Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Most adolescents and many adults, particularly women have acne at some point.
Acne is made up of two types of blemishes:
- Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face. As long as they remain uninfected, they are unlikely to lead to scarring.
- Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.
In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skin’s surface. If the pore’s opening is fully blocked, this produces a whitehead. If the pore’s opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflammed, they can become red pustules or papules. The acne bacteria moves in to consume sebum, resulting in more inflammation as the body's white blood cells attack the bacteria.
It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.
Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:
- Benzoyl Peroxide — Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles and kills acne bacteria.
- Topical Dapsone- repels neutrophils, the source of the inflammation.
- Combination Products - such as retinoid and benzoyl peroxide.
- Oral and Topical Antibiotics — Used to treat any infection in the pores.
- Hormonal Treatments — Can be used for adult women with hormonally induced acne.
- Retinoids — Are derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
- Extraction — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
- Isotretinoin --- Longstanding oral retinoid for severe acne, unresponsive to other treatment.
Birthmarks are abnormal skin colorations that are either present at birth or appear shortly thereafter. They can be flat or slightly raised from the skin. They can be any number of colors, including red, brown, black, tan, pink, white or purple. Birthmarks are generally harmless. There are two major categories of birthmarks: pigmented birthmarks and red (vascular) birthmarks.
Pigmented Birthmarks can grow anywhere on the skin. They are usually black, brown or skin-colored and appear singly or in groups. They can be moles (congenital nevi) that are present at birth, Mongolian spots, which look like bluish bruises and appear more frequently on people with dark skin, or café-au-lait spots that are flat, light brown or tan and roughly form an oval shape.
Red Birthmarks develop before or shortly after birth and are related to the vascular (blood vessel) system. There are a number of different types:
- Stork bites, which typically appear on the back of the head and neck. They may fade away as the child grows, but often persist into adulthood.
- Port-wine stains, which are flat deep-red or purple birthmarks made up of dilated blood capillaries (small blood vessels). They often appear on the face and are permanent.
- Strawberry hemangiomas, composed of small, closely packed blood vessels that grow rapidly and can appear anywhere on the body. They usually disappear by age nine.
- Cavernous hemangiomas are similar to strawberry hemangiomas but go more deeply into the layers of the skin. These can often be characterized by a bluish-purple color. They also tend to disappear naturally around school age.
A blister is a soft area of skin filled with a clear fluid. Blisters may form in response to an irritant. Frequently, the blister is caused from friction, such as a coarse fabric rubbing repeatedly against a person’s skin. In other cases, blisters form in response to a chemical or allergic irritant, which is known as contact dermatitis. Some oral and topical drugs may cause blisters to appear. Blisters can also be symptomatic of bacterial or viral skin infections, such as cold sores, chicken pox, shingles, impetigo or ringworm. Blisters can also occur when the skin comes in contact with a hot surface or is overexposed to the sun.
Most blisters do not require medical attention. The most important information to remember is never to pop or break open a blister. A blister acts as a protective covering for damaged skin and helps prevent infection. If a blister does open on its own, be sure to leave the covering in place to support further healing. Simply wash the area gently with mild soap and water, pat it dry and apply an antibacterial ointment. Cover the blister with bandage to keep it clean. Replace the dressing at least once a day. Watch for signs of infection, such as a white or yellow pus coming from the blister, redness or red streaks around the blister or an increase in skin temperature around the blister.
To avoid blisters, you need to eliminate the irritant. Some simple ways to avoid blisters are to avoid tight clothing, make sure socks and shoes fit properly, and when doing heavy work with your hands, wear work gloves.
Diabetes-Related Skin Conditions
It is estimated that about one-third of people with diabetes will have a skin disorder at some time in their lives caused by the disease. Diabetics are more susceptible to bacterial and fungal infections; allergic reactions to medications, insect bites or foods; dry itchy skin as a result of poor blood circulation; and infections from foot injuries for people with neuropathy.
There are a number of diabetes-specific skin conditions:
Acanthosis Nigricans. A slowly progressing skin condition, which turns some areas of skin, usually in the folds or creases, into dark, thick and velvet-textured skin. Acanthosis nigricans often precedes the diagnosis of diabetes. It is sometimes inherited, but is usually triggered by high insulin levels. It can occur at any age and usually strikes people who are obese. There is no treatment for the condition except to reduce insulin levels. Prescription creams may help lighten the affected area.
