Medical Dermatology / Evaluation
Human skin is susceptible to infection by a multitude of different organisms:
- Bacteria: Cellulitis occurs when a break in the skin allows bacteria to enter the body. This may occur after injury or a medical procedure. Bacterial infections are typically diagnosed with a simple culture, and they
may be treated with topical or oral antibiotics. While not usually serious, it is possible for bacterial skin infections to progress deeper into the tissues or into the blood stream.
- Viruses: Viral infections are common in childhood, though vaccines may help some children avoid chicken pox, measles, and mumps. Herpes simplex virus (HSV) may cause repeated flares of cold sores or genital herpes. Wart viruses cause benign, proliferating bumps in the skin. Shingles is caused by a recurrence of the chicken pox virus later in life. Occasionally, short-lived viral infections may cause a widespread skin rash. Viral cultures and skin biopsies are useful in diagnosing the above conditions while treatment includes oral antiviral medications, oral corticosteroids, or supportive care.
- Fungus and Yeast: Most fungal infections take the form of athlete’s foot, “jock itch,” or ringworm, which are all caused by the same fungus living in the outer layers of the skin. It is usually easily treated with topical creams, but more widespread infections are cleared with oral antifungals. Yeast infections occur in warm, moist areas that include the mucosal skin of the mouth or vagina, as well as skin folds in the groin and under the breasts.
- Parasites: Scabies are microscopic mites that live in the outer layers of the skin. They cause itching and irritation and they may be difficult to correctly identify without microscopic examination of skin scrapings. Scabies are highly contagious and many individuals experience a delay in diagnosis. They are readily treated with oral and topical medications, though all of a person’s close contacts need to be treated to achieve lasting resolution. Body lice, while not microscopic, cause similar itching and skin irritation in hair-bearing areas.
Early identification of skin infections can lead to more rapid relief of symptoms, lessen the risk of serious complications, and ensure that the infection does not spread to others.
Allergic reactions manifest themselves in the skin in three main ways:
- Eczema (atopic dermatitis) is a chronic skin sensitivity that usually first manifests in childhood. Individuals are predisposed to having very dry skin, and flares of itchy, red rash. Read more about eczema here.
- Hives (urticaria) appear as red or pink welts in the skin. They are swollen and itchy and they come and go over a short period of time. Hives appear in response to any number of triggers including medications, infections, insect bites, stress, sunlight, exercise and topical allergens. Rarely, physical stimuli such as heat, cold or pressure can induce hives. Cases of chronic hives may be linked to an underlying medical disorder such as thyroid disease or autoimmune disease, though most of the time a cause is difficult to find
- Allergic contact dermatitis occurs when an individual’s immune system becomes sensitized to a chemical after it comes into contact with the skin. There is a multitude potential allergens in our environment; some common ones include fragrances, dyes, preservatives, cosmetics, soaps, latex, metals, poison oak and various other botanicals. Symptoms can range from mild irritation or itching to severe red rash with blistering and weeping of the skin. Read more about allergic contact dermatitis here.
It can be difficult to differentiate between the types of allergic reactions in the skin, and overlapping conditions do occur. If you feel you may be suffering from skin allergies we will be able to recommend the appropriate testing and treatment for what is ailing you.
Hair loss, or alopecia, is a troubling affliction for men and women of all ages, including children. It may present as thinning of the scalp hair, or as patches that are completely bald. Shedding may occur suddenly or slowly over time. Hair loss may accompany changes to the underlying skin of the scalp, but in many cases it does not. Expert evaluation is necessarily to identify and treat the underlying cause, which may be any of the following:
- Pattern thinning/baldness, which is genetic in origin
- Underlying abnormalities of the blood or thyroid
- Medication induced hair loss
- Autoimmune disease
- Inflammatory/scarring skin conditions that damage the hair follicles
- Stress-induced shedding related to physical illness or mental/emotional distress
- Hair manipulation or styling methods
In addition to a thorough history and examination, it may be useful to perform a scalp biopsy, examine the hair under a microscope, or order blood tests to pinpoint the cause of alopecia. After a diagnosis is made, treatment options include topical or oral medications, corticosteroid injections, immunotherapy, and light therapy.