Heat Rash

I just flew back from Atlanta for the 4th of July weekend, and, boy, are my sweat glands killing me.

Atlanta has a way of making your sweat glands work overtime, and overworked sweat glands can lead to dreaded heat rash. Heat rash is a common, annoying problem in summertime that develops when sweat glands are blocked, thereby preventing sweat from escaping and irritating your skin.

Hot skin trapped under clothing is often affected, leading to red itchy or prickly bumps (hence it’s other name, prickly heat). Humid heat is worse than dry heat, and anything that blocks the sweat ducts such as lying on your back at night, wearing tight fitting clothing or even applying thick sunscreen is a sure way to bring the rash out.

Prickly heat is commonly seen in babies who aren’t able to tell us when they’re hot and sweaty from being overly bundled up. Hospital patients who are unable to move in bed are also commonly afflicted. Of course, healthy adults can get it too, especially during the dog days of summer.

The best treatment is to get cool. A cool shower, cranking the airconditioning, or taking a dip in the pool will stop the sweating and allow the sweat glands to recover. Sometimes a mild topical steroid such as cortisone cream is needed to calm the inflammation.

Or you can fly to San Diego where the temperature will top out at 72 degrees next week.

What’s The Fastest Way To Get Rid of a Zit? (Video)

From @debbieinHB on Twitter: @dermdoc what’s the fastest way to get rid of a zit?? I’m too old to still get these things!!

Do you have a question that you’d like me to answer on video? Then tweet me on Twitter.

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)

Cellulite: What Is It? How Can You Treat It?

Spring is here. You can finally stop salting your icy sidewalk and start focusing on summer issues, like cellulite.

What is cellulite?

It’s the dimpling and nodularity that occurs in women on the thighs, pelvis and abdomen. Cellulite is the result of fat pouching out of holes in the connective tissue on the skin. It occurs in 98% of girls and women post puberty. That’s right. Essentially all females have cellulite. It is a normal characteristic of sexually mature women.

Here’s what cellulite is not:

  • Cellulite is not fat. It is the appearance of the superficial fat held loosely beneath the skin. The fat is held more tightly in men which is why we do not develop cellulite.
  • Obesity doesn’t cause cellulite. Look around and you will see that skinny women have cellulite (in real life anyway).
  • Cellulite is not an accumulation of toxins or fluids; it is normal fat.

How Can You Get Rid of Cellulite?

The best treatments for cellulite have at most shown mild improvements in the appearance. Unfortunately, in almost all cases, the improvements are not maintained over time. This is because it is hard to change the loose connective fibers under the skin, which are the primary cause.

  • Weight loss can improve cellulite, but not always. Losing weight can make the skin sag, and weight loss has been shown to actually worsen the appearance of cellulite in some women.
  • Endermologie is a kneading system (like my grandmother would knead the pizza dough). Although there is some evidence it can reduce thigh circumference, how long the effects last is questionable.
  • Liposuction removes fat through suction. It is not a good treatment for cellulite because the fat is too superficial. Liposuction combined with a laser to treat cellulite sounds interesting, but has not been shown to work better than ordinary liposuction.
  • Subcision, which targets the connective tissue bands by snipping them, is a great idea, but in practice has not been shown to be very effective. There is some concern that snipping the connective fibers might actually make the fat looser, worsening the problem.
  • Mesotherapy is the injection of medications under the skin to dissolve the fat. Although it has worked for some, the results are unpredictable and can cause adverse side effects such as bruising or pain.
  • Radiofrequency treatments like TriActive or VelaSmooth generate heat under the skin damaging the fat and connective tissue, hopefully smoothing the cellulite. Improvements have been reported, but no long term efficacy has been demonstrated.
  • Herbal creams have been studied and had no effect on cellulite. It is unlikely that any topical treatment can penetrate far enough down and be potent enough to have any effect.
  • Diet has no effect on cellulite.
  • It is possible that regular exercise can improve the circulation of cellulite areas, improving the appearance, but no studies have shown that it has a significant impact. Work out because it is good for you, but stop looking at your behind in the gym mirror.
  • There are some upcoming technologies that are promising. I’ll post about them later.

What Should You Do About Cellulite?

Because it is a normal occurence in women, it’s reasonable to simply tell yourself: “Hey, this is normal!” and stop killing yourself trying to eliminate it. Many women have been pleased with any of the above treatments, but they’re all expensive and likely all temporary. If it is worth spending $500 to have a 50% improvement in your cellulite, then make an appointment with your dermatologist or plastic surgeon to discuss your options.

Keep in mind that your friends or partner might not notice that your cellulite is 50% better (what does 50% better cellulite look like anyway?). If you’re worried that you might be featured in a magazine, don’t fret. You will receive the only known cure for cellulite: Photoshop.

