It could be a common dry skin rash called pityriasis alba.
With pityriasis alba, the white patches of fine dry scale are usually located on the sides of the cheeks and the outer side of the upper arm. They’re more likely to occur when activities or weather conditions dry out the skin such as swimming in chlorinated pools or with the temperature extremes of a cold and dry winter. They also show up more when skin is tanned because the scaly patches stay white and contrast against the tanned skin. That means that towards the end of summer, they may well be in full bloom if you live in a dry climate.
What is pityriasis alba?
It’s a subtle form of eczema (also called dermatitis). It’s an unusual rash though because there really isn’t much, if any, inflammation. This means the involved skin doesn’t itch, it just looks funny. Most people mistake it for a fungus, which it isn’t. It’s just a form of dry skin eczema.
What treatments will help get rid of the white spots from pityriasis alba? Read more »
*This blog post was originally published at Dr. Bailey's Skin Care Blog*
One of the great things of being in a group practice is meeting and taking care of patients who may not necessarily be on your own personal patient panel. Walking into the room, I hear the patient say, “Doc, you gotta help me.” I see a red right forearm and on the “complaint” section, the nurse wrote “burn.”
So, I ask, “Well how did you burn your arm?” “Well, doc, I got cancer.” Hmm, that’s interesting. I didn’t make the connection until the next sentence. “It was my last treatment with chemotherapy about 2 weeks ago and for some reason, the needle slipped and the stuff went all over my arm. The cancer doc prescribed these pills, but they don’t seem to be helping. I asked the pharmacist about some salves and this is what they said.” He showed me a handful of creams and ointments purchased at the pharmacy.
Since I didn’t know this patient at all, I was leafing through a very thick paper chart to try to catch up. “Yeah, I’ve been coming to see Doc [name] for a long time now. I’m glad you were able to see me today since his schedule was full.” This very pleasant patient then told me about how they diagnosed his cancer – a tear came to his eye – it’s like he was re-living that moment again. Read more »
*This blog post was originally published at Doctor Anonymous*
Being a plastic surgeon, I have a great interest in the skin and no I don’t see or treat much dermatitis as the primary physician. Patients do occasionally ask me about patches/rashes they have. It’s always nice to be up on the topic and to know when it’s important to make sure they see a dermatologist.
The article listed below is a nice, simple review of conditions that fall into the eczema /dermatitis categories. The article discusses atopic dermatitis (AD), nummular (coin-shaped) eczema, contact dermatitis, and stasis dermatitis. It is not a deep article on the subject, but did include some nice reminders and tips.
Allergic dermatitis is not uncommon in patients with chronic wounds. One study documented more than 51% of leg ulcer patients acquire contact allergic dermatitis to local dressings and other topical treatment. This is important to any of us who treat wounds, acute or chronic. Sometimes the wound fails to heal due to this.
There is a nice table which lists the common allergens in patients with chronic wounds. If your chronic wound patient has a contact allergy to these products, it can certainly complicate their wound healing.
lanolin (common in moisturizing creams and ointments)
cetylsterol alcohol (used as an emulsifier, stabilizer, and preservative in creams, ointments, and paste bandages)
preservatives: quaternium 15, parabens, chlorocresol (all are used to prevent bacterial contamination in creams, but are not in ointments)
rosin (colophony) — a component of some adhesive tapes, bandages, or dressings
rubber / latex
The key to treatment and prevention of future exacerbations is identification of any provocative factors so that they may be avoided as there is no absolute cure for dermatitis. Here is a summary of tips the article gives:
Laundry and Clothing Suggestions
Avoid wearing wool or nylon next to their skin as they may exacerbate itch. Choose materials made of cotton or corduroy which are softer.
Rather than use fabric softeners and bleach, which may be irritating to the skin, add a white vinegar rinse in the washing machine rinse cycle cup/dispenser to remove excess alkaline detergent.
Keep water exposure to a minimum.
Use humectants or lubricants regularly to replenish skin moisture. Apply these agents immediately after bathing while the skin is damp.
For severe hand eczema, cotton gloves may be worn at night to augment the moisturizing effect of humectants and other topical treatments.
Topical steroids continue to be the mainstay therapy for treating dermatitis.
Topical steroid creams can be kept in the refrigerator or combined with 0.5% to 1% of menthol (camphor and phenol are alternatives) to give a cooling effect. This often helps.
Treat the dermatitis with a topical steroid when the skin is red and inflamed. Tapering the topical steroid use by alternating with moisturizers as the dermatitis resolves.
Remember that percutaneous absorption of topical steroids is greatest on the face and in body folds. They suggest only weak or moderate preparations be used in these areas.
Moderate to potent topical steroids should be used on the trunk and the extremities.
The palms and soles are low-absorption areas, so may require very potent topical steroids
The ABCs of Skin Care for Wound Care Clinicians: Dermatitis and Eczema; Advances in Skin & Wound Care: May 2009, Vol 22, Issue 5, pp 230-236; Woo, Kevin Y. RN, MSc, PhD, ACNP, GNC(C), FAPWCA; Sibbald, R. Gary BSc, MD, MEd, FRCPC (Med, Derm), ABIM DABD, FAPWCA (doi:10.1097/01.ASW.0000350837.17691.7f)
*This blog post was originally published at Suture for a Living*