skin problems

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Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. Acne usually appears on the face, neck, back, chest, and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent acne scars.

What causes acne?

Acne begins when the pores in the skin become clogged and can no longer drain sebum (an oil made by the sebaceous glands that protects and moisturizes the skin.) The sebum build-up causes the surrounding hair follicle to swell.

Acne Sketch
 

Hair follicles swollen with sebum are called comedones. If the sebum stays beneath the skin, the comedones produce white bumps called whiteheads. If the sebum reaches the surface of the skin, the comedones produce darkened bumps called blackheads. This black discoloration is due to sebum darkening when it is exposed to air. It is not due to dirt. Both whiteheads and blackheads may stay in the skin for a long time.

Bacteria called Propionibacterium acnes (P. acnes) that normally live on the top of the skin can enter the clogged pores and infect the sebum. This causes the skin to become swollen, red, and painful.

Infected sebaceous glands may burst, releasing sebum and bacteria into the surrounding skin, creating additional inflammation. In severe cases, larger nodules and cysts may form in the deeper layers of the skin.

What are the different types of acne?

Acne can be categorized by its severity:

Acne - severe, cystic acne on forehead
 

  1. Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).

  2. Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).

  3. Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed, and red. This form of acne is likely to lead to scarring if left untreated.

Who gets acne?

Anyone at any age can get acneAcne in teenagers is very common because the surging hormone levels (androgens) associated with puberty create more active sebaceous glands.

Acne in adults is is also very common, especially among women.

Acne is more likely to afflict people whose parents had acne.

What factors make acne worse?

Acne lesions can come and go. These factors can cause acne to flare:

  • Changing hormone levels in women 2 to 7 days before their menstrual period, during pregnancy, or when starting or stopping birth control pills

  • Oil from skin products (moisturizers or cosmetics) or grease in the workplace (for example, a kitchen with fry vats)

  • Pressure from sports helmets or equipment, backpacks, tight collars, or tight uniforms

  • Environmental irritants, such as pollution and high humidity

  • Squeezing or picking at blemishes

  • Hard scrubbing of the skin

What acne treatments are available?

Almost all cases of acne can be effectively treated. The goal of acne treatment is to heal existing lesions, stop new lesions from forming, and prevent acne scars.

Different acne medications are available that control one or more of the underlying causes of acne. Common classes of acne medications include the following:

  • Topical retinoids help unclog sebaceous glands and keep skin pores open.

  • Antibiotics, such as doxycycline and minocycline (Solodyn), may be used to fight the P. acnes bacteria.

  • Isotretinoin (Accutane) or hormonal agents, such as birth control pills, may be used to reduce sebum (oil) production.

Your doctor will prescribe acne medications based on the following factors:

  • Severity of your acne. Mild acne may respond well to a topical retinoid alone. Moderate acne may respond better to a combination of topical retinoid with an antibiotic or other medication. Severe acne with scarring may need treatment with isotretinoin, the active ingredient of Accutane (Amnesteem, Sotret).

  • Results of previous treatments. Medications may be added in a step-wise fashion, only if previous treatments are found to be ineffective.

  • Degree of scarring. More aggressive therapies may be started earlier if acne scars have already started developing.

  • Gender. Some treatments are available only for females, such as birth control pills.

Non-prescription acne medications may provide sufficient results for some people with mild acne. However, most people with moderate acne and all with severe acne will need to use prescription acne medications for effective treatment.

Whatever your treatment plan, it is important that you give it enough time to work. This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming. Staying on your medication is the most important step to getting acne under control.

How can I keep my acne under control?

After your acne clears, your doctor may recommend that you continue therapy with a topical retinoids to keep it under control. It is always a good idea to maintain good skin care and use skin care products labeled as “non-comedogenic” (do not promote acne)

For ongoing acne skin care and prevention of acne, follow a few simple guidelines:

  • Clean skin gently—Use a mild skin cleanser twice a day, and pat skin dry. Harsh cleansers and astringents can actually worsen acne.

  • Do not pop, squeeze, or pick at acne lesions, as this can promote inflammation and infection. Keep hands away from your face and other acne-prone parts of the skin.

  • Limit sun exposure—Tanning only masks acne at best. At worst, sun exposure can lead to skin damage, especially if you are using an acne treatment that makes your skin more sensitive to sunlight and UV rays (this includes tanning booths).

  • Choose cosmetics with care—As mentioned above, choose non-greasy skin products, and look for words like “non-comedogenic,” “oil-free,” and “water-based." Some facial products contain active acne-fighting ingredients, such as benzoyl peroxide or salicylic acid, to help keep mild acne at bay.

  • Be patient with your treatment—Find out how much time it should take for your acne treatment to work (generally 6-8 weeks) and then stick with it. Stopping treatment early may prevent you from seeing good results or even cause a relapse of symptoms. Your skin may look worse before it begins to improve. You may need to try more than one type of treatment.

Acne in Teenagers

Acne afflicts nearly every teenager at some point during adolescence, but that doesn’t make it easier to bear. The emotional toll of acne is a familiar problem for many young people and can wreak havoc on adolescent self-confidence. Fortunately, almost all cases of acne are treatable.
Teenage Acne in adolescents
 

Who gets acne?

Anyone of any age can get acne, even adults, but it is most common in teenagers. In fact, acne is considered a normal part of adolescence. 100% of the population can expect to have acne at some time during adolescence, regardless of race or ethnicity. During puberty, elevated hormone levels stimulate higher sebum production than usual, increasing the chance of acne flares.

Boys are more likely to get it during adolescence because their skin tends to produce more sebum. In adulthood, women are more prone to acne than men, likely because of the hormonal swings of menstruation, pregnancy, and menopause.

People with a family history of acne are also more likely to get acne.

How is teen acne treated?

It is important to treat acne early to prevent the development of acne scars.

There are a wide range of acne treatments available. Your doctor will recommend an acne treatment based on the location and severity of acne, response to previous treatment and other factors.

  • Many people attempt to first treat their acne at home with non-prescription medications that include benzoyl peroxide (Clearasil, Proactiv) or salicylic acid. Unfortunately, many people discover that these over-the-counter medications take too long to work, prolonging the acne and increasing the risk of developing acne scars.

  • For mild acne or moderate acne doesn’t respond to over-the-counter treatments, you may need a stronger prescription acne medication that acts faster and provides longer-lasting benefits. Physicians may prescribe a topical retinoid, a mainstay of acne therapy. Topical retinoids help to clear up acne quickly and provide ongoing clear skin. Brands of topical retinoids include Differin™(adapalene), Epiduo™(adapalene + benzoyl peroxide), Retin A Micro™(tretinoin), Tazorac™(tazarotene), or Ziana™(tretinoin + clindamycin). These medications may be used alone or in combination with other acne medications, such as antibiotics.

  • For the most severe cases of acne (such as cystic acne), physicians may prescribe isotretinoin (Accutane, Sotret). This daily oral medication has shown to be an effective treatment when other medications have failed, but it has serious possible side effects and should never be taken by pregnant women. Women using isotretinoin must agree to use two types of birth control, and abstain from sex within a month before and after taking the medication.

Sports and acne mechanica

Teens who play sports, wear a backpack, or play a musical instrument that comes into contact with the face and neck may get a form of acne called acne mechanica. This type of acne is caused by irritation to the skin from excessive heat or sweat, friction, or pressure. These are common causes of acne mechanica:

  • Helmets and helmet straps, especially those worn by football and hockey players and motorcycle riders

  • Shoulder pads and straps worn by football players

  • Tight clothing, particularly jeans, underwear (bras) or uniforms made of synthetic fabric

  • Tight hats or headbands worn for long periods of time

  • Backback straps

  • Musical instruments, such as the violin, tucked against the neck for hours

Stick with your acne treatment

No acne medication can do its job properly unless it is given time to work. It’s very important to be patient and take your medication as directed, for as long as directed.

If you don’t see results right away, don’t be discouraged. Your medication is hard at work preventing new lesions from forming. Stopping treatment early will likely cause pimples and zits to reappear.

Acne Myths and Acne Skin care

There are a lot of acne myths regarding the cause acne and possible home remedies. It is important to learn what is true, and what is not.

Acne can be aggravated by oily cosmetics, stress, picking at blemishes, rough cleansers, or hard scrubbing. It is important to follow basic acne skin care tips to get acne under control, and keep it under control

Acne isn't caused directly by eating sugar, chocolate, or greasy foods. However, there is some evidence that eating too many carbohydrates (sugars, pastas, bread, sodas) might be related to the development or worsening of acne. It is generally a good idea to limit the consumption of such snacks. (Acne and diet).

Although a suntan can temporarily lessen the appearance of acne lesions, it won’t make them go away. The ultraviolet light can also lead to significant skin irritation among those using acne medications, and the sun can damage the skin in other ways (wrinkles, skin cancer).

Overall it is best for everyone, even those with acne, to regularly use sunscreen and follow basic sun protection measures.

Acne Myths

Myth #1: Acne is caused by poor hygiene

If you believe this myth and wash your skin hard and frequently, you can actually make your acne worse. Acne is not caused by dirt or surface skin oils. Although excess oils, dead skin, and a day's accumulation of dust on the skin look unsightly, they should not be removed by hard scrubbing. Vigorous washing will actually irritate the skin and make acne worse. The best approach to hygiene and acne: Gently wash your face twice a day with a mild soap, pat dry--and use an appropriate acne treatment for the acne.

Myth #2: Acne is caused by diet

Extensive scientific studies have failed to find a connection between diet and acne. In other words, food does not cause acne. Not chocolate. Not french fries. Not pizza. Nonetheless, some people insist that certain foods affect their acne. In that case, avoid those foods. Besides, eating a balanced diet always makes sense. However, according to the scientific evidence, if acne is being treated properly, there's no need to worry about food affecting the acne.

Myth #3: Acne is caused by stress

The ordinary stress of day-to-day living is not an important factor in acne. Severe stress that needs medical attention is sometimes treated with drugs that can cause acne as a side effect. If you think you may have acne related to a drug prescribed for stress or depression, consult your physician.

Myth #4: Acne is just a cosmetic disease

Yes, acne affects only one's appearance and is not otherwise a serious threat to a person’s physical health. However, it can result in permanent physical scars. Acne and acne scars can affect the way people feel about themselves to the point of disrupting their confidence and self-worth.

Myth #5: You just have to let acne run its course

The truth is, acne can be cleared up. If the over-the-counter acne medications you have tried haven’t worked, consider seeing a dermatologist. With the products available today, there is no reason why someone has to endure acne or get acne scars.

Acne Scars

Millions of people have scars from the long-lasting inflammation caused by acne. Acne scars occur most frequently in those with moderate acne to severe acne. It remains unknown why some people develop acne scars when others don’t.

Many treatment options are available to diminish the acne scars’ appearance. Depending on the type and severity of scarring, improvement can be seen in 4 to 6 weeks.

Types of Acne Scars

  • Icepick. These deep pits in the skin are a classic sign of acne scarring. They are the most common type of acne scar and usually occur on the cheek. They may be shallow or deep and may be hard or soft to the touch.

  • Boxscar. These depressed, crater-like acne scars are larger than icepick scars.

  • Rolling scars. These acne scars are curved indentations on the skin.

  • Hypertrophic scars. These acne scars are elevations or areas of skin thickening. Large hypertrophic scars may be referred to as "keloids" and tend to run in families.

Acne scar before treatment
Before treatment
(See larger image)

Acne scar after treatment
After treatment
(See larger image)

The recommended treatment will depend upon the type of acne scar being treated, your skin type, your tendency to scar, and cost. Different treatments may be combined for optimal effect.

Treatment options

  • Topical retinoids - Some medications applied to the skin can help smooth out very superficial acne scars but may not be effective for deeper scars.

  • Dermabrasion - During this procedure, the skin is cleansed, numbed, and then vigorously rubbed with a high-speed brush to remove the top layer of skin. This results in a small injury, or "abrasion," that heals over several weeks. The healing process reshapes the skin. Dermabrasion is effective for superficial acne scars and reduces the severity of deeper scars, but it is ineffective for icepick scars. The skin may burn or feel sore and appear pink until healing is complete. The results are long-lasting. In darker-skinned people, the procedure may cause changes in skin color that require additional treatments.

  • Microdermabrasion - This procedure, lasting about 10-20 minutes, uses a machine to propel small crystals through a vacuum tube onto the skin. This removes superficial layers of the skin, stimulating new skin cell growth and improving skin tone. There are few side effects and almost no recovery time, but microdermabrasion can only treat superficial acne scars. As many as six treatments may be required, 1-2 weeks apart.

  • Excision and punch replacement graft - An acne scar, or cluster of small scars, is removed with a scalpel. The resulting "hole" is either sewn together or replaced with a patch of normal skin from elsewhere on the body. Excision is particularly effective for ice-pick or boxcar scars.

  • Subcision - The skin is made numb and a probe is inserted beneath the acne scar, which loosens it from the surrounding tissue. This allows the scar to be elevated to the level of the normal skin. Subcision is used for depressed acne scars such as a boxed scar or rolling scar.

  • Dermal fillers - Different types of "fillers" can be injected beneath a depressed acne scar to elevate it to the level of the surrounding skin. Dermal fillers are most effective for rolling scars. The benefit from soft tissue fillers usually lasts 3 to 18 months, depending on the material used. Treatment must be repeated to maintain the appearance.

  • Chemical peels - During a chemical peel, a fluid is applied to the skin to remove the top layer and generate new skin growth beneath the acne scars. This lifts the scar to the level of the surrounding skin, minimizing its appearance. In general, "medium" or "deep" peels are used to treat acne, meaning that the peel is designed to affect the deeper layers of the skin. Deep chemical peels may cause lightening of the skin and a change in skin texture. Bandages may be required for several days.

  • Laser skin resurfacing - This removes the top portion of the acne scars and creates heat in the deeper layers of the skin. This heat causes the skin to tighten and smooth out the scar. The result is the smoothing out of the skin. Laser resurfacing is particularly helpful for boxcar scars and further improvement of acne scars treated by other methods. In some cases, only a single treatment is required; however, final results may not be seen for 12-18 months. Redness following treatment may last for several months.

Acne Tips for Boys

What causes acne?

Acne is a skin condition that occurs because of clogged pores that result from an overproduction of sebum. Sebum is an oily substance secreted from the sebaceous glands under the skin of the face, neck, shoulders, back, and chest. Acne in teenagers is most common because of the hormonal activity of puberty, which stimulates sebum production.

How is acne different in boys?

In most teens, acne starts with the onset of puberty, a time of increased hormonal activity. In boys, puberty starts later than it does in girls, so boys typically get acne at a later age.

Another key difference is that boys have more androgens, a type of hormone associated with male characteristics (deeper voice, body hair). Androgen stimulates the sebaceous glands, making it a chief culprit in boys' acne.

Boys are more likely to get acne on the chest and back, and their acne tends to be more severe and long-lasting.

Boys who shave may also be at a higher risk for acne flares, especially if using dull, low-quality razors or not using shaving cream.

Finally, boys tend to be less likely to use acne skin care products than girls, so they may not be aware of the topical treatments available for acne. They may also be less likely to seek help for their acne.

What kinds of acne treatments are available for boys?

Acne treatments for boys and girls are very similar. The goal of acne treatment is to kill bacteria (p. acnes), remove dead skin cells, and lower sebum production. Your dermatologist will recommend a treatment based on the severity of the acne, which could be mild, moderate or severe.

Many cases of mild acne can be treated with over-the-counter medications (benzoyl peroxide), but your dermatologist may recommend something stronger to avoid prolonging the acne since persistent acne increases the risk of developing acne scars. In that case, you may be prescribed a topical or oral antibiotic, a prescription-strength topical retinoid, or both.

Topical retinoids are the mainstay of acne therapy. Medications in this class include generic tretinoin, Differin (adapalene), Tazorac (tazarotene), Retin A Micro (tretinoin), and newer combination therapies, such as Epiduo (adapalene + benzoyl peroxide) and Ziana (tretinoin + clindamycin)

The worst cases of acne may call for isotretinoin (Accutane), an effective prescription medication that carries potentially serious side effects. The doctor will monitor you closely for such side effects if you take this medication.

