The Barber's Itch

Barber's itch is a type of Folliculitis "an inflammation of one or more hair follicles".
It is an infectious skin disease which arises on bearded area of the face and upper lip. The condition takes place when the hair follicles get damaged by constant friction with clothing and it may even take place due to blockage and shaving

The disease develops and the first signs of the condition are the appearance of painful pimples that develop at the hair follicles along the beard, these pimples can grow either superficial or may occur in the deeper layers of the skin associated with some common symptoms as rash, itching, and pimples or pustules near a hair follicle in the neck, groin, or genital zone.

The cause that responsible for Barber`s folliculitis may be either a bacterial or a fungal infection :
- Mustache hair is usually affected by the bacteria; staphylococci.
- Bearded hair on the cheeks and the chin is commonly affected by the fungus.

#The condition is aggravated by shaving ,On the other hand the sharing of towels and razors passes on the highly contagious fungal infection

Acanthosis nigricans in diabetes mellitus

You note the shown skin disorder during a general medical evaluation. You explain to the patient they are at risk for the development of:

A) Alzheimer's disease

B) tuberculosis

C) diabetes mellitus

D) Grave's disease

E) melanoma



 The answer is C. (Diabetes mellitus) 
Although the majority of cases of acanthosis nigricans are benign and associated with obesity, the disease can represent the onset of malignancy as well as a variety of conditions related to insulin resistance.
Acanthosis nigricans has been reported in association with a number of malignancies, particular gastrointestinal cancers (e.g., gastric, hepatocellular) and lung cancer. The suspicion for malignancy increases in patients with extensive or rapidly progressive lesions, when there is mucous membrane involvement, or when there is prominent sole and palm disease.

The common finding in all non-malignancy associated cases of acanthosis nigricans is insulin resistance. This explains the relationship between this skin disorder and diseases such as diabetes mellitus, Cushing's syndrome, and hypothyroidism (most likely due to weight gain and subsequent insulin resistance), and with obesity.

Characteristic shape of Molluscum contagiosum infection

A 4-year-old preschooler presents with the skin lesions shown here. The area affected is just below the chin on the child's right side. The lesions have been present over the last month, and the child has reported no symptoms associated with them. The most likely diagnosis is

• A) varicella


• B) herpes zoster


• C) Rhus dermatitis


• D) molluscum contagiosum


• E) scabies

 The answer is D. (Molluscum contagiosum) 

Molluscum contagiosum is a common, superficial viral infection of the skin that typically occurs in infants and preschoolers. The incidence decreases after the age of 6 to 7 years. The condition can be spread via sexual contact in young adults.
The lesions are dome-shaped, waxy, or pearly-white papules with a central white core and are 1 to 3 mm in diameter. Frequently, groups of lesions are found. The lesions may resolve spontaneously. Treatment involves removal with a sharp needle or curette, application of liquid nitrogen, antiwart preparations, electrodessication and curettage, or trichloroacetic peels for extensive areas. Typically, infants or young preschool-age children should not be treated aggressively.

Typical flesh-colored, dome-shaped and pearly lesions

Photo illustration of Actinic Keratosis

Actinic keratoses generally appear as rough, red/brown, scaly macules or papules on the skin. They start to appear usually about age 30 or older.

Actinic keratoses (AKs) are A premalignant neoplasm of the epidermis caused by excessive exposure to sunlight and manifesting as an ill-marginated, erythematous, scaling, rough papule or patch that form on sun exposed areas of the skin, including the scalp, face, forearms, and back of the hands.

Actinic keratoses are usually scaly, feel like sandpaper to the touch, and range in color from skin-toned to reddish-brown " AK are more easily felt than seen, as their overlying scale is thick and firmly adherent".  Actinic keratoses may be as small as the head of a pin or as large as a quarter (or bigger, if left untreated).

Actinic keratoses on the scalp

Actinic keratoses are most common in individuals over 40 years old with fair skin and years of excessive sun exposure. However, even younger people (including those with dark skin) can develop actinic keratoses if they live in very sunny climates.

Lesions are occasionally tender to palpation. Fair-skinned persons, who burn easily and tan poorly, are most commonly affected. A small percentage of AK on non-mucosal skin can progress to skin cancer squamous cell carcinoma. Ultraviolet light exposure induces formation of the lesions.

Between Tinea capitis and Psoriasis of the scalp

 A 6-year-old child presents complaining of patchy hair loss on the back of the scalp. Examination reveals well-demarcated areas of erythema and scaling, and although there are still some hairs in the area, they are extremely short and broken in appearance. Which of the following is the most likely diagnosis?

