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Skin Care

Our skin care section contains products for treating acne, bacterial, fungal and viral skin infections and inflammatory conditions of the skin; as well as various skin beauty products.

The different classes of Skin Care products are listed on the left of the page and when you click on one of these, the principal brand name products display in the left column and generic alternatives to the right.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. Tretinoin or the product name, e.g. Retin A Cream

Our acne class of Skin Care products contain oral and topical medications to treat, prevent and heal acne skin spots and lesions, and treat infected acne, including keratolytics and antibiotics.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. azeleic acid, or the product name, e.g. Acnederm.

What is acne?

Acne vulgaris is the most common form of acne and can affect the face chest and back. It is often associated with adolescence and puberty when a surge of androgen hormones can over stimulate the sebaceous glands (oil producing glands in hair follicles) to produce too much sebum. This combines with skin cells that are shed from the lining of the hair follicle and become trapped in sebum forming a plug below the surface of the skin and clogging the pores forming comedones. The bacterium Propionibacterium acnes that normally lives in the skin multiplies rapidly in the presence of the extra sebum so that the clogged pores become infected triggering an inflammatory response causing inflammation and this is the start of an acne outbreak. There are several types of acne lesions including, open comedones or blackhead, closed comedones or whiteheads, pimples or papules, spots or pustules. If the lesions are extreme they can form cysts and nodules, which are likely to form scars as the skin heals.

Keratolytic acne treatments

Several of the medications used for treating acne have keratolytic activity. Keratinisation is the hardening processes of the outer skin layer, whereby as new keratinocytes move up from the lower to the upper layers of the epidermis keratin is deposited within the cells; they begin to die and are sloughed off. A keratolytic agent helps soften hardened skin by increasing turnover of keratinocytes, blocking the keratinisation process and promoting the shedding of old hardened skin cells, allowing new skin cells to take their place. This process helps remove excess hardened keratinocytes that block hair follicles leading the formation of acne lesions and this helps unblock the oil ducts allowing the comedomes and acne lesions to dry up and heal; also preventing the outbreak of new comedomes.
Topical keratolytic medications for acne include:
  • azelaic acid, a natural product of a yeast that lives on normal skin, with antibacterial and anti-inflammatory activity.

  • tretinoin and iso tretinoin are active metabolite of Vitamin A known as retinoids that stimulates skin cell proliferation, promoting growth of new skin cells to speed up skin cell turnover. They are available as creams and gels; tretinoin is also available is a gel containing microspheres that increases drug delivery direct into the hair follicles. These retinoids also block the activity of inflammatory cells like leukocytes and the production of inflammatory chemicals, which inhibits the inflammatory reaction. Tazarotene is also a retinoid and is a pro-drug of Vitamin A.

  • adapalene, is a retinoid-like compound with similar activity to tretinoin suitable for topical treatment of mild acne, but is more stable and more fat soluble and becomes trapped in the hair follicles.

  • benzoyl peroxide, an antiseptic and oxidising agent, with anti-inflammatory properties.

Antibacterial treatments

If acne lesions do not clear up using keratolytic medications and become infected, antibacterial treatments may be needed.
  • Topical antibiotics like clindamycin and erythromycin are used for mild to moderate acne. They are applied as a cream or gel that absorbs rapidly into the skin and penetrates the comedomes where they act directly on the Propionibacterium acnes bacteria, inhibiting bacterial protein synthesis, which kills the bacteria. They also reduce the amount of fatty acids in the skin that the bacteria live on.

  • Oral antibiotics are used to treat more severe cases of infected acne, including cystic and pustular types of acne lesions. Doxycycline and minocycline both broad-spectrum antibiotics belonging to the tetracycline group of antibiotics and inhibit protein synthesis in susceptible bacteria, including Propionibacterium acnes.

  • Other topical acne medications also have antibacterial activity. These include azelaic acid and benzoyl peroxide that penetrate the skin and reduce growth of the Propionibacterium acnes bacteria, which helps prevent the spread of infection. They also inhibit the production of acne-promoting fatty acid, which helps unblock the pores and promotes healing.

Anti-inflammatory treatments for acne

Topical retinoids like tretinoin, isotretinoin and tazarotene block the activity of inflammatory cells like leukocytes and the production of inflammatory chemicals, like prosyaglandins and leukotrienes. Adapalene also blocks formation of inflammatory chemicals. These actions inhibit inflammatory reactions and help reduce inflammation in acne lesions.

Anti-androgen hormonal therapy

Although androgens like testosterone are primarily male hormones, women also produce smaller amounts. The hormonal surge associated with puberty results in elevated levels of androgens and this stimulates overproduction of sebum, which is one of the main causes of adolescent acne. Overproduction of or increased sensitivity to androgens can also occur in adult women, a condition known as androgenisation, which can also lead to an outbreak of acne. Anti-androgen hormonal therapy can be used in women to counteract the actions of androgen to reduce sebum production and this reduces formation of acne comedomes. The anti-androgen cyproterone acetate blocks androgen production of by the ovaries and also blocks androgen stimulation of sebum, by binding to the androgen receptors in the sebaceous glands of hair follicles. Ethinyloestradiol, a synthetic oestrogen is used in combination with cyproterone acetate to amplify its anti-androgen effect by further reducing the amount of androgens produced in the ovaries.

