I have a skin problem: Who should I see?

Without question, it is ALWAYS best to see a well-trained, board-certified Dermatologist if one has any skin problems (rashes or growths).  Although many PCPs and Urgent care centers can handle COMMON problems (i.e. Shingles, poison ivy and minor burns), but what happens when both you and the doctor does not know what is the diagnosis? In many of these cases, patients are treated with Lotrisone (clotrimazole/betamethasone cream), which I call the “I have no idea what you have so I will give you this” medication.

In short, this medication is RARELY ever used by Dermatologists for a couple of reasons. It is a combination of a VERY STRONG topical steroid with an old anti-fungal agent. If one really had a fungal infection, topical steroids actually stimulate the growth of fungi. For this reason, it is uncommon to use a very strong steroid with an anti-fungal drug. Additionally, the use of strong topical steroids can thin the skin if used for more than 2 weeks, especially if used in the armpits, groin, face, or neck. I see patients regularly who are prescribed this medication only to be left with thin skin or stretch marks that will not go away. Dermatologists do occasionally use topical steroids with anti-fungal creams, although usually they prescribe them both separately, which costs less and is safer.

In summary, if you have an acute problem, such as an infection, Shingles, a burn, or Poison Ivy, your PCP and/or local Urgent Care Center will likely be able to treat you effectively. For these acute problems, you do not want to delay treatment.

If you have a “rash” or “growth” and do not know the cause, your best bet is to find a good Dermatologist. In my experience, it is far less costly to pay more for a visit with a Specialist than to be ineffectively treated with medications that can be costly. For example, a 15g tube (tiny) of generic Lotrisone can cost $131 compared with a 85g tube of another steroid that costs $12.

Most importantly, Emergency Rooms are for just that–life threatening emergencies. Nearly all skin conditions are NOT life-threatening, and unless one has reason to suspect otherwise (many blisters, sheets of skin coming off, or suspected serious infection), one should not seek advice for skin conditions in an Emergency Room Setting. There are times when one might be prompted to go to the Emergency Room. An example of such would be a diabetic who thinks that he/she has cellulitis who calls his/her PCP for advice and is then directed to go to the Emergency Room for evaluation.

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Fragrance-Free and Hypoallergenic Moisturizers: MOST are not!

A study published in JAMA looked at the 100 “best-selling” moisturizes that claim to be “hypoallergenic” found that 83% had a potentially allergenic chemical. Additionally, the study found that 45% of the products marketed as “fragrance-free” contained a botanical ingredient or one that reacts to a fragrance that can cause reactions.

Top 10 Allergens in Children

Topical allergies are common in both children and adults. If one suspects a topical allergy in children, this top 10 list contains the most likely culprits. One can start by avoiding these 10 compounds.

  • Tixocortol pivalate (a corticosteroid).
  • Propylene glycol (found in many creams, lotions, and solutions).
  • Methylchloroisothiazolinone (MCI)/methylisothiazolinone (MI) (a preservative used in anti-fungal and anti-bacterial medications)
  • Formaldehyde (found in dental materials, paper products, inks & dyes, & fire-resistant clothing).
  • Cocamidopropyl betaine (is known by many other names so one should research all of the possible names; found in many skincare products, including shampoos & conditioners, body washes, and hair dyes; also found in laundry detergents, hand soaps, toothpastes, cleaning products.
  • Lanolin (commonly found in lipsticks, cosmetic creams and powders, shaving creams, shampoos, and soaps).
  • Benzalkonium chloride (a preservative used in many injectable medications, eye drops, ear drops, and nasal sprays).
  • Fragrance and balsam of peru.
  • Neomycin (used in over-the-counter antibiotic ointments).
  • Nickel (in metals, including costume jewelry and gold that is not 24K).

Henna Tattoos: Severe reactions may occur

Most people think of Henna tattoos as a harmless ink that is applied to the skin. That is not always the case. Some Henna dyes contain paraphenayline diamine (PPD), which is the dye used in permanent hair dyes. This ingredient can result in severe allergic reactions.

In a case reported in BMJ Case, a 10-year old boy had a severe reaction to a Henna tattoo.