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Patient Information Leaflets (PILs)

These Patient Information Leaflets (PILs) are specially written by the British Association of Dermatologists (BAD). A small selection is available in booklet format and can be ordered by filling in an order form.

The BAD has been awarded The Information Standard certification for the process it employs to develop information products aimed at the general public, which include PILs, Sun Awareness Campaign materials, and other information products.

The BAD shall hold responsibility for the accuracy of the information published, and neither the scheme operator nor the scheme owner shall have any responsibility for costs, losses, or direct or indirect damages or costs arising from inaccuracy of information or omissions in information published on the website on behalf of the BAD.

Please note:

  1. There are thousands of different skin complaints, therefore, the focus of the British Association of Dermatologists' PILs production is on the most common, rarest or debilitating skin conditions.
  2. The offer to provide details of source materials used to inform British Association of Dermatologists' PILs is for instances where the advice provided perhaps does not reflect local practice, and not an offer to conduct literature searches or supply bibilographic materials for your own research.
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Folliculitis barbae

Hairs are formed within the skin in tiny structures known as hair follicles. The word folliculitis describes inflammation of hair follicles and may happen anywhere on the body. The term folliculitis barbae is inflammation of hair follicles in the beard area (‘barba’ is the Latin word for beard).  

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Folliculitis decalvans

Folliculitis decalvans is a rare chronic (long term) inflammatory condition of the scalp. Very rarely it can affect other hair-bearing skin such as beard, armpits, pubic area and legs. The prolonged inflammation that usually occurs leads to scarring. Folliculitis decalvans is derived from Latin and means inflammation of the hair root associated with hair loss.

Folliculitis decalvans is not contagious and is not a type of skin cancer.

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Fox-Fordyce disease

Fox-Fordyce disease is a rare skin disorder affecting the apocrine sweat glands. These are special sweat glands found in the armpits, genital region and breasts that produce a more dense secretion than the normal or ‘eccrine’ sweat glands found elsewhere on the body. Patients with this condition experience itchy bumps on the skin around the hair follicles. 

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Frontal fibrosing alopecia

Frontal fibrosing alopecia is a form of scarring hair loss affecting the hair margin on the front of the scalp. This happens due to inflammation and destruction of the hair follicles. There may also be hair loss around the ears and from the eyebrows. It most commonly occurs in women who have gone through menopause but can also occur in pre-menopausal women and, rarely, in men. It is thought to be a variant of another condition called lichen planopilaris

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Fumaric acid esters

Fumaric acid esters (FAE) are chemical compounds that have been used as a treatment of psoriasis for over 30 years. They are a popular medication in some European countries, but are not licensed as a treatment of psoriasis in the UK. A fixed combination of FAEs called Fumaderm® is approved for treatment of psoriasis in Germany. This contains dimethyl fumarate (DMF) which is thought to be the main active ingredient. 

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Fungal infections of the nails

Fungal infections of the nails are also known as dermatophytic onychomycosis, or tinea unguium. The responsible fungus is usually the same as that that causes athlete’s foot – a common infection of the skin of the feet, especially between the toes. In athlete’s foot the responsible fungus lives in the keratin that makes up the outer layer of the skin. When the fungus spreads to the keratin of the nails, the result is a fungal nail infection. 

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Granuloma annulare

Granuloma annulare is an uncommon skin condition, which most often affects children and young adults but can occur at any age. It is twice as common in women as in men. The reason for this is unknown. 

It usually presents as groups of small firm bumps in the skin which come together to form a characteristic ring shaped (annular) patch. These typically occur on only one or two sites of the body, often overlying bony areas such as the back of the hands, the feet, elbows or ankles. 

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Haemangioma of infancy

A ‘haemangioma’ (Greek for blood-vessel-growth) of Infancy is a benign (not cancerous) overgrowth of blood vessel cells that is self-limiting (will stop growing without treatment). The term ‘strawberry naevus’ or ‘strawberry haemangioma’ is used for a haemangioma that look similar to a strawberry.