Stick with it

No acne medication can do its job properly unless it is given time to work. You must be patient. It’s very important take your acne medication as directed, for as long as directed. If you don’t see results right away, don’t be discouraged. Your medication is hard at work preventing new lesions from forming. Stopping treatment early will likely cause pimples and zits to reappear.

What can boys do to prevent acne?

  • Cleanse your skin twice a day with a mild soap; avoid scrubbing hard with a washcloth—it won’t help the acne go away and it may worsen the condition by irritating the skin.

  • Teens tend to get acne in the T-zone of the face (chin, nose, and forehead), so use an oil-free moisturizer if possible, and use less moisturizer in those areas.

  • If your hair is long enough to touch your face, wash it daily to keep oil away from your skin. Avoid letting hair products touch your face.

  • Wash your face gently after working around oily substances (such as in a hot kitchen or gas station).

  • Bathe or wash your face after exercising, especially areas of the body that come into close, prolonged contact with sports gear (such as helmets, shoulder pads, backpacks, or bike shorts).

  • Don’t touch your face, because the oil and bacteria from your hands can worsen your acne.

  • Avoid the temptation to pick at or squeeze your pimples or zits—this can irritate them and cause scarring.

  • When using a medication, give it time to work. Your skin may look worse before it looks better, and it may be 6-8 weeks before you see improvement. If you don’t see results after two months, talk to your dermatologist about switching treatments or adjusting your dosage.

  • The sooner you treat your acne, the easier it will be to bring it under control. Virtually any case of acne is treatable, and it’s much easier to eliminate lesions in the early stages, which keeps them from growing and prevents scarring.

Tips for shaving when you have acne

Boys with facial hair know that shaving with acne can be a challenge. These tips may help minimize skin irritation when shaving with acne:

  • Before shaving, soften the hairs. Wetting the face thoroughly with lukewarm water can help soften the hairs.

  • Experiment. Try shaving with electric and safety razors to see which works best for you.

  • Make sure the blade is sharp. This helps prevents nicks from a safety razor, which can irritate the skin and lead to breakouts.

  • Shave lightly. This can help avoid nicking acne lesions, which can make acne worse.

  • Never try to shave off the acne. This aggravates the condition and makes the acne worse.

Acne Tips for Girls

What causes acne?

Acne is a skin condition that occurs because of clogged pores that result from an overproduction of sebum. Sebum is an oily substance secreted from the sebaceous glands under the skin of the face, neck, shoulders, back, and chest. Acne in teenagers is most common because of the hormonal activity of puberty, which stimulates sebum production.

How is acne different in girls?

Since acne is most often a hormonal event in teenagers, it usually occurs with the onset of puberty. In girls, puberty typically starts at a younger age than in boys, which means girls get acne earlier in life.

In addition to the puberty-related changes experienced by all teens, girls must also contend with the hormonal swings of menstruation, so acne may flare at certain times during the menstrual cycle.

Girls also differ in their response to acne. Because they are more likely to use acne skin careproducts than boys, they are often more receptive to the topical treatments recommended for acne. 

What kinds of acne treatments are available for girls?

The goal of acne treatment is to kill bacteria, remove dead skin cells, and lower sebum production. The dermatologist will choose a treatment based on the severity of the acne, which could be mild, moderate or severe.

Many mild cases may respond to the use of over-the-counter medications, but sometimes your physician will recommend something stronger to avoid prolonging the acne and the risk of scarring. In that case, you may be prescribed a topical or oral antibiotic, a prescription-strength topical retinoid, or both.

The worst cases of acne may call for isotretinoin (Accutane), an effective prescription medication that carries potentially serious side effects. The doctor will monitor you closely for such side effects if you take this medication. Pregnant women should never take isotretinoin.

Stick with it

No acne medication can do its job properly unless it is given time to work. It’s very important to be patient and take your medication as directed, for as long as directed. If you don’t see results right away, don’t be discouraged. Your acne medication is hard at work preventing new lesions from forming. Stopping acne treatment early will likely cause pimples and zits to reappear.

What should girls know about skincare products and acne?

In choosing cosmetics and skin cleansers, girls have many acne-fighting products to choose from. To kill P. acnes and other acne-causing bacteria, find a gentle cleanser containing benzoyl peroxide, sulfur, or salicylic acid. See the prevention section below for tips on using a cleanser properly.

When shopping for makeup, hair products, moisturizers, and other cosmetics, avoid heavy, greasy formulations that could clog pores and worsen your acne. Choose products labeled noncomedogenic or non-acnegenic, as these are less likely to block your pores. Today, you can even find acne-medicated makeup and spot treatments, which conceal and heal your lesions at the same time.

What can girls do to prevent acne?

  • Cleanse your skin twice a day with a mild soap; avoid scrubbing hard with a washcloth—it won’t help the acne go away and it may worsen the condition by irritating the skin.

  • Choose oil-free cosmetics, preferably those labeled noncomedogenic or nonacnegenic. Remove makeup at the end of the day to prevent clogged pores.

  • Teens tend to get acne in the T-zone of the face (chin, nose, and forehead), so use an oil-free moisturizer if possible, and use less moisturizer in those areas.

  • Keep hair products away from the face, and if your hair is long enough to touch your face, keep it clean to keep oil away.

  • Wash your face gently after working around oily substances (such as in a hot kitchen or gas station) and after exercising.

  • Don’t touch your face, because the oil and bacteria from your hands can worsen your acne.

  • Avoid the temptation to pick at or squeeze your pimples or zits—this can irritate them and cause scarring.

  • If you are using an acne medication, give it time to work. Your skin may look worse before it looks better, and it may be 6-8 weeks before you see improvement. If you don’t see results after two months, talk to your dermatologist about switching acne treatments or adjusting your dosage.

  • The sooner you treat your acne, the easier it will be to bring it under control. Virtually any case of acne is treatable, and it’s much easier to eliminate lesions in the early stages, which keeps them from growing and prevents scarring.

 

Aging Skin Animation

View the Aging Skin Animation from Understand.com explains how skin ages, what you can do to slow down the aging process and steps that can be take to reduce the signs of aging. 

If you have maintained a good skin care routine and avoided substantial sun exposure, your skin should look and feel beautiful in your twenties and your thirties.Aging Skin

By the time you reach your thirties, collagen and elastin fibers begin to decrease slightly. As a result, the first signs of aging may start to appear as fine lines and wrinkles around your eyes and mouth. You may also experience a slight change in skin texture, and a decrease in your skin"s overall moisture content.

By your forties and fifties, the effects of long-term sun exposure, repetitive facial expressions, and the normal aging process start to accumulate. The fine lines around your eyes and mouth deepen and forehead lines and glabellar creases may begin to appear. Age spots (lentigines) and other pigmentation irregularities generally start to appear in sun-exposed areas.

Using a daily moisturizer with sunscreen and continuing to exfoliate will help keep your skin looking radiant.Aging Skin Changes

If you are looking to improve the texture of your skin, ask your doctor about a prescription medication, such as a topical retinoid (Renova®) that can help with fine wrinkling or simple in office procedures like superficial chemical peels or microdermabrasion. Men and women who are looking for more rapid and dramatic results may be interested in botulinum toxin injections (Botox Cosmetic®, Dysport®). Dermal fillers such as Juvederm® or Restylane® can also help to reduce the appearance of deeper wrinkles. Additionally, chemical peels, intense pulsed light therapy, and laser resurfacing may help to improve your skin tone and texture and increase collagen production.

 

 

Aging Skin Basics

As our bodies age, the appearance and physical qualities of our skin change.Aging Skin on Hands

Over time, the skin loses its underlying layers of fat, and the production of collagen and elastin fibers slows. As a result, the skin loses its fullness and starts to sag.

Aging skin has the following qualities:

  • It becomes thinner.

  • It develops fine lines and wrinkles.

  • It develops darkened spots called lentigines.

  • It becomes drier and susceptible to itching

  • It loses underlying fat, leading to hollowed areas near the eyes and cheeks. This loss of fat also causes tendons and blood vessels in the hands to become more noticeable.

  • Hair loses pigment and turns gray or white hairs.

This change is slow and continuous, starting in our twenties. The pace of aging is due to a combination of genes (our inherited tendency) and external factors, such as exposure to sunlight and its ultraviolet (UV) radiation, and smoking.Aging Skin on Hand

Just a few minutes of sun exposure each day can cause noticeable changes to the skin over time. The term "photoaging" is used to describe this sun-related skin damage. In sunny climates, photoaging may be seen in people as early as in their twenties.

To minimize the premature aging of the skin, practice sun protection habits. And, if you are a smoker, you may see improvement in your skin after quitting, even if you have smoked for many years.

Aging skin should be examined regularly for precancerous and cancerous lesions. Doing this at home is referred to as a skin self-exam.

Treatments for aging skin

If you are bothered by visible signs of aging, there are a variety of treatments available to improve damaged skin:

  • Dermal fillers, or soft-tissue fillers, can be injected into the skin to fill out areas that look hollowed or wrinkled.

  • Botox is a purified form of botulinum toxin that is injected into targeted facial muscles to prevent and correct wrinkles and other damage related to certain facial expressions (such as squinting or frowning).

  • Dermabrasion is a common treatment in which the top layer of skin is abraded so that a new, smoother layer grows in its place. It’s used for many skin conditions, including acne, skin cancer, and photoaging.  

  • Chemical peels have many dermatological uses, including the treatment of wrinkles, age spots, and scars; a chemical solution is carefully applied to the skin to remove damaged outer layers, leaving smoother contours and an improved appearance.

  • Laser resurfacing helps correct wrinkles and age spots through use of a laser that vaporizes damaged skin tissue.

  • Unwanted hair can be removed through one or more methods, including waxing, chemical depilation, electrolysis, or laser removal; for best results, all methods should be performed or supervised by an experienced dermatologist. 

  • Liposuction is a way to reduce visible effects of aging by vaporizing and removing unwanted fat deposits that don’t respond to diet or exercise. Common target areas include the face, chin, neck, hips, and buttocks. 

  • Microdermabrasion gently scrapes away damaged and aging skin to trigger the growth of new layers.

  • Topical medications, such as topical retinoids, have been shown to reduce fine wrinkles, splotchy darkened areas, and signs of chronic sun exposure.

  • Over-the-counter products, such as moisturizers and "cosmeceuticals," products containing agents designed to reduce the signs of aging, such as alpha-hydroxy acids or antioxidants.

These may be used alone or in combination for a more complete skin care regimen.

In helping you evaluate your treatment options, your physician will consider these factors:

  • Areas to be treated

  • Darkness of your skin

  • Results of past treatments

  • Personal preferences

Alopecia Areata

Alopecia areata is an autoimmune disease, in which the body’s own immune system mistakenly attacks the hair follicles, the tiny structures in the skin from which hairs grow. This can lead to hair loss on the scalp and elsewhere.

In most cases of alopecia areata, hair falls out in small, round patches about the size of a quarter. In many cases, the disease does not extend beyond a few bare patches.

However, in some people, the hair loss is more extensive. Although uncommon, the disease can cause complete hair loss on the head (alopecia totalis) or the head, face, and body (alopecia universalis).

Alopecia areata is not a life-threatening disease and those with it are generally healthy. But the disease has unexpected impact on a person's appearance and can be a tremendous source of stress.

Alopecia Areata on back of the head

Alopecia Areata on top of the head

Young boy with Alopecia on head

Alopecia of the scalp

What causes alopecia areata?

In alopecia areata, cells of the body's immune system attack the rapidly growing cells in the hair follicles that make the hair. The affected follicles shrink and drastically slow down hair production. Fortunately, the stem cells that continually supply the follicle with new cells do not seem to be targeted. So the follicle always has the potential to regrow hair.

Scientists do not know exactly why the immune system targets the hair follicles this way. But they suspect that genetics may predispose some people to the disease. In these people, some type of trigger, perhaps a virus or something in the environment, brings on the attack against the hair follicles.

Who is most likely to get alopecia areata?

Alopecia areata affects an estimated four million Americans of both genders and of all ages and ethnic backgrounds. It often begins in childhood.

1 in 5 people with the disease has a family member who has it as well. Those with a close family member with alopecia areata are at slightly greater risk of hair loss themselves. If the family member developed a patch of hair loss before age 30, the risk to other family members is greater. 

Keep in mind that most children with alopecia areata do not have a parent with the disease, and the vast majority of parents with alopecia areata do not pass it along to their children.

Will the hair ever grow back?

There is a good chance your hair will regrow, but it may also fall out again. No one can predict when it might regrow or fall out. The course of the disease varies from person to person. Some people lose just a few patches of hair, then the hair regrows, and the condition never recurs. Others continue to lose and regrow hair for many years. A few lose all the hair on their head; some lose all the hair on their head, face, and body. Even in those who lose all their hair, the possibility for full regrowth remains.

In some, the initial hair regrowth is white, with a gradual return of the original hair color. In most, the regrown hair is ultimately the same color and texture as the original hair.

What can I expect next?

The course of alopecia areata is highly unpredictable, and the uncertainty of what will happen next is probably the most difficult and frustrating aspect of the disease. You may continue to lose hair, or your hair loss may stop. The hair you have lost may or may not grow back, and you may or may not continue to develop new bare patches.

How is it alopecia areata treated?

While there is neither a cure for alopecia areata nor drugs approved for its treatment, some people find that medications approved for other purposes can help hair grow back, at least temporarily. The following are some treatments for alopecia areata.

Keep in mind that while these treatments may promote hair growth, none of them prevent new patches or actually cure the underlying disease. Consult with your doctor about the best option for you.

Corticosteroids. Corticosteroids are powerful anti-inflammatory drugs similar to a hormone called cortisol produced in the body. Because these drugs suppress the immune system if given orally, they are often used in the treatment of various autoimmune diseases, including alopecia areata. Corticosteroids may be given three ways for alopecia areata:

  • Corticosteroid injections. Injections of corticosteroids directly into hairless patches on the scalp, brow, and beard areas increase hair growth in most people. Injections deliver small amounts of cortisone to affected areas, preventing the more serious side effects encountered with long-term oral use. After 1 or 2 months, new hair growth may become visible, and the injections usually have to be repeated monthly. The main side effects of injections are transient pain, mild swelling, and occasional changes in pigmentation, as well as small indentations in the skin that go away when injections are stopped. Injections usually must be repeated monthly. Because injections can be painful, they may not be the preferred treatment for children, nor for large areas.

  • Topical corticosteroids. Topical corticosteroids (ointments or creams rubbed directly onto the affected skin) are less traumatic than injections and are therefore sometimes preferred for children. However, topical corticosteroids alone are less effective than injections; they work best when combined with other topical treatments, such as minoxidil or anthralin.

  • Oral corticosteroids. Corticosteroids taken by mouth, such as prednisone, are a standard treatment for many autoimmune diseases and may be used in more extensive alopecia areata. But because of the risk of side effects, such as hypertension and cataracts, oral corticosteroids are used only occasionally for alopecia areata and for shorter periods of time.

Rogaine (minoxidil). Topical minoxidil solution promotes hair growth when the hair follicle is small and not growing to its full potential. Minoxidil is FDA-approved for treating male and female pattern hair loss. It may also be useful in promoting hair growth in alopecia areata. The solution, applied twice daily, has been shown to promote hair growth in both adults and children, and may be used on the scalp, brow, and beard areas. With regular and proper use of the solution, new hair growth appears in about 12 weeks.

Anthralin (Psoriatec). Anthralin, a synthetic, tar-like substance that alters immune function in the affected skin, is an approved treatment for psoriasis. Anthralin is also commonly used to treat alopecia areata. Anthralin is applied for 20 to 60 minutes ("short contact therapy") to avoid skin irritation, which is not needed for the drug to work. When it works, new hair growth is usually evident in 8 to 12 weeks. Anthralin is often used in combination with other treatments, such as corticosteroid injections or minoxidil, for improved results.

