Ebony Skin.Net

Definition: A velvety thickening & hyperpigmentation of the skin which mainly occurs in the skin of the axilla, groin, & nape. Less common areas are the areolae, submammary region, hands, and umbilicus.
Etiology: Related to factors of hereditary, diabetes, obesity, certain drugs (nicotinic acid, corticosteroids), and malignancy (gastrointestinal/genitourinary).
Clinical Features: Skin is thick and velvety, appears dirty, and has accentuated skin lines. Affects the axilla, groin, and nape.
Clinical Approach: Diabetes must be ruled out. Obesity must me assessed. In the absence of both an underlying malignancy, most commonly stomach cancer, must be investigated.
Treatment: Treat the underlying disorder. Lose weight, control diabetes, stop exacerbating drugs, or treat underlying malignancy. Topical retinoids and salicylic acid have some success in the cosmetic treatment of these lesions.

Definition: “Keloidlike” papules and plaques on the occipital scalp and the posterior part of the neck, almost exclusively in African American men.
Etiology: Not really known. Believed to be due injury caused by short haircuts along with a chronic low-grade bacterial infection. Exacerbating factors are the curvature of the hair & follicle along with the course nature of black hair.
Clinical Features: Initially itchy round small bumps appear within or close to the hair-bearing area of the back of the neck (occipital scalp). Sometimes there are pustules around the hair follicles (folliculitis). If untreated, as time goes on the bumps form small scars and then the small scars may greatly enlarge to become keloids. The scars are hairless and can form a band along the hairline.
Clinical Approach: A bacterial culture and sensitivity from any pustular or draining lesions should be taken intermittently. If pathogens are present, appropriate antibiotics should be prescribed.
Treatment: The first line of defense against AKN is prevention. People with AKN should not get the occipital part of their hairline edged with a razor. Reduce inflammation of follicles with topical/intralesional steroids, as well as treat underlying bacterial infection with oral/topical antibiotics. If scar formation occurs, surgery may be the final option.

Definition: Sunlight induced pre-cancerous lesions.
Etiology: Prolonged and repeated sun exposure in susceptible persons.
Clinical Features: Multiple, sharply bordered, irregular erythematous patches and papules with an adherent scale. Always on sun-exposed areas (face, scalp, arms, & hands). Have a “sandpaper” texture.
Clinical Approach: Diagnosis made on history and clinical findings.
Treatment: Freezing with liquid nitrogen. Curettage or electrodesiccation with a local anaesthetic. Surgical excision. Topical treatment with 5-Fluorouracil.

Definition: A multifactorial disorder resulting in the chronic inflammation of the pilosebaceous unit of certain body areas. Most commonly the face and trunk. Manifests as comedones, papules, nodules, and cysts. Can often result in pitted, depressed, or hypertrophic scars.
Etiology: Five major factors are involved in the cause of acne: abnormal keratinization of the hair follicle, increased steroid production (androgens), excess sebum production, bacteria (Propionibacterium acnes), and host immune response.
Clinical Features: Acne is classified into 5 grades, based on the predominant type of lesion:
Grade 1 — primarily comedonal
Grade 2 — inflammatory papules and pustules
Grade 3 — nodules/cysts
Grade 4 — severe scarring
Grade 5 — acne conglobata with sinus tracts

Clinical Approach: Comedones are required for a diagnosis of any type of acne. The patients past/present skin regimen should be elicited.
Treatment: : The principles of acne therapy aim to counter the five major factors in acnegenesis by correcting altered follicular keratinization, decreasing androgenic effects, reducing sebum production, inhibiting growth of P. acnes, and modulating the host response. Available treatments include topical/oral retinoids, azelaic acid, keratolytic agents, antibiotics, benzoyl peroxide, sulfones, antiandrogens/estrogens and glucocorticoids.

Definition: The rapid swelling (edema) of the skin, mucosa and submucosal tissues.
The skin of the face, normally around the mouth, and the mucosa of the mouth and/or throat, as well as the tongue, swell up over the period of minutes to several hours. Etiology: Most common triggers are food preservatives & additives, certain dyes, and ACE inhibitor medications. Often a trigger similar to ones causing urticaria, and often a trigger is never found. Hereditary cause due to a defect in C1-esterase inhibitor, leading to unchecked complement activation and recurrent subcutaneous and mucosal swelling.
Clinical Features: Can present anywhere, but most commonly involves mouth, face, and neck. Many patients have massive facial swelling. Involvement of the tongue of neck can lead to airway obstruction. Thus angioedema is a life-threatening situation.
Clinical Approach: A detailed history (previous diseases, drugs, foods, parasite infections, physical exertion) is extremely important. Type, duration, and symptoms of lesions. Also must rule-out a family history of Hereditary Angioedema.
Treatment: This is considered a medical emergency! Patient should be admitted to the hospital. Treatment consists of antihistamines and intravenous corticosteroids.

Definition: Fungal Infection of the feet and toes.
Etiology: Infections favored by poor hygiene, increased sweating, occlusive footwear. Swimming pool, community showers, and saunas are likely sources of infection.
Clinical Features: 4 possible clinical presentations of Tinea Pedis:
1) Interdigital - The interdigital presentation is the most characteristic type of tinea pedis, with erythema, maceration, fissuring, and scaling, most often seen between the fourth and fifth toes. This type is often accompanied by pruritus.
2) Chronic hyperkeratotic - This type is also called moccasin tinea pedis, after its moccasinlike distribution. Both feet are usually affected. Typically, the dorsal surface of the foot is clear, but, in severe cases, the condition may extend onto the sides of the foot.
3) Inflammatory/vesicular- Painful, pruritic vesicles or bullae, most often on the instep or anterior plantar surface, characterize the inflammatory/vesicular type. The lesions can contain either clear or purulent fluid; after they rupture, scaling with erythema persists.
4) Ulcerative- The ulcerative variety is characterized by rapidly spreading vesiculopustular lesions, ulcers, and erosions, typically in the web spaces, and is often accompanied by a secondary bacterial infection. This type is commonly seen in immunocompromised and diabetic patients.

Clinical Approach: Most diagnoses made on clinical suspicion. However, Wood’s Lamp can be used, skin scrapings for Direct Microscopy, or a fungal culture may be performed to confirm the diagnosis and to identify the pathogenic species of fungus.
Treatment: The treatment of Athlete foot can be divided into two parts. The first, and most important part, is to make the infected area less suitable for the Athlete foot fungus to grow. This means keeping the area clean and dry. This consists of absorbent socks that wick water away from your feet such as cotton socks, and powders, especially medicated powders (such as with miconazole or tolnaftate), can help keep your feet dry. The second part of treatment is the use of antifungal creams. Many medications are available including miconazole, clotrimazole, etc. Treatment should be continued for 4 weeks.

Definition: Also known as atopic dermatitis it is an atopic, hereditary, and non-contagious skin disease characterized by chronic inflammation of the skin.
Etiology: Although a very common disease, relatively little is understood about the underlying causes of eczema. Although it is an inherited disease, eczema is primarily aggravated by contact with or intake of allergens. It can also be influenced by other "hidden" factors such as stress or fatigue. Eczema consists of chronic inflammation and often occurs in people with a history of allergy disorders such as asthma or hay fever.
Clinical Features: Presents with pruritic, scaly, erythematous plaques. Follicular papules are more commonly seen in Blacks. Distribution involves the extensor surfaces and face in children, and flexural surfaces in adolescents and children ( insides of elbows and knees). Significant post-inflammatory hyperpigmentation is more common in Blacks. Symptoms of eczema appear to improve with age.
Clinical Approach: Elicit a family history of allergy disorders. Assess skin changes varying with age of patient. Prick testing with various foods and allergens, as well as patch testing with common allergens.
Treatment: Patient education. Routine skin care with emollient creams or ointments. Topical anti-inflammatory agents (steroidal/non-steroidal). Systemic antihistamines for itching. Most importantly, Avoid Triggers !!!

Definition: The most common skin cancer in the white population. It can be destructive and disfiguring. It is rarely life-threatening, but if left untreated, can be disfiguring, cause bleeding, and produce local destruction (e.g., eye, ear, nose, lip). Seen less in black skin, due to high melanin higher content allowing greater UV protection.
Etiology: The main trigger appears to be UVB rays. However there is a genetic component. About 2/3 of basal cell carcinomas occur on sun-exposed areas of the body. 1/3 occur on areas of the body that are not exposed to sunlight, more common in Blacks, emphasizing the genetic susceptibility of the basal cell cancer patients.
Clinical Features: Basal cell carcinomas present as a firm nodule, clearly growing within the skin and below it, rather than on the surface. Color varies from that of normal skin to dark brown or black, but there is a characteristic "pearly white" translucent quality on the periphery. Basal cell carcinomas display a characteristic "rolled edge". Various forms recognized.

Nodular: flesh-colored papule with telangiectasis; if it ulcerates, it becomes a "rodent ulcer" (an ulcerating nodule with a pearly border).
Cystic: rarer and difficult to distinguish from the nodular form, which has a central cavity with fluid
Pigmented: a variant of the nodular form that may be confused with melanoma. This is the most common seen in Blacks!
Sclerosing/cicratising: a scar-like lesion
Superficial: a red scaling patch.

Clinical Approach: Clinical examination and biopsy. Dermoscopy is very helpful for pigmented or atypical BCC’s. Fortunately BCC is a straight forward pathological diagnosis, even when clinical questions exist.
Treatment: The aim is complete removal and thus a 100% cure. Removal can be done by surgical excision, curettage & electrodessication, laser ablation, or radiation therapy.

Definition: A birthmark is a blemish on the skin formed before birth that ranges in color from brown or black to bluish or blue-gray. They are part of the group of skin lesions known as naevi or moles.
Etiology: The cause of birthmarks is unknown, but may include cellular damage due to radiation or chemicals. Some types seem to run in families.
Clinical Features: A number of different types of birthmarks are known that include, but are not limited to, stork bites, Mongolian blue spots, strawberry marks, café au lait spots, congenital melanocytic nevi, and port-wine stains.
Clinical Approach: Large moles present at birth (congenital nevi) are more likely to become skin cancer (malignant melanoma). This is especially true if the mole covers an area larger than the size of a fist. All congenital nevi should be examined by a health care provider, and any change in the birthmark should be reported. Watch for changes in the size or color, or sudden ulceration, bleeding, or itching in the birthmark.
Treatment: Treatment varies depending on the type of birthmark and associated conditions. Usually no treatment is required for the birthmark itself. However, Moles may be removed surgically if they affect the appearance or if they have an increased cancer risk.

