Frequent handwashing leading to irritation?

Whether it’s a need to do chores involving water, due to one’s occupation, or just a habit, frequent handwashing can lead to irritated skin of the hands.  The hands become dry and stripped of their natural protective oils.  Irritant dermatitis is the name of the rash which often ensues from frequent handwashing — it is a type of rash that occurs as a result of direct physical, mechanical or chemical trauma from an outside culprit.  The most frequent culprit is handwashing.  Between the soap and the water, the damage is done.  Skin becomes dry and rough, and can become variable degrees of pink/red.

So how can you prevent irritated hands from frequent handwashing?

– First, if it’s not necessary, then don’t wash your hands.  This is not to mean that you should not wash your hands when they are dirty or soiled. You should!  Handwashing is important in preventing spread of germs.  However, if you find yourself excessively handwashing, figure out if you can cut back.

– Although hot water helps cleanse the hands more readily of microbes, they can also strip the skin’s oils more readily.  Depending on how germy your hands are, you may considering using lukewarm or cold water to wash as opposed to hot water.

– Limit the amount of time you are washing.  Do not wash for an excessively long time.

– Pat dry instead of rubbing dry.

– Follow up with a moisturizer.

– If all else fails, see a medical professional such as a dermatologist for help.  If your rash is particularly bad, prescription medicated creams or ointments may be helpful.

How do you clip your baby’s nails?

How do you clip your baby’s nails?


Worried moms often fear clipping their little ones’ little fingers.  This is not uncommon as the infants don’t respond to directives to stay still.  This issue of nail clipping an important one for me as I learned to clip the nails of my eczema baby’s nails to prevent his nails from ripping up his skin.  Those nails needed to be short!  (This brings back memories from my violin teacher.)

So what are some ways to make keeping your baby’s nails short easier?

  • Use a nail clipper designed for babies.  No, do not use your adult-sized nail clippers.  They are too large and the blades may be too thick.
  • If you’re struggling to see your baby’s nails, look for a clipper with a little magnifying glass.
  • Try baby nail trimming scissors.  Those with the rounded tips may be best if you worry about poking your baby with sharp scissor tips.
  • Try this Zoli electric baby nail trimmer.  It has little “sandpaper” like pads that buff the excess nail away.  Each pad is meant for a different age range.  Just be careful, held next to skin, these pads can also buff away skin!
  • Try a good ol’ fashioned emery board.  This may be slow going though and it may be hard for your baby to keep still as long as you need to do an adequate job.

What other tips do you have?

Purple, pruritic, polygonal, planar papules and plaques

So there you have it! The 6 P’s of Lichen Planus.

Purple – This rash often takes on a purplish hue.

Pruritic – Lichen planus is often itchy.

Polygonal – The rash can consist of geometric looking shapes.

Planar – Lichen planus is often “flat-topped.”

Papules – Raised bumps.

Plaques – Larger than papules, these are raised as well.

Keep in mind that lichen planus can take on many forms though, and while the 6 P’s mnemonic works for most forms of lichen planus on the skin, the rash can present differently as well and can also show up in the mouth, genital area, and scalp.

What are those red spots on your body?

Photograph of a cherry angioma
Photograph of a cherry angioma

Patients often ask me about bright pink dots that they’ve noticed cropping up on their skin.  These little spots can be flat or raised, and are usually relatively small and only millimeters wide.  These spots are called cherry angiomas, aka cherry hemangiomas.  They are asymptomatic and benign, and do not need to be treated unless desired cosmetically.  They most often crop up in adulthood and those who develop one are more likely to develop others.  The majority of my adult patients have these growths.

If they are of cosmetic concern, pulsed dye laser treatment is a great way to remove these growths.  Otherwise, nothing has to be done!

What is the most common type of hair loss?

Example of male pattern baldness (aka androgenetic alopecia) in a young man. Image by wikipedia user Welshsk.
Example of male pattern baldness (aka androgenetic alopecia) in a young man. Image by wikipedia user Welshsk.

The most common type of hair loss is androgenetic alopecia.  This diagnosis is also known as male pattern baldness when it occurs in men, and female pattern hair loss when it occurs in women.  As its name implies, androgens contribute to this type of hair loss, as do genetics.  That’s right — if your mom, dad, brother, sister, etc have a receding hairline or hair loss, you will be more prone to getting this type of hair loss.

