Conditions

What are they?

They are also know as solar keratosis. These are pre-cancerous patches of thick, scaly or crusted skin on an red base which develop from years of  exposure to the sun. they are more common on areas commonly exposed to the sun like the face, scalp, neck, forearms and the back of the hands.

What causes Actinic Keratosis?

Actinic Keratosis  (AK) is a result of disruption of skin cell function. Where normal skin cells turn over on a systematic basis, the cells of an AK lesion develop in a haphazard fashion. This is primarily the result of  the damage  caused by UV exposure from the sun over the years.

Actinic keratosis is more common among fair-skinned people and those who have had years of outdoor or tanning bed exposure  or to ultraviolet light.  AKs can potentially go on to become skin cancers typically squamous cell carcinoma. That is  why treatment is important.

It is not possible to tell which ones will go on to become cancers. Some AKs go away without treatment.

How do you treat Actinic Keratosis ?

After a careful physical examination of the lesion, your dermatologist will opt for one of the following treatments to remove the growth:

  • Cryotherapy , which freezes off the growth using liquid nitrogen.
  • Curettage  in which the doctor scrapes off the lesion and bleeding is stopped by electrocautery.
  • Chemical peels that cause the top layer of skin to peel off.
  • Photodynamic therapy in which a solution  is applied that sensitizes the skin to light and the area is then exposed to light via a  light source.
  • Topical Chemotherapeutic agents (5 Fluorouracil, Aldara) can also be used.

Any non-healing or recurring AK in the same spot may need a small skin biopsy to make sure it has not turned into skin cancer.

How can I avoid getting Actinic Keratosis ?

Prevention is better than cure. Protecting yourself from the sun from earlier on in life is important.

Helpful measures include sun protection with hats, clothing, daily use of  sunscreen, and sun avoidance, particularly during the peak hours of 10 am to 4 pm to avoid developing new lesions.

What is Acne?

Acne is a common skin problem that affects teenagers and young adults. It is caused by blockage of the sebaceous or sweat glands, inflammation and the P. acnes bacteria.

It usually occurs in the areas of increased oil (sebaceous) glands – face, chest and back

It is characterized by plugged pores (white & black heads) from overproduction of sebum, red papules, pustules, nodules and cysts.  Scars, like small pits on the skin, can also form. Darkening (hyperpigmentation) in darker skin types, spots may last for months

Acne

What are the causes of Acne?

Acne is generally thought to be due to genetics, puberty, hormones and occasionally oil–based cosmetics and certain medications.

Why is Acne treatment necessary?

Acne can cause significant scarring and postinflammatory  hyperpigmentation  if left untreated. Emotional scars can often spoil the teen years, and acne can be equally distressing for adult women who often lament that they are starting to get wrinkles and still have acne.

How is Acne treated?

Dermatologists use combination therapy to treat acne for satisfactory results. The choice of combination is dependent  on the type of lesions one presents with.Treating acne is a slow  ongoing  process; there is no overnight remedy, it may take 4- weeks to start noticing results.

Some treatments include:

  • The doctor may prescribe topical creams, gels or lotions with Vitamin A acid or Benzoyl Peroxide to help unblock the pores and reduce bacteria. These products may cause some drying and peeling but are highly effective.  You will be  advised on the correct use and how to handle side effects.
  • Oral and Topical Antibiotics — these are used to treat any infection in the pores and reduce the bacteria in the follicle
  • Hormonal Treatments — Can be used for adult women with hormonally induced acne.
  • Isotretinoin (Accutane,oratane, roaccutane) is used in certain cases eg, severe acne or when acne does not respond well to any other treatments. Patients must understand there are  side effect to Isotretinoin. Frequent follow-up visits are necessary to monitor side effects. These drugs can cause severe birth defects if taken during pregnancy. A course of treatment  is usually 6-8 months depending on dosing, response to treatment, weight of the patient and tolerance of side effects. Because isotretinoin  shrinks all  the oil glands of the skin, dry lips/nose/eyes can be a problem. These common side effects are usually easy to control and disappear upon stopping of treatment.
  • Extraction — Removal of whiteheads and blackheads using a small metal instrument to extract the blocked pore.
  • Chemical peeling-deep exfoliation using a chemical agent to remove superficial dead skin
  • Laser or light treatment  destroys the most common bacteria that cause acne within the skin
  • Treatment of scars – Subcision. Microneedling, Laser

How can patients assure the best result from treatment?

      • Treating acne is a team effort, following through with the recommended treatment is the most important part of this teamwork. The most common cause of treatment failure is failure to use the prescribed medication correctly.
      • A good home care regimen using the correct products for your skin condition is highly recommended for optimum results and maintaining long lasting outcome, suggestions will be recommended by our doctor or therapist’s.
      • Treatment is usually very successful and can make the patient look and feel better as well as prevent scars.

 Acne keloidalis nuchae (AKN)/ folliculitis keloidalis

What is it?

This is a form of scarring hair loss resulting from the inflammation of the hair follicle unit affecting the nape of the neck, this condition may persist for many years.

Who gets AKN ?

AKN  is more common in dark-skinned people than in whites because of  black curly hair. It is commonly seen in males.

What does AKN look  like?A

It starts as small bumps appearing  within  the hair-bearing area of the back of the neck (occipital scalp). These firm papules can be very itchy, and scratching can lead to secondary bacterial infection.  Sometimes there are pustules around the hair follicles. As time goes on the bumps become small scars which can gradually   enlarge and join together  to become keloids. The scars are hairless and can form a band along the hairline.

