To improve diversity and inclusion, we must make sure skin health information is available to all, regardless of skin tones.

1. What are some of the misconceptions or /assumptions around skin of colour amongst the general public?

That skin of colour does not need sunscreen.

The misconception that melanin in our skin is all protective and we don’t need sunscreen. Black and Brown people have increased melanin that offers some measure of protection from the sun’s harmful rays but it is not all protective as many would like to believe. Overexposure to UV radiation can induce DNA damage resulting in sunburns, premature ageing, worsen hyperpigmentation by overstimulating melanin production and may cause skin cancers. 

2. Is there a lack of education in skin of colour diagnoses? What can be done to address this?

Education of health professionals when it comes to recognising and diagnosing skin conditions and how they present differently on darker complexioned skin could certainly be better. Textbooks and curriculums need to be updated to reflect the diversity of skin tones in our society. Many skin conditions from skin cancer to rosacea can present differently in patients of colour and failure to recognise them can delay treatment and worsen outcomes.

3. What can people do to look after their own skin?

Everyone, including people of colour, should have a professional full body skin check performed by a dermatologist at least once yearly to evaluate moles and rule out cancerous growths. 

Additionally, one should perform full self-skin checks at home using a full-length mirror or handheld mirror. Check for new moles, change in the size, shape, colour and texture of moles, . a sore that does not heal or heals and returns. In skin of colour, skin cancer like squamous cell carcinoma may arise in chronic wounds.

4. How important is diversity and inclusion in the skin community? What can be done to address this?

Diversity and inclusion are very important in the skin community because they underscore the value of human dignity and respect. To improve diversity and inclusion, we must make sure skin health information is available and accessible to all regardless of skin tones or ethnic background. It’s important that public health campaigns on dermatologic health include images with people of colour. People of colour are not as visible in awareness campaigns on sunscreen use and it helps foster the narrative that they do not need them. My inspiration in starting my platform @brownskinderm was to include people of colour in conversations on skin health which I deeply felt was missing in the greater public discourse.

5. Why is it important that dermatologists be well educated in treating skin of colour?

It’s important that all physicians are trained to provide competent and culturally sensitive care for all patients regardless of race, gender and ethnic background. In dermatology, which relies heavily on visual diagnosis with emphasis on pattern recognition to readily identify lots of skin conditions, it is even more important that dermatologists have a trained eye for not just picking up unique patterns in lighter skin tones but darker skin tones as well. 

Failing to be well rounded when it comes to treating skin of colour, limits access to care and fails patients of colour who already have a history and continue to experience systemic barriers in medicine. 

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Actinic keratosis is one of the most common diagnoses made by dermatologists in Europe and its prevalence can be calculated to be around 18% of the population in this continent.

Actinic keratosis (AK) is a common skin condition caused by sun damage occurring mainly in skin areas chronically exposed to ultraviolet (UV) radiation. Despite being among the five most common diagnoses in dermatological consultations, it is still an underdiagnosed pathology.¹

During the last years, an ageing population increased exposure to UV radiation and changes in UV-seeking behaviour² have increased its prevalence to approximately 18% of the population in Europe.^3,4

A precancerous condition

As the most common precancerous dermatological condition⁵, it is estimated that 40% to 80% of squamous cell carcinomas (SCC), the second most common form of skin cancer, evolve from simple AK lesions.^6,7 Awareness is therefore key, as early diagnosis can stop the progression of the disease.

To help further increase knowledge of AK, Almirall, a global biopharmaceutical company focused on skin health, launched the first AK Global Day on May 24 in collaboration with Euromelanoma and AEDV Piel Sana. The global event, which will be held every year, aims to raise awareness of the importance of monitoring the appearance and evolution of AK skin lesions.

During the last years, an ageing population, increased exposure to UV radiation and changes in UV-seeking behaviour have increased its prevalence to approximately 18% of the population in Europe.

Dr Volker Koscielny, Almirall’s Chief Medical Officer, explains that “actinic keratosis is an underestimated condition. It is where cells in some exposed areas develop over time into cancerous cells. While we see morphological changes in the skin, people often dismiss it and do not take it seriously.”

The high prevalence of AK means the disease burden is substantial, especially in middle-aged and elderly populations. “People are stoic, they dismiss it just as spots they get when they are older, but the sun exposes change in the genetic profile of cells and over a 10-year period there is a 17% risk of developing a certain type of skin cancer. That is not negligible,” states Dr Koscielny.

