Professional Help to Combat Hair Loss

Hope Dermatology welcomes our first guest blog contributor, Dr Elaine Sung (General Practitioner) from Doctors of South Melbourne, giving us her insights on hair loss from the GP perspective – 

 “Finding an increasing number of hair strands on the shower floor, in your brush or on your pillow can strike instant fear. The thought of premature baldness is something we would all rather not contemplate.

If this is something you have recently experienced, first and foremost don’t panic. There is every chance it’s a passing issue and absolutely nothing to worry about.

However, you should get the problem checked out if it persists or is severe.

As a GP, I’m usually the first medical professional patients visit to complain about their hair loss. We usually do a pretty good job at finding a cause. I always make a point to reassure patients that while not all hair loss is curable, it can be managed in the majority of cases.

GPs are well placed to discuss simple treatment options depending on the cause, of which there are many possibilities. Any good doctor will thoroughly go through a patient’s medical history, conduct an examination and order blood tests.

Importantly, I tell patients to steer clear of fads that promise quick results and deliver nothing but a lighter wallet. Herbal supplements and most lotions are as effective as placing a cut onion on your scalp (as someone had suggested to a recent patient).

I’ll usually write a referral to see a dermatologist if a patient’s diagnosis isn’t clear or more intensive treatment is needed.

Follicle Experts

Being leaders in the field of hair loss, dermatologists have access to an extensive range of treatment options. What’s more, they have the experience and tools to conduct more in-depth diagnosis, including scalp biopsies to determine the rarer causes of hair loss.

Depending on the circumstances, dermatologists can be better equipped to get patients on the right path to slow, stop or even reverse their hair loss.

Impact of Stress

Premature hair loss can cause enormous stress and anxiety. Sometimes it’s helped with education on the subject, other times this isn’t nearly enough.

Adding insult to injury, a poor mental state can itself contribute to further hair loss; quite a cruel double-edged sword.

Stress can be a factor in a hair loss condition called telogen effluvium. This is generally a condition that resolves on its own.

Stress and anxiety are also related to certain conditions that can trigger hair loss, such as trichotillomania: an anxiety disorder that results in people consciously or sub-consciously pulling their hair out.

GPs will talk with patients about options for managing anxiety issues stemming from hair loss. They can also arrange for specialists to assist in treatment, and coordinate care with a psychologist if required.”

Dr Elaine Sung is a local GP and owner of Doctors of South Melbourne. Her areas of special interest include women’s health, mental health and complex health needs.

Wet dressings provide soothing relief from itchy skin conditions

There are numerous skin conditions such as psoriasis, eczema or even urticaria (hives) that can be horrible and debilitating conditions that affect many people at some point in their life.

The itch can sometimes be unbearable to the point people can’t sleep and the rash itself is just a pain! Wet dressings come as a life saver to soothe and help cool the symptoms while moisturising the area to help heal the rash. Our dermatologists may prescribe you a certain medicated cream, ointment or just some moisturiser depending on the condition of concern. Either way wet dressings can help you! We have made this informative video on wet dressings to help our patients with the technique.

Method:

(1) Wet a crepe bandage with lukewarm water (you can add some bath oil into the water before-hand) and wring out excess water. You want it damp not dripping wet as you have to normally have the dressing on for a few hours! If suffering large areas on your body you can also use an old long sleeve cotton top or leggings and use these these as your “wet dressing.”(Much easier pulling on a stocking than wrapping a crepe bandage around)

(2) Apply medicated cream/ointment

(3) Apply Moisturiser over the top

(4) Apply wet dressing (either the crepe bandage or clothing)

You can put a pair of dry pyjamas/clothes over the top and sleep with it on for the night and by the morning you should be feeling better and had hopefully had a good night sleep! If you can only tolerate the wet dressings on your skin for a few hours at a time, that is fine too. It may take a few treatments to notice significant change however most of our patients notice a change in 24-48 hrs.

So next time you’re in to see one of our dermatologists for a skin concern, feel free to ask them if our nurses can show you how a wet dressing works and we would be happy to demonstrate for you!

UVA and PHOTO DAMAGE

This image has been doing the rounds in the cosmetic world since it was first published in the New England Journal of Medicine in 2012.

This gentleman was a truck driver who over his career was exposed to consistent, daily UV exposure to the left side of his face.

