The most common skin problems

If the skin is in balance, it does not cause any problems - it can be that simple. Unfortunately, the reality is often different: Environmental influences, lifestyle, incorrect care and genetic predisposition can trigger skin problems. As efficient and robust as the largest organ is in many respects, the skin is equally sensitive. We present the most important skin problems and their causes.

Skin diseases and problems can have purely physical causes or be based on psychological stress. How the skin reacts to specific circumstances is very individual. And unfortunately, there are a large number of skin diseases with which those affected sometimes have to come to terms for the rest of their lives. In the following we offer an overview of common skin problems, which should also help you with an initial self-assessment.

A note: Both their diagnosis and the coordination of therapeutic treatment always belong in medical hands. For each of the skin problems described below, we address, if possible, mildly pronounced precursors or refer to common skin conditions in this context. This should help you to adjust your care accordingly - however, this does not replace a visit to the dermatologist!

Acne: A skin problem for puberty?

Acne is - medically speaking - nothing more than pimples. For those affected, of course, this more severe manifestation does not feel so uncomplicated. With acne, the psychological burden can be enormous and the quality of life noticeably impaired. However, this is not a strange phenomenon. On the contrary, acne is a widespread skin problem that affects more than 80 percent of Germans at least once in the course of their lives. It is still considered a typical teenage problem. In fact, it occurs predominantly during puberty, between the ages of 12 and 20. But adults - or even newborns - are not immune, because this skin problem can occur at any age. Dermatologists have even observed an increase in acne outbreaks after the age of 24 in recent years.

In the initial stage, black or white blackheads, so-called comedones, appear. The blackheads look like small bumps. If the disease progresses, papules and pustules join the blackheads. Due to the inflammation, they are red, purulent and quite painful. In severe cases, abscesses and fistulas develop under the skin. Young men are affected more often than women. In these cases there is a risk of scarring. Therefore, dermatological treatment is absolutely advisable. In rare cases, fever and joint inflammation accompany the skin disease.

The trigger is clogged pores: the sebum, i.e. the sebum that the skin produces from the teenage years onwards, mixes with dead skin cells and clogs the pores - an ideal breeding ground for the bacterium Propionibacterium acnes. Actually a harmless fellow on our skin, but ... The bacterium likes it nice and warm and grows especially well when there is little oxygen. What could be better than a clogged pore? The strong growth of the bacteria creates enzymes that trigger inflammation in the skin. The immune system tries to fight these by commandeering white blood cells - which worsens the inflammation. Acne is therefore only the visible part of an acute inflammation of the skin. This means that anything that is anti-inflammatory is good for you. Further irritation only fuels the problems.

What promotes acne?

Teenagers and people with oily skin are more often affected because their skin sebum is a particularly acne-friendly environment. However, there are still some factors that can improve or worsen acne. For example, studies show that the risk increases when patients consume a lot of dairy products. Interestingly, this applies predominantly to low-fat dairy products. Researchers reason that low-fat milk contains hormonally active substances in such high concentrations that they have an unfavorable effect on the hormonal balance of the body. 

In addition, acne is said to have a pronounced sweet tooth. Because chocolate and generally sugary foods can bring acne to an undesirable peak. It is worth taking a closer look, because the decisive criterion is the glycemic index: The glycemic index (GI or glyx for short) is a measure used to determine the effect of a carbohydrate-containing food on blood sugar levels. The higher the GI value, the more sugar is in the blood. Our body breaks down sugar with insulin. If we have a lot of insulin in the blood on a permanent basis, the body produces more male hormones, which in turn boost sebum production in the skin. The result: more clogged pores, more pimples.

Sweets are particularly fast in raising the GI; however, convenience products, white bread, potato chips, alcohol or soft drinks are not much better. So if you eat chocolate in moderation, you won't necessarily get pimples. It depends on the sugar content and the associated GI within the overall diet. Other unfavorable factors are smoking and stress. Certain medications such as antileptics, steroids and antidepressants are also considered triggers.

The good news: acne is one of the skin problems that can be treated well nowadays. In most cases, the problems of a combination of therapy, gentle cleansing and proper care even disappear completely.

