Dr. Rockoff received his undergraduate degree from Yeshiva College with the distinction of Summa Cum Laude. He received his medical degree from the Albert Einstein College of Medicine. His internship and two years of Pediatric residency were at the Bronx Municipal Hospital Center, followed by training in Dermatology at the combined residency program at Tufts and Boston Universities. Dr. Rockoff is certified by both the American Board of Dermatology and the American Board of Pediatrics.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The term rash has no precise meaning but often is used to refer to a wide variety of skin disorders. In normal conversation, a rash is any inflammatory condition of the skin. Dermatologists have developed various terms to describe skin rashes. The first requirement is to identify a primary, most frequent feature. Then, other characteristics of the rash are noted including density, color, size, consistency, tenderness, shape, and perhaps temperature. The configuration of the rash is described using adjectives such as "circular," "ring-shaped," "linear," and "snake-like."
Finally, the distribution of the rash on the body can be very useful in diagnosis since many skin diseases have a predilection to appear in certain body areas. Although certain findings may be a very dramatic component of the skin disorder, they may be of limited value in producing an accurate diagnosis. These include findings such as ulcers, scaling, and scabbing. Using this framework, it is often possible to develop a small listing of the possible diseases to be considered. Below is a short discussion of some common categories of skin rashes:
Noninfectious, common rashes localized to a particular anatomical areas
Rashes produced by fungal or bacterial infection
Widely distributed rashes affecting large portions of the skin
Although most rashes are seldom signs of immediate impending doom, self-diagnosis is not usually a good idea. Rashes that quickly resolve are generally not dangerous. Proper evaluation of a skin rash requires a visit to a doctor or other health-care professional.
Scaly patches of skin produced by fungal or bacterial infection
When infections appear as rashes, the most common culprits are fungal or
bacterial infections.
Fungal infections: Fungal infections are fairly common but don't
appear nearly as often as
rashes in the eczema category. Perhaps the most common diagnostic mistake made
by both patients and non-dermatology physicians is to almost automatically call scaly rashes "a
fungus." For instance, someone with several scaly spots on the arms, legs, or
torso is much more likely to have a form of eczema or dermatitis than actual
ringworm (the layman's term for fungus). Likewise, yeasts are botanically related to fungi and can cause skin rashes. These tend to affect folds of skin (like the skin under the breasts or the groin). They look fiery red and have pustules around the edges. As is the case with ringworm, many rashes that are no more than eczema or irritation get labeled "yeast infections."
Fungus and yeast infections have little to do with hygiene -- clean people get them,
too. Despite their reputation, fungal rashes are not commonly caught from dogs
or other animals, nor are they easily transmitted in gyms, showers, pools, or
locker rooms. In most cases, they are not highly contagious between people
either.
Treatment is usually straightforward. Many effective antifungal creams can be
bought at the drugstore without a prescription, including 1% clotrimazole (Lotrimin, Mycelex) and 1% terbinafine
(Lamisil). In extensive cases, or when toenails are involved, oral terbinafine may be useful.
If a fungus has been repeatedly treated without success, it is worthwhile considering the possibility that it was never really a fungus to begin with but rather a form of eczema that should be treated entirely differently. A fungal infection can be independently confirmed by performing a variety of simple tests.
Bacterial infections: The most common bacterial infection of the skin is
impetigo. Impetigo is caused by staph or
strep germs and is much more common in children than adults. Eruptions caused by bacteria are often pustular (the
bumps are topped by pus) or may be plaque-like and quite painful (cellulitis). Again, poor hygiene plays little or no role. Nonprescription antibacterial creams like
bacitracin (Neosporin) are not very effective. Oral antibiotics or prescription-strength creams like
mupirocin (Bactroban) are usually needed.
Scabies are itch mites that burrow under the skin and produce intense itching that's usually worse at night. Symptoms of scabies are small bumps and blisters on the wrists, knees, between the fingers, on the back of the elbows, in the groin and on the buttocks. Treatment involves applying a mite-killing cream, antihistamines for itch relief, washing bedclothes and linens.
Infectious mononucleosis is a virus infection in which there is an increase of white blood cells
that are mononuclear (with a single nucleus) "Mono" and "kissing
disease" are popular terms for this very common illness caused by the
Epstein-Barr virus (EBV).
