cosmetic skin problems
What is Sebaceous Hyperplasia?
Sebaceous hyperplasia is a benign growth of the sebaceous gland in the skin. It is common in middle-aged and elderly people, with a familial form which can present as young as the puberty.
It can also be observed in patients treated with oral steroids, on hemodialysis, and in conditions such as Torre syndrome and X-linked hypohidrotic ectodermal dysplasia syndrome. There are also suggestions of an association with ciclosporin, a drug commonly used after organ transplantation.
These skin lesions are usually soft, yellow, dome-shaped ‘papules’. They commonly occur on the forehead, cheeks, and nose, with most being 2–4 mm in diameter.
How can we be sure of the diagnosis?
Dermoscopy is a non-invasive and widely used diagnostic procedure in both pigmented and non-pigmented skin lesions. Although sebaceous hyperplasia is a frequent finding especially in elderly people, it may be confused with other conditions, like early basal cell carcinomas. Sometimes, doctors need to take a biopsy to be confident about the diagnosis.
Only recently, we have found ways to be more confident in using dermoscopy to positively diagnose sebaceous hyperplasia. Bryden et al. defined ‘cumulus sign’ as a descriptive sign of sebaceous hyperplasia, resembling the cumulus clouds. This sign represents a sebum collection produced by growth of the sebaceous glands. A recent study detected this sign in 100% of patients.
It also associated with the ‘bonbon toffee sign’ - a simple and easily recognisable clinical sign.
Using these signs to establish a dermatoscopic diagnosis of the sebaceous hyperplasia will help avoid unnecessary biopsies.
Having diagnosed the condition, what next?
Despite being benign, lesions can have a major cosmetic and psychological effect on patients because they are predominantly located on the face. Treatment options include surgical excision, curettage, cryotherapy, cautery, and CO2 laser, all with associated risk of scarring and pigmentary change.
Recently, light based therapy has shown some good results, with shorter recover periods but more discomfort and higher cost.
Pulse Dye Laser (PDL) successfully treats other benign skin lesions and has been shown to be successful in treating sebaceous hyperplasia. Lesions are eliminated quickly, easily, and painlessly, leaving only a transient purplish (purpuric) effect. Treatment effect is explained by the fact the laser light is absorbed by the vascular component of the lesion, destruction of the vessels removing the nutritional support from the sebaceous hyperplasia.
Of course other non-ablative lasers will have a similar effect to PDL, when used correctly, and we can even offer the new plasma device which uses electrical (RF) energy to vaporize the lesions.
The key with Sebaceous Hypertrophy is to ensure correct diagnosis via dermoscopy and then agree, with your doctor, which treatment is best for you.
Dermoscopy assessment £50
Removal from £75
What are Milia?
Sometimes called “milk spots”, Milia are small, hard white lumps which are clearly visible on the surface of the skin.
Especially common in babies, they can occur at all ages. They usually arise on the face, most commonly around the eyes and cheeks. The underlying cause is a blockage of sweat ducts by dead skin cells. This can explain a worsening in the appearance and number of milia after any skin injury. Some common creams are too greasy for the skin and prevent natural shedding or exfoliation.
Although milia are harmless, people often find them unsightly and wish to have them removed.
We usually recommend the following:
Give them time, as some will resolve on their own if you swap greasy creams for a good exfoliating product. (We can guide you on this)
Using a cleansing brush will give your skin a deeper clean, encouraging the milia to resolve more quickly.
Consider a mild skin-peel. Here our Aesthetician can give you what is essentially a refreshing ‘facial’ using a series of products designed to refresh and exfoliate your skin. This will help your skin in general, and helps in a natural resolution of the milia.
If the milia don’t respond over a few weeks or months, consider seeing our doctor who will use minor surgical techniques to safely release the contents of blocked ducts.
FAQs in relation to surgical removal of milia:
Does milia removal hurt?
Removal of milia is virtually painless and doesn’t normally require any numbing cream.
Is milia removal safe?
Yes, as long as it is done safely by a trained professional.
What results will I see?
