Skin conditions

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Vitiligo – what are the signs, symptoms, triggers and treatments of vitiligo?

Vitiligo - Michael Jackson had the condition

Vitiligo – Michael Jackson had the condition

Vitiligo is a long-term condition where pale white patches develop on the skin. It’s caused by the lack of melanin, a pigment in the skin.

Vitiligo can affect any area of skin, but most commonly occurs on the face, neck and hands, and in skin creases.

The pale areas of skin are more vulnerable to sunburn, so it’s important to take extra care when in the sun and use a sunscreen with a high sun protection factor (SPF).

 

Symptoms of vitiligo

The areas most commonly affected by vitiligo include:

the skin around your mouth and eyes

fingers and wrists

armpits

groin

genitals

inside your mouth

It can also sometimes develop where there are hair roots, such as on your scalp. The lack of melanin in your skin can turn the hair in the affected area white or grey.

Vitiligo often starts as a pale patch of skin that gradually turns completely white. The centre of a patch may be white, with pale skin around it. If there are blood vessels under the skin, the patch may be slightly pink, rather than white.

The edges of the patch may be smooth or irregular. They’re sometimes red and inflamed, or there’s brownish discolouration (hyperpigmentation).

Vitiligo doesn’t cause discomfort to your skin, such as dryness, but the patches may occasionally be itchy.

The condition varies from person to person. Some people only get a few small, white patches, but others get bigger white patches that join up across large areas of their skin.

There’s no way of predicting how much skin will be affected. The white patches are usually permanent.

Types of vitiligo

There are two main types of vitiligo:

non-segmental vitiligo

segmental vitiligo

In rare cases, it’s possible for vitiligo to affect your whole body. This is known as universal or complete vitiligo.

Non-segmental vitiligo

In non-segmental vitiligo (also called bilateral or generalised vitiligo), the symptoms often appear on both sides of your body as symmetrical white patches. Symmetrical patches can appear on the:

backs of your hands

arms

skin around body openings, such as the eyes

knees

elbows

feet

Non-segmental vitiligo is the most common type of vitiligo, affecting around nine out of 10 people with the condition.

Segmental vitiligo

In segmental vitiligo (also known as unilateral or localised vitiligo), the white patches only affect one area of your body.

Segmental vitiligo is less common than non-segmental vitiligo, although it’s more common in children. It usually starts earlier and affects three in 10 children with vitiligo.

What causes vitiligo?

Vitiligo is caused by the lack of a pigment called melanin in the skin. Melanin is produced by skin cells called melanocytes, and it gives your skin its colour.

In vitiligo, there aren’t enough working melanocytes to produce enough melanin in your skin. This causes white patches to develop on your skin or hair. It’s not clear exactly why the melanocytes disappear from the affected areas of skin.

Autoimmune conditions

Non-segmental vitiligo (the most common type) is thought to be an autoimmune condition.

In autoimmune conditions, the immune system doesn’t work properly. Instead of attacking foreign cells, such as viruses, your immune system attacks your body’s healthy cells and tissue.

If you have non-segmental vitiligo, your immune system destroys the melanocyte skin cells that make melanin.

Vitiligo is also associated with other autoimmune conditions, such as hyperthyroidism (an overactive thyroid gland), but not everyone with vitiligo will develop these conditions.

Risk factors

You may be at increased risk of developing non-segmental vitiligo if:

other members of your family have it

there’s a family history of other autoimmune conditions – for example, if one of your parents has pernicious anaemia (an autoimmune condition that affects the stomach)

you have another autoimmune condition

you have melanoma (a type of skin cancer) or cutaneous T-cell lymphoma (cancer of the lymphatic system)

you have particular changes in your genes that are known to be linked to non-segmental vitiligo

Neurochemicals

Segmental vitiligo (the less common type) is thought to be caused by chemicals released from the nerve endings in your skin. These chemicals are poisonous to the melanocyte skin cells.

Triggers

It’s possible that vitiligo may be triggered by particular events, such as:

stressful events, like childbirth

skin damage, such as severe sunburn or cuts (this is known as the Koebner response)

exposure to certain chemicals – for example, at work

Vitiligo isn’t caused by an infection and you can’t catch it from someone else who has it.

Diagnosing vitiligo

Your GP will be able to diagnose vitiligo after examining the affected areas of skin.

