Mood disorders

Definition

Mood disorders are mental disorders characterized by periods of depression, sometimes alternating with periods of elevated mood.

Description
Demographics

Causes and symptoms

• loss of appetite

• change in the sleep pattern, like not sleeping (insomnia) or sleeping too much

• feelings of worthlessness, hopelessness, or inappropriate guilt

• fatigue

• difficulty in concentrating or making decisions

• overwhelming and intense feelings of sadness or grief

• disturbed thinking

• certain physical symptoms such as stomachaches or headaches

When to call the doctor

Diagnosis

Treatment

• heterocyclic antidepressants (HCAs), such as amitriptyline (Elavil)

• selective serotonin reuptake inhibitors (SSRI inhibitors), such as fluoxetine (Prozac), paroxetine (Paxil), and sertraline (Zoloft)

• monoamine oxidase inhibitors (MAOI inhibitors), such as phenelzine sulfate (Nardil) and tranylcypromine sulfate (Parnate)

• mood stabilizers, such as lithium carbonate (Eskalith) and valproate, often used in people with bipolar mood disorders

While many people go through sad or elated moods from time to time, people with mood disorders suffer from severe or prolonged mood states that disrupt their daily functioning. Among the general mood disorders are major depressive disorder, bipolar disorder, and dysthymia. In classifying and diagnosing mood disorders, doctors determine if the mood disorder is unipolar or bipolar. When only one extreme in mood (the depressed state) is experienced, this condition is called unipolar. Major depression refers to a single severe period of depression, marked by negative or hopeless thoughts and physical symptoms like fatigue. In major depressive disorder, some patients have isolated episodes of depression. In between these episodes, the patient does not feel depressed or have other symptoms associated with depression. Other patients have more frequent episodes.

Bipolar depression or bipolar disorder (sometimes called manic depression) refers to a condition in which people experience two extremes in mood. They alternate between depression (the low mood) and mania or hypomania (the high mood). These patients go from depression to a frenzied, abnormal elevation in mood. Mania and hypomania are similar, but mania is usually more severe and debilitating to the patient.

Dysthymia is a recurrent or lengthy depression that may last a lifetime. It is similar to major depressive disorder, but dysthymia is chronic, long-lasting, persistent, and mild. Patients may have symptoms that are not as severe as major depression, but the symptoms last for many years. It seems that a mild form of the depression is always present. In some cases, people may also experience a major depressive episode on top of their dysthymia, a condition sometimes referred to as double depression.

Psychologists have identified the teenage years as one of the most difficult phases of human life. Although they are often seen as a time for enjoying friendship and engaging in activities that adults would not usually do, the teenage period can be difficult. Many changes in the human mind take place during puberty. Apart from the onset of sexual maturity, teenagers must also make key decisions about their future, develop their identities, change schools and meet a new sets of friends, find out about their family's past, and cope with a wide range of other issues. Many young people have difficulty coping with these stresses.

Four out of five teenagers who commit suicide are male, but the average female teenager is prone to attempt suicide four more times during her teen years than the average male. White teenage males are more likely to commit suicide than any other ethnic group, but teenage suicide among blacks was as of 2004 increasing. Teenagers who have unsuccessfully tried to commit suicide in the past are more likely to attempt suicide in the future. The odds increase after each failed attempt. There are two groups of teens that are at the highest risk for committing suicide: Native Americans and teens who are gay, lesbian, bisexual, and transgendered.

Gay and bisexual male teens, which represent about 10 percent of the male teen population, are six to seven times more at risk for attempting suicide than their heterosexual peers. Several surveys show gay and lesbian youth account for 30 percent of all suicides among teens, according to the U.S. Department of Health and Human Services. Yet most studies of teen suicide have not been concerned with identifying sexual orientation.

As many as 14 percent of children will experience at least one episode of major depression by age 15. Girls are significantly more likely to experience depression than boys after the age of 16. Out of 100,000 adolescents, two to three thousand will have mood disorders out of which 8 to 10 will commit suicide. In the early 2000s, suicide, attempted suicide, and thoughts of committing suicide are growing problems among adolescents in the United States and much of the world. It is the third leading cause of death among 15 to 19 year olds in the United States and the sixth leading cause of death among 10 to 14 year olds. About 2 percent of adolescent girls and 1 percent of adolescent boys attempt suicide each year in the United States. Another 5 to 10 percent of children and teens each year come up with a plan to commit suicide.

Mood disorders tend to run in families. These disorders are associated with imbalances in certain chemicals that carry signals between brain cells (neurotransmitters). These chemicals include serotonin, norepinephrine, and dopamine. Women are more vulnerable to unipolar depression than are men. In adults, major life stressors (like divorce, serious financial problems, death of a family member, etc.) will often provoke the symptoms of depression in susceptible people. Children's versions of these stressors contribute to their vulnerability to depression.

