Are you under a lot of stress lately? Do you have a rash? The two might be related. I commonly get asked by patients in my clinic “Is my rash because of stress?” The answer is, it might be.

Stress has many effects on your body. When under significant physical of psychological stress, your body releases a stress hormone, called cortisol. Cortisol in the natural world, could help save your life in dire circumstances. It helps keep your blood pressure up, makes your kidneys work harder, pushes your liver to get rid of toxins more effectively, and changes your metabolism from storing energy to burning it. In a crisis such as life-threatening starvation or diarrhea, cortisol works to help keep you alive. In the modern world, however, where we sometimes experience chronic stress from work or family, cortisol’s effects can be counter productive.

We can see this in the skin where elevated cortisol can change both the skin’s structure and function. Studies have shown that chronically elevated cortisol levels lead to a decrease in your skin’s natural lipid or fat barrier. These lipids are essential to keep your skin protected and to prevent it from drying out. Without a layer of lipids on your skin, it is no longer waterproof, and irritating soap and water from hand washing or bathing is able to penetrate the skin, causing inflammation. Without a protective lipid layer, the moisture in your skin evaporates easily, leaving the skin dehydrated. This dry, flaky skin is even more susceptible to damage or irritation.

Elevated cortisol also impairs your skin’s natural defense system. Your skin is constantly producing specialized protiens that act as bacterialcides, killing off unwanted intruders on your skin. Stress can lead to a drop in production of these first line defense proteins, leaving your skin vulnerable.

The consequences of this loss of lipids and decreased defenses is that rashes such as eczema and psoriasis can be triggered or can flare, turning a minor irritation into a full blown outbreak. Other diseases such as herpes viral infections, bacterial infections, and even acne are much more likely to worsen when your cortisol levels are elevated from stress.

Although there is little you can do to prevent stress, there are some things you can do to help your skin. Exercising at least 3 days a week can help you manage your stress and can help reset your cortisol levels to healthier levels. Meditative activities such as walking or yoga may likely help you to manage your stress, thereby lowering your level of stress hormones.

You can also help your skin by doing what you can to counter the loss of lipids from cortisol. Use a non-soap cleanser such as Dove instead of soap. Apply a moisturizer heavy in lipids, like a body cream, to your skin everyday after showering. Eat a diet high in omega 3 rich foods like flaxseed, salmon, and walnuts.

Finally pick stocks that will make lots of money in the next year. Well, maybe you can’t do everything.

Photo: Faungg, Flickr.com

I don’t think Sockeye salmon is a Gerber Baby Food, but maybe it should be.

A recent study found that feeding fish to babies before they were nine months old might cut their risk of developing eczema (also called atopic dermatitis). The study, published in the Archives of Disease in Childhood, was part of a survey of over 8,000 families in Sweden. Study questionnaires asked about a whole range of medical issues and included information on breast feeding, diet, family history, and tobacco use in parents.

Having a parent or a sibling with eczema was the most important risk factor for children developing eczema in their study. Introducing eggs or dairy, two common food allergens, also did not change the risk of developing eczema.

Parents who reported feeding their children fish before they were 9 months old were 25% less likely to have the child develop eczema as compared to those who did not serve fish.

The study has some interesting implications. Previous studies have shown that delaying solid foods for infants does not seem to impact their chances of getting eczema. The findings in this study found that eggs or cow’s milk did not increase the risk of eczema, which is consistent with previous studies. Certainly some infants will develop food allergies, but this is different from eczema. Avoiding foods has similarly not been shown to be helpful in kids who already have eczema. Although food allergies can cause a rash (called urticaria or hives), they don’t cause or worsen eczema.

Previous studies have shown that breast feeding (up to 4 months of age) does seem to protect children from developing eczema. Based on the results of the current study, perhaps there is value to introducing a variety of foods, including fish, to infants after breast feeding for the first few months to a year.

Unfortunately the fish diet study only followed children up to 1 year of age. Eczema can develop after 1 year of age and it is not known if this would change the recommendations with respect to eating fish.

