Tag Archives: rash

Is Hard Water Causing Your Rash?

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Does Water Hardness Affect Skin?

Hard water is tap water that’s high in minerals such as calcium and magnesium. Hard water isn’t harmful, except the minerals prevent your soap from sudsing. Some people think that hard water is more likely to cause a rash than soft water.

Take a recent patient of mine: he moved his family to San Diego from the East Coast (good move this winter, no). After they moved here, they noticed their skin became dry and itchy. He blamed San Diego’s notoriously hard water and installed a water softener in the main water line. It was costly, but did it improve their skin?

A recent study from the UK looked at this question: Does hard water worsen eczema? The answer was, no, it doesn’t. Water hardness did not seem to have any impact on eczema, the most common skin rash.

What’s more important than the hardness of the water is the type of soap you use. True soap tends to strip the skin of its natural oils, leaving it exposed and irritated. Non-soap cleansers, of which Dove is the prototype, leave more oils on your skin, keeping it hydrated and protected.

My patient and his family didn’t get any better after installing a water softener (although he said they could drink our tap water without gagging now). I advised him to change to a moisturizing soap and to apply moisturizer daily.

San Diego is drier than most of the country, and the low humidity can be a shock to skin accustomed to humid air. Many people who move here find they have to moisturize more often than they did back home.  When they complain, I suggest they could alternatively move back to the East Coast this winter — no takers so far.

Photo: Angel Gonzalez, Flickr.

Itchy bottom? Moist Toilet Tissues Can Cause A Rash

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Itchy butts are part of my everyday. It shouldn’t be part of yours.

Itching on your bottom is usually a minor annoyance, but it can be debilitating. A patient of mine was unable to work because his derrière itching was so intense. A common cause of itching bottom, called pruritus ani, is allergic contact dermatitis.

Places where your skin transitions from outside to inside, such as lips or anus, are susceptible to dermatitis because your skin’s barrier is limited in these locations. Without a thick layer of keratin, irritants on the outside easily get into your skin. Moist toilet tissues, such as baby wipes or towelettes, might seem to get you cleaner than old-fashioned toilet paper, but chemicals in the wipes cause a rash in some people.

Preservatives such as methylchloroisothiazolinone/methylisothiazolinone (MCI/MI) or kathon CG are often used in packaged toilet wipes and are a common cause of allergic contact dermatitis. Many patients who have itching on their behinds fear that they are unclean, use more cleaning wipes, worsening their dermatitis. It becomes a vicious cycle. Avoiding all commercial wipes or towelettes usually resolves the rash and itching. If not, then see your dermatologist before you find yourself on extended medical leave.

Have you ever had an itch so bad that you thought you’d go mad?

Photo: RLHyde

10 Tips to Get The Most From Your Dermatology Visit

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Having a high quality doctor’s visit takes effort on my part and on yours. Here are 10 tips to get the most out of your next dermatology visit with me or any other dermatologist.

1. Write down all the questions you have and things you want to discuss with me. Be sure to list any spots you’d like me to check or any moles that have changed. Have a loved one lightly mark spots on your skin they are concerned about.

2. Know your family history: Has anyone in your family had skin cancer? What type? Patients often have no idea if their parents have had melanoma. It matters. If possible, ask before seeing me.

3. Know your history well: Have you had skin cancer? What type? If you have had melanoma, then bring the detailed information about your cancer. Your prognosis depends on how serious the melanoma was, that is its stage, 1-4. You need to know how it was treated, if it had spread, and how deep it was. The answers to these questions determines the risk of your melanoma returning.

4. If you have a rash, there are a few things I’ll need to know: Have you changed any of your medications? Soaps? Moisturizers? Cosmetics? Do you have a history of eczema? Asthma? Hayfever? Does anyone in your family have a skin disease? Take a picture of your rash at its worst with your phone; the rash might be improved by the time you see me.

5. If you are seeing me for acne, come prepared. Keep a journal of when your acne is worse. Is it around your period? When you are stressed? In summer or winter? What products or cosmetics are you using? What treatments have you tried? Have you had dryness or burning with previous treatments?

6. If you are seeing me for hair loss, then collect your hairs that fall out and count how many you lose in one day. It’s normal to lose 100-150 hairs per day. Make a list of other symptoms or health problems that you think might be related to your hair loss.

7. Always be honest with me. I’ll never judge you even if you are an avid tanner or a picker. I’m here to help, and I can only help if I know the whole story.