Rosacea

Rosacea is an inflammatory condition of the face and nose, which mostly affects people with fair skin who flush easily and that used to be called acne rosacea, but is a different condition. Rosacea is thought to be caused by overactive blood vessels in the face with inflammation triggered by several factors like excess alcohol, smoking, spicy food, exposure to sunlight. This causes, papules and pustules but no comedomes, as is common in acne; also reddened scaling skin with swelling of affected areas. Metronidazole is an antibacterial and antiprotozoal (single cell organism) activity that is used to treat rosacea, although the mechanism is not known but is probably due to its anti-inflammatory activity.
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Our Antibiotics class of Skin Care medications contain topical antibiotic ointments containing antibiotics used for treating skin infections.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. mupirocin, or the product name, e.g. Bactroban.

Types of skin infection

Topical antibiotics contained in an ointment are used to treat primary skin infections like impetigo (a contagious skin infection forming blisters or red spots), paronychia (infection of the nail fold), folliculitis (inflammation of hair follicles).  They are also used to treat secondary skin infections like infected cuts, grazes and abrasions, eczema and contact dermatitis, minor burns, and insect bites.  

Topical treatments for skin infections

Topical antibiotics prevent spread of bacteria and allow the infected skin to heal. 

They include:

  • Sodium fusidate, a topical antibiotic that blocks bacterial protein synthesis, and inhibits bacterial replication, but does not kill the bacteria.  It is very soluble in fat and water and penetrates the skin easily to get to the site of infection, which makes it a very efficient topical antibiotic.  
  • Mupirocin, a topical antibiotic that inhibits protein and RNA synthesis, which blocks growth and replication of these bacteria and kills the bacteria.
  • Neomycin a broad spectrum topical antibiotic that blocks bacterial protein synthesis needed for replication, and although it does not absorb into the skin, it is effective in preventing the spread of bacteria in the skin.  The antibiotic ointment is also combined with an anti-inflammatory corticosteroid to reduce inflammation in infected inflammatory skin disorders.
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Our Antifungal class of Skin Care medications include oral and topical treatments for fungal infections like thrush and ringworm, caused by most susceptible infective fungi.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. terbinafine, or the product name, e.g. Lamisil.

Types of fungal infection

Examples of common fungal infections include:
  • Tinea, a dermatophyte fungus that lives on human skin and promotes a reaction as it grows through the skin by small filaments called hyphae, causing symptoms including, inflammation, itching and rash, which can become severe. Tinea can infect many parts of the body causing infections like athlete's foot (tinea pedis), ringworm or tinea of the body (tinea corporis), tinea of the groin or jock itch (tinea cruris) and tinea of the scalp (tinea capitis).

  • Candida, a yeast that normally inhabits the gastrointestinal tract but when immunity is low or following a course of antibiotics, it can become overgrown and cause an infection called candidiasis or thrush. Areas infected by Candida include mucous membranes usually in the mouth, throat and genitals; Candida can also infect the skin and if the infection becomes systemic this can be more serious.

  • Infections of the finger nails and toe nails (onychomycosis) can be caused by Tinea or Candida, also by moulds, which are a different type of fungus.

  • Malassezia, a yeast normally found in the skin that can overgrow and cause problems like dandruff, when the rate at which dead skin cells are shed and replaced begins to speed up, as a reaction to irritation by the fungus.

  • Histoplasma that causes histoplasmosis, a rare systemic fungal infection from inhalation of a soil fungus into the lung causing flu-like symptoms and is an opportunistic infection common to people who are immunocompromised, such as due to HIV infection.

Types of anti-fungal medication

Most antifungals work by the same mechanism of action to kill the fungus that has caused the infection and prevent it spreading. They act by inhibiting the fungal enzyme, squalene epoxidase, which prevents the synthesis of ergosterol, an important component of fungal cell membrane that is not found in animal cells. This weakens the fungal cell membrane, causing the cell contents to leak out, which kills the fungus. Antifungals include:
  • Terbinafine, a broad spectrum antifungal drug that is used to treat a variety of fungal infections, and is particularly effective against tinea and candida. It is available as a cream for topical treatment and as tablets for oral administration.

  • Miconazole oral gel an antifungal drug, belonging to the imidazole group of antifungals that is used as a topical treatment for oral thrush.

  • Fluconazole a broad-spectrum antifungal drug belonging to the triazole group that is used to treat thrush and tinea and is available for oral administration as capsules and tablets.

  • Ketoconazole, a synthetic broad-spectrum antifungal drug that is used to treat a variety of fungal infections in several parts of the body, including pityriasis of the skin, candidiasis or thrush of the mouth and vagina and also systemic fungal infections. It is available as a cream or shampoo for topical treatment and as tablets for oral administration.

Antifungal application

Antifungal medications are available as creams, gels and shampoos for topical treatment of infection of the mouth, throat, skin and scalp. They are also available as capsules and tablets for treatment of more serious fungal infections, including persistent candidiasis of the vagina, pityriasis (tinea) infection of the skin and systemic infections.
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Our Anti-parasitic/Scabies class of Infections contain topical medications used to treat infections with the parasitic scabies mite that burrows into the skin and causes irritation.  <br/><br/>

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. permethrin or the product name, e.g. Lyderm Cream.<br/><br/>

What is scabies?

