Skin Conditions

We have included some information below on common skin conditions and problems that are regularly seen and treated at Hope Dermatology, South Melbourne.

Please contact us on (03) 9039 5644 to make an appointment to discuss your condition further with one of our dermatologists.

We also have complimentary appointments with our cosmetics nurse available for all your cosmetic dermatology needs.

A

Acne
Commonly affecting teenagers and adults, acne is caused by an overproduction of skin sebum (oil) from sebaceous glands, which then blocks pores, leading to pimples, blackheads, white-heads and nodular acne lesions. In some cases, the severe acne lesions may lead to scarring and hence it is important to gain control of acne quickly before this happens.

Mild acne can be treated with over-the-counter products and topical agents. Some mild acne can even be treated with skin peels and cosmeceuticals which are available at our clinic. More severe acne will need treatment with oral medications such as anti-inflammatory topical or oral antibiotics, topical vitamin A preparations, the oral contraceptive pill, anti-androgen tablets and isotretinoin (oral vitamin A tablets). In Australia isotretinoin prescriptions are restricted for dermatologists to prescribe only.

Acne Scarring
Acne scarring affects approximately 30% of those with moderate or severe acne. It can be quite cosmetically upsetting for some patients and it is therefore important to start patients on treatment for acne quickly to avoid scarring. Options for acne scarring include cosmeceuticals, skin peels, skin needling, radio frequency and laser treatments. It is best to speak with your dermatologist or cosmetics nurse to determine the best treatment for your skin.

Actinic Keratosis
This is a pre-cancerous growth that may occur because of repeated sun damage over a lifetime. These can occur on any part of the body and usually are small, scaly, red patches. Treatments for these include liquid nitrogen (freezing treatment), curettage (scraping) and, cream treatments such as Efudix (5-fluorouracil), Aldara (imiquimod) and Picato (ingenol mebutate) gel.

Allergies
This is a hypersensitive reaction by the immune system to a substance, food, object or chemical, which causes a skin rash and other symptoms. Skin prick testing may be useful in determining what allergies you might have. We work closely with immunologists/allergists to determine any potential allergies.

As dermatologists, we do see allergic contact dermatitis, which is where there is a reaction on the skin to a compound you may be allergic to; such as a cosmetic cream or sunscreen etc. To investigate allergic contact dermatitis, our experienced dermatologists may want to send you for patch testing which may be able to pin-point the exact allergens that you need to avoid.

Alopecia
A skin condition resulting in hair loss. Causes can be multifactorial and include hereditary, autoimmune, non-scarring or scarring and stress response. Our dermatologists will assess your hair loss thoroughly and this will include taking a full personal and family history, medication history and examination. Depending on the type of hair loss, blood tests and a scalp biopsy may be relevant to determine the type of hair loss you are suffering from. Treatments for hair loss do depend on the underlying condition causing your hair loss and this will be explained to you in the detailed consultation. Treatments including topicals, tablets and also cosmetic camouflage techniques.

Our 2 experienced dermatologists and cosmetics nurse will be able to help you navigate through your individualised treatment plan. Dr Hope Dinh has a sub-specialty interest in hair loss and is able to accept new patient referrals.

B

Basal cell carcinoma (BCC)
This is the most common type of skin cancer in Australia. There are different sub-types of BCC and some can be confused with sunspots or inflammatory conditions like a bite or acne. As such, it is very important to have BCCs diagnosed early to avoid extensive skin surgery. Depending on the subtype of BCC and also if the BCC is detected early, treatment may involve the use of a cream or surgery or radiotherapy. We work closely with plastic surgeons, Mohs surgeons, radiation oncologists and oncologists to ensure the best outcome for your individual case of BCC.

Benign
Benign means mild, harmless, having good prognosis and not malignant (non-cancerous).

