Dry skin can occur for a variety of reasons. Dryness in the surrounding air predisposes to dryness of the skin. The low humidity air in the wintertime makes dry skin a problem for many people. Some individuals may have a genetic predisposition to dry skin as well. As we all age, the oil production in the skin decreases making the skin more prone to dryness.

In some cases, medications, or internal conditions including dehydration or thyroid disease can also cause dryness.

What other symptoms can accompany dry skin?

Dry skin can lead to itching of the skin. Skin can become scaly, fissured, or cracked as well.

How can I treat dry skin?

- Use a humidifier if the surrounding air is dry.
- Use lukewarm water instead of hot water for showers or baths.
- Limit the amount of time you spend in the shower or bath.
- Avoid harsh soaps. Instead, choose a mild soap or cleanser.
- At any time, but especially after exposure to water, moisturize with a thick moisturizing cream or white petrolatum ointment.
- Drink enough water to keep hydrated.

When should I contact my physician?

If your dry skin does not improve, if there are many open areas from scratching, pus or crusting, or if you develop any concerning symptoms, let your doctor know.

Keratosis pilaris is a normal skin condition which presents as small dry rough bumps of the arms, thighs or legs. These bumps can become itchy. Keratosis pilaris is likely caused by follicles that produce too much keratin which collects in the follicles. It may be found in people that also have eczema. Patients often note that other family members have the same findings.

How is it diagnosed?

Your physician will make a diagnosis based on the appearance of the skin. A biopsy is not usually necessary for diagnosis.

How is keratosis pilaris treated?

Keratosis pilaris is a benign and chronic condition. Using a loofah sponge to gently exfoliate the affected areas can decrease the roughness and remove excess keratin. Your doctor may recommend certain moisturizers, a lactic acid lotion, tretinoin, tazarotene, alpha-hydroxy acid, urea or salicylic acid. If these topical therapies do not work, your doctor may recommend applying other medications such as a steroid-containing cream, ointment, gel, or lotion. Response to these treatments is variable.

What to let your doctor know:

Let your doctor know if you have ever had problems with a blood clot such as a deep vein thrombosis, thrombophlebitis, or any other condition involving the blood vessels. Sclerotherapy could increase your risk of blood clots.

Tell your doctor if you are pregnant or planning to become pregnant.
Also let your doctor know what medications you are taking or have recently taken, and if you have any allergies to medications. Your doctor may ask you to stop certain medications before and after the procedure.

What are the risks of sclerotherapy?

Your doctor will explain the risks and benefits of sclerotherapy. Risks of the procedure include blood clots, embolism, darkening of the skin, or ulcerations. Your skin may be red, itchy, swollen or bruised after injection. The appearance of new unwanted veins may occur. Hardness or lumps over the treated the vein may also occur.

What to expect:

The procedure usually lasts from 15 minutes to an hour and depends on the number of treated veins. Targeted veins will be injected with a liquid or foam irritating chemical. You may experience pain and some swelling or redness after injection. A compression dressing will be used on the treated area. Your physician may recommend that you wear compression hose after the procedure. You should be able to resume normal activity such as walking and driving immediately afterwards. Mild redness and itching may occur.

What to do at home:

You may be asked to discontinue certain medications such as aspirin or NSAIDs (such as ibuprofen) for 48 hours after the procedure. You can wash the area with mild soap and cool water. Avoid exposing the treated areas to heat from warm showers, compresses, or the like. Your doctor may ask you to continue wearing compression dressings or stockings for up to three weeks.

When to call your doctor:

Call your doctor immediately if you develop red streaks, pus, bleeding, excessive pain or skin breakdown by the injection sites; if you notice swelling, pain, color or temperature changes in one leg; or if you have fever, chills, or any other concerning symptoms.

Keloids most commonly present as raised, flesh-colored, pink or red growths that extend beyond the original injury. They usually occur on the face, ears or upper body, and can sometimes be itchy or painful.

How are keloids treated?

Keloids are difficult to treat, and recurrences are very common. However, if your keloid is painful or you do not like its appearance, treatment may be helpful. People who are predisposed to forming keloids should avoid any unnecessary injury such as tattoos or piercings. Early treatment is more likely to be effective.

Initial therapy usually consists of corticosteroid injections into the keloid at regular intervals. These injections may be combined with laser treatment to improve efficacy.

Surgical excision may be considered in those that do not respond to corticosteroids; sometimes injections are used after the excision. You may be asked to apply pressure, silicone sheets or silicone gel to the area afterwards. However, this surgery carries the risk of causing another keloid to form. Radiation and therapy with liquid nitrogen (cryotherapy) are sometimes used as well.

What can I expect from the treatment?

The majority of patients will see improvement with treatment, but the response to treatment varies.
When should I be concerned and contact my physician?

If you are predisposed to keloids, contact your doctor when your skin is injured to initiate preventative treatment. If you are not sure whether your growth is a keloid, see a doctor to have it evaluated.