What is the cause of AKN ?

Some researchers have concluded that folliculitis keloidalis may begin with an injury during a close hair cut or use of a razor. It is thought to be a mechanical form of folliculitis, in which ingrown hair shafts irritate the wall of the hair follicle resulting in inflammation. This completely destroys the hair follicle and results in scarring.

What is the treatment for AKN?

Unfortunately this condition often persists despite a variety of treatments. Best results occur if treatment is started early before significant scarring has developed.  The following measures are sometimes helpful:

  • Avoid irritants – high collars and helmets, should  not rub the back of the neck
  • Avoid a short or razor hair cut
  • Wash the affected area using an antimicrobial cleanser to reduce secondary infection.
  • The dermatologist may prescribe  topical steroids , antibiotics ,oral retinoids
  • Steroids may be  injected into the lesions
  • Laser can be used
  • Surgery to remove large thickened plaques or nodules

What is dermatosis papulosa nigra (DPN)?

Dermatosis papulosa nigra is a harmless condition which commonly affects the face and necks of blacks and asians. Women are affected more than men.

What is the cause of dermatosis papulosa nigra?

The exact cause of dermatosis papulosa nigra is unknown, although about half of people affected have a family history of the disease.

What does it look like?

It usually begins in adolescence and the number and size of lesions increases with age. The papules are symptomless but may be regarded as unsightly, rarely they may begin to itch in hot weather.

It presents as numerous small, firm, smooth or raised, dark brown to black papules on the face and neck.

dermatosis-papulosa-nigra

How is it treated?

Dermatosis papulosa nigra lesions are not harmful and can be left untreated. Treatment is usually sought for cosmetic reasons as they might appear unsightly.

Treatment choices include scraping (curettage), freezing with liquid nitrogen (cryotherapy) and burning (electrocautery). Lasers have also been used.

Treatment is kept superficial to minimise the risk of complications like dyspigmentation, scarring and keloid formation.

What is Eczema?

Eczema or atopic dermatitis (AD)  is a chronic skin condition characterized  by dry itchy areas of skin. Atopic dermatitis tends to run in families and in majority of cases it begins by the time they turn one.   (AD) is often the first manifestation of the “atopic march” triad the others being asthma and allergic rhinitis

It  is most common  in babies and young children but can continue into adulthood.

What causes Eczema?

Eczema is thought to be due to a combination of genetics and environmental influences. Harsh soaps and detergents, fragrances and hot  weather can all exacerbate Eczema.

What does it look like?

Itching is the most distressing symptom  in all patients with atopic dermatitis and can affect the  quality of life. It presents as a red scaly rash. It can occur on any areas of the body but the face and the creases of the elbows and the knees are the most common areas.  When scratched, the lesions may begin to ooze and get crusty, weepy or punched out indicating a superimposed infection. Over time the skin can become leathery and thick.

 eczema-

Will my child grow out of eczema?

Eczema usually improves in most children as they get older, but  a few will continue to have troublesome eczema which generally flares up and  recedes intermittently throughout the patient’s life. There is however no cure for eczema but flares can be controlled under the frequent monitoring by your dermatologist and avoiding triggers.

How is Eczema Treated?

Treatment  involves multiple factors including  the following:

    • Avoiding triggers
    • Avoid prolonged baths (> 10-15mins) and  the use of harsh soaps and bubble baths.
    • Treating any associated infections.
    • Maintaining skin hydration is extremely important  in the management of eczema.

Specific Therapy:

    • Topical steroids strength based on severity and location of disease. These should be used with caution and under the supervision of a dermatologist because if used incorrectly they can also cause damage to the skin.
  • Steroid sparing agents: calcineurin inhibitors

Systemic Therapy:

  • Patients who are not responding to topical therapy may be commenced on immunosuppressants
  • These treatments require careful blood monitoring under the guidance of a dermatologist.

Light Therapy:

  • This is a modality of treatment for moderate to severe eczema in patients not responsive to systemic therapy or were systemic therapy is contraindicated.

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Hair loss is one of the common reasons patients consult a dermatologist. It can have a major negative psychological impact. Studies have shown that it can lead to low self esteem and even depression in severe cases.  It is paramount to seek help early on so that the dermatologist can assess and determine the cause of your hair loss and prevent progression to permanent hair loss.

There are several different manifestations of hairloss. We broadly divide them into scarring(usually permanent) and non-scarring hairloss

Non Scarring

Scarring Alopecia

  • Central centrifugal cicatricial alopecia (CCCA)
  • Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) alopecia

Alopecia areata

What is alopecia areata (AA) ?

This is a condition that causes a person’s hair to fall out. It is an autoimmune disease in which  the person’s immune system attacks their own  hair follicles. When this happens, the person’s hair begins to fall out. It is believed that the person’s genetic makeup and stress may trigger the start of the disease.

What does it look like ?

It results patches of hair loss on the scalp and any other hair-bearing areas eg. Beard, eyebrows  It usually starts with one or more small, round, smooth patches on the scalp and can progress to total scalp hair loss (alopecia totalis) or complete body hair loss (alopecia universalis). The scalp is the most commonly affected area.

Who Gets Alopecia Areata?

Anyone can develop alopecia areata; however, your chances of having alopecia areata are slightly greater if you have a relative with the disease. In addition, alopecia areata occurs more often among people who have family members or a personal history of other autoimmune disorders such as diabetes, systemic lupus erythematosus (SLE) , or thyroid disease.

Can Alopecia Areata Be Cured?

Alopecia areata cannot be cured; however, it can be treated and hair can grow back.

