Acne Can be distressing and annoyingly persistent. Acne lesions heal slowly, and when one begins to resolve, others seem to crop up. This ongoing battle and long-lasting cycle is both wearisome and frustrating.

Hormones likely play a role in the development of acne, making the condition most common in teenagers. But people of all ages can get acne. Some adult women experience mild to moderate acne due to hormonal changes associated with pregnancy, their menstrual cycles, or starting or stopping birth control pills.

Teenage and adult acne can take months to treat successfully. Depending on its severity, acne can cause emotional distress and lead to scarring of the skin.

The good news is that effective treatments are available. Acne treatment for mild cases usually involves self-care measures, such as washing your skin daily with a gentle cleanser and using an over-the-counter acne cream. Acne treatment for severe cases usually includes one or more prescription medications. Once acne is under control, prevention strategies can help keep your skin clear of breakouts.

Symptoms

Acne typically appears on your face, neck, chest, back and shoulders, which are the areas of your skin with the largest number of functional oil glands. Acne can take the following forms:

Causes of Acne

Three factors contribute to the formation of acne:

• Comedones (whiteheads and blackheads). Are created when the openings of hair follicles become clogged and blocked with oil secretions, dead skin cells and sometimes bacteria. When comedones are open at the skin surface they're called blackheads because of the dark appearance of the plugs in the hair follicles. When comedones are closed, they're called whiteheads — slightly raised, skin-colored bumps.

• Papules. These are small raised bumps that signal inflammation or infection in the hair follicles. Papules may be red and tender.

• Pustules. Similar to papules, pustules are red, tender bumps with white pus at their tips.

• Nodules. These are large, solid, painful lumps beneath the surface of the skin. They're formed by the buildup of secretions deep within hair follicles.

• Cysts. These are painful, pus-filled lumps beneath the surface of the skin. These boil-like infections can cause scars.

Acne occurs when the hair follicles become plugged with oil and dead skin cells. Each follicle is connected to sebaceous glands. These glands secrete an oily substance known as sebum to lubricate your hair and skin. Sebum normally travels up along the hair shafts and then out through the opening of the hair follicle onto the surface of your skin. When your body produces an excess amount of sebum and dead skin cells, the two can build up in the hair follicle and form together as a soft plug.

This plug may cause the follicle wall to bulge and produce a whitehead. Or, the plug maybe open to the surface and may darken, causing a blackhead. Pimples are raised red spots with a white center that develop when blocked hair follicles become inflamed or infected. Blockages and inflammation that develop deep inside hair follicles produce lumps beneath the surface of your skin called cysts. Other pores in your skin which are the openings of the sweat glands onto your skin, aren't normally involved in acne.

It's not known what causes the increased production of sebum that leads to acne. But a number of factors — including hormones, bacteria, certain medications and heredity — play a role.
Contrary to what some people think, foods have little effect on acne. Acne also isn't caused by dirt. In fact, scrubbing the skin too hard or cleansing with harsh soaps or chemicals irritates the skin and can make acne worse.

Medical advice?

• Overproduction of oil (sebum).

• Irregular shedding of dead skin cells resulting in irritation of the hair follicles of your skin.

• Buildup of bacteria.

• Acne usually isn't a serious medical condition. But you may want to seek medical treatment from our qualified dermatologist for persistent pimples or inflamed cysts to avoid scarring or other damage to your skin.

Acne treatments include:

• Topical treatments. Acne lotions may dry up the oil, kill bacteria and promote sloughing of dead skin cells. Over-the-counter lotions are generally mild and contain benzoyl peroxide, sulfur, salicylic acid or lactic acid as their active ingredient. These products can be helpful for very mild acne. If your acne doesn't respond to these treatments, you may want to see the dermatologist to get a stronger prescription lotion. Tretinoin (Avita, Retin-A, Renova) are examples of topical prescription products derived from vitamin A. They work by promoting cell turnover and preventing plugging of the hair follicles. A number of topical antibiotics also are available. They work by killing excess skin bacteria. Often, a combination of such products is required to achieve optimal results.

• Antibiotics. For moderate to severe acne, prescription oral antibiotics may be needed to reduce bacteria and fight inflammation. You may need to take these antibiotics for months, and you may need to use them in combination with topical products.

• Isotretinoin. Roaccutane for deep cysts, antibiotics may not be enough. Isotretinoin (Accutane) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. It's very effective, but people who take it need close monitoring by a dermatologist. Isotretinoin is associated with birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment.

• Oral contraceptives. Oral contraceptives, including a combination of norgestimate and ethinyl estradiol , have been shown to improve acne in women. However, oral contraceptives may cause other side effects that you'll want to discuss with your doctor.