Sulfasalazine. A sulfa drug, sulfasalazine has been used to treat different autoimmune disorders, including psoriasis. It acts on the immune system and has been used in patients with severe alopecia areata.

Topical sensitizers. Topical sensitizers are medications that, when applied to the scalp, provoke an allergic reaction that leads to itching, scaling, and eventually hair growth. If the medication works, new hair growth is usually established in 3 to 12 months. Two topical sensitizers are used in alopecia areata: squaric acid dibutyl ester (SADBE) and diphenylcyclopropenone (DPCP). Their safety and consistency of formula are currently under review.

PUVA Phototherapy. With PUVA, a treatment used most commonly for psoriasis, a person is given a light-sensitive drug called a psoralen either orally or topically and then exposed to an ultraviolet (UV) light source. In clinical trials, approximately 55 percent of people achieve cosmetically acceptable hair growth using PUVA. However, the relapse rate is high, and patients must go to a treatment center where the equipment is available at least two to three times per week. Furthermore, the treatment increases the risk of developing skin cancer.

Alternative therapies. When drug treatments fail to bring sufficient hair regrowth, some people turn to alternative therapies. Alternatives purported to help alopecia areata include acupuncture, aromatherapy, evening primrose oil, zinc, vitamin supplements, and Chinese herbs. Because many alternative therapies are not backed by clinical trials, they may or may not be effective for regrowing hair. In fact, some may actually make hair loss worse. Furthermore, just because these therapies are natural does not mean that they are safe. As with any therapy, talk to your doctor before you try them.

In addition to treatments to help hair grow, there are measures that can be taken to minimize the physical dangers or discomforts of lost hair.

  • Sunscreens are important for the scalp, face, and all exposed areas.

  • Eyeglasses (or sunglasses) protect the eyes from excessive sun, and from dust and debris, when eyebrows or eyelashes are missing.

  • Wigs, caps, or scarves protect the scalp from the sun and keep the head warm.

  • Antibiotic ointment applied inside the nostrils helps to protect against organisms invading the nose when nostril hair is missing.

How can I cope with the effects of the disease?

Living with hair loss can be hard, especially in a culture that views hair as a sign of youth and good health. Even so, most people with alopecia areata are well-adjusted, contented people living full lives.

The key to coping is valuing yourself for who you are, not for how much hair you have or don't have. Many people learning to cope with alopecia areata find it helpful to talk with other people who are dealing with the same problems. More than four million people nationwide have this disease at some point in their lives, so you are not alone. If you would like to be in touch with others with the disease, the National Alopecia Areata Foundation (NAAF) can help through its penpal program, message boards, annual conference, and support groups that meet in various locations nationwide.

Another way to cope with the disease is to minimize its effects on your appearance. If you have total hair loss, a wig or hairpiece can look natural and stylish. For small patches of hair loss, a hair-colored powder, cream, or crayon applied to the scalp can make hair loss less obvious by eliminating the contrast between the hair and the scalp. Skillfully applied eyebrow pencil can mask missing eyebrows.

Children with alopecia areata may prefer to wear bandanas or caps. There are many styles available to suit a child's interest and mood-some even have ponytails attached.

For women, attractive scarves can hide patchy hair loss; jewelry and clothing can distract attention from patchy hair; and proper makeup can camouflage the effects of lost facial hair. If you would like to learn more about camouflaging the cosmetic aspects of alopecia areata, ask your doctor or members of your local support group to recommend a cosmetologist who specializes in working with people whose appearance is affected by medical conditions.

Arthritis: Psoriatic

About 10-30% of people with psoriasis will develop psoriatic arthritis. It usually arises in people 30-50 years old who have already experienced the skin symptoms of psoriasis. However, about 15% of people may develop joint symptoms before developing other signs of psoriasis on their skin.

Early diagnosis and treatment is important to minimize damage to the joints. Left untreated, psoriatic arthritis can result in permanent damage and disability.

What are the symptoms of psoriatic arthritis?

Like psoriasis, the symptoms of psoriatic arthritis can range from mild to severe.

Symptoms of psoriatic arthritis include the following:

  • Stiffness, pain, and swelling of the tendons and joints

  • Less mobility in affected parts of the body

  • Swelling of the fingers and toes (dactylitis)

  • Morning stiffness

  • Generalized fatigue

The joints most commonly affected are in the fingers and toes (the joints at the ends near the nails), the lower back, wrists, knees, and ankles. A small number of people with psoriatic arthritis develop spondylitis, an inflammation of the spinal column that can lead to pain and stiffness of the neck and back.

How is psoriatic arthritis treated?

There are a variety of treatments for psoriatic arthritis. Your doctor will recommend a treatment based on the severity of symptoms, results of past treatments, and your medical history.

Medications

Your doctor may prescribe medications to help manage your symptoms.  Medications include:

  • Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs)—Some of these, such aspirin, ibuprofen (Advil and Motrin), and naproxen (Aleve, Naprosyn) are available over-the-counter. Others, such as ketoprofen (Orudis), and diclofenac (Voltaren and Arthortec) require a prescription.

  • Corticosteroids taken by mouth (prednisone)—These reduce the inflammation and swelling in the joints. Because of the side effects that develop with prolonged use, oral corticosteroids are generally used for a limited time to get arthritis symptoms under control and then discontinued.

  • Corticosteroid injections—corticosteroids may be injected into some joints that are particularly inflamed without the side effects of taking corticosteroids by mouth

  • Antimalarials—Some of the medication used to treat malaria have been an effective treatment for different types of arthritis.

  • Soriatane (acitretin)

  • Cyclosporine

  • Methotrexate

  • Sulfasalazine

  • Azathioprine (Imuran)

Biologics for psoriasis

Biologics (also called “immunomodulators” or “disease-modifying therapies”) are a relatively new treatment option for moderate to severe psoriasis and psoriatric arthritis.   Biologics are especially effective at healing the progression of arthritis in patients with psoriasis.

Biologics are derived from human or animal proteins instead of chemicals. They work by targeting specific parts of the immune system such as T-cells or TNF, a chemical messenger used by immune cells. This focused approach reduces the likelihood of side effects that are seen following treatment with other medications that impact the entire immune system.

Biologics must be administered by injection, either into the skin (subcutaneously), into the muscle (intramuscular or IM), or by intravenous infusion (IV). Some biologics may require long-term use to keep psoriatic arthritis under control. 

Biologics available for the treatment of psoriatic arthritis include:

 

Atopic Dermatitis (Eczema) Basics

Atopic dermatitis (AD) is a chronic skin disorder that causes dry, itching, and inflamed skin. The rash of atopic dermatitis comes and goes.

The term eczema is sometimes used to describe atopic dermatitis. Eczema refers to inflamed, itching skin from a variety of causes. Atopic dermatitis is the most common type of eczema.

Atopic Dermatitis before treatment

Atopic Dermatitis after treatment

Before treatment

After treatment

Atopic dermatitis is very common, affecting 10-15% of people. The severe itching and irritation during flare-ups can be extremely bothersome. The resulting scratching can result in raw skin and skin infections.

Fortunately, most cases of atopic dermatitis respond well to treatment.

What are the symptoms of atopic dermatitis?

The most obvious symptoms of atopic dermatitis are intense itching, along with red, dry skin that is sometimes scaly.

The worsening of atopic dermatitis symptoms is referred to as a "flare". An atopic dermatitis flare can be triggered by a variety of factors (see below).

The appearance of atopic dermatitis varies tremendously from person to person. Most people with atopic dermatitis experience a short-term flare for a few weeks (acute), during which the skin looks red, raised, and cracked.

Between flares, the skin may appear normal or slightly dry. If the rash lasts a long time (chronic), the skin may start to change appearance, becoming thicker and darker. These patches of thickened skin take longer to respond to treatment.

The appearance of atopic dermatitis also tends to vary depending on the age of the person.

Atopic Dermatitis in Infants

Children less than one year old often have atopic dermatitis widely distributed over their body. The skin is usually dry, scaly, and red. The baby may scratch the skin, leading to scratch marks. The cheeks of infants are often the first place to be affected.

The diaper area is frequently spared because the moisture retained by the diapers prevents the skin from drying.

Atopic Dermatitis in Toddlers

As children reach 2 to 3 years old, atopic dermatitis becomes more localized to areas such as the outer part of the joint, including the front of the knees, outside elbows, and top of the wrists. Older children are also more capable of a vigorous scratch, creating very red and inflamed areas.

Atopic Dermatitis before treatment
Before treatment
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Atopic Dermatitis after treatment
After treatment
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Atopic Dermatitis in School-age Children

As children reach school age, atopic dermatitis tends to migrate to the part of the joint that flexes, such as the insides of the elbows and knees. atopic dermatitis may also start to appear on the eyelids, earlobes, neck, and scalp.

School-age children may develop itchy blisters on the fingers and feet known as dyshidrotic or vesicular dermatitis (pompholyx).

Atopic Dermatitis
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Atopic Dermatitis on Foot
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Atopic Dermatitis in Adults 

Adults with atopic dermatitis tend to have the rash localized to specific areas, particularly the hands, feet, eyelids, back of the knees, and insides of the elbows. However, the skin elsewhere on the body may feel dry and prone to itching.

Atopic dermatitis that starts in infancy often improves by the time the child is 5 years old and usually resolves by the teenage years. However, many people endure atopic dermatitis and need to manage it throughout their lives.

What causes atopic dermatitis?

The exact cause of atopic dermatitis is unknown, but the tendency to develop atopic dermatitis runs in families. People with atopic dermatitis are more likely to suffer allergies and/or symptoms of asthma. The connection between these disorders appears to be an overactive immune system.

T-cells, a type of white blood cell that fights infections, appear to be more active in people with atopic dermatitis. Changes beneath the skin make the skin of people with atopic dermatitis more susceptible to losing water quickly, leading to dry, cracked skin.

Although the immune system is overactive in people with atopic dermatitis, it is not always effective at fighting infections. In fact, people with atopic dermatitis are more susceptible to skin infections, such as impetigo.

What are the treatment options for atopic dermatitis?

The goals of atopic dermatitis treatment are to heal the skin, prevent new flare-ups, and reduce the urge to scratch, which can further irritate and prolong symptoms.

Atopic dermatitis treatment may last for many months, and treatments often need to be repeated.

There are several treatment options available. A treatment plan will be recommended based on several variables, including:

  • The person's age

  • The location of the rash (face vs. knee)

  • The severity of the flare

  • Acute vs. chronic (long-lasting symptoms may require more potent medications)

  • Results of past treatments

  • Personal preferences

It is generally recommended that all people with atopic dermatitis do their best to avoid known triggers and apply a moisturizer regularly.

Additional treatment options include:

 

  • Topical corticosteroids. Mild to mid-potency corticosteroids are applied to the skin on a short-term basis to bring the flare under control

  • Calcineurin inhibitors (Elidel, Protopic). Calcineurin inhbitors are non-steroidal medications may be used as an alternative to corticosteroids or in between use of corticosteroids. They too help to reduce inflammation.

  • Antihistamines (Benadryl, Claritin, Xyzal, Zyrtec). Antihistamines help to reduce the itching and scratching that can prevent the skin from healing

  • Antibiotics. These may be prescribed to treat an underlying bacterial infection of the skin that can be worsening symptoms of atopic dermatitis.

  • Oral corticosteroids (prednisone). These may be used to bring severe cases of atopic dermatitis under control quickly. Due to the wide variety of side effects caused by oral corticosteroids, they are generally prescribed for only a few days.

  • Immunosuppressants (cyclosporine). These may be considered for severe cases of atopic dermatitis that do not respond to other treatments.

What triggers atopic dermatitis?

Not everyone with atopic dermatitis will have the same triggers, so people with the disorder will have to keep track of their particular sensitivities. Because identifying triggers can be tricky (for example, sometimes there is a delay between eating a certain food and seeing a resulting flare-up), it’s a good idea to keep a journal of any atopic dermatitis symptoms and possible causes. 

Some commonly reported atopic dermatitis triggers include:

  • Irritants—These are substances that contact the skin directly, causing redness and inflammation. They include wool or other synthetic fabrics, soaps and detergents, perfumes and makeup, cigarette smoke, and chemicals (such as chlorine).

  • Allergens—Allergens are more indirect triggers, where the skin becomes inflamed and itchy because of an allergic reaction, such as from pollen, mold, or animal and pet dander.

  • Stress—While stress isn’t a known cause of atopic dermatitis, it can aggravate flare-ups.

  • Temperature—Many people with atopic dermatitis have chronically dry skin that is sensitive to certain climate conditions, such as cold winter weather, indoor heating, or warm baths. Humid environments, such as a sauna, may cause sweating that could trigger a flare-up.

Atopic Dermatitis and Moisturizers

One of the most important self-care steps for treating and managing atopic dermatitis (eczema) is to use a moisturizer.

Moisturizers provide a layer of protection from irritants, trap moisture in the skin, help restore the skin barrier, and improve the skin’s appearance. Regular use of a moisturizer may reduce the need for other medicines.

Moisturizers are best applied at least twice a day within 3 minutes after a bath, shower, or swim.

When choosing a moisturizer, look for a hypoallergenic and ointment-based product. Thicker moisturizers will protect the skin longer than lighter lotions. Avoid moisturizers containing alcohol, fragrances, or other chemicals that can irritate the skin. Even seemingly harmless substances like glycerin can dry the skin of people with atopic dermatitis (eczema).

Possible moisturizers include:

  • CeraVe

  • Cetaphil

  • Eucerin

  • Aquaphor

  • Vaseline Petroleum Jelly—-though thick, it is quickly absorbed by very dry skin

Before applying the moisturizer, use tepid water and a gentle cleanser to remove dead skin cells. Do not scrub or rub excessively. Apply the moisturizer immediately afterward while the skin is still damp.

Remember to use plenty of moisturizer to keep atopic dermatitis (eczema) under control, especially in children. Keeping a child’s skin sufficiently moisturized could require as much as 1-2 bottles of moisturizer per week. Adults will need even more.

 

Behcet's Syndrome

Behçet's disease is a chronic condition that causes canker sores or ulcers in the mouth and on the genitals, and inflammation in parts of the eye. In some people, the disease also results in arthritis (swollen, painful, stiff joints), skin problems, and inflammation of the digestive tract, brain, and spinal cord.

Behçet's disease relatively rare in the United States. It is more common In Middle Eastern and Asian countries and is more likely to affect men than women. Behçet's disease tends to develop in people in their 20's or 30's, but people of all ages can develop this disease.

The exact cause of Behçet's disease is unknown. Most symptoms of the disease are caused by inflammation of the blood vessels. Inflammation is a characteristic reaction of the body to injury or disease and is marked by four signs:

  • swelling

  • redness

  • heat

  • pain

It is thought that an autoimmune reaction may cause the blood vessels to become inflamed, but they do not know what triggers this reaction. Under normal conditions, the immune system protects the body from diseases and infections by killing harmful "foreign" substances, such as germs, that enter the body. In an autoimmune reaction, the immune system mistakenly attacks and harms the body's own tissues.

Behçet's disease is not contagious.

What are the symptoms of Behçet's disease?

Behçet's disease affects each person differently. Some people have only mild symptoms, such as canker sores or ulcers in the mouth or on the genitals. Others have more severe signs, such as meningitis, which is an inflammation of the membranes that cover the brain and spinal cord. Meningitis can cause fever, a stiff neck, and headaches.

More severe symptoms usually appear months or years after a person notices the first signs of Behçet's disease. Symptoms can last for a long time or may come and go in a few weeks. Typically, symptoms appear, disappear, and then reappear. The times when a person is having symptoms are called flares. Different symptoms may occur with each flare; the problems of the disease often do not occur together. To help the doctor diagnose Behçet's disease and monitor its course, patients may want to keep a record of which symptoms occur and when. Because many conditions mimic Behçet's disease, physicians must observe the lesions (injuries) caused by the disorder in order to make an accurate diagnosis.

The five most common symptoms of Behçet's disease are mouth sores, genital sores, other skin lesions, inflammation of parts of the eye, and arthritis.