They may ask whether:

there’s a history of vitiligo in your family

there’s a history of other autoimmune conditions in your family

you’ve injured the affected areas of skin – for example, whether you’ve had sunburn or a severe rash there

you tan easily in the sun, or whether you burn

any areas of skin have got better without treatment, or whether they’re getting worse

you’ve tried any treatments already

Your GP may also ask you about the impact vitiligo has on your life. For example, how much it affects your confidence and self-esteem, and whether it affects your job.

Wood’s lamp

If available, your GP may use an ultraviolet (UV) lamp called a Wood’s lamp to look at your skin in more detail. You’ll need to be in a dark room and the lamp will be held 10-13cm (4-5in) away from your skin.

The patches of vitiligo will be easier to see under the UV light, which will help your GP distinguish vitiligo from other skin conditions, such as pityriasis versicolor (where there’s a loss of pigment due to a fungal infection).

Other autoimmune conditions

As non-segmental vitiligo is closely associated with other autoimmune conditions, you may be assessed to see whether you have any symptoms that could suggest an autoimmune condition, such as:

being tired and lacking energy (signs of Addison’s disease)

being thirsty and needing to urinate frequently (signs of diabetes)

A blood test may also be needed to check how well your thyroid gland is functioning.

Treating vitiligo

The white patches caused by vitiligo are usually permanent, although treatment options are available to improve the appearance of your skin.

If the patches are relatively small, skin camouflage cream can be used to cover them up.

In general, combination treatments, such as phototherapy (treatment with light) and medication, give the best results.

Although treatment may help restore colour to your skin, the effect doesn’t usually last. Treatment can’t stop the condition spreading.

Read more about treating vitiligo.

Complications of vitiligo

Vitiligo can sometimes cause other problems.

Because of a lack of melanin, your skin will be more vulnerable to the effects of the sun. Make sure you use a strong sunscreen to avoid sunburn.

Vitiligo may also be associated with problems with your eyes, such as inflammation of the iris (iritis), and a partial loss of hearing (hypoacusis).

Problems with confidence and self-esteem are common in people with vitiligo, particularly if it affects areas of skin that are frequently exposed.

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Keratosis pilaris – the signs, symptoms and treatments of this condition

Keratosis pilaris or chicken skin

Keratosis pilaris or chicken sk

Keratosis pilaris is a common and harmless condition where the skin becomes rough and bumpy, as if covered in permanent goose pimples.

There’s no cure for keratosis pilaris, but you may be able to improve the rash by using soap-free cleansers, moisturising, and gently removing dead skin cells from the surface of the skin (exfoliating).

There’s no real need to see your GP unless the condition is causing you concern. It usually improves as you get older and sometimes disappears completely in adulthood.

This page provides more information on keratosis pilaris and explains what you can do if you have the condition.

Where keratosis pilaris occurs

Keratosis pilaris most commonly affects the back of the upper arms, and sometimes the buttocks and the front of the thighs. Less often, the forearms and upper back may be affected.

There are also rare variants of keratosis pilaris that can affect the eyebrows, face and scalp, or the entire body.

How it affects the skin

The patches of affected skin will be covered in tiny spiky bumps, which may be white, red or skin-coloured. This spotting looks like “chicken skin” or permanent goose pimples, and the skin feels rough, like sandpaper.

In some people, the skin itches and there may be inflammation and pinkness around the bumps.

Keratosis pilaris can’t be spread from person to person (contagious).

The skin tends to improve in summer and get worse during winter months or dry conditions.

Who’s affected

Keratosis pilaris is very common, affecting up to one in three people in the UK.

It can affect people of all ages, but it’s particularly common in:

children and adolescents

females

people with eczema or a condition called ichthyosis

people of Celtic origin

The condition typically starts during childhood, although it can sometimes occur in babies, and gets worse in adolescence, around puberty.

Keratosis pilaris sometimes improves after puberty, and may even disappear in adulthood, although many adults still have the condition in their 40s and 50s. It’s uncommon in elderly people.

What causes keratosis pilaris?

Keratosis pilaris runs in families and is inherited from your parents. If one parent has the condition, there’s a one in two chance that any children they have will also inherit it.

Keratosis pilaris occurs when too much keratin builds up in the skin’s hair follicles. Keratin is a protein found in the tough outer layer of skin, which causes the surface of the skin to thicken, hence the name “keratosis”.

The excess keratin blocks the hair follicles with plugs of hard, rough skin. The tiny plugs widen the pores, giving the skin a spotty appearance.

