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by: Patricia Pontejos-Canivel, MD, DPDS
Boils are caused by a bacterial infection of the hair follicle. It presents as a painful red nodule on the skin that can start draining pus. This condition usually develops in areas that are prone to perspiration, friction and occlusion:
There are some factors that can predispose a person to developing boils such as:
Some boils may resolve on its own but if you are experiencing the following, consult a board- Dermatologist immediately:
Here are some tips to manage a boil at home:
References:
AAD website: https://www.aad.org/public/everyday-care/injured-skin/treat-boils-styes
Fitzpatrick’s Dermatology 9th edition
By Lonabel A. Encarnacion MD,FPDS, Elaine Marie Gutierrez-Villaroman MD,FPDS, Rizia Margate MD, Melissa See MD
Contact Dermatitis is skin inflammation or eczema that is triggered by substances that come in contact with the skin. These substances may be a chemical, biologic or a physical agent. Contact Dermatitis after a single or multiple exposure may be irritant or allergic. Let’s start with the more common irritant contact dermatitis (ICD) and later understand the more complex allergic contact dermatitis (ACD)
IRRITANT CONTACT DERMATITIS (ICD)
What is Irritant Contact Dermatitis?
Irritant contact dermatitis or ICD is a nonspecific, nonallergic response of the skin to direct chemical damage. That means it’s a random, automatic skin response to a threat. ICD is a localized skin reaction to an irritant. Irritant chemicals are soaps, detergents, acids and alkalis, industrial solvents, even rough clothing, etc. It is the most common occupational skin disorder and hands are most often affected.
How do we get Irritant Contact Dermatitis?
ICD may be acquired from exposure to an irritant substance. This irritant is a corrosive agent that triggers release of inflammatory chemicals mainly from the upper layers of the skin. It is an immediate skin defense reaction.
Who can get affected with Irritant Contact Dermatitis?
Any individual who comes in contact with an irritant for a sufficient amount of time and adequate concentration will most likely have ICD.
For instance, an employed dishwasher whose occupation exposes him to constant soap & water work setting is prone to ICD. All of us now in this pandemic, who constantly wash hands, disinfect with alcohol or use bleach sanitizers are prone to ICD.
What are the usual signs & symptoms of Irritant Contact Dermatitis?
Clinical manifestations of ICD are stinging, burning and itching with reddish bumps. There could be redness, mild swelling and scaling. There could also be thickening & cracking of the skin with constant exposure with the irritant chemical.
How is Irritant Contact Dermatitis diagnosed?
Diagnosis of ICD is primarily clinical and rests on the exclusion of other cutaneous diseases especially allergic contact dermatitis. When a patch test is done and result is negative, that negative result is consistent with Irritant Contact Dermatitis. (Just read on!)
What is the treatment for Irritant Contact Dermatitis?
Protect the skin. Use Barrier creams. Use Personal Protective Equipment such as gloves.
If in contact with the corrosive chemical, right away wash-off with water. Topical/oral steroids are used. And on those itchy skin areas, massage with moisturizers instead of scratching. This calms that irritated & angry skin!
ALLERGIC CONTACT DERMATITIS (ACD)
What is Allergic Contact Dermatitis?
Allergic contact dermatitis or ACD is a “s-l-o-w” delayed type hypersensitivity reaction of the skin to an allergen. Contact allergens are like hair dye, metals, jewelry, rubber, topical medications, skin care products, plants, chemicals and many, many more. The skin may develop allergy to these environmental substances. It’s not immediate and it takes time.
How can we get Allergic Contact Dermatitis?
ACD may be acquired by contact to an allergen of a sensitized individual or someone who came in contact with the allergen days, weeks or even years prior to appearance of the lesions. This means a prior exposure to an allergen chemical initiates this skin sensitivity. It is not an immediate type of skin reaction.
Who can get affected with Allergic Contact Dermatitis?
Persons with persistent or relapsing dermatitis may have ACD. All ages can get affected with ACD but is usually uncommon in young children and seniors above 70 years old.
What are the usual signs & symptoms of Allergic Contact Dermatitis?
