Rosacea is a disorder that causes symptoms of stinging, flushing, redness, skin lesions, or eyelid changes.  It is an inflammatory condition of the skin of the center of the face.   There are four types of rosacea.

Erythematotelangiectatic rosacea- sensitive skin, flushing, redness or skin texture changes

Papulopustular rosacea- red, painful skin reactions in the center of the face

Phymatous rosacea- thickening of the skin, such as the nose or cheeks, that causes a change in appearance

Ocular rosacea- eyelid changes that result in swelling, redness or dry eyes

Certain conditions can exacerbate the symptoms of rosacea.  These include exercise, spicy food or alcohol, sunlight, temperature changes and sometimes hot flashes.

There are several treatments that are helpful for rosacea.  Removing irritating substances and keeping the skin moisturized is helpful.  Protecting the skin from the sun is helpful.  Laser treatment is sometimes used for the superficial vascular changes that occur, especially for cosmetic reasons.  Topical medicines like metronidazole gel can be helpful.  Sometimes oral antibiotic treatments are used also.

Plaque psoriasis

Plaque psoriasis is a skin disorder that is common to people who have psoriasis.  This causes a change in the skin that looks like a scaly or silvery plaque or patch surrounded by a reddened border.  This skin change is not contagious or infectious, it is caused by an autoimmune reaction in the skin.  The plaques are often found on the elbows or knees, the back or the neck.

The skin lesions of plaque psoriasis are treatable.  They may respond to topical steroids, vitamin D, UV light or sunlight, or medicines that suppress the immune system.

Scabies, bed bugs and crabs

What is the difference between scabies and crabs?

Both conditions cause an itchy, red rash that can be spread from person to person.

Crabs are a louse that can be seen by the naked eye.  They live on body hair, especially in the genital region.  Crabs tend to be spread by sexual contact.  Crabs are not seen often in people who do not have pubic hair.

Scabies are a mite that can only be seen under the microscope.  They are rarely found on the body, they are normally in clothing.  They cause numerous small bites.  The itching and scratching make it difficult to see any of the bites.  The sensation of itching tends to be worse in the evening.

What about bed bugs?  They are a small insect that can be seen by eye.  They tend to live in bedding or bed frames.  They can bite and cause an itchy rash.  Normally their bites appear in a line (breakfast, lunch and dinner!) or a grouping.  Bed bugs are more common in beds that see many guests, such as in hostels or hotels.

Bed bugs do not cause scabies.  Crabs are not bed bugs.  Scabies and crabs are not the same.  They are all different insects that can bite the skin and cause a rash.  The differences between these three are their size, where they live, and to some extent, the symptoms they cause.

Scabies are not equal to Bed Bugs are not equal to Crabs


What is psoriasis?

What is psoriasis?

Psoriasis is a skin disorder where there the surface of the skin becomes itchy and dry. It may affect small areas of the skin (such as the elbows) or very large areas.   Normally the patches appear silvery in color and feel dry to the touch.  Treatments for this condition prevent the accumulation of the silvery scale and irritation of the skin.  Psoriasis is considered to be an autoimmune condition, and it may be treated by a variety of medications and treatments, including steroid cream, UV light, and immune modulatory medications such as Humira (adalimumab).

There are other conditions that cause itchy and dry skin. These include eczema, dermatitis, and lichen planus.

Some people with psoriasis develop arthritis, which causes joint pain, stiffness and swelling. This is called psoriatic arthritis.

Delusions of Parasitosis

People may develop a condition described as having fibers or parasites live in skin.  Sometimes it is simply the sensation that these exist.  People may develop symptoms of crawling, biting, itching or other reactions to fibers or small bugs. They may be able to show proof of this by carrying a small collection of these fibers or mites.  When the evidence shows that there is no infestation, the diagnosis is delusions of parasitosis (also known as Morgellons syndrome).

In this situation it is important to address the possibility that people with these symptoms may be correct.  Examination of their skin and the evidence they provide should give the diagnosis.  People who genuinely have mites on their skin (such as scabies) can be treated effectively.  People who do not show evidence of infestation may improve with counseling or medications that suppress their sensation, such as risperidone.

The prognosis for this condition is favorable.  Some people improve with a thorough examination and discussion.