Not only are cracked heels and soles unsightly to look at, they can cause pain or discomfort in the feet. Bleeding may occur in severe cases. Infection may also occur, particularly if the person is diabetic. Simple measures such as proper foot care, with particular emphasis on keeping the feet well-moisturized, may help to prevent cracked heels and soles of the feet. If not dealt with early, the skin around the heels may become thick and callused with deep fissures in it, which will make healing more difficult.

Causes of Cracked Heels

Dry skin may predispose to development of cracked heels. Callus (dry, thickened skin) formation around the heels may lead to cracked heels. This can be caused by pressure on the heels caused by prolonged standing. Increased pressure on the fat pad under the heel makes it expand sideways which ultimately leads to splitting or cracking of the callus. Obesity may be another predisposing factor. People who go barefoot or those wearing sandals or shoes that are open at the heel are more prone to cracked heels.

Skin conditions such as eczema and psoriasis may cause this problem. Medical conditions such as diabetes and thyroid problems may also predispose to cracked heels. Sweating of the feet for a prolonged period wearing socks or shoes may make the feet soggy, as well as working barefoot in damp or waterlogged conditions. This may cause the heels to crack. Fungal infections can further aggravate the problem.

Symptoms of Cracked Heels

The initial symptom of cracked heels is callus formation around the heel. The skin will be thickened, dry, and hard and small cracks may be seen over it. If neglected at this stage, the cracks will become deeper and can cause pain or discomfort on standing or walking. Bleeding may occur from deep cracks. The cracks may become infected and result in cellulitis in severe cases.

Neuropathic changes in diabetic patients often result in decreased sensation in the feet. In such cases, even severely cracked feet may be ignored due to lack of pain sensation. Such patients are at risk of developing foot ulcers which are often difficult to heal.

Treatment of Cracked Heels

A little care can help to prevent cracked heels. Keeping the heels well-moisturized, especially in the winter months or in dry weather, can not only prevent the formation of calluses and cracked heels, it can heal the condition in the initial stages. Soaking the feet in warm water for 10 to 15 minutes, followed by rubbing gently with a pumice stone can remove the thickened skin. This may be followed by application of a moisturizer to keep the feet soft and smooth. Heel balms containing keratolytic or water-retaining agents may be used, such as urea, salicylic acid, alpha-hydroxy acids, or saccharide isomerate. In case of deep fissures, a liquid, gel, or spray bandage can help to protect the area and allow it to heal, as well as relieve pain.

A podiatrist may be consulted in severe cases that are not amenable to the above measures. Treatment may involve :

• Identifying the cause and treatment of the underlying condition such as diabetes.
• Appropriate antibiotics in case of infection.
• Debridement or removal of the hard skin by cutting it away.
• Strapping the heels with bandage or dressing.
• Use of softening or debriding agents such as urea or salicylic acid.
• Use of heel pads, heel cups, or insoles.
• Special tissue glue that can hold the cracked skin together, thus allowing it to heal.
• Advice regarding appropriate footwear.
• Maintaining proper foot care at home on a regular basis.

Causes of Jock Itch in Women

Jock itch is mainly caused by a certain type of skin fungi known as dermatophytes. The two species that are most likely to be responsible for a groin skin fungus is Trichophyton rubrum and Epidermophyton floccosum. Less often, other Trichophyton species and Candidia (yeasts) may also cause a fungal infection of the skin. Although many people are exposed to these fungi, a skin infection only occurs in some. There are number of known risks but even in the face of these factors, it appears that individual susceptibility which may be genetic or some other as yet unidentified mechanism is a major component of developing fungal infections of the skin.

A fungal infection of the groin is more likely to arise with some underlying skin disease. A common predisposing factor in this regard is intertrigo – chaffing of the skin. This is more common in obese women where the skin folds provide two opposing surfaces for abrasion. Another factor in terms of chaffing is tight underwear which may irritate the skin in the area and make it prone to a fungal infection. Furthermore, the groin area is generally warm and moist as it is covered for most of the day and this provides the ideal conditions for fungi to thrive.

