UNDERSTANDING SKIN DISEASES
Select a skin disease or scroll to learn more.
About the Disease
Psoriasis is a common, and sometimes severe, skin disease. It is thought to affect approximately 1 in 40 people worldwide, and affects all ethnic groups and both sexes. Typically its onset begins in adulthood, most commonly affecting those in their 20s, and then those in their 40s.Psoriasis is a papulosquamous eruption — that is to say, it is a skin rash that causes the development of raised, red, flaky, scaly patches of skin. These patches are most commonly found on areas including the elbows and knees, with other common areas including the scalp, navel, buttocks, and palms and soles. These areas often itch, flake, crack, and can be painful. Even if not painful, the patches are highly unsightly. Psoriasis patients report feeling treated as if they have a contagious skin infection. They report being told not to touch the food in the grocery store and not to touch other people for fear of “catching” the rash. They are treated like “lepers” and the resulting impact on a patient’s quality of life has been shown in studies to be greater than that of other “more serious” diseases such as diabetes and heart disease.
Treatments of Psoriasis
Treatments of psoriasis have targeted many points in the development of psoriasis and include:
- Topical cortisone creams attempt to reduce the inflammation in the skin that causes the redness and itching.
- Topical vitamin D medications try to slow the overly rapid growth of the skin cells in lesions of psoriasis.
- Biologic drugs designed to turn off the immune system’s overactive attack on the skin.
- Drugs like Enbrel and Humira pinpoint critical steps in the development of the immune attack. This ability to target specific steps have led to much more effective treatments, particularly for the most severe cases. MedaPhase has played a crucial role in the development of these biologic drugs.
Acne is fundamentally a hormonal disease. It is so common in teenagers due to the enormous hormonal changes that occur during puberty. It is the changes in hormones, especially the reproductive hormones like testosterone and estrogen, that lead to changes in the skin. The earliest change is a marked increase in the size and activity of the sebaceous “oil” glands, which are found mainly on the face, as well as the chest and upper back–the areas where we see acne.
A second change occurs in skin pores. These pores are lined with skin, and just like skin elsewhere, it is continuously growing and shedding the old dead skin cells on the surface. Normally these dead skin cells are washed out of the pore by the oil produced by the oil gland. However, in acne, a change in the skin lining the pores occurs. Instead of shedding individual skin cells, the skin begins to shed in sticky clumps of dead skin cells. These tend to “plug up” the pore, forming the plugged pores that we recognize as blackheads and whiteheads. If the pore remains blocked, the oil can no longer drain. The pore swells up like a balloon, and ultimately bacteria begin to build up in the swollen pore. If the pore ruptures, it triggers a powerful local inflammatory response, and the body rushes in white blood cells to clean up the bacteria and debris. This causes the formation of the large red pimples and pus bumps that are seen in more advanced acne.
Treatments for Acne
Treatment targets many of these steps. Vitamin A derivatives like Retin-A or Differin prevent the formation of the plug that blocks the pore. Antibiotics, both oral and topical, and benzoyl peroxide reduce the buildup of bacteria and reduce the inflammation that leads to pimples. Hormonal treatments like Yaz block the effects of hormones like testosterone on the skin. Isotretinoin (Accutane) dramatically reduces the size and activity of the oil glands in a lasting fashion. Despite the many available treatments, many patients still suffer with continued breakouts, and MedaPhase continues to work on developing better treatments for the future.
Skin cancer is a growing epidemic in the U.S. Hereditary factors combine with lifestyle exposures leading to cancer risks. Active, outdoor lifestyles, while wonderful in many ways, lead to substantial lifetime exposure to intense sunlight. More recently the easy availability of tanning parlors has led many to get substantial ultraviolet light exposure, often on a year-round basis. The net result is a marked increase in skin cancer in this country.
TYPES OF SKIN CANCER
There are three major types of skin cancer, melanoma, squamous cell, and basal cell carcinoma.
Melanoma is the most serious type of skin cancer.They are most commonly darkly pigmented, taking a black or blue-black coloration. Unlike the other forms of skin cancer, melanomas can arise at an earlier age, and melanomas are seen commonly in patients in their 20s and 30s. Once melanoma has spread, it has an extremely high mortality rate. Early detection is critical to survival, as melanomas that are diagnosed early can be surgically removed with a high cure rate. Any skin growth that is noted to be large, irregular in shape or color, and in particular, those which are rapidly becoming much darker, growing or raising up quickly, bleeding, or itching constantly, should be checked immediately by a dermatologist.
