Doctors' Answers to "Frequently Asked Questions" - Skin Problems

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Skin Rash of face [posted 1/11/99]
Question: I am in Hong Kong. I have had a skin rash on my face from my left lower eyelid to upper cheek: bumps/redness/itching and very minor swelling. The condition has persisted for nearly 4 weeks. I have consulted my GP who prescribed a mild cortico-steroid cream, which relieved redness, but had no lasting effect. He has now switched to 500 mg Amoxil 2 times daily, yet he still has no diagnosis. I have no known allergies.

Answer: Dermatology problems usually have to be seen. However, most would respond to steroids. See a dermatologist.

Rash treatment [posted 1/7/99]
Question: I am a 37 year old female living with AIDS. My dermatologist prescribed Accutane for Mites/Scabies, which have been a rash that has been on my whole body since the first part of May 1998 due to acquiring a bird and a dog and a 13 year old daughter or casual contact. Is this customary treatment for the above. Do I need to exterminate my house?

Answer: Not usual treatment, and you will need to find and eliminate the source or you will continue to have the problem.

Spots on the Skin [posted 11/25/98]
Question: Bright red quarter-sized (or larger) spots (with a small whitish center) have been for about two months coming on my Mother's legs, thighs, back. They fade after a few days only to reappear somewhere else on her. Is this anything to be concerned about? A chemical or vitamin imbalance in her body? She went to a dermatologist who apparently had no idea what was causing it. If it is prudent to see another doctor, would an internist be the kind of doctor to go to?

Answer: I'd see a Internist to get her organs checked etc. But, you may not find the answer.

Cracking, Tearing Skin & Sign of Rosacea [posted 10/23/98]
Question: I have a persistent problem of cracking or tearing at the edges of my mouth for the last 10 months. I would say over 15 years I have taken my centrum mutivitamins and eat Total cereal for breakfest daily. At the same time I started seeing signs of Rosacea. I have been using Neosporin which moistens the skin but thats it. I have also used Tropicort a steriod, it helps but what I want is a cure. Anything is possible, but do you think that this a sign of a much bigger problem? If I go to a doctor should I see a specialist? Should I start with a blood test looking for what? I stick with the same Products like soap and shampoo so unless they have changed the ingredients I wouldn't think that I am alergic to them. Thank You.

Answer: High doses of B 6 are sometimes helpful. Topical Vit E is also used. I would avoid the steroid unless you feel that this is the Rosacea, which would be uncommon in this area of the face.

Finding a Good Doctor for Skin Problems [posted 10/20/98]
Question: I need to contact a skin doctor in the Greenville, SC area. My father has a bad case of sarcoidosis. I am told is a rare skin disease that usually occures in young black males. As far as we know, it is external, but it could have gone internal since we lived in Charleston, SC. Any suggestions on finding the BEST skin doctor in my area. Or can you direct me to find any information on this skin disease? Thank you.

Answer: Sarcoidosis is generally considered a systemic disease. In about 25% it only appears to affect the skin. A dermatologist or a rheumatologist(arthritis specialist) would be useful for evaluation/ treatment of sarcoidosis. Look in the book "Best Doctors in America" Ed. by Steven Naifeh pub by Woodward/White pub in SC.

Morhia Skin Condition [posted 10/16/98]
Question: My 10 year old daughter has a skin condition known as morphia. It started with 1 small place on her back whichturned into a large scar. Numerous places have come up on her back in the past 2 weeks. How can this skin disease be dealt with? Surgery? Her scar is starting to look ugly.

Answer: This is thought to be an autoimmune disease and other than local steroids, there is no effective treatment.

Blotchy Skin When Emotional [posted 10/13/98]
Question: I am a 26 year-old female with have very fair skin. I tend to get blotchy patches that appear on my neck and upper chest. This occurs most often when I am very upset or emotional about something, when I go from cold to heat (mostly during winter), and sometimes when I drink alcohol. It is extremely embarrassing because I cannot control it and it is very noticeable because my skin is light. It doesn't itch or hurt, and it's never a raised bump. It's just very red. What causes this and how can I stop it?