Although jock itch is more common in males, it is likely to arise in any person with one or more of these risk factors apart from those mentioned above :

• Living in a hot and humid climate
• Poorly fitting undergarments – too tight
• Using repeat courses of broad spectrum antibiotics
• Diabetes mellitus
• Immune deficiency
• Excessive sweating
• Poor personal hygiene
• Wearing wet clothes
• Not wiping dry properly after bathing
• Sharing personal items such as towels or underwear with an infected person

Signs and Symptoms of Jock Itch

The most common symptom is an itchy skin rash. It is usually a persistent itch which may ease with scratching but tends to return a short while later. The skin tends be scaling or peeling and while the area is initially red, it gradually becomes darker in color. A person often finds small specks of skin after scratching the area intensely. Sometimes there is musty odor with dampness in the area even without sweating. Burning, pain and heat in the area with a foul smelling discharge may indicate a superimposed bacterial infection.

Treatment of Jock Itch in Women

There are a number of topical and oral medication that can help to eradicate the fungus. Antifungal shampoo should be used in the area at least twice a week and antifungal cream should be applied to the area at least twice a day after bathing. Underwear needs to be changed twice daily and older underwear should be discarded at the start of treatment as it may contain fungal spores which can re-infect the area. The area must be kept dry with thorough wiping after bathing and using an antifungal drying powder if necessary. Oral antifungal drugs are only considered if the infection does not respond to topical applications. A low dose corticosteroid cream may help to relieve itching but long term use should be avoided as it can weaken the skin. Antibiotics are necessary when there is a secondary bacterial infection.

Causes of Melasma

Melasma does not only occur in pregnancy but is more common in altered hormonal states such as pregnancy, or with the use or oral contraceptives and hormone replacement therapy (HRT) in menopause. It can affect men but 90% of the cases occur in women. The exact mechanism for the development of melasma is still not fully understood. It appears that photo-aging as a result of sunlight exposure is a major factor and this may also be associated with estrogen sensitivity of these cells. The concentration of the natural skin pigmentation, melanin, is increased along with the number of melanin-producing cells (melanocytes) containing more melanosomes than normal. Other risk factors for melasma include :

• Darker-skinned individuals.
• Living in areas of intense sun exposure.
• Family history particularly a first-degree relative like a parent, sibling or child.
• Certain cosmetics particularly fragranced skin applications.
• Skin disorders and growths like moles.

Melasma may also be associated with unknown causes and risks (idiopathic).

Signs and Symptoms

Melasma may occur in three different patterns – centrofacial (in the centre of the face), malar (on the cheeks) or mandibular (along the jaw). The patches of hyperpigmentation are irregularly shaped but occur on both sides of the face. Melasma is classified into three types whether the pigmentation occurs in the superficial or deep layers of the skin or in both. Typically darker brown patches lie more superficially in the epidermis while lighter brown patches occur deeper in the dermis. Mixed types of pigmentation are a combination of dark and light brown patches affecting both the epidermis and dermis. Melasma does not present with any itching although patients may report some tingling or burning when exposed to intense sunlight.

Treatment of Melasma

Melasma is diagnosed based on the physical presentation. A Wood’s lamp will help to differentiate between epidermal, dermal and mixed  types of melasma. Hydroquinone, tretinoin and azelaic acid are the main topical applications used in the treatment of melasma. These applications are used on its own or sometimes combined along with other agents like fluocinolone acetonide. Corticosteroids are less frequently used these days. Laser therapy and chemical peels may be effective to varying degrees. However, the greatest difficulty lies with sun exposure which aggravates the condition. Although sun exposure cannot be totally avoided, patients on treatment should try to minimize sun exposure. While sunscreens with a high protective factor may be helpful, it does not preclude the need to avoid the sun. Results may vary – epidermal pigmentation responds better to treatment than mixed or dermal types.

Acne Before Pregnancy

Acne, if pre-existing prior to pregnancy, may settle or even totally resolve during pregnancy. However many pregnant women with pre-existing acne experience an aggravation. The oil gland (sebaceous gland) increases production of oil (sebum) and when this combines with dead skin cells, dirt or cosmetic applications, it will form a plug that will block the pore from which the oil exits onto the skin surface. This will form a papule (pimple) and if it gets infected by bacteria, it will become a large, cyst like pimple.

