Fully Exposed


Posted on: February 18, 2015

Mycotic Conditions are those caused by yeast and fungus. A lipid dependent yeast that is normally found on the scalp, called Malessezia, feeds on the lipids from sweat glands and likely plays a role in dandruff and seborrheic dermatitis.

  • Dandruff: up to 50% of the population experiences dandruff at some point in their lives. Usually seen in individuals from adolescence to about age 50 when the sebaceous glands are most active. Fine white or gray scales are found diffusely in the scalp. Most people experience itching.
  • Seborrheic dermatitis: this itchy scalp condition lasts beyond 50 years of age and is usually chronic and recurring. Red patches, with large yellow greasy scales that may form crusts, commonly occur in the scalp, on the face (eyebrows, nasolabial folds, and eyelid margins), ears, armpits, groin and mid chest. MIld itching is common. It is most common in immunocompromised patients and in patients with neurological illnesses like Parkinson's and stroke patients.

Treatment: antifungal shampoos with the following ingredients may be helpful, pyrithione zinc, selenium sulfide, cicloprox, and ketoconazole. Both over-the-counter (OTC) and prescription products are available depending on severity. Sometimes coal tar or salicylic acid shampoos are beneficial. In severe cases, topical corticosteroids are used.

Itchy scalp caused by true fungal infections or "ringworm" (dermatophytes) is called tinea capitis

  • Tinea capitis: certain fungal organisms can infect the hair shaft itself, while others infect the hair follicle. This contagious condition is most commonly seen in pre-pubescents but can be seen in anyone. It is spread by contact with people, animals, and found in soil. Sharing pillows, hairbrushes and clothing (hats) may spread the condition. There are inflammatory (with pustules, abscesses, and often, lymph node swelling) and non-inflammatory infections (round patches of hair loss with fine scale).

Treatment: Prescription oral medication including griseofulvin, iatroconazole and terbinafine are most effective. Anti-fungal shampoos are prescribed, as well. Family members of infected individuals should be treated with antifungal shampoos and family pets should be checked for infection.

Parasitic Conditions: Head lice, also known as Pediculosis humanus capitis, is the most common parasitic infection to cause an itchy scalp. This infestation is seen most commonly in school aged children. Lice and their eggs (nits) are frequently seen in the posterior auricular scalp (area behind the ears) and occiptal scalp (lower posterior).  Lice (3 mm) and nits (0.8mm) can be seen with the naked eye. Nits, yellow to white oval encasings, usually attach to the hair shaft closest to the scalp. Lice prefer straight hair to curly hair. Lice are transferred from head to head by clothing, hairbrushes and pillows. Itching is very common. Sometimes secondary bacterial infection is seen due to scratching. Lymph node swelling and fever can also be seen in more severe infections.

Treatment: Pediculocide shampoos, lotions, and creams containing the ingredients permethrin or malathion applied once and repeated 6-7 days later is the most effective therapy. Nits can be removed with a fine-toothed comb. Bedding should be washed in hot water, clothing that has been worn should be washed and all family members should be inspected for possible infestation and appropriately treated.

Inflammatory Conditions: the most common cause of inflammatory scalp itching is psorasis. Psoriasis is a chronic, recurring condition that affects 2% of the populaton (a half of whom have scalp involvement.) There is often a family history of the disease. Red areas with silver-gray scaly patches are seen anywhere on the scalp, but especially along the hairline.

Treatment: Mild cases may improve with tar shampoos. Keratolytic shampoos (salicylic acid) are often helpful removing the scales. Topical steroids are the mainstay of treatment. In severe cases, oral medication (methotrexate, cyclosporine) is prescribed. Injectable immunobiologics are also an option for patients with severe psoriasis.

If persistant scalp itching is experienced, seek medical attention.


Posted on: February 02, 2015

Millions of Americans will take to the outdoors this winter. The health benefits of winter sports are numerous. The release of endorphins elevate mood and help ward off "cabin fever." Engaging in winter sports burns more calories than equivalent warm weather activites as it takes more energy for the body to maintain its body temperature in colder environments. But exposure to cold temperature, wind and wet weather may lead to freezing of the skin and underlying tissues, a condition called "frostbite."

Frostnip, the mildest form of frostbite, most often affects the face, nose, ears, fingertips and toes. It presents with numbness and a bluish or whitish skin color for a short period of time. After re-warming, normal skin color returns and the numbness resolves. Frostnip does not leave any permanent damage.

Deeper forms of frostbite may turn the skin red and blue. The skin may feel hard and swelling of the affected area often ensues. Fluid filled blisters commonly appear and with more severe cold injury, blisters may fill with blood. Stinging, throbbing, and burning can occur and discomfort with re-warming of the skin is not uncommon.

Full thickness frostbite is a very serious condition as damage to the skin is accompanied by cold injury to underlying muscles, tendons, and bone. This often leads to permanent loss of tissue, nerve damage and infection.

