Birthmarks are abnormal skin colorations in spots that are either present at birth or appear shortly thereafter. They can be flat or slightly raised from the skin. They can be any number of colors, including red, brown, black, tan, pink, white or purple. Birthmarks are generally harmless. There are two major categories of birthmarks: pigmented birthmarks and red birthmarks.
Pigmented Birthmarks can grow anywhere on the skin and at any time. They are usually black, brown or skin-colored and appear singly or in groups. They can be moles (congenital nevi) that are present at birth, Mongolian spots, which look like bluish bruises and appear more frequently on people with dark skin, or café-au-lait spots that are flat, light brown or tan and roughly form an oval shape.
Red Birthmarks (also known as macular stains) develop before or shortly after birth and are related to the vascular (blood vessel) system. There are a number of different types:
- Angel kisses, which usually appear on the forehead and eyelids.
- Stork bites, which appear on the back of the neck, between the eyebrows on the forehead, or on eyelids of newborns. They may fade away as the child grows, but often persist into adulthood.
- Port-wine stains, which are flat deep-red or purple birthmarks made up of dilated blood capillaries (small blood vessels). They often appear on the face and are permanent.
- Strawberry hemangiomas, composed of small, closely packed blood vessels that grow rapidly and can appear anywhere on the body. They usually disappear by age nine.
- Cavernous hemangiomas are similar to strawberry hemangiomas but go more deeply into the layers of the skin. These can often be characterized by a bluish-purple color. They also tend to disappear naturally around school age.
Also known as follicular keratosis, this is a hereditary skin disorder that causes goosebump-like lesions on the back of the arms, thighs or buttocks. The patches of bumps tend to get dry and itchy, particularly during the winter months. Keratosis pilaris occurs at any age. Because it is hereditary, there is no method of prevention. In some cases, it goes away on its own over time; in other cases, the condition is chronic. Keratosis pilaris is not harmful, however, it is very difficult to treat.
Keratosis pilaris is caused by a build-up of keratin, a protein in the skin that protects it from infection. Keratin plugs up hair follicles causing the rough, bumpy rash. Treatment options include prescriptions for:
- Medicated creams or lotions with 12 percent ammonium lactate that softens the affected skin.
- Moisturizers (urea) that help loosen and remove dead skin cells.
- Topical corticosteroids for short-term, temporary relief of symptoms.
- Topical retinoids that increase cell turnover, which reduces the plugging of hair follicles.
To help alleviate symptoms, be sure to keep the affected area moistened at all times and avoid harsh soaps.
Lumps, Bumps and Cysts
There are literally hundreds of different kinds of lumps, bumps and cysts associated with the skin. Fortunately, the vast majority of these are harmless and painless. The chart below provides a guide for some of the most common forms of skin lumps, bumps and cysts.
- Red, brown or purple growth; generally benign
- Usually found on arms and legs
- Feels like a hard lump
- Can be itchy, tender to the touch and sometimes painful
- Usually does not require treatment
- Most common removal by surgical excision or cryotherapy (freezing it off with liquid nitrogen)
Epidermoid Cysts (Sebaceous Cysts)
- Round small bumps, usually white or yellow
- Forms from blocked oil glands in the skin
- Most commonly appear on the face, back, neck, trunk and genitals
- Usually benign; occasionally leads to basal or squamous cell skin cancers
- If infected, will become red and tender
- Can produce a thick yellow, cheese-like discharge when squeezed
- Antibiotics might be prescribed if there is an underlying infection
- Dermatologist removes the discharge and the sac (capsule) that make up the walls of the cyst to prevent recurrence
- Laser surgery may be used for sensitive areas of the skin, like the face
- Red pimples around areas having hair
- Inflammation of the hair follicles
- Caused by infection or chemical or physical irritation (e.g., shaving, fabrics)
- Higher incidence among people with diabetes, the obese or those with compromised immune systems
- Topical antibiotics
- Oral antibiotics
- Antifungal medications
- Eliminating the cause
- Red, dome-shaped, thick bumps with craters in the center
- Abnormal growth of hair cells
- Triggered by minor skin injury such as a cut or bug bite
- Ultraviolet radiation from sun exposure is the most common risk factor
