Category Archives: Skin

Psoriasis

What is psoriasis? 

— Psoriasis is a skin condition that makes your skin thick and red. It also often causes silver or white scales to form on the skin. Doctors do not know what causes psoriasis.

What are the symptoms of psoriasis?

 — The symptoms of psoriasis can include:

●Areas of skin that are dry or red, and that are usually covered with silvery or white scales

●Rashes on the scalp, genitals, or in skin folds (like the folds you have at the elbow)

●Itching

●Nail changes that make the fingernails or toenails look pitted, crumbly, or different in color

Psoriasis has an emotional effect, too. People with the condition often feel embarrassed by their skin, and some get depressed or anxious. If you have these problems, mention them to your doctor or nurse. You might feel better with counseling or another type of mental health treatment.

Is there a test for psoriasis? 

— Your doctor or nurse should be able to tell if you have psoriasis by looking at your skin and by asking you questions. In rare cases, doctors take a small sample of skin to check if psoriasis is the problem.

What can I do to reduce my symptoms? 

— Use unscented thick moisturizing creams and ointments to keep the skin from getting too dry.

How is psoriasis treated? 

— There are treatments that can relieve the symptoms of psoriasis. But the condition cannot be cured.

Treatments for psoriasis come in creams and ointments, pills, or shots. There is also a form of light therapy that can help with psoriasis. All treatments for psoriasis work by slowing the growth of skin, controlling the immune response that causes psoriasis, or both. Most people need to try different treatments or combinations of treatments before they figure out what works best. The medicines that are used most often are called steroids. These medicines are applied to the skin.

People with psoriatic arthritis can take medicines to reduce pain and swelling. Exercise and physical therapy can also help. Plus, some of the same medicines that help with the skin problems caused by psoriasis also help with psoriatic arthritis.

Fire Ants

OVERVIEW OF IMPORTED FIRE ANTS — Imported fire ants (also known as fire ants) were accidentally imported into Mobile, Alabama in the early 1900s from South America. Since then, their range in the United States has expanded throughout the southeastern, southern, and southwestern United States, California, and into Puerto Rico. Regularly updated maps of their range and agricultural quarantine areas in the United States are available. They have also spread to Australia, New Zealand, Taiwan, Hong Kong, China, and Mexico.

Fire ants have a major impact because they prey on other insects and animals, sting humans and farm animals, and form large mounds of soil that damage farm machines and crops [1]. Although fire ant stings are rarely fatal, people who live in areas where fire ants are common should know how to avoid being stung, how to treat a fire ant sting, and how to use insecticides to control the fire ant population.

WHAT ARE IMPORTED FIRE ANTS? — Fire ants are aggressive, venomous insects that have become a serious problem in many areas of the United States and around the world. The ants range in size. Queens are often three-fourths of one inch long, while minor workers are approximately one-eighth inch.

The ants build dome-shaped nests (mounds) of soil that are 2.5 to 3 feet across. These tend to be flatter when built in sand. The queens are underground, protected by many workers, and continuously lay eggs to produce new ants. During dry or cold conditions, ant colonies move deeper into the mound or under paved areas and even into buildings. Mature colonies can contain as many as 100,000 to 500,000 worker ants.

The ants have pinching mandibles on the head and a sharp stinger on the rear of the body, which is connected to a large, internal venom sac. When attacking predators or disturbed by an object, the ant grasps the object with the mandibles, quickly inserts the stinger, and injects venom.

Once attached to the skin, fire ants continue to sting an average of three times before removal. Most stings occur on the feet or legs after stepping on a fire ant mound. Stings are largest and most painful during the summer when the ants have the largest quantity of venom. Up to 50 percent of people who live in an area of fire ant infestation are stung per year.

REACTIONS TO IMPORTED FIRE ANT STINGS — There are three main types of reactions to fire ant stings.

Local reactions – The most common reaction to fire ant stings is immediate, intense burning, followed by itching, redness, and a 12 to 20 cm (5 to 9 inches) raised red welt on the skin at the sting site. These symptoms usually resolve over four to six hours. The next day, there is usually a sterile pustule at the sting site, which is best described as a small bump with a white blister on top. The pustule resolves over one week or so, unless it is scratched off. Scratching is not recommended, because it can allow an infection to develop in the skin.

Large local reactions – A small percentage of people who are stung develop a large local reaction. Signs include extreme itching and a large raised red welt at the site of the sting. Over 6 to 12 hours, the swelling and intense itching increases and evolves into a large area of painful swelling. These reactions reach maximum size at 24 to 48 hours when they are hot, itchy, and painful.

Rarely, swelling can be large enough to interrupt the blood supply to toes or fingers. Fortunately, large local reactions do not cause a body wide allergic reaction (anaphylaxis).

Anaphylaxis – Between 0.6 and 16 percent of people who are stung by a fire ant have a severe, whole body allergic reaction called anaphylaxis. This type of reaction is more common in people who have previously been stung or had an allergic reaction to a wasp (yellow jacket) sting. Anaphylactic reactions are very serious and usually develop within 30 minutes of being stung. If left untreated, this reaction can be life-threatening. Signs of anaphylaxis include body wide itching, welts, difficulty breathing or swallowing, weakness, or fainting.

TREATMENT OF IMPORTED FIRE ANT STINGS — At the first sensation of a sting, the ant should be quickly killed with a slap. Then, wash the sting site with soap and cool (not hot) water.