Definition: A deep or ulcerative bacterial infection of the skin characterized by ulcers on the buttocks or legs of children.
Etiology: Skin bacterial organisms grow in excoriations, insect bites, and sites of trauma.
Clinical Features: Very tender vesicles or pustules progressing to an ulcer with subsequent scar formation. Most commonly seen in ankles, thighs, and buttocks.
Clinical Approach: Diagnosis is made by history & clinical examination, and confirmed by bacterial culture.
Treatment: Warm soaks to remove crusts. Topical and systemic antibiotics directed at cultured pathogen.

Definition: An acute, deep-seated, red hot, very tender, inflammatory nodule that evolves from a bacterial folliculitis. A carbuncle is a large plaque resulting from the coalescing of multiple furuncles.
Etiology: Begins as a folliculitis that becomes deeper and larger from friction or irritation.
Clinical Features: Begins as a firm red nodule that is extremely tender and fluctuant. Eventually ruptures into an ulcer with an erythematous halo. Most commonly occur on the neck, face, axillae, groin, and upper back.
Clinical Approach: Usually a clinical diagnosis. Diagnosis of Hidradenitis Supprativa must be ruled out clinically. In difficult diagnosis, an incision & drainage should be done for culture and antibiotic sensitivity.
Treatment: Use antibacterial soaps and topical antiseptics. In addition, when fluctuant, incision & drainage with systemic antibiotics.

Definition: Describes a condition that occurs in men and women where the skin of the lower limbs, abdomen, and pelvic region becomes dimpled with an “orange peel” appearance.
Etiology: The causes are poorly understood, and several changes in metabolism and physiology may cause cellulite or contribute to cellulite. Among these include:
Edema - Premenstrual water retention is a common phenomenon associated with the menstrual cycle.
Hormonal - Oestrogen initiates and aggrivates cellulite by encouraging the development and growth of fat cells around the buttocks, thighs and breast.

Genetic factors - Several genetic factors have been shown to be necessary for cellulite to develop. Gender - Around 85% of females display some degree of cellulite. It is rarely seen in males and usually in males
Diet - Excessive amounts of fat, carbohydrates, salt or too little have been shown to impact the development and amount of cellulite.
Lifestyle - Lack of exercise , tight clothes, high heeled shoes, and sitting or standing in a single position for long periods of time have all been associated with an increase in cellulite due to bad circulation which results in lack of oxygen to the cells and also a poor lymphatic system.
Pregnancy - Our bodies change drastically during pregnancy, certain hormones and fluid retention are increased and can lead to cellulite.

Clinical Features: Collections of fat push against the connective tissue in the subcutaneous layer of skin, which causes the surface of the skin to dimple or pucker and look lumpy or “cottage cheese-like”.
Clinical Approach: Diagnosis made on physical exam.
Treatment: Whatever the cause of cellulite, it's important to know that there aren't any miracle treatments. Treatments like liposuction (surgery to remove fat) and mesotherapy (injection of drugs into cellulite) may produce only temporary improvement. If you decide that you want to try to reduce the amount of cellulite you have, the best thing to do is to decrease excess body fat. Experts agree that an exercise routine that combines aerobic exercise with strength training is the best weapon against cellulite.

Definition: A highly contagious primary infection caused by varicella virus. Often associated with fever and malaise (general feeling of unease and discomfort).
Etiology: Varicella-zoster virus.
Clinical Features: Rash usually appears less than two weeks after exposure to the virus and begins as superficial spots. These spots quickly turn into small liquid-filled blisters that break open and crust over. New spots continue to appear for several days and may number in the hundreds. Itching may range from mild to intense. In adults, the rash may be preceded or accompanied by fever, decreased appetite, headache, or flu-like symptoms. In healthy children, the disease is generally mild.
Clinical Approach: Diagnosis made on physical exam.
Treatment: Immunization as prevention. Drying lotions (calamine) and antihistamines for itch. Systemic acyclovir may reduce course of disease.

Definition: Chloasma, known as the “mask of pregnancy”. Occurs in pregnancy and appears as a blotchy, brownish pigmentation on the face that develops slowly and fades with time. The pigment often fades a few months after delivery.
Etiology: The pigmentation is due to hormonal (estrogen) influence on melanin, the cells responsible for pigment. Causes the overproduction of melanin by the pigment cells.
Clinical Features: Melasma affects the forehead, cheeks and upper lips resulting in macules (freckle-like spots) and larger patches. Occasionally it spreads to involve the sides of the neck, and a similar condition may affect the shoulders and upper arms.
Clinical Approach: Melasma is usually diagnosed visually or with assistance of a Wood's lamp. Under Wood's lamp, excess melanin in the epidermis can be distinguished from that of the dermis.
Treatment: The discoloration usually disappears spontaneously over a period of several months after giving birth. Topical depigmenting agents (hydroquinones) which inhibit melanin production, topical retinoids, and chemical peels.

Definition: Is a yellowish, patchy, greasy, scaly and crusty skin rash that occurs on the scalp of recently born babies. It is usually not itchy, and does not bother the baby. Cradle cap most commonly begins in the first 3 months.

Clinical Features: The rash is often prominent on the scalp and around the ears, eyebrows, or eyelids. It may appear in other locations as well, where it is called seborrhoeic dermatitis rather than “cradle cap”.
Clinical Approach: Diagnosis is made by history & clinical examination. The cause of cradle cap is not clearly defined but it is not caused by infection, allergy or poor hygiene. Possibly it has to do with overactive sebaceous glands in the skin of newborn babies, due to the mother's hormones still in the baby's circulation. The glands release a greasy substance that makes old skin cells attach to the scalp as they try to dry and fall off. There may be a relationship with skin yeasts (malassezia).
Treatment: Remove crusts with olive oil compresses, followed by antifungal shampoo, and application of corticosteroid creams.

Definition: Is due to the excessive shedding of dead skin cells from the scalp
Etiology: The top layer on the scalp continually replaces itself, cells are pushed outward where they eventually die and flake off. In most people, these flakes of skin are too small to be visible. However dandruff causes cell turnover to be unusually rapid, especially in the scalp. For people with dandruff, skin cells may mature and be shed in 2 - 7 days, as opposed to around a month in people without dandruffClinical Features:
Clinical Approach: . Dead skin cells are shed in large, oily clumps, which appear as white or grayish patches on the scalp, skin, and clothes.
Treatment: Medicated “dandruff” shampoos containing zinc pyrithione, selenium sulphide, tar, or antifungals.

Darier’s Disease
Definition: It is a rare genetic disorder that is manifested predominantly by skin changes in areas that are abundant in sebaceous glands (face, neck, & upper chest)
Etiology: It is an autosomally dominant inherited disease. Family members can exhibit differences in the clinical severity of disease, suggesting that other genes or environmental factors affect the expression of Darier's disease.
Clinical Features: The skin lesions are characterised by persistent, greasy, scaly papules (small bumps) which tend to occur over the seborrhoeic areas of the face (scalp margins, forehead, ears, around the nostrils and sides of nose, eyebrows, and beard area), neck, and central chest and back. The flexures (within natural folds of the skin around joints such as armpits and groins) and skin under breasts and between buttocks are also commonly affected. The papules have a firm, harsh feel like coarse sandpaper and may be skin-coloured, yellow-brown or brown in colour. If several of the small papules grow together they may form larger warty lesions which can become quite smelly within skin folds. The rash can be aggravated by heat, humidity, and exposure to sunlight.
Clinical Approach: Clinical history and biopsy can aid in diagnosis.
Treatment: Treatment of choice for severe cases is oral retinoids. During flares, topical or oral antibiotics may be administered. Cyclosporin and topical corticosteroids have been used during acute flares. Some patients are able to prevent flares with use of topical sunscreens and oral vitamin C.

Dermatomyositis
Definition: Dermatomyositis (DM) is an idiopathic inflammatory muscle disorder with characteristic skin findings.
Etiology: Dermatomyositis belongs to a group of conditions called inflammatory myopathies. The cause of most inflammatory myopathies is unknown. Doctors suspect that inflammatory myopathies are autoimmune disorders, in which your immune system turns against normal body components.

Clinical Features: The most common signs and symptoms of dermatomyositis include:

A violet-colored or dusky red rash, most commonly on your face, eyelids, and areas around your nails, knuckles, elbows, knees, chest and back. Affected areas are typically more sensitive to sun exposure.
Progressive and symmetrical muscle weakness
Difficulty swallowing (dysphagia).
Muscle pain or tenderness.
Fatigue, fever and weight loss.
Hardened deposits of calcium under the skin (calcinosis), especially in children.
The skin rash usually occurs at the same time as muscle weakness. In some children with dermatomyositis, the skin may become thick and hard in a way similar to scleroderma. When this happens, the condition is called sclerodermatomyositis.

Clinical Approach: Sometimes, the skin rash alone determines the diagnosis. However, often certain lab investigations are needed to confirm the diagnosis.
Electromyography uses electrical activity to confirm a muscle disease.
Blood analysis. A blood test will let your doctor know if you have elevated levels of muscle enzymes, such as creatine kinase (CK) which elevated levels can indicate muscle damage.
Muscle biopsy may reveal abnormalities in your muscles, such as inflammation, damage or infection.
Treatment: Although there's no cure for dermatomyositis, treatment can improve your skin, muscle strength and function. Methods of therapy include Corticosteroids, Immunosuppressants, Antimalarial medications, Intravenous immunoglobulin (IVIg), and Physical therapy.

Definition: A benign cutaneous condition common among blacks. Characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adult blacks. Often cosmetically undesirable to patients.
Etiology: Unknown, but a strong family history suggests a genetic propensity.
Clinical Features: Characterized by multiple, firm, smooth, dark brown to black, flattened papules that measure 1-5 mm in diameter. Lesions occur mainly on the face and forehead, although they also may be found on the neck, upper back, and chest. Some patients have similar lesions on the upper trunk.
Clinical Approach: DPN is generally a clinical diagnosis and is only rarely confused with a cancerous lesions (melanoma). A skin biopsy would be helpful in such cases.
Treatment: No treatment generally is indicated for DPN unless lesions are cosmetically undesirable. Electrodesiccation has been shown to be the most effective treatment. Anaesthetic creams are effective for providing topical anesthesia.

