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CHAPTER 11:
Skin Problems and Care

  • General Treatment Rules
  • Itchy Skin
  • Moist Area Rashes
  • Insect Bites
  • Aging Skin and Cancer.
  • Foot Problems
  • Eczema
  • Acne
  • Seb(orrheic) Derm(atitis)
  • Psoriasis
  • Drug Reactions
This Chapter briefly reviews some general rules for treating the skin and the most common skin problems of adults.

General Treatment Rules

Doctors assume that many adults will try to treat their own skin problems. If you do, remember these basic points:

* Don't spend a lot of money. For example, petroleum jelly (Vaseline) is very good for keeping moisture in itchy, dry skin. Other preparations you buy will usually be more expensive and often contain perfumes, lanolins, or propylene glycols. Many persons often react to these substances. Before you spend a lot, talk to a doctor.

* Beware of "soothing" lotions containing mild anesthetics or diphenhydramine (Benadryl). Some persons react to these substances.

* Don't stop and start skin treatments and expect them to work. Use them consistently and follow directions carefully.

* Do not use cortisone creams on the face for more than a week without a doctor's instruction.

* Don't jump to conclusions. For example, an itch in the groin is not always "jock itch." You will see from the problems below that it could also be psoriasis, yeast, scabies, and several other conditions. If the first treatment does not work, it may be time to ask for help. A doctor has a lot of trouble figuring out the cause of a problem if you visit after you have tried many different treatments.


Common Problems:
Itchy Skin

Itchy skin is most often caused by dry skin, eczema, psoriasis, medication reactions, and scabies.

Dry skin, without an obvious red rash, will cause you to itch. Oily soaps (Dove), moisturizing body washes, and bath oils, or petroleum jelly applied to wet skin after a bath or shower usually help. Use as little soap as possible or reduce your frequency of bathing to relieve dry skin. Lotions or creams containing urea or lactate also hold the water in the skin. Hydrocortisone creams may be needed as well.

Scabies (as well as body lice) are spread from person to person. Scabies most often occurs between the fingers, and warm folds in the body (navel, behind the knees, and the groin).

Moist Area Rashes

The areas in the groin, between the toes, and under women's breasts are naturally moist. Sometimes, the moistness alone can cause the skin to itch and be red. Loose cotton clothing and non-medicated powders can help. Avoid ointments because they keep the area moist. Some persons find that using a hair dryer on the "low" setting after baths and showers is helpful.

Red, moist, small bumps, and pimples in moist areas of the body may be caused by yeast. Yeast is more difficult to treat when the person has diabetes.

Itching, cracking, and scaling on feet or hands may be caused by the fungus of athlete's foot. It is most noticeable between the toes. In the groin the skin is often redder. It also has a very clear border around the small red, scaly patches separating them from normal skin.

Yeast and "athlete's fungus" can be treated with over-the-counter azoles, nystatin, and many other new anti-fungal medications. The claims that one medication is better than another are generally not true -- all work in about 85% of cases; some work a bit faster but cost a lot more. If you have badly thickened skin from athlete's foot, the addition of a medicine that softens thick skin may be required.


Insect Bites

Many serious diseases can be spread by the bites of insects. A strong defense is the best approach. Always learn about dangerous insects in the environment in which you live and travel. Follow recommended approaches to avoid being bitten.

The strongest repellent for most flying insects is DEET. DEET (10-35%) lasts many hours on either the skin or clothes. Young children should use DEET 10% or less.

Soybean oil products last a few hours. Skin-So- Soft and citronella last about 30 minutes.

Once the insect has bitten, the itch may be relieved by 1% cortisone. The bites of some spiders and scorpions contain potent toxins that can cause deep skin damage and severe pain. Medical attention should be sought whenever the border of a bite keeps spreading.


Aging Skin and Cancer.

When adults age, changes in skin and hair seem to announce the passing of each year. The skin will become dryer with age -- young adult acne gives way to the "winter itch" of the elderly. Hair and skin lose pigment -- the hair becomes gray, for example. But some aging is preventable.

The amount of skin wrinkling and skin cancers doctors find in older age can be reduced if adults and children protect their skin from the sun by:

  • Not being in the sun from 10am - 2pm.
  • Protecting the skin and wearing at least UVA/UVB SPF 15 sun block when in the sun. HOWEVER, THIS MAY NOT PREVENT MELANOMA SKIN CANCER.

Almost all skin cancers are related to the sun. Check yourself regularly.

