Common skin conditions

 | March 1, 2007

Common skin conditions

Your skin becomes vulnerable to a number of conditions as you get older. Some are caused by hormonal shifts or occupational exposures. Others are caused by exposure to the elements, wear and tear on blood vessels, or infections. Dermatologists have a number of treatments available (see Table 1).

Table 1: Choosing the right treatment
Condition	Treatments
Dry skin	Petroleum jelly, mineral oil, or moisturizing lotions applied immediately after bathing
Sun damage, photoaging, and related skin conditions, such as lines and wrinkles, sagging skin, liver spots, actinic keratosis, loose eyelid skin	Sunscreens and sun blocks, cryotherapy, topical creams for actinic keratosis, laser therapy, chemical peels, soft-tissue augmentation, botulinum toxin injections, microdermabrasion, surgery
Hair loss	Minoxidil, finasteride, hair transplantation, scalp reduction, scalp flap surgery, tissue expansion
Birthmarks, tattoos, growths	Laser surgery, surgical excision, cryosurgery, chemical peels
Cysts, moles	Surgical excision
Fat deposits	Aerobic exercise, liposuction
Scars resulting from acne or injury	Laser therapy, soft-tissue augmentation, dermabrasion, surgical scar revision, chemical peels
Skin cancers	Surgical excision, Mohs' micrographic surgery, laser surgery, cryosurgery, topical chemotherapy
Rosacea	Topical antibiotics and other topical medications and systemic antibiotics to reduce papules and pustules; laser or light treatments for red or dilated blood vessels
Spider veins and varicose veins	Laser therapy, sclerotherapy

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Dry skin

Just about everyone has dry skin at some time in his or her life, but it becomes much more common with age. A tendency toward dry skin can be inherited, but experts estimate that at least 75% of people over age 64 have dry skin. Although you may take it for granted that skin becomes dry as a result of chronological aging, much of the loss of moisture is due not to aging, but rather to the cumulative effects of sun exposure. Sun damage results in thinner skin that doesn't retain moisture.

Over time, the production of natural oils in the skin also slows, and skin isn't as well lubricated as it once was. The outermost layer of the skin can be likened to a brick wall: The skin cells are stacked in layers with a "mortar" of keratin and natural oils that maintains the skin's suppleness. Just as a brick wall dries and crumbles with time and exposure to the elements, so, too, can skin become dry, cracked, and itchy. Some medical conditions, such as hypothyroidism, diabetes, and kidney disease, increase the likelihood of developing dry skin.

Symptoms of dry skin Scaly patches of skin Itching Scaly redness Overall dryness

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Treating dry skin with moisturizers

The first line of defense against dry skin is an effective moisturizer that softens and smoothes skin with water and lipids (fats). Some of these products attract water to the skin and seal it in, while others prevent skin from losing water by coating it with a thick, impermeable layer. One of the most effective products is petrolatum, also known as petroleum jelly. It's used in a number of moisturizers and ointments because it's inexpensive and stops water loss without clogging pores. Lanolin is another widely used ingredient. But despite their ability to soothe the irritation of dry skin, moisturizers can't prevent or reduce lines and wrinkles.

Petroleum jelly, although effective, isn't very popular as a moisturizer by itself because it feels greasy. And people with arthritic hands find such thick moisturizers difficult to apply. Moisturizing oils, such as mineral oil, are effective without being as greasy. Petroleum jelly and moisturizing oils contain no water. Because they don't add water, they're best used while the skin is still damp after bathing to seal in moisture, which prolongs their skin-softening effect.

Lotions and creams are emollients that contain basic ingredients of water and oil and can be used at any time to help add moisture to the skin at least temporarily. For commercial appeal, many have fragrance and color added. Lotions and creams are more popular than petroleum jelly or oils because they're less greasy and more cosmetically appealing. Lotions have a thinner consistency than creams because they contain more water. Most also contain an emulsifier to keep the product from separating. Humectants, including sorbitol and glycerin, are used to bind water to the skin and help it absorb moisture.

Fast fact When you shop for a moisturizer, don't assume that a hefty price tag will buy you a more effective product. Moderately priced moisturizers, available in drug stores and supermarkets, can be equal to or better than the expensive brands sold in department or specialty stores. One of the most effective products is one of the cheapest: petroleum jelly.