Shingles (herpes zoster) is a skin rash caused by the same virus that causes chickenpox. Under certain circumstances, such as emotional stress, immune deficiency, or with cancer, the virus re-activates causing shingles. Shingles are catching and can spread from an infected person to others who have not had chickenpox. There are a variety of treatments for shingles.
Eczema, also known as dermatitis, is a general term for many types of skin inflammation. The most common form of eczema is atopic dermatitis. The other forms of eczema include: contact eczema, seborrheic eczema, Nummular eczema, Neurodermatitis, stasis dermatitis, and dyshidrotic eczema. Symptoms, diagnosis, and treatment of eczema may vary from person to person and may depend on the type of eczema.
Staphylococcus or Staph is a group of bacteria that can cause a multitude of diseases. Staph infections can cause illness directly by infection or indirectly by the toxins they produce. Symptoms and signs of a Staph infection include redness, swelling, pain, and drainage of pus. Minor skin infections are treated with an antibiotic ointment, while more serious infections are treated with intravenous antibiotics.
The term "ringworm" or "ringworms" refers to fungal infections that are on the surface of the skin. A physical examination of the affected skin, evaluation of skin scrapings under the microscope, and culture tests can help doctors make the appropriate distinctions. A proper diagnosis is essential to successful treatment. Among the different types of ringworm are the following: tinea barbae, tinea capitis, tinea corporis, tinea cruris, tinea faciei, tinea manus, tinea pedis, and tinea unguium.
Bed bugs (from the insect family Cimicidae) are small, reddish-brown tick-like insects that feed by sucking the blood of mammals. They are often found in poorly sanitized areas or in crowded living quarters.
A skin tag is a small benign growth of skin that projects from the surrounding skin. Skin tags can vary in appearance (smooth, irregular, flesh colored, dark pigment, raised). Skin tags generally do not cause symptoms unless repeatedly irritated. Treatment for skin tag varies depending on the location on the body.
MRSA (methicillin resistant Staphylococcus aureus) bacteria causes skin infections with the following signs and symptoms: cellulitis, abscesses, carbuncles, impetigo, styes, and boils. Normal skin tissue doesn't usually allow MRSA infection to develop. Individuals with depressed immune systems and people with cuts, abrasions, or chronic skin disease are more susceptible to MRSA infection.
Hives, also called urticaria, is a raised, itchy area of skin that is usually a sign of an
allergic reaction. The allergy may be to food or medications, but usually the
cause of the allergy (the allergen) is unknown.
Athlete's foot (tinea pedis) is a skin infection caused by the ringworm fungus. Symptoms include itching, burning, cracking, peeling, and bleeding feet. Treatment involves keeping the feet dry and clean, wearing shoes that can breathe, and using medicated powders to keep your feet dry.
Lyme disease is a bacterial illness, which is spread by ticks when they bite the skin. Initially the disease affects the skin causing a reddish rash associated with flu-like symptoms. It takes weeks to months after the initial redness of the skin for its effects to spread throughout the body. Lyme disease can be treated with antibiotics. Lyme disease can be prevented by using tick avoidance techniques.
Systemic lupus erythematosus is a condition characterized by chronic inflammation of body tissues caused by autoimmune disease. Lupus can cause disease of the skin, heart, lungs, kidneys, joints, and nervous
system. When only the skin is involved, the condition is called discoid lupus.
When internal organs are involved, the condition is called systemic lupus
erythematosus (SLE).
Dengue fever is contracted from the bite of a striped Aedes aegypti mosquito. Symptoms of dengue include headache, fever, exhaustion, severe joint and muscle pain, rash, and swollen glands. Since dengue is caused by a virus, there is no specific medicine to treat it. Treatment instead focuses on relieving the symptoms.
Itching can be a common problem. Itches can be localized or generalized. There are many causes of itching to include: infection (jock itch, vaginal itch), disease (hyperthyroidism, liver or kidney), reactions to drugs, and skin infestations (pubic or body lice). Treatment for itching varies depending on the cause of the itch.
