sun and skin of colour

Sun exposure can affect all skin types including skin of colour. Although people with darker skin tones might not get sunburned as often, they’re still at risk of sun damage. Those with darker complexions may notice their skin getting even darker after sunburn, accompanied by a burning sensation and pain upon touching the area.

Here, we’ll examine the effects of sun exposure on darker skin and provide useful tips for effective sunburn prevention.

The effects of the sun on darker skin

The response of skin to the sun’s ultraviolet rays varies based on the skin tone. Darker skin is less prone to sunburn due to a higher presence of melanin, a pigment that gives skin its colour and provides some degree of protection against sun damage. In a study featured in the International Journal of Dermatology, approximately 66% of Black individuals in the UK stated that they had never experienced sunburn. And the same proportion had not used any form of sun protection.

However, despite its protective characteristics, darker skin is not invincible against sun damage, which can be more challenging to identify due to the skin’s pigmentation.

Another concern about the effect of sun exposure is sun-induced ageing and although brown and dark brown skin types have more natural protection against this than fairer skin types it can still occur.

People who have skin of colour are more prone to developing hyperpigmentation, in other words darker spots or patches caused by skin disease such as acne or injuries. Exposure to the sun can make these worse and sun protection creams may help to prevent this.

Sunburn in darker skin

Detecting sunburn in fair skin is relatively straightforward. It typically manifests as noticeable redness and inflammation. However, in darker skin tones, identifying the subtle red or pink hue of sunburn can be more challenging.

Regardless of skin tone, sunburn symptoms include a sensation of heat, sensitivity to touch, pain, irritation, and itching. As the healing process gets underway, the damaged skin starts to peel away. Despite the discomfort, sunburn typically resolves on its own within a few days, provided the skin is properly cared for during this period.

In darker skin, it’s important to note that severe sunburn leading to heat stroke might be harder to detect. If you have spent time in the sun and begin to experience symptoms like headaches, nausea or dizziness, visibly swollen skin with blisters, an unusually high temperature, shivering, chills, or muscle cramps, it’s advisable to seek medical assistance immediately.

Protecting darker skin against sunburn

It’s crucial for everyone, whatever their skin tone, to prioritise sun protection. Ensure regular application of broad spectrum sunscreen that protects against UVA and UVB radiation, preferably with a sun protection factor of 50. This should be applied at least 20 minutes before going outside and should be frequently reapplied outdoors, especially after swimming.

The Food and Drug Administration (FDA) suggests that physical sunscreens containing zinc oxide and titanium dioxide are the safest and most effective. These sunscreens can leave a white cast on the skin. However, advancements in the development of micronized versions have made them more aesthetically pleasing for those with darker skin tones.

For optimal sun protection, avoid the sun during peak hours (between 11am – 3pm), seek shade on extremely sunny days, and wear protective clothing such as sunglasses or wide-brimmed hats to safeguard any exposed skin.

People with darker skin can get skin cancer too

Skin cancer is much rarer in people with skin of colour, but it can be much harder to detect. This may lead to delays in seeking medical help so that it is not treated at an early stage and is more serious. For all skin types, if you have a new or changing skin lesion, especially one that won’t heal up you should book an appointment to have it checked. For people with darker skin types, it is especially important to check areas that can be overlooked. Check areas like the palms, soles, nails and mucous membranes (i.e. the moist surfaces inside the mouth, eyes, nose and genitals.) If you have any concerns, it is always better to request a consultation.

This leaflet here produced by the British Association of Dermatologists is very helpful.

 

severe acne

A detailed review carried out by health experts into the safety of isotretinoin, has led to several recommendations being made. More detailed guidance from the Commission on Human Medicines will follow to make sure that the powerful acne drug is used safely.

While isotretinoin is highly effective at treating severe acne, there have been some worries about its side effects. These include mental health and sexual side effects, which may persist even after the medication has been stopped.

Here, we look at the outcome of the review of isotretinoin prescribing, and consider what safer alternatives to isotretinoin for acne treatment are in development

Isotretinoin for severe acne

Isotretinoin, also known as Roaccutane or Accutane , is a commonly prescribed powerful drug used to manage severe acne, particularly when there’s a possibility of lasting scars. Taken in capsule form, the effects typically kick in around a week to ten days after beginning the treatment. It’s worth noting that it can make the skin slightly worse before it begins to show signs of improvement.

