In today’s day and age of Google, social media and magazines- it is easy to feel overwhelmed with all the information that is out there on Rosacea. It is even harder to try and filter this information, so you be confident that what you are reading is accurate, unbiased and reliable.
As dermatology specialists, we have written this simple guide to make it easier for you to choose the best Rosacea treatments and advice. Our guide is trustworthy, reliable and evidence-based (i.e. the treatments and advice have been proven to work in previous studies). It has been written by registered health-care professionals- hence you can trust that we will always put patient safety and choice above commercial interests.
We hope this guide will help you understand what Rosacea is, how to identify it and understand some of the treatment options available. There is also a great FAQ section at the end to answer some of the most puzzling Rosacea questions that people ask us. There is also a section on our Top Tips for Rosacea.
Please read the guide at your leisure and if you are still unsure of what treatment you may require, fill in a general questionnaire and attach some photos and we will suggest a treatment. Or you can book in for a telephone or video consultation with one of our friendly dermatology experts.
Rosacea is a common, long -term inflammatory skin condition that affects the face and causes symptoms of redness, flushing and spots. It is seen in both men and women and usually affects those over the age of 30, with fair-skin and blue eyes. It can sometimes cause intense swelling, burning or stinging of the skin. It tends to come and go and flare up when it is aggravated by things such as stress, caffeine, spicy foods, alcohol, sunlight and exercise.
Rosacea can also affect the eyes causing things like dryness and minor eye infections (e.g. conjunctivitis). Other rarer complications can include thickening of the tissues of the nose (Rhinophyma).
Rosacea affects about 5% of adults all over the world but the exact cause remains largely unknown. It is likely that the cause of rosacea is due to a combination of factors including:
In a nutshell:
Eye symptoms will also occur in around 50% of patients e.g. dry, irritated, red or infected eyes. In a very small number of patients there will be facial skin tissue thickening, including a bulbous-like appearance of the nose (Rhinophyma)- if this is severe then we would recommend seeing you G.P to discuss your options, which may include referral to a plastic surgeon.
Most cases of Rosacea are straightforward and easy to self-diagnose. We make the diagnosis of Rosacea based on the type and number of symptoms that are present (as recommended by the 2017 Global Rosacea Consensus (ROSCO) panel.
Identifying the right type of Rosacea will help us select the correct treatments which are more likely to be effective for treating certain symptoms. It is important to note that a person can have one type or multiple types existing together.
Type 1: Rosacea with mostly central facial redness, flushing, swelling and visible small blood vessels (Erythematotelangiectatic Rosacea)
Type 2: Rosacea with persistent redness and spots (some filled with pus)- No Blackheads as in acne (Papulopustular Rosacea)- we would include Perioral Dermatitis here (a variant of rosacea common in young women where there are spots and redness around the mouth).
BOTH TYPE 1 AND TYPE 2 CAN OCCUR ALONE OR TOGETHER AND MAY REQUIRE MORE THAN ONE TREATMENT
There are rarer forms of Rosacea that we do not treat at DigiDerm and are best looked at by you G.P:
Type 3: Rosacea with facial skin thickening, e.g., Rhinophyma of the nose- most seen in older men.
Type 4: Rosacea solely around the eye area- can cause irritation, dryness, watery eyes, minor eye infections including blepharitis and conjunctivitis.
What else could it be?
If you are unsure if you have Rosacea or something similar, then either fill in a general questionnaire with some photos and we will advise you; or you can book in for a telephone or video consultation.
The most common alternative diagnoses that can be quite similar to Rosacea are:
Acne: there is normally greasiness, whiteheads and blackheads (comedones) and lack of background redness.
Seborrhoeic Dermatitis: this may occur alongside rosacea and there is usually a history of dandruff, dryness and scaly (flakey) skin in the: naso-labial fold (the crease at the side of your nose), eyebrows, ears, chin, upper chest.
Perioral Dermatitis: this is a variant of rosacea and us typically seen in young women where there are spots (papules) around the mouth and/ or eyes.
Eczema: Atopic eczema would normally include redness and scaling on the arms or legs. Contact Dermatitis would normally include small fluid filled blisters on the face after using a particular product.
Psoriasis: Signs of psoriasis would include well-defined scaly patches on the knees, elbows and scalp with nail pitting.
NOTE: Don’t worry if you are unsure of what treatments to select or what type of Rosacea you have. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a 20 minute telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Whilst there is no known cure for Rosacea, we know that it can be very well controlled in the long. Patients are normally very responsive to the right treatment, and we can see great results. Many people will see results within days to weeks- however, we would recommend given treatments at least 3 months of consecutive use to see maximum benefits. If your Rosacea goes away but then comes back- a course of treatment can be repeated. If your rosacea keeps coming back frequently then after a standard course of treatment you may wish to consider staying on a preventative low dose course of treatment: e.g. the creams, gels or oral antibiotics 2-3 times per week instead of every day.
General advice for Rosacea
Here are some of the treatment choices that we offer for Rosacea in line with the latest clinical guidelines for dermatology in the UK (click on the product for more information and to start a consultation).
(MAIN SYMPTOMS ARE PERSISTENT REDNESS, TINY BLOOD VESSELS AND FLUSHING (PERIODIC FLARES OF REDNESS, WARMTH, STINGING)):
Mirvaso Gel: this is a topical Brimonidine Gel that can be used once daily on as ‘as needed’ basis for temporary relief of symptoms- it is fast-acting and can reduce redness within 30minutes of application and lasts up to around 6 hours.
Finacea 15% Gel: this is a topical gel with Azelaic Acid which is applied twice a day and helps reduce redness. It is naturally found in barley, wheat and rye and has antibacterial and anti-inflammatory properties.
Dermalex Rosacea Treatment: this is an over-the-counter product available at DigiDerm that can be used alone for very mild rosacea or combined with other prescription-only treatments. It is gentle on the skin and contains chamomile and echinacea.
(MAIN SYMPTOMS ARE INFLAMMED SPOTS (SOME FILLED WITH PUS) ON A BACKGROUND OF PERSISTENT REDNESS):
Soolantra Cream: this is a daily topical cream containing Ivermectin which kills the Demodex mite thought to be responsible for Rosacea. It is well tolerated and is recommended as the first-choice treatment for Type 2 rosacea.
Rozex 0.75% Gel: this is a topical antibiotic gel containing Metronidazole that is applied twice a day and will help to reduce the overall symptoms of rosacea.
Finacea 15% Gel: this is a topical gel with Azelaic Acid which is applied twice a day and helps reduce redness. It is naturally found in barley, wheat and rye and has antibacterial and anti-inflammatory properties.
If topical medication fails or if symptoms are more severe then oral antibiotics can be used for a standard treatment length of 3 months. It is possible to combined both an oral antibiotic with a topical cream or gel- for example, using Soolantra Cream and Efracea Capsules together for maximum effect.
Efracea 40mg MR Capsules: this is a once daily slow-release oral antibiotic containing Doxycycline which was specifically designed to treat rosacea- it will reduce the overall symptoms.
Tetralysal 300 Capsules: this is a once daily oral antibiotic containing Lymecycline which is from the same class of antibiotics (tetracyclines) as Efracea.
Erythromycin 250mg Tablets: this is an oral antibiotic designed to be taken twice a day and is a useful alternative to the tetracyclines (Efracea and Tetralysal) if you find them ineffective or have side effects. It may also be used in pregnancy and breastfeeding and we would advise discussing the risk versus benefits with a healthcare professional.
(REDNESS, FLUSHING, BLOOD VESSELS AND SPOTS)
If there are features of both type 1 and type 2 or more severe symptoms then we would advise:
Firstly: Try either Soolantra cream, Rozex Gel OR Finacea gel for 3 months (with or without Mirvaso on an ‘as needed’ basis for redness).
Secondly: If symptoms persist or are severe then we would advise combing a topical cream or gel with an oral antibiotic for 3 months (with or without Mirvaso on an ‘as needed’ basis for redness)
Suitable combinations would include:
IMPORTANT: If you have any severe symptoms that are causing psychological or social distress, or have tried a combination of topical and oral treatment for 3 months with no benefit- we would advise you to speak to your GP for further guidance on treatment. Your GP may be able to refer you to a consultant dermatologist for consideration of more specialist treatments such as oral isotretinoin.
Management of Eye Symptoms
Around 50% of patients with rosacea may suffer with some eye involvement e.g. dry, irritated, red eyes or minor eye infections such as blepharitis and conjunctivitis. If these symptoms are severe or very concerning for you then please consult with your G.P. If these are minor, then we would recommend:
in lower OTC strengths as part of other products it may help reduce redness and inflammation.
A water-soluble form of vitamin B3- may reduce inflammation and repair damaged skin in Rosacea.
Has anti-inflammatory and astringent properties which will help reduce redness of rosacea prone skin.
Skin camouflage is an easy-to-apply, long-lasting, waterproof, and highly pigmented cream and powder that can be applied over scars and non-infectious skin conditions to help them blend into the normal skin colour. Changing Faces is the leading UK charity that supports people with skin conditions such as rosacea, and they offer an excellent tailored Skin Camouflage service (https://www.changingfaces.org.uk/services-support/skin-camouflage-service/) where you can book an appointment yourself or if you prefer you can speak to your G.P first and they can refer you. Brands include Dermacolor, Veil, Covermark and Keromask and they are available on NHS prescription.
This has antioxidant and anti-inflammatory properties which may help redness redness and burning caused by rosacea.
Skin camouflage is an easy-to-apply, long-lasting, waterproof, and highly pigmented cream and powder that can be applied over scars and non-infectious skin conditions to help them blend into the normal skin colour. Changing Faces is the leading UK charity that supports people with skin conditions such as rosacea, and they offer an excellent tailored Skin Camouflage service (https://www.changingfaces.org.uk/services-support/skin-camouflage-service/) where you can book an appointment yourself or if you prefer you can speak to your G.P first and they can refer you. Brands include Dermacolor, Veil, Covermark and Keromask and they are available on NHS prescription.
These are particularly effective for treating rosacea where redness with visible blood vessels (telangiectasia) is a problem. Intense pulsed light (IPL) and pulsed-dye laser (PDL) can be very effective although improvement is not permanent and therefore maintenance treatment may be required. The treatments require a series of sessions every 1-2 months for 6-12months. These treatments are not available in all areas of the country for rosacea under the NHS, but you can find private dermatologist clinics who may offer this service.
This is a specialist medication normally prescribed within a hospital clinic led by a consultant dermatologist. It may help improve symptoms in severe, resistant forms of rosacea and is given at a lower dose than for acne. We do not offer this treatment at DigiDerm, but you may be able to speak to your GP to see if referral is available to specialist NHS dermatology services in your area.
These oral prescription-only medications may help with persistent redness, visible blood and vessels and flushing. We do not offer these treatments at DigiDerm, but we would advise discussing them with your family GP who may be willing to prescribe them off-license if other treatments haven’t worked.
In today’s day and age of Google, social media and magazines- it is easy to feel overwhelmed with all the information that is out there on Rosacea. It is even harder to try and filter this information, so you be confident that what you are reading is accurate, unbiased and reliable.
As dermatology specialists, we have written this simple guide to make it easier for you to choose the best Rosacea treatments and advice. Our guide is trustworthy, reliable and evidence-based (i.e. the treatments and advice have been proven to work in previous studies). It has been written by registered health-care professionals- hence you can trust that we will always put patient safety and choice above commercial interests.
We hope this guide will help you understand what Rosacea is, how to identify it and understand some of the treatment options available. There is also a great FAQ section at the end to answer some of the most puzzling Rosacea questions that people ask us. There is also a section on our Top Tips for Rosacea.
Please read the guide at your leisure and if you are still unsure of what treatment you may require, fill in a general questionnaire and attach some photos and we will suggest a treatment. Or you can book in for a telephone or video consultation with one of our friendly dermatology experts.
Rosacea is a common, long -term inflammatory skin condition that affects the face and causes symptoms of redness, flushing and spots. It is seen in both men and women and usually affects those over the age of 30, with fair-skin and blue eyes. It can sometimes cause intense swelling, burning or stinging of the skin. It tends to come and go and flare up when it is aggravated by things such as stress, caffeine, spicy foods, alcohol, sunlight and exercise. Rosacea can also affect the eyes causing things like dryness and minor eye infections (e.g. conjunctivitis). Other rarer complications can include thickening of the tissues of the nose (Rhinophyma).
Rosacea affects about 5% of adults all over the world but the exact cause remains largely unknown. It is likely that the cause of rosacea is due to a combination of factors including:
In a nutshell:
Eye symptoms will also occur in around 50% of patients e.g. dry, irritated, red or infected eyes. In a very small number of patients there will be facial skin tissue thickening, including a bulbous-like appearance of the nose (Rhinophyma)- if this is severe then we would recommend seeing you G.P to discuss your options, which may include referral to a plastic surgeon.
Most cases of Rosacea are straightforward and easy to self-diagnose. We make the diagnosis of Rosacea based on the type and number of symptoms that are present (as recommended by the 2017 Global Rosacea Consensus (ROSCO) panel.
Identifying the right type of Rosacea will help us select the correct treatments which are more likely to be effective for treating certain symptoms. It is important to note that a person can have one type or multiple types existing together.
Type 1: Rosacea with mostly central facial redness, flushing, swelling and visible small blood vessels (Erythematotelangiectatic Rosacea)
Type 2: Rosacea with persistent redness and spots (some filled with pus)- No Blackheads as in acne (Papulopustular Rosacea)- we would include Perioral Dermatitis here (a variant of rosacea common in young women where there are spots and redness around the mouth).
BOTH TYPE 1 AND TYPE 2 CAN OCCUR ALONE OR TOGETHER AND MAY REQUIRE MORE THAN ONE TREATMENT
There are rarer forms of Rosacea that we do not treat at DigiDerm and are best looked at by you G.P:
Type 3: Rosacea with facial skin thickening, e.g., Rhinophyma of the nose- most seen in older men.
Type 4: Rosacea solely around the eye area- can cause irritation, dryness, watery eyes, minor eye infections including blepharitis and conjunctivitis.
What else could it be?
If you are unsure if you have Rosacea or something similar, then either fill in a general questionnaire with some photos and we will advise you; or you can book in for a telephone or video consultation.
The most common alternative diagnoses that can be quite similar to Rosacea are:
Acne: there is normally greasiness, whiteheads and blackheads (comedones) and lack of background redness.
Seborrhoeic Dermatitis: this may occur alongside rosacea and there is usually a history of dandruff, dryness and scaly (flakey) skin in the: naso-labial fold (the crease at the side of your nose), eyebrows, ears, chin, upper chest.
Perioral Dermatitis: this is a variant of rosacea and us typically seen in young women where there are spots (papules) around the mouth and/ or eyes.
Eczema: Atopic eczema would normally include redness and scaling on the arms or legs. Contact Dermatitis would normally include small fluid filled blisters on the face after using a particular product.
Psoriasis: Signs of psoriasis would include well-defined scaly patches on the knees, elbows and scalp with nail pitting.
NOTE: Don’t worry if you are unsure of what treatments to select or what type of Rosacea you have. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a 20 minute telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Whilst there is no known cure for Rosacea, we know that it can be very well controlled in the long. Patients are normally very responsive to the right treatment, and we can see great results. Many people will see results within days to weeks- however, we would recommend given treatments at least 3 months of consecutive use to see maximum benefits. If your Rosacea goes away but then comes back- a course of treatment can be repeated. If your rosacea keeps coming back frequently then after a standard course of treatment you may wish to consider staying on a preventative low dose course of treatment: e.g. the creams, gels or oral antibiotics 2-3 times per week instead of every day.
