What is ringworm? Neither a ring nor a worm.

Ringworm is neither a ring nor a worm.  It’s the common name used for a rash called tinea corporis (yes, another fancy name).  This is a rash caused by an infection of your skin by fungus.  The reason it’s called ringworm is that it characteristically causes a rash that can look like a red (scaly) ring.  Sometimes the rings can be quite intricate too!  There are a lot of mimickers of ringworm, so you should get your rash checked out by a doctor — eczema, psoriasis, pityriasis rosea, lyme disease, etc. can look like ringworm to the untrained eye.  By looking at your rash and scraping it to look for fungi, your doctor can make the diagnosis.  Usually, creams are used to treat ringworm but if your rash is really extensive, you might need pills to get rid of your rash.

Neosporin and bacitracin causing a rash?

Neosporin and bacitracin can cause a rash after contacting with your skin — this rash is suitably called allergic contact dermatitis. In fact, neomycin (found in Neosporin) was named the contact allergen of the year in 2010 and bacitracin was the contact allergen of the year in 2003 (named by the American Contact Dermatitis Society). The most well known contact allergen is probably poison ivy. After performing biopsies and excision, we usually tell people to keep their wounds covered with plain old vaseline instead of Neosporin (a combination of bacitracin, neomycin, and polymyxin B,) or bacitracin because of this potential rash. While contact dermatitis is not a life-threatening rash, it can cause itching, discomfort and can mimic an infection because of the surrounding redness. Some clues to whether you have this type of rash is whether you used either product before the rash started, and whether the areas affected correspond to the areas that you placed the product. If you suspect that you’re having an allergic reaction to one of these products, stop using it! If it’s a bad rash, your doctor might prescribe another cream to place on top of the rash to help it go away faster and decrease any itching. In general though, if you develop a rash, redness or weeping around a wound, let your doctor know because you don’t want to miss an infection.

Contact dermatitis to bandaging materials.

Rash from the hot tub? It may be hot tub folliculitis (Pseudomonas folliculitis).

Now that the weather is slightly more chilly, you may feel inclined to relax in the warmth of your (or your friend’s) hot tub. Some folks might have second thoughts of spending time in the hot tub though because of a rash called hot tub folliculitis (aka Pseudomonas folliculitis). This rash is not limited to exposure to hot tubs though. Bathtubs, water slides, lakes etc. that are contaminated with the Pseudomonas bacteria could lead to this rash too! This rash consists of itchy red spots over follicles that start out flat but can then become raised and contain pus. Often, the areas affected are those under clothing (e.g. swimsuits) or in skin folds (e.g. armpits, upper thigh/groin area). This rash usually appears 12-48 hours after you’ve been in the hot tub (or other contaminated water), but you could develop it hours to days later too. The reason this rash develops is that the Pseudomonas bacteria makes its way into the hair follicles, causing infection and inflammation within the follicle. Now, in general, this rash goes away on its own and you don’t need pills. However, in patients who might not be able to fight off infections well, antibiotics may be needed as this could become a serious infection. Furthermore, proper use of chlorine in hot tubs, pools, water parks etc. could help prevent this pseudomonal/hot tub folliculitis!

“Popsicle panniculitis” leads to development of a fat removal technique called cryolipolysis

Years ago, people noted redness and then thinning of cheek fat on young children who sucked on popsicles. This entity became known as “popsicle panniculitis.” Panniculitis is a fancy word meaning inflammation of fat. The observation that cold temperatures could lead to destruction of fat was also made with scrotal panniculitis in pre-pubertal boys as well. (In boys, there’s more scrotal fat than in adult men.) Now, years later, this finding that cold temperatures leads to inflammation and destruction of fat has led scientists and physicians to develop a method of reducing fat called cryolipolysis. This is touted as a minimally invasive procedure by which the fat is cooled to a specific temperature which induces the destruction of fat. You may have heard this procedure by the name of the device used, e.g. Zeltiq. Data thus far shows that this technique is good for removing limited discrete amounts of fat (e.g. the love handles you just can’t get diet or exercise off, etc.)

Red rash all over your skin?

If you have a red rash all over your skin, there’s a name for that. It’s called erythroderma. There are a handful of conditions that can cause this condition such as:

– erythrodermic psoriasis
– atopic dermatitis
– hypersensitivity allergic reaction such as to medications, malignancies, infestations or infections (e.g. to a fungal infection, to scabies, etc)
– contact dermatitis
– erythrodermic seborrheic dermatitis
– pityriasis rubra pilaris
– lymphoma and leukemia

In children, one can also consider staph scalded skin syndrome as well as a diffuse icthyosis. Sometimes, no cause is found, and we call that idiopathic.

