Kaposi's sarcoma | Kawasaki's disease | Keloids and hypertrophic scars | Keratoacanthoma | Keratolysis exfoliativa | Keratosis pilaris

Kaposi's sarcoma is a rare cancer arising from the lining cells of blood vessels. There are two main forms of the disease:

• Endemic Kaposi's sarcoma (endemic means that it is frequently observed in one geographic region) - this form has been observed in elderly Mediterranean and Eastern European Jews and is slowly growing with little tendency to spread to distant sites.
• Epidemic Kaposi's sarcoma (epidemic means occuring as a sudden outbreak) - this form has been observed in patients with AIDS (acquired immune deficiency) and those on immunosuppressive drugs. It is aggressive and spreads quickly to parts of the skin and to internal organs.

  Causes

• Immune deficiency.
• Virus infection.

  Symptoms

• Red to purple patches which later develop into nodules (swellings) and plaques (elevated patches).
• Usually occur on the feet and legs in the endemic form and in many places on the body in the epidemic form.
• They may cause itching, burning, tenderness or pain.
• The lymph glands draining the area may be enlarged.
• In long-standing cases the lymphatic drainage is impaired and there may be swelling, especially of the affected limb.
• Involvement of mucous membranes such as inside the mouth (where they appear as a bruise that does not seem to heal) and internal organs is common in the epidemic form.

  Kaposi's sarcoma. Click on image for larger view

  What you can do

• You should consult a doctor.

  What the doctor may do

• Confirm the diagnosis by taking a skin biopsy.
• The doctor may just monitor the situation if Kaposi's sarcoma is not causing symptoms or affecting vital organs.
• X-ray therapy and chemotherapy may be used in selected cases. Antiviral drugs used to treat HIV infection improves survival but does not have any effect on Kaposi's sarcoma.
• Kaposi's sarcoma on cosmetically obvious areas may be surgically removed or treated with vascular lasers and x-ray therapy to remove the AIDS stigma.

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Kawasaki's disease or mucocutaneous lymph node syndrome is an acute illness that usually affects young children.

Causes

• Kawasaki's disease is believed to be a form of vasculitis, probably triggered by an infection.

  Symptoms

• High spiking fever >39.4 o C lasting 5 or more days..
• Conjunctivitis (red eyes).
• Enlarged lymph glands.
• Red, dry, cracked lips.
• Strawberry tongue.
• Redness or swelling of the palms and feet.
• Measles-like rash on the body or around the anogenital (anal-genital) area.
• Generalised peeling or peeling of the tips of the fingers and toes after about 2 weeks.
• There might be a slight cough, joint pains and headache.

  Kawasaki's disease. Click on image for larger view

  Complications

• Heart involvement can cause sudden death.

  What you can do

• You should consult a doctor.

  What the doctor may do

• Confirm the diagnosis and perform an electrocardiogram (ECG) or echocardiogram of the heart to detect heart involvement.
• Treat with intravenous gamma globulin.

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Hypertrophic scars and keloids are lumpy scars.

Causes

• Excessive formation of scar tissue in response to tissue injury.

  
  Aggravating factors

• Tension in the injured area.
• Injury or inflammation (e.g. acne vulgaris) in areas such as the face, earlobes (from ear-piercing), shoulders, upper back and chest.
• Blacks and dark-skinned individuals.
• Irritation from in-grown hairs in the beard area (pseudofolliculitis barbae) or neck (folliculitis keloidalis). These conditions usually affect individuals with curly or stiff hairs, especially Blacks.
• Certain types of injuries such as burns, scalds and surgical wounds.
• Infected wounds.

  Symptoms

• Firm raised scars.
• Hypertrophic scars are confined to the area of initial skin injury but keloids extend beyond, often with claw-like extensions.
• Itching, pain or tenderness.

  Keloids. Click on image for larger view

  What you can do

• Leave the scars alone if they do not particularly bother you.
• Apply silicone gel sheets which may help to flatten some keloids.
• Consult a doctor.

