Question: I have gotten hives all of my adult life. They seem to come and go for no apparent reason. I think it might be from stress from my job. None of my siblings get hives, but a couple of them have asthma and allergies. Could I have allergies? My doctor says my hives are from my nerves.
Answer: Although I addressed hives, or urticaria as we physicians call the condition, in a recent column, your question focuses on the problem of recurring hives.
Hives are officially caused by an allergic reaction in your body, but a lot of things can set them off. Just because you have had them for a long time doesn’t mean that you shouldn’t take the time now to investigate potential causes. Understanding the cause can help you manage and avoid recurrences.
A hive is a red, usually raised and very itchy lump that may come alone or in groups. Sometimes they spread out and cover most of your body. Other times they are isolated to only a few areas. Hives are the most common dermatological condition seen in emergency departments of hospitals in the United States.
About 20 percent of individuals will have an episode of hives at least once during their lifetime. Some people just get one outbreak; others, like you, will have a lifetime of recurring hives.
The cause of hives can be difficult to find as they may be caused by foods, food additives or chemicals. People who have only one episode of hives or very infrequent episodes may never find out the cause. But if you have hives all the time, it is well worth your time to get an allergy test.
Allergies do run in families, and since you have siblings with allergy-based conditions, you may share some of their allergies. Often there can be a bit of a delay between exposure to an allergen and the outbreak of hives, which makes the triggers for hives especially elusive.
The most common allergy test is the skin test. With the skin test, trace amounts of common environmental allergens, such as dust and pollen, and common food allergens are injected into the outer layer of the skin. The affected skin is then observed to see if it reveals any reactions and, if so, how severe they are.
The skin test is a generally painless procedure that can likely be done in a physician’s office. Sometimes blood tests for allergies are sent out. These are somewhat useful, but they are not as sensitive as the skin tests.
Although stress can aggravate hives, allergens are typically involved with this condition. With recurring hives, the most important approach is effective prevention. If allergens are behind your hives, this test can help you avoid those triggers. Prevention is the best treatment for urticaria or any allergy-based problem. It is never too late to have this testing done, even if you have had hives all of your adult life.
Thursday, May 13, 2010
WHITE SPOTS ON SKIN A COSMETIC NUISANCE
Question: I recently developed these little white areas on my fingers. My mother has them too, and she insists they are nothing to worry about. She says they’re called vitiligo and that she has had them as long as she can remember. Dangerous or not, I think they are ugly. What causes these? Are they anything to worry about? How can I make them go away?
Answer: Vitiligo is a relatively common skin condition that affects about 2 percent of all people in the world. It usually develops before the age of 20, and it seems to occur equally in both men and women and across all nationalities. Vitiligo results when melanocytes, the cells in the body that produce dark skin pigment, called melanin, stop working. When this occurs, the affected skin turns a pinkish white. If melanocytes stop producing melanin on the scalp, the hair in the affected area also turns white.
While there is no definitive cause for vitiligo, many theories exist. The most widely accepted theory is that it is an autoimmune disease, which occur when your immune system attacks your body’s healthy cells, destroying them. Although it is largely considered an autoimmune disease, most people with vitiligo do not have an underlying autoimmune disorder. Instead, vitiligo is more common in people with hyperthyroidism, adrenal insufficiency, pernicious anemia and alopecial areata. Also, vitiligo does seem to run in families, which might explain why both you and your mother experience the same symptoms.
The diagnosis of vitiligo involves a simple visual inspection of the affected skin by a trained physician. Sometimes the doctor will want to do a biopsy to confirm the diagnosis. She may also check your personal and family history for associated diseases like those mentioned above. If you or your family members do not have documentation of these conditions, your doctor may still want to test for them.
There are treatments for vitiligo. Topical steroid creams can help in restoring color to the de-pigmented areas, but it may take several months of regular use before you notice any improvements. Another treatment that works well is phototherapy with ultraviolet light, plus medication applied to the skin. These treatments are effective but they can be time-consuming, and the results are often delayed. For extreme cases –- people who have lost pigmentation on more than 50 percent of their skin surface, there are prescription cream treatments that fade the rest of the skin to match. Some people also choose skin grafts, which remove the affected areas of skin, but there can be complications from this treatment.
