Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems.

Hi Dr. Bailey,

I always seem to have dandruff – I use good shampoo and conditioner and wash my hair every other day. I dislike wearing black shirts since I feel that I am always “shaking off” the dandruff. Any suggestions?

Thank you,
Donna

Dear Donna,

Thank you for being the first person to take me up on my offer to provide skin care information based on your questions.

Dandruff, also called seborrheic dermatitis, is common and can vary from a mild itch to a severe crusty and scaly rash. Sounds like your problem is mostly scale on your scalp. When I advise people on the care of their scalp dandruff I recommend maintenance care (medicated shampoos) to suppress the problem and interventional care (cortisones and scale removing topical treatments) to control flair ups.

It’s important to know that doctors don’t know what causes dandruff and we can’t cure it. Our goal is to get dandruff into remission and keep it there. It’s easier to maintain a clear and healthy scalp than it is to control a constantly scaling one. That means that you should work really hard to get complete control of the problem by using effective interventional treatments plus shampooing with medicated shampoo every day. Once your scalp is dandruff-free then you can rely on the medicated shampoos for maintenance. Remember that scalp seborrheic dermatitis will flair up from time to time anyway, and you’ll need to go back to the interventional treatments.

In the fall I wrote 2 blog posts with detailed instructions for scalp dandruff. The first outlines my maintenance care with medicated shampoos, the second outlines the interventional care:

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

To summarize my advice for the treatment of scalp dandruff:

1. I recommend a person get 3 different medicated shampoos, with 3 different ingredients and rotate them (my favorites in the drug store are Nizoril, DHS Zinc and DHS Sal). The shampoos should be used as I describe in the first post. Ideally the medicated shampoos should be used every day until the dandruff is controlled.
2. In addition, interventional care needs to be done using treatments that remove the scalp scale quickly. This means using either the mineral oil or the P&S liquid (or alternate both) scalp treatments that I outlined in the second post as often as possible until the scalp scale is gone.
3. I also recommend using a topical cortisone product like Scalpicin with Hydrocortisone twice a day to the active areas until they clear up. It’s also possible to ask your doctor for a stronger prescription cortisone product.
4. Do this until the dandruff is gone, at which point the interventional treatments can be stopped.
5. I recommend continuing to use the medicated shampoos to suppress a recurrence of the dandruff. Shampooing as often as possible will really help to keep dandruff under control.

Remember, if dandruff does not improve within a few months, or if it gets worse with this treatment, then you must see a dermatologist for a diagnosis. There are other conditions that cause dandruff-like scalp scale including common problems like a scalp fungus infection (which will get worse with cortisone application) and psoriasis (which often needs prescription medicines).

Best Wishes and Warm Regards,

Cynthia Bailey MD, Dermatologist

To send me your skin care questions or to ask me to address a specific dermatology topic, please use the  ‘Contact Dr. Bailey page’ on the left sidebar or click here to load the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

Are you frustrated with your acne?

Do you feel like your ‘beating your head against the wall’ with your current acne treatment?

There are different reasons why people get pimples. It may be that you have one of the less common reasons for pimples.  Getting the right diagnosis and adding a specialized treatment medicine may finally clear up your acne.

In my practice, patients with pimples usually have one of the following problems:

1. Acne Vulgaris, the most common form of acne
2. Pityrosporum Folliculitis, which is also really common
3. Staph. Folliculitis, which is really an infection
4. Gram Negative Folliculitis, which happens because of acne treatment medicines

This sounds really complicated, but it’s actually not. The important point is that if you have one of the ‘folliculitis’ acne conditions, you need different treatment to clear up your pimples. If you think you have one of these forms of acne, talk with your doctor about getting the right treatment.  What you need to know:

Acne Vulgaris

This is the most common reason for pimples and it’s what we all think of as acne.  People with acne vulgaris have both blackheads and pimples, usually around the nose, cheeks and chin as well as the forehead.  The pimples may gradually spread to the neck and back.  As this form of acne worsens, the pimples and blackheads get bigger and more numerous.  In this type of acne the skin is usually really oily.

