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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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Kaposi's sarcoma

Kaposi’s sarcoma (KS) is a growth of the cells from the inner lining of blood vessels. It is linked to infection with Human Herpes virus type 8 (Kaposi sarcoma herpes virus, HHV8), and impairment of the immune system. It is named after Dr Moritz Kaposi, a Hungarian dermatologist, who first described it in 1872. ‘Sarcoma’ (from ancient Greek ‘flesh’) means a cancerous growth of the soft tissues under the skin and is present in other organs. Kaposi’s sarcoma is actually not a cancer, but rather a tissue-overgrowth.

Kaposi’s sarcoma can be mild, only affecting the skin, or more extensive with involvement of lymph nodes and internal organs such as the lungs or digestive system, in which case it may be fatal.

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Keloids

When a wound heals, it leaves a scar. A keloid (also called a keloid scar) is the name given to a scar that overgrows and becomes larger than the original wound. It is not uncommon for a scar to become slightly thick and raised. This is called a hypertrophic scar. Unlike hypertrophic scars, keloids:

  • Can develop after very minor skin damage, such as an acne spot, or sometimes without any obvious trauma to the skin (spontaneous keloids).
  • Spread beyond the original area of skin damage.
  • May be permanent.
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Keratoacanthoma

KA is a relatively common, rapidly growing skin lesion that usually develops on sun-exposed skin. It arises from skin cells that surround the hair follicle. Early diagnosis is needed to differentiate a keratoacanthoma from a skin cancer called squamous cell carcinoma (SCC) as, unlike an SCC, a keratoacanthoma is benign.  

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Keratosis pilaris

Keratosis pilaris (KP) is a very common and may be present in half the population. It is a completely harmless skin condition. It affects 50-70% of adolescents and approximately 40% of adults. Its name gives some idea of what it is; ‘keratosis’ means that there is too much keratin, which makes up the tough horny outer layer of the skin, while ‘pilaris’ comes from the Latin for hair (pilus). In keratosis pilaris, many small (1 to 2 mm across) horny plugs can be seen blocking the hair follicles on the upper and outer parts of the arms and thighs. This can look like goose bumps, but feels slightly rough.Keratosis pilaris appears when extra keratin accumulates in the hair follicles. This usually starts in childhood, and becomes more obvious during adolescence and in adulthood. For reasons not fully understood the condition seems to be better in the summer than in the winter perhaps because in winter the skin often gets dry while in summer the sweat makes it less dry. Keratosis pilaris may be associated with ichthyosis vulgaris and atopic eczema, however this may be coincidental.

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Latex Allergy

Latex is a milky sap from plants like the tropical rubber tree. It contains a mixture of water, sugar and proteins. The sap is collected by drilling into the tree and used to make rubber items such as household gloves and medical gloves, shoes, tyres, balloons and condoms. During the manufacturing process chemicals such as accelerators are added to harden it and the rubber item is heated then finally rinsed.  The finished item, in addition to latex, may contain residual added (non-latex) proteins and chemicals and these can also cause allergic reactions.     

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Lentigo maligna

Lentigo maligna is one type of the earliest stage of a skin cancer called melanoma.

The word ‘melanoma’ comes from the Greek word ‘melas’, meaning black. Melanin is the dark pigment that gives the skin its natural colour and is made in the skin by pigment cells called melanocytes. After our skin is exposed to sunlight, the melanocytes make more melanin, and so the skin becomes darker.

Melanocytes may grow together in harmless groups or clusters, which are known as moles. Most people have between 10 and 50 moles and often they are darker than the surrounding skin.

Melanomas can arise in or near to a mole, but can also appear on skin that looks quite normal. They develop when the skin pigment cells (melanocytes) become cancerous and multiply in an uncontrolled way. They can then invade the skin around them and may also spread to other areas such as the lymph nodes, liver and lungs.

Lentigo maligna is a type of melanoma called ‘in situ’ melanoma. ‘In situ’ means that the cancer cells have not had the opportunity to spread anywhere else in the body. There are cancer cells in the top layer of the skin (the epidermis) but they are all contained in the area in which they began to develop. They have not started to spread or grow (‘invade’) into deeper layers of theskin. This is why some doctors call in situ cancers ‘pre-cancer’.

Lentigo maligna is a slow growing condition which can take years to develop. It appears in skin that has had a lot of sun exposure, usually the face, neck or upper arms.

Lentigo maligna can be cured with surgery. However, if the whole area is not removed completely with the appropriate surgery, some may develop into an invasive melanoma. It is therefore important to have it removed with a rim of normal skin (an adequate surgical margin). There are also preventative measures which can be taken (see below) that will further lower the risk of recurrence in the future.