These products support you very well with blemished skin and acne

Allergies: Pay attention to the ingredients

The ancient Greeks put it in a nutshell: an allergy is a reaction that turns out differently than expected. At least that's what the compound word from the Greek állos, meaning "different" or "foreign," and érgon, the Greek word for "work" or "working," tells me. In the case of an allergy, the body goes berserk: the immune system discovers substances that it considers threatening and brings the appropriate artillery into position. The triggering substances are called allergens.

These rioters have not yet been fully researched. We know that they consist of carbohydrates, proteins or a mixture of both. And they have one important thing in common: They are so small that they slip through our body's protective functions - for example, the otherwise top-performing skin barrier - but at the same time they are complex enough to set the body on alarm.

Allergens can be found in food and jewelry, fly around in the air as pollen, or hide as ingredients in skin care. When skin care products trigger an allergy, it is usually due to typical contents such as fragrances and preservatives, emulsifiers or lanolin. Herbal ingredients can also irritate the skin in some people, for example arnica, chamomile or calendula.

When cosmetics trigger the allergy, it is assumed to be a delayed type IV contact allergy. This means that the defense cells in the body rush directly to the allergens. In doing so, they release messenger substances that lead to inflammation of the surrounding tissue. This often happens with a delay of one to two days.

Visible signs of contact allergy include swelling and redness of the skin, coupled with itching or burning. If the reaction is severe, wheals, crusts or weeping blisters develop. With prolonged contact with the allergen, chronic contact dermatitis develops, which means that the skin thickens and forms grooves (lichenification).

Causes and treatment of allergies

How and why a person reacts to certain allergens is not yet fully understood. Often there is a genetic predisposition which, together with aggravating factors such as environmental pollution, fatty diet, alcohol or smoking, increases sensitivity.

Dermatologists assume that excessive hygiene, especially in childhood, favors the occurrence of allergies because the immune system then attacks actually harmless substances out of boredom, so to speak.

Allergies are widespread and can first become apparent at any stage of life. New contact allergies occur even in old age.

A contact allergy is actually not curable. If the sensitization exists, it usually accompanies the affected person through life. However, the skin problems can be reduced, primarily by avoiding the triggering substances. In the case of acute skin problems and irritations, the affected area of the skin should be cleaned well so that it can initiate its own healing processes as unhindered as possible. In addition, moisturizing creams, oils and baths help the irritated skin to retain moisture.

If the allergic reaction is very pronounced, ointments containing cortisone can rapidly reduce the skin's immune response. But the quick remedy comes at a price: with prolonged use, cortisone damages the skin; it becomes thinner and blotchy. If the cortisone ointment is not enough, cortisone-containing tablets are the next step.

Atopic dermatitis (formerly: neurodermatitis)

Atopic dermatitis is the most common chronic skin disease - especially in industrialized countries. The term "atopic" is derived from the Greek "atopia," which means "unassignable" or "placeless. The outdated name neurodermatitis is still widely used.

The basis of atopic dermatitis is atopic skin. In it, several properties are impaired at once: The stratum corneum lacks lipid mortar, making the skin barrier permeable from the outside and inside. As a result, pollen and dust mites are more likely to penetrate from the outside, and moisture escapes to the outside from the inside, further impairing the atopic skin's ability to defend itself.

In addition, the skin is more heavily colonized with the harmful bacterium Staphylococcus aureus. This is involved in inflammatory processes on and in the skin. The symptoms of atopic skin thus reinforce each other - up to dermatitis. This is manifested by red, scaly, sometimes weeping eczema on the skin and severe itching.

By the way, the word eczema is a collective term for all non-infectious inflammations of the skin. Eczema often develops on dry skin.

Doctors distinguish two forms of eczema: endogenous and exogenous eczema. Endogenous eczema is caused by internal influences, mainly genetic factors. This includes atopic dermatitis, which is why it is often called atopic eczema. Exogenous eczema, on the other hand, is due to external influences, for example heat, cold, UV radiation or the contact allergy described above.

Typical places where the itching and eczema appear are

• Arm bends,
• Knee rolls,
• Neck and
• Face.

However, the symptoms can erupt in quite a few parts of the body, often in episodes. Those affected often do not recognize any reason for the outbreaks. However, atopic dermatitis is usually due to an interaction of cause and aggravating factors.

