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Warts

Warts

Warts are skin growths that arise from a human papillomavirus (HPV) infection in the upper layers of the skin. 

Warts are very common especially in children, they are not dangerous but they do spread easily through contact. A miniscule defect in the skin is all that is needed for the virus to infect the skin and a wart to form.

Regardless of where they are found on the body, warts have a very typical appearance and rarely require a biopsy. Some warts grow outwards and are raised, hard, rough and have cauliflower-like appearance. Some warts grow inwards – as seen in plantar warts found on the sole of the foot. These tend to look like indentations in the foot. You may see a tiny dark spot in the middle of a wart – this is called an intracorneal haemorrhage.

Here a 5 things that your GP will want to know about your warty growth:
– The duration that you have had the wart
– The location of the wart on your body
– Pain or irritation the wart may be causing you
– Growth of the wart
– Your expectations and wishes for management

These are the most commonly used treatment options:

  1. Watch and wait: most warts will resolve on their own after 12 months.
  2. Topical Salycylic acid 40%: carefully paint this ointment onto the wart every night and cover the area with a bandaid. This treatment can take up to 12 weeks, but can be effective. It can cause skin irritation so make sure you protect the normal skin around your wart and you speak to your GP if irritation occurs.
  3. Cryotherapy: your GP can use cryotherapy to freeze the wart off. Liquid nitrogen is applied to the wart either with a cotton swab or sprayed directly onto the affected area. This treatment causes localised irritation which resolves within a few days. You may require a few sessions every 2-4 weeks depending on the size and location of the wart. 
  4. A combination of topical salicylic acid and cryotherapy.

A wart that is causing you pain and affecting your ability to do your daily activities is worth treating, so speak to your GP to find the best option for you.

Vitiligo

Vitiligo

Vitiligo is an autoimmune condition which affects the skin’s pigmentation. The skin becomes de-pigmented and loses its colour due to damage or loss of melanocytes.

A person with vitiligo will have milky-white coloured patches of skin over the body alongside their normal skin. Vitiligo can have a significant effect on someone’s self-esteem.

A GP will want to know a few things when assessing for vitiligo:

  • The areas of the body affected by skin changes
  • Your age when you first noticed changes in your skin
  • The way your skin responds to injuries like small cuts and abrasions
  • Family history of vitiligo
  • Your perception of the vitiligo and the impact it has on your life

They may also consider sending you for blood tests to screen for other autoimmune issues. This can include checking your thyroid function and vitamin b12 levels.

There are topical corticosteroid creams and topical calcineurin inhibitor creams/ointments which your GP may prescribe for a short period of time. However the extent of the vitiligo and the areas of skin affected will guide your treatment.
Your GP may also consider referring you to a dermatologist.

Taking care of your skin is very important with vitiligo. The white patches are more susceptible to sunburn so don’t forget to apply sunscreen, seek out shade and cover up your skin when outdoors. Vitiligo patches are also more likely to form from injured skin so cover your skin to prevent cuts and grazes.

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For more information on skin health read on acne here www.hellodoc.nl/blog

Folliculitis

Folliculitis

Folliculitis occurs when the hair follicles on your skin become inflamed. This can be due to blockages of the hair follicles or infections in the follicles from things such as bacteria, viruses, fungi and yeast. The skin around the affected hair follicles will appear red and often there will be tiny white pustules – they appear like tiny pimples on the skin surface. 

To determine the cause of your folliculitis, your GP may want to know some of the following things: 

  1. Any creams you may have used recently on the affected area.
  2. If the skin has been irritated recently hair removal practices such as waxing or shaving.
  3. If you have recently been bathing in a spa 
  4. If the affected area was recently covered up by an adhesive
  5. Any contact you may have had with another person with a similar skin rash
  6. Don’t forget to disclose all the medications you use, including creams or ointments as they could cause folliculitis.

Your GP will prepare a management plan for you depending on the cause and severity of your folliculitis. Here are some examples of possible treatment options: 

  1. Watch and wait – this is appropriate for many cases of mild folliculitis. The folliculitis will resolve on its own with good hygiene and skin care practices. You will be asked to avoid covering up the affected area. Ensure that you keep the area clean of sweat and dirt. And avoid applying oils to the skin (use an oil free moisturiser if needed). 
  2. Oral antibiotics – for more severe bacterial folliculitis cases, your GP may prescribe a course of Flucloxacillin 500mg to be taken 4 times a day for 7 days. (If you have a Penicillin allergy – Clarithromycin or Clindamycin are alternative options).
  3. Antifungal treatments – either topical or oral – may be used if you have a yeast or fungal infection.
Moles

Moles

Moles are pigmented lesions on the skin. They can be flat or raised and vary in colour from fleshy pink to black.  A typical mole is benign and can be present from birth or appear a little later in life. But spots that look like moles can can develope in skin cancer such as melanoma.

