Acne

Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.

Acne is made up of two types of blemishes:

  • Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
  • Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.

Causes

In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skin’s surface. If the pore’s opening is fully blocked, this produces a whitehead. If the pore’s opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflammed, they can become red pustules or papules.

It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.

Treatment

Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:

  • Benzoyl Peroxide – Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
  • Oral and Topical Antibiotics – Used to treat any infection in the pores.
  • Hormonal Treatments – Can be used for adult women with hormonally induced acne.
  • Tretinoin – A derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
  • Extraction– Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.

Eczema (Dermatitis)

Eczema is a general term used to describe an inflammation of the skin. In fact, eczema is a series of chronic skin conditions that produce itchy rashes; scaly, dry and leathery areas; skin redness; or inflammation around blisters. It can be located anywhere on the body, but most frequently appears in the creases on the face, arms and legs. Itchiness is the key characteristic and symptom of eczema. When scratched, the lesions may begin to ooze and get crusted. Over time, painful cracks in the scaly, leathery tissue can form.

Eczema affects people of all races, genders and ages. It is thought to be hereditary and is not contagious. The cause of eczema remains unknown, but it usually has physical, environmental or lifestyle triggers. Coming into contact with a trigger, such as wind or an allergy-producing fabric, launches the rash and inflammation. Although it is possible to get eczema only once, the majority of cases are chronic and are characterized by intermittent flare-ups throughout a person’s life.

For mild cases, over-the-counter topical creams and antihistamines can relieve the itching. In persistent cases, a dermatologist will likely prescribe stronger medicine, such as steroid creams, oral steroids (corticosteroids), antibiotic pills or antifungal creams to treat any potential infection.

The best form of prevention is to identify and remove the trigger. You should also use mild cleansers and keep your skin well moisturized at all times. Also avoid scratching the rash (which can lead to infection) and situations that make you sweat, such as strenuous exercise.

Leading Types of Eczema

Eczema takes on different forms depending on the nature of the trigger and the location of the rash. While they all share some common symptoms – like itchiness – there are differences. Following are some of the most common types of eczema.

Atopic Dermatitis

The most frequent form of eczema, atopic dermatitis is thought to be caused by abnormal functioning of the body’s immune system. It is characterized by itchy, inflamed skin. Atopic dermatitis tends to run in families. About two-thirds of the people who develop this form of eczema do so before the age of one. Atopic dermatitis generally flares up and recedes intermittently throughout the patient’s life.

Contact Dermatitis

Contact dermatitis is caused when the skin comes into contact with an allergy-producing agent or an irritant, such as chemicals. Finding the triggering allergen is important to treatment and prevention. Allergens can be things like laundry detergent, cosmetics, jewelry, fabrics, perfume, diapers and poison ivy or poison sumac.

Dyshidrotic Dermatitis

This type of eczema strikes the palms of the hands and soles of the feet. It produces clear, deep blisters that itch and burn. Dyshidrotic dermatitis occurs most frequently during the summer months and in warm climates.

Neurodermatitis

Also known as Lichen Simplex Chronicus, this is a chronic skin inflammation caused by a continuous cycle of scratching and itching in response to a localized itch, like a mosquito bite. It creates scaly patches of skin, most commonly on the head, lower legs, wrists or forearms. Over time, the skin may become thickened and leathery.

Nummular Dermatitis

This form of eczema appears as round patches of irritated skin that may be crusted, scaly and extremely itchy. Nummular dermatitis most frequently appears on the arms, back, buttocks and lower legs, and is usually a chronic condition.

Seborrheic Dermatitis

Seborrheic dermatitis is a common condition that causes yellowish, oily and scaly patches on the scalp, face or other body parts. Dandruff, in adults, and cradle cap, in infants, are both forms of seborrheic dermatitis. Unlike other types of eczema, seborrheic dermatitis does not necessarily itch. It tends to run in families. Known triggers include weather, oily skin, emotional stress and infrequent shampooing.

Stasis Dermatitis

Also known as varicose eczema, this form of eczema is a skin irritation that appears on the lower legs of middle-aged and elderly people. It is related to circulation and vein problems. Symptoms include itching and reddish-brown discoloration of the skin on one or both legs. As the condition progresses, it can lead to blistering, oozing and skin lesions.

Rashes

“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.

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.

Scabies

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.