Biggest risk factors

Due to the recurrent and unpredictable nature of the disease, early detection and treatment is essential to reduce the consequences for patients. The potentially precancerous condition of the disease means that lesions can progress to squamous cell carcinoma (SCC) if not adequately monitored.

In the same vein, Dr Koscielny points out that “as the impetus to go to a doctor and be checked out and diagnosed is not always there, awareness is absolutely crucial. This is a chronic condition that you cannot cure, so people must take it seriously. Doctors need to be clear to patients that this is not an aesthetic condition, it is one that has potentially serious consequences.”

Potential consequences

While the core lesion is visible and can be removed, the ‘field’ around these lesions should be treated as the cells may be disturbed and could become cancerous. AK can also affect patients’ quality of life, as lesions can cause cosmetic discomfort and interfere with the patient’s daily activities. “Doctors must be very clear with patients about what to expect and educate them about the potential consequences,” emphasises Dr Koscielny.

[1] Ferrándiz C, Plazas MJ, Sabaté M, Palomino R; EPIQA Study Group. Prevalence of actinic keratosis among dermatology outpatients in Spain. Actas Dermosifiliogr.2016 Oct;107(8):674-80. 
[2] Chetty P, Choi F, Mitchell T. Primary care review of actinic keratosis and its therapeutic options: a global perspective. Dermatol Ther (Heidelb) 2015; 5(1): 19-35
[3] Lucas R, McMichael T, Smith W, Armstrong B. Solar ultraviolet radiation: Global burden of disease from solar ultraviolet radiation: World Health Organization, 2006. 
[4] Worldometer. Population of Europe. 2020. Available at: https://www.worldometers.info/world-population/europe-population/ Accessed: October 2020. 
[5] Skin Cancer Foundation. Actinic Keratosis Overview. Available at: https://www.skincancer.org/skin-cancer-information/actinic-keratosis/#:~:text=Actinic%20keratosis%20(AK)%20is%20the,to%20ultraviolet%20(UV)%20radiation January 2021
[6] Stockfleth, E., et al. (2015). Physician perceptions and experience of current treatment in actinic keratosis. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(2), 298–306. https://doi.org/10.1111/jdv.12530
[7] Fernández-Figueras, M. T., et al. (2015). Actinic keratosis with atypical basal cells (AK I) is the most common lesion associated with invasive squamous cell carcinoma of the skin. Journal of the European Academy of Dermatology and Venereology : JEADV, 29(5), 991–997. https://doi.org/10.1111/jdv.12848

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Dr Nicola Mulholland FRCR FRCP MA MSc

Consultant Radiologist and Nuclear Medicine Physician, King’s College Hospital London

A non-invasive treatment for skin cancer could improve the patient experience and lead to enhanced quality of life.

Traditionally, people with non-melanoma skin cancer face several courses of outpatient treatments, including surgery or radiotherapy, with more vulnerable patients admitted to hospital overnight.

Now, a new trial of an innovative patient-friendly therapy will be held at King’s College Hospital in London as a step towards making it available in the NHS.

Non-surgical treatment

The paint-like treatment – Rhenium-SCT – uses the Rhenium-188 isotope that emits beta-radiation to target skin cancer. A special applicator enables clinicians to apply the compound to deliver this epidermal radio-isotope therapy to kill cancerous cells, usually in a single session and with little to no resulting scarring.

Dermatologist Dr Saqib Jawaid Bashir, lead clinician for skin cancer at King’s College Hospital NHS Foundation Trust, says: “The aim is to provide patients with a non-surgical treatment for their cancer and also see multiple skin cancers treated in one visit.”

Painless therapy

The manufacturer, OncoBeta, is confident the painless therapy can effectively treat non-melanoma skin cancers, he adds, and this includes basal cell and squamous cell carcinoma which are common conditions.

Dr Bashir explains that sun-exposed patients can face multiple surgeries over consecutive years, with the anxieties of anaesthetic and stitch removal from wounds.

“Hopefully this treatment will provide these patients a way forward,” he says. “Compared to surgery, the advantages are that the patient does not have a procedure, or be anxious about anaesthetic injection, or aftercare.”

He said the NHS would benefit because there is less impact on resources and time of skilled personnel.

The aim is to provide patients with a non-surgical treatment for their cancer and also see multiple skin cancers treated in one visit.

