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Skin Deep

Our skin not only protects us, it can affect the way we feel about ourselves.

Our skin not only protects us, it can affect the way we feel about ourselves. When things go wrong, it can lead to both a loss of self-esteem and depression. Melak Foster has advice on how to combat some of the most common skin problems.

The skin is the largest organ in your body and the one that takes the worst beating every day of your life. It not only protects you but projects who you are, often getting ignored until a problem erupts or the panic of age related symptoms start creeping into the reflection in the mirror.

Women and men of all ages spend millions of dirhams each year on clearing, smoothing, doctoring and rejuvenating the skin, which suffers and reflects everything from sun damage and the harsh effects of pollution to diet and illnesses.

In an interview with Aquarius, Dr Fatima Habib MD, dermatologist at Cosmesurge in Dubai, addressed some of the more common skin problems, their symptoms and some of the remedies, therapies and myths associated with these conditions.

Keep in mind that many skin ailments are treatable and should symptoms reoccur, or be severe and uncomfortable, it's essential to consult a dermatologist.

Psoriasis is a non-contagious skin disease that affects about 2.5 per cent of the world's population. Researchers are not sure what causes it but many conclude that it's related to the immune system, which somehow triggers the cycle of skin cell growth to speed up.

Normal skin matures in approximately 28 days, the shedding of dead skin cells going unnoticed as this happens so gradually. With psoriasis, however, skin cells mature at as much as 10 times the speed they normally do and the increased volume of cells reaching the surface of the skin causes red lesions. Stress, ibuprofen and chloroquine, the anti malaria medication, can exacerbate psoriasis.

Psoriasis usually occurs in localised areas - often on elbows, knees and the scalp. It is a well-defined red colour, often with a silvery scale and, although not usually uncomfortable or itchy, is unsightly and if left untreated can lead to complications. Small pits on the surface of fingernails are also indicative of psoriasis.

Psoriasis tends to run in families and light skinned people between the ages of 10-40 are the most susceptible with the instances in people with dark skin being very rare.

Psoriatic arthritis - joint inflammation that produces symptoms of arthritis - develop in about 10-15 per cent of those with psoriasis.

Possible treatments
Says Dr Habib: “-Although there is no cure, there are many different treatments that can help clear up psoriasis. Depending on the severity of the case, the age of the patient and the area of inflammation, salicylic acid, phototherapy, ointments and vitamin D formulations can be quite effective. Mild topical steroids may also be used in conjunction with other therapies.”

The word eczema is synonymous with the word dermatitis, which means ‘inflamed skin'. Symptoms range from red, oozing and blistered patches to thickened brown areas, and eczema almost always itches to some degree. There are several different types of eczema, the most
common are:

  • Atopic Eczema: Most common in infants and young adults, one in 10 children have it. Atopic dermatitis can start in babies as young as eight weeks-old and is indicated by red and dry cheeks or an oozing, crusting scalp that can spread to the elbows and knees, leaving dry, angry looking skin.

    The condition usually improves as children grow up - in most cases disappearing by the ages of nine or 10 - although professional advice will certainly bring relief and reduce the severity of the symptoms before time takes its course.

  • Exogenous Eczema: This form of dermatitis can be caused either by contact irritant dermatitis or by inherent allergic dermatitis. In contact irritant dermatitis, eczema is brought on by overexposure of the skin to certain chemicals or abrasions such as the irritation which would be caused by washing the hands over 30 times with a harsh soap. Inherent allergic eczema flares up as a result of the skin coming into contact with substances that cause an allergic reaction - certain metals, for example.

    Widely thought to be a genetically acquired trait, there are many causes for eczema, among them the theory of food allergies. Says Dr Habib: “-Food allergies are really in and out of fashion. A lot of dermatologists do not really believe eczema is related to food allergies but I tell parents that if they think the eczema flares up as a result of eating certain foods, they should monitor the intake of that food and keep a record of subsequent outbreaks.

    “There is more a problem currently with parents who are ultra paranoid and, in an effort to control their children's eczema, withhold vital foods thereby causing malnutrition in their children.”
Possible treatments
Says Dr Habib: “Emollients such as moisturisers and bath products are very important in controlling eczema and parents need to be educated on how to moisturise their children, which may need to be done up to five times a day.

“For atopic eczema, mild to moderate topical steroids may be used in conjunction with other treatments but should not be continued on a long-term basis and only a very mild dosage will be used for small children and babies. If used for a long time, steroid creams can cause skin to become thin, atrophic and very dry with stretch marks and blood vessels becoming visible. Long-term absorption of steroids can lead to problems such as diabetes so it is best to consult a dermatologist.

“Although not yet available in the UAE, Tacrolimus, a new drug that may bring great relief to eczema sufferers, does not have the side effects of steroids and works by calming the immune system.”

Acne is the most widespread skin condition in the world. It affects 85 per cent of all adolescents, more than 20 million people. It usually occurs on the face, chest and back and falls under two categories: non-inflammatory acne and inflammatory acne.

Non-inflammatory acne is caused by a plugged follicle which becomes a whitehead or closed comedo (if it stays below the surface of the skin) or a blackhead or open comedo (if the plug enlarges and pushes through the surface of the skin).

