What would a dermatologist do? Your skin conditions deconstructed

In the quest for clear and healthy skin, we can end up wasting a lot of time and money on products that just don’t deliver. So how do we spot the solutions that are really worth investing in?

We spoke to Dr Susan Mayou, Consultant Dermatologist at Cadogan Cosmetics  for her targeted skin care action plan for tackling the most common skin conditions. From our T-zones to our jawlines, cheeks to our noses, here’s the dermatologist’s guide to good skin that works in both the short and long-term too.

1) The T-zone and jawline

Common skin conditions: Spots, acne and eczema.

Acne deconstructed

What are the symptoms?

Whiteheads, blackheads, inflamed spots, cysts and post-inflammation scarring. “The main cause of acne in both girls and boys is hormonal,” explains Dr Mayou. “The hormone responsible is testosterone, which occurs in lower levels in girls. The testosterone acts on the sebaceous glands, with breakouts occurring in the areas that have the highest concentrations. These tend to be the T-zone and away from the face, the upper chest and back.”

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What would a dermatologist do?

Step 1: “As a starting point, I recommend using skincare products from brands like La Roche-Posay - especially their cleansers - and Dermalogica . Neutrogena’s Visibly Clear Rapid Clear Treatment , £5.35, and Clinique’s Anti-Blemish Solutions Clinical Clearing Gel , £22, are also good for more targeted application," says Dr Mayou.

“I would keep the skin de-greased by washing it twice a day and incorporate a little exfoliating content, in order to try and aid and age the process of the unblocking of the follicles.

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“The products should be non-comedogenic and oil-free - opt for the acne-specific ranges that the above brands do as they’ll often have salicylic or glycolic acid in them and other agents which help to exfoliate and then dry the spots up.

“As acne can start from the age of 11 upwards, it is important to bear in mind that the skin is often still child-like and sensitive (as it might indeed be at any age), plus you might have eczema-prone skin as well as acneic. Acids can sometimes be too harsh, so we tell people to take a ‘paint by numbers’ approach; applying the harsher components on the affected bits only and the rest on the other areas.

“If you feel that there’s a food trigger or exacerbator - addressing that first can also help,” recommends Dr Mayou. “There’s always been conflicting data, but ultimately if an individual finds that dairy or sugar or anything like that causes a problem, it’s best not to eat them.

“The reason dairy may exacerbate acne is through hormonal mediators and by increasing plasma insulin-like growth factors (i.e. IGF-1). Both IGF-1 and androgens (such as testosterone) increase sebum production. Milk for example, contains testosterone precursors which stimulate sebum production and hyperkeratatinisation (i.e. shedding) of the cells’ ducts,” she adds. This then blocks the follicles and fuels the resultant inflammation.

“It is thought that milk acts through the IGF-1 pathway. Milk, especially skimmed milk correlates with higher plasma IGF-1 levels. It also contains less oestrogen, a hormone which reduces acne,” she explains.

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Step 2: “The next stage involves using an agent to dry the skin out more, such as benzoyl peroxide. You can buy this up to a certain strength without a prescription,” recommends Dr Mayou.

Step 3: If the above measures don’t work, that’s where seeing a dermatologist and prescription-strength products could hold the key to a clearer complexion. “If your skin is still not controlled, see a GP,” says Dr Mayou.

“They will most likely recommend a single topical antibiotic or a combination with a benzoyl peroxide. Bear in mind though, that antibiotics are recommended for their anti-inflammatory properties, rather than for their traditional roles as antibiotics. Topically, they work partly by drying up the spots. There are many different combinations and concentrations available - if one doesn’t work, there are many others one can try.

“Topical antibiotic creams with an alcoholic base are great for drying out the skin, but not so great if you have sensitive skin. We prescribe aqueous Dalacin T lotion for skin types that can’t tolerate Dalacin T with an alcohol base in those cases.”

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Step 4: “If it progresses to the stage where the papules and pustules are deeper and it becomes more than a superficial problem - it could be time for oral antibiotics, again due to their anti-inflammatory properties, not their antibiotic ones,” explains Dr Mayou.

“Normally, they can be taken four times a day for a week when used to help clear a skin or chest infection, but in this case a low dose long-term dosage is prescribed - usually 1 a day for several months. People can’t expect a quick fix though, as it may take up to 6 weeks for sufferers to start seeing results. After that, they can expect a 20% improvement after two months, 30% at three months, 40% at four months and so on.”

