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TATTOO REMOVAL

Tattooing is sometimes used to camouflage an underlying birthmark or blemish. More often however, tattooing is done for decorative reasons and for creating a permanent eyeliner or to alter the shape of the eyebrows and even the lips. No problems arise until the owner wishes to have a tattoo removed because he no longer wants it, because the shape is wrong or because of an allergic reaction to the tattoo pigment. Until the advent of pigment lasers, removal of tattoos was almost impossible without the risk of scarring.

What you can do

Think carefully before tattooing because removal is difficult and costly.
See a doctor if you would like a tattoo removed.
What the doctor may do
Excise small tattoos.
Use dermabrasion (skin planing).
Use salabrasian which involves using salt to sand the skin rather like dermabrasion.
Use pigment lasers to destroy tattoo pigment without harming the neighbouring tissues too severely and causing unacceptable scarring. This is currently the best method of tattoo removal but is expensive because of the high costs of laser machines.

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TELANGIECTASIAS

Telangiectasias are broken capillaries (tiny blood vessels) in the skin.

Causes

Sun damage.
Acne rosacea.
Connective tissue diseases such as scleroderma.
Overuse of strong topical steroids.
Radiation damage.
Liver disease.
Pregnancy and birth control pills.
Inheritance as in Osler Weber Rendu disease.
Prolonged standing.
Symptoms
Spider telangiectasias (spider naevi) - Red dots with dilated vessels radiating outwards like the legs of a spider. Compression of the central "body" results in the telangiectasia disappearing. Usually occur on the face, neck, and upper body.
Common telangiectasias - red wavy lines of blood vessels on the nose and cheeks of fair-skinned individuals and on the legs of women.
Osler Weber Rendu disease or hereditary haemorrhagic telangiectasia is characterised by telangiectasias around the lips, mouth, face, fingers, toes and nail beds and in the mucous membranes of the nose and gastrointestinal tract. It is inherited in an autosomal dominant fashion which means that each child has a 50% chance of inheriting and developing the disorder if one parent is affected.

Telangiectasias.
Click on image for larger view

Complications
Haemorrhage and anaemia may occur in Osler Weber Rendu disease.
What you can do
You should consult a doctor to determine the cause.
Use cosmetic to camouflage facial telangiectasias.
See a doctor if there are signs of Osler Weber Rendu disease or for treatment of the telangiectasias.
What the doctor may do
Exclude underlying diseases.
Treat with electrosurgery or vascular lasers.

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TELOGEN EFFLUVIUM

Telogen effluvium is a diffuse, temporary type of hairloss which occurs 2 - 4 months after the cause and resolves within 6 months of the cause being eliminated.

Causes
Normally, hairs grow in 3 stages - anagen (growth stage), catagen (transitional stage) and telogen (resting stage). Generally, about 85% of the hairs are in anagen and 15% are in telogen (very few are in catagen). Telogen effluvium occurs when many hairs (as much as 70%) are pushed into one cycle so that they are eventually all shed together. Such an alteration of the hair cycle may be precipitated by:-

Childbirth and cessation of oral contraceptives.
High fever.
Major surgery.
Underactive or overactive thyroid gland.
Haemorrhage (blood loss).
Iron deficiency anaemia.
Crash dieting.
Malnutrition.
Chronic illness.
Jet lag.
Accident.
Unusual stress.
Drugs such as anticoagulants (blood thinning drugs), anticancer drugs, birth control pills, vitamin A and its derivative, isotretinoin which used in the treatment of severe acne.
Symptoms
Increased shedding of hair in excess of the normal loss of 50-100 hairs a day.
What you can do
You should consult a doctor.
You can wear a wig to conceal the hairloss until the hair grows back.
What the doctor may do
Confirm the diagnosis by performing a telogen hair count (above 25%).
Exclude underlying diseases.
Do nothing and wait till the hair grows back.
Prescribe minoxidil lotion to promote hair growth.

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TINEA

Tinea or ringworm is a superficial fungal infection of the skin. The term "ringworm" is actually inappropriate because there is no worm involved and the ring-like expansion is due to the infection spreading. Different terms are used according to the areas involved.

