Skin Disorders

Click the disorder to expand or collapse a topic:

Acne is no fun. It can make you feel shy in front of your friends, which may also keep you from joining in on fun activities after school. Did you realize, though, that almost everyone suffers from acne at some time? Whether it's pimples, blackheads, or whiteheads, acne affects a lot of kids (and adults, too). But there's no need to worry: Acne is treatable! There are several things both you and your dermatologist can do to control outbreaks.

What is acne?
Our bodies produce hormones (called androgens) that make our skin oily. That oil can lead to acne in some people. Acne may also run in families, although dermatologists aren't sure exactly what the connection is yet.

Treating acne at home.
Most people can control pimples by taking good care of their skin at home. (Sometimes over-the-counter [OTC] creams and lotions help, too.) To help keep your skin clear and smooth, try these tips:

Avoid scrubbing. Dirt doesn't cause acne. Scrubbing will only inflame and irritate your tender skin.

Use a mild soap. Wash your skin gently with a soap or cleanser that's specially made for people with acne. Ask a pharmacist for help in choosing one that's right for you.

Smooth on benzoyl peroxide lotion. Benzoyl peroxide helps dry up your skin and reduce bacteria. (You'll find these lotions at pharmacies.)

Help from a dermatologist.
How do you know when it's time to get help from a dermatologist? If you've tried the tips listed above for a couple of months, and they haven't worked for you, it's a good idea to see a dermatologist, who can treat acne with many different medications.

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.

Not all rashes on the feet are athlete's foot. Before treating a foot rash yourself, check with your dermatologist, who can diagnose the condition and prescribe the correct medication. Using over-the-counter preparations on a rash that is not athlete's foot may make your condition worse. If athlete's foot isn't treated, it can result in skin blisters and cracks that can lead to bacterial infections.


Athlete's foot (tinea pedis) Athlete's foot (tinea pedis) Athlete's foot (tinea pedis)
How is athlete's foot diagnosed?
Your dermatologist will examine your feet. This examination may include a scraping of the skin on your feet. The skin scales are then examined under a microscope or placed in special substances to look for growth of the fungus.

How is athlete's foot treated?
Once the fungus is diagnosed, treatment should begin immediately. For simple cases, anti-fungal creams may be prescribed. The creams can relieve the symptoms fairly quickly. In more severe cases, your dermatologist may prescribe foot soaks before applying antifungal creams. If your athlete's foot is stubborn, antifungal pills may be prescribed. Toenail infections are very difficult to treat. Research is ongoing to try to find effective ways to treat toenail fungal infections.

It's important to continue the use of your prescribed antifungal creams and to take all medication. While your skin may look better, the infection can remain for some time afterwards and could recur.

What is the best way to prevent athlete's foot?
You can prevent athlete's foot by following some simple rules:

Wash your feet daily.
Dry your feet thoroughly, especially in between your toes.
Avoid tight footwear, especially in the summer. Sandals are the best warm weather footwear.
Wear cotton socks and change them daily or more frequently if they become damp. Don't wear socks made of synthetic materials.
If possible, go barefoot at home.
Dust an anti-fungal powder into your shoes in the summertime.

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 pamphlet 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.

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 dermatologist 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 dermatologist about proper bathing, moisturizing, and dealing with emotional upsets which may make the condition worse.

Your dermatologist 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 dermatologist may 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. www.eczema-assn.org

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. www.eczema.org 

Take the "Bite" Out of Summer
Insect bites can turn a wonderful day in the great outdoors into a nightmare. Insects circle your head on the hiking trail, land on your potato salad, and fly right into your s'mores. What a pain! And don't forget what comes later-the itch. Whether you're being annoyed by a flea, mosquito, fly, wasp, or bee, there are lots of ways you can keep them from bugging you!

Oh, those itchy bumps!
When an insect takes its first "bite" of your skin, it injects saliva or venom. Once your body notices the bite venom, it gradually becomes sensitive to the venom. So the next time you experience an insect bite, what happens? You may get a red, itchy bump.

When innocent bites go bad.
Not all bug bites are harmless. If someone in your family has had a bad reaction to a bee or wasp sting, for example, it's a good idea to keep an emergency kit available. (Your dermatologist can tell you what to put in the kit.) It's possible for a person to die from a severe reaction to an insect sting.

Some bug bites can cause bacterial infections (like impetigo). People with impetigo usually notice honey-colored, crusty patches that show up after they start scratching. Severe itching can also cause skin ulcers, scars, changes in skin color, swelling, allergic reactions, and thickened skin.

Some insects (ticks, for example) can cause serious illnesses, like Lyme disease and Rocky Mountain spotted fever. Many Northern, mid-Atlantic, and Western states are home to deer herds, and the ticks they carry.

When to see a doctor.
Dermatologists are able to treat bugbites even when they aren't sure what bit you. If you're worried about a bite, talk to your dermatologist. Your dermatologist may treat you with special creams or pills to lessen the itch.

How to pick a repellent.
DEET and permethrin insect repellents work best. Since insect repellents can be harmful if not used correctly, make sure to read and follow the label directions very carefully.

How to keep the bugs away.
Here are some ways to keep bugs from biting you in the first place.

When you're outside... DO

Make sure your picnic area is screened in.
Use insect repellent candles or electric bug "zappers."
Wear a hat outdoors to cover your hair.
Wear light-colored clothing that's snug at the wrist and ankles.
Keep garbage cans closed and clean.
Wipe off sweat as soon as possible. (It attracts insects.)
If you've been swimming, shake out your towels and clothes before you use them.
Use DEET repellents!
Keep emergency department and poison control center phone numbers handy (and a kit if any family member is seriously allergic to stings).

When you're outside... DON'T

Wear perfume, perfumed sun lotions, or hair spray.
Wash with scented soaps, creams, or cosmetics.
Wear dark-colored clothes.
Go near rotting fruit (like apples that have fallen from trees) in picnic areas.
Kick or move logs.
Wear jewelry or shiny buckles.


How much DEET do you need?
If you're spending a couple of hours in the yard, try an insect repellent that's 10% to 30% DEET. If you're going camping or taking a long hike, you may need to use a repellent that's 40% to 50% DEET. Two tablespoons should be sufficient to cover the arms, legs, and face of the average adult. Note: Kids shouldn't use more than 10% DEET at any time.

Herpes Simplex

The herpes simplex virus (HSV) can cause blisters and sores almost anywhere on the skin. These sores usually occur either around the mouth and nose, or on the genitals and buttocks.

HSV infections can be very annoying because they can periodically reappear. 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
The Type 1 virus causes cold sores. Most people get Type 1 infections during infancy or childhood. They usually catch 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. The sores most commonly affect the lips, mouth, nose, chin or cheeks and occur shortly after exposure. Patients may barely notice any symptoms or need medical attention for relief of pain.

The Type 2 virus causes genital sores. Most people get Type 2 infections following sexual contact with an infected person. The virus affects anywhere between 5 and 20 million people, or up to 20 percent of all sexually active adults in the United States.

With either type of herpes simplex, you can spread lesions by touching an unaffected part of the body after touching a herpes lesion.

What is Herpes?
Herpes is the scientific name used for eight related A viruses of humans. Herpes simplex is related to the viruses that cause infectious mononucleosis (Epstein-Barr Virus), chicken pox and shingles (varicella zoster virus).

Herpes Simplex Type 1
Often referred to as fever blisters or cold sores, HSV Type 1 infections are tiny, clear, fluid-filled blisters that most often occur on the face. Less frequently, Type 1 infections occur in the genital area. Type 1 may also develop in wounds on the skin. Nurses, physicians, dentists, and other health care workers rarely get a herpetic sore after HSV enters a break in the skin of their fingers.