Dr Saqib Jawaid Bashir

Radioactive particles

Dr Nicola Mulholland, clinical lead for nuclear medicine at King’s College Hospital, explains that people come into hospital as outpatients for the treatment and have the product painted on to the affected area.

Over a period usually between 30 minutes and three hours, the radioactive particles target the lesion and the patient can then go home.

The safety and effectiveness of the treatment will be further assessed under the EPIC Skin study at King’s College Hospital as part of a multi-centre study.

Availability of treatment

Rhenium-SCT has already been through clinical trials and is used in routine practice in other countries. It is expected that this Phase IV trial will also help with the introduction of the therapy into the UK healthcare system, initially for self-pay patients. It is hoped this will be by followed by reimbursement from health insurers and then be more widely available on the NHS.

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If you enjoy a healthy outdoor lifestyle, ensure your kit bag includes sun protection, closing the door on sunburn and the risk of skin cancer.

Many of us believe that sun protection is only relevant when on a beach holiday because that is how it has been sold to us and our parents before us. Look up ‘sunscreen advertising’ online and see for yourself.

Although we need sunscreen when in warmer climes, what about the accumulated sun exposure we experience in outdoor sport and recreation, both in the UK and abroad?

Skin cancer risk

Although physical activity is great for us and is associated with a reduced risk of most cancers, skin cancer is the exception. Both professional and amateur sportspeople regularly exceed the recommended ultraviolet exposure limit by up to eight-fold during the spring and summer months.

Currently, only 50% of people currently protect themselves from the sun when exercising outdoors in the UK. Factors such as sweating, water contact, minimal clothing and lack of shade whilst playing sport make it even more relevant. It is little wonder that since the early 1990s, rates of skin cancer in the UK have risen by 170%, with over 156,000 cases reported a year.

Only 50% of people currently protect themselves from the sun when exercising outdoors in the UK.

Sporting campaigns

The Melanoma Fund focuses on sun protection in sport and outdoor recreation and is the charity behind the Outdoor Kids Sun Safety Code for KS2 children, and Slip! Slap! Swing! for golf. They recognised there was a complete lack of sun protection guidance for adult sportspeople, and with the help of the UK sports industry, decided to fill it!

Supercharging sun protection

Sunguarding Sport launched this spring with the backing of over 60 national governing bodies including Sport England, Sport Wales, Sport Northern Ireland, the LTA and the ECB. It contains overall guidance for those participating, spectating and working in sport, as well as advice for specific sports, as requirements can differ.

The campaign addresses the barriers to application and re-application such as how to avoid a greasy grip, how to develop good habits, providing advice on heat exhaustion, the best sunscreen to use, dehydration and of course, avoiding sunburn.

Say’s CEO and campaign director Michelle Baker; “Our mission is to wake people up to the fact that like brushing teeth, sun protection needs to be part of a healthy lifestyle. It’s not just about avoiding skin cancer, it’s about sun damage – who wants to look older than their years, which will happen if you don’t protect your skin.”

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A synthetic dermal scaffold used in reconstructive operations is providing an effective alternative for skin cancer patients who, until recently, had no surgical options left.

Patients who undergo numerous operations to remove multiple skin cancers can have increasingly complex reconstructive needs, admits Mrs Aenone Harper Machin, consultant plastic surgeon, St Helens and Knowsley NHS Trust. In some cases — particularly when the patient is elderly and frail — surgery to remove a tumour may be impossible if post-operative wounds and skin grafts will not heal.

“We are seeing an ever-increasing cohort of elderly patients with multiple non-melanoma skin cancers, most commonly on the head and neck, and squamous cell carcinomas, most commonly on the scalp,” says Mrs Harper Machin. “Unfortunately, once patients have a number of these cancers, their reconstructive options become extremely limited.”

However, a synthetic dermal scaffold — known as biodegradable temporising matrix (BTM) — is being used by the NHS and provides an effective reconstructive alternative for skin cancer patients who, until recently, had no treatment options left. This is a sponge-like sheet that temporarily closes the wound, creates a foundation for the skin and encourages the body to generate new tissue. As such it can be applied to a range of wounds including traumatic injuries, burns, and necrotising soft tissue infections.

This is a sponge-like sheet that temporarily closes the wound, creates a foundation for the skin and encourages the body to generate new tissue.

