Primary Care Physician
Dr. Orrange received her BA in Biology at the University of California, San Diego, and a Masters Degree in Health Sciences at the Johns Hopkins University School of Public Health. She received her MD from the USC Keck School of…
11 Things you Should Know about your Skin
Posted in Acne by Dr. Sharon Orrange on Apr 27, 2009

Bumps, lumps, dry skin, and rashes are the most common thing I am asked about at dinner parties.  I have learned from the best during my training and hear the same "pearls of wisdom" over and over again that I pass on to my patients and friends. I'd like to pass them on to you.


1) Dry Skin: During the winter months you may wonder why your skin is so itchy, but you can't see a rash. It's dry skin. Here are the most important things for you to know about dry skin. Water is DRYING and hot water is worse. Hot showers and bathes are the evil and will dry your skin out more than anything. If you MUST take a bath use bath oils and NOT baby oil (baby oil will stay on the surface of the water whereas bath oils will blend in the water).What should you put on your skin, this brings us to number 2. You need an ointment.


2) What is the difference between Lotions, Creams and Ointments? This is the most important lesson to learn from this blog: Lotions are DRYING, what you need is an OINTMENT. Lotions are MOSTLY water (remember, water is DRYING) and a little oil. While you are in water it is hydrating but within 5 minutes after you get out, water is DRYING!!! Creams are water in OIL so they are better than lotions but you want an OINTMENT. An ointment is grease, it is petrolatum or oil based, think aquaphor and Vaseline petroleum JELLY (NOT Vaseline intensive care LOTION). NO LOTIONS, creams are a little better but OINTMENTS are the best for dry skin and most skin conditions.


3) Eczema: No physician can CURE your eczema but we can give you tools to manage it. For those of you with a chronic form (dry, scaly thickened patches with hyper or hypo pigmented skin) you need to be vigilant about avoiding dry skin and liberally use your creams and ointments. NO hot baths or showers and remember to put your ointments and creams on within 5 minutes of getting out of the shower or bath. Your doctor will also give you a regimen of topical steroids to use during a flare and ORAL STEROIDS are ALMOST NEVER indicated in the treatment of eczema.


4) Melanomas usually arise from a NEW MOLE that pops up and grows fast. In other words it is unusual for a melanoma to arise from a MOLE you've had for a LONG TIME.


5) Rosacea: Be careful here because many adults who think they have adult acne have rosacea and it is managed much differently. If you have flushing, broken capillaries AND ACNE on your face think Rosacea. Those who had the "peaches and cream" complexion at a younger age are those who have rosacea as adults. You are BORN with this and sun exposure BRINGS it out. The most important thing for you is to protect yourself from the sun.


6) Warts on your skin: Topical acids (compound W, topical salicylic acids), topical immunotherapy (imiquimod) and Liquid Nitrogen (freezing) are equally effective but the Liquid Nitrogen may give you the fastest results. You can buy the over the counter acid preparations (17% strength) and start on your own but your Physician can use Liquid Nitrogen (freezing) weekly to treat your warts and give you the fastest results.


7) Oral Steroids (steroids by mouth): There is generally NO ROLE for oral steroids (medrol dose packs, oral prednisone) for the treatment of eczema, contact dermatitis and even psoriasis. Avoid at ALL possible costs and use ONLY as a last resort because you will often get rebound symptoms upon stopping the oral steroids.


8) The Mantra: If it's DRY--> wet it, if it's WET-->dry it. Dermatologists and Internal medicine doctors follow this mantra. IF you have an oozing, wet, crusty rash (think a contact dermatitis like poison oak or poison ivy) you must DRY it first. To DRY an oozing, crusty, weepy lesion think of wetting a paper towel and draping it across the rash (remember...water is DRYING), or soaking in water or Burrows solution. Burrows solution is acetic acid (vinegar) and aluminum acetate and is a DRYING agent. AFTER you have dried it, you can then put a cream or ointment (topical steroid) on it. Get it: if it's wet, dry it THEN you can wet it. The flip side is that IF you start with a lesion that is dry and crusty you can "wet" it with a topical steroid ointment along with your doc's guidance.