Local reaction — If the sting site is itching severely, we recommend a nonsedating oral antihistamine, such as loratadine (brand name Claritin), fexofenadine (brand name Allegra), or cetirizine (brand name Zyrtec) and/or a topical anti-itch ointment (eg, 1 percent hydrocortisone). Itching can last for many hours. Diphenhydramine (sample brand name Benadryl) 50 mg is also effective, although it can cause a person to be very sleepy. Diphenhydramine should not be taken before driving or any other activity requiring alertness. All of these medications are available without a prescription.

Keep the sting site clean and avoid scratching it. If the site becomes oozy and wet, a prescription antibiotic ointment (mupirocin [brand name Bactroban]) is recommended to prevent infection. Avoid over-the-counter antibiotic ointments, such as Neosporin (brand name) or Bacitracin (brand name), which can themselves cause an allergic reaction.

If the sting site appears infected, continues oozing, grows larger, or develops red streaks, it should be evaluated by a health care provider as soon as possible.

Large local reaction — Large local reactions are best treated with an oral antihistamine (loratadine [brand name Claritin] or cetirizine [brand name Zyrtec]) and 1 percent hydrocortisone ointment (or diphenhydramine [sample brand name Benadryl]). The ointment should be covered with a bandage to increase absorption of the steroid. It may be applied four times per day, if needed.

Very large local reactions should be evaluated by a health care provider and are usually treated with a prescription steroid ointment and/or an oral steroid (eg, prednisone). Large reactions that surround a finger/toe or hand/foot should always be evaluated by a health care provider because of the risk that swelling could block blood flow.

Anaphylaxis — Anyone who develops difficulty breathing or swallowing, weakness, or fainting after being stung by a fire ant needs emergency medical treatment. The person (or a friend or family member) should call for emergency assistance, available in most areas of the United States by dialing 911. Do not wait to see if the reaction will get better. If available, the person should use an epinephrine autoinjector.

If the person is alert and able to swallow, he or she should take an over-the-counter antihistamine (eg, diphenhydramine [sample brand name Benadryl] 50 mg or cetirizine [brand name Zyrtec] 10 mg for adults, one-half of this dose for older children) while waiting for emergency assistance.

Anyone who experiences anaphylaxis should be evaluated by an allergist who can provide injections to desensitize the person to fire ant venom. These “allergy shots” can significantly reduce the risk of another anaphylactic attack if the person is stung again by a fire ant.

HOW TO AVOID BEING STUNG BY IMPORTED FIRE ANTS — The best ways to avoid being stung include the following:

●Know your environment. Walk around open areas and look for ant activity or mounds before using the area.

●Exterminate fire ants in frequently used areas with regular use of pesticides.

●In areas of infestation, wear lace-up shoes, thick socks, and long pants and avoid sandals. When gardening or working in the soil, wear long sleeves and gloves.

●Insect repellents are not effective in preventing fire ant stings.

CONTROL OF IMPORTED FIRE ANTS — The only effective methods available to the public to control fire ants are insecticides. There are no methods that permanently control or eliminate fire ants. The chemical insecticides are only effective for short-term control (3 to 12 months), must be reapplied periodically, and are costly. They can be used effectively to control infestations. Disturbing mounds can sometimes make the ants move their nests, especially if most of the colony is not killed.

Outdoor treatments — The four basic strategies used for controlling fire ants with chemicals include:

●Broadcast bait with granular pesticides

●Individual mound treatments

●A combination of broadcast bait and individual mound treatments

●Barrier and spot treatment

Safety instructions for each product should be carefully followed.

Broadcast baits — Broadcast baits reduce fire ant populations by using a small amount of insecticide dissolved into an attractant food source (eg, soybean oil). The oil containing the insecticide is then absorbed into a carrier (such as corn grits), which is dispersed over an area. This is considered the most effective and efficient method to control multiple colonies over a large area. Regular applications should be made in the spring and fall to control ants that move in from untreated areas.

Insecticides used in baits are usually slow-acting so that the foraging worker ant can pick up the bait, extract the toxic oil, and feed it to the queen and other ants before dying. Depending upon the active ingredient, the queen either dies, becomes infertile, or does not produce mature ants, leading to the eventual death of the colony. There are fast-acting baits that cause colony death in three days or less (compared with older baits that take two weeks or longer).

Broadcast bait applications eliminate the need to locate individual ant mounds, but instead depend upon foraging ants to take the bait back to the rest of the colony. In addition, the colony will usually not relocate, because the queen should be killed and the mound has not been disturbed. Because large areas can be treated, this method can result in slower reinfestation by colonies migrating from other untreated areas.

Individual mound treatments — Individual mounds can be treated by applying an insecticide. The chemicals should be specifically labeled for use on imported fire ants.

Ideally, contact insecticides should kill worker ants quickly because slower-acting chemicals may allow the ants to relocate.

Use of gasoline or kerosene directly on mounds can be dangerous and is not recommended. Nonchemical methods of treating individual mounds, such as the use of hot water or nest removal, usually are not successful with mature colonies.

Combination treatments — Many experts prefer the use of a combination of treatments to kill fire ants. Broadcast baiting can be combined with individual mound treatments. Baits should always be broadcast first to efficiently reduce fire ant populations. After one or two days, the worker ants have spread the bait through the colony, which can then be treated with an individual contact insecticide to quickly eliminate the worker ants, which can sting.

