Cold Sores

Cold sores, also known as fever blisters, are among the most common oral lesions, occurring on the lips or around the mouth. These sores, which are often painful, are caused by the herpes simplex virus. There are two types of herpes simplex virus, HSV-1 and HSV-2. Cold sores are usually caused by HSV-1, while HSV-2 is usually the cause of genital herpes.

The same virus that causes cold sores may also result in other symptoms, including fever, sore throat and swollen glands. Cold sores are normally diagnosed through physical examination alone, unless the physician suspects another variety of lesion.

Cold sores are highly contagious. Usually, the herpes virus affects the body when infected fluid enters a break in the skin. This typically happens through saliva contact, either through kissing or the use of shared eating utensils. Once an individual is infected, the virus can spread to other parts of the body. It is also possible for a person to have the herpes virus without visible cold sores.

There is no cure for cold sores, but they frequently go away after a few days without treatment. If a cold sore opens, lymph, a clear fluid, may drain from it. The cold sore will then typically form a scab. The cold sore scab normally heals within a few days to 2 weeks. Once an individual has contracted the virus, however it remains in the body and may precipitate subsequent outbreaks.

Outbreaks of cold sores tend to happen when the immune system is weakened: during or after an illness, during menstruation, or when an individual is under great stress. There are several topical treatment options available over-the-counter to hasten healing and lessen pain.


Impetigo is a contagious bacterial skin infection frequently occurring in infants and young children. It is almost always caused by one of two types of bacteria: staphylococcus (staph) or streptococcus. Impetigo usually develops where the skin surface is compromised, enabling bacteria to invade. This may occur where the skin has a cut, scratch, bite or itchy rash. Impetigo often occurs at the end of a cold, when the skin around the nose or mouth is sore. The first signs of impetigo are the appearance of small itchy pimple-like sores. They may appear anywhere on the body, but most frequently occur on the face, arms, or legs. The sores eventually fill with honey-colored pus, break open after a few days and form a yellowish crust. The itchy sores can be spread by scratching to other parts of the body or from one person to another.

Treatment of Impetigo

Treatment for impetigo depends on the severity of the infection, but most often involves soaking the crusted areas and applying topical antiseptics and antibiotics. In severe cases, impetigo is treated with oral antibiotics. The prescribed course of antibiotic treatment should always be completed to prevent reinfection and the possibility of the bacteria becoming antibiotic-resistant.

In certain cases, impetigo secretions may be cultured to make sure that the prescribed antibiotic will be effective against the particular strain of bacteria causing the problem. At times, impetigo may be caused by the bacteria methicillin-resistant staph aureus (MRSA) and may require treatment with more powerful antibiotics.

Risks of Impetigo

Because impetigo is highly contagious, it is important for patients with impetigo to wash frequently, using clean washcloths and towels each time. In order to prevent spreading the infection, children should be kept home from school for 1 to 2 days after beginning antibiotic treatment, and all patients should be careful not to share any personal items, such as washcloths or razors.

While impetigo is a highly treatable ailment that rarely involves complications, there are some risks if the disorder is left untreated. In severe cases, impetigo invades the skin more deeply, resulting in a skin disorder known as ecthyma. Echtyma usually occurs in older adults or in people with diabetes or other autoimmune diseases. Other rare complications include scarring, cellulitis, and kidney damage.


Ringworm is a contagious infection of the skin caused by a fungus called tinea, not a worm as one might infer from its name. Ringworm presents as itchy, scaly, ring-shaped red patches on the skin, bald spots in the hair or beard, or discolored, thickened nails. The most commonly infected areas of skin are on the scalp (tinea capitis), beard (tinea barbae), body (tinea corporis), groin (tinea cruris, jock itch or diaper rash) or foot (tinea pedis or athlete's foot). Ringworm tends to occur in warm, moist areas of the body, and can be passed by touching the skin of an infected person or by making contact with an contaminated item, such as a towel, hairbrush, or pool or shower surface. Pets, especially cats, can also transmit the fungus. Skin that is wet from sweat or the environment, or that is compromised by a minor injury, is more susceptible to an invasion of ringworm fungus.

The skin patches of ringworm have sharply defined borders and may present as rings, darker red at the perimeter and skin-toned within. Crusty or oozing blisters may also be present. When ringworm affects the scalp, there may be bald patches. When it affects the nails, the nails may discolor, thicken or even begin to decompose. Ringworm is generally diagnosed by a simple physical examination. Other methods of detection include lighting the skin with a blue light which causes the fungus to glow, administering a KOH exam during which a skin scraping is microscopically examined, or taking a skin culture or biopsy.

Once ringworm has been diagnosed, it is usually treated with over-the-counter antifungal powders or creams. It is also necessary to make sure the skin is kept clean and dry and that clothing and sheets are washed often to prevent reinfection. In especially resistant cases of ringworm, where the condition doesn't respond or worsens after treatment, or where a bacterial infection develops, more aggressive treatment is required. At this time, stronger antifungal medications, either topical or oral, will be prescribed. In order to prevent a recurrence of ringworm, the skin should continually be kept clean and dry, irritating clothing should be avoided, and antifungal powders or creams should be used prophylactically.


