Acne Vulgaris (Acne) (Cutaneous Lesion)

Excessive secretion of oils from the sebaceous glands accompanies the plugging of the pores with naturally occurring dead skin cells (corneocytes) blocking hair follicles. Oil secretions are said to build up beneath the blocked pore, providing a perfect environment for the skin bacteria Propionibacterium acnes and the lipophilic (oil/lipid-loving) yeast Malassezia to multiply uncontrollably. In response to the bacterial and yeast populations, the skin inflames, producing the visible lesion. The face, chest, back, shoulders and upper arms are especially affected.

The typical acne lesions are:

  • Comedones – a plugged hair follicle, may be open (blackheads) or nearly closed (whiteheads)
  • Papules - a small, solid and usually conical elevation of the skin. Papules do not contain pus, which distinguishes them from pustules
  • Pustules - collection of pus that has accumulated in a cavity formed by the tissue on the basis of an infectious process
    (usually caused by bacteria or parasites) or other foreign materials
  • Nodules - a small aggregation of cells
  • Cystic acne - one of the more severe forms. These are more inflamed and pus-filled or reddish bumps, which can easily lead to scarring or serious infections

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Telangiectasia (vascular lesion)

Small, unsightly red, purple or blue blood vessels found along the surface on the face, upper chest, neck and rarely on other parts of the body. Similar veins are found on the legs called spider veins. These blood vessels are abnormal, not necessary for any essential body function.

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Cherry Angioma (vascular lesion)

Small, smooth, dome-shaped papules superficially protruding from the skin. Acquired in adulthood, they usually are multiple lesions located on the trunk, and range in color from red to purple.

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Dermatosis Papulosa Nigra (DPN) (pigmented lesion)

A benign cutaneous condition common among darker skin types. It is usually characterized by multiple, small, hyperpigmented, asymptomatic papules on the face of adults with darker skin tones.

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Dyschromia

Irregular or patchy discoloration of the skin that can be caused either by variations in pigment density (melanin), or changes in blood vessels (vascular changes).

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Hemangioma (vascular lesion)

A benign proliferation of blood vessels in the dermis. The vascularity imparts a red, blue, or purple color to these lesions. Hemangiomas are usually present at birth, although they may appear within a few months after birth, often beginning at a site that has appeared slightly dusky or differently colored than the surrounding tissue.

Hemangiomas, both deep and superficial, undergo a rapid growth phase in which the volume and size increase rapidly. This phase is followed by a rest phase, in which the hemangioma changes very little, and an involutional phase in which the hemangioma begins to disappear.

During the involutional phase, hemangiomas may disappear completely. Large cavernous hemangiomas distort the skin around them and will ultimately leave visible changes in the skin. A superficial capillary hemangioma may involute completely, leaving no evidence of its past presence.

Examples of hemangiomas are Nevus flammeus “stork bite”, and strawberry hemangioma.

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Leg Veins (vascular lesion)

Often small, red or blue veins located closer to the surface of the skin than varicose veins. They can look like tree branches or spider webs with their short jagged lines. Spider veins can be found on the face.

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Lentigo (pl. Lentigines) “Age Spots”, “Liver Spots” (pigmented lesion)

A brown, sharply circumscribed spot caused by an increased number of melanocytes.   Actinic (solar) lentigines arise in middle age and are numerous in sun-exposed skin.

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Melasma (pigmented lesion)

Patchy light to dark brown hyperpigmentation of the cheeks and occasionally the forehead and upper lip that results from sun-exposure and is associated with estrogens.

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Neovascularization (vascular lesion)

An increased number of blood vessels in tissue not normally containing them, or proliferation of blood vessels of a different kind than usual in tissue. This can occur as a result of wound healing in the skin.

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Poikiloderma of Civatte (vascular lesion)

A common weathering change which affects the skin of the sides and front of the neck which characteristically spares the shaded area under the chin. The skin in the affected area is red-brown with prominent hair follicles. The term "poikiloderma" refers to a change in the skin where there is thinning, increased pigmentation and dilation of the fine blood vessels (Telangiectasia).

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Port-wine Stain (vascular lesion)

A vascular birthmark made of enlarged capillaries in the skin, which produce a reddish-purplish discoloration of the skin. Port-wine stains occur most often on the face but can appear anywhere on the body. Early stains are usually flat and pink in appearance. As the child matures, the color may deepen to a dark red or purplish color.