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Six ways to prevent dry skin

Along with moisturizers, a few changes in lifestyle or your environment can help alleviate dry skin:

Add moisture to the air with humidifiers or a pan of water set atop the radiator.

In the shower or bath, use water that's lukewarm instead of hot; hot water can further dry the skin by stripping it of natural oils.

Choose nondrying soaps that contain no abrasives or irritants. Super-fatted soaps or cleansing bars are less drying than regular, liquid, or antibacterial soaps.

Instead of rubbing, pat your skin dry after you bathe.

Apply moisturizer immediately to retain the water your skin absorbed while bathing.

Wear soft fabrics that won't scratch or irritate the skin.

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Adult acne

A common problem in adolescence, acne may appear for the first time or worsen in midlife for reasons not fully understood. Hormonal fluctuations associated with menstruation and menopause make women more susceptible to adult acne.

Acne is generally attributed to an excess of male hormones known as androgens. Androgens stimulate the production of oily, waxy sebum by sebaceous glands in the dermis associated with acne. Overproduction of sebum may lead to blocked pores in the skin and a rapid growth of normal skin bacteria.

Symptoms of adult acne Whiteheads (closed, plugged oil glands) Blackheads (open, plugged oil glands) Pustules (swollen red bumps), sometimes filled with pus

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Treating adult acne

Several effective treatments for acne are available. If you have mild acne that's not inflamed, treatment with a nonprescription cream or lotion that contains benzoyl peroxide will help keep pores open and inhibit bacterial growth. Salicylic acid and sulfur in nonprescription lotions, creams, or gels can't prevent new eruptions, but they can cause existing ones to dry and peel.

Topical antibiotics — erythromycin, clindamycin, and others — kill bacteria and are available with a prescription. So are oral antibiotics, which are even more effective. Both kill Propionibacterium acnes, the bacterium involved in the development of acne.

Retinoids, available by prescription, are derived from vitamin A and are a common and useful acne treatment. They cause several changes in skin cells that reduce the formation of pimples. Retinoids are especially effective when used with antimicrobial drugs — either antibiotics or benzoyl peroxide. Using a retinoid and an antimicrobial agent works better than using either drug alone. Tretinoin (Retin-A) is the retinoid most commonly used for treating acne, but it can irritate your skin. A microencapsulated form of tretinoin is less irritating. Tretinoin and two similar drugs, adapalene and tazarotene, are available only by prescription. Another treatment is azelaic acid, an antibacterial agent for mild or moderate acne.

The most powerful retinoid is isotretinoin (Accutane), which you take orally rather than apply topically like tretinoin. Isotretinoin is very effective for severe acne, but has some side effects, such as dry skin and chapped lips. Less common side effects are increased sun sensitivity, muscle and joint aches, headache, hair thinning, and impaired night vision. The drug is known to cause severe birth defects and must not be taken during pregnancy. A few patients taking isotretinoin have developed psychiatric problems including depression and, more rarely, suicidal behavior. As a safeguard, the federal government placed further restrictions on isotretinoin prescriptions. Doctors must register each patient in a national database and see the patient monthly, renewing the registration with each office visit.

Many women — up to 60%, according to the American Academy of Dermatology — show no response to routine acne treatment or find that their medications become ineffective over time. Because of this, isotretinoin has become a more common option, despite its drawbacks.

The same is true for hormonal treatments. Estrogen-dominant oral contraceptives often are effective in treating adult women with acne. The combined estrogen and progestin that they contain decrease androgen levels. Undesirable effects include nausea, headache, and breast tenderness, but oral contraceptives may help decrease bone loss and lower the risk for ovarian and colorectal cancers. The anti-androgen drug spironolactone may be added if oral contraceptives alone are not effective.

Women with hypertension or a history of stroke, blood clots, breast or uterine cancer, or who still smoke after age 35 should not use oral contraceptives. Alternatives include spironolactone, used with antibiotics or by itself. Light and laser treatments are also useful for treating acne and acne scars.

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Rosacea

This condition is sometimes confused with adult acne because it causes pimples on the face, affects mainly adults, and responds to some acne medications. But acne and rosacea are separate disorders. Rosacea is a chronic condition that affects the skin and sometimes the eyes. Symptoms may include pimples and enlarged blood vessels, causing redness and swelling mainly on the middle of the face. Eye irritation is another symptom, often referred to as ocular rosacea. Rosacea affects 14 million Americans. It's not clear what causes the condition, but genetics and environmental exposures seem to play a role. Rosacea runs in families. Some experts think that exposure to certain mites or bacteria may trigger rosacea by causing inflammation.

