Skin Conditions

Last updated: October 22 2008.

Introduction

Millions of people worldwide suffer from skin conditions, which have the potential to disrupt their lives and lifestyles in many ways. To provide a greater understanding of some of these conditions, some of the most common skin disorders as well as some rarer light related skin disorders are listed below.

Clinuvel PhotoprotectionPhotoprotection is protection from light and ultraviolet radiation. E.g. Melanin provides natural photoprotection, whilst sunscreens provide artificial photoprotection. Click here for more information. focuses on the following conditions, with further information available on other pages:

Squamous Cell CarcinomaSquamous Cell Carcinoma (SCC) is a malignant tumour of the skin. Invasive SCC indicates that the cancer cells have grown into the deeper layers of the skin (dermis), whereas the term in-situ SCC indicate that the cancer cells remain in the upper layers of the skin (epidermis). SCC is a very common form of skin cancer. Click here for more information. (SCC)
Actinic KeratosisActinic Keratoses are collections of abnormal skin cells found in the upper layers of skin that develop after prolonged exposure to sun light. AKs are precancerous lesions. Click here for more information. (AK) or Solar KeratosisActinic Keratoses are collections of abnormal skin cells found in the upper layers of skin that develop after prolonged exposure to sun light. AKs are precancerous lesions. Click here for more information.
Erythropoietic ProtoporphyriaErythropoietic Protoporphyria is a rare inherited metabolic disorder of the heme pathway. Click here for more information. (EPP)
Polymorphous Light EruptionAlso known as PLE, PME or PMLE, Polymorphic Light Eruption is the most common skin disorder characterized by photosensitivity and, after sunburn, is the most common sun-related problem seen by doctors. Click here for more information. (PLE)
Photodynamic TherapyPhotodynamic therapy (PDT) is a treatment modality used in oncology medicine by a variety of specialist physicians to eradicate premalignant and early-stage cancer and reduce the tumour size in end-stage cancers. Click here for more information. (PDT) and Phototoxicity
Solar UrticariaSolar Urticaria is a rare and severe allergic disorder following exposure to sun and or light, occurring in less than 1% of the population. Click here for more. (SU)

Acne Vulgaris

Incidence: It has been reported that 95%-100% of 16-17 year old boys and 83%-85% of 16-17 year old girls develop mild acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information, which is usually resolved by the age of 23-25. Nevertheless at the age of 40, 1% of men and 5% of women still bear acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information lesions.

Causes: The causes of acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information are thought to be mainly hormonal, while other factors such as stress, evolutionary biology and genetic factors also contribute.

Symptoms: There are two main types of acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information: non-inflammatory and inflammatory. Non-inflammatory acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information is associated with a few whiteheads and blackheads on the face, while inflammatory acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information results in whiteheads becoming inflamed, with red pimples and pustules developing. This type of acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information can form into disfiguring cysts and deep scars on the face, neck, back, chest and groin.

Treatment: To clear up mild acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information, there are many non-prescription acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information medications. Over-the-counter drugs may contain sulphur, resorcinol, salicylic acid, and benzoyl peroxide. It is recommended that you wash your face once or twice daily, but do not scrub, use a loofa, pick or squeeze pimples. For severe or persistent acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information, a dermatologist may recommend topical treatments (antibiotics or retinoids) or oral systemic retinoids. Early treatment is most effective in reducing the probability and severity of scarring.

Actinic Prurigo

Incidence: Actinic prurigoActinic Prurigo is a chronic, pruritic skin disease, where symptoms present hours after exposure to UV light. Click here for more information. is a very rare disease, and there has been very limited research into its incidence. It has been found to be more predominant in American Indians.

Causes: The symptoms of actinic prurigoActinic Prurigo is a chronic, pruritic skin disease, where symptoms present hours after exposure to UV light. Click here for more information. are caused when patients are exposed to long and short wave ultraviolet radiation, emitted from sources such as the sun or tanning beds, causing a photosensitive reaction within the skin hours after exposure.

Symptoms: Actinic prurigoActinic Prurigo is a chronic, pruritic skin disease, where symptoms present hours after exposure to UV light. Click here for more information. is characterised by an intensely itchy rash once affected skin has been exposed to some form of ultraviolet radiation, be it manmade (sun bed) or natural (sun). The symptoms are often much more prevalent during summer months because of the increased ultraviolet radiation levels.

Treatment: There is no cure for actinic prurigoActinic Prurigo is a chronic, pruritic skin disease, where symptoms present hours after exposure to UV light. Click here for more information., and treatments are based around relieving symptoms. Emollients, topical corticosteroids, antimalarials and thalidomide are medications developed to relieve itching.

