The eyes may be the window to the soul, but it’s your skin that’s the window to your body. In fact, common problems on the surface can be indicators of what’s really going on inside. “You get tipped off through your skin, hair, and nails,” says dermatologist Teresa V. Notari, MD, FAAD. “I can be treating someone for dry skin and wind up finding a thyroid problem. Signs of diabetes, high cholesterol, and anemia often show up on your skin before they show up anyplace else.”

Adult-onset acne

“ ‘I am getting wrinkles and pimples at the same time.’ That’s what my patients tell me,” says Notari, “and they can’t believe it.” But the acne you’re seeing now is not at all like what you dealt with as a kid. “Most women with adult-onset acne have one to three big pimples that are temporary, recurring, and usually appear on the lower third of the face,” she says. “I tell women it’s a hormonal reaction—like there’s a string attached from their chin to their ovaries.” Because this form of acne is so strongly caused by hormonal changes that occur on a monthly basis, it does not respond well to topical treatments. “A number of women come in so frustrated because they’re changing their products, they go for facials, they buy anti-acne products—and nothing works,” she says. What’s called for, Notari explains, is systemic treatment, whether it be antibiotics or birth control pills: “Antibiotics work, not because of infection but because of inflammation. And the birth control pill works because if you don’t ovulate, you also don’t get those hormonal fluctuations.”

Rosacea

Often mistaken for adult-onset acne, rosacea is actually just the appearance of reddening of the face, skin sensitivity (including itching and burning), and little pimples or pustules—but no blackheads. “Comedones, or blackheads, are the hallmark of true acne,” says Notari. In fact, rosacea is a lot easier to treat, first with antibiotics, then with a topical therapy and precautions against such common triggers as harsh products and spicy foods. “You should treat this,” Notari says. “You shouldn’t just live with it. If left untreated, it can damage skin in a permanent way.”

Nails

It’s unfortunate, but many women pick up fungal infections through manicures and pedicures. Other times, something may look infected but may simply be inflamed. The most common nail infection is a paronychia infection, explains dermatologist Chris W. Sciales, MD, FAAD—a result of bacteria, yeast, or fungus. “It’s particularly common among new mothers,” he says. “They’re washing their hands all the time, they’re washing bottles—their hands are always in water.” A quick fix, he says, is to wear gloves when washing dishes, but the answers aren’t always so simple.

“Dark streaks on nails are common among dark-skinned people,” says Notari, “but on a white person, it raises suspicion of melanoma. Also, if nails are splitting and cracking it could be a sign of dehydration—or it could be indicative of an iron deficiency caused by monthly bleeding. In otherwise healthy young women, I see a lot of hair and nail problems that are a result of menstruation.”

Hair loss

It’s a scenario Notari comes across all the time: “Patients will see me for a visit, and on the way out, ask, ‘Who should I see about hair loss?’ They don’t realize they’re right there!” In fact, hair loss is a common reason for seeing a dermatologist. For men, Propecia—the only FDA-approved treatment for hair loss in males over 18—is an effective course of action. But what most men don’t realize is that if there’s a genetic predisposition for hair loss, it can start as early as puberty. “Male-pattern hair loss, if it’s going to be severe, starts at a very young age,” says Notari. “But if you start treatment in your early twenties, you don’t have to go bald at all. Remember: You can prevent further hair loss, but once you’re bald, you cannot bring back a full head of hair.”

For women, the options are more limited. Notari says, “My patients tell me, ‘I used to not be able to get my hair in a ponytail holder, that’s how thick it was. Now, I’m shedding!’ Thinning of hair is a normal part of aging; virtually no one at 80 years old has the hair they had at 15.” Minoxidil, in the form of Rogaine or other brands, can help prevent additional hair loss and is definitely worth a try. The downside, cautions Notari, is that it is not especially convenient to use on the scalp twice a day (although the foam form is less of a struggle than the liquid form).

It’s important to note, too, that hair loss can be the result of normal hormonal changes, as occurs after pregnancy, or even two to four months following a major life stress. Other times, it can point to a more serious problem like an abnormal amount of male hormone or a tumor on the adrenal gland. So don’t brush off your hair loss—make sure a doctor looks into it.

Of course, when it comes to body hair, some patients are actually looking for a way to lose it. Here, laser treatments can be very effective (particularly on light skin with coarse, dark hair). “Legs, the bikini area, and underarms are perfect for this,” says Sciales. “So are men’s backs. But for light peach fuzz on the face, the laser doesn’t work as well.” There is some pain involved, although a numbing cream is applied beforehand, and the number and duration of treatments varies. “It’s usually anywhere from three to six visits,” he says. “A small area can require as little as two to eight minutes each treatment. Legs are a big project: It’s 25 minutes from the knees down, 25 minutes from the knees up.”

Preparing for laser hair removal is easy. “Two days before you come in, shave the area you want lasered. We don’t want much hair,” says Sciales. “We want just a little stubble so we can see where the hair is. And don’t pluck or wax for two weeks prior—it’s the hair under the skin that gets lasered. Instead, cut the hair short for a week or two.”

The Lips and Mouth

“In Europe there’s a separate specialist for lip and mouth issues,” says Sciales. “In this country, dermatologists are the doctors who take care of it.” Problems include everything from pigmented spots to chapped lips and split lips. Rashes are also common: “If it’s around the corner of mouth, the patient will think it’s a cold sore, but it could be a yeast infection, a nutritional deficiency, or even an allergic reaction. You just have to be a detective.”

When It’s More Than Just a Pimple
What you need to know now about staph infections and MRSA.

The news is alarming: Amid reports of increases in staph nfections and methicillin-resistant Staphylococcus aureus (MRSA) across the country, a study by researchers at Atlanta’s Emory University reveals that children are picking up more stubborn staph infections that don’t respond to common antibiotics, and the proportion of ear, nose, and throat infections resistant to standard drug treatment has increased dramatically. Adding to the problem is that it’s often hard to tell when an otherwise normal-looking bump is actually harboring staph or MRSA.

“Most of the time when you have an infection, there are signs of that infection,” says Richard Eisenberg, MD, section chief of dermatology at Overlook Hospital. “The skin is hot or tender; it’s painful, there’s discharge.
“The trick is to figure out who is at risk and who to culture. We could culture everybody, but that gets expensive. Or, do you culture people who have been treated with the appropriate therapy and who haven’t been getting better? Of course, not every lesion is able to be cultured—there’s not enough discharge, or no discharge. So we have to increase our level of suspicion.”

Eisenberg explains that it’s important for everyone to know his or her own body. “Get to recognize the usual things that happen, like ingrown hairs,” he says. “Get to know how something is healing.” If you’ve been prescribed antibiotics and you still have a fever or chills, don’t hesitate to go back to the doctor: Once bacteria enter the bloodstream, the results can be fatal.

Fortunately, the news is not all bad. Community-acquired MRSA—the kind being picked up in gyms and on playgrounds—is different than hospital-acquired MRSA. The community-acquired version, while scary, is not as serious, and Eisenberg explains that appropriate antibiotic therapy and good skin care prevent the condition from becoming more critical.

“There’s a fine line between scaring people off,” he says, “and not making them sufficiently aware of a serious situation. If you’re infected, you need to take it seriously so you don’t infect other people.”

To that end, Eisenberg offers these tips for protecting yourself from staph and MRSA:

• Wash hands frequently.


• Take appropriate measures to keep gym equipment clean.


• Don’t share towels or clothing.
  


• Don’t share personal hygiene items, like razors.
  


• At the barber, beautician, and nail salon, make sure they disinfect instruments properly