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Ask Dr Emma
Senior Health Editor, Dr Emma Amoafo-Mensah is back answering your health questions this month.
What is the best treatment for scalp psoriasis?
Psoriasis is a chronic skin condition that causes red, scaly patches on the skin and scalp. It’s an autoimmune condition characterised by an abnormal buildup of skin cells. Sometimes these patches can be very thick, and they are usually extremely itchy.
There are so many different treatments for psoriasis, the best treatment is the one that suits you the most. Psoriasis should be managed under the guidance of someone suitable, such as a general practitioner or dermatologist, as it can affect multiple parts of the body including the joints. Below are some tips for treating scalp psoriasis, but this doesn’t replace management with your usual doctor.
Your treatment should have two arms: your maintenance treatment and treatment for flares. If we start off with the maintenance treatment, I would first of all decide what formulation you would prefer – shampoo, oil, ointment etc. Most people need something to lift up the scale from the scalp, and you can use a tar-based shampoo to do this, such as Polytar or Alphosyl shampoo. Some people don’t like the smell of these tar-based preparations, and ointments like Sebco or Cocois could be applied overnight and washed out in the morning instead. Some people even prefer to use an oil such as coconut oil to lift off the scale and then wash with a shampoo of their choice. How often you need to do this will differ from person to person.
Often, despite a good maintenance routine, scalp psoriasis can flare. The most common treatment for this involves a steroid that you apply to the scalp. Topical steroids also come in a wide variety of formulations including shampoos, gels, foams, ointments, liquid scalp applications etc. Alongside your doctor, you’ll need to decide what works best for you. Usually, you should be aiming to use the lowest strength steroid that is effective. There are many products that combine topical steroids with other ingredients such as vitamin D analogues, which make the treatments more effective.
For some people, topical treatments aren’t effective alone and you might be referred to a dermatologist to consider being started on tablets to treat your psoriasis. If the psoriasis affects your joints, you may be referred to a rheumatologist.
Overall, I would always recommend a personalised approach in managing scalp psoriasis, which unfortunately might involve trying a few different things before settling on the most suitable. There’s so much choice, however, that you should be able to find something that works well for you.
Would it be advisable to take cranberry supplements every day?
I’m assuming you’re referring to the use of cranberry based products to prevent or treat urinary tract infections (UTIs), which is a question I’m commonly asked. Actually, there’s little evidence to support the use of cranberry products in the treatment of UTIs. A large review of the scientific literature found that when you compare groups of people taking cranberry supplements to those not, there was no difference in their risk of getting a UTI.
For this reason, NICE (National Institute for Clinical Excellence) don’t recommend their use. There are studies, however, that seem to support their use, and if you feel that it is beneficial for you, it would be safe to do so as long as you follow the manufacturer’s guidance. Some cranberry supplements contain antioxidants and other helpful compounds such as vitamin C or probiotics, so that can be beneficial also. My advice would be to follow the dosage as written on the bottle, and always check with your medical practitioner before starting a long term supplement, especially if you are on other medications, as some, such as warfarin can interact with cranberry based products.
I am keen on starting to use collagen powders. However, I would like to know what I should look out for when choosing appropriate collagen powders?
It’s very difficult to answer this question without knowing why you want to start collagen powders, and what you’re trying to achieve. Taking collagen supplements is becoming increasingly popular, and the most common reason for starting collagen supplements I’m aware of is to improve the appearance of the skin.
So first of all, what is collagen? Collagen is the most abundant protein in our bodies, responsible for the structure of our skin, bones, muscles but also things like our blood vessels and teeth. From our mid-twenties, collagen starts to break down faster than our bodies replace it, which is part of the reason our skin changes as we age.
Collagen is present in some foods such as meat, fish and poultry, but it’s not easily absorbed from the foods we eat. Even if collagen is absorbed, collagen that is eaten won’t necessarily find itself in the skin, because like other proteins, the collagen will be broken down to amino acids (the building blocks of protein), and treated like any other protein you may have consumed.
