Skin & Dermatology - Q4 - Dec 2018

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Skin & Dermatology

“Having a skin condition like psoriasis or eczema shouldn’t stop you from living your life” Luissa Burton Miss Europe World 2018 & British Skin Foundation Ambassador

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IN THIS ISSUE

READ Why GPs need more specialty training when it comes to skin

LEARN Do you know how it feels to live with psoriasis?

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ONLINE EXCLUSIVE Understanding the three major factors that can cause eczema

Do you have fair skin? You could be at greater risk of skin cancer It’s important to remember to check your skin for changes in moles year-round, not just in the summer months. Checking is easy and can be done at home with help from family.

Dr Rachel Abbott Dermatology Consultant, University Hospital of Wales and Spokesperson, British Skin Foundation

Skin cancer is increasingly common in people with fair skin due to changes in our behaviour in the sun over recent decades.

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olidaying abroad in areas with a high ultraviolet (UV) index has become more popular, together with use of sun beds and the desire for tanned skin.

However, if your skin goes red before you tan, then you are at increased risk of skin cancer. By taking simple precautions you can prevent the development of skin cancer which can be life threatening.

It is important to respect your skin, especially when on sunny Follow us

holidays abroad but also in the UK during the summer months.

When the UV index is 3 and above – particularly between 11am and 3pm – it is advisable to stay in the shade, wear a broad-brimmed hat, longsleeved clothing and high factor sunscreen (>30SPF, 4-5 star UVA) on any exposed skin.

UV radiation is not visible so, often, people are unaware of being sunburnt until the damage is done.

Signs of sunburn include redness and pain of sun exposed areas sometimes leading to permanent freckling and other signs of sun damage. No one is born with freckles.

Don’t risk your life in pursuit of a tan. Regular sun bed use under MediaplanetUK

If your skin goes red before you tan, then you are at increased risk of skin cancer the age of 35 doubles the risk of melanoma (cancerous mole).

Protecting children’s skin It is essential to protect children’s skin because one episode of blistering sunburn in childhood doubles their chances of developing melanoma in later life. Babies should be kept in the shade during peak UV times until they are able to move. @MediaplanetUK

Sunsuits and legionnaire style hats can be helpful for young children together with very high factor (>50SPF, 4-5 star UVA) sunscreen.

What to look for Examine your skin regularly – at least every three months - using a mirror to check your back (or ask a family member). And don’t forget to check your scalp, your nails and the bottom of your feet.

Use the ABCDE checklist for moles: Asymmetry (when one half of the mole doesn’t match the other), Border (when the edge of mole is irregular or blurred), Colour change (when the mole is more than one colour), Diameter (when the mole @MediaplanetUK

is 6mm or more), Evolving (any change in the mole over time). Also, check to see whether any of your moles stand out as looking different from the rest of your moles, which is known as the ‘ugly duckling’ sign. Other red flag signs for skin lumps and bumps include bleeding and pain.

If you are concerned about anything on your skin, seek medical advice.

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Year-round UV-ray protection for eyes has arrived

Dr Debbie Laughton Head of Professional Services, ZEISS Vision Care

Our eyes are precious, yet we may not be aware of how wide-ranging the damage caused by constant exposure to the sun might be year-round.

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t’s almost impossible not to be acutely aware of the dangers that our sun and its harmful Ultraviolet Radiation (UVR) poses to our skin. ‘Slip, slap and slop’ are words etched into the mind of any British holiday maker that takes themselves seriously, but have you ever ‘slipped, slapped and slopped’ your eyelids? A ridiculous question perhaps, but one that demands a serious answer.

What is UV? UVR, or Ultraviolet Radiation, is considered to be a high-energy type of radiation. If X-ray and visible light were at opposite ends of a spectrum, UVR sits in the middle.

It stands to reason, then, that high levels of exposure might not be good for any area of skin. Sunlight and UVR do encourage the production

of vitamin D in the body, yet chronic exposure to UV radiation can have harmful effects on the eyes and surrounding skin.

The eyes and the skin surrounding are often neglected in terms of care from harmful UV rays, with the public’s poor awareness and a lack of protection factors.