Diabetic Blisters. Rare blisters that appear on the hands, toes, feet or forearms that are thought to be caused by diabetic neuropathy.
Diabetic Dermopathy. Round, brown or purple scaly patches that most frequently appear on the front of the legs (most often the shins) and look like age spots. They are caused by changes in small blood vessels. Diabetic dermopathy occurs more often in people who have suffered from diabetes for decades. They are harmless, requiring no medical intervention, but they are slow to heal.
Digital Sclerosis. This condition appears as thick, waxy and tight skin on toes, fingers and hands, which can cause stiffness in the digits. Getting blood glucose levels back to normal helps alleviate this skin condition.
Disseminated Granuloma Annulare. A red or reddish-brown rash that forms a bull's eye on the skin, usually on the fingers and extremities. While not serious, it can be treated.
Eruptive Xanthomatosis. A pea-like enlargement in the skin with a red halo that itches. It most frequently appears on the hands, feet, arms, legs or buttocks. It is often a response to high triglycerides. Keeping blood glucose levels in the normal range helps this condition subside.
Necrobiosis Lipoidica Diabeticorum. This condition is similar to diabetic dermopathy, but the spots are larger, fewer, deeper in the skin and have a shiny porcelain-like appearance. It is often itchy or painful. It goes through cycles of being active and inactive. It is caused by changes in collagen and fat underneath the skin. Women are three times more likely to get this condition than are men. Typically, topical steroids are used to treat necrobiosis lipoidica diabeticorum. In more severe cases, cortisone injections may be required.
Eczema is a general term used to describe an inflammation of the skin. In fact, eczema is a series of chronic skin conditions that produce itchy rashes; scaly, dry and leathery areas; skin redness; or inflammation around blisters. It can be located anywhere on the body, but most frequently appears in the creases on the face, arms and legs. Itchiness is the key characteristic and symptom of eczema. When scratched, the lesions may begin to ooze and get crusted. Over time, painful cracks in the scaly, leathery tissue can form.
Eczema affects people of all races, genders and ages. It is thought to be hereditary and is not contagious. The cause of eczema remains unknown, but it usually has physical, environmental or lifestyle triggers. Coming into contact with a trigger often launches the rash and inflammation. Although it is possible to get eczema only once, the majority of cases are chronic and are characterized by intermittent flare-ups throughout a person's life.
For mild cases, over-the-counter topical creams and antihistamines can relieve the itching. In persistent cases, a dermatologist will likely prescribe stronger medicine, such as steroid creams, oral steroids (corticosteroids), and antibiotic pills to treat any potential infection.
The best form of prevention is to maintain a healthy skin barrier. This is done through mild cleansers and keeping your skin well moisturized at all times. Identifying and removing triggers is also helpful. Avoid scratching the rash (which can lead to infection) and promotes more itching. Also avoid situations that make you sweat such as strenuous exercise.
Leading Types of Eczema
Eczema takes on different forms depending on the nature of the trigger and the location of the rash. While they all share some common symptoms – like itchiness – there are differences. Following are some of the most common types of eczema.
The most frequent form of eczema, atopic dermatitis is thought to be caused by abnormal functioning of the skin's defense system, possibly atypical fliggrin production. It is characterized by itchy, inflamed skin. Atopic dermatitis tends to run in families. About two-thirds of the people who develop this form of eczema do so before the age of one. Atopic dermatitis generally flares up and recedes intermittently throughout the patient's life.
Contact dermatitis is caused when the skin comes into contact with an allergy-producing agent or an irritant, such as chemicals. Finding the triggering allergen or irritant is important to treatment and prevention. Allergens can be things like laundry detergent, cosmetics, jewelry, fabrics, perfume, diapers and poison ivy or poison sumac.
This type of eczema strikes the palms of the hands and soles of the feet. It produces clear, deep blisters that itch and burn along with scaling and fissures. Dyshidrotic dermatitis occurs most frequently in people who wash their hands often or wear heavy enclosed shoes resulting in feet sweating.
Also known as Lichen Simplex Chronicus, this is a chronic skin inflammation caused by a continuous cycle of scratching and itching in response to a localized itch. It creates scaly patches of skin. Over time, the skin may become thickened and leathery.
This form of eczema appears as round patches of irritated skin that may be crusted, scaly and extremely itchy. Nummular dermatitis most frequently appears on the lower legs, and is usually a chronic condition, worsening in cold months.
