Cafe au lait patches | Candidiasis | Canities | Canker sores (go to aphthous ulcers) | Capillaritis (go to pigmented purpuric dermatosis) | Cat scratch fever | Cavernous haemangioma | Celluilte | Cellulitis and erysipelas | Chalazion | Chapped skin (go to xerosis) | Chemical peels (go to treatments, chemical peels) | Cherry angioma | Chickenpox (go to varicella) | Chilblains | Chloasma (go to melasma) | Cold sores (go to herpes simplex virus infection) | Comedones | Congenital naevi | Connective tissue naevi | Contact dermatitis | Corns and callosities | Cradle cap | Cutaneous larva migrans (go to larva migrans) | Cuts and grazes | Cysts

Cafe au lait, as the name suggests refers to white coffee-coloured patches.

Cause

• Unknown
• May be a sign of neurofibromatosis, an inherited disease affecting the nerve fibre sheaths.

  Symptoms

• Light coffee-coloured patches hence, the name cafe au lait which is French for white coffee.
• Six or more cafe au lait patches that are larger than 1.5cm in diameter may indicate neurofibromatosis (von Recklinghausen's disease). Other signs of neurofibromatosis include multiple soft swellings called neurofibromas anywhere on the body and sometimes in the central nervous system where it can cause visual problems, hearing problems and epilepsy (fits) and spinal deformities.

  Cafe au lait patches Click on image for larger view.

  What you can do

• You should consult a doctor, especially if there is a family history or there are signs of neurofibromatosis.
• Seek treatment from the doctor if the patches are cosmetically disturbing.

  What the doctor may do

• Exclude neurofibromatosis.
• Use one of the pigment lasers to remove the patch.

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Candidiasis, also known as moniliasis or thrush is an infection caused by a yeastlike fungus called Candida albicans.

Causes

• Candida albicans is a yeast that is often found in the normal vagina, mouth and intestines. It does not usually cause any symptoms until certain conditions favour its proliferation (see predisposing factors).

   

  Predisposing factors

• Frequent contact with water (see paronychia).
• Anaemia.
• Diabetes.
• Tight foreskins that are difficult to retract (pull back) to clean.
• Warm moist macerated body fold areas, especially in overweight persons.
• Napkin dermatitis.
• Hormonal change, for example, during pregnancy and while taking the birth control pill.
• Oral antibiotics which kill off the harmless bacteria that normally keeps Candida albicans in check.
• Elderly persons wearing poorly fitting dentures.
• Lowered resistance caused by anticancer drugs and immunosuppressive drugs including systemic steroids and AIDS (acquired immune deficiency syndrome).

Symptoms
The symptoms of candidiasis vary according to the sites affected:

• Skin folds (candidal intertrigo)
  • Well defined moist red patches in body fold areas such as the groins, buttocks, under the breasts, between the toes and in the armpits.
  • Small red papules (pimply bumps) or pustules (pusheads) may be seen outside the main area. These are called satellite papules.
  • Itching.

• Mouth (oral candidiasis)
  • Red moist patches patches covered by a white cheesy membrane (which can be scraped off, leaving a bleeding inflamed surface) inside the cheeks or on the tongue.
  • Pain and a burning sensation.

   

• Lips
  • Cracking at the corners of the lips (see angular cheilitis).

   

• Penis (candidal balanitis)
  • Red spots and white patches on the head of the penis and under the foreskin.
  • Discharge.
  • Itching.

   

• Vulva and vagina (vulvovaginal candidiasis)
  • Thick white or yellow vaginal discharge.
  • Itchy, sore, red, swelling of the labia (vaginal lips).
  • Soreness during intercourse.

   

• Nail folds (candidal paronychia)
  • Redness, swelling and tenderness of the nailfolds (see paronychia).

  What you can do

• You should consult a doctor.
• Loose weight if obese.
• Keep diabetes under control. Follow the diet regimen recommended by the doctor or dietitian and take the medications/injections regularly.
• If possible, try to correct the predisposing factors.

  What the doctor may do

• Confirm the diagnosis by examining skin scrapings under the microscope or by culture.
• Rule out underlying medical problem.
• Circumcise patients with recurrent balanitis who have tight foreskins.