Answer: This is called stress urticaria and is fairly common. Many times they also itch, so count your blessings. An antihistamine will occasionally block this effect, try the non-sedating variety like Claritin, Allegra etc. first.

Skin Problems & Delusion: Any Connection? [posted 10/1/98]
Question: My mother has had a skin problem all her life. She's 78. I'm 42 and for as long as I can remember, she has been using betnovate(?) cream with cortisone in it. She has been told she doesn't have any sweat glands or what she does have, do not work. She has been very strange lately. The doctor has said she's paranoid delusional. She recently had blood tests, and the results said that the cortisone level should be 450 (in whatever they measure it in). Hers is 750. Very high. She has to immediately stop with the creams but is concerned because she hasn't found anything else that works. My question is: can having this amount of cortisone in her system, affect her enough to make her become paranoid? What can happen if she doesn't stop the cream and how long can does it take to leave ones body? Thanks for your help. I appreciate it.

Answer: Certainly can;but, unusual with topical skin creams unless used on large surface areas. I'm not sure where the level of 450 and 750 come from. These would not be usual basal levels of cortisol in most labs. The effect should clear within 1-2 weeks. However, patients usually exhibit mental status changes immediately with steroids if they are to develop, not after extended use. I'd suggest that there is another cause of her paranoia.

Persistant Skin Irritation [posted 10/1/98]
Question: Patient for past two years continues to have swelling and readness of the skin tried Allegra , claritin, steriods, various antihistimines no change, do you think taking injections to build up system would have positive effects (last resort) also taking Bio C-1000 and Alertonic Bio C-1000 10 a day Alertonic 3x.. Casonic Skin test conducted some reactions but none severe..Lab tests within norm any help would be appreciated.

Has there been a biopsy of the affected skin?

Skin Irritation on Testicles [posted 8/5/98]
Question: I have had a skin irritation for some time know. I have a really bad itch on my testicles, mainly on the right side. I can also tell you that sometimes it gets itchy around the rectal area. This has been going on for about a year and I don't know what to do.

Answer: Usually fungal infections in this part of the body. Prescription antifungals would be best, but over the counter medications are available.

Skin Reaction to Sun [posted 7/31/98]
Question: I seem to be allergic to the sun. Whenever I am exposed to it my skin breaks out, becomes very thick and itches. I solve part of the problem by using a 30 sunscreen. However, sometimes I do not manage to avoid it completely, either because I forget to put some more lotion, or for other reasons unknown. What antihistamine can I take to reduce the itch?

Answer: Many patients are sun sensitive. Sometimes this is induced by different medications: birth control pills, tetracycline, etc. Sometimes it is seen in patients with different types of connective tissue diseases, lupus etc. Sun block is the only effective treatment. However, this should be brought up with your doctor for further evaluation.

Dermatitis Treatment [posted 7/27/98]
Question: I've been diagnosed with dermatitis (non-specific). My treatment thus far has been creams and medication by the name of Trimeprazine Tartrate. I'm told this is an on going condition and nothing further can be done. I continue to experience major bouts of itchiness that can be so severe as to cause me to scratch myself relentlessly, even in my sleep. My current treatment is of little help. Are there new remedies or medicines available that might help my condition, or is jumping off a cliff the only way to stop this relentless itch?

Answer: First, ensure that there is no underlying medical problem. For example, different liver conditions can produce this itching, so get an examination and lab tests. Second, if they are normal, a trial of steroids is usually attempted to see if they will alleviate the condition for longer periods than topical treatment. Are you on Atarax, Elavil or other symptomatic treatments?

Nitroglycerin for Anal Fissures [posted 7/27/98]
Question: Do you know a nitroglycerin based Pomade that helps healing anal fissures (thanks to the dilation effect?). There is a drug that is only licensed on the US market.

Answer: Interesting idea, but I have not heard of a drug used for this purpose. There are local nitroglycerin skin preparations available. I suspect local application would achieve this purpose.

Itching [posted 7/16/98]
Question: Could Zyrtec or Prilosec be causing severe itching?

