Dermatology: what solutions to skin ailments

Redness

As soon as it is a little hot or cold, whether you eat spicy or drink a little alcohol, red you get on the cheeks? If you have a clear phototype (blond hair, clear eyes), there is nothing surprising: this rosacea due to the dilation of hair vessels is frequent in light skin. When is it justified to consult then? "At this stage, rosacea produces only aesthetic discomfort and is not easy to treat by simple creams. But it is possible to offer a topical treatment to be used in an ad hoc basis, before an interview or intervention in public for example, ”says Dre Eleonora Gambillara Thacher, dermatologist in the Lausanne region. These creams limit vascular dilation for ten to twelve hours, but have no long -term effect. A few sessions of laser or pulsed light can also make it possible to close the superficial vessels and therefore reduce redness, provided that the treatments are carried out with a certain regularity.

The inflammatory form of rosacea, defined by the appearance of small papules and pustules, can cause painful pimples and itching.The metronidazole and, more recently, the topical ivermectin has proven themselves.It may also be necessary to prescribe oral antibiotic therapy and, if the rosacea is resistant, isotretinoin.

Acne

Acne often has the image of adolescence disease, however many adults who consult for this indication.And the impact of this disease on quality of life would still be underestimated.In 2018, French researchers carried out a study with 1,000 adult patients with acne.Even those with mild to moderate forms declared a decrease in their quality of life, and some even reported in progress or at work related to their acne.If the majority of adults who suffer from it have developed the disease in their young years, it is not uncommon for patients, most often women, develop acne after 25 or 30 years.Solutions exist and age should not be a brake on consultation.

Some of these acnes are linked to the use of cosmetics that can obstruct the pores of the skin and promote the development of comedons.Using several layers of different products every day ("layering") or often changing care or makeup products can also promote the appearance of buttons.In this case, the management is simple and the problems are most often solved with a return to a simplified care routine and suitable hygiene products.

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Other forms of acne are the consequence of interactions between personal predispositions and environmental factors. If acne trigger elements are not yet all known, we know for example that intense and/or prolonged stress can promote the appearance or resurgence of this inflammatory disease. Having a family member who has acne also increases the risk. In women, hormonal fluctuations are also implicated. "Many women who have developed acne in adulthood have so far had oral contraception, often with anti-Androgenic action since their adolescence, which has somehow masked their acne. When they stop their contraception, acne reappears, "said Dre Gambillara Thacher. Contraception is also considered today as one of the elements of the therapeutic arsenal against acne in women. “You have to know the history and assess individual risk factors, in particular of thrombosis. The treatment is always adapted to each individual case by the gynecologist, ”underlines the dermatologist.

Among therapeutic options, patients can be offered topical treatments, antibiotics over a period of a few months or isotretinoine treatment in more severe cases or in scar acne.

Pigment spots

Patches, brown but sometimes white too, can appear after exposure to the sun.They are a sign that the skin can no longer face stress properly that exposure to radiation represents.This signal must therefore lead above all to protect itself more and better."Good protection is above all to avoid the sun, especially during the hottest hours, then wear covering clothes and/or filtering UVs, and putting a hat," recalls Dr Gambillara Thacher.Solar creams should be used when you cannot avoid solar exposure.If you tend to have stains, you have to choose a 50 index and reapply every 2-3 hours in sufficient quantity. "

Once the spots have been appeared, over -the -counter cosmetic products allow attenuation at best, but are generally not effective enough to completely erase them.For this, some laser sessions may be necessary.

Some women are also faced with another pigmentation disorder, melasma, still often wrongly called "pregnancy mask".Indeed, only 20% of cases would occur in pregnant women.The causes of this hyperpigmentation are not yet fully known, but hormonal contraception can promote the occurrence, the stop of the pill, however, rarely improving an improvement.Again, solar exposure can promote the maintenance of spots, and photoprotection is therefore recommended.Management is based on attack treatment with a cream containing hydroquinone, retinoic acid and dexamethasone acetate (kligman trio), then maintenance treatment.

Cancers de la peau: il n’y a pas que le mélanome!

When you talk about skin cancer, it is the melanoma that everyone thinks first of all. And yet, if it is the most aggressive, it is not the most common skin cancer. Basocellular and spinocellular carcinomas are much less known to the general public and yet they are the most likely to meet. These cancers are linked to the photoexposition, but develop mainly in seniors. "It's a bit like, who arrived at a certain age, you pay the addition of your exhibitions to the sun of decades earlier," said Dr. Rastine Mérat, dermato-oncologist at the Geneva University Hospitals (HUG). Adopting protective habits from childhood during solar exhibitions is therefore essential. And arrived at a certain age, knowing how to recognize these cancerous lesions is important. "They often go unnoticed because they can be small pink or red lesions that can be taken for a simple button. The lesion does not always grow but we must consult when we see that it persists over the months, "explains Dr. Mérat. Acting quickly makes it possible to prevent the lesion from infiltrating the surrounding tissues and thus limit the scars during removal.

It is also important to discuss with your doctor a possible treatment when presenting actinic keratoses, these small red plates or with rough white surface whose number generally increases over years on the areas exposed to the sun, hands and skullFor bald people in particular.These lesions are not cancerous but can evolve over the years in carcinomas."Unmmelastic skin cancers are sometimes seen as lesions that will evolve very slowly, but this is not always the case, including in very old people, warns Dr. Mérat.And even if it remains rare, some lesions can become metastatic.So, in case of doubt, it is better to talk about it with your doctor. ”

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Published in the special issue "Your Health", Le Nouvelliste/La Côte, November 2019.