I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.
A pilonidal cyst tends to announce itself in a particular way. They usually have complaints of difficulty sitting down or laying on their back because of pain.
A pilonidal cyst is a fluid-filled sac that forms above the crease of the buttocks. The cysts are usually red, inflamed and most often infected when I see them. In many cases the cysts are hard, but sometimes they have a small hole in them where some fluid or blood has been draining. Pus (milky yellow/green fluid) is sometimes draining from them as well. The drainage often has a foul smell.
Cause: The cause of these cysts is not clear. They may form when a hair is forced under the skin or when a hair follicle ruptures. Or, a person may be born with the cyst. These cysts are often diagnosed in people between the ages of 16 and 26. But people of any age can have a pilonidal cyst. And they affect both men and women.
Treatment: We usually refer patients to a surgeon who can drain the cyst or remove it with surgery. They are often very painful, so performing an incision and drainage in the urgent care or clinic is often not possible because the patient requires a higher level of pain control and possibly conscious sedation to tolerate the procedure. To drain a cyst, the medical provider will first numb the area and then cut open the cyst with a scalpel and push the fluid out. They will then wash the area to clean it thoroughly and sometimes they might pack the empty cyst with gauze or leave a drain in place so that it doesn’t fill up with blood or pus again immediately. The drain or gauze can then be removed in a few days. We usually try to provide the patient with medication for pain, and often recommend sitting on a doughnut-like pillow with a hole in the center to help with pain.
Removing the cyst entirely often requires a more extensive surgical procedure because pilonidal cysts often have a sinus (small channel) that goes deep under the skin and can lead to another cyst or be deep enough to almost touch the sacrum or tailbone area. Patients with multiple cysts often need an even larger surgical procedure and consequently the recovery time can be much longer for multiple or larger cysts.
I hope that you have found this information useful. Wishing you the best of health,
Carrying extra weight is one of the recognized risk factors for pilonidal disease and for it coming back after surgery. Weight is the other half of my practice now, so if that is on your list, here is what Wegovy and Zepbound cost without insurance.
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.
Splinter in a fingertip. Photo by Arria Belli, public domain, via Wikimedia Commons.
Splinters look like the simplest possible problem, right up until one of them is not. I thought I’d discuss some different types of splinters and some techniques that you can use at home to remove them. In addition, it’s important to know when to have it taken out in person for help with that process.
Splinters are common in both children and adults, usually a small foreign body embedded in the superficial or subcutaneous soft tissue of the hands or feet. Wood, glass and metallic splinters are the most common types. Many splinters can be removed at home by our patients, which leaves the physicians only the deeper and larger splinters or retained splinters that have been broken down during an attempt at removal. If splinters are not removed completely, they may cause complications such as infection and inflammation.
When to see a medical provider: I recommend that you see a medical provider instead of trying to remove the splinter yourself if there is lots of redness around the splinter, increased swelling or pus draining from the wound.
The severity of the reaction and type of reaction that the body has to a particular splinter. Some examples of reactions to retained foreign materials include:
1) Glass – Mild reaction and the body attempts encapsulation
2) Blackthorns – Severe reaction with inflammation from the plant alkaloids
3) Wood – Severe reaction with inflammation from the oils and resins
4) Cactus Spines – Moderate to severe reaction from the fungal coating on the plant and possibly an allergic reaction
5) Rose thorns – Moderate to severe reaction with inflammation from the fungal coating on the plant
6) Sea urchins – Moderate to severe reaction with inflammation and possible infection
7) Metal – Mild reaction and the body attempts encapsulation
8) Plant spines – Mild to severe reaction from the toxins in the plant
9) Animal spines – Mild to severe reaction from the toxins in the animal spines
10) Plastic – Mild reaction and the body attempts encapsulation
Sometimes splinters can be difficult to detect, especially if they are deep or very small. Clues that a splinter is present might be swelling, tenderness, a mass, or soft tissue infection such as cellulitis, or an abscess. Sometimes we might use a diagnostic test such as a x-ray, ultrasound, CT scan or MRI to detect a splinter if it’s deep and difficult to see.
Removal: We try to remove splinters quickly before inflammation or infection occurs. There are several ways to remove a splinter, some of those might include:
1) Using tweezers: Make sure you have the right kind of tweezers. The sharp tipped splinter tweezers work best most of the time. If the sliver is sticking out of the skin, clean the pair of tweezers with alcohol and carefully pinch the sliver as close to the skin as possible and gently slide it out.