Before starting isotretinoin treatment, you’ll need to undergo a blood test. This is done to ensure your body is compatible with the drug. Regular blood tests will also need to be carried out during treatment. This is a precautionary measure to monitor for any side effects that may arise.

Recommendations for safer use of isotretinoin

In response to concerns from patients received via the yellow card scheme, the Commission on Human Medicines (CHM) set up an Isotretinoin Expert Working Group. The goal was to focus on the safety of the drug. The review concluded that it’s still unclear if isotretinoin is the definitive cause of the short-term or long-term psychiatric and sexual side effects that have been reported.

Following the review, the CHM has put forward recommendations to increase the safety of the drug. These include:

  • Providing more information about the drug to patients and their families
  • Consistent monitoring of a patient’s mental and sexual health
  • Stricter initial prescribing rules for young people
  • Improved risk communication before consultation with a specialist
  • Encouragement for further research into the drug’s risks

These recommendations aim to empower patients with knowledge, while making the treatment safer, especially for younger people.

Could antimicrobial fat cell treatment be a safer alternative?

Isotretinoin’s efficacy is undeniable, but its side effects can pose considerable challenges. Fortunately, the field of acne treatment is witnessing promising developments, one of which is the innovative antimicrobial fat cell treatment.

Studies show that skin cells that grow outside the hair follicle have the ability to morph into antimicrobial fat cells, known to combat acne. This discovery not only gives us a deeper understanding of our skin’s inherent defences, but also opens new possibilities for acne treatment. Further research is needed to explore whether harnessing the body’s natural defences in this way may be used to manage this persistent skin condition.

At present, isotretinoin continues to show superior efficacy to any other acne treatment, and it will be fascinating to see if safer acne treatments emerge. Dr Juliet Williams follows current guidance around safe prescribing of isotretinoin and will be updating her practice in line with the detailed guidance when it is published. Book a consultation with Dr Juliet Williams today to discover the best treatment to suit you. After establishing the type of acne that you have, she can provide guidance on the most suitable treatment plan.

The range of treatment options includes topical solutions like creams and gels, both topical and oral antibiotics, as well as oral isotretinoin.

moles checked

Moles are small, pigmented spots on the skin that most of us have and are typically harmless. It isn’t unusual for babies to be born with moles, for new moles to develop during childhood and adolescence, or for moles to become less visible or vanish as we age. They can also darken during pregnancy. The majority of moles are benign, but change in a mole can be due to abnormality and even skin cancer.

In this blog, we will discuss when it might be necessary to get a mole checked out.

Learn your ABCDEs

The ABCDE acronym is a helpful tool to determine if a mole might be worrisome. This represents Asymmetry, Border irregularity, Colour variations, Diameter over 6 mm (about ¼”) or Dark, and Evolution or change.

Familiarising yourself with these indicators is an excellent starting point for self-examinations. However, there are limitations to the ABCDE approach, as it is designed to identify melanomas, but not other types of skin cancer. Even some melanomas may not be detected using this method.

For example, subungual melanomas begin as brown or black streaks beneath a fingernail or toenail and may grow. Amelanotic melanomas also lack the melanin pigment that gives most moles their colour, instead appearing pinkish, red, white, or translucent.

Does one mole look different to the others?

Often, most moles on each person’s body tend to look similar. If a mole appears significantly different from others, it should be considered potentially harmful. Dermatologists sometimes refer to this as an ‘ugly duckling’ lesion. For example, if you have numerous large, dark moles but discover a smaller reddish one, you will want to get it checked out.

Some types of skin cancer manifest in lesions that are not classified as moles. Basal cell carcinoma, the most common form of skin cancer, can appear as a shiny bump in various colours, including seemingly innocuous shades like pink, pearly white, or transparent. Squamous cell carcinoma might also manifest as a scaly patch or a bleeding, open sore.

Getting suspicious moles checked

Alterations in the size or appearance of a mole should be considered a warning sign. It is crucial to schedule an appointment with a dermatologist to ensure the mole is not malignant.

You can arrange a mole check consultation with Dr Juliet Williams at any time, during which she will ask about your family history and previous sun exposure before conducting a full skin examination. Any atypical moles or moles exhibiting changes will be examined with dermoscopy and photographed for monitoring purposes.