Major depression is more serious than just feeling sad or "blue." The symptoms of major depression may include the following:

Bipolar disorder includes mania or hypomania. Mania is an abnormal elevation in mood. These individuals may be excessively cheerful, have grandiose ideas, and may sleep less. They may talk nonstop for hours, have unending enthusiasm, and demonstrate poor judgment. Sometimes the elevation in mood is marked by irritability and hostility rather than cheerfulness. While the person may at first seem normal with an increase in energy, others who know the person well see a marked difference in behavior. The patient may seem to be in a frenzy and will often make poor, bizarre, or dangerous choices in his or her personal and professional lives. Hypomania is not as severe as mania and does not cause the level of impairment in work and social activities that mania can.

There are many methods for helping teenagers deal with mood disorders, both medical and psychological. Most teenagers who have mood disorders believe their problems are too hard or embarrassing to talk about, so it is important for a helper to show they can be trusted and talked to. Seeing a psychologist is widely recommended as well. Psychologists can improve a teenager's vision of life by listening to them and making them feel it will work out for the best.

If a child or teen is so depressed that he or she is talking about suicide, doctors recommend that parents or other helpers do not ask the adolescent what reason they have to think of such a thing to do; rather, one should listen and wait for the child to gain trust enough so that he or she finally can feel comfortable in talking about the problem. Helpers should, however, show understanding of the teenager's situation. 

Doctors also recommend that helpers do not mention any "reasons to live" to the teenager, as that might send the teenager back into depressing thoughts, e.g. "What reason do I have to live?" Many doctors recommend that teenagers be taken to a hospital immediately after they express the desire to commit suicide.

Doctors diagnose mood disorders based on the patient's description of the symptoms as well as the patient's family history. The length of time the patient has had symptoms is also important. Generally patients are diagnosed with dysthymia if they feel depressed more days than not for at least two years. The depression is mild but long lasting. In major depressive disorder, the patient is depressed almost all day nearly every day of the week for at least two weeks. The depression is severe. Sometimes laboratory tests are performed to rule out other causes for the symptoms (like thyroid disease). The diagnosis may be confirmed when a patient responds well to medication.

The most effective treatment for mood disorders is a combination of medication and psychotherapy. The four different classes of drugs used in mood disorders are as follows:

A number of psychotherapy approaches are useful as well. Interpersonal psychotherapy helps the patient recognize the interaction between the mood disorder and interpersonal relationships. Cognitive-behavioral therapy explores how the patient's view of the world may be affecting his or her mood and outlook.

When depression fails to respond to treatment or when there is a high risk of suicide, electroconvulsive therapy (ECT) is sometimes used. ECT is believed to affect neurotransmitters like the medications do. Patients are anesthetized and given muscle relaxants to minimize discomfort. Then low-level electric current is passed through the brain to cause a brief convulsion. The most common side effect of ECT is mild, short-term memory loss.

Alternative treatment

There are many alternative therapies that may help in the treatment of mood disorders, including acupuncture, botanical medicine, homeopathy, aromatherapy, constitutional hydrotherapy, and light therapy. The therapy used is an individual choice. Short-term clinical studies have shown that the herb St. John's wort (Hypericum perforatum) can effectively treat some types of depression. Though it appears very safe, the herb may have some side effects and its long-term effectiveness has not been proven. It has not been tested in patients with bipolar disorder. St. John's wort and antidepressant drugs should not be taken simultaneously, so patients should tell their doctor if they are taking St. John's wort.

Prognosis

Most cases of mood disorders can be successfully managed if properly diagnosed and treated.

Prevention

People can take steps to improve mild depression and keep it from becoming worse. They can learn stress management (like relaxation training or breathing exercises), exercise regularly, and avoid drugs or alcohol.

Parental concerns

Parents who are concerned that their child may have a mood disorder should seek help, such as from a psychiatrist, psychologist, or counselor. Make an appointment with a therapist or counselor who can talk to the child about his or her problems and ways to cope. There are a number of ways parents can help children and teens deal with loneliness, depression, and suicidal feelings. First, parents should let the child do the talking, and they should listen very carefully. They should let the child know they take his or her feelings and thoughts seriously. They should try to find out what is the root of the problem. They may also ask direct questions of the child, such as "Are you thinking of committing suicide?" or "Are you thinking of ending your life?" Third, they should stay with the child. They should not leave the child alone if they say they want to commit suicide. By staying with the child, the parent may be saving the child's life.

KEY TERMS

Cognitive therapy—Psychological treatment aimed at changing a person's way of thinking in order to change his or her behavior and emotional state.

Electroconvulsive therapy (ECT)—A psychological treatment in which a series of controlled electrical impulses are delivered to the brain in order to induce a seizure within the brain. This type of therapy is used to treat major depression and severe mental illness that does not respond to medications.

