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Dermatology Library

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ABCDs of Melanoma:

Created to help people recognize the warning signs of melanoma, the most lethal form of skin cancer. The ABCDs are:

  • A stands for Asymmetry, when one half of the mole doesn't match the other half.
  • B stands for Border, when the border or edges of the mole are ragged, blurred or irregular.
  • C stands for Color, when the color of the mole is not the same throughout or if it has shades of tan, brown, black, red, white or blue.
  • D stands for Diameter, when the diameter of a mole is larger than 6mm, about the size of a pencil eraser.
  • If a mole displays any of these signs, it should be checked promptly by a dermatologist.

Acne vulgaris and Cystic Acne:

Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). Acne can appear on the skin as any of the following:

- Congested pores ("comedones")/whiteheads and blackheads, pustules, or cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.

These lesions occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

Causes: No one factor causes acne. Acne happens when oil (sebaceous) glands increase around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.

Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.

Here are some factors that can cause acne,-usually not by themselves but in combination:

Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.

Stress: Some people get so upset by their pimples that they pick at them and make them last longer. When the body is stressed it tends to produce more oils which can worsen acne.

Hormones : Some women break out cyclically. Some oral contraceptive pills may help relieve acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.

Medications used for Acne: These are medications that your dermatology provider can prescribe if they are right for your type of acne:

- Topical (externally applied) antibiotics and antibacterials: These include erythromycin, clindamycin, sulfacetamide amongst others.

- Retinoids: Retin-A (tretinoin) has been around for years, and preparations have become milder and gentler while still maintaining its effectiveness. Newer retinoids include adapalene (Differin) and tazarotene (Tazorac). These medications are especially helpful for unclogging pores. Side effects may include irritation and a mild increase in sensitivity to the sun. With proper sun protection, however, they can be used even during sunny periods.

- Oral antibiotics: Most doctors start treatment with tetracycline or one of the related "cyclines," such as doxycycline and minocycline. Other oral antibiotics that are useful for treating acne are cefadroxil, amoxicillin, and the sulfa drugs.

- Isotretinoin: (Accutane was the original brand name; there are now several generic versions in common use, including Sotret, Claravis, and Amnesteem.) It should be used for people with severe acne, chiefly of the cystic variety, which has been unresponsive to conventional therapies like those listed above. Those with milder forms of acne often relapse shortly after finishing a course of isotretinoin, making this drug less useful in such cases. This means that isotretinoin is not a good choice for people whose acne is not that bad but who are frustrated and want "something that will knock acne out once and for all."

Acral lentiginous melanoma:

A brown, irregularly-shaped macular lesion of the unexposed skin that undergoes progression to nodular melanoma. It is found in patients older than 60 years, is more common in Africans and Asians, and occurs on areas of the body lacking hair, such as the soles, palms, fingers, subungual and periungual areas, and muscosal surfaces.

Submitted by: Laura L. Mays, PA-C

Actinic Cheilitis:

Actinic Cheilitis Actinic cheilitis is a degenerative change of the lip and the lip border as a result of sun damage. This most commonly affects men over the age of 50 and those with fair complexions. It is caused is by extreme sun exposure during the teen years, young adult life, and/or life-time occupational sun exposure increases the risk. The lip (usually the lower lip) becomes puffy, blotchy red and pale pink, with occasional white plaques and chronic ulcers. This is considered to be a pre-cancer, and has estimated 6% risk of developing into squamos cell carcinoma. Treatment includes close follow-up, and may involve removal of thick white or white/red patches or non-healing ulcers, liquid nitrogen treatment, carbon dioxide laser treatment, or topical 5-FU prescriptions such as Efudex or Aldara. Extensive lesions require complete removal of the lip mucosa and replacement with mucosa inside the mouth.

Actinic Cheilitis Submitted by: Mickelle Riley, MSN, ARNP, NP-C

Acne Keloidalis Nuchae:

Acne Keloidalis Nuchae, or hair bumps, is a condition that arises at the juncture of the scalp and the back of the neck (nape). Often seen in African American men, this problem can arise when hair, at the nape of the neck is cut or shaved quite short, typically less than 1/4 inch in length. In curly haired individuals, the hair is able to corkscrew back into the hair follicle where it causes irritation, much like an acne lesion. In the occasional unfortunate person prone to developing keloids, (firm raised scar tissue), this inflamed bump turns into a permanent ball of scar tissue. In severe cases, hair can be permanently lost in areas of widespread inflammation. Treatment is best aimed at preventing the ingrown hair in the first place. And if the ingrown hair does arise, it is equally important to prevent the development of inflammation.

Hair should be kept at least over 1/4 inch in length. For shaving in this region, try Aveeno Therapeutic Shaving Gel or California North Razor Shave cream which can help reduce the amount of acne which may arise and ultimately create the scar tissue. Also, prescription topical products such as Azelex Cream, Cleocin T lotion and topical erythromycin products can help prevent the inflammation. Some patients even need oral antibiotics.