Far from being a summer issue, ocular protection from UV rays is recommended throughout the year, according to Dr Debbie Laughton from ZEISS Vision Care.

“UV radiation is always there.

All year round, all day, in winter and summer, whether it is sunny or overcast.” Failure to pay proper attention to protecting the eyes and surrounding areas can cause long-term, wide-ranging damage, according to Dr Laughton.

Long-term exposure to the sun can cause cataracts “Long-term exposure to UVR can accelerate the development of eye conditions, with cataracts a perfect example.”

Cataracts, where the lens of the eye becomes clouded, is just one of the potential ill effects caused by prolonged exposure to UVR.

UV radiation is always there. All year round, all day, in winter and summer, whether it is sunny or overcast Photoageing of the skin around the eyes, manifested by deep wrinkles and loss of skin tone, could be prevented by sunscreen. Yet, many people actively avoid applying sunscreen around the eyes. The damaging effects of UV exposure happen over a long period of time, making it difficult to pick up and therefore prevent.

On bright, summer days, UV protective sunglasses are the perfect foil. However, UVR doesn’t become

less harmful outside of the summer months. Maintaining sunglasses level protection in normal, clear lenses, means glasses wearers can rest assured they will be protected from UV-rays all year round.

“It doesn’t matter if it's cloudy,” Dr Laughton explained. “While clouds do reduce the amount of visible light that reaches us on the ground, UV-rays still get through to our eyes. Sometimes the UV levels on cloudy days can be just as high as on a clear day.”

Current ISO standards for clear lenses require UV protection up to 380 nm. This is despite organisations such as the WHO defining the UV hazard as extending to 400 nm and is particularly concerning when you consider nearly 40% of UVR lies between 380 and 400 nm, effectively creating a UV protection gap.

Ninety-five per cent of consumers think protection from UVR is important, yet awareness of the potential damage to our eyes and surrounding areas is lagging behind.

ZEISS’s nationwide campaign aimed

at engaging the public on the dangers is going some way to putting the imbalance right.

James Alder

ZEISS UVProtect™ Technology

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Offering the best treatments to your patients may mean leaving the constraints of traditional organisations After Dr Neil Walker had learned to treat skin cancer and other dermatological conditions with the most advanced techniques, he found the only way to provide them was to establish his own clinic.

Many patients living and working in Cambridge and the Fens present with multiple skin cancers. I trained in dermatology in Cambridge, and I soon realised the importance of having the surgical skills to treat these patients but also recognised excisional surgery alone was not the answer.

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resolved to do a fellowship in the United States to further my training and expertise and spent a year at the Cleveland Clinic Foundation becoming a Fellow of the American College of Mohs Surgery.

An early research project investigated laser vaporisation in treating multiple basal cell carcinomas, which I wanted to explore further.

This was when laser technology was developing fast. On returning to the UK, I helped develop techniques for treating skin cancer, birthmarks and other dermatological conditions.

Being able to do all you can for a patient In common with other medical specialties, dermatology has a number of challenges. As a consultant dermatologist, you hope to do all you can for your patients but sometimes there are limits imposed by the constraints of the NHS or a private medical insurer.

Dermatology, despite skin conditions being the commonest reason for people consulting their GP, is often regarded as being of a lower priority than acute services and lack of access to the best facilities, staff

and most up-to-date equipment can be frustrating. These factors and an ambition to develop my own independent specialist clinic for dermatology patients led me to open Stratum Clinic in central Oxford where I had helped develop the NHS Mohs’ surgery and laser service.

At Stratum we endeavored to create an environment where our patients felt they were prioritised and had access, directly or through our connections, to all the options modern dermatology could offer, unconstrained by insurers’ or commissioners’ policies.

This means, if I operate on a patient to remove a skin cancer or treat severe acne, I can also offer treatments to help reduce their scarring or treat background sun damage, improving their outcome.

Dr Neil PJ Walker FRCP Consultant Dermatologist, The Dermatology Partnership

Working alongside, not apart from, the establishment Although being part of a large organisation like a hospital can be frustrating, it is a huge step to leave the comfort of an established facility.