Biologics
These are also known as biologic therapies or biological response modifiers. They are drugs that are formulated to target specific areas of the inflammatory pathway to treat and prevent immune-mediated inflammatory disorders and cancers. In Australia, dermatologists are the only specialists authorised to prescribe biologics for severe psoriasis. To qualify for biologics for psoriasis, patients must have their assessments done by a dermatologist and need to be regularly reviewed for side effects and medication effectiveness.

The current biologics for psoriasis on the PBS include - infliximab (Remicade), etanercept (Enbrel), ustekinumab (Stelara), adalimumab (Humira) and secukinumab (Cosentyx). Enbrel, Humira and Remicade block a factor involved in the inflammation pathway called TNF-alpha (tumour necrosis factor). Stelara blocks a protein called interleukin 12/23. Cosentyx is an IL17-A inhibitor. 

Another biologic medication (Omalizumab) has recently been approved (late 2017) on the PBS for chronic idiopathic urticaria via dermatologists holding public hospital provider numbers. Both Dr Georgina Lyons and Dr Hope Dinh are able to assess and prescribe biologics to eligible patients.

Bowen’s Disease
This is an early form of skin cancer that appears as a persistent, slow-growing, red and scaly skin patch. It is considered to be a more pronounced actinic keratosis. Treatment for Bowen’s disease (also known as SCC in-situ) include topical creams and surgery. A small proportion of Bowen’s disease lesions will progress to SCC and hence it is important to treat these as early as possible.

Bulla
A bulla is a large fluid-filled blister greater than 1 cm in diameter. It may be a single compartment or multiloculated (made of a few blisters all joined together). There are many underlying causes of blisters including trauma, autoimmune skin conditions or allergic reactions. Blisters can be benign or serious and life-threatening. Some blistering conditions need to have extensive assessment with a skin biopsy.

C

Cantharidine

Is a substance derived from the blister beetle “Cantharis Vesicatoria” used by dermatologists to treat common viral warts and molluscum contagiosum.  It is a compound that creates the formation of a blister when applied topically, causing the wart to lift off the skin and fall off once the blister has healed.  The mechanism of action is confined to the epidermal cells (top layer of skin) reducing risk of scarring as the basal (deep) layer of skin is unaffected.  The treatment is generally painless with the resultant blister causing mild discomfort.

Chloasma
Also known as melasma, this is dark skin discolouration on the face, usually affecting pregnant women or those on the oral contraceptive pill. It can be difficult to treat but strict photo-protection is always advised with SPF 50+. Additional treatments include tablets or, more commonly, creams to help fade the brown areas. Additionally, some treatments such as peels and laser may also be appropriate.

Cosmeceuticals

We stock various selected skin care ranges in our clinic including Rationale, La Roche Posay, Ego/QV ranges, O Cosmedics and DP Dermaceuticals. You are welcome to book for a complimentary appointment with our cosmetics nurse to discuss your skin care needs. Call (03) 9039 5644 for appointment bookings. 

Cradle Cap
A skin condition of patch, greasy and scaly rash that can occur on the scalp of new babies. It is caused by excessive production of sebum. In some cases the rash will resolve by itself. Treatment of cradle cap is with regular washing with mild baby shampoos and soft brushing to help remove the scales. Occasionally the rash may need medicated treatments such as shampoos containing ketoconazole and hydrocortisone cream for any red or inflamed areas.

Cryotherapy

Is a treatment where your dermatologist will use liquid nitrogen to freeze lesions off the skin. The dermatologist will spray the liquid nitrogen to the skin for a few seconds and sometimes the treatment will need to be repeated. Cryotherapy is a good way of removing certain skin lesions such as Actinic keratosis, viral warts and Seborrhoeic keratosis. Cryotherapy can also sometimes be used to treat superficial skin cancers such as superficial basal cell and in situ squamous cell carcinomas (Bowen’s Disease), these must be monitored closely as it is not always successful in some cases.

