Patient Information Leaflets (PILs)

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Acitretin (trade name Neotigason) is a member of a group of drugs called retinoids, closely related to Vitamin A. It works by slowing down cell reproduction in the skin.









Atopic eczema is an extremely common inflammatory condition of the skin. It may start any age but is most common in children, affecting 1 in every 5 children in the UK at some stage. The term ‘atopic’ is used to describe a group of conditions which include asthma, eczema and hay-fever. These conditions are linked by an increased activity of the allergy component of the immune system.

An atypical fibroxanthoma (AFX) is an uncommon (< 0.2 % of all skin cancers) type of skin cancer that occurs mainly in older people after the skin of the head and neck has been damaged by sunlight and/or by radiotherapy used to treat a previous cancer.





‘Naevus’ is Latin for birthmark. Dr Samuel Becker, an American dermatologist, described two men with a brown patch of skin with hair-growth on the upper body in 1949. Becker’s naevus is sometimes called ‘Becker's melanosis’ or ‘pigmented hairy epidermal naevus’.




Hairs form under the surface of the skin in structures known as hair follicles. A boil is an infection (abscess) of the deep part of a hair follicle with a bacterium called Staphylococcus aureus (S. aureus). Multiple boils are known as a carbuncle. Occasionally, the infection may spread into the surrounding tissues (cellulitis), causing fever and illness.





Chondrodermatitis nodularis is a localised inflammatory disorder affecting the ears. Literally, this Latin/Greek name means an inflammation both of the cartilage (chondro-) and of the skin (-dermatitis) causing a bump (a nodule, hence nodularis). It is common and harmless, but can be painful.

The term ‘chronic actinic dermatitis’ or “CAD” is used to describe a particularly severe form of eczema in which sensitivity to light is the main feature (photosensitivity). CAD is chronic, that is to say it typically persists for a number of years. ‘Actinic’ means “caused by sun” and ‘dermatitis’ (which is another term for eczema) means itchy inflammation of the skin. 


Like penicillin, ciclosporin was discovered as a substance produced by a fungus. Ciclosporin was found to suppress the immune system and was initially developed for suppressing the immune system of transplant patients to prevent them rejecting their transplanted organs. It was subsequently found to benefit patients with a range of diseases caused by immune reactions.











Vasculitis is a term referring to inflammation of blood vessels. These vessels may be arteries, veins or both, and vasculitis can affect any part of the body. When it affects small or medium sized blood vessels in the skin, it is known as cutaneous vasculitis. Occasionally cutaneous vasculitis can be a sign of inflammation occurring in other organs (a systemic vasculitis) and further investigation may be required for a full diagnosis.

By definition, cysts are closed sacs that have two main features:

  • A lining
  • Contents that are liquid or semi-solid



The contents. Both types of cyst contain a cheesy material, looking rather like toothpaste. This is made of soggy keratin - the material that makes up hair and the outer layer of the skin.

Dapsone is an antibacterial medicine belonging to the sulphonamide class of antibiotics. It is available only on prescription. It acts as an anti-inflammatory drug and has been used successfully as a treatment for several skin conditions such as dermatitis herpetiformis, pyoderma gangrenosum, Sweet’s syndrome and vasculitis for many years. Sometimes it can be used for other inflammatory skin conditions that are not mentioned here if none of the usual treatments are effective.

It is a rare inherited skin condition characterised by the loss of binding (acantholysis) between skin surface cells and there is also some thickening of the skin. It is also known as Keratosis Follicularis. The nails and mouth may also be affected. 







Digital myxoid cysts occur most frequently in people in their sixties.




Discoid lupus erythematosus is an uncommon rash, usually made worse by exposure to sunlight. The term ‘lupus erythematosus’ is applied to a range of related disorders. At one end of the range is ‘systemic’ lupus erythematosus, which can damage internal organs, whilst right at the other end of the range is ‘discoid’ lupus erythematosus, which is confined to the skin and does not cause general ill health.










Eczema herpeticum is a widespread, potentially serious infection of the skin that can affect people with atopic eczema.






