Everybody has areas where their skin folds over on itself. When skin is warm and sweaty the conditions are perfect for intertrigo, the common skin fold rash. The skin folds most affected by this rash are those under the breasts, under the stomach, and in the arm pits. The deeper the folds, the more likely the chance for intertrigo.

What makes the skin folds susceptible to this annoying red skin fold rash?

1. Moisture from sweat
2. Rubbing together of folded skin, causing the dead skin cells to rub off and accumulate
3. Irritation caused by normal skin germs which thrive in this environment
4. Growth of a yeast germ called candida, which occasionally also ‘dog piles’ on the problem making a real mess of the skin

Who gets intertrigo?

Anyone with sweaty skin. In my practice I mostly see adults with intertrigo. People with large breasts or a fold under their belly fat are especially prone to intertrigo. Babies can also develop intertrigo in their little skin folds. Because the skin germs thrive in a sweet and sugary environment, diabetics are particularly prone to intertrigo; they often also get the candidal yeast infection in the folds making their rash particularly severe.

The common risk factor is prolonged moist and warm skin from sweating. I see patients with this skin fold rash all year long. During the summer it’s due to the hot weather. In the winter it’s because of the layers of thick clothing worn to keep warm.

Dermatologist’s Recommendations for Care and Prevention for Intertrigo Prone Skin

These are the recommendations that I give my patients. I’ve found that the trick to treating and preventing intertrigo is to try to keep the skin folds dry and sweat free. Using anti-yeast skin care products also helps. For really irritated skin I add a short course of nonprescription cortisone cream.

Preventative care

• Wash your skin folds with Dial soap. The anti-bacterial ingredient in Dial will decrease the skin germs. Dial also has an ingredient that acts like an antiperspirant and will block your sweat ducts, decreasing sweat in your folds. I don’t recommend using Dial soap elsewhere on your body because it’s simply too drying, and frankly, you don’t need antibacterial ingredients and clogged sweat ducts on the rest of your skin.
• After bathing, towel-dry your skin and then blow dry your folds until they are totally dry.
• Apply Zeasorb AF powder to your dry skin folds. Zeasorb AF contains an anti-yeast medicine. Never ever apply corn starch based-powders to your skin folds because the starch feeds yeast.
• Wear breezy, loose cotton or linen clothing that breathes and allows sweat to air dry quickly. You can even separate your folds with absorbent cotton cloth. Avoid synthetic and thick fabrics that don’t allow your sweat to air dry.
• Stay cool to decrease sweating.

Treatment of Intertrigo

If the red, painful and sometimes even smelly rash of intertrigo flairs up in the skin folds in spite of following the skin care outlined above, then medicine is needed to control it. Luckily there are effective medicines over the counter. In addition to my care instructions above, I have my patients stop applying the Zeasorb AF powder after blow drying their folds and instead apply the following medicine to the affected area twice a day:

• Clotrimazole cream (eg. Lotrimin Cream). Clotrimazole Cream needs to be used for at least 2 weeks because it takes 2 weeks to fully treat a yeast infection.
• If clotrimazole cream alone does not start to decrease the redness within a few days, I then have patients add a thin layer of 1% hydrocortisone cream after the clotrimazole cream. I tell them to stop the hydrocortisone a soon as possible because it can thin the skin. (If you chose to use hydrocortisone, don’t use it or more than 2 weeks without seeing your doctor and having them supervise your treatment.)

Important precautions:

• All cream products have ingredients that can sting damaged skin, including the rash of intertrigo. Of course, severe stinging is a sign you need to see your doctor and have your diagnosis confirmed and treatment supervised by them.
• Don’t use clotrimazole or hydrocortisone creams with other active ingredients like anti-itch medicines (Benadryl, ‘cains’ etc) because you can become allergic to them, and this will make the rash even worse.
• Severe intertrigo can be weepy and very tender. You will need to see your doctor if your rash has gotten really bad.
• Not every skin fold rash is intertrigo, anyone whose rash is not responding within a week needs to see their doctor to confirm their diagnosis.
• Babies’ skin is so delicate that treatment should always start with a doctor’s exam and should be supervised by their doctor as well.
• Diabetics are much more prone to intertrigo than everyone else and so anyone who is continuously troubled by this annoying red skin fold rash needs to be seen by their doctor and tested for diabetes.

Lastly, I recommend that even non-diabetics who are prone to intertrigo consider avoiding foods that raise their blood sugar. This includes high glycemic foods like sweets, refined flour foods and sugary drinks. ‘We are what we eat’ and a low glycemic, veggie-intense healthy diet is ideal for supporting skin health.

