Leading dermatologist discusses symptoms and treatments

New Hyde Park, New York, September 2008 – Along with the change of any season and as we move indoors, in come some of those pesky annoyances such as the little bugs and their bites that irritate more than our nerves. Most insect bites cause a stinging sensation along with itching and mild swelling that disappears within a day or two.  But experiencing soreness, redness, swelling and warmth beyond the immediate bug bite, or pus are warning signs that a bug bite may be infected and you should see a doctor.

“If you scratch these bites, you could break the skin, which can lead to an infection and possibly scarring.”, notes Dr. Joshua Fox, founder of Advanced Dermatology and a spokesman for the American Academy of Dermatology. To reduce itching, prior to seeing the doctor, Dr Fox advises to

1.  Apply a hydrocortisone cream(0.5 percent or 1 percent), calamine lotion, Aveeno powder, or a baking soda paste (3 teaspoons baking soda to 1 teaspoon water) to the bite several times a day until symptoms subside.

2. A cold pack or baggie filled with ice can help reduce swelling and itching too.

3.  For stronger bug bite reactions, Dr. Fox recommends taking an antihistamine containing diphenhydramine (Benadryl, Tylenol Severe Allergy), chlorpheniramine maleate (Chlor-Trimeton, Actifed) or loratadine (Claritin) to reduce the body’s response and itch.

4.  Also, products with camphor and menthol often alleviate the severe itching.

“If a bite site develops a rash, or if you experience a fever, headache, joint pain, dizziness, fatigue, nausea or vomiting following a bug bite, it is important to consult a physician immediately,” says Dr. Fox. “Although rare, you can get a serious reaction to bug bites, which can result in swelling in your throat, significant hives and wheezing to arthritis and heart problems – all of which require immediate medical attention.”

Learn more about West Nile Virus

West Nile Virus is spread by the bite of an infected mosquito.  Mosquitoes become infected with the virus from biting infected birds, natural hosts of West Nile. About 80 percent of the people who are infected with West Nile Virus show no symptoms.  Up to 20 percent of the people who become infected have symptoms such as fever, headache, fatigue, body aches, nausea, vomiting, and sometimes swollen lymph glands or a skin rash on the chest, stomach and back. Symptoms can last for as short as a few days, though even otherwise healthy people have become sick for several weeks. People with West Nile fever recover on their own, though symptoms can be relieved through various treatments (such as medication for headache and body aches) — seeing a doctor is recommended.

What to do if you get a deer tick bite

If you get a deer tick bite, remove the entire tick from the bite and avoid squeezing the tick.  Use fine point tweezers to grasp the tick near its head or mouth and then pull gently to remove the whole tick without crushing it or leaving a piece of the tick in the skin.  It is often helpful to save the tick in a plastic bag (noting the date it was removed) in case you need to visit a doctor. After the tick is removed, wash the bite site with soap and water, or an antiseptic. The person who removed the tick should wash their hands thoroughly. Dr. Fox points out that ticks often hide in warm, moist places, such as the groin, armpits, the back of the neck, navel, ears and scalp.  He has pulled out multiple ticks which have even masqueraded as skin growths – including one on his own daughter.

If you see an expanding circle or circles of redness about two inches in diameter that radiates out from the bug bite, it could be a sign of Lyme disease and the bite needs to be evaluated by a doctor.  Lyme disease is an infection caused when a person is bitten by a deer tick that is infected with B. burgdorferi bacteria. About 80 percent of individuals with Lyme disease will develop a rash that looks like a bull’s–eye near the bite. The rash is often accompanied by flu-like symptoms such as fever or headache, nausea and vomiting. “Some people may only develop flu-like symptoms and not a rash but still have Lyme disease,” Dr. Fox advises.  “Treatment with antibiotics is necessary to fight the infection and prevent more serious, heart or arthritic symptoms.”

Dr. Fox recommends using insect repellents on the intact skin and clothing to be more completely protected against bug bites. Repellents containing permethrin should be applied only to clothing, where the agent has a residual effect through several wash cycles, providing lasting protection against bugs. Insect repellent containing 10% percent DEET should be applied directly onto the skin to ward off mosquitoes, ticks and other insects.

First aid for spider bites

If you are bitten by a jumping spider (the most common biting spider in the United States) or a brown recluse spider it is important to immediately see a doctor.  You can identify a brown recluse spider by violin shaped marking on its top. The brown recluse spider bite has cytotoxic venom which causes severe pain or burning accompanied by local redness and itching. The wound may take on a bull’s-eye appearance, with a center blister surrounded by a red ring and then a blanched (white) ring.  A fluid-filled blister forms at the site and then sloughs off to leave a deep, enlarging ulcer that scabs over. Other symptoms from a brown recluse spider bite are: fever, chills, nausea, vomiting, listlessness and muscle aches.

