Actinic Keratoses (AKs) are not skin cancers. They represent “precancerous” changes in the most superficial layer of the skin. They are caused by repeated or prolonged exposure to sunlight or tanning beds. Fair skin individuals are most at risk. They typically present as pink to yellowish-tan, rough spots most commonly in the sun exposed areas of the body. They can sometimes be scratched or picked off but will usually recur if not properly treated. AKs have the potential to turn into Squamous Cell Carcinoma, a serious form of skin cancer. Because their behavior is so unpredictable, it is most prudent to effectively treat AKs and to avoid the risk of progression into aggressive skin cancer.

Treatment

Proper treatment of AKs requires the complete destruction of the precancerous cells. Since AKs are so superficial, this procedure can quickly and easily be accomplished. There are several different treatment options that are equally effective. Most commonly the AKs are frozen with liquid nitrogen, but they can also be burned or scraped off the skin. If the AKs are very numerous or widespread, a chemotherapy cream may be prescribed. This cream is not as effective for actual skin cancers as it is for precancerous lesions.

If an AK has become particularly large, thick or rough, it can be difficult to tell whether it has transformed into a skin cancer. At that point it will be necessary to biopsy or sample the lesion and to send it off for microscopic analysis. Biopsy is the only certain method of determining whether or not a skin cancer is present.

After treatment with liquid nitrogen the lesions will scab or crust over. Typically, they will heal in one to two weeks, depending upon the size and location of the Keratoses. The hands and legs heal more slowly than the face.

Prevention

The sun damage that caused the Actinic Keratoses is permanent. Even without further sun exposure, AKs may continue to develop. However, medical studies have clearly shown that continued excessive sun exposure will lead to the more rapid development of AKs as well as further increasing your risk for skin cancers. Therefore, I strongly encourage the regular use of sun protection. If you have had enough sun exposure in your lifetime to develop AKs, you have had enough exposure to develop actual skin cancers as well as melanoma, the most aggressive and serious type of skin cancer. I encourage you to examine your entire body on a monthly basis and if you notice any new or changing lesions, to have them examined by a physician.Close

Allergic Contact Dermatitis can be difficult to distinguish from other rashes. The skin swells and blisters appear. Blisters may break, forming crusts and scales. Untreated, the skin may darken and become leathery and cracked.

What is the difference between irritant dermatitis and allergic contact dermatitis?

Allergic Contact Dermatitis is not usually caused by things like acid, alkali, solvent, strong soap or detergent. These harsh compounds, which can produce a reaction on anyone’s skin, are known as "irritants." Although some chemicals are both irritants and allergens, Allergic Contact Dermatitis results from brief contact with substances that don’t usually provoke a reaction in most people.

What is the cause of Allergic Contact Dermatitis?

Allergic Contact Dermatitis results from brief contact with substances that don’t usually provoke an irritant reaction in most people. The dermatologist and patient will discuss the materials that touch the person’s skin at work and home, to identify the allergen. The dermatologist may also perform patch tests. Patch testing is a safe and quick way to diagnose contact allergies. A small amount of the suspected allergen is applied to the skin for a fixed time, usually two days.

How is Allergic Contact Dermatitis treated?

People with Allergic Contact Dermatitis should: Avoid the allergen that causes the reaction, and materials that cross-react with it. Your dermatologist can help you identify items to avoid. Substitute a product made of materials that do not cause reactions. Patch testing by a dermatologist can alert patients to which substances to avoid.Close

The word "atopic" describes a group of allergic or associated diseases that often affect several members of a family. These families have allergies such as hay fever and asthma but also have skin eruptions called Atopic Dermatitis. About one patient in five with this condition does nothave any other allergies or atopic diseases in himself or his family members.

Atopic Dermatitis is very common in all parts of the world. It affects about ten percent of infants and three percent of the U.S. population overall.

The disease can occur at any age but is most common in infants to young adults. The skin lesions are very itchy and sometimes disfiguring.

The condition usually improves in early childhood or sometime before the age of 25. About sixty percent of patients keep some degree of Dermatitis and some suffer throughout life. These cases can cause frustration to both the patient and the treating physician

When the disease starts in infancy, it's sometimes called infantile eczema. This itching, oozing, crusting condition tends to occur mainly on the face and scalp, although spots can appear elsewhere. In attempts to relieve the itching, the child may rub his/her head and cheeks and other affected areas with a hand, a pillow, or anything within reach. Parents can be consoled with the fact that many babies improve before two years of age. Proper treatment can be helpful, sometimes controlling the disease until time solves the problem.

If the disease continues or recurs beyond infancy, the skin has less tendency to be red, blistering, oozing and crusting. Instead, the lesions become dry, red to brownish-gray, and the skin may be scaly and thickened. An intense, almost unbearable itching can continue, becoming severe during the night. Some patients scratch at their skin until the lesions become bloody and crusted.

In teens and young adults, the eruptions typically occur on the elbow bends and backs of the knees, ankles and wrists and on the face, neck and upper chest. Although these are among the most common sites, all body areas may be affected.

Recognizing Atopic Dermatitis

An itching rash as described above, along with a family history of allergies, may indicate Atopic Dermatitis. Proper, early and regular treatment by a dermatologist can bring relief and also may reduce the severity and duration of the disease.

There are instances when the disease does not follow the usual pattern. It also can appear on the palms or backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for many years.

Questions and Answers about Atopic Dermatitis

Q. Since this condition is associated with allergies, can certain foods be the cause?
A. Yes, but only rarely (perhaps 10 percent). Although some foods may provoke attacks, especially in infants and young children, eliminating them rarely will bring about lasting improvement or a cure. If all else fails, foods such as cow's milk, soy, eggs, fish, wheat, peanuts and other foods suggested by your dermatologist should be avoided at least for one to two weeks on a trial basis.

Q. Are environmental causes important, and should they be eliminated?
A. Rarely does the elimination of contacted or airborne substances bring about lasting relief. Occasionally dust and dust-catching objects like feather pillows and down comforters, kapok pillows and mattresses, carpeting, drapes, some toys, and wool along with other rough fabrics, can cause the condition to worsen.

Q. Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?
A. Sometimes, but not as a rule. A positive test signals allergy only about 20 percent of the time. If negative, the test is good evidence against allergy. If these tests are desired, ask your dermatologist to recommend someone who has experience in administering them.

Q. Are "shots" such as those given for hay fever and other allergies, useful?
A. Not as a rule. They may even make the skin condition worse in some patients.

Q. What then should be done to treat this condition?
A. See your dermatologist for advice on relieving irritating factors in creams and lotions, rough, scratchy or tight clothing and woolens, rapid changes of temperature and any violent exercise that provokes sweating. Seek dermatological help for proper bathing and moisturizing advice and dealing with emotional upsets which make the condition worse.

Atopic Dermatitis is a very common condition. With proper treatment, the disease can be controlled. Close

Anyone over the age of 15 can get Basal Cell Carcinoma. It’s the most common form of skin cancer. It will affect around 800,000 people this year. It affects men more often than women and is found most frequently on sun-exposed areas such as the face, neck, hands, and trunk. One-third of all Basal Cell Carcinomas are found on the nose.

HOW SERIOUS IS BASAL CELL CARCINOMA?

Basal Cell Carcinoma can be very serious. It can invade the skin and spread to underlying structures. It is highly unusual for a Basal Cell Carcinoma to spread to distant parts of the body. However, if a Basal Cell Carcinoma is left untreated, it can grow into nearby areas causing local destruction of the tissue.

What do BASAL CELL CARCINOMAS look like?

Basal Cell Carcinomas usually appear as slowly growing, raised, translucent, pearly nodules which, if untreated, may crust, ulcerate, and sometimes bleed.

Can BASAL CELL CARCINOMA be cured?

