Other Conditions


The specialists at The Skin Clinic treat all diseases of the skin, hair and nails. If you are concerned about one of the following conditions, please contact The Skin Clinic. We are confident that our medical professionals can help to diagnose, explain and treat any problem you may be experiencing.

Athlete's Foot

Athlete's FootAthlete's foot, or tinea pedis, is a fungal infection that can grow and multiply on human skin, especially the feet. It grows best in a dark, moist, and warm environment, such as a foot inside a shoe.

In some people, the skin between the toes (especially the last two toes) peels, cracks, and scales. There may be redness, scaling, and even dryness on the soles and along the sides of the feet. Athletes foot may also produce itching and burning of the feet. A few individuals may develop a single small patch of intensely itchy blisters. These skin changes can also be caused by other medical conditions like contact dermatitis and psoriasis.

Because all rashes on the feet are not athlete's foot, using over-the-counter antifungal preparations on a rash that is not athlete's foot may make your condition worse. You should see a dermatologist if over-the-counter medications do not clear the condition or if it becomes worse. Your dermatologist can correctly diagnose the condition and prescribe an effective medication, such as anti-fungal creams or, in more severe cases, anti fungal pills. Untreated, athlete's foot can result in blisters and cracks that may lead to secondary bacterial infections.

It's important to continue the use of your prescribed anti fungal creams and to take all the oral medications properly. While your skin may look better, the infection can remain active for some time and could get worse again if you stop your treatment before completion.

You can help prevent athlete's foot by following some simple rules:

  • Wash your feet daily.
  • Dry your feet thoroughly, especially between your toes, after bathing.
  • Avoid tight footwear, especially in the summer. Sandals and "flip-flops" are the best warm weather footwear.
  • Wear cotton or synthetic running socks, which absorb sweat, and change the socks daily or more frequently if they become damp.
  • Dust an antifungal powder on your feet and into your shoes
Atypical Nevus

Atypical NevusAn atypical nevus (also called a dysplastic nevus) is a benign growth, usually appearing at puberty, which may share some of the clinical or microscopic features of melanoma, but is not a melanoma or any other form of cancer. However, the presence of atypical nevi may increase the risk of developing a melanoma, especially for those with many nevi, or be a marker for someone who is at risk of developing melanoma.

Atypical nevi can have a variable appearance, often showing "ABCDE" features:

  • Asymmetrical - one portion is larger than the other is
  • Border - Tend to have an irregular border that can fade imperceptibly into the surrounding skin
  • Color - Variably colored (typically with shades of tan, brown, black; and red)
  • Diameter - Large, usually greater than 6 mm
  • Elevated - Slightly raised.

Atypical nevi can occur anywhere on the body, and usually begin to appear at puberty. They may however, be more common in sun-exposed areas, the back, and the legs.

When a patient has multiple atypical and normal nevi (moles) and one of their relatives has melanoma, they may have Familial Atypical Mole Syndrome (FAMS). Patients with FAMS should examine their own skin every two to three months. Information on the early signs of melanoma is available from your dermatologist or the American Academy of Dermatology. Patients, beginning at about puberty, should undergo a full body screen from their dermatologist every 3 to 12 months. Your dermatologist might also recommend regular ophthalmologic examination, baseline skin photographing, or even regular screening of relatives. The aim of all of these measures is to permit early detection of melanoma, should it occur because detection at the early stages has a much higher rate of cure than do later stages.

An atypical nevus is not the same as melanoma and does not need to be treated aggressively, but should be observed for changes, biopsied, or conservatively excised.

