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In this episode of Skinside Out, Dr. Zain Husain, Heather, and Courtney break down the most common summer skin problems they see in the dermatology office, including poison ivy, contact dermatitis, phytophotodermatitis, folliculitis, sunburns, fungal infections, bug bites, tick bites, heat rash, and swimmer’s itch.
They explain what these conditions can look like, what causes them, how they’re commonly treated, and when a rash or bite deserves professional attention.
You’ll also hear why limes and sunlight can cause a surprising skin reaction, why sitting in a wet bathing suit can lead to trouble, what a bull’s-eye rash may mean after a tick bite, and why not every suspected spider bite is actually a spider bite.
The goal isn’t to keep you indoors—it’s to help you enjoy summer while protecting your skin.
00:00 – Summer skin survival guide
01:00 – Poison ivy & contact dermatitis
06:00 – Lime + sun reactions
09:00 – Folliculitis & hot tubs
12:00 – Sunburns
16:00 – Fungal infections
19:00 – Ringworm & athlete’s foot
22:00 – Bug bites & spider bites
25:00 – Tick bites & Lyme disease
27:00 – Heat rash & swimmer’s itch
29:00 – When to see a dermatologist
30:00 – Summer skin takeaways
00:00 – Summer skin survival guide
01:00 – Poison ivy & contact dermatitis
06:00 – Lime + sun reactions
09:00 – Folliculitis & hot tubs
12:00 – Sunburns
16:00 – Fungal infections
19:00 – Ringworm & athlete’s foot
22:00 – Bug bites & spider bites
25:00 – Tick bites & Lyme disease
27:00 – Heat rash & swimmer’s itch
29:00 – When to see a dermatologist
30:00 – Summer skin takeaways
Creators and Guests
Host
Host
What is Skinside Out?
Welcome to Skinside Out, where science meets beauty, the ultimate dermatology podcast! Dive deep into the fascinating world of skin health with expert insights, evidence-based discussions, and myth-busting truths. Each episode explores the medical, cosmetic, and surgical aspects of dermatology, while keeping you informed about trending skincare topics. Whether you’re a skincare enthusiast, medical professional, or just curious about how to achieve your best skin, Skinside Out is your go-to resource for staying informed and inspired.
64 - Skinside Out
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Dr. Zain Husain, MD: [00:00:00] Welcome to Skin Side Out. I'm your host, Dr. Zane, with Heather and Courtney. So today we are going over our summer skin survival guide. So we're gonna be talking about rashes, irritation, bites. You name it, we're gonna talk about it, so let's get right into it. So Heather, what are the most common things that we see during the summertime in our clinic?
Heather: Um, we see a lot of contact dermatitis, whether that's irritant or allergic contact, which we'll get into. Um, phytophotodermatitis, which is [00:01:00] one of my favorite ones. I think it's- I
Dr. Zain Husain, MD: love the word, too.
Heather: Yeah. Mm-hmm. It's surprising. People don't expect you to-
Dr. Zain Husain, MD: Mm-hmm ...
Heather: to know about your history, so we'll get into that.
Yeah. Um, arthropod assaults, which are pretty much just bug bites. Um- Yeah. Those are probably my top three Sunburns. Yeah, I
Dr. Zain Husain, MD: guess. Like, excessive ones. Sunburns. Yeah, ringworm and- Mm-hmm ... you know, other skin infections. So we're gonna get into all that. So let's start off with contact dermatitis since it's so common.
I mean, I see at least half a dozen cases of poison ivy dermatitis every year in the summer, and it's incredible that, you know, patients come in and have no idea what it is. And these rashes are typically linear in nature, so, you know, brushing up against the poison ivy leads to rashes, sometimes really intense where we get blistering.
Mm-hmm. A lot of itching. It's very uncomfortable. And the interesting thing is you can actually [00:02:00] spread the resin from the plants to other parts of the body, and you can kind of induce this kinda whole body contact dermatitis.
Heather: Mm-hmm. Yeah. I had a, um, this, um, acquaintance that I knew in high school. He... I think he had thrown poison ivy into, like, the bonfire.
Oh. And I think the resin- Mm ... like, got on his face. Ooh. Yeah. Yeah. That's rough. Yeah.