Some studies have suggested that supplements that contain partially-digested collagen (hydrolysed collagen) may help with skin elasticity, which could theoretically reduce wrinkles and create a more youthful appearance of the skin. This isn’t widely supported scientifically at present.
It’s been suggested that collagen supplements can help with hair and nails, healthy joints and muscle growth, but unfortunately there isn’t any high-level, robust evidence supporting this either. This could change over the next few years, so I would keep a look out and check the recommendations from trustworthy sources such as the NHS website. Personally, I feel a surer way of ensuring good skin health is to eat a varied diet with enough protein, avoid the sun and don’t smoke.
However, collagen supplements from a reputable brand, taken according to the directions specified, are unlikely to do any harm, and I wouldn’t discourage anyone from trying it should they choose to. Collagen supplements can cause mild side effects such as stomach discomfort, diarrhoea or rashes, but they seem to overall be well tolerated.
How can I fix my ‘Indian pigmentation issues’ with a limited budget?
Hyperpigmentation is a very common issue in skin of colour. Common causes of hyperpigmentation include melasma and post-inflammatory hyperpigmentation. Less common causes include reactions to medications and medical problems such as Addison’s disease or haemochromatosis. Widespread, sudden onset or blue/black tinted hyperpigmentation should always be evaluated by a healthcare professional to ensure there isn’t an underlying cause.
At this point, I’d also like to highlight something I’m seeing more commonly – natural differences in pigmentation being referred to as something that needs medical treatment. A common example would be darker elbows and knees, or darker skin around the eyes in people of colour. I want to take this opportunity to say that in most cases, these are absolutely normal variants, and do not need any intervention. I do feel that the pressure of the media (social media being high up there) has caused some of us to have a tainted view of ourselves, but that’s a discussion for another day.
So… assuming there is no underlying medical condition, and you’re referring to true, abnormal hyperpigmentation, there are some things you can do to help fade it. By far, the most important and cost-effective thing you can do is apply sunscreen. The proper way to do this, is to apply a sunscreen with at least SPF30 and a 4 UVA star rating 15-30 minutes before going into the sun and then every 2 hours, or sooner if you’ve been in water or are sweating excessively etc. The NHS recommends 2 teaspoons of sunscreen should be used to cover your head, arms and neck, or 2 tablespoons if you’re covering your whole body. NB these recommendations are for protecting your skin in general, not for hyperpigmentation.
Aside from sunscreen, skincare products including retinols, vitamin C, Kojic acid, glycolic acid and azelaic acid are commonly used to treat hyperpigmentation. These can be sought at reasonable prices in the forms of toners, serums and moisturisers from brands such as the Ordinary and the Inkey list, to name a few.
It’s important to note that these skin products can cause irritation when first started, and if the skin is irritated, that can cause inflammation, which will cause it to become even more hyperpigmented. I would start one product at a time, and ensure you’re using a good moisturiser. Again, if you don’t use sunscreen after using these activities, you’re wasting your time. With a retinol, I would start at a low concentration such as 0.2% or 0.5% and slowly build up to 1%, applying at night and ensuring you moisturise after and put on sunscreen in the morning. Azelaic acid can be bought commercially at 15%, but some data shows that stronger concentrations at 20% work better; this would need to be prescribed by your doctor.
If you’ve been diagnosed with melasma, this can be treated on the NHS. Again, sun avoidance and sunscreen are important in the management, but your doctor may also prescribe other creams including Pigmanorm. This contains hydroquinone, and in most cases you will only be prescribed it for a maximum of three months because hydroquinone can cause other undesirable skin changes. Malasma can also be treated with a tablet called tranexamic acid, you would need to be referred to a dermatologist for consideration of this. Chemical peels, microneedling and lasers can be viable options that you would need to explore from private healthcare, with varying costs. My advice if you’re considering this is to see a reputable practitioner with experience in working on skin of colour, as more harm can be done if not performed carefully.