A patient of mine with severe hand dermatitis has an identity problem. She applied for a job that she is well qualified to get, except she doesn’t have any fingerprints. Her job requires a security clearance, and she has to have fingerprints to verify her identity (and to verify that she isn’t wanted in Montana). But her severe hand dermatitis has left her fingertips scarred, and she is unable to give adequate fingerprints.

Why do we have fingerprints in the first place? The ridges are unique and allow you to be distinguished from billions of other people. Although wonderful for the FBI, your fingerprints were never meant to assist in identifying you.

It has been traditionally thought that the tiny ridges increase the coefficient of friction of the skin making it easier to grasp and hold things. A smooth surface makes handling delicate objects like a dime, difficult, especially if your hands are wet.

New research suggests that the grooves have another, possibly more important function: they improve your sense of touch. Fingertips are exquisitely sensitive to touch. This is partly due to a special nerve called the Pacinian corpuscle. The tips of your fingers are packed with these sensitive receptors. One sensation that they are particularly attuned to is vibration. It turns out that the ridges on your fingertips when rubbed against an object create a  fine vibration that is not noticeable to you, but is detected by your Pacinian corpuscles.

Loss of fingerprints is uncommon. It can happen from trauma, as from a burn, or from chronic skin diseases such as eczema, psoriasis, or scleroderma. There are also rare genetic conditions such as dyskeratosis congenital, an inherited condition that leads to scaly skin and increased risk of skin cancers, where patients are born without fingerprints.

Excess inflammation, as from dermatitis or psoriasis, can sometimes lead to temporary changes in the fingerprints. These changes can be resolved with topical steroids or other systemic medications to treat the underlying condition. Once the fingerprint is scarred, however, there is no way to regenerate it.

Post written by Dr. Benabio Copyright The Derm Blog 2009

Photo: D. Sharon Pruitt (flickr)

Argh! You cleaned out your high school locker years ago and now you have acne pimples on your jaw this morning. You’re not alone — 1 in every 5 women over 25 has acne.

Adult acne, in contrast to the teenage type, occurs more often in women. For some women, this is the first time they had acne; we call this late-onset acne. For other women, their acne never stopped from childhood into adulthood; we call this persistent acne. Many of my women patients have other names for adult acne, but they cannot be printed here.

It Must Be Hormones

We like to blame everything on hormones. In the case of acne, hormones contribute, but they are not the only factor. Stopping birth control pills causes a change in hormones and is  a cause for acne in adult women. Similarly, using progestin-only birth control pills affects hormones in such a way as to cause breakouts. Pregnancy is a time of dramatic hormone fluctuations and for some women, dramatic acne. Similarly, menopause can trigger outbreaks. Despite these known hormonal triggers, most women who have acne do not have hormonal imbalances (they are normal fluctuations in hormones). Foods or supplements that claim to balance women’s hormones don’t. So save your time and money, they won’t help your acne.

You Can’t Scrub Acne Away

Exfoliating to open pores can help, but only when done in moderation. Harsh scrubs or repeated microdermabrasion will irritate the skin and make acne worse. Instead, use mild chemical exfoliators such as salicylic acid or glycolic acid which are found in many women’s cosmetics and in acne treatments. Products that contain benzoyl peroxide also help to exfoliate and will treat adult acne.

Don’t Give Up Your Scharffen Berger Chocolate

Although myths of chocolate and pizza causing acne have been disproved, it is true that consuming cow’s milk (which contains hormones) as well as eating a diet high in carbohydrates (which causes inflammation) can contribute to acne. Eating chocolate once and a while, especially good chocolate, will not cause or worsen your acne.

Cosmetics Cause Acne

Many skincare products contain ingredients that clog your pores, triggering acne. Pantene shampoo as well as many hair conditioners have been known to cause this problem. Also, sunscreens are notorious for causing acne. If you notice that your acne is worse around your hairline or that it has flared since you started sunscreens, then try changing your products; it might be all you need to clear up your face.

Photo: Foundphotoslj (flickr)

Post written by Dr. Benabio Copyright The Derm Blog 2009

Right now your hands are teeming with bacteria. Countless trillions of organisms call your skin home, and that’s a good thing. Skin infections do not arise because you have bacteria on your skin. Rather, they arise because the type of bacteria on infected skin is not healthy bacteria but aggressive pathogenic bacteria.

