Common dermatology skin conditions can be found below:

SCC is the second most common type of skin cancer (after BCC – internal link). Sometimes SCC is grouped together with BCC and called “non-melanoma skin cancers” because these types of skin cancer behave very differently to melanomas.

These skin cancers arise most commonly in sun damaged sites such as the face, ears, forearms and backs of the hands, though they can occur anywhere in the body. They usually appear as a scaly or crusty skin-coloured lump, which may ulcerate. Sometimes the lumps are tender or painful to touch.

The biggest risk factor for SCC development is high cumulative sun exposure and they are most likely to occur in people with fair skin types. Individuals with organ transplants or who take medications to suppress the immune system are also at high risk.

SCCs may arise from normal looking skin or from areas previously affected by sun spots (actinic keratosis – internal link) – if sunspots are left untreated they have a risk of developing into SCCs. The name for early SCCs that are superficial and have not spread beyond the top layer of skin is Bowen disease. Bowen disease should be treated to prevent it from developing into an invasive SCC.

Prevention is better than cure; using good sun protection measures is your best option to prevent SCCs (sunscreen/photo-protection internal link).

Because they have some potential to spread to other parts of the body including the lymph nodes SCCs require treatment. Because other lesions may have similar appearances to SCCs, a biopsy under local anaesthetic may be necessary to confirm SCC before treatment is started.

Treatment at The Skin Hospital
There are many treatment options and choice will depend on a number of factors including the type of SCC, size, location and patient-related factors.

  • Bowen disease
    • Cryotherapy (freezing with liquid nitrogen) can be used on the affected area and to a small margin of surrounding normal skin. The treated area might be left a lighter colour (hypopigmentation).
    • Photodynamic therapy (PDT) – an ointment can be applied to the area with a surrounding margin of normal skin, this is preferentially absorbed by the damaged skin and using a laser or non-laser light then activates the ointment to destroy the Bowen disease.
    • 5-Flurouracil 5% cream (efudix) can be applied at home twice a day for 3-6 weeks. The dermatologist may review progress after 3 weeks to determine duration of use.
    • Surgery may be considered, the following methods can be used under local anaesthetic:
      • Curettage & cautery – the skin cancer is scraped off and then cauterised to stop the bleeding and destroy any remaining abnormal cells. Stitches are not required.  
      • Excision – the skin cancer is cut out.
  • Other SCCs
    • Surgery is usually the best option – curettage & cautery and excision can be used (see Bowen disease). If the SCC is very large, recurrent, an aggressive sub-type or affecting an area such as the central part of the face, Mohs surgery may be the best option. Mohs surgery can be carried out at both of our Skin Hospital sites by any of our trained Mohs surgeons (link to Mohs surgery & list of Mohs surgeons).
    • Radiotherapy (treatment using X-rays) is also an option, especially if surgery is thought not to be appropriate. The Skin Hospital can refer you to a radiotherapy specialist.

SCCs are common in Australia and all of our specialists are skilled in recognising and treating SCCs (link to specialist list). If specialist surgery is required, individuals can be referred on to one of our skin cancer surgery specialists.

Further Information from trusted websites about SCC:
http://www.dermnetnz.org/lesions/squamous-cell-carcinoma.html
http://www.bad.org.uk/library media/documents/Squamous%20Cell%20Carcinoma%20Updated%20Jan%202012%20-%20Lay%20reviewed%20Dec%202011.pdf

Authors: Dr Charlotte Thomas & Dr Sarvjit Sohal, last updated 29 September 2015

 

Rosacea is a common condition that characteristically appears as redness and flushing of the central facial skin.  Broken capillaries are often prominent and red inflamed bumps and pimples can appear. Unlike in acne, there are no comedones, which are known more commonly as ‘blackheads’ or ‘whiteheads’. The eyes can also be affected in rosacea; resulting in redness, a gritty feeling or dryness.

Rosacea usually begins in the 30-40 year age-group and typically affects people with pale skin and green or blue eyes of celtic/north European origin.  Rosacea can affect both sexes, but is more common in women.  Rhinophyma, is where the skin of the nose becomes thickened, uneven and with prominent pores, is a rarer subtype of rosacea which affects men more than women.

