>> Frequently Asked Questions

Frequently-Asked Questions

Skin colour

I have been told I have melasma.  What can be done for this?

Melasma is increased pigmentation, usually on the face, in a rather patchy distribution.  Various treatments can be tried for melasma, but they do not always work.  One very important thing to do is to protect the skin from the sun every day.  When you go out in the sun, the darker parts of melasma get even darker, so you can minimise the effects of the sun by avoiding sitting out in the sun and always using a high sun-protection cream.

Some treatments can be tried to lighten the skin.  It is best to have a cream prescribed from a doctor as some of the ones that can be bought contain variable amounts of the constituents.  The usual active ingredient in bleaching creams is called hydroquinone (see below), but it should be used cautiously as sometimes it can produce an increased darkening of the skin which really is permanent.

Sometimes a mild chemical peel of the skin can help melasma.  The peels which might be worth considering are the mild trichloroacetic acid (TCA) peel or glycolic acid (as 50-70% glycolic acid).  These chemical peels should only be done by someone who is qualified and experienced in the use of them, as there can sometimes be adverse reactions.

Laser treatment is not usually advisable for melasma.

What can you tell me about bleaching creams?

Bleaching creams work by diminishing  the synthesis of melanin (brown pigment) in the skin or encouraging its degradation. Topical preparations include tretinoin (a vitamin A derivative) cream and hydroquinone cream.

Since January 2001 it has been illegal to sell any cosmetic product (other than some hair dyes) containing hydroquinone.

Stronger and combination preparations can be prescribed by your doctor or dermatologist, though they can potentially cause mild redness and flaking of the skin. Improvement is gradual and may take months.

The most important step in minimising pigmentation is to use a high factor sunscreen on a daily basis.

I have a lot of freckles – can they be removed or lightened?  Will a chemical peel help?

The first step in minimising the appearance of your freckles is daily use of a broad-spectrum (UVA and UVB) sunscreen which will prevent further darkening of the freckles.  A sun protection factor (SPF) 15 or higher is recommended to block UVB light, combined with UVA protection which is indicated with a star rating. A mild chemical peel can help to reduce the visibility of freckles. Bleaching creams may be effective in lightening some types of pigmentation or brown spots on the face.

Sometimes laser treatment can be used on freckles, but the results are variable.  Probably the best laser for freckling is the 532nm Q-switched Nd:YAG laser.

Treatment of freckles is not available on the NHS.

What treatments work for vitiligo?

Vililigo is caused by the body reacting against the pigment cells of the skin.  Why this happens is not known, so it is difficult to make a treatment that reverses this effect.

Ultraviolet light treatment can sometimes stimulate the skin pigment to be made in the skin again.  However, it can sometimes burn the pale skin and if it does not work, the surrounding skin tans a darker colour and the pale skin stays pale so it can make the areas of vitiligo look more obvious.  The new excimer laser treatment (which is not available on the NHS) can give ultraviolet light treatment which is better targeted to the pale skin only.

Skin Scars

I have some scars on my face due to acne.  Can these be removed? Can they be treated by laser?

Scars after acne come in different shapes and sizes.

If you have pink or red marks that are left after a spot has settled down, it is very likely that the redness will gradually fade, although this can take weeks to months.

Sometimes red, lumpy scars are left which do not settle – these can often be softened with a combination of a trichloroacetic acid face peel and treatment with a pulsed dye laser. 

Dips in the skin that can result from deep acne spots can sometimes improve with injection of a collagen or hyaluronic acid filler.  Sometimes laser resurfacing might improve the skin texture.

Deep narrow dents in the skin (known as ‘ice-pick’ scars) can be best treated by cutting that little piece of skin out.  There is a chance that this might leave a different sort of scar.

These sorts of treatment are not available on the NHS in the UK.

I have chicken pox scars – what can be done for these? 

Small dents in the skin left as a result of a chicken pox blister can sometimes persist for years after the rash.  In children, the dents can smooth over very slowly.   Removal of a persistent scar is not easy but individual scars can be removed by cutting out the area.  This will of course leave a line scar rather than the round dip of a chicken pox scar.  Sometimes the dent can be ‘filled in’ to a certain extent by injection of collagen just beneath the surface of the skin.  Treatment of chicken pox scars is not available as an NHS treatment.

Keloids

I have some keloids on my chest.  What can I do to remove them?

