Health Library Skin ChangesFrom Healthwise

Most skin bumps, spots, growths, and moles are harmless. Colored skin spots, also called pigmented lesions (such as freckles, moles, or flesh-colored skin spots), or growths (such as warts or skin tags) may be present at birth or develop as the skin ages.

Most skin spots on babies will go away without treatment within a few months. Birthmarks are colored marks on the skin that are present at birth or develop shortly after birth. They can be many different sizes, shapes, and colors, including brown, tan, black, blue, pink, white, red, or purple. Some birthmarks appear on the surface of the skin, some are raised above the surface of the skin, and some occur under the skin. Most birthmarks are harmless and do not need treatment. Many birthmarks change, grow, shrink, or disappear. There are many types of birthmarks, and some are more common than others. For more information, see the topic Birthmarks.

Cause of skin changes

Acne is a common skin change that occurs during the teen years and may last into adulthood. Acne may be mild, with just a few blackheads (comedones), or severe, with large and painful pimples deep under the skin ( cystic lesions). It may be present on the chest and back as well as on the face and neck. Boys often have more severe outbreaks of acne than girls. Many girls have acne before their periods that occurs because of changes in hormone levels. For more information, see the topic Acne Vulgaris.

During pregnancy, dark patches may develop on a woman's face. This is known as the "mask of pregnancy," or chloasma, and it usually fades after delivery. The cause of chloasma is not totally understood, although it is thought that increased levels of pregnancy hormones cause the pigment-producing cells in the skin (melanocytes) to produce more pigment. You can reduce skin pigment changes during pregnancy by using sunscreen and staying out of the sun.

Actinic keratosis is a type of colored skin spot that is caused by too much sun exposure. Although it is not a skin cancer, it may mean that you have an increased chance of getting skin cancer, such as squamous cell skin cancer.

You may have an allergic reaction to a medicine that causes a skin change, or develop a skin reaction when you are out in the sun while you are taking a medicine (this is called photosensitivity). Rashes, hives, and itching may develop, and in some cases may spread to areas of your skin that were not exposed to the sun (photoallergy). For more information, see the topic Allergic Reaction.

Skin changes can also be caused by:

• Autoimmune diseases, such as lupus and scleroderma.
• Reactions to a bite, such as Lyme disease from a tick bite. For more information, see the topic Lyme Disease.
• Bacterial skin infections, such as impetigo and cellulitis.
• Viral infections, such as chickenpox, shingles, or fifth disease.
• Liver problems, such as hepatitis, which may cause your skin and the whites of your eye to turn yellow ( jaundice).

Common skin changes

Some common skin growths include:

• Moles. Most people have between 10 and 40 moles. You may continue to form new moles until you are in your 40s. Moles may change over time. They can gradually get bigger, develop a hair, become more raised, get lighter in color, fade away, or fall off.
• Skin tags are harmless growths that appear in the skin folds on the neck, under the arms, under the breasts, or in the groin. They begin as small fleshy brown spots and may grow a small stalk. Skin tags never turn into skin cancer.
• Seborrheic keratoses are harmless skin growths that are found most often on the chest or back, occasionally on the scalp, face, or neck, and are less common below the waist. They begin as slightly raised tan spots that develop a crusty appearance like that of a wart. Seborrheic keratoses never turn into skin cancer. For more information, see the topic Seborrheic Keratosis.

Treatment of a skin change depends on what is causing the skin change and what other symptoms you are having. Moles, skin tags, and other growths can be removed if they become irritated, bleed, or cause embarrassment.

Skin cancer

While most skin changes are normal and occur with aging, some may be caused by cancer. Skin cancer may start as a growth or mole, a change in a growth or mole, a sore that does not heal, or irritation of the skin. It is the most common form of cancer in North America.

Skin cancer destroys skin cells and tissues and can spread (metastasize) to other parts of the body. The three most common types of skin cancer are basal cell cancer, squamous cell cancer, and melanoma. See a picture of the ABCDs of melanoma.

Causes of skin cancer include:

• Overexposure to the sun, such as a severe, blistering sunburn during childhood.
• Years of overexposure to the sun as an adult.
• The use of tanning beds or sunlamps. UV rays from a tanning bed may actually be more harmful than the sun because they are more intense.
• Repeated exposure to X-rays, chemicals, and radioactive substances.
• Radiation treatments for conditions such as eczema, psoriasis, or acne.

Kaposi's sarcoma is a serious form of skin cancer. It is often found in people who have an impaired immune system, such as people with AIDS. Blue-red raised bumps (nodules) may appear on the face, arms, and trunk and inside the mouth.

Early detection and treatment of skin cancer can help prevent problems. Treatment depends on the type and location of the growth and how advanced it is when it is diagnosed. Surgery to remove the growth will help determine what treatment will be needed. For more information, see the topics Skin Cancer, Melanoma or Skin Cancer, Nonmelanoma.