2) Use a small needle: If the sliver isn’t sticking out of the skin, often a needle can help push the sliver out. First clean the needle with alcohol and then push the sliver from the bottom (the pointed end that entered the skin first) and angle upward toward the puncture hold in the skin’s surface. Try to start at the bottom of the sliver so you don’t break it and leave sliver shreds in the skin.
3) Use a razor blade to make a small slice in the skin over the sliver: If the sliver is deep and using tweezers or a needle isn’t working well, you can clean a razor blade in alcohol and make a shallow incision parallel to the sliver, just above it. I know this sounds scary, but the top layer of skin is made of dead skin cells that do not have nerves, so this is not likely to hurt unless you cut too deeply. Once the incision is made, gently part the skin and pick out the sliver.
4) Clean the wound: Whatever method you use to remove the sliver, make sure you clean the wound with soap and water after the sliver is removed. Puncture wounds are often laced with bacteria and are very likely to become infected.
5) Antibiotics: Apply a small amount of antibiotic ointment such as bacitracin over the puncture wound.
6) Examine the area at least once a day for the next several days to look for increasing redness, swelling or pain. If any of these occur, I recommend that you see a medical provider because this might be the start of an infection.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
I can’t tell you how many patients come in to the clinic because of a callus or corn that’s bothering them – too many to count! Corns and calluses can cause significant pain, especially when they’re on the feet because we often get them in areas over pressure areas. When they get thickened they can re-distribute your weight onto other areas of your feet and that may lead to foot instability or worsening pain.
Calluses are usually on the hands and feet and basically just thickened areas of skin that form when something rubs or presses on these areas over prolonged periods of time.
Corns are thickened areas of skin that are often on the soles of the feet or sides of the toes and look like a small nodule that has a hard center. Corns are usually more painful because they are often over a smaller area and press harder on a more specific area of the foot.
Causes: Possible reasons that calluses or corns develop include:
1) Wearing shoes that don’t fit properly for your feet – either too loose or too tight
2) Walking barefoot
3) Wearing shoes without socks
4) Calluses on the hands can be caused by repetitive sports such as rowing, golfing, tennis or biking without gloves
Prevention:
1) Get shoes that fit properly! It’s important to be proactive and to prevent calluses or corns if they bother you. There are special shoe stores that work with foot doctors to help you select shoes that fit your feet properly. Some people are born with narrow or wide feet and that makes it more difficult to find shoes that fit properly. If you are getting painful corns or calluses, take time and visit a store where someone can help you to pick out shoes that fit you well
2) Avoid going barefoot or wearing shoes without socks
3) If you have spots on your feet that rub inside your shoes, you can get special pads that prevent rubbing
Treatment: I often work with patients who come into the clinic to trim the corn or callus down so that it reduces the pressure in the affected area. I use a scalpel to carefully trim away the thickened skin. A foot doctor (podiatrist or orthopedic surgeon who specializes in treating conditions of the foot/ankle) can make special orthotic devices that can help reduce the pain and help prevent recurrence of corns/calluses. Some people treat calluses themselves by purchasing special pads that contain medications to burn or dissolve the thick skin. I highly recommend that patients with diabetes be seen and treated by a medical provider to reduce the risk of infection. Diabetic patients are at increased risk of foot infections and should be seen for yearly foot examinations even if they don’t have calluses or corns.
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Reviewed and updated August 2026. Originally published June 2012.
I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.
A patient came into the clinic today and said she had a couple lumps in her left armpit (axilla) that have been very painful and draining some clear liquid. She told me that she had one before in her right arm pit and she had it treated by taking antibiotics and a doctor also performed an incision and drainage.
Hidrandenitis suppurativa (HS) is a condition in which there is red, swollen painful bumps in places where the skin rubs together. The nodules can make it difficult to move because they are so painful. They can also smell foul and drain pus or blood. These bumps may go away on their own, but often stay for weeks to months and often come back.
Causes: This is not caused by being unclean – it’s not an infectious disease. Often the area may become irritated by shaving in that area or a certain deodorant or antiperspirant. You cannot spread this to anyone else as it’s not contagious. It is generally a genetic condition that is more common in first-degree relatives that have the condition.
The bumps or nodules are usually located in the:
1) Armpits (axilla)
2) In the groin
3) Under the breasts (in women)
4) On the inner thighs
5) Buttocks
6) Around or near the anus
Often the skin hardens and scars around the painful nodules and some can form tunnels under the skin.