• Laser and light therapy. Laser- and light-based therapies reach the deeper layers of skin without harming the skin's surface. Laser treatment is thought to damage the oil (sebaceous) glands, causing them to produce less oil. Light therapy targets the bacterium that causes acne inflammation. These therapies can also improve skin texture and lessen the appearance of scars.

Atopic dermatitis, also referred to as eczema, is an itchy eruption of the skin. It's a long-lasting (chronic) condition that may be accompanied by asthma or hay fever. Atopic dermatitis is most often seen in infants and children, but it can continue into adulthood or first appear later in life.

Although atopic dermatitis may affect virtually any area, it classically involves skin on the arms and behind the knees. It tends to flare periodically and then subside for a time, even up to several years. The exact cause of atopic dermatitis is unknown, but it may result from a malfunction in the body's immune system.

Symptoms

Signs and symptoms of atopic dermatitis include:

• Red to brownish-gray colored patches

• Itching, which may be severe, especially at night

• Small, raised bumps, which may leak fluid and crust over when scratched

• Thickened, cracked or scaly skin

• Raw, sensitive skin from scratching

Though the patches can occur anywhere, they most often appear on the hands and feet, on the arms (antecubital fossa), behind the knees, and on the ankles, wrists, face, neck and upper chest. Atopic dermatitis can also affect the skin around your eyes, including your eyelids. Scratching can cause redness and swelling around the eyes. Sometimes, rubbing or scratching in this area causes patchy loss of eyebrow hair and eyelashes.

Atopic dermatitis most often begins in childhood — between the ages of 5 and 7 — and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Itching may be severe, and scratching the rash can make it even itchier. Breaking this itch-scratch cycle can be challenging.

Agreviating Factors:

The following factors can worsen signs and symptoms of atopic dermatitis:

• Long, hot baths or showers

• Dry skin

• Stress

• Sweating

• Rapid changes in temperature

• Low humidity

• Solvents, cleaners, soaps or detergents

• Wool or man-made fabrics or clothing

• Dust or sand

• Cigarette smoke

Infantile eczema

When atopic dermatitis occurs in infants, it's called infantile eczema. This condition begins in infancy and may continue into childhood and adolescence.

Infantile eczema often involves an oozing, crusting rash, mainly on the face and scalp, but it can occur anywhere. After infancy, the rash becomes dryer and tends to be red to brown-gray in color. In adolescence, the skin may be scaly or thickened and easily irritated and the intense itching may continue.

Causes

The exact cause of atopic dermatitis is unknown, but is likely due to a combination of dry, irritated skin together with a malfunction in the body's immune system. Stress and other emotional disorders can worsen atopic dermatitis, but they don't cause it.

Atopic dermatitis often occurs along with allergies and frequently runs in families in which other family members have asthma or hay fever. About three out of four children who have signs and symptoms of atopic dermatitis later develop asthma or hay fever.

Treatment of eczema

If the diagnosis is eczema, the dermatologist will explain what type of eczema you have and prescribe an appropriate treatment plan. Before prescribing a treatment plan, a dermatologist considers the type of eczema, extent and severity of the eczema, patient’s medical history, and a number of other factors.

Medication and other therapies will be prescribed as needed to:

• Control itching

• Reduce skin inflammation

• Clear infection

• Loosen and remove scaly lesions

• Reduce new lesions

It is important to realize that in most cases no one treatment will be effective. Medical research continues to show that the most effective treatment plan for eczema — regardless of type — involves using a combination of therapies to treat the skin and making lifestyle changes to control flare-ups. Doing so, tends to increase effectiveness and reduce side effects from medications.

Also referred to as chloasma or "mask of pregnancy," melasma (A) is a brown darkening of facial skin. Melasma likely occurs from a combination of factors, including exposure to sunlight and an increase in the female hormones estrogen and progesterone.

Melasma is very common in women who take oral contraceptives, hormone therapy or who are pregnant. The dark patches usually occur on the cheeks, forehead, nose and chin. They may or may not resolve after discontinuing the contraceptives or hormone therapy or at the end of the pregnancy.

Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Who gets melasma?

Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.

What causes melasma?

The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called chloasma, or the "mask of pregnancy." Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition.

Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with dark skin color have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.

Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

How is melasma diagnosed?

Because melasma is common, and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

How is it treated?

While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy, it may remain for many years, or a lifetime.

Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen the melasma. If melasma develops after starting birth control pills, it may improve after discontinuing them. Melasma can be treated with bleaching creams while continuing the birth control pills.

At EMC, a variety of topical treatment are available for the treatment of melasma. These creams do not "bleach" the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells.

Normally, it takes about three months to substantially improve melasma. Different combination formulas containing tretinoin, steroids, and glycolic acid are available in combination with hydroquinone to enhance the depigmenting effect.