Answer: Either possibly although I would suspect Prilosec more. Mentioned in the PDR for both drugs, however, pretty uncommon with either. Stop one at a time and see how the itching changes.

Hiding Scars
Question: Are there any products that are effective in hiding scars? Or is there anything that helps the appearance of scars?

Answer: Some people recommend topical Vitamin E, but with little evidence. However, it can't hurt. Scars are usually only changed with further surgery by a surgeon or plastic surgeon, and occasionally a ruby laser can remove superficial scars. There is no current topical treatment that will remove scars.

Light blotches on skin
Question: When people have light blotches on their skin (i.e. Micheal Jackson) is it do to less melanin or something else? And also if your skin regenerates every 3-4 weeks, why don't your scars heal?

Answer: Vitiligo is the disease that affects Michael Jackson. This is thought to be an autoimmune disorder where the melanin producing cells are attacked and destroyed leaving these white blotches. This produces an absence of melanin in the affected areas. Scar tissue is permanent due to the interruption of the dermis and regeneration in a manner not in conformance with the initial skin.

Treatment for Skin Redness on Face
Question: I am 58 years old woman. I am post-menopausal, but still suffering with hot flashes. I not on ERT, but that was my choice. For the past couple years I have been getting redness on my face, and small spider veins. I saw 2 dermatologists and a skin specialist, and they all told me to use Rosacea. I was given a topical cream which is a compound. I found out it contains cortisone, and after applying it to my face for two years, I found out that the cortisone will thin the skin. I happen to have a very fair complexion. I would like to know if there is any reason for me to worry.

Answer: Try metroniadazole cream instead. It works as well with none of the skin problems you refer to. Long term use of steroids on the face should be avoided if possible, and it also potentially causes fat change under the skin, really changing the morphology of the face.

Excess oil in nose pores
Question: I am 49 and have had oily nose problems since I was a teenager. Pores plug with sebum but don't always develop pimples. Is accutane something I should consider? Is this too strong of a drug for my problem?

Answer: I'd start with OTC like OXY-5, etc. if you haven't used them. Accutane is usually reserved for cystic and scarring acne-which you don't currently have. Topical antibiotics in addition would also be very effective.

Itching
Question: I've had intense itching several times a day for the past year lasting from 2-8 minutes. It happens right before I start to sweat or if I get too hot. Once I start sweating, the itching stops. I even itch if I take a shower that is too hot. Usually itch on back, chest, and hands. My hands also usually get cold when I itch.

Answer: Is the itching generalized or just one area of the body? Do you develop blotches or hives? There are people who have exercise induced urticaria. This is a release of histamine induced by exercise or heat. Antihistamines are about the only treatment. Occasionally, cromolyn sulfate or equivalent will help.

Darkening Skin
Question: I came here in the US. about five years ago. After being here for a while, the part that circles my lips began to get dark. Now the situation is terrible. This darkness has spread all over my face, and I look like a "Black Cat" now. What is the resolution for this? Overall, I am healthy, bright, and into a lot of sports activities.

Answer: There are several endocrine disorders that can cause increased melanin secretion. This should be seen by a physician and your pituitary and its axis tested.

Dry Skin / Seborrheic Dermatitis
Question: Is there a home remedy or over the counter product that is available to someone with extremely dry skin of the face and neck and seborrheic dermatitis of the scalp.

Answer: Seborrheic dermatitis is a common disorder of the skin usually seen in so-called atrophic individuals. That is, those prone to allergies, asthma, etc. A very effective treatment is full strength dandruff shampoo. This should be applied once to twice a day and left in place for 5 to 10 minutes. Topical over the counter steroid cream is also effective, but can cause atrophy of the fat under the face leading to lumps and wrinkles that will not go away. I'd avoid steroids except in severe cases.

Skin and Aging
Question: Does skin lose its elasticity as one ages uniformly or is there a particular age when your skin begins to sag more than at other times. Does it depend on a variety of factors such as diet, genetics, exercise, etc.?

