Tinea refers to a group of fungal infections that affect various parts of the body. These infections are caused by dermatophytes, which are fungi that thrive on keratin, a protein found in skin, hair, and nails. Tinea infections are commonly known by the part of the body they affect and are often referred to as ringworm due to the characteristic ring-shaped rash, even though no worm is involved.

Types of Tinea Infections:

1. Tinea Corporis (Ringworm of the Body):
   • Affects the arms, legs, and trunk.
   • Appears as circular, red, and scaly patches with a clear center, resembling a ring.
2. Tinea Pedis (Athlete’s Foot):
   • Affects the feet, especially between the toes.
   • Symptoms include itching, scaling, peeling skin, and sometimes blisters or cracks in the skin.
   • Often occurs in athletes or people who wear tight, sweaty shoes.
3. Tinea Cruris (Jock Itch):
   • Affects the groin, inner thighs, and buttocks.
   • It causes a red, itchy rash that can spread outward with a distinct border.
   • More common in men and athletes.
4. Tinea Capitis (Scalp Ringworm):
   • Affects the scalp and hair follicles.
   • Symptoms include patches of hair loss, scaling, and sometimes swollen, inflamed areas called kerions.
   • Common in children and is contagious.
5. Tinea Unguium (Onychomycosis, Nail Fungus):
   • Affects the fingernails or toenails, causing them to become thickened, discolored, brittle, and crumbly.
   • More common in toenails due to moist conditions in shoes.
6. Tinea Barbae (Beard Fungus):
   • Affects the beard area in men.
   • Symptoms include red, scaly patches, swelling, and sometimes hair loss in the infected area.
7. Tinea Manuum:
   • Affects the hands, causing dry, scaling patches, often on one hand.
8. Tinea Versicolor (Pityriasis Versicolor):
   • Not caused by dermatophytes but by a yeast-like fungus (Malassezia species).
   • Causes discolored patches on the skin, either lighter or darker than the surrounding skin, often on the chest, back, and shoulders.

Symptoms:

• Red, scaly, and itchy rashes.
• Ring-shaped patches with a clear or less scaly center (in some forms).
• Cracking, peeling, and softening of the skin.
• Blisters or pustules in severe cases.
• Hair loss in areas affected by scalp ringworm.

Causes:

• Fungi (dermatophytes): The most common fungi that cause tinea infections are Trichophyton, Microsporum, and Epidermophyton species.
• These fungi thrive in warm, moist environments, making areas like locker rooms, public showers, and sweaty skin more prone to infection.

Transmission:

• Direct contact: Skin-to-skin contact with an infected person.
• Indirect contact: Sharing contaminated items such as towels, clothing, combs, or surfaces.
• Animal contact: Tinea can also spread from infected animals (particularly pets like cats and dogs) to humans.

Diagnosis:

• Clinical examination: A healthcare provider can often diagnose tinea based on the appearance of the rash.
• KOH test: A scraping of the skin can be examined under a microscope with potassium hydroxide (KOH) to identify fungal elements.
• Fungal culture: A sample may be cultured in a lab to identify the exact fungal species.

Molluscum contagiosum is a common, contagious viral skin infection caused by the molluscum contagiosum virus (MCV), which belongs to the poxvirus family. It leads to the formation of small, raised, dome-shaped, and smooth skin-colored or pearly bumps (papules) on the skin. These bumps often have a central dimple or core and may appear singly or in clusters.

Key Characteristics:

• Appearance:
  • Small (2-5 mm in diameter), firm, round, flesh-colored or white papules with a characteristic central indentation (umbilicated).
  • Can sometimes become red and inflamed as the body’s immune system fights the virus.
• Location:
  • Commonly appears on the face, neck, armpits, arms, and hands in children, and on the genital or inner thigh area in adults (often related to sexual contact).
  • May also appear on other parts of the body, except the palms and soles.

Transmission:

• Direct skin-to-skin contact: Touching the lesions or coming into contact with an infected person.
• Fomite transmission: Sharing personal items such as towels, clothing, or gym equipment.
• Sexual contact: In adults, molluscum contagiosum can be transmitted through sexual activity, often appearing in the genital region.

