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Salmon patches | Scabies | Scars (go to keloids) | Scleroderma | Sebaceous hyperplasia | Sebaceous naevus (go to naevus sebaceum) | Seborrhoea | Seborrhoeic dermatitis or seborrhoeic eczema | Seborrhoeic keratoses | Senile lentigines (go to actinic lentigines) | Shingles (go to herpes zoster) | Skin cancers | Solar elastosis | Solar keratoses (go to actinic keratoses) | Squamous cell cancer | Steatocystoma multiplex | Strawberry haemangioma | Stretch marks (go to striae distensae) | Striae distensae | Sunburn | Sweet's disease | Sweaty palms/soles (go to hyperhidrosis) | Syringomas

Salmon patches or stork marks are common vascular birthmarks found in about a third of babies at birth.

Cause

• Abnormal development of the blood vessels in the skin.

  Symptoms

• Pink patches usually on the eyelids, between the eyebrows or on the back of the neck.

  What you can do

• Nothing - storkmarks on the eyelids usually disappear by 1 year of age. Those on the neck persist but are easily hidden by the hair.

  What the doctor may do

• Reassure you.
• Treat persistent storkmarks with one of the vascular lasers.

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Scabies is a contagious skin infestation caused by the scabies mite. Infestation begins when a fertile female mite burrows under the stratum corneum (the dead layer of the skin) and lays eggs which hatch after about 2 weeks. Itching develops about 4 - 6 weeks after infestation because it takes this time for the body to become allergic to the mite's proteins.

Cause

• Human scabies mite, Sarcoptes scabiei. Scabies is transmitted by skin-to-skin contact such as during sexual intercourse and among members in the household. The scabies mite can survive for 2 days on clothing or bedding so indirect transmission may also occur.

  Symptoms

• Burrows (greyish snail track marks) in the finger webs and on the front of the wrists.
• Red papules (bumps) or blisters around the armpits, along the waistline, inner thighs, the genital area and the buttocks. The face and scalp may be affected in children.
• Severe itching which is characteristically worse at night. In the early stages, itch may be the only symptom (see generalised pruritus).
• Excoriations from scratching.
• Norwegian crusted scabies is a more extensive variety which usually affects geriatric patients, inmates of mental institutions and people on immunosuppressive drugs (drugs which suppress the immune or defence system). It causes thick crusts and can look rather like psoriasis. In some patients it causes an erythroderma (generalised redness and scaling).

  Complications

• Secondary bacterial infection.
• Post-scabetic itch which may persist for several weeks despite eradication of the mites. It represents a residual allergic reaction.
• Scabetic nodules (firm red itchy swellings) which may persist for weeks following treatment. These usually occur on the armpits, penis, scrotum, buttocks and sides of the feet (in infants).

  What you can do

• You should consult a doctor.
• Take antihistamine and apply calamine lotion to relieve itching.
• Make sure all household members are treated. Remember that infested persons may not show any signs until 6 weeks later. They need treatment as well, otherwise infection will spread back to those already treated.

  What the doctor may do

• Confirm the diagnosis by microscopic examination of skin scrapings for the presence of mites or their eggs.
• Prescribe anti-scabies applications such as benzyl benzoate (Caution: May be very irritating to children), malathion, permethrin, crotamiton and gamma benzene hexachloride. Family members and sexual contacts must be treated to prevent reinfestation.
• Prescribe antibiotics for secondary bacterial infection.
• Treat scabetic nodules (the itchy firm reddish-brown swellings that persist after treatment) with intralesional steroids.

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Scleroderma is a skin disorder that affects the connective tissue. It affects women more commonly and may be divided into two types:

• Morphoea or localised scleroderma which affects connective tissue in the skin alone.
• Systemic scleroderma or systemic sclerosis which affects the connective tissue anywhere, especially in the lungs, heart, gastrointestinal tract, joints or kidneys as well as the skin.

  Cause

• An autoimmune disease (self-allergy) in which the immune system attacks the connective tissue as though it is foreign.
• Rarely, localised scleroderma have been caused by a bacteria known as Borrelia burgdorferi.
• Scleroderma-like changes may also occur porphyria cutanea tarda.

