Bruce P.Robinson, MD

Hives | Urticaria

Urticaria, also known as hives, are localized, pale, itchy, pink wheals (swellings) that can burn or sting. They may occur singularly or in groups on any part of the skin. They are part of an allergic reaction and are very common. Approximately 10-20 percent of the population will have at least one episode in their lifetime. Most episodes of hives disappear quickly in a few days to a few weeks. Occasionally, a person will have them for many months or years. New hives may develop as old ones fade. Hives can vary in size from as small as a pencil eraser to as large as a dinner plate, and may join to form even larger swellings.

Hives are produced by blood plasma leaking through tiny gaps between the cell lining small blood vessels in the skin. Histamine is a chemical released from cells in the skin called mast cells; which lie along blood vessels. Allergic reactions, chemicals in foods, or medications may cause hives; sometimes it is impossible to find out the cause. When hives form around the eyes, lips, or genitals, the tissue may swell excessively. Although frightening, the swelling usually goes away in less than 24 hours. Severe cases of hives may cause difficulty in breathing or swallowing and emergency room care is required.

Acute Urticaria

Acute urticaria lasts less than six weeks. An underlying cause can be frequently identified and eliminated. The most common causes for acute urticaria are foods, drugs, or infections. Insect bites, internal diseases, pressure, cold, or sunlight also may be responsible.

Foods

The most common foods that cause urticaria are: nuts, chocolate, shellfish, tomatoes, eggs, berries, and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also cause hives.

Hives may appear within minutes to several hours after eating, depending upon the site within the digestive tract where the food is absorbed.

Drugs

Almost any medication -- prescription or over-the-counter -- can cause hives. Antibiotics, pain medications, sedatives, tranquilizers, diuretics (water pills), diet supplements, antacids, arthritis medication, vitamins, herbal supplements, eye and eardrops, laxatives, vaginal douches, or any other non-prescription item can be a potential cause of urticaria. It is important to inform the dermatologist of ALL prescription and over-the-counter medications being used to help find the cause of the hives.

Infections

Many infections can cause urticaria. Viral upper-respiratory tract infections (colds) are a comon cause in children. Other viruses, including hepatitis and a number of bacterial and fungal infections, may cause urticaria.

Chronic Urticaria

Chronic urticaria lasts more than six weeks. The cause of chronic urticaria is more difficult to identify and is found only in a small percentage of patients. The dermatologist reviews a patient's medical history, asks extensive questions, and conducts a thorough physical examination. Testing, such as blood work or a biopsy, may be necessary.

Physical Urticarias

Physical urticaria may be caused by sunlight, heat, cold, water, pressure, vibration, or exercise. Solar urticaria forms within minutes of sun exposure and typically fades within one to two hours. Cold urticaria appears when the skin is warmed after exposure to cold. Urticaria, which forms in response to the cold or the water when swimming, for example, can produce wheezing, flushing, generalized hives, and fainting.

Dermatographic Urticaria (Dermatographiulesm)

Dermatographic urticaria forms after firmly stroking or scratching the skin, and can often occur with other forms of urticaria. It affects about five percent of the population. Most people with this condition are otherwise healthy. Dermatographism may last for months or even years.

Treatment

The best treatment for urticaria is to find and eliminate the cause whenever possible. Antihistamines are prescribed to provide relief and work best if taken on a regular schedule to prevent hives from forming. There are many antihistamines available. No one antihistamine works for everyone. The dermatologist may use combinations to control the urticaria. In severe cases, an injection of epinephrine (adrenalin) may be needed. Cortisone may also bring dramatic relief, but its use must be limited to short periods of time.

Tinea Versicolor

Tinea versicolor is a common skin condition due to overgrowth of a skin surface yeast. This overgrowth results in uneven skin color and scaling that can be unsightly and sometimes itch. The yeast normally lives in the pores of the skin and thrives in oily areas such as the neck, upper chest, and back. Tinea versicolor has small, scaly white-to-pink or tan-to-dark spots which can be scattered over the upper arms, chest and back. They may sometimes appear on the neck and the face. On light skin, Tinea versicolor may be faint or can appear as tan-to-pink spots, while on dark skin Tinea versicolor may be light or dark. The fungus grows slowly and prevents the skin from tanning normally. As the rest of the skin tans in the sun, the pale spots, which are affected by the yeast, become more noticeable, especially on dark skin.

What does Tinea Versicolor look like and how do you recognize it?

