Posts tagged #dermatologyarts
Psoriasis v. Eczema: ENDGAME

Recently, “Rashes & Skin Allergy Testing,” was posted and it reviewed what eczema looks like and how allergy patch testing can be helpful. What many may not know is how psoriasis and eczema are related, yet, are significantly different. Come to Dermatology Arts in Bellevue for help understanding if you have one of these conditions.

Both psoriasis and eczema are red, itchy rashes that can appear as scales or plaques, be improved by topical steroids, and worsen with cold weather. But, what sets the two apart is very clear. Psoriasis, while red and itchy, has distinct borders and the skin is often raised. Eczema rashes have ill-defined borders, making it difficult to know when it starts and stops.

Common places for psoriasis to appear include the elbows, knees, and belly button. It can even cause symptoms affecting the fingernails. Psoriasis rashes result from an autoimmune disorder where an excess of skin builds up and doesn’t shed. Typical treatments can include topical steroids, but in more severe cases systemic medicines may be needed. Psoriasis is also associated with several other conditions such as high blood pressure and heart disease. Among those who have psoriasis, 5% can also experience psoriatic arthritis.  

Eczema, on the other hand, can improve with topical steroids and or several lifestyle changes like taking warm showers, avoiding harsh soaps, etc. Although eczema may show up in the same places as psoriasis, there is less skin buildup and inflammation. The underlying cause is also very  different. Triggers such as environment, bacteria, allergens, and genetics all play a role in severity, onset, and symptom improvement. Related diagnoses include allergies, keratosis pilaris, and asthma.

Neither psoriasis or eczema have a cure, but Dermatology Arts offers many treatment options that can control symptoms and prevent frequent flare ups. It can be difficult to tell the difference between psoriasis and eczema, but with a trained eye and many years of experience dermatologists can successfully diagnose and treat appropriately.

Do the least you can do.

This past Sunday morning, perhaps as a small Father’s Day gift, my wife, Aditi, shared the Graduate English address by Lucila Takjerad at Harvard Commencement 2019. It had been forwarded to her from a lifelong friend in India. Before she showed me the video, Aditi narrated the story you are about to hear. With each advancing detail, Aditi’s eyes swelled with emotion; clearly Lucila’s words had resonated with Aditi.

As I subsequently watched the video, I understood that my wife and I live our lives moment by moment and action by action working to make small differences in the lives of the people around us. As a physician, I’m often humbled by the messages given to me by patients who seek my care. While I state that physicians are in the small group of people who regularly receive blessings from others, my patients—our patients—regularly touch our lives in many small ways which enrich our lives. Over the last few months, countless long time patients and many new ones have given us strength, endurance, and support. We “try harder” because of them.

Please take a few minutes to hear for yourselves the difference that small things can make in the lives of others.

What is Patch Testing?

If a red itchy rash has ever appeared after trying a new perfume or wearing latex gloves, it may have been caused by an allergic contact dermatitis--a fancy term for an allergic reaction on the skin caused by something in direct contact with the skin. Products or chemicals that cause allergic reactions are called contact allergens and are exactly what they sound like: an allergic reaction develops whenever it contacts the skin. It can be hard to determine which chemicals, products, or daily household items may be causing a rash. Even a small ingredient change in a detergent can trigger a reaction. To circumvent trial and error, and avoid getting more rashes, patch testing is helpful for determining common contact allergens.

In just one week, a tailored patch testing sequence can be developed, implemented, and reviewed. But, how does it work? What does a patch testing panel look like? In patch testing, small “stickers” with common allergen substances are uniformly placed on the back. After a few days, the patches are removed and specific markers are identified at each spot to determine if the test is positive or negative for an allergen. A positive result means the respective substance causes an allergic reaction and is an allergen, and a negative response means indicates the substance is does not.

To get started, patients interested in patch testing complete initial intake forms before the first visit with Dermatology Certified Nurse Practitioner Liz Schuringa, ARNP. Liz will review the procedure and any personal products (even ones used on occasion). At a separate visit, the patches will be applied and left on for 2 days. The patches are then removed at the third visit and the spots are observed after 3 days for any positive or negative result. This last visit consists of going over results and determining which products are allergens and which ones are not.

Most insurance companies cover patch testing, but may need confirmation to be sure. Insurance copays, are typically only required at the 1st and 4th visits. For scheduling, questions, or concerns please call the office at (425) 753-2918.

Non-Melanoma Skin Cancers

Most people have heard of melanoma skin cancer, but not everyone knows the two types of non-melanoma skin cancer: basal cell and squamous cell carcinoma. Basal cell carcinoma is the most common type of skin cancer. It forms at the bottom of the top layer of skin and grows relatively slowly. Squamous cell carcinoma occurs in the very outer layer of the skin. Less common than basal cell, squamous cell is more likely to grow into the deeper layers of the skin and, though this is uncommon, can spread to other parts of the body.

Basal cell carcinoma presents as pearly “bumps” that are either smooth or rough to the touch. When new spots appear, basal cell skin cancers can itch, bleed, and seem like sores that never heal. If untreated, it can spread to the surrounding skin and permeate into the bone. Thankfully, basal cell can be easily treated by excision, Mohs surgery, a procedure called “curettage and electrodessication,” and even topical medicated creams. Some families have an inherited condition where they can form hundreds of basal cell carcinomas.

Dermatology Arts’ Dr. Master worked with internationally renowned Basal Cell Nevus Syndrome (Gorlin’s Syndrome) researcher Ervin Epstein, MD at the University of California San Francisco in the early 1990s. Their work resulted in a publication which localized a tumor suppressor gene to the long arm of the Chromosome 9.

Various types of squamous cell carcinoma exist. There are keratoacanthomas, in situ, invasive, etc. These skin cancers often appear on the face, ears, neck, and back of the hands where sun exposure is high. Pre-cancerous spots known as actinic keratosis also appear in these areas and can become squamous cell carcinoma. Typically, cryotherapy or medicated creams can improve these spots before they become cancerous. The same treatment methods used for basal cell carcinoma can also treat squamous cell carcinoma.

Non-melanoma skin cancers are generally less harmful than melanoma, but far more common, and still require treatment. One of the best ways to prevent skin cancer is sun protection. Tanned skin, blistering sunburns, and other types of prolonged sun exposure are the main culprits for non-melanoma skin cancers. Wear sun protective clothing, when outside for long periods of time, and reapply sunscreen every hour to keep your skin looking younger and avoid future doctor visits.

Do You Use Protection?

Did you know UV exposure is the most preventable risk factor for skin cancer? The American Academy of Dermatology (AAD) recommends taking many precautions when going out in the sun. It’s important to minimize sun exposure and maximize protection. Enjoy a play on words in this video by the AAD

Summary:

  • Seek shade during times of peak sun rays

  • Wear protective clothing like hats and sunglasses. Pro-tip from Dermatology Arts: Use SPF shirts and shorts for water activities (for example. rash guards / swim shirts have a UPF / SPF equivalent)

  • Apply minimum SPF 30, broad spectrum, and water resistant sunscreen

  • Reapply sunscreen every hour on the hour when outside