Curettage

Curettage is a procedure in which your dermatologist uses an instrument to scrape off a skin lesion.  The curette is a spoon shaped or curved blade and can be used to both diagnose and treat lesions such as Seborrheic keratoses, Bowens disease (in situ squamous cell carcinoma), Basal cell carcinomas, Viral warts, Keratoacanthoma, Actinic keratoses, Pyogenic granuloma and skin tags.

D
DCP Diphenylcyclopropenone, or diphencyprone is a sensitising agent used in dermatology to treat skin conditions through contact immunotherapy. Where is it applied to the skin, DCP stimulates an allergic reaction and contact dermatitis.  It is used to treat alopecia areata, warts and molluscum contagiosum.  When treating warts/molluscum DCP application draws immune cells to the area to attack and destroy the wart virus.   With alopecia areata, the disease itself is an autoimmune attack on the hair follicles and topical application of DCP to the scalp draws the immune response more superficially, allowing the hair bulb to recover and regrowth of hair to occur. Desquamation Desquamation refers to skin coming off in scales or peeling. It usually denotes peeling in the very superficial layers of the skin. Dry Skin This develops when the skin is lacking moisture in the outermost skin layer, where the skin becomes stripped of its natural oils, and this causes cracks in the skin surface and impaired barrier function of the skin. It can lead to a dull complexion in the skin and surface cracks in the skin can make the skin susceptible to infection. Some people are genetically more susceptible to dry skin (such as people with a background history of eczema). Variation in seaon can have an impact on skin hydration too (Winter and cooler months can exacerbate dry skin). For general skin dryness and dull complexion, a simple change in your skincare may be all that is needed. We offer complimentary skin care consults with our cosmetics nurse.
Diathermy Also known as electrosurgery. It refers to a technique to stop bleeding and also to treat abnormal skin growths.
Dysplastic naevi (atypical moles)
Are moles with unusual features such as varying shades of colour or irregular borders. People with dysplastic moles have a slightly higher risk of developing melanoma, however most of the time these moles are harmless and don’t necessarily need to be removed unless the dermatologist advises to do so. It is therefore extremely important for the patient to self-examine themselves if they are told they have a dysplastic mole.
E
Eczema This is a very common skin condition, affecting about 1 in every 5 people at some time in their lives. There are multiple underlying factors contributing to eczema including hereditary and environmental factors. Eczema results in dry, red, itchy skin, which may crack and bleed, and may be quite uncomfortable for patients. Eczema can also sometimes become secondarily infected. We are able to treat eczema with creams, UV phototherapy and tablets. Occasionally an allergy may be the underlying cause and we maybe able to test for this. Dermatologists are experts in treating eczema. Epidermoid Cyst An epidermoid cyst is a benign cyst usually found on the skin. It does not usually need any treatment unless it is of a cosmetic concern to patients or if it becomes repeatedly irritated and infected. Exanthem A widespread rash that can be associated with systemic symptoms such as fever and headache. It is often caused by an infection or drug. Exfoliation Refers to peeling skin. Usually denotes very superficial skin peeling.
F

Fissure
A thin split or crack within the skin (epidermis), and can be due to excessive dryness.

G

Genital Dermatology

Genital skin problems can be common and often cause distress, embarrassment and be painful or itchy, interfering with relationships, self-image and sexual functioning.  Some genital disorders are contagious, including sexually transmitted diseases however there can be many other causes. Diagnosis is made via detailed patient history and skin examination and may include blood tests, skin biopsy or swabs from the affected area.

Grovers Disease
This is a condition characterised by itchy red spots on the trunk, most often in older men. It is generally seen in sun damaged skin and is sometimes associated with heat/sweat. It is also known as “transient acantholytic dermatosis.” Treatments include keeping cool, moisturising creams, oral antibiotics to settle down the inflammation and other tablets and also UVB phototherapy, which is available at our clinic.