Definition: An adverse drug reaction that consists of unwanted, negative consequences associated with the use a given medication. An adverse reaction to a drug that is manifested in the skin. Cutaneous drug reactions occur when your skin has a reaction to a drug you are taking. A red, itchy rash and hives are the most common reactions; however, there are many different types, and some can be life-threatening.
Etiology: Drugs that most frequently cause problems include sulfa drugs, antibiotics such as penicillins and tetracyclines, and phenytoin (a drug that prevents convulsions). Other drugs can also cause adverse reactions.
Clinical Features: Reactions vary and can range from red, itchy rash or blotches, hives, acne-like eruptions, pigmentation changes, dry, cracked skin as in eczema, peeling, or even skin tissue death (necrosis).
Clinical Approach: Your health care provider will examine your skin, mouth, and throat. You should make a list of all the drugs (prescription, nonprescription, and illegal) and herbal and vitamin supplements you've taken over the last four weeks.
Treatment: Choice of treatment depends on the type of reaction you are having and how serious it is. Symptoms will often disappear once you stop taking the suspected drug or take it at a lower dosage. However, you may need treatment to recover. Your health care provider may prescribe drugs to help stop the reaction, such as epinephrine, corticosteroids, antihistamines, or topical ointments. If you also have life-threatening symptoms, such as trouble breathing, you will be hospitalized until you are stable.
Dysplastic Nevis Syndrome

Definition: Is an atypical mole; a mole whose appearance is different from that of common moles.
Etiology: Is an autosomal dominant hereditary condition which causes the person to have a large quantity of nevi (moles), often 100 or more.
Clinical Features: Dysplastic nevi are generally larger than ordinary moles and have irregular and indistinct borders. Their color frequently is not uniform and ranges from pink to dark brown; they usually are flat, but parts may be raised above the skin surface. Dysplastic nevus can be found anywhere, but are most common on the trunk in men, and on the calves in women.
Clinical Approach: When an atypical mole has been identified, a biopsy takes place in order to best diagnose it. Local anesthetic is used to numb the area, then the mole is biopsied. The biopsy material is then sent to a laboratory to be evaluated by a Pathologist.
Treatment: Because melanomas may develop de novo on the skin and because the risk of any one AM developing malignant transformation is low, the prophylactic removal of all AMs does not prevent the development of melanoma and is not recommended. Changing lesions and any lesion worrisome for melanoma must be removed.

Definition: is the increase of interstitial fluid in any organ — swelling. Edema is usually of the legs, due to the accumulation of excessive fluid in the tissues. The edema that occurs in diseases of the heart, liver, and kidneys is mainly caused by salt retention, which holds the excess fluid in the body.
Etiology: Has 5 pathophysiologic causes. It can be due to increased hydrostatic pressure, reduced oncotic pressure, lymphatic obstruction, sodium retention, or inflammation.
Clinical Features: Usually swelling of the distal legs with “pitting edema”.
Clinical Approach: Medical history questions documenting swelling in detail may include the following:

Time pattern
Quality
Location
Other

What seems to make the swelling better?
What seems to make the swelling worse?
What other symptoms are also present?

Treatment: Edema cannot be cured. The only way to treat edema is to treat the condition that is causing it. The following are some things you can do to keep the swelling down:

Put a pillow under your legs when you are lying down.
Wear support stockings, which you can buy at most drugstores. Support stockings put pressure on your legs and keep water from collecting in your legs and ankles.
Do not sit or stand for too long without moving.
Follow your doctor's orders about limiting how much salt you eat.

Your doctor might want you to take a medicine called a diuretic, which is also called a water pill.

Definition: a group of inherited disorders that weaken connective tissues. Connective tissues are proteins that support skin, bones, blood vessels and other organs.
Etiology: Rare genetic disorder.
Clinical Features: Include:

Loose joints
Fragile, small blood vessels
Abnormal scar formation and wound healing
Soft, velvety, stretchy skin that bruises easily

Clinical Approach: Diagnosis can be made on clinical grounds, with any discrepancy precisely identified by genetic testing
Treatment: There is no known cure. Treatment is supportive.

Definition: Is a skin condition possibly mediated by deposition of immune complex in the superficial microvasculature of the skin and oral mucous membrane that usually follows an antecedent infection or drug exposure.
Etiology: Unknown, but the most common predisposing infection is Herpes simplex, but bacterial infections (commonly Mycoplasma) and fungal diseases are also implicated. Other causes include drug reactions, most commonly to sulfa drugs, phenytoin, barbiturates, penicillin, and allopurinol, or a host of internal ailments. The human form of orf can also cause erythema multiforme.
Clinical Features: Varies from a mild, self-limited rash (E. multiforme minor) to a severe, life-threatening form known as erythema multiforme major that also involves mucous membranes. This severe form may be related to Stevens-Johnson syndrome. The mild form is far more common than the severe form. The mild form usually presents with mildly itchy, pink-red blotches, symmetrically arranged and starting on the extremities. It often takes on the classical "target lesion" appearance, with a pink-red ring around a pale center. Resolution within 7-10 days is the norm.
Clinical Approach: Identification of the cause should be made if possible. If a drug is suspected, it must be withdrawn. Infections should be appropriately treated after cultures and/or serologic tests have been performed.
Treatment: For all forms of EM, symptomatic treatment, including oral antihistamines, analgesics, local skin care, and soothing mouthwashes, is of great importance. Topical steroids may be considered.

Definition: Erythema nodosum is a type of skin inflammation that is located in a certain portion of the fatty layer of skin.
Etiology: May occur as an isolated condition or in association with other conditions. Conditions that are associated with erythema nodosum include medications (sulfa-related drugs, birth control pills, estrogens), strep throat, Cat scratch disease, fungal diseases, infectious mononucleosis, sarcoidosis, Behcet's disease, inflammatory bowel diseases (Crohn's disease and ulcerative colitis), and normal pregnancy.
Clinical Features: Erythema nodosum (also called EN) results in reddish, painful, tender lumps most commonly located in the front of the legs below the knees. The tender lumps, or nodules, of erythema nodosum range in size from 1 to 5 centimeters. The nodular swelling is caused by a special pattern of inflammation in the fatty layer of skin.
Clinical Approach: Usually is a straightforward, simple diagnosis for a doctor to make simply by examining a patient and noting the typical firm area of raised tenderness that is red along with areas which have had lesions resolved, which might show a bruised-like appearance. It is not a difficult diagnosis for an experienced doctor. It does not typically require other investigative tests.
Sometimes a biopsy is done for confirmation, for example, if a patient presented with an isolated, singular area and a doctor was unable to make a diagnosis based on its appearance.
Treatment: Erythema nodosum is initially managed by identifying and treating any underlying condition present. Simultaneously, treatment is directed toward the inflamed skin from the erythema nodosum. Treatments for erythema nodosum include antiinflammatory drugs, and cortisone by mouth or injection. Colchicine is sometime used effectively to reduce inflammation.

Exogenous Ochronosis
Definition: This disorder is characterized by progressive sooty darkening of the skin area exposed to HQ. This degeneration is followed by the appearance of characteristic ochronotic deposits consisting of dark papules & nodules to areas.
Etiology: Unclear, but main contributory factors are the use of hydroquinone-containing creams and chronic sun exposure’
Clinical Features: Initially there is a faint, macular, sooty pigmentation in the malar distribution. It may appear ripple-like. If allowed to progress, the skin may become indurated and studded with discrete black papules. Keloid-like nodules and plaques mat be seen in advanced cases.
Clinical Approach: Usually only occurs in sun-exposed areas. Lesions are best seen with the skin stretched.
Treatment: Hydroquinones should be discontinued and sunscreen used daily. Occasionally a topical steroid cream may be necessary. The skin changes are often permanent.

Herpes
Definition: Herpes is the name of a group of viruses that cause painful blisters and sores. One kind of herpes, herpes simplex, causes both cold sores around the mouth and genital herpes (herpes around the sexual organs).
Etiology: There are two types of HSV.

HSV type 1 causes cold sores (also called fever blisters) on the lips. HSV-1 is generally spread by kissing or by sharing eating utensils (such as spoons or forks) when sores are present. HSV-1 can also cause sores around the genitals.
HSV type 2 causes sores in the genital area (genital herpes), such as on or around the vagina or penis. HSV-2 also causes the herpes infection seen in babies who are delivered vaginally in women who have genital herpes. HSV-2 is generally spread by sexual contact. HSV-2 can sometimes cause mouth sores.

Clinical Features: Symptoms of herpes outbreaks typically begin with pain, tenderness, or itching in the genital area and may also include fever and headache. Bumps and blisters may appear on the vagina, penis, scrotum, anus, thigh, or buttocks. Blisters soon open to form painful sores that can last up to 3 weeks.
Clinical Approach: Tests for HSV are most often done only for sores in the genital area. In rare cases, the test may be done using other types of samples, such as spinal fluid, blood, urine, or tears. Different types of tests that may be done are:

Herpes viral culture. Cells or fluid from a fresh sore are collected with a cotton swab and placed in a culture cup. A viral culture is the most specific method of finding a genital herpes infection.
Herpes virus antigen detection test. Cells from a fresh sore are scraped off and then smeared onto a microscope slide. This test finds markers (called antigens) on the surface of cells infected with the herpes virus. This test may be done with or in place of a viral culture.

Treatment: A herpes infection cannot be cured. Once you become infected with HSV, the virus stays in the body for life. It "hides" in a certain type of nerve cell and causes more outbreaks of sores in some people. Recurring infections can be triggered by stress, fatigue, sunlight, or another infection, such as a cold or flu. Medicine can relieve symptoms and shorten the length of the outbreaks, but medicine cannot cure the infection.

Definition: is a viral disease characterized by a painful skin rash with blisters in a limited area on one side of the body
Etiology: The initial infection with varicella zoster virus (VZV) causes the acute (short-lived) illness chickenpox, and generally occurs in children and young people. Once an episode of chickenpox has resolved, the virus is not eliminated from the body but can go on to cause shingles—an illness with very different symptoms—often many years after the initial infection.
Clinical Features: Before a rash is visible, the patient may notice several days to a week of burning pain and sensitive skin. Before the rash is visible, it may be difficult to determine the cause of the often severe pain. Shingles start as small blisters on a red base, with new blisters continuing to form for 3-5 days. The blisters follow the path of individual nerves that comes out of the spinal cord (called a dermatomal pattern). The entire path of the nerve may be involved or there may be areas with blisters and areas without blisters.
Clinical Approach: If the rash has appeared, identifying this disease (making a differential diagnosis) only requires a visual examination, since very few diseases produce a rash in a dermatomal pattern (see map). Laboratory tests are available to diagnose herpes zoster. The most popular test detects VZV-specific IgM antibody in blood; this only appears during chickenpox or herpes zoster and not while the virus is dormant.[16] In larger laboratories, lymph collected from a blister is tested by the polymerase chain reaction for VZV DNA, or examined with an electron microscope for virus particles.
Treatment: The aims of treatment are to limit the severity and duration of pain, shorten the duration of a shingles episode, and reduce complications. Symptomatic treatment is often needed for the complication of postherpetic neuralgia. Antiviral drugs inhibit VZV replication and reduce the severity and duration of herpes zoster with minimal side effects, but do not reliably prevent postherpetic neuralgia. Of these drugs, aciclovir has been the standard treatment, but the new drugs valaciclovir and famciclovir demonstrate similar or superior efficacy and good safety and tolerability.