Courtney: Yeah, I know even, like, sometimes dogs can bring it on their fur. So even if you have pets- Mm ... you have to kinda watch out if you know. '
Heather: Cause they don't really get a reaction.
Courtney: No.
Dr. Zain Husain, MD: I had a patient who went camping, and, you know, didn't really have a bathroom.
And they had used- Oh, no ... some leaves after number two and chose a poison ivy leaf. Oh.
Courtney: Oh. Ouch.
Dr. Zain Husain, MD: Yeah, that was pretty bad.
Courtney: Yeah.
Dr. Zain Husain, MD: Um, have you guys had poison ivy before? No.
Courtney: No.
Dr. Zain Husain, MD: So I'm the only one. So I- Yeah. So I [00:03:00] distinctly remember, I was in fifth grade, um, had it all over- Mm ... and it was so itchy, uncomfortable, and I was covered in calamine lotion.
I was like this pink blob. Mm-hmm. I had to go to the nurse's station to get reapplication.
Heather: Aw.
Dr. Zain Husain, MD: And it was miserable. So after that, I'm really careful about, you know, covering up or s- avoiding any, like, wooded areas, um, just because poison ivy's so ubiquitous.
Courtney: Mm-hmm. Yeah, I ha- First of all, I don't even know what poison ivy looks like.
I think we've talked about this on the podcast, or I've talked about it. It's got a thumb.
Dr. Zain Husain, MD: Leaves of three.
Courtney: Leaves of three, but I don't understand that. It's a
Heather: little thumb.
Courtney: Okay, the thumb makes more sense, and I think you told me that because I was like, "There's so many leaves of three."
Dr. Zain Husain, MD: What was that tip again?
Heather: It's like, I think if you look at photos of the leaves, it's they've, they have a little thumb sticking out on the side. Okay. And it's just on one side.
Dr. Zain Husain, MD: I see.
Heather: I think.
Courtney: I thought the leaves of three thing is always just the stupidest thing, because how many- There's so many plants ... plants have three leaves?
Yeah.
Heather: Yeah.
Dr. Zain Husain, MD: They're all shiny.
Courtney: Okay. That, that really puts a, like, a difference on the [00:04:00] poison ivy leaves.
Dr. Zain Husain, MD: Yeah. And poison oak and poison sumac also have a similar reaction. Yeah. So it's not like you can distinguish based on the rash. Right. It's more the history, and just kinda knowing what's in the local environment.
Heather: Yeah.
Dr. Zain Husain, MD: Um...
Courtney: I think the linear, um, nature of the rash does give it away a lot of times. Yeah. And then I think, like, distribution on the bo- like, obviously hands, arms, like, lower extre- you know, lower- Mm-hmm ... um, legs. Mm-hmm. But yeah, I think, um, when you see that linear, like, rash, then you're like, "All right, like-" Yeah
"were you outside at all? Were you hiking?" And they're like, "Oh, yeah, I was doing yard work." Yeah. Yeah. Yeah. It's always yard work. It's always do- it's always yard work. Always. Never do yard work.
Dr. Zain Husain, MD: See I don't need to do yard work because of the-
Courtney: Oh, yeah, your PTSD ... occupational risk. Your poison ivy.
Dr. Zain Husain, MD: Oh. But sometimes it's pretty intense.
You get blistering from that. Mm-hmm. And those are really gnarly. Um- Mm-hmm ... and oftentimes we have to use, like, systemic steroids- Mm-hmm ... to calm down the inflammation because it's so uncomfortable. Um, antihistamines, topical steroids, soothing soaks. Mm-hmm. Um, so in terms of, like, [00:05:00] the, you know, the treatment, I do think it's really worthwhile to see your dermatologist because otherwise you're gonna be in a lot of discomfort for a while.
Courtney: Mm-hmm.
Heather: Yeah, and so that's allergic contact dermatitis. There's also irritant contact dermatitis- Mm-hmm ... which we do see a lot in the summer. So you can get irritated or your skin can get irritated by coming into contact with lots of different things. Most commonly we see, like, harsh soaps, chlorine, um, any sort of, like, excessive water or sweat exposure- Mm-hmm
which we definitely see a lot of in the summer. Um, sunscreen ingredients, bug sprays, you can get a reaction to those too.
