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Heading Section 4 Malignancies of the Skin

The skin is the heaviest and largest single organ in the body. The skin performs many functions. It protects the internal organs from harmful physical and environmental factors such as dampness, cold and sunlight, but also from microbes and harmful infections. The skin is also responsible for the production of vitamin D with the help of ultraviolet rays from the sun. The skin also acts a store for fat and water.

15 Signs of Skin Disease You Should Never Ignore

There are hundreds of skin conditions that affect humans daily. Most skin diseases can have some signs and symptoms that are similar to each other. Below are 15 signs of skin disease you should never ignore.

Loss of skin pigment or Hyperpigmentation.

Our skin comes in different shades of colors, ranging from shades of almost white to dark brown. Every human skin color is affected by so many factors; the most significant of them all is the pigment called melanin. The pigment melanin also helps determine the color of our eyes and hair. Other factors include hormonal influence, exposure to ultraviolet radiation, certain food, etc. The levels of skin pigmentation are primarily determined by genetics; individuals born to fair-skinned parents will inherit their parent’s complexion, as individuals born to dark-skinned parents will inherit dark skin.

Skin hyperpigmentation or dark spots can occur due to over-production of melanin in certain areas of the body. There are different types of hyperpigmentation, and they vary from each other in terms of shape, size and color intensity. Common causes of skin hyperpigmentation include hormones, medications, sun exposure, certain jobs or occupation, and health-related causes.

  • Medications: Skin hyperpigmentation is a common side effect of certain hormone treatments, cancer drugs, antibiotics, antimalarials, epileptic drugs, and other medications.
  • Jobs or occupation: Some people are more predisposed to skin hyperpigmentation due to the nature of their jobs. People known to be at increased risk include gardeners, pitch or tar workers, and those who work in perfumeries or bakeries.
  • Health-related cause: Pregnancy is one of the common causes of hyperpigmentation in women. Chloasma, also known as melasma or “mask of pregnancy” affects so many women during pregnancy. It occurs as a result of hormonal imbalances during pregnancy and women who use oral contraceptive pills. Endocrine diseases, like Addison’s disease and hormone-secreting tumors, can alter hormone levels and can increase melanin production. Acanthosis nigricans is a rare condition that affects people who are obese or have diabetes. It causes areas of the body with folds and crease such as the armpit, neck, and crotch to develop a thick skin and dark pigmentation. Acanthosis is also a potential sign for gastric and liver cancer.

Skin hypopigmentation is as a result of the partial or complete loss of melanin. It can be inherited from birth or due to an underlying systemic disease. Skin disorders commonly associated with hypopigmentation include vitiligo, progressive macular hypomelanosis, pityriasis alba, tinea versicolor, post inflammatory hypomelanosis (i.e., loss of melanin), atopic dermatitis, psoriasis, and guttate parapsoriasis. Also, hypopigmentation is a common side effect of cosmetic and dermatologic treatments such as chemical peels, intralesional steroid therapy, and dermabrasion.

Bumps, Warts, or Other Skin Growths

Most skin growths are benign and harmless.

  • Moles: Moles are tiny birthmarks caused by the accumulation of pigment cells (melanocytes) in a localized area of the skin. They can be found anywhere on the body, and some may contain hair. Some moles have a high tendency to transform into malignant growths such as melanoma, a type of skin. These moles are atypical and congenital.
  • Wart: Warts are rough shaped harmless skin growth caused by the human papillomavirus. Depending on the types of warts, they can be found anywhere on the skin. Flat warts usually grow on the face, hands, arms or legs; filiform warts are found around the eyes, mouth, nose, or beard area, while periungual warts grow under and around the toenails and fingernails They are benign but highly contagious. They can spread through close contact with someone infected or by simply touching something that touched the wart. Warts usually go away on their own, but some may require treatment with liquid nitrogen or topical creams.
  • Skin tags: Skin tags are flesh-coloured or deeply pigmented flaps of skin, often connected by a narrow stalk to the surrounding skin. They are commonly seen on areas of the body, where the skin rubs together such as armpit, under the breast, groin, and Studies have shown that people with skin tags are at increased risk of developing heart diseases and metabolic syndrome. Skin tags are also known as skin polyps or acrochordons.
  • Lipomas: Lipoma is round, mobile lumps of fatty deposits under the skin. Lipomas tend to be more common in women and can be seen in certain areas of the body such as on the forearms, torso, and back of the neck. Lipoma is generally benign. But in some cases, they may increase in size and compress surrounding tissues and cause discomfort.


