Acne vulgaris or acne
is the medical term for pimples. It usually begins in puberty
in both sexes when the adrenal glands (which sit on top of the
kidneys) and sex organs start producing androgens (male hormones).
Acne is most common between the ages of 16 - 18 and becomes less
common thereafter. However, about 1 in 5 adults, especially women
continue to be troubled by acne, although it is usually less severe.
Acne usually affects the face and occasionally, the neck, chest,
shoulders and back, as well. Treatment is not a cure but it can
the problem and reduce the risk of permanent scars.
Causes
The exact cause is unknown but the following factors may play
a role:
Increased sebum
(skin oil) production by the sebaceous glands (skin's oil-glands)
under the influence of androgens.
Blockage of the hair follicles (skin
pores), resulting in comedones
(whiteheads and blackheads).
Proliferation of Propionibacterium
acnes (the acne bacteria) which converts sebum into irritating
fatty acids.
Inflammation caused by the seepage or release
of irritating fatty acids into the dermis, resulting in red papules
(red pimples) or pustules ("pusheads") and in some
patients, nodules (deep and sometimes painful swellings that
look like boils).
Aggravating factors
Family history of
severe acne.
Stress.
Hot, humid environment.
Occupational
due to exposure to acne causing chemicals such as mineral oil
and halogenated aromatic hydrocarbons, including dioxin. The
latter causes chloracne.
Pre-menstruation.
Cosmetics such as
moisturisers containing acne causing ingredients such
as isopropyl myristate, lanolin, sodium
lauryl sulfate, laureth-4, butyl stearate, lauryl alcohol, oleic
acid, petroleum oils).
Friction from headbands
and chin straps.
Medications such as
lithium (used to treat manic-depressive states), phenytoin (used
to treat epilepsy or fits), iodides, anti-tuberculous drugs (ethionamide,
rifampicin, isoniazid), B vitamins and cyclosporin (used to prevent
the rejection of transplanted organs), systemic steroids, testosteroneand anabolic steroids (sometimes abused by athletes and body-builders).
Polycystic ovaries
which produce androgens (male sex hormones).
Excessive production
of corticosteroids (Cushing's syndrome).
Key Points
Acne is not caused
by uncleanliness, unfulfilled sexual desires or "dirty blood".
Acne is not caused
by fatty foods or chocolates.
Acne gets better eventually
or "burns itself out" even without treatment but the
scars that result from neglected acne are permanent.
Early treatment is
advised, especially if the parents have a history of severe acne.
There is no quick
cure for acne but treatment can control acne and help to prevent
severe and permanent scarring.
Treatment is often
prolonged, spanning many months or even years and relapses are
common, requiring retreatment.
There is no definite
evidence that dietary items cause or flare-up acne. However,
there is no harm in avoiding those substances suspected of doing
so temporarily to see if there is any change.
Symptoms
Comedones - open comedones (blackheads)
and closed closed comedones (whiteheads).
Red papules (red bumps
or pimples).
Pustules (pusheads).
Nodules (large swellings
that may be painful and look like boils).
Cysts (fluid-filled
swellings).
Seborrhoea (increased oiliness) is frequently
present.
In a severe type of
acne known as acne conglobata, there are multiple nodules,
cysts and abscesses. Acne fulminans is even more severe.
It looks like acne conglobata but is associated with fever and
joint pains.
Moderately severe acne
showng inflamed papules.
Click
on image for larger view.
Cyst near the eye.
Click
on image for larger view.
Complications
Colour changes - postinflammatory
erythema (red blotches), postinflammatory hyperpigmentation (dark
blotches) and postinflammatory hypopigmentation (lightened blotches).
These are temporary.
Scarring - depressed
pock-like scars, pitted scars, ice pick scars and keloids. Scars
are permanent but can be improved with treatment.
Loss of self-esteem
What you can do
You should consult
a doctor if you have severe acme or want faster results.
See a doctor if these
measures don't help or if the acne is very severe and is causing
scarring.
Do not pick or squeeze
acne as this causes more inflammation and increases the risk
of scarring.
Emotional stress can
worsen acne. Learn to cope with stress.
Some drugs can make
acne worse. Check with your doctor.
Many cosmetic ingredients
can cause acne so switch products if you notice more acne appearing.
Avoid using moisturisers
routinely. If you must, use only water-based moisturisers and
check that the label says "non-comedogenic" or "non-acnegenic".
Preferably, they should not contain the acne-causing
ingredients above.
The use of make-up
is permissable if they are water-based or oil-free and non-comedogenic.
