The Dermatology Blog

A bruise is blood that has leaked into your skin. The blood is red, but it appears blue when seen though the skin layers. Bruises can be frustrating, especially for women who always get them on their legs the day they wear their new INC empire-waist jersey dresses.

Bruises are a normal response to injury. Who among us has not walked into the corner of the bed or miscalculated the exact location of the coffee table when crossing the room? Most of the time bruising does not indicate any underlying diseases, except for clumsiness.

Women bruise more easily than men, especially on their thighs, calves and buttocks. This easy bruising is because women have exposed blood vessels and thinner skin as compared to men, so even unnoticed injuries to their legs leave noticeable bruises.

Usually bruising is a minor, lifelong problem. However, if bruising develops rapidly or is getting progressively worse, then investigation is needed. Also, bruising that is associated with taking medications like aspirin, plavix or coumadin should be discussed with a physician. Bruises that appear on the face, back, or abdomen are not typical and should also be evaluated by a physician. Also, if bruising is accompanied by bleeding such as heavy periods, recurrent nose bleeds, bleeding from the gums, or blood in your urine or stool, then you should see a doctor.

There is little you can do to prevent bruises. When bruising is the result of taking certain medications such as ibuprofen, fish oil or ginkgo, then stopping these can lessen bruising. Also, wearing long sleeves and long pants can be the difference in whether a bruise develops or not after a minor injury.

After an injury, try to minimize the amount of blood that leaks out to minimize the bruise. Sit down and apply pressure to the injured spot for 10-15 minutes. You can also use ice, but only for 15-20 minutes (longer than 20 minutes can cause worsening of the bruise). Apply ice with a wash cloth or other layer between it and your skin. Avoid hot showers or hot baths for 24 hours after the injury as the heat can restart bleeding into the skin.

Vitamin K and bromelain (found in pineapples) might be helpful in resolving bruises more quickly. Look for them in topical products or in oral supplements that can be taken for a few days after a bruise develops. And look out for the coffee table.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Christy Gordon (flickr)

So how does a dermatologist like me protect against skin cancer? I go to Peet’s Coffee.

There are plenty of reasons to enjoy a cappuccino in the morning (if you can still afford it), and preventing skin cancer might be one of them.

Studies of mice have shown that feeding them caffeine protects them against ultraviolet radiation, which is similar to sun exposure for humans. The protection is most effective when the mice exercise. (So the researchers basically make them drink espresso then hit the exercise wheel.)

While epidemiologic studies and animal studies are helpful, it is nice to have a scientific explanation to support the claim. New studies show how it works.

Researchers exposed skin cells that were growing in culture to caffeine (possibly when one of the graduate students spilled his Red Bull on the petri dish). They then exposed the cells to damaging UVB light. They found that the caffeine-treated, UV-damaged cells underwent programmed cell death. When cells are damaged, but don’t die, they grow into cancerous tumors. When damaged cells die, they are no longer a threat to the body and are safely eliminated.

As sunscreens become more sophisticated, ingredients like caffeine will be added to soak up the damaging oxidants or to protect the skin from developing cancer. Botanicals like ferulic acid, derived from ferns, have proven themselves as powerful additives to sunscreens and are the future of sun protection.

Although there is not enough evidence to advise patients to drink more coffee as a means of sun protection, do you really need another reason to have a nice macchiato in the afternoon?

Photo: Burnt Phrases (flickr)

You might be getting some UV exposure long after the sun goes down — some new fluorescent light bulbs give off UV light.

Fluorescent light bulbs are everywhere now that people are trying to be more green. Most popular are the ice-cream-twist compact fluorescent bulbs called CFBs. CFBs create light by energizing a gas and exciting a phosphorous coating on their glass. The coating prevents most of the ultraviolet light from reaching you, but not entirely; some UV radiation leaks out of any fluorescent bulb. In some CFBs, the emission of UV light is so high that it exceeds the safety limits of the International Commission of Non-Iodizing Radiation.

So, should you be applying sunscreen before turning on your CFB reading light at night? No. Nor should you switch your CFBs back to energy wasting incandescent bulbs. The amount of UV exposure that you get from the light bulb is small compared to the UV exposure you get from just being outside; for most people it is not significant.

