Skin Care

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Local doctor offers his take on five common ailments.

By Gregory Lynam, MD
Henrico Monthly
November 2014

Everyone gets a rash from time to time. Everyone sees skin changes as they age. What do you need to know and what do you need to do about those rashes and skin changes? Fortunately, most skin conditions are easily cured, many by simple treatments you can take care of yourself.

A rash is not a specific illness. It is a change in the skin that is caused by something else, often something in the environment. Sometimes skin problems can be related to changes associated with aging. Some of the most common rashes and skin changes are outlined here.

1. Poison ivy

What is it and how does someone get it? It’s a bumpy, itchy, patchy rash with small blisters, caused by contact with resins found in the leaves of the poison ivy plant. Similar rashes can come from contact with poison oak and poison sumac plants. Some people may even get it when exposed to smoke from plants that have been burned.

How common is it? All too common in the warmer weather when the leaves are out and outside activities make people more likely to come in contact with the plants. Groundskeepers, gardeners and others working outside are more susceptible to exposure.

How do I know that’s what I have? The rash will usually start to show up 12 to 72 hours after exposure to the plant. It will often start with redness and swelling of the areas exposed to the resin and itching and blisters follow soon after. The fluid inside the blisters won’t cause anyone else to develop a rash but if the resin is on the hands, anywhere the hands touch skin may develop the rash. It will usually go away in one to three weeks.

How is it treated? The exposed areas should be rinsed under lots of water within about 30 minutes, if possible. Clean carefully under fingernails and wash your clothing or anything else that was exposed. Since the rash is generally self-limiting – even if not treated, it will go away by itself – the treatments are aimed at relieving symptoms. Treatments can include cool compresses or baths and calamine lotion or other over-the-counter remedies. Diphenhydramine (Benadryl) can help reduce itching and over-the-counter pain medications will be helpful if needed. The only time you need to see your doctor is if the rash becomes infected – avoid scratching! If the rash is severe or home remedies do not help, your doctor may prescribe a steroid cream, shot, or pills, but this is usually not necessary.

What is the prognosis? Excellent. It will go away by itself and can be prevented by being aware of your surroundings when outside.

2. Shingles

What is it and how does someone get it? If you had chickenpox as a child, you are at risk for shingles. The virus that causes chickenpox makes a home in a nerve root; sometimes it just stays there and causes no problems but sometimes it can be “awakened” by illness, stress or just aging, causing a painful blistery rash that follows the path of the nerve. Shingles can occur anywhere on your body but is most commonly found on the trunk. It affects a narrow strip of skin which seems to follow one rib on one side from the back to the front.

How common is it? It is estimated that about 500,000 people in the U.S. will develop shingles with the rate increasing with age. This means that about 20 percent of the population will eventually develop shingles.

How do I know that’s what I have? It may start as a flu-like illness with a headache and a tingly, itchy, painful feeling in a patch or strip of skin. After a few days, small blisters appear; these break and form a crusty area after several days. Many people have just itching, but sometimes the pain can be quite severe.

How is it treated? Shingles can be treated by many medications depending on the symptoms. As it is self-limiting and will go away by itself after three to five weeks, the treatment is focused on controlling symptoms. Some of the treatments may include pain medications, steroids and creams or gels. Prompt usage of antiviral drugs such as Acyclovir may shorten the course of the disease.

What is the prognosis? Otherwise healthy patients may be miserable for a few weeks but will usually completely recover. About 13 percent of older patients may develop an uncomfortable condition called post-herpetic neuralgia with continuing pain in the affected area after the skin has healed. There are occasional complications from shingles (especially in people who have suppressed immune systems) so if you think you have it, you will want to see your doctor for treatment. There is an effective vaccine available for people older than 50.

3. Mold rash

What is it and how does someone get it? Mold, also called fungus, is a general term describing many different organisms that we live with, eat and breathe every day of our lives. The organisms generate tiny bits of material called spores, which can land anywhere and form a colony of mold; many are too small to see, but we have all seen samples of fungal growth on bread and cheese. Most molds are harmless, but some people are allergic to mold and will have symptoms if exposed to sufficient amounts. Skin mold allergies often arise after someone has spent time in a garden and been exposed to damp earth or dead plants. Some foods may have otherwise harmless mold that is not visible to susceptible patients.