Alopecia areata is an unpredictable disease. In some people, hair grows back but falls out again later. In others, hair grows back and remains. Each case is unique. Even if someone loses all of his or her hair, there is a chance that it will grow back.

Treatment options for alopecia areata include:

  • Corticosteroids as anti-inflammatory drugs ,can be given as an injection into the scalp or other areas,or taken orally as a pill, or applied topically – rubbed into the skin.
  • Topical contact allergens or sensitizers( immunotherapy)
  • minoxidil
  • Immunosuppressive therapy
  • Phototherapy
  • Excimer laser

Androgenic alopecia

What is androgenic alopecia ?

Androgenetic alopecia is a common form of hair loss in both men and women.

The inheritance pattern of androgenetic alopecia is linked to  genetic and environmental factors. This condition tends to cluster in families. In women it is due to the action of androgens( male hormones )that are typically present in only small amounts .

What does it look like?

In men, this condition is also known as male-pattern baldness. Hair is lost in a well-defined pattern, beginning above both temples. Over time, the hairline recedes to form a characteristic “M” shape. Hair also thins at the crown (near the top of the head), often progressing to partial or complete baldness.

In women, the hair becomes thinner all over the head, and the hairline does not recede and rarely leads to total baldness

In women, this form of hair loss is associated with an increased risk of polycystic ovary syndrome (PCOS). PCOS is characterized by a hormonal imbalance that can lead to irregular menstruation, acne, excess hair elsewhere on the body (hirsutism), and weight gain.

How is it treated?

Hair loss can be slowed or reversed in its early stages with medication. approved medication  to treat male-pattern hair loss include minoxidil and finasteride.

Other causes of Hair Loss 

Traction Alopecia

This condition is caused by localized trauma to the hair follicles from  tight hairstyles that pull at the hair over time. If the condition is detected early enough, the hair will regrow. Braiding, cornrows, tight ponytails, and extensions are the most common styling causes of traction alopecia.

Anagen Effluvium

Anagen effluvium occurs after any insult to the hair follicle that impairs its cellular-level mitotic or metabolic activity. This hair loss is commonly associated with chemotherapy.

Telogen Effluvium

When your body goes through something traumatic like child birth, malnutrition, a severe infection, major surgery, or extreme stress, this can impact your hair. Many of the 90% or so of hairs in the growing (anagen) or transitional (catagen) phases can actually shift all at once into the resting (telogen) phase.This can occur about six weeks to three months after the stressful event,  It is possible to lose handfuls of hair at a time. complete hair regrowth is usually possible  as long as severely stressful events can be avoided. For some women, however, telogen effluvium is a mysterious chronic disorder and can persist for months or even years without any true understanding of the triggering factors or stressor.

SCARRING ALOPECIA

Central Centrifugal Cicatricial Alopecia (CCCA)

This is a  common cause of  hair loss among African women. In CCCA there is  destruction of the hair follicles  leading to scarring and permanent hair loss.

What is the cause of CCCA?

The exact cause of CCCA is unknown. There seems to be a very strong family history. It is also thought to be related to the use of hot combs, excessive heat and hot oils on the scalp, chemical relaxers, and excessive tension from braids, tight hair rollers, weaves or extensions.

How do I know if I have CCCA?hairloss

Hair loss occurs primarily in the central (crown) part of the scalp. The hairloss spreads outward in a circular pattern and  is usually gradual. Symptoms of CCCA can vary and may include itching, burning, tingling, painful pimples on the scalp, pain or no symptoms at all. Dermatologists typically suspect this condition by examining your scalp for certain clues, but  a small sample from the scalp (a biopsy) may need to be taken and send to the lab for evaluation and confirmation of the diagnosis.

What treatments are available for CCCA?

It is best to treat CCCA early before permanent hair loss develops. As the disease progresses, hair follicles may scar beyond the point of repair.

The mainstay of treatment is anti-inflammatory medication  to help stimulate hair growth from follicles that are not scarred and stop the process from progressing. Gentle hair grooming practices are  recommended  in order to prevent inflammation and concomitant hair breakage.

Hair transplantation may be considered in patients with permanent hair loss in whom scalp inflammation is absent or well controlled.

Hair Grooming Recommendations for someone with FFA/LPP/CCCA

  1. Keep natural hair (if possible, short hair)
  2. No weaving, No tight ponytails (causes pulling of the hair out of their roots)
  3. No tight braids/ tight dreads  or rather avoid them at all costs
  4. Loose twists are better.
  5. Infrequent mild relaxers every 4-6months if you have to, but better to avoid chemicals at all costs.
  6. Wigs for those with severe hair loss NOT weaving!

Make your appointment today to see the dermatologist  if you suspect you might have this  condition.

Lichen planopilaris (LPP) and frontal fibrosing alopecia (FFA) alopecia

LPP and  FFA are forms of scarring alopecia(permanent hair loss) that are seen in all races

but are more common in women than men.

What is the cause of FFA/LPP?

The exact cause of FFA/LPP is unknown, in some cases other family members are also affected pointing towards a family history (hereditary) playing a role. FFA/LPP causes inflammation and destruction of the hair follicles and scarring leading to permanent hair loss.

Lichenplano pilarisHow do I know if I have FFA/LPP?

Hair loss from FFA/LPP occurs primarily on the hairline and sometimes on the central (crown) part of the scalp. The hairloss  begins on the hairline and spreads backwards and may resemble traction  alopecia. It is usually gradual .

