Dermatology

What is acne?

(Acne Informational Video)

Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts.

Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum.

How does acne develop?

The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following manner:

• Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
• Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
• Infection and irritation cause whiteheads to form.

Eventually, the plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is called a comedo.
Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

What causes acne?

Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:

• Hormone level changes during the menstrual cycle in women
• Certain drugs (such as corticosteroids, lithium, and barbiturates)
• Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
• Bacteria inside pimples
• Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.

What are the symptoms of acne?

Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:

• Face
• Chest
• Upper back
• Shoulders
• Neck

The following are the most common symptoms of acne. However, each child may experience symptoms differently. Symptoms may include:

• Blackheads
• Whiteheads
• Pus-filled lesions that may be painful
• Nodules (solid, raised bumps)

The symptoms of acne may resemble other skin conditions. Always consult your child's physician for a diagnosis.

Treatment of acne:

• Specific treatment will be determined by your child's physician based on:
• Your child's age, overall health, and medical history
• Severity of the acne
• Your child's tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.

Topical medications to treat acne:

Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:

Benzoyl Peroxide	Kills the bacteria (P. acnes)
Antibiotics	Helps stop or slow down the growth of P. acnes and reduces inflammation
Tretinoin	Stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
Adapalene	Decreases comedo formation

Systemic medications to treat acne:

Systemic antibiotics are often prescribed to treat moderate to severe acne, and may include the following:

• Doxycycline
• Erythromycin
• Tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this prescription medication with your child's physician.

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Treatment for acne scars

Specific dermatological procedures to minimize acne scars will be determined by your physician based on:

• Your age, overall health, and medical history
• Severity of the scar
• Type of scar
• Your tolerance for specific medications, procedures, or therapies

• Your opinion or preference

Although acne often is a chronic condition, even if it lasts only during adolescence, acne can leave life-long scars. Acne scars typically look like "ice pick" pit scars or craterlike scars. Although proper treatment for acne may help minimize scarring, several dermatological procedures may help to further minimize any acne scars, including the following:

• Dermabrasion
  Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that abrades the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
• Chemical Peels
  Chemical peels are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving its appearance.
• Collagen Injections
  A type of collagen that is derived from purified bovine (cow) collagen is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
• Laser Resurfacing
  Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
• Punch Grafts
  Punch grafts are small skin grafts used to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
• Autologous Fat Transfer
  An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

What is actinic keratosis?

Actinic keratosis, also known as a solar keratosis, is a scaly or crusty bump that arises on the skin surface. The base may be light or dark, tan, pink, red, a combination of these, or the same color as the skin. The scale or crust is horny, dry, and rough, and is often recognized by touch rather than sight. Occasionally, it itches or produces a pricking or tender sensation.

Actinic keratosis can be the first step in the development of skin cancer, and, therefore, is considered a precancerous skin condition. The presence of actinic keratoses indicates that sun damage has occurred and that any kind of skin cancer can develop.

How does an actinic keratosis develop?

An actinic keratosis develops slowly and most likely appears on the face, ears, bald scalp, neck, backs of hands and forearms, and lips. It tends to lie flat against the skin of the head and neck, but appear elevated on arms and hands. Often, a person will have more than one actinic keratosis lesion.

The lesions are usually not life threatening, provided they are detected and treated in the early stages. However, if this is not done, they can grow large and invade the surrounding tissues and, on rare occasions, metastasize, or spread, to the internal organs.
The most aggressive form of keratosis, actinic cheilitis, appears on the lips and can evolve into squamous cell carcinoma. When this happens, about 20 percent of these carcinomas metastasize to other parts of the body.

It is estimated that up to 10 percent of active lesions, which are more red in color and more tender than the rest, will take the next step and progress to squamous cell carcinomas.

What causes actinic keratosis?

Sun exposure causes almost all actinic keratoses. Sun damage to the skin accumulates over time, so that even a brief exposure adds to the lifetime total. Certain groups of people are more at risk than others, including the following:

People who have fair skin, blonde or red hair, and blue, green, or gray eyes are at the greatest risk, but darker-skinned people can develop keratoses if they expose themselves to the sun without protection.

African-Americans rarely have these lesions.

Individuals who are immunosuppressed as a result of cancer chemotherapy, acquired immune deficiency syndrome (AIDS), or organ transplantation are also at higher risk.

One in six people will develop an actinic keratosis in the course of a lifetime, according to some estimates. Older people are more likely than younger people to develop actinic keratoses, because cumulative sun exposure increases with age.

Treatment for actinic keratosis:

Specific treatment for actinic keratosis will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the disease
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the disease
• Your opinion or preference

When diagnosed early, treatment for actinic keratosis may include cryotherapy (freezing the lesion), topical chemotherapy (anticancer drugs), or other treatments.

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Insect stings that most commonly cause allergic reactions:

Insects that are members of the Hymenoptera family most commonly cause allergic reactions. These include:

• Bees
• Wasps
• Hornets
• Yellow Jackets
• Fire Ants

Allergic reactions to insect stings:

Usually, the reaction is short-lived, with redness and swelling followed by pain and itching. Generally, the reaction lasts only a few hours, although some may last longer. For other people, however, allergic reactions to these insect stings can be life threatening.

Immediate medical attention is required.

This severe reaction is a medical emergency that can involve organ systems throughout the body. The reaction is called anaphylaxis and can include severe symptoms such as:

• Itching and hives over most of the body
• Swelling of the throat and tongue
• Difficulty in breathing
• Dizziness
• Headache
• Stomach cramps, nausea, or diarrhea
• Rapid fall in blood pressure
• Shock
• Loss of consciousness

Can insect stings be prevented?

Avoidance of insects is the best preventive measure. Suggestions include:

• When outdoors, be careful of eating or drinking uncovered foods or beverages, which can attract insects.
• Avoid going barefoot, and wear closed-toe shoes when walking in grassy areas.
• When gardening, watch for nests in trees, shrubs, and flower beds.
• Other areas in which to use caution: swimming pools, woodpiles, under eaves of houses, trash containers.

Treatment for insect stings:

Specific treatment for insect stings will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the reaction
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the reaction
• Your opinion or preference

Suggestions for immediate treatment for highly-allergic people, according to the American Academy of Allergy, Asthma and Immunology, include:

• When possible, immediately remove stinger, and scrape over the area with a fingernail. However, do not squeeze the area, which may force the venom into the body.
• An emergency treatment kit should be kept nearby at all times. Talk with your physician about what it should include.
• Seek emergency care as soon as possible.

What is poison ivy/poison oak?

There are three native American plants that collectively may be called poison ivy: poison ivy, poison oak, and poison sumac. These plants cause an allergic reaction in nearly 85 percent of the population. To be allergic to poison ivy, you must come in contact with the plant once for "sensitization" to the oils to occur. This means that next time contact with the plant occurs, a reaction may occur.

What causes the allergic reaction?

The resin in the plants contains an oily substance called urushiol. Urushiol is easily transferred from the plants to other objects, including tools and animals. This chemical can remain active for a year or longer. It is important to know that the oils can be transferred from clothing, pets, or smoke from a burning plant.

What is the allergic reaction to poison ivy/poison oak?

The reaction is usually contact dermatitis, which may occur several hours, days, or even weeks after exposure. The dermatitis is characterized by a rash followed by bumps and blisters that itch. Sometimes, swelling occurs in the area of contact. Eventually, the blisters break, ooze, and then crust over.

Treatment for poison ivy/poison oak:

There in no cure for poison ivy once the rash starts. Avoiding the poison plants is the best treatment. It is very important to teach your children what the plants look like and not to touch them.

If contact with the plants has already occurred, you should remove the oils from the skin as soon as possible. Cleansing with an ordinary soap within 6 hours after the initial exposure has proven to be effective. Repeat the cleaning with the soap three times. There are also alcohol-based wipes that help remove the oils. Wash all clothes and shoes also because the oils can remain on these.

For the itching, your physician may recommend over-the-counter creams, such as calamine lotion or bathing in Aveeno bath. Sometimes, your physician will prescribe a medication by mouth for the itching.

If the blisters and rash are on the face, near the genitals, or all over the body, your physician should be notified. After a thorough history and physical, your physician may prescribe a steroid cream or injection to help with the swelling and itching.

Is poison ivy/poison oak contagious?

No. It can not be spread from person to person by touching the blisters or from the fluid inside the blisters. It can be spread, however, if the oils remain on the skin, clothes, or shoes. This is why washing your hands, clothes, and shoes as soon as possible is very important.

Preventing poison ivy/poison oak:

• Teach all family members what the plants look like.
• Wear long pants and long sleeves when outside in woods or yard.
• Wash clothes and shoes immediately after being outside.
• Do not touch a pet that might have been in a poison plant.
• Wash hands thoroughly.

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Facts about the skin:

The skin is the body's largest organ, covering the entire body. In addition to serving as a protective shield against heat, light, injury, and infection, the skin also:

• Regulates body temperature;
• Stores water and fat;
• Is a sensory organ;
• Prevents water loss;
• Prevents entry of bacteria.

Throughout the body, the skin's characteristics vary (i.e., thickness, color, texture). For instance, the head contains more hair follicles than anywhere else, while the soles of the feet contain none. In addition, the soles of the feet and the palms of the hands are much thicker.

The skin is made up of the following layers, with each layer performing specific functions:

• Epidermis
• Dermis
• Subcutaneous fat layer

Epidermis	The epidermis is the thin outer layer of the skin which consists of the following three parts: Stratum corneum (horny layer) This layer consists of fully mature keratinocytes which contain fibrous proteins (keratins). The outermost layer is continuously shed. The stratum corneum prevents the entry of most foreign substances as well as the loss of fluid from the body. Keratinocytes (squamous cells) This layer, just beneath the stratum corneum, contains living keratinocytes (squamous cells), which mature and form the stratum corneum. Basal layer The basal layer is the deepest layer of the epidermis, containing basal cells. Basal cells continually divide, forming new keratinocytes, replacing the old ones that are shed from the skin's surface. The epidermis also contains melanocytes, which are cells that produce melanin (skin pigment).
Dermis	The dermis is the middle layer of the skin. The dermis contains the following: Blood vessels Lymph vessels Hair follicles Sweat glands Collagen bundles Fibroblasts Nerves The dermis is held together by a protein called collagen, made by fibroblasts. This layer also contains pain and touch receptors.
Subcutis	The subcutis is the deepest layer of skin. The subcutis, consisting of a network of collagen and fat cells, helps conserve the body's heat and protects the body from injury by acting as a "shock absorber."

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What is atopic dermatitis?

Atopic dermatitis, also called eczema, is a hereditary and chronic skin disorder that mostly affects infants or very young children, and may last until the child reaches adolescence or adulthood. Eczema causes the skin to itch, turn red, and flake.

Parents with eczema are more likely to have children with eczema. Different triggers can make eczema worse, including environmental irritants, allergies, and stress.

The condition tends to flare up during times of stress, when the temperature is extremely high or low, when the patient has a bacterial infection, or when the skin is irritated by fabrics (wool) or detergents. Of children who have eczema, 65 percent will show signs of eczema in the first year of life and 90 percent will show signs of eczema within the first 5 years.

What are the symptoms of eczema?

The distribution of eczema may change with age. In infants and young children, eczema is usually located on the face, outside of the elbows, and on the knees. In older children and adults, eczema tends to be on the hands and feet, the arms, and on the back of the knees. The following are the most common symptoms of eczema. However, each person may experience symptoms differently. Symptoms may include:

• Dry, scaly skin
• Small bumps that open and weep when scratched
• Redness and swelling of the skin
• A thickening of the skin (with chronic eczema)

Excessive rubbing and scratching can tear the skin and result in an infection. The symptoms of eczema may resemble other skin conditions. Always consult your physician for a diagnosis.

How is eczema diagnosed?

Atopic dermatitis is very common. Over 15 million American adults and children have atopic dermatitis. The National Institute of Arthritis and Musculoskeletal and Skin Diseases estimates that at least 20 percent of infants and children experience symptoms of atopic dermatitis. In addition to a complete medical history and physical examination, diagnostic procedures for eczema may include the following:

• Family history (Children born to a mother who has allergic conditions are more prone to eczema.)
• Personal history of allergies or asthma
• Blood tests

Treatment for eczema:

Specific treatment for eczema will be determined by your physician based on:

• Your (your child's) age, overall health, and medical history
• Extent of the reaction
• Your (your child's) tolerance for specific medications, procedures, or therapies
• Expectations for the course of the reaction
• Your opinion or preference

There is no cure for eczema. The goals of treatment are to reduce itching and inflammation of the skin, moisturize the skin, and prevent infection.

Management of eczema symptoms:

The following are suggestions for the management of eczema:

• Avoid contact with irritants, as determined by your physician.
• Take brief baths or showers using lukewarm water.
• Practice good skin care techniques.
• Do not use harsh soaps. Ask your physician to recommend a brand.
• Dress in light clothes - sweating can make eczema worse.
• Use lubricating lotions at least once a day. Ask your physician to recommend a brand.
• Avoid scratching the affected area.
• Minimize stress.

Your physician may also prescribe medications in severe cases. The following medications are most commonly used to treat eczema:

• Antihistamines
  These medications help to decrease the amount of itching. Some examples include diphenhydramine (Benadryl ®) or hydroxyzine (Atarax ®). These medications may cause drowsiness. Some new antihistamines are also available that do not cause drowsiness. Consult your physician for more information.
• Steroid creams
  These topical medications help to decrease the inflammation in the skin, thus decreasing the itching and swelling. Many topical steroids in various strengths are available. Steroids, if overused, are potentially damaging to the skin. Consult your physician for more information.
• Oral antibiotics
  These medications are derived from mold or bacteria and slow the growth of specific microorganisms. A sample from the body part thought to be infected may be taken and cultured in a lab to determine what type of antibiotic to use for the most effective treatment.
• Oral cyclosporine
  This medication is used primarily to prevent rejection after organ transplantation. It suppresses the immune system and has other side effects that should be considered. Consult your child's physician as needed.
• Phototherapy (light therapy)
  It is safest to have this treatment under medical supervision, but light therapy is not offered at all dermatology clinics. Home light therapy devices are available, but may not be covered by insurance. Narrow band UVB (ultraviolet B) light units are the most effective. Be sure to follow the manufacturer's instructions carefully to avoid injury.
• Topical immunomodulator (TIMs)
  Topical immunomodulators are a new class of drugs for the treatment of eczema. These drugs are applied directly to the skin to alter the immune response.

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The skin is the body's first barrier against bacteria that cause infections. Even though many bacteria live on the surface of our skin, healthy skin can usually protect us from infection. However, bacterial skin infections can affect a small spot or may spread, affecting a large area. They can range from a treatable infection to a life-threatening skin condition.

Any one who has a break in the skin is at risk for infection. However, certain conditions or diseases can put a person at greater risk for infection, including the following:

• diabetes (which causes poor blood flow to the skin)
• acquired immune deficiency syndrome, or AIDS (because of a depressed immune system that is unable to fight the infection
• skin damaged by sunburn or scratching

There are many types of bacterial skin infections that require clinical care by a physician or other healthcare professional. Listed in the directory below are some, for which we have provided a brief overview.

• Cellulitis
• Folliculitis, Boils, and Carbuncles
• Staphylococcal Scalded Skin Syndrome
• Other Bacterial Skin Infection
  

What is baldness?

Baldness, also known as alopecia, is hair loss, or absence of hair. Baldness is usually most noticeable on the scalp, but can occur anywhere on the body where hair grows. The condition is more common in men than in women.

What causes hair loss?

Hair loss is believed to be primarily caused by a combination of the following:

• Aging
• Change in hormones
• Illness
• Family history of baldness
• Burns
• Trauma
• However, hair loss is not caused by the following:
• Poor circulation to the scalp
• Vitamin deficiencies
• Dandruff
• Excessive hat-wearing
• A gene passed on from an individual's maternal grandfather
• Generally, the earlier hair loss begins, the more severe the baldness will become.

What are the different types of baldness?

Baldness can be classified into various types, depending on the cause. Several of the many different types of baldness include the following:

• Female-pattern baldness
  Although less common, female-pattern baldness differs from that of male-pattern baldness in that the hair generally thins all over the head, but the frontal hairline is maintained. Female-pattern baldness rarely results in total hair loss.
• Male-pattern baldness
  Male-pattern baldness usually is a hereditary condition. The condition may begin at any age. Hair loss often begins on the front, sides, and/or on the crown of the head. Some men may develop a bald spot or just a receding hair line, while others may lose all of their hair.
• Alopecia areata
  This hair loss disorder is characterized by sudden loss of hair in one particular area, which grows back after several months. However, if all body hair is suddenly lost, regrowth may not occur. The cause of this type of hair loss is unknown.
• Toxic alopecia
  Toxic alopecia may occur following a high fever or severe illness. Certain medications, especially thallium, high doses of vitamin A, and retinoids, may cause toxic alopecia. Medical conditions, such as thyroid disease, and after giving birth may also trigger toxic alopecia. The condition is characterized by temporary hair loss. Also, some cancer medications can cause hair loss.
• Scarring alopecia
  Scarred areas may prevent the hair from growing back. Scarring may occur from burns, injury, or x-ray therapy. However, other types of scarring that may cause hair loss can be caused by diseases such as lupus, bacterial or fungal skin infections, lichen planus, sarcoidosis, tuberculosis, or skin cancer.
• Trichotillomania (hair pulling)
• Hair pulling, a habit most common among children, may cause hair loss.

How is the type of baldness diagnosed?

In addition to a medical history and physical examination, a biopsy of the skin area may help to identify the type of baldness and/or its cause.

Treatment for baldness:

Specific treatment for baldness will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the condition
• Your tolerance for specific medications, procedures, and therapies
• Expectation for the course of the disease
• Your opinion or preference
• Most forms of baldness have no cure. Some types of baldness will disappear on their own. Treatment may include:
• Certain medications to promote hair growth (such as minoxidil and finasteride)
• Corticosteroid injections (when treating alopecia areata)
• Treating any underlying condition or disease
• Hair transplants
• Scalp reduction
• Skin lifts and grafts

What is hair replacement surgery?

