Skin conditions - common problems and self-care tips

Did you know your skin is the largest organ in your body? It protects you from the elements and keeps infection out - but time takes its toll. Most skin problems aren't life-threatening, but it's important to know when to get checked out.

Always see your doctor about a new or changing mole, or scabs or ulcers that don't heal - especially on the head and neck. Ringworm causes circular red or silver itchy patches. It's a fungal infection, not a worm - see your doctor for a cream.

Acne rosacea - not just a 'teen issue'

Have you ever wished for skin 'as smooth as a baby's bottom'? You're not alone - our skin is the first thing others see, and it forms a major part of first impressions. Sadly, you may think acne is one problem you said goodbye to with your teenage years. In fact, about one in 10 people gets a condition called acne rosacea, usually in middle age.

Caused by a combination of sun damage, leaky blood vessels and genetics, rosacea usually affects the central parts of your face - nose, cheeks, forehead. It often starts with flushing and redness, with acne-like lumps and prominent small blood vessels. It can also cause dry, stinging eyes.

Avoiding alcohol, stress, spicy foods and extremes of temperature may help keep flushing under control. It's important to wear high-SPF sunscreen (at least factor 30) on your face when you're out in the sun, and to reapply it regularly. Some medications which open up your blood vessels, such as calcium-channel blockers for high blood pressure, can make redness and flushing worse. You should avoid steroid creams and look carefully at facecare products (such as toners) to see if they're making symptoms worse.

Traditionally, medicines for rosacea have been limited to antibiotics, either in tablet form or as a gel. I was taught to prescribe metronidazole gel. However, more recent evidence (ref 1) has suggested a cream called ivermectin, which kills a skin mite and reduces inflammation, is more effective than metronidazole (ref 2) - it also has high patient satisfaction rates. Azelaic acid gel may also be more effective than metronidazole, although it can cause skin dryness and irritation. I'm pleased to have some effective alternatives to long-term antibiotics, especially given all the concerns we have these days about antibiotic resistance.

Facts about bruising

As you age, your skin tends to thin, making you more prone to bruising. This is more common if you take regular medicine like aspirin or clopidogrel . Blood-thinning agents like warfarin or one of the newer 'oral anticoagulant drugs' (used for conditions like atrial fibrillation) carry a higher risk still. If you're on warfarin and you get a large bruise, contact your doctor to see if you need a blood test. Occasionally, bruising without any trauma can be a sign of blood-clotting problems, especially if you have other signs of bleeding like nosebleeds or blood in your urine. Do get checked out if this happens.

Slower healing

Another risk of ageing skin is slower healing, especially on your lower legs. The skin on your shins is less well supplied with blood than other parts, so be particularly careful to avoid bumping your shins.

Inflamed skin - possible causes

Dermatitis is the medical name for any inflammation of the skin - it can be due to irritation or allergy. 'Irritant' dermatitis, the more common cause, is often due to chemicals (eg cleaning products). In allergic dermatitis the smallest contact with whatever you're allergic to causes inflamed, sore red skin. Common culprits include nickel (in metal buttons and earrings) or hair products.

Actinic keratosis, or solar keratosis, is found mostly on sun-exposed skin - face, neck, scalp and ears. It's one of the conditions most commonly treated by skin specialists, and often starts as areas of rough, 'sandpaper' skin you feel rather than see. More common with age, fair skin and high sun exposure (especially sunburn), having lots of actinic keratosis increases your risk of skin cancer. Most don't turn into cancer, but if you have lots of reddish-brown scaly areas and have had a lot of sun exposure, see your doctor.

Skin cancer - on the rise

Any cancer is worrying, and rates of skin cancer are rising faster than almost any other cancer. Over-65s are seven times more likely to develop melanoma than their parents were - and it's all down to too much sun. Don't ever burn!

Most skin lumps and bumps are nothing to worry about, but that doesn't mean you want to keep them. When I first became a GP, we would take off any non-cancerous skin lump just because the patient wanted it. But these are different days for the NHS.

For instance, skin tags are soft, smooth, fleshy growths with a stalk. They tend to grow where clothes rub your skin, so are most common around the neck, under breasts and armpits. They get more common with age as well as in pregnancy. Because they don't do any harm, they're classed as 'cosmetic', and cosmetic surgery is not what the NHS is meant for, unless it's causing severe psychological distress.



1) Taieb A, Ortonne JP, Ruzicka T, et al ; Superiority of ivermectin 1% cream over metronidazole 0.75% cream in treating inflammatory lesions of rosacea: a randomized, investigator-blinded trial. Br J Dermatol. 2015 Apr;172(4):1103-10. doi: 10.1111/bjd.13408. Epub 2015 Feb 11.

2) van Zuuren EJ, Fedorowicz Z, Carter B, et al ; Interventions for rosacea. Cochrane Database Syst Rev. 2015 Apr 28;4:CD003262. doi: 10.1002/14651858.CD003262.pub5.