Symptoms of rosacea Flushing of the face and neck Pimples Enlarged blood vessels (called telangiectasia) Redness and swelling of the nose Irritation of the eyes

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Treating rosacea

Rosacea has no cure, but treatment can help control pimples and prevent the most severe symptoms — enlarged blood vessels and redness and swelling of the nose. Treatment often involves applying topical medications, taking oral antibiotics, or both, as well as avoiding substances that irritate the skin and trigger symptoms.

Some of the same medications that are used to treat acne pimples are also used to treat pimples from rosacea, including antibiotics and benzoyl peroxide cream or lotion. Metronidazole and azelaic acid creams and gels are very helpful topical antibiotics. It can take at least a month to see results from topical medications.

For enlarged blood vessels, doctors often recommend laser surgery, light treatments, or electrosurgery with an electric needle. All of these procedures destroy the blood vessels that cause red lines and blotches.

Self-help measures are essential for controlling symptoms. Anything that increases blood flow to the face can potentially cause a flare-up of symptoms. This includes drinking hot drinks or alcohol, eating spicy foods, taking hot baths or showers, and rubbing the face while washing. Avoid lotions and cosmetics that contain alcohol and fragrances because these chemicals can irritate the skin and aggravate rosacea.

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Hair loss

Hair loss affects about 50 million men and 30 million women in the United States. Age-related hair loss usually results from hormonal changes and genetic predisposition. In recent years, topical medications and refined techniques in hair transplantation have helped ease the distress that hair loss causes.

A number of factors can cause hair loss, including immune disorders, exposure to toxic chemicals, stress, burns, and various skin disorders. But more commonly, hair loss is caused by aging or an inherited predisposition to premature thinning called androgenic alopecia. Often referred to as male pattern baldness, androgenic alopecia is more common in men because it develops in response to higher androgen levels. In women, a similar condition is called female pattern baldness. It may occur in women before age 40, but is more likely to coincide with menopause.

Symptoms of hair loss Hair loss may follow one of several patterns depending on the cause: receding hairline and gradual loss of hair on top of the head even thinning of hair over much of the scalp scattered areas of hair loss

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Treating hair loss with topical medications

Minoxidil (Rogaine), a nonprescription lotion which is applied topically, and finasteride (Proscar, Propecia), a prescription drug taken orally, are the only two medications the FDA has approved to treat hair loss in men. For women, only minoxidil is approved.

Minoxidil increases the anagen, or growth, phase of hair, and returns shrunken hair follicles to a more normal size. In one study, men who used minoxidil for 96 weeks experienced a 30% increase in hair weight, compared with a slight decrease in men who did not use the drug. A more concentrated solution of minoxidil — 5% versus 2% — has been found to be more effective in increasing the number of hairs in studies of men. In women, minoxidil has been shown to promote new hair growth, but there has been no difference between the two concentrations.

Finasteride, a drug also used to treat prostate enlargement in men, lowers levels of dihydrotestosterone, a hormone involved in hair loss, without disrupting testosterone activity. In a study of 1,215 men who used finasteride for two years, two-thirds had significant improvements in hair growth and the remaining third had as much hair as when the study began. On the other hand, finasteride has not been effective in postmenopausal women.

Thus far, only one study has directly compared minoxidil and finasteride, and it found finasteride more effective. For a year, 40 men with androgenic alopecia took finasteride once a day, and 25 men with the condition used a 5% solution of minoxidil twice a day. At the end of the study, 80% of the finasteride group and 52% of the minoxidil group had thicker hair. Because the medications promote hair growth in different ways, some people choose to use both at the same time. However, there's little evidence that simultaneous use results in more or faster growth.

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Hair transplants

Decades ago, the results of hair transplants weren't always attractive. Because transplants moved large "plugs" of hair to thinning, balding areas, the effect often was artificial-looking. Today, refinements in hair transplantation techniques offer a much more natural appearance.

To achieve natural-looking transplants and minimize scarring in the area from which hair has been transplanted, surgeons no longer "punch" pieces of hair-bearing skin from the back of the head. Instead, they cut a small strip of skin from the back of the head, which then is dissected into tiny sections. These micrografts and minigrafts contain as few as one to five hairs. Minigrafts and micrografts provide a natural look around the hairline, but larger grafts can be used behind the hairline to achieve greater density.

