tag:theconversation.com,2011:/au/topics/skin-series-50414/articlesskin series – The Conversation2018-03-22T23:46:30Ztag:theconversation.com,2011:article/914152018-03-22T23:46:30Z2018-03-22T23:46:30ZBeauty is skin-deep: why our complexion is so important to us<figure><img src="https://images.theconversation.com/files/210612/original/file-20180315-104673-c6hkvr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Skin is seen as a marker of health, and thus beauty. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/hDlIX2hq5u8">Noah Buscher/Unsplash</a></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>We’re all attracted to a beautiful face. We like to look at them, we feel drawn to them and we aspire to have one. Many researchers and others have investigated what we humans identify as “beautiful”: symmetry, large evenly spaced eyes, white teeth, a well-proportioned nose and of course, a flawless complexion. The skin is of utmost importance when people judge someone as beautiful.</p>
<p>When choosing a mate, men rank female beauty more highly than women rate male appearance. <a href="http://beauty-review.nl/wp-content/uploads/2014/04/The-effects-of-skin-colour-distribution-and-topography-cues-on-the-perception-of-female-facial-age-and-health.pdf">Female beauty</a> is thought to signal youth, fertility and health. </p>
<p>Beauty can also signal
<a href="https://wiwi.uni-paderborn.de/fileadmin/dep1ls6/Research/Beauty_and_the_Labor_Market_Hamermesh_Biddle.pdf">high status</a>. People with “plain looks” earn about 10% less than people who are average-looking, who in turn earn around 5% less than people who are good-looking.</p>
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Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
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<h2>Skin as a marker of health and beauty</h2>
<p>Even the best facial structure can be unbalanced by skin that is flawed.</p>
<p>There are many skin conditions that are perfectly natural, yet because of our beliefs around skin and health, these can cause the sufferers extreme self-consciousness. </p>
<p>Examples include: <a href="https://www.dermnetnz.org/topics/melasma/">chloasma</a>, the facial pigmentation that often occurs during pregnancy; <a href="https://www.dermnetnz.org/topics/telangiectasia/">starburst telangiectasias</a>, the broken capillaries that appear on the lower thighs and calves of many women as they age; and <a href="https://www.dermnetnz.org/topics/dermatosis-papulosa-nigra/">dermatosis papulosa nigra</a>, the brown marks that accumulate on the upper cheeks and temples, especially in people of Asian or African descent. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211317/original/file-20180321-165550-12h64i3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Chloasma (pigmentation) often affects pregnant women.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>Teenagers with <a href="https://escholarship.org/uc/item/4hp8n68p">acne</a> are more likely to withdraw socially. It may impair school performance and result in severe <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1440-1754.2006.00979.x">depression and even suicide</a>. </p>
<p>There are hundreds of <a href="http://www.dermnet.com/">skin diseases</a> that can change facial appearance, including rashes such as rosacea and skin cancers. Surgery for skin cancer can <a href="https://www.google.com.au/search?q=skin+cancer+disfigurement&rlz=1C1OKWM_enAU783AU786&source=lnms&tbm=isch&sa=X&ved=0ahUKEwjb7sicn_zZAhVHV7wKHcImAeoQ_AUICigB&biw=2560&bih=1334">leave noticeable marks and scars</a> that make the survivor self-conscious.</p>
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Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
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<h2>Industries built on our self-consciousness</h2>
<p>Perhaps alongside the greying of the hair, skin is the most visible sign of ageing. As we age the skin changes. These changes are most pronounced in the areas exposed daily to the sun, such as the face, neck and the backs of our hands. </p>
<p>There the skin thins, loses volume and elasticity and becomes dull. Dark rings develop under the eyes. Wrinkles appear. The skin sags and blemishes and scars accumulate. </p>
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<a href="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/211318/original/file-20180321-165583-btwc64.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Despite having no negative physical health effects, acne can cause major self-esteem problems in youth.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
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<p>People spend a lot of money in attempts to regain their youthful appearance. The global cosmetics industry is worth about <a href="https://www.businesswire.com/news/home/20150727005524/en/Research-Markets-Global-Cosmetics-Market-2015-2020-Market">US$500 billion</a>. Sales of skin and sun care products, make-up and colour cosmetics generate over 36% of the worldwide cosmetic market. </p>
<p>We use foundation makeup to conceal freckles and blemishes, moisturisers and fillers to hide dryness, concealers to disguise broken capillaries and pimples. And increasingly people are using botox to remove wrinkles, fillers to replace volume, and laser to remove flaws from the top layer of skin.</p>
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Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
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<p>We should all use sunscreen to protect the skin from sun damage and prescription medications to cure the skin of diseases when necessary.</p>
<p>In 2018, we find ourselves living longer, working later and remarrying more. We’re having to trade on our beauty much later in life.</p>
<p>In a better world, beauty would be irrelevant. Unfortunately in our world it’s one of our most valuable assets. The best we can do is to protect our skin from sunburn, seek advice from a dermatologist when we notice any skin problems, and accept we weren’t born with the skin of Beyonce. </p>
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Read more:
<a href="https://theconversation.com/four-of-the-most-life-threatening-skin-conditions-and-what-you-should-know-about-them-92610">Four of the most life-threatening skin conditions and what you should know about them</a>
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<img src="https://counter.theconversation.com/content/91415/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Rodney Sinclair does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Despite skin conditions such as acne having no negative health effects, they can take a huge toll on the confidence and mental health of the person.Rodney Sinclair, Professor of Dermatology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/915162018-03-22T19:08:38Z2018-03-22T19:08:38ZWrinkles, liver spots, crows’ feet: what happens to our skin as we age?<figure><img src="https://images.theconversation.com/files/210153/original/file-20180313-30965-1mepa4q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Reductions in collagen and elastin as we age are mostly to blame for our laugh lines. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/ZPynRLKjp9I">todd cravens/unsplash</a></span></figcaption></figure><p><em>This article is part of our series about skin: why we have it, what it does and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>The main factors that contribute to how old we look include the shape of our face, the number of lines or wrinkles, and the luminosity of our skin. Each of these is influenced by intrinsic and external factors.</p>
<p>Skin is the most visible organ. So ageing skin has a big impact on a person’s self-esteem. Aussies spend <a href="https://stat.mozo.com.au/images/more-on-mozo/media-releases/twenty-two-billion--the-annual-cost-of-vanity.pdf">nearly A$5 billion per year</a> on skin care products and treatments, with Queenslanders spending the most on beauty per capita.</p>