ACD is characterized by itchy reddish bumps and blisters sometimes oozing. Thickened itchy plaques indicate a longstanding condition. These lesions usually come and go.
How is Allergic Contact Dermatitis diagnosed?
Patch testing confirms ACD. This test involves the application of common allergens on the patient’s back to re-create and document skin reactivity. Remember, a positive patch test is able to identify the allergen which must definitely be avoided to resolve the disturbing, recurrent dermatitis.
What is the treatment of Allergic Contact Dermatitis?
Identify and remove the cause. This is the definitive management of this recurrent, disturbing skin condition known as Allergic Contact Dermatitis.
Topical and /or oral steroids are effective in controlling the signs and symptoms. And do consult a board-certified dermatologist for best advice to avoid the allergens!
References:
Medscape https://emedicine.medscape.com/article/1049216 updated Aug 20,2020. Allergic Contact Dermatitis Updated Aug 20, 2020 Author Thomas N Helm, MD
Medscape https://emedicine.medscape.com/article/1049353-overview
Irritant Contact Dermatitis Updated: Nov 20, 2020 Author: Savina Aneja, MD
Wolff K, Johnson RA, Saavedra A, Roh E. Fitzpatrick’s Color Atlas and Synopsis of Clinical Dermatology. 8th ed. New York: McGraw-Hill Medical. 2017: 20-33Kang S, Amagai M, et al. Fitzpatrick’s Dermatology. 9th ed. McGraw-Hill Education. 2019: 395-427
Pia Victoria Velasco, MD, FPDS
A. FACE MASK SKIN CARE – Masks play an important role in preventing the spread of Coronavirus. However, regular use of masks can cause skin problems such as acne, rashes and even itchiness. To prevent these skin problems, her are some helpful skin care tips:
Heavy make-up is more likely to clog your pores and lead to break outs. If you cannot skip your make-up, look for products labeled as “non-comedogenic” which will not clog your pores. Use make-up on the areas on the eye area only and skip it on the areas covered by the mask to lessen the risk of maskne.
B. HOW TO COPE WITH HAND DERMATITIS- Hand washing has been a mainstay in controlling the spread of Covid-19. Unfortunately, frequent hand washing and use of alcohol have often left hands feeling dry and irritated. Here are some helpful tips on how to keep Coronavirus away without compromising care for our hands:
References:
1. cdc.gov
2. pds.org: Recommendations for Addressing PPE-related Skin Care Issues during the COVID-19 Crisis
3. AAD COVID-19 Coronavirus Resource Center
Heirich Fevrier P. Manalili, RPh MD DPDS
Martha Joy Bruan-Tapales, RPh MD FPDS
There had been a lot of people (including doctors) who interchange a cream and an ointment. Knowing the difference between the two can help the patient and clinician decide on which preparation would benefit their condition more.
Ointments are semisolid preparations that contains lipid or hydrophobic ingredients intended for external application to the skin or other mucosal membranes1,2. It usually contains less than 20% of water and other volatile ingredients (eg. Ethanol), and more than 50% hydrocarbons and waxes1,2. They are designed to soften or melt at body temperature, spread easily, and have a smooth, non-gritty feel and appear translucent1. They are typically used as emollients to make skin pliable, barriers to prevent noxious substances from coming in contact to skin and vehicles for hydrophobic drugs1,2.
Creams are semisolid dosage forms containing one or more drug substances dissolved or dispersed in a suitable emulsion base1,2,3. They are more considered to be more fluid to other dosage forms1. They are usually found to have whitish, creamy appearance, due to scattering of light from dispersed phases (eg. Oil globules)1. Creams can either be on a water-in-oil emulsion (eg cold cream) which can be used as a softening and cleaning agent for make-ups1,2. On the other hand, it can also be in an oil-in-water emulsion (eg. Vanishing cream) which when rubbed on the skin, the water evaporates, leading to increased concentration of a water-soluble drug in the oily film which can adhere directly to the skin1,2.
