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with Rod Moser, PA, PhD

Stories from behind the examining room door, as told by Rod Moser, PA, a primary care physician assistant with more than 35 years of clinical experience.

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Monday, September 24, 2012

The Top 10 Yucky-Looking Skin Problems

By Rod Moser, PA, PhD

Skin Problems

I see some pretty nasty-looking skin diseases and conditions in my practice, but some of the more-yucky-looking skin disorders are non-contagious and not even considered diseases at all. A few are contagious, however. Both kinds should be recognized and treated as soon as possible.

1.  Poison Oak (or Ivy) dermatitis isn’t contagious, but it sure ranks high on the Yucky List, based solely on appearance. The skin lesions associated with this common allergic skin reaction can be red, blistering, crusting, and oozing. When on the face, it can cause considerable swelling. The “oozing” part is not the “poison coming out” as some people tend to believe, and that drainage cannot cause poison oak in others. Objects and clothing contaminated with the oil of the plant or exposure to burning poison oak plants can cause a reaction.

2. Atopic dermatitis (eczema) is a common, genetically dry skin condition (not a disease) that many people do not understand. Because this skin condition can cause considerable itching, many people with eczema will have deep scratch marks and excoriations. Over time, these open areas can even become secondarily infected. I cannot tell you the numbers of times that I have seen a child sent home from school or day care based on the appearance of his/her eczema. It can look nasty, but unless it becomes infected, it is not contagious.

3. Ringworm is not a worm at all, but because of the round, ring-like appearance on the skin, it can look like one. I guess it is the word “worm” that triggers a negative response, perhaps confused with pinworms or roundworms (which are actually worms). Ringworm, or tinea corporis, is a fungal infection, and it can be contagious from person to person if there is a very close and prolonged contact. Wrestlers are often excluded from participation if they have any type of fungal skin problem. More often, ringworm is transferred to children from animals, namely cats. Ringworm is no more serious than athlete’s foot or a yeast diaper rash and it is easily treated by over-the-counter antifungal creams.

4. Warts are a skin lesion caused by human virus. Children, with their weaker immune systems, are more commonly affected. They occur on hands, feet, arms, knees, or even the face and can last a year or more. While technically contagious (the kids got them from someone), they are no so contagious that parents should worry, or exclude them from school. Over-the-counter wart treatments may work (not advised for use on the face), but a faster and more effective way is to have your medical provider freeze it off using liquid nitrogen. There is also a prescription cream called Aldara that is highly effective (and highly expensive).

5. Molluscum skin lesions look a little like warts, but a closer inspect will reveal a firm, pearly bump with an indentation in the center like a tiny belly button. Children can get dozen of them on just about any body surface, from the trunk to genital areas. The scientific name for these bumps is molluscum contagiosum, indicating that it is somewhat contagious. Many medical providers ignore them, but they can be treated similarly to warts. Personally, I treat them on patients when I find them.

6. Hand, Foot, and Mouth Disease: Yes, that is its name, but it is not related to the cattle Hoof and Mouth Disease. These are tiny, blister-like viral lesions that occur primarily on the palms of the hand, soles of the feet, and inside the mouth. They can occur in other areas, too. This disease is considered contagious, but epidemics usually involve only a few, unfortunate children. There are no treatments, but luckily Hand, Foot, and Mouth Disease resolves on its own in a few weeks.

7. Hives or urticaria is an allergic response characterized by large, very itchy, welt-like blotches that can cover all or parts of the entire body. It comes on quickly in response to an allergen (either touched, breathed, or ingested) or an insect bite/sting. In many cases, the exact cause may never be determined. Hives can look horrible, with the eyes swollen shut or the lips bigger than some enhanced Hollywood models. Hives are not contagious, of course, but they will certainly get everyone’s attention.  Severe forms that cause respiratory difficulties are a true 9-1-1 emergency.

8. Impetigo is an infectious skin infection caused by either Staph or Strep bacteria. It has an oozing, honey-crusted appearance and can easily spread from person to person. Mild cases can be treated with topical antibiotic creams or ointments, but more severe cases are treated with oral antibiotics and should be cultured to make sure it is not MRSA (a highly resistant type of Staph).

9. Acne is not contagious, but it can be yucky-looking, especially if you are a teenager looking at yourself in a mirror. The scourge of highly hormonal adolescents, acne can be effectively treated with a variety of topical or oral medications. Acne has the potential to cause permanent scars if teens aggressively squeeze them. Popping zits never cures acne.

10. Diaper Rash is the last of our yucky skin diseases. There are three main types: the irritant type caused by defecating and urinating in a diaper, yeast (since yeast loves warm, dark, moist places), and bacterial types (often caused when the skin breaks down and bleeds). Either type can be quite severe looking. Once the type is correctly identified, it can be effectively treated and prevented. I saw a bad case yesterday that had ALL THREE types.

Photo: Hemera

Posted by: Rod Moser, PA, PhD at 1:00 am

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