There are two kinds of infections - primary and recurrent. Although most people when exposed to the virus get infected, only 10% will actually develop sores or cold blisters when this infection occurs. The sores of a primary infection appear two to twenty days after contact with an infected person and can last from seven to ten days.

The number of blisters varies from one to a group of blisters. Before the blisters appear, the skin may itch or become very sensitive. The blisters can break as a result of minor injury, allowing the fluid inside the blisters to ooze and crust. Eventually, crusts fall off, leaving slightly red healing skin.

The sores from the primary infection heal completely and rarely leave a scar. However, the virus that caused the infection remains in the body. It moves to nerve cells where it remains in a resting state.

Many people will not have a recurrence. Others will have a recurrence either in the same location as the first infection or in a nearby site. The infections may recur every few weeks or less frequently.

Recurrent infections tend to be milder than primary infections. They can be set off by a variety of factors including fever, sun exposure, and a menstrual period. However, for many, the recurrence is unpredictable and has no recognizable cause.

Herpes Simplex Virus Type 2
Infection with herpes simplex virus Type 2 usually results in sores on the buttocks, penis, vagina or cervix, two to twenty days after contact with an infected person. Sexual intercourse is the most frequent means of getting the infection. Both primary and repeat attacks can cause problems including: a minor rash or itching, painful sores, fever, aching muscles and a burning sensation during urination. HSV Type 2 may also occur in locations other than the genital area, but is usually found below the waist.
As with Type 1, sites and frequency of repeated bouts vary. The initial episode can be so mild that a person does not realize that he or she has an infection. Years later, when there is a recurrence of HSV, it may be mistaken for an initial attack, leading to unfair accusations about the source of infection.

After the initial attack, the virus moves to nerve cells remaining there until set off again by a menstrual period, fever, physical contact, stress, or something else.

Pain or unusual tenderness of the skin may begin between one to several days before both primary and recurrent infections develop. This is called a prodrome.

How Are the HSV Infections Diagnosed?
The appearance of HSV is often so typical that no further testing is necessary to confirm an HSV infection. However, if the diagnosis is uncertain, as it may be in the genital or cervical areas, a swab from the infected skin (culture) may be taken and sent to the laboratory for analysis. Other laboratory tests available for diagnosis include specially treated scrapings that are examined under the microscope, and blood tests for antibodies. Some tests are only valid in the early stages, and more than one of these tests may be required to confirm the presence of herpes. Genital herpes can be mistaken for other diseases, including syphilis. A small number of women with genital herpes don't know they have it because it occurs on the cervix which is not sensitive to pain.

How are Herpes Infections Treated?
There is no vaccine that prevents this disease from occurring. Oral anti-viral medications such as acyclovir, famciclovir, or valacyclovir have been developed to effectively treat herpes infections. These medications can be used to treat an outbreak or can be used for suppressing herpes recurrences. Lower doses may be helpful in reducing the number of herpes attacks in people with frequent outbreaks.

How Do You Prevent Transmission?
Between 200,000 and 500,000 people "catch" genital herpes each year and the number of Type 1 infections is many times higher. Prevention of this disease, which is contagious before and during an outbreak, is important.

If tingling, burning, itching, or tenderness (signs of a recurrence) occur in an area of the body where you had a herpes infection, then that area should not contact other people. With mouth herpes, one should avoid kissing and 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 to your sexual partner.

Can Herpes be Spread if there is No Visible Sore?
Not only can herpes be spread if there is no sore, MOST herpes is transmitted in the absence of lesions! It is now estimated that over 80% of all genital herpes is transmitted when there isn't anything on the skin and no symptoms. Patients have been aware for many years that if they kissed someone while having a fever blister or had sex with their partner while having an outbreak of genital herpes that they were likely to transmit the virus. Despite this knowledge, however, a 30% increase in the prevalence of HSV 2 infections was documented in the 1980s and 1990s. This increase is most likely due to the presence of HSV on the genital skin in the absence of lesions or symptoms. This phenomenon is known as "asymptomatic viral shedding" and has been demonstrated in well-controlled clinical investigations. Most recently, persons who never recall having had an outbreak of genital herpes, but who have had positive blood tests for antibodies to herpes, also have been demonstrated to "shed" the virus occasionally from lips or genital skin.

It has been demonstrated that persons who take acyclovir daily have reduced amounts of the virus in the absence of symptoms or lesions. The same is probably true of the newer drugs, famciclovir and valacyclovir. It is logical that taking one of these three drugs everyday would reduce the chances of passing the virus to an uninfected partner, but this has not yet been proven.

Other Serious Implications Of HSV
Eye Infections - HSV may infect the eye and lead to a condition called herpes keratitis. There is pain and light sensitivity, a discharge, and a gritty sensation in the eye. Without prompt treatment, scarring of the eye may result. Fortunately, there are drugs available that are quite effective in eliminating infection and preventing severe scarring in the cornea. Any patient with a suspected eye infection from herpes should be seen immediately by an ophthalmologist.

Infections in Pregnancy - A pregnant woman who has genital herpes at the time of childbirth may transmit the virus to her baby as it passes through the birth canal. If the birth occurs during the mother's first episode of genital herpes, the baby may suffer severe damage. Women who know that they have had genital herpes or think they might have it during their pregnancy should tell their physicians so the baby can be protected.

Pregnant women should avoid sexual contact with a partner who has active genital herpes, (especially late in the pregnancy). The use of condoms is recommended for those who do not abstain.

The newborn can also be infected by exposure to the virus from non-genital lesions. If the mother or a person working in the nursery has active blisters on the lips or hands, the baby can become infected. Family members and friends with active HSV should not handle the newborn child.

No special precautions need to be taken by the woman who has inactive herpes (genital or non-genital) at the time of delivery. Since the mother's infection is not active, the infant is not at risk.

HSV And The Seriously Ill - HSV can be life-threatening to the person who has cancer, a person who has had an organ transplant, or anyone who has some other major illness, because their immunity to infections has been reduced.

Can Herpes be Cured?
While there are no known cures for herpes, clinical studies are now ongoing to attempt to reduce or possibly eliminate outbreaks. These experimental therapies, however, have no potential to eliminate the virus from the affected nerve. Therefore, these investigations are also attempting to determine if the rate of "asymptomatic viral shedding" can also be reduced. 

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 pamphlet 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.

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 dermatologist 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 dermatologist about proper bathing, moisturizing, and dealing with emotional upsets which may make the condition worse.

Your dermatologist 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 dermatologist may 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. www.eczema-assn.org

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. www.eczema.org 

What causes a hand rash?
A hand rash, also called hand dermatitis or hand eczema, may be caused by many things.

Hand rashes are extremely common. Many people start with dry, chapped hands that later become patchy, red, scaly, and inflamed. Numerous items can irritate skin. These include overexposure to water, too much dry air, soaps, detergents, solvents, cleaning agents, chemicals, rubber gloves, and even ingredients in skin and personal care products. Once skin becomes red and dry, even so-called "harmless" things like water and baby products can irritate the rash, making it worse. Your doctor will try to find out what substance in your everyday routine could be causing or contributing to the problem. Often your skin will get better by changing products or avoiding an ingredient completely.

Atopic eczema
A tendency to get skin reactions is often inherited. People with these tendencies may have a history of hay fever and/or asthma. They may also have food allergies and a skin condition called atopic dermatitis or eczema. Their skin can turn red, and itch, indicating an allergy, after contact with many substances that might not bother other people's skin.