Red Skin or Excessive flushing  

Flushing occurs as a result of increased blood flow to the skin. This can be described as a warm feeling on the face or all over the body.

Flushed skin can be a normal physiological response to stress, anger, intense physical activity, anxiety or another extreme emotional condition. Many conditions can cause the skin to flush.

  • Menopause: Skin flushing is common among menopausal women. This is usually described as warm feeling or hot flashes. As women approach menopause, the level of sex hormones produced by the ovaries begins to drop. The symptoms women experience, including excessive skin flushing, are primarily due to a decreased production of the female sex hormones estrogen and progesterone.
  • Hyperthyroidism: Skin flushing can also be caused by hyperthyroidism, a condition in which the thyroid gland produces and releases excess thyroid hormones. One significant effect of thyroid hormone is that it increases the metabolic rate of the body, this increases the heart rate and flow of blood to all parts of the body.
  • Niacin overdose: Niacin flush is common in people who take high doses supplemental niacin. Niacin is prescribed for people with high cholesterol and triglycerides in the blood. In addition to a flush on the face, chest, and neck, other symptoms may include a tingling, burning sensation or pain.
  • Carcinoid syndrome: People with carcinoid syndrome experience facial flushing, which is redness and a warm feeling over the face. Other symptoms are wheezing and diarrhea. If you are experiencing any of these symptoms, you may want to visit a doctor.
  • Allergies: An allergic reaction can cause many signs and symptoms, including facial flushing. An allergic reaction is an exaggerated response of the body to an allergen (foreign agents or bodies). The binding of these allergens to specific receptors of the host’s immune system triggers the release of inflammatory chemicals such as histamine and basophil, resulting in dilation of blood vessels, hence skin flushing.
  • Cushing syndrome.
  • Horner syndrome: Unilateral skin flushing is sometimes seen in patients with Horner syndrome. Horner syndrome results from damage to the sympathetic trunk
  • Rosacea: Rosacea is an inflammatory skin condition characterized by skin redness, swelling, and acne-like sores. It mostly affects fair-skinned individuals and typically affects people in their 30s and older. Rosacea is commonly seen in women but tends to be more severe in men. Persistent facial redness is the most common visible sign seen in rosacea and may look similar to a sunburn that does not improve or go away with conventional sunburn treatments. While the cause of rosacea is unknown, it is believed to be caused by inflammatory changes that cause the blood to wear down, resulting in dilated blood vessels and increased blood flow.

Skin Ulcers

Skin ulcers are often round, open layers of skin that have eroded. Skin ulcers can be caused by a variety of factors, such as trauma, exposure to extreme temperatures or corrosive material, or blood circulation pathologies. Skin ulcers are usually seen in people with these medical conditions and they include; diabetes, chronic venous insufficiency, infections, peripheral vascular disease, and vasculitis.

There are different types of skin ulcers, the most common are:

  • Venous ulcer: Venous ulcers are common among older women. They are seen on the lower extremity and are due to poor circulations in the leg veins. Without appropriate treatment, an ulcer may become infected and lead to severe complications like sepsis.
  • Arterial ulcer: Arterial ulcers are caused by poor arterial blood circulation. They are usually found on the lateral side of the feet and distal digits.
  • Pressure ulcer: Pressure ulcers, also known as decubitus ulcers or bedsores, are skin ulcers that develop on areas of the body where the blood supply has been reduced because of prolonged pressure. Pressure ulcers are seen in people confined to bed or a chair, or in patients with broken and must wear a hard brace or plaster cast. Skin ulcers may become infected, which may lead to complications such as sepsis (infection in the blood).
  • Neuropathic ulcer: Neuropathic ulcers are very common in people with diabetes. They form as a result of the loss of peripheral sensation due to nerve damage. They are very painful and usually appear on the sole of the feet.

Exfoliating or Peeling Skin

Our skin is constantly exposed to physical and chemical agents in our environment that can irritate or damage it. Constant or repeated damage can lead to the skin coming off.  Some specific medical conditions and disease can cause the skin to peel off, and they include allergic reactions, pemphigus, ringworm, Kawasaki disease, psoriasis, cancer (such as Non-Hodgkin’s, cutaneous T-cell lymphoma), atopic dermatitis and athlete’s foot.

