• aesthetic
  • acne
  • Skin Cancer
  • Mole
  • dermatology
  • High quality, affordable, skin care by a fully qualified NHS and Private consultant dermatologist.
  • Acne Management - Real medicine, real results.
  • Unveil your real skin- Medical and Laser treatment of facial redness and rosacea.
  • Skin cancer: From check up to cure, from biopsy to Mohs surgery. Comprehensive care.
  • Everything skin!

Welcome to the wonderful world of Treatments! Most people don’t realise how many people suffer from skin disorders, skin disorders that can make life difficult. They don’t have to anymore because there are many treatments that can help restore confidence and change lives.

Click on the tabs below to discover more about various skin conditions.

Treatments

Acne

Acne vulgaris/ Spots/Pimples most commonly affect teenagers but can be seen in any age group. Typically acne suffers will experience oiliness of the skin around the face, upper parts of the chest and back. In some cases, acne can be so severe that it can leave scaring. Spots can be painful, red or yellow with whiteheads and blackheads or a mix of all these features.

There are many treatments both prescription and over the counter for acne. The aim should be to identify the type of acne and use a treatment that is most likely to target the specific type of acne. Most treatments will target only a specific type of acne lesion but some will be 'broad spectrum' that is to say target all the lesions seen in acne.

Oral antibiotics, creams or gels, chemical peels, laser light all improve acne. In case of females, oral contraceptive pills may be helpful. Isotretinoin or Roaccutane is one medication that has a very high success rate in the treatment of stubborn acne. This can be prescribed only by a fully trained dermatologist.

Treating acne early can prevent scarring, both physical and psychological.

Acne scarring

Acne scarring has major effect on self esteem, confidence and can lead to social ostracism, social withdrawal, unemployment , lost relationships, significant depression and even suicide.Scarring of varying severity occurs early and affects 95% of patients with acne.

Acne scars are of many types and one person may have a combination of these. Icepick, varicelliform, box car, rolling, hypertrophic, keloid and if scarring is widespread it causes elastolysis with appearance of premature ageing.

Not all acne scars are alike and an individual with acne will have different types of scars. This means that there is no single best treatment for established acne scars.

Treatment of acne scarring is usually sought for facial rather than truncal lesions. Each scar and patient is treated individually on their merits and according to the patients’ and the scars characteristics. Many treatments are available for acne scarring. Most of these are physical methods and involve one form of surgical procedure or other aimed at correction. Some procedures e.g. dermabrasion were quite popular in the last two decades have given way to newer safer and more effective techniques. Other techniques include chemical peeling using various organic fruit and inorganic acids and solutions. Whilst useful in very superficial scarring acne, this method is more useful for the pigmentary disturbance associated with the acne scarring. Moreover, any improvement with these peels is usually temporary.

Various surgical techniques for acne scarring include:

Punch excision/ elevation.

Underminig of scars/ subcision.

Dermal fillers, collagen and fat transplantation.

Laser resurfacing- CO2 Fractional and fully ablative and FRAXEL.

Combination of the above.


acne-scarring

acne-scarring2

acne-scarring-3

acne-scarring-4

acne-scarring-4

acne-scarring-4

acne-scarring-4

Alopecia

Alopecia or hair loss is a common problem.

The most common form of hair loss is male patterned baldness.

Others such as Alopecia Areata are also very common.

Treatments depend upon extent and nature of alopecia.

An evaluation is mandatory before commencing any treatment and sometimes scalp biopsies may be required.

A comprehensive range of treatments can be offered for alopecia or hair loss.

Birthmarks

Most common birthmarks are red (port-wine stains) or brown (congenital melanocytic naevi).

Many of these will improve with laser treatments.

birthmark-laser

birthmark-treatment

cafe-au-lait-birthmark

Blemishes

Age spots or Blemishes occur on chronically sun exposed skin. These can be very responsive to laser treatments, such as Q switched lasers.


sun-spots

wart-removal

blemish-removal

age-spots

age-spots

Botox

Botox

Botox/ BBoccoture/ Azzalure/ Dysport/ Myobloc are commercial names for botulinum toxin. Botulinum toxin has been used for medical indications for over 20 years and is an extremely safe cosmetic procedure. It 'numbs' the muscles by acting on the nerve fibres sitting on the top of muscles. When this happens the muscle movement is reduced for upto 3-4 months.

Being a reversible treatment, it is safe and highly effective for improving wrinkles on:
  • Forehead
  • Glabella (mid brow)
  • Crows feet (sides of eyes)
  • Bunny lines
  • Gum show
  • Prominent chin muscles

Chemical peels

Chemical peels are used for rejuvenation, acne, scarring and pigmentation on the skin. The nature of the condition and skin should dictate what kind of peels will be suited. Not all peels are suitable for all skin types. Superficial and medium depth peels such as mandelic, glycolic , salicylic and TCA are the most common. However, for pigmentation I also use a combination of azelaic, mandelic, weak TCA, phenol, arginine and Retinol. Sun avoidance is very important after ANY chemical peel.

