Lump on Neck: Could it be Cancer?

It is obvious to get concerned when you discover any new lump on neck. Good news is that, most of the cases of lumps on the neck are acute and harmless. However, sometimes lumps on the neck may be the presentation of more serious condition that may need immediate medical attentions.

Your body has many lymph nodes that plays key role in fighting off the virus, bacteria and other illnesses. Among all the areas, most common areas that you may notice swollen lymph nodes are neck, underarms and groin. Most of the lymph nodes in our body can’t be felt; they can only be felt during illness. In normal healthy person they are non-tender or painless. During illness they may be tender and swollen. In this article we’ll focus on lumps that arises in different location of the neck and their possible causes.

Lump below the jaw
Any lump below the jaw on either side may be due to swelling of the submandibular lymph node. Swelling occurs when there is infection of the head, neck, pharynx, ears, eyes, and scalp.

Lump below Chin
Any lump below the chin may be due to swelling of submental lymph node. Swelling occurs due to various conditions and disease like infectious mononucleosis, cytomegalovirus, Epstein-Barr virus, toxoplasmosis, dental pathology such as periodontitis.

Lump on side of neck
When you find any lumps on side of neck, they may be due to infection in the tonsils, tongue, pinna or parotid gland. Most common causes of lump on side of neck is pharyngitis

Lump behind the ears
Any lump behind the ears may be due to swelling of post-auricular lymph node. Most common cause for its swelling is local infection on the ear and sometime the scalp.

Lump in front of the ears
Swelling of pre-auricular lymph node results as lump in front of the ear. This may be due to infection in the external auditory canal of the ear.

Lump on Neck

Lump on Neck

Lump above the right clavicle
When there is any lump above the right clavicle, there may be something wrong with the lungs or the esophagus. When there is swollen right supraclavicular lymph node, it may suggest cancer of the lung or the stomach.

Lump above the left clavicle
Lump above the left clavicle may suggest lymphoma or thoracic cancer, while sometime it just may be due to fungal or bacterial infection.

Lump on back of neck
Lump on back of neck may just be due to local infection in the head or neck region. However, if the lumps are either side of the back of neck, they might also be due to lymphoma, tuberculosis or any head and neck cancer.

The most common causes of painful lump in the neck are due to infection and usually are self-limited and can resolve quickly after infection is controlled. However, some lumps can lasts longer for several months and can create confusion with the cancer. Experts agree that the lumps above the clavicle (supraclavicular) should be immediately investigated for cancer.

Risk factors for malignancy include the followings:

  • Old age
  • Firm, fixed and hard lump on neck
  • Painless
  • Duration more than 2 weeks
  • Supraclavicular location

Visit your doctor (especially ENT doctor) if you have any unexplained lumps on the neck. He/she will perform a though examination and when there are no any specific signs and symptoms of any serious disease or malignancy, your doctor may keep you on observation for a month. If the lesion still persists, he/she may perform biopsy or other specific tests.

If you are experiencing persistent enlargement of lymph nodes that lasts more than 2 weeks or if they feel hard and painless, you should get it checked immediately. Don’t rely on what you have learned and seen on the internet and try to diagnose yourself. Get it checked and confirm its benign nature so you don’t have to regret later.

Lumps Under Skin – Most Possible Causes

The moment you discover bumps or lumps under skin, first thing that comes on your mind is: what the hell is this, could it be cancer? Well, it is common to experience scary feelings but the truth is most lumps under the skin are benign harmless and can be treated easily or even left alone. There might be nothing to worry about but it is wise to confirm the diagnosis with the doctor so you don’t have to regret later. Never diagnose yourself by just looking at the pictures you find online.

What are the possible causes of lumps under the skin?

There are several causes of lumps under the skin; most of the cases are harmless while few may be harmful. The lump may be any of the following:

Lipoma
Lipoma is one of the most common causes of lumps under skin. Lipomas are small, fatty masses that are harmless to your health. Your lump may be a lipoma if it feels soft and rolls easily under your skin.

Cyst
Cysts are closed sac that can be found in or under the skin containing fluid or semisolid material. The inner contents may be yellow in color and can be removed easily with minor surgical extraction. Most of these cysts are harmless and may require no treatment.

Enlarged lymph nodes
Enlarged lymph nodes are often seen in the neck armpit and the groin. Enlarged lymph nodes can be caused by simple infections like cold and flu or acute injury and bacterial infection. In rare cases it can also be caused due to chronic diseases like cancer and HIV. They usually disappear once the infection subsides. However, if the swelling persists or gets worse, it may suggest something more serious like lymphoma.