Ageing is inevitable and dependent on time and genetics. However it is thought that 80% of age-related changes in our skin are the result of extrinsic factors, namely UV photodamage.  Extrinsic ageing (vs intrinsic, chronological “just getting old” ageing) is the result of external factors such as excess sun exposure (photo-damage) and other lifestyle habits such as smoking.  Photoaging can be avoided with good sun protection habits and in this blog we hope to clear up many misconceptions that we commonly find amongst our patients with regards to sun exposure and protection.

The first question I ask during a skin consultation is whether the patient uses SPF on a daily basis and what that SPF is.  If it’s not an immediate yes then I know I’m going to hear “I don’t really go outside”, “Only when I know I’m going to be outside”, “Only in summer” or a flat “no”.

UVA radiation in particular plays a significant role in photo-ageing as it is able to penetrate more deeply in the skin than UVB affecting the deeper dermal layers.  Here it can damage collagen and elastin – leading to deep wrinkling and reducing the skins’ resilience; damage vascular structures causing telangiectasia (visible blood vessels at the surface of the skin); and more superficially causes pigmentation irregularities and lesions.

What you may not know about UVA

  • UVA is present in equal strength all year regardless of season.
  • UVA accounts for 95% of the UV radiation we are exposed to with sun exposure
  • UVA can penetrate through both clouds and GLASS e.g. your office, bus, car, café window
  • Incidental sun adds up. Waiting for the bus, ducking out for your morning coffee, hanging out the washing.

We live a very long life and here in Australia our winters are relatively mild. We aren’t snowed in 3months of the year and we’re showing it on our faces (and necks, chests, hands…)

As well as this, UVA has been shown to cause damage in the more superficial layers of the skin in the epidermis where most skin cancers such as basal cell carcinomas (BCC’s) and squamous cell carcinomas (SCC’s) occur.

So how can we prevent photo ageing?

If you want to slow down your extrinsic ageing process the use of a DAILY high protection, broad spectrum sunscreen is a MUST, year-round.

Be aware of the daily UV index! Download the Sun Smart app to find out what the expected UV is for the day and how much protection you may require. UV levels are typically highest between 11am-3pm.

Wear sun-protective clothing such as a broad-rimmed hat, sunglasses, long-sleeved clothing and seek shelter during this time where you can. Sit under a tree, veranda, stay indoors.

Is it too late for me?!

Don’t panic. We’ve got you.

What you can do
  • Start wearing SPF 30+ – SPF 50+ EVERY DAY. Face, neck, chest and hands.
  • Active skincare such as AHA’s (alpha hydroxy acids), Vitamin C serums, topical retinoids (Vitamin A) will help to increase skin cell renewal, brighten dull skin, reduce and prevent pigmentation changes
  • Vitamin B products and moisturisers will help improve dry and flaky skin and restore the skins’ natural barrier protection.

Can we turn back the clock?

Treatments to reverse the damage
  • Dermal filler to re-volumise and plump any areas of deficit and soften deep furrows
  • Anti-wrinkle injections to reduce dynamic facial lines (expressive lines) and prevent existing lines from becoming deeper
  • Vascular and Pigment laser for colour irregularities
  • Resurfacing procedures such as peels, micro-needling, RF, RF needling, ablative lasers
  • Tightening and lifting treatments such as Rf, RF needling, Micro-focused Ultrasound

Are your days of tanning catching up with you?

Call us on 9039 5644 for a consultation with our Cosmetics Nurse for skin assessment and treatment plan.

Scar reduction treatments

Actual patient Hope Dermatology

 

This is a common question from patients.  Firstly in our assessment of scars, we have to assess the patient as a whole. Every scar in every patient is managed differently and there are lots of variables to consider.

These are the types of questions we need answers to before prescribing a scar reduction plan.

