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Posts for category: Skin News

By Dr. Maloney
July 27, 2015
Category: Skin News
Tags: bed bugs  


Bedbugs: Diagnosis, treatment, and outcome

Bedbug bites: When bedbugs bite, you often see clusters of bites. Each cluster usually contains 3 to 5 bites that appear in a zigzag pattern.

How do you know if you have bedbugs?

To find out if you have bedbugs, you need to look for two things:

  1. Bites on your body.
  2. Signs of bedbugs.

Bites on your body: If you have bedbugs, you’re likely to have bites. Bedbug bites usually cause itchy welts. These welts usually appear in a zigzag pattern as show in the photo above.

You’ll seldom see bedbugs, so many people mistakenly believe that mosquitos, fleas, or spiders bit them. Sometimes people mistake bedbug bites for a common skin condition such as an itchy rash, hives, or chickenpox.

To make sure you have bedbugs, you’ll need to look for signs of bedbugs.

How to check for bedbugs


Although bedbugs don’t usually require serious medical attention, they can cause a great deal of anxiety and restless nights. To help find bedbugs before they find you (and your belongings), dermatologists recommend looking for the following signs near places where you sleep.

Signs of bedbugs: This step is important. If you have a bedbug infestation, you need to find out so that you can get rid of the bedbugs. Getting rid of the bedbugs is the only way to stop the bites.

If you have a large number of bedbugs, you may see the bugs. Most people, however, only see signs of bedbugs. To look for signs of bedbugs, check the places that people sleep for the following:

  • A sweet, musty odor: Take a deep breath. If you notice a sweet, musty in your hotel room, cruise ship cabin, or other sleeping area, there may be a heavy bedbug infestation in the room. Bedbugs produce chemicals to help them communicate, although not everyone will notice the smell.
  • Specks of blood on bedding, mattresses, or upholstered furniture such as couches and headboards: Look carefully at your blankets, sheets, and mattress pads and then check the mattress and box spring. Are there specks of blood anywhere, especially near the seams? If so, there could be a bedbug infestation. You should also check for specks of blood on all upholstered furniture, including couches and headboards.
  • Exoskeletons: Bedbugs have an outer shell that they shed and leave behind. Do you see shell-like remains on the mattress, mattress pad, or beneath couch cushions?
  • Tiny, blackish specks: If you see blackish specks on the bedding, mattress, headboard, or beneath couch cushions, it could be bedbug excrement. 
  • Eggs: After mating, female bedbugs lay white, oval egs in cracks and crevices. Keep in mind that these will be small, as a bedbug is only about the size of an apple seed. The photo below shows a bedbug near eggs. The photo was magnified so that you can see the bedbug and eggs.

If you do get bedbugs and have many bites or a bite that looks infected, see a board-certified dermatologist. A dermatologist can treat an infection and help relieve the itch.


                bedbug with eggs

Bedbug with eggs: A bedbug is a tiny insect with broad, oval body. If it has recently eaten, it has a reddish-brown color.

If you see bedbugs, they will likely scurry toward the closest hiding place. Any dark place such as inside a mattress or even a picture frame makes a good hiding place.

As you watch bedbugs move, it can look like they are flying or jumping because they can crawl quickly. Bedbugs cannot fly or jump; they can only crawl.

If you find signs of bedbugs, call a pest-control company or your property manager. You should not use bug spray or a fogger. These products have little effect on bedbugs.

Treating bedbug bites

You should see a dermatologist for treatment if you have:

  • Many bites.
  • Blisters.
  • Skin infection (bites feel tender or ooze discharge such as pus).
  • An allergic skin reaction (skin red and swollen or hives).

Your dermatologist may prescribe the following to treat bedbug bites:

Allergic reaction: Some people may require an injection of an antihistamine, corticosteroid, or epinephrine (adrenaline) for a severe allergic reaction.

Infection: An infection may require an antibiotic. If the infection is mild, your dermatologist may recommend an antiseptic medication that you can buy without a prescription. Your dermatologist will tell you which one to use. Your dermatologist also may recommend an antiseptic to prevent a skin infection.

Itch: A prescription antihistamine pill or liquid can help. You also can apply a corticosteroid to the bites. Your dermatologist will tell you which is best for you.

Bedbugs bites can be intensely itchy, so treat the itch to prevent scratching. Scratching can cause a skin infection.

At-home treatment

If you do not have any signs of an infection or a serious reaction, you can often treat the bites at home.

To treat bedbug bites:

  • Wash the bites with soap and water. This will help prevent a skin infection and help reduce itchiness.
  • If the bites itch, apply a corticosteroid cream to the bites. You can get a weak form of this medicine without a prescription at your local drugstore. Stronger corticosteroids require a prescription.

Bedbug bites usually heal and go away within a week or two.