There is good news in all of this: interestingly, recent studies have shown that people with vitiligo may actually be at decreased risk for developing serious skin cancers.
Answer: Vitiligo is a relatively common skin condition that affects about 2 percent of all people in the world. It usually develops before the age of 20, and it seems to occur equally in both men and women and across all nationalities. Vitiligo results when melanocytes, the cells in the body that produce dark skin pigment, called melanin, stop working. When this occurs, the affected skin turns a pinkish white. If melanocytes stop producing melanin on the scalp, the hair in the affected area also turns white.
While there is no definitive cause for vitiligo, many theories exist. The most widely accepted theory is that it is an autoimmune disease, which occur when your immune system attacks your body’s healthy cells, destroying them. Although it is largely considered an autoimmune disease, most people with vitiligo do not have an underlying autoimmune disorder. Instead, vitiligo is more common in people with hyperthyroidism, adrenal insufficiency, pernicious anemia and alopecial areata. Also, vitiligo does seem to run in families, which might explain why both you and your mother experience the same symptoms.
The diagnosis of vitiligo involves a simple visual inspection of the affected skin by a trained physician. Sometimes the doctor will want to do a biopsy to confirm the diagnosis. She may also check your personal and family history for associated diseases like those mentioned above. If you or your family members do not have documentation of these conditions, your doctor may still want to test for them.
There are treatments for vitiligo. Topical steroid creams can help in restoring color to the de-pigmented areas, but it may take several months of regular use before you notice any improvements. Another treatment that works well is phototherapy with ultraviolet light, plus medication applied to the skin. These treatments are effective but they can be time-consuming, and the results are often delayed. For extreme cases –- people who have lost pigmentation on more than 50 percent of their skin surface, there are prescription cream treatments that fade the rest of the skin to match. Some people also choose skin grafts, which remove the affected areas of skin, but there can be complications from this treatment.
There is good news in all of this: interestingly, recent studies have shown that people with vitiligo may actually be at decreased risk for developing serious skin cancers.
Friday, April 23, 2010
SUN-INDUCED SNEEZING
Question: A friend of mine claims to only sneeze when she’s exposed to bright sunlight. As someone with seasonal allergies, I understand how pollen can cause people to sneeze, but why would bright light make my friend sneeze?
Answer: Sneezing is an involuntary reflex caused by many different things. As you noted, during the spring or fall months people with seasonal allergies sneeze in response to pollen or spores. The sneezing is your body’s attempt to clear out the allergens irritating the lining of your nose and throat.
Your friend’s claim, that bright sunlight can cause sneezing, is actually a documented medical syndrome. The syndrome is called ACHOO –- and no, I am not making this up. It stands for “Autosomal-dominant Compelling Helio-Ophthalmic Outburst,” also called photic sneezing. If you ever start to sneeze and it gets “stuck,” try looking toward a light source to see if it helps you finish the sneeze.
Sneezing from bright lights is a genetic condition that affects about 20 percent of the population. The term “autosomal-dominant” means that if one parent has the gene, each child has a 50 percent chance of inheriting it. The exact mechanism by which bright light brings on sneezing in certain people is not fully understood.
Aside from allergies, illness and bright lights, a number of other things reportedly cause sneezing. Some people say they sneeze when they pluck their eyebrows. Others sneeze when their stomach is full, which is referred to as stomach sneeze reflex. Still others sneeze when their stomach is empty and they feel nauseated. The nausea seems to be somehow relieved by sneezing. Physicians and scientists do not fully understand unusual sneezing triggers, and since the matter seems to be of no medical consequence, we are not likely to bother figuring it out.
Interestingly, the practice of saying “God bless you” to someone who has just sneezed began during the 6th Century bubonic plague epidemic. Sneezing took on troubling connotations since it was one of the earliest symptoms of infection with the plague.
Sneezing is also an early symptom for many other bacterial infections as well as viral illnesses such as the cold or the flu. If you develop more serious symptoms such as fever or body aches along with your sneezing, you should seek medical attention. Normally, however, a few isolated sneezes are not cause for alarm. Nearly anything can irritate the throat and nose even if you are not allergic to it, including excessive pollen, smoke, pepper and dust.