Tinea versicolor has small, scaly white-to-pink or tan-to-dark spots which can be scattered over the upper arms, chest and back. They may sometimes appear on the neck and the face. On light skin, Tinea versicolor may be faint or can appear as tan-to-pink spots, while on dark skin Tinea Versicolor may be light or dark. The fungus grows slowly and prevents the skin from tanning normally.

What are the symptoms?

Tinea Versicolor usually produces few symptoms. Occasionally, there is some slight itching that is more intense when a person gets hot.

Who may get this rash?

Most people get tinea versicolor when they are teenagers or young adults. It is rare in the elderly and children, except in tropical climates where it can occur at any age. Both dark and light skinned people are equally prone to its development. People with oily skin may be more susceptible than those with naturally dry skin.

The yeast is normally present in small numbers on everyone's skin. Anyone can develop an overgrowth of yeast. During the summer months when the temperature and humidity are high, the yeast can increase. The excess yeast on the skin prevents the normal pigmentation process, resulting in light and dark spots. In tropical countries with continuous high heat and high humidity, people can have these spots year round. In other climates, the spots generally fade in the cooler and drier months of the year. Why some people get tinea versicolor and others do not is unclear.

In tropical countries with continuous high heat and high humidity, people can have these spots year round. In other climates, the spots generally fade in the cooler and drier months of the year.

How is Tinea Versicolor diagnosed?

Although the light or dark colored spots can resemble other skin conditions, tinea versicolor can be easily recognized by a dermatologist. In most cases, the appearance of the skin is diagnostic, but a simple examination of the fine scales scraped from the skin can confirm the diagnosis. Scales are lightly scraped onto a slide and examined under a microscope for the presence of the yeast. A special light may help to make the diagnosis by showing a yellow green color where the skin is affected.

How is it treated?

Tinea versicolor is treated with topical or oral medications. Topical treatment includes special cleansers including some shampoos, creams, or lotions applied directly to the skin.

Several oral medications have been used successfully to treat tinea versicolor. Because of possible side effects, or interactions with other medications, the use of these prescription medicines should be supervised by a dermatologist. After any form of treatment, the uneven color of the skin may remain for several months after the yeast has been eliminated until the skin repigments normally.

Tinea versicolor may recur. Special cleansers may decrease episodes when used once or twice a month, especially during warm humid months of the year.

Each patient is treated by the dermatologist according to the severity and location of the disease, the climate, and the desire of the patient. It's important to remember that the yeast is easy to kill, but it can take weeks or months for the skin to regain its normal color.

Telangectasias | Dilated Blood Vessels

Telangectasias (commonly known as spider veins) are dilated or broken blood vessels located near the surface of the skin. They often occur on the face and particularly on the sides of the nose. They often look like small red or pink lines, which temporarily whiten when pressed.

Some Symptoms Of Spider Veins Include:

  • Swollen legs and/or ankles
  • Fatigue of the legs
  • A burning, itching, or throbbing sensation around the legs
  • Muscle cramps in the legs

Common Causes of Spider Veins

Spider veins are generally caused by weak or damaged valves. The following causes can contribute to weaker blood flow in certain areas of your body. 

  • Weight Gain
  • Sun Damage
  • Rosacea
  • Stress
  • Pregnancy
  • Hormonal Imbalance
  • Age
  • Genetics
  • Trauma

Treatment(s):

Thankfully, laser therapy is safe and efficacious treatment. It is an easy in-office treatment that can be performed during ones lunch break. In 10 minutes those red lines are gone and you can go right back to work. No wound care or dressings needed.

Sclerotherapy is also a treatment option. A special solution is injected directly into the affected veins, forcing the veins to close and the blood to redirect into healthier veins. The old vein turns into scar tissue that your body will eventually absorb, causing it to fade.

Sunburn Care

So You Have a Sunburn? No Judgement Here, Just Relief.

It is important to treat a sunburn as soon as you notice it.