Determining which bacteria are good and which are dangerous is difficult, but our immune systems have managed to get it right most of the time. When our immune systems are wrong, either an infection develops, or excess inflammation develops, as is the case in eczema or psoriasis.

Telling good from bad is hard. There are hundreds of types of bacteria on your hands right now. A recent study of college students (perhaps not the cleanest group of individuals) discovered that the average student has 140 different types of bacteria on his or her skin. There were over 4,000 different types of bacteria identified across all the students. Not surprisingly, the most common types were familiar household names: Propionobacterium (the bacteria responsible for acne), strep, and staph (of which the infamous methicillin resistant staph aureus, MRSA is a subtype).

There were also differences in the bacteria on the dominate hand versus the non-dominant hand — namely bacteria normally found in the gastrointestinal track was found more often on the dominant hand. This will no doubt lead to a follow up study of: “Do college students wash their hands before leaving the bathroom?” (Research so far does not look promising).

Photo: Pink Sherbert Photography (flickr)

A bruise is blood that has leaked into your skin. The blood is red, but it appears blue when seen though the skin layers. Bruises can be frustrating, especially for women who always get them on their legs the day they wear their new INC empire-waist jersey dresses.

Bruises are a normal response to injury. Who among us has not walked into the corner of the bed or miscalculated the exact location of the coffee table when crossing the room? Most of the time bruising does not indicate any underlying diseases, except for clumsiness.

Women bruise more easily than men, especially on their thighs, calves and buttocks. This easy bruising is because women have exposed blood vessels and thinner skin as compared to men, so even unnoticed injuries to their legs leave noticeable bruises.

Usually bruising is a minor, lifelong problem. However, if bruising develops rapidly or is getting progressively worse, then investigation is needed. Also, bruising that is associated with taking medications like aspirin, plavix or coumadin should be discussed with a physician. Bruises that appear on the face, back, or abdomen are not typical and should also be evaluated by a physician. Also, if bruising is accompanied by bleeding such as heavy periods, recurrent nose bleeds, bleeding from the gums, or blood in your urine or stool, then you should see a doctor.

There is little you can do to prevent bruises. When bruising is the result of taking certain medications such as ibuprofen, fish oil or ginkgo, then stopping these can lessen bruising. Also, wearing long sleeves and long pants can be the difference in whether a bruise develops or not after a minor injury.

After an injury, try to minimize the amount of blood that leaks out to minimize the bruise. Sit down and apply pressure to the injured spot for 10-15 minutes. You can also use ice, but only for 15-20 minutes (longer than 20 minutes can cause worsening of the bruise). Apply ice with a wash cloth or other layer between it and your skin. Avoid hot showers or hot baths for 24 hours after the injury as the heat can restart bleeding into the skin.

Vitamin K and bromelain (found in pineapples) might be helpful in resolving bruises more quickly. Look for them in topical products or in oral supplements that can be taken for a few days after a bruise develops. And look out for the coffee table.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Christy Gordon (flickr)

So how does a dermatologist like me protect against skin cancer? I go to Peet’s Coffee.

There are plenty of reasons to enjoy a cappuccino in the morning (if you can still afford it), and preventing skin cancer might be one of them.

Studies of mice have shown that feeding them caffeine protects them against ultraviolet radiation, which is similar to sun exposure for humans. The protection is most effective when the mice exercise. (So the researchers basically make them drink espresso then hit the exercise wheel.)

While epidemiologic studies and animal studies are helpful, it is nice to have a scientific explanation to support the claim. New studies show how it works.

Researchers exposed skin cells that were growing in culture to caffeine (possibly when one of the graduate students spilled his Red Bull on the petri dish). They then exposed the cells to damaging UVB light. They found that the caffeine-treated, UV-damaged cells underwent programmed cell death. When cells are damaged, but don’t die, they grow into cancerous tumors. When damaged cells die, they are no longer a threat to the body and are safely eliminated.