What the doctor
may do
Counsel you about
acne.
Perform blood tests
if there is evidence of excessive hormones and pelvic ultrasound
if he suspects polycystic ovaries.
Prescribe topical
(applied) or oral (taken by mouth) antibiotics, topical tretinoin
(vitamin A acid), oral isotretinoin
(another vitamin A acid), oral antiandrogens (used only in women
only).
This is a form of actinic
keratosis affecting the lower lip. Like actinic
keratoses, it is also more common among fair-skinned individuals,
especially those of Celtic origin.
Cause
Sun-damage.
Symptoms
Redness, scaling,
cracking and crusting of the lower lip.
Actinic keratoses or
solar keratoses are precancerous skin growths found on areas most
exposed to the sun such as the face, ears, sides of the neck and
back of the hands and forearms. The term actinic
cheilitis is used when it affects the lower lip. Actinic keratoses
are more common in the elderly because of years of exposure to
the sun and in fair-skinned individuals, especially those of Celtic
origin.
Cause
Sun-damage.
Symptoms
Red or yellow-brown,
scaly patches which feel coarse like sandpaper.
Other signs of chronic
sun damage such as solar elastosis, senile comedones
(whiteheads and blackheads) and telangiectasiasmay be present.
Cutaneous horns are a variety of actinic keratoses.
They project out of the skin rather like a small horn.
Actinic keratosis on the
neck.
Click
on image for larger view
Actinic lentigines,
senile lentigines, solar lentigines, "liver spots" and
"age spots" are different terms for the same condition.
They occur on the sun-exposed skin of the middle-aged and elderly.
Causes
Sun-damage.
Symptoms
Light or dark brown
blotches measuring 4 - 30 mm in size.
Affects the sun-exposed
areas, especially the face, back of the hands, the forearms,
upper back and chest.
Actinic lentigines.
Click
on image for larger view.
What you can
do
You can consult a
doctor for remioval.
Protect your skin
against further sun-damage (see sun
protection ).
Caution
Lentigo maligna appears as a slowly growing
flat dark patch with an irregular and indistinct border and various
shades of brown, tan and black. It occurs most commonly on the
face or neck of an elderly person and can develop into malignant
melanoma.
What the doctor
may do
Perform a skin biopsy
if the diagnosis of lentigo is uncertain or if there is a possibility
of lentigo maligna.
Intrinsic ageing
which is genetically
determined and
Photoageing (dermatoheliosis) which is caused by excessive
exposure to the sun. Fair-skin individuals and those occupationally
or recreational exposed to the sun are likely to develop photoageing
early. Eighty per cent of the signs of ageing is believed to
be caused by sun damage. Accordingly, the best way to delay ageing
is to minimise exposure to the sun (see sun
protection).
Symptoms
The symptoms depend on the site of damage:
This is a rare inherited
condition caused by the partial or total lack of melanin. The
most common form of albinism is called oculocutaneous albinism.
Partial albinism is much rarer and affects only the skin, the
hair or the eyes. Ocular albinism affects the eyes alone.
Causes
Inherited defect in
the synthesis of the skin pigment, melanin. Oculocutaneous albinism
and ocular albinism have different modes of inheritance - autosomal
dominant, autosomal recessive or X-linked.
Symptoms
In severely affected
cases, the skin and hair are snowy white.
The iris (the area
of the eyes surrounding the pupil) and the retina (back of the
eyes) are white and the eyes cannot tolerate bright lights and
are affected by nystagmus (abnormal jerky eye movements), squint
and myopia (short-sightedness).
Ocular albinism affects
the eyes alone.
Complications
There is a high risk
of skin cancer developing in oculocutaneous albinism because
the skin lacks the melanin that shields off harmful ultraviolet
rays.
What you can do
You should consult
a doctor.
Protection against
the sun is very important because of the risk of skin cancer
developing (see sun protection).
What the doctor
may do
Provide genetic counseling
and advice on sun-protection.
Follow-up closely
for the developing of skin cancers.
Allergy is an abnormal
reaction to substances that are normally harmless or beneficial
to the body.
Cause
Normally, our bodies
produce antibodies in response to attack by a potentially harmful
foreign substance such as viruses and bacteria. In the case of
an allergy, however, antibodies are produced against substances
that are harmless or good for the body (for example, food items
or a particular treatment). These antibodies combine with the
substance (known medically as the allergen) and this sets
off a chain of chemical reactions that lead to the release of
histamine, the chemical that produces most of the symptoms of
an allergy. The allergen may be a substance taken into the body
such as a drug or food item, dust, venom from an insect bite
(see bites and
stings) or a substance that has been in contact with the
skin such as costume jewelry, cosmetics or plants (see contact
dermatitis). Theoretically, any substance can cause an allergy,
including one the person has taken or been in contact with before
without problems.