The first thing you should do if you feel you have or are getting a sunburn is get out of the sun, preferably go indoors. Once indoors, these tips can help relieve the discomfort:

  • Frequent cool baths or showers can ease the pain.  Gently pat skin dry, with a little dampness left on the skin apply a moisturizer ‘cream or ointment”, preferably not a “lotion”.  The moisturizer will help trap the water in your skin and help ease the dryness. You can also place the cream or ointment in the refrigerator for extra coolness.
  • Use a moisturizer that contains aloe vera to help soothe sunburned skin. If a particular area feels especially uncomfortable, you may want to apply an over the counter hydrocortisone cream that you can buy without a prescription. Do not treat sunburn with “-caine” products (such as benzocaine), as these may irritate the skin or cause an allergic reaction.
  • Consider taking acetaminophen or ibuprofen to help reduce any swelling, redness and discomfort.
  • Drink extra water. A sunburn draws fluid to the skin’s surface and away from the rest of the body. Drinking extra water when you are sunburned helps prevent dehydration.
  • If your skin blisters, allow the blisters to heal. Blistering skin means you have a second-degree sunburn. You should not pop the blisters, as blisters form to help your skin heal and protect you from infection.  Once the blisters open you can apply an antibiotic ointment to prevent an infection.
  • Take extra care to protect sunburned skin while it heals. Wear clothing that covers your skin when outdoors. Tightly-woven fabrics work best. When you hold the fabric up to a bright light, you shouldn’t see any light coming through.

If you have fever, chills, headache or any questions about your sunburn please call our office to schedule an appointment. Although it may seem like a temporary condition, sunburn is a result of skin receiving too much exposure from the sun’s ultraviolet (UV) rays and can cause long-lasting damage to the skin. This damage increases a person’s risk for getting skin cancer.

Squamous Cell Carcinoma

Squamous cell carcinoma is the second most common cancer of the skin. More than 250,000 new squamous cell carcinomas are diagnosed every year in the United States. Middle-aged and elderly people, especially those with fair complexions and frequent sun exposure, are most likely to be affected.

The cancer develops in the outer layer of the skin (the epithelium). Some squamous cell carcinomas arise from small sandpaper-like lesions called solar (sun) or actinic keratosis. It is possible for squamous cell carcinoma to spread to other areas of the body; therefore, early treatment is important.

What does squamous cell carcinoma look like and where does it appear?

Squamous cell carcinomas usually appear as crusted or scaly patches on the skin with a red, inflamed base, a growing tumor, or a non-healing ulcer. They are generally found in sun-exposed areas like the face, neck, arms, scalp, backs of the hands, and ears. The cancer also can occur on the lips, inside the mouth, on the genitalia, or anywhere on the body. Any lesion, especially those that do not heal, grow, bleed, or change in appearance, should be evaluated by a dermatologist.

What are the factors that cause squamous cell carcinoma?

Ultraviolet light exposure (from the sun or indoor tanning devices) greatly increases the chance of developing skin cancer. Although anyone can get squamous cell carcinoma, people with light skin who sunburn easily are at the highest risk. The chance of developing skin cancer increases with age and a history of severe sunburns as a child. Many less common skin conditions, organ transplantation, chronic skin ulcers, prior x-ray treatment (e.g., for acne in the 1950s), arsenic ingestion, smoking, and toxic exposure to tars and oils can predispose individuals to the development of squamous cell carcinoma.

How serious is squamous cell carcinoma?

These skin cancers are usually locally destructive. If left untreated, squamous cell carcinoma can destroy much of the tissue surrounding the tumor and may result in the loss of a nose or ear, for example. Aggressive types of squamous cell carcinomas, especially those on the lips and ears, or untreated cancers, can spread to the lymph nodes and other organs resulting in approximately 2,500 deaths each year in the United States.

How do dermatologists treat squamous cell carcinomas?

A skin biopsy for microscopic examination may be done to confirm the diagnosis. A variety of different treatment options can be used depending on the location of the tumor, size, microscopic characteristics, health of the patient, and other factors. Most therapies are relatively minor office-based procedures that require only local anesthesia. Surgical excision to remove the entire cancer is the most commonly used treatment. "Mohs" micrographic controlled surgery, a method which requires specialized training by dermatologic surgeons, can be used to remove the tumor while sparing as much normal skin as possible. Other dermatologic surgical procedures include laser surgery, cryosurgery (liquid nitrogen - the frozen method), radiation therapy, and electrodesiccation and curettage which involves alternately scraping and cauterizing (burning) the tumor with low levels of electricity.

Spider Veins

Spider Veins are very small veins caused by a dilation of the small venules under the skin. This occurs when the pressure inside the vein increases enough to overcome normal resistance of the vein wall. The ability of veins to resist increased pressure is reduced with hormonal changes.