Learn more about bedbugs:


Leverkus M et al. “Bullous Allergic Hypersensitivity to Bedbug Bites Mediated by IgE against Salivary Nitrophorin.” J of Invest Dermatol. 2006;126:2364-2366. 

Liebold K et al. “Disseminated bullous eruption with systemic reaction caused by Cimex lectularius.”  J Euro Acad of Dermat and Vener. 2003;17:461-463.

Steen CJ, Carbonaro PA, Schwartz RA. “Arthropods in dermatology.”  J Am Acad Dermatol 2004; 50:819-42.

By J MIchael Maloney MD
February 16, 2015
Category: Skin News
Tags: measles   contagious disease  

Measles in the United States

Jill Jin, MD, MPH

JAMA. Published online February 16, 2015. doi:10.1001/jama.2015.1555

Measles is a very contagious and serious disease. It is also very preventable.

Measles is a viral illness that causes fever, rash, cough, runny nose, and reddened eyes. The vast majority of people who become ill with measles recover. But the virus can sometimes spread to the brain or lungs and cause severe illness or death. Babies, elderly people, and pregnant women have a higher risk of becoming severely ill from measles.

Measles is no longer naturally present (endemic) in the United States. But it can be brought into the country when people who are not vaccinated travel to and from other countries. The measles virus very easily spreads through the air through coughing and sneezing. Because the virus is so contagious, if there are clusters of people who are not vaccinated, an outbreak can easily occur.


The MMR vaccine, which is given as a shot (injection), protects against 3 different infections: measles, mumps, and rubella (German measles). It is both safe and effective. For preventing measles, 1 MMR dose works 93% of the time, and 2 doses work 97% of the time. The 3% of people who are fully vaccinated and still get measles often have a milder illness than those who were not vaccinated.


Currently, the US Centers for Disease Control and Prevention recommends that all children receive 2 doses of the MMR vaccine. The first dose is recommended between ages 12 and 15 months and the second dose is recommended between ages 4 and 6 years, before starting school.

Receiving the MMR vaccine is safer than becoming infected with measles. As with any vaccine, there is a small risk of an allergic reaction, which can be mild or severe. Other side effects include fever, rash, or joint pains. Pregnant women and people who have weak immune systems because of certain medical conditions should not get the MMR vaccine.

In 2011, the Institute of Medicine published a report that thoroughly studied the possible harmful effects of 8 major vaccines, including the MMR vaccine. They concluded that there was no evidence to suggest a causal relationship between the MMR vaccine and autism and that serious harmful effects from the MMR vaccine were rare. In 2014, the American Academy of Pediatrics published a review article of 67 studies that found strong evidence that the MMR vaccine is not associated with autism.


Most Americans are considered protected against, or immune to, measles, either because they were vaccinated or because they had measles before. You are considered protected against measles if


  • You have immunization records stating that you have received 2 doses of the MMR vaccine at any point in your life.

  • You have had a blood test confirming you have immunity against measles at any point in your life.

  • You have had a blood test confirming you had measles at any point in your life.

  • You were born before 1957.


If any of the above is true for you, you do not need to receive an MMR booster vaccine. You also do not need to go to the doctor for a blood test to confirm that you are immune to measles.

If you cannot find any immunization or blood test records, you can ask your doctor for a blood test to check if you are immune to measles. If the test shows that you are not immune, you should be vaccinated. If you received only 1 dose of the MMR vaccine, you should ask your doctor whether you should have a booster vaccination.

 Section Ref ID

For More Information


To find this and previous JAMA Patient Pages, go to the Patient Page link on JAMA’s website at Many are available in English and Spanish.

Sources: Centers for Disease Control and Prevention, Institute of Medicine, American Academy of Pediatrics

By Dr. Maloney
February 16, 2015
Category: Skin News
Tags: Eczema   Dermatitis   Rashes  


Image not available.

Atopic dermatitis is an itchy rash that comes and goes with redness, scaling, and swelling.

Atopic dermatitis can affect patients’ sleep, daily living, and overall well-being. Damage to the skin barrier in atopic dermatitis allows for increased loss of water resulting in dry, itchy skin, skin infections, and increased skin allergies. Patients with atopic dermatitis may also have allergic diseases such as asthma, hay fever, and food allergies.



  • Atopic dermatitis affects more than 1 in 10 US children and 1 in 10 to 14 US adults.

  • Most atopic dermatitis begins in infancy and lasts for years.

  • More than 4 in 5 children with atopic dermatitis have their disease as adults.

  • Up to 6 in 10 adults with atopic dermatitis report first getting their disease as an adult.

  • In infants, it affects the face and scalp. In older children and adults, it affects the creases of the elbows, backs of the knees, front of the neck, wrists, and ankles.

  • Rubbing and scratching results in thickening of the skin and over time worsens the itch.




