November 11, 2013
By Robert H. Shmerling M.D.
Beth Israel Deaconess Medical Center
I often describe minor abnormalities found during a physical examination as "sort of like a freckle; it's not entirely normal but nothing to worry about."
But what are freckles? Are they truly harmless? And what about the other common skin "abnormalities" that don't have much impact on health or well-being? Their names can sound scary. Find out which ones can you ignore and which ones you can't.
Common Skin Abnormalities
The skin is the largest organ in the body. And it's the first line of defense against harmful effects of the environment. Cold, heat, moisture, dryness, infectious organisms and chemicals are just some of the things that threaten your skin.
So, perhaps it shouldn't be surprising that skin can change in big and small ways over time. Some skin diseases have a major and immediate impact on health. Melanoma and serious skin infections are just two examples.
But some skin changes that aren't quite normal are harmless most of the time. You may not recognize their names. To you, it's a freckle; to your doctor, it's lentigo. Here are some other terms you may hear your doctor say.
Lentigo or ephelis (freckle) - This is the classic example of a variation in your skin that isn't harmful. Freckles tend to become more numerous or noticeable in summer and are more common among people with blonde hair and fair skin. Freckles tend to run in families and develop due to slight increases in pigment (called melanin) in the skin.
Ecchymosis (contusion or bruise) - After an injury, blood can leak out from damaged blood vessels. The appearance of blood under the skin is an ecchymosis. As the body reabsorbs it, the various pigments in blood become more apparent. That's why a bruise may start out quite dark (purple, black, dark brown or blue) and later appear lighter brown, green or yellow. Medical evaluation is recommended for unusually prominent ecchymoses that develop without trauma, as this may be due to a medication side effect or blood disorder.
Abrasion or excoriation (scrape) - When an injury removes the outermost layer of skin, the damaged skin is called an abrasion or excoriation. It's the sort of thing most people would simply call a scrape. Keeping it clean and dry will usually help it heal quickly.
Superficial laceration (a small cut near the surface) - The everyday minor cut that heals on its own might be called a superficial laceration by your doctor. With a deep laceration, the two sides of the cut may be too far apart to heal well. That's when you may need sutures (stitches). If you aren't sure or if bleeding is excessive or prolonged, seek medical attention.
Eczema (dry skin) - Dry skin is an extremely common condition, usually worsened by cold, dry climates. And, because dry skin tends to be pruritic (itchy), we often scratch it. Scratching or rubbing dry skin repeatedly over time causes the upper layers to become thickened (or "lichenified").
- Nevus (mole) - A nevus develops when melanocytes (the pigment producing cells in skin) grow in a clump rather than spread out through the skin. They are typically dark (brown or black) and raised, with smooth edges. They tend to appear in childhood and increase in number through early adulthood. They darken during pregnancy or after spending time in the sun. While most moles are benign, some are cancerous or "precancerous" and should be removed. The "ABCDE" screening is helpful to decide whether a nevus warrants removal due to a concern for skin cancer.
- Acrochordon (skin tag) - Skin tags are a bit of extra, "floppy" skin attached to the rest of the skin by a small "stalk." They tend to appear on the neck, back and armpits. While they are benign and best left alone, they can become irritated if they catch on clothes or jewelry or rubbed during normal activities. Fortunately, your doctor can easily remove them, or they may fall off on their own.
- Age spots (lentigo) - This is a type of freckle (hence the same name, lentigo) that is more common with age and sun exposure. Their impact is cosmetic and they pose no health threat. It's important to distinguish them from skin cancer.
- Seborrheic keratosis ("senile wart") - These pale or dark raised growths appear on the face, back or chest of older adults. They often appear "warty" as they grow. Their cause is unknown. As with many other benign skin conditions, they require no treatment (other than for cosmetic concerns). And they have little medical importance other than to distinguish them from skin cancer.
The Bottom Line
It can be scary to hear your doctor describe your skin as ecchymotic or lichenified. Most people would not choose to have multiple seborrheic keratoses. But some translation of what your doctor is saying can go along way toward reassuring you that your condition isn't as bad as it sounds.
Learn to speak your doctor's language. Even better, ask him to speak yours!
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Robert H. Shmerling, M.D. is associate physician at Beth Israel Deaconess Medical Center and associate professor at Harvard Medical School. He has been a practicing rheumatologist for over 20 years at Beth Israel Deaconess Medical Center. He is an active teacher in the Internal Medicine Residency Program, serving as the Robinson Firm Chief. He is also a teacher in the Rheumatology Fellowship Program.