Step 5: “Girls also have the option of going onto the contraceptive pill - a skin-friendly one such as Dianette, Yasmin or Cilest. Dianette used to be our first choice, but we tend to not prescribe it for as long a time anymore because of its association with deep vein thrombosis (DVT),” cautions Dr Mayou.

“The one prescribed depends on the age of the girl and her lifestyle. We avoid recommending it to young schoolgirls as we don’t want to disrupt their hormone balances earlier than needed.”

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Step 6: “If after a year it’s still a problem and it’s a case where they’ve been taken off antibiotics and their skin has flared up again, the next stage would be to prescribe Roaccutane - a vitamin A-derived acne remedy ,” says Dr Mayou.

Are the side-effects of Roaccutane worth it?

“We prescribe low doses of Roaccutane , the main side-effect being dryness. It’s dose-related and we also make sure to provide Lucas Papaw Ointmen t, £6.99 for our patients for the lips.”

It’s not a choice to be taken lightly though. “We have to keep a check on their blood to ensure their livers are healthy and girls who are sexually active have to be on the Pill because if they fell pregnant, they would need a termination - so it’s a serious option,” says Dr Mayou. “If people are prone to depression, they can also be affected by its mood-depressing effects. However, if you pick your patient right, you can get great results. I’ve found that many patients who have had it before and suffer from acne again, prefer a second course as it’s so effective rather than going back to trying the other options.”

Eczema deconstructed

What are the symptoms?

“This often affects the forehead, eyes, cheeks and around the mouth - anywhere on the face,” explains Dr Mayou. There are many different kinds, but common symptoms include redness, blistering, itching and extreme dryness.

What would a dermatologist do?

“We would usually treat this with a moisturiser and 1% hydrocortisone-based anti-inflammatory cream (which you can get over-the-counter); its strength depending on the severity,” says Dr Mayou.

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2) The nose

Common skin conditions: Seborrheic dermatitis and psoriasis.

Seborrheic dermatitis deconstructed

What are the symptoms?

“This is a very common skin condition that occurs on the face and presents clinically as dryness of the nasal crevices either side of the nostrils and also on the eyebrows and glabella - the area of skin between the eyebrows,” explains Dr Mayou. “A common misconception is that this dryness is just due to dry skin, especially if it isn’t unreasonably flakey.”

What would a dermatologist do?

“Often in greasy prone skin types, the condition can be helped to a point with a light moisturiser but if it has manifested itself in inflamed thicker flakes, I would normally prescribe a product called Daktacort,” says Dr Mayou. “This contains 1% hydrocortisone which acts as an anti-inflammatory (and is also available over-the-counter). I would also recommend Daktarin - an anti-yeast treatment created to help combat the natural yeast we have on our skin - which can often play a pathogenic role in causing seborrheic dermatitis.”

Psoriasis deconstructed

What are the symptoms?

There are many different forms, but generally it is characterised by scaly red plaques which are often itchy. “This can affect the same sorts of areas as seborrheic dermatitis, i.e. either side of and across the nose,” explains Dr Mayou. “It can be difficult to tell the difference, but psoriasis can be found on other areas outside of the face, looks redder and is flakier too.”

What would a dermatologist do?

“Depending on the degree of severity, we would often recommend a 1% hydrocortisone cream to act as an anti-inflammatory which can be obtained over-the-counter too,” says Dr Mayou. “Eumovate is a stronger over-the-counter option for tackling psoriasis on the body.”

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3) Cheeks

Common skin condition: Acne rosacea.

What are the symptoms?

“This is usually most common in people in their 30s and older; a persistent pinkness to cheeks that isn’t intermittent,” explains Dr Mayou. “The next stage includes the development of acne-looking papules and pustules. At this point, it’s no longer known as just rosacea, due to the presence of the acne vulgaris.”

What would a dermatologist do?

“We treat it with the same antibiotic that we treat the more common version of acne vulgaris detailed above - a once a day dose of tetracycline,” says Dr Mayou. “It can be flared by steroids so it’s best to see your GP first.”

Follow us  @getthegloss , Dr Mayou  @CadoganClinic  and Ayesha  @Ayesha_Muttu .

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