I was concerned about keeping in touch and collaborating with colleagues and ensuring patients had access to other areas where necessary.

We have worked hard to overcome these challenges. My colleagues and I work closely with local hospitals – NHS and private.

Using our range of lasers, we provide services for the NHS for specialised cases. Our proven success has now allowed me to take the next logical step. Recently we have formed The Dermatology Partnership with colleagues and two other clinics in London and Canterbury,

collaborating with other Consultant Dermatologists and pooling our learning and resources across what we hope will be an expanding network of clinics.

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More dermatology training is needed for GPs 70 years of the NHS has seen many changes. What has not changed is the way services for people with skin disease are delivered. There remains a lack of dermatological education for all doctors in medical school.

Dr Angelika Razzaque Executive Chair, Primary Care Dermatology Society

What are the best treatments for eczema?

Andrew Proctor Chief Executive, National Eczema Society

There’s a lot of misinformation online about how best to keep eczema under control. Plenty of emollient – and topicals steroids for flare-ups – is the way to go.

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czema, also known as dermatitis, is a non-contagious, inflammatory dry skin condition that can affect people from early infancy to old-age. It is a highly individual, long-term condition that comes in different forms.

The skin is often unbearably itchy – the urge to scratch can be irresistible – and during a flare-up it can also be red, sore and raw. Eczema is estimated to affect up to six million people in the UK and one in five children.

First line eczema treatments – a good skincare routine A good skincare routine is important for any form of eczema. It is essential to use emollients (medical moisturisers) to keep the skin protected and restore the skin barrier. There is a wide range of emollients available from lotions, gels, creams and ointments.

Different emollients suit different people – finding the best one(s) for you may involve some trial and error. Emollients should be applied at least twice a day, and every few hours when the skin is very dry. They should also be used for washing, as soap can irritate eczema.

Topical steroids (creams/ointments) are the most common form of treatment for inflammation in eczema. These are typically used for short treatment bursts during flare-ups and come in four levels of potency. Topical steroids of different potencies will usually be prescribed for different areas of the body: less potent ones for delicate skin and more potent ones for thicker skin.

Topical Calcineurin Inhibitors are a second-line treatment for eczema and can be used for flare-ups and twice-weekly ongoing maintenance treatment.

Treating more severe eczema Treatments for severe eczema include phototherapy, immunosuppressant and biologic drugs. Unfortunately, there is currently no cure for eczema, but there are other new treatments being developed.

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P speciality training, in particular, is not matching the fact that up to a quarter of GP consultations with patients are for a skin-related matters. Patient experiences and outcomes are inadvertently compromised.

GP services are under pressure.

Trying to provide access for unscheduled care and, at the same time, organise planned reviews for chronic disease management (namely under the Quality and Outcomes Framework, under which skin disease does not feature), is a resource-consuming balancing act.

How are GPs learning more about skin health?

GPs are addressing the lack of training within their continuous professional development (CPD) by attending already-existing educational events such as those organised by the Primary Care Dermatology Society (PCDS) or using the PCDS website for information.

Some take it even further to gain additional diplomas and become GPs with Extended Roles (GPER) under consultant mentorship.

This has, in some areas around the country, led to a model of care in which community dermatology services have supported primary and secondary care in taking the burden of diagnosing and managing skin disease. However, there is great variation of such provision, which results in health inequalities.

Hospitals lack dermatology services as cancer patients take priority Hospital-based dermatology services face challenges too. With a lack of consultants, vacant posts remain unfilled and services are often

outsourced to private providers.

The pressure on providing access for suspected skin cancer within a two-week time frame leads to increased waiting times for patients with other skin conditions, namely inflammatory skin conditions such as eczema, psoriasis and acne.

A lack of dermatological knowledge means delayed diagnoses Pharmacy First is one initiative to redirect the flow of minor skin conditions towards pharmacists in the community. This is faced with the same challenge of a general lack of education about skin disease.

Equally, other community-based services, such as podiatry, district nursing, practice nursing and physician’s assistants, midwifery and health visiting (all healthcare professionals that may see skin disease early on in its presentation), share the same predicament: a general lack of dermatological knowledge, which results in delay of diagnosis and management.

