You see, the entire surface of our skin is covered with microorganisms (bacteria, fungi, mites, and viruses). The collective term for all these living organisms that live in symbiosis with us is “microbiota.” Similarly, our gut is populated by microorganisms. Interestingly, our bodies contain more non-human cells than human ones. In other words, there are more bacteria than cells that make up the structure of our body and organs.

It is increasingly evident that there is a certain interaction between our microbiota and certain inflammatory diseases. In the case of acne, studies have primarily focused on the skin microbiota rather than the gut microbiota. I’ll tell you what we currently know about this topic.

What Are Probiotics for Acne?

As I mentioned, our skin is covered by microorganisms. We acquire bacterial colonization at birth, and it changes throughout our lives. Furthermore, these microorganisms are distributed differently depending on the part of the body. For example, we won’t find the same bacteria in the oilier areas (forehead, scalp, chest) as in the moist areas (armpits, groin, soles of the feet) or dry areas (forearms, legs, buttocks).

The bacterium most closely associated with acne, which lives specifically in the most sebaceous areas of our body, is Cutibacterium acnes (C. acnes, formerly known as Propionibacterium acnes). It plays a significant role in the development of pimples, both in teenage acne and in hormonal acne in adult women.

This bacterium lives in the hair follicle, thriving in environments with higher sebum levels. Additionally, it can cause inflammation, which leads to the appearance of red pimples or pustules.

On the other hand, Staphylococcus epidermidis (S. epidermidis) is another bacterium that permanently inhabits our skin. It is found primarily in the armpits, on the scalp, and in the nasal passages. The presence of this bacterium is important for maintaining a balance with C. acnes and other bacteria, such as Staphylococcus aureus, which is implicated in atopic dermatitis.

When there are imbalances among bacterial populations, we say that dysbiosis occurs. Probiotics for acne would be live microorganisms capable of correcting this dysbiosis. Studies are currently being conducted based on this premise, most of which involve oral or topical administration.

How Probiotics Work for Acne

It is believed that, through their effect on the gut microbiota, probiotics may reduce skin inflammation or lower insulin resistance. Both of these effects could be beneficial for acne. On the one hand, reduced inflammation would decrease the redness and pain associated with pimples. On the other hand, reduced insulin resistance would cause the skin to produce less sebum, which could indirectly improve acne.

Topically, applying products containing certain types of microorganisms could help regulate the microbiota. This would reduce the amount of C. acnes, thereby decreasing the formation of acne lesions.

Are Probiotics Effective for Acne?

The points discussed above make sense from a theoretical perspective. Along these lines, several studies have been conducted with probiotics containing different strains of a bacterium called Lactobacillus. All appear to improve the severity of acne.

Topically, one study showed an improvement in sebum production after 4 weeks of using a postbiotic consisting of a lysate of fermented Lactobacillus plantarum. In this case, the cosmetic does not contain bacteria, but rather fragments of them.

Read more about conventional treatments for acne

What Is the Best Probiotic for Hormonal Acne

The promising results obtained from the use of oral probiotics and topical postbiotics in the studies mentioned above are encouraging. However, all of these studies were conducted with a small number of patients (only one included more than 100 cases). Therefore, the current evidence is limited.

Furthermore, there is variability in the composition of the probiotics used, which makes it even more difficult to draw clear conclusions regarding their effectiveness or superiority over one another.

In conclusion:

It is possible that in the future we may be able to use probiotics to improve acne, as some studies suggest they are effective. However, we do not yet have sufficiently conclusive scientific evidence to recommend their systematic use.

Are you looking for a good treatment for your acne? You might be interested in my online dermatology service, backed by hundreds of patient reviews :)

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This week’s post is about pityriasis rosea. It is a disease (nothing serious, by the way) described by Camille-Melchior Gibert in 1860. It usually causes quite a bit of concern in those who suffer from it because it tends to appear suddenly, without any apparent cause, and spreads across the abdomen, back, and arms.

The good news is that it is fairly easy to diagnose and heals on its own, so once you know you have pityriasis rosea, you can rest assured.