Atopic Dermatitis (Eczema)

Incidence: Evidence suggests atopic dermatitisAtopic Dermatitis (atopic eczema) is a chronic, highly pruritic, eczematous skin disease characterized by extreme hypersensitivity to allergens. Click here for more information. most often begins in infancy (65% of patients first develop symptoms in the 1st yr of life), while 90% of patients develop the symptoms before the age of 5. It is estimated that 20% of infants and children develop the disease, and those who live in dry climates are more susceptible.

Causes: The cause of atopic dermatitisAtopic Dermatitis (atopic eczema) is a chronic, highly pruritic, eczematous skin disease characterized by extreme hypersensitivity to allergens. Click here for more information. is unknown, but it appears to be a result of hereditary and environmental factors. It seems to be a result of a malfunction of the body’s immune response, where the body attacks itself (autoimmunity).

Symptoms: Atopic dermatitisAtopic Dermatitis (atopic eczema) is a chronic, highly pruritic, eczematous skin disease characterized by extreme hypersensitivity to allergens. Click here for more information. is characterized by dry, itchy, inflamed skin.

Treatment: Medications, known as immuno-modulators, have been developed that can reduce immune response and help control inflammation. Topical corticosteroids are prevalently used to treat atopic dermatitisAtopic Dermatitis (atopic eczema) is a chronic, highly pruritic, eczematous skin disease characterized by extreme hypersensitivity to allergens. Click here for more information. and other autoimmune diseases. When this isn’t effective, phototherapy (application of UVA/B, with or without a photosensitiser) may also be recommended. Refractory cases require internal therapy suppressing the immune system. Steriods provide only temporary relief while drugs such as azathioprina and cyclosporine may be given for a longer reprieve. New immunomodulators are under development.

Online associations:
National Eczema Association for Education and Science (USA)
National Eczema Society (UK)
Eczema Scotland
Eczema Association of Australasia

Basal Cell Carcinoma (BCC)

Incidence: This is the most common form of skin cancer, accounting for around 75% of skin cancers, although it is rarely fatal. Australia has the highest rate of BCC incidence in the world, with around 1 case for every 100 people in the population.

Causes: Those with a fair complexion, those who spend considerable amounts of time in the sun, and those between the ages of 50 and 70 are most commonly associated with BCC. It has been postulated that the consistent occurrence of skin cancers in older patients is a result of the accumulation of exposure of ultraviolet light over a lifetime, with 80% of the ultraviolet damage incurred before the age of 18 years. BCCs start in the top layer of the skin (epidermis) and grow slowly and painlessly.

Symptoms: The cancer may appear as a bump or skin growth, or it could be flat or slightly raised. Colours may be:

White or light pink;
Flesh coloured or brown; or
Pearly, or waxy.

The abrasion may present itself as:

A skin sore that bleeds easily or doesn’t heal;
Oozing or crusting spots in a sore;
A scar like sore; or
A sore with a depressed (sunken) middle.

Treatment: Doctors will first exam the suspect spot, noting the colour, shape, size and texture. If the doctor then feels it necessary, they will perform a biopsy, which comprises of a small section of the sore being collected and examined to determine if it is cancerous.

If the spot (lesion) is cancerous, then either the spot is removed or the cancerous cells are killed. The treatment method undertaken is determined by the size, depth and location of the spot. Treatment methods include:

Excision - the tumour is cut out (total excision) and the skin stitched back together (primary closure).
Mohs surgery - sections of skin are excised and are instantly examined histopathologically to check for cancer cells. This process is repeated until no cancer cells are present.
Curettage/electrodesiccation - the cancer cells are scraped away and then electricity is used to kill any remaining cells.
Cryosurgery - freezing the cancer cells to kill them.

Melanoma

Incidence: The incidence of melanomaMelanoma is a malignant cancer of the skin. Click here for more information. varies geographically. Australia has the highest incidence, with 1 in 25 people succumbing to the disease in their lifetime, compared to 1 in 5000 in the USA and European countries .

Causes: High peaks to sun exposure (eg. sunburn in childhood) and overall lifetime overexposure to ultraviolet radiation contributes substantially to melanomaMelanoma is a malignant cancer of the skin. Click here for more information.

Symptoms: Melanomas can present themselves as moles in areas all over the body, from both areas that are constantly, and never, exposed to the sun. Along with being found on the skin, they can present themselves under finger or toe nails, in the mouth, digestive tract, vagina, and in the eye.

The self -examination guide can be used to detect melanomas or other skin cancers:

A (asymmetrical): moles with an irregular shape may be skin cancers or melanomaMelanoma is a malignant cancer of the skin. Click here for more information..

B (border): melanomas have irregular, ragged or blurred borders.

C (colour): melanomas may have a changing or irregular colour, which can range between black, brown and blue.

D (diameter): growths larger than 6mm (1/4 diameter) may suggest melanomaMelanoma is a malignant cancer of the skin. Click here for more information..

E (evolving): check for any moles that appear to change shape, colour or size.