Treatment: Possible treatment options include:
1) Antibiotic liquids or gels that you put on the affected areas – these actually work to reduce inflammation rather than treat infection
2) Antibiotic pills – to reduce inflammation
3) Injections of steroid medications into the areas to bring down the inflammation
4) Some women take hormone treatments to improve their condition
5) Surgery
Things you can do to reduce your symptoms:
1) If you are overweight, lose weight because this condition is more common or severe in people who are overweight
2) Try to avoid activities that cause your skin to rub against itself
3) Do not wear tight-fitting clothes
4) For people with recurrent infections, the use of an antibiotic lotion such as clindamycin 1% applied to the area twice a day can help prevent recurrence.
5) Show and wash the tender areas everyday gently. Do not scrub with a washcloth, brush or loofah
6) Avoid smoking
7) Use antiperspirants rather than deodorants
8) Avoid exposure to hot, humid environments as much as possible
I hope that you have found this information useful. Wishing you the best of health,
Updated for 2026: There Are Real Drugs For This Now
When I wrote this in 2012, hidradenitis suppurativa was a condition I could describe far better than I could treat. There were no approved medications for it. Antibiotics, drainage, and surgery, and a lot of people cycling through all three for years.
That has changed, and if you were told years ago that nothing much could be done, you were told something that was true then and is not true now.
Three biologics now carry FDA approval for moderate to severe disease. Adalimumab, a TNF inhibitor, was first, approved in 2015. Secukinumab, which blocks interleukin 17A, was approved on October 31, 2023, dosed at 300 milligrams every four weeks with the option to move to every two weeks if the response is not enough (1). Bimekizumab, which blocks both IL-17A and IL-17F, followed on November 20, 2024, with phase 3 responses holding out to forty eight weeks (2).
Two approvals in about a year, after a decade with one. That is the most movement this condition has seen in my career.
Staging Still Drives the Decision
Hurley staging has not changed and it is still how severity gets sorted. Stage one is abscesses without tunnels or scarring. Stage two adds recurrent abscesses with sinus tracts and scarring. Stage three is diffuse involvement with multiple interconnected tunnels (3).
The stage is what decides whether this is a topical and antibiotic conversation or a biologic conversation. It is worth knowing yours and asking for it by name.
What This Looks Like Over Video, and Where It Does Not Work
I can do a fair amount here. History, how long, what triggers a flare, what has already been tried and how far each was pushed. The effect on your life, which in this condition is enormous and routinely under-asked. Photographs of known lesions over time are genuinely useful for tracking whether something is working.
Where video runs out is staging and starting a biologic. Counting nodules and tunnels, and mapping how far the disease actually extends, needs hands and an in-person look. Starting a biologic also needs screening bloodwork first, tuberculosis testing and hepatitis serologies among them. That is a referral, not a video prescription, and I would be doing you a disservice to pretend otherwise.
The most useful thing I can do from here is name it correctly and get you to a dermatologist, because the average person with this condition spends years being told they have recurrent boils.
When To Be Seen Promptly
Fever, feeling systemically unwell, or redness spreading fast, which suggests infection beyond the usual flare. A lesion tense and painful enough to need draining. And any long standing wound in advanced disease that will not heal, changes character, or starts behaving differently, because squamous cell carcinoma arising in chronic hidradenitis is rare but real and is the reason nobody should be managing stage three alone.
The Bottom Line
If your information about this condition is more than a few years old, it is out of date in a way that matters. Find out your Hurley stage, and if it is moderate or severe, ask specifically about biologics. This is no longer a condition where the honest answer is to keep draining them.
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Recently I’ve been noticing patients are coming in with sunburns even though the weather has been cloudy. They are often unaware that the sun is causing damage to their skin at the time, and come in later with severe sunburns. Even on cloudy days, it is important to protect your skin because UV radiation can pass through the clouds and cause sunburns. In addition, UV rays can be reflected off surfaces like sand, snow, cement and water.
Prevention: Here are several ways to help prevent sunburn:
1) Avoid sun exposure: If you plan to be out in the sun during the day, keep in mind that the suns rays are strongest between 10:00am and 4:00pm in the continental U.S. and avoiding exposure during these hours decrease your risk of burning. Wearing a topical sunscreen as well as clothing that blocks the suns rays are helpful in reducing your chance of sunburns.
2) Find Shade: Areas that don’t have direct sunlight reduce your chances of sunburn. These areas include under trees, an umbrella or structures such as porches, or tents. A topical sunscreen is still recommended while sitting in the shade because your skin is still exposed to some UV radiation.
3) UV Index: One way to predict your risk of sunburn on a given day is a numerical value called the UV index. It is a number between 0 and 11+, in which 0 indicates a lower risk of sun exposure and 10 indicates high risk with 11+ an extreme risk. You can find the UV Index online.
