Acne is an inflammatory disease of the sebaceous glands and hair follicles, characterised by the appearance of comedones, papules and pustules on the skin. The face, chest and spine – where the sebaceous glands are more abundant – are most often affected. Acne is particularly common among young people, with at least half of boys and girls aged 14-19 having less or more noticeable acne.

There are several causes of the disease – lipid overgrowth due to an excess of androgens or increased sensitivity of the sebaceous glands to androgens, blockage of the sebaceous gland duct due to its overcollection or a change in the composition of the fat, colonisation of the acid-fast anaerobic bacterium Propionibacterium acnesin the skin.

Acne is diagnosed on the basis of the clinical picture. Further tests are needed to rule out diseases that cause endocrine disruption. Bacteriological tests may be necessary to provide effective treatment.

The treatment of acne depends on the severity of the disease – mild acne is treated with topical medications (gel, cream, skin solution), moderate and severe acne is treated systemically (oral medications). Photodynamic therapy with anti-inflammatory effects is also recommended. Daily skin care, including cleansing the skin with the right products, choosing the right cosmetics, etc., plays a role in the success of the treatment.

Asthenozoal eczema is a form of eczema in the elderly, characterised by dry, cracked skin with subtle signs of exematisation. Causes of the disease may include age-related reduction in skin lipids and water reserve, co-morbidities or poor diet, excessive use of soaps and other skin cleansers, recurrent microtrauma, low environmental humidity and dry cold winds, exposure to skin irritants, use of medications (diuretics, cimetidine, glucocorticosteroids), zinc, linoleic or linolenic acid deficiency.

Asthenotic eczema is more often found on the legs, arms or hands. Itching and redness, crusting and swelling caused by the bite are common with dry skin.

Treatment recommendations include:

• shower as briefly as possible, avoid hot water;
• do not wash the eczema affected areas with soap, avoid strong skin cleansers;
• use strong moisturising creams after washing;
• use moisturising creams several times a day;
• use topical creams containing corticosteroids.

Infectious molluscum is more common in children at play age and can spread over a fairly large area of skin. It is a viral infection that spreads by contact or through contaminated surfaces or objects. The mollusc typically looks like a shiny, 1-10 mm in diameter papule, higher than the skin, with a depression in the middle, the “tail”.

Infectious molluscs are treated with mollusc tweezers (the infective mass is squeezed out, the shell is removed), freezing or diathermy. In the case of extensive skin bruising, the procedure will take longer, so it may be more appropriate for children to have a general anaesthetic.

Psoriasis is a chronic immuno-inflammatory disease that can present in a wide range of different ways – from a few scarring patches on the skin to virtually the whole body. Rashes are more common on the scalp, knees and elbows covered with hair. The classic psoriasis scar is sharply circumscribed, red, slightly higher than the surrounding skin and scaly. Often skin burns are accompanied by nail damage. One third of patients have joint inflammation (psoriatic arthritis) along with skin rash.

The clinical picture is usually sufficient to diagnose psoriasis and no further tests are needed. In some cases – when the clinical picture is more atypical – a skin biopsy may be appropriate.

Treatment for psoriasis is a stepwise approach, which means starting with simpler topical treatments (creams, skin solutions, etc.). Extensive skin or joint problems require systemic treatment (tablet therapy, UVB light therapy, biological injection therapy). In addition to direct treatment, it is advisable to treat any chronic inflammatory conditions such as broken teeth, sinus or tonsillitis, reduce excess weight, and stop smoking and drinking alcohol – studies show that such lifestyle changes ease the course of the disease, significantly contributing to treatment.

Wart warts are spongy growths on the skin or mucous membranes caused by the human papilloma virus (HPV). Infection occurs through contact or through contaminated surfaces or objects. Warts are most common on the hands and feet, but also occur on other areas of the body including the face and genitals. Warts on the soles of the feet are usually flat but can be very painful.

There are different ways of treating salivary warts – from the use of local corrosive agents (skin solution, patches) to more effective cryotherapy and laser treatment.

