Skin camouflageBMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.d7921 (Published 05 January 2012) Cite this as: BMJ 2012;344:d7921
- Louise McMichael, product information officer
- Accepted 17 November 2011
A Health Care Needs Assessment, Skin Conditions in the UK, estimated that skin problems account for about 10% of a general practitioner’s surgery time and 6% of hospital outpatient referrals.1 According to the British Association of Dermatologists (www.bad.org.uk, July 2011), 15% of the population per year will be seeking help from their general practitioner for a skin condition, and most patients will have their skin disorder diagnosed and treated in primary care.1 2 As many as 30% of these patients also experience psychological distress owing to perceived disfigurement.3 This can affect quality of life and ability to participate in work and social activities, which in turn can affect the quality of life of their family members.4 For those with permanent or chronic disfigurement, use of skin camouflage can help a patient to adjust to an altered image and regain their self esteem by creating a sense of personal wellbeing.5
Which patients might benefit from skin camouflage?
For skin camouflage to be applied safely, the skin needs to be sealed, healed, and non-infectious, which rules out its use in many skin conditions seen in primary care.6 The Monthly Index of Medical Specialities (MIMS) lists the conditions suitable for skin camouflage as port wine stain, vitiligo, and scarring (see table⇓), but it overlooks other conditions in which these products may be suitable and beneficial.⇓ ⇓ ⇓ ⇓ ⇓ For example, beauticians and make-up consultants traditionally advise that patients with acne and rosacea should not cover up their skin with any cosmetic preparation, especially when it contains oils and waxes. However, a 2005 clinical report on acne treatment found that patients with inflammatory eruptions, including those with typical rosacea and mild to moderate acne, psychologically benefited from wearing skin camouflage.7 During the study, inflammatory eruptions decreased, and quality of life indicators such as reoccurrence, appearance, frustration, embarrassment, being annoyed, and feeling depressed showed significant improvement. A research report about patients with keloid and hypertrophic scarring concluded that those with scar tissue 5 cm in length were particularly concerned with their appearance, regardless of whether the scar was immediately visible or hidden by clothing (Scar Information Service www.scarinfo.org; research sponsored by Smith and Nephew undertaken by Entri Research, 1999).
What is para-medical skin camouflage?
At first there would appear to be little difference between over the counter corrective make-up and skin camouflage products—both set out to achieve the same result, which is to hide erythema, hyperpigmentation and hypopigmentation, unwanted tattoos (from radiography treatment), and scarring. However, products designed for skin camouflage differ from normal cosmetics in that they are very durable, lasting 8 to 16 hours before they need to be reapplied, and, when correctly applied, they make the camouflaged area water resistant. Skin camouflage products are designed to mimic and blend in with the natural skin colour, while the structure of the skin will remain unchanged. Service providers are careful not to use the words “make-up” and “cosmetics” when discussing skin camouflage. The term “skin camouflage” is non-exclusive, whereas “cosmetics” and “make-up” can create anxiety for those who would not normally wear decorative cosmetics.6
Where can patients obtain skin camouflage products?
The brands of skin camouflage currently listed in the Drug Tariff, MIMS, and BNF are available in the United Kingdom on National Health Service prescription at the healthcare adviser’s discretion. These brands can also be readily obtained privately through the internet and mail order, and can be ordered off prescription at a chemist.
How is skin camouflage used?
The usual method of application uses simple techniques to apply a fine layer of camouflage cream, followed by a setting powder. Although the products contain sun protection, additional (oil-free) sunscreen can be applied under and over the camouflage. The patient’s normal make-up can be worn over their camouflage, and topical medication (including silicone gel scar treatment) or emollients can be applied before the camouflage.
Brands of skin camouflage vary in texture, slip, durability, and sun protection factor, which means one product may be better than another for a certain skin type and condition or more suitable for a patient’s lifestyle. Before issuing the patient with any product, it is important to achieve an acceptable match between their unaffected skin colour and a camouflage cream. If no single colour is suitable, two can be mixed together.
The British Association of Skin Camouflage recommends that users remove their camouflage on a daily basis. However, the organisation has not received any reports that camouflage cream and powder, when correctly applied, encourage comedones or worsen scarring or skin conditions.
Camouflage services are not readily available in primary or secondary care, but can be sought privately through the British Association of Skin Camouflage, the Skin Camouflage Network, and the Red Cross Camouflage Service (see box). The British Association of Skin Camouflage has trained members worldwide.
Resources for patients
British Association of Skin Camouflage (www.skin-camouflage.net)—national and international provider of training for medical professionals and qualified beauticians (NHS and private practice)
British Red Cross Skin Camouflage Service (www.redcross.org.uk)—trains volunteers for the NHS
Skin Camouflage Network (www.skincamouflagenetwork.co.uk)—national association of practitioners in skin camouflage (does not provide training)
These organisations also offer an internet, postal, and telephone help line for patients, healthcare professionals, and others with questions about skin camouflage
The British Association of Skin Camouflage is the only organisation that trains professionals for both NHS and private practice, and its graduates use both prescription and over the counter products. The Red Cross trains volunteers who work within the NHS and consequently uses only prescription products. We recommend that primary care services consider employing a member of staff who is trained to consult with patients requiring skin camouflage. During a consultation, the patient should be taught the correct procedure for applying the products, maintenance during their use, and methods of effective removal. A model for such a service is established at the Vitality Community Dermatology Service in Birmingham, which employs a specialist dermatology nurse to advise patients on skin camouflage (see box).
A nurse specialist’s perspective
Skin camouflage is provided as part of the community dermatology service. I usually meet the patient in the dermatology clinic before their specific camouflage appointment. This provides the opportunity to introduce myself, to inform them about skin camouflage, and to manage their expectations.
The patients appreciate the “one stop” service; they do not have to wait for a further referral to the hospital, as they are booked in for the next available camouflage appointment. If the patient requires a routine dermatology review, the camouflage appointment can be arranged to coincide with this, thus avoiding multiple attendances. If the patient is not due for a review but expresses concerns about their condition or the management, then these would also be addressed during the camouflage consultation.
Camouflage consultations take up to one hour. In addition to educating the patient about the use of camouflage, the consultation provides the opportunity to offer further support and education about their underlying condition.
Providing the service in house benefits the patient, as they are treated holistically and the camouflage is offered as part of a management plan. It is rewarding to see the patient leave happier and with increased confidence after a successful consultation.
Julie Panter, dermatology nurse (BASC graduate), Vitality Dermatology Practice, Birmingham, UK
Cite this as: BMJ 2012;344:d7921
Competing interests: All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.
Provenance and peer review: Commissioned; externally peer reviewed.
Patient consent: Images supplied by British Association of Skin Camouflage, which obtained patient consent for publication.