S
Salmon
patches | Scabies | Scars (go to keloids)
| Scleroderma | Sebaceous
hyperplasia | Sebaceous naevus (go to naevus
sebaceum) | Seborrhoea | Seborrhoeic
dermatitis or seborrhoeic eczema | Seborrhoeic
keratoses | Senile lentigines (go to actinic
lentigines) | Shingles (go to herpes
zoster) | Skin cancers | Solar elastosis | Solar keratoses
(go to actinic keratoses)
| Squamous cell cancer |
Steatocystoma multiplex
| Strawberry haemangioma
| Stretch marks (go to striae distensae)
| Striae distensae | Sunburn
| Sweet's disease | Sweaty palms/soles
(go to hyperhidrosis) | Syringomas
SALMON
PATCHES
Salmon patches or stork
marks are common vascular birthmarks found in about a third of
babies at birth.
Cause
- Abnormal development
of the blood vessels in the skin.
Symptoms
- Pink patches usually
on the eyelids, between the eyebrows or on the back of the neck.
What you can do
- Nothing - storkmarks
on the eyelids usually disappear by 1 year of age. Those on the
neck persist but are easily hidden by the hair.
What the doctor
may do
- Reassure you.
- Treat persistent storkmarks
with one of the vascular
lasers.
TOP
SCABIES
Scabies is a contagious
skin infestation caused by the scabies mite. Infestation begins
when a fertile female mite burrows under the stratum corneum
(the dead layer of the skin) and lays eggs which hatch after
about 2 weeks. Itching develops about 4 - 6 weeks after infestation
because it takes this time for the body to become allergic to
the mite's proteins.
Cause
- Human scabies mite,
Sarcoptes scabiei. Scabies is transmitted by skin-to-skin
contact such as during sexual intercourse and among members in
the household. The scabies mite can survive for 2 days on clothing
or bedding so indirect transmission may also occur.
Symptoms
- Burrows (greyish snail
track marks) in the finger webs and on the front of the wrists.
- Red papules (bumps)
or blisters around the armpits, along the waistline, inner thighs,
the genital area and the buttocks. The face and scalp may be
affected in children.
- Severe itching which
is characteristically worse at night. In the early stages, itch
may be the only symptom (see generalised
pruritus).
- Excoriations from
scratching.
- Norwegian crusted
scabies is
a more extensive variety which usually affects geriatric patients,
inmates of mental institutions and people on immunosuppressive
drugs (drugs which suppress the immune or defence system).
It causes thick crusts and can look rather like psoriasis.
In some patients it causes an erythroderma
(generalised redness and scaling).
Complications
- Secondary bacterial
infection.
- Post-scabetic itch
which may persist for several weeks despite eradication of the
mites. It represents a residual allergic reaction.
- Scabetic nodules (firm
red itchy swellings) which may persist for weeks following treatment.
These usually occur on the armpits, penis, scrotum, buttocks
and sides of the feet (in infants).
What you can do
- You should consult
a doctor.
- Take antihistamine
and apply calamine lotion to relieve itching.
- Make sure all household
members are treated. Remember that infested persons may not show
any signs until 6 weeks later. They need treatment as well, otherwise
infection will spread back to those already treated.
What the doctor
may do
- Confirm the diagnosis
by microscopic examination of skin scrapings for the presence
of mites or their eggs.
- Prescribe anti-scabies
applications such as benzyl benzoate (Caution: May be very irritating
to children), malathion, permethrin, crotamiton and gamma benzene
hexachloride. Family members and sexual contacts must be treated
to prevent reinfestation.
- Prescribe antibiotics
for secondary bacterial infection.
- Treat scabetic nodules
(the itchy firm reddish-brown swellings that persist after treatment)
with intralesional
steroids.
TOP
SCLERODERMA
Scleroderma is a skin
disorder that affects the connective tissue. It affects women
more commonly and may be divided into two types:
- Morphoea or localised
scleroderma
which affects connective tissue in the skin alone.
- Systemic scleroderma
or systemic sclerosis
which affects the connective tissue anywhere, especially in the
lungs, heart, gastrointestinal tract, joints or kidneys as well
as the skin.
Cause
- An autoimmune disease
(self-allergy) in which the immune system attacks the connective
tissue as though it is foreign.
