Making People Better
Making People Better
Skin Health Essentials: Sun Protection and Early Diagnosis
Do you think sun protection is only crucial for fair skin? Think again. Join us for an essential conversation on skin health and dermatology with experts Sophia Brown, Lead Dermatology nurse at Vita Health Group, and Dr. Sharon Belmo, a Consultant Dermatologist. We dive deep into the critical role dermatology plays in healthcare, from medical and surgical treatments to holistic approaches. You'll learn about the importance of early detection of skin issues, the psychological effects of skin diseases, and how community dermatology initiatives can help reduce wait times.
Think darker skin tones don't need sunscreen? There's a lot more at stake. We break down common misconceptions about sun protection for diverse skin tones, highlighting the higher mortality rates of skin cancer in communities of color due to delayed diagnosis. Sophia and Dr. Belmo also discuss hyperpigmentation, the challenges of diagnosing conditions in darker skin, and the importance of culturally competent healthcare. Learn how cultural habits impact skin and hair health and why sunscreen is non-negotiable for everyone.
Struggling with textured hair care? We've got you covered. This episode shifts focus to specialized care for textured hair and skin of color, tackling seborrheic dermatitis, pseudofolliculitis barbae (razor bumps), and hair loss. Dr. Belmo shares practical tips for managing these conditions and the significance of early diagnosis through a GP referral. Discover the range of specialized services available at Dr. Belmo's private dermatology clinic on Harley Street. Don't miss this enlightening episode, packed with valuable insights from Sophia Brown and Dr. Sharon Belmo.
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Speaker 2:Yes, hello and welcome. I'm Glenn Tompsett. Yes, it's time for another of the Making People Better podcasts with Vita Health Group. This continuing series explores the challenges of everyday life, with a special focus on mental and physical health and well-being, and we hope very much that you enjoy the series. We've got a great back catalogue of materials, so please do check our previous episodes and I'm joined on each podcast by various experts in their chosen field. Today, I'm joined by Sophia Brown. Sophia is a lead dermatology nurse at Vita and we're also joined by Dr Sharon Belmo, a consultant dermatologist. Welcome to both of you. How are you doing? Great? Thank you, glenn. Great Nice to have you on board today. We'll have a chat with you more in detail, dr Sharon Belmo, a little later in the podcast. But first of all, sophia, your particular role within Vita as a lead dermatology nurse. What does that entail exactly?
Speaker 3:so it's a variety of things. It can be looking at medical aspects of the skin, surgical aspects. You know, skin is the largest organ in your body, so it's really important that we deal with this in a medical way. A lot of people think that skin is, you know, facials. When they think about dermatology, they think we're giving people skin facials. But um, it's not the case. We are very medically treating skin conditions and skin is something.
Speaker 2:As you say, it's the major organ of the body. Most of us focus on just our face, though, don't we? Particularly, if you know you want a face scrub, or you know a face massage or whatever, but it's all over the body, isn't it? We shouldn't neglect other parts of the body when it comes to skin.
Speaker 3:No, that's exactly right. It can affect you know all areas of the skin. It can even affect the hair and the nails, so it's really important that it's looked at holistically.
Speaker 2:Okay, Sophia. Why would you be referred to dermatology then?
Speaker 3:You'll be referred to dermatology if you have a new mole or abnormal area of skin and if you notice an existing change to a mole, it's really important to get that expert medical advice from the team. Dermatology conditions can also involve hair and nails and if you're looking at a mole, there's an ABCDE checklist that you can do for self-surveillance where you're looking at a mole. There's an ABCDE checklist that you can do for self surveillance where you're looking at asymmetry border, colour, diameter and evolving and patients can do this at home.
Speaker 2:And I guess the trick here, sophia, is to catch it early, isn't it?
Speaker 3:Yeah, early detection of skin cancer has better treatment outcomes for patients if you can catch it early.
Speaker 2:Okay, what does community dermatology entail then?
Speaker 3:So health services across the UK since the pandemic have experienced huge backlogs. There's a national shortage of dermatologists like Sharon across the UK and waiting times have increased. Community dermatology is really just to offer a range of services that you would normally get at the hospital in your community that can be delivered by healthcare professionals. It helps with the reduction of the wait time.
Speaker 2:And which is the most common skin condition you see, treated within community dermatology.
Speaker 3:In community dermatology we see a lot of acne. The waiting lists are quite low, so patients tend to come to us as opposed to waiting a long time to get the same care at the hospital.
