Is it possible to remove scars?
    Scars are harmless excess growth of the connective tissue of the skin that occurs after injuries or operations, or also as a result of inflammatory skin conditions. On healing, the scars may be flush with the skin, or have a raised profile, or form “craters” or “worm holes” in the skin, especially following acne. These occur most frequently in the face, on the ears and neck, the trunk – especially the region of the breast bone – and the upper arms.
    Scars cannot be completely removed. Sunken (atrophic) scars can be filled with materials that are also used for treating deep wrinkles caused by ageing (see “Ageing”).
    Hyaluronic acid or collagen can be used for this purpose, and, in some cases own body fat.
    Another possibility is so-called Z-plasty. When a scar runs at right angles to the natural folds of the skin, it is more conspicuous than when it lies parallel with them. In this kind of case, scars can be corrected surgically.
    To treat acne scars, dermabrasion or chemical peeling are other methods that are often used. In both cases, the upper layers of skin are removed to different depths, reducing the difference in level between the scar tissue and the surrounding skin. Similar effects can also be obtained by CO2 laser treatment. In the case of raised scar tissue, cryotherapy (the spraying-on of freezing substances) or injections of cortisone or interferon are other possibilities. As conservative treatment, ointments containing heparin or also plant extracts may be suitable. Silicon gel films and special plasters are also useful in the treatment of raised (hypertrophic) scars.

    What are aphthae?
    Aphthae are small, roundish, painful ulcers that occur on the mucous membranes of the mouth; they are usually greyish-white or yellowish coloured in the centre, with a red, inflamed rim. What causes them is not known. They sometimes occur frequently in some families. They may be triggered by certain foodstuffs or drugs, exhaustion and stress, as well as various illnesses. They eventually clear up spontaneously, without treatment. Gels may be applied to kill the pain.

    What is dandruff and how can it be treated?
    Our skin renews itself continuously approx. every 4 weeks, starting from the basal cell layer (see “Structure of the skin”). If this cell renewal process is accelerated through some kind of inflammatory condition, the result is visible scaling, or dandruff. It may also be accompanied by itching.
    The treatment is by special shampoos or solutions which may, for instance, also containing anti-mycotic (i.e. anti-fungal) substances, as severe scaling is often accompanied by colonisation of the scalp with certain yeasts. Shampoos containing salicylic acid, sulphur, tar, zinc pyrithion and selenium sulphide are also helpful. To stop the itching, preparations containing menthol or, in severe cases, also cortisone can be given.

    Are skin diseases catching?
    Only very few!
    Most children’s diseases such as chicken pox, measles and scarlet fever are infectious. Also parasites such as fleas, lice and the mites that cause scabies can be transmitted from person to person. Bacteria, fungi and viruses are transmittable to some extent, though more easily to people with a weakened immune system or whose a skin that is susceptible to eczema. Neurodermatitis, acne, eczema, nettle rash (urticaria) and allergies are not infectious.

    Is psoriasis catching?
    No. Psoriasis is a hereditary disorder of the skin, i.e. people are born with a genetic predisposition to suffer from it. It is not caused by a lack of personal hygiene. It cannot be transmitted through normal or intimate contact.

    Is there a cure for psoriasis?
    As psoriasis is a congenital disease, it is ultimately not curable. However, through continuous care and treatment, the visible symptoms and the severity of the disease can be positively influenced. Healing of the symptoms on the skin does not mean that the condition as such has been cured, and it can recur at any time throughout life. It is impossible to predict how the disease will progress and how well it will respond to any particular therapy. However, modern methods of treatment such as phototherapy (light therapy) are able to produce good results in many cases.

    Does psoriasis, neurodermatitis or severe contact eczema lead to skin cancer?
    No. All experience to date suggests that this fear can be ruled out.

    What is the difference between ointment, cream, milk and lotion?
    The main difference lies in the lipid (fat or grease) content. Ointments contain a high volume of lipids, creams a lower volume, milks even less and lotions hardly any.
    Ointments should be used on dry skin and for chronic skin diseases. With weeping and acute skin conditions, creams, milks or lotions should be preferred. For daily care, especially on the only slightly hairy areas of the body such as the trunk, arms and legs, body milk or lotion is recommended.

    What forms of medical preparations are best for use on the scalp?
    Solutions with differing levels of alcohol content and the appropriate active ingredients are best suited for the scalp. For dry, irritable skin, lotions should be preferred. Severe scaling (dandruff) can be improved with oil, including even olive oil, with additional salicylic acid to release the scales. All forms of medical preparations should be applied directly to the skin of the scalp by parting the hair. Oils should be applied very thinly to allow them to be washed out with mild shampoos. It is not the hair but the scalp that has the problem and therefore needs treating.

    What is an emulsion?
    An emulsion consists of oil and liquid, in most cases water. To be able to mix water and oil and achieve a stable combination between them, an emulsifier is necessary. In general, a distinction is made between oil/water (O/W) and water/oil (W/O) emulsions. The former contain a little oil in a lot of water, the latter a little water in a lot of oil.