Families – and the wider community – feel the burden of disease The psychosocial impact of skin disease on individuals and their families as well as financial implications, including for the wider economy, has been very well demonstrated. People with eczema, for example, consider the impact on their quality of life to be greater than that felt by people who have diabetes1. Advances in treatments for severe skin disease have resulted in better quality of life and a reduction in morbidity and mortality.

However, prescribing incentive schemes and local formularies, on

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the other hand, restrict prescribing for much-needed treatments for the majority of mild and moderate skin diseases.

Online tools and mobile phone apps have been developed to improve diagnosis with the intention of addressing the lack of education and to enable faster access to treatment.

This does not address the fact that the gold standard is a face-to-face consultation with dermatology also being very much a threedimensional discipline.

Minimum of four-weeks’ dermatology teaching How could this evident ‘dermatological crisis’ potentially be addressed? A call for all medical schools to incorporate a minimum of four weeks’ dermatological teaching with evidence of competency achieved is paramount to raise standards in education.

Furthermore, incorporating dermatological exposure in GP training through sit-in clinics during hospital rotation or in community clinics during GP placements as well as increased education during VTS half days should ensure competency in diagnosis and management among future GPs. Bridging the gap between primary and secondary care by standardisation of community services provision will reduce health inequalities. Investment in technology and resources, including education of the wider healthcare team, is needed to improve clinical efficiencies and improve patient experience.

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Eczema-prone skin? You probably need to ‘feed your ďŹ laggrin’

Dr Neil Gibbs Founder and Chief Technology OfďŹ cer, Curapel

Many people with eczema-prone skin rely on potions and lotions to control their symptoms.

But what if there was a new way to tackle the root problem?

In the UK, one in five children and one in twelve adults1 are living with some form of eczema. It causes dry, scaly, red, itchy skin, has a huge impact on quality of life and until relatively recently, has been largely misunderstood.

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r Neil Gibbs, Founder of Curapel and Honorary Lecturer at the University of Manchester’s Dermatology Centre, says: “Up until relatively recently, if you asked what was the principle cause of eczema, the answer would be an imbalanced skin immune system and exaggerated inflammatory response.�

Ground-breaking research showed a weak skin barrier increases the risk of eczema Then a seminal study from a group led by Professor Irwin McLean2 in Dundee, demonstrated that genetic variants of the skin barrier protein, filaggrin, were the most strongly associated marker for the common

form of eczema – atopic dermatitis. “It made people think again.

Suddenly we knew that eczema wasn’t only about immune system function, it was also about skin barrier function,� said Dr Gibbs, who has worked in skin research for over 35 years.

The filaggrin protein plays an important role in the building of the skin’s protective barrier, the outer layer that keeps irritants and allergens out and moisture in.

Without adequate amounts of ďŹ laggrin the skin’s barrier is weakened, there is dryness due to water loss and a greater susceptibility to inammation triggered by irritants and allergens.

Steroid creams often come with side-effects; ‘feeding filaggrin’ is safe This all sparked something of a lightbulb moment for Dr Gibbs’ team: what if they could ďŹ nd a safe way to boost the body’s production of the ďŹ laggrin protein? “There are so many products out there to manage eczema, most of which attempt to suppress the inammatory response,â€? he said,

adding that the mainstay of such therapies is corticosteroid creams, which often come with side effects.

Dr Gibbs’ team developed pellamex, a safe and natural food supplement that incorporates an amino acid known to be an important building block for the formation of the ďŹ laggrin protein. Then they asked eczema patients to give it a try.

Patients saw a 40% improvement in one month The results stopped them in their tracks. Those who had taken the supplement every day for a month saw, on average, a 40% improvement in their skin condition. “That’s equivalent to the results you would expect from mid-potency corticosteroid creams, but instead we used a food supplement that is natural and very safe,â€? said Dr Gibbs, adding that there had been no reported side effects during the study. This ‘feeding ďŹ laggrin’ approach is unique. Unlike other products, pellamex is safe and is working with the skin’s natural biology rather than against it. We are

targetting root causes of the condition, not just the symptoms.�

Curapel launched pellamex late last year at the Royal Society of Medicine and in a subsequent survey the message was clear from customers with eczema; not only had pellamex helped their skin but it had also reduced their steroid cream use by a third!