Erythromelalgia (or erythermalgia) is a rare condition. It causes intermittent, painful swelling and redness of the feet or hands. Sometimes the legs and arms can be affected, or, less often, other areas such as the ears or nose. It usually affects both sides of the body. In ancient Greek, ‘Eythros’ means ‘red’ and ‘melalgia’ means pain in a limb.  Early-onset erythromelalgia starts before the age of 25, and late-onset develops between the ages of 40 to 60. 


Etanercept is a powerful drug that has been specially designed to mimic normal human molecules, and for this reason it is classed as a “biological” drug. It can reduce inflammation and affect the immune system (the body's own system of defence). One of its actions in psoriasis is to reduce the activity of a chemical in the body called ‘tumour necrosis factor alpha’ (TNF-alpha). This name is misleading since, apart from attacking tumours, TNF-alpha has many important functions such as fighting infections. There are, however, many diseases in which too much TNF-alpha is produced, causing unwanted inflammation. Etanercept opposes the effects of TNF-alpha.

Hairs are formed within the skin in tiny structures known as hair follicles. The word folliculitis describes an inflammation of these hair follicles. This may happen anywhere on the skin; the term folliculitis barbae is confined to inflammation of the hair follicles in the beard area (‘barba’ is the Latin word for beard).

Folliculitis decalvans is a rare chronic (long term) inflammatory condition of the scalp. Very rarely it can affect other hair-bearing skin such as beard, armpits, pubic area and legs. The prolonged inflammation that usually occurs leads to scarring. Folliculitis decalvans is derived from Latin and means inflammation of the hair root associated with hair loss.


Fox-Fordyce disease is a disease of the apocrine sweat glands of the skin. These are special sweat glands found on the armpits, genital region and breasts that produce a more dense secretion than the normal eccrine sweat glands. Patients with this condition experience itchy bumps on the skin near to hairs.

Frontal fibrosing alopecia is a form of scarring hair loss affecting the hair margin on the front of the scalp. This happens due to inflammation and destruction of the hair follicles. There may also be hair loss around the ears and from the eyebrows. It most commonly occurs in women who have gone through menopause but can also occur in pre-menopausal women and, rarely, in men. It is thought to be a variant of another condition called lichen planopilaris

The fumaric acid esters (FAE) are a medicine used to treat psoriasis, and have been used to treat psoriasis for over 30 years. The FAE are a popular licensed oral treatment for psoriasis in some countries; however, they are not yet licensed for treating psoriasis in the UK. You may, however, be prescribed them by your dermatologist.




A ‘haemangioma’ (Greek for blood-vessel-growth) of Infancy is a benign overgrowth of blood vessel cells in the skin. The term ‘strawberry naevus’ or ‘strawberry haemangioma’ is used for a haemangioma that looks like a strawberry.

Hailey-Hailey disease is also known as familial benign chronic pemphigus. It is a rare inherited skin condition in which red scaly areas that can be itchy and sore can lead to superficial blisters and eroded (broken) areas of the skin folds of the groin, armpits, neck and under the breasts. The condition flares intermittently and tends to come and go. Many patients are able to lead full and normal lives, with their condition being a nuisance rather than a serious problem. Some patients are more severely affected and experience more persistent painful raw areas of the skin with development of superficial blisters.




Head lice are common. They are small (adult lice are 3 - 4 mm long) greyish parasitic insects that live only on human scalps. They cannot fly, or jump, or burrow into the scalp, but their six legs are perfectly adapted for clinging firmly onto scalp hairs. Their presence does not imply a lack of cleanliness.

Head lice are usually picked up from someone who has them by head-to-head contact; it takes about 30 seconds for a louse to transfer from one scalp to another.


Hidradenitis suppurativa is a chronic, recurrent, and painful disease in which there is inflammation in areas of the apocrine sweat glands. These glands are found mainly in the armpits and groins. Within hidradenitis there is a blockage of the hair follicles. This causes a mixture of boil-like lumps, areas leaking pus, and scarring.

Hidradenitis tends to begin in early life, and is more common in women, black and Mediterranean people. It affects about 1% of the population.

Hirsutism essentially means that an individual, usually female, grows too much body or facial hair in a male pattern. Although hirsutism sometimes occurs in males, it is more difficult to detect because of the wide range of normal hair growth in men. Hirsutism affects approximately 10% of women in Western societies and is commoner in those of Mediterranean or Middle-Eastern descent.