4) Sunscreen: There are many sunscreen products on the market, and most of them work by protecting the skin via absorbing the radiation or reflecting it. SPF or Sun Protection Factor is a numerical indicator that gives us some idea of how much protection the sunscreen offers against UVB (Ultraviolet B) burns. It’s important to look for a sunscreen that protects against both UVA (Ultraviolet A) and UVB rays – sometimes they label these products broad-spectrum. Here are some additional tips.
A) I often get asked what SPF rating is best. My first response is usually “the maximum you can get,” because I realize that even low levels of ultraviolet radiation increase your risk for sun damaged skin, skin cancers and a poor cosmetic outcome with increasing age. The American Academy of Dermatology recommends an SPF of 30 or greater on sun exposed skin with protection of UVA and UVB and recommends a higher SPF in your are fair-skinned or will be out in the sun for longer periods of time or anticipate intense exposure (such as on a beach or skiing trip).
B) Use enough: I find that most people don’t use enough sunscreen, and they don’t put it on soon enough. Your really need about 2 tablespoons of lotion to cover an adults arms, legs, neck and face. If you want to cover your back and chest, you will need more than that. You should also apply it at least 15-30 minutes before going out in the sun for it to become active.
C) Reapply: Even if the sunscreen bottle says that it’s sweat-proof, or water-proof, I recommend reapplying every 2-3 hours or after drying off with a towel or swimming. There is some evidence that suggests that after being out in the sunlight for 20 minutes, you should reapply the sunscreen even if you’re not in the water or haven’t been sweating profusely.
D) Protect your lips: Make sure your remember to protect your lips with lip balm that has an SPF of 30 or higher and reapply frequently.
E) Buy new sunscreen each year: Chemical sunscreens become less effective with time. Leaving them in the sun or where it is hot, such as in the car may speed this degradation process. Expired sunscreen is likely less effective and reduces the SPF rating.
Definition: Sunburns occur when the skin is burned by UV radiation. Often sunburns are not severe, but it’s the exposure over years that increase your risk of skin cancer, wrinkles and other cosmetic concerns. In todays society, we often think about the immediate gratification which might include a suntan, however often the harmful consequences come years later often after we are no longer spending as much time in the sun. I show my younger patients who have sunburned skin several photos of older patients who’ve spent years in the sun or had sunburns over years. Hopefully that helps them understand the consequences that come with repeated exposure so they can make more informed decisions about protecting their skin from harmful radiation.
Symptoms: Sunburns are often not immediately apparent because the redness and pain develop 3-5 hours after being out in the sunshine. Redness of the skin that is hot and painful to touch is common. There may also be blistering and swelling over the affected areas. The redness is usually at it’s worst by 12-24 hours after sun exposure and this fades over 72 hours.
Causes: Melanin is a pigment in the skin that causes your skin to appear dark or light colored. Your skin can temporarily increase the amount of melanin to help protect from burns (suntan). The amount of ultraviolet radiation that is needed to burn your skin depends on several factors:
1) Melanin: The amount of melanin in your skin affects how quickly you can get burned. People with light colored skin and light hair generally have a higher risk of sunburn compared with patients with dark colored skin. Some individuals with a low amount of melanin can burn in less than 15 minutes.
2) Location: There is increased UV radiation due to more direct sunlight near the equator so individuals who are in these locations are at more risk of sunburn (Hawaii for example).
3) Medications: Certain medications can increase the risk of sunburn including ibuprofen, some blood pressure medications such as hydrochlorothiazide (HCTZ), and some antibiotics such as tetracycline.
Complications: Premature skin aging, permanent discoloration of the skin, wrinkles, skin cancers such as malignant melanoma, basal cell and squamous cell carcinomas, cataracts (the lens of the eye becomes cloudy).
Treatment:
1) Stay out of the sun until the redness and pain go away. Repeated sun damage after a recent burn is even more harmful.
2) After noticing a sunburn, I often recommend immediately taking ibuprofen or Aleve to help with the pain
3) Cool compresses, and aloe-based lotions and sprays
4) Sprays with a local anesthetic that numbs the skin such as Solarcaine may help decrease the pain but they do not decrease the long-term risks of skin cancer and sun damaged skin.
If you have had repeated sunburns, a history of skin cancer, or strong family history of skin cancers, I recommend that you see a dermatologist at least every year for a head to toe skin examination.