It may sometimes be associated with sparse hair on the eyebrows, and other hair bearing sites body eg.( arms , armpits,pubic area). In some people it starts with darkening of the face ,arms and v-neck(sun exposed areas).

Dermatologists typically suspect this condition by examining your scalp for specific signs but at times may need to take a small sample from the scalp (a biopsy) and send it to the lab for assessment for  confirmation of the diagnosis if it is not clear.

What treatments are available for FFA/LPP?

It is best to treat FFA early before permanent hair loss develops. As the disease progresses, hair follicles may be damaged  beyond the point of repair.. The fundamentals of treatment include use of anti-inflammatory medications to help stimulate hair growth from follicles that are not scarred and to stop the process from progressing .Gentle hair grooming practices or  natural hair styles are  recommended in order to prevent inflammation and hair breakage. Hair transplantation may be considered in patients with permanent hair loss in whom scalp inflammation is absent or well controlled.

Hair Grooming Recommendations for someone with FFA/LPP/CCCA

  1. Keep natural hair (if possible, short hair)
  2. No weaving, No tight ponytails (causes pulling of the hair out of their roots)
  3. No tight braids/ tight dreads  or rather avoid them at all costs
  4. Loose twists are better.
  5. Infrequent mild relaxers every 4-6months if you have to, but better to avoid chemicals at all costs.
  6. Wigs for those with severe hair loss NOT weaving!

Make your appointment today to see the dermatologist  if you suspect you might have this  condition.

Hyperhidrosis (Excessive Sweating)

Excessive or heavy sweating is a medical condition that can be devastating. It can affect every day functioning leading to avoidance of shaking hands or even social interaction. It commonly affects the armpits, soles and palms and head.

What Causes Hyperhidrosis?

The condition is caused by hyper-functioning of the sweat glands. It can be triggered by emotional stress, high temperature, hot food and less often by an underlying medical condition.

How Do You Treat Hyperhidrosis?

Treatment depends on the type of hyperhidrosis and where the excessive sweating occurs on the body after excluding treatable causes.
• The “first line” of treatment for severe underarm sweating is over-the-counter and prescription antiperspirants work by blocking sweat ducts, which reduces the amount of perspiration that reaches the skin. The most widely used ingredients in antiperspirants are metallic salts, including aluminum chloride hexahydrate. Antiperspirants can cause skin irritation and damage to clothing.
• Deodorants are not effective in treating the excessive sweat but they help control body odour, which is caused by a reaction between bacteria and the sweat.
• Iontophoresis- this uses a special device which is applied to the affected areas
• Some patients receive a prescription for a medicine that temporarily prevents them from sweating. These medicines work throughout the body so common side effects include dry mouth and eyes.
• BOTOX® injections – these control the condition by temporarily blocking the chemical signals from the nerves that stimulate the sweat glands. The treatment is very effective, but results are not permanent so it may need to be repeated after 6mnths to a year depending on when symptoms return.
• Surgery – more invasive procedures are considered as last resort, this cuts out nerve supply to the area of excessive sweating

Useful Tips:

• Common triggers include heat, feeling anxious, and certain foods so avoiding triggers might be beneficial
• Food to avoid:
-Hot beverages and caffeinated drinks such as coffee and tea
-Alcohol
– “Hot” spices and foods with strong odors, such as garlic and onions

• Bathe daily and dry thoroughly to keep the amount of bacteria on your skin under control
• Antiperspirants may be used on sweaty hands and feet as well.
• Sweaty armpits:
-Apply antiperspirant products in the evening. If you’re using a prescription or high-potency antiperspirant, follow your doctor’s instructions carefully and remember that these products may damage clothing and linens. To limit this damage, wear old pyjamas if the antiperspirant is applied before bedtime.
-Choose air-permeable clothing. Wear natural fabrics, such as cotton, wool, and silk, which allow your skin to breathe
– When you exercise, you might prefer high-tech fabrics that wick moisture away from your skin
– keep an extra shirt with you for emergencies
• Sweaty feet:
– use foot powders to help absorb the sweat
-Rotate your shoes as they may not dry out overnight, so try not to wear the same pair two days in a row
-Change your socks or pantyhose often
-Air your feet, go barefoot whenever you can

What causes Keloids?

When skin is injured, fibrous tissue, called scar tissue, forms over the wound to repair and protect the injury. In some cases, scar tissue grows excessively, forming smooth, hard growths called keloids. Those with darkly pigmented skin  are more prone to keloids.

What are the triggers of keloids?

The most common skin injury types  which can contribute to keloid scarring include the following:

  • acne scars, burns, chicken pox scars, ear piercing ,scratches, surgical incision sites and vaccination sites
  • Rarely keloids may occur without any trigger.

What do they look like?

Keloids are usually deep red  lesions growing well beyond the borders of the original wound. They can be itchy  and painful. Although they can  occur anywhere on the body,  keloids are  commonly found on the chest, shoulders, earlobes, and cheeks.

Should I seek treatment?

Reasons to pursue treatment for keloids include aesthetic concerns  related to the psychological stress of cosmetic disfigurement especially if it  visible to everyone or  the physical complaints of pain and pruritus.

How Is the Condition Treated?

Keloid therapy requires commitment from the patient as multiple and frequent visits to the doctor may be required to prove effective.

Examples of keloid treatments include:

  • corticosteroid injections to reduce inflammation
  • using pressure or silicone gel pads after injury
  • freezing the tissue to kill skin cells
  • injecting of chemotherapy drugs to kill the cells
  • laser treatments to reduce scar tissue
  • radiation to shrink keloids

Initially, the doctor will assess the extent of your keloid and then recommend a treatment plan for you.