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This is the medical term for greying of the hair.

Causes

• Natural ageing process.
• Premature ageing which is defined as ageing in the early 20s may be due to genetic factors or pernicious anaemia, a disease caused by the lack of intrinsic factor which is needed for the absorption of vitamin B12.
• Vitiligo may also affect the melanocytes in the base of the hair follicles and cause the hairs in that patch to become white.

  What you can do

• Nothing, live with it.
• See a hairdresser to get the hair dyed.
• Consult a doctor if greying is premature.

  What the doctor may do

• Rule out underlying causes in cases of premature greying.

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This is an illness that occurs after a scratch or bite from a cat.

Cause

• Bacterial infection transmitted by a cat bite or scratch. The cat itself is usually healthy. The infection is usually temporary.

  Symptoms

• Small red papule or blister at the site of injury.
• Swollen painful lymph glands near the site about 3 - 10 days after the bite or scratch.
• May be fever, rash, and headache.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Take a biopsy of the enlarged lymph gland.
• Perform a skin test with the cat-scratch antigen.

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The cavernous haemangioma is a deep haemangioma (vascular birthmark) that usually affects young children. It usually appears at birth and may occur anywhere on the body, especially on the head and neck.

Cause

• A type of vascular birthmark. Abnormally large and malformed blood vessels develop in the deep dermis and subcutaneous tissue.

  Symptoms

• Deep blue to purple (sometimes skin coloured) soft compressible growth.
• Unlike strawberry marks, cavernous haemangiomas do not usually disappear completely with age.

  Cavernous haemangioma. Click on image for larger view

  Complications

• Cosmetically disfiguring, especially when it occurs on the face.
• May obstruct vision if it occurs around the eyes.
• Ulceration and bleeding may follow trauma.
• Underlying tissue may overgrow resulting in enlargement of the affected limb. This is known as Klippel-Trenaunay-Weber syndrome.
• Sometimes platelets (special white blood cells that help clotting) get caught and destroyed in the haemangioma resulting in thrombocytopaenia purpura. This is known as Kasabach-Merritt syndrome).

  What you can do

• You should consult a doctor.

  What the doctor may do

• Prescribe systemic or inject intralesional steroids to shrink the haemangioma.
• Destroy the abnormal blood vessels using electrosurgery or vascular lasers.

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Cellulite refers to the uneven dimpled skin that results from lumpy deposits of fat in the skin. It usually occurs on the hips, buttocks and thighs of women.

Cause

• Cellulite is common in women because their fat is separated into vertical compartments by fibrous bands running from the skin to the muscle fascia (layer) beneath. It is believed that poor blood circulation causes these fat compartments to swell while the fibrous bands pull the skin down. This causes the skin to develop mattress-like protrusions and dimples, respectively.

  Symptoms

• Lumpy fat deposits in areas such as the buttocks, hips and thighs.
• The skin usually shows a dimpled, orange-peel appearance.

  What you can do

• Nothing, live with it.
• Cellulite become more obvious with obesity. Regular exercise and weight reduction is helpful.
• If the above doesn't work which is not uncommon, consider seeing a doctor for liposuction (fat suction).

  What the doctor may do

• Refer to a dietitian.
• Perform liposuction. However, it must be emphasized that recurrence is very common unless you exercise regularly and avoid putting on weight.

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Cellulitis and erysipelas (St Anthony's fire) are acute bacterial infections of the skin.

Causes

• Cellulitis is usually caused by the streptococcal bacteria, staphylococcal bacteria or both.
• Erysipelas is caused by streptococcal bacteria.
• The bacteria usually enter through a small break in the skin.

   

  Predisposing factors

• Diabetes.
• Intravenous drug abuse.
• Poor immunity.

   

  Symptoms

• Cellulitis:
  • Red, hot, swollen, tender area sometimes associated with lymphangitis (red lines spreading upwards).
  • The margins are not well-defined.
  • Fever and chills.
  • Enlarged tender lymph glands draining the region.

• Erysipelas:
  • Red, hot, swollen, tender patch with a raised sharply defined edge.
  • Fever may be high and associated with chills.
  • There may be malaise (feeling of illness), headache and vomiting.
  • Enlarged tender lymph glands draining the region.

