Common Dermatological Diagnoses S through W

• Scabies
  
  

  What is scabies?

  Scabies is an infestation of mites (tiny insects) characterized by small, red bumps and intense itching. This highly contagious infection often spreads from person to person while they are sleeping together in the same bed, or during close, personal contact. The itching is caused by the mites burrowing into the skin where they lay eggs that hatch a few days later. Scabies can affect people of all ages. Scabies occurs mostly in children and young adults.

  What are the symptoms of scabies?

  It may take between four to six weeks for a person to develop symptoms of scabies after coming in contact with an infected person.

  In children younger than 2 years of age, the lesions caused by the mites tend to occur on the head, neck, palms, and soles. In older children and adults, the lesions are usually on the hands, between the fingers, wrists, belt line, thighs, belly button, in the groin area, around the breasts, and in the armpits. The following are the most common symptoms of scabies. However, each individual may experience symptoms differently. Symptoms may include:

  • itching, usually severe
  • rash, with small pimples or red bumps
  • scaly or crusty skin (with advanced conditions)

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

  How is scabies diagnosed?

  In diagnosing scabies, the skin and skin crevices are examined by your physician. A sample of skin, obtained by scraping the skin, may be examined under a microscope to confirm the presence of mites.

  Treatment for scabies:

  • Specific treatment for scabies will be determined by your physician based on:
  • your age, overall health, and medical history
  • extent of the infestation
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the infestation
  • your opinion or preference
  • Scabies is treatable and usually all members in a family are treated at the same time. Treatment may include:
  • applications of prescription creams and lotions, such as permethrin and lindane solutions
  • oral antihistamine medication (to help relieve itching)
  • in some cases, topical ointments are recommended

  In addition, it is important to wash all clothes and bedding in hot water and dry in a hot dryer. Clothing and other objects that cannot be washed (i.e., pillows, stuffed animals) should be placed in a plastic bag for at least one week. The itching may continue for many weeks after the initial treatment of the scabies.

• Scars
  
  

  What is a scar?

  A scar is the body's natural way of healing and replacing lost or damaged skin. A scar is usually composed of fibrous tissue. Scars may be formed for many different reasons, including as a result of infections, surgery, injuries, or inflammation of tissue. Scars may appear anywhere on the body, and the composition of a scar may vary - appearing flat, lumpy, sunken, colored, painful, or itchy. The final look of a scar depends of many factors, including the skin type and location on the body, the direction of the wound, the type of injury, age of the person with the scar, and his/her nutritional status.

  How can a scar be minimized?

  Specific dermatological procedures to minimize scars will be determined by your physician based on:

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

  Scars usually fade over time. Make-up can help cover the scar while it is healing. Some scars can be minimized by certain dermatological techniques. However, treatment can only improve the appearance of a scar, but cannot completely erase it.
  The following are some of the more common scar-minimizing procedures:

  • Dermabrasion
    Dermabrasion may be used to minimize small scars, minor skin surface irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves removing the top layers of skin with an electrical machine that "abrades" the skin. As the skin heals from the procedure, the surface appears smoother and fresher.
  • Chemical Peels
    Chemical peel are often used to minimize sun-damaged skin, irregular pigment, and superficial scars. The top layer of skin is removed with a chemical application to the skin. By removing the top layer, the skin regenerates, often improving the skin's appearance.
  • Collagen Injections
    One type of collagen, which is derived from purified bovine (cow) collagen, is injected beneath the skin to replace the body's natural collagen that has been lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
  • Cortisone-like Injections
    These types of injections can help soften and then shrink hard scars.
  • Cryosurgery
    Cryosurgery can help reduce the size of scars by freezing the top skin layers. The freezing causes the skin to blister.
  • Laser Resurfacing
    Laser resurfacing uses high-energy light to burn away damaged skin. Laser resurfacing may be used to minimize wrinkles and fine scars.
  • Punch Grafts
    Punch grafts are small skin grafts to replace scarred skin. A hole is punched in the skin to remove the scar, which is then replaced with unscarred skin (often from the back of the earlobe). Punch grafts can help treat deep acne scars.
  • Surgical Scar Revision
    Surgical scar revision involves removing the entire scar surgically and rejoining the skin. Although a new scar will form, the goal of the surgical technique is to create a less obvious scar. Surgical scar revision is usually reserved for wide or long scars, scars that healed in an unusual way, or scars in very visible places.

  • Autologous Fat Transfer
    An autologous fat transfer uses fat taken from another site on your own body and it is injected into your skin. The fat is placed beneath the surface of the skin to elevate depressed scars. This method is used to correct deep contour defects caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the skin over a period of months, there may be a need for the procedure to be repeated.

  What are the different types of scars and treatment?

  Abnormal scars sometimes form after the wound has healed. There are many different types of scars, including the following:

  • Keloid Scars
    These are thick, rounded, irregular clusters of scar tissue that grow at the site of a wound on the skin, but beyond the edges of the borders of the wound. They often appear red or darker in color, as compared to the surrounding normal skin. Keloids are formed from collagen that the body produces after a wound has healed. These scars may appear anywhere on the body. They occur more often in darker-skinned people. Keloid scars may occur up to one year after the original trauma to the skin.
    