9) Length of use. NO topical steroid, even an over the counter hydrocortisone cream, should be used for longer than 3 weeks without your doctor knowing about it.


10) Melanoma is the leading cause of cancer death in people in their 20's. Risk factors are: family history, > 100 moles, history of sunburns (serious sunburns), male sex and high risk skin types (light eyes and light hair).


11) Get a BIOPSY! Any lesion that is dry or scabs--> then bleeds-->then heals-->then bleeds again needs to be biopsied as it may be a non melanoma skin cancer; a basal cell carcinoma or a squamous cell carcinoma.


Dr O.

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TOTAL COMMENTS: 16 - View All Comments »

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Displaying comments 16-1 of 16
i have rosacea and have alot of red spots and spider veins anything i can do i had lazer it does not last long
By michelesmith  Oct 15, 2011
i have rosacea and have alot of red spots and spider veins anything i can do i had lazer it does not last long
By michelesmith  Oct 15, 2011
I am 59 yrs old and have large dark brown blotches. (some are scaley) Is there anything in the pantry or on the shelves at stores that will get rid of them? Have had them frozen off, but they come back after a while. I always wear sunscreen..even my foundation has sunscreen in it. Also..dark circles under my eyes? any hope of getting rid of that problem? When I was growing up, we didn't have sunscreen and we spent a lot of time water skiing, snow skiing and swimming in lakes. Help! :D
By junipers  Mar 09, 2010
All my chronic health started late 2006, starting with severe and first case of MRSA--so bad three sites req. surgical romoval, only on thighs, buttocks are of body--and was HIV Neg then, a month later had more MRSA issues and when tested again, I was then HIV POZ with CD4's and 5's that gave me an AIDS status immediately, went on Atripla and MRSA started clearing up but the peripheral neuropathy I was developing before taking Atripla progressively got worse and am on several meds for that. My question and comment in; I recently had some high anxiety provoking events in my life and the outbreaks started again only around trunk area of body. Tests are pending on whether I am still considered a MRSA carrier--they did nostril and thigh swabs and more bloodwork. I am undetectable and even though my % is 47.7, there was a dip in my CD4and 5's during this latest outbreak, showing my immune system is reacting at least...just wondering if MRSA is ever going to be added as an opportunistic Infection? And does anyone else fight this battle? Quite maddening, considdering all the mental things/family I have going asking for your prayers as well.
By namnibor  Jun 13, 2009
Everyone who cares about their skin should read this! It's about nutrients that nourish the skin and mentions toxins that are bad for the skin. This is just the tip of the iceberg, but it's worth reading...

The Top Five Nutrients for Healthy Skin:

Anybody who doesn't think skin is affected by both nutrients and toxins is kidding themselves.
Peace to y'all.
By MudPuddLe  May 30, 2009
I like what RaeOfSunshine80 said most. I sort of see the truth in what EPagain was saying also, except that the medical community over-prescribes antibiotics and bacteria are becoming resistant.

It is important for people to know that skin conditions can be affected by bacteria, viruses, protozoans, mites, parasites, insects, environmental toxins, physical irritation, and of course any kind of immunity, histamine, or allergic reaction to those.

I would guess that many skin conditions are often and easily misdiagnosed as one thing or the other. So diagnosis-specific advice may not be totally practical. Someone could be trying to treat their skin for a diagnosis that they might not actually have. This is why some of the general tips to improve overall physical health and hygiene as much as possible may have a greater impact on average. And I do agree with preventative measures and getting tested for anything odd.

Personally I'm not sure I buy the advice about wet and dry lotions and cremes and ointments. I think it depends specifically on the person's health and their skin type. Some people have skin that is both oily and dry depending upon which exact area. I know this is the case for me.

There is also recent science research being done that is suggesting that many cosmetic skin products are actually cancer risks! And I also read somewhere that most cosmetics products have little to no FDA nor EPA review of ingredient saftey! Check the web for this type of research. Maybe we can get some answers on this. They are also talking about sunblock causing cancer as well!