Scabies is a parasitic skin disease caused by an itch mite. The life activity of the fluke is dependent on oxygen and the fluke does not penetrate deeper than the stratum corneum (the surface layer of the skin). Infection occurs through skin-to-skin contact – close physical contact with a person with scabies (such as sexual partners) or prolonged physical contact (such as parents and children).

Symptoms of the disease develop up to 3-6 weeks after infection: severe itching that worsens in the evenings, fine papular rash (papules in pairs) and crusting. Common sites of rash are the fingertips, wrist creases, breasts, around the navel, buttocks, thighs, genitals. In children and the elderly, the rash can also affect the face, palms and soles of the feet.

Principles of treatment:

• all family members and contacts are treated at the same time, regardless of whether or not they (already) have symptoms;
• the medicine is applied to the whole body (except the head in adults);
• after washing with soap and water, reapply the medicine to the hands;
• change your clothes and bed linen at the start and end of treatment;
• after treatment, wash clothes at least 60°C, dry-clean outerwear (or avoid using contaminated items for 3-4 days).

How does it affect people?

Heavy sweating causes discomfort, and worrying about the unpleasant smell of perspiration causes psychological and social problems – people’s moods drop, their self-esteem and self-confidence decline. People may start to avoid public places, become reclusive, and avoid contact with even their closest friends. You can’t wear everything you want on your back.Often, clothing materials (avoiding silk, for example, in favour of cotton) and colours (avoiding bright colours, opting for black and white) are chosen to make sweating less visible. Some people always carry a change of clothes with them so they don’t have to be wet all day.

What are the reasons?

Causes of sweating over the body include: tumour diseases, metabolic disorders such as diabetes, thyroid diseases, neurological diseases, febrile diseases (e.g. infectious diseases), panic attacks, anxiety, some medicines. In such cases, the underlying cause should be treated rather than excessive sweating. The causes of local (armpits, palms, soles) hyperalgesia are unknown and are more likely to be related to emotional factors.

How to treat local hyperhidrosis?

Antiperspirants are the first choice – antiperspirants are sweat-retardants (as opposed to deodorants, which simply hide the smell of sweat). If antiperspirants have not been effective within 2 weeks of use, the next step is treatment with botulinum toxin.

What is botulinum toxin?

Botulinum toxin is a biological neurotoxin (nerve poison) produced by the bacterium Clostridium botulinum that causes muscle paralysis. Botulinum toxin is used both in conventional medicine to treat tendinitis, muscle spasms and associated pain, and in aesthetic medicine to reduce mimic wrinkles and sweating.
Type A botulinum toxin is used in aesthetic medicine.
How does botulinum toxin work?
The injectable drug blocks nerve transmission to the sweat gland, preventing the sweat gland from functioning properly and sweat production stops.

Who can have Botulinum treatment?

Suitable for people with hyperhidrosis:
– interferes with daily life or occurs more than once a week
– mucous membranes under the armpits on both sides of the body
– starts before the age of 25
– ends at night

Are there any contraindications?

Pregnancy and breastfeeding. Under 18 years of age. Muscle disorders, blood clotting disorders, general infection, skin inflammation at the injection site. Inflammatory diseases should be treated before botulinum injections.

What does the procedure look like?

The procedure takes about 30 min. During this time, approximately 30 intradermal injections are made under the armpit on each side at 8-10 mm intervals. This means that 100 active units of botulinum are injected into each side. If necessary, a numbing cream is used to relieve the pain and applied to the area to be injected 60 minutes before the procedure.
It is not recommended to go for massages, sauna, sunbathing or to consume alcoholic beverages for 2-3 days after the injection.

How good are the injections?

Studies show that there is a 75% reduction in sweating, which is accompanied by an increase in emotional and physical well-being and a reduction in activity limitations. Patients are very satisfied, with an average symptom-free period of 6-9 months. If the effect disappears, botulinum treatment can be repeated.

Anti-hyperhidrosis botulinum toxin injection therapy is a safe and highly effective treatment. The indications and doses of the medicine used are registered in the national medicines register. Only doctors are allowed to inject the medicine.

The injection is performed by Dr Ulvi Loite (dermatovenerologist).

The cost of the procedure is €395.