Dr. Zain Husain, MD: Yeah. So as you can see, I mean, contact dermatitis is pretty widespread, and just because we're more active, we're outdoors, we're doing different types of activities, um, just make us more prone.
Courtney: Mm-hmm. Mm-hmm.
Dr. Zain Husain, MD: All right, let's go to phytophotodermatitis, one of my favorite words.
Courtney: Me too. Yeah. Yeah, and I, I... This is so fun to, like, diagnose, right? Yeah. I, I, I think Heather and I are both thinking of the patient we had, like, a few [00:06:00] months ago. Well, it was Heather's patient, and I was helping out. I pulled him back, and, um, he comes in, and he has rash on his hands and then a little bit on his thigh.
And, you know, he gives me a little bit of the history, and the next question I asked, I said, "Oh, were you traveling at all?" And he goes, "Yeah, I just got back from Cancun." Mm-hmm. I said, "Oh, were you drinking, like, any, like, Coronas with lime or margaritas with lime, like squeezing the limes?" And he's, like, looking at me like, "Okay, you have my Instagram."
Like, "How do you know?" Yeah. He's
Heather: like, "Yeah." Like-
Courtney: Stalker ... he was perplexed. Yeah. He was like, "Yeah." And I said, "Okay, just checking," you know? In the back of my head, I'm like, "Phytophoto." I get Heather, and sure enough she comes in and, you know, explains everything to him. And- So
Dr. Zain Husain, MD: what is phyto- photodermatitis?
Heather: It's a reaction that you get from, technically from the sun, but there are certain chemicals within certain foods- Mm-hmm
that make you reactive to the sun. So, like, limes.
Dr. Zain Husain, MD: Mm-hmm.
Heather: Um, tomatoes I think are another- Mm-hmm ... big one. A lot of citrus. So, [00:07:00] yeah. Citrus foods, yeah.
Dr. Zain Husain, MD: Yeah, so it's phyto coumarins, that's what they're- Yeah ... called, those chemicals, and it's a very unique type of reaction. Mm-hmm. Um, so the light and those phytocoumarins- Mm-hmm
they have this reaction, leads to... And oftentimes it's in the distribution exactly where- Yeah ... it's contacting. Mm-hmm. So like splashing or dripping. Mm-hmm.
Heather: Mm-hmm.
Dr. Zain Husain, MD: Um, that's why it can kind of be a dead giveaway.
Heather: Yeah. I-
Courtney: I was gonna say, it's very well,
Heather: like, demarcated in an area. Yes. Yeah. I had a patient, um, previously who came in for this rash, and it was, like, linear streaks up the sides of her thighs.
Mm-hmm. And then she had, like, a little bit, like, on the sides of her buttocks and, like, the stomach, but, like, kind of streaky, and it was, um, like, very hyperpigmented at that point. Mm-hmm. Like, these aren't, like, scaly- Mm ... or anything like that. Mm-hmm. And she had gone to Mexico. Um, and she had said that she had a lot of margaritas, and then, like, the- Mm
the excess, [00:08:00] um, like, drink would get on her hands, and she wiped her hands, like, up her thighs and on her... Like, almost like you j- just kind of you're wiping your hands off, and she got that reaction in that pattern. And it took a long time to fade. But-
Dr. Zain Husain, MD: Yeah, I mean, it's surprising, the- Yeah ... hyperpigmentation.
Heather: Yeah.
Dr. Zain Husain, MD: It's pretty intense.
Heather: Yeah.
Courtney: And, and with the phytophoto also, I think another area that gets affected is the lips. And that is coming- Mm ... from someone that has- Has had this. Has been there. When I went to St. Martin in September, I was drinking margaritas. Mm-hmm. A lot of Cor- Corona's my favorite beer.
So yeah, I was drinking a lot of like lime-essenced items, and yeah, my lips were so swollen it looked like I had bad lip filler. I think I sent you a picture, and I was like ju- I was like, "Got lip filler on the island," 'cause they were like uneven. Oh, I
Heather: remember. Oh. Yeah, yeah. Yeah,
Courtney: yeah. It was so bad. I feel like it, yeah, it took forever to clear up.
Heather: Yeah.