If detected and treated early, there is a greater than 95 percent cure rate for Basal Cell Carcinoma.

Once removed, will BASAL CELL CARCINOMA recur?

If there is a recurrence of this disease, one third of the time it will happen within three years of the first cancer, and half the time within five years. Thirty-five to fifty percent of patients diagnosed with Basal Cell Carcinoma will develop a new skin cancer within five years of the first diagnosis. If you’ve had a Basal Cell Carcinoma, regular periodic checkups are recommended. Close

Malignant melanoma is a very serious skin cancer characterized by the uncontrolled growth of pigment-producing tanning cells. Melanomas may suddenly appear without warning but can also develop from or near a mole. They are found most frequently on the trunk of fair-skinned men and the lower legs of fair-skinned women, but they can occur anywhere on the body.

What causes MELANOMA?

Excessive exposure to the ultraviolet radiation of the sun may be the primary cause of melanoma. Persons in southern regions, where the sunlight is more intense, are more likely to develop melanoma than those in the north. Other possible causes include genetic factors and immune system deficiencies. Malignant melanoma has also been linked to more severe sunburns and younger ages of sun exposure.

Is MELANOMA a serious disease?

Yes, malignant melanoma is an extremely serious disease if not detected at an early stage. In later stages, malignant melanoma spreads to other organs and may result in death. But if detected in the early stages, melanoma can usually be treated successfully.

How many people will develop MALIGNANT MELANOMA this year?

At least 41,600 new cases of malignant melanoma were expected to be diagnosed in 1998 in the United States, and 7,300 people were expected to die from the disease. Since 1973 the rate of new melanomas diagnosed each year has doubled from six per 100,000 to twelve per 100,000.

What are my chances of getting MALIGNANT MELANOMA?

Although malignant melanoma is less common than other skin cancers, it is increasing at a faster rate than any other form of cancer. Recent studies showed that by the year 2000, 1 in 75 persons could develop malignant melanoma.

Who gets MELANOMA?

While malignant melanoma can strike anyone, Caucasians are at far greater risk than those of other races. About fifty percent of all melanomas occur in people over the age of fifty with nearly fifty percent of all melanoma deaths occurring in white men fifty years of age and above. However, melanoma can occur in young people. Among Caucasians, certain individuals are at higher risk than others. For example:

If you’re a Caucasian with fair skin, your risk is twice as great as a Caucasian with olive skin; Excessive sun exposure in the first 10 to 15 years of life increases your chances for developing melanoma three-fold; Redheads and blondes have a two-fold to four-fold increased risk of developing melanoma; If you’ve already had one melanoma, your chances of another are increased by five to nine times; You’re at increased risk of developing melanoma if you have atypical moles or dysplastic nevi (unusual moles); Your risk is increased two to ten times if your parent, child or sibling has had melanoma.

WHAT ARE ATYPICAL MOLES OR DYSPLASTIC NEVI?

The average young adult has at least 25 brown moles, or nevi. Almost all moles are normal. Atypical moles are unusual moles that are generally larger than normal, variable in color, often have irregular borders, and may occur in far greater numbers than ordinary moles. Atypical moles occur most often on the back and also commonly occur on the chest, abdomen and legs in women. They can also appear on the scalp, breasts, and buttocks. The presence of atypical moles may mark a greater risk of malignant melanoma developing in a mole or on apparently normal skin.

SHOULD ATYPICAL MOLES BE REMOVED BEFORE THEY BECOME CANCEROUS?

Dermatologists are divided on the value of preventive removal of atypical moles. Because they can occur in larger numbers (sometimes more than 100), their removal may be expensive and cosmetically unsatisfactory. Many dermatologists recommend careful and regular monitoring of these moles and surgical removal of suspicious lesions.

WHAT DOES MALIGNANT MELANOMA LOOK LIKE?

The ABCD rule can help tell a normal mole from one that could be a melanoma. Asymmetry: One-half of the mole does not match the other half. Border Irregularity: The edges of the mole are ragged or notched. Color: The color over the mole is not the same. There may be differing shades of tan, brown, or black, and sometimes patches of red, blue, or white. Diameter: The mole is larger than six millimeters (pencil eraser size). The most important sign of melanoma is the change in size, shape, or color of a mole.

CAN MELANOMA BE CURED?

When detected early, surgical removal of thin melanomas can cure the disease in most cases. Early detection is essential; there is a direct correlation between the thickness of the melanoma and survival rate. Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance, especially changes in existing moles or blemishes. Additionally, patients with risk factors should have a complete skin examination annually. Anyone with a large number of changing moles should be examined immediately.

CAN MELANOMA BE PREVENTED?

Yes. Because overexposure to ultraviolet light is thought to be a primary cause of malignant melanoma, dermatologists recommend the following precautions:

Avoid "peak" sunlight hours – generally 10AM to 4PM – when the sun's rays are most intense. Apply a sunscreen with a sun protection factor (SPF) of at least 15 between fifteen and thirty minutes before going outdoors. Reapply every two hours, especially when playing, gardening, swimming, or doing any other outdoor activities. Wear protective clothing with a tight weave to the cloth, long-sleeved shirt, pants, and a wide brimmed hat during prolonged periods of sun exposure. Close

Warts come in many different varieties. Common warts typically occur on the hands or other areas of the body, while plantar warts occur on the soles. Genital warts develop in the genital or anal areas, and flat warts commonly appear on the face or legs. All warts are caused by a virus called the human papilloma virus (HPV). Common and plantar warts typically develop during childhood or early adulthood. Common warts are usually without symptoms but deep plantar warts can be painful when walking. Warts occur only on the skin and mucous membranes and are not dangerous. The exception to this statement is long-standing genital warts which can occasionally develop into cervical or genital cancer.

The wart virus is acquired through direct contact with an infected person (not toads!!!). Once contracted they can be spread around one's own body. After the skin becomes infected by the wart virus, it usually takes several weeks to months before a visible wart develops. The virus most easily implants in small breaks in the skin. Shaving, scratching, or chewing on the finger nails can easily produce the small break in the skin that allows a wart to develop. It must be emphasized that warts are only slightly contagious from person to person. Repeated exposure to the virus may be necessary for their development and some people may actually be immune to the development of warts. There is no way to prevent the spread of common or plantar warts from person to person. It is not recommended that any person with warts be segregated or quarantined in any manner.

TREATMENT FOR WARTS

Childhood warts typically disappear spontaneously without treatment over a period of months to several years. At the end of one year, approximately 50% of children clear their warts, while 67% resolve them by the end of two years. In adults, warts do not disappear as easily nor as quickly as they do in children. In young children, a “wait and see” treatment is advisable to avoid exposing the patient to a painful therapy. If one elects to treat warts, several therapeutic measures are available. All the treatments target the destruction of virally-infected cells and none of the treatments specifically targets the human papilloma virus. No treatment is universally effective and warts can recur after any (or all) treatments. Common treatments include:

FREEZING: Liquid nitrogen can be applied to destroy the infected cells by producing frostbite. This procedure is often quite painful and typically results in a scar and/or a lightening of the treated area. The change in pigment may be permanent and is particularly noticeable in darker skinned individuals.

SALICYLIC ACID: Acid containing products can be effective in treating warts. When applied directly to the wart they slowly dissolve the infected cells. Several weeks of continuous use is necessary for the treatment to be effective. This method is most effective for smaller warts and typically does not work for warts around the finger nails. Salicylic acid treatment can also help soften and shrink the size of a wart and allow other treatment methods to be more effective and less uncomfortable. If this treatment option is recommended, instructions on proper use of the salicylic acid products will be provided.

BURNING: An electric current can be used to destroy the wart. This method is often used in conjunction with surgical excision.