Shingles is a disease caused by the varicella-zoster virus, the herpes virus responsible for chickenpox. Once an individual has been infected with chickenpox, this virus lies dormant within the body's nerve tissue. Years later, the virus may reactivate as shingles, often after another illness or during a period of great stress. Advancing age and immune deficiency disorders are also risk factors for shingles.

Shingles most commonly presents as a painful rash of fluid-filled blisters wrapping around the back and chest, typically affecting only one side of the body. It is possible, however, for patients to have shingles with only a very mild rash or even no rash at all. Early treatment for shingles may minimize symptoms and prevent complications.

Since shingles affects the nerves, patients may experience a wide variety of sensations at the affected site, including shooting pain, itching, burning and numbness. Additional symptoms of the disorder may include headache, fever, fatigue and body aches. The shingles rash usually lasts for several weeks to as much as a month. For most individuals, the pain lessens as the rash heals. Some patients, however, experience long-term nerve pain after a case of shingles, pain which may linger for more than a year.

Normally the doctor diagnoses shingles by an examination of the rash and a discussion of the patient's symptoms. If blisters are present at the time of the examination, the doctor may take a sample of fluid for a laboratory culture. Treatment of shingles consists of the use of analgesics and antiviral medications. The former provide symptom relief and the latter may shorten the course of the illness or lessen the severity of the symptoms.

While shingles is not a life-threatening disease, it can be extremely painful and interfere greatly with normal activities and quality of life. A shingles vaccine is now available and recommended for individuals age 60 and older. While not preventative of the reactivation of the shingles virus in all cases, it has been demonstrated to greatly reduce the risk of an outbreak, as well as to lessen the severity of the disease should it occur.


Scabies is a skin condition caused by a mite (Sarcoptes scabiei) that burrows into the skin, causing itchiness in the affected area. The itching is the result of the body's allergic reaction to the mite, its eggs and its waste products.

This condition is highly contagious, spreading quickly through physical contact, and contact with personal belongings such as sheets and towels. Because of the contagion factor, an entire family or contact area (a classroom or a section of a nursing home) is often treated to prevent recontamination. Scabies can affect anyone, and at any age. Cleanliness, or lack of it, is not a factor in its transmission.

Signs of Scabies

Although symptoms of scabies may be confused with other allergic reactions, the following are usually indicators:

  • Severe itching that is usually worse at night
  • Irregular rows of tiny bumps or blisters at the site
  • Connected individuals having symptoms at the same time
  • Irritation in the folds of the skin

The small rows of blisters that appear on the skin are actually the burrows of the mites. Most commonly, they appear between the fingers, in the armpits, and on the inner wrists, knees, breasts, shoulder blades or buttocks. In men, scabies are often found in the pubic region. Children most frequently show evidence of the infestation on the scalp, face, neck, palms, and soles of the feet.

Diagnosis and Treatment of Scabies

If scabies is suspected, the doctor should be consulted as soon as possible to avoid the risk of infection, and to keep the condition from spreading to others. Scabies is diagnosed by taking a scraping of skin tissue and examining it microscopically. Under the microscope, mites and their eggs will be readily visible. There are several effective medications that treat scabies. While these medications usually quickly kill the mites, itching may persist for weeks after treatment.

Complications of Scabies

While not a serious condition, scabies may lead to other medical problems. If vigorous scratching leads to broken skin, bacterial infections, such as impetigo, may occur. Crusted scabies, a more severe variety of the condition, may have serious consequences for high-risk individuals, including those with weakened immune systems from advanced age or chronic health problems.


Folliculitis is the inflammation of hair follicles, resulting from small skin abscesses, that can occur anywhere on the skin. The cause of most cases of folliculitis is the bacteria Staphylococcus aureus which enters the body through tiny breaks in the skin, such as those caused by friction with clothing, shaving too closely, or insect bites.

Bacteria rapidly reproduce in environments where pores or follicles are clogged, often the groin, neck or underarms. Folliculitis may also occur from exposure to other bacteria in hot tubs. This condition, dubbed "hot tub folliculitis," has the same symptoms as folliculitis from other causes, including:

  • Itching
  • Rash or reddened areas of skin
  • Pustule development

Ingrown hairs, particularly in the beard region, may be confused with folliculitis because they result in mild inflammation and irritation. Since there is no actual infection present, this condition is referred to as pseudo folliculitis.

The best method of prevention of folliculitis is meticulous skin hygiene and careful maintenance of the chlorine level in hot tubs. Risk factors for folliculitis, apart from lack of proper hygiene or living in an unsanitary environment, include being elderly, obese, having diabetes or a weakened immune system.

Treatment of folliculitis involves cleansing of the area, application of topical antiseptics and antibiotic ointments. In more severe cases, oral antibiotics may be prescribed by the doctor. If the infection persists, a culture of the abscess may be taken for laboratory examination.

Complications of folliculitis include the spreading of infection to adjacent areas and the development of methicillin-resistant bacteria, or MRSA, which, in worst case scenarios, may become a serious systemic infection.

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