Treatment for keloids can be challenging as the keloid scarring is the result of the body’s attempt to repair itself. After removing the keloid, the scar tissue may grow back again, and sometimes it grows back larger than before but there are ways to try and prevent the recurrence.

What is Melasma?

This is a hyperpigmentation condition triggered by hormonal changes/influences like  pregnancy  or  the use of birth control pills, as this  can trigger overproduction of  melanin.

What does it look like ?melasmamelasma

Melasma  causes dark, blotchy patches on the face.  It is more common on the cheeks, forehead, upper lip and nose. It occurs more commonly in females.

It is also more common in people with darker skin and those who live in very sunny places.

The doctor can easily diagnose this condition by examining your skin.

How is Melasma Treated?

Melasma caused by pregnancy usually fades away in about a year. It can however persist for  a long time.

This condition is sensitive to the sun so it is always important to protect your skin from the sun to prevent further darkening of the brown patches. You should wear a broad- brimmed sun hat when going outdoors. You should also use a sunscreen with a sun protection factor (SPF) of at least 30.

The dermatologist can prescribe various creams to lighten the dark patches, however these are actually not adequate on their own. It is recommended to use them together with other treatment modalities like chemical peels or lasers in certain cases.

If hydroquinone is prescribed it should be used with caution under a specialist’s  supervision  and for limited periods only.

Depths of pigmentation vary and this influences the treatment choice and can predict to a certain extent the response to therapy: one may have superficial or deep pigmentation or a combination.

Your dermatologist will assess and determine the depth of your pigmentation using special devices.

Epidermal (superficial) hyper-pigmentation

This hyperpigmentation can be treated effectively with cosmeceutical products containing active depigmenting ingredients as it sits in the epidermis, with or without chemical peels based on the severity

Dermal (deeper hyper pigmentation)

This hyper pigmentation cannot be treated effectively with cosmeceutical de-pigmentation ingredients alone  as it lies in the dermal layer. The only effective treatments are specific pigment lasers. These however have to be used with caution in darker skin toned individuals.

Following a pigmentation home care regimen is essential for achieving satisfactory results.

This condition can be tricky to treat and can worsen if treatment instructions are not adhered to.

Results take time and are variable . As the condition is chronic, treatment is continuous to maintain the results.

Moles

Concern about moles is one of the most common reasons for visiting a dermatologist, they are very common growths on the skin. Moles are pigmented skin growths medically known as nevi.

Moles can be present at birth, but most moles develop later in childhood until adulthood.

What causes a mole?

Moles are made of cells called melanocytes. Melanocytes are found scattered throughout our skin and are the cells that give  our skin its natural colour  by generating a pigment called melanin. A mole is made of many melanocyte cells clustered together.

What do they look like?

Moles are usually brown but can vary in color (skin colored to pink to light brown to dark brown to blue to black). They can be flat (junctional nevi) or raised (compound nevi).

  • Some people have many more moles than others—the average person has 10- 40 moles. Moles may darken during pregnancy or after sun exposure. They grow very slowly and some may have hair in them. Moles can be found anywhere on your skin, including your scalp, nails and genitalia.

Can a mole turn into cancer?

Yes, when a mole becomes cancer it is called a melanoma.this is the most serious type of skin cancer

When should I be concerned about a mole?“A” asymmetric shape (if you cut it in half and one side is different from the other). “B” irregular border (scalloped or ill-defined border). “C” variegated or uneven color. “D” diameter greater than a pencil eraser (6mm) “E” evolving or changing mole.

  • When it is an “ugly duckling”-  It looks different from your other moles.
  • When there is pain, bleeding, ulceration ,change in colour or shape

How is a mole evaluated by the dermatologist?

  • Your doctor will examine your skin, comparing one mole to the next, looking for the “ugly duckling” or stand-out mole. During your exam, point out any moles that you are concerned about. Your doctor may use an instrument that illuminates and magnifies the mole called a dermatoscope.
  • Molemapping can be done to keep record of the mole for future reference to monitor change.
  • If a mole is suspicious, a biopsy will be done. This involves numbing the affected skin and removing a small area to determine under the microscope if the mole is abnormal.
  • Results are usually available within a  few days
    • Normal moles: No further treatment is needed. If your entire mole was not removed with the biopsy, some color may persist or recur at your biopsy site
    • Abnormal moles: This includes a variety of terms including “atypical” or “dysplastic”. These moles are not cancer and may or may not need to be removed completely. Your doctor will recommend treatment based on the specifics of your results.. Annual full body skin exams are often recommended for patients with a history of abnormal moles as this diagnosis may increase your risk for melanoma.
    • Malignant melanoma: This is the most concerning type of skin cancer. Expect that you will need to have skin surgery to remove the cancer, you will be referred for further evaluation of your lymph nodes and removal of the cancer based on your results.

What should I do at home for prevention?

You can help prevent skin cancer by protecting your skin from the sun’s rays from an early age.

  • Monitor your moles by examining your skin carefully, including areas of skin not exposed to the sun, on a monthly basis.
  • Avoid tanning and do not use UV tanning booths.
  • Avoid burning.
  • Use a broad spectrum sunscreen that has coverage for both UVA and UVB daily. Apply atleast  30 minutes before going outside. Reapply every two hours—more frequently if in water or in the sun a lot.
  • Seek shade, especially at times of peak sun between 10 AM and 4 PM.
  • Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
  • See your dermatologist once a year for a check -up or more if you have a suspicious lesion. Better safe than sorry.