Courtney: Yeah. Oh,
Dr. Zain Husain, MD: I s- thought it was still going on.
Courtney: Oh, no, well it happened again this weekend ac- I was gonna say that too. I don't know if it's wind burn or sunburn or phytophoto. There was a lot of contributing factors- Yeah ... this past [00:09:00] weekend. So- Do as I say, not as I do. I'm like peeling.
Dr. Zain Husain, MD: So remember, when you're on vacation, just be careful, um, especially if you're indulging in some beverages with citrus.
So just be careful. All right, moving on. Folliculitis, so this is a really common one. We're hot, we're sweating. Um, Heather, what do we typically see with these patients?
Heather: So folliculitis, just to break down the word, means inflammation around the hair follicles. Um, we can see this related to most commonly bacteria on the skin, but also like fungus and yeast can contribute, too.
Lots of, um, things that we do or wear in the summer can contribute to it, so like tight clothing, lots of sweating, shaving, that can all be irritating to the hair follicles. Um, that's, you know, just folliculitis in general, but then we also have hot tub folliculitis, which I guess you could see [00:10:00] any time of year, but that's a very specific type of folliculitis where you get, um, bacteria, specifically pseudomonas, which gets, um, into that hair follicle area and causes a reaction.
Dr. Zain Husain, MD: Which distribution do you typically see it in? What are the most common areas? Like I often see on the buttock area- Legs, yeah ... and on the legs- Yeah ... um, abdomen, 'cause that's kind of like where you're submerged Where you're sitting in
Heather: the hot tub.
Dr. Zain Husain, MD: Yeah.
Heather: Mm.
Dr. Zain Husain, MD: So remember to be careful about, you know, hot tubs, how they're being cleaned.
Um, pool maintenance is so important.
Heather: Mm-hmm.
Dr. Zain Husain, MD: Um, so just keep that in mind.
Heather: Yeah.
Dr. Zain Husain, MD: So what do we do, um, Courtney, for these patients who are suffering from folliculitis, these pimples and, you know, inflamed cysts that develop from this? What do we do?
Courtney: Um, usually you can calm it down with either a topical or an oral antibiotic.
So usually clindamycin tends to be, like, the first-line treatment- Mm-hmm ... a topical clindamycin. And then if someone's really having a more severe case, you could use something like a oral doxycycline- Mm-hmm ... or even sometimes, like, chemical [00:11:00] peels, like glycolic acid or sal acid I'll recommend for those patients if they're really just trying to get things at bay.
Dr. Zain Husain, MD: Yeah. And just from a daily skincare hygiene standpoint, you know, making sure that you shower, like, immediately after- Mm-hmm ... like, exercise or intense sweating.
Courtney: Mm-hmm.
Dr. Zain Husain, MD: Um, I like benzoyl peroxide as a wash or hypochlorous acid. Mm. And those kill the bacteria that are on our skin, which often lead to folliculitis.
Mm-hmm. So those little tips can really reduce your chances of developing folliculitis.
Heather: Mm-hmm, and changing out of your bathing suit- Mm. Mm-hmm ... too. Even if you, like, let's say you don't have access to a shower or anything like that, just changing into something more breath- breathable can help.
Dr. Zain Husain, MD: Yeah.
Courtney: Ugh, sitting in a wet bathing suit's like my nightmare situation.
Yeah.
Dr. Zain Husain, MD: Yeah. Like, gosh. It's like the worst.
Courtney: Yeah.
Dr. Zain Husain, MD: All right. Let's move on to sunburn. So Courtney's gonna take this, 'cause she got one last weekend.
Courtney: I did. You know what? I was gonna make, like, a video about that saying, like, we're all human, and sometimes things happen. You can take all [00:12:00] the preventative steps, and sometimes you're just human at the end of the day.
So yes, the esthetician did get the sunburn on a boat trip that was all day. whale watching, also on the Pacific coast Did you
Heather: bring sunscreen with you to repeat?
Courtney: No. I
Heather: She did
Courtney: it shorts out. I'm watching whales. Yeah. I'm seeing a once in a lifetime opportunity. Shame, shame. And I'm like, "Let me put my sunscreen on," you know?
