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Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here today with Dr. Mark Eliason. He is an assistant professor of dermatology. Some people are very terrified that a bite might actually be due to a spider such as a brown recluse or a black widow. How often does that occur and if you have been bitten by one of those types of spiders, should you seek medical attention?

Dr. Eliason: Well, first, I should say that they are actually very rare. We do see spider bites that happen, but when they do, you can often see a change. You can actually see the little fang marks on the skin, although that's hard for most people to see. They're very small.

Dr. Miller: Not like a rattlesnake bite?

Dr. Eliason: No, definitely not. They're smaller than that. But they're usually extremely painful right at the site where the bite occurred, and then they’re less so farther away. Most bites that happen from the dangerous spiders like the black widow or the brown recluse or the hobo spider, which sometimes happens here in Utah as well, those can be associated with what we call necrosis, which is skin that starts to die locally. The skin turns a dark purple color. It starts to die a little bit. And usually the problem with these is that people get secondary bacterial infections. It's not so much that the spiders' bite that hurts them. It's the lack of wound care that then leads to further problems.

Dr. Miller: So if you see a spider, and you are bitten by one, you should probably seek some medical attention, or not?

Dr. Eliason: Well, by and large, the spiders, the most prevalent ones that are in this area, particularly the ones that live in homes are very seldom the dangerous ones. Hobo spiders do like to live in certain types of homes. I don't want to make everyone paranoid about that. But they don't like people. They run away from us. They avoid us. They don't sneak out at night and bite.

Dr. Miller: Most spiders do.

Dr. Eliason: Yeah. So with few exceptions, most spider bites could be managed just by washing the area with a topical antibiotic like the bacitracin or polysporin you can get from the store, and then if the area that was bit, that dark red or darkened area doesn't expand, people don't get a fever. Usually, you can just watch those.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: November 27, 2018
originally published: March 24, 2015

Dr. Miller: Your child has eczema. How do you stop that scratching and itching that's driving them crazy? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Miller: I'm here with Dr. Mark Eliason. He's an assistant professor in dermatology. Mark, how do you help kids get through eczema?

Dr. Eliason: I'd love to talk about that. Eczema also called atopic dermatitis in children. It's a condition that occurs . . .

Dr. Miller: Atopic, what does that mean?

Dr. Eliason: Oh, atopic means that someone develops eczema with kind of a family disposition. It's not that they ran into something that caused the eczema, it's not that they're doing something wrong, their skin just tends to do this easily on its own.

Dr. Miller: So they tend to come from a family of scratchers and itchers?

Dr. Eliason: A lot of people in their family probably have it. So, when we help and we counsel parents who have children who have atopic dermatitis, we talk to them about some strategies they can use at home. In addition to some of the medications they can get from their pediatrician or dermatologist, there are some simple things that they can do to make it better. One of them is to try to make sure the skin stays moist. Kids with atopic dermatitis dry out a lot faster than the average person, and their skin doesn't always look dry. It doesn't always look flaky or look like it's peeling off, but it is dryer than the average person's skin.

Dr. Miller: So would that be more common in dry climates?

Dr. Eliason: It's exacerbated and worsens in dry climates such as Nevada and Utah.

Dr. Miller: Perfect.

Dr. Eliason: Yeah. So what we often talk to people about are ways to avoid making the skin dryer. And this sounds pretty counter-intuitive, but bathing can actually be a problem. Our skin stays moist, not because of water, but because of oils that we produce naturally, and children with atopic dermatitis make less of this oil and they can't keep it in there like a normal person can.

Dr. Miller: So too frequent bathing could definitely be a cause . . .

Dr. Eliason: Right.

Dr. Miller: . . . or an exacerbant.

Dr. Eliason: Precisely. In our culture, we encourage people to bathe every day, but in actuality, our skin doesn't actually need it, and it can actually be harmful. It's okay to take a bath that's warm, that's comfortable. But a bath that's blazing hot is not good. Or a bath that's too long, longer than 10 minutes or so can actually start to pull more oils out than they have and it will make things worse when they get out of the bath.

Dr. Miller: Now what would be the typical age range for children with eczema? What would be the peak ages, if there is such a thing for eczema?