Who is at Risk:

• Children: It is most common in young children, especially those who come into contact with infected individuals in schools or daycare centers.
• Adults: Molluscum in adults is often transmitted sexually, but it can also affect athletes or people who use shared facilities (e.g., swimming pools, gyms).
• Immunocompromised individuals: People with weakened immune systems (e.g., HIV/AIDS patients, organ transplant recipients) may experience more widespread and persistent molluscum contagiosum infections.

Symptoms:

• Painless bumps: Molluscum lesions are typically painless, but they can become itchy or irritated.
• Inflammation: In some cases, the immune system responds by causing the bumps to become inflamed or red as the body fights the virus.

Treatment:

Molluscum contagiosum often resolves on its own without treatment within 6 to 12 months, although it may take up to 4 years in some cases. However, treatment may be sought for cosmetic reasons or to prevent the spread of the infection.

• Topical therapies:
  • Cantharidin: A blistering agent applied by a healthcare provider.
  • Imiquimod cream: An immune response modifier that helps clear the virus.
  • Retinoids: Topical retinoid creams may be used to irritate the skin and help eliminate the lesions.
• Cryotherapy: Freezing the lesions with liquid nitrogen.
• Curettage: Surgical removal of the lesions using a small tool to scrape them off.
• Laser therapy: In some cases, laser treatment may be used to remove the lesions.

Cutaneous lymphomas are a type of non-Hodgkin lymphoma (cancer of the lymphatic system) that primarily affects the skin. These cancers originate from lymphocytes, a type of white blood cell, and manifest in the skin, though they can sometimes involve other organs. Cutaneous lymphomas are classified into two main types based on the type of lymphocyte involved: T-cell and B-cell cutaneous lymphomas.

Types of Cutaneous Lymphomas

1. Cutaneous T-Cell Lymphomas (CTCL):
   • These are the most common form of cutaneous lymphomas. They develop from T-cells, which are part of the immune system.
   • Mycosis Fungoides:
     • The most common form of CTCL. It usually presents as patches of scaly, red skin that resemble eczema or psoriasis. Over time, it can progress to form plaques and tumors.
     • It often affects areas like the chest, back, or buttocks, and can be slow-growing.
   • Sézary Syndrome:
     • A more aggressive form of CTCL, where cancerous T-cells are found in the blood in addition to the skin.
     • It often causes widespread skin redness, scaling, and severe itching, along with enlarged lymph nodes.
2. Cutaneous B-Cell Lymphomas (CBCL):
   • Less common than CTCL, these develop from B-cells, another type of lymphocyte.
   • Primary Cutaneous Follicle Center Lymphoma:
     • Presents as nodules or plaques, often on the head, neck, or upper body. This form tends to have a favorable prognosis.
   • Primary Cutaneous Marginal Zone B-Cell Lymphoma:
     • Usually appears as small, painless lumps or nodules on the arms or trunk.
   • Primary Cutaneous Diffuse Large B-Cell Lymphoma, Leg Type:
     • A more aggressive form of CBCL, typically presenting as large, rapidly growing tumors, often on the legs.

Symptoms of Cutaneous Lymphomas:

• Red, scaly patches or plaques on the skin
• Raised lumps or tumors
• Itching (pruritus)
• Eczema-like rashes or psoriasis-like plaques
• In advanced cases, ulceration or infection of lesions
• Enlarged lymph nodes (in more aggressive forms like Sézary syndrome)

Causes:

• The exact cause of cutaneous lymphomas is unclear, but they are believed to result from genetic mutations in lymphocytes.
• Environmental triggers, immune system dysfunction, and viral infections (e.g., HTLV-1) may play a role in some cases.