Barrier and spot treatments — Barrier and spot treatments contain active ingredients that kill ants on contact and are usually sold as sprays or dusts. Some are mixed into latex paint. They may be applied in wide bands on and around building foundations, equipment, and other areas to create ant barriers. Barrier and spot treatments do not eliminate colonies but can prevent fire ants from foraging indoors or infesting electrical and electronic equipment.

Indoor treatments — On occasion, ants build colonies indoors that can be located by following foraging ant trails back to nesting areas. A professional licensed exterminator should be consulted to treat indoor colonies.

Blisters

What are blisters? — Blisters are fluid-filled bumps on the skin.

What causes blisters? — Many things can cause blisters, including:

●Something rubbing or pressing against the skin – This might happen from wearing a tight-fitting shoe or gripping a tool.

●Bad burns, often from something very hot (like a boiling water or a stove) or a sunburn

●Allergic reactions to something that touches the skin, such as poison ivy or poison oak

●Problems with the body’s infection-fighting system (called the “immune system”)

What are the symptoms of blisters? — The symptoms include one or more fluid-filled bumps on the skin. The fluid is usually clear.

Should I see a doctor or nurse? — See your doctor or nurse right away if you are not sure what caused your blisters or if you have:

●Blisters in your mouth, near your eyes, or in or near your anus or genital area

●Blisters all over your body

●Painful blisters

●Blisters with pus inside

Will I need tests? — Maybe. If you need to see a doctor or nurse for your blisters, he or she might do tests to find the cause of your blisters. This might include taking a sample of your skin.

How should I take care of a blister? — To care for a blister caused by something rubbing or pressing the skin or a burn, you should:

●Wash the area with soap and water.

●Do not pop or poke the blister with a sharp object. Opening the blister makes it more likely to get infected and slows healing.

●If the blister pops, keep the area clean and cover with a bandage to protect it.

●Do not scratch blisters. Scratching blisters makes them more likely to get infected. If you have itchy blisters, your doctor might recommend medicine to help with itching.

Most blisters heal in about a week.

Can blisters be prevented? — You can reduce your chances of getting blisters if you:

●Wear shoes that fit properly

●Use gloves or protective padding when working with tools

●Wear a hat, protective clothing, and sunscreen when out in the sun

Folliculitis

What is folliculitis? 

— Folliculitis is a skin problem that happens when a hair follicle gets infected. A hair follicle is a sac under the skin where a hair starts to grow. Usually, folliculitis happens because bacteria (a kind of germ) get into the hair follicle. Occasionally, folliculitis is caused by a fungus or virus in the hair follicle, or because of another reason.

What are the symptoms of bacterial folliculitis? — The main symptom is a group of small, raised red bumps on your skin. These bumps can be tender or itchy, and they might have pus in them.

What can I do on my own to treat it? — Wet a clean washcloth with warm water and put it on the bumps. When the cloth cools, reheat it with warm water and put it back on the area. Repeat these steps for 10 to 15 minutes, 3 times a day.

Do not shave the area that has folliculitis. That will just irritate it more and might spread the infection.

Should I see a doctor or nurse? — See your doctor or nurse if the folliculitis does not go away after you treat it at home. You should also see your doctor or nurse if:

●The bumps get larger or more painful

●The bumps go away but then come back

●You get a fever

Will I need tests? — Not usually. To make sure you do not have another skin condition, your doctor or nurse will ask about your symptoms and do an exam. If it is hard to tell what is causing your folliculitis, he or she might test a sample of pus, or do a different test.

What other treatment might I have? — If your bacterial folliculitis does not go away on its own, your doctor might prescribe an antibiotic cream. If a lot of your skin is affected, you might need an antibiotic pill. But most cases of folliculitis get better without treatment.

Bartholin Cyst

What is a Bartholin gland cyst? 

— A Bartholin gland cyst is a small sac of fluid that forms when the opening of a Bartholin gland is blocked. All women and girls have 2 Bartholin glands just below the opening of the vagina.

The Bartholin glands make small amounts of fluid. The fluid helps keep the vulva moist. (The vulva is the area around the opening of the vagina that includes the labia.) If something blocks the opening of a Bartholin gland, fluid can build up and form a cyst. This usually happens in just one gland, not both at once.

What are the symptoms of a Bartholin gland cyst? 

— Most women notice a lump in the vulva, but Bartholin gland cysts often do not cause any other symptoms. If they do, the main symptoms are pain or discomfort when a woman walks, sits, or has sex.

If a Bartholin gland cyst gets infected, it can form an abscess. An abscess is a pocket of pus that can cause a lump to form on the vulva. Symptoms of an abscess include:

●Severe pain – It might be painful to walk. You also might not be able to sit or have sex.

●Swelling

●Redness

Should I see a doctor or nurse? 

— See your doctor or nurse if:

●You see or feel a lump in the vulva.

●It is painful to walk, sit, or have sex.

Will I need tests? 

— Maybe. If you have an abscess, the doctor or nurse will send a small sample of the pus to a lab for testing. This can show what type of germ caused the infection. You might need antibiotics for an infection caused by certain germs.

If you are older than 40, the doctor or nurse might do a test called a “biopsy” to check for cancer. (Cancer in a Bartholin gland is rare, but it can happen.) In this test, the doctor takes a small sample of tissue from the area. Then he or she sends the tissue to a lab. Another doctor looks at it under a microscope to check for cancer.