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Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
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<h2>Intrinsic ageing of the skin</h2>
<p>Rates of intrinsic (also known as chronologic) ageing are predicted, to a degree, by our genetic makeup, including our skin colour.</p>
<p>With age, the epidermis (the top layer of the skin) becomes thinner and more transparent. This means that it reflects less light and so appears less luminous as time goes on. </p>
<p>The epidermis may also start to develop growths, including small brown dots (dermatosis papulosa nigra and seborrhoic keratoses) and overgrown oil glands, as well as spots that result from ultra-violet (UV) light exposure such as lentigines (freckles), melasma (pigmentation), solar keratoses (sun spots) and skin cancers.</p>
<p>Our dermis (the layer of skin under the epidermis) loses collagen and elastin as we age, causing the skin to sag and develop wrinkles when our muscles move under the skin. The blood vessels in the dermis also become thinner, which leads to easy bruising. And because the dermis and epidermis are thinner and hence closer together as we age, the blood vessels become more visible on the surface of the skin with time.</p>
<p>The reason collagen decreases as we age is complex, but is partly due to the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1606623/">reduced function of the cells</a> that make collagen (fibroblasts) and an increase in the enzyme that breaks down collagen. </p>
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<a href="https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210615/original/file-20180315-104699-c011qh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Cross-section of the skin.</span>
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<p><a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4174174/">Research has also shown</a> that fat is lost and bone is resorbed from different compartments of the face at different rates, and this affects our perceived age.</p>
<p>When fat disappears from under the eyes (usually in our 20s or 30s), a dark shadow appears, making us look tired. And as the fat pad around the cheeks moves downwards (in our 30s and 40s), lines are created that extend outwards from the nose. </p>
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<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
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<p>Decreases in collagen and elastin cause frown lines and crows feet to develop, alongside other dynamic wrinkles (wrinkles from muscle movement). Meanwhile, the edge of the brow begins to drop and the lips start to thin out.</p>
<p>As we move into our 50s, collagen and elastin levels fall further, causing our wrinkles to deepen, and resorption of bone occurs around the eyes causing “bags” to form. Fat hanging from now less-elastic skin causes our eyebrows and nasal tips to droop and the skin on our neck to sag.</p>
<p>But intrinsic factors aren’t the whole story. Our lifestyle, environment and habits also play a role in skin ageing.</p>
<h2>Extrinsic ageing of the skin</h2>
<p>Extrinsic ageing can be induced by environmental factors such as UV exposure, smoking and air pollution. This means the skin’s apparent age and its chronological age are not always the same.</p>
<p>UV light breaks down elastin in the dermis, causing saggy, stretchy skin. The skin also bruises and tears more easily and takes longer to heal with ongoing exposure to UV rays.</p>
<p>Tobacco smoke results in insufficient oxygen supply to the skin and blocked blood vessels. It reduces immunity (meaning skin cancers can develop more easily) and increases the level of an enzyme that breaks down collagen. Reduced collagen results in wrinkles and loss of volume. Smoking also increases dryness, coarseness and a dull appearance of the skin, and increases wrinkles around the mouth.</p>
<p><a href="https://www.ncbi.nlm.nih.gov/pubmed/20664556">Recent research</a> also suggests a positive correlation between air pollution and extrinsic skin ageing, with 20% more pigment spots noted on the forehead and cheeks of those with exposure to more soot and particles from traffic.</p>
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<a href="https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210154/original/file-20180313-30958-1twaha.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">More pigmented skin is usually thicker, meaning it won’t wrinkle as much as white skin.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/Oed8cpob9VM">tikkho maciel unsplash</a></span>
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<h2>Differences in ageing</h2>
<p>So why is it that people of different ethnicities and skin colours seem to age differently? Different types of skin have different amounts of elastin, collagen, pigment cells (melanocytes), and fats. </p>
<p>Darker skin has larger, more numerous <a href="https://en.wikipedia.org/wiki/Melanosome">melanosomes</a>, which manufacture, store and transport melanin, in turn giving the skin pigment. This provides protection against UV rays in people with darker skin types. </p>
<p>The average protective factor against UV-B radiation in black skin was found to be 13.4 – compared with 3.4 for white skin, while the average rate of UV-B transmission into the dermis was 5.7% in black skin, compared with 29.4% in white skin. </p>
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Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
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<p>While increased melanin serves as an inbuilt sunscreen, it’s also the responses of these pigment cells that make patients with skin of colour more susceptible to pigment problems over time. </p>
<p>And those with darker skin types are said to have a thickened outer layer of the skin with larger and more numerous fibroblasts (cells that make connective tissue and collagen) and compact collagen. This means this type of skin won’t wrinkle as easily, but has a greater chance of keloid scarring (overgrowth of scar tissue).</p>
<p>So it seems that not all skin is created equal, but there are things we can do to optimise our skin health. Sun protection (hat, sunscreen, seeking shade) and avoiding smoking are good places to start. Retinoids have been proven to help minimise fine lines, pigmentation and to increase collagen and repair sun-damaged skin. </p>
<p>As for the myriad lotions and potions that claim to magically make us look 21 again … if I find one that works I’ll let you know. </p>
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Read more:
<a href="https://theconversation.com/four-of-the-most-life-threatening-skin-conditions-and-what-you-should-know-about-them-92610">Four of the most life-threatening skin conditions and what you should know about them</a>
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<img src="https://counter.theconversation.com/content/91516/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michelle Rodrigues does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>There’s not much we can do about the reduction in collagen and fat that cause lines and circles under our eyes as we age. But sunscreen and a healthy lifestyle can help keep the signs of ageing at bay.Michelle Rodrigues, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/926102018-03-21T19:33:10Z2018-03-21T19:33:10ZFour of the most life-threatening skin conditions and what you should know about them<figure><img src="https://images.theconversation.com/files/209970/original/file-20180312-30965-xaeir3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some serious skin conditions are more likely to affect those with weaker immune systems. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>Dermatological emergencies are uncommon, but can cause devastating complications and death if not recognised and treated early. Some skin conditions require treatment in an intensive care unit. Here are some of the most serious skin conditions and what you should know about recognising them.</p>