Pityriasis rosea is quite common; it is estimated that 2 out of every 100 people who visit a dermatologist suffer from it. It usually occurs in older children or young adults, more frequently in females.

WHAT DOES PITIRIASIS ROSEA LOOK LIKE?

Pityriasis rosea usually appears as pink, generally oval spots scattered across the trunk, which tend to form imaginary horizontal lines, often referred to as a “Christmas tree pattern.” The patches may have a white scaly border. In addition to affecting the trunk, they can appear on the arms or legs (most frequently on the thighs and rarely below the knees). It is rare for them to appear on the face. In more than half of cases, the first spot is larger and appears alone (which we call “Broq’s heraldic medallion”), followed by other smaller spots.

They are oval, pink spots that appear on the trunk and do not usually itch.

Normally, these spots do not itch much and do not usually cause discomfort.

WHY DOES IT APPEAR?

The cause of this disease is not well understood. Recently, some studies have been published that seem to link it to certain types of viruses (including herpes viruses 6 and 7, as well as the flu virus), but their role in the development of this disease is not yet clear.

HOW IS IT DIAGNOSED?

The diagnosis can usually be made during a simple visit to the dermatologist, who must differentiate it from other skin diseases that may have similarities (eczema, psoriasis, pityriasis versicolor, etc.). No specific tests are necessary to confirm the diagnosis.

No tests are usually necessary to diagnose pityriasis rosea.

HOW IS IT TREATED?

It is known to be a condition that disappears on its own within several weeks (even 2-3 months). In order to avoid unnecessary worry, it is very important to understand that it lasts for a while (which can be a long time) and that new spots may appear in the meantime. After a few weeks/months, the spots begin to disappear on their own and, in most cases, without leaving any marks.

It is usually recommended to apply a moisturizing cream to keep the skin well cared for during the process. On the other hand, although it is rare, some people experience itching from the spots caused by pityriasis rosea; in these cases, the doctor or dermatologist may prescribe a soothing cream or topical corticosteroid to relieve this discomfort.

Pityriasis rosea does not require treatment. It heals on its own.

IS IT CONTAGIOUS?

Pityriasis rosea is not contagious, and those who suffer from it can lead a completely normal life. The only thing to bear in mind is that if you are exposed to the sun while you have the spots on your skin, they may leave a kind of darker “mark” for a few weeks or months after healing, so we always recommend using sunscreen.

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They can sometimes grow quite large (up to several centimeters), but this is quite rare. They do not usually cause any symptoms, although they can be a little annoying when they catch on shirt collars or jewelry.

Fibromas are extremely common, with almost half of all people having at least one (49%), so they can be considered almost “healthy skin.”

Skin tags are not contagious

Fibromas or skin tags are not a type of wart, so they are not contagious. It is often thought that rubbing one, or occasional bleeding, can cause more fibromas to appear around it, but this is not the case. The fibromas that appear on our skin do so independently of those around them or anything we may have done.

Older people, obese people, or people with diabetes are more likely to have skin tags.

However, they can be more common in certain specific cases:

• Older people: the older we are, the more likely we are to develop fibromas. Six out of ten people aged 70 have them.
• Obese or overweight people.
• People with type 2 diabetes.
• People with a family history of numerous fibromas.

Fibromas can be confused with other similar skin lesions such as viral warts, intradermal nevi (a type of mole), neurofibromas, or basal cell carcinomas. No specific tests are needed to differentiate them; dermatologists (I work as an online dermatologist and may be able to help you) can diagnose them with a simple examination.

It is not necessary to remove fibromas, as they are lesions that pose no risk. In any case, they can be removed for cosmetic or comfort reasons. There are different ways to do this, all of them very simple, but I will talk about that in another post :).

Do you have skin tags?

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What Is Frictional Dermatitis?

Frictional dermatitis is a benign skin eruption that usually affects school-aged children. It typically appears in the summer months, presenting as small, flat, skin-colored or whitish bumps that may itch. These lesions often appear in areas of repetitive rubbing or friction, such as the elbows, knees, and backs of the hands.