Ultraviolet light avoidance is important to help prevent development of melanoma. Regular use of sunscreen (SPF 15 or higher) is advised, even for a brief exposure to sunlight

Herpes Zoster (Shingles)

ShinglesHerpes zoster, also known as shingles or zoster, is a viral infection caused by the same virus that causes chicken pox. Anyone who has had chickenpox can develop herpes zoster, but usually only get it once. Although children can get zoster, it is more common in people over the age 50. Illness, trauma, stress, and other conditions that weaken the immune system may also trigger zoster. Zoster is most common on the trunk and buttocks, but it can also appear on the face, arms, or legs if nerves in these areas are involved. /p>

Symptoms of zoster occur in the following order:

  • Burning, itching, tingling, or extreme sensitivity in one area of the skin usually limited to one side of the body that last about one to three days.
  • A red rash and possibly fever or headache
  • Groups of blisters that usually last for two to three weeks. These blisters start out clear but then look yellow or bloody before they crust over (scab) and disappear.

It is unusual to have pain without blisters, or blisters without pain. If zoster affects the eye and is not treated early, it can lead to complications like glaucoma, scarring, and blindness.

Zoster is much less contagious than chicken pox. Persons with zoster can transmit the virus if blisters are broken. Newborns or those with decreased immunity are at the highest risk for contracting chicken pox from someone who has zoster. Patients with zoster rarely require hospitalization.

Zoster usually clears on its own in a few weeks and seldom recurs. Pain relievers and cool compresses are helpful in drying the blisters. If diagnosed early, oral anti-viral drugs can be prescribed to decrease both viral shedding and the duration of skin lesions. The earlier treatment is started the better. The drugs may rarely cause headache, stomach upset, or lightheadedness.

Herpes Simplex

Herpes Simplex 1The herpes simplex virus (HSV) causes blisters and sores around the mouth, nose, genitals, and buttocks, but they may occur almost anywhere on the skin. HSV infections can be very annoying because they may reappear periodically. The sores may be painful and unsightly. For chronically ill people and newborn babies, the viral infection can be serious, but rarely fatal.

There are two types of HSV - Type 1 and Type 2

Type 1 infections are tiny, clear, fluid-filled blisters that most often occur on the face and are often referred to as fever blisters or cold sores. Less frequently, these infections can occur in the genital area and may also develop in wounds on the skin. This infection usually occurs during infancy or childhood. They usually get it from close contact with family members or friends who carry the virus. It can be transmitted by kissing, sharing eating utensils, or by sharing towels.

Type 1 infections are tiny, clear, fluid-filled blisters that most often occur on the face and are often referred to as fever blisters or cold sores. Less frequently, these infections can occur in the genital area and may also develop in wounds on the skin. This infection usually occurs during infancy or childhood. They usually get it from close contact with family members or friends who carry the virus. It can be transmitted by kissing, sharing eating utensils, or by sharing towels.

Type 2 infections usually results in sores on the buttocks, penis, vagina, or cervix, two to twenty days after contact with an infected person. Between 200,000 and 500,000 people "catch" genital herpes each year. Sexual intercourse is the most frequent means of getting the infection although touching an unaffected part of the body immediately after touching a herpes lesion can spread the lesions of both types of herpes simplex.

There is no vaccine that prevents this contagious disease, but other methods of prevention before and during an outbreak are important. If tingling, burning, itching, or tenderness occurs in an area of the body where there is a herpes infection, the area should be kept away from other people. With mouth herpes, one should avoid kissing, sharing cups, or lip balms. For persons with genital herpes, this means avoiding sexual relations, including oral/genital contact during the period of symptoms or active lesions. Condoms can help prevent transmission of genital herpes between sexual partners and should always be used. However, they will not protect against the virus that may be living on nearby genital skin that is not covered by the condom.

While there are no known cures for herpes, there are several safe medications to reduce outbreaks. Studies to improve treatment methods or eliminate outbreaks entirely, continue. See your dermatologist for more information.

Lupus

Patients with lupus erythematosus (LE) often have skin signs and develop many different types of lesions. These lesions are either LE-specific skin lesions (only occurring in people with LE) or LE-non-specific skin lesions (occur not only in people with LE but also those with other diseases).

