Department of Dermatology

Common Dermatological Diagnoses D-F

Common Dermatological Diagnoses D-F

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  • Dermabrasion/Dermaplaning

    What is dermabrasion?

    Similar to a chemical peel, dermabrasion is a procedure that removes fine wrinkles and/or minimizes scars on the skin. The difference between a chemical peel and dermabrasion, however, is the method used. Dermabrasion involves the surgeon utilizing a high speed rotating brush to remove the top layer of skin. The size and depth of the scars, as well as the degree of wrinkling, determine the appropriate level of skin that will be surgically sloughed.

    Possible complications associated with dermabrasion

    Possible complications associated with dermabrasion may include but are not limited to the following:

    • Fever blisters
      Dermabrasion can cause fever blisters to reappear in those who are prone to frequent herpes simplex infections. Antiviral medications are often used to treat this symptom.
    • Pigmentation changes
      Some individuals may develop a change in the pigmentation of their skin after undergoing the procedure. Treatment for this symptom may include the use of bleaching creams as prescribed by a physician. A decrease in pigmentation can be permanent.

    • Thickened skin
      Thickening of the skin can develop. This symptom may be treated with cortisone creams or injections that help the skin return to its normal state.

    What is dermaplaning?

    Dermaplaning is used to treat deep acne scars with a handheld instrument called a dermatome. The dermatome resembles an electric razor and has an oscillating blade that moves back and forth to evenly "skim" off the surface layers of skin that surround the craters or other facial defects.

    Both dermabrasion and dermaplaning can be performed on small areas of skin or on the entire face. They can be used alone or in conjunction with other procedures. Neither treatment, however, will remove all scars and flaws or prevent aging.

    Who can benefit from dermabrasion or dermaplaning?

    Men and women of all ages can benefit from dermabrasion and dermaplaning. Important factors that help determine the potential effectiveness of treatment include the following:

    • skin type
    • skin coloring
    • medical history

    About the procedure

    Although each procedure varies, generally, dermabrasion and dermaplaning surgeries follow this process.

    Location options may include:

    • surgeon's office-based surgical facility
    • outpatient surgery center
    • hospital outpatient
    • hospital inpatient

    Anesthetic options may include:

    • local anesthesia, combined with a sedative (allows the patient to remain
      awake but relaxed)
    • a numbing spray, such as freon, may be used along with or instead
      of local anesthesia
    • general anesthesia

    Average length of procedure:

    • from a few minutes to an hour or more, depending on the size of the area of skin to be refinished. The procedure may be performed more than once, or in stages.

    Some possible short-term side effects of surgery:

    • The skin may be red and swollen.
    • Eating and talking may be difficult for a few days following the procedure.
    • Tingling, burning, or aching may occur.
    • Swelling and scabbing may occur.

    As the new skin begins to grow, it may appear and feel swollen. The skin may also be sensitive and bright pink in color, which may take about three months to fade. Protection from the sun is very important following this type of procedure.

  • Dermatitis Herpetiformis

    What is dermatitis herpetiformis?

    Dermatitis herpetiformis is an intensely pruritic (itchy) skin disease characterized by eruptions of clusters of small blisters or vesicles (small elevations of the skin containing fluid) and small bumps or papules (small, solid, elevations on the skin). Dermatitis herpetiformis usually occurs in young adults. It affects twice as many men as it does women.

    What triggers dermatitis herpetiformis?

    Dermatitis herpetiformis is related to the presence of IgA deposits under the skin. These deposits occur in response to consuming glutens (proteins) in the diet, such as those found in wheat, barley, rye, and oat products. However, once IgA deposits occur, they are slowly cleared by the body even when the individual is gluten free. The disease is not common among African-Americans or Asians. Persons with dermatitis herpetiformis often have a high incidence of autoimmune disorders and thyroid disease.

    What are the symptoms of dermatitis herpetiformis?

    The following are the most common symptoms of dermatitis herpetiformis. However, each individual may experience symptoms differently. Symptoms may include:

    • clusters of itchy, small blisters, mostly on the elbows, lower back, buttocks, knees, and back of the head
    • itching and burning are often severe

    Most individuals will also have some damage to their intestines.The symptoms of dermatitis herpetiformis may resemble other skin conditions. Always consult your physician for a diagnosis.