Feet - Tinea pedis or athlete's foot.
Nails - Tinea ungium or onychomycosis.
Body - Tinea corporis.
Groins - Tinea cruris, jock itch or dhobi itch.
Scalp - Tinea capitis.
Causes
Fungi known as dermatophytes. Infection may be contracted from other humans or from pets and farm animals.
Symptoms
Tinea pedis (athlete's foot)
- Scaling and white macerated skin or blisters between the toes, especially between the fourth and fifth toes.
- Scaling, blisters or pustules (pusheads) on other areas of the feet, especially the arch.
- Itching.
Tinea corporis (Body ringworm)
- Ring-like patches with a red scaly edge that may contain small blisters or pusheads and a clearer centre.
- Itching.
Tinea cruris (jock itch)
- As for tinea corporis.
Tinea capitis (scalp ringworm)
- Scaly bald greyish patches with broken-off hair stumps.
- Kerion - a painful red boggy mass discharging pus. Hairs often fall out.
- Favus - bald patches with yellowish adherent crusts.
- "Black dot" ringworm - bald patches with hairs broken off close to the surface resulting in a polka dot-like appearance.
- Tinea capitis is more common in children.

Tinea ungium (see onychomycosis).

Tinea cruris.
Click on image for larger view Tinea pedis.
Click on image for larger view

Complications

Secondary bacterial infection.
Hairloss in tinea capitis.
What you can do
You should consult a doctor.
Apply topical antifungals for at least 2 weeks after the infection has cleared.
Keep the skin clean and dry well after baths.
See a doctor if you have tinea capitis or tinea ungium (onychomycosis) because these require oral antifungal medicines or if there are no signs of improvement after 3 weeks of using topical antifungal medicines.
Some infections are transmitted by hairy pets so get them checked by a Vet, as well.
What the doctor may do
Confirm the diagnosis by examining skin scrapings, hairs or nail clippings for the presence of fungi. This gives an immediate result. He may also illuminate the area with a Wood's lamp as some types of fungi fluoresce a green colour. Occasionally, the doctor may perform a fungal culture which takes about 4 weeks to be ready.
Prescribe topical, systemic antifungal agents or both. An antifungal nail lacquer is available for onychomycosis.
Prescribe antibiotics for secondary bacterial infection.
Preventing the recurrence of tinea pedis
Bathe and wash the feet thoroughly, especially between the toes.
Dry thoroughly afterwards and dust with talc or better still, an antifungal powder.
Wear lightweight cotton socks and change frequently if you sweat a lot.
Avoid occlusive footwear such as plastic shoes and tight footwear.
Air shoes regularly and dust the inside of the shoes with anti-fungal powders.
Avoid walking barefoot in public or communal baths.

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TRAUMATIC ALOPECIA

Traumatic alopecia is a form of hairloss resulting from trauma.

Causes

Traction alopecia - caused by tight braids and pony tails.
Hot-comb alopecia due to attempts to straighten the hair.
Pressure - seen in the back of the heads of babies or people who lie on their backs for prolonged periods.
Trichotillomania - a self induced alopecia caused by habitually plucking, pulling or cutting the hair. In children, mild emotional problems may be present. In adults, there may be underlying deep emotional and psychiatric problems.
Burns - thermal, electrical or chemical.
Symptoms
The hairloss is patchy and it's pattern depends on the type of trauma.
Traction alopecia usually occurs at the margins of the hairline, along the part or scattered through the scalp depending on the hair style.
Hot-comb alopecia is usually seen in Blacks and affects the crown.
Traumatic alopecia due to burns occur at the site of injury.
Trichotillomania causes irregularly shaped angular areas of hairloss. The hairs within the area are short or stubbly and broken off at different lengths.

Trichotillomania.
Click on image for larger view
What you can do
Eliminate the cause, if any, eg., change the hair style.
You can consult a doctor to confirm the diagnosis and cause.
What the doctor may do
Confirm the diagnosis.
Excision of small areas of traumatic alopecia caused by burns may be possible.
Gently counsel children with trichotillomania. Adult cases often have deep emotional or psychiatric problems and may require referral to a psychiatrist.

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TRICHOEPITHELIOMA

Trichoepithelioma is an inherited condition that causes skin coloured or yellow bumps around the centre of the face. It usually affects women.

Cause

Inherited.
Symptoms
Multiple small (less than 1 cm) skin-coloured rounded bumps around the nose, on the cheeks and eyebrows.

Trichoepithelioma.
Click on image for larger view

What you can do
You should consult a doctor to confirm the diagnosis.
What the doctor may do
Perform a skin biopsy to confirm the diagnosis.
Treat for cosmetic reasons. Excision, electrosurgery and carbon dioxide laser may be used.

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TRICHOSTASIS SPINULOSA

Trichostasis spinulosa is a harmless condition that affects the pores of some adults.

Cause

Blockage of the hair follicles which cause hairs to be retained in the follicle.
Symptoms
Open pores which on careful examination contain tiny short hairs. They are often mistaken for blackheads.
Usually occur on the nose and sometimes, on the chest and back.

What you can do
You should consult a doctor.
What the doctor may do
Reassure you.
Treat with keratolytics which help to unclog the pores.

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