Squamous Cell Carcinoma
Squamous cell carcinoma (SCC) is the next most dangerous skin cancer. It is a cancer of the skin cells on the outermost layer of the skin. SCCs are rough, raised, “crusty” growths, typically with little to no pigmentation. Often they begin to scab, bleed, and do not heal well. Many SCCs develop from precancerous actinic keratoses. If the actinic keratosis can be treated before progressing to cancer, SCC can be prevented. If allowed to grow to large size, typically over years, they can spread, but it is much less common than with melanoma.
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common, but least dangerous form of skin cancer. It too is found predominantly in sun-exposed areas of the body. It develops from skin cells at a lower layer than SCC. . They are distinct in appearance, typically beginning as a small pink, almost translucent-appearing growth. With time they enlarge and eventually tend to scab, bleed, and ulcerate. BCC, if allowed to grow for long periods of time, can spread to the point where the patient loses an entire ear, or nose, or a huge area of scalp when the tumor is removed. BCC does not have a precancerous stage, and thus early detection is again critical to allow treatment before the cancer becomes large and more challenging to remove.
Actinic keratosis (AK) is an extremely common skin growth, which is felt to represent a precursor to full-blown squamous cell carcinoma
Some actually view it as a small, early stage of SCC, but in general these are viewed and treated differently than true SCCs, which have grown “roots” into the deeper layers of skin. AK is closely related to total sun exposure and total hours exposed to the sun, and so are particularly common in people who have worked outside, like farmers and construction workers. The vast majority of these develop on the face, ears, arms, tops of the hands, and the scalp (in balding men). AK are small: typically 1/8th to as much as 1/4 inch in some cases. They are ill-defined, and often easier to feel than they are to see. They are small “crusty” growths, often described as feeling “hard” or “sharp” to the touch. They can be very numerous: some ptients will have dozens of AKs when examined. While the risk that a single AK becomes a cancerous SCC is small (some estimates are a two percent chance per year), if multiple lesions are allowed to grow for many years, the odds of developing an SCC become very high.
Treatment of Actinic Keratosis
AK are traditionally treated in the U.S. with cryotherapy which involves destruction of individual AK by freezing with liquid nitrogen. It is quick, easily done by a dermatologist, and effective at eliminating individual lesions. However, it is also true that AK is more than just an isolated lesion. It’s often likely that for every visible AK, there are several tiny ones that are too small to be seen. Thus, typically, AK patients must continue to have regular visits so that each succeeding “crop” of AKs are treated.This problem has created interest in ways of trying to treat the underlying problem, which is the widespread severe sun damage and tiny “subclinical” AKs that are too small to see. A variety of “field therapies” have been developed which attempt to treat not just the individual lesions, but the entire sun-damaged area. This has become a very active area of investigation, one in which MedaPhase has played an important role.
Onychomycosis, also known as toenail fungus, is a common, stubborn infection of the nails, especially the toenails.
It becomes more and more likely to develop as we age, so that some estimate that as many as 50 percent of people over the age of 60 have some degree of onychomycosis. Onychomycosis causes damage to the nails. They become thickened, yellow or brown in color, and gradually separate from the underlying nail bed. As the nail separates, the area under the nail fills with a thick, “cheesy” material. As it worsens, onychomycosis can distort the nail enough so that wearing shoes is painful. In patients with a tendency towards infection such as a diabetic, the distorted nail can also lead to more serious bacterial infections of the toe itself. The infection is caused by a type of fungus called a dermatophyte. This is a type of fungus which also causes athlete’s foot and ringworm. With onychomycosis, the fungus actually grows in the area underneath the nail. This is why it is so difficult to treat the condition.
Treatment of Onychomycosis
Topical medications are generally ineffective, as the medications cannot penetrate the nail to get at the fungus. To date, only potent oral medications such as Lamisil have high success rates. The search for easier, more effective, and safer treatments is ongoing, and MedaPhase continues to perform studies on these new treatments.
This skin disease is often called eczema.
Actually it is only one of several types of eczema, which is a term that describes a flaky, patchy dry rash which is typically very itchy. Atopic dermatitis is one of the common types of eczema, found most commonly in infants and children, though it can occur at any age. Atopic dermatitis is one of a group of diseases which are known as atopy. Other components of atopy include asthma and allergic rhinitis (hay fever). It tends to be hereditary, although different family members may get different aspects — one may get asthma, the second, allergies, and the unfortunate third, all three conditions.