Keloid scars cannot be removed.  They can often be made to soften and flatten by injection of a strong steroid into the skin.  Injection of 5-fluorouracil ( a strong chemical which in high doses is used as chemotherapy) can also be atreatment that can help to stop a keloid being thick.  Another treatment which can help is the use of a silastic covering dressing.  This has to be used regularly for many weeks to have a chance of working, but it has the advantage that it is not painful at all.

Cutting a keloid out seems like a good idea, but it is not!  Usually, if a keloid is cut out, it comes back in the new scar and is therefore bigger than before.  Sometimes a combination of cutting out the keloid and then immediately treating the scar site with radiotherapy and steroid injection can be tried, but there is still a fair chance that the keloid will come back bigger.

Hair – loss and removal

I have thinning hair.  Can I do anything to thicken it up?

Hair thins out naturally as the years go by in men and also in women.  Such thinning of the hair is usually most marked on the top of the head.  Hair thinning that affects all the head may be as a result of general ill health, especially if it comes on suddenly.  If this is the case, you should see your doctor.

My hair has become fine and dry.  What can I do to thicken it?

Hair is dead and is only growing at the scalp.  It can become dull and dry if it dries out too much.  Such drying can occur with over-frequent washing, or the use of strong detergents.  Moisturising treatments will not alter the overall thickness of the individual hairs.

I have heard that hair on the face or body can be removed by laser treatment.  Does it work? 

Laser treatment of unwanted hair can be quite effective for people who have pale skin and dark hair.  It is not so good for people with pale hair or with dark skin.  Usually the area has to be treated 2 or 3 times before the hair is noticeably finer.  Laser treatment does not completely stop the hair growing.

Is there any sort of cream that stops hair from growing?

There are several ‘hair retardant’ creams on the market.  The ones that can be bought over the counter probably have a very mild effect on hair growth.

One cream containing a chemical called eflornithine is available in the USA and will soon be available in the UK mainly as a private treatment.  It does seem to reduce hair growth.

Where can I find a doctor who does laser hair removal? 

Laser hair removal is not usually available as an NHS treatment.  However, some doctors (usually dermatologists or plastic surgeons) who are fully qualified specialist consultants may use the laser for hair removal as a private treatment.  Your family doctor should know which doctors in your area would be able to do this sort of treatment.

I have in-growing hairs in my beard area which is called pseudofolliculitis barbae.  How can I  treat this?

Hair that is cut or removed close to the surface of the skin, for instance by shaving, can sometimes grow back as an in-growing hair.  This is more likely to happen if the hair is strong and thick or if it is curly.  If this is happening, it is best to stop cutting the hair close to the skin and to allow the hair to grow out from the skin naturally.  Sometimes if the shaving or short trimming continues, the in-growing hair causes inflammation and soreness in the skin which may lead on to scarring with lumpy and uncomfortable scars.  Laser treatment of the hair in the affected area might be able to stop neraby hairs from growing for a while, but does not work very well if the skin and the hair are both dark.

Wrinkles

Would you advise a face peel?  Are there any risks? 

There are many types of face peel available, the most important factor to consider is the depth of the peel.  They are:  very superficial, superficial, medium and deep. Very superficial and superficial peels may have some beneficial effect, but the medium and deep peels will give more dramatic and lasting results. The depth of the peel, however, is also proportional to the recovery time required and the risks.

These risks include:  pain, redness, infection, scarring and uneven pigmentation.  Your dermatologist or practitioner will be able to advise on which type and depth of peel is suitable for your skin.

Can the laser remove face wrinkles?  Are there any risks?

The laser can be used to try to reduce wrinkles – see the question on laser resurfacing, below.  Fine wrinkles may be improved with a chemical peel.

What is photorejuvenation?

Photorejuvenation is a term used to improve the ageing effects which occur on the skin due to cumulative exposure to the sun.  These changes include coarse wrinkles, sallow colour, leathery texture and irregularities in pigmentation or blemishes.  The changes occur most commonly on the face, v-of-the neck and backs of the hands and forearms.  Numerous treatments exist from topical retinoid creams, chemical peels (which range from superficial to deep, the latter having more dramatic improvement but longer recovery time), microdermabrasion, dermabrasion, and different types of laser treatments.

What is laser resurfacing and does it work? 

There are two types of laser resurfacing – ablative and non-ablative.  In ablating resurfacing, the laser treatment destroys the most superficial layers or the skin (the epidermis and uppermost part of the dermis).  The skin takes quite a while to grow back and repair after this.  This is an expensive treatment and can be effective for fine and moderate wrinkles.  However, as it is so damaging to the skin, there is a risk of infection, scarring, prolonged redness or other problems.  Non-ablative laser resurfacing causes less damage to the epidermis, but damages the dermis,  It is not as effective as ablative resurfacing, but has less risks of unwanted reactions.

