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Balanitis | Baldness (go to alopecia) | Basal cell cancer | Beau's lines | Becker's naevus | Behcet's syndrome | Birthmarks | Bites, insect bites and stings | Blackheads (go to comedones) | Blisters | Boils (go to furuncles) | Bowen's disease | Brittle nails | Broken capillaries/veins (go to telangiectasias) | Bromhidrosis | Bruises | Bullous pemphigoid (go to pemphigus and bullous pemphigoid) | Burns and scalds

BALANITIS

The term, balanitis refers to an inflammation of the foreskin and/or head of the penis.

    Causes

  • Allergy to antiseptic creams, spermicides and condoms (see contact dermatitis).
  • Fixed drug eruption affecting the penis.
  • Skin diseases such as psoriasis and lichen planus.
  • Candidiasis.
  • Sexually transmitted diseases such as herpes genitalis (see herpes simplex virus infections), chancroid, syphilis and nonspecific urethritis (NSU).

    Symptoms

  • Red dots.
  • Red scaly patches.
  • Swelling, cracks and ulcers.
  • Occasionally, discharge of pus.

    Complications

  • Recurrent balanitis can lead to a tightening of the foreskin, requiring circumcision.

    What you can do

  • You should consult a doctor.
  • Wash frequently with saline prepared by dissolving a teaspoonful of salt in a pint of water.

    What the doctor may do

  • Perform tests to determine the cause and treat accordingly.

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BASAL CELL CANCER

Basal cell cancers (BCCs) or rodent ulcers are the most common type of skin cancer. They usually occur on the sun-exposed areas of skin, especially on the face, forehead, scalp and back of the hands. Fair-skinned individuals, especially those of Celtic origin, albinos and those heavily exposed to the sun are at higher risk of developing BCCs.

    Causes

  • Heavy occupational or recreational exposure to the sun.
  • Previous radiation damage.
  • Basal cell naevus syndrome (rare inherited condition).

    Symptoms

  • A shiny bump that is transluscent or pearly in appearance. Tiny blood vessels may be seen growing over it.
  • A small ulcer covered by a crust and an elevated, rolled pearly border which may have tiny blood vessels growing over it.
  • Pigmented BCC shows any of the features above but has brown or black pigment, as well.
  • Morphoea-like BCC appears as a shiny whitish scar-like area with blood vessels growing over it.
      Basal cell cancer .
    Click on image for larger view.
    Complications
  • Basal cell cancers do not usually spread to distant sites but can spread deeper or wider into the skin, damaging underlying tissues such as muscles and bones and eroding into neighbouring structures such as the eye.

    What you can do

  • You should consult a doctor. Early basal cell cancers can be cured.

    What the doctor may do

  • Perform a skin biopsy to confirm the diagnosis.
  • Excise with or without skin grafts.
  • Treat with , electrosurgery, carbon dioxide laser, liquid nitrogen, X-ray therapy and Moh's chemosurgery.
  • Counsel about sun-protection.

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BEAU'S LINES

Beau's lines are horizontal depressions caused by a temporary disturbance of nail growth as a result of acute illness such as measles, mumps, inflammatory bowel disease, systemic lupus erythematosus and heart attack or acute stress. It usually affects all the nails. You should consualt a doctor to determine the cause. Treatment is not necessary because the lines outgrow themselves.

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BECKER'S NAEVUS

This is a harmless pigmented "birthmark" that appears around puberty. It is more common in boys and usually occurs on the upper half of the trunk, especially around one shoulder.

    Cause

  • A late onset pigmented "birthmark".

    Symptoms

  • Light brown hairy patch of irregular outline about the size of a hand or greater.
  • The hairs may become coarse with time.

    What you can do

  • You can consult a doctor to confim the diagnosis.
  • You can choose to have treatment if it bother you.

    What the doctor may do

  • Treat with carbon dioxide laser.

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BEHCET'S SYNDROME

This is a rare disorder that involves the skin and other systems such as the joints, eyes, mucous membranes of the mouth and genitalia, blood vessels and the central nervous system.

    Cause

  • May be a autoimmune disease (self allergy).

    Symptoms

  • Skin
    • Vasculitis and painful punched-out vasculitic ulcers (see vasculitis).
    • Pustules (pusheads), especially at venesection sites (where blood has been taken)..
    • Erythema nodosum (painful nodules on the lower limbs).
     
  • Superficial thrombophlebitis (painful red nodules along the leg veins).
  • Aneurysms (weakening and dilatation of the arteries).
  • Genital and mouth ulcers.
  • Arthritis (joint inflammation).
  • Inflammatory bowel disease with ulceration.
  • Eye inflammation.
  • Central nervous system problems including encephalitis (brain inflammation), paralysis and nerve palsies and psychiatric symptoms.

    Complications

  • Eye inflammation resulting in blindness.
  • Central nervous system involvement may resulting in fatalities.

    What you can do

  • You should consult a doctor as Behcet's syndrome may affect vital organs and cause death.

