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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WHAT IS PITYRIASIS VERSICOLOR?

Pityriasis versicolor appears as spots that do not itch or hurt, usually located on the trunk or arms, although they can also appear on the face or body folds. It is more common in adolescents and young adults.

The name “versicolor” comes from the fact that these spots can be different colors: pink, brownish, or white. These spots may be scattered or may join together to form larger spots. When you scratch the spots with your fingernail, you may see a white flake come off. Here you can see images of pityriasis versicolor.

It does not normally cause discomfort, although some people report slight itching.

Pityriasis versicolor is much more common in tropical areas than in northern regions. In our environment, it is most frequently seen during the summer months.

WHY DOES IT APPEAR?

Pityriasis versicolor is caused by fungi of the Malassezia genus, which is saprophytic flora on human skin (this means that it lives normally on our skin and needs the fats in it to survive). Due to factors that are not very clear (sweating, skin sebum composition), in some people Malassezia proliferates and forms these spots.

During the summer, it prevents the area where it is located from pigmenting, which is why white spots that are lighter than healthy skin are usually seen, while in winter (when there is no sun exposure) they are usually pink or orange, darker than normal skin.

In summer, white spots are usually seen, while in winter they are reddish or brownish.

There are other skin conditions that can resemble pityriasis versicolor, so it is a good idea to consult a doctor (consulting a dermatologist online is a good option) to confirm the diagnosis.

HOW IS IT TREATED?

The treatment for pityriasis versicolor is simple. In most cases, it is sufficient to apply a cream, spray, or gel to the spots for a few days. These products contain antifungals (antibiotic for fungi such as ketoconazole, terbinafine, ciclopirox, selenium sulfide) that eliminate them from the skin’s surface. In rare cases where the spots are very extensive or there is no improvement with creams, gels, or sprays, the same drugs can be taken orally. To assess which treatment is best in each case, it is advisable to see a dermatologist.

Treatment is simple, but the spots may persist for weeks or months after treatment is completed.

It is important to know that in most cases, the spots do not disappear immediately after treatment. It is normal (especially in the case of white spots) for them to last for weeks or months after treatment. This is how long it takes for the skin to regain its normal pigmentation, but we must know that the process is cured and exercise patience until everything returns to normal.

ARE THERE ANY PRECAUTIONS TO TAKE?

Contrary to popular belief, pityriasis versicolor is not contagious.

People who are particularly prone to pityriasis versicolor can apply the treatment preventively every month or every two weeks to prevent it from appearing so frequently.

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What is a skin biopsy?

A biopsy involves taking a small piece of skin so that it can be studied by pathologists. They examine this skin under a microscope and extract more information from it than we can obtain with the naked eye during a clinical examination.

A biopsy involves removing a small piece of skin for analysis under a microscope.

The pathologist’s report will clear up any doubts in many cases, and in others it will provide us with information that complements what we dermatologists obtain during the consultation, so that by combining both sources it is easier to reach an accurate diagnosis.

When is a skin biopsy performed?

Many skin diseases can be diagnosed with the naked eye (psoriasis, acne, dermatitis, rosacea, etc.), but there are times when we may not be sure what we are dealing with. The same can happen with some moles or lumps on the skin. We recommend a biopsy in these cases, where information from pathological anatomy can be key.

How is a skin biopsy performed?

A skin biopsy is a simple procedure that is often performed in the doctor’s office. Here are the steps involved:

1. To perform a skin biopsy, we anesthetize the area we want to study so that the procedure is not painful. This is done by giving a small injection in the area, usually with a fine needle that causes slight discomfort when it pricks the skin. A small amount of anesthetic is injected, which may cause a burning, stinging, or slight pain sensation. This lasts only a few seconds, as the anesthetic takes effect relatively quickly and the area of skin becomes numb.

   

2. Once the skin has been anesthetized, we take the small piece of skin. This is usually done with an instrument called a “punch,” which allows us to extract a perfect cylinder of skin between 3-6 mm, depending on the case. Sometimes the piece of skin is simply cut out with a scalpel.

   

3. The wound is usually closed with one or more stitches. Sometimes, if the biopsy is small, stitches may not be necessary.

   

What precautions should be taken after the biopsy?

In the days following the procedure, you should take care of the wound and avoid sudden movements to prevent it from opening up. The wound can get wet, so you can shower as normal, and your dermatologist may recommend applying an antiseptic or antibiotic to the area.

The stitches are usually removed between 5 and 15 days after the biopsy. Your dermatologist will tell you the exact time frame, as it depends on the area of the body where the biopsy was performed and your specific case.

What complications can a skin biopsy have?

Complications from a skin biopsy are very rare. In any case, before the biopsy, it is important for the dermatologist to know if you have any allergies and what medications you are taking.

