Skin Disorders

Red Scrotum Syndrome

January 28, 2013 by Dr.Deepak 11 Comments

Red scrotum syndrome is a chronic disease of unknown cause characterized by persistent redness of the scrotum in association with pain, itching and burning sensation. It usually affects males in their second half of their life. Red scrotum syndrome (RSS) can develop after prolonged application of topical corticosteroids to the scrotal area like in the red face syndrome. However, in majority of cases there may not be history of corticosteroid use.

Other factors that are thought to contribute or co-exist with red scrotum syndrome include sexually transmitted diseases, fungal infections, bacterial infection and few other skin conditions.

A person with RSS may have difficulties sitting as it aggravates the pain. The patients may need to sit forward, allowing the scrotum to hang down past the seat edge. RSS involves the scrotum and sometimes base of penis. Scrotum may look bright red in color and associated with itching, pain and burning sensation. Although itching can be experience in almost all people, major problem is neurological pain and burning.

To exclude other disease fungal testing, patch testing, some blood works and biopsy may be needed.

Several treatments both topical and oral have been tried with not much success. Recently it has been suggested that oral doxycycline has good response in RSS with satisfactory improvement after 2 weeks of starting therapy and marked or sometimes comlete improvement after 3-4 months of therapy. If doxycycline fails oral gabapentine is another option.

As some experts believe that it might also be influenced by stress, anxiety and depression, so using some relaxation techniques and may be self hypnosis could work on some individuals.

Reference:

Wollina U. Red scrotum syndrome. J Dermatol Case Rep. 2011 Sep 21;5(3):38-41. Red Scrotum Free Open Access
Abbas O, Kibbi AG, Chedraoui A, Ghosn S. Red scrotum syndrome: successful treatment with oral doxycycline.J Dermatolog Treat. 2008;19(6):1-2

Spots on Nose: What could be the cause?

January 26, 2013 by Dr.Deepak Leave a Comment

Spots on the nose may be due to several factors, some affects just the skin while few may be the skin manifestation of systemic disease. In most of the cases dark or black spots on nose are harmless but there are few conditions like melanoma which must be identified as early as possible. So make no mistake and consult dermatologist if you suspect any abnormal spots around the nose. These spots on the nose are usually prominent and can be very annoying which force one to visit the dermatologist. Here, in this article we’ll try to brief some spots on the nose that are commonly encountered in dermatologist office. Please remember that there are several other lesions that can arise on nose and few may be harmful. This article will only focus on flat hyperpigmented lesions.

Melasma

Melasma which is harmless and common condition seen on cheeks, forehead and the lips can also occur on the nose. This problem is common in women and seen usually during pregnancy which may fade gradually after delivery. These lesions are often light-brown patches with irregular border.

Fixed Drug Eruption

Sometimes fixed drug eruption can also cause grey-brown, oval or round with sharp edges spots on nose. Although several drugs are associated to cause fixed drugs eruption, most common are cotrimoxazole (Bactrim) and naproxen.

Actinic lichen planus

A type of lichen planus which is seen in sun exposed areas like nose. One may notice brown to black patches or flat plaques with irregular border.

Lichen planus pigmentosus

This is another variant of lichen planus which sometimes involves the face and nose and is characterized as brown to greyish black spot.

Acanthosis Nigricans

Acanthosis nigricans which is commonly seen in neck and underarms can also be associated with hyperpigmentation on ala nasi. Severe forms and atypically located lesions can be associated with malignancies.

Freckles

Freckles are very common pigmented lesions often starting during early childhood and commonly seen in fair skinned individuals. Freckles are harmless, small tan-brown irregular lesion commonly seen on sun exposed areas, especially the nose and cheeks. They tend to be prominent during summer and fade during winter.

Lentigo

Lentigo, especially solar lentigo, is also quite commonly seen in sun exposed areas including nose. They are initially small, brown, yellow-tan to black, sharply circumscribed, pigmented lesion. They slowly increase in size and number. In case of xeroderma pigmentosum, nose is mostly covered with lentigines and freckles.

Lentigo maligna

Lentigo maligna is an early form of lentigo maligna melanoma, a potentially life-threatening form of skin cancer. It can be seen as irregular hyperpigmented spots on the nose. As the lesion advance into invasive stage, the initial flat lesion will slowly progress to raised lesion. Early diagnosis and treatment is very important to avoid further complications.