Neurotransmitter—A chemical messenger that transmits an impulse from one nerve cell to the next.

Serotonin—A widely distributed neurotransmitter that is found in blood platelets, the lining of the digestive tract, and the brain, and that works in combination with norepinephrine. It causes very powerful contractions of smooth muscle and is associated with mood, attention, emotions, and sleep. Low levels of serotonin are associated with depression.

Whitehead

What Is a Whitehead?

A whitehead is a type of acne that forms when dead skin cells, oil, and bacteria become trapped within one of your pores. Unlike a blackhead, a whitehead forms under the surface of a closed pore.Whiteheads can occur at any age. However, they most often accompany hormonal changes during puberty, menstruation, pregnancy, and menopause.In most cases, whiteheads can be prevented with a combination of lifestyle changes and medical treatments.

Causes of Whiteheads

Whiteheads are the result of blocked pores. Your pores may become blocked for several reasons.Hormonal changes are the most common triggers of acne. Certain life stages can increase the amount of sebum—or oil—your pores produce, leading to clogged pores and whiteheads. These stages include:

• puberty

• menstruation

• pregnancy

• menopause

Certain medications can also increase your hormone levels and lead to acne. Women may experience more acne during certain stages of their menstrual cycles once they stop taking birth control pills.Genetics play a role in whitehead formation as well. If someone in your family suffered from bouts of whiteheads, you are at an increased risk for developing them.

How Common Are Whiteheads?

A whitehead can develop anywhere on your body where pores might clog. The oily portions of your face—such as the nose, chin, and forehead—are the most prone to acne. However, you may also develop whiteheads on your chest, back, shoulders, and arms.Women are more prone to whiteheads since they experience the most significant hormonal changes in their lifetimes. Still, men are not immune to whiteheads, especially during puberty.In both genders, acne can occur at any age. This means that even if you did not experience problems with whiteheads as a teen, you may still develop them at some point during adulthood.

Treating Whiteheads

Whiteheads are generally considered a mild form of acne, since they are relatively easy to treat. Both over-the-counter and prescription washes and ointments can treat this condition. Products that contain benzoyl peroxide help to reduce oil production in your pores. Those containing salicylic acid work directly to break down existing whiteheads.It can take up to eight weeks for a particular treatment method to work. If you see no improvement after this period, contact your doctor about other treatment options.

Preventing Acne

Although oral and topical medications can help treat whiteheads, certain lifestyle changes can also prevent them from occurring.If you wear makeup, look for brands that are noncomedogenic. These products will not clog your pores. You should also use oil-free lotions to prevent adding more oil to your skin.Wash your hair and skin on a regular basis, but take care to avoid excessive washing. Stripping your skin of oils only increases oil production, which actually raises your risk of developing whiteheads. Use a mild cleanser to wash your face twice a day. If your hair is oily, wash it once a day.

Misconceptions About Whiteheads

There are a variety of misconceptions about whiteheads. Keep these facts in mind:

• Excessive washing and scrubbing does not prevent whiteheads.

• Junk food does not cause acne.

• Chocolate does not make acne worse.

• Stress does not trigger whiteheads.

Possible Complications of Whiteheads

The way you deal with whiteheads can affect the health of your skin. If you constantly pick at a whitehead, it is more likely to become irritated and infected. In severe cases, irritated whiteheads may cause acne scars or dark spots on your skin. Surgery may be required to treat severe scarring.Severe cases of acne can affect your emotional health. Acne is linked to low self-esteem because those with this condition often do not feel good about the way they look. According to the American Academy of Dermatology, teens with severe acne are more prone to the suicidal thoughts linked to clinical depression. For this reason, many people with severe acne are also treated for depression. You should call your doctor immediately if you experience depression that lasts for more than a few days. 

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Cyst

What Is a Cyst?

• the type of cyst

• the location of the cyst

• if the cyst causing pain or discomfort

• whether the cyst is infected

• infected

• very large

• growing in a sensitive area

• affecting the function of an organ

• infections

• inherited diseases

• chronic inflammation

• blockages in ducts

Sebaceous CystGanglion CystOvarian CystBreast CystChalaziaPilonidal CystHome CareMedical Care

• draining the cyst using a needle: This is done if a cyst becomes infected or ruptures. The fluids or other matter in the cyst will be removed.

• using anti-inflammatory medications: Cortisone injections can reduce inflammation in a cyst.

• surgical removal of the cyst: This may be used when draining does not work. Hard-to-reach internal cysts can be surgically removed instead of drained if treatment is needed.