While most moles are harmless, they can be removed if they catch on clothing, impact your self-confidence, or are highly visible. If your mole has worrying features, Dr Williams will recommend its removal and biopsy. Causes for concern include the appearance of a new mole, a mole becoming itchy, red, or bleeding, irregular mole edges, or changes in shape or colour.

acne and diet

What is the relationship between acne and diet? This common skin condition can occur due to a wide range of factors including excessive oil production, clogged pores, hormonal changes, genetics, smoking, and stress. However, diet can also potentially impact the condition by promoting inflammation and affecting the hormone levels.

Foods high in sugar and dairy, like milk and whey protein, have specifically been linked to acne. So, how exactly does diet contribute to skin conditions such as acne? And can you eliminate the condition by controlling what you eat?

The link between acne and diet

A 2020 study published in JAMA Dermatology, analysed dietary surveys of over 24,000 adults with an average age of 57. The research identified a link between the likelihood of having active acne and consuming high-fat foods (such as milk and meat), sugary foods and beverages, and a diet combining high-fat and high-sugar foods.

Compared to those who never experienced acne, participants with ongoing acne were 54% more likely to follow this type of diet. Increased consumption of high-fat, high-sugar foods correlated with a higher prevalence of active acne.

For instance, compared to acne-free respondents, those with current acne were 76% more likely to have consumed at least five glasses of milk the day before, over twice as likely to have had at least five servings of high-sugar drinks, and eight times more likely to have eaten a full meal of fatty and sugary products the day before.

Can the right diet get rid of acne?

Many of us typically consume high-glycaemic foods and beverages that rapidly increase blood sugar levels. These include white bread, white rice, crisps, sugary drinks, and snacks. Some small studies suggest that a low-glycaemic diet may help reduce acne. Low-glycaemic foods consist of fresh vegetables, some fresh fruits, beans, and steel-cut oats.

Researchers theorise that a low-glycaemic diet may reduce acne by preventing blood sugar spikes. These are known to cause body-wide inflammation and increased sebum production in the skin. Both inflammation and excess sebum contribute to acne.

However, not all studies have found a link between high-glycaemic diets and acne, indicating that further research is necessary to explore this connection.

Could your skin troubles be down to SIBO?

Small Intestinal Bacterial Overgrowth (SIBO) occurs when there is an imbalance in the gut’s microorganisms responsible for healthy digestion. Excessive or abnormal bacteria in the small intestine can cause symptoms like gas and diarrhoea, hindering nutrient digestion and absorption from food. This imbalance may contribute to the development of skin conditions such as acne and rosacea, an inflammatory facial skin disorder.

While recent genetic and epidemiological research has hinted at connections between rosacea and gastrointestinal issues, the available data remains limited.

Treating acne

If you are struggling to get acne or rosacea under control, book a consultation with Dr Juliet Williams today. She can assess the type of acne that you are experiencing and will be able to advise on the most appropriate and effective treatments. This may include topical treatments, for example benzoyl peroxide or retinoids.

For more severe acne, she can prescribe oral antibiotics, and oral Isotretinoin (Roaccutane).

sun protection

We all know that protecting our skin from the sun is important. But few people understand the true risks it poses to our health. Skin cancer rates are rapidly growing in the UK, with estimates that it will rise by 9% between the years 2023-2025.

Understandably, patients often have questions about sun protection and the risk of skin cancer. So this blog provides answers to some of the most common questions about sun protection you may have.

What is the cause of skin cancer?

Each year, nearly 100,000 new cases of melanoma are diagnosed. It is assumed that it mostly affects older adults, which is a common misconception. While the risk of developing melanoma does increase with age, it is the most diagnosed cancer among adults between the ages of 25 to 29. These findings from the Melanoma Research Alliance, emphasise the need for increased sun protection awareness and education around skin cancer prevention in younger people.

The most significant risk factor for skin cancer is failing to protect the skin against harmful UV. Exposure to direct sunlight is the leading cause of skin cancer, and UV exposure from tanning beds is also dangerous.

Although the popularity of indoor tanning is decreasing, there are still millions of adults who use these beds. This is extremely worrying given that just one session on an indoor tanning bed before the age of 35 increases the risk of melanoma by 75%.

Types of skin cancer

There are three main types of skin cancer, including Basal Cell Carcinoma, Squamous Cell Carcinoma, and Malignant Melanoma. Of these, Malignant Melanoma is considered the most dangerous form of skin cancer and is more likely to spread to other parts of the body if left untreated.