This condition has been known by many different names (reflecting the uncertainty around its exact cause): “juvenile papular dermatitis,” “frictional lichenoid eruption,” or even “slide dermatitis” (due to its association with play on friction-inducing surfaces).

How Is Frictional Dermatitis Diagnosed?

The diagnosis is clinical, meaning it’s based on what we see during a skin exam and the patient’s context. Affected children are usually otherwise healthy, with no other skin diseases, and the lesions appear exclusively during the summer.

The lesions have a typical distribution: small, flat, skin-colored tiny bumps, sometimes accompanied by mild redness or signs of scratching. Parents often consult because of the rash, especially if it itches, though it’s usually not very bothersome.

A biopsy or other tests are rarely needed unless the diagnosis is unclear. In such cases, it’s important to rule out other conditions that might look similar, such as keratosis pilaris, lichen nitidus, or polymorphic light eruption.

Is Frictional Dermatitis Dangerous?

No, it’s not dangerous. This is a mild, temporary skin condition with no serious consequences. It doesn’t affect internal organs, doesn’t leave scars, and has no long-term effects.

It often resolves on its own by the end of the summer, even without treatment. There is no clear association with atopic dermatitis, although some overlap may occur in certain cases.

How Is Frictional Dermatitis Treated?

In many cases, no active treatment is needed, as it tends to disappear spontaneously. However, if the lesions are itchy or bothersome, the following measures can help:

• Moisturizing creams or emollients to soothe and protect the skin
• Mild topical corticosteroids for a few days, if there’s significant itching or inflammation

The most important thing is not to worry because this is not a serious or contagious condition. No special preventive measures are needed, although reducing friction (e.g., wearing looser clothing or avoiding rough play surfaces) may help.

In Summary

Frictional dermatitis is a benign, seasonal, and self-limiting condition. Knowing about it helps avoid unnecessary concern or overtreatment.

The post Small bumps on the hands, elbows, and feet: friction dermatitis first appeared on Dra. LOREA BAGAZGOITIA.

WHAT IS polymorphic light eruption?

These are skin lesions of different shape and appearance (hence the name “polymorphous rash”) usually located on the neckline, shoulders and back of the hands. It is rarer, but can also affect the legs. Characteristically, it appears in areas that are usually covered during the winter.

Polymorphous light eruption is the most common form of sun allergy, usually appearing in spring and improving as summer progresses.

Small pimples (most common), welts or even vesicles or small blisters may appear. Sometimes it resembles insect bites. It usually appears in spring or early summer, fading as the weeks go by and disappearing again at the end of summer. It often recurs year after year.

Images of polymorphic light eruption

¿HOW IS polymorphous light eruption DIAGNOSED?

The appearance and evolution of the pimples are often sufficient to make a diagnosis. In specific cases, a skin biopsy may be necessary to confirm the diagnosis.

PLE is the most common form of sun allergy; however, it is important to rule out other causes of sun allergy.

If pimples or other lesions appear after sun exposure, it is important to consult a dermatologist to confirm whether it is a polymorphous light eruption or other skin diseases that are also aggravated by the sun.

Is polymorphous light eruption HEREDITARY OR CONTAGIOUS?

It is thought that there is a certain genetic component in the appearance of polymorphous luminal rash, so that up to 45% of people who suffer from it have some history in the family.

Can polymorphic light eruption be prevented?

•SUN PROTECTION:

Obviously the most important measure to take is photoprotection. It is important to use physical measures (such as hats, T-shirts…) and protective creams for UVB as well as for UVA. All sunscreens in the European Union are required to protect against UVA at least 1/3 of what they protect against UVB; but from this minimum there are those that cover more and those that cover less. This is important, because both UVB and UVA (and even in some cases, visible light) can trigger the appearance of pimples.

•PHOTOTHERAPY:

Curiously, it seems that as exposure to the sun increases, the skin acquires a kind of tolerance to the sun. Somehow it seems to get used to it and as the summer progresses, the appearance of pimples becomes less likely. Therefore, in cases where photoprotection is not sufficient, their appearance can be prevented by phototherapy (UVA or UVB rays administered in a medical center). Phototherapy prepares the skin before sun exposure, so that when it arrives, the skin is already “prepared”.