A cyst is a sac-like pocket of tissue that contains fluid, air, or other substances. Cysts can grow almost anywhere in your body or on your skin.There are many different types of cysts. Most cysts are benign, or non-cancerous.Whether a cyst needs treatment depends on a number of factors, including:

Recognizing Cysts
A cyst can appear as a bump on your skin. It may also feel like a small lump if it is growing just under your skin.Some cysts grow deep inside your body where you cannot feel them. However, they may cause other symptoms. For example, ovarian cysts can cause hormonal problems. Polycystic kidney disease can affect kidney function.Cysts usually grow slowly and have a smooth surface. They can be tiny or very large. Most cysts are not painful. They usually do not cause problems unless they are:

Why Do Cysts Form?
Cysts form for a number of different reasons. They can be caused by:The exact cause depends on the type of cyst.

Types of Cysts
There are hundreds of different types of cysts.Cysts can grow almost anywhere in your body.Some cysts occur as part of another condition, such as polycystic kidney disease (PKD) or polycystic ovary syndrome (PCOS). Some of the more common types of cysts include:These are small, benign bumps filled with an oily substance called sebum. They are also known as epidermoid cysts.

Sebaceous cysts often form within hair follicles. They can also be caused by ruptured sebaceous glands. These are the glands that make oil for your skin and hair.In rare cases, sebaceous cysts can be caused by an inherited condition called Gardner’s syndrome.These benign cysts usually form on your wrist or hand. However, they can also develop on your feet. The reason why they form is not known.

Ganglion cysts tend to occur along a tendon sheath. They are more common in women than in men.Ovarian cysts form when the follicle that normally releases an egg does not open. This causes fluid to build up and form a cyst. These cysts occur most often between the onset of puberty and menopause. They are usually found during pelvic exams.Ovarian cysts are associated with an increased risk of cancer when they occur after menopause. (MedlinePlus)

Benign cysts can develop in your breasts when your milk ducts are blocked. They commonly occur in women in their thirties and forties. They can cause pain or tenderness in the affected area.Chalazia are benign cysts that occur on your eyelids when the oil gland duct is blocked. These cysts can cause tenderness, light sensitivity, and painful swelling. If they get too big, they can cause vision problems.These cysts form near the top of the buttocks. They are usually filled with skin debris, hair, and other matter.

Pilonidal cysts occur more often in men than in women. They can develop when loose hairs become embedded in your skin. Chronic infections in these cysts might increase your risk of a type of skin cancer called squamous cell carcinoma. (MayoClinic)

When to See Your Doctor
Schedule an appointment with your doctor if your cyst becomes very painful or red. This could be the sign of a rupture or infection.
A doctor should check your cyst even if it is not causing any pain or other problems. Abnormal growths can be a sign of cancer. Therefore, your doctor might want to remove a tissue sample for testing.

Treating Cysts
In some cases, cysts go away on their own. Putting a warm compress on a cyst can speed up the healing process by helping it drain.

You should never try to squeeze or pop a cyst on your own. This can lead to infection.Common methods of medical treatment for cysts include:

What Is the Long-Term Outlook?
Benign cysts usually do not cause long-term problems. Sometimes they even go away on their own.Cysts can grow back after being drained. If you have a cyst that keeps returning, you might want to consider having it surgically removed.Your doctor will discuss treatment if you have cancerous cysts. The outlook will vary depending on the type of cancer involved.

Preventing Cysts
Most types of cysts cannot be prevented. However, there are certain exceptions.
Women prone to ovarian cysts may be able to prevent new cysts from forming by using hormonal contraceptives.
Cleaning your eyelid near the eyelash line with a gentle cleanser can help keep the oil ducts from becoming blocked. This may help prevent chalazia.You can prevent pilonidal cysts from forming by keeping the skin in the affected area clean. You can also put powder on your skin to keep it dry. Getting up every so often instead of sitting for a long time can also help prevent these cysts.

Morbid Obesity

What is Morbid Obesity?

Obesity is a condition in which you have a high body mass index (BMI), or too much body fat for your height. Obesity is the not the same as being overweight, which is when your weight is higher than what is healthy for your height. In people who are overweight, the excess weight may be caused by high bone density, body structure, or excess body fat.

Morbid obesity occurs when the excess body fat becomes a danger to your overall health.

What Causes Morbid Obesity?

When you eat, your body stores the calories you consume for energy in your muscles and tissues. If those calories are not used, the body stores them as fat. If you continue to eat more calories than your body can use during daily activities and exercise, your body will build up fat stores. Obesity and morbid obesity are the result of too much fat being stored in your body.

Many behavioral factors play a role in obesity, including your eating habits and daily activity level. Many people develop their eating habits as children and have trouble refining them to maintain proper body weight as they age. As an adult, you may be inactive at your job and have less time for exercise, meal planning, and physical activity.

Other factors, such as stress, anxiety, and lack of sleep, can lead to weight gain. People who quit smoking often experience temporary weight gain. Women may also have trouble losing the weight they gain during pregnancy or gain additional weight during menopause. These rarely lead to morbid obesity by themselves, but can be a contributing factor.