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Lichen planopilaris

Lichen planopilaris is a type of scarring hair loss that occurs when a relatively common skin disease, known as lichen planus, affects areas of skin where there is hair. Lichen planopilaris destroys the hair follicle and then replaces it with scarring. It is between 2 and 5 times more common in women than it is in men and is seen mostly in Caucasian adults, with the commonest age of onset being in the mid-40s. 

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Lichen planus

Lichen planus is a fairly common (0.2-1% of the population worldwide), itchy, non-infectious rash that usually occurs in adults over the age of 40. In dermatology, the word ‘lichen’ means small bumps on the skin and ‘planus’ means ‘flat’, so the name comes from a description of the rash’s appearance.

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Lichen sclerosus (female)

Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin, but in females it most often affects the genital skin (vulva) and the skin around the anus. It can start in childhood - or adulthood and affect girls or women of any age. 

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Lichen sclerosus (male)

Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin, but in men is most often seen on the foreskin and tip of the penis. Lichen sclerosus in men does not usually affect the skin around the anus. It can affect boys or men of any age.

In some people, lichen sclerosus also affects the skin elsewhere on the body, where it can cause whitish patches of skin, but usually no discomfort.

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Lichen simplex

The term ‘lichen’ is Latin and means a plant, a moss covering trees. Lichen simplex describes a response of the skin to being repeatedly scratched or rubbed over a long period of time (also called lichen simplex chronicus). A plaque (thickened area of skin) of rough skin forms, with increased markings and sometimes little bumps around hair follicles. There may be only one plaque of lichen simplex or many plaques. 

Lichen simplex can affect any age group, but is most common in adults and unusual in children.

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Linear IgA disease

Linear IgA disease is a very rare blistering condition of the skin in adults. A similar condition affecting children is known as Chronic Bullous Disease of Childhood (CBDC).

The condition is called ‘Linear IgA disease’ because a type of protein called  immunoglobulin A (IgA) can be seen deposited under the outer layer of the skin (the epidermis) in a line (linear) when a small sample of skin biopsy is prepared specially and examined under the microscope. 

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Melanocytic naevi (moles)

Melanocytic naevi are pigmented moles. The word ‘melanocytic’ means that they are made up of the cells (melanocytes) which produce the dark pigment (melanin) that gives the skin its colour. Melanocytes clustered together form naevi. This type of moles vary in colour in different skin tones and they are easier to see on pink skins.

Some moles are present at birth or appear within first two years of life are known as congenital melanocytic naevi. Most develop during childhood and early adult life and are consequently called acquired melanocytic naevi. The number of moles increase up to the age of 30-40. Thereafter, the number of naevi tend to decrease. New moles appearing in adulthood need to be monitored and checked if growing or changing. Moles can be found anywhere on the skin, including on the hands and feet, genitals, eyes and scalp.

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Melanoma - Stage 1

Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin. In a melanoma skin cancer the melanocytes become malignant and multiply excessively. One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight. The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma.

Melanocytes make a brown/black pigment (known as melanin), and often the first sign of a melanoma developing is a previous mole changing in colour or a new brown/black lesion developing. Most frequently there is darkening in colour but occasionally there is loss of pigmentation with pale areas or red areas developing. This melanoma on the skin is known as the primary melanoma.

Melanoma is considered to be the most serious type of skin cancer because it is more likely to spread (metastasise) from the skin to other parts of the body than other types of skin cancer. If melanoma has spread to other parts of the body, those deposits are known as secondary melanoma (secondaries/metastases).

Stage 1 melanomas are present in the skin only and have not spread elsewhere in the body.

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Melanoma - Stage 2

Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin. In a melanoma skin cancer the melanocytes become malignant and multiply excessively. One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight. The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma.

Melanocytes make a brown/black pigment (known as melanin), and often the first sign of a melanoma developing is a previous mole changing in colour or a new brown/black lesion developing. Most frequently there is darkening in colour but occasionally there is loss of pigmentation with pale areas or red areas developing. This melanoma on the skin is known as the primary melanoma.

Melanoma is considered to be the most serious type of skin cancer because it is more likely to spread (metastasise) from the skin to other parts of the body than other types of skin cancer. If melanoma has spread to other parts of the body, those deposits are known as secondary melanoma (secondaries/metastases).

Stage 2 is considered a thick melanoma present in the skin only.

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Melanoma - Stage 3

Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin. In a melanoma skin cancer the melanocytes become malignant and multiply excessively. One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight. The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma.

Melanocytes make a brown/black pigment (known as melanin), and often the first sign of a melanoma developing is a previous mole changing in colour or a new brown/black lesion developing. Most frequently there is darkening in colour but occasionally there is loss of pigmentation with pale areas or red areas developing. This melanoma on the skin is known as the primary melanoma.

