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Dermatology Library

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Scabies:

Description

  • Scabies is an infestation by the mite Sarcoptes Scabiei which thrive and multiply only on human skin.
  • Mites can be transmitted by skin to skin contact as with sexual partners, children playing, and by persons living in close proximity such as in a nursing home, hospital or college dormitory.
  • Mites can live on clothing or bed linen for greater than 2 days so it is possible to become infested without skin to skin contact.
  • Skin findings can vary from individuals but most frequently lesions are slightly raised papules occurring in lines - located on the hands, in between fingers, wrist, genitals, and possibly other folds of the skin.
  • Itching is described as severe in some individuals and usually worse at night.
  • Scratching may cause multiple excoriations leading to secondary skin infections.
  • Occasionally itching can persist for weeks after treatment even if treatment was adequate.

Diagnosis - Can be made by history and visualization of lesions; sometimes may require a biopsy of the skin to rule out other conditions

Treatment

  • Treatment is generally a topical lotion applied from the neck down overnight & rinsed off in am; some providers will also recommend a second application in one to two weeks to ensure that treatment was effective.
  • It is also recommended that all linens are then washed in hot water and other individuals in the same house with symptoms also be treated to prevent re-infection.

Submitted by: Heather R. Brock, MSN, ARNP, NP-C

Scars:

Scars result when the skin repairs wounds caused by accident, disease, or surgery. They are a natural part of the healing process. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar. Typically, a scar may appear redder and thicker at first, then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time.The way a scar forms is affected by an individual's age and the location on the body or face. Younger skin makes strong repairs and tends to result in larger, thicker scars than does older skin. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. A scar that crosses natural expression lines or is wider than a wrinkle, will be more apparent because it will not follow a natural pattern nor look like a naturally occurring line. Any one, or a combination of these factors may result in a scar that, although healthy, may be improved by dermatologic surgical treatment.

Scleroderma:

Also called systemic sclerosis, it is a chronic connective tissue disease generally classified as one of the autoimmune rheumatic diseases.The word “scleroderma” comes from two Greek words: “sclero” meaning hard, and “derma” meaning skin. Hardening of the skin is one of the most visible manifestations of the disease. The disease has been called “progressive systemic sclerosis,” but the use of that term has been discouraged since it has been found that scleroderma is not necessarily progressive. The disease may take several forms. There is also much variability among patients. Scleroderma is a disease whose symptoms may be visible, as is the case when the skin is affected, or the symptoms may be invisible, as when internal organs are affected. Scleroderma is not contagious, it is not infectious, it is not cancerous or malignant. As a chronic disease, however, scleroderma can be serious. The symptoms of scleroderma vary greatly from individual to individual, and the effects of scleroderma can range from very mild to life-threatening. The seriousness will depend on what parts of the body are affected and the extent to which they are affected. A mild case can become more serious if not properly treated. Prompt and proper diagnosis and treatment by qualified physicians may minimize the symptoms of scleroderma and lessen the chance for irreversible damage.

For more information, visit:

Scleroderma Foundation at: www.scleroderma.org
Scleroderma Research Foundation: www.srfcure.org

Sclerotherapy:

The injection of aqueous solutions into abnormally dilated or cosmetically unacceptable veins. These solutions irritate and damage the endothelial lining of the treated vein, causing it to thrombose, fibrose, stenose, and be absorbed by surrounding tissue. The term varicose vein is used to designate enlarged tortuous veins that are often associated with abnormal valvular function. The term telangiectasia is used to designate smaller, visible blood vessels that are permanently dilated.

Also see: Veins

Sebaceous cyst:

A sebaceous cyst is a closed sac occurring just under the skin which contains a "pasty" or "cheesy" looking substance. A foul odor is also often present in the substance called keratin which fills sebaceous cysts. Keratin is a protein that creates the sac of cells called sebaceous cysts. The bumps or lumps you can feel under your skin are actually the sac of cells.

Causes - Sebaceous cysts are often the result of swollen hair follicles, or skin trauma.

Symptoms - Small lumps or bumps that occur just under the skin of the vagina, genitalia, breast, abdomen, face, neck, or elsewhere on the body are the most common symptom of sebaceous cysts.

