Dermatology-Dermoscopy

Acne is one of the most common skin conditions. It usually starts during puberty but sometimes can also continue into adult life. Acne affects mainly the hair follicles, in particular the oily areas of the body, such us the face, back and chest.

Comedones (blackheads and whiteheads) are the most characteristic acne lesions but inflamed red papules, and pus-filled spots (pustules) are very frequent as well. Occasionally, large, tender spots or cysts may develop and in some patients the lesions tend to scar the skin.

There are many treatments available for acne, depending on the disease type, severity and patient’s choice. Oral antibiotics, oral contraceptives tablets and topical creams are effective. In some cases, patients need oral isotretinoin, which is probably the most effective treatment for acne but it requires careful discussion and blood test monitoring. The course of oral isotretinoin usually lasts for 4-6 months, depending on the doses and patient response. 

Rosacea is a common skin condition, which presents with persistent redness and spots on the central areas of the face, sometimes causing eye irritation as well. It is more common in women, usually with fair skin who flush easily. Most of patients suffering from rosacea have also sensitive skin.

The cause of rosacea is not fully understood, but it seems the problem lies in the blood vessels in the skin of the face, which dilate too easily. These “hyper-reactive blood vessels” can react to several stimuli, in particular, the sunlight.

There are several subtypes of rosacea and the treatment must be tailored to each individual case. In addition to medical treatment (oral antibiotics, topical creams and occasionally oral isotretinoin), it is important for the patient to identify the possible trigger factors for this skin condition. 

Cosmetics and skin care products are assuming an increasingly important role in dermatology. Hair and nail care products have also a deep impact on these structures and improper use can lead to exacerbation of some dermatoses.

There are three basic types of skin care products: cleansers, astringents (or toners) and moisturizers. In some cases, cosmetics can aggravate or induce skin problems, such us eczema, acne. It is important to use the appropriate products for oily, sensitive or dry skin. 

There are multiple benign lumps (dermal moles, seborrheic keratoses, dermatofibromas), which can be removed for cosmetic reasons. Shaving under local anaesthesia is enough to get rid of them in most cases with good cosmetic results. Cryotherapy (freezing) is another technique frequently used in dermatology to remove benign skin conditions (viral warts, small skin tags, actinic lentigos). 

Below you can find a few useful links related with the above topic:

Eczema is a broad term applied to a range of persistent skin conditions characterized by redness, skin edema (swelling), itching, dryness, and crusting. 

There are two basic types of eczema: endogenous (atopic dermatitis, pompholix), and exogenous (contact eczema). Endogenous eczema has a genetic background in most cases and is usually precipitated by internal factors. Exogenous eczema is caused by external factors, irritant or allergic reaction to different stimuli. In some cases the cause of eczema is mixed.

Topical steroids and moisturisers are the mainstay of eczema treatment. Oral tablets are kept for severe and refractory cases.

Biopsy consists in removing a small piece of skin for histologic examination. Various different types of skin surgery can be done under local anaesthesia:

Punch biopsy: Involves the removal of a full thickness skin sample a few millimetres in diameter using a special instrument, similar to a small pen. 

Shave biopsy: consists in removing the uppermost portion of a skin lesion and often leads to an excellent cosmetic result.

Curettage is the removal of the uppermost portion of a skin lesion using a specially designed instrument, which is called curette.

Elliptical excision: a full thickness of the skin is removed in an elliptical shape. This is the technique we use to remove deep lesions or when the whole thickness of the skin needs to be analysed under microscope, such as atypical moles or lesions suspicious of skin cancer. 

Melanocytic naevi (moles) are benign clusters of melanocytes. They may present at birth (congenital melanocytic naevi) or later in life (acquired melanocytic naevi). Their cause is not fully understood.  A genetic factor is likely as a tendency to have several moles runs in some families.  Another factor is exposure to too much sun in childhood.

There are three main types of acquired melanocytic naevi: junctional (flat), compound (usually brown bumps) and dermal (flesh-coloured bumps). 

Dermoscopy is a new non-invasive technique that increases the diagnostic accuracy of moles and skin cancer. It also provides the possibility to monitor any mole changes over time. 

It involves using a hand-held device (dermatoscope) that provides illumination plus a 10-fold magnification of the skin, allowing to check deeper structures, which would be impossible to examine with the naked eye. It needs some training and experience.

For more information about moles or dermoscopy visit the below links:

Psoriasis is a chronic, autoimmune disease that appears on the skin but may involve also joints. It affects 2% of the population and is not contagious. 

Clinically, it consists in red scaly patches on the skin but can also affect scalp and nails. There are five types of psoriasis: plaque, guttate, inverse, pustular and erythrodermic. 

The treatment of psoriasis depends on the psoriasis type and severity. Topical treatments (creams) are the first step for psoriasis; in resistant cases, light therapy and systemic therapies need to be considered.

For more information about psoriasis please use these links

Skin cancer is one of the most common cancers in the UK and the number of people who develop it is increasing. The majority of cases are caused by ultraviolet radiation from the sun or sunbeds. 

There are basically three types of skin cancer:

Basal cell carcinoma (BCC) is the most common cancer in humans. It mainly affects the face of fair skinned individuals who have had extensive sun exposure. They present as a scab that may bleed or as a painless lumps.

The commonest treatment for basal cell carcinoma is surgery. Other types of treatment includes curettage and cautery, cryotherapy, radiotherapy, special creams and photodynamic therapy.

Skin colour is mainly determined by the amount and type of melanin (cutaneous pigment). Any changes to skin colouration need medical investigation. In most cases, they are related with benign conditions but can represent a considerable cosmetic problem, especially in dark skinned people.

Whitening of the skin may appear after any inflammation of the skin and it is usually transient. Vitiligo is another common cause of white patches, it affects 1% of normal population and is considered an autoimmune condition.

Vililigo is caused by the body reacting against the pigment cells of the skin.  Why this happens is not known, so it is difficult to make a treatment that reverses this effect. 

Ultraviolet light treatment can sometimes stimulate the skin pigment to be made in the skin again.  However, it can sometimes burn the pale skin and if it does not work, the surrounding skin tans a darker colour and the pale skin stays pale so it can make the areas of vitiligo look more obvious. 

Darkening of the skin is very frequent after many skin problems, especially in dark skinned races, but can be a symptom of other medical conditions. Melasma is one of the most common causes of increased pigmentation. It affects usually the face and is related with pregnancy, contraceptive pills and sun exposure. 

Some treatments can be tried to lighten the skin.  It is best to have a cream prescribed from a doctor as some of the ones that can be bought contain variable amounts of the constituents.  The usual active ingredient in bleaching creams is called hydroquinone, but it should be used cautiously as sometimes it can produce an increased darkening of the skin which really is permanent.

Sometimes a mild chemical peel of the skin can help melasma.  The peels which might be worth considering are the mild trichloroacetic acid (TCA) peel or glycolic acid (as 50-70% glycolic acid).  These chemical peels should only be done by someone who is qualified and experienced in the use of them, as there can sometimes be adverse reactions.

A rash indicates a change in the normal colour of the skin or in its texture. Skin rashes may be induced by infections, drugs, internal diseases and autoimmune conditions. They can also be associated with some specific skin diseases (lichen planus, eczema). 

The treatment depends on the type and cause of the eruption.