Common Skin & Hair Conditions
By Dr. T
ECZEMA/ ATOPIC DERMATITIS
The word eczema describes certain kinds of dermatitis (inflamed skin). Early eczema can be red, blistering, or oozing. Later on, eczema can be scaly, brownish, or thickened. Almost always, eczema itches. Examples of eczema include allergic contact dermatitis, seborrheic dermatitis, and nummular dermatitis. This page will describe and discuss a special type of eczema called atopic dermatitis or atopic eczema.
Atopic Dermatitis or Atopic Eczema
The word "atopic" refers to a tendency for excess inflammation in the skin, linings of the nose, and lungs. It often runs in families. These families may have allergies such as hay fever and asthma, but can also have sensitive skin and a history of eruptions called atopic dermatitis. While most people with atopic dermatitis have family members with similar problems, 20 percent of patients may be the only one in their family bothered by this condition.
Atopic dermatitis is very common in all parts of the world. It affects about ten percent of infants and three percent of all people in the United States.
The disease can occur at any age but is most common in infants to young adults. The skin rash is very itchy and can be widespread or limited to a few areas.
The condition frequently improves in childhood or at least before age 25. About 50 percent of patients are affected throughout life, although not as severely as during early childhood. Atopic dermatitis cases can cause frustration to both the patient and the physician.
When the disease starts in infancy, it's often called infantile eczema. The itchy rash is an oozing, crusting condition that occurs mainly on the face and scalp, but patches can appear anywhere. Because of the itch, children may rub their head, cheeks, and other patches with a hand, a pillow, or anything within reach. Many babies improve before two years of age. Proper treatment can help until time solves the problem.
Infantile Eczema/Atopic Dermatitis
After infancy, the skin tends to be less red, blistering, oozing, or crusting. Instead, the patches are dry, red to brownish-gray, and may be scaly or thickened. The intense, almost unbearable itching can continue, and may be most noticeable at night. Some patients scratch the skin until it bleeds and crusts. When this occurs, the skin can get infected.
In teens and young adults, the patches typically occur on the hands and feet. Although these are the most common sites, any area such as the bends of the elbows, backs of the knees, ankles, wrists, face, neck, and upper chest may also be affected.
Eczema/Atopic Dermatitis
Recognizing Atopic Dermatitis
An itchy rash as described above, along with a family history of atopic problems, may indicate atopic dermatitis. Proper, early, and regular treatment can bring relief and may also reduce the severity and duration of the disease.
The disease does not always follow the usual pattern. It can appear on the palms, backs of the hands and fingers, or on the feet, where crusting, oozing, thickened areas may last for years.
Questions and Answers About Atopic Dermatitis
Q. Since this condition is associated with allergies; can certain foods be the cause?
A. Yes, but only rarely (perhaps 10 percent). Although some foods may provoke atopic dermatitis, especially in infants and young children with asthma, eliminating them rarely will be a cure. Foods that cause immediate severe reactions or welts, should be avoided. Unless you are under a doctor's supervision, you should limit trials of certain foods to one food at a time, for no longer than two weeks.
Q. Are environmental causes important and should they be eliminated?
A. Rarely does the elimination of contact or airborne substances bring about lasting relief. Occasionally, dust and dust-catching objects (feather pillows, down comforters, kapok pillows, mattresses, carpeting, drapes, some toys, wool, and other rough fabrics), can worsen atopic dermatitis.
Q. Are skin tests, like those given for hay fever or asthma, of any value in finding the causes?
A. Sometimes, but not as a rule. A positive test means allergy only about 20 percent of the time. If negative, the test is a good evidence against allergy. If these tests are desired, ask your dermatologist to recommend someone who has experience.
Q. Are "shots" such as those given for hay fever and other allergies, useful?
A. Not usually. They may even make the skin condition worse in some patients.
Q. What then should be done to treat this condition?
A. See your doctor for advice on avoiding irritating factors in creams and lotions, rough, scratchy, or tight clothing, and woolens. Rapid changes of temperature and any activity that causes sweating can aggravate atopic dermatitis. Seek advice from your doctor about proper bathing, moisturizing, and dealing with emotional upsets which may make the condition worse.
Your doctor can prescribe external medications such as cortisone creams, ointments on lotions and sometimes tars. Internal medications such as antihistamines can help deal with the itch. Oral antibiotics may be prescribed if there is also a secondary infection. For severe cases, your doctor may refer you to a dermatologist who might recommend ultraviolet light treatments.