General advice for Rosacea
Here are some of the treatment choices that we offer for Rosacea in line with the latest clinical guidelines for dermatology in the UK (click on the product for more information and to start a consultation).
(MAIN SYMPTOMS ARE PERSISTENT REDNESS, TINY BLOOD VESSELS AND FLUSHING (PERIODIC FLARES OF REDNESS, WARMTH, STINGING)):
Mirvaso Gel: this is a topical Brimonidine Gel that can be used once daily on as ‘as needed’ basis for temporary relief of symptoms- it is fast-acting and can reduce redness within 30minutes of application and lasts up to around 6 hours.
Finacea 15% Gel: this is a topical gel with Azelaic Acid which is applied twice a day and helps reduce redness. It is naturally found in barley, wheat and rye and has antibacterial and anti-inflammatory properties.
Dermalex Rosacea Treatment: this is an over-the-counter product available at DigiDerm that can be used alone for very mild rosacea or combined with other prescription-only treatments. It is gentle on the skin and contains chamomile and echinacea.
(MAIN SYMPTOMS ARE INFLAMMED SPOTS (SOME FILLED WITH PUS) ON A BACKGROUND OF PERSISTENT REDNESS):
Soolantra Cream: this is a daily topical cream containing Ivermectin which kills the Demodex mite thought to be responsible for Rosacea. It is well tolerated and is recommended as the first-choice treatment for Type 2 rosacea.
Rozex 0.75% Gel: this is a topical antibiotic gel containing Metronidazole that is applied twice a day and will help to reduce the overall symptoms of rosacea.
Finacea 15% Gel: this is a topical gel with Azelaic Acid which is applied twice a day and helps reduce redness. It is naturally found in barley, wheat and rye and has antibacterial and anti-inflammatory properties.
If topical medication fails or if symptoms are more severe then oral antibiotics can be used for a standard treatment length of 3 months. It is possible to combined both an oral antibiotic with a topical cream or gel- for example, using Soolantra Cream and Efracea Capsules together for maximum effect.
Efracea 40mg MR Capsules: this is a once daily slow-release oral antibiotic containing Doxycycline which was specifically designed to treat rosacea- it will reduce the overall symptoms.
Tetralysal 300 Capsules: this is a once daily oral antibiotic containing Lymecycline which is from the same class of antibiotics (tetracyclines) as Efracea.
Erythromycin 250mg Tablets: this is an oral antibiotic designed to be taken twice a day and is a useful alternative to the tetracyclines (Efracea and Tetralysal) if you find them ineffective or have side effects. It may also be used in pregnancy and breastfeeding and we would advise discussing the risk versus benefits with a healthcare professional.
(REDNESS, FLUSHING, BLOOD VESSELS AND SPOTS)
If there are features of both type 1 and type 2 or more severe symptoms then we would advise:
Firstly: Try either Soolantra cream, Rozex Gel OR Finacea gel for 3 months (with or without Mirvaso on an ‘as needed’ basis for redness).
Secondly: If symptoms persist or are severe then we would advise combing a topical cream or gel with an oral antibiotic for 3 months (with or without Mirvaso on an ‘as needed’ basis for redness)
Suitable combinations would include:
IMPORTANT: If you have any severe symptoms that are causing psychological or social distress, or have tried a combination of topical and oral treatment for 3 months with no benefit- we would advise you to speak to your GP for further guidance on treatment. Your GP may be able to refer you to a consultant dermatologist for consideration of more specialist treatments such as oral isotretinoin.
Management of Eye Symptoms
Around 50% of patients with rosacea may suffer with some eye involvement e.g. dry, irritated, red eyes or minor eye infections such as blepharitis and conjunctivitis. If these symptoms are severe or very concerning for you then please consult with your G.P. If these are minor, then we would recommend:
in lower OTC strengths as part of other products it may help reduce redness and inflammation.
A water-soluble form of vitamin B3- may reduce inflammation and repair damaged skin in Rosacea.
Has anti-inflammatory and astringent properties which will help reduce redness of rosacea prone skin.
This has antioxidant and anti-inflammatory properties which may help redness redness and burning caused by rosacea.
Skin camouflage is an easy-to-apply, long-lasting, waterproof, and highly pigmented cream and powder that can be applied over scars and non-infectious skin conditions to help them blend into the normal skin colour. Changing Faces is the leading UK charity that supports people with skin conditions such as rosacea, and they offer an excellent tailored Skin Camouflage service (https://www.changingfaces.org.uk/services-support/skin-camouflage-service/) where you can book an appointment yourself or if you prefer you can speak to your G.P first and they can refer you. Brands include Dermacolor, Veil, Covermark and Keromask and they are available on NHS prescription.
These are particularly effective for treating rosacea where redness with visible blood vessels (telangiectasia) is a problem. Intense pulsed light (IPL) and pulsed-dye laser (PDL) can be very effective although improvement is not permanent and therefore maintenance treatment may be required. The treatments require a series of sessions every 1-2 months for 6-12months. These treatments are not available in all areas of the country for rosacea under the NHS, but you can find private dermatologist clinics who may offer this service.
This is a specialist medication normally prescribed within a hospital clinic led by a consultant dermatologist. It may help improve symptoms in severe, resistant forms of rosacea and is given at a lower dose than for acne. We do not offer this treatment at DigiDerm, but you may be able to speak to your GP to see if referral is available to specialist NHS dermatology services in your area.
These oral prescription-only medications may help with persistent redness, visible blood and vessels and flushing. We do not offer these treatments at DigiDerm, but we would advise discussing them with your family GP who may be willing to prescribe them off-license if other treatments haven’t worked.
There is not a great deal of evidenced- based over the counter treatments for rosacea available in the UK. There are many non-prescription skincare products that are marketed for rosacea, and these may be suitable for very mild rosacea symptoms. Those that contain Azelaic acid in lower strengths are probably the most effective. It is easy to spend lots of money on the various brands of skincare products without getting any results- be careful not to waste your money. At DigiDerm we believe that anything more than very mild rosacea is best treated by a qualified dermatology healthcare professional as there is often a place for prescription-only medications in the treatment pathway.
Here at DigiDerm we are big fans of keeping it simple. We find that this means people are more likely to get into the habit of a consistent routine. If you have a consistent, simple daily routine, you are more likely to see quicker and better results. Rosacea doesn’t get cured overnight. It can take anywhere from 2-3 months to see maximum improvement, although some people may see quite significant improvement in a matter of days to weeks There is no ‘one-size fits all’ routine as people with rosacea may have different skin types (e.g. oily, sensitive, dry).
Morning
Afternoon
Rosacea and Acne are different skin conditions and have different causes and treatments. They can appear to look the same to the untrained eye, but there are a few key differences:
Mainly affects those over 30 years old (more common in those with fair skin)
Mainly affect Teenagers and those in 20’s
No blackheads, Pimple-like breakouts mainly on face and eyes (redness can extend to scalp, neck, chest, upper back)
Blackheads, whiteheads, pimples, cysts and nodules on face, jawline, back and chest
Widespread Redness in the centre of your face -cheeks, forehead, nose and chin- this can come and go or be permanent
Redness around your spots only
Widespread Redness in the centre of your face -cheeks, forehead, nose and chin- this can come and go or be permanent
Oily skin
Large pores in the skin and visible blood vessels
Bumpy skin textures from blemishes or scar
Eye problems- bloodshot eyes, swollen eyelids and discomfort
Other skin conditions that commonly disguise themselves as rosacea are perioral dermatitis, folliculitis and keratosis pilaris. If you are unsure whether you have rosacea, please book in for a friendly telephone consultation with one of our dermatology pharmacists who can discuss how we can help.
No, but it can be very well managed. It is a chronic (long-term) condition which goes through periods of getting better and worse. Avoiding your triggers, wearing SPF and using the right treatments are crucial to long term successful management.
Rosacea can occur in pregnancy and sometimes worsens due to stress. As with all medicines and treatments in pregnancy, there will always be a small risk attached of potential harm to the unborn child and mother. This is because most Rosacea medications and products have not been tested in pregnant women (for ethical reasons!) and therefore they do not have a robust safety profile to grant them a product license. When in doubt it is best to have a chat to a registered healthcare professional who will discuss the risk versus benefits of using medicines and treatments in pregnancy. You can book a friendly telephone consultation with one of our dermatology pharmacists to discuss treatment options for Rosacea in pregnancy if you’d prefer.
If you are planning a pregnancy or pregnant then you must avoid using topical and oral retinoid products and oral tetracycline antibiotics as these carry a high risk of harm. Treatments that are generally accepted to be safe in pregnancy include Azelaic Acid gel (Finacea), Metronidazole gel (Rozex) and Erythromycin oral antibiotics tablets. We would also advise avoiding any skincare products containing the aspirin derivative ‘salicylic acid’ as this could pose the risk of harm to an unborn baby.
Guidance for pregnancy and breastfeeding can vary from product to product so please carefully read the product information before use and always inform us if you are currently pregnant/ planning pregnancy or breastfeeding whilst completing a consultation.
There are common triggers for rosacea but there are also triggers that may be specific to you. Common food triggers include Alcohol, Spicy food, Cinnamaldehyde-containing foods (e.g. tomatoes, citrus fruits, chocolate), hot drinks, histamine-rich foods (e.g. aged cheese, wine, processed meats).
Prescription-only medicated creams and gels will unlikely cause you rosacea to get any worse, although it is possible to experience sensitivity or side effects from all medications. When buying over the counter creams make sure they don’t include any common irritants which may worsen you rosacea- avoid ingredients such as Alcohol, Witch Hazel, Peppermint, Propylene Glycol, Parabens, Camphor, Fragrance, Glycolic acid, Lactic acid, Menthol, Sodium laurel sulphate (SLS) and Urea. Use retinoids creams with caution as they can sometimes cause rosacea to flare. A useful tip is to trial a new skincare product on a small patch of skin first, for example, on the hairless part of your forearm- to make sure it does not cause you any irritation.
Unfortunately, scientists haven’t discovered a cure for rosacea yet. However, it can be well managed using treatments. Also, what is meant by natural? If you interpret natural as something that contains an active ingredient that is found in a plant or animal, then you might want to consider trying Azelaic Acid gel (Finacea) which is a prescription-only medication. Azelaic acid is a naturally occurring acid that is found in grains such as wheat, barley and rye. Other over the counter natural ingredients which may benefit very mild rosacea include aloe vera, chamomile, green tea and niacinamide- but be careful as certain people may still be sensitive to these ingredients. There is some evidence that omega-3 fish oil (as oral supplements or in fish )may have some benefit in treating rosacea, especially if it affects the eyes.
Generally, for most rosacea medications, we recommend at least 2-3 months of consistent, daily treatment to see maximum effects. Although some patients will see benefits within hours to days to weeks depending on the individual medication. For example, topical Brimonidine gel (Mirvaso) will usually reduce facial redness within minute to hours of application.
The good news for you is that DigiDerm provides an online platform for you to access treatments wherever and wherever you are. Either fill in an online questionnaire and attach some photos or book in for a telephone or video consultation with a dermatology specialist. Your medications can arrive in the post the next day. If you have very severe rosacea, rosacea that is no responding to prescription-only medication treatments, or severe psychological distress- we would recommend booking an appointment with your G.P in the first instance.
The most common classes of antibiotics used for treating Rosacea in Europe and the US are Tetracyclines, Macrolides and Metronidazole.
The benefit of Tetracyclines is that they have an additional anti-inflammatory effect which can help reduce redness and swelling- Tetracyclines would include doxycycline 40mg mr capsules (Efracea) and lymecycline. Doxycycline also comes in a 100mg capsules strength however we know that the lower 40mg MR (slow release) formulation is just as effective in reducing inflammatory lesions and has less risk of bacterial resistance developing in the long term.
Metronidazole topical treatments are effective in treating rosacea and can safely be used with suitable oral antibiotics- for example the combination of topical metronidazole gel (Rozex) and Doxycycline 40mg MR capsules (Efracea) can produce excellent results in some patients.
Macrolides include antibiotics such as Erythromycin 250mg tablets are generally considered second line for treatment in rosacea as they me be slightly less efficacious due to the lack of anti-inflammatory properties as found in tetracyclines. However, they remain a good option for patients who want to try an alternative, cannot tolerate side effects from other medications such as tetracyclines or those who are pregnant or breastfeeding.
If you require further guidance, help and support with managing any aspect of your Rosacea condition, including your mental health, then there are various organisations that may be able to provide additional support. One of them is the National Rosacea Society. Please visit our Mental Health and Skin page for further information.
At DigiDerm, we understand that everyone has their struggles, and your skin can affect your confidence, mood and self-esteem. Whilst we do not provide direct psychological therapy or prescribe mental health medications, we will do our best to listen, offer advice and point you in the right direction if needed. Your GP can also be a source of help and guidance if needed. If you feel you require more urgent care, then either speak to your GP or contact urgent out-of-ours services- see our Urgent Care Services page for more information.
At DigiDerm we know how frustrating it is to suffer with skin conditions and how easy it is to get lost in all the information out there on the internet. We’ve put together this guide to give you all you need to know about psoriasis and most importantly how you can manage your psoriasis, and get back to doing the things you love, without it getting in the way!
DigiDerm is run by practicing NHS clinicians and we pride ourselves on providing you the best evidence based care. If you know what you need you can go straight to our treatments and select the treatment you want.
If you’re not sure what you need then we’ve put together some info below to help you find out more about psoriasis and what treatment is right for you. If you’re still not sure at the end then don’t hesitate to book a telephone or video consultation with one of our clinicians. We would be happy to help with any questions and if we can’t help, you won’t pay a penny. We’ll follow you up to check everything’s working as it should be and make sure you get the right treatments for your psoriasis.
Make sure to check out our FAQs section below, which has some of the most common questions we get about psoriasis.
Psoriasis is a fairly common inflammatory condition of the skin affecting around 3% of the population. Recent research suggests that psoriasis is likely an autoimmune disease. This is a condition where the body’s own immune system attacks itself.
Psoriasis can start at any age but is most likely to present between the ages of 20 and 30 or 50 and 60. It can affect anyone and is equally likely to affect men and women but is more common amongst white people and less common amongst the Asian, black and Hispanic races. It tends to present as red and inflamed scaly plaques and most commonly appears on extensor areas of the skin. This means the areas of the skin that bend such as the front of the knees or backs of the elbows and can also commonly occur on the scalp. Whilst these are the most common presentations of psoriasis, symptoms can also be widespread covering large areas of the body.
Is Psoriasis linked to arthritis?
Put simply yes. This condition is commonly associated with a particular form of arthritis called psoriatic arthritis and studies suggest that up to 30% of people with psoriasis could have this form of arthritis.
Is psoriasis linked to Heart Disease?
Sadly this is another yes. Studies suggest a strong link between psoriasis and heart disease, although this is more common in people that have severe psoriasis. It is important to report any potential heart issues to your GP and even more important if you have psoriasis. Your GP will likely have a lower threshold for referring you for further tests. Potential signs of heart disease include: chest pain, shortness of breath, dizziness, blackouts, palpitations (feeling your heart flutter in your chest), etc.
If you have had any of the above symptoms we recommend contacting your GP for further advice.
There is thought to be a very strong link with genetics and the cause of psoriasis. Of the people that develop psoriasis, 40-50% of them are estimated to have another family member that suffers with the condition. This is even more likely to be the case if you first developed psoriasis before the age of 20.
