DERMATOLOGY

The skin is the largest organ of the body, covering the entire body. As the outer protective
covering of the body, it is exposed to the environment, making it vulnerable to growths,
rashes, discolorations, cysts, burns, injuries, infections, and other disorders.
Dermatology is the study of skin diseases and conditions. A dermatologist treats disorders
relating to the skin, hair, and nails. A dermatologist is a physician who has completed medical
school, at least one year of  postdoctoral training and three or more years of intensive residency
training in dermatology. After medical school, internship, and residency, a dermatologist is
eligible to take the board certification examination
offered by the American Board of Dermatology.
Currently, there are close to 8,500 board certified
dermatologists in the US.
Other physicians and specialists, may be involved in
the prevention and treatment of skin disorders.

ANATOMY OF THE SKIN

Facts about the skin:

The skin is the body's largest organ, covering
the entire body. In addition to serving as a protective
shield against heat, light, injury, and infection, the
skin also:
 regulates body temperature.
 stores water and fat.
 is a sensory organ.
 prevents water loss.
 prevents entry of bacteria.

Throughout the body, the skin's characteristics (thickness, color, texture) vary. For
instance, the head contains more hair follicles than anywhere else, while the soles of the feet
contain none. In addition, the soles of the feet and the palms of the hands are much thicker. The
skin is made up of the following layers, with each layer performing specific functions:
 epidermis
 dermis
 subcutaneous fat layer

epidermis The epidermis is the thin outer layer of the skin and consists of three
parts:
 stratum corneum (horny layer)
This layer consists of fully mature keratinocytes which contain
fibrous proteins (keratins). The outermost layer is continuously
shed. The stratum corneum prevents the entry of most foreign
substances as well as the loss of fluid from the body.
 keratinocytes (squamous cells)
This layer, just beneath the stratum corneum, contains living
keratinocytes (squamous cells), which mature and form the
stratum corneum.
 basal layer
 The basal layer is the deepest layer of the epidermis, containing
basal cells. Basal cells continually divide, forming new
keratinocytes that replace the cells that are shed from the skin's
surface.
The epidermis also contains melanocytes, which are cells that produce
melanin (skin pigment).

dermis The dermis is the middle layer of the skin. The dermis contains the
following:
 blood vessels
 lymph vessels
 hair follicles
 sweat glands
 collagen bundles
 fibroblasts
 nerves
The dermis is held together by a protein called collagen, made by
fibroblasts. This layer also contains pain and touch receptors.

subcutis The subcutis is the deepest layer of skin. The subcutis, consisting of a
network of collagen and fat cells, helps conserve the body's heat and
protects the body from injury by acting as a shock absorber.

COMMON SKIN DISORDERS

The skin is one of the most vulnerable organs of the body. Though seldom life threatening,
skin disorders can be uncomfortable and may cause chronic disabilities. In addition, because the
skin is so visible, skin disorders can lead to psychological stress.
There are many disorders of the skin that require clinical care by a physician or other healthcare
professional. Listed in the directory below are some, for which we have provided a brief
overview.

ACNE

Meaning
Acne is a disorder of the hair follicles and sebaceous glands. The glands become clogged,
leading to pimples and cysts.

Incidence
Acne is very common - nearly 17 million people in the US are affected by this condition.
Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase
in both boys and girls, causing the sebaceous glands to become more active - resulting in
increased production of oil (sebum).
Pathophysiology
The sebaceous glands produce sebum that normally travels via hair follicles to the skin
surface. However, skin cells can plug the follicles, blocking the sebum coming from the sebaceous
glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P.
acnes) begin to grow inside the follicles, causing inflammation. Acne progresses in the following
manner:
1. Incomplete blockage of the hair follicle results in blackheads (a semisolid, black plug).
2. Complete blockage of the hair follicle results in whiteheads (a semisolid, white plug).
Infection and irritation cause whiteheads to form.
Eventually, the plugged follicle bursts, spilling oil, skin cells, and bacteria onto the skin surface. In
turn, the skin becomes irritated and pimples or lesions begin to develop. The basic acne lesion is
called a comedo.
Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push
down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).

