According to the Centre of Evidence Based Dermatology, 54 per cent of the UK population experiences a skin condition in any given twelve-month period. Skin conditions are in fact the most common reason why people consult their general practitioner with a new problem. As patients increasingly also turn to cosmetic practitioners for solutions to their skin conditions, practitioners are well-placed to provide patients with skincare advice and treatment options to address their specific requirements.
Skin conditions can leave patients feeling concerned about their appearance, resulting in them seeking treatments to help manage and hopefully eradicate the problem. For practitioners it is important that you are able to recognise common skin conditions in order to offer the most suitable treatments, and best outcomes, for your patients.
With August being National Psoriasis Awareness Month, it is the perfect opportunity for practitioners to educate and inform patients about the common skin condition.
Psoriasis is a skin condition that affects around two per cent of people in the UK. It equally affects both men and women, of all races and all ages, and can display on a variety of body parts at any given time. People with psoriasis have an increased production of skin cells – normally, skin cells are made and replaced every three to four weeks, however with psoriasis, the process only takes around three to seven days. This results in a build-up of skin cells, which creates the patches associated with psoriasis.
The cause of psoriasis is not completely understood, however it is thought to be related to problems within the immune system and genetics.
Characteristics: Red, flaky, crusty patches of skin covered with silvery scales.
Areas most affected: Elbows, knees, scalp and lower back, but can appear anywhere on the body.
Treatments available: Topical treatments such as creams and ointments are recommended in the first instance. Corticosteroids, for example, reduce the inflammation and itching associated with the condition. Dithranol, Vitamin D3 analogues (a form of synthetic vitamin D that you rub on your skin) and Vitamin A derivatives have also been shown to slow skin cell growth. Phototherapy is also another option for more persistent symptoms. If the skin does not respond to the previous treatments then systemic treatments may be offered in the form of oral or injected medicines, as instructed by a doctor.
Moles are growths on the skin that are usually brown or black. They mostly appear in early childhood and during the first 25 years of a person’s life – it is normal to have between 10-40 moles by adulthood.
Moles tend to change slowly throughout the years – they may become raised or change colour slightly or may just stay the same. As a practitioner, it is your responsibility to look out for any cancerous moles and to provide patients with treatment options or refer them to their GP.
Characteristics: Moles can be flat or raised, however irregular enlarged moles may either indicate skin cancer or developing skin cancer.
Areas most affected: Moles can appear anywhere on your body.
Treatments available: Moles can either be removed by laser removal or excision, depending on their size and shape. Non-cancerous moles do not pose a risk to the patient and therefore do not require removal or treatment unless requested for cosmetic reasons.
Rosacea is a common skin condition and can affect all skin types, but predominantly fair-skinned people aged 40 to 60 years old. It is a chronic condition – it can persist for a long time and the severity tends to fluctuate depending on the patient. Triggers can include the sun, alcohol, exercise, high and low temperatures, hot drinks, spicy foods and stress. It is the practitioner’s responsibility to advise patients on how best to manage these triggers and provide suitable treatment options if necessary.
Characteristics: Persistent redness caused by dilated blood vessels, small bumps and pus-filled spots, pustules.
Areas most affected: Cheeks, forehead, chin and nose.
Treatment options: Topical treatments such as metronidazole and azelaic acid cream are usually prescribed first, however light-based treatments such as pulsed dye laser (PDL) or intense pulsed light (IPL) have been shown to reduce the appearance of rosacea.
Acne is a common skin condition that tends to start in puberty and varies in severity from a few spots, to a more significant problem that may cause scarring and impact on self-confidence. The acne bacterium (known as Propionibacterium acnes) lives on everyone’s skin. It usually causes no problems but, in those prone to acne, the build-up of oil produces an ideal environment in which these bacteria can multiply. This triggers inflammation and the formation of red or pus-filled spots. Patients may wish to seek cosmetic treatment for acne and acne scarring.
Characteristics: Comedones (blackheads and whiteheads), papules, pustules, nodules, cysts
Areas most affected: Acne can occur anywhere on the body but most commonly appears on the face, neck, back and chest.
Treatment options: It is the practitioner’s responsibility to ensure the patient has a good skincare regime and to recommend ingredients that will help with their overall skin health and their acne. As well as creams and serums, cosmetic treatment options include dermabrasion, skin peels and laser, which can help treat acne scarring.
Acne is a common skin condition affecting 650 million people worldwide, with more than 90 per cent of the world’s population suffering from the condition at some point during their lives. Although more prevalent in teenagers, acne can affect up to 43 per cent of adults in their 30s. Acne can have a dramatic effect on a patient’s confidence and self-esteem, with many patients seeking aesthetic treatment to tackle the underlying issues. Hamilton Fraser Cosmetic Insurance’s 2020 annual survey found ‘skin care’ to be within the top three most popular treatment requests and solutions provided by practitioners.
