DermHelpCentral

Tinea Versicolor

Tinea versicolor (TV), a superficial yeast infection of the skin, is caused by Pityrosporon orbiculare, a normal scalp organism. Obesity, pregnancy, and a warm, moist environment may predispose a person to this infection.  The disorder is more common in the warm summer months.

One of many presentations

TV may show up as white, tan, or brown spots on the skin. The back, chest, and upper arms are most frequently involved, but other areas may be affected. It may be first noticed after the skin is tanned, because the color difference is then obvious. The yeast may interfere with the normal tanning process and therefore, the skin may look pale in the affected areas. Usually there are no symptoms or only mild itching.

 

Untreated, TV may persist for many years. Thorough scrubbing of the skin with a rough washcloth and the use of ketoconazole shampoo will usually control the infection, but the skin may not return to its normal color for a number of months. Sun exposure will eventually re-tan the affected skin. In addition, most patients who have TV will experience relapses.

Treatment Directions

There are various therapies for TV, and no one of them is perfect for all patients.

At present, we prefer 2% ketoconazole shampoo.  Selenium sulfide suspension (Selsun, not Selsun Blue) was been the standard therapy for years but it is less aesthetic.  Both are prescription medications. The over-the-counter 1% ketoconazole shampoo may not be effective.

2% ketoconazole should be massaged into the skin from the neck down covering all affected areas, allowed to dry, and remain on for 10-15 minutes, after which it is washed off in a shower. This is repeated two or three times a week.  Some people clear after as little as two weeks of treatment. After the first two weeks, the medication may be reapplied weekly or every other week in a similar fashion.  Treatment over the winter is not needed for most patients.

Imidazole creams and lotions (Miconazole, Clotrimazole, Econazole, and Ketoconazole, and others) are effective when only reasonably small area are involved. They should be rubbed in once or twice daily to the affected areas for three to four weeks.

In patients with very extensive disease, oral ketoconazole is very effective in eradicating the infection. This is not for every patient, because of possible serious, but very infrequent, side effects. An informed patient may decide to use this drug after appropriate blood tests are done. Recurrences are the rule, however.

For a good description of tinea versicolor with photos see DermNet.

PDF of this handout:  Download Tinea Versicolor

Listerine for Nail Fungus

From The People's Pharmacy:

"A reader offered the following suggestion for getting rid of nail fungus: “I cured my toenail fungus using a 50/50 mixture of vinegar and Listerine. I combined them in a quart jar with a screw-on lid and used a clean paintbrush to apply the liquid to the affected toes morning and night. “Then I put my socks on to keep it acting a while longer and protect the bed sheets at night. The fungus took about three months to clear up. It is slow growing, but is also slow to cure. I hope this helps someone else."

The herbal ingredients in Listerine (menthol, eucalyptol, thymol and methyl salicylate) may have anti-fungal properties, but home remedies rarely come with specific guidelines. This reader combined a couple of favorite remedies. Many people have reported success soaking infected nails in one part vinegar to two parts water. Others got good results soaking their toes in Listerine. Such remedies won’t work for everyone and take several months to produce results.

Other home remedies that readers have used to treat their nail fungus include Vicks VapoRub, hydrogen peroxide, tea tree oil and cornmeal mush as a foot soak. Search this site to find more details on using home remedies against nail fungus. The comments below also contain advice that may be helpful."

Comment: The standard treatment for proven fungal nails (onychomycosis) is Lamisil 250 mg a day for 6 weeksfor finger nails and 250 mg a day for 12 weeks for toe nails.  This has a 40 - 50% success rate which mayu not be all that better than with Listerine.  Of course, one needs to consider the severity of the infection, and then any contraindications to the oral meds.

Lyme Disease Foundation

"The best private organization-based site that can be recommended to patients for education on Lyme disease is that of the American Lyme Disease Foundation."*  This is a valuable resource for patients with Lyme Disease and also their health care providers.  Lyme Disease has become a controversial topic.  If you want to stick with "science" the ALDF is a good place to start.

*Quote taken from:

Clin Infect Dis. 2002 Aug 15;35(4):451-64. Epub 2002 Jul 19.

Effective retrieval of Lyme disease information on the Web.

Sood SK.

Pediatric Infectious Diseases, Schneider Children's Hospital at North Shore, Manhasset, NY, USA.

Abstract:

The spirochetal infection Lyme disease, although now usually easily diagnosed and treated, has acquired an aura of ambiguity for many laypersons and medical professionals. The existence of controversy makes it difficult for infectious diseases physicians and scientists to readily obtain accurate information on Lyme disease by casually browsing the World Wide Web. Informative and current Web sites on the diagnosis, epidemiology, treatment, and prevention of Lyme disease can be found on-line, as can clear images of its clinical variants and of ticks. There are a handful of on-line resources on the biology of Borrelia and ticks, which can be tapped by the research community. These Web sites are described in the present article.

NPR Sunscreen Update June 2012

NPR had an informative piece about sunscreens this morning: "Consumers Stuck With Murky Sunscreen Labels Another Summer."  It is worth readng and listeninbg to. 

Human Microbiome Project

Image from sciencedaily.com

"A microbiome is the totality of microbes, their genetic elements (genomes), and environmental interactions in a particular environment. The term "microbiome" was coined by the Nobel Prize laureate Joshua Lederberg, who argued that microorganisms inhabiting the human body should be included as part of the human genome, because of their influence on human physiology. The human body contains over 10 times more microbial cells than human cells.

Microbiomes are being characterized in many other environments as well, including soil, seawater and freshwater systems.

A recent article in the NY Times, “In Good Health? Thank Your 100 Trillion Bacteria” by Gina Kolata, is a great introduction to the Human Microbiome Project and the recently reported initial findings.  This important field will impact on all interested in health and disease.

Here is an informative YouTube site about The NIH Human Microbiome Project (< 3 minutes).

On June 19, the NY Times had another article onthis subject:  "Tending the Body's Microbial Garden."  which is also worth reading.  These concepts have important implications for healthand disease.

Brachioradial Pruritus: Overview

 

BRP: Typical Location

Brachioradial pruritus is an annoying itch which usually appears on the arms near the elbows.  It was first described in 1968 and has puzzled physicians ever since.  Even today, most doctors (even some dermatologists) are not familiar with it.  This leaves the patient isolated and often confused.

In 2011, we posted two cases of Brachioradial Pruritus on the Virtual Grand Rounds in Dermatology Blog (VGRD Blog) and it has attracted a fair amount of atention.  That prompted us to write an overview for persons with an interest in this disorder.   Download BRP DermCentral

Therapeutic Flow Sheet (prepared by Desire Gijima, Mayo Medical School): Download BRP Protocol

Product in Actual Use

Most people with BRP get some relief with ice packs.  3M makes "Cold Comfort" which costs $2.50 USD.  This is a cheap way to initiate treatment.  Other packs will be good, too, but this is inexpensive and lasts quite a while as it is reusable.

 

If you have your own story to tell, we can post that on the blog as well.  You may send it to DJE.