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Acanthosis nigricans | Acne vulgaris | Acrochordons | Actinic cheilitis | Actinic keratoses | Actinic lentigines | Age Spots (go to actinic lentigines) | Ageing skin | Albinism | Allergy | Alopecia | Alopecia areata | Anaphylaxis | Androgenetic alopecia | Angioedema | Angiokeratomas | Angular cheilitis | Annular erythema | Aphthous ulcers | Aplasia cutis | Athlete's foot (see tinea pedis) | Atopic dermatitis | Atopic eczema (go to atopic dermatitis) | Atrophie blanche

This is a skin condition that causes a dark velvety thickening of the skin on the neck, armpits and groin.

Causes

• Endocrine of hormonal abnormality.
• Inherited disorder.
• Drug induced eg., from nicotinic acid, oral contraceptives and stilboestrol.
• Obesity when it is called pseudoacanthosis nigricans.
• Underlying cancer.

  Symptoms

• Thick, grey or black velvety skin on the neck, groin or armpits.
• In acanthosis nigricans due to underlying cancer, there may be velvety thickening inside the mouth, as well.

  Acanthosis nigricans affecting the armpit in a patient with underlying cancer. Click on image for larger view.

  What you can do

• You chould consult a doctor to determine the cause.
• Weight reduction may improve pseudoacanthosis nigricans.

  What the doctor may do

• Determine the cause.
• Treat the underlying cause.

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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, testosterone and 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.
• Clean with a medicated cleanser/soap.
• Apply topical keratolytics (peeling agents) containing benzoyl peroxide, sulphur or salicylic acid.
• 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).
• Inject intralesional steroids into nodules, cysts and keloids (lumpy scars).
• Perform surgery to drain cysts (rarely necessary nowadays with new and more effective medication) or to improve scars.
• Perform chemical peels and laser resurfacing to improve acne scars.

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Acrochordon (papilloma) is the medical term for a skin tag. This is a harmless skin growth, commonly seen in middle-aged adults.

Causes

Uncertain but the following factors appear to influence it's development:-


• Familial tendency.
• Obesity.

  Symptoms

• Small fleshy skin-coloured tags.
• Occur on areas subjected to friction such as the neck, armpits, groins and under the breasts and occasionally, on the eyelids as well.
• They may increase in numbers during pregnancy.

  Acrochordons (skin tags) on the neck. Click on image for larger view.

  Complications

• Torsion (twisting on itself) causing inflammation and pain.

  What you can do

• You can consult a doctor for removal.
• Do nothing since skin tags are cosmetic in nature.

  What the doctor may do

• Remove them using surgical excision, electrosurgery, carbon dioxide laser or liquid nitrogen.

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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.

  Complications

• May develop into a squamous cell cancer.

  What you can do

• You should consult a doctor.
• Use sunscreen-containing lip balms or lip sticks.

  What the doctor may do

• Perform a skin biopsy to confirm the diagnosis.
• Counsel you about sun protection.
• Excise (cut) or treat with the carbon dioxide laser or electrosurgery.

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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 telangiectasias may 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

  Complications

• May develop into a squamous cell cancer.

  What you can do

• You should consult a doctor.
• Protect your skin against further sun-damage (see sun protection).

  What the doctor may do

• Perform a skin biopsy to confirm the diagnosis.
• Counsel about sun protection.
• Treat with topical 5-fluorouracil, liquid nitrogen, electrosurgery and curettage (scraping), dermabrasion (skin planing), laser resurfacing or chemical peels.
• Examine the skin carefully for skin cancers.

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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.
• Signs of chronic sun-damage such as telangiectasias, solar elastosis and coarse wrinkles are often present.

  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.
• Counsel about sun protection.
• Remove or lighten for cosmetic reasons using a number of different methods:

   

  • Liquid nitrogen applications.
  • Application of trichloroacetic acid (20-40%) or phenol (80%).
  • Electrosurgery.
  • Hydroquinone-containing lightening creams.
  • Tretinoin (vitamin A acid) cream.

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Skin ageing may be divided into two types:

• 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:

   

• Epidermis (superficial skin)
  • Xerosis or dryness.
  • Atrophy or thinning of the skin.
  • Seborrhoeic keratoses or age warts.
  • Actinic keratoses (solar keratoses).
  • Basal cell and squamous cell cancer cancers.

   

• Melanocytes (pigment cells)
  • Ephelides or freckles.
  • Actinic lentigines (solar lentigines) or "age spots".
  • Malignant melanoma
  • Idiopathic guttate hypomelanosis.

   

• Connective tissue
  • Wrinkles and frown lines.
  • Yellow appearance of the skin.
  • Solar elastosis.

  Coarse wrinkles due to photoageing. Click on image for larger view.

• Sebaceous glands
  • Senile comedones

   

• Hair
  • Thinning of the scalp (see androgenetic alopecia)
  • Increased in facial hair (see hirsutism).
  • White hair (see canities).

   

• Blood vessels
  • Cherry angiomas.
  • Telangiectasias or broken capillaries.
  • Senile purpura (easy bruising).
  • Venous lakes.

   

• Subcutaneous fat
  • Fat atrophy leading to sunken cheeks, thinned skin.