Speaker 2:What about the psychological impact of having a skin disease? That must be quite huge, and how do you deal with that?
Speaker 3:Yeah, skin disease is devastating for people, you know they do come into our clinics, don't they, sharon? And they're very emotional and upset. It's big low self-esteem and, again, you know they have people that can comment on it and they feel that, you know, people can be quite cruel. I think, you know, in the media we've got a lot of perceptions that we feel like we've got to live up to and it just seems to be, you know, a lot of pressure on people to look a certain way and also feel a certain way, and it is associated with depression and social isolation. If you've got bad skin on your face, you know you don't want to come out, you don't want to do activities if you're going to sweat and it's going to make your skin quite sore. So it is really important that we address and listen to those psychological aspects of how it's bothering them let's bring dr sharon belmo, consultant dermatologist, into the conversation, then.
Speaker 2:Founder of dr sharon belmo dermatology, a private dermatology clinic on harley street specializing in skin of color and afro textured hair. Dr sharon, thanks for joining us on the podcast today. Fair to say, isn't it that most people you know, if they've got a skin condition, they just think, well, I'll put a bit of cream on it, it'll go away? That's not the case, is it?
Speaker 4:not necessarily. I think the most important thing with skin conditions is having the correct diagnosis first, and there are so many different skin conditions in dermatology more than people think. So I would strongly advise, as Sophia said earlier, if there is a change in the skin or there are symptoms in the skin like itching or soreness, that a patient seeks advice from the GP or directly from a dermatologist.
Speaker 2:Okay. Well, what about patients getting those yearly checks then, for things like skin cancer? Vitally important, isn't it, sophia?
Speaker 3:Yeah, what we've got to be conscious of is if you're high risk, if you've had previous skin cancers, melanoma, then a yearly check with a dermatologist you know is really important. Get that yearly check in with a dermatologist because that will really help. If you've got any changes or any suspicions that moles are growing, then it's really important.
Speaker 2:All right, sharon coming back to you then one of the first things you noticed was that things like books, images and medical journals focus on skin and hair conditions. In white skin. There was little emphasis on darker skin types. Why did this concern you?
Speaker 4:Yes, I noticed this very early on when I started dermatology and that a lot of the teachings and images were only in the context of lighter skin tones. It is concerning because there are many conditions that look different in darker skin tones. For example, say, eczema a very common condition that we see in dermatology almost every day is generally presented or described as a red, scaly, itchy rash. In darker skin tones it may not necessarily be red. Quite often it's brown or even grayish or dark brown, and the problem is, if conditions are only taught or portrayed in one way, there's a risk that these conditions can be under treated, under diagnosed or even missed in darker skin tones. I think it's really important that all skin types are represented in medical journals and books and in all types forms of teaching.
Speaker 2:Sharon, it's a common belief, isn't it among black and brown communities that we don't need to wear sunscreens and that we don't get sunburned. What's the actual truth there?
Speaker 4:Anyone can get sunburned, actually, and one thing that does bother me slightly is that there seems to be a one-size-fits-all for black and brown skin, when actually people of color, there's huge, huge variation in skin tone. So there can be someone who is brown, which would be considered Asian, or black, considered African or Caribbean, who's very, very, very fair skinned, you know, and would burn in the sun and can get skin cancer. So black and brown skin is not just one skin tone, it's very, very, very varied. And there can be people that are black but they're McRae, you know, and they're very, very fair, or people from some parts of the Caribbean who are very, very fair. You know there's a lot of variation in skin tone.
Speaker 4:So it isn't true that all people with black and brown skin cannot get sunburn. It isn't true that people with black and brown skin don't tan. We actually tan the quickest because we have more melanin and that's what absorbs the sun. And it isn't true that people of color do not get skin cancer. In fact, although skin cancer is rarer, the mortality rates or the death rates are actually higher, because it's often missed, the diagnosis is delayed, the treatment is later and it's often much worse. In fact, bob Marley passed away from melanoma skin cancer really yeah, that's what he had, so it does exist.
Speaker 4:The other reason for wearing sunscreen in um darker skin tones is the fact that the sun causes hyper pigmentation, which is a issue that bothers people with darker skin a lot.
Speaker 2:It's something I see in clinic every day, and and this is worsened by sunlight all forms of light, actually so sunscreen is necessary for that as well so it's important, doesn't matter what skin tone you are, then you know if you're on holiday in the sunshine strong sunshine, you you need to apply a high factor sun lotion yeah, definitely I know you're a strong advocate of equality in health care. What are the gaps in dermatology faced in darker skin types then?