Scabies is an infection caused by the parasitic mite Sarcoptes scabiei that burrows into the skin causing irritation and itching.  Scabies infection is caused by direct skin contact and burrow lines can be seen at the site of infection, usually between the fingers, on the skin of the hands, feet, wrist, elbows, buttocks and genitals.  After a few weeks the immune system develops an allergic reaction to the scabies mite and to its droppings and this can result in severe itching and discomfort, with a rash over the whole body.  

Treatment for scabies infection

Treatment with the insecticide permethrin is effective in killing the scabies mite by acting as a neurotoxin and interfering with the nervous system of the parasite.  This causes paralysis and death of the mite.  The symptoms of scabies infection often continue after the scabies mite has been killed due to the allergic reaction, although this will eventually ease and symptoms disappear. 
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Our Cold Sore Treatments class of Skin Care medications are topical and oral antiviral drugs that are used to treat infection of the lips and mouth with Herpes Simplex virus, which causes cold sores.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. acyclovir, or the product name, e.g. Zovirax.

What are cold sores?

Herpes Simplex Virus (HSV) is a virus that infects mucous membrane cells and exists in two forms;HSV I that infects the lips, mouth and face, and HSV-II that infects the genitals. A cold sore is the result of an infection with HSV I and early warning signs of active virus include a tingling sensation on the lips or face. If untreated at an early stage the virus will multiply rapidly and within 24 hours a cold sore will form, starting as small blisters on the surface of the skin, which join up to form a weeping sore. This is when the virus is contagious and can spread to form more cold sores or can infect others by direct contact. Eventually the immune system kicks in to kill the virus and the cold sore crusts over to form a scab as it heals.

Once infected with HSV it is always possible that re-infection will occur, as the virus can persist undetected by travelling down a nerve fibre and lying dormant or inactive in a nerve cell, to be reactivated under certain conditions, such as by stress, illness, sunlight or a compromised immune system.

Treatments for cold sores

Acyclovir is an antiviral drug that can be used to treat infection with HSV-1. It is a nucleoside analogue, which means that it becomes incorporated into the viral DNA within the host cell and replaces building blocks needed for viral DNA synthesis. This inhibits the action of viral DNA polymerase and prevents normal viral DNA synthesis, without affecting normal processes of the host cells, which prevents the virus replicating and therefore stops the growth and spread of the virus. If applied to the skin within 24 hours of the first tingle, acyclovir can prevent a cold sore from developing. However, it can be used at any stage of infection, to prevent spread of infection, reduce and relieve painful symptoms, and speed up the heeling process to help heal blisters and sores caused by the infection. Acyclovir can also be taken orally to suppress recurrent infection of HSV and to prevent infection in people who are immunocompromised. Valacyclovir is a similar antiviral to acyclovir and is a prodrug of acyclovir that is more readily absorbed and is converted to acyclovir by the liver.
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Our Haemorrhoids class of Skin Care treatments are topical medications for haemorrhoids also known as piles, to reduce pain and inflammation.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. fluocortolone, or the product name, e.g. Ultraproct.

What are haemorrhoids?

Haemorrhoids are swollen veins in the lining of the lower part of the rectum and anus. They are caused by an increase in pressure within the rectum and anus such as during pregnancy, due to pressure of the enlarged uterus, and straining due to constipation.
This causes the swollen veins to become permanently dilated, swollen and inflamed. Haemorrhoids can be internal within the lining of the lower rectum and anal canal, or external, which surround the anus. Internal haemorrhoids are made up of blood vessels, supporting connective tissue and smooth muscle. They are usually pain free but can cause bleeding and may also become prolapsed when protrude into the anal canal and can cause problems. External haemorrhoids may also bleed if they become thrombosed, which is when there is bleeding within the haemorrhoid and the blood clots. External haemorrhoids may cause itching due to irritation of the surrounding skin, but this may also be due to rectal or anal fissures, which are small tears or cuts in the anal or rectal canal through which stools are passed. Muscle spasm is also a symptom of haemorrhoids, which can be painful.

Treatment for haemorrhoids

Treatments for haemorrhoids are available as an ointment applied to the anal area or as a suppository that is inserted into the rectum. Haemorrhoid treatments usually combine a corticosteroid anti-inflammatory, like fluocortolone or hydrocortisone, with a local anaesthetic, like cinchocaine, to treat the inflammation and pain associated with haemorrhoids. The corticosteroid inhibits the formation of inflammatory chemicals like interleukins that stimulate the formation of other inflammatory chemicals like prostaglandins. This reduces pain and swelling, associated with inflammation. The anaesthetic component acts locally to reduce pain, discomfort and itching.
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Our Psoriasis Treatments class of Skin Care products contain topical medications to treat psoriasis and help prevent the formation of psoriatic plaques and relieve inflammation and other symptoms of psoriasis.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. calcipotriol, or the product name, e.g. Daivonex.

What is psoriasis?

Psoriasis is a non-allergic, chronic skin condition that has a genetic predisposition and can affect anyone at any age. It is characterised by red scaly patches of skin ranging from mild, with a few patches usually at the backs of the knees and elbows, and minimal discomfort, to severe with psoriatic lesions covering large areas of the body and causing extreme itching, pain and discomfort. Psoriasis is thought to be an automimmune disease, where certain cells of the immune system (T lymphocytes) are triggered to overproduce inflammatory chemicals, particularly TNF alpha, a cytokine that stimulates excessive growth and proliferation of keratinocytes (epidermal skin cells), causing thickening and scaling of the skin as well as inflammation.