- Cryotherapy (freezing off the bump with liquid nitrogen)
- Curettage (surgically cutting out or scraping off)
- Small, rough white or red bumps that neither itch nor hurt
- Usually worse during winter months or when there is low humidity and the skin gets dry
- Usually does not require treatment
- In most cases disappears on its own by age 30
- Intensive moisturizing is the first line of treatment
- For more difficult cases, use of medicated creams with urea or alpha-hydroxy acids
- Soft fatty tissue tumors or nodules below the skin’s surface
- Usually slow growing and benign
- Appear most commonly on the trunk, shoulders and neck
- May be single or multiple
- Usually painless unless putting pressure on a nerve
- Usually does not require treatment unless it is compressing on the surrounding tissue
- Easy to remove via excision
- Soft fleshy growths under the skin
- Slow growing and generally benign and painless
- Pain may indicate a need for medical attention
- May experience an electrical shock at the touch
- Usually does not require treatment, particularly if it does not cause any symptoms
- If it affects a nerve, it may be removed surgically
- Closed pockets of tissue that can be filled with fluid or pus
- Can appear anywhere on the skin
- Smooth to the touch; feels like a pea underneath the surface
- Slow growing and generally is painless and benign
- Only needs attention if it becomes infected or inflamed
- Usually does not require treatment; often disappears on its own
- May need to be drained by a physician
- Inflamed cysts respond to an injection of cortisone, which causes it to shrivel
Moles are brown or black growths, usually round or oval, that can appear anywhere on the skin. They can be rough or smooth, flat or raised, single or in multiples. They occur when cells that are responsible for skin pigmentation, known as melanocytes, grow in clusters instead of being spread out across the skin. Generally, moles are less than one-quarter inch in size. Most moles appear by the age of 20, although some moles may appear later in life. Most adults have between 10 and 40 moles. Because they last about 50 years, moles may disappear by themselves over time.
Most moles are harmless, but a change in size, shape, color or texture could be indicative of a cancerous growth. Moles that have a higher-than-average chance of becoming cancerous include:
Moles present at birth. The larger their size, the greater the risk for developing into a skin cancer.
Atypical Dysplastic Nevi
Irregularly shaped moles that are larger than average. They often appear to have dark brown centers with light, uneven borders.
Higher frequency of moles
People with 50 or more moles are at a greater risk for developing a skin cancer.
In some cases, abnormal moles may become painful, itchy, scaly or bleed. It’s important to keep an eye on your moles so that you can catch any changes early. We recommend doing a visual check of your body monthly, including all areas that don’t have sun exposure (such as the scalp, armpits or bottoms of feet).
Use the American Academy of Dermatology’s ABCDEs as a guide for assessing whether or not a mole may be becoming cancerous:
- Asymmetry: Half the mole does not match the other half in size, shape or color.
- Border: The edges of moles are irregular, scalloped, or poorly defined.
- Color: The mole is not the same color throughout.
- Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.
- Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.
If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine if it is or isn’t cancerous and/or may surgically remove it.
Molluscum contagiosum is a common skin disease caused by a virus. This virus easily spreads from person to person. People can get molluscum by sharing towels and clothing. Skin-to-skin contact also spreads the virus. Whenever you can see the bumps on the skin, molluscum contagiosum is contagious.
Often the only sign of molluscum is pink or flesh-colored bumps on the skin. These bumps can appear anywhere on the skin. Most people get about 10 to 20 bumps on their skin. If a person has a weakened immune system, many bumps often appear. People who have AIDS can have 100 or more bumps.
A dermatologist often can diagnose molluscum contagiosum by looking at the skin. Your dermatologist may refer to the bumps on the skin as mollusca. Sometimes the mollusca look like another skin condition. They can look like warts, chickenpox, and even skin cancer. If this happens, your dermatologist will scrape off a bit of infected skin. The infected skin will be examined under a microscope. After diagnosis, treatment helps to prevent the virus from:
- Spreading to other parts of your body.