    How is dermatitis herpetiformis diagnosed?

    In addition to a medical history and physical examination, dermatitis herpetiformis is usually confirmed with a skin biopsy with immunofluorescence (a specialized type of stain which helps to detect the presence of IgA antibodies).

    Treatment for dermatitis herpetiformis:

    Specific treatment for dermatitis herpetiformis will be determined by your physician based on:

    • your age, overall health, and medical history
    • extent of the condition
    • your tolerance for specific medications, procedures, and therapies
    • expectation for the course of the condition
    • your opinion or preference

    The symptoms of dermatitis herpetiformis may clear when all gluten is eliminated from the diet, although healing may take several weeks to months. Treatment may also include drug therapy. Dapsone, a medication which can improve symptoms by suppressing the skin response, may be prescribed. However, dapsone has been associated with some side effects, especially anemia. Your physician will carefully monitor your blood count, if prescribed this medication.

  • Dermatitis

    Dermatitis is an inflammation of the skin. Dermatitis actually refers to a number of skin conditions that inflame the skin. Dermatitis is characterized by skin that may be red, swollen, blistered, scabbed, scaly, oozing, or itchy. Some types of dermatitis are caused by allergies, while the majority do not have any known causes. There are many types of dermatitis that require clinical care by a physician or other healthcare professional. Listed in this directory are some for which we have provided a brief overview.

    • Atopic Dermatitis (Eczema)
    • Contact Dermatitis
    • Dermatitis Herpetiformis
    • Generalized Exfoliative Dermatitis
    • Seborrheic Dermatitis
    • Other Dermatitis Conditions
  • Describing a Skin Condition

    How to describe a skin condition:

    A physician may ask you to describe your dermatological condition and its location. Here are some of the more common terms that may help you in providing a more accurate description:

    Atrophic thin, wrinkled
    Blister fluid-filled bump
    Crust/Scab formation of dried blood, pus, or other skin fluid over a break in the skin
    Cyst deeply seated lesion that contains material
    Excoriation a scratch
    Hives/Wheals pink or white swelling of the skin
    Lichenification skin that has thickened
    Macule a flat discolored spot
    Nodule/Papule solid, raised bump
    Raised Bumps bumps that stick out above the skin surface
    Patch flat, discolored spot
    Pustule (pimple) inflamed lesions that appear to contain pus
    Scales dead skin cells that form flakes
    Scar fibrous tissue that forms after a skin injury
  • Diagnosis and Staging of Melanoma

    How is melanoma diagnosed?

    Medical examinations and tests are used to determine if a suspicious area is melanoma skin cancer. In addition to a complete medical history, including family history, questions are asked about the marking on the skin, such as when you first noticed it, as well as if and how it has changed in size or appearance.

    The suspected area, as well as the rest of your body is examined, noting the size, shape, color, texture, and if there is bleeding or scaling. A skin sample will probably be examined by a biopsy. The biopsy procedure chosen depends on the site and size of the affected area.

    Types of biopsies:

    The different types of biopsies include the following:

    • Excisional or incisional biopsy
      This type of biopsy is often used when a wider or deeper portion of the skin is needed. Using a scalpel (surgical knife), a full thickness of skin is removed for further examination, and the wound is sutured (with surgical thread).
    • When the entire tumor is removed, it is called excisional biopsy technique. If only a portion of the tumor is removed, it is called incisional biopsy technique. Excisional biopsy is often the method usually preferred when melanoma is suspected.
    • Fine needle aspiration (FNA) biopsy
      This type of biopsy involves using a thin needle to remove very small pieces from a tumor. Local anesthetic is sometimes used to numb the area, but the test rarely causes much discomfort and leaves no scar.
      • FNA is not used for diagnosis of a suspicious mole, but may be used to biopsy large lymph nodes near a melanoma to see if the melanoma has metastasized (spread). A computed tomography scan (CT or CAT scan) - an x-ray procedure that produces cross-sectional images of the body - may be used to guide a needle into a tumor in an internal organ such as the lung or liver.
    • Punch biopsy
      Punch biopsies involve taking a deeper sample of skin with a biopsy instrument that removes a short cylinder, or "apple core," of tissue. After a local anesthetic is administered, the instrument is rotated on the surface of the skin until it cuts through all the layers, including the dermis, epidermis, and the most superficial parts of the subcutis (fat).
    • Shave biopsy
      This type of biopsy involves removing the top layers of skin by shaving it off. Shave biopsies are also performed with a local anesthetic.