  • Mouth sores affect almost all patients with Behçet's disease. Individual sores or ulcers are usually identical to canker sores, which are common in many people. They are often the first symptom that a person notices and may occur long before any other symptoms appear. The sores usually have a red border and several may appear at the same time. They may be painful and can make eating difficult. Mouth sores go away in 10 to 14 days but often come back. Small sores usually heal without scarring, but larger sores may scar.

  • Genital sores affect more than half of all people with Behçet's disease and most commonly appear on the scrotum in men and vulva in women. The sores look similar to the mouth sores and may be painful. After several outbreaks, they may cause scarring.

  • Skin problems are a common symptom of Behçet's disease. Skin sores often look red or resemble pus-filled bumps or a bruise. The sores are red and raised, and typically appear on the legs and on the upper torso. In some people, sores or lesions may appear when the skin is scratched or pricked. When doctors suspect that a person has Behçet's disease, they may perform a pathergy test, in which they prick the skin with a small needle; 1 to 2 days after the test, people with Behçet's disease may develop a red bump where the doctor pricked the skin. However, only half of the Behçet's patients in Middle Eastern countries and Japan have this reaction. It is less commonly observed in patients from the United States, but if this reaction occurs, then Behçet's disease is likely.

  • Uveitis involves inflammation of the middle or back part of the eye (the uvea) including the iris, and occurs in more than half of all people with Behçet's disease. This symptom is more common among men than women and typically begins within 2 years of the first symptoms. Eye inflammation can cause blurred vision; rarely, it causes pain and redness. Because partial loss of vision or blindness can result if the eye frequently becomes inflamed, patients should report these symptoms to their doctor immediately.

  • Arthritis, which is inflammation of the joints, occurs in more than half of all patients with Behçet's disease. Arthritis causes pain, swelling, and stiffness in the joints, especially in the knees, ankles, wrists, and elbows. Arthritis that results from Behçet's disease usually lasts a few weeks and does not cause permanent damage to the joints.

In addition to mouth and genital sores, other skin lesions, eye inflammation, and arthritis, Behçet's disease may also cause blood clots, and inflammation in the central nervous system and digestive organs.

How is Behçet's disease diagnosed?

Diagnosing Behçet's disease is very difficult because no specific test confirms it. Less than half of patients initially thought to have Behçet's disease actually have it. When a patient reports symptoms, the doctor must examine the patient and rule out other conditions with similar symptoms. Because it may take several months or even years for all the common symptoms to appear, the diagnosis may not be made for a long time. A patient may even visit several different kinds of doctors before the diagnosis is made.

These symptoms are key to a diagnosis of Behçet's disease:

  • Mouth sores at least three times in 12 months

  • Any two of the following symptoms: recurring genital sores, eye inflammation with loss of vision, characteristic skin lesions, or positive pathergy (skin prick test)

Besides finding these signs, the doctor must rule out other conditions with similar symptoms, such as Crohn's disease and reactive arthritis. The doctor also may recommend that the patient see an eye specialist to identify possible complications related to eye inflammation. A dermatologist may perform a biopsy of mouth, genital, or skin lesions to help distinguish Behçet's from other disorders.

How is Behçet's disease treated?

Although there is no cure for Behçet's disease, people usually can control symptoms with proper medication, rest, exercise, and a healthy lifestyle. The goal of treatment is to reduce discomfort and prevent serious complications such as disability from arthritis or blindness. The type of medicine and the length of treatment depend on the person's symptoms and their severity.

It is likely that a combination of treatments will be needed to relieve specific symptoms. Patients should tell each of their doctors about all of the medicines they are taking so that the doctors can coordinate treatment.

Topical medicine

Topical medicine is applied directly on the sores to relieve pain and discomfort. For example, doctors prescribe rinses, gels, or ointments. Creams are used to treat skin and genital sores. The medicine usually contains corticosteroids (which reduce inflammation), other anti-inflammatory drugs, or an anesthetic, which relieves pain.

Oral medicine

Doctors also prescribe medicines taken by mouth to reduce inflammation throughout the body, suppress the overactive immune system, and relieve symptoms. Doctors may prescribe one or more of the medicines described below to treat the various symptoms of Behçet's disease.

  • Corticosteroids--Prednisone is a corticosteroid prescribed to reduce pain and inflammation throughout the body for people with severe joint pain, skin sores, eye disease, or central nervous system symptoms. Patients must carefully follow the doctor's instructions about when to take prednisone and how much to take. It also is important not to stop taking the medicine suddenly, because the medicine alters the body's production of the natural corticosteroid hormones. Long-term use of prednisone can have side effects such as osteoporosis (a disease that leads to bone fragility), weight gain, delayed wound healing, persistent heartburn, and elevated blood pressure. However, these side effects are rare when prednisone is taken at low doses for a short time. It is important that patients see their doctor regularly to monitor possible side effects. Corticosteroids are useful in early stages of disease and for acute severe flares. They are of limited use for long-term management of central nervous system and serious eye complications.

  • Immunosuppressive drugs--These medicines (in addition to corticosteriods) help control an overactive immune system, which occurs in Behçet's disease, and reduce inflammation throughout the body, and can lessen the number of disease flares. Doctors may use immunosuppressive drugs when a person has eye disease or central nervous system involvement. These medicines are very strong and can have serious side effects. Patients must see their doctor regularly for blood tests to detect and monitor side effects.

Doctors may use one or more of the following immunosuppressive drugs depending on the person's specific symptoms.

  • Azathioprine--Most commonly prescribed for people with organ transplants because it suppresses the immune system, azathioprine is now used for people with Behçet's disease to treat uveitis and other uncontrolled disease manifestations. This medicine can upset the stomach and may reduce production of new blood cells by the bone marrow.

  • Chlorambucil or cyclophosphamide--Doctors may use these drugs to treat uveitis and meningoencephalitis. People taking either agent must see their doctor frequently because either can have serious side effects, such as permanent sterility and cancers of the blood. Patients have regular blood tests to monitor blood counts of white cells and platelets.

  • Cyclosporine--Like azathioprine, doctors prescribe this medicine for people with organ transplants. When used by patients with Behçet's disease, cyclosporine reduces uveitis and uncontrolled disease in other organs. To reduce the risk of side effects, such as kidney and liver disease, the doctor can adjust the dose. Patients must tell their doctor if they take any other medicines, because some medicines affect the way the body uses cyclosporine.

  • Colchicine--Commonly used to treat gout, which is a form of arthritis, colchicine reduces inflammation throughout the body. The medicine sometimes is used to treat arthritis, mucous membrane, and skin symptoms in patients with Behçet's disease. A research study in Turkey suggested that the medication works best for males with the disorder. Common side effects of colchicine include nausea, vomiting, and diarrhea. The doctor can decrease the dose to relieve these side effects.

  • Combination treatment--Cyclosporine is sometimes used with azathioprine when one alone fails. Prednisone along with an immunosuppressive drug is a common combination.

If these medicines do not reduce the symptoms, doctors may use other drugs such as methotrexate. Methotrexate (Rheumatrex,Trexall), which is also used to treat various kinds of cancer as well as rheumatoid arthritis, can relieve Behçet's symptoms because it suppresses the immune system and reduces inflammation throughout the body.

Rest and exercise

Although rest is important during flares, doctors usually recommend moderate exercise, such as swimming or walking, when the symptoms have improved or disappeared. Exercise can help people with Behçet's disease keep their joints strong and flexible.

What is the prognosis for a person with Behçet's disease?

Most people with Behçet's disease can lead productive lives and control symptoms with proper medicine, rest, and exercise. Doctors can use many medicines to relieve pain, treat symptoms, and prevent complications. When treatment is effective, flares usually become less frequent. Many patients eventually enter a period of remission (a disappearance of symptoms). In some people, treatment does not relieve symptoms, and gradually more serious symptoms such as eye disease may occur. Serious symptoms may appear months or years after the first signs of Behçet's disease.

 

Boils and Carbuncles

Boil, staph infection, leg

Boils and carbuncles are bacterial infections of the skin that form red, painful, pus-filled bumps. They usually arise on the face, neck, back, legs, and buttocks.

Carbuncles is the name given to a cluster of boils. Carbuncles tend to cause deeper, more severe infections than boils.

Boils and carbuncles are due to a hair follicle becoming infected with bacteria, usually staphylococcus aureus).

You should seek medical attention if a boil or carbuncle becomes extremely painful, lasts more than 2 weeks, or is accompanied by a fever.

In some cases, cellulitis can develop around the boil or carbuncle. Cellulitis causes the skin to turn pink or red, become painful and tender to the touch. Cellulitis requires medical attention.

Your doctor may drain the boil or carbuncle by making a small incision at the top. This releases the infected fluids, resulting in less pain and a lower risk of scarring. Deep infections that can't be completely drained may be covered with sterile gauze so that infected fluids can continue to drain.

Your doctor may prescribe antibiotics to treat severe or recurrent infections.

The following steps may help you avoid staph infections:

  • Clean all cuts and scrapes with soap and water, then apply an over-the-counter antibiotic ointment, such a Neosporin or Bacitracin.

  • Avoid tight clothes that can chafe skin and irritate hair follicles.

The following steps may help a boil or carbuncle heal faster and avoid spreading.

  • Apply a warm washcloth for at least 10 minutes every few hours. This helps the boil drain more quickly.

  • Gently wash the boil at least twice a day with antibacterial soap.

  • After washing, apply a topical antibiotic and cover it with a bandage.

  • Wash your hands thoroughly after touching a boil.

  • Launder any clothing, towels, or compresses that have touched the infected skin.

 

Bullous Pemphigoid

Bullous pemphigoid
 

Bullous pemphigoid (BP) is a chronic blistering of the skin. It ranges from mildly itchy welts to severe blisters that are susceptible to infection.

It may affect a small area of the body or be widespread. The majority of those affected are elderly, but it can occur in people of any age.

What Causes Bullous Pemphigoid?

Bullous pemphigoid is an autoimmune disorder, meaning it is caused when the body's own immune system attacks healthy tissue. The immune system produces antibodies to defend the body against bacteria, viruses, and other infections. People with BP produced antibodies that attack certain parts of the skin. Some factors have been shown to play a role in triggering BP. These include drugs (furosemide, penicillin), mechanical trauma, and physical traumas (burns from radiation, sun, or heat).

Bulla is the medical term for a large blister (a thin-walled sac filled with clear fluid). Usually the skin in BP is very itchy, and large, red welts and hives may appear before or during the formation of blisters. The blisters are widespread and usually appear on the areas of the body that flex or move (flexural areas). About 15-20 percent of people with BP also develop blisters in the mouth or down the throat in the esophagus.

How is Bullous Pemphigoid Diagnosed and Treated?

Because BP can appear in many different ways, your doctor may perform a skin biopsy to confirm the diagnosis.

Treatment is focused on relieving symptoms and preventing infection. Oral antibiotics, such as doxycycline or minocycline, may be useful for mild to moderate disease. Their anti-inflammatory effects are used to control the immune system, not to kill bacteria. They can be used in combination with potent topical corticosteroids for more rapid relief.

Oral steroids (prednisone) are the treatment of choice for severe cases. Regular visits will be needed because the dose must be adjusted frequently, and side effects must be monitored. A fairly high dose is needed initially, and once the blisters have stopped appearing, it is slowly reduced over many months or years. As steroids have some undesirable side effects, doctors try to reduce the dose as low as possible. If this is done too quickly, the blisters may reappear.

Often, immunosuppressive agents (Imuran, Cellcept, methotrexate, cyclophosphamide, and Neoral) are combined with the oral steroids to allow a lower dose. Severe cases are best treated in the hospital to allow expert dressing of the wounds and intravenous injections of the most potent treatments.

What Should I Expect if I Have Bullous Pemphigoid?

BP is a self-limiting disease that is in most cases completely clears up over time and the treatment can be stopped. Treatment is usually needed for several years, but generally after a few months it is possible to reduce the dose to reasonably low levels. BP sometimes has a pattern of remissions and flare-ups. It may be dormant for 5 or 6 years, and then suddenly flare.

With careful management, most patients with BP do well. Be patient and follow your instructions faithfully; these are the keys to good results.

 

Candidiasis: Oral (Thrush)

Thrush (also called oropharyngeal candidiasis) is the overgrowth yeast in the mouth or on the tongue.

The yeast is called Candida. Candida is normally found on the skin and mucous membranes. Candida can grow excessively if the environment inside the mouth or throat becomes imbalanced.

When this happens, symptoms of thrush appear. Candida overgrowth can also develop in the esophagus (esophageal candidiasis) or vagina (vulvovaginal candidiasis).

Who gets thrush?

Thrust can affect normal newborns, persons with dentures, and people who use inhaled corticosteroids. It occurs more frequently and more severely in people with weakened immune systems, particularly in persons with AIDS and people undergoing treatment for cancer. 

Thrush is very unusual in otherwise healthy people.

How does someone get thrush?

Most cases of thrush are caused by the person’s own Candida organisms which normally live in the mouth or digestive tract. A person has symptoms when overgrowth of Candida organisms occurs.

What are the symptoms of thrush?

People with thrush usually have painless, white patches in the mouth. Others may have redness and soreness of the inside of the mouth. Cracking at the corners of the mouth, known as angular cheilitis, may occur. Symptoms of Candida esophagitis may include pain and difficulty swallowing. Other conditions can cause similar symptoms, so it is important to see your doctor.

How is thrust diagnosed?

Thrust is often diagnosed based on the clinical appearance of the mouth and by taking a scraping of the white patches and looking at it under a microscope. A culture may also be performed. Because Candida organisms are normal inhabitants of the human mouth, a positive culture by itself does not make the diagnosis.

How is thrust treated?

Prescription treatments include clotrimazole troches or lozenges and nystatin suspension (nystatin “swish and swallow”). Another commonly prescribed treatment is oral fluconazole. For infection which does not respond to these treatments, there are a number of other antifungal medications that are available.

 

Cellulitis

Cellulitis is an infection of the skin and deep underlying tissues. Erysipelas is an infection of the outermost layers of the skin.

What causes cellulitis?

Group A strep (GAS) and staphylococcus aureus bacteria are the most common causes of cellulitis and erysipelas.

Both cellulitis and erysipelas begin with a minor incident, such as a bruise. They can also begin at the site of a burn, surgical cut, or wound, and usually affect your arm or leg.

When the rash appears on your trunk, arms, or legs, however, it is usually at the site of a surgical cut or wound.

Even if you have no symptoms, you carry the germs on your skin or in your nasal passages and can transmit the disease to others.

What are the symptoms of cellulitis?

Symptoms of cellulitis include:

  • Fever and chills

  • Swollen glands or lymph nodes

  • Tender, painful, red skin that may blister and scab over

  • Perianal (around the anus) itching and painful bowel movements

Symptoms of erysipelas include:

  • A fiery red rash with raised borders on your face, arms, or legs

  • Hot, red skin with sharply defined raised areas

In addition, the infection may come back, causing chronic (long-term) swelling of your arms or legs (lymphedema).

How is cellulitis diagnosed and treated?

Your doctor may take a sample or culture from your skin lesions to identify the bacteria causing the infection. He or she may also identify the bacteria by running a blood test.

In most cases, your doctor will prescribe antibiotics to be taken by mouth. In severe cases, your doctor may recommend that you be hospitalized to receive intravenous antibiotics

 

Chickenpox

Chickenpox is a childhood illness caused by infection with the varicella zoster virus (VZV) that causes a distinctive rash, fever, and fatigue.

Chickenpox was very common prior to the development of the varicella vaccine (chickenpox vaccine), affecting nearly all school-aged children.

The varicella virus that causes chickenpox remains dormant in the body after the chickenpox symptoms resolve. The virus may be triggered years later and cause a different set of symptoms called shingles, or zoster.

What Are the Symptoms of Chickenpox?

The rash of chickenpox usually begins as small itchy red bumps (papules) that appear on the trunk, scalp, and face. These bumps spread to other parts of the body, such as the limbs.

The papules evolve into small pink blisters (pustules) that have been described as “dew drops on a rose petal". The blisters eventually crust over with small dark scabs. A person infected with chickenpox may have bumps, blisters and scabs on the skin at the same time.