To find a Dermatologist in your area, the American Academy of Dermatology’s Website has a very useful locator: http://www.aad.org/find-a-derm
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Patients often come into the urgent care and ask about lesions on their skin. It’s a very good practice to have skin lesions examined by a medical provider because without actually seeing the lesion, it can be difficult to make the proper diagnosis. As you probably know, some skin lesions can be cancerous and so proper diagnosis is critical to ensure you get the right treatment and prevent complications.
Skin tags are non-cancerous lesions that are an outgrowth of normal skin. They occur in about 25% of adults and are more common as we age. They commonly occur at areas of skin friction such as in the armpit (axilla), on the neck, under the breast tissue, or in the groin. They can become painful when jewelry or clothing rub on them. If they get twisted, the blood supply to the skin tag can tear or become compromised and they sometimes change to a red or black color.
Diagnosis: I recommend that you have any skin lesion that you’re unsure about examined by a medical provider. If you have a history of skin cancer or family history of certain types of skin cancer, I recommend being examined by a dermatologist at least once a year and perhaps even more frequently. The diagnosis of skin tags is usually fairly easy based on the appearance, but they must be differentiated from other types of skin lesions that may look similar.
Treatment: If you have healthcare insurance, it may not provide coverage for removal of skin tags if they are being removed only for cosmetic reasons. Usually if they are painful or bleeding however, health insurance will cover the treatment for removal. Some possible treatment options for removal include:
1) Using forceps and fine grade scissors – these lesions often bleed vigorously so larger lesions may need suturing or cauterization
2) Cryosurgery or liquid nitrogen treatment. This freezing treatment is often done by super-cooling fine tipped forceps in liquid nitrogen and then gently squeezing the “stalk” of the skin tag to freeze it. The procedure of freezing and un-thawing is similar to treating warts.
3) Electrodessication
Recurrence: Unfortunately, skin tags can come back soon after they are treated.
To find a Dermatologist in your area, the American Academy of Dermatology’s Website has a very useful locator: http://www.aad.org/find-a-derm
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Seborrheic keratosis. Photo by Lmbuga, public domain, via Wikimedia Commons.
Patients often come in to see their doctor because of skin lesions that they are unsure about. I encourage anyone with a skin lesion they are unsure about be evaluated by a medical provider because some lesions can be cancerous or pre-cancerous.
Seborrheic keratosis (SK’s) are very common, often developing after age 50 and occasionally as a young adult. They are non-cancerous lesions and are more common in some families (genetic). There is no way to prevent the development of new lesions.
They are non-cancerous but have been reported in association with a number of other skin malignancies, most commonly basal cell carcinomas and infrequently, melanoma. The sign of “Leser-Trelat,” is the sudden onset of multiple seborrheic keratoses in association with skin tags and acanthosis nigrans. This has been associated with a variety of cancers including gastrointestinal and lung cancers.
Diagnosis: The appearance of the lesions is usually characteristic “stuck-on” or “warty” looking and they may be tan, light brown or dark-brown to black. They are most commonly on the trunk of the body, face and arms/hands. They are often scaly. Microscopic examination is sometimes needed if they are small or atypical.
Treatment: These lesions do not need to be treated, but due to cosmetic reasons they can be removed. Insurance will usually not pay to have them removed unless they become painful, or bleed. They can be treated by:
1) Excisional biopsy – we send the specimen for examination under the microscope to rule out cancer if the lesion is suspicious
2) Shave excision
3) Cryotherapy with liquid nitrogen – sometimes a lighter skin pigment may occur after treatment and healing
Again, I encourage anyone with a skin lesion that they are unsure about be evaluated by a medical provider because some lesions can be cancerous or pre-cancerous.
To find a Dermatologist in your area, the American Academy of Dermatology’s Website has a very useful locator: http://www.aad.org/find-a-derm
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Acute urticaria. Image CC0, via Wikimedia Commons.
Some patients come to the urgent care with swelling or puffiness under the skin, usually in the face, eyelids, ears, mouth, tongue, hands, feet or genital area. The most common place that we see this is on the upper lip but it can occur in many areas on the body. We call this condition angioedema.
Hives are another common problem that sometimes occur with angioedema. They are red, raised patches of skin that are generally very itchy. Urticaria is the medical term for hives. They are raised areas of skin that itch intensively and are red with a pale center. About 20% of people get hives at some time during their lives. When someone comes into contact with a substance that they are allergic to, the body releases histamine from mast cells. In most cases, hives appear and the disappear within several areas, and so the rash may look like it migrates or spreads around the body. Sometimes the red raised areas get bigger or merge together and form larger hives. Hives are generally not painful and do not have blood-blister type areas in them. Hives usually do not appear with fever and joint pain.
