Question:

I am 34 years old with two small children, a husband, and hands that are red, scaly, and cracked. My hands are at a point where even water causes a burning sensation, and moisturizers do not help. I am desperate for some type of relief. Why is this happening to me? I have friends with similar life situations, and their hands are fine!

Answer:

You have a common skin problem called Hand Eczema (Hand Dermatitis). It is usually chronic with remissions and recurrences and is characterized by a red, scaly, itchy rash on the palms, back of the hands, and the fingers. Hand Eczema usually results from a combination of irritants and, at times, allergic substances that come in contact with the skin. Everyone routinely touches soaps, detergents, raw foods, fruits, and home cleaning agents around the house, as well as the chemicals, inks, adhesives, solvents, and other products in the work place.

As you can see, our hands take a beating; but not everyone gets Hand Eczema. Many people have “tough” skin, and their exposure time to irritants is minimized. Unfortunately, many people have “sensitive” skin, and contact with irritating agents is abusive. We can’t make one’s skin tougher, but there are ways to protect the skin and to treat Hand Eczema. Physical protection when possible is essential. Wear gloves (latex, vinyl, or plastic) to avoid contact with detergents, scouring powders, solvents, bleach, raw foods, fresh lemons, fresh fruits, onions, etc. It is important to have more than one set of gloves and to avoid the hands sweating inside the gloves. Use gloves that are lined or use thin, cotton liner gloves to wear underneath the heavier, protective gloves. Abuse your gloves, not your hands!

The most important part of treatment is protection and prevention. However, when Hand Eczema appears, apply a cortisone cream (over-the-counter hydrocortisone cream, 1 percent) several times a day. Apply a small amount of medicine to the rash, and massage it in well. If the skin is still dry, you may apply plain white petrolatum (Vaseline) or other non-medicated hand cream. When your rash is better, you can use the medicine less often.

You should apply a hand cream several times a day to prevent dry skin on the hands. Pamper your hands for several months after healing. It takes 2-3 months for the skin to totally recover. Hand Eczema is chronic and stubborn, and not treating the symptoms creates frequent recurrences. Pamper your hands with protection and immediate treatment with recurrences. If your Hand Eczema does not respond to these recommendations, evaluation by a dermatologist and prescription medications are recommended.

Question:

I am 28 years old, and while pregnant I developed some breakouts which left discolorations on my face. Since the delivery of my baby eight months ago, the discolored spots have remained. What can I do to make them go away?

Answer:

There are generally two terms people use to describe their skin - firmness and tone.

Skin tone is altered and damaged by inflammation from pimples, ingrown hairs, skin infections, and insect bites, etc. It can also be affected by sun exposure, tanning beds, smoking, age, environmental pollutants, and in the case of pregnancy, fluctuations in hormones or the use of medications. These insults can create a blotchy complexion that is marked by areas of pallor and brownish-colored skin. The uneven skin tones create an aged look.

Improving your skin tone is essential for a more youthful and healthy appearance.

The first step is to exfoliate the skin. There are cleansers containing glycolic and salicylic acids and glycolic acid creams and lotions that can be used on a daily basis for skin exfoliation. There are also salon services, such as glycolic peels, microdermabrasion, and facial masks that can be used on a weekly basis to exfoliate the skin. There are more aggressive physician services available to improve skin tone as well, including lasers and intense pulse light treatments.

Skin tone can be evened out with a foundation or moisturizer (tinted or untinted) that matches your skin color. There are special cover-up products available for specific areas of the face, such as around the eyes, as well as cosmetic products that can be used to enhance skin tones on the face. Bleaching creams can also be used to fade and decrease the appearance of brown spots.

Use antioxidant creams, lotions, and serums, such as retinol, vitamin C and growth factors to help maintain skin tone once it has been improved by reparative skin creams containing glycolic acid and retinoic acid.

Also, don’t forget the importance of sun protection. If your foundation, moisturizer or makeup does not contain sunblock, then sunblock should be applied under your make-up products.

Question: I am 22 years old with a scaly brown-colored rash on my chest and back that will not tan. My boyfriend told me it was ugly and I have a fungus. He thinks I am contagious and wants me to see a dermatologist. Any suggestions for my skin condition?

Answer: Your spots probably represent a skin condition called “tinea versicolor.” The scaly spots are due to the over-growth of a superficial fungus which lives in the outer layer of the skin in everyone. Therefore, it is not contagious. The fungus just likes your skin oils and cells in the area between your neck and waist better than people who do not have this superficial fungal infection.

The spots on the skin represent the organism’s ability to impair normal tanning and pigment formation. The scaly skin can be scraped and the fungus identified under a microscope. Tinea versicolor does not influence your general health. Although it may itch, the major concern is its appearance.

Tinea versicolor can be treated with daily showers followed by the daily application of an over-the-counter antifungal cream such as miconazole or clotrimazole. The pigmentation will persist for some time after eradication of the fungus, at least until the pigment cells have recovered and are able to produce normal pigmentation in the skin. It is best to use the antifungal cream daily until the skin pigment has returned to normal.

Widespread cases of tinea versicolor can be treated with oral and topical medication under the direction of a dermatologist. Tinea versicolor is similar to other infections. That is, once it is cured you can get it again and it does have a tendency to recur. Should this happen, repeat the treatment program.

Question:

My husband has a red, dry, and flaky patch of skin on both cheeks and a similar rash in the beard area and sideburns that will not go away. He is retired and plays golf three days a week. I cannot seem to get him to wear sunscreen. Is this just dry skin and sun damage?

Answer:

I am jealous that he gets to play golf three times a week! He should be applying sunscreen at least one hour prior to playing and reapplying after nine holes. As a general rule, we under apply sunscreens, which is why I recommend a sunscreen with an SPF of 30 or greater and prefer one that contains either micronized zinc oxide or titanium dioxide.

His skin problem sounds like seborrheic dermatitis rather than dry skin. Dry skin should be eliminated with a moisturizer. Seborrheic dermatitis is a common, scaly rash that affects the face and scalp. Dandruff is seborrheic dermatitis of the scalp. Other commonly affected areas are the eyebrows, eyelashes, ears, and skin near the nose, sideburns and beard area. It can affect skin fold areas such as the armpits, groin, and buttocks, as well as the mid-chest and back areas. The cause is unknown, but appears to worsen with stress, illnesses, surgery, and significant weather changes; but it is not contagious. It can appear at any age and tends to run in families.

There is no cure for seborrheic dermatitis; however, there are topical treatments. Based on the area of the body involved, medicated shampoos and topical solutions are available for scalp seborrheic dermatitis. On the skin of the face and ears, over-the-counter cortisone cream is available for twice-daily application as needed. Cortisone cream applied to limited areas of the skin do not affect you general health.

Once seborrheic dermatitis is under control, begin to taper the cortisone cream usage until it is being used only as needed for the presence of the rash. It may be possible to stop the medication completely, but it can be resumed on an as-needed basis. Seborrheic dermatitis can be a chronic, recurrent dermatitis requiring periodic treatment. If seborrheic dermatitis is not controlled with medicated shampoos and over-the-counter topical medications, evaluation by a dermatologist is required. There are prescription medications to treat seborrheic dermatitis that can be used with the evaluation and supervision of a dermatologist.