Once the scar has formed, it is very difficult to eradicate it. The use of steroid injections into the larger lesions can help shrink it down, but for very tiny bumps, it is often impossible to get rid of these. If possible, simple camouflage by covering the area with long hair is the best way to hide the condition. The use of steroid impregnated tapes, and steroid ointments (Cortaid 1% Hydrocortisone Anti-Itch Cream) can also be used in place of the injections. However, I find the injections the most helpful. For disfiguring cases, excision of the scarred area can be performed by a competent surgeon.

Submitted by: Laura Mays, PA-C

Actinic Keratoses:

Actinic keratosis (also called solar keratosis, or AK) is a premalignant condition of thick, scaly, or crusty patches of skin. It is more common in fair-skinned people, especially those who are frequently exposed to the sun, as it is usually accompanied by solar damage. Actinic keratosis can progress to squamous cell carcinoma, therefore they should be treated.

They range in size from as small as a pinhead to over an inch across. They may be light or dark, tan, pink, red, a combination of these, or the same color as ones skin. The scale or crust is horn-like, dry, and rough, and is often recognized easier by touch rather than sight. Keratoses are most likely to appear on sun exposed areas: face, ears, bald scalp, neck, backs of hands and forearms, and lips. They may be flat or raised on appearance.

The most aggressive form of keratosis, actinic cheilitis, appears on the lips and can evolve into squamous cell carcinoma. When this happens, roughly one-fifth of these carcinomas metastasize. People with actinic keratosis are more likely to develop melanoma also. Sun exposure is the cause of almost all actinic keratoses. Individuals who are immunosuppressed as a result of cancer, chemotherapy, AIDS, or organ transplantation, are also at higher risk.

There are a number of effective treatments for eradicating actinic keratoses. Cryosurgery, the most common treatment, freezes off lesions through application of liquid nitrogen. Curettage is another treatment. The physician scrapes the lesion and may take a biopsy specimen to be tested for malignancy. Shave removal utilizes a scalpel to shave the keratosis and obtain a specimen for testing. The base of the lesion is destroyed in the process. Chemical peels make use of acids applied all over the area. The top layers of the skin peel off and are usually replaced within seven days by growth of new skin. Topical creams such as Aldara, Efudex and Carac are effective in treating keratoses, particularly when lesions are numerous.

In conclusion, large, multiple or inflamed actinic keratosis need to be treated to prevent their conversion to squamous cell carcinoma. This avoids the potentially more invasive and extensive treatment of a subsequent malignancy. Regular follow-up visits are usually needed when there are many keratoses.

Submitted by: Nitra Cole, MSN, ARNP, NP-C

Age spots:

Also called "liver spots." Flat, brown areas usually found on the face, hands, and feet. They are associated with aging, but chronic sun exposure is a major cause. They are easily removed by a dermatologist.

AIDS:

Acquired Immune Deficiency Syndrome (AIDS) is the loss of the body's ability to fight infections due to the infection caused by a virus called Human Immunodeficiency Virus (HIV). Some patients infected with HIV may develop skin conditions, fungal, viral, and bacterial infections as well as cancer. A common side effect is a skin lesion known as Kaposi's Sarcoma.

Allergy rashes:

Allergic contact dermatitis is caused by a reaction to substances called allergens that come into contact with your skin. In susceptible people, these contact allergens can cause itching, redness, and blisters that is known as allergic contact dermatitis.

Alopecia Areata:

A highly unpredictable, autoimmune skin disease resulting in the loss of hair on the scalp and elsewhere on the body.

Androgenic Alopecia:

Androgenetic alopecia, also known as common balding in men and hereditary thinning in women, is a common trait caused by androgens in genetically susceptible men and women. It begins in the teens, 20s, or 30s in both sexes and frequently is fully expressed by the 40s.

Athlete's Foot:

Athlete's foot is a very common skin condition - many people will develop it at least once in their lives. It is more frequent among teenage and adult males, but may occur in women and in children under the age of 12. Athlete's foot can be easily treated, but may recur in susceptible individuals.

Atopic eczema/dermatitis:

The terms eczema or dermatitis are used to describe certain kinds of inflamed skin conditions including allergic contact dermatitis, seborrheic dermatitis, photoallergic dermatitis and stasis dermatitis. Eczema can be red, blistering, oozing, scaly, brownish, or thickened and usually itches. A special type is called atopic dermatitis or atopic eczema.

Atypical nevus (also called a dysplastic nevus):

A benign growth that may share some of the clinical or microscopic features of melanoma, but is not a melanoma or any other form of cancer. However, the presence of atypical nevi may increase the risk of developing a melanoma, or be a marker for someone who is at risk of developing melanoma.