Skin camouflage may offer a simple option to help people who need to adjust to an altered self-image. Camouflage does not alter the structure, function or condition of the skin, but its immediate visual effect may help people to regain self-esteem and confidence, improving their quality of life and assisting in their return to normal social and sporting activities, education and employment.
Prescription, quality of life, self-confidence, self-esteem, self-image, skin camouflage, wellbeing
It is estimated that in the UK, 54% of the population experience a skin condition in any 12-month period. Of those, 14% seek medical advice, usually from their GP or a community nurse.1
Approximately 25% of the population have skin lesions that would benefit from medical attention.2 Up to 15-20% of a GP's workload and 6% of hospital outpatient referrals are taken up by dermatology and wound care patients, with up to 30% of those people experiencing psychological distress as a direct result of their condition.3
Independent research into keloid and hypertrophic scarring concluded that those people with scar tissue measuring 5cm or more in length were particularly concerned. The psychosocial inhibition was irrespective of the scar being immediately visible or hidden by clothing.4
Camouflage is designed to replicate natural skin colour (Images: BASC)
Camouflage is not a medicine and it cannot alter the function of the skin or remedially affect the lesion; however, the immediate visual effect does help people to regain their confidence and self-esteem. It is generally accepted that skin camouflage can be a vital tool during the early stages of the person's rehabilitation and adjustment to an altered self-image. For some people, it may be considered a long-term process.
Skin camouflage products differ from standard cosmetics in that they are also designed to replicate the natural colour of the unaffected skin. Using quick and simple techniques, correctly applied camouflage should not attract attention.
Topical medication and sun protection can be used before the camouflage is applied and cosmetic make-up can be worn over the set camouflage. Although make-up is effective in concealing minor discoloration, such as mild erythema and periorbital dark circles, it is usually less successful in camouflaging conditions such as hypopigmentation, hyperpigmentation and erythema.
Choosing camouflage products
A British Association of Skin Camouflage (BASC) trained specialist will help the individual to find an acceptable skin match from the vast choice of premixed skin-coloured camouflage products available. If one single colour is unsuitable, two can be mixed together to achieve an acceptable skin match.
Most camouflage products are set with loose powder. With due care, an application of camouflage should last for up to 16 hours. Different brands have different properties, so one product may be easier to apply or better suited to an individual's lifestyle.
There are currently five brands of camouflage listed as 'covering agents' in MIMS and they are available on prescription in accordance with local agreements for non-infectious lesions and scarring.
We all see colour slightly differently, so it is vital for people to be involved in selecting a skin match that is acceptable to them. During the consultation, people are also advised on application techniques suitable to their needs, how to maintain the camouflaged area during wear and how to remove the products effectively and efficiently.
Personal preferences are important, including how they want to obtain their products. Therefore, the camouflage practitioner must involve the individual at every stage of the process.
These products are water resistant, which allows people to enjoy sporting activities (such as swimming) while wearing their camouflage. However, camouflage is quickly removed by soap, soap substitutes and oil-based products, such as emollients.
BASC recommends that camouflage is removed on a daily basis, to allow people to apply topical medication and emollients. This also gives them the opportunity to inspect their skin for any changes that might require medical attention.
BASC is currently unaware of any confirmed allergy to these products, but there is always the potential for an unexpected allergic reaction to an ingredient. Should this occur, BASC recommends discontinuing use until a clinical patch test identifies the cause.
Although camouflage should not be considered completely rub-proof, any soiling to clothes is easily removed with ordinary laundry products. Unfortunately, camouflage applied to the hands may not withstand normal daily activities and frequent hygienic practices.
The Products Available To Camouflage Hands (PATCH) survey undertaken by BASC in conjunction with the Vitiligo Society confirmed skin-staining products (fake tans) were the preferred choice, even when the colour was not an acceptable skin match. It is hoped that manufacturers will be encouraged to produce more natural-coloured stains, suitable for all six Fitzpatrick skin groups.
Camouflage, not cosmetics
BASC practitioners are very careful not to use the words 'make-up' and 'cosmetics', because these may create anxiety in those who would not normally wear decorative cosmetics. Such expressions will also trivialise camouflage to a beautifying aid, instead of its intended paramedical use.