Review the Check Your Symptoms section to determine if and when to see a doctor.

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have any of the following symptoms, evaluate those symptoms first:

• A rash that may be caused by an allergic reaction: Go to the topic Allergic Reaction.
• A bump, sore, or ulcer in or around the mouth: Go to the topic Mouth Problems, Noninjury or Toothache and Gum Problems.
• A boil, swollen gland, or other lump under the skin: Go to the topic Swollen Glands and Other Lumps Under the Skin.
• A bump, sore, or ulcer on the genitals or around the anus: Go to the topics:
  • Exposure to Sexually Transmitted Diseases.
  • Male Genital Problems and Injuries.
  • Rectal Problems.
• A blister: Go to the topic Blisters.
• An insect bite or sting: Go to the topic Insect Bites and Stings and Spider Bites.
• A red bump that develops within weeks of a known tick bite: Go to the topic Tick Bites.

	Yes	Do you think you have a skin infection?
When to See a Doctor See significance of a skin infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have diabetes? Yes Do you have peripheral arterial disease? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have increased pain, swelling, redness, or warmth around the affected area? Yes Do you have red streaks extending from the affected area? Yes Do you have drainage of pus from the affected area? Yes Do you have swollen lymph nodes in your neck, armpit, or groin? Yes Do you know or think you have a fever? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had mild pain and swelling with redness less than 1 in. (2.5 cm) around a sore for 24 hours or longer? Yes Have you had swollen lymph nodes near a sore for 24 hours or longer? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had changes in a mole or other colored skin spot?
When to See a Doctor See significance of a mole or colored skin spot that bleeds or changes in size, shape, texture, color, or sensation if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Has a mole or colored skin spot gotten larger? Yes Has a mole or colored skin spot developed jagged or scalloped edges (irregular borders)? Yes Has part or all of a mole or colored skin spot turned red, white, blue, black, or a mix of colors? Yes Has part or all of a mole or colored skin spot lost its color? Yes Has color from part or all of a mole or colored skin spot spread into surrounding skin? Yes Has a flat mole or colored skin spot become thicker or raised? Yes Does a mole or colored skin spot look scaly, crusty, or worn down (eroded)? Yes Does a mole or colored skin spot itch, tingle, burn, or hurt when you touch it? Yes Do you have an open sore (ulcer) in a mole or colored skin spot? Yes Has a mole or colored skin spot started to break off or bleed easily? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your skin changes may be caused by a medicine?
When to See a Doctor See significance of medicines and skin changes if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Do you think that your skin change may be caused by a medicine? Note: Call the doctor who prescribed the medicine to find out if you should stop taking the medicine or take a different one. An appointment may not be necessary. If you are taking a nonprescription medicine, stop taking the medicine. Call your doctor if you feel that you need to continue taking the medicine. If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Does your skin look yellow?
When to See a Doctor See significance of skin that looks yellow if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do the whites of your eyes look yellow? Yes Is your urine a dark amber color? Yes Does your skin itch? Yes Are your stools whitish or very light-colored? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does your skin look yellow, but you do not have other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have irritation in or around a skin bump, spot, growth, or mole?
When to See a Doctor See significance of irritation of a skin bump, spot, growth, or mole if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Does the location of a spot or bump, such as having a mole in an area where you shave, make irritation difficult to avoid? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Are you worried about or embarrassed by a skin bump, spot, or growth?
When to See a Doctor See significance of a worrisome or embarrassing skin bump, spot, or growth if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Does a raised skin bump have a smooth, shiny, pearly appearance? Yes Does a raised, firm bump look like a scar? Yes Does a firm, red bump bleed easily or look scaly or crusty? Yes Do you have a rough, red or brown scaly spot or patch of skin? Yes Are you worried about a new skin growth or mole? Yes Have you had a skin spot, bump, or growth for 4 weeks or longer without other symptoms? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think that your skin changes are related to pregnancy?
When to See a Doctor See significance of skin changes during pregnancy if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Do you think that your skin changes are related to pregnancy? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• A bump on the toe, foot, or heel: Go to the topic Toe, Foot, and Ankle Problems, Noninjury.
• A bump on the finger, hand, or wrist: Go to the topic Finger, Hand, and Wrist Problems, Noninjury.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Most bumps, spots, growths, or moles do not need any type of home treatment. However, the following measures may be helpful:

• Keep the area clean and dry. Wash with a mild soap and warm (not hot) water. Do not scrub.
• Avoid irritating the area.
  • Do not squeeze, scratch, or pick at the spot.
  • Leave the spot exposed to the air whenever possible.
  • Adjust your clothing to avoid rubbing the bump or spot, or cover it with a bandage.
• Conceal a mole or birthmark if you are embarrassed by how it looks. Many cosmetics are designed for this purpose.
• Use a humidifier in your home in the winter or all year if you live in a dry climate.
• Shower after swimming or using a hot tub to rinse off chlorine or salt water. Use a moisturizer after showering.
• Perform a skin self-exam to learn about your skin. This will help you spot new skin growths.
• Eat a balanced diet and drink 8 to 12 glasses of water each day. For more information, see the topic Healthy Eating.