<h2>1. Necrotising fasciitis</h2>
<p>Necrotising fasciitis is a severe infection of the skin, the tissue below the skin, and the fascia (fibrous tissue that separates muscles and organs), resulting in tissue death, or necrosis. The infection is rapid, fast-spreading and fatal if not detected and treated early. If not treated with antibiotics and surgery early, <a href="https://rarediseases.org/rare-diseases/necrotizing-fasciitis/">toxic shock and organ failure are common</a>.</p>
<p>Necrotising fasciitis may occur in anyone. Previously healthy young people are often affected. </p>
<p>The cause may be one or more bacteria entering the body via an external injury or punctured internal organ. Group A streptococci bacteria, which are the organisms implicated in “strep throat”, are <a href="https://www.dermnetnz.org/topics/necrotising-fasciitis/">among the most common causes</a>.</p>
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Read more:
<a href="https://theconversation.com/explainer-what-causes-necrotising-fasciitis-the-flesh-eating-bug-49369">Explainer: what causes necrotising fasciitis, the flesh-eating bug?</a>
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<p>Early necrotising fasciitis is easily missed, as similar symptoms are commonly seen in less severe infection. The initial area is painful, red and swollen. This progresses to a dark, blistered, malodorous and blackened area, which is a sign of tissue death. Other symptoms include fever, intense pain, low blood pressure and shock. </p>
<p>The most important risk factors for necrotising fasciitis include diabetes, peripheral vascular disease, trauma, alcohol and intravenous drug use, and use of non-steroidal anti-inflammatory drugs. </p>
<p>Treatment of necrotising fasciitis is immediate hospitalisation, surgical removal of all dead tissue, and intravenous antibiotics. Patients often require intensive care. Management of shock and other complications reduces the risk of death. Use of a hyperbaric chamber (to increase oxygen delivery to the tissue) and immune therapy may also be required. </p>
<p><a href="https://www.dermnetnz.org/topics/necrotising-fasciitis/">Around a quarter of people diagnosed</a> with necrotising fasciitis will die, and sepsis occurs in up to 70% of cases.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209956/original/file-20180312-30989-nmadph.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most have heard of necrotising fasciitis as the ‘flesh-eating bug’.</span>
<span class="attribution"><a class="source" href="https://www.dermnetnz.org/">DermNet New Zealand</a></span>
</figcaption>
</figure>
<h2>2. Scalded skin syndrome</h2>
<p><a href="https://rarediseases.org/rare-diseases/staphylococcal-scalded-skin-syndrome/">Staphylococcal scalded skin syndrome</a> is an uncommon major skin infection. It typically affects newborn babies, young children and adults with reduced immune systems or kidney failure. This syndrome is caused by toxins produced by the bacterium <em>Staphylococcus aureus</em>, which is common in throat, ear and eye infections.</p>
<p>Around 15-40% of adults carry <em>Staphylococcus aureus</em> <a href="https://www.dermnetnz.org/topics/staphylococcal-scalded-skin-syndrome/">on the skin surface</a> and have no problems. But these adults may inadvertently introduce the bacteria into nurseries or daycare centres. Because young children have weak immunity to specific toxins, they’re at increased risk of scalded skin syndrome.</p>
<p>Scalded skin syndrome is characterised by a red, blistering rash resembling burns. Early symptoms include fever, skin redness and skin tenderness. Other symptoms may include sore throat or conjunctivitis. </p>
<p>Within 24-48 hours, fluid-filled blisters form on the entire body. The blisters may rupture, leaving areas resembling burns. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5012080/">Large areas of the skin peel off</a> and fall away with only minor touch. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
</strong>
</em>
</p>
<hr>
<p>Scalded skin syndrome requires hospitalisation for intravenous antibiotics and treatment of the wounds. Ruptured blisters require wound dressings, and the skin surface requires intense care to avoid further damage. </p>
<p>Other treatment includes intravenous fluid and electrolyte maintenance to prevent shock and other complications, paracetamol for pain and fever, and avoidance of severe sepsis. Sepsis is when chemicals released into the bloodstream to fight an infection trigger inflammatory responses throughout the body, which can be life-threatening. </p>
<p>Complications of scalded skin syndrome include severe infection, pneumonia, cellulitis (a bacterial skin infection) and dehydration. Most children treated appropriately recover well and healing is complete within a week.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209955/original/file-20180312-30961-hqxkv4.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Staphylococcal scalded skin syndrome is more likely to occur in people with weaker immune systems – such as children.</span>
<span class="attribution"><a class="source" href="https://www.dermnetnz.org/">DermNet New Zealand</a></span>
</figcaption>
</figure>
<h2>3. DRESS syndrome</h2>
<p>Standing for “drug reaction with eosinophilia and systemic symptoms,” DRESS syndrome is a severe reaction that affects the skin and internal organs. The patient may have an extensive rash, fever, enlarged lymph nodes and damage to the liver, kidneys, lungs, heart, blood components or pancreas. Symptoms usually start <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3718748/">two to eight weeks after</a> the responsible drug has been taken.</p>
<p>The death rate is estimated <a href="https://www.researchgate.net/publication/298485704_Dress_Syndrome_A_Review_and_Update">between 10 and 20%</a>, most often due to liver failure.</p>
<p>The most common drugs responsible include anticonvulsants, antidepressants, non-steroidal anti-inflammatory drugs, antibiotics and sulfa drugs (a type of synthetic antibiotic). The severe reaction is thought to occur due to a pre-existing genetic change in the immune system, a triggering illness (most often a viral infection) and defective breakdown of the drug by the body. </p>
<p>Early diagnosis is essential. The responsible drug must be stopped immediately and patients may require intensive care or burn unit management. More intensive treatment is needed if organs are involved.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209952/original/file-20180312-30986-18pi6cw.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">DRESS syndrome appears a few weeks after taking a drug the patient is allergic to.</span>
<span class="attribution"><a class="source" href="https://www.dermnetnz.org/topics/drug-hypersensitivity-syndrome/">DermNet New Zealand</a></span>
</figcaption>
</figure>
<h2>4. Life-threatening drug reactions</h2>
<p>Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018455/">variants of a life-threatening reaction</a> that affects the skin and mucous membranes (mouth, eyes, genitals, respiratory or gastrointestinal tracts).</p>
<p>These are unpredictable reactions that leave sufferers critically unwell, with widespread death of the outer skin layer (epidermis), which peels off. The rash <a href="https://www.dermnetnz.org/topics/stevens-johnson-syndrome-toxic-epidermal-necrolysis/">generally begins on the trunk</a> and extends to the limbs and face, and there is intense skin pain. Before the rash appears, symptoms include fever, sore throat, runny nose, conjunctivitis and general aches.</p>
