talkeczema

I live with contamination OCD which manifests itself in excessive washing. I have very dry skin all over but I now seem to be developing rosacea. How is it treated?

Dr Alia Ahmed:

It is difficult to tell from your description if you have rosacea or not. Your symptoms may be due to excessive washing and products. I would suggest, when able, that you are assessed by your GP and/or dermatologist.

With regards to your question about products/tips, I would suggest the following to reduce damage to the skin:

1. Wash face with a soap substitute (e.g. Dermol 500 lotion that contains antimicrobial) or a very gentle cleanser (e.g. Effaclar H cleansing cream)

2. Dry gently and thoroughly with a soft towel after washing to ensure all remains of products are removed from the skin. Pat dry and don't rub harshly (this avoids over-exfoliating the skin)

3. Use an emollient post-washing and overnight to re-hydrate the skin (Effaclar H cream moisturiser overnight, Toleriane Sensitive Fluid during the day)

4. Avoid highly perfumed and irritant ingredients in products as this may make your symptoms worse by irritating your skin further

Just to add to this: having OCD can have a huge impact on your quality of life and the way you feel. This may be something you want to address formally with your health care practitioner (if you haven't already). There are some very good treatment options available, including both medication and psychological interventions/talking therapies.

I have severe eczema and use emollients frequently, which often stain by sheets. My partner has an aversion to oils of all kinds - his skin gets quite irritated by the oiliness of my skin. We argue about it and that depresses me. What can I do?

Ben Choi:

Firstly, well done for talking about this with your partner. Communication is an essential part of working through any relationship issue. Using different sheets may help things. In terms of other everyday changes, you could look at the timing of your application and when you might be in close proximity to your partner. I know it might not be ideal, but it might allow you to take care of your skin and be able to lie down together.

Some people do the majority of their skincare in the evenings which might give you more time to let the emollient sink in before dressing or going to bed but this could also be the most likely time you lie down together.

If intimacy is an issue, physical touch is one of many forms of connecting. Working on alternative methods of intimacy together and doing activities like cooking, baking or board games together might help you feel more connected when you have a flareup and need to apply your emollients more often.

Professor Andrew Thompson:

Many skin conditions can have an impact on intimacy and sex, and sadly these issues often remain hidden because of feelings of embarrassment. Talking therapies may help you as an individual. However, it might also be worth considering couple counselling (https://www.relate.org.uk/) which could help provide a space for you to talk together about these issues.

At a nursing/medical level, it would also be worth sharing your concerns so that an expert can help consider if there might be other emollients available.

Red rash-like patches have appeared on my cheeks. I am 55 and first noticed them a couple of years ago. They are also getting progressively more visible…what is happening?

Dr Anton Alexandroff:

You have a skin condition called rosacea. You should use sun protection in summer and you can also ask you dermatologist or GP to prescribe you Soolantra cream and Mirvaso gel to soothe the flush.

Can stress bring our rashes and spots? My 30-year-old son has been taking isolation and the threat of coronavirus very badly, having regular anxiety attacks. He has now come out in spots and rashes. Why?

Ben Choi:

It’s important to recognise the effect that Covid-19 has on everyone's mental health and that stress can impact skin health and bring about issues with skin.

While I can’t diagnose the reaction your son has had, I would say never underestimate the power of routine and how it can impact mental health and thus his skin. For example, he could follow a routine that is as close to normality as possible. This could involve doing his ‘normal’ morning routine, using the working day to do some professional development online or some activities that engage his brain like learning a new language or skill online or on an app.

If he was physically active before quarantine or wanting to be more so, he could exercise outside or at home in the evenings or weekends (there are a lot of free resources being released on Youtube).

Socialising could look like video calls with friends between these evenings and weekends, perhaps doing an online quiz or online game with them might make it feel more natural.

He could also look at creating his own routine that might support his mental health more. This might involve meditation (again there are free apps such as Headspace and Insight Timer), or it could involve some artistic creativity such as drawing or painting or even some light DIY if that’s more his thing.

My son, 16, has acne and he’s fed up. He washes regularly and I have bought La Roche Possay (Effeclar) face wash and topical cream for him which helps a little. He eats a good and varied diet and I have also encouraged him to eat lower GI foods where he can to help regulate blood sugar. I am reluctant for him to take antibiotics. Could a good probiotic help? 

Dr Alia Ahmed:

There is some evidence for the benefits of gut health and skin, so a probiotic is not a bad idea but it is unlikely to solve the problem on its own. There are several in the market, such as Bio-Kult.

To my knowledge, the use of the HistaminX for acne is not one that is recommended by dermatologists. Although you are understandably concerned about antibiotic use, it is very commonly used to treat acne in the early stages. It might be helpful to see your GP, if you haven't already done so, to discuss the medical options for treatment - especially if your son is starting to feel fed up with his skin.