Causes
Rising hormone levels during puberty may cause acne. In addition, acne is often inherited.
Other causes of acne may include the following:
 hormone level changes during the menstrual cycle in women
 certain drugs (such as corticosteroids, lithium, and barbiturates)
 oil and grease from the scalp, mineral or cooking oil, and certain cosmetics
 bacteria inside pimples
Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard. Skin may
also become irritated with friction or pressure from helmets, backpacks, or tight collars. Some
environmental conditions such as pollution or humid conditions can also irritate the skin.

Symptoms
Acne can occur anywhere on the body. However, acne most often appears in areas where
there is a high concentration of sebaceous glands, including the following:
 face
 chest
 upper back
 shoulders
 neck
The following are the most common symptoms of acne. However, each individual may
experience symptoms differently. Symptoms may include:
 blackheads
 whiteheads
 pus-filled lesions that may be painful
 nodules (solid, raised bumps)
The symptoms of acne may resemble other skin conditions. Always consult your physician for a
diagnosis.

Treatment of acne:
The goal of acne treatment is to minimize scarring and improve appearance. Treatment
for acne will include topical or systemic drug therapy. Depending upon the severity of acne,
topical medications (applied to the skin) or systemic medications (taken orally) may be
prescribed by your physician. In some cases, a combination of both topical and systemic
medications may be recommended.

Topical medications to treat acne:

Topical medications are often prescribed to treat acne. Topical medication can be in the form of
a cream, gel, lotion, or solution. Examples include:
benzoyl
kills the bacteria (P. acnes)
peroxide

antibiotics helps stop or slow down the growth of P. acnes and reduces inflammation

tretinoin stops the development of new acne lesions (comedones) and encourages cell
turnover, unplugging pimples

adapalene decreases comedo formation

Systemic medications to treat acne:

Systemic medications, or oral antibiotics, are often prescribed to treat moderate to severe acne,
and may include the following:
 doxycycline
 erythromycin
 tetracycline

Treatment for severe, cystic, or inflammatory acne:

Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe,
cystic, or inflammatory acne that cannot be effectively treated by other methods to prevent
extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil,
increases skin cell shedding, and affects the hair follicles, thereby reducing the development of
acne lesions. Isotretinoin can clear acne in 85 percent of patients. However, the drug has major
unwanted side effects, including psychiatric side effects. It is very important to discuss this
medication with your physician.
Isotretinoin must not be taken by women who are pregnant or who are able to become
pregnant, because there is a very high likelihood of birth defects occurring in babies whose
mothers took the medication during pregnancy. Isotretinoin can also cause miscarriage or
premature birth. Because of these effects and to minimize fetal exposure, isotretinoin is approved
for marketing only under a special restricted distribution program approved by the US Food and
Drug Administration (FDA). This program is called iPLEDGE.
The goal of the iPLEDGE program is to prevent pregnancies in females taking isotretinoin and to
prevent pregnant females from taking isotretinoin. Requirements of the iPLEDGE program
include:
 Isotretinoin must only be prescribed by prescribers who are registered and activated with
the iPLEDGE program.
 Isotretinoin must only be dispensed by a pharmacy registered and activated with
iPLEDGE.
 Isotretinoin must only be dispensed to patients who are registered with and meet all the
requirements of iPLEDGE
 Female patients who can get pregnant are required to use birth control for one month
prior to treatment, during treatment, and for one month after stopping treatment.
  Pregnancy tests are required before, during, and after treatment.

