Acne is a skin disorder that is characterised by pimples, blackheads, whiteheads, and, in bad cases, cysts (deeper lumps). Acne usually starts at puberty and is in response to our body’s production of hormones, called androgens. These hormones cause the sebaceous glands (oil-producing glands in the skin) to get bigger and produce more oil. The extra oil (sebum) mixes with dead skin cells and naturally occurring bacteria on the surface of the skin and blocks pores. Once a pore is blocked the bacteria multiply and cause inflammation, which produces the characteristic signs of acne.

Acne commonly occurs on the face, neck, back and chest. Acne can lead to permanent scarring.

Other causes of acne may include:

• genetics
• heavy makeup
• harsh and repetitive cleansing
• picking and squeezing
• certain medications
• diet

Acne vulgaris is the most common form of acne.

Adult acne occurs in about 30% of people at some stage in their adult life. It is thought that adult acne also has some hormonal influences.

Acne rosacea is similar to acne vulgaris, with oily skin and spots, but also has flushing or redness of the skin in the affected area. The flush may be set off by certain spicy food or alcohol.

Treatment

Usually acne can be treated successfully, but results do not happen overnight and what can work for one person may not work for another. It may take several months to see initial results, and once it significantly clears treatment is still required to keep it from coming back.

Some medications for acne can only be prescribed by a dermatologist. When acne is treated early the results are very good and it also helps to reduce scarring.

Over-the-counter products are available to treat mild-to-moderate acne, but check with a pharmacist which product is the best for your type of acne. In moderate-to-severe acne, treatment usually requires the help of a dermatologist and often more than one type of treatment. Treatments may include:

• antibiotic creams
• topical (apply to your skin) retinoids
• oral (take by mouth) antibiotics: these reduce the number of bacteria present on the skin which leads to a decrease in inflammation
• oral contraceptives: these reduce the amount of oil produced by the sebaceous glands. However, possible side effects must be taken into consideration before starting treatment
• over-the-counter acne products

Severe acne, with deep cysts, inflammation and scarring, should be treated by a dermatologist and in most cases can be successfully treated.

Treatment for severe acne may include:

• surgery: the deep cysts are removed and drained
• corticosteroid injection: used to treat the inflammation, promote healing of an acne cyst and help prevent scarring
• isotretinoin: an oral medication prescribed by a dermatologist that effectively works on all factors that cause acne. It can also have some side effects so you will need to be continually monitored whilst on this medication
• oral antibiotics
• oral contraceptives

A naevus is a common skin growth composed of special pigment-producing cells. Naevi can vary in size, with small naevi requiring only simple surgery for removal, while the removal of larger naevi may require more than one operation and may involve skin grafts.

Raised naevi may be removed surgically by cutting down to the level of the skin but naevi that may have become cancerous will be cut out entirely and stitches will be required.

• Laser treatments
• Cosmetic injectables
• Skin treatments
• Scar revision

Cosmetic medicine services may include treatments such as cosmetic Botulinum Toxin injections, dermal filler, and laser skin therapy.

Also known as port wine stains or strawberry haemangiomas, these are non-cancerous, vascular skin lesions. These usually appear in the first month after birth and can grow very quickly for about 8 months. Haemangiomas generally start to fade and become smaller after 2-10 years of age but usually do not disappear completely. Treatment is not usually recommended unless the haemangioma is causing problems such as bleeding, feeding or breathing difficulties or impairing vision. Recommended treatments depend on the type and location of the haemangioma and include medication, laser treatment and surgery. If surgery is required, it usually does not require an overnight stay in hospital.

This is a specialised and precise technique used to remove skin cancer, especially in areas where you want to keep as much healthy skin as possible, like the face. The surgeon removes the cancer in thin layers, checking each layer under a microscope to make sure all the cancer is gone before removing more. This way the cancer is fully removed in one operation, avoiding more complicated and expensive repeat surgery later if the skin cancer has not been removed fully by another technique.

Rosacea is a long-term, inflammatory skin condition that causes redness on the face, especially on the cheeks, nose, and forehead. Read more about rosacea on the Healthify website Rosacea | Healthify

Shave Biopsy: the top layers of skin in the area being investigated are shaved off with a scalpel (surgical knife) for investigation under a microscope.

Punch Biopsy: a small cylindrical core of tissue is taken from the area being investigated for examination under a microscope.