Another term is used if the excessive hair is generalised and not in a gender specific pattern. This term is ‘hypertrichosis’, which means increased (‘hyper’) hair (‘trichosis’). In this leaflet we will discuss only hirsutism.


You may have been diagnosed with a skin cancer that rarely can spread into the lymphatic system, for example melanoma or squamous cell carcinoma.

As part of your examination the lymph nodes are examined by your doctor at follow-up appointments. The lymph nodes examined depend on the location of your skin cancer, e.g. if the skin cancer was on your leg then the lymph nodes in your inguinal area (groin) will be felt, or, if the skin cancer was on your face then the nodes in the head and neck would be examined. The aim is to detect any enlargement of the lymph nodes and undertake investigation at an early stage.

Some people express a wish to check their own lymph nodes between clinic appointments. The aim is to ensure that, in the unlikely event that there is spread of your skin cancer to the lymph nodes, it is detected and reported to your doctor or nurse straight away, rather than waiting until your next clinic appointment.













Imiquimod is a topical immuno-modulator. The cream triggers the immune system to recognise abnormal cells and causes inflammation to remove them. It may also remove abnormal cells from the lymph drainage vessels around a tumour.



1.    Recommended before you start immune suppressing medicines


3.    Need to be avoided 

Impetigo is a bacterial infection of the surface of the skin. In the UK it is the most common skin infection seen in young children.




Isotretinoin is a member of a group of drugs, closely related to vitamin A, called retinoids. Isotretinoin is the generic name of a drug marketed by a number of companies, but the original brand name was Roaccutane. It works in a variety of ways, targeting several of the factors that cause acne and other skin conditions including the production of sebum (an oily substance produced by the skin) and the production of keratin (outer scales of skin) that block the pores of the hair follicle and cause acne.






When a wound heals, it leaves a scar. A keloid is a special type of scar; one that grows too much and can even become larger than the original wound. It is not uncommon for surgical or injury scars to become a little lumpy (hypertrophic). A keloid differs from these in several ways:

  • It can spread outside the original area of skin damage.
  • It may last permanently.

KAs are relatively common benign skin growths from the cells surrounding the hair unit that usually appear in sun exposed skin. Clinically they can’t be easily differentiated from a more serious skin cancer, a squamous cell carcinoma (SCC). KAs grow quickly over the first few weeks but do not spread to other parts of the body. If left alone, they will usually go away by themselves in 4 to 6 months.


Lentigo maligna is one type of the earliest stage of a skin cancer called melanoma.




Lentigo maligna is a type of melanoma called ‘in situ’ melanoma. ’In situ’ means that the cancer cells have not had the opportunity to spread anywhere else in the body. There are cancer cells in the top layer of the skin (the epidermis) but they are all contained in the area in which they began to develop. They have not started to spread or grow (‘invade’) into deeper layers of the skin. This is why some doctors call in situ cancers ‘pre-cancer’.



Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin, but in females it most often affects the vulva skin and the skin around the anus. It can start in child- or adulthood and affect girls or women of any age.

Lichen sclerosus is a chronic inflammatory skin condition which can affect any part of the skin, but in men is most often seen on the foreskin and tip of the penis. Lichen sclerosus in men does not usually affect the skin around the anus, although this can be a common area for the problem in women.

It can start in child- or adulthood and affect boys or men of any age.


The term ‘lichen’ is Latin and means a plant, a moss covering trees. Lichen simplex describes a response of the skin to being repeatedly scratched or rubbed over a long period of time (also called lichen simplex chronicus). A plaque (thickened area of skin) of rough skin forms, with increased markings and sometimes little bumps around hair follicles. There may be only one plaque of lichen simplex or many plaques. 




The lay term for a melanocytic naevus is a “mole”. The word ‘melanocytic’ means that they are made up of the cells (melanocytes) which produce the dark pigment (melanin) that gives the skin its colour. Melanocytes clustered together form naevi. In other words, moles are benign (harmless) groups of melanocytes.