H
Haemangioma of Infancy A benign (non-cancerous) condition affecting blood vessels of the skin. It usually appears in the first four weeks of life and grows most rapidly over the first six to nine months. It tends to self-involute with time. Treatments for haemangiomas can include topical preparations, injections, tablets and vascular laser. Hair Loss - see alopecia Heat Rash Occurs when the skin’s sweat glands are blocked and the sweat produced cannot get to the surface of the skin to evaporate. This causes inflammation that results in a rash. Hives Hives, otherwise called urticaria, is an outbreak of swollen, itchy pale red bumps or plaques on the skin that appear suddenly and usually self resolves within a few hours to days. The lesions migrate around the body. Hyperhidrosis A condition characterized by excess sweating. It can be generalised or localised to certain body areas (for example, the underarms). Hyperhidrosis can be a sign of a different underlying conditions. Treatment can include topicals, anti-sweating injections, iontophoresis bath treatments, laser and oral medication to reduce sweating. For axillary (underarm) hyperhidrosis, dermatologists can offer injections directly into the underarm skin to reduce the sweating. There is a Medicare Rebate for this procedure and these injections can be performed every 4 months to control the sweating. Please contact our staff for an appointment.
I

Imiquimod

Is an immune response modifier, produced as the topical cream Aldara.  It works by stimulating the immune system and is used to treat superficial Basal cell carcinoma (BCC), Actinic keratoses (solar keratoses or AKs), Bowen’s disease and viral infections such as genital warts or common warts.

Impetigo
A highly contagious skin condition. It usually occurs on the face, neck, and hands of young children and infants. Impetigo is most commonly caused by two bacteria — streptococcus pyogenes and staphylococcus aureus.

Inflammation
This is a physical reaction by the body’s immune system which causes redness, heat, pain and swelling in a particular area of the body, e.g. the skin.

J

Juvenile Xanthogranuloma
This is a benign red-yellowish lesion seen on the face, scalp and upper torso. They are found in babies and toddlers  and will self resolve.

K

Keratin
This is a structural protein found within the nails, hair and skin.

L
Laser Therapy Laser is an acronym for Light Amplification by Stimulated Emission of Radiation. We are able to offer our patients vascular and pigment laser treatments and also Laser Genesis. Please contact our cosmetics nurse for an appointment. Lentigo Maligna Also known as “Hutchinson’s melanotic freckle” is a slow growing melanoma in situ, that is commonly seen in the elderly, on the face. Lesion A lesion is any single area of altered skin. It may be solitary or multiple. Lichen Planus An inflammatory condition of unknown cause, that commonly presents as itchy purple flat- topped papules. The mouth and genitalia may also be involved.
M
Maceration Maceration describes moist peeling skin. Melasma Melasma is a symmetrical, blotchy, darkening of the skin that is chronic and can be distressing for sufferers.  It commonly affects women more so than men, manifesting around the ages of 20-40.  It results from an overstimulation of melanin by melanocytes, the pigment producing cells.  The cause of melasma can be complex and can have a genetic predisposition.  Common triggers can include sun exposure, pregnancy, hormone therapy such as the oral contraceptive pill, other medications and inflammation from cosmetics such as perfumes or soaps.  Treatment can be challenging and includes SPF, bleaching creams and laser. Melanoma The full name is malignant melanoma: a potentially fatal form of skin cancer caused by cancerous melanocytic cells, which can spread (metastasize) to other parts of the body. Signs that a lesion could be a melanoma including A - Asymmetry B - irregular or growing Border C - multiple Colours D - Large size/growing in Diammeter E - change in history of the lesion or Evolution Risk factors for melanoma include family history of melanoma, fair skin/light eyes, large total number of moles, multiple dysplastic/atypical moles, solarium use, blistering sunburns.  Milia Miliaria Also called “sweat rash”, “heat rash” or “prickly heat” is a skin disease marked by a small and itchy rash. Miliaria is a common ailment in hot and humid conditions, such as in the tropics and during the summer season.
Mole A small flat or raised round spot on the skin which may vary in colour from pink through to dark brown. Some people have more moles than others. They are for the large part harmless although a small percentage of these can become cancerous.
Molluscum Contagiosum A skin infection caused by a virus (a pox virus) that, is spread through warm water, such as having baths and swimming lessons in a warm heated pool. Small pearly like umbilicated lesions are seen. Some treatments are dermatologist-only treatments such as DCP cream, cantharidine and imiquimod.
N
Nail conditions Nail conditions are an area of sub-speciality for Dr Hope Dinh. She sees issues such as nail infections (fungal and thrush), nail brittleness and lifting of the nail (onycholysis), nail psoriasis, nail lichen planus, nail bed tumours, nail discolouration. Dr Dinh is part of the team at the specialty Nail Clinic at the Skin and Cancer Foundation Inc.  Nodular Melanoma A less common but more serious form of melanoma. If a red or black nodule is growing rapidly it needs to be looked at by your doctor or dermatologist immediately.
O