Drug-induced hyperpigmentation

Some drugs like antimalarial drugs, quinidine and amiadarone can cause drug-induced hyperpigmentation. Such lesions are often bluish grey in color and affects nose along with the cheeks and forehead.

PUVA therapy

PUVA therapy can also cause hyperpigmentation on sun exposed areas including nose and other areas of the face.

Argyria

Argyria manifests as slate grey pigmentation on nose and face. Argyria is caused by long term use of products containing silver, resulting in deposition of silver particles in the skin and mucosa. Excessive use of topical cream containing silver
Sulfadiazine may also cause local discoloration

Ochronosis

Onchronosis occurs as a result of deposition of homogentisic acid and is usually seen in middle aged individuals. The lesion is mostly seen on the nose and ears and is bluish black or greyish in color with irregular pigmentation.

Common Causes of Bumps on Penis

January 13, 2013 by Dr.Deepak 64 Comments

There are several reasons one can develop papules or bumps on penis. It may be either due to non-infectious cause like pearly penile papules and Fordyce spots or may be due to sexually transmitted disease like genital warts. It is obvious to fear when someone gets bumps on penis or anywhere around genital areas but not every bumps are sexually transmitted, in fact most of the bumps around penis are harmless. Being said that, it is always wise to visit the doctor and confirm the case rather than trying to diagnose your-self just by looking picture on internet.

Molluscum Contagiosum

Molluscum contagiosum are small dome-shaped and painless pearly flesh-colored bumps with central depression. MC can occur in penis, scrotum, inner thigh or any other parts of the body. Early lesion may be confused with genital warts or herpes but unlike herpes they are painless and have distinguishing features like pearly bumps with central depression. Molluscum Contagiosum is harmless and is usually self-limited which gradually resolves over several months.

Pearly Penile Papules

Pearly penile papules, also called as hirsuties papillaris genitalis or hirsuties coronae glandis are small dome-shaped, skin-colored bumps seen on sulcus or corona of the glans penis. These papules are arranged in one or several rows around the base of the head of the penis. They are commonly seen in men with uncircumcised penis. They are usually asymptomatic and may persist throughout the life. No treatment is necessary for pearly penile papules except for cosmetic purpose.

Fordyce Spots

Fordyce spots are extremely common skin lesion occurring in around 80% to 95% of the total population. Fordyce spots can be commonly seen on glans penis, shaft of penis and scrotum and are usually multiple small, pinhead, painless, yellowish or whitish focally grouped macules or papules. Fordyce spots are non-infectious and totally harmless so, no treatment is required.

Genital warts or Condyloma Acuminata

Genital warts are pink to skin-colored bumps commonly seen on perianal areas, shaft of penis and scrotum. They are very common viral infection caused by human papillomavirus (HPV) which are acquired through sexual contact. Some people may never develop signs and symptoms but most develop lesion within 1-3 months of sexual contact with the partner. However, for some individuals it may take several months to years for warts to be clinically apparent. Genital warts initially starts with small, smooth or rough, flesh-colored bump and gradually increase in number and size which may be arrange in a groups resembling cauliflower appearance. Sometimes giant cauliflower like appearance may be seen on glans penis, foreskin and perianal areas which is termed as giant condyloma acuminata. Some papers suggest that they may represent a malignant transformation, verrucous carcinoma (VC).

Lichen Nitidus

Lichen Nitidus appear as small tiny clusters of red, brown violet or skin-colored shiny bumps with flat-topped. They are relatively uncommon and may appear on genitals. Although most of the lesions are asymptomatic, some may complain of mild itching. The cause of lichen Nitidus is unclear. Lichen Nitidus is harmless and no treatment is required.

Angiokeratomas

Angiokeratoma are harmless lesion commonly seen on scrotum, shaft of penis and glans penis in men. They appear as tiny black, blue, or dark red dome-shaped bumps with scaly surface. Although most of the cases are asymptomatic few may be associated with pain and itching. In young individuals the lesion tend to be smaller red and less scaly, while larger, dark blue or black with more scales in old individuals. Although angiokeratoma of the scrotum is often considered as harmless condition, it has the potential to cause considerable worry and distress to patients.