Surgeons may choose among several grafting techniques. Needles and blades commonly are used to create the small slits or holes into which the grafts are placed. Sometimes lasers are used. While lasers may result in less bleeding and scarring, regrowth of the transplanted hair may be slower than with more traditional methods. Automated grafting devices that resemble a ballpoint pen with a retractable needle may be used, too. On average, it takes about four hours to transplant 1,000 grafts by hand. But one of the automated devices has been clocked at 38 grafts per minute. Despite their speed, these automated devices may be more expensive to use because they have to be replaced more often than needles and blades, and results with fine hair may not be as good as with coarse hair.

Surgeons perform graft procedures on an outpatient basis with local anesthesia. Bandages can be removed the next day, and most people can resume their everyday activities, with the exception of strenuous exercise. It takes a week to 10 days for scabs or crusting to heal, but many people feel comfortable going out in public wearing a hat or scarf three to five days after the transplant. The transplanted hair begins to grow within three to six months. Within ten to twelve months, most people can expect to see their transplant reach its maximum density.

Most hair transplants will not be completed in one session. Two or three sessions are often needed, depending on the desired result, and they should be spaced about four months apart so the scalp heals adequately between surgeries.

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Other hair-restoration techniques

A less common procedure is called skin flap surgery. A section of scalp with healthy hair is cut and moved with one end still attached to maintain blood supply. Essentially, it replaces a piece of bald scalp with a piece that has growing hair. New hair grows and covers the scars.

Another technique, scalp reduction surgery, reduces the size of bald spots at the crown. In this procedure, the surgeon cuts out the hairless area of skin, stretches the scalp, and then sutures it so the areas that are covered with hair will meet. Sometimes physicians combine scalp reduction surgery with the use of scalp extenders or tissue expanders that stretch areas of skin, which is then excised, further reducing the size of the bald area. Physicians also can use these techniques along with grafts or topical minoxidil. Some procedures may require general anesthesia. You can determine which approach is best for you by consulting a dermatologic surgeon.

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Excessive hair growth

Just as hormones influence hair loss, they can also cause an overgrowth of hair. This condition is called hypertrichosis. It's most common in women and often occurs around the time of menopause because of increased androgen levels. Hypertrichosis is characterized by excessive growth in locations that already have fine, light-colored hair, such as the upper lip or along the jaw line. It differs from hirsutism, which causes women to develop male hair growth patterns. While hypertrichosis is related to age and hormonal changes, hirsutism is caused by underlying endocrine disorders such as adrenal gland tumors or polycystic ovary syndrome. Regardless of the cause, excess hair growth can be embarrassing. A variety of solutions, including new laser treatments, are available.

Symptoms of excessive hair growth The appearance of thick dark hair in areas where light hairs ordinarily grow An increase in dark hair on the body following menopause

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Treating excessive hair growth

The most common, temporary solution is shaving the excess growth. Plucking, waxing, and depilatories also offer temporary solutions. Traditionally, the only permanent means of removing excess hair has been with electrolysis, which uses a shortwave electrical current to destroy the hair follicles. Electrolysis can be used safely on most parts of the body except the underarms, where there is an increased risk for bacterial infection, and the delicate skin under the eyebrows.

Physicians have discovered how to permanently destroy hair growth using lasers or intense light sources. Certain laser light frequencies are absorbed by the dark pigment in hair, causing selective thermal damage to or destruction of the hair follicle. A single treatment can destroy up to 30% of follicles in the area treated. Hairs that do grow back are thinner and softer. Three treatments may destroy about half of the follicles in the area treated.

One type of laser used for this purpose is the long-pulsed alexandrite laser, which, in its Q-switched version, is also used to eliminate brown pigmented areas. People with fair skin and dark hair are most likely to obtain the best results with laser hair removal, while the treatment is ineffective in people with blond, white, or gray hair. In order to work, the light has to be absorbed by pigment in and around the hair follicle. Light-colored hair has little or no pigment and therefore does not absorb laser light. For most people, laser hair removal is faster, safer, and more effective than electrolysis. The cost depends on the size of the area being treated and the number of treatments needed.

In addition to lasers, a different kind of light source, called intense pulsed light, is effective in removing hair. (For more information on different types of lasers and cosmetic laser procedures, see "Laser and other procedures.")