Oral Lichen Planus
Lichen planus affecting the mouth presents as white lacy like areas usually on the tongue and the inside of the cheeks. It can be painful and uncomfortable, making it difficult to eat spicy and sour foods.

P

Phototherapy 

Phototherapy is a treatment of the skin using ultraviolet light on a regular basis. We use ultraviolet B light to treat skin conditions. It is used to treat a range of different skin conditions such as atopic dermatitis, psoriasis and urticaria (hives). At Hope Dermatology we have the latest in computerised Waldmann UV technology and we have both the Full Body Cabinet as well as the Hand & Foot Machines for your convenience. All phototherapy treatments are fully bulk billed; meaning no out of pocket costs for our patients for the actual phototherapy sessions. 

Pigmentation

Refers to the colour of the skin and is determined by the level of melanin, produced by melanocytes.  Melanin production is determined by racial origin and sun exposure.   People with dark skin produce more melanin than those who are fair skinned.  Disorders of pigmentation can have a number of origins and can be classed as generalised or localised hyperpigmentation (increased skin colour), hypopigmentation (reduced skin colour), or achromia (absent skin colour).

Peels
We offer a variety of skin peels at our clinic. Our cosmetics Nurse, Kristie, is able to perform a detailed assessment of your skin and recommend a tailored skin care solution. 

Psoriasis
This is a chronic, genetic condition that causes well-defined large red, scaly plaques to appear on the skin. These red areas have a silvery superficial appearance and develop on the elbows, knees, scalp and chest. The nails and joints can also be involved. Treatments include steroid creams, creams containing vitamin D, UV phototherapy treatments, oral tablets and the newest in injectable biologic medications. Our dermatologists are experts in psoriasis diagnosis and management. 

R
Rash This is a medical term used to describe a change in the colour, texture or appearance of the skin. A rash can also be associated with other features such as itching and other symptoms, e.g. fever and chills. Retinoid creams Retinoid creams are topical products containing ingredients derived from Vitamin A. Different forms of retinoids, from weakest to strongest include Retinyl-palmitate, Retinol, Retinaldehyde (available over the counter and frequently found in anti-ageing skincare) to Tretinoin or Retin-A which are prescription strength and TGA approved for treatment of acne.  Synthetic Retinoids (Adapalene, Tazarotene and Isotretinoin) are also available on prescription. Retinoids are often used to treat moderate sun damage, melanoma, acne and for generalised rejuvenation. Retinoid use promotes cellular proliferation and reduced keratinisation of skin cells and should be used with caution to prevent skin irritation, peeling, excessive dryness. Ringworm Ringworm is also called tinea, and is a contagious skin condition occurring in ring like patches. It is, caused by a fungal (dermatophyte infection). It can affect the body skin (tinea corporis), hair (tinea capitis), groin (tinea cruris or “jock-itch”) or the nails (onychomycosis). Depending on the body area affected, the treatment will vary but includes creams, tablets and even laser therapies. Rosacea A chronic rash characterized by central facial redness, small and superficial dilated blood vessels on facial skin, papules, pustules, and swelling. There can also be an associated grittiness of the eyes and also facial flushing. It most often affects those between 30-60 years of age. Treatments depend on the subtype of rosacea but would include creams, tablets and laser.
S

Scabies
Scabies is a skin infestation caused by parasitic mites leading to red, itching bumps or blisters on the skin. It is highly contagious and hence it is important to treat this condition promptly to avoid spread to others. Treatments include creams and tablets and anti-itch soothing creams.