  Complications

• Certain strains of the streptococcal bacteria can cause glomerulonephritis (kidney inflammation).

  Key point

• Rapidly progressive cases with necrosis (dead skin) need to be differentiated from ecthyma gangrenosum (caused by the pseudomonas bacteria) and necrotising fasciitis caused by a particularly virulent form of the streptococcal bacteria dubbed the "flesh-eating bacteria").

  What you can do

• You should consult a doctor.
• Apply a warm compress to the area two or three times a day.

  What the doctor may do

• Take a culture to choose the best antibiotic to use.
• Treat with antibiotics.
• Hospitalise severe cases for management.

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This is a relatively cyst affecting the eyelid.

Cause

• Obstruction of one of the meibomian glands in the eyelids.

  Symptom

• Round cyst on the eyelid.
• If infected, the swelling becomes painful and red.

  What you can do

• You should consult a doctor.
• Apply warm compress for 20 minutes if the swelling is inflamed.

  What the doctor may do

• Prescribe antibiotic drops/ointment.
• Cut and drain large chalazions.

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Cherry angiomas, senile angiomas or Campbell de Morgan spots are bright red dome-shaped bumps on the trunk and upper parts of the limbs. They usually appear during middle age and increase in number with age.

Cause

• Enlarged small capillaries in the skin due to ageing.

  Symptoms

• Bright red dome-shaped bumps.

  Cherry angiomas. Click on image for larger view

  Complications

• Minor - may bleed a little if traumatised.

  What you can do

• You can consult a dotor.
• Avoid scratching them.
• Decide not to have any treatment as cherry angiomas are cosmetic.

  What the doctor may do

• Destroy with electrosurgery, the carbon dioxide laser or one of vascular lasers.

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Chilblains (also called perniosis) is an abnormal response to moderately cold temperatures. It is more common in temperate climates and usually affects the extremities, including the earlobes and nose. Children, especially young girls are more likely to be affected. Chilblains is self-limiting and usually resolves within 1 or 2 weeks.

Cause

• The body normally reacts to cold by cutting down the blood flow to the skin. In chilblains, this reaction is exaggerated such that certain parts of the skin are so deprived of blood that they become red and swollen.

  Predisposing factors

• Family tendency.
• Poor circulation due to diabetes, smoking or atherosclerosis..
• Poor nutrition.
• Collagen vascular diseases such as systemic lupus erythematosus

  Symptoms

• Itchy, red or purple swellings. In severe cases, there may be blistering and ulceration.
• Usually affects the legs and ends of the body such as the digits, heels, nose and ears.
• Itching, burning or pain.

  What you can do

• You should consult a doctor.
• Prevention is very important as treatment is not very effective once chilblains has developed.

  Prevention

• Avoid cold environments. Move to a warm climate.
• Keep the whole body, especially the fingers and toes warm by wearing gloves and stockings. Avoid wearing open-ended sandals when the weather is cold.
• Avoid wearing tight-fitting shoes.
• Exercise regularly.
• Stop smoking.

  What the doctor may do

• Exclude underlying circulatory disorder and diabetes.
• Prescribe topical steroids.
• Prescribe oral nifedipine to dilate the constricted blood vessels.

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Comedones are the blackheads and whiteheads that occur in acne vulgaris (pimples). They usually occur on the face, chest and back. Senile comedones are those that occur on the sun-damaged skin of the elderly.

Causes

• Acne vulgaris.
• Sun-damage (solar or senile comedones).

  Symptoms

• Open comedones - whiteheads.
• Closed comedones - blackheads.
• Solar or senile comedones usually occur on leathery, yellow sun-damaged skin of elderly individuals. This condition is called Favre Racouchot syndrome.

  Closed comedones (whiteheads) due to acne vulgaris. Click on image for larger view

  Complications

• Acne associated comedones may rupture and develop inflamed papules (inflamed pimply bumps), pustules (pusheads), nodules and cysts.