Definition: Are clusters of concentrated melanin which are most often visible on people with a fair complexion.
Etiology: The formation of freckles is triggered by exposure to sunlight. The exposure to UV-B radiation activates melanocytes to increase the melanin production, which causes freckles to become darker and more numerous.
Clinical Features: There are 2 types of freckles:

Ephelides is a genetic trait. It’s used to describe a freckle that is flat, light brown or red, and fades in the winter. Ephelides are more common in those with light complexions and with the regular use of sunblock, can be suppressed.
Liver spots (also known as sun spots) are freckles that do not fade in the winter. Rather, they form after years of exposure to the sun. Lentigines are more common in older people.

Clinical Approach: People with freckles usually have a lower concentration of photoprotective melanin and are therefore more susceptible to the harmful effects of the sun. An overexposure of UV-radiation should be avoided.
Treatment: Can be treated with lasers and fading creams. However, upon exposure to the sun, freckles will reappear if they have been altered with lasers or creams and not protected from the sun, but do however fade with age in some cases.

Definition: Granuloma annulare is a raised, bumpy, or ring-shaped lesion, which can occur singly or in groups on the skin. It is more common in children and young adults, although it may affect people of all ages. Women are twice as likely as are men to develop granuloma annulare.
Etiology: No one knows what causes granuloma annulare, but a reaction in the immune system may play a role. There may be a relationship between granuloma annulare and diabetes. so far, this remains unproven.
Clinical Features: Granuloma annulare may be pearly white, skin-colored, red, or purple. It is most often in an isolated area, but may appear as several "bumps" spread over the body. Beginning as a round, firm, smooth bump, the lesion becomes a circular ring with a clear center, which resembles the shape of a doughnut. While granuloma annulare can develop on any part of the skin it appears most often on the tops of the hands and feet, elbows, and knees. It usually does not peel or itch and for that reason, can often go unnoticed.
Clinical Approach: Sometimes your dermatologist diagnoses granuloma annulare by examining the lesion. A biopsy, a small sample of skin examined under a microscope, may be performed to confirm the diagnosis. To rule out other medical conditions, your dermatologist may recommend blood work.
Treatment: As most people do not have symptoms, treatment is not necessary. The spots on the skin generally disappear on their own without leaving scars. Within a few months, most lesions are gone. Occasionally, clearing takes years. If lesions are widespread or cosmetically undesirable, there are several treatment options. Your dermatologist may prescribe a steroid cream to apply, or inject steroids directly into the spot to help it disappear faster. Steroids can thin the skin and should be used according to your dermatologist's directions.

Definition: Is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks. It is more commonly found in women and can be present under the breasts.
Etiology: The historical understanding of the disease is that there are dysfunctional apocrine glands or dysfunctional hair follicles, possibly triggered by a blocked gland, creating inflammation, pain, and a swollen lesion. More recent studies imply there is an autoimmune component. HS is not caused by any bacterial infection -- any infection is secondary -- and is therefore not contagious. Most cultures done on HS lesions come back negative for bacteria, so antibiotics should be used only when a bacterial infection has been confirmed by a physician.

Small pitted areas of skin containing blackheads, often appearing in pairs or a "double-barrel" pattern.
One or more red, tender bumps (lesions) that fill with pus. The bumps often enlarge, break open and drain pus. The drainage may have an unpleasant odor. Itching, burning and excessive sweating may accompany the bumps.
Painful, pea-sized lumps that grow under the skin. These hard lumps, which may persist for years, can enlarge and become inflamed.
Painful bumps or sores that continually leak fluid. These open wounds heal very slowly, if at all, often leading to scarring and the development of tunnels under the skin.

For some people, the disease progressively worsens and affects multiple areas of their body. Other people experience only mild symptoms. Excess weight, stress, hormonal changes, heat or excessive perspiration can worsen symptoms.

Clinical Approach: To make a diagnosis, your doctor may ask about your symptoms and medical history, examine your skin, and order blood tests. If pus or drainage is present, your doctor may send a sample of the fluid to a laboratory for testing. This test is known as a culture. Such tests may be necessary to rule out other skin conditions, such as tuberculosis of the skin, a carbuncle or a pilonidal cyst.
Treatment: Treatments depend on the extent of the affected areas and whether the sores are painful or infected. Mild cases can be treated with self-care measures, including warm compresses and regular washings with antibacterial soap. Moderate cases may require medications, such as those you rub on the affected areas (topical medications) or those you take by mouth (oral medications). Possible medications include:

Antibiotics to treat infection. Antibiotics taken for a long time early in the disease may prevent future outbreaks or prevent the disease from worsening.
Oral retinoid medications to stop oil gland functions and to prevent the plugging of the hair follicle.
Nonsteroidal anti-inflammatory drugs to reduce pain and swelling.
Corticosteroids or immunosuppressant drugs.

Definition: Also known as heat rash, or miliaria, prickly heat is an itchy and red skin rash which often causes a stinging, or prickling, sensation. It often occurs when you sweat more than usual, which is usually due to a hot or humid climate.
Etiology: Prickly heat occurs when your sweat glands become blocked. If you sweat excessively, it is easier for dead skin cells and bacteria on your skin to collect in your sweat glands. If these glands become blocked, the sweat is trapped underneath your skin, and seeps into the nearby tissue. Trapped sweat irritates your skin and causes tiny pockets of inflammation which also contain sweat. When these pockets burst and release the sweat, it causes a stinging, prickling sensation that gives the condition its name.
Clinical Features: Heat rash develops when your sweat ducts become blocked and perspiration is trapped under your skin. Symptoms range from superficial blisters to deep, red lumps. Some forms of heat rash can be intensely itchy or prickly.Adults usually develop heat rash in skin folds and wherever clothing causes friction. In infants, the rash is mainly found on the head, neck, shoulders, chest and back, but it can also occur in the armpits and groin.
Clinical Approach: Diagnosis made from clinical exam and history.
Treatment: Mild heat rash doesn't require any other treatment, but more severe forms may need topical therapies to relieve discomfort and prevent complications. Topical treatments may include:

Calamine lotion to soothe itching
Anhydrous lanolin, which may help prevent duct blockage and stop new lesions from forming
Topical steroids in the most serious cases

Definition: A raised, itchy area of skin that is usually a sign of an allergic reaction.
Etiology: Hives are produced by histamine and other compounds released from cells called mast cells, which are a normal part of skin. Histamine causes fluid to leak from the local blood vessels, leading to swelling in the skin. Many cases of ordinary hives are "idiopathic," meaning no cause is known. Others may be triggered by viral infections. A few may be caused by medications, usually when they have been taken for the first time a few weeks before. (It is uncommon for drugs taken continuously for long periods to cause hives or other reactions.)
Clinical Features: Ordinary hives flare up suddenly and usually for no specific reason. Welts appear, often in several places. They flare, itch, swell, and go away in a matter of minutes to hours, only to appear elsewhere. This sequence may go on from days to weeks. Most episodes of hives last less than six weeks. Although that cutoff point is arbitrary, hives that last more than six weeks are often called "chronic."
Clinical Approach: It's sometimes impossible to determine the cause of hives or angioedema. Your doctor will begin by asking you about your medical history. This may include asking you to create a detailed diary of exposure to possible irritants. It's important to tell your doctor about all medications you take, including over-the-counter (OTC) drugs and herbal remedies, even if you don't take them every day. Your doctor may also want to conduct allergy tests, such as skin tests.
Treatment: The goal of treating most cases of ordinary urticaria is to relieve symptoms while the condition goes away by itself. The most commonly used oral treatments are antihistamines, which help oppose the effects of the histamine leaked by mast cells. The main side effect of antihistamines is drowsiness. Oral steroids can help severe cases of hives in the short-term, but their usefulness is limited by the fact that many cases of hives last too long for steroid use to be continued safely. Topical therapies for hives include creams and lotions which help numb nerve endings and reduce itching.

Definition: An inherited skin disorder that causes dead skin cells to accumulate in thick, dry scales on the skin's surface.
Etiology: Most often, ichthyosis is inherited in an autosomal dominant pattern. It occurs when the production of skin cells is too fast or the skin's natural shedding process is too slow. This causes dead skin cells to collect into thick flakes that stick to the outer surface of skin. These thick flakes can resemble fish scales.

Very dry, scaly skin.
Tile-like scales that are small, polygonal in shape.
Scales that range in color from white to dirty gray to brown. People with darker skin tend to have darker colored scales.
Flaky scalp.
In severe cases, deep painful cracks in the palms and soles.

The scales usually appear on the elbows and lower legs and may be especially thick and dark over the shins. Though most cases of ichthyosis are mild, some can be severe.
Clinical Approach: A physician often can diagnose ichthyosis by looking at the skin. A family history is also very useful. In some cases, a skin biopsy will be done to help to confirm the diagnosis.

Treatment: Treatments for ichthyosis often take the form of topical application of creams and emollient oils, in an attempt to hydrate the skin. Retinoids are also used for severe conditions. Exposure to sunlight may improve or worsen the condition.

Definition: Stings and bites from insects resulting in redness and swelling in the injured area.
Etiology: A sting or bite injects venom composed of proteins and other substances that may trigger an allergic reaction in the victim. The sting also causes redness and swelling at the site of the sting (i.e. spiders, mosquitos, lice, fire ants, wasps, bees).
Clinical Features: The response to a sting or bite from insects is variable and depends on a variety of factors. Most bites and stings result in pain, swelling, redness, and itching to the affected area. The skin may be broken and become infected if the bite area is scratched. If not treated properly, these local infections may become severe and cause a condition known as cellulitis.
You may experience a severe reaction beyond the immediate area of the sting if you are allergic to the bite or sting. This is known as anaphylaxis. Symptoms of a severe reaction include hives, wheezing, shortness of breath, unconsciousness, and even death within 30 minutes.

