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 Healthy Steps for Healthy Skin
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Skin is a waterproof, flexible, but tough protective covering for your body.
Normally the surface is smooth, punctuated only with hair and pores for
sweat. A cross-section of skin shows the major parts. It is divided into
three layers. The outer layer is the epidermis. The dermis is in the middle
and fat forms the innermost layer. Blood vessels, nerves, hair follicles,
oil glands and sweat glands are located in the dermis.
The major function of skin is to provide a barrier between you and the
outside environment. Without this protective covering, your life on earth
would be impossible. The outermost layer of the epidermis is made up of
sheets of dead cells that serve as the major waterproof barrier to the
environment. In addition, special cells called melanocytes inside the
epidermis produce brown pigment which helps protect you from ultraviolet
light.
The middle layer, the dermis, provides a tough, flexible foundation for the
epidermis. In the dermis, sweat glands and blood vessels help to regulate
body temperature, and nerve endings send the sensations of pain, itching,
touch, and temperature to the brain. Oil glands produce a substance called
sebum, which help to moisturize the skin. Hair is primarily decorative in
humans. The fat under the dermis provides insulation and helps to store
calories.
Aging Skin
Americans spend billions of dollars each year on skin care products that
promise to erase wrinkles, lighten age spots, and eliminate itching,
flaking, or redness. But the simplest and cheapest way to keep your skin
healthy and young looking is to stay out of the sun.
Sunlight is a major cause of the skin changes we think of as aging - changes
such as wrinkles, dryness, and age spots. Your skin does change with age.
For example, you sweat less, leading to increased dryness. As your skin
ages, it becomes thinner and loses fat, so it looks less plump and smooth.
Underlying structures - veins and bones in particular - become more
prominent. Your skin can take longer to heal when injured. You can delay
these changes by staying out of the sun. Although nothing can completely
undo sun damage, the skin sometimes can repair itself. So, it’s never too
late to protect yourself from the harmful effects of the sun.
Wrinkles
Over time, the sun’s ultraviolet (UV) light damages the fibers in the skin
called elastin. The breakdown of these fibers causes the skin to lose its
ability to snap back after stretching. As a result, wrinkles form. Gravity
also is at work, pulling at the skin and causing it to sag, most noticeably
on the face, neck, and upper arms.
Cigarette smoking also contributes to wrinkles. People who smoke tend to
have more wrinkles than nonsmokers of the same age, complexion, and history
of sun exposure. The reason for this difference is not clear. It may be
because smoking also plays a role in damaging elastin. Facial wrinkling
increases with the amount of cigarettes and number of years a person has
smoked.
Many products currently on the market claim to “revitalize aging skin.”
According to the American Academy of Dermatology, over-the-counter “wrinkle”
creams and lotions may soothe dry skin, but they do little or nothing to
reverse wrinkles. At this time, the only products that have been studied for
safety and effectiveness and approved by the Food and Drug Administration
(F D A) to treat signs of sun-damaged or aging skin are tretinoin cream and
carbon dioxide (CO2) and erbium (Er:YAG) lasers.
Tretinoin cream (Renova), a vitamin A derivative available by prescription
only, is approved for reducing the appearance of fine wrinkles, mottled
darkened spots, and roughness in people whose skin doesn’t improve with
regular skin care and use of sun protection. However, it doesn’t eliminate
wrinkles, repair sun-damaged skin, or restore skin to its healthier, younger
structure. It hasn’t been studied in people 50 and older or in people with
moderately or darkly pigmented skin.
The CO2 and Er:YAG lasers are approved to treat wrinkles. The doctor uses
the laser to remove skin one layer at a time. Laser therapy is performed
under anesthesia in an outpatient surgical setting.
The F D A currently is studying the safety of alpha hydroxy acids (AHAs),
which are widely promoted to reduce wrinkles, spots, and other signs of
aging, sun-damaged skin. Some studies suggest that they may work, but there
is concern about adverse reactions and long-term effects of their use.
Because people who use AHA products have greater sensitivity to the sun, the
FDA advises consumers to protect themselves from sun exposure by using
sunscreen, wearing a hat, or avoiding mid-day sun. If you are interested in
treatment for wrinkles, you should discuss treatment options with a
dermatologist.
Dry Skin and Itching
Many older people suffer from dry skin, particularly on their lower legs,
elbows, and forearms. The skin feels rough and scaly and often is
accompanied by a distressing, intense itchiness. Low humidity - caused by
overheating during the winter and air conditioning during the summer -
contributes to dryness and itching. The loss of sweat and oil glands as you
age also may worsen dry skin. Anything that further dries your skin - such
as overuse of soaps, antiperspirants, perfumes, or hot baths - will make the
problem worse. Dehydration, sun exposure, smoking, and stress also may cause
dry skin.
Dry skin itches because it is irritated easily. If your skin is very dry and
itchy, see a doctor. Dry skin and itching can affect your sleep, cause
irritability, or be a symptom of a disease. For example, diabetes and kidney
disease can cause itching. Some medicines make the itchiness worse.