Stress is a well-documented trigger for psoriasis flares. If you are struggling with your stress levels then this is something worth looking at to get your psoriasis under control. At DigiDerm we understand how important stress and mental health are when it comes to skin conditions, so check out our mental health page for more information and resources that can help you.
Sunlight: Most people will find sunlight beneficial to their psoriasis and will actually find exposure to sunlight will settle their psoriasis however in a smaller number of people sunlight can make their condition worse.
Smoking is generally terrible for your health and so if you needed another reason to quit it’s also known to cause and worsen psoriasis. Not to mention it increases your risk of heart disease which having psoriasis already does. Stopping smoking is very difficult but with the right help it is absolutely possible. Talk to your local Chemist about how they can help you with this.
Trauma: Sometimes psoriasis can occur at the site of an injury to your skin. This is known as Koebner Phenomenon.
Drugs: A number of medications have been linked with psoriasis. Some of the most common examples include but are not limited to: lithium, imiquimod, terbinafine, beta blockers and drugs to treat malaria such as chloroquine.
If you think one of your medications has caused psoriasis, it is important you do not stop taking them but to speak to your GP or whoever prescribes it to you for more advice.
Pregnancy: Many women will find that their psoriasis actually improves during pregnancy. It can however get worse after giving birth.
Alcohol: Heavy drinking has been linked with psoriasis and it is thought that alcohol may have a direct impact in worsening psoriasis. If you feel you need help with cutting back on drinking then contact your GP or local drug and alcohol service.
Streptococcal infections: Streptococcus is a type of bacteria commonly associated with tonsillitis (Infection of the tonsils). Infections with this bacteria particularly of the throat are known to provoke a specific type of psoriasis known as guttate psoriasis. Guttate psoriasis causes small (generally less than 1cm) sores to appear often covering a large area of the body including the chest, arms, legs and scalp.
HIV: It’s important to be aware that severe or treatment resistant psoriasis has been identified as a recognised potential indicator of HIV and can be the first sign in some patients. If you think this is a possibility then its best to speak to your local sexual health clinic who can help you with getting tested and ruling this out.
There are different types of psoriasis and it can appear in a variety of circumstances or areas, so the symptoms may differ depending on the type of psoriasis you are experiencing.
We will cover the most common types in this guide but there are some rarer forms as well. The main types of psoriasis are listed below with example images to demonstrate how it can present.
This is the most common type of psoriasis and of the people that develop psoriasis 80-90% develop this type. Dry and scaly skin lesions known as plaques develop on the skin. These lesions can appear anywhere on the body but are most common on the elbows, knees, scalp and lower back. The plaques can be itchy and painful.
This is a type of plaque psoriasis as mentioned above. It can appear in parts or over the whole scalp. Some people find it very itchy whilst others will experience no discomfort.
Nails are affected in around half of all people that suffer with psoriasis. It can cause the nails to develop dents or become discoloured. In some circumstances it can even cause nails to crumble or separate from the nail bed. You can use the same creams to treat nail psoriasis as with other forms of psoriasis however you may need to treat these longer than a flare on the skin, as nails can be difficult to treat. If using steroid creams potent or very potent steroids tend to be better suited for nail psoriasis. See our steroid guide for more info.
This type of psoriasis has been shown to occur more commonly after sore throat infections caused by the bacteria streptococcus. It presents as small (less than 1cm) sores over large portions of the body, often including the chest, arms, legs and scalp. This condition is more likely to occur in younger people such as children and teenagers.
This type of psoriasis effects the folds in the skin and areas of skin that regularly rub together. This is most likely to occur in the armpits, between the buttocks, under the breasts and around the groin. These are also common locations for eczema to occur so it is important to consider this and get a diagnosis from a healthcare professional before starting treatment.
Psoriasis is generally not too difficult for a clinician to diagnose. It has some typical features generally including red, inflamed, dry skin with a fairly characteristic silvery scale in most cases.
Whilst it is generally straight forward it can at times be unclear if its psoriasis or another skin condition, so if you are in any doubt after looking at the pictures above, please don’t hesitate to book for a telephone or video consultation with one of our dermatology Pharmacists and we’ll be more than happy to help you figure it out. Click here to make appointment
NOTE: Don’t worry if you are unsure of what treatments to select. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Here we will discuss some of the treatment choices that we offer for psoriasis in line with the latest clinical guidelines for dermatology in the UK. We will also discuss some alternative treatments towards the end that we don’t currently offer but are interesting to learn about (click on the products for more information and to start a consultation).
We will start with steroids. These are to be used when you have a flare of psoriasis. Make sure to apply them sparingly and usually for no longer than 7 days continuously unless advised by a clinician. They are a great way to settle down a flare of psoriasis but not a long term solution.
There are varying strengths of steroids from mild to very potent. If you already know what strength you need, as you’ve had it before, this is likely to work for you again. If you have not tried steroid creams before it is worth being cautious and starting with a milder steroid, only using potent steroids on the advice of a clinician.
You should be particularly careful when applying steroid creams to sensitive skin areas such as your face. You shouldn’t apply steroids to the face unless advised to do so by a clinician after assessment and you should never use anything more than moderate strength steroids in this area.
We are happy to have a look at some pictures or speak on a video or telephone call to advise on what strength we think you need if you’re unsure. Click here to book an appointment
e.g- Hydrocortisone 1.0% ointment/cream
(Can be applied to the face on advice of a clinician)
e.g- Eumovate (clobetasone butyrate 0.05%) cream and Betnovate RD (betamethasone valerate 0.025%)
(Can be applied to the face or genitals on advice of a clinician)
e.g- Betnovate (betamethasone valerate 0.1%)
Combination products with vitamin D analogues (psoriasis only):
– Dovobet (betamethasone dipropionate 0.05% with calcipotriol 50mcgs/g)
– Enstilar (betamethasone dipropionate 0.05% with calcipotriol 50mcgs/g)
Do NOT apply to the face or genitals.
e.g- Dermovate (clobetasol propionate 0.05%)
Do NOT apply to the face or genitals.
Vitamin D analogues have been shown to be very effective in treating psoriasis flares. These provide a potential alternative to steroids so are particularly useful if you struggle with side effects when using steroids such as skin thinning or staining. They can also be used long term if needed whilst steroids can only be used for limited courses.
Dovonex (calcipotriol) Ointment: This can be used for psoriasis flares although should not be used on the face or genitals, as it can cause irritation.
Silkis (calcitriol) ointment: This has a similar effect to the above ointment however has the added benefit of being suitable for use on the genitals or face. For this reason the ointment is particularly useful for flares in these areas where potent steroid creams would be inappropriate.
In addition to products containing vitamin D analogues alone, we also offer combination products that also contain a steroid. These are particularly useful in difficult to treat psoriasis or where the individual products alone have not cleared the flare.
Dovobet ointment/gel or Enstilar foam (calcipotriol and betamethasone).
Both of these products contain a strong steroid as well as a vitamin D analogue and for this reason attack the psoriasis flare in two separate ways.
Enstilar is particularly useful if your psoriasis covers a large area, as it comes as a foam spray making it easier to apply over a large area more quickly.
The other major component of most psoriasis treatment is finding the right emollient for you. Emollients form a protective barrier on the skin and block moisture from escaping. This prevents the skin from drying out and makes it less likely to become irritated and inflamed, as can often happen in psoriasis.
It is important to apply plenty of emollient and to do so regularly. Thicker ointments last for around 12 hours whilst creams, lotions and gels only tend to last around 8 hours, meaning you would need to apply these thinner preparations at least three times a day and ointment twice a day for optimal results.
Ointments are better at locking in moisture because they are thicker and more oily however because of their oily texture some people don’t like applying these as much, as they can remain visible on the skin for longer after being applied and can stick to clothing and bedding, etc. Creams, lotions and gels are generally better tolerated due to them being thinner and thus more easily absorbed by the skin but because of this they will not moisturise the skin as affectively as ointments. Some people choose to combine multiple emollients, such as a cream and an ointment by putting the cream on throughout the day and ointment at night.
If you are using a cream, lotion or gel and your skin is still dry it is worth considering if you are applying regularly enough and if so, it might be worth trying a thicker preparation such as an ointment. We’ve put together an emollient guide below to help you choose the right emollient for you. This shows you the different types of emollients with the thinnest least moisturising lotions at the top and thickest most moisturising ointments at the bottom. The thinner lotions are good for people with mild psoriasis that is well controlled and just need a small amount of moisturiser to manage their symptoms, while the thicker ointments are useful for someone with extremely dry skin that is still dry after applying plenty of gels. See our guide below for more information about the various emollients we offer and find the best one for you.
(Less moisturising)
Lotions: Aveeno Daily Moisturising Lotion, CeraVe AM Facial Moisturising Lotion, Cetraben Lotion, Dermol 500 Lotion.
(More moisturising)
Ointments: Cetraben Ointment, Epaderm Ointment, Sebco Ointment.
Soap substitutes: Cetraben Bath Additive, Dermol 200 Shower Emollient, CeraVe Hydrating Cleanser.
Soap substitutes are useful if soaps trigger your psoriasis however they are washed off quickly so will not moisturise the skin very effectively.
Antimicrobial Creams: Dermol Cream, Dermol 200 Shower Emollient, Dermol 500 Lotion, Hibiscrub Antibacterial Skin Cleanser.
Antimicrobial creams are useful if your psoriasis is often getting infected or if you are using the cream as a soap substitute.
Antibiotic Creams: Fucidin Cream, Fucidin H Cream, Fucibet Cream, Betamethasone with Neomycin Cream, Betamethasone with Clioquinol cream.
Antibiotic containing creams should only be used where you are treating an active infection. They are for short-term use to treat the infection. Some of these also contain steroids to treat active flares of psoriasis at the same time. You should only use these if you have been told by a clinician your psoriasis is infected.
Some psoriasis patients find their lesions can develop very thick scale. For this reason it is sometimes necessary to remove some of this scale before starting some of the treatments mentioned above. Salicylic acid can be useful in removing this scale and can be combined in certain products with a potent steroid (e.g.- Diprosalic) to help treat plaques with significant scale.
These can be used long term and are particularly useful for large thin plaques. They can also be used in patients with many smaller plaques that are present over a large area of the body, where applying a steroid to each plaque individually would be challenging. Coal tar products are also safe to use on sensitive and thinner areas of skin.
These are specialist creams reserved to treat certain types of difficult to treat psoriasis. They include the creams Elidel (pimecrolimus) and Protopic (tacrolimus). They work by affecting the immune system, blocking it from reacting and stopping psoriasis flares.
These creams are particularly useful in patients with psoriasis in areas of sensitive skin such as the face or genitals, or in those that have experienced significant negative side effects from steroid creams. These creams are relatively new but are not thought to have the same negative side effects associated with steroid creams, such as skin thinning or staining, so can be a better alternative in people that would otherwise require regular courses of steroids to treat psoriasis in sensitive areas of their skin.
These treatments are available here at DigiDerm but due to the specialist nature, we may need to speak to you, to make sure it’s the right treatment for you, if you haven’t had it from us before. If you think you might need one of these creams find out more information here
This is a retinoid medication. Retinoids are molecules related to vitamin A. They are often used in acne but this medication in particular can be used to treat mild to moderate plaque psoriasis. It is licensed to be applied to areas of up to 10% of the body so is not appropriate if your psoriasis is all over your body.
They are very dangerous for the baby if taken in pregnancy and for this reason pregnant women or those planning a pregnancy cannot use them and women of child bearing potential should use a reliable form of contraception if there is any chance of sexual activity whilst using the medication.
These creams can be used once daily for up to 12 weeks and work by slowing the overgrowth of skin cells and thus reducing the inflammation associated with psoriasis.
These creams can cause some skin irritation as a side effect such as burning, itching or stinging and for this reason are sometimes used with a steroid cream at the other end of the day to minimise irritation.
We do not currently offer this treatment so if you think it might be right for you we would recommend consulting with your GP or dermatologist.
For patients that do not see benefit from the various applications mentioned above, second line options may be considered.
These include:
Specialist dermatology centres can use certain types of ultraviolet light to help treat psoriasis. This is usually done with a form of light known as ultraviolet light B or UVB. UVB light slows the growth of the skin cells helping to reduce inflammation and when used on a regular schedule can successfully control psoriasis in certain people.
This medication suppresses the immune systems response and as a result improves psoriasis symptoms. It can affect the liver, kidney and immune system and for this reason requires regular blood tests to monitor. For this reason we are unable to prescribe this at DigiDerm. If you feel this medication might be right for you, it will need to be prescribed by a dermatologist so we would recommend contacting one or talking to your GP about the potential for a referral to dermatology.
This is another medication that works by suppressing the immune systems response to help treat psoriasis. It is also used in psoriatic arthritis so may be beneficial if you also suffer with this. This is a highly effective medication for psoriasis but like ciclosporin above will require regular blood tests and thus cannot be prescribed here at DigiDerm so a dermatologist appointment will be needed if you want to discuss starting this medication.
Biologics and biosimilars are newer forms of medication used to treat psoriasis and psoriatic arthritis. They work by targeting specific stages of the autoimmune response, as opposed to some of the immunosuppressants mentioned above that weaken the whole immune response.
There is a lot of new evidence emerging around the use of these medications but at the moment the long term effects are not well known, so they tend to be reserved for use after first line and second line treatments have failed.
Much like the immunosuppressants mentioned above they will require regular blood monitoring and so would need to be prescribed by a specialist dermatologist.
This is a tablet form of retinoid (vitamin A type molecule). It works similarly to the cream form mentioned above (tazarotene) by reducing the overgrowth of skin cells and through this action helps to treat psoriasis.
This medicine is particularly useful for treating hand and foot psoriasis with significant thick plaques of hardened skin.
Make sure to moisturise regularly multiple times a day. If you have dry skin despite moisturising regularly. You may not be using the right moisturiser. Thicker ointment moisturisers are better at locking moisture into the skin than thinner creams and lotions. Consider switching to one of our ointments and this should improve things.
Use steroid creams when needed for flares but apply thinly and only for a maximum of 2 weeks at a time. 1 week is usually sufficient.
Try to identify triggers and avoid these wherever possible. This could be certain foods, soaps, clothing or detergents.
Small amounts of regular sunlight can help improve psoriasis symptoms but be careful not to get too much, as sunburn along with any trauma to the skin, can be a trigger for psoriasis. Too much sun can also increase your risk of skin cancers so make sure to keep the exposure limited and avoid midday sun.
Stress can cause psoriasis flares. It’s a busy life and sometimes stress can get on top of us. There is lots of help out there though, so try bringing down your stress levels and you may find this improves your psoriasis. Check out our mental health page for more information.
At DigiDerm we know how frustrating it is to suffer with skin conditions and how easy it is to get lost in all the information out there on the internet. We’ve put together this guide to give you all you need to know about psoriasis and most importantly how you can manage your psoriasis, and get back to doing the things you love, without it getting in the way!
DigiDerm is run by practicing NHS clinicians and we pride ourselves on providing you the best evidence based care. If you know what you need you can go straight to our treatments and select the treatment you want.
If you’re not sure what you need then we’ve put together some info below to help you find out more about psoriasis and what treatment is right for you. If you’re still not sure at the end then don’t hesitate to book a telephone or video consultation with one of our clinicians. We would be happy to help with any questions and if we can’t help, you won’t pay a penny. We’ll follow you up to check everything’s working as it should be and make sure you get the right treatments for your psoriasis.
Make sure to check out our FAQs section below, which has some of the most common questions we get about psoriasis.