As one of the most common concerns in aesthetics, what are the key considerations for practitioners when assessing and treating patients with acne?
Acne is typically found on the face, with clusters usually on the cheeks, chin and forehead, as well as the neck, back and chest. According to the British Association of Dermatologists, it is most likely caused by a combination of genetic, hormonal and lifestyle factors (such as diet, stress and skincare products), which act in combination as the cause of most acne.
“Fluctuations in hormone levels – for example in puberty, during the menstrual cycle, or during menopause – are known to exacerbate acne. Medical conditions that affect patients’ hormone levels, like polycystic ovarian disease (PCOS), are also associated.”
- Aesthetic practitioner and founder of Ashley Aesthetics, Dr Emmaline Ashley
According to the NHS, despite being one of the most common skin complaints, acne is actually one of the least understood, leading to a number of misconceptions about the condition. Acne being caused by a bad diet is a common myth associated with the skin condition; there is no definitive proof that certain foods directly cause acne.
“It is believed that diet can cause acne, however there is no research to support this, although a healthy balanced diet is always recommended for general health as well as skin health.”
- Tania Rashid, co-founder of Aesthetics Lab
If left untreated, acne can cause scarring, so it is important for practitioners to be able to identify acne in the early stages, in order to prevent it from worsening and causing scar formation. For this reason, an accurate assessment of acne is key. The first stage is to examine the skin to identify what type of acne the patient has. Acne may be inflammatory or noninflammatory, with subtypes including:
When it comes to assessing acne, Tania says, “We assess the acne by completing a full and thorough visual assessment of the skin as well as carrying out an in-depth questionnaire, thanks to which we can find out the frequency, duration, severity and possible triggers contributing to worsening of acne.”
In terms of grading the severity of acne, Dr Emmaline advises, “The severity of acne is graded by the presence and number of these different types of lesions. A simplification is that mild acne is graded when there are 30 or fewer lesions, moderate is when there are between 30-125 lesions, and severe acne has the presence of cysts or nodules, or more than 125 lesions.”
It is also important for practitioners to take into consideration different skin types and concerns, according to Dr Emmaline, who says, “I am very conscious in targeting my treatments for patients’ skin types and adjusting the ingredients to be as effective as possible with minimum irritation. For example, oily skin may be able to tolerate more drying ingredients than sensitive skin. Skin of colour can be more prone to post-inflammatory hyperpigmentation, so a gentler approach to using retinoids is needed. Additionally, if patients are suffering more than one skin concern, certain ingredients can be targeted to address both at the same time. For example, azelaic acid has shown to be very effective for both acne and rosacea.”
Patient age is also an important area to consider when treating many skin conditions, such as acne. Middle aged patients may be looking for a very different treatment type and outcome, such as skin rejuvenation compared to that of a younger patients, who may be seeking more preventative solutions for their skin. As always, treatment types should be specifically tailored to the individual needs of the patient and carefully assessed during the consultation and consenting process.
There are numerous treatment options for acne, some of which include:
“The most important thing to know is the scope of your practice, for example when you are able to appropriately treat acne, and when you need to signpost a patient back to their GP for a referral to a dermatologist,”
- Dr Emmaline Ashley
“Consider the skin being the biggest living, breathing and detoxifying organ – a true reflection of your inner health. Be curious and investigate for potential causes of acne from other sources. If an imbalance is showing on the skin in the form of acne, it is likely for an imbalance to be present internally too. Refer or work together with an experienced functional nutritionist, doctor or naturopath if possible, for best results.”
- Tania Rashid, co-founder of Aesthetics Lab
“It is also very important to manage patient expectations – make sure you have explained your treatment plans clearly, and practise patient selection appropriately. Even if a patient is on the perfect treatment for their skin, the results are never going to be immediate, and patience and consistency will be key to achieve what you both want.”
- Dr Emmaline Ashley
Skin conditions are often complicated to treat and may require different approaches dependent on individual patient circumstances. You can encourage your patients to help their skin health personally by:
Practitioners should ensure they are in a position to be able to identify common skin conditions and advise their patients on a course of action, providing suitable treatments if appropriate. In some instances practitioners may need to encourage patients to seek medical advice, for example if a mole is showing signs of being cancerous. As ever, understanding your patient’s specific needs, identifying exactly what your patient hopes to achieve from a treatment and managing their expectations is invaluable when it comes to being able to provide practical and meaningful support for your patients.