The most common treatment for dry skin is the use of moisturizers to reduce
water loss and soothe the skin. Moisturizers come in several forms -
ointments, creams, and lotions. Ointments are mixtures of water in oil,
usually either lanolin or petrolatum. Creams are preparations of oil in
water, which is the main ingredient. Creams must be applied more often than
ointments to be most effective. Lotions contain powder crystals dissolved in
water, again the main ingredient. Because of their high water content, they
feel cool on the skin and don’t leave the skin feeling greasy. Although they
are easy to apply and may be more pleasing than ointments and creams,
lotions don’t have the same protective qualities. You may need to apply them
frequently to relieve the signs and symptoms of dryness. Moisturizers should
be used indefinitely to prevent recurrence of dry skin.
A humidifier can add moisture to the air. Bathing less often and using
milder soaps also can help relieve dry skin. Warm water is less irritating
to dry skin than hot water.
Skin Cancer
Skin cancer is the most common type of cancer in the United States.
According to current estimates, 40 to 50 percent of Americans who live to
age 65 will have skin cancer at least once. Although anyone can get skin
cancer, the risk is greatest for people who have fair skin that freckles
easily.
UV radiation from the sun is the main cause of skin cancer. In addition,
artificial sources of UV radiation - such as sunlamps and tanning booths -
can cause skin cancer. People who live in areas of the U.S. that get high
levels of UV radiation from the sun are more likely to get skin cancer. For
example, skin cancer is more common in Texas and Florida than in Minnesota,
where the sun is not as strong.
There are three common types of skin cancers. Basal cell carcinomas are the
most common, accounting for more than 90 percent of all skin cancers in the
United States. They are slow-growing cancers that seldom spread to other
parts of the body. Squamous cell carcinomas also rarely spread, but they do
so more often than basal cell carcinomas. The most dangerous of all cancers
that occur in the skin is melanoma. Melanoma can spread to other organs, and
when it does, it often is fatal.
Both basal and squamous cell cancers are found mainly on areas of the skin
exposed to the sun - the head, face, neck, hands, and arms. However, skin
cancer can occur anywhere. Changes in the skin are not sure signs of cancer;
however, it’s important to see a doctor if any symptom lasts longer than 2
weeks. Don’t wait for the area to hurt - skin cancers seldom cause pain.
All skin cancers could be cured if they were discovered and brought to a
doctor’s attention before they had a chance to spread. Therefore, you should
check your skin regularly. The most common warning sign of skin cancer is a
change on the skin, especially a new growth or a sore that doesn’t heal.
Skin cancers don’t all look the same. For example, skin cancer can start as
a small, smooth, shiny, pale, or waxy lump. Or it can appear as a firm red
lump. Sometimes, the lump bleeds or develops a crust. Skin cancer also can
start as a flat, red spot that is rough, dry, or scaly.
In treating skin cancer, the doctor’s main goal is to remove or destroy
cancer completely, leaving as small scar as possible. To plan the best
treatment for each person, the doctor considers the type of skin cancer, its
location and size, and the person’s general health and medical history.
Treatment for skin cancer usually involves some type of surgery. In some
cases, radiation therapy or chemotherapy (anticancer drugs) or a combination
of these treatments may be necessary.
Age Spots
Age spots, or “liver spots” as they’re often called, have nothing to do with
the liver. Rather, these flat, brown spots are caused by years of sun
exposure. They are bigger than freckles and appear in fair-skinned people on
sun-exposed areas such as the face, hands, arms, back, and feet. The medical
name for them is solar lentigo. They may be accompanied by wrinkling,
dryness, thinning of the skin, and rough spots.
A number of treatments are available, including skin-lightening, or “fade”
creams; cryotherapy (freezing); and laser therapy. Tretinoin cream is
approved for reducing the appearance of darkened spots. A sunscreen or sun
block should be used to prevent further damage.
Shingles
Shingles is an outbreak of a rash or blisters on the skin that may cause
severe pain. Shingles is caused by the varicella-zoster virus, the same
virus that causes chickenpox. After an attack of chickenpox, the virus lies
silent in the nerve tissue. Years later, the virus can reappear in the form
of shingles. Although it is most common in people over age 50, anyone who
has had chickenpox can develop shingles. It also is common in people with
weakened immune systems due to HIV infection, chemotherapy or radiation
treatment, transplant operations, and stress.
Early signs of shingles include burning or shooting pain and tingling or
itching, generally on one side of the body or face. A rash appears as a band
or patch of raised dots on the side of the trunk or face. The rash develops
into small, fluid-filled blisters, which begin to dry out and crust over
within several days. When the rash is at its peak, symptoms can range from
mild itching to intense pain. Most people with shingles have only one bout
with the disease in their lifetime. However, those with impaired immune
systems - for example, people with AIDS or cancer - may suffer repeated
episodes.