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Hailey-Hailey disease

Hailey-Hailey disease is also known as familial benign chronic pemphigus, as originally described by the Hailey brothers. It is a rare inherited skin condition in which red scaly areas that can be itchy and sore, can lead to superficial blisters and eroded (broken) areas of the skin folds of the groin, armpits, neck and under the breasts. The condition flares intermittently and tends to come and go. Many patients are able to lead full and normal lives, with their condition being a nuisance rather than a serious problem. Some patients are more severely affected and experience more persistent painful raw areas of the skin with development of superficial blisters.Hailey-Hailey disease is also known as familial benign chronic pemphigus. It is a rare inherited skin condition in which red scaly areas that can be itchy and sore can lead to superficial blisters and eroded (broken) areas of the skin folds of the groin, armpits, neck and under the breasts. The condition flares intermittently and tends to come and go. Many patients are able to lead full and normal lives, with their condition being a nuisance rather than a serious problem. Some patients are more severely affected and experience more persistent painful raw areas of the skin with development of superficial blisters.

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Hair loss - female pattern (androgenetic alopecia)

Female pattern hair loss (FPHL) has also been called androgenetic alopecia. It is the most common type of alopecia (hair loss) in women and the severity can vary.

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Hair loss - male pattern (androgenetic alopecia)

Male pattern hair loss (MPHL) is the most common type of hair loss in men. It is also known as androgenetic alopecia. It affects about 50% of men over the age of 50.

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Hand dermatitis

Hand dermatitis is also called hand eczema. It is common and can affect about one in every 20 people. It can start in childhood as part of an in-built tendency to eczema, but is commonest in working-age adults. Hand dermatitis may be a short-lived, mild problem. However, in some people it lasts for years in a severe form that can have a great impact on daily life and restrict someone’s ability to work.

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Head lice

Head lice are very common. They are small (adult lice are the size of a sesame seed) grey-brown insects that live only on human scalps. They cannot fly or jump; neither can they burrow into the scalp. They can affect anyone, with long or short hair, no matter how clean the hair is

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Herpes Simplex

Herpes simplex is an infection of the skin with the herpes simplex virus. There are two types of herpes virus, called herpes simplex type 1 and herpes simplex type 2. Herpes infection is caught from another person through contact with mouth, eye or genital secretions or through direct contact with an active lesion. Herpes simplex type 1 usually infects the mouth or eye and herpes simplex type 2 usually infects the genital area. After the virus infects the person, whether it shows on the skin or not, it goes to local sensory nerves and lies hidden (dormant) until reactivation (recurrence of the herpes infection). Reactivation can occur after a few weeks or even years, when the virus travels to the skin supplied by the nerve and appears as a blister or rash on the skin. The commonest areas to be affected by herpes simplex are the lips (as cold sores), and the genital area (as genital herpes). Genital herpes infection is usually a sexually transmitted disease.  

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Hidradenitis Suppurativa

Hidradenitis suppurativa is a long term, recurrent, and painful disease in which there is inflammation (redness, tenderness and swelling) in areas of skin containing apocrine sweat glands. These glands are found mainly in the armpits, breasts and groins. Within HS there is a blockage of the hair follicles. This causes a mixture of boil-like lumps, areas leaking pus, and scarring.Hidradenitis suppurativa is a long term, recurrent, and painful disease in which there is inflammation (redness, tenderness and swelling) in areas of skin containing apocrine sweat glands. These glands are found mainly in the armpits, breasts and groins. Within HS there is a blockage of the hair follicles. This causes a mixture of boil-like lumps, areas leaking pus, and scarring.

Hidradenitis suppurativa tends to begin around puberty age, and is more common in women. It is estimated to affect about 1% of the population.

