Does using topical steroids cause thinning of the skin?
Some doctors warn that using topical steroids causes thinning of the skin. Fear of steroid creams is over exaggerated, and patients suffer as a consequence - my rule is to stay off creams for twice as many days as you are on.
My doctor tells me that my child has molluscum - what is it and can I do anything about it?
Can stretch marks be removed?
Molluscum contagiosum (full name) is a variation of warts. They are skin lesions typically about 3mm in diameter which (unlike most warts) do not develop a scaley surface - instead, they remain smooth and skin coloured but some become very red and angry. They are contagious and your child should use its own towels etc in the bathroom. Playing with other children can also lead to spread eg at school etc. Usually they will go away if left alone for long enough - but if there are more than about 10 of them and they are multiplying you might want to take further action -
gently massaging them with eyelash tweezers so as to squeeze out the cheesey white central contents (which is often followed by a single drop of blood) often makes them disappear
This is my preferred advice - other treatments such a cryotherapy are potentially much more painful for the child. If you are going to attempt this self treatment programme - first, make absolutely sure by seeing a doctor that the diagnosis is correct - second, dont start the massage without getting some antiseptic paint eg Betadine - a single drop should be applied immediately after treatment to each single site. Good luck!
What is psoriasis, is it infectious, will my children get it if I have it?
Stretch marks are initially quite red and purple - they later become less angry and much less apparent. They usually appear after the body has grown - typical periods of rapid growth are normal puberty growth, body building and physical training, pregnancy.
They are due to the stretching of the tissues just beneath the skin surface thereby making the inner tissues of the skin more visible through the outer layers.
I have never seen convincing evidence that any treatment can reverse the changes of stretch marks. I certainly do believe that the discolouration of the marks can improve both with time and also perhaps with laser therapy which acts to reduce blood vessel visibility.
Strong skin steroid creams should probably be avoided because these can have an additional skin thinning effect which could make the situation worse.
I have pigmentation on my forehead and face which my doctor has called chloasma or melasma - is there an easy way to reduce this pigmentation which always seems to get worse in the sunshine?
Psoriasis is a red skin disease - often dry and scaley - which affects about 1 person in every 50 - in other words it is very common indeed - every bus load of people you see contains one present or future sufferer. Typical sites affected are the points of the elbows and knees, the scalp and sometimes the nails become irregular. The condition is not infective and you cannot give it to anyone in that sense. Psoriasis is to a large extent genetic and there is an approximate 1 in 10 chance of your child having it at some stage in their life. If both parents have psoriasis then this chance is increased.
How do I live with fragrance allergy?
Chloasma/Melasma is a pigmentary change on the face, most commonly in women. In many patients it seems to be related to hormonal change - for example it tends to appear whilst either taking the oral contraceptive pill or alternatively in relationship to being pregnant or having children. Patients with quite a dark complexion or patients with Asian colouring, tend to get the problem worse but very fair patients can also get the disorder. The forehead, the bridge of the nose and the cheeks are the most commonly affected areas. The affected site tends to become slightly darker than the surrounding skin and the problem tends to spread with each passing year particularly if sunshine exposure is not avoided. Skin lightening creams such as those containing hydroquinone are not usually very helpful and many patients find them of no benefit whatever. IPL/laser therapies are often equally unhelpful. However, some patients do find this type of treatment to be of some benefit but the benefit is usually temporary. If further sunshine exposure is not avoided then any benefit from treatment is usually very rapidly reversed. You may detect from these comments that I feel that sunshine exposure must be avoided if the patient is serious about getting better. Sunshine avoidance should be total and absolute because even minimal exposure to UV light will reverse the benefits of any treatments. I spend a great deal of time with my patients explaining exactly what I mean by avoiding sunshine exposure. My own recommendations in this particular condition are very strict and quite often the patients find my recommendations unacceptable. I am afraid that under these circumstances, the patient usually has to learn to live with the condition and obscure it with cosmetics. I do not think I have ever had a single patient improve with treatments whilst continuing to expose the skin cells to sunshine. My own recommendations are actually a mixture of - firstly avoidance - and secondly one of a variety of skin lightening creams. I am also happy to offer IPL/laser therapy but I would only do so if the patient is very clear about UV avoidance.
Am I safe from sunshine exposure so long as I use a strong sunblock?
Allergy to fragrance is one of the commonest allergic causes of eczema (others include nickel sensitivity, rubber chemicals sensitivity, etc).
Fragrance allergy is in fact a very complicated situation because there are many dozens of different fragrances used in modern products. These products obviously include actual perfumes themselves but what patients need to understand is that many other household products also contain fragrance. These include fairly obvious things such as shampoos, washing soaps, fabric conditioners, etc., but also include other less well recognised items such as smooth surface polishes, air fresheners, automobile fresheners, and of course plants and flowers themselves.
