It’s often not acne, but the hyperpigmentation and scars from acne that are the most bothersome, especially in skin of colour individuals. The darker the skin, the more likely it will hyperpigmented and potentially scar.

A common misconception is that acne is caused by being unsanitary or not cleansing enough. Dirt, oil, and makeup can clog pores and contribute to acne, but the aetiology of acne is complex and multifactorial. Factors such as genetics, hormones, environment, even stress, and diet can play a role.

Treatment is based on the type and severity of acne.

For mild acne, topical treatment is recommended. For more extensive and severe acne, it often involves a combination of topical and oral medications. Acne has no cure, and therapies take time. But with proper treatment, your skin can significantly improve.

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Vitamin C (ascorbic acid) is a molecule that has been shown to keep your skin healthy and vibrant thanks to its antioxidant properties and role in stimulating collagen synthesis.

The nutrient is naturally found in the skin’s epidermis (uppermost) and dermis (middle) layers. Like many other substances like collagen and hyaluronic acid, vitamin C declines with age. Its quantity can also be more quickly depleted by pollution, sun exposure, and lifestyle habits like cigarette smoking.

L-ascorbic acid is the active form of vitamin C that carries out the biological effects. Besides retinoids, vitamin C is probably the next most studied ingredient in skincare. Ascorbic acid has many benefits. Repeat studies have shown it helps to prevent photodamage from UVA and UVB radiation. It stimulates collagen production, serving as a co-factor for enzymes in collagen production. Lastly, vitamin C is a great lightening ingredient. It blocks tyrosinase, a key enzyme in melanin production.

However, vitamin C is highly unstable. It easily oxidizes in light, heat, pH change, and the presence of other ions. This has led to the development of various vitamin C derivatives that are more stable while trying to retain efficacy. However, formulation continues to be a challenge. Demonstrating ingredient effectiveness needs to occur not just in the laboratory setting or on animals, it also needs assessment on human skin.

Unfortunately, there’s a paucity of data regarding skincare ingredients in general (compared to medical dermatology), and some publications are conflicting. One study may show the benefit of a derivative, while another demonstrates no efficacy. This inherently speaks to the challenges of manufacturing L ascorbic acid, as the formulation is everything.

References
Pinnell, Sheldon R., et al. “Topical L-Ascorbic Acid: Percutaneous Absorption Studies.” Dermatologic Surgery, vol. 27, no. 2, 2001, pp. 137–142.

Stamford, Nicholas P J. “Stability, Transdermal Penetration, and Cutaneous Effects of Ascorbic Acid and Its Derivatives.” Journal of Cosmetic Dermatology, vol. 11, no. 4, 2012, pp. 310–317.

“Ferulic Acid Stabilizes a Topical Solution Containing Vitamins C and E and Doubles Its Photoprotection for Skin.” Journal of the American Academy of Dermatology, vol. 52, no. 3, 2005.

Lin, Jing-Yi, et al. “UV Photoprotection by Combination Topical Antioxidants Vitamin C and Vitamin E.” Journal of the American Academy of Dermatology, vol. 48, no. 6, 2003, pp. 866–874.

Stamford et al. “Stability, transdermal penetration, and cutaneous effects of ascorbic acid and its derivatives.” Journal of Cosmetic Dermatology. vol. 11, 2012. pp: 310–317.

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There are as many as 80 different types of autoimmune diseases and they can affect one or many different types of body tissues and may also cause abnormal organ growth and changes in organ function. The symptoms of many autoimmune diseases are similar, making them difficult to diagnose. It is possible to have more than one at a time.

Autoimmune diseases often run in the family and about 75% of those affected are women.

Currently, treatment for autoimmune diseases focuses on relieving symptoms because there is no curative therapy.

No one is exactly sure what causes autoimmune diseases, but there are many theories about what triggers them. These triggers include –

• Bacteria or virus
• Drugs
• Chemical irritants
• Environmental irritants
• Genetics – you are more susceptible to an autoimmune disease if you have a family member with one.

There are many symptoms that could indicate that you have an autoimmune disease. Here are the most common symptoms of autoimmune diseases include –

• Fatigue
• Fever
• Muscle ache
• General malaise (feeling ill)
• Inflammation causes redness, heat, pain, and swelling

Tissues and organs that are commonly affected by autoimmune diseases include –

• Joints
• Muscles
• Skin
• Red blood cells
• Blood vessels
• Connective tissue
• Endocrine glands

In order to diagnose an autoimmune disease, the doctor needs to run one of the various tests that are used to diagnose autoimmune diseases or a combination of the tests.

