When I was in medical school on my dermatology rotation, we joked that all skin treatments boil down to three decrees: If it’s wet, dry it. If it’s dry, wet it. And if in doubt, use steroids.
Some other time I’ll discuss the “drying” of skin, or the use of steroids (which are not, by the way, the kind of steroids taken illegally by athletes!) Today I’ll cover how to keep the skin “wet” – and some principles of moisturizing.
Skin is our first line of defense against disease. Bacteria, viruses, parasites – dangers lurk everywhere. But our epidermis (the outer layer of our skin) blocks them almost always. When people have inflamed skin, the epidermis becomes disrupted and infectious particles can enter their body.
The key to keeping the epidermis intact is keeping it moist. Now, I’m talking about moisture just below the surface of the skin (within the epidermis), so the outside surface doesn’t feel wet. There are molecules within the epidermis that Read more »
*This blog post was originally published at Making Sense of Medicine*
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*
Hard water is tap water that’s high in minerals such as calcium and magnesium. Hard water isn’t harmful, except the minerals prevent your soap from sudsing. Some people think that hard water is more likely to cause a rash than soft water.
Take a recent patient of mine: He moved his family to San Diego from the East Coast (good move this winter, no?) After they moved here, they noticed their skin became dry and itchy. He blamed San Diego’s notoriously hard water and installed a water softener in the main water line. It was costly, but did it improve their skin?
A recent study from the UK looked at this question: Does hard water worsen eczema? The answer was no, it doesn’t. Water hardness did not seem to have any impact on eczema, the most common skin rash.
What’s more important than the hardness of the water is the type of soap you use. True soap tends to strip the skin of its natural oils, leaving it exposed and irritated. Non-soap cleansers, of which Dove is the prototype, leave more oils on your skin, keeping it hydrated and protected.
My patient and his family didn’t get any better after installing a water softener (although he said they could drink our tap water without gagging now.) I advised him to change to a moisturizing soap and to apply moisturizer daily.
San Diego is drier than most of the country, and the low humidity can be a shock to skin accustomed to humid air. Many people who move here find they have to moisturize more often than they did back home. When they complain, I suggest they could alternatively move back to the East Coast this winter — no takers so far.
*This blog post was originally published at The Dermatology Blog*
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*