- Spreading to other people.
- Growing out of control in people who have a weakened immune system.
There are many treatment options. The treatment your dermatologist prescribes will depend on your age, health, where the bumps appear on your body, and other considerations. Treatments may include:
- Cryosurgery: The dermatologist freezes the bumps with liquid nitrogen.
- Curettage: The dermatologist may use a small tool called a curette to scrape the bumps from the skin.
- Laser surgery: A dermatologist uses a laser to target and destroy the bumps. This can be an effective treatment for people who have a weakened immune system.
- Topical (applied to the skin) therapy: Your dermatologist can apply various acids and blistering solutions to destroy the bumps. These work by destroying the top layers of the skin. Tricholoracetic acid is often used to treat people who have a weak immune system and many bumps.When a patient has many bumps or large bumps, a dermatologist may need to repeat the procedure every 3 to 6 weeks until the bumps disappear. These procedures cause some discomfort. While treating the bumps, it is normal for new bumps to appear as others fade.
Also known as seborrheic verruca, most people will develop at least one seborrheic keratosis during a lifetime. Fortunately, these lesions are benign and don’t become cancerous. They are characterized as brown, black or yellow growths that grow singly or in groups and are flat or slightly elevated. Often they are mistaken for warts. Generally, no treatment is required unless the growth becomes irritated from chafing against clothing. However, because it look similar in appearance to precancerous growths (actinic keratosis), your dermatologist will likely biopsy the tissue to confirm the diagnosis.
If a seborrheic keratosis becomes irritated or unsightly, removal is conducted using one of these three methods:
- Cryosurgery, which freezes off the growth using liquid nitrogen.
- Curettage, in which the doctor scrapes the growth off the surface of the skin.
- Electrocautery, used alone or in conjunction with curettage to burn off the tissue and stop the bleeding.
Warts are small, harmless growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance. Warts can be surrounded by skin that is either lighter or darker. Warts are caused by different forms of Human Papilloma Virus (HPV). They occur in people of all ages and can spread from person to person and from one part of the body to another. Warts are benign (noncancerous) and generally painless. They may disappear without any treatment. However, in most cases eliminating warts takes time.
The location of a wart often characterizes its type:
Common warts can appear anywhere on the body, although they most often appear on the back of fingers, toes and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite. They can range in size from a pinhead to 10mm and may appear singly or in multiples.
Filiform warts look like a long, narrow, flesh-colored stalk that appears singly or in multiples around the eyelids, face, neck or lips. They are sometimes called facial warts. They may cause itching or bleeding, but are easy to treat with over-the-counter medications.
Flat (plane) warts appear on the face and forehead. They are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.
Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth (known as oral warts). The lesions start small and soft but can become quite large. They often grow in clusters. They are both sexually transmitted and highly contagious. In fact, it is recommended you generally avoid sex with anyone who has a visible genital wart. Genital warts should always be treated by a physician.
Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. They have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can spread rapidly.
Subungual and periungual warts appear as rough growths around the fingernails and/or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can impede healthy nail growth. Because of their location, they are difficult to treat and generally require medical attention.
Most warts respond to over-the-counter treatments, including:
- Cryotherapy, which freezes off the wart using liquid nitrogen or nitrous oxide.
- Electrosurgery, which sends an electric current through the wart to kill the tissue.
- Laser surgery, which essentially heats up the wart until the tissue dies and the wart eventually falls off.
- Nonprescription freezing products (dimethyl ether), aerosol sprays that freeze the warts and cause them to die off.
- Salicylic acid preparations, which dissolve the protein (keratin) that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops and plasters and takes 4 to 6 weeks to eradicate the warts.
If self-treatments don’t work after a period of about 4 to 12 weeks, contact our dermatologist. We’ll assess your warts and recommend the best option.
Always contact the dermatologist if a wart is causing pain, changes in color or appearance and for all genital warts.