Sun protection is the most important preventive measure. In some cases, it can be prevented with dermatologist-controlled phototherapy.

•VITAMINS AND OTHER ANTIOXIDANTS:

Vitamin supplements with antioxidants can be taken a few months before sun exposure, although their effectiveness is still controversial, since there are not enough scientific studies with clear conclusions to recommend their use in all cases.

HOW IS polymorphic light eruption TREATED?

In cases where you have not been able to prevent the appearance, the spots can be treated with a corticosteroid cream; with which the spots disappear within days (as long as you do not continue to expose yourself to the sun :). In more severe cases, it may be necessary to take corticosteroids in pill form.

HOW LONG does polymorphic light eruption last?

It is considered to be a chronic disease, so it is likely to appear year after year and relevant prevention and precaution must be maintained over time. But it is also true that over time (within years), in about half of the cases the symptoms tend to diminish or even disappear.

In conclusion…

The most common cause of sun allergy is polymorphous light eruption. This is not a serious disease but it tends to recur every year. To prevent it, sun protection (UVB and UVA) is essential, not only with sunscreen but also with hats, shirts,…. In some cases more specific treatment is needed, for which it is advisable to see a dermatologist.

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The realization of a mole map makes it easier to follow up in such cases. The system consists of a camera connected to a computer, where the images obtained during the scan are recorded, which will facilitate future revisions.

We take standard images and mark moles with arrows on them, which are also photographed at high magnification with polarized light (these images are the actual dermoscopic images).

Advantages of digital dermoscopy

Digital dermoscopy has a number of advantages that make it more effective than traditional mole check-up.

·DETECTS NEW MOLES

On the one hand, it allows us to photograph your entire body surface. In this way, the system records images where you can see the areas where there are moles, but also those where there are hardly any.

Basically, the idea is to “keep track” of as much of the body area as possible in order to evaluate possible changes over time. This makes it easier to detect new moles that appear after the first dermoscopy.

·DETECTS CHANGES IN EACH MOLE

On the other hand, since we record each mole individually, the procedure allows us to observe at each check-up, one by one, if the moles have changed shape, color, or any of the dermoscopic characteristics have changed.

If we have any doubts about a mole, we will always have a previous photo that will allow us to confirm if that mole is changing or if it was the same in the previous revision (which always gives us peace of mind).

·REDUCES THE NUMBER OF UNNECESSARY EXCISIONS

In people with a large number of moles, it is not uncommon to have several removed during their lifetime, either because of suspicion or because of small changes. Digital dermoscopy makes it possible to define much better the relevance of certain signs or changes, so that it “saves” removals.

In situations in which without it as a tool we might recommend removing a mole, digital dermoscopy, through the option of comparing with previous photos, can give us peace of mind. In this way, moles can be followed more closely and unnecessary excisions can be avoided.

When is it advisable to perform a mole mapping?

Not everyone needs to follow up closely with digital dermoscopy. If, for example, you have very few moles, it will be easy for you to observe yourself and detect changes (in shape, color or new moles). However, there are certain situations or personal characteristics in which digital dermoscopy helps greatly when performing mole checks:

• People with a large number of moles (more than 50)
• People with a family or personal history of melanoma.
• People with very fair skin or red hair, especially if they have suffered numerous sunburns throughout their lives.

Have you ever had a digital dermoscopy?

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It is estimated that 3% of people suffer from it and it is more common around the age of 30-40. It is more common in HIV+ people and Parkinson’s patients. It can also occur in infants, but I will discuss seborrheic dermatitis in children in another, more specific post.

Although it is an extremely common condition, the causes are not clear. It is known to be somehow related to the presence of a fungus called Pityrosporum ovale (of the genus Malasezzia), which normally lives on the skin of humans, but which, by mechanisms that are not entirely clear, causes this kind of “irritation” to appear on the skin of some people.