Some moles (congenital melanocytic naevi) are present at birth. Most develop during childhood and early adult life (acquired melanocytic naevi). Almost everyone has moles: many people have between 30 and 50. Many go away in later adult life. Moles can be found anywhere on the skin, including on the hands and feet, genitals, eyes and scalp.















When the melanoma has spread beyond the primary site and the local lymph nodes to other areas in the body, it is known as stage 4 melanoma. Stage 4 melanoma is a form of secondary melanoma where melanoma has spread to distant lymph nodes (glands) or internal organs such as the liver, lungs bones and brain (distant metastases).

Melanoma in situ is the very earliest stage of a skin cancer called melanoma. ‘In situ’ means that the cancer cells have not had the opportunity to spread to anywhere else in the body.


Melasma, also called ‘chloasma’ and ‘pregnancy mask’, is a common skin condition of adults in which light to dark brown or greyish patches of pigmentation develop mainly on facial skin. The name comes from melas, the Greek word for black. It is more common in women, especially pregnant women, and people with darker skin-types who live in sunny climates. However, it can also affect men (10% of patients) and any race. Melasma usually becomes more noticeable in the summer and improves during the winter months. It is not an infection therefore it is not contagious and it is not due to an allergy. It is not cancerous and will not develop into skin cancer.

Mepacrine (an unlicensed drug in the UK) was introduced as a treatment for malaria and for certain other tropical infections. It is one of several antimalarial drugs that have been found also to have anti-inflammatory properties, which can help some skin conditions.

Methotrexate is known as a disease-modifying drug. It slows the production of new cells by the body’s immune system (the body's own defence system) and hence reduces inflammation whilst at the same time suppresses the activity of the immune system. It was first used to treat certain types of cancer, and was then found to also be an effective treatment for skin and joint diseases when used at lower doses.

Mohs micrographic surgery is a specialised surgical method for removing certain types of skin cancer. It was first developed by Dr Frederic Mohs in the 1930s.

Traditionally, operations for treating skin cancer surgically have involved removal of the area affected by the skin cancer together with an area of healthy unaffected skin around and below the skin cancer in order to ensure that the entire cancer has been completely removed with suitable margins of excision. Once removed, the skin is sent to the laboratory for examination by a pathologist (a doctor who specialises in medical diagnosis by looking at the cells with a microscope) to confirm whether the operation has been successful or not. It usually takes about 2 weeks for pathology report to become available. If the report shows that the skin cancer has not been fully removed, a further procedure may be necessary.



Morphoea, also known as localised scleroderma, is uncommon (fewer than 3 per 100,000 people). The word ‘scleroderma’ originates from two words, ‘sclero’ meaning ‘hard’ and ‘derma’ meaning ‘skin’. These are the main feature of morphoea, with areas of morphoea being thicker and firmer than the rest of the skin.

Morphoea should not be confused with systemic sclerosis, in that the damage in morphoea occurs only in the skin, and does not affect internal organs as happens in systemic sclerosis. However, morphoea itself is not one disease with one prognosis. Types of morphoea include: plaque, linear (with a special linear type on scalp called ‘en coup de sabre’), and the generalised type. These types will be discussed later on.

MMP is the most up-to-date term for this condition. Other names include cicatricial pemphigoid, oral pemphigoid and ocular pemphigoid.

MMP is an uncommon blistering condition which most frequently affects the lining of the mouth and gums. Other moist surfaces of the body (known as mucous membranes) can also be affected, and these include the surface layers of the eyes, the inside of the nose, the throat and the genitalia. The skin is sometimes affected by a few scattered blisters. MMP usually starts in middle and old age. Although it is not usually a serious condition in the mouth, the diagnosis of any type of MMP is important as it will alert your specialist to the possibility that the condition may involve your eyes, even if you have no symptoms. Eye involvement (known as ocular cicatricial pemphigoid or ocular MMP) does not occur in all people with MMP, but is potentially serious as it may cause scarring and affect your eyesight.  Scarring may also affect the throat and the genitalia, and may be very serious if the larynx is affected.

Mycophenolate mofetil (MMF) is a very powerful medicine used mainly to stop the body rejecting a transplanted organ (e.g. kidney, heart and liver). However, it is also a useful treatment for a variety of skin conditions. It reduces the action of the body’s own defence system (the immune system) and is one of a group of drugs known as immunosuppressive agents. It is used in certain skin conditions in which the immune system loses control and begins to act against the body.

