Spotty annoyances

By JUDY SIEGEL-ITZKOVICH
Hands with sun spots (photo credit: INGIMAGE)
Hands with sun spots
(photo credit: INGIMAGE)
Veteran Jerusalem dermatologist Dr. Julian Schamroth comments: Liver spots are pigmented patches that commonly appear on the skin of people over the age of 50. They have nothing to do with liver disease, but they get their name from the fact that the patches are the same color as liver. They are also known as solar lentigines, as they occur predominantly on sun-exposed areas, mostly the arms and face. They are harmless, do not turn into cancer and are not associated with any underlying disease. Their main problem is cosmetic.
Several treatments are available, including freezing with liquid nitrogen (cryotherapy), removing the outermost layer of the skin (dermabrasion) and topical treatment with creams containing retinoids or alpha-hydroxy acids. Unfortunately, there is a poor response to all these forms of treatment, and even where therapy is successful, the patches tend to recur fairly rapidly. Daily, long-term application of sun-blocking creams is probably the most effective therapy, but even so, these creams do not remove the patches, but only make them lighter.
I have heard of several home remedies, including applying lemon juice, or rubbing on garlic or household bleach. However, I do not recommend any of these, as they may damage the skin or cause allergies.
Lastly, it is very important that any brown patch be seen by a dermatologist, since there are some patches that look very much like liver spots but are, in fact, precancerous.
My nine-year-old son has sensitive skin. Often, usually in the winter but sometimes in hot weather as well, he gets a bumpy red rash around his mouth.
His doctor said it was probably due to perioral dermatitis and would go away, but it hasn’t. What can we do to get rid of it? A.N., Rishon Lezion Clalit Health Services pediatrician Dr. Shmuel Gur replies: Perioral dermatitis is a facial rash that tends to occur around the mouth or near the nose, especially in winter. Small children and babies are usually the ones to suffer from it, but it occurs in older children and adults as well. The rash is usually red and slightly scaly or bumpy, and any burning feeling or itching is usually mild. It can return periodically over a period of months or even years. A common skin problem, it usually can be eliminated with proper treatment.
Cold temperatures and dryness can trigger it. Children tend to lick their lips to cope with the dryness, but this can cause the condition. Other common factors include prolonged use of topical steroid creams and prescription steroid sprays used in the nose and the mouth. Allergies to milk, fruit, vegetables or other foods may be a factor. Overuse of heavy face creams and moisturizers are another common cause, while skin irritations and fluorinated toothpastes may also be involved.
A dermatologist usually diagnoses perioral dermatitis solely by examining the skin. The first step in treating perioral dermatitis is to discontinue all topical steroid creams, even nonprescription hydrocortisone.
Heavy face creams should also be stopped.
Once the steroid cream is discontinued, the rash appears and feels worse for days to weeks before it starts to improve. One must resist the temptation to apply any of these creams to the face when this happens.
A mild soap or soap substitute should be used for washing; avoid scrubbing the area. Try using non-fluoridated instead of fluoridated toothpaste for a while.
The most reliably effective treatment is oral antibiotics, prescribed in decreasing doses for three to 12 weeks. Topical antibacterial creams and lotions may also be used for faster relief. These can be continued for several months to prevent recurrences.
Even after successful treatment, perioral dermatitis sometimes returns. Usually, giving the same type of treatment again will be effective.
Rx for Readers welcomes queries from readers about medical problems. Experts will answer those we find most interesting. Write Rx for Readers, The Jerusalem Post, POB 81, Jerusalem 9100002, fax your question to Judy Siegel-Itzkovich at (02) 538-9527, or email it to jsiegel@jpost.com, giving your initials, age and place of residence.