Onychomycosis is a fungal infection of the nail. Toenails are more commonly affected than fingernails. The infection can affect one or more nails, but rarely affects all nails. Individuals who attend public pools, gyms, or showers, have underlying nail disease or trauma, wear occlusive footwear, live in warm climates, have an impaired functioning immune system, or are older in age are at increased risk.

What are the symptoms of onychomycosis?

Onychomycosis is usually asymptomatic, but can cause pain, discomfort and disfigurement. Affected nails may become discolored, resulting in a white, yellow, or brown appearance. Nails may also appear thickened, hardened, and distorted in appearance. They may become crumbly, rough, and brittle, resulting in the collection of debris under the nail.

How is onychomycosis diagnosed?

Your physician may scrape your nail and look at the contents under the microscope to determine if fungus is present. Your physician may also clip or biopsy the nail to send to a laboratory for culture or microscopic examination for fungus.

How is onychomycosis treated?

Treatment of onychomycosis is difficult because the fungus is difficult to reach within the nail and nails grow very slowly. Onychomycosis that is not bothersome to you does not need to be treated. If treatment is undertaken, oral medication is more effective than medication that is applied directly to the nail (such as a cream of lacquer). However, oral medication must be taken for 6-12 weeks, can be costly, and could affect your liver. Blood tests may be done when you are taking oral medication to monitor your liver function. Even after oral therapy, the fungus could persist or, the nail infection could return.

Topical medication, including antifungal creams and lacquers that are painted onto the affected nail, may be useful in combination with oral therapy. Other therapies such as laser therapies or surgical removal of the nail, is sometimes performed as well.

It is important for patients to know that onychomycosis may be difficult to completely cure even with full treatment, and fungal infections have high recurrence rates. It is thought that patients may reinfect themselves with fungal spores present in their shoes. Using topical antifungal medication and purchasing new footwear may be helpful to prevent this reinfection. Even if treatment is effective, it may take up to several months for your nail to look normal again.

What is the usual course of onychomycosis?

Oncychomyosis is a chronic infection of the nail. The natural course of onchychomycosis is slow and insidious. Without treatment, the fungal infection does not usually resolve on its own, but does not usually cause any long term problems.

When should I be concerned/contact my physician?

Onychomycosis is not a life-threatening condition, but may require treatment if it is particularly bothersome, painful, or if you have an impaired immune system. If you have any concerns, you should let your physician know. If you develop side effects while on medications including a worrisome skin rash, call your physician.

Vitiligo is a skin condition in which areas of the skin lose color (pigment) resulting in white spots. The loss of skin color is due to the death of cells called melanocytes which make skin pigment. The cause of vitiligo is unknown, but doctors and scientists think it may be a disorder of the immune system. Vitiligo runs in certain families, but it is not contagious. It can occur anywhere on body and commonly affects areas such as the hands, face, and genitals. Vitiligo can develop at any age, but it is often diagnosed in children and young adults. Although it may be more easily noticed in individuals with darker skin, it affects all races.

What are the symptoms of vitiligo?

The main symptom is loss of skin color resulting in white spots on your skin. These white areas may be focal or widespread, and they may occur over sites of trauma. You may also notice white hairs or early graying of your hair. Although vitiligo causes no physical pain, it may be emotionally distressing.

How is vitiligo diagnosed?

Your physician may use a special device called a Wood’s light to examine your skin. This lamp shines ultraviolet light onto the skin to highlight areas that have lost their pigment. A skin biopsy is not always necessary.

Vitiligo can be associated with other disorders, including autoimmune thyroid disease, diabetes, and a type of anemia (low level of red blood cells), so your doctor may test your blood for these disorders.

How is vitiligo treated?

Vitiligo can be difficult to treat. Treatments are aimed at slowing or stopping progression of the disease and promoting return of the skin color. Treatment options include light therapy (called phototherapy), medical therapies including creams and ointments, surgical therapies, and the use of cosmetic cover-up. If the vitiligo is extensive, some individuals may prefer to “bleach” or depigment the rest of the skin.

What is the usual course of vitiligo?

The natural course of vitiligo is highly variable and can be difficult to predict. The white spots may gradually enlarge over time, and new areas of skin can become affected. On the other hand, in some individuals, the pigment returns on its own even without treatment.

When should I be concerned and contact my physician?

Vitiligo itself is not a life-threatening skin condition. However, there are other skin conditions that can cause whitening of the skin, so if you notice white spots appearing, have a physician evaluate you to determine whether or not you have vitiligo. Also, sometimes vitiligo is associated with other diseases, so if you notice other symptoms in addition to whitening of your skin, let your physician know.

Eflornithine (brand name Vaniqa®) is a medication used to slow the growth of unwanted hair. It does not prevent hair growth and stops working when the cream is discontinued.

How do I use eflornithine?

Eflornithine is available as a cream. It is applied to areas of unwanted hair growth twice a day. The eyes, mouth, and vaginal area should be avoided. Your doctor may recommend an alternative schedule of application. In this case, follow your doctor’s recommendations. You may continue to use other methods of hair removal while using the cream.