The interest in hair replacement has significantly increased over the past 10 years. Two out of every three men, and one in five women, suffer from hair loss. For men, the main cause of a diminishing hairline is heredity. Hormonal changes such as menopause can cause both thinning and hair loss in women.

There are a number of hair replacement techniques that are available, although hair replacement surgery cannot help those who suffer from total baldness. Candidates for hair replacement must have a healthy growth of hair at the back and sides of the head. The hair on the back and sides of the head will serve as hair donor areas where grafts and flaps will be taken.

There are four primary different types of hair replacement methods, including the following:

• Hair transplantation
  During hair transplantation, the surgeon removes small pieces of hair-bearing scalp grafts from the back or sides of the head. These grafts are then relocated to a bald or thinning area.T
• Tissue expansion
  In this procedure, a device called a tissue expander is placed underneath a hair-bearing area that is located next to a bald area. After several weeks, the tissue expander causes the skin to grow new skin cells. Another operation is then required to place the newly expanded skin over the adjacent bald spot.
• Flap surgery
  Flap surgery is ideal for covering large balding areas. During this procedure a portion of the bald area is removed and a flap of the hair-bearing skin is placed on to the bald area while still attached at one end to its original blood supply.
• Scalp reduction
  Scalp reduction is done in order to cover the bald areas at the top and back of the head. This technique involves the removal of the bald scalp with sections of the hair-bearing scalp pulled together filling in the bald area.

Possible complications associated with hair transplantation procedures:

Possible complications associated with hair transplantation procedures may include, but are not limited to, the following:

• Patchy hair growth
  Sometimes, the growth of newly placed hair has a patchy look, especially if it is placed next to a thinning area. This can often be corrected by additional surgery.
• Bleeding and/or wide scars
  Tension on the scalp from some of the scalp reduction techniques can result in wide scars and/or bleeding.
• Grafts not taking
  Occasionally, there is a chance that the graft may not "take." If this is the case, surgery must be repeated.
• Infection
  As with any surgical procedure, there is the risk of infection.

What is basal cell carcinoma?

Basal cell cancer, sometimes called non-melanoma skin cancer, usually appears as a small, fleshy bump or nodule on the head, neck, or hands. Occasionally, these nodules appear on the trunk of the body, usually as flat growths. Basal cell carcinoma accounts for more than 90 percent of all skin cancers in the United States. It is often easily detected and has an excellent record for successful treatment.

According to the American Academy of Dermatology, the cure rate for basal cell carcinoma is 95 percent, when properly treated. Although this type of cancer rarely spreads to other parts of the body, it can extend below the skin to the bone and cause considerable local damage. And, non-melanoma skin cancer places people at high risk for developing additional skin cancers.

Who is at risk for basal cell carcinoma?

Basal cell carcinoma is the most common skin cancer found in Caucasians. It seldom occurs in dark-skinned persons. People who have this cancer frequently have light hair, eyes, and complexions, and they do not tan easily. Risk for basal cell carcinoma includes:

• excess exposure to UV radiation (sunlight or tanning beds)
• chemical exposure
• radiation exposure
• long-term skin inflammation or injury
• treatment of psoriasis
• immunosuppression such as in persons who have had organ transplants
• history of skin cancer

How does basal cell carcinoma develop?

This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. A basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin, and mainly on the areas exposed to the sun, such as the head, neck, arms, hands, and face.

The risk for ovarian cancer and skin cancer is increased with basal cell nevus syndrome (also called Gorlin syndrome and nevoid basal cell carcinoma), a rare autosomal dominant cancer genetic syndrome. Features associated with basal cell nevus syndrome may include the following:

• development of more than two basal cell carcinomas (cancer of the outer layer of the skin) before the age of 30
• cysts in the jaw
• characteristic facial appearance (60 percent of people)
• calcification of the falx (a variation in the appearance of the skull that is visible on x-rays)
• pits in the palms and soles of the feet
• eye abnormalities
• rib or vertebral abnormalities
• increased risk of medulloblastoma
• increased risk of cardiac and ovarian fibromas (benign, or noncancerous, tumors)

Basal cell nevus syndrome is caused by a tumor suppressor gene, called PTCH, located on chromosome 9. Mutations in this gene may increase the risk of ovarian cancer.

Tumor suppressor genes usually control cell growth and cell death. Both copies of a tumor suppressor gene must be altered, or mutated, before a person will develop cancer. With basal cell nevus syndrome, the first mutation is inherited from either the mother or the father in 60 percent to 80 percent of cases. In 20 percent to 40 percent of cases, the first mutation is not inherited and arises de novo (for the first time) in the fertilized egg from which the person with symptoms was conceived. Whether de novo or inherited, this first mutation is present in all of the cells of the body and, as such, is called a germline mutation.

Whether a person who has a germline mutation will develop cancer and where the cancer(s) will develop depends upon where (which cell type) the second mutation occurs. For example, if the second mutation is in the skin, then skin cancer may develop. If it is in the ovary, then ovarian cancer may develop. The process of tumor development actually requires mutations in multiple growth control genes. Loss of both copies of PTCH is just the first step in the process. What causes of these additional mutations to be acquired is unknown. Possible causes include chemical, physical, or biological environmental exposures (such as sunlight) or chance errors in cell replication.

Some individuals who have inherited a germline tumor suppressor gene mutation may never develop cancer because they never get the second mutation necessary to knock out the function of the gene and start the process of tumor formation. This can make the cancer appear to skip generations in a family, when, in reality the mutation is present. Persons with a mutation, regardless of whether they develop cancer, however, have a 50/50 chance to pass the mutation on to the next generation.

It is also important to remember that the gene responsible for basal cell nevus syndrome is not located on the sex chromosomes. Therefore, mutations can be inherited from the mother or the father's side of the family.

What are bed sores?

Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time.

Why does a bed sore develop?

A bed sore develops when blood supply to the skin is cut off for more than two to three hours. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns purple. Left untreated, the skin can break open and become infected. A bed sore can become deep, extending into the muscle. Once a bed sore develops, it is often very slow to heal. Bed sores often occur in the buttocks area (on the sacrum or iliac crest), or on the heels of the feet.

Preventing bed sores:

Bed sores can be prevented by inspecting the skin for areas of redness (the first sign of skin breakdown). Other methods of preventing bed sores and preventing progression of existing bed sores include the following:

• frequent turning and repositioning
• providing soft padding in wheelchairs and beds to reduce pressure
• providing good skin care by keeping the skin clean and dry 

Treatment for bed sores:

Specific treatment of a bed sore is determined by your physician and based on the severity of the condition. Treatment may be more difficult once the skin is broken, and may include the following:

• removing pressure on the affected area
• protecting the wound with medicated gauze or other special dressings
• keeping the wound clean
• transplanting healthy skin to the wound area
• medication (i.e., antibiotics to treat infections)

What are birthmarks?

Birthmarks are areas of discolored and/or raised skin that are apparent at birth or within a few weeks of birth. Birthmarks are made up of malformed pigment cells or blood vessels. About 10 in every 100 babies have vascular birthmarks (birthmarks made up of blood vessels).

Although the cause of birthmarks is not known, most of them are benign (non-cancerous) and do not require treatment. Babies with birthmarks should be examined and diagnosed by a physician.

What are the most common types of vascular birthmarks?

The following are the most common types of vascular birthmarks:

• flat not elevated stains ("angel's kisses" or "stork bites")-the most common type of vascular birthmark, characterized by pink to red marks that may appear anywhere on the body;
• "angel's kisses"-marks located on the forehead and eyelids, which usually disappear after age 2 years;
• "stork bites"-marks on the back of the neck, which may last into adulthood;
• hemangioma-a common vascular birthmark. Hemangiomas become visible within the first few weeks of life and continue to grow rapidly for about six to nine months. Then, they gradually lose this red color and also shrink. They are called strawberry hemangiomas;
• port-wine stains-a port-wine stain, also called a nevus flammeus, is a flat, pink, red, or purple mark that appears at birth, often on the face, arms, and legs, and continues to grow as the child grows. Port-wine stains do not go away and often require treatment if located on the eyelid or forehead. Port-wine stains involving the face may cause eye problems.

>What causes a blister?

Blisters are caused by injury, allergic reactions, or infections, which may include the following:

• burns/scalds
• sunburns
• friction (from a shoe, for example)
• eczema (also known as atopic dermatitis)
• impetigo - a contagious infection of the skin
• pemphigus - a rare, blistering skin disease often occurring in middle-aged and elderly adults
• pemphigoid - a blistering autoimmune disorder
• dermatitis herpetiformis - a blistering autoimmune disorder
• viral infections (including chickenpox and herpes zoster)

The symptoms of a blister may resemble other skin conditions. Always consult your physician for a diagnosis.

First-aid for blisters

Blisters often heal spontaneously. Treatment will vary, depending on the cause. Some general guidelines for first-aid may include:

• Wash the area with soap and water.
• A cold or ice pack may help reduce swelling and discomfort.
• Keep the area clean and dry - do not burst or puncture the blister.
• If the blister bursts, place an adhesive bandage or dressing on the area to keep it clean.

Observe the area for signs of infection such as increased warmth, swelling, redness, drainage, pus formation, or pain. If you notice any signs of infection, call your physician. Antibiotics may be needed.

Treatment for blisters

A blister will usually heal on its own. Treatment may include:

• keeping the area clean
• antibiotics (to treat infections)
• dressings on burst blisters

What are burns?

Burns are a type of traumatic injury caused by thermal, electrical, chemical, or electromagnetic energy. An open flame is the leading cause of burn injury for adults, while scalding is the leading cause of burn injury for children. Both infants and the elderly are at the greatest risk for burn injury.

What are the different types of burns?

A burn injury usually results from an energy transfer to the body. There are many types of burns caused by thermal, radiation, chemical, or electrical contact:

• thermal burns-burns due to external heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring. Hot metals, scalding liquids, steam, and flames, when coming in contact with the skin, can cause thermal burns.
• radiation burns-burns due to prolonged exposure to ultraviolet rays of the sun, or to other sources of radiation such as x-ray.
• chemical burns-burns due to strong acids, alkalies, detergents, or solvents coming into contact with the skin and/or eyes.
• electrical burns-burns from electrical current, either alternating current (AC) or direct current (DC).

How are burns classified?

Burns are classified as first-, second-, or third-degree, depending on how deep and severe they penetrate the skin's surface:

• First-degree (superficial) burns
  First-degree burns affect only the epidermis, or outer layer of skin. The burn site is red, painful, dry, and with no blisters. Mild sunburn is an example. Long-term tissue damage is rare and usually consists of an increase or decrease in the skin color.
• Second-degree (partial thickness) burns
  Second-degree burns involve the epidermis and part of the dermis layer of skin. The burn site appears red, blistered, and may be swollen and painful.
• Third-degree (full thickness) burns
  Third-degree burns destroy the epidermis and dermis. Third-degree burns may also damage the underlying bones, muscles, and tendons. The burn site appears white or charred. There is no sensation in the area since the nerve endings are destroyed.

The effects of burns:

A severe burn can be a seriously devastating injury - not only physically but emotionally - and not only to the burn victim, but to the entire family. Persons with severe burns may be left with a loss of certain physical capabilities, disfigurement, a loss of mobility, scarring, infection, nightmares or flashbacks from the traumatizing event, loss of a limb, and/or loss of a friend or family member and possessions in the fire. In addition, severe burns are capable of penetrating deep skin layers, causing muscle or tissue damage, virtually affecting every system of the body.

Treatment for burns

Specific treatment for burns will be determined by your physician based on:

• your age, overall health, and medical history
• type, classification, location, and severity of the burn
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the burn injury
• your opinion or preference

Treatment may include:

• wound care
• intravenous (IV) fluids and electrolytes
• pain management
• physical therapy
• occupational therapy
• skin grafting
• functional and cosmetic reconstruction

What are calluses and corns?

Calluses are protective pads made up of the thickened upper layer of skin due to repeated rubbing of the area. Corns are small calluses that develop on the top of the toes due to pressure or rubbing against shoes or other toes.

Treatment for calluses and corns:

Calluses are usually painless, but corns can be quite painful. Sometimes, corns are confused with warts. Calluses can be avoided by removing the source of the rubbing and thinning the callus with a pumice stone. Treatment for corns may include:

• applying pads around the corn area
• wearing larger, more comfortable shoes
• surgery

What is candidiasis?

Candidiasis, sometimes called moniliasis or a yeast infection, is an infection caused by yeast on the skin and/or mucous membranes. Although yeast is normally a harmless inhabitant of the digestive system and vaginal area, it may cause an infection when the skin is damaged, when conditions are warm and humid, and/or when a person has a depressed immune system. Antibiotics can also cause yeast to grow, because the normal bacteria in tissues are killed, letting the yeast grow unhampered.

What are the symptoms of candidiasis?

The symptoms of candidiasis vary depending on the location of the infection. The following are the most common symptoms of a yeast infection. However, each individual may experience symptoms differently. Symptoms may include:

Location	Symptoms
Skin folds or navel	Rash Patches that ooze clear fluid Pimples Itching or burning
Vagina	White or yellow discharge from the vagina Itching Redness in the external area of the vagina Burning
Penis	Redness on the underside of the penis Scaling on the underside of the penis Painful rash on the underside of the penis
Mouth (thrush)	White patches on tongue and inside of the cheeks Pain
Corners of the mouth (perleche)	Cracks and/or tiny cuts at the corners of the mouth
Nail beds	Swelling Pain Pus White or yellow nail that separates from the nail bed

The symptoms of candidiasis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is candidiasis diagnosed?

In addition to a medical history and physical examination, your physician may scrape off a skin sample to confirm the diagnosis with a microscope or a culture.

Treatment for candidiasis:

Specific treatment for candidiasis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Candidiasis is highly treatable with medicated ointments. Yeast infections in the vagina or anus can be treated with medicated suppositories. Thrush may be treated with a medicated mouthwash or lozenges that dissolve in the mouth. Severe infection or infections in an immunocompromised person may be treated with oral anti-yeast medications.

What is cellulitis?

Cellulitis is a deep bacterial infection of the skin. The infection usually involves the face, or the arms and legs. It may happen in normal skin, but it usually occurs after some type of trauma causes an opening in your child's skin. This opening can lead to an infection.

What is the cause of cellulitis?

Cellulitis is usually caused by a bacterial infection of a wound or area of skin that is no longer intact. The most common bacterial causes of cellulitis include the following:

• group A ß - hemolytic streptococcus
• Streptococcus pneumoniae
• Staphylococcus aureus

Other causes may include human or animal bites, or injuries that occur in water.

What are the symptoms of cellulitis?

The following are the most common symptoms of cellulitis. However, each child may experience symptoms differently. Symptoms may include:

swelling of the skin tenderness warm skin pain bruising

blisters fever headache chills feeling weak red streaks from the original site of the cellulitis

Some cases of cellulitis are considered an emergency. Consult your child's physician immediately if you notice any of the following symptoms in your child:

• a very large area of red, inflamed skin
• fever
• if the area affected is causing your child to complain of numbness, tingling, or other changes in a hand, arm, leg, or foot
• if the skin appears black
• if the area that is red and swollen is around your child's eye(s) or behind his/her ear(s)
• if your child has diabetes or has a weakened immune system and develops cellulitis

The symptoms of cellulitis may resemble other skin conditions. Always consult your child's physician for a diagnosis.

How is cellulitis diagnosed?

Diagnosis is usually based on a medical history and physical examination of your child. Blood and skin samples may be taken to confirm the diagnosis and the type of bacteria that is present.

Treatment for cellulitis:

Specific treatment for cellulitis will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference
• Immediate treatment can help prevent the spread of cellulitis. Treatment may include:
• oral or intravenous (IV) antibiotics
• warm, wet dressings on the infection site
• surgical intervention
• if your child has an extremity (arm or leg) that is affected, his/her physician may have you elevate the extremity and decrease the amount of activity
• rest

Based on the physical examination, your child's physician may treat your child in the hospital depending on the severity of the cellulitis. In the hospital, your child may receive antibiotics and fluids through an intravenous (IV) catheter.

Are there any complications from cellulitis?

Complications can be reduced with prompt and accurate treatment by your child's physician. The most common complications include the following:

• meningitis-an inflammation of the membrane of the brain and the spinal cord.
• septic (infectious) arthritis-an infection of a joint caused by bacteria.
• glomerulonephritis-an inflammation of the kidneys.

What is a chemical peel?

Chemical peeling uses a chemical solution to improve the skin's appearance. It can reduce or eliminate fine lines under the eyes and around the mouth, correct uneven skin pigmentation, remove precancerous skin growths, and soften acne or treat scars caused by acne. The procedure can also treat wrinkles caused by sun damage and scarring, as well as skin blemishes common with age and heredity. Chemical peels can be performed on the face, neck, chest, hands, arms, and legs.

Possible complications associated with chemical peels

Possible complications associated with chemical peels may include but are not limited to the following:

• Change in skin tone color
  For certain skin types, there is a risk of developing a temporary or permanent skin color change. Taking birth control pills, being pregnant, or having a family history of brownish discoloration on the face may increase the possibility of developing the abnormal pigmentation.
• Scarring
  Chemical peels can cause scarring. However, if scarring occurs, it can usually be treated effectively.
• Cold sores and fever blisters
  Those who are susceptible to cold sores, or herpes simplex infections, may have a reactivation of cold sores or fever blisters following a chemical peel.

A chemical peel is most commonly performed for cosmetic reasons to enhance appearance and self-confidence and may be performed in conjunction with a facelift. However, a chemical peel is not a substitute for a facelift and does not prevent or slow the aging process.

What substances are used for chemical peels?

Phenol, trichloroacetic acid (TCA), and alphahydroxy acids (AHAs) are used for chemical peels. The precise formula used may be adjusted for each patient.