How is a Bartholin gland cyst treated?

— Treatment depends on your age and whether the cyst is causing symptoms. If you do not have symptoms, you might not need any treatment. Otherwise, treatments can include:

Draining the cyst or abscess

– In this procedure, the doctor cuts a small hole to let fluid or pus out. Then he or she puts a tiny balloon in the hole to keep it from closing completely. The balloon is connected to a tiny tube called a “catheter” that helps fluid drain from the Bartholin gland. The doctor takes the balloon out in about 1 month. It leaves a small opening where fluid can drain. This procedure is often done in a doctor’s office. But if you have a large or deep abscess, you might need treatment in the hospital.

Antibiotics are usually not needed. But you might get them in some cases, like if you have had an abscess before or are at high risk of the infection spreading.

●Surgery – Doctors can do this if draining fluid and putting in a balloon does not work well. A doctor can make a new opening to help the Bartholin gland drain fluid. Or he or she can remove the gland and any cyst or abscess. But surgery has a higher risk of side effects than other treatments, so doctors don’t do it as often.

Lichen Planus

What is lichen planus? 

— Lichen planus is a condition that causes red, purple, or white spots to form on the skin. These spots often itch or hurt. Lichen planus can affect the skin anywhere on the body, including the skin in and around the vagina and penis, and the pink, moist skin that lines the mouth.

In most cases, doctors do not know what causes lichen planus.

What are the symptoms of lichen planus? 

— Lichen planus causes different symptoms, depending on which part of the body is affected.

●On the skin, it usually causes shiny, flat, red, or purple spots (picture 1). These spots tend to form on the wrists, arms, or legs, but might also show up on other areas. The spots are often very itchy. As the spots heal, they can turn dark.

●On the nails, it can cause lines or ridges to form.

●On the “mucous membranes,” the pink, moist skin that lines the inside of the mouth, the vagina, and other organs, it can cause redness, painful sores, or patterns that look like white lace. When lichen planus affects the mouth, it can make it hard to eat.

Should I see a doctor or nurse? 

— Yes, if you have symptoms like those listed above, see your doctor or nurse.

Your doctor or nurse will probably be able to tell if you have lichen planus by learning about your symptoms and doing an exam. It’s also possible your doctor or nurse will take a small sample of skin to send to the lab. This is called a skin “biopsy.”

How is lichen planus treated? 

— Treatment is different depending on which part of the body is affected and how bad the symptoms are. In general, treatment can include:

●Steroid medicines that come in ointments, creams, or gels – These steroid medicines reduce inflammation and help the skin heal. Examples include fluocinonide or clobetasol.

●Medicines called calcineurin inhibitors, such as pimecrolimus (brand name: Elidel) and tacrolimus (brand name: Protopic).

●Medicines that numb the skin and help with pain, especially for people who have sores on their mouth or sex organs.

●Pills that help to reduce inflammation and help the skin heal

●A special type of light treatment called phototherapy

Some people need to try more than one medicine before they find the medicine that works best for them.

Is there anything I can do on my own to feel better? 

— Yes. Here are some things you should do:

●Take good care of your skin. Wash and dry your skin gently when you take a shower or bath. Try not to scratch itchy skin because that can increase the chance of infection. Scratching can also make lichen planus worse.

●If you have lichen planus in your mouth, make sure you take good care of your teeth and gums. You should brush your teeth twice a day with a soft brush and floss every day. Not taking good care of your mouth could make lichen planus worse and might cause other problems from unhealthy teeth and gums.

Ingrown Toenail

What is an ingrown toenail? 

— An ingrown toenail happens when the side or corner of your toenail grows into the flesh around it. It usually affects the big toe.

What are the symptoms of an ingrown toenail? 

— The symptoms include pain, redness, and swelling where the nail has grown into the flesh.

Is there a test for an ingrown toenail? 

— No. Your doctor or nurse should be able to tell if you have it by learning about your symptoms and doing an exam.

Is there anything I can do on my own to feel better? 

— Yes. Some people feel better if they:

●Place a small piece of a cotton ball or some dental floss underneath the nail to take pressure off the toe.

●Soak the foot in warm, soapy water. Do this for 10 to 20 minutes, 2 to 3 times a day for 1 to 2 weeks. You can also use 1 to 2 teaspoons of Epsom salts (available in drug stores) in the water instead of soap.

Should I see a doctor or nurse?

 — See your doctor or nurse if redness and swelling become worse and there is pus.

How is an ingrown toenail treated? 

— If the treatments you have tried on your own don’t help, your doctor might cut away part of your toenail. He or she will first inject a medicine to numb your toe. Afterwards, you will need to:

●Clean the area 2 to 3 times per day. Make a mixture of equal parts of water and hydrogen peroxide and dab it on your toe with a cotton swab.

●Put antibiotic ointment on your toe. Examples include bacitracin and mupirocin (brand name: Bactroban).

Can an ingrown toenail be prevented?

 — You can reduce your chances of getting an ingrown toenail by:

●Wearing shoes that are not too tight around your toes

●Cutting your toenails straight across and not too short

Wound Care

Does my cut need stitches? 

— If your cut does not go all the way through the skin, it does not need stitches . If your cut is wide, jagged, or does go all the way through the skin, you will most likely need stitches. If you are unsure if your cut needs stitches, check with your doctor or nurse.

This article discusses cuts and scrapes that do not need stitches. Stitches are discussed in a separate article. 