Treatment for psoriasis

Calcipotriol is a derivative of calcitriol or Vitamin D (also known as 1,25 dihydroxycholecalciferol or 1,25(OH)2D3). Vitamin D is primarily involved regulating calcium metabolism but has other actions including inhibition of cell proliferation, stimulation of cell differentiation and immunomodulation. Calcipotriol binds to the same receptor in skin cells as Vitamin D and has the same activity in regulating cell growth and differentiation but is less effective in terms of calcium metabolism. Calcipotriol is used as a topical treatment for psoriasis and helps to prevent over production of hardened keratinocytes and restores normal cell growth and behaviour to the epidermal skin cells.

Tazarotene is a retinoid pro-drug of Vitamin A that affects skin cell behaviour and helps reverse abnormal changes in keratinocyte behaviour; it also has anti-inflammatory properties.

Both medications reduce the inflammation, scaling and thickening of psoriatic plaques and relieve symptoms of psoriasis.
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Our Scalp products class of Skin Care products contain topical medications to treat skin conditions of the scalp, like dermatitis, dandruff, seborrhoeic dermatitis and psoriasis to relieve itchy painful symptoms.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. ketoconazole, or the product name, e.g. Kenozole. 

Conditions of the scalp

Many skin conditions that affect the rest of the body also affect the scalp and cause itching, redness, scaling and crusting of the skin of the scalp.  These include

  • inflammatory skin conditions, like dermatitis and eczema
  • seborrhoeic dermatitis
  • dandruff
  • psoriasis

Dermatitis is a general term that applies to inflammation of the skin and can occur affect any area of the skin, including the scalp.  There are many possible causes for dermatitis such as an allergic reaction, contact with an irritant or excessively dry skin.  Eczema, another term for dermatitis usually refers to chronic itchy inflammatory skin condition that is also known as atopic eczema or atopic dermatitis, as there is a genetic predisposition due to an inherited atopic tendency, with a family history of three closely linked conditions: asthma, eczema and hay fever.

Seborrhoeic dermatitis is a chronic form of dermatitis that affects the scalp and is thought to be due to an inflammatory reaction to a common inhabitant of the skin, the yeast fungus Malassezia (previously called Pityrosporum) that lives in the sebum.  Symptoms include greasy scaling of the scalp with itchy red and crusty patches and flaky persistent dandruff, which is a common mild form of seborrhoeic dermatitis, characterised by flaking of the skin on the scalp.  

Psoriasis a non-allergic, chronic autoimmune skin condition that has a genetic predisposition, where certain cells of the immune system overproduce inflammatory chemicals that stimulate excessive growth and proliferation of keratinocytes (epidermal skin cells), causing thickening and scaling of the skin as well as inflammation.  

Treatments for scalp conditions

Medications used to treat inflammatory skin conditions of the scalp contain a range of ingredients that work by different mechanisms of action.

  • Clobetasol and fluocinolone are potent synthetic corticosteroid hormones with anti-inflammatory action based on blocking the production of chemicals that are inflammatory mediators, particularly prostaglandins and leukotrienes.  This action prevents migration of inflammatory cells, which helps dampen down the inflammatory response; reducing capillary wall permeability and promoting vasoconstriction, which causes blood vessel narrowing, and helps reduce swelling and redness. 
  • Ketonazole is an antifungal that kills the yeast fungus Malassezia responsible for seborrhoeic dermatitis, by inhibiting the synthesis of ergosterol, an important component of fungal cell membrane that weakens the membrane and kills the fungus.  Zinc pyrithione is a chemical antifungal that is sometimes used in combination with ketonazole to enhance its antifungal action.
  • Salicylic acid is a keratolytic that is included in treatments for hyperkeratotic conditions, which are scaly skin conditions where the skin has become thickened, scaly and flaky.  It works by softening keratin, which is a fibrous structural protein found in the upper layer of the skin, and this helps loosen the dry scaly skin and also allows other medications like corticosteroids to penetrate the skin more easily.  
  • Coal tar is also used for hyperkeratotic conditions to reduce scaling itching and inflammation, due to its antimicrobial and antipruritic (reduces itching) properties.  It is also a keratoplastic and interacts with skin cells to slow down the rapid growth of keratinocytes to normal turnover so that dead cells are shed from the surface, which reduces scaling. 
  • Calcipotroil is used as a topical treatment for psoriasis and helps to prevent over production of hardened keratinocytes, restores normal cell growth and behaviour to the epidermal skin cells, as well as reducing inflammation.  Calcipotroil, a derivative of calcitriol or Vitamin D works by regulating cell growth and differentiation and modulating the immune system, causing inhibition of cell proliferation and stimulation of cell differentiation.  This action helps reduce the scaling and thickening of psoriatic plaques and relieves symptoms of psoriasis. 

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Our Skin Beauty class of Skin Care products contains oral and topical treatments for aging and damaged skin, also creams for improving the appearance of scars.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. cepalin, or the product name, e.g. Mederma.

