I still get eczema. What can I do?
Flare-ups and hard-to-control chronic eczema are often due to a coexisting bacterial, fungus, or viral infection. If your eczema is weeping or oozing or crusted, your doctor will probably take a swab and treat for bacterial infection. We are greatly concerned with MRSA infections. Many patients with eczema have staph bacteria on their skin, which may require systemic antibiotics to limit the infection.
If you develop infections repeatedly, long-term antibiotics may be used in maintenance doses.
What is MRSA, and what do I need to watch for?
Ron said this:
I’ve got these abscesses on my left jaw line and left upper thigh. I’ve had them for over a month. A few weeks back I tried to clear them up. I used some penicillin that I had from an infection last year, and I put on some topical antibiotics; however, these keep coming and I can’t get them to stop, and they hurt.
The pus-filled abscesses were lanced, cleaned, and packed to prevent another reinfection of the wound area. Cultures of the areas were then sent to a reference laboratory for identification and sensitivity. The culture of the abscess revealed colonies of methicillin resistant Staphylococcus aureus (MRSA), and Ron was put on the appropriate antibiotic. He was instructed to return at a later date to determine the efficiency of the antibiotics and to monitor the healing process. An infection with MRSA is a very serious matter, and prompt treatment saved him the potentially harsh physical discomfort and disfigurement.
S. aureus, discovered in pus from surgical abscesses by the surgeon Sir Alexander Ogston in Aberdeen, Scotland in 1880, is the most virulent of all 33 staphylococcal species. Staphylococcus aureus literally translates to “golden cluster seed.” When S. aureus is grown on blood agar, it takes on a yellow-gold appearance. S. aureus produces an enzyme called penicillinase (a beta-lactamase) that is secreted from the bacteria and hydrolyzes the beta-lactam ring on the penicillin, thus inactivating penicillin.
Term:
Abscesses – Closed pockets containing pus.
Methicillin is used to treat bacteria that produce penicillinase. This drug is a penicillinase-resistant drug that is used to treat bacteria (such as S. aureus) that produce the penicillinase enzyme. An increasing number of strains of S. aureus are resistant to methicillin.
MRSA is resistant to many antibiotics, and intravenous vancomycin is one of the few that is useful in treatment. Because Ron came to our clinical office and not to a hospital, intravenous medications would not be practical. Trimethoprimsulfamethoxazole (TMP-SMX) was found to be effective against Ron’s particular MRSA strain. Ron returned in 2 weeks, and his healing reflected that the antibiotic and his immune system had worked effectively.
I was told that I have a fungus infection. What can I do?
Fungal skin infection includes tinea pedis (athlete’s foot), the most common type of fungal infection. It is spread by direct contact and may infect the sole and sides of the feet. It may result in peeling, scaling, itching, and sometimes blistering. Onychomycosis (tinea unguium, nail fungus) is a toenail infection that is usually associated with tinea pedis; it can be very difficult to eradicate. Tinea cruris (jock itch) is a rash in the groin. It has an itchy spreading red border that is quite common, especially in men who sweat a lot. Tinea corporis (ringworm) may occur on the trunk or other areas. Tinea capitis (scalp ringworm) can result in scaling and patchy, moth-eaten-appearing hair loss and is epidemic in many Black communities. With the correct treatment, the hair will grow back normally and not result in permanent hair loss. Tinea infections can be effectively treated by a variety of over-the-counter prescription creams, shampoos, and oral medications.
How can I prevent recurrence of fungal infections?
Fungal infections often recur in many people even after effective clearing with medication. Fungus likes warmth and moisture, making certain parts of the skin more vulnerable. A fungus sheds spores, like tiny seeds, which wait for the right moment to grow into new fungus, and chooses places such as in our shoes. After effective treatment, here are some rules for prevention:
• Finish your medicine completely and as recommended. The fungus may still be present long after it is no longer visible as a rash.
• Keep feet clean, cool, and dry, and change socks frequently. Make sure that your shoes fit correctly and are not too tight. Discard old shoes, boots, slippers, and sneakers, and do not share footwear with others.
• Apply an antifungal cream twice a week to the bottom of the feet and on the nails.
• Apply an antifungal powder such as Zeasorb-AF® inside the shoes every day to keep spores from growing. • Avoid walking barefoot in bathrooms, locker rooms, gyms, and public areas and on carpeting.
• Keep toenails short, and cut straight across. Avoid ingrown nails. Make sure that you do not use the same clippers on abnormal nails and normal nails. If you go to a salon to get your nails done, consider bringing in your own set of clippers.
• Consider using an antidandruff shampoo, such as Selsun Blue®, twice a month if you have had a body fungus. The most effective way to get the best results is to lather up and leave it on the skin for about 5 minutes (two songs long) and then wash off completely.
I have a lot of small, warty growths on my back and other places. Should I be worried that these are cancer?
Those rough, dark colored plaques that have a “stuck-on,” mole-like appearances are called seborrheic keratoses. My patients often call them barnacles. They are generally symptom free but occasionally can itch and be bothersome. If they are irritated or cause discomfort, they can be frozen off with liquid nitrogen or removed by a shave procedure.
Those rough, dark colored plaques that have a “stuckon,” mole-like appearance are called seborrheic keratoses. My patients often call them barnacles.
I get little yellow bumps on my face. Are these cancerous?
These are probably sebaceous hyperplasia. Clinically, hyperplastic glands look like yellow nodules that may have a central pore. The number of sebaceous glands remains constant as a person ages, but the glands increase in size and become more visible, particularly in chronically sun-exposed skin. Paradoxically, sebum production decreases over time, contributing to the dry skin seen in normally aged as well as photo-aged skin.
It is important to distinguish sebaceous hyperplasia from nodular basal cell cancer (Plate 6). In contrast to nodular basal cell cancer, the sebaceous gland is not translucent and does not have telangiectatic blood vessels. Nevertheless, when in doubt, it is always best to perform a biopsy.
Terms:
Sebaceous hyperplasia – A condition that affects the sebaceous glands that produce the oily fluid known as sebum.
Basal cell cancer – The most common type of skin cancer. The lesions appear as a flesh-colored papule with blood vessels and a shiny border.
It looks like I have acne on my upper cheeks. What is that?
Favre-Racouchot disease includes a variety of primarily suninduced skin changes and is common on the face, neck, and back. It is technically called nodular elastosis with cysts, comedones, and sebaceous hyperplasia, and shows yellowish thickening of the skin and nodules acne (comedones) and follicular cysts (Plate 7), especially around the orbits. It can usually be seen in the 4th or 5th decade in those chronically exposed to sun. The skin becomes less firm because of degeneration of elastic tissue and fills in with cystic material. Superficial vascular changes result in irregular pigmentation and redness.
Term:
Favre-Racouchot – A condition in which the skin turns yellow and thickens. The skin appears to have cysts or nodules.
What are those little tags that I get on my neck and other places?
They are called acrochordons. These are the fleshy or dark colored benign pedunculated papules or nodules-skin tags- on the neck, axillae, groin, chest, and abdomen. Usually, the only time they get painful is when they get tangled in necklaces or clothing. The treatment is snip (scissors) excision, cryotherapy, or cautery.
Term:
Acrochordons – Commonly known as skin tags.
