Alopecia Areata

Have you noticed bald patches appearing on your scalp or just general thinning of the hair?? You may have Alopecia Areata, also known as autoimmune hair loss, where one or more round bald patches appear suddenly, most often on the scalp.

Image of man showing patches of hair missing as he suffers from alopecia areata
Alopecia Areata can affect males and females at any age. It starts in childhood in about 50%, and before the age of 40 years in 80%. Lifetime risk is 1–2% and is independent of ethnicity.

What causes alopecia areata?
Alopecia areata is classified as an autoimmune disorder. It is characterised by immune cells flooding the area around the hair follicles. These immune cells then attack the hair and don’t allow the hair to grow. The exact mechanism is not yet understood.
The onset or recurrence of hair loss is sometimes triggered by:
• Viral infection
• Trauma
• Hormonal change
• Emotional/physical stressors
Alopecia areata can also be associated with nail changes such as pitting or ridging. Alopecia areata can be associated with other conditions such as eczema, urticaria (hives) and autoimmune thyroid issues.
Alopecia areata is clinically diagnosed by a qualified dermatologist.

The doctor may also assess the area by using a dermatoscope, if needed a biopsy may be taken to diagnose or confirm the condition.

Related image

So what can you do for your Alopecia Areata?
There is not yet any reliable cure for Alopecia Areata and other forms of autoimmune hair loss, because spontaneous regrowth can occur.
Several topical treatments such as potent steroids used for Alopecia Areata are reported to result in temporary improvement in some people.
Another common treatment method is Intralesional injections – corticosteroid injections into patchy hair loss in the scalp, beard or eyebrows. We normally see patients every 6-8 weeks for follow up injections. Injections are easily tolerated by patients and takes no longer than a few minutes!
Oral medications may also be used but again it isn’t a cure, and ongoing treatment is key with this condition.

Say Goodbye To Hyperhidrosis (Excessive Sweating)

Do you suffer from excessive sweating, have to change your shirts multiple times a day or just from sitting doing nothing you get sweat patches? ….Then we could help you!
Hyperhidrosis also known as excessive sweating can be a very debilitating condition. It can affect people’s confidence, hygiene and also not to mention washing clothes more often!
Hyperhidrosis occurs when over-active sweat glands release a volume of sweat that is significantly more than the body’s normal requirements for cooling. There are two types of hyperhidrosis: Focal Hyperhidrosis (sweating confined to a particular area and Generalised hyperhidrosis (sweating all over the body).

Lucky we have an in clinic treatment that can help, a lot!

What can cause hyperhidrosis?
• Starts in childhood or adolescence
• May persist lifelong or improve with age
• There may be a family history
• Tends to involve armpits, palms and/or soles symmetrically
• Usually, sweating reduces at night and disappears during sleep
• Obesity
• Diabetes
• Menopause
• Overactive thyroid
• Cardiovascular disorders
• Respiratory failure

What can I do to help the condition?
General measures
• Wear loose-fitting, stain-resistant, sweat-proof garments.
• Change clothing and footwear when damp.
• Socks containing silver or copper reduce infection and odour.
• Use absorbent insoles in shoes and replace them frequently.
• Use a non-soap cleanser.
• Apply corn starch powder after bathing.
• Avoid caffeinated food and drink.
• Discontinue any drug that may be causing hyperhidrosis.
• Apply antiperspirant.
• Deodorants are fragrances or antiseptics to disguise unpleasant smells; on their own, they do not reduce perspiration.
• Antiperspirants contain 10–25% aluminium salts to reduce sweating; “clinical strength” aluminium zirconium salts are more effective than aluminium chloride.

In clinic treatment when these measures fail?
There are also some oral medications the dermatologist can prescribe. If all measures fail we can then look at anti sweating injections for under arm sweating! These types of injections are approved for hyperhidrosis affecting the armpits. It is a safe and effective treatment all done in clinic.
Unlike topical treatments, Anti Sweating Injections target sweating at its source. With a few tiny injections, Anti Sweating Injections enter the specific glands in the underarms responsible for excessive sweating. Once there, it blocks the release of a chemical that signals the perspiration.

Effectiveness has been found at 95% in Clinical studies, 1-week post treatment has shown a reduction at an average of 83%. Injection results generally last between 6 – 9 months; although some patients require re treatment after around 4 months (123 days) and others have had success for longer periods of time. An indication for another treatment is the return of symptoms.

How much does it cost???
The other great thing is because it is a medical condition Medicare will pay for some of the costs if the anti-sweating injections are performed by a dermatologist!
With such an easy treatment available it is becoming more and more common in our clinic.
With 95% improvement in sweating for around 6-9 months, what are you waiting for?!

Say goodbye to those sweat patches!

Molluscum Contagiosum

Molluscum Contagiosum

You may have experienced a bumpy rash like condition but unsure what it was or if it has been diagnosed incorrectly. Molluscum contagiosum is a common and stubborn viral infection that causes a mild skin rash. It is important to get the correct diagnosis to ensure the best treatment quickly for fast results. The rash looks like one or more small growths or wart-like bumps that are usually pink, white, or skin-coloured. The bumps are usually smooth and shiny or pearly-looking, and may have an indented centre.

We treat these similar to how we treat warts; we apply topical solutions or pastes to the skin. Sometimes we can also use cryotherapy where we freeze them off.