IMMUNOTHEARPY: New treatments such as Aldara (Imiquimod) may be applied to warts to stimulate the body's own immune system to fight off the virus that causes warts. In addition, products that the majority of people are allergic to, such as candida antigen, can be injected into the wart to stimulate the body's own immune system to fight off the virus that causes warts.

No wart treatment is fool proof. There is always the risk that a treated wart will recur. The treatment of all visible warts does not prevent the development of new warts at other locations. Complete clearance of all warts only occurs when your body develops a natural immunity to the virus. When (or if) this immunity develops, you will spontaneously resolve your warts without a trace. Since warts are not dangerous, the decision whether or not to treat is yours. Close

"Follicular Degeneration Syndrome" goes under a variety of names including "hot comb alopecia".

Follicular Degeneration Syndrome was first identified in black African-American women and thought to be due to the overuse of hot combs and oil pomades. It was though that the oils applied to the hair were heated up by the hot comb and liquified. The liquid oil then dribbled down the hair fiber into the hair follicle opening and irritated the skin causing inflammation around the upper hair follicle. However, it is now known that, while hot combing might elicit the condition in some individuals, it can also occur in the absence of any cosmetic procedure. With this discovery the condition has been renamed Follicular Degeneration Syndrome.

Follicular Degeneration Syndrome is hair loss from the prolonged use or overuse of chemical hair straighteners, perms, relaxers, hot oils and hot combs.

Chemical hair straighteners can be very damaging to the hair and the hair follicles. These strong chemicals change the structure of hair, so using them frequently only weakens one's hair. Two types of relaxers are readily available: lye (contain sodium hydroxide) and no-lye (contain guandine hydroxide) relaxers. Lye relaxers are used primarily in hair salons, and while quite effective and require a short processing time, they also can cause significant damage to the hair and irritation to scalp and skin. No-lye relaxers, most often used at home, cause less skin and scalp irritation, but require a longer processing time and can be more drying to the hair than sodium hydroxide. While the straightened hair is easier to style, it may also become brittle and break easily. Relaxers strip away the hair's outer layer, causing the loss of its natural elasticity, thus causing strands to “snap off” during styling. This is why nearly three-quarters of African-American women with chemical relaxers at one point or another complain of hair breakage, split ends, and dryness. Breakage usually occurs immediately or within six months after the straightening process.

The hot comb is thought to a major cause Follicular Degeneration Syndrome. This hot metal comb, usually set to very high heat (400 degrees to 500 degrees Fahrenheit), is used in conjunction with a pressing oil or pomade (like Vaseline). The pressing straightens extremely curly hair and makes it more manageable, but this styling method usually leads to a slow, progressive, and often irreversible hair loss usually beginning at the crown and spreading symmetrically across the entire head. It is a form of scarring alopecia which is most often first visible as a well-defined patch of diffuse scarring hair loss. The affected region usually starts on the top of the scalp and may extend out to other areas of the scalp. Once there is scarring of the hair follicle, the hair is not able to return. The affected region may slowly expand in size over time, even if all caustic treatments to the scalp are stopped. Gentle hair care however can be helpful in some people to prevent worsening of this condition.

Usually treatment focuses on gentle hair care and removing the hair follicle inflammation using topical corticosteroids in intradermal corticosteroid injection. Because no reliable or proven treatment is known this often is a very frustrating condition for both patients and doctors. Close

Shingles, known medically as Herpes Zoster or varicella zoster, is a rather common disorder that is caused by the reactivation of the chicken pox (varicella) virus. During the initial infection with the varicella virus, chicken pox develops. Once this initial infection resolves, the virus remains dormant in the nervous system for a lifetime. Shingles results when this latent virus reactivates and travels down a nerve to the skin. The condition becomes much more common as we age but can occur in anyone who has had chicken pox earlier in their lifetime. About 20% of the population will experience shingles during their lifetime. The reason why the virus “reactivates” is not completely understood. Most physician believe that a temporary or permanent weakening in the body’s immune system causes the appearance of shingles. This weakening of the immune system occurs as we age but can also result from other conditions such as malignancies, leukemias, lymphomas, organ transplants, other immune system disorders, or from medications that depress the immune system. Patients with underlying immune system problems may have severe or widespread cases of shingles. However, it must be emphasized that the great majority of persons with shingles are healthy and have no detectable immune defects.

The initial presentation of Herpes Zoster is somewhat variable. Signs and symptoms typically occur in a band of skin on the face, trunk, arm, or leg on one side of the body only. Some patients will develop red bumps or patches before going on to produce blisters within these patches. Other patients never develop actual fluid-filled blisters. The condition is typically associated with disturbances in skin sensation. The symptoms include burning, pain, tingling, throbbing, or extreme sensitivity to touch or temperature. Some patients actually suffer these changes in sensation without developing an actual rash. These symptoms are variable in their onset and can proceed or postdate the appearance of the rash. The pain of shingles is also quiet variable, ranging from nonexistent to unbearable. This pain or discomfort results from inflammation of the nerves caused by the varicella virus. The affected area typically feels hot and can become quiet swollen, particularly if the rash occurs on the face. Shingles is commonly accompanied by fever, headache, or flu-like symptoms. If Herpes Zoster occurs in or near the eye, serious and permanent damage to vision can occur. To prevent this permanent loss of vision, prompt therapy must be instituted. Shingles affecting the eye is a true medical emergency that requires immediate medical attention.

Varicella zoster is less contagious than the initial chicken pox infection. A person who has never had chicken pox can contract chicken pox only through direct contact with the fluid from a shingles blister. This is the only means of transmitting the virus. A person with shingles can not produce disease in any person who has already had chicken pox nor can they cause shingles to occur in another individual. Since chicken pox can be very serious in pregnant women or persons undergoing chemotherapy, such persons should avoid contact with people experiencing active shingles. Once the shingles blisters have dried, the virus can no longer be transmitted.

TREATMENT FOR HERPES ZOSTER

Several oral anti-viral medicines are available to treat shingles. These medications help reduce the pain associated with shingles and cause the more rapid clearing of the rash. These medications are most effective if started early in the course of the disease. Shingles that is more than 3 or 4 days old may not respond significantly to treatment. It is important that the full course of medication be completed to maximize its therapeutic benefit. The oral anti-viral medications are very safe with few side effects. They can cause some headache or upset stomach, but do not interact with any other medications. You should inform your physician if you have any underlying kidney problems, since the dosage of medication may require adjustment in persons with kidney disorders.

The acute pain associated with shingles can be treated with a number of different measures. If the discomfort is mild, aspirin, ibuprofen, or similar over the counter pain killers are very effective. If the pain is more severe, a prescription pain killer can be provided until the discomfort subsides. Simple measures that can provide comfort include cool compresses or ice packs, avoidance of overheating caused by hot baths or showers, avoidance of skin irritation caused by wearing course or tight fitting clothing or by applying irritating topical medicines such as alcohol or hydrogen peroxide. Do not open the blisters since this action can increase the chances of a secondary bacterial infection. If the area becomes infected, drains pus, or appears to flare as the rash is resolving, oral antibiotics may be necessary. In patients with organ transplants, underlying malignancies, or those receiving chemotherapy or immune suppressing medications, severe and widespread shingles can develop, This condition can be life threatening. If you are a high risk patient or if you notice the development of blisters outside the initial band of skin, immediately contact your physician.

After the blisters and rash resolve, some scarring or splotchiness in skin coloration may result. No treatment is available for this scarring or pigmentary changes. The discomfort from shingles can linger long after the rash resolves. This constant or intermittent pain is called post-herpetic neuralgia (PHN). Most patients resolve their PHN within several weeks or months without treatment. This spontaneous resolution occurs when the inflammation of the nerves subsides. However, some patients experience discomfort for many months or even years. PHN tends to be more severe and long lasting in older individuals. If PHN develops, treatment can be instituted to help relieve your discomfort. If your discomfort persists for more than 2-3 months, therapy for post-herpetic neuralgia should be considered. However, PHN can be quite difficult and frustrating to treat.