• a.Androgenic hair loss
• b.Psoriasis of the scalp
• c.Seborrheic dermatitis
• d.Tinea capitis
• e.Carbuncle

 The answer is d. 

The history is most consistent with tinea capitis due to either Trichophyton tonsurans or Microsporum canis. It is usually seen in school-age children and may be transmitted from person to person.

 A mild but widespread infection by Tinea capitis (Scalp ringworm). Inflamed areas are seen on the front, behind the ear and on the back of the neck.Black dots are from broken hair

Psoriasisis a hereditary disorder characterized by scaling patches and plaques appearing in specific areas of the body, such as the scalp, elbows, lumbosacral region, and knees. The lesions are “salmon pink” with a silver-colored scale that on removal produces blood (Auspitz sign). The Koebner phenomenon (with trauma, the lesion jumps to a new location) is also elicited in patients with psoriasis.
Seborrheic dermatitisis a common chronic dermatosis occurring in areas with active sebaceous glands (face, scalp, and body folds) and may occur either in infancy or in people over the age of 20. The eczematous plaques of seborrheic dermatitis are yellowish red and are often greasy with a sticky crust. Androgenic hair loss is a progressive hereditary bitemporal, frontal, or vertex balding that may begin any time after puberty. A carbuncle is a deep infectious collection of interconnecting abscesses (furuncles) arising from several hair follicles.

Photos and information about Blue Nevus

- Blue Nevus is a group of melanocytic lesions which all appear blue in colour due to the optical effects of light reflecting off melanin deep in the dermis.

- The blue nevus is a benign, usually solitary lesion, represents a localized proliferation of dermal melanocytes. It presents as a dark blue to black, moderately firm, rounded, sharply defined nodular tumour composed of spindle-shaped melanocytes with slender cytoplasmic processes, occurring often in association with melanin-laden macrophages in a sclerotic dermis.
- A blue naevus (nevus) is a rather unusual but non-cancerous mole.

- The blue nevus is also called the blue skin mole, or Jadassohn-Tièche nevus with 2 clinically recognized variants : the common blue nevus and the cellular blue nevus.

- Cellular blue nevus is larger, especially on buttocks and can degenerate into malignant melanoma.

- Clinically The blue nevus appears as a dark-blue or blue-black smooth nevus formed by melanin-heavily pigmented spindle cells in the middle and lower two-thirds of the dermis. Also, the blue nevus appears as a slate blue or bluish black, sharply circumscribed, flat or slightly elevated nodule, occurring on any area of the body.
- A biopsy should be performed on any changing pigmented lesion. For a solitary lesion, simple excision is usually curative. Rare cases of persistent blue nevi, manifesting as satellite lesions around the original excision site, have been reported. These must be distinguished from malignant blue nevus, and reexcision is recommended.

Common blue nevus

Atypical "Rodent Ulcer" Basal Cell Carcinoma

These lesions are moist ulcers which may not have the characteristic rolled, translucent border of a nodular Rodent Ulcer or Basal Cell Carcinoma BCC. Often, they are much larger than the pre-auricular lesion seen here, and represent neglected lesions.

The typical basal cell carcinoma appears as a small, pearly, dome-shaped nodule with small visible blood vessels (telangiectasias).

Images for Skin manifestations in hyperlipidemia

Xanthelasma in a 43-year-old patient with hyper-cholesterolemia.

-Severe hyperlipidemia, particularly primary forms of hyperlipidemia, can be associated with lipid deposits in the skin and in joints. However, a corneal arcus, an arcus lipoides, and xanthelasma may be present with normal cholesterol levels after the age of 40.

-Tendon xanthoma and palmar xanthoma occur in some of the primary dyslipoproteinemias.
Tendinous xanthomas are nodose, subcutaneous lesions attached to ligaments and tendons, particularly the Achilles tendon due to accumulations of lipid-laden macrophages (foam cells) in tendons.
The nodules may be yellowish, but are usually skin colored. They are often associated with other xanthomas, and indicate the presence of hypercholesterolemia or other lipid abnormality.

-Also Tubero-eruptive xanthoma that may itch and the lesions may be reddened due to inflammation and scratch effects.

 Eruptive xanthoma in hyperlipidemia.

Laser surgery Norwich, Norfolk, UK

CO2 laser surgery for rhinophyma. Removal of moles, lumps, cysts and skin tags with laser in Norfolk, UK.

Illustrated photos of Milia

Definition of Milia :

Milia form as multiple, firm, white lesions that range from 1 to 4 mm in diameter. They are very common, benign, keratin-filled cysts.