There are three broad categories of LE-specific skin lesions:

Chronic cutaneous LE (CCLE) - Discoid lupus (DLE) is the most common form of CCLE. The coin-shaped or disk-like "discoid," lesions are mostly present on the scalp and face, but can be seen on other parts of the body. DLE lesions are usually painless and do not itch. Sun exposure may make lesions in CCLE patients worse. Skin cancer can occasionally develop in long-standing DLE lesions. Any changes should be brought to your dermatologist's attention. Another form of CCLE is lupus erythematosus panniculitis (LEP) and it occurs when discoid lesions occur with firm lumps in the fatty tissue underlying the skin.

Subacute cutaneous LE (SCLE) - One type of SCLE looks like psoriasis and has red scaly patches on the arms, shoulders, neck, and trunk, with fewer patches on the face. The other type has red ring-shaped areas with a slight scale on the edges. Sun exposure can make lesions worse. The lesions of SCLE are not particularly itchy, and may heal with light or dark marks.

Acute cutaneous LE (ACLE) - The most typical form of ACLE has flattened areas of red skin on the face that look like sunburn. When the cheeks and nose are involved, it is called a "butterfly rash." Generalized ACLE can be seen on the arms, legs, and body. ACLE lesions are sunlight sensitive (photosensitive) and may discolor the skin, but there is no scarring. ACLE usually occurs in patients with active systemic disease.

LE-non-specific skin lesions inlclude Vasculitis and hair loss. Vasculitis appears as small red-purple spots or bumps on the lower legs, but can also be hive-like or have small red or purple lines in the fingernail folds or on the tips of the fingers and are caused by damage to the blood vessels in the skin.

Protection against the sun is very important for people with LE. ACLE is treated with systemic drugs such as prednisone, or in combination with other drugs that suppress the immune system. Discoid lesions and SCLE skin lesions can be treated with the application of corticosteroid creams, ointments, gels, tapes, and solutions. Individual lesions can be injected with a corticosteroid suspension. Patients with more widespread LE skin lesions and stubborn lesions are treated with oral antimalarial drugs. Your dermatologist will provide necessary information in choosing the right treatment, as well as proper selection and use of sunscreens.

Melasma

Melasma is a skin condition presenting as brown patches on the face of adults. Both sides of the face are usually affected. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip.

Who gets melasma?
Melasma mostly occurs in women. Only 10% of those affected are men. Dark-skinned races, particularly Hispanics, Asians, Indians, people from the Middle East, and Northern Africa, tend to have melasma more than others.

What causes melasma?
The precise cause of melasma is unknown. People with a family history of melasma are more likely to develop melasma themselves. A change in hormonal status may trigger melasma. It is commonly associated with pregnancy and called chloasma, or the "mask of pregnancy." Birth control pills may also cause melasma, however, hormone replacement therapy used after menopause has not been shown to cause the condition.

Sun exposure contributes to melasma. Ultraviolet light from the sun, and even very strong light from light bulbs, can stimulate pigment-producing cells, or melanocytes in the skin. People with skin of color have more active melanocytes than those with light skin. These melanocytes produce a large amount of pigment under normal conditions, but this production increases even further when stimulated by light exposure or an increase in hormone levels. Incidental exposure to the sun is mainly the reason for recurrences of melasma.

Any irritation of the skin may cause an increase in pigmentation in dark-skinned individuals, which may also worsen melasma. Melasma is not associated with any internal diseases or organ malfunction.

How is melasma diagnosed?
Because melasma is common, and has a characteristic appearance on the face, most patients can be diagnosed simply by a skin examination. Occasionally a skin biopsy is necessary to differentiate melasma from other conditions.

How is it treated?
While there is no cure for melasma, many treatments have been developed. Melasma may disappear after pregnancy, it may remain for many years, or a lifetime.

Sunscreens are essential in the treatment of melasma. They should be broad spectrum, protecting against both UVA and UVB rays from the sun. A SPF 30 or higher should be selected. In addition, physical sunblock lotions and creams such as zinc oxide and titanium oxide, may be used to block ultraviolet radiation and visible light.

