What can be done to treat acne?

There is a wide range of treatments for acne. These include creams and gels, antibiotics, hormonal therapies and isotretinoin. Alongside these are non-medicinal approaches, including light and laser treatments and chemical peels. For most people with mild cases of acne, over-the-counter medications such as benzoyl peroxide can be adequate. However, for more complex and stubborn cases, your consultant dermatologist has the expertise to determine the best treatment for you and your skin type.

We at Cedars we have access to the fully comprehensive suite of cutting-edge treatments. Our dermatologists are leaders in providing the innovative combinations that will best combat your acne.

What is acne?

Acne is a very common skin problem that most people have probably suffered at some point in their lives. It can show up as a few spots on the face, neck, back or chest but, in severe cases, can cause deep scarring in the skin. Sadly, though, it can be mentally scarring too. Severe acne, especially on the face, can obviously have a massive impact on self-esteem and self-confidence. It can really limit how you enjoy your life and, having personally suffered from acne since the age of 12, I know only too well how distressing its effects are. But it can be treated, and the key point is that if you’re suffering from it, it’s really important to seek professional help as early as possible to prevent permanent scarring.

Can I improve acne scarring on my skin?

The scarring that may be left behind by acne can be as distressing as the acne itself and many people believe there’s nothing that can be done about it. However, there are many different treatments that can improve the scarring, including chemical peels, micro-needling, laser treatment and surgery. So if you suffer from acne don’t suffer in silence. You have plenty of options to combat it. Our dermatological expertise at Cedars is world class and we’re here to help you be happy again with your skin.

Who gets acne?

Acne is not just a teenage problem. Although it usually begins during puberty, it can actually occur at any age, sometimes developing for the first time in people in their 20s or 30s. In fact, cases of adult acne are becoming much more common, although we don’t know as yet why this is.

There are multiple causes of acne, including genetics, hormonal factors, lifestyle and diet. For example, there’s emerging evidence that an excess of refined carbohydrates in your diet can promote acne, and some body building supplements can also contain hormones that contribute. It’s a pretty complex picture and the key point is that every person’s circumstances are unique. So at Cedars we tailor each treatment plan to you and your individual requirements

Are acne treatments anything to worry about?

Now, you may be worried about using some stronger acne treatments such as antibiotics or Accutane, but these medications in the expert hands of a consultant dermatologist can be highly effective in treating acne with minimal potential side effects.

We at Cedars take a holistic approach to the well-being of our patients, and our team partners with allied health professionals such as psychologists to offer the full spectrum of support.

What are the treatments for skin pigmentation conditions?

At Cedars we very often see patients who wish to address their concerns about the pigmentation of their skin. The skin producing an excess of pigment in areas anywhere on the body can lead to patches of uneven complexion and skin tone. Highly visible conditions affecting the skin like this, especially those which will remain in place unless treated, can cause considerable self-consciousness and emotional distress.

At Cedars we understand these impacts on your well-being and will work with you to offer the best treatment from our range together with the most careful psychological support in dealing with every aspect. There are various different underlying causes for such localised excess pigmentation, which is more common in the facial area. So, despite superficial similarities, there are actually different conditions that require different approaches to treatment. The most common pigmentation conditions we see are age spots and melasma.

Age spots develop as part of natural ageing process in both men and women but are more usually a consequence of sun damage and so often are also known as sun spots. They can occur in patches or scattered and are not typically symmetrical. Although they are not usually harmful, in some cases they may represent something more serious. A consultant dermatologist at Cedars will be able to diagnose this for you. More often, though, our patients wish to have them removed for aesthetic reasons. Age spots respond to retinoid creams that stimulate new cell formation on the skin surface to replace the hyperpigmented areas. Cedars also offers sophisticated laser treatments. The laser light is tuned into a particular colour that passes through the skin but is selectively absorbed by the skin pigment, breaking it up. The process isn’t particularly painful, it will feel like a hot prickling sensation, but the area maybe a little sensitive afterwards. It will shortly form a scab, which will fall off in a week or two. It needs no dressing or special attention, but avoid picking at it, and sun avoidance is very important for four to six weeks.

