Ask the Skin Experts

At DermLetter, and on our corresponding YouTube channel, SkinExpertsTalk, we sometimes get impossible requests: Online diagnosis, personalized medical advice, or advice about the safety profiles of unregulated products, and other similar requests.

As the skin experts, we are sometimes stuck between a rock and a hard place. There are very good reasons that doctors do not and should not provide diagnoses online. Unfortunately, some of the people that reach out to us don’t have very good access to medical care, and that’s precisely the reason that they are soliciting advice online.

Access to healthcare is often thought of in narrow terms--geographic access. Geographic access is a problem that’s easy to identify with since it’s very much a problem in North America as well--the rural areas have far less access to specialists like dermatologists which is becoming a chronic problem in Canada, and access to cosmetic dermatology is nearly exclusive to large cities everywhere in the world. In many developing nations, however, affordability and acceptability are also important limitations. That is, access to quality care may be limited, as is the affordability of the care. While we often are forced to say, “we advise you to see a doctor,” for many people, this is both unaffordable and impractical, particularly if the quality of health care that they have access to is low. If a patient spends a relatively large amount of their available budget to see a physician about their acne, and receives low quality care, and sees no results, it’s not practical at all to see a physician to treat acne, even if it’s affecting their quality of life significantly. Needless to say, this is a serious problem and there are no quick and easy solutions.

Skin concerns are often trivialized as “cosmetic” everywhere in the world--and if access to healthcare is either expensive, ineffective, or inconvenient, often it’s the first concern that gets ignored. There are good reasons why it’s important to see a medical professional for a proper diagnosis, and to gain access to the treatments that are needed. Unfortunately, for many people the ground reality is that they need to pick and choose what to handle at home, and what to go to the doctor for. This is also true in North America as well. With greater “access” in the broader senser of the word, patients are less likely to fight skin problems on their own, but the fact is, people will need to pick and choose what to deal with at home, and what to go to the doctor for and making that important decision is up to the judgment of the patients.

While we can’t solve the problem of healthcare access in an article, we wanted to provide some self-help tips for the most common complaints that we hear from people:

Dry Skin/Eczema

  • Improve your bathing habits. Specifically, bathe and shower less, and lower the temperature. Hot water strips off the skin oil that helps seal moisture in the skin.
  • Keep a moisturizer at hand in the bathroom. After a shower or bath, pat your skin off gently instead of rubbing vigorously. Your skin should be moist at this point still. Apply moisturizers to your body, focusing on the dry areas. This helps amplify the effect of the moisturizers, helping your body seal in some of the natural moisture that it has. This simple trick alone can make a big difference.
  • If you live in a cold arid climate, protect your skin from exposure. Cover your skin by wearing longer sleeves.
  • If you follow all of these tips, and still have severe dryness, rashes, or itching, it’s a good idea to see a doctor.

Acne/Oily Skin

  • Acne is not only common; it’s commonly ignored. While acne won’t kill you, it’s also not trivial, and can lead to scarring which can be hard to fix later.
  • If you have access to a doctor, don’t ignore acne, and don’t let your kids ignore acne. There are effective and safe treatments for acne, so there’s no need to suffer.
  • Don’t over-cleanse the skin, especially with harsh soaps. Acne is not caused by dirt so be gentle with your skin.
  • Cut your hair short if it’s long to prevent hair from coming into contact with the face, or tie or clip your hair back.
  • The relationship between diet and acne is not understood well. These types of causal relations are extremely hard to isolate in controlled studies as there are many factors in acne, many of which are individual. There is a reasonable case to be made from the mountain of anecdotes that in some people, there is a link. If you notice that certain foods seem to be correlated to acne formation, do the reasonable thing and try and avoid those foods as much as possible.
  • If you have inflamed acne, or significant acne on non-facial areas, it’s a good idea to see a doctor. These have a higher chance of leading to scarring.

Dark Spots/Uneven Spots/Hyperpigmentation

  • Just as early wrinkling and volume loss is a common concern among people with light skin color, hyperpigmentation is a very common concern among people of color. Melanin helps protect the skin from UV damage, but it can also be the cause of problems like hyperpigmentation.
  • Hyperpigmentation is often challenging to treat, even with the help of a dermatologist. Sun protection is the crucial element in preventing it in the first place. It’s especially important if you are applying treatments for hyperpigmentation, as many ingredients used to treat hyperpigmentation also makes the skin especially sensitive to sunlight.
  • Post-inflammatory hyperpigmentation (PIH) is also very common. Scars, even very minor ones will often cause the healed skin to become darker compared to surrounding skin. These won’t go away anytime soon, but they also are not permanent in most cases. Most of the time PIH will slowly fade away over time--from 6 to 18 months.


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