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Skin Conditions

Primary care physicians are able to evaluate many skin conditions. They may be the first health care professionals you discuss your skin problems with. However, dermatologists are physicians with extensive training in skin care and skin disorders. Skin conditions can be difficult to diagnose because there are so many different skin problems and symptoms may be similar. Consultation with a dermatologist is recommended to get an accurate diagnosis and treatment plan, and may be the more cost-effective means of diagnosing and treating skin disease.

Types of skin problems and their diagnosis

Acne

Acne is a build-up of oil, microorganisms and dead skin cells in the hair follicles under the skin. When the hair follicle ruptures, the rupture triggers an "acne cascade," which inflames surrounding tissue.

Rosacea

Rosacea can present itself in different ways. It may appear as pink or red flushing or dilated blood vessels alone or with pus-filled bumps or deeper red bumps. It rarely appears as cysts and rarely results in scarring.

Eczema

Also known as atopic dermatitis, this condition causes an itchy, red, cracked, scaly rash that can occur anywhere on the body, but most commonly around joints as well as on the hands, feet, face and the back of the knees, the neck, elbows and wrists.

Dandruff

Mistakenly attributed to dryness because of the flaking it causes, dandruff is actually caused by inflammation in the scalp. The microscopic scales accumulate and then fall off in visible flakes.

Hives

Called urticaria, hives are an allergic reaction. It's rarely clear what triggers hives. They can be stress-related. These pink, itchy swellings are caused by the release of histamine and other chemicals in the skin. Individual hive lesions generally fade in 24 hours or less.

Psoriasis

Psoriasis causes the skin to become inflamed with red, thickened areas that become covered with flaky, silvery scales. Psoriasis typically appears on elbows, knees and scalp, but it can also arise on your lower back, buttocks, palms, soles and genital region. Psoriasis can occur in areas of trauma such as severe sunburns or surgical scars.

Stretch marks

During pregnancy, as a woman's skin stretches to accommodate her baby's growth, stretch marks may appear. They are initially light pink or purple lines that eventually fade to white. Stretch marks are most often found on the breasts, thighs, abdomen or hips. Stretch marks may also be caused by pubescent growth spurts or other rapid weight gain or muscle build-up.

Skin Cancer

An early warning sign of severe sun damage is the development actinic keratoses. According to the American Academy of Dermatology More than 10 million Americans are affected by actinic keratoses. These lesions appear as scaly red/brown bumps on the face, ears, neck, lips and forearms or on the backs of the hands. These lesions may itch or feel tender, especially when exposed to sunlight. Risk factors for skin cancer include:

• Exposure to toxic materials, such as arsenic
• Radiation therapy
• Chronic, non-healing or scarred skin such as long-standing ulcers or severe burn scars.

Treatment of skin conditions

There are many new or refined treatment options available today for skin conditions. Consultation with a dermatologist is recommended to determine which option is best for your condition as well as for recommendations about how to keep your skin healthy. Here are a few treatment options for common skin conditions.

Acne

Treatment can include topical or oral antibiotics and special creams to remove plugs at the opening of the oil glands. Birth control pills can sometimes improve acne. When washing, you should use a mild soap and avoid scrubbing. Topical benzoyl peroxide can help reduce bacteria, and retinoic acid can help unblock pores. Acne washes and non-prescription preparations may also be helpful. When not treated, moderate and severe acne can cause significant scarring. Cosmetic treatment for scarring includes chemical peels, dermabrasion and laser resurfacing.

Rosacea

Treatment includes avoiding dietary, environmental and emotional triggers known to cause flare-ups, as well as practicing "sun safety" whenever possible – cover up with sunscreen, wear light-colored, tightly woven protective clothing and avoid the sun. This condition also can be managed with topical or oral antibiotics. Metronidazole, another prescription medication, in cream, lotion or gel form is often used to treat the condition. Topical sodium sulfacetamide with or without sulfur preparations may be prescribed for rosacea treatment.

Eczema

Treatment includes oral antihistamines for relief of the severe itching, as well as topical steroids to relieve the inflammation and itchiness. Recently, Protopic (Tacrolimus ointment) and pimecrolimus were approved by the U.S. Food and Drug Administration, the first two medications of a new (within the last 40 years) class of drugs called topical immunomodulators (or TIMS) to treat eczema. Moisturizers are an essential part of eczema therapy but should be chosen carefully because they can inflame sensitive skin. Petroleum jelly is an excellent bland lubricant for this condition.