The various tests include –

• Autoantibody tests: Any of several tests that look for specific antibodies to your own tissues
• Antinuclear antibody tests: A type of autoantibody test that looks for antinuclear antibodies, which attack the nuclei of cells in your body
• Complete blood count: Measures the numbers of red and white cells in your blood; when your immune system is actively fighting something, these numbers will vary from the normal.
• C-reactive protein (CRP): Elevated CRP is an indication of inflammation throughout your body.
• Erythrocyte sedimentation rate: This test indirectly measures how much inflammation is in your body.

Autoimmune diseases are chronic conditions with no cure. The treatment involves attempts to control the process of the disease and to decrease the symptoms, especially during flare-ups. Below is a list of things you can do to alleviate symptoms –

• Eat a balanced and healthy diet
• Exercise regularly
• Get plenty of rest
• Take vitamin supplements
• Decrease stress
• Limit sun exposure
• Avoid any known triggers of flare-ups

If the symptoms persist after you have tried to alleviate them, make an appointment to see your doctor. The doctor can then diagnose your autoimmune disease and prescribe the best course of treatment. Treatment could include –

• Hormone replacement therapy, if necessary
• Blood transfusions, if blood is affected
• Anti-inflammatory medication, if joints are affected
• Pain medication
• Immunosuppressive medication
• Physical therapy

Common Autoimmune diseases –

• Rheumatoid Arthritis – inflammation of joints and surrounding tissues
• Celiac Sprue disease – a reaction to gluten (found in wheat, rye, and barley) that causes damage to the lining of the small intestine
• Inflammatory Bowel Diseases – a group of inflammatory diseases of the colon and small intestine
• Vitiligo – white patches on the skin caused by loss of pigment
• Type 1 Diabetes: the destruction of insulin-producing cells in the pancreas
• Grave’s Disease
• Multiple Sclerosis
• Alopecia Areata

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Warts are considered to be contagious and although they often only affect one part of the body, they can spread to other areas by picking them.

There are different types of warts which include – common warts, plantar warts, periungual warts, flat warts and filiform warts.

The different types of warts look different and are found on different parts of the body.

Common warts are dome-shaped and found on the backs of fingers, toes and knees. Plantar warts are found on the sole of the foot and grow into the skin, not out of it. Periungual warts grow around or under the nails and can be quite painful. Flat warts arise on the face, thighs or arms, often in large numbers. Filiform warts have a single long stalk and are the same colour as your skin, often growing around your mouth and nose.

Most warts have a rough surface and a number of black pinpoint spots that represent small clotted capillaries.

There are many methods of treatment for warts. These include –

• Freezing – Spray concentrated cold air onto your warts that kill the skin and allow you to scrape away the surface of the wart.
• Treatments and patches containing salicylic acid – These products have to be used every day, often for a few weeks.
• Duct tape – Cover the wart with a small piece of duct tape for several days, then soak the wart, and, finally rub the wart to remove the dead skin.
• Liquid Nitrogen – Warts are frozen with liquid nitrogen that causes a blister under the wart, lifting it away from the skin.
• Surgery – usually considered when warts do not respond to other treatments.

Warts may recur after treatment.

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The extent and rate of colour loss from vitiligo are unpredictable. Vitiligo occurs when the cells that produce melanin die or stop functioning. Often vitiligo appears before the age of 20, but it can start at any age. People of all skins types can be affected, but it is more noticeable in people with darker skin. It is neither life-threatening nor contagious.

Doctors don’t know why the cells fail or die, but it may be related to –

• A disorder in which your immune system attacks and destroys the melanocytes in the skin
• Family history
• A trigger event, such as sunburn, stress or exposure to industrial chemicals.

The main sign of vitiligo is a colour loss that produces light or white patches on the skin. Other signs include whitening or greying of the hair on your scalp, eyelashes, eyebrows or beard, loss of colour in the tissues that line the inside of your mouth and nose, loss of or change in colour of the inner layer of the eyeball, and discoloured patches around the armpits, navel, genitals and rectum.

If a doctor suspects you have vitiligo, they will ask about your medical history and do an examination to try to rule out other medical problems. A small sample of the affected skin may be taken and some tests will be done in addition to the examination and gathering of your medical history.

Treatment for vitiligo may improve the appearance of the affected skin but does not cure the disease. Medication alone or combined with light therapy can help to improve the skin’s appearance. There are creams that control the inflammation. The creams are easy to use and they are effective. They help return the colour to your skin.

Medications that affect the immune system can also be used. Light therapy is also used to help treat vitiligo on the face, trunk and limbs. Laser therapy brings back colour to the light patches by treating them with an excimer laser; however, it can only be used in small areas.

Surgery may only be an option for you if light therapy and medication don’t work.