Abscess

Abscess is generally painful swelling resulting from collection of fluid or pus that is trapped inside a closed space. It is generally due to acute injury, bacteria or parasites. One may experience raised, red, hot and pain in the affected area and sometime associated with yellowish tip.

Malignant tumor

Although the possibilities for malignant tumor are less, one must still rule out the possibility of its malignancy. Fortunately, lumps under skin are rarely cancerous but one must always keep in mind of the following possibilities:

Soft tissue sarcoma
Soft tissue sarcoma is the cancer of the tissues underneath the skin, and may cause a lump almost anywhere on the body.

Lymphoma
Lymphoma (not to confuse with harmless lipoma) this is cancer of the lymph glands, and causes a painless swelling in the neck, armpit or groin.

Ganglion
Ganglion is cysts that are commonly seen around the joints and tendons. Most commonly seen on the back of the wrist, the cyst is smooth and soft lump under the skin. Inside the cyst is a thick jelly-like fluid. The ganglion can be removed if its causing you discomfort, otherwise it can be left alone.

Hernias
Hernias are small soft swelling that can be seen around the groin or the lower abdomen. It results in bulging of the abdominal content due to weak muscle wall of the affected area. Generally hernia is not that serious, but medical consultation is very important to avoid complications like strangulation.

 

Interesting facts about the lumps

  • Lumps that are movable are less likely to be dangerous than the fixed ones.
  • Soft lumps are less likely to be dangerous than the hard ones.
  • Painful lumps are less dangerous than the painless ones.
  • Smooth lumps are less dangerous than the rough ones.
  • Lumps that appear suddenly are less likely to be dangerous.
  • Lumps that grow rapidly are less likely to be dangerous.

Warning: These guidelines in most cases are true, but don’t apply in all the cases. If you are worried visit your doctor immediately.

In general lumps and swelling under skin may be classified according to the area affected

Lumps on facial areas

  • Mumps
  • Angioedema
  • Dental abscess
  • Salivary gland stone

Lump in the neck or throat

  • Swollen lymph nodes
  • Cysts
  • Skin tags
  • Goitre

Lump in the armpits

  • Swollen lymph nodes
  • Lymphoma

Lump on the shoulder, back, chest and arms

  • Lipomas
  • Epidermal or pilar cysts

Lump in the breast

  • Enlarged milk ducts
  • Fibroadenomas
  • Mastitis
  • Cysts
  • Skin Tags
  • Lipomas

Lump on the hand, wrist or finger

  • Ganglion
  • Warts

Lump around the groin area

  • Swollen lymph nodes
  • Cysts
  • Hernia
  • Saphena varix
  • Genital warts

Lump or swelling in the testicle

  • Varicocele
  • Hydrocele
  • Epididymal cyst

Lump around the anus

  • Abscess
  • Haemorroids
  • Rectal prolapse
  • Skin tags
  • Genital warts

Cradle Cap in Babies – Causes and Remedies

If you are first time mother, you may be worried about your baby’s thick, greasy scalp. But it usually is nothing to worry about. Most likely, it is due to a common but harmless and temporary condition that many babies develop called cradle cap. Although it might look worrisome, it rarely causes any discomfort to the child and is totally harmless that resolves on its own after few months.

What is Cradle Cap?

Cradle cap is relatively common harmless condition of the scalp presenting in the first 3 months of the baby’s life. Cradle cap appears as patches of thick, greasy, yellowish, crusty, scaly rash over the soft scalp. The vertex and the frontal area are commonly involved. However, cradle cap is not limited to the scalp, it can occur on face and other parts of the body too. Cradle cap is basically the infant form of seborrheic dermatitis, so called as “Infantile seborrhoeic dermatitis” that is limited to the scalp.

Other names given to cradle cap

  • Infantile seborrhoeic dermatitis
  • Honeycomb disease
  • Pityriasis capitis
  • Milk crust
  • Crusta lacteal
What Causes Cradle Cap?

The exact cause of cradle cap is not clear, but it is clear that it is not due to any allergies, infections or lack of hygiene. Experts agree that it is probably due to overactive sebaceous glands that produce excess sebum, which prevent the old skin cells from drying and falling off, as a result they stick to the scalp giving a thick greasy look. It is believed that babies have high level of mother’s hormones in their body even after several weeks or months following birth that is responsible for excess sebum production. Another factor like yeast infection (commonly malassezia) may also play role in the development of cradle cap.