The name mycosis fungoides is 200 years old and hints, quite wrongly, that it is some sort of fungal infection. In fact it is one of a group of conditions known as cutaneous T-cell lymphoma. Mycosis fungoides is the most common type of Cutaneous T-Cell Lymphoma. A cutaneous T-cell lymphoma is a cancer (an uncontrolled growth) of the T-cell lymphocytes within the skin. (Lymphocytes are a type of white blood cell: they are found in the blood stream and organs, and help to protect us from infections. There are 2 types of lymphocytes: B-cells and T-cells.)

Mycosis fungoides is rare and for many affected people does not affect life expectancy.

Necrobiosis lipoidica is an uncommon inflammatory condition in which shiny, red-brown or yellowish patches develop in the skin, usually in young adults and in early middle age. The condition is most commonly seen in conjunction with diabetes - both the insulin-dependent and non-insulin-dependent types.


Lichen planus is an inflammatory condition of the skin but can also affect the mouth (oral lichen planus). Oral lichen planus may occur on its own or in combination with lichen planus of the skin, nails or genitals. It is thought to affect 1 to 2% per cent of the population, and typically it affects women after the age of 40 years. Oral lichen planus can occur in men but children are rarely affected.

Your body produces corticosteroids naturally, on a daily basis. Without them it would not be possible to survive. Corticosteroids are made in the cortex of the adrenal glands (hence the ‘cortico-’ part of the name). The ones used most often in medical treatment (prednisolone and dexamethasone) are not exactly the same as the ones produced in the body (mainly hydrocortisone). It is convenient to refer to them just as ‘corticosteroids’ or 'steroids', but you should be aware that they are different from the type of steroids (anabolic steroids) used for power building (which are correctly termed androgenic steroids).


Patch testing is a specialist procedure carried out by dermatology clinicians. It can help your referring doctor find out whether your skin condition is caused by an allergy to substances (these substances are called allergens) which come into contact with your skin, such as products at home, at work or in leisure activities. You can then be advised of the names of any identified allergens in order to help you to avoid them.


Pemphigoid gestationis is a rare auto-immune skin blistering disorder that occurs in pregnant women after 13 weeks gestation. It appears with an itchy rash that develops into blisters. It usually recurs in subsequent pregnancies and once triggered tends to occur in women who go on to take oral contraceptive therapy, or rarely during menstruation when periods restart following pregnancy.

Pemphigus vulgaris is a rare autoimmune disease (up to 3.2 cases per 100,000 population) that causes severe blistering of the skin and of the mucous membranes lining the mouth, nose, throat and genitals. Blisters are sacs with fluid that develop on the upper layer of the skin so their roofs are very thin and fragile, and break easily to leave raw areas (erosions) that can be extensive and painful. Pemphigus does not go away by itself, and always needs treatment by a Dermatologist.



A pilomatricoma is a benign (non-cancerous) growth arising from the cells at the base of hair follicles. It has also been called a pilomatrixoma, trichomatricoma or a ‘calcifying epithelioma of Malherbe’.


Pityriasis lichenoides is a rare skin disorder that is limited to the skin. The term ‘pityriasis lichenoides’ means that the rash is scaly (pityriasis) and that it was once thought to look like a lichen (a type of plant that lives on rocks) because it is made up of small bumpy areas. 








A Port Wine Stain is a collection of abnormally formed capillaries in the skin, which results in a red mark that may have the colour of port wine. Although most Port Wine Stains are present at birth, it has been reported in few cases to develop later in life (‘acquired Port Wine Stain’).


Important safety advice:

  1. Never swallow or take internally.


Pruritus (itching) refers to a sensation of the skin which causes a desire to scratch. Itching is a normal body response to protect us from harmful external substances or parasites such as insect bites. However it can be due to a wide range of skin and internal diseases. Pruritus lasting more than 6 weeks is called chronic pruritus.