Reticular Veins are small, bluish-colored veins that carry blood to the skin venules and are larger than spider veins. These veins have thin walls and dilate with excessive venous pressure. When this occurs, they become large enough to be unsightly, but are not considered to be varicose veins.

In recent years medical lasers have made great advancements in sophistication. Today, lasers are safely used for a wide variety of cosmetic non-invasive treatments. Laser Therapy treatment is extremely safe and effective on leg veins, as well as veins visible on the face, neck, and chest. Laser treatment also corrects benign pigmented lesions such as age spots and birthmarks. These non-invasive treatments are increasingly popular because they have very few side effects, and one can resume regular activities immediately following treatment.

Who are candidates for treatment?

Both men and women, light and dark-skinned individuals can now safely and effectively benefit from laser therapy for spider veins. Patients using blood thinners or afflicted with a serious illness generally are not candidates for treatment. Patients with dark suntans or photosensitivity disorders, uncontrolled or severe diabetes, bleeding disorders, or those currently taking photosensitizing medications may also be restricted from candidacy.

How many treatments are required?

The number of treatments necessary to resolve your vein concerns depends on the size of the vein and your body's ability to heal. During your consultation, you will be given an estimate of the number of treatments required to obtain optimal results.

What does the treatment involve?

Treatment may vary from 15 to 30 minutes. As a result of treatment, the walls of the veins are damaged by the laser's heat. The body next induces a healing process. The veins shrink and become less visible or disappear altogether. Medical studies have documented exceptional results on veins with laser treatments.

What are the side effects and is there "downtime"?

The beauty of this treatment is that there is no down time involved. You can resume most of your regular activities immediately. Your doctor may use various methods to reduce the pain that may be associated with this procedure. Swelling and mild bruising can occur, but almost always resolve over a short period of time. Limiting sun exposure, avoiding strenuous exercise, and wearing compression stockings will greatly minimize the risk of complications immediately following your treatment.

Which type of veins can Laser Therapy treat?

Laser Therapy treats many types of leg veins, including shallow spider veins and reticular veins.

Spider Veins are very small veins caused by a dilation of the small venules under the skin. This occurs when the pressure inside the vein increases enough to overcome normal resistance of the vein wall. The ability of veins to resist increased pressure is reduced with hormonal changes.

Reticular Veins are small, bluish-colored veins that carry blood to the skin venules and are larger than spider veins. These veins have thin walls and dilate with excessive venous pressure. When this occurs, they become large enough to be unsightly, but are not considered to be varicose veins.

Cosmetic Consultation Reimbursement Policy

Schedule an office visit to discuss your concerns and skincare goals with Dr. Robinson and the office visit cost will be applied to the future cost for the "consulted procedure". The "consulted procedure" must be completed within 30 days of your consult visit.

Skin Cancer

Skin Cancer is the cancer you can see! Yet skin cancer often goes undetected. With over 5 million cases of skin cancer diagnosed in the U.S. each year, skin cancer is America's most common cancer. More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.

Types of skin cancers include: Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma and Merkel Cell  Carcinoma, they are mainly caused by UV exposure to ultraviolet (UV) radiation from the sun. However, skin cancer can form anywhere on the body even if it is not exposed to the sun. All ethnicities and skin tones are at risk.

Basal Cell Carcinoma is the most common skin cancer. It is also one of the easiest to spot and treat. Squamous Cell Carcinoma is the second most common skin cancer and Melanoma the third. Despite Melanoma being the third most common form of skin cancer, it accounts for 75% of all skin cancer deaths. 

Basal Cell Carcinomas are quite common, and the number of reported cases in the U.S. is steadily increasing. An estimated 3.6 million cases of Basal Cell Carcinomas are diagnosed each year in the U.S..

Squamous Cell Carcinoma is the second most common. An estimated 1.8 million cases are diagnosed each year in the U.S. which translates to about 205 cases every hour. SCC incidence has increased up to 200% in the past three decades.

Melanoma is the third most common and deadly cancers. Early detection is critical! In the past decade (2012-2022) the number of new invasive melanoma cases diagnosed annually increased by 31%. An estimated 197,700 cases of melanoma will be diagnosed in the U.S. in 2022 and 7,650 people will die of melanoma in 2022. (5,080 men & 2,570 women). 

Merkel Cell Carcinoma is about three - five times more likely to be deadly than melanoma. Approximately 3,000 new cases of Merkel Cell Carcinoma are diagnosed annually in the U.S. 