In around 20% of patients diagnosed with melanoma, the melanoma spreads to the lymph nodes. This is classed as stage 3 melanoma.

Lymph nodes, or lymph glands, are found in our lymphatic system which is part of the body’s immune system. The (skin) lymphatics are tiny channels in the skin, which move lymph fluid around the body to the lymph nodes in the groin, under the arms (arm pits) and in the neck. As part of the immune system, the lymph fluid can carry bacteria and even cancer cells with it. Once contained within the lymph nodes, the immune system attempts to destroy them. If the immune system fails to destroy such cancer cells they can grow within the lymph nodes creating a lump. However, the lymph nodes can also swell for other reasons such as infection (e.g. when we have a sore throat there may be swollen glands in the neck).

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Melanoma - Stage 4

Melanoma is a type of skin cancer, which arises from the pigment cells (melanocytes) in the skin. In a melanoma skin cancer the melanocytes become malignant and multiply excessively. One of the most important causes of melanoma is exposure to too much ultraviolet light in sunlight. The use of artificial sources of ultraviolet light, such as sunbeds, also increases the risk of getting a melanoma.

Melanocytes make a brown/black pigment (known as melanin), and often the first sign of a melanoma developing is a previous mole changing in colour or a new brown/black lesion developing. Most frequently there is darkening in colour but occasionally there is loss of pigmentation with pale areas or red areas developing. This melanoma on the skin is known as the primary melanoma.

When the melanoma has spread beyond the primary site and the local lymph nodes to other areas in the body, it is known as stage 4 melanoma. Stage 4 melanoma is a form of secondary melanoma where melanoma has spread to distant lymph nodes (glands) or internal organs such as the liver, lungs bones and brain (distant metastases).

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Melanoma in situ

Melanoma in situ is the very earliest stage of a skin cancer called melanoma. ‘In situ’ means that the cancer cells have not had the opportunity to spread to anywhere else in the body.

About 7,000 people in the UK are diagnosed with melanoma each year. The word ‘melanoma’ comes from the Greek word ‘melas’, meaning black. Melanin is the pigment that gives the skin its natural colour. Melanin is made in the skin by pigment cells called melanocytes. After our skin is exposed to sunlight, the melanocytes make more melanin, and so the skin becomes darker.

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Melasma

Melasma, also called ‘chloasma’ and ‘pregnancy mask’, is a common skin condition of adults in which light to dark brown or greyish patches of pigmentation develop mainly on facial skin. The name comes from melas, the Greek word for black. It is more common in women, especially pregnant women, and people with darker skin-types who live in sunny climates. However, it can also affect men (10% of patients) and any race. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection therefore it is not contagious and it is not due to an allergy. It is not cancerous and will not develop into skin cancer.

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Mepacrine

Mepacrine (an unlicensed drug in the UK of which there are many) was introduced as a treatment for malaria and for certain other tropical infections. It is one of several antimalarial drugs that have been found to also have anti-inflammatory properties, which can help some skin conditions.

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Methotrexate

Methotrexate is known as a disease-modifying drug or DMARD. It slows the production of new cells by the body’s immune system (the body's immune defence system) and reduces inflammation. It was first used to treat certain types of cancer and was discovered to be an effective treatment for skin and joint diseases when used at lower doses.

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Mohs micrographic surgery

Mohs micrographic surgery is a specialised surgical method for removing certain types of skin cancer. It was first developed by Dr Frederic Mohs in the 1930s.

Traditionally, operations for treating skin cancer surgically have involved removal of the area affected by the skin cancer together with an area of healthy unaffected skin around and below the skin cancer in order to ensure that the entire cancer has been completely removed with suitable margins of excision. Once removed, the skin is sent to the laboratory for examination by a pathologist (a doctor who specialises in medical diagnosis by looking at the cells with a microscope) to confirm whether the operation has been successful or not. It usually takes about 2 weeks for pathology report to become available. If the report shows that the skin cancer has not been fully removed, a further procedure may be necessary.

During the procedure of Mohs micrographic surgery, the skin cancer is removed a thin layer at a time with a small margin of healthy skin surrounding it. Each layer is immediately checked under the microscope by either the surgeon or a pathologist. The layer of skin is examined in horizontal sections. A further layer is taken from any areas in which the tumour remains until all of the skin cancer has been fully removed. The advantage of removing the skin layer by layer in this way is that as little healthy skin around the skin cancer is removed, which keeps the wound as small as possible. Secondly, your dermatological surgeon can be almost certain that the skin cancer is fully removed on the day of the procedure. 

