nail fungal infection treatment Surrey

One of the occupational hazards of being a Dermatologist is making diagnoses on members of the public. Sometimes I wonder if I should offer unsolicited advice on the checkout operator’s acne at the supermarket, or suggest that a complete stranger on the beach has a mole checked.  Especially in the summer, another part of the skin that catches my eye is the feet.

Dermatologists get a lot of referrals about dark marks under toenails and, rightly so, since this can be a presentation of melanoma under the nail.  My big toenail currently has a large black mark under it but I don’t have a melanoma. I ran the London Vitality 10k race a few weeks ago and all that pounding of the pavements of London has left me with a sub-ungual haematoma ie a bruise under the nail. It doesn’t need any treatment and I simply plan to hide it under a dark nail polish until it grows out. However, if you notice a dark mark under the nail and you can’t think of an obvious explanation for how it has appeared, it is important to have it checked out.

Causes of nail discolouration

Discolouration and thickening of the nail can also occur because of an underlying skin disease such as psoriasis. The nail can be affected by a fungal infection, which can be treated in less extensive cases with topical lacquer, or in more extensive infections with oral antifungal medication.

Another fungal infection is athlete’s foot that can usually be treated with creams or powders that can be bought over the counter. It can be more difficult to treat if you are immunosuppressed for example because of diabetes, or certain medications. In those situations, it is especially important to clear the infection so that cracks in the skin do not allow bacteria to enter and cause cellulitis.

Veruccas are warts that occur on the sole of the foot that is caused by infection with the human papilloma virus. They can be unsightly and uncomfortable and a Consultant Dermatologist can offer treatment with cryotherapy or advice about topical treatment. A solitary lesion on the foot may not be a verucca, but a skin cancer or another benign lesion, for example, a poroma and it is important to have any lesion that does not go away checked promptly.

To arrange a consultation with Dr Juliet Williams at her Surrey Dermatology Clinic to diagnose whether you’re suffering from a fungal infection or other foot problem, call 01483 555 907.

How to mole check

Golden, glowing skin is an aspiration for many in the summer months, but it is important not to pursue this at the expense of our health. Skin cancer is one of the most common cancers in the UK, with almost 15,000 new melanoma cases diagnosed every year.

Before heading out into the sun this summer stop and think: how mole aware are you? Moles are a cluster of skin cells known as melanocytes that give pigment to our skin.  The medical term for a mole is a ‘naevus’ from the Latin word for birthmark although, in fact, the majority of moles are not present at birth.

It’s normal to have between 10- 40 moles on the face and body and the majority are completely harmless.  If you notice a new mole or a change within one or your existing moles it is important to have it checked to make sure it is not an abnormal mole or melanoma.

5 steps to checking your moles

 What should you look out for when you check your skin?

The ABCDE acronym has been developed as a handy guide to self-checking your moles:

  • Asymmetry: a ‘healthy’ mole is more likely to be symmetrical whereas asymmetry is a warning sign that a lesion is abnormal.
  • Borders: a benign mole usually has a smooth, regular border, so notched or ragged borders can be a cause for concern.
  • Colour: a single colour, paler colours and regular arrangement of the colour are all reassuring signs that a mole is likely to be normal. Moles with several different colours, or darker colours arranged in an irregular pattern are more worrying and should be checked out.
  • Diameter: a melanoma is often larger in size than the normal moles so look for any unusually large moles and check these especially carefully.
  • Evolving: arrange an appointment with a dermatologist if you notice any changes to size, prominence or colour of an existing mole or the appearance of a new mole or lesion. Taking pictures of your moles as a point of reference can help. If a mole starts to bleed, itch or crust, then it should be checked out immediately.

There is widespread agreement that the ABCD of checking moles are Asymmetry, Border, Colour and Diameter but several different options for what E should be.  I teach medical students to look ‘Elsewhere’ i.e. at the surrounding skin for clues like inflammation.

The NHS website tool suggests ‘Elevation’ or ‘Enlargement’.  I think the British Association of Dermatologists probably has the most sensible suggestion; E is for ‘Expert’ – if you are worried about a mole contact a Consultant Dermatologist and arrange an appointment.

Is Roaccutane safe for acne treatment

The acne treatment Isotretinoin (often known by its original brand name in the UK, Roaccutane) was the subject of a recent BBC Victoria Derbyshire programme covering the stories of a number of patients who had experienced rare side effects of it.

The headline of the BBC website for the story reads: ‘The parents of young people who have killed themselves and patients unable to have sex are calling for the NHS to stop prescribing acne drug Roaccutane’.

They reported the story of Ed Henthorn who took the drug when he was 19 for three weeks. He decided to stop because he experienced erectile dysfunction, psychosis and suicidal thoughts which he still suffers from five years after discontinuing the medication. His is a tragic story and it is not the first time that isotretinoin has been the source of controversy, or that campaigners have called for the NHS to ban the drug on the basis that its side effects mean that its risks outweigh the benefits.

As the BBC acknowledge in their article, the majority of patients who take Isotretinoin have a positive experience and the Manufacturer Roche can claim with justification that ‘millions of patients worldwide have benefited from taking the drug’. The British Association of Dermatologists points out that many people who have not experienced severe acne may see it as a minor, cosmetic issue.

However, there is extensive evidence to show that acne is a disfiguring skin complaint that can cause irreversible scarring and can lead to low mood, low self-esteem and a negative body image, which for some patients can have an extremely detrimental impact on their quality of life. Although there have been reports of a minority of patients taking isotretinoin experiencing mood disorders for many years and more recent reports of male sexual dysfunction it is very difficult to establish in any individual case that the drug has caused these symptoms.

Evaluating acne treatments

Acne is one of the most commonly treated skin diseases and accounts for 3.5 million visits to GPs and dermatologists in the UK every year. Milder cases are often treated by GPs with creams and gels and oral antibiotics. Isotretinoin is used to treat more severe cases that have not responded to other treatments, or scarring acne.  It is estimated that more than 30,000 patients take the drug annually in the UK.

The British Association of Dermatologists encourages members to follow guidelines regarding acne and isotretinoin that stress the importance of taking a comprehensive history from patients before and during treatment.  It is recommended that healthcare practitioners should discuss with the patient from the outset the possibility of low mood, including depression, and review this throughout treatment. There should be documentation of mental health and/or mood state whilst on isotretinoin, both at the initial assessment for treatment and at follow-up appointments.

The association has informed members of the 2017 MHRA alert about adverse sexual effects in men who have taken isotretinoin, and our patient information leaflet on this medication has also been updated accordingly.  For this reason, while isotretinoin is a highly effective treatment for a distressing skin disease, doctors have to very carefully weigh up the potential risks and benefits of the drug in each individual patient.

For more information, call 01483 555 907 to book an acne consultation with Dr Juliet Williams.