Psoriasis is a fairly common inflammatory condition of the skin affecting around 3% of the population. Recent research suggests that psoriasis is likely an autoimmune disease. This is a condition where the body’s own immune system attacks itself.
Psoriasis can start at any age but is most likely to present between the ages of 20 and 30 or 50 and 60. It can affect anyone and is equally likely to affect men and women but is more common amongst white people and less common amongst the Asian, black and Hispanic races. It tends to present as red and inflamed scaly plaques and most commonly appears on extensor areas of the skin. This means the areas of the skin that bend such as the front of the knees or backs of the elbows and can also commonly occur on the scalp. Whilst these are the most common presentations of psoriasis, symptoms can also be widespread covering large areas of the body.
Is Psoriasis linked to arthritis?
Put simply yes. This condition is commonly associated with a particular form of arthritis called psoriatic arthritis and studies suggest that up to 30% of people with psoriasis could have this form of arthritis.
Is psoriasis linked to Heart Disease?
Sadly this is another yes. Studies suggest a strong link between psoriasis and heart disease, although this is more common in people that have severe psoriasis. It is important to report any potential heart issues to your GP and even more important if you have psoriasis. Your GP will likely have a lower threshold for referring you for further tests. Potential signs of heart disease include: chest pain, shortness of breath, dizziness, blackouts, palpitations (feeling your heart flutter in your chest), etc.
If you have had any of the above symptoms we recommend contacting your GP for further advice.
There is thought to be a very strong link with genetics and the cause of psoriasis. Of the people that develop psoriasis, 40-50% of them are estimated to have another family member that suffers with the condition. This is even more likely to be the case if you first developed psoriasis before the age of 20.
Stress is a well-documented trigger for psoriasis flares. If you are struggling with your stress levels then this is something worth looking at to get your psoriasis under control. At DigiDerm we understand how important stress and mental health are when it comes to skin conditions, so check out our mental health page for more information and resources that can help you.
Sunlight: Most people will find sunlight beneficial to their psoriasis and will actually find exposure to sunlight will settle their psoriasis however in a smaller number of people sunlight can make their condition worse.
Smoking is generally terrible for your health and so if you needed another reason to quit it’s also known to cause and worsen psoriasis. Not to mention it increases your risk of heart disease which having psoriasis already does. Stopping smoking is very difficult but with the right help it is absolutely possible. Talk to your local Chemist about how they can help you with this.
Trauma: Sometimes psoriasis can occur at the site of an injury to your skin. This is known as Koebner Phenomenon.
Drugs: A number of medications have been linked with psoriasis. Some of the most common examples include but are not limited to: lithium, imiquimod, terbinafine, beta blockers and drugs to treat malaria such as chloroquine.
If you think one of your medications has caused psoriasis, it is important you do not stop taking them but to speak to your GP or whoever prescribes it to you for more advice.
Pregnancy: Many women will find that their psoriasis actually improves during pregnancy. It can however get worse after giving birth.
Alcohol: Heavy drinking has been linked with psoriasis and it is thought that alcohol may have a direct impact in worsening psoriasis. If you feel you need help with cutting back on drinking then contact your GP or local drug and alcohol service.
Streptococcal infections: Streptococcus is a type of bacteria commonly associated with tonsillitis (Infection of the tonsils). Infections with this bacteria particularly of the throat are known to provoke a specific type of psoriasis known as guttate psoriasis. Guttate psoriasis causes small (generally less than 1cm) sores to appear often covering a large area of the body including the chest, arms, legs and scalp.
HIV: It’s important to be aware that severe or treatment resistant psoriasis has been identified as a recognised potential indicator of HIV and can be the first sign in some patients. If you think this is a possibility then its best to speak to your local sexual health clinic who can help you with getting tested and ruling this out.
There are different types of psoriasis and it can appear in a variety of circumstances or areas, so the symptoms may differ depending on the type of psoriasis you are experiencing.
We will cover the most common types in this guide but there are some rarer forms as well. The main types of psoriasis are listed below with example images to demonstrate how it can present.
This is the most common type of psoriasis and of the people that develop psoriasis 80-90% develop this type. Dry and scaly skin lesions known as plaques develop on the skin. These lesions can appear anywhere on the body but are most common on the elbows, knees, scalp and lower back. The plaques can be itchy and painful.
This is a type of plaque psoriasis as mentioned above. It can appear in parts or over the whole scalp. Some people find it very itchy whilst others will experience no discomfort.
Nail Psoriasis
Nails are affected in around half of all people that suffer with psoriasis. It can cause the nails to develop dents or become discoloured. In some circumstances it can even cause nails to crumble or separate from the nail bed. You can use the same creams to treat nail psoriasis as with other forms of psoriasis however you may need to treat these longer than a flare on the skin, as nails can be difficult to treat. If using steroid creams potent or very potent steroids tend to be better suited for nail psoriasis. See our steroid guide for more info.
Guttate Psoriasis
This type of psoriasis has been shown to occur more commonly after sore throat infections caused by the bacteria streptococcus. It presents as small (less than 1cm) sores over large portions of the body, often including the chest, arms, legs and scalp. This condition is more likely to occur in younger people such as children and teenagers.
This type of psoriasis effects the folds in the skin and areas of skin that regularly rub together. This is most likely to occur in the armpits, between the buttocks, under the breasts and around the groin. These are also common locations for eczema to occur so it is important to consider this and get a diagnosis from a healthcare professional before starting treatment.
Psoriasis is generally not too difficult for a clinician to diagnose. It has some typical features generally including red, inflamed, dry skin with a fairly characteristic silvery scale in most cases.
Whilst it is generally straight forward it can at times be unclear if its psoriasis or another skin condition, so if you are in any doubt after looking at the pictures above, please don’t hesitate to book for a telephone or video consultation with one of our dermatology Pharmacists and we’ll be more than happy to help you figure it out. Click here to make appointment
NOTE: Don’t worry if you are unsure of what treatments to select. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Here we will discuss some of the treatment choices that we offer for psoriasis in line with the latest clinical guidelines for dermatology in the UK. We will also discuss some alternative treatments towards the end that we don’t currently offer but are interesting to learn about (click on the products for more information and to start a consultation).
We will start with steroids. These are to be used when you have a flare of psoriasis. Make sure to apply them sparingly and usually for no longer than 7 days continuously unless advised by a clinician. They are a great way to settle down a flare of psoriasis but not a long term solution.
There are varying strengths of steroids from mild to very potent. If you already know what strength you need, as you’ve had it before, this is likely to work for you again. If you have not tried steroid creams before it is worth being cautious and starting with a milder steroid, only using potent steroids on the advice of a clinician.
You should be particularly careful when applying steroid creams to sensitive skin areas such as your face. You shouldn’t apply steroids to the face unless advised to do so by a clinician after assessment and you should never use anything more than moderate strength steroids in this area.
We are happy to have a look at some pictures or speak on a video or telephone call to advise on what strength we think you need if you’re unsure. Click here to book an appointment
e.g- Hydrocortisone 1.0% ointment/cream
(Can be applied to the face on advice of a clinician)
e.g- Eumovate (clobetasone butyrate 0.05%) cream and Betnovate RD (betamethasone valerate 0.025%)
(Can be applied to the face or genitals on advice of a clinician)
e.g- Betnovate (betamethasone valerate 0.1%)
Combination products with vitamin D analogues (psoriasis only):
Dovobet (betamethasone dipropionate 0.05% with calcipotriol 50mcgs/g)
Enstilar (betamethasone dipropionate 0.05% with calcipotriol 50mcgs/g)
Do NOT apply to the face or genitals.
e.g- Dermovate (clobetasol propionate 0.05%)
Do NOT apply to the face or genitals.
Vitamin D analogues have been shown to be very effective in treating psoriasis flares. These provide a potential alternative to steroids so are particularly useful if you struggle with side effects when using steroids such as skin thinning or staining. They can also be used long term if needed whilst steroids can only be used for limited courses.
Dovonex (calcipotriol) Ointment: This can be used for psoriasis flares although should not be used on the face or genitals, as it can cause irritation.
Silikis (calcitriol) ointment: This has a similar effect to the above ointment however has the added benefit of being suitable for use on the genitals or face. For this reason the ointment is particularly useful for flares in these areas where potent steroid creams would be inappropriate.
In addition to products containing vitamin D analogues alone, we also offer combination products that also contain a steroid. These are particularly useful in difficult to treat psoriasis or where the individual products alone have not cleared the flare.
Dovobet ointment/gel or Enstilar foam (calcipotriol and betamethasone).
Both of these products contain a strong steroid as well as a vitamin D analogue and for this reason attack the psoriasis flare in two separate ways.
Enstilar is particularly useful if your psoriasis covers a large area, as it comes as a foam spray making it easier to apply over a large area more quickly.
The other major component of most psoriasis treatment is finding the right emollient for you. Emollients form a protective barrier on the skin and block moisture from escaping. This prevents the skin from drying out and makes it less likely to become irritated and inflamed, as can often happen in psoriasis.
It is important to apply plenty of emollient and to do so regularly. Thicker ointments last for around 12 hours whilst creams, lotions and gels only tend to last around 8 hours, meaning you would need to apply these thinner preparations at least three times a day and ointment twice a day for optimal results.
Ointments are better at locking in moisture because they are thicker and more oily however because of their oily texture some people don’t like applying these as much, as they can remain visible on the skin for longer after being applied and can stick to clothing and bedding, etc. Creams, lotions and gels are generally better tolerated due to them being thinner and thus more easily absorbed by the skin but because of this they will not moisturise the skin as affectively as ointments. Some people choose to combine multiple emollients, such as a cream and an ointment by putting the cream on throughout the day and ointment at night.
If you are using a cream, lotion or gel and your skin is still dry it is worth considering if you are applying regularly enough and if so, it might be worth trying a thicker preparation such as an ointment. We’ve put together an emollient guide below to help you choose the right emollient for you. This shows you the different types of emollients with the thinnest least moisturising lotions at the top and thickest most moisturising ointments at the bottom. The thinner lotions are good for people with mild psoriasis that is well controlled and just need a small amount of moisturiser to manage their symptoms, while the thicker ointments are useful for someone with extremely dry skin that is still dry after applying plenty of gels. See our guide below for more information about the various emollients we offer and find the best one for you.
(Less moisturising)
Lotions: Aveeno Daily Moisturising Lotion, CeraVe AM Facial Moisturising Lotion, Cetraben Lotion, Dermol 500 Lotion.
Creams: Aveeno Cream, Aveeno Dermexa Cream, Balneum Cream, Balneum Plus Cream, CeraVe Moisturising Cream, CeraVe SA Smoothing Cream, Cetraben Cream, Cetraben Oatmeal Cream, Dermol Cream, Diprobase Cream, E45 Cream, E45 Dermatitis Cream, Epaderm Cream, Zerobase Cream
Gels: Adex Gel, Doublebase Dayleve Gel, Doublebase Gel.
(More moisturising)
Ointments: Cetraben Ointment, Epaderm Ointment, Sebco Ointment.
Soap substitutes: Cetraben Bath Additive, Dermol 200 Shower Emollient, CeraVe Hydrating Cleanser.
Soap substitutes are useful if soaps trigger your psoriasis however they are washed off quickly so will not moisturise the skin very effectively.
Antimicrobial Creams: Dermol Cream, Dermol 200 Shower Emollient, Dermol 500 Lotion, Hibiscrub Antibacterial Skin Cleanser.
Antimicrobial creams are useful if your psoriasis is often getting infected or if you are using the cream as a soap substitute.
Antibiotic Creams: Fucidin Cream, Fucidin H Cream, Fucibet Cream, Betamethasone with Neomycin Cream, Betamethasone with Clioquinol cream.
Antibiotic containing creams should only be used where you are treating an active infection. They are for short-term use to treat the infection. Some of these also contain steroids to treat active flares of psoriasis at the same time. You should only use these if you have been told by a clinician your psoriasis is infected.
Some psoriasis patients find their lesions can develop very thick scale. For this reason it is sometimes necessary to remove some of this scale before starting some of the treatments mentioned above. Salicylic acid can be useful in removing this scale and can be combined in certain products with a potent steroid (e.g.- Diprosalic) to help treat plaques with significant scale.
These can be used long term and are particularly useful for large thin plaques. They can also be used in patients with many smaller plaques that are present over a large area of the body, where applying a steroid to each plaque individually would be challenging. Coal tar products are also safe to use on sensitive and thinner areas of skin.
These are specialist creams reserved to treat certain types of difficult to treat psoriasis. They include the creams Elidel (pimecrolimus) and Protopic (tacrolimus). They work by affecting the immune system, blocking it from reacting and stopping psoriasis flares.
These creams are particularly useful in patients with psoriasis in areas of sensitive skin such as the face or genitals, or in those that have experienced significant negative side effects from steroid creams. These creams are relatively new but are not thought to have the same negative side effects associated with steroid creams, such as skin thinning or staining, so can be a better alternative in people that would otherwise require regular courses of steroids to treat psoriasis in sensitive areas of their skin.
These treatments are available here at DigiDerm but due to the specialist nature, we may need to speak to you, to make sure it’s the right treatment for you, if you haven’t had it from us before. If you think you might need one of these creams find out more information here
This is a retinoid medication. Retinoids are molecules related to vitamin A. They are often used in acne but this medication in particular can be used to treat mild to moderate plaque psoriasis. It is licensed to be applied to areas of up to 10% of the body so is not appropriate if your psoriasis is all over your body.
They are very dangerous for the baby if taken in pregnancy and for this reason pregnant women or those planning a pregnancy cannot use them and women of child bearing potential should use a reliable form of contraception if there is any chance of sexual activity whilst using the medication.
These creams can be used once daily for up to 12 weeks and work by slowing the overgrowth of skin cells and thus reducing the inflammation associated with psoriasis.
These creams can cause some skin irritation as a side effect such as burning, itching or stinging and for this reason are sometimes used with a steroid cream at the other end of the day to minimise irritation.
We do not currently offer this treatment so if you think it might be right for you we would recommend consulting with your GP or dermatologist.
For patients that do not see benefit from the various applications mentioned above, second line options may be considered.
These include:
Specialist dermatology centres can use certain types of ultraviolet light to help treat psoriasis. This is usually done with a form of light known as ultraviolet light B or UVB. UVB light slows the growth of the skin cells helping to reduce inflammation and when used on a regular schedule can successfully control psoriasis in certain people.
This medication suppresses the immune systems response and as a result improves psoriasis symptoms. It can affect the liver, kidney and immune system and for this reason requires regular blood tests to monitor. For this reason we are unable to prescribe this at DigiDerm. If you feel this medication might be right for you, it will need to be prescribed by a dermatologist so we would recommend contacting one or talking to your GP about the potential for a referral to dermatology.
This is another medication that works by suppressing the immune systems response to help treat psoriasis. It is also used in psoriatic arthritis so may be beneficial if you also suffer with this. This is a highly effective medication for psoriasis but like ciclosporin above will require regular blood tests and thus cannot be prescribed here at DigiDerm so a dermatologist appointment will be needed if you want to discuss starting this medication.
This is a tablet form of retinoid (vitamin A type molecule). It works similarly to the cream form mentioned above (tazarotene) by reducing the overgrowth of skin cells and through this action helps to treat psoriasis.
This medicine is particularly useful for treating hand and foot psoriasis with significant thick plaques of hardened skin.
Biologics and biosimilars are newer forms of medication used to treat psoriasis and psoriatic arthritis. They work by targeting specific stages of the autoimmune response, as opposed to some of the immunosuppressants mentioned above that weaken the whole immune response.