Occasionally infections may occur. Signs or symptoms that may indicate infection of sebaceous cysts include:

  • Redness
  • Tenderness
  • Increased temperature of the skin over the bumps or lumps
  • Grayish white, cheesy, foul smelling material draining from the bump or lump

Treatments for sebaceous cysts - Sebaceous cysts most often disappear on their own and are not dangerous. Occasionally, they may become inflamed and tender. Sometimes sebaceous cysts grow large that they may interfere with your everyday life. When this happens, surgical removal in your health care provider's office may be necessary. Small inflamed cysts can often be treated by injection of steroid medications or with antibiotics.

Complications of sebaceous cysts - Sebaceous cysts may occasionally become infected and form into painful abscesses. It is important when sebaceous cysts are surgically removed that the entire sac is excised to help prevent a recurrence. However, it's important to note that sebaceous cyst recurrence is not unusual.

Remember to consult your health care provider anytime you notice any type of growth, bump, or lump on your body. Although sebaceous cysts are not dangerous, your doctor should examine you to ensure that skin cancer is not present.

Submitted by: Laura L. Mays, PA-C

Sebaceous glands:

Glands in the skin that produce an oily substance called sebum - these glands are the sites of acne lesions. Sebaceous glands are attached to hair follicles and are found mostly on the face, neck, back and chest.

Sebum:

The oily substance produced by sebaceous glands.

Seborrheic Dermatitis:

Description

  • Seborrheic dermatitis is a chronic condition that is characterized by redness and scaling occurring on the scalp, ears, forehead, eyebrows, folds along side the nose and occasionally on the folds of the body.
  • Can occur at any age and effects 2-5% of the population.
  • Emotional stress & variations in weather may induce flares.
  • Seborrheic dermatitis may also occur more frequently in people who have neurological conditions, such as Parkinson's disease.
  • Itching can be variable with condition but often it is increased with sweating.

Cause - The exact cause isn't known. The cause may be different in infants and adults. Seborrheic dermatitis may be related to hormones, because the disorder often appears in infancy and disappears before puberty. Or the cause might be a fungus, called malassezia. This organism is normally present on the skin in small numbers, but sometimes its numbers increase, resulting in skin problems.

Diagnosis - Can easily be made by visual inspection and history.

Treatment

  • Condition cannot be cured but easily controlled with the right treatment.
  • Multiple treatments exist-including shampoos, ointments, creams, and foams.

Submitted by: Heather R. Brock, MSN, ARNP, NP-C

Seborrheic Keratosis:

Seborrheic Keratosis Seborrheic keratoses are non-cancerous growths on the outer layer of the skin. They are usually oval, slightly raised plaques or papules, vary in color from light tan to black, and can be up to 3 cm in diameter. They look waxy, “stuck-on” and appear to be able to be easily picked off. They are often rough and itchy.

Seborrheic Keratosis The cause of seborrehic keratoses is not known. They develop in both sun-exposed and non sun-exposed areas and are more common in older people. Some patients will develop a few lesions while others will develop multiple lesions scattered over their entire body. Seborrheic keratoses are not cancerous. They are often confused with warts, moles, or skin cancers. If a lesion develops suddenly, a biopsy may be performed to determine if it is cancerous or not.

Treatment is not necessary for seborrheic keratosis. Some lesions may become large, irritated, itch, or bleed. These lesions can be treated with several methods. Cryosurgery can be used to freeze the area with liquid nitrogen. Curettage can be used to scrap the lesion from the skin. Electro surgery can be used to burn the lesion off with electric current.

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

Self Exam:

How to Perform a Self Exam from the American Academy of Dermatology (AAD)

Sjögren's Syndrome:

An autoimmune disease in which the body's immune system mistakenly attacks its own moisture producing glands. Sjögren's is one of the most prevalent autoimmune disorders, striking as many as 4,000,000 Americans. Nine out of ten patients are women. The average age of onset is late 40s although Sjögren's occurs in all age groups in both women and men. About 50% of the time Sjögren's syndrome occurs alone, and 50% of the time it occurs in the presence of another connective tissue disease. The four most common diagnoses that co-exist with Sjögren's syndrome are Rheumatoid Arthritis, Systemic Lupus, Systemic Sclerosis (scleroderma) and Polymyositis/Dermatomyositis. Sometimes researchers refer to the first type as "Primary Sjögren's" and the second as "Secondary Sjögren's." All instances of Sjögren's syndrome are systemic, affecting the entire body.

