Don’t ignore skin problems, urges Suffolk GP Dr Matt Piccaver
When I was at medical school, I didn’t really take dermatology very seriously. Constantly reminded that the skin was the ‘biggest organ of the human body’, many of us referred to the speciality placement as ‘derma-holiday’. I look back at those days with shock at my naivety.
Some of the commonest problems I see are skin complaints. If any of my former teachers are reading, I apologise on behalf of myself and former classmates. Skin disease is serious business.
Most skin conditions I see are without major consequence. Some can inflict great misery on the sufferer, some can be life threatening.
One of the commonest skin complaints I see is eczema. Often going hand-in-hand with hayfever and asthma, eczema can be markedly troubling for some. A dry, itchy rash, often occurring on areas we call flexures - inside the creases of skin in front of the elbow and behind the knee. Sometimes these areas can get infected. Treatment usually involves plenty of moisturisers (emollients) and occasional steroid creams or ointments. Some people may need more aggressive treatments, but the vast majority of patients settle with the sort of treatment available in general practice.
Another problem people often complain about is warts. Areas of the skin infected with the human papilloma virus, warts are more unsightly than they are anything else (unless on the genitals). Many warts will slowly settle in time, without any treatment at all. If treatment is required, most over-the-counter remedies are sufficient. If you need advice or treatment for your warts, the high street pharmacist is usually your first port of call. Please bear in mind that sometimes it takes many months for the wart to go, even with treatment. The same can be said for verrucas.
Some professions are at risk of skin problems caused by their job. Anyone who spends a long time getting their hands wet will soon complain of dry, red, sore skin. The same can be said for hairdressers. Some people react badly to dyes, especially brown dyes. Dry, swollen, red and cracked hands are not uncommonly seen in people who work with certain hair products. Treatment is usually to avoid the cause, or reduced exposure to them.
There are a few problems particular to people as time goes by. At the end of the spectrum, some older people noticed very easy bruising, especially on their arms. There are a number of causes, but in general this is something called senile purpura. Thinning skin, which happens to many of us over time, can cause some large, purple bruise-like areas on the arms. These are usually of no great consequence.
Some people tell me about thick, crusty skin patches that feel as if they’re stuck on. These could be areas of seborrhoeic keratosis, a condition characterised by dark, thickened areas that feel like they’re stuck on and occasionally flake off. However, I would advise anyone with a pigmented skin condition that is changing to seek medical advice.
East Anglia is a sunny, relatively dry part of the UK. As such we see rather a lot of skin cancer. The most worrying skin cancer is malignant melanoma. Often seen in people who have been exposed to a lot of sun in their life, these are characterised by dark, pigmented ‘moles’. They might be new, changing in shape and size, and have several different colours to them (brown, blue, black). You might notice a new mole, which is getting bigger, might be crusty or bleed. Regardless, the take home message is get it looked at.
The skin is the largest organ in the body. Looking after it is so very important. If you notice a new problem, get it seen to. `Til next time . . .