    

    Treatment for keloid scars varies. There is no one simple cure for keloid scars. Recurrence after treatment is common. Treatment may include the following:

    • Steroid Injections
      Steroids are injected directly into the scar tissue to help decrease the itching, redness, and burning sensations that these scars may produce. Sometimes, the injections help to actually decrease the size of the scar.
    • Cryotherapy
      Cryotherapy involves the scar being "frozen" off by a medication.
    • Pressure Therapy
      Pressure therapy involves a type of pressure appliance worn over the area of the scar. These may be worn day and night for up to four to six months.
    • Surgery
      If the keloid scar is not responsive to nonsurgical management options, surgery may be performed. One type of surgery directly removes the scar formation with an incision, and stitches are placed to help close the wound. Sometimes, skin grafts are used to help close the wound. This involves replacing or attaching skin to an area that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area.
      
      Another option is laser surgery. Scars may be treated with a variety of different lasers, depending on the underlying cause of the scar. Lasers may be used to smooth a scar, remove the abnormal color of a scar, or flatten a scar. Most laser therapy for scars is done in conjunction with other treatments, including injections of steroids, use of special dressings, and the use of bandages. Multiple treatments may be required, regardless of the initial type of therapy.

       

  • Hypertrophic Scars
    Hypertrophic scars are similar to keloid scars, however, their growth is confined within the boundaries of the original skin defect. These scars may also appear red, and are usually thick and elevated. Hypertrophic scars usually start to develop within weeks after the injury to the skin. Hypertrophic scars may improve naturally, although this process may take up to a year or more.
    
    In treating hypertrophic scars, steroids may be the first line of therapy with this type of scar, although there is not one simple cure. Steroids may be given as an injection or by direct application. These scars may also be removed surgically. Often, steroid injections are used along with the surgery and may continue up to two years after the surgery to help maximize healing and decrease the chance of the scar returning.

  • Contractures
    Contractures are an abnormal occurrence that happens when a large area of skin is damaged and lost, resulting in a scar. The scar formation pulls the edges of the skin together, causing a tight area of skin. The decrease in the size of the skin can then affect the muscles, joints, and tendons, causing a decrease in movement.
    
    There are many different surgical treatment options for contractures, including the following:
  • Skin graft or Skin flap
    Skin grafts or skin flaps are done after the scar tissue is removed. Skin grafts involve replacing or attaching skin to a part of the body that is missing skin. Skin grafts are performed by taking a piece of healthy skin from another area of the body (called the donor site) and attaching it to the needed area. Skin flaps are similar to skin grafts, where a part of the skin is taken from another area, but with the skin flaps, the skin that is retrieved has its own blood supply. The section of skin used includes the underlying blood vessels, fat, and muscles. Flaps may be used when that area that is missing the skin does not have a good supply of blood because of the location or because of damage to the vessels.
  • Z-plasty
    A Z-plasty is a type of procedure that is used to revise a scar by using a Z-shaped incision to help decrease the amount of contractures of the surrounding skin. It also may attempt to relocate the scar so that the edges of the scar look more like the normal lines and creases of the skin. Small stitches may be used to help hold the skin in place.

  • Tissue expansion
    Tissue expansion is a newer technique being used, and involves a process that increases the amount of existing tissue available for reconstructive purposes. This procedure is often used in addition to the flap surgery.

  • Adhesions
    Another type of scarring, called adhesions, may form between unconnected internal organs. Adhesions may cause complications during certain surgeries.

  Recovery from scar revision surgery:

  As with all surgeries, it is important to follow all instructions to help maximize recovery and healing. Your physician will advise you on all activity restrictions, depending on the type of surgery that was performed. Scars cannot be removed completely. Many factors will be involved in the degree of healing of your particular scar, with some scars taking more than a year to show improvement in appearance following surgery.

• Sebaceous Cysts
  
  

  What are sebaceous cysts?

  Sebaceous cysts are harmless, slow-growing bumps under the skin, often appearing on the scalp, face, ears, back, or groin area. The cysts usually contain dead skin and other skin particles.

  Treatment for sebaceous cysts:

  Sebaceous cysts can usually be treated by a physician by puncturing the top and removing its contents. However, large cysts may reappear and may have to be surgically removed. If a cyst becomes infected, treatment may include administering antibiotics and then surgically removing the cyst.

• Seborrheic Dermatitis
  
  

  Did You Know? Seborrheic dermatitis is different than dandruff. Dandruff usually limits itself to the scalp and is characterized by scaling without redness, while seborrheic dermatitis has both redness and scaling.

  What is seborrheic dermatitis?

  Seborrheic dermatitis is an inflammation of the upper layers of skin, characterized by red, itchy skin that sheds scales. A hereditary condition, seborrheic dermatitis is often aggravated by cold weather conditions.
  Seborrheic dermatitis is most common during:

  • Infancy
    In infants, the condition is also called "cradle cap," because of its characteristic scaly appearance on the scalp. However, cradle cap can also occur in the diaper area. Seborrheic dermatitis in this age group usually clears up on its own within the first year.
  • Middle Age
    When seborrheic dermatitis occurs at this age, the condition is usually more intermittent.

  • Old Age
    When seborrheic dermatitis occurs at this age, the condition is usually more intermittent.

  Persons with oily skin or hair are also more at risk for developing seborrheic dermatitis.

  What are the symptoms of seborrheic dermatitis?

  The following are some of the other symptoms associated with seborrheic dermatitis. However, each person may experience symptoms differently. Symptoms may include:

  • itching scalp
  • dry or greasy scales on the scalp
  • a yellow or red scaly rash along the hairline, behind the ears, in the ear canal, on the eyebrows, around the nose, and/or on the chest

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

  How is seborrheic dermatitis diagnosed?

  A complete medical history and physical examination helps the physician in diagnosing seborrheic dermatitis.