As sunscreens become more sophisticated, ingredients like caffeine will be added to soak up the damaging oxidants or to protect the skin from developing cancer. Botanicals like ferulic acid, derived from ferns, have proven themselves as powerful additives to sunscreens and are the future of sun protection.

Although there is not enough evidence to advise patients to drink more coffee as a means of sun protection, do you really need another reason to have a nice macchiato in the afternoon?

Photo: Burnt Phrases (flickr)

You might be getting some UV exposure long after the sun goes down — some new fluorescent light bulbs give off UV light.

Fluorescent light bulbs are everywhere now that people are trying to be more green. Most popular are the ice-cream-twist compact fluorescent bulbs called CFBs. CFBs create light by energizing a gas and exciting a phosphorous coating on their glass. The coating prevents most of the ultraviolet light from reaching you, but not entirely; some UV radiation leaks out of any fluorescent bulb. In some CFBs, the emission of UV light is so high that it exceeds the safety limits of the International Commission of Non-Iodizing Radiation.

So, should you be applying sunscreen before turning on your CFB reading light at night? No. Nor should you switch your CFBs back to energy wasting incandescent bulbs. The amount of UV exposure that you get from the light bulb is small compared to the UV exposure you get from just being outside; for most people it is not significant.

However, some people are exquisitely sensitive to ultraviolet light. Auto immune diseases such as lupus, inflammatory disease such as rosacea, and certain drugs such as HCTZ can be triggered by even small amounts of UV light from CFBs.

If you are particularly sensitive to UV, then select CFBs that have a double envelope instead of single, as it will block most of the UV light. And always stay at least one foot away when using fluorescent bulbs of any sort.

Also, remember to sit back from your TV (which my mother taught me to do when I was a kid). Of course, now with HDTVs, you get the best picture when you’re sitting a distance of 3 times the diameter of your TV. If you just bought a 60 inch HDTV, you might need to be in your neighbor’s living room to watch it. This, fortunately, should be safely away from any radiation.

Photo: Steven Fernandez (flickr)

There are some lucky people who don’t get poison ivy or oak. If you’re like me, you do. Here are some poison plant pointers:

Ivy block cream prevents poison ivy or oak, but only if it is applied 15 minutes before exposure. It doesn’t work after you’ve been exposed.

The intensely itchy, sometimes frighteningly-bubbly rash is an allergic reaction to oil, urishiol, found on poison ivy, oak and sumac plants.

You can wash off the oil with soap and water. Do not use laundry detergent, alcohol, or expensive poison ivy soap — any ordinary bar of soap will wash off the oil. However, the oil is quickly absorbed into your skin, like olive oil into nice piece of Italian bread, so time is of the essence. Once the oil is absorbed in your skin, you cannot get it out no matter what you use.

• You can wash off 50% of the oil within 10 minutes
• You can wash off 10% of the oil within in 30 minutes
• After 1 hour, no amount of washing will make any difference. Nothing will prevent the soon to be rash.

Whatever you do, don’t touch your groin in the first hour or so. You could end up in the hospital; I’ve seen it.

After one hour, you cannot spread poison ivy to someone else. Scratching or breaking the water blisters does not spread the poison ivy or the rash.

The rash lasts for 2 weeks, sometimes less if it is not severe. No cream or treatment, however expensive, can shorten the duration. The rash must run its course.

Once your arms and face turn into wet tapioca pudding, use a drying astringent like Domboro soaks to dry it out.

Once the blistering dries up, apply a topical steroid like hydrocortisone 1% cream or anti-itching lotions like topical Calamine or Benadryl. Cool baths with collodial oatmeal will also help. Super hot showers will relieve the itching, but only temporarily, and in the end, only makes it worse.

If you have a severe case of poison ivy, defined by your mother doesn’t recognize you or you are unable to sit, stand, or lie down, then see a dermatologist for prescription drugs to help.

Photo: Jim Frazier (flickr)

Post by Dr. Benabio, copyright The Derm Blog 2009.

Eczema or atopic dermatitis is a common skin disorder seen mostly in children. It is characterized by a red, scaly, itchy rash that can occur on the face, neck, arms, legs, and sometimes the trunk.