For more information on skin cancer visit http://www.cansa.org.za/do-a-monthly-spot-the-spot-skin-check/

This is a common viral infection of childhood . It is contagious and is usually transmitted from one person to the next through skin contact.  Extensive lesions may be associated with immunosuppression  in  adults.  It is caused by Pox virus.

What does it look like?MOLLUSCUM CONTAGIOSUM

They are usually asymptomatic, shiny skin coloured bumps with a white “umbilicated” centre  that can occur anywhere on the skin. They may be secondarily infected or have a surrounding  eczematous reaction.

How do you treat molluscum contangiosum ?

      • They often clear spontaneously over time but this might take very long.
    • Treatment includes topical therapy or physical methods like cautery or cryotherapy amongst others to destroy the lesion

A napkin rash is an inflammation of the skin in the napkin area.  It usually occurs between 6-12 months of age.

What causes a napkin dermatitis?

There are many causes of a nappy dermatitis and they look similar thus can be easily confused by the untrained eye. It may be one of the following:

  • It may be due to irritation ( urine, faeces, soaps,  perfumes and dyes in the napkins)
  • Infections  such as candidiasis
  • Inflammatory conditions such as psoriasis, seborrhoeic dermatitis and eczema
  • Infestations such as scabies
  • More sinister conditions such as Langerhans cell histiocytosis, acrodermatitis enteropathica, which are uncommon.

How do you treat napkin dermatitis?

The letters ABCDE are a useful way to remember how to prevent/treat napkin rashes.

  • A = air out the skin by allowing the child to go napkin-free
  • B = barrier; use a paste or ointment to protect the skin
  • C = clean; keep the skin clean
  • D = disposable napkins; during an episode of napkin rash, consider using disposable rather than cloth napkins and avoid keeping them on for too long.
  • E = educate; educate yourself about how to prevent a recurrence of napkin rash

 If a child with napkin rash does not improve after a few days or if the child develops, fever, persistent diarrhea , blisters or pus-filled sores, see the dermatologist urgently.

What is psoriasis?

Psoriasis is a chronic skin disorder  due to a combination of immune, genetic, and environmental factors. It commonly affects more than one family member.

 What causes psoriasis?

The exact cause of psoriasis is unknown. If you have psoriasis, your skin cells grow faster than normal due to cytokines release by T-cells. The body naturally develops new skin cells every month to replace skin that sheds or flakes off. With psoriasis, new skin cells form within days rather than weeks. This rapid growth causes dead skin cells to accumulate on the skin’s surface. The redness is from the increased blood supply required for the increased growth of cells.


How do I know if I will get psoriasis?

Psoriasis is not contagious. However, the condition may run in families. Risk factors for psoriasis include:

  • family history of the condition
  • having a viral or bacterial infection
  • it can also be triggered or worsened by uncontrolled stress, smoking , obesity and use of certain medications, such as those used to treat bipolar disorder and high blood pressure

What does it look like ?nail psoriasis

There are about five types of psoriasis but the plaque type is the most common.

The accumulation of dead cells on the skin results in well demarcated areas of thickened, red or salmon pink  itchy plaques, often covered with silvery scales.

Lesions are symmetrically distributed, often involving the scalp, elbows, knees, and lower back.

Guttate psoriasis refers to a special type of psoriasis where the lesions occur rapidly . It is commonly associated with underlying infection especially Streptococcal infection.

Psoriasis can cause nail abnormalities like multiple tiny pits or brittle ugly looking nails.

What other areas can psoriasis affect?

psoriasisPsoriasis can increase your risk for other illnesses. Some people develop psoriatic arthritis, which can cause severe joint damage. You’ll need to see a rheumatologist for treatment if your dermatologist suspects this type of psoriasis.

You also have a greater risk of developing type 2 diabetes , heart  disease and celiac disease amongst others.

Because psoriasis can develop anywhere on the body and become a widespread problem, you may also deal with periods of low self-esteem, social isolation, and depression.

What can make psoriasis worse?

  • Smoking and alcohol  tends to increase the severity of psoriasis as well as affect response to treatment.
  • Emotional stress can contribute to the  initial onset of psoriasis and flares  of existent disease
  • Skin trauma caused by  scratching, sunburn and viral infection may make exacerbate psoriasis
  • Certain medications like steroid injections can worsen the disease

How is it diagnosed?

Psoriasis can be diagnosed by examining the skin. Occasionally, a skin biopsy or scraping may be taken to rule out other disorders. There is no blood test to diagnose psoriasis.

How do you treat psoriasis ?

There’s no cure for psoriasis. But with treatment, you can reduce inflammation and skin irritation. Some treatment options are described below.

Topical Therapy

Your doctor may prescribe creams or ointments for your skin or scalp. These can include:

  • Combination of topical corticosteroids and vitamin D analogues
  • Calcineurin inhibitors for sensitive areas
  • Keratolytics to peel off the thick scales eg, salicylic acid
  • Tar based formulation reduce the fast growth of skin cells

Light Therapy

This therapy exposes skin to artificial ultraviolet light under medical supervision. This treatment helps slow the growth of new skin cells. You may need to attend the clinic 2 -3 times each week.

Medications

If your psoriasis is severe or doesn’t respond to other treatments, the dermatologist  may prescribe medications to suppress your immune system. These require taking of blood and close monitoring.

Psoriasis Prevention

There’s no way to prevent psoriasis. You can reduce flare-ups by following your doctor’s treatment plan and recommendations and by avoiding common triggers like stress and smoking.