If you found this information helpful, you may also want to read:

Stop The Summer Darkening Of Your Age Spots

Cracked, Dry and Splitting Fingernails; Dermatologist’s Tips

Dermatologist’s 3 Simple Steps To Have Sandal Ready Feet By Spring

Photo: Gratitude and thanks to Conorwithonen

Each season has its special impact on your skin — both good and bad. Summer’s no different. While you’re outdoors and active in the heat and sun, your skin is exposed to some pretty harsh conditions. Keep it healthy and looking great with some simple changes in your skin care.

Solutions for the biggest summer skin problems that I see in my dermatology practice:

Thick, rough and cracked feet: Walking barefoot or in sandals leaves feet thick, rough and cracked. Keep them soft with exfoliation. My ’step by step’ instructions to keep your feet soft and attractive this summer: Dermatologist’s 3 Simple Steps For Sandal Ready Feet By Spring

Athlete’s foot: sweaty athletic shoes and public showers breed fungus. If your feet are scaly, itchy and cracked you may well have picked up this highly contagious problem. Get rid of the fungus before it gets worse by following my instructions: Dermatologist’s Tips For Athlete’s Foot Fungus Treatment.

Chapped and sunburned lips: Sun and wind chap and burn lips fast. You need good sun protection when you’re outdoors, and mineral sunscreen products designed specifically for the lips, such as Lip Cotz, are the best. Some colored lipsticks can also give your lips good sun protection.

For moist, healthy lips you also need constant applications of a really good lip balm like Ceralip or pure shea butter. I recommend avoiding lip balms with a lot of medicated or herbal ingredients because I see so many people whose severely chapped lips are actually due to allergic reactions to these ingredients. I recommend using just the hydrating ointment base in lip balms and skipping all the dicey ‘extras.’

Gardener’s Hands: chapped, rough and cracked hands are a part of summer for you if you’re a gardener (like me). Good hand care is essential to keeping your hands looking even remotely presentable outside of the garden. The same hand care that I outlined in the winter for all the folks with chapped hands from hand sanitizers will fix your gardener-worn hands too.

“Embarrassing” arms and legs!: I can’t tell you how many people are embarrassed to show off their arms and legs; like it or not, summer fashions show more skin. After about our mid-twenties, just about everybody has to put a little work into keeping their arm and leg skin looking good. My recommendations:

At a minimum, moisturizing will help control the dry, flaky scale and give your skin an attractive, dewy look.

Adding sun protection plus alpha hydroxy acid hydration combined with physical exfoliation keeps the age spots from darkening. I give you instructions in my post: Stop The Summer Darkening of Your Age Spots.

On top of that, if you add a sunless tanner, you’ll have evenly bronzed, dewy hydrated skin with a buffed and polished glow! I tell you how in: Use Self Tanners Like A Pro.

Stressed facial skin: In the summer, facial skin care is all about survival; summer sun and environmental exposure will cause permanent damage to your facial skin unless you protect it every day. Sunscreen and antioxidant skin care products are essential for anyone seriously concerned about facial wrinkles and age spots (not to mention skin cancer). The best sunscreens are the mineral-based products. The best antioxidant protection comes from products with high concentrations of vitamin C and products that combine green tea and caffeine. Every day there are new ‘miracle’ antioxidants and sunscreens hitting the skin care market, but in my opinion, the mineral sunscreens and vitamin C and green tea/caffeine antioxidant products have the best scientific evidence proving their benefits; they’re what I personally use and recommend for my patients.

With good skin care you can have soft, healthy and fabulous-looking skin all summer long.

If you found this information helpful, you may also want to read:

How To Get The Most Out Of Your Anti Aging Skin Care

5 Steps For Smart Sun Protection

Photo: Thanks and gratitude to Dystopian

Age spots on the skin really darken up from summer sun exposure. They tan better than normal skin and really stand out, even after the briefest sun exposure. There are three things I tell my patients to do to help keep their age spots from getting darker during the summer. People who do all three get the best results.