Cherry Angiomas

Small cherry like lesions are absolutely benign and normal but many people seek treatment for cosmetic reasons. Associated lesions are called angiokeratomas which can be seen on genital skin as well. Laser treatment is highly effective in the treatment of these lesions.

Cherry Angiomas

Comedones

Blackheads can be seen around the eyes, foreheads and cheeks. These not only appear in acne but can also appear in sun damaged skin. A modified laser technique is highly effective in the treatment of these lesions.

Rai S, Madan V, August PJ, Ferguson JE.Favre-Racouchot syndrome: a novel two-step treatment approach using the carbon dioxide laser. Br J Dermatol. 2014 Mar;170(3):657-60.


Blackheads

Comedones

Comedones

Cysts

These can get inflamed and unsightly and result in scarring. These are best excised. It is possible to remove cysts leaving a very tiny mark.


Cysts

Dermaroller / Skin Microneedling

One of the safest procedure with minimal downtime. 

A small drum like device with titanium needles is used to create superficial skin injury. The procedure is undertaken under topical anaesthetic meaning a numbing cream is applied on to the skin. Full face treatment takes 20 mins and achieves a fresher look and feel. Downtime of few hours to 1 day. 

Sun avoidance is important and skin will be red after treatment. Useful for superficial acne scarring and skin rejuvenation. I also use a Dermapen which achieves similar but better results.

Dermapen

Eczema

Eczema or Dermatitis refers to inflammation of the skin which has the following signs and symptoms:

  • Redness
  • Scaling
  • Itching

Eczema can be of many types. Common ones being atopic, irrritant, seborrhoeic and discoid. All are different and required tailored treatments.

Facial thread veins

Facial thread veins are common but can be cosmetically unacceptable. Fortunately, there are excellent treatments for the thread veins which incliude

  • KTP laser
  • Pulsed dye laser

Both treatments produce excellent results, some such results can be seen below.

Thread Veins

Facial Thread Veins

Spider Vein

Facial redness

Facial redness

Fillers

Fillers are used for replacement of volume into the skin. The most common and safest fillers used these days are Hyaluronic acid based fillers. Juvederm and Restylane are such fillers.

Common areas of the face that fillers are used for include: Nasolabial folds I Lips I Cheeks I Tear troughs I Temples.

Fillers

Lip fillers

Fraxel

Fraxel

Fraxel laser treatments are indicated for acne scarring, facial rejuvenation and facial pigmentation (Melasma).

Unlike many other laser systems it is safe to be used in patients who have darker skin colour.

Fraxel Face

Fraxel Face

Freckles

Freckles

Keloid scars

Keloid scars are commonly seen on earlobes, chest, shoulders and back. They can be resistant to treatments- they may not completely resolve. Two best treatments for this condition:

  • Steroid injection- This serves to flatten the scars, and improve the discomfort and itching which can be associated with keloid scars.
  • Pulsed dye laser- The redness associated with these scars can improve with the laser treatment, which works best in combination with steroid injections.

Stephanides S, Rai S, August P, Ferguson J, Madan V.Treatment of refractory keloids with pulsed dye laser alone and with rotational pulsed dye laser and intralesional corticosteroids: A retrospective case series. Laser Ther. 2011;20(4):279-86

Keliod scars

Lasers

I use the following lasers in my practice.

  • Carbon dioxide for resurfacing.
  • Fractional CO2 for acne scars and rejuventation.
  • Fraxel for acne scars, skin rejuvenation and melasma.
  • Q qwitched Nd:YAG and Ruby for pigmentation and tattoos.
  • Q qwitched Alexandrite for pigmentation and tattoos.
  • Pulsed dye laser for facial redness and thread veins.
  • Nd:YAG for hair and leg thread veins.
  • KTP for thread veins.

Leg thread veins

Small leg veins are a cosmetic problem. A careful examination is important to identify which veins will improve with Sclerotherapy injections and which will improve with laser treatment.

Microsclerotherapy is injection of a chemical such as Aethoxysklerol or Polidocanol (Sclerovein) to cause irritation of the vein wall which leads to closure of the vein wall.

Laser treatment is suited to some very small veins which are not injectable. Both laser and microsclerotherapy are offered by Dr Madan.

Lumps and bumps

Lumps and Bumps may affect skin of all colours and ages. First principle of treatment is to establish that the lump is benign. A diagnosis is important before the lump is removed. This diagnosis can be made on clinical examination, small biopsy or by excision (complete removal) of the lump.