Psoriasis is a lifelong condition but it doesn’t have to negatively impact the quality of your life. Talk to your doctor if you have symptoms of psoriasis or if the condition causes depression or mood problems.

Rosacea is a common, chronic but treatable condition that typically affects the central third of the face. It often begins with a tendency to blush or flush more easily than other people. It tends to affect fair skinned individuals more.

What does it look like?

There are Four Subtypes of Rosacea

  • Erythemato telangiectatic – flushing and persistent redness.
  • Papulopustular—persistent redness with bumps or pimples.
  • Phymatous—skin thickening and enlargement usually around the nose.
  • Ocular—irritation and stinging of the eyes resulting in watery and/or bloodshot appearance.

Many patients will experience features of more than one subtype at the same time, and those often may develop in succession.

What causes Rosacea ?

The underlying cause(s) of Rosacea  are unclear but involve blood vessel factors such as increased blood flow, increased tissue fluid and interaction with the nervous system via flushing.

Much more is known about what triggers Rosacea, the most common being sun exposure, emotional stress, hot or windy weather. Certain food, beverages, medicines and skin care products may also have a negative effect.

How is Rosacea treated?

The treatment is tailored for each individual as the signs and symptoms of Rosacea vary from one patient to another.

Rosacea Treatment Therapy Combines:

  • Consistent use of a broad spectrum sunscreen and a gentle skin care routine , using non irritating skin care products recommended by the doctor
  • Topical antibiotics and anti-inflammatories
  • Mild and/or medicated cleansers
  • Oral antibiotics (used for their anti-inflammatory properties)
  • Pulsed dye lasers and intense pulsed light devices (targeting persistent redness and blood vessels) when appropriate

Avoiding lifestyle and environmental factors that trigger Rosacea flare ups eg. Sun exposure, stress, hot weather or hot baths, spicy food and alcohol amongst others may also help.

Pityriasis versicolor / Tenia Versicolor

This is a common fungal infection of the skin especially in teens and young adults. It is not contagious or harmful but can lead to emotional distress or self-consciousness.

What is pityriasis versicolor and what causes it?

It is a skin eruption caused by overgrowth or multiplication of a yeast called Malassezia (also called Pityrosporum). The fungus interferes with the normal pigmentation of the skin, resulting in small, hypopigmented patches. Hot, sunny or humid weather as well as excessive sweating seem to be triggering factors

What does it look like?

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It  usually starts as small pale patches. In  darker than the skin in fair-skinned people, and in this case it looks like brown marks. It commonly affects the back, chest and shoulder area. Occasionally it may affect your face. The affected skin may become slightly scaly. The rash can be slightly itchy or be without symptoms.

You may not notice it until after you sunbathe. Affected areas do not tan and therefore the rash becomes more obvious on tanned skin. The pale patches are more obvious if you have dark skin.

What is the treatment for pityriasis versicolor?

  • Antifungal creams, lotions or shampoos can help treat tinea versicolor.selenium sulfide shampoo is also commonly used but might irritate the skin.
  • Antifungal tablets: may be prescribed if the rash is over a large area of your skin, or is not cleared by the above treatments. Antifungal treatment may need to be repeated if this rash comes back (recurs) and becomes scaly again.

Even after successful treatment, the colour of the affected skin usually takes 2-3 months or even longer to return to normal.

How can I prevent the rash from coming back?

One option is to apply one of the above shampoos to your skin every 2-4 weeks, this  prevents the numbers building up, which will prevent the rash from recurring. Alternatively, if you have frequent recurrences then your doctor  may advise you  to take antifungal tablets  as a preventative measure.

Skin cancer is the most common cancer and is increasing at a rapid rate.

what causes skin cancer?

Skin cancer happens when normal cells in the skin change into abnormal cells. The cause is complex and involves multiple factors including ultraviolet light exposure (sunlight, tanning beds), genetics and changes in genes (DNA) that control cell growth.

There are 2 main types of skin cancer :

  • melanoma
  • non-melanoma – “basal cell carcinoma” and “squamous cell carcinoma.”

Chronic sun exposure and sunburn are major contributing factors to skin cancer . The damaging effects of the sun build up over time. The more you are exposed to the sun (or to tanning beds) in your life, the higher your risk of skin cancer.

Non-melanoma skin cancer can occur anywhere on the skin, but is often found on the head, face, neck, back of the hands, arms, and legs. This is because those body parts are most exposed to the sun’s rays.

Most forms of non-melanoma skin cancer can be easily treated because they grow slowly. But if not treated, some non-melanoma skin cancers can become large or spread inside the body.

BCCBasal Cell Carcinoma (BCC)

This is the most common cancer affecting human beings. It is a slow growing skin cancer. It is often painless. The majority of lesions appear on sun exposed skin .The cancer can present as a longstanding ulcer with a shiny or pink-  pearly raised  papules.. Sometimes, they may have a firm, scar like appearance with no symptoms. BCC rarely spreads to internal organs, but can be dangerous in that they can destroy important structures such as the eyelid, nose or lips.

Therapy includes surgical excision,PDT radiation therapy and in selected cases, use of creams that stimulate the immune system to destroy or shrink the tumor. The cure rate is over 95% if diagnosed and treated at an early stage.

Squamous Cell Carcinoma (SCC)

SCC usually appears in elderly patients due to cumulative chronic sun exposure It  favors sun exposed skin as well as skin that may have received radiation therapy or skin near a chronic wound such as an  ulcer. . They appear as growths that may be pink or flat or bumps with some red or pink color. They often have a rough, scaling, “dry” appearing surface and may be tender to the touch. Advanced SCC has the potential of spreading to internal tissues such as lymph nodes .This is why early diagnosis and treatment is crucial.

