Nearly one in five people in the UK self-identify as having a visible difference or disfigurement such as a mark, scar or condition, and research on skin conditions shows that they are often vulnerable to isolation, loneliness, social anxiety and low self-esteem.

In this week’s Real Voices, we hear from Joan, a Skin Camouflage Practitioner from the charity Changing Faces, which champions people with visible differences. Joan explains how the charity works, and describes the amazing reactions she has seen from people after benefitting from skin camouflage.

I originally trained in accountancy for hotel management many years ago, and subsequently I worked in cosmetics, for Estee Lauder and then Lancome.

Lancome in those days did a lot of skincare, and I became very interested in this whilst working there.

I changed careers and eventually became a volunteer with the Red Cross in the early nineties. The Red Cross did skin camouflage at that time. I was on duty for first aid at an event, and mentioned to a lady that I was chatting to that I had formerly worked in cosmetics. She asked if I would be interested in training to do skin camouflage, and I said yes.

After doing skin camouflage for a number of years, the Red Cross decided to cut its skin camouflage service in 2011 in order to focus on emergency response and refugee work. Fortunately, delivery of the skin camouflage service was transferred to the charity Changing Faces.

What is Changing Faces?

Changing Faces was initially founded as a psychosocial support charity, which focused on enabling and empowering people to live with visible differences. But at the same time the Red Cross decided to cut its skin camouflage service, Changing Faces had fortuitously decided, due to popular requests from clients, to set up a similar service of its own. So about 180 practitioners were transferred from the Red Cross to form our service. I am a trainer as well as a practitioner, but since Covid hit we haven’t been able to train face-to-face.

How we help people

People with visible differences can make their own appointments to see us, or they can ask their GP to refer them to our service. When the patient arrives, the practitioner will have received limited information about a patient’s condition. For example, a GP referral letter might simply say ‘port wine stain’.

I always begin with a new patient by sitting down with them and having an honest conversation about what their outcomes are likely to be. The reality is that we can’t take their visual difference away, we are simply camouflaging.

We then start colour matching with the products to create a shade which is as close as possible to the person’s natural skin tone (of the unaffected area of skin) . We have around 400 shades across four different products, all of which are available on prescription. All four products have slightly different textures and components, as some of them contain lanolin or others have a beeswax base.

Colour matching products to match skin tones

We take little scoops of the product and try it on the patient’s skin, until we get an idea of what shade is best for their skin tone. This is very varied from person to person, as the acidity and alkalinity of the skin can change the colour of the product once it’s applied. Once we’ve decided on the product and shade, we start applying it onto skin that isn’t the affected area, because I’m trying to get an exact skin match. Then once we’re both happy, we start to apply it to the afflicted area.

We have a number of different methods of application; one that I particularly favour is a sponge, but some prefer a foundation brush. I always say to my clients to experiment with different application methods on their own to find out what works best for them. I encourage them to have a go themselves during the appointment so that they can practice and gain confidence.

Getting a GP prescription

Finally, I make a prescription list for the client to take to their doctor, so they can order exactly the right product and shade. Only twice during my time as a Skin Camouflage Practitioner have I seen a doctor refuse to issue a prescription.

I also write down some recommendations for clients, reminding them that they need to use an oil-based cleanser because all our products are waterproof. You can swim or shower with them, as long as you gently pat the area dry afterwards.

I’ve got a lady who’s been coming to me for quite some years, who is a swimming instructor. She told me she takes a kitchen roll to pat herself dry, and that works great. Some people manage to get the product to last for up to 72 hours. Furthermore, if any of the products get onto your clothing or bed linen, it will come out in one wash.

The benefits of using skin camouflaging products

The purpose of skin camouflaging is to reduce the impact of a physical difference when someone is walking towards you. Fortunately, at my clinic in Newcastle, the wall is mirrored. So I get my clients to walk towards their own reflection to see the difference once I’ve applied the camouflage.