Skin Rash

Almost everyone has had one form of a rash or the other. A rash is simply the skin reacting to foreign bodies or factors. Many rashes are itchy, swollen, painful and irritated. It can be localized in part of the body or affect all area of the body depending on the severity. Skin rashes can be caused by a variety of factors such as heat, allergens, infections (fungal, bacteria, viral or parasitic), drugs and immune system disorders. Any type of rash, lasting more than a week and without any association to a cause should be evaluated by a dermatologist or a general doctor.

Dry and Cracked Skin

Dry skin or xerosis is a condition we experience from time to time. The skin becomes dry when its water retention capability is impaired due to the breakdown of its natural lipid barrier. This causes the skin to water at a fast rate, causing the superficial layers to dehydrate. Our skin becomes more prone to dryness as we grow older. Common causes of extremely dry and cracking skin include:

  • Environmental factors (seasonal changes, extreme weather conditions, and ultraviolet sunlight).
  • Poor skin care: Frequent skin washing, use of alkaline soaps, bathing or showering for too long with hot water, can strip off the lipid that constitutes the natural skin barrier, affecting the ability of the skin to retain moisture. A good moisturizer that has been specially formulated for dry skin should be applied regularly to affected areas of the skin.
  • Certain medication (such as hypertensive drugs, acne medications) and medical treatments (such as hemodialysis, chemotherapy or radiotherapy) can cause the body to lose large volumes of liquid, resulting in dry
  • Diet: Vitamin C and E are two important vitamins the skin requires in order to function properly. Adequate vitamin C intake can help to strengthen the skin by enhancing natural collagen synthesis. Vitamin C and E also have powerful antioxidant properties that can help protect the skin from further damage.
  • Smoking: Cigarettes contain many harmful chemicals and toxins including nicotine. These chemicals are known to reduce blood flow to the skin, depriving the skin of necessary nutrients and oxygen, possibly leading to dryness
  • Health-related conditions: Skin conditions like psoriasis, ichthyosis, keratosis Polaris, and atopic dermatitis can affect different areas of the skin, often leaving patches of dry and cracked skin on any part of the body. Diabetes mellitus and diabetes insipidus are two different conditions that can also cause the skin to become dry.

Butterfly Rash

Also known as malar rash, is a raised, red or purplish rash with a distinctive “butterfly” shape. The rash is usually seen as the eruption on the cheek and bridge of the nose. Malar rash is commonly seen in people with systemic lupus erythematosus, an autoimmune disease, in which the host’s antibodies attack normal healthy cells. Other health conditions that can cause a butterfly rash include Lyme disease, rosacea, pellagra (vitamin B3 deficiency), Bloom syndrome, dermatomyositis, photosensitivity, seborrheic dermatitis, homocystinuria, erysipelas, and cellulitis.

Carbuncle

A carbuncle is an infection of the skin characterized by a red, swollen, and painful cluster of pus that is connected to each other deep under the skin. It is commonly caused by Staphylococcus aureus or Streptococcus pyogenes. Carbuncles are usually seen on the back of the neck, shoulders, or thigh. They can also be found between the armpits, on the face, neck, or buttocks; or any part of the body that produces sweat or rub against each other. Recurrent carbuncles are commonly associated with these conditions; diabetes, liver disease, poor hygiene, dermatitis, and a weak immune system.

Cold Sores.

Cold sores are small, fluid-filled blisters or sores that are seen on the lips, corners of the mouth and nose. These sores are extremely painful and usually resolve within a few days. Cold sores are caused by virus, the herpes simplex virus (HSV-1), but sometimes, the herpes simplex type 2 (HSV-2) can cause it. The herpes simplex virus is highly contagious. It is easily transmitted from one person to another either through kissing or close contact with someone with the cold sores or even from contact with normal skin. Cold sores do tend to recur in more or less the same place each time and are always triggered by certain conditions such as trauma to the skin, stress, hormonal imbalance, cold, fever and exposure to sunlight.