Aging, free radicals and damaged skin

The environment, particularly exposure to UV from the sun, contributes to skin damage and together with the natural aging process causes the appearance of fine lines and wrinkles. 

Free radicals are unstable and highly reactive chemicals produced by oxidation, which is a chemical reaction that occurs in the body as a result of normal metabolism or due to environmental factors such as UV radiation or pollution and cigarette smoke.  Free radicals can cause cell damage and cell death and are thought to contribute to skin damage.  Antioxidants are stable compounds that neutralise free radicals and therefore, protect against the damage they can cause.  Some antioxidants like glutathione occur naturally in the body, they can also be obtained from the diet in a range of fruits and vegetables, such as Vitamin E, the most common fat-soluble antioxidant and Vitamin C, the most common water-soluble antioxidant. 

As we age the appearance of the skin changes, the epidermis becomes thinner, less collagen is produced and more moisture is lost, all of which are accelerated by UV exposure.  Age-related changes in melanocyte (cells that produce the pigment melanin) size and activity, can result in the formation of large patches of pigment known as age spots, liver spots or lentigos. 

Dietary supplements 

The visible signs of aging and the impact of the environment on the skin include dryness, fine lines and wrinkles and dullness of complexion.  These signs are a reflection of changes in the epidermis and dermis layers of the skin due to environmental damage, loss of collagen and elastin, and loss of moisture, resulting in reduced elasticity and thinning of the skin. 

Dietary supplements, containing a marine extract rich in proteins and polysaccharides similar to those naturally found in connective tissue and containing vitamin C, zinc, and other antioxidants like lycopene, have been found to help restore the structure and function of damaged and aging skin.  Scientific studies have shown that when this extract is added to skin in tissue culture, there was an increased production of collagen and elastin, increased life span of skin cells in culture, improved dermal and epidermal skin structure, reduced amount of free radicals produced and reduced damage caused by UV radiation.  When taken orally this extract helped enhance the quality and appearance of skin over the whole body as well as the face, reducing loss of moisture in the skin and the appearance of fine lines and wrinkles. 1

Topical treatments

Certain medications that are generally used for treating acne can also be helpful for reducing skin blemishes, including azaleic acid and tretinoin. 

Tretinoin is an active metabolite of Vitamin A that interacts with retinoid receptors in skin cells and affects several processes, including cell growth, proliferation and differentiation, and production of sebum.  It also increases collagen and elastin production and inhibits the activity of certain enzymes that break down collagen and elastin.  Tretinoin works by blocking the keratinisation process, which is hardening of the outer skin layer due to deposition of keratin; also by promoting skin turnover replacing old damaged skin with new skin, which helps the natural exfoliation process of the outer skin layer.  Increased collagen helps restore skin flexibility.  All these actions contribute to the anti-aging action of tretinoin, which can be used as topical treatment in a cream or gel to reduce visible signs of ageing on the face, including age spots and fine wrinkles.  Other effects include lightening of age spots or pigmented patches of skin. 

Azelaic acid is a natural product with keratolytic properties.  Like tretinoin it speeds up skin turnover by promoting the shedding of old damaged skin and growth of new skin cells.  

Treatments for scars

Scar formation is a result of the wound healing process, which is triggered when the integrity of the skin is broken due to damage or injury, including cuts, burns, surgery and acne.  This process comprises several stages, which are haemostasis (stopping bleeding and plugging broken blood vessels), inflammation, in which special cells remove bacteria and debris from damaged tissue, and produce chemicals that stimulate new cell growth to replace damaged skin and blood vessels; also collagen is produced to replace connective tissue.  Finally the tissue is remodelled to restore skin as close as possible to its pre-wound state.  However, most scars do not have the appearance or texture of normal skin and may be raised due to excess collagen, lower than surrounding skin due to insufficient collagen or less flexible due to defects in the remodelling process.  A topical herbal gel based on onion extract that contains the active ingredient cepalin, has been found to help improve the appearance of scars and stretch marks (overstretching of the connective tissue of skin) and can be used to help make scars less noticeable by improving the softness, texture and overall appearance of the scar. 

References 

Vicanova J, Bouez C, Lacroix S,Lindmark L,Damour O. Epidermal and dermal characteristics in skin equivalent after systemic and topical application of skin care ingredients. Ann N Y Acad Sci. 2006 May;1067:337-42.
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Our Skin Lightener/Bleachers class of Skin Care products contains topical treatments that lighten skin to hide skin blemishes due to conditions like vitiligo and to lighten patches of highly pigmented skin like age spots and freckles.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. monobenzone, or the product name, e.g. Benoquin Cream.

Vitiligo

Vitiligo, or depigmentation of the skin, is a skin condition caused by destruction of melancocytes, which are the cells that produce the pigment melanin. This results in loss of skin colour and the appearance of patches of pale skin that can occur anywhere on the body. Vitiligo is thought to be an autoimmune condition, whereby the body destroys its own melanocytes and cannot be cured. However, creams containing a skin lightener are used to lighten the surrounding skin and thereby mask the existing depigmented patches. Monobenzone (monobenzyl ether of hydroquinone) works by causing free-radical formation in the skin and this causes destruction of remaining melanocytes. As melanin production decreases the areas of normal skin gradually lighten to match the patches of vitiliginous paler skin.