Any facial cleansers, creams, or make-up which irritates the skin should be stopped, as this may worsen the melasma. If melasma develops after starting birth control pills, it may improve after discontinuing them. Melasma can be treated with bleaching creams while continuing the birth control pills.

A variety of bleaching creams are available for the treatment of melasma. These creams do not "bleach" the skin by destroying the melanocytes, but rather, decrease the activity of these pigment-producing cells. Over-the-counter creams contain low concentrations of hydroquinone, the most commonly-used depigmenting agent. This is often effective for mild forms of melasma when used twice daily. A dermatologist may prescribe creams with higher concentrations of hydroquinone.. Creams containing tretinoin, steroids, and glycolic acid are available in combination with hydroquinone to enhance the depigmenting effect. It is important to follow the directions of your dermatologist carefully in order to get the maximum benefit from your treatment regimen and to avoid irritation and other side effects.

Chemical peels, microdermabrasion, and laser surgery may help melasma, but have the potential of causing irritation, which can sometimes worsen melasma. Generally, they should only be used by a dermatologist in conjunction with a proper regimen of bleaching creams and prescription creams tailored to your skin type.

Management of melasma requires a comprehensive and professional approach by your dermatologist. Avoidance of sun and irritants, use of sunscreens, application of depigmenting agents, and close supervision by your dermatologist can lead to a successful outcome.

Poison Ivy, Sumac, & Oak

Poison ivy, poison oak, and poison sumac are the most common cause of allergic reactions in the United States. Each year 10 to 50 million Americans develop an allergic rash after contact with these poison plants, a rash that and can affect almost any part of the body.

Poison Oak
In the West, this plant may grow as a vine but usually is a shrub. In the East, it grows as a shrub. It has three leaflets to form its leaves' "hairs."

Poison Ivy
In the East, Midwest and South, it grows as a vine. In the far Northern and Western United States, Canada and around the Great Lakes, it grows as a shrub. Each leaf has three leaflets.

Poison Sumac
Grows in standing water in peat bogs in the Northeast and Midwest and in swampy areas in parts of the Southeast. Each leaf has seven to 13 leaflets.

Poison Plant rash is an allergic contact dermatitis caused by contact with oil called urushiol. Urushiol is found in the sap of poisonous plants like poison ivy, poison oak, and poison sumac. It is colorless or pale yellow oil that oozes from any cut or crushed part of the plant, including the roots, stems, and leaves. After exposure to air, urushiol turns brownish-black. Damaged leaves look like they have spots of black enamel paint making it easier to recognize and identify the plant. Contact with urushiol can occur in three ways:

  • Direct contact - touching the sap of the toxic plant.
  • Indirect contact - touching something on which urushiol is present. The oil can stick to the fur of animals, to garden tools or sports equipment, or to any objects that have come into contact with it.
  • Airborne contact - burning poison plants put urushiol particles into the air.

When urushiol gets on the skin, it begins to penetrate in minutes. A reaction appears, usually within 12 to 48 hours. There is severe itching, redness, and swelling, followed by blisters. The rash is often arranged in streaks or lines where the person brushed against the plant. In a few days, the blisters become crusted and take 10 days or longer to heal. The rash does not spread by touching it, although it may seem to when it breaks out in new areas. This may happen because urushiol absorbs more slowly into skin that is thicker such as on the forearms, legs, and trunk.

Prevention of Poison Ivy
Prevent the misery of poison ivy by looking out for the plant and staying away from it. You can destroy these weeds with herbicides in your own backyard, but this is not practical elsewhere. If you are going to be where you know poison ivy likely grows, wear long pants, long sleeves, boots, and gloves. Remember that the plant's nearly invisible oil, urushiol, sticks to almost all surfaces, and does not dry. Do not let pets run through wooded areas since they may carry home urushiol on their fur. Because urushiol can travel in the wind if it burns in a fire, do not burn plants that look like poison ivy

Barrier skin creams such as a lotion containing bentoquatum offer some protection before contact with poison ivy, poison oak, or poison sumac. Over-the-counter products prevent urushiol from penetrating the skin. Ask your dermatologist for details.