 

At The Skin Hospital
There are a number of different types of rosacea and the treatment you are recommended will depend on the type you have.

General measures:

  • It is important to try and avoid triggering factors such as alcohol and spicy foods.
  • Careful sun protection is of high importance as sun damage can worsen rosacea (link to sunscreen).

Topical treatments:

  • Cosmetic camouflage can be used to hide the red appearance
  • Brimonidine gel may improve the redness for short time periods.
  • Antibiotic gels such as metronidazole are often helpful in mild rosacea.

Oral treatments:

  • Oral antibiotics, such as tetracycline work to reduce inflammation, though often take weeks-months to work.
  • The retinoid isotretinoin, which is used in acne, can also be used in rosacea. 

Physical treatments:

  • For the type of rosacea where redness and broken capillaries are seen, light and laser treatments can help to reduce the discolouration. Laser and intense-pulsed light (IPL) or broadband light (BBL) treatments are available at the Darlinghurst and Westmead sites of The Skin Hospital (link to laser treatments and specialists offering laser treatment).
  • Other laser types can be used to treat rhinophyma.

Dermatologists at The Skin Hospital to consult about your rosacea:

  • Dr Penny Alexander (Darlinghurst)
  • Dr Keng Chen (Darlinghurst)
  • Dr Monisha Gupta (Darlinghurst)
  • Dr Esther Hong (Darlinghurst)
  • Dr Joseph Krivanek (Darlinghurst and Westmead)
  • Dr Hanna Kuchel (Darlinghurst)
  • Dr Eddie Lobel (Darlinghurst)
  • Dr Roland Nguyen (Darlinghurst)
  • Dr Sarvjit Sohal (Darlinghurst and Westmead)
  • Dr Nicholas Stewart (Darlinghurst and Westmead)
  • Dr Kavita Enjeti (Westmead)
  • A/Professor Pablo Fernandez-Penas (Westmead)
  • Dr Claire Koh (Westmead)
  • Dr Brian Wallace (Westmead)
  • Dr Supriya Venugopal (Westmead)

 

Further information about rosacea can be obtained from the following trusted sites:
http://dermnetnz.org/acne/rosacea.html
http://www.bad.org.uk/shared/get-file.ashx?id=229&itemtype=document

Authors: Dr Charlotte Thomas & Dr Nick Stewart, last updated 16th November 2015

 

Psoriasis is a common condition affecting up to 2% of the population, which varies in severity between individuals. The most common form is known as ‘chronic plaque psoriasis’ and is characterised by the presence of raised red areas of skin covered by silvery-white scale.  It most commonly affects the knees, elbows and scalp, however  it can affect any part of the body.   Other less common forms include ‘guttate’ psoriasis (multiple small areas, often occurring after an infection) and ‘palmoplantar pustulosis’ (pustules and inflammation affecting the hands and/or soles).

The cause of psoriasis is not fully known, however genetics, environmental factors and the immune system play important roles.  Some individuals report psoriasis worsening with physical or emotional stress, alcohol and smoking may also be exacerbating factors. It is not possible to catch psoriasis from an affected person; it is not an infection.

Depending on the areas of skin affected, patients may report dandruff, redness scaling, flaking, itch and/or cracking and fissuring.  Many of these symptoms can be improved with treatments.

Psoriasis is a systemic disease that affects more than just the skin. Psoriatic arthritis and cardiovascular disease are more frequent in people with psoriasis.  In addition, the psychological impact on quality of life can be immense.

Management at The Skin Hospital      
There are many effective treatment options available however there is no cure.

  • Topical therapies (lotions, creams and ointments). When psoriasis affects small areas, topical therapies may be the best option. Products containing vitamin D analogues and steroids alone or combination can be helpful. When the scalp is a particular problem shampoos and lotions including tar or steroid can be used.
  • Systemic therapies. These are used when topical therapies are poorly tolerated, or difficult to apply due to extensive psoriasis. 
    • Phototherapy (narrow band-UVB) can be done at Darlinghurst and Westmead sites (DH/ WM phototherapy); sessions (often 3 times per week) need to be attended regularly for good benefit.
    • Oral treatments (methotrexate, ciclosporin and acitretin). As with all medicines, these tablets can have side-effects, therefore  the benefits must be weighed against the potential for side-effects by the patient and specialist together. Regular monitoring blood tests are required.
    • Biologics are injectable medicines, which are very effective for psoriasis. Agents available at The Skin Hospital include: etanercept, adalimumab, ustekinumab and secukinumab. To qualify for biologics under Medicare, certain conditions must be met – the specialist can discuss these requirements.
    • Other therapies: new therapies are in the process of becoming approved and may soon be available.  We regularly undertake  clinical trials for patients with psoriasis and are often recruiting patients. If you are interested in taking part in a clinical trial for psoriasis treatments please get in touch with the clinical trials team (clinical trials for patients link).