Excision Biopsy: all of the lesion or area being investigated is cut out with a scalpel for examination under a microscope.

Incision Biopsy: part of the lesion is cut out with a scalpel for examination under a microscope.

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.

Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.

There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.

Basal Cell Carcinoma (BCC):

This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCCs can ulcerate and scab so it is important not to mistake it for a sore.

BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.

Treatment:

Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.

Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.

Squamous Cell Carcinoma (SCC):

This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated.

A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal.

All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC.

Malignant Melanoma:

This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.

A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles.

What to look for:

• an existing mole that changes colour (it may be black, dark blue or even red and white)
• the colour pigment may be uneven
• the edges of the mole/freckle may be irregular and have a spreading edge
• the surface of the mole/freckle may be flaky/crusted and raised
• sudden growth of an existing or new mole/freckle
• inflammation and or itchiness surrounding an existing or new mole/freckle.

Treatment:

It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.

A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread.

Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).

A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.

Skin checks and biopsies can be used to identify suspicious moles, lesions, or spots and diagnose different types of skin cancer.

Skin lesions can be divided into two groups:

• Benign (non-cancerous): e.g. moles, cysts, warts, tags. These may be removed to prevent spreading (warts), stop discomfort if the lesion is being irritated by clothing/jewellery or to improve appearance.
• Malignant (cancerous): basal cell and squamous cell carcinomas are generally slow growing and unlikely to spread to other parts of the body. Melanoma is a serious skin cancer that can spread to other parts of the body. Urgent removal is recommended.

Surgery to remove skin lesions usually involves an office or outpatient visit, local anaesthesia (the area around the scar is numbed by injecting a local anaesthetic) and stitches. You may or may not have a dressing put on the wound and it is important to keep the area dry for 24 hours. Stitches may be removed in 1-2 weeks. You may need to take a few days off work after the surgery.

There are three main types of wart infections that occur on our body: common warts, plantar warts and venereal warts (genital warts).

Common Warts

These are caused by a slow-growing virus. Warts are more common in children and are caught from direct contact with someone else who has warts. Most people have had warts at some stage in their lives.

To look at they have a rough, irregular surface and are usually round in shape. They often appear on the hands, feet or knees.

Plantar Warts

Also known as verrucas, these occur most often on the soles of the feet. They can be very tender, as they take the pressure of movement.

They are skin-coloured and have a slightly irregular surface. They can grow larger than a common wart. As these are painful, they usually need to be removed or treated. They are generally harder and more painful to treat than the common wart.

Treatment

There are many over-the-counter treatments available, but most warts will disappear over time (around 18-24 months) with or without treatment, especially in children.

If the wart has become painful or unsightly, it can be treated. Types of treatment are as follows:

• Liquid nitrogen (a freezing process)
• Diathermy (burning away of the wart)
• Laser
• Chemical acid
• Surgical removal

After most of these treatments, the area will need to have a dressing and to be kept clean and dry. If the wart is surgically removed a hole is left that will need to heal on its own.

Once a wart has been removed or treated there is no guarantee that it will not return and in a number of cases they do recur.

Remember to get your doctor to look over your warts next time you are visiting, as some skin cancers are very much like warts.

Venereal Warts (Genital Warts)

Venereal warts are caused by a virus called human papillomavirus (HPV). This condition is known as a sexually transmitted disease (STD). It is a common disease and has a higher occurrence in males. Genital warts can be passed on during a sexual encounter, even if no symptoms or warts are present. Warts appear from 1-6 months after initial infection.

Genital warts look like small flat irregular shaped growths, often occurring in clusters that enlarge quickly. They usually grow on the shaft of the penis and on the vulva in women (the external female parts), but they can also grow around the anus and rectum.

Treatment

Genital warts can be difficult to get rid of. Treatment options include: freezing, chemical methods, laser or, if the warts are large, surgical removal. The warts tend to recur and new ones grow, so treatment can sometimes take a long time. Sometimes the treatment will require a local anaesthetic (the area with the wart is numbed) or in some cases a general anaesthetic (you are put to sleep during the operation).

HPV in women is linked to cervical cancer, thus it is very important for woman with genital warts to go to the doctor and to have regular smear tests.

Prevention is the key in reducing the spread of genital warts. Practising safe sex is the only real way to prevent a sexually active person from getting this. In some cases condoms will not prevent the spread, as they will not cover the whole area that is infected.