You can Eat Your Way to Healthier Skin

You can Eat Your Way to Healthier Skin
You can Eat Your Way to Healthier Skin

As a child, what you try to put in your mouth invariably ends up on your skin. Well, as we grow up what we eat becomes more and more important to our long-term health. That includes our skin health – what we eat will be reflected in how our skin looks. For Dermatologists such as Dr. Jessica Wu, what a person eats is “as important as the products they apply to their skin.” So, what should we be eating then?

Stage 1: Removing the Bad Stuff

Several types of products are known to cause bad skin outbreaks including acne. The two main food-based culprits are sugar and dairy products. Dairy may be controversial to some because there are many experts who recommend yogurt for improving skin care by improving digestion with probiotics, but others disagree. Sugar is less controversial. We do need sugars; especially for brain function, but they need to be good sugars, such as those from fruits. Spiking insulin levels in the blood can cause acne reactions.

Stage 2: Build a Sustainable, Healthy Diet

By sustainable we are not talking about ecological, though that would be great too. No, many diets are fads, so what you need is something which is varied and balanced. It feels good, but it is also healthy for you at the same time. There are, therefore, a range of superfoods which are good for your insides, but also good for your skin. Here’s a few:

Fruits: The best of the best, fruits are full of vitamins and minerals, but also natural sugars. Go for strawberries most of all because their Vitamin C levels are even higher than oranges.

Meats: Go for fatty fish over any other kind of meat. Tuna, salmon, and mackerel are the best options as they are rich in Omega 3 fatty acids. They are fantastic also for repairing sun-damaged skin and wrinkles.

Vegetables: Plenty of options here. The best ones to go for include spinach, avocados, bell peppers, and tomatoes. However, surprisingly, one of the best of the best is the humble sweet potato. They are vitamin factories and are full of vitamin A, B1, B2, B3, B6, C, biotin, iron, and potassium. Quite a haul.

Don’t Forget What You Drink: Green tea is a proven powerhouse in promoting healthier, glowing skin. This is because it has antioxidants and anti-inflammatories like polyphenols. This antioxidant has also been shown to reduce damage from UV radiation.

Stevens-Johnson syndrome – What are the signs and symptoms of Stevens-Johnson syndrome?

Stevens-Johnson syndrome is a rare but serious disorder that affects the skin, mucous membrane, genitals and eyes.

The mucous membrane is the soft layer of tissue that lines the digestive system from the mouth to the anus, as well as the genital tract (reproductive organs) and eyeballs.

Stevens-Johnson syndrome is usually caused by an unpredictable adverse reaction to certain medications. It can also sometimes be caused by an infection.

The syndrome often begins with flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.

Stevens-Johnson syndrome is a medical emergency that requires treatment in hospital, often in intensive care or a burns unit.

Treatment aims to identify the underlying cause, control the symptoms and prevent complications.

Erythema multiforme is a similar, but less severe, skin reaction that’s usually caused by infection, particularly herpes viral infections, and a bacteria called mycoplasma that causes chest infections.

 

Symptoms of Stevens-Johnson syndrome

Skin pain is the most common symptom of Stevens-Johnson syndrome.

Flu-like symptoms are also usually present during the initial stages, and may include:

feeling generally unwell

a high temperature (fever) of 38C (100.4F) or above

headache

joint pain

cough

After a few days a rash appears, which may look like a target – darker in the middle and lighter around the outside (see below). The rash isn’t usually itchy, and spreads over a number of hours or days. Large blisters then develop on the skin, which after bursting leave painful sores.

Facial swelling and swollen lips covered in crusty sores are common features of Stevens-Johnson syndrome. The mucous membranes inside your mouth, throat, eyes and genital tract may also become blistered and ulcerated. This can make swallowing painful and lead to serious problems such as dehydration.

The surface of the eyes can also sometimes be affected, which if not treated quickly can cause corneal ulcers and vision problems

Causes of Stevens-Johnson syndrome

In children, Stevens-Johnson syndrome is usually triggered by a viral infection, such as

mumps

flu

herpes-simplex virus, which causes cold sores

Coxsackie virus, which causes Bornholm disease

Epstein-Barr virus, which causes glandular fever

Less commonly, bacterial infections can also trigger the syndrome.