Chickenpox
 

Most, but not all, infected individuals develop a fever at the onset of the rash. If exposed, people who have been vaccinated against the disease may get a milder illness, with less severe rash (sometimes involving only a few red bumps that look similar to insect bites) and mild or no fever.

The number of skin lesions can vary from just a few to more than 1,000. Children with skin disorders such as atopic dermatitis generally develop more lesions. Unless the blisters become infected, there is no long-term scarring of the skin.

Healed chickenpox lesions may appear lighter (hypopigmentation) or darker (hyperpigmentation) than the surrounding skin for several months.

Are There Complications of Chickenpox?

People infected with chickenpox are at risk of developing other complications, including bacterial infection of the skin (cellulitis), swelling of the brain, and pneumonia. Adolescents and adults are more at risk for severe cases of chickenpox. Chickenpox during pregnancy may be complicated by pneumonia, premature delivery, and infection of the fetus.

How is Chickenpox Spread?

Chickenpox is very contagious and is spread by coughing and sneezing, direct contact with a lesion, and formation of tiny airborne droplet of virus from skin lesions. If exposure occurs in the early phase of disease, a person who is not immune to varicella has nearly an 80% chance of infection.

A person with chickenpox is considered contagious 2 days prior to the onset of rash and until all lesions have formed scabs, which usually takes a week to 10 days. The incubation period for chickenpox is 10-21 days; that is, a person exposed to chickenpox may take up to three weeks to develop symptoms.

What Is the Chickepox Vaccine?

The varicella vaccine can prevent chickenpox. Currently, two doses of vaccine are recommended for children, adolescents, and adults.

In children, varicella vaccine is now routinely administered at 12-15 months and again at 4-6 years. It is thought to be extremely effective against more severe cases, and nearly 90% effective against mild chickenpox cases. Even if the vaccine is given after exposure to varicella, it may help modify the severity of infection.

What Home Treatments are Available for Chickenpox?

Parents can do several things at home to help relieve their child’s chickenpox symptoms. Because scratching the blisters may cause them to become infected, keep your child’s fingernails trimmed short. Calamine lotion and Aveeno (oatmeal) baths may help relieve some of the itching.

Do not use aspirin or aspirin-containing products to relieve your child's fever. The use of aspirin in children with chickenpox has been associated with development of Reye’s syndrome (a severe disease affecting all organs, most seriously affecting the liver and brain, that may cause death). Use non-aspirin medications such as acetaminophen (Tylenol).

What Treatments Might Be Prescribed for Chickenpox?

Your doctor will advise you on treatment options.

Antiviral medications may help reduce the severity of symptoms. These include:

Antiviral medications may be recommended for people who are more likely to develop serious disease, including people with chronic skin or lung disease, otherwise healthy individuals 13 years of age or older, and people receiving steroid therapy.

People whose immune systems have been weakened from disease or medication should contact a doctor immediately if they are exposed to or develop chickenpox. If you are pregnant and are either exposed to or develop chickenpox, immediately discuss prevention and treatment options with your doctor.

Can I Avoid Getting Chickenpox if I Have Been Exposed to the Varicella Virus?

Yes, varicella zoster immune globulin (VZIG) can prevent or modify disease after exposure to chickenpox. However, because it is costly and only provides temporary protection, VZIG is only recommended for people at high risk of developing severe disease who are not eligible to receive the chickenpox vaccine. VZIG should be administered as soon as possible, but no later than 96 hours, after exposure to chickenpox.

 

Contact Dermatitis

Allergic contact dermatitis is an extremely itchy rash that develops when someone comes into contact with a substance to which he or she is allergic.

These substances ("allergens") are harmless to most people but trigger immune reactions in those who are sensitive. Only a small amount of the allergen is required to trigger an allergic reaction.

Repeated exposure of the skin to an allergen is required to develop contact dermatitis. Most people might be exposed to an allergen for years before finally developing a rash. However, once a person's skin becomes sensitized to a particular substance, that person usually remains sensitive to it for life.

Allergens that commonly trigger allergic contact dermatitis include:

  • Plants (poison oak, poison ivy)

  • Metals, particularly nickel allergy. Nickel is found in jewelry (earrings, watches, necklaces), buttons (inside portion of jeans), or belt buckles

  • Fragrances (including those found in lotions, shampoos, and other cosmetics)

  • Preservatives (found in lotions, or leather and other fabrics)

  • Rubber (gloves)

  • Hair dyes

  • Glues

  • Medications (Neosporin)

After exposure to an allergen, the skin may appear red, swollen, and blistered, or dry and bumpy. The location of the rash helps to determine the source of the allergy since it develops where the allergen contacts the skin.

For instance, a rash on the neck or wrist may suggest an allergy to the metal (nickel) found in a necklace or wristwatch. Rashes on both feet may be due to chemicals found in the leather or rubber of shoes.In severe cases, the rash may extend beyond the point of contact and appear elsewhere in the body.

The rash of contact dermatitis may start as soon as several hours after contact with the allergen. And it can take days to weeks to heal even after the allergen is removed from the skin.

If the cause of the allergic reaction is uncertain, your doctor may perform a patch test. This an an allergy test for the diagnosis of allergic contact dermatitis. The suspected allergen may be applied several times a day to a small patch of sensitive skin (such as the inner arm) for several days. The area is then monitored for changes.

The focus of treatment for allergic contact dermatitis is avoidance of the allergen (the substance that causes the allergy).

The symptoms of allergic contact dermatitis might be treated with one or more of the following:

  • Anthistamines to control the itching

  • Moisturizers, to heal damaged skin and provide a barrier

  • Topical corticosteroids

  • Oral steroids, such as prednisone, used for a short period for severe cases

  • Topical immunomodulators (Elidel, Protopic)

 

Cutaneous T-cell Lymphoma (CTCL)

Cutaneous T-cell lymphoma (CTCL) is a type of skin cancer. A type of white blood cell called T-cell lymphocytes that normally fight infections become cancerous and affect the skin.

What are mycosis fungoides and the Sezary syndrome?

Mycosis fungoides and the Sézary syndrome are the two most common forms of cutaneous T-cell lymphoma.

In mycosis fungoides, T-cells become cancerous and spread to the skin.

In the Sézary syndrome, T-cells become cancerous affect the skin and the blood.

What are the symptoms of CTCL?

Mycosis fungoides and the Sézary syndrome may evolve through the following phases:

  • Premycotic phase: A scaly, red rash in areas of the body that usually are not exposed to the sun. This rash does not cause symptoms and may last for months or years. It is hard to diagnose the rash as mycosis fungoides during this phase.

  • Patch phase: Thin, reddened, eczema-like rash.

  • Plaque phase: Thickened, red patches or reddened skin.

  • Tumor phase: Tumors form on the skin. These tumors may develop ulcers and the skin may get infected.

The Sézary syndrome is an advanced form of mycosis fungoides during which the skin all over the body is reddened, itchy, peeling, and painfu and cancerous T-cells are found in the blood.

Mycosis fungoides does not always progress to the Sézary syndrome.

How are mycosis fungoides and the Sézary syndrome diagnosed?

The following tests and procedures may be used to diagnose mycosis fungoides and Sézary syndrome:

Physical exam and history: An exam of the body to check general signs of health, including checking for signs of disease, such as lumps, the number and type of skin lesions, or anything else that seems unusual. Pictures of the skin and a history of the patient’s health habits and past illnesses and treatments will also be taken.

Complete blood count with differential: A CBC blood test checks for the number and type of lympocytes and other blood cells.

Peripheral blood smear: A procedure in which a sample of blood is viewed under a microscope to count different circulating blood cells (red blood cells, white blood cells, platelets, etc.) and see whether the cells look normal.

Biopsy: The removal of cells or tissues so they can be viewed under a microscope to check for signs of cancer. The doctor may remove a growth from the skin, which will be examined by a pathologist. More than one skin biopsy may be needed to diagnose mycosis fungoides.

Immunophenotyping: A process used to identify cells, based on the types of antigens or markers on the surface of the cell. This process may include special staining of the blood cells. It is used to diagnose specific types of leukemia and lymphoma by comparing the cancer cells to normal cells of the immune system.
 
Immunogenotyping: A procedure in which a sample of DNA from a skin biopsy is studied to see if the genes for certain kinds of immune system proteins, such as the T-cell receptor or antibody proteins, are arranged in one pattern. Normally T-cell receptor genes and antibody genes are arranged in many different patterns. In mycosis fungoides and the Sézary syndrome, the genes are arranged in a single pattern.

What factors affect prognosis and treatment options?

The prognosis (chance of recovery) and treatment options depend on the following:

  • The stage of the cancer (the amount of skin affected and whether cancer has spread to the lymph nodes, the blood, or other places in the body).

  • The type of lesion (patches, plaques, or tumors).

  • The number of cutaneous T-cell lymphocytes in the blood.

Mycosis fungoides and the Sézary syndrome are difficult to cure. Treatment is usually palliative, to relieve symptoms and improve the quality of life. Patients can live many years with this disease.

How do doctors determine if the disease has spread?

After mycosis fungoides and the Sézary syndrome have been diagnosed, tests are done to find out if cancer cells have spread from the skin to other parts of the body.

The process used to find out if cancer has spread from the skin to other parts of the body is called staging. The information gathered from the staging process determines the stage of the disease. It is important to know the stage in order to plan treatment. The following procedures may be used in the staging process:

  • Chest X-ray: An X-ray of the organs and bones inside the chest. An X-ray is a type of energy beam that can go through the body and onto film, making a picture of areas inside the body.

  • CT scan (CAT scan): A procedure that makes a series of detailed pictures of areas inside the body, such as the lymph nodes, chest, abdomen, and pelvis, taken from different angles. The pictures are made by a computer linked to an X-ray machine. A dye may be injected into a vein or swallowed to help the organs or tissues show up more clearly. This procedure is also called computed tomography, computerized tomography, or computerized axial tomography.

  • MRI (magnetic resonance imaging): A procedure that uses a magnet, radio waves, and a computer to make a series of detailed pictures of areas inside the body, such as the lymph nodes, chest, abdomen, and pelvis. This procedure is also called nuclear magnetic resonance imaging (NMRI).

  • Lymph node biopsy: The removal of all or part of a lymph node. A pathologist views the tissue under a microscope to look for cancer cells.

What are the stages of mycosis fungoides and the Sézary syndrome? 

The following stages are used for mycosis fungoides and the Sézary syndrome:

Stage I

  • Stage IA: Less than 10% of the skin surface is covered with patches and/or plaques.

  • Stage IB: Ten percent or more of the skin surface is covered with patches and/or plaques.

Stage II

  • Stage IIA: Any amount of the skin surface is covered with patches and/or plaques. Lymph nodes are enlarged but cancer has not spread to them.

  • Stage IIB: One or more tumors are found on the skin. Lymph nodes may be enlarged but cancer has not spread to them.

Stage III

In stage III, nearly all of the skin is reddened and may have patches, plaques, or tumors. Lymph nodes may be enlarged but cancer has not spread to them.

Stage IV

  • Stage IVA: Most of the skin is reddened and any amount of the skin surface is covered with patches, plaques, or tumors. Cancer has spread to lymph nodes, and the lymph nodes may be enlarged.

  • Stage IVB: Most of the skin is reddened and any amount of the skin surface is covered with patches, plaques, or tumors. Cancer has spread to other organs in the body. Lymph nodes may be enlarged and cancer may have spread to them.

Stages of mycosis fungoides and the Sézary syndrome may also have a B classification, which is based on how many abnormal lymphocytes are found in the blood.

How is it treated?

Five types of standard treatment are used:

Photodynamic therapy

Photodynamic therapy is a cancer treatment that uses a drug and a certain type of laser light to kill cancer cells. A drug that is not active until it is exposed to light is injected into a vein. The drug collects more in cancer cells than in normal cells. For skin cancer, laser light is shined onto the skin and the drug becomes active and kills the cancer cells. Photodynamic therapy causes little damage to healthy tissue. Patients undergoing photodynamic therapy will need to limit the amount of time spent in sunlight.

In one type of photodynamic therapy, called psoralen and ultraviolet A (PUVA) therapy, the patient receives a drug called psoralen and then ultraviolet radiation is directed to the skin. In another type of photodynamic therapy, called extracorporeal photochemotherapy, the patient is given drugs and then some blood cells are taken from the body, put under a special ultraviolet A light, and put back into the body.

Radiation therapy

Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy. External radiation therapy uses a machine outside the body to send radiation toward the cancer. Internal radiation therapy uses a radioactive substance sealed in needles, seeds, wires, or catheters that are placed directly into or near the cancer.

Sometimes, total skin electron beam (TSEB) radiation therapy is used to treat mycosis fungoides and the Sézary syndrome. This is a type of radiation treatment in which the skin over the whole body is treated with rays of tiny particles called electrons.

The way the radiation therapy is given depends on the type and stage of the cancer being treated.

Chemotherapy

Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body (systemic chemotherapy). When chemotherapy is placed directly into the spinal column, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas (regional chemotherapy). Sometimes the chemotherapy is topical (applied to the skin in a cream or lotion.) The way the chemotherapy is given depends on the type and stage of the cancer being treated.

Other drug therapy

Retinoids, are drugs related to vitamin A that can slow the growth of certain types of cancer cells. The retinoids may be taken by mouth or applied to the skin.

Biologic therapy

Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer. This type of cancer treatment is also called biotherapy or immunotherapy.

Specific types of biologic therapy used in treating mycosis fungoides and the Sézary syndrome include the following:

  • Monoclonal antibody therapy: A cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell. These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion. They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells.

  • Interferon alfa: A substance that interferes with the division of cancer cells and can slow tumor growth.

  • Interleukin-2: A substance that can improve the body's natural response to infection and disease.

New types of treatment are being tested in clinical trials. These include high-dose chemotherapy and radiation therapy with stem cell transplant. This treatment is a method of giving high doses of chemotherapy and radiation therapy and replacing blood-forming cells destroyed by the cancer treatment. Stem cells (immature blood cells) are removed from the bone marrow or blood of the patient or a donor and are frozen and stored. After therapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into (and restore) the body's blood cells.

 

Dandruff

Dandruff is the shedding of excessive amounts of dead skin from the scalp. This may show up as white flakes on dark clothing. It usually worsens in dry, winter weather and improves in warm, humid conditions. Dandruff may also worsen during times of stress.

Dandruff usually leads to some degree of scalp itching, but there is no redness or other skin abnormalities.

The cause of dandruff is related to the overgrowth of certain fungi on the scalp. The fungi grow on the skin of nearly everyone, but some people are susceptible to an overgrowth that can lead to itching and dry, flaky skin.

Dandruff cannot be cured, but it can be controlled with regular hair washing, particularly with medicated shampoos.

Effective dandruff shampoos might include the following ingredients:

  • Selenium sulfide (Selsun Blue)

  • Zinc pyrithione (Head & Shoulders, ZNP)

  • Ketoconazole (Nizoral AD)

  • Tar (T/Gel, Pentrax)

  • Sulfur (Sebulex)

 

 

Decubitus Ulcers (Bed Sores)

A decubitus ulcer is an area of skin that breaks down when you stay in one position for too long without shifting your weight. Decubitus ulcers are also called "pressure ulcers" or "bed sores".

This often happens if you use a wheelchair or you are bedridden, even for a short period of time (for example, after surgery or an injury). The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies.

A pressure ulcer starts as reddened skin but gets progressively worse, forming a blister, then an open sore, and finally a crater. The most common places for pressure ulcers are over bony prominences (bones close to the skin) like the elbow, heels, hips, ankles, shoulders, back, and the back of the head.

What causes decubitus ulcers?

These factors increase the risk for pressure ulcers:

  • Being bedridden or in a wheelchair

  • Fragile skin

  • Having a chronic condition, such as diabetes or vascular disease, that prevents areas of the body from receiving proper blood flow

  • Inability to move certain parts of your body without assistance, such as after spinal or brain injury or if you have a neuromuscular disease (like multiple sclerosis)

  • Malnourishment

  • Mental disability from conditions such as Alzheimer's disease -- the patient may not be able to properly prevent or treat pressure ulcers

  • Older age

  • Urinary incontinence or bowel incontinence

What are the signs of decubitus ulcers?

Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst):

  • Stage I: A reddened area on the skin that, when pressed, is "non-blanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop.

  • Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated.

  • Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin.

  • Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

What is the proper treatment for a decubitus ulcer?

Once a pressure ulcer is identified, steps must be taken immediately:

  • Relieve the pressure on that area. Use pillows, special foam cushions, and sheepskin to reduce the pressure.

  • Treat the sore based on the stage of the ulcer. Your health care provider will give you specific treatment and care instructions.

  • Avoid further trauma or friction. Powder the sheets lightly to decrease friction in bed. (There are many items made specifically for this purpose -- check a medical supplies store.)

  • Improve nutrition and other underlying problems that may affect the healing process.

  • If the pressure ulcer is at Stage II or worse, your health care provider will give you specific instructions on how to clean and care for open ulcers. It is very important to do this properly to prevent infection.

  • Keep the area clean and free of dead tissue. Your health care provider will give you specific care directions. Generally, pressure ulcers are rinsed with a salt-water rinse to remove loose, dead tissue. The sore should be covered with special gauze dressing made for pressure ulcers.

  • New medicines that promote skin healing are now available and may be prescribed by your doctor.

DO NOT

  • Do NOT massage the area of the ulcer. Massage can damage tissue under the skin.

  • Donut-shaped or ring-shaped cushions are NOT recommended. They interfere with blood flow to that area and cause complications.

How can pressure ulcers be prevented?

If bedridden or immobile with diabetes, circulation problems, incontinence, or mental disabilities, you should be checked for pressure sores every day. Look for reddened areas that, when pressed, do not turn white. Also look for blisters, sores, or craters. In addition, take the following steps:

  • Change position at least every two hours to relieve pressure.

  • Use items that can help reduce pressure -- pillows, sheepskin, foam padding, and powders from medical supply stores.

  • Eat healthy, well-balanced meals.

  • Exercise daily, including range-of-motion exercises for immobile patients.

  • Keep skin clean and dry. Persons with incontinence need to take extra steps to limit moisture.

When should I contact a medical professional?

Contact your health care provider if an area of the skin blisters or forms an open sore. Contact the provider immediately if there are any signs of an infection. An infection can spread to the rest of the body and cause serious problems. Signs of an infected ulcer include:

  • A foul odor from the ulcer

  • Redness and tenderness around the ulcer

  • Skin close to the ulcer is warm and swollen

  • Fever, weakness, and confusion are signs that the infection may have spread to the blood or elsewhere in the body

Dermatitis, Hand

Hand dermatitis is a general term describing inflammation of the skin of the hands Any type ofdermatitis that develops on the hands can be classified as “hand dermatitis".

Hand dermatitis is a common subset of eczema that may account for 80% of all job-related skin conditions. This is due to the hands being exposed to a variety of chemicals in the workplace that may irritate the skin or trigger an allergic reaction.

Although common, hand dermatitis is categorized separately because it may require a unique approach to evaluation and treatment.

Symptoms may range from mild to severe and include the following:

  • dry chapped skin

  • red, scaly and itchy patches of skin

  • blisters or weeping areas.

  • painful cracked skin

  • deformed fingernails (may occur with long-standing hand dermatitis)

Without proper treatment, hand dermatitis symptoms can worsen and become chronic. Hand dermatitis can interfere with tasks and diminish one’s quality of life.

Causes of Hand Dermatitis

Irritatants. Even mild substances can irritate the skin. In fact water is a common cause of hand dermatitis because frequent hand washing can remove protective oils from the skin. Cleaning agents and other chemicals can also strip the skin of its oils, leading to dry, cracked skin.

Allergy. Allergic contact dermatitis is an allergic reaction to substances that come into contact with the skin. Certain allergens can trigger hand dermatitis, including nickel, Balsam of Peru, fragrances, rubber, food substances and topical vitamin E.

Hand Dermatitis Risk Factors

Having atopic dermatitisasthma, or allergies increases a person's risk of developing hand dermatitis. When combined with frequent hand washing or even frequently immersing the hands in water or chemicals, the risk is even greater.

Certain work-related tasks increased the risk of developing hand dermatitis. Immersing one's hands in water several times a day, using cleaning agents or exposure to other chemicals can strip the skin of its protective barrier and lead to dermatitis. Occupations with high rates of hand dermatitis include nurses, hair stylists/bartenders, chefs/caterers/dishwashers, mechanics, painters and metalworkers.

Other factors that can trigger or worsen hand dermatitis includes stress, cold air, dry air (low humidity), and perspiration.

Diagnosis of Hand Dermatitis

In addition to a medical history and physical exam, the doctor may perform additional tests to diagnose hand dermatitis and determine the underlying cause.

Patch testing involves applying suspected allergens on the skin and monitoring the reaction.

Skin scraping and culture allows the doctor to examine skin under the microscope or determine if there is an underlying fungal skin infection.

Treatment of Hand Dermatitis

There are several treatment options available. A recommended treatment plan will be based on the possible cause, the severity of the dermatitis, its duration and response to past treatments.

Medication

Topical corticosteroids help to reduce skin inflammation. These products are available in a variety of strengths. Due to the relatively thick skin on the hands, a moderate to very potent corticosteroid may be prescribed for short-term use.

Calcineurin inhibitors provide a non-steroidal alternative to corticosteroids that also help to control inflammation.

Antibiotics may be prescribed to treat any underlying bacterial infection.

Botulinum toxin (Botox) may be offered to those whose hands sweat excessively (palmar hyperhidrosis)

Oral corticosteroids (prednisone) and immunosuppressants (cyclosporine, methotrexate, and mycophenolate mofetil) may be prescribed for severe cases of hand dermatitis that do not respond to other treatments.

Hand Dermatitis Prevention

  • Apply moisturizers regularly. For best results, these should be applied after bathing and frequently throughout the day.

  • Avoid known allergens. For example, if the patch test shows a nickel allergy, avoid wearing costume jewelry.

  • Avoid irritants.

  • Use gloves and change work habits. Wearing gloves can protect the skin from substances found in the workplace and while working around the home. A few days away from the job may clear a mild case. Changing a few habits can help keep the skin clear. Sometimes a material used to make the gloves causes hand dermatitis. For example, some medical professionals develop raw, inflamed hands after wearing latex gloves. Switching to a glove that does not contain latex usually brings relief.

 

Dermatofibroma

Dermatofibromas are firm bumps, or nodules, that form in the deep layers of the skin. They can appear pink or dull red, or can resemble a mole (nevi). They are usually small, about a quarter- to a half-inch wide but can grow to be over an inch in diameter. When pinched, dermatofibromas tend to create a dimple on the skin where the nodule attaches to the upper layers of the skin.

They are common and tend to occur in response to an injury, even minor events like an insect bite. This makes them more likely to appear on the arms and legs.

Dermatofibromas may persist for years. They are benign lesions so can be left alone without treatment. If their presence is bothersome, such as making it difficult to shave, they can be removed or shrunken with surgery or cryotherapy (freezing)

 

Dermatographism

Dermatographism (also called dermographism) describes very reactive skin that becomes red and swollen after it is scraped or scratched. This may occur even after gentle stroking. The phenomenon is sometimes referred to as "skin writing" and it represents a time of hives(urticaria).

The skin may itch and appear with welts or raised patches.

The reaction is not caused by an allergy to the substance that touches the skin (as in contact dermatitis) but is a reaction to the physical impact of being touched.

What are the symptoms of dermatographism?

Red, linear hives appear in the areas where the skin has been scratched or rubbed, as if someone “wrote” on the skin (the term dermatographism literally means "skin writing"). The area may become itchy , leading to further scratching that triggers additional inflammation.

Dermatographism is most common in young adults but can appear at any age. Some people may experience these symptoms for only a few months, while others may experience dermatographism for years.

What causes dermatographism?

The symptoms are thought to be caused by an exaggerated immune response that releases histamine into the skin. Histamines cause the skin to swell up, turn red, and develop wheals (welts) in the affected areas. For unknown reasons, people with dermatographism release more histamine into the skin following otherwise normal skin contact.

How is dermatographism treated?

Since most occurrences of dermatographism produce only mild symptoms that go away on their own, treatment is usually not necessary.

For persistent or bothersome cases, antihistamines can often provide relief.

Diaper Dermatitis

Diaper dermatitis, also known as diaper rash, is a skin irritation that results from prolonged contact with urine and feces.

Diaper rash is common among anyone wearing diapers due to incontinence. This may include infants and children who are not yet potty trained, or adults who are incontinent due to medical conditions, such as spinal cord injury.

The rash may include the groin, genitals, lower stomach, upper thighs, and buttocks.

Bacterial and yeast overgrowth may occur after skin becomes irritated and loses its protective barrier. This overgrowth causes the skin to become especially red and inflamed. The use of antibiotics can worsen the overgrowth of yeast. For instance, parents may notice the worsening of diaper rash in their children who have taken antibiotics for ear infections.

How is diaper rash treated?

Most cases of diaper dermatitis can be treated successfully with the over-the-counter antifungal creams, such as Lotrimin AF or Micatin. Do not use neosporin or other antibiotic creams, as their ingredients may cause an allergic reaction and worsen the rash.

Some cases of diaper dermatitis persist despite treatment, or become worse if the affected skin develops an allergic reaction to one of the topical medications.

How can diaper dermatitis be prevented?

You can prevent diaper dermatitis by following a few simple steps:

  • Use absorbent disposable diapers that don't allow urine to come into contact with the skin.

  • Change the diaper any time it is soiled by feces; it's the combination of feces and urine that causes the rash, not urine alone.

  • If you choose reusable cloth diapers, change them each time they get wet or soiled, or every one to hours.

  • With disposable diapers, do not allow the tape to stick to the skin.

  • Keep the diaper area as dry as possible; powder is generally not needed for this. In fact, baby powder can worsen the rash, especially in creases of the legs.

  • To prevent rashes that may develop at night, apply a paste containing zinc oxide, such as Desitin. This protects the skin by creating a barrier between the skin and the irritants.

 

Dry Skin (Xerosis)

Dry skin, also referred to as xerosis, is often itchy and irritating.

Dry skin results from the loss of oils (sebum) in the skin that serve as a natural moisturizer. This may occur with excessive bathing (particularly with hot water), low humidity (in desert climates or cold winter weather), advancing age, or the use of drying soaps (antibacterial, deodorant soaps, Ivory). 

In addition, several skin disorders, such as atopic dermatitis, lead to dry skin.

The tendency for dry skin runs in families and is usually a recurring problem, especially in winter. Because of this seasonal occurrence, it is sometimes referred to as “winter itch.”

It is important to regularly apply a moisturizer when your skin becomes dry. Moisturizer is best applied within 3 minutes after a shower or bath when your skin is still damp, but not wet.

Use hypoallergenic and fragrance-free moisturizers. The drier the skin, the “thicker” the moisturizer should be. For some people with very dry skin, petrolatum (Vaseline) is quickly absorbed and may be required to sufficiently moisturize the skin. Other effective moisturizers that are readily available include:

  • CeraVe

  • Cetaphil

  • Eucerin

  • Aquaphor

Eczema (Dermatitis)

Eczema and dermatitis are similar terms used to describe an itchy rash with inflamed skin.

Symptoms can range in severity from mild itching and redness to severe blistering and cracked skin.

There are many types of dermatoses that may be categorized by the following:

  • the location of the rash. For instance, dermatitis on the hands that may be referred to as such as "hand eczema"

  • the appearance of the rash. For instance the term "discoid eczema" describes a type fo eczema with coin-shaped lesions.

  • the underlying cause of the rash. For instance, allergic contact dermatitis is due to the skin coming into contact with something that triggers an allergic response.

Types of Eczema

Some of the most common forms of dermatitis (eczema) include the following:

  • Atopic dermatitis. Atopic dermatitis is the most common form of eczema. It describes the dry, sensitive skin associated with allergies and asthma that tends to be inherited. It is common in infants and toddlers who may “grow out of it” by school age. Moderate to severe cases require ongoing treatment and appropriate skin care to prevent flares.

  • Asteatotic dermatitis This form of dermatitis is caused by dry skin, particularly on the lower legs of elderly people. This is due to a reduction in sebum, the natural oil in skin that normally protects and moisturizes the skin.

  • Contact dermatitis. Contact dermatitis is a localized skin reaction to an allergen or irritant, causing redness, inflammation, and intense itching.

  • Dyshidrotic dermatitis. Dyshidrotic eczema, also called pompholyx or vesicular hand/foot dermatitis,  causes small, intensely itchy blisters to form on the palms of the hands or soles of the feet.

  • Nummular dermatitis. Nummular eczema is identifiable by coin-shaped patches of irritated skin, occurring sometimes after a skin injury or insect bite.

  • Seborrheic dermatitis. Seborrheic dermatitis is sometimes called “cradle cap” in newborns. This rash often appears on the scalp, behind the ears, or on the face and is identifiable by waxy, yellowish, scaly patches of skin.

  • Stasis dermatitis shows up as red, irritated skin on the lower legs and is often associated with circulation problems.

Dermatitis can be short-term (acute) or long-term (chronic). Acute dermatitis usually appears as a red rash, which may be blistered or swollen. When the dermatitis becomes chronic, the skin may become thickened, rough, and darker than the surrounding skin due to prolonged scratching.

Eczema Treatment

The recommended treatment for eczema will depend on several variables, including the type of eczema, it's cause and severity.

Finding the underlying cause of dermatitis is one of the primary steps of treatment.

The dry irritated skin can be treated with one or more of the following medications:

  • Topical corticosteroids

  • Topical immunomodulators (Elidel, Protopic)

  • Antibiotics, if an additional skin infection is suspected

  • Oral antihistamines (Benadryl), which help reduce the itching and help prevent scratching at night.

Tips for avoiding flare-ups include:

  • Using lukewarm water (not hot) and avoiding soap when bathing. If soap is necessary, apply a mild, moisturizing soap. Hot water and soaps tend to dry the skin.

  • Apply a moisturizer at least once a day. Apply the moisturizer within 3 minutes after bathing

  • Wear smooth, cool clothes. Avoid wool.

 

 

Erythema Infectiosum (Fifth Disease)

Erythema infectiosum, also called "fifth disease" is a viral illness that occurs most commonly in children.

The ill child typically has a red rash on the cheeks that often gives a "slapped-cheek" appearance. There often appears a lacy red rash on the trunk and limbs. Occasionally, the rash may itch. An ill child may have a low-grade fever, malaise, or other cold-like symptoms a few days before the rash breaks out. The child is usually not very ill, and the rash resolves in 7 to 10 days.

What causes fifth disease?    

Fifth disease is caused by infection with human parvovirus B19. This virus infects only humans. Pet dogs or cats may be immunized against parvovirus, but these are animal parvoviruses that do not infect humans. Therefore, a child cannot "catch" parvovirus from a pet, and a cat or dog cannot catch human parvovirus B19 from a child.

Can adults get fifth disease?    

Yes, they can. An adult who is not immune can be infected with parvovirus B19 and either have no symptoms or develop the typical rash of fifth disease, joint pain or swelling, or both. Usually, joints on both sides of the body are affected. The joints most frequently affected are the hands, wrists, and knees. The joint pain and swelling usually resolve in a week or two, but they may last several months. About 50% of adults, however, have been previously infected with parvovirus B19, have developed immunity to the virus, and cannot get fifth disease.

Is fifth disease contagious?    

Yes. A person infected with parvovirus B19 is contagious during the early part of the illness, before the rash appears. By the time a child has the characteristic "slapped cheek" rash of fifth disease, for example, he or she is probably no longer contagious and may return to school or child care center. This contagious period is different than that for many other rash illnesses, such as measles, for which the child is contagious while he or she has the rash.

How does someone get infected with parvovirus B19?