Treatment
If you think you've had a brush with poison ivy, poison oak, or poison sumac, follow these simple steps:

Wash all exposed areas with cold running water as soon as you can reach a stream, lake, or garden hose. If you can do this within five minutes, the water may keep the urushiol from contacting your skin and spreading to other parts of your body. Within the first 30 minutes, soap and water are helpful.

Relieve the itching of mild rashes by taking cool showers and applying over-the-counter preparations like calamine lotion or Burow's solution. Soaking in a lukewarm bath with an oatmeal or baking soda solution may also ease itching and dry oozing blisters. Over-the-counter hydrocortisone creams are not strong enough to have much effect on poison ivy rashes.

Prescription cortisone can halt the reaction if used early. If you know you have been exposed and have developed severe reactions in the past, consult your dermatologist. He or she may prescribe cortisone or other medicines that can prevent blisters from forming. If you receive treatment with a cortisone drug, you should take it longer than six days, or the rash may return.

Scabies

Scabies is caused by a tiny mite that has infested humans for at least 2,500 years. It is often hard to detect, and causes a fiercely, itchy skin condition. Dermatologists estimate that more than 300 million cases of scabies occur worldwide every year. The condition can strike anyone of any race or age, regardless of personal hygiene. The good news is that with better detection methods and treatments, scabies does not need to cause more than temporary distress.

How Scabies Develops
The microscopic mite that causes scabies can barely be seen by the human eye. Being a tiny, eight-legged creature with a round body, the mite burrows in the skin. Within several weeks, the patient develops an allergic reaction causing severe itching; often intense enough to keep sufferers awake all night.

Human scabies is almost always caught from another person by close contact. It could be a child, a friend, or another family member. Everyone is susceptible. Scabies is not a condition only of low-income families and neglected children, although, it is more often seen in crowded living conditions with poor hygiene.

Attracted to warmth and odor, the female mite burrows into the skin, lays eggs, and produces toxins that cause allergic reactions. Larvae, or newly hatched mites, travel to the skin surface, lying in shallow pockets where they will develop into adult mites. If the mite is scratched off the skin, it can live in bedding for up to 24 hours or more. It may take up to a month before a person will notice the itching, especially in people with good hygiene and who bathe regularly.

What to Look For
The earliest and most common symptom of scabies is itching, especially at night. Little red bumps like hives, tiny bites, or pimples appear. In more advanced cases, the skin may be crusty or scaly.

Scabies prefers warmer sites on the skin such as skin folds, where clothing is tight, between the fingers or under the nails, on the elbows or wrists, the buttocks or belt line, around the nipples, and on the penis. Mites also tend to hide in, or on, bracelets and watchbands, or the skin under rings. In children, the infestation may involve the entire body including the palms, soles, and scalp.

Diagnosis
Your dermatologist will do a thorough head-to-toe examination in good lighting, with careful attention to skin crevices

Getting Rid of Scabies
5% permethrin cream or 1% lindane lotion is applied to the skin from the neck down at bedtime and washed off the next morning. Dermatologists recommend that the cream be applied to cool, dry skin over the entire body (including the palms of the hands, under finger nails, soles of the feet, and the groin) and left on for 8 to 14 hours. A second treatment one week later may be recommended. Side effects include mild temporary burning and stinging. Lesions heal within four weeks after the treatment. If a patient continues to have trouble, reinfestation may be a problem requiring further evaluation by the dermatologist.

Antihistamines may be prescribed to relieve itching, which can last for weeks, even after the mite is gone.