  • A raised, thickened skin lump that may form an ulcer -- basal cell cancer.
  • A raised, scaly, sometimes itchy skin lump can indicate actinic or squamous cancer.
  • A raised, dark spot that is Asymmetrical (one half does not match the other) with an irregular Border and an uneven Color can mean melanoma. (Remember: ABC)

A doctor needs to see any skin changes you are concerned about.

What about Tretinoin (Retin A) for skin cancers and wrinkles? This cream will reduce many changes of sun-aged skin -- particularly wrinkles and mottled pigment. But this medication dries the skin and must be used all of the time to keep its effect. Studies do not yet show if its use prevents cancer.

You must protect yourself from the sun when you use Tretinoin.

Foot Problems

Dry skin sometimes results in itching and burning feet. Dryness can be helped by applying a body lotion to the legs and feet every day. Also use a less drying soap, like Dove, when you bathe. Since all soaps can dry the skin, use them sparingly. The best moisturizers contain petrolatum like Vaseline. But be cautious about adding oils to bath water since it can make the feet and bathtub very slippery.

Fungal and bacterial infections, including athlete's foot, occur because the feet are usually enclosed in a damp, warm place. This is an ideal growing place for fungi and bacteria. Such infections cause redness, blisters, peeling and itching. If not treated promptly, an infection may become chronic and difficult to cure. To prevent infection, keep the feet -- especially the area between the toes -- clean and dry. Expose the feet to sun and air whenever possible. If you are prone to fungal infections on your feet, you may want to dust your feet daily with a fungicidal powder. (See Moist Area problems above).

Warts are skin growths caused by viruses. They are sometimes painful. If your doctor finds that a wart is the cause of your problem, your doctor will partially remove it with a knife and treat it with a liquid.


Common Diseases
Eczema

In adults eczema causes itching, scaling, and red patches, but usually less wetness than in the young. Some eczema is caused by a skin reaction to things like dust, pet fur, or perfumes.

You should avoid things that obviously bother your skin. Usually, eczema responds very well to 1% hydrocortisone (steroid) cream. Hydrocortisone (which can be purchased without a prescription) is best if used at least twice a day. If the skin is usually very dry, mixing the hydrocortisone with Vaseline can help. Many persons find that putting the cream on damp skin (after a shower) works very well. Eczema on the palms of the hands often needs much stronger medicine.

Over time, eczema can lead to thickened itchy skin that is much more difficult to treat, so contact your doctor if it does not clear within a week or two.


Acne

Acne reaches its peak by age 18. When it lasts into adulthood the same treatments work -- see Adolescent Acne. Seborrheic dermatitis can look like acne, and respons to similar treatments. (See below).

Seb(orrheic) Derm(atitis)

Seb derm appears as poorly demarcated greasy scaled patches on scalp, eyebrows, around the nose, sometimes behind the ears, on the chest or the groin. It seldom itches. It responds to zinc pyrithione, selenium shampoos, and ketoconazole (prescription). Very weak hydrocortisone (0.5%) applied several times a day to the face is also helpful. If it does not respond, anti-biotics can be used on the skin along with retinoids.

Psoriasis

Psoriasis often shows up as well defined, silvery scaling patches on the scalp, knees, and elbows. It may involve the nails, groin, or entire abdomen and back. It often itches. A number of treatments are recommended. Many patients do well with strong steroid creams in a greasy ointment form. This problem can be made worse by several common medications: lithium, beta blockers, and even aspirin, ibuprofen, and related arthritis medications. More severe psoriasis benefits from "vitamin D" like drugs and "PUVA".

"Shingles" - Herpes Zoster

The risk that an adult will have an attack of adult chicken pox, (shingles, zoster) is about 1/10 (105). Shingles is most common in person above age 75.Early shingles causes discomfort or pain. After about 1-5 days, a red, blistering rash will appear. The rash will heal in 2-4 weeks and may have pain that lasts many months.When given within 3 days of the rash, several medications may reduce the severity of this pain by about 50%.

Drug Reactions

Drug reactions appear in almost any form but most often cause itchy hives and redness. Medications that cause problems often include those that contain aspirin and sulfa. Sulfa is often present in antibiotics and diuretic (fluid) pills used for high blood pressure and heart disease.

We have tried to make the How's Your Health error-free. However, those involved in its preparation can not warrant that all of the information is accurate and complete. When you use How's Your Health as a guide for your health and medical care, be sure to discuss any questions about it with your doctor, nurse, or other health care worker.



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Last reviewed: January 2010
© 1997-2010 FNX Corporation
and Trustees of Dartmouth College.
All Rights Reserved.