Is every dry, flaky rash from “eczema”?

It would certainly seem like it, wouldn’t it? Eczema, also called atopic dermatitis, is the most common skin disorder I see in practice, particularly in the African-American population. Eczematous rashes are all generally dry, itchy, flaky, bothersome lesions that occur most frequently in the elbow area (antecubital fossae), knees (posterior patellar regions), and behind the neck. I’ll often see lesions on the anterior abdomen, surrounding the ear or belly button, which can be complicated by allergies to metal, like nickel. Nickel is usually present in buttons on pants (one can try putting tape or cloth between the skin and the button to avoid touching), watches, or earrings, causing a similarly annoying itchy, sometimes sensitive and occasionally painful rash. Eczema, and possibly nickel allergy, is hereditary. Why does it also appear to be more prevalent in black patients? Unsure. My theory is it may be due to the allergies from which we suffer in our homes, products, and environments.

Dyshidrosis, or dry skin, is a cardinal symptom of eczema, so directing attention to keeping the skin moist is paramount. This is why it seems harder to control the rash either in the winter when it’s cold, or during the heat of the summer when we sweat profusely. Interestingly, although we want the skin moist, we don’t want it wet, which is also when eczema becomes worse. Counter-intuitive, right? I think the hardest piece of advice, I’ve found, for my patients to follow is cutting the time in the bathtub or shower short. If a child spends 20 minutes twice daily in the water, cut if half if you can. Also, while in the tub, the more lukewarm the water, the better. No one likes a cold shower, so keep the temp reasonable. As soon as he or she jumps out of tub, dry quickly and moisturize even more quickly. One can imagine how difficult this would be for those of us who feverishly wash our hands in scalding hot water every 5 minutes or use alcohol hand sanitizers to keep clean. It all dries the skin out. I’ve prescribed the strongest, highest strength steroid creams there are, but I’ve had it confirmed by Dermatologists that good old petroleum jelly (ie. Vaseline) is as good as gold. Cocoa butter and shea butter are ok alternatives as well for twice daily moisturizing. Over the counter, my other favorites to suggest are Eucerin and Aquaphor for their thickness and staying power. The thinner, fancier lotions seem to evaporate right into the air after putting onto the skin. Children, and adults for that matter, with history of allergies, eczema, or asthma, often have one of the others or all 3. This comes from atopy * (explain definition). So, when I know one of patients has asthma, and they call with complaints of a dry, itchy rash in one of those special areas, I can pretty much put money on what it is.

With all of the great, sweet smelling soaps, washes, and shower gels out there, it isn’t a good idea for a patient with eczema to use any of these. Because of the allergy rationale, the more pure and simple one’s soap, the better it is for sensitive skin type. I generally recommend regular and plain Dove, without scent or color, for its gentle nature on the skin. Sorry to all of the Bath and Body and Victoria Secret lovers (like me).

If decreasing water exposure and temperature, soap, and lathering from head to toe in lotion won’t help, in comes the steroid treatment. The steroids work by helping the body to decrease the atopic response that occurs. I explain their action by saying they help the body to stop reacting against itself, similar to how antihistamines and allergy medicines work. The simplest one to use is an over the counter (OTC) steroid. There are forms of generic steroid or allergy creams and ointments of varying strengths of hydrocortisone you can buy from the store without a prescription. The 2% strength is available OTC, and it’s a good start. You use it twice a day, sometimes mixed in with your lotion or petroleum for better absorption, for no more than 2 weeks in a row. If the rash is something that recurs regularly, I’ll have patients skip 1 or 2 weeks between their 2 week treatment to give the body a rest from the strong steroids. The body seems . This is also why I usually suggest the ointments instead of the cream, because the ointments remain on the skin longer usually. However, some complain that it’s messier on clothing. If the OTC doesn’t help, we can prescribe a variety of types depending on the severity of the rash and whether it’s occurring on the body versus the face. Names include Triamcinolone, Elidel, or Desonide.

Now, back to my original question. Does this mean that every flaky rash is eczema? No, certainly not. Others that come to mind include candida (yeast), psoriasis, or tinea (fungal). Candidal or tinea rashes are typically more moist or wet in nature, occurring in the creases of skin, and psoriatic rashes have more of a shiny patch appearance on the surface of the elbow or knee. Just another friendly reminder to see your local doctor to help determine the right diagnosis and treatment.