However, some people are exquisitely sensitive to ultraviolet light. Auto immune diseases such as lupus, inflammatory disease such as rosacea, and certain drugs such as HCTZ can be triggered by even small amounts of UV light from CFBs.

If you are particularly sensitive to UV, then select CFBs that have a double envelope instead of single, as it will block most of the UV light. And always stay at least one foot away when using fluorescent bulbs of any sort.

Also, remember to sit back from your TV (which my mother taught me to do when I was a kid). Of course, now with HDTVs, you get the best picture when you’re sitting a distance of 3 times the diameter of your TV. If you just bought a 60 inch HDTV, you might need to be in your neighbor’s living room to watch it. This, fortunately, should be safely away from any radiation.

Photo: Steven Fernandez (flickr)

There are some lucky people who don’t get poison ivy or oak. If you’re like me, you do. Here are some poison plant pointers:

Ivy block cream prevents poison ivy or oak, but only if it is applied 15 minutes before exposure. It doesn’t work after you’ve been exposed.

The intensely itchy, sometimes frighteningly-bubbly rash is an allergic reaction to oil, urishiol, found on poison ivy, oak and sumac plants.

You can wash off the oil with soap and water. Do not use laundry detergent, alcohol, or expensive poison ivy soap — any ordinary bar of soap will wash off the oil. However, the oil is quickly absorbed into your skin, like olive oil into nice piece of Italian bread, so time is of the essence. Once the oil is absorbed in your skin, you cannot get it out no matter what you use.

• You can wash off 50% of the oil within 10 minutes
• You can wash off 10% of the oil within in 30 minutes
• After 1 hour, no amount of washing will make any difference. Nothing will prevent the soon to be rash.

Whatever you do, don’t touch your groin in the first hour or so. You could end up in the hospital; I’ve seen it.

After one hour, you cannot spread poison ivy to someone else. Scratching or breaking the water blisters does not spread the poison ivy or the rash.

The rash lasts for 2 weeks, sometimes less if it is not severe. No cream or treatment, however expensive, can shorten the duration. The rash must run its course.

Once your arms and face turn into wet tapioca pudding, use a drying astringent like Domboro soaks to dry it out.

Once the blistering dries up, apply a topical steroid like hydrocortisone 1% cream or anti-itching lotions like topical Calamine or Benadryl. Cool baths with collodial oatmeal will also help. Super hot showers will relieve the itching, but only temporarily, and in the end, only makes it worse.

If you have a severe case of poison ivy, defined by your mother doesn’t recognize you or you are unable to sit, stand, or lie down, then see a dermatologist for prescription drugs to help.

Photo: Jim Frazier (flickr)

Post by Dr. Benabio, copyright The Derm Blog 2009.

Eczema or atopic dermatitis is a common skin disorder seen mostly in children. It is characterized by a red, scaly, itchy rash that can occur on the face, neck, arms, legs, and sometimes the trunk.

We have known for some time now that eczema, also called atopic dermatitis, is also associated with asthma and allergic rhinitis (hay fever). At least 50% of children with severe eczema also develop asthma. Research from the Washington University School of Medicine might shed light on why these diseases go together.

The research, published in the journal PLoS, found that in mice, eczema-damaged skin produced a substance called thymic stromal lymphopoietin (TSLP). TSLP is a signal to the body that the skin has been damaged. When TSLP circulates through the blood, it elicits a powerful immune response. As such, TSLP is your skin’s way of warning you that its protective barrier has been breached and that backup defenses are needed to keep you protected.

Similar to your skin, your lungs are in direct contact with your environment as well, although we don’t often think of it that way. Like skin, lungs are exposed to the air with all its potential pathogens such as bacteria and viruses. It is not hard to see how an inflammatory disease that affects the skin might also affect the lungs. This is exactly what researchers found — when TSLP from the damaged skin traveled in the bloodstream to the mice’s lungs, it triggered inflammation in the lungs (similar to an asthma attack in humans). The researchers believe that TSLP is the link between eczema and asthma.

Ideally, if a drug was developed that blocked the production of TSLP, this might be a way to prevent people with eczema from developing asthma later in life. It also suggests that minimizing damage to the skin can help limit production of TSLP and improve both eczema and asthma.

Photo: Penreyes (flickr)