Dermatologists at The Skin Hospital with special interests in the treatment of psoriasis include:

  • Dr Kate Dunlop (Darlinghurst)
  • Dr Monisha Gupta (Darlinghurst)
  • Dr Hanna Kuchel (Darlinghurst)
  • A/Professor Pablo Fernandez-Penas (Westmead)

For further information on psoriasis, please see the following trusted pages:
http://www.dermnetnz.org/scaly/psoriasis.html
http://www.bad.org.uk/shared/get-file.ashx?id=178&itemtype=document

The following support groups may be of interest to patients and families of those suffering with psoriasis:
http://www.psoriasisaustralia.org.au (new site coming soon)

Authors: Dr Charlotte Thomas & Dr Nicholas Stewart, last updated 18 September 2015

 

Photoaging is the ageing effect of ultraviolet (UV) rays upon the skin. This is characterised by increased or mottled pigmentation- particularly brown spots, wrinkles and the appearance of broken blood vessels. The skin can also take on a ruddy or yellow tone as well as feeling rough to touch.

 

At The Skin Hospital
There are many treatment options, depending on the nature of the skin changes and the skin type. Some treatments are not suitable for all skin types. Often, multiple treatment modalities are used together for the best result. The face, neck and chest are commonly treated. Discuss a tailored approach for your skin with your dermatologist.

General measures

  • Preventing further sun damage is an important step. Stay out of the sun when the UV rays are most intense and cover up with protective clothing. Frequent application of a high factor broad-spectrum sunscreen is crucial.
  • Smoking can lead to a yellowish discolouration of the skin, increased wrinkles and blackhead formation. Cessation of Smoking can improve skin quality.
  • Skin that has been exposed to high cumulative sun exposure is also more likely to develop skin cancer; a skin check by a dermatologist is advisable.

Medical therapies

  • Cosmetic creams: can help reduce the appearance of photoaging.
    • Over the counter products that contain Vitamin C and alpha-hydroxy acids can be of benefit.
    • Creams containing retinoids (vitamin A derivative) can be prescribed to smooth out roughness, fine lines and dyspigmetation in the skin.
  • Treatments for actinic keratosis (sun spots)
    • Various creams can be used to treat sun spots, which are pre-cancerous and cause skin roughness and scaliness. The type of cream and duration of use depends on how much damage there is to your skin (see actinic keratosis page).

Physical therapies

  • For fine lines and wrinkling
    • Muscle relaxant injections - Botulinum toxin (Botox or Dysport). This is injected in to the skin using a very fine needle.  Areas such as horizontal forehead lines, frown lines and crow’s feet can be readily treated. The injections work by preventing nerve impulses from triggering muscle contraction. This is a temporary treatment and to maintain the effect, injections are usually required every 3-4 months.
    • Dermal Fillers. These are injected under the skin to reduce hollowing, furrows and wrinkles & plump up the skin. Fillers are not permanent, therefore injections may need to be repeated to maintain the appearance. The frequency depends on the product used. Hyaluronic acid fillers will need to be repeated every (3-12 months) to maintain the appearance.
    • Fractionated laser (Pearl fractional). This exposes only a portion of skin to the laser beam, making the recovery faster than from fully ablative laser. Beams of laser penetrate deeper than non-fractionated laser, which stimulates the collagen underneath the skin and causes plumping of the skin over 3 months.
    • Ablative laser (Carbon dioxide/ Erbium). This can result in good improvement of fine lines and wrinkles; however the recovery period is longer. Topical anaesthetic and sometimes regional or general anaesthetics are used to reduce procedure-related pain. This is not suitable for some patients.
    • Intense pulsed light (IPL)/ broadband light (BBL). IPL/BBL uses flashes of visible light. Often a course of 3-4 treatments are required, with a 4 week break in between. Maintenance therapy can be used and has shown to keep the skin looking younger. This is more effective for facial redness and pigmentation than wrinkles.
  • For pigmentary changes: variable or increased pigmentation, freckles and lentigos – brown spots.
    • Intense pulsed light (IPL)/ broadband light (BBL) (see above).
    • Pigment laser. Certain lasers are effective at clearing brown pigmentation. The type of laser used depends on your skin tone and the type of pigmentation.
    • Fractionated non-ablative laser. This can be very helpful for brown pigmentation, which peels off over a week or two after treatment.

