Polymorphic light eruption | Pompholyx | Porokeratosis | Porphyria cutanea tarda | Portwine stain | Pregnancy rashes | Prickly heat (go to milaria) | Prurigo nodularis | Pruritus | Pruritus ani | Pruritus vulvae | Pseudofolliculitis barbae (razor bumps) | Psoriasis | Purpura | Pyoderma gangrenosum | Pyogenic granuloma | Previous ....

Polymorphic light eruption (PMLE) is the most common type of true photosensitivity. It usually affects young and middle-aged women. PMLE is more common in temperate climates and usually occurs during spring. The skin hardens (becomes more resistant) as the summer approaches. It is less commonly seen in tropical countries which are sunny throughout the year, presumably because the skin has hardened.

Cause

• Sensitivity to ultraviolet B and occasionally ultraviolet A.
• An inherited form of PMLE has been observed in American Indians.

  Symptoms

• Pink or red papules (bumps ) on the arms, chest or legs. The face is usually spared.
• Sometimes PMLE is more severe and blisters may develop.

  What you can do

• You should consult a doctor.
• Reduce exposure to the sun (see sun protection).

  What the doctor may do

• Prescribe beta carotene, antimalarial drugs or oral steroids.
• Use PUVA to help the skin harden and become tolerant of the sun.

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Pompholyx or dyshidrotic eczema is a type of eczema characterised by small deep-seated blisters on the palms and/or soles.

Cause

• A type of endogenous eczema characterised by small vesicles (blisters).

  Predisposing factors

• Hyperhidrosis (sweaty palms or soles).
• Heat, whether due to the environment or the climate.
• Allergy to chromates and nickel in the diet.
• Stress.

  Symptoms

• Small deep-seated blisters looking like sago grains or frog spawn.
• Affects the sides of the fingers, palms and the soles.
• Itching and burning
• As blisters dry up, the skin becomes dry and cracked.

  Pompholyx. Click on image for larger view

  Complications

• Deep cracks may cause bleeding and pain.
• Secondary bacterial infection.

  What you can do

• You should consult a doctor.
• Soak in potassium permanganate solution for 15 minutes twice a day until the blisters dry up.
• Do not break blisters as this encourages bacterial infection.
• Take antihistamines to relieve itching.
• Adopt the same measures as for hand eczema.

  What the doctor may do

• Prescribe topical steroids and in severe cases, a short course of oral steroids.
• Exclude underlying tinea pedis which may produce an allergic reaction consisting of blisters on the hands.
• Perform patch tests to exclude allergy to nickel or chromate. Those found to be allergic may benefit from nickel- or chromate- free diets.

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Porokeratosis refers to a group of 3 rare skin disorders:

• Porokeratosis of Mibelli,
• Disseminated superficial actinic porokeratosis.
• Porokeratosis plantaris or palmaris.

  Cause

• 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 the defect and developing the disorder.

  Symptoms

• Porokeratosis of Mibelli.

   

  • Thinned depressed area with a raised slowly enlarging ridged border.
  • My occur singly or in groups over a segment of the skin.
  • Usually appears in early childhood and may enlarge to several centimeters in size.

   

• Disseminated superficial actinic porokeratosis

   

  • Affects the sun-exposed skin.
  • Multiple small, slightly depressed red or brownish spots with a ridged border.
  • Often itchy.
  • Affects young adults.

   

• Porokeratosis palmaris or plantaris

   

  • Similar to disseminated superficial actinic porokeratosis except that they are confined to the palms and soles.
  • Usually occurs in the teens.

  Complications

• Squamous cell cancer may occasionally develop in porokeratosis of Mibelli.

  What you can do

• You should consult the doctor.
• Disseminated superficial actinic porokeratosis is induced by sunlight. Therefore, use physical protection and sunscreens (see sun-protection).

  What the doctor may do

• Follow-up, especially in cases of porokeratosis of Mibelli.
• Treat with 5 fluorouracil cream.
• Small lesions may be removed surgically or destroyed with the carbon dioxide laser or with electrosurgery.

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Porphyria cutanea tarda is a rare photosensitive (light-sensitive) skin disorder.

Cause

• A defect in a liver enzyme (uroporphyrinogen decarboxylase) that is involved in the synthesis of the haem (red pigment in haemoglobin). This results in abnormal levels of porphyrins in the skin, making it sensitive to light.

  Aggravating factors

• Alcohol.
• Oral contraceptives.
• Excessive intake of iron.
• Exposure to polychlorinated hydrocarbons (found in some pesticides), chlorinated phenols , tetra-chlorodibenzo-p-dioxin.

