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Symptoms, Their Causes & Cures: Skin Sores

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Skin Sores

WHEN TO SEE YOUR DOCTOR

* A sore is unusual in appearance, does not heal after two weeks or grows rapidly.

* Sores are recurring or multiplying.

* You also have fever or nausea.

What Your Symptom Is Telling You

When you have a sore, you want it to go away. So does your body's immune system. It goes to work right away, sends in the cellular repair crews and—zip, zip—cleans it up. Usually.

Some sores prove to be more stubborn than others—they just hang in there and keep on coming.

Sores have hundreds of possible causes, many of which are hard to pinpoint and even harder to shake. According to William Dexter, M.D., assistant professor of clinical community and family medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire: "When a sore rears its ugly head, it's telling you one of three things: Some kind of disease process is going on within the skin, something is going on elsewhere in the body that is being expressed through the skin or else the skin has come in contact with something it doesn't agree with."

Quite often it is the latter. The skin is a magnet for a variety of creepy crawlies—from the bites and stings of mosquitoes and bees to the burrowing and tunneling of tiny little parasites. Any of these bites and burrows can become infected, making the sores even more pronounced. And don't forget germs.

"Most of the really ugly-looking sores with pus, scabs and redness are the work of infectious microorganisms," says Guy F. Webster, M.D., Ph.D., assistant professor of dermatology and director of the Center for Cutaneous Pharmacology at Thomas Jefferson University in Philadelphia.

The most common and contagious of these are bacteria. Conditions they cause include boils, impetigo (a reddish rash on the face that forms pus-filled and crusty scabs) and folliculitis (an infected hair follicle.) Viruses are responsible for such sore-sprouting diseases as chickenpox, herpes, shingles and warts. Finally, fungi are little invaders that produce such unsavory skin conditions as athlete's foot, jock itch and ringworm.

Many skin conditions can develop sores and pustules if they get infected. Skin afflicted with dermatitis or eczema is very susceptible to secondary infections, especially if there's a break in the skin's surface (from scratching, for example.)

But infectious agents aren't the only culprits that make sores. Things like age spots or cysts form benign skin growths. A precancerous lesion with the potential of becoming a true skin cancer may first appear as a tiny sore.

Deep wounds, skin breakdown and ulcerations on the surface of the body are really signs of more serious conditions deep inside. Examples are sores associated with poor circulation, diabetes, Lyme disease and AIDS.

Symptom Relief

The secret to treating sores is to treat the cause, but in most cases, a person really doesn't have a clue whether he's dealing with a case of shingles, impetigo or bedbugs.

"There's no such thing as a general, all-purpose treatment for sores, because they have so many different causes," says Stephen M. Schleicher, M.D., clinical instructor of dermatology at Temple University Medical School and Philadelphia College of Osteopathic Medicine and co-director of The Dermatology Center in Philadelphia. "You would treat a virus much differently than you would a bacterial infection, and what works on one cause may have disastrous results if used on another."

Because improper self-medication can delay healing, treating stubborn sores should be in the hands of a doctor. In the case of minor sores, the body's natural defense system is usually sufficient to clean up lesions on its own—given time and proper care. Here's how you can help.

Keep the sore clean. "The best thing you can do for sores is to keep them as clean as possible," says Dr. Schleicher. "You don't want to traumatize a sore by scrubbing it roughly. Just use gentle soap and warm water one or two times per day and pat it dry with a towel."

Keep most sores exposed and dry. "Open air on a sore will cause sores to dry up and encourage bacteria to move away," says Lawrence C. Parish, M.D., clinical professor of dermatology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. "Covering up sores will encourage bacteria and other germs to breed and fester." The exceptions are large open sores that are oozing pus, blood or liquid. These should be cleaned and covered tightly with a bandage to absorb the ooze and to keep out infectious germs.

Ditch the itch. Nothing will invite infection faster than scratching an itchy sore. Oral antihistamines like Chlor-Trimeton and Benadryl reduce the urge to scratch, says Dr. Dexter. So will bathing in Aveeno, a commercial colloidal bath product made from oatmeal. You can also apply a 0.5 to 1 percent hydrocortisone cream to the itchy sore, but ask your doctor first: Some infections will intensify if exposed to these medications. (For other ways to deal with skin itching, see page 469.)

Check your medicine cabinet. Some medications produce an allergic-type reaction, causing eruptions to appear all over the skin. Ask your doctor if a change in your medications is in order.

Ask your doctor about these treatments. Bacterial infections are treated with a variety of antibiotics. These include over-the-counter topical ointments like Neosporin and Polysporin and bacitracin as well as more potent oral and topical drugs like penicillin and cephalosporin. Prescription antiviral medications include acyclovir for chickenpox and shingles. Scabies respond to prescription creams like Kwell and Scabene. And over-the-counter medications like tolnaftates and miconazoles will handle most fungal infections.

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