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Actinic keratosis

Actinic keratosis (AK) is a precancerous skin condition that appears as scaly pink or red-brown raised, rough patches on sun-exposed skin. Fair-skinned people are more likely than darker-complexioned individuals to develop AK. The condition can cause discomfort and itching, but its biggest danger is as a precursor to squamous cell carcinoma (see "Basal cell and squamous cell carcinoma"). The FDA has estimated that almost half of all skin cancers begin as AK spots. Most treatments can remove these crusty patches without scarring.

Symptoms of actinic keratosis Rough, scaly red or brown patch on skin Most likely to appear on face, back of hands, or other areas commonly exposed to sun

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Treatment for actinic keratosis

Several methods exist for removing areas of actinic keratosis:

Cryotherapy. The standard treatment for AK is to freeze the area with liquid nitrogen. Inflammation, swelling, and occasionally blistering may occur. A small scab forms, and healthy new skin emerges as it heals.

Topical medications. A prescription cream containing the chemotherapy drug fluorouracil (5-FU) can be used once or twice a day for several weeks or on two consecutive days a week for several months. The cream removes the AK patch, but it causes sun sensitivity and, often, considerable discomfort. A topically applied drug called imiquimod is also very effective in treating AK spots. Imiquimod stimulates the immune system to release cytokines, chemicals that fight cancer cells and viruses. Imiquimod causes AK patches to become inflamed, crust over, and heal.

Deeper treatments. Widespread facial patches may warrant deeper treatments such as laser resurfacing (see "Laser and other procedures"), which vaporizes the epidermis and upper dermis, or a chemical peel, which dissolves the outer layers of the skin with a chemical solution. Laser resurfacing and chemical peels can involve local or general anesthesia. Depending on how deeply the skin is penetrated, they may result in considerable swelling. Still another effective treatment is electrodesiccation and curettage (see "Treating basal cell and squamous cell cancers."

Photodynamic therapy. This is a relatively new treatment, which uses light exposure to activate a therapeutic agent. In this case, the agent is Levulan, a topical solution of aminolevulinic acid, which occurs naturally in the body to process heme, a red blood cell component. First, Levulan is applied to AK spots, where it is converted into a light-sensitive molecule. Several hours to a day later, light or laser treatment activates the drug and destroys the AK cells. In a few days, the spots crust over and heal. Photodynamic therapy is appropriate when there are many AK spots on the face and scalp.

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Shingles

Shingles, also known as herpes zoster, is a viral infection of the nerves that causes a painful, blistering rash. The virus responsible, the varicella-zoster virus, is the same one that causes chickenpox.

Most people born before the chickenpox vaccine became available have been exposed to this virus. After the initial exposure, the virus lies dormant in the spinal nerves and, most of the time, remains inactive throughout life. But sometimes, particularly in people over age 60 or those who have a weakened immune system, the varicella-zoster virus "reawakens" and causes shingles. Initially, shingles causes sharp, burning pain near the surface of the skin. Several days later, a rash of red raised bumps appears. These bumps turn to itchy blisters loaded with viral particles. If your immune system is weakened by other health conditions, the complications from shingles can be life-threatening.

The blisters form distinct patterns along nerve pathways, often appearing in a band over the ribs on one side of the body, or on the face. They usually disappear in two to three weeks, crusting over and occasionally leaving scars. Pain may persist for weeks or, less commonly, for several months. The affected area can become so sensitive that even light bed sheets or clothing cause intense pain, a condition called postherpetic neuralgia. This condition, which results from damage to the nerves, affects about 10%–15% of people who get shingles. For some, antidepressants, corticosteroids, capsaicin cream, or the antiseizure drug carbamazepine have been useful for relieving the pain. Postherpetic neuralgia often disappears on its own over time.

Symptoms of shingles Tingling, itching sensation on skin Sharp burning pain on skin Clusters of small fluid-filled sacs Extreme sensitivity to touch Chills, fever, nausea, diarrhea occur in some people before other symptoms

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Treating shingles

If you suspect that you have shingles, it's important to see a doctor immediately for treatment to shorten the course of the condition, minimize pain, and reduce the risk for nerve damage. Your doctor may prescribe an oral antiviral drug such as acyclovir, famciclovir, or valacyclovir. Analgesic drugs (pain relievers) may be useful in relieving pain and discomfort. Corticosteroid drugs may help reduce swelling, inflammation, and postherpetic neuralgia. Keeping the skin clean is important to avoid secondary bacterial infection. Applying cool compresses also may help ease the discomfort.

