Man with groin rash that won’t go away. What is your diagnosis? Crutchfield Dermatology Case of the Month.

A 64 year old man presented with a diagnosis of tinea cruris. He said that he had been treating it for 3 years without resolution. He reported using at least 3 different prescription anti-fungal creams and for the past 5 months and used a different prescription cream called triamcinolone. He reports little to no pruritus. With the rash being so resistant, his primary care doctor referred him to a dermatologist for evaluation. Continue reading Man with groin rash that won’t go away. What is your diagnosis? Crutchfield Dermatology Case of the Month.

An infant with papules and pustules on feet. What is your diagnosis? Dr. Crutchfield’s Case of the Month

Foot sores

11-month-old infant presents with pruritic crusted papules and pustules on feet, as seen in the picture. Also hand and axilla involvement. A teen cousin visiting for the summer has a similar rash, and both are very pruritic.

Here is a picture of a mineral oil scraping I took through the microscope ocular with my cell phone.

Microscopic photo

What is your diagnosis?

Continue reading An infant with papules and pustules on feet. What is your diagnosis? Dr. Crutchfield’s Case of the Month

Olympics bring attention to cupping therapy

Cupping therapyDear Dr. Crutchfield: I was watching the Olympics and noticed several athletes had purple circular marks on their skin. Michael Phelps was one of the athletes. I was told the marks resulted from a treatment called “cupping.” What is cupping?

 

Although very popular now, cupping is actually an ancient medical treatment popular in Egyptian, Middle Eastern, and Chinese cultures. There are historical reports of cupping’s use as far back as 3,500 years ago. Continue reading Olympics bring attention to cupping therapy

Hyperpigmentation

Hi, this is Dr. Charles Crutchfield clinical professor of dermatology and medical director at Crutchfield Dermatology.

One of the most challenging and common problems in skin of color are skin disorders that effect the intensity of skin color. Some diseases make skin lighter and other skin diseases make the skin darker.

For example babies when they have diaper rash this can cause the skin in the area to become a lot lighter. It’s very common for a child of color to have a very light area especially after a diaper rash. This is where the inflammation of the diaper irritation causes the melanocytes to stop producing color even light or white patches.

With the appropriate treatment the color will almost always return within a few weeks In older patients inflammation can cause darkening of the skin. This is known as post inflammatory hyperpigmentation.

This is commonly seen in areas where acne blemishes have healed, leaving a dark spot in that area. These, too, will fade with time. However, it can be quite persistent and sometimes doctors must use
medicines to make the dark areas fade faster.

Darkness after skin irritation is notoriously difficult to treat and can take time.

Midline Hyperpigmentation & Macular Hypomelanosis

Hi this is Dr. Charles Crutchfield clinical professor of dermatology and medical director at Crutchfield Dermatology.

Today we are going to talk about two conditions– Midline Hyperpigmentation and also Macular Hypomelanosis. Two crazy long terms but you’ve seen them. They are real common. Often the central chest area can be slightly lighter in color than the other areas around it this is just a normal variation that we see in skin of color. Continue reading Midline Hyperpigmentation & Macular Hypomelanosis

Treating skin of color – Part 3 of 4

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Most skin diseases occur in people of all nationalities, regardless of their skin color. Certain problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This week continues our review of these disorders and their treatment.

 

Keloids

Throughout evolution, our skin has become quite skillful at repairing any sites of injury or damage. Once the integrity of the skin barrier has been interrupted, invaders such as bacteria, fungus, and virus can penetrate the skin and important

Keloids before (l) and after

Keloids before (l) and after

bodily fluids can leak out. As a result, the skin’s repair system is rapid and complete.

Cells known as fibroblasts migrate into the area and produce protein to fill in the hole. The major component of the repair product is collagen, and that is what makes up a scar. Unfortunately, in some cases, and commonly in African Americans, the fibroblasts receive the signal to come in and repair the defect; however, they do not get the signal to turn off.

As a result, too much collagen is produced and the scar can become thick and hard. When the collagen presses on nearby sensory nerves, the keloidal scar can also produce tenderness, pain, and extreme itching.

