Patient Information Leaflets (PILs)
These Patient Information Leaflets (PILs) are specially written by the British Association of Dermatologists (BAD).
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.
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.
The offer to provide details of source materials used to inform the British Association of Dermatologists' PILs is for instances where the advice provided in the PILs does not reflect local practice and therefore evidence supporting said advice needs to be produced. It is not an offer to conduct literature searches or supply bibilographic materials for your own research.
Palmoplantar pustulosis is a long term (chronic) condition which affects the skin of the palms and soles. It can sometimes occur with the skin condition psoriasis.
Patch testing is a specialist procedure carried out by dermatology doctors and dermatology nurses to find out whether your skin condition is caused or aggravated by an allergy to substances which have come into contact with your skin. This is called contact allergy.
Substances that cause an allergic reaction are called allergens. They can be found at home, at work or in leisure activities.
Pemphigoid is a rare blistering disorder, which usually occurs in later life, the average age of onset being over 70 years. The blisters come up on the skin and, less often, in the mouth too. This is in contrast to a related condition known as ‘mucous membrane pemphigoid’ in which the brunt of the trouble is borne by the moist surfaces of the body (the mucous membranes) such as the eyes, inside the nose and mouth, and the genitals.
Pemphigoid gestationis is a rare skin blistering disorder that occurs in women. It usually presents in mid to late pregnancy (13 to 40 weeks gestation, known as the second and third trimesters) with an itchy rash that develops into blisters. It may recur in subsequent pregnancies and occasionally recurs in women who go on to take oral contraceptive therapy or during menstruation when their periods restart after pregnancy.
It was previously known as herpes gestationis but this name has been changed as there is no association with herpes virus (cold sore) infection.
Pemphigus vulgaris is a rare autoimmune skin disease and affects around 3 people per 100,000 population. Pemphigus vulgaris may cause severe blistering of the skin and the mucous membranes lining the mouth, nose, throat, eyes and genital area. Blisters develop in the upper layer of the skin and have a thin and fragile outer surface that breaks away easily leaving raw areas (erosions) that can be extensive and painful.
Photodynamic therapy (PDT) is a technique for treating skin cancers and sun-damaged skin which might one day turn cancerous (pre-cancers). In PDT, a special light activates a cream, which was applied to the lesion (affected area of skin). This treatment kills the abnormal cells in the skin.
The term phototherapy literally means the use of light to treat medical conditions. Natural sunlight has been known to be beneficial in certain skin disorders for thousands of years, and it is the ultraviolet part of the radiation produced by the sun that is used in phototherapy, in particular the ultraviolet A (UVA) and ultraviolet B (UVB) wavelengths.
A pilomatricoma is a benign (non-cancerous) growth arising from the cells at the base of hair follicles. Hair follicles are specialized structures in the skin where hair grows from. Pilomatricoma has also been called a pilomatrixoma, trichomatricoma or a ‘calcifying epithelioma of Malherbe’.
Pityriasis alba is a common skin complaint of children and young adults. It appears as pink scaly patches which later leave pale areas on the skin. These pale areas are more noticeable in people with dark skin, and more pronounced after exposure to the sun and the tanning of the non-affected skin. Pityriasis means skin scaling and alba means white.
Pityriasis lichenoides is a rare skin disorder of unknown cause. There are two types of pityriasis lichenoides: an acute form usually found in children known as pityriasis lichenoides et varioliformis acuta (PLEVA), and a more long-lasting form known as pityriasis lichenoides chronica (PLC).
Pityriasis rosea is a common rash that is usually mild and lasts about 6 to 8 weeks. Its name means that the rash has a fine scale (pityriasis) and it tends to be pink (rosea).
Pityriasis rubra pilaris
Pityriasis rubra pilaris is the name given to a group of uncommon skin disorders. The name means scaling (pityriasis), redness (rubra) and involvement of the hair follicles (pilaris).
Several types of pityriasis rubra pilaris are currently recognised including:
Type I. This is the commonest and is called ‘classic adult type’. It causes a widespread red and scaly rash. A variation of this affects children, and is called ‘classic juvenile type’ (type III).
Another type that affects children is called ‘circumscribed juvenile type’ (type IV) and causes a rash on the palms and soles, the front of the knees, and the back of the elbows.
