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Spotlight on Common Skin Problems

Prevention and early detection of skin problems and conditions is important for overall health. Our skin is the largest organ and protects the body in various ways. There are many different kinds of skin problems, conditions, and diseases that present different risks to our health, ranging from many that are minor to some that are life threatening. The following sections focus on a few skin problems and conditions that require special attention.

Pressure sores
Prevention of pressure sores (sometimes referred to as bedsores or decubitus ulcers) is particularly important for consumers who have limitations in mobility and physical activity, or for consumers who need assistance from others to change their body position. The risk for pressure sores is great when these conditions are present.

A pressure sore is caused from too much pressure being placed on the skin in one area for too long, resulting in damage to underlying tissue. Pressure sores are most likely to form over an area of tissue covering bony parts of the body. For example, a person sitting in a wheelchair for extended periods of time may have areas on their back and buttocks that press against the wheelchair. Having this pressure for long periods of time prevents proper blood circulation. This in turn causes skin breakdown and open sores that can lead to very serious infections.

Pressure sores may also be caused by friction when the skin frequently rubs against something such as bedding or ill-fitting clothing or shoes. Supportive devices, braces, casts, and bandages can all exert pressure and/or friction on the skin and cause irritation and skin breakdown.

Pressure sores are prevented by frequent changes in body position, at least every two hours or more often as may be needed. Skin also should remain clean and dry. Assistive, supportive, and prosthetic devices should be checked routinely to ensure proper fit. In some cases, pressure-reducing devices such as special mattress pads, bolsters, or cushions may be needed.

The first sign of skin breakdown is irritation and redness of the skin. It is very important to frequently check skin condition for these signs. If irritation and redness remains longer than a few hours, a health care professional should be consulted. Without appropriate and aggressive treatment, pressure ulcers or wounds can quickly develop, may be difficult to heal, and may progress to a life-threatening infection. Basic treatment consists of alleviating pressure, protecting and cushioning the area, and maintaining good hygiene and nutrition. Advanced stages of pressure ulcers may require use of antibiotics, removal of dead tissue, and treatment by wound specialists.

Photosensitivity
Photosensitivity is an increased sensitivity to sunlight or ultraviolet light. This means that a consumer may experience sunburns, hives, and rashes after exposure to sunlight for a length of time that would not usually cause problems. This problem can occur even after very brief periods of time. Medications, food additives, and other products like deodorants and soaps may cause this increased sensitivity.

There are dozens of medications that may contribute to photosensitivity. Examples of some of these medications include:

• Antihistamines used in cold and allergy medicines (Claritin, Benadryl, Phenergan);
• Non-steroidal anti-inflammatory drugs (NSAIDs) used for pain and inflammation (Ibuprofen, Motrin, Aleve);
• Antibiotics used to treat infections (Tetracycline, Bactrim, Vibramycin);
• Medications used to treat mental health conditions (Sinequan, Trilafon, Elavil, Prolixin, Thorazine, Stelazine, Mellaril);
• Diuretics used to treat cardiovascular problems (Lasix, Diuril);
• Anti-epileptic drugs used to treat seizures (Tegretol, Depakote); and
• Acne preparations (Retin-A).

As with any medication, it is important to check the warning labels on the medication bottle and packaging, and to ask questions of the pharmacist and physician. Taking simple precautions when going outdoors can protect the skin. These precautions include applying sunscreen, wearing protective clothing, and avoiding exposure during peak hours of intense sunlight.

Skin cancer
The most common type of cancer in the United States is skin cancer. It is estimated that approximately half of the people who live to age 65 will have skin cancer at least once. While anyone may get skin cancer, the risk is greatest for people who are fair-skinned and easily freckle such as people with red or blond hair and blue or light-colored eyes. The main cause of skin cancer is ultraviolet radiation from the sun.

There are three major kinds of skin cancer. The vast majority of skin cancer is basal cell carcinoma or squamous cell carcinoma. These are slow-growing cancers that usually do not spread to other parts of the body. The most serious kind of skin cancer that occurs less frequently is malignant melanoma. Melanoma is a highly aggressive cancer that often spreads to other parts of the body and may be fatal if not treated early.

The most common warning sign of skin cancer is a change in the skin, especially a new growth or sore that does not heal. Skin cancers may have different appearances. Some may first appear as a patch of red or brown, scaly, rough skin. Some can also appear as a smooth, shiny, pale, or waxy lump. In other cases, the appearance is that of a red lump that may bleed or develop a crust.

The first sign of melanoma is often a change in the size, shape, color, or feel of an existing mole. Melanomas may also appear as a new mole or skin growth that itches or becomes sore, enlarges, grows crusty, and bleeds. Most melanomas have a black or blue-black area. It is important to note that moles are very common and few become cancerous. The American Cancer Society developed a simple ABCD guide to outline warning signals concerning moles or mole-like growths. It is important to watch for the following:

• Asymmetry: shape of one half does not match the other;
• Border: edges are irregular, may be ragged, notched, or blurred;
• Color: color is uneven and shades of black, brown, tan may be present; and
• Diameter: change in size, usually an increase and usually larger than the eraser of a pencil.

Early detection of skin cancer is best accomplished by frequent checks of the entire body for any new growths or other skin changes. Any suspicious areas or changes in moles should be reported without delay to a health care professional for further assessment. Also, a physician should check a person's skin during visits for regular checkups and physical exams.

Treatment of basal cell carcinoma and squamous cell carcinoma usually consists of surgical removal. Treatment of malignant melanoma is more complex and may involve surgery, chemotherapy, radiation therapy, and biological therapy.

Dermatitis
Dermatitis is a common condition that affects about one in every five people at some time in their lives. There are different causes and various types of dermatitis. The terms "dermatitis" and "eczema" are often used interchangeably. Dermatitis is an allergic reaction and involves an inflammation of the skin. Areas of the skin itch and appear red, irritated, and may be dry and flaky or seep fluid. Dermatitis may cause intense discomfort because of itching and burning of the skin. Further, dermatitis may lead to skin breakdown and infection.

Contact dermatitis is a localized rash or irritation of the skin caused by contact with a foreign substance. Substances that may cause contact dermatitis in many people include "poisonous" plants such as poison ivy, certain foods, some metals, latex, rubber, and substances in cleaning solutions, detergents, cosmetics, perfumes, and industrial chemicals.

Atopic dermatitis is a chronic or recurrent skin disease often associated with other allergies like hay fever and asthma. While this type of dermatitis often first appears in children, it may also continue into adulthood as a significant problem. Symptoms may vary, but the most common are dry, itchy skin and rashes on the face, inside the elbows, behind the knees, and on the hands and feet. Itching is the most common and critical symptom. Scratching and rubbing in response to itching irritates the skin, increases inflammation, and increases the itch sensations. This type of dermatitis will flare up and be followed by periods when the skin improves or completely clears up. Atopic dermatitis in not contagious and currently cannot be cured.

Treatment of dermatitis involves avoiding or removing whatever is causing the allergic reaction; however, severe forms are caused by intense allergic reactions to external agents that cannot be eliminated from the environment. Steroid creams and antihistamine medications are usual treatments.

Additional information about these and other skin conditions may be found at the following websites:

National Institute of Health
http://www.nih.gov