Inevitably, when someone has a visible difference, their eye will go directly to the site when they see their reflection. However, once the camouflage is applied successfully, other people’s eyes will not be drawn to the affected area.

Vitiligo and other common conditions

There are lots of different conditions that people come to our service to get camouflaged for. The most common is vitiligo, which is where you have light and dark patches on the skin. It is believed that it may have something to do with immunology, and it tends to run in families. You see it most commonly in Afro-Caribbean skin, but we’re seeing it more prominently now in caucasian skin as well. Winnie Harlow is a famous supermodel who has the condition.

Vitiligo is one of the conditions where the product changes colour as it is applied. So you can do a camouflaging session, be happy with the result, but five minutes later due to the chemical reaction, it’s gone slightly orangey and you need to start over. To counteract that, there are certain creams that may look completely different to the skin tone that you’re trying to match, but as they’re applied to the skin they change colour and match up.

Covering scars, birthmarks, veins, and tattoos

We also treat lots of people with scarring, or birthmarks. We used to see a lot of people asking to get tattoos covered up, but we are seeing fewer these days as tattoos become more socially acceptable (though we do still occasionally get people who need their ex-partner’s name covered up). Patients come in with eczema, and psoriasis. We also do quite a lot of vein cover-up, such as if older women want to wear skirts or dresses to an event, they might get skin camouflage to cover veins in their legs.

Types of products

One of the four creams that we have is called Veil, which was invented for McIndoe’s Guinea Pigs. These were RAF pilots who had sustained burns during the Battle of Britain in the Second World War, who were treated by plastic surgeon Sir Archibald McIndoe at his specialist burns unit. McIndoe had a friend, Thomas Blake, who was an analytical chemist. McIndoe asked Blake to make a cream for his patients for after their skin grafts, as their skin tones were now different.

Veil was originally available in three shades, which went on general sale in the early 1950s. Today we have 14 different shades.

Another cream we use is Keromask, which was invented by a doctor specifically for port wine stains.

The third is Covermark, which was invented by a lady in the 1920s in America. She was both an artist and a chemist, and she also had a port wine stain. She managed to make this cream to cover her stain, and was so successful that she was asked to make it widely available. By 1925, 25% of sales were for men, to cover up their injuries from the First World War.

The final cream is a German make called Dermacolor, which has a huge range of shades available and is a slightly different texture to the others.

Each product has its own use. For instance, Veil is very easy to apply but it’s sometimes not pigmented enough to cover up more severe differences. Less is more with skin camouflage, it needs to be built up in layers to get the most effective result.

Emotional reactions

Patients often have a very emotional reaction to the results, and we get lots of lovely feedback.

However, the difference for some people can be daunting, as their reflection may have completely changed. They feel that they’re not looking at the same person that they have been for years. Very occasionally, I’ll be asked to remove it before the person leaves the consultation, because they want to take small steps by trying the creams out at home before they feel confident enough to go in public.

People mostly don’t just come in for one consultation, they often need to come back when the seasons change as their skin tone changes from summer to winter. I had a young man come to me for the first time when he was eight years old, with vitiligo. Over the years his skin changed with puberty, so he would come in with a new colour match each time. Last year, he came in with his fiancee as he wanted to get a colour match for his wedding. It’s lovely when you get to see patients grow up and their confidence grow after their consultation.

“Skin camouflage services get people their lives back”

It sometimes takes people a while to pluck up the courage to come, as visible differences can really destroy one’s confidence. I treated a lady recently who was so distressed by her condition that she had not left her house in nine years. She made several appointments but would cancel or fail to show up due to nerves. She eventually managed to make it, along with her husband. By the time the consultation was over, she was so pleased with the results that she wanted to go shopping at Fenwick’s in Newcastle straight afterwards. Her husband turned to me and said “You do realise you’ve just cost me a lot of money”. It’s so satisfying to get reactions like that, skin camouflage services like ours do so much good and can get people their lives back.

Find out more about Changing Faces at changingfaces.org.uk.

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