    • Skin biopsy
      Skin biopsies involve removing a sample of skin for examination under the microscope to determine if melanoma is present. The biopsy is performed under local anesthesia. The patient usually just feels a small needle stick and slight burning for about one minute, with a little pressure, but no pain.

    Biopsies are obtained from the different skin layers:

    • A shave biopsy generally involves obtaining tissue specimens from the thin outer layer of skin, called the epidermis.
    • A punch biopsy generally involves obtaining tissue specimens from the epidermis. However, in some cases, a punch biopsy involves the dermis and subcutaneous tissue.

    • An excisional biopsy generally involves obtaining tissue specimens from the deepest layer of skin, called the subcutaneous tissue.

    What is staging?

    When melanoma is found, more tests will be done to find out if the cancer cells have spread to other parts of the body. This is called staging, and is necessary before treatment for the cancer can begin.

    What are the stages for melanoma?

    The National Cancer Institute stages of melanoma are:

    Stage 0 Abnormal cells are found only in the outer layer of skin and have not invaded deeper tissue.
    Stage IA
    		 Cancer is found in the outer layer of the skin (epidermis) and/or the upper part of the inner layer of skin (dermis), but it has not spread to nearby lymph nodes. The tumor is less than 1.0 millimeters thick.
    Stage IB The tumor is less than 1.0 millimeters thick and ulcerated, or 1.0-2.0 millimeters and not ulcerated.
    Stage IIA
    		It has spread to the lower part of the inner layer of skin (dermis), but not into the tissue below the skin or into nearby lymph nodes. The tumor is 1.0-2.0 millimeters ulcerated or 2.0-4.0 millimeters and not ulcerated.
    Stage IIB The tumor is 2.0-40 millimeters thick and ulcerated, or greater than 4.0 millimeters and not ulcerated.
    Stage IIC The tumor is greater than 4.0 millimeters thick and ulcerated.
    Stage III The tumor has spread to the body tissue below the skin and to nearby lymph nodes.
    Stage IV The tumor has spread to other organs, or to lymph nodes far away from the original tumor.

    Always consult your physician for more information regarding the staging of melanoma.

  • Drug Rashes

    What are drug rashes?

    Drug rashes are the body's reaction to a certain medication. The type of rash that occurs depends on the type of drug that is causing it. Rashes can range from mild to severe.
    Rashes caused by drugs can be categorized in the following groups:

    • Rashes caused by an allergic reaction to the medication
    • Rashes produced as an unwanted effect of a particular medication
    • Rashes due to hypersensitivity to sunlight caused by the medication

    What are the different types of rashes caused by drugs?

    Type of Rash Symptoms Cause
    Acne pimples and red areas that appear most often on the face, shoulders, and chest anabolic steroids, corticosteroids, bromides, iodides, and phenytoin
    Exfoliative Dermatitis red, scaly skin that may thicken and involve the entire body antibiotics that contain sulfa, barbiturates, isoniazid, penicillins, and phenytoin
    Fixed Drug Eruption a dark red or purple rash that reacts at the same site antibiotics and phenolphthalein (found in certain laxatives)
    Hives raised red bumps aspirin, certain drug dyes, penicillins, and many drugs
    Morbiliform/Maculopapular Rash a flat, red rash which may include pimples similar to the measles antibiotics and barbiturates are the more common causative drugs; however, any drug can cause this rash
    Purpuric Eruptions purple areas on the skin, often on the legs some anticoagulants and diuretics
    Stevens-Johnson Syndrome blisters or a hive-like rash on the lining of the mouth, vagina, or penis antibiotics that contain sulfa, barbiturates, penicillins, and certain drugs used for high blood pressure and diabetes

    How are drug rashes diagnosed?