Acne vulgaris responds to the standard acne treatments.  Topical acne treatment products aim to unclog the blackheads in the pores and kill the acne causing germ p. acnes. If over the counter products don’t work, doctors add stronger prescription products and oral  antibiotics that basically do the same thing.  Really bad cases of acne vulgaris may be treated with the powerful drug Accutane.

Pityrosporum Folliculitis

Pimples and clogged pores happen with this form of acne too, but they are in different areas of your skin and they look different than in acne vulgaris.

The pimples and clogged pores usually start on the forehead, the nose and along the jaw line.  There are often little pimples on the neck at the hairline and in the little indentation below the ear.  They also happen on the chest and back.

The key points are that there are often millions of little pimples and clogged pores on the forehead and many of the clogged pores are covered over by skin instead of open like blackheads.  The pimples on the chest and back are really bright red almost like a bug bite and they either itch or are really tender.  There may even be pimples or dandruff on the scalp.

You’re more prone to this type of acne if you or your family members have a history of allergies or asthma.  You’re also more likely to get pityrosporum folliculitis if you’re often really sweaty, like if you’re an athlete or you live in a hot climate.  That’s because this type of acne is due to an overgrowth of normal skin yeast germ called pityrosporum and the germ grows really well on sweaty, oily skin in predisposed people. We all have this yeast germ in the pores on our face and upper body.  Sweating and having a genetic predisposition (people with allergies and asthma) promotes the growth of the yeast, which then causes the pimples and clogged pores.

Obviously, treatment needs to kill the yeast and regular acne medicines don’t.  My favorite treatment for pityrosporum folliculitis is pyrithione zinc in the form of soaps and cleansers. I like Noble Zinc Soap for the face and OTB SKIN Medicated Cleanser #2 for the back, neck, chest and scalp.  It’s also important to use medicines that unclog the pores such as benzoyl peroxide, glycolic acid or salicylic acid.  My OTB SKIN Acne Kits for the face and the back include these ingredients.

Staph Folliculitis and Gram-negative Folliculitis

These are skin infections and require prescription oral antibiotics that specifically kill these types of germs.

Staph. folliculitis is caused by the staphylococcus bacteria that causes impetigo.  25% of everyone you know carries this germ on their body.  Most of the time it doesn’t cause any problems, but it can.  One of the skin problems looks like acne with pimples and white heads.  This can occur anywhere on the body, including the usual acne vulgaris places on the face and back.  Any break in the skin including injuries, or your acne lesions, can become infected with staph.  When pimples become infected with staph. they get really big and are much more sever than normal. Regular acne treatments don’t work against staph.  Your doctor needs to do a culture of your pimples (a test for the bacteria) to tell if you have a staph. infection and then prescribe the correct antibiotic.  Ask them to do this if you’re not getting better on your acne treatment.

Gram negative folliculitis is the strangest of all these conditions.  It happens when doctors do such a good job of killing the p. acnes bacteria with topical or oral antibiotics that this germ moves into the pores and starts causing pimples.  What I see in patients with this problem is that their pimples (not their blackheads) all of a sudden get really bad in spite of being on antibiotics. The gram negative germ is not killed with the acne antibiotics and needs to be treated by different types of antibiotics that we don’t usually use to treat acne.  This is one of the most common reasons that acne patients come to see me after being treated by another doctor.  It’s easy to fix if you know to look for it.  It’s one of the reasons I try to get my acne patients off both oral and topical antibiotics as soon as possible.

Remember, this information is intended to be educational, giving you a better understanding of the range of acne problems that affect the skin so that you can have a valuable discussion with your doctor of skin care professional.  It isn’t intended to give a specific diagnosis or treatment for your skin problem.

If you found this post helpful, you may also like to read:

Dermatologist’s Tips for Dry Flaky Skin on Your Face and Scalp

Photo attribution: Elaine with Gray Cats

After the holidays my BMI tipped up to 25-the gateway BMI of the overweight! There’s no denying it anymore, this time I really am fat!