The cornerstone of eczema prevention in all children is to have good moisturization. This is especially important in the winter months when babies’s skin tends to dry out from cold, dry air and from indoor heating. Be sure that you apply a moisturizer such as Cerave Cream after every bath. This can help prevent eczema and can also treat eczema in infants who already have it.

Photo: Qole Pejorian

1. Surf Early, Surf Late

Of all the insults to your skin when surfing, ultraviolet light exposure is the most important. Often the best surfing is very early in the morning — the beach is quiet and there is plenty of room to spread out. This is also the best time to minimize sun exposure. When the sun is low in the sky as it is during the early morning and in late evening, the ultraviolet light must pass though much more atmosphere before it gets to your skin, so the sun’s rays are weaker and cause less harm.

2. Cover Up Before Heading Out

The best way to protect your skin is to cover it up. In cold weather, a wet suit made of neoprene will protect you from the sun for as long as you have it on. In warm weather, wear a lycra rash that has UV protection built into it to protect your skin. Go for long sleeves, and consider the hooded variety, especially if you have fair skin and spend a considerable amount of time surfing. Wetsuits and rash guards are better than wearing sunscreen because even the best sunscreens wear off when surfing. Sunscreens can also make your skin greasy, making it (more) difficult to stay on your board. If you don’t have a hooded suit, then consider donning a surf cap that covers your head and ears. The top of your head is particularly vulnerable to sun damage (especially if your comb-over won’t stay put in the surf).

For areas not covered by your suit or rash guard, apply a water resistant sunscreen. Choose one designed for surfing that is alcohol or gel based and won’t make you slippery or interfere with your surf wax. If possible, choose a sunscreen with zinc oxide or titanium dioxide. These physical sunscreens provide excellent protection for both UVA and UVB light and are less irritating to your eyes and skin. Don’t forget your lips: wear a thick zinc oxide sunscreen, and re-apply often since this thin skin is so vulnerable.

3. Rinse, Moisturize, Repeat

Take your wetsuit or rash guard off as soon as possible after surfing since leaving a damp wetsuit on for hours can irritate your skin. Also the sand in your suit will act like sandpaper against your skin when you move around with your suit still on. The salts from the ocean can be both drying and irritating, so wash your whole body with a mild cleanser such as Dove after surfing. Since you will have lost your skin’s natural oils from hours in the surf and wind, it is important to replenish them with a good moisturizing cream after your shower. If you develop a rash from the seams of your wetsuit, then try wearing your rash guard under your wetsuit or purchase a rash guard gel to apply before putting your suit on.

Post written by Jeffrey Benabio, MD. You might also like:

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Photo credit: Mike Baird

What’s the first thing you should do when you check into a hotel? Look for bedbugs.

To be honest, I didn’t know that bedbugs really existed until my dermatology residency (they’re on our board exam). I always thought that they were the fictional creatures of a nursery rhyme: Good night, sleep tight, and don’t let the bed bugs bite.

Well they are real. Believed to have been brought here by original colonists, bedbugs were nearly extinct a few years ago when DDT was in widespread use. They have since made a significant comeback, increasing by 500% over the last few years. They are known to infest hotels and apartment buildings and can come home with you by hitching a ride in your luggage.

Bedbugs (also spelled bed bugs, or Cimex lectularius) are small brown flat wingless insects about the size of an apple seed. They live in crevices in walls, furniture, baseboards, mattresses, comforters, and even drapes. They can live for months without a meal. In heavily infested rooms they can give off a coriander-like odor.

They come out just before dawn to grab a snack on your skin and secrete a numbing substance that prevents you from waking and discovering them biting you.

If you had been bit, you would develop itchy bumps or welts, often in a straight line, on exposed areas of your skin. The bites are often in 3’s; in dermatology we call it the “breakfast, lunch, and dinner” sign.

