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Hair is present over most areas of the body. Our follicles are the source of these hairs. Although most of them are very fine, the top of the head, the eyebrows, the eyelashes, and the groin are sources of coarser pigmented hair. A tiny muscle is attached to each hair follicle, and can literally make the hair stand on end! Goose flesh is an example of this, when the muscle contracts in an attempt to reduce heat loss and generate body heat. This same muscle (the arrector pili) helps to compress the oil glands, lubricating not only the hair but also the surrounding skin. Specialized hairs, such as eyebrows and eyelashes, prevent dust from irritating the eyes and give symmetry and shade.

When hair loss occurs over the scalp, varying degrees of baldness may develop. Some types are hereditary, others are related to hormonal changes, aging, or the presence of disease. It is important to exclude fungus infections and carefully examine the hair shaft and follicles for signs of disease. Meticulous evaluation of the diet, together with hygienic care of the scalp and the use of appropriate bathing aids can reduce the amount of hair loss and its associated distress. When unusual necessity requires, transplants are even available to restore hair to bald areas. Because of significantly increased heat generated over the scalp, the employment of wigs and hairpieces is best avoided. Contentment with our appearance is a great gift. When all natural health measures are being encouraged, we can certainly be at peace and trust our countenance to the Creator.

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Although the symptom of itching (pruritis) has been discussed in connection with some of the above disorders, this symptom warrants separate discussion, because it is so common and there are many approaches to therapy. Most normal people have some irritated places that they scratch every day. Often the sensation is so mild that it is barely noticed. There is no harm in an occasional scratching, but constant itching is different. It is typically a distress signal indicating specific trouble.

With about 20 square feet of skin covering our bodies, there are literally millions of nerve receptors. Many of these can convey the sensation of itching, at times becoming so sensitive as to be almost beyond control. Allergies may produce itching and are described in Chapter Ten. Insect bites, pinworms, nettles, plant juices, chemicals, metals and many body secretions can produce similar distress. Excessive sweating, as well as unusual dryness, can provoke itching. In the winter season, many people suffer from dry skin. Often this is made worse by bathing especially with soap or worse yet, the bubble bath, a detergent bath water that removes most natural body oils. Mild soaps such as Dial, Aveeno, Neutrogena, and AlphaKeri are good for sensitive skin. Occasionally, the habit of scratching can develop. When present, this should be overcome. Nervous tension often aggravates itching, as does anxiety.

Relief can usually come by breaking the “itch-scratch cycle,” and simply refusing to scratch. If this is impossible, careful trimming and filing of the nails, or the wearing of soft gloves at night may be necessary. Starch baths are useful using either cornstarch or powdered oatmeal. It is important to avoid soap, except in cleansing the groin, armpits, or feet. Avoid all excessive washing. Hydrotherapy employing moist, hot packs or the contrast shower acts as a counter irritant and relieves the itching. Further examination, laboratory tests, and hormone analyses can become worthwhile in difficult cases. In all these conditions the cause should be ascertained. Then nature can be assisted in restoring health again.

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Characteristic skin changes occur as a person grows older. In most individuals there is a loss of subcutaneous elastic tissue and wrinkles appear. Sometimes these are distressing, and many plastic surgery operations have been devised to lift the face, correct baggy eyelids, or otherwise make a person look younger. More important are the changes that can lead to disease. Chronic exposure to wind and sun with other forms of irritation to the skin may produce dry, scaling plaques, particularly on the face or exposed areas. A premalignant skin irritation known as senile keratosis may occur under these circumstances. The lesion should be removed or otherwise treated to prevent skin cancer.

Common raised pigmented waxy looking plaques occur in aging skin, both on the face, extremities, and trunk. These seborrheic keratoses are completely benign and are normally quite superficial. Freezing with liquidmnitrogen, electrodesication (cautery), scraping, or curetting of the lesions may remove them completely and allow for the return of normal skin in that area.Thinning of the hair and eyebrows are also common in the aging process. Individuals should anticipate the waning of youth with an acceptance of certain changes and the cultivation of a disposition that will produce “happy wrinkles” and an adjustment to the golden years that preserves maximal health and interests in life.