  Treatment for seborrheic dermatitis:

  Specific treatment for seborrheic dermatitis 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

  Although the condition responds to treatment, it may recur. Treatment is usually effective in alleviating symptoms and may include:

  • corticosteroid cream or lotion
  • anti-fungal topicals (such as ciclopirox)
  • medicated shampoo for adults, as prescribed by your physician
• Shingles (Herpes Zoster)
  
  

  What is shingles?

  Shingles, or herpes zoster, is a common viral infection of the nerves, which results in a painful rash of small blisters on an area of skin anywhere on the body. Even after the rash is gone, the pain can continue for months, even years.

  Shingles is caused by the reactivation of the varicella-zoster virus, which causes chickenpox. After a person has had chickenpox, the virus lies dormant in certain nerves for many years. Herpes zoster is more common in persons with a depressed immune system, and in persons over the age of 50.

  According to the National Institute of Allergy and Infectious Diseases, this year more than 500,000 people will develop shingles.

  What are the symptoms of shingles?

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

  • skin sensitivity and/or pain in the area of the skin before the rash appears
  • rash, which appears after five days and initially looks like small, red spots that turn into blisters (usually takes about two to three days)
  • blisters turn yellow and dry, often leaving small, pitted scars
  • Other early symptoms of shingles may include:
  • gastrointestinal upset
  • feeling ill
  • fever
  • headache

  The symptoms of shingles may resemble other medical conditions or problems. Always consult your physician for a diagnosis.

  How is shingles diagnosed?

  In addition to a complete physical examination and medical history, diagnostic tests for shingles may include the following:

  • skin scrapings-a procedure in which the skin is gently scraped to determine if the virus is shingles or another virus.
  • blood tests

  Complications of shingles:

  Active shingles symptoms usually do not last longer than three to five weeks. However, complications do occasionally occur. The two major complications that can occur as a result of a case of shingles include the following:

  • Postherpetic Neuralgia (PHN)
    The most common complication of shingles is postherpetic neuralgia (PHN). PHN is characterized by continuous, chronic pain that a person feels even after the skin lesions have healed. The pain may be severe in the area where the blisters were present, and the affected skin may be very sensitive to heat and cold.
    
    Persons who are at increased risk for PHN include those who have severe pain during active shingles, those with sensory impairment, and elderly persons. Early treatment of shingles may prevent PHN. In addition, analgesics (pain relieving medications) and steroid treatment (to help reduce inflammation) may be used to treat the pain and inflammation.
  • Bacterial Infection
    A second common and severe complication of shingles is a bacterial infection on the skin where the lesions are located. Infections can lead to further complications, such as superficial gangrene and scarring. When an infection occurs near or on the eyes, a secondary bacterial infection or corneal opacification (clouding of the cornea) may occur.

  Treatment for shingles:

  Specific treatment for shingles 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

  Shingles has to run its course, because there is no cure for the disease. Treatment usually focuses on pain relief. Treatment may include painkillers to help alleviate some of the pain, and antiviral drugs to help lessen some of the symptoms and minimize nerve damage. Other treatments may include:

  • bed rest, especially during the early phase of shingles, if fever is present
  • calamine lotion or other topical agents
  • cool compresses applied to affected skin areas
  • antiviral medications (such as acyclovir, valacyclovir, and famcyclovir)
  • steroids
  • antidepressants
  • anticonvulsants

  A vaccine to prevent shingles was approved by the US Food and Drug Administration (FDA) in May, 2006. The new vaccine, Zostavax®, is recommended for adults 60 years of age and older who have previously had chicken pox but have not had shingles. Zostavax is expected to prevent 250,000 cases of shingles in the US each year and to reduce the severity of shingles in another 250,000 cases per year.

• Skin Cancer
  
  

  What is skin cancer?

  Skin cancer is a malignant tumor that grows in the skin cells and accounts for more than 50 percent of all cancers.

  What are the different types of skin cancer?

  There are three main types of skin cancer, including:

  Name	Description
  Basal cell carcinoma	Basal cell carcinoma accounts for approximately 90 percent of all skin cancers. This highly treatable cancer starts in the basal cell layer of the epidermis (the top layer of skin) and grows very slowly. Basal cell carcinoma usually appears as a small, shiny bump or nodule on the skin - mainly those areas exposed to the sun, such as the head, neck, arms, hands, and face. It commonly occurs among persons with light-colored eyes, hair, and complexion.
  Squamous cell carcinoma	Squamous cell carcinoma accounts for about 20 percent of all skin cancer cases. Although more aggressive than basal cell carcinoma, this cancer is highly treatable. Squamous cell carcinoma may appear as nodules or red, scaly patches of skin, and may be found on the face, ears, lips, and mouth. However, squamous cell carcinoma can spread to other parts of the body. This type of skin cancer is usually found in fair-skinned people.
  Malignant melanoma	Malignant melanoma starts in the melanocytes - cells that produce pigment in the skin. Malignant melanomas usually begin as a mole that then turns cancerous. This cancer may spread quickly. Malignant melanoma most often appears on fair-skinned men and women, but persons with all skin types may be affected.

