Some skin conditions are temporary and will go away on their own, but others like eczema, acne, and rosacea may require the expertise of a physician. Today, I’m joined by Dr. Daniel Heckman, a board-certified family physician with a special interest in treating dermatological conditions and performing skin procedures. I’ve got many questions for him, including some about skin cancer, so I hope he’s ready. This is The Franciscan Health Doc Pod, and I’m Scott Webb. Dr. Heckman, thanks so much for your time today. We’re going to talk about common skin conditions that many of us experience when we’re younger and then as we age. It’s great to have your expertise today.
What is Eczema and What Causes It?
Eczema essentially is just a broad term for dermatitis or inflammation of the skin. You can think about this in a way of what would cause this inflammation of the skin. Usually, it is due to a decreased barrier function of the skin, making it more leaky where water can then evaporate out. This leads to dryness, which leads to irritation, which leads to itching. Itching triggers that whole inflammatory cascade of redness and thickening of the skin. It can even get infected.
Common Areas Affected by Eczema
In my experiences over the years, I’ve seen folks with eczema on their elbows and knees. Is that the only place folks get eczema, or can it be other places as well?
It depends on what age the person is. This is classically a condition of childhood and affects 5 to 20% of children worldwide. You’ll see it in the flexural surfaces, like the area on the front side of your elbows and the back side of your knees. For whatever reason, into adulthood, it does change over to the knee caps and the elbows themselves.
Is Eczema Itchy and Painful?
I’ve always wondered, is eczema just itchy? Is it also painful, and are folks making it worse by scratching it?
It is itchy. If it gets infected, it can become painful. If you are scratching it, that is actually an injury to your skin, calling in more inflammatory cells that then propagate the itching. It becomes a vicious cycle that isn’t broken until you treat it topically.
Treatment for Eczema
There is treatment for eczema. The main question is, because you continue to see folks have this in adulthood, is the treatment permanent or is it a temporary fix?
As this is most common in children, our skin thickens and we produce more natural oils as we age, which naturally treats it. Essentially, people generally grow out of this eczema condition. In childhood, to treat it, you first want to prevent it by filling in the gaps of that leaky skin with a natural moisturizer free of fragrances, such as cave products or Vaseline. If it progresses to the redness and itching stage, you want to pop the inflammatory cells with a topical corticosteroid.
What is Acne and What Causes It?
Let’s switch up here and talk about acne. What essentially is acne, and are there things that we do that lead to it? Is it genetic, family history, or behavior and lifestyle, or a combination?
Acne, or acne vulgaris, means common acne. Your skin has a bunch of pores, and in those pores, there is an oily substance called sebum that acts as a natural moisturizer. When this oil is overproduced or becomes trapped in the pores by clumped dead skin cells, it becomes food for bacteria that then grow, leading to an infection that calls in inflammatory cells, creating a pus-filled bump.
Acne in Teenagers vs. Adults
Most of us associate acne with teenagers, but you also see adults with acne. What are you doing in terms of treatment?
Teenagers most commonly get it because hormones stimulate increased production of sebum. For teenagers, you can’t control their hormone levels, so you try to control the bacteria by killing it with either topical treatments or an oral antibiotic. For adults, it’s more about self-esteem and confidence. There are several types of acne, and a genetic component. In adults, we typically use a topical vitamin A derivative called a retinoid. If the inflammation is so deep causing cystic formation and scarring, the ultimate treatment is high-dose oral vitamin A, also called Accutane.
What is Rosacea and What Causes It?
Let’s talk about rosacea. What is it, what are the symptoms, and what treatments are available?
Rosacea, or acne rosacea, is characterized by a red flushing appearance of the face and can be associated with inflammatory bumps. It is essentially from chronic sun damage creating micro scars in the skin. These scars change the skin’s architecture, causing abnormal regrowth and making blood vessels more visible.
Treatment for Rosacea
There are two main types of acne rosacea. If it creates inflammatory bumps, we treat it similarly to acne vulgaris. If it involves abnormal blood vessel growth, we treat the flushing part by making the blood vessels smaller and avoiding triggers that flare them up.
Understanding Skin Cancer
Switching to a more serious topic, skin cancer. If we have a particular growth, does that automatically mean it’s cancer? How do we know the difference between harmless things and more cancerous ones?
Most often, it’s not cancer. Most growths are benign, like skin tags or seborrheic keratosis. For moles, we use the ABCDE criteria: asymmetry, borders, color, diameter, and evolution. If a mole stands out or changes, we may biopsy it to ensure it’s not cancer.
Skin Care for Seniors
As we get older, especially seniors, they tend to have thinner and drier skin. Is there anything they can do about that?
Two words: sunscreen. The sun’s UV rays damage the skin, causing scarring and thinning over time. Using sunscreen and physical protection like wide-brimmed hats or UV shirts can help.
Preventing and Treating Wrinkles
Is there anything we can do to eliminate or prevent wrinkles?
Besides sunscreen, retinol products can help. They cause skin rejuvenation and reduce fine wrinkles by increasing skin cell turnover.
