Doctor ONeill

Common Skin Conditions

Acne

1. What is acne?

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. Untreated acne can leave lifelong scars.

2. Does cleansing help?

Yes. For the normal care of your skin, wash your face with soap and warm water twice a day. Washing too often may actually make your acne worse.

3. Does diet make a difference?

Acne is not caused by the foods you eat. Some people find that certain foods seem to make their acne worse. If that's the case, foods that clearly worsen your acne should be avoided.

4. Will sunlight improve acne?

A tan can mask your acne, but the benefits are temporary. Since sunlight ages the skin and can cause skin cancer, you should avoid sunburns and the use of sunlamps. Choose a sunscreen that is oil-free, such as a gel sunscreen.

5. Do cosmetics increase the severity of acne?

If you wear a liquid foundation or use a moisturizer, look for ones that are oil-free and not just water-based. Remove your cosmetics every night with soap and water. Shield your face when applying hairsprays and gels. If the spray comes in contact with your facial skin, it can cause whiteheads and blackheads.

6. How is acne treated?

There are several effective treatments for acne. Over-the-counter gels containing benzoyl peroxide are helpful for mild acne. Prescription retinoids (molecules that treat blackheads and whiteheads by helping to unclog pores) or a variety of other topical medications can be used to help prevent pimples from forming. For moderate to sever cases of acne, oral antibiotics can be very effective.

For the most severe cases of acne, an oral medication called Isotretinoin, or “Accutane,” is sometimes used. This treatment generally yields excellent results.

Don't pick, scratch, pop or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation and scarring may result.

Control of acne is an ongoing process. All acne treatments work by preventing new acne. Improvement takes time. If your acne has not improved after 6 to 8 weeks, your dermatologist may need to change your treatment.

Dermatitis (Rashes)

Allergic Contact Dermatitis

1. What is the cause of allergic contact dermatitis?

Allergic contact dermatitis results from brief contact with substances that don’t usually provoke an irritant reaction in most people. The dermatologist and patient will discuss the materials that touch the person’s skin at work and home, to identify the allergen.

Atopic Dermatitis

1. What is atopic dermatitis?

The word "atopic" describes a group of allergic or associated diseases that often affect several members of a family. These families may have allergies such as hay fever, asthma, or a sinus condition but also have skin eruptions called atopic dermatitis.

Perioral Dermatitis

1. What is perioral dermatitis?

Perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. Common characteristics include redness, small red bumps, pus bumps, and mild peeling, accompanied by mild itching and/or burning. Perioral dermatitis is a combination of both acne and dermatitis (eczema).

 Seborrheic Dermatitis (“Dandruff”)

1. What is seborrheic dermatitis?

This condition is an inflammation in areas having the greatest number of sebaceous or oil glands. The scalp, sides of the nose, eyebrows, eyelids, and the skin behind the ears and middle of the chest are the most common sites. The affected skin is red and the scale can be yellowish and greasy. Itching may occur but is usually mild.

Eczema

1. What does eczema look and feel like?

Although eczema may look different from person to person, it is most often characterized by dry, red, extremely itchy patches on the skin. Eczema is sometimes referred to as "the itch that rashes," since the itch, when scratched, results in the appearance of the rash.

Eczema can occur on just about any part of the body; however, in infants, eczema typically occurs on the forehead, cheeks, forearms, legs, scalp, and neck.

2. Who gets eczema?

Eczema occurs in both children and adults, but usually appears during infancy. Although there is no known cause for the disease, it often affects people with a family history of allergies.

3. How common is eczema?

The National Institutes of Health estimates that 15 million people in the United States have some form of eczema. About 10 percent to 20 percent of all infants have eczema; however, in nearly half of these children, the disease will improve greatly by the time they are between five and 15 years of age. Others will have some form of the disease throughout their lives.

Herpes Virus

Herpes Simplex

1. What is herpes?

Herpes is the scientific name used for some 50 related viruses. Herpes simplex is related to the viruses that cause infectious mononucleosis (Epstein-Barr Virus) and for chicken pox and shingles (Varicella Zoster virus).

2. How are herpes infections treated?

Oral anti-viral medications, called acyclovir or famcyclovir have been developed for primary or frequently recurrent infections. Low doses of these medicines may be helpful in suppressing the number of herpes attacks in people with frequent outbreaks.

