SKIN PROBLEMS AND TREATMENTS
Treating medical problems in a remote homestead or after a disaster won’t always be about gunshot wounds and broken bones. Sometimes, little things can make people miserable and affect their ability to contribute to group efforts. Skin inflammation, called “dermatitis“, is one of the issues that a caregiver can’t ignore if the group is going to function at 100% efficiency.
This condition has various causes and varies in appearance from case to case, although most present with redness and itchiness, sometimes with swelling. You might not consider itchiness to be a problem worth the medic’s attention, but continuous scratching traumatizes the skin, your natural armor, and may lead to a type of infection called “cellulitis“ once the skin is broken. Cellulitis has nothing to do with “cellulite”.
TYPES OF DERMATITIS
Contact dermatitis is caused by physical contact with allergy-causing substances called “allergens”. The allergen involved is so varied as to include almost everything, including:
- laundry soap and detergents
- Household cleaning products
- Rubber or latex
- Perfumes, makeup, deodorants
- Metals, such as nickel
- Weeds, such as poison ivy, oak or sumac
Usually, the first exposure only produces antibodies but not major skin reactions. Once antibodies exist against a certain substance, the next exposure can cause significant irritation (or worse general reactions such as anaphylaxis).
Once the allergen is identified, avoidance is the best way to prevent contact dermatitis. Corticosteroid creams and cool moist compresses are the cornerstones of treatment. Use these only until the rash is improved. Antihistamines such as Benadryl or Claritin will help relieve itching.
Atopic Dermatitis or Eczema is a chronic itchy rash that can be found in various areas at once (oftentimes, the face) that may be accompanied by hay fever or asthma. Dust mites, animal dander, and food allergies are possible causes. Atopic dermatitis sometimes flares up in cold weather. Treatment is similar to contact dermatitis.
Seborrheic dermatitis is a condition that affects areas that contain oil-rich glands called sebaceous glands. It is characterized by scaling, redness, and itching. The most common version of this is dandruff or, in infants, “cradle cap”. The area near the nose and lips is another place where you might see this type of dermatitis.
Scalp irritations caused by Seborrhea may be treated by shampoos that contain tar or pyrithione zinc (Head and Shoulders). It also can be treated by the anti-fungal ketoconazole, which supports the belief that yeast plays a part in the development of this condition.
Neurodermatitis is a type of dermatitis that manifests as chronic itchy and raised patches, sometimes red and sometimes just darker than normal skin. The cause is unknown, although insect bites, tight clothing, dryness, and even anxiety have been implicated as possibilities. A vicious cycle of itching and scratching leads to thick, scaly, and leathery skin called “lichenification”.
Treatment includes Antihistamines such as diphenhydramine (Benadryl) and steroid creams, especially at night when some people scratch irritated areas without knowing. Injections of corticosteroids are given into the affected area in severe cases. Anti-anxiety medications are given to those who scratch out of nervousness.
Shingles is also known as herpes zoster, and is seen in people who have previously been infected with Chicken Pox. The dormant chickenpox virus, called varicella zoster, becomes active in nerves and appears as a blistering rash with itching, burning, and pain, usually localized to the distribution of a particular nerve.
Shingles usually resolves after a very uncomfortable 2-4 weeks but may be treated with anti-viral agents, such as Acyclovir, Valtrex, or Famvir (but not by the anti-viral Tamiflu, a commonly used antiviral for influenza).
Shingles is sometimes confused with dermatitis herpetiformis, a chronic skin condition characterized by blisters that is actually not associated with herpes virus.
Stasis dermatitis appears as an inflamed area caused by fluid and poor blood flow under the skin. It is commonly seen on the lower legs of individuals with varicose veins. Rarely seen in those under 50, poor circulation is a major factor although trauma damaging the circulation may be a factor. To deal with dermatitis related to poor circulation, you may have to use support stockings and mild steroids. In normal times, varicose veins may be dealt with surgically or with other high technology. See our article on varicose veins.