  • Atopic dermatitis affects 1 in 5 black children and 1 in 10 white children in the United States.

  • Genetic defects in skin barrier (filaggrin gene) are found in more than 20% of whites and fewer than 5% of blacks with atopic dermatitis.

  • Patients with black skin can have atopic dermatitis show up with:

    • Papular eczema, or brown bumps;

    • Follicular eczema, or accentuation of hair follicles;

    • Lichenoid eczema, or flat-topped bumps from rubbing; and/or

    • Skin more often involved in nonflexural areas.



There is no cure for atopic dermatitis. Treatments moisturize and soothe the skin, repair the skin barrier, and calm the itch and inflammation. The treatment will depend on how much of your skin is involved. If only a little skin is affected, use of mild soaps, cool baths or showers, or a lot of skin moisturizer and ointments applied to the skin may be enough. If a large area is involved, then oral medicines, UV light therapy, and other treatments may also be needed


From JAMA Dermatol. 2014;150(12):1380. doi:10.1001/jamadermatol.2014.2757 by Jonathan I. Silverberg, MD, PhD, MPH

By J Michael Maloney MD
February 16, 2015
Category: Skin News
Tags: Acne   skin care  

Information from the American Medical Association:

Acne is the most common skin disorder in the United States.

Most people with acne are teenagers and young adults, but the condition can persist into adulthood. Adult acne is becoming more common, especially in women, for reasons that are not understood. Acne usually affects the face, chest, and upper back. Untreated acne can cause temporary skin discoloration or permanent scarring. In some people, acne can lead to low self-esteem, avoidance of social situations, and even depression.


Image not available.



  • Skin cell turnover: Skin is always being renewed, shedding dead cells as new cells emerge. Sometimes this process speeds up, resulting in a buildup of dead skin cells inside hair follicles.

  • Sebum production: Glands associated with hair follicles in the skin secrete sebum, a waxy material that moisturizes the skin. The body makes more sebum when androgens (hormones) increase, which is why acne often occurs during puberty. Sebum traps dead skin cells inside the follicle, resulting in a comedo (small plug).

  • Bacterial colonization: A bacterium that lives on the skin and is usually harmless can multiply inside a comedo. The result is inflammation (redness and swelling), which leads to a rupture of the comedo under the skin. This rupture can result in larger, more painful lesions.


Other factors can contribute to acne. Genetics is believed to play a role, making some people more likely than others to develop acne. Friction (from a helmet, headband, tight clothing, or scrubbing the skin) and picking or squeezing acne lesions can cause or worsen acne. Drugs including steroids and anticonvulsants may contribute to acne. Some cosmetics and hair products make acne worse.


Acne severity depends on the type of lesions present and how much skin is affected. Most cases of acne can be successfully treated. But even with proper medication use, it may take up to 2 months to see improvement. Mild acne can often be treated with topical (applied to the skin) over-the-counter medications. For more severe acne, a doctor may prescribe stronger topical medicines, oral antibiotics, or oral contraceptives (for women). Isotretinoin is used to treat severe acne, but strict monitoring is necessary for patients taking this drug

By J Michael Maloney MD
October 07, 2014
Category: Skin News
Tags: Psoriasis   Drugs   drug   treatment  

New Drug for Psoriasis:

Apremilast approval expanded to include plaque psoriasis

By: ELIZABETH MECHCATIE, Skin & Allergy News Digital Network

September 24, 2014

The oral phosphodiesterase-4 inhibitor apremilast is now indicated for the treatment of moderate to severe plaque psoriasis.

On Sept. 23, the manufacturer, Celgene, announced that the Food and Drug Administration had approved the expanded indication for apremilast, which was initially approved in March 2014 for treating psoriatic arthritis. The new indication is for the treatment of patients with moderate to severe plaque psoriasis who are candidates for phototherapy or systemic therapy.

Approval was primarily based on the results of two multicenter, randomized, double-blind, placebo-controlled studies of adults with moderate to severe plaque psoriasis, according to Celgene. At 16 weeks, 33% and 29% of those randomized to the 30-mg, twice daily dose of apremilast had achieved at least a 75% reduction in the Psoriasis Area and Severity Index (PASI 75), compared with 5%-6% of those on placebo, according to the prescribing information.

Celgene markets apremilast as Otezla.The most common adverse events reported in studies, which affected at least 1% of treated patients and were more common than in patients on placebo, included diarrhea in 17% and nausea in 17%; other adverse events included upper respiratory infection, tension headache, and headache. The warnings and precautions section of the label includes the recommendation to be alert for the emergence or worsening of depression, suicidal thoughts, or other mood changes in patients treated with the drug, and to monitor weight regularly for significant weight loss. In studies, treatment with apremilast has been associated with an increase in reports of depression and significant weight loss.


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