What is Eczema?

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The meaning of the word “eczema” can cause confusion. Many people use this word to refer to a common skin condition called atopic dermatitis. When this is the meaning, the words “eczema/atopic dermatitis” may be used.

The word “eczema” also has a more general meaning. Eczema can mean a family of skin conditions that causes the skin to become swollen, irritated, and itchy.

Many skin conditions are considered a type of eczema. Atopic dermatitis is one type. Other types include hand dermatitis, nummular dermatitis, and seborrheic dermatitis. Dandruff is a mild type of seborrheic dermatitis. Diaper rash and the rash that many people get after coming into contact with poison ivy are other types of eczema.

Beauty Tips for Menopausal Skin

                                  Image via WikipediaIts tough to feel beautiful when your skin starts to age. The wrinkles, crackles, and dark circles are stumbling blocks for many women going through menopause, but they don't have to be. The Wall Street Journal has a great article on how to overcome these flaws and links to sites that have just the right treatment for your problem spot. Click here to find out more!

Psoriasis and Psoriatic Arthritis

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Many people who have psoriasis will have this medical condition for life. It is possible to see clearer skin by learning about psoriasis and seeing a dermatologist for treatment.

What causes psoriasis?

Research shows that the person's immune system plays an important role. It seems that the immune system mistakenly activates a type of white blood cell called a T cell. Once activated, the T cells trigger a reaction, causing the skin cells to grow too quickly. New skin cells form in days rather than weeks. The body does not shed these skin cells, so the cells pile up on the surface of the skin. The result is psoriasis.

Despite its appearance, psoriasis is not contagious. People who get psoriasis tend to have a blood relative who has psoriasis, indicating that to get psoriasis a person must have the genes for psoriasis. Scientists have learned that not everyone who inherits genes for psoriasis gets psoriasis. For psoriasis to appear, it seems that a person must inherit the right mix of genes and be exposed to a trigger.

What triggers psoriasis?

People have different triggers. Common triggers include stress, strep throat, and winter weather. Many people see their psoriasis flare during the winter or a particularly stressful time. A scratch or bad sunburn can trigger psoriasis. For some people, psoriasis flares about 10 to 14 days after they injure their skin. Some medications can trigger psoriasis, including lithium, some drugs taken to lower blood pressure, and some medication taken to prevent malaria.

What are the types of psoriasis?

• Plaque psoriasis
  About 80% of people living with psoriasis have plaque psoriasis. This type causes patches of raised, reddish skin covered by silvery white scale. Patches frequently form on the elbows, knees, and lower back, but can occur anywhere on the skin.
• Scalp psoriasis
  This type of psoriasis is dentical in appearance to plaque psoriasis on the body; it is characterized by silvery white scales and reddish patches. Scalp psoriasis also tends to be very itchy. Because patients often cannot help scratching and the scales fall onto a patient's clothing, scalp psoriasis can be misdiagnosed as dandruff. Even with the right diagnosis, scalp psoriasis can be difficult to control.
• Nail psoriasis
  Psoriasis can affect the fingernails and toenails. One sign of this is tiny pits in the nails. As the psoriasis worsens, the nails may loosen, thicken, and eventually crumble. Sometimes nail psoriasis is misdiagnosed as a nail infection.
• Guttate psoriasis
  This type usually occurs in children and young adults, causing small, red spots on the skin. It often appears after a sore throat and frequently clears up by itself in weeks or a few months. Many people never have psoriasis again. If a person already has plaque psoriasis and guttate psoriasis develops, it often means the psoriasis is worsening.
• Pustular psoriasis
  Usually appearing on the palms and soles, this type of psoriasis looks like white pus-filled bumps surrounded by red skin. Pustular psoriasis also can develop all over the body. This causes a severe and sometimes life-threatening psoriasis that dermatologists call generalized pustular psoriasis.
• Inverse psoriasis
  Smooth, red patches appear in the folds of the skin, including in the armpits, under the breasts, in the crease of the buttocks, and in the genital area. It can be painful.
• Erythrodermic psoriasis
  This is the least common type, and it causes severe redness and shedding of the skin over a large portion of the body. The skin looks as if it has been burned. There is often severe itching and pain. Erythrodermic psoriasis can be life-threatening.