  • How old is the patient? If the patient is a young child, the scar may enlarge with their natural growth and can stretch. Older patients tend to heal up better from surgical scars as there is less tension in the skin.
  • What is the scar from? A traumatic fall? a burn? an acne scar? or a surgical scar? Each of these types of injuries will result in different types of scars. If the scar is from acne (for example), there needs to be complete control of any breakouts of acne before we then tackle the scarring. There is no point addressing the scarring without treating the new bouts of acne.
  • Where is the scar? Certain areas on the body will scar more severely than other areas. In general, areas of poor scarring include the chest, upper arms/shoulders and upper back as these are areas where there is the most tension on the skin and these areas can be prone to keloid or hypertrophic scarring
  • What skin phototype is the patient? Typically patients with darker skin types will scar worse than people with fairer skin types. However, a true scar is not to be confused with post inflammatory hyper-pigmentation (PIH). This PIH is more common in darker skinned people and PIH should resolve without scarring but it can take 6 months or more to resolve in darker skinned people. Hence PIH differs to scarring as often with PIH there is no need for any treatment other than waiting for spontaneous resolution.
  • How long has the scar been present for? Scars can take about 2 years before they fully mature and transition from the acute red/pink colour to the long-term pale/white colour. So if a scar is only recent, it should be explained to the patient that there is a fair chance the scar will improve naturally without any treatment.
  • Could the scar actually be a skin cancer? There are some types of skin cancers that can mimic scar and for this reason, patients ignore the lesion. If there is a scar area or an ulcer that is worsening with time, we should alway consider scar-like skin cancer. The most common one would be sclerosing basal cell carcinoma. This type of skin cancer can be difficult to treat; particularly as patients may not seek treatment quickly.
  • Is the patient taking any medication? Some medications can delay wound healing and hence continuation of such medication needs to be carefully considered in the context of scarring.
  • Is the patient using sunscreen?  UV exposure not only increases the risk of and darkens any existing PIH in a scar, it also impedes our natural wound healing response leading to a poorer cosmetic outcome.
  • Is the patient allergic to any wound dressings? Avoiding irritants in the area, whether it be a traumatic or surgical scar,  will enable better healing without causing additional inflammation in the surrounding skin. If the wound is carefully looked after in the early stages of healing, the risk of a scar, or the extent of scarring can be minimised.
  • Is the patient using any medical grade skin care? This is particularly relevant to facial scars or acne scars and depending on the evolution of the scar (i.e. new, old, currently being treated) active skincare such as Vitamin A creams or prescription fading creams such as Hydroquinone preparations can either aid or hinder healing and must be used under the supervision of an experienced practitioner.

Treatments for scarring

Effective treatment for scarring involves accurate assessment of the scar.

  • Is it tethered to the underlying tissues? If so, subcision, where there is manual release of the tethered tissue could be appropriate.
  • Box car, rolling, ice pick – these are all terms for the different types of scarring in acne. Acne scarring can be treated by a number of modalities including Fractionated laser, Radio frequency, Fractional radio frequency or Skin needling.  Each of these vary with respect to downtime, discomfort, cost, result and suitability of skin type.
  • Keloid scar? Intralesional steroid injections could be appropriate to flatten the areas and improve the pain of the scar for patients, as often patients often have exquisitely sensitive skin over their keloid area. The dermatologist will decide on the strength of the steroid injection needed. This is important as too weak a strength will result in no change in the keloid scar; and too concentrated an injection will mean skin dipping where the injection is. Hence injections should be performed carefully by experienced doctors. These injections are usually performed every 4-6 weeks until good cosmetic result is seen.
  • PIH or post-inflammatory erythema?  As mentioned, assessment is important to not only ensure the correct treatment is selected but in some instances, no treatment is in fact the best treatment.  Patients often present looking to improve their self-perceived acne scars when in fact the skin is still healing from recent breakouts and any post-inflammatory redness will fade with time without intervention as will PIH.  In saying this, we can often speed up this process with vascular laser (for a red scar) and prescription fading creams/skin needling/laser for pigmented scars.

We offer a variety of treatments for many types of scars here at Hope Dermatology and encourage you to book with our team of Specialist dermatologists and cosmetic team to discuss the most appropriate treatment plan for you and your skin.

Call us on (03) 9039 5644 for a consultation. 

 

Nail conditions we treat

Apart from consulting in our wonderful clinic in South Melbourne, I also am a staff specialist at The Alfred Hospital in the general dermatology clinic and have held that position for about 6 years. But another position I also hold is at the Nail Clinic in the Skin and Cancer Foundation Inc in Carlton. Here at this monthly clinic, our team consisting of dermatology specialists, podiatrist, nurses and clinical photography assess all manner of nail conditions and concerns. Dr Anne Howard leads our team and she has contributed to a recent article in Prevention Magazine about Nail Conditions in Salons. A lot of patients may not even know that nail conditions are managed by dermatologists! Nail conditions are a sub-specialty interest of mine and I see a lot of patients with nail issues in my private clinic in South Melbourne too. Recently I have seen a whole load of nail cases and below are some of my recommendations about nail issues arising from common cases or questions that my patients ask me.