There are several newer types of medications that may be helpful for patients when standard treatment doesn't work.
Internal cortisone should be avoided if possible. However, when other measures have failed, your physician may prescribe cortisone in the form of pills or an injection.
Eczema/Atopic Dermatitis
It has been 40 years since a new class of topical medications specifically for this disease has been introduced. However, a new class of drugs called topical immunomodulators (TIMs) will soon be available that show promise in the treatment of moderately severe eczema. Two TIMs in development, tacrolimus and ascomycin, are steroid-free. Tacrolimus is likely to be the first TIM approved and available in the United States. Studies have shown that this new class of drugs will improve or completely clear eczema in more than 80 percent of treated patients, with an improved side-effect profile compared with topical steroids.
Atopic dermatitis is a very common condition. With proper treatment, the disease can be controlled in the majority of people.
Support Groups
The National Eczema Association for Science and Education works to improve the health of people living with eczema.
The National Eczema Society is a worldwide organization dedicated to the needs of people with eczema, dermatitis, and sensitive skin. Based in the United Kingdom, they can provide information and encouragement for children in the 11-16 age group.
ACNE
Acne is the term for plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), that occur on the face, neck, chest, back, shoulders and even the upper arms. Most teenagers have some acne. However, adults in their 20's, even into their 40's or older, can get acne. Acne often clears up after several years even without treatment, but you need not wait to outgrow it. Untreated acne can leave scars, which can be treated by a referral to a dermatologist as well.
While not a life threatening condition, acne can be upsetting and disfiguring. Acne can also lead to serious and permanent scarring.
How Acne Forms
Male hormones found in both males and females rise during adolescence (puberty) and stimulate and enlarge the oil (sebaceous) glands of the skin. These glands are found in areas where acne is common (the face, upper back, and chest). Rarely, acne can be due to a hormonal imbalance.
The oil glands are connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum which reaches the skin surface by emptying through the skin surface opening of the follicle. The hair follicle opening is sometimes called the pore. The oil (sebum) causes the cells from the follicular lining to shed more rapidly and stick together, forming a plug at the hair follicle opening. Bacteria grow in the mixture of oil and cells in the follicle. These bacteria make chemicals that stimulate inflammation and cause the wall of the follicle to break. The sebum, bacteria, and shed skin cells spill into the skin causing redness, swelling, and pus - a pimple.
Cleansing
The black in a blackhead is dried oil and shed skin cells in the openings of the hair follicles, not dirt. For the normal care of your skin, wash your face with a mild soap and warm water twice a day. Acne is not caused by dirt. Washing too often or too vigorously may actually make your acne worse. Regular shampooing is also recommended. If your hair is oily, you may want to wash it more often. Your doctor can recommend the best face and hair washing routine.
Men with acne who shave should try both an electric and a safety razor to see which is more comfortable. If you use a safety razor, soften your beard thoroughly with soap and warm water before applying shaving cream. To avoid nicking pimples, shave as lightly as possible. Shave only when necessary and always use a sharp blade.
Diet
Acne is not caused by the foods you eat. Doctors have differing opinions on the importance of your diet in the management of acne. One thing is certain; a strict diet by itself will not clear your skin. On the other hand, if certain foods seem to make your acne worse, then try to avoid them. But be careful about jumping to conclusions, acne may get better or worse on its own. It is always important to eat a well balanced diet.
Sunlight
A tan can mask your acne, but the benefits are temporary. Since sunlight ages the skin and can cause skin cancer, you should not sunburn, "bake in the sun," or use sunlamps. Choose a sunscreen that is oil-free, such as a gel or light lotion.
Cosmetics
If you wear a liquid foundation or use a moisturizer, look for ones that are oil-free and not just water-based. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with soap and water.
A flesh-tinted acne lotion containing benzoyl peroxide, such as Clearasil, salicylic acid or sulfur can safely hide blemishes. Loose powder mixed with oil-free product is also good for cover-up.
Shield your face when applying hairsprays and gels.
Treatment
Control of acne is an ongoing process. All acne treatments work by preventing new acne. Existing blemishes must heal on their own. Improvement takes time. If your acne has not improved after 6 to 8 weeks, you may need a change in your treatment. Please call our office for an appointment.