  Symptoms

• Morphoea (localised scleroderma)

   

  • Smooth waxy looking stiff scar-like patch on the trunk, limbs, face and scalp (where it may cause scarring hairloss). The border may be red initially but this fades gradually to leave an ivory white patch which may turn a brownish with time.
  • Linear morphoea or linear scleroderma is a type of morphoea which occurs in a line along one limb. This type usually affects children.
  • Coup de sabre is a type of linear scleroderma that occurs on the scalp and temple. It has the appearance of a sabre cut, hence its name.
  • Pansclerotic morphoea is another type that affects underlying tissues such as muscles and bones. This type usually affects children.
  • Atrophoderma of Pierini and Pasini may be another variant in which there is loss of the underlying subcutaneous tissue such that the skin appears depressed.

  
  

  Morphoea. Click on image for larger view

• Systemic scleroderma (systemic sclerosis)

   

  • Tight shiny stiff skin on the hands causing tapering of the fingers and restriction of hand movements.
  • Smooth shiny stiff skin on the face results in a mask-like face with a fixed stare, pinched nose, small pursed mouth and reduced expression lines. Telangiectasias (broken capillaries) may be seen near the nail folds. Mat-like telangiectasias may be seen on the face, lips, neck and upper trunk.
  • Raynaud's phenomenon in which the digits become white (spasm of arteries) in the cold. As blood flow resumes, the skin becomes blue and on rewarming, it becomes red. There is often a tingling sensation, numbness or burning during the attack.
  • Symptoms related to the involvement of other organs such as heart, lungs, gastrointestinal tract (causing difficulty swallowing), arteries, joints and kidneys.
    
    

  Complications

• Scleroderma affecting the scalp may cause scarring alopecia (permanent hairloss).
• Deep forms of scleroderma, especially pansclerotic sceroderma can affect muscles (causing contractures) and bones (causing deformities).
• Calcium deposits may form on skin affected by scleroderma and these sometimes ulcerate through the skin.
• Systemic sclerosis may cause death if vital organs such as the heart, lungs and kidneys are involved.
• Severe Raynaud's phenomenon may result in the finger tips becoming gangrenous.

  What you can do

• You should consult a doctor.
• Raynaud's phenomenon can be reduced by avoiding exposure to the cold.
• Perform physiotherapy and exercises to keep the joints mobile.
• Quit smoking.

  What the doctor may do

• Take a skin biopsy to confirm the diagnosis.
• Conduct tests to determine the extent of involvement in systemic scleroderma.
• Morphoea does not usually require treatment. Topical steroids, topical calcipotriol, intralesional steroids injections or oral steroids may be used if morphoea is spreading.
• Treat cases of systemic scleroderma with D-penicillamine, diphenylhydantoin, cyclosporin or methotrexate (both are immunosuppressive drugs).
• Treat Raynaud's phenomenon with vasodilators such as nifedipine and pentoxyfylline.
• Treat the complications when they occur.

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Sebaceous hyperplasia usually affects the face of middle-aged and elderly adults, especially men with oily skin.

Cause

• Enlarged sebaceous glands due to ageing.

  Symptoms

• Small yellowish lobe-surface growths on the face, particularly the forehead and cheeks. A small pore representing the hair follicle may be seen in the centre.
• The skin is often oily.
• On the nose, sebaceous hyperplasia may cause an enlargement of the nose known as rhinophyma. This consition is usually seen in patients with acne rosacea.

  Sebaceous hyperplasia. Click on image for larger view

  What you can do

• Nothing.
• Consult a doctor if you wish them removed for cosmetic reasons.

  What the doctor may do

• Destroy the enlarged oil glands with electrosurgery or carbon dioxide laser.
• The doctor may prescribe anti-androgens in women. They cannot be used in men because of the the risk of feminisation.
• Prescribe oral isotretinoin (a vitamin A derivative also used to treat severe acne) is sometimes used to reduce their size.

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Seborrhoea or oily skin is a common problem which usually appears after puberty when there is increased production of androgens (male hormones).

Cause

• Overactive sebaceous glands due to stimulation by androgens (male hormones).

  Symptoms

• Oily face.
• Greasy scalp.

  What you can do

• Frequent washing of the face.
• Use acne soaps or soaps for oily skin.
• Use drying gels and lotions.
• Avoid oil-based cosmetics and moisturisers.
• You can consult a doctor.