Symptoms of Cradle Cap

Not all cases of cradle looks the same, it may look different on every baby. However, there are some common signs and symptoms that are usually present with the cradle cap, some of which are listed below:

  • No itching
  • Greasiness
  • Thick, scaly and flakey scalp
  • White, discolored or yellow crusts
  • Reddening of the affected skin
  • Temporary hair loss

 

Cradle Cap Pictures
Cradle Cap Treatment

Cradle cap usually doesn’t require any medical treatments which may disappear on its own after few weeks or months. It can sometime take more than a year for cradle cap to go. In the meantime, there are several remedies that can help loosen the scales and prevent scale buildups. Some of which are discussed below:

Cradle Cap Remedies

Home remedies of cradle cap

  • Gently massage your baby’s scalp with the mineral oil (baby oil will do) and leave it overnight, then wash your baby’s scalp with mild baby shampoo next morning.
  • Gently rub your baby’s scalp with finger to loosen the crusts and scales. You may also use soft brush to loosen the crusts.
  • Repeat this process every day until you see improvement and continue using every few days to help prevent scale buildups.
  • You may use mild anti-dandruff shampoo if above option is not working but these dandruff shampoo can irritate the baby skin and eyes. To be on the safe side, you may go to the nearest pharmacy and ask for cradle cap shampoo.

 

  • Maintenance therapy with mild shampoo every few days is a must as baby’s skin will continue to produce sebum several months after birth.
  • If frequent shampooing is not helping, it’s time to visit your doctor. He/she may prescribe stronger shampoo containing antifungal medications or hydrocortisone cream.
  • If your baby’s cradle cap looks red, inflamed or swollen, this could be suggestive of infection. Visit your doctor immediately; he/she will manage accordingly with antifungal and antibiotics.

Things you should avoid

  • Never pick cradle cap off your baby scalp; you may end up with the infected scalp.
  • Be sure not to use adult strength prescription dandruff shampoos.
  • Never use over the counter steroids and antifungal creams without talking to your doctor, as some products can harm your baby.
  • Avoid shampoo containing salicylic acid that can be absorbed through skin and irritate the baby.

Remember, most of the babies might looks funny in the beginning as they have been through 9 months journey. They need some time to adjust to the new world. Some might have oddly shaped head as a result of narrow vaginal canal; some might have cradle cap that might look scary. The good thing is, these initial imperfections are temporary and you know your baby is always beautiful.

Medications that can Cause Skin Pigmentation

Skin pigmentation due to drugs is quite common and accounts for 10 to 20% of all cases of acquired hyperpigmentation. Skin pigmentation can be due to variety of drugs that can arise due to direct effects of the drugs as in combination with triggering factors like sun exposure. Out of several drugs some of the most common drugs that cause skin pigmentation are antimalarials drugs, tetracyclines, nonsteroidal anti-inflammatory drugs, cytotoxic drugs, amiodarone, heavy metals and psychotropic drugs.

Treatment of drug induced pigmentation is usually withdrawal from the offending medicine and avoiding sun exposure. It may be accompanied by fading creams for several weeks to help improve the pigmentation.

Tetracyclines Groups

Hyperpigmentation is common in individuals taking tetracycline, especially minocycline. Tetracycline and minocycline may also cause brown discoloration of teeth, so is not recommended in children. Some of the drugs in these groups are:

  • Doxycycline
  • Demeclocycline
  • Minocycline
  • Oxytetracycline
  • Tetracycline
Heavymetals

The heavy metals are also considered to be causative factors for pigmentation disorders. Presentation may differ from metals to metals but are usually slate-gray or blue-gray in appearance. Some of the heavy metals that may cause pigmentation are below:

  • Arsenic
  • Bismuth
  • Gold (compounds)
  • Iron
  • Lead
  • Mercury
  • Silver
Antiretroviral drugs

Antiretroviral drugs can also cause skin and nail pigmentation that may resolve gradually when the drug is withdrawn. These drugs include:

  • Indinavir
  • Emtricitabine
  • Saquinavir
  • Zidovudine
Topical medications

There are several topical medications that might cause skin pigmentation, some of which are listed below:

Aminolevulinic acid
Carmustine (BCNU)
Bergamot
Bimatoprost
Carteolol
Chlorhexidine
Imiquimod
Latanoprost
Nitrogen mustard
Tretinoin
Verteporfin

Antihypertensive drugs

Sometimes antihypertensive drugs can also cause pigmentary changes in the skin. Some of the drugs that might cause pigmentation are: that might causes pigmentation on skin are

Acebutolol
Betaxolol
Bisoprolol
Captopril
Clonidine
Diltiazem
Esmolol
Indapamide
Labetalol
Methyldopa
Metoprolol
Minoxidil
Nisoldipine
Propranolol
Spironolactone
Timolol

Antimalarial drugs that can cause pigmentary changes are

Amodiaquine
Chloroquine
Hydroxychloroquine
Pyrimethamine
Quinacrine
Quinine

Anti-fungal agents that can cause pigmentation disorders are

Amphotericin B
Griseofulvin
Ketoconazole
Sertaconazole
Terbinafine
Voriconazole

Chemotherapeutics agents that can cause pigmentation on skin are

Bleomycin
Busulfan
Doxorubicin
Daunorubicin
fluorouracil
cyclophosphamide
carmustine
docetaxel
Bevacizumab
Capecitabine
Carboplatin
Cisplatin
Dactinomycin
Epirubicin
Estramustine
Etoposide
Floxuridine
Fluorouracil
Hydroxyurea
Ifosfamide
Irinotecan
Mechlorethamine
Mercaptopurine
Methotrexate
Mitomycin
Mitotane
Mitoxantrone
Paclitaxel
Pentostatin
Procarbazine
Thiotepa
Vinblastine
Vincristine
Vinorelbine

Immunosuppressive drug
Azathioprine
Cyclosporine

Antiviral Drugs

Ganciclovir
Cidofovir
Foscarnet
Ribavirin

Antidepressants, Antipsychotic and anxiety disorders medications

Phenothiazines
Imipramine
Desipramine
Chlorpromazine
Amitriptyline
Citalopram
Clomipramine
Clonazepam
Diazepam
Fluoxetine
Promazine
Fluvoxamine
Fluphenazine
Haloperidol
Promazine
Perphenazine
Thiothixene
Loxapine
Mesoridazine
Molindone
Olanzapine
Paroxetine
Pimozide
Risperidone
Thioridazine

Antiepilectic
Phenytoin
Carbamazepine
Mephenytoin
Tiagabine
Topiramate

Other drugs acting on Central nervous system
Methamphetamine
Tolcapone
Eletriptan
Donepezil

Anaesthetic drugs, pain reliever and muscle relaxant drugs

Levobupivacaine
Lidocaine
Orphenadrine
Cyclobenzaprine
Leflunomide
Etodolac
Phenazopyridine
Methysergide
Ketoprofen
Pentazocine

Antibiotics that may sometime cause pigmentation are
Ceftriaxone
Enoxacin
Grepafloxacin
Linezolid
Lomefloxacin
Ofloxacin
Sparfloxacin
Sulfadiazine

Anti-tuberculosis and Antileprosy drugs
Rifabutin
Rifapentine
Clofazimine
Dapsone

Hormones
Chlorotrianisene
Corticosteroids
Diethylstilbestrol

Thyroid Hormone to treat hyperthyroidism
Propylthiouracil
Methimazole

Anti-allergic drugs
Promethazine
Cetirizine

Anti-nausea/vomiting,
Metoclopramide
Prochlorperazine

Antiulcer drug
Rabeprazole
Pantoprazole

Retinoids
Isotretinoin
Alitretinoin

Other Miscellaneous Drugs
Amiodarone
Cevimeline
Deferoxamine
Dicumarol
Dinoprostone
Glatiramer
Heroin
Interferon
Methoxsalen
Nicotine
Phenolphthalein
Psoralens
Riluzole
Sulfasalazine
Niacin
Smallpox vaccine
Quinidine

 

amiodarone induced pigmentation

amiodarone induced pigmentation

Tripe palms: Almost Always a Sign of Internal Cancer

Tripe palms are very rare skin condition associated with internal cancer. It is estimated that more than 90% of the cases with tripe palms have underlying malignancy. In most of the cases, it usually occurs before cancer is diagnosed, but can arise at any point during the course of the cancer.

