Again underlining the tremendous store of knowledge within the club, our own member Prof David Gawkrodger FRCP, honorary professor in dermatology at Sheffield University, began his talk with the basic facts in looking after your skin. He drew to our attention that skin is the largest organ in the body and detailed the three layers of skin, working in from the outside – epidermis, dermis and subcutaneous fat.
Skin growth replicates itself and prevents loss of body fluids. It regulates body temperature as it is a sensory organ and provides immune defence against external agents. He stated the importance of Vitamin D which helps contribute to healthy bones, teeth, muscles and our immune systems. In the UK, from April to September, our bodies should be able to create all the vitamin D we need from sunlight exposure to our skin. However, from October to March, the weaker sunlight does not have enough solar UVB radiation to allow for vitamin D production and this is when we need to turn to food and supplements for a boost.
UVB radiation makes up only five per cent of the UV rays from the sun, but it is very high energy. It does not penetrate as deeply as UVA, but it can wreak havoc on the top layers of ones skin. UVB damages skin cells and causes DNA mutations that can eventually lead to malignant melanoma and other types of skin cancer. Black skin, compared with white skin, is generally assumed to be more resistant to the consequences of sun exposure due to its epidermal melanin content.
David stated that people who spend a lot of time indoors need extra vitamin D in the form of tablets, as do people with milk allergies such as lactose intolerance. It is also important for breast-fed infants to receive a proper amount of vitamin D in their diets. He went on to highlight other ways of protecting ones skin, namely not to smoke, to wash with normal soap and to use good moisturiser. People should also avoid artificial tanning and use water emollient skincare products , generally creams which tend to be tacky on the skin. He illustrated how one can often see cricketers protecting their skin with factor 510 white moisturiser sunscreen, showing a picture of Ollie Pope, the England batsman.
David reached a key point in his talk by stating that the skin is intensely personal, quoting “the leper in the bible”. Psychological pressures at all stages of our lives can affect our skin conditions in various ways and he highlighted the following common conditions: eczema, psoriasis, skin infections, acne and rosacea leg ulcer, hair and nails. David elaborated briefly on these six conditions. Eczema, where there is now a better understanding of the aetiological factors causing it, which has led to the design of new ‘biologic’ drugs and antibiotics discovered over the last 20 years. He mentioned symbolic keratosis, which can be removed surgically.
The main symptoms of psoriasis, which affects two per cent of the population, are patches of skin that are dry, red and covered in silver scales. Mild psoriasis can be treated with creams and ointments. If these do not work, one may need light treatment (phototherapy) or stronger medicines.
Serious skin infections were next explained, with David then dwelling particularly on melanoma skin cancers and p re-malignant conditions such as solar keratosis that can be removed surgically. He explained that a new mole or a change in an existing mole may be signs of malignant melanoma. They can appear anywhere on your body but they are most common in areas that are often exposed to the sun. Some types can affect the soles of the feet, palms of the hands or genitals. The most common way to treat melanoma skin cancer is by surgery, cutting out or sometimes scraping away the cancer cells.
Antibiotics discovered in the 1940s are now available to treat fungal conditions, herpes, shingles and cold sores as well as boils and verrucas. He highlighted scabies and headlice which can be prevalent in school children and is very infectious. This is best dealt with by using lotions and specially designed combs.
Acne and rosacea on the face which looks like flushing can be treated with Roaccutane but this can have side effects and needs to be taken with care and under strict medical supervision for it has even been linked to some suicides. David next mentioned leg ulcers which can be treated by applying compression therapy to accelerate their removal.
Hair loss tends to come mostly, but not always, with ageing. This can be treated by having hair transplanted and here David produced a slide of Elton John before and after having hair implants which are inserted one by one. We have up to 100,000 hairs on our heads at a certain stage in our lives.
David brought his excellent and highly informative talk to an end by stating that inevitably the skin deteriorates as we age. This process can be delayed by using suitably pure skin moisturisers and designer drugs where appropriate. He ended by stating how skin cancer treatments now take up about 33 per cent of his former department’s time.