  What the doctor may do

• Hormone pills may be used in women to block the effects of androgens. They cannot be used in men because of the the risk of feminisation.
• Oral isotretinoin (a vitamin A derivative also used to treat severe acne) is sometimes used in severe or distressing cases of seborrhoea.

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Seborrhoeic dermatitis is a common condition. In its mildest form, seborrhoeic dermatitis causes dandruff. If more severe, the face, chest, back and body folds may be affected. Seborrhoeic dermatitis usually occurs during the neonatal period and after puberty. Cradle cap is believed to be a form of seborrhoeic dermatitis affecting the scalp of newborns.

Causes

• The exact cause is unknown but there is recent evidence to suggest that an overgrowth of a normal skin yeast known as Pityrosporon orbiculare may be partly responsible.

   

  Aggravating factors

• Patients with Parkinson's disease (a neurological disease) are more commonly affected.
• HIV (human immunodeficiency virus) infected patients have more severe seborrhoeic dermatitis.

  Symptoms

• Common dandruff.
• Cradle cap in newborn babies.
• Greasy yellow-red scaling of the scalp, eyebrows, nasolabial folds, sideburns, behind the ears, upper central chest and the back. Sometimes seborrhoeic dermatitis affects the ear canals and is one of the causes of otitis externa.
• Redness, scaling and weeping in the body folds, eg., in the groins, armpits and under the breasts.
• Itching may be mild or absent.

  Seborrhoeic dermatitis. Click on image for larger view

  Complications

• May very rarely spread to become an erythroderma.
• Secondary bacterial infection, especially in the scalp.
• Secondary infection by Candida albicans, especially in the body folds.

  What you can do

• You should consult a doctor.
• Use antidandruff shampoos (active ingredients include zinc pyrithione, selenium sulphide, salicylic acid, sulphur, ketoconazole and coal tar) regularly.
• Cleanse the other affected areas of skin regularly.
• Mild sunlight may help to clear the problem, especially in temperate countries.
• Take antihistamines to relieve itching.

  What the doctor may do

• Confirm the diagnosis.
• Prescribe topical steroids or tar preparations or in severe and extensive cases, oral ketoconazole or itraconazole.

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Seborrhoeic keratoses or age warts are non-cancerous pigmented growths on the skin of middle aged and elderly individuals. Dermatosis papulosa nigra is believed to be a type of seborrhoeic keratosis.

Causes

• Unknown, probably a manifestation of ageing.
• Inheritance. Multiple seborrhoeic keratoses may sometimes run in families.

  Symptoms

• Raised, warty, flattened yellowish, brown or black greasy growths that look as though they have been stuck on the skin.
• They occur most commonly on the trunk, face and under the breasts and increase in numbers with age.

• Seborrhoeic keratoses. Click on image for larger view

  
  

  Complications

• Seborrhoeic keratoses may become inflamed, causing itching and soreness.

  What you can do

• You should consult a doctor, especially if multiple seborrhoeic keratoses appear very suddenly because this may be a sign of internal malignancy. Doctor's call this the Lesser Trelat sign.

  What the doctor may do

• Confirm the diagnosis by physical examination or skin biopsy.
• Remove with liquid nitrogen, curettage, electrosurgery, carbon dioxide laser or by shave excision.

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Skin cancers are predominantly caused by chronic sun exposure. Although more common in late adult life, an earlier onset has been observed in individuals who suffered sunburns during the teens and early adult life. Fair-skinned individuals, especially those of Celtic origin are more susceptible. There are 3 main types of skin cancers which are described separately:

• Basal cell cancer
• Squamous cell cancer
• Malignant melanoma

  Warning signs of skin cancers
  Be wary of the following:

   

• Mole that:

   

  • Shows the ABCD signs.
  • Changes in colour
  • Increases in size or thickness
  • Changes in texture
  • Becomes irregular in outline
  • Appears after the age of 21

   

• Any spot or sore that scabs, crusts or bleeds and does not heal within 2 weeks.
• Any skin growth that increases in size.
• Any spot that appears pearl-coloured or translucent.

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Solar elastosis is a degenerative condition of the skin caused by over-exposure to the sun. It occurs in people heavily exposed to the sun, particularly those who work outdoors such as farmers. Fair-skinned individuals and persons of Celtic origin are more prone.