If you are a fragrance allergy sufferer you need to sit down and really think very hard indeed about the types of exposures you receive both at home and also at work. There are well documented cases of patients breaking out into eczema simply by occasionally watering plants in the workplace. Fragrance allergy can give very severe reactions. The key to living with fragrance allergy is avoidance. Of course treatment is important and skin surface steroid creams are usually needed to bring about rapid improvement. Very occasionally oral steroids are required for a short period of time. For further information see the section on allergic contact dermatitis. Of interest, the British Journal of Dermatology (Volume 142 No 2 February 2000) contains an extensive editorial on the subject by a world expert, Dr M H Beck.
Is there a permanent cure for athletes foot?
Smoking 80 cigarettes per day is more harmful than smoking one cigarette per day. Unprotected sunshine exposure is more harmful than protected sunshine exposure. However, even smoking one cigarette per day is harmful to the human body and in the same way even filtered sunshine exposure is almost certainly harmful to human skin.
In other words, I think it is reasonable to say that there is no such thing as absolutely safe sunshine exposure, however, this statement has to be balanced against the fact that we all enjoy outdoor activities, etc.
My practical advice to patients is this - you should take whatever precautions you need to take (strong sunscreens, wearing appropriate teeshirts, or even staying indoors if required, in order to stop your skin from going red or irritable. This broad rule can be applied no matter what type of sunshine exposure you are anticipating, i.e. you may need to take much more rigorous precautions in one climate versus a different climate. A key area of importance here is the matter of observation. That is - we should all be very aware of our own skin blemishes, moles, naevi, etc., and we should be prepared to seek medical advice if they change. The majority of patients who I deal with get into trouble from skin cancer, not because they have exposed themselves to unreasonable sunshine necessarily but mainly because they have failed to spot an early changing skin lesion and seek medical advice in the early stages.
What is a dermatologist and what do they do?
Athletes foot (or tinea pedis) is a fungal infection of the skin typically starting between the fourth and fifth toes but it can extend to spread to a much greater area of skin on the feet. All of us are regularly exposed to fungi but only some of us get regular or recurrent attacks of Athletes Foot. It is rather similar to the situation where some people are very prone to coughs and colds but other people never seem to get coughs or colds despite similar exposures. This must be something to do with internal immunity but we do not fully understand the situation. In Athletes Foot there are additional factors such as the precise shape of the toes, the skin surface temperature, the habits of the patient, etc. In other words, if you have toes which are tightly pressed together thus allowing little or no circulation of air into the toe web spaces then you are probably more at risk of Athletes Foot development. Additional factors such as footwear, tendency to sweating, etc., all play their own part.
Although there are good treatments for Athletes Foot you have no known way of preventing exposure to fungus because fungus is everywhere in our environment. It is for this reason that there is no permanent cure for Athletes Foot.
However, there are certain preventative strategies which can minimise the frequency of attacks even in patients predisposed to getting the trouble. Antifungal talcum powders regularly used after showering, exercise, etc., are always worth a try. Rigorous attention to drying the tow web spaces after showering is also tremendously important (using a hair dryer to thoroughly dry the skin is a helpful tip). Patients also apply antifungal creams on a regular basis after bathing. Finally, it is always worth considering the possibility of some underlying disorder if very frequent attacks occur and you would need to have a chat with your doctor about this.
Underlying conditions which might predispose to skin infections on a repeated basis include diabetes and if you have a family history of this condition then you should certainly consider a simple urine test to exclude it.
What is the day-to-day life of a dermatologist like, what makes us tick?
Dermatologists are medical doctors who have trained in medicine and then decided to specialise in dealing with disease of the skin (also the hair and nails). Most of our work is based in clinics seeing outpatients but many of us also have a commitment to overseeing inpatients with more serious diseases. Another part of our job is Skin Surgery - removing various cancerous and non-cancerous skin lesions - or trying to improve cosmetic defects (birth marks, scars, etc).
Can I improve my acne by eating a healthy diet or by increasing the frequency of washing my skin?
To answer these questions I have an area on this web site which you might like to visit - it is called Dermatologist's Diary in which I will regularly update life as a dermatologist, interesting problems, unusual situations, etc.
Is it harmful to pick or squeeze my normal spots or my acne spots?
Probably not. Acne does not appear to be related to eating either healthy food or junk food - it seems to make no difference to most patients. Also personal hygiene seems to have little or nothing to do with the development of acne. The cause of acne is an abnormality in the skin itself leading to microscopic blockage of the pilo-sebaceous unit and its outlet onto the skin surface.
My child has eczema - what is it and will it be cured?
If you can clearly see a yellow-head in the middle of a spot it might not be harmful to squeeze the yellow contents out - HOWEVER - it is always advised that you have an antiseptic lotion or cream available to immediately sterilise the area you have squeezed. If you have red spots without any obvious yellow-head in the centre (and most acne spots are of this kind) then it is not advised to squeeze them, it is far better to apply a skin surface antiseptic or one of a variety of anti-acne products.
Most young children with eczema have a kind of eczema called "atopic eczema". The condition is red, itchy and scaley see picture. This is usually genetic and is associated with someone in the family tree having eczema, asthma or hay fever (because these are genetically linked to each other). At the moment we do not have a "cure" but we have many very effective suppressive treatments and - here is the good news! - nearly all children with eczema get very much better or totally healed as they get older. Our site on eczema carries many more details of the condition.