  Distinguishing benign moles from melanoma

  To prevent melanoma, it is important to examine your skin on a regular basis, and become familiar with moles, and other skin conditions, in order to better identify changes. According to recent research, certain moles are at higher risk for changing into malignant melanoma. Moles that are present at birth, and atypical moles, have a greater chance of becoming malignant. Recognizing changes in moles, by following this ABCD Chart, is crucial in detecting malignant melanoma at its earliest stage. The warning signs are:

  Normal Mole / Melanoma	Sign	Characteristic
  	Asymmetry	When half of the mole does not match the other half
  	Border	When the border (edges) of the mole are ragged or irregular
  	Color	When the color of the mole varies throughout
  	Diameter	If the mole's diameter is larger than a pencil's eraser
  Photographs Used By Permission: National Cancer Institute

  Melanomas vary greatly in appearance. Some melanomas may show all of the ABCD characteristics, while other may only show changes in one or two characteristics. Always consult your physician for a diagnosis.

  What is a risk factor?

  A risk factor is anything that may increase a person's chance of developing a disease. It may be an activity, such as smoking, diet, family history, or many other things. Different diseases, including cancers, have different risk factors.
  Although these factors can increase a person's risk, they do not necessarily cause the disease. Some people with one or more risk factors never develop the disease, while others develop disease and have no known risk factors.
  But, knowing your risk factors to any disease can help to guide you into the appropriate actions, including changing behaviors and being clinically monitored for the disease.

  What are the risk factors for melanoma?

  Skin cancer is more common in fair-skinned people - especially those with blond or red hair, who have light-colored eyes. Skin cancer is rare in children. However, no one is safe from skin cancer. Almost half of all Americans who live to age 65 will be diagnosed with skin cancer at some point in their lives, according to the National Cancer Institute. Other risk factors include:

  • family history of melanoma
  • sun exposure
    The amount of time spent unprotected in the sun directly affects your risk of skin cancer.
  • early childhood sunburns
    Research has shown that sunburns early in life increase a person's risk for skin cancer later in life.
  • many freckles
  • many ordinary moles (more than 50)
  • dysplastic nevi

  Prevention of skin cancer

  The American Academy of Dermatology (AAD) has declared war on skin cancer by recommending these three preventive steps:

  • Wear protective clothing, including a hat with a four-inch brim.
  • Apply sunscreen all over your body and avoid the midday sun from 10 a.m. to 4 p.m.
  • Regularly use a broad-spectrum sunscreen with an SPF of 15 or higher, even on cloudy days.
  • The following six steps have been recommended by the AAD and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer.
  • Minimize exposure to the sun at midday - between the hours of 10 a.m. and 4 p.m.
  • Apply sunscreen, with at least a SPF-15 or higher that protects against both UVA and UVB rays, to all areas of the body that are exposed to the sun.
  • Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or perspiring.
  • Wear clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of our eyes as well as the lens.
  • Avoid exposure to UV radiation from sunlamps or tanning parlors.
  • Protect children. Keep them from excessive sun exposure when the sun is strongest (between 10 a.m. and 4 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.
  • The American Academy of Pediatrics (AAP) approves of the use of sunscreen on infants younger than 6 months old if adequate clothing and shade are not available. Parents should still try to avoid sun exposure and dress the infant in lightweight clothing that covers most surface areas of skin. However, parents also may apply a minimal amount of sunscreen to the infant's face and back of the hands.

  Remember, sand and pavement reflect UV rays even under the umbrella. Snow is even a particularly good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sun rays.

  How to perform a skin self-examination

  Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-exam is usually the first step in detecting skin cancer. The following suggested method of self-examination comes from the American Cancer Society: (You will need a full-length mirror, a hand mirror, and a brightly lit room.)

  • Examine your body front and back in mirror, then the right and left sides, with your arms raised.
  • Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands.
  • Look at backs of your legs and feet, spaces between your toes, and the soles
    of your feet.
  • Examine the back of your neck and scalp with a hand mirror.
  • Check your back and buttocks with a hand mirror.
  • Become familiar with your skin and the pattern of your moles, freckles, and other marks.
  • Be alert to changes in the number, size, shape, and color of pigmented areas.
  • Follow the ABCD Chart when examining moles of other pigmented areas and consult your physician promptly if you notice any changes.

  Treatments for skin cancer

  Specific treatment for skin cancer will be determined by your physician based on:

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

  There are several kinds of treatments for skin cancer, including the following:

  • Surgery
    Surgery is a common treatment for skin cancer, which is used in about 90 percent of treated cases. Some types of skin cancer growths can be removed very easily and require only very minor surgery, while others may require a more extensive surgical procedure. Surgery may include the following procedures:
  • Cryosurgery
    Using liquid nitrogen, cryosurgery uses an instrument that sprays the liquid onto the skin, freezing and destroying the tissue.
  • Curettage and electrodesiccation
    This common type of surgery involves scraping away skin tissue with a curette (a sharp surgical instrument), followed by cauterizing the wound with an electrosurgical unit.
  • Excision
    A scalpel (sharp surgical instrument) may be used to excise and remove the growth. The wound is usually stitched or held closed with skin clips.
  • Mohs' microscopically controlled surgery
    This type of surgery involves excising a lesion, layer by layer. Each piece of excised tissue is examined under a microscope. Tissue is progressively excised until no tumor cells are seen. The goal of this type of surgery is to remove all of the malignant cells and as little normal tissue as possible. It is often used with recurring tumors.
  • Laser therapy
    Laser surgery uses a narrow beam of light to remove cancer cells, and is often used with tumors located on the outer layer of skin.
  • Radiation therapy
    X-rays are used to kill cancer cells and shrink tumors.