Skin discolouration

Melanin is produced by the melanocytes in the skin epidermis to protect the deeper layers of the skin from damage due to ultraviolet radiation. Increased production of melanin causes the skin colour to darken. Repeated exposure to the sun results in more melanin production and eventually this causes formation of liver spots also known as solar lentigine, which are visible signs of sun damage. Liver spots become more common as we age, known as age spots or senile lentigine, and are more frequent in parts of the body receiving the most sun exposure, like the face, forearms and shoulders. Freckles are similar to sun spots and are caused by areas of concentrated melanin production, triggered by sun exposure. They are usually related to a genetic predisposition and associated with fair skin.

Another form of skin discolouration, melasma or chloasma has a genetic predisposition and is more common in women. Melasma is triggered by sun exposure, hormonal treatments like contraceptives and HRT, pregnancy and thyroid disease. These patches of increased pigmentation appear on the face and are also caused by overproduction of melanin. Skin discolouration can also be caused by scar formation, such as acne scars.

Lightening the skin

A cream containing hydroquinone is used to lighten patches of skin discolouration such as age spots, sun spots, freckles and acne scars. It works by Inhibiting tyrosinase, an enzyme involved in the production of melanin, which decreased the amount of melanin produced, as well as increasing the breakdown of melanosomes in melanocytes that contain the melanin. This action gradually causes the skin to lighten and match the surrounding normal skin colour.
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Our Topical Corticosteroids class of Skin Care medications are used to treat inflammatory skin conditions like eczema, dermatitis and mouth ulcers to relieve symptoms of inflammation.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. triamcinolone, or the product name, e.g. Aristocort Cream.

What is an inflammatory skin condition?

Inflammation of the skin is usually a symptom of an underlying condition like eczema or dermatitis, although it can also be caused by an allergic reaction such as contact dermatitis or a reaction to an insect bite. Often inflammatory skin conditions are due to a chronic autoimmune condition like lupus erythematosus or lichen planus. Mouth ulcers caused by a skin lesion in the mouth or an infection can become inflamed. Symptoms vary from mild irritation with itching, redness and discomfort, to severe with blisters, scaly patches of skin and weeping sores.

Examples of inflammatory skin conditions

Inflammatory skin conditions include:
  • Eczema, a chronic itchy skin condition caused by inflammation of the epidermis or outer layer of skin. It is also known as atopic eczema or atopic dermatitis, as there is a predisposition due to an inherited atopic tendency, with a family history of three closely linked conditions: asthma, eczema and hay fever.

  • Irritant contact dermatitis, which is caused by direct skin contact with an irritant like solvents and harsh chemicals.

  • Allergic contact dermatitis, an allergic reaction caused by contact with a substance that triggers a delayed immune hypersensitivity reaction in response to a specific allergy such as to perfume, latex or nickel.

  • Seborrhoeic dermatitis, also known as cradle cap in babies, is a scaly rash that usually affects areas of the face or scalp that are greasy or oily, causing peeling similar to dandruff.

  • Neurodermatitis, a repeated rubbing or scratching due to a constant itch scratch cycle, causing a thickened pigmented patch of skin.

  • Lichen planus, an abnormal immune reaction, in which the body’s immune cells attack self but may also be a reaction to a medication or to a viral infection. Symptoms include, papules (bumps on the skin) forming a rash with raised reddened patches and they can occur anywhere on the skin, particularly the wrist, ankles and lower back; also on mucous membranes like the mouth.

  • Psoriasis a non-allergic, chronic automimmune skin condition that has a genetic predisposition, where certain cells of the immune system overproduce inflammatory chemicals that stimulate excessive growth and proliferation of keratinocytes (epidermal skin cells), causing thickening and scaling of the skin as well as inflammation. Symptoms including red scaly patches of skin ranging from mild to severe with psoriatic lesions covering large areas of the body and causing extreme itching, pain and discomfort.

  • Discoid lupus erythematosus is a chronic autoimmune condition that affects the skin usually of the face, ears and scalp but can affect other parts. Symptoms include red scaly patches with sores and inflammation leaving and scarring.

  • Mouth ulcers originally caused by injury to or infection of the skin, which develops into an inflammatory lesion.

How corticosteroids work

Corticosteroids are glucocorticoid steroid hormones that are produced naturally by the body and are involved in regulation of many functions including inflammatory and allergic reactions. Their anti-inflammatory action is based on blocking the production of chemicals that are inflammatory mediators, particularly prostaglandins and leukotrienes. They work by binding to a specific receptor in inflammatory cells like leukocytes and macrophages at sites of inflammation in the skin, and blocking the action of phospholipase A2, the first enzyme involved in the synthesis of prostaglandins and leukotrienes, as well as the cyclooxygenase enzymes (COX 1 and COX 2), that are specifically involved in prostaglandin production.

Synthetic corticosteroids that are used in topical corticosteroid medications mimic natural corticosteroids and work in the same way. These include triamcinolone a moderately potent corticosteroid, betamethasone, mometasone, hydrocortisone 17-butyrate, and clobetasol, which is the most potent of the synthetic corticosteroids. Some of these corticosteroids like triamcinolone also blocks formation of other inflammatory mediators, such as kinins, also histamine release which is the cause of itching, and also modifies the body's immune response.