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Hirsutism

Hirsutism refers to excessive growth of dark, thick and coarse hair in an individual (usually female) in a male pattern. Commonly affected areas are upper lips, chin, central chest, midline of the stomach, lower back, buttocks and front of thighs. Hirsutism affects approximately 10% of women in Western societies and is commoner in those of Mediterranean or Middle-Eastern descent.

If the excessive hair is generalised and not in a gender specific pattern, the term is ‘hypertrichosis’, which means increased (‘hyper’) hair (‘trichosis’). In this leaflet we will only discuss hirsutism.  

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How to care for your hands

Our hands come into daily contact with many substances such as soap, detergent, shampoo, household cleaning chemicals, water and food. These can take away the protective oils that keep the skin moist, leading to chapping, dryness, and irritation.  Frequent contact with water is one of the commonest causes.  Once the skin on the hands is irritated and damaged, it is prone to further damage and a vicious circle is set up leading to hand dermatitis, or making existing dermatitis worse.     

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How to check your lymph nodes

The Lymphatic System

Lymph nodes are part of the lymphatic system, which is a network of tiny tubes that carry a colourless fluid called lymph through the skin and deeper parts of the body.  Lymph fluid contains immune cells (lymphocytes) nutrients and waste materials.

 Lymphatic Vessels

It bathes the cells of the skin and internal organs and   drains into lymphatic vessels then larger ducts in the neck before joining the blood stream near the heart (see Figure 1).

Lymph Nodes

Lymph nodes (‘glands’) are small oval nodules and contain millions of infections fighting lymphocyte cells.  They are found at intervals along the lymphatic vessels like ‘beads on a string’ (see Diagram 1). The lymph nodes filter out harmful organisms and abnormal cells before the lymph reaches the blood stream. Lymph nodes can only be felt in certain areas:

  • head and neck
  • arms
  • axilla (armpit)
  • inguinal area (groin)
  • back of knees

Lymph node are usually too small to feel except in slim people when they can be felt as smooth pea-sized lumps in the groin. Another common exception is when people get a sore throat or an ear infection, which can make the neck lymph nodes enlarged, painful and tender.

Lymph nodes can also become enlarged if cancer cells lodge in them. In this case, they are usually painless.

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Hydroa vacciniforme

Hydroa vacciniforme is an extremely rare skin condition in which there is an abnormal sensitivity of the skin to sunlight (photosensitivity). It is neither infectious nor dangerous, but it can restrict an affected person’s lifestyle, particularly during the summer months and on holidays.

The term hydroa is possibly from the Greek for ‘watery eggs’, a reference to the blisters that characterise this condition; vacciniforme derives from the Greek for the ‘pox-like’ permanent scars (resembling large deep chicken pox scars) that result when the blisters heal.

Hydroa vacciniforme usually affects children aged 3-15 years, and is more common in females than males. In boys, hydroa vacciniforme may develop at a later age than in girls, and go on for longer.

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Hydroxycarbamide

Hydroxycarbamide, formerly known as hydroxyurea, affects cells that are dividing rapidly, such as the skin cells in psoriatic plaques and the blood cells in the bone marrow. It is mainly used for cervical and blood cancers, but is also used to treat psoriasis. It is known as a ‘cytotoxic’ medicine, meaning that it interferes with cell growth. 

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Hydroxychloroquine

Hydroxychloroquine is one of several antimalarial drugs that have anti-inflammatory effects useful in other diseases. It is licensed in the UK for the treatment of malaria.

Hydroxychloroquine is particularly effective for systemic lupus erythematosus (SLE) and discoid lupus erythematosus (DLE). By reducing inflammation, hydroxychloroquine can decrease pain, swelling and stiffness of joints, and improve or clear some rashes.

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Hyperhidrosis

Hyperhidrosis means excessive sweating. It can be localised or affect the whole body.

Sweating is controlled by the brain, which sends signals along nerves called “sympathetic nerves” to the small sweat glands in the skin. These nerves are part of the “autonomic nervous system” which controls many unconscious body functions.