In adults, Stevens-Johnson syndrome is often caused by an adverse reaction to medication. The medications associated with a high risk of Stevens-Johnson syndrome are:

allopurinol

carbamazepine

cotrimoxazole and other anti-infective sulfonamides – including sulfasalazine, sulfadiazine, sulfadoxine and sulfafurazole

lamotrigine

nevirapine

certain types of non-steroidal anti-inflammatory drugs (NSAIDs) – including meloxicam, piroxicam and tenoxicam

phenobarbital

phenytoin

sertraline

As a result of the associated risk, a thorough evaluation of the expected benefits of treatment is required when prescribing the above medications. Doctors are advised to carefully consider using these medications as first-line treatments, particularly if there are safer alternatives.

It’s important to emphasise that Stevens-Johnson syndrome is rare, and the overall risk of getting the syndrome is low, even for people using “high risk” medications (one in 1,000 to one in 100,000).

Risk factors

Risk factors for Stevens-Johnson syndrome may include:

viral infections – such as herpes, hepatitis, viral pneumonia or HIV

a weakened immune system – as a result of HIV or AIDS, autoimmune conditions, such as lupus, or certain treatments, such as chemotherapy and organ transplants

a previous history of Stevens-Johnson syndrome – if the syndrome was previously caused by medication, you’re at risk of it reoccurring if you take the same medication again, or medications from the same family of medications

a family history of Stevens-Johnson syndrome – if a close family member has had the syndrome, your risk of getting it may be increased

Specific genes have also been identified that increase the risk of Stevens-Johnson syndrome among certain groups of people.

For example, Chinese people with the HLA B1502 gene have experienced Stevens-Johnson syndrome after taking carbamazepine, and allopurinol has also triggered the syndrome in Chinese people with the HLA B1508 gene.

Diagnosing Stevens-Johnson syndrome

Stevens-Johnson syndrome should be diagnosed by a dermatologist (skin specialist). A diagnosis is often based on a combination of your:

symptoms

physical examination

medical history (including any medication you’ve recently taken)

To confirm the diagnosis, a small sample of skin may be removed (biopsy) so that it can be tested in a laboratory.

Treating Stevens-Johnson syndrome

If Stevens-Johnson syndrome is suspected, you or your child will be immediately referred to hospital for treatment. Without treatment, the symptoms can become very severe and be life-threatening.

Severe cases of Stevens-Johnson syndrome may need to be treated in an intensive care unit (ICU) or burns unit.

The first step is to stop taking any medications that may be causing Stevens-Johnson syndrome. However, it can sometimes be difficult to determine which medication is causing it, so stopping all non-essential medications may be recommended.

Treatment for relief of symptoms while in hospital may include:

cool, moist compresses held against the skin – dead skin may be gently removed and a sterile dressing placed over the affected area

regularly applying a plain (unscented) moisturiser to the skin

replacement fluids – you may receive fluids and nutrition through a tube that’s passed through your nose and into your stomach (a nasogastric tube)

mouthwashes containing anaesthetic and/or antiseptic – to temporarily numb your mouth and make swallowing easier

a short course of corticosteroid tablets (topical corticosteroids) to control skin inflammation (only on specialist advice)

antibiotics – if blood poisoning (sepsis) is suspected

eyedrops or eye ointment – for eye-related symptoms

Once the cause of Stevens-Johnson syndrome has been identified and successfully treated (in the case of an infection), or stopped (in the case of medication), the skin reaction will stop. New skin may start to grow after a few days.

However, the length of time it takes to recover from Stevens-Johnson syndrome will depend on how severe it is, and it can sometimes take many weeks or months to fully recover.

If the cause was an adverse reaction to medication, you’ll need to avoid that medication and possibly other similar medications for the rest of your life. The doctor treating you will be able to advise you further about this.

Complications of Stevens-Johnson syndrome

As Stevens-Johnson syndrome severely affects the skin and mucous membranes, it can cause a number of complications. These include:

skin changes – when your skin grows back it may be uneven in colour; less commonly, scarring may occur

secondary skin infection (cellulitis) – which can lead to further, serious problems such as blood poisoning (sepsis)

problems with internal organs – organs can become inflamed – for example, the lungs (pneumonia), heart (myocarditis), kidneys (nephritis) or liver (hepatitis); the oesophagus may also become narrowed and scarred (oesophageal stricture)

eye problems – the rash can cause problems with your eyes which, in mild cases, may be irritation and dry eyes, or in severe cases may result in corneal ulceration, uveitis (inflammation of the uvea, which is the middle layer of the eye) and, possibly, blindness

Problems with the sexual organs, such as vaginal stenosis (narrowing of the vagina caused by a build-up of scar tissue), and scarring of the penis, is also a possible complication of Stevens-Johnson syndrome.

