Benign flesh-colored, pink, and red skin growths




11: Benign flesh-colored, pink, and red skin growths


Abstract:



The vast majority of growths on the skin are benign. To appropriately reassure patients of their benignity and to manage them accordingly, it is important for clinicians to be familiar with the broad range of benign skin lesions. This chapter reviews many flesh-colored, pink, and red common benign skin lesions that are not discussed elsewhere.

Key terms:


lichen simplex chronicus


keloid


erythema nodosum


cherry angioma


digital mucous cyst


pearly penile papules


chondrodermatitis nodularis helicis



Lichen simplex chronicus


Clinical features


Lichen simplex chronicus (LSC; also known as “neurodermatitis”) is a common secondary skin condition characterized by the development of thickened plaques with accentuated skin lines (i.e., lichenification).




LSC can either arise in areas affected by a different primary dermatosis (e.g., atopic dermatitis [AD]) or de novo from idiopathic pruritus.



Differential diagnosis


The differential for LSC includes squamous cell carcinoma (SCC), lichen sclerosus, prurigo nodularis, lichen planus (LP), and psoriasis. Importantly, lichenification can arise secondary to a number of pruritic skin conditions. In all cases, it is important to recognize that patients may have a separate, underlying primary skin condition (including those in the differential diagnosis).



Work-up


LSC can typically be diagnosed clinically; however, histopathologic confirmation is occasionally necessary.


The presence of an isolated, lichenified plaque with accentuated skin lines and dyspigmentation is suggestive of a diagnosis of LSC.



Patients who do not respond as expected to a 4-week course of occluded, super-potent topical corticosteroids or intralesional corticosteroids should undergo biopsy to rule out more significant pathology.


Initial steps in management


General management comments


Management of LSC differs based on whether or not the patient has an underlying primary dermatosis.



Recommended initial treatment


Patients should be treated with either potent topical corticosteroids under occlusion or intralesional corticosteroids.



Partial but inadequate response


If there is a partial but inadequate response after a trial of topical or intralesional corticosteroids, confirm the diagnosis, if it is in question, with a biopsy. Then add systemic anti-itch medications (e.g., gabapentin, pregabalin, n-acetylcysteine) or consider referral to a dermatologist.



Warning signs/common pitfalls


SCC can mimic LSC and can develop concomitantly in patients with known LSC. If suspected LSC continues to grow despite treatment, a biopsy is always indicated.


Antihistamines and oral corticosteroids are frequently prescribed for the treatment of LSC but are unlikely to offer the patient any benefit.


A major pitfall in the treatment of LSC is failure to identify the primary driver of the patient’s scratch–itch cycle.



LSC can become superinfected. Skin lesions demonstrating signs of warmth, erythema, or discharge should be cultured and treated with either a topical or oral antibiotic.


Counseling


You have a condition called “lichen simplex chronicus.” This type of rash is usually caused by excessive scratching or rubbing of the same area of skin over time. This condition is frequently difficult to treat.


There are several things you should do to treat your rash. First, you have been prescribed a topical corticosteroid. Apply this to the affected area and then wrap the area with saran wrap to help get the medicine into the skin. If this is not feasible, apply a bandage over the prescription cream. Second, keep the area covered with a bandage at all times, even when you sleep. Lastly, apply a thick moisturizing cream to the area every time that it itches as many times as is necessary throughout the day.


If your rash fails to improve despite this therapy, we will re-evaluate it.


Keloids


Shivani Sinha, Gloria Lin, and Katalin Ferenczi


Clinical features


Keloids are characterized by an excessive growth of scar tissue in response to dermal injury; rarely, they have been reported to present spontaneously in patients prone to developing keloids. They are more commonly seen in younger, darker-skinned individuals, who may be genetically predisposed to developing these lesions. Their cosmetically disfiguring nature and lack of efficacious therapies can make this a challenging diagnosis because patients may be disappointed with the treatment outcomes.



Differential diagnosis


The differential diagnosis for keloids include hypertrophic scars, dermatofibromas (DFs), dermatofibrosarcoma protuberans (DFSP), foreign body reaction, sarcoidosis, keloidal scleroderma, and lobomycosis.




Work-up


This is usually a clinical diagnosis based on physical examination and history.



Initial steps in management


The initial management of keloids is complex and often requires a combination of therapies. The most important step in management is to educate the patient on avoiding cutaneous injury and to discuss realistic treatment expectations.


Jul 22, 2021 | Posted by in Dermatology | Comments Off on Benign flesh-colored, pink, and red skin growths
Premium Wordpress Themes by UFO Themes