Skin conditions

Leave a comment Posted on A to Z of Medical Conditions, Skin conditions

Actinic keratoses – what are the signs, symptoms, causes and treatments of solar or actinic keratoses

Actinic keratoses

Actinic keratoses

Actinic keratoses, also known as solar keratoses, are dry scaly patches of skin caused by damage from years of sun exposure.

The patches can be pink, red or brown in colour, and can vary in size from a few millimetres to a few centimetres across. The skin in affected areas can sometimes become very thick, and occasionally the patches can look like small horns or spikes.

Actinic keratoses are found on areas of skin that are exposed to the sun, such as the:

face, especially the nose and forehead

forearms and backs of hands

in men, on the rims of the ears and bald scalps

in women, on the legs below the knees

The patches are usually harmless and sometimes get better on their own, but they can be sore, itchy and look unsightly. There is also a small risk that the patches could develop into a type of skin cancer called squamous cell carcinoma if they’re not treated.

You should see your GP if you think you may have actinic keratoses, so they can discuss treatment options with you.

Who is affected

Actinic keratoses are most commonly seen in fair-skinned people, especially those with blue eyes, red hair, freckles and a tendency to burn easily in the sun. Men are affected more often than women.

People who have lived or worked abroad in a sunny place, or who have worked outdoors or enjoy outdoor hobbies, are most at risk.

It may take many years before actinic keratoses develop – they don’t usually appear before the age of 40.

Studies carried out in the UK have suggested that around one in every four or five people over the age of 60 has actinic keratoses.

Diagnosing actinic keratoses

Your GP may be able to diagnose actinic keratoses by examining the patches on your skin.

In some cases, the diagnosis may need to be confirmed by removing a small sample of skin and examining it under the microscope.

Actinic keratoses can often be managed by your GP, but you may need to see a skin specialist (dermatologist) for further assessment if:

your GP is not certain about your diagnosis

your GP thinks one or more of your patches may be cancerous or at a high risk of becoming cancerous

your patches are particularly severe or widespread

you are taking immunosuppressant drugs – for example, following an organ transplant

your patches have not responded to treatment

Treatment options

If the patches are not troublesome, your doctor may simply recommend that you keep an eye on them and come back if they change in any way – for example, if you develop new symptoms such as a patch growing quickly, bleeding or forming an ulcer.

However, actinic keratoses are often removed because of concerns they may develop into skin cancer (see below) or, less commonly, for cosmetic reasons.

The patches can be removed using a variety of treatments, depending on your individual circumstances. The main treatments used are summarised below.

Creams or gels

There are a number of creams and gels that can be applied to the skin if you have several patches. Commonly used treatments include 5-fluorouracil cream, imiquimod cream, diclofenac gel and ingenol mebutate gel.

These creams and gels are usually applied daily (washing your hands carefully after), often for several weeks, and they cause the abnormal skin cells to die. They may make the skin sore, and it may weep and blister after a few days of treatment.

The various creams and gels seem to be similarly effective in treating actinic keratoses, although the potential side effects and the length of time that treatment is needed differs between each of them. Not all are easily available.

Discuss the benefits and risks of the different creams and gels available with your GP before starting treatment.

Freezing with liquid nitrogen (cryotherapy)

In some cases, freezing the patches (cryotherapy) may be recommended. This causes blistering and shedding of the sun-damaged areas of skin.

The time it takes the skin to heal varies, depending on the areas of the body treated. Some areas may heal in a week or two, whereas others may take a few months to fully heal.

A light freeze usually leaves no scar, but thicker lesions or early skin cancer may need longer freezes, which can leave a permanently pale or dark mark.

Scraping (curettage) 

Curettage is where the abnormal patches are scraped off with a sharp spoon-like instrument called a curette. This procedure is done under a local anaesthetic (where the treated area is numbed) and is generally used to treat thicker patches and early skin cancers, or to help confirm a diagnosis.

Cautery (heat treatment) is used to stop any bleeding after the cells have been removed. A scab forms after the procedure, which heals over a few weeks to leave a small scar.

The scrapings that are removed can be examined under the microscope to confirm the diagnosis.

Cutting it out (excision)

If your doctor suspects the patch may be cancerous or pre-cancerous, they may cut it out using a scalpel under local anaesthetic and close the wound with stitches. The piece of skin is then examined under the microscope to confirm the diagnosis.

Removing the patch will leave a permanent scar.

Other treatments

There are also a number of other treatments that may be effective in treating actinic keratoses, including:

photodynamic therapy (PDT) – where light is shone onto the affected area of skin after a light-activated cream has been applied; the light activates this cream and causes it to form a chemical that kills the abnormal cells

laser resurfacing – where a laser beam is used to remove the abnormal patches of skin

dermabrasion – where specially-designed abrasive instruments are used to remove the abnormal patches

chemical peels – where a corrosive liquid is applied to the affected area of skin to remove the abnormal patches

However, these treatments are not in widespread use and there is no clear evidence that they offer any additional benefit.