Alphahydroxy acids (AHAs)

Alphahydroxy acids (AHAs) such as glycolic, lactic, or fruit acids are the mildest of the peel formulas and produce light peels that can often provide smoother, brighter-looking skin. AHA peels may be used to accomplish the following:

• reduce fine wrinkling
• treat areas of dryness
• reduce uneven pigmentation
• aid in control of acne
• smooth rough, dry skin
• improve texture of sun-damaged skin

AHA peels may cause the following:

• stinging
• redness
• irritation
• crusting, flaking, or scaling
• dryness

Generally, no anesthesia is needed for AHA peels since they cause only a slight stinging sensation during application.
Protecting skin from the sun is important following AHA peels.

Trichloracetic acid (TCA)

Trichloroacetic acid (TCA) can be used in many concentrations and is used to accomplish the following:

• smooth fine surface wrinkles
• remove superficial blemishes
• correct pigment problems

TCA can be used on the neck or other body areas, and may require pretreatment with Retin-A or AHA creams. This procedure is preferable for darker-skinned patients.

Anesthesia is not usually required for TCA peels because the chemical solution acts as an anesthetic. Although, sedation may be used before and during the procedure to help the patient relax. Two or more TCA peels may be needed over several months to obtain the desired result, although mild TCA peels may be repeated more frequently.

The results of a TCA peel are usually less dramatic than and not as long-lasting as those of a phenol peel. More than one TCA peel may be needed to achieve the desired result.
TCA-peel patients are advised to avoid sun exposure for several months. The procedure also may produce some unintended color changes in the skin.

Phenol

Phenol is the strongest of the chemical solutions and produces a deep peel. A phenol peel is mainly used to accomplish the following:

• correct blotches caused by sun exposure, birth control pills, or aging
• smooth out coarse wrinkles
• remove precancerous growths

Phenol:

• should be used on the face only, as scarring may result if used on the neck or other body areas.
• is not recommended for darker-skinned individuals.
• may pose risk for patients with heart problems.
• may permanently remove facial freckles.
• may cause permanent skin lightening.
• may leave lines of demarcation.

Recovery may be slow and complete healing may take several months.
After a phenol peel, new skin may lose its ability to produce pigment. The skin will be lighter and will always have to be protected from the sun.

About the procedure:

The procedure involves a chemical solution that is applied to the skin. The solution causes a layer of skin to separate and peel off. The new, regenerated skin underneath is usually smoother, less wrinkled, and more even in color than the old skin.

Considerations Before Having a Chemical Peel

It is very important to find a physician who has adequate training and experience in skin resurfacing.

In some states, a medical degree is not required to perform a chemical peel - even the strongest phenol peels - and many states have laws that permit non-physicians to administer certain peel solutions but regulate the strengths which they are permitted to apply.

What are cold sores?

Cold sores are small blisters around the mouth, caused by the herpes simplex virus. The most common strain of the virus is herpes simplex virus 1.

Herpes simplex is not curable, but may lie dormant for long periods of time. Episodes of the cold sores last no longer than two weeks. Hot sun, cold wind, a cold, or a depressed immune system can cause an outbreak of herpes simplex virus.

What are the symptoms of cold sores?

Some people never experience any symptoms with the first attack; others have severe flu-like symptoms and ulcers in and around the mouth. The following are the most common symptoms of cold sores. However, each individual may experience symptoms differently. Symptoms may include:

• tingling of the lips
• small blisters on the lips and mouth that enlarge, burst, then crust over
• itching and irritation of the lips and mouth
• soreness of the lips and mouth

The symptoms of cold sores may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for cold sores

Cold sores cannot be cured, but, if symptoms are severe, treatment may help alleviate some symptoms. Treatment may include:

• antiviral topical ointments (such as acyclovir and penciclovir)
• antiviral oral medications (such as acyclovir, famciclovir, and valaciclovir)

The skin, the largest organ of the body, helps define a person's look. Any unsightly skin appearance, such as scarring, can affect both mental and physical well-being. In addition, because the skin is on the outside of the body, it is more susceptible to growths, discolorations, and disease.

There are many different dermatological procedures designed to improve the condition or appearance of the skin. Listed in this directory  are some, for which we have provided a brief overview.  

• Acne Scar Removal
• Treating Aged or Sun-Damaged Skin
• Chemical Peels
• Dermabrasion/Dermaplaning
• Laser Surgery Overview
• Laser Surgery for Skin Conditions

What is contact dermatitis?

Contact dermatitis is a physiological reaction that occurs after skin comes in contact with certain substances.

The majority of these reactions are caused by irritants to the skin. The remaining reactions are caused by allergens, which trigger an allergic response. In allergic reactions, the reaction may not start until after several days. Contact dermatitis caused by an irritant that is not an allergic response occurs from direct contact with the irritant.
Adults are affected by allergic contact dermatitis more than young children or the elderly.

What causes allergic contact dermatitis?

The most common causes of allergic contact dermatitis in adults and children include the following:

soaps drool different foods

detergents harsh baby lotions perfumes

Plants, as well as metals, cosmetics, and medications may also cause a contact dermatitis reaction:

Poison Ivy

Poison ivy, which is part of a plant family that includes poison oak and sumac, is the most common cause of a contact dermatitis reaction.

Metals

Nearly 3,000 chemical agents are capable of causing allergic contact dermatitis. Nickel, chrome, and mercury are the most common metals that cause contact dermatitis:

• Nickel is found in costume jewelry, belt buckles, and wristwatches, as well as zippers, snaps, and hooks on clothing.
• Contact with objects that are chrome-plated, which contain nickel, will probably cause skin reactions in people sensitive to nickel.

• Mercury, which is found in contact lens solutions, can cause problems for some sensitive individuals.

Cosmetics

Many types of cosmetics can cause allergic contact dermatitis. Permanent hair dyes that contain paraphenylenediamine are the most frequent causes. Other products that may cause problems include dyes used in clothing, perfumes, eye shadow, nail polish, lipstick, and some sunscreens.

Medications

Neomycin, which is found in antibiotic creams, is the most common cause of medication contact dermatitis. Penicillin, sulfa medications, and local anesthetics, such as novocaine or paraben, are other possible causes.

What are the symptoms of contact dermatitis?

The following are the most common symptoms of contact dermatitis. However, each individual may experience symptoms differently. Symptoms may include:

• mild redness and swelling of the skin
• blistering of the skin
• itching
• scaling and temporary thickening of skin

The most severe reaction is at the contact site. The symptoms of contact dermatitis may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for contact dermatitis:

Specific treatment for contact dermatitis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the reaction
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

The best treatment is to identify and avoid the substances that may have caused the allergic reaction. The following is recommended by the American Academy of Allergy, Asthma, and Immunology, for mild to moderate reactions:

• Thoroughly wash skin with soap and water as soon after the exposure as possible.
• Wash clothing and all objects that touched plant resins (poison ivy/oak) to prevent re-exposure.
• Use wet, cold compresses to soothe and relieve inflammation if blisters are broken.
• For severe reactions, always contact your physician.

What is creeping eruption?

Creeping eruption is a skin infection caused by hookworms, which normally are found on dogs and cats. The parasite spreads to humans through skin contact with the eggs found in dog and cat feces on the ground. Characterized by severe itching, the infection usually appears on the feet, legs, buttocks, or back.

What are the symptoms of creeping eruption?

The following are the most common symptoms of creeping eruption. However, each individual may experience symptoms differently. Symptoms may include:

• winding rash - usually the hookworm burrows along a tract which creates a winding rash
• itching

The symptoms of creeping eruption may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for creeping eruptions:

Creeping eruption may be treated with liquid thiabendazole and other topical treatments.

What is cutaneous T-cell lymphoma?

Cutaneous T-cell lymphoma is a disease caused when T-lymphocytes become malignant and affect the skin. T-lymphocytes are the infection-fighting white blood cells in the lymph system that kill harmful bacteria in the body, among other things. Cutaneous T-cell lymphoma usually is a slow-growing cancer that often develops over many years.

What are the symptoms of cutaneous T-cell lymphoma?

Symptoms of cutaneous T-cell lymphoma depend on the stage of the cancer (how far it has spread). The following are the most common symptoms of cutaneous T-cell lymphoma. However, each individual may experience symptoms differently. Symptoms may include:

Stage	Symptoms
Stage I	dry, red, scaly patches on skin lymph nodes are normal
Stage II	dry, red, scaly patches on skin lymph nodes are normal or larger than normal, but not cancerous tumors on the skin (called mycosis fungoides)
Stage III	most of the skin is dry, red, and scaly lymph nodes are normal or larger than normal, but not cancerous
Stage IV	skin is dry, red, and scaly cancer cells are in the lymph nodes cancer has spread to other organs

The symptoms of cutaneous T-cell lymphoma may resemble other dermatological conditions. Always consult your physician for a diagnosis.

How is cutaneous T-cell lymphoma diagnosed?

In addition to a medical history and physical examination, a physician may order a biopsy of a skin tumor to confirm the diagnosis. A biopsy is a procedure in which tissue samples are removed (with a needle or during surgery) from the body for examination under a microscope; to determine if cancer or other abnormal cells are present.

Treatment for cutaneous T-cell lymphoma

Specific treatment for cutaneous T-cell lymphoma will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, and therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• chemotherapy-treatment with drugs to destroy cancer cells.
• radiation therapy-uses a radiation machine that emits x-rays to kill cancer cells and shrink tumors.
• photodynamic therapy-uses a certain type of light and a special chemical to kill cancer cells.

Clinical trials are currently being conducted using biological therapy, also called biological response modifier (BRM) therapy, or immunotherapy. Biological therapy tries to get your own body to fight cancer by using materials made by your own body, or made in a laboratory, to boost, direct, or restore your body's natural defenses against disease.

What is dermabrasion?

Similar to a chemical peel, dermabrasion is a procedure that removes fine wrinkles and/or minimizes scars on the skin. The difference between a chemical peel and dermabrasion, however, is the method used. Dermabrasion involves the surgeon utilizing a high speed rotating brush to remove the top layer of skin. The size and depth of the scars, as well as the degree of wrinkling, determine the appropriate level of skin that will be surgically sloughed.

Possible complications associated with dermabrasion

Possible complications associated with dermabrasion may include but are not limited to the following:

• Fever blisters
  Dermabrasion can cause fever blisters to reappear in those who are prone to frequent herpes simplex infections. Antiviral medications are often used to treat this symptom.
• Pigmentation changes
  Some individuals may develop a change in the pigmentation of their skin after undergoing the procedure. Treatment for this symptom may include the use of bleaching creams as prescribed by a physician. A decrease in pigmentation can be permanent.

• Thickened skin
  Thickening of the skin can develop. This symptom may be treated with cortisone creams or injections that help the skin return to its normal state.

What is dermaplaning?

Dermaplaning is used to treat deep acne scars with a handheld instrument called a dermatome. The dermatome resembles an electric razor and has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects.

Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone or in conjunction with other procedures. Neither treatment, however, will remove all scars and flaws or prevent aging.

Who can benefit from dermabrasion or dermaplaning?

Men and women of all ages can benefit from dermabrasion and dermaplaning. Important factors that help determine the potential effectiveness of treatment include the following:

• skin type
• skin coloring
• medical history

About the procedure

Although each procedure varies, generally, dermabrasion and dermaplaning surgeries follow this process.

Location options may include:

• surgeon's office-based surgical facility
• outpatient surgery center
• hospital outpatient
• hospital inpatient

Anesthetic options may include:

• local anesthesia, combined with a sedative (allows the patient to remain
  awake but relaxed)
• a numbing spray, such as freon, may be used along with or instead
  of local anesthesia
• general anesthesia

Average length of procedure:

• from a few minutes to an hour or more, depending on the size of the area of skin to be refinished. The procedure may be performed more than once, or in stages.

Some possible short-term side effects of surgery:

• The skin may be red and swollen.
• Eating and talking may be difficult for a few days following the procedure.
• Tingling, burning, or aching may occur.
• Swelling and scabbing may occur.

As the new skin begins to grow, it may appear and feel swollen. The skin may also be sensitive and bright pink in color, which may take about three months to fade. Protection from the sun is very important following this type of procedure.

Dermatitis is an inflammation of the skin. Dermatitis actually refers to a number of skin conditions that inflame the skin. Dermatitis is characterized by skin that may be red, swollen, blistered, scabbed, scaly, oozing, or itchy. Some types of dermatitis are caused by allergies, while the majority do not have any known causes. There are many types of dermatitis that require clinical care by a physician or other healthcare professional. Listed in this directory are some for which we have provided a brief overview.

• Atopic Dermatitis (Eczema)
• Contact Dermatitis
• Dermatitis Herpetiformis
• Generalized Exfoliative Dermatitis
• Seborrheic Dermatitis
• Other Dermatitis Conditions

What is dermatitis herpetiformis?

Dermatitis herpetiformis is an intensely pruritic (itchy) skin disease characterized by eruptions of clusters of small blisters or vesicles (small elevations of the skin containing fluid) and small bumps or papules (small, solid, elevations on the skin). Dermatitis herpetiformis usually occurs in young adults. It affects twice as many men as it does women.

What triggers dermatitis herpetiformis?

Dermatitis herpetiformis is related to the presence of IgA deposits under the skin. These deposits occur in response to consuming glutens (proteins) in the diet, such as those found in wheat, barley, rye, and oat products. However, once IgA deposits occur, they are slowly cleared by the body even when the individual is gluten free. The disease is not common among African-Americans or Asians. Persons with dermatitis herpetiformis often have a high incidence of autoimmune disorders and thyroid disease.

What are the symptoms of dermatitis herpetiformis?

The following are the most common symptoms of dermatitis herpetiformis. However, each individual may experience symptoms differently. Symptoms may include:

• clusters of itchy, small blisters, mostly on the elbows, lower back, buttocks, knees, and back of the head
• itching and burning are often severe

Most individuals will also have some damage to their intestines.The symptoms of dermatitis herpetiformis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is dermatitis herpetiformis diagnosed?

In addition to a medical history and physical examination, dermatitis herpetiformis is usually confirmed with a skin biopsy with immunofluorescence (a specialized type of stain which helps to detect the presence of IgA antibodies).

Treatment for dermatitis herpetiformis:

Specific treatment for dermatitis herpetiformis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, and therapies
• expectation for the course of the condition
• your opinion or preference

The symptoms of dermatitis herpetiformis may clear when all gluten is eliminated from the diet, although healing may take several weeks to months. Treatment may also include drug therapy. Dapsone, a medication which can improve symptoms by suppressing the skin response, may be prescribed. However, dapsone has been associated with some side effects, especially anemia. Your physician will carefully monitor your blood count, if prescribed this medication.

How to describe a skin condition:

A physician may ask you to describe your dermatological condition and its location. Here are some of the more common terms that may help you in providing a more accurate description:

Atrophic	thin, wrinkled
Blister	fluid-filled bump
Crust/Scab	formation of dried blood, pus, or other skin fluid over a break in the skin
Cyst	deeply seated lesion that contains material
Excoriation	a scratch
Hives/Wheals	pink or white swelling of the skin
Lichenification	skin that has thickened
Macule	a flat discolored spot
Nodule/Papule	solid, raised bump
Raised Bumps	bumps that stick out above the skin surface
Patch	flat, discolored spot
Pustule (pimple)	inflamed lesions that appear to contain pus
Scales	dead skin cells that form flakes
Scar	fibrous tissue that forms after a skin injury

How is melanoma diagnosed?

Medical examinations and tests are used to determine if a suspicious area is melanoma skin cancer. In addition to a complete medical history, including family history, questions are asked about the marking on the skin, such as when you first noticed it, as well as if and how it has changed in size or appearance.

The suspected area, as well as the rest of your body is examined, noting the size, shape, color, texture, and if there is bleeding or scaling. A skin sample will probably be examined by a biopsy. The biopsy procedure chosen depends on the site and size of the affected area.

Types of biopsies:

The different types of biopsies include the following:

• Excisional or incisional biopsy
  This type of biopsy is often used when a wider or deeper portion of the skin is needed. Using a scalpel (surgical knife), a full thickness of skin is removed for further examination, and the wound is sutured (with surgical thread).
• When the entire tumor is removed, it is called excisional biopsy technique. If only a portion of the tumor is removed, it is called incisional biopsy technique. Excisional biopsy is often the method usually preferred when melanoma is suspected.
• Fine needle aspiration (FNA) biopsy
  This type of biopsy involves using a thin needle to remove very small pieces from a tumor. Local anesthetic is sometimes used to numb the area, but the test rarely causes much discomfort and leaves no scar.
  • FNA is not used for diagnosis of a suspicious mole, but may be used to biopsy large lymph nodes near a melanoma to see if the melanoma has metastasized (spread). A computed tomography scan (CT or CAT scan) - an x-ray procedure that produces cross-sectional images of the body - may be used to guide a needle into a tumor in an internal organ such as the lung or liver.
• Punch biopsy
  Punch biopsies involve taking a deeper sample of skin with a biopsy instrument that removes a short cylinder, or "apple core," of tissue. After a local anesthetic is administered, the instrument is rotated on the surface of the skin until it cuts through all the layers, including the dermis, epidermis, and the most superficial parts of the subcutis (fat).
• Shave biopsy
  This type of biopsy involves removing the top layers of skin by shaving it off. Shave biopsies are also performed with a local anesthetic.

• Skin biopsy
  Skin biopsies involve removing a sample of skin for examination under the microscope to determine if melanoma is present. The biopsy is performed under local anesthesia. The patient usually just feels a small needle stick and slight burning for about one minute, with a little pressure, but no pain.

Biopsies are obtained from the different skin layers:

• A shave biopsy generally involves obtaining tissue specimens from the thin outer layer of skin, called the epidermis.
• A punch biopsy generally involves obtaining tissue specimens from the epidermis. However, in some cases, a punch biopsy involves the dermis and subcutaneous tissue.

• An excisional biopsy generally involves obtaining tissue specimens from the deepest layer of skin, called the subcutaneous tissue.

What is staging?

When melanoma is found, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging, and is necessary before treatment for the cancer can begin.

What are the stages for melanoma?