If you suspect you have shingles, see a doctor right away. The severity and
duration of an attack of shingles can be reduced significantly by immediate
treatment with antiviral drugs. These drugs also may help prevent the
painful aftereffects of shingles known as postherpetic neuralgia.
Bruising
Many older people notice an increased number of bruises, especially on their
arms and legs. The skin becomes thinner with age and sun damage. Loss of fat
and connective tissue weakens the support around blood vessels, making them
more susceptible to injury. The skin bruises and tears more easily and takes
longer to heal.
Sometimes bruising is caused by medications or illness. If bruising occurs
in areas always covered by clothing, see a doctor.
Acne
Acne is a disorder resulting from the action of hormones on the skin's oil
glands (sebaceous glands), which leads to plugged pores and outbreaks of
lesions commonly called pimples or zits. Acne lesions usually occur on the
face, neck, back, chest, and shoulders. Nearly 17 million people in the
United States have acne, making it the most common skin disease. Although
acne is not a serious health threat, severe acne can lead to disfiguring,
permanent scarring, which can be upsetting to people who are affected by the
disorder.
The exact cause of acne is unknown, but doctors believe it results from
several related factors. One important factor is an increase in hormones
called androgens (male sex hormones). These increase in both boys and girls
during puberty and cause the sebaceous glands to enlarge and make more
sebum. Hormonal changes related to pregnancy or starting or stopping birth
control pills can also cause acne. Another factor is heredity or genetics.
Certain drugs, including androgens and lithium, are known to cause acne.
Greasy cosmetics may alter the cells of the follicles and make them stick
together, producing a plug.
Factors that can cause an acne flare include:
- Changing hormone levels in adolescent girls and adult women 2 to 7 days
before their menstrual period starts
- Friction caused by leaning on or rubbing the skin
- Pressure from bike helmets, backpacks, or tight collars
- Environmental irritants, such as pollution and high humidity
- Squeezing or picking at blemishes
- Hard scrubbing of the skin.
Myths About the Causes of Acne
There are many myths about what causes acne. Chocolate and greasy foods are
often blamed, but foods seem to have little effect on the development and
course of acne in most people. Another common myth is that dirty skin causes
acne; however, blackheads and other acne lesions are not caused by dirt.
Finally, stress does not cause acne.
Who Gets Acne?
People of all races and ages get acne. It is most common in adolescents and
young adults. Nearly 85 percent of people between the ages of 12 and 24
develop the disorder. For most people, acne tends to go away by the time
they reach their thirties; however, some people in their forties and fifties
continue to have this skin problem.
Atopic dermatitis
Atopic dermatitis is a chronic (long-lasting) disease that affects the skin.
It is not contagious; it cannot be passed from one person to another. The
word "dermatitis" means inflammation of the skin. "Atopic" refers to a group
of diseases where there is often an inherited tendency to develop other
allergic conditions, such as asthma and hay fever. In atopic dermatitis, the
skin becomes extremely itchy. Scratching leads to redness, swelling,
cracking, "weeping" clear fluid, and finally, crusting and scaling. In most
cases, there are periods of time when the disease is worse (called
exacerbations or flares) followed by periods when the skin improves or
clears up entirely (called remissions). As some children with atopic
dermatitis grow older, their skin disease improves or disappears altogether,
although their skin often remains dry and easily irritated. In others,
atopic dermatitis continues to be a significant problem in adulthood.
Atopic dermatitis is often referred to as "eczema," which is a general term
for the several types of inflammation of the skin. Atopic dermatitis is the
most common of the many types of eczema. Several have very similar symptoms.
Although it is difficult to identify exactly how many people are affected by
atopic dermatitis, an estimated 20 percent of infants and young children
experience symptoms of the disease. Roughly 60 percent of these infants
continue to have one or more symptoms of atopic dermatitis in adulthood.
This means that more than 15 million people in the United States have
symptoms of the disease
Rosacea
Rosacea is a chronic (long-term) disease that affects the skin and sometimes
the eyes. The disorder is characterized by redness, pimples, and, in
advanced stages, thickened skin. Rosacea usually affects the face; other
parts of the upper body are only rarely involved.
Approximately 14 million people in the United States have rosacea. It most
often affects adults between the ages of 30 and 60. Rosacea is more common
in women (particularly during menopause) than men. Although rosacea can
develop in people of any skin color, it tends to occur most frequently and
is most apparent in people with fair skin.
There are several symptoms and conditions associated with rosacea. These
include frequent flushing, vascular rosacea, inflammatory rosacea, and
several other conditions involving the skin, eyes, and nose.
Frequent flushing of the center of the face - which may include the
forehead, nose, cheeks, and chin - occurs in the earliest stage of rosacea.
The flushing often is accompanied by a burning sensation, particularly when
creams or cosmetics are applied to the face. Sometimes the face is swollen
slightly.