With the topical medications you keep the medication on overnight ideally, if the patient can tolerate. Expect the skin to blister and go red, this is what we want as this means it is doing something!!!

We will also give you home treatment to use every night as much as you can tolerate. Home treatment is extremely important as we normally only see patients every 3-4weeks with Molluscum, so attacking the virus daily at home helps to stop the spread and keeps killing it!

There are four main types of how it can be spread:

  • Direct skin-to-skin contact
  • Indirect contact via shared towels or other items
  • Auto-inoculation into another site by scratching or shaving
  • Sexual transmission in adults.

Molluscum is most commonly seen in children, although we see this virus in adults as well. The most important thing is to treat this condition as early as possible! This is to avoid it spreading to the whole body. Your child may just have one or two bumps on the arm or leg, this can spread quickly so prompt treatment is needed to stop the virus as quickly as we can.

It can be a big confidence issue for some children as it is quite visible to others, so that’s why we like to treat when we just see a couple of lesions.

Once we start treatment the immune system is woken up and kicked into gear to start erasing this virus. So we don’t have to necessarily treat every single spot for all of them to disappear, as the body will start to mop up any ones we miss. The immune system is an amazing thing!! Sometimes it just needs something to kick start it and refresh it and get back to its normal self!!

Contact Dermatitis- Patch Testing Techniques

Contact Dermatitis

If you have ever experienced dry, red or itchy skin, you know how frustrating and debilitating it can be.

Whether it is a small rash on your face or a rash covering your entire body, it is possibly due to Contact Dermatitis.

 

We recently attended the Melbourne Dermatology Conference in May 2019 and the Skin and Cancer Foundation patch test training day, where we got to learn more interesting information about Allergic Contact Dermatitis and refine our skill in patch testing. Patch testing is the way forward in allowing out patients to find out what they are allergic to!

Allergic Contact dermatitis (also called contact eczema) refers to a group of skin disorders in which the skin reaction is due to direct contact with the causative agent. The term dermatitis implies that the outside layers of skin are affected. It can be acute (a single episode) or chronic (persistent). Dermatitis is nearly always itchy.

Allergic Contact dermatitis is the most common cause of occupational skin disease, and is particularly common in cleaners, healthcare workers, food handlers and hairdressers due to the sheer numbers of chemicals these professionals come into contact with on a daily basis with work.

What does it look like?

  • Redness (erythema)
  • Blisters that are small (vesicles) or large (bullae)
  • Swelling (oedema)
  • Dryness or scaling
  • Cracks (fissuring)
  • Lichenification (thickened, lined skin)
  • Pigmentation increased (hyperpigmentation) or reduced (hypopigmentation).

What will patients complain of?

Itchy, dry skin in a patterned distribution. So for example, with hair dye allergy, it will come up as a scalp rash but also a rash and swelling around the eyes. For nail cosmetics allergy, this may come up as a rash around the eyelids. For allergies to clothing textiles and dyes, the rash might outline the exact pattern of the clothing (eg socks, gloves etc).

How is the diagnosis for contact dermatitis made?

The dermatologist will take you through a thorough consult, taking down all history carefully and making note of all possible irritants and exposures. Once the dermatologist can clearly identify what is causing your rash, it is important to avoid direct contact with those irritants.

  • Avoid soap – use a pH-balanced cleanser suitable for sensitive skin
  • Dry skin carefully after washing

The rash can be treated with a short course of topical corticosteroid steroid. Apply emollients/moisturiser frequently while the rash is active and for some weeks afterwards as the normal skin barrier function is restored. Severe contact dermatitis may be treated with a short course of systemic corticosteroids, e.g. oral prednisone. Occasionally, for chronic contact dermatitis, phototherapy may be tried, or immunosuppressive agents such as methotrexate,ciclosporin or azathioprine may be prescribed.

 

Patch Testing

If the dermatologist can’t determine the exact cause of your dermatitis straight off sometimes we have to do a bit of detective work to get to a diagnosis, that’s where patch testing comes in!

 

Patch testing is a simple and non-invasive way of detecting what your body is allergic or reacting too. We are looking for a diagnosis to help narrow down how your skin reacts to certain stimulants when placed on your skin for a certain amount of time. The first appointment will be a history taking exercise and thorough examination to narrow down potential allergens.

 

After the allergens for patch testing are then ordered (which can take 1-2 weeks), we will bring you back for an appointment to place allergen strips on your back. You will then come back 48 hours later to have your first reading; the second reading will be a further 48hrs to see if you have had a late reaction. Hence, we find doing a Monday-Wednesday-Friday cycle the most efficient way of conducting the readings.

 

We do a very thorough testing and can test for a range of different irritants such as

-Sunscreens                     -Airborne Allergies                -Tapes/dressings

-Fragrances                     -Textile dyes                          -Metals/nickel

-Cosmetics                     -Corticosteroids                     –Car Fragrance/air fresheners

-Hairdressing products

 

Once we get a diagnosis, we can then look at removing these from your routine and start treatment for you. These results can be positive OR negative, all leading to a diagnosis. If not allergic contact dermatitis then possibly irritant contact dermatitis could be the diagnosis.

Just remember to be patient, it is a process to get to a diagnosis, but it can be life changing once we get a diagnosis for you!

To start your skin journey and for patch testing appointments with one of our dermatologists please call our clinic on 9039 5644.