Folliculitis

Folliculitis is an inflammation of one or more hair follicles. It appears as a rash or white-headed pimples or pustules near a hair follicle. It can occur anywhere on the body, but typically affects hairy areas, such as the neck or groin. Follicles can be damaged from repeated friction (such as rubbing of too tight clothes) or a blockage of the hair follicle (for instance, from shaving). In most cases, follicles become infected with the Staphylococcus bacteria.

There are two types of folliculitis:

Superficial Folliculitis affects the upper area of the hair follicle and may cause red, inflamed skin, small clusters of red bumps, blisters that break open and crust over and/or itchiness and tenderness. When the infection occurs in men’s beards, it is called Barber’s Itch.. When it is caused by a fungal infection, it is known as Tinea Barbae (ringworm).

Deep Folliculitis affects the entire follicle from its deepest parts under the skin to the surface of the skin. This less-common form of folliculitis is seen in people who are undergoing chronic acne antibiotic treatment, people with HIV or people with boils and carbuncles.

Generally, folliculitis is treated with antifungal medications.

Lyme Disease

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.

Granuloma

Granuloma is a generic term that refers to a small nodule. It can be any type of nodule, from benign to malignant. Granulomas occur throughout the body. Two types of granuloma apply expressly to the skin:

Pyogenic Granuloma. Pyogenic granuloma looks like small, reddish bumps on the skin that tend to bleed. It is caused by an injury to the skin. It is most frequently found on the hands, arms and face. In some cases, the nodule will spontaneously disappear. More often, the lesions need to be removed by surgery. There may be some scarring as a result of these treatments.

Granuloma Annulare. This type of nodule can occur in any person, but is more common in children and young adults. It is characterized by a ring-shaped lesion that is round and firm; red, white or purple skin around a clear crater of normal skin. It can appear individually or in groups. Most often, it appears on tops of hands and feet, elbows and knees. Most people have no other symptoms, but some may experience itchiness at the site of the lesion. Granuloma annulare can resolve itself and may or may not disappear over time without treatment. However, if the incidence is widespread or aesthetically undesirable, a dermatologist may prescribe a steroid cream or inject steroids just below the skin’s surface to speed healing. Another successful treatment is PUVA, in which a medication called psoralen is given and then the area is exposed to ultraviolet light.

Boils

Also known as skin abscesses, boils form as a result of a cut or break in the skin, which leads to a bacterial infection. They are characterized as a red, tender area with a painful, pus-filled center that can open spontaneously or by surgical incision. Some boils are caused by an ingrown hair. Others are caused by plugged-up sweat glands, such as some types of cystic acne. Anyone can get a boil. They grow quickly and are usually painful until they drain. However, left alone a boil will naturally come to a head and burst open, allowing the pus to drain and the skin to heal. People with weakened immune systems are more susceptible to boils than the general population.

Boils tend to occur on parts of the body that have hair or sweat glands and are exposed to friction, typically on the face, neck, armpits or buttocks. There are a variety of different types of boils:

Furuncle or Carbuncle. These abscesses are caused by the Staphylococcus aureus bacterium. A furuncle is an individual boil; carbuncles are deep clusters of boils that most often form on the back of the neck, shoulders or thighs.

Pilonidal Cyst. An infected hair follicle around the buttocks area caused by long periods of sitting. Pilonidal cysts almost always require medical treatment.

Hidredenitis Suppurativa. These are multiple abscesses that form from blocked sweat glands in the armpits or groin areas.

Cystic Acne. These boils are situated more deeply into skin tissue than the more superficial forms of acne. It typically occurs among teenagers.

Boils respond well to home remedies. To promote healing, apply heat to the boil in the form of hot soaks or compresses. Keep the area clean, apply over-the-counter antibiotics and then cover with gauze. Do not puncture or squeeze the boil because it can lead to further infection. If the boil does not go away within two weeks, is accompanied by a fever or is painful, contact your dermatologist. The doctor will clean, lance and drain the boil and prescribe an antibiotic to alleviate the infection.

Intertrigo

A skin inflammation that occurs in warm, moist folds of the body where two skin surfaces chafe against each other. It most commonly appears on the inner thighs, armpits, groin, the crease on the back of the neck, the bottom of breasts in women and below the belly in obese people. It can be caused by a bacterial, yeast or fungal infection. Symptoms include a reddish-brown rash that looks raw and may ooze or itch. In severe cases, the skin may crack or bleed.

Treatment for intertrigo focuses on keeping the affected area dry and exposed to air. Your dermatologist may prescribe steroidal creams, oral antibiotics or antifungal medications (depending on the cause of the infection) to relieve itching and promote healing. Applying warm, moist compresses to the area can also help relieve itching.

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