Doctor, Doctor: When To See A Doctor About Your Skin

Introducing Dr. Olga O'Driscoll, our resident nerdie GP with a special interest in Dermatology. Members of the Nerd Network can book in for one-on-one online medical consultations with Dr. Olga, once referred by their Nerd or Nerdette.

“Skin is in” as they say and never was a truer word spoken. Skin has finally taken its pride of place at the top of the leaderboard, representing the pinnacle of health and beauty across all ages, gender and race. It has never been more in to have good skin.

Alas, the quest to attain “good skin” is something so many of us struggle with on a daily basis, and despite trying every “holy grail” product on the market, the reality of problematic skin is that sometimes an extra helping hand is needed in the form of medical advice and management.

While skin health and some of the more minor skin ailments can be well-managed with a skincare regime that is tailored to your individual needs, some skin conditions can and should be treated by a medical professional. We visit our GP when we are feeling acutely unwell or for management of a chronic medical condition, and we must remember that the skin is an organ too and should be cared for and treated with the same respect that we lend to the rest of our bodies.

The skin is our largest organ and quite literally we wear it every day! We invest so much in keeping up with the latest trends in hair, makeup and clothes and personally, I’m so delighted to finally see people investing in their skin health too. Life is difficult enough these days without our skin getting us down on top of it all. For those of us who struggle with our skin, we know that it is a deeply personal issue that affects our confidence and self-esteem, and can hugely impact on our happiness and sense of self-worth. Beauty is so much more than skin deep, but when our skin is not glowing on the outside, it can be hard to put our best face forward to the world.

When to see a doctor for your skin

So, what is it that we all strive for? Most of us wish for clear, smooth, radiant, youthful skin, free from unwanted blemishes and pigmentary problems. Is this the impossible dream? With the right skincare and medication where necessary, hopefully not! We are all born different with very different skin, and we certainly cannot change our genetics, but for all of us, healthy skin requires internal and external nourishment. It needs to be protected from environmental damage and where possible we can try to correct existing skin damage.

Dermatological conditions (skin problems) that may also need prescribed medications as part of this holistic treatment model include acne, rosacea, melasma, psoriasis, and eczema.

There is no “one size fits all” when it comes to skincare and skin health, but there certainly are lots of treatment options these days to help you on your personal skin journey.

Signs that you should see a doctor about your skin

• You have persistent acne that is not responding to a topical skincare regime, especially if you have signs of early scarring, such as a difference in texture in areas where you have had breakouts.
• You have eczema or psoriasis that is not easing with the use of emollients or moisturisers.
• You have unwanted patches of pigmentation (sun spots or darker spots or areas of skin) after pregnancy or sun exposure that are persistent.
• You think you may have rosacea, a very common skin condition amongst Irish people characterised by recurrent facial flushing and ongoing erythema (redness), often with broken capillaries, and acne rosacea (spots and pustules across the nose, cheeks and chin).

The medical treatments for acne

Almost all of us will experience acne at some point in our lives, mostly during our teenage years, but it can persist, begin, or become more severe during adulthood. While mild acne might be adequately managed with a good skincare regime, any moderate or severe acne should be reviewed by a doctor and treated medically where necessary.

Individual spots arise from the pilosebaceous unit (the hair follicle and oil gland) and several types of acne spots can occur. Acne can take the form of comedones (whiteheads and blackheads), papules (small, tender, superficial bumps), pustules (white or yellow spots), nodules (large, tender, red lumps) or cysts (large, soft, tender swellings). Most people with acne exhibit a mixed picture of comedonal and inflammatory acne, with moderate acne being graded as 30 - 125 total lesions present, and severe acne graded as 125 or more total lesions present.

In reality, any acne that is persisting and causing distress should be reviewed by a medical professional, and certainly any skin that is exhibiting early signs of acne scarring should be treated to prevent further, permanent scarring. Treatment options include both topical and oral medications, or often a combination of the two. The type of acne you have, and its severity will guide its treatment plan.