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Molluscum contagiosum

Molluscum contagiosum is a common and relatively harmless viral infection of the skin. As its name implies, it is contagious (can be caught from another person by direct contact). It is most common in children and young adults, but can occur at any age.

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Morphoea

Morphoea is a rare skin disorder/ disease / complaint where areas of skin become much thicker and firmer than normal. It is sometimes called ‘localised scleroderma.’  This term originates from two words ‘sklero’ meaning ‘hard’ and ‘derma’ meaning skin.  It should not be confused with systemic sclerosis which is a different disease that affects internal organs and the blood circulation as well as the skin. Morphoea usually affects a few small areas of the skin. Very rarely, it can occur over larger areas of the body in a form called ‘generalised morphoea.’   

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Mucous membrane pemphigoid

MMP is the most up-to-date term for this condition. Other names include cicatricial pemphigoid, oral pemphigoid and ocular pemphigoid.

MMP is an uncommon blistering condition which most frequently affects the lining of the mouth and gums. Other moist surfaces of the body (known as mucous membranes) can also be affected, and these include the surface layers of the eyes, the inside of the nose, the throat and the genitalia. The skin is sometimes affected by a few scattered blisters. MMP usually starts in middle and old age. Although it is not usually a serious condition in the mouth, the diagnosis of any type of MMP is important as it will alert your specialist to the possibility that the condition may involve your eyes, even if you have no symptoms. Eye involvement (known as ocular cicatricial pemphigoid or ocular MMP) does not occur in all people with MMP, but is potentially serious as it may cause scarring and affect your eyesight.  Scarring may also affect the throat and the genitalia, and may be very serious if the larynx is affected.

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Mycophenolate mofetil

Mycophenolate mofetil (MMF) is a medicine that is mainly used to stop the body from rejecting a transplanted organ (e.g. kidney, heart and liver). MMF can also be used to treat skin conditions. It reduces the action of the body’s own defence system (the immune system) and is one of a group of drugs known as immunosuppressive agents. It is used in certain skin conditions in which the immune system loses control and begins to act against the body. 

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Mycosis fungoides

The name mycosis fungoides is 200 years old and hints, quite wrongly, that it is some sort of fungal infection. In fact it is one of a group of conditions known as cutaneous T-cell lymphoma. Mycosis fungoides is the most common type of Cutaneous T-Cell Lymphoma. A cutaneous T-cell lymphoma is a cancer (an uncontrolled growth) of the T-cell lymphocytes within the skin. (Lymphocytes are a type of white blood cell: they are found in the blood stream and organs, and help to protect us from infections. There are 2 types of lymphocytes: B-cells and T-cells.)

Mycosis fungoides is rare and for many affected people does not affect life expectancy.

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Necrobiosis Lipoidica

Necrobiosis lipoidica is an uncommon inflammatory condition in which shiny, red-brown or yellowish patches develop in the skin, usually in young adults and in early middle age. The condition is most commonly seen in conjunction with diabetes - both the insulin-dependent and non-insulin-dependent types.

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Nodular prurigo

‘Pruritus’ is the medical term for itching. ‘Prurigo’ is a related word, which describes the changes that appear in the skin after it has itched and been scratched for a long time. In nodular prurigo these changes take the form of firm very itchy bumps (nodules) on the skin’s surface. These can resolve when the person stops scratching the area, although in many cases this can be very difficult without proper and sometimes prolonged treatment.

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Omalizumab

Omalizumab is a drug that has been specially designed to mimic normal human molecules, and for this reason is classified as a biologic drug. It blocks natural antibodies called IgEs in the body and prevents them from causing an allergic reaction and histamine release.

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Oral lichen planus

Lichen planus is an inflammatory condition of the skin but can also affect the mouth (oral lichen planus). Oral lichen planus may occur on its own or in combination with lichen planus of the skin, nails or genitals. It is thought to affect 1 to 2% per cent of the population, and typically it affects women after the age of 40 years. Oral lichen planus can occur in men but children are rarely affected.

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Oral treatment with corticosteroids

Your body produces corticosteroids naturally, on a daily basis. Without them it would not be possible to survive. Corticosteroids are produced in the cortex of the adrenal glands (hence the ‘cortico-’ part of the name). The ones used most often in medical treatment (prednisolone and dexamethasone) are not exactly the same as the ones produced in the body. It is convenient to refer to them just as ‘corticosteroids’ or 'steroids', but you should be aware that they are different from the type of steroids (anabolic steroids) used for body building. 

The word ‘oral’ means that the steroids are taken in tablet form by mouth. Oral treatment with corticosteroids is also known as ‘oral cortisone therapy’ or ‘systemic steroid therapy’.                  

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