Sneezing, which employs several muscle groups from your abdomen to your throat, is a very powerful “outburst” and a very effective way of spreading germs. During an ordinary sneeze, saliva can fly up to ten feet at roughly 75 miles per hour. Even if you are not feeling sick, you should always cover your nose and mouth when you sneeze.
Friday, April 16, 2010
PREVENTION IS BEST “TREATMENT” FOR ITCHY CHIGGER BITES
Question: My husband and I have been bothered with chiggers. We have tried everything for the itching – alcohol, peroxide, sprays, lotions, nail polish and cream from the doctor. This has been going on for about four months, and they seem to be spreading. What can be done?
Answer: First, I’ll describe what chiggers are and why they cause itching. Then I’ll tell you how to prevent and treat them. You and you doctor can decide if you really have chigger bites.
Chiggers are microscopic insects in the mite family. They are arachnids and are closely related to ticks. It is the larval form of the mite that bites. Interestingly, after they feast on humans and other animals, they mature and eat only the eggs of certain other insects.
Chiggers do not burrow under the skin, as is commonly believed. Instead, when chigger larvae bite, they insert a mouth part that injects saliva into a skin pore or hair follicle. This dissolves the skin cells it contacts into a liquid that the chigger can ingest. After a few hours, the tissues surrounding the withdrawn liquid harden, creating a tube-like structure. This structure, called a stylostome, acts like a drinking straw, allowing more saliva to be injected, and more liquefied skin to be withdrawn. This is what creates the appearance of burrowing.
It is the stylostome that causes the itching and characteristic red welt to form. The itchiness can be quite severe and usually peaks about two days after the bite. The stylostome is destroyed by your body in about 10 days.
Chiggers are found in grassy places, and in thick brush. They are most active when the ground temperature is between 77 and 86 degrees and become inactive below 60 degrees.
Chiggers are found in grassy places, and in thick brush. They are most active when the ground temperature is between 77 and 86 degrees and become inactive below 60 degrees.
Prevention is the best way to manage chiggers. Wear clothes that prevent chiggers from making contact with your skin. Long-sleeved shirts, tightly woven socks, pants tucked inside of boot tops, and buttoned cuffs will all reduce chigger bites. Most mosquito repellants will fend off chiggers, too, so it’s good idea to use these products when you go into fields or woods or if you plan to sit on the grass. Remember to reapply it every few hours since repellants only last a few hours.
After you return from any potential exposure, a hot bath with lots of soap will wash many chiggers off before they have a chance to bite. If you have been bitten, over-the-counter creams with benzocaine or camphor-phenol can help reduce the itching.
It’s also a good idea to wash clothes that are potentially chigger-infested in hot, soapy water. Unlaundered clothes or clothes washed in cool water will allow chiggers to survive.
It’s also a good idea to wash clothes that are potentially chigger-infested in hot, soapy water. Unlaundered clothes or clothes washed in cool water will allow chiggers to survive.
Unless you keep getting re-infested with chiggers, it seems unlikely to me that you would still be itching from chiggers after four months. You and your husband need to see your physician for a reevaluation of your rashes. What you have may not be chiggers at all.
WARTS CAUSED BY VERSATILE HPV VIRUS
Question: I frequently have warts on my fingers that come and go. My mom says I will outgrow them, but in the meantime, they’re very ugly. Why do I get them? Is there anything I can do about them? Should I see a doctor?
Answer: It sounds like you have common warts, called verruca vulgaris by physicians. These occur mainly on the hands, fingers and knees; and your mother’s right that they are most common in children.
Common warts are caused by the human papilloma virus (HPV). An infection of the skin with this virus causes the outer layer of the skin to grow rapidly, which forms a wart. Warts are contagious. They can be passed from person to person through direct contact, which is partially why they are more common in children.
There are more than 100 types of human papilloma viruses. Many are harmless, and others can cause serious problems like cervical cancer. Different types of HPV cause different types of warts. For example, HPV can cause genital warts, which stem from a sexually transmitted infection. HPV also causes plantar warts, which occur on the soles of the feet and can be spread in public showers and other places where people walk around barefooted.