The low fat vegetarian diet greatly improves circulation. Its influence on the skin is beneficial as well. Many are promoting the use of Vitamin E toretard aging. While this oil is helpful in certain topical applications, wholesale supplementation is seldom necessary. In preference, I recommend the use of nuts, whole grains, fruits, and vegetables as the diet best calculated to promote longevity and insure good health of the skin. Cleansing baths, exercise, and regular changing of clothing are just as helpful to the senior citizen, as they are important for the baby.

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The terms dermatitis and eczema are used for a variety of inflammatory allergens, and other factors. Characteristically, the skin changes consist of reddening’s swelling, moist “weeping,” and mild to severe itching. Later stages exhibit scaling with crust formation and eventual scarring. Several types are described below.

Contact Dermatitis

Skin changes in this category of inflammation start in areas of contact with the irritating or allergy-producing agent. The reaction is usually localized, and limited to the area of exposure. There are two main types. Primary or toxic dermatitis may occur in any individual without prior exposure. The allergic type occurs only in sensitized individuals. Some of these will be considered in the next Category Blog post.

Substances that contact the skin and produce this rash are found in clothing, soaps or detergents, cosmetics, industrial chemicals, or the outdoor environment. An example of the latter is the distressing rash produced by poison ivy, poison oak, and poison sumac. The causative agent is a plant resin, called urushiol. Certain exotic hardwoods resins, and the sap from the mango tree can produce a similar rash. Formalin and certain flame-retardant chemicals may be impregnated in garments and cause the same rash described above.

Occupational dermatitis may be due to cement (chromics) in bricklayers, to wheat in bakers, to adhesive tape, anesthetics, sunscreen lotion, and many other substances. Most important, first eliminate the offender as soon as it can be identified. Then apply soothing lotions to relieve the itching and prevent further spread. Needless to say, it is imperative to avoid scratching these lesions or otherwise irritating them during the healing phase.

Seborrheic Dermatitis

Areas of the body richly supplied with sebaceous glands may develop this skin condition. Scaly, somewhat greasy material is produced, which can vary from the dandruff of scalp involvement to the cradle cap seen on babies. Redness around the face is common, with specific involvement of the eyebrows, scalp, and other areas rich in oil glands. Dietary changes to reduce the fat intake in conjunction with adequate sun exposure, frequent shampooing, reduction of stress factors, and improvement of skin hygiene are all important in relieving these conditions.

Atopic Dermatitis

Called at times infantile eczema, this condition typically begins early in life. Usually there is a strong family history of various allergic conditions.

Dryness, cracking, and scaling produces the characteristic lichen-like (lichenification) appearance that is the hallmark of atopic eczema. The disease reaches its maximum severity during the second and third decades of life, then gradually subsides. Each episode starts with violent attacks of itching, probably related to excessive dryness of the skin. These attacks frequently occur at night, and provoke furious scratching, which often leads to infection.

Treatment is difficult in this chronic condition. It is important to avoid measures that produce excessive drying of the skin, such as harsh soaps, frequent washing, or scratching involved lesions. Special nondrying soaps, such as Neutrogena, or Cetaphil lotion can be soothing. Reduction of all known stress factors careful examination of the diet, and general habits of temperance are important to control this troublesome condition. The itching can often be relieved temporarily with the use of a moist oatmeal paste applied to the skin. Aveeno baths are also beneficial in this regard. The challenge of eczema is well worth further study for physicians or families interested in granting relief for these highly visible problems.

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A number of distinct species of yeasts or fungi can infect the skin and its appendages. Although some are always disease producing (called pathogenic), many are opportunists and live normally on the skin, causing infection and symptoms only when conditions prevail that allow excessive growth or an imbalance in normal body flora.