Other symptoms of a changing mole to be wary of are itching, a change in texture, and oozing or bleeding.

Treatment: Surgical removal, such as excision or mohs surgery, is used to remove melanomas. When the cancer grows, it is able to spread (metastasis) via the blood stream, which gives it access to distant organs, where it can form secondary tumours. Advanced melanomas are treated with chemotherapy, radiation therapy, and immunotherapy.

Online resources:
Body Mole Map from the American Academy of Dermatology
AT-RISC Alliance - Dedicated to the reduction of incidence and severity of skin cancer in organ transplant patients
A-Z of Skin: Types of Skin Cancers. Includes images and differences between three main types of Skin Cancer from the Australasian College of Dermatologists
Skin self examination: how to perform a self examination for skin cancers, with images from DermNet NZ
Types of skin cancer - quick reference guide with images from SunSmart Victoria

Online associations:
Melanoma International Foundation
Melanoma Patients Australia
American Melanoma Foundation
The Melanoma Foundation (Australia)
British Skin Foundation
Cancer Council Australia
Skin and Cancer Foundation Victoria
International Transplant Skin Cancer Collaboration (ITSCC)
The Skin Cancer Foundation (USA)
Society for Melanoma Research
Melanoma Research Foundation

Psoriasis

Incidence: PsoriasisPsoriasis is a lifelong, non-contagious skin disease, characterised by patches of red skin covered in silver scales. Click here for more information. is found to affect between 1 and 3% of the population, with no bias to gender, age or race.

Causes: It seems that psoriasis is caused by genetic, environmental, and immune response factors. 9 gene mutations have been discovered that could be involved in psoriasis, while an excessive amount of immune responsive T-cells are found to be overactive. There are also several forms of psoriasis that can develop from certain environmental triggers.

Symptoms: PsoriasisPsoriasis is a lifelong, non-contagious skin disease, characterised by patches of red skin covered in silver scales. Click here for more information. is characterised by recurring outbreaks of distinct red areas of skin, covered by white, flaky skin. The patches can cover large areas or just small spots.

There are several forms of psoriasis:

Erythrodermic psoriasis; The least common form of psoriasis, it can cover one's body in a peeling, red, itchy, burning rash. Triggers vary, but include severe sunburn, corticosteroids and other medications.
Guttate psoriasis; Usually affecting those younger than 30, it is caused by a bacterial infection. The sores are more nuisance than painful, with small, red, scaly marks covering the trunk and limbs. These may disappear on their own, or may reoccur.
Inverse psoriasis; This form of psoriasis is found under the armpits, groin, breasts and genitals, and is distinguished by red, smooth skin. This is aggravated with friction and sweating, and is more common in overweight people.
Nail psoriasis; This form affects toe and finger nails, resulting in abnormal nail growth.
Plaque psoriasis; This is the most common form of psoriasis, and results in dry, red, scaly, skin lesions. These sores can form anywhere on the body.
Psoriatic arthritis; This is a form of psoriasis that results in red, scaly, itchy areas of skin, and can also develop into swollen painful joints, potentially compromising long-term joint function.
Pustular psoriasis; This form of psoriasis is quite rare, and causes either small or large areas or quickly developing pus filled blisters.

Treatment: Depending on the type of psoriasis, different treatments may result. They can include one or combinations of topical treatments, systematic treatments, and phototherapy.

Online resources:
National Psoriasis Foundation (USA) survey panels

Online associations:
International Federation of Psoriasis Associations

Rosacea

Incidence: RosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information. is most likely to first present between the ages of 20-30 or 40 -50. Recent incidence estimates vary from 5-10% of Americans and 16% of Caucasian women, although rates could be higher as it often goes undiagnosed.

Women are up to three times more likely to contract the disease, and almost half of people diagnosed are between the ages of 30 and 60. Those with skin types one and two (fair skin and blue eyes) and of Celtic origin are more likely to develop rosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information..

Causes: Sebaceous glands are known to be involved, as in acneAcne is an inflammatory disease of the skin, caused by clogged sebaceous glands which result in pimples/pustules, extremely common in adolescence. Click here for more information. In some cases hair follicle mites (demodex folliculorum) have been found in far greater numbers within patients with rosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information. papules.

Some facial creams, oils and topical steroids have been found to provoke rosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information.. Along with these, sun exposure, and hot and spicy foods or drinks can also aggravate its onset.

Symptoms: RosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information. presents itself as a red facial rash with the following features:

Red papules and pustules, most commonly to the face;
Frequent blushing/flushing
Red facial skin, due to persistent teleangiectasias (dilated capillaries)
Dry and flaky facial skin
Conjunctivitis may arise;
Swelling of facial areas, including the eyelids

Treatments: General measures to reduce severity of rosaceaRosacea is a common and chronic, dermatitis of the face which results in red patches of skin and pimples. Click here for more information. include avoiding substances that induce the disease, such as oil-based creams, topical steroids, and staying out of the sun. There are oral antibiotics, such as tetracycline antibiotics, that reduce inflammation, redness, papules and eye symptoms.