In addition to skin problems, up to 50 percent of people who have rosacea
have eye problems caused by the condition. Typical symptoms include redness,
dryness, itching, burning, tearing, and the sensation of having sand in the
eye. The eyelids may become inflamed and swollen. Some people say their eyes
are sensitive to light and their vision is blurred or otherwise impaired.
Doctors do not know the exact cause of rosacea but believe that some people
may inherit a tendency to develop the disorder. People who blush frequently
may be more likely to develop rosacea. Factors that cause rosacea to flare
up in one person may have no effect on another person. Although the
following factors have not been well-researched, some people claim that one
or more of them have aggravated their rosacea: heat (including hot baths),
strenuous exercise, sunlight, wind, very cold temperatures, hot or spicy
foods and drinks, alcohol consumption, menopause, emotional stress, and
long-term use of topical steroids on the face.
Although there is no cure for rosacea, it can be treated and controlled. A
dermatologist (a medical doctor who specializes in diseases of the skin)
usually treats rosacea. The goals of treatment are to control the condition
and improve the appearance of the patient's skin. It may take several weeks
or months of treatment before a person notices an improvement of the skin.
Psoriasis
Psoriasis is a chronic (long-lasting) skin disease of scaling and
inflammation that affects 2 to 2.6 percent of the United States population,
or between 5.8 and 7.5 million people. Although the disease occurs in all
age groups, it primarily affects adults. It appears about equally in males
and females. Psoriasis occurs when skin cells quickly rise from their origin
below the surface of the skin and pile up on the surface before they have a
chance to mature. Usually this movement (also called turnover) takes about a
month, but in psoriasis it may occur in only a few days. In its typical
form, psoriasis results in patches of thick, red (inflamed) skin covered
with silvery scales. These patches, which are sometimes referred to as
plaques, usually itch or feel sore. They most often occur on the elbows,
knees, other parts of the legs, scalp, lower back, face, palms, and soles of
the feet, but they can occur on skin anywhere on the body.
The disease may also affect the fingernails, the toenails, and the soft
tissues of the genitals and inside the mouth. While it is not unusual for
the skin around affected joints to crack, approximately 1 million people
with psoriasis experience joint inflammation that produces symptoms of
arthritis. This condition is called psoriatic arthritis.
Individuals with psoriasis may experience significant physical discomfort
and some disability. Itching and pain can interfere with basic functions,
such as self-care, walking, and sleep. Plaques on hands and feet can prevent
individuals from working at certain occupations, playing some sports, and
caring for family members or a home. The frequency of medical care is costly
and can interfere with an employment or school schedule. People with
moderate to severe psoriasis may feel self-conscious about their appearance
and have a poor self-image that stems from fear of public rejection and
psychosexual concerns. Psychological distress can lead to significant
depression and social isolation.
Psoriasis is a skin disorder driven by the immune system, especially
involving a type of white blood cell called a T cell. Normally, T cells help
protect the body against infection and disease. In the case of psoriasis, T
cells are put into action by mistake and become so active that they trigger
other immune responses, which lead to inflammation and to rapid turnover of
skin cells. In about one-third of the cases, there is a family history of
psoriasis. People with psoriasis may notice that there are times when their
skin worsens, then improves. Conditions that may cause flareups include
infections, stress, and changes in climate that dry the skin. Also, certain
medicines, including lithium and betablockers, which are prescribed for high
blood pressure, may trigger an outbreak or worsen the disease.
Doctors generally treat psoriasis in steps based on the severity of the
disease, size of the areas involved, type of psoriasis, and the patient's
response to initial treatments. This is sometimes called the "1-2-3"
approach. In step 1, medicines are applied to the skin (topical treatment).
Step 2 uses light treatments (phototherapy). Step 3 involves taking
medicines by mouth or injection that treat the whole immune system (called
systemic therapy).
Over time, affected skin can become resistant to treatment, especially when
topical corticosteroids are used. Also, a treatment that works very well in
one person may have little effect in another. Thus, doctors often use a
trial-and-error approach to find a treatment that works, and they may switch
treatments periodically (for example, every 12 to 24 months) if a treatment
does not work or if adverse reactions occur.
Scleroderma
Derived from the Greek words "sklerosis," meaning hardness, and "derma,"
meaning skin, scleroderma literally means hard skin. Though it is often
referred to as if it were a single disease, scleroderma is really a symptom
of a group of diseases that involve the abnormal growth of connective
tissue, which supports the skin and internal organs. It is sometimes used,
therefore, as an umbrella term for these disorders. In some forms of
scleroderma, hard, tight skin is the extent of this abnormal process. In
other forms, however, the problem goes much deeper, affecting blood vessels
and internal organs, such as the heart, lungs, and kidneys.
Scleroderma is called both a rheumatic (roo-MA-tik) disease and a connective
tissue disease. The term rheumatic disease refers to a group of conditions
characterized by inflammation and/or pain in the muscles, joints, or fibrous
tissue. A connective tissue disease is one that affects the major substances
in the skin, tendons, and bones.