What is psoriatic arthritis?

Some people who have psoriasis develop a type of arthritis called psoriatic arthritis. The first sign is frequently swollen, stiff, and sometimes painful joints when waking up. If this happens, tell a dermatologist right away.

How is psoriasis diagnosed?

Dermatologists diagnose psoriasis by examining the patient's skin, nails, and scalp. To find out if anything else may have developed such as an infection, a dermatologist may perform a biopsy. To perform a biopsy, a dermatologist removes a small bit of skin or nail. This procedure can be safely performed during an office visit.

How is psoriasis treated?

There is no cure for psoriasis, but treatment can help control psoriasis. Because psoriasis can be stubborn, gaining control may require trying different types of treatment and several appointments with a dermatologist. Some patients receive more than one type of treatment. For example, a patient may receive light therapy and medication. When psoriasis requires strong medicine, using more than one treatment often produces the best results and causes fewer side effects.

The following describes the different treatments that the U.S. Food and Drug Administration (FDA) has approved for psoriasis.

Topical Medicine

Topical medicine is applied to the skin. These medicines help control mild to moderate psoriasis.

• Corticosteroids (cortisone)
  The most frequently prescribed medication for treating mild to moderate psoriasis, it is available as a cream, ointment, gel, foam, spray, and lotion. Some corticosteroids are very strong and are used for short periods. These help clear the skin. Others are mild and can be used for longer periods to keep psoriasis under control. No matter which type is prescribed, it is important to follow the dermatologist's instructions. Side effects can occur when instructions are not followed. For example, applying the medication every day and then suddenly stopping can cause a serious psoriasis flare. If this happens, stronger medication may be needed to control the psoriasis.
• Anthralin
  This medication is often used to treat thick patches of psoriasis. In the past, many patients disliked using it because anthralin would irritate and stain the skin. With newer formulas and new ways to use this medication, these problems rarely occur.
• Calcipotriene and Calcipotriol (Vitamin D3 Preparations)
  Many patients use this medication along with a corticosteriod. Using both medications as prescribed can be very helpful. To avoid side effects such as irritated skin, always use the medications as directed.
• Retinoids (Vitamin A Preparations)
  Some patients find that applying this medication to their psoriasis is enough to control the psoriasis. For patients who need a bit more help, a dermatologist may prescribe a topical (applied to the skin) corticosteriod. Women should not use a retinoid if they are pregnant.
• Coal Tar
  For more than 100 years, coal tar has been used to safely and effectively treat psoriasis. Many patients disliked this treatment because it was messy and had an awful odor. Newer products are much better.

Light Therapy

Under a dermatologist's care, light therapy can provide safe and effective treatment for many patients with psoriasis. Because too much ultraviolet (UV) light can make psoriasis worse, it is important to see a dermatologist for treatment. Never try to self-treat by using a tanning bed or sunbathing.

Before prescribing light therapy, a dermatologist will meet with a patient. Light therapy is not for everyone. Some patients' skin is too sensitive. Some patients cannot spare the time that light therapy requires. Several treatments are required. The patient must go to a dermatologist's office, psoriasis center, or hospital for the treatments. If light therapy is appropriate for a patient, the dermatologist may prescribe one of the following:

• Laser Therapy
  A laser can target the psoriasis and not touch the surrounding skin. Because the light treats only the psoriasis, a strong dose of light can be used. This offers many people an effective way to treat a stubborn patch of psoriasis, such as on the scalp, feet, or hands. A laser is not the right treatment for psoriasis that covers a large area.
• Ultraviolet B (UVB) Light
  To receive this therapy, a patient stands in a light box or in front of a light panel. If the psoriasis responds, about 24 treatments over a 2-month period should clear the psoriasis. Although UVB is safe and effective, it does have possible side effects. These include burns, freckling, and premature skin aging. A patient's risk of developing skin cancer appears to be about the same as a lifetime of going out in the sun without sun protection. The dermatologist and the patient will weigh the risks, and dermatologists will closely monitor their patients for skin cancer.
• PUVA
  Dermatologists prescribe PUVA when psoriasis does not respond to other treatments. This treatment combines a medication called psoralen with UVA light therapy. Psoralen increases a person's sensitivity to UVA light. The patient may be asked to apply psoralen to the skin or take a pill containing psoralen. After a certain amount of time passes, the patient enters a UVA light box. Research shows that PUVA is effective in about 85% of cases.
• Goeckerman Treatment
  These combine topical (applied to the skin) therapy with UV light treatments. This combination can be very effective for treating severe psoriasis. There are disadvantages. Neither is widely available in the United States. Both require intensive treatment for several hours a day in a psoriasis clinic or hospital. Most patients receive treatment 5 days a week for 3, 4, or 5 weeks.

When light therapy is effective, some patients may receive a prescription for a home UV unit. These patients are carefully monitored and must see a dermatologist for skin checkups.

Systemic Medicine

Systemic medicine works throughout the body. These medications are used to treat moderate to severe psoriasis:

• Methotrexate
  This medication has been used for years to treat moderate to severe psoriasis. It continues to be one of the most effective treatments for patients with erythrodermic psoriasis or pustular psoriasis. Patients taking methotrexate must be carefully monitored with regular blood tests for side effects. Sometimes a chest x-ray or liver biopsy may be necessary.
  
  Pregnant women must not take methotrexate. If a woman wants to become pregnant, she should not take methotrexate for at least 12 weeks before becoming pregnant. Men who are trying to get a woman pregnant also should not take methotrexate for at least 12 weeks.
  
  If a patient drinks alcohol, it is important to tell the dermatologist before taking methotrexate. Methotrexate can cause serious side effects in people who drink alcohol regularly.

• Retinoids (Vitamin A derivatives)
  Patients with moderate to severe psoriasis may be able to control their psoriasis by taking retinoid pills and getting light therapy. These retinoid pills are not the same as vitamin A pills available without a prescription.
  
  Patients taking retinoid pills require careful monitoring. Regular blood tests are necessary. Some patients develop high cholesterol from these pills. Retinoid pills can cause other side effects, including dry skin, lips, and eyes.
  
  Pregnant women should not take this medication. Retinoid pills can cause birth defects. If a woman wants to get pregnant, she should stop taking retinoid pills for 3 years before trying to get pregnant.
• Cyclosporine
  This medication suppresses the immune system, which makes it an effective psoriasis treatment. While effective, cyclosporine is usually only prescribed for severe psoriasis that has not responded to other treatments. Most patients take cyclosporine for a short time, usually 3 to 6 months. Before a dermatologist prescribes cyclosporine, a patient must have blood tests and a blood pressure check. Due to possible side effects, patients taking cyclosporine require regular blood tests and blood pressure checks.

Biologics

For patients with moderate to severe psoriasis, a biologic may be a treatment option. The FDA approved the first biologic for psoriasis in 2003. Today, dermatologists have a choice of biologics that can be used to treat psoriasis.

A few of the biologics have been approved to treat psoriatic arthritis. Research shows that these biologics may slow or even stop joint damage. This is a significant medical advance. Before the biologics, people with psoriatic arthritis could take medication to alleviate the pain and swelling, but could not prevent joint damage. It may now be possible to prevent the lifelong disability that psoriatic arthritis can cause.

Biologics are given by injection (shot) or infusion (IV). For a few of the biologics, the patient can learn how to inject the medication at home. To receive the other biologics, the patient must go to the dermatologist's office, psoriasis treatment center, or hospital for every treatment.

Patients interested in using a biologic to treat psoriasis should talk with a dermatologist. Many people who were not able to control their psoriasis have been helped by a biologic. The biologics also have potential side effects, so it is important to discuss this option. A number of medical tests are required to find out which biologics may be appropriate. 

