Basal cell carcinoma (BCC)

 Basal cell carcinoma (BCC) is the most common type of skin cancer and originates from basal cells (small, round cells) in the lower part of the epidermis (outermost layer of the skin) Although BCC grows slowly and rarely spreads to other parts of the body, if left untreated it can cause significant damage to surrounding tissue.

 Causes and risk factors:

 Main causes:

 Ultraviolet (UV) light: damages the DNA of skin cells. 

 Risk factors:

1. White skin: people with fair skin, blonde or red hair, blue or green eyes are at higher risk.
2. Age: more common in older people, but young people can also get the disease if they have high sun exposure. 
3. Gender: more common in men: slightly more common in men than in women. 
4. Geographical factors: living in sunnier areas or at higher altitudes increases the risk.
5. Family history: genetic predisposition may play a role. Arsenic exposure: occupational exposure increases the risk.
6. Radiotherapy: previous treatment for other diseases increases susceptibility.
7. Immunosuppression: HIV/AIDS and drug treatment (e.g. after organ transplantation) may increase the risk. 

Symptoms :

1. Pearl-like or waxy bumps: usually develop on sun-exposed areas such as the face, neck and ears. Blood vessels may be visible.
2. Flat, scaly patches: More likely to appear on the back and chest. 
3. Non-healing sores: bleed, ooze or crust over and do not heal completely.
4. Scar-like areas: white, yellow or waxy, often with indistinct borders.
5. Dark lesions: rarely have melanoma-like pigmentation.

 Types of basal cell carcinoma:

• Nodular BCC: the most common type. Occurs as pearly, dome-shaped nodules with visible blood vessels. 
• Superficial BCC: usually appears as flat scaly plaques on the trunk. It may resemble eczema or psoriasis.
•  Sclerosing BCC: appears as scar-like, whitish areas. It is more aggressive and can be difficult to treat.
•  Pigmented BCC: contains melanin and can be brown, blue or black in color. It is often confused with melanoma.
•  Basal squamous cell carcinoma: Rare hybrid form with features of both basal cell carcinoma and squamous cell carcinoma. The risk of metastasis is slightly higher. 

Diagnosis :

1. Physical examination: the dermatologist examines the skin and records the size, shape and texture of the lesion.
2.  Dermatoscopy: a hand-held device (dermatoscope) is used to more clearly identify skin structures. 

• Skin biopsy: shave biopsy: removal of the superficial layer of the lesion.
•  Punch biopsy: a small cylindrical sample is taken. 
• Extraction biopsy: if small, the entire lesion is removed.

   3. Histopathology: The biopsy sample is examined under a microscope to confirm that it is BCC. 

Treatment options 

The choice of treatment depends on the size, location and type of BCC and the general condition of the patient.

1.Surgical options :

• Excisional surgery: the lesion is excised and healthy tissue is left intact.
• Mohs micrographic surgery: 
•  best for high-risk areas (face, ears, hands).  
•  The tumor is removed layer by layer and observed under a microscope until the cancer cells disappear. 

  Curettage and electrocautery:

• the tumour is scraped out and then cauterized to destroy the remaining cells.
•  Suitable for small, low-risk BCC.

2. Non-surgical option:

cryotherapy:

• freezing the lesion with liquid nitrogen. 
• Effective for small, superficial BCCs. 

Local treatment: 

imiquimod cream: 

• boosts the immune response to attack cancer cells.

 5-fluorouracil (5-FU): 

• chemotherapy cream that destroys cancer cells.

 Photodynamic therapy (PDT):

• uses light-sensitive drugs activated by laser light to kill cancer cells.
•  Suitable for superficial BCC. 

3. Radiotherapy: 

• used when tumors are large, recur or surgery is not an option.
•  Targeted radiation is given to destroy cancer cells.

 4. Targeted therapy: 

hedgehog pathway inhibitors (for advanced BCC): 

vismodegib (Elivedge) and sonidegib (Odomzo): 

• Oral drugs that inhibit signaling pathways important for BCC growth. 
• It is used when surgery or radiotherapy is not possible.

 Prognosis and follow-up :

Prognosis: Good if treated early. The cure rate for small, localized BCCs is over 95%. 

Risk of recurrence: Higher in patients with a history of BCC. Regular skin checks (every 6-12 months) are recommended after treatment.

 Long-term management Sun protection: comprehensive sun protection, protective clothing, avoidance of peak UV hours. Self-examination for new lesions or skin changes. 

Prevention tips :

Sunscreen:

•  use sunscreen with SPF 30 or higher every day, even on cloudy days. 
• Wear a wide-brimmed hat, sunglasses and long-sleeved clothing.

 Avoid tanning beds: 

• UV radiation from tanning beds significantly increases the risk of skin cancer. 
• Regular skin checks: do monthly self-checks and see a dermatologist once a year.

 Healthy lifestyle: 

• avoid smoking and excessive alcohol consumption.
•  Eat a balanced diet high in antioxidants.

 Key points :

• Early diagnosis and treatment of basal cell carcinoma is important to prevent extensive tissue damage and improve prognosis. 
• Sun protection and regular dermatologic check-ups can significantly reduce the risk of BCC.