Tripe palms are characterized by velvety, rugose thickening of the palms that resembles tripe, the villous stomach lining of pork, beef, or sheep. Many experts consider this to be a form of palmar acanthosis nigricans, because of its clinical similarities and frequency of co-occurrence. Some also called it as “acanthosis palmaris” and “acanthosis nigricans of the palms”. One may sometime experience tenderness around periungual region.

What Causes Tripe Palms?

The exact cause of tripe palm is unclear but some suggest that it might be due to some substances from the associated cancer that might stimulate the palm skin cells to proliferate. Tripe palms are frequently seen in associated with acanthosis nigricans. In patient with both acanthosis nigricans and tripe palms, stomach cancer is common findings while in patient with tripe palms alone, lung cancer is most common. Other cancers associated with tripe palms are tumors of head and neck and tumors of genitourinary tract. In few cases they are also associated with psoriasis, bullous pemphigoid and exfoliative dermatitis.

If one has tripe palm, a detail cancer checkup should be done because in almost 50% of the cases, they are the initial signs of internal cancer.

 

 

How is tripe palm diagnosed?

Your doctor can diagnose the condition just by its characteristics appearance. If there is confusion your doctor may perform biopsy to confirm the case.

Treatment of Tripe Palm

There is no specific treatment for tripe palms. Treatment modalities are targeted in treating the underlying cause for tripe palms. Removal of the underlying tumor may allow improvement in around 30% of the cases. Few papers have suggested that retionids alone or in combination with metformin might help in improving the lesion.

There is no way to prevent the development of tripe palms. Patients should be up to date with standard cancer screenings.

Erythema Nodosum

Erythema nodosum is an inflammation of the subcutaneous fat. It is not a disease but a reaction pattern to various immunological reactions caused by different viral, bacterial, fungal infections, drugs, malignant disorders and other causes.

Erythema nodosum is commonly seen in women of age 20 to 40 but may occur at any age. Erythema nodosum starts with a sudden onset of symmetric, tender and erythematous nodules or raised plaque on the legs or forearm, most often seen on shin of the legs. After few days the nodules turn purple or red color than to green or yellowish color. One may have fever, headache, joint pain, abdominal pain, vomiting and diarrhea. The nodules may be so tender that walking may be difficult. Lesions usually resolve without scarring within 5-6 weeks. There is no ulceration seen and the lesion heals without scarring or atrophy. These lesions usually last 3-6 weeks and resolves, however, EN may recur frequently if the causative agent is not removed or treated.

Although erythema nodosum results from wide variety of etiologic agents, streptococcal infections are considered as most frequent causative factor in children. In contrast, adult erythema nodosum is most commonly associated with drugs, sarcoidosis, and inflammatory bowel disease to a large number of inciting factors. Below are several etiological factors for Erythema Nodosum

Infections

Bacterial Infections

Streptococcal infections
Tuberculosis
Yersinia infections
Salmonella infections
Syphilis
Campylobacter infections
Brucellosis
Q fever
Tularemia
Atypical mycobacterial infections
Chancroid
Meningococcemia
Corynebacterium diphtheriae infections
Cat-scratch disease
Propionibacterium acnes
Shigella infections
Gonorrhea
Leptospirosis
Lymphogranuloma venereum
Chlamydia
psittaci infections
Mycoplasma pneumoniae infections

Viral Infections

Herpes simplex
Infectious mononucleosis
Hepatitis B
Milker’s nodules
Orf
Measles
Cytomegalovirus infections

Fungal Infections

Histoplasmosis
Dermatophytes
Blastomycosis
Coccidioidomycosis
Sporotrichosis
Aspergillosis

Protozoal Infections

Giardiasis
Ancylostomiasis
Toxoplasmosis
Amebiasis
Ascariasis

Erythema Nodosum Pictures

Drugs

Oral contraceptives
Sulfonamides
Bromides
Iodides
Minocycline
Aminopyrine
Gold salts
Penicillin
Salicylates
Isotretinoin
Chlorothiazides
Phenytoin
Arsphenamine
Hepatitis B vaccine
Nitrofurantoin
Pyritinol
D-penicillamine
Thalidomide
Interleukin

Malignant Diseases

Leukemia
Renal carcinoma
Hodgkin disease
Non-Hodgkin
Lymphoma
Sarcoma
Post-radiotherapy for pelvic carcinoma

Miscellaneous Conditions

Ulcerative colitis
Pregnancy
Chronic active hepatitis
Sweet syndrome
Sarcoidosis
Colon diverticulosis
Crohn disease
Behçet disease
Reiter syndrome
Takayasu arteritis
Immunoglobulin A nephropathy
Granulomatous mastitis
Vogt-Koyanagi disease
Sjögren syndrome

Treatment of Erythema Nodosum

As several agents may cause erythema nodosum, eliminating these causative factors is the main aim of the treatment. Besides treating causative factors, bed rest is also very important part of treatment. Pain killers like aspirin, indomethacin or ibuprofen are helpful for those experiencing pain. In severe cases systemic corticosteroids may be given by your doctor or are not generally required for mild cases.