A game-changer for wound treatment

“Patients with multiple skin cancers, or those who are very frail, can now be treated adequately under local anaesthetic,” says Mrs Harper Machin, who has been using BTM in her surgical operations for almost three years. “They can even undergo radiotherapy afterwards which is a game-changer because, previously, radiotherapy would have destroyed their skin grafts.”

Apart from being life-altering for patients, it has been beneficial for surgeons, too. “Other dermal matrices can be expensive and their results can be mixed,” says Mrs Harper Machin. “But this latest innovation is straightforward to use. It generates a blood supply faster than other dermal matrices so any infections can be treated with antibiotics. Recovery time is quick and outcomes are extremely good. While it won’t necessarily change the course of a patient’s disease it can give them a more comfortable life.”

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Understanding your unique skin microbiome can literally save your skin and save money too.

Do you know your skin type? Of course you do – but think again. Research shows that nearly two in three women (63%) do not know their correct skin type. That means many are wasting money on unsuitable skincare products – and may even be inadvertently damaging their skin.

David Caballero-Lima, who carried out this research, is Head of Research & Development at Labskin, a company which makes human skin to provide animal-free testing for cosmetics and pharmaceuticals. Caballero-Lima says: “After 15 years of research we know that each one of us has a different collection of microbes living on our skin. That’s your skin microbiome and it’s unique to you.”

It varies according to many factors, including your ethnic origins, age, hormone status, the season and your environment. Your skin microbiome at puberty will differ from the one you have as an adult and in later life. It changes across your menstrual cycle and will differ according to whether you take HRT or not.

It all means that there’s a lot more to skin analysis than patting your face with a tissue to see if it’s dry, oily or combination. Therefore, knowing your skin microbiome helps when it comes to choosing a skin care routine.

Research shows that nearly two in three women (63%) do not know their correct skin type.

Bespoke skin analysis

How do you get to know your skin microbiome and what kind of products will suit you?

Caballero-Lima says: “Using our expertise in analysing ingredients and formulations for pharmaceutical and cosmeceutical uses, we can analyse your skin microbiome to determine which kinds of products would suit your skin, based on our testing of their ingredients.”

Labskin has launched a skin health tracking app called Skin Trust Club. A self-administered skin swab, combined with environmental data such as levels of pollution and the average UV index in your location is used to create a report about your skin. This includes personalised skincare recommendations for a morning and evening skincare routine.

Applications for dermatologists

Dermatologists can also use the app as a medical diagnostic tool to enhance diagnosis of skin conditions such as psoriasis. Caballero-Lima says: “At a first visit the patient could take our test, alongside the dermatologist’s observations, and at a second visit the results could be used to monitor the progress of their treatment, with only a few days delay.” The app will be released to dermatologists soon, once it has been validated by the EU as a medical device.

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Dr. Neesha Oozageer Gunowa PhD, DN, RN, QN, SFHEA

Pathway Lead in Community Nursing, Teaching Fellow

Pressure ulcers are more likely to be missed in people with darker skin tones because of the technique used to assess the condition, according to research.

Pressure ulcers are traditionally assessed through red discolouration on the skin, this approach results in them being missed, or picked up later, especially in people with darker skin. Research is reshaping the way pressure ulcers are assessed in people with darker skin tones.

Skin tones

Educator and researcher Dr Neesha Oozageer Gunowa, community pathway lead in community nursing at the University of Surrey, conducted a study on pressure ulcers in people with darker skin for her PhD.

With a background in district and community nursing, she says: “I was working in an area highly-populated with people with dark skin tone and recognised in my practice that dark skin tone patients with pressure ulcers were more likely to be picked up later.”

She found little research had been conducted on why people with darker skin develop more severe pressure ulcers than people with lighter skin tones.

Nursing education

The investigations highlighted a gap in nursing education, with the diagnosis of pressure ulcers still determined by the so-called “react-to-red” approach. Red areas, she explains, show up on lighter skin but are not so prominent on darker skin tones but may be just as serious.

“Nurse educators need to talk about skin tone differences and that not everyone is the same,” she says. “The evidence is saying that people with dark skin tones are more likely to be getting more severe pressure ulcers; therefore, we need to recognise that there are differences.”

The language, she continues, needs to change from the “react-to-red” pressure ulcer prevention initiative to the Stop the Pressure programme, shifting the emphasis away from colour alone.

Her research has influenced healthcare policy, with the National Wound Care Strategy Programme acknowledging the findings. Additionally, Wound UK recently published a best practice statement on wounds in people with dark skin tones.