Finding the culprit
Your dermatologist will work with you to uncover and identify the possible causes of a hand rash. Could it be irritation? Could it be an allergy? Like a detective, your dermatologist will ask many questions. These may include information about previous rashes, whether you have any history of hay fever or asthma, or any other medical problems. The dermatologist will also want to know what kinds of things your hands are exposed to all day long, what creams or lotions you apply to your skin, and whether or not you wear gloves. The doctor may examine your hands, feet, and the rest of your skin to determine what's causing the rash. Your doctor may order special tests to see if you have a skin infection or other problems. Your dermatologist may do a skin scraping and a microscope exam while you wait in the office. Most of the causes usually fall into one of three types: an externally triggered "contact" rash, an internally generated skin reaction, or a fungal infection.

If your doctor suspects the rash is due to an allergy to some external substance, a patch test may be done. This involves testing the skin on your arms or back to see what specific ingredients might be causing your skin to react. If so, you will receive a list of products that contain these ingredients.

How are hand rashes treated?
Your dermatologist may offer a combination of methods to heal your skin. It is possible you may need an oral antibiotic if an infection is present. Medicated ointment or cream may also be prescribed. Be certain not to use this in combination with other hand creams unless your doctor approves. If the prescribed cream doesn't seem to be helping, tell your doctor right away. You can speed up the healing process by keeping your hands away from other irritants. Discuss with your doctor what to avoid while your skin is healing.

Is hand protection really important?
It may take months for your hands to be normal. Regardless of the cause of your rash, you'll want your hands to heal and to stay healthy. There are ways to pamper them now, and in the future, to lessen the chance of getting a rash again:

Protect hands against soaps, cleansers, and other chemicals by wearing vinyl gloves - available at local grocery stores and pharmacies. Have four or five pairs and keep them in the kitchen, bathroom, nursery, and laundry areas. Have other pairs for non-wet housework and gardening. Avoid rubber/latex gloves since many people are sensitive to them. Always replace any gloves that develop holes. Dry out gloves between cleaning jobs. Wear your gloves even when folding laundry, peeling vegetables, or handling citrus fruits or tomatoes.
Use an automatic dishwasher as much as possible. Avoid hand washing dishes or clothes as much as you can.
When you wash your hands, use lukewarm water and very little soap. Remove rings whenever washing or working with your hands because they trap soap and moisture next to skin.
When outdoors in cool weather, wear unlined leather gloves to prevent dry and chapped skin. Always use a dermatologist recommended product to keep your hands soft and supple. Apply it as many times a day as you need it.
If the type of work you do is affecting your hands, talk to your supervisor about ways that you and other employees can better protect their skin.
Hand eczema is not contagious. Although some fungal infections may look like eczema, it is important to have your rash checked by a dermatologist who can do the appropriate testing. Hand rashes sometimes temporarily look worse while they are healing - and sometimes rashes just come back. Try to remember which substance or what activity triggered the recent "flare-up." Let your doctor know about it. Since many hand rashes can be stubborn, it's important to keep up with your medication, stay in contact with your doctor, and not get discouraged.

Hair has been called our "crowning glory." Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper hair care result in excessive hair loss. People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining the scalp and hair, the dermatologist may check a few hairs under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It's important to find the cause and whether or not the problem will respond to medical treatment.

Normal Hair Growth
About 90 percent of the hair on a person's scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair is in a resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000 hairs) or redheads (90,000 hairs). Most hair shedding is due to the normal hair cycle, and losing 50-to-100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

Causes of Excessive Hair Loss
Improper Hair Cosmetic Use/Improper Hair Care - Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it's best to stop until the hair has grown out.

Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. The constant pull causes some hair loss, especially along the sides of the scalp.

Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Don't follow the old rule of 100 brush strokes a day-that damages hair. Instead, use wide toothed combs and brushes with smooth tips.

Hereditary Thinning or Balding - Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family.

Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties. There is no cure, although medical treatments have recently become available that may help some people. One treatment involves applying a lotion, minoxidil, to the scalp twice a day. Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of the active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly.

Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia Areata - In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age.

The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.

Childbirth - When a women is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.

High Fever, Severe Infection, Severe Flu - Illnesses may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.

Thyroid Disease - Both an over-active thyroid and an under-active thyroid can cause hair loss. Your physician can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.

Inadequate Protein in Diet - Some people who go on crash diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.

Medications - Some prescription drugs may cause temporary hair shedding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinner. High doses of vitamin A may also cause hair shedding.

Cancer Treatments - Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.

Birth Control Pills - Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a women stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.

Low Serum Iron - Iron deficiency occasionally produces hair loss. Some people don't have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.

Major Surgery/Chronic Illness - Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.

Fungus Infection (Ringworm) of the Scalp - Caused by a fungus infection, ringworm (which has nothing to do with worms) begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.

Hair Pulling (Trichotillomania) - Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

Questions?
See your dermatologist - Excess hair loss can have many different causes. Hair will regrow spontaneously in some forms of hair loss. Other forms can be treated successfully by a dermatologist. For the several forms of hair loss for which there is no cure at present, there is research in progress that holds promise for the future.

Urticaria - Hives


Hives, or "wheals", are pale red swellings of skin that occur in groups on any part of the skin. Urticaria is the medical word for hives. Each hive lasts a few hours before fading without a trace. New areas may develop as old areas fade. They can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. Hives usually are itchy, but may also burn or sting.

Hives are formed by blood plasma leaking out of small blood vessels in the skin. This is caused by the release of a chemical called histamine. Histamine is released from cells called "mast cells" that lie along the blood vessels in the skin. Allergic reactions, chemicals in foods, or medications can cause histamine release. Sometimes it's impossible to find out why hives are forming.

Hives are very common - 10-20 percent of the population will have at least one episode in their lifetime. Most episodes of hives disappear quickly in a few days to a few weeks. Occasionally, a person will continue to have hives for many years.

When hives form around the eyes, lips, or genitals, the tissue may swell excessively. Although frightening, the swelling usually goes away in less than 24 hours. However, if you have difficulty breathing or swallowing you should go to the emergency room.

Acute Urticaria
Hives lasting less than six weeks are called "acute urticaria." With this type of hives, the cause can usually be found. The most common causes are foods, drugs, or infections. Insect bites and internal disease may also be responsible. Other causes can be pressure, cold, or sunlight.

Foods
The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries, and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also cause hives.

Hives may appear within minutes or up to two hours after eating, depending on where the food is absorbed in the digestive tract.

Drugs
Almost any prescription or over-the-counter medication can cause hives. Some of those drugs include antibiotics, pain medications, sedatives, tranquilizers, and diuretics (fluid pills). Diet supplements, antacids, arthritis medication, vitamins, eye and eardrops, laxatives, vaginal douches, or any other non-prescription item can be a potential cause of hives. If you have an attack of hives, it's important to tell your doctor about all of the preparations that you use to assist in finding the cause.

Infections
Many infections can cause hives. Colds are a common cause of hives in children.

Chronic Urticaria
Hives lasting more than six weeks are called "chronic urticaria". The cause of this type of hives is usually much more difficult to identify than that of acute urticaria. In patients with chronic urticaria, the cause is found in only a small number of patients. Your doctor will need to ask many questions in an attempt to find the possible cause. Since there are no specific tests for hives, testing will depend on your medical history and a thorough examination by your dermatologist.

Physical Urticarias
Hives can be caused by sunlight, heat, cold, pressure, vibration, or exercise. Hives due to sunlight are called solar urticaria. This is a rare disorder in which hives form on exposed areas within minutes of sun exposure and fade within one to two hours. Hives due to the cold are more common. These appear when the skin is warmed after exposure to cold. If the cold has affected large areas of the body, large amounts of histamine may be released which can produce wheezing, flushing, generalized hives, and fainting.

