Skin Health; Diagnosis
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.
This aggravating condition may be mild comedones (blackheads and whiteheads), moderate inflammatory, with pustules (closed pus-containing pockets) and red pimples or severe (large cysts or nodules) and can result in permanent scarring. Contrary to popular belief, greasy foods and dirt do not cause acne. Acne is caused by genetic influences–if your parents had acne, you are more likely to develop it. Hormones, specifically male hormones called androgens, of which testosterone is the best known, also play the other major role in acne’s development.
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. Androgens are a major influence on acne because they stimulate the hormone-sensitive sebaceous glands, which produce sebum. That’s why you don’t see acne before puberty. In women, birth control pills can either aggravate or improve acne. This probably depends on your response to progestin–one of the hormones used in many birth control pills. Greasy hair and skin products, perspiration, headbands and other things that can plug up pores make acne worse, also called pomade acne. Stress may trigger acne flare-ups. Squeezing pimples can make acne worse and more likely to leave scars.
Approximately 14 million Americans suffer have rosacea, but are unaware of it. Most common in fair-skinned women between ages 30 and 50, although can occur in all races. 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. Rosacea may worsen with exposure to certain factors such as hot or cold temperatures, sunlight, alcohol, spicy foods, stress and smoking. Chronic use of topical steroids on the face may cause steroid rosacea. The cause of rosacea is unknown.
An estimated 15 million people in the United States have some form of 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. It is hereditary and often occurs in those individuals who suffer asthma or hay fever. Cold, dry weather worsens the condition; humid, warm weather may improve it. Adults may get a less itchy form called nummular eczema, which tends to be scaly, coin-shaped spots on the arms and legs.
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.
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. Eggs, chocolate, seafood, nuts, milk and medications are occasional triggers of hives for some people, as are exposure to cold temperatures or infections. Individual hive lesions generally fade in 24 hours or less. When hives develop in the throat, breathing can become difficult and may be life threatening, and immediate treatment is required.
A chronic disease affecting about 2.6 percent (over seven million) of people in the U.S, psoriasis causes the skin to become inflamed with red, thickened areas that become covered with flaky, silvery scales. The condition is not contagious, and the ultimate cause is not known, although it is thought to be an immunologic genetic disorder. Because of this immune stimulation, the uppermost layer of skin cells multiplies at an accelerated rate. A normal epidermis is replenished about every 28 days, but psoriasis causes the skin cells to multiply so quickly that it replenishes every two to four days. This new skin grows so fast the cells don’t have a chance to slough normally. 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. Psoriasis may be associated with a specific type of arthritis, known as psoriatic arthritis. Lesions can be triggered by stress, infection, climate changes and medications. There is no cure for this condition, but treatments can reduce skin inflammation. The use of topical steroid medications is the most popular treatment, but the condition often returns quickly once the cream is discontinued. Light therapy may also be recommended. There are also new topical medications such as Dovonex (calcipotriene) ointment and Tazorac (tazarotene) gel, which offer new treatment options. Exciting new oral immunological treatments are being developed that will revolutionize psoriasis therapy. Remission rates vary but can last several months or longer after light therapy. Many treatments are available.
* 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.
An early warning sign of severe sun damage is the development actinic keratoses. Most common in people over age 50, this precancerous condition develops as a result of cumulative, extensive sun exposure and can lead to skin cancer, specifically squamous cell carcinoma. Although actinic keratoses are usually more prevalent in older people, this precancerous growth is appearing more frequently in people between the ages of 20 and 40, 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.
There are two main groups of skin cancer: nonmelanoma skin cancer, the most common type of skin cancer, and melanoma (sometimes referred to as “malignant melanoma” skin cancer).
Basal cell carcinoma and squamous cell carcinoma are the most common forms of non-melanoma skin cancers, accounting for about 95 percent of all new cases of skin cancer, of which there are about 1.3 million cases each year in the U.S. These types of cancer start in the skin’s basal cell layer or squamous cell layer. Men are at higher risk than women for basal cell carcinoma and squamous cell carcinoma, according to the American Cancer Society (ACS).