Bowenoid papulosis

Bowenoid papulosis usually occurs in young sexually active individuals. Bowenoid papulosis appear as single or multiple, small red, brown to flesh-colored bumps with flat or rough surface. Lesion occurs most commonly on shaft of penis, although it can occur anywhere around ano-genital areas. They are caused by human papillomavirus (the virus that causes genital warts) and are sexually transmitted and shares clinical similarities with genital warts. They are most commonly caused by HPV 16. Bowenoid papulosis is considered to be transitional state between genital warts and Bowen disease and has potential to be malignant.

Scrotal Calcinosis

Scrotal calcinosis is an uncommon harmless condition characterized by slowly growing multiple, painless, hard scrotal papules or nodules that occur in the presence of normal calcium and phosphate metabolism.

Penile syringoma

Syringoma that are localized on penis are thought to be rare dermatological condition. Only few cases of syringoma of the penis are documented in English literature. Clinically, syringoma on the penis appear as small asymptomatic yellow-brown or skin-colored bumps that may be localized on back or lateral surface of shaft of penis. Syringoma are harmless lesion and no treatment is required.

Penile Milia

Although not quite common, milia on penis can be occasional findings in men. These are again harmless and can be treated simply by unroofing the with a tip of a needle and extracting the contents. This is often quick and painless procedure.

There are several other disease and condition that can develop on scrotum or penis some of which are listed below. Please be warned that several other disease can also develop on genital areas that has not been discussed in this articles. To know more about skin colored, pigmented or red bumps on penis please refer to another article here

Seborrheic keratosis
Penile epidermoid cysts
Lichen planus
Lichen nitidus
Secondary syphilis
Epidermoid cyst
Neurofibroma
Leiomyoma
Mucinous syringometaplasia
Acrochordons (skin tags)
Melanocytic nevus
Scabies
Venous varicosities
Granuloma annulare
Nevus comedonicus
xanthogranuloma
Pseudo-Kaposi sarcoma
Carcinoma erysipeloids
Leprosy
Amyloidosis
Lipoid proteinosis
Tuberculide
Insect bite and tick bite
Primary lymphogranuloma venereum
Primary granuloma inguinale

Perioral Dermatitis – Causes, Symptoms and Treatment

January 10, 2013 by Dr.Deepak 1 Comment

Perioral dermatitis is a skin disorder characterized by small red bumps that are seen predominantly around the mouth. Perioral dermatitis is commonly seen in young females and accounts for almost 80-90% of the total adult cases. The granulomatous form of perioral dermatitis has been reported commonly in children of prepubertal age. Perioral dermatitis is often chronic and disfiguring which affects patient’s lifestyle and self-esteem. This condition is very common and it tends to come and go in many people over time

Perioral Dermatitis Causes

The exact cause of perioral dermatitis is unclear. POD is thought to be a multifactorial disease caused by several factors that are listed below:

Topical steroid preparations
Nasal steroids and steroid inhalers.
Fluoride containing toothpaste
Skin care products containing paraffin and petrolatum as base.
Regular use of foundation makeup
physical sunscreens
UV light, heat, and wind
Candidial and fungal or bacterial infection
Hormonal changes
Oral contraceptives
Malabsorption

Perioral Dermatitis Symptoms

Perioral dermatitis is commonly associated with burning sensation around the mouth. The red tiny bumps may be filled with fluid or pus. These bumps rarely itch. Such rash may also be seen on periorbital area and forehead and may be mistaken for acne. These lesions are usually symmetrically distributed but may also be unilateral. The granulomatous variant of perioral dermatitis manifests as tiny, red, yellow-brown or flesh-colored bumps. These lesions may also appear on scalp, ears, scalp, trunk, extremities and labia majora.

Perioral Dermatitis Pictures

How is Perioral Dermatitis Diagnosed?

Perioral dermatitis can be diagnosed just by direct examination by a dermatologist. Your dermatologist may also perform some tests if he suspects the causative agents to be fungal or bacterial origin.

Other conditions that may resemble perioral dermatitis

Allergic contact dermatitis
Irritant contact dermatitis
Acne
Rosacea
Lupus miliaris disseminates faciei
Seborrheic dermatitis
Lip-licking cheilitis
Gram-negative folliculitis

Perioral Dermatitis Treatment

Perioral dermatitis is often very difficult to treat successfully. It usually requires several months of treatment. Recurrence of bumps is common, especially if you unknowingly apply skin creams containing steroids on your face or use any other products that are known to be aggravating factors.