About Atopic Dermatitis
For unknown reasons, there is a huge increase in the frequency of atopic dermatitis being diagnosed in the U.S. Although It is generally like psoriasis, atopic dermatitis is less clearcut, tending to fade gradually into normal skin areas. Unlike psoriasis, it tends to occur in fold areas, like in the inside of the bend of the elbows, on the back of the knees and back of the neck, and tops of the ankles. Facial involvement is particularly common in infants. Itching is much more severe than in typical psoriasis. Patients often scratch their eczema so much that the skin becomes dark, thickened, and leathery. This level of eczema is extremely difficult to control. Itching is often severe enough to interfere with sleep, studying, or work.
Treatment is most commonly done with topical cortisone creams, although more severe flares may require oral steroids. Antibiotics are often used, as areas of eczema are very prone to staph infection. Medications like antihistamines are used solely for management of itch. More recent developments include the topical non-steroid based topical immunomodulators, Elidel and Protopic, which have significant advantages for long term use compared to cortisone creams. It remains true that, especially for more severe cases, treatment for atopic dermatitis leaves much to be desired, thus our interest in continuing to research potentially better treatments.
Warts are a very common skin growth. They are the result of an infection of the surface of the skin by a virus known as a human papilloma virus (HPV)
The infection causes a localized rapid growth of skin cells that results in a raised, thick, hard crusted nodule. Warts are most common in children, but they can develop at any age.Warts can develop over any area of the skin. Interestingly, different strains of HPV have very strong preferences as to where they will grow. Some strains cause warts on the palms and soles, while other strains cause warts on the tops of the hands and feet. Some strains are found almost exclusively in the genital area. Certain locations are a particular challenge. Warts on the palms and soles (“plantar warts”) are often very deep and painful, and difficult to treat. Genital warts can develop internally in women, infecting the cervix (mouth of the womb). Some of these genital HPV strains in addition can trigger the development of cervical cancer. Warts can also be extremely challenging in patients whose immune systems are weakened, such as organ transplant patients.
Treatment of Warts
There are dozens of treatments for warts, ranging from surgical removal to herbal remedies. The existence of so many treatments is a testimony to the fact that no existing treatment comes close to perfection. Common approaches include freezing, an attempt to destroy the wart by spraying it with liquid nitrogen. A number of topical medications are used to try and gradually peel away the infected area, or by stimulating the local skin immune system to try and fight the virus. Surgical approaches attempt to cut or scrape away the infected skin. None of these treatments is close to 100 percent effective, and many treatments are painful, especially for children. It is our hope that our research efforts will make life easier for future wart sufferers.
Molluscum are another type of skin growth triggered by a viral infection. They can be viewed as cousins to warts
Molluscum are almost always seen in children, and those who have atopic dermatitis appear to be more prone to molluscum. Molluscum are tiny round raised skin colored bumps, no more than 1/16 of an inch in diameter. Some have a tiny indentation on the top. They often occur in clusters. Common areas include the trunk, neck, and upper arms and thighs. They sometimes are itchy, and occasionally can become infected. They are contagious (the full name is molluscum contagiosum) and can spread from child-to-child by direct skin-to-skin contact. They are also commonly spread from one part of the body to another, typically by scratching. Molluscum are much less commonly seen in adults, but when they are, they are often found in the genital area, where they represent a sexually transmitted disease.
Treatment of Molluscum
Treatment is similar to that of warts in many cases, with cryotherapy a common option. Another popular treatment is cantherone, a topical medication that is painted onto the molluscum by the dermatologist and which cases a small blister to develop. When the blister scabs and peels away, the molluscum is often removed. As with warts and other viral skin infections, treatment can be frustratingly ineffective in some cases.
One of the most common facial rashes that develops in adults, rosacea leads to redness, telangiectasia (broken capillaries), and inflammatory papules (pimples)
These are located over the nose, chin, and inner cheeks. It is typically seen in those of Celtic origin — German, English, Irish, etc., but can be found in any ethnic group. Rosacea patients often note that they flush and blush much more frequently than others, particularly after some triggers such as alcohol or spicy food consumption. It is typically a gradually worsening condition, beginning with just redness that becomes more and more noticeable, followed by the development of the broken blood vessels and actual breakout bumps that are the hallmark of active rosacea.
Treatments of Rosacea
Left untreated, rosacea can lead to more severe changes, including rhinophyma, a bulbous, lumpy distortion of the nose that was a famous characteristic of the 20th century comedian, W.C. Fields. Another frequent complication of rosacea is ocular rosacea, which leads to chronic swelling of the eyelids, red, bloodshot eyes, and a sensation of constant dryness and tiredness of the eyes.Treatment begins with sun protection, because sun exposure appears to worsen rosacea. Active treatment may involve the use of one of several topical creams, typically containing an antibiotic. More severe cases may require long term treatment with oral antibiotics such as tetracycline. Oral antibiotics are generally the only effective treatment for ocular rosacea.