Herpes Zoster (Shingles)

1. Who can get herpes zoster?

Anyone who’s had chicken pox can develop herpes zoster, or shingles. The reason is that same virus that causes chicken pox causes herpes zoster. The virus remains in a dormant state in certain nerve cells of the body and then reactivates, causing herpes zoster. About 20 percent of the population is affected at some time during their lives.

People whose ability to ward off disease is weakened are more prone to develop herpes zoster. They are also more likely to have a serious form of it. This includes some people with cancer, such as leukemia or lymphoma, or who have undergone chemotherapy or radiation therapy for cancer. People who have had organ transplants and are taking drugs to ward off transplant rejection may also be more susceptible, as well as those with diseases that affect the immunological system, such as AIDS.

2. What are the symptoms of zoster?

The first symptom of herpes zoster is a burning pain or tingling and extreme sensitivity in one area of the skin. This may be present for one to three days before a red rash occurs. The rash soon turns into groups of blisters that look a lot like chicken pox. The blisters generally last for two to three weeks. The blisters will then crust over and begin to disappear. The pain may last longer.

3. Is zoster contagious?

The virus that causes herpes zoster can be passed on to others, but they will develop chicken pox, not herpes zoster. Herpes zoster is much less contagious than chicken pox. Persons with herpes zoster can only transmit the virus to someone who never has had chicken pox. Newborns, pregnant women or those who are immunosuppressed, such as cancer patients, are at the highest risk.

Keratoses

Actinic Keratosis

1. What is an actinic keratosis?

Actinic keratosis is also called solar keratosis. It’s a precancerous skin condition that begins in the epidermis, or upper layer of the skin.

2. How are actinic keratoses treated?

Many methods are used to remove actinic keratoses. Cryotherapy often is used if a patient has just a few lesions. This treatment freezes the affected skin, thereby destroying the precancerous cells. Other methods are used also, depending on the number of lesions and the extent of skin damage.

3. Can actinic keratoses be prevented?

With appropriate sun protection habits, including wearing long-sleeved shirts, long pants and wide-brimmed hats as well as using sunscreens, most actinic keratoses are preventable.

Seborrheic Keratoses

1. What are seborrheic keratoses?

Seborrheic keratoses are benign growths of the outer layer of skin. They can vary in color from brown to light tan, all the way to black. They can thicken and develop a rough, warty surface.

2. Can seborrheic keratoses be treated?

Most often seborrheic keratoses are treated by cryotherapy, or freezing. A very cold liquid called liquid nitrogen is applied to the growth with a spray gun to freeze it. The keratosis usually falls off within a few weeks. Although occasionally there may be a small dark or light spot, usually no mark remains.

Moles

1. Can moles become cancerous?

Yes. Moles that appear at birth occur in about 1 in 100 people. They are called congenital nevi. These moles may be more likely to develop into melanoma than moles which appear after birth..

2. How do I recognize abnormalities in a mole?

Recognizing the early warning signs of malignant melanoma is important. Remember the ABCD's of melanoma when examining your moles.

• 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, if the diameter of a mole is larger than the eraser of a pencil.

If a mole displays any of these signs, it should be checked immediately by a dermatologist.

The only spots or blemishes that warrant medical concern are those that do something out of the ordinary – those that act differently from other existing moles. This includes any spot that suddenly changes in size, shape or color or one that bleeds, itches, becomes painful, or first appears when a person is past his/her twenties.

Psoriasis

1. What causes psoriasis?

The cause is unknown. The skin sheds itself too rapidly, every three to four days. People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it.

Rosacea

1. What is acne rosacea?

Acne rosacea or rosacea is a skin disease that causes redness and swelling on the face. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area. When it first develops, rosacea may appear, disappear, and then reappear a short time later. The condition rarely reverses itself and may last for years. It will become worse without treatment.

2. Who develops rosacea?

Those most likely to develop rosacea are fair-skinned adults, especially women, between the ages of 30 and 50. It may first seem like a tendency to blush easily, a ruddy complexion, or an extreme sensitivity to cosmetics. The exact cause of rosacea is still unknown, although studies have shown that many factors can irritate the condition.