<p>It’s almost always caused by medications. The most common medications causing this reaction are anticonvulsants, antibiotics, allopurinol (<a href="https://theconversation.com/got-gout-heres-what-to-eat-and-avoid-50239">gout</a> medication), non-steroidal anti-inflammatory drugs and an HIV drug. The reaction usually occurs in the first eight weeks after taking the drug. It’s more likely to happen if the patient has cancer, HIV or specific genes that may play a role.</p>
<p>This reaction can be fatal by causing dehydration and malnutrition, severe infection, respiratory failure, gastrointestinal complications and multi-organ failure.</p>
<p>The responsible drug has to be stopped, and treatment (in a burns unit and intensive care unit) includes wound care, fluid management, pain management and prevention of infection. Long-term complications, including scarring, eye, oral, genital, lung disease and mental health disorders, are common. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3018455">Around a quarter of people</a> with this reaction will die. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
</strong>
</em>
</p>
<hr>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=452&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=452&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=452&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=568&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=568&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210609/original/file-20180315-104645-374jy0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=568&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">This reaction to medications is totally unpredictable.</span>
<span class="attribution"><span class="source">DermNet NZ</span></span>
</figcaption>
</figure><img src="https://counter.theconversation.com/content/92610/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>William Cranwell does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Deadly skin conditions are rare, but can be misdiagnosed.William Cranwell, Dermatology Clinical Research Fellow, Melbourne HealthLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/915182018-03-20T19:04:37Z2018-03-20T19:04:37ZCommon skin rashes and what to do about them<figure><img src="https://images.theconversation.com/files/209558/original/file-20180308-30983-e4u830.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">What's that rash? Here's what to look for to diagnose a common skin complaint. </span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
<hr>
<p>Everyone has had the unpleasant experience of a rash on the skin – pink, red or purple, flat or bumpy, itchy, scaly, pus-filled, or just plain unsightly. This variety isn’t surprising, because the skin is a complicated organ. </p>
<p>Infections, allergic reactions, immune system problems and even bad reactions to medication can all manifest as a rash. </p>
<p>Here are a few of the most common types.</p>
<h2>Drug allergy</h2>
<p><a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">Almost every prescription medication</a> available can cause a rash as a side effect, and more than 80% of those are “<a href="https://www.dermnetnz.org/topics/morbilliform-drug-reaction/">exanthematous drug eruptions</a>”, meaning a widespread rash accompanied by other symptoms such as headache, fever and feeling generally unwell. </p>
<p>This rash usually appears within two weeks of starting a new medication, as a widespread, symmetrical rash with pink-to-red spots that are flat or elevated and firm, and that might join together in patches. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/common-lumps-and-bumps-on-and-under-the-skin-what-are-they-59313">Common lumps and bumps on and under the skin: what are they?</a>
</strong>
</em>
</p>
<hr>
<p>This type of rash is a hypersensitivity reaction, in which the attacking soldiers of the immune system (called “T-cells”) detect the drug and try to clear it from the body by releasing inflammatory proteins. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206734/original/file-20180216-131003-1a7s5jg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Exanthematous drug eruption.</span>
<span class="attribution"><span class="source">DermNet New Zealand.</span></span>
</figcaption>
</figure>
<p>Very rarely, a drug can cause a severe and life-threatening rash called “toxic epidermal necrolysis” where the skin begins to peel off in sheets. It’s more common in Han Chinese people with a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2586963/">specific genetic variant</a>, and requires intensive care or burn unit treatment. </p>
<p>Most drug eruptions <a href="http://www.nejm.org/doi/full/10.1056/NEJMcp1104080">go away within a week</a> once the patient stops taking the problem medication, or within several weeks in protracted cases. In the meantime, or if the drug is essential, steroid creams (which reduce inflammation) and emollient (softening) moisturisers can bring some relief. </p>
<h2>Allergic contact dermatitis</h2>
<p><a href="https://www.dermnetnz.org/topics/allergic-contact-dermatitis/">Allergic contact dermatitis</a> is caused by direct skin contact with a substance to which the person is allergic. The immune system’s T-cells overreact to the allergen and release proteins that call more immune cells to the area, making it red and swollen. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/why-does-australia-have-so-much-skin-cancer-hint-its-not-because-of-an-ozone-hole-91850">Why does Australia have so much skin cancer? (Hint: it's not because of an ozone hole)</a>
</strong>
</em>
</p>
<hr>
<p>It’s often itchy and can be blistered or dry but bumpy. The reaction is often delayed by 48-72 hours, so it can be difficult to determine exactly what caused the reaction. It should also die down by itself over a few days, as long as the allergen is no longer on the skin. </p>
<p>Contact allergies <a href="https://www.dermcoll.edu.au/atoz/allergic-contact-dermatitis-acd/">can develop suddenly</a> after years of exposure to an allergen. Jewellery containing nickel, fragrances in lotions, household cleaners, preservatives in hair products, and latex in gloves or condoms are common sources. A dermatologist can carry out a patch test to determine whether a substance is the allergen, by applying it to a small patch of skin.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=686&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=686&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=686&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=862&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=862&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206735/original/file-20180216-131006-fpfxkj.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=862&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Severe contact dermatitis from a drug patch.</span>
<span class="attribution"><span class="source">Dr. Khatmando</span></span>
</figcaption>
</figure>
<p>Active dermatitis is treated with emollient moisturisers and steroid creams, or with oral steroids or drugs to suppress the immune system if very severe. Further episodes can be prevented by becoming aware of the sources of the allergen, reading labels carefully, and using gloves to handle allergen-containing products. </p>
<h2>Eczema</h2>
<p><a href="https://www.dermcoll.edu.au/atoz/atopic-dermatitis/">Atopic dermatitis</a> or atopic eczema (often just called eczema) is very common in children from three months old onwards, but appears in adults too, often with hay fever and asthma. </p>
<p>Atopic dermatitis features patches of intensely itchy red skin, sometimes with blisters and weeping patches. Children often have open sores and scabs, because it’s so itchy that it’s hard to refrain from scratching. </p>
