Skin S.O.S

Is your skin crying out for help? We run through the causes, symptoms and treatments of some of the most common skin complaints – from A to Z.

It’s easy to tell when your skin sends out an SOS. Your once-clear complexion may have erupted in a seemingly unstoppable outbreak of acne, it may appear red and flushed, or dry and cracked. Too long spent in the sun may have fast tracked your path to fine lines and wrinkles, and pigmentation may be starting to rear its head. Here, we get to know some of the most common skin concerns, investigating the causes, symptoms and cures.

A is for Acne

Thought to affect up to 80 percent of girls aged 15 to 16 and 95 percent of boys aged 17 to 18, acne vulgaris is the bacterial infection of the pilosebaceous unit, or the hair follicle and its adjacent sebaceous glands. And its not just adolescents who are affected by the dreaded outbreaks; it affects adults too, with women far more likely than men to continue to suffer acne into adulthood.

Acne develops within the skin’s pores. Fine hairs grow through these pores, alongside sebaceous glands that produce oil to lubricate the hair and protect the skin. In response to a number of factors, most predominantly the rise of testosterone levels in both males and females during puberty, these sebaceous glands can begin to secrete excessive oil, termed sebum. This oil, combined with a build up of dead skin cells, can plug the pore, creating an optimum breeding ground for bacteria. As hypercolonisation of bacteria occurs, so too does the formation of a puss-trapped, inflamed pimple. Blackheads, whiteheads, pustules and cysts are all forms of acne and can ultimately lead to scarring, not to mention affecting self-confidence.

From toothpaste cleansers to oatmeal paste masks, it seems every remedy type has been tried and tested in a bid to clear the spots of acne. Mild acne can usually be treated with regular skin cleansing, topical moisturisers and dietary adjustments. Moisturisers rich in active ingredients will strengthen the skin’s protective oil/water layer and improve the integrity of its structure, making it more resistant to infection and more efficient in shedding dead skin cells.

In more severe cases, medical grade treatment is often required. Prescription ointments can reduce levels of the Propionibacterium acne, the bacteria responsible for most acne infections, while antibiotics can fight the same bacteria or reduce testosterone hormone levels in the body. However, these treatments dehydrate the skin and can cause redness, irritation and sensitivity to sunlight. Laser therapy, chemical peels, microdermabrasion and light induction therapy can also be effective in reducing the appearance of acne and acne scarring.

D is for dehydration

As much as 60 percent of the body is comprised of water and, with the skin its largest organ, it makes sense you need to keep your skin hydrated. Tired, aged, wrinkled and pimpled skin are all signs of dermal dehydration, where enzyme activity is impaired and skin health has deteriorated. Quite simply, to regain and retain hydration, the skin’s oil barrier, known as the acid mantle, must be restored. The acid mantle – the outermost layer of the epidermis – is secreted by the sebaceous glands to keep water and nutrients circulating between skin cells in the epidermis, preventing water loss and protecting against pathogens. When the acid mantle is depleted, ‘transepidermal water loss’ occurs and enzyme activity, which is dependent on water and responsible for the correct functioning of skin cells, is compromised.

Water intake, humidity, lymphatics and essential fatty acids can influence dehydration and enzyme activity. Increasing the amount of water consumed, upping your exercise regime and supplementing your diet with omega oils can boost the amount of water reaching the epidermis through the dermal-epidermal junction and maintain hydration within the skin. These changes, complemented with a diligent skincare regime, can restore enzyme activity and reduce the premature signs of ageing associated with dehydration. A home-care range for dry skin should incorporate hyaluronic acid to attract water, antioxidants to regenerate and repair, and vitamin A to stimulate the dermis and normalise cell function.

E is for eczema

A form of dermatitis, eczema is the inflammation of the skin’s outer layer, resulting in rashes that can exhibit dryness, redness, swelling, crusting and flaking. These symptoms can cause itchiness, oozing infection and bleeding, which sometimes leads to scarring.

With no known cause, some researchers speculate limited exposure to environmental pathogens as a child can lead to a heightened susceptibility to eczema. Authors of a 2005 study into the so-called hygiene hypothesis Flohr, Pascoe and Williams urge caution in prescribing antibiotics to children, particularly those with a family history of atopic dermatitis, or eczema. Others speculate eczema may be triggered by an allergic reaction after exposure to proteins in meat or vegetables, whilst some researchers speculate eczema may be linked to dust mites and celiac disease.

With no single causal factor, eczema cannot be ‘cured’ but the skin irritations can be managed. Once again an array of home remedies have been put forward to reduce inflammation, and certainly modifying your diet and exposure to certain irritants can go lengths in achieving relief from eczema symptoms.

A study by Hoare, Li Wan Po and Williams found the use of immunosuppressant medication, corticosteroid creams (using chemicals that resemble steroid hormones produced in the body) and ultraviolet light therapy were most effective in eczema treatment.

