Page 38 - Demo

36 HEALTH SKIN CONDITIONS FROM PAGE 35 Pores for thought While atopic dermatitis is a type of eczema causing the skin to become inflamed through contact with allergens or irritants, acne is the result of excess sebum (the skin’s natural oil), dead skin cells, or other products clogging our pores. Both conditions can be mild or very severe and, depending on a number of factors such as age, sex, severity and frequency, both can be treated with OTC products, or perhaps warrant urgent specialist care. To the untrained eye, atopic dermatitis and acne can appear similar, but there are clear indicators helping health professionals recognise the cause of the condition. Retail Pharmacy asked GP, skin care specialist and TV presenter Dr Ginni Mansberg, co-host of the show Embarrassing Bodies Down Under, to explain how acne and severe atopic dermatitis occur, and outline some of the recommended approaches to treatment. “The thing we need to understand is our skin is a purpose-built barrier designed to keep moisture from getting out and make sure that no nasties, whether they’re bugs, chemicals or toxins, make their way through the skin into the body,” she said. “To do this, the skin has an unbelievably complicated matrix of cells and proteins. “In dermatitis, for various causes you have an interruption of that skin barrier function. With the skin performing poorly at its job, the immune system will be compromised, and it won’t defend as well against infection. “The other thing that happens is you have an escape of water from the skin, which dries it out quite significantly. When we consider the skin is designed to keep water in, it’s not surprising it becomes quite inflamed and uncomfortable. “Dermatitis is often genetic, and there’s emerging evidence around atopic dermatitis that those patients make less of some of the ceramides and other oils and fats that sit in the skin and lubricate it.” In women, hormone fluctuations can also trigger acute flare-ups of atopic dermatitis, commonly just before and during menstruation, during pregnancy, and following the birth of a child, and these typically fade when non-menstrual hormone balance returns. “The other big hormonal cause is around menopause, mainly because “Things like sun damage will exacerbate that entire process, although a lot of people who have acne don’t think of using sunscreen, which is actually really important.” estrogen increases the collagen-elastin matrix that allows for skin health,” Dr Mansberg said. “That results in post- menopausal skin being much thinner with less ability to retain moisture. “With skin conditions like acne and rosacea, which also tend to be very sensitive with locally inflamed skin, there will also be a disruption in skin barrier functioning, although the cause is completely different from atopic dermatitis. “The cause of acne is incredibly complex, but in essence there’s a decrease in skin cell turnover and a build-up of sebum, which is the good oil normally lubricating the skin. “Over-production of sebum by the sebum glands that attach at the base of the hair follicle is often triggered by a hormone. When combined with the skin overgrowth as a result of the retained skin cells, the sebum and bacteria, particularly Cutibacterium acnes, cause inflammation, and the inflammation causes the skin to dry out and be very sensitive. “Things like sun damage will exacerbate that entire process, although a lot of people who have acne don’t think of using sunscreen, which is actually really important. It’s an area where pharmacists can make a real difference simply by educating patients. “There’s a lot of shaming of people with acne – telling them they should eat less pizza or McDonald’s – but a lot of these kids are really healthy, while a lot of really unhealthy kids don’t get any acne. “So, the evidence linking acne to diet is quite poor. I’m a doctor, so if anybody wants to use it as an excuse to eat less McDonald’s and more veggies, I’m very happy, but I’m not absolutely convinced that it’s going to help with acne.” Consider patient compliance In terms of the advice a pharmacist can give, Dr Mansberg believes much depends on whether the patient is a teenager or, for example, a 40-year-old woman. “These are two very different patients,” she said, “because with the older patient, it’s really likely to be perimenopause when you get the acne breakout, and it affects about 15 or 16 per cent of perimenopausal women. On the other hand, with teenagers, about 80 per cent get some sort of acne but very few of them get the severe version. “With more mature women, they’ll follow a number of steps to complete an effective regime, but when you’re looking at a teenager, there are a couple of rules to consider. “Number one is don’t make it too complex, because they’re not going to do TO PAGE 38 RETAIL PHARMACY • JUN 2021