Causes of Hives: There are several possible and may include:
1) Infections – viral infections that cause the common cold are the cause of hives in 80% of children
2) Medications
3) Painkillers such as codeine or morphine
4) IV contrast dye
5) Insect stings
6) Food allergies – typically occur with 30 minutes of eating the food. Typical foods that cause hives include milk, eggs, peanuts or other nuts, soy, wheat, fish or shellfish.
7) Physical contact – After touching a certain substance such as animals, certain plants, raw fruits/vegetables or latex (found in balloons, latex gloves and condoms)
Causes of Angioedema: In people who get angioedema for the first time, it might be because of a new allergy. Allergies are common to several of the following and can cause angioedema or hives:
1) Medicines such as antibiotics or aspirin
2) Foods such as eggs, fish, nuts or shellfish
3) Insect stings
4) Exercise can cause angioedema or hives
5) Environmental substance such as a plant, animal, laundry detergent, soap, perfume latex, etc.
6) Many times we are unsure of what caused the angioedema or hives to occur
7) Certain blood pressure medications called “ACE Inhibitors” such as lisinopril, enalapril, captopril (and many others) can cause angioedema
8) Ibuprofen/Advil or Aleve
Treatment: Minimizing exposure to the allergic agent is the first step. Depending on the severity of symptoms, your medical provider may provide treatment including a second-generation antihistamine such as cetirizine, loratadine or fexofenadine, which is preferred over older sedating agents like diphenhydramine (Benadryl), and in more severe cases prednisone or another steroid (either pills or shots) .
Prevention: Avoiding foods, medicines or exposure to insects that you have allergies to can decrease your chances of developing angioedema or hives. Some people take antihistamines every day to help prevent getting angioedema if they get it frequently.
When to seek medical care: Make sure you are evaluated by a medical provider right away if you have any of the following:
1) Trouble breathing
2) Tightness in the throat
3) Nausea/vomiting
4) Abdominal pain/cramping
5) Passing out or fainting
I hope that you have found this information useful. Wishing you the best of health,
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Quite a few patients come to the urgent care and see me for an animal bite. Usually it’s a dog or cat bite, but sometimes I’ve seen patients who’ve been bit by a squirrel or raccoon and then there’s the rare person who is worried that a bat might have bit them. In the US, two to five million people get bit each year and children are bitten much more often than adults.
Most people worry about the possibility of rabies, although an infection in the skin is much more common. Bites on the hands can be serious because the skin surface is close to underlying bones and joints.
Dog bites: Most dog bites are to boys between the ages of 5-9 years old, and the most common areas to be bit are on the head and neck for the younger children. The right hand is the most frequent site of injury for older children and adults. The complications of the bite range in severity from tearing away a body part to deep open cuts, crush injuries, to minor scratches. In Washington State, we have not had a rabies case from a dog bite in many years and do not routinely give rabies treatments for individuals bitten by a dog unless it is known to have rabies infection.
Cat bites: Claws or teeth can cause wounds from cats. 67% of cat bites are on the arms or hands and scratches are most often on the face. Puncture wounds that are deep from a cat bite is concerning because bacteria from the cat’s mouth can go deep into the wound and cause infection to the underlying bones or joints. Infections from cat bites generally cause increased redness to the skin, swelling and pain as early as 12-24 hours after the bite and progress quickly.
Rodent bites: Rats are the most common rodents that cause bites, but squirrels, hamsters, rabbits and guinea pigs are generally all treated the same way as cat bites.
Other bites: Bites from raccoons, skunks, fox, coyote or bats should be evaluated right away even if the bite is small and does not look like it’s infected. These animals can carry rabies and medications are generally given to prevent rabies infection in individuals who are bit by these types of animals.
Treatment: The first step is to clean the wound with soap and lots of water. In the event of bleeding, gauze pads can be applied and pressure used to stop the bleeding once the wounds have been washed.
When to seek medical care:
1) The bleeding has not stopped after applying pressure for 15 minutes
2) There is a broken bone or serious injury such as large or deep laceration
3) The bite victim has medical problems such as diabetes, cancer, HIV or takes medication that weaken the immune system
4) The animal is from one of the animals listed above which have a high risk of rabies
Antibiotics: Skin infections are the most common complication of an animal bite. High-risk wounds such as on the face, or involving the bone or a joint are usually treated with an antibiotic. Many experts also recommend antibiotics to treat people bitten by cats because of the high risk of infection from cat bites. Most of the time oral antibiotics such as Augmentin are given to treat animal bites however in severe bites with infections that are already present, we will use IV antibiotics.
