American Medical Association Family Medical Guide - American Medical Association [764]
Diagnosis and Treatment
Because the symptoms of pityriasis rosea can resemble the symptoms of other disorders, such as ringworm, your doctor will perform a physical examination to confirm the diagnosis. If you have pityriasis rosea, your doctor may recommend monitoring the rash for about a month to see if the spots go away on their own. In the meantime, he or she may recommend that you avoid taking hot showers or baths because the heat can dry the skin and make itching worse. You also can apply an over-the-counter cold cream to the rash. Your doctor may prescribe a corticosteroid medication to relieve the inflammation and an antihistamine to relieve the itching.
Keloids
A keloid is scar tissue that has grown excessively. Keloids can occur at the site of a surgical incision, burn, vaccination, piercing, severe acne, or even a small scratch, or they may occur spontaneously. Keloids are more common in people with dark skin.
Symptoms and Treatment
A keloid starts out like normal scar tissue but, after several months, grows and becomes larger and thicker (see page 122). Keloids can itch and cause discomfort.
Keloids sometimes stop growing or disappear without treatment. They cannot be removed surgically because scar tissue from the surgery can develop into another keloid. If you have a thin keloid, you can apply over-the-counter sheets of silicone gel to make it smaller. Your doctor may inject the keloid with a corticosteroid medication or prescribe a topical corticosteroid cream or ointment to stop the growth of scar tissue. Laser surgery (see page 1088) and, in rare cases, radiation therapy (see page 23) can be used to reduce the size of keloids.
Lichen Planus
Lichen planus is an inflammatory disease that is most common in middle-aged people. It can affect the mouth (oral lichen planus; see page 745) as well as the skin. Although the cause is not known, some doctors think that lichen planus is more common in people who have a weakened immune system or who are under stress. In some cases, lichen planus occurs as an allergic reaction to some medications.
Symptoms
The rash consists of small, shiny, reddish spots that appear suddenly (often on the wrists; see page 124); patches of thickened, discolored skin that gradually fade and leave a brown mark; or a lacy pattern of slightly raised tissue in moist areas such as the vulva or mouth. The rash may itch. Fingernails and toenails that are affected by lichen planus may be ridged.
Diagnosis and Treatment
If you have lichen planus, your doctor may refer you to a dermatologist, who can diagnose lichen planus by its appearance. However, because the symptoms of lichen planus resemble the symptoms of other, sometimes serious, skin disorders, the doctor may take a sample of skin cells for examination under a microscope (biopsy) to rule out cancer or other disorders. If a diagnosis of lichen planus is confirmed, the doctor will recommend a corticosteroid ointment to apply to the rash to reduce the inflammation; this medication usually clears up the rash. Treatment is repeated if the rash recurs.
Discoid Lupus Erythematosus
Discoid lupus erythematosus is a chronic skin disorder of unknown cause. The skin rash of discoid lupus resembles that of systemic lupus erythematosus (see page 920), but discoid lupus has none of the other symptoms of systemic lupus. Discoid lupus is more common in women than in men and usually develops between ages 30 and 40.
Symptoms
Discoid lupus usually takes the form of a red, itchy, scaly rash on the bridge of the nose and cheeks (often shaped like a butterfly; see page 124). However, circular patches of the rash may appear in other skin areas (particularly those exposed to the sun) with or without the butterfly rash on the face. When the patches of skin heal, they may be thin, pale, and scarred.
Diagnosis and Treatment
If you have symptoms of discoid lupus, your doctor will perform