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Some doctors will recommend changing your lifestyle a bit to help improve your symptoms. Things that make your sweating worse, like spicy foods, should be avoided. Avoid wearing tight-fitting or restrictive clothing, as well as clothing made from man-made fibres, like nylon. White or black clothing may help reduce the signs of sweating. Use antiperspirant instead of deodorant and get armpit shields that absorb sweat and protect your clothes.

Sometimes anxiety can be a factor that makes your sweating worse. In this case, medication may not be prescribed because it may increase the sweating; however, the doctor will recommend that you go for therapy to help with the anxiety.

If you have excessive sweating that affects your hands and feet, Iontophoresis may help. The affected areas are treated with a weak electric current passed through water or a wet pad. This helps block the sweat glands. This form of treatment is not painful; it may just cause mild discomfort and possible skin irritation.

Special over-the-counter antiperspirants or prescription sprays, lotions, and roll-ons can help control the symptoms of sweating. There are also some medications that can help stop the sweat glands from producing excessive sweat.

Some doctors may recommend Botox. Botox injections can temporarily stop the nerves from triggering sweating. This procedure has been approved for the treatment of excessive underarm sweating.

A more invasive method of treatment includes surgery.
Surgery is usually a permanent solution to excessive underarm sweating. There are a few different surgical procedures a doctor may choose to treat your sweating.

One of the procedures is Endoscopic Thoracic Sympathectomy (ETS). ETS is usually used to treat cases of sweating that affect the palms and armpits. This procedure involves making small incisions on the side of the chest cutting or clipping the nerves that control sweating.

Another procedure involves removing or destroying the sweat glands. This procedure is generally performed to reduce the sweating in the armpits. The doctor may make an incision in the armpit and scrape away or cut out the sweat glands. The doctor may insert a laser device under the skin through a small incision that will destroy the sweat glands.

Alternatively, the doctor may use a probe that is held above the skin, which emits electromagnetic radiation that destroys the sweat glands. These procedures will usually be carried out under local anaesthetic.

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There are three major types of skin cancer: Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma.

Skin cancers are not considered to be hereditary; however, genetics is important because your skin colour is hereditary. Skin cancers are caused by exposure to UV light, putting fair-skinned people at more risk of getting skin cancer. Skin cancer typically appears on the skin that has been exposed to sunlight repeatedly for many years, such as the nose, ears, back of the neck and the bald area of the scalp.

If any of the below-mentioned symptoms are experienced, an appointment with a dermatologist needs to be made to check for the possibility of skin cancer.

• Pink skin growths or lesions with raised borders that are crusted in the centre
• Open sore that does not go away for weeks
• A wart-like growth
• Raised reddish patch of skin that may crust or itch, but is usually not painful
• A white, yellow, or waxy area with a poorly defined border that may resemble a scar
• A raised growth with a rough surface that is indented in the middle.

The most important warning sign for melanoma is any change in size, shape, or colour of a mole or other skin growth. Watch for changes that occur over a period of time.

The ABCDE system tells you what changes to look for –

• A – Asymmetry. One-half of the mole or skin growth doesn’t match the other half.
• B – Border irregularity. The edges are ragged, notched, or blurred.
• C – Colour. The colour is not the same throughout the mole.
• D – Diameter. The mole or skin growth is larger than the size of a pencil eraser.
• E – Evolution. There is a change in size, shape, symptoms, surface, or colour of a mole.

A definitive way to determine if you have skin cancer is to have a skin examination done by a dermatologist. A skin biopsy is then done to confirm the diagnosis. A small portion of the tumour is sliced away and then examined under a microscope by a pathologist.

There are several effective ways of treating skin cancer. The location and the size of the tumour, the microscopic characteristics of cancer, as well as the general health of the patient determine what form of therapy will be needed.

Topical medications can be used in the case of superficial basal cell carcinomas. A fast, easy, and relatively inexpensive method of treatment is destruction by electrodesiccation and curettage. The more expensive and complicated procedure to remove skin cancer would be surgical excision.

Mohs micrographic surgery is the treatment of choice for tumours where normal tissue preservation is vital, where the tumour margins are poorly defined, in tumours that have been previously treated and have recurred, and in certain high-risk tumours. For patients who are not candidates for surgical procedures, radiation therapy is recommended.

Early detection of skin cancers can lead to better outcomes. If you have any moles or spots that are suspect, see a dermatologist for a skin cancer screening.

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Rosacea may be mistaken for rosy cheeks, sunburn, or quite often, acne. It can be bothersome and embarrassing.

The symptoms of rosacea differ according to the subtype of rosacea. The most common symptoms include –

• Facial flushing
• Burning
• Skin redness
• Tiny red pimples and red fine lines
• Rhinophyma – an enlarged, bulbous red nose
• Visibly broken blood vessels

The symptoms of rosacea tend to come and go. The skin may be clear for a while and then erupt again.