I’ve always had a BMI of around 23.  I’ve been health conscious since I was 15, and I’ve always exercise regularly….. so what’s happened at 51?

• Yes, my clothes were getting tight.
• Yes, clothes shopping was becoming traumatic.
• And yes I’ve begun taking on a middle age shape that I don’t recognize.

From what I can tell, this new middle age BMI problem is also a middle body problem.

At 51, my post menopausal pear shaped body is morphing into an apple too.  Together, my fruit make a papple; there’s a fruit basket happening between my waist and my hips and it’s not pretty.  It’s gotta stop!

Like most women, I’ve never been thrilled with my pear body shape, but I’d made peace with it.   Pear shaped bodies are healthy, according to science. We have less cardiovascular, high cholesterol and diabetes risk than our apple friends.  The apple that’s joining my pear comes with trouble and I mean to send it packing.  I’ve been ineffectively trying to shoo it off with a little more exercise or a little less food, but now with a BMI of 25, I mean business.

My plan to slim down and loose the belly fat:

• Add 150 minutes of sustained cardio per week in three 50 minute segments
• Continue with my other physical activities like yoga, ballroom dance and gardening
• Adhere more closely to my Alkaline Mediterranean diet by limiting my acid forming protein portions (fish, chicken and beans) to 6 oz per serving and really cut down on acid forming ‘treats’

I tested whether this would work over the last 3 weeks and so far it’s amazing!  My belly blubber has slimmed down, cloths fit better and I feel great!

It’s do-able with my busy work schedule, I’m not hungry, the foodie in me isn’t feeling deprived and I feel like I can keep this up.

I plan to post what I’ve learned about belly fat, optimal fitness activities and diet over the next month.  I’ve been doing a lot of research and this is an area of ongoing interest for me.  Menopause and middle age has brought it front and center-literally-and I’m surveying both the scientific and popular literature on the subject.  There’s a lot out there, some good and some so-so.  Being the good doctor, I’m filtering the information I find using my western scientific skills, but I also look at it from my vantage point as a baby boomer post menopausal female consumer with a new found papple of belly fat sharing her body. I want my pear back! Wish me luck!

Photo Attributions:

Selma90, Sarah Baker, Jill Clardy

The east side of North Main Street has 2 really wonderful stores that I return to time and time again.  It’s also home to the copy center that I use for my business paper/publishing needs.

In my February 3rd post I described my favorite stores on the west side of the Sebastopol’s North Main Street. In today’s post I’ll complete my recommendations on our  main shopping street with the east side of North Main Street.

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Silk Moon

This store is a Sebastopol treasure chest of extraordinary hand woven textiles from around the world.  The owner Janet started with a small store and has had to move into bigger spaces twice to keep up with the demand; people just can’t get enough of her beautiful textiles, most of which are from South East Asia.  Janet travels extensively in Asia, developing personal relationships with the people who produce the beautiful hand woven textiles that she sells. All the items are fair trade and her relationships with her producers can be felt in the warm ambiance of the store.  I’ve bought many gifts and items for myself at Silk Moon, including the blue runner on the reception room table in our office.

195 North Main Street, Sebastopol, CA 95472 Phone (707) 824-4300

Web Site www.silkmoon.org

Dressers

Mother and daughter owners Mary and Tessa carry many of my favorite clothing brands at Dressers. These are perfect California clothes that can be dressed up or down and are flattering and wonderful to wear. A quick survey of their merchandise in my closet includes Velvet, Michael Starrs, Repeat, Cosabella, White+Warren, Christopher Blue, Theory, , Weston Wear, and Bibelot, all of which I’ve gotten good use out of.  Mary, Tessa and their staff know their fashion and will help you find stylish clothes that look good on your particular body. The clothing brands at Dressers aren’t cheap, but because the staff are terrific at putting clothing combinations together I get the maximal use out of what I buy.  Most of the cloths they carry are for women, but there is a small selection of men’s cloths too.