Oral treatment is not always necessary; some medications for acne are available as creams/lotions and are extremely effective.

I have dark skin and hyperpigmentation all over my face and body from where eczema used to dwell. It's depressing - is there anything I can do about it? 

Dr Alia Ahmed:

If your eczema is no longer active (i.e. not red, itchy or flaky), you may be a candidate for cream-based treatment to lighten the dark areas. You would need to see a dermatologist to be assessed for your eligibility. These creams have to be used carefully and under proper supervision.

We know that having a visible skin problem can have psychological consequences for some people, so it is important that you are able to share your feelings with people that you trust and/or your healthcare practitioner. If you are feeling low about your skin and this is making you unable to do the things you want to do then please discuss with your GP. You may benefit from a formal referral to dermatology to discuss treatment options, as well as access to psychological interventions/talking therapies.

Professor Andrew Thompson:

It is not unusual for changes in skin appearance to detrimentally affect our well-being. The charity Changing Faces also has many excellent self-help resources aimed at building confidence. It also has a camouflage service.

If you are worried about the impact that your current mood is having on your wider life then counselling, CBT and IPT (specific forms of talking therapy) are very good for mild to moderate depression and are recommended prior to considering medication.

There is nothing to lose from having a chat to your GP or visiting NHS IAPT/Psychological services which often now accept direct referrals.

My skin has gone saggy after losing 2nd and it’s depressing. Will it fill back out if I put back on a little weight?

Dr Alia Ahmed:

Loss of weight, especially around areas where the skin was previously stretched, can lead to a loss of elasticity. Changes in appearance can make some people feel emotionally distressed. It is possible that some of the changes will reverse as you return to your previous weight. In addition, good skin care may improve the texture and appearance of your skin.

I suggest:

1. Improving texture by maintaining good hydration (drink at least 2 litres of fluid a day), regularly moisturising, using body washes close to the skin's natural pH

2. Massage to maintain suppleness (you can do this yourself!)

3. Be gentle with your skin, pat dry and avoid rubbing harshly

4. Consider a collagen supplement. Hormonal changes can also contribute to skin changes so please discuss with your GP if you think this may be a contributing factor.

My 15-year-old daughter has an area of dry/red skin that appears around the corner of her mouth (just one side). It does not itch. We have tried various creams such as Vaseline, hydrocortisone and moisturisers. Nothing has worked. Any advice?

Dr Anton Alexandroff:

This might be cheilitis due to a lack of certain vitamins. Your GP can run some blood tests to check and may decide to prescribe Daktacort ointment.

Is there a link between generalised anxiety disorder and psoriasis? If so, what’s the best way to manage both and reduce the severity of psoriasis?

Dr Alia Ahmed:

We know that having psoriasis is linked to psychological health outcomes. It will be difficult to tell you definitively if one caused the other, but we do know that treatment of both the mind and skin together generally leads to better outcomes.

People with psoriasis do tend to have higher levels of anxiety and depression than those without skin conditions. I would suggest seeing a psychodermatologist/psychodermatology service to address both issues concurrently. This may include better medical treatment of your skin coupled with psychological interventions or anxiety-reducing medications.

I have recently suffered from anxiety and have found that in the daytime, especially when stressed, I experience sore wrists, elbows and ankles. Are these skin problems from anxiety or something else like nerve damage?

Dr Anton Alexandroff:

You need to see your GP or neurologist to check if your nerves are involved and whether you are suffering from neuropathy.

My son has depression and anxiety (he’s taking Citalopram) and has very oily skin. He has acne on his face and body and previous medications haven't helped. Can you advise as it is impacting his mental health?

Dr Alia Ahmed:

If he has already tried the conventional treatments for acne (i.e. antibiotics and creams) from his GP, then he may benefit from treatment by a dermatologist. I would suggest that you encourage him to see his GP and let them know how his skin problem may be holding him back and that he would like more advanced treatment if appropriate.

A dermatologist can consider the use of treatments that GPs are not able to prescribe. We know that people with acne can experience psychological distress and there is also good evidence to show that appropriate medical treatment of acne can make them feel a lot better.

Your son’s pre-existing depression should not stop him from obtaining the right treatment… in fact, it makes accessing the best treatment available much more of a necessity.

Other things that he can try in the meantime include:

1. Face/body wash containing salicylic acid (use this 2-3 times a week at first as it can be irritating if overused)

2. Use non-oily moisturisers if the skin feels dry

3. Use 2% salicylic acid directly on large spots once daily to shrink them quickly

You can read more about the British Skin Foundation clinic on mental health & skin here. Thank you to our experts who so kindly gave their time to answer questions.