Diagnosis:

• Skin biopsy to examine cells under a microscope
• Blood tests to look for abnormal lymphocytes (especially in Sézary syndrome)
• Imaging to assess lymph node involvement
• Flow cytometry or other advanced tests to determine the type of lymphoma

Autoimmune blistering diseases are a group of rare conditions where the body’s immune system mistakenly attacks the skin and mucous membranes, leading to the formation of blisters. These diseases occur when the immune system targets specific proteins that hold the layers of the skin together, causing them to separate and form blisters.

Here are some common types of autoimmune blistering diseases:

1. Pemphigus:
   • In this condition, antibodies attack proteins in the skin and mucous membranes, causing fragile blisters that easily rupture. There are different forms of pemphigus, including:
     • Pemphigus vulgaris: The most common form, affecting the skin and mucous membranes (e.g., mouth, throat).
     • Pemphigus foliaceus: Affects only the skin, causing more superficial blisters.
2. Bullous Pemphigoid:
   • This disease typically affects older adults and involves deeper, more resilient blisters than pemphigus. The immune system attacks the basement membrane, which connects the epidermis to the underlying layers of skin.
3. Dermatitis Herpetiformis:
   • Often associated with celiac disease, this condition results in itchy blisters and is typically found on areas like the elbows, knees, and buttocks. It is caused by the immune system reacting to gluten.
4. Epidermolysis Bullosa Acquisita (EBA):
   • A rare disease where antibodies attack collagen in the skin, leading to fragile skin that easily forms blisters after minor trauma.

Symptoms of Autoimmune Blistering Diseases:

• Blisters on the skin or mucous membranes (mouth, throat, eyes, genitals)
• Itchy, painful skin
• Erosions or sores when the blisters break
• Scarring or pigment changes after healing

Causes:

• Genetic predisposition
• Environmental triggers (infections, medications)
• No definitive cause is often identified, but the immune system mistakenly attacks its own tissue.

Diagnosis:

• Skin biopsy with direct immunofluorescence
• Blood tests to detect specific autoantibodies

About Actinic Keratoses

What is it?

What causes it?

• Rough, dry or scaly patch of skin, usually less than 1 inch (2.5 centimeters) in diameter
• Flat to slightly raised patch or bump on the top layer of skin
• In some cases, a hard, wartlike surface
• Color variations, including pink, red or brown
• Itching, burning, bleeding or crusting
• New patches or bumps on sun-exposed areas of the head, neck, hands, and forearms

Common Treatments?

• Freezing (cryotherapy). Actinic keratoses can be removed by freezing them with liquid nitrogen. Your doctor applies the substance to the affected skin, which causes blistering or peeling. As your skin heals, the damaged cells slough off, allowing new skin to appear. Cryotherapy is the most common treatment. It takes only a few minutes and can be done in your doctor’s office. Side effects may include blisters, scarring, changes to skin texture, infection, and changes in skin color of the affected area.
• Scraping (curettage). In this procedure, your doctor uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which the doctor uses a pencil-shaped instrument to cut and destroy the affected tissue with an electric current. This procedure requires local anesthesia. Side effects may include infection, scarring, and changes in skin color of the affected area.
• Laser therapy. This technique is increasingly used to treat actinic keratosis. Your doctor uses an ablative laser device to destroy the patch, allowing new skin to appear. Side effects may include scarring and discoloration of the affected skin.
• Photodynamic therapy. Your doctor might apply a light-sensitive chemical solution to the affected skin and then expose it to a special light that will destroy the actinic keratosis. Side effects may include redness, swelling, and a burning sensation during therapy.

Providers

Our approach & expertise

Our practice has skilled dermatologic experts who have the experience and knowledge to provide effective solutions for your particular needs and goals. Our focus on you as a person is what makes us different from others, and we’ll be with you each step of the way with empathy, advice, and support. Healthy skin is our passion. Contact us today if you have actinic keratosis so that we can help you.

About Skin Cancer

What is it?

Skin cancer is the most common form of cancer in the US, affecting around 20 percent of Americans. However, it does not have to be fatal, especially when caught early. That’s why you shouldn’t ignore unusual skin bumps, lesions, discolorations, and other irregularities when they appear. Although the causes of skin cancer vary, there are common risk factors to be aware of, which include chronic sun exposure, a family history of skin cancer, fair skin, multiple sunburns throughout your life, precancerous skin lesions, and sunny and/or high-altitude climates and locales.