Dermatographic Urticaria
Hives that form after firmly stroking or scratching the skin are called "dermatographism". It affects about 5 percent of the population. Most people with this condition are otherwise healthy. These hives can also occur along with other forms of urticaria. They may typically appear in young women and last for months or even years.

Treatment
The best treatment for hives is to find and remove the cause. This is not an easy task and often not possible. Antihistamines are usually prescribed by your dermatologist to provide relief. Antihistamines work best if taken on a regular schedule to prevent hives from forming. No one antihistamine works best for everyone, so your dermatologist may need to try more than one or different combinations to find what works best for you. In severe hives, an injection of epinephrine (adrenalin) or a cortisone medication may be needed.

What is molluscum contagiosum?
Molluscum contagiosum is a common non-cancerous skin growth caused by a viral infection in the top layers of the skin. They are similar to warts, but are caused by a different virus. The name molluscum contagiosum implies that the virus and the growths are easily spread by skin contact. The virus that causes molluscum contagiosum belongs to a family of viruses called poxviruses. This virus can enter through small breaks in the skin or hair follicles and can lead to the development of the molluscum lesions. It does not effect any internal organs.

What do molluscum look like?
Molluscum are usually small flesh-colored or pink dome-shaped growths. They may appear shiny and have a small indentation in the center. Molluscum are often found in clusters on the skin of the chest, abdomen, arms, groin or buttock. They can also involve the face and eyelids. Because they can be spread by skin-to-skin contact, molluscum are usually found in areas of skin that touch each other such as the folds in the arm or in the groin. Often the molluscum may become red or inflamed. This tends to occur just before the growth is ready to go away on its own. Sometimes, the dermatologist might scrape some cells from the lesion and look at these under the microscope to confirm the diagnosis of molluscum. In people with diseases of the immune system, the molluscum may be very large in size and may involve the face.

How do you get molluscum?
The molluscum virus is transmitted from the skin of one person who has these growths to the skin of another person. Molluscum occur most often in cases where skin-to-skin contact is frequent. They often occur in young children, especially among siblings. Molluscum can also be sexually transmitted if growths are present in the genital area. It is also possible, but less likely to acquire the molluscum virus from non-living objects. Molluscum may be spread between children in swimming pools.

Why do some people get molluscum and others don't?
People that are exposed more often to the molluscum virus through skin-to-skin contact, have an increased risk of developing these lesions. It is common in young children who have not yet developed immunity to the virus. Children tend to get molluscum more than adults do. Molluscum also seems to be more common in tropical climates as warmth and humidity tend to favor the growth of the virus. People with HIV infections are more susceptible to acquiring molluscum.

Do molluscum need to be treated?
Many dermatologist advise treating molluscum because they spread. However, molluscum will eventually go away on their own without leaving a scar. Because the growths are easily spread from one area of the skin to another, some growths may appear as others are going away. It may take from 6 months up to 5 years for all of the molluscum to go away on their own. They may be more persistent in people with a weakened immune system.

How do dermatologists treat molluscum?
Molluscum are treated in the same ways that warts are treated. They can be frozen with liquid nitrogen, destroyed with various acids or blistering solutions, treated with an electric needle (electrocautery), scraped off with a sharp instrument (curette), treated daily with a home application of a topical retinoid cream or gel, with a topical immune modifier, or with a topical anti-viral medication. Laser therapy has also been found to be effective in treating molluscum. Some discomfort is associated with freezing, scraping, the electric needle and laser therapy. Often these procedures are reserved for older children and adults. If there are many growths, multiple treatment sessions may be needed every 3 to 6 weeks until the growths are gone. It is also an option, especially with young children, not to treat, and to wait for the growths to go away on their own.

What if the molluscum come back after treatment?
It is always possible for a person's skin to get infected again with the molluscum virus. The condition may be easier to control if treatment is started when there are only a few growths. The fewer the growths, the better the chance for stopping their spread.

Is there any research going on about molluscum?
New drugs are being developed to treat viral infections. Molluscum infection has improved in some patients with AIDS who were taking certain antiviral drugs. If new and effective antiviral drugs can be developed in a topical form, perhaps they may be of benefit in the treatment of molluscum in the future.

Did you know that the way your fingernails and toenails look tell a doctor a lot about your health? That's why, when you have a physical exam, your doctor looks at them closely.
Why are nails so important?
Not only are nails nice to look at, they also help us pick things up. (Think how hard it would be to pick a dime up off a table without them!) They also help to support the skin underneath our fingers and toes.

Nail problems and solutions.
Sometimes, no matter how well we take care of our nails, something goes wrong. But the good news is that your skin doctor (dermatologist) can take care of most nail problems easily. Here are a few common nail conditions and what you can do about them.

Ingrown nails. Ouch! If you touch the tip of your big toe and it makes you flinch, you may have an ingrown toenail. Lots of people have them, especially on their big toes. (You'll notice that the skin around the tip of the nail is also red and swollen.) You might get an ingrown toenail if you trim your toenails at an angle or wear shoes that are too tight. It's best to see a dermatologist if you have an ingrown toenail, because you may get an infection if you try to cut the nail out yourself.

Fungal infections. If you've ever seen someone with a dark, thick toenail, you've probably seen someone with a fungal infection. These types of infections (which are more common in toenails than fingernails) often separate the tip of the toenail from the skin on your toe. And sometimes white, green, yellow or black "gunk" builds up under the nail, making the nail look dark. People get fungal infections in their toenails because funguses like to grow where it's warm and moist (like inside your shoes). Your dermatologist may treat the fungus with pills or lotions.

What is perioral dermatitis?
Perioral dermatitis is a common skin problem that mostly affects young women. Occasionally men or children are affected. Perioral refers to the area around the mouth, and dermatitis indicates redness of the skin. In addition to redness, there are usually small red bumps or even pus bumps and mild peeling. Sometimes the bumps are the most obvious feature, and the disease can look a lot like acne. The areas most affected are within the borders of the lines from the nose to the sides of the lips, and the chin. There is frequent sparing of a small band of skin that borders the lips. Occasionally, the areas around the nose, eyes, and cheeks can be affected. Sometimes there is mild itching and/or burning.

How long does it last?
If not treated, perioral dermatitis may last for months to years. Even if treated, the condition may recur several times, but usually the disorder does not return after successful treatment.

What causes perioral dermatitis?
The cause of perioral dermatitis is unknown. But some dermatologists believe it is a form of rosacea or sunlight-worsened seborrheic dermatitis. Strong corticosteroid creams applied to the face can cause perioral dermatitis. Once perioral dermatitis develops, corticosteroid creams seem to help, but the disorder reappears when treatment is stopped. In fact perioral dermatits usually comes back even worse than it was before use of steroid creams. Some types of makeup, moisturizers, and dental products may be partially responsible.

Can it be prevented?
There is no guaranteed way to prevent perioral dermatitis. Do not use strong prescription strength corticosteroid creams on the face. Your dermatologist may have suggestions about the use of moisturizers, cosmetics, and sunscreens and may advise against using toothpaste with fluoride, tartar control ingredients, or cinnamon flavoring.

Are laboratory tests needed to diagnose the problem?
Most of the time, no tests are necessary. A dermatologist can usually make an accurate diagnosis by just examining the skin. Sometimes, scraping or a biopsy of the skin is done. Occasionally, blood tests are ordered to eliminate other conditions that can look similar.

How is this condition treated?
An oral antibiotic, like tetracycline, is the most common treatment for perioral dermatitis. Treatment may be needed for several months to prevent recurrence. For milder cases or pregnant women, topical antibiotic creams may be used. Occasionally, your dermatologist may recommend a specific corticosteroid cream, just for a short time to help your appearance while the antibiotics are working.