Treatment for acne scars:

Although acne often is a chronic condition, even if it lasts only during adolescence, acne
can leave life-long scars. Acne scars typically look like "icepick" pit scars or crater-like scars.
Although proper treatment for acne may help minimize scarring, several dermatological
procedures may help to further minimize any acne scars, including the following:
 Dermabrasion : Dermabrasion may be used to minimize small scars, minor skin surface
irregularities, surgical scars, and acne scars. As the name implies, dermabrasion involves
removing the top layers of skin with an electrical machine that "abrades" the skin. As the
skin heals from the procedure, the surface appears smoother and fresher.
 Chemical peels :Chemical peels are often used to minimize sun-damaged skin, irregular
pigment, and superficial scars. The top layer of skin is removed with a chemical
application to the skin. By removing the top layer, the skin regenerates, often improving
the skin's appearance.
 Collagen injections : One type of collagen, which is derived from purified bovine (cow)
collagen, is injected beneath the skin to replace the body's natural collagen that has been
lost. Injectable collagen is generally used to treat wrinkles, scars, and facial lines.
 Laser resurfacing : Laser resurfacing uses high-energy light to burn away damaged skin.
Laser resurfacing may be used to minimize wrinkles and fine scars.
 Phototherapy/blue light therapy : Phototherapy using a blue light source has been
shown to decrease the number of acne-causing bacteria with minimal side effects, such as
dry skin.  Blue light therapy does not use ultraviolet (UV) light, so it does not damage the
skin as earlier types of light therapy did. According to the American Academy of
Dermatology, blue-light therapy is the best-known light therapy for acne treatment.
 Pulsed light and heat energy (LHE) therapy: This type of combined light and heat
therapy is believed to work by destroying acne-causing bacteria and by shrinking the oil-
producing glands in the skin. The FDA has approved an LHE system that uses green light
and heat pulses for treating mild to moderate acne.
 Punch grafts : Punch grafts are small skin grafts used to replace scarred skin. A hole is
punched in the skin to remove the scar, which is then replaced with unscarred skin (often
from the back of the earlobe). Punch grafts can help treat deep acne scars.
 Autologous fat transfer : An autologous fat transfer uses fat taken from another site on
your own body and it is injected into your skin. The fat is placed beneath the surface of the
skin to elevate depressed scars. This method is used to correct deep contour defects
caused by scarring from nodulocystic acne. Because the fat may be reabsorbed into the
skin over a period of months, there may be a need for the procedure to be repeated.

BED SORES

Meaning
Bed sores can occur when a person is bedridden, unconscious, unable to sense pain, or
immobile. Bed sores are ulcers that occur on areas of the skin that are under pressure from lying
in bed, sitting in a wheelchair, and/or wearing a cast for a prolonged period of time.
Causes and pathophysiology
A bed sore develops when blood supply to the skin is cut off for more than two to three
hours. As the skin dies, the bed sore first starts as a red, painful area, which eventually turns
purple. Left untreated, the skin can break open and become infected. A bed sore can become
deep, extending into the muscle. Once a bed sore develops, it is often very slow to heal. Bed sores
often occur in the buttocks area (on the sacrum or iliac crest), or on the heels of the feet.

Preventing bed sores:

Bed sores can be prevented by inspecting the skin for areas of redness (the first sign of skin
breakdown). Other methods of preventing bed sores and preventing progression of existing bed
sores include the following:
 frequent turning and repositioning
 providing soft padding in wheelchairs and beds to reduce pressure
 providing good skin care by keeping the skin clean and dry

Treatment for bed sores:

Specific treatment of a bed sore is determined by your physician and based on the severity
of the condition. Treatment may be more difficult once the skin is broken, and may include the
following:
 removing pressure on the affected area
 protecting the wound with medicated gauze or other special dressings
 keeping the wound clean
 transplanting healthy skin to the wound area
 medication (i.e., antibiotics to treat infections)

DRY SKIN
Meaning
Dry skin is a very common skin condition, usually characterized by irritated skin and
itchiness. Dry skin often worsens in the winter, when the air is cold and dry. In addition, frequent
bathing can aggravate dry skin. Dry skin may become flaky or scaly.
However, dry skin symptoms may resemble other skin conditions or result from other disorders
such as an underactive thyroid or acquired immune deficiency syndrome (AIDS). Always consult
your physician for a diagnosis.