Lupus

 Systemic Lupus Erythematosus (SLE) is a chronic autoimmune disease in which the immune system attacks healthy tissue, causing inflammation and damage to various organs and tissues. Lupus affects the skin, joints, kidneys, heart, lungs, brain, and blood cells. It is a complex condition with varying severity, and its cause is not fully understood. 

Types of Lupus

1. Systemic Lupus Erythematosus (SLE): -

•  The most common and severe form of the disease. 
•  It affects multiple organ systems, including the skin, kidneys, and central nervous system. 

2. Cutaneous lupus erythematosus: - 

• Primarily affects the skin

         Types include: 

•      Discoid lupus erythematosus (DLE):  may cause scarring.

•    Subacute cutaneous lupus erythematosus: red, scaly  lesions, sensitive to sunlight; 

3. Drug-induced lupus: 

       

•  caused by certain drugs (hydralazine, procainamide, isoniazid, etc.).
•  Symptoms resolve when the drug is discontinued.

 4. Neonatal lupus: - 

• Rare disease that affects newborns of mothers with lupus. 
•  May cause skin rash, liver damage, congenital heart block.

 Causes: - 

 The exact cause of lupus is unknown, but is thought to be the result of a combination of genetic, environmental, and hormonal factors. 

• Risk Factors - Gender More common in females (90% of cases). 
• Age: 15-45 years most common. 
• Ethnicity: More common in African Americans
• Heredity: Family history of lupus and other autoimmune diseases. 
• Environmental factors: 

1. sunlight (u.v light)
2. Infections (e.g., Epstein-Barr virus).  
3. Certain medications. 

•  Hormones: estrogen may be involved. 

 Symptoms:

 Symptoms of lupus are variable, with flare-ups and remissions.

 Common symptoms include:

 1. General Symptoms - 

• Fatigue. 
• Fever. 
• Weight loss or gain;

 2. Skin and hair -

• Erythema Butterfly red rash across cheeks and nose;
• Photosensitivity (photosensitivity). 
• Discoid (round, scaly) rash. 
• Hair thinning or alopecia.

 3.Joints and muscles: -

•  Joint pain, swelling (arthritis), especially morning stiffness. 

4. Kidneys: - 

• Lupus nephritis: inflammation of the kidneys that causes protein in the urine, swelling, and high blood pressure. 

5. Heart and lungs: -

•  Pleurisy (chest pain when breathing).
•  Pericarditis (inflammation around the heart).

 6. Nervous System: -

• Headaches, confusion, memory loss. 
•  Seizures or strokes

 7. Hematologic and Immune System: - 

• Anemia. 
• Low platelet or white blood cell counts.
• Increased risk of blood clots. 

 Diagnosis:

 Lupus can be difficult to diagnose because the symptoms are similar to those of other diseases. Diagnosis is based on a combination of the following: 

1. History and physical examination; 

2. Clinical examination: - 

• Antinuclear antibody (ANA) test: detects autoantibodies. 
•  Anti-dsDNA and anti-Smith's antibodies: specific by lupus. 
•  Complement levels (C3, C4): often low during disease activity.
•   Urinalysis: detects renal involvement; 

3. Imaging: - chest x-ray or echocardiography to look for heart or lung involvement;

4. Biopsy: - renal biopsy to evaluate for lupus nephritis;

 Treatment :

There is no cure for lupus, but treatment is aimed at controlling symptoms, preventing flare-ups, and reducing organ damage.

1. Medication - 

• Nonsteroidal anti-inflammatory drugs (NSAIDs): for joint pain and inflammation.
• Antimalarial drugs (e.g., hydroxychloroquine): reduce skin and joint symptoms and prevent flare-ups. 
• Corticosteroids(e.g., prednisone): Used for severe inflammation.
• Immunosuppressants(e.g., methotrexate, azathioprine): suppress the immune system. 
• Biologic therapies (e.g., belimumab, rituximab): target specific immune pathways 

2. Improve lifestyle habits: - 

•   Avoid sun exposure and use sunscreen and protective clothing. 
•  Exercise regularly to reduce joint pain and fatigue. 
•  Manage stress to prevent flare-ups. -
•  Maintain a healthy diet to maintain general health.

 3.Treatment of Organ Complications: - 

• Dialysis or kidney transplantation for severe lupus nephritis. 
•  Use blood thinners for blood clotting disorders.

Complications:

1. Organ damage: - permanent damage to kidneys, heart, lungs, or brain

2. Infections: - due to compromised immune system or immunosuppressive therapy

3. Cardiovascular disease: - increased risk of heart attack or stroke 

4.Pregnancy complications: - increased risk of miscarriage, preeclampsia, or premature delivery.

 Prognosis - 

• Mild to moderate: Most people can manage lupus effectively with treatment and lifestyle adjustments. 
• Severe cases: Aggressive treatment and regular follow-up are necessary if organ involvement is present.  
• Advances in treatment have improved lupus survival and quality of life.

    Living with lupus:

•   Establish a strong support system, including health care providers, family members, and support groups. 
• Identify symptoms and triggers and address flare-ups. 
• Stay informed about the latest research and treatments.