It is not a serious condition, nor is it contagious, nor does it have any worrying consequences. Nevertheless, it is usually quite annoying because it can recur for decades and in many cases (not to say almost all) is not completely cured. It tends to get worse with stress and in the cold months, while getting better in the summer (partly because of the peace and quiet and partly because of the sun’s UV rays).

Seborrheic dermatitis can in some cases resemble other skin diseases, but its diagnosis is relatively simple for dermatologists, so it is usually not necessary to do any kind of test.

Follow this link to see more pictures of seborrheic dermatitis.

Since the flare-ups tend to come and go, the way to control them is to use an appropriate treatment for each of these flare-ups. We will talk about this in another post ….:)

The post What is seborrheic dermatitis? first appeared on Dra. LOREA BAGAZGOITIA.

What is bakuchiol?

Bakuchiol is a phenolic meroterpene compound derived from the plant Psoralea corylifolia (babchi). It is a plant of Asian origin, traditionally used in traditional Chinese medicine and in Ayurveda in India.

It can also be extracted from other plants such as Psoralea glandulosa, Pimelea drupaceae, Ulmus davidiana, Otholobium pubescens and Piper longum.

In various scientific studies it has been found to have antiproliferative, anti-inflammatory, antioxidant and anti-acne properties. These effects are due to the fact that it modulates pathways similar to those activated by retinoids, and can also activate collagen synthesis and enzymes involved in the synthesis of extracellular matrix.

What is bakuchiol used for?

Bakuchiol is used in numerous cosmetic products for its role in preventing and improving signs of skin aging. Its effects have been found to be very similar to those of retinol/retinoic acid, although not at the molecular level.

Various studies have shown that it may be involved in collagen synthesis, barrier function and angiogenesis. Clinically, it has been shown to reduce fine wrinkles and improve skin firmness and quality after 3 months of use.

A recent study published in the British Journal of Dermatology showed that the effects of bakuchiol are comparable to those of retinol in terms of anti-aging improvement.

In general, bakuchiol is used twice a day, unlike retinol, which we recommend as a single daily application, preferably in the evening.

Is bakuchiol safe?

Currently, the demonstrated safety of bakuchiol makes it a good alternative to retinoids in certain circumstances.

We know that retinoids cause irritation when first used and may not even be tolerated in reactive skin. In the study mentioned above, it was found that people who used bakuchiol instead of retinol experienced less burning and peeling after the first application. Therefore, in sensitive skin, it can serve as an anti-aging routine when our tolerance to retinoids is not good.

In addition, unlike retinol, bakuchiol does not increase sensitivity to the sun, so it can be used safely both day and night.

In conclusion…

Bakuchiol is positioned as a promising alternative to retinol, offering similar results with fewer side effects. Ideal for sensitive skin or for those who wish to avoid traditional retinoids.

The post What is bakuchiol? first appeared on Dra. LOREA BAGAZGOITIA.

What is perioral dermatitis?

It is an inflammatory skin disease.

It is characterized by pimples of various sizes located around the mouth or nostrils (in some cases we can even see it around the eyes).

These pimples cause a sensation of discomfort and burning.

It is more common in women than in men, usually between the ages of 16 and 45. Although it is less common, children can also suffer from it (the average age is around 6 years).

Why does perioral dermatitis occur?

As with so many things in dermatology, we do not know the exact cause of an outbreak of perioral dermatitis. However, there are certain factors that are often associated:

• Irritating factors: creams, cosmetics… in this pandemic, the use of the mask, which constantly rubs the area, has undoubtedly had an effect.
• The previous use of topical corticosteroids. It is not known exactly what the mechanism is, but it is true that it is often seen after they have been used as a treatment. It is typical that it improves with corticosteroids, but the flare is much more severe after they are stopped.
• No association has been found with atopic dermatitis, allergies or infections.
• Stress, the phase of the menstrual cycle or the use of contraceptives may influence its development.

How is perioral dermatitis diagnosed?

Dermatologists usually make the diagnosis based on clinical data and a simple examination. In many cases it is possible to make the diagnosis through an online dermatological consultation and very rarely it may be necessary to perform a biopsy.

