How many times have you had a rash or other skin problem and not been able to get into the doctor to get treatment right away? This has become much more common with the advent of HMO plans and the shortage of dermatologists. Although none of these recommendations should replace speaking with or seeing your doctor, these are some options to have on hand to try to alleviate your discomfort in an appropriate, more effective manner while you await your appointment. Too many times I've seen patients who have complicated their condition with improper OTC selections. So let me try to guide you on what to have on hand.

BLISTERS

Blisters can develop for any number of reasons - chicken pox, shingles, poison ivy/oak, friction blisters, drug eruptions, and some bug bites. There's a classic dermatology saying "if it's dry, wet it and if it's wet, dry it." So when it comes to dealing with drying out a blister, one of the quickest treatments is still an OTC product called Domeboro Astringent Solution. Not only does it help dry out the lesions quickly, it also helps to prevent secondary infection by bacteria. It comes in both tablet and powder formulation, which truly doesn't matter. Simply follow the package directions to mix. Compress the blistered area for approximately 20 minutes twice daily. Do not use this product around the eyes.

Skip pulling the top off a blister. Think of the skin instead as a natural alternative to a Band-Aid. But if the blister causes you pain, you can take a sterile needle and gently pop the blister, allowing the fluid out. Release of the water will quickly relieve the pain.

Anytime the skin is open, it is vulnerable to infection. Don't forget to apply a topical antibiotic ointment like Polysporin First Aid Antibiotic Ointment to denuded blisters. Taking this step helps prevent infection and helps the new raw exposed areas heal faster.

ITCHING

Itching regardless of cause is dreadful. Who can't recall a sleepless night thrashing about and scratching for one reason or another? Dealing with itching inside and out helps hasten relief. OTC Children's ZYRTEC Allergy Liquid Grape Flavor is very helpful at controlling itching. One of the best reasons to use it is that you can take as little as you need to help prevent the potential side effect of sedation. This isn't possible with the pill formulation. Be wary of sedation! If you plan to take it for bedtime relief, do so at least an hour before bed.

You can turn to your pantry for added relief by adding about a box of baking soda to your bath water. Or you can use Ole Henriksen Detox Tea Tree Oil Soak.

Instead of scratching, apply something that will temporarily soothe the trouble spot. Topical antipruritic products like PrameGel, Prax Lotion and Caladryl Clear Lotion can also help provide temporary soothing relief from highly itchy areas.

Reasons to go see the doctor: itching from head to toe (especially without cause), an isolated skin growth (like a mole) continuously itching, or for an unidentified rash.

HIVES

Take an antihistamine, apply your Cortaid Maximum Strength Cream and rub your favorite topical anesthetic instead of scratching like mad. Unfortunately 95% of the time the cause of a bout of hives is impossible to determine. However, think about medications you're taking (especially those new within the past 6 weeks), recent or ongoing infections and foods you've eaten. Strawberries, citrus fruit, seafood, shellfish, nuts and peanuts are the top offenders. Remember, you have to have been exposed to something before in order to become allergic to it.

Reasons to go the ER: difficulty breathing, swallowing or speaking. For hives lasting more than 6 weeks, a work-up is helpful. Please refer to my article on Hives for more information on this annoying problem.

CUTS

Keep those cut and scrapes clean with hydrogen peroxide and Polysporin First Aid Antibiotic Ointment. Do this at least twice daily. Neosporin has a long tradition in wound care, but as a dermatologist, I have had a problem with patients using it. Several times a year I will see patients who actually are allergic to the Neomycin component in Neosporin (this also goes for "triple antibiotic ointment"), and the area becomes very swollen and red. The patient misconstrues this as a signal that the infection has escalated, applies more Neosporin and the cycle continues. It's best to avoid this situation entirely. I'd also avoid Silver Sulfidine Cream. It can also occasionally cause allergic reactions.

Reason to go see a doctor: a wide area of redness around the wound, red streaking extending from the wound, extreme tenderness or pus draining from the site are all reasons to make an emergency call to the doctor on a weekend.

SUNBURN

The best way to treat sunburn is not to get one! Keep your sunscreen with SPF of a minimum of 15, (preferably 30-45), with UVA and UVB protection and by all means use it. It needs to be reapplied every 2 hours while outdoors, and after swimming. Waterproof sunscreens still need to be reapplied after water exposure. It usually says so in the fine print on the bottle. Also, wear sun protective clothing, hats and sunglasses with UVA/UVB protection. Hats need to have a 3-inch brim. Baseball caps don't protect most of the face or the ears.

If you do get sunburn, Motrin in the OTC form of Advil, or Naprosyn in the OTC form Aleve will help relieve some of the discomfort and help diminish the inflammation associated with the burn.

