ACNE

Acne is an inflammatory condition of the hair follicle known as the pilosebaceous unit, and its related sebaceous glands. It is especially common during adolescence (in girls, from the ages of 11-16, in boys from 14-18) but it can occur at any age.

Yeditepe University Hospital’s specialists explain: 

Why does acne occur?

There are 4 main factors: an elevated production of the oil in skin known as sebum, increased stickiness in the hair follicle, micro-organisms on the surface of the skin, and infection. Acne requires the active production of sebum. In adolescence, male hormones (androgens) stimulate the growth of the sebaceous glands and the production of sebum is increased. People with acne have an oilier skin type than other people. Some of the sebum-stimulant hormones can also lead to other problems in girls and women such as the growth of body hair and menstrual irregularities. Hair follicle cells increase in acne sufferers and can cause blockages. Spots commonly called blackheads form; these are clinically termed open comedones (blackheads) and closed comedones (whiteheads).

Microbial impact on the skin

The accumulation of certain microbes in the hair follicles causes acne. These are the propionibacterium acnes, staphylococcus epidermidis and pityrosporumovale bacteria.

Inflammation

Certain substances released by the bacteria can lead to an inflammatory reaction.

How significant are genetic factors in the development of spots?

If either parent has suffered from acne, there is a more than 50% chance that the child will have the condition. 

How do hormonal problems cause spots?

Before adolescence the sebaceous glands are very small in size and cannot cause spots. Hormonal factors that emerge in adolescence and afterwards (hormones secreted in the ovaries and testes) cause the growth of the sebaceous glands and the accumulation of excessive oil on the skin. Androgens (most importantly the androgenic hormone testosterone) are present in both males and females. The androgen level rises during adolescence. Androgens can cause the sebaceous glands to function excessively and this leads to the growth of spots.

What triggers acne?

Acne (adolescent spots)

Some foods: chocolate, nuts, peanuts.

Certain medications: steroids, body-building drugs.

Menstrual cycle

Sunlight

Cosmetics

Excessive sweating

Psychological factors and stress

Smoking

Recent studies indicate that "hidden diabetes" (reactive hypoglycemia) can cause the formation of acne.

 How and where does acne appear?

 Acne appears mainly on the face, back, chest and upper arms. It can take the form of black spots, red swelling, inflamed wounds and cysts. Long-term and untreated spots can appear as raised or sunken marks on the skin.

Recommendations for the treatment of acne

Skin cleansers (pH-neutral soap), External treatments (creams, lotions), benzoyl peroxide medications, antibiotics (clindamycin, erythromycin, tetracycline), Retinoids (vitamin A derivatives), azelaic acid, salicylic acid, sulfur, and resorcinol.

Systemic Treatments

Antibiotics (tetracycline, doxycycline, minocycline, erythromycin, clindamycin), Retinoids (vitamin A derivatives), hormonal medications (birth control pills)

Physical Treatments

Comedone (blackhead) removal, chemical peeling (scar removal by chemical peeling process), 'dermabrasion'skin peeling method using special equipment), derma-rollers, laser treatments, PRP (platelet rich plasma) therapy.

SKIN CANCER

Skin cancer is one of the most commonly occurring forms of cancer. Research indicates that skin cancer is becoming ever more frequent.

Who is most at risk of skin cancer?

Pale-skinned people (blondes, redheads)

People who get easily sunburned

People who have suffered from sunburn in childhood

People with a history of skin cancer in the family

Prolonged exposure to X-rays

Weak immune system

Long-term wounds or injuries caused by a disease, burns or stress

Exposure to carcinogens such as arsenic

People who often go a solarium

Occupational groups exposed to more sunlight (farmers, fishermen, construction workers, etc.) 

What does skin cancer look like?

There are many types of skin cancer, each of which has a different appearance.

Actinic keratosis (AK)

These are often the first stage of skin cancer and appear as dry coarse marks. They are precursors to skin cancer and can turn into cancer if left untreated. They generally appear on pale-skinned people after the age of 40. This is because they develop as a result of prolonged exposure to the sun over a period of years. In spite of this, AK can occur in young people living in sunny regions or those who use a solarium. They most frequently occur on the head, neck, hands and arm regions. The risk that they may become cancerous means that they require treatment.

Basal Cell Carcinoma (BCC)

This is the most common type of skin cancer. It appears as a pearly swelling or open wound. They can sometimes appear as pinkish patches. They appear in regions most exposed to the sun such as the head, neck and arms. In rarer cases they appear on the trunk and limbs. They do not usually grow rapidly and rarely spread to other parts of the body. However they do require immediate treatment. This type of cancer can penetrate and cause damage to the surrounding tissue, nerves and bones and cause disfigurement.

Squamous Cell Carcinoma (SCC)

SCC is the second most common type of skin cancer. It generally appears as hard swellings in the form of large red colored patches, or else it heals and recurs in the form of ulcers. More common in pale-skinned people, it does also affect people with darker complexions. It can cause severe injury and disfigurement as it metastasizes on the skin. Early detection can prevent it spreading to other parts of the body.