For most patients, the removal of milia is permanent. Some patients are prone to repeated break-outs and these are usually new milia.
Is there any down-time after removal of milia?
Some redness and swelling is to be expected in the treatment area. This typically resolves within a few days.
How much does removal cost?
Removal from £65
What is Xanthelasma Palpebrarum?
Xanthelasma Palpebrarum (XP) is a type of skin lesion that commonly presents in middle-age.
A benign cosmetic lesion, more correctly known as a xanthoma, they are largely composed of cholestrol. As such, having these lesions can point to an underlying dyslipidaemia, most commonly a high cholestrol level.
XP has been reported following inflammatory skin disorders, and allergic contact dermatitis in spite of normal lipid levels.
Lesions present clinically as distinct yellowish skin plaques on the eyelids, usually close to the nose.
Incidence in middle-age:
Women – 1.1%
Men – 0.3%
Various treatments have been used for patients with XP, including surgical excision, eletrocautery, and trichloroacetic acid (TCA) application. Care must be taken to avoid scarring, everted eyelid (ectropion) and pigmentary changes, especially with more aggressive treatment and higher concentrations of TCA.
A more high-tech approach would involve the use of laser. In fact different types of laser have been tried, including carbon dioxide laser, argon laser, KTP laser, erbium: YAG laser, and pulsed dye laser.
It’s worth adding the new kid on the block, the plasma device. This readily available hand-held device utilises electrical energy to produce a plasma medium, allowing us to provide ’tissue sublimation’ which literally vapourises tissue. While clinical trials are awaited, it appears to be offering a good alternative with good tolerability and outcomes.
Removal from £119
Before and after images of treated Xantheasma
Warts & Verrucae
What are warts and verrucas?
Warts are caused by an infection with a type of ‘human papilloma virus’ (HPV) in the outer layer of the skin (the epidermis). This infection causes growth and thickening of this outer layer.
Verrucas, also known as plantar warts, occur on the soles of the feet (the plantar surface).
How do we get warts and verrucas?
Although this infection is ‘caught’ by contact with virally-infected skin scales, the virus is not highly contagious. Infection is more common in childhood and when using public locker rooms.
How can warts and verrucas be treated?
Considering treatment, it is important to remember the following:
Warts usually go away by themselves, and, when this happens, no scarring occurs
Even if a particular wart or verruca is successfully treated, new ones may develop
Some warts can be very stubborn, even against agressive treatment
Treating warts and verrucas can be painful and can occasionally leave a scar which, on the sole of the foot, can be uncomfortable
If treatment is necessary, we usually start with less painful options, especially for children.
Commonly used treatments are:
Salicylic acid preparations – This chemical helps removal of the hard outer layer of the wart. Skin should be pared down or filed with sandpaper prior to application of the acid solution.
Formaldehyde preparations – Mosaic warts (many small warts packed together in a small area) in particular may respond to a gel containing formaldehyde
Cryotherapy – Freezing the warts with liquid nitrogen, using either a cotton wool bud or a spray, may be the next option. Treatment is usually repeated every 3-4 weeks. It is painful and may lead to blistering afterwards, and so it may not be suggested by your doctor for small children
If the above treatments do not clear the warts, your doctor may advise on the following:
Removal under local anaesthetic – A sharpened spoon-like instrument (a curette) is used to gently scrape the wart away, the remaining raw area then being cauterized. As with all surgical procedures, a small scar may result, and this may be painful on the sole of the foot
Laser treatment – Here a targeted beam of laser light is aimed at the wart or verruca. Energy from the laser destroys the blood vessels feeding the area, the wart or verruca naturally falling off after a few weeks. This highly effective treatment may still require multiple treatments when dealing with deep-seated stubborn warts and verrucas
What can I do?