An old home remedy: my mother always rubbed distilled white vinegar on our sunburns and it really did take the sting out of the burn once the initial sting from the vinegar wore off. The reason it works is that the acetic acid in the vinegar works as a topical NSAID. Of course we all smelled like salad!

Other options include applying Ole Henriksen All Purpose Aloe Vera Gel which is a cooling oil-free gel that helps sooth skin irritations with chamomile. A refreshingly, light as a feather gel for skin that "acts up" caused by a rash, cut or sunburn.

Reason to go see your doctor: symptoms of heat stroke such as nausea, vomiting, fainting. Also, consult your doctor if your burn blisters.

POISON IVY

Poison Ivy can now be prevented or the development of the rash attenuated with the use of Ivy Block. This lotion is applied 15 minutes before known exposure and helps to neutralize the gum from the plant. It is not to be applied to active poison ivy rashes. Try to wash with Burt's Bees Poison Ivy Soap after being outdoors if there is any risk of exposure. This helps economically and effectively wash away much of the plant oil responsible for the rash.

Once you've gotten poison ivy, dry out blisters with a compress of Domeboro Astringent Solution, and consider applying Zanfel Poison Ivy Cream. You can also apply plain Cortaid Maximum Strength Cream. While strong prescription steroid (preferably a gel like Temovate Gel) are ideal and faster acting than Cortaid, on Saturday night, this may be all you can find OTC. By the way, Cortisone 10 may sound strong, but it is really 1% hydrocortisone.

Once more, rely upon you Zyrtec.

Reason to call your doctor: blisters and swelling on the face especially near the eyes or for generalized cases of poison ivy. Poison ivy is unpleasant, and in an ideal world everyone would be able to get in to see the doctor right away, but reality dictates this isn't possible. I would refer you to my article on Poison Ivy for more information.

ATHLETE'S FOOT AND JOCK ITCH

Fungal infections of the feet and groin are usually red, scaly and very itchy. The best prescription topical antifungal cream (in my opinion) has gone over the counter, so you're in luck. DERMAdoctor Feet Accompli Ultimate Antifungal Pedicure Cream cream is available.

Keeping skin dry is essential to solving the problem. Hot, dark moist skin folds are a breeding ground for fungus. Try using medicated absorbent powders like Zeasorb-AF Antifungal Powder. For athlete's foot sufferers, consider wearing special socks made to wick away perspiration. Jobst SensiFoot Unisex Athletic Support Socks, Mild Compression 8-15 mmHg is ideal.

Kick off your shoes and socks when you get home and allow air to circulate. Try to avoid wearing leather athletic shoes, try canvas instead. Leather traps moisture inside the shoes and prevents your feet from breathing.

If you suffer from chronic jock itch, try boxers instead of briefs, again for circulation. Another trick is to dry the area after showering with a hand held hair dryer set on the coolest setting. This tactic helps reduce surface moisture before dressing.

In cases where oozing and weeping have occurred, try using Lamisil AT Continuous Spray for Athlete's Foot to kill the fungus instead of the cream base and try to heal any splits in the skin.

Reasons to see the doctor include extension of the infection to other areas, lack of response to topicals (sometimes oral antifungal pills are necessary), involvement of toe nails. Also, I recommend that diabetics or anyone who is immunosuppressed see their dermatologist. Fungi are capable of producing microscopic breaks in the skin which for the healthiest patients may not be a problem but for anyone prone to infection, this can lead to a condition like cellulitis (bacterial infection of the skin). Seeing your doctor before this occurs can be beneficial.

Dandruff

Thick greasy scale of the scalp, often known as dandruff is highly responsive to OTC medicated dandruff shampoos. Try alternating them to get better results. Dandruff responds to pyrithione zinc, (DHS Zinc Shampoo), glycolic acid (Aqua Glycolic Shampoo & Body Cleanser) and ketoconazole (Nizoral A-D Shampoo). Keep a few on hand and use whenever needed. Both seborrhea and psoriasis can result in chronic dandruff conditions. Knowing how to keep them under control helps reduce flaking and discomfort due to itching.

Feel free to use the conditioner or cream rinse of your choice after shampooing to help make hair feel silkier and restore pH balance. Ionil makes a cream rinse which has long been a favorite of mine to combine for dandruff shampoo users. Looking for some light reading? Please refer to my article Dandruff which should tell you everything you've ever wanted to know.

Reasons to see the doctor: resistance to treatment, extension of flaking onto the face or other areas of the body and hair loss.

WARTS

Warts usually need some medical intervention to clear them, but if you know you have a wart, you may want to get started on either Occlusal-HP or Dr. Scholl's Wart Pads. This is applied nightly to the wart after soaking and lightly roughening up the surface of the wart with a pumice stone or emery board. Two coats are applied. These salicylic acid based products will help soften the wart and help debride it. The area will get white, soft and peely.