Parvovirus B19 has been found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) of infected persons before the onset of rash, when they appear to "just have a cold." The virus is probably spread from person to person by direct contact with those secretions, such as sharing drinking cups or utensils. In a household, as many as 50% of susceptible persons exposed to a family member who has fifth disease may become infected. During school outbreaks, 10% to 60% of students may get fifth disease.

How soon after infection with parvovirus B19 does a person become ill?    

A susceptible person usually becomes ill 4 to 14 days after being infected with the virus, but may become ill for as long as 20 days after infection.

Does everyone who is infected with parvovirus B19 become ill?    

No. During outbreaks of fifth disease, about 20% of adults and children who are infected with parvovirus B19 do not develop any symptoms. Furthermore, other persons infected with the virus will have a non-specific illness that is not characteristic of fifth disease. Persons infected with the virus, however, do develop lasting immunity that protects them against infection in the future.

How is fifth disease diagnosed?    

A physician can often diagnose fifth disease by seeing the typical rash during a physical examination. In cases in which it is important to confirm the diagnosis, a blood test may be done to look for antibodies to parvovirus. Antibodies are proteins produced by the immune system in response to parvovirus B19 and other germs. If immunoglobulin M (IgM) antibody to parvovirus B19 is detected, the test result suggests that the person has had a recent infection.

Is fifth disease serious?    

Fifth disease is usually a mild illness that resolves on its own among children and adults who are otherwise healthy. Joint pain and swelling in adults usually resolve without long-term disability.

Parvovirus B19 infection may cause a serious illness in persons with sickle-cell disease or similar types of chronic anemia. In such persons, parvovirus B19 can cause an acute, severe anemia. The ill person may be pale, weak, and tired, and should see his or her physician for treatment. (The typical rash of fifth disease is rarely seen in these persons.) Once the infection is controlled, the anemia resolves. Furthermore, persons who have problems with their immune systems may also develop a chronic anemia with parvovirus B19 infection that requires medical treatment. People who have leukemia or cancer, who are born with immune deficiencies, who have received an organ transplant, or who have human immunodeficiency virus (HIV) infection are at risk for serious illness due to parvovirus B19 infection.

Occasionally, serious complications may develop from parvovirus B19 infection during pregnancy.

How are parvovirus B19 infections treated?    

Treatment of symptoms such as fever, pain, or itching is usually all that is needed for fifth disease. Adults with joint pain and swelling may need to rest, restrict their activities, and take medicines such as aspirin or ibuprofen to relieve symptoms. The few people who have severe anemia caused by parvovirus B19 infection may need to be hospitalized and receive blood transfusions. Persons with immune problems may need special medical care, including treatment with immune globulin (antibodies), to help their bodies get rid of the infection.

Can parvovirus B19 infection be prevented?    

There is no vaccine or medicine that prevents parvovirus B19 infection. Frequent handwashing is recommended as a practical and probably effective method to decrease the chance of becoming infected. Excluding persons with fifth disease from work, child care centers, or schools is not likely to prevent the spread of the virus, since people are contagious before they develop the rash.

 

Fungal Nail Infection (Onychomycosis)

Fungal infection of the toenails and fingernails is referred to as onychomycosis. It appears as white or yellowed nails that may be thickened and brittle. One or more nails may be involved, and different parts of a nail may be affected. 

Fungal infection of the toenail (onychomycosis)
 

Toenails are the most vulnerable to fungal infection because shoes and socks trap moisture that promotes the growth of fungi.

 

If left untreated, fungal infections can lead to permanent nail damage.

Fungal infections of the nails are difficult to treat, and recurrence is common. Most antifungal medications applied to the directly onto the nail (topical) are not every effective because they cannot penetrate the hard nail in sufficient concentration to kill the fungi. There are, however, some formulations specifically designed to penetrate the nail.

Fungal Nail Infection before treatmentFungal Nail Infection after treatment

                       Before                                               After

If the fungal infections have already reached the nail bed (the place where the nail starts growing), oral medications may be prescribed. These medications reach the nail bed through the blood.

If a nail is badly damaged, nail removal may be recommended.

Follow these steps to prevent fungal nail infections:

  • Practice good hygiene and keep hands and feet clean.

  • Keep your skin dry, especially between the toes.

  • Wear shower sandals in damp public places, such as swimming pools and locker rooms.

  • Keep your nails trimmed and clean.

  • Wear well-ventilated shoes, and change socks regularly, especially after exercise.

  • Wear rubber gloves when washing dishes or doing other housework that could overexpose your hands to moisture.

  • Sterilize any instruments you use on your nails before and after every use. This includes nail clippers and any instruments used in manicures or pedicures. 

  • Wash your hands after touching an infected nail.

 

 

Fungal Skin Infections (tinea, ringworm)

Fungal infections are due to an overgrowth of fungus on the skin.

Microscopic-sized organisms called live normally on everyone's skin without causing problems. In some instances they grow out of control and cause fungal infections of the skin, hair, and nails.

Fungal skin infection are very common. They are especially among children and teenagers, but can affect people of all ages.

Fungal infections can appear anywhere on the body and lead to a variety of symptoms depending on the type and location of fungi.

The symptoms of fungal skin infections include:

  • Skin: Itchy, red, raised, scaly patches that may blister and ooze. The patches often have sharply-defined edges. They are often redder around the outside with normal skin tone in the center. This may create the appearance of a ring. Your skin may also appear unusually dark or light.

  • Hair: If your scalp or beard is infected, you may develop bald patches.

  • Nails: Fungal infections of the toenails or fingernails can cause the nails to become discolored and thick.

Some fungal infections are given unique names to describe their location or the type of fungi involved.

Ringworm

Ringworm (tinea corporis)
 

Fungal infections on the body is often referred to as “ringworm". This is because the rash sometimes appears as a ring, or partial ring. This is a confusing and unnecessarily alarming name because the rash is not caused by a worm.

When ringworm appears on the body, it may be called "tinea corporis". When it appears in the genital area, it is referred to as "jock itch" or "tinea cruris".

When a fungal infectionappears on the scalp, it may be called "tinea capitis". Tinea capitis can lead to hair loss. 

Athlete's Foot (tinea pedis)

Athlete’s foot is a fungal infection of the feet and is very common between the toes. Feet that remain in shoes all day retain warmth and moisture, which promote the growth of fungi.

Athlete's Foot causing dry, cracked skin
Athlete's foot infection (tinea pedis)
 

Onychomycosis (tinea uguium)

Toenail infection (onychomycosis)
 

Onychomycosis refers to a fungal infection of the toenail or fingernail.

Infections that involve the base of the nail (the nail bed) are more difficult to treat and often recur without sufficient treatment.

Fungal nail infection may require the removal of part or all of the nail and/or the use of oral antifungal medications.

Tinea Versicolor

Tinea versicolor
 

Tinea versicolor is a common and harmless fungal infection caused by Pityriasis versicolor. It appears on the back, chest, neck, and upper arms as light-colored patches of discolored skin.

Tinea nigra is a fungal infection caused by specific type of fungi (exophiala phaeoannellomyces) found in the soil of tropical regions. The infection generally occurs in individuals prone to excessive sweating (hyperhidrosis). It appears as slowly expanding brown or black patches on the skin of the palms and/or soles. 

How Are Fungal Infections Diagnosed?  

Your physician will diagnose a fungal infection primarily based on the appearance of the skin.

A Wood’s lamp may be used to identify fungi that appear fluorescent under its blue light. The skin may also be scraped to obtain cells for examination under a microscope or for growth in a fungal “culture” that is sent to a lab for identification.

How Are Fungal Infections Treated?

Most cases of ringworm (jock itch and athlete’s foot) and and tinea versicolor can be treated effectively with antifungal medicationsapplied to the skin (topical medications).

Tinea capitis often requires the use of an oral antifungal agent, such as griseofulvin, because the fungi can reside deep in the hair follicles and can't be reached by topical medications.

Similarly, nail infections where the fungi have penetrated the nail bed may require an oral antifungal, though some specially formulated topical antifungals might be tried first.

Tinea nigra generally responds well to topical antifungal agents and peeling agents such as salicylic acid or topical retinoids.

The paper-thin patches of fungal overgrowth found with tinea versicolor can be treated effectively with topical antifungal solutions.

What Should I Expect from Treatment?

Topical medications applied to the skin are usually effective at treating fungal infections within 4 weeks. If your infection is severe or resistant (meaning that it does not respond well to self-care), it will usually respond quickly to oral medications.

How Can I Prevent a Fungal Infection?

Fungal infections on the skin are contagious. They can be passed from one person to the next by direct skin-to-skin contact or by contact with contaminated items such as combs, unwashed clothing, and shower or pool surfaces. You can also catch ringworm from pets that carry the fungus. Cats are common carriers.

Fungi thrive in warm, moist areas. Infections are more likely when you have frequent wetness (such as from sweating) and minor injuries to your skin, scalp, or nails.

To prevent fungal infections:

  • Keep your skin and feet clean and dry.

  • Shampoo regularly, especially after haircuts.

  • Do not share clothing, towels, hairbrushes, combs, headgear, or other personal care items. Such items should be thoroughly cleaned and dried after use.

  • Wear sandals or shoes at gyms, lockers, and pools.

  • Avoid touching pets with bald spots. Wash your hands if you pet a stray animal.

 

 

Hair Loss (Balding)

Hair loss is a common complaint among our patients, both men and women.

Although is it normal to shed hairs each day, excessive hair loss can lead to a thinning hair line, and areas of baldness.

There are hair loss treatments that help promote hair growth or hide hair loss. For some types of hair loss, hair growth may return without any treatment.

Normal Hair Growth

To understand how hair loss happens, it is helpful to understand how hair normally grows.

Each shaft of hair is produced by a hair follicle. The cells in the hair follicle produce hair for about 2 to 3 years. During this "growth phase", each hair grows about 1 centimeter (1/2 inch) per month. After this growth phase, the hair follicle enters a resting phase during which the hair remains in place, but stops growing. This "resting phase" lasts about 3-4 months, after which the hair falls out. After the hair falls out, the hair follicle starts producing a new shaft of hair.

On average, 90% of the hairs on the head are in the "growth phase" at any one time (and 10% are in the resting phase). People normally shed hairs each day as the hair follicles reach the end of the resting phase and prepare to produce new hairs.

Hair Loss Causes

The most common cause of hair loss among men is called male-pattern baldness, or androgenic alopecia. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. With male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head (vertex).

Women may develop female-pattern baldness. With this form of hair loss, the hair can become thin over the entire scalp. Female-pattern baldness is much more common than is generally recognized.

Other less common causes of hair loss include:

  1. Alopecia areata. Alopecia areata is an autoimmune disease, in which the body’s own immune system mistakenly attacks the hair follicles leading to hair loss. In most cases the hair falls out in small, round patches about the size of a quarter. More severe cases can involve the entire scalp or other parts of the body.

  2. Extreme stress. 3-4 months after a severely stressful event, such as an illness or major surgery, large amount of hair may be lost. The stress caused the hair follicles to cease the growing phase prematurely. This stress-induced hair loss is temporary and the hair usually grows back.

  3. Hormonal problems. Hypothyroidism or hyperthyroidism can lead to hair loss, as can imbalances in androgens (males hormones) and estrogen. For instance, anabolic steroids taken by athlete’s for performance enhancement can lead to premature hair loss. The correction of hormonal imbalances can, in some instances, return hair growth to normal.

  4. Post-partum hair loss. Many women experience hair loss 3-4 months after having a child. This hair loss is also related to hormonal changes due to pregnancy. Elevated levels of certain hormones during pregnancy lead to the hair follicles staying in growth phase longer than normal. When the hormones return to pre-pregnancy levels, those follicles enter the resting phase and start to fall out 3-4 months later.

  5. Certain Medications. Some medicines, such as blood thinners (coumadin), anti-hypertensives, antidepressants and birth control bills can lead to excessive hair loss.. This type of hair loss usually improves when the medication is stopped.

  6. Fungal infections. Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.

  7. Excessive tension on the hair. Wearing tight pigtails or cornrows or using tight hair rollers, can pull on the hair and damage the hair follicle. This can lead to a type of hair loss called traction alopecia. The hair can grow back normally, if the pulling is stopped before scars develop.

Hair Loss Treatments

Hair loss treatment are recommended based on several variables, including the type of hair loss, the degree of hair loss, your gender, and your personal preferences.

There are several hair loss medication that can help slow or prevent the development of common baldness (androgenic alopecia). The effectiveness of these medications depends on the cause of hair loss, extent of the loss and individual response. Generally, hair loss medications are less effective for more extensive cases of hair loss. These hair loss medication require 3-6 months of regular use to determine if they are helping.

Rogaine (minoxidil) is a non-prescription topical medication applied to the scalp to grow hair and to prevent further hair loss. It may also be used for the treatment of alopecia areata.

Rogaine is usually recommended for use twice daily and can be used by both men and women.

New hair resulting from Rogaine (minoxidil) use may be thinner and shorter than previous hair. But there may be sufficient hair growth in some to hide bald spots and have the new hair blend with existing hair. It is important to note that hair growth stops after you discontinue the use of Rogaine. Side effects can include irritation of the scalp.

Propecia (finasteride) is a prescription medication taken daily by mouth. It is available for use by men only. Many men taking Propecia experience a slowing of hair loss, and some may show some new hair growth. It may take several months for new hair growth to appear. Any hair growth obtained while taking Propecia will stop after the medication is no longer

Propecia works by stopping the conversion of male hormones into dihydrotestosterone (DHT), which can shrink hair follicles in men who are susceptible to its effects.

Other hair loss medications that may be attempted in specific clinical cases include:

  • Injections of corticosteroid into the scalp to treat alopecia areata. Treatment is usually repeated monthly. New hair grwoth may be visible four weeks after the injection. Doctors sometimes prescribe oral corticosteroids (prednisone) for extensive hair loss due to alopecia areata.

  • Anthralin is usually used to treat psoriasis, but it may be used in some cases to stimulate new hair growth for cases of alopecia areata. It may take up to 12 weeks for new hair to appear.

Hair Surgery

Hair transplantation techniques have evolved considerably over the years to provide a treatment for male-pattern or female-pattern baldness when other measures have not succeeded.

Most hair transplantation procedures involve takes tiny plugs of skin, each containing one to a few hairs, from the back or sides of your scalp and implanting them into bald sections. Several transplant sessions may be needed, as hair loss may continue over time. Scalp reduction is another technique that involves the removal of bald areas of skin and closing in the sapcew ith hair-bearing skin. Scalp reduction may, in some instances, be combined with hair transplantation. 

Hair transplantation procedures are painful and not usually covered by health insurance.   Possible risks include infection and scarring.

Wigs and hairpieces

Wearing a wig or hairpiece provides a useful alternative to medical treatment. Quality, natural-looking wigs and hairpieces are now more readily available that can effectively cover areas of baldness.

 

Hair Loss: Female

Hair loss is commonly considered an issue for men (two thirds of all males can expect some hair loss by the age 60), but women make up 40 percent of all hair loss sufferers.

In the normal cycle of hair growth, it is natural to lose up to 100 hairs per day. If you are losing more than that, or if parts of your scalp are becoming prominent, it could be a sign of excessive hair loss

The medical term for hair loss is alopecia. The most common type of hair loss is calledandrogenic alopecia, which is an inherited tendency to stop producing new hairs. In women, this is referred to as female pattern hair loss.Female Hair Loss and Balding

Each hair follicle produces a single hair that normally grows about a half inch per month for about 4 to 6 years. It then goes into a resting phase and loses the hair before growing a new one. The number of hair follicles entering the resting phase is equal to the number of hair follicles starting the growth phase, so the number of hairs on the head remain the same.

With androgenic alopecia, an increasing number of hair follicles never recover from the resting phase, resulting in a scalp with less hair. This loss of active hair follicles may take place over months or years before it is noticeable.

Although androgenic alopecia occurs in both men and women, the pattern of hair loss is different. Instead of the receding hairline of male pattern baldness, in women the hair becomes thinner over the whole scalp, and the frontal hairline is usually spared.