Self-help

It is important to protect your skin from the sun if you have actinic keratoses. This can reduce the risk of further patches developing and may help reduce the number of patches you already have.

To protect yourself from the sun, you should:

apply sunscreen with a sun protection factor (SPF) of at least 15 before exposing yourself to direct sunlight

cover up your skin with clothes and a hat during the summer months

try to avoid direct exposure to the sun when it is at its strongest (between 11am and 3pm)

It may also be helpful to regularly use emollients on your skin to stop it becoming dry.

Outlook

Actinic keratoses that have been treated usually go away, but it is likely that more patches will develop, requiring further treatment.

The development of actinic keratoses is a sign that the underlying skin is damaged from many years of sun exposure, and this cannot be reversed. It means you have a higher than average risk of developing skin cancer.

However, the exact chances of actinic keratoses developing into skin cancer are not clear. Some research has suggested the chances of a patch becoming cancerous are less than 1 in 1,000 every year, whereas other studies suggest the overall chances of actinic keratoses becoming cancerous may be as high as 1 in 10.

Leave a comment Posted on A to Z of Medical Conditions, Skin conditions

Acne – causes , symptoms, treatments and myths.

Acne is a common skin condition that affects most people at some point. It causes spots to develop on the skin, usually on the face, back and chest.

Molluscum Contagiosum

Acne?

The spots can range from surface blackheads and whiteheads – which are often mild – to deep, inflamed, pus-filled pustules and cysts, which can be severe and long-lasting and lead to scarring.

Read more about the symptoms of acne.

What can I do if I have acne?

Keeping your skin clean is important, but will not prevent new spots developing. Wash the affected area twice a day with a mild soap or cleanser, but do not scrub the skin too hard to avoid irritating it.

If your skin is dry, use a moisturiser . Most of these are now tested so they don’t cause spots (non-comedogenic).

Although acne can’t be cured, it can be controlled with treatment. Several creams, lotions and gels for treating spots are available at pharmacies.

If you develop acne, it’s a good idea to speak to your pharmacist for advice. Products containing a low concentration of benzoyl peroxide may be recommended, but be careful as this can bleach clothing.


If your acne is severe or appears on your chest and back, it may need to be treated with antibiotics or stronger creams that are only available on prescription.

When to see your GP

See your GP if you cannot control your acne with over-the-counter medication or if it is causing you distress and making you feel unhappy.

Also see your GP if you develop nodules or cysts, as they will need to be treated properly to avoid scarring.

Treatments can take up to three months to work, so don’t expect results overnight. Once they do start to work, the results are usually good.

Read more about treating acne.

Try to resist the temptation to pick or squeeze the spots as this can lead to permanent scarring.

Find out more about complications of acne.

Why do I have acne?

Ehlers-Danlos syndrome.

Ehlers-Danlos syndrome.

Acne is most commonly linked to the changes in hormone levels during puberty, but can start at any age.

It affects the grease-producing glands next to the hair follicles in the skin. Certain hormones cause these glands to produce larger amounts of oil (abnormal sebum).

This abnormal sebum changes the activity of a usually harmless skin bacterium called P. acnes, which becomes more aggressive and causes inflammation and pus.

The hormones also thicken the inner lining of the hair follicle, causing blockage of the pores (opening of the hair follicles). Cleaning the skin does not help remove this blockage.

Acne is known to run in families. If both your mother and father had acne, it is likely that you will also have acne.

Hormonal changes, such as those that occur during the menstrual cycle or pregnancy, can also lead to episodes of acne in women.

There is no evidence that diet, poor hygiene or sexual activity play a role in acne.

Read more about the causes of acne, including some common acne myths.

Who is affected?

Acne is very common in teenagers and younger adults. About 80% of people between the ages of 11 and 30 will be affected by acne.

Acne is most common between the ages of 14 and 17 in girls, and boys between 16 and 19.

Most people have acne on and off for several years before their symptoms start to improve as they get older. Acne often disappears when a person is in their mid-twenties.

In some cases, acne can continue into adult life. About 5% of women and 1% of men have acne over the age of 25.