  What the doctor may do

• Distinguish keloids from hypertrophic scars which do not usually require treatment since they usually heal after 6 - 24 months.
• Treat keloids with intralesional steroid injections, liquid nitrogen, x-ray therapy or mechanical pressure. Keloids are usually not excised because they usually recur larger. If excision is attempted, intralesional steroid injections are usually given to reduce the likelihood of recurrence but very often, this fails, as well.

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The keratoacanthoma is a rapidly enlarging growth, most commonly seen in the elderly. Despite the rapid growth, keratoacanthomas are benign (non-cancerous).

Cause
Keratoacanthomas arise from the cells of the hair follicle. The cause is uncertain but the following factors may play a role:


• Exposure to the sun - keratoacanthomas usually occur on sun-exposed skin.
• Immunosuppression - keratoacanthomas are more common in those taking immunosuppressive drugs.
• Exposure to tars.

  Symptoms

• Begins as a small dome-shaped bump which enlarges rapidly and developes a central depression filled with keratin. It resembles a small volcano because of the central crater and sloping sides.
• Usually occurs singly.
• Grows rapidly for 6 weeks, remains the same for 6 weeks and then regresses and heals over the next 6 weeks, leaving a pitted scar.

  Karetoacanthoma. Click on image for larger view

  What you can do

• You should consult a doctor as squamous cell cancer needs to be ruled out.

  What the doctor may do

• Confirm the diagnosis. A biopsy is usually performed to exclude squamous cell cancer.
• Treat with 5-fluorouracil, intralesional steroid injections, oral isotretinoin, (an oral retinoid), X-ray therapy, electrosurgery and curettage, liquid nitrogen or surgical excision.
• Do nothing and allow it to heal on its own. It may take 2 - 6 months to as long as a year.

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This is a common condition that causes the skin on the palms and sometimes the feet to peel.

Cause

• A superficial form of pompholyx.

  Symptoms

• The blisters are superficial, multiple and dry up easily such that all that can be seen are air-filled spaces. Patients usually complain of the skin peeling and often cannot resist the temptation to peel off the peeling skin.

  Keratolysis exfoliativa. Click on image for larger view

  Aggravating factors

• Contact with soaps and water.
• Hand or feet hyperhidrosis (sweaty palms and soles).

  What you can do

• Consult a doctor to confirm the diagnosis.
• Reduce contact with water and soaps.
• Apply handcreams regularly.

  What the doctor may do

• Confirm the diagnosis.
• Counsel you on how to care for the skin.

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Keratosis pilaris is a common disorder affecting the outer parts of the upper arms and occasionally, the back of the forearms and front of the legs. It usually appears during childhood and is most prominent during the teens. Keratosis pilaris improves with age. Lichen spinulosus is probably a variant of keratosis pilaris where the papules are more spiny.

Cause

• Obstruction of the hair follicles (skin pores) by keratin (horny) plugs.
• The tendency is often inherited and other family members are often affected.

   

  Aggravating factors

• Winters.
• Over-drying of the skin.

  Symptoms

• Horny plugs on the upper arms, thighs and buttocks. The affected area feels rough.
• Occasionally, a rare variety called keratosis pilaris atrophicans or ulerythema oophoryogenes affects the face causing worm-like areas of skin atrophy (thinning) or loss of the eyebrow hair.
• Ichthyosis and atopic dermatitis may be present.

  Lichen spinulosus, a form of keratosis pilaris. Click on image for larger view

  What you can do

• Do nothing if the condition does not bother you since it usually improves with age.
• Use abrasive scrubs or an abrasive polyester sponge to gently rub the skin.
• Moisturise the skin regularly, especially when abrasive treatment is used or when kin is dry or the humidity is low (eg., during winter).

  What the doctor may do

• Prescribe keratolytics (keratin softening agents).
• Prescribe topical tretinoin (vitamin A acid).

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