<p>Over time the skin becomes thickened and rough from frequent scratching and rubbing. Childhood atopic dermatitis tends to improve as the child grows up, but may continue. Far less commonly, atopic dermatitis can also appear first in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122283/">adulthood</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206736/original/file-20180216-131003-ts387q.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Atopic dermatitis is very common in children, but often improves as they get older.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Atopic dermatitis is a <a href="https://www.dermnetnz.org/topics/causes-of-atopic-dermatitis/">disease of the immune system</a>, in which
structural defects in the skin barrier make it easier for irritants to penetrate into the skin. This throws the delicate balance of the microbial community on our skin out of whack, causing the immune system to go into overdrive. Triggers include stress, sweating, coarse fibres in clothing, inhalation of allergens such as pollen, irritants such as soap or perfumes, and eating food we’re allergic to.</p>
<p>Steroid creams can help treat a bad flare of atopic dermatitis, but shouldn’t be used constantly. In very severe cases, immunosuppressant drugs are prescribed. Ongoing control of atopic dermatitis often includes using emollient moisturisers to combat dry skin, keeping cool, avoiding hot water or irritants, and reducing allergens such as dust mites in the home. </p>
<p>For severe cases that don’t respond to these methods, the drug <a href="https://www.tga.gov.au/prescription-medicines-registration-new-chemical-entities-australia">dupilumab</a> has just been approved for use in Australia. This drug blocks a specific cell receptor to prevent immune cells from detecting two overactive inflammatory proteins.</p>
<p>Atopic dermatitis can have a big impact on quality of life, due to insomnia from the constant itchiness, and restrictions on clothing, body products, pets or activities. Its presence on prominent parts of the body like the face and hands can also reduce self-esteem. Evening sedatives to improve sleep and psychotherapy can help reduce the impact on everyday life. </p>
<h2>Psoriasis</h2>
<p>Psoriasis is another chronic immune disorder. It can start at any age and can be lifelong, and is usually present as red plaques (raised or thickened skin) with well-defined edges and silvery-white scales, ranging from a few millimetres to several centimetres across. The overactive inflammation can also damage the joints and lead to <a href="https://www.dermnetnz.org/topics/psoriatic-arthritis">psoriatic arthritis</a>.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
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<p>Often the plaques feel <a href="https://www.dermcoll.edu.au/atoz/psoriasis/">itchy or sore</a>, and because psoriasis is long-lasting and can appear prominently on highly visible parts of the body, it often comes with <a href="https://www.dermnetnz.org/topics/psychological-effects-of-psoriasis">severe psychological effects</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206737/original/file-20180216-131010-1sqaufr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Psoriasis lesions are raised, red and often have white scales.</span>
<span class="attribution"><span class="source">DermNet New Zealand</span></span>
</figcaption>
</figure>
<p>Psoriasis is caused by too many new skin cells being produced and moving up to the surface of the skin <a href="https://www.nhs.uk/conditions/psoriasis/causes/">too quickly</a>. It’s not known exactly why, but there’s usually an overabundance of inflammatory messenger proteins in the skin. </p>
<p>It can be triggered or aggravated by a streptococcal infection such as tonsillitis, smoking, hormonal changes such as menopause, and some medications. Genetics play an important role in susceptibility to psoriasis and also in what treatments are effective.</p>
<p><a href="https://www.dermnetnz.org/topics/plaque-psoriasis/">Chronic plaque psoriasis</a>, the most common form, can be very resistant to treatment. Small areas can be treated with creams containing steroids, coal tar, or vitamin D. If a lot of the body is covered by plaques, oral immunosuppressant drugs are used, or <a href="https://www.ncbi.nlm.nih.gov/pubmed/29369396">phototherapy</a>, which uses targeted UV light to destroy over-active immune cells. Moderate sun exposure sometimes improves psoriasis, but sunburn can worsen it – a tricky balance in Australia’s high-UV environment. </p>
<p>These treatments can usually improve the plaques, but it can be very difficult to clear it completely. There are several <a href="https://www.psoriasis.org/about-psoriasis/treatments/biologics">new drugs</a> coming onto the market for severe psoriasis that hasn’t responded to other treatment.</p>
<h2>Tinea</h2>
<p>Tinea, or ringworm, is not caused by worms at all but a fungal infection. Tinea is usually named according to the body site it’s on, but the same few kinds of fungus can cause tinea in many parts of the body and it can be spread from one part of the body to another, such as by scratching or using a contaminated towel.</p>
<p><a href="https://www.dermnetnz.org/topics/tinea-pedis/">Tinea pedis</a>, on the foot, is an important type because spores can live for weeks in communal showers and changing rooms, making it a common source of infection that can then spread to the trunk, arms and legs (<a href="https://www.dermnetnz.org/topics/tinea-corporis/">tinea corporis</a>) or groin (<a href="https://www.dermnetnz.org/topics/tinea-cruris/">tinea cruris</a>, or jock itch). Cats, dogs and other animals are a common source of ringworm fungus, but many types can be spread between people too.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206738/original/file-20180216-131006-142aznr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The fungus continues to spread further out while the inner area heals, forming a distinctive ring shape.</span>
<span class="attribution"><span class="source">Grook Da Oger</span></span>
</figcaption>
</figure>
<p>Typically, tinea spreads in a circular or oval patch, often healing in the middle so that it appears to be a red scaly ring of infection. Sometimes it can also become a fungal abscess that looks like a boil, feels boggy, and has pustules. </p>
<p>On the feet it can look like ringworm circles, patchy fine dry scales on the sole, blisters on the instep or a moist, red peeling area between the toes (athlete’s foot). </p>
<p>In the groin, it can have a scaly, red raised border and be extremely itchy.</p>
<p>Tinea is diagnosed by microscopic examination and laboratory culture of skin scrapings. It’s usually treated with antifungal creams, or oral antifungal drugs if it persists. It can become chronic in the warm, moist folds of the body.</p>
<h2>Shingles</h2>
<p>Shingles is a famously painful, blistering rash caused by the reactivation of chicken pox virus, <a href="http://www.sahealth.sa.gov.au/wps/wcm/connect/public+content/sa+health+internet/health+topics/health+conditions+prevention+and+treatment/infectious+diseases/chickenpox+and+shingles">varicella-zoster virus</a>, usually years or decades after the original infection. </p>
<p>The virus lies dormant in nerves near the spine and migrates down the sensory nerve to the skin when it is reactivated, but it’s not known why the virus is reactivated. Some possible triggers are radiotherapy, spinal surgery, other infections, or cancers.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=378&fit=crop&dpr=1 600w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=378&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=378&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=474&fit=crop&dpr=1 754w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=474&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/206740/original/file-20180216-130997-1yurw17.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=474&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Shingles forms a painful, blistered red rash along the line of a sensory nerve.</span>
