Advanced Skin Care

Dandruff Signs and Symptoms

The scalp is itchy and flakey.
One or more of the following areas may have patches of red, scaly skin: the scalp, hairline, forehead, eyebrows, eyelids, creases of the nose and ears, ear canals, beard areas, breastbone, midback, groin, or armpit.
In darker skin, affected areas may look lighter in color.
Mild dandruff – only some flaking with or without redness in a few small areas
Moderate dandruff – several areas affected with bothersome redness and itch
Severe dandruff – large areas of redness, severe itch, and unresponsive to self-care measures
Self-Care Guidelines
Most cases of dandruff are easy to control with non-prescription home measures. These include:
Frequent (daily) shampooing or a longer lather time.
Stopping use of any hairstyling products.
If a regular daily shampoo fails, consider an over-the-counter dandruff shampoo. There are several types (containing ketoconazole, selenium sulfide, 2% pyrithione zinc, salicylic acid, or tar), and one may work better than another. Sometimes one will work well for a time and then become less helpful; then it may help to switch to a different type.

To remove thick scale, apply warm mineral oil or olive oil and wash out several hours later with dishwashing liquid or a tar shampoo.

Cutaneous Horn Overview

A cutaneous horn, also known as cornu cutaneum, refers to a specific appearance of a skin lesion in which a cone-shaped protuberance arises on the skin caused by overgrowth of the most superficial layer of skin (epidermis). A cutaneous horn is not a particular lesion but is a reaction pattern of the skin. Approximately 40% of cutaneous horns represent precancerous lesions called actinic keratoses. Cutaneous horns may also overlie skin cancer. When overlying cancerous skin, squamous cell carcinoma is typically at the base of the cutaneous horn, but basal cell carcinoma is also possible.
Who's At Risk
Cutaneous horns most often occur in adults, usually elderly, fair-skinned individuals with a history of significant sun exposure.
Signs and Symptoms
A cutaneous horn most often occurs on sun-exposed areas and appears as a cone-shaped protuberance arising from a skin-colored to red/pink bump or flat lesion.
Self-Care Guidelines
None necessary.
When to Seek Medical Care
Seek medical evaluation if a cutaneous horn is noted. A biopsy may be needed to assess whether the lesion is benign, precancerous, or cancerous.
Treatments Your Physician May Prescribe
If the lesion is benign, no further treatment may be needed.

If the lesion is precancerous, the physician may:
Freeze the lesion with liquid nitrogen.
Use a topical chemotherapy agent, such as 5-Fluorouracil or a topical medicine that stimulates the immune system, imiquimod.
Scrape and burn (curettage and electrodesiccation) the lesion.

Cherry Hemangioma Signs and Symptoms

Cherry hemangiomas may be found on any body location. They range from a small, red, flat dot to a larger, round-topped, bright-cherry-red bump. Sometimes cherry hemangiomas are more purple than red in color. Rarely, a cherry hemangioma lesion demonstrates a dark brown to an almost black color.
Self-Care Guidelines
No self-care is needed except avoiding trauma, which may cause bleeding of the lesions.
When to Seek Medical Care
Cherry hemangiomas typically require no treatment, although lesions that are irritated or bleeding (most commonly occurring due to injury) usually require removal. Cherry hemangioma lesions can also be removed if they are cosmetically undesirable.
Treatments Your Physician May Prescribe
Lesions may be surgically removed by cutting away the area (excision), burning away the area (electrocautery), laser, or freezing the area (cryosurgery).

Chapped Lips (Cheilitis)

Chapped lips (cheilitis) are lips that appear dry, scaly, and may have one or more small cracks (fissures). Often, the lips are sensitive, and there may or may not be redness (erythema) and swelling (edema) present. Retinoids (isotretinoin and acitretin) are the most frequent drug-induced causes for chapped lips. Other drugs reported to have induced chapped lips include:
High doses of vitamin A
Lithium
Chemotherapeutic agents (busulfan and actinomycin)
D-penicillamine
Isoniazid
Phenothiazine
Other possible causes of chapped lips include high fevers as well as environmental conditions, such as cold weather, dehydration, and certain vitamin deficiencies.
Who's At Risk
Chapped lips may be seen in people of all ages. However, lip-licking cheilitis is usually seen in 7–15 year olds and is typically seen as a scaling, pink band around the mouth.
Signs and Symptoms
Chapped lips involves scaling (with or without fissures) and mild to moderate swelling of the lips.
Self-Care Guidelines
To treat chapped lips:
Discontinue use of the causing medications, if possible.
If medications cannot be discontinued, apply petroleum jelly as often as needed.
Avoid lip licking because this will only worsen the condition.
Avoid "medicated" lip preparations because they increase the risk of developing an allergic reaction.