The good news is that skin cancer can be prevented, and it can almost always be cured when it’s found and treated early.

A change in your skin is the most common sign of skin cancer. This could be a new growth, a spot that doesn’t look like others on your body, a sore that doesn’t heal, or a change in a mole. The “ABCDE rule” can be used as a guide. The “ABCDE rule” can be used as a guide (see below).

Skin cancer isn't going to check itself out. Therefore, an annual skin check by a board-certified dermatologist and a monthly skin check by you is vital to good skin care. See something NEW, keep an eye out for any New moles or blemishes that have popped up, CHANGING, a leopard's spots don't change and neither should yours, always check if your spots are Changing in color, size, shape, or texture, or UNUSUAL, one of these things is not like the others ... look for spots that are unusual in outline or continuously itch, hurt, crust or bleed for more than 3 weeks. It could be skin cancer.

When these skin cancers are detected early, treatment often results in a cure. Be sure to schedule an yearly skin exam with your dermatologist and more often if you have a family history of skin cancer.

Take these simple steps today to protect your skin:

  • Stay out of the sun as much as possible between 10 a.m. and 4 p.m.
  • Use a broad spectrum (UVA/UVB) sunscreen with SPF 30 or higher
  • Put on sunscreen every 2 hours and after you swim or sweat
  • Cover up with long sleeves and a hat
  • Check your skin regularly for changes
  • Report any unusual moles or changes in your skin to your doctor

The ABCDE's of Skin Cancer.

How To Check Your Skin ...

Here’s what you’ll need: a bright light, a full-length mirror, a hand mirror, two chairs or stools and a blow-dryer.

  • Examine your face: Especially your nose, lips, mouth and ears—front and back. Use one or both mirrors to get a clear view
  • Inspect your scalp: Thoroughly inspect your scalp using a blow-dryer and mirror to expose each section to view. Get a friend or family member to help, if you can.
  • Check your hands: Standing in front of the full-length mirror, begin at the elbows and scan all sides of your upper arms. Don’t forget the underarms.
  • Inspect your torso: Next, focus on the neck, chest and torso. Women should lift breasts to view the undersides.
  • Scan upper back: With our back to the full-length mirror, use the hand mirror to inspect the back of your neck, shoulders, upper back and any part of the back of your upper arms you could not view in step 4.
  • Scan lower back: Still using both mirrors, scan your lower back, buttocks and backs of both legs.
  • Inspect your legs?: Sit down; prop each leg in turn on the other stool or chair. Use the hand mirror to examine the genitals. Check the front and sides of both legs, thigh to shin, ankles, tops of feet, between toes and under toenails. Also examine the soles of your feet and heels.

Treatments:

Dr. Robinson is improving skin cancer treatments with less invasive treatments. No scarring, no bleeding, functional & cosmetic results are superior to cold steel excision & MOHS. Patients on anticoagulant therapy do not have to stop their medication before treatment, therefore not increasing their risk for stroke and/or heart attack, quick healing, & no risk of post-operative complications! This is especially helpful with Infirm or older patients, great for professionals who can't afford downtime or a scar.

Using non-ablative fractional laser therapy offers a Gentle Approach to Treating Pre-Cancerous Growths and Overall Healthier Skin.

Skin cancer is the most prevalent cancer in the United States. More than 3 million Americans are diagnosed with non-melanoma skin cancer(s), such as basal cell & squamous cell carcinoma each year. These two types of cancers are collectively known as keratinocyte carcinoma or (KC).

In individuals with a history of a prior KC, the risk of developing subsequent KC remains a significant concern. 

In our study using non-ablative fractional laser therapy, including 4 sessions spaced at 2-4 week intervals, w/ follow-up assessments, 1-3 months after the final treatment session 60% had greater reduction of the development of KC and had improved overall health of sun-damaged skin. There was also a lower recurrence rate of MOHS. Lowering the rate of infection directly related to lack of having an open wound.

Non-ablative fractional laser therapy has already demonstrated remarkable success with minimal downtime & discomfort as a gentle yet effective treatment of actinic keratosis (AK), the most common type of pre-cancerous skin conditions. Other benefits to using non-ablative fractional laser therapy is it's ability @ ameliorating photo damage, utilizing precise photothermolysis to stimulate collagen and elastin production, promote dermal wound healing & decreasing and improving hyperpigmentation, telangiectasias, skin tone, skin laxity, and tactile roughness. Now we can add treatment of certain skin cancers to the list.