Treatment options are targeted towards the underlying cause of the perioral dermatitis. If topical corticosteroids are being used, they should be stopped immediately. It is wise to stop using all cosmetics, makeups and skin care products for some time. Avoid using foundations with moisturizers as it can aggravate the condition. One study showed that applying foundation in addition to moisturizer and night cream resulted in a 13-fold increased risk for perioral dermatitis, so avoid using it. However, moisturizer alone has no increase risk for POD. Always use mild soap-free cleansers and wash your face twice daily. Avoid using toothpaste containing fluoride or other products that contain chloride. For mild cases of perioral dermatitis topical antibiotics like metronidazole may be given. Other topical medications include clindamycin, erythromycin, azelaic acid, Benzoyl peroxide, Tacrolimus, Pimecrolimus, etc.

In case of moderate to severe disease, your doctor may prescribe combination therapy of topical medication with oral medications like oral doxycycline, tetracycline or minocycline for a course of 8-10 weeks. Patients with tetracycline allergy or children below 8 years and nursing mothers may be given oral erythromycin. Photodynamic therapy with topical 5-aminolevulinic acid has also shown some promising results in treating perioral dermatitis.

Acrocyanosis

January 9, 2013 by Dr.Deepak Leave a Comment

Acrocyanosis is a persistent dusky or blue painless discoloration of hands, feet and less commonly the face. It is commonly seen during winter months and is accentuated by cold exposure and is frequently associated with local hyperhidrosis of hands and feet. Cyanosis of the hands and feet increases as the temperature decreases. Acrocyanosis commonly starts in adolescence and may persist into adult life, while in some individuals it may spontaneously remits.

This condition is most probably a vascular defect where there is constriction of peripheral arterioles when exposed to low temperature. This results in decrease blood flow to the peripherals. It is usually associated with painless mottled duskiness of both hands and feet. Less frequently it can also affect facial areas like tip of nose and ears. Trophic changes like ulceration are very rare. It may sometimes be confused with Raynaud phenomenon which is usually associated with pain and is often episodic and segmental. In case of acrocyanosis secondary to systemic disorder, it often affects digits asymmetrically and may be associated with pain and tissue loss. The skin changes in acrocyanosis may be temporary after cold exposure but usually persist during the winter and even throughout the summer months.

What causes Acrocyanosis?

Acrocyanosis is genetically determined and usually starts in adolescence. In some cases the cause is unknown while in some cases it may be secondary to several systemic disorders which are listed below. When it develops for the first time during adulthood, it is very important to find out the secondary cause. In few cases it may be induced by drugs like Butyl nitrate, Interferon-alfa (2a) etc.

Acrocyanosis due to systemic disorders

Connective tissue disorders
Primary and secondary antiphospholipid antibody syndrome
Benign and malignant paraproteinaemias
Paraneoplastic syndrome
Cold agglutinin disease
Cryoglobulinaemia
Anorexia nervosa
Bulimia nervosa
Chronic orthostatic intolerance
Postural orthostatic tachycardia syndrome of adolescents
Adolescent chronic fatigue syndrome
Brachial plexus neuropathy
Chronic arsenic poisoning
Fucidosis
Ethylmalonic encephalopathy
Mental retardation
Schizophrenia
Essential thrombocythaemia

Treatment of Acrocyanosis

There is no effective medical treatment for acrocyanosis. Supportive measures to keep the skin warm are helpful. The commonly affected areas like hands are feet should be protected with woolen clothing throughout the winter season. Heating pads may be used to warm the peripherals. Smoking should be strictly avoided. As central cooling triggers peripheral vasoconstriction, keeping the whole body warm is very important. If acrocyanosis was due to drugs, stopping the drug will improve the condition. Treatment with vasodilator medications have been tried with limited success. In case of secondary acrocyanosis, treatment of underlying systemic cause may improve the condition.

Pressure Urticaria: Risk Factors and Treatment Option

December 5, 2012 by Dr.Deepak 1 Comment

Pressure urticaria is a physical urticaria characterized by red, local swelling and often painful rash that arises at the site of sustained pressure. Pressure urticaria may occur immediately after few minutes of pressure stimulus or may occur after hours, generally 3-6 hours in case of delayed pressure urticaria. Unlike other urticarias, treatment of pressure urticaria is often unsatisfactory and may severely impair the quality of life of the individuals.