The National Cancer Institute stages of melanoma are:

Stage 0	Abnormal cells are found only in the outer layer of skin and have not invaded deeper tissue.
Stage IA	Cancer is found in the outer layer of the skin (epidermis) and/or the upper part of the inner layer of skin (dermis), but it has not spread to nearby lymph nodes. The tumor is less than 1.0 millimeters thick.
Stage IB	The tumor is less than 1.0 millimeters thick and ulcerated, or 1.0-2.0 millimeters and not ulcerated.
Stage IIA	It has spread to the lower part of the inner layer of skin (dermis), but not into the tissue below the skin or into nearby lymph nodes. The tumor is 1.0-2.0 millimeters ulcerated or 2.0-4.0 millimeters and not ulcerated.
Stage IIB	The tumor is 2.0-40 millimeters thick and ulcerated, or greater than 4.0 millimeters and not ulcerated.
Stage IIC	The tumor is greater than 4.0 millimeters thick and ulcerated.
Stage III	The tumor has spread to the body tissue below the skin and to nearby lymph nodes.
Stage IV	The tumor has spread to other organs, or to lymph nodes far away from the original tumor.

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Always consult your physician for more information regarding the staging of melanoma.

What are drug rashes?

Drug rashes are the body's reaction to a certain medication. The type of rash that occurs depends on the type of drug that is causing it. Rashes can range from mild to severe.
Rashes caused by drugs can be categorized in the following groups:

• Rashes caused by an allergic reaction to the medication
• Rashes produced as an unwanted effect of a particular medication
• Rashes due to hypersensitivity to sunlight caused by the medication

What are the different types of rashes caused by drugs?

Type of Rash	Symptoms	Cause
Acne	pimples and red areas that appear most often on the face, shoulders, and chest	anabolic steroids, corticosteroids, bromides, iodides, and phenytoin
Exfoliative Dermatitis	red, scaly skin that may thicken and involve the entire body	antibiotics that contain sulfa, barbiturates, isoniazid, penicillins, and phenytoin
Fixed Drug Eruption	a dark red or purple rash that reacts at the same site	antibiotics and phenolphthalein (found in certain laxatives)
Hives	raised red bumps	aspirin, certain drug dyes, penicillins, and many drugs
Morbiliform/Maculopapular Rash	a flat, red rash which may include pimples similar to the measles	antibiotics and barbiturates are the more common causative drugs; however, any drug can cause this rash
Purpuric Eruptions	purple areas on the skin, often on the legs	some anticoagulants and diuretics
Stevens-Johnson Syndrome	blisters or a hive-like rash on the lining of the mouth, vagina, or penis	antibiotics that contain sulfa, barbiturates, penicillins, and certain drugs used for high blood pressure and diabetes

How are drug rashes diagnosed?

Diagnosing a rash caused by a reaction to medication is complicated. Even a small amount of a drug can cause a major reaction in the skin. In addition, the reaction can occur after the patient has taken a medication for a long time. Your physician will usually advise you to stop taking any medication that is not necessary to sustain your life, to see if the reaction abates. Other medications may be substituted, if possible.

Treatment for drug rashes:

The condition usually clears up if the patient stops taking the medication that is causing the reaction. Other treatment may include:

• Corticosteroids
• Antihistamines

Allergic reactions can be serious and even fatal.

What is dry skin?

Dry skin is a very common skin condition, usually characterized by irritated skin and itchiness. Dry skin often worsens in the winter, when the air is cold and dry. In addition, frequent bathing can aggravate dry skin. Dry skin may become flaky or scaly.
However, dry skin symptoms may resemble other skin conditions or result from other disorders such as an underactive thyroid or acquired immune deficiency syndrome (AIDS). Always consult your physician for a diagnosis.

Treatment for dry skin

Treating dry skin may be as simple as keeping the skin moist - by taking fewer baths and using ointments or creams that keep the moisture in. Treatment may also include:

• Avoiding harsh soaps, detergents, and perfumes, which tend to dry the skin
• Avoiding rubbing or scratching the skin, which can aggravate the symptoms and cause infection
• Applying a salicylic acid solution or cream (which removes the top layer of skin) - if the skin is scaly

Sunscreens Can Help

Studies have shown that sunscreens can prevent UV-induced wrinkling. Animal studies demonstrated that sunscreens with adequate UVA coverage can prevent sagging and wrinkling due to high-intensity UVA.

Exposure to UV rays is linked to a number of harmful health conditions, including the following:

Skin Cancer
Consider the following statistic related to skin cancer:

• More than 1 million cases of nonmelanoma skin cancer are diagnosed in the US each year.
• Most skin cancers appear after age 50, but skin damage from the sun begins at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

Premature Aging (Photo-aging)
Sun exposure also causes premature aging of the skin, a condition called photo-aging, which is different than chronological aging.

• People who sunbathe regularly show photoaging early in life - often before 30 years of age. Chronologically-aged skin, more often, shows changes after age 40 or older.
• Freckling, fine wrinkling, and dilation of capillaries are often seen early in the photoaging process.
• Photoaged skin often develops irregular pigmentation (liver spots) in later years.
• Both photoaging and chronological aging cause wrinkling and loss of skin elasticity. However, these changes occur much earlier when skin has been overexposed to the sun.

Cataracts and Other Eye Disorders
Cataracts, an eye disorder characterized by a change in the structure of the crystalline lens that causes blurred vision, are a leading cause of blindness around the world - and excessive UV exposure is one of the risk factors in the development of cataracts. In fact, persons who spend more time in the sun may develop cataracts earlier than others. The American Academy of Ophthalmology now recommends wearing UV sunglasses and a wide brimmed hat to lessen exposure to ultraviolet rays.

Corneal sunburn, growths on the outer surface of the eye, retinal-tissue damage, and other eye diseases are also known, or suspected, to be related to long-term exposure to UV rays.

Immune System Damage
The skin is part of the body's natural defense system. Many healthcare professionals believe that UV radiation can alter immune system functions. When UV radiation suppresses immune responses, the body's ability to fight certain diseases, including skin cancer, is reduced. It is suspected that overexposure to UV radiation also interferes with the effectiveness of immunizations given through the skin.

What is erythema multiforme?

Erythema multiforme is a skin disorder characterized by symmetrical, red, raised skin areas all over the body. These patches often look like "targets" (dark circles with purple-grey centers). The skin condition may be chronic and usually lasts for two to four weeks each time.

Most often, this disorder is caused by the herpes simplex virus. Other causes may include the following:

• An interaction with a certain medication
• Other infectious diseases
• Certain vaccines

What are the symptoms of erythema multiforme?

The following are the most common symptoms of erythema multiforme. However, each individual may experience symptoms differently symptoms may include:

• Sudden, red patches and blisters, usually on the palms of hands, soles of feet, and face
• Flat, round red "targets" (dark circles with purple-grey centers)
• Itching
• Cold sores
• Fatigue
• Joint pains
• Fever

The symptoms of erythema multiforme may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for erythema multiforme

Specific treatment for erythema multiforme will be determined by your physician
based on:

• your age, overall health, and medical history
• severity of the condition
• stage of the condition
• your tolerance of specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The condition usually clears up on its own. However, if a person develops a more severe form of erythema multiforme, the condition can become fatal.

Treatment may include:

• treating the infectious disease causing the disorder
• eliminating any medication causing the disorder
• cool compresses
• corticosteroids
• antibiotic

What is erythema nodosum?

Erythema nodosum is characterized by tender, red bumps, usually found on the shins. Quite often, erythema nodosum is not a separate disease, but, rather, a sign of some other disease, or of a sensitivity to a drug.

Diseases that can cause erythema nodosum:

• streptococcal infections
• sarcoidosis (inflammation of the lymph nodes and other organs)
• leprosy
• coccidioidomycosis (infection of the upper respiratory tract and lungs)
• histoplasmosis (an infectious pulmonary disease)
• tuberculosis
• psittacosis (a flu-like disease)
• Lymphogranuloma venereum (a venereal infection)
• Ulcerative colitis

Drugs that can cause erythema nodosum:

• Antibiotics containing sulfa
• Bromides
• Iodides
• Oral contraceptives

What are the symptoms of erythema nodosum?

The following are the most common symptoms of erythema nodosum. However, each individual may experience symptoms differently. Symptoms may include:

• Raised bruises on the shins
• Fever
• Joint pain
• Enlarged lymph nodes in the chest

Young adults are particularly susceptible to erythema nodosum. The symptoms of erythema nodosum may resemble other skin conditions. Always consult your physician for a diagnosis.

How is erythema nodosum diagnosed?

A biopsy (removal of tissue for examination under a microscope) of a bump can usually confirm the diagnosis. However, the exact cause cannot always be identified. Drug-induced erythema nodosum can usually be diagnosed by careful elimination of the drug causing the reaction.

Treatment for erythema nodosum:

• Specific treatment for erythema nodosum will be determined by your physician based on:
• Your age, overall health, and medical history
• Extent of the condition
• Your tolerance for specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference
• Treatment may include:
• Antibiotics
• Treatment of underlying cause
• Bed rest (to relieve pain)
• Aspirin
• Corticosteroids

What is excessive hairiness?

Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.

What causes excessive hairiness?

Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids and certain medications, also may cause excessive hairiness.

How is excessive hairiness diagnosed?

Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests if an endocrine disorder is suspected.

Treatment for excessive hairiness:

Specific treatment for excessive hairiness will be determined by your physician based on:

• Your age, overall health, and medical history
• Extent of the condition
• Cause of the condition
• Your tolerance for specific medications, procedures, and therapies
• Expectation for the course of the condition
• Your opinion or preference

Treatment may include:

• Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
• Medication (to control any underlying endocrine disorder)

What is excessive sweating?

Excessive sweating, also called hyperhidrosis, can affect the entire body, but usually occurs in the palms, soles, armpits, and/or groin area. Excessive sweating is normal when a person is anxious or has a fever. However, when the condition is chronic, it may signal thyroid problems, low blood sugar, nervous system disorders, or other medical problems.

What are the symptoms of excessive sweating?

Areas that produce excessive sweat usually appear pink or white, but, in severe cases, may appear cracked, scaly, and soft (especially on the feet). Other symptoms may include a bad odor caused by bacteria and yeast in the wet skin. The symptoms of excessive sweating may resemble other medical conditions. Always consult your physician for a diagnosis.

Treatment for excessive sweating:

Specific treatment for excessive sweating will be determined by your physician, based on:

• Your age, overall health, and medical history
• Severity of the condition
• Cause of the condition
• Your tolerance of specific medications, procedures, or therapies
• Expectations for the course of the condition
• Your opinion or preference

Treatment may include topical, oral, surgical, or nonsurgical treatments:

• Methenamine solution applications to the area (to control heavy sweating)
• Nighttime applications of aluminum chloride solution to the area (to control heavy sweating)
• Thoracoscopic sympathectomy - a surgical interruption of the sympathetic nerve pathways that lead to the sweat glands
• Botulinum toxin A injection (Botox®) - botulinum toxin helps to inhibit the release of acetylcholine (a substance that is active in the transmissions of nerve impulses) 
• Tap water iontophoresis (applying a weak electrical current to the area)
• Psychological counseling and/or medication (to reduce anxiety

What are folliculitis, boils, and carbuncles?

Folliculitis is the inflammation of hair follicles due to an infection, injury, or irritation. It is characterized by tender, swollen areas that form around hair follicles, often on the neck, breasts, buttocks, and face. Boils are pus-filled lesions that are painful and usually firm. Boils are usually located in the waist area, groin, buttocks, and under the arm. Carbuncles are clusters of boils. These are usually found in the back of the neck or thigh.

What are the symptoms of folliculitis, boils, and carbuncles?

The following are the most common symptoms of folliculitis, boils, and carbuncles. However, each person may experience symptoms differently. Symptoms for folliculitis may include:

• pus in the hair follicle
• irritated and red follicles
• damaged hair
• Symptoms for boils may include:
• pus in the center of the boil
• whitish, bloody discharge from the boil

Symptoms for carbuncles (clusters of boils) may include:

• pus in the center of the boils
• whitish, bloody discharge from the boils
• fever
• fatigue

The symptoms of folliculitis, boils, and carbuncles may resemble other skin conditions. Always consult your physician for a diagnosis.

How are folliculitis, boils, and carbuncles diagnosed?

Diagnosis of folliculitis, boils, and carbuncles are made by your physician after a thorough medical history and physical examination. After examining the lesions, your physician may culture the wounds (obtain a sample of the drainage of the wound, allow it to grow in the laboratory, and identify specific bacteria) to help verify the diagnosis and to help in selecting the best treatment.

Treatment for folliculitis, boils, and carbuncles

Specific treatment for folliculitis, boils, and carbuncles will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference
• Treatment may include:
• topical antibiotics (for folliculitis)
• for carbuncles and boils, a warm compress may be used to help promote drainage of the lesion
• oral or intravenous (IV) antibiotics (to treat the infection)
• possible removal of the boils and carbuncles

Carbuncles heal more slowly than a single boil. Keeping the skin clean helps to prevent these conditions from occurring.

Skin fungi live in the dead, top layer of skin cells in moist areas of the body, such as between the toes, groin, and diaper area. Some fungal infections cause only a small amount of irritation. Other types of fungal infections penetrate deeper and may cause itching, swelling, blistering, and scaling. In some cases, fungal infections can cause reactions elsewhere on the body. For example, a child may develop a rash on the finger or hand associated with an infection of the scalp or foot.

There are many different types of fungal skin infections that require clinical care by a physician or other healthcare professional. Listed below, in the directory, are some for which we have provided a brief overview.

• Candidiasis (Yeast Infection)
• Tinea Infections (Ringworm)
• Tinea Versicolor

What is generalized exfoliative dermatitis?

Generalized exfoliative dermatitis is a severe inflammation of the entire skin surface due to a reaction to certain drugs, or as a result of complications from another skin condition. In some cases, lymph node cancer (lymphoma) can cause generalized exfoliative dermatitis. Often, however, no cause can be found.

What are the symptoms of generalized exfoliative dermatitis?

The following are the most common symptoms of generalized exfoliative dermatitis. However, each individual may experience symptoms differently. Symptoms may include:

• extreme redness of the skin
• scaling
• thickened skin
• itching
• swollen lymph nodes
• fever
• loss of fluids and proteins through the damaged skin

The symptoms of generalized exfoliative dermatitis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is the cause of generalized exfoliative dermatitis determined?

Diagnosis includes careful elimination of known causes, such as certain drugs (i.e., penicillin and barbiturates). In addition, your physician may check for other skin conditions such as atopic dermatitis, as well as for lymphoma (which may be the cause of the generalized exfoliative dermatitis condition), during a physical examination and medical history.

Treatment for generalized exfoliative dermatitis

Specific treatment for generalized exfoliative dermatitis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the reaction
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the reaction
• your opinion or preference

Severe cases of generalized exfoliative dermatitis may require hospitalization while the person is being treated with antibiotics, intravenous (IV) fluids, and nutritional supplements. Treatment will vary depending upon the cause:

• If certain drugs are causing the condition, eliminating them usually clears up generalized exfoliative dermatitis condition.
• If another skin condition causes generalized exfoliative dermatitis, treating the other skin condition usually clears up the generalized exfoliative dermatitis condition.

• If lymphoma is causing the condition, treating the lymphoma usually clears up the generalized exfoliative dermatitis condition.

Other treatments may include:

• heated blankets (to keep warm)
• cool baths
• petroleum jelly applied to skin, followed by gauze
• corticosteroids

Forty to 50 percent of Americans who live to the age of 65 will have skin cancer at least once. The most common types of skin cancer in the United States are basal cell and squamous cell carcinomas. These are referred to as nonmelanoma skin cancers and are generally the result of sun exposure.

Approximately one in 59 people will develop melanoma during their lifetime. Malignant melanoma is a cancer that begins in the melanocytes, the pigment-producing cells in the skin. The majority of melanoma cases (90 percent) are due to environmental factors such as ultraviolet radiation (sun exposure). However, about 5 percent to 10 percent of cases occur in people with a family history of melanoma. In some of these families, the risk to develop melanoma will be inherited in an autosomal dominant fashion. In other words, parents with a mutation have a 50/50 chance to pass on the susceptibility to each of their children regardless of gender.

One type of hereditary melanoma, called the familial cutaneous malignant melanoma/dysplastic nevus syndrome  is caused by a gene on chromosome 9, known as p16, or CDKN2A. This condition accounts for about 20 percent of the familial cases of melanoma. Mutations in p16 result in unregulated cell growth. Persons with a p16 mutation have an increased lifetime risk to develop melanoma (50 percent or more) as well as an increased risk (approximately 17 percent) to develop pancreatic cancer. Genes on chromosomes 1 and 12 have also been found to be involved in familial cases of melanoma.

What is granuloma annulare?

Granuloma annulare is a chronic skin condition characterized by small, raised bumps that form a ring with a normal or sunken center. The cause of granuloma annulare is unknown.

What are the symptoms of granuloma annulare?

The following are the most common symptoms of granuloma annulare. However, each individual may experience symptoms differently. Symptoms may include:

• yellowish or skin-colored bumps
• one or several rings of bumps on feet, legs, or hands

The symptoms of granuloma annulare may resemble other skin conditions. Always consult your physician for a diagnosis.

How is granuloma annulare diagnosed?

In addition to a complete medical history and physical examination, diagnosis is usually confirmed with a skin biopsy (removing a small sample of tissue for examination under a microscope).

Treatment for granuloma annulare

Specific treatment for granuloma annulare will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Granuloma annulare usually clears up by itself. Treatment may include corticosteroid treatments (cream, tape, or injections).

What is an ingrown hair?

An ingrown hair is a hair that curls and penetrates the skin with its tip, causing inflammation. Ingrown hairs are more common among people with very curly hair. Most ingrown hairs occur in the beard area.

What are the symptoms of an ingrown hair?

The most common symptom of an ingrown hair is inflammation of the skin, followed by pus formation. However, each individual may experience symptoms differently. The symptoms of an ingrown hair may resemble other skin conditions. Always consult your physician for a diagnosis.

How is an ingrown hair diagnosed?

Diagnosis of an ingrown hair can be confirmed with a medical history and a physical examination.