    Diagnosing a rash caused by a reaction to medication is complicated. Even a small amount of a drug can cause a major reaction in the skin. In addition, the reaction can occur after the patient has taken a medication for a long time. Your physician will usually advise you to stop taking any medication that is not necessary to sustain your life, to see if the reaction abates. Other medications may be substituted, if possible.

    Treatment for drug rashes:

    The condition usually clears up if the patient stops taking the medication that is causing the reaction. Other treatment may include:

    • Corticosteroids
    • Antihistamines

    Allergic reactions can be serious and even fatal.

  • Dry Skin

    What is dry skin?

    Dry skin is a very common skin condition, usually characterized by irritated skin and itchiness. Dry skin often worsens in the winter, when the air is cold and dry. In addition, frequent bathing can aggravate dry skin. Dry skin may become flaky or scaly.
    However, dry skin symptoms may resemble other skin conditions or result from other disorders such as an underactive thyroid or acquired immune deficiency syndrome (AIDS). Always consult your physician for a diagnosis.

    Treatment for dry skin

    Treating dry skin may be as simple as keeping the skin moist - by taking fewer baths and using ointments or creams that keep the moisture in. Treatment may also include:

    • Avoiding harsh soaps, detergents, and perfumes, which tend to dry the skin
    • Avoiding rubbing or scratching the skin, which can aggravate the symptoms and cause infection
    • Applying a salicylic acid solution or cream (which removes the top layer of skin) - if the skin is scaly
  • Effects of UV Exposure

    Sunscreens Can Help

    Studies have shown that sunscreens can prevent UV-induced wrinkling. Animal studies demonstrated that sunscreens with adequate UVA coverage can prevent sagging and wrinkling due to high-intensity UVA.

    Exposure to UV rays is linked to a number of harmful health conditions, including the following:

    Skin Cancer
    Consider the following statistic related to skin cancer:

    • More than 1 million cases of nonmelanoma skin cancer are diagnosed in the US each year.
    • Most skin cancers appear after age 50, but skin damage from the sun begins at an early age. Therefore, protection should start in childhood to prevent skin cancer later in life.

    Premature Aging (Photo-aging)
    Sun exposure also causes premature aging of the skin, a condition called photo-aging, which is different than chronological aging.

    • People who sunbathe regularly show photoaging early in life - often before 30 years of age. Chronologically-aged skin, more often, shows changes after age 40 or older.
    • Freckling, fine wrinkling, and dilation of capillaries are often seen early in the photoaging process.
    • Photoaged skin often develops irregular pigmentation (liver spots) in later years.
    • Both photoaging and chronological aging cause wrinkling and loss of skin elasticity. However, these changes occur much earlier when skin has been overexposed to the sun.

    Cataracts and Other Eye Disorders
    Cataracts, an eye disorder characterized by a change in the structure of the crystalline lens that causes blurred vision, are a leading cause of blindness around the world - and excessive UV exposure is one of the risk factors in the development of cataracts. In fact, persons who spend more time in the sun may develop cataracts earlier than others. The American Academy of Ophthalmology now recommends wearing UV sunglasses and a wide brimmed hat to lessen exposure to ultraviolet rays.

    Corneal sunburn, growths on the outer surface of the eye, retinal-tissue damage, and other eye diseases are also known, or suspected, to be related to long-term exposure to UV rays.

    Immune System Damage
    The skin is part of the body's natural defense system. Many healthcare professionals believe that UV radiation can alter immune system functions. When UV radiation suppresses immune responses, the body's ability to fight certain diseases, including skin cancer, is reduced. It is suspected that overexposure to UV radiation also interferes with the effectiveness of immunizations given through the skin.

  • Erythema Multiforme

    What is erythema multiforme?

    Erythema multiforme is a skin disorder characterized by symmetrical, red, raised skin areas all over the body. These patches often look like "targets" (dark circles with purple-grey centers). The skin condition may be chronic and usually lasts for two to four weeks each time.

    Most often, this disorder is caused by the herpes simplex virus. Other causes may include the following:

    • An interaction with a certain medication
    • Other infectious diseases
    • Certain vaccines

    What are the symptoms of erythema multiforme?