Rosacea is an extremely common condition that manifests as a reddened area on the face that is caused by swollen blood vessels, usually in fair-skinned individuals beginning in middle age. It is accompanied by spider veins, flushing, and, sometimes, a markedly red nose and an appearance like acne. It is not acne, however, and will not respond to over-the-counter acne medicine. Antibiotics are sometimes used, and Vitamin A-related medications like Accutane may help.
Psoriasis is a series of thickened patches of reddened skin with silvery flaking. The most common areas affected are the elbows, knees, scalp, armpits, scalp, and lower back. An auto-immune condition, Psoriasis causes the buildup of new skin cells where the body mistakenly thinks an injury has occurred. Moisturizers as well as corticosteroids and coal tar ointments are helpful; Psoriasis responds to sunlight, so phototherapy using special lamps are used for this type of dermatitis.
Natural supplements that improve dermatitis are numerous and often involve Omega-3 fatty acids, which have an anti-inflammatory effect. Used with evening primrose oil, it is especially effective. Chamomile cream is thought to be as potent as a mild hydrocortisone. Calendula has skin-soothing properties and may protect against contact dermatitis. Be aware that it may trigger an allergic reaction on broken skin. I’ll bet you have your own home remedies for various skin problems as well.
MEDICAL SUPPLIES FOR SKIN
Clearly, the medic will need to include some skin treatments in their medical kit. Some useful items, some with links to medical issues we’ve covered before, include:
Hydrocortisone Cream: Various mild steroid creams are useful in decreasing inflammation in an area of the skin that is inflamed.
Clotrimazole (Lotrimin in the U.S.): Helpful in the treatment of skin yeast infections, including athlete’s foot, ringworm, and others.
Triple Antibiotic Cream: Helpful in preventing infections in areas of minor scrapes and cuts.
Insect Repellant: These are useful in preventing insect bites, which may prevent more serious medical problems such as malaria, Lyme disease, and severe allergic reactions. Commercial products usually contain DEET. Natural products, like lemon eucalyptus, lemongrass and citronella, also serve to repel insects and can be grown in many areas.
Fels-Naptha soap: This time-honored item helps to remove toxins from poison ivy, oak, and sumac from both skin and clothes. Studies show pre-bathing with Fels-Naptha may decrease effects of these rash inducing plants.
Permethrin shampoos/lotions (NIX, Elemite in the U.S.): Helpful in the treatment of lice and mite-related issues (head lice, scabies, etc.)
Sunscreen: Often overlooked as a medical supply, sunscreen will help prevent many skin problems down the road.
Aloe Vera: Natural product useful in treating burns. Others which may be effective include vinegar, witch hazel, diluted lavender and tea tree essential oils, etc.
Non-stick gauze dressings (e.g., Telfa brand dressing): these dressings have a shiny non-stick surface and are especially used for burns and other raw skin areas to prevent removal of healing tissue during dressing changes.
Diphenhydramine (Benadryl in the U.S.): Useful for suppressing minor reactions to bug bites and allergy-causing agents such as hives, redness, or swelling, but can cause drowsiness. Claritin and Zyrtec are milder antihistamines, but do not usually cause severe sleepiness like Benadryl can.
Epi-Pens: A self-contained prescription injection of epinephrine (adrenaline outside the U.S.) that will improve severe allergic reactions, also referred to as anaphylactic shock. Few physicians would deny you a supply of this important item, especially if they are aware that you are often outdoors.
Natural Remedies: Vinegar, witch hazel, diluted lavender and tea tree essential oils,used as a compress is calming to rashes and burns. Baking soda or an oatmeal paste or bath are both very soothing to irritated or itchy skin. Apply raw honey to open skin areas for healing and infection prevention, and cover with non-stick dressings.
Other Natural Remedies: Balms containing Arnica are useful for pain relief in many people. French green clay paste used as a pack or mask has been studied for it’s healing properties. Warm tea bags (especially Chamomile) or a tea leaves poultice, (add raw honey for extra healing) contains tannins that help calm irritated skin. Just like the French green clay, cornstarch paste can be used as a soothing pack.
Joe Alton MD
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