Do you have cellulite? Have you tried to eliminate it? How successful was it?

Photo: Tassoman

Red Spots

Lots of women have been Going Red lately. “Go Red” is a campaign to raise awareness of heart disease in women. Some women I see are often going red for a different reason: they’re covered in little red spots called cherry angiomas.

Cherry angiomas are tiny lumps of overgrown blood vessels in the skin. Their name derives from their often bright or deep red color. Like a cherry. Get it?

In your thirties and forties you might have a few. By the time you’re 80, you’ll probably have many (hence their other, more unfortunate name: senile angiomas). They cluster on the chest and back and can number in the hundreds. Although they grow on men and women equally, women are more likely to see a physician to have them checked.

Cherry angiomas are harmless, but many people hate the way they look. Fortunately, they’re easy to treat. Each little red spot represents a tiny, tangled knot of blood vessels. Treatments destroy the tiny vessels, making the red spot disappear. Treatments include:

Liquid nitrogen: A blast of icy cold air freezes the vessels. Often a blister develops the next day and can leave a lightened spot.

Electrocautery: A zap of electricity burns the vessels. It can sometimes leave a tiny scar.

Laser: The blood in the vessels absorbs a blast of light energy, exploding the tiny vessels and removing the spot. The ruptured vessel can cause a bruise that lasts for weeks.

All three methods are effective at removing the red spots, although each hurts a little and each usually requires multiple treatments. The more destructive the treatment, the more likely it is to work the first time, but the more likely it is to leave a scar.

It can be difficult to determine if a red spot on your skin is a harmless cherry angioma or if it is a skin cancer. If you have spots that are changing, bleeding, or multiplying quickly, or if you have any concerns, then you should see a physician.

Photo: Bensonkua (flickr)

iPhone App Claims to Treat Acne. Does it?

I love my iPhone. (No, that’s not me in the photo.)

My iPhone is teeming with apps that help me get through my day (like Doodle Jump for instance). An emerging iPhone trend is the development of apps that diagnose and treat diseases. For example, there is the stethoscope app to help diagnose heart murmurs. In dermatology, there is an app designed to treat acne.

We know that specific wavelengths of light can have medicinal effects such as killing bacteria (red light) and reducing inflammation (blue light). This app produces light at those wavelengths to treat acne. The claim is that by holding the iPhone to your face, the light produced from the app will treat your acne.

Although it scores a 10 on 10 in the coolness factor, it scores a 0 on 10 for proof of efficacy. The studies that looked at treating acne with light used much more intense light than an iPhone uses. The studies with more powerful light exposed faces for 60 minutes every week, which is about 8 minutes on each side every day. Even then, light treatments for acne have not been shown to be consistently better than standard acne treatments such as antibiotics and tretinoin.

So does the acne app work? Well, there are no studies to tell us. Given that the light intensity is low and that most people would not do the treatment — try holding your phone for 2-5 minutes on each side of your face every day for months — I doubt it works.

Acne is common and naturally gets better and worse at times no matter what you do. It is unfortunate that products like this are sold that do not have any proof that they work. There will be people who buy this app and believe that it helped them, (“My acne was clear in just THREE DAYS!”) but the two bucks is better spent on Doodle Jump.

See also:

Can an iPhone App Clear Up Your Acne?

In Light and Heat, Gadgets Claim to Fight Acne

Better Skin to the Touch?

Can You Treat Acne With an iPhone App?

A study to determine the effect of combination blue (415 nm) and near-infrared (830 nm) light-emitting diode (LED) therapy for moderate acne vulgaris.

Photo: Aye Shamus (flickr)

Extract from White Birch Tree Relieves Itch

The forest is full of things that make you itchy: poison ivy, poison oak, mosquitoes, chiggers. But for the wise adventurer, the forest also provides a way to heal your itch. The remedy might be found in the beautiful white birch tree.

White birch trees are ubiquitous in cold climates. A photo of the white tree against white snow is iconic of New England winters. A bark extract called Betulin (a terpene like tea tree oil) has been shown in animal studies to be antimicrobial, anti-inflammatory, and to aid in wound healing. Research presented at the annual congress of the European Academy of Dermatology and Venerology showed that a cream containing betulin significantly reduced itching in red, irritated skin in psoriasis and eczema patients.

The study is only preliminary, and betulin will need to be tested in rigorous trials to see if the extract makes a cream much better than placebo cream; however, betulin is already available in creams in Europe.

So how do you get the extract out of the bark if you’re  itchy while hiking in a forest? I’ll wait for Bear Grylls to show us on a future episode of Man Vs. Wild. No doubt a fire and half a plastic bottle will be needed.

Photo: Nicolas T