- Rarely, localised
scleroderma have been caused by a bacteria known as Borrelia
burgdorferi.
- Scleroderma-like changes
may also occur porphyria cutanea
tarda.
Symptoms
- Morphoea (localised
scleroderma)
-
- Smooth waxy looking
stiff scar-like patch on the trunk, limbs, face and scalp (where
it may cause scarring hairloss). The border may be red initially
but this fades gradually to leave an ivory white patch which
may turn a brownish with time.
- Linear morphoea
or linear scleroderma
is a type of morphoea which occurs in a line along one limb.
This type usually affects children.
- Coup de sabre is a type of linear scleroderma
that occurs on the scalp and temple. It has the appearance of
a sabre cut, hence its name.
- Pansclerotic morphoea is another type that affects
underlying tissues such as muscles and bones. This type usually
affects children.
- Atrophoderma of
Pierini and Pasini
may be another variant in which there is loss of the underlying
subcutaneous tissue such that the skin appears depressed.
- Systemic scleroderma
(systemic sclerosis)
-
- Tight shiny stiff
skin on the hands causing tapering of the fingers and restriction
of hand movements.
- Smooth shiny stiff
skin on the face results in a mask-like face with a fixed stare,
pinched nose, small pursed mouth and reduced expression lines.
Telangiectasias (broken
capillaries) may be seen near the nail folds. Mat-like telangiectasias
may be seen on the face, lips, neck and upper trunk.
- Raynaud's
phenomenon
in which the digits become white (spasm of arteries) in the cold.
As blood flow resumes, the skin becomes blue and on rewarming,
it becomes red. There is often a tingling sensation, numbness
or burning during the attack.
- Symptoms related to
the involvement of other organs such as heart, lungs, gastrointestinal
tract (causing difficulty swallowing), arteries, joints and kidneys.
|
Systemic scleroderma.
Click
on image for larger view |
- Complications
- Scleroderma affecting
the scalp may cause scarring alopecia
(permanent hairloss).
- Deep forms of scleroderma,
especially pansclerotic sceroderma can affect muscles (causing
contractures) and bones (causing deformities).
- Calcium deposits may
form on skin affected by scleroderma and these sometimes ulcerate
through the skin.
- Systemic sclerosis
may cause death if vital organs such as the heart, lungs and
kidneys are involved.
- Severe Raynaud's phenomenon
may result in the finger tips becoming gangrenous.
What you can do
- You should consult
a doctor.
- Raynaud's phenomenon
can be reduced by avoiding exposure to the cold.
- Perform physiotherapy
and exercises to keep the joints mobile.
- Quit smoking.
What the doctor
may do
- Take a skin
biopsy to confirm the diagnosis.
- Conduct tests to determine
the extent of involvement in systemic scleroderma.
- Morphoea does not
usually require treatment. Topical steroids,
topical calcipotriol, intralesional
steroids injections or oral steroids
may be used if morphoea is spreading.
- Treat cases of systemic
scleroderma with D-penicillamine, diphenylhydantoin, cyclosporin
or methotrexate (both are immunosuppressive
drugs).
- Treat Raynaud's phenomenon
with vasodilators such as nifedipine and pentoxyfylline.
- Treat the complications
when they occur.
TOP
SEBACEOUS HYPERPLASIA
Sebaceous hyperplasia
usually affects the face of middle-aged and elderly adults, especially
men with oily skin.
Cause
- Enlarged sebaceous
glands due to ageing.
Symptoms
- Small yellowish lobe-surface
growths on the face, particularly the forehead and cheeks. A
small pore representing the hair follicle may be seen in the
centre.
- The skin is often
oily.
- On the nose, sebaceous
hyperplasia may cause an enlargement of the nose known as rhinophyma. This consition is usually
seen in patients with acne rosacea.
|
Sebaceous hyperplasia.
Click
on image for larger view |
What you can
do
- Nothing.
- Consult a doctor if
you wish them removed for cosmetic reasons.
What the doctor
may do
- Destroy the enlarged
oil glands with electrosurgery
or carbon dioxide laser.
- The doctor may prescribe
anti-androgens in women. They cannot be used in men because of
the the risk of feminisation.
- Prescribe oral isotretinoin (a vitamin
A derivative also used to treat severe acne) is sometimes used
to reduce their size.