How do I take care of a cut or scrape on my own? 

— To take care of your cut or scrape, follow these basic first aid guidelines:

●Clean the cut or scrape – Wash it well with soap and water. If there is dirt, glass, or another object in your cut that you can’t get out after you wash it, call your doctor or nurse.

●Stop the bleeding – If your cut or scrape is bleeding, press a clean cloth or bandage firmly on the area for 20 minutes. You can also help slow the bleeding by holding the cut above the level of your heart. If the bleeding doesn’t stop after 20 minutes, call your doctor or nurse.

●Put a thin layer of antibiotic ointment on the cut or scrape.

●Cover the cut or scrape with a bandage or gauze. Keep the bandage clean and dry. Change the bandage 1 to 2 times every day until your cut or scrape heals.

●Watch for signs that your cut or scrape is infected.

Most cuts and scrapes heal on their own within 7 to 10 days. As your cut or scrape heals, a scab will form. Be sure to leave the scab alone and not pick at it.

When should I call the doctor or nurse? 

— Call the doctor or nurse if you have any signs of an infection. Signs of an infection include:

●Fever

●Redness, swelling, warmth, or increased pain around the cut or scrape

●Pus draining from the cut or scrape

●Red streaks on the skin around the cut or scrape

Cuts called “puncture wounds” have a higher chance of getting infected. A puncture wound is a type of cut that is made when a sharp object goes through the skin and into the tissue underneath.

Will I need a tetanus shot? 

— Maybe. It depends on how old you are and when your last tetanus shot was. Tetanus is a serious infection that can cause muscle stiffness and spasms, and even lead to death. It is caused by bacteria (germs) that live in the dirt.

Most children get a tetanus vaccine as part of their routine check-ups. Vaccines can prevent certain serious or deadly infections. Many adults also get a tetanus vaccine as part of their routine check-ups. Getting all your vaccines is important, since it’s possible to get tetanus even from a small cut or scrape.

If your skin is cut, and especially if the cut is dirty or deep, ask your doctor or nurse if you need a tetanus shot.

Dr. Carlo Oller
Board Certified Emergency Physician

Please visit my website,

www.DrER.tv
make sure you subscribe, comment, and share!
That is the best way to show your support.

How to take care of a laceration after the repair?

Does my cut need stitches? 

— If your cut does not go all the way through the skin, it does not need stitches . If your cut is wide, jagged, or does go all the way through the skin, you will most likely need stitches. If you are unsure if your cut needs stitches, check with your doctor or nurse.

This article discusses cuts and scrapes that do not need stitches. Stitches are discussed in a separate article.

How do I take care of a cut or scrape on my own? 

— To take care of your cut or scrape, follow these basic first aid guidelines:

Clean the cut or scrape – Wash it well with soap and water. If there is dirt, glass, or another object in your cut that you can’t get out after you wash it, call your doctor or nurse.

Stop the bleeding – If your cut or scrape is bleeding, press a clean cloth or bandage firmly on the area for 20 minutes. You can also help slow the bleeding by holding the cut above the level of your heart. If the bleeding doesn’t stop after 20 minutes, call your doctor or nurse.

Put a thin layer of antibiotic ointment on the cut or scrape.

Cover the cut or scrape with a bandage or gauze. Keep the bandage clean and dry. Change the bandage 1 to 2 times every day until your cut or scrape heals.

Watch for signs that your cut or scrape is infected.

Most cuts and scrapes heal on their own within 7 to 10 days. As your cut or scrape heals, a scab will form. Be sure to leave the scab alone and not pick at it.

When should I call the doctor or nurse? 

— Call the doctor or nurse if you have any signs of an infection. Signs of an infection include:

Fever

Redness, swelling, warmth, or increased pain around the cut or scrape

Pus draining from the cut or scrape

Red streaks on the skin around the cut or scrape

Cuts called “puncture wounds” have a higher chance of getting infected. A puncture wound is a type of cut that is made when a sharp object goes through the skin and into the tissue underneath.

Will I need a tetanus shot? 

— Maybe. It depends on how old you are and when your last tetanus shot was. Tetanus is a serious infection that can cause muscle stiffness and spasms, and even lead to death. It is caused by bacteria (germs) that live in the dirt.

Most children get a tetanus vaccine as part of their routine check-ups. Vaccines can prevent certain serious or deadly infections. Many adults also get a tetanus vaccine as part of their routine check-ups. Getting all your vaccines is important, since it’s possible to get tetanus even from a small cut or scrape. If your skin is cut, and especially if the cut is dirty or deep, ask your doctor or nurse if you need a tetanus shot.
Dr. Carlo Oller Board Certified Emergency Physician Please visit my website, www.DrER.tv make sure you subscribe, comment, and share! That is the best way to show your support.

Tinea Versicolor

(Pityriasis versicolor)

 

What tinea versicolor? — Tinea versicolor is a skin infection that causes areas of the skin to change color. The skin might have lighter patches, darker patches, or both light and dark patches.

Tinea versicolor is caused by a fungus. This fungus lives on people’s skin and does not cause problems normally. But in some people, the fungus can cause tinea versicolor. This happens more often in people who live where the weather is hot and humid.

Even though tinea versicolor is caused by fungus, it does not spread from one person to another. It is not “contagious.”

What are the symptoms of tinea versicolor? — Tinea versicolor often appears as lots of small spots of color that seem to run into each other and form large patches. The colors can vary from white to light brown, dark brown, gray-black or pinkish red. There can also be a mix of colors.