Is a common condition that causes yellowish, oily and scaly patches on the scalp and face. Dandruff, in adults, and cradle cap, in infants, are both forms of seborrheic dermatitis. Unlike other types of eczema, seborrheic dermatitis does not necessarily itch. It tends to run in families. Known triggers include weather, oily skin, emotional stress and infrequent shampooing.
Also known as varicose eczema, this form of eczema is a skin irritation that appears on the lower legs of middle-aged and elderly people. It is related to circulation and vein problems. Symptoms include itching and reddish-brown discoloration of the skin on one or both legs. As the condition progresses, it can lead to blistering, oozing and skin lesions.
Head lice are small parasitic insects that thrive in human hair by feeding on tiny amounts of blood from the scalp. An estimated six to 12 million infestations occur in the U.S. annually. It is particularly common among pre-school and elementary school children. Head lice do not transmit any diseases, but they are very contagious and can be very itchy. They are characterized by the combination of small red bumps and tiny white specks (also known as eggs or nits) on the bottom of hair closest to the skin (less than a quarter-inch from the scalp).
Head lice are visible to the naked eye. The eggs look like yellow, tan or brown dots on a hair. Live lice can also be seen crawling on the scalp. When eggs hatch, they become nymphs (baby lice). Nymphs grow to adult lice within one or two weeks of hatching. An adult louse is about the size of a sesame seed. Lice feed on blood from the scalp several times a day. They can also survive up to two days off of the scalp.
Head lice are spread through head-to-head contact; by sharing clothing, linens, combs, brushes, hats and other personal products; or by lying on upholstered furniture or beds of an infested person. You can determine if your child has head lice by parting the child's hair and looking for nits or lice, particularly around the ears and nape of the neck. If one member of your family is diagnosed with head lice, you'll need to check on every member of the same household.
Medicated lice treatments include shampoos, cream rinses and lotions that kill the lice. Many of these are over-the-counter, but prescription drugs are available for more severe cases. It is important to use these medications exactly as instructed and for the full course of treatment to eliminate the lice. Do not use a cream rinse, conditioner or combined shampoo and conditioner on your hair before a lice treatment. You also should not shampoo for one or two days following the application of a treatment. After applying the medicated treatment, use a special comb to comb out any nits on the scalp. Repeat the entire treatment seven to ten days after the initial treatment to take care of any newly hatched lice. Please note that you should not treat a person more than three times with any individual lice medication.
To get rid of the lice, you’ll also have to:
- Wash all bed linens and clothing warm by the infested person in very hot water.
- Dry clean clothing that is not machine washable.
- Vacuum upholstery in your home and car.
- Any items, such as stuffed toys, that can’t be machine-washed can be placed in an airtight bag and stored away for two weeks. Lice cannot survive this long without feeding.
- Soak combs, brushes, headbands and other hair accessories in rubbing alcohol or medicated shampoo for at least one hour or throw them away.
If your child still has head lice after two weeks with over-the-counter medicated products, contact your dermatologist for more effective treatment.
Considered a follicular occlusion disorder, hidradenitis suppurativa is a chronic skin inflammation that usually occurs deep in the skin in areas of the body with sweat glands, such as the groin or armpits. It is characterized by a combination of blackheads and red lesions that break open and drain pus, which may cause itching. As the red bumps grow in size, they can become more painful. Sometimes scarring and tracts occur in later stages.
Hidradenitis suppurativa occurs when oil glands and hair follicles become blocked with sweat gland fluid, dead skin cells and other elements found in hair follicles. These substances become trapped and push out into the surrounding tissue. A break or cut of the skin then allows bacteria to enter the area and cause the inflammation.
Treatment depends on the severity of the condition. For mild cases, home remedies work well, such as warm compresses and regular washing with antibacterial soap. In more difficult cases, a topical or oral antibiotic medication may be needed to treat the infection. Laser can also be effective. Your dermatologist may also prescribe oral retinoids to stop oil glands from plugging up the hair follicle; non-steroidal anti-inflammatory drugs to relieve pain and swelling; and corticosteroids. An injectable medicine has recently been improved for treatment.
Hives are characterized as itchy red, raised welts (also known as wheals) on the skin's surface that can spread or join together and form larger areas of raised lesions. They are generally triggered by exposure to an allergen or chemical irritant. They tend to appear suddenly and often disappear equally as suddenly.