Clinical Approach: The diagnosis of a reaction to a bite or sting is usually obvious from the history. The doctor will perform a physical examination to look for effects of the bite or sting on various parts of the body. Examination of the skin, respiratory system, cardiovascular system, and oral cavity are particularly important.
Treatment: Treatment depends on the type of reaction. If there is only redness and pain at the site of the bite, application of ice is adequate treatment. Clean the area with soap and water to remove contaminated particles left behind by some insects (such as mosquitoes). These particles may further contaminate the wound if not removed. Refrain from scratching because this may cause the skin to break down and an infection to form. You may treat itching at the site of the bite with an over-the-counter antihistamine such as diphenhydramine (Benadryl) in cream or pill form. Calamine lotion also helps relieve the itching.
Impetigo

Definition: Is a superficial bacterial skin infection most common among children age 2–6 years
Etiology: Impetigo is usually caused primarily by Staphylococcus aureus, with frequent secondary infection by Streptococcus pyogenes. The infection is spread by direct contact with lesions or with nasal carriers. The incubation period is 1–3 days.
Clinical Features: 3 types:
1) Impetigo contagiosa has pimple-like lesions surrounded by reddened skin. Lesions fill with pus, then break down over 4–6 days and form a thick, honey-colored crust. Impetigo is often associated with insect bites, cuts, and other forms of trauma to the skin. Itching is common.
People who suffer from cold sores have shown higher chances of suffering from impetigo. Those who normally suffer from cold sores should consult a doctor if normal treatment has no effect.
Impetigo also causes flu-like symptoms which may cause tiredness, weakness of muscles, headaches and vomiting.
2)Bullous impetigo primarily affects infants and children younger than 2 years. It causes painless, fluid-filled blisters — usually on the trunk, arms and legs. The skin around the blister is usually red and itchy but not sore. The blisters, which break and scab over with a yellow-colored crust, may be large or small, and may last longer than sores from other types of impetigo
3)Ecthyma is a more serious form of impetigo in which the infection penetrates deeper into the skin's second layer (dermis). Signs and symptoms include:

Painful fluid- or pus-filled sores that turn into deep ulcers, usually on the legs and feet
A hard, thick, gray-yellow crust covering the sores
Swollen lymph glands in the affected area
After crust disappears little holes the size of pinheads to the size of pennies appear
Scars that remain after the ulcers heal

Clinical Approach: Doctors usually can diagnose impetigo by looking at the sores on a child's skin. Sometimes they use a cotton swab to gently remove a small bit of material from one of the sores. The material is sent to a lab where it's applied to a special medium (culture) to check for the presence of bacteria.

Hygienic measures. Keeping your child's skin clean can help mild infections heal on their own.
Topical antibiotics. An antibiotic that you apply to your child's skin (topical antibiotic), such as mupirocin ointment (Bactroban).
Oral antibiotics. The specific antibiotic will depend on the severity of the infection and any allergies or conditions your child might have.

Definition: Jaundice is not a disease but rather a sign that can occur in many different diseases. Jaundice is the yellowish staining of the skin and sclerae (the whites of the eyes) that is caused by high levels in blood of the chemical bilirubin.
Etiology: Jaundice occurs when there is 1) too much bilirubin being produced for the liver to remove from the blood. (For example, patients with hemolytic anemia have an abnormally rapid rate of destruction of their red blood cells that releases large amounts of bilirubin into the blood), 2) a defect in the liver that prevents bilirubin from being removed from the blood, converted to bilirubin/glucuronic acid (conjugated) or secreted in bile, or 3) blockage of the bile ducts that decreases the flow of bile and bilirubin from the liver into the intestines. (For example, the bile ducts can be blocked by cancers, gallstones, or inflammation of the bile ducts).
Clinical Features: The color of the skin and sclerae vary depending on the level of bilirubin. When the bilirubin level is mildly elevated, they are yellowish. When the bilirubin level is high, they tend to be brown.
Clinical Approach: Many tests are available for determining the cause of jaundice, but the history and physical examination are important as well. The history can suggest possible reasons for the jaundice. For example, heavy use of alcohol suggests alcoholic liver disease, whereas use of illegal, injectable drugs suggests viral hepatitis. Recent initiation of a new drug suggests drug-induced jaundice. Episodes of abdominal pain associated with jaundice suggests blockage of the bile ducts usually by gallstones.
Treatment: With the exception of the treatments for specific causes of jaundice mentioned previously, the treatment of jaundice usually requires a diagnosis of the specific cause of the jaundice and treatment directed at the specific cause, e.g., removal of a gallstone blocking the bile duct.

Definition: Keloids are the result of an overgrowth of dense fibrous tissue that usually develops after healing of a skin injury. The tissue extends beyond the borders of the original wound, does not usually regress spontaneously, and tends to recur after excision. In contrast, hypertrophic scars are characterized by erythematous, pruritic, raised fibrous lesions that typically do not expand beyond the boundaries of the initial injury and may undergo partial spontaneous resolution.
Etiology: The cause of keloids is unknown. Researchers believe that keloids are caused by the body's failure to turn off the healing process needed to repair skin.
Clinical Features: Keloids/Hypertrophic scars range in consistency from soft and doughy to rubbery and hard. Recent studies have demonstrated how to differentiate and classify keloids according to how they feel. Early lesions are often erythematous. Lesions become brownish red and then pale as they age. Lesions are usually devoid of hair follicles and other functioning adnexal glands.
Clinical Approach: Diagnosis is made on the basis of the appearance of the skin or scar. A skin biopsy may be needed to rule out other skin growths (tumors).
Treatment: No treatment for keloids is considered to be 100% effective. Some of the treatments that are currently available are described below:

Definition: Palmoplantar keratoderma (PPK) constitutes a group of disorders characterized by thickening of the palms and the soles of individuals who are affected.
Etiology: May be inherited (hereditary) or, more commonly, acquired.

Clinical Features: “Keratoderma” is a term that means marked thickening of the skin. “Palmoplantar” refers to the skin on the soles of the feet and palms of the hands; these are the areas keratoderma affects most often

Clinical Approach: Diagnosis usually made from history and clinical examination.
Treatment: There is no cure, however the following treatments soften the thickened skin and makes it less noticeable.

Definition: Is a harmless skin disorder that causes small, acne-like bumps.
Etiology: No clear etiology has been defined
Clinical Features: the skin of the outer upper arms and thighs is frequently affected. The skin is described as chicken skin or goose bumps. Often, 10-100 very small slightly rough bumps are scattered in an area. Palpation may reveal a fine, sandpaperlike texture to the area.
Clinical Approach: Diagnosis usually made from history and clinical examination.

Treatment: No single treatment universally improves keratosis pilaris. But most options, including self-care measures and medicated creams, focus on softening the keratin deposits in the skin.
Prescription medications used to treat keratosis pilaris include:

Using a medication regularly may improve the appearance of your skin. But if you stop, the condition returns. And even with medical treatment, keratosis pilaris tends to persist for years.

Definition: Leg ulcers skin loss on the leg or foot due to any cause. They occur in association with a range of disease processes, most commonly with blood circulation diseases.
Etiology: Leg ulcers may be caused by:

Clinical Features: The features of venous and arterial ulcers differ somewhat.
Characteristics of venous ulcers:

Clinical Approach: First, the patient’s medical history is evaluated. A wound specialist will examine the wound thoroughly and may perform tests such as X-rays, MRIs, CT scans and noninvasive vascular studies to help develop a treatment plan.
Treatment: Treatment options for all ulcers may include:

Definition: Is an inflammatory disease that affects the skin and the oral mucosa.
Etiology: The cause is not known.
Clinical Features: The typical rash of lichen planus is well-described by the "5 P's": well-defined pruritic, planar, purple, polygonal papules. The commonly affected sites are near the wrist and the ankle. The rash tends to heal with prominent blue-black or brownish discoloration that persists for a long time. Besides the typical lesions, many morphological varieties of the rash may occur. The presence of cutaneous lesions is not constant and may wax and wane over time. Oral lesions tend to last far longer than cutaneous lichen planus lesions.
Clinical Approach: A preliminary diagnosis may be made on the way your skin or mouth lesions look. A skin lesion biopsy or biopsy of a mouth lesion can confirm the diagnosis.
Treatment: Currently there is no cure but there are certain types of medicines used to reduce the effects of the inflammation. Lichen planus may go into a dormant state after treatment. There are also reports that lichen planus can flare up years after it is considered cured.
Medicines used to treat lichen planus include:

Definition: Is a chronic inflammatory disease of unknown etiology, characterized by 1-2mm, discrete and uniform, shiny, flat-topped, pale flesh-colored or reddish-brown papules that may be hypopigmented in blacks. A disease process that usually affects children and young adults, and is painless and nonpruritic.
Etiology: The cause is unknown.
Clinical Features: Appear as numerous skin-colored, shiny papules on your skin. The pinpoint- to pinhead-sized bumps usually appear in clusters and may resemble warts. Papules most often occur on the body trunk, legs and forearms, and genitalia.
Clinical Approach: Diagnosis usually made from history and clinical examination.
Treatment: It usually gets better on its own after several years. Or you may choose to seek therapy for cosmetic reasons. The treatment options for lichen nitidus include corticosteroids applied on your skin (topical) which may reduce inflammation.

Definition: A lipoma is a slow-growing, fatty tumor situated between your skin and the underlying muscle layer. Often a lipoma is easy to identify because it moves readily with slight finger pressure.
Etiology: The exact cause of lipomas isn't clear. Lipomas also tend to run in families, so genetic factors likely play a role in their development.
Clinical Features: symptoms include:

Because it grows slowly, you might have a lipoma for years before you notice it.

Clinical Approach: Diagnosis is made on the basis of the appearance of the skin or scar. A skin biopsy may be needed to rule out other skin growths (tumors).
Treatment: No treatment is usually necessary for a lipoma. However, if the lipoma is in a bothersome location, is painful or is growing, your doctor might recommend that it be removed.

Definition: Are benign, keratin-filled cysts that can appear just under the epidermis or on the roof of the mouth. They are commonly associated with newborn babies but can appear on people of all ages. They are usually found around the nose and eyes.
Etiology: Are believed to arise in sebaceous glands that are not fully developed.
Clinical Features: Are superficial, uniform, pearly white to yellowish, domed lesions measuring 1-2 mm in diameter.

Clinical Approach: No investigations are needed for simple milia.
Treatment: The clinical appearance is diagnostic. No topical or systemic medications are effective on primary and secondary milia. Milia can be safely left alone, but if the patient requests treatment, then incision with a cutting-edge needle and manual expression of the contents are effective.