Androgenetic alopecia commonly affects certain areas of the scalp.  For guys, this is often the hairline up front by the forehead and the back top of the head (see photo).  For women, it’s often the top of the head.  Women may first note that their part seems to be getting wider.  Affected individuals may also notice that the hair gets thinner in the affected areas.

So how can you treat androgenetic alopecia and prevent fuurther hair loss?  It depends on your gender.  For both men and women, an applied medication called minoxidil is available over the counter (more often known as Rogaine).  For men, finasteride (Propecia) or dutasteride are possibilities.  In the US, these medications are not used in women except in rare instances.  A medication called spironolactone is sometimes used in women who have adrogenetic alopecia.  Another option is hair transplantation.  Evaluation by an experienced physician is recommended if you are interested in a hair transplant. You want to make sure you are an appropriate candidate and that you get a good aesthetic outcome.  Regardless, if you are considering medications for androgenetic alopecia or hair transplantation, you should have a discussion with your physician to discuss whether you are the right candidate for these treatments and what to expect from these treatments.

You’ve been prescribed Retin A. Now what?

An example of acne on a teenage boy's forehead.
An example of acne on a teenage boy’s forehead.

Retin-A ® or tretinoin is a popularly prescribed medication for acne as well as preventing the signs of skin aging.  For acne, it is particularly effective for “whiteheads” (aka closed comedones) or “blackheads” (aka open comedones).  In terms of skin aging prevention, it can help improve the texture of skin, even out skin tone, and prevent really fine wrinkles from appearing.

However, many people find Retin A difficult to use and will note irritation.  Especially in the beginning of use, the skin often becomes reddish, dry, scaly, and sometimes itchy.  This is because the medication helps regulate the turnover of your skin cells and can speed up this turnover.

Here are some tips that you can stick to to make it easier to stick with your medication and see some really good results.

– Use a pea-sized drop for the whole face.  Squeeze out a little bit on one index finger and dab it on the other. Dot over the areas to treat (e.g. forehead, cheeks, chin) and then rub in.

– Apply at night

– If you’re having problems with irritation:

  • Mix the medication with a gentle face moisturizer (non-comedogenic of course!)
  • Space out use.  Start every other day and work up to every day.
  • Avoid the areas right by your eyes, nose and mouth where the skin is thinner.
  • Avoid any areas of open or damaged skin.
  • Start with a low dose.
  • Ask your physician if there is a gentler formulation of the medication if the above tips don’t help.

– Use sunscreen in the morning.  This is normal recommended practice anyways, but the Retin A can “thin out” your skin and make it easier to get a sunburn. Also, it’s no fun getting a sunburn over already irritated areas!

Another important point is that if you are thinking about getting pregnant or are pregnant, stop the medication and let your doctor know.

What is the difference between a keloid, hypertrophic scar and normal scar?

Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia
Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia

You may have heard the terms keloid and hypertrophic scar thrown around.  Both are types of scars, but they are not the run-of-the mill normal scars.  Keloids tend to be bulky and “spill over” the footprint of the wound.  A hypertrophic scar is also larger than normal, but its edges do not “spill over” the footprint of the wound.  Instead, it is raised upwards.

Scars including large scars such as keloids or hypertrophic scars follow injury to the skin, and this injury may be seemingly minor (e.g. ear piercing, acne, or a minor cut).  An exuberant scar response ensues, leading to a keloid or hypertrophic scar.

Who is more likely to develop keloids and hypertrophic scars?

Certain ethnicities are more likely to develop these big scar, especially those of African or Asian heritage.

So what can be done to treat keloids or hypertrophic scars?

First, prevention is key.  If you can prevent unnecessary trauma, this would prevent the keloids or hypertrophic scars from forming. However, sometimes the trauma is not preventable. In this case, many treatments exist.

Injections may be performed on keloids and hypertrophic scars.
Injections may be performed on keloids and hypertrophic scars.

When patients see me in the office for these large scars, I offer to inject these scars with a corticosteroid solution if appropriate.  Several injections are often necessary.  Many other treatments exist as well, and are outlined in this article.  Regardless, these large scars can reappear, even after flattening out after treatment.


Is stress causing you to lose your hair?

Diagram of the cross section of hair
Diagram of the cross section of hair

There’s a condition where  a stressful event such as surgery, trauma, childbirth, extreme weight loss, severe illness, extreme emotional stress or other causes of stress causes your hair to fall out.  This condition is called telogen effluvium.  Telogen is a phase of the normal hair cycle.  It also happens to be the cycle where hair is shed off the scalp.  In this condition, many of the hairs enter into this telogen phase at the same time and end up being shed around the same time.  The shedding usually happens a few months after the stressful event.  The good news is that after the stressful event is resolved, the hair usually grows back.