Tinea versicolor usually shows up on the back, chest, or upper arms. It can also happen on the face or in places where the skin rubs together, such as the armpit.

People often notice this problem more in the summer when affected areas of the skin stand out because they don’t get tan from the sun.

Is there a test for tinea versicolor? — Yes. After learning about your symptoms and doing an exam, your doctor or nurse might gently scrape the surface of your skin and look at the scrapings under a microscope. This procedure is usually not painful. If you have tinea versicolor, the doctor or nurse will see the fungus that causes the condition in the scrapings from your skin.

How is tinea versicolor treated? — Most mild cases of tinea versicolor only need a special “shampoo” or cream. The shampoo is used like a soap on the affected skin.

If your tinea versicolor covers a large part of your body, or if it doesn’t get better with the shampoo or cream, you might need medicine that comes in pills. Your doctor will decide if you need pills.

Even after you get treated, your skin might not go back to its normal color for several months. This does not mean the treatment didn’t work. It just takes time for the skin to heal.

First-line therapy — Topical antifungal medications, topical selenium sulfide, and topical zinc pyrithione are effective and well-tolerated first-line therapies for tinea versicolor.

Topical antifungals — Topical azole antifungals, topical terbinafine, and topical ciclopirox improve tinea versicolor via direct antifungal activity. Effective treatment regimens ranging from a few days to four weeks in length are reported in the literature.

Azole antifungals – Small randomized trials support the efficacy of various topical azole antifungals. In one randomized trial, ketoconazole 2% cream applied once daily for 11 to 22 days (mean 14 days) was superior to placebo (84 versus 22 percent achieved mycologic cure). A typical course of treatment with a topical azole antifungal is daily application for two weeks.

The shampoo formulation of ketoconazole appears to be effective with a shorter duration of therapy. The shampoo is applied to affected areas and is washed off after five minutes. In a randomized trial, a single application of ketoconazole 2% shampoo was compared with treatment on three consecutive days. Both regimens resulted in mycologic cure in approximately 80 percent of patients.

Terbinafine – Topical terbinafine 1% solution applied twice daily for one week has been proven effective in small randomized trials.

Ciclopirox – Topical ciclopirox olamine 1% cream was effective in two small randomized trials when applied twice daily for 14 days.

Selenium sulfide — Topical selenium sulfide exerts antifungal activity primarily through the promotion of shedding of the infected stratum corneum. In a randomized trial, application of selenium sulfide 2.5% lotion for 10 minutes for seven days was superior to placebo in achieving mycologic cure (81 versus 15 percent cured, respectively).

The shampoo formulation of selenium sulfide 2.5% is often prescribed in clinical practice. Patients apply the shampoo to the affected area daily for one week. The shampoo is rinsed off after 10 minutes.

A non-prescription selenium sulfide 1% shampoo is also available, but the efficacy of this product for the treatment of tinea versicolor has not been studied. Selenium sulfide 2.25% foam is a newer product that is applied twice daily without rinsing.

Zinc pyrithione — In a controlled trial that included 40 patients with tinea versicolor, zinc pyrithione 1% shampoo applied for five minutes per day for two weeks was more effective than placebo for the treatment of tinea versicolor. All patients treated with zinc pyrithione shampoo were successfully treated compared with none of the patients in the placebo group.

Severe or recalcitrant disease — Oral therapy is reserved for patients with tinea versicolor that is refractory to topical therapy or widespread disease that makes the application of topical drugs difficult. It is important to note that persistent dyspigmentation is not a good indicator of failure of topical therapy. 

Oral therapies — Oral azole antifungals such as itraconazole and fluconazole are effective for the treatment of tinea versicolor. In contrast to topical terbinafine, oral terbinafine is not effective. Similarly, griseofulvin cannot be used for this condition.

Systemic therapy is not used as a first-line treatment for limited tinea versicolor to minimize risk of adverse effects. Abnormalities in liver function tests and drug interactions can occur with systemic azole antifungals. 

Oral therapy is not typically used for the treatment of tinea versicolor in children.

Itraconazole — Itraconazole therapy for tinea versicolor in adults is usually given as 200 mg per day for five days. Multiple randomized trials have reported mycologic cure rates between 70 and 100 percent with 200 mg of itraconazole daily for seven days, and dose comparison studies have shown similar success with treatment durations of five days.

Data conflict on the efficacy of a single 400 mg dose of itraconazole. In a randomized, open-label trial, a single 400 mg dose was as effective as 200 mg daily for seven days. However, a low rate of response to a single 400 mg dose of itraconazole was reported in a trial that compared single-dose fluconazole and single-dose itraconazole.

Fluconazole — Fluconazole for tinea versicolor in adults is typically given as a 300 mg dose once weekly for two weeks. In a small, uncontrolled study, 300 mg once weekly for two weeks led to mycologic and clinical cure in 75 percent of patients with tinea versicolor. A dose-finding randomized trial also supports the efficacy of this regimen; 300 mg once weekly for up to two weeks resulted in mycologic cure in 87 percent of patients.

A single dose of fluconazole may be effective. In an uncontrolled study of 24 individuals with extensive or recurrent tinea versicolor treated with a single 400 mg dose of fluconazole, resolution of clinical disease occurred in 74 percent.

Other therapies — Additional topical and systemic therapies have been used for the treatment of tinea versicolor.