Skin:

The skin is the largest organ of the human body. Its size (about 20 square feet in an average sized adult) and external location make it susceptible to a wide variety of diseases, disorders, discolorations, and growths, as well as to damage from the environment and the aging process. The severity and appearance of skin problems vary considerably. Most can be removed or improved with a minimum of pain and risk in a dermatologist's office.

Smallpox:

Smallpox (or variola) is a highly infectious, often fatal, viral infection that last occurred naturally in 1977 in Somalia. In 1980, the World Health Organization declared the disease eradicated. All smallpox specimens and laboratory material have been destroyed except for authorized stocks of virus maintained at two World Health Organization laboratories, one at the Centers for Disease Control and Prevention (CDC) in Atlanta and one in Russia.

Soft Tissue Augmentation:

For centuries physicians have attempted to augment skin by injecting a variety of agents into the dermis and subcutaneous fat. Bovine collagen implants have become increasingly popular for use in dermal augmentation of the skin since their introduction in the 1980’s. After implantation, all current products undergo degradation by the body’s own mechanisms. For this reason periodic maintenance injections are necessary to sustain correction. The following conditions are amenable to treatment with bovine collagen injections:

  • Painful corns or calluses
  • Depressed scars
  • Postsurgical (e.g., after rhinoplasty or skin grafting)
  • Trauma induced
  • Resulting from acne or other disease
  • Wrinkles, creases, and lines caused by facial expression, aging, and other
  • Dermal atrophy from disease or from injection of corticosteroids
  • Angular cheilitis
  • Situations in which enhancement of facial contour is desirable (e.g., patient desires thicker lips)

SPF:

SPF stands for sun protection factor rating system. You should use an SPF 15 sunscreen every day, since that number would block most of the sun's rays. (If you'll be out in the sun for more than an hour, though, use an SPF 30.) If you'll be sweating a lot, you may want to use an SPF 30 on your face no matter what, because the sweat will thin it down to an SPF 15 fast!

Also see: Sun Protection

Spider and varicose veins:

See: Veins

Squamous cell carcinoma:

Squamous cell carcinoma (SCC) is the second most common cancer of the skin. Squamous cell carcinoma is a tumor that arises in the outer layer of the skin (the epithelium). More than 250,000 new SCCs are diagnosed every year in the U.S. Middle-aged and elderly persons, especially those with fair complexions and frequent sun exposure, are most likely to be affected. If treated in a timely manner, it is uncommon for skin squamous cell carcinoma to spread to other areas of the body. Squamous cell carcinomas often arise from small sandpaper-like growths called solar or actinic keratoses.

Stasis Dermatitis:

strong>Definition - Stasis dermatitis is a condition due to the build-up of fluid under the skin. It occurs on the lower extremities in patients when circulation becomes sluggish.

Description

  • Poor blood flow causes fluids to build up and the legs swell. Over time, this build up of fluids affects the skin, causing a rash that usually itches, painful sores, thinning of the skin, and discoloration of the skin.
  • It can begin so slowly that it is barely noticeable or so rapidly that it seems to develop overnight.
  • Honey-colored crusting occurs when the skin becomes infected.

Causes

  • Poor circulation in the lower legs leads to stasis dermatitis. One of the primary causes of poor circulation is advancing age. A deep vein thrombosis, surgery, or injury that damages the veins in the lower leg also can cause stasis dermatitis.
  • Obesity, high blood pressure, and a sedentary lifestyle also contribute to the disorder.
  • Heart conditions and kidney failure may also result in stasis dermatitis.

Diagnosis

  • Medical history and visual examination of the skin aid in diagnosis.
  • Doppler testing to evaluate blood flow of the legs should also be conducted.