Treatment for dry skin:

Treating dry skin may be as simple as keeping the skin moist - by taking fewer baths and
using ointments or creams that keep the moisture in. Treatment may also include:
 avoiding harsh soaps, detergents, and perfumes, which tend to dry the skin
 avoiding rubbing or scratching the skin, which can aggravate the symptoms and cause
infection
 applying a salicylic acid solution or cream (which removes the top layer of skin) - if the
skin is scaly
 CALLUSES AND CORNS

Meaning
Calluses are protective pads made up of the thickened upper layer of skin due to repeated
rubbing of the area. Corns are small calluses that develop on the top of the toes due to pressure
or rubbing against shoes or other toes.

Treatment for calluses and corns:

Calluses are usually painless, but corns can be quite painful. Sometimes, corns are
confused with warts. Calluses can be avoided by removing the source of the rubbing and thinning
the callus with a pumice stone. Treatment for corns may include:
 applying pads around the corn area
 wearing larger, more comfortable shoes
 surgery

KERATOSIS PILARIS

Meaning
Keratosis pilaris is a common skin disorder characterized by small, pointed pimples. The
pimples usually appear on the upper arms, thighs, and buttocks. The condition worsens in the
winter and usually clears up in the summer. Keratosis pilaris has no known cause, but tends to
run in families.

Treatment for keratosis pilaris:

Usually no treatment is necessary for keratosis pilaris, since it normally clears up by itself.
Treatment may include:
 using petroleum jelly with water, cold cream, or salicylic acid (which removes the top
layer of skin) to flatten the pimples
 using a tretinoin cream (a drug which is chemically related to vitamin A)

PSORIASIS

Meaning
Psoriasis is a chronic skin condition characterized by inflamed, red, raised areas that often
develop as silvery scales on the scalp, elbows, knees, and lower back. Psoriasis is estimated to
affect between 5 million to 7 million people in the US.

Causes
The cause of psoriasis is unknown, however, it is thought to be caused by abnormally fast-
growing and shedding skin cells. The skin cells multiply so quickly, causing the skin to shed every
three to four days. Though not contagious, the condition is hereditary. Psoriasis is often recurrent
and occurs in varying severities.
Symptoms
The following are the most common symptoms of psoriasis. However, each individual may
experience symptoms differently, as psoriasis comes in several forms and severities. Symptoms
may include:
 discoid psoriasis: Also called plaque psoriasis, this type of psoriasis is the most common.
Symptoms may include patches of red, raised skin on the trunk, arms, legs, knees, elbows,
genitals, and scalp. Nails may also thicken, become pitted, and separate from the nail beds.
 guttate psoriasis : This type of psoriasis affects mostly children. Symptoms may include
many small patches of red, raised skin. A sore throat usually proceeds the onset of this
type of psoriasis.
 pustular psoriasis : Symptoms may include small pustules (pus-containing blisters) all
over the body or just on the palms, soles, and other small areas.

Diagnosis
When the condition progresses to the development of silvery scales, the physician can
usually diagnose psoriasis with a medical examination of the nails and skin. Confirmation of
diagnosis may be done with a skin biopsy (taking a small skin specimen to examine under a
microscope).

Treatment for psoriasis:

The goal of treatment is to reduce inflammation and slow down the rapid growth and
shedding of skin cells. At the present time, there is no cure for psoriasis. Treatment may include:
 ointments and creams (to moisturize the skin)
 sunlight or ultraviolet light exposure (under a physician's supervision)
 steroids (such as cortisone creams)
 vitamin D cream
 creams containing salicylic acid or coal tar
 Anthralin - a drug that treats the thicker, hard-to-treat patches of psoriasis.
 methotrexate - an anti-cancer drug that interrupts the growth of skin cells.
 oral or topical retinoids
 immunosuppressive medications (such as Cyclosporine)

PITYRIASIS ROSEA

Meaning
Pityriasis rosea is a mild, but common, skin condition. Characterized by scaly, pink,
inflamed skin, the condition can last from four to eight weeks and usually leaves no lasting marks.