  Symptoms

• Blisters on the back of the hands and the forearms.
• The blisters break to form small ulcers which heal with scarring and milia formation (milia are small whitehead-like cysts).
• Occasionally the skin may become brown and hardened (scleroderma-like) on the face, neck and "v" of the chest.
• There may be increased facial hair.

  What you can do

• You should consult the doctor.
• Protect the skin against the sun (see sun protection).
• Avoid alcohol, oral contraceptives and iron supplements.

  What the doctor may do

• Perform a skin biopsy.
• Examine the urine and stools for porphyrins. Urine containing porphyrins give a coral red fluorescence when illuminated with a Wood's lamp.
• Perform blood tests to check on the haemoglobin level, iron stores and liver enzymes.
• Perform phlebotomy (blood-letting) to remove haemoglobin.
• Prescribe anti-malarial medication to promote urinary excretion or porphyrins.

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The portwine stain or naevus flammeus is a vascular birthmark. It may be found on any part of the body, especially on one side of the face where it can be cosmetically, very distressing. Portwine stains are present at birth and persist for life.

Cause

• Abnormal development of the blood vessels in the skin.

  Symptoms

• Pink or purple patch that looks like the stain left by rich red port wine.
• Usually unilateral (one-sided).
• The colour may be become deeper purple when the child cries.

  Complications

• The portwine stain on one side of the face may occasionally be associated with with underlying malformation of the blood vessels inside the skull, epilepsy (fits) and glaucoma. This condition is known as Sturge-Weber syndrome.
• Portwine stains affecting the extremity may occasionally be associated with an overgrowth of the underlying bone and soft tissue (a condition known as Klippel-Trenaunay-Weber syndrome).

  What you can do

• Leave alone or use cosmetic camouflage.
• You should consult a doctor.

  What the doctor may do

• Treat with vascular lasers.

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Pre-existing skin conditions such as acne, eczema or psoriasis may sometimes get worse during pregnancy. However, there are other disorders that are specifically caused by pregnancy and are described below:

• Spangler's dermatitis (papular dermatitis of pregnancy).

   

  • Groups of red papules (bumps) with scratched-off crusted tops.
  • Fade after pregnancy.
  • Heal with a dark stain.
  • Associated with 30% risk of stillbirth or spontaneous abortion.
  • Treatment is with oral steroids.
  • May recur with subsequent pregnancies.

   

• Pruritic urticarial papules and plaques of pregnancy (PUPPP)

   

  • Red papules (bumps) plaques (elevated patches) that look like urticaria (hives).
  • They usually start on the abdomen, especially along the stretch marks and spread to the thighs, buttocks and arms.
  • They usually appear during the last 3 months of pregnancy.
  • Itch is very severe and often disturbs sleep.
  • Not associated with any adverse effects on the baby.
  • Clears with delivery of the child.
  • Usually affects first time pregnant women.
  • Usually does not recur with subsequent pregnancies. If it does, it is usually less severe.
  • Treatment is with oral antihistamines and topical steroids. Oral steroids may be used in severe cases.

  Pruritic urticarial papules and plaques of pregnancy (PUPPP). Click on image for larger view

• Immune progesterone dermatitis of pregnancy
  • Papules (pimply bumps) and pustules (pusheads) that resemble acne on the buttocks and limbs.
  • Occurs during the first trimester of pregnancy.
  • May recur with subsequent pregnancies.
  • Treatment is with oestrogens (one of the female hormones).

   

• Pruritus gravidarum
  • Itching during the third trimester which clears after birth.
  • Recurs with subsequent pregnancies.

   

• Melasma (mask of pregnancy).
• Striae distensae (stretch marks).

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This is a nodular form of lichen simplex chronicus. It may affect adults of any age but is more common in the elderly.

Cause

• The cause is unknown but it may have something to do with the sensory nerves in the skin which appear to be hypertrophied (enlarged) and possibly oversensitive.
• Patients with a personal or family history of atopic dermatitis, asthma and hay fever are more prone to develop prurigo nodularis.

  Symptoms

• Intensely itchy nodules (swellings) which cause the person to scratch and dig at their skin.
• The tops are often scratched off and topped by a crust or dried blood.
• Prurigo nodularis usually affects the neck and limbs.

  Prurigo nodules. Click on mage fo larger view

  Complications

• Secondary bacterial infection.

  What you can do

• You should consult a doctor.
• Avoid scratching or picking the nodules as this usually cause the nodules to enlarge.