Dr. Eliason: Well so it happens at any time. For most kids, it happens before puberty, and then it will sometimes happen though in adulthood.

Dr. Miller: It tends to get better after puberty?

Dr. Eliason: So it's a rough estimate, but about a quarter of kids grow out of it as they go through adolescence. When we talk to parents also, we talk to them about simple things they can also try to help their kids with, which includes things like when kids are bathing, you want to use milder cleansers, not the harsh bar soaps but maybe mild soaps, the kinds that don't bubble up or form a lot of lather.

Dr. Miller: Such as?

Dr. Eliason: Cetaphil cleansers is one example. Eucerin cleansers, a lot of these soaps that are kind of targeted towards dry skin or hypoallergenic can be helpful. Soaps that have fragrances in them can also be irritants. When your kid get out of the bath tub, it's also a useful thing to do is to moisturize them right away using creams instead of lotions, as lotions don't really moisturize as well as the cream does.
Kids that still are having problems beyond that sometimes benefit from the use of antihistamines, things like Benadryl in the evening. Again, you want to make sure they're safe to take those, but those can take away some of the itching, and by helping kids get a little bit sedated will actually help them fall asleep sometimes when the flares are really bad.

Dr. Miller: So frequent bathing, not a great idea, use mild soaps, and use creams to keep the skin moist.

Dr. Eliason: Exactly. And we even have children sometimes be on creams into ointments or things that have names like Aquaphor or even Vaseline is a simple, very effective thing that can keep the skin very moist and lubricated, and it helps to avoid overuse of some of the prescription medicines that doctors use.

Dr. Miller: And so if those things aren't working, maybe see the dermatologist?

Dr. Eliason: Definitely.

Dr. Miller: Thanks very much, Mark.

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Dr. Miller: You've had a big reaction to a bug bite. When should you see a physician? We're going to talk about that next on Scope Radio. I'm Dr. Tom Miller.

Announcer: Access to our experts with in-depth information about the biggest health issues facing you today. The Specialists with Dr. Tom Miller is on The Scope.

Dr. Miller: I'm here with Dr. Mark Eliason. He is an assistant professor in dermatology. Mark, sometimes I have patients come into the office with a large, red, inflamed area where they've been bitten either by a tick or even stung by a wasp, or a bee, and my understanding is that they don't necessarily need to be treated for an infection, but this is just a reaction to the sting that may take a few days to go down. Could you comment on that?

Dr. Eliason: Sure, I'd love to. So when we get a bite or a sting or some sort of an insect penetrates our skin in some way, it can often look very impressive. People can get reactions that range from the size of a dime to the size of your hand, and even though it's large and it can be very frightening to see that, it often is something that is self-resolving, and it will get better whether it's treated or not.

Dr. Miller: Now sometimes these patients will seek antibiotics thinking that it is an infection and they need to be treated, but my understanding and training has been, no, in most cases, that's not true.

Dr. Eliason: That's right, and it's a hard thing to sometimes make a distinction for because when someone has a real infection, the skin is red, it's hot, and it often hurts. These bites can also be red and they can be swollen and sometimes it will overlap with the systems that we are worried about, but there are some things you can watch for that can help you understand, is this something that's worrisome enough it should be treated with prescription medication, or can some simple maneuvers at home take care of this.

Dr. Miller: Now what kinds of medications other than antibiotics might affect or help with this kind of a large reaction?

Dr. Eliason: In most cases, these reactions, especially the ones that happen quickly within a couple of hours from the bite or the sting, are mediated or caused by a molecule in your skin that's called histamine. Therefore, medicines that are antihistamines such as Benadryl and Allegra and Zyrtec are my first-line treatments for these. These usually work pretty fast. You have to be aware, some of these are sedating, and so people that take them can get pretty tired, so when you pick them up, if you're not certain which ones make people tired and which ones don't, check with the pharmacist or ask if this is going to make you fall asleep when you're driving your car because you don't want to do that.

Dr. Miller: Mark, depending on which antihistamine you take, whether that's sedating or non-sedating, how quickly should you see a response in reducing the size of the bite?