Like any wound, a wound caused by a skin biopsy has the potential to become infected. This does not normally occur if we follow the instructions and aftercare properly.

Infection or bleeding, although rare, are the most common complications following a skin biopsy.

Similarly, as with any wound, there is a (very low!) risk of bleeding in the hours following the procedure. Normally, if this occurs, the bleeding will stop simply by applying continuous pressure to the area for 15 minutes.

In rare cases, the stitches may open in the days following the biopsy, which is usually linked to excessive strain or stretching of the skin where the biopsy was performed.

In summary…

A skin biopsy is a simple, quick, and low-risk technique that is sometimes extremely useful to dermatologists in reaching a diagnosis and prescribing appropriate treatment.

I would like to thank my colleague and friend Sergio Vañó for the photos for this article, without which I would not have been able to clearly illustrate the biopsy process. 

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Scabies is caused by a microscopic mite that burrows under the epidermis, causing inflammation of the skin that leads to intense itching. Typically, the itching affects the body, sparing the head, and is especially intense at night. I wrote about it some time ago in this article.

It is transmitted through close skin-to-skin contact, usually between cohabitants or sexual partners.

Scabies can be confused with other skin diseases that can also cause severe itching. This is not uncommon, as many professionals are not used to seeing this disease on a regular basis. However, it is worth considering in any case of sudden skin lesions.

What is happening with scabies?

As I was saying, we are seeing more cases of scabies than usual in our clinics. We are also struck by the fact that in many cases the treatment is not always effective, even though the method is well established in the guidelines.

Given this situation, the scientific community is considering two options:

1. That the mite is developing resistance to the drugs we have available, in the same way that many bacteria do to widely used antibiotics. There are already some cases of resistance in other mites (such as lice) to permethrin, and therefore it is thought that sarcoptes (the cause of scabies) could develop this mechanism.
2. The patient is not following the treatment properly.

Undoubtedly, we must bear in mind the first option, which is possible. However, the second option is most likely the reason why treatment is unsuccessful in many cases.

Why is the treatment not being carried out properly?

The characteristics of the disease make it difficult to treat correctly.

On the one hand, because it is easy for several people within the same household to suffer from it. On the other hand, because treatments must be repeated weekly, and this is not done in all cases. Topical treatments (permethrin) must also be applied meticulously, and this does not always happen.

In addition to all this, it is necessary to eliminate the mite from the living environment. If this is not done effectively, there will always be a certain risk of reinfestation.

Tips for effective treatment of scabies

1-Follow the guidelines given by your doctor.

You may have been prescribed oral treatment (ivermectin) or topical treatment (permethrin). In the case of permethrin, it is important to follow these tips: you must use the cream for a minimum of 8 hours (some sources indicate that 12 hours is better). Spread it over all areas of your body from the neck to the feet. Pay special attention to all folds, including between the fingers and around the nails. If you find that you do not have enough to cover your entire body, talk to your doctor. Otherwise, the treatment will not be effective. Wash it off in the shower and apply plenty of moisturizer to minimize skin irritation.

2-Repeat the treatment after 7-14 days.

This is important due to the life cycle of the sarcoptes scabiei mite. It is possible that at the time of the first treatment, the mite has laid its eggs and these will hatch in the following days. Repeating the treatment will eliminate the mites born from those eggs.

3-Eliminate the mite from your environment

On the same night as the first treatment, it is essential to wash previously worn clothing at a minimum temperature of 50º. This can be replaced by putting the clothes in the dryer. Shoes and delicate garments, as well as cushions, can be placed in plastic bags and left closed for at least 5 days (this will suffocate the mites). It is also advisable to vacuum large cushions, mattresses, and sofas.

4-Inform your household members and close/sexual contacts.

All members of a household must be treated, as well as other close contacts such as partners or sexual contacts. Treatment must be simultaneous. Otherwise, a “ping pong effect” may occur, in which some members of the same household are reinfected by those who have not yet been treated.

Have you followed your treatment properly?

The post How to cure scabies first appeared on Dra. LOREA BAGAZGOITIA.

What is a salmon patch?

These are pink spots (single or multiple) with irregular outlines that appear on the forehead, eyelids, between the eyebrows, nape of the neck, or neck of babies. These spots are usually present from birth in 4 out of 10 newborns. Their color becomes more intense and the spots become more noticeable as the baby grows.

The salmon patch is present in 40% of newborns and usually becomes more noticeable when they cry.

Those located on the back of the neck and nape of the neck are often called “stork bites,” while those that appear on the bridge of the nose, between the eyebrows, or on the eyelids are called “angel kisses.”

Are salmon patches dangerous?

The exact cause of these spots is unknown, but it is known that, except in very rare cases, they are benign lesions and do not indicate any internal disease in the baby. They are not contagious and do not pose a risk of becoming malignant.