G is for Glycation

If you indulge in sugary delights, you’re probably fully aware of the havoc it will reap on your hips and waistline, yet as sugar bombards your system your skin can suffer too. Glycation presents itself as aged skin, leading to cross-hatched wrinkles on the chin and around the eyes. It is caused by the bonding of sugar molecules onto protein or lipid molecules without the controlling action of an enzyme. The end result is an abundance of ‘advanced glycation end products’, or AGEs, which stiffen and weaken the collagen and elastin in our skin. When this happens, the elasticity, plumpness and youthfulness of skin deteriorate, and the telltale fine lines start to appear.

To a certain extent, glycation is inevitable, as AGEs will exist in even the cleanest of diets. To slow the process, you can avoid foods that include pre-formed AGEs, caused by cooking sugar alongside protein or fat. ‘Browned’ products like chips and baked goods achieve their colour through dietary glycations, while soft drinks and caramelised treats also contain the pre-formed toxins. To help ward off glycation’s effect on the skin, many cosmetic skincare ranges include antiglycation agents. Retinoids promote new collagen formation to eradicate the damage caused by sugar, and pharmaceutical companies are working on products to break the AGE cross-links after they’re formed.

P is for Pigmentation

Hyperpigmentation, or the darkening of the skin in localised areas such as the cheeks, forehead and around the eyes, can be triggered by several factors and can spoil an otherwise clear complexion. The appearance of dark, often brown spots is caused by the overproduction of melanin by melanocytes in the basal layer of the epidermis. This can occur in response to hormonal changes, pregnancy, inflammation and sun damage.

The most avoidable form of pigmentation, particularly common in Australia, is caused by sun exposure, when melanin is produced to protect skin cells from harmful UV rays. Acting like an umbrella, melanocytes release pigment into the skin cells to surround and protect the cell’s nucleus. This causes skin darkening and concentrated spots of melanin, often termed ‘sun spots’.

Certain products such as perfumes, soaps or cosmetics contain ‘phototoxic’ ingredients, which induce a sensitised reaction to sun exposure can also trigger excessive melanin secretion.

Presenting in a more ordered, symmetrical pattern, hormonal melasma is caused by overstimulation of melanocytes in response to increased levels of oestrogen and progesterone. Most common in women, hormonal melasma can arise after pregnancy, in women with a history of taking the oral contraceptive pill or in those undergoing hormonal therapy. Finally, post-inflammatory pigmentation occurs as a result of injury to the epidermal/dermal junction. This can appear in skin conditions like eczema, acne or chronic dermatitis, or in some cases after harsh cosmetic treatments.

Pigmentation of all forms can lie unnoticed in the lower layers of the epidermis for years before appearing on the face. Because of this, and the fact it is so sensitive to inflammation, treating visible signs of pigmentation can be difficult with no guarantee of complete eradication.

Regardless of the cause, all pigmentation is treated with a similar approach. Topical treatments are the first step, with a skincare range incorporating vitamin A to normalise cell function, vitamin C to protect DNA and niacinamide (the active form of vitamin B) to inhibit the synthesis of melanin and lighten existing pigmentation. This treatment can be combined with collagen induction therapy (skin needling), light-emitting diode (LED) therapy and chemical peels. It is best to work with a dermatologist when fighting the appearance of pigmentation, as it is often a long process involving multiple aspects.

R is for rosacea

Evident as redness, pimples, flushing and pustules, rosacea is a vascular disorder that can arise in the centre plane of the face, across the cheeks, neck, chest and around the eyes. A flushed appearance occurs on account of mildly inflamed superficial vasculature, and the redness can be dotted with small bumps called papules or, in more severe cases, inflamed pustules.

Rosacea symptoms can flare up in response to various triggers, including sun exposure, heat, alcohol, spicy foods and certain cosmetics. Treatment for rosacea will usually begin with a patient journal to identify the triggers most troublesome to the individual so that lifestyle adjustments can be made to avoid these irritants.

Skincare with anti-inflammatory ingredients can be effective in combating the appearance of rosacea, with aloe vera, provitamin B5, green tea, red algae, and zinc just some of the ingredients shown to sooth skin irritation. Salicylic acid can help with rosacea, and retinaldehyde, the milder version of retinoid, is usually appropriate to promote skin integrity in rosacea patients, though progressive adoption is recommended. Alongside topical treatments, oral antibiotics can be used to reduce inflammation and eradicate the papules and pustules that can sometimes arise.

Though steroid treatment will succeed in promoting short-term relief of rosacea symptoms, it will usually increase capillary formation and result in amplified redness and flushing in the long term. While some cosmetic treatments like chemical peels and microdermabrasion will inflame rosacea symptoms, other procedures like vascular laser therapy or intense pulsed light (IPL) treatment can successfully relieve redness and flushing. By targeting the capillaries in the dermis, these treatments use light to destroy the tiny blood vessels and reduce flushing.