Vitiligo refers to the development of white patches anywhere on the skin. With this condition, pigment-forming cells (known as melanocytes) are destroyed by the immune system causing the loss of pigmentation in the skin. Vitiligo usually develops between the ages of 10 and 40. It affects both men and women and appears to be hereditary.

Vitiligo usually affects areas of skin that have been exposed to sun. It also appears in body folds, near moles or at the site of previous skin injury. The condition is permanent and there is no known cure or prevention. However, there are some treatments that can be used to improve the appearance of the skin, such as steroid creams and ultraviolet light therapy.

A blister is a soft area of skin filled with a clear fluid. Blisters may form in response to an irritant. Frequently, the blister is caused from friction, such as a coarse fabric rubbing repeatedly against a person’s skin. In other cases, blisters form in response to a chemical or allergic irritant, which is known as contact dermatitis. Some oral and topical drugs may cause blisters to appear. Blisters can also be symptomatic of bacterial or viral skin infections, such as cold sores, chicken pox, shingles, impetigo or ringworm. Lastly, blisters occur when the skin is exposed to a flame, comes in contact with a hot surface or is overexposed to the sun.

Most blisters do not require medical attention. The most important information to remember is never to pop or break open a blister. A blister acts as a protective covering for damaged skin and helps prevent infection. If a blister does open on its own, be sure to leave the covering in place to support further healing. Simply wash the area gently with mild soap and water, pat it dry and apply an antibacterial ointment. Cover the blister with bandage to keep it clean. Replace the dressing at least once a day. Watch for signs of infection, such as a white or yellow pus coming from the blister, redness or red streaks around the blister or an increase in skin temperature around the blister.

To avoid blisters, you need to eliminate the irritant. Some simple ways to avoid blisters are to avoid tight clothing, make sure socks and shoes fit properly, and when doing heavy work with your hands, wear work gloves.

Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body. The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will then cycle through flare-ups and remissions throughout the rest of the patient’s life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.

In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.

Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.

Types of Psoriasis

There are five distinct types of psoriasis:

• Plaque Psoriasis (Psoriasis Vulgaris)  About 80% of all psoriasis sufferers get this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red lesions covered by silvery-white scales.
• Guttate Psoriasis This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
• Inverse Psoriasis This type of psoriasis appears as bright red lesions that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
• Pustular Psoriasis  Pustular psoriasis looks like white blisters filled with pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, infections and sudden withdrawal from systemic (treating the whole body) medications.
• Erythrodermic Psoriasis One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.

People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.

Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.

Treatment

Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.

Mild to Moderate Psoriasis

Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.

Over-the-Counter Medications

The U.S. Food and Drug Administration has approved of two active ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:

• Scale lifters that help loosen and remove scales so that medicine can reach the lesions.
• Bath solutions, like oilated oatmeal, Epsom salts or Dead Sea salts that remove scaling and relieve itching.
• Occlusion, in which areas where topical treatments have been applied are covered to improve absorption and effectiveness.
• Anti-itch preparations, such as calamine lotion or hydrocortisone creams.
• Moisturizers designed to keep the skin lubricated, reduce redness and itchiness and promote healing.

Prescription Topical Treatments

Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:

• Anthralin, used to reduce the growth of skin cells associated with plaque.
• Calcipotriene, that slows cell growth, flattens lesions and removes scales. It is also used to treat psoriasis of the scalp and nails.
• Calcipotriene and Betamethasone Dipropionate. In addition to slowing down cell growth, flattening lesions and removing scales, this treatment helps reduce the itch and inflammation associated with psoriasis.
• Calcitriol, an active form of vitamin D3 that helps control excessive skin cell production.
• Tazarotene, a topical retinoid used to slow cell growth.
• Topical steroids, the most commonly prescribed medication for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions.

Light Therapy/Phototherapy

Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:

• Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be in controlled, short bursts.
• Excimer lasers. These devices are used to target specific areas of psoriasis. The laser emits a high-intensity beam of UVB directly onto the psoriasis plaque. It generally takes between 4 and 10 treatments to see a tangible improvement.
• Pulse dye lasers. Similar to the excimer laser, a pulse dye laser uses a different wavelength of UVB light. In addition to treating smaller areas of psoriasis, it destroys the blood vessels that contribute to the formation of lesions. It generally takes about 4 to 6 sessions to clear up a small area with a lesion.

Moderate to Severe Psoriasis

Treatments for moderate to severe psoriasis include prescription medications, biologics and light therapy/phototherapy.

Oral medications. This includes acitretin, cyclosporine and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.

Biologics. A new classification of injectable drugs, biologics are designed to suppress the immune system. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases.

Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:

• Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be limited to controlled, short bursts.
• PUVA. This treatment combines a photosensitizing drug (psoralens) with UVA light exposure. This treatment takes several weeks to produce the desired result. In some severe cases, phototherapy using UVB light may lead to better results.

Head lice are small parasitic insects that thrive in human hair by feeding on tiny amounts of blood from the scalp. An estimated six to 12 million infestations occur in the U.S. annually. It is particularly common among pre-school and elementary school children. Head lice do not transmit any diseases, but they are very contagious and can be very itchy. They are characterized by the combination of small red bumps and tiny white specks (also known as eggs or nits) on the bottom of hair closest to the skin (less than a quarter-inch from the scalp).

