such as laser treatments and electrosurgery, destroy the blood vessels that cause red lines and blotches and can remove tissue buildup around your nose.
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