Prevent frostbite. Limit the time spent oudoors in cold, wet or windy conditions. Wear layered clothing as air trapped between the layers act as an insulator against the cold. Wear waterproof and windproof gear to protect against wind, snow and rain. Remove wet clothing as soon as possible. Wear protective headgear that covers the ears and wear mittens (which provide better protection than gloves.) Stay hydrated and eat a healthy meal before going out in the cold. Avoid alcoholic beverages.

All forms of frostbite require medical attention except frostnip, which can usually be treated at home by re-warming frostbitten areas in warm water soaks (99-107 F) for about 20 minutes. Remove any jewelry, especially rings on fingers, that could tighten as swelling develops. Avoid further cold exposure. Over-the-counter anti-inflammatory medication like Advil or Motrin may be beneficial for throbbing or discomfort.

Seek medical attention if:

  • Skin appears white or pale.
  • Numbness or blistering occurs.
  • Pain, swelling or redness of the affected area develops.
  • Fever occurs.
  • Or other new unexplained symptom develops.



Posted on: December 29, 2014

Cracked heels, also known as heel fissures, are experienced by over 20% of US adults over age 21. More common in women than men, this condition is often nothing more than a cosmetic nuisance. Deep "heel fissures" however, can develop and be quite painful. In rare cases, heel fissures may lead to infection.

This condition is generally caused by dry callused skin around the rim of the heel. Prolonged standing (especially on hard floors), obesity (due to an increase in pressure exerted on the fat pad in the heel), and open backed shoes or sandals can exacerbate the condition. Certain medical conditions can also predispose people to dry skin and cracked heels. Neuropathy (associated with diabetes), psoriasis, eczema, and fungal infections are just a few of the conditions that can lead to skin dryness and increase the likehood of heel cracking.

The best treatment for cracked heels is prevention. Feet should be moisturized after showering with therapeutic emollients. Once dry heels develop, moisturizers containing humectants (water absorbing compounds like urea or lactic acid) applied twice daily may improve the condition. In addition, alpha hydroxy acid creams may help with exfoliation. Occlusive based moisturizers, like Petrolatum, applied at bedtime may soften calluses and help repair skin dryness and heel cracking. After showering, when the skin is soft, the use of a pumice stone, prior to moisturizing, to gently remove dry skin and callus may be beneficial. Deep fissures should be covered with antibacterial ointment to prevent infection.

Seek immediate medical attention should pain, redness, bleeding or swelling develop.

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Posted on: November 06, 2014

Spider veins are those small weblike networks of red, purple and blue vessels that are easily visible through the skin and found most commonly on the legs and ankles. Women are more susceptible than men to develop them and those with blood relatives with spider veins are more predisposed to developing these roadmap veins.  Heredity seems to play an important role in the development of spider veins. There is little scientific evidence that crossing the legs causes spider veins.

Spider veins are usually painless and are more of a cosmetic concern for most but rarely can cause a dull ache or burning sensation, especially after standing on one's feet for prolonged periods of time.

Although laser light therapy is an option for spider veins, sclerotherapy, a proven procedure that has been performed since the 1930's, is still considered the gold standard treatment for spider veins on the legs and ankles.  With a very fine needle, the small veins are injected with a sclerosing agent (usually a salt solution) that irritates and eventually scars the inside lumen of the veins causing them to fade from view.  More than one treatment is often necessary but this procedure is usually quite effective.  Sclerotherapy can be done in the doctor's office with each treatment taking approximately 15-30 minutes.  Side effects include localized swelling, itching, skin color changes that usually fade with time, and rarely skin ulceration. The development of new tiny vessels may occur at injection sites but often fade after several months.

Because the exact cause of spider veins is unknown, they cannot always be prevented. Try to maintain a healthy weight and stay physically fit.

Spider veins are not harmful to overall health, but, if self conscious about them, see a dermatologist for possible therapy options.



Posted on: October 20, 2014

Hangnails are not nails at all, but little triangular pieces of skin at the edge of a fingernail that occassionally bleed and, are often, quite irritating. They are more common in the winter due to dry skin from the cold winter air but harsh chemicals, nail biting, and excessive hand washing can also cause the development of hangnails. If not properly cared for, hangnails can be the site at which bacteria enters the skin and causes an infection around the nail cuticle.

PREVENTION: Since dry skin is the primary cause of hangnails, moisturize the hands and nail beds several times a day to prevent hangnail development. If you are nail biter, QUIT! 

TREATMENT: If you get a hangnail, don't rip it off!  It'll hurt. Secondly, the site may become more inflamed and more painful. And thirdly, a larger skin wound may result.

  • Cut off the hanging skin with a clean nail clipper or small nail scissor.
  • Wash your hands with water and a mild soap free cleanser and apply a hand cream to the site.
  • Cover the site with a Band-Aid.
  • Follow this routine daily until the area where the hangnail was removed has healed.

If the area does not improve, if pain continues, or if redness and/or swelling ensues, see a dermatologist immediately.


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I've been a New York based dermatologist for over 25 years. I love music. I love triathlons. I love chemistry. (I love petroleum jelly.) I study skincare ingredients and product formulation. I listen to skincare "advice" from self-proclaimed ......Read More

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