Go to the nearest
Accident and Emergency Department if you have generalised urticaria
or swelling of the eyelids, lips or difficulty breathing or if
there are signs of anaphylaxis developing.
Determine the cause
of the allergy with the aid of patch
tests, skin tests
(prick or intradermal tests) or RAST
tests if necessary.
Desensitise selected
cases. This is done by injecting small doses of an allergen in
order to train the body to accept it. However, desensitisation
is only available for some allergens such as house dust, poison
ivy and bee
and wasp stings and there is a small risk of desensitisation
causing a severe reaction.
Prevention
Avoid the substances
you are allergic to.
Apply for a medical
alert (for example, Medik Awas) card and carry it on your person
all the time. Get the application form from your doctor.
Inform your doctor,
dentist, and pharmacist each time you see them.
Inform your relatives
about your allergy, as well.
Alopecia is the medical
term for hairloss. Doctors divide alopecia into non-scarring and
scarring alopecia. Scarring alopecia is due to inflammation causing
scarring and destruction of the hair follicles. The causes include:
Alopecia areata causes
hairloss in round patches. It usually affects young adults and
children and may be associated with a family history of alopecia
areata or other autoimmune disorders (self-allergies) such as
vitiligo and thyroid disease (Hashimoto's thyroiditis).
Cause
Alopecia areata is
believed to be an autoimmune disorder in which the body produces
antibodies that attack the hair follicles as though they were
foreign.
Symptoms
Solitary or multiple
well-defined circular bald patches on a normal or occasionally,
slightly reddish skin.
Broken hairs may be
seen in the bald patch. They have broken-off stubbled ends and
are often referred to as exclamation mark hairs because of their
appearance.
The scalp is most
commonly affected. Less commonly affected areas include the eyebrows,
eyelashes, pubic hair and beard.
Complications
Alopecia areata may occasionally lead to widespread hairloss
causing:
Alopecia totalis which causes total baldness
of the scalp.
Alopecia universalis where the hairloss affects
the entire body including eyebrows, armpit and the pubic hair.
Muliple patches of alopecia
areata.
Click
on image for larger view.
Severe alopecia areata
progressing to alopecia totalis.
Click
on image for larger view.
What you can
do
You should consult
a doctor.
Nothing if the patches
are small, few and not increasing is size or number. Eighty per
cent of patients with alopecia areata will regrow hair, though
it may take up to 6 months.
Consider wearing a
wig during the interim period.
What the doctor
may do
Exclude other causes
of patchy hairloss such as scalp ringworm (tinea
capitis) and folliculitis.
Prescribe dithranol
(a tar derivative) cream, topical minoxidil
5% or use PUVA.
Keypoints
New hairs may be white
and fine but they will become normal eventually.
There is a 50% relapse
rate within 5 years of successful treatment.
The chances of regrowth
is less if alopecia areata develops before puberty or is very
extensive (for example, alopecia totalis and alopecia universalis).
Anaphylaxis is a severe
and potentially fatal type of allergic reaction. Antibodies react
with the allergen (allergy causing substance) stimulating the
release of chemical substances, especially histamine. Histamine
causes the muscles in the muscles in the digestive and respiratory
tracts to contract, causing abdominal cramps and wheezing. Histamine
also causes the blood vessels to enlarge and leak fluid into the
surrounding tissues, causing weals (urticaria)
and swelling of the throat and larynx (angioedema),
causing breathing difficulties. The movement of fluid out of the
blood vessels into the surrounding tissues also leads to a decrease
in blood volume, causing low blood pressure and shock.
This is a very common
type of hairloss known also as common baldness, male pattern baldness
and female pattern baldness. It may begin early as after puberty.
Causes
Androgens (male hormones).
Inherited sensitivity
of the hair follicles to androgens.
Symptoms
The symptoms may differ in men and women:
Male androgenetic
alopecia (male pattern hairloss)
Begins as a receding
hairline around the temples, producing an M-shaped pattern. Then
thinning or a bald patch develops at the crown. In severe cases,
these areas merge leaving a horseshoe rim of hair at the back
and sides of the head.
Cheilitis refers to
inflammation of the lips. Angular cheilitis is a type of cheilitis
affecting the corners of the mouth.
Causes
Chapping from cold
dry environments.
Atopic cheilitis (exfoliative
cheilitis) which is a type of atopic dermatitis affecting the
lips (see atopic dermatitis).