Fortunately the bugs aren’t known to carry disease; it is possible they can carry the virus for hepatitis, but there have been no instances of the bugs transmitting that disease. The main problem is the psychological impact they can have on you. Just the idea that there might be bugs living in your mattress that come out to bite can give you plenty of sleepless nights.

Treatment is usually with a topical steroid cream or oral antihistamine for the itching (like for mosquito bites).

How can you prevent getting bed bugs the next time you travel?

• Check the mattress, running your fingers along the seams. Make sure to check the mattress tag, bed bugs often hide there.
• Check crevices in the box spring and headboard if possible.
• Check the night tables. Look for signs of bed bugs in the drawers and along the wall on the side of the bed.
• Keep your clothes in your luggage (not the hotel drawers) and keep your luggage zippered up at night.
• Before you return home, inspect your luggage and clothing. Laundering your items with hot water and a hot dryer (97 °F) should kill all bed bugs.
• Remember that the bugs can live in furniture for months without a meal. You should inspect secondhand furniture (including antiques) thoroughly before bringing them into your home.

So if you suspect your home might be infected what can you do?

• The bugs can’t tolerate extremes of temperature. Freeze your pajamas, sheets, and other bedclothes for at least 24 hours or launder them in hot water and hot dryer.
• Vacuum the area of infestation daily.
• Caulk holes in floors and walls.
• Consider hiring an exterminator. They can use insecticides or other techniques like icy liquid carbon dioxide or super hot room heaters to kill the bugs.

Here is an excellent algorithm from the Harvard School of Public Health.

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An excellent study done several years ago published the the Journal of the American Academy of Dermatology showed that although 10-15% of people with dermatitis (an itchy skin rash) blame laundry detergent, less than 1% of patients who were tested actually had an allergy to detergent.

Most people who have an itchy rash don’t really have an allergy at all; there are many causes of itching, including dry skin, medications, bug infestations, etc. Therefore, the percentage of people with an itchy rash who are actually allergic to their laundry detergent is probably much less than 1%.

Of course, there are some people who do have an allergy to some component in their detergent such as the fragrance or bleaching agent, but this is rare.

So, before you chuck all your laundry detergents and change to a fragrance free or an “all natural” product to stop your itching, remember that this is unlikely the cause of your rash.

Instead, invest in a good moisturizer and apply copiously and often. If the problem persists, see your physician.

In particular, chronic hand dermatitis has been associated with eating foods high in nickel in patients with a known allergy. If you are allergic to nickel and have a chronic rash, especially of your hands, then consider a nickel-free diet. Try to avoid:

• Chocolate
• Potatoes
• Salmon
• Nuts and Legumes (beans, lentils)
• Any canned food or canned fruit
• Hot water from the tap
• Anything acidic (like tomatoes) cooked in a stainless steel pan
• Leafy green vegetables

Measles (rubeloa) is a highly contagious virus that causes one of the most deadly childhood illnesses in the world. In 2006, an estimated 242,000 children died from measles worldwide. It is preventable with the MMR (measles, mumps, rubella) vaccine that almost all children get around their first birthday and again at 5 years old.

Transmission of the measles virus is person to person by respiratory droplets, similar to common cold viruses. The virus can live for hours on surfaces. Once a person is exposed, it can take 1-2 weeks before symptoms begin.

The symptoms of measles include high fever, cough, runny nose, and conjunctivitis (pink eye). It has a unique rash that begins 2-4 days after the fever and persists for up to a week. The rash is bright red; it begins on the face and proceeds down the trunk, arms, and legs over 2-3 days. The rash then fades in the same order starting from the head down.

A rash also develops inside the mouth; it is characterized by bright red spots with blue or white centers inside the cheeks, near the lower molars.

The virus is highly contagious and can be transmitted from 4 days before the rash to 4 days after the rash.

Complications from measles include ear infections, pneumonia, blood disorders, swelling of the brain, called encephalitis, and death. Infections in pregnant women can result in severe birth defects or miscarriage.