Causes and incidence

The cause of pityriasis rosea is not known, but it is commonly believed to be caused by a
virus. It is usually seen in children, adolescents, and young adults. Most people with the rash are
10 to 35 years of age.
The condition is more prevalent in spring and fall.

Symptoms
Pityriasis rosea usually starts with a pink or tan oval area (sometimes called a herald or
mother patch) on the chest or back. The main patch is usually followed (after a couple of weeks)
by smaller pink or tan patches elsewhere on the body - usually the back, neck, arms, and legs. The
scaly rash usually lasts between four to eight weeks and will disappear without treatment.
The following are other common symptoms of pityriasis rosea. However, each individual may
experience symptoms differently. Symptoms may include:
 headaches
 fatigue
 aches
 itching

diagnosis
Pityriasis rosea is usually diagnosed based on a medical history and physical examination.
The rash of pityriasis rosea is unique, and the diagnosis is usually made on the basis of a physical
examination. In addition, your physician may order the following tests to help aid in the
diagnosis:
 blood tests
 skin biopsy - the removal of some of the diseased skin for laboratory analysis. The sample
of skin is removed after a local anesthetic is administered.

Treatment for pityriasis rosea:

The goal of treatment for pityriasis rosea is to relieve symptoms associated with the
condition, such as itching. There is no cure for pityriasis rosea. The condition will resolve
spontaneously. Treatment may include:
 medicated lotions and creams (to soothe the itching)
 medications by mouth (to soothe the itching)
 cool baths with or without oatmeal (to soothe the itching)
 ultraviolet exposure (under a physician's supervision)
 cool compresses (to soothe the affected skin)

ROSACEA

Meaning
Rosacea is a common skin condition that usually only affects the face and eyes.
Characterized by redness, pimples, and broken blood vessels, rosacea tends to begin after middle
age (between the ages of 30 and 60) and is more common in fair-skinned people.

Cause and incidence

The cause of rosacea is unknown. An estimated 14 million people in the US have rosacea.

Symptoms
Rosacea often begins with easy blushing and flushing of the facial skin. Eventually, redness
will persist around the nose area, extending to the rest of the face. Rosacea has a variety of
clinical symptoms and is classified into the following four types, based on these different
symptoms:
 Type Symptoms

prerosacea frequent episodes of blushing and

flushing of the face and neck

vascular swelling of blood vessels under the

rosacea facial skin, leading to swollen, warm
skin (common in women)

inflammatory formation of pimples and enlarged

rosacea blood vessels on the face

rhinophyma enlarged oil glands in the nose and

cheeks that cause an enlarged,
bulbous red nose
In addition, approximately 50 percent of those affected by rosacea will have eye involvement. Eye
symptoms may include:
 redness
 burning
 tearing
 inflamed eyelids
 sensation of a foreign object in the eye
The symptoms of rosacea may resemble other dermatologic conditions, such as acne. Always
consult your physician for a diagnosis.

Diagnosis
Rosacea is usually diagnosed with a complete medical history and physical examination.

Treatment for rosacea:

The goal of treatment is to control the symptoms associated with rosacea. Treatment may
include:
 diet modifications (such asavoiding foods that dilate the skin's blood vessels, such as
caffeine, spicy foods, and alcohol)
 topical and oral antibiotics
 glycolic acid peels
 cortisone cream
 laser therapy
 dermabrasion
 electrosurgery
 Sebaceous Cysts
Meaning
Sebaceous cysts are harmless, slow-growing bumps under the skin, often appearing on the
scalp, face, ears, back, or groin area. The cysts usually contain dead skin and other skin particles.

Treatment for sebaceous cysts:

Sebaceous cysts can usually be treated by a physician by puncturing the top and removing
its contents. However, large cysts may reappear and may have to be surgically removed. If a cyst
becomes infected, treatment may include administering antibiotics and then surgically removing
the cyst.