  What you can do

• Apply topical anti-acne products containing benzoyl peroxide, sulphur or salicylic acid which help to peel the skin.
• Do not squeeze comedones as this may cause them to rupture, increasing the risk of inflammation and scarring.
• Avoid using moisturisers routinely. If you must, use only water-based moisturisers.
• Consult a doctor if there is no improvement.
• Protect the skin against the sun to reduce the risk of senile comedones developing.

  What the doctor may do

• Prescribe topical tretinoin (vitamin A acid).
• Use a comedo extractor to extract comedones under sterile conditions.
• Perform superficial chemical peels.

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Congenital naevi (plural for naevus) or congenital moles are pigmented birthmarks that appear at or within a year of birth. They vary in size but are generally larger than ordinary moles. Congenital naevi may occur anywhere on the body and may have a hairy surface.

Cause

• A pigmented birthmark.

  Symptoms
  Congenital naevi are usually divided into 3 types:-
  

• Small congenital naevi - diameter less than 1.5cm.
• Intermediate congenital naevi - diameter of 1.5cm to 19.9cm.
• Giant congenital naevi - size greater than 20cm. Giant congenital naevi may cover large areas like a garment and are also termed bathing trunk naevi, coat-sleeved naevi and stocking-type naevi according to their location.

  Complications

• There is an increased risk of developing malignant melanoma compared with normal moles. The lifetime risk of developing malignant melanoma is 4% for giant congenital naevi. The risk for the smaller varieties is unknown but higher than for ordinary moles.

  What you can do

• You should consult a doctor to have congenital naevi removed because of the melanoma risk.

  What the doctor may do

• Excise congenital naevi in order to eliminate any risk of melanoma developing.

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These are rare developmental abnormalities involving the connective tissues.

Cause

• Developmental abnormality involving the connective tissue.

  Symptoms

• Elastoma - a plaque (raised patch) comprised of smooth skin-coloured papules (pimply bumps). Usually occurs on the trunk.
• Collagenoma - yellowish raised patch on the upper trunk or limbs. Usually appears at or soon after birth.
• Shagreen patch - a yellowish thickening of the skin. Usually occurs on the lower back. May be associated with tuberous sclerosis, an autosomally inherited disorder causing an acne like eruption on the face (adenoma sebaceum), epilepsy, mental retardation (in some patients) and subungual fibromas (overgrowths of fibrous tissue on the sides of the nails).
• Buschke-Ollendorf syndrome - multiple yellow-orange papules (pimply bumps), nodules or plaques (raised patch) on the thighs, buttocks and abdomen. Occurs in early adult life. Inherited by autosomal dominant transmission which means only one parent need to be affected and the offsprings have a 1 in 2 chance of inheriting and developing the disorder.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Perform a skin biopsy to confirm the diagnosis.
• No treatment is needed.
• Excise or treat with the carbon dioxide laser or electrosurgery.

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Contact dermatitis is an eczema or dermatitis caused by contact with a substance. It appears at the site of contact initially but may later spread to other parts of the body.

Causes

• Allergic contact dermatitis where the dermatitis is caused by an reaction between the body's immune system and the allergy causing substance (known as the allergen). It takes 1 week to years for the body's immune system to react and during this time (known as sensitisation), the skin can appear completely normal. It is only on re-exposure that the dermatitis develops. This is why a person may become allergic to a substance he has used for years without problems. Common causes of allergic contact dermatitis include:

   

  • Metals
    • Nickel - Allergy to nickel is more common in women. Common sources of nickel include costume jewelry, zips, jeans studs, metal spectacle frames, and metal fasteners on brassieres, watch straps, belts. 12 carat gold and silver are generally safe but 9 carat gold or white gold contain nickel. Nickel allergy affects 5% of women.

     

    • Chromates - A common cause of contact dermatitis in men. It is found in cement, tanned leather, photographic dyes, primer paint and anti-corrosives.

     

  • Rubber additives - Found in tyres, footwear, belts, condoms and gloves.
    • Mercaptobenzothiazole
    • Thiuram
    • Paratertiarybutylphenol

     

  • Resins, plastics and adhesives
    • Colophony - Plasters, adhesive tapes, glue, varnish and polish.
    • Epoxy resins - Usually causes occupational dermatitis.
    • Formalin resins - Used for water-proofing fabrics.