The treatment your doctor recommends will vary according to your type of acne. Occasionally, an acne-like rash can be due to another cause - such as from makeup, lotions, or from an oral medication. It's important to help your doctor by providing a history of what you are using on your skin or taking internally.
Many non-prescription acne lotions and creams help milder cases of acne. However, many will also make your skin dry if used too often. If you use these products, follow instructions carefully.
Your doctor may prescribe topical creams, gels or lotions with vitamin A acid or benzoyl peroxide to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. We will advise you on the correct use and how to handle side effects.
There are also antibiotics that are applied to the skin. These are used in less severe cases of acne. When large red bumps (cysts) are present, we may refer you to a dermatologist who may inject cortisone directly into the bumps to help them go away.
Your physician may open pimples or remove blackheads and whiteheads. Don't pick, scratch, pop or squeeze your pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation and scarring may result.
Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline or erythromycin are often prescribed for moderate or severe cases, especially when there is a lot of acne on the back or chest. Antibiotics reduce the bacteria in the follicle and may also decrease the skin redness directly. When taking oral antibiotics, some women may develop a vaginal yeast infection. If this occurs, discontinue your medicine and contact your doctor immediately for treatment of the yeast.
Women who are taking birth control pills may notice a significant improvement in their acne, and these pills are sometimes used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. This is uncommon but possible, especially if you notice break-through bleeding. As with most medicines, check with your doctor about taking antibiotics if you are pregnant or nursing, or if you are trying to get pregnant.
In cases of severe acne, other drugs may be used. These may include female hormones or medications that decrease the effects of male hormones. Another oral medication, isotretinoin is sometimes used for severe acne that has not responded to other treatments. Patients using isotretinoin must thoroughly understand the side effects of this drug. Frequent follow-up visits with a dermatologist are necessary to monitor side effects. Prevention of pregnancy is a must, since the drug causes severe birth defects if taken during pregnancy.
Moderate Acne
Treatment of Acne Scarring
Should scarring be already present prior to treatment or be a residual of treatment, a dermatologist can treat these scars by a variety of methods. Combination skin resurfacing with laser, dermabrasion, chemical peeling or electrosurgery, can flatten depressed scars. Soft tissue elevation with collagen, filling products or fat can elevate scars. Scar revision by your dermatologic surgeon with a microexcision and punch grafting can correct pitted scars, and combinations of these dermatologic surgical treatments can make noticeable differences on the appearance of the scars.
Proper care is necessary
No matter what special treatments your doctor or dermatologist may use, remember that you must continue proper skin care until the tendency to have acne has passed. There is no instant or permanent cure for acne, but it is controllable, and proper treatment may prevent scars.
ATHLETE'S FOOT/ TINEA PEDIS
Athlete's foot is a very common skin condition--many people will develop it at least once in their lives. It occurs mostly among teenage and adult males. It is uncommon in women and children under the age of 12. If a child displays what appears to be the symptoms of athlete's foot, chances are it's another skin condition. Athlete's foot should not be ignored--it can be easily treated, but it also can be very resistant to treatment.
Athlete's foot is a term used to describe what really is a form of fungus infection of the feet. The correct term for athlete's foot is tinea pedis. The fungi that cause it are living germs, like small plants, that grow and multiply on all humans. Some people may actually have the fungus on their skin, but unless the conditions are agreeable, athlete's foot will not develop. Why some people develop athlete's foot and others don't is not clearly known.
Athlete's foot does not occur among people who traditionally go barefoot. It's moisture, sweating and lack of proper ventilation of the feet that present the perfect setting for the fungus of athlete's foot to grow.
Why does athlete's foot develop?
The fungi that cause athlete's foot like to grow in moist, damp places. Sweaty feet, not drying feet well after swimming or bathing, tight shoes and socks, and a warm climate all contribute to the development of athlete's foot.
It's commonly believed that athlete's foot is highly contagious -- that you can easily catch it from walking barefoot in the locker room. This is not true. Experiments to infect healthy skin with athlete's foot have failed and often one family member may have it without infecting others living in the same house.
What does athlete's foot look like?
Athlete's foot may affect different people in different ways. In some, the skin between the toes (especially the last two toes) peels, cracks and scales. In others, there is redness, scaling and even blisters on the soles and along the sides of the feet. These skin changes may be accompanied by itching.
Toenail infections can also occur and can be very stubborn to treat. Toenail infections result in scaling, crumbling and thickening of the nails and even nail loss.