<span class="attribution"><span class="source">Fisle</span></span>
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</figure>
<p>Shingles <a href="https://www.mja.com.au/journal/2008/188/3/prevention-and-management-herpes-zoster">starts with pain in the skin</a> that is often described as burning or stabbing, followed in one to three days by a rash of raised red bumps that become blisters and then crust over. The rash is usually confined to a narrow arc of skin, along the sensory nerve that was harbouring the virus. </p>
<p>Patients often have a fever, headache and swollen lymph nodes. Recovery takes two to four weeks but the pain can persist after the rash has healed, called <a href="https://www.dermnetnz.org/topics/post-herpetic-neuralgia">post-herpetic neuralgia</a>. </p>
<p>If it’s caught within three days of onset, antiviral medication can reduce the severity of symptoms and length of the infection. Otherwise, treatment consists of powders or solutions to dry out the rash, as well as pain relief and rest. </p>
<p>Australians aged over 70 are eligible for a <a href="https://beta.health.gov.au/services/shingles-herpes-zoster-immunisation-service">free zoster vaccine</a>, which reduces the risk of shingles by half.</p><img src="https://counter.theconversation.com/content/91518/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>H. Peter Soyer receives funding from NHMRC and ARC.</span></em></p><p class="fine-print"><em><span>Katie Lee does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Here’s a list of the most common rashes and what you need to look for.H. Peter Soyer, Professor of Dermatology, The University of QueenslandKatie Lee, Research assistant, The University of QueenslandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/918502018-03-20T03:30:52Z2018-03-20T03:30:52ZWhy does Australia have so much skin cancer? (Hint: it’s not because of an ozone hole)<figure><img src="https://images.theconversation.com/files/208115/original/file-20180227-36700-648hek.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">White people are not made for Australia's weather conditions.</span> <span class="attribution"><span class="source">from www.shutterstock.com</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>Skin cancer is one of Australia’s most common cancers, with data showing <a href="https://wiki.cancer.org.au/skincancerstats/Skin_cancer_incidence_and_mortality">almost a million</a> cases of skin cancer in 2015. </p>
<p>Skin cancer is primarily caused by excessive exposure to ultraviolet (UV) radiation from the sun, causing DNA damage to skin cells. If this damage is not repaired by the body’s internal DNA repair machinery, then faulty cell replication can occur – triggering the abnormal growth of cells – which <a href="http://www.publish.csiro.au/book/7227">eventually become cancers</a>. </p>
<p>People with pale skin types are more vulnerable to skin cancer and, broadly, the more sun they are exposed to – and the greater the intensity of the UV radiation – the higher their risk.</p>
<p>Cutaneous malignant melanoma is the most aggressive skin cancer claiming more than 1,700 lives in 2016. Squamous cells carcinoma and basal cell carcinoma are far more common but far less life threatening. Despite being very amenable to treatment if identified at an early stage, squamous cells carcinomas still caused 560 deaths in 2016. </p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/sun-damage-and-cancer-how-uv-radiation-affects-our-skin-34538">Sun damage and cancer: how UV radiation affects our skin</a>
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<p>International comparisons highlight the extent to which we and our Kiwi friends are undisputed world champions in skin cancer. Unfortunately, we’ve long occupied gold and silver on the skin cancer Olympic podium.</p>
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<p><iframe id="8dMRN" class="tc-infographic-datawrapper" src="https://datawrapper.dwcdn.net/8dMRN/1/" height="400px" width="100%" style="border: none" frameborder="0"></iframe></p>
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<p>A conservative estimate of the cost of treating melanoma in Australia <a href="https://www.ncbi.nlm.nih.gov/pubmed/28756584">exceeds A$270 million</a> annually. If we add non-melanoma skin cancers (now called “keratinocyte cancers” after their cell of origin) and the bill is likely <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4871202/">more than A$1billion</a> a year.</p>
<h2>Why us?</h2>
<p>Most Australians (and Kiwis) have the wrong type of skin for their environment. Basically, through migration, our two countries have been populated by many people with fair skin whose ancestors come from much less sunny climates. Lack of protective pigmentation leaves skin cells especially vulnerable to the DNA-damaging rays from the sun. </p>
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<strong>
Read more:
<a href="https://theconversation.com/common-skin-rashes-and-what-to-do-about-them-91518">Common skin rashes and what to do about them</a>
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<p>During human evolution, our early hominid ancestors in Africa lost their covering of body hair and developed pigmented skins, presumably as protection against the harsh tropical sun. With subsequent migration out of Africa into Europe, the protective benefits of dark skin became less important for survival and were likely a hindrance to effective vitamin D production. There was selective pressure for <a href="http://www.pnas.org/content/pnas/107/Supplement_2/8962.full.pdf">less pigmented skin with more distance from the equator</a>. </p>
<p>In contrast, those who migrated out of Africa to Asia, Australia and the islands of Melanesia were constantly exposed to sunlight. So they retained their protective pigmentation. This explains why the recent European migrants to the Americas and Oceania arrived in the “new worlds” with skin types <a href="https://www.sciencedirect.com/science/article/pii/S0022202X15356025">poorly suited to their new environments</a>. This was in stark contrast to the well-adapted skin of the indigenous inhabitants. </p>
<p>While melanin provides <a href="https://www.ncbi.nlm.nih.gov/pubmed/?term=Fajuyigbe+D+Su+M.+Lwin+Diffey+bl+baker++Tobin+Young">protection against the damage caused by exposure</a> to UV radiation, it’s not a “suit of armour”. <a href="https://www.aihw.gov.au/getmedia/0368fb8b-10ef-4631-aa14-cb6d55043e4b/18197.pdf.aspx?inline=true">Melanoma rates are far lower</a> in people with pigmented skin such as Aboriginal people, but not non-existent.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=421&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=421&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=421&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=529&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=529&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208116/original/file-20180227-36696-12y3dfq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=529&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Melanin, which pigments the skin, protects against UV radiation. This is why paler people will get more skin cancer.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>A major factor is geography – that is proximity to the equator (the line on the globe that gets the greatest amount of sun). Generally speaking, the closer to the equator someone lives, the greater the amount and intensity of sun exposure they receive. That gradient is seen in a comparison of <a href="https://www.aihw.gov.au/getmedia/0368fb8b-10ef-4631-aa14-cb6d55043e4b/18197.pdf.aspx?inline=true">skin cancer rates across Australian states</a> with Queensland reporting much higher rates than New South Wales, which is in turn higher than Victoria. </p>