Hives are usually an allergic reaction to food, medicine or animals. They can also be triggered by sun exposure, stress, excessive perspiration or other, more serious diseases, such as lupus. Anyone can get hives. They are harmless and non-contagious. Hives may itch, burn or sting. They rarely need medical attention as they tend to disappear on their own. However, in persistent cases, your dermatologist may prescribe antihistamines and other medications or short courses of oral corticosteroids. The best way to prevent hives is to discontinue exposure to the allergic irritant.
Hives lasting more than six weeks are known as chronic urticaria or, if there is swelling below the surface of the skin, angioedema. There are new medicines helpful for chronic Urticaria. There are no known causes of angioedema, but it can affect internal organs and therefore requires medical attention.
Keratosis Pilaris (KP)
Also known as follicular keratosis, this is a hereditary skin disorder that causes goosebump-like lesions on the back of the arms, thighs or buttocks. The patches of bumps tend to get dry and itchy, particularly during the winter months. Keratosis pilaris occurs at any age, but most often starts when young. Because it is hereditary, there is no method of prevention. In most cases, it goes away on its own over time; usually by age 40. In other cases, the condition is chronic. Keratosis pilaris is not harmful, however, it is very difficult to treat.
Keratosis pilaris is caused by a build-up of keratin, a protein in the skin that protects it from infection. Keratin plugs up hair follicles causing the rough, bumpy rash. Treatment options include:
- Intensive moisturization is the first line of treatment.
- Medicated creams with ammonium lactate or salicylic acid that softens the affected skin.
- Moisturizers (urea) that help loosen and remove dead skin cells.
- Topical corticosteroids for short-term, temporary relief of symptoms.
- Topical retinoids that increase cell turnover, which reduces the plugging of hair follicles. These can be irritating, however they reduce the plugging of hair follicles.
- Topical Vitamin D ointments.
To help alleviate symptoms, be sure to keep the affected areas moistened at all times and avoid harsh soaps and scrubbing the areas.
Lichen Simplex Chronicus
Also known as neurodermatitis or scratch dermatitis, this condition is caused by a chronic cycle of scratching and itching an area of skin that becomes rough or leathery. While it is not dangerous, Lichen Simplex Chronicus can be a difficult cycle to break because of the severity of the itchiness. It can occur anywhere on the skin, but is most commonly found on the ankles, neck, wrist, forearms, thighs, lower leg, behind the knee or on the inner elbow. It may also be associated with other skin conditions, such as dry skin, eczema or psoriasis.
Lichen Simplex Chronicus occurs more frequently among women than men and generally appears in people between the ages of 30 and 50. If you are unable to break a scratch and itch cycle somewhere on your skin or if the skin becomes painful, contact your dermatologist. Persistent scratching can lead to bacterial infection. The doctor may prescribe topical steroids or short courses of oral corticosteroids and antihistamines to reduce the inflammation and relieve the itching. In some cases, antidepressant or anti-anxiety medications provide relief to sufferers. If scratching does lead to an infection, your dermatologist will likely prescribe an oral or topical antibiotic.
Some patients gain relief from the itching by applying a moisturizing cream and covering the area with a wet dressing. Moisture helps the skin absorb the cream. Creams containing salycylic acid may also be recommended to soften rough skin.
Lumps, Bumps, and Cysts
There are literally hundreds of different kinds of lumps, bumps and cysts associated with the skin. Fortunately, the vast majority of these are harmless and painless. The chart below provides a guide for some of the most common forms of skin lumps, bumps and cysts.
- Red, brown or purple firm growth
- Usually found on arms and legs
- Feels like a hard lump and is somewhat scar-like
- Can be itchy, tender to the touch and sometimes painful
- Usually caused by trauma to the skin or hair follicle inflammation
- Usually does not require treatment
- Most common removal by surgical excision or cryotherapy (freezing it off with liquid nitrogen), but can recur larger.