Head lice are visible to the naked eye. The eggs look like yellow, tan or brown dots on a hair. Live lice can also be seen crawling on the scalp. When eggs hatch, they become nymphs (baby lice). Nymphs grow to adult lice within one or two weeks of hatching. An adult louse is about the size of a sesame seed. Lice feed on blood from the scalp several times a day. They can also survive up to two days off of the scalp.

Head lice are spread through head-to-head contact; by sharing clothing, linens, combs, brushes, hats and other personal products; or by lying on upholstered furniture or beds of an infested person. You can determine if your child has head lice by parting the child’s hair and looking for nits or lice, particularly around the ears and nape of the neck. If one member of your family is diagnosed with head lice, you’ll need to check on every member of the same household.

Medicated lice treatments include shampoos, cream rinses and lotions that kill the lice. Many of these are over-the-counter, but prescription drugs are available for more severe cases. It is important to use these medications exactly as instructed and for the full course of treatment to eliminate the lice. Do not use a cream rinse, conditioner or combined shampoo and conditioner on your hair before a lice treatment. You also should not shampoo for one or two days following the application of a treatment. After applying the medicated treatment, use a special comb to comb out any nits on the scalp. Repeat the entire treatment seven to ten days after the initial treatment to take care of any newly hatched lice. Please note that you should not treat a person more than three times with any individual lice medication.

To get rid of the lice, you’ll also have to:

• Wash all bed linens and clothing warm by the infested person in very hot water.
• Dry clean clothing that is not machine washable.
• Vacuum upholstery in your home and car.
• Any items, such as stuffed toys, that can’t be machine-washed can be placed in an airtight bag and stored away for two weeks. Lice cannot survive this long without feeding.
• Soak combs, brushes, headbands and other hair accessories in rubbing alcohol or medicated shampoo for at least one hour or throw them away.

If your child still has head lice after two weeks with over-the-counter medicated products, contact your dermatologist for more effective treatment.

“Rash” is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.

Rashes can be a symptom for other skin problems. The most prevalent of these are:

• Atopic Dermatitis, the most common form of eczema.
• Bacterial Infections, such as impetigo.
• Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
• Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
• Fungal Infections, such as ringworm and yeast infection.
• Viral Infections, such as shingles.

A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.

Eczema is a general term used to describe an inflammation of the skin. In fact, eczema is a series of chronic skin conditions that produce itchy rashes; scaly, dry and leathery areas; skin redness; or inflammation around blisters. It can be located anywhere on the body, but most frequently appears in the creases on the face, arms and legs. Itchiness is the key characteristic and symptom of eczema. When scratched, the lesions may begin to ooze and get crusted. Over time, painful cracks in the scaly, leathery tissue can form.

Eczema affects people of all races, genders and ages. It is thought to be hereditary and is not contagious. The cause of eczema remains unknown, but it usually has physical, environmental or lifestyle triggers. Coming into contact with a trigger, such as wind or an allergy-producing fabric, launches the rash and inflammation. Although it is possible to get eczema only once, the majority of cases are chronic and are characterized by intermittent flare-ups throughout a person’s life.

For mild cases, over-the-counter topical creams and antihistamines can relieve the itching. In persistent cases, a dermatologist will likely prescribe stronger medicine, such as steroid creams, oral steroids (corticosteroids), antibiotic pills or antifungal creams to treat any potential infection.

The best form of prevention is to identify and remove the trigger. You should also use mild cleansers and keep your skin well moisturized at all times. Also avoid scratching the rash (which can lead to infection) and situations that make you sweat, such as strenuous exercise.

Leading Types of Eczema

Eczema takes on different forms depending on the nature of the trigger and the location of the rash. While they all share some common symptoms, like itchiness, there are differences. Following are some of the most common types of eczema.

Atopic Dermatitis

The most frequent form of eczema, atopic dermatitis is thought to be caused by abnormal functioning of the body’s immune system. It is characterized by itchy, inflamed skin. Atopic dermatitis tends to run in families. About two-thirds of the people who develop this form of eczema do so before the age of one. Atopic dermatitis generally flares up and recedes intermittently throughout the patient’s life.

Contact Dermatitis

Contact dermatitis is caused when the skin comes into contact with an allergy-producing agent or an irritant, such as chemicals. Finding the triggering allergen is important to treatment and prevention. Allergens can be things like laundry detergent, cosmetics, jewelry, fabrics, perfume, diapers and poison ivy or poison sumac.

Dyshidrotic Dermatitis

This type of eczema strikes the palms of the hands and soles of the feet. It produces clear, deep blisters that itch and burn. Dyshidrotic dermatitis occurs most frequently during the summer months and in warm climates.

Neurodermatitis

Also known as Lichen Simplex Chronicus, this is a chronic skin inflammation caused by a continuous cycle of scratching and itching in response to a localized itch, like a mosquito bite. It creates scaly patches of skin, most commonly on the head, lower legs, wrists or forearms. Over time, the skin may become thickened and leathery.