    What a doctor may do

  • Look for other organ system involvement and treat accordingly.
  • Prescribe oral steroids, azathioprine (an immunosuppressive drug), colchicine (used to treat gout), levamisole, chlorambucil (an immunosuppressive drug), cyclosporin (a immunosuppressive drug used to prevent the rejection of transplanted organs) and thalidomide (used to treat hypersensitivity reactions in leprosy).
  • Treat ulcers with intralesional steroids injections.

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BIRTHMARKS

Birthmarks may be caused by a malformation of the blood vessels (vascular birthmarks or haemangiomas) or the pigment cells or melanocytes (pigmented birthmarks).

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BITES, INSECT BITES AND STINGS

Insect bites and stings vary in severity from mild localised to severe systemic life-threatening reactions.

    Causes
    The causes of bites and stings are many, some of only the more common or important culprits include:
     
  • Mosquitoes.
  • Fleas.
  • Mites.
  • Ticks.
  • Midges.
  • Sand flies ("no-see-ums").
  • Ants.
  • Bed bugs.
  • Certain spiders
  • Insects of the hymenoptera order which includes three families:
    • Honeybee and bumblebees
    • Wasps, hornets and yellow jackets and
    • Some species of ants.

    Symptoms

  • Mild local reaction - transient itchy weal which subsides within a few hours.
  • Severe local reaction - itch, pain, swelling and blistering and in some spider bites, especially those caused by the black widow and brown recluse spiders, the skin may become necrotic (dead).
  • Papular urticaria - persistent papules (bumps) lasting more than 48 hours and sometimes, for weeks. The papules are often topped by a small blister or a crust.
      Sandfly bites.
    Click on image for larger view
    Complications
  • Secondary bacterial infection.
  • Severe toxic reaction from black widow spider and brown recluse spider bites may cause death from kidney failure and paralysis.
  • Allergic reaction which may result in generalised urticaria or anaphylaxis.
  • Infections such as dengue haemorrhagic fever, malaria and viral encephalitis may be transmitted by some mosquitoes.

    What you can do

  • Clean the area with soap and water.
  • Apply calamine lotion to relief itching.
  • Take antihistamines to relieve itching.
  • Do not scratch.
  • In the case of a bee sting, remove the stinger with a pair of tweezers or with the flick of a penknife taking care not to squeeze the venom sac.
  • Apply a cold compress for about 20 minutes to relieve pain and swelling. For bee stings, apply a paste of baking soda to neutralise the acidic venom before starting the compress. For wasp stings, use vinegar to neutralise the alkaline wasp venom.
  • Have your pets examined by a Vet if the cause of your bites is uncertain.
  • Consult a doctor reactions are severe or become infected.
  • Instututes measures to reduce the risk of further bites (see prevention).

    Key points
    Go to the nearest Accident and Emergency Department if:

  • You have been bitten by the brown recluse spider or the black widow spider.
  • You have generalised urticaria, signs of anaphylaxis developing , fever chills, weakness or vomiting.
    • What the doctor may do

    • Prescribe topical or in more severe cases, even systemic steroids.
    • Prescribe antibiotics for infection.
    • Institute emergency measures for severe toxic or allergic reactions plus hospitalisation.
    • Give desensitising injections for bee and wasp venom allergy.

      Prevention

    • The only successful way to treat bites and stings is to prevent them occuring in the first place:
    • Use screens and nets to keep out mosquitoes and and other flying insects.
    • Remove garbage and cover food in order not to attract insects, particularly bees and wasps.
    • Eliminate the breeding grounds of mosquitoes.
    • Use insect repellents to deter bites. Examples include DEET (diethyltoluamide) and DMP (dimethyl phthalate).
    • Consult a pest control company to eliminate fleas and bedbugs.
    • Have your pets examined regularly by a Vet.
    • Have the Ministry of the Environment remove any bee and wasp nests near home.
    • Carry an emergency kit if you have severe life-threatening allergic reactions to insect bites or stings.

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    BLISTERS

    Blisters are collections of fluid under the skin. In medical terminology, blisters less than 1cm are called vesicles and those above are termed bullae (singular bulla).

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    BOWEN'S DISEASE

    This is a type of squamous cell cancer that has not invaded into the skin. It is also known as in-situ squamous cell cancer.

      Cause

    • Chronic sun-exposure
    • Chronic ingestion of arsenic (previously used in some traditional asthma remedies).

      Symptoms

    • Reddish, slightly scaly patch with sharp borders. It may be misdiagnosed as eczema.
    • Erythroplasia of Queyrat which appears as a red, velvety patch on the penis (usually in the uncircumcised) or vulva is also a type of Bowen's disease.

      Complications

    • Development into squamous cell cancer. Squamous cell cancers arising from Bowen's disease are more aggressive and more likely to spread to lymph glands.

      What you can do

    • You should consult a doctor as soon as possible because early treatment can result in cure.