How are salmon patches diagnosed?

It is advisable to see a dermatologist or pediatrician to confirm the diagnosis, as salmon patches can be confused with other skin lesions such as other types of capillary malformations or hemangiomas. The diagnosis is simple to make and a clinical examination is usually sufficient.

How are salmon patches treated?

Salmon patches do not require any treatment. Those on the face (“angel kiss”) disappear on their own during the first or second year of life. Those on the back of the neck (“stork bite”) tend to last longer and are usually hidden by hair as it grows, persisting into adulthood.

The salmon patch on the face disappears, while those on the back of the neck usually remain until adulthood.

The post Pink spots on babies first appeared on Dra. LOREA BAGAZGOITIA.

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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The reality is that antihistamines are safe medications with very few adverse effects and can be used with confidence if necessary. The question is whether they should be used in people with atopic dermatitis.

Surely your pediatrician or doctor has prescribed them to you “for the itching” at some point, and yes, they may have provided some relief… but have you seen any improvement in the areas of dermatitis? Have you seen the redness and flaking disappear? Is the relief really that great? If it is the inflammation of the skin that causes the itching and antihistamines do not seem to improve it, do you think there is any point in taking them?

Let’s see what the scientific evidence says about this.

How do antihistamine pills work?

As their name suggests, these compounds block histamine receptors, which cause allergies, hives, and some types of itching in our bodies. Specifically, type 1 antihistamines are used for these conditions, as type 2 antihistamines are usually used for digestive conditions that have nothing to do with what we are talking about.

There are two types of type 1 antihistamines:

• Sedatives: these are drugs that are able to cross the blood-brain barrier, reach the brain, and have a mild sedative effect. They make us sleepy. Examples of this type include Polaramine® and Atarax®.
• Non-sedatives: these are the most commonly used, especially for seasonal allergies, as they do not cross the blood-brain barrier and therefore do not cause drowsiness. Other antihistamines you may be familiar with belong to this type: loratadine, desloratadine, cetirizine, ebastine, bilastine, etc.

  

Are antihistamines commonly used?

A recent publication by the JAAD revealed that 22% of patients with atopic dermatitis who visited a dermatologist in the US were prescribed an antihistamine, usually of the sedative type. Pediatricians also prescribe this type of antihistamine in 16% of cases. However, non-dermatologist specialists prescribe non-sedating antihistamines in approximately one in three patients.

I believe that these data may reflect what is happening in our country as well.

Are antihistamines effective for the itching associated with atopic dermatitis?

The reality is that numerous scientific studies, reviewed by the Cochrane Library, show that antihistamines do not actually reduce itching in atopic dermatitis. Of course, they are not useful for improving eczema.

It is known that in many cases, people with atopic dermatitis take them because they relieve other symptoms also related to atopy, such as allergic rhinitis, conjunctivitis, or food allergies.

Just because they are prescribed does not mean they are effective. In many cases, we give them with the idea that, as sedatives, they can help you fall asleep and have a better night’s sleep by “masking” the itching. However, it has been found that these medications can worsen sleep quality by shortening REM sleep. Not only that, but if their effect persists in the morning (which it often does), they can interfere with learning ability and memory.

So what are the recommendations?

You know that the star treatment for atopic dermatitis is topical corticosteroids. In some cases, we also resort to calcineurin inhibitors. And it is on these two pillars that we must focus the treatment of atopic dermatitis in children and adults to control outbreaks. Obviously, all this must be accompanied by appropriate care and moisturizing measures, which I already mentioned in another article.

I’m not the only one saying this; the American Academy of Dermatology advises against the use of antihistamines exclusively to control the itching of atopic dermatitis. They can, of course, be used in people who, in addition to their dermatitis, suffer from another condition that clearly improves with these medications (rhinitis, conjunctivitis, etc.).

I hope this article has answered your questions about antihistamines.

Do you usually use them for your dermatitis or your child’s? Do you find them useful?

If you have any further personal questions, I can help you through the online consultation.

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ANDROGENETIC ALOPECIA IN MEN

It is the most common form of baldness in men. Fifty percent of men have some degree of androgenetic alopecia by the age of 50, although it can begin as early as adolescence.
The factors involved in its development are male hormones and genetics. Androgenetic alopecia is more common in people with a family history of baldness. However, it is estimated that 15% of men will never develop it.

ANDROGENETIC ALOPECIA IN WOMEN

Androgenetic alopecia, also known as female pattern hair loss, is not uncommon. In the US, it affects 19% of white women. It frequently affects the crown and upper scalp, differing from androgenetic alopecia in men in that the hairline (the hairline on the forehead) is not lost and total hair loss is rarely seen.
It is more common in postmenopausal women, although it can begin as early as puberty.
The relationship with male hormones (androgens) is unclear, as many women with androgenetic alopecia do not have elevated levels of these hormones. There is also a certain genetic influence.