3 Easy Steps You Can Take to Help Prevent Darkening of Age Spots:

1. Keep the sun off of your skin
2. Exfoliate regularly
   
3. Use skin lightening products to ‘turn down’ your skin’s ability to tan

1. How to best keep the sun off your skin to prevent age spot darkening:

The best way to keep the sun off of your age spots is by covering them with clothing. For areas of your skin that you can’t cover (eg. your face), wear a sunscreen with an SPF of 30 or higher that contains 5% or more micro zinc oxide. I give extensive recommendations on sun protection in some of my recent posts:

Are Your Summer Clothes Good Enough To Be Sun Protective Clothing

How To Apply Sunscreen & Have Healthy, Fabulous Skin Forever

2. Exfoliation to lighten age spots:

Exfoliating lightens your age spots because the dead skin cell layers above them are extra thick and the brown color is carried up through every layer. Because of this, age spots are sort of like little speed bumps and regular exfoliation of the dead skin really lightens up the dark color because they sit slightly higher than the rest of the skin. The best way to do this is with my Anti Aging Body Skin Care Kit that includes both physical exfoliation and strong AHA glycolic acid exfoliation. Over the years, I’ve had many thousands of my patients using this kit and it works beautifully to lighten age spots. I’ve used it myself for at least 10 years and have watched my age spots actually go away just because I’m using these products; I created the kit for my 40th birthday when I got my first age spot on my arm — it went away in a few months after using my new kit, which was a great ‘happy birthday to me’ !

3. Using skin pigment lighteners to fade age spots:

I also have my patients ‘turn down’ pigment production with prescription bleaching creams that contain 4% hydroquinone, and prescription Retin A (tretinoin). There are tricks to using these products and they have side effects so ask your doctor if these treatments would be appropriate for you. One of my favorite skin lightening programs is The Obagi Nu Derm System and I discussed it during a post that I wrote this winter:

Winter: Now Is The Time To Fix Your Unwanted Age Spots and Skin Pigmentation

The good news about age spots is that it really is possible to get through the summer without getting spottier and spottier. Using any one of these steps to prevent age spot darkening will help, and doing all three is even more effective. You might even see them get lighter than they are in the winter!

A final note on age spots:

Remember that not every brown spot is an age spot. Melanoma, a deadly cancer, can often start looking like one of your age spots. If you have age spots, you’ve probably also had a lot of sun exposure in your life and would be well served by getting an annual skin exam by your dermatologist. Early detection of skin cancer really does save lives, I see it every day.

If You Found This Information Helpful, You May Also Want To Read:

How To Get The Most Out Of Your Anti Aging Skin Care

Choosing The Right Make Up For Post Menopausal Skin

Use Self Tanners Like A Pro

Skip The Tan And Eat Your Veggies For Beautiful Skin Color

Photo Mik Hartwell Flickr

The New York Times online health blog yesterday featured a fascinating article about tanning addiction, Addicted To Tanning?  One of the most interesting aspects of the article was a study showing that chronic tanners experienced withdrawal symptoms (jitters and nausea) when they were given the narcotic withdrawal drug called naltrexone, suggesting that pleasure-giving endorphins may be part of tanning addiction.

Well, I just had to post a comment on the New York Times!  I’m surprised at what memories came up for me when I read the article and wanted to share my comment with you.  Here is the comment I left on the New York Times online health blog concerning the article:

I’m a practicing dermatologist and was probably addicted to tanning as a teen and young adult. I was unable to stop tanning in spite of having surgery for a skin growth that was at first thought to be a very aggressive melanoma. In the end the growth was not cancer, I did not have the lower leg amputation recommended by my first dermatologist, but the scare did not deter me from tanning.

It wasn’t until my dermatology residency in San Diego that I found the resolve to stop; seeing sun damage and skin cancer in patient after patient was like the shock therapy used to help people stop smoking. For the last 25 years I’ve avidly sun protect my skin. Interestingly, my facial skin texture looks younger now than when I was in my 20’s and tanning. Also interesting is that my family now has a strong family history of melanoma and I’m convinced that if I had continued tanning I probably would not be here today.

As for vitamin D, fair skin makes all it needs in the first few minutes of sun exposure. Continued exposure actually starts to break the vitamin D down. Knowing that sun protection is never perfect, I recommend sun protecting your skin, and the ‘margin of error’ usually lets enough sun into your skin for vitamin D production. To really know what your vitamin D needs are, get it measured and ask your doctor for advice. I find there is very little correlation between patients that sun protect or tan and vitamin D levels. My specific advice and more information on vitamin D is available on one of my recent blog posts.

It’s funny that I didn’t go into dermatology because of this early near brush with cancer.  It’s also funny that it took my residency experiences to get me out of the sun, now I know why.

You may also want to read my sun protection advice:

5 Steps For Smart Sun Protection

If You Want A Nice Sunburn Use Last Year’s Sunscreen

How To Pick The Best Sunscreen

Are Your Summer Clothes Good Enough To Be Sun Protective Clothing

Photo Attribution:

Your nails don’t always stand up to the use you put them to, and when they don’t, they crack!