What can be expected with treatment?
Most patients improve with two months of oral antibiotics. If corticosteroid creams were used for treatment, there may be a brief flare-up when the creams are stopped. If antibiotic treatment is stopped too early however, the problem can come back.

Pityriasis rosea (Pit-ih-RYE-ah-sis Ro-ZEA) is a rash that can occur at any age but it occurs most commonly in people between the ages of 10 and 35 years. The rash can last from several weeks to several months. Usually there are no permanent marks as a result of this disease, although some darker-skinned persons may develop long-lasting flat brown spots that eventually fade.

What are the signs and symptoms of this disease?
The condition often begins as a large single pink patch on the chest or back. This patch may be scaly and is called a "herald" or "mother" patch. Often the person with this condition will think this patch is a ringworm and will apply creams that are used to get rid of fungus. This will not help since the rash is not caused by a fungus.

Within a week or two, more pink patches, sometimes hundreds of them, appear on the body and on the arms and legs. Patches may also occur on the neck, and though rare, the face. These spots usually are smaller than the "herald" patch and may also be mistaken for ringworm. The patches are oval and often form a pattern over the back that resembles the outline of a Christmas tree. Sometimes the disease can produce a more severe and wide-spread skin eruption. About half the patients will have some itching, especially when they become overheated.

Occasionally there may be other symptoms, including tiredness and aching. The rash usually fades and disappears within six to eight weeks, but can sometimes last much longer. Physical activity-like jogging and running, or bathing in hot water may cause the rash to temporarily worsen or reappear. In some cases, the patches will reappear up to several weeks after the first episode and can continue for many months.

What is the cause of this skin disorder?
The cause is unknown. It is not caused by a fungus or bacteria. It also is not due to any type of allergy. Pityriasis rosea is not a sign of any internal disease.

A virus may cause this rash. Like other known viral diseases, pityriasis rosea usually occurs only once in an individual, and occasionally makes a person feel slightly ill. But the virus theory has not been proven. Unlike many viruses, however, pityriasis rosea does not seem to spread from person to person.

How is it diagnosed?
Diagnosis is usually made by a dermatologist, a physician with special training in skin diseases. Pityriasis rosea usually affects the back, neck, chest, abdomen and upper arms and legs. The rash may differ from person to person, making the diagnosis more difficult. The numbers and sizes of the spots can also vary and occasionally the rash can be found in an unusual location, such as the lower body or on the face. Fungus infections, like ringworm, may resemble this rash. Reactions to certain medications, such as antibiotics, "water pills" and heart medications can also look the same as pityriasis rosea.

The dermatologist may order blood tests, scrape the skin, or take a sample from one of the spots (skin biopsy) and examine it under a microscope to make the diagnosis.

What is the treatment?
Treatment may include external or internal medications for itching. Soothing medicated lotions and lubricants may be prescribed. Lukewarm rather than hot baths may be suggested. Strenuous activity that could aggravate the rash should be avoided. Ultraviolet light treatments given under the supervision of a dermatologist may be helpful.

Occasionally anti-inflammatory medications such as corticosteriods may be necessary to stop itching or make the rash go away. Patients should be reassured that this disease is not a dangerous skin condition even if it occurs during pregnancy.

Remember that pityriasis rosea is a common skin disorder and is usually mild. Most cases usually do not need treatment and fortunately even the most severe cases eventually go away.

Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back.

In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Doctors can help even the most severe cases.

Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

What Causes Psoriasis?
The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.

People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.

Types of Psoriasis
Psoriasis comes in many forms. Each differs in severity, duration, location, and in the shape and pattern of the scales. The most common form begins with little red bumps. Gradually these grow larger and scales form. While the top scales flake off easily and often, scales below the surface stick together. When they are removed, the tender, exposed skin bleeds. These small red areas then grow, sometimes becoming quite large.

Elbows, knees, groin and genitals, arms, legs, palms and soles, scalp and face, body folds and nails are the areas most commonly affected by psoriasis. It will often appear in the same place on both sides of the body.
Nails with psoriasis have tiny pits on them. Nails may loosen, thicken or crumble and are difficult to treat.

Inverse psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks, and genitals.

Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with many small, red, drop-like, scaly spots appearing on the skin. It often clears up by itself in weeks or a few months.

Up to 30% of people with psoriasis may have symptoms of arthritis and 5-10% may have some functional disability from arthritis of various joints. In some people, the arthritis is worse when the skin is very involved. Sometimes the arthritis improves when the condition of the patient's skin improves.

How Is Psoriasis Diagnosed?
Dermatologists diagnose psoriasis by examining the skin, nails, and scalp. If the diagnosis is in doubt, a skin biopsy may be helpful.

How Is Psoriasis Treated?
The goal is to reduce inflammation and to control shedding of the skin. Moisturizing creams and lotions loosen scales and help control itching. Special diets have not been successful in treating psoriasis, except in isolated cases.

Treatment is based on a patient's health, age, lifestyle, and the severity of the psoriasis. Different types of treatments and several visits to the dermatologist may be needed.

The doctor may prescribe medications to apply on the skin containing cortisone-like compounds, synthetic vitamin D, tar, or anthralin. These may be used in combination with natural sunlight or ultraviolet light. The most severe forms of psoriasis may require oral medications, with or without light treatment.

Sunlight exposure helps the majority of people with psoriasis but it must be used cautiously. Ultraviolet light therapy may be given in a dermatologist's office, a psoriasis center or a hospital.

Types of Treatment
Steroids (Cortisone) - Cortisone creams, ointments, and lotions may clear the skin temporarily and control the condition in many patients. Weaker preparations should be used on more sensitive areas of the body such as the genitals, groin, and face. Stronger preparations will usually be needed to control lesions on the scalp, elbow, knees, palms and soles, and parts of the torso and may need to be applied under dressings. These must be used cautiously and with the dermatologist's instruction. Side effects of the stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, and skin color changes. Stopping these medications suddenly may result in a flare-up of the disease. After many months of treatment, the psoriasis may become resistant to the steroid preparations.

The dermatologist may inject cortisone in difficult-to-treat spots. These injections must be used in very small amounts to avoid side effects.

Scalp Treatment - The treatment for psoriasis of the scalp depends on the seriousness of the disease, hair length, and the patient's lifestyle. A variety of non-prescription and prescription shampoos, oils, solutions, and sprays are available. Most contain coal tar or cortisone. The patient must take care to avoid harsh shampooing and scratching the scalp.

Anthralin - a medication that works well on tough-to-treat thick patches of psoriasis. It can cause irritation and temporary staining of the skin and clothes. Newer preparations and methods of treatment have lessened these side effects.

Vitamin D - A synthetic Vitamin D, calcipotriene, is now available in prescription form. It is useful for individuals with localized psoriasis and can be used with other treatments. Limited amounts should be used to avoid side effects. Ordinary Vitamin D, as one would buy in a drug store or health food store, is of no value in treating psoriasis.

Retinoids - Prescription vitamin A-related gels may be used alone or in combination with topical steroids for treatment of localized psoriasis. Women who are or may become pregnant should not use topical retinoids.

Coal Tar - For more than l00 years, coal tar has been used to treat psoriasis. Today's products are greatly improved and less messy. Stronger prescriptions can be made to treat difficult areas.

Goeckerman Treatment - named after the Mayo Clinic dermatologist who first reported it in 1925. Combining coal tar dressings and ultraviolet light, it is used for patients with severe psoriasis. The treatment is performed daily in specialized centers. Ultraviolet exposure times vary with the kind of psoriasis and the sensitivity of the patient's skin.