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Pseudofolliculitis Barbae (PFB), "Shaving Bumps"

"Shaving bumps" is a foreign body inflammatory reaction involving papules and pustules. It primarily affects curly haired men who shave. It can also affect some hirsute black women.

Two mechanisms are involved in the pathogenesis of PFB: (1) extrafollicular penetration occurs when a curly hair reenters the skin, and (2) transfollicular penetration occurs when the sharp tip of a growing hair pierces the follicle wall.

Black men who shave are predisposed to this condition because of their tightly curved hair. The sharp pointed hair from a recent shave briefly surfaces from the skin and reenters a short distance away. The close shave results in a sharp tip below the skin surface, which is then more likely to pierce the follicular wall, causing PFB with transfollicular penetration .

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Rosacea (vascular lesion)

Rosacea is a chronic skin condition involving inflammation of the cheeks, nose, chin, forehead, or eyelids. It may appear as redness, prominent spider-like blood vessels, swelling, or skin eruptions similar to acne.

  • Subtype 1 Rosacea : Erythematotelangiectatic rosacea, characterized by flushing and persistent redness. Visible blood vessels may also appear
  • Subtype 2 Rosacea: Papulopustular rosacea, characterized by facial redness with bumps or pimples
  • Subtype 3 Rosacea: Phymatous rosacea, characterized by thickening or growth of excess tissue, often around the nose
  • Subtype 4 Rosacea: Ocular rosacea, characterized by watery or bloodshot appearance, irritation, burning or stinging of the eyes

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Seborrheic Keratoses (cutaneous lesion)

A superficial benign neoplasm of epidermal cells that presents as a papule or plaque with a characteristic “pasted-on” appearance.  These lesions are usually acquired later in life (middle age and beyond) and tend to grow slowly.

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Skin Tags (cutaneous lesion)

Soft, pedunculated, fleshy papules commonly found under the arm and around the neck. These lesions are benign. They may be excised for cosmetic reasons, or if they frequently become irritated by friction, clothing or jewelry.

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Spider Angioma (vascular lesion)

An abnormal collection of blood vessels near the surface of the skin. The appearance is often similar to that of a small spider web. A spider angioma lesion typically has a red dot in the center with reddish extensions radiating out for some distance around it (a few millimeters to a centimeter or more). Spider angiomas can occur anywhere but are most common on the face and trunk.

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Telangiectasia (vascular lesion)

Small, unsightly red, purple or blue blood vessels found along the surface on the face, upper chest, neck and rarely on other parts of the body. Similar veins are found on the legs called spider veins. These blood vessels are abnormal, not necessary for any essential body function.

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Venous Lake (vascular lesion)

An asymptomatic, generally solitary, soft, compressible, dark blue to purple, 0.2 to 1cm papule commonly found on sun-exposed surfaces of the vermilion border of the lip, face and ears. Lesions generally occur among the elderly.

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Verruca (Warts) (cutaneous lesion)

Small, usually painless growths on the skin caused by a virus. They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet).

Different types of warts include:

  • Common Warts - usually on the hands, but can appear anywhere
  • Flat Warts - generally found on the face and forehead. Common in children, less so in teens, and rare in adults
  • Genital Warts - usually found on the genitals, in the pubic area, and the area between the thighs, but can appear inside the vagina and anal canal
  • Plantar Warts - found on the soles of the feet
  • Subungual and Periungual Warts - appear under and around the fingernails or toenails

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Wrinkles (Rhytids)

Wrinkles appear on the parts of the body where sun exposure is greatest. These especially include the face, neck, the backs of the hands, and the tops of the forearms. Wrinkles come in two categories: fine surface lines and deep furrows. Wrinkle treatments are in general much more effective for fine lines. Deeper creases may require more aggressive techniques, such as injection of fillers or plastic surgery. Most wrinkles are associated with aging changes in the skin. Aging of the skin and related structures (hair and nails) is a natural process. Nothing can be done to decrease the rate of skin aging, but many environmental factors will increase the rate.

Frequent exposure to sunshine results in premature skin wrinkling and increased pigmentation (Lentigines).

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