Northwest Health Spring 2012

Sores, Moles, and Rashes. Oh My!

Skin, our largest organ, is a window into our health that's visible to us as well as the outside world.

Go to: Northwest Health Index

Rashes, breakouts, flaking, redness, flushing — they're all right there for everyone to see. Some skin problems are not medically serious but may cause itching, minor pain, general discomfort, and temporary physical disfigurement. The latter can also lead to psychological distress.

 "It can be one of the hardest things for people to cope with," says Sarah Nyland, MD, a personal physician at Group Health Medical Centers Tacoma clinic. "These conditions can really affect a person's mental health. People with psoriasis often won't go swimming, or other people won't get in the pool with them because they have a misperception about the condition they're seeing. There can be mental health issues over severe acne."

Some skin conditions might not seem serious but should be checked out. Group Health Physicians dermatologist Rachel Garton, MD, says that a change in the appearance of a mole or other lesion — which can signal skin cancer — is a common reason that patients come to see her.

Do you have a skin condition you're concerned about? Drs. Garton and Nyland offer this guide to help you sort through common conditions.

Acne Rosacea

What it is: A chronic skin condition that may cause redness and flushing, visible veins, or acne-like bumps on your cheeks, nose, and chin. All or just some of these symptoms can be present. Burning or stinging on the face and bloodshot eyes can also occur. Usually affects those aged 30 and over. Exact cause is unknown.

Treatment: There is no cure, but antibiotics or topical agents (anti-inflammatory or antibacterial) may be prescribed. Lasers and light treatment may also be used to treat the visible blood vessels or redness, though this treatment is typically considered cosmetic.

Prevention: Since sun exposure, stress, exercise, anger, embarrassment, spicy food, alcohol, and extreme temperatures (hot or cold) can cause flare-ups, avoid these when possible. Use sunscreen daily. Consider ways to reduce stress such as meditation, deep breathing, and yoga.

When to seek medical help: If blushing, flushing, sores, or visible veins on the nose, cheeks, and chin are persistent. Some of these can permanently alter the skin's appearance.

Acne Vulgaris

What it is: An inflammatory condition that is the scourge of 'tweens and teens. Also called common acne, it can range from mild to severe, leaving physical scarring and emotional distress in its wake. It can also hit women and men in middle age. Symptoms include whiteheads, blackheads, and cysts primarily on the face but also on the back, chest, and neck.

Treatment: Over-the-counter products containing salicylic acid or benzyl peroxide are the first line of defense. Many prescription topical agents can be used. Birth control pills and other hormonal treatments can improve acne in females. Oral antibiotics are another treatment. Isotretinoin may be prescribed for more severe cases of acne, but requires close monitoring by a physician experienced with this drug. Some therapies can take six to eight weeks for a good response, so diligence and patience are required.

Prevention: Wash with a mild cleanser for gentle exfoliation, and avoid touching blemishes to prevent further infection or scarring. Vigilance in the use of topical or oral medications is needed to ensure ongoing results.

When to seek medical help: When over-the-counter products do not work or have been of limited help, or scarring has occurred.

Psoriasis

What it is: A chronic autoimmune disease that affects the skin. Symptoms include red patches of skin covered by a silvery, flaky surface with tiny spots that bleed underneath if scraped often on identical areas of either side of the body. It can also make nails thick or ridged. Psoriasis is difficult to conceal and can negatively affect self-esteem and relationships.

Treatment: Topical steroids and other topical medications are the mainstay of treatment. Aggressive daily moisturizing is also important. If topical agents don't work, phototherapy — a special light treatment — can be administered by a physician. If this time-intensive treatment isn't possible or effective, systemic immunosuppressant agents, including some newer biologic agents, are the next step. "The biggest thing with psoriasis is it takes a huge amount of care," says Dr. Nyland. "You just have to be incredibly vigilant."

Prevention: Nothing can totally prevent this condition, but special attention to skin care can help prevent or lessen symptoms, including daily lubrication with thick and creamy moisturizers or petroleum jelly; cooler, shorter showers and baths; and avoiding soap and hand sanitizers when possible since both are drying. Men and women need to be careful when shaving. Some drugs can worsen psoriasis outbreaks, so patients should inform their doctor of all prescribed and over-the-counter medications they're taking. Avoid cold, dry weather or use a humidifier during these conditions. Also avoid alcohol and smoking.

When to seek medical help: Except in the mildest cases, most patients with this condition should have ongoing care from a medical provider.

Skin Cancer

What it is: This disease appears in multiple forms. Early detection is important for successful treatment.

Basal cell carcinoma symptoms: Pearly or waxy bumps that can look like a tiny pimple or sore with a small crater in the center that resists healing. Also watch for red patches, pink growths, or shiny bumps. Bumps sometimes can feel sensitive or painful.

Squamous cell carcinoma symptoms: Open sores, scaly red patches, or wart-like patches that are also scaly and red.

Melanoma symptoms: A mole or growth that assumes a number of different appearances. Look for the A-B-C-D-E symptoms:

  • A for asymmetry. Edges are asymmetrical.
  • B for border. Areas with odd-looking, irregular borders.
  • C for color. Multiple colors in an area, such as brown and white.
  • D for diameter. A spot more than 6 mm in diameter, roughly the size of a pencil eraser.
  • E for evolving. The appearance of an area of skin is changing in appearance over time.

Treatment: There's a large variation in treatment depending on the type of cancer. But treatment must be performed by or supervised by a physician.

Prevention: Stay out of the sun when possible, and wear sunscreen year-round, applying it generously and frequently. An ounce, about the amount that would fit in a shot glass, is needed to cover all body parts exposed to the sun. Wait 20 minutes after applying before going out in the sun. Look for a sunscreen that says "broad spectrum" and has an SPF of 30. Always avoid indoor tanning or tanning beds. Examine skin monthly for any changes in appearance.

When to seek medical help: If you notice changes in the appearance of a mole, or have a blemish or a red patch on your skin that doesn't heal or appears crater-like (see symptoms). Your personal physician can help determine whether you need to see a specialist.

Eczema

What it is: An inflammatory skin condition characterized by scaling, sometimes thickened patches of skin that can become red, fissured, and weeping. Itching is common and can be intense. It often appears on arms and behind the knees. Because other skin problems cause symptoms similar to eczema, proper diagnosis is important before any treatment begins. Children with eczema are often predisposed to other autoimmune conditions such as allergies and asthma.

Treatment: Careful daily skin care including moisturizing at least once every day with a cream or ointment, avoiding long, hot showers, minimizing the use of soap, and using a humidifier. A 2009 study published in Pediatrics found that diluted bleach baths (half a cup in a bathtub of water) reduced symptoms and the extent of the condition in school-age children.

Prevention: Follow the same regimen as for treatment.

When to seek medical help: If help is needed to control itching, or if there's skin breakdown which can lead to infection.

Impetigo

What it is: A common skin infection in young children and babies, and also seen in those who play contact sports. It looks like a red, blister-like sore that may ooze a yellow discharge. It usually appears on the face, arms, and legs.

Treatment: Washing the area with mild soap and water followed by air drying is the normal course of treatment. Topical or oral antibiotics are often prescribed.

Prevention: Spread through physical contact with another infected person or an object carrying the bacteria. If someone in your household has impetigo, take steps to prevent its spread, including bleaching towels and thorough hand washing. Athletes need to practice careful hygiene.

When to seek medical help: If symptoms worsen or fail to respond to treatment, or if affected areas morph into painful fluid- or pus-filled sores.

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