The following ‘self-care’ advice will help minimize discomfort and spread of warts and verrucas:
Never try to remove the wart or verruca yourself
Choose comfortable shoes that minimise pressure on verrucas
Avoid sharing shoes or socks with anyone else
Pressure-relieving pads can be purchased at any pharmacy
Keep feet clean and dry, and change socks daily
Avoid going barefoot in public places. Cover plantar warts with waterproof plasters or ‘verruca socks’ if you go swimming
Avoid picking at plantar warts. When paring your wart down, carefully dispose of the dead skin. Sand paper will also have living wart virus on it, so avoid using it for any other purpose
Take care when paring or filing down warts, as damage to the surrounding skin may cause spreading of the warts
Check your children periodically for warts and verrucas
Removal by curettage and cautery from £115
At the Ever Clinic, we recommend that skin tags are properly assessed to ensure:
A medical diagnosis is made
A professional assessment is undertaken to inform how best to remove them
What are skin tags?
Skin tags are small brown or skin-coloured growths on the skin. The range in size form a few millimeters to a few centimetres and protrude from the skin.
Skin tags are often incorrectly diagnosed as warts. They usually occur on areas where the skin rubs a lot. Eg. Neck, armpits, groin or eyelids
How do skin tags affect people?
There is no health issue associated with skin tags but they can:
Hurt or bled if they catch on clothing or jewellery
Cause difficulties when shaving
How are skin tags removed?
Anaesthetic is applied either as a cream or small injection
The tags are removed quite simply and with virtually no discomfort
What treatment is used?
They may be removed by ‘snip’ or ‘shave’ excision using a minor surgery kit
They may also be removed using a ‘hyfrecator’ which uses electricity to quickly dehydrate the skin tags (the skin tags fall off a few days later)
What happens afterwards?
A small white scar will remain after treatment
The skin tags are removed permanently but others may grow
Seborrheic keratosis (SK) is one of the most common benign skin lesions treated by doctors.
Also known as seborrheic warts and basal cell papillomas, their cause is not fully understood. Sunlight and human papilloma virus (HPV) may be risk factors and there seems to be a tendency for them to ‘run in families’.
What do they look like?
Seborrheic Keratosis typically are rough and have a ‘stuck on’ appearance. Their colour may range from golden brown to mid brown to almost black. They affect all skin types, but in dark skin they may also appear as multiple small dark brown or black bumps, especially on the face and the neck – in such cases this is called Dermatosis Papulosa Nigra.
Size varies from less than one centimetre to several centimetres in diameter.
Seborrheic Keratosis occur most often on the trunk, but they are also common on the head and neck. Some people may have just one lesion whilst others may have hundreds.
What symptoms do they cause?
Lesions are usually asymptomatic but sometimes do itch. Part or all of the Seborrheic Keratosis may also fall off with minimal trauma.
Why is it important to be treated by a doctor?
Traditionally Seborrheic Keratosis’s were treated without biopsy and were most frequently frozen off using liquid nitrogen. Occasionally, the abnormal ones were excised (cut out) to make sure they weren’t cancerous. A number of studies have now shown that SKs can in fact be melanomas in disguise. An example study found that when suspicious looking SKs were sent for pathology, up to 8.2% can be melanomas.
With the introduction of dermoscopy in 1998, came much more accurate diagnoses. Dermoscopy uses mixed light sources to actually look into the skin, confirming the clinical diagnosis of SK by assessing specific dermoscopic features within the skin. Sadly, the majority of non-doctors are unable to perform dermoscopy and even among doctors this is a relatively new skill.
Dermoscopic features of Seborrheic Keratosis:
comedo-like openings were observed – 30.6%
scale and hyperkeratosis surface – 33.6%
yellowish surface areas – 31.3%
milia-like cysts – 22.4%
fissure and ridges – 11.2%
What options are available for treatment?
Unfortunately, the NHS does not currently fund SK treatment.
Potential treatments available include:
Surgical excision and histopathology (specimen analysis at the lab)
Surgical removal with a curette
Long-pulse Alexandrite laser
Actikerall cream daily for 4 weeks (off license use)
Recommended treatment will be guided by your doctor as this will vary depending on the size and thickness of the particular SK of concern.
Small area (less than 1cm2) £69
Up to 3 small areas £159
Up to 6 small areas £199
If you have any questions about the treatment or would like a callback to discuss, please complete the form below.