How common is it? Since mold is everywhere, mold allergy is fairly common but can be tricky to diagnose since it looks like other rashes. Hives may also arise and the skin gets itchy and red. Once the acute problem is controlled, allergy testing is often recommended.

How do I know that’s what I have? The skin reaction will usually occur shortly after exposure to mold.

How is it treated? The exposed areas should be rinsed under lots of water and diphenhydramine (Benadryl) can quickly relieve some of the symptoms. Clean carefully under fingernails and wash your clothing or anything else that was exposed. Your doctor may prescribe a steroid, depending on the severity of your reaction.

What is the prognosis? Like any allergy, you are likely to develop another rash after each exposure. While it is not a dangerous condition, it is uncomfortable and there are things you can do to de-mold your environment to reduce the risk. Try to have any damp areas in your home cleaned out, keep your house aired and dry, and be aware that any areas of moisture may pose a hazard. Online there is lots of information including tips to help patients with mold allergy.

4. Animal/pet rash

What is it and how does someone get it? While the most common symptoms of pet allergies are sneezing, red and itchy eyes and trouble breathing, skin rashes can also occur. These will frequently take the form of hives – relatively large flat, itchy bumps on the skin. Any pet with fur or hair can trigger an allergy. Dead skin cells (dander) and dried animal saliva and urine can remain airborne for hours, collecting on clothes, upholstery and rugs. They are among the worst culprits for pet allergies.

How common is it? While about 15 percent of the U.S. population may have an allergy to animals, a skin reaction – which is uncomfortable but harmless – is less common than upper respiratory problems.

How do I know that’s what I have? Also called allergic dermatitis, hives will form within minutes to hours after exposure. The hives are raised, red welts or oval spots which are very itchy.

How is it treated? Antihistamines will quiet down the reaction and reduce the hives and itching. Like for most conditions, prevention is the best treatment. Remove carpets, wash animal bedding frequently, use a HEPA filter, wash your hands and clean regularly. There are many good tips online.

What is the prognosis? As with any potential allergies, allergy testing should be performed and, depending on the results, you and your doctor can work out a strategy that is best for you and your pet.

5. Aging skin

What is it and how does someone get it? You don’t have to do anything except get older! The lifetime effects of sun, wind, lifestyle and genetics all contribute to skin aging. The skin contains elastic fibers which keep it taut and fresh when we are young but they gradually reduce in number and elasticity, resulting in loose, wrinkled skin.

How common is it? Universally common! Signs often start in the fourth decade of life with some lines along movement areas in the face.

How do I know that’s what I have? The signs and symptoms are unmistakable: gradual loosening of the skin with resulting wrinkles; areas that are darker (sometimes called liver spots or age spots); the development of a wrinkly neck and jowls; and a rougher texture and drier skin, sometimes becoming very itchy in the winter. You’ve noticed a slow but steady progression over the years.

How is it treated? Prevention helps. Sunlight is the major culprit in skin aging and lifetime users of sunscreen and other skin protection age much more slowly. Smokers have been found to show signs of aging much earlier than those who don’t smoke. Unfortunately, there are no creams or medications that can restore elasticity. Surface treatments such as chemical peels or laser resurfacing may temporarily reduce the appearance of aging as can botulinum toxins and injected skin fillers. Plastic surgery to remove excess skin results in a tauter surface but the effects of age are not stopped and remaining skin will continue to stretch and sag over time. Any invasive or significant surface treatment should be carefully discussed with your doctor so that you know the costs, risks, benefits and options!

What is the prognosis? Since it’s not an illness, the prognosis is good – it’s a good sign that you’re doing something right!

Dr. Gregory Lynam is a board certified plastic surgeon who earned his medical degree at the Medical College of Virginia. He is the founder of Richmond Surgical Arts and former chief of medical staff at Stony Point Surgery Center.