Topical agents – Whitfield ointment and sulfur-salicylic acid shampoo are effective for tinea versicolor, but may cause skin irritation in a minority of patients. Small uncontrolled studies suggest that propylene glycol and benzoyl peroxide may also improve tinea versicolor.

Oral ketoconazole – Although oral ketoconazole was effective for tinea versicolor in small randomized trials, life-threatening hepatotoxicity and adrenal insufficiency, along with multiple potential drug-drug interactions, have been reported with oral ketoconazole therapy, making it an unfavorable choice for the treatment of tinea versicolor. Although these adverse effects appear to be rare with the short duration of therapy used for tinea versicolor [44], knowledge of the potential for hepatotoxicity and the wide availability of safer oral antifungal agents led the European Medicines Agency to release a 2013 recommendation that marketing authorizations for oral ketoconazole be suspended throughout the European Union [45]. The US Food and Drug Administration (FDA) simultaneously removed its indication for use of the drug for dermatophyte and Candida infections based upon risks for hepatotoxicity, adrenal insufficiency, and drug-drug interactions. The FDA also recommended that oral ketoconazole should not be used as a first-line agent for any fungal infection. The indications for treatment of blastomycosis, coccidioidomycosis, histoplasmosis, chromomycosis, and paracoccidioidomycosis have been retained only for patients in whom other antifungal treatments have failed or are not tolerated.

In 2016, following an FDA safety review that found continued prescribing of oral ketoconazole for fungal skin and nail infections, the FDA released a drug safety communication warning healthcare professionals to avoid prescribing oral ketoconazole for fungal skin and nail infections. The risks of oral ketoconazole treatment outweigh the benefits.  

Treatment failure — Hypopigmentation and hyperpigmentation can persist for months following successful treatment of tinea versicolor, and may cause patients to assume incorrectly that treatment has failed. The presence of scale plus a positive potassium hydroxide (KOH) preparation is considered indicative of active infection.

Resistance to therapy, frequent recurrence, or widespread disease should prompt consideration of an immunodeficient state.

Can tinea versicolor be prevented? — If the tinea versicolor keeps coming back, there are shampoos or medicines that can help prevent it. Your doctor will work with you on the best treatment plan for your situation.

Dr. Carlo Oller
Board Certified Emergency Physician

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Contact Dermatitis

DERMATITIS OVERVIEW 

— Dermatitis is defined as an inflammation of the skin resulting in redness, itching, and/or scale. Contact dermatitis refers to dermatitis that is caused by contact between the skin and a substance. The substance can be an allergen (a substance that provokes an allergic reaction) or an irritant (a substance that damages the skin). Irritants are responsible for about 80 percent of cases of contact dermatitis.

In most cases, self-care measures and drug therapy can control the symptoms and prevent complications of contact dermatitis.

IRRITANT CONTACT DERMATITIS 

— Irritant contact dermatitis occurs when the skin comes in direct contact with a substance that physically, mechanically, or chemically irritates the skin, causing the normal skin barrier to be disrupted.

Cause — 

The most common causes of irritant dermatitis are products used on a daily basis, including soap, cleansers, and rubbing alcohol. People with other skin conditions, dry skin, and light-colored or “fair” skin are at greatest risk, although anyone can develop irritant dermatitis.

Symptoms 

— Mild irritants cause redness, dryness, fissures (small cracks), and itching. Strong irritants may cause swelling, oozing, tenderness, or blisters. The hands are commonly affected, often between the fingers. Irritant dermatitis can also affect the face, especially the thin skin of the eyelids.

Diagnosis 

— The diagnosis of irritant contact dermatitis is usually based upon a person’s history and physical examination. In some cases, a patch test (applying a small amount of a substance to the skin) may be recommended to determine if the dermatitis is allergic or irritant-type. Patch testing should be done by a dermatologist or allergist who is trained in this procedure.

Treatment

— The goal of treatment of irritant contact dermatitis is to restore the normal skin barrier and protect the skin from future injury. Reducing or avoiding altogether exposure to known irritants is essential. In some cases, simply reducing the use of soap and using an emollient cream or ointment completely alleviates symptoms. Wearing gloves when working with irritants may help as well.

In more severe cases, topical corticosteroids (steroids) may be recommended. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription. Steroid treatments for contact dermatitis are most effective when applied and covered with a barrier, such as plastic wrap, a dressing (eg, Telfa), cotton gloves, or petroleum jelly. Oral steroids (eg, prednisone) may be used briefly to treat severe dermatitis, but are not recommended for long-term treatment of irritant contact dermatitis.

ALLERGIC CONTACT DERMATITIS

 — Allergic contact dermatitis occurs when the skin comes in direct contact with an allergen. This activates the body’s immune system, which triggers inflammation. Allergic contact dermatitis can occur after being exposed to a new product or after using a product for months or years. Weak allergens require exposure of weeks to months before they cause dermatitis. The patient can help find the cause of allergic contact dermatitis by providing a history of exposures. As an example, if the patient presents with sudden-onset allergic contact dermatitis with blisters, plant exposure history is most helpful. In contrast, with chronic allergic contact dermatitis with skin redness and thickening, exposure to everyday items, such as clothing, shoes, cosmetics, and metals, should be mentioned.

Common allergens 

— Poison ivy, poison oak, and poison sumac contain an oil called urushiol, which is the most common cause of allergic contact dermatitis. Ginkgo fruit and the skin of mangos also contain urushiol and can cause allergic contact dermatitis.

