Lichen Simplex Chronicus
Also known as neurodermatitis or scratch dermatitis, this condition is caused by a chronic cycle of scratching and itching an area of skin that becomes rough or leathery. While it is not dangerous, Lichen Simplex Chronicus can be a difficult cycle to break because of the severity of the itchiness. It can occur anywhere on the skin, but is most commonly found on the ankles, neck, wrist, forearms, thighs, lower leg, behind the knee or on the inner elbow. It may also be associated with other skin conditions, such as dry skin, eczema or psoriasis.
Lichen Simplex Chronicus occurs more frequently among women than men and generally appears in people between the ages of 30 and 50. If you are unable to break a scratch and itch cycle somewhere on your skin or if the skin becomes painful, contact your dermatologist. Persistent scratching can lead to bacterial infection. The doctor may prescribe oral corticosteroids and antihistamines to reduce the inflammation and relieve the itching. In some cases, antidepressant or anti-anxiety medications provide relief to sufferers. If scratching does lead to an infection, your dermatologist will likely prescribe an oral or topical antibiotic.
Some patients gain relief from the itching by applying a moisturizing lotion and covering the area with a wet dressing. Moisture helps the skin absorb the lotion. Peeling ointments containing salycylic acid may also be recommended to soften rough skin.
Lyme disease is a bacterial illness and inflammatory disease that spreads through tick bites. Deer ticks house the spirochete bacterium (Borellia burgdorferi) in their stomachs. When one of these ticks bites the human skin, it may pass the bacteria into the body. These ticks tend to be attracted to creases in the body, so Lyme disease most often appears in armpits, the nape of the neck or the back of knees. It can cause abnormalities in the skin, heart, joints and nervous system.
Lyme disease was first identified in 1975 in Old Lyme, Connecticut. More than 150,000 cases have been reported to the Centers for Disease Control since 1982. Cases have been reported from every state, although it is more commonly seen in the Northeast, Upper Midwest and Pacific Coast. Lyme disease has also been reported in European and Asian countries.
There are three phases to the disease:
Early Localized Phase. During this initial phase, the skin around the bite develops an expanding ring of redness. The ring may have a bull’s eye appearance with a bright red outer ring surrounding clear skin in the center. Most people don’t remember being bitten by a tick. More than one in four patients never gets a rash. The skin redness may be accompanied by fatigue, chills, muscle and joint stiffness, swollen lymph nodes and/or headaches.
Early Disseminated Phase. Weeks to months after the rash disappears, the bacteria spread throughout the body, impacting the joints, heart and nervous system. Symptoms include migrating pain in the joints, neck ache, tingling or numbing of the extremities, enlarged lymph glands, sore throat, abnormal pulse, fever, changes in vision or fatigue.
Late Dissemination Phase. Late in the dissemination of the disease, patients may experience an inflammation of the heart, which can lead to heart failure. Nervous system issues develop, such as paralysis of facial muscles (Bell’s Palsy) and diseases of the peripheral nerves (peripheral neuropathy). It is also common for arthritis and inflammation of the joints to appear, which cause swelling, stiffness and pain.
Lyme disease is diagnosed through a combination of a visual examination and a blood test for Lyme bacteria antibodies. Most cases of Lyme disease are curable using antibiotics, but the longer the delay, the more difficult it is to treat. Your dermatologist may prescribe medications to help alleviate joint stiffening.
The best form of prevention is to avoid tick bites. Use insect repellent containing DEET. Wear long sleeves and pants when outdoors. Tuck the sleeves into gloves and pants into socks to keep your skin covered. After a hike, check the skin and look for any tick bites, especially on children. If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination.
Poison Ivy, Poison Oak and Poison Sumac
Poison ivy, poison oak and poison sumac are plants that produce an oil (urushiol) that causes an allergic reaction among humans. The inflammation is a reaction to contact with any part of the plant, which leads to burning, itching, redness and blisters. The inflammation is a form of contact dermatitis, an allergic reaction to an allergen that comes into direct contact with the skin. It is not contagious. Poison ivy is more prevalent in the eastern part of the country; poison oak is more prevalent in the southeastern part of the country.
Poison ivy is characterized by red, itchy bumps and blisters that appear in the area that came into contact with the plant. The rash begins one to two days after exposure. The rash first appears in curved lines and will clear up on its own in 14 to 21 days.
Treatment for poison ivy, poison oak and poison sumac is designed to relieve the itching and may include oral antihistamines and cortisone creams (either over-the-counter or prescription). These treatments need to be applied before blisters appear or after the blisters have dried up to be effective. In severe cases, oral steroids, such as prednisone, may be prescribed.
