Davis Square Family Practice Newsletter
In This Issue
Common Skin Conditions
Job Prospect
Join Our List

Join Our Mailing List

Common Skin Conditions
skin cross section
Job Opportunity
Deborah Bershel, M.D.
 Marie Botte, N.P.
Robert Love, N.P.
Anne Roche
Office Manager
Qianna Price
Lead Medical Assistant
Kristen O'Callaghan
Medical Assistant
Randi Baxter
Medical Assistant
 Monica Pereira
Jason Joyce
Dorothy Anderson
Issue: #10June 9,2010
Sneezing boy

I hope you find the article on common skin diseases informative and will keep it handy for future reference. If you misplace the article, it will be posted on our website at www.dsfamilypractice.com .  Also, I will begin posting potential job prospects in the newsletter.   For many of us a rewarding career is an important part of overall wellness. So, if any of our patients would like to forward any employment opportunities to us, we will be glad to post them here and/or on the website.
Deb Bershel, MD
Common Skin Conditions
skin cross section
skin cross section

Common Skin Disorders

Skin conditions are one of the more frequent causes for office visits. Fortunately, they are usually self-limited and resolve with little or no intervention on your part. But when 'rashes' don't want to go away and they hurt or feel itchy then they can be a cause of considerable consternation. Perhaps the most useful aspect of this article will be the photos. Most of the dematological  conditions I will discuss truly match up nicely with the photos.

The commercial website Medicinenet.com  has an excellent photo slide show of 20 common skin rashes at the following Skin rash photos   I will make some brief comments on these dermatoses in their order of appearance on the slide show. Please continue to refer back to the slide show as you read my blurbs on the specific conditions.

Shingles - Very important to treat early.  May start out as a burning sensation with mild rash.  Call within 24 hours if you think you may have it. We will treat sometimes over the phone. I'm not crazy about the vaccine but some people may benefit from it.

Hives - Usually self-limited. If over-the-counter antihistamines fail to help, oral steroids may sometimes be employed.  Although rare, if you have any concern about breathing issues, then go to the emergency room or call an ambulance.

Psoriasis - Hereditary in nature, it typically starts in childhood . Can be associated with arthritis.

Eczema - Sometimes used interchangeably with the term atopic dermatitis and other times used as a 'wastebasket' term for any itchy rash that we don't know what the heck it is. Usually responds to steroid cream quite readily (or avoiding the irritant such as a rubber gloves or an annoying boss.)

Rosacea - Also called acne rosacea. This can be confused with garden variety acne or seborrheic dermatitis (see below). Often successfully treated with topical antibiotics and avoiding items that might make you flush such as alcohol or caffeine.

Contact Dermatitis (rash from plants) - You can get this from poison ivy or contact with any item you are sensitive to such as nickel or a chemical such as hair dye. This rash can slowly spread over large parts of the body. Topical steroids work, but oral steroids are often necessary when large areas are affected.

Razor bumps (psedofolliculitis barbae) - Often due to curly hairs growing out and curving back into the skin, this condition may require antibiotics and usually respond to allowing the hairs to grow out.

Skin tags - Yes they are ugly but purely a cosmetic nuisance unless they get caught in jewelry.

Acne- I do consider this an important problem and if we cannot help you, I'd certainly refer you to a dermatologist. Sometimes acne is confused with folliculitis or rosacea which may be caused by a different bacterium than that which causes typical acne.

Athelete's foot (tinea pedis) - Over-the-counter Lamisil is great for this.  If Lamisil and keeping feet dry doesn't cure you, then you may have a shoe/sneaker sensitivity. Sometimes the rubber and chemicals in our shoes and sneakers can cause contact dermatitis.

Moles - The picture here is NOT a good one and just looks like a pigmented skin tag to me. You can get new moles up until 35 years of age (not 20 as noted in photo blurb).

Lintigene - Cosmetic. I can't wait to get them.

Pityriasis rosea - Common in young adults and older kids.  Looks scary but no treatment is necessary.

Melasma - Certainly can be cosmetically important.  Over-the-counter hydroquinolones can help. Paint the margins of the pigmented area with petroleum jelly to prevent lightening the normal skin. Adding tretinoin (Retin-A)  may help if the hydroquinolone fails.

Fever Blisters (Herpes oralis) - Caused by essentially the same herpes simplex virus that causes genital herpes.  I think oral medicine works better than topicals. Come in or call if you feel you get cold sores more often than you'd like.