Risk Factors for Pressure Urticaria

Anything that results in pressure may stimulate pressure urticaria. These includes but not limited to:

Sitting on a hard surface, standing or walking
Works that needs to carry heavy tools by hands
Hand clapping
Carrying heavy objects or even a handbag
Wearing tight-fitting clothes like belts, shoes, bra etc.
Dental work
Kissing and sexual activities

Symptoms of Pressure Urticaria

Pressure urticaria is usually associated with deep, red, swelling of the skin (wheals) that may last for 8-72 hours. The wheal may be seen within few minutes or most commonly 3-5 hours after pressure stimulus. The swelling may be often itchy, burning and painful that may persist for several days and sometimes blistering may be seen. Commonly affected sites are the hands, feet, legs, buttocks, trunk, and the face. The lesion may also be seen in genitals. Sometimes the wheals may be accompanied by systemic flu-like symptoms like fever, chills, headache and joint pain. It is estimated that up-to 60% of the individual with pressure urticaria also have chronic urticaria.

Diagnosis of Delayed Pressure Urticaria

Delayed pressure urticaria may be diagnosed clinically based on the appearance of wheal in the areas of the pressure stimulus. It can also be confirmed by pressure challenge testing. In pressure challenge testing, the tests are generally applied on shoulder, upper back, or posterior thigh and the result is read after around 6 hours.

Treatment of Pressure Urticaria

Treatment of pressure urticaria is usually unsatisfactory, and antihistamines are generally not effective. There is no known cure, the ideal initial treatment would be to avoid the cause. Several other therapies have been tried, but results are often disappointing. Although high dose of antihistamines may be helpful in some patients, results are still not satisfactory. Several other therapies have also been tried with conflicting results and include nonsteroidal anti-inflammatory drugs (NSAID), Colchine, dapsone, sulfasalazine and ciclosporin.

Oral steroids, although not recommended for long term use, are thought to be the most effective treatment for delayed pressure urticaria. Topical steroids under occlusion may also be useful in local lesion.

Beside treatment it is necessary to avoid the aggravating factors. Always remember:

Avoid wearing tight fitting clothes
Avoid sitting or standing on hard surface for long duration of time.
Avoid long walk; take a rest in between if you are for a long walk.
Avoid lifting heavy items or broaden the handles of heavy items.

Cutaneous Larva Migrans

November 26, 2012 by Dr.Deepak Leave a Comment

Cutaneous larva migrans also called as creeping eruption or sand worm occurs when canine hookworm penetrate the skin and start moving through the superficial layer of the skin (epidermis). It is one of the most common skin diseases among the travelers returning from tropical countries.

Cutaneous larva migrans is most commonly seen in the sole of the foot. In few cases, it can also be seen on thigh, buttocks and the back that may have come in contact with the soil or sand contaminated with animal feces.

As the larva lacks certain enzymes that are necessary to penetrate the deeper dermis, they keep wandering randomly creating a route in a snake-like pattern. They can borrow at the rate of around 2 cm per day. The humans are actually the accidental host, so it’s the dead-end for the larva. Unable to find their way into the circulation they die in about 2 to 8 weeks.

Who is at risk?

People of all races, ages and sex can be affected by sand worm or cutaneous larva migrans. People living or travelling around tropical or subtropical region are the most groups at risk. These may include:

Travelling around tropical and subtropical region
Occupations and hobbies that involve skin contact with soil and sand.
Beach loving, sunbathers
Plumber, farmers, hunters and gardeners
Children in sandboxes
Pest exterminator

Signs and Symptoms of Cutaneous Larva Migrans

The lesion are very classical with a distinct serpiginous borrows created by the larva. When combined with the recent history of possible exposure, the diagnosis is clear. The lesion may be itchy and red. Symptom starts to show up within first 2 weeks of the individual’s return from endemic or tropical areas. Lesion may sometimes be mistaken for fungal infection or other inflammatory disorders. So, it is wise to visit a dermatologist if in confusion.

Treatment of Cutaneous Larva Migrans

As the human are accidental and dead-end host, the larva can’t survive in the epidermis and eventually dies after 2-8 weeks. If untreated, the lesion will resolve in 4-8 weeks. However, there are several effective treatments which can shorten the disease course.

