Trust in more than skin folklore
The biggest organ of the body is the most obvious, but few think
of skin as an organ.
Sometimes, the skin is the disease. But, at other times, a disease
expresses itself in the skin. And, if people can see that something
is wrong with someone’s skin, they commonly remark on what appears
to be the problem.
This obviousness of any skin complaint has brought about the trial
of many treatments over the centuries, and that has made for endless
folklore. Just the names for a skin condition can be many. Eczema
is often used in the same context as dermatitis but, in technical
terms, the two can be different things.
Various schemes have been invented to “classify” skin conditions,
but each has had the problem of inconsistencies and thereby increased
the many names for the same conditions. The thing to remember about
skin conditions is that you will likely hear as much incorrect information
about them as you will facts about diagnosis and treatment.
Check with a doctor if you have any doubt about what is wrong with
your skin. And understand what is being treated so you do not run
into long-term problems.
Many substances are sold to “apply” to the skin, but prove to be
of no use at all. Be sure not to pay good money for treatments that
are most likely to make a condition worse rather than better.
While I might describe skin conditions in one way, other forms of
description do exist, and are accurate. A skin abnormality is often
referred to as a lesion.
Information on a skin problem comes from the type of lesion, the
shape, and the arrangement in groups.
The type can be flat (macule or spot), elevated (blister or boil),
or depressed (ulcer). Shape can be linear (scratch), round (freckle
or ringworm) and take many other forms. If they are arranged in groups
(shingles) or spread out (bites), the cause becomes more obvious.
They can be distributed around the body – isolated lesions, regional
(arm or trunk) – or generalized.
So many variations make the whole issue of the skin interesting,
and open to many interpretations.
Most often, the diagnosis is relatively straightforward, but the
types of treatment can be relatively few. So, sometimes, the diagnosis
can be made by trying one treatment and waiting to see if the skin
improves.
If the skin heals, it indicates that the treatment was correct,
and the diagnosis becomes obvious (a small spot that gets better with
anti-fungal cream indicates that ringworm was the diagnosis). Sometimes,
the spot would get better anyway, so the treatment’s coincidental
application to the spot might have had nothing to do with the healing.
Commonly, cold sores are the reason for many strange applications.
Cold sores are the rash from a virus called herpes simplex, usually
type 1. Cold-sore blisters usually occur around the mouth or nose
and are often painful. Just about every person who has had a cold
sore will have his or her own treatment recipe. Yet, in properly controlled
trials, the only treatments that will work are anti-viral lotions
(acyclovir) or anti-viral tablets.
Offers of natural products with supposedly magical properties might
make you feel better but wont make the sore go away any quicker. Despite
proof that many treatments do not work, there always exists anecdotes
and folklore to the contrary.
A skin treatment might do nothing, which is very frustrating in
the case of a blemish. Pimples are a case in point. The acne-treatment
industry – worth millions – is based on the insecurities of adolescents
and makes products that do not work.
The cause of pimples is within the skin, and in the way the skin
reacts to hormones. Applying lotions can produce minor modifications
to acne, but serious acne needs hormonal manipulation or potent drugs,
like Roaccutane. But new and varied products never stop flooding the
market.
Treatment using cortisone creams is a common application and prescription.
Cortisone decreases the swelling of any skin tissue; and most conditions
have some skin swelling, so some improvement will occur. The downside
is that, if any infection exists (bacterial, viral, fungal), it is
likely to get worse, as the cortisone will suppress the immune system.
The anti-inflammatory effect of the steroid will disguise the worsening
infection and end up causing severe infection.
Some of the different types of cortisone cream are good for the face
(hydrocortisone), while some are better for the hands and feet (fluorinated
cortisones). Some creams work better in ointment form. Although these
creams are commonly prescribed, they should be used appropriately
and with caution. Used properly, cortisone creams are the mainstay
of the treatment of skin conditions.
Sometimes, even the most experienced dermatologists might not be
able to diagnose a skin condition. The approach then is a biopsy –
to cut out some skin or lesion and look at it under the microscope.
The pathologist can add to the certainty of the diagnosis but, even
then, the answer might be inconclusive.
When is comes to diagnosing moles and growths, the biopsy is the
most useful tool to employ. An excision biopsy means removing the
entire mole and confirming the diagnosis at the same time. A punch,
or shave, biopsy might involve removing part of the mole. This is
so that any surgery can be guided by the preliminary pathology reports
as to how big the cut needs to be to remove the entire mole safely.
A melanoma needs a wide margin around the mole to stop it coming
back. But a benign freckle may be safely left in the skin, even though
the skin might show some discoloration.
Some skin conditions are part of other diseases, so the lesson about
skin problems is to get them checked if in doubt. Do not waste money
on useless lotions. Give an accurate history on how a lesion started,
and get good advice on how to treat anything.
Acting on hundreds of years of skin folklore could result in the
wrong treatment.