Drugs such as isotretinoin, a vitamin
A acid used to treat severe acne.
Contact cheilitis
(a type of allergic or irritant contact
dermatitis affecting the lips) due to lipsticks, lipbalms,
toothpastes, foods, saliva (lip licking cheilitis).
Cheilitis glandularis.
Symptoms
Red, scaly, cracked
lips.
Redness, swelling
and blistering may be seen in contact cheilitis.
Cracks with scaling
at the corners of the mouth in angular cheilitis.
Swollen lips with
numerous pinhead sized openings of the salivary glands in the
lips may be seen in cheilitis glandularis.
Itching.
Pain.
Complications
Secondary bacterial
infection.
What you can do
You should consult
a doctor.
Avoid lip licking.
Avoid eating acidic
foods or insert directly into the mouth without touching the
lips.
This is a type of urticaria involving the deeper parts
of the skin and mucous membranes. It may be life threatening when
it affects the throat as it may cause suffocation and death.
Causes
Allergy, for example
to food products, drugs, insect bites.
Inherited angioedema which is caused by the lack
of a C1 esterase inhibitor, an enzyme that keeps the complement
system in check. The complement system controls the production
of chemicals that cause inflammation.
Symptoms
Large swellings in
the skin and and mucous membranes. On the face, it may cause
swelling of the eyelids and lips and severely distort the facial
contours. In the throat, the swelling may cause difficulty breathing
and suffocation.
Abdominal cramps,
nausea and vomiting due swelling in the mucous membrane lining
of the intestines.
Burning pain and occasionally,
itching.
Complications
Impairment of vision
due to swollen eyelids.
Breathing difficulties,
wheezing and suffocation when it affects the throat.
Death from suffocation.
What you can do
Go to the nearest
Accident and Emergency department.
What the doctor
may do
Administer antihistamines,
adrenaline and corticosteroids
and insert a breathing tube or perform a tracheostomy (create
a hole in the windpipe) if there is suffocation.
Determine the cause
so that future attacks can be avoided.
Prescribe danazol
in cases of inherited angioedema.
Angiokeratomas are red-purple
bumps. Most angiokeratomas occur for no known reasons and are
few and generally harmless. Some angiokeratomas are more widespread
and these may be associated with a genetic disorder known as Fabry's
disease.
Cause
Unknown.
Due to Fabry's
disease (angiokeratoma corporis diffusum) which is inherited
as an X-linked recessive disorder. X-linked means the defect
occurs in the X chromosome and only males are affected and women
are carriers.
Symptoms
Red-purple raised
spots on the body, scrotum or hands and feet.
Fabry's disease is
associated with heart and kidney disease and high blood pressure
and widespread angiokeratomas.
Complications
Only occurs in Fabry's
disease because of heart and kidney involvement. Death may result
from kidney or heart failure.
What you can do
You should consult
a doctor.
What the doctor
may do
Exclude the Fabry's
disease which causes kidney and heart problems.
Remove angiokeratomas
using lasers, electrosurgery
or surgical excision.
Annular means ring-like and erythema
means reddish. Annular erythema, therefore is the term used for
a group of skin disorders characterised by reddish ring-shaped
rashes.
Erythema chronicum
migrans (ECM)
Expanding red ring
with clearer centre.
Fever, chills, muscle
pains and headaches.
ECM is due to a spiral
shaped bacteria called Borrelia burgdorferi which is transmitted
by tick bites. It is more common in the US and Parts of Europe.
Erythema annulare
centrifugum
Expanding red ring-shaped
patch with a scaly border lagging behind. Lasts weeks to years.
May be associated
with fungal infection, parasitic bowel disease or autoimmune
disorders.
Erythema gyratum
repens
Red ring-shaped rashes
that are arranged in a wood-grain pattern.
Usually associated
with underlying cancer.
Erythema marginatum
Red ring-shaped rashes
that change in size and shape.
A sign of rheumatic
fever, a streptococcal bacterial infection that causes arthritis,
heart valve inflammation and fever.
What you can do
You should consult
a doctor.
What the doctor
may do
Perform investigations
to determine the cause, if any.
Aphthous ulcers or canker
sores are common mouth ulcers that affect at least 20% of the
population. They occur most frequently during early adult life
and become less common with age. The ulcers number from 1 - 5
and heal spontaneously after 1 - 2 weeks but often recur.
Causes
The exact cause is unknown but the following may play a role:
Trauma during chewing
and brushing.
Food allergies.
Stress.
