The Clinical Picture of Actinic Keratosis

Actinic keratosis is a scaly or crusty bump that forms on the skin surface. They are also known as a solar keratosis. Dermatologists call them "AK's" for short. They range in size from as small as a pinhead to an inch across. They may be light or dark, tan, pink, red, a combination of these, or the same color as ones skin. The scale or crust is horn-like, dry, and rough, and is often recognized easier by touch rather than sight. Occasionally it itches or produces a pricking or tender sensation, especially after being in the sun. It may disappear only to reappear later. Half of the keratosis will go away on their own if one avoid all sun for a few years. One often sees several actinic keratoses show up at the same time.

A keratosis is most likely to appear on sun exposed areas: face, ears, bald scalp, neck, backs of hands and forearms, and lips. It tends to lie flat against the skin of the head and neck and be elevated on arms and hands.Why is it dangerous? Actinic keratosis can be the first step in the development of skin cancer, and, therefore, is a precursor of cancer or a precancer. It is estimated that up to 10 percent of active lesions, which are redder and more tender than the rest will take the next step and progress to squamous cell carcinomas.

The Keratosis Pilaris Picture

Keratosis pilaris is a common skin disorder. In its clinical picture, althoughkeratosis pilaris isn't serious, it can be frustrating because it's difficult to treat.
Keratosis pilaris occurs most often in children. It results from the buildup of a protein called keratin in the openings of hair follicles in the skin. This produces small, rough patches — usually on the arms, thighs and face. The exact cause isn't known, but it may be associated with eczema.
Keratosis pilaris typically causes no pain or itching. Treatment is directed at softening the keratin deposits in the skin and may include medicated creams containing urea or lactic acid. Even with treatment, this condition tends to remain for years. If associated with eczema, keratosis pilaris may improve with treatment of the underlying eczema.

THE ECZEMA SKIN PICTURE

Differences in the skin of people with eczema may contribute to the symptoms of the disease. The epidermis, which is the outermost layer of skin, is divided into two parts: the inner part, which contains moist, living cells; and the outer part, which consists of dry, flattened, dead cells. Under normal conditions, the outer layer of skin acts as a barrier, keeping the rest of the skin from drying out and protecting other layers of skin from damage caused by irritants and infections. When this barrier is damaged or is naturally thin, irritants act more intensely on the skin.
The skin of a person with eczema loses too much moisture from the epidermal layer. This allows the skin to become very dry, which reduces its protective abilities. In addition, the skin is very susceptible to recurring disorders, such as staphylococcal and streptococcal bacterial skin infections, warts, herpes simplex, and molluscum contagiosum (which is caused by a virus).

The Cheilitis Picture

Cheilitis refers to persistent inflammation of one or both lips. Scaling, cracking, and swelling may occur on the vermilion border, which is the area where lip mucosa meets the normal skin of the face.
There are several types of cheiliits:

actinic cheilitis, painful swelling of the lip(s) and development of scaly crust and erosions on the vermilion border after overexposure to sun rays; it may be acute or chronic. Called also solar c.

angular cheilitis, perlèche.

apostematous cheilitis, see c. glandularis.

commissural cheilitis, cheilitis affecting principally the angles (commissures) of the mouth. See also perlèche.

cheilitis exfoliati¢va, persistent exfoliation of the lip caused by inflammation of the mucous membrane, similar to but not identical with dermatitis seborrheica.

cheilitis glandula¢ris, a rare disease in which the lower lip becomes enlarged and later everted, exposing the openings of the accessory salivary glands, which are inflamed and dilated; the glands themselves are enlarged and sometimes nodular. It may be associated with carcinoma of the lip. There are three types: the simple type is characterized by multiple painless, pinhead-sized lesions, with central depressions and dilated canals, and may develop into one of the other types; the superficial suppurative type (called also Baelz's disease) is characterized by painless swelling, induration, crusting, and ulcerations of the lip; the deep suppurative type is a deep-seated infection with abscesses and fistulous tracts that eventually form scars. Called also apostematous c., c. glandularis apostematosa, and myxadenitis labialis.

cheilitis glandula¢ris apostemato¢sa, see c. glandularis.

cheilitis granulomato¢sa, granulomatous cheilitis, an inflammation of the lips characterized by granulomas and swelling; it is sometimes part of Melkersson-Rosenthal syndrome. Called also Miescher's granulomatous c.

impetiginous cheilitis, impetigo of the lips.

Miescher's granulomatous cheilitis, granulomatous c.

migrating cheilitis, perlèche.

solar cheilitis, actinic c.

cheilitis venena¢ta, that due to a toxic substance.

The Cosmetic Eczema Picture

Cosmetic eczema is an unpredictable itchy, red reaction to a cosmetic applied to the face or lips. It is usually caused by skin-irritating chemicals present in a cosmetic, but may also represent a true allergy or sensitivity to one or more of the components of the cosmetic. Such an allergy may lead to more severe itching, burning, and swelling of the skin and lips.
A cosmetic allergy results when an individual develops a sensitivity to certain ingredients (such as dyes in lipsticks or flavoring agents). Allergies are unpredictable and can happen even in reaction to well-manufactured products made by reputable companies. Since sensitivities often develop and increase over time, a reaction can occur from an ingredient in a product even if you have used the product for years. Unfortunately, once an allergic reaction occurs, it will generally happen again.
Individuals who develop an allergic reaction to cosmetics should immediately discontinue their use. They should individually test cosmetic formulas to find one which will not affect them. If the reaction continues, they should see their physician.

Defining Varicose Eczema

Varicose eczema or stasis dermatitis occurs in the middle to late years of life and appears on the lower legs. It is caused by poor circulation. It is also called stasis eczema. It affects the ankles, which become speckled, itchy and inflamed. It is frequently treated with emollients and steroid creams. If untreated, an ulcer may develop.
A common problem that is associated with varicose ulcers is contact allergic eczema caused by medications applied to the skin such as steroids, topical antibiotics, lanolin and also preservatives in various preparations. If this is suspected, skin patch testing may help to identify the problematic substance.