Old therapies like freezing the edge of the skin burrow by liquid nitrogen, solid CO2 or ethylene rarely works, as larva is usually located few centimeters beyond the visible end of the burrow. Anthelmintics drugs like albendazole and tiabendazole are effective against the cutaneous larva migrans. For early, localized and mild lesions, topical 10%-15% thiabendazole is considered the treatment of choice, as it has advantage of no systemic side effects. Although not approved by FDA, Ivermectin is another good choice and is effective with just a single dose.

If in case of any secondary infection, antibiotics may be needed. After initiation of medication itching will be reduced within 24-48 hours and the track created by larva resolves within 7-10 days.

How to prevent Cutaneous Larva Migrans

Cutaneous larva migrans can be easily prevented with some measures listed below:

Avoid skin contact with the soil or sand contaminated with animal feces.
Always wear enough footwear and use cloth barrier or mattress when sitting or lying on the beach or ground.
Always avoid lying on dry sand, even on a towel.

Dermatographic Urticaria

November 25, 2012 by Dr.Saiyan Amatya Leave a Comment

Dermatographic Urticaria is a common form of physical urticaria where linear wheal occurs when skin is stroked with a firm object. The wheal may occur rapidly within 5-10 minutes and usually fades within 20-30 minutes. In some cases wheal may develop slowly and may last several hours to days, so called delayed dermographism. Dermatographic urticaria is also known as Dermographism, dermatographism or skin writing.

Although, more common in young adults; dermatographic urticaria can be seen at any age, with peak incidence in the twenties and thirties.

Dermatographic Urticaria Causes

The exact cause of dermatographic urticaria remains uncertain. Trauma to the skin causes the mast cells to release certain chemicals like histamine and few others. This process causes small blood vessels to leak, which allow fluid to accumulate in the skin resulting in wheal.
Dermographism may also be triggered by allergy to certain drugs (like penicillin), scabies, insect bites or a worm infestation. Congenital dermographism has been associated with systemic mastocytosis. Anxiety and stress may also be a triggering factor in some patients.

Signs and Symptoms of Dermatographism

When skin is stroked wheal develops immediately and usually lasts for 15-30 minutes before it fades out. In symptomatic individuals it is also associated with itching and may be more severe at night. as a result itch-scratch sequence may appear. These symptoms can be aggravated by physical pressure, exercise, heat, stress and emotions. In delayed type of dermographism wheal usually develops after 3-6 hours and generally last for 24 to 48 hours. Itching and whealing may affect whole body, but the scalp and genital area are often spared.

Dermatographic Urticaria Treatment

Although, dermographism can be very distressing condition, it is not a life threatening. Individuals with simple dermographism are usually asymptomatic and don’t require any treatment. In case of symptomatic dermographism, treatment is given until the problem resolves, which may take several months.

Identifying the cause and avoiding the triggering factors is the most important strategy in the management of this condition. In addition, avoidance of very hot bath and use of good moisturizers during winter is a must to avoid dry skin that may lead to scratching of the skin.

Oral antihistamines are the drugs of choice for most cases. There are several non-sedating one which can also be bought over the counter. For successive results treatment may be needed to continue for several months.

Light therapy like narrowband UVB phototherapy and PUVA (oral psoralen plus UVA) may also be beneficial for resistance cases. However, the beneficial effect may not last long and relapse within few months.

Cold Urticaria: Causes, Risk Factors and Treatment

November 24, 2012 by Dr.Saiyan Amatya 1 Comment

Cold urticaria is a skin disorder where affected patients develop urticarial rash after physical exposure to cold objects such as cold water, air, or foods. These symptoms can develop within minutes of exposure to cold stimulus.

There are two types of cold urticaria; acquired cold urticaria and familial cold urticaria. Familial type is a rare one. The symptoms of acquired type occur within minutes while those of familial type may take 24-48 hours.

What Triggers Cold Urticaria?