Seborrheic Dermatitis

Seborrheic dermatitis is a common skin disorder that can be easily treated. This condition is a red, scaly, itchy rash most commonly seen on the scalp, sides of the nose, eyebrows, eyelids, skin behind the ears, and middle of the chest. Other areas, such as the navel (belly button), buttocks, skin folds under the arms, auxillary regions, breasts, and groin, may also be involved.

Diagnosis

Your doctor will likely be able to determine whether you have seborrheic dermatitis by examining your skin. He or she may scrape off skin cells for examination (biopsy) to rule out conditions with symptoms similar to seborrheic dermatitis, including:

  • Psoriasis. This disorder also causes dandruff and red skin covered with flakes and scales. With psoriasis, usually you'll have more scales, and they'll be silvery white.
  • Atopic dermatitis (eczema). This skin reaction causes itchy, inflamed skin in the folds of the elbows, on the backs of the knees or on the front of the neck. It often recurs.
  • Tinea versicolor. This rash appears on the trunk but usually isn't red like seborrheic dermatitis patches.
  • Rosacea. This condition usually occurs on the face and has very little scaliness.

Are Dandruff, Seborrhea and Seborrheic Dermatitis the same?

Dandruff appears as scaling on the scalp without redness. Seborrhea is excessive oiliness of the skin, especially of the scalp and face, without redness or scaling. Patients with Seborrhea may later develop Seborrheic Dermatitis. Seborrheic Dermatitis has both redness and scaling.

Who gets Seborrheic Dermatitis?

This condition is most common in three age groups - infancy, when it's called cradle cap, middle age, and the elderly. Cradle cap usually clears without treatment by age 8 to 12 months. In some infants, Seborrheic Dermatitis may develop only in the diaper area where it could be confused with other forms of diaper rash. When Seborrheic Dermatitis develops at other ages it can come and go. Seborrheic Dermatitis may be seasonally aggravated particularly in northern climates; it is common in people with oily skin or hair, and may be seen with acne or psoriasis. A yeast-like organism may be involved in causing Seborrheic Dermatitis.

How long does this disease last?

Seborrheic Dermatitis may get better on its own, but with regular treatments, the condition improves quickly.

Can it be prevented or cured?

There is no way to prevent or cure Seborrheic Dermatitis. However, it can be controlled with treatment.

Treatment

Medicated shampoos, creams and lotions are the main treatments for seborrheic dermatitis. Your doctor will likely recommend you try home remedies, such as over-the-counter dandruff shampoos, before considering prescription remedies. If home remedies don't help, talk with your doctor about trying these treatments.

  • Creams, shampoos or ointments that control inflammation. Prescription-strength hydrocortisone, fluocinolone (Capex, Synalar), clobetasol (Clobex, Cormax) and desonide (Desowen, Desonate) are corticosteroids you apply to the scalp or other affected area. They are effective and easy to use, but should be used sparingly. If used for many weeks or months without a break, they can cause side effects, such as thinning skin or skin showing streaks or lines.Creams or lotions containing the calcineurin inhibitors tacrolimus (Protopic) and pimecrolimus (Elidel) may be effective and have fewer side effects than corticosteroids do. But they are not first-choice treatments because the Food and Drug Administration has concerns about a possible association with cancer. In addition, tacrolimus and pimecrolimus cost more than mild corticosteroid medications.
  • Antifungal gels, creams or shampoos alternated with another medication.Depending on the affected area and the severity of your symptoms, your doctor might prescribe a product with 2 percent ketoconazole (Nizoral) or 1 percent ciclopirox. Or you doctor may prescribe both products to be used alternately.
  • Antifungal medication you take as a pill. If your condition isn't improving with other treatments, your doctor may recommend an antifungal medication in pill form. These aren't a first choice for treatment because of possible side effects and drug interactions.

Scabies

Scabies is an infestation of the skin by the human itch mite. The tiny mites burrow into the upper layer of the skin where it lives and lays its eggs. It has infested humans for at least 2,500 years. It is often hard to detect, and causes a fiercely itchy skin condition. Dermatologists estimate that more than 300 million cases of scabies occur worldwide every year. The condition can strike anyone of any race or age, regardless of personal hygiene. The good news is that with better detection methods and treatments, scabies does not need to cause more than temporary distress.