    The following are the most common symptoms of erythema multiforme. However, each individual may experience symptoms differently symptoms may include:

    • Sudden, red patches and blisters, usually on the palms of hands, soles of feet, and face
    • Flat, round red "targets" (dark circles with purple-grey centers)
    • Itching
    • Cold sores
    • Fatigue
    • Joint pains
    • Fever

    The symptoms of erythema multiforme may resemble other skin conditions. Always consult your physician for a diagnosis.

    Treatment for erythema multiforme

    Specific treatment for erythema multiforme will be determined by your physician
    based on:

    • your age, overall health, and medical history
    • severity of the condition
    • stage of the condition
    • your tolerance of specific medications, procedures, or therapies
    • expectations for the course of the condition
    • your opinion or preference

    The condition usually clears up on its own. However, if a person develops a more severe form of erythema multiforme, the condition can become fatal.

    Treatment may include:

    • treating the infectious disease causing the disorder
    • eliminating any medication causing the disorder
    • cool compresses
    • corticosteroids
    • antibiotic
  • Erythema Nodosum

    What is erythema nodosum?

    Erythema nodosum is characterized by tender, red bumps, usually found on the shins. Quite often, erythema nodosum is not a separate disease, but, rather, a sign of some other disease, or of a sensitivity to a drug.

    Diseases that can cause erythema nodosum:

    • streptococcal infections
    • sarcoidosis (inflammation of the lymph nodes and other organs)
    • leprosy
    • coccidioidomycosis (infection of the upper respiratory tract and lungs)
    • histoplasmosis (an infectious pulmonary disease)
    • tuberculosis
    • psittacosis (a flu-like disease)
    • Lymphogranuloma venereum (a venereal infection)
    • Ulcerative colitis

    Drugs that can cause erythema nodosum:

    • Antibiotics containing sulfa
    • Bromides
    • Iodides
    • Oral contraceptives

    What are the symptoms of erythema nodosum?

    The following are the most common symptoms of erythema nodosum. However, each individual may experience symptoms differently. Symptoms may include:

    • Raised bruises on the shins
    • Fever
    • Joint pain
    • Enlarged lymph nodes in the chest

    Young adults are particularly susceptible to erythema nodosum. The symptoms of erythema nodosum may resemble other skin conditions. Always consult your physician for a diagnosis.

    How is erythema nodosum diagnosed?

    A biopsy (removal of tissue for examination under a microscope) of a bump can usually confirm the diagnosis. However, the exact cause cannot always be identified. Drug-induced erythema nodosum can usually be diagnosed by careful elimination of the drug causing the reaction.

    Treatment for erythema nodosum:

    • Specific treatment for erythema nodosum will be determined by your physician based on:
    • Your age, overall health, and medical history
    • Extent of the condition
    • Your tolerance for specific medications, procedures, or therapies
    • Expectations for the course of the condition
    • Your opinion or preference
    • Treatment may include:
    • Antibiotics
    • Treatment of underlying cause
    • Bed rest (to relieve pain)
    • Aspirin
    • Corticosteroids
  • Excessive Hairiness (Hirsutism)

    What is excessive hairiness?

    Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.

    What causes excessive hairiness?

    Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids and certain medications, also may cause excessive hairiness.

    How is excessive hairiness diagnosed?

    Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests if an endocrine disorder is suspected.

    Treatment for excessive hairiness:

    Specific treatment for excessive hairiness will be determined by your physician based on:

    • Your age, overall health, and medical history
    • Extent of the condition
    • Cause of the condition
    • Your tolerance for specific medications, procedures, and therapies
    • Expectation for the course of the condition
    • Your opinion or preference

    Treatment may include:

    • Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
    • Medication (to control any underlying endocrine disorder)
  • Excessive Sweating

    What is excessive sweating?

    Excessive sweating, also called hyperhidrosis, can affect the entire body, but usually occurs in the palms, soles, armpits, and/or groin area. Excessive sweating is normal when a person is anxious or has a fever. However, when the condition is chronic, it may signal thyroid problems, low blood sugar, nervous system disorders, or other medical problems.

    What are the symptoms of excessive sweating?