Capillaritis

Capillaritis is characterized by leakage of red blood cells from small, superficial blood vessels that results in pinpoint-like hemorrhages (petechiae). Capillaritis is frequently found in patients with long periods of extended standing related to their occupations. A skin hypersensitivity reaction, salicylates and nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly associated origins of capillaritis, though the precise cause is unclear. Capillaritis is usually a life-long condition, flaring intermittently.

Signs and Symptoms

The most common location for capillaritis is the leg, though it may manifest on the trunk and upper extremities. Capillaritis never presents on the face. Presentation may include:
Brown-red or deeply pigmented, pepper-like petechiae in dark-skinned individuals
Cayenne-pepper–colored petechiae in lighter-skinned individuals
Color variations in the lesions due to different stages of blood breakdown product (hemosiderin) reabsorption

Bug Bite or Sting
Signs and Symptoms
Insect bites usually appear as small, itchy, red bumps, occasionally with a blister. Very young children may be more prone to developing blisters than older children. Some insects, such as fire ants, can cause a painful and itching raised area containing pus (a pustule).

Flying insects tend to bite exposed areas not covered by clothing, while some bugs (such as fleas) focus on the lower legs. Bedbugs prefer the head and neck area, often biting several times in the same area and leaving a group of lesions.

Common reactions to arthropod stings may include:
Redness, pain, and swelling
Severe reactions such as facial swelling, difficulty breathing, and shock
(anaphylaxis)
Fever, hives, and painful joints (although these reactions are not as common)
Very few spiders cause severe reactions. The black widow spider may cause only a mild reaction at the bite site, but pain, stiffness, chills, fever, nausea, and abdominal pain may follow within a few hours. Similarly, the brown recluse spider bite may cause a severe skin reaction after a few hours, with redness, pain, blistering, and ulcers forming, as well as fever, nausea, and fatigue.

Bedbug Bite Signs and Symptoms

The morning after being bitten the bedbug, you may notice an itchy hive-like bump at the site of the bite mark, which will go away through the course of the day. There may or not may not be a visible bite mark in the center of the bump. After that, what start as small bruise-like areas turn into red, intensely itchy bumps on the exposed parts of the body (arms, legs, chest, and sometimes the face). There may be a clustered configuration of 3 bites in a line (commonly known as "breakfast, lunch, and dinner"). Resolution takes about 2 weeks and leaves some darkening of the skin (post-inflammatory hyperpigmentation).

You may see tell-tale signs of the bedbug's presence, such as blood stains on the sheets, flecks of bedbug dung on or around your bed, or you may smell a sweet odor that occurs when there is a large bedbug infestation. You may be able to spot a moving bedbug if you are searching at night.
Self-Care Guidelines
The management of bedbug bites includes removing the bedbug infestation and controlling the itching.

The best time to look for live bedbugs is the middle of the night, when they come out to feed. Wash all linens in hot water and dry in a hot dryer. You may also need to wash your curtains. Scrub furniture to remove eggs, and fix any cracks that may be in the furniture; you may need to take the furniture apart to do this well. Vacuum the room, including the mattress (concentrating on the seams) and any surrounding crevices. You may want to fill and seal any cracks around the room and paste down any rolling wallpaper seams. Check the adjoining rooms for bugs as well, even if the occupants don't complain of itching.

Sometimes, in cases of severe infestation, it may be best to have a licensed pest control agent inspect and eradicate the bedbugs. Be aware that some insect repellants can be toxic to children, so make sure to find out exactly what chemicals they will be using and what the chemical's risk profile is.

Diphenhydramine (Benadryl®) can be used to control the itching. A low-strength topical corticosteroid cream or ointment, such as hydrocortisone, can be purchased over the counter to help with itching.

Basal Cell Carcinoma (BCC)

Signs and Symptoms
The most common location for basal cell carcinoma is on sun-damaged skin, especially the following areas:
Face
Head
Neck
Chest
Upper back
However, basal cell carcinomas can occur on any part of the skin, except for the palms and soles.

Nodular basal cell carcinomas are described as "pearly" in appearance. They are usually skin-colored or pink bumps, and tiny blood vessels (telangiectasias) can frequently be seen on their surfaces. As a basal cell carcinoma grows, it can develop a shallow depression in its center, and bleeding with minor trauma can occur.

Infiltrating or morpheaform BCCs tend to appear as scar-like growths on the skin. They can be slightly shiny, and sometimes have telangiectasias, sores (erosions), or scabs on their surfaces. These skin changes can be subtle.