Dr. Eliason: Sure, so the Benadryl seems to work a little bit faster, and for most people, within a couple of hours, the swelling starts to go down. That's not the case in all situations. Sometimes it takes a whole day to see the improvement. But generally, it's pretty fast. The non-sedating antihistamines like Zyrtec and Allegra are designed to stay in our system a little bit longer, that means it takes a little bit more time for them to have an effect, and so most people may take a whole day after they take those before they can see swelling improve.

Dr. Miller: Regarding one of the most common sedating antihistamines, Benadryl or diphenhydramine, which it's known as generically, would you recommend taking one or two pills at the beginning?

Dr. Eliason: Sure. It's often based upon weight. So an average-sized adult could actually take safely more than one Benadryl. I have some patients and of course we look at other medicines that they're on first to make sure this is okay, but they'll take between two to four Benadryl depending on what we're treating and if they're a large enough individual to take that, so a 70-kilogram/150-pound person can usually take 2 Benadryl very safely, and it does work better than just one.

Dr. Miller: So you might think that there would be an infection though it wouldn't be very common if the redness started to spread up the arm or if you developed a fever or if you had some of the other signs of infection, then at that point you should probably be seen by a physician.

Dr. Eliason: Absolutely. When bites or these reactions occur on the skin and they're symmetric, they look like a nice oval or a nice circle and they're kind of the same distance in each direction, usually that's associated with a local reaction to whatever the insect put in the skin when the bite happened. When they're spreading, when people get lines in the arms or someone's reporting that they're getting a figure, that's a horse of a different color, so to speak. Those are things that need to be addressed by a physician.

Announcer: Have a question about a medical procedure? Want to learn more about a health condition? With over 2,000 interviews with our physicians and specialists, there’s a pretty good chance you’ll find what you want to know. Check it out at TheScopeRadio.com.

updated: July 2, 2019
originally published: March 3, 2015

Dr. Miller: Hives, what are they? How do we get them? And what do we do about them? This is Dr. Tom Miller on Scope radio. We're going to talk about that next.

Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier and healthier life. You're listening to The Scope.

Dr. Miller: Hi, I'm here with Dr. Mark Eliason. And he is a professor of dermatology here at the University of Utah. And Mark is going to tell us a little bit about hives. What are hives? What's a hive? I think of a beehive but I don't know if that's what a hive is.

Dr. Eliason: This is the right state for that. No, well a hive is simply... the easiest way to think about it is like a bug bite. Imagine a mosquito bite. Something that's raised, it itches, and it bothers you. Most all hives will itch. And there are a lot of things that will cause them as well. But generally speaking, they're raised areas on the skin that are red and usually they will draw your attention to them.

Dr. Miller: I mean, do they happen rarely? Do some people get them and others don't? I mean, who get's a hive?

Dr. Eliason: So, we know that anyone who spends any time outside, especially in the morning or in the evening during mosquito season certainly knows what hives are. You can get a lot from the environment. But beyond just the hives that come from insects that bother you, a number of people develop hives spontaneously. And that can be because they have an allergy to something that they've taken, or something that they've eaten. Or they can also get hives sometimes without anything that they've done wrong, so to speak. Their body sometimes just makes their own hive.

Hives are interesting things to think about because it's an old reflex that our bodies have built into it that draws our attention to a part of us. And if you think about it, when something hurts, we pull away from something. Hurting is a way for our bodies to say, "Stop what you're doing." Itching and hives are a way to tell us that we need to pay attention to a part of our body.

Dr. Miller: Like a mosquito bite. You're near mosquitoes, move away from them.

Dr. Eliason: Right, or something is in us that's itching. Pull that thing out of us. And so it's sort of an opposite built in reflex that sometimes gets turned on inappropriately if something triggers it when it shouldn't.

Dr. Miller: Now, I think our audience might actually be interested in the spontaneous hives, because I've had patients who come in and they describe hives as being something that just pops up in an area that they didn't have any insect bite. So tell me about that a little bit. Because I think if people have hives that are due to, say mosquitoes, they kind of know what's caused that. But sometimes they just don't know.