The most common medical acne treatments

Topical treatments for acne

Prescribed topical preparations include keratolytics and antibiotics. Keratolytics reduce the build-up of dead skin cells and unplug blocked follicles, for example, topical retinoids such as Adapalene, commonly known by the trade name Differin. Topical antibiotics reduce the number of bacteria on the surface of the skin and are anti-inflammatory in nature, such as topical Clindamycin.

Acne pustules

Oral treatments for acne

The oral contraceptive pill can often be effective in treating hormone-driven acne. Oral antibiotics (eg. Doxycycline, Limecycline, Trimethoprim) can be used to treat moderate acne, especially nodular, cystic type acne, where antibiotics are useful in reducing both bacterial numbers as well as inflammation. Oral treatments will be prescribed for at least 3-6 months, usually alongside a topical agent to improve efficacy, and long-term control may often require continuing the topical therapy. Antibiotics do not “cure” acne, and unfortunately further treatment courses may be needed for future flare-ups.

Roaccutane for acne

Roaccutane (isotretinoin) is an effective oral medication used in severe acne which has failed to respond to first and second line treatments including topical retinoids, topical and oral antibiotics, or the contraceptive pill.

It is an oral retinoid, a derivative of Vitamin A and part of the same family as retinol. Roaccutane reduces sebum production in the sebaceous gland, as well as reducing the numbers of acne-causing bacteria on the skin, and acting as an anti-inflammatory. A remarkable 3-pronged approach! It must be prescribed by a specialist dermatologist. While it can be extremely effective, it requires careful patient selection and careful monitoring of side-effects.

Unwanted side-effects may include severely dry skin, lips and eyes, sensitivity to sunlight, muscle and joint pains, gastrointestinal problems and mood changes. A patient must attend for monthly blood tests, and female patients must also be using at least one reliable form of contraception as Roaccutane can cause serious birth defects. Despite these potential serious side effects, Roaccutane is one of the few clinically proven treatments for acne with an 80% success rate if given for 4-5 months.

The most common medical rosacea treatments

The exact cause of rosacea is not fully understood but is thought to involve an altered immune response. An increased number of Demodex mites (which usually inhabit human hair follicles) may also play a role. Rosacea is three times more common in women than in men, and first appears between 30 and 60 years of age.

Treatment of rosacea depends on the severity and type. As rosacea is a chronic condition, treatment regimes can continue for several months, and are repeated when necessary.

Skin with rosacea

Non-medical treatment of rosacea

• Avoiding triggers; alcohol, caffeine, spicy foods, stress, sun/wind, temperature changes
• Daily application of SPF
• Avoidance of topical steroids
• Avoiding astringents, toners and harsh exfoliants
• Use of a non-comedogenic (non-pore-clogging) emollient if skin is dry

Medical treatments for rosacea

Mild to moderate rosacea can be treated with a topical agent, such as Metronidazole gel 0.75%. Moderate to severe rosacea usually requires an oral antibiotic, for example, Doxycycline, Limecycline or Erythromycin. These are thought to act by virtue of their anti-inflammatory, rather than their anti-microbial action.

As with acne, a combination of topical and oral treatment is often used, to improve efficacy. Ivermectin 1% is another topical agent that has gained popularity in recent times. It displays antimicrobial, antibacterial and anti-inflammatory action, as well as killing the Demodex mite that can contribute to rosacea.

Brimodine 0.5% gel is a novel topical therapy used to target the facial flushing and redness associated with rosacea. It can be applied once daily and starts to take effect within 30 minutes of application. Roaccutane is occasionally used in severe, refractory cases.

Dr. Olga, as a member of Team Nerd, is knowledgeable in all of the ways of the Nerd and takes care to ensure that you are using the correct topical skincare alongside your pre-existing, results-driven skincare routine. 

Want to find out more about Dr. Olga? Email us at consult@theskinnerd.com.