Ringworm is a common and very distressing fungal infection. It is classified sometimes by location and also biologically to describe different organisms which can be cultured. Small red, itching, scaling spots develop on the skin surface, then grow outward. The margin gradually increases in size, while the central portion of the eruption begins to heal spontaneously. Occasionally, after shaving their legs, women can develop deeper fungus infection of the hair follicles, characterized by redness, itching, and granuloma formation.

Another location for infection with the ringworm (Tinea) organism is the nails. Called onychomycosis, this infection usually involves single nails, more commonly on the toes. As fungal organisms grow in the nail plate, the nail becomes opaque, brittle, cracked, and partially separated from its bed. Occasionally an associated fungus infection occurs in the surrounding skin.

The third type of ringworm, Tinea cruris, occurs in the groin. This may itch and exude some fluid. It slowly spreads until treatment is instituted. The hands, feet, and scalp can also be involved with the Tinea family of organisms. Formerly occurring as an epidemic in children, Tinea capitis is now less common. These round or oval, sharply defined lesions cause breaking of the hair, patchy baldness, and occasionally drain a pus-like material. A special fluorescent (Wood’s) light may illuminate the lesions, producing a bright yellowish-green fluorescence.

The most superficial infection, Tinea versicolor, occurs in hot humid climates. Slight scaling patches usually involve the trunk, neck, and upper arms. Gentle scraping may make the scaling more evident. Confirmation of the diagnosis in these fungus infections involves scraping the scaling lesions into a glass slide. After applying a 10% solution of potassium hydroxide and heating the slide gently, the characteristic fungus organism can be seen under the microscope. They usually appear, like most yeasts and fungi, as branching strands, called hyphae.

Treatment of superficial fungus infections is quite effective, using a number of common antifungal preparations. The application of sulfur ointment, painting with tincture of iodine, or half strength of Whitfield’s s ointment is usually helpful. Topical salicylic acid, or the use of newer creams, such as Tinactin can prove beneficial. Most are over—the—counter items available at any pharmacy. Toenail involvement is often resistant to therapy. It may require the surgical removal of the nail, or periodic trimming and tolerance of a slow, ever present infection.

Many yeast-type organisms can infect the skin, The most common infection, however, is produced by the yeast Candida albicans. Formerly called monilia, this infection still is described occasionally as Moniliasis. When seen in the mouth, the disease is called thrush. Cottage cheese-like growths are seen along the surface of the cheeks, in the tonsillar area, and coating the tongue surface. Frequent in infancy, this lesion responds well to specific antifungal therapies, such as nystatin, or the painting with Gentian violet.

Vaginal involvement with yeast is also a common occurrence. Often producing inflammation, pain, or a cheesy discharge these Vaginitis infections are easily treated, but seldom completely eradicated. Aggravating factors include the use of hormone agents, birth control pills, and elevated blood sugar, as in uncontrolled diabetes. It is a troublesome affliction of pregnancy, also seen commonly in times of stress, and immune deficiencies. Common hygienic measures, such as the use of cotton undergarments, frequent bathing, and the avoidance of panty hose can allow necessary aeration, to reduce the moist and warm environment that favors growth of Monilia. Douching with one tablespoon of white vinegar in a quart of warm water or the topical application of specific yeast inhibitors may give rapid relief of symptoms and reduce the risk of recurrence.

A third type of yeast infection is seen in babies, occurring again in the moist diaper area. Appearing as pinpoint red papules, then coalescing to a red diaper rash, the yeast grows and spreads. Plastic “disposable” diapers contribute to this predicament. Careful drying, cleansing, and the topical use of mild ointments, such as A & D ointment, Desitin, or a powdered cornstarch can allow improvement of most cases. Ultraviolet light from the sun is helpful, not only in drying involved skin, but killing the offending
organism.

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