A scar is inevitable but an experienced and trained surgeon can use their skills in minimizing the scar significantly.

Lumps and bumps

MOHS surgery

Mohs  micrographic surgery is one of the most effective treatments for basal cell carcinomas (BCC) also known as rodent ulcers. BCC’s are the most common form of skin cancers.

Why Mohs surgery?

Mohs surgery is a highly specialised way of treating BCC’s and certain other skin cancers. Many BCC’s may look smaller on the surface but may have deep and sideways extensions that are not often visible from the surface. Unlike other treatments, Mohs technique allows the surgeon (dermatologist who has had  training in Mohs surgery) to visualise the skin cancer in its entirety. This means that the sideways extensions of the skin cancer and its roots that are not otherwise visible on naked eye examination can be visualised under the microscope, thus permitting the surgeon to perform a complete examination of the margins of the skin cancer. This reassures the surgeon that the entire skin cancer with itsroots and extensions has been  removed. For this reason, Mohs surgery has the highest cure rate of all techniques employed for the treatment of BCC’s.

For more information on Mohs surgery please email: enquiries@ukdermatologist.co.uk

Here are some pictures of skin defects after cancer surgery and results after treatment.

MOHS surgery

MOHS surgery

MOHS surgery

MOHS surgery

MOHS surgery

Mole removal

Unwanted moles can be removed by-

  • Shaving
  • Laser Ablation
  • Excision

Not all moles should be shaved or laser treated. If the mole is suspicious looking it is best to have it checked by your doctor or dermatologist who will use a dermatoscope to examine the moles and discuss with you the best treatment for them.

Mole removal

Mole removal

Mole removal

Mole removal

Mole removal

Mole removal

Mole removal

Mole removal

Pigmentation



Pigmentation

Psoriasis

Psoriasis is a chronic skin condition in which the skin goes red, itchy and very scaly. There is no relation with diet but the exact cause of psoriasis is not known. Psoriasis can affect the skin, nails and joints and severe psoriasis is linked to heart disease.

Many good treatments are available for psoriasis. These include creams and gels, tablets and more recently injections which are very helpful in improving severe psoriasis.

Rhinophyma

Rhinophyma is the term given to thickening of the skin of the nose. It has been wrongly associated with chronic alcoholism. Most patients will have Rosacea as well. 

Treatment with CO2 laser is preferred. It is quick (30-45mins) and carried out under local anaesthetic.

Madan V, Ferguson JE, August PJ. Carbon dioxide laser treatment of rhinophyma: a review of 124 patients. Br J Dermatol. 2009 Oct;161(4):814-8

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rhinophyma

Rejuvenation

Skin rejuvenation is achievable by a number of means including chemical peels, lasers and other cosmetic treatments.

Below are some examples of skin rejuvenation results using laser resurfacing.

Rejuvenation

Rejuvenation

Rejuvenation

Scar revision

Scars can be improved by surgery or laser treatment. This would depend upon the type of scar. Raised red scars can be flattened by use of steroid injections and lasers.

Scar revision

Scar revision

Scar revision

Scar revision

Scar correction

Skin Cancer

The first principle treatment of skin cancers is appropriate and early diagnosis. The three most common types of skin cancer are Basal cell carcinoma, Squamous cell carcinoma and Melanoma.

Below are examples of these skin cancers.

Any suspicious skin lesion needs to be examined by a doctor who is knowledgeable in making the diagnosis.

Basal Cell Carcinoma (Rodent ulcer)
Cancer

Malignant Melanoma
Cancer

Squamous Cell Carcinoma
Cancer

Skin tags

Skin tags are small skin growths that can be very annoying cosmetically and can catch on clothing getting inflamed. These can be snipped. Some on the face of darker skin patients are called Dermatosis Papulosa Nigra and can be effectively treated using lasers.

Skin Tags

Skin Tags

Vitiligo treatment

The term vitiligo refers to loss of pigment of the skin. There are many hypotheses explaining why some people get vitiligo which is though to be mediated by an auto immune process- meaning the pigment producing cells 'melanocytes' are under attack from the body's own immune system.

Treatment options are topical steroids, the newer immuno-modulator creams, light therapy and surgery.

Vitiligo

Vitiligo

Venous lakes

These are not uncommonly seen on lower lips. Small lesions can respond to laser treatment and larger ones to cold point cautery.

Venous lakes

Warts and Verrucae

Some warts can be incredibly stubborn and often painful.

Common treatments such as wart paints or solutions may be a good initial choice.

For stubborn warts, I use pulsed dye laser which has a high cure rate with no scarring.

Wart-Verrucae

Wart-Verrucae

Wart-Verrucae

Xanthelasma



Xanthelasma