Shame. No, I'm watching orcas, okay? So, so no. Sunburns we see obviously very commonly in the summertime. Um, it's basically like an inflammatory response to the UV damage to your skin cells. It's so common. I think, you know, living here in North Carolina, we just have such a beat down with the sun, and I think the UV really extends to almost, like, 7:00 sometimes.
Mm-hmm. I mean, it stays so light out. Mm-hmm. Um, but yeah, sometimes they can be tender, blister. You can have some swelling. Um, you know, dehydration sometimes in severe cases, like the sun poisoning- Mm-hmm ... which I think is- Mm-hmm ... a little bit more rare. I haven't seen [00:13:00] that in a long time. I guess people are taking better care of their skin.
I
Dr. Zain Husain, MD: often find that those patients already, like, go to the ER.
Heather: Yeah.
Courtney: Yeah. They
Dr. Zain Husain, MD: don't really come to, you
Courtney: know.
Heather: To
Courtney: me. Yeah. They're like... On their deathbed they're like, "Help me." But yeah, they, um... I would say very, very common, frequent issue.
Heather: Yeah. Mm-hmm.
Dr. Zain Husain, MD: So Heather, how do we treat them?
Heather: Um, I think it, it depends on the sunburn.
Usually for, like, some moderate sunburns, we'll give, like, a topical steroid- Mm-hmm ... to help calm down the inflammation. Usually, if I'm seeing milds in the office, they're using something like aloe or- Mm-hmm ... just something soothing.
Dr. Zain Husain, MD: Yeah.
Heather: Um, and a lot of times they've had the sunburn already, so like, for a- Yeah
at least a few days, so it's kind of on its way out for milds. Um, don't see a lot of severe, like, blistering or anything- Mm-hmm ... in the office.
Dr. Zain Husain, MD: Yeah. And what measures can patients take to avoid them, um, Courtney?
Heather: That's me.
Courtney: [00:14:00] A reapplication every two hours. Wear a hat. Um-
Dr. Zain Husain, MD: Sun protective clothing.
Courtney: Yeah. I did wear my SPF shirt, so obviously I didn't get burnt anywhere else, just the- It
Heather: was just your face.
Courtney: Mm-hmm. Yeah. And you know what? I normally do actually wear, like, a, a cap, but I wore... They said, like, with the whale watching and the wind and stuff to wear more of, like, a beanie to cover your ears. Mm. Mm-hmm. So that's, I think, a little... You know, not to blame anyone else, but, um- You
Heather: can wear, like, your rain jacket or your windbreaker with a hat on underneath.
Mm. Like
Courtney: a
Heather: cap.
Courtney: I'll remember that for next time. Yeah.
Dr. Zain Husain, MD: So you wa- definitely wanna avoid sunburns. And if you do get one, you know, we can help in the office, but, you know, remember that every sunburn is increasing your risk of developing skin cancer.
Courtney: Mm-hmm.
Dr. Zain Husain, MD: So that is really important, especially blistering sunburns.
Um, the incidence of melanoma is directly related to that.
Courtney: I'm gonna do a little soft plug right now for Playted, because I gen- I'm, like, a big believer right now that the Playted genuinely helped my sunburn so [00:15:00] much. Like, I got really badly burned, like, on my... Not ba- not really badly, but badly for me- Mm
um, on my nose, and I used the Playted, like, that and, like, basically three days after, and I feel like what normally would've taken me, like, a week or two, like, man, it just went down so fast. I mean, like, you can barely see- Mm-hmm ... any red, so.
Dr. Zain Husain, MD: Mm-hmm. Yeah. Yeah. So you think the exosomes, like, reduced the inflammation-
Courtney: Oh, 100%
Dr. Zain Husain, MD: probably also accelerated the
Courtney: cell turnover. The cellular repair. Yeah. Mm-hmm. I absolutely think that. Yeah. I mean, it was... Compared to other times that I've had, like- Mm ... burns like that, I mean, it was night and day. So- Yeah ... yeah, I think that could be helpful.
Heather: Yeah.
Dr. Zain Husain, MD: All right. So let's go on to the next category, which are skin infections.
So fungal infections are really common, right? We're sweating. We're moist. Um, we're not necessarily always, like, changing our clothes, um, frequently. So what are the type of fungal infections that we see?