  Other types of treatment include the following:

  • chemotherapy-chemotherapy uses drugs to kill cancer cells.
  • topical chemotherapy-chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.
  • systemic chemotherapy-chemotherapy administered orally or intravenously (IV).
  • immunotherapy-Immunotherapy of melanoma is a complex type of treatment involving various approaches to boost the body's own immune system, helping it to slow the growth of the cancer.
• Skin Cancer Treatment
  
  

  Treatment for skin cancer:

  • Specific treatment for skin cancer will be determined by your physician based on:
  • your age, overall health, and medical history
  • extent of the disease
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the disease
  • your opinion or preference

  
  

  There are several kinds of treatments for skin cancer, including the following:

  • Surgery
    Surgery is a common treatment for skin cancer - used about 90 percent of the time - and often includes the following procedures:
    
    • Cryosurgery - freezing the tumor, which kills cancer cells.
    • Electrodesiccation and Curettage - using an electric current to dehydrate the lesion and removing it with a sharp instrument.
    • LaserTherapy - using a narrow beam of light to remove cancer cells.
    • Mohs Micrographic Surgery - removing the cancer and as little normal tissue as possible. During this surgery, the physician removes the cancer and then uses a microscope to look at the cancerous area to make certain no cancer cells remain.
    • Simple Excision - cutting the cancer from the skin along with some of the healthy tissue around it.
    • Grafting - uses a skin graft to replace skin that is damaged when cancer is removed. This can be done following any other type of surgery for skin cancer.
  • External Radiation (external beam therapy)
    A treatment that precisely sends high levels of radiation directly to the cancer cells. The machine is controlled by the radiation therapist. Since radiation is used to kill cancer cells and to shrink tumors, special shields may be used to protect the tissue surrounding the treatment area. Radiation treatments are painless and usually last a few minutes.
  • Electrochemotherapy
    Electrochemotherapy uses a combination of chemotherapy and electrical pulses to treat cancer.

  Other types of treatment include:

  • Chemotherapy - the use of anticancer drugs to treat cancerous cells. In most cases, chemotherapy works by interfering with the cancer cell’s ability to grow or reproduce. Different groups of drugs work in different ways to fight cancer cells.
  • Topical Chemotherapy - chemotherapy given as a cream or lotion placed on the skin to kill cancer cells.
  • Systemic Chemotherapy - chemotherapy taken by pill, or needle injection into a vein or muscle.
  • Biological Therapy (also called biological response modifier (BRM) therapy, immunotherapy, or immunotherapy) - fights cancer by using materials made by your own body, or made in a laboratory, to boost, direct, or restore your body's natural defenses against disease.
  • Interferon - a biological drug used to treat melanoma. Interferon boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects may include flu-like symptoms (such as fever, chills, and headache) and temporary liver problems. However, each individual may experience side effects differently.
  • Interleukin - a biological drug used to treat advanced stages of melanoma. Interleukin boosts the body’s own immune system, helping it to slow the growth of the cancer. Side effects may include flu-like symptoms (such as fever, chills, and headache), swelling, and change in blood counts. However, each individual may experience side effects differently.
  • Photodynamic Therapy (PDT) - a type of laser treatment that involves injecting photosensitizing chemicals into the bloodstream. Cells throughout the body absorb the chemicals. The chemicals collect and stay longer in the cancer cells, than in the healthy cells. At the right time, when the healthy cells surrounding the tumor may already be relatively free of the chemical, the light of a laser can be focused directly on the tumor. As the cells absorb the light, a chemical reaction destroys the cancer cells.
• Skin Pigment Disorders
  
  

  What are skin pigment disorders?

  Skin color is determined by a pigment (melanin) made by specialized cells in the skin (melanocytes). The amount and type of melanin determines a person's skin color.

  What is the function of melanin?

  Melanin gives color to the skin, hair, and iris of the eyes. Levels of melanin depend on race and amount of sunlight exposure. Sun exposure increases melanin production - to protect the skin against harmful ultraviolet rays. In addition, hormonal changes can affect melanin production.

  What are the different types of skin pigment disorders?

  Pigment Disorder	Characteristics	Treatment
  Albinism	This rare, inherited disorder is characterized by a total or partial lack of melanin in the skin, compared to the pigmentation of siblings and parents. Albinos (people with albinism) have white hair, pale skin, and pink eyes. Vision is often affected.	There is no cure for albinism. Albinos should avoid sunlight because they lack natural protection from sunlight - melanin.
  Melasma	Dark brown, symmetric patches of pigment on the face. During pregnancy this is called the "mask of pregnancy."	Sunscreens and avoiding sun exposure can prevent melasma from becoming worse. Other treatment may include prescription creams to lighten the patches.
  Pigment loss after skin damage	Sometimes, following an ulcer, blister, burn, or infection, the skin does not replace some of the pigment in that area.	No treatment is necessary. Cosmetics can usually cover the blemish.
  Vitiligo	Smooth, white patches in the skin, vitiligo is caused by the loss of pigment-producing cells in the skin (melanocytes). The white patches are very sensitive to the sun.	There is no cure for vitiligo. Treatment may include covering smaller patches with long-lasting dyes, light-sensitive drugs, in addition to ultraviolet A light therapy, corticosteroid creams, and depigmentation of the remaining skin.

• Skin Self Exam
  
  

  How to perform a skin self-examination:

  Finding suspicious moles or skin cancer early is the key to treating skin cancer successfully. A skin self-examination is usually the first step in detecting skin cancer. The following suggested method of self-examination is from the American Cancer Society:
  (You will need a full-length mirror, a hand mirror, and a brightly lit room.)