Melasma is different in several key ways from age spots. It is usually symmetrical and appears as brown or greyish patches, mainly on facial skin – the forehead, cheeks, chin and upper lip. These can be quite densely pigmented. Melasma is much more common in women than men and is generally worse during the summer, improving during the winter. We don’t know its precise causes but hormonal factors such as pregnancy, oral contraceptives and hormone replacement therapy can be triggers. Avoiding these where possible can lessen the impact of melasma. It can also benefit from topical treatments that prevent new pigment formation, such as hydroquinone, as well as techniques aimed at removing the pigment layers from the skin directly, such as chemical peels and micro-needling. Lasers are also effective in treating melasma, although that requires much greater skill. Cedars dermatologists all have a great deal of expert training with and considerable experience in the use of such lasers, which ensures the treatment we offer you is safe and world-class. As both melasma and age spots are exacerbated by sun exposure, however, we once again urge sufferers to be diligent in using broad-spectrum sun-cream. Very recent research also suggests that visible light can induce pigmentation and dark skin types, so individuals may benefit from using sun-cream that also blocks it. Prevention is always better than treatment, of course, but for any of your needs in dealing with hyperpigmentation, you’re in safe hands with Cedars. We will always tailor your treatment plan specifically to you, your lifestyle and your needs.

How and when should moles be checked for skin cancer?

Unfortunately rates of skin cancer have been steadily increasing since the 70s. The main cause of skin cancer is absorption of ultraviolet radiation, UV, which damages skin’s DNA at the molecular level. UV is in sunlight and is also produced by tanning booths. It’s what causes tanning in paler skin. A suntan is actually the skin’s defensive mechanism in response to damage caused by UV. Darker skin absorbs less UV and is therefore better protected from its effects. The increase in skin cancer rates are largely due to people’s desire to looked tanned, together with a fall in cost of travel to sunny climates.

Melanoma is a type of skin cancer affecting melanocytes, the pigment-producing cells in skin. It is also the most dangerous type because of its nature and potential to metastasise – that is spread to other organs of the body. Melanoma can develop from moles and is noticeable in differences or changes in their appearance. Giving that the skin such a visual organ it is easy to screen it and pick up potentially concerning mole differences.

Mole checking therefore provides a simple way in which to detect the incidence of melanoma early, which is extremely important. When caught early, melanoma has a good five-year survival rate of up to 99% but if picked up late, this drops to around 80%, which is of course very worrying. As such, dermatologists recommend that mole checks are carried out regularly. You should check yourself monthly. Higher-risk individuals may need professional check-ups at least once a year and, of course, if you notice any concerning changes to your moles. Some new research, which you might not be aware of, suggests that if you have 11 or more moles on either of your arms then you’re at a higher risk of melanoma and should seek professional advice. A self-check is best carried out after a bath or shower and in front of a full-length mirror. But what should you look out for?

Dermatologists use the acronym ABCDE to categorise which features of moles require attention. This refers to symmetry, border, colour, diameter and evolving change. The presence of any one of these features in one of your moles does not necessarily mean you have skin cancer but it does mean you should get it checked out by a dermatologist as soon as possible.

Let’s look at each in turn. Asymmetry is apparent when one half of a mole is different in shape from the other. Compare the normal mole on the left with the asymmetrical example on the right.

Look at the mole’s borders or any irregular or scalloped? Do any have a poorly defined edge?

What is the mole’s colour like? Is it uneven or variable within a mole? How big is the mole? If its diameter is greater than six millimetres, it needs a closer look.
And finally the most important is evolving change. Do you notice that the mole has changed over time in its size, shape or colour?

In addition to these five parameters we also use the ‘ugly duckling’ sign. Do you notice a mole that stands out from your others, one that is darker or substantially different in size for example? Again, spotting any of these conditions doesn’t necessarily mean you have cancer. Moles can naturally get darker, during pregnancy for example, but if you do, or even if you’re in any doubt about the condition of one of your moles, you must see a dermatologist as soon as possible. We will then carry out a more thorough check of your moles, examining potentially concerning ones using a device called a dermatoscope. This is effectively a giant magnifying glass with a very bright light built into it that provides a close and very clear look at the mole. In addition to that, selected individuals may benefit from mole mapping using digital imaging, which can help monitor for changes.

Confocal microscopy is a new technology that can provide even more information about a mole and prevent the need for surgery. Cedars is one of only a handful of practices offering this service.

Should we detect anything concerning or unusual, our approach is to remove it under local anaesthetic and send it for a laboratory biopsy that will confirm whether it’s cancerous or not. If stitches are in place, that will be removed 10 to 14 days later.