The best form of prevention is to recognize and avoid contact with the plants. This can be difficult because these plants tend to grow around other vegetation. These three poison plants can be distinguished by their classic three-leaf formation. To avoid contact with these plants, wear long sleeves and pants when hiking outdoors and keep to the trails. Tuck the ends of your sleeves into gloves and the bottom of your pants into socks so that no area of skin on your arms or legs is exposed. If you think you have come into contact with a poison plant, wash the area of skin with cool water as quickly as possible to help limit the reaction. Also, wash the clothing you were wearing immediately after exposure.
Pruritus refers to the sensation of itching on the skin. It can be caused by a wide range of skin conditions, including dry skin, infection, fungus, other skin diseases and, rarely, cancer. While anyone can experience pruritus, it is more commonly seen among the elderly, diabetics, people with suppressed immune systems and those with seasonal allergies, like hay fever or eczema. Additionally, there is a type of pruritus, called PUPPP (Pruritic Uticarial Papules & Plaques of Pregnancy) that affects pregnant women.
Treatment for pruritus depends on identifying the underlying cause. Your dermatologist will examine the itchy area and may make a small scrape on any rash to collect tissue for diagnostic testing. Typical treatment involves topical and/or oral steroids and antihistamines to help relieve the itch. To avoid pruritus, make sure to follow healthy skin care procedures.
“Rash” is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.
Rashes can be a symptom for other skin problems. The most prevalent of these are:
- Atopic Dermatitis, the most common form of eczema.
- Bacterial Infections, such as impetigo.
- Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
- Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
- Fungal Infections, such as ringworm and yeast infection.
- Viral Infections, such as shingles.
A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.
Ringworm (Tinea Corporis)
Ringworm is a common fungal infection, especially among children, that appears on different parts of the body. It is characterized by ring-shaped, scaly and itchy patches of the skin. The patches may blister or ooze fluid. Ringworm is contagious and can be passed from person to person or through contact with contaminated personal care products, clothing or linens. Pets, particularly cats, can also pass on the infection.
The fungi are attracted to warm, moist environments, which is why the most common forms of ringworm include:
- Tinea Barbae, which occurs on bearded areas of the face and neck.
- Tinea Capitis, which occurs on the scalp.
- Tinea Cruris, also known as Jock Itch, occurs in the groin area.
- Tinea Pedis, also known as Athlete’s Foot, occurs between the toes.
Ringworm generally responds well to home remedies and will disappear in about four weeks. In addition to keeping the area clean and dry, you can apply over-the-counter antifungal powders, lotions or creams. In more severe cases, your dermatologist may recommend prescription antifungal medications and antibiotics.
Rocky Mountain Spotted Fever
Rocky Mountain Spotted Fever is a bacterial infection transmitted by ticks. It is relatively rare, but can cause serious damage to the heart, lungs and brain. The difficulty lies in diagnosis because many people are unaware that they’ve been bitten by a tick. Three types of ticks transmit the Rickettsia rickettsii bacteria:
- Dog ticks, usually in the Eastern part of the country,
- Wood ticks, usually in the Rocky Mountain states, and
- Lone star ticks, usually on the West coast.
Rocky Mountain Spotted Fever is characterized by a rash that begins as small red spots or blotches on the wrists, ankles, palms or soles of the feet. It spreads up the arms and legs to the trunk of the body. These symptoms take between one and two weeks to appear following a tick bite. The rash is often accompanied by fever, chills, muscle ache, red eyes, light sensitivity, excessive thirst, loss of appetite, diarrhea, nausea, vomiting and/or fatigue. While there are lab tests your doctor can use to diagnose the disease, they take time to complete, so you may be placed on a course of antibiotic treatment right away.
The best way to prevent Rocky Mountain Spotted Fever is to avoid tick-infested areas. If you spend any time in areas with woods, tall grasses or shrubs, wear long sleeves and pants. Tuck pants legs into socks. Wear closed shoes, not sandals. Do a visual check of each member of your family upon returning home. And don’t forget to check your dog for ticks (if applicable).
If you do find a tick, don’t panic. Use tweezers to disengage the tick from the skin. Grab the tick by the head or mouthparts as close as possible to where the bite has entered the skin. Pull firmly and steadily away from the skin until the tick disengages. Clean the bite wound with disinfectant and monitor the bite mark for other symptoms. You can place the tick in a jar or plastic bag and take it to your dermatologist for examination. Because less than one percent of tick bites transmit this bacteria, antibiotics are not generally prescribed unless there are other symptoms present.
Scabies is a harmless but very itchy and highly contagious skin condition caused by mites that burrow into the skin and lay eggs. Symptoms include a severe itch, often worse at nighttime, and thin burrow tracks made of tiny bumps or blisters on the skin. Humans are allergic to the mites, which is what causes the itching.