  • Examine your body front and back in mirror, then the right and left sides, with your arms raised.
  • Bend your elbows, look carefully at your forearms, the back of your upper arms, and the palms of your hands.
  • Look at backs of your legs and feet, spaces between your toes, and the soles of your feet.
  • Examine the back of your neck and scalp with a hand mirror.
  • Check your back and buttocks with a hand mirror.
  • Become familiar with your skin and the pattern of your moles, freckles, and other marks.
  • Be alert to changes in the number, size, shape, and color of pigmented areas.
  • Follow the ABCD chart when examining moles of other pigmented areas and consult your physician promptly if you notice any changes
• Squamous Cell Carcinoma
  
  

  What is squamous cell carcinoma?

  Squamous cell skin cancer (sometimes referred to as non-melanoma carcinoma) may appear as nodules, or as red, scaly patches of skin.

  Who is at risk for squamous cell carcinoma?

  Squamous cell carcinoma is the second most common skin cancer found in Caucasians, and is usually found on fair-skinned persons. According to the American Academy of Dermatology, the cure rate for squamous cell carcinoma is 95 percent, when properly treated. The risk factors for squamous cell carcinoma include the following:

  • human papilloma virus (HPV)
  • smoking
  • history of skin cancer
  • immunosuppression, such as in persons who have had organ transplants
  • treatment of psoriasis
  • long-term skin inflammation or injury
  • radiation exposure
  • chemical exposure
  • excessive exposure to UV radiation (sunlight or tanning beds)

  Where is squamous cell carcinoma found?

  Squamous cell carcinoma is typically is found on the rim of the ear, face, lips and mouth, however, it can spread to other parts of the body. Although generally more aggressive than basal cell carcinoma, this cancer is highly treatable.

• Staphylococcal Scalded Skin Syndrome
  
  

  What is staphylococcal scalded skin syndrome?

  Staphylococcal scalded skin syndrome is a response to a staphylococcal infection and is characterized by peeling skin. The disease mostly affects infants, young children, and individuals with a depressed immune system or renal insufficiency. The disease can be life threatening.

  What are the symptoms of staphylococcal scalded skin syndrome?

  The following are the most common symptoms of staphylococcal scalded skin syndrome. However, each individual experiences symptoms differently. The disease usually begins with a fever and redness of the skin. Then, a fluid-filled blister may form. This blister ruptures very easily, leaving an area of moist skin. Other symptoms may include the following:

  • crusted infection site, often around the nose or ears
  • red, painful areas around infection site
  • blistering
  • fever
  • chills
  • weakness
  • fluid loss
  • top layer of skin begins peeling off in sheets

  After the top layer of skin has peeled off, the following symptoms may be present:

  • fever
  • chills
  • weakness
  • fluid loss

  In newborns, the lesions are often found in the diaper area or around the umbilical cord. Older children more commonly have the lesions on their arms, legs, and trunk. The symptoms of staphylococcal scalded skin syndrome may resemble other skin conditions. Always consult your physician for a diagnosis.

  How is staphylococcal scalded skin syndrome diagnosed?

  In addition to a medical history and physical examination, the diagnosis may be confirmed with a biopsy (taking a tissue sample to be examined under a microscope) and bacterial culture.

  Treatment for staphylococcal scalded skin syndrome

  Specific treatment for staphylococcal scalded skin syndrome will be determined by your physician based on:

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

  Treatment usually requires hospitalization, often in the burn unit of the hospital. Treatment may include:

  • oral antibiotics
  • intravenous (IV), penicillin-type antibiotics
• Sunscreens
  
  

  What are sunscreens?

  Sunscreens protect the skin against sunburns. Sunscreens also play an important role in blocking the penetration of ultraviolet (UV) radiation, which damages the skin and can lead to skin cancer. However, no sunscreen blocks UV radiation 100 percent.

  What is the difference between a sunscreen and a sunblock?

  The terminology used on sunscreen labels can be confusing. The protection provided by a sunscreen is indicated by the sun protection factor (SPF) listed on the product label. A sunblock is considered to be any sunscreen with an SPF of 15 or more. In theory, sunscreens protect an individual during an incident of ultraviolet B (UVB) radiation exposure according to the following:

  • SPF 15 sunscreen may absorb more than 92 percent of UVB radiation.
  • SPF 30 sunscreen may absorb 97 percent of UVB radiation.

  How to use sunscreens

  A sunscreen protects from sunburn and minimizes suntan by reflecting UV rays. Using sunscreens correctly is important in protecting the skin. Consider the following:

  • Use of a sunscreen with SPF of 20 to 30 offers substantial protection against sunburns, and usually prevents tanning.
  • Choose a broad spectrum sunscreen that filters out ultraviolet A (UVA) and ultraviolet B (UVB).
  • A sunscreen that provides an SPF under 4 offers the least protection. If you rarely burn and always tan, this level of skin protection may be sufficient to help prevent burning and uneven coloration.
  • Sunscreens with high SPF sunscreens protect from burning for longer periods of time than do sunscreens with lower SPFs.
  • Apply sunscreens to all exposed areas of skin, including those easily overlooked areas such as the rims of the ears, lips, back of the neck, and feet.
  • Sunscreens are recommended for everyone (over 6 months of age), regardless of skin or complexion type, because all skin types need protection from solar UV rays. Lighter skin types are at the greatest risk of developing skin cancer; but all people are at some risk. Research has shown that UVA rays may contribute to premature aging and skin cancer.
  • Apply sunscreen liberally. The recommended dose is one ounce per application. Reapply every two hours, after being in the water, or after exercising or sweating. Incidental time in the sun could add up to a sunburn. Do not forget the time spent walking your dog, window shopping, or jogging on your lunch hour.
  • Do not forget the sunscreen when performing outdoor chores.