Although scientists don't know exactly what causes scleroderma, they are
certain that people cannot catch it from or transmit it to others. Studies
of twins suggest it is also not inherited. Scientists suspect that
scleroderma comes from several factors that may include:
- Abnormal immune or inflammatory activity: Like many other rheumatic
disorders, scleroderma is believed to be an autoimmune disease. An
autoimmune disease is one in which the immune system, for unknown reasons,
turns against one's own body.
- In scleroderma, the immune system is thought to stimulate cells called
fibroblasts to produce too much collagen. In scleroderma, collagen forms
thick connective tissue that builds up around the cells of the skin and
internal organs. In milder forms, the effects of this buildup are limited to
the skin and blood vessels. In more serious forms, it also can interfere
with normal functioning of skin, blood vessels, joints, and internal organs.
- Genetic makeup: While genes seem to put certain people at risk for
scleroderma and play a role in its course, the disease is not passed from
parent to child like some genetic diseases.
However, some research suggests that having children may increase a woman's
risk of scleroderma. Scientists have learned that when a woman is pregnant,
cells from her baby can pass through the placenta, enter her blood stream,
and linger in her body--in some cases, for many years after the child's
birth. Recently, scientists have found fetal cells from pregnancies of years
past in the skin lesions of some women with scleroderma. They think that
these cells, which are different from the woman's own cells, may either
begin an immune reaction to the woman's own tissues or trigger a response by
the woman's immune system to rid her body of those cells. Either way, the
woman's healthy tissues may be damaged in the process. Further studies are
needed to find out if fetal cells play a role in the disease.
- Environmental triggers: Research suggests that exposure to some
environmental factors may trigger the disease in people who are genetically
predisposed to it. Suspected triggers include viral infections, certain
adhesive and coating materials, and organic solvents such as vinyl chloride
or trichloroethylene. In the past, some people believed that silicone breast
implants might have been a factor in developing connective tissue diseases
such as scleroderma.
- Hormones: By the middle to late childbearing years (ages 30 to 55), women
develop scleroderma at a rate 7 to 12 times higher than men. Because of
female predominance at this and all ages, scientists suspect that something
distinctly feminine, such as the hormone estrogen, plays a role in the
disease. So far, the role of estrogen or other female hormones has not been
proven.
- Although scleroderma is more common in women, the disease also occurs in
men and children. It affects people of all races and ethnic groups.
Seborrheic dermatitis ("dandruff”)
Seborrheic dermatitis is a disease that causes flaking of the skin. It
usually affects the scalp. In adolescents and adults, it is commonly called
"dandruff." In babies, it is known as "cradle cap."
Seborrheic dermatitis can also affect the skin on other parts of the body,
such as the face and chest, and the creases of the arms, legs and groin.
Seborrheic dermatitis usually causes the skin to look a little greasy and
scaly or flaky.
Seborrheic dermatitis most often occurs in babies younger than 3 months of
age and in adults from 30 to 60 years of age. In adults, it's more common in
men than in women.
The exact cause isn't known. The cause may be different in infants and
adults. Seborrheic dermatitis may be related to hormones, because the
disorder often appears in infancy and disappears before puberty. Or the
cause might be a fungus, called malassezia. This organism is normally
present on the skin in small numbers, but sometimes its numbers increase,
resulting in skin problems.
Seborrheic dermatitis has also been linked to neurologic disorders such as
Parkinson's disease and epilepsy. The reason for this relationship isn't
known.
The treatment of seborrheic dermatitis depends on its location on the body.
Treatment also depends on the person's age.
Seborrheic dermatitis of the scalp (dandruff) in adults and adolescents.
Dandruff is usually treated with a shampoo that contains salicylic acid
(some brand names: X-Seb, Scalpicin), the prescription medicine selenium
sulfide (brand names: Selsun, Exsel) or pyrithione zinc (some brand names:
DHS Zinc, Head & Shoulders). These shampoos can be used 2 times a week.
Shampoos with coal tar (some brand names: DHS Tar, Neutrogena T/Gel, Polytar)
may be used 3 times a week. If you have dandruff, you might start by using
one of these shampoos daily until your dandruff is controlled, and then use
it 2 or 3 times a week.
When you use a dandruff shampoo, rub the shampoo into your hair thoroughly
and let it stay on your hair and scalp for at least 5 minutes before
rinsing. This will give it time to work.
If the shampoo alone doesn't help, your doctor might want you to use a
prescription steroid lotion once or twice daily, in addition to the shampoo.
Red, bumpy, scaly, itchy, swollen skin-any of these symptoms can signify an
allergic skin condition. These skin problems are often caused by an immune
system reaction, signifying an allergy. Allergic skin conditions can take
several forms and are due to various causes.
Hives and angioedema
Hives or urticaria are red, itchy, swollen areas of the skin that can range
in size and appear anywhere on the body. Approximately 25% of the U.S.
population will experience an episode of hives at least once in their lives.