Tetanus immunization: Tetanus is a serious, and potentially life threatening infection that can be transmitted by animal or human bite. If the last vaccine was greater than 5 years ago, the patient should receive a tetanus vaccine.
Sutures (aka stiches): Wounds on the face are usually closed to avoid developing a scar however due to the risk of infection, some bites may not be sutured immediately. They may be flushed with a sterile solution and left open for 72 hours after injury and watched closely for signs of infection.
Infected bite wound: If bite wounds are not treated appropriately right after the injury, an infection may develop. Surgical treatment and antibiotics may be required at that point.
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
Reviewed and updated August 2026. Originally published April 2012.
I am Scott Rennie, DO, board certified in Family Medicine and Obesity Medicine. I practice entirely by telemedicine, licensed in all 50 states. Most of my work now is weight loss, metabolic health and menopause care. If this was useful, Start here lists what I write about now.
Onychomycosis due to Trichophyton rubrum. Image: CDC Public Health Image Library #579, public domain.Tinea corporis (ringworm). Image: CDC Public Health Image Library #2909, public domain.Moccasin-type tinea pedis. Image by Dr Gannavarapu Narasimha Murthy, CC0, via Wikimedia Commons.
People come to their doctor quite frequently due to fungal infections of the skin or nails. One might think that because of the name, “Ringworm,” it would be caused by a worm, but it is actually caused by a fungus. The shape of the rash looks like a ring and thus it got its name. It’s a red, itchy rash on the skin and is also caused tinea.
Four different type of ringworm infections are named for the body-part that is affected:
1) Tinea capitis affects the head or scalp and is mostly seen in children
2) Tinea pedis affects the feet and is called athlete’s food because athlete’s common acquire it in the locker room
3) Tinea cruris affects the groin and is also called jock itch because it also commonly affects athletes or “jocks” presumably because of the moisture on the skin that the fungus prefers
4) Tinea corporis is a term for fungal infections that affect other body surfaces
Ringworm is a contagious infection and can be spread by someone else who is infected or even by an infected dog or cat. It may be spread in a shower stall, locker room floor or pool area. Often small skin shavings from the infected person are left behind in these areas and an unknowing person touches the infected area with their feet or other body part.
Tinea capitis: a fungal infection of the scalp may be related to cradle cap in children. It causes a red scaly rash and can lead to bald patches. It rarely affects adults. We treat scalp infections with either oral or topical medications or a combination of both. Children often improve with the use of gentle massage of the scalp during a bath to remove the scaly areas and then use of an antifungal medical on the scalp to kill the bacteria. Adults and children are usually treated with oral medications and treatment can take 2-12 weeks depending on the severity of the infection.
Tinea pedis (athlete’s foot): the skin of the feet (often between the toes of the 3-5th toes) become itchy, red, tender, cracked and scaly. We also see it on the soles of feet and in this area it is usually scaly and simply looks like dry skin. Sometimes blisters form on the feet, especially between the toes. It’s very important to treat athlete’s foot in diabetic patients because the fungal infection predisposes the patient even worse – a bacterial infection in the feet. Diabetic patients can have a decreased sensation on their feet, so they can develop worsening infections without realizing it. We usually start by removing the dead, scaling skin from the feet, and then treat athlete’s foot with a topical antifungal cream such as Lamisil AT twice a day for up to 12 weeks. The fungus can live on the skin even after the scaling skin is gone, so it’s important to treat the infection even for 1 week after the infection is totally gone. This infection can be very difficult to treat because if you miss a day of applying the cream, the fungal infection can grow rapidly. It’s important to keep the feet as dry as possible because fungal infections grow better in warm, damp areas.
Tinea corporis (body infection): often occurs when the fungal infection is transferred from one part of the body to another. It is commonly seen in high school wrestlers. It usually appears as a circular or oval scaly area with an outer red edge that is slightly raised while the center is usually flat and skin colored. We treat this infection with a topical antifungal medication twice a day for 1-2 weeks. Wrestlers may not be allowed to compete (by their school policy) until their infection clears.
Onychomycosis (fungal nail infection): a fugal infection of the nail that causes the nail to thicken, and change color such as white, yellow or brown. This type of infection happens most commonly in the toenail but can also happen in fingernails. Fungal nail infections are common and don’t usually lead to serious long-term problems. It is usually very easy to diagnose a fungal infection of the nails just by examining them. Most over the counter medications don’t work for fungal nail infections. In fact even prescription medications don’t work very well, and most fungal nail infections return after being treated with oral antifungal medications. In addition, the oral medications used to treat fungal infections of the nails can cause severe liver disease, so I usually don’t recommend treating this type of infection and instead recommend keeping the nails trimmed to prevent nail fracture or trauma.