  Matching sunscreens with skin type

  Knowing your skin type can help you pick the right sunscreen for you. The US Food and Drug Administration (FDA) recommends the following:

  Sun Exposure History	Recommended Sun Protection Factor (SPF)
  Burns easily, rarely tans	20 to 30
  Burns easily, tans very little	12 to 20
  Burns moderately, tans gradually	8 to 12
  Burns minimally, tans well	4 to 8
  Rarely burns, tans well	2 to 4

• Tinea Infections (Ringworm)

  Did You Know? "Ringworm" is a misleading term that refers to the circular appearance of the fungal lesion. There are no worms involved.

  What are tinea infections (ringworm)?

  Different fungi, depending on their location on the body, cause ringworm. Ringworm is characterized by ring-shaped, red, scaly patches with clearing centers. There is an increased risk of contracting ringworm if a person:

  • is malnourished.
  • has poor hygiene.
  • lives in a warm climate.
  • has contact with other persons or pets that have ringworm.
  • is immunocompromised by disease or medication.

  What are the most common types of ringworm?

  The most common types of ringworm include the following:

  • Athlete's foot (tinea pedis or foot ringworm)
    This common condition mostly affects teen and adult males. It less frequently affects children before puberty. Contributing causes include sweating, not drying the feet well after swimming or bathing, wearing tight socks and shoes, and warm weather conditions. Symptoms of athlete's foot may include:
    • whitening of the skin between the toes
    • scaling of the feet
    • itchy rash on the feet
    • blisters on the feet
  • Jock itch (tinea cruris or groin ringworm)
    This condition is also more common in males and occurs more often during warm weather conditions. It is very rare in females. Symptoms of jock itch may include:
  • red, ring-like patches in the groin area
  • itching in the groin area
  • pain in the groin area
  • does not usually involve the scrotum
  • Scalp ringworm (tinea capitis)
    Scalp ringworm is highly contagious, especially among children. It occurs mainly in children between the ages of 2 to 10 years. It rarely occurs in adults. Symptoms of scalp ringworm may include:
    • red, scaly rash on the scalp
    • itching of the scalp
    • hair loss on the scalp
    • rash elsewhere on the body
    • Ringworm of the scalp can also develop into a kerion, a large, tender lesion over the area of the initial ringworm. This is caused by a hypersensitivity to the ringworm and may be associated with a rash elsewhere and tender lymph nodes in the neck.
  • Nail ringworm (tinea unguium)
    An infection of the finger or toe nail, characterized by a thickened, deformed nail. This condition more often affects the toenails than the fingernails. This occurs more often in adolescents and adults rather than young children. Symptoms of nail ringworm may include:
    • thickening of the ends of the nails
    • yellow color to the nails
  • Body ringworm (tinea corporis)
    This skin infection is characterized by a ring-like rash anywhere on the body or the face. This occurs in all ages and is more common in warmer climates. The symptoms of body ringworm may include:
    • red, circular lesion with raised edges
    • the middle of the lesion may become less red as the lesion grows
    • itching of the affected area
    • The symptoms of ringworm may resemble other skin conditions. Always consult your physician for a diagnosis.

  How is ringworm diagnosed?

  Ringworm is usually diagnosed based on a medical history and physical examination. The lesions of ringworm are unique, and usually allow for a diagnosis simply on physical examination. In addition, your physician may order a culture or skin scraping of the lesion to confirm the diagnosis.

  Treatment for ringworm

  • Specific treatment for ringworm will be determined by your physician based on:
  • your age, overall health, and medical history
  • extent of the condition
  • location of the ringworm
  • your tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

  Treatment for scalp ringworm (tinea capitis) may include an oral anti-fungal medication that is usually prescribed for four to eight weeks. Some people require longer treatment. Treatment for scalp ringworm may also involve the use of a special shampoo, to help eliminate the fungus. If a kerion is present (a large, tender, swollen lesion), your physician may order additional medications, such as steroids, to help reduce the swelling. Treatment for ringworm of the body, groin, and foot is usually a topical anti-fungal agent or an oral antifungal medication. The length of the treatment depends on the location of the ringworm. Because the fungi can live indefinitely on the skin, recurrences of ringworm are likely. Treatment may need to be repeated.

• Tinea Versicolor
  
  

  What is tinea versicolor?

  Tinea versicolor is a common fungal skin infection characterized by lighter or darker patches on the skin. Patches are most often found on the chest or back and prevent the skin from tanning evenly. It occurs mostly in adolescence and early adulthood, but it can occur at any time.

  What are the symptoms of tinea versicolor?

  Usually, the only symptom of tinea versicolor is the white or light brown patches. Patches may scale slightly, but rarely itch or hurt. Other common characteristics of the rash include the following:

  • white, pink, or brown patches
  • infection only on the top layers of the skin
  • the rash usually occurs on the trunk
  • the rash does not usually occur on the face
  • patches worsen in the heat, humidity, or if you are on steroid therapy or has a weakened immune system
  • patches are most noticeable in the summer

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

  How is tinea versicolor diagnosed?

  Tinea versicolor is usually diagnosed based on a medical history and physical examination. The patches seen with this condition are unique, and usually allow the diagnosis to be made on physical examination. In addition, your physician may use an ultraviolet light to see the patches more clearly. Also, your physician may do skin scrapings of the lesions to help confirm the diagnosis.