 But HOW DOES THIS HAPPEN?

What underlies both types of androgenetic alopecia is what is known as “hair follicle miniaturization.” Let me explain: hair in people with androgenetic alopecia falls out just like it does in people without it. In people without this problem, the hair that has fallen out grows back with the same strength and thickness as its “predecessor.” However, in people with androgenetic alopecia, the hair grows back a little finer and more fragile than in its previous “life.” It grows back over months or years and falls out again. In the next cycle, it will be a little finer, and so on, until it becomes almost imperceptible or disappears.

Androgenetic alopecia cannot be cured, but there are treatments available to prevent it from progressing.

The harsh reality of androgenetic alopecia is that it cannot be cured, and it is difficult to regrow hair that has already been lost. There is no such thing as hair growth products :(. The good news is that there are treatments that help prevent it and stop it from progressing, as well as cosmetic or surgical solutions to address reduced hair density. I will discuss all of this in other posts, which need to be paced out… :)

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While it is normal to lose up to 100 hairs a day, during telogen effluvium, the loss is greater.

Normally, up to 100 hairs are lost per day.

Despite the dramatic appearance, the good news is that hair lost as a result of telogen effluvium recovers over the months following the episode. No specific treatment is necessary. Time simply heals it.

It is important to differentiate telogen effluvium from other types of diseases that cause hair loss, such as androgenetic alopecia, alopecia areata, nutritional deficiencies, or systemic diseases, so it may be necessary to consult a dermatologist.

The post What is a telogen effluvium? first appeared on Dra. LOREA BAGAZGOITIA.

We are not sure of the exact cause of this worsening, but hormonal changes during pregnancy undoubtedly play a significant role. Some studies indicate that the worsening is greater in the third trimester, as a result of increased androgens, while other studies found that acne was more severe mainly in the first trimester.

Whatever the situation, whether you didn’t have acne before pregnancy and it has appeared, or you already suffered from it and it has worsened, it’s normal to try to find a solution. The problem arises when, during pregnancy, it is impossible to use the most effective treatments for acne in adult women: retinoids (either in cream form, such as adapalene or retinoic acid, or orally, such as isotretinoin) and antiandrogens (contraceptives, spironolactone).

Despite this, there are certain options that we can use during pregnancy to control acne. I’ll tell you about them below.

What topical treatments can be used for acne during pregnancy?

AZELAIC ACID:

Marketed at 15 or 20%, this product has an effect on pimples (keratolytic, cleanses pores), is antibacterial and anti-inflammatory, and also slows down skin pigmentation, which can help prevent spots on the face as a result of pimples, especially if you have dark skin.

Azelaic acid may cause slight irritation when first used, but the skin gradually becomes accustomed to it.

BENZOYL PEROXIDE:

When applied topically, it has antibacterial, comedolytic, and anti-inflammatory effects. It has a “bleaching” effect on fabrics, discoloring them, so be very careful after using it (wash your hands and use a white pillowcase).

Some time ago, I wrote an article about benzoyl peroxide (in Spanish) where you can learn more about it.

ANTIBIOTICS:

The most commonly used are erythromycin and clindamycin. Both are suitable for use during pregnancy, but are not recommended for prolonged periods of time in order to avoid the development of bacterial resistance.

It has been shown that combined use with benzoyl peroxide helps reduce the risk of resistance, so antibiotics are not recommended as the sole treatment for acne.

SALICYLIC ACID

Found in cosmetic products (gels, creams, tonics), it helps dissolve keratin in the pores, producing a comedolytic effect. It is clear that salicylic acid alone will not cure acne, but it can be useful as a supplement.

What oral treatments can be used for acne during pregnancy?

We will reserve oral treatment for acne outbreaks that are not adequately controlled with topical products and are highly inflammatory, which can result in persistent marks or scars.

ANTIBIOTICS:

For these situations, we can use antibiotics from the macrolide family (erythromycin or azithromycin) or cephalexin. Once again, in order to prevent the development of bacterial resistance, it is advisable not to prolong treatment for more than 3 months and to combine it with benzoyl peroxide. If more than one course of antibiotics is required, it is preferable to always use the same one, which also minimizes the risk of resistance.

ORAL STEROIDS:

We would only use them in very severe cases where the acne is highly inflammatory, such as acne fulminans. As I said, this is exceptional, but it is certainly good to know that we have tools available to treat severe cases with a lot of inflammation and pain.

Are you pregnant and have acne? What treatment have you used?

The post How to treat acne while pregnant? first appeared on Dra. LOREA BAGAZGOITIA.