Androgenetic alopecia | Angioedema | Angiokeratomas | Angular cheilitis | Annular erythema | Aphthous ulcers | Aplasia cutis | Athlete's foot (see tinea pedis) | Atopic dermatitis | Atopic eczema (go to atopic dermatitis) | Atrophie blanche | Previous .....

This is a very common type of hairloss known also as common baldness, male pattern baldness and female pattern baldness. It may begin early as after puberty.

Causes

• Androgens (male hormones).
• Inherited sensitivity of the hair follicles to androgens.

Symptoms
The symptoms may differ in men and women:

• Male androgenetic alopecia (male pattern hairloss)

   

  • Begins as a receding hairline around the temples, producing an M-shaped pattern. Then thinning or a bald patch develops at the crown. In severe cases, these areas merge leaving a horseshoe rim of hair at the back and sides of the head.

   

• Female androgenetic alopecia (female pattern hairloss)

   

  • May follow the pattern in men or more commonly, as diffuse thinning which is most prominent on the top front of the scalp.

  Male androgenetic alopecia. Click on image for larger view

  What you can do

• Nothing, live with it.
• Consider cosmetic measures such as having a hairdresser style the hair so that it hides the hairloss, hair weaving or using a hairpiece.
• Consult a doctor for treatment.

  Key points

• Women with androgenetic alopecia who have the following symptoms should consult a doctor for tests to exclude increased production of male hormones:
• Severe acne.
• Hirsutism.
• Enlargement of the clitoris.

  What the doctor may do

• Confirm the diagnosis.
• Prescribe minoxidil lotion or finasteride tablets which may reduce the rate of hairloss or induce some hairgrowth.
• Oestrogens (female hormones) and antiandrogens tablets may be helpful in women.
• Consider surgery such as scalp reduction and hair transplantation in very motivated patients.

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Cheilitis refers to inflammation of the lips. Angular cheilitis is a type of cheilitis affecting the corners of the mouth.

Causes

• Chapping from cold dry environments.
• Atopic cheilitis (exfoliative cheilitis) which is a type of atopic dermatitis affecting the lips (see atopic dermatitis).
• Drugs such as isotretinoin, a vitamin A acid used to treat severe acne.
• Contact cheilitis (a type of allergic or irritant contact dermatitis affecting the lips) due to lipsticks, lipbalms, toothpastes, foods, saliva (lip licking cheilitis).
• Cheilitis glandularis.

  Symptoms

• Red, scaly, cracked lips.
• Redness, swelling and blistering may be seen in contact cheilitis.
• Cracks with scaling at the corners of the mouth in angular cheilitis.
• Swollen lips with numerous pinhead sized openings of the salivary glands in the lips may be seen in cheilitis glandularis.
• Itching.
• Pain.

  Cheilitis Click on image for a larger view

  Complications

• Secondary bacterial infection.

  What you can do

• You should consult a doctor.
• Avoid lip licking.
• Avoid eating acidic foods or insert directly into the mouth without touching the lips.
• Use vaseline to moisturise the lips.

  What the doctor may do

• Determine the cause and eliminate it.
• Diagnose and treat complications.
• Perform patch or prick tests to detect allergies.
• Prescribe a mild topical steroids.
• Give intralesional steroid injections in cheilitis glandularis.

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This is a type of urticaria involving the deeper parts of the skin and mucous membranes. It may be life threatening when it affects the throat as it may cause suffocation and death.

Causes

• Allergy, for example to food products, drugs, insect bites.
• Inherited angioedema which is caused by the lack of a C1 esterase inhibitor, an enzyme that keeps the complement system in check. The complement system controls the production of chemicals that cause inflammation.

  Symptoms

• Large swellings in the skin and and mucous membranes. On the face, it may cause swelling of the eyelids and lips and severely distort the facial contours. In the throat, the swelling may cause difficulty breathing and suffocation.
• Abdominal cramps, nausea and vomiting due swelling in the mucous membrane lining of the intestines.
• Burning pain and occasionally, itching.

  Complications

• Impairment of vision due to swollen eyelids.
• Breathing difficulties, wheezing and suffocation when it affects the throat.
• Death from suffocation.

  What you can do

• Go to the nearest Accident and Emergency department.