Avoid triggers if possible

In addition to the genetic predisposition to these skin problems, there are unfavorable circumstances and lifestyles that fuel disease flare-ups.

Typical trigger factors are

• Sweating,
• Contact with skin-irritating substances,
• Tobacco smoke,
• Car exhaust,
• hot baths and
• frequent hand washing.

Those affected also suffer more from atopic dermatitis in times of emotional stress. Allergens such as dust, pollen or animal hair, as well as irritating additives in skin care products, also lead to the typical formation of eczema in some patients. In addition, there appear to be links with certain foods, including components of wheat, cow's milk, egg, nuts, soy and tomatoes.

Welche Faktoren die atopische Dermatitis letztlich auslösen, ist sehr individuell. Schafft man es, die schubfreien Zeiten zu verlängern, ist der nächste wichtige Baustein einer Therapie, die gestörte Hautbarriere zu unterstützen. Die Haut soll stets gut gereinigt werden. Empfohlen sind kurze, nicht zu heiße Bäder (<32° C), nach denen sich die Betroffenen nur sanft mit einem Handtuch abtupfen. Eine rückfettende und feuchtigkeitsspendende Creme stabilisiert und schützt die Haut.

According to studies, urea-containing care products lead to a significant improvement in itching in many sufferers. Nevertheless, the treatment of atopic dermatitis must be individualized depending on its severity. Even though many sufferers develop their own, quite effective methods to get their skin problems under control, you should always seek advice from a dermatologist.

Couperose and rosacea: When the skin sees red

The inflammatory skin disease rosacea and its precursor couperosis (visible veins) are among the most common skin diseases in Germany: more than one in ten Germans is affected. Visible characteristics of couperosis and rosacea are permanently or regularly appearing redness on the cheek and/or nose. These are due to translucent blood vessels that are dilated by a - genetically determined - weak connective tissue. However, in addition to the genetic disposition, external stress factors or a special skin mite can also be behind it.

We have dedicated a separate blog post to red skin. Here you can learn more about the different manifestations, causes and helpful therapies and care tips.

These products can help you with rosacea

Skin cancer: Prevention is the be-all and end-all

Skin cancer is by far the most common type of cancer; in Germany alone, well over 200,000 people contract it every year. Although it is responsible for only one percent of all cancer deaths, the trend in new cases is nevertheless worrying: they double around every 10 years!

The two most common types of skin cancer belong to the so-called white skin cancer: Basal cell carcinoma and spinalioma together account for nearly 90 percent of all skin cancer cases. The third most common type of skin cancer is malignant melanoma, also known as black skin cancer. It originates in pigment cells, hence its usually dark color. Unlike white skin cancer, malignant brother can form daughter tumors (metastases). The main trigger for all skin cancers is excessive UV radiation from the sun and solarium, as well as sunburns. Accordingly, people with light skin types (Fitzpatrick skin types I and II) are particularly at risk. In most cases, skin cancer is surgically removed; drug therapy is also possible.

An important prerequisite for early diagnosis and therapy is regular examination of the entire body for changes and abnormalities by an appropriately authorized physician. In addition to specialists for skin and venereal diseases, these can also be family doctors or specialists for general medicine and internists. 

By the way, the so-called skin cancer screening is paid by all statutory health insurances from the age of 35 (by some even earlier)! 

Your own regular examination of all moles, pigment spots and skin changes is a useful addition to the biennial medical examination. Although it does not replace a visit to the doctor, it helps you to detect conspicuous changes as early as possible and to have them examined by a dermatologist.

Take your time and rest for the examination at home - if it is done in a few minutes, it was not thorough enough! A mirror helps you to examine areas that are difficult to access.

These products support you with sun protection

Skin fungus: Annoying, but treatable

Fungi are part of the natural microbiome of the skin and are not automatically harmful. However, if individual fungal genera become prevalent on the skin, a skin infection occurs and the term skin fungus is used (and physicians speak of dermatomycosis). There are many types of skin fungus - the most common skin fungus is athlete's foot. However, the face and neck can also be affected by skin fungus. The yeast Malassezia furfur is suspected of being the main trigger for seborrheic eczema. Colloquially also called gneiss, is one of the most common skin diseases. 