Melanoma is the least common, but most aggressive of the three most common types of skin cancer. Melanoma originates in the skin’s melanocytes–the cells that produce pigment, or melanin. Melanoma typically appears in or around a pre-existing mole, but it may also develop on clear skin. It may be a flat, brown, black or tan spot or a raised bump. Unlike a noncancerous mole, melanoma often is irregularly shaped.
More than 95,000 new cases of melanoma are expected each year–about four percent of all diagnosed skin cancers–but it accounts for about 77 percent of skin cancer deaths, according to the ACS.
Anyone may develop skin cancer, but people with fair complexions are more susceptible to precancerous conditions and skin cancer than people with darker skin tones. Caucasians have a ten-fold increased risk of developing skin cancer than African-Americans. Darker skin has more melanin, which provides some natural protection against the sun’s damaging rays. In addition to fair skin, other 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.
* a family history of melanoma skin cancer or other conditions that are more likely to develop into skin cancer (such as dysplastic nevus syndrome, see “Diagnosis” section)
* a personal history of skin cancer
* a tendency to freckle or burn easily
* lots of sun exposure throughout your life
* many sunburns as a child or adolescent
* outdoor summer employment during adolescence
Check Your Skin Regularly
Precancerous skin changes and skin cancer are easy to recognize and are often curable when detected and treated in early stages.
The first step in detecting abnormalities that may be skin cancer begins with you. Examine your skin once a month for any suspicious changes. Sores that won’t heal may also indicate skin cancer or precancerous conditions that need attention.
The American Academy of Dermatology has developed an easy-to-use method to evaluate your skin for melanoma. Look for the “ABCDs”:
* Asymmetry: One half of the spot is not shaped like the other half
* Border irregularity: Poorly defined or “scalloped” border
* Color: Shades of tan, brown, black and sometimes red, white and blue, vary across the spot
* Diameter: The spot is larger than six millimeters, the diameter of a pencil eraser
A condition called dysplastic nevus/melanoma syndrome can increase a person’s risk for developing melanoma. A “nevus” is a mole. These particular moles are often irregularly shaped and may be larger than other moles. They can appear anywhere on the body–sun-exposed or not. This condition tends to run in families. A person with this condition may have many moles on her body, or just a few. Researchers believe that a genetic predisposition for dysplastic nevus syndrome may exist.
Diagnosing Skin Cancer
There are four primary tests that health care professionals may perform if you have suspicious-looking growths on your skin that could be skin cancer:
* Skin biopsy. After giving you a local anesthetic, a sample of skin will be taken for examination under a microscope. You may feel minor discomfort–a small needle stick and burning–for a few seconds. Types of biopsies are as follows:
* Shave biopsy. The epidermis and the upper part of the dermis are shaved off in a thin slice. This procedure is performed with local anesthesia.
* Punch biopsy. After giving you a local anesthetic, a sample of the entire thickness of the skin is taken (about 1/8 inch) with an instrument that takes a cylindrical core sample of the skin and a small part of the underlying fat layer.
* Incisional biopsy and excisional biopsy. With a scalpel, a wider and deeper sample of skin with various amounts of the underlying fat will be removed, and then the wound is closed with stitches or staples. Incisional biopsy removes a portion of the growth, and excisional biopsy is used to remove or sample broad or deep growths.
“14 Million Americans Have Rosacea and Most of Them Don’t Know It.” National Rosacea Society. 2004. http://www.rosacea.org/. Accessed January 7, 2005.
“What is Eczema?” EczemaNet. American Academy of Dermatology. Copyright 2004. http://www.skincarephysicians.com/eczemanet/whatis.html#who. Accessed January 7, 2005.