Definition: Measles is an infectious disease caused by a virus. It spreads easily from person to person. The main symptom of measles is an itchy skin rash.
Etiology: Measles is spread through respiration (contact with fluids from an infected person's nose and mouth, either directly or through aerosol transmission), and is highly contagious—90% of people without immunity sharing a house with an infected person will catch it
Clinical Features: The classical symptoms of measles include a fever for at least three days, the three Cs—cough, coryza (runny nose) and conjunctivitis (red eyes). Koplik's spots seen inside the mouth are pathognomonic (diagnostic) for measles but are not often seen, even in real cases of measles, because they are transient and may disappear within a day of arising. : Koplik's spots (kop'liks) are small, irregular, red spots with a minute bluish white speck in the center of each seen on the buccal mucosa and lingual mucosa (mucous membrane of the inside of the cheek and tongue) and are pathognomonic of early stage measles. The characteristic measles rash is classically described as a generalized, maculopapular, erythematous rash that begins several days after the fever starts. It starts on the head before spreading to cover most of the body, often causing itching. The rash is said to "stain", changing colour from red to dark brown, before disappearing.

Clinical Approach: Clinical diagnosis of measles requires a history of fever of at least three days together with at least one of the three Cs. Observation of Koplik's spots is also diagnostic of measles. Alternatively, laboratory diagnosis of measles can be done with confirmation of positive measles IgM antibodies or isolation of measles virus RNA from respiratory specimens.
Treatment: There is no specific treatment or antiviral therapy for uncomplicated measles. Most patients with uncomplicated measles will recover with rest and supportive treatment.

Definition: Melasma (also known as chloasma or the mask of pregnancy when present in pregnant women) is a tan or dark facial skin discoloration. Although it can affect anyone, melasma is particularly common in women, especially pregnant women and those who are taking oral contraceptives or hormone replacement therapy (HRT) medications.
Etiology: Melasma is thought to be the stimulation of melanocytes or pigment-producing cells by the female sex hormones estrogen and progesterone to produce more melanin pigments when the skin is exposed to sun. Women with a light brown skin type who are living in regions with intense sun exposure are particularly susceptible to developing this condition.
Clinical Features: The symptoms of melasma are dark, irregular patches commonly found on the upper cheek, nose, lips, upperlip, and forehead. These patches often develop gradually over time. Melasma does not cause any other symptoms beyond the cosmetic discoloration.
Clinical Approach: Melasma is usually diagnosed visually or with assistance of a Wood's lamp (340 - 400 nm wavelength). Under Wood's lamp, excess melanin in the epidermis can be distinguished from that of the dermis.
Treatment: The mainstay of treatment remains topical depigmenting agents. Hydroquinone is most commonly used.

Definition: Is a relatively common viral infection of the skin that most often affects children. It results in firm bumps (papules) that are painless and usually disappear within a year without treatment.
Etiology: It results from an infection by the molluscum contagiosum virus — a member of the poxvirus family. This virus spreads easily through direct skin-to-skin contact and through contact with contaminated objects, such as toys, doorknobs and faucet handles. The virus also spreads through sexual contact with an affected partner. Scratching or rubbing the papules spreads the virus to nearby skin, as can shaving.

Clinical Features: Molluscum contagiosum results in raised, round, flesh-colored bumps (papules) on the skin. The papules are small — typically about 2 to 5 millimetersin diameter. They characteristically have a small indentation or dot at their top.
Clinical Approach: Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy.
Treatment: Molluscum contagiosum resolves without treatment within six to 12 months, though it can sometimes take years to disappear completely. It may take longer for children whose immune systems aren't fully developed.
Because molluscum spreads easily, doctors often recommend medical treatment. Treatment for molluscum contagiosum may include removal of the papules by:

Definition: Morphea, also known as localized scleroderma, is a disorder characterized by excessive collagen deposition leading to thickening of the dermis, subcutaneous tissues, or both.
Etiology: The exact cause is unknown. It's believed that a reaction of the immune system plays a role in the development of this rare condition.
Clinical Features: Symptoms of morphea include hardening and thickening of the skin. Also, discoloration of the affected skin to look lighter or darker than the surrounding area. Morphea usually affects only the uppermost layers of your skin, but in some cases may involve fatty or connective tissue below your skin.

Clinical Approach: Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy.
Treatment: Morphea has no known cure. Treatment of morphea focuses on controlling the signs and symptoms and slowing the spread of the disease. The earlier you begin treatment, the more effective it is. The precise treatment depends on the extent and severity of your condition, but may include:

Definition: Is a degenerative disease of the connective tissue in the skin. That presents with a rash. It is more common in women. It usually occurs on the lower part of the legs.
Etiology: The cause is unknown. Necrobiosis lipoidica usually occurs more often in people with diabetes, in people with a family history of diabetes or a tendency to get diabetes.
Clinical Features: The first symptom is often a "bruised" appearance that is not necessarily associated with a known injury. The individual spots typically consist of a circular array of reddish to brown and slightly translucent bumps.
Sign and symptoms may include the following :

Clinical Approach: Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy. Some advocate checking for glucose intolerance to evaluate for the presence or absence of diabetes mellitus. NL has been the first sign of diabetes in some patients and a clue to possible diabetic potential in others.
Treatment: Treatment of necrobiosis lipoidica diabeticorum is difficult. Cortisone injections can also be used to treat NLD. These are more effective than cortisone creams. Ultraviolet light treatment has been found to control this condition when it is flaring. Many medications have been tried, including aspirin, fibrinolytic agents, nicotinamide, pentoxifylline, heparin, antiplatelet agents, ticlopidine, tretinoin, and cyclosporine.

Definition: Neurofibromatosis is a genetic disorder of the nervous system. It mainly affects how nerve cells form and grow. It causes tumors to grow on nerves.
Etiology: You can get neurofibromatosis from your parents, or it can happen because of a mutation (change) in your genes. Once you have it, you can pass it along to your children.

1) Café au lait spots are irregularly shaped, evenly pigmented, brown macules. Most individuals with neurofibromatosis have 6 or more spots that are 1.5 cm or greater in diameter. In young children, 5 or more café au lait macules greater than 0.5 cm in diameter are suggestive of neurofibromatosis and should be pursued. Less than 1% of healthy children have 3 or more such spots, although 1 or 2 café au lait macules are commonly encountered in healthy individuals without disease.

2) Lisch nodules are hamartomas of the iris that appear dome shaped and are found superficially around the eyes on slit lamp examination. They are asymptomatic, but they help in confirming the diagnosis of neurofibromatosis.

3) Axillary freckling (as well as freckling on the perineum), known as the Crowe sign, is a helpful diagnostic feature in neurofibromatosis. Both axillary freckling and inguinal freckling often develop during puberty.
Clinical Approach: Diagnosis made by the presence of 1 or more of the following:
Family history of NF1
       6 or more light brown ("cafe-au-lait") spots on the skin
       Presence of pea-sized bumps (neurofibromas) on the skin
       Larger areas on the skin that look swollen (plexiform neurofibromas)
       Freckling under the arms or in the groin area
Treatment: There is no cure. Treatment is aimed at controlling symptoms. Depending on the type of disease and how bad it is, treatment may include surgery to remove tumors, radiation therapy and medicines.

Definition: A chronic, scarring, atrophy producing, photosensitive dermatosis. Some patients also have the lesions of subacute cutaneous lupus erythematosus (SCLE), and some may have a malar rash.
Etiology: The exact cause is unknown, but it is thought to be autoimmune with the body's immune system incorrectly attacking normal skin.
Clinical Features: These lesions develop as a red, inflamed patch with a scaling and crusty appearance. The center areas may appear lighter in color with a rim darker than the normal skin.
Clinical Approach: Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy. However, since DLE may occur in patients with systemic lupus erythematosus (SLE), and some patients (<5%) with DLE progress to SLE, lab investigations to rule out these must be done.
Treatment: Cortisone ointment applied to the skin in the involved areas will often improve the lesions and slow down their progression. Cortisone injections into the lesions will also treat discoid lupus and usually are more effective than the ointment form of cortisone. Alternatively, calcineurin inhibitors, pimecrolimus cream or tacrolimus ointment may be used. Imiquimod has also been reported to be helpful in a few patients.

Definition: In subacute LE, a non-itchy dry rash appears on the upper back and chest, often following sun exposure. Subacute LE does not scar. It includes the following clinical types:
Etiology: Occurs in genetically predisposed individuals
Clinical Features: · SCLE often begins as a papular eruption. Papules may show a photosensitive distribution. Many patients notice that sun exposure results in an exacerbation of their disease, and some report worsening each spring and summer. Patients may complain of mild pruritus, but most patients are asymptomatic. Eventually, lesions develop into annular erythema or become psoriasiform in character. SCLE may wax and wane. Approximately 50% of SCLE patients have accompanying joint involvement such as arthralgias and arthritis.

Clinical Approach: : Diagnosis is based on the appearance of the lesion and can be confirmed by a skin biopsy. SLE must be ruled out.
Treatment: Antimalarials are the mainstay of systemic therapy. The basic therapy of skin disease uses sun-protection methods, such as sunscreens, sun-protective clothing, and alteration of exposure by decreasing activities during times of high intensity UV light. Topical corticosteroids are used and selected by the appropriate strength for the area of the body. Intralesional injection of triamcinolone is useful for individual recalcitrant lesions.

Definition: is a chronic raised indurated (hardened) lesion of the skin, often purplish in color. It resembles frostbite as it is seen on ears, cheeks, lips, nose, hands, fingers, and forehead. It is most often associated with sarcoidosis.
Etiology:
Clinical Features:
Clinical Approach:
Treatment:

Definition: An autoimmune disease involving multiple organ systems that is defined clinically and associated with antibodies directed against cell nuclei.
Etiology: Autoantibodies, circulating immune complexes, and T lymphocytes all contribute to the expression of disease. Organ systems affected include dermatologic, renal, central nervous system (CNS), hematologic, musculoskeletal, cardiovascular, pulmonary, the vascular endothelium, and gastrointestinal.
Clinical Features: SLE symptoms may develop slowly over months or years, or they may appear suddenly. Symptoms tend to be worse during winter months, perhaps because prolonged exposure to sunlight in the summer causes a gradual build-up of factors that trigger symptoms months later. The most common symptoms are:

Arthritic Pain

The most common symptom is joint pain, which occurs in about 90% of patients with SLE.

Fever

Fever occurs in 90% of patients with SLE and is usually caused by the inflammatory process of the disease, not by infection. It is low-grade except during an acute lupus crisis.