Be healthy and be blessed,

Dr. Swiner

*As of October 1, 2010, we are happy to announce UNC Durham Family Practice becoming Durham Family Medicine. We welcome our new patients to call us at 220-

9800, and visit us at our same location, 2400 Broad St., Ste. 1 in Durham. We are conveniently located across the street from the Costco and Kroger shopping areas. Come see us!

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Healthy Women, Sound Minds

During this past winter, I spoke to the ladies of Triumphant Tabernacle Church in Durham for their Empowered Women conference. I was given the theme of “Healthy Women, Sound Minds,” which was a timely topic to speak on and around. We had some fruitful conversations and I thought I’d share a bit about what these wonderful women shared with me.

To review, I’m a Family doctor, which means I care for the entire family, from newborns to the elderly. Since practicing in the Durham community for the past 2 years, I’ve seen a large amount of young and older black women for a variety of reasons. Recently with the economy failing and making a slow comeback, I’ve seen a rash of women, married and single, young and old, who all feel the weight of the world on their shoulders right now. Some of the medical and emotional trends that seemed to have spiked at this time include: domestic abuse, sexually transmitted disease, high blood pressure, depression, and anxiety. The STDs in particular seemed to be at a high during the summer for some reason. Because of my frustration and sadness as I saw these women and attempted to help in some way, I took a step back to see if I could find similarities with these patients and what research there is on the link between emotional and medical health.

I began my talk with the women at the conference about depression and anxiety and reviewed the cardinal signs and symptoms of depression in particular. You may have heard of the “SIGE- CAPS” method before as a screen for depression (using each first letter of the list to make up the acronym). Because we were discussing women specifically, I put a star (*) next to those that seem to appear in women more–

Sleeping problems*

Interest decreasing in social activities

Guilt and self-worthlessness*

Energy decrease or fatigue

Concentration problems

Appetite or weight changes (up or down) *increased appetite

weight gain

Psychomotor slowing (moving more slowly, decreased motivation)

Suicidal thoughts

1 out of 10 all Americans admit to some form of mental illness-depression, anxiety, schizophrenia, etc.-each year. Women suffer from depression 2 times more than men, which means 2 out of 10. Why is there a difference? Studies say a definitive answer is unknown. However, with research, I found similar theories, including the following: higher incidence of physical or sexual abuse in women, use of birth control and having hormones in general, and persistent psychosocial stressors (such as loss of job) affecting women more.

Untreated emotional or mental illness can lead to suicide attempts—more women attempt suicide, but more men complete it. The likelihood is 4 to 1 that a man will be “successful” with suicide. Why? My theory is women use it more as a cry for help than men do. Women also use self- poisoning or drug overdose as the usual tactic, and that’s 70% of the time. However, that does not mean we should ever take threats of suicide from a female patient any less serious than from male.

So what can we do to have healthy bodies and more sound minds? Together, with research and our discussion at the conference, we identified a couple of ideas.

a. The majority of medical studies confirm that spirituality or religion is associated with better outcomes in many cases.

b. Have your annual check ups! Take care of yourself!

c. Have a great support system—family, friends, faith group/community d. Get more exercise and movement.

e. Eat “happy foods”—less caffeine/alcohol, more omega 3 fatty acids (salmon, cod, sardines, nuts help brain and nerve cells), reduce intake of refined carbs that cause sugar highs and then severe crashes, and eat more veggies and vitamins.

f. Pay attention to yourself and your moods. Recognize your symptoms early!

Resources

: Am Fam Physician 1999;60:225-40, Depression in Women: Diagnostic and Treatment Considerations.

BIO–Dr. C.Nicole Swiner is currently a Family Physician in Durham, NC, and has worked in a clinic owned by the University of North Carolina since 2007, after completing her residency training there. She received her undergraduate degree from Duke University. She also serves as an Associate Professor at UNC and

has interests in minority health, gynecology, and pediatrics.

has interests in minority health, gynecology, and pediatrics.

Eyelash growth serums—all talk?