Implications in Dermatology practice
As a vehicle, ointments have higher penetrability and are useful for thickened skin over palms and soles and over lichenified skin (eg. ichthyoses, psoriasis)4. The downside is that they are relatively greasy and messy to use. On the other hand, creams are less greasy and are more suited for moist and weeping areas of the skin (eg. Wounds with pus, blood and serum)4. Creams are preferred over ointments for mucosal areas because they are easier to spread and remove2.
In using topical steroids, the vehicle play an important role in determining the potency of the active ingredient4. For example, Mometasone furoate 0.1% cream is classified under Mid-potent (Class IV) while its counterpart Mometasone furoate 0.1% ointment is classified as high-potent (Class II).
References:
By: Bernadette Caluya, MD, DPDS
What is Dandruff?
Dandruff is a common skin condition where dry scales flake from the scalp. It is not contagious but it can be itchy and embarrassing to those who have it. It can occur across all age groups.It can be chronic and recurrent for many years. Dandruff may worsen during low temperature seasons and may also be associated with immunodeficiency and stress.
What are the symptoms?
It can be associated to the following symptoms:
-itchiness
-oily scalp
– scales on your scalp, eyebrows, back of ears, sides of the nose, chin, chest and upper back
What causes dandruff?
– seborrhea or increased sebum production in the scalp
– some cases are associated with increase of a fungus called Malassezia furfur on affected skin
– skin conditions like Seborrheic Dermatitis, Psoriasis, Eczema or Contact dermatitis to hair products
How to treat dandruff?
It is advisable to seek consult to a board-certified dermatologist before starting any treatment so that one’s condition will be assessed adequately and proper treatment will be prescribed.
Stephanie Katalbas-Asi, MD, FPDS
What is diaper rash?
Diaper rash is a common form of reddish, inflamed skin on the areas covered by a diaper. This covers the genital area, buttocks, inner thighs, and sometimes the lower abdomen. This commonly affects babies, but it can also happen in adults who wear diapers.
In mild cases the skin can look pink, dry-looking skin, but in more severe cases it can resemble red, irritated, raw or burnt-looking skin with open wounds. It usually feels itchy or burning. Your child may seem more uncomfortable or irritable than usual, especially when changing diapers.
What causes diaper rash?
How is it treated?
The best thing to do is to keep the affected skin clean and dry as much as possible. Change diapers immediately after they are wet or soiled.
The exact treatment varies, depending on the exact cause for the diaper rash. This may include a mild steroid cream (e.g. hydrocortisone) and other antimicrobial creams. These medications should only be used under proper guidance from your doctor.
What can I do at home?
How to prevent diaper rash?
When should we see a doctor?
If the diaper rash doesn’t improve after 2-3 days with home treatment or shows any of the following changes, it’s best to consult a PDS certified Dermatologist for proper treatment.
Bibliography:
Stamatas, Georgios N., and Neena K. Tierney. “Diaper Dermatitis: Etiology, Manifestations, Prevention, and Management.” Pediatric Dermatology, vol. 31, no. 1, 2014, pp. 1-7.
by: Trixie Valle-Tin, MD, FPDS
What is Folliculitis?
Folliculitis is an inflammatory process that involves the hair follicle or the pilosebaceous unit. It often manifests with redness, swelling, itching, or tenderness around the follicle and the perifollicular area. Folliculitis usually evolves in appearance and associated symptoms depending on the underlying cause and the depth of involvement. Clinically, it may appear as a dry thickened bump or as a pustule (pus-filled space) in the follicular opening or as a nodule deep in the follicle. It may also be a primary skin condition or as a secondary process in relation to another dermatologic disease. The location and the course of the folliculitis may help your dermatologist in determining the cause of the folliculitis.
What causes folliculitis?
Generally, folliculitis can either be infectious or non-infectious in origin.
