Thursday 21 st August Skin Problems

Thursday 21 st August 2014 Skin Problems

Skin Problems The Sun and the Skin Sun Damage Recognising the early signs of skin cancer The Big 3 inflammatory condi=ons Acne & Rosacea Eczema (Including Seborrhoeic Derma==s) Psoriasis Extras: Warts, Moles & Skin Tags Ques=ons & Answers

Maximum recommended sun exposure =me per day based on skin type with 30 SPF Skin s natural Protec1on Normal Sun Strong Sun Extreme Sun Skin Type 1 Skin type 2 Skin type 3 Skin type 4 Skin not used to sun Skin used to sun Skin not used to sun Skin used to sun Skin not used to sun Skin used to sun Skin not used to sun Skin used to sun 3 min 2 h 15 1 h 45 1h 10 10 mins 3 h 45 3 h 1 h 45 10 mins 4 h 30 3 h 30 2 h 15 20 mins 7 h 30 6 h 3 h 45 20 mins 6 h 45 5 h 3 h 30 30 mins 10 h 9 h 45 5 h 30 30 mins 8 h 6 h 30 5 h 45 mins 10 h 10 h 7 h 30

Avoiding Sun Damage Use minimum of SPF 30 & 4or 5 * Apply before going out and allow =me to soak in UV clothing great for kids and adults Apply generously or apply second coat Re- apply a]er long periods in water Get out of Mid- day sun Enjoy warmth, avoid burn and don t die for a tan

Sun Damage Len=go Seborrhoeic Keratoses Campbell de Morgan Spots Ac=nic Keratoses

Len=go O]en mul=ple Small Regular Numerous Worry if larger, irregular, changing Harmless ones can be treated with cryotherapy with liquid nitrogen

Seborrhoeic Keratosis Classical stuck on lesion Warty Brown Waxy/Rough Mul=ple Harmless but can cause concern Occasional become inflamed, itchy or catch Can be shaved or treated with cryotherapy

Campbell de Morgan Spots Vascular prolifera=on Increase with age & sun Benign NOT contagious! Can be treated with hyfreca=on

Ac=nic Keratoses Thickened, rough areas Corn flakes stuck on the skin Can come and go, worsening with sun exposure If persistent or thickened may herald skin cancer change

Ac=nic Keratoses Cream based treatments to treat the field Vary from twice daily for 3 months to 3 days only O]en cause worsening of skin before see improvement Thickened lesions can be curemed or treated with liquid nitrogen

Picato New 3 day treatment Excellent compliance Individual tubes for 5 x 5 cm area Severe reac=on, but surprisingly well tolerated Easier to fit around working life

Recognising Early Signs of Skin Cancer Basal Cell Carcinoma Squamous Cell Carcinoma Malignant Melanoma Only Melanoma is pigmented Public o]en only focus on pigmented skin change

Basal Cell Carcinoma Commonest skin cancer (80%) More common than all other cancers put together If fair and had reasonable sun exposure +/- episodes of sun burn you are highly likely to get one of these! These do not spread, effect general health or life expectancy

A Scab with a rolled edge and arborizing vessels = BCC

Basal Cell Carcinomas - Nodular New lump (papule) O]en Pearly Prominent Vessels tree like Ulcerate centrally O]en present as a lesion that bleeds and then scabs May appear to improve but doesn t disappear

Basal Cell Carcinoma - Other Can present as scar like area without history of trauma = Morphoeic type Can present as well demarcated red patch or mul=ple patches (typically on back) = Superficial type

Basal Cell Carcinomas Gold standard treatment is surgical excision with clear margins Usually simple procedure under local anaesthe=c carried out as day case Facial BCCs may require specialist surgical techniques and reconstruc=on

Squamous Cell Carcinoma Associated with chronic sun exposure Increased if immune system is suppressed Present as dome like lesion with central scaly area kera=n May arise from thickened Ac=nic Keratoses Most cured with treatment but small malignant poten=al, especially from high risk sites e.g. ear

Squamous Cell Carcinoma Gold standard treatment is surgical excision with clear margins Can be curemed Radiotherapy over 10 treatments

Malignant Melanoma The one not to miss! If caught early completely cured by surgery If missed has high malignant poten=al spreading to lymph glands and organs such as brain, lung, gut and liver

Malignant Melanoma Most present as irregular pigmented flat lesion Ugly Asymmetric Irregular border Stand out as different Ugly Duckling Itching is probably not relevant

Malignant Melanoma Colour change in a mole or varia=on is worrying Black Mul=ple shades of brown Milky- Red Blue- Grey Moles that bleed without trauma are worrying New pigmented lump

Malignant Melanoma Surgery can be cura=ve O]en carried out as two stage procedure Narrow margin to remove and diagnose Wide local excision to clear area Pa=ents require regular skin checks

If in doubt photo and see again

Acne Disorder of hair follicles Blocked pores Increased Sebum from puberty Increased Bacteria Inflamma=on

Acne Pathology

Acne No quick fixes! Conven=onal medical therapy vs Re=noids Re=noids a lot of bad press but in the right hands completely life changing Everyone gets dryness Monitor for mood change and avoid pregnancy

Rosacea

Rosacea F>M >30s +, o]en post- menopausal Pale skin types, + Sun exposure Mostly facial, but frequently involves eyes, can involve scalp and body O]en chronic / intermiment Ae=ology unknown -?Demodex mite

Rosacea Flushing - triggers spicy food, alcohol No comedones Papules, Pustules, Telangiectasia Rhinophyma

Rhinophyma before and a]er surgery

Eczema Disorder of barrier func=on Lack or decreased protein Fillagrin Water escapes, allergens and irritants can penetrate Childhood onset good prognosis Adults control and not cure

Eczema Give the barrier a helping hand Switch off inflamma=on Alterna=ves to steroids Immune- modulators Phototherapy Immunosuppressives

Seborrhoeic Derma==s Sub- type of eczema Reac=on to a common yeast on the skin Eyebrows, nasolabial folds, chest, back and groins Comes and goes control and not cured Worse with Parkinsons & HIV

Psoriasis 3%, M=F Thickened scaly areas scalp, elbows, knees, trunk Combina=on products can control Alterna=ves Phototherapy Systemics Biologics

Warts Viral warts triggered by HPV Very resistant to treatment Salicylic acid Occlusion Cryotherapy Curemage Laser + Bleomycin

Moles & Skin Tags Mul=ple skin tags can be associated with pre- diabetes Skin tags and raised moles (compound naevi) can be shave excised Snip excision alterna=ve

Q&A