Inhibiting production of inflammatory mediators has several anti-inflammatory and immunosuppressive effects, including preventing migration of inflammatory cells, which helps dampen down the inflammatory response; reducing capillary wall permeability and promoting vasoconstriction, which causes blood vessel narrowing, and helps reduce swelling and redness. Antipruritic actions help stops itching.

Application of topical corticosteroids

Corticosteroid medications are available in various applications to be used on different parts of the body and are suitable for different skin conditions. These include:
  • A protective, emollient (soothing and moisturising) dental paste containing triamcinalone for mouth ulcers.

  • Creams containing triamcinalone, mometasone, hydrocortisone, betamethasone and clobetasol are best used for moist lesions skin that is inflamed and itchy, as they can be rubbed into the skin without being greasy and have emollient (soothing and moisturising) properties.

  • Ointments containing mometasone and clobetasol can be used for dry scaling and fissured (cracked due to dryness) lesions as they contain a mixture of oil and water that helps keep moisture in and preventing evaporation.

  • Scalp lotion containing clobetasol for Inflammatory skin conditions of the scalp.
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Our Miscellaneous class of Skin Care medications are used to treat warts, benign skin tumours and haemorrhoids, remove unwanted facial hair, and for local anaesthetic.

Use the search feature to quickly find the product you are looking for, by entering either the active ingredient, e.g. imiquimod, or the product name, e.g. Aldara Cream.

Warts

Warts are formed as a result of non-cancerous overgrowth of outer layers of skin around skin cells infected with Human Papillomavirus (HPV). Genital warts are a sexually transmitted condition with symptoms including pain, bleeding and itching. Common skin warts usually form as raised bumps on the hands and feet, also elbows and knees. Warts on the underside of the foot are known as verrucae and can be painful as they grow into the foot.

A topical treatment for genital and perianal warts is a cream containing Imiquimod, which acts as an immunomodifier by stimulating immune cells in the outer skin layers to produce chemicals called cytokines involved in fighting invasion by pathogens like HPV.

Keratoses

Exposure to ultraviolet radiation from the sun can damage the skin and cause various skin abnormalities, including lesions called actinic keratosis (also known as solar keratosis). These lesions are pre-malignant and if untreated can develop into squamous cell carcinoma (SCC), which is a non-melanoma type of malignant skin cancer that develops from the upper skin layer or epidermis but then grows down into the deeper skin layers of the dermis. Actinic keratosis form due to overproduction of keratin, which is a fibrous structural protein in the outer skin layers (epidermis) and are characterised by thick raised scaly patches of skin.

Basal cell carcinoma (BCC) is another lesion caused by UV exposure and is the most common form of skin cancer; it is malignant (invasive) but not usually harmful. BCC develops in the basal layer of the epidermis and is found mainly on the head, neck and other exposed areas in skin of fair-skinned people. It grows slowly and varies in appearance from small translucent nodules to larger brown, reddened or thickened patches of skin and can form ulcers and bleed easily.

Superficial skin lesions can be treated using a cream containing fluorouracil, that works by blocking the use of another metabolite used in a normal metabolic process, in this case the incorporation of the nucleotides into DNA and RNA, which inhibits cell growth and eventually leads to cell death, particularly of rapidly growing cancerous cells.

Another topical treatment is a cream containing Imiquimod, which acts as an immunomodifier and stimulates an inflammatory reaction that helps remove the malignant and pre-malignant cells. The skin then settles down and heals.

Unwanted facial hair

Hirsutism is increased hair growth in women and occurs often in unwanted places such as on the face, around the lips and chin. This is usually due to hereditary factors but can also be due to over production of androgens or some conditions like polycyctic ovary syndrome (PCOS). It is also a natural effect of aging during menopause. A cream containing eflornithine can be used to remove unwanted facial hair. Eflornithine works by inhibiting an enzyme found in hair follicles of the skin called ornithine decarboxylase, which is needed for hair growth and this slows down the rate of hair growth to the areas where it is applied, but it does not destroy the hair or prevent it from growing back.

Local anaesthetic

Application of local anaesthetic is often needed for minor surgical procedures such as taking blood or inserting a catheter needle, cleaning leg ulcers or skin grafting. A cream containing two the local anaesthetics lignocaine and prilocaine can be used to provide analgesia during and after the procedure. They both work by blocking the generation and transmission of specific nerve impulses, which provides reversible loss of sensation in the superficial pain receptors in the area of skin where the cream is applied.

haemorrhoids

Haemorrhoids are swollen blood vessels around the anus that cause pain and inflammation. The combination ointment and suppositories containing the local anaesthetic cinchocaine and the anti-inflammatory hydrocortisone are used as a topical treatment for haemorrhoids.
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About the skin


The skin is the body’s largest organ and plays several important roles. It acts as physical barrier and serves as protection from infection, injury and the sun’s rays; it prevents dehydration, provides insulation and helps regulate body temperature. The skin also produces vitamin D, which is essential for healthy bones.

The structure of the skin comprises two layers, the epidermis and the dermis, with a subcutaneous layer containing the body fat. The epidermis is made up of keratinocytes; cells that produce keratin a protein that gives the skin its strength and is also found in nails and hair. Skin is constantly being renewed as new cells are produced at the base of the epidermis and old cells move to the surface, die, harden and are eventually rubbed off. The epidermis also contains the pigment melanin, which give the skin its natural colour and protects against ultraviolet (UV) rays from the sun to prevent burning. More melanin is made in response to increased exposure to the sun.