“Please excuse the mess as we try to expand” was the Facebook status I used a couple of months ago to explain the uncoordinated look of my eyebrows as I’ve let them grow out of their “manicured” shape. I’ve been plucking, waxing, and threading my eyebrows since my freshman year in college to get that certain look, and now that I’m in my 30’s, they won’t grow the way I want. When I asked cosmetologists and spa aestheticians about the issue, there appeared to be no real eyebrow growth product. Instead, I heard or read in magazines about olive oil, massage, or Minoxidil (ie. Rogaine). I really wanted to try Minoxidil, but my husband was worried when he read it was hormonally based. So, I became interested in these new products on the market myself as I became frustrated with the lack of growth, even with avoiding waxing for weeks. I did some research, and this is what I found.

Latisse, which is the first marketed product for eyelash growth, was actually found by mistake. Its main ingredient is called bromatoprost, which was and is the main ingredient in glaucoma eye drops, which had the side effect of making eyelashes grow longer. It’s a prostaglandin, or fatty acid, that helps build muscle and hair. How smart was it that someone discovered a way to isolate this ingredient and make an eyelash growth product!

To review the medical background with patients who may deal with a lack of or slowed hair growth, we have to review the definition of alopecia. Damaged hair follicles or lack of growth of hair on the face can be related to many causes—those medical, and those we cause ourselves. My experience had to do with too much waxing and threading, where others may have experienced actual alopecia. Alopecia, in general, is hair loss due to trauma or medical reasons, such as cancer, anemia, thyroid, or other hormonal issues. The most common type is alopecia areata, which occurs in 2% of the population, and is primarily on the head. It usually returns spontaneously on ½ of cases within a year. Alopecia universalis is when damaged hair follicles occur all over the body, including the eyebrows and eyelashes, and is generally longer lasting.

The most important thing to do, I think, is to first understand the natural growth cycle of hair on the face before figuring out how the marketed serums will work. Naturally, it takes a full‐grown eyelash about 6‐8 weeks to grown on its own. It takes an eyebrow about 4 months and hair on the scalp about 3‐4 years. Because I was more interested in re‐growing my eyebrows, I wanted something to shorten that length of time.  Unfortunately, there are no “eyebrow growth serums”, but there are those marketed specifically for eyelashes. Some of these serums can be used on the eyebrows also, understanding of course the longer growth cycle. What I’ve tried recently is use one of the marketed eyelash serums on both my eyebrows and my eyelashes. To avoid liability, I won’t say which one I’m using, but at least for these past couple of weeks I’ve not experienced any side effects, such as eye irritation, conjunctivitis, or skin changes. Do I think my eyebrows have grown longer than they would have without the serum? I’m not sure yet, but maybe. If you’re interested, try one and let me know what you think.

Be Healthy and Be Blessed,

Dr. Swiner

References:

Canadian Family Physician, July 2000, p. 1469

STDs

There must be something about the warm weather and sunshine of the summer that causes some young (and some old) minds to become reckless. I say this in awe, as I seem to have been treating many more sexually transmitted diseases (STDs) within the past couple of months than I have all year long! And unfortunately, those that I have been treating for it are my young teenagers and 20-somethings. This inspired and prompted me to do a review of the most common STDs and myths about them. I hope that if you’re a parent with a child in this age group that you remind them of a couple of things.

The first issue is a scary one for me as a doctor is I hear the statement, “But I feel fine and don’t have any problems” as a frequent answer to whether a person wants to be tested for STDs. Let me say that this is an uninformed statement to make, especially for my men out there. STDs often are transmitted and can linger around and inside the body for years before they’re detected with testing. Even though you personally don’t have symptoms doesn’t mean that you can’t pass it to the next person. Don’t ever let the fact that you don’t “feel bad” be your rationale for declining testing.

Statistically, all women between ages 15-25years should have testing for Gonorrhea and Chlamydia every time they have their annual pap smears and physical exams, regardless of whether or not they have any symptoms. Both are bacterial infections of the sexual organs. Typically, women will complain of a different kind of discharge (mucus) than they would normally have. Sometimes, this mucus is of a different color or character (yellow or green, thick) and may cause irritation, itching, or burning with urination or with intercourse. Both men and women can experience these symptoms, but what I’ve noticed is that men may not suffer ANY of these classic symptoms and still have the infection.