How Scabies Develops

The microscopic mite that causes scabies can barely be seen by the human eye. Being a tiny, eight-legged creature with a round body, the mite burrows in the skin. Within several weeks, the patient develops an allergic reaction causing severe itching; often intense enough to keep sufferers awake all night.

Human scabies is almost always caught from another person by close contact. It could be a child, a friend, or another family member. Everyone is susceptible. Scabies is not a condition only of low-income families and neglected children, although, it is more often seen in crowded living conditions with poor hygiene.

Attracted to warmth and odor, the female mite burrows into the skin, lays eggs, and produces toxins that cause allergic reactions. Larvae, or newly hatched mites, travel to the skin surface, lying in shallow pockets where they will develop into adult mites. If the mite is scratched off the skin, it can live in bedding for up to 24 hours or more. It may take up to a month before a person will notice the itching, especially in people with good hygiene and who bathe regularly.

What to Look For ...

The earliest and most common symptom of scabies is intense itching, especially at night. Little red bumps like hives, tiny bites, or pimples appear. In more advanced cases, a rash can spread slowly over a period of weeks or months and the skin may be crusty or scaly.

Scabies skin mite is about 0.4mm, just visible to the human eye

The scabies mite is very small, about the size of the tip of a needle and very difficult to see. It’s white to creamy-white in color. It has eight legs and a round body, which you can see if the mite is magnified. Scabies prefers warmer sites on the skin such as skin folds, where clothing is tight, between the fingers or under the nails, on the elbows or wrists, the buttocks or belt line, around the nipples, and on the penis. Mites also tend to hide in, or on, bracelets and watchbands, or the skin under rings. In children, the infestation may involve the entire body including the palms, soles, and scalp. The child may be tired and irritable because of loss of sleep from itching or scratching all night.

Bacterial infection may occur due to scratching. In many cases, children are treated because of infected skin lesions rather than for the scabies itself. Although treatment of bacterial infections may provide relief, recurrence is almost certain if the scabies infection itself is not treated.

How is Scabies Treated?

Your healthcare provider must order a cream that contains a medicine called permethrin to treat scabies. The cream is applied to your whole body below your head, including the hands, palms, and soles of the feet.

In children with scabies, the cream may need to be applied to the scalp. Be sure that skin is clean, cool and dry before applying the cream.

Permethrin cream is left on the skin for eight to 14 hours and then washed off. (The cream is most often applied at night and washed off in the morning.)

Ivermectin is another option for treating scabies. This is an antiparasitic pill given in a single dose, followed by a second dose one to two weeks later.

If you’re pregnant or lactating, you shouldn’t use ivermectin. If your child weighs less than 35 pounds (15 kilograms), they shouldn’t use ivermectin.

Your provider might also suggest antihistamines, which can be taken by mouth and as a cream, to relieve itching. Your provider will also treat any type of infection that may be present.

How soon are the mites killed?

The mites that cause scabies are killed after one treatment. The treatment doesn’t need to be repeated unless the infection doesn’t go away or comes back.

How soon does the itching stop?

The itching may take two to four weeks to go away, even though the mites have been killed.

How soon does the scabies rash go away?

Red bumps on the skin should go away within four weeks after treatment.

How can I prevent spreading scabies?

You can prevent spreading scabies by:

  • Washing bed linens, towels and clothing in hot water and machine dry.
  • Making sure family members and others in close contact with the infected person get checked for scabies.
  • Limiting close contact with others if you know you’ve got scabies.

Can a person get scabies more than once?

Yes. You can get scabies any time that you come into close contact with an infected person.

Will scabies go away on its own?

No, scabies won’t go away on its own. If you don’t treat it, you’ll probably continue to spread the disease to other people. In addition, the constant itching will probably lead to constant scratching and will cause some type of bacterial infection of the skin.

Is scabies hard to get rid of?

Scabies is treatable, but they can be hard to get rid of completely. Certain forms of scabies are harder to treat, such as the crusted form. In addition, you might need more than one round of treatment to make sure all of the mites are gone.

If you have a rash and it’s so itchy that you can’t sleep, make sure you contact your healthcare provider. You may have scabies, which is an infectious disease. You and other people close to you should be tested and treated. You’ll want to schedule an appointment with Dr. Robinson if you have any kind of skin rash that doesn’t go away and that causes problems for you. Scabies, like many other types of red itchy rashes, can be treated successfully.