It is important to distinguish perioral dermatitis from other conditions that also characteristically present in the form of pimples in this area: outbreaks of atopic dermatitis, contact eczema, seborrheic dermatitis, impetigo, adult female acne, or rosacea.

How is perioral dermatitis treated?

It is important to eliminate the two best known causative factors: topical corticosteroids (if they were being used) and possible irritating factors (avoid cosmetics in the area, in the current situation avoiding the use of masks is not easy …).

From there, to accelerate healing we use medical treatments:

• Calcineurin inhibitors in cream:
• Antibiotics:
  • Topical: Erythromycin or metronidazole.
  • Oral: tetracyclines or erythromycin.

In general, perioral dermatitis is a “fickle” disease. It is often adequately cured with these treatments, but it is not uncommon for new outbreaks to occur, even years after it first appeared.

Have you had symptoms of perioral dermatitis?

The post Pimples around the mouth and nose: perioral dermatitis first appeared on Dra. LOREA BAGAZGOITIA.

Have you heard about scabies recently? In this article I will review the most important characteristics of this disease, which is not so uncommon nowadays.

What is scabies?

It is a disease characterized by intense itching, especially at night. It is accompanied by pimples, typically on the hands and feet, armpits, chest, genital area and buttocks. If not diagnosed in time, it can spread to the whole body.

The pimples may start as small vesicles with fluid that burst when scratched. It is very characteristic that some of them have the shape of a linear path of a few millimeters, you will read later why ;)

They rarely appear on the face, except in young children.

In this link you can see pictures of scabies.

The disease is acquired through close skin-to-skin contact (including sexual contact) with someone who has the disease. It can also be transmitted through casual contact and fomites (bedding, pillows, etc.), but this is less common. It is not uncommon for people living in the same house to have the disease at the same time.

Why does scabies appear?

The infestation is caused by the sarcoptes scabiei mite, which measures approximately 0.3 mm (females are larger than males).

It produces a proteolytic enzyme that allows it to penetrate the most superficial layer of the skin, crawl through it, lay its eggs and reproduce. Hence the linear appearance we sometimes see, called an acarine burrow.

The body reacts to this “foreign presence” with a very itchy reaction.

Sarcoptes scabiei can live outside the skin for 24-36 hours, which is why it can sometimes be spread through sheets, pillows, or other fomites shared with a sick person.

How is scabies diagnosed?

The most accurate diagnosis is made by scraping scales from one of the pimples (usually on the hands) and examining it under a microscope to find the mite, its eggs, or its feces. There are other diseases that also cause skin rashes that we need to differentiate from.

However, in most cases where we do not have a microscope, the typical characteristics of the disease mentioned above help us to make the diagnosis. If we also use a dermatoscope, the diagnosis is usually easier because we can observe the sarcoptes with it. It is rare that we need to take a biopsy.

How is scabies treated?

It is important to treat the diagnosed person, as well as those who live with him/her. At the same time, to avoid relapses, hygiene protocols should be followed to eliminate the mite from the environment.

How to remove the s.scabiei?

Permethrin 5% cream is used as a treatment, which is applied to the entire surface of the skin (including the head in young children) and left on overnight. It is washed off in the morning. Another oral treatment is ivermectin.

Both treatments must be prescribed by a doctor and are repeated every week to prevent recurrence of sarcoptes that have not hatched from their eggs.

It is important to note that treatment will improve itching in the first few days after treatment, but some itching may persist for up to four weeks.

Treating scabies is a real challenge in many cases, as recurrence within the same family is not uncommon. In this article I will talk about how to cure scabies (in Spanish).

How do I prevent reinfestation?

The treatment of scabies requires an important cleaning ritual at home.

All clothing, sheets, towels, and shoes used during the illness should be washed at 60°. Delicate clothing or shoes that cannot be washed should be placed in sealed plastic bags for 5 days.

The post Pimples that itch at night:scabies first appeared on Dra. LOREA BAGAZGOITIA.