  What the doctor may do

• Treat with topical steroids or intralesional steroids injections or liquid nitrogen.
• Prescribe antihistamines and occasionally, antidepressants.
• Treat with PUVA phototherapy.
• A gluten free diet may help to protect the intestine and improve the skin.

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Pruritus is the medical term for itching. Pruritus may be localised to one area such as the vagina (pruritus vulvae) or around the anus (pruritus ani) or it may be generalised (generalised pruritus).

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Pruritus ani is the medical term for itching around the anus.

Causes

• Faecal soiling due to haemorrhoids, fissures (tears) and fistulae (tunnels connecting the rectum to the outside skin).
• Skin problems affecting the area such as atopic dermatitis, seborrhoeic dermatitis, psoriasis, lichen sclerosus et atrophicus and fungal infection (see tinea).
• Irritation or allergy to antiseptics, scented toilet paper or medicines for haemorrhoids (piles).
• Threadworm infestation (in children).
• Diabetes.
• Diet of highly seasoned foods.
• Idiopathic (of unknown cause).

  What you can do

• You should consult a doctor.
• Observe careful anal hygiene; clean thoroughly after each bowel movement. Wash the area with water after bowel movement or wipe the area with cotton moistened with water.
• Avoid strong antiseptics.
• Wear loose fitting cotton underwear.
• Avoid highly seasoned foods.
• Avoid constipation.
• Take antihistamines to relieve itching. Resist scratching.

  What the doctor may do

• Diagnose the underlying cause and treat accordingly.
• Prescribe mild topical steroids.

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Pruritus vulvae is the medical term for itching of the vaginal area.

Causes

• Candidiasis.
• Allergy or irritation caused by contraceptives, deodorants and douches.
• Threadworms infestations (in young girls).
• Skin diseases affecting the area such as atopic dermatitis, psoriasis, lichen simplex chronicus, seborrhoeic dermatitis, fungal infection (see tinea) and lichen sclerosus et atrophicus.
• Menopause which causes a degenerative condition of the vagina known as senile or atrophic vaginitis.

  What you can do

• You should consult a doctor.
• Use warm water or very mild soap to clean.
• Keep the area cool, avoid nylon underwear.
• Take antihistamines to relieve itching. Try not to scratch.

  What the doctor may do

• Determine the cause and treat accordingly.
• Prescribe mild topical steroids.

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Pseudofolliculitis barbae or razor bumps is commonly seen in men with stiff or curly hairs, especially black men.

Causes

• Ingrown hairs due to stiff hairs piercing the follicular canal or due to curly hairs re-entering the skin and causing inflammation.

  
  Symptoms

• Papules (pimply bumps) and pustules around the hair follicles.
• May be itchy or painful.
• Usually affects the scalp, pubic and beard areas.
  
  Complications
• Scarring.

  
  What you can do

• You should consult a doctor.
• Switch to electric razors if you have pseudofolliculitis barbae or grow a beard.
  

  What the doctor may do

• Treat with oral or topical antibiotics.
• Prescribe mild steroid creams to reduce the inflammation.
• Remove the in-grown hairs.

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Psoriasis is a chronic skin disorder affecting about 1 - 2% of the population. It usually begins between the ages of 15 and 30 years and tends to run in families. Psoriasis runs a very protracted course with periods of exacerbations and remissions and there is no permanent cure. However, treatment is available to control the disease and permit a productive life.

Causes

• The cause is unknown but in psoriasis the skin cells are dividing faster than normal, resulting in a scaly thickening of the skin. Fifty per cent of those affected give a family history of psoriasis, suggesting that genetic factors may play a role. If one parent is affected, the offspring has a 1 in 4 chance of developing psoriasis.

  Precipitating factors

• Stress.
• Streptococcal sorethroat.
• Drugs such as beta blockers (used to treat high blood pressure), lithium (used to treat manic-depressive states) and antimalarial medicines.
• Alcohol.
• Stopping systemic steroids.

  Symptoms

• Well-defined pink patches with characteristic, silvery white scales.
• Affects any part of the body, especially on the elbows, knees, near the base of the spine and on the scalp.
• Usually symmetrically located, that is on more or less identical sites on each side of the body.
• Red glazed patches in the body fold areas such as the armpits and groins.
• Nail changes in the form of pitting, brown spots resembling oil stains on a paper bag, onycholysis and thickening or crumbling of the nail plate may be seen.
• Itching may or may not be present.
• Palmoplantar pustulosis - is a form of pustular psoriasis that affects the hands and feet. It may also cause the skin to crack and bleed.