Preventing Stevens-Johnson syndrome

If Stevens-Johnson syndrome has been caused by an adverse reaction to a medication, you’ll need to avoid taking this medication and other similar medications. Other family members may also want to avoid using the medication in case there’s a genetic susceptibility within your family.

If you’ve had Stevens-Johnson syndrome in the past, and your doctor thinks you’re at risk of getting it again in the future, you’ll be warned to look out for the symptoms.

If you’re of Chinese, southeast Asian or Indian descent, genetic testing may be recommended before taking medications, such as carbamazepine and allopurinol, that are known to have an associated risk of causing Stevens-Johnson syndrome. Testing will help determine whether you carry the genes (HLA B1502 and HLA B1508) that have been associated with the syndrome when taking these medications.

Bullous pemphigoid – so what is Bullous pemphigoid?

Bullous pemphigoid
Bullous pemphigoid

Introduction

Bullous pemphigoid is a blistering skin disease that tends to affect the elderly.

It’s caused by a problem with the immune system, but usually goes away on its own within a few years. In the meantime, blisters can be controlled with medication.

About 1 in 10,000 people are affected by the condition in the UK each year.

What are the symptoms?

Bullous pemphigoid typically starts with a red, itchy rash that looks a bit like dermatitis (a type of eczema) or hives. This tends to last several weeks or months.

Groups of large, itchy blisters usually then appear on the red patches, just beneath the surface of the skin. They can be up to 5cm in diameter and full of fluid, with the thick skin of the blisters stretched tightly.

The fluid inside is usually clear, but can turn cloudy or bloodstained.

Blisters last a few days before healing without leaving a scar, but a cycle develops where more form.

The rash and blisters are usually seen on the upper arms and thighs, sometimes spreading to body folds and the tummy. In severe cases, the blisters may cover most of the skin, including the inside of the mouth.

However, some people have no symptoms or just have mild redness and irritation without blisters.

Who is affected?

The condition is usually seen in older people aged over 70. Rarely, it can affect children and younger adults.

Bullous pemphigoid is also slightly more common in women than men.

What is the cause?

Bullous pemphigoid is an autoimmune condition, which means the immune system attacks the body’s own tissues and organs.

The person’s immune system produces antibodies against the skin. These antibodies attack the basement membrane, which lies between the skin’s top layer (epidermis) and the next layer (dermis), and holds the skin together. The skin layers start to separate and fluid builds up in between.

It’s not understood why autoimmune diseases like bullous pemphigoid happen, but it’s thought something triggers the immune system to attack the body’s own tissues. Certain medicines and sunburn have been known to act as a trigger.

Symptoms usually come on unexpectedly.

Bullous pemphigoid isn’t:

  • infectious
  • caused by an allergy
  • affected by diet or lifestyle

How is it diagnosed?

Your GP may suspect bullous pemphigoid just by looking at your skin.

The diagnosis is then confirmed by taking a small sample of your affected skin (biopsy) and sending it to a laboratory to be inspected to see if the top layers of skin have separated.

Special staining (immunofluorescence) may be used to show up the antibodies, and a blood sample may be taken and checked for the presence of pemphigoid antibodies.

How is it treated?

If you’ve been diagnosed with bullous pemphigoid, you’ll probably be referred to a dermatologist (skin specialist) for treatment.

The aim of treatment is to stop new blisters forming and heal the blisters that are already there.

Your specialist may prescribe quite powerful medication with potentially severe side effects, so the smallest possible dose is used to minimise this.

You’ll usually be prescribed corticosteroids (either tablets or cream), sometimes alongside “steroid-sparing” medication that allows doctors to reduce the dose of steroids. You may also be prescribed an antibiotic.

Corticosteroids

Corticosteroids, or steroids, are an anti-inflammatory medicine prescribed for a wide range of conditions.

If the affected area of skin is only small, you may be prescribed steroid cream to rub into the area. For larger areas of blisters, you may be given steroid tablets.

If the blisters are severe, you may be given a high dose to start with to get the condition under control and stop the blisters appearing. This may take several weeks.

The dose is then gradually reduced, and you’ll either come off the steroids or be kept on a low dose for a long time.

To use the lowest possible effective dose of steroids, your doctor may give you “steroid-sparing” medicine to take alongside, which is described below.

Read more about steroid medicines, including the side effects.

Tablets to suppress your immune system

You may be prescribed azathioprine or methotrexate medicine to take alongside steroids. These work by suppressing your production of antibodies.