Epidermoid Cysts (Sebaceous Cysts)
- Round small bumps, usually white or yellow
- Forms from blocked oil glands in the skin
- Most commonly appear on the face, back, neck, trunk and genitals
- If infected or inflamed, will become red and tender
- Can produce a thick yellow, cheese-like discharge when squeezed
- Antibiotics might be prescribed if there is an underlying infection or inflammation
- Dermatologist removes the discharge and the sac (capsule) that make up the walls of the cyst to prevent recurrence
- Red pimples around areas having hair
- Inflammation of the hair follicles
- Caused by infection or chemical or physical irritation (e.g., shaving, fabrics)
- Higher incidence among people with diabetes, the obese or those with compromised immune systems
- Topical Benzoyle peroxide
- Topical antibiotics
- Oral antibiotics
- Antifungal medications for some cases
- Eliminating the cause
- Soft fatty tissue tumors or nodules below the skin’s surface
- Usually slow growing and benign
- Appear most commonly on the trunk, shoulders and neck
- May be single or multiple
- Usually painless unless putting pressure on a nerve
- Usually does not require treatment unless it is compressing on the surrounding tissue
- Remove via excision
- Soft fleshy growths of the skin
- Slow growing and generally benign and painless
- Pain may indicate a need for medical attention
- May experience an electrical shock at the touch
- Usually does not require treatment, particularly if it does not cause any symptoms
- If it affects a nerve, it may be removed surgically
- Closed pockets of tissue that can be filled with fluid or pus
- Can appear anywhere on the skin
- Smooth to the touch; feels like a pea underneath the surface
- Slow growing and generally painless and benign
- Only need attention if become infected or inflamed
- Usually do not require treatment; often disappears on their own
- May need to be drained by a physician
- Inflamed cysts respond to an injection of cortisone, which causes them to shrivel
Poison Ivy, Poison Oak, Poison Sumac
Poison ivy, poison oak and poison sumac are plants that produce an oil (urushiol) that causes an allergic reaction among humans. The inflammation is a reaction to contact with any part of the plant, which leads to burning, itching, redness and blisters. The inflammation is a form of contact dermatitis, an allergic reaction to an allergen that comes into direct contact with the skin. It is not contagious.
Poison ivy is characterized by red, itchy bumps and blisters that appear in the area that came into contact with the plant. The rash begins one to two days after exposure. The rash first appears in curved lines and will clear up on its own in 14 to 21 days.
Treatment for poison ivy, poison oak and poison sumac is designed to relieve the itching and may include oral antihistamines and cortisone creams (either over-the-counter or prescription). These treatments need to be applied before blisters appear or after the blisters have dried up to be effective. In severe cases, oral steroids, such as prednisone, may be prescribed.
The best form of prevention is to recognize and avoid contact with the plants. This can be difficult because these plants tend to grow around other vegetation. These three poison plants can be distinguished by their classic three-leaf formation. To avoid contact with these plants, wear long sleeves and pants when hiking outdoors and keep to the trails. Tuck the ends of your sleeves into gloves and the bottom of your pants into socks so that no area of skin on your arms or legs is exposed. If you think you have come into contact with a poison plant, wash the area of skin with cool water as quickly as possible to help limit the reaction. Also, wash the clothing you were wearing immediately after exposure.
Pregnancy-Related Skin Conditions
PUPPP (Pruritic Uticarial Papules and Plaques of Pregnancy). This condition occurs in roughly one percent of pregnant women. It is characterized by itchy red bumps and hive-like rashes that usually appear on the belly or around stretch marks. The rash may spread to the arms, legs, breasts or buttocks. PUPPP usually begins in the third trimester of pregnancy. It is harmless, but the itchiness can be severe. There is no known cause for the condition. Treatment typically includes the use of topical ointments, antihistamines and, in more severe cases, oral steroids to help alleviate the itch. PUPPP usually disappears a few days after the baby's birth.
Prurigo of Pregnancy (Papular Eruptions of Pregnancy). A rare skin condition that can occur anywhere on the body. Prurigo looks like a collection of bug bites. Its onset is usually not before the third trimester and it typically lasts up to three months after delivery. The condition is harmless to mother and baby. Like PUPPP, it is generally treated with topical ointments, oral medications, antihistamines or steroids.
Pemphigold Gestationis (Herpes Gestationis). This extremely rare condition starts as a hive-like rash, which turns into large blistering lesions. It usually begins on the abdomen and spreads to the mother’s arms and legs. It causes severe itchiness. It typically begins in either the second or third trimester. It may also come and go intermittently throughout a pregnancy. Pemphigold gestationis is associated with an increased risk for pre-term delivery and fetal health issues. If you suspect you may have this condition, seek immediate medical attention.
Pruritus refers to the sensation of itching on the skin. It can be caused by a wide range of skin conditions, including dry skin, infection, fungus, other skin diseases and, rarely, cancer. While anyone can experience pruritus, it is more commonly seen among the elderly, diabetics, people with suppressed immune systems and those with seasonal allergies, like hay fever or eczema. Additionally, there is a type of pruritus, called PUPPP (Pruritic Uticarial Papules & Plaques of Pregnancy) that affects pregnant women.