The dermis contains superficial blood vessels, nerves and sensory nerve endings. It is composed of connective tissue containing the fibrous proteins collagen and elastin that give skin its strength and flexibility. As we age, reduced amounts of these proteins results in normal age-associated thinning of the skin and formation of wrinkles. Hair follicles in the dermis produce new hairs which grow up through the hair shaft and emerge through the epidermis. Attached to the base of each hair follicle is a sebaceous gland, which produces sebum, an oily secretion that helps lubricate the skin. The sweat glands are also found in the dermis producing sweat, which is released through pores that open through the epidermis, cooling the skin and excreting waste products like urea.

The surface of the skin is home to many microorganisms, including yeasts and bacteria, which under normal circumstances do not cause any problems. If the natural balance is disturbed, infection may develop. Dead skin cells mixed with sebum provide nutrients for bacterial growth, therefore it is important to keep skin clean.

Types of skin conditions

Skin conditions are due to a variety of problems, including infection, inflammation, sun damage and changes in pigmentation. The more common skin conditions that are covered in this section are:
  • Acne, which usually affects teenagers and is caused by overproduction of sebum cloging up pores in the skin, leading to the formation and spread of pimples (papules), spots or whiteheads (pustules) and blackheads (comedones), which can become infected with bacteria.
  • Fungal infections cause thrush and ringworm, amongst other skin conditions and affect several parts of the body including the mucous membranes of the mouth and vagina, ranging from mild to severe.
  • Infection with Herpes Simplex Virus (HSV) that infects mucous membrane cells of the lips causing cold sores.
  • Bacterial infection of skin cells like impetigo, folliculitis (infected hair follicles) and furunculosis (boils); also secondary infection of damaged skin.
  • Inflammatory skin conditions due to hyperactivity of the immune system, such as psoriasis, a non-allergic autoimmune condition that causes dry scaly patches; also dermatitis and eczema, allergic skin conditions causing redness and itching.
  • Skin discolouration due to loss of pigment, a condition called vitiligo, or due to patches of increased pigmentation, such as age spots, freckles and acne scar tissue.
  • Warts, which are raised lumps of hard skin caused by infection with human papillomavirus
  • Solar or actinic keratoses, which are patches of pre-cancerous skin caused by sun damage.
  • Unwanted growth of facial hair or hirsutism.
  • Haemorrhoids, which are swollen blood vessels around the anus.

Range of treatments for skin conditions

The range of products available for skin conditions that are covered in this section include:
  • Topical and oral acne medications containing tretinoin and adapalene, which are retinoid-like compounds, or azelaic acid, an antibacterial with keratolytic properties; also antibiotics for infected acne.
  • Antifungals, antivirals and anti-bacterials for various skin infections.
  • Topical treatment containing calcipotriol, a Vitamin D derivative for treatment of psoriasis.
  • Topical skin lighteners for treating skin discolouration and vitiligo.
  • Topical corticosteroids for treating inflammation in inflammatory skin conditions like dermatitis and eczema.
  • Topical cream containing imiquimod, an immunomodifier that acts as antiviral and antitumour agent for treating warts and solar or actinic keratoses.
  • Topical treatment containing the anti-metabolite fluorouracil that is used to treat pre-malignant skin lesions.
  • Topical cream containing eflornithine an inhibitor of hair growth for preventing unwanted facial hair.
  • Topical treatment for haemorrhoids containing cinchocaine a local anaesthetic and the corticosteroid hydrocortisone.

Caring for your skin

The environment, particularly exposure to UV from the sun, contributes to skin damage and together with the natural aging process causes skin to lose moisture resulting in the appearance of fine lines and wrinkles. Free radicals are unstable and highly reactive chemicals produced by oxidation, which is a chemical reaction that occurs in the body as a result of normal metabolism or due to environmental factors such as UV radiation or pollution and cigarette smoke. Free radicals can cause cell damage and cell death and are thought to contribute to skin damage. Antioxidants are stable compounds that neutralise free radicals and therefore protect against the damage they can cause. Antioxidants occur naturally in some fruits and vegetables, such as Vitamin E, the most common fat-soluble antioxidant and Vitamin C, the most common water-soluble antioxidant.

As we age the appearance of the skin changes, the epidermis becomes thinner, less collagen is produced and more moisture is lost, all of which are accelerated by UV exposure. Age-related changes in melanocyte (cells that produce the pigment melanin) size and activity, can result in the formation of large patches of pigment known as age spots, liver spots or lentigos.

Several oral and topical skin care products are available made form natural biological extracts containing antioxidants, vitamins, minerals and nutrients to help to keep the skin hydrated and nourished and to protect the skin from damage. Certain medications that are generally used for treating acne can also be helpful for reducing skin blemishes, including the keratolytic agent azaleic acid and tretinoin a, retinoid-like compound.

Scar formation

A scar is the visible sign of healing a wound in the skin and consists of fibrous tissue that replaces normal skin. New scar tissue usually has a different appearance and texture to the surrounding skin. Topical herbal extracts are available to help improve the appearance of scars.

Topical anaesthetic

Topical analgesia for minor surgical procedures of the skin is available as a cream containing the local anaesthetics lignocaine and prilocaine.

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