(25) Skin Disorders
My leg veins stick out, and I don’t like them. What can I do?
Join the crowd-about 80 million adults in the United States have varicose veins and their smaller cousins known as spider veins.
Varicose veins usually occur in the legs, where their knotted bluish appearance can be a substantial problem. Complications can develop such as venous stasis ulcers, inflammation of veins (phlebitis), or, in severe cases, blood clots that come loose and become emboli to distant organs such as the lungs. Spider veins are formed by the dilation of small blood vessels and become visible because they live near the surface of the skin. Although not a threat to health, they can be disfiguring. Spider veins are commonly found on the face and legs and appear as a “sunburst” pattern of reddish to purplish small veins.
The incidence of both varicose veins and spider veins increases with age and may be an inherited trait. Pregnancy and hormonal changes may contribute to the development of enlarged veins. Although there is no sure method of preventing varicose veins and spider veins, protection against forming varicose veins may be provided by wearing support hose and maintaining a normal weight.
Treatment for varicose veins and spider veins include:
• Sclerotherapy: a chemical solution is injected into veins to cause them to collapse and close up. It may require multiple treatments to clear all affected veins and more treatments may be needed from time to time as new enlarged veins appear. Side effects can include slight bruising and swelling at injection sites.
• Phlebectomy: an enlarged vein is removed through tiny incisions along its course. The procedure is done in an outpatient setting and is particularly useful for large varicose veins.
• Electrodessication: an electrical current is used to seal off enlarged veins.
• Laser surgery: pulses from a laser selectively destroy enlarged veins and spider veins.
• Surgical ligation and stripping: a procedure usually reserved for larger varicose veins, often done by a vascular surgeon in a hospital. The varicose vein is tied off (ligated) or completely removed.
I get little cherry-colored bumps on my skin. What are they?
These are angiomas, benign growths that consist of small blood vessels that can be located anywhere on the body. Different types include spider angiomas, cherry angiomas, and angiokeratomas. Although the cause of most types of angiomas is not known, cherry angiomas are due to aging and do not have any known significance. Spider angiomas are more common in childhood and during pregnancy, but when present in large numbers, they may warn of liver damage. Angiokeratomas are an overgrowth of blood vessels and skin cells.
Treatment of angiomas is not necessary unless they bleed or are bothersome. If treatment is required, the dermatologist will recommend the most appropriate method. Electrodesiccation, which is touching the skin with an electric needle to destroy the blood vessels, is one of the treatments. We also occasionally use this treatment to eliminate the unwanted facial veins of rosacea. Liquid nitrogen is a cold gas that is sprayed on the skin with a spray gun to destroy the angiomas and is also used in treatment of lesions such as seborrheic keratoses and warts. Laser uses a beam of concentrated light to destroy the lesion and is also used at times to destroy unwanted leg veins or the facial veins of rosacea. All of these common treatment modalities usually give a good cosmetic result, although angiomas sometimes recur after treatment.
If I get a dark blue bump on my lip, is it skin cancer?
This is most likely a venous lake-an asymptomatic, solitary, soft, compressible, dark blue to violaceous, 0.2- to 1-cm papule commonly found on sun-exposed surfaces of the vermilion border of the lip (Plate 14), face, and ears. Lesions generally occur among older individuals. If it persists, itches, bleeds, or gets larger and more irregular, get a biopsy.
What can I do about dark circles under my eyes?
Do you look into the mirror and seeing a raccoon staring back at you? What causes dark circles under the eyes? Working late, allergies, too little sleep, increasing age, and poor nutrition all can contribute. These are not the physiological reason for the dark circles, however.
The same kind of chemical reaction that produces bruises hits around your eyes. This area is the thinnest and most delicate skin of your face and is populated by with tiny capillaries. Blood sometimes leaks from these capillaries, and your body tries to mop up the loose blood by breaking it down in an oxidization process known as hemoglobin degradation. As the hemoglobin degrades, it turns a dark bluish red. Guess what? You get dark circles under the eyes, but you don’t have to get hit in the face!
What can you do to get rid of the circles? Certain eye circle creams speed up the rate of the hemoglobin degradation and strengthen the capillaries in your skin to help fade the dark pigmentation and prevent more damage. Some of the bleaching creams containing hydroquinone also help the darkness diminish but should be used with caution near the eyes. Tanning can make dark under-eye circles even worse by bringing the melanin to the surface of the skin, making it darker.
What else?
Allergies can contribute to dark under-eye circles. The allergic reaction can elicit allergic shiners that can reflect under the eye. If the allergies cause you to rub or scratch your eyes, the fragility of the skin can break down the capillaries and darken the skin. Fatigue or inadequate rest can make your skin paler, and this makes dark circles look darker. During pregnancy and/or menstruation, skin becomes pale, and thus, the dark circles look darker. Too much sun can make the circles appear darker.
As you get older, the skin around your eyes becomes thinner, and the dark under-eye circles can become more pronounced. Eating a balanced and healthy diet allows you to take in essential nutrients that inhibit dark under-eye circles. A patient of mine named Lisa had tried everything.
Lisa said this:
I put drops of lemon juice under my eyes, but it got in my eyes. So in addition to my dark circles, I also had bloodshot eyes. I used creams, slices of cucumber, slices of potato, tea bags, and everything else. Then I found what worked for me. I took a vitamin E capsule and pierced it with a pin. Then I dabbed a bit of it on the skin under my eyes. It helped cut down my dark eye circles and puffiness as well. Then I swallowed the rest of the capsule. In the evening before going to sleep I put on a small amount of a prescription bleaching cream, and that also helped my skin. Until I got better, I used a concealer. Cold washcloth compresses can help constrict the blood vessels and decrease the under-eye darkness. Drinking more water (at least 8 to 10 glasses per day) can help to cleanse your body of impurities that can contribute to dark eye circles.
Don’t get discouraged, as there are many ways to improve your looks.
Terms:
Angiomas - These are benign tumors that are comprised of lymph tissue and blood vessels. These tumors are red in color and not usually life-threatening.
Electrodesiccation - Scraping or burning off skin growths (also known as electrodesiccation and curettage). It can be used for less serious skin cancers, precancers, and benign growths.
Venous lake - A lesion that appears purple and raised. It is generally located on the lip, and is caused by the leakage of capillaries or due to the inability of blood to flow out freely.
Certain eye circle creams speed up the rate of the hemoglobin degradation and strengthen the capillaries in your skin to help fade the dark pigmentation and prevent more damage.