Nummular Dermatitis

This form of eczema appears as round patches of irritated skin that may be crusted, scaly and extremely itchy. Nummular dermatitis most frequently appears on the arms, back, buttocks and lower legs, and is usually a chronic condition.

Seborrheic Dermatitis

Seborrheic dermatitis is a common condition that causes yellowish, oily and scaly patches on the scalp, face or other body parts. Dandruff, in adults, and cradle cap, in infants, are both forms of seborrheic dermatitis. Unlike other types of eczema, seborrheic dermatitis does not necessarily itch. It tends to run in families. Known triggers include weather, oily skin, emotional stress and infrequent shampooing.

Stasis Dermatitis

Also known as varicose eczema, this form of eczema is a skin irritation that appears on the lower legs of middle-aged and elderly people. It is related to circulation and vein problems. Symptoms include itching and reddish-brown discoloration of the skin on one or both legs. As the condition progresses, it can lead to blistering, oozing and skin lesions.

Wrinkles are a natural part of the aging process. They occur most frequently in areas exposed to the sun, such as the face, neck, back of the hands and forearms. Over time, skin gets thinner, drier and less elastic. Ultimately, this causes wrinkles – either fine lines or deep furrows. In addition to sun exposure, premature aging of the skin is associated with smoking, heredity and skin type (higher incidence among people with fair hair, blue-eyes and light skin).

Treatment for wrinkles runs the gamut from topical creams and moisturizers to cosmetic procedures. The most common medical treatments are:

• Alpha-hydroxy acids, preparations made from “fruit acids” that produce subtle improvements in the appearance of wrinkles.
• Antioxidants, creams consisting of Vitamins A, C and E and beta-carotene that improves the appearance of wrinkles and provides some additional sun protection.
• Moisturizers, which temporarily reduce the appearance of wrinkles.
• Vitamin A Acid, which helps alleviate some of the signs of aging, including mottled pigmentation (e.g., liver spots), roughness and wrinkling.

Cosmetic procedures include:

• chemical peels
• dermabrasion
• fillers
• laser resurfacing
• plastic surgery

The best prevention for wrinkles is to keep the skin moisturized and use sunscreen and sunblock to prevent additional damage from the sun.

Roughly 300,000 people in the United States suffer from scleroderma. This chronic connective tissue disease results from an over-production of collagen in the skin and other organs. Scleroderma usually appears in people between the ages of 25 and 55. Women get scleroderma more often than men. The disease worsens slowly over years.

There are two types of scleroderma: localized scleroderma, which involves only the skin, and systemic scleroderma, which involves the skin and other organs, such as the heart, lungs, kidneys, intestine and gallbladder. Typical symptoms of the skin include skin hardening, skin that is abnormally dark or light, skin thickening, shiny hands and forearms, small white lumps beneath the skin’s surface, tight facial skin, ulcerations on the fingers or toes and change in color of the fingers and toes from exposure to heat or cold. Other symptoms impact bones, muscles, lungs and the digestive tract.

There is no known cause of scleroderma, nor is there a cure. There are individualized treatments that are designed to help alleviate certain symptoms and decrease the activity of the immune system to further slow down the disease.

Also known as follicular keratosis, this is a hereditary skin disorder that causes goosebump-like lesions on the back of the arms, thighs or buttocks. The patches of bumps tend to get dry and itchy, particularly during the winter months. Keratosis pilaris occurs at any age. Because it is hereditary, there is no method of prevention. In some cases, it goes away on its own over time; in other cases, the condition is chronic. Keratosis pilaris is not harmful, however, it is very difficult to treat.

Keratosis pilaris is caused by a build-up of keratin, a protein in the skin that protects it from infection. Keratin plugs up hair follicles causing the rough, bumpy rash. Treatment options include prescriptions for:

• Medicated creams or lotions with 12 percent ammonium lactate that softens the affected skin.
• Moisturizers (urea) that help loosen and remove dead skin cells.
• Topical corticosteroids for short-term, temporary relief of symptoms.
• Topical retinoids that increase cell turnover, which reduces the plugging of hair follicles.

To help alleviate symptoms, be sure to keep the affected area moistened at all times and avoid harsh soaps.

Hives are characterized as itchy red, raised welts (also known as wheals) on the skin’s surface that can spread or join together and form larger areas of raised lesions. They are generally triggered by exposure to an allergen or chemical irritant. They tend to appear suddenly and often disappear equally as suddenly.

Hives are usually an allergic reaction to food, medicine or animals. They can also be triggered by sun exposure, stress, excessive perspiration or other, more serious diseases, such as lupus. Anyone can get hives. They are harmless and non-contagious. Hives may itch, burn or sting. They rarely need medical attention as they tend to disappear on their own. However, in persistent cases, your dermatologist may prescribe antihistamines or oral corticosteroids. The best way to prevent hives is to discontinue exposure to the allergic irritant.

Hives lasting more than six weeks are known as chronic urticaria or, if there is swelling below the surface of the skin, angioedema. There are no known causes of angioedema, but it can affect internal organs and therefore requires medical attention.