Certain medications, such as birth control pills and antidepressants, can cause weight gain. Medical conditions such as hypothyroidism can lead to weight gain, but do not usually lead to obesity.

Genetic factors can play a role in how your body stores energy, but this relationship has not been fully researched. Current research is investigating the relationship between genetics and body weight.

Who is at Risk for Morbid Obesity?

Anyone can gain weight and become obese if they eat more calories than their bodies can use.

Symptoms and Complications of Morbid Obesity

The symptoms of obesity are weight gain and a body mass index (BMI) above 30. BMI is an estimate of your body fat content and is calculated using your height and weight measurements.

Without proper treatment, obesity can lead to other serious health problems, such as:

• osteoarthritis
• heart disease
• stroke
• diabetes
• sleep apnea (when you periodically stop breathing during sleep)

Diagnosing Morbid Obesity

Calculating BMI

Your doctor will measure your weight and height in order to calculate your BMI. Your BMI is an estimate of your body fat and is used as a primary screening tool for obesity. Your provider may also take a measurement of your waist circumference. These combined measurements will help estimate how much body fat you have and determine your risk of diseases, such as heart disease, stroke, and type 2 diabetes.

The acceptable percentage of body fat can vary by age, sex, and ethnicity, but typically ranges between 10 and 22 percent for men and 20 to 32 percent for women. Your doctor will provide more specific information about your BMI and what it means for you.

BMI Ranges are as follows (CDC):

BMI	Weight Status
Under 18.5	Underweight
18.5 to 24.9	Normal
25.0 to 29.9	Overweight
30.0 and above	Obese

Calculating Body Fat Percentage

A skinfold test may also be done to check your body fat percentage. In this test, a doctor measures the thickness of a fold of skin from the arm, abdomen, or thigh with a caliper.

Other Tests

Your healthcare provider may also ask questions about your lifestyle to find out more about your eating and exercise habits. Your doctor may order additional blood tests to look for hormonal or other medical problems that could be causing your weight gain.

Treating Morbid Obesity

Diet & Exercise

The most effective way to lose weight is to adopt healthy eating habits, exercise routines, and stress management techniques. Regular exercise and healthy eating are important, and even modest weight loss will improve your health. It is also important to learn stress management tools that can be used in place of overeating or snacking during stressful times.

You should work with your doctor and a dietician to set realistic goals that will help you lose weight slowly through diet and exercise. It may be helpful to find support from friends, family, or your community in order to make lifestyle changes that will lead to long-term weight loss.

Weight Loss Drugs

Sometimes, weight loss drugs may be prescribed. While these medications may cause weight loss, most people regain the weight once they stop taking the medication. There are many herbal and over-the-counter supplements that claim to help you lose weight, but many of these claims have not been verified.

Surgery

Surgery may also be an option to treat obesity if you have tried other methods for losing weight but have not been successful in maintaining long-term weight loss. It can often help reduce the risk of other diseases (e.g. diabetes, heart disease, sleep apnea) that are associated with severe obesity.

Surgery may cause complications, and you should talk with your doctor to determine if this is an option for you. There are two common types of weight-loss (bariatric) surgeries:

Laparoscopic gastric bypass: In this procedure, the surgeon will place a band around the upper part of your stomach. This limits the amount of food you can eat at one time by making you feel full after eating small amounts of food.

Gastric bypass surgery: This surgery will change how the food you eat travels through your digestive tract by bypassing a portion of your stomach and small bowel. It will make you feel full when you’ve eaten less food.

Preventing Morbid Obesity

Obesity and morbid obesity are serious and potentially life-threatening conditions. A healthy lifestyle that includes a healthy diet and regular exercise are important for preventing obesity.

Diet and Exercise

People who are morbidly obese should avoid “fad” diets and focus instead on changing eating behaviors. Recommendations include:

• adding more fruits and vegetables to your diet
• eating smaller meals
• count calories
• avoid saturated fats, trans fats, and refined sugars

Physical activity is good for overall health and is especially important if you’re trying to lose weight. To begin losing weight, you will need to do moderate to vigorous exercise for more than three hours per week. Vigorous activity raises your heart rate significantly. Examples include:

• running or jogging
• swimming
• jumping rope

Moderate exercises include brisk walking or biking, and can also include everyday activities like shoveling snow or yard work (CDC).

Breast Lump

What Is a Breast Lump?

Finding a lump on your breast can be scary. It’s important to remember that most breast lumps are non-cancerous (benign).

However, a breast lump can be a sign of cancer, so you should always seek a medical evaluation of any lumps or swelling you discover on your breasts.

Although associated with women, breast tissue is present both males and females. Your hormones affect this tissue. Hormonal changes can cause lumps to form and in some cases, to naturally disappear. You can develop lumps at any age.

Some babies develop breast lumps due to the estrogen they get from their mothers during birth. These generally clear up as the estrogen leaves their bodies.