This information comes from the American Academy of Dermatology website and should be attributed as such (www.aad.org)

Dealing with Melanoma

Melanoma doesn't have to be a death sentence

Idaho has the highest per capita rate of death from skin cancer in the nation and the 7th highest incidence.  For me, as a dermatologist, this makes the fight against melanoma very personal.  In dermatology, melanoma is public enemy #1.If your doctor just told you that you have melanoma, it doesn't necessarily mean that the first order of business is to make sure your life insurance is up to date.  Fortunately, even though more melanomas are being diagnosed than ever before, most are early.

Some Facts About Melanoma

Image via Wikipedia The deeper a melanoma is, the more likely it is to have spread by the time that it is diagnosed.  There is something called a Breslow's depth and generally melanomas less than 1mm in depth are considered early and the survival rates are in the high ninety percentile.  Most of the melanomas diagnosed in North Idaho are in situ melanomas.  In situ means that the melanoma is still in the upper part of the skin known as the epidermis.  The next step beyond a in situ melanoma would be a melanoma with a Breslow's depth of 0.1 or 0.2 mm.  There are all kinds of terms bantered about concerning melanoma such as the stage or Clark's level, but the Breslow's depth is the most useful information concerning survivability of melanoma.  An in situ melanoma has no Breslow's depth and is basically 100% curable.  All of this information is obtained from a biopsy reading by a dermatopathologist.  Though many medical providers have experience with melanoma, a board-certified dermatologist working in concert with a trained dermatopathologist can provide the best assurance that a suspicious lesions will be diagnosed and handled correctly. 

Treatment of Melanoma

The most important treatment for a melanoma is surgical excision.  Sometimes this is combined with a technique called a sentinel node biopsy, where tissue from a lymph node is removed for examination.  If a melanoma is deeper than 1mm a sentinel biopsy can help determine prognosis more accurately.  Unfortunately, some individuals want to do "everything possible" and want to get a sentinel node biopsy whatever the depth of their melanoma.  There is no firm evidence that removing a lymph node or having a sentinel node biopsy is a cure.  The best cure is early detection and excision of a melanoma, but the sentinel node biopsy is a useful information that helps the patient receive the appropriate treatment for a deeper melanoma, especially great than 1mm in Breslow's depth.  North Idaho Dermatology has extensive experience in diagnosing and treating melanomas.  When needed we involve other local professionals and Kootenai Medical Center, especially when a sentinel node biopsy is an appropriate option.

Melanoma Myths

There are a couple of prevailing myths about melanoma that I hear a lot.  It is important that these myths are exposed and dispelled:

MYTH: If a melanoma is biopsied, the cells can break off and spread the cancer all over the body.

FACT: Research has shown that biopsying a melanoma is the best way to diagnose.  If cancerous cells are going to migrate, they do so in a complex process of metastasis; a biopsy isn’t the catalyst for spread of melanoma

MYTH: Sun exposure doesn't causes melanoma

FACT: Melanoma has many risk factors, but decades of research and experience show that sun and other UV exposure is one of the greatest risk factors, and can exacerbate other risk factors.  People with the following characteristics have the highest risk for melanoma:

• Fair complexions that burn or blister easily
• Blond or red hair
• Excessive sun exposure during childhood and teen years, blistering and sunburns before age 18
• Family history of melanoma
• More than 100 moles or more than 50 if you are under 20 years of age.

However, anyone can be diagnosed with melanoma.

Dr. Stephen D. Craig is a board-certified dermatologist and the owner of North Idaho Dermatology in Coeur d'Alene, Idaho.

Don't Miss Out!

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Congratulations to VAL SOUMAS who won a free facial by joining our Skin Care Club! 

Who couldn't use a free facial?! Don't miss out by ignoring this opportunity! If you'd like a chance to win, text key word 'niderm' to 41242 to join the club and be entered into our monthly drawing! Good Luck!

Tanning Truths

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Darker Side of Tanning

Dermatologists and public health professionals are concerned about the dangers of ultraviolet (UV) radiation from the sun, tanning beds, and sun lamps. The two types of ultraviolet radiation are Ultraviolet A (UVA) and Ultraviolet B (UVB). UVB has long been associated with sunburn and UVA has been recognized as a deeper-penetrating radiation that causes more damage.