Shellac/SNS/gel nails 

  • Be careful to only use LED light and not UV light in the curing phase for these types of nail treatments. There have been studies to suggest that using UV lamps to harden gel nail polish may be harmful and lead to skin cancers. One observational study from Ireland has recently published about this risk in the Australasian Journal of Dermatology and has suggested the use of a high SPF, broad spectrum sunscreen before lamp exposure or the use of fingerless gloves to minimise risk.
  • Try to avoid pushing back or cutting the nail cuticles with your nail treatment as the cuticle is important for healthy nail growth.
  • Some chemicals used in the nail manicure process can cause allergic contact dermatitis which can show up first as an eyelid/facial eczema. The only way to confirm such an allergy is to perform patch testing. Common allergens include –
    • methylisothiazolinone (or MI for short) – used in some wet wipes in the prep phase of a nail treatment
    • toluene sulfonamide formaldehyde resin (or TSFR for short) – a chemical in many nail polishes and nail hardeners
    • acrylates – a chemical used in the binding process and seen in nail polishes and artificial nails

Nail infections

  • Tinea (fungal infection) of the nail plate typically leads to a thick, crumbling and discoloured nail plate. It’s always best to prove there is a fungal infection present by taking a good quality nail clipping of the affected area and send for fungal culture. If fungal infection is proven, then a course of oral anti-fungal tablets is required (can be a 3-6 month treatment). Typically, topical anti-fungal paints/tinctures are not effective when the nail plate is heavily infected. If you are going to salons for your mani/pedi, be careful to ensure instruments are sterilised properly; or better yet, bring your own set of instruments.
  • Thrush infection of the nail plate can cause discoloured nails and lifting of the nail plate and may need treatment with oral anti-yeast tablets.
  • Pseudomonas (bacterial infection) of the nail plate can cause the nail to have a black/green discolouration. Dilute white vinegar soaks can help to improve the appearance of the nail.

Onycholysis (lifting) of the nail plate

  • Too much manipulation of the nail can lead to lifting of the nail plate – manicures/pedicures with soaking of the nails, inserting instruments to clean under the nail, trauma (from footwear and running for example)…all these factors influence the “adhesiveness” of the nail plate to the underlying nail bed.
  • Another cause of nail plate lifting can be psoriasis of the nail; with other features seen including pitting of the nail, discoloured red/yellow nails and thick crumbling nails. Nail psoriasis can sometimes be mistaken for tinea (fungal infection).

Onychogryphosis 

  • This refers to very thick nails that can resemble a scallop shell with layers upon layers of keratin deposited over many years. Often patients are concerned about tinea infection of the nail but nail clippings do not grow any tinea. Management of this condition is cutting back and filing down the nail (with podiatry help if needed) and getting good supportive footwear to prevent the condition worsening.

Longitudinal melanonychia (pigmentation) of the nail 

  • These present as long brown/black streaks on the nail plate and in most cases, is benign. Longitudinal melanonychia is seen often in patients with darker skin (Asians, Africans, Indians, Mediterranean backgrounds). It is thought to be due to a mole or a freckle residing around the area of the nail matrix and hence, as the nail grows, pigment is deposited along the nail plate.
  • We always need to be on the lookout for melanoma of the nail unit. Features which are suspicious for melanoma include asymmetry of the pigment band, asymmetrically placed globules and dots, pigment bands of uneven thickness and uneven colour, and pigmentation on the skin at the base of nail (periungual fold).

Brittle nails/splitting of the nails 

  • can be dietary related and hence bloods to check on general health could be helpful
  • General weathering of the nails from ageing, wet work, trauma etc can lead to brittle nails. We would recommend using a good quality hand cream and ensure the cuticles are not damaged.
  • Nail supplements containing biotin (vitamin B) may be helpful.

Nail tumours/cysts

  • These are rare but can present as a split in the nail, a sore lump under the nail, or a lump that discharges fluid under the nail or around the nail fold. Treatment for these types of lumps is usually surgical excision via dermatologist or plastic surgeon.