Cause

• Chronic over-exposure to the sun. It is the cumulative dose of sunlight that is important.

  Symptoms

• Yellowish, thickened skin.
• Furrowing (coarse wrinkling) and rhomboidal patterns, particularly prominent on the back of the neck (cutis rhomboidailis nuchae).
• Senile comedones (whiteheads and blackheads).

  What you can do

• Prevent worsening by taking precautions against the sun (see sun protection).

  What the doctor may do

• Prescribe topical tretinoin (vitamin A acid).
• Counsel about sun protection.
• Examine the skin for other complications of chronic sun damage such as solar keratoses and skin cancers.

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This is the second most common type of skin cancer after the basal cell cancer. It may occur in a precancerous skin conditions such as solar keratosis/actinic cheilitis and Bowen's disease, in old radiation burns, chronic ulcers and areas of chronic inflammation.

Symptoms

• Fleshy or ulcerated growth with variable degrees of scaling and crusting.
• Enlarged lymph glands draining the area.

  Complications

• Metastases or systemic spread may occur in those arising in the lips and in areas of chronic inflammation.

  What you can do

• You should conault a doctor as early treatment is curative.

  What the doctor may do

• Perform a skin biopsy to confirm the diagnosis.
• Treat with electrosurgery and curettage (scraping), surgical excision, liquid nitrogen and X-ray therapy or Moh's chemosurgery for recurrences and squamous cell cancers in difficult locations.

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Steatocystoma multiplex is an inherited disorder in which multiple cysts develop in the skin.

Cause

• Inherited as an autosomal dominant characteristic which only one parent need to be affected and the offsprings have a 1 in 2 chance of inheriting and developing the disorder.

  Symptoms

• Multiple cysts, usually on the chest and forearms.
• The cysts are more easily felt or they may become visible when the skin is stretched.
• The cysts usually appear during puberty.

  Complications

• Inflammation and pain.

  What you can do

• You can consult a doctor.
• Do not squeeze or puncture the cyst.

  What the doctor may do

• Reassure you.
• Excise unwanted cysts. Puncturing the cysts results in the release of an oily yellow liquid but this is only temporary as the oil soon accumulates and the cysts recur.
• Treat inflamed cysts with antibiotics.

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This is a superficial haemangioma that occurs in children, most commonly on the face, scalp, trunk and legs.

Symptoms

• Begins soon after birth as a red patch and enlarges rapidly to form a bright red raspberry shaped growth. It generally stops growing by the time the child is 1 year of age and then shrinks in size over the ensuing years. Fifty per cent disappear by 5 years of age , 70% by 7 years and 90% by 9 years of age.

  Strawaberry haemangioma. Click on image for larger view

  Complications

• May affect vision when it occurs near the eye.
• May bleed if traumatised.

  What you can do

• You should consult a doctor.
• Do nothing and wait for it to resolve on its own.
• Apply firm pressure for 5 minutes if it bleeds.
• Use cosmetic camouflage if there are residual marks.

  What the doctor may do

• Reassure you that most strawberry haemangiomas will resolve on their own.
• Use vascular lasers to treat haemangiomas that encroach on important areas such as the eyes, nostrils, throat and ear canal or treat portions of the haemangioma that remain after natural resolution has occurred.
• Prescribe oral steroids or intralesional steroids to suppress rapidly growing strawberry haemangiomas.

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Striae distensae is the medical term for stretch marks.

Cause

• Stretching of the skin resulting in loss of elasticity of the underlying dermis.

   

  • During adolescence as a result of the growth spurt.
  • During pregnancy due to increased girth.

   

• Thinning of the skin due to decreased collagen production.

   

  • Overuse of strong topical steroids.
  • Oral or systemic steroids.
  • Excess production of steroids by the body (Cushing's syndrome)
    .

  Symptoms

• Red or purplish raised streaks.
• Flatten with time and become white.
• Commonly occur on the thighs, hips and lower abdomen.

  Striae distensae. Click on image for larger view

  What you can do

• Avoid stretch marks in the first place by using steroids only under a doctor's supervision.
• Avoid sudden weight gain.

  What the doctor may do

• Tretinoin (vitamin A acid) help to fade the stretch marks but only when they are still red or purple. Remember that tretinoin cannot be used by pregnant and nursing mothers.