Developing products that support filaggrin production holds huge potential — which can only be great news for the estimated 15 million people3 in the UK who live with some form of eczema, explained Dr Gibbs. “While the severity of eczema varies, the impact it can have on someone’s life can be signiďŹ cant. It’s distressing, and can greatly lower a person’s quality of life,â€? he concluded.

About Curapel’s pellamex

Originating from university research and inspired by clinical testing in eczema, Curapel’s pellamex is a natural, safe, oncea-day food supplement specially developed for adults with eczema-prone skin. Rather than just managing the symptoms, pellamex supports ďŹ laggrin, a crucial skin barrier protein and a root cause of eczema.

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With a reputation as a leading private Dermatology and laser treatment FOLQLF ZH RÍž HU VSHFLDOLVW GLDJQRVLV DQG WUHDWPHQW RI VNLQ GLVHDVHV DQG VNLQ cancer in both adults and children.

Based in Canterbury, Kent, we welcome patients from across the South East.

The clinic is headed by a Consultant Dermatologist and laser supervisor. All medical consultations are provided by doctors with years of dermatology experience to bring you the best possible care at all times.

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Psoriasis doesn’t hold back Miss Europe World 2018 as she summits Europe’s highest mountain

Luissa Burton Miss Europe World 2018, British Skin Foundation Ambassador

Taunted and teased at school, many who suffer from skin conditions never recover. Luissa Burton hopes that sharing her experience will allow others to plot a way through the clouds.

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his year, Luissa Burton became the first UK winner of the Miss Europe World title in the competition’s history.

She has modelled for a decade, during which time she has struggled with her skin condition; psoriasis.

Throughout the Miss Europe World competition, Luissa was completely covered in the psoriasis that has had such an enormous effect on her life to this point.

Appearing in a bikini and openly discussing the long-term, mental effect the condition has had on her life with the judges, the childhood taunts that once threatened to quash her dreams of becoming a model were finally silenced.

Parents would tell their kids not to sit next to me “As a child, I remember crying endlessly. I just felt dirty, with people wrongly assuming it was something they could catch from me,” Luissa remembers.

“It affected everything.

Friendships, relationships. Parents would actually tell their kids not to sit next to me. That left me feeling like I was broken, not like a normal child.”

Having recently taken her Miss Europe World sash to the summit of Europe’s highest peak (Mount Elbrus in Russia) Luissa is focused on how she can continue to rid people of the ignorance that led to her being called

a ‘leper’ and a ‘lizard’ at school.

Her ascent of Mount Elbrus, which stands at over 5,000 metres and claims an average of 26 lives each year, has raised more than £10,000 for the British Skin Foundation so far.

Psoriasis isn't contagious “What people don’t understand is that psoriasis is not contagious.

Having a skin condition like psoriasis or eczema shouldn't stop you from living your life and taking part in normal things."

Much like those experiences of cruelty from the children around her, psoriasis and eczema do stay with you for life. Currently, both are conditions that can only be managed, not cured.

Sixty per cent of people in the UK have been affected by a skin condition at some point in their life.

Issues with self-esteem are common, with some cases sadly leading to depression and even suicide.

The outbreak covered my whole body at the Miss Europe World competition Luissa, however, is determined to show others who also suffer from psoriasis and similar conditions that beauty isn’t binary. Her openness about how she manages her condition is all aimed at helping others to realise their potential and refuse to let something so normal hold them back.

“My modelling career, strangely enough, really started to take off when my condition was at its worst,” she explained. “I was at university, so it had taken a long time for me to become truly comfortable. I used to cover up if I had a flare up, not

wearing dresses or anything with short sleeves to try and hide it.”

Although it may have taken a long time, the support of her family and her confidence of her career going from strength to strength means covering up her psoriasis is a thing of the past.

“If I have an outbreak that covers my whole body, as I did at the Miss Europe World competition, I don’t really care. I’ll wear what I want anyway.”