The bite from a jumping spider is painful and itchy — the site becomes red and there is significant swelling. Symptoms can include painful muscles and joints, headaches, fever, chills, nausea and vomiting which may last from one to four days.  “It’s important to stay as motionless as possible to prevent the venom from spreading and if the spider bite site is at an arm or leg, it should be elevated to reduce swelling,” says

Dr. Fox. “Wash the wound with cool water and mild soap and then apply ice to decrease the pain and swelling.  Use acetaminophen for pain relief and antihistamines such as Benadryl can be taken for itching and swelling.”

How to treat bedbug bites

A bedbug is a small (about the size of a pencil eraser), flat, reddish-brown bug that feeds on human and animal blood.  Bedbugs are active at night and bite any areas of exposed skin.  The bite feels itchy and looks like little red bumps (similar to mosquito bites) which often occur in a line on the body. “Wash the bites with soap and water and use calamine lotion or a topical corticosteroid cream to help with the itching,” says Dr. Fox.  “Bedbugs pose very little health risk for infection and minimal risk for other diseases.”  They often present with three adjacent red bumps on an exposed extremity after getting a “new mattress”.



SEEKING THAT SUMMER GLOW YEAR ROUND? SKIP THE SUN AND TANNING BED FOR A “SPRAY TAN”: Leading dermatologist discusses the newest – and safest – way to achieve sunkissed skin sans the risks

Advanced Dermatology, September 2008 – Ever since Coco Chanel returned from a French yachting voyage with a suntan in 1920, women, men, and even young teens have revered tanned skin as a sign of beauty and good health. Yet, the truth about skin that is exposed to the sun’s harmful UVA and UVB rays is just the opposite. Sun-damaged skin is prone to premature aging, causing wrinkles, uneven skin tone, enlarged pores and age spots. What’s more, UV exposure is the leading cause of skin cancer, which strikes one million Americans each year – nearly double the number of all other cancers combined. Although many of these cancers are rarely life threatening, they all can be disfiguring if they need to be surgically removed from the face, shoulders, chest or other commonly exposed area. Melanoma, of course, is the deadliest skin cancer…and it is thought to be almost exclusively caused by sun exposure or use of tanning beds.

Fortunately, “spray-on tans” are a new alternative to “baking” on a tan that can provide a realistic, natural-looking tan without any UV exposure at all. Joshua Fox, MD, founder of Advanced Dermatology, P.C. in New York and on Long Island, and a spokesman for the American Academy of Dermatology and the American Society of Dermatologic Surgery, explains, “Based on the available research, ’spray tans’ are a safe alternative to any UV-based tanning process, because they color the skin using an FDA-approved compound called DHA that simply tints the dead skin cells at the very top layer of the epidermis.” While a ‘spray tan’ does not actually fade, Dr. Fox points out, “it will disappear as the layer of skin is sloughed off – usually within a week.”

Getting the word out remains a challenge

“Despite the fact that ‘spray tans’ provide all the aesthetic benefits of a suntan without the serious dangers,” Dr. Fox notes, “recent research suggests that many sun-worshippers and tanning bed fans are still not getting the message.” For example, a study completed at Northwestern University and published in the April edition of Archives of Dermatology analyzed the knowledge, attitudes and behavior of young adults regarding indoor tanning over the course of 12 years. Researchers found that, between 1994 to 2007, the percentage of participants who knew that limiting tanning can help prevent melanoma actually decreased from 77% to 67% — a factor that coincided with an increase in the number of subjects who thought “having a tan looks better,” from 69% in 1994 to 81% in 2007. “Perhaps the most surprising statistic of all is that tanning bed use has remained at around 26-27% between 1994 and 2007, despite the fact that we learned during this time period just how dangerous these tanning beds can be,” Dr. Fox says.

In another recent study, researchers at Boston University Medical Center found that 44% of young adults surveyed had either used sunless tanning products like a ‘spray tan’ over the preceding 12 months or had planned to use them over the following 12 months. Unfortunately, these self-tanners were also more likely to use a tanning bed than those who had not used the sunless method. “There are certainly misconceptions and myths that still exist about the use of tanning beds, including the notion that the UVA rays in these machines are ‘healthier’ than UVB rays, but this is simply not the case,” Dr. Fox says. “In fact, UVA rays have been shown to penetrate more deeply than UVB rays, which are the main culprits in a ‘surface’ sunburn,” he adds.  UVA also promotes skin cancer, wrinkling and other bad effects on the skin.

A ‘spray tan’ can either be applied at home by oneself or can be applied in a booth in a salon by trained personnel, to ensure even coverage. There are many choices of spray-on products so one should try to match the color.  At a salon, the cost is usually between $25 and $40 per application, and the effects last about a week. After application, the tanning substance stays on the skin for about four hours before it can be showered off. While the compound itself is deemed safe, Dr. Fox offers two caveats: “’Spray tan’ participants should avoid inhaling the compound during application, and always remember that a ‘spray tan’ does not offer any significant protection at all from the harmful rays of the sun. In fact, DHA may make skin more sensitive and susceptible to UV damage – so a broad-spectrum sunscreen with an SPF of 30 is a must.”  But the DHA product itself – without sun exposure – is safe and recommended if used to avoid tanning.  Dr. Fox also recommends supplementing your diet with Vitamin D pills since you may not be getting enough supply from the sun.