Because wart viruses can live on surfaces for a while, they can be spread by indirect contact, like wearing someone else’s shoes. Also, it may take several months for a wart to develop after exposure, so it’s often difficult to determine the source of the infection.
People with compromised immune systems, such as people with cancer or AIDS, are at increased risk for contracting any viral illness, including warts. Also at increased risk are children and young adults.
Many common warts will go away on their own, but people often treat them for cosmetic reasons or to help prevent their spreading. One recently confirmed home remedy involves duct tape. Simply adhere a small piece of duct tape directly to the wart to progressively kill the abnormal skin cells. Change the duct tape weekly, and file down the dead skin before reapplying. Continue until the wart is gone. Several-over-the-counter wart treatments are effective as well.
If warts are resistant to both the duct tape and over-the-counter-treatments, then a visit to your primary care physician or a dermatologist may be in order. Warts can be frozen off with liquid nitrogen, or treated with an acid or chemical. Both of these procedures may need to be repeated several times before the wart is fully removed. Sometimes the wart needs to be cut away. This can usually be done in the doctor’s office under a local anesthetic. Laser treatment can also be used, but is considered a last-resort option due to scarring.
As with anything, prevention is always best. If you have a wart, be sure to cover it to prevent spreading it to others. Finally, wash your hands frequently and always wear shower shoes in public showers.
Answer: It sounds like you have common warts, called verruca vulgaris by physicians. These occur mainly on the hands, fingers and knees; and your mother’s right that they are most common in children.
Common warts are caused by the human papilloma virus (HPV). An infection of the skin with this virus causes the outer layer of the skin to grow rapidly, which forms a wart. Warts are contagious. They can be passed from person to person through direct contact, which is partially why they are more common in children.
There are more than 100 types of human papilloma viruses. Many are harmless, and others can cause serious problems like cervical cancer. Different types of HPV cause different types of warts. For example, HPV can cause genital warts, which stem from a sexually transmitted infection. HPV also causes plantar warts, which occur on the soles of the feet and can be spread in public showers and other places where people walk around barefooted.
Because wart viruses can live on surfaces for a while, they can be spread by indirect contact, like wearing someone else’s shoes. Also, it may take several months for a wart to develop after exposure, so it’s often difficult to determine the source of the infection.
People with compromised immune systems, such as people with cancer or AIDS, are at increased risk for contracting any viral illness, including warts. Also at increased risk are children and young adults.
Many common warts will go away on their own, but people often treat them for cosmetic reasons or to help prevent their spreading. One recently confirmed home remedy involves duct tape. Simply adhere a small piece of duct tape directly to the wart to progressively kill the abnormal skin cells. Change the duct tape weekly, and file down the dead skin before reapplying. Continue until the wart is gone. Several-over-the-counter wart treatments are effective as well.
If warts are resistant to both the duct tape and over-the-counter-treatments, then a visit to your primary care physician or a dermatologist may be in order. Warts can be frozen off with liquid nitrogen, or treated with an acid or chemical. Both of these procedures may need to be repeated several times before the wart is fully removed. Sometimes the wart needs to be cut away. This can usually be done in the doctor’s office under a local anesthetic. Laser treatment can also be used, but is considered a last-resort option due to scarring.
As with anything, prevention is always best. If you have a wart, be sure to cover it to prevent spreading it to others. Finally, wash your hands frequently and always wear shower shoes in public showers.
SHINGLES NOT CONTAGIOUS FOR MOST
Question: Recently my 15-year-old daughter got shingles while we were on vacation visiting relatives. Everyone was worried about catching it; they thought every bug bite was the beginning of shingles. We were forced to return home early, because no one wanted to be around us. No one else got shingles, and my child is fine now. Did we do the right thing by leaving early to keep the grandparents and others from getting shingles?
Answer: Although your family’s concern was doubtlessly well-intended, the only people potentially at risk at your family gathering would have been any children who have never had chickenpox and never been vaccinated against chickenpox -- not the grandparents.
