American Medical Association Family Medical Guide - American Medical Association [763]
Varicose Ulcers
If you have stretched or twisted veins directly under the skin, especially in the legs (varicose veins; see pages 125 and 602), you have poor circulation. Blood flow through the lower parts of your body (especially the calves, ankles, and feet) becomes sluggish, making small injuries or cracks in the skin less likely to heal, often causing them to enlarge and gradually become ulcers (sores). Varicose ulcers are more common in older people, pregnant women, and people who are obese or confined to bed.
Symptoms
Varicose ulcers are shallow sores that can become infected. They may heal and continuously recur or not heal at all. Varicose ulcers usually occur on the inside of the leg just above the ankle. The skin around the ulcer turns red and then brownish purple and is itchy and flaky. The ankles often swell.
Diagnosis and Treatment
A doctor can usually diagnose a varicose ulcer by its appearance. He or she may order an ultrasound (see page 111) of the legs to rule out another disorder.
If you have a varicose ulcer, your doctor will recommend that you avoid standing for long periods (but walk regularly), keep the affected area raised (preferably above the level of your heart) as often as possible (even while lying down), and wear an elastic support stocking during the day. He or she may show you how to clean the ulcer. Clean the ulcer often and keep it covered with a bandage.
If the ulcer is severe, the doctor may coat it with a medication specially formulated to soothe and heal wounds, and bandage it. You may need to have a skin graft (replacement skin taken from another part of the body) to cover the affected area and promote healing. If more serious complications develop, your doctor may prescribe a medication called becaplermin, which contains a natural blood factor that improves healing. If the ulcer gets worse, you may have to be hospitalized.
Epidermal Cysts
Epidermal cysts (also called sebaceous cysts) are benign (noncancerous) cysts that originate in the epidermis (the thin, protective outer skin layer made up mostly of dead cells). An epidermal cyst is formed when keratin (the hard substance that is the main component of the epidermis) blocks a sebaceous gland, producing a cyst that grows slowly over many years. Epidermal cysts are common and sometimes are associated with acne (see page 1065).
Symptoms
An epidermal cyst looks like a pale lump beneath the skin (see page 122), and may have a narrow pore that is visible on the surface of the skin. If the cyst becomes infected, it fills with pus and becomes red, inflamed, and tender and may eventually burst.
Diagnosis and Treatment
Doctors can diagnose an epidermal cyst by its appearance. If a cyst is not infected, no treatment is necessary, and the cyst may eventually go away on its own. If the cyst is infected, your doctor may prescribe antibiotics and ask you to apply warm, moist compresses to the area to release the buildup of pus. Alternatively, your doctor may inject the cyst with a corticosteroid medication, which will temporarily relieve the inflammation and pain. Sometimes a cyst breaks under the skin, causing redness and pain; eventually, scar tissue may form that can make the cyst difficult to remove surgically. Even if pus is released and the inflammation subsides, a cyst that has been infected should be removed surgically because it is likely to become infected again. Your doctor can remove the cyst in an outpatient procedure. However, if even a small part of an epidermal cyst is left behind, it can recur.
Pityriasis Rosea
Pityriasis rosea (see page 123) is a common skin disorder that affects primarily children and young adults. The cause is unknown, but some doctors think that a virus may be responsible.
Symptoms
Pityriasis rosea starts as one or more large, red, scaly spots, usually on the trunk. Over a few days, the spots grow and new ones appear on the trunk and upper part of the arms (in a T-shirt-like distribution).