Causes of skin disease

As well as differing in terms of their course, skin conditions also differ with respect
to their onset. There are twomain types of skin condition onset, namely congenital
and acquired.
Congenital
Congenital conditions are those that are present at birth. Conditions that are
present at birth are usually the result of genetic inheritance and include conditions
such as port-wine stains and albinism. Some of the conditions which fall under
this category may occur in brief episodes, may be treatable and may require little
adaptation from the affected person. Other conditions, such as vascular disorders,
may remain with the patient throughout life and hence require more long-term
adaptation. In the case of most conditions which fall under this category, initially
the parents may be more affected than the infant. The way that parents cope with
their child’s condition will inevitably affect how the child will cope and adapt to it
(this is discussed in more detail in Chapter 6).
Acquired
Conditions which fall under this category may be either a symptom of another
condition, as in the case of AIDS-related Kaposi’s sarcoma, or a condition in and of
itself, for example skin cancer. In the former case, patients have to contend with
various issues including a reduced life expectancy, physical handicap and altered
appearance. Past reports from sufferers suggest that people with life-threatening
conditions which have a disfiguring aspect are often as concerned about their
altered appearance as they are about their deteriorating health. Therefore, the
assumption that the impact of the disfiguring nature of certain conditions is
lessened or overshadowed by the physical significance is not necessarily true. In
the latter case, the focus tends to be on the condition, its progression, appearance,
spread and symptoms. The sufferer may become obsessed with the shape and size
of their lesions and engage in frequent checking behaviours to see if they have
changed. Since the cause of many skin conditions is unknown, the sufferer may
build their own beliefs surrounding the cause and progression of their condition
and may, in turn, engage in ‘superstitious’ behaviours to gain control over the
condition. For example, someone who developed psoriasis after using a public
swimming pool may avoid any form of swimming for fear that the condition will
get worse.
Common skin conditions
The facts on some of the most common skin conditions, their incidence in the
general population and treatments are outlined below.
Acne
Definition – a chronic inflammation of the pilosebaceous glands (hair
follicles that contain large oil-producing cells) of the face, upper arms and
upper chest. Lesions over the follicles, which become blocked by oil, may
appear as solid elevations of the skin (papules), as pus-filled blisters
(pustules), as cysts or as scars. Clinical variants of the condition include:
– acne conglobata: this is the most severe form in which large nodules and
cysts rupture under the skin leaving scars;
– acne cosmetica: a mild non-inflammatory form of the condition often
triggered by cosmetics;
– actinic acne: a rare form which occurs following exposure to sunlight;
– acne excorie: a form seenmore frequently in females, where lesions tend
to appear on the surface of the skin;
– acne vulgaris: the most usual form, where a variety of lesions may be
present, ranging from blackheads and whiteheads to inflamed nodules
and cysts, depending on the severity.
Distribution and severity – common sites of involvement include the face,
neck, shoulders, chest and back. The severity of acne depends on its extent
and the type of lesion, with cysts being the most damaging. In many cases
long-term scarring can result.
Prevalence – acne vulgaris is one of the most common skin conditions,
occurring, usually temporarily, in more than 80 per cent of the population
in some form. Acne affects males and females equally and the age of onset is
usually early puberty, with persistence often into the early twenties.
Cause – three general mechanisms have been put forward as causing acne:
(i) excessive sebumproduction;
(ii) abnormal shedding of a layer of skin cells that line the follicles;
(iii) a bacterium, often initiated by the hormonal increases of adolescence
and known as Propionibacterium acnes, which collects in the follicles as a
consequence of the increased sebum.
Treatment – Treatment depends on the type and extent of the acne.
Over-the-counter creams and topical treatment are usually effective for mild
acne, and a combination of varying strengths of antibiotics and topical
treatments are used for more severe cases.