The difference between a hypertrophic and kelodial scar is that that hypertrophic scars usually stay right at the site of injury, whereas keloids can actually spread and invade normal surrounding skin. In our clinic, we use an aggressive six-month program to effectively treat keloids.

It is one thing to surgically remove a keloid, yet it is another thing to keep it from coming back. Remember, the development of a keloid is a response to injury. By surgically removing a keloid, the skin is being re-injured, and that area has already shown it can form a keloid.

We perform regular treatments every two to four weeks over a six-month period, including anti-inflammatory injections, topical silicone-based preparations, pressure dressings, and laser treatments to prevent the return of keloids.

 

 

Acne keloidalis nuchae

This condition is also known as folliculitis keloidalis nuchae, where small, very itchy bumps can occur at the nape of the neck. This is most commonly seen in African American patients, but to a lesser degree it can affect all patients. It is most commonly seen in men, but can also be seen in women.

Many male patients believe this is a result from a barber shop treatment where the barber had unclean clippers. This is quite untrue, and I have seen many cases that develop without any previous haircuts.

One theory is that this condition is a result of a deep fungal infection. However, in my experience, I have performed many biopsies and analyzed cultures for fungus and special histology stains, but I have not yet identified a fungus infection. I believe this condition is just an anatomic and genetic variant, with itchy bumps developing from very mild irritation in this particular anatomic location.

Smaller bumps can be treated very effectively when treated with a combination of topical and oral anti-inflammatory medications. In many cases, a short course can provide long-term results. Often a surgical approach is required if the lesions are too large. Nevertheless, the condition can be managed quite well.

 

Pseudofolliculitis barbae 

This condition is also known as “razor bumps.” Hair is made of protein called keratin and it can be extremely inflammatory to the skin. It is called “pseudo” folliculitis because the hair can actually come out of the follicular opening and penetrate nearby skin, causing it to look like an inflammation or folliculitis of that pore. However, because it is just nearby the actual follicle, it is “pseudo” folliculitis.

This is most often seen in persons with curly hair or hair that grows at an oblique angle to the skin. Sometimes, if curly hair is cut extremely close, it never even exits the skin but instead penetrates the sidewall of the follicle (known as transfollicular penetration), or it comes out of the follicle and pokes the skin (known as extrafollicular penetration). The results are the same: the keratin invades the skin, producing a brisk inflammatory reaction that causes itching and the formation of pustules.

When pseudofolliculitis is mild to moderate, many topical treatments can be implemented, including a very mild oatmeal-based shaving cream, and a non-electric razor with a safety guard so the hairs are not cut too short. Shaving after a shower is also recommended — the hair is hydrated, so the final tip is soft as opposed to sharp.

In addition, using a soft-bristle toothbrush to make circular motions in the beard area before bedtime can prevent the hair from penetrating as it grows throughout the night. Topical anti-inflammatory aftershave lotions and oral anti-inflammatories can also be used if necessary.

In the majority of cases, this can provide satisfactory relief. However, in certain cases where relief is not achieved through these means, the best treatment is to remove the offending agent. In this case, I recommend laser hair removal.

Pseudofolliculitis barbae has been a vexing problem throughout history and can even interfere with occupations that require a clean-shaven face, such as military officers, peace officers and firefighters. Thankfully, this condition can be addressed by implementing appropriate treatments and techniques.

 

Next week: more skin problems common to people of color

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the U.S. by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Recognizing and treating Molluscum Contagiosum

What is Molluscum Contagiosum? 

Molluscum Contagiosum is a viral infection that produces small, flesh-colored, dome shaped bumps that can often become irritated or painful. They may appear to have a shiny surface in a small central indentation, or white core.

Why should I care about Molluscum Contagiosum?

Molluscum Contagiosum is a benign condition that will spread through direct skin contact. This contact can be in the patient’s own skin spreading to other areas, or from direct skin-to-skin contact, especially in children. Molluscum Contagiosum can also be transmitted through swimming pools and shower room floors.

Most cases of Molluscum Contagiosum will go away without treatment. As the name implies, the condition is very contagious. Some of the lesions can become very painful and infected. When this happens, treatment is usually indicated.

man locker room

What causes Molluscum Contagiosum?