8. Have you read something online that you’d like to discuss with me? Print it and bring it. Sometimes patients will tell me they saw something about their disease on the web; without knowing the source, I cannot say if the information is valid or helpful.

9. Am I leaving too soon? Stop me. My time with you is yours. If you see me heading for the door, then tell me that you still have things you’d like to cover. If we are out of time, then ask me if you can set up a follow-up appointment to continue the visit.

10. Don’t leave empty handed — I’m not talking about the freebie hand lotion or drug samples. For every doctor’s visit, you should leave with printed or written instructions about what we discussed and what you should do next. Patients who receive hand-outs from their doctor are more likely to have positive outcomes.

Have you had an excellent or not-so-excellent dermatology visit you’d like to share? Do you have any tips for us?

Photo: Maggie Osterberg

Get Rid of Your Jock Itch Once and For All

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I’ve been seeing a lot of jocks lately. The anatomical area, not the athletes. Summertime means heat and humidity, sports, and itchy groins. Jock itch is a general term for an itchy rash in the area. Heat, sweat, and skin rubbing on skin can leave the area looking like you slid into second base, groin first.

There are three main causes of an itchy groin. Classic jock itch is caused by a fungus, the same fungus that causes athlete’s foot. This fungus often causes a red scaly rash on the inner thighs. It tends to be dry and can have bumps or pimples. The fungus is often spread from your feet or from contaminated sports equipment, towels, etc. It can be treated with topical terbinafine cream 1% twice a day for 2-4 weeks. Severe cases can require oral anti-fungal medications, especially if the fungus has spread to other areas on your body.

The second cause of an itchy groin is a yeast infection (yes, the same yeast that can cause a vaginal yeast infection in women). The yeast grows well in warm, moist areas and causes a bright pink, moist, irritated rash. Unlike the fungus, yeast can spread onto the scrotum. It can be treated with topical clotrimazole cream 1% twice a day for 2-4 weeks.

The third common cause of a jock itch is a bacterial infection. Certain bacteria take advantage of the irritated skin and warm environment causing a rash called erythrasma. This can be treated with miconazole 2% cream twice a day for 2 weeks.

For all causes of jock itch it is important to keep the area clean and dry. Sometimes washing your groin with anti-dandruff shampoo such as zinc or selenium sulfide shampoos can help clear unwanted organisms. Hydrocortisone 1% cream can be added to any of the above treatments to reduce the redness and itching while the infection is being treated. Use it once to twice daily.

Remember, it is important to keep the area dry. The standard way is to use powders (some of which are medicated for an added bonus, such as Gold Bond). Once the active infection is resolved, treating your groin with your underarm antiperspirant can help keep this area dry, thereby making it less inviting for fungus and other organisms to return.

However, I don’t recommend spraying antiperspirant on your groin if you’re in the midst of a raging jock itch — you’ll spend the entire day scratching an area that shouldn’t be scratched in public.

Photo: jkstrapme (flickr)

Can You Be Allergic To the Sun?

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You know that the sun increases the risk of skin cancer for most people. You probably don’t know that for some people, the sun is the source of a terrible itchy rash — they’re allergic to the sun.

The radiation from the sun triggers some response in everyone’s skin. In some, the radiation triggers an immune reaction, leading to red, itchy, burning bumps. There are several diseases that are caused by sun which lead to rashes. Here are a few:

Polymorphous Light Eruption (PMLE): This is the  most common. It is usually characterized by tiny, itchy red bumps that develop on the arms, neck and face hours after sun exposure. It is often seen in the spring and occurs more frequently in young people.

Actinic Prurigo: This is seen as itchy red bumps that occur mostly in children who are sensitive to the sun. Like PMLE, it occurs mostly on the face (including lips), arms, and hands. It can be more severe than PMLE and can lead to scarring in rare instances.

Chronic Actinic Dermatitis: This usually affects adults. It starts in areas exposed to the sun, but can spread to other areas. It is often terribly itchy and can be triggered by sunlight even though car windows.

Solar hives (urticaria): These are itchy pink whelts that develop within minutes of sun exposure. The rash develops quickly and fades quickly but can be intensely itchy. Antihistamines such as Zyrtec (ceterizine) or Benedryl (diphenhydramine) can help.

There are other sun-induced diseases, including ones triggered by medications. I’ll write about them in a future post. In all of these conditions, the most important thing to remember is to avoid sun exposure as much as possible. If you develop an itchy or burning rash after sun exposure, then see your physician for an exam and for advice.

Photo: Sandman (flickr)