<p>Another is the <a href="https://www.space.com/14142-earth-closest-approach-sun-perihelion.html">earth’s elliptical orbit around the sun</a>. The planet is about 1.7% closer to the sun in January, during the southern summer, and 1.7% further away in July – northern summer. So that means when the sun is strongest the southern hemisphere is 3.4% closer to the sun than the north is during their summer. This increases UV by about 7%.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/four-of-the-most-life-threatening-skin-conditions-and-what-you-should-know-about-them-92610">Four of the most life-threatening skin conditions and what you should know about them</a>
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<p>Add to that the lower pollution levels and clearer air in the southern hemisphere – due largely to much lower population densities – resulting in UV levels about 7% higher than in the northern hemisphere. </p>
<p>Taking all these factors together, <a href="https://theconversation.com/how-does-the-ozone-layer-protect-earth-from-radiation-9206">southern hemisphere locations receive about 15% more UV radiation</a> than the equivalent northern latitude location in any given year.</p>
<h2>What about the ozone hole?</h2>
<p>Many believe the ozone hole – a naturally-occurring pool of ozone-depleted air arising over the poles – explains much of our excess skin cancer rates. Stratospheric ozone does reduce the amount of UV reaching the Earth’s surface. When the ozone layer was damaged by the release of CFCs and halon from refrigerants from the 1960s onwards, more UV reached ground level. </p>
<p>So the depletion of the ozone layer caused legitimate concern and prompted the establishment of the <a href="https://theconversation.com/setting-a-good-example-australia-and-the-ozone-layer-9248">“Montreal protocol”</a> designed to eliminate ozone-damaging pollutants and repair the ozone hole. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=440&fit=crop&dpr=1 600w, https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=440&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=440&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=553&fit=crop&dpr=1 754w, https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=553&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/208118/original/file-20180227-36686-bc9mm2.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=553&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Most people think our rates of skin cancer are due to a ‘hole’ in the ozone layer, but this isn’t really the case.</span>
<span class="attribution"><span class="source">from www.shutterstock.com</span></span>
</figcaption>
</figure>
<p>As the ozone hole over the south pole breaks up in spring, pockets of ozone depleted air drift across Tasmania, southern Victoria and the southern part of New Zealand’s south island. The effects are minor and transient, and are being closely <a href="https://ozonewatch.gsfc.nasa.gov/SH.html">monitored by NASA</a> and other agencies.</p>
<p>In reality, ozone depletion has made no appreciable difference to skin cancer rates in Australia and New Zealand. The quantum of additional UV exposure was modest – and at a time of year when most skin was covered so as to stay warm. Happily, the Montreal Protocol has proven successful in facilitating ozone repair.</p>
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<strong>
Read more:
<a href="https://theconversation.com/the-skin-is-a-very-important-and-our-largest-organ-what-does-it-do-91515">The skin is a very important (and our largest) organ: what does it do?</a>
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</em>
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<h2>Are we making any headway?</h2>
<p>Melanoma rates in the under 40s age group (those who grew up with “Slip Slop Slap”) are coming down. This makes sense given the timing of the programs and the decades-long lag between protecting our skin and the benefits of “avoided” skin cancers. But rates in the 60+ age group are still going up and as a result so are the overall rates. We anticipate and hope those will fall over the next decade.</p>
<p>Comparisons with NZ suggest they have a lot to learn from our skin cancer messaging campaigns. But we both still have a long way to go to decrease the burden of skin cancer.</p><img src="https://counter.theconversation.com/content/91850/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Terry Slevin works for Cancer Council Western Australia (CCWA). CCWA attracts program funding from the WA Department of Health and Healthway to conduct skin cancer prevention programs, and he has contributed to many research initiatives on skin and other cancers, which have been funded by NHMRC, and Healthway. He is editor of "Sun Skin and Health", a book by CSIRO Publishing 2014.
He is affiliated with Cancer Council Australia, as Chair of the Occupational and Environmental Cancer Committee and Deputy Chair of the Public Health Committee. </span></em></p><p class="fine-print"><em><span>David Whiteman is Deputy Director of the QIMR Berghofer Medical Research Institute. He receives project and fellowship funding from the National Health and Medical Research Council of Australia, and project funding from Cancer Council Australia.</span></em></p>Most Aussies think we have such high rates of skin cancer due to an ‘ozone hole’. But that’s not the case. Here’s why we have nearly a million cases of skin cancer per year.Terry Slevin, Adjunct Professor, School of Psychology, Curtin University; Education and Research Director, Cancer Council WA; Chair, Occupational and Environmental Cancer Committee, Cancer Council AustraliaDavid Whiteman, Professor and Group Leader at the Cancer Control Group, QIMR Berghofer Medical Research InstituteLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/915152018-03-18T18:56:44Z2018-03-18T18:56:44ZThe skin is a very important (and our largest) organ: what does it do?<figure><img src="https://images.theconversation.com/files/209150/original/file-20180306-146700-1n7s3lp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It doesn't just hold everything in. </span> <span class="attribution"><span class="source">Unsplash/Lucaxx Freire</span></span></figcaption></figure><p><em>This article is part of our <a href="https://theconversation.com/au/topics/skin-series-50414">series about skin</a>: why we have it, what it does, and what can go wrong. Read other articles in the series <a href="https://theconversation.com/au/topics/skin-series-50414">here</a>.</em></p>
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<p>Our skin is a big deal – literally. It’s the largest organ in the body and one of the most complicated. It has many roles in the maintenance of life and health, but also has many potential problems, with more than <a href="https://www.ncbi.nlm.nih.gov/pubmed/28259441">3,000 possible skin disorders</a>.</p>
<p>Not only does the skin hold everything in, it also plays a crucial role in providing an airtight, watertight and flexible barrier between the outside world and the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2843412/">highly regulated systems within the body</a>. It also helps with temperature regulation, immune defence, vitamin production, and sensation. </p>
<p>The skin is unique in many ways, but no other organ demands so much attention and concern in both states of disease and health. There is a huge focus on skin health, with fierce competition to have glowing, clearer, healthier, younger and fresher skin. And this focus can cause secondary problems with self-esteem and mental health. </p>