The idea is that side effects will be less troublesome if low doses of two different tablets (steroids and immunosuppressants) are used instead of one high dose of steroids. This is known as steroid sparing.

Looking after your skin

Blisters should be left intact, if possible, to reduce your risk of infection.

However, if they’re particularly large and in a difficult place – such as the sole of your foot – they may be carefully pierced with a sterile needle to release the fluid. The skin of the blister should be left.

If blisters do break, they heal quickly.

Outlook

It’s not possible to cure the condition with treatment, but it usually goes away on its own within five to six years. In the meantime, medication is effective in keeping the blisters under control.

Regular follow-up appointments are usually necessary in the meantime so any side effects of the medication can be monitored, and to make sure the symptoms are under control.

Hidradenitis suppurativa – what are the signs, symptoms and treatments of Hidradenitis suppurativa?

Hidradenitis suppurativa (HS) is a painful, long-term skin condition that causes abscesses and scarring on the skin.

The exact cause of hidradenitis suppurativa is unknown, but it occurs near hair follicles where there are sweat glands, usually around the groin, buttocks, breasts and armpits.

For reasons that are unclear, more women than men have the condition. It’s thought to affect about 1% of the population.

Symptoms

The symptoms of hidradenitis suppurativa range from mild to severe.

It causes a mixture of red boil-like lumps, blackheads, cysts, scarring and channels in the skin that leak pus.

The condition tends to start with a firm pea-sized lesion that develops in one place. This will either disappear or rupture and ooze pus after a few hours or days.

New lumps will then often develop in an area nearby. If these aren’t controlled with medication, larger lumps may develop and spread. Narrow channels called sinus tracts also form under the skin that break out on the surface and leak pus.

Hidradenitis suppurativa is very painful. The lumps develop on the skin in the following areas:

around the groin and genitals

in the armpits

on the buttocks and around the anus (back passage)

below the breasts

The abscesses may also spread to the nape of the neck, waistband and inner thighs. Other isolated areas that have been known to be affected include the front or back of the legs, the sides, the back area and even the face.

Some of the lumps may become infected with bacteria, causing a secondary infection that will Hidradenitis suppurativa (HS) 2need to be treated with antibiotics (see below).

Many people with hidradenitis suppurativa also develop a pilonidal sinus, which is a small hole or “tunnel” in the skin.

What causes hidradenitis suppurativa?

The exact cause of hidradenitis suppurativa is unclear, but the lumps develop as a result of blocked hair follicles.

Smoking and obesity are both strongly associated with hidradenitis suppurativa, and if you’re obese and/or smoke it’s likely to make your symptoms worse.

Hidradenitis suppurativa usually starts around puberty, but it can occur at any age. It’s less common before puberty and after the menopause, which may suggest that the sex hormones play a part. Many people with the condition also have acne and hirsutism (excessive hair growth).

In rare cases, hidradenitis suppurativa may be linked to Crohn’s disease, particularly if it develops around the groin area and the skin near the anus. Crohn’s disease is a long-term condition that causes the lining of the digestive system to become inflamed.

Hidradenitis suppurativa runs in families in about a third of all cases. It’s not infectious and isn’t linked to poor hygiene.

Diagnosing hidradenitis suppurativa

There’s no definitive test to help diagnose hidradenitis suppurativa.

Your GP will examine the affected areas of skin, and they may take a swab of an infected area. This can be helpful in making a diagnosis because the condition isn’t usually associated with the presence of bacteria that cause skin infections.

Hidradenitis suppurativa could potentially be mistaken for acne or folliculitis (inflammation of the hair follicles).

Treating hidradenitis suppurativa

Hidradenitis suppurativa is a lifelong, recurring condition that requires constant management and is often difficult to manage.

It’s important to try to recognise and diagnose the condition in its early stages and prevent it getting worse.

Treatment for hidradenitis suppurativa will be tailored to the individual. In the early stages, it may be controlled with medication. Surgery may be required in severe or persistent cases. The treatments are outlined below.

Surgery

Surgery may be considered in cases where hidradenitis suppurativa can’t be controlled with medication.

Lifestyle advice

If you have hidradenitis suppurativa you should:

lose any excess weight

stop smoking, if you smoke

use an antiseptic skin wash or antiseptic soap – this may be prescribed alongside other treatment (see above)

hold a warm flannel on the lumps to encourage the pus to drain

wear loose-fitting clothes

avoid shaving affected skin and avoid wearing perfume or perfumed deodorants in the affected areas

Outlook

Although hidradenitis suppurativa can persist for many years, if it’s diagnosed early the symptoms can be improved with treatment.