Seborrheic eczema can be recognized by yellowish, greasy scales under which the skin is reddened. Lesser mycosis is also found in the upper regions of the body and is mainly noticeable by spots that change color. This is due to the dense fungal carpet on the skin, which blocks UV radiation. Thus, the underlying skin can no longer form a color pigment (melanin).

Skin fungi are transmitted from person to person or via contaminated objects. If the barrier function of the affected skin is weakened or the blood supply is poor, for example due to a weak immune system or very dry skin, this favors the infection. Fungal infections usually go unnoticed for quite a while. Frequently, the fungal colonization first shows itself in the form of scaling and redness. Many affected people think this is a dry skin spot and try to treat it with a rich cream. This often makes the skin fungus even more favorable, because most types of fungus like it moist.

However, early diagnosis by a dermatologist is absolutely advisable, because many skin fungus types are very contagious and can take a chronic course. Therapy is comparatively simple: after diagnosis of the type of fungus, appropriate antifungal agents in the form of ointments, tinctures or powders help.

Skin fungus treatment at home must be carried out regularly and consistently. Above all, it is important that it is continued even after the visible symptoms have subsided. The reason: If only one fungal spore remains, the skin fungus can break out again.

Milia: a cosmetic skin problem

Milia are also known as skin grits or semolina and are small white lumps under the surface of the skin. To be clear: They are a purely cosmetic skin problem. Milia do not affect the functioning of the skin or its health. Visually, however, they can be very disturbing, especially if they appear on the face. There they are mainly found on the eyelids or below the eye, but also on the cheeks.

Milia form where sebum escapes: at the exit of the sebaceous glands. If the horny cells here are not repelled in time, they can stick together. They are then trapped by the skin surface over time and the lump develops. Overly oily, rich skin care can encourage this process. Dry skin is also more prone to milia formation, as its natural exfoliation is impaired.

Because these lumps often shimmer whitish through the skin, they are often mistaken for sebaceous collections, although they consist of horny cells. That's why they can't be squeezed like a pimple - don't even try! Apart from painful bruising and, in the worst case, inflammation, this leads to nothing.

The treatment of milia belongs in the professional hands of the specialist cosmetician or (especially near the eyes) dermatologist. He will scratch them and professionally remove the accumulation of horny cells. Less targeted, but suitable for home treatment is the application of fruit acids and retinol. However, this only applies to the milia that are not located near the eye.

Perioral dermatitis: less is more

Clown eczema or stewardess disease: What sounds amusing at first glance can put a great strain on the psyche. The reason for this is skin irritation, often the result of overgroomed skin. Unfortunately, when it comes to skin, too much of a good thing rarely leads to a beautiful result. Professionals who have to take care of their appearance for professional reasons or who put on makeup very frequently are correspondingly susceptible to perioral dermatitis. This is a skin rash on the face. It manifests itself in redness, pustules, small blisters and inflamed to purulent nodules. In some cases, the affected areas begin to flake.

The skin problems mainly occur around the mouth, hence the name "perioral". Only sometimes the skin around the nose, or the eyes are additionally - or exclusively - affected. Typically, a ring-shaped strip around the mouth remains symptom-free.

Basically, people who have a genetic predisposition, are prone to allergies and have very sensitive skin seem to be particularly frequently affected. This predisposition in combination with a certain trigger can then lead to the skin problems of perioral dermatitis.

For example, certain substances cause intolerances; these include asthma sprays or creams and medications containing cortisone. Also

Promoting factors of perioral dermatitis:

• Hormonal changes
• Stress
• Bacteria
• Fungal infestation
• Strongly occluding (i.e., sealing) skin care products (e.g., foundation, sunscreens with physical filters).
• Too frequent cleaning
• Excessive or incorrect care
• hormonal changes
• Stress
• Bacteria
• Fungal infestation

Over a longer period of time, an intolerance develops, which in turn disturbs the skin barrier: too much moisture is lost, the skin dries out, becomes flaky and taut. Renewed creaming against the feeling of tightness (usually using moisturizers) overmoisturizes the horny layer, causing the outer skin layer to swell and making the skin even more permeable. Germs and bacteria can now easily penetrate and trigger inflammatory reactions.