If you have any questions concerning Herpes Zoster, its complications, its treatment, or post-herpetic neuralgia, please contact your physician. Close

Keratosis Pilaris (KP) is an extremely common skin condition that is in no way serious or dangerous. This condition tends to run in families, to be worse in the wintertime, and to be more severe in patients who have underlying atopic dermatitis (eczema). The condition typically begins during childhood or young adulthood as pinpoint-sized , rough, white bumps on the outer arms, thighs, buttocks or trunk. There may be some redness associated with these bumps. In children, the bumps may also be found on the cheeks, but the face is not usually involved in adults. These small bumps may feel like sandpaper. The white center may look like a pimple, but KP is not an infectious process nor is there any pus in these lesions. The fundamental cause of KP is an abnormality in the skin cells that line the hair follicles. For unknown reasons, these cells are abnormally “sticky” and form a tiny spine or plug of dead cells at the opening of the hair follicle.

TREATMENT FOR KERATOSIS PILARIS

At this time, there is no cure for Keratosis Pilaris. However, there are simple treatments that tend to decrease the appearance of the condition. These therapies must be used continually since the condition tends to recur if treatment is stopped. KP does tend to improve somewhat as one approaches middle age.

Keratosis Pilaris can be improved by bathing with mild soaps such as unscented Tone, Dove, Purpose or Cetaphil. The use of moisturizers on a twice daily basis can also lead to improvement. The use of retinoic acid (Retin-A or Renova) or products containing lactic, uric or glycolic acids (alpha hydroxy acids) is beneficial in normalizing the stickiness of the cells in the hair follicles. Since these medicines treat the most fundamental cause of KP, they can be quite helpful in this condition. However, these medications can be somewhat irritating to the skin if used improperly and typically take several weeks before effects are apparent. To decrease the irritation, use these medications sparingly and gradually increase the frequency of their use as your skin gets use to their irritating properties. Close

Lichen Planus is an inflammatory disease that strikes primarily the skin and mucous membranes. In rare cases, it also affects the hair and nails. The causes of Lichen Planus are largely unknown. A few cases are linked to allergic reactions to specific drugs or dental materials. It affects men and women equally and occurs most often in middle-aged adults. Lichen Planus of the Skin

WHAT DOES IT LOOK LIKE?

The rash is characterized by reddish-purple, flat-topped bumps that are usually very itchy. They can be anywhere on the body but seem to favor the inside of the wrists and ankles. The disease can also occur on the lower back, neck, genitals and in rare cases, the hair and nails. Thick patches may occur, especially on the shins.

WHAT CAUSES LICHEN PLANUS OF THE SKIN?

The causes of skin Lichen Planus are not known. Allergic reactions to medications for high blood pressure, heart disease, and arthritis may cause Lichen Planus. In those cases, identifying and stopping use of the drug helps clear up the rash within a few weeks. Most cases of Lichen Planus go away within two years. About one out of five people will have a second attack of Lichen Planus.

HOW IS LICHEN PLANUS TREATED?

There is no known cure for skin Lichen Planus but treatment is often effective in relieving itching and improving the appearance of the rash until it goes away. The two most common methods include the use of topical corticosteroid creams and antihistamine drugs taken by mouth. More severe cases of Lichen Planus may require stronger medications such as cortisone taken internally or a specific form of ultraviolet light treatment called PUVA.

LICHEN PLANUS OF THE MOUTH

Which areas of the mouth are commonly affected by oral Lichen Planus? Lichen Planus of the mouth most commonly affects the inside of the cheeks, gums and tongue. Oral Lichen Planus is more difficult to treat and typically lasts longer than skin Lichen Planus. Fortunately, most cases of Lichen Planus of the mouth cause minimal problems. About a third of all people who have oral Lichen Planus also have skin Lichen Planus.

WHAT DOES ORAL LICHEN PLANUS LOOK LIKE?

Oral Lichen Planus typically appears as patches of fine white lines. These changes usually do not cause symptoms. More severe forms of oral Lichen Planus can cause painful sores and ulcers in the mouth.

HOW IS ORAL LICHEN PLANUS TREATED?

There is no known cure for oral Lichen Planus. The good news is that the disease often causes no pain or burning and treatment may not be needed. More severe forms of oral Lichen Planus with pain, burning, redness, blisters, sores and ulcers can be treated with a variety of topical and oral medications.

WHO IS AT RISK FOR ORAL CANCER?

When Lichen Planus is very severe, especially if the underside of the tongue is involved, there is a slightly increased risk of developing oral cancer. This risk is about twice that of the general population.

SHOULD CERTAIN FOODS BE AVOIDED?

Spicy foods, citrus juices, tomato products, caffeinated drinks like coffee and cola, and crispy foods like toast and corn chips should be decreased or eliminated from the diet as they can aggravate Lichen Planus and interfere with its ability to heal.

NAIL INVOLVEMENT

Nail changes have been reported in about 10 percent of Lichen Planus cases. Usually only a few fingernails or toenails are involved, but occasionally all are affected.

HAIR INVOLVEMENT

In rare cases, Lichen Planus can affect hairy areas. This is called lichen planopilaris and can lead to inflammation, and in some cases to permanent hair loss.Close

Everyone has moles, sometimes 40 or more. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance.

At one time, a mole in a strategic spot on the cheek of a woman, was considered fashionable. Some were even painted on. These were called "beauty marks." However, not all moles are beautiful. They can be raised from the skin and very noticeable, or they may contain dark hairs.

Moles can appear anywhere on the skin, alone or in groups. They usually are brown in color and can be various sizes and shapes. The brown color is caused by special cells that contain the pigment melanin.

Moles probably are determined before a person is born. Most appear during the first 20 years of a person's life. Some may not appear until later in life.

Each mole has its own growth pattern. At first, moles are flat and are brown or black in color, like a freckle. Over time, they usually enlarge and some may develop hairs. As the years pass, moles usually change slowly, becoming raised and lighter in color. Some will not change at all. Most moles will slowly disappear, seeming to fade away. Others will become raised so far from the skin that they develop a small "stalk" and eventually fall off or are rubbed off.

This is the typical life cycle of the common mole. These changes occur slowly since the life cycle of the average mole is about 50 years.

Moles may darken, which can happen after exposure to the sun and sometimes during therapy with certain steroid drugs. During the teen years and pregnancy, moles tend to become darker and larger and new ones may appear.

DIFFERENT TYPES OF MOLES

Recent studies have shown that certain types of moles have a higher-than-average risk of becoming cancerous. Some may develop into a form of skin cancer known as malignant Melanoma. Sunburns may increase the risk of Melanoma.

Moles that appear at birth occur in about 1 in 100 people. They are called Congenital Nevi. These moles may be more likely to develop into Melanoma than moles which appear after birth. When a congenital nevus is more than eight inches in diameter, it poses the greatest risk.

Moles known as Dysplastic Nevi or atypical moles are larger than average (usually larger than a pencil eraser) and irregular in shape. They tend to have uneven color with dark brown centers and lighter, uneven edges. These moles tend to be hereditary.

Persons with Dysplastic Nevi may have a greater- than-average chance of developing malignant Melanoma. These people should be checked by a dermatologist to detect any changes that might indicate skin cancer.

RECOGNIZING THE EARLY WARNING SIGNS - THE ABCD's

Recognizing the early warning signs of malignant Melanoma is important. Remember the ABCD's of Melanoma when examining your moles.