It’s often associated with other dry skin conditions, such as eczema and ichthyosis, which make the rash worse.

Treating keratosis pilaris

There’s little that can be done to treat keratosis pilaris, and it often gets better on its own without treatment.

However, if it’s bothering you, the following measures may help improve your rash:

use non-soap cleansers rather than soap – ordinary soap may dry your skin out and make the condition worse

moisturise your skin when it’s dry – your GP or pharmacist can recommend a suitable cream, although moisturisers and emollients only reduce the dryness of your skin and won’t cure the rash; creams containing salicylic acid, lactic acid or urea are thought to be the most effective

gently rub the skin with an exfoliating foam pad or pumice stone to exfoliate the rough skin – be careful not to scrub too hard and rub off layers of skin

take lukewarm showers rather than hot baths

You can also ask your GP about “off-label” treatments that may help. These are products that haven’t been officially approved and licensed for treating keratosis pilaris, but are sometimes used because they’ve helped people in the past.

Examples include:

creams containing retinol, which is derived from vitamin A

chemical peels

microdermabrasion – a cosmetic exfoliation treatment that is sometimes offered in health spas

There’s no strong evidence to suggest that these therapies are effective treatments for keratosis pilaris. You may also have to pay for some of them privately.

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Molluscum contagiosum – the signs ,symptoms and causes

Molluscum Contagiosum

Molluscum Contagiosum

Molluscum contagiosum (MC) is a viral infection that affects the skin. It most commonly affects children, although it can occur at any age.

Usually, the only symptom of MC is a number of small, firm, raised papules (spots) that develop on the skin. They are not painful, but can be itchy.

Although the spots can look unpleasant, MC is generally a harmless condition that will normally resolve in a few months without any specific treatment.

 

When to seek medical advice

Visit your GP if you think you or your child may have MC. Your GP will examine your skin (or your child’s) and ask about any other symptoms.

The spots of MC are usually easy to recognise, so your GP should be able to diagnose the condition without the need for further tests.

 

What causes MC?

MC is caused by a virus known as the molluscum contagiosum virus (MCV).

This virus can be spread through:

close direct contact – such as touching the skin of an infected person

touching contaminated objects – such as towels, flannels, toys and clothes

sexual contact – this includes intimate physical contact as well as sexual intercourse

If you become infected by the virus and spots appear on your skin, the virus can also spread to other areas.

It is not known exactly how long someone with MC is contagious for, but it is thought the contagious period may last up until the last spot has completely healed.

Who is affected

MC can affect anyone at any age, but the condition is most common in young children – particularly those aged between one and five.

It is also more common in people with a weakened immune system – either due to a condition such as HIV or a treatment such as chemotherapy.

MC can affect a person on more than one occasion, but this is uncommon.

How MC is treated

In people who are otherwise healthy, individual spots usually clear up within two months. However, it is common for the condition to spread around the body, so it can take up to 18 months or more for the condition to resolve completely.

Routine treatment for MC, particularly in children, is generally not recommended because:

the infection usually clears up on its own

the infection does not normally cause any symptoms other than the spots

the infection does not usually interfere with everyday activities, such as going to work, swimming or playing sports

treatments can be painful and may cause scarring or damage to the surrounding skin

Treatment is usually only recommended for older children and adults when the spots are particularly unsightly and affect quality of life, or for people with weakened immune systems.

In such cases, treatments that may be offered include liquids, gels or creams that are applied directly to the skin, or minor procedures such as cryotherapy (where the spots are removed by freezing them).

In rare cases, the spots can become infected with bacteria, and occasionally the condition can lead to an eye infection, such as conjunctivitis. These complications may need additional treatment with antibiotics to clear the infection.

Read more about treating MC and the complications of MC.

Preventing MC

Although MC is infectious, the chance of passing it on to others during normal activities is small.

It is therefore not necessary to stay away from work, school or nursery, or to stop doing activities such as swimming if you have MC.

However, you should take some steps to avoid spreading the virus to other people. You should:

avoid squeezing or scratching the spots – as well as increasing the risk of the infection spreading, this can cause pain, bleeding and can lead to scarring

keep affected areas of skin covered with clothing whenever possible – a waterproof bandage can be put over the area if you go swimming

avoid sharing towels, flannels and clothing

avoid sharing baths

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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.

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Panniculitis – What are the signs, symptoms and treatments 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.