 

  • For broken blood vessels and redness.
    • Vascular lasers (nd-Yag, VBeam).  Vascular laser is helpful for treating blood vessels on the face and legs, as well as venous lakes and cherry angiomas. Some are also helpful for generalised redness and rosacea as well.
    • Intense pulsed light (IPL)/ broadband light (BBL). This is effective for generalised redness and also rosacea.
  • For rough skin
    • Ablative laser (Carbon dioxide/ Erbium) (see above)
    • Fractional laser (Pearl fractional) (see above)
    • Chemical peels (TCA or glycolic acid peels). These can be used to remove the uppermost layer of cells. The skin takes 7-10 days to heal and may appear a little red for weeks to months following the treatment.

 

  • For actinic keratosis (sunspots) and photorejuvenation
    • Photodynamic therapy (PDT) with IPL. This is a good treatment for sun damage, pigmentation and redness. It involves application of a photosensitising cream that is left on for 2-3 hours. After this, IPL is performed on the area, which activates the cream. The skin is often quite red afterwards, however usually heals in a week.

 

Dermatologists at The Skin Hospital to consult about cosmetic treatment for photoaging:

  • Dr Penny Alexander (Darlinghurst)
  • Dr Hanna Kuchel (Darlinghurst)
  • Dr Kavita Enjeti (Westmead)
  • Dr Tanya Gilmour ( Darlinghurst and Westmead)
  • Dr Rhonda Harvey (Darlinghurst )
  • Dr Sam Kalouche (Westmead)
  • Dr Shawn Richards (Westmead)
  • Dr Adrian See (Westmead)

Further information about photoaging and its treatments can be obtained from the following trusted sites:
http://dermnetnz.org/site-age-specific/ageing.html
http://dermnetnz.org/procedures/facial-rejuvenation.html
http://www.dermnetnz.org/procedures/implants.html

 

Authors: Dr Charlotte Thomas &, Dr Penny Alexander, last updated 3rd December 2015

 

Distorted, discoloured or otherwise unsightly fingernails and toenails are very common problems in people of all ages. Nail damage is frequently caused by injury or fungal infections. Skin conditions (such as psoriasis, eczema and alopecia areata) can also be evident in the nails.  In addition, conditions affecting the internal body organs can sometimes be seen in the nails and might prompt further investigation, for example, bulbous nails (known as clubbing) can result from disorders affecting the lungs, heart or liver.
Below are a number of commonly experienced problems:

  • Lifting of the nail plate (onycholysis) – often a result of repeated minor injury to the underside of the nail. It appears white rather than pink as air gets under the nail. This can also be caused by psoriasis, fungal nail infections (onychomycosis) or water immersion.
  • Pitting – describes individual depressions around the size of a pinhead. This is commonly seen in psoriasis, other causes include eczema and alopecia areata.
  • Ridging– either along (longitudinal) or across (transverse) the nail. Longitudinal ridging becomes more prominent with age or may be associated with conditions such as lichen planus and repetitive nail injury. Transverse depressions often appear after a significant illness (called Beau lines) or secondary to episodes of paronychia (see below) – which is often associated with nail biting. Fiddling with nails or cuticles can also produce irregular ridging.
  • Thickening of nail (onychogryphosis) – frequently seen in toenails of the elderly often resulting from the long term use of ill-fitting footwear and neglect of the nails. It may also be secondary to medical conditions such as psoriasis or fungal infections.
  • Discolouration
    • Yellow: commonly, this is due to fungal nail infection (oncychomycosis) but nails affected by psoriasis can also appear yellow. Smoking can also leave the nails yellow in colour. Very rarely, ‘yellow nail syndrome’ is seen, here yellowing of the nails is related to an underlying disorder affecting the lungs and lymphatics.
    • Green: usually secondary to a bacterial nail infection (pseudomonas) or infection by a yeast called candida. Often pseudomonas infection can affect nails previously damaged by a common fungal infection or trauma.
    • Brown: this can be caused by medications, chemicals from hair dyes, nail varnish, nicotine, trauma, chemotherapy and antibiotics. Rarely, melanomas may present as brown or black pigmentation on or under the nail – it is important to seek medical advice to rule out melanoma in the case of a single brown/black nail.
    • White (leuconychia): this may run in families or can be caused by any medical condition that results in low levels of protein in the blood (i.e. hypoalbuminaemia – resulting from nephrotic syndrome or liver failure, for example).
  • Inflammation of the nail fold (paronychia) – acute infection of the nail fold (cuticle) causes redness, swelling, tenderness and pain, sometimes with pus formation. It is often seen in nurses, hospitality workers and hairdressers, from over-zealous manicuring or when nails are immersed in water for long periods of time. Occasionally, this condition can be seen in infants who suck their thumbs.  A long-term (i.e. chronic) variant is also seen.  This requires meticulous hand hygiene.

Management at The Skin Hospital
There are many possible underlying causes of the problems noted above. Sometimes a diagnosis can be made without the need for any tests. Fungal nail infections are very common amongst the general population, therefore often a nail clipping will be taken for examination under a microscope and culture to assess if a fungus is present. A nail biopsy, where a piece of nail is surgically removed under local anaesthetic is very rarely required.  

Treatment will depend on the underlying cause. Where the nail changes are related to a skin or medical condition, treatment of the underlying cause can usually improve the appearance of the nails. As the nails grow slowly, improvements take many months to become apparent.

Fungal nail infections are very common and can be very slow to respond to treatment:

  • Topical therapy: antifungal paints and creams may be used to treat infection affecting small parts of the nails. The benefit of using these is that there are few side effects, however, success is not guaranteed and may require many months of treatment.
  • Oral therapy: antifungal tablets (e.g. terbinafine, itraconazole, fluconazole) can be used alone or in combination with topical treatments and need to be continued for months to have a beneficial effect. These tablets can interact with other medications and may not be appropriate in patients with some medical conditions, so it is important to update the treating dermatologist with your relevant medical conditions. Blood tests may be needed prior to starting treatment and during therapy.
  • Physical therapy: lasers have been shown to effectively treat fungal infection in some cases, though there is somewhat limited evidence available for this treatment. Laser treatments are available at our Darlinghurst and Westmead sites.

 

Dermatologist at The Skin Hospital with a special interest in nails:

  • Dr Penny Alexander (Darlinghurst)
  • Dr Keng Chen (Darlinghurst)
  • Dr Monisha Gupta (Darlinghurst)
  • Dr Esther Hong (Darlinghurst)
  • Dr Joseph Krivanek (Darlinghurst and Westmead)
  • Dr Hanna Kuchel (Darlinghurst)
  • Dr Eddie Lobel (Darlinghurst)
  • Dr Roland Nguyen (Darlinghurst)
  • Dr Sarvjit Sohal (Darlinghurst and Westmead)
  • Dr Nicholas Stewart (Darlinghurst and Westmead)
  • Dr Kavita Enjeti (Westmead)
  • A/Professor Pablo Fernandez-Penas (Westmead)
  • Dr Claire Koh (Westmead)
  • Dr Brian Wallace (Westmead)
  • Dr Supriya Venugopal (Westmead)

 

Further information about nail disease can be obtained from the following trusted sites:
http://www.dermnetnz.org/hair-nails-sweat/nails.html

Website content updated by Dr Charlotte Thomas & Dr Nicholas Stewart, last updated 11 November 2015

 

Melanoma or malignant melanoma is a type of skin cancer which arises from the pigment (skin colour-producing) cells. Melanoma is less common than the other types of skin cancer (basal cell carcinoma and squamous cell carcinoma link), but more serious, as melanoma has much higher potential to spread to other organs of the body.