Therapy includes surgical excision, radiation therapy and injection of medication into the SCC. The cure rate for early SCC is very high but declines for more advanced tumors.

Malignant Melanoma

This is a cancer of the pigment cells (melanocytes) of the skin, and is a very dangerous  type of skin cancer. It often presents as a dark brown or black skin growth or ulcer.  It may look like an ordinary mole.  Unlike the common mole however, it grows more rapidly; its surface may have varying shades of colour; its surface may be thick and irregular; its margin may be irregular; and it may show features of change over time.

Melanomas may occur spontaneously, or arise from a pre-existing “normal” mole. People who are born with large moles (giant congenital nevi) or who have a positive family history of melanoma are at increased risk.

Melanoma is more common among Caucasians . It can occur on any site, including the palms and soles. Excessive exposure to the sun and a history of sunburns are predisposing factors.

Melanomas have a tendency to spread (metastasize) to surrounding lymph nodes or other parts of the body, leading to morbidity and mortality. Early detection and treatment of this condition is therefore  important.

Diagnosis of skin cancers

Any skin lesion that is progressively enlarging should be examined by a trained doctor.

If you notice any of these warning signs, see a doctor or dermatologist immediately: 

“A” asymmetric shape (if you cut it in half and one side is different from the other). “B” irregular border (scalloped or ill-defined border). “C” variegated or uneven color. “D” diameter greater than a pencil eraser (6mm) “E” evolving or changing mole.

If a skin cancer is suspected, your doctor may advise a biopsy to be done under local anesthetic. Upon confirmation of a skin cancer, the doctor can assess and advise on the best option for treatment. The right treatment for you will depend  on the type of skin cancer you have, its size and location, as well as your  age and other health problems.

Treatment

The most common form of treatment of a malignant skin tumour is excision,  which involves removing the entire skin lesion. In certain situations whereby complete excision may not be feasible, other forms of therapy such as radiotherapy, photodynamic therapy or topical therapy may be used. If the cancer has spread to involve the lymph nodes or other organs then the patient may need to be managed jointly with an oncologist and/or surgeon.

Follow up

After removal of a  skin cancer,  patients will need to be followed up regularly by the doctor for a few years. This is to look out for any recurrences of the skin cancer  that may occur. It also gives the doctor a chance to assess whether new skin cancers have developed in other areas.

For more information visit cansa.org

What is Urticaria?urticaria

Urticaria refers to a skin rash that consists of itchy red bumps called wheals or hives with or without associated angioedema. Angioedema is a swelling of the deeper tissue of the skin and mucous membranes. This commonly presents as swelling of the lips, face or eyes.  Urticarial lesions usually disappear within 30min to 3-4 hours but usually never last longer than 1 day. In contrast the swelling of angioedema may persist for a few days.

What causes Urticaria?

Urticaria can be caused by certain medications, allergies to certain foods , physical factors and rarely underlying disease eg. Infections and autoimmune  or connective tissue diseases… Unfortunately in a large number of cases there may be no cause found.

Who needs laboratory tests?

Patients that get urticaria for the first time do not need special tests. When the hives continue appearing or persist for more than 6 weeks (chronic urticaria) your doctor will suggest special blood tests. Skin tests are usually not helpful.

How do you treat Urticaria?

The best treatment is to identify and withdraw the cause. Avoid drugs that may aggravate urticaria, even if they are not the cause: aspirin, codeine, morphine, NSAIDs, ACE- inhibitors

Antihistamine tablets are very helpful even in cases where the cause cannot be identified. Antihistamines should never be combined with alcohol. If the disease persists to occur despite the use of antihistamines your doctor will discuss the potential benefits and side effects of the other specialized systemic medications with you including leukotriene antagonists and immunosuppressive medications

Elimination diets are not helpful, unless there is a high association with the onset of lesions.

What is Vitiligo?

Vitiligo is as skin disease that causes white patches on the skin due to progressive loss of melanocytes. Melanocytes are the cells that produce the brown pigment  called melanin that give our skin colour.

Who gets Vitiligo?

Vitiligo occurs worldwide and affects people of all races.  It can start at any age but in most people it begins in childhood or early adulthood  Vitiligo is not contagious but the tendency to get vitiligo can run in families.

What does it look like?vitiligo

Patients usually have chalk white or milky white patches on their skin. These patches are usually surrounded by skin that is normal in colour or darker looking. Some lesions are tan in colour or halfway between the natural skin colour and white.  Lesions may also present with a combination of white, tan and brown lesion these are called trichrome

Is vitiligo associated with other diseases

Persons with vitiligo have a higher incidence of certain diseases these including diabetes mellitus, thyroid diseases and  alopecia areata.

How can it be treated?

Treatment works best if seeked early.

Options include the following:

    • Steroid creams
    • Steroid sparing agents – calcineurin inhibitors
    • Sunscreens-  help to prevent sunburn which may traumatize the skin and  stimulate the formation of more vitiligo patches.
    • Phototherapy
    • Laser
    • Surgical treatments  can be attempted in cases where creams ointments and light therapy has failed eg.  micro punch grafting and needling.

What can I do if my skin does not respond to these treatments?

Cosmetics can provide excellent camouflage and are particularly useful for white patches on the face and back of the hands.

In severe cases where most of the body is affected by vitiligo and not responding to treatment the doctor may recommend complete depigmentation or bleaching.