Preventing ringworm:
1) Do not share clothing or sports equipment/towels with others
2) Wear slippers or sandals at the gym, local pool or public shower
3) Wash with soap and shampoo after skin-to-skin contact with others
4) Avoid tight-fitting clothing to allow the skin to dry
5) With athlete’s foot, put socks on before underwear to prevent spread of the fungal infection to other parts of the body including the groin
6) Treat pet fungal infections to prevent spread to humans
7) If a family member has a fungal infection, make sure they get treatment right away
To find a Dermatologist in your area, the American Academy of Dermatology’s Website has a very useful locator: http://www.aad.org/find-a-derm
I hope that you have found this information useful. Wishing you the best of health,
Athlete’s foot and thickened fungal nails matter more than they look, because the cracks they leave between the toes are a common entry point for a deeper foot infection. That risk is highest in diabetes, which is why I wrote a separate post on how to check and protect your feet when you have diabetes.
Updated for 2026: There Is a Resistant Ringworm Now
When I wrote this in 2012, ringworm was a nuisance with a reliable answer. Put an antifungal cream on it, wait a couple of weeks, done. For most people that is still true.
But a genuinely new problem has arrived and it is worth your knowing about, because it changes what to do when the cream does not work.
Trichophyton indotineae emerged on the Indian subcontinent and has spread internationally, including to multiple US states. It is frequently resistant to terbinafine through mutations in the squalene epoxidase gene. One documented US case had a terbinafine minimum inhibitory concentration of 16 micrograms per milliliter, which is to say the drug was doing essentially nothing (1).
It tends to look different. Extensive rather than a tidy ring. Often on the face, trunk, and groin at once. Sometimes a ring inside a ring. Intensely itchy, widespread, and stubborn in a way ordinary ringworm is not. It has also been reported as possibly sexually transmitted (2).
The frustrating part is that an ordinary fungal culture cannot tell it apart from garden variety Trichophyton. Identifying it takes specialized gene sequencing available at only a handful of labs. Itraconazole usually works, but often needs more than three months.
Terbinafine resistant Trichophyton rubrum, the far more common species, is also increasing in the United States (3).
What That Means Practically
Mostly it means stop assuming that treatment failure is your fault for not applying the cream long enough.
If you have had an adequate course of a topical antifungal, or a proper course of oral terbinafine, and the rash is still spreading, that is not a reason to run the same drug again. That is a reason to have the diagnosis reconsidered and, if it still looks fungal, to change class rather than repeat.
For ordinary tinea nothing has changed much. Body and groin ringworm respond to a topical antifungal over about two weeks, and the terbinafine class tends to clear it slightly faster than the azoles. Athlete’s foot takes longer, roughly four weeks with an azole. For toenails, oral terbinafine 250 milligrams daily remains first line, and current guidance is to confirm the diagnosis with testing before committing someone to months of an oral antifungal (3).
The Video Visit Version
Most of what I need for this one I can get from a photograph and a few questions, which makes it a reasonable fit for a virtual visit.
What helps me is a well lit close up, plus a wider shot showing how far it extends. Tell me how long it has been there, what you have already tried and for how long, whether anyone else at home or any pet has it, and whether you have been treating it with a steroid cream, because a steroid on ringworm changes its appearance and makes it worse.
Where I will send you elsewhere is toenails. If we are talking about months of an oral antifungal, I want the diagnosis confirmed rather than assumed, and roughly half of thickened toenails turn out not to be fungal at all.
When To Be Seen In Person
Extensive or rapidly spreading tinea that has already failed proper treatment, which raises the question of the resistant species and needs specialized testing. Scalp involvement, which needs oral treatment and cannot be handled with cream. Pain, warmth, or spreading redness suggesting a bacterial infection on top, particularly if you are diabetic. And any widespread fungal infection if your immune system is suppressed.
The Bottom Line
Ordinary ringworm is still ordinary and still responds to cream. What is new is that a failed course now means something. If two weeks of the right treatment has not touched it, do not just buy another tube. Get it looked at again.
Scott Rennie, D.O. Board Certified in Obesity Medicine and Family Medicine
This blog is for educational purposes only and does not constitute individual medical advice. Always consult your own physician before making changes to your health, medications, or treatment plan.