Furuncle

Furuncle, also commonly known as a boil, are bacterial or fungal infections of the hair follicle. It is usually caused by Staphylococcus aureus. This bacteria forms part of the normal flora of normal skin but may find its way into the body through tiny breaks in the skin or by travelling down a hair to the follicle. Furuncles are commonly seen on the neck, breasts, face, and buttocks. Risk factors associated with furunculosis include diabetes mellitus, obesity, lymphoproliferative neoplasms, poor nutrition, weakened immune system and use of immunosuppressive drugs.

Telangiectasia.

Telangiectasia is a skin condition in which the tiny blood vessels found on the surface of the skin or mucous membrane form a visible web-like appearance. They’re sometimes referred to as “spider veins” because of their delicate and web-like appearance. The exact cause of telangiectasia is unclear, but several factors have been attributed to its development, and they include pregnancy, prolonged use of oral or topical corticosteroid, pregnancy, chronic alcohol use, old age, hormonal therapy or use of oral contraceptive pills. Telangiectasia is sometimes associated with the more severe medical condition, such as:

  • Osler-Weber-Rendu syndrome, or hereditary hemorrhagic telangiectasia
  • Bloom syndrome.
  • Sturge-Weber syndrome (SWS)
  • Liver disease: Telangiectasia is one of the stigmata of liver disease, liver failure, and It is caused by the inability of the liver to metabolize estrogen.
  • Xeroderma pigmentosum (XP): This is a rare genetic disease in which sufferers show extreme sensitivity to ultraviolet rays. Progressive sun exposure can lead to telangiectasia and other skin manifestations. They are also at risk of developing skin cancer.
  • Spider angioma: Spider angioma is a type telangiectasia found slightly beneath the skin surface, with a central red spot and reddish extensions which radiate outwards like a spider’s web.


Skin Thickening

Lichenification, also known as thickening of the skin is as a result of chronic scratching of the skin. On white skin, the thickened skin may appear pink or red, while on dark skin, the lichenified areas may appear darker than the unaffected skin around them.

One common cause of skin thickening is scleroderma. Scleroderma is a rare skin condition characterized by progressive thickening of areas of the skin and also internal organs and blood vessels. The cause of skin thickening is as a result of the host’s immune system attacking the connective tissues, leading to over-production of collagen fibres under the skin, and around internal organs and blood vessels.

A new study has found that thickened skin in palms and soles, may be a sign of oesophageal cancer. Tylosis, an inherited form of cancer of the esophagus causes severe thickening of the skin of the soles and palm.

Itchy skin

Itchy skin or pruritus is a symptom common to many skin diseases. It is an uncontrollable and irritating sensation that makes you want to scratch to relieve the feeling. There are a number of different health conditions that can cause the skin to itch and they include;

  • Chronic renal failure
  • Liver disease
  • Bugs like scabies, lice, bed bugs, and pinworms.
  • Blood malignancy like leukemia and lymphoma
  • Alcohol intoxication (delirium tremens)
  • Side effects of medications

Age Spots

Age spots or liver spots are tiny dark spots that appear on areas of the skin exposed to the sun. They are usually seen on the face, upper back, shoulders, arms, and hand. Age spots are associated with the following risk factors and include; fair skin with red hair, history of frequent tanning bed use, history of intense sun exposure or sunburn, and older than 50 years of age.

Age spots are usually harmless and don’t require medical treatment. However, dark spots with uneven appearance should be examined by a doctor to rule out any malignancies or skin cancer.

 

References

Berger, A., Oster, G., Edelsberg, J., Huang, X., & Weber, D. (2013). Initial Treatment Failure in Patients with Complicated Skin and Skin Structure Infections. Surgical Infections, 14(3), 304-312. doi: 10.1089/sur.2012.103

Henderson, M., Abboud, J., Cogan, C., Poisson, L., Eide, M., Shwayder, T., & Lim, H. (2012). Skin-of-Color Epidemiology: A Report of the Most Common Skin Conditions by Race. Pediatric Dermatology, 29(5), 584-589. doi: 10.1111/j.1525-1470.2012.01775.x

Jaulim, Z., Salmon, N., & Fuller, C. (2015). Fungal skin infections: current approaches to management. Prescriber, 26(19), 31-35. doi: 10.1002/psb.1394

Kurban, A., Farah, F., & Chaglassian, H. (1964). Capillary Changes in Some Connective Tissue Diseases. Dermatology, 129(3), 257-265. doi: 10.1159/000254632