In addition to treating acne, skin cancer, moles, and all of the other common and uncommon skin conditions, there is one skin condition that is often misdiagnosed several times by other clinics before I see it. This would be Tinea Versicolor. This is a common skin condition that usually occurs on the chest and looks like light or dark lesions that usually do not itch. They are most obvious after someone has had some sun and the lesions will appear lighter because the surrounding skin tans while the lesions themselves do not. The rash can be flaky, it can be circular lesions, or sometimes it can be in an hourglass shape as it goes above, below, and between the breasts. It usually does not itch. It tends to occur where there is increased sebaceous activity and where there are more hair follicles. The organism that causes this condition is part of the skins normal flora. It is usually diagnosed by the history and symptoms of the conditions as well as what has been used to treat it. A sample of skin cells scraped from the affected area and then placed on a slide to view under a microscope will reveal broad hyphae and clusters of budding cells that look like spagetti and meatballs. Typical anti-fungal creams do not work very well to treat this. It requires prescription strength lotions and pills to clear it. It is the type of condition that can often recur. We can minimize the chance of recurrence by using anti-fungal pills that are taken once monthly for up to 3 months( you have to put it on your calender to remember). Sometimes these rashes can be biopsied to confirm the diagnosis, but that is usually not necessary unless there is no response to the treatments.
Another condition that often occurs on the chest and is often misdiagnosed is Herpes Zoster, otherwise known as the “shingles”. This condition is caused by the same virus that causes chicken pox. The virus remains dormant in our nerves for the rest of our lives after we are exposed to it usually as a child. Vaccinations have lessened the severity of the chicken pox and will probably lessen the severity of the shingles as well. I continue to see pretty severe cases on a regular basis. The rash is usually reactivated by a weakening of a persons immune system, most commonly caused by stress. It comes out as a burning sensation and patch of little blisters along a dermatome, or nerve bed, on one side of the body. The rash gets better with time, but will improve sooner with if anti-viral medications are started as soon as possible. This also minimizes the chance of chronic pain called “post herpetic neuralgia” that occurs more often as people get older and end up getting the shingles. Often these patients require chronic medications to control the pain. There are many other skin conditions that affect the chest area that I will discuss in later blog entries.