“Frequently Asked Questions About Psoriasis.” PsoriasisNet. American Academy of Dermatology. Copyright 2004. http://www.skincarephysicians.com/psoriasisnet/FAQs.html2. Accessed January 7, 2005.
“Fact Sheet:Actinic Keratosis and Skin Cancer.” American Academy of Dermatology. Copyright 2004. http://www.aad.org/public/NEWS/DermInfo/ActKerSkCancerFAQ.htm. Accessed January 7, 2005.
Judy Tidwell. “Topical Immunodilators Prove Effective in Treating Eczema.” About, Inc. August 11, 2004. http://www.allergies.about.com/b/a/102504.htm. Accessed January 7, 2005.
“ASPS (American Society of Plastic Surgeons) Welcomes CaptiqueT to the InjectableWrinkle Fighters Market.” U.S. Newswire. December 14, 2004. http://www.releases.usnewswire.com/GetRelease.asp?id=40678. Accessed January 7, 2005.
“FDA Approves New Product for Facial Wrinkles.” FDA Talk Paper. U.S. Food and Drug Administration. December 12, 2003. http://www.fda.gov/bbs/topics/ANSWERS/2003/ANS01271.html. Accessed January 7, 2005.
“FDA Approves Fourth Wrinkle Filler.” WebMDHealth. April 23, 2004. http://www.my.webmd.com/content/article/86/98898.htm. Accessed January 7, 2005.
“Injectable Fillers.” American Society of Plastic Surgeons. 2004. http://www.plasticsurgery.org/public_education/procedures/InjectableFillers.cfm. Accessed January 7, 2005.
“Skin Cancer.” American Cancer Society. http://www.cancer.org/downloads/PRO/SkinCancer.pdf. Accessed January 7, 2005.
“Skin Cancer.” American Academy of Dermatology. 2000. http://www.aad.org/public/Publications/pamphlets/SkinCancer.htm. Accessed January 7, 2005.
“News Release Archives-Melanoma, Skin Cancer and Sun Safety.” American Academy of Dermatology. 2000-2003. http://www.aad.org/public/News/NewsReleases/Press+Release+Archives/Skin+Cancer+and+Sun+Safety/melanoma.htm. Accessed January 7, 2005.
“New Class of Eczema Drugs Associated with Significant Quality of Life Benefits in Adult and Child Sufferers” American Academy of Dermatology. Nov. 2001. http://www.aad.org/public/News/NewsReleases/Press+Release+Archives/Skin+ Conditions/EczemaNewDrugs.htm. Accessed January 7, 2005.
“Combination Therapies Offer New Management Options for Acne and Rosacea” American Academy of Dermatology. Oct. 2001. http://www.aad.org/public/News/NewsReleases/Press+Release+Archives/Acne/CombinationTherapies.htm. Accessed January 7, 2005.
National Institute of Arthritis, and Musculoskeletal and Skin Diseases. Health Topics. Updated September 9, 2004. http://www.niams.nih.gov/hi/index.htm#O-U. Accessed January 7, 2005.
“Skin Cancer.” National Cancer Institute, National Institutes of Health. May 19, 2004. http://www.nci.nih.gov/cancertopics/types/skin/. Accessed January 7, 2005.
“Understanding Wrinkle Treatment” American Academy of Facial and Reconstructive Plastic Surgery. 2000. http://www.facial-plastic-surgery.org/patient/procedures/wrinkles.html. Accessed January 7, 2005.
Dermatologic Disease Database: Dandruff. American Osteopathic College of Dermatology. 2001. http://www.aocd.org/skin/dermatologic_diseases/dandruff.html. Accessed January 7, 2005.
Editorial Staff of the National Women’s Health Resource Center 2002/03/01 2005/03/16 The importance of keeping your skin healthy can’t be overemphasized. It’s the body’s first defense against disease and infection, and it protects your internal organs from injuries. Acne,Actinic keratoses,Collagen,Eczema,Elastin,Melanin,Melanocytes,Skin health
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