Chapter 11: Common Skin Complaints

Management strategies range from topical minoxidil and corticosteroids for localized loss to systemic agents like finasteride and immunomodulators for extensive involvement. The chapter then addresses pigmentation disorders, emphasizing the importance of recognizing that darker skin naturally contains larger melanosomes and benign variations that must be distinguished from pathological conditions. Vitiligo represents autoimmune-mediated melanocyte loss treated with corticosteroids, tacrolimus, or phototherapy, while melasma and chloasma respond to combination approaches using sunscreen, hydroquinone, and retinoids. The discussion includes systemic causes of hyperpigmentation such as Addison's disease and guidance on melanoma screening using the ABCDE criteria, with particular attention to acral presentations in darker-skinned populations. Pruritus is presented as a symptom requiring differentiation based on presence or absence of visible rash, with rash-associated cases suggesting external causes like scabies and contact dermatitis, while pruritus without rash often indicates systemic disease including renal failure, liver disease, thyroid dysfunction, or malignancy. The chapter emphasizes breaking the itch-scratch cycle through antihistamines, topical anesthetics, and emollients. Life-threatening conditions including mammary Paget's disease and toxic shock syndrome are highlighted as requiring urgent intervention. Finally, urticaria is explained as mast cell-mediated histamine release presenting as transient wheals, with acute and chronic variants managed through trigger avoidance and stepwise pharmacological escalation from second-generation antihistamines through immunosuppressive and biologic agents for refractory cases.