     

  • Cosmetics
    • Fragrance - These include cinnamic alcohol, cinnamic aldehyde, musk ambrette, isoeugenol, geraniol, oil of Bergamot, and many more. Fragrances are found in many products including soap, deodorants, cosmetics, creams and perfumes.
    • Lanolin (wool fat) - A type of fat derived from sheep oil glands. It is often used in cosmetics and creams.
    • Preservatives - These include chemicals such as parabens, quarternium 15, diazolidinyl urea and imidazolidynyl urea that are added to prevent the product from going bad. They are often used in cosmetics, creams and shampoos.
    • Toluenesulfonamide formaldehyde resin - Found in nail polish and causes rashes when it comes into contact with the eyelids and neck before it has dried.

     

  • Dyes in clothings.
    • Paraphenylenediamine (PPD) - Blue, black dyes. PPD is alos used in black hair dye.
    • Paratoluenediamine - Red dyes.
    • Azo dyes - Orange, yellow and red dyes.

     

  • Medicaments
    • Neomycin - Found in some antibiotic medication.
    • Acriflavine - Used in antiseptic lotions.
    • 'Caine' local anaesthetics - Used in some anti-itch products and haemorrhoids medication.
    • Diphenhydramine - Used in anti-itch products.

     

  • Plants or of plant source
    • Chrsanthemums - May cause a photoallergic contact dermatitis.
    • Poison Ivy , cashews, pistachios, mangoes.
    • Chinese and Japanese lacquer; oak, rosewood, primula.
    • Tulip bulbs, garlic.

     

  • Industrial chemicals - A multitude of industrials, too many to be listed, may cause contact dermatitis (see occupational dermatitis).

   

• Irritant contact dermatitis which is due to the direct effects of the substance on the skin without involving the immune system. Strong irritants such as acids and alkalis can cause dermatitis after a short exposure whereas weak irritants such as water, detergents, solvents, abrasive dusts and coolants do so after repeated exposure over a longer period. The latter variety is known as cumulative insult dermatitis. Examples of cummulative insult dermatitis include "housewife's dermatitis" and "bartender's hands".
  
  
• Photocontact dermatitis which is contact dermatitis that occurs only in the presence of light. There are two types:

   

  • Photoallergic contact dermatitis is a type of allergic contact dermatitis that takes place only in the presence of light. The causes include musk ambrette in male aftershave lotions and sunscreen chemicals such as PABA or its esters and topical sulphonamides.

   

  • Phototoxic contact dermatitis which occurs in the presence of light but does not involve an allergic reaction. may be caused by certain perfumes, tar products, plant psoralens (psoralens are light sensitising chemicals).

   

  Symptoms

  Contact dermatitis begins at the site of contact but may spread to distant sites if there is continued contact.

   

• Acute eczema - blisters, swelling and weeping.
• Chronic eczema - dry, red, scaly thickened areas.
• Itching.

  Allergic contact dermatitis. Click on image for larger view

  Complications

• Secondary bacterial infection.

  What you can do

• You should consult a doctor.
• Avoid scratching.
• Take antihistamines.

  What the doctor may do

• Determine the cause using the history, appearance and with the aid of allergy tests (patch tests).
• Prescribe topical and in severe cases, even systemic steroids.
• Prescribe antibiotics if there is a bacterial infection.
• If you are allergic to nickel, the doctor may give you a nickel testing (dimethylglyoxamine) solution for detecting the persence of nickel in metal objects. Dampen a tissue with the solution and rub the object with it. A pink colour on the tissue indicates the presence of nickel.

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Corns and callosities are common thickenings of the skin seen most commonly on the feet. Callosities may also develop on the hands of people who constantly handle heavy tools.

Causes

• Repeated friction and/or pressure causes the skin to thicken and harden.

  Symptoms
  

• Calluses
  • Thickening of the skin.
  • Cracking of the skin and sometimes pain.

• Corns
  • Thickened skin with a central whitish core.
  • Pain due to the hard, central core pressing on the nerve endings in the feet when walking.
  • Soft corns - a soft whittish variety of corn occuring between the toes.