A stands for ASYMMETRY, when one half of the mole doesn't match the other half.
B stands for BORDER, when the border or edges of the mole are ragged, blurred or irregular.
C stands for COLORS, when the color of the mole is not the same throughout or if it has shades of tan, brown, black, red, white or blue.
D stands for DIAMETER, if the diameter of a mole is larger than the eraser of a pencil.
If a mole displays any of these signs, it should be checked immediately by a dermatologist.

Many people have flat moles. Studies have shown that a large percentage of people in their 20's have at least one flat mole on the palms of the hands, soles of the feet and the genitals. These moles are rarely cancerous. It's important to remember that not all moles look alike. They may be skin colored or pink, light tan to brown, and even blue-black. They may be round or oval, or their shape may be irregular. They may be flat or raised, large or small, with or without hairs, mottled or evenly colored. If the appearance of a mole worries you or if it changes suddenly in any way, you should consult a dermatologist.

OTHER PIGMENTED PATCHES ON THE SKIN

If you look closely at your skin, you may notice darkened spots that are not moles. Freckles are the most common of these spots. Unlike moles, they are rarely larger than the size of a pea, although sometimes they may seem to be because they blend into one another. Sun exposure may make freckles darker and they may fade completely in the winter. While moles may appear anywhere on the skin, freckles ordinarily are limited to sun exposed areas, such as the face, neck and upper back. Blondes and redheads freckle most easily.

After a person reaches middle age, he or she may acquire other dark areas that are not moles. The brown, wart-like growths that appear on the face or trunk and look as if they have been stuck to the skin may be seborrheic keratoses.

Multiple small gray-brown spots that may appear on wrists, backs of the hands, forearms, and face could be actinic lentigines. These are also called "liver spots" or "age spots." Both actinic lentigines and seborrheic keratoses are easily diagnosed by your dermatologist and are not cancerous.

MEDICAL TREATMENT OF MOLES

The majority of moles and other blemishes are benign (noncancerous). They will never be a threat to the health of the person who has them. The only spots or blemishes that warrant medical concern are those that do something out of the ordinary--those that act differently from other existing moles. This includes any spot that suddenly changes in size, shape or color or one that bleeds, itches, becomes painful, or first appears when a person is past his twenties.

Occasionally, though, a mole may be a cancerous growth. Therefore, it's best to get medical advice if you notice a mole that does not follow the normal pattern. A dermatologist may be able to assure you that the mole is harmless. To accomplish this, he or she may wish to study a sample of it under a microscope for an accurate diagnosis.

The dermatologist will remove the mole, or part of it, so that thin sections from the tissue can be cut, stained, and examined under a microscope. This is a simple and harmless procedure. Even if the lesion in question is a cancer, cutting through it will not cause the cancer to spread. If the growth was only partially removed and it is found to be cancerous, the dermatologist will then remove the entire lesion.

A person may wish to get rid of a mole simply because it's annoying or unattractive. The most common methods of removal include removing the mole by shave excision or cutting out the entire mole and stitching the area closed.

Most procedures used to remove moles take only a short time and can be performed in a dermatologist's office. Usually a mole will not return once it has been removed. If it does begin to reappear, the patient should see the doctor.

MORE ABOUT MOLES

Many people wonder if it's safe to shave over a mole. Medical studies show that irritation such as shaving will not cause a mole to become cancerous. A person might want to have moles in the beard area removed because they are annoying.

Some moles contain hairs, which a person may consider unattractive. The hairs can be clipped close to the skin's surface, or a dermatologist can remove these hairs permanently.

Another way to make a mole less conspicuous is to disguise it with makeup. Cosmetics specifically designed to cover blemishes provide more complete coverage than do ordinary cosmetics.

Most moles cause few problems. But occasionally a mole may be unattractive, annoying or changing. If you see any signs of change, or want a mole to be removed for cosmetic reasons, consult your dermatologist. Close

Molluscum contagiosum is an extremely common, harmless condition that consists of small, flesh-to-pink colored growths on the skin. When these lesions are small, they can resemble pimples, but as they enlarge they will become waxy or shiny in appearance and may have a small central pit or crater. These growths are caused by a virus. Molluscum are contracted through direct contact with lesions on an affected individual. After one is exposed to the virus, it typically takes several weeks before the first lesions appear. In children, molluscum are typically found on the face or trunk and can number from just one or two to hundreds. Since molluscum is so common and is not dangerous, children do not need to be kept out of school or isolated in any manner. Once lesions are present, they can be easily spread by scratching or picking at the bumps, and like warts, can spread quite rapidly and extensively. The virus easily implants in small breaks in the skin caused by scratching, abrasions or nicks from shaving. The virus affects only the skin and never spreads to internal parts of the body.

TREATMENT FOR MOLLUSCUM CONTAGIOSUM

If left untreated, the body will eventually mount an immune response to the virus, and the lesions will spontaneously disappear without a trace. Unfortunately, this natural immune process may take many months or even years, and many new lesions can develop in the interim. There is no treatment that specifically targets the molluscum virus. All available treatments are effective only through destruction of the virally infected cells. No one treatment is universally effective, and the choice of a particular treatment depends upon the size and number lesions, their locations, and the age of the patient. Treatment options include:

CURETTAGE
This procedure involves using a surgical instrument to quickly scrap the molluscum lesions off the skin. This therapy is somewhat painful or uncomfortable and in some instances, can leave a small scar. It is most effective when only a few lesions are present.

FREEZING WITH LIQUID NITROGEN
This treatment method is also very quick, but is also somewhat painful since the freezing feels similar to a burn. A small scar of light-colored spot can result from this form of treatment.

ACID PREPARATIONS
Lesions can be treated by applying acid directly to the surface of the molluscum. The acid destroys the lesions. However, multiple treatments may be necessary and the medicine can be irritating. PODOPHYLLIN

Podophyllin is a medication used to treat genital warts, but it can sometimes be effective in eliminating molluscum. This medication is applied twice a day for three consecutive. The remaining four days of the week is a rest period that allows recovery from the significant irritation that develops from the treatment. Usually three to six weeks of treatment are necessary.

SIMPLY WAITING
With time the vast majority of patients will spontaneously resolve their molluscum. Since these lesions are not dangerous, the decsion to treat is yours. You should consider the cosmetic apperance of the molluscum as well as the discomfort involved with the treatments and the risks of leaving a scar.

CANTHRONE
A liquid that is derived from the blister beetle is applied to each molluscum and left on for four to six hours. This will cause a small blister to form over the next 24 to 48 hours that may be somewhat uncomfortable. Multiple treatments may be necessary to get rid of all lesions. Close

Pityriasis rosea can occur at any age but it's more common between the ages of 10 and 35. It appears as a rash which can last from several weeks to several months. Usually there are no permanent marks as a result of this disease, although some darker-skinned persons may develop long-lasting flat brown spots. The condition often begins with a large single pink patch of skin on the chest or back. This is usually scaly and is called a "herald" or "mother" patch. Frequently the person with pityriasis rosea will think the patch is a ringworm because of its appearance and will apply anti-fungal medications. This is not beneficial since the rash is not caused by any type of fungus. Within a week or two a few to many smaller pink patches will occur over the trunk and, to a lesser degree, over the skin of the arms and legs. Lesions may also occur on the neck and, rarely, on the face. These later-appearing spots are usually smaller than the "herald patch" but may still be mistaken for ringworm. Occasionally there may be other symptoms, including tiredness and aching. The rash usually fades and disappears within six weeks but can last much longer. The cause of pityriasis rosea is unknown. It definitely is not caused by a fungus or bacterial infection. It is also not due to any known type of allergic reaction. This condition is not a sign of any type of internal disease. Some dermatologists have suggested that a virus may cause this rash. This is based on the fact that the disease usually occurs only once, and occasionally makes a person feel slightly ill. This theory has not been proven, however. It cannot be spread from person to person.