Milia usually appear on the face and most commonly affect the eyelids, nose, and malar region, sometimes on the genitalia; It is formed at base of hair follicle or sweat gland.

Milia are commonly associated with newborn babies 40% of newborns, but can appear on people of all ages.


Other names: milk spot or an oil seed.Milium is the single of milia.

Types of Milia :

1- Primary or spontaneously.
2- secondary caused by trauma, radiotherapy, skin infection, or bullous diseases.

Treatment:

In children milia often disappear within two to four weeks.Options include simple excision, electrodessication of the surface, or puncture and expression of the contents

Non-healing ulcer of Basal cell carcinoma

A 60-year-old retired construction worker presents with a non-healing skin lesion on the back of his hand that occasionally bleeds when he gets out of the shower. The most likely diagnosis is

• A) basal cell carcinoma
• B) squamous cell carcinoma
• C) superficial spreading malignant melanoma
• D) actinic keratosis
• E) keratoacanthoma

The answer is A. (Basal cell carcinoma)

Basal cell carcinoma is the most common form of skin cancer. The lesions are induced by ultraviolet radiation in susceptible individuals. Risk factors include age older than 40, light complexion, positive family history, and male sex. The lesion in the photo has pearly, raised borders with telangiectasia and a central ulcer that may crust. Sun-exposed areas are most commonly affected. Diagnosis is achieved with shave or excisional biopsy.

Treatment is accomplished with excision, electrodessication and curettage, liquid nitrogen application, Moh's surgery, radiation treatment, and topical 5-fluorouracil cream. Almost 50% of patients with basal cell carcinoma will have another within 5 years.

Mottled skin or Cutis Marmorata in neonates

Cutis marmorata or "marbled skin" refers to mottled skin, typically in newborns in the first few months of life.
This reticulated pattern of constricted capillaries and venules is often called "mottling" due to vasomotor instability in immature infants. It generally resolves with increasing age and for most infants is of no significance.

Explanation of cutis marmorata :

This phenomenon is caused by instability or immaturity of the nerve supply to the superficial capillary blood vessels in the skin. This causes the blood vessels in some regions of the skin to dilate, producing a red color of the skin, while other regions are contracting, producing pale skin.

In spite of it`s insignificance in most babies ,it may reflect underlying poor perfusion and infants who develop mottling and are unwell need to be clinically evaluated for sepsis and other illnesses.

Cutis Marmorata Telangiectatica Congenita :

Reticular skin lesions on the right arm of a 7-y girl

It is localised , marked and more pronounced form of cutis marmorata which may be associated with other defects. It is uncommon and sometimes called (congenital generalized phlebectasia)
cutis marmorata telangiectatica congenita is often reported in association with a variety of other congenital anomalies, the most common anomaly associated is Body asymmetry.

Skin manifestations of Pellagra

Pellagra is a a vitamin deficiency disease caused by chronic lack of nicotinic acid (niacin, vitamin B3) or its precursor, tryptophan.Niacin is required for most cellular processes.

CAUSE of Pellagra:

Inadequate niacin and/or tryptophan in the diet mainly seen in developing countries or poverty stricken areas "called Primary pellagra".But usually there is something prevents Niacin absorption and processing and causes secondary pellagra such as:
• Alcoholism, malabsorption, anorexia nervosa, Prolonged diarrhoea, Liver cirrhosis, Drugs e.g. isoniazid, azathioprine

• Carcinoid tumors (excessive use of tryptophan, which produces serotonin)

Symptoms and signs of Pellagra is classically described by "the four D's": diarrhea, dermatitis, dementia and If left untreated, death.

Skin manifestations and clinical finding of Pellagra:

-At first there is reddened skin with superficial scaling in areas exposed to sunlight, heat & friction. This may resemble severe sunburn then gradually subsides leaving a dusky brown-red colouration .
-The rash is usually symmetrical with a clear edge between affected and unaffected skin and sometimes may be itching or burning sensation
-Other features sometimes present include cheilosis, glossitis, angular stomatitis, and oral or perianal sores.

Legs and feet of a patient with niacin deficiency. A, Before therapy. B, After therapy.

(From Swartz MH: Textbook of Physical Diagnosis, 5th ed. Philadelphia, WB Saunders, 2006.)

TREATMENT of Pellagra:

• Nutritional supplementation with niacin will improve the appearance of skin lesions

Psoriasis photo affects the elbows

A 45-year-old woman presents with a localized area of erythematous scaly patches that comes and goes and typically affects the elbows. The likely diagnosis is.........