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Sunburn is caused by an acute overdose of ultraviolet light (natural sunlight or artificial). The particular wavelength responsible is the ultraviolet B range (see Figure below). Light reflected off water, snow and the ground as well as direct sunlight may be the cause which explains why umbrellas and brimmed hats are not entirely protective.

	200nm	290nm	320nm	400nm	700nm
Gamma rays	X-Rays	Ultraviolet (UV)			Visible Light	Infra Red
		C	B	A
			Sunburn, Skin cancer, Ageing	Tanning, Skin cancer, Ageing

Symptoms
The susceptibility towards sunburn varies according to the skin phototype.


• Redness and swelling which stops more or less at the areas covered by the clothes.
• Pain.
• In severe cases, blistering and fever.
• Peeling of the skin occurs as the sunburn resolves. During this stage, there may be some itching.

  Complications

• Headaches, fever and chills if sunburn is severe.
• Pigmentation after the reaction resolves.

Skin Phototypes

Skin type	Reaction to sun-exposure	Examples
Type 1	Always burns, never tans	Light-eyed, fair-skinned Northern Europeans
Type 2	Always burns, sometimes tans	Fair-skinned Europeans.
Type 3	Sometimes burns, always tans	Mediterranean origin eg. Spaniards, Italians and Greeks
Type 4	Never burns, always tans	Hispanics and Asians.
Type 5	Dark pigmented Asian skin.	Hispanics and Asians.
Type 6	Black skin.	Darkly pigmented Africans and Southern Indians.

Complications

• The long term cosmetic complication is photoageing (see ageing).
• The longterm medical complication is an increased risk of developing skin cancers with each episode of sunburn.

  What you can do

• Apply cool compresses for 15 minutes 2 or 3 times a day.
• Apply calamine lotion.
• Take simple painkillers.
• Consult a doctor if you have blisters or other symptoms such as fever and chills.

  Prevention of sun damage (sun protection)

• Limit exposure to sunlight especially between 11am to 3pm.
• Wear protective clothing (densely woven fabric is best) and broad-brimmed hats.
• Use umbrellas and try to stay in the shade.
• Remember that the sun can penetrate through water and wet white clothing and UV-A can pass through window glass.
• Apply sunscreens to all exposed parts at least 30 minutes before going out. Reapply every 2 hours and more frequently if you are swimming or sweating profusely.

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Sweet's disease is named after the English dermatologist who first described it. It is also known as acute neutrophilic dermatosis and usually affects middle aged women.

Cause

• Upper respiratory infection.
• Inflammatory bowel disease such as ulcerative colitis and Crohn's disease.
• Rheumatoid disease.
• Haematological abnormalities including leukaemia.
• Vaccination.

  Symptoms

• Fever which may be high.
• Tender red or bluish red tender plaques (elevated patches), sometimes with tiny blisters or pustules (pusheads).
• These plaques may clear slightly in the centre and become ring-like or semi-circular in shape.
• May be single or multiple.
• Usually occurs on the face, neck and upper limbs.
• May be associated with joint pains, tiredness, malaise (feeling of illness) and conjunctivitis (red sore eyes).

  Sweets disease. Click on image for larger view

  Complications

• Bullous Sweet's syndrome with large blisters may be associated with underlying leukaemia.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Perform a skin biopsy.
• Perform blood tests which usually show a high erythrocyte sedimentation ratio (ESR) and a raised white cell count.
• Exclude undlerlying leukaemia.
• Treat with oral steroids or dapsone.

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Syringomas are small pin-head size papules (bumps) occurring around the eyes. Syringomas usually occur during puberty and are more common in females. They are often mistaken for oil deposits.

Cause

• Syringomas are caused by the overgrowth of the cells lining the sweat duct. It may sometimes run in families.

  Symptoms

• Small, skin-coloured, pin-head size papules (bumps) around the eyes and on the cheeks.

  Syringomas. Click on image for larger view

  What you can do

• You should consult a doctor.
• Leave alone as they are a harmless cosmetic problem or seek treatment from a doctor.

  What the doctor may do

• Reassure you that they are harmless.
• Excise (cut) them or burn them with electrosurgery and the carbon dioxide laser. However, recurrences are common, requiring retreatment.

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