Skin Conditions
Exploring Common & Complex
Explore the variety of common and complex skin conditions that we see and treat at Carlisle Dermatology Group.
Atopic Dermatitis
Eczema
Atopic dermatitis is a chronic skin disorder that causes dry, itching, and inflamed skin, with an intermittent rash.
The term eczema is often used to describe atopic dermatitis, as it is the most common type of eczema.
This skin condition is very common, affecting 10-15% of people. The severe itching and irritation during flare-ups can be extremely bothersome and causes individuals to scratch, sometimes until the skin is raw and/or develops an infection. Most cases of atopic dermatitis respond well to treatment.
Symptoms
- Intense itching
- Red, dry skin
- Scaly skin (some cases)
- Acute flare - Short-term flare lasting a few weeks, skin is red, raised, cracked
- Chronic flare - Long-lasting flare, skin starts to change appearance (thicker & darker)
Common reported triggers
Not everyone with the condition will have the same triggers, so each person must keep track of their particular sensitivities.
- Irritants - Substances that contact the skin, leading to redness & inflammation. (wool or synthetic fabrics, soaps, detergents, perfumes, makeup, cigarette smoke, & chemicals like chlorine)
- Allergens - Indirect trigger causing a skin inflammation & itching reaction. (pollen, mold, & animal/pet dander)
- Stress - Can aggravate flare-ups.
- Temperature - Sweating can trigger a flare-up (humid environments such as a sauna). Skin sensitive to certain climate conditions (cold winter weather, indoor heating, warm baths).
The appearance of atopic dermatitis tends to vary depending on the age of the person.
Contact/Allergic Dermatitis
Allergic contact dermatitis is a highly itchy rash that occurs when an individual comes into contact with a substance they are allergic to.
Unlike many other forms of eczema, this condition is not due to genetics and does not typically run in families. It is the result from skin irritation caused by exposure to allergens or irritants.
These substances (allergens) are harmless to most people, but can trigger immune reactions in those who are already sensitive. Only a small amount of exposure to the allergen is needed to trigger an allergic reaction.
Repeated exposure of the skin to an allergen is required to develop contact dermatitis. Most people might be exposed to an allergen many times or for years before finally developing a rash. However, once a person's skin becomes sensitized to a particular substance, that personally usually remains sensitive to it for life.
Common triggering allergens
- Plants (poison oak, poison ivy)
- Metals (particularly nickel found in jewelry, buttons of jeans, or belt buckles)
- Fragrances (including those found in lotions, shampoos, and other cosmetics)
- Preservatives (found in lotions, leather, and other fabrics)
- Rubber (gloves)
- Hair dyes
- Glues
- Medications (Neosporin)
Symptoms after exposure
- Skin appears red
- Area is swollen
- Blisters on affected area
- Dry skin in area
- Bumpiness
The rash may start as soon as several hours after contact with the allergen. It can take days or weeks to heal.
Please note: in several cases, the rash may extend beyond the point of contact and appear elsewhere on the body.
Hidradenitis Suppurativa
Hidradenitis (HS)
Hidradenitis (HS) is a chronic skin condition characterized by painful lumps or abscesses that form under the skin, typically in areas with skin-to-skin contact that rubs together, such as the armpits, groin, inner thighs, buttocks, and under the breasts. These lumps can become inflamed, fill with pus, and sometimes rupture, leading to scarring and tunnels under the skin (sinus tracts). HS is classified into three stages of severity and its cause is not fully known—it is thought to be related to blocked hair follicles and inflammation in sweat glands.
Signs & symptoms
Symptoms can vary widely in severity and can change over time.
- Painful, inflamed lumps or nodules under the skin, often in areas with skin-to-skin contact (Armpits, groin, inner thighs, buttocks, under breasts).
- Swollen, red, pus-filled lesions called abscesses, resembling boils or deep cysts that can painful, hot to the touch, and last for weeks (or even months).
- Tunnels (Sinus Tracts) beneath skin, connecting areas of inflammation, cause significant discomfort. Sometimes leak fluid or pus, creating an unpleasant discharge.
- Pus-filled lesions that when ruptured may leak a foul-smelling pus. If not healed properly, may lead to persistent drainage and infection.
- Permanent scarring from repeated cycles of inflammation, abscess formation, and rupture. Skin may be pitted or "rope-like" with thick, fibrous scars. In severe cases can restrict movement.
- Clusters of blackheads (comedones) in a "double-barreled" or paired pattern, common in affected areas.
- Swelling from inflammation in affected areas leads to severe discomfort. May make movements painful depending on location of lesions.
- Recurrent flare-ups may occur, after one set of lesions heal, new ones may form nearby or in other areas.
Triggers
- Hormonal changes (menstruation, puberty, etc)
- Heat & sweating
- Friction in areas where skin rubs together
- Stress
- Smoking can exacerbate condition
- Obesity can make condition worse
Stages of Hidradenitis (Hurley Stages)
- Hurley Stage 1 (Mild): Single or multiple isolated lumps or abscesses without scarring or sinus tracts.
- Hurley Stage 2 (Moderate): Recurrent abscesses with the formation of sinus tracts and scarring. The lesions are more widespread but are still separated by areas of normal skin.
- Hurley Stage 3 (Severe): Multiple interconnected sinus tracts and widespread inflammation. There is extensive scarring and persistent draining of lesions.
Hives
Cold Urticaria
Hives (cold urticaria) are a type of skin rash characterized by raised bumps or welts that are often red and itchy.