Molluscum Contagiosum is a viral infection caused by the poxvirus that infects only the skin and not any internal organs.

How common is Molluscum Contagiosum?

Molluscum Contagiosum is very common, especially in children whose immune systems have not developed immunity to the poxvirus that causes Molluscum Contagiosum. advice.42 web

 

How is Molluscum Contagiosum diagnosed?

The diagnosis of Molluscum Contagiosum is most commonly identified by a visual diagnosis; however, a biopsy of the skin and/or skin scrapings can also confirm the diagnosis.

flip flops

Can Molluscum Contagiosum be prevented?

Molluscum Contagiosum can be prevented by avoiding direct skin-to-skin contact with other persons who have Molluscum and wearing flip-flops to protect the skin from the floors of shower rooms. It is important for patients not to scratch Molluscum as it can spread to other areas of the body. This is especially important because shaving the legs is a common cause of spreading.

sandals

How is Molluscum Contagiosum treated?

Molluscum Contagiosum is often treated by “lack of treatment,” because many of the lesions will resolve on their own. As a dermatologist, I usually encounter the more difficult cases that do require treatment. I believe if you’re going to treat Molluscum, one should treat it early to prevent spreading it to others.

Because it is a viral infection, we must recruit the patient’s immune system to do a better job at recognizing the cells infected with the virus, and then eliminating the infected skin cells. This can be done by several methods including freezing, scraping, topical medications and laser therapy. All of these treatments can be performed in a dermatologist’s office.

If there are many lesions, several treatment sessions may be required for complete clearing. Some discomfort is also associated with Molluscum Contagiosum treatments. Sometimes an “at-home treatment” is also recommended; this can include applying topical medications. During treatment sessions, some new Molluscum may develop, and this is normal.

Action steps for anyone with unwanted Molluscum Contagiosum

Lesions should be covered to avoid direct skin contact with other schoolchildren, or other people, to prevent spreading of Molluscum. If a patient has Molluscum Contagiosum, the condition should be evaluated by a primary care physician or dermatologist to see if treatment is required.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African-American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.

Why should I care about DPNs (face flesh moles)?

Dermatosis papulosa nigra (DPN) is a unique skin condition seen primarily in persons of color. It appears as small, dark bumps and most commonly affects the forehead, cheeks, and neck. The bumps increase in size and number over time, initially appearing in people ages 20-30. Some people call them “flesh moles.” Bill Cosby, Morgan Freeman and Condoleezza Rice are notable people with the condition. It tends to occur slightly more frequently in women than in men.

What causes DPN?

The cause of dermatosis papulosa nigra is uncertain. There is a strong genetic basis for the disorder, and oftentimes the lesions can be seen in several members of the same family. Under the microscope, the lesions are a type of keratosis that is harmless. Dermatosis papulosa nigra is not a skin cancer, and it will not turn into a skin cancer.

 

How is DPN diagnosed?

The diagnosis is easily made by a dermatologist.

Face moles before treatment
Facial moles before treatment & removal

 

 

face mole removal
Face after mole treatment and removal

Can DPN be prevented?

No, because it is passed on genetically. One can treat the bumps when they are small to prevent them from becoming obvious and maintain a regular treatment program (every 1-4 years) to keep them away.

 

How is DPN treated?

Generally speaking, no treatment is necessary other than for cosmetic concerns. In certain circumstances, if the lesions are symptomatic (painful, inflamed or itchy) or cosmetically undesirable, the lesions can be treated via a minor in-office surgical procedure with excellent results. Your doctor will review treatment options with you and recommend the one that is most appropriate for your condition.

 

Action steps

Realize the condition is inherited and occurs later in life but does not turn into skin cancer. The spots may get worse over time, and they can be removed if they are irritated or unwanted. If DPN is undesirable, there are techniques used by an experienced dermatologist to provide excellent treatment results.

 

Charles E. Crutchfield III, MD is a board-certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine and one of the top 21 African American physicians in the U.S. by the Atlanta Post. Dr. Crutchfield is an active member of the Minnesota Association of Black Physicians, MABP.org.