Superficial BCCs often appear as pink or red dry, scaly spots. They slowly enlarge and may develop a raised edge. Often, people mistake a superficial BCC as a dry patch of skin or a non-itching rash that won't go away. This subtype of BCC is most often found on the trunk (chest or upper back), arms, or legs.
Self-Care Guidelines
Preventing sun damage is crucial to avoiding the development of a basal cell carcinoma. Wearing a broad-spectrum sunscreen with SPF 30 or higher and donning wide-brimmed hats and long-sleeved shirts can help avoid some sun exposure. In addition, staying out of the sun in the middle of the day (between 10:00 AM and 3:00 PM) can be helpful.

If you suspect that you may have a basal cell carcinoma, you should see your primary care provider or a dermatologist as soon as possible. There are no effective self-care treatment options.

Once a month, you should perform a self-exam to look for signs of skin cancer. It is best to perform the exam in a well-lit area after a shower or bath. Use a full-length mirror with the added assistance of a hand mirror when necessary. Using a hair dryer can help you examine any areas of skin covered by hair, such as your scalp.

In front of a full-length mirror, inspect the front of your body making sure to look at the front of your neck, chest (including under breasts), legs, and ge****ls.
With your arms raised, inspect both sides of your body making sure to examine your underarms.
With your elbows bent, examine the front and back of your arms as well as your elbows, hands, fingers, area between your fingers, and fingernails.
Inspect the tops and bottoms of your feet, the area between your toes, and toenails.
With your back to the mirror and holding a hand mirror, inspect the back of your body, including the back of your neck, shoulders, legs, and buttocks.
Using a hand mirror, examine your scalp and face.
As you perform your monthly self-exam, familiarize yourself with the moles, freckles, and other marks on your body, and look for any changes in them from month to month, including shape, size, color, or other changes, such as bleeding or itching.

Athlete's Foot (Tinea Pedis)

Athlete's foot (tinea pedis), also known as ringworm of the foot, is a surface (superficial) fungal infection of the skin of the foot. The most common fungal disease in humans, athlete's foot, may be passed to humans by direct contact with infected people, infected animals, contaminated objects (such as towels or locker room floors), or the soil.

Who's At Risk
Athlete's foot may occur in people of all ages, of all races, and of both sexes. However, athlete's foot is more common in males than in females. Children rarely develop athlete's foot.

Some conditions make athlete's foot more likely to occur:
Living in warm, humid climates
Using public or community pools or showers
Wearing tight, non-ventilated footwear
Sweating profusely
Having diabetes or a weak immune system
Signs and Symptoms
The most common locations for athlete's foot include:
Spaces (webs) between the toes, especially between the 4th and 5th toes and between the 3rd and 4th toes
Soles of the feet
Tops of the feet
Athlete's foot may affect one or both feet. It can look different depending on which part of the foot (or feet) is involved and which fungus (ie, dermatophyte) has caused the infection:
On the top of the foot, athlete's foot appears as a red scaly patch or patches, ranging in size from 1 to 5 cm. The border of the affected skin may be raised, with bumps, blisters, or scabs. Often, the center of the lesion has normal-appearing skin with a ring-shaped edge, leading to the descriptive but inaccurate name ringworm. (It is inaccurate because there is no worm involved.)
Between the toes (the interdigital spaces), athlete's foot may appear as inflamed, scaly, and soggy tissue. Splitting of the skin (fissures) may be present between or under the toes. This form of athlete's foot tends to be quite itchy.
On the sole of the foot (the plantar surface), athlete's foot may appear as pink-to-red skin with scales ranging from mild to widespread (diffuse).
Another type of tinea pedis infection, called bullous tinea pedis, has painful and itchy blisters on the arch (instep) and/or the ball of the foot.
The most severe form of tinea pedis infection, called ulcerative tinea pedis, appears as painful blisters, pus-filled bumps (pustules), and shallow open sores (ulcers). These lesions are especially common between the toes but may involve the entire sole. Because of the numerous breaks in the skin, lesions commonly become infected with bacteria. Ulcerative tinea pedis occurs most frequently in people with diabetes and others with weak immune systems.

Anthrax Signs and Symptoms

Cutaneous Anthrax
Characteristic rash*
*The characteristic rash of anthrax looks like pink, itchy bumps that occur at the site where B. anthracis comes into contact with scratched or otherwise open skin. The pink bumps progress to blisters, which further progress to open sores with a black base (called an eschar). The early rash (the pink, itchy bumps) looks like many other rashes, so a history of exposure to the bacterium will be important to making the diagnosis. The eschar is more characteristic of anthrax infection, but if diagnosis and treatment are delayed until the eschar appears, the prognosis is poor.

