WEEK 1 – ASK THE DOCTOR

Question: 

“I am just gone 30 and have started to notice some small changes in my face and body recently. I am getting some skin colour bumps on my eye lids (one on each inner eyelid so far) and am not sure why. Should I exfoliate more or will these just continue to form? I know it’s a silly question but I want to prevent more as much as possible.

Dr Mukesh:

Dear reader, thanks for your list of questions, I hope I can answer them for you in a way that makes sense but is not too boring.

With regard to the first part of your question, you have a condition of your eyelid skin called Primary Milia. Usually they are found around the eyelids and cheeks. They are caused by the formation of tiny white cysts in small areas under the surface of the skin, usually the eyelids or cheeks.  Typically any product that is greasy can block one of your pores and lead to Milia. Avoiding these products and using and regular good cleansing may be preventative.

There is no cream or way to remove them. These tiny cysts have a thin almost translucent skin covering which is usually opened, de-roofed, with the tip of a needle allowing the contents to be removed. A simple and often painless doctor’s office procedure.

Below is a picture of one under the microscope that I removed today in fact from a young woman in her late twenties.

You also say that you can see red veins under the skin but the redness and sometimes slight irritation is getting worse. I could be wrong, but to my mind, it sounds like you are suffering from Rosacea. Rosacea is an allergic condition of the skin on the face and nose.

It is found in people who have a very low grade allergy to a mite that we all carry on our skin called the Demodex mite. This little guy is the cause of misery for thousands of Celtic men and women in particular and the chronic low grade allergic reaction causes dry sensitive skin, which can produce some spots, even though it is dry and eventually the low grade chronic allergy shows itself in the second and third decades as increasingly sensitive skin with the appearance of superficial capillaries that lead to increased redness.

The condition can be controlled by reducing the numbers of the mites with topical antibiotics, but not cured. Laser treatments help too, but only if they are done the right way.

They can help kill the mites and so reduce the allergy in the skin and I usually find I can clear the red veins in one to two treatments. I also give six months of a particular antibiotic cream and tell people not to keep swapping creams in the hope of finding a cure, just stick to a range that suits you and that you can tolerate, nothing you can DO will cure it I am afraid.

Under the microscope the skin can look like this:
With regard to the third part of your question (‘One more problem I have had for years now is irritated red skin on my upper arms on the outside after I shower. I’ve started using shower cream for sensitive skin but that doesn’t seem to help’)

I have no doubt that what you have is called Keratosis Pilaris.

There’s no cure for Keratosis Pilaris, but you may be able to improve the rash by using soap-free cleansers, moisturising and gently exfoliating (removing dead skin cells from the surface of the skin). Urea based creams help along with cool showers.

There’s no real need to see your GP unless the condition is causing you concern. It usually improves as you get older and sometimes disappears completely in late adulthood.

Keratosis Pilaris most commonly affects the back of the upper arms, and sometimes the buttocks and front of the thighs.

The patches of affected skin will be covered in tiny spiky bumps, which may be white, red or skin-coloured. This spotting looks like “chicken skin” or permanent goose pimples, and the skin feels rough, like sandpaper. In some people, the skin itches and there may be pinkness around the bumps.

Keratosis Pilaris isn’t contagious. The skin tends to improve in summer and get worse during winter months or dry conditions.

It is is very common, affecting up to one in three people in Ireland and the UK. It can affect people of all ages, but it’s particularly common in children and adolescents, females, people with eczema or a condition called ichthyosis (thick, dry scaly skin), people of Celtic origin

The condition typically starts during childhood, and gets worse in adolescence, around puberty.

Keratosis Pilaris sometimes improves after puberty, and may even disappear in later adulthood, although many adults still have the condition in their 40s and 50s. It’s uncommon in elderly people.

Keratosis Pilaris runs in families and is inherited from your parents. If one parent has the condition, there’s a one in two chance that any children they have will also inherit it.

Keratosis Pilaris occurs when too much keratin builds up in the skin’s hair follicles. Keratin is a protein found in the tough outer layer of skin, which causes the surface of the skin to thicken (hence the name “Keratosis”). The excess keratin blocks the hair follicles with plugs of hard, rough skin. The tiny plugs widen the pores, giving the skin a spotty appearance.

It’s often associated with other dry skin conditions. There’s little that can be done to treat keratosis pilaris, and it often gets better on its own without treatment.

However, if it’s bothering you, the following measures may help improve your rash:

Use non-soap cleansers rather than soap – ordinary soap may dry your skin out and make the condition worse.

Moisturise your skin when it’s dry –your GP or pharmacist can recommend a suitable cream. However, moisturisers and emollients only reduce the dryness of your skin and won’t cure the rash. Creams containing salicylic acid, lactic acid or urea are thought to be the most effective.

Gently rub the skin with an exfoliating foam pad or pumice stone to exfoliate the rough skin – be careful not to scrub too hard and rub off layers of skin.

Take lukewarm showers rather than hot baths.

I hope this helps.

Dr. Mukesh Lalloo FRCS(Ed) MICGP