Psoriasis

Psoriasis is a chronic autoimmune skin disease that causes rapid accumulation of skin cells, scaling, redness, and inflammation. Psoriasis is not contagious and often has a genetic component. Psoriasis can occur on any part of the body and varies in severity. 

 Types of Psoriasis:

1. Psoriasis Vulgaris: - 

• Most common form. 
• It is characterized by raised red patches covered with silvery-white scales.
• Typically seen on the scalp, elbows, knees, and lower back

2. Guttate Psoriasis: - 

• appears as small, drop-like sores on the trunk, arms, legs, or scalp. 
• Often provoked by bacterial infections such as streptococci.

3. Psoriasis Inversa: - 

• occurs in folds of skin (e.g., under the breasts, around the groin area). 
• Smooth, shiny red patches without scaling;

 4. Pustular psoriasis: -

• characterized by white pustules (pus-filled blisters) surrounded by red skin. 
• It may be localized to the hands and feet or spread over the entire body.

5. Erythrodermic Psoriasis: - 

• Rare and severe form, causing extensive redness, scaling, and desquamation. 
• It can be life-threatening and requires immediate treatment.

6. Nail Psoriasis: -

• Fingernails and toenails are affected, causing depression, discoloration, thickening or peeling of the nail bed.

7. Psoriatic Arthritis: -

•  Joint pain, stiffness and swelling, often with skin symptoms. 

General Skin Symptoms: - 

• Red inflamed patches on the skin.
• Silvery-white scales or plaques.
• Dry, cracked skin may bleed. 
• Itching, burning, and pain in affected areas. 

 Nail changes: -

• Pitted, raised or thickened nails. 
• Nail detachment from nail bed. 

 Joint Symptoms(in psoriatic arthritis): - 

• Joint pain, swelling, stiffness. 
• Decreased range of joint motion. 
• Morning stiffness lasting several hours. 

Causes and Triggers :

 Causes: Psoriasis is an autoimmune disease, which causes rapid cell turnover (3-7 days instead of the usual 28 days) as the immune system mistakenly attacks healthy skin cells. The result is an accumulation of skin cells and characteristic scaling.

 

Triggers :

• Stress: Stress exacerbates symptoms. 
• Infections: e.g., streptococcal or respiratory infections. 
• Weather: Cold, dry weather can aggravate symptoms. 
• Injuries: wounds, cuts, sunburn (Kevner's phenomenon). 
• Medications: beta-blockers, lithium, antimalarials. 
• Lifestyle: smoking, alcohol consumption, obesity. 

 Diagnosis : 

Physical Examination: - 

• Based on the appearance of the skin, scalp, or nails.

Skin biopsy: - 

• Rarely, a small sample of skin may be examined under a microscope to confirm the diagnosis and rule out other conditions. 

Treatment:

 There is no cure for psoriasis, but there are a variety of treatments aimed at reducing symptoms, reducing flare-ups, and improving quality of life. 

Topical Treatments: 

1.Corticosteroids: -

•  Reduce inflammation and itching.
• Examples: hydrocortisone, betamethasone; 

2. Vitamin D analogues: -

•  slow skin cell growth. 
•  Examples: calcipotriol, calcitriol.

3. Cole tar: -

• reduces scaling, itching and inflammation.

4. Salicylic acid: -

•  removes scaling and promotes the effects of other treatments.

5. Hydrating agents and emollients: - 

• moisturizes skin and reduces scaling.

  Phototherapy:

1. Ultraviolet Phototherapy: - 

• irradiate skin with controlled amounts of ultraviolet B.

 2. PVA Therapy: - 

• use UVA light in combination with a photosensitizer (psoralen).

 Systemic Therapy (moderate to severe): 

1. Medications: - 

• Methotrexate: methotrexate: reduces inflammation and suppresses the immune system.
• Cyclosporine: suppresses the immune system. 
• Acitretin: retinoid that normalizes skin cell growth.

 2. Biologic Therapy: - 

• Targets specific immune pathways involved in psoriasis.
• Examples: adalimumab, infliximab, etanercept, secukinumab, ustekinumab. 

Complications - 

Psoriatic arthritis: - 

•  may cause permanent joint damage if untreated.

Increased risk of other diseases: -

•  Cardiovascular disease, type 2 diabetes, metabolic syndrome.
•  Anxiety, depression, low self-esteem. 

 Infections: - 

• Open or cracked skin can become infected.

 

Prevention and Management - 

Avoid Triggers: - 

• Identify and minimize stress, injuries, and irritants that aggravate symptoms. 

 Maintain a healthy lifestyle: - 

• Eat a balanced diet, exercise, avoid smoking and alcohol. 

 Skin Care - 

• Use gentle cleansers, moisturize frequently, and avoid harsh chemicals.

 - Regular checkups: - 

• Monitor symptoms and consult a health care professional to adjust treatment as needed. 

Prognosis :

Psoriasis is a lifelong disease with periods of remission and flare-ups. With effective management, most individuals can control symptoms and maintain a good quality of life. Newer therapies, especially biologic agents, have significantly improved the prognosis of patients with moderate to severe psoriasis.