Treatment for an ingrown hair

An ingrown hair often heals on its own. However, in the case of chronic ingrown hairs, treatment may include:

• allow the hair to grow longer
• depilatory (to remove the hair)
• electrolysis (to remove the hair

What is keratosis pilaris?

Keratosis pilaris is a common skin disorder characterized by small, pointed pimples. The pimples usually appear on the upper arms, thighs, and buttocks. The condition worsens in the winter and usually clears up in the summer. Keratosis pilaris has no known cause, but tends to run in families.

Treatment for keratosis pilaris

Usually no treatment is necessary for keratosis pilaris, since it normally clears up by itself. Treatment may include:

• using petroleum jelly with water, cold cream, or salicylic acid (which removes the top layer of skin) to flatten the pimples
• using a tretinoin cream (a drug which is chemically related to vitamin A).

There are many different types of lesions and skin conditions that can be treated with laser surgery. Your physician will decide if you are a candidate for the particular surgery. The following is a brief overview of some of the skin conditions that can be treated with laser surgery:

Port-wine stains
Port-wine stains are congenital (present at birth) capillary malformations. The color of this birthmark is usually pink, red, or purple. About 0.3 percent of children are born with port-wine stains. As the child grows, the mark may become darker. Port-wine stains can appear on any part of the body and can vary in size. The type of laser usually used for this condition is the pulsed dye laser.

A pulsed dye laser is a type of laser that has a high electric lamp which produces a short, high-energy flash of light. The light is colored when it passes through a dye. The color of the dye can be changed, depending upon the type of pigmented skin spots that are being treated. Adults may have this procedure performed on an outpatient basis with only local anesthesia. Children or persons with large port-wine stains, may be treated under general anesthesia. Multiple treatments may be necessary.

Hemangiomas
Hemangiomas are a common type of vascular birthmark. About 10 percent of Caucasians have hemangiomas. Hemangiomas may vary in appearance, from red, raised patches to deeper, purple areas. Hemangiomas usually appear within the first month of life, grow rapidly for the first year, and may start to go away by the time the child is 5 years old. Fifty percent of hemangiomas become smaller naturally by age 5. Hemangiomas are either superficial or deep. Surgery may be indicated for large or growing hemangiomas, or hemangiomas that are causing problems because of their location. The type of laser usually used for this condition is the pulsed dye laser. Multiple treatments may be necessary.

Café au lait macules
These are tan-colored lesions that may appear anywhere on the body. The size of the lesions varies. Some of the lesions can be very large, and cosmetic removal may be desired. A variety of lasers may be used for removal of these spots. Recurrence is common.

Telangiectasias
Telangiectasias are small blood vessels that are located under the surface of the skin. The vessels may appear red, purple, or blue. The most common places these are seen include the face, upper chest, and neck. Related vessels can be found in the legs, called spider veins. Removal is usually for cosmetic reasons.

There are many causes of telangiectasia, including heredity, sun damage, hot and spicy foods, emotions, hormones, some medications, and adult acne. Treatment of these lesions may include lasers or sclerotherapy. Sclerotherapy is a procedure in which a small needle is used to inject medication into the vessels, causing them to shrink. New vessels may continue to develop throughout the person's life, depending on the underlying cause of the lesions.

Wrinkles
The use of lasers to help remove wrinkles is one of the great advances in cosmetic plastic surgery. The term used to describe this procedure is a laser peel. This type of wrinkle removal process is safer than other methods of wrinkle removal when performed by an experienced surgeon. There is less of a chance of scaring, swelling, and crusting with the laser peel. Prior to the actual surgery, your physician may prescribe facial medications for you to use to help prepare your skin. These medications may be used for four to six weeks prior to the laser peel. After the laser peel, your physician will explain proper skin care to prevent crust formation and infection. Many different types of lasers may be used for laser peels.

Warts
Warts are growths of skin or membrane that are not malignant (cancerous). Warts are caused by the human papilloma virus and are often hard to destroy. Many different types of treatments have been used for wart removal, including surgical excision, application of medications to the wart, or freezing the wart. As a result of the side effects of these treatment modalities, use of the laser has been warranted. The type of laser used is usually the pulsed dye laser. Multiple treatments may be necessary until the wart is gone.

Scars
Scars may be formed for many different reasons, including infections, surgery, injuries, or inflammation of tissue. A scar is the body's natural way of healing and replacing lost or damaged skin. Scars may appear anywhere on the body. The composition of a scar may vary - the scar may be flat, lumpy, sunken, colored, painful, and/or itchy. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is performed in conjunction with other treatments such as injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be necessary.

Tattoo removal
Approximately 10 million Americans have some type of tattoo. There are several types of tattoos: decorative tattoos, which are placed for decorative purposes; cosmetic tattoos, which are known as permanent cosmetics, such as permanent eyeliner or lipstick; traumatic tattoos, which are a result of a trauma that embeds a foreign substance, such as dirt, in the skin; medical tattoos, such as those placed by a physician as landmarks for radiation therapy; and amateur tattoos, done by individuals on themselves or by nonprofessionals. There are many factors that determine the outcome of laser surgery on removing tattoos. These include the patient's age, skin type, type of tattoo, age of the tattoo, color of the tattoo, size and depth of the tattoo, and whether the tattoo was performed by a professional or an amateur. Some ink colors may be completely resistant to laser treatment. Laser removal of tattoos breaks up the color without damaging normal skin. The body then absorbs the pieces of pigment without leaving a scar as previous tattoo removal methods did. Multiple treatments may be necessary.

What is laser surgery?

Laser surgery is a type of surgery that uses special light beams instead of instruments for surgical procedures. Laser stands for "light amplification by the stimulated emission of radiation." Lasers were first developed in 1960. Newer laser modifications continue to have a large impact on medical and surgical practices. A large part of their impact has been seen in the treatment of various skin lesion and diseases.

How does a laser work?

The functioning of a laser goes back to Albert Einstein's quantum theory of radiation and includes other theories that help explain local tissue damage. As the light beam hits the skin, the skin may either reflect the light away, scatter the light, absorb the light, or let the light pass through the different layers. Each layer of the skin uses the light differently.
Certain parts of the skin, called chromophones, absorb the light. When these chromophones absorb the light, physical, mechanical, chemical, or temperature changes may occur in the tissue. There are many different types of lasers, including the carbon dioxide laser, the YAG (neodymium, or yttrium aluminum garnet) laser, and the argon laser. Each type works in a different manner and may be used for different treatment options. Laser light can be delivered either continuously or intermittently.

What types of surgeries use lasers?

There are many indications for the use of lasers in surgery. The following are some of the more common indications:

• to remove tumors;
• to help prevent blood loss by sealing small blood vessels;
• to seal lymph vessels to help decrease swelling and decrease the spread
  of tumor cells ;
• to treat some skin conditions, including to remove or improve warts, moles,
  tattoos, birthmarks, scars, and wrinkles.

What are lice?

Lice are tiny insects that can infest the skin anywhere on the body. Lice infection is characterized by intense itching.
Lice are highly contagious, spreading from person to person by close body contact, shared clothes, and other items (such as hats, hairbrushes, and combs). There are three types of human lice, including the following:

• Head lice
• Body lice
• Pubic lice

Facts about lice

Head lice:

• Head lice are less likely to occur in African-Americans.
• Head lice are seen mostly in childcare settings and among school-aged children.
• The child usually has itching in the head area.
• Lice, or the eggs (called nits), can usually be seen on the hair, behind the ears, and on the neck.

Body lice:

• Body lice are usually seen in people with poor hygiene.
• Body lice are rare in children.
• Body lice cause severe itching, which is often worse at night.
• With body lice, in some cases, lice and eggs can be found in the seams of clothes.

Pubic lice:

• Pubic lice are very contagious and can be transmitted through sexual contact, or by contaminated items such as towels and clothes.
• Pubic lice can affect the pubic hair, but also can cause infections of the hair on the chest, abdomen, thighs, and eyebrows.
• Itching of the affected area is a common symptom of pubic lice.

How are lice diagnosed?

The eggs laid by lice are usually visible to the naked eye, making it easy for your physician to diagnose. Pubic lice leave small, brown spots on the parts of clothing that come into contact with the genitals or anus.

Treatment for lice

Specific treatment for lice will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the infestation
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the infestation
• your opinion or preference

Lice are treatable. Application of a medicated cream rinse or shampoo is usually effective treatment for head and/or pubic lice. Specific instructions need to be followed. Discuss this with your physician. Examples of medicated cream rinses or shampoos include the following:

• Malathion (Ovide®) - this is a new treatment that is safe and effective for lice and nits
• Lindane (Kwell®) - do not use if there are open sores on the head because of toxicity
• Pyrethrins (RID®) - this treatment does not kill nits (lice eggs)
• Permethrin cream rinse (Nix®) - this treatment does not always work due to lice resistance
• Nits need to be removed from the hair with a fine-tooth comb.
• Combs and brushes should be soaked in hot water with the shampoo for period of at least 15 minutes.

For body lice:

• Medications are usually not needed to treat body lice.
• Treatment for body lice usually consists of improving hygiene and washing clothes.
• Bed sheets and blankets should be washed in hot water and dried in a hot dryer.

What is melanoma?

Melanoma is a disease of the skin in which cancer cells are found in the melanocytes, the cells that produce color in the skin or pigment known as melanin. Melanoma usually occurs in adults, but it may occasionally be found in children and adolescents. Melanoma may also be called cutaneous melanoma or malignant melanoma. Melanoma is the rarest, but most virulent, form of skin cancer.
Melanoma is a more serious type of cancer than the more common basal cell cancer, or squamous cell cancer. Although the incidence of melanoma is lower than other types of skin cancer, it has the highest death rate and is responsible for 75 percent of all deaths from skin cancer.

Where is melanoma most often found?

Melanoma most often appears on fair-skinned men and women, but people with other skin types can be affected. Rarely, melanomas can form in parts of the body not covered by skin such as the eyes, mouth, vagina, large intestine, and other internal organs.

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for melanoma?

Persons with the following characteristics may be at an increased risk for melanoma:

• blond or red hair;
• blue eyes;
• fair complexion;
• family history of melanoma;
• a changed or changing mole;
• many ordinary moles (more than 50);
• many freckles;
• an immunosuppressive disorder;
• dysplastic nevi;
• sun exposure (The amount of time spent unprotected in the sun directly affects your risk of skin cancer);
• inability to tan.

Dark-brown or black skin is not a guarantee against melanoma. African-Americans can develop this cancer, especially on the palms of the hands, soles of the feet, under nails, or in the mouth.

What are the symptoms of melanoma?

The following are the most common symptoms of melanoma. However, each individual may experience symptoms differently. Symptoms may include:

• change in the size, shape, or color of a mole;
• oozing or bleeding from a mole;
• a mole that feels itchy, hard, lumpy, swollen, or tender to the touch.

Because most malignant melanoma cells still produce melanin, melanoma tumors are often shaded brown or black. Melanoma can also appear on the body as a new mole. Men most often develop melanoma on the area of the body between the shoulders and hips, or on the head or neck. Women most often develop melanoma on the arms and legs. However, melanoma can spread quickly to other parts of the body through the lymph system, or through the blood. Like most cancers, melanoma is best treated when it is diagnosed early.

The symptoms of melanoma may resemble other conditions or medical problems. Always consult your physician for a diagnosis.

Distinguishing benign moles from melanoma

To prevent melanoma, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at a higher risk for changing into malignant melanoma. Moles that are present at birth, and atypical moles, have a greater chance of becoming malignant. Recognizing changes in your moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal Mole / Melanoma	Sign	Characteristic
	Asymmetry	When half of the mole does not match the other half
	Border	When the border (edges) of the mole are ragged or irregular
	Color	When the color of the mole varies throughout
	Diameter	If the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission: National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult your physician for a diagnosis.

What is Merkel cell cancer?

Merkel cell cancer is also known as neuroendocrine cancer of the skin, or trabecular cancer. Characterized by firm, shiny skin lumps, this rare cancer develops on or just beneath the skin and in the hair follicles. Merkel cell cancer most often is found on sun-exposed areas of skin, such as the neck and head. The cancer mostly affects Caucasian people between the ages of 60 and 80 years of age. The cause of the cancer is unknown.

What is the appearance of Merkel cell cancer tumors?

Merkel cell cancer tumors usually are firm, shiny skin lumps that do not hurt. The lumps, or tumors, may be red, pink, or blue and can range in size from smaller than a quarter inch to larger than two inches in diameter.

How is Merkel cell cancer diagnosed?

Early diagnosis and treatment of Merkel cell cancer is crucial in preventing the cancer from spreading. However, diagnosis of Merkel cell cancer is difficult, as it can resemble many other types of cancer.

Treatment for Merkel cell cancer:

Specific treatment for Merkel cell cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, and therapies
• expectations for the course of the disease
• your opinion or preference

Treatment may include:

• surgery to remove the tumor (including a border of healthy tissue)
  Since Merkel cell cancer grows fast and often spreads (metastasizes), your physician may also remove nearby lymph nodes.
• chemotherapy-treatment with drugs to destroy cancer cells.
• radiation therapy-uses a radiation machine that emits x-rays to kill cancer cells and shrink tumors.

What is molluscum contagiosum?

Molluscum contagiosum is a viral disease of the skin that causes small, pink or skin-colored bumps on the skin. It is not harmful and usually does not have any other symptoms. The virus is inside the bumps and is mildly contagious. These bumps usually clear over an extended period of time.

What causes molluscum contagiosum?

Molluscum contagiosum is caused by a virus called the poxvirus. It is most common in children and adolescents, although it can affect adults. The virus usually is spread through skin-to-skin contact with an infected person. People with weakened immune systems, young children, and people living in warm, humid climates are more susceptible to molluscum contagiosum.

What are the symptoms of molluscum contagiosum?

The bumps are small and are usually pink or skin-colored. Eventually, the bumps tend to have a small sunken center. The number of lesions usually ranges between two to 20. The lesions usually occur in groups or clusters. They are not harmful, but may cause some cosmetic concern for the individual if they appear on the face or other visible areas.

How is molluscum contagiosum diagnosed?

Molluscum contagiosum is usually diagnosed based on a medical history and physical examination. The lesions are unique and usually are diagnosed on physical examination. Additional tests are not routinely ordered.

Treatment for molluscum contagiosum:

Specific treatment for molluscum contagiosum will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

In most cases, the lesions will heal without treatment over a period of six to nine months. Additional treatment options may include:

• removal of the lesions
• use of topical medications (to speed the resolution of the lesions)

This website was compiled from a variety of sources including the online resources listed below, but is not intended to substitute or replace the professional medical advice you receive from your physician. The content provided here is for informational purposes only, and was not designed to diagnose or treat a health problem or disease. Please consult your physician with any questions or concerns you may have regarding your condition.

This page contains links to other websites with information about dermatology. We hope you find these sites helpful, but please remember we do not control or endorse the information presented on these Web sites, nor do these sites endorse the information contained here.

• American Academy of Dermatology
• American Cancer Society
• American Osteopathic College of Dermatology
• Centers for Disease Control and Prevention (CDC)
• National Cancer Institute (NCI)
• National Eczema Association
• National Eczema Society
• National Institute of Child Health and Human Development
• National Psoriasis Foundation
• Skin Cancer Foundation
• US Food and Drug Administration (FDA)
• Vascular Birthmarks Foundation

What are some other types of bacterial skin infections?

The following are other common bacterial skin infections:

Infection	Symptoms	Treatment
Erysipelas	A skin infection caused by hemolytic streptococci, this condition usually affects the face, arms, legs, or where the skin is cut. Symptoms may include: shiny, red, raised rash small blisters enlarged and tender lymph nodes	Treatment may include: penicillin erythromycin
Erythrasma	A skin infection of the top layers of skin, more prevalent in the tropics. The condition mainly affects adults and persons with diabetes. The condition usually appears in areas on the body where skin touches skin, such as under the breast and in the groin area. Symptoms may include irregular pink patches that turn into brown scales.	Treatment may include: antibiotics antibacterial soap The infection may recur, requiring another treatment.
Impetigo	A skin infection, caused by a staphylococci infection, which is characterized by pus-filled blisters. Blisters can range in size from peas to large rings. Impetigo tends to occur on the face, arms, or legs.	Immediate treatment may help prevent impetigo from infecting deeper layers of skin. Treatment often includes antibiotics.
Paronychia	A skin infection around a fingernail or toenail. The infection can be caused by a break in the skin due to a hangnail, manicuring, or other chronic irritation. Symptoms may include: pain pus-filled abscess	Treatment may include: hot compresses soaking in warm water cutting the abscess to drain the pus antibiotics if caused by a fungus, an applications of antifungal cream or another antifungal medication

The symptoms of bacterial skin infections may resemble other skin conditions. Always consult your physician for a diagnosis.

What are other benign skin growths?

As a person grows older and is exposed to sunlight, the skin changes. Most people have some skin marks, such as freckles and moles, which may multiply or darken over time.

What are the different types of skin growths?