Hypersensitivity reaction
to bacteria.
Hormonal factors may
be involved as some women develop the ulcers just before menstruation.
Symptoms
1 - 5 small, round
painful ulcers with yellowish-white base and a red halo. They
are most frequently found on the lips, the inside of the cheeks
and sometimes, the tongue.
What you can do
Gargle with an antiseptic
mouth wash or salt solution prepared by dissolving a teaspoonful
of table salt in 1 pint of water two or three times a day.
You can consult a
doctor.
What the doctor
may do
Confirm the diagnosis.
Prescribe anaesthetic
gels to rub into the ulcers so as to reduce pain.
Atopic dermatitis is
a type of eczema that occurs in people with a family history of
allergic conditions such as asthma (wheezy breathing), allergic
rhinitis (itchy, runny nose) and atopic dermatitis. Atopic is
the adjective for "atopy" which is an inherited predisposition
to hypersensitivity reactions in the skin (atopic dermatitis),
bronchi or breathing tubes (asthma) and allergic rhinitis (nasal
passages). Atopic dermatitis usually occurs between the 2 months
and 2 years of age and improves with age so that 80 - 90% of those
affected are very much improved by the time they reach puberty.
The sites most commonly affected include the face, neck, front
of the elbows and behind the knees. Atopic dermatitis is estimated
to affect 3% of children.
Cause
The atopic tendency
or predisposition to asthma, allergic rhinitis and atopic dermatitis
is believed to be inherited. However, this tendency is not specific
which means that a parent with atopic dermatitis may have an
offspring with asthma rather than atopic dermatitis or vice versa.
Two-thirds of patients give a personal or family history of asthma,
allergic rhinitis or atopic dermatitis.
Symptoms
In young children,
atopic dermatitis usually affects the face, scalp, napkin areas
and limbs or it can be quite generalised
In older children
and adults, it usually affects the neck and front of the elbows
and back of the knees.
Itch is usually severe
and there are often scratch marks and even bleeding points. Scratching
make the dermatitis worse so an itch-scratch-rash cycle develops,
causing the dermatitis to flare suddenly. Constant scratching
leads to lichenification (leathery thickened and darkened skin).
Recurrences are characteristic.
The other signs are:
Acute eczema - redness, papules (pimply
bumps), weeping, crusting and broken skin due to scratching.
Chronic eczema - dry, scaly and lichenified
(leathery thickened and often darkened) skin.
Atopic dermatitis affecting
the backs of the knees.
Click
on image for larger view.
Complications
Bacterial infection
due to scratching.
Herpes simplex virus
infection ("cold sores") leading to eczema
herpeticum.
You should consult
a doctor for treatment and advice.
Take simple antihistamines
to relief itch.
Avoid over-drying
the skin (see preventing dryness below).
Avoid rough textured
fabrics.
Avoid foods that appear
to aggravate the eczema.
Cut the fingernails
short so as to reduce trauma to the skin. Mittens can be worn
at night for the same purpose.
Take Evening Primrose
Oil or Borage Oil (types of health food) which may sometimes
help to reduce the severity of atopic dermatitis.
Stress is a common
cause of relapse. Confront and deal with stresses.
Keep away from persons
with active herpes
simplex virus infection ("cold sores").
Avoid careers which
involve excessive exposure to heat, chemicals and degreasing
agents; for example, hairdressing, nursing or industrial work.
Avoid hot humid jobs.
Preventing dryness
Avoid long, hot baths.
Instead take short warm showers.
Avoid soap or use
emulsifying ointment in place of soap.
If you find not using
soaps unpalatable, use a mild dermatological soap or bath oil
instead.
Apply moisturisers
after baths/showers and as frequently as necessary.
What the doctor
may do
Prescribe topical
steroids and in severe cases, even oral steroids and cyclosporin
(an immunosuppressive
drugs used to prevent the rejection of transplanted organs).
PUVA may be used in adults
with very resistant atopic dermatitis.
Hospitalise severe
cases for treatment and rest. Severe eczema can sometimes improve
in response to a change in the environment alone.
Prescribe antibiotics
for secondary bacterial infection.
Perform skin
tests (prick or intradermal tests) and RAST
to exclude food allergies in selected cases.
Advise elimination
diets in selected cases. A small proportion (about 10%) of children
with atopic dermatitis have food allergies and improve when the
offending food is eliminated from the diet. Some of the foods
reported to cause allergies include eggs, cow's milk, nuts and
fish. Because many of these foods have superior nutritional value,
elimination diets are generally used only under a doctor's supervision
and when simple treatments do not work.