3. What should patients with rosacea avoid?

Drinking too much alcohol of any type, spicy foods, hot drinks, caffeine, and smoking will dilate blood vessels and cause blood to rush to the affected areas.

• Limiting exposure to sunlight, or extreme hot and cold temperatures will help relieve the symptoms of rosacea. Use a nonalcohol based sunscreen with an SPF of 15 or higher.
• Rubbing or massaging the face should also be avoided because it will tend to irritate the reddened skin.
• Avoiding irritating cosmetics and using hair sprays properly will help prevent redness and swelling.

Skin Cancers

Basal Cell Carcinoma

1. Who can get basal cell carcinoma?

Anyone over the age of 15 can get basal cell carcinoma. It’s the most common form of skin cancer. It will affect around 800,000 people this year. It affects men more often than women and is found most frequently on sun-exposed areas such as the face, neck, hands, and trunk. One-third of all basal cell carcinomas are found on the nose.

2. How serious is basal cell carcinoma?

Basal cell carcinoma can be very serious. It can invade the skin and spread to underlying structures. It is highly unusual for a basal cell carcinoma to spread to distant parts of the body. However, if a basal cell carcinoma is left untreated, it can grow into nearby areas causing local destruction of the tissue.

3. Can basal cell carcinoma be cured?

If detected and treated early, there is a greater than 95 percent cure rate for basal cell carcinoma.

4. Once removed, will basal cell carcinoma recur?

If there is a recurrence of this disease, one third of the time it will happen within three years of the first cancer, and half the time within five years. Thirty-five to fifty percent of patients diagnosed with basal cell carcinoma will develop a new skin cancer within five years of the first diagnosis. If you’ve had a basal cell carcinoma, regular periodic checkups are recommended.

Squamous Cell Carcinoma

1. Who can get squamous cell carcinoma?

Anyone can get this disease, but it’s more common among men than women and the incidence of the disease rises sharply with advancing age in both sexes. It’s two to three times more common in men than in women and is usually found on sun exposed areas of the body such as the face, ear, neck, lip, and backs of hands.

2. Is squamous cell carcinoma serious?

Squamous cell carcinomas tend to be more aggressive than basal cell carcinomas and more often invade tissues beneath the skin. They are slightly more likely than basal cell carcinomas to spread to distant parts of the body. Even so, less than one percent of squamous cell carcinomas of the skin spread to lymph nodes and other organs. Approximately 1,900 deaths result from squamous cell carcinoma of the skin each year.

3. Can squamous cell carcinomas be cured?

Yes. The cure rate is very high. Ninety-five percent of all squamous cell carcinomas can be cured if detected and treated early.

Malignant Melanoma

1. What is malignant melanoma?

Malignant melanoma is a very serious skin cancer characterized by the uncontrolled growth of pigment-producing tanning cells. Melanomas may suddenly appear without warning but can also develop from or near a mole.

2. What causes melanoma?

Excessive exposure to the ultraviolet radiation of the sun may be the primary cause of melanoma. Persons in southern regions, where the sunlight is more intense, are more likely to develop melanoma than those in the north. Other possible causes include genetic factors and immune system deficiencies. Malignant melanoma has also been linked to more severe sunburns and younger ages of sun exposure.

3. Is melanoma a serious disease?

Yes, malignant melanoma is an extremely serious disease if not detected at an early stage. In later stages, malignant melanoma spreads to other organs and may result in death. But if detected in the early stages, melanoma can usually be treated successfully.

4. How many people will develop malignant melanoma this year?

At least 41,600 new cases of malignant melanoma were expected to be diagnosed in 1998 in the United States, and 7,300 people were expected to die from the disease. Since 1973 the rate of new melanomas diagnosed each year has doubled from six per 100,000 to twelve per 100,000.

5. What are my chances of getting malignant melanoma?

Although malignant melanoma is less common than other skin cancers, it is increasing at a faster rate than any other form of cancer. Recent studies showed that by the year 2000, 1 in 75 persons could develop malignant melanoma.