If you have a red rash all over, you should see a doctor soon! Erythroderma can sometimes lead to life-threatening complications.

What is Botox and is it right for you?

Botox is the brand name for onabotulinum toxin A (yes, it’s a mouthful!). There’s a product called Dysport (abobotulinum toxin A) which acts very similarly. And now, there’s another one on the market called Xeomin (incobotulinum toxin A).

How do these toxins work? These toxins prevent nerves from releasing a neurotransmitter called acetylcholine. Usually the acetylcholine is the messenger from the nerve to the muscle, telling the muscle to contract and move. Thus, these toxins are used to treat wrinkles caused by muscle movement (“dynamic rhytides”). These toxins aren’t helpful in wrinkles that are not caused by muscle movement.

Cosmetically, what are these toxins good for? Many patients opt to have treatment for forehead wrinkles, the glabellar wrinkles (the ones between your eyebrows — also called the frown lines), or crow’s feet. Botox, etc. can also be used to achieve a brow lift, reduce “bunny lines,” or to soften vertical lines and furrows around the mouth.

How long do the effects last for? Effects are not permanent and last for months before wearing off. As you get more injections, you may be able to spread out injections further apart.

Is Botox, Dysport or Xeomin right for you? It’s wise to speak to someone who performs many of these procedures (e.g. a cosmetic dermatologist) about what your goals from treatment are and whether you can fulfill that goal with these products. There are also contraindications to having these treatments performed so your provider will review that with you as well. Also remember that Botox, Dysport or Xeomin injections are out-of-pocket costs and not covered by insurance.

Is laser hair removal right for you?

Illustrations from the Nuremberg Chronicle, by Hartmann Schedel (1440-1514). Image part of US public domain.
Many of us have hair in unwanted areas and some of us spend a lot of effort getting rid of this hair. Women often want hair removed from armpits, bikini area, face and neck region or legs. Men often want hair removed from the chest, back or buttocks. Shaving, waxing, or tweezing can be painful and takes time. Laser hair removal provides the option of long-term hair removal.

How does laser hair removal work? The laser targets hairs and heats the hairs. Surrounding cells which give rise to the hair (called stem cells) are then damaged and unable to produce hair in the future.

So who is the best candidate for laser hair removal? The best candidate has light skin, and dark, coarse hairs. We want the laser to remove the hair without damaging the surrounding skin.

What does laser hair removal feel like? Many people compare laser hair removal to getting a rubber band snapped against the skin. Others say it feels like little stings. Applying ice packs or creams after the procedure can lessen the pain.

How often do you need to get treated? Because hairs cycle through different stages, you need to have several treatments in order to get rid of all the hair in an area. Even still, effects might not be permanent and you might need touch-ups to treat straggling hairs.

How long do the effects last for? Often, effects are permanent. However, sometimes touch-ups may be needed.

What should I do if I’m interested in laser hair removal? Find someone who is trained in laser hair removal and who has had experience treating patients. The physician will evaluate your skin type, hair type, and ask you other questions to assess whether you are the ideal candidate. Keep in mind that treatment is rarely covered by insurance — so the cost can add up!

How to do a self-skin exam

It’s a good idea to look over your skin about once a month. This allows you to get to know your skin and what your skin looks at baseline. Anything new or changing on top of your first exam would be of concern. Secondly, anything that looks suspicious, especially via the ABCDE criteria for melanoma, would be of concern as well.

Having a full-length mirror and handheld mirror can be helpful tools. First, look over the front of your body: your face, neck, chest, arms, belly, thighs and legs — including under the undergarment areas. Examining the back side of your body can be a little more difficult. Using a hand held mirror along with the full-length mirror can allow you to visualize the back of the neck, the back, buttocks, and back of the thighs and legs. Also look at the hands including the palms, and soles. Check behind the ears and through the scalp as well. If you don’t have a hand held mirror or find that you still don’t have good visualization of certain areas of your body, you might to have someone examine your skin for you (e.g. a partner or spouse). Your barber/hairdresser can also help you look through your scalp. If any of the spots on your skin are concerning to you, you should let your dermatologist know even before your regularly scheduled skin examination.

The American Academy of Dermatology (AAD) has a good webpage diagramming the steps to the self-skin exam.