Factors that can predispose to bacterial folliculitis include: conditions that lead to occlusion or maceration of the skin and exposure to contaminated surfaces, pre-existing itchy skin diseases that tend to be scratched such as eczema, and practices that may irritate the follicular unit such as improper hair removal. Nasal carriage of Staphylococcus aureus may also lead to repeated folliculitis in a person or his close contacts. Fungal folliculitis may occur with exposure to pets, soil, or another infected person, and usually appears in the setting of scaly red plaques with advancing borders that are typical of fungal infections. Folliculitis can also be seen in conditions of yeast overgrowth. Viral infections, most especially from the herpes virus, can also cause folliculitis and appear as pustular grouped skin lesions that tend to be recurrent in certain locations. A parasitic type of folliculitis may be caused by a mite such as Demodex that usually resides in the hair follicle and the sebaceous glands. When infection is a possible underlying cause of folliculitis, it is worthwhile to ask if the patient is immunosuppressed, or may be taking or applying immune-suppressing medications which may make the skin vulnerable to secondary infection if not taken under supervision of a doctor.
The non-infectious types of folliculitis are many and may be associated with genetics, gender, race and age and may be caused by several factors: stress, sun exposure, nutritional deficiency, hormones, drugs and medications, systemic illnesses such as diabetes or kidney disease, and occupational exposure to certain chemicals of which the most well-known are cutting oil, tar, DDT, and halogenated hydrocarbons. Chronic recurrent folliculitis may result from any of these factors or a combination thereof. Acne is a type of chronic folliculitis and the other conditions that may mimic acne like rosacea, perioral dermatitis, and acneiform eruptions have distinct clinical manifestations that must be differentiated from each other to be addressed appropriately.
How do we manage folliculitis?
The first step in managing folliculitis is to identify what causes it so it can be treated or avoided. Frequently, a thorough history and physical examination may be adequate to guide your board-certified dermatologist in giving the proper treatment. In some cases, certain diagnostic tests such as gram staining, culture, KOH smear, Tzanck smear, serologic tests, PCR, and histopathology may be warranted to arrive at the specific diagnosis.
When caused by infection, the treatment therefore is an antibacterial, antifungal, antiviral, or antiparasitic as deemed appropriate by a dermatologist. Any underlying skin disease such as an eczema or other conditions of impaired skin barrier must be treated as well. When the folliculitis is recurrent, it is important to identify external triggering factors such as occlusion, friction, chemicals, and improper shaving, but also internal and systemic factors such as nutrition, metabolic diseases, hormones, and immunosuppression among others. Regardless, consult with a board-certified dermatologist who can give the appropriate management of folliculitis.
How can we avoid getting folliculitis?
The following tips may help:
REFERENCES:
Luelmo-Aguilar, J., & Santandreu, M. S. (2004). Folliculitis: recognition and management. American journal of clinical dermatology, 5(5), 301–310. https://doi.org/10.2165/00128071-200405050-00003
Key differences from acne and how we diagnose and treat it
Dr. Mara Padilla Evangelista-Huber, FPDS, FDSP, MClinRes
What are the main major differences between acne and “fungal acne”?
| Acne | Fungal acne | |
| Causes | Chronic inflammatory disorder of the hair follicles and the sebaceous glands.Occurs due to: Follicular hyper-keratinization (i.e. when old cells of the hair follicle do not shed normally onto the skin’s surface)Overproduction of oil /sebum (may be hormonally-related)Cutibacterium acnesInflammation | More appropriately called Malassezia folliculitis Malassezia – family of fungi that are often part of normal cutaneous flora. An overgrowth of this yeast can occur due to some factors, leading to skin conditions like tinea versicolor, folliculitis and seborrheic dermatitis. “Folliculitis” – inflammation of the hair follicle Although Malassezia folliculitis is caused by a fungus, it is not contagious. |
| Presentation | “Polymorphic” lesions Open and closed comedones, inflammatory papules (red bumps) and pustules (bumps with pus), and sometimes nodules and cysts | “Monomorphic” lesions Fine 1-2 millimeter papules and pustules in a follicular distribution (where the hair follicles are) |
| Location | Face, chest, shoulders, back | Face, chest, shoulders, back of arms and back (especially on areas of the body covered by occlusive clothing) If on face, upper forehead and hairline > central face |
| Other suggestive symptoms | Some variants get better with antibiotics targeting C. acnes Unaffected by antifungal therapy Not usually itchy | Persists or worsens despite the use of antibiotics targeting C. acnes (likely because these alter normal cutaneous flora, allowing for overgrowth of the fungus) Gets better with antifungal therapy Often itchy or burning |
Who is at risk of developing “fungal acne”?