Myths relating to acne during pregnancy are usually unfounded. Whether you are pregnant with a male baby or eat unusual foods during pregnancy as a result of cravings has no bearing on developing acne during pregnancy.

Acne and the Oral Contraceptive Pill

One of the treatment options for acne is the oral contraceptive pill, which mimics pregnancy so that the body will not release an egg cell (ovum). One would think that pregnancy would therefore settle every case of acne, however this is not always the case. In fact, the converse is true. The female sex hormones exist at high levels during the course of pregnancy and this can affect the oil production on the skin as well. Women who had acne prior to falling pregnant are more prone to this aggravation.

Acne After Childbirth, Breastfeeding

After childbirth, acne that started up during pregnancy may not resolve. If breastfeeding, the hormonal change may persist for a period of time and this continues to contribute to the acne. However, breastfeeding women should not consider stopping feeding in order to settle their skin condition. This is irresponsible since breastfeeding can have a significant health impact on the baby, whereas acne is a cosmetic skin condition.

Treating Acne in Pregnancy

Any oral medication for the treatment of acne during pregnancy is not recommended, even antibiotics. Acne in pregnancy should be conservatively managed with a combination of good skin care and antibacterial skin applications. Vitamin A cream should be avoided altogether as there is always the risk of high amounts absorbing into the blood stream and affecting the fetus. It is important to not that acne during pregnancy is difficult to treat due to the extensive changes in hormone levels as a result of the physiological state.
Avoid using OTC (over the counter) skin care products until you first consult with your doctor. Not all these products are safe during pregnancy and even some natural or herbal acne products may have the potential to affect your pregnancy. Never continue with your oral contraceptive as a means of controlling the extent of the pimples and acne drugs like isotretinoin should never be considered. Attempting to cover up the pimples and acne scars with cosmetics like foundation or powder will often aggravate your acne further and lead to infections prompting the need for antibiotics. The best approach to acne during pregnancy or when breastfeeding is patience and a “wait and see” approach.

Causes of A Fungus Under the Breast

The dark, warm and moist conditions under the breast is ideal for any skin fungus to thrive and even spread with time. A fungal infection under the breast usually arises as a secondary infection due to other factors, usually persistent chaffing or injury of the skin, known as intertrigo. The breaks in the skin is prone to infection, bacterial or fungal, unless appropriate measures are taken to stop the skin irritation. A breast fungus can affect any woman due to the micro-environment of the target area but some women are more prone to developing a fungus under the breast.

Predisposing Factors

Some of these risk factors for developing a breast fungus may also cause other skin conditions that may lead to  itchy breasts.

• Tight brassieres or incorrectly fitting bras.
• Larger busts, pregnant, breast feeding women, women with naturally large busts and obese women.
• Pre-existing skin conditions in the affected area like eczema and psoriasis.
• Fungal infections elsewhere on the body.

Treating a Fungal Infection Under the Breast

A breast fungus may appear similar to other skin diseases and it is important that your doctor diagnose a skin fungal infection before commencing treatment. Most breast fungi are caused by skin yeasts (candida) and are medically known as submammary candidiasis. Using an antifungal ointment for a few months usually resolves the infection although oral antifungals may have to be considered in severe cases. A corticosteroid cream may be used if the itching and inflammation is severe but should be a short term  measure. The affected area may become dry and start cracking or peeling and a suitable emollient may be necessary.

Preventing a Breast Fungus

It is important to identify any predisposing conditions that may be contributing towards a persistent breast fungus. Tight underwear or poorly designed bras are by far the most common cause of chaffing under the breast and should be changed immediately. Treating any pre-existing skin conditions should be the first consideration to prevent a skin fungus from setting in. An antifungal drying powder may be useful for reducing the sweat and moisture under the breast, especially in women with larger busts or those who tend to perspire profusely.

A prolonged fungal infection under the breast usually causes a dark discoloration of the skin which may not resolve spontaneously. This can be quite distressing for most women and it is therefore important to attend to a breast fungus as soon as it appears. Always consult with a medical doctor for the appropriate treatment or the fungal infection may persist, spread and affect surrounding skin.