TOP
SEBORRHOEA
- Seborrhoea or oily
skin is a common problem which usually appears after puberty
when there is increased production of androgens (male hormones).
Cause
- Overactive sebaceous
glands due to stimulation by androgens (male hormones).
Symptoms
- Oily face.
- Greasy scalp.
What you can do
- Frequent washing of
the face.
- Use acne soaps or
soaps for oily skin.
- Use drying gels and
lotions.
- Avoid oil-based cosmetics
and moisturisers.
- You can consult a
doctor.
What the doctor
may do
- Hormone pills may
be used in women to block the effects of androgens. They cannot
be used in men because of the the risk of feminisation.
- Oral isotretinoin
(a vitamin A derivative also used to treat severe acne) is sometimes
used in severe or distressing cases of seborrhoea.
TOP
SEBORRHOEIC DERMATITIS OR SEBORRHOEIC
ECZEMA
Seborrhoeic dermatitis
is a common condition. In its mildest form, seborrhoeic dermatitis
causes dandruff. If more severe, the face, chest, back
and body folds may be affected. Seborrhoeic dermatitis usually
occurs during the neonatal period and after puberty. Cradle
cap is believed to be a form of seborrhoeic dermatitis affecting
the scalp of newborns.
Causes
- The exact cause is
unknown but there is recent evidence to suggest that an overgrowth
of a normal skin yeast known as Pityrosporon orbiculare
may be partly responsible.
-
- Aggravating factors
- Patients with Parkinson's
disease (a neurological disease) are more commonly affected.
- HIV (human immunodeficiency
virus) infected patients have more severe seborrhoeic dermatitis.
Symptoms
- Common dandruff.
- Cradle
cap in newborn
babies.
- Greasy yellow-red
scaling of the scalp, eyebrows, nasolabial folds, sideburns,
behind the ears, upper central chest and the back. Sometimes
seborrhoeic dermatitis affects the ear canals and is one of the
causes of otitis externa.
- Redness, scaling and
weeping in the body folds, eg., in the groins, armpits and under
the breasts.
- Itching may be mild
or absent.
|
Seborrhoeic dermatitis.
Click
on image for larger view |
Complications
- May very rarely spread
to become an erythroderma.
- Secondary bacterial
infection, especially in the scalp.
- Secondary infection
by Candida albicans,
especially in the body folds.
What you can do
- You should consult
a doctor.
- Use antidandruff shampoos
(active ingredients include zinc pyrithione, selenium sulphide,
salicylic acid, sulphur, ketoconazole and coal tar) regularly.
- Cleanse the other
affected areas of skin regularly.
- Mild sunlight may
help to clear the problem, especially in temperate countries.
- Take antihistamines
to relieve itching.
What the doctor
may do
- Confirm the diagnosis.
- Prescribe topical
steroids or tar
preparations or in severe and extensive cases, oral ketoconazole
or itraconazole.
TOP
SEBORRHOEIC KERATOSES
Seborrhoeic keratoses
or age warts are non-cancerous pigmented growths on the skin
of middle aged and elderly individuals. Dermatosis
papulosa nigra is believed to be a type of seborrhoeic keratosis.
Causes
- Unknown, probably
a manifestation of ageing.
- Inheritance. Multiple
seborrhoeic keratoses may sometimes run in families.
Symptoms
- Raised, warty, flattened
yellowish, brown or black greasy growths that look as though
they have been stuck on the skin.
- They occur most commonly
on the trunk, face and under the breasts and increase in numbers
with age.
|
Seborrhoeic keratoses.
Click
on image for larger view |
- Complications
- Seborrhoeic keratoses
may become inflamed, causing itching and soreness.
What you can do
- You should consult
a doctor, especially if multiple seborrhoeic keratoses appear
very suddenly because this may be a sign of internal malignancy.
Doctor's call this the Lesser Trelat sign.
What the doctor
may do
- Confirm the diagnosis
by physical examination or skin
biopsy.
- Remove with liquid
nitrogen, curettage,
electrosurgery,
carbon dioxide laser
or by shave excision.
TOP
SKIN
CANCERS
Skin cancers are predominantly
caused by chronic sun exposure. Although more common in late
adult life, an earlier onset has been observed in individuals
who suffered sunburns during the teens and early adult life.
