The booming, billion pound UK skincare industry has been swamped by endless products but Neil Trainis seeks out the wisdom of expert Dr Aamer Khan to sort out the best-selling and most effective treatments on the market.

Everyone desires clear skin since it is a sign of health as much an indicator of beauty but when it comes to choosing a suitable treatment things can quickly become blurred.
Professional advice tends to cut through the technical jargon and confusion that sometimes consumes customers, not to mention pharmacists deliberating on the most effective treatments to stock for a variety of ailments, from dry skin and skin infections to acne, psoriasis and eczema.
Dr Aamer Khan is a principle in general practice in the NHS and runs a private medical skin practice in Harley Street, London. His expertise, however, extends beyond skin cosmetics and into the domain of skin care.
The Association of the British Pharmaceutical Industry (ABPI) cited acne, eczema, skin infections and dry skin as the most common skin complaints seen by GPs in the UK. A BBC health study found that over 90% of teenagers are affected by acne, a particular specialism of Dr Khan's. Acne can be treated with retinoids, gels and antibiotics. His practice receives 30 cases a week on average but the alternative to cosmetic treatment is a labyrinthine array of medicated treatments.
“We sometimes get 10 cases a day. Premature ageing from sun damage is very common too but acne is an extremely common complaint. I would recommend alphahydroxy creams and vitamin A retinol products as the best on the market to combat this,” Dr Khan said.
“Alpha betahydroxy, salicylic acid and A retinol products address bacteria, blockages and congestion and excessive oil production. Neostrata as a brand has very good products for acne and there's a whole range of products for dry skin too. These are excellent products.
“Jan Marini products are also very effective but are stronger than over-the-counter products in hydrating the skin and combating acne. Avène is another very good product line. It is very gentle on the skin and there are products for oily skin and and dry skin. Avène is very good for soothing sensitive skin. Products containing low oils are very good and Cetaphil products are great because they work without stripping the skin of its natural oils. Products with low oils are the best products. Low oil and non-comedogenic products are good because they do not block the pores of the skin. Clearasil have a popular line of treatments too.”
There is no known cure for eczema and current treatments are designed to alleviate inflammation and itching rather than eradicate it. It is treated by corticosteroids, medications, immunomodulators, antibiotics, immunosuppressants (ciclosporin, azathioprine, methotrexate) and anti-itch drugs, sedating antihistamines such as promethazine, whose brand name is Phenergan, and diphenhydramine, whose brand name is Benadryl.
Dr Khan's knowledge of eczema is thorough. “With eczema there is a lot of dryness, so anything which hydrates the skin is good. Aqueous creams are effective and diprobase ointments are a very good hydrating produce because they retain oil in the skin,” he said.
“Anything which calms down the skin is effective too, so I would recommend anti-itch, anti-inflammatory products. Antibiotics are also effective but anything with antihistamines in them are good. You have to be careful with these but hay fever treatments are good for itchy skin because they contain antihistamines.” His choice of eczema treatments included corticosteroids such as Eurax HC cream and Eurax hydrocortisone cream because they contain crotamiton which breaks down the dead skin layer and relieves itching to calm the skin.
Skin infections broadly fall into three categories; bacterial, fungal and viral. Treatments in this area continue to flood the market. “I would advise people with skin infections to see their doctor and get a prescription,” Dr Khan suggested. “Antiseptic treatments for bacterial infections can be effective but the problem with bacterial infections is that they spread very quickly so you need to see the doctor as soon as possible.” For fungal infections he highlighted Daktarin and Lamisil and for viral infections he suggested pharmacists would be advised to stock up on antiviral creams such as Zovirax.
Psoriasis, in its numerous guises (Guttate, Plaque, Pustular, Psoriatic Arthritis and Flexural Psoriasis) remains enigmatic. Last year a report on thehealthierlife.co.uk claimed the disease affected 3% of the world's population while talkpsoriasis.com suggested that 1.2 million people in Britain are afflicted, and yet there is still no cure and no definitive cause or catalyst for the condition, although medicine largely believes its origins lie in genetics.
Statistics supplied by emedicine.com identifying western European and Scandinavian populations where psoriasis is most prevalent, with the disease less apparent among Japanese and Inuit peoples, rare among west Africans and African Americans and “nearly absent” in north American Indians, is interesting but not particularly insightful in pinning down psoriasis. Stress, excessive alcohol consumption and smoking are all thought to play a part but a person from any race is susceptible to it despite such epidemiological optimism. Chronic plaque psoriasis remains the most common type of the disease.
Pharmacists and psoriasis sufferers continue to grapple with the three main treatments available; topical, ultraviolet light and systemic. Topical solutions such as ointments and vitamin D creams include Calcipotriol (brand name Dovonex), Calcitriol (Silkis) and Tacalcitrol (Curatoderm). Tests have found that Calcipotriol and Calcitriol are equally effective but Calcipotriol appears to work better than Tacalcitrol. “Outside prescription, anything which helps with inflammation, dryness and the build-up of  dead skin. Coal tar is a great treatment. It's anti-inflammatory and soothes the skin,” Dr Khan advises, before promoting the benefits of emollients such as E45 and Diprobase. “Anything with salicylic and glycolic acid can help in the treatment of psoriasis. Diprobase creams are good and Oilatum emollients are recommended.”
Systemic treatments incorporate drugs which must not be taken by pregnant women as they can harm  her baby and biological drugs tackling severe psoriasis by affecting the immune system and reducing inflammation have been withdrawn from the market because of the potential health risks they pose. “Again, anything with antihistamines in them will help but the problem with systemic treatments is that they affect the liver and heart and can cause bone marrow suppression. These treatments are designed to suppress activity in the cells and can affect the central nervous system,” Dr Khan said.
He did not single out any particular systemic treatment, maintaining that only “in extreme cases” would he recommend the implementation of systemic drugs and insisted that anyone taking those must be regularly monitored for side effects. “I would say that 85% of patients need topical treatment. They need to look at their lifestyle choices. Cutting out dairy products for example, or trying to reduce stress. Managing stress can help reduce the trigger factors.”
Nonetheless, systemic treatment brands perforate the market and these include Neotigason, Neoral and Remicade, although these are treatments whose potential damage may outweigh the benefits in controlling severe psoriasis. Etanercept, whose brand name is Enbrel, affects the immune system, blocking chemicals in the body known as cytokines that produce inflammation in the body, yet it can cause serious side effects, such as heart problems, severe infections, nervous system diseases, blood problems and allergies.
Dry skin may not generate as much misery as psoriasis or eczema but it has caused a furore for some time. A UK skincare review claimed last year that the facial skincare market was worth around £673 million while women spent £32 million on eye care products in 2008 according to The Daily Mail.
“Dry skin affects more people than psoriasis. It affects older people because as you get older your skin gets drier and you get irritation and cracking. Postmenopausal women suffer from this,” said Dr Khan, who recommended Eurax cream “as this contains shea butter, an emollient, and some people go all the way down to Vaseline products which hold moisture in.”
Among the more common types of skin pain are rashes, infections, boils, blisters, ulcers, shingles and skin allergies. Dr Khan advises pharmacists stock up on flamazine for ulcers as it contains silver sulfadiazine, an antibiotic which soothes the affected area. “Ulcers need managing because they are caused by different things,” Dr Khan said, “like poor blood supply for instance.”