A rarer genetic form also occurs (type V).
Pityriasis means a type of fine skin scaling, and versicolor means changing colour. It is a common and harmless rash due to the overgrowth of yeasts that live on everyone’s skin. These yeasts, called Malassezia, are not related to yeast in food or to those that cause thrush. It is also sometimes called tinea versicolor.
Warts are localised thickenings of the skin, and the term ‘plantar warts’ is used for those that occur on the soles of the feet (the ‘plantar’ surface). They are also known as verrucas.
Polymorphic eruption of pregnancy
Polymorphic eruption of pregnancy is a relatively common skin disorder that can occur in women during pregnancy. It usually presents within a women’s first pregnancy. It is characterised by an itchy rash that commonly begins on the abdomen, particularly within stretch marks (striae). It most usually develops during late pregnancy (third trimester) but can also present immediately after the baby is born.
It was previously known as PUPPP (pruritic and urticarial papules and plaques of pregnancy).
Polymorphic light eruption
The term ‘light eruption’ means a rash that comes up after exposure to light. ‘Polymorphic’ is two words; ‘poly’ means ‘many’, and ‘morphic’ means ‘forms’. In other words, the rash of PLE can take on many different forms, including small red bumps, larger red areas, and blisters. In PLE, a rash with one or more of these components comes up a day or two after exposure to the sun. PLE is common, perhaps affecting up to 10% of the population. It tends to be more common in the spring.
Porphyria cutanea tarda
PCT is one of a group of disorders (known as the porphyrias) caused by a range of enzyme defects in one of the biochemical pathways in the body. Any one of these can result in a build-up of chemicals called porphyrins. In PCT the porphyrins are produced from the liver and cause the skin to become very sensitive to light (photosensitive). Some of the other types of porphyria affect internal organs and can cause symptoms unrelated to the skin but this does not happen in PCT.
PCT is an uncommon condition affecting about 1 in 25,000 people.
Port wine stain
A Port Wine Stain is a collection of abnormally formed blood vessels (capillaries) in the skin, which results in a red mark that may have the colour of port wine. Although most Port Wine Stains are present at birth, it has been reported in few cases to develop later in life (‘acquired Port Wine Stain’).
Potassium permanganate solution soaks
Potassium permanganate, when diluted, is a mild antiseptic and astringent (something that dries the skin). It is for external use only.
Important safety advice:
Never swallow or take internally.
Always wearing gloves when handling the Permitabs® to avoid staining or irritant reactions on the fingers.
Propranolol for haemangiomas of infancy
Propranolol belongs to a group of drugs known as beta-blockers, which are used to treat high blood pressure and fast heart rate. They work by slowing the heart and narrowing blood vessels. This is helpful in haemangiomas, as it reduces the blood flow through them, fading the colour and making them softer. Also, the cells that cause the growth of the haemangioma are affected by propranolol so that the haemangioma starts to reduce in size. Research is under way to find out exactly how propranolol works to reduce the growth and size of haemangiomas.
Pruritus (itching) refers to a sensation of the skin which causes a desire to scratch.
Itching is a normal body response to protect us from harmful external substances or parasites such as insect bites. However, pruritus (or itch) is a common and distressing symptom of many skin diseases, systemic illnesses and psychological disorders.
Itch is perhaps the commonest presenting symptom of skin disorders. In any two week period, 8-9% of the population suffer from significant pruritus. Pruritus lasting more than 6 weeks is called chronic pruritus. Pruritus may be localised to one area or generalized all over the skin.
‘Pruritus’ means itching. Pruritus ani is itching around the opening of the back passage (the anus). It is a symptom with many causes, but sometimes no obvious cause can be found. Pruritus ani is common and occurs more often in men than women. It is seldom due to an underlying serious condition and those who have pruritus ani are usually otherwise well.
Pseudofolliculitis, also known as ‘shaving bumps’, or ‘razor bumps’, is inflammation of hair follicles and surrounding skin, caused by hairs trapped beneath the skin surface. It appears similar to folliculitis, which is inflammation of hair follicles due to infection, but the inflammation in pseudofolliculitis is not primarily due to infection. Pseudofolliculitis is typically seen on the face and neck of men who shave, when it may be called pseudofolliculitis barbae, (“barba” being the Latin word for a beard). It is more common in men of sub-Saharan African lineage, however, can affect men and women of all ethnicities in any body area where hairs are coarse, abundant and subject to shaving, waxing and tweezing.