Fair-skinned individuals, especially those of Celtic origin are
more susceptible. There are 3 main types of skin cancers which
are described separately:
- TOP
SOLAR
ELASTOSIS
Solar elastosis is
a degenerative condition of the skin caused by over-exposure
to the sun. It occurs in people heavily exposed to the sun, particularly
those who work outdoors such as farmers. Fair-skinned individuals
and persons of Celtic origin are more prone.
Cause
- Chronic over-exposure
to the sun. It is the cumulative dose of sunlight that is important.
Symptoms
- Yellowish, thickened
skin.
- Furrowing (coarse
wrinkling) and rhomboidal patterns, particularly prominent on
the back of the neck (cutis rhomboidailis nuchae).
- Senile comedones
(whiteheads and blackheads).
|
Solar elastosis.
Click
on image for larger view |
What you can do
- Prevent worsening
by taking precautions against the sun (see sun
protection).
What the doctor
may do
- Prescribe topical
tretinoin (vitamin A
acid).
- Counsel about sun protection.
- Examine the skin for
other complications of chronic sun damage such as solar
keratoses and skin cancers.
TOP
SQUAMOUS CELL CANCER
This is the second
most common type of skin cancer after the basal
cell cancer. It may occur in a precancerous skin conditions
such as solar keratosis/actinic cheilitis and Bowen's disease, in old radiation
burns, chronic ulcers and areas of chronic inflammation.
Symptoms
- Fleshy or ulcerated
growth with variable degrees of scaling and crusting.
- Enlarged lymph glands
draining the area.
|
Squamous cell cancer.
Click
on image for larger view |
Complications
- Metastases or systemic
spread may occur in those arising in the lips and in areas of
chronic inflammation.
What you can do
- You should conault
a doctor as early treatment is curative.
What the doctor
may do
- Perform a skin
biopsy to confirm the diagnosis.
- Treat with electrosurgery
and curettage (scraping),
surgical excision, liquid
nitrogen and X-ray therapy or Moh's chemosurgery for recurrences
and squamous cell cancers in difficult locations.
TOP
STEATOCYSTOMA MULTIPLEX
Steatocystoma multiplex
is an inherited disorder in which multiple cysts develop in the
skin.
Cause
- Inherited as an autosomal
dominant characteristic which only one parent need to be affected
and the offsprings have a 1 in 2 chance of inheriting and developing
the disorder.
Symptoms
- Multiple cysts, usually
on the chest and forearms.
- The cysts are more
easily felt or they may become visible when the skin is stretched.
- The cysts usually
appear during puberty.
|
Steacystoma multiplex.
Click
on image for larger view |
Complications
- Inflammation and pain.
What you can do
- You can consult a
doctor.
- Do not squeeze or
puncture the cyst.
What the doctor
may do
- Reassure you.
- Excise unwanted cysts.
Puncturing the cysts results in the release of an oily yellow
liquid but this is only temporary as the oil soon accumulates
and the cysts recur.
- Treat inflamed cysts
with antibiotics.
TOP
STRAWBERRY HAEMANGIOMA
This is a superficial
haemangioma that occurs in children, most commonly on the face,
scalp, trunk and legs.
Symptoms
- Begins soon after
birth as a red patch and enlarges rapidly to form a bright red
raspberry shaped growth. It generally stops growing by the time
the child is 1 year of age and then shrinks in size over the
ensuing years. Fifty per cent disappear by 5 years of age , 70%
by 7 years and 90% by 9 years of age.
|
Strawaberry haemangioma.
Click
on image for larger view |
Complications
- May affect vision
when it occurs near the eye.
- May bleed if traumatised.
What you can do
- You should consult
a doctor.
- Do nothing and wait
for it to resolve on its own.
- Apply firm pressure
for 5 minutes if it bleeds.
- Use cosmetic camouflage
if there are residual marks.
What the doctor
may do
- Reassure you that
most strawberry haemangiomas will resolve on their own.
- Use vascular
lasers to treat haemangiomas that encroach on important areas
such as the eyes, nostrils, throat and ear canal or treat portions
of the haemangioma that remain after natural resolution has occurred.
- Prescribe oral steroids or intralesional
steroids to suppress rapidly growing strawberry haemangiomas.
TOP
STRIAE DISTENSAE
Striae distensae is
the medical term for stretch marks.
