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.