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.
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.
• 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