Treatment

  • Stasis dermatitis is a long-term condition that requires care even when the skin clears.
  • Elevating the legs above the heart can improve circulation and decrease swelling.
  • Wearing compression stockings while awake can improve circulation.
  • Treatment of heart failure and hypertension will improve the condition.
  • Topical steroid can reduce inflammation.
  • Topical antibiotics may be necessary if infection occurs.
  • Avoid scratching.
  • After the signs and symptoms have cleared, prevention of recurrence may require regular walks, limited standing, elevation of legs, and moisturizing the legs regularly.

Submitted by: Elisa D. Endicott, P.A.-C.

Stomatitis:

See: Mouth Care

Stretch marks:

See: Melasma

Sturge-Weber Syndrome:

Sturge-Weber syndrome (SWS) and Klippel-Trenaunay syndrome (KTS) are syndromes with vascular birthmarks as their common manifestation. Separately, they are conditions that – besides skin – may also involve the eye and brain (in SWS), and soft tissue, muscle and bone (in KTS). The psychological impact of living with one of these syndromes is just now being investigated. The true prevalence of these syndromes is unknown. 1 in 200 individuals are born with a Port Wine Stain (PWS) in the United States. The incidence of SWS is thought to be 8-15% in live births with an associated facial Port Wine Stain.

Also see: Birthmarks

Sun Protection:

Sun protection at any age is important to prevent short- term and long-term damaging effects of sunlight. Sunscreens are an important part of a sun protection regime and should be used in conjunction with other sun safety steps for optimal sun protection. Overexposure to sunlight can result in painful, red, sunburned skin. A bad burn can cause serious consequences like skin cancer later in life. Long-term overexposure can cause wrinkles, freckles, age spots, dilated blood vessels, changes in the texture of the skin that make skin look older, and skin cancers. Using sun protection will help prevent skin damage, wrinkles, and reduce the risk of cancer. The American Academy of Dermatology recommends that you avoid deliberate sunbathing, wear a wide- brimmed hat, sunglasses, and protective clothing. If you must be in the sun, use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 even on cloudy days.

Superficial spreading melanoma:

One of the four clinical types of malignant melanoma, presents as a raised, irregular, colored area that starts in a mole-like shape but spreads across the skin.

See: Melanoma

Systemic therapy:

Treatment that consists of taking medication internally, such as in pill form or by injection or infusion.

Syphilis:

Syphilis Definition - Syphilis is an infectious disease that is most often spread by sexual contact. It is referred to as “the great imitator” because so many of the signs and symptoms are indistinguishable from other diseases.

Description - Syphilis involves 3 stages: primary, secondary, and tertiary.

  • Primary syphilis is the first stage. Painless sores, called chancres, form about 2-3 weeks after you are infected. They occur at the site of inoculation which is frequently the mouth or genitals. The sores disappear in about 4-6 weeks. Swollen lymph nodes are also present. If adequate treatment is not received, the disease progresses to the next stage.
  • Secondary syphilis occurs about 2-8 weeks after the first sores form. Skin rash and mucous membrane lesions characterize the second stage. Symptoms include fever, fatigue, aches and pain, and loss of appetite. The signs and symptoms of this stage will resolve without treatment, but without treatment, the disease will enter the latent and possibly late stages of the disease.
  • Tertiary syphilis causes heart, brain, and nervous system disorders. In the late stages of syphilis, the disease may subsequently damage the internal organs, including the brain, nerves, eyes, heart, blood vessels, liver, bones and joints. Signs and symptoms of the late stage of syphilis include difficulty coordinating muscle movements, paralysis, numbness, gradual blindness, and dementia. This damage may be serious enough to cause death.

Cause - Syphilis is an easily spread infection caused by the bacteria Treponema pallidum.

Diagnosis - Diagnosis is made through blood tests.

Treatment

  • Antibiotics are used to treat syphilis. With prompt treatment and follow-up care, syphilis can be cured.
  • Follow-up blood tests are done at 3, 6, 12, and 24 months to make sure the infection is gone.

Submitted by: Elisa D. Endicott, P.A.-C.