Thank you for following the skin disorders online column this year. We conclude our 2020 journey together by looking at uncommon skin disorders, including peeling skin syndrome, elastoderma, chromhidrosis, and acanthosis nigricans. PEELING SKIN SYNDROME Peeling skin syndrome is a genetic disorder characterized by the constant flaking of the skin, itchiness, and erythema. The symptoms of this disorder can present shortly after birth or develop in adolescence or adulthood. Subtypes The first type of peeling skin syndrome is noninflammatory type A. This presents with generalized white scaling and painless flaking. The second type is inflammatory type B, an inflamed, itchy area with superficial patchy flaking. Some families report an acral form of peeling skin syndrome, in which peeling occurs only on the hands and feet. Identification of mutations in the Transglutaminase X and Cystatin A genes have been linked to this condition.Peeling skin syndrome is inherited in an autosomal recessive pattern, meaning that two copies of an abnormal gene must be present in each cell. Both parents must carry these mutated genes to pass along the disorder to their child. Typically, neither parent will display any symptoms of the disorder. Science is still searching for a cure. Symptoms According to The Human Phenotype Ontology database, approximately 80% to 99% of patients with peeling skin syndromedisplay symptoms, some of which include between30% to 79% of patients displaying an abnormal hair texture. Other symptoms and conditions include the following: Abnormal or generalized blistering of the skin Aminoaciduria–high levels of amino acids in the urine Dry skin Ichthyosis–dry, thickened, and scaly skin Treatment A medical professional must test for and diagnose this condition. Unfortunately, science is still searching for effective treatment options. Topical emollients (skin softeners) provide some comfort and keratolytic. Keratolytic (exfoliating) agents can soften the surface cells of the stratum corneum and speed up desquamation to improve the appearance of the skin. ELASTODERMA Another rare skin condition is elastoderma, sometimes referred to as acquired skin laxity. It displays as lax or sagging skin in a specific area of the body. The elasticity of the skin is substantially decreased.Commonly affected areas are the neck, elbows, and knees. The exact cause is unknown as it affects males and females and all ethnicities equally. Elastoderma can occur in adults as well as adolescents. The exact cause of this condition is known, but many health professionals believe that an overabundance of elastin fibers in the affected area may play a factor. Diagnosis and Treatment A medical professional must diagnose this condition after a complete evaluation, including a skin biopsy. Some patients have been treated with surgical removal of the affected skin, but the laxity usually returns. There is ongoing research to find the exact cause and effective treatment options for elastoderma. Chromhidrosis The secretion of colored sweat identifies this rare skin condition. The sweat discoloration is caused by the lipofuscin deposits in the sweat glands. Lipofuscins are yellow-brown pigment granules composed of lipid-containing residues that occur as cells disintegrate in the cell turnover process. The condition itself is harmless, but it may lead to embarrassment, causing depression or anxiety. Symptoms Sweat secretions can be blue, green, yellow, pink, or black. Usually, chromhidrosis affects the apocrine glands, mainly on the face and underarms. The apocrine glands are the sweat glands that open into the hair follicle. Diagnosis and Treatment A medical diagnosis is required to confirm chromhidrosis. A biopsy is looking for an increased number of lipofuscin granules in the apocrine cells. Two commonly used treatments are over-the-counter capsaicin cream 0.025% (applied topically) and Botox injections. ACANTHOSIS NIGRICANS Acanthosis nigricans is a common, chronic skin condition that presents as dark, velvety patches in body folds and creases. Roughly, 3,000,000 cases are reported each year in the United States.This condition can last for years or even throughout an individual’s lifetime. The armpits, groin, and neck are commonly affected areas. Changes in skin color and texture occur slowly. Occasionally, the affected skin is itchy and may have an odor.Association with other conditions or diseases is also common. Insulin resistance or diabetes Hormonal disorders, underactive thyroids, or problems with the adrenal glands High-dose niacin, birth control pills, prednisone, and other corticosteroids Cancer has been found that patients with lymphoma or a cancerous tumor in the stomach, colon, or liver have developedacanthosisnigricans. Treatment Options The primary treatment option is to address the underlying issue, which will often return normal skin color and texture.Weight loss, regaining a hormonal balance, and using skin lightening creams can also be helpful. The message is simple. Develop a good relationship with a physician, especially a dermatologist. Many conditions that the aesthetician may encounter need to be diagnosed and treated by a medical provider. Clients often ask their aesthetician’s opinion on various skin abnormalities. They must politely remind clients that we cannot diagnose any condition and refer them to their medical provider for guidance. References “Peeling Skin Syndrome.” Genetic and Rare Diseases Information Center. U.S. Department of Health and Human Services, 2020. https://rarediseases.info.nih.gov/diseases/7347/peeling-skin-syndrome. Fletcher, Jenna. “Chromhidrosis: Definition, Causes, and Treatment.” Medical News Today.MediLexiconInternational, 2020. https://www.medicalnewstoday.com/articles/chromhidrosis. “Acanthosis Nigricans.” Mayo Clinic. Mayo Foundation for Medical Education and Research, June 9, 2020. https://www.mayoclinic.org/diseases-conditions/acanthosis-nigricans/diagnosis-treatment/drc-20368987. “Elastoderma.” Genetic and Rare Diseases Information Center. U.S. Department of Health and Human Services, 2015. https://rarediseases.info.nih.gov/diseases/12716/elastoderma. Brenda Lindayis a licensed aesthetician, licensed aesthetic instructor, and certified aesthetic consultant with over 16 years’ experience in the medical aesthetic industry. Linday serves as a consultant for medical and aesthetic companies desiring to build strong sales and education teams. She develops clinical and sales education content, and trains sales and educational units, clinicians, physicians, and distributors around the world. Linday is also a featured author in many industry publications. Her passion is sharing her wealth of knowledge with other like-minded professionals who believe that education is the key to building lasting relationships with our clients, making each clinician more successful by increasing client satisfaction. Reach her at bThis email address is being protected from spambots. You need JavaScript enabled to view it. or @LindayConsult. Want to read more? Subscribe to one of our monthly plans to continue reading this article.