Using her worst days to spread awareness and positivity Having been an ambassador for the British Skin Foundation for five years, Luissa feels her ability to positively influence others in her position is a big responsibility.

“Working with the charity enables me to share my story with a much wider audience. I call it, ‘turning your worst days in to your best days’. Using my worst experiences to help others is something I really believe in.”

Even now, Luissa does still occasionally get that sinking feeling when being singled out by someone.

But as she explains, it doesn’t always end up being a negative exchange.

“I had someone come up to me this summer while I was in France and ask, “Oh, what’s that on your elbow?’ That triggered that ‘here we go again’ feeling. I’m going to have to do the whole speech here. But they just said, ‘Oh that’s so cool! They’re your logo!’ It ended up being a nice experience, I wish more people were like that.”

James Alder

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How to self-manage dry, itchy skin this winter From drinking plenty of water to avoiding aggressive laundry detergents and adding O'Keeffe's to your daily routine, there's lots you can do to prevent dry, itchy skin all year round.

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e can all take steps to ease dry, itchy skin without needing to seek medical treatment, says Jake Witherington, Senior Brand Manager at O'Keeffe's Company, who offer a range of

moisturisers specially-designed for dry skin.

“Anyone can be vulnerable to dry skin and it might be for any number of reasons,” he said, adding that younger and older people are more susceptible to the problem of dry skin.

The skin is a barrier The skin is made up of several layers, the outer of which is called the epidermis. It keeps allergens, pollution and irritants on the outside, and the water our skin needs to stay healthy on the inside. Dry skin can occur when this barrier gets damaged.

“A breakdown of the epidermis allows water to escape, and this is a key driver of dry skin,” said Witherington, adding that dry skin can develop on any part of the body.

“Factors that can contribute to someone being susceptible to dry skin include genetics – some people are just unfortunate enough to have

it in their family tree. But it could also be to do with lifestyle.”

Impact to skin can be caused by central heating or air conditioning systems, for example. People who work outdoors through the cold season often suffer with dry skin, as do those who frequently wash their hands.”

“It can be itchy, flaky, scaly and in some cases skin can even crack, which could then potentially lead to infection. It can be debilitating and can really get in the way of everyday life, especially for people who work with their hands.”

While it is more common during the winter, Witherington says dry skin can flare up at any time of the year.

Self-management of skin conditions But whatever the cause, there are ways of managing it without needing to seek medical treatment.

O'Keeffe's, which was developed in California more than 20 years ago, has a high concentration of glycerine that draws moisture from the atmosphere and locks it in, known as a humectant action, providing your

skin with that extra moisture to help your body repair.

O’Keeffe’s Skin Repair is effective for 48 hours after one application and is safe for people with skin conditions including eczema or diabetes.

“For people suffering with dry skin, it’s incredibly important to moisturise with a product such as O’Keeffe’s Skin Repair after regular bathing to help lock in moisture. Avoiding perfumed products is also recommended as there are often substances present which have been shown to impact sensitive skin and increase the likelihood of an adverse reaction,” said Witherington.

Lifestyle changes However, it's not all about moisturiser, he said.

Getting out in the sun – which stimulates your skin to produce vitamin D – as per Public Health England’s advice – together with managing stress, drinking plenty of water and eating healthily, will all help maintain adequate levels of water within the skin and keep the barrier strong.

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A multi-disciplinary approach to scar treatment Patients with scars should be treated by an entire team of medical specialists who can offer them help and support in variety of different areas, say two experts in the field.

Dr Emma Craythorne Consultant Dermatologist and Dermatological Surgeon, The London Scar Clinic

No two scars are ever the same, notes Mr Jorge LeonVillapalos, Consultant in plastic, reconstructive, aesthetic and burns surgery, and Clinical Lead of The London Scar Clinic. And, certainly, no two patients are ever the same.

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hat's why he believes in treating everyone in his care as individuals.

It's not just a person's scars that are the focus of his attention, he says. It's the person as a whole.

"We don't treat scars,” he insists. “We treat patients with scars.”