Cause
- Stretching of the
skin resulting in loss of elasticity of the underlying dermis.
-
- During adolescence
as a result of the growth spurt.
- During pregnancy due
to increased girth.
-
- Thinning of the skin
due to decreased collagen production.
-
- Overuse of strong
topical steroids.
- Oral or systemic steroids.
- Excess production
of steroids by the body (Cushing's syndrome)
.
Symptoms
- Red or purplish raised
streaks.
- Flatten with time
and become white.
- Commonly occur on
the thighs, hips and lower abdomen.
|
Striae distensae.
Click
on image for larger view |
What you can
do
- Avoid stretch marks
in the first place by using steroids only under a doctor's supervision.
- Avoid sudden weight
gain.
What the doctor
may do
- Tretinoin (vitamin A acid) help to fade
the stretch marks but only when they are still red or purple.
Remember that tretinoin cannot be used by pregnant and nursing
mothers.
TOP
SUNBURN
Sunburn is caused by
an acute overdose of ultraviolet light (natural sunlight or artificial).
The particular wavelength responsible is the ultraviolet B range
(see Figure below). Light reflected off water, snow and the ground
as well as direct sunlight may be the cause which explains why
umbrellas and brimmed hats are not entirely protective.
|
200nm |
290nm |
320nm |
400nm |
700nm |
|
Gamma rays |
X-Rays |
Ultraviolet
(UV) |
Visible
Light |
Infra
Red |
C |
B |
A |
|
|
|
Sunburn, Skin cancer,
Ageing |
Tanning, Skin cancer,
Ageing |
|
|
- Skin
Phototypes
Skin type |
Reaction to sun-exposure |
Examples |
Type 1 |
Always burns, never tans |
Light-eyed, fair-skinned Northern Europeans |
Type 2 |
Always burns, sometimes tans |
Fair-skinned Europeans. |
Type 3 |
Sometimes burns, always tans |
Mediterranean origin eg. Spaniards, Italians
and Greeks |
Type 4 |
Never burns, always tans |
Hispanics and Asians. |
Type 5 |
Dark pigmented Asian skin. |
Hispanics and Asians. |
Type 6 |
Black skin. |
Darkly pigmented Africans and Southern Indians. |
TOP
SWEET'S
DISEASE
Sweet's disease is
named after the English dermatologist who first described it.
It is also known as acute neutrophilic dermatosis and usually
affects middle aged women.
Cause
- Upper respiratory
infection.
- Inflammatory bowel
disease such as ulcerative colitis and Crohn's disease.
- Rheumatoid disease.
- Haematological abnormalities
including leukaemia.
- Vaccination.
Symptoms
- Fever which may be
high.
- Tender red or bluish
red tender plaques (elevated patches), sometimes with tiny blisters
or pustules (pusheads).
- These plaques may
clear slightly in the centre and become ring-like or semi-circular
in shape.
- May be single or multiple.
- Usually occurs on
the face, neck and upper limbs.
- May be associated
with joint pains, tiredness, malaise (feeling of illness) and
conjunctivitis (red sore eyes).
|
Sweets disease.
Click
on image for larger view |
Complications
- Bullous Sweet's syndrome
with large blisters may be associated with underlying leukaemia.
What you can do
- You should consult
a doctor.
What the doctor
may do
- Perform a skin
biopsy.
- Perform blood tests
which usually show a high erythrocyte sedimentation ratio (ESR)
and a raised white cell count.
- Exclude undlerlying
leukaemia.
- Treat with oral steroids or dapsone.
TOP
SYRINGOMAS
Syringomas are small
pin-head size papules (bumps) occurring around the eyes. Syringomas
usually occur during puberty and are more common in females.
They are often mistaken for oil deposits.
Cause
- Syringomas are caused
by the overgrowth of the cells lining the sweat duct. It may
sometimes run in families.
Symptoms
- Small, skin-coloured,
pin-head size papules (bumps) around the eyes and on the cheeks.
|
Syringomas.
Click
on image for larger view |
What you can
do
- You should consult
a doctor.
- Leave alone as they
are a harmless cosmetic problem or seek treatment from a doctor.
What the doctor
may do
- Reassure you that
they are harmless.
- Excise (cut) them
or burn them with electrosurgery
and the carbon dioxide
laser. However, recurrences are common, requiring retreatment.
TOP |