Usually when I put any kind of moisturizer on my skin, it irritates my skin and it breaks out more. Some of my skin goes through different phases of being oily or being dry. I have found that my skin tends to be healthier when I wash it a lot, even if that results in it getting dry. After thorough washing, it seems to start clearing up and healing better. I do hot showers and I think they help because they get my pores to open up. Eventually after being dry long enough, my skin's natural oil starts coming back, especially if the weather is warm. I try not to over-wash however, because I've heard (and experienced) that it can make your skin too dry and the skin's natural oils have their own beneficial aspects, even when they have a bit of bacteria (but not too much).

Overall, I think that the immunologists, dermatologists, physicians, endocrinologists, gastroenterologists, nutritionists, infectious disease specialists, and dieticians need to form a consortium of skin disorder study and treatments. Really... because they each know some things that the others don't! And they really ought to invite actual patients too! It's a big puzzle and each of us only have a few pieces.
By MudPuddLe  May 17, 2009
i recently developed eczema started taking more omega fatty acids specifically epa dha and GLA and in a couple weeks it had dramaticly lessoned. to see if that was a fluke i discontinued it for a few weeks and it got worse again started up again and it got better. then ran out and it came back. i also have been eating more sulfur containing foods trying to keep my body more ph balanced or alkaline as i tend to be acidic. but by far the most dramatic results was the omega fatty acids. i also notice it tends to flare up when my allergies and chronic sinus infections do.

i know that gla specifically has in some studies been linked to eczema though not in all cases. though it does need its cofactors to work its best.
By raeofsunshine80  May 08, 2009
I think it is very great that you shared with us. I am not trying to be argumentative at all. I did have a malignant melanoma that was a mole I always had. I know you said it is UNUSUAL, however my experience was not unusual at all. In fact all of my melanomas were moles I had. I just don't want people to take it literally and neglect it. My melanoma kept getting bigger and it was bright red, it did not exhibit the usual characteristics of melanomas except it kept getting bigger. You do have a lot of great advice and there is no question it is great to have your notes. Vaseline is a petroleum product and I don't think it is a good idea to utilize petro chemicals on the skin. If you know that it is completely safe I would love to hear more on that.
By SpeedQueen  May 07, 2009
does the injection betaseron for Multiple sclerosis age the skin or make it dry?
By spirit71  May 02, 2009
Eczema - By giving my son probiotics 80% of his eczema was gone in one week. By continuing probiotics and making his diet more base/alkaline (higher pH) with less milk and a few more veggies his eczema was gone after 7 months. I think there is not a enough good gut bacteria to absorb the nutrients and too many bad bacteria.

About 2 months ago I spoke with an MD who worked with a dermatologist who uses antibiotics and this kills the "over growth of bad bacteria" he thinks is taking place when good results.
By EPagain  May 01, 2009
It's odd that you mention all these skin afflictions without mentioning psoriasis or seborrheic dermatitis. I have psoriatic scaling on my elbows, behind my ears and sometimes on my knees. Whereas I have seborrheic dermatitis in the folds of my outer ear. Both look an awful lot alike, but respond completely different to topical treatments.

Combine that with keratosis pilaris and I'm just a mess. All topical treatments have had only marginal effect of very short duration and stress just exacerbates them all.

I wish I could get help with that.
By mstelly  Apr 28, 2009
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By john0099  Apr 28, 2009
I'd add a bit to #11 -- how about a funky, changing lesion? I have a basal cell carcinoma on my face that never was dry, scabbed, bleeding -- just pearly w/an igrregular border. It had been there awhile, then started growing. Now I'm more alert to "funky skin change"...
By frogerina  Apr 28, 2009
I have a question...I have these small bumps on my color to them...not pimples..a doctor told me they were from high cholesterol..they tend to kinda come and go...some days more prominent than others. Also another question..anything ya can do with what look like small spider veins on your face(my cheeks have them)besides putting on makeup thru-out the day? Thanx.
By lynn09  Apr 28, 2009
Has anyone had any success treating keratosis pilaris? I know it cannot be cured, but I'm thinking there must be some way to minimize it's effects.
By Susan151  Apr 28, 2009
now i know why my granny put vasoline on her hands every night and slept with gloves on. she passed at 93 years old with hands that were so pretty. they looked younger than mine.
By dancer4wind  Apr 27, 2009
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