People are more likely to have melanoma if they have high levels of sun-exposure and in particular have burnt frequently, especially in childhood. The risk of developing a melanoma can be reduced by using careful sun protection measures, by avoiding the sun, wearing protective clothing and hats and adequate sunscreen (link sun protection). Other factors that increase risk of developing a melanoma include: a positive family history, having pale skin that freckles or burns easily and having large numbers of moles (especially if these moles are ‘atypical’ in appearance’). Melanoma usually occurs in sun exposed sites, they are most common on the backs of men and lower legs of women. They can also occur (though less often) in areas such as the nails, genitals and back of the eye. It is important to have unusual lesions checked, even if they are not in sun-exposed sites. 

Finding a melanoma early and treating it is very important to reduce the risk of spread – if you are concerned you have a melanoma you should see a dermatologist as soon as possible. Self-checking your skin is very important to identify suspicious lesions.  It is also helpful to take photographs of your skin to help identify if any moles are changing.
The following ‘ABCDE’ criteria can be helpful to identify a mole of concern:

  1. Asymmetry – melanomas tend to be asymmetrical, that is, if you were to cut it in half the two sides, they would not match each other.
  2. Border – melanomas tend to have an irregular or “moth eaten” border.
  3. Colour – melanomas tend to have multiple different colours within them – this might be different shades of brown, black, blue or grey. A benign mole tends to be of a uniform (normally brown) colour.
  4. Diameter – melanomas tend to be larger than 6mm.
  5. Evolving – any mole that is changing – e.g. growing or changing in appearance. Melanomas are more likely to itch or bleed than a ‘normal mole’.

If any of your moles show these features, it is wise to have a skin check. Melanomas can appear from existing moles or come from previously normal skin. Other factors to consider include whether you have one mole that ‘stands out’ or looks very different from the other moles that you have, which should also prompt you to have a skin check.

At The Skin Hospital
Any suspected melanoma is removed by surgery. Suspected melanomas should never be frozen off. When a melanoma is confirmed, a second episode of surgery is needed to remove more skin around where the melanoma is found – how much depends on the depth of the melanoma.

If the melanoma is ‘early’, your dermatologist will need to follow you up with regular checks, where your skin and lymph nodes will be monitored. If you have a more advanced melanoma, you may also need investigation by sampling the lymph nodes, and may need follow-up with a specialist oncologist.

Any specialist at The Skin Hospital will be able to check your skin and can remove a suspicious mole if required. If required, due to the size or position of the melanoma, your specialist may refer you on to one of our skin cancer surgery specialists.

 

Further information about melanoma can be obtained from the following trusted site:
http://www.dermnetnz.org/lesions/melanoma.html

A loss of pigmentation of the skin affecting 1-2% of Australians caused by the destruction of melanocytes or pigment cells and the skin becomes white.

Scabies caused by a sarcoptes scabei var hominis mite which only lives on humans.

A common skin disorder which causes a red rash on the face, nose, cheeks, ears and neck. It may have inflamed red bumps with pustules, resembling acne.

 A benign skin disease producing red, scaly patches. It usually appears on the knees, elbows and scalp although it can occur on any part of the body. Psoriasis may be inherited and manifests most frequently in young adults.

Port wine stains are common birthmarks caused by tiny blood capillaries in the skin and get their name due to the colour on the skin.

Distorted, discoloured or otherwise unsightly fingernails and toenails are common problems in people of all ages.

The most common sign of allergy are raised, itchy lumps called hives which affects 20% of Australians. Hives are an inflammatory response to an irritant or foreign substance.

Eczema is an inherited skin disease which causes itchy and red inflamed skin which may crack, ooze fluid, and form crusts.

Alopecia is the medical term for hair loss and is common in both men and women. Alopecia usually, and most noticeably, affects the scalp but can affect any part of the body where hair grows. Alopecia has many different causes and depending on the cause, different treatment will be recommended.

Acne is a skin disease which affects 85% of Australians and can be very severe in 5%. Acne usually occurs in adolescence when the hormones are seeking a new balance, although can occur from birth through to middle age.

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