Can blisters on the skin mean allergy to a medication?

Bullous Pemphigoid with secondary bacterial infection. Caused by an allergy to hydrochlorthiazide diuretic.
Bullous Pemphigoid with secondary bacterial infection. Caused by an allergy to hydrochlorthiazide diuretic.

Yes. In particular there is a condition known as bullous pemphigoid. This eruption consists of blisters scattered over different parts of the body. It is considered to be either a drug  (medication) rash or one that is autoimmune (not caused by medication but by the body’s own immune process).

The most common class of drugs that cause bullous pemphigoid are the sulfa drugs. These drugs can range from certain diuretics, antibiotics, anti-inflammatory drugs to diabetic medications. The rash is extremely itchy. This eruption can also develop a secondary bacterial infection resulting in crusted lesions scattered all over the body.

Bullous pemphigoid must be treated by eliminating the offending medication, as well as topical and systemic therapy.

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661

Are there rashes related to pregnancy?

PUPPP
PUPPP

Itching during pregnancy can be something very simple like eczema (patches of dry skin), seborrheic dermatitis (scaling and flaking of the scalp and central face), and other common dermatoses. However, itching associated with blistering can represent a condition known as pemphigoid gestationis, sometimes called herpes gestationis—completely different from what is commonly referred to as the herpes virus. It is uncommon however very symptomatic when it is seen during and immediately after pregnancy.

Lesions can appear as red patches or blisters all over the body. Conditions such as allergic contact dermatitis, drug allergies and a condition known as pruritic urticarial papules and plaques of pregnancy (PUPPP) can also be confused with herpes gestationis.

The condition may last for weeks or months and is usually treated with various forms of cortisone.

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661

What should you avoid if you are allergic to poison oak?

Poison oak is now prevalent in southern California. For those of you who have ever had a poison oak allergy, it is now time to be particularly careful. Hiking areas and even park grounds can hide this devious culprit. You must be vigilant in trying to avoid contact, especially during this time of year.

Some of the things that you might want to consider would be avoiding rubbing up against any kind of brush/trees/bushes while walking or running outdoors and avoiding all fires made with wood or branches where poison oak may be growing as the smoke is a strong allergen for every part of the body with which it comes in contact.

I recently saw a patient who had been carrying pieces of wood across his arm while clearing brush. The wood had been in contact with poison oak, and the bark had rubbed the resin into his skin.

The rash seen from poison oak is red, itchy, and frequent blistering. In many areas, a linear scratch can be observed.

Poison oak on black skin reacts similarly to the allergies on whiter skin; however, the lesions may be harder to diagnose and differentiate from other skin conditions.

In addition to the allergic reaction, poison oak frequently becomes secondarily infected, which can add honey-colored crusting to areas that have been scratched. The rash tends to be intensely itchy.

Initial treatment at home can be over-the-counter 1% hydrocortisone cream applied frequently throughout the day, as well as calamine lotion to the blistering areas. Over-the-counter Polysporin ointment (not any neomycin containing ointments) can be applied to any bacterial infected areas producing these honey-colored crusts.

A poison oak allergic reaction can be very serious and extremely uncomfortable. If at-home treatment doesn’t significantly help, a visit to your local dermatologist is highly recommended.

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661

Are insect and spider bite reactions a summertime hazard in Los Angeles?

Yes, there are many more cases of severe reactions with insects and spider bites during the summer. Insect bite reactions are especially common in Los Angeles because of our varied topography: hills, mountains, reservoirs, and beach cities.  LA insects can be found almost anyplace within the city. Dermatologists in Los Angeles recommend the use of an insect repellent whenever possible when enjoying the LA outdoors.

Mosquito bites can usually be treated with over-the-counter 1% hydrocortisone cream and over-the-counter antihistamines; however, if the bites become severely red and itchy, then a visit to a dermatologist would be appropriate.