Skin Growth	Characteristics	Treatment
Dermatofibromas	Small, firm, red or brown bumps caused by an accumulation of fibroblasts (soft tissue cells under the skin). They often occur on the legs and may itch.	Dermatofibromas can be surgically removed if they become painful or itchy.
Dermoid Cyst	A benign tumor which is made up of hairs, sweat glands, and sebaceous glands. Some internal dermoid tumors may even contain cartilage, bone fragments, and teeth.	Dermoid cysts may be removed surgically for cosmetic reasons.
Freckles	Darkened, flat spots that typically appear only on sun-exposed areas of the skin. Freckles are common in people with blond or red hair.	No treatment is necessary for freckles.
Keloids	Smooth, firm, raised, fibrous growths on the skin that form in wound sites. Keloids are more common in African-Americans.	Keloids respond poorly to most treatment approaches. Injections of corticosteroid drugs may help to flatten the keloids. Other treatment approaches may include surgery or silicone patches to further flatten the keloids.
Keratoacanthomas	Round, flesh-colored growths that have a crater that contains a pasty material. These growths tend to appear on the face, forearm, or back of the hand. They usually disappear after a couple of months, but may leave scars.	Treatment usually includes a skin biopsy to rule out skin cancer. Other treatment may include surgical removal and/or injections of corticosteroids or fluorouracil.
Lipomas	Round or oval lumps under the skin caused by fatty deposits. Lipomas are more common in women and tend to appear on the forearms, torso, and back of the neck.	Lipomas are generally harmless, but if the lipoma changes shape, your physician may perform a biopsy. Treatment may include removal by surgery.
Moles (Nevi)	Small skin marks caused by pigment-producing cells in the skin. Moles can be flat or raised, smooth or rough, and some contain hair. Most moles are dark brown or black, but some are skin-colored or yellowish. Moles can change over time and often respond to hormonal changes.	Most moles are benign and no treatment is necessary. Some benign moles may develop into skin cancer (melanoma). See below for signs.
Atypical Moles (Dysplastic Nevi)	Larger than normal moles (more than a half inch across), atypical moles are not always round. Atypical moles can be tan to dark brown, on a pink background. These types of moles may occur anywhere on the body.	Treatment may include removal of any atypical mole that changes in color, shape and/or diameter. In addition, people with atypical moles should avoid sun exposure, since sunlight may accelerate changes in atypical moles. Persons with atypical moles should consult a physician with any changes that may indicate skin cancer.
Pyogenic Granulomas	Red, brown, or bluish-black, raised marks caused by excessive growth of capillaries (small blood vessels) and swelling. Pyogenic granulomas usually form after an injury to the skin.	Some pyogenic granulomas disappear without treatment. Sometimes, a biopsy is necessary to rule out cancer. Treatment may include surgical removal.
Seborrheic Keratoses	Flesh-colored, brown, or black wart-like spots. More common in middle-aged and older people, seborrheic keratoses may be round or oval and look like they are "stuck" on the skin.	Usually, no treatment is necessary. If the spots are irritated, or the patient wants them removed for cosmetic reasons, treatment may include freezing the area with liquid nitrogen or surgery.
Skin Tags	Soft, small, flesh-colored skin flaps on the neck, armpits, or groin.	If the skin tags are irritated, or the patient wants them removed for cosmetic reasons, treatment may include freezing the tags with liquid nitrogen or surgery.

 

Distinguishing benign moles from melanoma:

According to recent research, certain moles are at higher risk for changing into cancerous growths, including malignant melanoma, a form of skin cancer. Moles that are present at birth and atypical moles have a greater chance of becoming malignant. Recognizing changes in your moles, by following this ABCD Chart, is crucial in detecting malignant melanoma, and other cancerous skin growths at its earliest stage of development. The warning signs are:

Name	Description
Basal cell carcinoma	Basal cell carcinoma accounts for approximately 90 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin - mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.
Squamous cell carcinoma	Squamous cell carcinoma accounts for about 20 percent of all skin cancer cases. Although more aggressive than basal cell carcinoma, this cancer is highly treatable. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips, and mouth. However, squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.
Malignant melanoma	Malignant melanoma starts in the melanocytes - cells that produce pigment in the skin. Malignant melanomas usually begin as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

Distinguishing benign moles from melanoma

To prevent melanoma, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth, and atypical moles, have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal Mole / Melanoma	Sign	Characteristic
	Asymmetry	When half of the mole does not match the other half
	Border	When the border (edges) of the mole are ragged or irregular
	Color	When the color of the mole varies throughout
	Diameter	If the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission: National Cancer Institute

What does tanning do to the skin?

Tanning is the skin's response to ultraviolet (UV) light - a protective reaction to prevent further injury to the skin from the sun. However, tanning does not prevent skin cancer.

What are risk factors for skin cancer?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

The following are possible risk factors for skin cancer:

• heredity
  People with a family history of skin cancer are generally at a higher risk of developing the disease. People with fair skin and a northern European heritage appear to be most susceptible.
• environment

• Due to a reduction of ozone in the earth's atmosphere, the level of UV light today is higher than it was 50 or 100 years ago. Ozone serves as a filter to screen out and reduce the amount of UV light that we are exposed to. With less atmospheric ozone, a higher level of UV light reaches the earth's surface.

Other factors that contribute to skin cancer:

• multiple nevi (moles) or atypical moles
• exposure to coal and arsenic compounds
• elevation
  Ultraviolet light is stronger as elevation increases (because the thinner atmosphere at higher altitudes cannot filter UV as effectively as it does at sea level).
• latitude
  The rays of the sun are strongest near the equator.
• repeated exposure to x-rays
• scars from disease and burns
• immune suppression, such as in persons who have had organ transplants
• repeated unprotected exposure to the sun with or without sunburn

What are some other dermatitis conditions?

The following are some of the other common dermatitis conditions:

Condition	Description	Symptoms	Treatment
Localized Scratch dermatitis	A chronic inflammation of the skin that usually affects more women than men, and more Asians and Native Americans than other races. The cause is unknown.	The condition can occur anywhere on the skin, including the anus. Symptoms may include: itching dryness and scaling dark areas from rubbing	Effective treatment usually includes cessation of scratching or rubbing. Other treatment may include: antihistamines or topical medications to control itching corticosteroid creams
Nummular Dermatitis	A chronic rash that usually affects middle-aged people and is more common in the winter. The cause is unknown.	The condition is characterized by circular spots with small blisters, scabs, or scales. Although the condition can occur anywhere on the body, it usually appears on the back of the arms and legs, and on the buttocks. Other symptoms may include: itchy areas of pimples dry skin Always consult your physician for a diagnosis	Treatment depends on the individual person, as one treatment approach is not effective for everyone with this condition. Treatment may include: antibiotics corticosteroids ultraviolet light therapy
Perioral Dermatitis	A red, bumpy rash around the mouth and chin that usually affects women between the ages of 20 and 60. The cause is unknown.	Symptoms may include acne- or rosacea-like bumps.	Treatment may include: tetracyclines (antibiotics) acne medication
Stasis Dermatitis	A chronic inflammation of the lower legs. Caused by pooling of blood and fluid under the skin, the condition tends to affect people with varicose veins and edema (swelling).	The skin may turn dark brown from this condition. Other symptoms may include: red and scaly skin swelling warm skin	The goal of treatment is to reduce the pooling of blood in the veins in the legs. Treatment may include: elevating the legs wearing support pantyhose to prevent fluid accumulation applying cool compresses keeping the skin clean to prevent infection corticosteroid creams antibiotics (if infection occurs) zinc oxide dressings skin grafts (if the skin develops large ulcers)

What is Kaposi's sarcoma?

Kaposi's sarcoma is a skin cancer that starts in the skin's blood vessels. Kaposi's sarcoma comes in two forms: a slow-growing form, and a more aggressive, faster-spreading form. The slow-growing form usually starts as a purple or dark-brown, flat or raised, area on the lower leg. The more aggressive form of Kaposi's sarcoma starts as a pink, red, or purple, round or oval, spot anywhere on the body, including internally.

Who is at risk for Kaposi's sarcoma?

• classic Kaposi’s sarcoma-a slower-growing form of the disease, is more common in older people, especially those of European, Jewish, or Italian descent.
• African Kaposi’s sarcoma-can be slow - growing or more aggressive, and often affects children and young men in African nations near the equator.
• treatment-related Kaposi’s sarcoma - occurs in people receiving immune-suppressing drugs, such as after organ transplants.
• epidemic Kaposi’s sarcoma - an aggressive form of the disease, occurs more often in people with acquired immune deficiency syndrome (AIDS).

What is Paget's disease?

Paget's disease is a rare form of skin cancer that begins in the glands in or under the skin. Characterized by inflamed, red patches on the skin, Paget's disease often originates from breast duct cancer. The patches can occur in sweat glands, in the groin, or near the anus.

Because Paget's disease often originates from breast duct cancer, the eczema-like cancer usually appears around the nipple. Paget's disease is also considered a rare form of breast cancer.

What is pityriasis rosea?

Pityriasis rosea is a mild, but common, skin condition. Characterized by scaly, pink, inflamed skin, the condition can last from four to eight weeks and usually leaves no lasting marks.

What causes pityriasis rosea?

The cause of pityriasis rosea is not known, but it is commonly believed to be caused by a virus. It is usually seen in children, adolescents, and young adults. More than 75 percent of people with the rash are 10 to 35 years of age. The condition is more prevalent in spring and fall.

What are the symptoms of pityriasis rosea?

Pityriasis rosea usually starts with a pink or tan oval area (sometimes called a herald or mother patch) on the chest or back. The main patch is usually followed (after a couple of weeks) by smaller pink or tan patches elsewhere on the body - usually the back, neck, arms, and legs. The scaly rash usually lasts between four to eight weeks and will disappear without treatment.
The following are other common symptoms of pityriasis rosea. However, each individual may experience symptoms differently. Symptoms may include:

• headaches
• fatigue
• aches
• itching

The symptoms of pityriasis rosea may resemble other skin conditions. Always consult your physician for a diagnosis.

How is pityriasis rosea diagnosed?

Pityriasis rosea is usually diagnosed based on a medical history and physical examination. The rash of pityriasis rosea is unique, and the diagnosis is usually made on the basis of a physical examination. In addition, your physician may order the following tests to help aid in the diagnosis:

• blood tests
• skin biopsy-the removal of some of the diseased skin for laboratory analysis. The sample of skin is removed after a local anesthetic is administered.

Treatment for pityriasis rosea:

• Specific treatment for pityriasis rosea will be determined by your physician based on:
• your age, overall health, and medical history
• extent of the rash
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the rash
• your opinion or preference

The goal of treatment for pityriasis rosea is to relieve symptoms associated with the condition, such as itching. There is no cure for pityriasis rosea. The condition will resolve spontaneously. Treatment may include:

• medicated lotions and creams (to soothe the itching)
• medications by mouth (to soothe the itching)
• cool baths with or without oatmeal (to soothe the itching)
• ultraviolet exposure (under a physician's supervision)
• cool compresses (to soothe the affected skin)

Did You Know? Scratching poison ivy blisters will not spread the rash. In addition, the poison ivy rash is not contagious - only urushiol (oil found in the sap of poison ivy) can cause a reaction.

What is poison ivy/poison oak?

There are three native American plants that collectively may be called poison ivy:

• Poison Ivy
• Poison Oak
• Poison Sumac

These plants can cause an allergic reaction in nearly 85 percent of the population. To be allergic to poison ivy, you must first be "sensitized" to the oils. This means that next time there is contact with the plant, a rash may occur.

What causes an allergic reaction?

The resin in the plants contains an oily substance called urushiol. Urushiol is easily transferred from the plants to other objects, including toys, garments, tools, and animals. This chemical can remain active for a year or longer. It is important to know that the oils can also be transferred from clothing, pets, and can be present in the smoke from a burning plant.

What are the symptoms of poison ivy/poison oak?

The following are the most common symptoms of poison ivy. However, each individual may experience symptoms differently. Symptoms may include:

• a contact dermatitis rash characterized by bumps and blisters that itch
• swelling in the area of contact sometimes occurs
• blisters that eventually break open, ooze, and then crust over

The symptoms of poison ivy may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for poison ivy/poison oak:

Specific treatment for poison ivy/poison oak will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Making sure you avoid the poisonous plants is the best treatment. It is important to teach your family members what the plants look like and not to touch them.

If contact with the plants has already occurred, you should remove the oils from the skin as soon as possible. Cleansing with an ordinary soap within six hours after the initial exposure has proven to be effective. Repeat the cleaning with the soap three times. There are also alcohol-based wipes that help remove the oils. Wash all clothes and shoes also, because the oils can remain on these.

If the blisters and rash are on the face, near the genitals, or all over the body, your physician should be notified. After a medical history and physical examination, your physician may prescribe a steroid cream, oral steroids, or steroid injections to help with the swelling and itching, depending upon the severity of the rash.

Is poison ivy/poison oak contagious?

Poison ivy/poison oak cannot be spread from person to person by touching the blisters, or from the fluid inside the blisters. It can be spread, however, if the oils remain on the skin, clothes, or shoes. This is why washing your hands, clothes, and shoes as soon as possible is very important.

Preventing poison ivy/poison oak:

• Teach all family members to recognize the plants.
• Make sure you wear long pants and long sleeves when poison ivy or poison oak are in the vicinity.
• Wash all clothes and shoes immediately after you have been outside.
• Make sure you do not touch a pet that might have been in contact with a poisonous plant.
• Wash your hands thoroughly.

What is prickly heat?

Prickly heat is a skin rash caused by trapped sweat under the skin. Sweat can become trapped when the narrow ducts through which sweat travels to the surface become clogged. Prickly heat tends to be more common in warmer, more humid climates. The condition usually appears on the torso and thighs.

What are the symptoms of prickly heat?

The following are the most common symptoms of prickly heat. However, each individual may experience symptoms differently. Symptoms may include:

• itching
• irritation (prickling)
• small blisters
• large, red areas on skin

The symptoms of prickly heat may resemble other skin conditions. Always consult your physician for a diagnosis.

Treatment for prickly heat

The condition usually clears up when sweating is avoided. Other treatment may include:

• keeping the skin cool and dry
• corticosteroid lotion

What is psoriasis?

Psoriasis is a chronic skin condition characterized by inflamed, red, raised areas that often develop as silvery scales on the scalp, elbows, knees, and lower back. Psoriasis affects nearly 6 million people in the US.

What causes psoriasis?

The cause of psoriasis is unknown, however, it is thought to be caused by abnormally fast-growing and shedding skin cells. The skin cells multiply so quickly, causing the skin to shed every three to four days. Though not contagious, the condition is hereditary. Psoriasis is often recurrent and occurs in varying severities.

What are the symptoms of psoriasis?

The following are the most common symptoms of psoriasis. However, each individual may experience symptoms differently, as psoriasis comes in several forms and severities. Symptoms may include:

• Discoid Psoriasis
  Also called plaque psoriasis, this type of psoriasis is the most common. Symptoms may include patches of red, raised skin on the trunk, arms, legs, knees, elbows, genitals, and scalp. Nails may also thicken, become pitted, and separate from the nail beds.
• Guttate Psoriasis
  This type of psoriasis affects mostly children. Symptoms may include many small patches of red, raised skin. A sore throat usually proceeds the onset of this type of psoriasis.
• Pustular Psoriasis
  Symptoms may include small pustules (pus-containing blisters) all over the body or just on the palms, soles, and other small areas.

The symptoms of psoriasis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is psoriasis diagnosed?

When the condition progresses to the development of silvery scales, the physician can usually diagnose psoriasis with a medical examination of the nails and skin. Confirmation of diagnosis may be done with a skin biopsy (taking a small skin specimen to examine under a microscope).

Treatment for psoriasis:

• Specific treatment for psoriasis will be determined by your physician based on:
• your age, overall health, and medical history
• severity of the condition
• your tolerance of specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of treatment is to reduce inflammation and slow down the rapid growth and shedding of skin cells. At the present time, there is no cure for psoriasis. Treatment may include:

• ointments and creams (to moisturize the skin)
• sunlight or ultraviolet light exposure (under a physician's supervision)
• steroids (such as cortisone creams)
• vitamin D cream
• creams containing salicylic acid or coal tar
• Anthralin - a drug that treats the thicker, hard-to-treat patches of psoriasis.
• methotrexate - an anti-cancer drug that interrupts the growth of skin cells.
• oral or topical retinoids
• immunosuppressive medications (such as Cyclosporine)

What is rosacea?

Rosacea is a common skin condition that usually only affects the face and eyes. Characterized by redness, pimples, and broken blood vessels, rosacea tends to begin after middle age (between the ages of 30 and 60) and is more common in fair-skinned people.
The cause of rosacea is unknown. An estimated 14 million people in the US have rosacea.

What are the symptoms of rosacea?

Rosacea often begins with easy blushing and flushing of the facial skin. Eventually, redness will persist around the nose area, extending to the rest of the face. Rosacea has a variety of clinical symptoms and is classified into the following four types, based on these different symptoms:

Type	Symptoms
Prerosacea	frequent episodes of blushing and flushing of the face and neck
Vascular rosacea	swelling of blood vessels under the facial skin, leading to swollen, warm skin (common in women)
Inflammatory rosacea	formation of pimples and enlarged blood vessels on the face
Rhinophyma	enlarged oil glands in the nose and cheeks that cause an enlarged, bulbous red nose

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In addition, approximately 50 percent of those affected by rosacea will have eye involvement. Eye symptoms may include:

• redness
• burning
• tearing
• inflamed eyelids
• sensation of a foreign object in the eye

The symptoms of rosacea may resemble other dermatologic conditions, such as acne. Always consult your physician for a diagnosis.

How is rosacea diagnosed?

Rosacea is usually diagnosed with a complete medical history and physical examination.

Treatment for rosacea:

Specific treatment for rosacea will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the rash
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the rash
• your opinion or preference

The goal of treatment is to control the symptoms associated with rosacea. Treatment may include:

• diet modifications (such as avoiding foods that dilate the skin's blood vessels, such as caffeine, spicy foods, and alcohol)
• topical and oral antibiotics
• glycolic acid peels
• cortisone cream
• laser therapy
• dermabrasion
• electrosurgery

What is rubella (German measles)?

Rubella is a viral illness that results in a viral exanthem. Exanthem is another name for a rash or skin eruption. It is spread from one child to another through direct contact with discharge from the nose and throat.

Infants and children who develop the disease usually only have a mild case of the rash and side effects. However, children who contract rubella from their mother while she is pregnant, can have severe birth defects and consequences. It is also very dangerous for pregnant women to come in contact with someone who has rubella, because it may cause a miscarriage.

What causes rubella?

Rubella is caused by a virus, called a Rubivirus. It can be spread from a pregnant mother to the unborn child, or from secretions from another infected person. It is most prevalent in late winter and early spring. Rubella is preventable by proper immunization with the rubella vaccine.

What are the symptoms of rubella?