Other treatment programs like different type of chemical peels have been found to help melasma. It is important to follow the directions of your dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects. Remember, a sunscreen should be applied daily in addition to the treatment. Some topical creams are combined with a sunscreen.

Psoriasis is a common skin disease that affects the life cycle of skin cells. Normally, new cells take about a month to move from the lowest skin layer where they're produced, to the outermost layer where they die and flake off. With psoriasis, the entire life cycle takes only days. As a result, cells build up rapidly, forming thick silvery scales and itchy, dry, red patches that are sometimes painful.

Psoriasis is a persistent, long-lasting (chronic) disease. You may have periods when your psoriasis symptoms improve or go into remission alternating with times your psoriasis becomes worse.

Symptoms

Psoriasis symptoms can vary from person to person but may include one or more of the following:

• Red patches of skin covered with silvery scales

• Small scaling spots (commonly seen in children)

• Dry, cracked skin that may bleed

• Itching, burning or soreness

• Thickened, pitted or ridged nails

• Swollen and stiff joints

Psoriasis patches can range from a few spots of dandruff-like scaling to major eruptions that cover large areas. Mild cases of psoriasis may be a nuisance. But more severe cases can be painful, disfiguring and disabling.

Most types of psoriasis go through cycles, flaring for a few weeks or months, then subsiding for a time or even going into complete remission. In most cases, however, the disease eventually returns.

Causes

The cause of psoriasis is related to the immune system, and more specifically, a type of white blood cell called a T lymphocyte or T cell. Normally, T cells travel throughout the body to detect and fight off foreign substances, such as viruses or bacteria. In people with psoriasis, however, the T cells attack healthy skin cells by mistake as if to heal a wound or to fight an infection.

Overactive T cells trigger other immune responses that cause an increased production of both healthy skin cells and more T cells. What results is an ongoing cycle in which new skin cells move to the outermost layer of skin too quickly — in days rather than weeks. Dead skin and white blood cells can't slough off quickly enough and build up in thick, scaly patches on the skin's surface. This usually doesn't stop unless treatment interrupts the cycle.

Just what causes T cells to malfunction in people with psoriasis isn't entirely clear, although researchers think genetic and environmental factors both play a role.

Risk factors

Perhaps the most significant risk factor for psoriasis is having a family history of the disease. About one in three people with psoriasis has a close relative who also has the condition. On the other hand, roughly the same proportion of people carries genes that have been linked to psoriasis yet never develop skin problems, indicating just how complex and perplexing psoriasis is.

Complications

Depending on the type and location of the psoriasis and how widespread the disease is, psoriasis can cause complications. These include:

• Severe itching, which can lead to thickened skin and bacterial skin infections

• Fluid and electrolyte imbalance in the case of severe pustular psoriasis

• Low self-esteem

• Depression

• Stress

• Anxiety

In addition, psoriatic arthritis can be debilitating and painful, making it difficult to go about your daily routine. Despite medications, psoriatic arthritis can cause erosion in your joints.

Treatments

Psoriasis treatments aim to interrupt the cycle that causes an increased production of skin cells, thereby reducing inflammation and plaque formation. Other treatments, especially those you apply to your skin (topical treatments), help remove scale and smooth the skin.

At EMC our doctors choose the suitable treatments based on the type and severity of psoriasis and the areas of skin affected.

In spite of a wide range of options, psoriasis treatment can be challenging. The disease is unpredictable, going through cycles of improvement and worsening seemingly at whim. Effects of psoriasis treatments also can be unpredictable; what works well for one person might be ineffective for someone else. Your skin can also become resistant to various treatments over time, and the most potent psoriasis treatments can have serious side effects.

Skin cancer is a malignant growth on the skin; this makes most skin cancers detectable in the early stages. There are several types of skin cancer. The most common are basal cell cancer and squamous cell cancer. Skin cancer is more common in people with light colored skin who have spent a lot of time in the sunlight. Skin cancer can occur anywhere on the body, but it is most common in places that have been exposed to more sunlight, such as the face, neck, hands, and arms.

Types of Skin Cancer

Basal Cell Carcinoma is the most common type of skin cancer. It’s also the least dangerous kind. It tends to grow slowly, and rarely spreads beyond its original site. Though basal cell carcinoma is seldom life-threatening, if left untreated it can grow deep beneath the skin and into the underlying tissue and bone, causing serious damage particularly if it’s located near the eye.

Squamous Cell Carcinoma is the next most common kind of skin cancer, frequently appearing on the lips, face, or ears. It sometimes spreads to distant sites, including lymph nodes and internal organs. Squamous cell carcinoma can become life threatening if it’s not treated.