Psoriasis - an overview
Psoriasis is a common inflammatory skin disease affecting 2% of the population. It occurs equally in men and women, can appear at any age, and tends to come and go unpredictably. It is not infectious, therefore you cannot catch psoriasis from someone else. It does not scar the skin although sometimes it can cause a temporary increase or reduction in skin pigmentation. Although psoriasis is a long-term condition there are many effective treatments available to keep it under good control.
Psoriasis - topical treatments
A topical treatment is something that is applied directly to the skin or body surface. The commonest examples are lotions, creams, ointments, gels and shampoos. Most people with mild psoriasis are able to manage their skin complaint with topical treatment. Moderate or severe psoriasis usually needs additional therapy such as ultraviolet or oral (by mouth) medication. See patient information leaflet “Treatments for moderate or severe psoriasis”.
Psoriasis - treatment for moderate or severe psoriasis
Patients with psoriasis are usually treated with creams and ointments, which are applied to the skin. These are discussed in a separate leaflet (“Topical treatments for psoriasis”). Sometimes other forms of treatment are needed and this leaflet has been written to help you to understand more about them. It tells you what they are, how they are used, and where you can find out more about them.
PVL staphylococcus aureus skin infection
Staphylococcus aureus ('SA') is a bacterium (germ) that commonly lives on healthy skin. About one third of healthy people carry it quite harmlessly, usually on moist surfaces such as the nostrils, armpits and groin.
PVL is a toxin produced by certain types of Staphylococcus aureus. The toxin can kill white blood cells and cause damage to skin and deeper tissues.
Pyoderma gangrenosum is a rare treatable cause of skin ulceration. It is not a type of gangrene. Pyoderma gangrenosum is not contagious and cannot be transferred from person to person.
A pyogenic granuloma is a harmless overgrowth of large numbers of tiny blood vessels on the skin. It carries no risk of cancer, is not contagious (cannot be spread to another person) and is not due to an infection.
Radiotherapy for skin cancer
Radiotherapy is the use of X-rays to destroy cancerous cells. In the skin, it is mainly used to treat basal cell carcinomas and squamous cell carcinomas although other conditions may also benefit from the therapy.
Rhinophyma is a progressive skin condition that affects the nose. The condition is mainly seen in those who have rosacea, a rash that can affect the cheeks, forehead and nose (see rosacea leaflet for further information). If rosacea progresses, the nose becomes redder, swollen at the end and gains a bumpy surface which changes in its shape. This swelling is because there is formation of scar-like tissue and the sebaceous glands (which produce oil on the skin) get bigger. Much more rarely, swelling can arise on other parts of their face such as the ears and chin.
Rhinophyma usually only develops in rosacea which has been active and untreated for many years. However, although rosacea affects women more than men, rhinophyma mainly affects fair-skinned men aged 50 to 70 years.
Rosacea is a common rash, usually occurring on the face, which predominantly affects middle-aged (age range 40 to 60 years old) and fair-skinned people. It is more common in women, but tends to be more severe in men. It is a chronic condition and, in any individual, the severity tends to come and go. Rosacea tends to affect the cheeks, forehead, chin and nose, and is characterised by flushing and redness, dilated blood vessels, small red bumps and pus-filled spots (sometimes these may only be visible with a magnifying glass). There may also be uncomfortable inflammation of the surface of the eyes and eyelids.
Sarcoidosis is a disease that can affect just one part of the body, or different parts at the same time. Most commonly it affects the skin, lungs, lymph nodes, or eyes. Less often it can affect the joints, the nervous system, the liver and the kidneys. Sarcoidosis causes a type of inflammation known as a ‘granuloma’, which consists of a cluster of cells that can stop an organ from working properly. For example, granulomas in the lungs can cause breathing problems.
Scabies is a common and very itchy skin condition caused by a tiny mite called Sarcoptes Scabiei. It can affect people of any age but is most common in the young and the elderly.