Pre-pubescent girls sometimes get lumps that feel tender. These later clear up naturally during puberty. Adolescent boys can also get breast lumps during puberty. These are temporary and usually disappear in a few months as well.

Causes of Breast Lumps

Many things can cause a lump to form in your breast, including:

• breast cysts (soft, fluid-filled sacs)
• milk cysts (sacs filled with milk that can occur during breast-feeding)
• fibrocystic breasts (breast tissue that feels lumpy in texture and is sometimes accompanied by pain)
• fibroadenoma (non-cancerous, rubbery lumps that move easily within the breast tissue and rarely become cancerous)
• hamartoma (a benign, tumor-like growth)
• intraductal papilloma (small, non-cancerous tumor in a milk duct)
• lipoma (a slow-growing, non-cancerous, fatty lump)
• mastitis (infection of the breast)
• injury
• breast cancer

How Your Breasts Should Feel

Breast tissue varies in consistency, with the upper-outer part of the breast being firm and the inner-lower parts feeling somewhat softer. If you are a woman, your breasts can become more tender or lumpy during your menstrual cycle. Breasts tend to get less dense as you get older.

It is important to be familiar with how your breasts normally feel so you are aware of changes. You should report any changes or concerns to your doctor.

Signs You Should See a Doctor

Remember, most breast lumps are non-cancerous. However, you should make an appointment to see your doctor if:

• you discover a new lump
• an area of your breast is noticeably different than the rest
• a lump does not go away after menstruation
• a lump changes or grows larger
• your breast is bruised for no apparent reason
• the skin of your breast is red or begins to pucker like an orange peel
• you have an inverted nipple (if it was not always inverted)
• you notice bloody discharge from the nipple

What to Expect at Your Doctor Visit

When you visit your doctor to report a breast lump, he or she will probably ask you questions about when you discovered the lump and if you have any other symptoms. He or she will also perform a physical exam of the breasts.

If your doctor cannot identify the cause of the lump, additional testing may be ordered.

Mammogram

This is an X-ray of the breast that helps identify breast abnormalities. A diagnostic mammogram can be compared to previous screening mammograms (if available) to see how the breast tissue has changed.

Ultrasound

This is a non-invasive, painless procedure that uses sound waves to produce images of your breast.

Magnetic Resonance Imaging (MRI)

This test uses a magnetic field and radio waves to get detailed pictures of the breast.

Fine-needle Aspiration

Fluid from the lump can be removed with a needle. In some cases, an ultrasound is used to guide the needle. Non-cancerous cysts go away when the fluid is removed. If the fluid is bloody or cloudy, the sample will be analyzed by a laboratory for cancer cells.

Biopsy

This is a procedure to remove a sample of tissue for analysis under a microscope. There are several types of breast biopsy:

• fine-needle aspiration biopsy—a tissue sample is taken during a fine-needle aspiration
• core needle biopsy—uses an ultrasound for guidance. A larger needle is used to get a tissue sample
• vacuum-assisted biopsy—a probe with a vacuum is inserted into a small incision in the skin and a tissue sample is removed using an ultrasound for guidance
• stereotactic biopsy—a mammogram takes images from different angles and a tissue sample is taken with a needle
• surgical biopsy (excisional biopsy)—the whole breast lump, along with surrounding tissue, is removed
• surgical biopsy (incisional biopsy)—only part of the lump is removed

Treatment for Breast Lumps

Your doctor must determine the cause of your breast lump before he or she can formulate a treatment plan. Not all breast lumps will need treatment.

If you have a breast infection, your doctor will probably prescribe antibiotics to cure it. If you have a cyst, it can be drained of fluids. Usually, cysts will go away after they’re drained.

If the lump is found to be breast cancer, treatment can include:

• lumpectomy (removal of the lump)
• mastectomy (removal of the breast)
• chemotherapy (the use of drugs to fight or destroy the cancer)
• radiation (the use of radioactive rays or materials to fight the cancer)

Your treatment will depend on the type of breast cancer you have, the size and location of the tumor, and whether the cancer has spread beyond your breast. 

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Blackheads

What are Blackheads?

Blackheads are small bumps that appear on your skin due to clogged hair follicles. These bumps are called “blackheads” because the surface looks dark or black. Blackheads are a mild type of acne that usually form on the face, but they can also appear on the back, chest, neck, arms, and shoulders. Acne affects 40 to 50 million Americans and is the most common skin disorder in the United States, according to the American Academy of Dermatology (AAD).

What Causes Blackheads?

Blackheads form when a clog or plug develops in the opening of hair follicles in your skin. Each follicle contains one hair and a sebaceous gland that produces oil, called sebum, which helps keep your skin soft. Dead skin cells and oils collect in the opening to the skin follicle, producing a bump called a comedone. If the skin over the bump stays closed, the bump is called a whitehead. When the skin over the bump opens, exposure to the air causes it to look black and a blackhead forms.