Metronidazole cream and azelaic acid cream are effective for mild cases, and isotretinoin can be used when antibiotics are ineffective, although it can have some important side effects.

Blushing/flushing can be reduced by medications such as clonidine, although these may result in a variety of side effects, and the redness and discomfort of skin can be minimized by anti-inflammatory agents.

Intense Pulsed Laser (IPL) treatment and vascular lasers can reduce the effects of persistent teleangiectasias.

Online associations:
International Rosacea Foundation
National Rosacea Society (USA)
Rosacea Net from the American Academy of Dermatology
Rosacea Research and Development Institute
Rosazea.net (Germany)
Rosacea Support Group
The Netherlands Institute for Pigment Disorders

Vitiligo

Incidence: Incidence of vitiligoVitiligo is a relatively common (1-2% of the population) pigmentation disorder which results in wide patches of skin. Click here for more information. is thought to range from .5%-1%, and has been found to be irrespective of gender or race.

Causes: VitiligoVitiligo is a relatively common (1-2% of the population) pigmentation disorder which results in wide patches of skin. Click here for more information. is a skin condition that results in the loss of pigment in the skin of affected areas. The cause of vitiligoVitiligo is a relatively common (1-2% of the population) pigmentation disorder which results in wide patches of skin. Click here for more information. is unknown, although it is possible that is associated with autoimmune disorders and enzymatic self-destruction mechanisms. 30% of patients have family members with the same condition, suggesting that it is genetic. Onset is sometimes reported to be preceded by a stressful physical or psychological event.

Symptoms: Symptoms include premature greying of hair and white patches on the skin in areas such as the face, limbs, torso, eyes, and nostrils. Sun sensitivity also occurs in affected areas as a result of lose of the photoprotectivePhotoprotection is protection from light and ultraviolet radiation. E.g. Melanin provides natural photoprotection, whilst sunscreens provide artificial photoprotection. Click here for more information. melanin in the skin. VitiligoVitiligo is a relatively common (1-2% of the population) pigmentation disorder which results in wide patches of skin. Click here for more information. can have damaging psychological effects on darker individuals, as the loss of pigment can be obvious and embarrassing.

Treatment: Treatment of vitiligoVitiligo is a relatively common (1-2% of the population) pigmentation disorder which results in wide patches of skin. Click here for more information. is often not successful, with partial or complete pigmentation in 10%-20% of cases. To induce repigmentation, phototherapy, narrowband UVA, Psoralen and UVA (PUVA) and topical corticosteroids are often used. Melanocyte transplantations have recently been used to cause complete repigmentation in some patients. For patients that have extensive affected areas, depigmentation of remaining melanin may be an option.

Online associations:
National Vitiligo Foundation (USA)
American Vitiligo Research Foundation
Vitiligo Society (UK)
The Netherlands Institute for Pigment Disorders
Portal of the German Vitiligo Self-help Groups

References

acrf.com.au (2008) Skin cnacer and melanoma. [Online]. Available from: http://www.acrf.com.aupage.skin_cancer_melanoma.html [Accessed 23/04/2008].
nlm.nih.gov (2008) Basal Cell Carcinoma. [Online]. Available from: http://www.nlm.nih.gov/medlineplus/ency/article/000824.htm [Accessed 23/04/2008].
Wrongdiagnosis.com (2008) Prevalence and Incidence of Psoriasis. [Online]. Available from: http://wwww.wrongdiagnosis.com/p/psoriasis/prevalence.htm [Accessed 23/04/2008].
about.com (2007) What causes psoriasis - Causes of psoriasis. [Online]. Available from: http://dermatology.about.com/od/psoriasisbasics/a/psoracause.htm [Accessed 23/04/2008].
Eczema.com (2007) Psoriasis Symptoms and Treatments. [Online]. Available from: http://www.eczema.com.au/psoriasis.php [Accessed 23/04/2008].
mayoclinic.com (2007) Psoriasis: Signs and Symptoms. [Online]. Available from: http://www.mayoclinic.com/health/psoriasis/DS00193/DSECTION=2 [Accessed 23/04/2008].
2004, Therapeutic Guidelines:Dermatology, North Melbourne, Therapeutic guidelines Limited.
Cunliffe, W J. Gould, D J (1979). 'Prevalence of facial acne vulgaris in late adolesence and in adults'. British Medical Journal, Vol 1 pp. 11109-11110.
Burton, J L. Cunliffe, W J. Stafford, I. Shuster, S (1971). 'The prevalence of acne vulgaris in adolescence'. British Journal of Dermatology, Vol 85, pp. 119-126.

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