The herpes zoster virus that causes shingles is related to chickenpox, or the varicella zoster virus (VZV). Though shingles is not contagious to people who have had chickenpox before, it does originate in people –- usually adults -- who have had chickenpox. That is because the VZV permanently stays in your system after you recover from the chickenpox, typically in a dormant stage that does not make you sick. When the VZV reactivates, it causes shingles. It is not known what stimulates the virus to reactivate, but it is most likely to occur in people over the age of 50, and in people whose immune system is weakened by either chronic disease or chemotherapy. There is also a remote possibility that the tendency to develop shingles runs in families.
Shingles is not, itself, contagious. However, someone who has never had chickenpox and never received the chickenpox vaccine may catch chickenpox from a person with active shingles. The virus can spread through airborne droplets either from the rash itself or from sneezing or coughing, much like any viral illness.
Shingles does not usually start as a rash, but it is when the rash appears that most people go to the doctor. Like many viral illnesses, the person becomes ill and can spread the virus before they notice any specific symptoms. Shingles usually starts out with mild flu-like symptoms: headache, fatigue and sometimes a mild fever. Pain or abnormal sensations usually precede the appearance of the rash by a day or so. The rash is most common on the trunk and is limited to one side of the body, however, the rash can appear anywhere on the body.
If begun early enough, antiviral medication can help the rash heal more quickly than it would without any treatment. However, medication is not very helpful when started more than 72 hours after the appearance of symptoms.
There is a vaccine on the market to help prevent shingles, and it is recommended for people over the age of 60. Once someone gets shingles, they should avoid unvaccinated children who have never had chickenpox. If children are around, keep the rash covered and follow the rules regarding the spread of any virus: cover your mouth when you sneeze, and frequently wash your hands to help prevent the virus from spreading to a chickenpox-susceptible person.
Answer: Although your family’s concern was doubtlessly well-intended, the only people potentially at risk at your family gathering would have been any children who have never had chickenpox and never been vaccinated against chickenpox -- not the grandparents.
The herpes zoster virus that causes shingles is related to chickenpox, or the varicella zoster virus (VZV). Though shingles is not contagious to people who have had chickenpox before, it does originate in people –- usually adults -- who have had chickenpox. That is because the VZV permanently stays in your system after you recover from the chickenpox, typically in a dormant stage that does not make you sick. When the VZV reactivates, it causes shingles. It is not known what stimulates the virus to reactivate, but it is most likely to occur in people over the age of 50, and in people whose immune system is weakened by either chronic disease or chemotherapy. There is also a remote possibility that the tendency to develop shingles runs in families.
Shingles is not, itself, contagious. However, someone who has never had chickenpox and never received the chickenpox vaccine may catch chickenpox from a person with active shingles. The virus can spread through airborne droplets either from the rash itself or from sneezing or coughing, much like any viral illness.
Shingles does not usually start as a rash, but it is when the rash appears that most people go to the doctor. Like many viral illnesses, the person becomes ill and can spread the virus before they notice any specific symptoms. Shingles usually starts out with mild flu-like symptoms: headache, fatigue and sometimes a mild fever. Pain or abnormal sensations usually precede the appearance of the rash by a day or so. The rash is most common on the trunk and is limited to one side of the body, however, the rash can appear anywhere on the body.
If begun early enough, antiviral medication can help the rash heal more quickly than it would without any treatment. However, medication is not very helpful when started more than 72 hours after the appearance of symptoms.
There is a vaccine on the market to help prevent shingles, and it is recommended for people over the age of 60. Once someone gets shingles, they should avoid unvaccinated children who have never had chickenpox. If children are around, keep the rash covered and follow the rules regarding the spread of any virus: cover your mouth when you sneeze, and frequently wash your hands to help prevent the virus from spreading to a chickenpox-susceptible person.
WHEN STYES GET IN YOUR EYES
Question: Lately I’ve been getting these red bumps on my eyelids, and my mother keeps calling them “pig sties.” She told me to put hot compresses on them, and this usually works. Lately, they’re not going away, and I think I’m going to go to the doctor. Do I need to? What causes these? What can I do to treat or prevent them?
