The tanning booth industry has a problem. Their product causes cancer. You don’t have to take my word for it, trust the World Health Organization. It is officially on their list of known carcinogens. This is an issue which patients have actually argued with me about. Young women especially often believe that there is no danger to tanning booth usage and this is because the people who own and operate these machines tell them so. Nobody promotes a product by telling you it causes cancer. Many states have now passed laws that do not allow underage teens to visit a tanning booth without the consent of a guardian. I recently had a teen from Fort Mill,South Carolina who admitted to using tanning booths since she was 15. She has many scary moles and “only” went to the booths once a week, while many of her friends were going three times per week.

I have had patients that own tanning salons and they usually do not go into the booths. They know the dangers and the severe photo-damage that comes with tanning. They usually tell me that they are smarter than their clients. The problem is that people falsely believe that they are safe and they often develop an addiction to the tanning rays. This addiction is well documented and many patients will readily admit to it. This tends to be more of a winter issue and is likely related to Seasonal Affective Disorder.  I even had a young woman from Ballantyne recently trying to convince me that she is doing the smart thing going to indoor tanning. She was not very convincing.

As a dermatologist their is no doubt in my mind that younger and younger patients are developing scarier moles and melanoma. I had a patient in my New York practice who had a melanoma at the age of 18. She was a frequent visitor to the tanning booths and had even worked at one. She had used the booths DAILY as they were free for employees. Happily she had an early melanoma and is one of the lucky melanoma survivors. But the lesson was learned and she tried spreading the word to her friends. Most went less frequently, but still kept tanning. Even seeing a scar on their pals couldn’t change their minds completely.

So if you tan or care about someone who does, just ask them not to. Have them Google “Tanning” and “World Health Organization”. They might learn a lesson that could save their lives.

Few things are as annoying as hives. Patients are often desperate from the itch and the accompanying lack of sleep. The medical name for hives is urticaria. Hundreds of things can cause hives and nearly every medicine ever used will lead to someone somewhere getting hive. The most common medicines are the penicillen antibiotics, along with sulfa antibiotics. The opiate family of pain medications, which includes morphine, demerol, and codeine are also major causes of hives. Imagine being in pain and then having the added joy of a new insanely itching rash. That is an unhappy person. Foods can be another cause of hives, and peanuts have become public enemy number one at many schools. Many nuts and berries bring on hives. There are also hives that are from viruses. Instead of getting a cold, your skin may get the reaction.

Hives are an inflammatory reaction in your skin with the release of histamine causing swelling and redness in the skin. The itch gets worse with itching and this can lead to a snowball effect of increasing itching. The most important thing to be aware of is that what is happening in the skin can also affect breathing. ANY challenge with breathing needs to be treated immediately as a medical emergency. Dial 911 and don’t take any chances if there is any question about a respiratory emergency. I recently gave Epipens to two patients in one week with severe hives. A man from Tega Cay and a woman from Ballantyne both had reported that they had had minor trouble breathing when their hives began. An Epipen is a dose of adrenaline that is carried for respiratoy emergencies and can be given to help open the airways. If a pen is needed, the next step is getting to an emergency room because the medication does not have a long term effect.

How do I know if it’s hives? If it is an itching rash that moves from place to place that’s likely what you have. If you scratching your skin and it welts up in the scratch line that’s an easy way to confirm. That is a finding called dermatographism- the ability to write on the skin and get it to welt. A small percent of people always have dermatographism and I recently saw a woman from Lake Wylie who has been suffering from this for years. Without daily anti-histamines she has hives from nearly any skin contact.

So if it is hives you have, I hope it doesn’t last long and that you aren’t suffering too much.

Even with my new practice being small, I’m impressed that nearly everyday a patient will show me something or tell me something that I have seen or heard that way before. With 16 years of pure dermatology experience and everything I have seen, there is always something new and different. Some way to keep me interested and on my toes. I saw a patient from Waxhaw who had a new house. She mentioned that Waxhaw was the poison ivy capital of  the entire Charlotte area. She had been clearing vines and discovered this added attraction to her yard. She had plenty of insect bites as well and her legs looked like one of those people on survivor at day 30. I had seen hundreds of poison ivy cases before this woman, but she seemed to be almost numb from the itch and the lack of sleep. Most of the new developments in the Ballantyne area are beginning to get the infiltration of this vine that can burrow long distances before popping up and growing. A landscaper patient told me that finding poison ivy in the Ballantyne area was a new issue for him and his workers, where they normally see it all over areas like Matthews and South Park. The evil vine is prolific and hard to permanently beat.  Remember, leaves of three, let them be.

Zoster is an eruption of the skin that is one of the most dreaded conditions that a person can have. Shingles and zoster are the same condition, and they come up as an eruption of an old chicken pox virus travelling down a nerve root. The full name of the virus is the Varicella Zoster Virus (VZV). The area affected may have pain that starts days before there are any visible lesions of zoster. The pain is often thought to be orthopedic or even cardiac depending on the location that the virus is coming up in. The first visible sign of shingles may be a red patch or patches and these are typically in a line that traces the nerve root. The skin area of a nerve root is called a dermatome and on the trunk a dermatome extends from the spine to the center of chest or abdomen. On the extremities or head dermatomes are also linear, and in areas there is usually a near perfect cut off of lesions at the mid-line. After redness, the next thing that is typically seen is a cluster of vesicles and blisters. These blisters are the classic picture of zoster and when a patient states that they have a line of blisters it is likely that they have zoster.

Most people who have zoster can remember that they had chicken pox. I saw a gentleman from Fort Mill, South Carolina who remembers all of his siblings having the pox together, nearly 80 years ago. You cannot “catch” or “get” zoster from another person, it is an old chicken pod infection that has resurfaced along a nerve route. The virus has remained dormant in the nerve root, often for decades. A person with zoster can give the chicken pox virus to others and this has been well documented. One reason I have seen so many people from Fort Mill with zoster is that there is a growing population of those over fifty years old retiring to the area. The older one gets, the more likely zoster is to occur. It may be difficult to get an emergency dermatolgy visit in Fort Mill and hopefully a person in need can find the right care quickly because the faster that medicine is started, the more it can help.
The pain of zoster can be a nightmare. The pain may begin before the rash and can last for months and even years. The long term pain is called post-herpetic neuralgia. There are many treatments for this but the best treatment is likely vaccination to decrease a person’s chances of getting shingles, or early treatment of the infection. The areas of zoster may scar and this is especially significant on the face. The upper face can get zoster and the real danger there is that the virus can involve and damage of the eye.

The older a person is the more likely that zoster occurs. I have seen cases younger than five, but most often see people over fifty. The zoster vaccine, Zostavax, is a new option to try and prevent cases of zoster. It is the same vaccination as that given to children for preventing chicken pox. Just as children may still get an eruption of chicken pox after getting vaccinated, adults can still have an outbreak of zoster even though they have been vaccinated. The vaccine does lower the odds for an eruption, and the zoster that does happen appears to be less severe. The vaccine is approved for those over fifty and people with certain medical conditions. It is definitely something worth considering to try and prevent the pain of zoster. I recently saw a woman from Fort Mill, South Carolina with Zoster who had been vaccinated. There were only a few months between vaccination and her zoster and happily she had only a mild eruption and minor pain. The pain of the vaccination is minor compared to the pain of actual zoster.
So, remember to think of zoster if there are painful blisters, especially in a linear pattern. The medications for treating zoster are excellent, but they need to started early to be effective. So if you see linear blister and feel pain, please get seen.

David Schulman
Pineville Dermatology, South Charlotte Dermatology. Matthews Dermatology, Ballantyne Dermatology