The term 'skin camouflage', however, does not generate psychological barriers. It is non-exclusive and indicates that products should be made available to men, women and children, regardless of ethnicity, religion and skin group.
Camouflage can play a vital part in the recovery of people who deliberately cut themselves, because their self-inflicted injuries are not so apparent once camouflaged. There is also some therapeutic value when applying camouflage, because the person is touching their skin in a benign way.
Benefits of camouflage
Although not frequently researched, studies confirm the benefits and efficacy of using camouflage on non-infectious lesions and scarring,5 including paediatric use.6
Children usually cope when given appropriate emotional and educational support, and any playground curiosity is soon satisfied with simple explanation.
Recently published research confirms that children using camouflage were less likely to be teased and their wellbeing significantly improved – the average score on the Children's Dermatology Life Quality Index was 5.1 before the study, dropping to 2.1 when skin camouflage was worn for six months.6 However, BASC would advise caution when camouflage is requested for children.
The camouflage practitioner will need to decide who is requesting camouflage and why – is it the child or the family, and for what purpose? Most children do not think of skin camouflage until they reach puberty; however, it may be that the practitioner has not been made aware of the reasons for the medical adviser and/or psychologist recommending camouflage at an earlier age.
In addition, camouflage is not rub-proof and children are tactile. Embarrassment would result from transfer of the product on to school equipment, toys or another child. It is best practice to direct parents to support groups that have dedicated specialists to help adults support children with skin lesions.
How to achieve good outcomes
Outcomes tend to be better if the lesion and any scarring are the same height as the surrounding unaffected skin.
Hyperkeratinisation is not a contraindication, although people with psoriasis may need to stabilise their camouflage with a fixing spray, which is not available on prescription.
Unwanted tattoos are another reason for requesting skin camouflage. Sometimes this is required only for use when the person is at work or while they are undergoing the process of laser tattoo removal. Another reason would be to cover a radiographer's indicating mark.
Tattoos require the use of a complementary colour, which is applied as an undercoat to cover vivid and black tattoo inks before the skin match product is used.
BASC-trained consultants providing services within private clinics and pharmacies will accept self-referrals, but a consultation fee may apply. Access to free NHS clinics provided by BASC-trained practitioners requires referral in accordance with local agreements. Although BASC graduates work independently (we do not employ anyone) we are naturally proud of the part they play in helping others to face the world with confidence.
- Elizabeth Allen is principal tutor and chair, BASC education team
Competing interests: None declared
1. All Party Parliamentary Group on Skin (APPGS) Monthly Monitoring Report (week 1). Statistics from debate in the House, December 2013.
2. APPGS. Report on the enquiry into the impact of skin diseases on people's lives, London, July 2013.
3. Gawkrodger DJ. Dermatology: An Illustrated Colour Text (fourth edition). Oxford, Churchill Livingstone, 2007.
4. Scar Information Service (sponsored by Smith & Nephew)
5. Levy LL, Emer JJ. Emotional benefit of cosmetic camouflage in the treatment of facial skin conditions: personal experience and review. Clin Cosmet Investig Dermatol 2012; 5: 173-182.
6. Ramien ML, Ondrejchak S, Gendron R et al. Quality of life in pediatric patients before and after cosmetic camouflage of visible skin conditions. JAAD 2014; 5: 935-40.
Up to 30% of people experience psychological distress because of their skin condition
Skin camouflage can be a vital tool during the early stages of rehabilitation, but also forms part of a long-term process
Skin blemishes and scars may result from conditions present at birth, or developing later in life
Low self-esteem is equally devastating to men, women and children, irrespective of age, nationality and religion
The British Association of Skin Camouflage (BASC) was set up by Joyce Allsworth, who was instrumental in establishing the camouflage service in the Red Cross and remained its chief trainer for many years. In 1985 she responded to the need for training private as well as NHS camouflage practitioners.
Since then, BASC has become the leading provider for training medical professionals, make-up artists and tutors of beauty therapy in the skills necessary to undertake clinic, media and salon practice. Its diploma is acknowledged for indemnity purposes by medical and industrial agencies.
BASC is an independent association run by dedicated professionals who volunteer their expertise. It is not linked to any industry, company, organisation or authority, allowing them to promote skin camouflage independently and free from restrictions.
Find out more about BASC at www.skin-camouflage.net