Rosacea

Rosacea is a common skin disease that causes redness, papules, and swelling on the face. Often referred to as adult acne, rosacea frequently begins as a tendency to flush or blush easily. It may progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. The eyes, ears, chest, and back may also be involved. With time, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

When rosacea first develops, the redness may come and go. Some people may flush or blush and never form pustules or papules. Small dilated vessels may also be present. However, when the skin doesn't return to its normal color, and when other symptoms such as pimples and enlarged blood vessels become visible, it's best to seek advice from a board-certified dermatologist. The condition may last for years, rarely reverse itself, and can become worse without treatment.

How to Recognize Rosacea

Small red bumps, some of which may contain pus, appear on the face. These may be accompanied by persistent redness and the development of many tiny blood vessels on the surface of the skin.

In more advanced cases, a condition called rhinophyma may develop. The oil glands enlarge causing a bulbous, red nose, and puffy cheeks. Thick bumps may develop on the lower half of the nose and nearby cheeks. Rhinophyma occurs more commonly in men.

Who is at Risk for Rosacea?

Anyone can get Rosacea. It is more common in fair skinned adults between the ages of 30 and 50. Since it may be associated with menopause, women are affected more often than men and may likely have an extreme sensitivity to cosmetics. In people of color, studies show that early symptoms can often be missed and may be under diagnosed because dark skin can mask facial redness. Few children get rosacea, but it is worth considering if the signs and symptoms are there.

Tips for Rosacea Patients

  • Avoid triggers, including hot drinks, spicy foods, caffeine and alcoholic beverages that make the face red or flushed. It's important to note that although alcohol may worsen rosacea, the condition may be just as severe in someone who doesn't drink at all; thus rosacea has been unfairly linked to alcoholism.
  • Practice good sun protection. Seek shade when possible and limit exposure to sunlight, wear hats and use broad spectrum sunscreens with SPF of 15 or higher; reapply every 2 hours.
  • Avoid extreme hot and cold temperatures which may exacerbate the symptoms of Rosacea. Exercise in a cool environment. Do not overheat.
  • Avoid rubbing, scrubbing or massaging the face.
  • An occasional embarrassment or a tense moment also may trigger flushing.
  • Avoid cosmetics and facial products that contain alcohol. Use hair sprays properly, avoiding contact with facial skin.
  • Keep a diary of flushing episodes and note associated foods, products, activities, medications or other triggering factors.

Treatment

Many people with Rosacea are unfamiliar with it and do not recognize it in its early stages. Identifying the disease is the first step to controlling it. Self-diagnosis and treatment are not recommended since some over-the-counter skin products may make the problem worse.

Dermatologists often recommend a combination of treatments tailored to the individual patient. These treatments can stop the progress of rosacea and sometimes reverse it.

  • Creams, lotions, foams, washes, gels, and pads that contain various topical antibiotics, metronidazole, sulfcetimide, benzoyl peroxide, and retinoids may be prescribed. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months.
  • Oral antibiotics tend to produce faster results than topical medications. Cortisone creams may reduce the redness of rosacea; however, they should not be used for longer than two weeks since they can cause thinning of the skin and flare-ups upon discontinuation. It is best to use these creams only under the direction of a dermatologist.
  • Cosmetics may be helpful. Green tinted makeup may mask the redness.
  • HydraFacial MD® treats rosacea by gently exfoliating the uppermost layer of skin and extracting impurities and dead skin cells through a patented vortex suction method. Then, it infuses a calming serum packed with antioxidants, peptides and hyaluronic acid. Maintenance treatments are recommended on a monthly basis or as needed.
  • Relief From Rosacea With V-Beam Laser Therapy. V-Beam laser is a pulse-dye laser that delivers short bursts of light to the treatment area. The light beam targets and coagulates broken and damaged blood vessels and vascular lesions so they may be naturally reabsorbed by your body during the healing process.
  • For rhinophyma, surgery is usually the main treatment to: Reshape a disfigured nose, remove tissue overgrowth & minimize enlarged blood vessels.

The key to successful management of Rosacea is early diagnosis and treatment. Rosacea can be treated and controlled if medical advice is sought in the early stages. When left untreated, Rosacea will get worse and may be more difficult to treat.

Bruce Robinson: New York Super Doctor 2023Bruce Robinson: New York Top Doctor 2023Bruce Robinson: New York Super Doctor 2022Bruce Robinson: New York Top Doctor 2022
Copyright © 2024 Bruce Robinson, MD • All Rights Reserved
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