Acne myths

Despite being one of the most widespread skin conditions, acne is also one of the most poorly understood. There are many myths and misconceptions about it:

  • “Acne is caused by a poor diet.” So far, research has not found any foods that cause acne. Eating a healthy, balanced diet is recommended because it is good for your heart and your health in general.
  • “Acne is caused by having dirty skin and poor hygiene.” Most of the biological reactions that trigger acne occur beneath the skin, not on the surface, so the cleanliness of your skin will have no effect on your acne. Washing your face more than twice a day could just aggravate your skin.
  • “Squeezing blackheads, whiteheads and spots is the best way to get rid of acne.” This could actually make symptoms worse and may leave you with scarring.
  • “Sexual activity can influence acne.” Having sex or masturbating will not make acne any better or worse.
  • “Sunbathing, sunbeds and sunlamps help improve the symptoms of acne.” There is no conclusive evidence that prolonged exposure to sunlight or using sunbeds or sunlamps can improve acne. Many medications used to treat acne can make your skin more sensitive to light, so exposure could cause painful damage to your skin, not to mention increase your risk of skin cancer.
  • “Acne is infectious.” You cannot pass acne on to other people.

[Original article on NHS Choices website]

Leave a comment Posted on A to Z of Medical Conditions, Skin conditions

Acanthosis nigricans – what are the signs and why we need to be aware of it?

Acanthosis nigricans

Acanthosis nigricans

It’s not a condition in itself, but can be a sign of an underlying health problem. These underlying conditions aren’t usually serious, although occasionally acanthosis nigricans can be sign of cancer.

Signs and symptoms

Dark, velvety patches.  If you have acanthosis nigricans, you’ll have thickened, brownish-grey or black patches of skin.

The patches will be dry and rough, feeling similar to velvet. They may also be itchy.

These patches may occur anywhere, but are usually seen around the neck, in the armpit, around the groin and sometimes in other skin folds. Occasionally, the skin over the joints of the fingers and toes may be affected, as well as the lips, palms of the hands and soles of the feet.

The patches usually develop slowly over time. Patches that grow and spread quickly are more likely to be associated with cancer. In these cases, the mouth, tongue, throat, nose and windpipe may also be affected.

Tiny growths on the skin

You may also have lots of tiny finger-like growths from the patches. This is known as papillomatosis.

There may also be skin tags around the affected area. These are small flesh-coloured or pigmented growths that hang off the skin and look a bit like warts.

When to see your GP

Acanthosis nigricans is usually harmless, but as it can be a sign of something serious it’s a good idea to see your GP if you think you have it. They may suspect acanthosis nigricans just by looking at your skin.

If the cause isn’t clear, you may have blood tests to check your blood sugar or hormone levels, and you might need additional tests such as an endoscopy or X-ray.

What causes acanthosis nigricans?

Acanthosis nigricans sometimes occurs in people who are otherwise in good health, particularly dark-skinned people of African descent.

However, in most cases it’s a sign of an underlying problem or condition such as obesity, diabetes or abnormal hormone levels. Some of the main causes of acanthosis nigricans are outlined below.

Obesity

Acanthosis nigricans is usually the result of obesity. This is known as obesity-associated acanthosis nigricans.

It occurs because obesity can cause insulin resistance (when the body is unable to properly use the hormone insulin), which may lead to high levels of insulin in the blood, affecting the skin cells.

Insulin resistance can also cause type 2 diabetes, so acanthosis nigricans can be an early sign that you have diabetes or are at risk of developing the condition.

Syndromes and hormone problems

Acanthosis nigricans is sometimes associated with an underlying syndrome or hormone problem, such as:

This type of acanthosis nigricans is known as syndromic acanthosis nigricans.

Genes

In rare cases, acanthosis nigricans can be caused by a faulty gene inherited directly from your parents. This is known as familial or benign genetic acanthosis nigricans.

This type is usually passed on in an autosomal dominant pattern, which means it can be passed on if only one of your parents carries the faulty gene.

Cancer

If the dark skin patches come on suddenly and spread quickly, it may be a sign you have cancer (usually stomach cancer). This is known as malignant acanthosis nigricans.

This is a rare condition that tends to affect middle-aged or elderly people, regardless of their weight or ethnic background.

The patches are more severe and the mouth, tongue and lips may also be affected. The skin may also become irritated and itchy.

How acanthosis nigricans is treated

Treatment for acanthosis nigricans aims to correct the underlying cause of your symptoms. This will usually cure the acanthosis nigricans or significantly improve the appearance of your skin.

Treatments that may be recommended include:

There’s no specific treatment to get rid of the patches, but a dermatologist (skin specialist) may be able to recommend treatments such as creams or tablets that may help improve the look of your skin.

Outlook

Most cases of acanthosis nigricans are harmless and not a sign of anything serious. The skin patches often fade with time as the underlying condition is treated.

If you have inherited acanthosis nigricans from your parents, your patches may gradually get bigger before staying the same or eventually fading on their own.

Only in cases where there is underlying cancer is the situation very serious. If the tumour is successfully treated, the condition may disappear, but unfortunately the types of cancer that cause acanthosis nigricans tend to spread quickly and a cure is often not possible.

[Original article on NHS Choices website]