Dr. Eliason: Sure, and hives can be scary. Because sometimes you get one or two little spots that will show up on your skin and that's not too much of a problem. But people will come in sometimes, they can be covered in hives. And not only are they just uncomfortable because they're itching like crazy, but it's frightening. Some people will feel parts of their body swelling. Like their lips can swell. They can feel like, sometimes they get nervous. Their breathing can be affected too. Hives can become something very worrisome.

Dr. Miller: But more rarely, correct?

Dr. Eliason: That's correct. I should be careful to tell you that most of the times hives that happen on the outside of the body, don't actually cause problems with breathing. But it is one of the things that people watch out for. The number one rash that people go into the emergency room for are hives.

Dr. Miller: So let's talk about that for a second. So let's say a person has never had hives before and they develop one or two episodes, do they need to see a physician? Or should they just maybe not worry about it so much?

Dr. Eliason: That's a great question. And a lot of it depends on what the hives are doing to them. People that are developing a handful of hives, some that are bothersome but they're not affecting at all the way that they're working or their ability to do the things they do during the day, usually don't necessarily need to see a physician until they've tried some of the over the counter products that are available to treat hives easily.

Dr. Miller: And what would those be?

Dr. Eliason: Of course assuming that people don't have any reasons why they couldn't take them, simple things like Benadryl or some of the non-sedating antihistamines with names like Zyrtec or Allegra. Or of course the generic equivalents of those are very safe things for people to start to just try to treat their hives and see if you can get them to go away easily.

Dr. Miller: Is one better than the other? The non-sedating versus the sedating? Because some people will take Benadryl and fall asleep at work, which is bad. Or if they're operating expensive dangerous machinery. That could be a problem.

Dr. Eliason: Right. That's a great point because any medicine that you give someone, if you give them enough of it, you can get side effects with it. So during the day I usually advise patients to consider using things like Zyrtec or Allegra because those are non-sedating. And most people do great with them.

Dr. Miller: Now how often do you find a reason for someone to have spontaneous urticaria? Aside from an insect bite.

Dr. Eliason: Yeah, this is a hard question. And with the spontaneous or acute urticaria, that's the kind that just shows up. It's only around for a couple of weeks. We don't always find the causes. In children it's usually related to an infection. And so it doesn't mean you have an infection that's creating your hive. You could have an infection like a common cold. You could have strep throat.

Dr. Miller: A virus.

Dr. Eliason: Exactly.

Dr. Miller: Or a bacterial pharyngitis.

Dr. Eliason: Precisely.

Dr. Miller: Sore throat.

Dr. Eliason: Those infections can, they don't cause hives, but your body's response to the infection accidentally creates hives on you. It's almost like your body makes a little bit of a mistake while it's cleaning out the infection and incidentally creates hives in the process.

Dr. Miller: Well when should that patient find their way to your office?

Dr. Eliason: We like to see patients when it bothers them. And so for some people that means that they get hives and they have a chance to try some of the over-the-counter antihistamines. And they don't work. In which case we certainly want to help them because there's a lot of other things that we have access to, prescription-wise, that can be stronger.

Dr. Miller: Do you have a definition of, sort of, mild, moderate, or severe hives in terms of how often they occur or how extensive they might be? Maybe that would help our audience know when they should seek medical advice.

Dr. Eliason: A lot of this isn't necessarily with the frequency but more of the severity. Hopefully I can make that make sense. When hives are developing and they aren't preventing people from doing what they normally do during the day, and they also are not causing any changes where parts of their body are swelling, then usually people can try over-the-counter products without having a worry that they need to rush in to see a physician for it.

If people are developing hives where they are getting swelling in their skin, so like I mentioned, lips can swell, ears can swell, or they can just have big welts. Their wrist gets too large. And it looks kind of doughy sometimes. Those are reasons to get into be seen by a physician sooner. Of course if people are having any difficulty breathing, it's a trip to the emergency room very quickly.

Sometimes when hives present, and they cause changes in breathing, people don't necessarily feel like they can't breathe. But they just start coughing sometimes. And those are things to watch for. Of course, you don't ever delay in that case. If you ever feel, if people ever feel like they can't breathe normally, it's straight to the ER.

Dr. Miller: Thank you very much. This is very helpful Mark.

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updated: August 21, 2018
originally published: February 23, 2015