Other common allergens include nickel in jewelry, perfumes and cosmetics, components of rubber, nail polish, and chemicals in shoes (both leather and synthetic. Allergic contact dermatitis can also be triggered by certain medications, including hydrocortisone cream, antibiotic creams (sample brand names: Neosporin, Bacitracin), benzocaine, and thimerosal. Laundry detergents are an uncommon cause of allergic contact dermatitis.

Symptoms 

— Symptoms include intense itching and a red raised rash. The rash may blister in severe cases. The rash is usually limited to areas that were in direct contact with the allergen, but a rash can appear in other areas of the body, if the allergen was transferred to those areas on a person’s hands. Washing the allergen away with soap and water can usually prevent this spread.

The rash typically appears within 12 to 48 hours of exposure to the allergen, although in some cases it may not appear for up to two weeks. Less commonly, the rash persists for months or years, which makes it difficult to identify the cause of the reaction.

Diagnosis 

— The diagnosis of allergic contact dermatitis is based upon a person’s history and physical examination. If symptoms improve after the allergen is eliminated, this supports the diagnosis. Patch testing may be recommended in some cases and is usually performed by a dermatologist or allergist.

Treatment — Allergic contact dermatitis usually resolves within two to four weeks after the allergen is eliminated, although it can take more time in some cases. Several measures can minimize symptoms during this time and help to control symptoms in people who have chronic allergic contact dermatitis.

Whenever possible, identify and stop all exposure to the allergen.

Oatmeal baths or soothing lotions such as calamine lotion can provide relief in mild cases.

Topical corticosteroids (steroids) may be recommended for people with mild to moderate symptoms. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available in the United States without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.

For people with more bothersome symptoms, wet or damp dressings are recommended, especially when the affected area is oozing fluid and crusting. Such dressings are soothing and relieve itching, reduce redness, gently remove crusts, and prevent additional injury from scratching.

A damp cotton garment (the garment is soaked with water and then wrung out) is worn over the affected area and covered with a dry garment. As an example, for an adult with allergic contact dermatitis of the legs, wet long underwear can be covered with larger dry long underwear. Adults may prefer to apply wet dressings at night. When used during the day, wet dressings should be changed every eight hours. Infants and toddlers with extensive skin involvement can wear wet pajamas covered by a dry pair of pajamas or a sleep sack.

In people with severe dermatitis, a short course of steroid pills (eg, prednisone) may be recommended to get symptoms under control.

The use of topical antihistamines (sample brand name: Benadryl) should be avoided because it can cause contact dermatitis.

LATEX DERMATITIS 

— Latex is a fluid produced by rubber trees that is processed into a variety of products, including gloves, balloons, and condoms. In some individuals, exposure to these products and others can cause a contact dermatitis that is either an irritant or allergic reaction. Less commonly, a person can develop a potentially life-threatening allergic reaction to latex.

Irritant dermatitis 

— Irritant dermatitis usually occurs on the hands of people who wear latex or other rubber gloves, but the problem is not the latex. These gloves—whether or not they contain latex—often contain chemical additives that irritate the skin. Also, the gloves trap moisture against the skin, making it softer and more vulnerable to irritants. The combination of these factors can lead to dermatitis.

The symptoms of irritant rubber or latex dermatitis include redness and itching on the skin. There may also be dryness and cracking. People with irritant dermatitis often believe they have a latex allergy and then discover that their dermatitis occurs even when they use latex-free gloves. For them, treatment involves avoiding products that contain the irritants and using an emollient cream or ointment.

Latex allergy 

— A true latex allergy causes a different response than that seen with irritant dermatitis. A latex allergy can cause hives (raised, red, itchy welts on the skin), nasal and eye irritation or congestion, asthma, and even a life-threatening reaction called anaphylaxis. Also, people who have a latex allergy often also have allergic responses to fruits or vegetables that contain proteins similar to those found in latex. These foods include banana, kiwi, avocado, chestnut, papaya, potato, and tomato.

Diagnosis — To diagnose a latex allergy, healthcare providers learn as much as possible about a person’s responses when they have been exposed to latex and related allergens in the past. If the pattern suggests a latex allergy, they usually confirm the allergy using blood or skin tests. In the United States, the preferred way to diagnose a latex allergy is through a blood test. In other parts of the world, diagnosis can be done with skin tests using latex derivatives, but such testing products are not easily available in the United States. Diagnosis of a latex allergy is usually done by an allergist

Treatment 

— The primary treatment for latex allergy is to avoid all latex-containing products. Non-latex examination gloves are widely available, and use of glove liners may also be an effective approach.

Natural membrane (sometimes called sheep skin) condoms may be used in place of latex condoms, and are effective for preventing pregnancy. However, natural membrane condoms do not protect against sexually transmitted diseases such as HIV, gonorrhea, and chlamydia. People with a serious latex allergy should wear a bracelet, necklace, or similar alert tag at all times. If a reaction occurs and the person is too ill to explain their condition, this will help responders provide the proper care as quickly as possible. This measure is especially important in children. The alert tag should include a list of known allergies, as well as the name and phone number of an emergency contact. People with a latex allergy should inform their doctors, dentists, and other healthcare providers about their allergy. Some patients are advised to carry an anaphylaxis kit (containing epinephrine that can be injected under the skin) as a precautionary measure.
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