American Medical Association Family Medical Guide - American Medical Association [765]
If more treatment is needed, your doctor will prescribe an anti-inflammatory medication such as chloroquine or dapsone. A topical corticosteroid cream can help reduce inflammation and improve the appearance of the rash; however, long-term use of corticosteroids is not recommended because they can thin the skin and the symptoms recur when the medication is stopped.
Vitiligo
Vitiligo is a common disorder in which patches of skin lose their color (pigment), usually on the face and hands (see page 118) and in the armpits and groin. The condition seems to be an autoimmune disorder in which the immune system mistakenly attacks the pigment-producing cells in the skin. The loss of pigmentation is especially obvious in people who have dark skin. The condition may occur in cycles and then stop altogether.
Symptoms
In vitiligo, the irregular, unpigmented patches of skin often appear symmetrically on both sides of the body. The patches may grow, shrink, or stay the same size and, because they lack protective pigment, are especially sensitive to sunlight. In severe cases, the condition affects the whole body.
Diagnosis and Treatment
A doctor can usually diagnose vitiligo by its appearance. He or she may order a skin biopsy to rule out other disorders.
There is no cure for vitiligo. In rare cases, pigment returns to the skin. Makeup, self-tanners, dyes that color the skin, or tattooing small areas of skin with a skin-colored pigment can darken the lighter areas. It is important to protect these nonpigmented areas from sunburn (see page 1067) with a sunblock that has an SPF of at least 15. Topical corticosteroid medications or phototherapy (light therapy) can help temporarily return pigment to small areas. To even out their skin tone, some people choose to have the remaining pigment permanently removed from their skin with a chemical. In rare cases, skin grafts (transferring skin from one part of the body to another) are done, but they seldom result in a total return of pigment.
Tinea Infections
Tinea is a fungus that can infect the skin, hair, or nails. As the fungus grows, it spreads out in a circle, leaving normal-looking skin in the middle that makes the growth look like a ring. The skin at the edge of the ring is lifted up slightly and looks red and scaly. Because the infection can look like a worm under the skin, it is sometimes referred to as ringworm. On the feet, a tinea infection is called athlete’s foot; in the genital area or groin, it is called jock itch. The fungus can spread easily from person to person by direct contact or in showers, bathrooms, or locker rooms, and can be transmitted to people from cats, dogs, or farm animals.
Athlete’s foot
You can get athlete’s foot (tinea pedis; see page 123) from direct contact with the fungus or contact with contaminated skin cells shed from an infected person. If the fungus spreads to the toenails, it makes them thick and crumbly. The fungus also can spread from the feet to the hands and fingernails.
Jock itch
When the tinea fungus grows in the genital area, usually in men, it is called jock itch (tinea cruris). The infection is especially common in athletes who wear elastic shorts or athletic supporters, which can make the groin area moist and warm (conditions favorable for fungus to grow).
Ringworm
Ringworm (tinea capitis) usually develops on the head and is most common in children. The fungus destroys the hair, leaving bald patches (see pages 123 and 1075).
Symptoms
In athlete’s foot, the skin becomes red, flaky, and itchy. If the skin is moist (from water or perspiration), the top layer of skin becomes soggy and whitish. In jock itch, scaly, itchy patches of skin appear on the upper and inner thigh. Ringworm produces itchy, red areas on the scalp.
Diagnosis
Tinea infections can usually be diagnosed by their appearance. To