‘Dermatitis’ is a red, itchy, flaky (inflamed) skin complaint; ‘seborrhoeic’ means that the rash affects greasy (sebaceous) skin zones such as the face, scalp and centre of the chest.
Seborrhoeic dermatitis is very common and many people don’t even know they have it. Overall it has been reported to affect about 4% of the population, and dandruff (which is mild seborrhoeic dermatitis of the scalp) can affect almost half of all adults. It can start at any time after puberty and is slightly commoner in men. Babies can also get a short lived type of seborrhoeic dermatitis in the scalp (cradle cap) and nappy area, which usually clears after a few months.
Seborrhoeic keratoses (SK) are also known as seborrhoeic warts, and as basal cell papillomas. They are benign growths due to a build-up of skin cells. SK are very common, harmless, often pigmented, growths on the skin. In the UK more than half the men and more than third of women would have at least one SK. By the age of 40 30% of the population would be affected while by the age of 70 it increases to 75%. They are also found in younger people. Some people will have only few seborrhoeic keratoses, while others will have large numbers.
They are not infectious and do not become skin cancer.
Secukinumab is a drug that has been specially designed to mimic normal human molecules, and for this reason it is classed as a ‘biological’ drug. It blocks the activity of a naturally occurring chemical ‘cytokine’ in the body called interleukin-17a (IL-17a). We know that psoriatic plaques contain high levels of IL-17a, and that it drives inflammation in the skin, leading to redness, thickening and flaking.
Shingles is a painful blistering rash caused by the same virus that causes chickenpox, known as the varicella (chickenpox) zoster (shingles) virus.
Skin camouflage is best described as the application of highly pigmented creams, that are designed to effectively mask skin discolouration and/or scarring. Skin camouflage products are matched to normal skin colour and are significantly different from ordinary cosmetics. When correctly applied, the products are water resistant, allowing you to swim without the fear of the product washing off. Despite the manufacturer’s claims, no skin camouflage product should be considered as totally “rub-proof”; there may be some transfer onto clothing, furnishings and bed linen, which can usually be removed by normal household cleansers.
The camouflage should be removed daily using a soap substitute (cleansing cream) or toilet soap and water. This allows you to inspect the skin for any changes to the condition and allows topical medication and emollients to be applied
Skin cancer - how to reduce the risk of getting a second one
This leaflet has been written to help you understand how to reduce the risk of developing a skin cancer. It is aimed at people with increased risk, such as those who have been previously diagnosed with a skin cancer, who have significant sun damage to their skin or those on immunosuppressive drugs, particularly after an organ transplant. It describes the main types of pre-cancerous and cancerous skin growths and explains the importance of detecting and treating them early. It tells you how to reduce the risk of getting another skin cancer, and how these can be treated.
Skin cancer - information for patients awaiting an organ transplant
This leaflet has been written to help you reduce the risk of developing skin cancer in the future after receiving an organ transplant.
If you are going to have, or have had an organ transplant, it is important that you take good care of your skin in the sun. This is because people having transplants are more at risk of developing skin cancer. This leaflet has been written to help you reduce the risk of developing skin cancer in the future after receiving an organ transplant. If you are going to have, or have had an organ transplant, it is important that you take good care of your skin. This is because people having transplants are more at risk of developing skin cancer.
Skin cancer - information for patients with an organ transplant
This leaflet has been written to help you understand the risk of developing skin cancer after receiving an organ transplant. It explains the importance of early detection and treatment of skin cancers. It describes the main types of precancerous and cancerous skin growths, how you can reduce the risk of getting skin cancer, and how skin cancer can be treated.
The term ‘solar urticaria’ describes a relatively rare type of urticaria which is triggered by exposing the skin of susceptible individuals to sunlight. Urticaria is also known as hives, weals or nettle rash.
Solar urticaria is found worldwide, and whilst it can start at any age it appears to be those aged between 20 and 40 who are most affected.
A spider angioma is an enlarged blood vessel in the skin (resembling the body of a spider), from which smaller blood vessels extend (resembling the spider’s legs). It has also been called ‘naevus araneus’, ‘vascular spider’, ‘arterial spider’, ‘spider telangiectasia’ and ‘spider naevus/nevus’.