But, guess what? These misconceptions don’t only occur in the young population. I had one older male patient, who doesn’t use condoms with his 2 female partners, recently tell me that because he urinated and wiped himself clean after intercourse that he was “fine”. Oh no! He’s putting both himself and his 2 partners at risk for all sorts of infections. Gonorrhea, Chlamydia, Trichomonas, HPV, and Herpes are transmitted the very same way that HIV/AIDs,  Syphilis, and Hepatitis are transmitted. If you’ve never heard of Trichomonas, or “Trich”, it is also an STD. It is characterized as a frothy, greenish discharge that causes irritation in the abdominal and pelvic area that needs antibiotic treatment.

Are all STDs fatal? No, but women in particular can have damage of their female organs to the point they have to have surgery or can’t have children, which can be devastating. Sometimes these diseases, such as Herpes, can cause meningitis. Hepatitis causes liver damage and can lead to death. Syphilis, which still exists, can cause neurological problems. HPV, clearly, is concerning because of its link to cervical cancer. HIV/AIDs goes without saying.

What’s the way to never come into contact with these infections? Never have sex. But because this isn’t realistic in the real world, don’t have sex until you’re ready and for goodness sakes, use a condom. Plain and simple. Ladies, protect yourselves because not everyone is looking out for you and your safety. Men, be smart and protect yourselves as well. If you have any questions, go to the doctor to be tested, and please have regular HIV testing. Don’t be afraid to talk about those things that can potentially save your life.

Be safe and be blessed,

Dr. Swiner (formerly Dr. Price)

 

What is a fibroid tumor?

I went to the Women’s Empowerment Expo for the first time this year, which I enjoyed immensely. There, I met more than one woman that asked me specifically about fibroids. I also have a good many women in the office that seek counseling regarding this topic often.  Fibroids, also known as leiomyomas, are essentially muscle “tumors” of the uterus. They are called tumors, not because they are cancerous, but because they are a collection of cells or muscle that don’t really belong. Fibroids are very common, up to 80% in African‐American women and 70% in Caucasian women. They also appear to be hereditary and occur more often in obese women and those who have never had children.

A fibroid’s growth is affected by the circulation of hormones, namely estrogen and progesterone, which is why they usually diminish after menopause. Fibroids are generally located inside the uterus but can also hang on the outside. Sizes vary and cause enlargement of the uterus. As mentioned above, they can continue to grow up until the time of menopause.

Not all women with fibroids know they have them, or even complain of symptoms. Patients who do have significant fibroids can develop symptoms ranging from increasingly worsened cramping and heavier bleeding during their menses, abdominal pain from pressure of the uterus sitting atop the bladder and pulling the pelvic muscles, more frequent urination or urinary urgency because of the same reason, to increased abdominal girth and weight.

I have felt these muscular masses during physical exams while palpating the uterus and stomach. If and when a woman mentions signs or symptoms that make me suspicious of fibroids, or anytime I feel masses during a pelvic or vaginal exam, the next step is usually to an ultrasound. An ultrasound is a study performed, much like in pregnancy, either on top of the abdomen or through the vagina for visualization of the female organs and abnormalities therein. If a fibroid is found, the size and number can be determined as well, as there is frequently more than one.

In regards to treatments, there are generally 3 categories: those directed only at the symptoms patients complain about, those directed at shrinking the size, and those directed at getting rid of them altogether. But let me also say there is usually a fear once fibroids are diagnosed. There is good news‐‐fibroids do not become cancerous nor are they malignant. So, honestly, one treatment choice is to do nothing at all. If one does want to try something, referring to what was said before, to treat symptoms, we have medicines such as Naprosyn (available over the counter as Aleve) or Ibuprofen. These medicines serve as anti‐inflammatories for pain and heavy menstrual cramping. There are stronger anti‐inflammatories if these don’t work well.

If size reduction is the goal, which can also occur sometimes with the anti‐inflammatories, hormones or birth control can be used. Since fibroids are controlled by our own hormonal cycles, more regulation with things like estrogen and progesterone‐containing pills, help slow growth and even shrink the size of fibroids.

If one doesn’t want to be on hormonal or birth control pills, then there is more definitive treatment involving either removing the fibroid itself with the use of laser or surgery, or even with a hysterectomy. Some women see the surgical options as the last resort, but they are available with OB‐gyn specialists. Feel free to talk to your medical professional if you’re ever worried about any of these things.

Be healthy and be blessed,

Dr. Price