Answer: The skin certainly ages at different rates. This is influenced more by sun exposure, chemical exposure and different drugs (especially nicotine). Sun and nicotine will age skin faster than almost any other factors for most people. There is also an effect seen in people who have lost a lot of weight. The skin has difficulty regaining its previous shape and often requires plastic surgery to restore tone and shape.

Seborreic Dermatitis
Question: What is the most common physician-provided treatment for seborreic dermatitis affecting the head and ears?

Answer: Seborreic Dermatitis is treated with topical steroids and with topical dandruff shampoos. Over the counter steroid creams are effective and surprisingly full strength dandruff shampoo left on for 4 to 5 minutes can be very effective.

Perioral Dermatitis
Question: Do you know of an effective over-the-counter remedy for perioral dermatitis? If not, is the best prescription remedy oral or topical?

Answer: Occasionally large doses of Vitamin B complexes will help this problem. It needs large doses 3 times or so of usual daily dosage.

Dermatology
Question: What might be the cause and treatment for scars that leave dark red/purple marks on the skin? I have numerous spots on my lower legs from old scars. These are just spots with no change in the thickness of the skin. Some of these are a few years old. I believe a lot of them are from possibly mosquito/gnat bites. Is there anything to fade or lighten them?

Answer: These type of changes in the legs only usually signal a lack of good venous return to the heart from the feet. If they occur on other parts of the body as well, they may indicate a clotting problem (very common on aspirin for example). These on the legs are usually called trophic changes and indicate blood pooling in the legs while you are standing.

Dermatology
Question: I am 47 years old and have started getting what appears to be liver spots. I have had the discolorations examined by a Dermatologist previously and he said the spots were not cancerous. There are also small dry spots that appear from time to time. I know that a lot of this comes with my age but is there anything I can do to slow the process (cream, face peel, etc.) or could it be coupled to some vitamin deficiency? I know there are a lot of other Baby-boomers now facing this problem but is there anything you may recommend to clear up the problem?

Answer: There are several types of so-called “liver spots”. I would need to have a Dermatologist’s diagnosis to help further.

Chin Rash
Question: My roommate has had a rash just below his lower lip and extending down to the top of his chin for about 3 months. At first it looked like acne, but got larger, then oozy, then crusty. It substantially healed, with only a little redness present, but now it seems to be re-emerging as small raised red bumps in the same area. A non-medical skin specialist thought it may be related to "impetigo". At one point, a doctor's visit yielded little, as there was little to see at the time - the flare-up had substantially subsided. Do you have any ideas? We're afraid it could be something contagious, of course - otherwise, we just want to clear this up.

Answer: This certainly sounds like impetigo. Impetigo is a skin infection of the face caused by bacteria, typically streptococci. It is very infectious and should be treated early to avoid spread to close contacts.

Contact dermatitis
Question: What is the strongest, most effective medication to get rid of contact dermatitis on my fingers and palm? I have topicort and I've tried basic calydryl. Does it just need to run its course? I'm in Southern California, so the temperature is warm. How can I avoid contact dermatitis? I know I 'm allergic to poison ivy, sumac, etc., from living in New York, but now I'm sensitive to any sort of vine growing outside in Southern California or ground cover like honey suckle.

Answer: People who have allergic reactions are called "atopic" individuals. Once the immune system begins the process the number of allergies tends to increase and rarely decrease. Many things can cause allergic reactions. Use of gloves outdoors is highly recommended. Sometimes use of hand creams will reduce the risk by sealing the pores prior to working. Prescription strength steroids will help clear it up faster. Calydryl will only help the itching, not speed up the healing.

Skin Rash
Question: My father has developed a skin rash on his body that his family physician believes is probably due to his medications. He is taking Parlodel, Sinemet, Imdur, and Atenonol for Parkinson's Disease and heart problems, respectively. He is 78 years old and this rash has been evident for 10 weeks with no relief. The Parkinson's medicine has been taken for 11 years, but the heart medication for only 3 months. He also takes one Vitamin E and one Ecotrin aspirin daily. Any suggestions would be greatly appreciated, because he must continue to take these medications.