Heather: Um, we see tinea. There's different types of tinea. So most commonly I think we see tinea versicolor and- Mm-hmm
um, tinea corporis, which is ringworm. [00:16:00] But tinea versicolor is, um, a little bit different. It's not the same fungus that tinea corporis is caused by. Um, it's usually caused by Malassezia, which is a yeast that we all have on our skin, but it really likes warm, moist environments, so we see it commonly flare in the summer.
Um, I've had a couple cases recently, like on the back, especially for like females who do hot yoga- Mm-hmm ... or something like that. I've seen that, um, lately.
Dr. Zain Husain, MD: So how does it present? What does it look like?
Heather: So, um, it can look different on different skin types. So for lighter skin types, it looks like more of like a, um, hyperpigmented kind of like s- annular or circular to oval patches.
They may have like a very fine scale on the outer edge. Um, a lot of times they're not very itchy. Mm-hmm. But they're very common on the trunk, but you could get them, you know, [00:17:00] in other places, too. Um-
Dr. Zain Husain, MD: Why does it look more prominent in the summertime?
Heather: Because a lot of times people are getting more sun exposure- Mm-hmm
and so the contrast between the, the rash and the normal skin is heightened. Mm-hmm. But in darker skin types, we do typically see, like, hypopigmentation- Mm ... within the rash itself.
Dr. Zain Husain, MD: Yeah. Um, and Courtney, what do we typically, um, treat our patients with?
Courtney: Usually antifungals. So whether that be topical, sometimes we'll use a topical, um, ketoconazole cream- Mm
or even a shampoo as, like, a wash in the shower. It tends to be a chronic, um, like, people who, they have the tendency to kind of get this, like, during the summertime, like, almost like a, you know, repeat offenders. But- Yeah ... um, and then also if it's really severe enough might warrant, like, a oral, like fluconazole or something.
Mm-hmm.
Dr. Zain Husain, MD: Yeah.
Courtney: Um.
Dr. Zain Husain, MD: I feel like patients get reinfected with the same type of activities. Yeah. Mm-hmm. And, you know, they just think that it never went away, but- Mm-hmm ... they just got reinfected. Yeah.
Courtney: Yeah. Athlet- yeah, athletic people, like athletes, like you said, [00:18:00] yoga I think- Mm-hmm ... is a huge one. Um, yeah, more active people I, I would say tend to get this more.
Yeah.
Dr. Zain Husain, MD: I've had some patients, um, you know, think that they got vitiligo with the hypopigmented version- Yeah ... of the, "Am I getting vitiligo on the freak out?" I'm like, "No."
Heather: Yeah.
Dr. Zain Husain, MD: Um, which this is a lot easier to treat. Yes. Yeah. Um, so reassuring the patient's always helpful. But with the hyperpigmented spots too, like, patients are thinking, "Oh, like, I've been out in the sun.
Is this, you know, sun damage?" Mm-hmm. And then like, I'm like, "Yeah, the tan's causing you sun damage, but those spots- Mm ... actually are- Mm-hmm ... an infection."
Heather: Yeah. Usually vitiligo's more depigmented. Mm-hmm. Mm-hmm. So there's a much more distinct contrast, and a more of a, um, like, distinct border between the rash and the normal skin.
Whereas a lot of times, like you mentioned, like some people who don't have the scale- Mm-hmm ... it'll be kind of a fade from normal skin to light skin. Yeah,
Courtney: it's like more mottled.
Heather: Yeah.
Courtney: Yeah.
Dr. Zain Husain, MD: Yeah. Yeah. All right. So let's go to ringworm then. Closely related, um, different fungus.
Heather: Mm-hmm.
Dr. Zain Husain, MD: So how do, how does ringworm typically [00:19:00] present?
Courtney: Ringworm is also usually, like, a circular pattern. I would say more, like, discreetly circular than, like, versicolor. Like, versicolor can be kind of more, like, sporadic I guess. Mm-hmm. But yeah, it's typically more, like, circular. And it's funny 'cause I feel like everyone always thinks they- Yeah ... have ringworm.
Dr. Zain Husain, MD: Yeah. Always.