Melanoma

This type of cancer looks more like a mole or a suddenly appearing black spot on the skin. In either case the condition can be fatal. 8,500 people die of melanoma every year in the United States and so it has become known as the most deadly form of cancer. It is also increasing in frequency in Turkey and other countries in the region.

What are the symptoms?

The location and appearance of moles that form on the body are significant factors. If detected and treated early, the chances of recovery are high. Look for the ABCDE's of melanoma:

Asymmetry: one half of the mole looks different from the other

Borders (irregular, jagged and ill-defined)

Color (variegated): the color varies from one part to the other. They can be brown, black, sometimes white, red and blue

Diameter (greater than 6 mm (0.24 in), about the size of a pencil eraser), can be smaller

Evolving over time: evolving over time in a way that does not resemble other moles on the body, or as a skin lesion with a changing shape, size and color. Other distinguishing features can be secretions, itching or bleeding.

What are the risk factors?

Exposure to sunlight: this risk can be minimized by using protective lotions and clothing, and avoiding any kind of sunbathing.

Pale skin color (blondes, redheads): People with darker complexions can also be at risk. These people generally develop melanoma on the palms, soles of the feet, cuticles, mouth and genital regions.

A family history of melanoma: your risk of melanoma is significantly increased if you have a first degree relative (parent, sibling or child) with melanoma.

The risk is heightened if you have a large number of moles or atypical moles (50 or more). Atypical moles are not carcinogenic. However, they do require close monitoring due to the different ways in which they can develop.

Are skin tests important?

The recovery rate for BCC and SCC cases when there is early detection and treatment is about 95%. The recovery rate for melanoma is high as long as it is treated before metastasis occurs. Frequent check-ups are the best method of early detection. Self-examination is also possible. You should seek medical treatment without delay if you notice the sudden emergence of a mole or a change in the appearance, size or color of an existing mole.

People with prolonged exposure to the sun, with a family history of skin cancer (especially melanoma), with numerous moles, atypical moles or who are in any other high risk group should attend a dermatologist for regular check-ups, annually or in some cases more frequently.

If your dermatologist detects a risk of skin cancer, he or she will remove a section to be microscopically examined. This is known as a biopsy. The dermatologist can easily carry out this procedure in a clinical environment. In the event that the biopsy examination reveals the existence of cancer, further treatment may be required. In cases of early detection, surgical treatment may be sufficient. In more advanced cases, (especially if it has spread to other organs), the treatment protocol may vary. The treatment will depend on the type of cancer, its extent and location and also on the individual requirements of the patient.

URTICARIA

Popularly known as "hives", urticaria is a skin disease associated with itching and blisters. In the most severe cases the blisters can spread to other organs (especially the lips, trachea and eyelids). It is a common condition that affects 20-30% of the population. Urticaria can cause skin lesions anywhere on the body that generally disappear within about 24 hours. Fresh blisters can form adjacent to the healed lesions. There are two types of urticaria: the acute and chronic forms. In its acute form, the disease clears up in less than six weeks. But in its chronic form it can last longer than six weeks and have a negative impact on the patient's quality of life.

There are various possible causes of urticaria, but the most common is allergic factors, especially to medication (mainly antibiotics, pain killers and epilepsy medication) and food (shellfish, fish, milk, nuts, peanuts, potatoes, beans, celery, parsley, carrots, spices, rice, bananas, apples, and oranges). In addition, urticaria can be triggered by food additives, respiratory allergens (such as plant and tree pollen), insect stings (such as bee stings) and implants (such as false teeth and dentures). Urticaria is more common in people who are prone to allergies. This is because they are more sensitive than other people to the substances listed above and show a greater reaction to them.

Urticaria may also be related to environmental changes or changes in body temperature. In susceptible people it may develop after consuming something cold like ice cream. It can also form as a result of sweating after physical exercise. It can be associated with the use of vibrating devices. Along with exercise it may be related to the consumption of nuts, shellfish or wheat.

Urticaria may not always be related to allergic factors. It can also be caused by points of infection in the body (dental infections, or infections in the urinary tract), radio-contrast medications used in radiology examinations, anesthetics used in surgery, and stress.

The cause of urticaria in the great majority of cases that last longer than six weeks may never be determined. The condition, which constantly itches, has a negative impact on sufferers' daily Lives. Urticaria patients need to be examined very carefully. In the event that the patient is not properly assessed and the symptoms become more severe, life threatening conditions may arise. Swelling of the lips and trachea can restrict breathing and require emergency intervention.

For these reasons the condition requires a very thorough examination procedure, with detailed information on the patient's daily life, working life, habits and any other diseases or conditions that may exist. Allergy and blood tests may be required in order to establish the cause. The treatment of mild cases is easy. However, the longer-term form of the disease can be challenging for both patient and doctor.

 

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