Answer: None of these medications are particularly noted for causing allergic reactions. However, I'd start with the most recent addition and stop that for a while. Potentially, he is having an allergic reaction to one of the binders or additives in the medications. Also, be alert to changes in manufacturers (especially generic medications). These can be the culprit.

Dry Skin
Question: My skin and scalp are itchy. I believe that it is just the dry winter weather. What can I do to care for and prevent dry skin?

Answer: Dry skin in the winter is a very common problem. It can be treated by using a humidifier at home and at work (add one to the furnace if possible) and by use of bath/shower oils. Use these oils on a daily basis (available in any drug store) and try to minimize the amount of soap, especially deoderant soap.

Severe Itching
Question: I have bumps on the back of my head, neck, and left collar bone. They are extremely itchy and seem to get worse when I sweat, get too hot, or too cold. I've had this condition for over 18 months. I have also had them on my arms and legs. This past October, I scratched my leg so much that my knee got infected and I spent a week in the hopital. I've been treated for scabies, had several blood tests, and one culture. I have been told that I have a staph infection.

Answer: Chronic conditions which cause itching of the skin are both very common and very difficult to cure. I don't have any ideas other than what has been told to you by the two specialists. I would concentrate on attempts to reduce the itching. I suspect this represents your skin trying to heal like when a scab itches before it comes off. Application of topical benadry may help. Also, try Vitamin E. I would avoid steroids if it really is a bacterial infection, but topical antibiotics may also be useful.

Dermatology
Question: For about three weeks I have been having occassional, but extreme ichiness on the top side of my left forearm. There are no outward signs of infection or irritation (no reddness, no swelling, and no apparent bites or stings). I do not recall any event triggering this reaction, nor do I recall any contact with potential allergens. I am, however, an agricultural aid and my days are spent around various fruit trees and I handle extremely small quantities of pesticide and chemical pheromones. There has been no incident to warrant suspicion of these chemicals. Also, the area of ichiness on my forearm is localized to an area 5 inches by 2.5 inches, it is not spreading, and it does not seem to be contagious to those around me.

Answer: There are several ways that the itching could occur. These mainly fall into local allergic or chemical reactions and different infections. In the absence of redness of swelling, local fungal infections are unlikely. However, some fungal infections will start in this manner. I would use some topical steroid cream (hydrocortisone is available in the pharmacy over the counter) two to three times a day for a week or so. If you don't have any improvement or if it worsens time to see a physician. However, it it goes away it was probably a local allergic or chemical reaction.

Skin
Question: I've got a reddish, dry patch (flakes too) on my scalp near my hariline. It seems to come and go, but doesn't necessarily improve with Cortaid. It doesn't seem to be a winter condition because I've had it since the summer. Do you think this is something that can be cured by a shampoo? Please advise before I lose two days of work (one to see my GP, the other to go to a derm if I'm referred.)

Answer: Reddish flakes on the scalp are usually one of several entities. These include psoriasis, seborrheic dermatatis, fungal infections or drug reactions due to sun sensivity. The only red scaly condition which responds to shampoo is seborrheic dermatatis. This commonly responds to concentrated dandruff shampoo (Head & Shoulders, Tegrin, and the like). This should be applied full strength for several minutes each day and washed off. If it does not respond to this treatment, I recommend a medical evaluation since each of the other conditions requires a prescription medicine and longer treatment.

Hives
Question: Are there any medications for hives that do not make you drowsy? I have been suffering from hives for 3 weeks now and have chest pains occasionally. I have been to the doctor and they gave me atarax and said that it is from stress. It's hard to take this medication when I have to work because it makes me very drowsy. I have discussed this with the doctor but they said they can't give me anything that does not make me drowsy.

Answer: Hives are very irritating. Unfortunately, the treatment usually involves antihistamines to decrease the itching and swelling and these almost always are sedating. Atrax (hydroxyzinehydrochloride) is sometimes effective without the sedation. Steroids are also used occasionally for extended or severe hives. These have other potential severe side effects, but are usually not sedating. In general, steroids are rarely used for extended periods. An old but useful home remedy is colloidal oatmeal. This can be obtained at the drug store and bathed in cool water. This usually helps for a period of time.