Courtney: Always. And it's actually n- I won't- I'm not gonna say it's rare, but, like, it's not as- Mm-hmm ... it's usually eczema. Yeah. Like, you know, people come in, they have a circular patch, and they're like, "This is ringworm." Yeah. Yeah. And it's, no, it's eczema. But yeah, it's usually gonna be circular. Um, also have, like, that kind of slight scale to it.
Dr. Zain Husain, MD: Mm-hmm. Mm-hmm. Yeah. Usually annular or ring-like.
Courtney: Mm-hmm.
Dr. Zain Husain, MD: Mm-hmm. Um, I've also had patients who've had granuloma annulare- Mm-hmm ... like, and they're constantly treating with antifungals- Yeah ... in the past. And, you know, I'm like, "This is a little bit more papular." Mm-hmm. Um, it looks a little bit more suspicious. We do a biopsy- Mm-hmm
and usually confirms a diagnosis. So there are a lot of mimickers. Mm-hmm. So I mean, the answer's not always ringworm.
Heather: Yeah. Yeah. The same tinea, we see, um, I guess a lot on the feet too, so tinea pedis. Mm-hmm. [00:20:00] Which is, like, athlete's foot. We, I think we see that a lot in the summer. Yeah. So, like- Hot and sweaty environments, locker rooms- Mm-hmm
swimming, a lot- Jock itch. Yeah, jock itch. Mm-hmm. Tinea cruris. Mm-hmm. Um, so a lot of the tinea, um, conditions are- Mm-hmm ... based on, like, their name is based on their location. Wow. So, like, tinea capitis is- Mm-hmm ... in the scalp. Tinea cruris is in the groin. Tinea corporis is on the body. Tinea pedis is on the feet.
Tinea
Dr. Zain Husain, MD: unguum is up
Heather: here. Tinea unguum, yeah. And tinea
Courtney: manus, is that-
Dr. Zain Husain, MD: Yeah. Yeah.
Heather: Yeah. Yeah, hands. Yeah.
Dr. Zain Husain, MD: Yeah. So obviously, with, you know, these fungal infections, like tinea versicolor, we're treating with antifungals- Mm-hmm ... and typically does the trick. Topical creams usually are mainstay of treatment. I also use topical shampoos that are antifungal.
Mm-hmm. We typically have patients use it in a manner where they're leaving it on- Yeah ... for a few minutes before rinsing it off- Mm-hmm ... so it has enough time to penetrate and really treat the fungus. For more, um, [00:21:00] severe cases, we do use oral antifungals. Mm-hmm. Yeah.
Heather: And try to avoid, like, sharing towels when you can.
Mm-hmm. Um, changing out wet clothing. Again, try to keep your shoes dry, um, 'cause, 'cause this, um, fungus does like those wet environments.
Dr. Zain Husain, MD: Yeah.
Courtney: And wear socks with your
Dr. Zain Husain, MD: sneakers. Oh my God, yeah, please.
Courtney: I, I'm s- like, it
Heather: needs- Common sense stuff. Preach
Dr. Zain Husain, MD: it.
Courtney: Oh, it i- Preach it ... it needs to be said. I think we've had a few that are like, you know, wear socks with your sneakers a- and wear underwear with your jeans.
Dr. Zain Husain, MD: Oh,
Heather: yeah.
Dr. Zain Husain, MD: Oh, yeah.
Courtney: Am I living- Okay ... in an alternate reality? Like- Ugh, I can't, I'm not even, I can't even talk about it. Like... Oh. So yeah, maybe- Yeah, yeah ... maybe help you help yourself.
Default_2026-07-29_2: Yeah.
Dr. Zain Husain, MD: Yeah. All right, moving on.
Heather: Yeah. Next topic.
Dr. Zain Husain, MD: Arthropod assault. So this sounds like a very charged kind of term, so what does this mean?
Heather: It does sound pretty intense.
Dr. Zain Husain, MD: Yes.
Courtney: It's, anything- It can be ... assault, yeah, it [00:22:00] can be. Um-
Heather: I was assaulted by an arthropod ...
Courtney: yeah, I'm gonna start saying that. Um, it's essentially a nice name for a bug bite. Yeah. Yeah. And arthropods are what? Like eight-legged cre- I think six ... six or eight. Six. Maybe six. Okay. Um, I know there's like a quantifying factor for them, but it'd be fleas, bug bites, ticks chigger.