Inflammatory acne is characterised in its mildest form as a papule or small, firm but tender bump. Pustules characterise more severe inflammatory acne, and nodule or cyst acne is indicated by large, painful and pus-filled lesions lodged deep in the skin.

There are many myths associated with acne, one of which is that chocolate, French fries and other oily foods cause outbreaks. In fact, although a healthy diet is vital in giving your skin the nutrients it needs to regenerate itself, what you eat has very little to do with acne.

Another untruth is the misconception that acne is caused by dirt. Actually, pimples are a result of dead skin cells mixing with sebum (the body's natural oil) and forming a plug in hair follicles - also called pores. The black part of blackheads, for example, is not caused by dirt but rather by a buildup of melanin - the skin's darkening pigment.

Possible treatments
Dr Habib: “Five per cent of women have acne and 90 per cent of men get it at some stage, which makes it very clear that acne is a hormonal issue. Retin A is good for clearing up blackheads and Roaccutane is very effective for severe cases of acne.

“It is important to see a dermatologist early on before any scarring occurs but should there be scarring, there are methods to reduce or completely erase scarring and photo damage too. Chemical peels using fruit acids are very effective although darker skins may get, temporarily, some high pigmentation that is reversible.

“The process takes about 20 minutes and healing time takes approximately one week during which the skin on the face is very tight and will peel. Initially there is some swelling but the results are excellent.

“Laser resurfacing is more severe; there is more swelling and the skin will be pink for up to six months. There is scabbing with this procedure and a lot more after care with dressings. This procedure is good for deep wrinkles or deep acne scars and clients can expect a face-lift effect.”

The Roaccutane debate
Often called the miracle drug for acne, Roaccutane (UK), known as Accutane in the US, has become highly controversial in the last few years due to reports of deep depression and suicides sometimes attributed to those taking this drug.

Although the association is difficult to confirm as many of those suffering from acne are already depressed, the list of those plagued with adverse psychological reactions is growing with the most recent and highly publicised Roaccutane-suspected casualty occurring in January of this year when Charles Bishop flew a Cessna light aircraft into the Bank of America Plaza in Tampa, Florida.

Bishop was taking prescribed Accutane and a note found in his pocket after the incident indicated his death was suicide and not simply an unfortunate accident.

Roaccutane (isotretinion) by Roche Pharmaceuticals is a high concentration derivative of Vitamin A administered in tablet form once or twice a day and is indicated in cases of severe recalcitrant nodular acne. In layman's terms, this is disfiguring cystic acne, the deep acne that causes scarring.

Exactly how Roaccutane works is not known but the drug relieves acne sufferers by inhibiting the secretion of the oil glands, thus clearing up acne from deep within the body - something topical Vitamin A ointments are unable to do.

“Because the amount of sebum is reduced throughout the body, excessive dryness of the lips, hair, skin and mucous membranes can be expected with users sometimes having to forgo the use of contact lenses during the course of treatment due to the lessening of moisture in the eyes.

Minor nosebleeds are also a possible side effect. But what of the reported darker, psychological side effects associated with this miracle drug? In the 1880s, Arctic explorers are known to have become mentally unstable after devouring the liver of a polar bear, which is now known to contain toxic levels of vitamin A.

The explorers documented feelings of paranoia, aggression, irritability and ideations of suicide, which have also become classic warning signs of the preliminary effects of an adverse reaction to Roaccutane.

One person we interviewed began taking Roaccutane at the age of 17 and, midway through a four-month course of the drug, described feeling intensely self-conscious and worried constantly about being disliked - even by the family pet. After relaying his developing paranoia to his doctor, the patient was advised to stop taking the drug and switched to topical and oral antibiotics, which
continued the already visible progress Roaccutane was making.

The feelings of anxiety and depression went away but only after a period of approximately one-month due to the fact that Roaccutane is stored in the fatty tissues of the body and can take a long time to work its way out of the system.

Since the licensing of isotretinion in 1982, over 12 million people worldwide have been treated with this drug and knowing exactly how many of these people have suffered psychological damage during the course of usage is impossible to know.

It has been estimated that 5-8 per cent of patients on Roaccutane develop depression and as recently as 2001, Roche Pharmaceuticals in the US was required to change the product information sheet included in packets of Accutane to include a more prominent warning on psychiatric disorders associated with isotretinion including depression, psychosis, suicide ideations and attempts.

Roaccutane is widely prescribed in the UAE but only by prescription from a dermatologist. Women taking Roaccutane will possibly be put onto the birth control pill as a precaution against pregnancy whilst on the drug which may be damaging to the foetus.

Roaccutane is highly effective in treating severe cases of acne that can be scarring emotionally as well physiologically and many clear complexions are happily attributed to this seeming wonder drug.

Most drugs however have side effects and isotretinion is no different. Patients using this drug will be closely monitored by their prescribing dermatologist for behavioural changes amongst other possible side effects
including muscle and joint pain, headaches, intestinal upsets, raised cholesterol levels and changes in the red or white blood cell count. In addition, parents and friends of those taking Roaccutane should be aware and watchful should the user become aggressive, confused or depressed.

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