References
Fitzpatrick’s Dermatology in General Medicine, 7th Edition

Vaginal Itching in Children

Vaginal itching in children is relatively common issue and may be associated with redness, inflammation, and discharge or even bleeding. Most of the cases are harmless and can be effectively managed and prevented by removing the irritating cause or with some home remedies and over the counter medications.

Vaginal itching is quite common in children and young girls. In girls between 2-4 years, bacterial vaginitis due to bacteria entering the vagina as a result of poor toilet hygiene is quite common. So it is important for mother to educate about proper washing and wiping after urination and bowel moments. Lazy to wash/wipe or excessive washing and wiping can both cause irritation.

As your child reaches eight or nine, vaginal itching may be due to vaginal yeast infections. Although yeast normally lives in the vagina without harming, they can be symptomatic when they overgrow. This can lead to severe itching, burning, redness and inflammation and may also be associated with thick white discharge. Overgrowth of the yeast can be due to antibiotics that are usually given for ear and throat infection in children or any other condition that weakens the immune system.

In rare cases, vaginal itching can also be due to pinworm that causes itching around anal areas. They can migrate out of the anal areas and reach towards lower vagina. Itching due to pinworm is severe during nights.

Vagina can be very sensitive before puberty and easily irritated by several substances. Experts agree that most of the cases of genital itching and redness are caused by local irritants like bubble bath, scented soap and shampoos. Strong detergents and bleach used to clean the under garments can also cause irritation and itching, as can tight fitting nylon panties. Several other nonspecific vulvo-vaginitis can cause itching in children and young girls before puberty. However, once puberty begins, the vagina tends to be more acidic, that can fight and help prevent infections.

Psoriasis, lichen sclerosus et atrophicus, childhood eczema, and seborrhea are some of the other conditions that can cause vaginal itching in children.

It is very important for parents to educate their child (between age 10-13 years), about the vaginal parts and commonly encountered issues, so she can be aware of the changes and manage accordingly. Also when there is unexplained recurrent infection that is resistant to treatment, one should suspect sexual abuse in a child. As this matter is very sensitive, you should talk to your child about it and try to help and support her in every way.

Vaginal itching

Vaginal itching in children

Home Remedies for vaginal itching in children

There are several remedies that can get rid of vaginal itching, few are listed below:

  • Maintain good toilet hygiene.
  • Avoid bubble bath, scented soap and shampoo.
  • Avoid tight fitting nylon underwear; always wear loose fitting cotton underwear.
  • For yeast infection baking soda soaks is preferred in children and thought to work better than vinegar soaks.
  • If there is inflammation low strength steroid (1% hydrocortisone) for 2-3 days might help.

If the symptom doesn’t subside within a week or if your child has vaginal discharge, bleeding, painful urination or any other symptoms contact your health care provider immediately.

Erythema ab Igne: Warning for Laptop Users

I’m sure many of us use Laptops, and as the name suggest they are supposed to be placed on your laps. But have you ever thought that long term placement of laptops on your laps can cost you much. Yes, placing laptops on your laps without any cooling device or barrier can cause a skin condition called erythema ab igne, commonly known as toasted skin syndrome, fire stains or laptop thigh. Since the development of laptop computers, it has been a major risk factor for erythema ab igne and is increasing dramatically among the individuals who are prolonged laptop users.

Who Gets Erythema ab Igne?

Previously it was a common condition of elderly individuals and women, who are more prone to heat exposure. It was commonly seen on sins among the house-wife who were frequently involved in cooking on wood-burning stoves or close to fires. Other risk factors were those people who use electric heater, hot water bags or heating pads for joint pain or lower back pain. It can also be seen on the arms of chefs and bakers who are often exposed to the heat and radiation from ovens, as well as in glassmakers and jewelers. People with underlying conditions like hypothyroidism and poor microcirculation are more prone to this condition.