Skin Rashes

Three-quarters of patients with SLE have skin inflammation and skin lesions (ulcers, rashes, or other injured areas). About half of these lesions are photosensitive; that is, they are aggravated by ultraviolet (UV) radiation from sunlight, even from light coming through a window.

Clinical Approach: For a diagnosis of SLE 4 of the following must occur at any time during a patient's history:

Treatment: There is no permanent cure for SLE. The goal of treatment is to relieve symptoms and protect organs by decreasing inflammation and/or the level of autoimmune activity in the body. In addition to potent topical steroids, Hydroxychloroquine (Plaquenil) an antimalarial medication, is found to be particularly effective for SLE patients with skin manifestations.

Definition: Nevus (plural nevi ) is the medical term for a birthmark. Nevi are the most common abnormality of the skin, and apparently serve no function
Etiology: . If a birthmark is caused by pigment, it's called a pigmented or melanocyticnevus. If it is present at birth, it's called congenital.

Clinical Features:
Congenital nevi include Mongolian Spot, Cafe-au-Lait spots, Nevus Spilus, and Congenital Melanocytic Nevi.
Acquired nevi are the pigmented moles with which everyone is familar. They are classified into three types, Junctional, Compound, or Intradermal. These usually become more evident and numerous after puberty.
Junctional nevi are flat, brown to black in color, slightly elevated. They can appear anywhere but are more common on sun-exposed surfaces. They are small, 1-5 mm in diameter.
Compound nevi are also brown to black, and slightly elevated. they may develop corarse hairs within them.
Intradermal nevi are dome shaped or pedunculated (hangs by a stalk). They may eventually become fleshy colored, and also may develop coarse hairs within them.

Clinical Approach: A mole should be biopsied and examined histologically if it has characteristics of concern; the specimen must be deep enough for accurate microscopic diagnosis and should contain the entire lesion if possible, especially if the concern for malignancy is high.
Treatment: It is not necessary to have these nevi removed under ordinary circumstances, but any mole that ulcerates, becomes painful or itchy, or changes rapidly in size, shape or color should be removed and checked for malignancy.

Definition: Is a benign flat congenital birthmark with wavy borders and irregular shape, most common among East Asians and Turks, and named after Mongolians, extremely prevalent among East Africans. The most common color is blue, although they can be blue-gray, blue-black or even deep brown.
Etiology: The Mongolian spot is a congenital developmental condition exclusively involving the skin.
Clinical Features: The blue colour is caused by melanocytes, melanin-containing cells, that are deep under the skin. Usually, as multiple spots or one large patch, it covers one or more of the lumbosacral area (lower back), the buttocks, flanks, and shoulders.
Clinical Approach: No tests is needed. Diagnose can be made from history and clinical examination.
Treatment: No treatment is necessary or recommended. It normally disappears three to five years after birth and almost always by puberty.

Definition: A blue or gray patch on the face, which is congenital or acquired and is within the distribution of the ophthalmic and maxillary branches of the trigeminal nerve. The nevus can be unilateral or bilateral, and, in addition to skin, it may involve eye and mouth surfaces.
Etiology: Unknown
Clinical Features: Most frequently presents as blue-to-gray speckled or mottled coalescing macules or patches affecting the forehead, temple, malar area, or periorbital skin. Nevus of Ito presents as a patch on the shoulder or upper arms with blue, gray, or brown pigmentation.
Clinical Approach: Diagnose can be made from history and clinical examination.
Consider ophthalmologic examination and follow-up care for nevus of Ota because of an association of nevus of Ota with increased intraocular pressure.

Definition: A nickel allergy may develop after your initial exposure to items containing nickel, or after repeated or prolonged exposure to nickel. In most cases, the resulting rash occurs only at the site of contact, though it may be found on other parts of your body as well.
Etiology: Unknown.
Clinical Features: Within one or two days of contact signs include a red, swollen rash and watery blisters.
Clinical Approach: Diagnose can be made from history and clinical examination. If the cause of your rash isn't apparent, however, you may require a patch test (contact hypersensitivity allergy test).
Treatment: There's no cure for nickel allergy. Instead, identifying sources of nickel and avoiding nickel is the primary form of treatment. Temporary solutions for the rashes and blisters that mark a nickel allergy may include high-potency topical corticosteroid creams, such as clobetasol propionate (Temovate, others). They can help speed the disappearance of and improve the appearance of the rash and blisters. In severe or widespread cases the patient may require oral corticosteroids.

Definition: Is reddening of the palms at the thenar and hypothenar eminences. It is associated with various physiological as well as pathological changes, the principal one of which is portal hypertension. It is also seen in patients with liver dysfunction, such as chronic liver disease, and also in pregnant women.
Etiology: It is a sign associated with many diseases but is probably most commonly seen as a normal variant. It is probably a manifestation of many underlying pathophysiological processes, the balance of which will vary between different individuals and causes. These processes include:

Clinical Features: Reddening of the skin on the palmar aspect of the hands, usually over the hypothenar eminence. It may also involve the thenar eminence and fingers. It can be found on the soles of the feet, when it is termed plantar erythema.
Clinical Approach: It is not a very discriminative sign in terms of reaching a diagnosis, but can be useful as a marker. It may also suggest an alternative diagnoses when conducting an initial clinical assessment.
Treatment: Successful diagnosis of cause, then treatment directed towards it.

Definition: Is an uncommon, potentially fatal, autoimmune disease characterized by intraepidermal bullae and extensive erosions on apparently healthy skin and mucous membranes.
Etiology: Autoantibodies directed against components of epidermis cause separation of layers within the epidermis, resulting in blistering. These antibodies are present in both blood and skin during active disease.
Clinical Features: The primary lesions are flaccid bullae of various sizes, but often skin or mucosa just shears off, leaving painful erosions. Lesions typically occur first in the mouth, where they rupture and remain as chronic, often painful, erosions for variable periods before the skin is affected. Cutaneous bullae typically arise from normal-appearing skin, rupture, and leave a raw area and crusting. Itching is usually absent.
Clinical Approach: Two physical signs in pemphigus are helpful: lateral pressure on skin adjacent to a blister causes epidermal detachment (Nikolsky's sign) and pressure on a blister can cause the blister to extend to adjacent skin. Patients should have biopsy of the edge of a fresh lesion and from a nearby area of normal skin; light microscopy and direct immunofluorescent staining are usually diagnostic. Serum antibodies (eg, to desmoglein-3) can be used for diagnosis and for differentiating from pemphigus foliaceous.
Treatment: Drug treatment aims to stop the eruption of new lesions. The mainstay is systemic corticosteroids. Some patients with few lesions may respond to oral prednisone but most initially require IV therapy with prednisolone Immunosuppressants such as methotrexate, cyclophosphamide, azathioprine, gold, mycophenolate mofetil, or cyclosporine can reduce the need for corticosteroids and thus minimize the undesirable effects of long-term corticosteroid use.

Definition:. Is a vesiculobullous disease of the skin and mucous membranes that causes vesicles (blisters), bullae and raw sores. Considered a milder form of Bullous Pemphigoid.
Etiology: It is an autoimmune disease caused when the body's defenses mistake its own tissues as foreign and attempts to destroy it. It may be caused by medications, e.g. Penicillamine. Antibodies that attack one's own cells are called autoantibodies. In pemphigus, the target of these autoantibodies is a protein called desmoglein. Desmoglein forms the "glue" that attaches adjacent epidermal cells via attachment points called desmosomes. When autoantibodies attack desmogleins, the cells become separated from each other and the epidermis becomes "unglued", a phenomenon called acantholysis. This causes blisters that slough off and turn into sores. In some cases, these blisters can cover a significant area of the skin.
Clinical Features: Is characterized by crusty sores that often begin on the scalp, and may move to the chest, back, and face. Mouth sores do not occur. It is not as painful as pemphigus vulgaris, and is often mis-diagnosed as dermatitis or eczema.
Clinical Approach: Pemphigus is recognized by a dermatologist from the appareance and distribution of the skin lesions. Definitive diagnosis requires examination of a skin biopsy by a dermatopathologist. The skin biopsy is taken from the edge of a blister, prepared for histopathology and examined with a microscope.

Treatment: If not treated, pemphigus can be fatal due to overwhelming infection of the sores. The most common treatment is the administration of oral steroids, especially prednisone. Intravenous gamma globulin (IVIG) may be useful in severe cases, especially paraneoplastic pemphigus. Mild cases sometimes respond to the application of topical steroids.

Definition: is a common skin condition mostly occurring in children and usually seen as dry, fine scaled, pale patches on their faces.
Etiology: There is no specific known cause for this condition, but any dermatitis inflammation of the skin may heal leaving pale skin.
Clinical Features: A flaky, hypopigmented, patchy dermatitis with fine scales involving the face and, at times, the neck and shoulders typically is found.
Clinical Approach: A workup may be undertaken to exclude other causes of hypopigmentation. Potassium hydroxide stain of a skin scraping will be positive if the patient has a fungal infection. Wood light examination will help in a patient who has vitiligo.
Treatment: It is self limiting and usually only requires use of moisturiser creams.

Definition: A condition related to acne vulgaris, consists of red papules that effect the nasolabial folds, perioral area or perioccular area. It usually affects women between the ages of 20 and 45.
Etiology: An underlying cause cannot be detected in all patients. The etiology of perioral dermatitis is unknown; however, the uncritical use of topical steroids for minor skin alterations of the face often precedes the manifestation of the disease.
Clinical Features: Skin lesions occur as grouped follicular reddish papules, papulovesicles, and papulopustules on an erythematous base with a possible confluent aspect. The papules and pustules have mainly perioral locations. The predominant locations of POD lesions are the perioral area, nasolabial fold, and lateral portions of the lower eyelids.

Clinical Approach: The diagnosis is made clinically. No laboratory abnormalities can be expected.
Treatment: It is treated in a similar manner to acne vulgaris with tetracycline antibiotics or erythromycin but, without the use of topical steroids.

Definition: Is a common human skin disease which presents as numerous patches of pink or red oval rash, mainly on the torso.
Etiology: Although the cause remains unknown, it is presumed to be a virus.
Clinical Features: Large patches of pink or red, flaky, oval-shaped rash on the torso, similar to ringworm, psoriasis or eczema. A single, large red "herald" patch may occur 1 to 20 days before smaller, more numerous patches of rash.
Clinical Approach: Diagnosis usually made on clinical grounds. Biospy may be needed to confirm diagnosis.
Treatment: No treatment is necessary. The disease appears to be entirely self-limiting in all cases.