Most common are acute cases of hives, where the cause is identifiable-often
a viral infection, drug, food or latex. These hives usually go away
spontaneously. Some people have chronic hives that occur almost daily for
months to years. For these individuals, various circumstances or events,
such as scratching, pressure or "nerves," may aggravate their hives.
However, eliminating these triggers has little effect on this condition.
Angioedema, a swelling of the deeper layers of the skin, sometimes occurs
with hives. Angioedema is not red or itchy, and most often occurs in soft
tissue such as the eyelids, mouth or genitals. Hives and angioedema may
appear together or separately on the body. Hives are the result of a
chemical called histamine-responsible for many of the symptoms of allergic
reactions-in the upper layers of the skin. Angioedema results from the
actions of these chemicals in the deeper layers of the skin. These chemicals
are usually stored in our bodies' mast cells, which are cells heavily
involved in allergic reactions. There are several identifiable triggers that
release histamine and other chemicals from the mast cells, causing hives.
In adults, reactions to medicines are a common cause of acute hives.
Medications known to cause hives or angioedema include aspirin and other
non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, high blood
pressure medicines known as ACE-inhibitors, or pain-killers containing
codeine or codeine-like drugs. Like all drug-induced hives, these reactions
occur within only minutes to an hour of taking the drug. Adults can also
develop hives after eating certain foods, including nuts, eggs, shellfish,
soy, wheat or milk-the culprits in more than 90% of proven food-induced
hives. In children, foods or viral infections such as a cold can trigger
acute hives. Physical urticaria are hives resulting from an outside source:
rubbing of the skin, cold, heat, physical exertion or exercise, pressure or
direct exposure to sunlight. Patients with chronic urticaria often report
that at least one of these triggers induces their hives.
Whenever there is an identifiable trigger of hives, it should be eliminated.
In patients with acute hives, some drugs or foods may take days to be
eliminated from the body. For these individuals, an allergist may prescribe
antihistamines to relieve symptoms until the culprit is eliminated. For
patients with chronic hives, treatment cannot control the eruptions; these
hives will eventually disappear on their own, with or without treatment. For
50% of these patients, the hives will clear in three to 12 months; 40% will
clear in one to five years. Up to 1.5% of these patients may experience
these hives for more than 20 years. Forty percent of patients with chronic
hives will have at least one more episode of chronic hives in their
lifetime. For these patients, the treatment objective is to provide comfort.
If you experience chronic hives, your allergist will prescribe
antihistamines, and will combine medications and adjust your dosages as
needed for your individual symptoms. In rare cases, if antihistamines do not
provide appropriate comfort, the allergist will prescribe an oral
corticosteroid.
Contact dermatitis
When some substances come into contact with skin, they may cause a rash
called contact dermatitis. Some of these reactions are the result of an
allergic reaction that involves the immune system, but many are the result
of a non-allergic, or irritant, reaction. Often, it is difficult to tell the
difference between these two types of reactions. The hallmark of allergic
contact dermatitis is that it occurs almost exclusively where the offending
agent-such as a plant or chemical-comes in contact with the skin. Irritant
contact dermatitis is often more painful than itchy, and is the result of an
offending agent that actually damages the skin with which it comes into
contact. The longer the skin is in contact-or the more concentrated the
agent-the more severe the reaction. Water with added soaps and detergents is
the most common cause. Thus, it is not surprising that these reactions
appear most often on the hands, and are frequently work-related. Individuals
with other skin diseases, especially eczema (ex-zeh-ma), are most
susceptible.
Allergic contact dermatitis is best exemplified by the itchy, red, blistered
reaction that almost everyone experiences after touching a plant in the "rhus"
family-poison ivy, poison oak or poison sumac. This allergic reaction is
caused by a chemical in the plant called urushiol. You can have a reaction
from touching other items with which the plant has come into contact,
including yard tools or the family dog. However, once your skin has been
washed, you cannot get another reaction from touching the rash or blisters.
Unlike irritant contact dermatitis, which occurs within minutes of coming
into contact with an offending agent, allergic contact dermatitis reactions
can occur 24-48 hours after contact. Once a reaction starts, it takes 14-28
days to resolve, even with treatment.
Other agents that frequently cause allergic contact dermatitis include
nickel, perfumes and fragrances, dyes, rubber (latex) products and
cosmetics. Some ingredients in medications applied to the skin also can
cause an allergic reaction, most commonly neomycin, an ingredient in
antibiotic creams. To avoid reactions, any cream that ends in "caine" should
never be applied to damaged skin.
Treatment of irritant contact dermatitis requires that the skin be kept from
contact with the agent that is causing the reaction, and that every
precaution is taken to avoid spilling caustic chemicals on the skin. Gloves
can sometimes be helpful. Since these reactions are non-allergic in nature,
treatment is directed toward relieving symptoms and preventing any permanent
damage to the affected skin.