Rosacea is a skin disease that causes redness of the forehead, chin, and lower half of the nose. In addition to inflammation of the facial skin, symptoms include dilation of the blood vessels and pimples (acne rosacea) in the middle third of the face. Oral and topical antibiotics are treatments for rosacea. If left untreated, rhinophyma (a disfiguring nose condition) may result.
Eczema is a general term for many types dermatitis (skin inflammation). Atopic dermatitis is the most common of the many types of eczema. Other types of eczema include: contact eczema, allergic contact eczema, seborrheic eczema, nummular eczema, stasis dermatitis, and. dyshidrotic eczema.
Impetigo is a contagious skin infection caused by staph and strep bacteria. There are two types of impetigo: non-bullous and bullous. Symptoms of non-bullous impetigo include small blisters on the nose, face, arms, or legs and possibly swollen glands. Bullous impetigo symptoms include blisters in various areas, particularly in the buttocks area. Treatment involves gentle cleansing, removing the crusts of popped blisters, and the application of prescription-strength mupirocin antibiotic ointment.
Jock itch is an itchy red rash that appears in the groin area. The rash may be caused by a bacterial or fungal infection. People with diabetes and those who are obese are more susceptible to developing jock itch. Antifungal shampoos, creams, and pills may be needed to treat fungal jock itch. Bacterial jock itch may be treated with antibacterial soaps and topical and oral antibiotics.
Hand-foot-and-mouth syndrome is clinical pattern consisting of a rash on the hands and feet, and in the mouth. Hand-foot-and-mouth syndrome is caused by various viruses including several types of the coxsackievirus. Other symptoms include sore throat, decreased appetite, irritability, and (or) fever.
Coxsackie viruses may be divided into two groups. Type A causes hand, foot, and mouth disease and conjunctivitis, while type B causes pleurodynia. Both types sometimes cause meningitis, myocarditis, and pericarditis. There is no specific treatment for this disease.
Tinea versicolor is a fungus infection that mainly affects the skin of young people. Recognized by light or reddish brown spots, and areas lighter than the surrounding skin. Tinea versicolor is caused by yeast actually found in our skin. Factors like heat, humidity, and sweat help it proliferate in people, resulting in a rash that is not contagious to others.
An allergy refers to a misguided reaction by our immune system in response to bodily contact with certain foreign substances. When these allergens come in contact with the body, it causes the immune system to develop an allergic reaction in people who are allergic to it. It is estimated that 50 million North Americans are affected by allergic conditions. The parts of the body that are prone to react to allergies include the eyes, nose, lungs, skin, and stomach. Common allergic disorders include hay fever, asthma, allergic eyes, allergic eczema, hives, and allergic shock.
Keratosis pilaris (KP) is a common skin disorder in which small white or red bumps appear around hair follicles on the upper arms, thighs, buttocks, and cheeks. The cause of KP is unknown. There is no cure for keratosis pilaris, and the condition may resolve on its own. Gentle exfoliation, professional manual extraction, chemical peels, and microdermabrasion, along with topical products, are the best treatments for this condition.
Henoch-Schonlein Purpura (HSP or anaphylactoid purpura), a type of blood vessel inflammation, results in rash, arthritis, and occasional abdominal cramping. HSP often resolves on its own. Joint pain may be treated with anti-inflammatory and cortisone medications.
Chickenpox (chicken pox) is a contagious childhood disease caused by the varicella-zoster virus. Symptoms have an incubation period of 14 to 16 days and include a couple days of mild fever, weakness, and red, raised rash that progresses to blisters that eventually burst and crust over. Complications include bacterial infection of the open sores, scarring, encephalitis, nerve palsies, and Reye's syndrome.
Measles (rubeola) is a highly contagious disease that's caused by a virus. Symptoms include a rash, high fever, cough, runny nose, and red eyes. Treatment focuses on symptom relief. The disease can be prevented with the measles, mumps, and rubella vaccine.
Lichen planus is a common skin disease that features small, itchy pink or purple spots on the arms or legs. the abnormal areas on the skin in lichen planus are typically flat-topped (hence the term planus), itchy, and frequently have a polygonal or angular shape.
Roseola is a viral illness that most commonly affects young children. Symptoms and signs include a sudden high fever that lasts for three to five days, swollen neck glands, runny nose, puffy eyelids, diarrhea, irritability, and a bulging soft spot on the head.
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