Basal Cell Carcinoma typically presents as a skin lesion that fails to heal and may occasionally bleed. It is slow-growing and does not typically spread to other organs, but early treatment is always recommended.

Squamous Cell Carcinoma, on the other hand, usually appears as a firm lump that may be crusted or scaly. It can grow more rapidly than Basal Cell Carcinoma and has the potential to spread if left untreated.

Finally, Malignant Melanoma develops from pigment cells or melanocytes, and commonly presents as a new or changing mole-like lesion.

Who is susceptible?

Skin cancer can affect people of all ages, but the amount of damage sustained depends on various factors such as skin type, geographic location, and level of sun exposure. Lighter skin types for example are generally more susceptible. But those with darker skin, although less prone to developing skin cancer, can still be affected. It is also worth noting that cases of skin cancer in men are on the rise, with death rates more than tripling since the 1970’s.

Best sun protection precautions

As well as protecting the skin with a good quality sunscreen, even on cloudy days, there are several precautions you can take to reduce the risk of skin cancer. Wearing protective clothing and eye protection, especially in winter, can greatly help to prevent damage to the skin.

If you need guidance, expert dermatologist Dr Juliet Williams will discuss with you the best course of action. If you do have a precancerous lesion and it is caught early, then it might be possible to treat it with Cryotherapy, or creams. Alternatively, you may need a skin excision to be performed on the area under local anaesthetic. If necessary, Dr Williams can arrange a sample biopsy to help determine the best course of treatment.

If you are concerned that you may have a precancerous lesion, book an appointment with Dr Juliet Williams by calling 01483 555 907 or email info@drjulietwilliams.co.uk .

Acne

A recent survey conducted in Australia has revealed that acne’s effects go beyond the surface of the skin. The condition, which affects 95% of people in England at some point in their lives, can lead to significant psychological distress.

Severe, and even mild forms of acne can negatively impact self-esteem, and even influence social media behaviour. While previous studies have demonstrated that acne can have negative effects on adolescents’ body image, confidence, and self-esteem, this survey is among the first to explore its impact on relationships and social media use amongst young people.

Here, we look at the psychological impact acne can have, and reveal some top tips to help clear up the condition.

The psychological impact of acne on young people

A recent study, led by Dr Rhiannon Russell, a resident medical officer at The Wollongong Hospital in New South Wales, Australia, found that young people with severe acne often edit their photos and refrain from sharing them on social media. They also face difficulties in meeting new people and finding a partner.

Results showed that those with severe acne avoided posting pictures of themselves on social media. Even in cases of mild acne, a considerable proportion of participants (59%) stated that they would not post a picture of themselves to their profiles.

The study also found that people with severe acne are more likely to have trouble going out in public, meeting new people, and engaging with potential romantic interests. Over 80% of respondents with severe acne reported significant difficulties in this regard, while only a third of respondents with mild acne reported the same issues.

Young people suffering with acne should have access to psychological support since it can have a significant negative impact on all aspects of their lives. Consequently, NICE brought out guidance in 2021 for supporting the mental health of people affected by acne.

Tips for dealing with acne that won’t clear up

While most cases of acne do clear up by themselves, in stubborn cases there are things you can do to help speed up the process. Let’s look at some of the top tips you can follow to clear up mild to severe acne…

Give treatments time to work

Effective acne treatment requires time to work and switching products frequently can irritate your skin. It’s important to be patient and allow time for a treatment to take effect. Improvement may be noticeable within 4 to 6 weeks, but it can take two to three months or longer for significant clearing to occur.

Once you see an improvement, it’s essential to continue using the treatment, even if your acne has cleared up. This can help to prevent new breakouts from occurring, as well as help maintain healthy skin.

Don’t over-wash the skin

Acne-prone skin is delicate and easily irritated. Over-washing, especially more than twice a day, can aggravate the skin, making the symptoms worse.

To achieve best results, wash your face, using a product designed for skin with acne, first thing in the morning, before going to bed, and after sweating. These are the times when your skin is most susceptible to accumulating impurities and bacteria.

Visit a dermatologist

If nothing you try is working, visit a dermatologist. Thanks to developments in modern treatments, a trained dermatologist can help to clear up even the most stubborn cases of acne. They will work with you to develop a customised treatment plan that addresses your specific needs and concerns.

Book a consultation with Dr Juliet Williams today. An expert dermatologist, she will help you on your journey to healthy, glowing skin.

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.