Although it's been known for some time that too much UV radiation can be harmful, new information may make this concern even more important. Recently, some scientists have suggested recently that there may be an association between UVA radiation and melanoma, the most serious type of skin cancer.

What are the dangers of tanning?

Skin cancer has been associated with sunburn, and even moderate tanning may also produce the same effect. UV radiation from the sun, tanning beds, or sun lamps may cause skin cancer and can have a damaging effect on the immune system. It also can cause premature aging of the skin, giving it a wrinkled, leathery appearance.

Is sun good for your health?

People have associated a suntan with good health and vitality. Vitamin D is necessary, but just a small amount of sunlight is needed for the body to manufacture it. It does not require a suntan!

Are people actually being harmed by sunlight?

Yes. The number of skin cancers has been rising over the years due to increasing exposure to UV radiation from the sun, tanning beds, and sun lamps. More than 1.3 million new skin cancer cases are likely to be diagnosed in the United States this year.

Are the types of skin cancer caused by the sun, tanning beds, and sun lamps easily curable?
Not necessarily. Melanoma, with a suspected link to UVA exposure, is fatal if not detected early. The number of melanoma cases is rising in the United States, with an estimated 47,700 new cases and 7,700 deaths anticipated this year.

Does the skin of young people show these harmful effects?

Skin aging and cancer are delayed effects that show up many years after the exposure. Unfortunately, because the damage is not immediately visible, young people often are unaware of the dangers of tanning. It is estimated that cases of skin cancer will continue to increase as people who are tanning in their teens and 20s reach middle age.

Why can some people tan for many years and still not show damage?

People who tan are greatly increasing their risk of developing skin cancer. This is especially true if tanning occurs over a period of years because damage to the skin accumulates. Premature aging of the skin (wrinkles) will occur in everyone who is repeatedly exposed to the sun over a long period time. Damage may be less apparent and take longer to show up in people with darker skin.

Which skin type are you?

People with skin types I, II, and III are at greatest risk in the sun.

I. Pale white skin: Always burns; never tans
II. White: Burns easily; tans minimally
III. White (Average): Burns moderately; tans gradually to light brown
IV. Beige or lightly tanned: Burns minimally; always tans well to moderately brown
V. Moderate brown or tanned: Rarely burns; tans profusely to dark
VI. Dark brown or black: Never burns; deeply pigmented

Are sun lamps and tanning safer than natural sunlight?

No. Most sun lamps and tanning beds emit mainly UVA radiation; these so-called "tanning rays" are less likely to cause a sunburn than the UVB radiation from sunlight. Contrary to the claims of some tanning parlors, that does not make them safe, in fact, they cause deeper skin damage. UVA rays have a suspected link to melanoma, and like UVB rays, they also may be linked to immune system damage and premature skin aging.

Tips to Avoid Sun Damage

• Plan your outdoor activities to avoid the sun's strongest rays. As a rule, avoid the sun between 10 a.m. and 4 p.m.
• Wear protective covering such as broad-brimmed hats, long pants, and long-sleeved shirts to reduce sun exposure.
• Wear sunglasses that provide 100 percent UV ray protection.
• When outdoors, always wear a broad-spectrum sunscreen with a sun protection factor (SPF) of 30 or greater, which will block both UVA and UVB. Apply the sunscreen 30 minutes before sun exposure and reapply approximately every 1 1/2 to 2 hours.

For more information on the levels of ultraviolet radiation reaching your area at noon, you can get the Global Ultraviolet (UV) Index from local newspapers, radio, or TV in many cities. The UV Index is a number from 0-10. The higher the number, the more intense the exposure.

See a dermatologist if you notice an unusual mole, a scaly patch, or a sore that does not heal. This may be a pre-cancer or a skin cancer. If you develop severe itching or rashes in the sun, this may be an allergic reaction. The dermatologist may be able to treat or reverse sun damage such as wrinkles and other skin changes with medical treatments and dermatologic surgery.

This information comes from the American Academy of Dermatology website and should be attributed as such (www.aad.org)