Sebaceous Cyst
A skin swelling arising from a sebaceous gland, typically filled with yellowish/oily sebum.

Seborrhoeic dermatitis 

Skin Cancer
Skin cancer occurs when skin cells are damaged, for example, by overexposure to ultraviolet (UV) radiation from the sun. Most skin cancers can be prevented by sun protection including sunscreens from an early age. Taking nicotinamide (vitamin B3) can also reduce the risk of non-melanoma skin cancers.
There are three main types of skin cancer:

Skin Care Ranges

We stock various selected skin care ranges in our clinic including Rationale, La Roche Posay and Ego/QV ranges.

Skin Surgery

We are pleased to perform skin surgery on-site in our comfortable purpose-built clinic assisted with our procedural nurses. Our dermatologists are highly skilled at surgical procedures to treat benign and cancerous skin conditions; including surgical repair with primary closure, grafts and flaps. 

Skin Tags

Common, soft harmless lesions that appear to hang off the skin. They are commonly found in the skin folds (neck, underarms, under the breasts, in the groin etc). Factors leading to skin tags include friction from chafing such as tight pants, necklaces and collared shirts etc. Treatments include cryotherapy (freezing), surgical excision (with snip excision) and diathermy (electro-surgery).

Solar Keratosis
These lesions are also known as actinic keratosis. They are small scaly skin growths which are pre-cancerous and caused by prolonged sun exposure. Treatment of these lesions is usually advised to prevent progression onto skin cancer.

T
Telangiectasia These are small linear red blood vessels (broken capillaries). They are most commonly acquired. They usually appear on the face but can also appear on other areas of the body including the legs and trunk. Cosmetic treatment for these include creams, cosmetic camouflage and laser. It is also very important to implement strict sun protection to prevent them worsening. Tags (Skin tags) Common, soft harmless lesions that appear to hang off the skin. They are commonly found in the skin folds (neck, underarms, under the breasts, in the groin etc). Factors leading to skin tags include friction from chafing such as tight pants, necklaces and collared shirts etc. Treatments include cryotherapy (freezing), surgical excision (with snip excision) and diathermy (electro-surgery). Tinea Tinea is also called ringworm, and is a contagious skin condition occurring in ring like patches. It is, caused by a fungal (dermatophyte infection). It can affect the body skin (tinea corporis), hair (tinea capitis), groin (tinea cruris or “jock-itch”) or the nails (onychomycosis). Depending on the body area affected, the treatment will vary but includes creams, tablets and even laser therapies.
U

UV (Ultraviolet) Index

Is a simple and accurate way of forecasting the daily danger risks of UV radiation. It gives you a good guide as to how strong the sun radiation is when the day may not feel that hot it may still have a very high UV index. For example, it can be overcast and still have a UV index of 10.

Being Sunsmart means keeping an eye on the UV index to ensure you have adequate sun protection (clothing and SPF). In Melbourne in particular, cold grey skies do not mean that the UV index is low (we can get burnt on overcast days in Melbourne!) We recommend downloading the SunSmart App to your phone so that you are up to date with the weather conditions. You can download the APP for free here

Ultraviolet Radiation

Is the energy and sunlight from the sun that is invisible to the naked eye. It is the biggest cause of skin cancer, premature aging, tanning, sunburn and eye damage. Ultraviolet radiation is made up of 3 types of wavelengths, UVA, UVB and UVC. You can’t feel or see this radiation so it’s important to wear sunscreen even in the winter months!