Two vaccines can help prevent shingles. The varicella-zoster vaccine is recommended for children and adults who haven't had chickenpox. This vaccine cannot help people who've already been infected with the virus; that includes the vast majority of today's adults, who had chickenpox before immunization was available.

A newer shingles vaccine was approved in 2006 for adults ages 60 and older. A major clinical trial of more than 38,000 adults found that the vaccine cut the incidence of shingles by half. Vaccinated adults who did get infected had milder cases with fewer complications than people who weren't vaccinated.

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Herpes simplex

There are two types of herpes simplex viruses. HSV-1 is the main cause of oral herpes, or cold sores. HSV-2 causes most cases of genital herpes, although HSV-1 can cause it, too.

More than 90% of people have been exposed to HSV-1 by the time they reach their 40s. It is transmitted by kissing or other contact with saliva. The first sign of a cold sore is pain, burning, or tingling followed about 24 hours later by a tender bump, which quickly becomes a blister. Within a week, the blister opens, leaving a shallow ulcer that crusts over and heals.

About 45 million people in the United States have genital herpes, a sexually transmitted disease that usually spreads through kissing, contact with infected skin, and intercourse. Small, itchy, burning blisters form in the genital area and, in some people, around the mouth. A pregnant woman with HSV infection can pass the virus to her baby during delivery, causing infections of the baby's skin, mouth, lungs, or eyes.

Symptoms of both may occur just once or in recurrent bouts. Cold sores usually appear for no apparent reason, but they can be triggered by intense exposure to sunlight, fever, skin trauma, menstruation, and emotional distress. Once you are infected with a herpes simplex virus, it remains in the body for the rest of your life.

Symptoms of herpes simplex Tender bump or cold sore that develops into a blister on the lips or inside the mouth (oral herpes) Small blisters in the genital area (genital herpes) Itching, burning, and soreness (oral and genital herpes) Pain during urination from contact (genital herpes) Enlarged or painful lymph nodes in the groin (genital herpes) Headache, fever, and generally sick feeling (genital herpes)

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Treating herpes simplex

Oral and genital herpes have no cure, but your doctor may prescribe an oral antiviral medication such as acyclovir, famciclovir, or valacyclovir to shorten the duration of the symptoms and help prevent recurrences or make them less severe. Newborns of mothers with genital herpes receive antiviral medications intravenously.

For cold sores, antiviral medications are most effective when taken as soon as itching and burning begin but before the blisters form. Sometimes doctors prescribe antiviral drugs to people before exposure to a cold sore trigger such as intense sunlight or a skin procedure such as dermabrasion. When herpes outbreaks occur frequently, doctors may prescribe antiviral medications to be taken regularly to minimize recurrences. Over-the-counter anesthetic ointments such as Zilactin can temporarily relieve pain and protect the affected area from cracking and irritation.

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Drug-resistant skin infections

Skin infections are usually minor, causing small pimples or boils that go away without antibiotics. But a growing number of skin infections are severe or life-threatening and do not respond to most antibiotics.

More than half of skin infections treated in emergency rooms in the United States may be caused by a persistent bacterium called methicillin-resistant Staphylococcus aureus, or MRSA. Until recently, MRSA infections occurred mainly in patients in hospitals and long-term care facilities, but new studies show that they are becoming increasingly common in the general population, including previously healthy children and adults. One study in 2003 estimated that 12% of the infections were in the population at large.

While everyone is at some risk of getting an MRSA infection, you can help protect yourself with good hygiene such as washing your hands frequently, not sharing personal items like towels, and cleaning and covering any cuts or other skin wounds.

Symptoms of drug-resistant skin infections Pimples or boils that are red, swollen, and painful or are filled with pus Painful red sores that look like spider bites Wound infections Blood infections Pneumonia Bone infections Heart valve infections

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Treating drug-resistant skin infections

If you have symptoms of a skin infection, see a doctor right away. Treatment depends on its location and severity. For a local pimple, boil, or abscess, the doctor will probably surgically drain it and may prescribe antibiotics. However, about 25% of people with MRSA infections need to be hospitalized because the infection can be difficult to treat and can be deadly.