Getting rid of the mites is critical in the treatment of scabies. Everyone in the family or group, whether itching or not, should be treated at the same time to stop the spread of scabies. This includes close friends, day care or school classmates, or nursing homes.

Tanning

Dermatologists and public health professionals are concerned about the dangers of ultraviolet (UV) radiation from the sun, tanning beds, and sun lamps. Two types of ultraviolet radiation are Ultraviolet A (UVA) and Ultraviolet B (UVB). UVB has long been associated with sunburn while UVA has been recognized as a deeper penetrating radiation that causes more damage. Some scientists have suggested recently that there may be an association between UVA radiation and melanoma, the most serious type of skin cancer. Although getting some sun good for your health, just a small amount of sunlight is needed for the body to manufacture all the vitamin D you need.

UV radiation from the sun, tanning beds, or sun lamps may cause skin cancer. While skin cancer has been associated with sunburn, moderate tanning may also produce the same effect. UV radiation can also have a damaging effect on the immune system and cause premature aging of the skin, giving it a wrinkled, leathery appearance.

Although most sun lamps and tanning beds emit mainly UVA radiation, and these so-called "tanning rays" are less likely to cause sunburn than UVB radiation from sunlight, it doesn't make them safe.

Skin aging and cancer are delayed effects that don't usually show up until many years after the exposure. Unfortunately, since the damage is not immediately visible, young people are often unaware of the dangers of tanning. 80% of sun damage occurs before age 18.

Tips to Avoid Sun Damage

  • Plan your outdoor activities to avoid the sun's strongest rays.
  • As a general rule, avoid the sun between 10 a.m. and 4 p.m.
  • Wear protective covering such as broad-brimmed hats, long pants, and long-sleeved shirts to reduce sun exposure.
  • Wear sunglasses that provide 100% UV ray protection.
  • When outdoors, always wear a broad-spectrum sunscreen with Sun Protection Factor (SPF) 15 or greater, which will block both UVA and UVB, and apply it thirty minutes before sun exposure.

If you believe that some damage has already been done:

  • Seek medical attention from your dermatologist to evaluate if you received skin or eye damage from the sun or if you experienced an allergic reaction to the sun.
  • See your dermatologist if you develop an unusual mole, a scaly patch or a sore that doesn't heal. You may have developed a pre-cancer or a skin cancer. Your dermatologist can also repair and reverse sun-damaged wrinkles through medical treatments and dermatological surgery.
Vitiligo

Vitiligo is a skin condition resulting from loss of pigment, which produces white patches. Any part of the body may be affected. Usually both sides of the body are affected. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas. Vitiligo affects one or two of every 100 people, both children and adults. Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as thyroid disease.

Treatments of Vitiligo include:

  • Using sunscreen to protect from sun exposure
  • Cover-up measures including make-up and self-tanning products
  • Repigmentation therapy
  • PUVA (a form of Repigmentation therapy using psoralen)
  • Narrow Band UVB (NBUVB)
  • Grafting
  • A new topical class of drugs called immunomodulators
  • Excimer lasers

Sometimes the best treatment for vitiligo is no treatment at all.

At this time, the exact cause of vitiligo is not known, however, there may be an inherited component. Although treatment is available, there is no single cure. Research is ongoing in vitiligo and it is hoped that new treatments will be developed.

Warts

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth. There are several different kinds of warts including common warts, foot (plantar) warts, and flat warts. Warts are passed from person to person, sometimes indirectly. The time from the first contact to the time the warts have grown large enough to be seen is often several months. The risk of catching hand, foot, or flat warts from another person is small.

Treatments include the use of salicylic acid plasters, applying other chemicals to the wart, or one of the surgical treatments including laser surgery, electrosurgery, or cutting.

There are some wart remedies available without a prescription. However, you might mistake another kind of skin growth for a wart, and end up treating something more serious as though it were a wart. If you have any questions about either the diagnosis or the best way to treat a wart, you should seek your dermatologist's advice.