There is a lot of new evidence emerging around the use of these medications but at the moment the long term effects are not well known, so they tend to be reserved for use after first line and second line treatments have failed.
Much like the immunosuppressants mentioned above they will require regular blood monitoring and so would need to be prescribed by a specialist dermatologist.
Make sure to moisturise regularly multiple times a day. If you have dry skin despite moisturising regularly. You may not be using the right moisturiser. Thicker ointment moisturisers are better at locking moisture into the skin than thinner creams and lotions. Consider switching to one of our ointments and this should improve things.
Use steroid creams when needed for flares but apply thinly and only for a maximum of 2 weeks at a time. 1 week is usually sufficient.
Try to identify triggers and avoid these wherever possible. This could be certain foods, soaps, clothing or detergents.
Small amounts of regular sunlight can help improve psoriasis symptoms but be careful not to get too much, as sunburn along with any trauma to the skin, can be a trigger for psoriasis. Too much sun can also increase your risk of skin cancers so make sure to keep the exposure limited and avoid midday sun.
Stress can cause psoriasis flares. It’s a busy life and sometimes stress can get on top of us. There is lots of help out there though, so try bringing down your stress levels and you may find this improves your psoriasis. Check out our mental health page for more information.
Sadly there is no one treatment that is best. When using steroid creams, the preparation you use will largely depend on how severe your psoriasis is. You will hopefully have tried some of these creams already and will know if they have worked for you or not. If they have not worked for you, then there is a chance you may need to use a stronger steroid, additionally if you have only ever used steroid creams it may be worth trying a cream that contains both a steroid and a vitamin D analogue, as these can be particularly beneficial for treating psoriasis flares.
See our guide above titled ‘What is the Best Treatment for Psoriasis?’. This takes you through the various psoriasis creams available and discusses their potency, side effects, advantages and disadvantages to help you find the right treatment for you. When it comes to steroids, the best cream for you is the lowest potency steroid required to clear your flare up.
See our ‘steroid cream guide’ above to find out more about the strength of different steroid creams available. If you still aren’t sure which to use then we are happy to discuss further over a video/telephone call or look at some pictures. Make an appointment now
In terms of emollients, again there is no ‘best’ cream. The best cream is one that works for you. Ointments are the best at locking in moisture and this is because they are thicker than creams or lotions. If your skin is very dry, an ointment is probably best however due to their thickness they are sometimes not tolerated by everyone, as they can leave the skin visibly oily and stick to clothes. Creams and lotions are generally preferred as they are better absorbed by the skin and don’t leave as thick of a coating on the skin. Whilst creams and lotions are generally preferred cosmetically they are not as successful at moisturising the skin but might be better if you can use them more regularly. You can also try using a combination such as applying the ointment at night and cream throughout the day. See our emollient guide above for more details on the right emollient for you.
If only! It would be great if we could get rid of psoriasis entirely but sadly this is generally not the case unless there is a clear cause for the psoriasis. Generally speaking, psoriasis will come and go in flares throughout your life. Whilst it is generally not possible to completely cure psoriasis, with the right help, you can get it under control and stop it impacting your life.
Check out the images above for various examples of psoriasis and its different types in our ‘How is Psoriasis Diagnosed?’ Section.
Psoriasis can occur at any time in life but is most likely to present between the ages of 20 and 30 or 50 and 60. It is thought to be highly related to genetics, so it’s likely it wasn’t caused by anything you’ve done although it can be triggered by certain actions such as excessive alcohol consumption, smoking, trauma to the skin, and certain infections.
Although psoriasis and eczema are often confused and can at times look similar, these are different conditions and are not related.
Psoriasis is an autoimmune disease caused by the body’s immune system attacking normal tissues such as the skin. Psoriasis is also associated with inflammation in other parts of the body and can increase the risk of other conditions developing such as: Type 2 diabetes and cardiovascular disease.
Eczema is a group of seven different skin conditions that cause the skin to become itchy and inflamed however is doesn’t increase you risk of other chronic conditions the way psoriasis does.
They both can lead to dry, itchy and inflamed/painful skin however they tend to have different appearances making them fairly easy to distinguish.
Psoriasis tends to have a more defined border and a silvery/scaly appearance.
Eczema is more common in the creases of joints such as the knees and elbows. While psoriasis is more common in the areas that extend so the back of the elbow or front of your knees.
Psoriasis: The image above shows typical psoriasis. Note the defined border, silvery scaly appearance to the lesion and the location on the back of the elbow.
Eczema: The image above shows typical eczema. Note the lack of a clear border, the inflamed red appearance and location at the crease of the elbow.
Most moisturising creams/lotions/ointments are safe during pregnancy. You should always read the label to check for each cream but these do not tend to contain anything harmful for your baby.
Here are some examples of pregnancy safe emollients we stock: Doublebase gel; Dermol lotion; Epaderm Ointment, E45 Cream and many more.
Vitamin D analogue containing products such as Enstilar and Dovobet are generally avoided as there is insufficient data for their safety in pregnancy and breast feeding.
Steroid creams are generally considered safe to use during pregnancy however you should try to avoid using potent steroids during pregnancy, as there is more theoretical risk of the cream being absorbed into the blood stream. The lowest strength cream required to treat your psoriasis is best. If you are pregnant and requesting medication from us, make sure to make a note of this on your request so we can advise accordingly.
While these medications are safe when breastfeeding you should avoid applying to the breast directly before breastfeeding, to avoid the baby ingesting any cream.
Psoriasis is not contagious and does not spread from person to person. When you are having a psoriasis flare it can become larger and seem to spread for a variety of reasons. This can be caused by irritation due to itching and could also happen if the skin has become infected. If you are concerned about your psoriasis spreading try one of our treatments or book an appointment with one of our clinicians
Sadly there is no catch all cure for psoriasis however with the right creams and treatments lots of people can get their psoriasis under control and stop it impacting their lives. We’ve helped lots of people do this here at DigiDerm and would love to help you do the same.
At DigiDerm we know how frustrating it is to suffer with skin conditions and how easy it is to get lost in all the information out there on the internet. We’ve put together this guide to give you all you need to know about eczema and most importantly how you can manage your eczema and get back to doing the things you love without it getting in the way!
DigiDerm is run by practicing NHS clinicians and we pride ourselves on providing you the best evidence based care. If you know what you need then you can go straight to our treatments (and select what you need.
If you’re not sure what you need then we’ve put together some info below to help you find out more about eczema and what treatment is right for you. If you’re still not sure at the end then don’t hesitate to book a telephone or video consultation with one of our clinicians. We would be happy to help with any questions and if we can’t help, you won’t pay a penny. We’ll follow you up to check everything’s working as it should be and make sure you get the right treatments for your eczema.
Make sure to check out our FAQs section at the end which has some of the most common questions we get about eczema.
Firstly there are multiple types of eczema. The most common form is known as atopic dermatitis or atopic eczema but there are 7 types of eczema in total. These include:
Atopic eczema causes, red, itchy and dry patches of skin. Atopic basically means prone to allergies and for this reason atopic eczema is thought to be a form of allergic reaction. It is more likely to occur in people who also suffer with hay fever or asthma although this is not always the case. It also frequently first occurs in childhood so you may have been suffering from it for a long time.
Contact dermatitis is caused by an allergic reaction to a substance that the body has had prolonged exposure to. This can be caused by a number of different items such as: jewellery, belt buckles, metal zips, hair dye, etc. The image above shows a contact dermatitis reaction caused by a ring.
Contact dermatitis is common in individuals who are in regular contact with chemicals as part of their profession such as healthcare workers or mechanics.
Dishydrotic or Pompholyx eczema causes bubbly itchy blisters that most commonly occur on the palms of the hands or soles of the feet. They can also occur around the toes and fingers. This form of eczema tends to run in families and is most common in people who already have another form of eczema.
Neurodermatitis or Lichen Simplex tends to affect individual patches of skin and occurs as a result of intense itching of those areas which leads to thickening and discolouration of these areas of skin.
Over time intense itching can damage the nerve endings and lead to further itching and discomfort as a result.
This form of eczema is more common in people that already suffer with other forms of eczema and can be more common in people that suffer with anxiety conditions.
Discoid or Nummular Eczema appears as numerous round lesions of itchy, irritated skin. These can appear as red, pink or brown in colour.
This form of eczema can be mistaken for other skin conditions such as ringworm or psoriasis so if you have not been formerly diagnosed it is worth having a discussion with one of our experts to confirm the diagnosis. Make an appointment here.
Seborrheic dermatitis is often associated with the scalp however it can occur anywhere on the body with lots of oil producing glands. These are called sebaceous glands and there are lots of these on your nose, upper back and scalp which is why these areas tend to be affected.
If this is on your face then you need to be extra careful when applying steroid creams, as this area of skin is more sensitive and you shouldn’t apply anything more than moderate strength steroid to this area. If you’ve never used steroids on your face before make sure to chat through with one of our experts. Make appointment here.
Varicose eczema occurs on the lower legs and is caused by fluid build-up, as a result of poor circulation.
This type of eczema is most likely to occur after the age of 50 and can signal other health conditions such as heart failure or high blood pressure. If you think you have this form of eczema it’s worth seeing your GP if you haven’t already, so they can check you over.
Eczema tends to have periods of time when it is fairly inactive but then have periods in which it flares causing itching, sensitivity and inflamed skin.
The treatment of eczema tends to be broken down into two main steps. These include using steroid creams short term to manage flares and using emollients to manage the dry skin often associated with eczema.
Through keeping the skin moisturised effectively we can reduce the amount you need to use steroid creams and the amount of flares you have so it is important to continue to use them regularly even if your eczema is under control however moisturisers are unlikely to have much effect on an active flare of eczema and steroids are usually the best treatment option for these flares. Take care to always apply steroids thinly and only for short periods of time. One week is usually enough for most people.
Unfortunately there isn’t one simple cause for eczema. It can be caused by a variety of factors which we will discuss below:
Genetics- There is likely a genetic component to eczema and this is why it often runs in families.
Studies have linked eczema to a deficiency in a protein called fillagrin. This is responsible for forming a healthy barrier on the skin and not having enough fillagrin can cause people to have dry and flaky skin more prone to eczema.
Allergies- Whilst the exact cause of eczema is not known it is thought to be related to an overactive immune system and can be made worse by certain triggers that cause the immune system to react. Many of these triggers can come from regular household items such as: washing up liquid, soaps and detergents, etc. Other allergies such as dust mites, pet fur and many more can also cause it to flare. Sometimes we can identify what these triggers are and if you can eliminate them from your day to day life, this can help to manage your eczema.
Food allergies- Certain foods are also thought to play a role in some people. Keeping a food diary and making note of when your eczema is at its worst can help you to identify certain trigger foods for you.
Other triggers are also thought to play a role in certain people such as the weather and stress.
In summary there are lots of triggers and different people will find different things make their eczema worse. It is worth thinking about what some of your triggers might be and avoiding these where possible.
In a nutshell:
• Greasy skin
• Blackheads and Whiteheads (Comedones)
• Larger red inflamed spots with pus (Papules and Pustules)
• Scarring (In moderate to severe disease)
Acne can appear slightly differently in different people- most people will have greasy skin which usually affects the face but can also occur commonly on the back and chest. At the milder stage it can present as blackheads and whiteheads (little pimples under the surface of the skin from blocked pores). As acne progresses in severity it can lead to inflamed red spots (known as papules) and spots containing pus (pustules). The most severe forms of acne can include deep red painful large spots called cysts- these are best assessed by a consultant dermatologist in a hospital setting. In some cases acne may also lead to scarring which can either be atrophic (loss of tissue) or hypertrophic (increase of fibrous tissue) scars- there is more information below in the FAQs about acne scarring and how to manage it.
Eczema is usually not too complicated to diagnose and presents fairly typically with red, inflamed, dry and irritated skin. It is most common to occur in childhood so the chances are you have known or suspected you have eczema for a while. If you are in any doubt about what you have then feel free to book a consultation with one of our clinicians and we would be more than happy to help, get in touch here.
The images above show typical eczema. As in the above images eczema is most likely to occur flexural areas. This means where there are bends in the body that result in skin rubbing together frequently. Most commonly this occurs at the flex of the elbows or knees.
Eczema can also occur in other areas of the body such as the hands and neck as seen above.
It’s important to realise that eczema doesn’t look the same in all skin tones. On darker skin tones, eczema can often appear darker like the image above.
NOTE: Don’t worry if you are unsure of what treatments to select. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Here are some of the treatment choices that we offer for eczema in line with the latest clinical guidelines for dermatology in the UK (click on the product for more information and to start a consultation).
We will start with steroids. These are to be used when you have a flare of eczema. Make sure to apply them sparingly and usually for no longer than 7 days continuously unless advised by a clinician. They are a great way to settle down a flare of eczema but not a long term solution.
There are varying strengths of steroids from mild to very potent. If you already know what strength you need as you’ve had it before then this is likely to work for you again. If you have not tried steroid creams before it is worth being cautious and starting with a milder steroid, only using potent steroids on the advice of a clinician.
You should be particularly careful when applying steroid creams to sensitive skin areas such as your face or genitals. You shouldn’t apply steroids to these areas unless advised to do so by a clinician after assessment and you should never use anything more than moderate strength steroids in these areas.
We are happy to have a look at some pictures or speak on a video call to advise on what strength we think you need if you’re unsure, get in touch here.
e.g- Dermovate (clobetasol propionate 0.05%)
The other major component of most eczema treatment is finding the right emollient.
Emollients form a protective barrier on the skin and block moisture from escaping. This prevents the skin from drying out and makes it less likely to become irritated and inflamed, as can often happen in eczema.
It is important to apply plenty of emollient and to do so regularly. Thicker ointments last for around 12 hours whilst creams, lotions and gels only tend to last around 8 hours which means you would need to apply these thinner preparations at least three times a day and ointment twice a day for optimal results.
Ointments are better at locking in moisture because they are thicker and more oily however because of their oily texture some people don’t like applying these as much, as they can remain visible on the skin for longer after being applied and can stick to clothing and bedding, etc. Creams, lotions and gels are generally better tolerated due to them being thinner and thus more easily absorbed by the skin but because of this they will not moisturise the skin as effectively as ointments. Some people choose to combine multiple emollients, such as a cream and an ointment by putting the cream on throughout the day and ointment at night.
If you are using a cream, lotion or gel and your skin is still dry it is worth considering if you are applying regularly enough and if so it might be worth trying a thicker preparation such as an ointment. We’ve put together an emollient guide below to help you choose the right emollient for you. This shows you the different types of emollients with the thinnest least moisturising lotions at the top and thickest most moisturising ointments at the bottom. The thinner lotions are good for people with mild eczema that is well controlled and just need a small amount of moisturiser to manage their symptoms, while the thicker ointments are useful for someone with extremely dry skin that is still dry after applying plenty of gels. See our guide below for more information about the various emollients we offer and find the best one for you.
(Less moisturising)
(More moisturising)
Ointments: Cetraben Ointment, Epaderm Ointment, Sebco Ointment.
Antibiotic Creams: Fucidin Cream, Fucidin H Cream, Fucibet Cream, Betamethasone with Neomycin Cream, Betamethasone with Clioquinol cream.
Antibiotic containing creams Should only be used where you are treating an active infection. They are for short-term use to treat the infection. Some of these also contain steroids to treat active flares of eczema at the same time.
Soap Substitutes: Cetraben Bath Additive, Dermol 200 Shower Emollient, CeraVe Hydrating Cleanser.
Soap substitutes are useful if soaps trigger your eczema however they are washed off quickly so will not moisturise the skin very effectively.