Cold urticaria can be triggered by many factors, few are listed below:
Cold air
Cold fluids
Swimming in cold water
Contact with cold surface
Ingestion of cold liquids and foods
Restriction of blood blow

Cold Urticarial Causes

As name suggest, cold urticarial is primarily caused by exposure to cold. However, why the cold stimulus causes such urticarial lesion is still unclear. It may also be due to secondary causes like blood disorders and infectious disease. Some condition that have been associated with secondary cold urticarial are:

Lymphosarcoma
Viral hepatitis
Infectious mononucleosis
Chickenpox
Chronic lymphocystic leukaemia
Cryoglobulinemia
Hypothyroidism
Leukocytoclastic vasculitis
Drugs like penicillin, oral anticoagulants and antifungal

Symptoms of Cold Urticaria

Symptoms of cold urticaria show up within 3-5 minutes after exposure to cold stimulus. Within minutes of exposure red itchy wheals develops that may be localized to the area of exposure or generalized to whole body. Some may also experience severe systemic and anaphylactic reactions, which is often due to swimming in cold water. Systemic symptoms may include:

Swelling on the pharynx, uvula, tongue and lips
Difficulty in breathing
Nausea, vomiting, stomachache and cramps
Rapid irregular heart rate, low blood pressure, shock, collapse
Headache, disorientation and unconsciousness

How is Cold Urticaria diagnosed?

The diagnosis is based on clinical features and cold stimulus test like “ice cube test” or “hand immersion test”. When ice cube is applied for 1-5 minutes; red swollen wheal may develop within minutes, if a person has cold urticarial. Beside this, complete blood counts and other related test must also be performed in order to exclude any underlying systemic condition.

Treatment for Cold Urticaria

Treatment includes strict avoidance of cold environment. Those with cold urticaria should always avoid cold foods, ice-creams, cold beverages and most importantly should strictly avoid swimming alone in cold water. Severe form of cold urticaria can be very fatal. Although antihistamines may be enough for mild rashes and itching, systemic reaction needs immediate medical attention and hospital admission. There are some reports of successful treatment with systemic corticosteroids, dapsone, oral antibiotics, ciclosporin, leukotriene antagonists and synthetic hormone danazol.

Another option is desensitization therapy with slowly and gradually exposing the skin to cold condition.

Lip Licker’s Dermatitis-A Common Problem During Winter

November 8, 2012 by Dr.Deepak 6 Comments

Lip licker’s dermatitis or lick eczema is quite common among the children during winter season. It’s a rash that occurs around the lips in response to chronic licking around the mouth with saliva. This is associated with cracked and chapped lips. When the lips get dried your child will more likely moisten the lips by saliva. When it is repeatedly done by your child, it becomes a habit, just like nail biting, thumb sucking. This rash gets better when the habit is stopped.

Lip licker’s dermatitis is cause by direct irritation of saliva, so, it is considered as irritant contact dermatitis. Severe irritation may further lead to cracking and secondary bacterial infection.

What Causes Lip Licker’s Dermatitis?

During cold season or during dry climates our lips often get dried. When lips gets dried child often develops a habit of repetitive licking of their lips to moisten them with saliva, which will temporary relief the dryness. But, when saliva comes in constant contact with lips and surrounding skin it dries and irritates the skin resulting in lip licker’s dermatitis.

Diagnosis of Lip Licker’s Dermatitis

It is diagnosed clinically by typical rash around the mouth that can be easily reached by tongue. But be warned there are other conditions that might also resemble such rash, so if you are unsure, visiting a dermatologist might be helpful.

Lip Licker’s Dermatitis Treatment

It is often difficult to treat lip lickers dermatitis, as child develops a habit of persistent lip leaking. The most important treatment is to ask for the child to stop licking her lips. So educating child about the habit and its consequences might help.

For mild cases regular application of Vaseline will work wonder. For moderate to severe cases your doctor may prescribe 1% hydrocortisone cream for a few days, which will usually clear the skin. After that, regular use of Vaseline will help moisturize and protect the skin. For best result apply a thick layer of Vaseline around the mouth and re-apply every 30 minutes. It is better to give a box of Vaseline to your child so he/she can apply on regular interval. With proper treatment, it goes away in a couple of weeks with no scarring or permanent skin damage.

How can I Prevent Lip Licker’s Dermatitis?

As always said, prevention is better than cure, so preventing is much easier than treating the condition. As soon as the lips feel dry start using the lip balm. It is better to use regular lip balm during dry and winter season, which will keep the lip moistened throughout the season and prevent cracking, drying and lip licker dermatitis.