Cherry Hemangiomas
Question: I have been wondering if I should be concerned about these little red dots that have been appearing on my skin. Also, it is not only skin that is exposed to the sun where these dots appear. Maybe it is not a big deal, but I am not sure. What do you think?

Answer: These little red dots are probably cherry hemangiomas these are dilated small veins-usually due to estrogen level. Women on birth control pills get these. Also, anyone with higher estrogen levels will develop them-even men with cirrhosis of the liver. However, they are usually randomly distributed-more on the trunk if anything. Distribution in sun exposed areas is unusual. There are several conditions which can produce sun changes. Different drugs can produce sun sensitivity, different inherited conditions like porphyria, etc. I'd see your doctor and see if they are sun sensitive which is usually treatable or if they are cherry hemangiomas which are not-short of decreasing your estrogen levels.

Eczema or Psoriasis
Question: The skin on my hands cracks and could bleed if a ignored it. My hands get covered with large white flaks of skin. I have tried various types of dry skin hand creams which are of limited help. Suggestions??

Answer: This kind of skin condition sounds like either eczema or psoriasis. Eczema is usually associated with other allergies or asthma and is usually seen in so called atopic individuals. Psoriasis is a skin condition characterized by rapid turnover of cell tissue creating whitish areas which are usually well circumscribed. Both conditions will respond to topical steroid cream-available over the counter at any pharmacy. If it does not respond completely you'll need to see your physician.

Psoriasis
Question: I have been experiencing a real flare-up of my psorisis lately. Although it is always there, it often is not very bad. Lately, I have been getting cracks in my skin on the joints on my hands and the effected areas are much more intense than usual. Are there eating, drinking, and other lifestyle changes that I can make to help the condition and are there any really effective treatments for the condition in general?

Answer: Psoriasis is a skin problem that is fairly common in a physicians practice. It is a skin disorder characterized by round, red areas of raised skin-usually covered with a silvery scale. These are most often seen on the elbows, knees, scalp and eyebrows and around the belt line. Some patients will have involvements of their joints causing a peculiar type of arthritis and occasionally of their nails. Stress and lack of sleep is thought by some to produce a flare of this disease. Treatment centers on topical creams and sunlight. Coal tar, UV or sunlight and topical steroid creams are the mainstay. For severe psoriasis and for those with joint involvement, use of methrotrexate is an option.

Blotchy Skin
Question: I have a small, oval blotch (slightly darker than regular skin tone) on the front of my left hip. Can you tell me what this is? Cancer runs in my family, should I be worried?

Answer: This must be visualized to tell. However, change in size or color is bothersome. A raised lesion is rarely a problem-see your doctor or health professional.

Cellulitis
Question: What is cellulitis? What are the symptoms and treatments? How can it be avoided?

Answer: Cellulitis is an inflammation of the skin. Usually due to infectious agents -usually bacteria. There are many bacteria which can cause an infection; but, the common ones are staph and strep species. It is prevented by ensuring that there is no breaks in the skin integrity and usual body cleanliness. However, once the bacteria find a portal of entry and start the infection below the dermis of the skin, it can spread with incredible rapidity. It is usually seen as red, hot inflammation of the skin. The most common sites are the legs and feet; but, it can start anywhere-especially with any crack, puncture, etc. of the skin.

Minocycline
Question: How safe is minocycline for teen skin problems? A friend shared concern about liver damage. She was told to have her teen take potent garlic soft gel capsules as well as natural brand acid ophilus along with the minocucline to keep up the immune system. I would appreciate any information.

Answer: Topical or systemic? Topical appears very safe-systemic has some potential problems. There is no assault on the immune system; rather, bacteria will arise that are resistant to the antibiotic. This can cause problems with resistant infections in other parts of the body when/if they occur. However, your bodies ability to fight them is not impaired. Taking the acid ophilus is aimed at replacing bacteria that the minocycline kills so that the resistant bacteria(or yeast) do not take over parts of your body(vagina, colon, mouth etc.). I'm not aware of any benefit with taking garlic concerning antibiotics.



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