UVB phototherapy

Is a specialised machine treatment at dermatology clinics that uses short bursts of ultraviolet light to help resolve skin conditions such as eczema/dermatitis, urticaria (hives) or psoriasis. This narrowband ultraviolet B light can help reduce itch, calm inflammation and increase the ability for the immune system to heal. Patients are usually advised to come 3 times a week to obtain the best results. This treatment can be done when the rash is all over the body or just localized (hands or feet) when topical treatments have failed. At our clinic, the actual phototherapy treatments are fully bulk billed which means no out-of-pocket costs for the treatment sessions for our patients. 

Urticaria
This is also known as hives. It is a skin condition where there are small itchy red bumps on the skin that are migratory and self-resolve after hours to a few days. It can be acute or chronic. There may be an underlying medical reason associated with urticaria and patients may need blood tests to exclude these. Treatments include avoidance of precipitating factors, creams, moisturiser, anti-histamines, UVB phototherapy and tablet medications to soothe the body’s immune response.

Omalizumab (a biologic injectable medication) has recently been approved (late 2017) on the PBS for chronic idiopathic urticaria via dermatologists holding public hospital provider numbers. Both Dr Georgina Lyons and Dr Hope Dinh are able to assess and prescribe this biologic to eligible patients.

V

Vasculitis 

Vitiligo
Vitiligo is a chronic auto-immune skin condition where areas of the skin lose their pigmentation. The pale, depigmented areas are prone of burning with sun exposure. There are various sub-types of vitiligo including localised, generalised and segmental. Treatment depends on the location of the vitiligo and how extensive the condition is. Treatments include creams, UV phototherapy, laser therapies, cosmetic camouflage and surgical correction procedures.

Vulval conditions

Our female dermatologists Dr Hope Dinh and Dr Georgina Lyons are well trained to diagnose and manage vulval conditions such as vulval lichen sclerosus, vulval lichen planus, vulval dermatitis and vulval skin cancers.

See Genital conditions under "G" for more information

W

Warts
These are very common, small hard, scaly lesions, caused by a viral infection. The most common location of warts will be on the hands and feet. Children will commonly be affected by warts due to their immature immune system and  also direct spread of warts between children.

Treatments for these warts include cryotherapy, diathermy, wart paint treatments and immunotherapy cream treatments. Viral warts can also occur in the genital areas and can be treated with a variety of modalities as above also. In the case of genital warts, it is also advisable to have a full STD screen.

X

Xerosis
Dry skin commonly seen in those with atopic eczema or the elderly. It is where the outermost layer of the skin becomes dehydrated. The skin loses its suppleness and then this leads to flaking or scales. The skin may also become red and itchy. It may be exacerbated by the cooler months where heated indoors conditions can dry out the skin. Over-washing can also lead to xerosis. Some commonly prescribed medications can also lead to exacerbation of dry skin.

Xanthelasma
These are cholesterol deposits around the eyelids, reflecting elevated blood lipids in half of cases. They are usually painless yellow/orange plaques. Treating the underlying lipid disorder may reduce the clinical appearance of the lesions. Cosmetic treatments for any residual skin lesions include peels, diathermy, laser and excision.

Y
Yeast Infection The most commonly seen yeast infection of the skin is called pityriasis versicolour. This typically causes a red brown or whitish scaly rash on the trunk and back. Usually, healthy young adults are affected and predisposing factors include humidity, sweating and oily skin . Topical anti-fungal agents will help control this condition. Very occasionally oral antifungal agents are required.
Z

Zinc Deficiency and the skin
Zinc deficiency can look like eczema (atopic dermatitis) in the early stages but unlike eczema, it does not respond to topical steroids and moisturising creams. The skin around the mouth, napkin area and hands can be affected with a dry, cracked appearance and other areas on the body may be affected as well including hair and nail changes and also diarrhoea. The cause of zinc deficiency may be hereditary or due to poor dietary intake of zinc. Zinc replacement is usually very successful in clearing up the skin changes.