Get Rid of Your Jock Itch Once and For All

I’ve been seeing a lot of jocks lately. The anatomical area, not the athletes. Summertime means heat and humidity, sports, and itchy groins. Jock itch is a general term for an itchy rash in the groin. Heat, sweat, and skin rubbing on skin can leave the area looking like you slid into second base, groin first.

There are three main causes of an itchy groin. Classic jock itch is caused by a fungus, the same fungus that causes athlete’s foot. This fungus often causes a red scaly rash on the inner thighs. It tends to be dry and can have bumps or pimples. The fungus is often spread from your feet or from contaminated sports equipment, towels, etc. It can be treated with topical terbinafine cream 1% twice a day for 2-4 weeks. Severe cases can require oral anti-fungal medications, especially if the fungus has spread to other areas on your body.

The second cause of an itchy groin is a yeast infection (yes, the same yeast that can cause a vaginal yeast infection in women). The yeast grows well in warm, moist areas and causes a bright pink, moist, irritated rash. Unlike the fungus, yeast can spread onto the scrotum. It can be treated with topical clotrimazole cream 1% twice a day for 2-4 weeks.

The third common cause of a jock itch is a bacterial infection. Certain bacteria take advantage of the irritated skin and warm environment causing a rash called erythrasma. This can be treated with miconazole 2% cream twice a day for 2 weeks.

For all causes of jock itch it is important to keep the area clean and dry. Sometimes washing your groin with anti-dandruff shampoo such as zinc or selenium sulfide shampoos can help clear unwanted organisms. Hydrocortisone 1% cream can be added to any of the above treatments to reduce the redness and itching while the infection is being treated. Use it once to twice daily.

Remember, it is important to keep the area dry. The standard way is to use powders (some of which are medicated for an added bonus, such as Gold Bond). Once the active infection is resolved, treating your groin with your underarm antiperspirant can help keep this area dry, thereby making it less inviting for fungus and other organisms to return.

However, I don’t recommend spraying antiperspirant on your groin if you’re in the midst of a raging jock itch — you’ll spend the entire day scratching an area that shouldn’t be scratched in public.

Photo: jkstrapme (flickr)

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Sunscreens Cause Acne! (and Other Fun Summer Acne Facts!)

With blonde hair and big blue eyes, she looked like a young Betty Draper from Mad Men. My patient, Julie, had been faithfully treating her acne for months. Just when she was starting to clear (in time for her senior photos), wham! Red dots cropped up over her forehead and cheeks. What went wrong? Summertime.

July can be the cruelest month for acne. Acne on the chest and back (bacne) and big, red pimples on your face can make going to the beach an embarrassing experience. Here are a few acne facts for summer:

1. Although there is some suggestion that sun can help acne, its effect varies and sun often makes acne worse. (Bacne + sunburn = bacne burn. Not good).

2. Retinoinds such as topical Retin-A, tretinoin, Differin, Tazorac, Ziana, Atralin, and Accutane all remove the outer layer of skin, leaving you more susceptible to a bad sunburn. Benzoyl peroxide and salicylic acid also peel the outer layer of skin, making you more sensitive.

3. Oral antibiotics such as doxycycline, minocycline, tetracycline, and sulfa antibiotics predispose you to a  painful pink burn on your nose, hands, and arms called a phototoxic rash; I see patients with this all summer long. The pink splotches can take weeks to fade and sting every time you’re in the sun.

4. Sunscreens can cause acne. It’s a cruel fact. Often the best sunscreens such as zinc and titanium, or water resistant sunscreens are the most likely to worsen acne. In order to be effective, sunscreens have to coat your skin which also clogs your pores.

Here are 5 tips to help keep you acne-clear this summer:

1. Remember that sun exposure is not a good way to clear up acne; most people get far more sun that what is helpful and just the right amount of sun to make it worse.

2. If you have fair or sensitive skin and are taking oral antibiotics for acne, then discuss with your physician if you are taking the best antibiotic during summer. Some patients take a break from antibiotics during summer months or switch to antibiotics that are less sun sensitizing.

3. Find ways to protect against the sun other than sunscreen: avoid the sun between 10 AM and 2 PM, wear a big hat (demonstrated here) and cover up.

4. When you need sunscreen, consider products designed for your face which are less oily or less likely to worsen acne such as: Neutrogena Ultra-sheer Dry Touch, Eucerin Facial Moisturizer with SPF 30, La Roche-Posay Antihelios Tinted Cream, or Proactiv’s Daily Protection Plus Sunscreen.