Other causes of hair loss in women include:

  • Alopecia areata, an autoimmune disorder that attacks the hair follicles, shrinking them and inhibiting hair growth

  • Hormonal changes, such as pregnancy, menopause, or low thyroid hormone (hypothyroidism). Many women notice hair loss about 3 months after they've had a baby. This is due to high levels of pregnancy hormones that keep the hair follicles from entering the resting phase. When the hormones return to pre-pregnancy levels, a large number of hair follicles enter the resting phase all at once. This results in a significant numbers of hair falling out at one time. After a few months, the normal cycle of growth and loss starts again.

  • Constant pulling from hair that is tightly pulled back in a cap or in cornrows or ponytails (traction alopecia)

  • Stressful events, such as major surgery

  • Medications that can damage hair follicles, such as chemotherapy or blood thinners

  • Fungal infections (tinea capitis)

  • Chronic illnesses, such as diabetes or lupus

What Are Some Treatments for Female Hair Loss?

Although the vast majority of hair loss isn’t life-threatening, the emotional effects of a changing appearance are enough to make most women seek treatment.

Your doctor will determine the best treatment for your hair loss by diagnosing the cause.

If your hair loss is caused by a medication or underlying disease, your doctor may switch your medication or recommend treatment of the underlying problem.

Hair loss that cannot be corrected using those methods, such as androgenic alopecia, may be treated with a medication to stimulate the hair follicles.

One such medication is topical minoxidil (Rogaine), which is available over the counter in formulations for men and women. Minoxidil can stimulate hair growth and slow down hair loss, but it cannot “cure” baldness. It may take up to 6 months to see any results.

Hair transplants are also an option.

If adequate treatment is not available for your type of hair loss, you may consider trying different hairstyles or wigs, hairpieces, hair weaves, or artificial hair replacement.

Is Hair Loss Preventable?

In general, androgenic alopecia (female pattern hair loss) cannot be avoided. However, you can prevent additional hair loss by not wearing your hair in ways that can pull on it (ponytails, cornrows, or tight rollers) and avoiding hot oil treatments or perms, which can scar the hair follicle.

 

Hair Loss: Male

Most men—and some women—experience some degree of hair loss (balding) as they grow older.  In the normal cycle of hair growth, it is natural to lose up to 100 hairs per day. If you are losing more than that, or if your hairline becomes more prominent, it could be a sign of excessive hair loss.

The medical term for hair loss is alopecia. The most common type of hair loss in men is male pattern baldness, or androgenic alopecia. This is an inherited tendency to stop producing new hairs.Hair Loss in Men, Vertex

Each hair follicle produces a single hair that normally grows about a half inch per month for about 4 to 6 years. It then goes into a resting phase and loses the hair before growing a new one. The number of hair follicles entering the resting phase is equal to the number of hair follicles starting the growth phase, so the number of hairs on the head remains the same.

With androgenic alopecia, an increasing number of hair follicles never recover from the resting phase, resulting in a scalp with less hair. This loss of active hair follicles may take place over months or years before it is noticeable.

The hair follicles that usually stop producing new hairs are located along the frontal part of the scalp and along the crown of the head. This results in a receding hairline and/or balding at the top of the head.

Other causes of hair loss include:

  • Alopecia areata, an autoimmune disorder that attacks the hair follicles, shrinking them and inhibiting hair growth (can also lead to bald spots of facial hair)

  • Stressful events, such as major surgery

  • Medications that can damage hair follicles, such as chemotherapy or blood thinners

  • Fungal infections (tinea capitis)

  • Chronic illnesses, such as diabetes or lupus

What Are Some Treatments for Hair Loss?

Many men are dismayed enough by their balding appearance to seek medical advice and possible treatment.

Hair loss due to androgenic alopecia does not go away on its own and cannot be cured. But the following treatments may slow hair loss or promote hair growth:

  • Minoxidil (Rogaine). This topical, over-the-counter medication has been shown to regrow hair and prevent further hair loss in some people with alopecia areata and male pattern baldness. It is rubbed into the scalp twice per day. Minoxidil only works while you are taking it, so any new hair will stop growing if you discontinue use of the medication. Results may not be seen until after 6 months of use.

  • Finasteride (Propecia). This prescription medication is taken by mouth once a day and is designed to treat male pattern baldness. It works by decreasing the growth of DHT, a hormone that shrinks hair follicles and inhibits hair growth. As with minoxidil, the benefits of finasteride stop if you stop using it. Results may not be seen until after 6 months of use.

The effectiveness of these medications depends on the cause and extent of hair loss and each person’s individual response. Usually, the more recent the hair loss, the more effective the treatment will be. Extensive hair loss probably won’t respond well to medications.

One other option for treating hair loss is hair transplantation, where tiny plugs of hair-growing skin are removed from one part of the scalp and re-implanted on the balding areas.

Hair Transplantation

Hair transplantation transfers hair follicles from areas of thick growth (“donor” sites) to balding areas (“recipient” sites).

Hair transplantation is commonly used for the treatment of male pattern baldness and female pattern hair loss (androgenic alopecia). It may also be used to treat other forms of hair loss.

The hair that grows from transplanted follicles will have the same color and texture it had before it was moved.

Itch

Itch is the uncomfortable, irritating feeling which creates the desire to scratch. It can be the result of a nearly endless number of possible causes, ranging from skin conditions, such aseczema or poison oak, to internal diseases.

Itch can occur with no visible skin changes or may be marked by redness, raised spots or bumps, blisters, cracked or dry skin, or scaly skin texture.

Unfortunately, scratching itchy skin often makes the itch worse, which can set off an itch-scratch cycle.

The only way to get lasting relief from itch is to identify and treat the underlying cause. Most cases of itch can be treated easily with medications, cold compresses, cool baths, or light-based therapy.

What conditions are associated with itch and itching?

Dry skin is the most common culprit for causing itch in skin that has no obvious signs of rash or other changes. Dry skin can result from hot or cold temperatures, indoor heating and cooling systems, or washing or bathing excessively.

These conditions may also cause itchy skin:

  • Skin conditions and rashes, such as scabies, lice, chickenpox, hivespsoriasis, eczema (dermatitis).

  • Internal disorders, such as celiac disease, liver problems, kidney failure, anemia, certain cancers, and thyroid dysfunction. These conditions may produce itch over the entire body with no outward changes in the skin (except for the scratched areas).

  • Irritants and allergens, including cleaning products, soaps, wool, poison ivy or cosmetics. Wool, chemicals, soaps and other substances can irritate the skin and cause itching.

  • Food allergies

  • Certain medications, like antibiotics or antifungals, can provoke rashes in some people.

  • Pregnancy

When should I seek medical advice for itch?

If your itch lasts more than a couple weeks, is severe enough to disrupt your everyday activities or sleep, has no obvious cause, or affects your whole body, see a doctor or dermatologist. You should also see a doctor if the itch occurs with other symptoms, such as fatigue, weight loss, bowel or urinary problems, fever, or skin redness.

How will my doctor test and diagnose my itch?

Your doctor will likely start by giving you a physical exam and getting your health history, including when the itching started, what makes it worse or improves it, what cosmetics and skin care products you use, and what you do to care for your skin.

If an underlying condition is suspected, your doctor may run diagnostic tests, such as a blood test.

After the exam and any diagnostic tests, it may be determined that your itching is a symptom of one of the following related conditions:

  • Dermatitis (eczema). Dermatitis causes swelling, irritation, itchiness, and redness and can be caused by many factors, including contact irritants or allergens (such as nickel or wool).

  • Psoriasis. In this disorder, the accelerated lifecycle of skin cells causes rough, dry patches on the skin from accumulated dead skin cells. These patches are called scales and often look thick and silvery, and are sometimes painful.

  • Fungal infections. The tinea fungus is a common culprit in itchy skin, being the root cause of athlete's foot, ringworm, and jock itch.

  • Hives. These itchy, raised bumps are often caused by allergies to certain foods or medications.

  • Lice. The intense itching of body lice or head lice is hard to ignore. A lice infestation is easily spread and often identifiable by the small, red bumps caused by the tiny, wingless parasites. 

  • Scabies. Scabies are tiny mites that burrow into the skin, causing intense itching wherever they are present. This condition is contagious.

What are the complications of prolonged itch?

Unfortunately, itching is often intensified when scratched, which can lead to complications like neurodermatitis, a condition that causes the skin to become red, raw, thick and leathery. These patches can become infected and lead to scarring or pigment changes in the skin.

What are the treatments for itch?

Depending on the cause of your itch, the treatment may include:

  • Medications, including topical corticosteroid creams or oral antihistamines

  • Wet dressings, in which you apply medicated cream to the itchy areas and cover them with moist cotton material—the dampness of the dressing helps the skin absorb the medication.

  • Treating any underlying disease. If your doctor has identified an underlying disease that’s causing the itch, then he or she will treat that disease, possibly combining that treatment with those listed above.

  • Light therapy (phototherapy). This involves exposing the affected areas to certain wavelengths of ultraviolet (UV) light in multiple sessions until the itch is resolved.

For more immediate relief, you may want to try certain topical medications, such as creams, ointments, and lotions containing lidocaine, benzocaine, menthol, camphor, or calamine. However, these solutions should only be used in the short term until the primary cause of the itch has been resolved.

What at-home measures can I take to relieve itch?

For treating itch at home, try one or more of these home remedies:

  • Don’t scratch! This will likely intensify the itch and lead to an itch-scratch cycle. Try to cover the itchy area. Keep nails short and wear gloves at night, if necessary.

  • Avoid substances you know to be irritants or allergens to your skin, which may include nickel, certain skincare products or cosmetics, certain cleansers, or wool.

  • Take cool baths and sprinkle baking soda or uncooked oatmeal into the water. Aveeno and other brands make finely ground oatmeal just for baths.

  • Choose mild soaps and laundry detergents with no dyes or perfumes, and make sure to rinse soap away carefully.

  • For temporary relief, use an over-the-counter hydrocortisone cream or oral antihistamine (Benadryl) to keep the itch at bay, especially during sleep.

  • Keep the skin cool and moist with cold compresses, which you can use to cover affected areas to protect the skin and prevent yourself from scratching.

Sunburn

Sunburn occurs after excessive exposure to the ultraviolet radiation (UV rays) from the sun or indoor tanning booths.Sunburn

The amount of sun exposure required to burn a person depends on that person’s skin type. Someone who is light-skinned might get a sunburn in less than 15 minutes of exposure to mid-day sun. Medications and other factors can also make the skin more susceptible to sunburn.

 Moderate cases can lead to temporary disability, and severe cases can lead to swelling, blistering, fever, and dehydration.

The burn is not due to the heat of the sun. It is due to the ultraviolet radiation bombarding the cells in the deeper layers of the skin. Since we cannot feel the radiation, the symptoms appear only after the cells are damaged and become inflamed.

It takes time for inflammation to occur, so a sunburn may not be apparent until after you have gotten out of the sun.

The pain of sunburn also worsens over time, reaching a peak 12 to 48 hours later. Damaged skin later peels off, usually 2 to 7 days later.

Once the skin has burned, there is little that can be done other than providing comfort while the body heals itself. Therefore, prevention is the most important step to take. Use sunscreen and follow recommendations for sun protection.

Sunburn has long-term risks. Blistering sunburns, particularly in children, increase the risk of melanoma skin cancer years later. And ongoing sun exposure, even without burning, leads to premature aging of the skin and other forms of skin cancer (basal cell and squamous cell).

If you do get a sunburn, these measures will provide comfort:

  • Cool shower or bath, or placing cold, wet washcloths over the burn.

  • Over the counter medications, like ibuprofen (Motrin, Advil). (Aspirin should not be given to children with a fever, or those who are allergic).

  • Avoid using products containing benzocaine or lidocaine, which can further damage the skin, or petroleum (Vaseline), which can block pores.

Call your doctor if you have a fever, or blisters, or develop dizziness with the sunburn. Your doctor may recommend the use of dry bandages on the blisters, or other measures.

 

Warts

Warts are growths on the skin caused by the human papillomavirus (HPV).  They are very common, particularly in school-age children.Plantar Warts

Warts can spread by direct contact to other parts of the body, or to others. They are painless unless they appear on the soles of the feet.

Types of Warts

Warts are sometimes described by their appearance or location:

Warts on a hand
 

  • Common warts (verruca vulgaris) can appear anywhere on dry skin, but they are more commonly seen on the hands. They can appear in clusters.

  • Flat warts are often on the face or legs. They are smaller and can be difficult to see.

  • Plantar warts (foot warts) are located on the soles of the feet. The weight of the body pushes them into the deeper tissues, which can make them painful.

The wart virus (HPV) is very common. Most people who are exposed to the virus do not develop warts. This is because their body’s immune system recognizes the HPV virus and attacks it before it can start a growth.

The HPV virus enters the skin through a small scratch or wound. This explains why warts often appear around fingernails where the skin is often dry or cracked. After the skin becomes infected by the HPV virus, skin cells to start reproducing more rapidly. This creates small bumps where the skin becomes a bit thicker than the surrounding skin. The infected skin may also have a slightly different color. It can take 12 months for the growths to appear after an infection with the virus.

Even those who develop warts may find that they disappear on their own without treatment.

It seems In those cases, the warts go away when the body’s immune system finally recognizes the virus as foreign and starts to attack the underlying infection. Warts tend to heal on their own within 2 years in children and 5 to 7 years in adults.

Wart Treatment

Wart before
Before Treatment

Wart after
After Treatment

 

These commonly used

 

treatments remove warts more quickly:

  • Occlusion—covering the wart in a bandage or strip of tape

  • Over the counter medications (salicylic acid)

  • Cryotherapy (freezing)

  • Electrosurgery

  • Prescription medications

 

Wrinkles (Rhytides)

Our skin changes as we age. With time, aging skin develops wrinkles, lines and furrows.

There are several factors that determine the age at which wrinkles first appear, their location, and their prominence. These include the following:

  • Age. The older a person, the more likely he or she is to have wrinkles. Some people start developing wrinkles as early as their twenties, particularly if they have spent their teenage years in a sunny location without using sunscreen and other sun protection measures.

  • Family history. A person's skin type is inherited. This means that a parent whose skin was prone to wrinkles at an early age can pass that trait onto their children.

  • Environmental Factors. There are several external factors that can cause age to wrinkle at an earlier age. Most important of these is smoking and exposure to UV radiation from sunlight or indoor tanning booths.

Wrinkles before treatment Wrinkles after treatment

Wrinkles before and after treatment with a topical retinoid

Fine lines

Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the amount of water held by the epidermis. This is mainly caused by exposure to the UV radiation of sunlight and exposure to damaging chemicals, such as from smoking cigarettes.

Furrows

Deeper lines or furrows are described as either “dynamic” when they appear as different muscles move, or “static” if they remain unchanged with muscle movement. Eventually, dynamic lines become static furrows. Some furrows are so common that they have been given their own names.

  • Crow's feet” appear around the eyes. These are due to smiling and activity of the eyelid muscles.

  • Worry lines” appear on the forehead. These are due to contraction of muscle used when raising the eyebrows

  • Frown lines” appear between the eyebrows are due to contraction of muscles when concentrating or angry.

  • Smile lines” frame the lips. These are due to the contraction of muscle due to smiling.

Wrinkle Treatment Options

There are a variety of cosmetic products, medications and procedures that can lead to younger looking skin. These are often combined for best results.

Wrinkle Prevention

Wrinkles are a fact of life. But there are some basic measures that can prevent their premature development. These include:

  • Stop smoking

  • Do not use indoor tanning booths or tanning lights.

  • Use sunscreen every day, even on cloudy days or when the sun penetrates through glass. (UVA rays are a part of the UV spectrum that can pass through glass. Though these UVA rays do not burn, they are responsible for causing premature aging of the skin)

  • Practice other sun protection measures, such as avoiding sunlight during peak hours and wearing a wide-brimmed hat.

 

 

 

 

Tip of the day >>

A dash of cider vinegar added to a foot soak will help eliminate itching and athletes foot, dry well especially between the toes and rather than using talcum powder dry off with surgical spirit.

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