Atopic Dermatitis/Eczema Explained
Atopic dermatitis (AD), or eczema, is a very common skin condition that is worldwide and can occur at any age, but it typically appears before age five and may persist into the adult years. The disease presents as dry, chapped, flaky skin appearing in the skin folds, such as the inside of the elbow creases and behind the knees and ears, though it may appear anywhere on the body. Some forms, such as dyshidrotic eczema, may cause painful and severe breaks in the skin or small, itchy blisters on the hands and feet. The condition may be associated with allergic rhinitis or asthma. Eczema can have profound spells of itching and severe skin inflammation complicated by infection caused by scratching the skin, thus producing persistent, non-healing wounds.
Treatment: Avoiding irritants to the skin, such as harsh soaps or deodorant soaps, and using moisturizers make up the front line of treatment. mild soaps, such as Dove, Tone and Oil of Olay, as well as non-soap cleansers like Cetaphil or CeraVe, are recommended. Over-bathing or taking long, hot and/or frequent showers can also contribute to or exacerbate eczema. In persistent and severe cases, topical cortisone cream, oral antihistamines and occasionally even oral or systemic cortisone, such as prednisone, may be prescribed. In some cases, antibiotics may also be prescribed. Extreme cases may be treated with light therapy, such as PUVA, or an immune modifier such as methotrexate.
Seborrheic Dermatitis (Dandruff)
Seborrheic dermatitis is a very common skin disorder that is often dismissed as dry skin on scalp. Seborrheic dermatitis presents as persistent itchy, flaky skin in the eyebrows, sides of the nose, and ear canals. The diffuse redness, scaling and itching can also appear in the scalp, beard and chest hair in some men. Patients typically use moisturizers to treat the problems, only to make it worse. Rather than resulting from a lack of moisture, seborrhea is believed to be an "allergic phenomenon," a reaction to an overgrowth of yeast-like organisms and bacteria. It often appears in the elderly and also in infants, in which case it is called "cradle cap."
Treatment: Seborrheic dermatitis is generally controlled by the combination of medicated shampoos containing zinc, selenium and ketoconazole compounds. Topical corticosteroid creams, lotions or antifungal preparations may also be prescribed. Unfortunately, the condition is often persistent and requires daily or intermittent therapy to control it.
Tinea Versicolor
Tinea versicolor is a fungal infection that earns its name due to the multiple colors that may appear in the circular or oval patches of mildly scaly skin often seen during the summer months on the upper chest and back, though the face and other parts of the body may be involved. White is the most common color seen in the patches, though the lesions may also appear medium brown and quite red. Various factors secreted by the fungus inhibit tanning, causing the skin to burn readily. Typically the patches appear during the teenage years and then spontaneously resolve in the 40s and 50s. Some patients may experience only one or two "attacks," but others may be plagued by frequent recurrences. The fungus grows in warm climates, becoming prominent during the summer. The organism that causes tinea versicolor is a normal resident of the skin. Most people are able to inhibit its growth. Thus, patients who present with the disease lack the ability to prevent it from growing on the skin.
Treatment: TV usually responds well to topical therapy with antifungal shampoos or creams and rarely needs oral antifungal medication.
Spider Veins
Spider veins, known as telangiectasias, are small capillaries commonly seen on the legs of women and occasionally on men. They may also appear on the face. In time, they may become quite prominent and cosmetically disfiguring.
Treatment: Sclerotherapy, in which 20 percent saline is injected into the capillaries, remains the gold-standard treatment for spider veins on the legs. The saline destroys the veins, leaving a small bruise, which lasts usually three to four weeks. Most patients achieve 85 to 90 percent clearing after several sessions. Lasers, although widely promoted as a treatment, have produced disappointing results with fewer veins responding to the treatment. Also, complications such as an increased possibility of permanent scarring and discoloration have occurred. Conversely, for spider veins on the face, pulse dye laser therapy is a safe and highly effective treatment, creating dramatic clearing in two to three sessions with minimal side effects.