Antimicrobial Creams: Dermol Cream, Dermol 200 Shower Emollient, Dermol 500 Lotion, Hibiscrub Antibacterial Skin Cleanser.
Antimicrobial creams are useful if your eczema is often getting infected or if you are using the cream as a soap substitute.
These are specialist creams reserved to treat certain types of difficult to treat eczema. They include the creams Elidel (pimecrolimus) and Protopic (tacrolimus). They work by affecting the immune system, blocking it from reacting and stopping eczema flares.
These creams are particularly useful in patients with eczema in areas of sensitive skin such as the face or genitals, or in those that have experienced significant negative side effects from steroid creams. These creams are relatively new but are not thought to have the same negative side effects associated with steroid creams, such as skin thinning, so can be a better alternative in people that would otherwise require regular courses of steroids to treat eczema in sensitive areas of their skin.
These treatments are available here on DigiDerm but due to the specialist nature we may need to speak to you to make sure it’s the right treatment for you if you haven’t had it from us before. If you think you might need one of these creams find out more information here.
This is where different wavelengths of UV light are used to treat eczema. This treatment is generally reserved for people where creams have failed and is offered in specialty dermatology clinics.
Medications such as methotrexate, azathioprine, ciclosporin and mycophenolate mofetil can be initiated by a specialist. These reduce the body’s immune response and can improve eczema symptoms. You would need regular blood monitoring in order to take these medicines and so we are not able to start these medications at DigiDerm. You will need to see a dermatologist to discuss these treatments if you think you might need them.
These are another class of immunosuppressant drugs that are given by injection. Like the tablets mentioned above they would need to be started by a dermatologist. Biologics used in eczema include Dupilumab (Dupixent) and Tralokinumab (Adtralza).
Make sure to moisturise regularly multiple times a day.
Use steroid creams when needed for flares but apply thinly and only for a maximum of 2 weeks at a time. 1 week is usually sufficient.
Try to identify triggers and avoid these wherever possible. This could be certain foods, soaps, clothing or detergents.
Antihistamines can be used to help with itching associated with eczema.
Heat can trigger eczema, so keep your house cool and try not to take very warm showers.
If you have dry skin despite moisturising regularly. You may not be using the right moisturiser. Thicker ointment moisturisers are better at locking moisture into the skin than thinner creams and lotions. Consider switching to one of our ointments and this should improve things.
Stress can cause eczema flares. It’s a busy life and sometimes stress can get on top of us. There is lots of help out there though, so try bringing down your stress levels and you may find this improves your eczema.
At DigiDerm we know how frustrating it is to suffer with skin conditions and how easy it is to get lost in all the information out there on the internet. We’ve put together this guide to give you all you need to know about eczema and most importantly how you can manage your eczema and get back to doing the things you love without it getting in the way!
DigiDerm is run by practicing NHS clinicians and we pride ourselves on providing you the best evidence based care. If you know what you need then you can go straight to our treatments (and select what you need.
If you’re not sure what you need then we’ve put together some info below to help you find out more about eczema and what treatment is right for you. If you’re still not sure at the end then don’t hesitate to book a telephone or video consultation with one of our clinicians. We would be happy to help with any questions and if we can’t help, you won’t pay a penny. We’ll follow you up to check everything’s working as it should be and make sure you get the right treatments for your eczema.
Make sure to check out our FAQs section at the end which has some of the most common questions we get about eczema.
Firstly there are multiple types of eczema. The most common form is known as atopic dermatitis or atopic eczema but there are 7 types of eczema in total. These include:
Atopic eczema causes, red, itchy and dry patches of skin. Atopic basically means prone to allergies and for this reason atopic eczema is thought to be a form of allergic reaction. It is more likely to occur in people who also suffer with hay fever or asthma although this is not always the case. It also frequently first occurs in childhood so you may have been suffering from it for a long time.
Contact dermatitis is caused by an allergic reaction to a substance that the body has had prolonged exposure to. This can be caused by a number of different items such as: jewellery, belt buckles, metal zips, hair dye, etc. The image above shows a contact dermatitis reaction caused by a ring.
Contact dermatitis is common in individuals who are in regular contact with chemicals as part of their profession such as healthcare workers or mechanics.
Dishydrotic or Pompholyx eczema causes bubbly itchy blisters that most commonly occur on the palms of the hands or soles of the feet. They can also occur around the toes and fingers. This form of eczema tends to run in families and is most common in people who already have another form of eczema.
Neurodermatitis or Lichen Simplex tends to affect individual patches of skin and occurs as a result of intense itching of those areas which leads to thickening and discolouration of these areas of skin.
Over time intense itching can damage the nerve endings and lead to further itching and discomfort as a result.
This form of eczema is more common in people that already suffer with other forms of eczema and can be more common in people that suffer with anxiety conditions.
Discoid or Nummular Eczema appears as numerous round lesions of itchy, irritated skin. These can appear as red, pink or brown in colour.
This form of eczema can be mistaken for other skin conditions such as ringworm or psoriasis (Link to psoriasis page) so if you have not been formerly diagnosed it is worth having a discussion with one of our experts to confirm the diagnosis. Make an appointment here.
Seborrheic dermatitis is often associated with the scalp however it can occur anywhere on the body with lots of oil producing glands. These are called sebaceous glands and there are lots of these on your nose, upper back and scalp which is why these areas tend to be affected.
If this is on your face then you need to be extra careful when applying steroid creams, as this area of skin is more sensitive and you shouldn’t apply anything more than moderate strength steroid to this area. If you’ve never used steroids on your face before make sure to chat through with one of our experts. Make appointment here.
Varicose eczema occurs on the lower legs and is caused by fluid build-up, as a result of poor circulation.
This type of eczema is most likely to occur after the age of 50 and can signal other health conditions such as heart failure or high blood pressure. If you think you have this form of eczema it’s worth seeing your GP if you haven’t already, so they can check you over.
Eczema tends to have periods of time when it is fairly inactive but then have periods in which it flares causing itching, sensitivity and inflamed skin.
The treatment of eczema tends to be broken down into two main steps. These include using steroid creams short term to manage flares and using emollients to manage the dry skin often associated with eczema.
Through keeping the skin moisturised effectively we can reduce the amount you need to use steroid creams and the amount of flares you have so it is important to continue to use them regularly even if your eczema is under control however moisturisers are unlikely to have much effect on an active flare of eczema and steroids are usually the best treatment option for these flares. Take care to always apply steroids thinly and only for short periods of time. One week is usually enough for most people.
Unfortunately there isn’t one simple cause for eczema. It can be caused by a variety of factors which we will discuss below:
Genetics- There is likely a genetic component to eczema and this is why it often runs in families.
Studies have linked eczema to a deficiency in a protein called fillagrin. This is responsible for forming a healthy barrier on the skin and not having enough fillagrin can cause people to have dry and flaky skin more prone to eczema.
Allergies- Whilst the exact cause of eczema is not known it is thought to be related to an overactive immune system and can be made worse by certain triggers that cause the immune system to react. Many of these triggers can come from regular household items such as: washing up liquid, soaps and detergents, etc. Other allergies such as dust mites, pet fur and many more can also cause it to flare. Sometimes we can identify what these triggers are and if you can eliminate them from your day to day life, this can help to manage your eczema.
Food allergies- Certain foods are also thought to play a role in some people. Keeping a food diary and making note of when your eczema is at its worst can help you to identify certain trigger foods for you.
Other triggers are also thought to play a role in certain people such as the weather and stress.
In summary there are lots of triggers and different people will find different things make their eczema worse. It is worth thinking about what some of your triggers might be and avoiding these where possible.
In a nutshell:
• Greasy skin
• Blackheads and Whiteheads (Comedones)
• Larger red inflamed spots with pus (Papules and Pustules)
• Scarring (In moderate to severe disease)
Acne can appear slightly differently in different people- most people will have greasy skin which usually affects the face but can also occur commonly on the back and chest. At the milder stage it can present as blackheads and whiteheads (little pimples under the surface of the skin from blocked pores). As acne progresses in severity it can lead to inflamed red spots (known as papules) and spots containing pus (pustules). The most severe forms of acne can include deep red painful large spots called cysts- these are best assessed by a consultant dermatologist in a hospital setting. In some cases acne may also lead to scarring which can either be atrophic (loss of tissue) or hypertrophic (increase of fibrous tissue) scars- there is more information below in the FAQs about acne scarring and how to manage it.
Eczema is usually not too complicated to diagnose and presents fairly typically with red, inflamed, dry and irritated skin. It is most common to occur in childhood so the chances are you have known or suspected you have eczema for a while. If you are in any doubt about what you have then feel free to book a consultation with one of our clinicians and we would be more than happy to help, get in touch here.
The images above show typical eczema. As in the above images eczema is most likely to occur flexural areas. This means where there are bends in the body that result in skin rubbing together frequently. Most commonly this occurs at the flex of the elbows or knees.
Eczema can also occur in other areas of the body such as the hands and neck as seen above.
It’s important to realise that eczema doesn’t look the same in all skin tones. On darker skin tones, eczema can often appear darker like the image above.
NOTE: Don’t worry if you are unsure of what treatments to select. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Here are some of the treatment choices that we offer for eczema in line with the latest clinical guidelines for dermatology in the UK (click on the product for more information and to start a consultation).
We will start with steroids. These are to be used when you have a flare of eczema. Make sure to apply them sparingly and usually for no longer than 7 days continuously unless advised by a clinician. They are a great way to settle down a flare of eczema but not a long term solution.
There are varying strengths of steroids from mild to very potent. If you already know what strength you need as you’ve had it before then this is likely to work for you again. If you have not tried steroid creams before it is worth being cautious and starting with a milder steroid, only using potent steroids on the advice of a clinician.
You should be particularly careful when applying steroid creams to sensitive skin areas such as your face or genitals. You shouldn’t apply steroids to these areas unless advised to do so by a clinician after assessment and you should never use anything more than moderate strength steroids in these areas.
We are happy to have a look at some pictures or speak on a video call to advise on what strength we think you need if you’re unsure, get in touch here.
e.g- Hydrocortisone 1.0% ointment/cream
e.g- Eumovate (clobetasone butyrate 0.05%) cream and Betnovate RD (betamethasone valerate 0.025%)
e.g- Betnovate (betamethasone valerate 0.1%)
e.g- Dermovate (clobetasol propionate 0.05%)
The other major component of most eczema treatment is finding the right emollient. Emollients form a protective barrier on the skin and block moisture from escaping. This prevents the skin from drying out and makes it less likely to become irritated and inflamed, as can often happen in eczema.
It is important to apply plenty of emollient and to do so regularly. Thicker ointments last for around 12 hours whilst creams, lotions and gels only tend to last around 8 hours which means you would need to apply these thinner preparations at least three times a day and ointment twice a day for optimal results.
Ointments are better at locking in moisture because they are thicker and more oily however because of their oily texture some people don’t like applying these as much, as they can remain visible on the skin for longer after being applied and can stick to clothing and bedding, etc. Creams, lotions and gels are generally better tolerated due to them being thinner and thus more easily absorbed by the skin but because of this they will not moisturise the skin as effectively as ointments. Some people choose to combine multiple emollients, such as a cream and an ointment by putting the cream on throughout the day and ointment at night.
If you are using a cream, lotion or gel and your skin is still dry it is worth considering if you are applying regularly enough and if so it might be worth trying a thicker preparation such as an ointment. We’ve put together an emollient guide below to help you choose the right emollient for you. This shows you the different types of emollients with the thinnest least moisturising lotions at the top and thickest most moisturising ointments at the bottom. The thinner lotions are good for people with mild eczema that is well controlled and just need a small amount of moisturiser to manage their symptoms, while the thicker ointments are useful for someone with extremely dry skin that is still dry after applying plenty of gels. See our guide below for more information about the various emollients we offer and find the best one for you.
(Less moisturising)
Lotions: Aveeno Daily Moisturising Lotion, CeraVe AM Facial Moisturising Lotion, Cetraben Lotion, Dermol 500 Lotion.
(More moisturising)
Ointments: Cetraben Ointment, Epaderm Ointment, Sebco Ointment.
Creams: Aveeno Cream, Aveeno Dermexa Cream, Balneum Cream, Balneum Plus Cream, CeraVe Moisturising Cream, CeraVe SA Smoothing Cream, Cetraben Cream, Cetraben Oatmeal Cream, Dermol Cream, Diprobase Cream, E45 Cream, E45 Dermatitis Cream, Epaderm Cream, Zerobase Cream
Gels: Adex Gel, Doublebase Dayleve Gel, Doublebase Gel.
Antibiotic Creams: Fucidin Cream, Fucidin H Cream, Fucibet Cream, Betamethasone with Neomycin Cream, Betamethasone with Clioquinol cream.
Antibiotic containing creams Should only be used where you are treating an active infection. They are for short-term use to treat the infection. Some of these also contain steroids to treat active flares of eczema at the same time.
Soap Substitutes: Cetraben Bath Additive, Dermol 200 Shower Emollient, CeraVe Hydrating Cleanser.
Soap substitutes are useful if soaps trigger your eczema however they are washed off quickly so will not moisturise the skin very effectively.
Antimicrobial Creams: Dermol Cream, Dermol 200 Shower Emollient, Dermol 500 Lotion, Hibiscrub Antibacterial Skin Cleanser.
Antimicrobial creams are useful if your eczema is often getting infected or if you are using the cream as a soap substitute.
These are specialist creams reserved to treat certain types of difficult to treat eczema. They include the creams Elidel (pimecrolimus) and Protopic (tacrolimus). They work by affecting the immune system, blocking it from reacting and stopping eczema flares.
These creams are particularly useful in patients with eczema in areas of sensitive skin such as the face or genitals, or in those that have experienced significant negative side effects from steroid creams. These creams are relatively new but are not thought to have the same negative side effects associated with steroid creams, such as skin thinning, so can be a better alternative in people that would otherwise require regular courses of steroids to treat eczema in sensitive areas of their skin.
These treatments are available here on DigiDerm but due to the specialist nature we may need to speak to you to make sure it’s the right treatment for you if you haven’t had it from us before. If you think you might need one of these creams find out more information here.
This is where different wavelengths of UV light are used to treat eczema. This treatment is generally reserved for people where creams have failed and is offered in specialty dermatology clinics.
Medications such as methotrexate, azathioprine, ciclosporin and mycophenolate mofetil can be initiated by a specialist. These reduce the body’s immune response and can improve eczema symptoms. You would need regular blood monitoring in order to take these medicines and so we are not able to start these medications at DigiDerm. You will need to see a dermatologist to discuss these treatments if you think you might need them.
These are another class of immunosuppressant drugs that are given by injection. Like the tablets mentioned above they would need to be started by a dermatologist. Biologics used in eczema include Dupilumab (Dupixent) and Tralokinumab (Adtralza).
Make sure to moisturise regularly multiple times a day.
Use steroid creams when needed for flares but apply thinly and only for a maximum of 2 weeks at a time. 1 week is usually sufficient.
Try to identify triggers and avoid these wherever possible. This could be certain foods, soaps, clothing or detergents.
Antihistamines can be used to help with itching associated with eczema.
Heat can trigger eczema, so keep your house cool and try not to take very warm showers.
If you have dry skin despite moisturising regularly. You may not be using the right moisturiser. Thicker ointment moisturisers are better at locking moisture into the skin than thinner creams and lotions. Consider switching to one of our ointments and this should improve things.
Stress can cause eczema flares. It’s a busy life and sometimes stress can get on top of us. There is lots of help out there though, so try bringing down your stress levels and you may find this improves your eczema.