    Areas that produce excessive sweat usually appear pink or white, but, in severe cases, may appear cracked, scaly, and soft (especially on the feet). Other symptoms may include a bad odor caused by bacteria and yeast in the wet skin. The symptoms of excessive sweating may resemble other medical conditions. Always consult your physician for a diagnosis.

    Treatment for excessive sweating:

    Specific treatment for excessive sweating will be determined by your physician, based on:

    • Your age, overall health, and medical history
    • Severity of the condition
    • Cause of the condition
    • Your tolerance of specific medications, procedures, or therapies
    • Expectations for the course of the condition
    • Your opinion or preference

    Treatment may include topical, oral, surgical, or nonsurgical treatments:

    • Methenamine solution applications to the area (to control heavy sweating)
    • Nighttime applications of aluminum chloride solution to the area (to control heavy sweating)
    • Thoracoscopic sympathectomy - a surgical interruption of the sympathetic nerve pathways that lead to the sweat glands
    • Botulinum toxin A injection (Botox®) - botulinum toxin helps to inhibit the release of acetylcholine (a substance that is active in the transmissions of nerve impulses) 
    • Tap water iontophoresis (applying a weak electrical current to the area)
    • Psychological counseling and/or medication (to reduce anxiety
  • Folliculitis, Boils, and Carbuncles

    What are folliculitis, boils, and carbuncles?

    Folliculitis is the inflammation of hair follicles due to an infection, injury, or irritation. It is characterized by tender, swollen areas that form around hair follicles, often on the neck, breasts, buttocks, and face. Boils are pus-filled lesions that are painful and usually firm. Boils are usually located in the waist area, groin, buttocks, and under the arm. Carbuncles are clusters of boils. These are usually found in the back of the neck or thigh.

    What are the symptoms of folliculitis, boils, and carbuncles?

    The following are the most common symptoms of folliculitis, boils, and carbuncles. However, each person may experience symptoms differently. Symptoms for folliculitis may include:

    • pus in the hair follicle
    • irritated and red follicles
    • damaged hair
    • Symptoms for boils may include:
    • pus in the center of the boil
    • whitish, bloody discharge from the boil

    Symptoms for carbuncles (clusters of boils) may include:

    • pus in the center of the boils
    • whitish, bloody discharge from the boils
    • fever
    • fatigue

    The symptoms of folliculitis, boils, and carbuncles may resemble other skin conditions. Always consult your physician for a diagnosis.

    How are folliculitis, boils, and carbuncles diagnosed?

    Diagnosis of folliculitis, boils, and carbuncles are made by your physician after a thorough medical history and physical examination. After examining the lesions, your physician may culture the wounds (obtain a sample of the drainage of the wound, allow it to grow in the laboratory, and identify specific bacteria) to help verify the diagnosis and to help in selecting the best treatment.

    Treatment for folliculitis, boils, and carbuncles

    Specific treatment for folliculitis, boils, and carbuncles will be determined by your physician based on:

    • your age, overall health, and medical history
    • extent of the condition
    • your tolerance for specific medications, procedures, or therapies
    • expectations for the course of the condition
    • your opinion or preference
    • Treatment may include:
    • topical antibiotics (for folliculitis)
    • for carbuncles and boils, a warm compress may be used to help promote drainage of the lesion
    • oral or intravenous (IV) antibiotics (to treat the infection)
    • possible removal of the boils and carbuncles

    Carbuncles heal more slowly than a single boil. Keeping the skin clean helps to prevent these conditions from occurring.

  • Fungal Infections

    Skin fungi live in the dead, top layer of skin cells in moist areas of the body, such as between the toes, groin, and diaper area. Some fungal infections cause only a small amount of irritation. Other types of fungal infections penetrate deeper and may cause itching, swelling, blistering, and scaling. In some cases, fungal infections can cause reactions elsewhere on the body. For example, a child may develop a rash on the finger or hand associated with an infection of the scalp or foot.

    There are many different types of fungal skin infections that require clinical care by a physician or other healthcare professional. Listed below, in the directory, are some for which we have provided a brief overview.

    • Candidiasis (Yeast Infection)
    • Tinea Infections (Ringworm)
    • Tinea Versicolor