What causes it?

Skin cancer is caused by mutations in the DNA of skin cells, which then spreads to adjacent cells. When the spread is rapid or uncontrolled, it can easily become malignant. Three types of skin cancer are prevalent. The first is squamous cell carcinoma, which is located in cells just beneath the skin surface. The second is basal cell carcinoma (the most common type of skin cancer) which develops in the layer beneath squamous cells. Lastly, there is melanoma, the most dangerous variant. Melanoma forms under the other two layers of cells. A precancerous lesion, actinic keratosis (AK), also is possible; it usually is not life-threatening, but it can become cancerous if ignored.

Common treatments

Our skin cancer experts have the experience and training to help you overcome this disease. We highly recommend regular skin cancer screenings, especially if you are prone to the above risk factors. If a carcinoma is found, we’ll discuss the best solution with you from among the following treatment options: excisional surgery, electrodesiccation and curettage (EC&D), cryotherapy, and Mohs micrographic surgery.

Providers

Our approach & expertise

We provide an assortment of treatment options that can be customized to suit your needs based on your goals, concerns, and opinions about which treatment is right for you. We’ll be with you throughout the process with compassionate care and support so you can have your life back and live it to the fullest. We understand that a diagnosis of skin cancer can be traumatic and painful, both physically and emotionally. As your community skin cancer specialists, we’re here to provide encouragement, advice, and answers to your questions should you ever receive such a diagnosis. What sets us apart is our focus on you as a person. Our warm, compassionate practitioners are ready to address your concerns to be here as an essential part of your support.

Learn more about a common skin condition, eczema, and how our board-certified dermatologists can help you.

Eczema, sometimes referred to as atopic dermatitis, is a condition of the skin that leaves it dry and irritated, causing it to crack and sometimes bleed. Eczema can be seen in patients of all ages, but particularly children. It is a very common term used to describe inflammatory skin conditions that lead to chronic itching and skin damage. There are numerous things that can trigger and/or worsen eczema, including soaps, chemicals, fragrances, food allergies, pet dander, other systemic allergies, and other irritants to name a few. There are numerous treatments including topical corticosteroid creams, immunomodulators, ultraviolet light treatment, and others.

Causes

While physicians are unsure of the exact cause of eczema, it is thought to be a combination of several factors:

• Genetics
• Immune dysfunction
• Environmental exposures, including:
• Irritating soaps
• Changes in weather

Children are more likely to have eczema; however, people can develop eczema at any age. Some children will grow out of it but it may return again in later years. Those with asthma, hay fever, and certain allergies are more prone to eczema than others. Additionally, a family history of eczema or asthma and hay fever can increase the risk of developing eczema to flare.

Symptoms

Eczema presents with dry, itching skin that can be red and cracked, or can occasionally be bumpy. Severe forms of eczema can cause fluid to come out from the cracks left in the skin. If left untreated, these cracks can allow bacteria and viruses to penetrate the skin and lead to a more serious infection.

Treatment

Eczema cannot be cured, but needs to be managed chronically. Occasionally, changes to the patient’s skincare routine are all that is needed to maintain clear skin. Flares and poorly controlled eczema can be treated with medicated ointments or creams. Antibiotics may be necessary if there is concern for infection. Similarly, bleach baths or vinegar water soaks may be used to prevent infections. 

As fragrances, dyes and other chemicals can exacerbate eczema, it is important to use fragrance-free and sensitive skin self-care and laundry products. Avoid alcohol-based products, including aerosol and waterless hand sanitizers, as alcohol is very drying for the skin. Antihistamines taken routinely can decrease the itch associated with eczema and are particularly helpful in patients with associated hay fever and seasonal allergies.

Because eczema cannot be cured, a patient will always have the tendency for flares of the skin. And while hereditary eczema cannot be prevented, the frequency and severity of the flares can be managed with good skincare and avoidance of irritants.