There is no treatment for measles; antibacterials have no effect because it is a virus. Bed rest and fluids are recommended. It is also widely recommended that children who are hospitalized with measles be treated with high does of vitamin A. There is evidence to suggest that vitamin A minimizes eye complications and may improve survival.

The Institute of Medicine along with the National Academy of Sciences, the Centers for Disease Control, and the American Academy of Pediatrics have all concluded that there is no link between autism and the measles (MMR) vaccine. In fact, measles vaccine is one of the most cost effective public health interventions in the world. It has the potential to save thousands of lives for less than a dollar per vaccine.

Photo credit: Centers for Disease Control

Cold air holds little moisture and dries your skin all over, especially exposed lips and hands. Constant hand washing to ward off a cold that’s going around only exacerbates the problem by stripping your hands of natural oils. Once your hands have become dry and irritated, every time they get wet and soapy, it exacerbates the problem.

Here are four tips for hand dermatitis:

• Minimize hand washing. Use sanitizer alcohol gels instead.
• Apply a good hand cream to your hands after every time you do wash them. I often recommend Eucerin Intensive Repair Hand Cream® because it has dimethicone (silicone) to help protect your hands against further assault from water.
• Wash your hands before bed then don’t dry them completely. While they are still moist apply a layer of Vaseline® or other hand ointment to them. Then put on cotton gloves like the ones pictured here. These help to lock in the moisture overnight, and you will wake with softer, soothed hands. Do this for a week and your hand dermatitis will begin to thaw.
• This technique also works for medicated cream such as AmLactin®, an over the counter cream with lactic acid, which helps soften the scale on your hands. Cotton gloves can also be used with prescription steroids, which are sometimes needed for particularly irritated hand dermatitis.

The patch test showed he was 3+ positive (that’s very positive) for carba mix, compounds used in the manufacturing or rubber. “That’s impossible,” he said. “Why?” I asked. “Because I’ve worked in a tire store my whole life,” he replied.

It is a pervasive misconception that if you have been using a product like a lotion, or been in contact with something like rubber, or even taken a medication like aspirin for a long time that you cannot be allergic to it. That’s false. You can become allergic to it.

In order to be allergic to something, like rubber, you must have been exposed to it or to something very similar to it. You cannot be allergic to something you have never been exposed to. My patient was exposed to rubber without problem for years, but then suddenly his immune system targeted it, leading to his allergy. Although it is most common to develop an allergy to something that you have been exposed to recently, the allergy can develop after prolonged exposure.

The immune system is fantastically complex. It manages to determine what is foreign and harmful to you with almost flawless accuracy, but sometimes it gets it wrong. The times when it responds inappropriately to harmless chemicals in your environment is what keeps me in business.

Photo credit: Eric Castro

Brachioradial pruritis is a condition characterized by intractable itching on the top of the forearms (overlying the brachioradialis muscle). Patients often report that the itching actually gets worse with scratching instead of better. It affects mostly middle aged women (which all my patients have been) and presents as a burning and itching sensation on the arms. The symptoms can sometimes be described as tingling or even painful. It can involve one or both arms.

Unfortunately the cause is not well understood. Current thinking is that it is associated with sun damage and/or with cervical nerve root impingement. The sun damage theory is that deep penetrating ultraviolet light (UVA) damages fine pain nerve fibers in the skin of the arms. The cervical spine theory is that impingement (pinching) of the C5 to C8 cervical nerve roots leads to nerve damage. The nerves that emerge from these roots provide sensation to the arms, so damage to them might cause the burning and itching symptoms. Although studies have found that cervical spine disease is more common in patients with brachioradial pruritis, no study has demonstrated that cervical spine disease causes the condition.

Treatments for brachioradial pruritis include:

• Avoidance of sun exposure (probably most important)
• Topical capsaicin (hot pepper oil)
• Gabapentin
• Cervical spine manipulation
• Anti-inflammatory medications such as naproxen (Alleve®)
• Above all, I think it is helpful just to have a physician who understands that the patient’s symptoms are real and who is willing to try various treatments until a satisfactory remedy is found.