With the development of laptops computers it has been a major concern since heat and infrared radiation can directly affect the thighs. The underside of a laptop can be above 50 celcius, which is much warmer than you might have imagine and is enough to cause erythema ab igne when exposed for prolonged time. The heat and radiation source can be the fan, the battery or the optical drive.

How does it look like?

Initially, there may be mild and transient redness on the affected area. After prolonged repetitive exposure, the characteristics rash of erythema ab igne develops. The rash of erythema ab igne looks like reticular (net-like), red to brown pigmented patch on the area that has been affected by prolonged heat or radiation. In some cases there may be mild itching and burning sensation but most often it may be asymptomatic and go unnoticed until one see it.

Erythema ab Igne and Cancer

Although most experts agree on the fact that erythema ab igne due to laptops may not cause any long-term side effects or lead to severe complications, there is still a small chance of malignant transformation. Few papers have suggested that, on rare occasions, squamous cell carcinoma and Merkel cell carcinoma may arise in the lesions of erythema ab igne, but it may take more than 30 years of chronic exposure.[1-4] So, individuals with a history of long-standing erythema ab igne should consult dermatologist for detail examination and if needed the area should be biopsied.

Treatment of Erythema ab Igne

The treatment of erythema ab igne is to avoid exposure to heat and radiation source. You may need to add something in between your laptop and the leg to prevent further damage to the skin. The rash will ultimately fade and return to normal several months after discontinuation of direct heat or radiation. However in dark skinned individuals there may be pigmentation abnormalities that might take longer than normal or even permanent. So, the earlier you start preventing the more chances of complete recovery.

Hyperpigmentation can be improved with the use of topical agents like hydroquinone or tretinoin. If there is itching and inflammation mild corticosteroids may be applied.

Prevention of to
  • Avoid using laptops on naked thighs.
  • Add some cooling fan or any other barrier in between your laptop and the leg.
  • If possible try to avoid further heat exposure by placing the laptop on the desk.

References

  1. Cross F. On a turf (peat) fire cancer: malignant change superimposed on erythema ab igne. Proc R Soc Med 1967;60:1307-8.
  2. Peterkin GA. Malignant change in erythema ab igne. BMJ 1955;2:1599-600.
  3. Jones, CS, Tyring SK, Lee PC, Fine JD. Development of neuroendocrine (Merkel cell) carcinoma mixed with squamous cell carcinoma in erythema ab igne. Arch Dermatol 1988;124:110-3.
  4. Hewitt JB, Sherif A, Kerr KM, Stankler L. Merkel cell and squamous cell carcinomas arising in erythema ab igne [letter]. Br J Dermatol 1993;128:591-2.

Tinea Cruris: Bothersome Ringworm of the Groin

Tinea cruris, jock itch, ringworm of groin or whatever you name it, is the most common superficial fungal infection of the groin area and adjacent skin. Although can be seen throughout the year tinea cruris is most common during summer months. Male are at risk higher than females. Tinea cruris is not that serious problem and can be managed effectively by keeping the area clean, dry and applications of anti-fungal medications. However, recurrence is very common and this creates problem for most of the people.

Who is at Risk?

Tinea cruris is commonly seen in adolescent boys and adult men. Person having tinea cruris may also be having fungal infection on the foot and body (athlete’s foot and ringworm). It is common among the people who are obese and who sweats a lot, but can occur to anyone. It can be aggravated by repetitive friction in the groin area. It is contagious and can be spread through skin-skin contact or through unwashed clothing.

How is Tinea Cruris diagnosed?

Your doctor can diagnose the lesion based on direct examination and symptoms of the lesion. No other tests are generally necessary. If it creates confusion with other disease, your doctor may perform a quick KOH test to confirm or culture and biopsy as needed to exclude other diseases.

Other condition that can be confused with tinea cruris are:

Candida infection/Candidial intertrigo: Generally acute onset, usually bright red rash with satellite pustules surrounding the rash.

Inverse psoriasis: Chronic red scaly rash,Mild or no itch,often associated with rash elsewhere on body (scalp, knee,elbow,nails)

Erythrasma: Usually asymptomatic patches with dry, red to brown color.

Dermatitis: Several other dermatitis like seborrhoeic dermatitis, irritant contact dermatitis, allergic contact dermatitis

Symptoms of Tinea Cruris

Red, itchy, ring shaped rash in the groin area and adjacent skin is the most common presentation. The red patch is often associated with scales, small blisters and redness around the periphery while normal skin tone in the center. Both groins are commonly affected. The rash usually spreads few cm down inside to the thighs.