Treatments Your Physician May Prescribe
Your doctor can diagnose anthrax by testing your blood, respiratory secretions, or wounds. The diagnosis may be difficult to make without history of exposure, so be sure to tell your doctor if you think you may have come into contact with B. anthracis or if you meet any of the above risk factors.

Anthrax is treated with common antibiotics. If you have been exposed but are not yet sick, you will get the anthrax vaccine. (This vaccine is available only to people in the military, people who work with B. anthracis, and people who have been exposed to B. anthracis.) If you are infected, you will take a long course of antibiotics.

Actinic Keratosis (Solar Keratosis)

Signs and Symptoms
The sun-exposed areas of the face, scalp (where balding), ears, neck, forearms, and backs of the hands are most commonly affected with actinic keratoses, but any skin area frequently exposed to sun can be involved.

Patches are usually less than an inch in size with slight scale (sometimes thick like a wart) and a pink, red, or brownish color. They are slightly rough to the touch, like fine sandpaper, and may be a bit sensitive.
Mild – one or two spots, not thick or hard
Moderate – scattered, few spots
Severe – numerous or thick, hard, or bleeding spots
Self-Care Guidelines
Prevention is very important. Sun protection can reduce the number of new areas occurring and may help small lesions go away on their own.
Avoid direct sun in the middle of the day (10 AM to 3 PM). Remember: snow and water reflect light to the skin, and clouds still let a lot of light through, so you may still be exposed to ultraviolet light even on cloudy days.
Use a hat with a wide brim. A baseball hat does not give much protection.
Cover up with tightly woven clothing. Some manufacturers make specialty clothing with a high sun protection factor (SPF) rating, or you can purchase a special ingredient to be added to your washer that can "wash" SPF into your clothing.
Use sunscreen on all exposed skin areas, including the lips, before going outdoors. A broad spectrum (blocks UVB and UVA light), with an SPF of at least 30, is best. Apply generously 30 minutes before going outdoors and reapply every 2 hours or after swimming or sweating a lot.
Do not use tanning beds!
A low-fat diet (less than 21% calories from fat) has been shown to reduce the incidence of actinic keratoses.
Once a month, you should perform a self-exam to look for signs of skin cancer. It is best to perform the exam in a well-lit area after a shower or bath. Use a full-length mirror with the added assistance of a hand mirror, when necessary. Using a hair dryer can help you examine any areas of skin covered by hair, such as your scalp.
In front of a full-length mirror, inspect the front of your body making sure to look at the front of your neck, chest (including under breasts), legs, and ge****ls.
With your arms raised, inspect both sides of your body making sure to examine your underarms.
With your elbows bent, examine the front and back of your arms as well as your elbows, hands, fingers, area between your fingers, and fingernails.
Inspect the tops and bottoms of your feet, the area between your toes, and toenails.
With your back to the mirror and holding a hand mirror, inspect the back of your body, including the back of your neck, shoulders, legs, and buttocks.
Using a hand mirror, examine your scalp and face.
As you perform your monthly self-exam, familiarize yourself with the moles, freckles, and other marks on your body, and look for any changes in them from month to month, including shape, size, color, or other changes, such as bleeding or itching.

Hair Loss (Alopecia Areata)

Signs and Symptoms
Hair loss most commonly occurs on the scalp, but it can also target the eyebrows, eyelashes, beard, and other body sites. Symptoms may include the following:
Round, patchy areas of non-scarring hair loss, ranging from mild to severe
Mild: 1–5 scattered areas of hair loss on the scalp and beard
Moderate: More than 5 scattered areas of hair loss on the scalp and beard
Severe: loss of all of the hair on the scalp and body
Scalp burning (without redness), accompanying lesions
Pitting and ridging of the fingernails
Hairs that do grow back often lack color, or may be either temporarily or permanently white. This hypopigmentation is not seen in other forms of alopecia.
Self-Care Guidelines
Psychological support may be beneficial.

Wigs may be worn to camouflage hair loss.
When to Seek Medical Care
Those experiencing areas of patchy hair loss are advised to seek evaluation from a primary care provider or dermatologist.
Treatments Your Physician May Prescribe
Both topical and systemic medications may be prescribed, as well as injections. Treatments include:
Localized steroid injections (to help speed regrowth)
Clobetasol propionate gel or solution, a potent topical steroid
Anthralin cream, a topical irritant
Light therapy
Topical steroids plus minoxidil (Rogaine®)
Systemic steroids, such as prednisone, though they have no long-term benefit and are not recommended for use beyond the short-term