      What the doctor may do

    • Surgically remove the abnormal area, use liquid nitrogen, carbon dioxide laser or electrosurgery.

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    BRITTLE NAILS

    This is a common problem in women and has many causes.

      Causes

    • Excessive contact with water, alkalis, detergents, solvents and other chemicals.
    • Trauma.
    • Polishes and solvents used in nail polish removers.
    • Nail hardeners and false nails.
    • Fungal nail infections (onychomycosis).
    • Iron deficiency anaemia.
    • Old age.
    • Circulatory problems.
    • Skin diseases affecting the nails such as eczema, psoriasis and lichen planus.
    • Unknown.

      What you can do

    • You should consult a doctor.
    • Wear cotton lined rubber or vinyl gloves to protect the hands against water, detergents and soaps, and household cleansers.
    • Minimise the use of nail polish removers. Touch up chipped polish instead.
    • Moisturise the skin around the nails regularly.
    • Avoid the habit or pushing the cuticles back.
    • Keep the nails short in order to reduce trauma.

      Keypoint

    • Nail hardeners that are meant to strengthen nails may actually be harmful.

      What the doctor may do

    • Exclude skin diseases affecting the nail such as onychomycosis, eczema, psoriasis and lichen planus.
    • Treat underlying conditions.

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    BROMHIDROSIS

    Bromhidrosis is the medical term for body odour.

      Cause

    • Bacterial decomposition of sweat produced by the apocrine glands (the special sweat glands found in the armpits, nipple and pubic area).

      What you can do

    • You can consult a doctor for treatment.
    • Wear loose clothing and shave off the hair to facilitate sweat evaporation.
    • Omit foods that contain garlic, onion and asparagus which are excreted in sweat.
    • Bathe or shower regularly.
    • Change clothes frequently.
    • Use antiperspirants to reduce sweating.
    • Use deodorant soaps. These work by leaving traces of antibacterial chemicals such as triclosan and benzathonium chloride on the skin in order to inhibit the action of bacteria. Do not use ordinary soaps afterwards as these will wash the antibacterial chemicals away.
    • Use talc to absorb the sweat.
    • Avoid hot environments.
    • Limit physical activity, if possible.
       
      What the doctor may do
    • Counsel on the above measures.
    • Prescribe antibacterial soaps.

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    BRUISES

    A bruise is a blue-black discoloration caused by bleeding under the skin.

      Cause

    • Trauma.
    • Blood disorders.
    • Fragile blood vessels.
    • Septicaemia (blood poisoning).
    • Drugs that affect clotting such as aspirin, warfarin (blood thinning drugs).

      Symptoms

    • Initially blue-black then yellow.

      What you can do

    • You should consult a doctor if brusing is spontaneous or occurs after minor trauma.
    • Application of a cold compress or ice pack after injury will help to prevent a bad bruise from forming.
    • Vitamin C 500mg twice a day may help to build up collagen which strengthens the blood vessel walls.

      What the doctor may do

    • Determine the cause.
    • Perform blood tests to look for underlying blood abnormalities.

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    BURNS AND SCALDS

    Burns and scalds occur in different grades of severity depending on the cause and the duration of contact.

      Causes

    • Burns are caused by dry heat for example, fire, radiation (x-rays, sunlight), hot object and electricity.
    • Scalds are caused by wet heat for example, hot liquids, strong chemicals and steam.

      Symptoms

      This depends on the depth of injury:
       
    • First degree burns (superficial burns) affect the epidermis (top layer of the skin).
      • Redness but no blisters or swelling.
      • Pain.
      • The damaged skin peels off after 2 - 3 days without scars.
       
    • Second degree burns (partial thickness burns) affect part of the dermis.
      • Redness.
      • Blisters.
      • Swelling.
      • Severe pain.
      • May or may not heal with scars.
       
    • Third degree burns (deep burns) affect all layers of the skin.
      • Pale white or charred black areas.
      • Painless due to the destruction of the pain nerves.
      • Heal with scarring.
       
    • Fourth degree burns (very deep burns) that involve the muscle and bones. It occurs when the area is trapped in flame or in an electrical burn.
      • Deep black burn.
       
      Complications
    • Infection which if extensive, can spread through the bloodstream, causing septicaemia and death.
    • Scarring and contraction of the skin, restricting movement.
    • Shock due to loss of fluid from extensive burns and death.

      What you can do

    • You should consult a doctor.
    • Remove the cause immediately.
    • Immerse the area in cold or running water for 15 minutes or until the pain disappears.
    • Cover with a non-stick dressing.

      Go to the Accident and Emergency department if:

    • Face, hands, feet, joints and genitals are affected.
    • Second, third and fourth degree burns.
    • Extent of burn is greater than the size of your palm.
    • Shock develops.
    • Electrical, chemical and radiation burns.

      What the doctor may do

    • Prescribe antibiotics for secondary infection.
    • Hospitalise severe cases for treatment.

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