When your GP examines your mole(s), they will apply the ABCDE rule:

A – Asymmetry: is the spot symmetrical or not

B – Border: is there a clearly defined border around the outside or is it irregular

C – Colour: brown, black, blue, pink, white and how even is the colour distribution

D – Diameter: Is the mole wider than 6mm and is it increasing in size

E – Evolving: the GP wants to see if the mole has been changing over a period of time

Your GP will also want to know about:

  • The age of your mole(s)
  • Any changes in their shape and size 
  • If your mole bleeds and/or has trouble healing
  • If you have pain or an itch

In the case of any suspicious findings your GP may want to take a biopsy of the mole. He or she may also examine your lymph nodes. A referral to a dermatologist may also be required in this case. If the mole appears benign, then your GP may ask you to keep an eye on the mole yourself and return if there are any changes. 

It is a good idea to keep a photo diary of your mole(s) and have your skin checked at least once a year. Of course if you have previously had any skin cancers, then you should have a skin check every 3 to 6 months depending on your specialist’s advice.

Finally, keep your skin safe from developing all forms of skin cancer by being Sun Safe:

  • Smeer in your high spectrum sunscreen
  • Put on a hat, sunglasses and clothes to cover your skin
  • Seek out shade when outdoors
  • Avoid tanning beds

Psoriasis

Psoriasis

Psoriasis is a complex inflammatory disease. It is perhaps best known for the plaque-like skin changes it causes, but it can also be linked to conditions that affect many other parts of the body. In this post we will focus on plaque psoriasis of the skin. 

Psoriasis plaques have a scaly, red and raised appearance and commonly affect the scalp and the outer surfaces of joints (such as the elbows or knees). These plaques can vary in size and severity. Some people experience itch with their plaques, for others the skin can break and become very painful. For many, the plaques are a cause for loss of self-confidence. 

There are a few things that are known to make psoriasis worse. Here are 5 common exacerbating factors:

  1. Stress
  2. Cold weather
  3. Smoking
  4. Alcohol
  5. Injury to the skin

Your GP will follow a stepwise plan to help manage your psoriasis. An example of a 3 step approach your GP may follow is:

Step 1: A potent topical corticosteroid once a day for 4 weeks

Step 2: If there is incomplete resolution after step 1, change to a potent topical corticosteroid once a day PLUS a Vitamin D analogue ointment once a day for 4 weeks

Step 3: If there is incomplete resolution after step 2, change to a very potent topical corticosteroid once a day for 4 weeks.

Your GP may also need to refer you to a dermatologist if

  • Symptoms have not resolved with the above mentioned approach
  • Your GP feels your psoriasis is severe
  • You have associated joint pain that does not improve with non-steroidal anti-inflammatory use for 4 weeks
  • There is any uncertainty about your diagnosis
  • You have a form of psoriasis called Erythrodermic psoriasis – this is very uncommon, the skin over the entire body is red, itchy and peels. 
  • You have a form of psoriasis called Guttate psoriasis that does not resolve after 2-4 weeks. This form is most commonly seen in children following a bacterial strep throat infection. They get small red scaly lesions on their trunk, upper arms and thighs

People with psoriasis can also develop other health problems, so keep in touch base with your GP regularly for health checks. Here are 6 conditions that are linked to psoriasis:

  1. Psoriatic arthritis – up to 40% of people with psoriasis of the skin will develop an inflammatory arthritis known as Psoriatic arthritis. Let your GP know if you have any joint pains as it is important to treat this early to avoid long term damage to your joints.  
  2. Crohn’s disease
  3. Type 2 Diabetes 
  4. Obesity
  5. Depression
  6. Cardiovascular disease including high blood pressure
Cellulitis

Cellulitis

Cellulitis is a bacterial skin infection. Signs are acute redness of the skin, and oedema with rough borders. It usually affects lower limbs but any skin region can become infected.

The causes of cellulitis in when the skin barrier is damaged such that bacteria can cross over the skin layers and infect cells. People with pre-existent conditions such as diabetes, obesity, bite wounds or insufficient pump function of the veins are susceptible to cellulitis. Bacteria called stapylococcus aureus is the cause in 80% of cases.

The GP will differentiate between cellulitis and erysipelas. The latter is more superficial and has well marked edges or borders and usually is elevated. The GP will want to know

  1. How long the region of the skin has been affected
  2. what happened prior to developing symptoms
  3. Recurrence of symptoms
  4. Recovering from skin disease
  5. Presence of fever or general unwell
  6. If the redness spread out
  7. if there is pain or hypersensitivity
  8. Pre-existent conditions as mentioned above

A GP will check physically for the size, thickness of the cellulitis. Also comparing the skin temperature difference beween the affected skin are and normal area can be performed. Palpating for lymph nodes is an important part of the physical examination. Blood tests may be requested by the GP if cellulitis is associated with fever, chills, general unwell appearance, lymph nodes oedema or cellulitis located near the mouth or eye.

Management of cellulitis consists of

  • Hygiene; keep the area clean and dry
  • Pain relief; cellulitis can be very painful. Take Paracetamol 500mg, 2 tablets 4 times a day
  • Bandage, elevate and immobilise the limb
  • Oral antibiotics in those with no pre-existent conditions
    • Flucloxacilline 500mg one tablet four times a day for 10 days
  • Oral antibiotics in those with pre-existent conditions
    • Amoxicilline/Clavulanic acid 625mg, one tablet 3 times a day for 7 to 10 days
    • Doxycycline 200 mg one tablet once a day for 7 to 10 days