The disease itself does not have any long-term consequences. The biggest concern is to prevent an affected child from infecting a pregnant woman. It may take between 14 to 21 days for a child to develop signs of rubella after coming in contact with the disease. It is important to know that a child is most contagious when the rash is erupting. However, the child may be contagious beginning 7 days before the onset of the rash 7 to 14 days after the rash has appeared. Therefore, children may be contagious before they even know they have the disease. The following are the most common symptoms of rubella. However, each child may experience symptoms differently. Symptoms may include:

Childhood rubella

• Rubella may begin with a period of not feeling well, a low-grade fever, and diarrhea. This may last one to five days.
• The rash then appears as a pink rash with areas of small, raised lesions.
• The rash begins on the face and then spreads down to the trunk, arms, and legs.
• The rash on the face usually improves as the rash spreads to the arms and legs.
• The rash usually fades by the third to fifth day.
• Lymph nodes in the neck may also become enlarged.
• Older children and adolescents may develop some soreness and inflammation in their joints.

Congenital rubella (rubella that is present at birth; the child contracted it from his/her mother while in utero) can result in many problems, including the following:

• cataracts in the eyes
• heart problems
• mental retardation
• growth retardation
• enlarged liver and spleen
• skin lesions
• bleeding problem

The symptoms of rubella may resemble other skin conditions or medical problems. Always consult your child's physician for a diagnosis.

How is rubella diagnosed?

Rubella is usually diagnosed based on a medical history and physical examination of your child. The lesions of rubella are unique, and usually the diagnosis can be made on physical examination. In addition, your child's physician may order blood or urine tests to confirm the diagnosis.

Treatment for rubella:

• Specific treatment for rubella will be determined by your child's physician based on:
• your child's age, overall health, and medical history
• extent of the disease
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

The goal of treatment for rubella is to help prevent the disease, or decrease the severity of the symptoms. Since it is a viral infection, there is no cure for rubella. Treatment may include:

• increased fluid intake
• rest

Prevention of rubella:

Since the introduction of rubella vaccine, the incidence of rubella has decreased by more than 99 percent. Most cases today occur in adults who have not been vaccinated. The rubella vaccine is usually given in combination with the measles and mumps vaccine. It is called the MMR vaccine. It is usually given when the child is 12 to 15 months old and then again between 4 to 6 years of age. If the second dose has not been received at 4 to 6 years of age, it should be received by 11 to 12 years of age. In addition, girls should have completed rubella vaccination before they reach childbearing age.

Other ways to prevent the spread of rubella:

• Children should not attend school for seven days after the onset of the rash.
• Children who are born with rubella are considered contagious for the first year of life.
• Assure that all of your child's contacts have been properly immunized.

What is scabies?

Scabies is an infestation of mites (tiny insects) characterized by small, red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed, or during close, personal contact. The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

What are the symptoms of scabies?

It may take between four to six weeks for a person to develop symptoms of scabies after coming in contact with an infected person.

In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children and adults, the lesions are usually on the hands, between the fingers, wrists, belt line, thighs, belly button, in the groin area, around the breasts, and in the armpits. The following are the most common symptoms of scabies. However, each individual may experience symptoms differently. Symptoms may include:

• itching, usually severe
• rash, with small pimples or red bumps
• scaly or crusty skin (with advanced conditions)

The symptoms of scabies may resemble other skin conditions. Always consult your physician for a diagnosis.

How is scabies diagnosed?

In diagnosing scabies, the skin and skin crevices are examined by your physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

Treatment for scabies:

• Specific treatment for scabies will be determined by your physician based on:
• your age, overall health, and medical history
• extent of the infestation
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the infestation
• your opinion or preference
• Scabies is treatable and usually all members in a family are treated at the same time. Treatment may include:
• applications of prescription creams and lotions, such as permethrin and lindane solutions
• oral antihistamine medication (to help relieve itching)
• in some cases, topical ointments are recommended

In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week. The itching may continue for many weeks after the initial treatment of the scabies.

What is a scar?

A scar is the body's natural way of healing and replacing lost or damaged skin. A scar is usually composed of fibrous tissue. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue. Scars may appear anywhere on the body, and the composition of a scar may vary - appearing flat, lumpy, sunken, colored, painful, or itchy. The final look of a scar depends of many factors, including the skin type and location on the body, the direction of the wound, the type of injury, age of the person with the scar, and his/her nutritional status.

How can a scar be minimized?

Specific dermatological procedures to minimize scars will be determined by your physician based on:

• your age, overall health, and medical history
• severity of the scar
• type of scar
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Scars usually fade over time. Make-up can help cover the scar while it is healing. Some scars can be minimized by certain dermatological techniques. However, treatment can only improve the appearance of a scar, but cannot completely erase it.
The following are some of the more common scar-minimizing procedures:

• Dermabrasion
  Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
• Chemical Peels
  Chemical peel are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
• Collagen Injections
  One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
• Cortisone-like Injections
  These types of injections can help soften and then shrink hard scars.
• Cryosurgery
  Cryosurgery can help reduce the size of scars by freezing the top skin layers. The freezing causes the skin to blister.
• Laser Resurfacing
  Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
• Punch Grafts
  Punch grafts are small skin grafts to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
• Surgical Scar Revision
  Surgical scar revision involves removing the entire scar surgically and rejoining the skin. Although a new scar will form, the goal of the surgical technique is to create a less obvious scar. Surgical scar revision is usually reserved for wide or long scars, scars that healed in an unusual way, or scars in very visible places.

• Autologous Fat Transfer
  An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

What are the different types of scars and treatment?

Abnormal scars sometimes form after the wound has healed. There are many different types of scars, including the following:

• Keloid Scars
  These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from collagen that the body produces after a wound has healed. These scars may appear anywhere on the body. They occur more often in darker-skinned people. Keloid scars may occur up to one year after the original trauma to the skin.
  
  

  Treatment for keloid scars varies. There is no one simple cure for keloid scars. Recurrence after treatment is common. Treatment may include the following:

  • Steroid Injections
    Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to actually decrease the size of the scar.
  • Cryotherapy
    Cryotherapy involves the scar being "frozen" off by a medication.
  • Pressure Therapy
    Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.
  • Surgery
    If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.
    
    Another option is laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.

     

• Hypertrophic Scars
  Hypertrophic scars are similar to keloid scars, however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.
  
  In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to two years after the surgery to help maximize healing and decrease the chance of the scar returning.

• Contractures
  Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement.
  
  There are many different surgical treatment options for contractures, including the following:
• Skin graft or Skin flap
  Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when that area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
• Z-plasty
  A Z-plasty is a type of procedure that is used to revise a scar by using a Z-shaped incision to help decrease the amount of contractures of the surrounding skin. It also may attempt to relocate the scar so that the edges of the scar look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.

• Tissue expansion
  Tissue expansion is a newer technique being used, and involves a process that increases the amount of existing tissue available for reconstructive purposes. This procedure is often used in addition to the flap surgery.

• Adhesions
  Another type of scarring, called adhesions, may form between unconnected internal organs. Adhesions may cause complications during certain surgeries.

Recovery from scar revision surgery:

As with all surgeries, it is important to follow all instructions to help maximize recovery and healing. Your physician will advise you on all activity restrictions, depending on the type of surgery that was performed. Scars cannot be removed completely. Many factors will be involved in the degree of healing of your particular scar, with some scars taking more than a year to show improvement in appearance following surgery.

What are sebaceous cysts?

Sebaceous cysts are harmless, slow-growing bumps under the skin, often appearing on the scalp, face, ears, back, or groin area. The cysts usually contain dead skin and other skin particles.

Treatment for sebaceous cysts:

Sebaceous cysts can usually be treated by a physician by puncturing the top and removing its contents. However, large cysts may reappear and may have to be surgically removed. If a cyst becomes infected, treatment may include administering antibiotics and then surgically removing the cyst.

Did You Know? Seborrheic dermatitis is different than dandruff. Dandruff usually limits itself to the scalp and is characterized by scaling without redness, while seborrheic dermatitis has both redness and scaling.

What is seborrheic dermatitis?

Seborrheic dermatitis is an inflammation of the upper layers of skin, characterized by red, itchy skin that sheds scales. A hereditary condition, seborrheic dermatitis is often aggravated by cold weather conditions.
Seborrheic dermatitis is most common during:

• Infancy
  In infants, the condition is also called "cradle cap," because of its characteristic scaly appearance on the scalp. However, cradle cap can also occur in the diaper area. Seborrheic dermatitis in this age group usually clears up on its own within the first year.
• Middle Age
  When seborrheic dermatitis occurs at this age, the condition is usually more intermittent.

• Old Age
  When seborrheic dermatitis occurs at this age, the condition is usually more intermittent.

Persons with oily skin or hair are also more at risk for developing seborrheic dermatitis.

What are the symptoms of seborrheic dermatitis?

The following are some of the other symptoms associated with seborrheic dermatitis. However, each person may experience symptoms differently. Symptoms may include:

• itching scalp
• dry or greasy scales on the scalp
• a yellow or red scaly rash along the hairline, behind the ears, in the ear canal, on the eyebrows, around the nose, and/or on the chest

The symptoms of seborrheic dermatitis may resemble other skin conditions. Always consult your physician for a diagnosis.

How is seborrheic dermatitis diagnosed?

A complete medical history and physical examination helps the physician in diagnosing seborrheic dermatitis.

Treatment for seborrheic dermatitis:

Specific treatment for seborrheic dermatitis will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Although the condition responds to treatment, it may recur. Treatment is usually effective in alleviating symptoms and may include:

• corticosteroid cream or lotion
• anti-fungal topicals (such as ciclopirox)
• medicated shampoo for adults, as prescribed by your physician

What is shingles?

Shingles, or herpes zoster, is a common viral infection of the nerves, which results in a painful rash of small blisters on an area of skin anywhere on the body. Even after the rash is gone, the pain can continue for months, even years.

Shingles is caused by the reactivation of the varicella-zoster virus, which causes chickenpox. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Herpes zoster is more common in persons with a depressed immune system, and in persons over the age of 50.

According to the National Institute of Allergy and Infectious Diseases, this year more than 500,000 people will develop shingles.

What are the symptoms of shingles?

The following are the most common symptoms of shingles. However, each individual may experience symptoms differently. Symptoms may include:

• skin sensitivity and/or pain in the area of the skin before the rash appears
• rash, which appears after five days and initially looks like small, red spots that turn into blisters (usually takes about two to three days)
• blisters turn yellow and dry, often leaving small, pitted scars
• Other early symptoms of shingles may include:
• gastrointestinal upset
• feeling ill
• fever
• headache

The symptoms of shingles may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

How is shingles diagnosed?

In addition to a complete physical examination and medical history, diagnostic tests for shingles may include the following:

• skin scrapings-a procedure in which the skin is gently scraped to determine if the virus is shingles or another virus.
• blood tests

Complications of shingles:

Active shingles symptoms usually do not last longer than three to five weeks. However, complications do occasionally occur. The two major complications that can occur as a result of a case of shingles include the following:

• Postherpetic Neuralgia (PHN)
  The most common complication of shingles is postherpetic neuralgia (PHN). PHN is characterized by continuous, chronic pain that a person feels even after the skin lesions have healed. The pain may be severe in the area where the blisters were present, and the affected skin may be very sensitive to heat and cold.
  
  Persons who are at increased risk for PHN include those who have severe pain during active shingles, those with sensory impairment, and elderly persons. Early treatment of shingles may prevent PHN. In addition, analgesics (pain relieving medications) and steroid treatment (to help reduce inflammation) may be used to treat the pain and inflammation.
• Bacterial Infection
  A second common and severe complication of shingles is a bacterial infection on the skin where the lesions are located. Infections can lead to further complications, such as superficial gangrene and scarring. When an infection occurs near or on the eyes, a secondary bacterial infection or corneal opacification (clouding of the cornea) may occur.

Treatment for shingles:

Specific treatment for shingles will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Shingles has to run its course, because there is no cure for the disease. Treatment usually focuses on pain relief. Treatment may include painkillers to help alleviate some of the pain, and antiviral drugs to help lessen some of the symptoms and minimize nerve damage. Other treatments may include:

• bed rest, especially during the early phase of shingles, if fever is present
• calamine lotion or other topical agents
• cool compresses applied to affected skin areas
• antiviral medications (such as acyclovir, valacyclovir, and famcyclovir)
• steroids
• antidepressants
• anticonvulsants

A vaccine to prevent shingles was approved by the US Food and Drug Administration (FDA) in May, 2006. The new vaccine, Zostavax®, is recommended for adults 60 years of age and older who have previously had chicken pox but have not had shingles. Zostavax is expected to prevent 250,000 cases of shingles in the US each year and to reduce the severity of shingles in another 250,000 cases per year.

What is skin cancer?

Skin cancer is a malignant tumor that grows in the skin cells and accounts for more than 50 percent of all cancers.

What are the different types of skin cancer?

There are three main types of skin cancer, including:

Name	Description
Basal cell carcinoma	Basal cell carcinoma accounts for approximately 90 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin - mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.
Squamous cell carcinoma	Squamous cell carcinoma accounts for about 20 percent of all skin cancer cases. Although more aggressive than basal cell carcinoma, this cancer is highly treatable. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips, and mouth. However, squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.
Malignant melanoma	Malignant melanoma starts in the melanocytes - cells that produce pigment in the skin. Malignant melanomas usually begin as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

Distinguishing benign moles from melanoma

To prevent melanoma, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth, and atypical moles, have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

Normal Mole / Melanoma	Sign	Characteristic
	Asymmetry	When half of the mole does not match the other half
	Border	When the border (edges) of the mole are ragged or irregular
	Color	When the color of the mole varies throughout
	Diameter	If the mole's diameter is larger than a pencil's eraser
Photographs Used By Permission: National Cancer Institute

Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult your physician for a diagnosis.

What is a risk factor?

A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

What are the risk factors for melanoma?

Skin cancer is more common in fair-skinned people - especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Almost half of all Americans who live to age 65 will be diagnosed with skin cancer at some point in their lives, according to the National Cancer Institute. Other risk factors include:

• family history of melanoma
• sun exposure
  The amount of time spent unprotected in the sun directly affects your risk of skin cancer.
• early childhood sunburns
  Research has shown that sunburns early in life increase a person's risk for skin cancer later in life.
• many freckles
• many ordinary moles (more than 50)
• dysplastic nevi

Prevention of skin cancer

The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

• Wear protective clothing, including a hat with a four-inch brim.
• Apply sunscreen all over your body and avoid the midday sun from 10 a.m. to 4 p.m.
• Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.
• The following six steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.
• Minimize exposure to the sun at midday - between the hours of 10 a.m. and 4 p.m.
• Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of the body that are exposed to the sun.
• Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
• Wear clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of our eyes as well as the lens.
• Avoid exposure to UV radiation from sunlamps or tanning parlors.
• Protect children. Keep them from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.
• The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is even a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sun rays.

How to perform a skin self-examination

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-exam is usually the first step in detecting skin cancer. The following suggested method of self-examination comes from the American Cancer Society: (You will need a full-length mirror, a hand mirror, and a brightly lit room.)

• Examine your body front and back in mirror, then the right and left sides, with your arms raised.
• Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands.
• Look at backs of your legs and feet, spaces between your toes, and the soles
  of your feet.
• Examine the back of your neck and scalp with a hand mirror.
• Check your back and buttocks with a hand mirror.
• Become familiar with your skin and the pattern of your moles, freckles, and other marks.
• Be alert to changes in the number, size, shape, and color of pigmented areas.
• Follow the ABCD Chart when examining moles of other pigmented areas and consult your physician promptly if you notice any changes.

Treatments for skin cancer

Specific treatment for skin cancer will be determined by your physician based on:

• your age, overall health, and medical history
• extent and type of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

There are several kinds of treatments for skin cancer, including the following:

• Surgery
  Surgery is a common treatment for skin cancer, which is used in about 90 percent of treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure. Surgery may include the following procedures:
• Cryosurgery
  Using liquid nitrogen, cryosurgery uses an instrument that sprays the liquid onto the skin, freezing and destroying the tissue.
• Curettage and electrodesiccation
  This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), followed by cauterizing the wound with an electrosurgical unit.
• Excision
  A scalpel (sharp surgical instrument) may be used to excise and remove the growth. The wound is usually stitched or held closed with skin clips.
• Mohs' microscopically controlled surgery
  This type of surgery involves excising a lesion, layer by layer. Each piece of excised tissue is examined under a microscope. Tissue is progressively excised until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors.
• Laser therapy
  Laser surgery uses a narrow beam of light to remove cancer cells, and is often used with tumors located on the outer layer of skin.
• Radiation therapy
  X-rays are used to kill cancer cells and shrink tumors.

Other types of treatment include the following:

• chemotherapy-chemotherapy uses drugs to kill cancer cells.
• topical chemotherapy-chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.
• systemic chemotherapy-chemotherapy administered orally or intravenously (IV).
• immunotherapy-Immunotherapy of melanoma is a complex type of treatment involving various approaches to boost the body's own immune system, helping it to slow the growth of the cancer.

Treatment for skin cancer:

• Specific treatment for skin cancer will be determined by your physician based on:
• your age, overall health, and medical history
• extent of the disease
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the disease
• your opinion or preference

There are several kinds of treatments for skin cancer, including the following:

• Surgery
  Surgery is a common treatment for skin cancer - used about 90 percent of the time - and often includes the following procedures:
  
  • Cryosurgery - freezing the tumor, which kills cancer cells.
  • Electrodesiccation and Curettage - using an electric current to dehydrate the lesion and removing it with a sharp instrument.
  • LaserTherapy - using a narrow beam of light to remove cancer cells.
  • Mohs Micrographic Surgery - removing the cancer and as little normal tissue as possible. During this surgery, the physician removes the cancer and then uses a microscope to look at the cancerous area to make certain no cancer cells remain.
  • Simple Excision - cutting the cancer from the skin along with some of the healthy tissue around it.
  • Grafting - uses a skin graft to replace skin that is damaged when cancer is removed. This can be done following any other type of surgery for skin cancer.
• External Radiation (external beam therapy)
  A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
• Electrochemotherapy
  Electrochemotherapy uses a combination of chemotherapy and electrical pulses to treat cancer.

