Acne, eczema and hair loss is often genetic

The Vaseline Healing Project in partnership with international medical aid organisation Direct Relief was launched this year to help people in need of dermatological care across the world.

Professor Ncoza Dlova, who heads the charitable initiative in KwaZulu-Natal, is chief specialist and head of the dermatology department at the University of KwaZulu-Natal, with special interest in ethnic skin, pigmentation, hair disorders, HIV and skin.

She is one of the most prominent voices in the anti-skin bleaching campaign and a march that will take place in Durban on August 26.

What are the most common skin ailments experienced by South Africans?

Acne. It is often genetic but there has also been an increase in steroid-induced acne brought on by the abuse of topical steroids for skin bleaching.

Eczema, inflamed, itchy patches on the skin, is also genetic and common in children under 5 years of age.

We see many skin infections: viral, bacterial, fungal and parasitic. There has also been an increase in skin infections due to the high prevalence of HIV infection.

Pigmentation: melasma (brown patches on the face, which we might call hyper pigmentation) and vitiligo (the loss of skin colour in patches) are common in African and Indian patients.

Both these are genetic, but melasma can be aggravated by sun exposure and use of contraceptives. Vitiligo is common in dark-skinned patients and can be challenging to treat. It sadly has major psychosocial sequelae.

Hair disorders and hair loss are increasingly common too. We see traction alopecia common with Africans because of mechanical pulling of hair (because of braids and weaves), while androgenetic alopecia (baldness and often a receding hairline) is common with Indian and white patients.

Central centrifugal alopecia (a type of scarring with hair loss) often affects Africans and lichen planopilaris (the loss of patches of hair) affects all ethnic groups.

What are inflammatory skin diseases?

There are some skin conditions associated with inflammation and these include eczema, psoriasis and lichen planus. They can be caused by a number of conditions, from reaction to medication to contact dermatitis, such as an irritation from soap or a fragrance.

What are auto immune skin diseases?

These are skin conditions that occur when the body starts producing certain cells called antibodies which start attacking the body’s own cell. These include systemic lupus erythematosus, dermatomyositis, scleroderma, rheumatoid arthritis, discoid lupus erythematosus.

Are skin conditions linked to allergies?

Yes, these are most commonly eczemas and urticaris (hives). It is worth looking more closely at the diet in these conditions.

We often use steroid creams to treat skin ailments but are these safe and how long is too long for steroid use?

Steroid creams have a big role to play in treating skin conditions but they need to be used under the dermatologist’s supervision. It depends on the strength of the cream and where it is used.

For example using a very strong cream like Dovate or Elocon on the face can result in skin damage within four to eight weeks, whereas if you use an appropriate mild steroid cream on the face you may use it for a long time without any side effects.

Your dermatologist knows when to stop or start the cream.

It should not be used for bleaching the skin or treating pimples. One should not use these creams without consulting a doctor.

What do parents of acne-prone teenagers need to be aware of?

Teenagers should seek help for their acne as this is a treatable condition. Leaving acne untreated and hoping the child will outgrow it may lead to irreversible scarring and psychological disturbance which may affect the teenager’s self-esteem.

Why do older women suffer acne?

This is called middle-age acne and tends to occur around the mouth and jaw line. Treatment is similar to ordinary acne and includes the use of antibiotics and retinoids (a group of compounds such as Vitamin A). Middle age acne tends to be difficult to treat and one may need to use retinoids as first line treatment rather than antibiotics.

Many women find that their skin changes during or after pregnancy. How is this best tackled?

One may get chloasma associated with pregnancy or melasma which may be worsened by contraceptives. Treatment includes strict sun avoidance, use of broad spectrum sunscreen (UVA and UVB), protective clothing and safe depigmenting agents which your dermatologist can advise you about.

Is there effective keloid treatment or advice?

A keloid is an irregular fibrous tissue formed at the site of a scar or injury.

This is challenging in patients who are keloid prone or have a family history. I suggest avoiding ear piercing altogether or pierce before age 12. Keloids tend to recut even after excision, so it may not be worth trying to have it removed, especially if it is already huge and long-standing.

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