The cause of acne is fourfold: plugging of the pores, excessive oil production, plentiful bacteria, and subsequent inflammation due to the aforementioned causes.

See Control Acne.

Bullous Pemphigoid
This is an autoimmune blistering disease of the skin, usually seen in the elderly. It can become chronic over months to years, with blisters spontaneously appearing. It can be very mild to extremely severe. These blisters are deep enough that they do not rupture with light pressure on the skin, nor do they become larger with such pressure. They generally begin with itching and redness before the appearance of the blisters.

Candidiasis
The most frequent forms of this overgrowth of yeast is seen in the diaper area of babies, and within skin folds beneath large breasts or in the groin area. It typically presents with redness, mild erosions, and a burning sensation in skin folds. Occasionally, satellite pustules, or “pus bumps” will form off to the edges of these areas. Topical antifungal creams and powders to keep the areas free of moisture and humidity will generally cure, and prevent this problem. Anti-inflammatories may need to be used initially to calm down the intense redness that occurs as a reaction to the yeast organisms thriving on the skin.

Contact Dermatitis (Allergic)
There are many allergens that may contact the skin and cause itching, vesicles, or even significant swelling. Allergies may develop at any time. The old adage of “not using anything new recently” does not apply here! When the immune system of the body has had enough of a certain molecule touching the skin after many years, you may draw the lucky ticket of a “new allergy”. The most common allergens include nickel, neomycin (in Neosporin), Balsam of Peru, fragrances, preservatives, and hair dyes.

Dilated Pore (of Winer)
This is typically a large pore with black or brown debris contained centrally. These are common in elderly individuals on the upper back or face.

Epidermal inclusion cyst
This is classically known as the ‘sebaceous cyst’, which is not the appropriate terminology. Nonetheless, this is a very common, round nodule that occurs slightly beneath the skin. A dilated, small pore overlying the nodule is usually visible, which is the extension of the follicle that undergoes abnormal proliferation called the infundibulum. These cysts may rupture beneath the skin and produce a prolific response of redness and tenderness. This will result in an abscess that requires drainage of contents and later removal of the cyst wall.

Granuloma annulare
Granuloma annulare is a relatively common reaction that occurs in the dermis on the backs of the hands and arms of women. It may also affect men, but less commonly. This disorder is analogous to a foreign body reaction, without any foreign body being present in the skin, however, the body tries to “wall off” something that isn’t even actually there. Spontaneous resolution may occur with loss of elastic tissue. Treatments with localized steroid injection are extremely helpful.

Hidrocystoma
These are small translucent bumps measured 1-3 mm. They are usually on the eyelids, upper cheeks, and occasionally the scalp. They may increase in size during hot weather. These are usually removed if causing visual disturbance, eyelid drooping, or pain.

Lentigo
Brown spots that are usually seen on the face, arms, and backs of hands are generally lentigines (plural for lentigo). They are NOT precancerous. These are treated with liquid nitrogen, bleaching creams containing retinoids, hydroquinone, and corticosteroids. Laser is of major benefit in eliminating this sign of aging.

Milia
Milia occur in half of newborns on the nose, eyelids, and upper cheeks. They also form from occlusive moisturizers and healing wounds that trap keratin protein beneath the surface of the skin. Multiple milia may form suddenly over several weeks or months. The cause is unknown. These are generally pricked with a small needle and extracted.

Pilar Cyst
The most common hard nodule located on the scalp is a pilar cyst. These are firm, mobile, and feel like marbles beneath the skin. They are inherited genetically. They may rupture beneath the skin, much like an epidermal inclusion cyst, and cause profound tenderness eventuating in an abscess. These are easily removed under local anesthetic.

Rosacea
Rosacea is a common disorder among adult men and women alike. It’s characterized by redness, bumps, and swelling of the central face. It may even affect the eyes and produce discomfort due to dryness with resultant irritation and redness.

If rosacea is left untreated, dilated blood vessels eventually become prominent on the face, and over time, persist.

See Clear Rosacea.

Syringoma
These are common, small tumors that appear in multiple numbers under the eyelids. They are derivatives of sweat ducts. They may be yellow, brown, or pink. They respond to light treatment with electrodessication or removal with a small blade and anesthetic. Not covered by insurance, removal typically costs $50-100 per treatment session.

Syringocystadenoma Papilliferum
This lesion develops within a nevus sebaceous. These tend to look like warts with extensive finger-like projections on the scalp.

Spider Veins
Spider veins are small red or purple veins that occur on the legs and face, and appear to twist and branch in a very fine pattern. Let’s face it…no one likes spider veins! Spider veins found on the legs are caused by cumulative added pressure on the venous system of the legs over time, caused from pressure in weak-walled vessels resulting in prominent dilation.

See Remove Spider Veins.

Vitiligo
Vitiligo is an autoimmune condition of the skin, where the body attacks its cells that give the skin its pigmentation. Most people recognize this condition as the “Michael Jackson” disease. He wore a white glove to conceal his vitiligo before he bleached his skin.

The most common way vitiligo presents is with symmetrical patches of depigmentation, which are usually chalky-white in color, located on the face, upper chest, hands, ankles, axillae, groin, and around orifices such as the eyes, nose, mouth, urethra, and anus. The patches usually don’t itch or burn.