Malassezia species are present on an estimated 92% of the world’s population as part of normal skin flora – but it does not overgrow in everyone who has it on their skin.
Can you distinguish “fungal acne” from acne with your naked eyes?
The diagnosis of Malassezia folliculitis is usually made based on the patient’s history and physical examination, but occasionally, there are challenging cases where further examination is warranted.
Because both acne and folliculitis affect the pilosebaceous unit, they can appear similar in presentation. In addition, like C. acnes, Malassezia has been shown to induce skin cells to generate inflammation via a similar pathway, adding to the potential overlap in clinical appearance.
What are the diagnostic tools commonly used to diagnose “fungal acne” and the treatment options?
Some of the diagnostic tools include:
Treatment options:
Because topical antifungals do not penetrate well into the hair follicle, first-line treatment is generally with oral antifungals. Improvement is expected within 1–2 months.
Supportive measures:
References:Rubenstein RM, Malerich SA. Malassezia (pityrosporum) folliculitis. J Clin Aesthet Dermatol. 2014;7(3):37-41.
Ayers K, Sweeney SM, Wiss K. Pityrosporum folliculitis: diagnosis and management in six female adolescents with acne vulgaris. Arch Pediatr Adolesc Med. 2005;159:64–67.
Gaitanis G, Velegraki A, Mayser P, et al. Skin diseases associated with Malassezia yeasts: facts and controversies. Clin Dermatol. 2013;31:455–463
Yu HJ, Lee SK, Son SJ, et al. Steroid acne vs Pityrosporum folliculitis: the incidence of Pityrosporum ovale and the effect of antifungal drugs in steroid acne. Int J Dermatol. 1998;37:772–777
Let’s talk About HPV, Baby!
By: Dr. Charina Ann R. Pelayo
Genital warts are the most common Sexually Transmitted Infections (STI) globally. They are caused by particular types of Human Papilloma Virus (HPV) and may be passed on through direct skin-to-skin contact with someone who has HPV on their skin during genital, oral or anal sex.
Genital warts may appear on the penis and scrotum in males, on the labia or in the vagina of females, and even on the anus and mouth or throat of both sexes. They may appear as flesh-colored bumps or look like small pieces of cauliflower. You can have just one genital wart or a bunch of them. Sometimes they itch, but most of the time you don’t feel anything at all. It is possible to get or even spread these warts even if you cannot see them. Although rare, a child may get infected with HPV while passing through the birth canal of the mother with genital warts.
Now, not all bumps on the genitals are caused by HPV. There are other skin conditions that might look like genital warts but are not. If you think you have genital warts, it’s important to get checked out by a board-certified dermatologist.
A dermatologist can diagnose genital warts by examining the warts during a consultation. Sometimes, the dermatologist will remove the genital wart or a part of it to send to the laboratory to confirm the diagnosis of HPV. For females, getting a PAP smear once a year is highly encouraged since HPV is the major cause for cancer of the cervix.
If you do get diagnosed with genital warts, there are several treatment modalities that can be done. A dermatologist may freeze or burn the warts in the clinic. He or she may also prescribe medicine that you will apply at home like Imiquimod, which increases the body’s immune system to get rid of the virus.
To protect yourself from getting infected with HPV, get vaccinated with the HPV vaccine. Practice safe sex. Latex condoms can lower your chances of getting HPV, but you may still get infected from the areas not covered by a condom.
Corazon Almira Mella, MD, DPDS
Hair loss among women remains a “taboo” topic. Unlike with men wherein it is considered socially acceptable with advancing age, women carry the pressure of maintaining a full scalp of hair throughout life. The notion that hair is associated with one’s beauty, as old-fashioned as it seems, still encompasses today’s culture. But just like men, women also suffer from hair thinning and hair loss – medically termed as female pattern hair loss (FPHL). And, it’s about time the discussion on such topic be normalized – because the more women are aware of it, the more that they can take control. Moreover, the earlier the hair loss is acknowledged and addressed, the better the outcome will be.
What is female pattern hair loss?