Speaker 4:I. I'd say the main gap is diagnosis. So, as I mentioned before, because most skin conditions are generally portrayed in light skin types, it's harder for some clinicians and nurses to be able to diagnose these same conditions in darker skin because they've never seen it before and they weren't taught it. So it means people may go with skin conditions for longer than other.
Speaker 3:I was thinking about a time on holiday when I really burnt my nose really badly and I'm brown, but it was really bad and it was sensitive for like eight. Yeah, really, really, really sensitive.
Speaker 4:Yeah, and I never have burnt but one time I did get caught out so you gotta be so careful haven't you really very careful if people are not used to how things look in darker skin, then they will not diagnose and treat and it it means people are undertreated or not treated at all. The other thing is there are many conditions that are more common in people of color and again, if you're not used to treating a diverse population then you may not be familiar with these conditions and then again you know there's inequality in health care. The other thing with people of color is that there are cultural habits that can influence the skin and hair and of course people can't know every cultural habit for every community. But being aware of some of them, particularly if they do affect the skin and hair, I think is important when you treat diverse populations.
Speaker 2:Okay, sophia, I know you want to fast forward with Sharon. 11 years now, don't you?
Speaker 3:Yeah. So, sharon Belmo, you've opened your own clinic in Harley Street and I know you're really successful in treating textured hair for skin of colour. Oh, thank you. What do you do when patients present with seborrheic dermatitis? What do we need to be aware of in this condition?
Speaker 4:I see this a lot. I mean, seborrheic dermatitis is common in general, but I do see it a lot in my clinic for different reasons. Seborrheic dermatitis is caused by yeast that we all have on our skin. Particularly in the rich areas like the face around the nose, eyebrows and on the scalp, these yeast can multiply and what happens is our skin has this sort of inflammatory response to it. When that happens, our skin turns over skin too quickly and becomes flaky and with inflammation you can get itching and burning and soreness as well. So I do see it a lot. The reason why I probably see it more in afro-textured hair is because there are hair care practices that probably promote yeast growth, like applying oils and grease to the hair and scalp in order to manage the curly afro-textured hair. There's a lower washing frequency in afro-textured hair, which is necessary because our hair is drier, but sometimes the frequency I'd say is too low and again when there's lots of product buildup, it just allows the yeast to accumulate and the scalp to become more inflamed. So I do see it a lot.
Speaker 4:I have to talk about hair care when I see it, as well as medical treatment, and that involves washing the hair more frequently. So I'd say the sweet spot for aqua-protected hair is actually once a week or once every seven to ten days. The hair is dry. It doesn't tend to get greasy, so washing it frequently isn't as necessary as in straight hair and avoiding oils and grease and conditioner and products on the scalp. The scalp just needs to be clean. The scalp makes sebum, the natural oil that the skin produces, so we don't need to add any more. And then I give a treatment, medical treatment, advice, which is usually anti-inflammatories if it is very inflamed, if it is very sore and itchy, and or using shampoos that are classed as anti-dandruff, but generally anti-dandruff shampoos are anti-fungal or anti-yeast shampoos, so these help rid the scalp of the excess yeast.
Speaker 3:So three or four times would be too much, sharon For aqua textured hair.
Speaker 4:It absolutely would be too much and you'd find that most women, particularly, would not do that because it's difficult to manage. But the hair is drier, it's very fragile and it's very dry and simple. Grooming such as brushing or combing or washing makes the hair even weaker and break. So, one, it's not necessary because the hair doesn't tend to get greasy. And two, two, it would cause more damage. Once a week is sufficient.
Speaker 3:Okay, so moving on to men, what kind of conditions do men get? I know they get these razor bumps. What do you advise for length of hair that males should keep when they get this folliculitis razor bump? Oh yes, I see this a lot.
Speaker 4:We call it pseudofolliculitis barbate.
Speaker 4:It's essentially ingrown hairs in the beard area.
Speaker 4:Aphrodite hair, of course is curly and after shaving the hair sort of tracks back into the skin because it's curly, it curls back into the skin and the skin then sees it as a foreign body, because the skin grows out, not in to the skin, sees it as a foreign body because the skin grows out, not in to the skin, and the skin again has an inflammatory response to this hair which it sees as a foreign body, and you get a pimple forming which can be sore or pussy, and the pores are essentially blocked with hair, with skin, with oil, with debris.