Spider bites present more of a problem. If you get a bite that becomes very red, hot, and swollen, it is best to seek medical attention from a competent dermatologist. Such bites may require oral or injectable medications to prevent severe infection and allergic reactions. If a severe bite goes untreated, the infection can become systemic and spread throughout the entire body.

Bees and wasps can also present a problem in the summertime. For a quick treatment if the stings are not too severe, a small amount of household ammonia can be applied to the area in an attempt to neutralize the reaction. If you have an aloe vera plant at home, you can snip off the end of one of the leaves and put a small amount of the aloe vera juice on the area and rub it in.  In addition, the over-the-counter treatments mentioned above are also effective for these reactions.

Stings from bees and wasps can also produce very severe allergic reactions that can result in death if not properly treated. If you experience any generalized rash (hives), especially associated with trouble breathing, then you should seek out your nearest emergency room for immediate treatment.

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661

Can allergies causing skin rashes be detected and treated?

Oleander

People can be allergic to environmental substances and not even know. Nuts, dust mites, pollen, grasses, mold and animal dander are all common allergens. There are now very sophisticated tests through a simple blood drawing, which identify multiple food and environmental allergens such that one can know what to avoid. People can also be very allergic to certain flowers such as oleander. Being tested and subsequently treated can help prevent serious rashes and allergic reactions, which can close the airway and result in an inability to breathe. Knowing what one is allergic to may help with one’s eczema, which is a dry itchy skin condition seen in people with allergies. Hives, the medical term being urticaria, is also frequently a skin manifestation of severe allergies.

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661

Do campers need to take special skin care precautions?

Poison Oak

Absolutely. If you are going camping, your skin will be exposed to unusual conditions. If you want to protect your skin, you should always apply a sunblock such as our Bussell Skin Care Sunblock SPF 30. A hat and sunglasses should also be worn because of sun damage to the eyes that can cause eye conditions such as cataracts.

Campers are also exposed to insect bites, poison ivy and poison oak. Insect repellent can sometimes irritate your skin. I advise spraying clothing with insect repellent rather that spraying your skin. Do this outside in a well-ventilated area. If you are allergic to insect bites or stings, I advise bringing with you a dose of epinephrine in the form of an Epi-pen, but you should consult a physician to understand how to use it. Individuals who are allergic to bee stings should always camp with an Epi-pen in their backpacks if they are severely allergic. It is always wise to have an emergency number you can call in case of a severe allergic reaction during your camping trip.

Many people are allergic to poison ivy and poison oak to some degree. Poison ivy is generally found on the East coast and poison oak on the West coast. The type of allergic reaction caused by these plants is known as a rhus dermatitis. If you are camping, you should bring along with you a bottle of calamine lotion to soothe skin rashes caused by these plants. Make sure you know how to identify these plants in order to avoid them. I also suggest keeping your lower legs covered with socks and long pants.

Poison Ivy

A little known way of getting a severe poison oak or poison ivy rash is from campfires. Be careful not to put wood containing these plants into a campfire as the smoke can cause a very severe allergic reaction as it tends to diffuse all over the skin’s surface.  Carrying antihistamines to take for a poison oak/poison ivy reactions or reactions to insect bites can be very helpful.

Campers and hikers may also find that they perspire in their shoes. This can lead to an ideal environment for fungus or athlete’s foot to thrive. Changing socks as soon as they feel moist, adding foot powder in the socks and shoes and wearing shoes that breathe can all help reduce the chances of a fungus infection developing during your trip.

If you are hiking in an area known to have snakes, try to stay on the hiking path and wear high top shoes or boots. Also bring along a little emergency kit filled with first aid supplies, antibacterial wipes and Tylenol, aspirin or ibuprofen for pain, keeping in mind that aspirin or ibuprofen can cause a bleeding wound to clot less easily.

Related post: What should you avoid if you are allergic to poison oak?

– Dr. Bussell

Beverly Hills Dermatology Consultants

433 N. Camden Drive, Suite 805   Beverly Hills, CA 90210 | 310-550-7661