A dermatologist is a physician that specializes in skin, hair and nails.  If you are not sure what is causing your hair loss, get it checked out.  Sometimes the hair can be gently pulled or forcibly plucked to examine the stage of the hair.  In telogen effluvium, a larger than normal percentage of the hairs that are plucked for sampling would be in telogen phase.  The distribution of hair loss on your scalp and the skin of your scalp will also be examined.  Sometimes hair loss can be multifactorial.  In difficult cases of hair loss, biopsies (sampling) of the scalp may be necessary to help diagnose your hair loss.

Pesky leg veins? They can be treated!

PregnantWomanThe wear and tear that comes with time shows up on our skin.  For many of us, adulthood and various stages of life (eg pregnancy) come with skin changes.  I’ve recently had several patients ask me about pesky spider veins and varicose veins.

These are veins that become dilated or “loose” over time. They lose their elasticity and like old panty hose, become loose and wider.  They become more visible through the skin and this becomes a cosmetic concern for many.  Like leaky pipes, they also become functionally deficient.

So how can varicose veins and spider veins be treated?

A number of treatments exist for each type of dilated vein.  The varicose veins can be removed or “stripped” surgically, or a laser device can be inserted up the vein to destroy the vein.  Sometimes special solutions can be injected that will also lead to destruction of the vein, a procedure called sclerotherapy.  Sclerotherapy can also be done for spider veins.  Spider veins are called such because the appearance of the reddish or purplish veins can resemble legs of a spider.  A special laser can also be used to get rid of these spider veins, although this treatment is sometimes less effective than sclerotherapy.

If you are interested in removal, find a surgeon who is experienced in spider vein and varicose vein removal. Dermatologists often perform sclerotherapy and laser treatment for the smaller spider veins, whereas vascular surgeons or interventional radiologists often take care of varicose vein removal.

Additionally, ask your physician about compression stockings.  These are stockings that can be bought both off the shelf and are also available by prescription.  Your physician can determine how much compression is appropriate for you and prescribe these socks for you.  As someone who is on her feet a lot at work, I have found these compression stockings to be very helpful in preventing leg and foot fatigue and preventing the appearance of dilated veins.  During pregnancy, the legs often swell, and this becomes a time when women develop these dilated veins.  It would be a good idea to talk to your obstetrician about compression stockings if you are experiencing the swelling or dilated veins.

Do you have a new or changing growth? Don’t wait to get it checked out!

Pigmented Lesion - MelanomaToo frequently, I meet new patients who come in noting they’ve had a skin growth they’ve been concerned about for months, a year, or even years.  Some have had growths that have continued to grow in size, bleed, break open and even take over the face — growing into the eye, ear, or lip.  Not surprisingly, these were skin cancer.

Why this wait before seeking care?

Is it because it takes so long to get in to see doctor?  Certainly, access to a physician, and specifically a dermatologist, can be difficult and healthcare systems need to work on this problem, but wait times will rarely be over a year!  Many practices also triage their calls to get patients who may have skin cancers in earlier.

In several of my interactions, people have been reluctant and even scared to seek care.  Reasons I’ve heard include: 1) the growth wasn’t bothering them that much, 2) they didn’t think it would be anything serious, and 3) they were scared about what would happen if they did have a skin cancer.

Interestingly, I think back to why people do seek care for a new or changing growth.  Oftentimes, it is a spot that the patient has picked up him/herself, but often, it’s someone else — most commonly a spouse — who has encouraged the patient to seek care.  I’ve also had a handful of patients whose hairdressers kept pressing the patient to seek care.  And guess what?  Turned out that they did have skin cancer.

Have you waited before seeking care for a new or changing growth?  If so, why? 

Is there enough awareness about getting skin checks from your doctor, doing your own self skin checks, or when to seek care?

If you do have a new or changing growth on your skin, don’t wait.  Pick up the phone and call a/your dermatologist or your primary physician to get it checked out.  Explain your concerns about having skin cancer.  When skin cancers are caught early, they can be very curable.  However, there are many types of skin cancers, and some unfortunately are aggressive and not easy to cure once they have progressed or traveled to other parts of the body.