They can appear anywhere on the body. It is common for anyone to get hives; an estimated 20% of people will have hives at some point. Since it's possible for hives to move to different areas of the body, they may only last a few hours in one spot before disappearing and reappearing elsewhere.
Typically, hives last from a few days to 1-2 weeks, however, some cases can last up to 6 weeks. Chronic hives (chronic urticaria) is a condition characterized by persistent hives for six weeks or longer. With this type of hives, they can last for months or even years. In patients with chronic hives, about 21% of them have an autoimmune disease, with the three main diseases affected being thyroiditis, rheumatoid arthritis, & antiphospholipid antibody syndrome.
*If you are experiencing hives along with other signs of a serious allergic reaction (anaphylaxis), use your epinephrine and seek medical care or call 911 immediately.
Symptoms
- Intense itching
- Red raised bumps or welts anywhere on body
- Can be various shapes & sizes
- Rash localized (1 part of body) or spread out across body
- When pressed on, the center of the hive will turn white
- Individual hives can be as small as 1 millimeter or as large as 6-8 inches in diameter
- Stress and other psychological factors can worsen symptoms
Common reported triggers
While many people think of hives as part of an allergic reaction, they can be caused by a variety of things.
- Infections are responsible for most cases (28%-60%)
- Allergic reactions can trigger hives, common culprits include: food, insect stings, & certain medications
- Exercise may cause hives in some
- Sensitivity to temperature or sunlight in some people
- Pregnancy doesn't cause hives, but hormonal changes during may bring them out
- In children - most common cause is an infection (viral infections, urinary tract infection), food allergies is another.
Melasma
Melasma is a harmless skin condition in which dark patches appear on the face (forehead, cheeks, upper lip) due to excessive pigment (melanin) collecting in the skin.
The dark patches usually have distinct edges and are symmetrical (similar on both sides of the face). When it occurs during pregnancy, it is often referred to as "chloasma" or the "mask of pregnancy".
This condition is very common and occurs in up to 6 million American women.
Types of melasma
(Based on the depth & location of pigmentation)
- Epidermal - The pigment (melanin) is in the more superficial, top layer of the skin (epidermis). Responds quicker to treatment.
- Dermal - Pigmentation is deeper, in the inner layer of the skin (dermis).
- Mixed - This type involves pigmentation in both the epidermis & dermis. Can be more challenging to treat due to involvement of multiple skin layers.
Risk factors
- Prevalence - More common in women, especially those of Hispanic or Asian descent.
- Genetics - Having relatives with melasma increases risk of developing it.
- Hormonal factors - Women are at higher risk if pregnant, taking birth control pills, or undergoing hormone replacement therapy.
- Sunlight exposure - Sunlight contributes to melasma development, patches tend to darken with sun exposure.
Rosacea
Rosacea is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions.
Mild symptoms typically begin any time after the age of 30 as a come-and-go redness on the cheeks, nose, chin, and forehead. Rosacea is infrequent in children, but eyelid styes may occur. In rare cases, rosacea has been seen to develop in other places including the neck, chest, scalp or ears.
Though there is no cure, treatment options are available to reverse symptoms and reduce the frequency of flares.
Subtypes
- Facial redness (erythematotelangiectatic rosacea) - Flushing & persistent redness. Visible blood vessels may appear.
- Bumps & pimples (papulopustular rosacea) - Persistent facial redness with bumps & pimples. Often seen following or with subtype 1.
- Skin thickening (phymatous rosacea) - Skin thickening & enlargement, usually around nose.
- Eye irritation (occular rosacea) - Watery or bloodshot appearance, irritation, burning, or stinging.
Major signs & symptoms
- Flushing - History of frequent blushing or flushing. May feel a sense of heat, warmth, or burning with it.
- Bumps - Small red solid bumps or pus-filled pimples often develop. Might resemble acne, blackheads are absent, & may experience burning or stinging.
- Visible blood vessels - Prominent & visible small blood vessels on the cheeks, nasal bridge, & other areas of central face.
- Eye irritation - Eyes may be irritated & appear watery or bloodshot. Eyelids may be red or swollen, styes are common, crust & scale may accumulate around eyelids or eyelashes, might notice visible blood vessels around lid margins, & severe cases can result in corneal damage & loss of visual acuity.
Secondary signs & symptoms
- Burning & stinging - Burning or stinging sensations may occur on face. Itching or feelings of tightness may develop.
- Swelling - Facial swelling (edema) may accompany other signs or independently. Raised red patches (plaques) may develop without changes in surrounding skin.
- Dryness - Central facial skin may be rough & scaly (despite some patients complaining of oily skin).
Symptoms may worsen during "flares".
Shingles
Shingles is an outbreak of a rash or blisters on the skin caused by the varicella-zoster virus (the same virus that causes chickenpox).
After you have chickenpox, the virus stays in your body. It may not cause problems for many years, but as you get older, the virus may reappear as shingles. The rash is not contagious, but it is possible to get chickenpox from someone who has shingles (if haven't had chickenpox, the vaccine, or have a weakened immune system). Shingles usually appear as a single stripe on one side of the body or face and might cause mild to severe pain. In rare cases (usually among people with weakened immune systems), the rash may be more widespread and resemble the chickenpox rash.
Risk factors
- People with weakened immune systems are at higher risk (immune system diseases, certain cancers, or take immunosuppressive drugs).
- An individual has an immune system that is weaker due to infection or stress
Shingles can cause other health issues and complications. Speak with your doctor about any questions or concerns.
It is uncommon, but possible, to get shingles more than once.
Early signs & symptoms
- Chills
- Shooting pain
- Tingling
- Itching