Treatment of pityriasis rosea may include external and internal medications for itching. Soothing medicated lotions and lubricants may be prescribed to combat the rash. Lukewarm, rather than hot, baths may be suggested. Occasionally even anti-inflammatory medications such as corticosteroids may be necessary to promote healing. Patients should be reassured that this disease is not a dangerous skin condition. Pityriasis rosea is a common skin disorder with few symptoms. It is usually mild, and fortunately even the most severe cases respond quickly to proper treatment. Close

Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back.

In some cases, Psoriasis is so mild that people don't know they have it. At the opposite extreme, severe Psoriasis may cover large areas of the body. Doctors can help even the most severe cases.

Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have Psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

WHAT CAUSES PSORIASIS?

The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. This causes the skin to shed itself too rapidly, every three to four days.

People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.

TYPES OF PSORIASIS

Psoriasis comes in many forms. Each differs in how bad it is, how long it lasts, where it is, and in the shape and pattern of the scales. The most common form begins with little red bumps. Gradually these grow larger and scales form. While the top scales flake off easily and often, scales below the surface stick together. When they are removed, the tender, exposed skin bleeds. These small red areas then grow, sometimes becoming quite large.

Elbows, knees, groin and genitals, arms, legs, scalp, and nails are the areas most commonly affected by Psoriasis. It will often appear in the same place on both sides of the body.

Nails with Psoriasis have tiny pits on them. Nails may loosen, thicken or crumble and are difficult to treat.

Inverse Psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks, and genitals.

Guttate Psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, drop-like, scaly spots appearing on the skin. It often clears up by itself in weeks or a few months.

About seven percent of Psoriasis patients also have arthritis, which fortunately is not too severe in most people. In some people, the arthritis is worst when the skin is very involved. Sometimes the arthritis improves when the condition of the patient's skin improves.

HOW IS PSORIASIS DIAGNOSED?

Dermatologists diagnose Psoriasis by examining the skin, nails, and scalp. They may need to take a skin biopsy to examine under the microscope. Close

Rosacea is a very common skin disease that causes redness, swelling or bumps on the face. It previously was referred to as “acne Rosacea” because of its similarities to common teenage acne. However, unlike acne there are no white heads or black heads, and the disease usually starts during adulthood. However, anyone may be affected. The condition is also more frequent in women, fair skinned individuals, and certain families. The cause of Rosacea is unknown.

There are several different forms of Rosacea. In one form telangiectasias (small blood vessels) predominate. These are thin red lines on the face that represent enlarged superficial blood vessels. These vessels sometimes form a net- like pattern or appear as a persistent flushing. The telangiectasias are most commonly found on the checks and the nose, although any area of the face may be affected. Other common lesions are small red bumps which may have superimposed pimples. Rarely, patients may develop deeper, larger, painful cysts. In long-standing, untreated, advanced Rosacea a condition called rhinophyma may develop. This is characterized by a bulbous, enlarged, red nose and puffy checks. The pores are very predominate and the skin is quiet oily. Rhinophyma is much more common in men than it is in women. Several famous people have had rhinophyma including J.P. Morgan, Jimmy Durante and W.C. Fields. In some patients the eyelids or the eyes themselves may become involved. You may experience burning or grittiness in the eyes as a manifestation of this inflammation called conjunctivitis. If this conjunctivitis remains untreated, serious complications and damage to the eyes may develop. If you are experiencing these or other eye symptoms, it is recommended that you be seen by an ophthalmologist.

TREATMENT

At this time there is no cure for Rosacea. However, a number of treatments are available which may alleviated or reduce the symptoms and appearance of Rosacea. Antibiotics in topical and/or oral forms remain the mainstay of medical therapy. Rosacea is not an infectious or contagious disease, and the mechanism by which antibiotics improve this condition is unknown.

There are a number of factors that are known to flare or worsen the symptoms and appearance of Rosacea. It is important to avoid as many of these irritating factors as possible. These irritating factors include: drinking to much alcohol of any type, spicy foods, hot beverages, caffeine, tobacco smoking, extremes in environmental temperature, exposure to sunlight, strong emotions that result in flushing, excessive rubbing or massaging of the face and irritating cosmetics or cleansers. Rosacea is seen in drinkers as well as non-drinkers so it is not a sign of alcohol intake or achoholism.

Despite medical treatment and the avoidance of irritating factors, it can frequently be very difficult to completely eliminate the cosmetic appearance of Rosacea. It is particularly common to have persistent telangiectasias or a flushed appearance to the face. If this appearance is troublesome, a number cosmetic options are available. “Green-based” makeups can be effective in covering the red appearance. The redness and small blood vessels can now be treated with either a laser or intensed pulsed light treatment.

If you have any of the eye symptoms mentioned above it is best that you be treated and regularly followed by a ophthalmologist. Because Rosacea can be so difficulty to control, it is not uncommon that a number of different treatment method or medications must be tried before finding the most effective modality for a particular patient. Close

Seborrheic Dermatitis is one of the most common skin disorders. It is mainly a cosmetic problem and usually can be easily treated.

WHAT IS SEBORRHEIC DERMATITIS?

This condition is an inflammation in areas having the greatest number of sebaceous or oil glands of the skin. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are most commonly affected. Other areas, such as the navel and skin folds under the arms, breasts, groin and buttocks, may also be involved. The affected skin is red and is covered by yellowish, greasy-appearing scales. Itching may or may not occur. When it does, it is usually mild.

ARE DANDRUFF, SEBORRHEA AND SEBORRHEIC DERMATITIS THE SAME?

Dandruff is characterized by excessive scaling on the scalp. There is no skin inflammation. Seborrhea describes excessive oiliness of the skin, especially on the scalp and face. There is no redness and scaling. Patients with seborrhea may later develop Seborrheic Dermatitis.

WHO GETS SEBORRHEIC DERMATITIS?

This condition can occur at any age, but is most common in three distinct age groups-- infancy, when it's called "cradle cap," middle age, and old age. It's not known why it occurs in older people.

Cradle cap in infancy usually clears without treatment by age eight to 12 months. This may be due to the gradual disappearance of hormones passed from the mother to the child before birth. Gentle shampooing is helpful. In some children, this condition may develop only in the diaper area where it could be confused with other forms of diaper rash. When Seborrheic Dermatitis develops at other ages, it may appear, disappear and then reappear. Whether treated or not, this condition comes and goes.

IS THIS CONDITION ASSOCIATED WITH OTHER DISEASES?

Because this is such a common disorder, it's not surprising that some patients may have other skin or systemic diseases. There is an increased occurrence in adults with conditions of the nervous system such as Parkinson's disease and in some patients recovering from stressful medical conditions such as heart attack. Those who have been confined to hospitals or nursing homes for long periods of time and those with immune system disorders, such as AIDS, appear to be more prone to this disorder. Some more intense forms of this condition can be seen in those with psoriasis. People with Seborrheic Dermatitis have no increased risk of other skin diseases. This condition does not progress to, or cause skin cancer, no matter how long it remains untreated.

HOW LONG DOES THIS DISEASE LAST?

While it may subside without treatment, it usually improves temporarily with treatment. In any case, this condition tends to recur.

CAN IT BE PREVENTED?

There is no way to prevent the development or recurrence of Seborrheic Dermatitis. If the rash is a cosmetic problem or if symptoms such as itching are significant, it should be treated. If the scalp is involved, frequent shampooing is usually recommended once the condition clears up. Close

Seborrheic Keratoses (SKs) are a very common condition seen by dermatologists. They are frequently confused with warts or moles. They represent benign (non-cancerous) overgrowths of the outer layer of skin. The cause of SKs is not known; however, they are much more common in certain families. They tend to become more numerous with advancing age. They are not influenced or caused by sun exposure. They are not contagious nor can they be spread.