Typically, scabies appear in folds of the skin, such as the armpits, around the waist, inside the wrists, between the fingers, on the soles of feet, on the back of knees or on inner elbows. In children, they more commonly appear on the face, scalp, neck, palms and soles. Scabies is spread through direct contact with an infected person or by sharing clothing and linens. It is so contagious that frequently when one person in a family is diagnosed with scabies, all family members are treated for it. It takes about 21 days for eggs to mature and new mites to begin burrowing through the skin.
Generally a visual examination of the skin is all that is needed to diagnose scabies. However, your dermatologist may take a small scrape of the skin to examine under a microscope. The typical treatment is prescription medicated creams applied liberally all over the body. It takes a few days of treatment before the sensation of itchiness begins to go away.
To help prevent further spreading, be sure to clean all clothes and linen in hot water and dry with high heat. Dry clean items you cannot machine wash in this manner or place the item in a sealed plastic bag and put it away for two weeks. The mites will die without a food source for this length of time.
Roughly 300,000 people in the United States suffer from scleroderma. This chronic connective tissue disease results from an over-production of collagen in the skin and other organs. Scleroderma usually appears in people between the ages of 25 and 55. Women get scleroderma more often than men. The disease worsens slowly over years.
There are two types of scleroderma: localized scleroderma, which involves only the skin, and systemic scleroderma, which involves the skin and other organs, such as the heart, lungs, kidneys, intestine and gallbladder. Typical symptoms of the skin include skin hardening, skin that is abnormally dark or light, skin thickening, shiny hands and forearms, small white lumps beneath the skin’s surface, tight facial skin, ulcerations on the fingers or toes and change in color of the fingers and toes from exposure to heat or cold. Other symptoms impact bones, muscles, lungs and the digestive tract.
There is no known cause of scleroderma, nor is there a cure. There are individualized treatments that are designed to help alleviate certain symptoms and decrease the activity of the immune system to further slow down the disease.
Seborrheic dermatitis is a very common skin disease that causes a rash. Despite its appearance, it does not result from poor hygiene. The skin tends to have a reddish color, swollen and greasy appearance, and a white or yellowish crusty scale on the surface. Sometimes, the affected skin itches.
Many infants get cradle cap. This is a type of seborrheic dermatitis that develops in babies. Scaly, greasy patches form on the baby’s scalp. The patches can become thick and crusty, but cradle cap is harmless. Cradle cap usually goes away on its own within a few months.
When an adult gets seborrheic dermatitis, the condition can come and go for the rest of the person’s life. Flare-ups are common when the weather turns cold and dry. Stress also can trigger a flare-up. The good news is that treatment can reduce flare-ups and bring relief.
If you think you might have seborrheic dermatitis, you should see a dermatologist for a diagnosis. This common skin condition can look like psoriasis, eczema, or an allergic reaction. Each of these skin diseases requires different treatment.
Shingles (Herpes Zoster)
Shingles is a painful rash that is caused by the varicella zoster virus. It usually appears as a band or strip of blisters on one side of the body that goes from the spine around the front to the breastbone. However, shingles can also appear on the neck, nose and forehead.
Shingles derives from the same virus that causes chicken pox. After having chicken pox, the virus lies dormant in nerve tissue underneath the skin. Years later, and with no known reason, it reactivates and causes shingles. Shingles is contagious and can easily pass through touching from one person to another. The virus develops into shingles for people who have had chicken pox and develops into chicken pox for those who have not had it. Shingles appears most frequently among older adults (age 60+) and in people with compromised immune systems. Generally, a person only gets shingles once; it rarely recurs.
Symptoms for shingles include:
- Pain, burning, numbness or tingling on one side of the body. The pain often precedes any other symptoms.
- A rash that appears a few days after the pain. It may be itchy.
- Blisters that break open and then crust over.
- Fever, achiness or headache.
Some people never get a rash or blisters with shingles, but simply experience the pain.
Shingles is diagnosed based on a medical history and physical examination of the telltale rash. If you suspect you may have shingles, it is important to contact your doctor as quickly as possible. Early treatment can reduce the pain and severity of the episode. Two types of medications are prescribed to treat shingles:
- Antiviral drugs to combat the virus, such as acyclovir, valacyclovir and famciclovir.
- Pain medicines, from oral pain pills and antidepressants to anticonvulsants and topical preparations that contain skin-numbing agents.
Shingles usually heals in about 2 to 3 weeks without any problem. However, there is a small percentage of patients (10% to 15%), predominantly over age 50, who experience pain that lasts beyond one month after the healing period. This is called postherpetic neuralgia. Catching shingles early and beginning treatment can reduce the likelihood and severity of postherpetic neuralgia. See your dermatologist for pain relief.