Definition: Symptoms may include reddish-orange patches on the skin, severe flaking, uncomfortable itching, thickening of the skin on the feet and hands, and thickened bumps around hair follicles. For some, early symptoms may also include generalized swelling of the legs, feet and other parts of the body.
Etiology: The etiology is unknown. A familial form of the disease exists, with an autosomal dominant inheritance pattern; however, most cases are sporadic.
Clinical Features: Is characterized by orange-red or salmon-colored scaly plaques with sharp borders, which may expand to involve the entire body
Clinical Approach: No specific laboratory tests are available to confirm the diagnosis of PRP. The diagnosis is usually made on the basis of a correlation between clinical findings and histologic findings.
Treatment: Topical corticosteroids may provide some patient comfort, but they are believed to have little long-term therapeutic effect. Emollients reduce fissuring and dryness, providing some patient comfort.

Definition: Is a common type of eczema affecting the hands, and sometimes the feet. It is also known as dyshidrotic eczema or vesicular eczema of the hands and/or feet.
Etiology: The exact cause is not known. Some investigators consider it is caused by abnormal sweating.
Clinical Features: The first (acute) stage shows tiny blisters (vesicles) deep in the skin of the palms, fingers, instep or toes. The blisters are often intensely itchy or have a burning feeling. The condition may be mild with only a little peeling, or very severe with big blisters and cracks which prevent work. The later and more chronic stage shows more peeling, cracking, or crusting. Then the skin heals up, or the blistering may start again. One site may be blistering, while another is dry and cracked.

Clinical Approach: Diagnosis usually made on clinical grounds. Biospy may be needed to confirm diagnosis.
Treatment: Treatment may include oral anti-pruritic tablets to alleviate itching. Antibiotics for secondary infection caused by scratching. In addition, potent topical steroids should be applied to the affected areas nightly.

Definition: Is a disease which affects the skin and joints. It commonly causes red scaly patches to appear on the skin. The scaly patches caused by psoriasis, called psoriatic plaques, are areas of inflammation and excessive skin production. Skin rapidly accumulates at these sites and takes a silvery-white appearance. Plaques frequently occur on the skin of the elbows and knees, but can affect any area including the scalp and genitals.
Etiology: The cause of psoriasis is not fully understood. There are two main hypotheses about the process that occurs in the development of the disease. The first considers psoriasis as primarily a disorder of excessive growth and reproduction of skin cells. The second hypothesis sees the disease as being an immune-mediated disorder in which the excessive reproduction of skin cells is secondary to factors produced by the immune system.
Clinical Features: The symptoms of psoriasis vary. The most common symptoms seen are:

Clinical Approach: Diagnosis usually made on clinical grounds. Biospy may be needed to confirm diagnosis.
Treatment: 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.
Psoriasis treatments can be divided into three main types: topical treatments, light therapy and oral medications.
Topical psoriasis treatments include:

Definition: Is a disease that causes tissue to become necrotic, causing deep ulcers that usually occur on the legs which can lead to chronic wounds. Ulcers initially look like small bug bites or papules, and they progress to larger ulcers that cause severe pain and scarring.
Etiology: Though the etiology is not well understood, the disease is thought to be due to an immune system dysfunction.
Clinical Features: Usually starts quite suddenly, often at the site of a minor injury. Begins as a small pustule, red bump or blood-blister, then breaks down resulting in an ulcer. The ulcer can deepen and widen rapidly. Characteristically, the edge of the ulcer is purple and undermined as it enlarges. It is usually very painful.
Clinical Approach: Diagnosis usually made on clinical grounds. Biospy may be needed to confirm diagnosis.
Treatment: Treatment usually stops the disease process; however, complete healing may take months and the condition may recur or cause scarring. Antibiotics are often prescribed during diagnosis as a precaution for wound bacteria or secondary infections in surrounding skin areas. Small ulcers are best treated with topical steroid creams and oral anti-inflammatory antibiotics. Severe disease requires one or more of the following treatments oral steroids, Immunosuppressives such as cyclosporine or azathioprine,or blood products (such as intravenous immune globulins) can decrease the body's production of antibodies and help remove excess antibodies which provoke immune reactions.

Definition: Is a relatively common benign vascular lesion of the skin and mucosa whose exact cause is unknown. The lesion usually occurs in children and young adults as a solitary glistening red papule or nodule that is prone to bleeding and ulceration.
Etiology: The precise mechanism for the development of pyogenic granuloma is unknown. Trauma, hormonal influences, viral oncogenes, underlying microscopic arteriovenous malformations, the production of angiogenic growth factors, and cytogenetic abnormalities have all been postulated to play a role.
Clinical Features: The typical solitary lesion is a bright red, friable polypoid papule or nodule ranging from a few millimeters to several centimeters. Bleeding, erosion, ulceration, and crusting frequently are noted. The head and neck (specifically the gingiva, lips, nasal mucosa, and face), distal extremities (especially the fingers) are the sites of predilection, but lesions occur anywhere.
Clinical Approach: Dermoscopy may be helpful in the recognition of pyogenic granulomas. A reddish homogeneous area surrounded by a white collarette is found in the majority of cases. A specimen for histologic examination may be obtained by shave, punch, scalpel, or laser excision.

Treatment: Shave, punch, scalpel, or laser excision may be curative if the lesion is completely removed. If a shave biopsy is performed, curettage with electrodesiccation to the base decreases the likelihood of recurrence. Sclerotherapy, chemical cauterization with silver nitrate, ligation of the base, and cryotherapy have all been reported effective.

Definition: Is a condition resulting in a particular series of discolorations of the fingers and/or the toes after exposure to changes in temperature (cold or hot) or emotional events. Raynaud's phenomenon most frequently affects women, especially in the second, third, or fourth decades of life. People can have Raynaud's phenomenon alone or as a part of other rheumatic diseases. When it occurs alone, it is referred to as "Raynaud's disease" or primary Raynaud's phenomenon. When it accompanies other diseases, it is called secondary Raynaud's phenomenon.
Etiology: The causes of primary and secondary RP are unknown. Both abnormal nerve control of the blood vessel diameter and nerve sensitivity to cold exposure have been suspected as being contributing factors. The characteristic color changes of the digits are in part related to initial blood vessel narrowing due to spasm of the tiny muscles in the wall of the vessels, followed by sudden opening (dilation), as described above.
Clinical Features: Most patients with mild disease only notice skin discoloration upon cold exposure. They may also experience mild tingling and numbness of the involved digit(s) that will disappear once the color returns to normal. When the blood vessel spasms become more sustained, the sensory nerves become irritated by the lack of oxygen and can cause pain in the involved digit(s). Rarely, poor oxygen supply to the tissue can cause the tips of the digits to ulcerate. Ulcerated digits can become infected. With continued lack of oxygen, gangrene of the digits can occur.
Clinical Approach: Patients have characteristic sequence of skin-color changes of the digits upon cold exposure. Abnormal nailfold capillary patterns can suggest the possibility of an associated rheumatic condition. There is, however, no single blood test to help the doctor to confirm the diagnosis.
Treatment: Treatment of Raynaud's phenomenon involves protection of the digits, medications, and avoiding emotional stresses, smoking, cold temperature, and tools that vibrate the hands.

Definition: The term "ringworm" or "ringworms" refers to fungal infections that are on the surface of the skin. The early belief was that the infection was due to a worm, which it is not. It is a result of a fungus infection.
Etiology: Although the world is full of yeasts, molds, and fungi, only a few cause skin problems. These agents are called the dermatophytes, which means "skin fungi." Skin fungi can only live on the dead layer of keratin protein on top of the skin.
Clinical Features: When fungus affects the skin of the body, it often produces the round spots of classic ringworm. Sometimes, these spots have an "active" outer border as they slowly grow and advance. It is important to distinguish this rash from other even more common rashes, such as nummular eczema.
Clinical Approach: The diagnosis of ringworm is obvious from its location and appearance. Otherwise, skin scrapings for microscopic examination and a culture of the affected skin can establish the diagnosis of tinea or rule it out.
Treatment: Oral or topical antifungals.

Definition: Is an inflammatory skin disease that causes facial redness. You may mistake some of its characteristics — small, red, pus-filled bumps or pustules — for acne.
Etiology: The cause of rosacea is unknown, but researchers believe it's likely due to some combination of hereditary and environmental factors.
Clinical Features: Signs and symptoms include:

Clinical Approach:
Treatment: Although there's no way to eliminate rosacea altogether, effective treatment can relieve its signs and symptoms. Often topical antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. A common topical antibiotic prescribed is metronidazole. Another prescription medication is azelaic acid, which reduces redness and inflammation.

Oral antibiotics also are prescribed because they tend to work faster than topical ones. Some of the most common prescription oral antibiotics include tetracycline, minocycline, doxycycline and erythromycin.

Definition: Is a chronic disease characterized by excessive deposits of collagen in the skin or other organs.
Etiology:
Clinical Features: Affects the skin to cause local or widespread signs of inflammation (redness, swelling, tenderness, itching, and pain) that can lead to skin tightness or hardening. These skin changes most commonly affect the fingers, feet, face, and neck. This can lead to decreased range of motion of the fingers, toes, and jaw.
Clinical Approach: Diagnosis is by clinical suspicion, presence of autoantibodies (specifically anti-centromere and anti-scl70/anti-topoisomerase antibodies) and occasionally by biopsy. Of the antibodies, 90% have a detectable anti-nuclear antibody.
Treatment: There is no cure for every patient with scleroderma, though there is treatment for some of the symptoms, including drugs that soften the skin and reduce inflammation such as NSAIDS and steroids. The skin tightness may be treated systemically with methotrexate and cyclosporin.

Definition: Lupus pernio is a chronic raised indurated (hardened) lesion of the skin, often purplish in color. It resembles frostbite as it is seen on ears, cheeks, lips, nose, hands, fingers, and forehead. It is most often associated with sarcoidosis.
Etiology: The etiology of sarcoidosis is unknown, but several immune aberrations have been noted and are thought to play a role in its pathogenesis.
Clinical Features: The lesion is typically described as red to purple (due to increased vasculature), swollen, with shiny skin changes on the nose, cheeks, lips or ears.
Clinical Approach: Given the high correlation with systemic sarcoidosis, patients with lupus pernio deserve an evaluation for sarcoidosis. Initial evaluation, in addition to a complete history and physical examination, should include chest X-ray study, calcium level, renal and hepatic function panels, tuberculin skin testing, electrocardiogram, ophthalmologic evaluation, and pulmonary function testing.
Treatment: The most commonly used medications in the treatment of cutaneous sarcoidosis are corticosteroids (eg, topical, intralesional, oral), methotrexate, azathioprine, and hydroxychloroquine.