Protect your skin from the sun:

• Limit your exposure to the sun, especially from 10 a.m. to 4 p.m.
• Wear protective clothing, including a wide-brimmed hat, a long-sleeved shirt, and pants.
• Wear sunglasses that block ultraviolet (UV) rays.
• Use a sunscreen that blocks ultraviolet rays (both UVA and UVB) and has a sun protection factor (SPF) of 15 to 30 every day, all year, even when it is cloudy.
• Use a product with an SPF of 15 to 30 on the backs of your hands.
• Do not use tanning booths and sunlamps, which give off ultraviolet radiation and can cause skin damage and increase the risk of skin cancer.

Try the following measures if a bump, spot, or growth shows minor signs of infection, such as a small amount of pus or redness around the bump:

• Gently wash the spot with an antibacterial soap once or twice a day.
• Leave the spot unbandaged, unless it becomes irritated or dirty.
• If a spot becomes dirty or irritated, apply an antibiotic ointment, such as bacitracin or polymyxin B sulfate, and cover it with an adhesive bandage. The ointment will keep the spot from sticking to the bandage.

  Note: Stop using the ointment if the skin under the bandage begins to itch or develops a rash. The ointment may be causing a skin reaction.

• Change the bandage every day and any time it gets wet. If a dressing is stuck to a scab, soak the dressing in warm water to soften the scab and make it easier to remove the bandage.
• Watch for other signs of infection, such as increasing pain, swelling, redness, heat, fever, or chills.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Signs of a skin infection develop.
• A mole or colored skin spot:
  • Bleeds or forms an ulcer.
  • Changes in size, shape, or texture.
  • Becomes sensitive, itchy, or painful.
• Symptoms do not improve, become more severe or frequent, or don't go away.

Most noncancerous skin bumps, spots, and growths cannot be prevented. However, there are steps you can take to help prevent some skin problems:

• Prevent irritation.
  • Wear soft, cotton clothing or moleskin under sports equipment (if possible). Parts of equipment, such as chin straps, can rub your skin spots and irritate them.
  • Avoid wearing clothing that is too tight.
  • Adjust your clothing so that belts, straps, or elastic from your bra or underwear don't rub against spots.
• Decrease the chance of skin infection.
  • Wash with lukewarm water and a mild soap or cleanser. Do not use deodorant soaps or soaps and skin cleansers that contain irritating substances.
  • Rinse your skin thoroughly after you wash it.
  • Gently pat your skin dry.
  • Avoid squeezing any lumps that form under the skin.
  • Wash soon after participating in activities that cause you to sweat.
  • Avoid skin care products that contain oil, which may clog your pores. Instead, use water-based skin care products. Read the labels on products and look for the terms oil-free, hypoallergenic, and noncomedogenic.

Prevent skin cancer

Most skin cancer can be prevented. Use the following tips to protect your skin from the sun. You may decrease your chances of developing skin cancer and help prevent wrinkles.

Avoid sun exposure

The best way to prevent a sunburn is to avoid sun exposure.

Stay out of the midday sun (from 10 in the morning to 4 in the afternoon), which is the strongest sunlight. Find shade if you need to be outdoors. You can also calculate how much ultraviolet (UV) exposure you are getting by using the shadow rule: A shadow that is longer than you are means UV exposure is low; a shadow that is shorter than you are means the UV exposure is high.

Other ways to protect yourself from the sun include wearing protective clothing, such as:

• Hats with wide 4 in. (10 cm) brims that cover your neck, ears, eyes, and scalp.
• Sunglasses with UV ray protection.
• Loose-fitting, tightly woven clothing that covers your arms and legs.

Preventing sun exposure in children

You should start protecting your child from the sun when he or she is a baby. Because children spend a lot of time outdoors playing, they get most of their lifetime sun exposure in their first 18 years.

• Keep babies younger than 6 months of age out of the sun. If sunscreen is needed, a small amount on the face or the back of the hands is not harmful.
• Teach children the ABCs of how to protect their skin from getting sunburned.
  • A = Away. Stay away from the sun in the middle of the day (from 10 in the morning to 4 in the afternoon).
  • B = Block. Use a sunscreen with a sun protection factor (SPF) of 30 or higher to protect babies' and children's very sensitive skin.
  • C = Cover up. Wear clothing that covers the skin, hats with wide brims, and sunglasses with UV protection. Even children 1 year old should wear sunglasses with UV protection.
  • S = Speak out. Teach others to protect their skin from sun damage.