Light Therapy - Sunlight and ultraviolet light slow the rapid growth of skin cells. Although ultraviolet light or sunlight can cause skin wrinkling, eye damage, and skin cancer, light treatment is safe and effective under a doctor's care. People with psoriasis all over their bodies may require treatment in a medically approved center equipped with light boxes for full body exposure. Psoriasis patients who live in warm climates may be directed to carefully sunbathe. Seek the advice of a dermatologist before self-treating with natural or artificial sunlight.

PUVA - When psoriasis has not responded to other treatments or is widespread, PUVA is effective in 85 to 90 percent of cases. The treatment name comes from "Psoralen + UVA," the two factors involved. Patients are given a drug called Psoralen, then are exposed to a carefully measured amount of a special form of ultraviolet (UVA) light. It takes approximately 25 treatments, over a two- or three-month period, before clearing occurs. About 30-40 treatments a year are usually required to keep the psoriasis under control. Because Psoralen remains in the lens of the eye, patients must wear UVA blocking eyeglasses when exposed to sunlight from the time of exposure to Psoralen until sunset that day. PUVA treatments over a long period increase the risk of skin aging, freckling, and skin cancer. Dermatologists and their staff must monitor PUVA treatment very carefully.

Methotrexate - an oral anti-cancer drug that can produce dramatic clearing of psoriasis when other treatments have failed. Because it can produce side effects, particularly liver disease, regular blood tests are performed. Chest x-rays and occasional liver biopsies may be required. Other side effects include upset stomach, nausea and dizziness.

Retinoids - Prescription oral vitamin A-related drugs may be prescribed alone or in combination with ultraviolet light for severe cases of psoriasis. Side effects include dryness of the skin, lips and eyes, elevation of fat levels in the blood, and formation of tiny bone spurs. Oral retinoids should not be used by pregnant women or women of childbearing age who intended to become pregnant during or within 3 years of discontinuation of therapy, as birth defects may result. Close monitoring is required together with regular blood tests.

Cyclosporine - an immunosuppressant drug used to prevent rejection of transplanted organs (liver, kidneys). It is used for treatment of widespread psoriasis when other methods have failed. Because of potential effects on the kidneys and blood pressure, close medical monitoring is required together with regular blood tests.

New Therapies Under Investigation
The above treatments alone or in combination can clear or greatly improve psoriasis in most cases, but no treatment permanently "cures" it. Dermatologists and other researchers are continually testing new drugs and treatments.

For more free information on psoriasis please contact The National Psoriasis Foundation (800) 723-9166, www.psoriasis.org , or email: getinfo@npfusa.org .

A tiny mite has infested humans for at least 2,500 years. It is often hard to detect and causes a fierce, itchy skin condition known as scabies. 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. But there is good news: with better detection methods and treatments, scabies need not cause more than temporary distress.

More than an Itch: How Scabies Develops
The microscopic mite that causes scabies can barely be seen by the human eye. A tiny, eight-legged creature with a round body, the mite burrows within the skin. Within several weeks the patient develops an allergic reaction. This results in 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. Dermatologists, who frequently treat patients with scabies, point out that scabies is not a condition only of low-income families, neglected children, or poor hygiene. Although, more prominent in crowded living conditions, and poor hygiene - everyone is susceptible.

Scabies skin mite is about 0.4mm, just visible to the human eye

Attracted to warmth and odor, the female mite burrows into the skin, lays eggs, and produces secretions 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 up to 24 hours. It may be up to a month before a newly infested 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. Early on, 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. These areas include between the fingers, on the elbows or wrists, buttocks or belt line, around the nipples, and on the penis. Mites also tend to hide in, or on, the skin under rings, bracelets or watchbands, or under the nails. In children, the infestation may involve the entire body, including the palms, soles, and scalp. The child may be tired and irritable as a result of loss of sleep from itching or scratching all night long.

Bacterial infection may occur secondarily with scabies due to scratching. In many cases, children are treated because of infected skin lesions rather than for the scabies itself. Although treatment of bacterial infections sometimes provides relief, recurrence is almost certain if the scabies infection is not treated.

Crusted Scabies
Crusted scabies is a form of the disease in which the symptoms are far more severe than usual. Large areas of the body, including hands and feet, may be scaly and crusted. These crusts hide thousands of live mites and their eggs, making treatment difficult because medications applied directly to the skin may not be able to penetrate the thickened skin. This type of scabies occurs mostly among the elderly, in some AIDS patients, or in people whose immunity is decreased. These cases are extremely infectious.

Diagnosis
A thorough head-to-toe examination in good lighting, with careful attention to skin crevices, will usually be recommended and performed at your dermatologist's office.

Many cases of scabies can be diagnosed by dermatologists without special tests. To confirm scabies your dermatologist can perform a painless test that involves applying a drop of oil to the suspected lesion. The site is then scraped and transferred to a glass slide which is then examined using a microscope. A diagnosis is made by finding scabies mites or their eggs.

Who is most at risk?
Scabies is most common in those who have close physical contact with others, particularly children, mothers of young children, and elderly people in nursing homes.

All in the family - Studies of families have shown that children under two years of age are most at risk, followed by mothers and older female siblings, and then by other family members who have frequent and close physical contact.

Among the elderly - Scabies among resident patients of nursing homes and extended care facilities has become a common problem due to delayed diagnosis since it can often be mistaken for other skin conditions. The delay allows time for scabies to spread to nursing home staff and other residents. Because residents require assistance in daily living activities, this intimate exposure provides an opportunity for the scabies mite to spread.

Getting Rid of Scabies
Scabies is easy and quick to treat with prescription drugs: 5 percent permethrin cream is applied to the skin from head-to-toe 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, soles of the feet, groin, under finger nails, and the scalp in small children) and left on for 8 to 14 hours. A second treatment one week later may be recommended for infants with scabies of the palms and soles, or if new lesions appear after treatment. The only reported side effect of 5 percent permethrin cream is a mild, temporary burning and stinging, particularly in bad cases of scabies. All lesions should be healed within four weeks after the treatment. If a patient continues to have trouble, he or she may be getting reinfested and require further evaluation and treatment by a dermatologist.

Another effective prescription treatment is 1 percent lindane lotion. Also an overnight treatment, lindane is effective after 1 to 2 doses. Patients using lindane are instructed to wash the lotion off after 8 to 12 hours, not to exceed recommended doses, and to avoid a second treatment within a 7-day period.

Lindane should not be used on infants, small children, pregnant or nursing women, or people with seizures or other neurological diseases.

Sulfur ointment and Crotamiton cream are other special care treatment options.

(Note: Antihistamines may be prescribed to relieve itching, which can last for weeks.)

Ivermectin is an oral medicine which may be prescribed for certain cases of scabies, especially the difficult to treat crusted form. Like lindane, it is not for use by infants or pregnant women.

The critical factor in the treatment of scabies is getting rid of the mite. Each individual in the family or group, whether itching or not, should be treated. The entire community at risk must be treated to stop an epidemic of scabies.

In a family, all members should be treated at the same time, as well as others who are in close contact, such as close friends, and sometimes day care or school classmates. Scabies in institutions can be kept to manageable levels by routinely examining patients and conducting thorough skin exams of all new residents. The most successful, cost-effective approach is to treat all patients and health care personnel at the same time. Bedding and clothing must be washed or dry-cleaned.