<p>So, what exactly is our skin meant to do and how does it impact our life?</p>
<h2>The structure of the skin</h2>
<p>The skin is divided into three layers known as the epidermis, dermis and subcutis. These layers are well defined but together they allow the skin to function effectively.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=600&fit=crop&dpr=1 600w, https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=600&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=600&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=754&fit=crop&dpr=1 754w, https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=754&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/210434/original/file-20180314-113475-ei3p4v.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=754&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption"></span>
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<p>The epidermis is the outermost, cellular layer of the skin which varies in thickness depending on the body site. On average it’s <a href="https://www.ncbi.nlm.nih.gov/pubmed/10354068">less than half a millimetre thick</a>. The epidermis resembles a “brick wall” of cells known as keratinocytes, which are bound tightly together and act to prevent free movement of moisture, pathogens and chemicals into or out of the body. </p>
<p>Keratinocytes replicate from the basal layer and work their way up to the outer surface (known as the stratum corneum) over a period of about 28 days. Once they reach the surface the tight bonds between them break apart and they are shed.</p>
<p>Other than keratinocytes, pigment-producing cells known as melanocytes and immune cells known as Langerhans cells also exist within the epidermis. Melanocytes inhabit the basement membrane, at the base of the epidermis and produce a pigment known as melanin both innately (giving the skin its natural colour), and in response to ultraviolet light (UV) exposure (giving the skin a sun tan). </p>
<p>The melanin is a brown pigment that is taken up into the overlying keratinocytes. This pigment will then absorb UV light (from the sun) when it hits the skin, thereby protecting the basal calls underneath from UV damage. </p>
<p>The epidermal cells also develop hair follicles, sweat glands and sebaceous (oil) glands which extend down into the layer below known as the dermis. The small ducts from each of these glands open onto the skin surface. Sweat and sebum (oil) provide an antibacterial and protective barrier on the skin. </p>
<p>The dermis lies beneath the epidermis and is <a href="https://emedicine.medscape.com/article/1294744-overview">20-30 times thicker</a>. It’s made up of a dense layer of fibrous (collagen) and elastic (elastin) tissue. The dermis gives the skin its integrity, strength and elasticity; and houses blood vessels, glands and hair follicles, as well as nerves and their receptors. </p>
<p>Beneath the dermis lies the subcutis (also known as the hypodermis), a specialised layer of adipose (fat) and fibrous tissue. The thickness of this layer varies dramatically depending on the site and a person’s body shape and weight. It cushions the body from external trauma, insulates from the cold and stores energy (fat).</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209151/original/file-20180306-146655-1be3bc7.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">We pay more attention to the health of our skin than perhaps any other organ.</span>
<span class="attribution"><span class="source">Unsplash/Isabelle Winter</span></span>
</figcaption>
</figure>
<h2>The function of the skin</h2>
<p>The extraordinary array of functions performed by healthy skin is still coming to light. The basic day-to-day functions include:</p>
<ul>
<li><p><a href="https://www.sciencedirect.com/science/article/pii/S0005273606002410">Working as a barrier</a> – protecting against water loss as well as physical and chemical injury, and bugs </p></li>
<li><p>Helping us fight off bugs, allergens, toxins and carcinogens via the parts of our immune system that exist in our skin</p></li>
<li><p><a href="https://www.ncbi.nlm.nih.gov/pubmed/24692134">Regulating our temperature</a> by dilating and constricting our blood vessels near the skin surface, controlling the transfer of heat out of the body. Temperature is also regulated by evaporative cooling due to sweat production and by the insulating effect of erect hairs on the skin surface. Heat loss is also affected by the insulating layer of subcutaneous fat</p></li>
<li><p>Protecting us from UV radiation by <a href="https://www.ncbi.nlm.nih.gov/pubmed/22404235">producing melanin</a></p></li>
<li><p>Giving us the sense of touch _ providing interaction with physical surroundings, allowing all fine and gross motor activities and allowing pleasurable and sexual stimulation</p></li>
<li><p>The <a href="https://www.ncbi.nlm.nih.gov/books/NBK278935/">production of Vitamin D</a>, which helps <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3356951/">prevent many diseases</a> including osteoporosis, cancer, heart disease, obesity and neurological diseases</p></li>
<li><p>Wound healing</p></li>
<li><p>Beauty and physical attraction – the quality and condition of the skin greatly contributes to the perception of health, wellness, youth and beauty. </p></li>
</ul>
<h2>What is normal skin and how can you optimise it?</h2>
<p>Normal healthy skin has many important roles and thus should be treated with care and respect. Many people only start focusing on the skin once there is an abnormality or at least a perceived problem. </p>
<p>Common concerns include dryness, sensitivity, oiliness, congestion, wrinkles, sun damage and signs of ageing. Although these states are all within the spectrum of normal functional skin, they may be considered problematic if severe or undesirable. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=397&fit=crop&dpr=1 600w, https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=397&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=397&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=499&fit=crop&dpr=1 754w, https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=499&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/209155/original/file-20180306-146671-jdn1v3.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=499&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">You only get one skin. Don’t do this to it.</span>
<span class="attribution"><span class="source">Unsplash/Maciej Serafinowicz</span></span>
</figcaption>
</figure>
<p>Normal, healthy skin that is not exposed to excessive physical or environmental insults may not require any specific care or protection, but for those who want to optimise or improve their skin, some basic steps can make a big difference.</p>
<p>The key to skin care is consistency and routine, and it can take time to appreciate the changes. A basic regime of daily protection from excessive UV radiation, protection from excessive irritation and drying (by avoiding drying soaps, excess water or irritating chemicals) and aiding of the skin’s barrier properties (using a moisturising protective layer) will result in noticeable improvement in almost all skin. </p>
<p>Switching and changing products and routines is usually counterproductive and will prevent you from seeing expected improvement in time. It’s worth looking after your skin, as you’ll wear it every day for the rest of your life.</p><img src="https://counter.theconversation.com/content/91515/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Cara McDonald does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>We spend a lot of time thinking about our skin - from worrying about its health to trying to get it to look its best. But there’s much more to skin than what it looks like.Cara McDonald, Consultant Dermatologist, St Vincent's Hospital MelbourneLicensed as Creative Commons – attribution, no derivatives.