MRSA infections are resistant to antibiotics in the penicillin family, but other classes of antibiotics appear more effective, including linezolid, daptomycin, and quinupristin-dalfopristin. Sulfa drugs, clindamycin, and some tetracycline derivatives may also be effective. If antibiotics are prescribed, it's essential that you finish the entire prescription, even if the infection is getting better.

To prevent the infection from spreading, practice commonsense hygiene: Wash your hands regularly with soap and water, clean and cover all open skin wounds with a bandage until they heal, and don't share clothing or other personal items.

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Varicose veins and spider veins

More than 56 million people in the United States — 40% of women and 15% of men — have varicose veins or spider veins (telangiectasia). One of the most important distinctions between these conditions is that varicose veins sometimes develop into a serious medical problem.

Although these conditions may mar the appearance of the skin, they aren't actually skin conditions, but rather circulatory problems. In your legs, veins have the unenviable job of working against gravity to push the blood upward. Healthy veins do this with pulsing movements and one-way valves that encourage the blood to flow up and prevent it from flowing back down. As you age, the valves can malfunction, and the veins may stretch. Blood can stagnate, causing the veins to dilate. Heredity and hormonal changes also can influence the development of varicose veins.

For most people, varicose veins are more a cosmetic issue than a medical one. Often you can treat them by wearing elastic support stockings, avoiding standing for long periods, and sitting with the feet elevated. Exercise such as walking, jogging, or bicycling can help. However, advanced cases of varicose veins can result in blood clots, inflammation of the veins, or ulcers. Signs that medical attention is needed include muscle cramps, fatigue or swelling in the legs, excessive tenderness, or any indication of an ulcer. Larger varicose veins may require surgery.

Spider veins form when groups of blood vessels close to the surface of the skin dilate. As a result, fine networks of red, blue, or purple veins — each barely more than the width of a hair — appear on the thighs, calves, and ankles. They may form patterns resembling a sunburst, spider web, or tree branches, or they may appear just as short, unconnected lines. Age, heredity, hormonal changes, or external injuries increase the likelihood of spider veins.

One of the best ways to prevent spider and varicose veins is with regular exercise that keeps blood from pooling in the veins. Walking, jogging, bicycling, and swimming are good choices.

Symptoms of varicose veins and spider veins Generalized swelling and aching in the legs Aching in the area where the veins are swollen Leg muscles that tire easily Itching around the veins Leg cramps Sores on your skin, especially near the ankle Spider veins A fine network of red, blue, or purple veins close to the skin

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Treating varicose veins

The oldest procedures for getting rid of varicose veins involve open surgery, but a newer, less invasive approach, called endovascular ablation, has become more popular. This method employs heat to collapse and close varicose veins.

Endovascular ablation is done with a thin catheter that contains either a laser (called endovascular laser ablation, or EVLA) or a device that generates high-frequency radio waves (called radiofrequency ablation or VNUS closure). Both procedures can be performed in a doctor's office. Local anesthesia is used to numb the area being treated, and then the catheter is inserted into an enlarged vein in the lower leg and directed to the varicose vein, heating the vein wall. The heat makes the vein collapse and seals it shut. Once the varicose vein is closed, other healthy veins take over and circulate blood from the legs, and symptoms significantly improve. Most people can return to their normal activities after a day or two.

Studies show that endovascular ablation is as effective as surgery for up to two years after treatment, but with less pain, scarring, and recovery time. As a result, endovascular techniques have replaced longstanding surgical procedures in most cases.

One traditional surgical technique is stripping, which involves removing the vein through small incisions and diverting the blood flow to another vein. Ligation is similar to stripping, but instead of removing the vein, the surgeon ties it off at a point close to the source of the blood flow, and the blood is rerouted to another vein.

A less invasive surgery called ambulatory phlebectomy may be recommended for removing varicose veins that remain after endovenous ablation. Using an instrument that hooks the vein, the surgeon removes it by pulling it through a series of tiny punctures created along the length of the vein.

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Treating spider veins

Spider veins pose no medical risk. They can be treated with a painless, nonsurgical procedure called sclerotherapy. Sclerotherapy involves injecting a solution, usually a highly concentrated saline, into the blood vessel cluster. The vessel collapses, and blood easily diverts itself into nearby healthy veins. In addition, improvements in laser technology now permit the use of these devices in the successful treatment of spider veins and other enlarged veins. Smaller varicose veins, those 3–5 millimeters long, can also be treated with these procedures.

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Review Date: 2007-03-01

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