Common Patient Questions – By Skin Condition– Answers from a Consultant Dermatologist in London

Patients often have similar questions about each condition. Below are the top 5 questions for each major dermatology condition, answered by Dr Bryan McDonald, Consultant Dermatologist in London.

Acne Vulgaris

1. What causes acne?
   Blocked hair follicles, excess oil, bacteria, and inflammation. Hormonal changes can worsen it.

2. Do over-the-counter creams work?
   Mild acne may respond, but persistent or cystic acne usually needs prescription treatment.

3. Can acne cause permanent scars?
   Yes, if untreated. Early specialist intervention reduces risk.

4. Is Roaccutane safe?
   Yes, under specialist supervision, with regular monitoring.

5. How long before I see improvement?
   Typically 6–8 weeks for noticeable improvement; full results may take months.

Eczema

1. Is eczema contagious?
   No, eczema is not infectious.

2. Why do steroid creams sometimes fail?
   Incorrect strength, application frequency, or lack of maintenance therapy can reduce effectiveness.

3. Are steroid creams safe long-term?
   Yes, if used correctly and monitored by a dermatologist, though constant use can lead to side effects.

4. Can eczema flare from diet?
   Sometimes — triggers vary between patients.

5. When should a child see a specialist?
   If eczema is severe, infected, or not responding to GP treatment.

Psoriasis

1. Is psoriasis contagious?
   No.

2. What triggers flares?
   Stress, infections, medications, alcohol, and weather changes can trigger flares.

3. Do creams work for all patients?
   Topical therapies help mild psoriasis; moderate to severe cases may need systemic treatment.

4. Can psoriasis affect my nails?
   Yes, nail involvement is common.

5. Are injections or tablets safe?
   Yes, when prescribed and monitored by a dermatologist.

Rosacea

1. Is rosacea acne?
   No — though it can cause acne-like bumps.

2. What triggers rosacea?
   Heat, alcohol, spicy foods, stress, sun exposure.

3. Can it be cured?
   It cannot be cured, but symptoms can be controlled.

4. Does IPL or laser help?
   Yes, particularly for redness and visible blood vessels.

5. Should I avoid certain skincare products?
   Yes — harsh exfoliants or irritating products can worsen rosacea.

Hair Loss / Alopecia

1. Why am I losing hair?
   Causes vary: genetic, autoimmune, hormonal, stress, or scarring conditions.

2. Can hair regrow?
   Some types like alopecia areata are reversible; scarring alopecia is permanent.

3. Do I need blood tests?
   Sometimes — to check thyroid, iron, or hormonal causes.

4. Are steroid injections safe?
   Yes, when administered by a specialist.

5. How long until I see regrowth?
   Usually 4–8 weeks for visible improvement.

Hidradenitis Suppurativa (HS)

1. Is HS contagious?
   No.

2. Why do antibiotics fail?
   HS is inflammatory, not infectious.

3. Will I need surgery?
   Some patients benefit from minor procedures for persistent areas.

4. Can HS be cured?
   It is chronic, but flares can be controlled with treatment.

5. What lifestyle changes help?
   Weight management, smoking cessation, and friction reduction can reduce flares.

Male Genital Dermatology

1. Is this an STI?
   Most conditions are not sexually transmitted.

2. Why hasn’t GP treatment worked?
   Many genital skin conditions require specialist diagnosis to guide further treatment.

3. Are steroid creams safe here?
   Yes, when prescribed correctly.

4. Should I be worried about cancer?
   Rare, but concerning lesions can be assessed safely.

5. Are consultations confidential?
   Yes — all appointments are discreet and professional.

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Vitiligo

1. What causes vitiligo?
   Vitiligo is an autoimmune condition where pigment cells are attacked by the immune system.

2. Is vitiligo contagious?
   No — it cannot be spread to others.

3. Can lost pigment return?
   In many cases, early treatment can stimulate partial repigmentation.

4. Does stress make vitiligo worse?
   Stress and skin trauma can trigger spread in some patients.

5. What treatments are available for vitiligo?
   Prescription creams, light-based therapies, and monitoring to prevent progression.

Hyperhidrosis (Excessive Sweating)

1. Why do I sweat excessively even when I’m not hot?
   Hyperhidrosis is caused by overactive sweat glands due to nerve overstimulation.

2. Which areas are most commonly affected?
   Underarms, hands, feet, face, and scalp.

3. Can hyperhidrosis be treated?
   Yes — with prescription treatments, tablets, or injectable therapies to block sweat signals.

4. Does this condition start in adulthood?
   It often begins in childhood or teenage years but can persist into adulthood.

5. When should I see a dermatologist for sweating?
   If sweating affects confidence, work, or daily activities, specialist treatment is very effective.

Urticaria (Hives)

1. Why do my hives keep coming back?
   Chronic urticaria is often autoimmune and may not have an obvious trigger.

2. How long is too long for hives to last?
   If hives persist for more than 6 weeks, this is considered chronic urticaria and needs specialist care.

3. Are hives an allergy?
   Sometimes, but often there is no allergic cause.

4. What is the best treatment for chronic urticaria?
   Higher-dose non-sedating antihistamines and, if needed, immune-modulating treatments.

5. Can stress make urticaria worse?
   Yes — stress is a common trigger for flares.

Skin Cancer & Mole Checks

1. How often should I have my moles checked?
   Depends on risk factors, self monitoring 3 monthly and this can be complemented by an annual dermatologist skin check with dermoscopy.

2. Does a mole check hurt?
   No — it is a visual examination.

3. Can you remove a mole on the same day?
   Often yes, depending on the lesion.

4. What is ABCDE?
   Asymmetry, Border, Colour, Diameter, Evolving — signs to watch for melanoma.

5. Are biopsies safe?
   Yes — performed under local anaesthetic.

Benign Lesions (Skin Tags, Seborrhoeic Keratoses)

1. Are these dangerous?
   Usually harmless.

2. Should I have them removed?
   Yes, if irritating or for cosmetic reasons.

3. Does removal hurt?
   Procedures are quick with minimal discomfort.

4. Will they grow back?
   Sometimes, depending on lesion type.

5. How long to heal?
   1–3 weeks on average.

Cryotherapy

1. What can cryotherapy treat?
   Warts, seborrhoeic keratoses, skin tags.

2. Does it hurt?
   Brief stinging or burning sensation.

3. How many treatments are needed?
   Most lesions need one; some warts require multiple.

4. Is it safe for children?
   Yes.

5. Are there side effects?
   Minor redness or blistering, usually temporary.

IPL & Laser

1. What conditions can IPL/laser treat?
   Rosacea, acne scarring, pigmentation, unwanted hair.

2. Does it hurt?
   Mild stinging or heat; topical anaesthetic optional.

3. How many sessions are needed?
   Typically 3–6 sessions.

4. Is it safe for all skin types?
   Some treatments are better for lighter skin; patch tests used to ensure safety.

5. Is there downtime?
   Minimal — most patients resume daily activities immediately.