Nurse educators need to talk about skin tone differences and that not everyone is the same.

The role of technology to eliminate inequalities

Emphasising that pressure ulcers are generally preventable wounds, Dr Oozageer Gunowa says technology also has a role with SEM (sub-epidermal moisture) scanners able to identify increased localised oedema in vulnerable areas of the skin (regardless of skin tone) such as the heels at an earlier stage than the current pathway – allowing for earlier treatment to help prevent the condition worsening.

She says an “element of systemic racism” surrounding pressure ulcers is leading to health inequalities for people with darker skin tones.

“Once that is addressed, people are less likely to die from pressure ulcers and more likely to be picked up sooner. We as nurses and clinicians need to see people as individuals.”

Scanners better assess and guide treatment of pressure ulcers

Martin Burns

CEO, Bruin Biometrics

Technology modernises a standard of care that fails to fully protect patients, especially those with dark skin tones.

Bedsores, also known as pressure ulcers, occur most frequently on the bottom or heels. Usually caused by deformation of the skin due to poor mobility, they vary from small, reddened areas to large open wounds.

“They can be painful, distressing and embarrassing,” explains Martin Burns, CEO of biometric sensor technology specialists Bruin Biometrics LLC.

They can be painful, distressing, and embarrassing.

Risk assessment

He explains that current care requires healthcare practitioners to undertake a risk assessment, assess vulnerable areas like the heels and look for redness as an early indicator of ulceration.

“Since redness is not readily observable on dark skin tones, this in particular fails the dark skin tone population.

“Broken skin is observable but once the skin breaks, treatment complexity rises four-fold,” he says. Patients with dark skin tones are four times more likely to die from pressure ulcers.

Scanner technology

“The current standard of care is not good enough,” he adds. Localised oedema/sub-epidermal moisture (SEM) is a recognised biomarker for pressure ulcer management and identified by hand-held medical devices, such as Bruin Biometrics’ Provizio® SEM Scanner technology.

Irrespective of skin tones, it identifies skin damage on average five days earlier than nursing staff can see them on the skin surface, says Burns and can be used in different care settings.

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Skin cancer is the most common cancer in the UK. One in five of us will develop skin cancer in our lifetime, yet around 90% of cases are preventable and 98% treatable or curable if detected and diagnosed early.

Here are our top six tips to reduce your risk and detect the early warning signs: 

1) Prevention is better than cure 

It is estimated that 90% of skin cancers are caused by over-exposure to ultraviolet radiation (UVR) from the sun and/or sun beds. To reduce your risk: 

• Cover up with clothing, including a wide brimmed hat and quality sunglasses. 
• Apply SPF 30+ sunscreen with 4 or 5 star UVA protection liberally to exposed skin and reapply at least every two hours. 
• Seek shade whenever possible, particularly during peak UV hours 11am-3pm. 
• Avoid tanning or reddening of the skin and never use sunbeds! 

2) Check the daily UV Index 

The UV Index is an international standard measurement of the strength of harmful UV radiation at a particular place and time. The higher the UV Index the less time it takes damage to occur. When UV levels reach three, sun protection measures should be implemented. 

3) Know your risk 

An individual’s personal level of risk for the development of skin cancer is based on the following key factors: age, sex, skin type, history of UV exposure, medical conditions, family history and sun protection habits. Understanding your personal level of risk, particularly if you are at greater risk is essential. 

As a rule, you should see your GP with any skin lesion that is new, looks unusual or is changing in any way.

4) Check your skin monthly for signs of change 

Conducting thorough, full-body skin examinations once a month is the smartest way to get to know your skin and identify potential abnormalities that could indicate the early signs of skin cancer. 

5) Early detection saves lives 

Skin cancer comes in many guises, so it’s wise to learn about the various forms and how they present to help you identify the early signs and symptoms when conducting your month skin checks. As a rule, you should see your GP with any skin lesion that is new, looks unusual or is changing in any way. 

6) Track and monitor lesions for signs of change 

Manage your skin checking routine by taking photos and notes of lesions to help you identify and provide evidence of changes to lesions over time. 

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Acne affects more than 640 million people worldwide and this incidence is increasing. Although it typically begins around the time of puberty, it can affect all ages.

Acne is an inflammatory disorder of the skin’s oil producing (sebaceous) glands. It predominantly affects face, back or chest, presenting as red spots (papules or nodules), yellow heads (pustules), cysts or blocked pores (comedones).