    Will my skin lose the ability to produce its own lipid film if I use creams?
    No. The lipid film of the skin depends on the congenital (inherited) ability of the body to produce sebum. The production of sebum (grease) by the sebaceous glands depends on the hormones and the external temperature. Sweating increases the distribution of the film of grease on the skin. So the level of skin care required depends ultimately on genetic factors, hormone production and the ambient temperature. Regular creaming will not cause the skin to lose its ability to produce its own grease film.

    Why is the skin usually drier in the cold seasons?
    The main reason is that at low ambient temperatures, the production of grease by the sebaceous glands is reduced. Another factor is that in centrally heated rooms with tight, insulating windows, the air humidity is reduced, causing increased evaporation of moisture from the skin. Additionally, the grease on the skin is rubbed off by the thicker clothing usually worn and by showering with hotter water. Moreover, there is no “hidden” care with sun creams in winter, which are, after all, basically skin care products with additional UV filters.

    Is cortisone harmful when used externally?
    If used properly, cortisone accelerates the healing of acute or chronic skin conditions and has no harmful side effects. The important thing is that it should only be used for a temporary period, which in the case of stubborn skin conditions can be up to 2-3 weeks. Once the acute phase has healed up, treatment should be continued with a cortisone-free ointment or cream. The length of application and the level of side effects also depends on the localisation. The eyelids and genitals, for example, are particularly able to absorb corticosteroids. The face, armpits, groin and major body folds are less absorptive but are still more sensitive than the rest of the body. Treatment of the scalp with cortisone lotions or tinctures is relatively unproblematic. The 4th generation cortisone preparations are well tolerated, easily controlled and seldom produce side effects.

    Do skin conditions worsen during pregnancy?
    There is no clear answer to this question. Some women report a deterioration during pregnancy, while others report a marked improvement, e.g. in the case of neurodermatitis or psoriasis. On the basis of experience, acne improves during pregnancy, as well as about half the cases of psoriasis. Normal skin changes during pregnancy are general hyperpigmentation — especially of the surrounds of the nipples and in the genital region – and, because of the increased volume of blood in the blood vessels, enlargement of vein marks. Some skin conditions only occur during pregnancy and are known as pregnancy dermatoses. They are frequently accompanied by severe itching. Most of these phenomena only occur during the last three months or the last few weeks of pregnancy and disappear spontaneously after the birth.

    I have great problems with my skin condition. What can I do?
    Skin conditions that can be seen by other people unquestionably cause great mental stress. They often reduce the quality of life and the level of self-esteem. It is important to inform other people openly of the condition and to point out that only very few skin diseases are catching.
    Information and assistance can be obtained from patient organisations and self-help groups such as (in Germany) the German Psoriasis League (Internet: www.psoriasisbund.de) or the Skin Information Centre (www.treffpunkt-haut.de). These groups can also provide the addresses of local self-help groups or patient organisations.

    What is the acid barrier?
    The surface of our skin is covered by the hydrolipid film, i.e. a film of water and grease, consisting of sebum, the decomposition products of the keratinisation process, and sweat. As this hydrolipid film has a pH value of around 5.5 and therefore reacts acidically, it is known as the acid barrier.

    Why does the skin dry out through washing?
    Protective lipids on the surface of the skin provide a seal for the horny cells and so prevent the water which is stored in certain substances in the horny layer from evaporating. Through washing, especially with alkaline soaps, the lipid layer is removed, allowing the water in the horny layer to escape and evaporate. As a result, the skin becomes dry. By using acidic soaps and washing/showering with water that is not too hot, the layer of protective lipids is preserved. People with dry skin should regularly use care creams. Those who shower daily, do sport, sweat a lot and so degrease the skin, should regularly use skin care products such as creams, body milks or lotions.

    What factors cause the skin to wrinkle?
    Strong exposure to sunlight, and especially UVA radiation, damages the fibrous structure of the dermis, and this promotes the wrinkling process. As nearly all solariums use sunbeds with UVA tubes, they should only be used in moderation. Like severe exposure to sunlight, heavy smoking also fosters wrinkling. Frequent sunbathing and heavy smoking virtually double the level of wrinkling. Exposure to sunlight and smoking also have a negative effect on the immune system and so increase the likelihood of skin cancer.

    Is it safe to use solariums?
    Almost certainly, as far as sunburn is concerned. However, it has been proved that long-wave UVA radiation penetrates through the outer skin down to the dermis, the deeper layer of the skin, where it damages the fibres and supporting structures of the skin and promotes the formation of wrinkles. Additionally, increased occurrence of malignant melanoma (“black skin cancer”) is observed as a result of massive exposure to UVA radiation.

    Can I lessen the risk of contracting skin cancer?
    This question can be answered by a clear “yes”.
    The most important thing is, from earliest childhood, to avoid sunburn and to be sensible about exposure to the sun. Up to 80% of the skin damage that appears in advanced age has in fact already been acquired by the time people were aged 20. (See also “The sun and your skin”)!

    Note: It is not the sun that causes illness, but our underestimation of the sun’s effects!