Reasons to see the doctor: the mere presence of warts. Warts are tough to treat and often need some medical help to really go away. While it's certainly possible that a single tiny wart will respond to persistent home treatment, if they begin to spread, make your doctor appointment. I hate when a patient presents with innumerable warts because they were told the warts would resolve on their own. This isn't usually true.

BUG BITES

For mosquito or chigger bites itch control is your biggest issue. Try applying a topical anesthetic like PrameGel Prax Lotion, or Caladryl Clear Lotion. Natural remedies like the Cellex-C Skin Perfecting Pen can be dabbed onto annoying bug bites and quickly control itching as well. These are convenient to carry in your purse, automobile or keep in your desk at the workplace. OTC 1% Hydrocortisone Cream (Cortaid Maximum Strength Cream) twice aims at the actual inflammation as well as the itching. If you're having trouble scratching instead of sleeping at night, this is another time to consider a bedtime antihistamine. If you scratch too vigorously, this can lead to a bacterial infection, discoloration or scar formation. Always keep open skin wounds clean with hydrogen peroxide and a topical antibiotic ointment.

BEE STINGS

Assuming you aren't highly allergic, once the stinger has been removed, apply an ice pack for 15-20 minutes at least after getting stung. Then mix up a paste of baking soda or meat tenderizer and apply to the sore area. This helps reduce much of the local inflammation and swelling. I typically recommend taking an antihistamine such as the Zyrtec or perhaps some Triaminic syrup will help with the swelling. The nice thing about antihistamine syrups is that you can titrate the amount taken, so you can control your level of drowsiness.

Reason to see the doctor: go to a hospital emergency room if there is any shortness of breath or difficulty talking or swallowing.

SPIDER BITES

I'd call the doctor. I would also take a baby aspirin to help improve the circulation. Usually you need to take an antibiotic and watch the site carefully.

TICK BITES

While most ticks are harmless, concern about a potential infection harbored by the tick is understandable. First, the best method of removal is to pull the tick off gently but firmly with a pair of tweezers. Don't bother with the hot match tip, the death by asphyxiation with Vaseline method or drowning with alcohol. Many of these tricks don't work or worse, cause the tick to grab on more forcefully. Also, I've personally found that metal tweezers or forceps are much better at pulling the tick off. Clean up the area with rubbing alcohol and apply a dab of Polysporin First Aid Antibiotic Ointment.

Reason to call the doctor: with the spread of Lyme Disease, Rocky Mountain Spotted Fever and Erlichiosis, it's worth taking the time to call your doctor and ask if you require prophylactic antibiotics.

SWOLLEN EYELIDS

For presumed pollen allergies or allergic contact dermatitis, try taking Zyrtec according to package directions and apply and some plain Cortaid Maximum Strength Cream (1% Hydrocortisone Cream) ever so slightly to the eyelid no more than twice daily. Make absolutely certain you don't apply the cream so that it can go into the eye. Stop wearing make-up and use a gentle hypoallergenic cleanser like Cetaphil or Vanicream.

Sometimes a contact dermatitis occurs only on the eyelids. Read through my article Patch Testing to get some background on this essentially painless work-up method before you get to the dermatologist.

Reason to see the doctor: make an appointment with your doctor if this lasts more than a day or 2, or is recurrent; if there is drainage, or if the eye itself or vision seems affected.

CRACKED FINGERTIPS

Knowing how painful a tiny paper cut can be, can you imagine how debilitating chronically dry, cracking, splitting fingertips are? Once the skin is broken, whether due to cold weather, a contact dermatitis or eczema, obsessive care can help expedite healing. Fill the splits with Polysporin First Aid Antibiotic Ointment at least twice a day. Forget about the notion of using glue or rubber cement. Alternate hand creams like Theraseal and Vanicream. Don't waste time with a hand lotion at this point, your skin needs a massive dose of moisture! At night, apply DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone, which really helps soften those crusty edges and allows them to heal. Keep a jar or tube of your favorite moisturizing cream at the office and reapply each and every time you wash your hands.

DIAPER RASH

I have always been a big fan of using prescription Mycostatin powder to help prevent and treat diaper rash. However, not all newborns are going to respond as well as hoped for. Zinc oxide plays a roll in creating a protective barrier between baby's delicate skin and the rest of the mess. Also, zinc has long been a dermatologist's tool in helping improve the overall health of the skin. Look for a plain zinc based diaper rash cream. Avoid additives like color, fragrance or potential irritants like Vitamin E or Vitamin A. Remember to try to allow air to get to your child's bottom. Keeping the area dry is the best medicine! Avoid the use of powders that contain cornstarch. These act as food for bacteria and yeasts and may exacerbate the problem.

Again, none of the above is meant to replace your physician. I just feel very strongly that a patient will feel more comfortable at handling minor problems if they have some understanding of what to select on their own. It can be very overwhelming going to the drug store without directions.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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