The U.S. Food and Drug Administration has approved a vaccine, called Zostavax, for the prevention of adult shingles. It is approved for adults age 60 or older who have had chicken pox. Essentially, the vaccine delivers a booster dose of chicken pox. The vaccine has proven to be very effective in reducing the incidence of shingles and postherpetic neuralgia.
Tanning Beds/Tanning Booths
According to the American Academy of Dermatology and the U.S. Department of Health and Human Services, ultraviolet (UV) radiation from tanning beds, tanning booths and sun lamps is a known carcinogen (cancer-causing agent). Exposure to UV radiation during indoor tanning has been proven to increase the risk of all skin cancers, including melanomas, squamous cell carcinomas and basal cell carcinomas. In fact, the risk of melanoma increases by 75 percent when indoor tanning devices are used before the age of 30. The UV radiation during indoor tanning also leads to skin aging, hyper – and hypopigmentation, immune suppression and eye damage, such as cataracts.
Therefore, the use of tanning beds, tanning booths and sun lamps is not recommended by dermatologists.
A tattoo is created by injecting ink into the dermis (the second layer of skin) to incorporate a form of skin decoration. Tattooing is practiced worldwide and has often been a part of cultural or religious rituals. In Western societies today, tattooing has re-emerged as a popular form of self-decoration.
Technically, a tattoo is a series of puncture wounds. An electric device uses a sterilized needle and tubes to penetrate to a deeper layer of skin and inject ink into the opening it creates. The tattoo machine moves the needle up and down between 50 and 3,000 times per minute. The machine’s operator, a tattoo artist, will use a flash or stencil of the design you select. Typically the design is outlined in black, shading is filled in and then solid areas of color are completed.
Any puncture wound is susceptible to bacterial or viral infection, which is why it is imperative that you work with a licensed tattoo artist who adheres to stringent infection control standards. Single-use needles and disposable materials should be used in conjunction with sterile procedures, such as the artist wearing latex gloves, cleaning the affected area after each stage of tattooing and using an autoclave to sterilize any materials or equipment that is re-used.
After the tattooing is completed, it is important to care for the damaged skin until it fully heals. Keep a bandage on the area for at least the first 24 hours. Wash the tattoo with antibacterial soap once daily and gently pat it dry. Avoid touching the tattoo and don’t pick at the scabs as they form. You can also use an antibiotic ointment to help prevent infection. Do not use petroleum jelly because it may cause fading. If you experience redness or swelling, put ice on the tattoo. Keep your tattoo away from water and out of the sun until it has completely healed.
Complications from tattoos generally involve either an infection or an allergic reaction to the ink. If you have a skin condition, like eczema, you should probably avoid getting any tattoo.
A tattoo is designed to last for a lifetime. However, if your feelings about a tattoo change over time, there is laser removal technology available. The process tends to be expensive, requires multiple visits and can be painful. Essentially, the laser’s energy is aimed at pigments in the tattoo. The laser emits short zaps of targeted light that reach the deeper layers of the skin. This stimulates the body’s immune system to remove the pigment. It is critical that the procedure be handled in a sterile manner in order to prevent infection. Home care following laser removal treatments is similar to the care recommended for getting a tattoo.
Vitiligo refers to the development of white patches anywhere on the skin. With this condition, pigment-forming cells (known as melanocytes) are destroyed by the immune system, causing loss of pigmentation in the skin. Vitiligo usually develops between the ages of 10 and 40. It affects both men and women and appears to be hereditary.
Vitiligo usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.
Wrinkles are a natural part of the aging process. They occur most frequently in areas exposed to the sun, such as the face, neck, back of the hands and forearms. Over time, skin gets thinner, drier and less elastic. Ultimately, this causes wrinkles – either fine lines or deep furrows. In addition to sun exposure, premature aging of the skin is associated with smoking, heredity and skin type (there is a higher incidence among people with fair hair, blue-eyes and light skin).
Treatment for wrinkles runs the gamut from topical creams and moisturizers to cosmetic procedures. The most common medical treatments are:
- Alpha-hydroxy acids, preparations made from “fruit acids” that produce subtle improvements in the appearance of wrinkles.
- Antioxidants, creams consisting of Vitamins A, C and E and beta-carotene that improves the appearance of wrinkles and provides some additional sun protection.
- Moisturizers, which temporarily reduce the appearance of wrinkles.
- Vitamin A Acid, which helps alleviate some of the signs of aging, including mottled pigmentation (e.g., liver spots), roughness and wrinkling.
Cosmetic procedures include:
The best prevention for wrinkles is to keep the skin moisturized and use sunscreen and sunblock to prevent additional damage from the sun.