Sadly there is no one treatment that is best. Which steroid cream you use will largely depend on how severe your eczema is. You will hopefully have tried creams already and will know if they have worked for you or not. If they have not worked for you then there is a chance you may need to use a stronger steroid. See our guide above ‘What is the Best Treatment for Eczema?’
This takes you through the various steroid creams available and their potency. The best cream for you is the lowest potency steroid required to clear your flare up. If you still aren’t sure which to use then we are happy to discuss further over a video call or look at some pictures. Make an appointment now
In terms of emollients, again there is no ‘best’ cream. The best cream is one that works for you. Ointments are the best at locking in moisture and this is because they are thicker than creams or lotions. If your skin is very dry, an ointment is probably best however due to their thickness they are sometimes not tolerated by everyone as they can leave the skin visibly oily and stick to clothes. Creams and lotions are generally preferred as they are better absorbed by the skin and don’t leave as thick of a coating on the skin. Whilst creams and lotions are generally preferred cosmetically they are not as successful at moisturising the skin but might be better if you can use them regularly. You can also try using a combination such as applying the ointment at night and cream throughout the day. See our emollient guide above for more details on the right emollient for you.
If only! It would be great if we could get rid of eczema entirely but sadly this is generally not the case unless there is a clear cause for the eczema. Generally speaking eczema will come and go in flares throughout your life. Whilst it is generally not possible to completely cure eczema, with the right help you can get it under control and stop it impacting your life.
Check out the images above for various examples of eczema and its different types in our ‘How is Eczema Diagnosed?’ Section.
There are 7 different types of eczema in total, including: atopic eczema, contact dermatitis, dishydrotic eczema, neurodermatitis, discoid eczema, seborrheic dermatitis and varicose eczema. Check out our “What you need to know about Eczema” section for more information and example images to help you better identify which type of eczema you have. If you’re still unsure don’t hesitate to book a video consultation, or send us some images and we can help you get the right diagnosis. Make an Appointment
Although eczema and psoriasis are often confused and can at times look similar, these are different conditions and are not related.
Psoriasis is an autoimmune disease caused by the body’s immune system attacking normal tissues such as the skin. Psoriasis is also associated with inflammation in other parts of the body and can increase the risk of other conditions developing such as: Type 2 diabetes and cardiovascular disease.
Eczema is a group of seven different skin conditions that cause the skin to become itchy and inflamed however is doesn’t increase you risk of other chronic conditions the way psoriasis does.
They both can lead to dry, itchy and inflamed/painful skin however they tend to have different appearances making them fairly easy to distinguish.
Psoriasis tends to have a more defined border and a silvery/scaly appearance.
Eczema is more common in the creases of joints such as the knees and elbows. While psoriasis is more common in the areas that extend so the back of the elbow or front of your knees.
Psoriasis: The image above shows typical psoriasis. Note the defined border, silvery scaly appearance to the lesion and the location on the back of the elbow.
Eczema: The image above shows typical eczema. Note the lack of a clear border, the inflamed red appearance and location at the crease of the elbow.
Most moisturising creams/lotions/ointments are safe during pregnancy. You should always read the label to check for each cream but these do not tend to contain anything harmful for your baby.
Here are some examples of pregnancy safe emollients we stock: Doublebase gel; Dermol lotion; Epaderm Ointment, E45 Cream and many more.
Steroid creams are also generally considered safe to use during pregnancy however you should try to avoid using potent steroids during pregnancy as there is more theoretical risk of the cream being absorbed into the bloodstream. The lowest strength cream required to treat your eczema is best. If you are pregnant and requesting medication from us, make sure to make a note of this on your request so we can advise accordingly.
While these medications are safe when breastfeeding you should avoid applying to the breast directly before breastfeeding to avoid the baby ingesting any cream.
Eczema is not contagious and does not spread from person to person. When you are having an eczema flare it can become larger and seem to spread for a variety of reasons. This can be caused by irritation due to itching or exposure to an allergen (substance you are allergic to). It could also happen if the skin has become infected. If you are concerned about your eczema spreading try one of our treatments or book an appointment with one of our clinicians
Sadly there is no catch all cure for eczema however with the right creams and treatments lots of people can get their eczema under control and stop it impacting their lives. We’ve helped lots of people do this at DigiDerm and would love to help you do the same.
Put quite simply- there is bucket loads of information out there on Acne. The internet, social media and magazines are awash with the latest advice on the best products and the hottest tips- but what information can you actually trust and what really works?! As dermatology specialists, we have written this simple guide to make it easier for you to choose the best acne treatments and advice. Our guide is trustworthy, reliable and evidence-based (i.e. the treatments and advice have been proven to work in previous studies). It has been written by registered health-care professionals- hence you can trust that we will always put patient safety and choice above commercial interests.
We hope this guide will help you understand what acne is, how to identify it and understand some of the treatment options available. There is also a great FAQ section at the end to answer some of the most puzzling acne questions that people ask us. There is also a section on our Top Tips for Acne. Please read the guide at your leisure and if you are still unsure of what treatment you may require, fill in a general questionnaire and attach some photos and we will suggest a treatment. Or you can book in for a telephone or video consultation with one of our friendly dermatology experts.
Pretty much everyone has had acne themselves or knows someone who has, and it affects most people between the ages of 11-30 but can also run into the 30s, 40s and 50s. Some people suffer short term bouts or ‘flares’ of acne and some people suffer more long term over a number of years.
Acne is a skin condition that has four major features:
1) Excessive grease on the skin
2) Presence of black-head and whiteheads,
3) Infection with acne bacteria
4) Production of inflammation
Acne can affect the face (forehead, cheeks, jawline), back, shoulders and less common areas such as the buttocks.
The magic question. If we could identify a clear single cause of acne then it would probably be much easier to treat. However, there are several factors which may lead to the development of acne:
Hormonal Factors e.g. puberty – during this period of our life we start to produce hormones such as testosterone (males) and androgens (females) and both of these can increase the greasy oil production in our skin that starts the acne process. This is why about 75% of woman will notice their acne worsening around the time of their period.
Genetics – people with persistent (stubborn!) acne will often have a family history of acne and will often inherit larger more active oil glands in their skin. Whilst we cant control who our parents are, do not worry, as there are PLENTY of treatments options available on our website to help you control your acne.
Cosmetics – Oil based treatment options can sometimes cause or worsen acne e.g. waxes and gels that contain petroleum jelly or lanolin.
Diet – Sugary foods may be associated with an increased risk of developing or worsening acne- so it may be wise to try to cut down on your treats (biscuits, ice cream, chocolate).
Stress – The evidence says there may be an association between stress and acne- and some people may also scratch and pick their acne as a result of stress- making it worse!
Medications and Medical Conditions e.g. Steroids (Creams and Tablets), Polycystic Ovary Syndrome (PCOS)
In a nutshell:
• Greasy skin
• Blackheads and Whiteheads (Comedones)
• Larger red inflamed spots with pus (Papules and Pustules)
• Scarring (In moderate to severe disease)
Acne can appear slightly differently in different people- most people will have greasy skin which usually affects the face but can also occur commonly on the back and chest. At the milder stage it can present as blackheads and whiteheads (little pimples under the surface of the skin from blocked pores). As acne progresses in severity it can lead to inflamed red spots (known as papules) and spots containing pus (pustules). The most severe forms of acne can include deep red painful large spots called cysts- these are best assessed by a consultant dermatologist in a hospital setting. In some cases acne may also lead to scarring which can either be atrophic (loss of tissue) or hypertrophic (increase of fibrous tissue) scars- there is more information below in the FAQs about acne scarring and how to manage it.
The vast majority of cases of acne are straightforward and easy to self-diagnose. The following categories help us break down the severity of the acne and help us select the correct treatments.
Mainly consists of non-inflamed blackheads and whiteheads (comedones) but may have a few little inflammatory red spots (papules)
More widespread blackheads and whiteheads with a higher number of inflamed red spots (papules) some which may have small amounts of pus in them (pustules)
Widespread areas of inflamed papules, pustules and larger nodules and cysts- there may also be scarring of the skin.
NOTE: Don’t worry if you are unsure of what treatments to select or what type of acne you have. You can start a simple online questionnaire-based consultation, attach some photos, and we will let you know if the treatment you have selected is safe and appropriate- if not, we will recommend an alternative. If you’d prefer to talk over the phone, you can book in for a 20minute telephone or video consultation with one of our friendly dermatology specialists and we can recommend suitable treatments and advice.
Here are some of the treatment choices that we offer for acne in line with the latest clinical guidelines for dermatology in the UK (click on the product for more information and to start a consultation). Remember- treating acne and getting your skin under control does not happen overnight- we would recommend given treatments at least 3 months of consecutive use to see maximum benefits.
Differin ® Cream or Gel (Adapalene) – A retinoid that reduces the amount of grease and helps unblock pores.
Epiduo 0.1% ® (Adapalene combined with BPO (benzoyl peroxide)) – A retinoid plus the antibacterial and anti-inflammatory action of BPO which reduces grease, redness and unblocks pores to help reduce blackheads and whiteheads, and larger papules and pustules.
Isotrex ® (Isotretinoin gel) – A retinoid that reduces the amount of grease and helps unblock pores to reduce blackheads and whiteheads.
Skinoren (Azelaic acid) 20% Cream – Antibacterial and reduces blackhead and whitehead formation – good for sensitive skin and those with darker skin where acne can lead to darkening (hyperpigmentation).
Acnecide Gel (Benzoyl peroxide) – Antibacterial and helps unblock pores and prevent formation of blackheads and whiteheads.
Epiduo 0.1% ® (Adapalene combined with BPO (benzoyl peroxide)) – A retinoid plus the antibacterial and anti-inflammatory action of BPO which reduces grease and unblocks pores to help reduce blackheads and whiteheads, and larger papules and pustules.
Treclin ® gel (clindamycin and tretinoin)– A retinoid plus a topical antibiotic which helps reduce grease, unblock pores and kill the acne bacteria.
Duac ® gel (clindamycin + BPO)– A topical antibiotic to help reduce the acne bacteria plus BPO which has antibacterial and anti-inflammatory effects to reduce blackheads, whiteheads and larger papules and pustules.
Zineryt Lotion (Erythromycin and Zinc acetate)– A topical antibiotic that will reduce acne bacteria and zinc can help dry and tighten the skin to reduce grease, as well as having antibacterial properties.
Dalacin-T Lotion (Clindamycin)– A topical antibiotic that helps reduce the amount of acne bacteria living on the skin- this in turn lowers the number of red and irritating pimples and spots (papules and pustules) and is particularly good for greasy skin.
Zindaclin 1% Gel (Clindamycin)– A gel form of a topical antibiotic that is easy to apply and reduces the amount of acne bacteria on the skin- this in turn reduces redness, irritation, greasiness and number of blackheads, whiteheads, pimples and spots.
An effective choice for many is to combine oral antibiotics with an appropriate topical agent (cream or gel)- for example- Epiduo gel once daily+ Lymecycline 408mg capsules once daily. Oral antibiotics should not be used alone because they can worsen antibiotic resistance which can make acne worse in the long run.
Tetralysal (Lymecycline 408 mg) capsules – An oral antibiotic from the tetracycline class which has antibiotic and anti-inflammatory actions – helps to reduce the growth of acne bacteria and therefore reduces redness, inflammation, grease and number of acne spots.
Doxycycline 100 mg capsules – An oral antibiotic from the tetracycline class which has antibiotic and anti-inflammatory actions – helps to reduce the growth of acne bacteria and therefore reduces redness, inflammation, grease and number of acne spots.
Oxytetracycline 250mg tablets – An oral antibiotic from the tetracycline class which has antibiotic and anti-inflammatory actions – helps to reduce the growth of acne bacteria and therefore reduces redness, inflammation, grease and number of acne spots.
Minocycline 100mg mr capsules – An oral antibiotic from the tetracycline class which has antibiotic and anti-inflammatory actions – helps to reduce the growth of acne bacteria and therefore reduces redness, inflammation, grease and number of acne spots. Convenient once-daily dosage.
Clarithromycin 250mg tablets – An oral antibiotic from the macrolide class – helps to reduce the growth of acne bacteria and therefore reduces redness, inflammation, grease and number of acne spots. Better for light-sensitive skin than the tetracycline antibiotics listed above.
Epiduo 0.1% or 0.3% gel® (Adapalene combined with BPO (benzoyl peroxide)) – A retinoid plus the antibacterial and anti-inflammatory action of BPO which reduces grease and unblocks pores to help reduce blackheads and whiteheads, and larger papules and pustules.
Acnecide Gel (Benzoyl peroxide) – Antibacterial and helps unblock pores and prevent formation of blackheads and whiteheads.
Differin ® Cream or Gel (Adapalene) – A retinoid that reduces the amount of grease and helps unblock pores.
Hormonal Treatments – Contraceptive Pills (Females Only)
These can be used alone or in combination with creams, gels and oral tablets/ capsules. They may be used for moderate to severe acne and are particularly good for inflamed acne (papules and pustules) or where a hormonal component is suspected to be a major factor. We offer 2 choices of combined oral contraceptive pills (COCPs) that may be specifically better for acne than other more common COCPs that are prescribed in the UK. As with all medications, COCPs must be safe for the patient to use, therefore there are certain checks that need to take place before they can be prescribed safely. For example, before purchasing COCPs you must be able to provide us with an up-to-date blood pressure which can be obtained from your own purchased machine at home or from popping into a pharmacy or G.P to have it taken.
Dianette (Cyproterone Acetate/Ethinylestradiol) – Contains the anti-androgen Cyproterone which will help reduce greasy skin and improve overall symptoms of acne. It may also have a benefit of reducing excessive hair growth. Ethinylestradiol is a type of oestrogen (female sex hormone) that may help stabilise hormonal activity and acts as a contraceptive.
Eloine (Ethinylestradiol/ drospirenone) – A combined oral contraceptive pills (COCPs) containing a lower dose estrogen that may help improve overall symptoms of acne.
We do not treat severe acne as this is best done by a consultant dermatologist who may decide to use specialist treatments such as oral Isotretinoin. If you feel you have severe acne it is best to see your GP who will be able to refer you to a dermatologist.
All acne types may also benefit from a daily Acne Cleanser and those with dry or sensitive skin may also benefit from an Acne Moisturiser- this is in addition to a separate acne cream or gel applied at night. Also don’t forget your suncream (SPF), especially during summer. For information on how and when to apply these (your skincare routine for acne) please see the FAQ’s below.
– CeraVe SA Smoothing Cleanser
– Cetaphil Gentle Skin Cleanser
– Acnecide Daily Cleanser
– Acnecide Face Wash
– Quinoderm Antibacterial Facewash
– CeraVe AM Facial Moisturising Lotion
– Cetaphil Moisturising Lotion
– Acnecide Moisturiser SPF30
– SunSense Sunsensitive Cream 100g SPF50+
– Eucerin Sun Gel Cream Oil Control Sun Cream SPF50
The treatments we offer for acne at DigiDerm are all medications that are ‘evidenced-based’ – this means that there have been robust clinical trials that have proven that these medications are safe and effective treatments. However, there are 1000’s other products and ingredients that some may find useful in treating and preventing their acne – although these may not have been through the same rigorous testing as prescription-only or pharmacy only medications- they may still be beneficial. These ingredients are often found in products such as cleansers, toners, moisturisers, scrubs, peels and masks.