  What the doctor may do

• Administer antihistamines, adrenaline and corticosteroids and insert a breathing tube or perform a tracheostomy (create a hole in the windpipe) if there is suffocation.
• Determine the cause so that future attacks can be avoided.
• Prescribe danazol in cases of inherited angioedema.

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Angiokeratomas are red-purple bumps. Most angiokeratomas occur for no known reasons and are few and generally harmless. Some angiokeratomas are more widespread and these may be associated with a genetic disorder known as Fabry's disease.

Cause

• Unknown.
• Due to Fabry's disease (angiokeratoma corporis diffusum) which is inherited as an X-linked recessive disorder. X-linked means the defect occurs in the X chromosome and only males are affected and women are carriers.

  Symptoms

• Red-purple raised spots on the body, scrotum or hands and feet.
• Fabry's disease is associated with heart and kidney disease and high blood pressure and widespread angiokeratomas.

  Complications

• Only occurs in Fabry's disease because of heart and kidney involvement. Death may result from kidney or heart failure.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Exclude the Fabry's disease which causes kidney and heart problems.
• Remove angiokeratomas using lasers, electrosurgery or surgical excision.

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Annular means ring-like and erythema means reddish. Annular erythema, therefore is the term used for a group of skin disorders characterised by reddish ring-shaped rashes.

• Erythema chronicum migrans (ECM)
  • Expanding red ring with clearer centre.
  • Fever, chills, muscle pains and headaches.
  • ECM is due to a spiral shaped bacteria called Borrelia burgdorferi which is transmitted by tick bites. It is more common in the US and Parts of Europe.

   

• Erythema annulare centrifugum
  • Expanding red ring-shaped patch with a scaly border lagging behind. Lasts weeks to years.
  • May be associated with fungal infection, parasitic bowel disease or autoimmune disorders.

   

• Erythema gyratum repens
  • Red ring-shaped rashes that are arranged in a wood-grain pattern.
  • Usually associated with underlying cancer.

   

• Erythema marginatum
  • Red ring-shaped rashes that change in size and shape.
  • A sign of rheumatic fever, a streptococcal bacterial infection that causes arthritis, heart valve inflammation and fever.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Perform investigations to determine the cause, if any.
• Treat the cause.

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Aphthous ulcers or canker sores are common mouth ulcers that affect at least 20% of the population. They occur most frequently during early adult life and become less common with age. The ulcers number from 1 - 5 and heal spontaneously after 1 - 2 weeks but often recur.

Causes
The exact cause is unknown but the following may play a role:


• Trauma during chewing and brushing.
• Food allergies.
• Stress.
• Hypersensitivity reaction to bacteria.
• Hormonal factors may be involved as some women develop the ulcers just before menstruation.

  Symptoms

• 1 - 5 small, round painful ulcers with yellowish-white base and a red halo. They are most frequently found on the lips, the inside of the cheeks and sometimes, the tongue.
  

  Aphthous ulcer Click on image for larger view

• What you can do
• Gargle with an antiseptic mouth wash or salt solution prepared by dissolving a teaspoonful of table salt in 1 pint of water two or three times a day.
• You can consult a doctor.

  What the doctor may do

• Confirm the diagnosis.
• Prescribe anaesthetic gels to rub into the ulcers so as to reduce pain.
• Prescribe tetracycline gargles.
• Prescribe steroid pastes or inject intralesional steroids into the base of the ulcers to expedite resolution.

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Aplasia cutis refers to the congenital absence of skin. It occurs in newborns and is sometimes blamed on forceps, if used to assist delivery.

Cause

• Developmental abnormality in which skin fails to develop over localised areas such as the scalp.

  Symptoms

• Appears at birth.
• Usually occurs on the scalp and rarely on other parts of the body.
• It appears as an ulcer which is raw or covered by a crust or as a depressed area covered by a tough smooth membrane.
• The raw area eventually heals leaving a flat or raised scar.
• Hairs are absent over the affected area.
• Aplasia cutis may sometimes be associated with trisomy 13, a chromosomal disorder.

  Complications

• Secondary bacterial infection.
• Haemorrhage.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Confirm the diagnosis.
• Treat the complications.
• Surgically remove the affected area if healing is poor or for cosmetic reasons.