Location 145 North Main Street, Sebastopol, CA Phone (707) 829-8757

Sprint Copy Center

The paper wizards at family run Sprint Copy Center keep my business going with the educational pamphlets and other paper products that we use in our practice.  If you have a business or personal project that involves formatting or printing, these guys give you the personal attention that gets the job from creative inception to finished product.

Located at 175 North Main Street, Sebastoopol, CA 94572 Phone (707) 823-3900

Web Site www.sprintcopycenter.net

See my post on the West Side of North Main Street.

More ideas for spending quality time in Sebastopol: Take a wonderful art walk on Florence Ave and grab a bite at Peter Lowell’s.

Dry, itchy, scaly skin on your foot may indicate that you have a foot fungus infection, more commonly called athlete’s foot.  This highly contagious fungus infection is common and not limited to athletes.

Athlete’s Foot Fungus Infection may show up as:

• excessive dry skin or thick skin on the soles of your feet
• a painful crack between some of your toes
• an itchy, scaly rash on part of your foot
• small blisters on your foot

Foot fungus may involve both of your feet, just one foot or just a small part of your foot skin.  Sometimes people with the athlete’s foot fungus have  excessively smelly feet because of the fungal infection.

Anyone can get foot fungus infections, but you’re at higher risk if you have:

• excessively sweaty feet
• wear hot enclosed shoes that make your feet sweat
• share shoes with other people who may have athletes foot (example bowling shoes or ice skates)
• share a shower with people who may have athletes foot (like at the gym, in a fire station, or even family members with athletes foot or nail fungus)

The athlete’s foot fungus lives on the outer layer of your skin and does not enter deeper into your body.  It is the same fungal germ that causes jock itch, most nail fungus infections and ‘ring worm’ infection (not a real worm) of the scalp or body.  It is highly contagious!

My Treatment Recommendations for Athlete’s Foot Fungus Infection

1. Apply over the counter antifungal cream with either terbinafine or clotrimazole twice a day for 2 months to treat an active infection.  Don’t stop before 2 months regardless of how fast the antifungal cream product claims it works.  That’s because these creams need to be applied for the full time that it takes for you to grow new skin on your feet, and that’s 2 months typically.
2. Dust your shoes with Zeasorb AF athlete’s foot powder every time you wear them during the 2 month treatment phase and for 6 months after your feet are cured to prevent a recurrence.  Discard shoes that are really old, worn out and that may harbor lots of fungal organisms.
3. Disinfect your home shower during your treatment period by spraying or washing the floor with a dilute bleach solution made of 1 part bleach to 9 parts water.  Of course wear gloves and keep the bleach solution out of your eyes.

General Foot Care Recommendations to Help Prevent You From Getting A Foot Fungus Infection

• Always wear thongs or sandals in public or communal showers like at the gym.
• Wash your feet and between your toes with soap every day.  Use a wash cloth or exfoliating cloth like the Salux cloth to remove excessive dead skin that can harbor the fungus.  If you use a communal shower like a gym shower, do this right before you exit the shower.
• Dry well between your toes after bathing using a towel.  If you are highly susceptible to foot fungus infection you should also blow dry between your toes because the athlete’s foot fungus loves to grow between damp toes.
• Keep your toenails trimmed short so that you can keep this little space between your nail and your toe skin clean, dry and inhospitable for the fungus.
• Always wear cotton socks in closed shoes to absorb sweat and that allow your feet to stay dry.
• Wear shoes that ‘breath’, meaning don’t wear plastic/synthetic enclosed shoes made from nonporous material that prevents evaporation of sweat.
• Dust your shoes with Zeasorb AF powder if you are excessively susceptible to athlete’s foot, if you have excessively sweaty feet or if you often wear hot enclosed shoes.

If you found this information helpful, you may also want to read some of my other posts:

Dermatologist’s 3 Simple Steps for Soft Sandal-Ready Feet by Spring

Dermatologist’s Tips for Dry, Flaky Skin on Your Face and Scalp-Tis the Season For Seborrheic Dermatitis

Pandemic of Dry Hands; Hand Sanitizers, the Swine Flu and Tips to Save Your Hands

Photo Attribution: aussiegall