Treatment for allergic contact dermatitis depends on the severity of the
symptoms. Cold soaks and compresses can offer relief for the acute, early,
itchy blistered stage of the rash. When the rash is limited to small areas
of the skin, topical corticosteroid creams may be prescribed to offer
relief. When large areas of the body are involved, oral corticosteroids may
be prescribed.
Common warts are noncancerous skin growths caused by the human
papillomavirus (HPV), which stimulates the rapid growth of cells of the
outer layer of your skin. More than 60 types of HPV occur.
Some types of HPV tend to cause warts on your skin. Common warts usually
occur on your hands, fingers or near your fingernails. Other types of HPV
tend to cause warts in other places:
Plantar warts. These occur on the soles of your feet. They usually look like
flesh-colored or light brown lumps with tiny black dots in them. These dots
are small, clotted blood vessels.
Genital warts. These are among the most common types of sexually transmitted
diseases. They can appear on your genitals, in your pubic area or in your
anal canal. In women, genital warts can also grow inside the vagina.
Flat warts. These warts are smaller and smoother than other warts. They
generally occur on your face or, if you're a woman, on your legs. They're
more common in children and teens than in adults.
Common warts are usually harmless, and most disappear on their own. But they
may be bothersome or embarrassing, and you may need treatment to remove
them. Common warts may recur after treatment and may be a persistent
problem.
Cleaning your face: Be gentle
Cleaning is an essential part of caring for your complexion. Whatever your
skin type - oily, dry, balanced or combination the key to cleaning is to
treat your skin gently.
When washing your face:
- Remove eye makeup. Use a soft sponge, cotton cloth or cotton balls and
moisturizing cream to avoid damaging the delicate tissue around your eyes.
If you wear heavy, waterproof makeup, you also may need to use an oil-based
product such as petroleum jelly.
- Use lukewarm water. Avoid washing your face with very hot water, which can
dry out your skin.
- Avoid strong soaps. Strong soaps - those most capable of stripping oil
from your skin - can leave your skin dry. These products don't contain
additives such as moisturizers or moisture retainers. Products containing lauryl sulfates are harsher than products containing sarcosinates,
sulfosuccinates and cocoamphodiacetates. A mild cleanser, typically labeled
as such, may also be a good choice.
- Avoid irritating additives. If you have sensitive skin, avoid products
containing perfumes or dyes. These can irritate your skin and may possibly
trigger an allergic response.
- Use your hands to wash your face. Instead of using a washcloth, which can
be abrasive, wash your face gently using your fingers.
- Rinse thoroughly and pat dry. Use a soft cotton towel to dry your face.
Generally, wash your face once in the morning, once in the evening and after
exercising or engaging in sports. If your skin is very dry and easily
irritated, washing once a day may be enough to remove sweat and oil from
your skin. If your skin is oily or prone to blackheads or acne - and you
live in a warm and humid environment - you may need to wash it more
frequently than twice a day. Otherwise, twice a day may be enough,
especially if you use soaps or other cleansers designed for oily skin. These
products strip more oil away from the skin and aren't as likely to contain
oil or moisturizers.
You may also consider using a toner or astringent after washing your face.
These products, which remove oil and soap residue, help make your skin feel
tight and clean. They're generally drying and may contain water, alcohol or
witch hazel, propylene glycol or salicylic acid. Some people find them to be
too drying and irritating. Others find that they work well in removing
excess oil.
Bathing: Avoid drying out
Bathing is essential to good hygiene. But bathing removes natural oils from
your skin, which can result in dryness and irritation. To minimize the
drying effects of bathing, follow these steps:
- Bathe once a day. Bathing once a day is generally enough to maintain good
hygiene. If your complexion is very oily, you live in a warm and humid
environment or you're physically active, twice a day may be more
appropriate. If you have dry skin, bathing every other day may be best.
- Use warm water and limit bath time. Hot water and long showers or baths
remove even more oil. Limit your bath or shower time to about 15 minutes or
less. And use warm, rather than hot, water.
- Use appropriate soaps. Choose mild, superfatted soaps, which are products
that have oils and fats added to them just after the soap manufacturing
process. Add bath oils, which are very moisturizing, to your bath. Consider
using a soap substitute. These products vary, but may include a mild
synthetic detergent or an oil mixed with a wetting agent (surfactant). They
typically come in a bar, gel or liquid form, and are less drying than are
deodorant and antibacterial detergents or soaps. If you have dry or
sensitive skin, use soap only on your face, underarms, genital area, and
hands and feet.
- Pat dry. After bathing, gently pat or blot your skin dry with a towel so
that some moisture remains on the skin. Immediately moisturize your skin
with an oil or cream.
Moisturizing: Hydrate your skin
Moisturizers help maintain your skin's natural moisture levels, which the
environment and your lifestyle frequently deplete. Moisturizers work by
providing a seal over your skin - to keep water from escaping - or by slowly
releasing water into your skin.