The exact cause of rosacea has not been determined. A combination of hereditary and environmental factors may be the cause. Many things are known to trigger or make the symptoms of rosacea worse. These include –

• Alcohol
• Hot or spicy foods
• Emotional stress
• Hot or cold weather
• Heavy exercise
• A skin mite called Demodex and the bacterium it carries

Rosacea is generally diagnosed based on the red or flushed facial skin appearance and symptoms. In most cases, no specific tests are required for the diagnosis. Many people don’t even realise that they have rosacea.

The facial redness of rosacea may be transient and come and go very quickly and many people may not associate the flushing symptoms with a medical condition. If rosacea is left untreated, it tends to worsen over time.

In the rare case that the dermatologist cannot confirm the diagnosis of rosacea based on the redness of the facial skin, a skin biopsy may be done. Blood tests are not usually required but may be used to help exclude less common causes of facial blushing.

Because there is no cure for rosacea, treatment focuses on controlling the signs and symptoms. Often this requires a combination of skincare and prescription treatments.

The medications that the dermatologist prescribes will depend on what signs and symptoms you’re experiencing. Prescription treatments include medications that reduce redness, oral antibiotics, and isotretinoin.

Laser therapy may help to reduce the redness of enlarged blood vessels. Dermabrasion, intense pulsed light therapy, and electro-surgery may also be used to treat the signs and symptoms of rosacea.

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Psoriasis causes cells to build up rapidly on the surface of the skin. The extra skin cells form thick, silvery scales and itchy, dry, red patches that are sometimes painful.

It typically occurs on the knees, elbows, and scalp, as well as on the nails and it can also affect the torso, palms, and soles of the feet. Psoriasis can also be found on the eyelids, ears, mouth and lips, and in skin folds.

If you are experiencing one or more of the following symptoms, you should make an appointment to see your doctor –

• Red patches of skin covered with silvery scales
• Small, scaling spots
• Dry, cracked skin that may bleed
• Itching, burning, or soreness
• Thickened, pitted, or ridged nails
• Swollen and stiff joints

The causes of psoriasis include –

• Infections, such as strep throat or skin infections
• Injury to the skin (cuts, scrapes, bug bites, or severe sunburn)
• Stress
• Cold weather
• Smoking
• Heavy alcohol consumption
• Certain medications

A variety of factors can cause an episode of psoriasis, including anything from trauma and emotional stress to streptococcal infection. The key cause of psoriasis is said to be some abnormality in the immune system.

There are no special blood tests or tools to diagnose psoriasis. A dermatologist usually examines the affected skin and determines if it is psoriasis. If the symptoms are unclear or if your doctor wants to confirm their diagnosis, a biopsy may be done with a small skin sample.

Psoriasis can be mild, moderate, or severe. Treatment will depend on how severe your psoriasis is. The severity of psoriasis is based on how much of your body is affected.

Topical treatments, such as moisturisers, over-the-counter and prescription creams, and shampoos, are generally used to treat mild psoriasis. Moderate to severe psoriasis usually involves using a combination of treatment strategies to treat it.

Light therapy may be prescribed along with topical treatments. Light therapy or topical treatments are often used when psoriasis is only limited to a specific part of the body. If it is widespread or greatly affects your quality of life, a doctor might prescribe oral or injectable drugs.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission.

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Nail infections occur more often in men than in women, and they are found in adults more often than in children. Nail fungus is typically caused by a dermatophyte fungus. Yeasts and moulds also can be responsible for nail fungal infections.

You’re more likely to develop a fungal infection if you –

• Have diabetes
• Have a disease that causes poor circulation
• Wear artificial nails
• Have a nail injury
• Have a skin injury to the nail
• Swim in public swimming pools
• Are over the age of 65
• Have a weakened immune system
• Have moist fingers or toes for an extended time
• Wear closed-toe shoes.

Symptoms of nail fungus include –

• Thickened nails
• Brittle, crumbly or ragged edges
• Distorted in shape
• Dull, with no shine
• A dark colour, caused by debris building up under your nail.
• A distorted nail that may lift off from the nail bed
• An odour coming from the infected nail
• Scaling under the nail
• White or yellow streaks on the nail
• Flaking white areas on the nail’s surface
• The appearance of yellow spots at the bottom of the nail
• Loss of the nail

If the condition is mild and does not bother you, you may not need treatment. If the nail fungus is painful and has caused the nail to thicken, self-care steps and medication may help. Even often successful treatment, nail fungus could come back.

If self-care strategies and over-the-counter products haven’t helped, your doctor may suggest a combination of prescription drugs and other approaches.

• Medications –
  • Oral antifungal drugs
  • Medicated nail polish
  • Medicated nail cream
• Surgical or other procedures
  • Nail removal
  • Laser and light-based therapy

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