Treatment for pruritus depends on identifying the underlying cause. Your dermatologist will examine the itchy area and may take a small biopsy of any rash to collect tissue for diagnostic testing. Typical treatment involves topical and/or oral steroids and antihistamines to help relieve the itch. To avoid pruritus, make sure to follow healthy skin care procedures and moisturize often.
Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body. The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will cycle through flare-ups and remissions throughout the rest of the patient's life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.
In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.
Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.
Types of Psoriasis
There are five distinct types of psoriasis:
Plaque Psoriasis (Psoriasis Vulgaris) — About 80% of all psoriasis sufferers get this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red lesions covered by silvery-white scales.
Guttate Psoriasis — This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
Inverse Psoriasis — This type of psoriasis appears as bright red lesions that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
Pustular Psoriasis — Pustular psoriasis looks like white blisters filled with pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, oral steroids, infections and sudden withdrawal from systemic (treating the whole body) medications.
Erythrodermic Psoriasis — One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.
People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.
Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.
Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.
Mild to Moderate Psoriasis
Mild to moderate psoriasis can generally be treated using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.
The U.S. Food and Drug Administration has approved two active over the counter ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:
Bath solutions, like oatmeal, Epsom salts or Dead Sea salts that remove scaling and relieve itching.
Occlusion, in which areas where topical treatments have been applied are covered to improve absorption and effectiveness.
Anti-itch preparations, such as calamine lotion or Sarna lotion.
Moisturizers designed to keep the skin lubricated, reduce redness and itchiness and promote healing.
Prescription Topical Treatments
Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:
Calcipotriene, that slows cell growth, flattens lesions and removes scales. It is also used to treat psoriasis of the scalp and nails.
Calcipotriene and Betamethasone Dipropionate. In addition to slowing down cell growth, flattening lesions and removing scales, this treatment helps reduce the itch and inflammation associated with psoriasis.
Calcitriol, an active form of vitamin D3 that helps control excessive skin cell production.
Tazarotene, a topical retinoid used to slow cell growth.
Topical steroids, the most commonly prescribed medication for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions.
Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:
Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to avoid burning and over exposure. It is advised that exposure to sunshine be in controlled, short bursts.
Excimer lasers. These devices are used to target specific areas of psoriasis. The laser emits a high-intensity beam of UVB directly onto the psoriasis plaque. It generally takes between 4 and 10 treatments to see a tangible improvement.
Pulse dye lasers. Similar to the excimer laser, a pulse dye laser uses a different wavelength of UVB light. In addition to treating smaller areas of psoriasis, it destroys the blood vessels that contribute to the formation of lesions. It generally takes about 4 to 6 sessions to clear up a small area with a lesion.
Moderate to Severe Psoriasis
Treatments for moderate to severe psoriasis include prescription medications, topicals, biologics and light therapy/phototherapy.
Oral medications. These include apremilast (the newest), acitretin, cyclosporine, and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.
Biologics. A newer classification of injectable drugs, biologics are designed to suppress specific parts of the immune system. These tend to be very expensive and can have side effects, but they are typically very effective.
Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:
Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to avoid burning and over exposure. It is advised that exposure to sunshine be limited to controlled, short bursts.
PUVA. This treatment combines a photosensitizing drug (psoralens) with UVA light exposure. This treatment takes several weeks to produce the desired result. In some severe cases, phototherapy using UVB light may lead to better results.
"Rash" is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing creams.
Rashes can be a symptom for other skin problems. The most prevalent of these are:
- Atopic Dermatitis, the most common form of eczema.
- Bacterial Infections, such as impetigo.
- Contact Dermatitis, a type of eczema caused by coming into contact with an allergen or irritant.
- Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
- Fungal Infections, such as ringworm and yeast infection.
- Viral Infections, such as shingles.
A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see a dermatologist to have it properly diagnosed and treated.
Rosacea is a chronic skin condition that causes facial redness, acne-like pimples, visible small blood vessels on the face, swelling and/or watery, irritated eyes. This inflammation of the face can affect the cheeks, nose, chin, forehead or eyelids. More than 14 million Americans suffer from rosacea. It is not contagious, but there is some evidence to suggest that it is inherited. There is no known cause or cure for rosacea. There is also no link between rosacea and cancer.