Increased sweating is a normal response to a rise in body temperature, and to emotions such as anxiety.

A treatment which reduces sweating is called an antiperspirant. This is different from a deodorant, which reduces odour, usually through an antibacterial effect. The two are often combined in the same product.

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Ichthyosis

Ichthyosis is the term used to describe continual and widespread scaling of the skin. It may be inherited (genetic) or acquired during life. The inherited forms are rare, generally present from infancy, and are usually lifelong conditions. Acquired ichthyosis can develop at any age due to a number of medical problems, such as kidney disease. 

The commoner forms of inherited ichthyosis are mild and do improve during warmer weather. There are a number of very rare conditions where ichthyosis occurs with problems in other systems of the body. Each of the major types of ichthyosis will be discussed briefly, followed by an outline of the management.

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Imiquimod cream

Imiquimod is a topical immuno-modulator. The cream triggers the immune system to recognise abnormal cells and causes inflammation to remove them. It may also remove abnormal cells from the lymph drainage vessels around a tumour.

In the UK, two strengths of Imiquimod cream are available, a 5% cream (trade name Aldara®) and a 3.75% cream (Zyclara®). 

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Immunisation recommendations for children and adult patients treated with immune-suppressing medicines

This leaflet has been written to give you information aboutimmunisations (vaccinations), which may affect you when you are taking medicines that act by suppressing the immune system. This includes information about vaccinations which are:

1.    Recommended before you start immune suppressing medicines

2.    Safe for you to have while you are taking this treatment

3.    Need to be avoided 

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Impetigo

Impetigo is a bacterial infection of the surface of the skin. In the UK, it is the most common skin infection seen in young children, but may be seen in people of any age. 

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Infliximab

Infliximab is a powerful anti-inflammatory drug that has been designed to resemble normal human molecules, and is therefore classed as a “biological” treatment. It reduces inflammation by inhibiting the activity of a chemical (“cytokine”) in the body called ‘tumour necrosis factor alpha’ (TNF-alpha).

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Intralesional steroid therapy

This is a procedure involving the injection of a steroid solution into abnormal skin, with the aim of improving its appearance or reducing symptoms such as itch or pain. The steroid preparation most frequently used in this procedure is called triamcinolone acetonide, and you may hear the procedure referred to as “intralesional triamcinolone”. 

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Iontophoresis for hyperhidrosis

Iontophoresis (pronounced eye-on-toe-for-ee-sis) is a safe and effective treatment that can be used to reduce excessive sweating (hyperhidrosis) of the hands, feet and underarms.

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Isotretinoin

Isotretinoin is a member of a group of drugs, closely related to vitamin A, called retinoids. Isotretinoin is the generic name of a drug marketed by a number of companies, but the original brand name was Roaccutane. It works in a variety of ways, targeting several of the factors that cause acne and other skin conditions including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle and cause acne.

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Junctional epidermolysis bullosa

Junctional epidermolysis bullosa (JEB) is a rare inherited (genetic) skin disorder. It is different from the other forms of epidermolysis bullosa (EB), which include epidermolysis bullosa simplex, dystrophic epidermolysis bullosa and Kindler Syndrome. Individuals who have JEB will not develop one of the other types of epidermolysis bullosa at a later date.

The skin of those who have JEB is fragile and minor everyday knocks and friction cause blisters or raw areas. There are 3 main types of JEB (Herlitz JEB, Non-Herlitz JEB and JEB with pyloric atresia). JEB varies in severity, from relatively mild disease with normal lifespan to the most severe form, Herlitz JEB, in which babies may not live beyond their first birthday. JEB is not an infection, it is not contagious and it is not due to an allergy.

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Juvenile xanthogranuloma

JXG is a skin lump caused by an excess of cells known as histiocytes. It is rare and occurs mainly in infants and young children, although about 10% occur in adults. It is not known what causes this condition. It is not a type of cancer. 

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