Apply moisturizers immediately after taking a shower or bath, as this helps
to trap water in the upper layers of your skin. You may like the feel of an
oil-in-water cream, such as Cetaphil or Vanicream. If you have dry skin,
consider using a heavier, water-in-oil moisturizer - such as Eucerin or
Nivea - rather than a light, disappearing moisturizing lotion that contains
mostly water. If your skin is very dry, you may want to apply an oil, such
as baby oil, while your skin is still moist. Oil has more staying power than
moisturizers do and prevents the evaporation of water from the surface of
your skin. If your skin is oily, you may prefer to skip moisturizing.
During the winter months, you may notice that your skin is drier. This is
due to lower relative humidity, with a combination of cold air outside and
dry heat indoors. Keeping the air in your home somewhat cool and humid may
help, so consider purchasing a humidifier.
Facial moisturizers help hydrate the skin on your face. The moisturizer
that's best for you and the frequency with which you need to moisturize
depend on your skin type, your age and whether you have specific conditions
such as acne or wrinkles. If you have oily skin, choose a light,
oil-in-water product. Or, you may prefer not to moisturize. For sensitive
skin, select products that have a good proportion of oil and water, rather
than those that are primarily water. Look for products free of heavy dyes,
perfumes or other additives. During the daytime, use a moisturizer with a
sun protection factor (SPF) of at least 15 to help protect your skin from
damaging ultraviolet rays, which can cause wrinkles, dark spots, rough skin
and skin cancer.
Shaving: Gently remove hair
Shaving is a common and inexpensive way to remove unwanted hair. However,
shaving can cause skin irritation, especially if your skin is thin, dry or
very sensitive.
If you shave with a blade razor, always use a sharp blade. If you're a man,
soften your beard before shaving by applying a warm washcloth to your face
for a few seconds. Then use plenty of shaving cream to further soften the
hair. Pass the blade over your beard only once, in the direction of hair
growth. Don't reverse the stroke, as it can cause a skin irritation called
razor burn. If you're a woman, use cream or lubricating gel when shaving
your legs. Shave in the direction of hair growth, and not against it.
If you use an electric razor, know that this method also can be irritating
to your skin if done too vigorously. Move the razor gently over your skin.
Electric razors work best - and are least irritating - when used on hair
that is dry, stiff, and free of perspiration and excess oil. If irritation
does occur, use a lotion that doesn't contain either ethyl or isopropyl
alcohol. Alcohol and alcohol-based products may feel cooling due to the
evaporation of the alcohol from the skin, but they don't really help
irritated skin. If you nick yourself while shaving, apply alum - a natural
mineral with antiseptic properties - to stop bleeding and soothe irritation.
Alum is available over-the-counter in block or stick forms.
Maintaining a healthy lifestyle: How it helps your skin
Good skin care involves more than just using the right soap and moisturizer.
Your lifestyle also plays an important role in your skin's health and
appearance. Follow these lifestyle tips for healthier skin:
- Eat a healthy diet. Your body needs adequate amounts of protein, vitamins
and minerals in order to keep your skin healthy. Eat a diet rich in fruits,
vegetables and whole grains. And drink plenty of water to help keep your
skin hydrated.
- Exercise. Exercising improves blood circulation, which in turn may improve
your skin's tone and color.
- Sleep well. If you're not getting enough sleep, or the quality of your
sleep is poor, your face will show it. A lack of sleep may turn your
complexion puffy, lackluster and sallow.
- Quit smoking. In addition to putting you at risk of heart disease and
cancer, smoking may cause your face to age prematurely.
- Protect yourself from the sun. Dark skin can tolerate the sun better than
fair skin can, in that it absorbs less harmful rays. However, any complexion
can become blotchy, leathery and wrinkled from continued sun overexposure.
Overexposure also increases the risk of skin cancer. Use sunscreen
generously, wear protective clothing, and try to avoid sun exposure between
10 a.m. and 4 p.m.
- Avoid using soaps labeled "antibacterial" or "antimicrobial." These tend
to reduce the skin's acidity, which acts as a protection from infection.
- Skin folds or creases (as in the groin area and underarms) need washing
more frequently - twice a day, morning and bedtime. Rashes can easily form
in these areas because of increased moisture and warmth. Increasing the air
circulation to these areas to help prevent rashes can be accomplished by
positioning the arms and legs so the skin surfaces are separated.
- Avoid using talc powders, as they may support yeast growth. They can also
"cake up" and keep moisture in, causing skin breakdown.
- Calluses may form on your feet and hands. These can be removed by soaking
frequently in warm water and toweling briskly to remove dead skin. You can
use moisturizing creams to help soften calluses.
- Finger and toe nails require special care. Soak them and rub gently with a
towel to remove dead skin and decrease the chance of hangnails forming.
Nails are easier to cut after soaking; be sure to cut them straight across
to avoid ingrown nails, and keep them short for safety.
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