Dandruff

Medicated shampoos containing coal tar (Ionil T, T/gel, Pentrax), salicylic acid (X-Seb, Scalpicin), selenium (Selsun Blue), zinc (Head & Shoulders, ZNP), Nizoral AD or sulfur (Meted or Sebulex) can help this condition. For best results, buy two or three brands/types and alternate them. Prescription shampoos and topical steroid medications may be necessary in difficult-to-treat cases.

Hives

Antihistamines and (sometimes) oral steroids usually are prescribed to treat hives. Leukotriene inhibitors (oral medications) that are used to treat asthma can also be used to help treat difficult cases of hives.

Psoriasis

There is no cure for this condition, but treatments can reduce skin inflammation. Topical steroid medications are frequently prescribed, but the condition often returns quickly once treatment ends. UVB light therapy, sunlight, oral and topical vitamin A derivatives, coal tar, anthralin and topical vitamin D derivatives often help. Tacrolimus (oral medication) and new injectable medications used for treating arthritis, such as Enbrel (etanercept) or Remicade (infliximab), seem to be very effective for some individuals with psoriasis.

Stretch marks

There is no cure for stretch marks, although topical retinoic acid and laser treatments may lighten them. Treatment may not be worth the cost since it won't completely eliminate stretch marks. Topical camouflaging makeup provides a quick cover up for stretch marks.

Skin Cancer Treatments

There are three primary kinds of treatments your health care professional may use to treat your actinic keratoses (precancerous lesions) or your skin cancer:

• Surgery, which removes the cancer, or destroys these abnormal cells
• Chemotherapy, which uses drugs to kill these abnormal cells
• Radiation therapy, which uses x-rays to kill cancer cells

Prevention of skin problems

Skin care starts with you. Many simple lifestyle changes—such as improving your diet and learning basic skin care techniques can help improve your skin's appearance. Discuss prevention tips with your health care professional, and consider these steps:

  • Good nutrition
  • Drinking six to eight glasses of water per day
  • Avoiding alcohol
  • Stopping smoking
  • Using sunscreen regularly
  • Avoiding sun exposure during peak sun hours between 10 a.m. and 4 p.m.
  • Wearing protective clothing when outside.

Most health care professionals recommend a simple cleansing regimen as the best approach to keep skin healthy: a gentle cleanser using warm (not hot) water, no abrasive scrubs and, when necessary, a moisturizer with sunscreen protection. In addition, you should gently pat your skin dry rather than rub it vigorously after a bath or shower to help avoid irritation and itching.

Dry Skin

Moisturizers for dry skin come in three preparations: lotions, creams and ointments. Lotions are least effective at replacing and retaining lost moisture in very dry skin. But they disappear after application very quickly, making them the most convenient to use, and possibly helpful for normal and oily skin. Creams are heavier than lotions and are therefore more effective at sealing in moisture for normal to dry skin.

Ointments, such as Vaseline, are thick and are best for preventing moisture from escaping from the skin, but you may find that they are inconvenient to use regularly. Health care professionals advise women with very dry skin against using soap and also alcohol-based astringents (toners), which typically dry out the skin.

Protect Your Skin from the Sun

Sunlight consists of two main types of ultraviolet (UV) rays that damage skin—UVA and UVB rays. UVB rays are the main cause of sunburn and skin cancer. This type of sunlight intensifies during the summer and can do more damage more quickly than UVA rays. The epidermis absorbs most of the intensity of UVB rays. UVB rays cannot pass through glass. UVC rays, another spectrum in sunlight, are also potentially harmful, but the ozone layer blocks them from reaching the earth. UVA and UVB rays are present all year and are hazardous whether they are direct or reflected.

Sunscreens

Sunscreens should be an important part of your skin health routine because they absorb or block UV rays. Sunscreens are rated by how much sun protection factor (SPF) they offer. SPF calculations are based on laboratory comparisons of how much sunlight will cause mild sunburn on the unprotected skin of a person with a fair complexion and on the same skin area protected by sunscreen.

Don't forsake the sun altogether. Learn how to protect your skin from the sun's harmful rays and practice "sun safety" whenever you can—cover up with sunscreen and wear light-colored, tightly woven protective clothing and be sensible about how much time you spend in the sun. These steps can help reduce your risk for developing skin cancer and keep your skin looking its best.

 

 
   
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