Do exfoliating creams help wrinkles? Are there any side effects from exfoliating creams?

Exfoliating creams remove a little bit from the surface of the skin, the dead skin cells that form the outermost layer of the skin.  This layer is very important for the skin and without it, the skin would become very sensitive and sore.  It sheds itself naturally. Exfoliating creams remove some of this layer and so can make the skin feel smoother for a while.  Vigorous or too frequent exfoliation will make the skin red and flaky.  Exfoliating does not really remove wrinkles, but may allow moisturisers to get into the surface of the skin better, allowing the skin to ‘plump up’.

Skin marks

I have visible veins on my face.  Will laser treatment help? 

Yes, laser treatment can help to destroy the veins and so reduce their visibility.

I have a lot of stretchmarks.  What treatment can I use?

Stretchmarks are caused when the elastic layer of the skin under the surface is overstretched and the network of collagen and elastic fibres becomes weakened.  There is no treatment that will reverse this, although, with time, stretch marks usually gradually improve. Laser treatment is sometimes tried as a treatment for stretchmarks, but it is not very effective.

I have a tattoo I want removed.  What is the best treatment? 

If the tattoo is small, it may be easy to cut the tattooed skin out.  This will, of course, leave a scar.

Laser treatment can be used.  This breaks up the small bits of colour pigment into smaller pieces which the skin can remove naturally.  However, several laser treatment sessions are needed, even for small tattoos and there is usually some colour left in the skin at the end.

I have little purple/red spots over my upper chest.  What are these? How can I get rid of them?

These may be small knots of visible blood vessels, called angiomas or Campbell de Morgan spots.  They are very common and usually develop in adult life.  Their appearance does not mean that anything is wrong.  They do not usually disappear by themselves.  If some of the spots are particularly bothersome, they can be made to shrivel up by using a laser or pinpoint cautery.  There is a slight risk, especially with cautery, that this will cause a pale mark or a little dent on the skin.

I have had semi-permanent make-up (e.g. a false mole, eyeliner).  How can I get rid of it? 

Semi-permanent make-up is a type of tattoo.  Laser treatment may help to remove the dark colour pigment – see question on tattoo removal, above.

Skin care

Do aromatherapy oils help dry skin?

Any cosmetic oil or cream can help to moisturise dry skin as long as it is used regularly.  Anything added to the cream or oil such as perfumes or plant extracts might irritate certain skins or cause an allergy.  It is better to use a cream or oil with as few additives as possible for regular moisturising of dry skin.

I have to wash my hands a lot at work. What sort of soap / detergent is best?

Washing the skin with any soap or detergent or even frequent washing with water alone will dry the skin and reduce its ability to act as an effective barrier against anything that touches it.  An ‘ideal’ soap for frequent washing would be a mild detergent, be pH-balanced and also contain a moisturiser.  However, the most important thing for skin that has to be washed very often is the use of a moisturiser after washing.  This will help to replace the skin oils that are removed with each wash and so will help to restore some of the barrier function.

Miscellaneous

I have had cryotherapy for a mark on my face.  The area is changing colour. Is this normal?

After cryotherapy (freezing treatment), the skin immediately becomes red and a little puffy.  Sometimes a blister forms.  As the redness, puffiness and blister settles down after a few days, the skin usually remains reddish for a while and then gradually turns a brownish colour.  Over a few weeks, the brown colour should fade back to normal skin colour.

I have had a face peel (TCA) – what should I expect?  My face is sore and peeling – is this normal? 

Some redness and soreness can be expected after a face peel, especially if the peel depth is medium or deep.  Persistent soreness, redness and peeling lasting over a week can indicate infection and if you are concerned, you should contact your practitioner.  Moisturising the skin regularly from the fourth day onwards will help to stop the skin getting dry and scaly.

I have had skin surgery this year.  What sun protection should I use?

A scar in the skin often loses the natural pigment cells which help to provide a little protection from the effects of ultraviolet light in the sun.  Any recent or pale scar should be well protected from the strong sun’s rays by the use of clothing to cover the area and a sun protection cream with a high (30 or more) sun protection factor.

I have rough skin at the top of my arms.  What can I use to get rid of this?

You may have skin condition called keratosis pilaris.  This is a very common problem but does not mean that anything is wrong.