Tag Archives: rash

Herpes (Genital)

What is herpes? 

— Herpes is an infection that can cause blisters and open sores on the genital area. Herpes is caused by a virus that is passed from person to person during vaginal, oral, or anal sex. Sometimes, people do not know they have herpes because they do not have any symptoms.

Herpes cannot be cured. But the disease usually causes most problems during the first few years. After that, the virus is still there, but it causes few to no symptoms. Even when the virus is active, people with herpes can take medicines to reduce and help prevent symptoms.

What are the symptoms of herpes? 

— Some people with herpes never have any symptoms. But other people can develop symptoms within a few weeks of being infected with the herpes virus.

Symptoms usually include blisters in the genital area. In women, this area includes the vagina, butt, anus, or thighs. In men, this area includes the penis, scrotum, anus, butt, or thighs. The blisters can become painful open sores, which then crust over as they heal.

Sometimes, people can have other symptoms that include:

●Blisters on the mouth or lips

●Fever, headache, or pain in the joints

●Trouble urinating

In people with herpes, symptoms usually go away and come back. A return of symptoms is called an “outbreak.” Outbreaks usually include blisters and open sores in the genital area. In most people, the first outbreak is the worst and can last as long as 2 to 3 weeks. Outbreaks that happen later are usually not as severe and do not last as long.

Outbreaks might occur every month or more often, or just once or twice a year. Sometimes, people can tell when an outbreak will occur, because they feel itching or pain beforehand. Sometimes they do not know that an outbreak is coming because they have no symptoms. Whatever your pattern is, keep in mind that herpes outbreaks usually become less frequent over time as you get older.

Certain things, called “triggers,” can make outbreaks more likely to occur. These include stress, sunlight, menstrual periods, or getting sick.

Is there a test for herpes? 

— Yes. If you have blisters or ulcers when your doctor or nurse examines you, he or she can order a test to look for herpes. There are a few different tests that can do this. For all of them, the doctor or nurse takes a sample of cells or fluid from a sore and sends it to the lab. Sometimes they will also take a blood sample to find out if you have been exposed to the virus.

Should I see a doctor or nurse? 

— See your doctor or nurse the first time you have symptoms, or if your symptoms are severe.

How is herpes treated? 

— Your doctor can prescribe different medicines to help reduce symptoms and speed up the healing of an outbreak. These medicines work best when people start them soon after an outbreak starts. You and your doctor should work together to decide which medicine is right for you.

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

— Yes. To reduce the pain during an outbreak, you can:

●Use a portable bath (such as a “Sitz bath”) where you can sit in warm water for about 20 minutes. Your bathtub could also work. Avoid bubble baths.

●Keep the genital area clean and dry, and avoid tight clothes.

●Take over-the-counter pain medicine such as acetaminophen (brand name: Tylenol) or ibuprofen (sample brand names: Advil, Motrin). But avoid aspirin.

You should also let your doctor or nurse know if you are worried or upset about your herpes. He or she can talk with you about your feelings. Plus, you might want to join a support group for people with herpes. You can also call the Centers for Disease Control and Prevention (CDC) STD hotline at 1-800-227-8922 for help.

What if I am pregnant? 

— If you are pregnant, talk with your doctor. It is possible for a baby to get herpes from its mother during birth, especially if the mother’s first outbreak starts near the time of delivery. Talk with your doctor or nurse about things you can do to help prevent this.

Can future outbreaks of symptoms be prevented? 

— Some people with herpes take a medicine every day to help prevent future outbreaks.

What can I do to prevent spreading herpes to my sex partner? 

People are most likely to spread herpes to a sex partner when they have blisters and open sores on their body. But people can also spread herpes to their sex partner when they do not have any symptoms. That is because herpes can be present on the body without causing any symptoms, like blisters or pain. You can decrease the risk of spreading herpes to your partner by taking an antiviral medicine every day.

You can also reduce the chance of your sex partner getting herpes by:

●Telling your sex partner that you have herpes

●Using a condom every time you have sex

●Not having sex when you have symptoms

●Not having oral sex if you have blisters or open sores (in the genital area or around your mouth)

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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Ringworm

What are ringworm, athlete’s foot, and jock itch?

They are skin infections caused by a fungus. These types of fungal infections are also called “tinea.”

Some people call these fungal infections “ringworm,” because they often cause a ring-shaped, red, itchy rash on the skin. But a ring-shaped rash is not always there. People with athlete’s foot might instead have moist, raw skin between their toes, or flaking skin on the bottoms of their feet. People with jock itch often just have a red rash on the groin. Sometimes, especially in children, the fungus can infect the scalp. On the scalp, the infection can look like a bald spot or a round flaky patch of skin.

How did I get a fungal infection? 

— You can catch fungal infections from anyone who is infected. You can also catch them from an infected dog or cat. Plus, you can pick up the infections from places where the fungus might be, such as:

A shower stall

The locker room floor

The area near a pool

If you have a fungal infection on one part of your body, you can also spread it to other parts. For instance, men with a fungal infection on their feet sometimes spread it to their groin.

How are fungal infections treated? 

— The treatment for a fungal infection depends on which body part is affected. If you have a fungal infection on your scalp, you must take pills that will kill the fungus. Treatment for scalp infections usually lasts 1 to 3 months.

If you have a fungal infection on your feet, groin, or another body part, you probably will not need pills. Instead, you can use a special gel, cream, lotion, or powder that kills fungus. Treatment with these products lasts 2 to 4 weeks. If you have a fungal infection on your groin and on your feet, you must treat both infections at the same time. If you do not, the infection on your feet can spread to your groin again.

How do I keep from getting a fungal infection again? 

— If someone in your home has had a fungal infection on their scalp:

Get rid of any combs, brushes, barrettes, or other hair products that could have the fungus on them

Make sure a doctor or nurse checks everyone in the house for a fungal infection

If the fungal infection might have come from a pet, have it checked by a vet

Here are some other general tips on how to prevent fungal infections:

Do not share unwashed clothes, sports gear, or towels with other people

Always wear slippers or sandals when at the gym, pool, or other public areas. That includes public showers.

Wash with soap and shampoo after sports or exercise

Change your socks and underwear at least once a day

Keep your skin clean and dry. Always dry yourself well after swimming or showering.

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.

Allergic Reacion

An allergic reaction is the body’s way of responding to an “invader.” When the body senses a foreign substance, called an antigen, the immune system is triggered. The immune system normally protects the body from harmful agents such as bacteria and toxins. Its overreaction to a harmless substance (an allergen) is called a hypersensitivity reaction, or an allergic reaction. screen-shot-2016-07-20-at-9-31-52-am 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.