If the signs of perioral dermatitis appear, the products used so far should no longer be used. The best thing to do is to put the skin on a zero diet for at least eight weeks: lukewarm water or extremely mild cleansers - otherwise simply nothing at all.

For recovery, the skin needs time. As a rule, it takes several weeks to months to restore the natural functions. Future skin care should avoid alcohol and fragrances, parabens and emulsifiers, not be occlusive and in no case overload the skin with active ingredients.

After or during perioral dermatitis. less is more:

Patients who regularly use cortisone preparations are best advised to discuss their skin problems with their doctor. Cortisone can cause additional damage to the skin barrier or even trigger perioral dermatitis.

Rhagades: Cracks in very dry skin

The term "rhagade" means nothing to you? "Rhagade" is more common colloquially and means the same thing, namely a smooth, deep skin tear that can extend into the dermis and is correspondingly painful. Rhagades affect very dry skin areas, which are also subject to constant mechanical stress. The lack of elasticity eventually leads to cracks. These often appear on the hands and feet, but also in the anal region. On the face, the corners of the mouth are particularly affected.

Possible causes of rhagades are previous infections and injuries that have not been able to heal completely. Hormonal fluctuations or external factors such as an unbalanced diet (and an associated vitamin deficiency) and dry indoor air can also cause the painful cracks in the skin. In general, atopic skin is more prone to rhagades.

Important rule of conduct for torn corners of the mouth: Avoid moistening them with saliva. It dries out the skin and aggravates the skin problems. A cream with panthenol is the more sensible alternative .

In the case of persistent rhagades, I recommend that you consult a doctor. Only he can clarify whether something else is behind the torn skin - because chronic diseases such as diabetes, allergies or gastrointestinal problems can also cause rhagades.

Psoriasis: Skin problems due to stress

Psoriasis and atopic dermatitis are often forcibly conflated. Both are chronic inflammatory diseases of the skin, but apart from that they do not have much in common. Nevertheless, especially laymen regularly confuse the two skin pictures, while the demarcation is not difficult for doctors.

While atopic dermatitis can even manifest itself in infants, psoriasis usually appears later - usually between the ages of 15 and 25. Heredity also seems to play an important role in this disease. If only one parent suffers from psoriasis, the children's risk of also developing the disease is already four times higher. If both parents have psoriasis, even eight times. In addition, as with many skin problems, there are aggravating factors. These include the usual suspects such as

• an unfavorable diet,
• Smoking,
• Alcohol,
• Overweight or
• Medication.

The most serious trigger for psoriasis in many cases is stress. This applies to personal, psychological stress as well as to stress at work. That is why many psoriasis patients look for suitable methods to reduce the perceived stress in everyday life and to relax specifically.

Psoriasis is not an atopic disease; it is a systemic autoimmune disease. This means that the immune system works incorrectly and attacks the body's own cells. The symptoms appear predominantly on the skin: there is visible redness, thickening and the typical silvery scales.

More than sensitive skin

An acute flare-up is often preceded by an infection. Streptococci, staphylococci or viruses spread on the skin. The skin then sends its defense troops to fight the infection. Then the real problem begins: the immune cells remain in the uppermost skin layer and multiply enormously. They become overactive and trigger a process in which the body's defenses are directed against healthy skin cells. These in turn become inflamed and grow excessively fast. This often takes place on the outsides of knees and elbows, on the head and behind the ears. In severe cases, however, the entire body can be affected by the scaling.

Underlying is a systemic inflammation of the body. In every third patient, therefore, the joints (psoriatic arthritis) are also affected, and even more frequently the nails. The risk of concomitant diseases such as cardiovascular diseases also increases; the psychological burdens associated with the skin problems are enormous. The good news is that modern therapies can improve symptoms by 80 to 90 percent in many cases and noticeably prolong relapse-free periods.

The starting point for this is a topical therapy with urea and salicylic acid, which are applied locally as an ointment. In the case of moderately severe or very severe courses of the disease, light therapy has been delivering good results for many years. However, it also carries risks because the skin can be damaged in long-term therapy or by faulty equipment.

If these measures are not sufficient, systemic therapy takes effect. Patients then receive additional drugs in tablet form, as infusions or injections. In recent years, dermatologists have had great success with biologics. They manipulate the messenger substances of the immune system and thus stop the inflammation.