Scarring can happen as the result of trauma (such as self-harm or accidents), surgical intervention, burns, skin infections (chickenpox, for example) and scarring diseases, plus inflammatory conditions such as acne vulgaris. Scars themselves are fibrous tissue that may be hyper- or hypo-pigmented, raised, depressed, or feel tight, itchy and painful.

A multi-disciplinary approach to treatment Yet, whatever a scar's cause or appearance, patients do have to face an uncomfortable truth: medicine is not yet at the stage where scars can be eliminated. They can, however, be ameliorated; and this is best done with the help and support of an entire team of professionals.

A single patient should therefore be referred to a variety of specialists from numerous medical fields, including dermatology, laser treatment, cosmetic, plastic and reconstructive surgery, physiotherapy, scar management and hair transplantation.

This multi-disciplinary approach is vital in modern scar treatment, explains

Dr Emma Craythorne, Consultant Dermatologist and Dermatological Surgeon at The London Scar Clinic. It's necessary precisely because each patient has such individual needs.

In fact, she maintains that the days of a scar being treated by just one healthcare professional should be consigned to the past. “It's such an old-fashioned way of thinking,” says Dr Craythorne. “And it's ineffective. The fact is that whatever has caused the scar, a multi-disciplinary team can achieve much better results for a patient. For example, a case of skin cancer would be reviewed by healthcare professionals including a dermatologist, plastic surgeon, oncologist, radiologist and pathologist.”

Physical scars can cause long-lasting mental scars that may lead to anxiety and depression The benefits of a personalised plan After opinions have been given from each specialism, a personalised treatment plan is created for the patient. Drawing up such a plan requires a thorough knowledge of the patient's history and an awareness of their concerns.

“It's very important to listen carefully to the patient,” says Mr Leon-Villapalos.

“We have to find out what their worries are, and how far they want to go in terms of complexity of treatments. This involves an honest discussion about what can be done to help minimise the impact of their scar.”

Treatments range in complexity from massage, moisturising and sun protection, to cosmetic camouflage,

Mr Jorge Leon-Villapalos Consultant in Plastic Surgery & Burns, Clinical Lead, The London Scar Clinic

micropigmentation, laser treatments, micro-needling, dermal fillers, fat injections and more invasive treatments such as subcision (cutting fibrotic strands between a scar and underlying tissue, to reduce indentation) and ultimately surgery.

Physical scars can have a psychological impact Physical scars can also cause long-lasting mental scars that may lead to anxiety and depression issues. Dr Craythorne believes that today's 'selfie' culture has to take its share of the blame for this, because it has made many of us feel increasingly selfconscious about our looks.

“We live in an image-conscious society, which can be problematic for some people's mental health,” she says, pointing out that even a tiny physical imperfection can have major consequences for a person's psychological wellbeing. “For instance, scars which may seem small to others, such as a chicken pox scar, may subjectively be a greater problem for the person carrying it and can have a devastating impact on their quality of life.

They may find social interaction difficult, and may avoid school, university or work.”

Psychological support for patients Mr Leon-Villapalos agrees. He recalls treating people who have even been too ashamed to show their scars to close family members. “Some patients have concealed them for years and some have undressed in the dark to avoid revealing scars to their partners,” he says.

Others believe that scars — particularly facial scars — can impact their careers.

“They may avoid doing workplace presentations or meeting clients,” says Mr Leon-Villapalos. “In some cases, people

feel that they have been passed over for promotion because of their scars.” Many patients are so troubled by their scars, they never leave their house.

This is why psychological support can also be of value during the treatment process. “Yes, it's important to treat a scar with such interventions as laser therapy or surgery,” says Dr Craythorne. “But it can also be important to treat the person's response to that scar. A lot of our work is done in conjunction with psychologists, because this is often a way of helping people deal with the emotional effects their physical scars can leave. It can be a key part of a patient's multi-disciplinary holistic treatment.”

Ultimately, it's no longer credible for patients to be offered limited treatment, stresses Mr Leon-Villapalos. “Most scars — other than simple ones — require more than one treatment from more than one professional,” he notes. “With the right mix of holistic treatments from a range of experts, we can aim to return patients to their normal life with the best outcome possible.”

Tony Greenway

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