Rosacea generally begins after age 30 and goes through cycles of flare-ups and remissions. Over time, it gets ruddier in color and small blood vessels (like spider veins) may appear on the face. If left untreated, bumps and pimples may form, the end of the nose may become swollen, red and bulbous and eyes may water or become irritated.
Rosacea occurs most often among people with fair skin who tend to blush or flush easily. It occurs more often among women than men, but men tend to suffer from more severe symptoms. Most patients experience multiple symptoms at varying levels of severity. Common symptoms include:
- persistently red skin on the face
- bumps or acne-like pimples
- visible blood vessels on facial skin
- watery or irritated eyes
- burning, itching or stinging of facial skin
- skin roughness and dryness
- raised red patches
- swelling (edema)
These symptoms may also rarely appear on the neck, chest, scalp and ears.
Research conducted by the National Rosacea Foundation found that the leading triggers for rosacea are:
- sun exposure
- hot or cold weather
- emotional stress
- heavy exercise
- spicy foods
- hot baths
- heated beverages
- some skin care products
- indoor heat
While there is no cure for rosacea and each case is unique, your doctor will probably prescribe low dose oral antibiotics and topical medications to reduce the severity of the symptoms. When the condition goes into remission, only topical treatments may be needed. In more severe cases, a vascular laser, intense pulsed light source or other medical device may be used to remove any visible blood vessels and reduce excess redness.
To help reduce the incidence of flare-ups, a gentle daily skin care routine is recommended that includes the use of mild, non-abrasive cleansers, soft cloths, rinsing in lukewarm water (not hot or cold), and blotting the face dry (not rubbing). Additionally, individuals with rosacea need to protect themselves from sun exposure by using sunscreens with SPF 15 or higher and sunblocks that eliminate UVA and UVB rays. Patients are also encouraged to keep a record of flare-ups to determine the lifestyle and environmental triggers that aggravate the condition.
Roughly 300,000 people in the United States suffer from scleroderma. This chronic connective tissue disease results from an over-production of collagen in the skin and other organs. Scleroderma usually appears in people between the ages of 25 and 55. Women get scleroderma more often than men. The disease worsens slowly over years.
There are two types of scleroderma: localized scleroderma, which involves only the skin, and systemic scleroderma, which involves the skin and other organs, such as the heart, lungs, kidneys, intestine and gallbladder. Typical symptoms of the skin include skin hardening, skin that is abnormally dark or light, skin thickening, shiny hands and forearms, small white lumps beneath the skin’s surface, tight facial skin, ulcerations on the fingers or toes and change in color of the fingers and toes from exposure to heat or cold. Other symptoms impact bones, muscles, lungs and the digestive tract.
There is no known cause of scleroderma, nor is there a cure. There are individualized treatments that are designed to help alleviate certain symptoms and decrease the activity of the immune system to further slow down the disease.
Vitiligo refers to the development of white patches anywhere on the skin. With this condition, pigment-forming cells (known as melanocytes) are destroyed by the immune system causing the loss of pigmentation in the skin. Vitiligo usually develops between the ages of 10 and 40. It affects both men and women and appears to sometimes be hereditary.
Vitiligo usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.
Wrinkles are a natural part of the aging process. They occur most frequently in areas exposed to the sun, such as the face, neck, back of the hands and forearms. Over time, skin gets thinner, drier and less elastic. Ultimately, this causes wrinkles - either fine lines or deep furrows. In addition to sun exposure, premature aging of the skin is associated with smoking, heredity and skin type (higher incidence among people with fair hair, blue-eyes and light skin).
Treatment for wrinkles runs the gamut from topical creams and moisturizers to cosmetic procedures. The most common medical treatments are:
- Alpha-hydroxy acids, preparations made from "fruit acids" that produce subtle improvements in the appearance of wrinkles.
- Antioxidants, creams consisting of Vitamins A, C and E and beta-carotene that improves the appearance of wrinkles and provides some additional sun protection.
- Moisturizers, which temporarily reduce the appearance of wrinkles.
- Retinoids, which help alleviate some of the signs of aging, including mottled pigmentation (e.g., liver spots), roughness and wrinkling.
- Growth factors which promote new collagen.
Cosmetic procedures include:
- chemical peels
- laser resurfacing
The best prevention for wrinkles is to use sunblock to prevent additional damage from the sun.