Some factors can increase your chances of developing acne and blackheads, including:

• producing too much body oil
• buildup of the p. acnes bacteria (propionibacterium acnes) on the skin
• irritation of the hair follicles when dead skins cells don’t shed on a regular basis
• undergoing hormonal changes that cause an increase in oil production during the teen years, during menstruation, or while taking birth control pills
• taking certain drugs, such as corticosteroids, lithium, or androgens

Some people believe what you eat or drink can affect acne. Dairy products and foods such as carbohydrates that increase blood sugar levels may play a part in triggering acne, but researchers aren’t convinced that there is a strong connection.,

What Are Symptoms of Blackheads?

Blackheads are easy to spot on the skin because of their dark color. They are slightly raised, although they are not painful because they are not inflamed like pimples. Pimples form when bacteria invade the blockage in the hair follicle, causing redness and inflammation.

How Are Blackheads Treated?

Over-the-Counter Treatments

Many acne medications are available at drug and grocery stores without a prescription. These medications are available in cream, gel, and pad form and are put directly on your skin. The drugs contain ingredients such as salicylic acid, benzoyl peroxide, and resorcinol. They work by killing bacteria, drying excess oil, and forcing the skin to shed dead skin cells.

Prescription Medications

If over-the-counter treatment doesn’t improve your acne, your doctor may suggest that you use stronger prescription medications. Medications that contain vitamin A, such as tretinoin, tazarotene, and adapalene keep plugs from forming in the hair follicles and promote more rapid turnover of skin cells. These medications are applied directly to your skin. Your doctor may also prescribe another type of topical medication that contains benzoyl peroxide and antibiotics. This type of medication may be particularly helpful if you have pimples or acne cysts in addition to blackheads.

Manual Removal

Dermatologists, who are doctors specializing in skin care, use a special instrument called a round loop extractor to remove the plug causing the blackhead. After a small opening is made in the plug, the doctor applies pressure with the extractor to remove the clog.

Microdermabrasion

During microdermabrasion, doctors use a special instrument that contains a rough surface to sand out the top layers of your skin. Sanding the skin removes clogs that cause blackheads.

Chemical Peels

Chemical peels also remove clogs and get rid of dead skins cells that contribute to blackheads. During a peel, a strong chemical solution is applied to the skin. Over time, the top layers of the skin peel off, revealing smoother skin underneath. Mild peels are available over-the-counter, while stronger peels are performed by dermatologists or other skincare professionals.

Laser and Light Therapy

Laser and light therapies use tiny beams of intense light to decrease oil production or kill bacteria. Both lasers and light beams reach below the surface of the skin to treat blackheads and acne without damaging the top layers of the skin.

How Can Blackheads be Prevented?

You can prevent blackheads without spending a lot of money by trying a few of the following ideas:

Wash Regularly

Wash your face when you wake up and before you go to bed to remove oil buildup that can cause blackheads. Washing more than twice each day can irritate your skin and make your acne worse. Use a gentle cleanser that doesn’t make your skin red or irritated. Some acne cleansing products have antibacterial ingredients that kill p. acnes bacteria. Don’t forget to wash your hair every day, particularly if it is oily. Hair oils can contribute to clogged pores. It is also important to wash your face after you eat oily foods, such as pizza, because oil from foods can clog pores.

Use Oil-Free Products

Any product that contains oil can contribute to new blackheads. Choose oil-free makeup, lotions, and sunscreens to avoid making your problem worse.

Try an Exfoliating Product

Exfoliating scrubs and masks remove dead skin cells from your face and can help reduce blackheads. Look for products that don’t irritate your skin.

Acne

What Is Acne?

Your skin has tiny holes called pores that that can become blocked by oil, bacteria, and dirt. When this occurs, you may develop a pimple or “zit.” If your skin is repeatedly affected by this condition, you may have acne. According to the American Academy of Dermatology (AAD), acne is one of the most common skin problems in the United States. At any one time, between 40 and 50 million people have this condition (AAD, 2012 ). Although acne is not a life-threatening condition, it can be painful, particularly when it is severe. It can also cause emotional distress. Acne that appears on the face can impact self-esteem and, over time, may cause permanent scarring. Fortunately, there are effective treatments for this condition that reduce both the number of pimples you get and the chance for scarring to occur.

What Causes Acne?

Acne occurs when the pores on your skin become blocked with oil, dead skin, or bacteria. Each pore on your skin is the opening to a follicle. The follicle is made up of a hair and a sebaceous (oil) gland. The oil gland releases sebum (oil), which travels up the hair, out of the pore, and onto your skin. The sebum keeps your skin lubricated and soft. If you develop acne, this may be because of one or more problems in this lubrication process. These possible causes include:

• too much oil or sebum is being produced by the follicle
• dead skin cells are accumulating in the pore
• bacteria has built up in the pore

An overabundance of oil, a pore clogged by dead skin cells, and bacteria all contribute to the development of pimples. A zit appears when the bacteria grows in the clogged pore and the oil is unable to escape.