Sunscreen protection

If you can't avoid being in the sun, use a sunscreen to help protect your skin while you are in the sun.

• Use a sunscreen that has a sun protection factor (SPF) of at least 30 or higher. Sunscreens that say "broad-spectrum" can protect the skin from ultraviolet A and B ( UVA and UVB) rays. Sunscreens come in lotions, gels, creams, and ointments.
• Apply the sunscreen at least 30 minutes before going in the sun.
• Apply sunscreen to all the skin that will be exposed to the sun, including the nose, ears, neck, scalp, and lips. Sunscreen needs to be applied evenly over the skin and in the amount recommended on the label. Most sunscreens are not completely effective because they are not applied correctly. It usually takes about 1 fl oz (30 mL) to cover an adult's body.
• Apply sunscreen every 2 to 3 hours while in the sun and after swimming or sweating a lot. The SPF value decreases if a person sweats heavily or is in water, because water on the skin reduces the amount of protection the sunscreen provides. Sunscreen effectiveness is also affected by the wind, humidity, and altitude.
• Use lip balm or cream that has SPF of 30 or higher to protect your lips from getting sunburned or developing cold sores.
• Use a higher SPF at higher elevations or in tropical climates.

Some sunscreens say they are water-resistant or waterproof and can protect for about 40 minutes in the sun if a person is doing a water activity. Apply sunscreen more often if you are in water. Wet skin can burn easily, so it is important to protect your skin even if you do not feel that you are getting sunburned. Wearing a T-shirt while swimming does not protect your skin unless sunscreen has also been applied to your skin under the T-shirt.

The following tips about sunscreen will help you use it more effectively:

• Older adults should always use a sunscreen with an SPF of at least 30 to protect their very sensitive skin.
• If you have sensitive skin that burns easily, use a sunscreen with an SPF of at least 30.
• If you have dry skin, use a cream or lotion sunscreen.
• If you have oily skin or you work in dusty or sandy conditions, use a gel, which dries on the skin without leaving a film.
• If your skin is sensitive to skin products, use a sunscreen that is free of chemicals and alcohol.
• If you have had a skin reaction (allergic reaction) to a sunscreen, look for one that is free of para-aminobenzoic acid (PABA), preservatives, and perfumes. These ingredients may cause skin reactions.
• If you are going to have high exposure to the sun, consider using a physical sunscreen (sunblock), such as zinc oxide, which will stop all sunlight from reaching the skin.
• If you need to use sunscreen and insect repellent with DEET, do not use a product that combines the two. You can apply sunscreen first and then apply the insect repellent with DEET, but the sunscreen needs to be reapplied every 2 hours.

Do not use tanning booths to get a tan. Artificial tanning devices can cause skin damage and increase the risk of skin cancer.

For more information on warts, see the topic Warts and Plantar Warts.

For more information on how to help prevent acne, see the topic Acne Vulgaris.

To prepare for your appointment, see the topic Making the Most of Your Appointment

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• How long have you had the skin spot?
• Has your skin spot changed? If so, how?
• Where did it first appear? Where is it now?
• What other symptoms, such as itching or pain, do you have?
• Are there any other family memebers who have the same skin changes or a history of skin changes?
• Is there anything new or different that you have been exposed to, such as a medicine, personal care products, products at work, OR things related to sports or hobbies?
• What home treatment have you tried? How did it work?
• Have you ever been treated for a skin condition like this in the past?
• What prescription and nonprescription medicines do you take?
• Do you have any health risks?

• Acne Vulgaris
• Allergic Reaction
• Birthmarks
• Blisters
• Chickenpox (Varicella)
• Exposure to Sexually Transmitted Diseases
• Finger, Hand, and Wrist Problems, Noninjury
• Genital Herpes
• Genital Warts (Human Papillomavirus)
• Growth and Development, Newborn
• Human Immunodeficiency Virus (HIV) Infection
• Insect Bites and Stings and Spider Bites
• Lyme Disease
• Male Genital Problems and Injuries
• Mouth Problems, Noninjury
• Rash, Age 11 and Younger
• Rash, Age 12 and Older
• Rectal Problems
• Ringworm of the Scalp or Beard
• Ringworm of the Skin
• Shingles
• Skin Cancer, Melanoma
• Skin Cancer, Nonmelanoma
• Sunburn
• Swollen Glands and Other Lumps Under the Skin
• Testicular Examination and Testicular Self-Examination (TSE)
• Tick Bites
• Toe, Foot, and Ankle Problems, Noninjury
• Warts and Plantar Warts

Author:	Jan Nissl, RN, BS	Last Updated: July 10, 2007
Medical Review:	William M. Green, MD - Emergency Medicine Alexander H. Murray, MD, FRCPC - Dermatology
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