Tag Archives: skin

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.

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

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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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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.