Treatment of Tinea Cruris

Several treatment options are available both over the counter and prescription medications. You can buy over the counter antifungal cream containing Butenafine, terbinafine, Tolnaftate, ketoconazole, clotrimazole, miconazole, econazole and apply on regular basis. Application of antifungal 2-3 times a day and maintaining the area clean and dry is usually sufficient in most cases.  Terbinafine in compared to other azoles is expensive but is the most effective medication, also requiring shorter treatment duration. If it doesn’t work you may need prescription antifungal creams.

How to apply antifungal for maximum result and to avoid recurrence

  • Apply the cream to the affected area including surrounding 2-3 cm of normal skin.
  • Apply for longer duration and continue applying even if the lesion has healed (you may adjust maintenance dose to once daily or alternate days for few weeks after lesion heals).
  • Application may differ according to medication; see the leaflet for more detail on each medication.
  • If there is inflammation, you doctor may also provide with mild steroids to subside the inflammation. Steroids will also soothe the itching and redness. Never use steroids for more than a week.

Oral antifungal may also be prescribed by your doctor if the infection is severe. Oral antifungals like terbinafine, fluconazole or itraconazole may be given by your doctor.

How can I prevent Tinea Cruris from recurring?

Although tinea cruris can be treated effectively by both over the counter and prescription medications, recurrence is very common. So, in order to prevent from recurring there are several things you have to keep in mind. Few are listed below:

  • Wash your groin area daily with mild soap and dry thoroughly. It is very necessary to keep the area dry; fungi can grow faster and multiply in wet and moist environment.
  • Change your underwear on daily basis; don’t give any change for fungus to multiply.
  • Don’t wear underwear or any clothing that irritates the area. Avoid tight-fitting and rough-textured clothing.
  • People often ignore and put on the underwear while the skin is still wet, never repeat such mistake.
  • Check for fungal infection on other areas like foot (athlete’s foot) and treat it accordingly, if left untreated it can spread to the groin and other areas too.
  • Never share private clothing and towels with other people. Always wash towel frequently and dry it in the sun daily after you use it.
Final Words

Tinea cruris usually responds well to treatment and complications are rare. However, if left untreated, secondary bacterial infection or even permanent darkening of the skin color may occur. So don’t wait and keep scratching, consult a dermatologist and get it treated.

Another condition called erythrasma can also occur on the same area and sometimes misdiagnosed. Erythrasma is caused by bacterial infection so applying anti-fungal won’t work.

Bier spots: Small White Spots on Skin

Bier spots, also called physiologic anemic macules, are small white irregular spots on the skin usually seen on arms and legs of young adults that are thought to be due to vascular anomaly. In few cases they may also be seen on the trunk making the diagnosis more confusing. They are usually harmless and require no treatment.

Bier spots are usually seen in individuals between 20-40 years and are more common in women than men. They are characterized by numerous irregular white spots (macules) with red erythematous surrounding that blanch on pressure. These white macules often disappear when affected limb is raised. These spots are thought to arise due to physiologic response of small blood vessels of the skin to venous hypertension and constriction of small blood vessels leading to tissue hypoxia. So, there is dilation of vessels in red area and constriction of vessels in pale areas.

Although Bier spots are considered as harmless physiologic response, they sometimes may represent systemic disease like scleroderma renal crisis, lymphoma and mixed cryoglobulinemia. So never underestimated the disease, always seek professional help before confirming the disease. Your doctor may order some tests to confirm that they are not due to some underlying systemic disease. When your doctor confirm they are totally harmless, it can be ignored or treated for cosmetic reason. If it was due to underlying disease, treating the cause will resolve the spots. Sometimes, they are also associated with pregnancy in women.

Other possibilities that may mimic Bier spots
  • Vitiligo
  • Post-inflammatory hypopigmentation
  • Pityriasis versicolor
  • Pityriasis alba
  • Nevus anemicus
Treatment options for Bier spots

In normal physiologic cases no treatment is required because the lesion is harmless, asymptomatic and resolve spontaneously. If it was due to underlying systemic illness, treating the cause will resolve the lesions. As early intervention can increase the chances of positive outcomes, always seek professional help as early as possible, don’t try to diagnose your-self just by looking few images online.