Our key point with respect to melanoma, though, is that prevention is always better than treatment. This means protecting yourself from UV radiation at all times. Wear protective clothing and sunglasses when you’re out in the sun and ensure you wear sun-cream on any exposed skin. Your sun-creams should offer broad-spectrum protection, that is protection from both UVA and UVB radiation, and have an SPF of at least 30. Irrespective of this you should always avoid being in the midday sun in equatorial or other hot climates. And we dermatologists are absolutely united in saying that sunbeds are extremely risky and strongly recommend that you avoid them. We are dedicated to ensuring your safety from skin cancer, and you can minimise these risks if you follow these simple steps.

How can I combat the signs of ageing?

Ageing is a completely natural process we all go through. Many individuals are comfortable with the changes it brings on, and nothing needs to be done about it, but on the other hand, a large number of people feel that their outward appearance does not match the person they are on the inside. You may therefore want to know what can be done to address these concerns. As we age, a number of processes occur that affect the appearance of the skin. Fine lines and wrinkles develop, some due to sun damage and others due to frowning or smiling, for example. As we age we also lose collagen, the protein that gives structure to skin, leaving it less elastic. And then there’s a loss of volume with the fat pads and bone to support the skin both becoming thinner. The outcome is that as the skin ages, it loses its firmness and definition and can sag. In addition, skin can become uneven in texture and pigmentation.

At Cedars we offer a range of cosmetic treatments that can combat the signs of ageing in the skin. You’ve probably heard of botulinum toxin injections. About 25 years ago it was discovered by a British dermatologist that when injected in carefully controlled doses it works to relax the muscles in the target area. Since then it’s been used to reduce and soften fine lines and wrinkles.

Muscle relaxing injections are commonly used to improve the eyes, forehead and lips and can help with jawline definition. Improvements can usually be seen in three to five days, but may take a fortnight to reach full effect, but the results will last for 2-3 months after treatment.

You may be aware that dermal fillers are used to enhance the lips but they are also injected under the skin of the face to adjust the volume loss from ageing and scarring, and for facial contouring. The injectable filler is a water-based gel of which the key ingredient is usually a substance called hyaluronic acid. Hyaluronic acid is found in all living organisms and is a key part of the support medium that exists between the cells in our bodies. The non-allergenic synthetically produced hyaluronic acid gel we use replaces some of the skin support and volume that is lost over time. This helps to even out lines, especially the smile lines that run from the nose to the side of the mouth, and makes the skin firmer. It can be used to give volume to the lips as well. The effects are immediate, although there can be mild swelling for a few days after the procedure. Once the skin then evens out, the results last for between six and 18 months, depending on the product used.

Cedars’ cosmetic dermatology service also offers several more generalised skin rejuvenation procedures. These stimulate the body’s own repair mechanisms to improve the condition and appearance of the skin. These include chemical peels and micro-needling as well as laser treatments, which we’ll talk about in a later video. A chemical peel is typically employed to counteract sun damage, mild scarring as might be caused by acne, or skin discolouration. Chemical agents are applied directly to the skin of the face, neck and hands. This helps to wear away the damaged surface in the target area. This half-hour procedure may sting a little but it’s not too uncomfortable and no anaesthetic should be required. A few days later the skin will peel away revealing new skin surface growth underneath that is smoother, more even in tone, brighter in complexion and ultimately younger looking. Good results can be achieved after only one peel, although most patients will benefit from repeated applications.

Micro-needling improves skin texture, scars, fine lines and stretch marks. It’s carried out with a device that rolls across the skin, uniformly applying tiny punctures to its surface with small sterile needles. These tiny wounds stimulate a heal-and-repair response in the skin, which stimulates the production of new collagen – a key structural support protein in skin. Although the technique is minimally invasive, local anaesthetic is usually applied to ensure it’s not painful. The effects of micro-needling are gradual. It usually takes two to three treatments, separated by four to six weeks, to achieve the best results.

If you decide you wish to undergo any cosmetic dermatology procedures, I cannot stress enough how essential is to visit a highly trained and skilled specialist, such as a consultant dermatologist or plastic surgeon. Injectable treatments in particular require expert understanding of the structure, nerve and blood supply of the face and neck. Good outcomes to any of these procedures depend on the aptitude of the practitioner, and dermatologists’ advanced medical training ensures all are carried out safely, correctly and effectively. Each of Cedars’ dermatologists have many, many years of expert training and clinical experience in medicine and the procedures offers. Before any treatment is undertaken we will carry out a consultation to discuss with you what each involves and we’ll advise which is best for you. At Cedars we pride ourselves on achieving results that look natural, organic and that you, our patients, are delighted to see.