FPHL is the most common cause of hair loss among women. It can affect any age group but is more widely seen after menopause. It is characterized by progressive and widespread thinning of hair over the top of the head or crown. Dermatologists refer to this as the “Christmas tree” pattern but the younger generation have termed it is as hair or scalp cleavage. In contrast with male hair loss, female pattern hair loss does not usually result in total baldness. The process usually occurs in bouts – wherein there are accelerated periods of hair loss of around 3-6 months that are followed by episodes of stability that can last a year.
What causes female pattern hair loss?
Now, there are many reasons for female hair loss and this not only includes FPHL but also other medical conditions, physical and emotional stress. To be able to rule out other possible causes, a consult with a board certified dermatologist should be done.
The condition has a strong genetic predisposition and these genes could be inherited from either or both parents. Unlike with male hair loss, it is not clear whether or not androgens or male sex hormones play a role in its development. Environmental factors such as psychological stress, hypertension, diabetes mellitus, smoking, lack of photoprotection and physical activity have also been noted to be possibly related to FPHL.
Are there diagnostic tests that needs to be done for female pattern hair loss?
To properly investigate the root cause of hair loss, several tests are done by the dermatologist. This may include a hair pull test which is done by gently pulling one’s hair to evaluate how many hairs come out, blood examinations to check for vitamin, mineral and hormone levels as well as scalp examination and trichoscopy to rule out other causes of hair loss. In select cases, a scalp biopsy might also be done by a dermatologist. Biopsies are done to exclude more other types of hair loss such as scarring alopecias (scarring alopecias leads to permanent hair loss).
What is the treatment for female pattern hair loss?
Although there is no absolute cure for female pattern hair loss, there are several treatments available. These treatments are mainly done to slow down or stop the progression of hair loss and not to promote hair regrowth, in general. Thus when getting treatment, it is important to manage expectations. Treatment outcome may also be quite variable.
Treatment options are classified to either topical or systemic. When it comes to topical medications, the most well-known is Minoxidil. Minoxidil was initially used to treat hypertension; but, over time, people who used Minoxidil noted hair growth areas in their body where they had lost hair. Studies have confirmed that application of Minoxidil can induce hair growth. However, it should not be regarded as a quick fix because it will take 4-6 months before improvement in hair density is noted. Furthermore, the use of the medication might actually cause more hair fall during the first few months of use. Another readily available topical treatment is Ketoconazole. Ketoconazole is recognized as an antifungal medication; however, it also has anti-androgenic properties that can be significant in controlling the hormones implicated in hair loss.
Aside from those mentioned, there are other forms of topical treatment – platelet rich plasma therapy, microneedling, and low level light therapy. These options may be presented to you by your dermatologist during consult.
Systemic treatment mainly involves the use of prescription medications such as Spironolactone and Finasteride. Unlike in male pattern hair loss, the use of these oral medications for female pattern hair loss have yet to receive approval from the FDA. The use of these medications should be done with precaution as they are not safe to use for pregnant women or women who are planning to get pregnant.
It might seem like a novel idea, but hair transplant can also be an option for females suffering from hair loss. Dermatologists who have been trained in hair transplant can provide appropriate counseling and assessment on whether or not a person is a good candidate for hair transplant.
Indeed, hair loss in women is not a topic often talked about and a lot of women still suffer in silence. However, it is time to discard the perception that hair loss only happens in men. Female pattern hair loss is not as uncommon as one thinks. There are board certified dermatologists available to help women go through such battle.
They are best qualified to counsel such patients and give proper advice on treatment options.
Reference:
Yip, L. et al. Female pattern hair loss. https://dermnetnz.org/topics/female-pattern-hair-loss. Jul. 2015.
Bhat, Yasmeen Jabeen et al. “Female Pattern Hair Loss-An Update.” Indian dermatology online journal vol. 11,4 493-501. 13 Jul. 2020, doi:10.4103/idoj.IDOJ_334_19
Singal A, Sonthalia S, Verma P. Female pattern hair loss. Indian J Dermatol Venereol Leprol. 2013 Sep-Oct;79(5):626-40. doi: 10.4103/0378-6323.116732. PMID: 23974580.
