10 Tips to Get The Most From Your Dermatology Visit

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

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?

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)

Can Exercise Give You Hives?

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Hives are itchy pink blotches that develop on your skin. They come up quickly, are extremely itchy, then disappear without a trace in minutes to hours. Many things trigger hives including foods, medicines, and sometimes exercise.

Exercise-induced hives (or urticaria) develop when your skin warms during exercise. Once your skin reaches a certain temperature, itchy welts suddenly bloom. The hives favor your stomach, back, or chest but can occur anywhere. One thing is for certain: They always intensify into a maddening itch.

Eating cheese, seafood, celery, or wheat within a few hours of starting exercise can trigger an outbreak. People who have exercise-induced hives also sometimes react when they take medications such as aspirin, ibuprofen, or naproxen before exercising.

In some people, exercise-induced hives occur when they exercise in cold weather. This often happens when they jog in cold weather, ski, or swim in the ocean (especially here in California where the water is always chilly).

If you’re exercising and you develop an itchy red rash, then stop exercising. If the hives don’t go away within 15 minutes, then stop your workout. Avoid eating cheese, celery, seafood, or wheat  for 4 hours before your workout. Similarly, avoid aspirin or ibuprophen for 4 to 6 hours before exercising. Taking antihistamines such as Benedryl or Zyrtec an hour before exercising may help block an outbreak. Antihistamines also hasten the resolution if taken immediately when the rash occurs.

In rare cases, exercise-induced hives cause swelling of the throat, difficultly breathing, and even death. If you develop swelling of your mouth or throat, or difficulty breathing or swallowing, then seek immediate medical help. Patients with high-risk allergic reactions should carry an epi-pen at all times and should never exercise alone.

Photo: Ernst Moeksis

Poison Ivy and Poison Oak Treatment

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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 and Asthma Link

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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)