Seborrheic keratoses are most commonly found on the face and trunk; however, they may appear anywhere on the body. They can range in size from a pinpoint to an inch and a half. Typically the SKs will enlarge for a period of time before stopping their growth and remaining stable for many years. It is impossible to predict what size an individual SK will eventually obtain. The SKs can vary in color from a light yellowish-tan to almost black. The surface can be virtually flat or be very raised and warty. None of these characteristics indicate that a particular SK is dangerous. Occasionally these keratoses will appear on an area of skin that is rubbed by clothing or eyewear and subsequently become irritated or infected. At that time removal or destruction is indicated. Because the Seborrheic Keratoses are located so superficially on the skin, they may sometimes be knocked off with minor trauma or fall off in the shower. If the entire keratoses was not removed, it may return.

TREATMENT

There is no medication available to prevent the development of Seborrheic Keratoses. However, there are a number of approaches for treating SKs that have been developed. All of the treatments involve removing or destroying the cells that make up the keratoses. Treatment options include:

CRYOTHERAPY (FREEZING)
This involves the application of liquid nitrogen to the keratosis. The liquid nitrogen causes instantaneous frostbite which destroys the lesion. The area will then become crusted and scabbed and heal up in several weeks. This treatment is most successful for thinner keratoses.

CURETTAGE
This treatment involves anesthetizing (numbing) the area and using a sharp instrument to scrape the keratosis off the skin. This procedure results in an open wound approximately the size of the keratosis. The wound does not require any stitches and is similar to a burn or a scrape. Instructions on caring for the wound site will be provided. Typically one to several weeks is required for healing, depending upon the size of the original keratosis.

The above treatment methods are equally successful in removing or destroying the SKs. The method chosen will depend upon the size, location and thickness of the lesion. After proper removal, the keratosis should not return; however, it is still possible to develop keratoses at other locations.

Seborrheic keratoses can easily be confused with or mimic more serious skin lesions such as actinic keratoses (pre-cancers), moles or even melanoma, the most serious and aggressive type of skin cancer. Seborrheic Keratoses and melanoma can both enlarge very rapidly, appear very dark in color, and have a variety of colors present in an individual lesion. If you become particularly concerned about a changing lesion, it is advisable that you have it examined by a physician. Do not neglect a potentially serious disorder. The importance of regularly examining your skin can not be overemphasized. Close

Skin cancer is the most prevalent of all cancers. Estimates vary on its occurrence but it is estimated that approximately 700,000 Americans develop skin cancer every year.

SUN AVOIDANCE IS THE BEST DEFENSE AGAINST SKIN CANCER.

The principal cause of skin cancer is almost universally accepted by medical experts to be overexposure to sunlight, especially when it results in sunburn and blistering. Other less important factors would include: repeated medical and industrial x-ray exposure; scarring from diseases or burns; occupational exposure to such compounds as coal and arsenic, and family history.

Prevention is a matter of guarding the skin against the known causes. Since the sun and its ultraviolet rays would seem to be the main culprit, the most effective preventive method is sun avoidance. Limit the exposure of the skin to harmful rays by covering up and using sunscreens with at least a 15 SPF rating.

EARLY DETECTION IS THE SUREST WAY TO A CURE

It is a simple routine to inspect your body for any skin changes. Actinic keratosis and each of the skin cancers depicted in the following pages can be readily detected. If any growth, moles, sore or discoloration appears suddenly or begins to change, see your dermatologist.

PRECANCEROUS SKIN CONDITIONS

In addition to the types of skin cancers illustrated here, be alert for a precancerous lesion called actinic keratosis. These small scaly spots are most commonly found on the face and back of the hands in fair skinned individuals who have had significant sun exposure. If they are not treated, some of them may become skin cancer, requiring more extensive treatment. If they are diagnosed in the early stages, actinic keratosis can be removed by cryotherapy (freezing), by applying a topical form of chemotherapy or by other outpatient procedures.

There are three forms of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.

BASAL CELL CARCINOMA

This tumor of the skin usually appears as a small, fleshy bump or nodule on the head, neck and hands. Occasionally these nodules may appear on the trunk of the body, usually as flat growths. Basal cell carcinomas seldom occur in dark-skinned persons; they are the most common skin cancers found in Caucasians. It has been found that people who have this cancer frequently have light hair, eyes and complexions, and they don't tan easily. These tumors don't spread quickly. It may take many months or years for one to reach a diameter of one half inch. Untreated, the cancer will begin to bleed, crust over, then repeat the cycle.

Although this type of cancer rarely metastasizes (spread to other parts of the body), it can extend below the skin to the bone and cause considerable local damage.

SQUAMOUS CELL CARCINOMA

These tumors may appear as nodules or as red, scaly patches. Squamous cell carcinoma is the second most common skin cancer found in Caucasians. It typically is found on the rim of the ear, the face, the lips and mouth. It is rarely found on dark-skinned persons. This cancer will develop into large masses. Unlike basal cell carcinoma, it can metastasize. It is estimated that there are 2,300 deaths from non-melanoma skin cancers every year.

The cure rate for both basal cell and squamous cell carcinoma is 9 5 percent, when properly treated.

MALIGNANT MELANOMA

It is projected that this most virulent of all skin cancers develops on the skin of 32,000 Americans annually. And every year an estimated 6,800 Americans will die from melanoma. It is important to note that the death rate is at last declining, because patients are seeking help earlier. Melanoma, like its less aggressive cousins, basal cell and squamous cell carcinomas, is almost always curable in its early stages.

Melanoma has its beginnings in melanocytes, the skin cells that produce the dark protective pigment called melanin. It is melanin that is responsible for suntanned skin, acting as partial protection against sun. Melanoma cells usually continue to produce melanin, which accounts for the cancers appearing in mixed shades of tan, brown and black. Melanoma has a tendency to spread, making it essential to treat.

Melanoma may suddenly appear without warning but it may also begin in or near a mole or other dark spot in the skin. For that reason it is important that we know the location and appearance ofthe moles on our bodies so any change will be noticed.

Excessive exposure to the sun, as with the other skin cancers, is accepted as a cause of melanoma, especially among light-skinned people. Heredity may play a part, and also atypical moles, which may run in families, can serve as markers, identifying the person as being at higher risk for developing melanoma there or elsewhere in the skin.

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

Other warning signs include: changes in the surface of a mole; scaliness, oozing, bleeding or the appearance of a bump or nodule; spread of pigment from the border into surrounding skin; and change in sensation including itchiness, tenderness, or pain.

HOW SKIN CANCER IS TREATED

If a laboratory test reveals that an area of the skin is cancerous, the dermatologist has an array of procedures to choose from, dependent on the needs of the individual patient. In the treatment of any of the skin cancers, early detection and removal is the best defense.

Fortunately, skin cancers are relatively easy to detect and most can be cured. Even malignant melanoma, if caught in its early stages, can be treated successfully.

Dermatologists recommend that one helpful way to guard against melanoma/skin cancer is to do periodic self-examinations. Get familiar with your skin and your own pattern of moles, freckles and "beauty marks." Be alert to changes in the number, size, and shape and color of pigmented areas. If any changes are noticed call your dermatologist.

THE ABCD's OF MELANOMA

ASYMMETRY
One half doesn't match the other half.

BORDER IRREGULARITY
The edges are ragged, notched or blurred.

COLOR
The pigmentation is not uniform. Shades of tan, brown and black are present. Dashes of red, white and blue add to the mottled appearance.

DIAMETER
Greater that six millimeters (about the size of a pencil eraser). Any growth of a mole should be of concern.