However, the condition can have a significant impact on a person’s everyday life. Having to regularly change dressings and constantly live with the pain, discomfort and embarrassment of the symptoms can affect your quality of life and lead to depression.

Speak to your GP if you’re having problems coping. Charities, such as The Hidradenitis Suppurativa Trust, can also provide help support.

Panniculitis – What are the signs and symptoms of Panniculitis?

Pannicullitis
Pannicullitis

Panniculitis is a broad term referring to inflammation of the fatty layer underneath the skin. It’s usually seen in women, on the thighs and lower legs.

There are many types of panniculitis – with different causes – but the condition generally causes the skin to feel hard and to develop painful red lumps (nodules) or patches (plaques), making it look darker in places.

Panniculitis usually affects the shins and calves, but may spread to the thighs, forearms and chest. It tends to clear up within six weeks, fading like a bruise, usually without scarring.

When the inflammation has settled, a depression in the skin may be left, which can be temporary or permanent.

Many people get recurring bouts of panniculitis.

Other symptoms

As well as skin symptoms, panniculitis may also be associated with:

fever

fatigue

weight loss

nausea and vomiting

joint pain

What are the causes?

There are a wide range of possible causes of panniculitis, although often the cause is not known. Common causes include:

an infection – usually a viral or bacterial infection, but sometimes tuberculosis

an inflammatory disease such as Crohn’s disease or ulcerative colitis

some medicines, including the oral contraceptive pill or sulphonamides (a group of antibiotics)

sarcoidosis – a rare disease that causes body cells to form into clumps, called granulomas, in the lungs and skin

leukaemia (cancer of the white blood cells) or lymphoma (cancer of the lymphatic system, part of your immune system)

Some cases of panniculitis may be caused by the body’s immune system mistakenly attacking the fat cells.

Types of panniculitis

The layer of fat underneath the skin is made of lobules (groups of fat cells) held together by connective tissue. Doctors sometimes classify the disease as either:

‘mostly septal’ – the inflammation mostly affects the connective tissue

‘mostly lobular’ – it mostly affects the fat lobules

Some people will also have vasculitis, where the immune system attacks the body’s blood vessels. If a blood vessel is inflamed, it can narrow or close off, this can limit, or even prevent, blood flow through the vessel and potentially damage organs.

The most common type of panniculitis is erythema nodosum, which affects the shins. In about half of all cases of erythema nodosum, the cause is unknown.

A similar form of the disease is Weber-Christian disease, also known as idiopathic lobular panniculitis (idiopathic means ‘unknown cause’). This most commonly affects the thighs and lower legs of women aged 30-60, and can also cause the non-skin symptoms mentioned above, such as fever and fatigue.

Other types include:

erythema induratum (nodular vasculitis), which usually affects the calves of young women and is often caused by tuberculosis

cold panniculitis, which affects areas of skin exposed to the cold – for example, it can affect the cheeks and forehead of infants and children

subcutaneous sarcoidosis, when the cause is the rare disease sarcoidosis

A full list of all the different types of panniculitis can be found on DermNet NZ, which provides pictures and detailed information on the specific types.

How is panniculitis treated?

Doctors will aim to treat the underlying cause of the panniculitis, if known, and relieve some of the symptoms. While treatment is underway, you will be asked to ensure you get enough rest and to elevate the affected area when possible.

Treatments will vary; for example, if panniculitis is triggered by medication, this medicine should be stopped – but don’t stop taking any medication without first speaking to your GP.

If the cause is a bacterial infection, you will be prescribed anti-inflammatory antibiotics, such as tetracycline, to clear the infection.

If the cause is sarcoidosis, you may not need any medical treatment as the disease often goes away on its own with time (usually a couple of years). Often, simple lifestyle changes, over the counter painkillers, and support bandages are all that is needed to control any flare ups. Read more about managing sarcoidosis.

The following treatments may help to relieve symptoms:

Joint pain and painful skin nodules can be relieved with anti-inflammatory painkillers  such as ibuprofen.

A solution of potassium iodide may help to relieve symptoms – this is thought to have an effect on white blood cells

The inflammation may occasionally be treated with other therapies  if the immune system is responsible.

If the condition is severe and the above treatments don’t help, you may wish to consider surgical removal of particularly bad patches of skin. Your GP will refer you to a dermatologist (skin specialist) to discuss the pros and cons of surgery.