National screening programmes like breast and colon cancer do not exist for skin cancers. Skin cancer is the most common and fastest-growing cancer in the U.K. Basal Cell Carcinoma is the most common skin cancer followed by Squamous Cell Carcinoma. Malignant melanoma is one of the most common cancers in the young age group aged 15-34 years. The more moles one has the higher the risk of melanoma. Other risk factors include skin that burns easily, increased freckling, red-blonde hair, blue-green-hazel eye colour and a high number of sunburns in the past. Previous history of melanoma significantly increases the risk of developing another melanoma. Early diagnosis improves the outcome significantly. Annual screening by a professional is recommended for all. Individuals who spend greater amounts of time outdoors and exposed to UV radiation for prolonged periods of time (outdoor workers, outdoor sports, with sports enthusiasts, gardeners etc.); those with personal or family history of skin cancer and immunosuppression will benefit the most for skin cancer screening through a total-body skin examination.
Losing excessive hair is distressing both for men and women. In the absence of any disease men generally start losing hair from their crown in their 40’s along with receding hairline but this can start at an earlier age especially if there is a family history. Hair loss in women in the absence of any disease presents as thinning of hair on the front top part of the scalp along with increased shedding and notice wider parting. This is called Androgenetic Alopecia and affects 70% of men and 30% of female. This is not a disease and is related to declining hormones and hair follicle ageing as long as there are no underlying hormonal abnormalities like excess androgens.
Another common cause of hair loss is telogen effluvium. This can be caused by stress, rapid weight loss, fad or starvation diets, thyroid dysfunction and low iron. Generally, we lose approximately 100 hair per day which is normal but in this condition, we lose more hair due to the underlying triggers.
Traction Alopecia is a condition which affects afro Caribbean scalp mostly and is related to traction or tight hairstyles like braiding or ponytails and chemical or heat treatments.
Alopecia Areata is an immune-mediated condition which causes patchy and shiny bald areas on the scalp and other hair-bearing sites (mostly eyebrows, beard area). It affects 2% of the population and is one of the most common conditions seen in dermatology clinics.
There are conditions like frontal fibrosing alopecia, lichen planopilaris, folliculitis decalvans and lupus which can cause scarring alopecia. Early recognition and treatments help prevent disease progression.
There are medical treatments available for most of the conditions mentioned above. Multi-vitamins rich in zinc, selenium and biotin help with pattern hair loss. Another effective treatment for pattern hair loss is Minoxidil foam. Telogen effluvium generally improves spontaneously if the underlying triggers are removed or treated. Treatment of traction alopecia involves loosening the hairstyle and avoid traction. Alopecia Areata can be treated with steroid cream or steroid injections. There are specialised treatments available to stop the progression of various forms of scarring alopecia.
This is not needed in the majority of cases. Most children with mild to moderate eczema which respond well to treatment do not have a food allergy especially if there has been no link identified by parents with a flare-up of eczema with a particular food. In such cases, no investigations are recommended. Allergy testing should be considered in children with mild to moderate eczema that does not respond to treatment, children with moderate to severe eczema, children with co-existing gastrointestinal symptoms (diarrhoea, vomiting, reflux, colic etc.) and if eczema is associated with a perioral flare when eating and perianal erythema. Food allergy can also manifest as hives/urticaria, angioedema and anaphylaxis. This is seen with peanuts, tree nuts, shellfish, white fish (e.g. cod), egg white, cows milk, soya, wheat and sesame seeds. These are called type 1 or immediate hypersensitivity reactions as the reactions occur within minutes of ingesting or contact with an allergen. Most of the time patient or parents in case of children are able to identify the cause. If it is not clear from history then allergy testing is recommended to identify the potential allergen. Patients with nut allergies, often have multiple allergies and usually require further investigations.
Food allergy has a role to play in 7-10% of patients with atopic dermatitis/eczema. Food allergens exacerbate eczema in one-third of children with eczema. It predominantly affects infants and younger children under the age of 3. Children older than 5 years old are less likely to have a food allergy as the cause of their eczema. In children who have a food allergy, most outgrow their food allergy except to peanuts, tree nuts and fish which tends to persist. Defective skin barrier in eczema and other immune-mediated mechanisms are involved. Risk of food allergy is high if there is a history of atopy (hay fever, asthma, eczema) in self or family members. It is important to know whether one has a true food allergy, intolerance or sensitization. Detailed medical history, blood tests and sometimes a skin prick test is required to differentiate between these.
The link between diet and acne exists. Affected individuals often report acne worsening after drinking milk or after having chocolate and scientifically there is an explanation for this but this does not mean that you have a food allergy. Food with high glycaemic index (chocolate, sweets, pizza, cakes, fast food, fizzy drinks) is absorbed rapidly by the body which leads to increase the blood glucose (sugar) levels which in turn cause the release of insulin and insulin-like growth factors. Both of these are hormones which increase oil or sebum production by increasing the production of androgens (testosterone) in both men and women.
Another commonly known link is with dairy products. The scientific theory behind this is similar to mechanisms to diets rich in high glycaemic index mentioned above. Additionally, it has been suggested that milk from dairy cows either naturally contains growth hormones or is treated with growth hormones. Growth hormones increase androgen levels, which promote oil glands to release more sebum.
My advice to patients is to follow a healthy diet which is low in sugar and refined carbohydrates. Eat vegetables and fruit with a low glycaemic index along with fish high in omega 3 fatty acids. Avoiding processed food as much as possible. Keep a food diary for 12 weeks.
Another fascinating link has been found between in skimmed (low fat) milk and acne. It has been proposed that the process of removing fat from the milk removes some of its healthy components and higher oestrogen levels in skimmed milk.
Allergy UK – www.allergyuk.org
Alopecia UK – www.alopeciauk.org.uk
British Association of Camouflage – www.skin-camouflage.net
British Skin Foundation – www.britishskinfoundation.org.uk – Popular
Eczema Outreach Support – www.eos.org.uk
Hidradenitis Suppurativa Trust – www.ba-hs.org.uk
The British Association of Dermatologists – www.bad.org.uk – Popular
A-Z Conditions & Treatments – BAD Patient Hub (skinhealthinfo.org.uk) – Popular
Dermet NZ – www.dermnet.nz – Popular
Changing Faces – www.changingfaces.org.uk
Hyperhidrosis – www.hyperhidrosisuk.org
Lichen Sclerosus and Vulval Health – www.lichensclerosos.org
Lymphoedema – www.lymphoedema.org
Mastocytosis – www.ukmasto.co.uk
Melanoma UK – www.melanomauk.org.uk
National Eczema Society – www.eczema.org
Nodular Prurigo International – www.nodular-prurigo.org.uk
Skin Cancer Awareness – wwww.skicin.org
Vulval Pain Society – www.vulvalpainsociety.org
Vitiligo – www.vitiligosupport.org.uk
UK Lichen Planus – www.uklp.org.uk
Telengiectasia – www.telengiectasia.co.uk
Psoriasis Association – www.psoriasis-association.org.uk
Ichthyosis – www.ichthyosis.org.uk
Scleroderma and Raynaud’s UK – www.sruk.co.uk