Common Conditions
Rosacea & Rashes
Rosacea
Rosacea is a chronic skin condition that causes facial redness, acne-like pimples, visible small blood vessels on the face, swelling and/or watery, irritated eyes. This inflammation of the face can affect the cheeks, nose, chin, forehead or eyelids. More than 14 million Americans suffer from rosacea. It is not contagious, but there is some evidence to suggest that it is inherited. There is no known cause or cure for rosacea. There is also no link between rosacea and cancer.
Rosacea generally begins after age 30 and goes through cycles of flare-ups and remissions. Over time, it gets ruddier in color and small blood vessels (like spider veins) may appear on the face. If left untreated, bumps and pimples may form, the end of the nose may become swollen, red and bulbous and eyes may water or become irritated.
Rosacea occurs most often among people with fair skin who tend to blush or flush easily. It occurs more often among women than men, but men tend to suffer from more severe symptoms. Most patients experience multiple symptoms at varying levels of severity. Common symptoms include:
Burning, itching or stinging of facial skin
Skin roughness and dryness
Raised red patches
Swelling (edema)
Flushing
Persistently red skin on the face
Bumps or acne-like pimples
Visible blood vessels on facial skin
Watery or irritated eyes
These symptoms may also appear on the neck, chest, scalp and ears.
Research conducted by the National Rosacea Foundation found that the leading triggers for rosacea are:
Emotional stress
Heavy exercise
Heated beverages
Indoor heat
Wind
Spicy foods
Hot or cold weather
Alcohol
Hot baths
Humidity
Sun exposure
Some skin care products
While there is no cure for rosacea and each case is unique, your doctor will probably prescribe oral antibiotics and topical medications to reduce the severity of the symptoms. When the condition goes into remission, only topical treatments may be needed. In more severe cases, a vascular laser, intense pulsed light source or other medical device may be used to remove any visible blood vessels and reduce excess redness and bumpiness on the nose.
To help reduce the incidence of flare-ups, a gentle daily skin care routine is recommended that includes the use of mild, non-abrasive cleansers, soft cloths, rinsing in lukewarm water (not hot or cold), and blotting the face dry (not rubbing). Additionally, individuals with rosacea need to protect themselves from sun exposure by using sunscreens with SPF 15 or higher and sunblocks that eliminate UVA and UVB rays. Patients are also encouraged to keep a record of flare-ups to try and determine the lifestyle and environmental triggers that aggravate the condition.
Rashes
"Rash" is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.
Rashes can be a symptom of other skin problems. The most prevalent of these are:
Atopic Dermatitis, the most common form of eczema.
Bacterial Infections, such as impetigo.
Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
Fungal Infections, such as ringworm and yeast infection.
Viral Infections, such as shingles.
A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.
Acne
Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.
Acne is made up of two types of blemishes:
Whiteheads and Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring. Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.
Causes
In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skin's surface. If the pore's opening is fully blocked, this produces a whitehead. If the pore's opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflamed, they can become red pustules or papules.
It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.
Treatment +
Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:
Benzoyl Peroxide - Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
Oral and Topical Antibiotics - Used to treat any infection in the pores.
Hormonal Treatments - Can be used for adult women with hormonally induced acne.
Tretinoin - A derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
Extraction - Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.
Psoriasis
Types and Treatments for Psoriasis
Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body.
The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will then cycle through flare-ups and remissions throughout the rest of the patient's life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.
In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.
Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.
There are Five Types of Psoriasis +
Plaque Psoriasis (Psoriasis Vulgaris)
- About 80% of all psoriasis sufferers get this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red lesions covered by silvery-white scales.
Guttate Psoriasis
- This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
Inverse Psoriasis
- This type of psoriasis appears as bright red lesions that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
Pustular Psoriasis
- Pustular psoriasis looks like white blisters filled with pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, infections and sudden withdrawal from systemic (treating the whole body) medications.
Erythrodermic Psoriasis
- One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.
People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.
Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.
Treatment
Psoriasis is classified as mild to moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.
Mild to Moderate Psoriasis
Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.
Over-the-Counter Medications
The U.S. Food and Drug Administration has approved of two active ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:
Scale lifters that help loosen and remove scales so that medicine can reach the lesions.
Bath solutions, like oilated oatmeal, Epsom salts or Dead Sea salts that remove scaling and relieve itching.
Occlusion, in which areas where topical treatments have been applied are covered to improve absorption and effectiveness.
Anti-itch preparations, such as calamine lotion or hydrocortisone creams.
Moisturizers designed to keep the skin lubricated, reduce redness and itchiness and promote healing.
Prescription Topical Treatments +
Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:
Anthralin, used to reduce the growth of skin cells associated with plaque.
Calcipotriene, that slows cell growth, flattens lesions and removes scales. It is also used to treat psoriasis of the scalp and nails.
Calcipotriene and Betamethasone Dipropionate. In addition to slowing down cell growth, flattening lesions and removing scales, this treatment helps reduce the itch and inflammation associated with psoriasis.
Calcitriol, an active form of vitamin D3 that helps control excessive skin cell production.
Tazarotene, a topical retinoid used to slow cell growth.
Topical steroids, the most commonly prescribed medication for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions.
Light Therapy/Phototherapy +
- Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:
- Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be in controlled, short bursts.
- Excimer lasers. These devices are used to target specific areas of psoriasis. The laser emits a high-intensity beam of UVB directly onto the psoriasis plaque. It generally takes between 4 and 10 treatments to see a tangible improvement.
- Pulse dye lasers. Similar to the excimer laser, a pulse dye laser uses a different wavelength of UVB light. In addition to treating smaller areas of psoriasis, it destroys the blood vessels that contribute to the formation of lesions. It generally takes about 4 to 6 sessions to clear up a small area with a lesion.
Moderate to Severe Psoriasis +
Treatments for moderate to severe psoriasis include prescription medications, biologics and light therapy/phototherapy.
Oral medications. This includes acitretin, cyclosporine and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.
Biologics. A new classification of injectable drugs, biologics are designed to suppress the immune system. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases.
Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:
Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be limited to controlled, short bursts.
PUVA. This treatment combines a photosensitizing drug (psoralens) with UVA light exposure. This treatment takes several weeks to produce the desired result. In some severe cases, phototherapy using UVB light may lead to better results.