5. Avoid overusing scrubs, toners and slamming face-first into the beach; the added exfoliation will only make risk of sunburn worse.

Just hang-on, winter will be here again before you know it. Does your acne get worse in summer? What sunscreen do you use.

Photo: Foreversouls (flickr). Patient identity changed.

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Where Are You More Likely To Sunburn: Beach Or Mountains?

While vacationing in Idaho and Montana last week (blissfully off the grid), I experienced something beautiful: altitude. At 6,260 feet Stanley, Idaho is a mile higher than my home in San Diego. The skies there were a brilliant blue. There was daylight well after 10 PM. The mornings were a chilly 35 degrees. And I got sunburned.

How can this be? Montana is over 1,000 miles north of San Diego. Shouldn’t the sun be stronger down here?

Several things determine the sun’s intensity. The closer to the equator you are, the more intense the sun’s rays. But also, the higher up you are, the more intense the sun’s rays. Your UV exposure increases by 10% for every 3,280 feet in altitude; at 6,000 to 8,000 feet in elevation, you’re exposed to 25% more ultraviolet radiation than at sea level.

Also, snow (which fell during our mid-June trip) is an efficient reflector of sunlight. When skiing or hiking in snow, 80-90% of UV light is reflected at you, dramatically increasing your sun exposure. Grass in comparison reflects only about 3% of sunlight.

Water, especially when still, also reflects sunlight. Still lakes, including the beautiful Yellowstone Lake pictured above, can reflect up to 100% of UV light (hence the term mirrored lake), doubling your UV exposure.

So although you might feel hot lying on the beach in June in Southern California, you might be more vulnerable to sunburn on a chilly hike in Yellowstone after a June snowstorm, which is exactly what happened to me. (Hence the Stetson later in the trip…)

Photos: Madsit, Stanley, ID (top) Purticortico Yellowstone Lake, WY (middle) Dermdoc White Bird, ID (bottom).

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Dermdoc Drills Down Vitamin D in High Def!

You know the sun makes vitamin D. Did you know that it does so in just minutes?

After a few minutes of sun, your skin stops making vitamin D.

After a few minutes of sun, your skin starts making skin cancer.

Lying out at the beach or the pool for hours this summer will do far more damage than good.

What do you think, should Dr. Oz be worried? (Or should I stick to podcasts?)

What do you think about the sun and your vitamin D?

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Skin Cancer Is More Common On Which Side?

Photo: jvision (flickr)

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Sunscreens Cause Skin Cancer? What?!

Just what you needed: another mixed message about your health. The top health story this Memorial Weekend was sunscreens might cause skin cancer.

The story originated from the Environmental Working Group (EWG), a nonprofit organization that “protect(s) the most vulnerable… from health problems attributed to a wide array of toxic contaminants.”

EWG announced their list of best and worst sunscreens last week. They also published a statement that claims creams which contain a vitamin A derivative, retinyl palmitate, increase the risk of skin cancer in laboratory mice. The creams studied were not sunscreens, but rather simple cream with retinyl palmitate. Because many sunscreens contain retinyl palmitate, the EWG is urging the FDA to study this further and is also urging people to avoid sunscreens with vitamin A derivatives in the meantime. Some sunscreens contain retinyl or retinols as a “wrinkle-fighting” ingredient in the sunscreen.

So what should you do? Here are my tips:

• Ultraviolet light from the sun is radiation and is unquestionably the most important cause of skin cancer.
• Sunscreens in general do not cause skin cancer.
• No study has yet looked at retinyl palmitate when used in a sunscreen.
• It is reasonable to avoid sunscreens that contain retinyl or other vitamin A derivatives until more studies are done, if you’re concerned.
• Choose a sunscreen with an SPF of 30. Look for zinc oxide, titanium dioxide, avobenzone, ecamsule (Mexoryl) or octocrylene.
• Reapply sunscreen every 2 hours.

What is your take on sunscreen safety?

What about sunscreens and vitamin D?

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Why Tanning Is An Unsafe Way To Get Vitamin D

I made this video while at the Lance Armstrong Foundation Headquarters in Austin, TX to help people understand why tanning is an unsafe way to get your vitamin D.

• Your skin needs UVB to make vitamin D.
• Many tannning beds use little or no UVB, so they wouldn’t increase your vitamin D levels.
• Tanning beds increase your risk for melanoma, squamous cell carcinoma, and basal cell carcinoma skin cancers.
• Vitamin D3 supplements at doses of 1,000 to 2,000 IU are readily available.
• Supplements have been proven to safely increase and maintain high levels of vitamin D.

