Information sheet

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Dermatology Information Sheet for Patients
Benign moles Moles are extremely common and they
very seldom cause any problems. Most moles
develop in childhood and early adult life. They
are often brown but may be skin coloured. They
may be flat, slightly raised or very lumpy. They
can occur on any part of the body including the
face. Often moles gradually disappear as you
get older but some may remain into old
age. There is a very small risk of moles
becoming cancerous. Any mole that is growing,
changing shape or changing colour should be
checked by your doctor. However the vast
majority of moles are completely benign and need
no treatment. Removal of benign moles for
cosmetic reasons is not possible on the NHS.
Viral Warts Viral warts are very common in both
children and adults. They are caused by
infection with the wart virus ( or human
papilloma virus, HPV ), and are therefore mildly
contagious. Warts and verrucas are the same
thing, although verrucas on the feet may be
larger and tend to be more painful because of the
pressure from walking. There is no reason not to
go swimming, although some people prefer to wear
a verruca sock. Most warts, especially in
children, do not need treatment as they will
disappear spontaneously. 75 will go within 2
years. 20 of school children will have warts at
any one time. The treatments available are
destructive and only work in about 70 of people.
Many people don't bother to treat them because
treatment can be more uncomfortable and
troublesome than the warts - they are hardly ever
a serious problem. However, warts may be painful
and they often look ugly and cause embarrassment.
To get rid of them, we have to stimulate the
body's own immune system to attack the wart
virus. Persistence with the treatment and
patience is essential. The best treatment is to
use a wart paint, available from the
pharmacist. The paint is normally applied once
daily. Perseverance is essential - although 70
of warts will go with wart paints, it may take at
least twelve weeks to work! Even if the wart
doesn't go completely, the wart paint usually
makes it smaller and less uncomfortable. First,
the skin should be softened in a bath or bowl of
hot soapy water. The hard skin should be rubbed
away from the wart surface with a piece of pumice
stone or emery board. The wart paint or gel
should be applied accurately, allowing it to dry.
It works better if covered with plaster or duct
tape (particularly recommended when the wart is
on the foot). This procedure should be repeated
daily until the wart has gone.
Seborrhoeic Keratoses Seborrhoeic keratoses (or
seborrhoeic warts) are harmless common skin
growths that first appear during adult life. They
have a warty surface and appear stuck onto to the
skin. As time goes by, seborrhoeic keratoses
become more numerous. Some people inherit a
tendency to develop a very large number of them.
They may appear on any part of the body, but are
probably commonest on the trunk. Nothing can be
done to prevent them appearing. Seborrhoeic
keratoses are harmless although they be rubbed by
clothing and become sore and inflamed. They begin
as slightly raised, light brown spots. Gradually
they thicken and take on a rough, warty surface.
They slowly darken and may turn black. These
colour changes are harmless. People who have had
several seborrhoeic keratoses can usually
recognize this type of benign growth. Skin
cancers are sometimes difficult to tell apart
from seborrhoeic keratoses, so if you are
concerned or unsure about any skin lesion consult
your doctor. Seborrhoeic keratoses do not need
treatment unless they are causing significant
symptoms. If a wart is catching on clothes or in
other ways causing a problem then treatment may
be undertaken. They usually respond to
cryotherapy (freezing treatment), but
occasionally are scraped away under local
anaesthetic.
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Dermatology Information Sheet for Patients
Skin Tags Skin tags are little raised pieces of
skin that are usually found around the neck,
under the arms and breast and in the groin
rubbing of the skin creases may be one of the
triggers for their development. They are
completely benign and never turn into skin
cancer. They are extremely common and have a
tendency to run in families. They are more likely
to develop if you are overweight. There is no way
to prevent you from growing new tags but weight
reduction may help a little. Treatment is not
necessary. If you want treatment then the tags
can be snipped off or removed using fine cautery.
However this treatment is considered a cosmetic
procedure and is not available on the NHS.
Solar Keratoses Solar keratoses (also known as
Actinic Keratoses) are scaly lesions found on
sun-exposed sites. They can be very small and
superficial or a bit larger and hard and scaly.
They may be sore or itchy and can become inflamed
and bleed if knocked. They may come and go, and
are often better in the winter months. Solar
keratoses are due to sun damage and are commoner
in older people as they have accumulated more sun
exposure. They are usually found on the face, the
back of the hands, the forearms and the lower
legs. The scalp in bald men is a very common
site. Solar keratoses are NOT skin cancers, but
a sign that the skin has had too much sun. Minor
lesions do not need any treatment, or perhaps a
simple moisturising cream. If they are a nuisance
then treatment can be undertaken with either
cryotherapy (a freezing spray) or active creams
such as Efudix or Solaraze. There is a very small
risk of Solar keratoses changing into a skin
cancer (less than 3). If any of your lesions
start growing, becoming thicker and more raised
or if they constantly bleed, then you need to get
your GP to check that you do not need any further
investigation or treatment. Treatment with
Efudix There are different ways of using this
cream but usually you will be asked to apply to
the scaly areas once or twice a day for 3 to 6
weeks. Be careful not to get it in your eyes.
After several applications (and the timing will
vary between patients) a reaction will develop.
The area will become red, angry and weepy. This
reaction is important and the cream should not be
stopped until a good reaction has started. Once
this has happened the cream can be stopped and
the area allowed to settle down over the next few
days. A hydrocortisone cream may be suggested to
hasten this improvement. This course of treatment
can be re-used to treat new or recurrent lesions
whenever necessary. In some patients we use the
cream twice a week for many months. This produces
much less in the way of reaction but has a slower
beneficial effect.
Molluscum Contagiosum Molluscum contagiosum are
small spots caused by an infection with the
molluscum virus. The pimples often have a typical
indentation in the top and look like tiny
volcanos. They are usually found on the trunk but
can occur on the limbs. They very rarely affect
the face. There are usually several lesions
coming up at different times. These are very
common in children and often appear after the
child first goes to toddler group or school. They
are mildly contagious and are caught by contact
with other infected children. They are less
common in older children who will often have
developed immunity when they were
younger. Occasionally a patch of itchy inflamed
eczema may develop around the molluscum spots,
even in patients who do not normally have eczema.
This can be treated with an ordinary moisturising
cream or with 1 hydrocortisone cream if
necessary. Molluscum are not dangerous in any
way and are simply a nuisance. They do not need
treatment as they disappear spontaneously. They
usually only last a few months but can last more
than a couple of years in rare cases. All
treatments that have been used are destructive in
nature (e.g. Freezing sprays, cautery etc). They
are not always successful, are more likely to
cause permanent scarring and are inappropriate to
use in children as they are painful. If the
child is particularly worried about the lesions
then the parent can use a cocktail stick to prick
out the centre of the pimple. The stick should be
dipped in boiling water first and then allowed to
cool. The procedure is uncomfortable and only one
or two lesions should be treated at any one time.
The parent must be aware of the increased
possibility of causing scarring compared to
natural resolution. The best option is to LEAVE
THEM ALONE AND ALLOW THEM TO GO AWAY NATURALLY