Speaker 4:So again there are two sort of things that we do. One is to try and minimize the hair going back into the skin, so using electric shavers, ideally leaving the hair about two millimeters, one to two millimeters above the surface of the skin, so that it makes it less likely that it will track back into the skin. And then often using um products, either over the counter products or things that we prescribe to reduce inflammation or to, we say, exfoliate the skin, so to try and unblock the pore and make it easier for the hair to come out and, ultimately, if the hair is left to grow, this condition would settle on its own. Or if there was no hair at all, meaning laser hair removal, the condition would settle on its own, but that may not be cosmetically acceptable to all men settle on its own, but that may not be cosmetically acceptable to all men.
Speaker 4:Finally, sharon, afro hair loss, textured hair how do you deal with that? It depends on the cause. I'd say in dermatology in general, diagnosis or in medicine in general. Diagnosis is important first because I do see a lot of patients that come and tell me they've got alopecia, which in medical terms just means hair loss is not a diagnosis. So the first thing is we need a diagnosis. So I go through their history, we call it. They tell me what's been happening, how long the hair loss has been, where is the hair loss being? Because sometimes it's in patterns, it's in certain areas of the scalp or the face and body and I ask them about symptoms. Some people have itching and soreness or bumps, folliculitis associated with it, and when I combine all of these things it generally will lead me to a diagnosis. Sometimes I may have to do a biopsy and take a sample of the skin on the scalp to look at the hair follicles under the microscope if the diagnosis is not clear. But once we have a diagnosis then we go ahead and treat and again, treatment depends on the cause.
Speaker 4:The typical things that I see in clinic are female and male pattern hair loss. That's the most common cause of hair loss in any racial or ethnic group. I see it just as much in my clinic. In terms of afrotextured hair, I see a lot of a condition called traction alopecia, which is where people lose hair, generally on the hairline, but it can be anywhere, but it's as a result of chronic tension to the hair where it's pulled for prolonged periods or too tightly. And we see this more in afrotextured hair because of cultural hairstyling like braids and weaves and things like that. So I see that a lot.
Speaker 4:There's a condition that is like an epidemic in black women that I see every day in clinic, called centrifugal cicatricial alopecia, or CCCA for short, and that's pretty serious and I'm seeing too many too late. Unfortunately. It's something that you want to have diagnosed very early because it's something called a scarring alopecia, meaning the hair follicles are scarred, they're gone, and when that happens in hair loss you cannot regrow the hair. You need a hair follicle to be able to grow the hair and it happens as a result of chronic inflammation deep in the hair follicle. So treatment for that tends to be anti-inflammatory as well, because you want to stop it as soon as possible and prevent further hair loss so the trick there then, sharon, is early diagnosis is best, yeah absolutely tigress follicles and also the psychological impact of women losing their hair as well okay, well, it's an area that we can talk for hours on.
Speaker 2:It's a massive area, sharon, isn't it? It's a huge area of dermatology. It is a huge area. I think it's a massive area, sharon, isn't it?
Speaker 4:It's a huge area of dermatology. It is a huge area. I think it's much larger than people think. It's way more than skin care and Botox and fillers and things like that.
Speaker 3:Okay, well, thank you both, and it's very medical, isn't it? It's very medically managed, it is. It's a medical specialty.
Speaker 2:Yeah, it is indeed, and I want to thank you both for joining me today on the Making People Better podcast, sophia Brown and also Dr Sharon Belmo. Sophia, if anybody wants details, where can they get more on this particular area of their health?
Speaker 3:We have a Vita website with plenty of great dermatology information.
Speaker 2:But again, if it's patients, really it's important that you get that GP referral and get that early diagnosis that gp referral and get that early diagnosis and sharon, if anybody wants to get in touch with you directly, as we mentioned, you've got a clinic on harley street. How do they get in touch with you?
Speaker 4:my website is just my name it's wwwdrdrsharonbelmocom. I also have an instagram, which is just at dr sharon belmo all right, well, listen.
Speaker 2:Thank you both for joining us today. That's uh sophia brown, the lead dermatology nurse at vita, and also dr sharon belmore, a consultant dermatologist and a private dermatology clinic on harley street specializing in skin of color and afro textured hair.
Speaker 1:Thank you so much both of you for joining us today thank you for having us thank you for listening to this Making People Better podcast, part of the Wellbeing series from Vita Health Group. Improving your lives, physically and mentally, drives everything we do, and getting you back to doing what you love is our priority. Vita Health Group making people better wwwvitahealthgroupcouk.