  Psoriasis. Click on image for larger view

  Complications

• Psoriasis may spread to involve the whole body, causing an erythroderma. This type of psoriasis is called erythrodermic psoriasis.
• Psoriasis may become pustular (with pusheads) all over the body. This is called generalised pustular psoriasis. When this is accompanied by fever and malaise (feeling of illness), the term von Zumbusch's pustular psoriasis is used.
• Psoriatic arthritis occurs in 10% of cases.

  What you can do

• You should consult a doctor.
• Avoid scratching as psoriasis tends to develop at sites of skin injury.
• Apply moisturisers after baths to reduce flakiness and roughness.
• Avoid strong topical medicaments because they can make psoriasis worse and cause it to develop into an erythroderma or become pustular.
• Avoid obesity as this may cause psoriasis to develop in the body folds.
• Try to get some sunlight (not sunburn) on the skin as this helps to clear psoriasis.
• Confront and deal with stresses.
• Maintain a positive outlook on life.
• Maintain good physical health by avoiding drug abuse, alcohol and smoking.

  What the doctor may do

• Prescribe topical steroids, tar preparations, anthralin or dithranol (a tar derivative) and calcipotriol, a vitamin D-like compound.
• Prescribe oral methotrexate (an immunosuppressive drugs), acitretin (an oral retinoid) or cyclosporin (an immunosuppressive drugs used to prevent the rejection of transplanted organs) in resistant or extensive cases.
• Start phototherapy (light treatment) using tar and ultraviolet-B (Geokerman regimen) or anthralin and UVB (Ingram regime) or PUVA.

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Purpura is caused by the leakage of blood from the vessels into the skin.

Causes
Purpura is usually classified into two types:

• Thrombocytopaenic purpura caused by a deficiency in the number of platelets (a type of white blood cells that plug up any holes in blood vessels and stop bleeding). Causes include:

   

  • Autoimmune (self-allergy)
  • Drugs.
  • Infections, including dengue haemorrhagic fever.
  • Bone marrow abnormality.
  • Enlarged spleen.

  
  

• Non-thrombocytopaenic purpura in which the number of platelets are normal. This type of purpura may be due to:

   

  • Drugs.
  • Coagulation defects (deficiency of clotting factors in the blood)
  • Vasculitis.
  • Weakening of the blood vessel walls due to ageing and/or sun-damage (senile purpura) or overuse of topical and systemic steroids (steroid purpura).

  Symptoms

• Red or purplish haemorrhagic patches which do not disappear when pressed.

  Senile purpura. Click on image for larger view

  What you can do

• You should consult a doctor.

  What the doctor may do

• Determine the cause and treat accordingly.

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This is a rare ulcerative skin condition that may be associated with internal disorders.

Cause

• May be a hypersensitivity reaction to underlying disorders such as:-

   

  • Inflammatory bowel disease such as Crohn's disease and ulcerative colitis.
  • Rheumatoid arthritis.
  • Chronic active hepatitis.
  • Haematological abnormalities.

  
  Symptoms

• Begins as one or more red papules (bumps) or pustules (pusheads) that break down rapidly to form ulcers.
• The ulcers enlarge several centimeters a day and have a bluish or purple undermined edge.
• Pain is often severe.

  Pyoderma gangrenosum. Click on image for larger view

  Complications

• Very rarely, pyoderma gangrenosum runs a very aggressive course, affecting nerves and resulting in fatalities. This aggressive form is sometimes called malignant pyoderma gangrenosum.

  What you can do

• You should consult a doctor.
• Clean the ulcer gently and cover with a dressing.

  What the doctor may do

• Treat with topical, intralesional or oral steroids, sulphapyridine, methotrexate (an immunosuppressive drug), minocycline (an antibiotic), antileprosy drugs such as dapsone and clofamazine. Cyclosporin (an immunosuppressive drug) may also be used.
• Pyoderma gangrenosum is generally very difficult to treat. The underlying cause should be identified and treated.

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Pyogenic granulomas or proud flesh are rapidly developing vascular growths appearing at the sites of injury.

Cause

• Non-cancerous proliferation of the blood vessels in reaction to injury.

  Symptoms

• Occurs anywhere especially on the lips, gums, digits, face and scalp.
• Soft raspberry-like growth.
• Fragile, bleeds with minor trauma.

  Pyogenic granuloma Click on image for larger view

  What you can do

• You should consult a doctor.
• If bleeding occurs, apply pressure for 5 minutes.

  What the doctor may do

• Destroy with liquid nitrogen, electrosurgery, curettage, carbon dioxide laser or a vascular laser.
• Recurrence after treatment is common, requiring retreatment.

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