Answer: What you are describing is called a “stye”, not a “pig sty” (the medical condition can be spelled with or without the “e” at the end). The official medical term for a stye is a hordeolum. They occur when an oil gland -- called a meibomian gland -- in the eyelid becomes inflamed or infected. At that point, they swell up, much like a pimple, and they usually feel warm to the touch.
An internal stye occurs when a meibomian gland under the surface of the skin becomes infected, and an external stye occurs when the base of the eyelash gets infected, leaving a red lump on the edge of the eyelid. Most physicians do not distinguish between the two since the treatment is the same for both.
Your eyelids have many functions, but primarily, their job is to open and close in order to clean and lubricate your eyes. There are oil glands on the edge of the upper and lower eyelids that produce the necessary lubricant for your eyes. Unfortunately, bacteria can get into these glands and cause inflammation and infection. This leads to styes, which are a bit like boils that occur on your eyelids.
An experienced physician can diagnose a stye just by looking at it. Usually, no additional testing is necessary. You are right to apply warm compresses to treat these. I would recommend you use a warm compress about four times a day. If the styes don’t respond in a day or so, you may need to see a physician to get antibiotic eye ointment. Do not ever attempt to drain a stye by squeezing it or poking it with a sterilized needle. It is always best to leave them alone except for hot packs and medications. Squeezing can spread infection into the tissue around your eye, which can lead to serious medical conditions. Poking can do the same, plus it opens the risk of seriously damaging your eye.
While styes will usually heal and go away on their own or with a little antibiotic ointment, they sometimes do not drain if the oil gland becomes fully blocked. When this occurs, we call it a chalazion. This kind of infection may need to be drained by a licensed ophthalmologist.
One thing that will help prevent styes is to avoid pulling on your eyelashes. Sometimes excessive or old mascara can contribute to the development of a stye. Most importantly, always wash your hands before touching the area around your eyes.
Styes are a relatively common occurrence, but not everyone gets them. Some chronic conditions like diabetes and chronic dandruff increase their likelihood. It sounds as though your styes come often enough, and stay long enough, to warrant attention from your family physician.
Answer: What you are describing is called a “stye”, not a “pig sty” (the medical condition can be spelled with or without the “e” at the end). The official medical term for a stye is a hordeolum. They occur when an oil gland -- called a meibomian gland -- in the eyelid becomes inflamed or infected. At that point, they swell up, much like a pimple, and they usually feel warm to the touch.
An internal stye occurs when a meibomian gland under the surface of the skin becomes infected, and an external stye occurs when the base of the eyelash gets infected, leaving a red lump on the edge of the eyelid. Most physicians do not distinguish between the two since the treatment is the same for both.
Your eyelids have many functions, but primarily, their job is to open and close in order to clean and lubricate your eyes. There are oil glands on the edge of the upper and lower eyelids that produce the necessary lubricant for your eyes. Unfortunately, bacteria can get into these glands and cause inflammation and infection. This leads to styes, which are a bit like boils that occur on your eyelids.
An experienced physician can diagnose a stye just by looking at it. Usually, no additional testing is necessary. You are right to apply warm compresses to treat these. I would recommend you use a warm compress about four times a day. If the styes don’t respond in a day or so, you may need to see a physician to get antibiotic eye ointment. Do not ever attempt to drain a stye by squeezing it or poking it with a sterilized needle. It is always best to leave them alone except for hot packs and medications. Squeezing can spread infection into the tissue around your eye, which can lead to serious medical conditions. Poking can do the same, plus it opens the risk of seriously damaging your eye.
While styes will usually heal and go away on their own or with a little antibiotic ointment, they sometimes do not drain if the oil gland becomes fully blocked. When this occurs, we call it a chalazion. This kind of infection may need to be drained by a licensed ophthalmologist.
One thing that will help prevent styes is to avoid pulling on your eyelashes. Sometimes excessive or old mascara can contribute to the development of a stye. Most importantly, always wash your hands before touching the area around your eyes.
Styes are a relatively common occurrence, but not everyone gets them. Some chronic conditions like diabetes and chronic dandruff increase their likelihood. It sounds as though your styes come often enough, and stay long enough, to warrant attention from your family physician.
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