Other types of treatment include:

• Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells.
• Topical Chemotherapy - chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.
• Systemic Chemotherapy - chemotherapy taken by pill, or needle injection into a vein or muscle.
• Biological Therapy (also called biological response modifier (BRM) therapy, immunotherapy, or immunotherapy) - fights cancer by using materials made by your own body, or made in a laboratory, to boost, direct, or restore your body's natural defenses against disease.
• Interferon - a biological drug used to treat melanoma. Interferon boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects may include flu-like symptoms (such as fever, chills, and headache) and temporary liver problems. However, each individual may experience side effects differently.
• Interleukin - a biological drug used to treat advanced stages of melanoma. Interleukin boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects may include flu-like symptoms (such as fever, chills, and headache), swelling, and change in blood counts. However, each individual may experience side effects differently.
• Photodynamic Therapy (PDT) - a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells, than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells.

What are skin pigment disorders?

Skin color is determined by a pigment (melanin) made by specialized cells in the skin (melanocytes). The amount and type of melanin determines a person's skin color.

What is the function of melanin?

Melanin gives color to the skin, hair, and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production - to protect the skin against harmful ultraviolet rays. In addition, hormonal changes can affect melanin production.

What are the different types of skin pigment disorders?

Pigment Disorder	Characteristics	Treatment
Albinism	This rare, inherited disorder is characterized by a total or partial lack of melanin in the skin, compared to the pigmentation of siblings and parents. Albinos (people with albinism) have white hair, pale skin, and pink eyes. Vision is often affected.	There is no cure for albinism. Albinos should avoid sunlight because they lack natural protection from sunlight - melanin.
Melasma	Dark brown, symmetric patches of pigment on the face. During pregnancy this is called the "mask of pregnancy."	Sunscreens and avoiding sun exposure can prevent melasma from becoming worse. Other treatment may include prescription creams to lighten the patches.
Pigment loss after skin damage	Sometimes, following an ulcer, blister, burn, or infection, the skin does not replace some of the pigment in that area.	No treatment is necessary. Cosmetics can usually cover the blemish.
Vitiligo	Smooth, white patches in the skin, vitiligo is caused by the loss of pigment-producing cells in the skin (melanocytes). The white patches are very sensitive to the sun.	There is no cure for vitiligo. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive drugs, in addition to ultraviolet A light therapy, corticosteroid creams, and depigmentation of the remaining skin.

How to perform a skin self-examination:

Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-examination is usually the first step in detecting skin cancer. The following suggested method of self-examination is from the American Cancer Society:
(You will need a full-length mirror, a hand mirror, and a brightly lit room.)

• Examine your body front and back in mirror, then the right and left sides, with your arms raised.
• Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands.
• Look at backs of your legs and feet, spaces between your toes, and the soles of your feet.
• Examine the back of your neck and scalp with a hand mirror.
• Check your back and buttocks with a hand mirror.
• Become familiar with your skin and the pattern of your moles, freckles, and other marks.
• Be alert to changes in the number, size, shape, and color of pigmented areas.
• Follow the ABCD chart when examining moles of other pigmented areas and consult your physician promptly if you notice any changes

What is squamous cell carcinoma?

Squamous cell skin cancer (sometimes referred to as non-melanoma carcinoma) may appear as nodules, or as red, scaly patches of skin.

Who is at risk for squamous cell carcinoma?

Squamous cell carcinoma is the second most common skin cancer found in Caucasians, and is usually found on fair-skinned persons. According to the American Academy of Dermatology, the cure rate for squamous cell carcinoma is 95 percent, when properly treated. The risk factors for squamous cell carcinoma include the following:

• human papilloma virus (HPV)
• smoking
• history of skin cancer
• immunosuppression, such as in persons who have had organ transplants
• treatment of psoriasis
• long-term skin inflammation or injury
• radiation exposure
• chemical exposure
• excessive exposure to UV radiation (sunlight or tanning beds)

Where is squamous cell carcinoma found?

Squamous cell carcinoma is typically is found on the rim of the ear, face, lips and mouth, however, it can spread to other parts of the body. Although generally more aggressive than basal cell carcinoma, this cancer is highly treatable.

What is staphylococcal scalded skin syndrome?

Staphylococcal scalded skin syndrome is a response to a staphylococcal infection and is characterized by peeling skin. The disease mostly affects infants, young children, and individuals with a depressed immune system or renal insufficiency. The disease can be life threatening.

What are the symptoms of staphylococcal scalded skin syndrome?

The following are the most common symptoms of staphylococcal scalded skin syndrome. However, each individual experiences symptoms differently. The disease usually begins with a fever and redness of the skin. Then, a fluid-filled blister may form. This blister ruptures very easily, leaving an area of moist skin. Other symptoms may include the following:

• crusted infection site, often around the nose or ears
• red, painful areas around infection site
• blistering
• fever
• chills
• weakness
• fluid loss
• top layer of skin begins peeling off in sheets

After the top layer of skin has peeled off, the following symptoms may be present:

• fever
• chills
• weakness
• fluid loss

In newborns, the lesions are often found in the diaper area or around the umbilical cord. Older children more commonly have the lesions on their arms, legs, and trunk. The symptoms of staphylococcal scalded skin syndrome may resemble other skin conditions. Always consult your physician for a diagnosis.

How is staphylococcal scalded skin syndrome diagnosed?

In addition to a medical history and physical examination, the diagnosis may be confirmed with a biopsy (taking a tissue sample to be examined under a microscope) and bacterial culture.

Treatment for staphylococcal scalded skin syndrome

Specific treatment for staphylococcal scalded skin syndrome will be determined by your physician based on:

• your age, overall health, and medical history
• severity of the condition
• your tolerance of specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment usually requires hospitalization, often in the burn unit of the hospital. Treatment may include:

• oral antibiotics
• intravenous (IV), penicillin-type antibiotics

What are sunscreens?

Sunscreens protect the skin against sunburns. Sunscreens also play an important role in blocking the penetration of ultraviolet (UV) radiation, which damages the skin and can lead to skin cancer. However, no sunscreen blocks UV radiation 100 percent.

What is the difference between a sunscreen and a sunblock?

The terminology used on sunscreen labels can be confusing. The protection provided by a sunscreen is indicated by the sun protection factor (SPF) listed on the product label. A sunblock is considered to be any sunscreen with an SPF of 15 or more. In theory, sunscreens protect an individual during an incident of ultraviolet B (UVB) radiation exposure according to the following:

• SPF 15 sunscreen may absorb more than 92 percent of UVB radiation.
• SPF 30 sunscreen may absorb 97 percent of UVB radiation.

How to use sunscreens

A sunscreen protects from sunburn and minimizes suntan by reflecting UV rays. Using sunscreens correctly is important in protecting the skin. Consider the following:

• Use of a sunscreen with SPF of 20 to 30 offers substantial protection against sunburns, and usually prevents tanning.
• Choose a broad spectrum sunscreen that filters out ultraviolet A (UVA) and ultraviolet B (UVB).
• A sunscreen that provides an SPF under 4 offers the least protection. If you rarely burn and always tan, this level of skin protection may be sufficient to help prevent burning and uneven coloration.
• Sunscreens with high SPF sunscreens protect from burning for longer periods of time than do sunscreens with lower SPFs.
• Apply sunscreens to all exposed areas of skin, including those easily overlooked areas such as the rims of the ears, lips, back of the neck, and feet.
• Sunscreens are recommended for everyone (over 6 months of age), regardless of skin or complexion type, because all skin types need protection from solar UV rays. Lighter skin types are at the greatest risk of developing skin cancer; but all people are at some risk. Research has shown that UVA rays may contribute to premature aging and skin cancer.
• Apply sunscreen liberally. The recommended dose is one ounce per application. Reapply every two hours, after being in the water, or after exercising or sweating. Incidental time in the sun could add up to a sunburn. Do not forget the time spent walking your dog, window shopping, or jogging on your lunch hour.
• Do not forget the sunscreen when performing outdoor chores.

Matching sunscreens with skin type

Knowing your skin type can help you pick the right sunscreen for you. The US Food and Drug Administration (FDA) recommends the following:

Sun Exposure History	Recommended Sun Protection Factor (SPF)
Burns easily, rarely tans	20 to 30
Burns easily, tans very little	12 to 20
Burns moderately, tans gradually	8 to 12
Burns minimally, tans well	4 to 8
Rarely burns, tans well	2 to 4

Did You Know? "Ringworm" is a misleading term that refers to the circular appearance of the fungal lesion. There are no worms involved.

What are tinea infections (ringworm)?

Different fungi, depending on their location on the body, cause ringworm. Ringworm is characterized by ring-shaped, red, scaly patches with clearing centers. There is an increased risk of contracting ringworm if a person:

• is malnourished.
• has poor hygiene.
• lives in a warm climate.
• has contact with other persons or pets that have ringworm.
• is immunocompromised by disease or medication.

What are the most common types of ringworm?

The most common types of ringworm include the following:

• Athlete's foot (tinea pedis or foot ringworm)
  This common condition mostly affects teen and adult males. It less frequently affects children before puberty. Contributing causes include sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions. Symptoms of athlete's foot may include:
  • whitening of the skin between the toes
  • scaling of the feet
  • itchy rash on the feet
  • blisters on the feet
• Jock itch (tinea cruris or groin ringworm)
  This condition is also more common in males and occurs more often during warm weather conditions. It is very rare in females. Symptoms of jock itch may include:
• red, ring-like patches in the groin area
• itching in the groin area
• pain in the groin area
• does not usually involve the scrotum
• Scalp ringworm (tinea capitis)
  Scalp ringworm is highly contagious, especially among children. It occurs mainly in children between the ages of 2 to 10 years. It rarely occurs in adults. Symptoms of scalp ringworm may include:
  • red, scaly rash on the scalp
  • itching of the scalp
  • hair loss on the scalp
  • rash elsewhere on the body
  • Ringworm of the scalp can also develop into a kerion, a large, tender lesion over the area of the initial ringworm. This is caused by a hypersensitivity to the ringworm and may be associated with a rash elsewhere and tender lymph nodes in the neck.
• Nail ringworm (tinea unguium)
  An infection of the finger or toe nail, characterized by a thickened, deformed nail. This condition more often affects the toenails than the fingernails. This occurs more often in adolescents and adults rather than young children. Symptoms of nail ringworm may include:
  • thickening of the ends of the nails
  • yellow color to the nails
• Body ringworm (tinea corporis)
  This skin infection is characterized by a ring-like rash anywhere on the body or the face. This occurs in all ages and is more common in warmer climates. The symptoms of body ringworm may include:
  • red, circular lesion with raised edges
  • the middle of the lesion may become less red as the lesion grows
  • itching of the affected area
  • The symptoms of ringworm may resemble other skin conditions. Always consult your physician for a diagnosis.

How is ringworm diagnosed?

Ringworm is usually diagnosed based on a medical history and physical examination. The lesions of ringworm are unique, and usually allow for a diagnosis simply on physical examination. In addition, your physician may order a culture or skin scraping of the lesion to confirm the diagnosis.

Treatment for ringworm

• Specific treatment for ringworm will be determined by your physician based on:
• your age, overall health, and medical history
• extent of the condition
• location of the ringworm
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment for scalp ringworm (tinea capitis) may include an oral anti-fungal medication that is usually prescribed for four to eight weeks. Some people require longer treatment. Treatment for scalp ringworm may also involve the use of a special shampoo, to help eliminate the fungus. If a kerion is present (a large, tender, swollen lesion), your physician may order additional medications, such as steroids, to help reduce the swelling. Treatment for ringworm of the body, groin, and foot is usually a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of the ringworm. Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely. Treatment may need to be repeated.

What is tinea versicolor?

Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the skin. Patches are most often found on the chest or back and prevent the skin from tanning evenly. It occurs mostly in adolescence and early adulthood, but it can occur at any time.

What are the symptoms of tinea versicolor?

Usually, the only symptom of tinea versicolor is the white or light brown patches. Patches may scale slightly, but rarely itch or hurt. Other common characteristics of the rash include the following:

• white, pink, or brown patches
• infection only on the top layers of the skin
• the rash usually occurs on the trunk
• the rash does not usually occur on the face
• patches worsen in the heat, humidity, or if you are on steroid therapy or has a weakened immune system
• patches are most noticeable in the summer

The symptoms of tinea versicolor may resemble other skin conditions. Always consult your physician for a diagnosis.

How is tinea versicolor diagnosed?

Tinea versicolor is usually diagnosed based on a medical history and physical examination. The patches seen with this condition are unique, and usually allow the diagnosis to be made on physical examination. In addition, your physician may use an ultraviolet light to see the patches more clearly. Also, your physician may do skin scrapings of the lesions to help confirm the diagnosis.

Treatment for tinea versicolor

Specific treatment for tinea versicolor will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the condition
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

Treatment usually includes the use of dandruff shampoo on the skin, as prescribed by your physician. The shampoo is left on the skin overnight and washed off in the morning. To be effective, the shampoo treatment may be required for several nights. Tinea versicolor usually recurs, requiring additional treatments. Your physician may also prescribe topical creams or oral antifungal medications. It is also important to know that improvement in the skin may only be temporary, and a recurrence of the condition is possible. Your physician may also recommend using the shampoo monthly to help prevent recurrences. The treatment will not bring the normal color back to the skin immediately. This will occur naturally and may take several months.

What is ultraviolet radiation?

Energy from the sun reaches the earth as visible, infrared, and ultraviolet (UV) rays.

• Ultraviolet A (UVA) is made up of wavelengths 320 to 400 nanometers (nm) in length.
• Ultraviolet B (UVB) wavelengths are 280 to 320 nm in length.
• Ultraviolet C (UVC) wavelengths are 100 to 280 nm in length.

Only UVA and UVB ultraviolet rays reach the earth's surface. The earth's atmosphere absorbs UVC wavelengths.

• UVB rays cause a much greater risk of skin cancer than UVA. However, UVA rays cause aging, wrinkling, and loss of elasticity.
• UVA also increases the damaging effects of UVB, including skin cancer and cataracts (an eye disorder characterized by a change in the structure of the crystalline lens that causes blurred vision).

In most cases, ultraviolet rays react with a chemical called melanin, that is found in the skin. This is the first defense against the sun, as it is the melanin that absorbs the dangerous UV rays that can do serious skin damage. A sunburn develops when the amount of UV damage exceeds the protection that the skin's melanin can provide. While a small amount of exposure to sunlight is healthy and pleasurable, too much can be dangerous. Measures should be taken to prevent overexposure to sunlight in order to reduce the risks of cancers, premature aging of the skin, the development of cataracts, and other harmful effects.

What is the Ultraviolet (UV) Index?

In response to the increasing incidence of skin cancer, cataracts, and other effects from exposure to the sun's harmful rays, the National Weather Service (NWS), the US Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) collaborated on a sun-awareness information program. An important part of this program is the Ultraviolet (UV) Index, developed by the National Meteorological Center of the National Weather Service.

The Index is a next-day forecast that estimates the amount of ultraviolet radiation that will reach the earth's surface - providing important information to help you prevent overexposure to the sun's rays. The Index also includes the effects of cloud cover on the anticipated UV exposure level for the next day.

What is the Ultraviolet (UV) Index?

In response to the increasing incidence of skin cancer, cataracts, and other effects from exposure to the sun's harmful rays, the National Weather Service (NWS), the US Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) collaborated on a sun-awareness information program. An important part of this program is the Ultraviolet (UV) Index, developed by the Climate Prediction Center of the National Weather Service.
The Index is a next-day forecast that estimates the amount of ultraviolet radiation that will reach the earth's surface - providing important information to help you prevent overexposure to the sun's rays. The Index also includes the effects of cloud cover on the anticipated UV exposure level for the next day.

What are the UV exposure categories?

Index Values	Exposure Categories
0 - 2	Low-An index reading of 2 or less low danger from the sun's UV rays for the average person.
3 - 5	Moderate-An index reading of 3 to 5 means a moderate risk of harm. Take precautions if you will be outside. Stay in shade near midday.
6-7	High-An index reading of 6 to 7 means you may be at high risk of harm from unprotected exposure to the sun. Wear a wide brim hat and sunglasses. Wear sunscreen, as protection against sunburn is needed. Reduce time in the sun between 11 a.m. and 4 p.m.
8-10	Very High-An index reading of 8 to 10 and above means you are at a very high risk of harm from unprotected sun exposure. Take extra precautions. Minimize exposure between 10 a.m. and 4 p..m. Cover up and wear a hat and sunglasses. Wear sunscreen.
11 +	Extreme-An index reading of 11 and above means you are at extreme risk of harm from unprotected sun exposure. Follow all of the above suggestions to protect yourself from the sun.

What are warts?

Warts are non-cancerous skin growths caused by the papillomavirus. Warts are more common in children than adults, although they can develop at any age. Warts can spread to other parts of the body and to other persons. There are many different types of warts, due to many different papillomavirus types (more than 60). Warts are not painful, except when located on the feet. Most warts go away, without treatment, over an extended period of time.

Common types of warts:

The following are the more common types of warts:

Common warts	growths around nails and the back of hands; usually have a rough surface; grayish-yellow or brown in color
Foot warts	located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them); clusters of plantar warts are called mosaic; can be painful
Flat warts	small, smooth growths that grow in groups up to 100 at a time; most often appear on children's faces
Genital warts	grow on the genitals and are occasionally sexually transmitted; are soft and do not have a rough surface like other common warts
Filiform warts	small, long, narrow growths that usually appear on eyelids, face, or neck

Treatment for warts:

Specific treatment for warts will be determined by your physician based on:

• your age, overall health, and medical history
• extent of the growths
• your tolerance for specific medications, procedures, or therapies
• expectations for the course of the growths
• your opinion or preference

Warts often disappear without treatment. Treatment of warts depends on several factors, including the following:

• length of time on the skin
• location
• type
• severity

Treatment may include:

• application of salicylic and lactic acid (to soften the infected area)
• freezing with liquid nitrogen
• electrodesiccation (to destroy the wart with an electrical current)
• immunotherapy
• laser surgery