We have known for some time now that eczema, also called atopic dermatitis, is also associated with asthma and allergic rhinitis (hay fever). At least 50% of children with severe eczema also develop asthma. Research from the Washington University School of Medicine might shed light on why these diseases go together.

The research, published in the journal PLoS, found that in mice, eczema-damaged skin produced a substance called thymic stromal lymphopoietin (TSLP). TSLP is a signal to the body that the skin has been damaged. When TSLP circulates through the blood, it elicits a powerful immune response. As such, TSLP is your skin’s way of warning you that its protective barrier has been breached and that backup defenses are needed to keep you protected.

Similar to your skin, your lungs are in direct contact with your environment as well, although we don’t often think of it that way. Like skin, lungs are exposed to the air with all its potential pathogens such as bacteria and viruses. It is not hard to see how an inflammatory disease that affects the skin might also affect the lungs. This is exactly what researchers found — when TSLP from the damaged skin traveled in the bloodstream to the mice’s lungs, it triggered inflammation in the lungs (similar to an asthma attack in humans). The researchers believe that TSLP is the link between eczema and asthma.

Ideally, if a drug was developed that blocked the production of TSLP, this might be a way to prevent people with eczema from developing asthma later in life. It also suggests that minimizing damage to the skin can help limit production of TSLP and improve both eczema and asthma.

Photo: Penreyes (flickr)

“It’s like a mini tanning bed for your fingers. ”

Artifical nails are a $6.3 billion dollar industry. There are nearly 60,000 nail salons in the US — 5 times as many Starbucks! Many of these nail salons use UV light, which might increase the risk of skin cancer on your fingers.

Researchers from the M.D. Anderson Cancer Center at the University of Texas noticed that some of their patients with skin cancer on their fingers (an uncommon place to get skin cancer) reported having had UV light for artificial nails. Such UV light has been shown to damage cells’ DNA (the genetic code in all cells) and to cause mutations that lead to skin cancer.

There are several types of nails. The most popular is acrylic, a two part process where a liquid monomer is combined with a powder polymer. It hardens in seconds, but takes an hour for the final hardness to set. Ultraviolet light is used to speed up the hardening.

A second type of artificial nail is the UV-gel. These are more flexible and have a high-gloss finish than acrylics. As their name suggests, ultraviolet light is used to harden the nails.

UV light is also used for a topcoat sealant. Because artificial nails yellow from UV light (especially tanning booths), a top coat can be used to protect the nail. This topcoat is cured (or set) using UV light.

The amount of radiation that your fingers get from the nail treatment is comparable to what you would get in a tanning booth. Because nails are done every 2-4 weeks (one would hope), that can add up to a significant amount of UV exposure over years.

No large scale studies have been done to examine the danger of using UV light for nails, but these patients suggest that there is likely a risk, especially if you have fair skin or have a history of skin cancer.

Photo: Monibela (flickr)

Is the milk you drink rBST-free? Is your physician board certified?

Many people take the time to buy hormone free milk, but they don’t make an effort to choose a physician who is board certified. That’s a shame.

Asking a friend or family member might be a good way to choose a hairdresser, but it is not a good way to choose a physician. Medicine is difficult. The same way that you want the pilot of your next flight to be maintaining his or her skills and knowledge of flying, you also want your physician to maintain his or her skills in medicine. The truth is, you are much more likely to die from your doctor’s mistake than from a pilot’s mistake.

Being board certified is no guarantee that your physician is good (or nice!), but it does assure you that your physician is committed to continuing education and is learning advances in medicine. It also assures you that your physician has completed the necessary training and passed a certification exam for the field of medicine he or she is practicing. Having a license means only that they completed the minimal requirement to practice medicine. Maintaining active board certification means that your physician has undergone yearly continuing education and has passed a re-certification exam every few years.

Certainly there is more to being a good physician than completing residency and passing written and oral examinations. But studies show that high exam scores do correlate with practicing better medicine.

There are 24 board specialties. You can check to see if your physician is board certified by going to the American Board of Medical Specialties site at ABMS.org, registering, and putting in your physician’s name. It is a free and confidential service. You can have a nice glass of rBST-free milk in the meantime.

Post written by Dr. Jeffrey Benabio, Copyright The Derm Blog 2009.

Photo: Ingrid Taylar (flickr)