Malignant Melanoma is the least common, but its incidence is increasing rapidly. Malignant melanoma is also the most dangerous type of skin cancer. If discovered early enough, it can be completely cured.

Moles: There are two kinds of moles: normal moles - the small brown blemishes, growths, or "beauty marks" that appear in the first few decades of life in almost everyone - and atypical moles. Regardless of type, the more moles you have, the greater the risk for melanoma.

ABCD’s, of Skin Cancer

Early detection is the safest way to a cure.

Develop a regular routine to inspect your body for any skin changes. If any growth, mole, sore or skin discoloration appears suddenly or begins to change, see your skin specialist. Skin cancers can be treated if detected early.

A: Asymmetry

Asymmetry can be assessed by comparing one half of the growth to the other half to determine if the halves are equal in size. Unequal or asymmetric moles are suspicious.

B: Border

If the mole’s border is irregular, notched, scalloped, or indistinct, it is more likely to be cancerous (or precancerous) and is thus suspicious.

C: Color

Variation of color (e.g., more than one color or shade) within a mole is a suspicious finding. Different shades of browns, blues, reds, whites, and blacks are all concerning.

D: Diameter

Any mole that has a diameter larger than a pencil’s eraser in size (>6mm) should be considered suspicious.

Vitiligo is a condition in which your skin loses melanin, the pigment that determines the color of your skin, hair and eyes. Vitiligo occurs when the cells that produce melanin die or no longer form melanin causing slowly enlarging white patches of irregular shapes to appear on your skin.

It affects both sexes and all races, but is often more noticeable and more disfiguring in people with darker skin. Vitiligo usually starts as small areas of pigment loss that spread and become larger with time. These changes in your skin can result in stress and worries about your appearance.

Symptoms

The main sign of vitiligo is pigment loss that produces milky-white patches (depigmentation) on your skin. Other less common signs may include:

Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard

Although any part of your body may be affected by vitiligo, depigmentation usually develops first on sun-exposed areas of your skin, such as your hands, feet, arms, face and lips. Although it can start at any age, vitiligo often first appears between the ages of 20 and 30.

Vitiligo generally appears in one of three patterns:

• Focal. Depigmentation is limited to one or a few areas of the body.

• Segmental. Loss of skin color occurs on only one side of the body.

• Generalized. Pigment loss is widespread across many parts the body.

The natural course of vitiligo is difficult to predict. Sometimes the patches stop forming without treatment. In other cases, pigment loss can involve most of the surface of your skin.

Causes

Vitiligo occurs when melanin — the dark pigment in the epidermis that gives your skin its normal color — is destroyed or not produced. The involved patch of skin then becomes white. Why this occurs is unknown.

Doctors and scientists have theories as to what causes vitiligo. It may be due to an immune system disorder. Heredity may be a factor because there's an increased incidence of vitiligo in some families. Some people have reported a single event, such as sunburn or emotional distress, that triggered the condition. However, none of these theories has been proved as a definite cause of vitiligo.

When to seek medical advice

See your doctor if areas of your skin, hair or eyes lose coloring. Although there's no cure for vitiligo, treatments exist that may help to stop or slow the process of depigmentation and attempt to return some color to your skin.

Tests and diagnosis

If your doctor suspects you have vitiligo, he or she will ask about your medical history. Important factors in your medical history include:

• A family history of vitiligo

• A rash, sunburn or other skin trauma at the site of vitiligo within two to three months of the start of pigment loss

• Premature graying of the hair (before age 35)

• Stress or physical illness

In addition, your doctor needs to know whether you or anyone in your family has had an autoimmune disease and will ask if your skin is sensitive to the sun. He or she will examine you to rule out other medical problems or skin conditions, such as dermatitis or psoriasis.

Your doctor may take a small sample (biopsy) of your affected skin. He or she may take a blood sample to check your blood cell count and thyroid function. In some cases, your doctor may recommend an eye examination to check for inflammation in your eye (uveitis). A blood test to look for the presence of anti-nuclear antibodies (a type of autoantibody) also may be done to determine if you have an autoimmune disease.

Treatments

In some cases, medical treatment for vitiligo may not be necessary. Self-care steps, such as using sunscreen and applying cosmetic camouflage cream, may improve the appearance of your skin. For fair-skinned individuals, avoiding tanning can make the areas almost unnoticeable.

Depending on the number, size and location of the white patches, you may decide to seek medical treatment. Medical treatments for vitiligo aim to even out skin tone, either by restoring color (pigment) or destroying the remaining color.

Depending on the type of therapy, treatment for vitiligo may take from six to 18 months. Medical treatment choices are based on the number of white patches you have and how widespread they are. Each person responds differently to treatment, and a particular therapy may not work for you.