Successful eradication of this infestation requires the following:

See a dermatologist as soon as possible to begin treatment. Remember, although you may be disturbed at the thought of bugs, scabies is no reflection on your personal cleanliness.
Treat all exposed individuals whether obviously infested or not. Incubation time is 6-8 weeks so symptoms may not show up for a while. If you do not treat everyone, it is as if you were never treated.
Apply treatment to all skin from neck to toes. If you wash your hands after application, you need to reapply the medication to your hands again.
Wash all personal items. The mite is attracted to scent. Any clean clothes hanging in the closet or folded in the drawers are ok. Do all the laundry.
Items you do not wish to wash may be placed in the dryer on the hot cycle for 30 minutes.
Items may be dry-cleaned.
Rid or R&C spray may be used on items not laundered such as belts, shoes, purses, etc.
Pets do not need to be treated.
Carpets or upholstery do not need to be treated, though, some people will spray heavily on traffic areas.
Itching may persist for two or more weeks after successful eradication of the mite.
Items may also be placed in plastic bag and placed in the garage for two weeks. If the mites do not get a meal within one week, they die.
Vacuum the entire house and discard the bag, just to be on the safe side.
What Not to Do
Don't attempt to treat scabies with home remedies. Scrubbing with laundry detergent or hard soaps, or applying kerosene will only make the condition much worse.
Don't use steroids or any other creams unless prescribed by a dermatologist.
Don't repeat the treatment more than twice unless specifically instructed by a dermatologist.

Who doesn't love to spend time playing in the sunshine? We all do! If you spend too much time in the sun, though (especially if you're not wearing sunscreen), you could be at risk for getting skin cancer. Most people think that "cancer" is a scary word. But your doctor can treat and cure most types of skin cancer, as long as you catch it early. Remember it's important to use sunscreen when you're outside, avoid the mid-day sun, cover up, and to check your skin for changes every month or two. Here's what you need to know about skin cancer, and how to give yourself a great skin exam to prevent it.

The three types of skin cancer.
Each of the three different kinds of skin cancer looks a little different. Some are red and blotchy sores, other types look like clear bumps.

Basal cell carcinoma.
Basal cell carcinoma is the most common skin cancer. If you catch it early, it's very likely that your doctor can cure it.
What it looks like. A pearly bump that sometimes won't heal. It can also look like a sore that won't heal.
Who could get it. Anyone can get basal cell carcinoma, especially those people who have been out in the sun a lot.
How it's treated. Your dermatologist can remove a basal cell carcinoma usually with a simple office procedure.

Squamous cell carcinoma.
Squamous cell carcinoma is the second-most common skin cancer. It is also likely that your doctor can cure it if you find it early. But squamous cell carcinoma can spread (and some people die from it if it spreads) if you don't treat it early.
What it looks like. A crusty, scaly patch with a hard surface.
Who could get it. Anyone can get squamous cell carcinoma, especially those people who have been out in the sun a lot.
How it's treated. Your dermatologist can remove this kind of skin cancer usually with a simple office procedure.

Melanoma.
Although melanoma is the least common type of skin cancer, it is the most dangerous. People can die from melanoma. If you have a family history of this skin cancer, you could get it even if you've never been out in the sun.
What it looks like. Usually a dark mole, sometimes with an uneven edge. The color and size may change as time passes.
Who could get it. Anyone-especially those with fair skin, people who have had lots of blistering sunburns when they were kids, or people with a family history of melanoma.
How it's treated. A dermatologist cuts the cancer out of your skin. (If the cancer is caught early, the dermatologist will need to cut away less skin.) If the cancer has spread, you may need other treatments, too.

The perfect skin exam.
We know that finding skin changes early can help dermatologists cure skin cancer. One way to keep track of skin changes is to give yourself an exam every couple of months. You'll want to look for growing, bleeding, crusting, or other changing spots on your skin. (If you see these or other unusual skin changes, see your dermatologist as soon as possible. But don't worry-The changes don't always mean skin cancer.)

Sometimes it's easier to do a good skin exam if you have someone with you (they can see places on your body that you can't see). Whether you have someone help you or not, though, it's easy to do a skin self-exam if you follow these steps.

You'll need:
* a full-length mirror
* a hand-held mirror

Without any mirror, check:
* the tops of your feet and between toes
* your palms and your hands

In the full-length mirror, check:
* where your hair parts, your face, neck, chest, underarms, elbows, belly, and the fronts of your legs \


With the full-length and hand-held mirror (or with someone's help), check:
* your back, the back of your neck, legs, and your buttocks

With just the hand-held mirror, check:
* the soles of your feet
* your genital area

Are you at risk?
Some people get skin cancer even if they've never spent time in the sun. You need to be especially careful to check your skin if you:
* have light hair and skin
* freckle and burn easily
* have a family member who's had skin cancer
* spent a lot of time in the sun throughout your life
* had blistering sunburns as a youngster
* have blue, green or gray eyes

It's okay to have fun playing in the sun as long as you protect yourself. How do you do it?

Watch the clock. Stay out of the sun from 10 a.m. to 4 p.m., when the sun's rays are strongest.

Make it a routine. Use a broad-spectrum sunscreen every day.

Choose SPF 15. Whenever you go out, use a sunscreen with a SPF of 15 or higher.

Reapply. If you're out in the sun between 10 and 4, make sure you slather on more sunscreen (even the waterproof kind) every 2 hours.

Seek shade. Play in the shade whenever you can.

Watch out for the pool. Try to stay away from swimming pools and snow, which reflect the sunlight. (Reflected light can burn your skin even faster.)

Cover up. Wear long pants and shirts with sleeves. If the sun can't get to you, it can't hurt your skin!

Wear a hat. Choose one with a wide (4-inch) brim to protect your face and neck.

What to look for in your next bottle of sunscreen.
If there's one thing dermatologists would like you to know it's this: Use a sunscreen everyday. It's a lot easier to choose (and use) a sunscreen if you know what to look for. Keep your eyes open for these words on your next bottle of sunscreen:

SPF (Sun Protection Factor).
You should use an SPF 15 sunscreen every day, since that number would block most of the sun's rays. (If you'll be out in the sun for more than an hour, though, use an SPF 30.) If you'll be sweating a lot, you may want to use an SPF 30 on your face no matter what, because the sweat will thin it down to an SPF 15 fast!

PABA or PABA-free.
PABA (short for para-aminobenzoic acid) is used in many sunscreens. It works well, but some people are allergic to it. If you're allergic to PABA, use a PABA-free sunscreen instead.

Broad spectrum.
The sun shoots off two different rays that affect your skin: UVA and UVB.
UVA rays make your skin wrinkle and may cause skin cancer. UVB rays burn. A broad-spectrum sunscreen helps protect your skin from both rays.

Waterproof
Waterproof sunscreens aren't just important when you're swimming and windsurfing-they also stay on longer when you sweat. So if you're active, in or out of the water, a waterproof product may be right for you.

Lotion, cream or gel.
The type of sunscreen you choose depends on which you like best. You may want to use a cream on your face, since gels can sting around your eyes. If you have acne, try a light texture sunscreen first. (Apply a thick layer, so it will protect you better.)

If you have acne, a waterproof sunscreen could make your skin break out. Try re-applying your regular sunscreen more often, instead.

Vitiligo is a skin condition of white patches resulting from loss of pigment. Any part of the body may be affected. Usually both sides of the body are similarly affected by a few too many milky-white patches. Common areas of involvement are the face, lips, hands, arms, legs and genital areas.

Who Gets Vitiligo?
Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about one fifth have a family member with this condition. Most people with vitiligo are in good general health.

What Determines Skin Color?
Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white.

What Causes Vitiligo?
Vitiligo is the result of the disappearance of the skin’s melanocytes. No one knows why, but four main theories exist:

1. Abnormally functioning nerve cells may make toxic substances that injure melanocytes
2. The body’s immune system may destroy melanocytes. Researchers think pigment may be destroyed as the body responds to a substance it perceives as foreign.
3. Pigment-producing cells may self-destruct. While pigment is forming, toxic byproducts could be produced and destroy melanocytes.
4. There is a genetic defect that makes the melanocytes susceptible to injury.