6. Who gets melanoma?

While malignant melanoma can strike anyone, Caucasians are at far greater risk than those of other races. About fifty percent of all melanomas occur in people over the age of fifty with nearly fifty percent of all melanoma deaths occurring in white men fifty years of age and above. However, melanoma can occur in young people. Among Caucasians, certain individuals are at higher risk than others. For example:

• If you’re a Caucasian with fair skin, your risk is twice as great as a Caucasian with olive skin;
• Excessive sun exposure in the first 10 to 15 years of life increases your chances for developing melanoma three-fold;
• Redheads and blondes have a two-fold to four-fold increased risk of developing melanoma;
• If you’ve already had one melanoma, your chances of another are increased by five to nine times;
• You’re at increased risk of developing melanoma if you have atypical moles or dysplastic nevi (unusual moles);
• Your risk is increased two to ten times if your parent, child or sibling has had melanoma.

7. What are atypical moles or dysplastic nevi?

The average young adult has at least 25 brown moles, or nevi. Almost all moles are normal. Atypical moles are unusual moles that are generally larger than normal, variable in color, often have irregular borders, and may occur in far greater numbers than ordinary moles. Atypical moles occur most often on the back and also commonly occur on the chest, abdomen and legs in women. They can also appear on the scalp, breasts, and buttocks. The presence of atypical moles may mark a greater risk of malignant melanoma developing in a mole or on apparently normal skin.

8. Should atypical moles be removed before they become cancerous?

Dermatologists are divided on the value of preventive removal of atypical moles. Because they can occur in larger numbers (sometimes more than 100), their removal may be expensive and cosmetically unsatisfactory. Many dermatologists recommend careful and regular monitoring of these moles and surgical removal of suspicious lesions.

9. What does malignant melanoma look like?

The ABCD rule can help tell a normal mole from one that could be a melanoma.

Asymmetry: One-half of the mole does not match the other half.

Border Irregularity: The edges of the mole are ragged or notched.

Color: The color over the mole is not the same. There may be differing shades of tan, brown, or black, and sometimes patches of red, blue, or white.

Diameter: The mole is larger than six millimeters (pencil eraser size).

The most important sign of melanoma is the change in size, shape, or color of a mole.

10. Can melanoma be cured?

When detected early, surgical removal of thin melanomas can cure the disease in most cases. Early detection is essential; there is a direct correlation between the thickness of the melanoma and survival rate. Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance, especially changes in existing moles or blemishes. Additionally, patients with risk factors should have a complete skin examination annually. Anyone with a large number of changing moles should be examined immediately.

11. Can melanoma be prevented?

Yes. Because overexposure to ultraviolet light is thought to be a primary cause of malignant melanoma, dermatologists recommend the following precautions:

• Avoid "peak" sunlight hours – generally 10AM to 4PM – when the sun’s rays are most intense.
• Apply a sunscreen with a sun protection factor (SPF) of at least 15 between fifteen and thirty minutes before going outdoors. Reapply every two hours, especially when playing, gardening, swimming, or doing any other outdoor activities.

Wear protective clothing with a tight weave to the cloth, long-sleeved shirt, pants, and a wide brimmed hat during prolonged periods of sun exposure.

Urticaria (Hives)

1. What does urticaria look like?

Hives are pink swellings called "wheals" that occur in groups on any part of the skin. Each individual wheal lasts less than a day before fading away, leaving no trace. When hives are forming they usually are very itchy and also may burn or sting. Hives are very common with 10 - 20 percent of the population having at least one episode in their lifetime.

2. What is the treatment for urticaria?

The best treatment for hives is to find the cause and then eliminate it. While investigating the cause of hives, antihistamines are usually prescribed by your dermatologist to provide relief from itching. Antihistamines work best if taken on a regular schedule to prevent hives from forming. In severe cases of hives, oral cortisone or an injection of a cortisone preparation may bring dramatic relief.

Warts

1. What are warts?

Warts are skin growths caused by a viral infection in the top layer of the skin or mucous membranes. The appearance of a wart depends on where it is growing.

How many kinds of warts are there?

There are several different kinds of warts including:

• Common warts
• Plantar warts
• Flat warts
• Genital warts

3. How do dermatologists treat warts?

Common warts in young children can be treated at home by their parents on a daily basis by painting on a low strength salicylic acid. There is usually little discomfort but it can take many weeks of treatment. Frequent "painting" with cantharidin in the dermatologist’s office causes a blister to form under the wart.

For adults and older children cryotherapy (freezing) is generally preferred. This treatment is not too painful and rarely results in scarring. However, repeat treatments at one to three-week intervals are often necessary.