Pseudofolliculitis is inflammation caused by cut hairs growing back into or under the skin surface. It is not due primarily to infection, but does look rather like the spots caused by inflammation of hair follicles due to infection (folliculitis). Pseudofolliculitis is usually seen on the face and neck of men who shave, when it may be called pseudofolliculitis barbae, (“barba” being the Latin word for a beard), but it can occur in other body regions that are shaved, in both men and women. It is also known as ‘shaving bumps’, or ‘razor bumps’. 


Treatments that are applied directly to the skin are known as topical treatments. They are the main type of treatment prescribed for most patients with psoriasis. More severe psoriasis may need a variety of other treatments including ultraviolet light or special tablets. Details of these further treatments are given in a separate Patient Information Leaflet: “Treatments for moderate or severe psoriasis”. However, most patients on these further (second line) treatments will still need to continue to use topical treatments.




Pyoderma gangrenosum is a rare treatable cause of skin ulcers. It is not related to gangrene. Pyoderma gangrenosum is not contagious and cannot be transferred from or to another person by touching or in any other way.






Sarcoidosis is a relatively uncommon disease that can affect just one part of the body, or different parts at the same time. Most commonly it affects the skin, lungs, lymph nodes, or eyes. Less frequently it can affect the joints, the nervous system, the liver and the kidneys. Sarcoid causes a type of inflammation known as a ‘granuloma’, which consists of a cluster of cells that can stop an organ from working properly. For example, granulomas in the lungs can cause breathing problems.




Seborrhoeic keratoses are also known as seborrhoeic warts, and as basal cell papillomas. Seborrhoeic keratoses are very common harmless, often pigmented, growths on the skin.



Skin camouflage is best described as the application of highly pigmented creams that are designed to effectively mask skin discolouration and scarring. Skin camouflage products mimic normal skin colours and are significantly different from ordinary cosmetics. When correctly applied the products are waterproof, allowing you to swim without the fear of the product washing off. Despite manufacturer’s claims no product is fully “rub-proof”, there may be minor transfer on to clothes, furnishings and bed linen, which can easily be removed by normal household cleansers.

The camouflage is removed daily using a soap substitute (cleansing cream) or toilet soap and water. This allows you to apply topical medication, and emollients, and also to inspect your skin for any changes to the condition.

This leaflet has been written to help you understand and reduce the risk of developing a skin cancer. It is aimed at people at increased risk, such as those who have been previously diagnosed with a skin cancer, or who have significant sun damage to their skin, or those on immunosuppressive drugs, particularly after an organ transplant. It describes the main types of pre-cancerous and cancerous skin growths, and explains the importance of detecting and treating them early. It tells you how to reduce the risk of getting another skin cancer, and how these can be treated.





A spider angioma is an enlarged little artery (resembling the body of a spider), from which smaller blood vessels are filled (resembling the spider’s legs). It has also been called several other names, for example ‘naevus araneus’, ‘vascular spider’, ‘arterial spider’, ‘spider telangiectasia’ and ‘spider naevus/nevus’.

Some of these names are Latin: ‘araneus’ for ‘spider’, ‘angioma’ for ‘blood vessel’ and ‘telangiectasia’ for ‘enlarged blood vessel’. 'Naevus’ stands for ‘birthmark’, which is incorrect, as spider angioma are usually not present at birth and develop later.






It is normal to shed approximately 30-150 hairs from our scalp daily as part of our hair cycle. Hair regrows automatically so that the total number of hairs on our head remains constant. Telogen effluvium occurs when there is a marked increase in hairs shed each day. An increased proportion of hairs shift from the growing phase (anagen) to the shedding phase (telogen). Normally only 10% of the scalp hair is in the telogen phase, but in telogen effluvium this increases to 30% or more. This usually happens suddenly and can occur approximately 3 months after a trigger.



Tinea capitis or ‘scalp ringworm’ as it is more commonly known, is the name used to describe an infection of the scalp hair with a type of fungus. Fungi are tiny microscopic organisms that can live on the dead tissue of the hair, nails, and outer skin layer.

It is an infection which occurs most commonly in children; however, it can also occur in adults.










A venous leg ulcer is an open sore in the skin of the lower leg due to high pressure of the blood in the leg veins.

Vitiligo is a condition in which areas of skin lose their normal pigment and become white. It is common, affecting about 1% of the world’s population. 








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