  What you can do

• Eliminate friction and pressure.
• Use products containing salicylic acid (corn pads, paints and lotions) to soften the thickened skin. Do not use these if you have diabetes or circulatory problems.
• Regularly rub away the thickened skin with a pumice stone or file. (See a doctor if you have diabetes or circulatory problems because of the risk of delayed healing and infection should you accidentally injure the skin).
• Use protective felt pads to relieve the pressure on the thickened skin and reduce pain.
• Use small gauze pads to separate the toes in the case of soft corns.

  Prevention

• Wear protective gloves when handling heavy tools.
• Take a rest between heavy jobs.
• Wear proper fitting shoes that are sufficiently wide at the front.
• Avoid high heels as they increase the pressure on the forefeet and toes during walking.

  What the doctor may do

• Exclude warts.
• Relieve pain by removing the thickened skin of a callus or the core of a corn.
• Inject intralesional steroids into the centre of a corn.
• Inject implant material such as collagen or silicone under the corn or callus to act as a cushion.
• Correct arthritic joints/deviated toes or surgically remove bony prominences that are pressing on the thickened skin.

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This is a common self-limiting condition causing greasy crusts on the scalps of babies.

Cause

• It is a form of seborrhoeic dermatitis in infants. Inadequate cleansing out of fear of injuring the soft spot is contributory cause as it leads to an accumulation of grease and scales.

  Symptoms

• Thick, yellow, greasy scales over the scalp, especially on the soft spot.
• There may be evidence of seborrhoeic dermatitison the face, neck, behind the ears and the napkin area.
  

  What you can do

• Soften the scales with baby oil/olive oil overnight and brush the scales off with a soft toothbrush.
• Keep the area clean by shampooing regularly.
• Consult a doctor if the condition gets worse.

  What the doctor may do

• Prescribe a mild topical steroid.

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The skin has a unique ability to prevent infection after minor injuries. Bleeding occurs which help to wash away germs, then blood clots form a hard scab, under which new skin grows to eventually close the wound.

Cause

• Cuts are caused by sharp objects.
• Grazes are caused by rough surfaces rubbing against the skin.

  Symptoms

• Slight bleeding.
• Pain.

  Complications

• Secondary bacterial infection.
• Severe bleeding if the larger blood vessels are cut.
• Scars and keloids.

  What you can do

• Rinse under running water or clean with a liquid antiseptic.
• Apply an antiseptic cream.
• Stop bleeding by pressing with a cotton pad for about 5 minutes.
• Consulat a doctor if bleeding continues, if there is a large gaping wound that needs stitching or if there is an infection.

  What the doctor may do

• Stop the bleeding.
• Stitch open wounds.
• Prescribe antibiotics for infection.
• Give antitetanus toxoid injections.

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A cyst is a sac containing fluid or semi-solid material. The common cysts of the skin are:

• Milia
• Sebaceous cysts (also called epidermal or epidermoid cysts and wens).
• Pilar cysts.

  Cause

• Damage or blockage of the hair follicle.
• inheritance may play a role in pilar cysts as they tend to run in families.

  Symptoms

• Milia
  • Pin-head size white cysts resembling whiteheads.
  • They occur most frequently on the eyelids, cheeks and forehead of infants and middle-aged women and at sites of trauma.

   

• Sebaceous cysts
  • Skin coloured swellings, sometimes with an opening through which a smelly creamy paste may be expressed.
  • They occur most commonly on the face, ear, scalp, neck, back, upper trunk and scrotum.

• Pilar cysts
  • Similar to sebaceous cysts except more commonly found on the scalp and may run in families. If pierced, a gelatin-like secretion which is non-smelly may be expressed.

  Complication

• Cysts may become infected and painful.

  What you can do

• Milia in children can be left to resolve spontaneously.
• Consult a doctor if you wish milia or cysts removed
  
  What the doctor may do
• Extract milia by nicking the surface with a scalpel blade and extracting the contents with a comedo (blackhead) extractor.
• Destroy milia with electrosurgery.
• Excise sebaceous cysts and pilar cysts. The sac or cyst wall must be removed or the cyst may recur.
• Treat infected sebaceous cysts with antibiotics together with drainage, if necessary.

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