How Does Vitiligo Develop?
The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo and suntanned skin in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment virtually everywhere. There is no way to predict how much pigment an individual will lose.

Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within each vitiligo patch. There may be different shades of pigment in a patch or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn't change, may continue indefinitely.

It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. While their skin is all one color, they still have vitiligo.

How is Vitiligo Treated?
Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals, avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable. The white skin of vitiligo has no natural protection from sun. These areas are very easily sunburned. A sunscreen with a SPF of at least 15 should be used on all areas of vitiligo not covered by clothing. Avoid the sun when it is most intense to avoid burns.

Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less noticeable. Waterproof cosmetics to match almost all skin colors are available at many large department stores. Stains that dye the skin can be used to dye the white patches to more closely match normal skin color. These stains gradually wear off. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams also slowly wears off. None of these change the disease, but they can improve appearance. Micropigmentation tatooing of small areas may be helpful.

If sunscreens and cover-ups are not satisfactory, your doctor may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are total, permanent cures.

Repigmentation Therapy
Topical Corticosteroids
Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist's care.

PUVA is a form of repigmentation therapy where a type of medication known as psoralen is given. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light call UVA. Special medical equipment is needed for this treatment. Sometimes, when vitiligo is very limited, psoralens can be applied to the skin before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50-70% chance of returning color on the face, trunk, and upper arms and upper legs. Hands and feet respond very poorly. Usually at least a year of twice weekly treatments are required. PUVA must be given under very close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day. This eye protection is needed to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women or in individuals with certain medical conditions.

Grafting - Transfer of skin from normal to white areas is a treatment available only in certain areas of the country and is useful for only a small group of vitiligo patients. It does not generally result in total return of pigment in treated areas.

Depigmentation Therapy
For some patients with severe involvement, the most practical treatment for vitiligo is to remove remaining pigment from normal skin and make the whole body an even white color. This is done with a chemical called monobenzylether of hydroquinone. This therapy takes about a year to complete. The pigment removal is permanent.

Treatment of Vitiligo in Children
Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored. PUVA is usually not recommended until after age 12, and then the risks and benefits of this treatment must be carefully weighed.

Is Vitiligo Curable?
Research is ongoing in vitiligo and it is hoped that new treatments will be developed. At this time, the exact cause of vitiligo is not known and although treatment is available, there is no single cure.

What are warts?
Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat and smooth. The appearance of a wart depends on where it is growing.

How many kinds of warts are there?
There are several different kinds of warts including:
* Common warts
* Foot (Plantar) warts
* Flat warts

Common warts - usually grow on the fingers, around the nails and on the backs of the hands. They are more common where skin has been broken, for example where fingernails are bitten or hangnails picked. These are often called "seed" warts because the blood vessels to the wart produce black dots that look like seeds.

Foot warts - are usually on the soles (plantar area) of the feet and are called plantar warts. When plantar warts grow in clusters they are known as mosaic warts. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Like common warts, these warts may have black dots. Plantar warts have a bad reputation because they can be painful, feeling like a stone in the shoe.

Flat warts - are smaller and smoother than other warts. They tend to grow in large numbers - 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are often found in the beard area in men and on the legs in women. Irritation from shaving probably accounts for this.

How do you get 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.

Why do some people get warts and others don't?
Some people get warts depending on how often they are exposed to the virus. Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails. Some people are just more likely to catch the wart virus than are others, just as some people catch colds very easily. Patients with a weakened immune system also are more prone to a wart virus infection.

Do warts need to be treated?
In children, warts can disappear without treatment over a period of several months to years. However, warts that are bothersome, painful, or rapidly multiplying should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat warts?
Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of wart.

Common warts - in young children can be treated at home by their parents on a daily basis by applying salicylic acid gel, solution or plaster. There is usually little discomfort but it can take many weeks of treatment to obtain favorable results. Treatment should be stopped at least temporarily if the wart becomes sore. Warts may also be treated by "painting" with cantharidin in the dermatologist's office. Cantharidin causes a blister to form under the wart. The dermatologist can then clip away the dead part of the wart in the blister roof in a week or so.

For adults and older children cryotherapy (freezing) is generally preferred. This treatment is not too painful and rarely results in scarring. However, repeat treatments at one to three week intervals are often necessary. Electrosurgery (burning) is another good alternative treatment. Laser treatment can also be used for resistant warts that have not responded to other therapies.

Foot warts - are difficult to treat because the bulk of the wart lies below the skin surface. 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. The dermatologist may recommend a change in footwear to reduce pressure on the wart and ways to keep the foot dry since moisture tends to allow warts to spread.

Flat warts - are often too numerous to treat with methods mentioned above. As a result, "peeling" methods using daily applications of salicylic acid, tretinoin, glycolic acid or other surface peeling preparations are often recommended. For some adults, periodic office treatments for surgical treatments are sometimes necessary.

What are some of the other treatments for warts?
There are several different lasers used for the treatment of warts. Laser therapy is used to destroy some types of warts. Lasers are more expensive and require the injection of a local anesthesia to numb the area treated.

Another treatment is to inject each wart with an anti-cancer drug called bleomycin. The injections may be painful and can have other side effects.

Immunotherapy, which attempts to use the body's own rejection system is another method of treatment. Several methods of immunotherapy are being used. With one method the patient is made allergic to a certain chemical which is then painted on the wart. A mild allergic reaction occurs around the treated warts, and may result in the disappearance of the warts.

Warts may also be injected with interferon, a treatment to boost the immune reaction and cause rejection of the wart.

Can I treat my own warts without seeing a doctor?
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.

What about the use of hypnosis or "folk" remedies?
Many people, patients and doctors alike, believe folk remedies and hypnosis are effective. Since warts, especially in children, may disappear without treatment, it's hard to know whether it was a folk remedy or just the passage of time that led to the cure. Since warts are generally harmless, there may be times when these treatments are appropriate. Medical treatments can always be used if necessary.

What about the problem of recurrent warts?
Sometimes it seems as if new warts appear as fast as old ones go away. This may happen because the old warts have shed virus into the surrounding skin before they were treated. In reality new "baby" warts are growing up around the original "mother" warts. The best way to limit this is to treat new warts as quickly as they develop so they have little time to shed virus into nearby skin. A check by your dermatologist can help assure the treated wart has resolved completely.

Is there any research going on about warts?
Research is moving along very rapidly. There is great interest in new treatments, as well as the development of a vaccine against warts. We hope there will be a solution to the annoying problem of warts in the not too distant future.

1. The following morning remove the Band-Aid.
2. Cleand the area with hydrogen peroxide.
3. Apply an antibiotic ointment: we prefer Polysporin or you can use Vaseline. **DO NOT USE NEOSPORIN**
4. Cover the site with a new Band-Aid.
5. Repeat daily for 1 week.
6. You may have some discomfort. Take Tylenol to relieve the pain and apply an ice pack.
7. You may be left with a scar. Scaring is usually minimal. If you are dissatisfied with the scar or if the scar becomes raised please schedule another appointment.

If you have not received a phone call or a card within one week with the results of your biopsy, please call the office at 706-235-7711 or toll free at 1-888-969-3376. Your specimen is being sent to Southeastern Pathology. They will bill you separately for the work they perform.

Address

103 John Maddox Drive
Rome, Ga 30165

100 Market Place Blvd. Suite 300
Cartersville, Ga 30121

Contact

Email: SkinCare@NWGADermatology.com
Rome: 706-235-7711
Fax: 706.235.9944

Cartersville: 770-334-8821

Monday thru Friday 8am to 5pm

(closed 12noon till 1:30pm each day)

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