• A) pityriasis rosacea
• B) mycosis fungoides
• C) tinea corpora
• D) nummular eczema
• E) psoriasis

The answer is E. (Psoriasis) 

Psoriasis usually manifests itself as erythematous scaly patches that affect the knees or elbows. More severe cases can involve multiple areas over the entire body. Extensor surfaces are predominantly affected. Nail pitting may be present. The condition appears to be hereditary. Diagnosis is usually based on clinical findings. Skin biopsy may be helpful for definitive diagnosis. Treatment consists of topical steroids, intralesional steroids, tar preparations, anthralin, tazarotene, and calcipotriene.

lip filler (Restylane Lipp) treatment

Here is one of the patients having lip filler (Restylane Lipp) treatment on her upper lip which is performed by Tracey BellDermal Fillers are an excellent treatment option for:

Lip enhancement
Volume augmentation of the lips
Shaping facial contours (such as cheeks and chin correcting)
Smile lines (correcting thin, superficial lines around the eyes, mouth and forehead)

associated diseases with types of Acanthosis nigricans

Which of the following malignancies is associated with the skin condition in the photo?

• A) Ovarian carcinoma
• B) Gastric carcinoma
• C) Malignant melanoma
• D) Multiple myeloma
• E) Hodgkin's lymphoma

The answer is B. (Acanthosis nigricans)
Acanthosis nigricans is associated with hyperpigmented areas that typically affect flexural folds (axilla). The two basic types of acanthosis nigricans are benign and malignant.
-The benign form is associated with obesity, diabetes, Stein-Leventhal syndrome, Cushing's disease, Addison's disease, pituitary disorders, and hyperandrogenic syndromes. Drugs, including glucocorticoids, nicotinic acid, diethylstilbestrol, and growth hormone therapy, have also caused acanthosis nigricans. Many cases are idiopathic.
-Malignant acanthosis nigricans is associated with an intestinal cancer such as gastric carcinoma.

Basosquamous Carcinoma in the Temple

This photo shows  large, crusted tumor on the temple that has clinical features of both squamous cell carcinoma (scaly crust), and basal cell carcinoma (translucency in some areas). Histologically, it also has features of both, hence the name basosquamous.

These lesions have a biological aggressiveness intermediate between basal cell and squamous cell carcinomas. They are also called keratotic basal cell carcinoma, squamous cell carcinoma with basaloid differentiation, or "collision tumors."

Ramsay Hunt Syndrome(clinical)

CAUSES:
Classic Ramsay Hunt syndrome is ascribed to infection of the geniculate ganglion by herpesvirus 3 (varicella-zoster virus [VZV]).



HISTORY:
*Patients usually present with paroxysmal pain deep within the ear. The pain often radiates outward into the pinna of the ear and may be associated with a more constant, diffuse, and dull background pain.

*The onset of pain usually precedes the rash by several hours and even days.

*Classic Ramsay Hunt syndrome can be associated with the following:
-Vesicular rash of the ear or mouth (as many as 83% of cases),The rash might precede the onset of facial paresis/palsy.
-Ipsilateral lower motor neuron facial paresis/palsy (CN VII)
-Vertigo and ipsilateral hearing loss (CN VII)
-Tinnitus,Otalgia,Headaches,DysarthriaGait,ataxia.
-Fever,Cervical adenopathy.

*Facial weakness usually reaches maximum severity by one week after the onset of symptoms.

*Other cranial neuropathies might be present and may involve cranial nerves (CNs) VIII, IX, X, V, and VI.

*Ipsilateral hearing loss has been reported in as many as 50% of cases.

*Blisters of the skin of the ear canal, auricle, or both may become secondarily infected, causing cellulitis.


EXAMINATION:

.The primary physical findings in classic Ramsay Hunt syndrome include peripheral facial nerve paresis with associated rash or herpetic blisters in the distribution of the nervus intermedius.
.The location of the accompanying rash varies from patient to patient, as does the area innervated by the nervus intermedius. It may include the following:
1.Anterior two thirds of the tongue
2.Soft palate
3.External auditory canal
4.Pinna
.The patient may have associated ipsilateral hearing loss and balance problems.
.A thorough physical examination must be performed, including neuro-otologic and audiometric assessment.

Actinic Keratosis of Scalp

This photo shows An actinic keratosis of the scalp. These lesions are often difficult to see.
Description: They are rough, sandpaper-like plaques occurring on sun-exposed surfaces. They are pre-malignant, since a small percentage of them develop into squamous cell carcinoma. The lesion here is darker than the surrounding skin; the lighter area is from the camera flash.

Cystic Acne

Cystic Acne is a severe acne with the formation of cysts enclosing a mixture of keratin and sebum in varying proportions. Cystic acne is more likely to leave scars and should be treated by a dermatologist.

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