Warts -  These babies in the photo are too numerous and big for home remedies and a dermatologist referral would be in order. But for most warts, over-the-counter treatments usually work well.  One offbeat but proven approach is using duct tape. Duct tape protocol is:  6 days on and one day off. File wart down and repeat duct tape as before until wart gone. If it's a small wart, we can freeze them in the office.

Seborrheic Keratosis - These can look worrisome, but they are benign and usually start popping up in our 40's and beyond. Some squamous cell carcinomas can look like this so if you are unsure about what you have we can take a peak.

Ringworm - More common in kids as their immune systems are less mature. If over-the-counter antifungals like Lamisil don't work within 10-14 days (anti-yeast meds won't cure typical ringworm), then let us have a look.

Boil (skin abscess) - Let us 'pop' them for you. We are usually better at it and can try to minimize scarring. Warm compresses can help (and rarely antibiotics help).

Cellulitis -  Basically an infection of the skin that slowly, or sometimes quickly, spreads.  This condition does respond to antibiotics. If you have such a rash and a fever or if you have diabetes or a chronic illness, please call us, or the covering physician, immediately.  In such cases, this infection can be life-threatening. Occasionally confused with a reaction to a bug bite.


Seborrhea -  This is usually a chronic rash that many people surprisingly are willing to put up with for years even though it is often easily treatable. Caused by a fungus (pityrosporum ovale), topical or oral antifungals can really help. Often appears on scalp, eyebrows, chin and middle of chest.  Frequently confused with rosacea


Lyme Disease - The rash shown is erythema marginatum. Unfortunately, lyme disease can present with almost any type of rash (or no rash at all). If it is the spring or summer and you or your children have a fever and muscle aches with or without a rash, please think of lyme disease and not the flu. Lyme disease can present any time of the year. It can be carried by the deer or the dog tick.  Remember, we will treat adults and children over the phone with one dose of antibiotic if you have had a tick on you for more than a few hours.  Authorities say 48-72 hours, but I don't like those guidelines. I had a separate article on this earlier and you can refer back to it on the practice website.

lyme diseaseLyme Tick

Skin Cancer -  I hesitate to show pictures of skin cancers as I would NEVER want someone to ignore a cancer because it didn't match up with a photograph you had seen either in this article or on the internet. With regard to possible skin cancer of any type, in my opinion, your job as a patient  is to recognize that you have a new growth on your body and if it just isn't going away then you should have us take a look.

Melanoma will not be discussed at length, because even I find them challenging to diagnose without performing a biopsy.  If you look at the pictures of melanoma, you will notice irregular borders and multiple coloration. Many people have many moles on them that look similar to those in the picture and they DO NOT have melanoma. If you are concerned that a pigmented mole has changed in color, size or shape than we should see it.  We will work you into the schedule so as to ease your mind.

The most common skin cancer is the basal cell carcinoma and closely followed by the squamous cell carcinoma. I will show you examples of each. The basal cell cancer is often easy to recognize because it often appears as a growth  with heaped up edges that can have a volcano-like appearance. Sometimes they do not have such a classic presentation. They often appear on sun exposed areas such as the face and shoulders but can be found almost anywhere on the body.
basal cell carcinoma

Squamous cell cancer tends to look more like a crusty, scaly growth. In light-skinned people who worshipped the sun there may be hordes of scaly lesions on the face and these are called actinic keratoses. Some of these can become squamous cell cancers down the road but most will not. I like to have a dermatologist check folks on a regular basis if they have these actinic keratoses.  Dermatologists have some simple methods for clearing them up. Sometimes seborrheic keratoses (see earlier photos) can be confused with squamous cell cancer and we can easily settle the issue with an office visit.

squamous cell carcinomaactinic keratosis
squamous cell cancer     actinic keratosis

If there are other skin conditions you'd like me to discuss please let me know. I hope to cover common childhood rashes in the future.


Job Prospect
jobs -humorous 
Jay Taylor of Jason R. Taylor Associates is looking for a talented, motivated individual to fill a job position.  Applicants should be able to program interactive, animated apps for the iPad and iPhone.  If this sounds like you, please contact Jay Taylor directly at gailjay@edufables.com.
Good Luck!
We have a wonderful website that offers many services to help enhance your patient care experience with us.  Refill prescriptions, request a referral authorization, read one or more of the many articles listed in our Medical Library and pay your bill, and these are just a few of the services our website has to offer.  Check our site out at www.dsfamilypractice.com.
Until next time,
Deb Bershel, MD