What Are the Risk Factors for Developing Acne?

Myths about what contributes to acne are quite common. Many people believe that foods such as chocolate or French fries will contribute to the development of acne. While there is no scientific support for these claims, there are certain risk factors that may put you at risk for developing acne. These include:

• hormonal changes caused by puberty or pregnancy
• certain medications such as birth control pills or corticosteroids
• a diet high in refined sugars or carbohydrates such as bread and chips

Young people are most at risk for developing acne during puberty. During this time, the body undergoes drastic hormonal changes. These hormones can trigger oil production, leading to an increased risk of acne. Hormonal acne related to puberty usually subsides when a teenager reaches adulthood.

What Are the Symptoms of Acne?

Acne can be found anywhere on your body. It most commonly develops on the face, back, neck, chest, and shoulders. If you have acne, you will typically notice pimples that are white or black in appearance. Both blackheads and whiteheads are known as comedones. Blackheads open at the surface of the skin giving them a black appearance. Whiteheads are closed just under the surface of the skin, giving them a white appearance. While whiteheads and blackheads are the most common types of acne, other lesions can occur. Inflammatory lesions are more likely to cause scarring of the skin and include the following:

• papules—small red, raised bumps caused by infected hair follicles
• pustules—small red pimples that have pus at their tips
• nodules—solid, painful lumps that are beneath the surface of the skin
• cysts—infections found beneath the skin that contain pus and are often painful

How Is Acne Diagnosed and Treated?

If you have symptoms of acne, your doctor will be able to confirm a diagnosis by examining your skin.

At-Home Care

You can use a number of self-care activities at home to prevent pimples and to clear up your acne. Home remedies for acne may include:

• cleaning the skin daily with a mild soap to remove excess oil and dirt
• regularly shampooing your hair and keeping it out of your face
• not squeezing or picking pimples, as this spreads the bacteria and excess oil
• avoiding hats or tight headbands
• avoiding touching your face
• using makeup that is water-based or labeled as “noncomedogenic” (not pore-clogging)

Medication

If self-care activities do not help with your acne, there are a number of over-the- counter acne medications that may be helpful. Most of these medications contain ingredients that can help kill bacteria or dry the skin. These active ingredients include:

• benzoyl peroxide: present in many acne creams and gels, used for drying out existing pimples and preventing new ones
• sulfur: a natural ingredient with a distinctive smell that is found in lotions, cleansers, and masks
• resorcinol: a less common ingredient that is used to remove dead skin cells
• salicylic acid: often contained in soaps and acne washes

Sometimes, you may continue to experience symptoms. If this happens, you may want to seek medical advice. Your doctor can prescribe medications that may help reduce your symptoms and prevent scarring. Your doctor may give you oral or topical antibiotics. These kill the bacteria that cause pimples. Typically, antibiotics are only used for a short amount of time so that your body doesn’t build up a resistance. Antibiotic resistance can make you prone to infections. Topical creams like retinoic acid or prescription strength benzoyl peroxide are often stronger formulas of over-the-counter treatments. These work to dry out the skin and reduce oil production. Women with hormonal acne may be treated with birth control pills or spironolactone. These medications seek to regulate the hormone-causing acne. Isotretinoin (Accutane) is a vitamin A-based medication that is used to treat certain cases of severe nodular acne. It has serious side effects, and is only used when all other treatments have failed.

Additional Treatments

Your doctor may recommend additional procedures to treat severe acne and prevent scarring. Many of these work by removing damaged skin.

• photodynamic therapy: also known as laser treatment, uses light pulses to remove the top layer of skin
• dermabrasion: removes the top layer of skin with a rotating brush
• chemical peel: an aesthetician applies a chemical to your face which essentially burns the top layer of skin. That skin later peels off to reveal less damaged skin underneath

Your doctor may suggest using cortisone injections if your acne consists of large cysts. Cortisone is a steroid naturally produced by the body. It can reduce inflammation and speed healing.

What Is the Outlook for Someone With Acne?

Treatment for acne is often successful. Most people can expect their acne to clear up within six to eight weeks. However, flare-ups of the condition are common and may require additional treatment. Scarring that occurs as a result of acne can cause emotional distress. Prompt treatment can help prevent scarring.

How Can Acne Be Prevented?

It’s difficult to prevent acne. However, you can take some steps at home to help prevent acne following treatment. These include:

• washing your face twice a day with an oil-free cleanser
• using an over-the-counter acne cream to remove excess oil
• avoiding makeup that contains oil
• cleaning the skin thoroughly before bed, including removing makeup
• showering after exercising
• avoiding tight-fitting clothing