Just yesterday, an 80 year old patient asked me why his fingernails were dry, brittle and splitting on the ends.  He’d always had strong nails.  He wanted to know if I thought Knox Gelatin Capsules would work for him; it’s what his mother used when she had nail problem. They didn’t work for her, but he didn’t know what else to do.

Almost every day I’m asked by someone for advice to fix their brittle, splitting fingernails because the problem is so common. It can happen at any age, but it’s definitely one of those “as we age” stories. If your nails are splitting, there are things you can do to improve them, but there are also common ‘remedies’ that actually make the problem worse.

THE PROBLEM:

Your nails dry out as you age, losing their natural oils which act as a glue to hold the nail layers together. If you have thin fingernails and dry skin to begin with you can expect this to happen to you ‘sooner rather than later’.  Exposing your hands to harsh soaps, cleaning products, solvents and rough work makes things worse. At first your nails begin to ‘fray’ on the edges, becoming brittle. Eventually the layers split.  Nail hardeners make this worse because the alcohols, formaldehyde and other chemicals in the nail hardeners really dry out your natural oils. (Crazy fact: Nail hardeners actually contain more of these chemicals than nail polishes!  It’s these chemicals that make the nails feel harder at first, but- whammo- after a few weeks the splitting is worse than ever.)

THE FIX:

Dermatologist’s 3 Simple Tricks To Treat Cracked And Splitting Fingernails:

1. Hydrate and add oils.  Use creams, oils and ointments on your nails everyday after they’ve been wet. My favorite is good old Bag Balm with it’s wool alcohol (aka lanolin).  Some of my other favorite hydrating ingredients for nails are Shea Butter, Jojoba oil, avocado oil, or other rich natural oils.  The thicker the cream the better, and oils or ointments are best. The trick is to use something that stays put for awhile and doesn’t just rub off right away.  Plus, you always moisturize skin and nails immediately after water exposure; applying moisturizers to dry nails is a waste of time.  Put your moisturizer on within minutes after your bath or shower, or after washing your hands.  Do it as often as possible.  You can use a hand cream during the day (I love my Intensive Hand Cream, which is non-greasy), but use a thicker product like Bag Balm at bed time. If your nails are really bad, apply Bag Balm to them numerous times a day after washing your hands.
2. Clip and file your nails when they’re wet. Clipping and filing dry nails makes the splits worse so always do it after water exposure.  Towel off the water and then use sharp nail clippers to trim your nails, followed by gently filing the edges.  You can also very gently buff the nail edges to keep the splitting layers from catching on things and progressing down the nail.
3. Wear gloves when you do rough work or get your hands into harsh chemicals. Obviously you want to protect your brittle and splitting nails from the things that make them worse.

Gelatin capsules don’t work but vitamin supplements formulated specifically for nail growth may help. I’ve had patients who feel that their nails grew a lot faster and stronger once they started taking supplements. Nail supplement formulations appear to vary, though most contain biotin.  I tell patients to go to their favorite high quality natural food store and ask the vitamin specialist for their best nail formula.  It’s important to know that many of the ingredients in these supplements are lavishly present in whole foods like fruits, vegetables, whole grains, nuts, natural oils, beans and fish.  Eating a richly nutritious diet is key to supporting healthy nails and vitamin supplements should be used in addition to, not in place of a healthy diet.

Your fingernails grow slowly, about 1mm per month.  As you age, the growth slows down even more.  This means it will take several months for the dry and split portion of your nails to grow out.  Depending on the condition of the rest of your existing nails, it could take as long as a year for proper nail care, good diet and your vitamin supplements to stop the nail splitting, so hang in there and don’t give up.

Lastly, there are internal diseases that can affect your nails, the most common being thyroid problems and anemia.  Some skin diseases affect the nails as well and cause splitting.  If your nails don’t improve, see your doctor.

I’d love to hear any tricks or products you’ve found to improve your brittle and splitting fingernails.

If you found this information helpful you may also want to read:

Pandemic Of Dry Hands; Hand Sanitizers, The Swine Flu And Tips To Save Your Hands

Natural Skin Health; Dermatologist’s Diet Recommendations For Healthy Skin

Dermatologist’s 3 Simple Steps For Sandal Ready Feet By Spring

Photo:

http://www.flickr.com/photos/tonythemisfit/2432720887/ Tony The Misfit