PERIODIC SELF-EXAMINATION
Prevention of melanoma/skin cancer is obviously the most desirable weapon against this disease. But if a lesion should develop, it is almost totally curable if caught in the early stages. To aid in early recognition of any new or developing lesion, periodic self-examinations are helpful. The following is a suggested method of self-examination that will ensure that no area of the body is neglected. To perform your self-examination you will need a full length mirror, a hand mirror and brightly lit room.

1. Examine body front and back in mirror, then right and left sides, arms raised.
2. Bend elbows, look carefully at forearms, back of upper arms and palms.
3. Next, look at backs of legs and feet, spaces between toes, and soles.
4. Examine back of neck and scalp with a hand mirror. Part hair to lift.
5. Finally, check back and buttocks with a hand mirror. Close

Hives are pink swellings called "wheals" that occur in groups on any part of the skin. Each individual wheal lasts a few hours before fading away, leaving no trace. New hives may continue to develop as old areas fade. They can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. When hives are forming they usually are very itchy, but may also burn or sting.

Hives are produced by blood plasma leaking through tiny gaps between the cells lining small blood vessels in the skin. A natural chemical called histamine is released from cells called "mast cells" which lie along the blood vessels in the skin. A number of different things including allergic reactions, chemicals in foods, or medications can cause a histamine release. Sometimes it's impossible to find out why histamine is being released and hives are forming.

Hives are very common --10-20 percent of the population will have at least one episode in their lifetime. Hives usually go away within a few days to a few weeks. Occasionally, a person will continue to have hives for many years.

When hives form around the eyes, lips or genitals, the tissue may swell excessively. Although frightening in appearance, the swelling usually goes away in less than 24 hours. Your dermatologist may use the term angioedema to describe this type of swelling. It's also used to describe very deep large hives on other areas of the body.

ACUTE URTICARIA

Hives are classified according to how long the attacks last and how frequently they occur. The term "acute Urticaria" is used for hives lasting less than six weeks. With this type of hives, the cause or causes can usually be identified and eliminated. The most common causes of hives are foods, drugs or infections. Insect bites and internal disease may also be responsible. Other causes can be physical stimuli, including pressure, cold and sunlight.

FOODS

The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also be responsible.

Hives may appear within minutes or up to two hours after eating, depending on where the food is absorbed in the digestive tract.

DRUGS

Almost any prescription or over-the-counter medication can cause hives. Some of those drugs include antibiotics (especially penicillin ), pain medications, sedatives, tranquilizers and diuretics. Antacids, vitamins, eye and ear drops, laxatives, vaginal douches, or any other non-prescription item can be a potential cause of hives. If you have an attack of hives, it's important to tell your doctor about all of the preparations that you use to assist him/her in finding the cause.

INFECTIONS

Many infections can cause hives. Viral upper respiratory tract infections are a common cause in children. Other viruses including hepatitis B may also be a cause, as well as a number of bacterial and fungal infections.

CHRONIC URTICARIA

Bouts of hives lasting more than six weeks are called chronic Urticaria. The cause of this type of hives is usually much more difficult to identify than that of acute Urticaria. In studies of patients with chronic Urticaria, the cause was identified in only a small percentage of patients. Your doctor will need to ask numerous questions in an attempt to find the possible cause. Since there are no specific tests to determine the cause of hives, testing will vary depending on your medical history and based on a thorough examination by your dermatologist. Routine blood tests are of little or no value.

PHYSICAL URTICARIAS

Certain people can develop hives from sunlight, cold, pressure, vibration or exercise. Hives due to sunlight are called solar Urticaria. This is a rare disorder in which hives come up within minutes of sun exposure on exposed areas and fade within one to two hours. Reaction to the cold is more common. Hives appear when the skin is warmed after exposure to cold. If the exposure to cold is over large areas of the body, large amounts of histamine may be released which can produce wheezing, flushing, generalized hives and fainting. A simple test for this type of hives can be done by applying an ice cube to the skin.

Cholinergic Urticaria consists of tiny (about 1/8 inch) bumps surrounded by a white or red halo which come on with exercise, heat or emotion. These bumps itch intensely. Anything which raises the skin temperature can cause these tiny hives - sweating, sunlight, hot baths, blushing or anger.

The most common of the physical Urticarias is called dermatographism. It affects about 5 percent of the population. Most people with this condition are otherwise healthy. Hives form from firmly stroking or scratching the skin. These hives may be very itchy. This condition can also occur along with other forms of Urticaria. If it is present along with hives, finding and eliminating the cause usually clears the dermatographism. Otherwise, it may persist for months or even years.

TREATMENT

The best treatment for hives is to find the cause and then eliminate it. Unfortunately, this is not always an easy task. While investigating the cause of hives, or when a cause cannot be found, antihistamines are usually prescribed by your dermatologist to provide some relief. Antihistamines work best if taken on a regular schedule to prevent hives from forming. No one antihistamine works best for everyone, so your doctor may need to try more than one or different combinations to find what works best for you.

In severe cases of hives, an injection of epinephrine (adrenalin) or a cortisone preparation, as prescribed by your dermatologist, may bring dramatic relief. Close

Vitiligo is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few to many milky-white patches.

WHO GETS VITILIGO?

Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about one fifth have a family member with this condition. Most people with Vitiligo are in good general health.

WHAT DETERMINES SKIN COLOR?

Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white.

WHAT CAUSES VITILIGO?

Vitiligo is the result of the disappearance of the skin's melanocytes. No one knows why, but four main theories exist:
1. Abnormally functioning nerve cells may make toxic substances that injure melanocytes.
2. The body's immune system may destroy melanocytes. Researchers think pigment may be destroyed as the body responds to a substance it perceives as foreign.
3. Pigment-producing cells may self-destruct. While pigment is forming, toxic byproducts could be produced and destroy melanocytes.
4. There is a genetic defect that makes the melanocytes susceptible to injury.

HOW DOES VITILIGO DEVELOP?

The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of Vitiligo and suntanned skin in the summer. Year round, Vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment virtually everywhere. There is no way to predict how much pigment an individual will lose.

Typical Vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each Vitiligo patch. There may be different shades of pigment in a patch or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely.

It is rare for skin pigment in Vitiligo patients to return on its own. Some people who believe they no longer have Vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. While their skin is all one color, they still have Vitiligo.

HOW IS VITILIGO TREATED?

Sometimes the best treatment for Vitiligo is no treatment at all. In fair-skinned individuals, avoiding tanning of normal skin can make areas of Vitiligo almost unnoticeable.

The white skin of Vitiligo has no natural protection from sun. These areas are very easily sunburned. A sunscreen with an SPF of at least 15 should be used on all areas of Vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.

Disguising Vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. Stains that actually dye the skin gradually wear off and can be used to dye the white patches to more closely match normal skin color. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance.

If sunscreens and coverups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are total, permanent cures.

REPIGMENTATION THERAPY

Topical Corticosteroids - Creams containing corticosteroid compounds can be effective in returning pigment to small areas of Vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

PUVA is a form of repigmentation therapy where a type of medication known as psoralen is given. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Special medical equipment is needed for this treatment. Sometimes, when Vitiligo is very limited, psoralens can be applied to the skin before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50-70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under very close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, special glasses must be worn during treatment and usually for at least 12 hours after treatment. This eye protection is needed to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 9, in pregnant or breast feeding women or in individuals with certain medical conditions.

Grafting - Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of Vitiligo patients. It does not generally result in total return of pigment in treated areas.

DEPIGMENTATION THERAPY

For some patients with severe involvement, the most practical treatment for Vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.

TREATMENT OF VITILIGO IN CHILDREN

Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA is usually not recommended until after age 9, and then the risks and benefits of this treatment must be carefully weighed.

IS VITILIGO CURABLE?

Research is ongoing in Vitiligo and it is hoped that new treatments will be developed. At this time, the exact cause of Vitiligo is not known and although treatment is available, there is no single cure. Close