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Atopic dermatitis is a type of eczema that occurs in people with a family history of allergic conditions such as asthma (wheezy breathing), allergic rhinitis (itchy, runny nose) and atopic dermatitis. Atopic is the adjective for "atopy" which is an inherited predisposition to hypersensitivity reactions in the skin (atopic dermatitis), bronchi or breathing tubes (asthma) and allergic rhinitis (nasal passages). Atopic dermatitis usually occurs between the 2 months and 2 years of age and improves with age so that 80 - 90% of those affected are very much improved by the time they reach puberty. The sites most commonly affected include the face, neck, front of the elbows and behind the knees. Atopic dermatitis is estimated to affect 3% of children.

Cause

• The atopic tendency or predisposition to asthma, allergic rhinitis and atopic dermatitis is believed to be inherited. However, this tendency is not specific which means that a parent with atopic dermatitis may have an offspring with asthma rather than atopic dermatitis or vice versa. Two-thirds of patients give a personal or family history of asthma, allergic rhinitis or atopic dermatitis.

  Symptoms
  

• In young children, atopic dermatitis usually affects the face, scalp, napkin areas and limbs or it can be quite generalised
• In older children and adults, it usually affects the neck and front of the elbows and back of the knees.
• Itch is usually severe and there are often scratch marks and even bleeding points. Scratching make the dermatitis worse so an itch-scratch-rash cycle develops, causing the dermatitis to flare suddenly. Constant scratching leads to lichenification (leathery thickened and darkened skin).
• Recurrences are characteristic. The other signs are:

   

  • Acute eczema - redness, papules (pimply bumps), weeping, crusting and broken skin due to scratching.
  • Chronic eczema - dry, scaly and lichenified (leathery thickened and often darkened) skin.

  Atopic dermatitis affecting the front of the elbows. Click on image for larger view.

  Atopic dermatitis affecting the backs of the knees. Click on image for larger view.

  Complications

• Bacterial infection due to scratching.
• Herpes simplex virus infection ("cold sores") leading to eczema herpeticum.
• Increased susceptibility to warts and molluscum contagiosum.

  What you can do

• You should consult a doctor for treatment and advice.
• Take simple antihistamines to relief itch.
• Avoid over-drying the skin (see preventing dryness below).
• Avoid rough textured fabrics.
• Avoid foods that appear to aggravate the eczema.
• Cut the fingernails short so as to reduce trauma to the skin. Mittens can be worn at night for the same purpose.
• Take Evening Primrose Oil or Borage Oil (types of health food) which may sometimes help to reduce the severity of atopic dermatitis.
• Stress is a common cause of relapse. Confront and deal with stresses.
• Keep away from persons with active herpes simplex virus infection ("cold sores").
• Avoid careers which involve excessive exposure to heat, chemicals and degreasing agents; for example, hairdressing, nursing or industrial work.
• Avoid hot humid jobs.

  Preventing dryness

• Avoid long, hot baths. Instead take short warm showers.
• Avoid soap or use emulsifying ointment in place of soap.
• If you find not using soaps unpalatable, use a mild dermatological soap or bath oil instead.
• Apply moisturisers after baths/showers and as frequently as necessary.

  What the doctor may do

• Prescribe topical steroids and in severe cases, even oral steroids and cyclosporin (an immunosuppressive drugs used to prevent the rejection of transplanted organs). PUVA may be used in adults with very resistant atopic dermatitis.
• Hospitalise severe cases for treatment and rest. Severe eczema can sometimes improve in response to a change in the environment alone.
• Prescribe antibiotics for secondary bacterial infection.
• Perform skin tests (prick or intradermal tests) and RAST to exclude food allergies in selected cases.
• Advise elimination diets in selected cases. A small proportion (about 10%) of children with atopic dermatitis have food allergies and improve when the offending food is eliminated from the diet. Some of the foods reported to cause allergies include eggs, cow's milk, nuts and fish. Because many of these foods have superior nutritional value, elimination diets are generally used only under a doctor's supervision and when simple treatments do not work.

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Atrophie means thinned and blanche means white. The term atrophie blanche therefore, means thinned white scars.

Cause

• Healed leg ulcers from vasculitis or stasis ulcers.
• Livedo vasculitis.

  Symptoms

• Thinned white scars with red spots or telangiectasias (broken capillaries).

  What you can do

• You should consult a doctor.

  What the doctor may do

• Treat with drugs that prevent the aggregation of platelets such as aspirin, pyridamole and pentoxyfylline.

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