  
  What you can do
  Obviously you cannot prevent ageing but the following measures may help:

   

• Avoid sun-damage (see sun protection).
• Get enough sleep and rest.
• Exercise
• Healthy diet.
• Don't smoke.
• Don't take too much alcohol.
• Don't do drugs.

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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.

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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.

  Symptoms

• Contact dermatitis - Eczema or itchy red scaly or weepy patches.
• Urticaria (weals or nettle rash).
• Morbilliform (measles like) rash.
• Purpura.
• Vasculitis.
• Erythema multiforme.
• Erythema nodosum.
• Fixed drug eruption.

  Complications

• Anaphylaxis - A severe reaction resulting in shock, suffocation and even death.

  What you can do

• You should consult a doctor.
• Take antihistamine to relieve itch.
• Apply calamine lotion.
• 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.

  What the doctor may do

• Hospitalise severe cases of allergy.
• Give antihistamine injections.
• Prescribe systemic steroids.
• 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.

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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:

Non-scarring alopecia

• Androgenetic alopecia due to androgens (male hormones).
• Ageing - causes the same pattern of hairloss as androgenetic alopecia.
• Alopecia areata due to autoimmunity (self-allergy).
• Telogen effluvium due to abnormal hair cycle.
• Traction alopecia.
• Trichotillomania.
• Superficial scalp infections - ringworm (tinea capitis) and folliculitis.
• Systemic lupus erythematosus.

  
  Scarring alopecia

• Burns.
• Physical trauma.
• Discoid lupus erythematosus.
• Lichen planus
• Folliculitis decalvans.
• Kerion or favus (see tinea).
• Scleroderma.

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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 topical steroids.
• Inject intralesional steroids into the bald areas.
• 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).

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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.

Causes

• Drug allergy, including vaccinations.
• Allergy to insect bee and wasp stings.
• Allergy to food items.

  Symptoms

• Anxiety.
• Rapid heartbeat.
• Generalised urticaria.
• Angioedema.
• Breathing difficulty and wheezing.
• Vomiting, diarrhoea and abdominal cramps.
• Loss of consciousness.
• Convulsions (fits).
• Shock in which the pulse becomes rapid and weak and the person becomes cold, clammy and faint.

  Complications

• Death may result unless treated early.

  What you can do

• Immediate treatment is necessary. Go to the nearest Accident & Emergency department.

  What the doctor may do

• Institute emergency measures to support respiration and the circulation.
• Inject adrenaline, antihistamine, steroids and bronchodilators (which help breathing).
• Admit to the hospital for monitoring.

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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.

   

• Female androgenetic alopecia (female pattern hairloss)

   

  • May follow the pattern in men or more commonly, as diffuse thinning which is most prominent on the top front of the scalp.

  Male androgenetic alopecia. Click on image for larger view

  What you can do

• Nothing, live with it.
• Consider cosmetic measures such as having a hairdresser style the hair so that it hides the hairloss, hair weaving or using a hairpiece.
• Consult a doctor for treatment.

  Key points

• Women with androgenetic alopecia who have the following symptoms should consult a doctor for tests to exclude increased production of male hormones:
• Severe acne.
• Hirsutism.
• Enlargement of the clitoris.

  What the doctor may do

• Confirm the diagnosis.
• Prescribe minoxidil lotion or finasteride tablets which may reduce the rate of hairloss or induce some hairgrowth.
• Oestrogens (female hormones) and antiandrogens tablets may be helpful in women.
• Consider surgery such as scalp reduction and hair transplantation in very motivated patients.

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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.
• Use vaseline to moisturise the lips.

  What the doctor may do

• Determine the cause and eliminate it.
• Diagnose and treat complications.
• Perform patch or prick tests to detect allergies.
• Prescribe a mild topical steroids.
• Give intralesional steroid injections in cheilitis glandularis.

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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.

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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.

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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.
• Treat the cause.

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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.
• Prescribe tetracycline gargles.
• Prescribe steroid pastes or inject intralesional steroids into the base of the ulcers to expedite resolution.

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Aplasia cutis refers to the congenital absence of skin. It occurs in newborns and is sometimes blamed on forceps, if used to assist delivery.

Cause

• Developmental abnormality in which skin fails to develop over localised areas such as the scalp.

  Symptoms

• Appears at birth.
• Usually occurs on the scalp and rarely on other parts of the body.
• It appears as an ulcer which is raw or covered by a crust or as a depressed area covered by a tough smooth membrane.
• The raw area eventually heals leaving a flat or raised scar.
• Hairs are absent over the affected area.
• Aplasia cutis may sometimes be associated with trisomy 13, a chromosomal disorder.

  Complications

• Secondary bacterial infection.
• Haemorrhage.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Confirm the diagnosis.
• Treat the complications.
• Surgically remove the affected area if healing is poor or for cosmetic reasons.

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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.
• Increased susceptibility to warts and molluscum contagiosum.

  What you can do

• 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.

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Atrophie means thinned and blanche means white. The term atrophie blanche therefore, means thinned white scars.

Cause

• Healed leg ulcers from vasculitis or stasis ulcers.
• Livedo vasculitis.

  Symptoms

• Thinned white scars with red spots or telangiectasias (broken capillaries).

  What you can do

• You should consult a doctor.

  What the doctor may do

• Treat with drugs that prevent the aggregation of platelets such as aspirin, pyridamole and pentoxyfylline.

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