As with all ingredients and medications, they may cause sensitivity and/or allergic reactions – so if you notice any adverse effects then stop using the product and contact a pharmacist or doctor for advice. If you have very mild acne you may wish to try some of the over-the-counter ingredients for a few weeks first before potentially moving on to stronger prescription-only medications.
Glycolic, Lactic, Tartaric, Citric, Malic, Mandelic Acids
These are water soluble acids that may have a mild exfoliating effect (peeling) which can help new healthier skin cells emerge. They can also help with darkening (hyperpigmentation) and mild scarring in acne. They are also good for fine lines and wrinkles, and evening out skin-tone.
Salicylic Acid, Citric Acis
These are fat (oil) soluble acids that can penetrate the skin and reduce grease, remove dead skin cells and reduce clogging of the pores in acne.
A water-soluble form of vitamin B3 – may reduce inflammation and repair damaged skin in acne.
Retinol, Retinaldehyde, Retinyl Palmitate- Weaker non-prescription strength forms of retinoids (Vitamin A derivatives) that help reduce the ‘stickiness’ of skin cells – this helps keep pores unblocked and prevents the build up of sebum (grease). They may also have good effects at reducing darkening (hyperpigmentation) and fine lines and wrinkles.
A natural ingredient that has antiseptic properties and may reduce the overall symptoms of acne.
Has anti-inflammatory and astringent properties which will help reduce redness & greasiness of acne prone skin.
Has antiseptic and keratolytic properties which help reduce acne bacteria and unblock pores.
This is an oral medication (tablet/ capsule) that is prescription only and prescribed by consultant dermatologists for severe forms of acne. We do not currently provide prescriptions for Isotretinoin at DigiDerm. It is a Vitamin A derived drug that is very effective in severe Acne and is usually tried after other prescription treatments have been used and have not sufficiently improved the patient’s acne. It can have some unpleasant side effects including headaches, dry skin and lips- and will require blood tests during treatment. As it is a potent retinoid it can damage an unborn baby and therefore patients will require adequate contraception and a discussion of the risks versus benefits of treatment. You can request a referral from your G.P to a consultant dermatologist if you believe you may be suitable for oral Isotretinoin. We do not do referrals for Isotretinoin at DigiDerm currently.
An oral medication (tablet/ capsule) that is classed as a diuretic (water tablet) but which can sometimes have a role in acne especially in women with polycystic ovary syndrome (PCOS). Due to the need for blood tests and other factors, spironolactone tends to only be prescribed by specialist consultant dermatologists in the hospital setting. We do not offer prescriptions for spironolactone at DigiDerm currently.
There are several commercially available ‘do-it-at-home’ light and laser therapies for acne available, but so far there is not a large enough evidence base for these types of treatments to be included in UK clinical dermatology guidelines. They may be a handy alternative for acne sufferers who do not like creams or tablets or want to try an alternative and may provide some benefit. Laser therapy such as laser resurfacing can also be used for acne scarring and this is best done by a trained consultant dermatologist (see FAQs below for more info on scarring).
A type of exfoliative treatment whereby the skin is cleansed and then a chemical solution is applied to the skin for several minutes and then washed off. A few days later the skin will shed (minor peeling) hopefully revealing healthier less acne-prone skin. Superficial chemical peels may be particularly useful for those with many whiteheads and blackheads and milder forms of acne. You can get medical and clinic grade peel and we would advise you do your research and make sure it is a trained professional who is doing the procedure.
We would love to give you a clear-cut answer for this one, but the jury is still out on this. There is some newish evidence that eating foods with a low glycaemic index as opposed to a high glycaemic index may improve acne. There is also some weaker evidence to suggest that dairy products may worsen acne, however it is important to note that currently there are limited clinical trials to support this idea. It is thought that these foods can lead to sugar spikes and the release of hormones such as insulin and androgen -which can act to increase sebum and worsen acne.
Low glycaemic index foods that may benefit acne:
Vegetables (Peppers, broccoli, tomatoes, lettuce)
Wholegrain foods
Fish, Olive Oil, Garlic (Mediterranean style diet)
Fruits (e.g. Strawberries, apples, pears)
Beans and Legumes (e.g. Chickpeas, beans (dried or boiled), legumes.)
Dark chocolate with more than 70% cocoa (this is better than milk chocolate!)
Nuts (e.g. Cashews, peanuts.)
High glycaemic index foods to avoid which may worsen acne:
Sweets, chocolate and biscuits
Most fast foods
Sugary fizzy drinks
White bread
We would recommend a balanced diet overall, but people may recognise that certain foods can worsen their acne- therefore it makes sense to try to reduce or cut these foods out completely from your diet. Another idea is to keep a daily food diary for 2-3 months which may help you identify specific food triggers for your acne. Some people with acne may also have an eating disorder and if you feel that you are struggling with this then please let someone know and seek some help from your G.P.
Here at DigiDerm we are big fans of keeping it simple. We find that this means people are more likely to get into the habit of a consistent routine. If you have a consistent, simple daily routine, you are more likely to see quicker and better results. Acne doesn’t get cured overnight. It can take anywhere from 3-6-9 months to see maximum improvement, although some people may see quite significant improvement in a matter of weeks. There is no ‘one-size fits all’ routine as people may have different skin types (e.g. oily, sensitive, dry). Most people with acne will have some degree of oily skin so therefore we would recommend:
Morning
Cleansing with an aqueous based cleanser (see treatments section above)
Apply Prescription or other acne treatment cream (If appropriate)
Moisturising with a water-based product (especially if you have dry skin or skin irritated from you prescription strength acne treatment)
Apply SPF / Sunscreen
Apply make-up last (although make-up is best avoided whilst undergoing acne treatment!)
Afternoon
Remove Makeup using an oil-free makeup remover
Cleansing with an aqueous based cleanser (see treatments section above)
Apply Prescription or other acne treatment cream (If appropriate)
Moisturising with a water-based product (especially if you have dry skin or skin irritated from you prescription strength acne treatment)
Most people can wear makeup without it worsening their acne or interfering with acne treatment. However, if you think you makeup is a problem then stop using it and try something else. Read the labels on the products you are using and choose makeups that are water-based, free from oil or labelled as ‘non-comedogenic’. This will avoid the makeup occluding your skin and blocking pores, which could potentially cause acne (‘acne cosmetica’) or worsening your existing acne. Remove your makeup before going to bed with a water-based cleanser.
To avoid skin irritation, apply makeup gently with a ‘feather-light touch’ using brushes. To avoid increasing the bacterial load of acne on your skin wash your makeup brushes weekly and do not share them with others. Acne cosmetica (where your makeup is causing your acne) can cause lots of whiteheads and papules (pimples) to appear on your face and it can sometimes take months to appear. If you are in doubt if you have acne cosmetica and would like some advice, then feel free to book a telephone consultation with one of our friendly dermatology specialists.
Acne is not caused by having a ‘dirty’ face or being ‘unhygienic’- however, having a good cleansing routine will help improve acne. We would recommend cleansing the face at least once per day with an acne wash as this will help remove any excess grease, cosmetics and other substances that may block the skin pores. See the treatment section for some options for cleansers.
Consultant dermatologists are the best people to deal with very severe or complex forms of acne. This includes patients with significant scarring, those with moderate acne who are not responding to treatments, and those with associated severe psychological symptoms such as anxiety and depression. We do not currently refer patients to consultant dermatologists- this would be best done via your G.P.
Acne is a chronic (long-term) disease which means that for most people it will last longer than a few weeks. Most cases will clear up by the time people reach their late teens or early 20’s, however about 20% of women and 10% of men will still have acne after the age of 25. A smaller group of people may have acne that lasts into their 30’s and 40’s. The good news is with early and consistent treatment many people can bring their acne under control, so it is almost unnoticeable.
It is unusual for the skin to completely return to normal, however, with early intervention and the right mix of treatments then you can see significant improvements. About half of smaller scars may improve naturally within a few months to a year. Those with more severe, deeper acne lesions and those who are constantly squeezing or picking their spots (stop!) are more likely to have more pronounced acne scarring that is more difficult to correct. Broadly speaking there are two different types of acne scars: Atrophic scars (depressed scars) and Hypertrophic (elevated scars).
We would not recommend patients to start having treatment for scarring whilst they still have ongoing acne because this can cause the acne to flare. For minor elevated scars which often effect the shoulders, chest and jaw- there is the option to treat with a silicone gel such as Dermatix Silicone Scar Gel or Kelo-Cote Scar Gel. Another option could be the careful short-term application of a potent topical steroid cream such as Betnovate Cream- however it is important this is only applied to the scar tissue itself and not the surrounding skin. Other effective treatment options include laser therapies, chemical peels, microneedling and surgical treatments- these treatments are best accessed from a consultant dermatologist who will be safely and competently trained. The key take-home message with scarring is that ‘prevention is better than cure’ so therefore it is important to access effective treatments as soon as possible.
Acne will affect most of us at some point during our lives and all types of acne can cause a person to feel psychological distress such as low self-esteem, anxiety and depression. More than 90% of people say their skin condition affects their self-esteem and more than 80% say their skin has affected their sleep. At DigiDerm we understand the impact that poor mental health can have on someone’s life, and we are here to listen and support the best we can. Check out our free mental health advice for people with skin conditions which contains some practical tips on how you can improve your mental wellbeing. If you think you are suffering with serious signs of poor mental health, then please SPEAK UP and LET SOMEONE KNOW– we would encourage you to seek help via your NHS G.P or local mental health service. You can find a bunch of helpful numbers and contacts for mental health support on our mental health advice page.
There is no ‘one size fits all’ treatment approach for acne as people have different severity of acne and different skin types (oily, dry, sensitive etc). We would recommend looking above at our diagnosis and treatment sections and selecting a product that matches the level of severity of your acne. If you are still unsure if a product is right for you, simply complete the questionnaire-based consultation, attach some photos and we will advise you if the product is suitable or suggest an alternative. You can also book a friendly telephone consultation if you’d prefer.
The face, back and chest are the main areas where there is a higher amount of oil glands in the skin. These oil glands (pilosebaceous units) secrete sebum which can block pores and cause acne. Forehead acne can be caused by oily hair rubbing against your forehead e.g., having a fringe or wearing a hat. Also, hair products especially those with occlusive ingredients such as thick oils and waxes can cause acne on your forehead. Acne on the jawline, lower cheeks and chin may be more prominent in women and it can also be related to using your mobile phone on the one side of your face. Try to clean your phone now and again and give your skin a break from the bacteria, heat and pressure that comes from pressing a phone screen against your skin.
Acne can occur in pregnancy and sometimes worsens due to hormonal changes. As with all medicines and treatments in pregnancy, there will always be a small risk attached of potential harm to the unborn child and mother. This is because most acne medications and products have not been tested in pregnant women (for ethical reasons!) and therefore they do not have a robust safety profile to grant them a product license. When in doubt it is best to have a chat to a registered healthcare professional who will discuss the risk versus benefits of using medicines and treatments in pregnancy. You can book a friendly telephone consultation with one of our dermatology pharmacists to discuss treatment options for acne in pregnancy if you’d prefer. If you are planning a pregnancy or pregnant then you must avoid using topical and oral retinoid products and oral tetracycline antibiotics as these carry a high risk of harm. Treatments that are generally accepted to be safe in pregnancy include benzoyl peroxide e.g., Acnecide Gel, Erythromycin and zinc topical solution (Zineryt Lotion) and Azelaic Acid cream/ gel. We would also advise avoiding any skincare products containing the aspirin derivative ‘salicylic acid’ as this could pose the risk of harm to an unborn baby.
Guidance for pregnancy and breastfeeding can vary from product to product so please carefully read the product information before use and always inform us if you are currently pregnant/ planning pregnancy or breastfeeding whilst completing a consultation.
There is no conclusive evidence that acne is caused by covid although the emotional and physical stress of having coronavirus may cause a worsening of acne. The main problem people have is that they find that wearing a facemask to protect against covid may in fact worsen their acne. Facemasks can cause the build up of sweat, oil and acne bacteria and may cause irritation. Here are a few tips to help minimise these problems and get your skin looking healthier:
Whilst there is limited conclusive evidence that proves an association between stress and acne, we have found that many of our patients believe this to be true. A small study in the Archives of Dermatological Research in 2003 found that as people’s stress levels increase so does the severity of their acne- this could be related to external emotional events. Stress may also delay the healing of acne spots and cause people to pick their spots compulsively- known as ‘Acne Excoriee’.
Acne and Rosacea are different skin conditions and have different causes and treatments. They can appear to look the same to the untrained eye, but there are a few key differences:
Mainly affect Teenagers and those in 20’s
Mainly affects those over 30 years old (more common in those with fair skin)
Blackheads, whiteheads, pimples, cysts and nodules on face, jawline, back and chest
No blackheads, Pimple-like breakouts mainly on face and eyes (redness can extend to scalp, neck, chest, upper back)
Redness around your spots only
Widespread Redness in the centre of your face -cheeks, forehead, nose and chin- this can come and go or be permanent
Oily skin
Very sensitive skin- burning, stinging, itching- especially when applying certain products
Bumpy skin textures from blemishes or scars
Large pores in the skin and visible blood vessels
Eye problems- bloodshot eyes, swollen eyelids and discomfort
Other skin conditions that commonly disguise themselves as acne or rosacea are perioral dermatitis, folliculitis and keratosis pilaris. If you are unsure whether you have acne or rosacea, please book in for a friendly telephone consultation with one of our dermatology pharmacists who can discuss how we can help.
To many people the words acne and pimples mean the same thing, but if we’re going to get technical, then there is a difference. Acne is a disease that may cause pimples (small spots or blemishes) as one of its symptoms, along with excess sebum, redness etc. It is also normal for some people to get a few minor pimples as part of their normal skin type without necessarily having acne. Minor pimples would have a shallow blemish with a whitehead or blackhead. If you are suffering from acne, you would likely have a larger number of persistent pimples which may have additional swelling, redness, tenderness and a greater sebaceous/oil content.
Acne can unfortunately cause changes to your skin colour due to inflammation (known as post-inflammatory hyperpigmentation). In white or paler skin this can look red, and in pigmented or darker skin this can look dark brown. This can be significant and sometimes last for months to years. Pigmentation will usually fade over time, but it is important to access early treatments for acne to try to prevent this happening in the first place. There are a few options for treating hyperpigmentation in acne which may help the skin turn back to its original colour quicker- these include retinoids (e.g. Differin 0.1% Cream/Gel), or Azaelic Acid (e.g. Skinoren 20% Cream).
If you have ‘acne-like’ spots on your buttocks it is much more likely to be due to another condition called folliculitis – this is where your hair follicles become infected with bacteria and inflamed leading to an itchy red rash. If you suffer from this it may be worth trying to avoid wearing tight-fitting clothing and to bathe regularly after exercise or when you may become excessively sweaty. Folliculitis is also common in the beard area in adult males. Most cases of folliculitis will resolve without treatment, however, topical antiseptic solutions such as chlorhexidine (Hibiscrub) may help to treat and prevent. In more severe cases of folliculitis then oral antibiotics may be warranted- we do not currently offer this treatment at DigiDerm and would recommend you contact your G.P.
Also know as ‘Bacne’, this affects around half of all people with acne. People tend to get more painful, deeper acne spots on the back due to the thicker epidermal layer of skin that grows here. The treatments for the back are essentially the same as for any other area of acne, however if you have widespread acne on the back, it may be more practical to go for an oral antibiotic such as Lymecycline 408mg Capsules (it can be very difficult to apply a cream to your own back!). The usual hygiene measures would apply here such as wearing loose fitting clothing and showering after exercise or periods of excessive sweat.