Common causes of acne

Acne results from an interaction between genetics and environmental factors (exposomes). There is a significant genetic contribution, with estimates of heritability between 50-80%. 

External influences include nutrition, medication and lifestyle. Increasingly westernised diets, high glycaemic index foods (such as refined grains and sugary food) and high dairy intakes have all been linked with acne. 

Hormonal abnormalities such as polycystic ovaries may underlie some cases. Acne cosmetica is the term for acne associated with skincare, as certain cosmetic ingredients are pore blocking (comedogenic).

Acne is often perceived as a mild skin condition or a rite of passage in teenagers. However, it can have a significant impact on psychological wellbeing.

Finding a suitable treatment

Acne is a treatable condition, although there is frequently considerable delay to definitive treatment, resulting in scarring and long-term psychological impacts.

Simple cleansing and over the counter ingredients such as salicylic acid and benzyl peroxide can be helpful, alongside avoidance of pore blocking ingredients such as coconut oil or cocoa butter. A low glycaemic index diet may be helpful, however, very restrictive diets are not advised.

The first line of treatment involves vitamin A based creams (retinoids). Topical retinoids are effective, but acne may take up to three months to show improvement. Slow introduction and gentle skincare can help manage skin irritation. Other medicated creams include benzyl peroxide, topical antibiotics and azelaic acid. 

Oral treatments for severe cases

In more severe acne, tablets may be required. There are three classes of tablets which can be used:

1. Antibiotics. These rebalance the microbiome and reduce inflammation and are usually used for a minimum of three months. 
2. Hormonal treatments – combined oral contraceptive pills and anti-androgens. These are useful treatments in women who experience premenstrual flares.
3. Oral isotretinoin (roaccutane) is indicated for severe acne. However, it has a number of potential side effects.

Acne is often perceived as a mild skin condition or a rite of passage in teenagers. However, it can have a significant impact on psychological wellbeing. Depression, anxiety and suicidal thoughts are all more common in acne sufferers. 

In addition, acne is linked with social isolation, low self-esteem and poor body image. It is a manageable condition and effective treatment should be instituted as soon as possible to reduce the risk of scarring and the psychological burden.

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Menopause is defined as one year after a woman’s last menstrual period and in the UK the average age is 52. The decline in oestrogen (oestradiol) is the defining feature, which can have an impact on your skin.

Oestrogen has a multitude of effects on the skin via oestrogen receptors present in the nuclei of skin cells. Therefore, it is no surprise that the skin can change significantly during menopause. Studies suggest that around 70% of women will notice some changes in their skin during menopause and this can manifest in a number of ways:

1) Dryness

Oestrogen boosts skin barrier function and hydration of skin, increasing levels of natural water-holding molecules known as glycosaminoglycans. As menopause approaches, skin gets dryer and more sensitive due to the loss of moisture.

2) Sensitivity:

The loss of hydration results in a reduction in skin’s natural robustness and it can become increasingly sensitive. People may notice reactions to harsher products like acids or fragrances and the skin may feel uncomfortable with burning and stinging. Hot flushes of menopause may exacerbate this and redness may also be a problem.

3) Skin thinning

Menopausal women will often notice an increase in lines, wrinkling and sagging. This is a result of the reduction in collagen. Collagen is a key structural protein within our skin and as we get older, the quantity and the quality of collagen reduces, lines and wrinkles start to appear on the skin. Loss of collagen is gradual over many years but accelerates around the time of the menopause. 

Studies suggest that around 70% of women will notice some changes in their skin during menopause

4) Breakouts:

Perimenopause, in particular, may be a time of intense hormonal fluctuation. This can result in more breakouts and spots, particularly around the lower face and jaw. In addition, changing HRT regimes with varying components of progesterone and testosterone can also contribute.

5) Supporting skin during menopause

There are a number of ways you can support your skin during the menopausal period.

Firstly, keep skincare very gentle. If you are noticing signs of ageing, the temptation may be to ramp up your skincare, but go slowly. A gentle nonfoaming cleanser, rich moisturiser and unfragranced products are essential at this time. Skin also becomes more vulnerable to environmental damage as it ages, so daily sunscreen and careful sun protection are important.

Finally, a healthy lifestyle is an important component of keeping skin healthy during menopause. Boost your oral antioxidant intake with plenty of fruit and vegetables. Stop smoking, minimise alcohol and keep active.

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