  Treatment for tinea versicolor

  Specific treatment for tinea versicolor 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 usually includes the use of dandruff shampoo on the skin, as prescribed by your physician. The shampoo is left on the skin overnight and washed off in the morning. To be effective, the shampoo treatment may be required for several nights. Tinea versicolor usually recurs, requiring additional treatments. Your physician may also prescribe topical creams or oral antifungal medications. It is also important to know that improvement in the skin may only be temporary, and a recurrence of the condition is possible. Your physician may also recommend using the shampoo monthly to help prevent recurrences. The treatment will not bring the normal color back to the skin immediately. This will occur naturally and may take several months.

• Ultraviolet Radiation
  
  

  What is ultraviolet radiation?

  Energy from the sun reaches the earth as visible, infrared, and ultraviolet (UV) rays.

  • Ultraviolet A (UVA) is made up of wavelengths 320 to 400 nanometers (nm) in length.
  • Ultraviolet B (UVB) wavelengths are 280 to 320 nm in length.
  • Ultraviolet C (UVC) wavelengths are 100 to 280 nm in length.

  Only UVA and UVB ultraviolet rays reach the earth's surface. The earth's atmosphere absorbs UVC wavelengths.

  • UVB rays cause a much greater risk of skin cancer than UVA. However, UVA rays cause aging, wrinkling, and loss of elasticity.
  • UVA also increases the damaging effects of UVB, including skin cancer and cataracts (an eye disorder characterized by a change in the structure of the crystalline lens that causes blurred vision).

  In most cases, ultraviolet rays react with a chemical called melanin, that is found in the skin. This is the first defense against the sun, as it is the melanin that absorbs the dangerous UV rays that can do serious skin damage. A sunburn develops when the amount of UV damage exceeds the protection that the skin's melanin can provide. While a small amount of exposure to sunlight is healthy and pleasurable, too much can be dangerous. Measures should be taken to prevent overexposure to sunlight in order to reduce the risks of cancers, premature aging of the skin, the development of cataracts, and other harmful effects.

  What is the Ultraviolet (UV) Index?

  In response to the increasing incidence of skin cancer, cataracts, and other effects from exposure to the sun's harmful rays, the National Weather Service (NWS), the US Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) collaborated on a sun-awareness information program. An important part of this program is the Ultraviolet (UV) Index, developed by the National Meteorological Center of the National Weather Service.

  The Index is a next-day forecast that estimates the amount of ultraviolet radiation that will reach the earth's surface - providing important information to help you prevent overexposure to the sun's rays. The Index also includes the effects of cloud cover on the anticipated UV exposure level for the next day.

• UV Exposure Categories
  
  

  What is the Ultraviolet (UV) Index?

  In response to the increasing incidence of skin cancer, cataracts, and other effects from exposure to the sun's harmful rays, the National Weather Service (NWS), the US Environmental Protection Agency (EPA), and the Centers for Disease Control and Prevention (CDC) collaborated on a sun-awareness information program. An important part of this program is the Ultraviolet (UV) Index, developed by the Climate Prediction Center of the National Weather Service.
  The Index is a next-day forecast that estimates the amount of ultraviolet radiation that will reach the earth's surface - providing important information to help you prevent overexposure to the sun's rays. The Index also includes the effects of cloud cover on the anticipated UV exposure level for the next day.

  What are the UV exposure categories?

  Index Values	Exposure Categories
  0 - 2	Low-An index reading of 2 or less low danger from the sun's UV rays for the average person.
  3 - 5	Moderate-An index reading of 3 to 5 means a moderate risk of harm. Take precautions if you will be outside. Stay in shade near midday.
  6-7	High-An index reading of 6 to 7 means you may be at high risk of harm from unprotected exposure to the sun. Wear a wide brim hat and sunglasses. Wear sunscreen, as protection against sunburn is needed. Reduce time in the sun between 11 a.m. and 4 p.m.
  8-10	Very High-An index reading of 8 to 10 and above means you are at a very high risk of harm from unprotected sun exposure. Take extra precautions. Minimize exposure between 10 a.m. and 4 p..m. Cover up and wear a hat and sunglasses. Wear sunscreen.
  11 +	Extreme-An index reading of 11 and above means you are at extreme risk of harm from unprotected sun exposure. Follow all of the above suggestions to protect yourself from the sun.

• Warts
  
  

  What are warts?

  Warts are non-cancerous skin growths caused by the papillomavirus. Warts are more common in children than adults, although they can develop at any age. Warts can spread to other parts of the body and to other persons. There are many different types of warts, due to many different papillomavirus types (more than 60). Warts are not painful, except when located on the feet. Most warts go away, without treatment, over an extended period of time.

  Common types of warts:

  The following are the more common types of warts:

  Common warts	growths around nails and the back of hands; usually have a rough surface; grayish-yellow or brown in color
  Foot warts	located on the soles of feet (plantar warts) with black dots (clotted blood vessels that once fed them); clusters of plantar warts are called mosaic; can be painful
  Flat warts	small, smooth growths that grow in groups up to 100 at a time; most often appear on children's faces
  Genital warts	grow on the genitals and are occasionally sexually transmitted; are soft and do not have a rough surface like other common warts
  Filiform warts	small, long, narrow growths that usually appear on eyelids, face, or neck

  
  

  Treatment for warts:

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

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

  Warts often disappear without treatment. Treatment of warts depends on several factors, including the following:

  • length of time on the skin
  • location
  • type
  • severity

  Treatment may include:

  • application of salicylic and lactic acid (to soften the infected area)
  • freezing with liquid nitrogen
  • electrodesiccation (to destroy the wart with an electrical current)
  • immunotherapy
  • laser surgery