Some of these names are Latin: ‘araneus’ for ‘spider’, ‘angioma’ for ‘blood vessel’ and ‘telangiectasia’ for ‘enlarged blood vessel’. ‘Naevus’ means an increase in normal or healthy tissue within the skin
Squamous cell carcinoma (SCC)
A squamous cell carcinoma is a type of skin cancer. There are two main types of skin cancer: melanoma and non-melanoma skin cancer. Squamous cell carcinoma (SCC) is a non-melanoma skin cancer (NMSC), and the second most common type of skin cancer in the UK. NMSC accounts for 20% of all cancers and 90% of all skin cancers. SCC accounts for 23% of all NMSC.
Staphylococcal scalded skin syndrome
Staphylococcal scalded skin syndrome is a widespread painful rash caused by a bacteria called Staphylococcus aureus, which produces a toxin that damages the outer layer of the skin causing it to be shed.
Subacute lupus erythematosus
Lupus erythematosus covers a group of related conditions, all of which can affect the skin and includes systemic lupus erythematosus, a chronic inflammatory disease affecting many systems of the body. However, there are forms of lupus which chiefly affect the skin, such as discoid lupus erythematosus and subacute lupus erythematosus.
Subcorneal pustular dermatosis
Subcorneal (under the top layer of the skin) pustular (pus forming) dermatosis (skin problem) is a relatively harmless blistering skin condition. Women develop it more often than men (at a ratio of 4:1), and it usually starts after the age of 40. It may come and go, and can eventually resolve and not require any further treatment.Subcorneal (under the top layer of the skin) pustular (pus forming) dermatosis (skin problem) is a rare blistering skin condition. Women get it more often than men (at a ratio of 4:1), and it usually starts after the age of 40. It may come and go, and can eventually resolve and not require any further treatment. Drs Ian Sneddon and Darrell Wilkinson first described the condition in 1956, which is why it is also called Sneddon-Wilkinson-Disease.
Sweet’s syndrome (also known as acute febrile neutrophilic dermatosis) is a rare skin disorder characterised by a fever and the appearance of tender solid red lumps on the skin. It is a reactive condition with a number of potential triggers. It is not contagious and is not skin cancer.
It is normal to shed approximately 30-150 hairs from our scalp daily as part of our hair cycle, but this can vary depending on washing and brushing routines. Hair regrows automatically so that the total number of hairs on our head remains constant. Telogen effluvium occurs when there is a marked increase in hairs shed each day. An increased proportion of hairs shift from the growing phase (anagen) to the shedding phase (telogen). Normally only 10% of the scalp hair is in the telogen phase, but in telogen effluvium this increases to 30% or more. This usually happens suddenly and can occur approximately 3 months after a trigger.
Thalidomide was first used in the 1950s as a gentle sedative tablet that can also control severe morning sickness in pregnant women without apparent side effects on the mother. However, after it was discovered to cause severe birth defects when taken in pregnancy, it was withdrawn from use.
Later, thalidomide was discovered to be helpful for certain skin reactions caused by leprosy (erythema nodosum leprosum), and it was then found to have other beneficial anti-inflammatory effects. This has led to its carefully controlled use in the treatment of some skin disorders for which other medication has not worked. All use of thalidomide must be carefully monitored, with particular attention paid to avoid its use in pregnancy.
Tinea capitis or ‘scalp ringworm’ is an infection of the scalp hair and the surrounding skin with a fungus. It is not cause by a worm, despite its name. It is called “ringworm” as it can cause a ring-shaped, scaly, red rash. Fungi are microscopic organisms that can live on the hair, nails, and outer skin layer.
It occurs most commonly in children; however, it can also occur in adults.
Steroids are naturally occurring chemicals, produced mainly by the adrenal glands in the abdomen. There are different types of steroids, and the type most commonly used to treat skin problems is known as a corticosteroid. Corticosteroids treat skin conditions by suppressing inflammation and reducing the amount of collagen in the skin. Corticosteroids that are applied to the skin in the form of creams, ointments, lotions, mousses, shampoos gels or tapes are known as topical corticosteroids (TCS).
TCS are available in four potencies: mildly potent, moderately potent, potent and very potent. Your doctor will decide on the correct strength for you on the basis of the nature of your condition, your age and the area of your body being treated.