What are contraindications to eflornithine?

Do not use eflornithine if you have had an allergic reaction to it in the past.

Is eflornithine safe to use during pregnancy?

Eflornithine is a pregnancy category C medication. This means that some studies in animals have shown some evidence of birth defects. Studies in pregnant women have not been conducted. If you are planning to become pregnant or are pregnant, your doctor may advise you to stop this medication.

What are possible side effects?

Side effects include the development of red bumps, a rash, redness, or irritation. If these symptoms develop, stop the medication and contact your doctor.

When should I call my doctor?

Let your doctor know if you develop any of the side effects listed above.

Identifying possible exposure to one of these plants can help your physician to diagnose the condition. Poison Ivy and Poison Oak are classically characterized as possessing “leaves of three,” while Poison Sumac leaves possess 7-14 leaflets that give the appearance of a feather.

What are the symptoms of Poison Ivy, Oak, or Sumac dermatitis?

Initially, the areas of skin exposed to the plant will become red, swollen, and intensely itchy. This occurs within four hours to a few days after initially touching the plant for people who have been exposed to urushiol in the past. People who are coming in contact with Poison Ivy, Oak, or Sumac for the first time in their lives may experience delayed symptoms that arise up to three weeks after initial contact. The reddened areas may develop small red bumps and fluid-filled blisters. These bumps and blisters are not contagious, and you should expect the symptoms to self-resolve within three weeks. For some individuals, the affected area of skin may take on a darker color even after the rash disappears. This is often just a temporary part of the healing process, and the skin will generally return to its normal tone within a few months.

How is Poison Ivy, Oak, or Sumac dermatitis treated?

Because contact dermatitis due to urushiol exposure nearly always self-resolves within three weeks, the treatment focuses on reducing the intense itchiness associated with the condition. Your physician may recommend oatmeal baths, cool compresses, calamine lotion, or other strategies to reduce your symptoms. In addition, antihistamines such as Benadryl can be used to reduce itchiness, especially if the symptoms are preventing you from falling asleep.
If you are quickly diagnosed within days of exposure to the plant, your physician may prescribe a steroid cream to rub on the affected skin in hopes of reducing the full extent of your symptoms. Patients who are severely affected by the dermatitis may need to take steroid pills by mouth over the course of two or more weeks in order to sufficiently relieve their symptoms.
Finally, your physician may discuss with you options for preventing future reactions to Poison Ivy and its related plants. Recommendations may include protective clothing, immediate washing of the skin and clothing after suspected contact with a plant, and potentially even the use of a barrier cream on your skin as a preventive measure.

What can I expect from treatment?

All of the treatments described above should help to reduce the amount of itchiness you experience as the rash gradually heals on its own. Certain types of antihistamines, including Benadryl, can make you sleepy. As a result, you should discuss with your doctor which types of antihistamines to take during the day versus at bedtime if you end up requiring the medicine. In the case that you are prescribed oral steroids, be sure to take the full course of the medication exactly as prescribed, as cutting the treatment short can sometimes cause the rash to come back.

When should I be concerned/contact my physician?

You should see your doctor if your rash does not improve within three weeks. Occasionally, the irritated area of skin can become infected by bacteria. If you experience additional symptoms such as a fever, tenderness of the skin, notice pus from the skin, or simply feel that the rash does not seem to be improving even after a few weeks, you should not hesitate to contact your physician. Finally, if you begin to develop rashes in parts of your body that were not exposed to one of the urushiol-containing plants, you should see your physician to investigate further.

What causes skin tags?

Skin tags may arise on their own or they can be associated with weight gain, pregnancy, or diabetes.

How are skin tags treated?

Skin tags are harmless and do not need to be treated. Health insurances rarely pay for removal as the procedure is considered cosmetic. However, if you desire treatment, your doctor may cut off the skin tags using special scissors or a scalpel, burn them off with an electric needle (electrocautery) or freeze them with liquid nitrogen. If there is a concern for the lesion being something other than a tag, it may be removed and sent for evaluation.

When should I contact my physician?

Other skin growths can mimic skin tags. If you have any question about the nature of your skin growth, seek medical evaluation.

What causes dermatofibroma?

Some individuals will report trauma to the area from shaving, or an insect bite prior to the dermatofibroma’s appearance. However, sometimes dermatofibromas appear without any report of preceding trauma.

How are dermatofibromas treated?

Dermatofibromas are not harmful and many soften over time. Thus, they do not need to be treated. For those desiring cosmetic treatment, the dermatofibroma could be cut out. However, doing this would leave a scar, often quite similar to the dermatofibroma. Injections of corticosteroid have also had mixed results.

When should I contact my physician?

Other skin growths can mimic dermatofibromas. If you are unsure about the nature of your skin growth of if your dermatofibroma continues to change, see your doctor to have your skin evaluated.