Make a donation to the Lance Armstrong Foundation and win a chance to see Lance in France at the Tour de France.

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Can You Be Allergic To the Sun?

You know that the sun increases the risk of skin cancer for most people. You probably don’t know that for some people, the sun is the source of a terrible itchy rash — they’re allergic to the sun.

The radiation from the sun triggers some response in everyone’s skin. In some, the radiation triggers an immune reaction, leading to red, itchy, burning bumps. There are several diseases that are caused by sun which lead to rashes. Here are a few:

Polymorphous Light Eruption (PMLE): This is the  most common. It is usually characterized by tiny, itchy red bumps that develop on the arms, neck and face hours after sun exposure. It is often seen in the spring and occurs more frequently in young people.

Actinic Prurigo: This is seen as itchy red bumps that occur mostly in children who are sensitive to the sun. Like PMLE, it occurs mostly on the face (including lips), arms, and hands. It can be more severe than PMLE and can lead to scarring in rare instances.

Chronic Actinic Dermatitis: This usually affects adults. It starts in areas exposed to the sun, but can spread to other areas. It is often terribly itchy and can be triggered by sunlight even though car windows.

Solar hives (urticaria): These are itchy pink whelts that develop within minutes of sun exposure. The rash develops quickly and fades quickly but can be intensely itchy. Antihistamines such as Zyrtec (ceterizine) or Benedryl (diphenhydramine) can help.

There are other sun-induced diseases, including ones triggered by medications. I’ll write about them in a future post. In all of these conditions, the most important thing to remember is to avoid sun exposure as much as possible. If you develop an itchy or burning rash after sun exposure, then see your physician for an exam and for advice.

Photo: Sandman (flickr)

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Behold, The Holy Grail of Wrinkle Creams: A Topical Botox

You think Apple’s new 4G iPhone is hot?

I was at a coffee bar in Redwood City yesterday, minding my own business when I found a tube of medication. Someone had accidently left a tube of topical Botox at the bar. Was this a plant? Is this the real prototype or just a fake? What should DermodoDoc do? I just had to blog on it.

Botulinum toxin is the most common cosmetic treatment with millions of patients injected every year. Brand names like Botox and Dysport are injectable drugs that cause temporary paralysis of the muscles in your face smoothing wrinkles, sometimes dramatically.

Injected botulinum toxin is also a good treatment for excess sweating in your underarms or on your hands, which is called hyperhidrosis. The toxin blocks the signals that turn on sweating thereby preventing you from sweating.

Up to now, the only way to use Botox has been to inject it. That may change. There is a topical botulinum toxin gel being developed. If the toxin could penetrate the skin, then  it could work without having to be injected, which is a good thing since there are people out there who really don’t like needles. Topical botulinum toxin would likely be most effective in places where the skin is thin, such as the underarms. Getting enough medication to penetrate your forehead might be difficult. How effective it will be for treating wrinkles is yet to be seen.

We will have to wait to see when the product is finally released. Until then, I’m waiting for Steve Jobs to call me personally to ask for his Botox back. It must be his, right?

Photo: Izaeus |Argazkiak, flickr

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Gluten-Free Skin Products And Cosmetics

I just returned from the International Association of Culinary Professionals Conference in Portland, OR with @foodblogga (she was at the conference, I was just there to eat Voodoo Doughnuts). One of the hottest topics in food now is the gluten-free diet.

Gluten sensitivity isn’t new; it was first described in the first century AD. Celiac disease (the medical diagnosis for gluten-sensitive patients) was known in the 1880’s.

Despite the recent attention, true gluten sensitivity is uncommon and affects < 5% of the population. People who are sensitive to gluten develop an autoimmune reaction to wheat, barley, rye and other grains which leads to inflammation of their small intestine. Some gluten-sensitive people actually develop a rash called dermatitis herpetiformis (we derms love the big names, don’t we?).

Being the only dermatologist at this food conference (weird, huh?), people wanted to know: “If someone is gluten sensitive, must they also avoid applying cosmetics or using products that contain gluten?”

No.

Gluten sensitivity is specific to your intestines; applying gluten to your skin will not trigger a gluten reaction. You can trigger a reaction if you eat your cosmetic, which is not that crazy when you consider that lip balms or toothpaste can contain gluten.

Other gluten-free products including shampoos, conditioners, makeup, etc. are unlikely to have any significance. If you develop a rash from your cosmetics, then see your physician — allergic contact dermatitis to fragrance or preservatives might be the cause for your rash.

If you develop a rash after eating several Maple and Bacon Voodoo Doughnuts, it was the gluten.

Photo: Bern@t (flickr)

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