Chiggers are huge here in North Carolina. I mean, I think almost every person- Mm-hmm ... during the summertime on a skin check has some chigger bites.
Heather: Mosquitoes.
Courtney: Mm-hmm. Mm-hmm. Mites, spiders, which-
Dr. Zain Husain, MD: Yeah ...
Courtney: you know, not everything also is a spider bite.
Heather: I think a lot of people will come in and think- Yeah ... they've been bit by a spider, and- Yeah
it's something different.
Dr. Zain Husain, MD: The PA we- I had one, I had one last week who thought she had a spider bite, and it was actually shingles.
Heather: Oh,
Dr. Zain Husain, MD: yeah.
Heather: Yeah, remember? Yeah. Like she had like two puncture wounds. Yeah. I saw her back, yeah. And I'm like, "Oh, that,
Dr. Zain Husain, MD: those are just blisters." Yeah. Yeah. She- Is she doing better?
Heather: Yeah. Oh, okay, good. Yeah, she's doing better.
Courtney: The PA I used to work with, um, would actually a- when people said they had a spider bite, she would say, "Did you see the spider?" "Then how do you know it's a spider bite?" Uh-huh. "And how do you know it's not another bite from this, [00:23:00] this, or that?" Yeah. Yeah. She used to get so peeved when people said-
spider 'cause she'd be like- Yeah ... "There's so many other insects."
Heather: Yeah,
Courtney: yeah.
Dr. Zain Husain, MD: So oftentimes they have similar presentations. Obviously, there are characteristic bites of certain arthropods, but typically how do they present?
Courtney: Red, swollen
Dr. Zain Husain, MD: Swollen. Mm-hmm
Courtney: Itchy. I think the-
Dr. Zain Husain, MD: Oh, yeah.
Courtney: Yeah ... so itchy.
Heather: Yeah.
Dr. Zain Husain, MD: Yeah.
Heather: Yeah.
Courtney: Yeah.
Dr. Zain Husain, MD: They're the worst. I get bit by mosquitoes like crazy.
Heather: A lot of times you can see the little, um, like puncture in the middle. Mm-hmm. Um, it's very common for like children to get a little bit more swelling- Mm-hmm ... too, just their
Courtney: immune system's different. Also, I just want to put this out here, because I think it's giving spiders a bad rep if we're just like, "Oh, I got bit by a spider."
Blaming it on a spider. Mm-hmm. I-
Heather: Spiders are doing a, you a lot
Courtney: more good. Yeah. Yeah. I pi- I pick up a lot of spiders, and I've never gotten bit by a spider. Yeah. And I think the only spiders we really should be worried about biting us anyways are obviously a black widow, which you will know if you get bit, because you'll end up in the hospital.
Yeah. Or a brown recluse, which [00:24:00] your skin will start becoming necrotic. So-
Dr. Zain Husain, MD: Do they have many in this area or not really?
Courtney: Yeah.
Dr. Zain Husain, MD: Yeah. Yeah?
Courtney: They hang out under like wheelbarrows a lot- Oh ... and like in dark, and so same with black widows. But, um, I think the brown recluses are more like wooded. Like they like a more wooded area.
Dr. Zain Husain, MD: Yeah. Yeah. And along with arthropod bites snake bites are pretty-
Courtney: Mm-hmm ...
Dr. Zain Husain, MD: you know, feared around here. Oh, God. There's a lot of snakes. Copperheads.
Courtney: Copperheads. Yeah.
Dr. Zain Husain, MD: Yeah.
Courtney: Mm-hmm.
Dr. Zain Husain, MD: So you just gotta be careful about, I
Courtney: mean- I mean, that will send you to the hospital too. You'll know. You'll know.
Heather: Yeah.
Courtney: Yeah. So.
Dr. Zain Husain, MD: Yeah. So how do we treat bug bites?
Heather: Um, usually topical steroids. Mm-hmm. Um, antihistamines can help too with the itching. Um, cold compresses can just- Yeah ... help soothe the skin. So supportive
Dr. Zain Husain, MD: care.
Heather: Yeah.
Courtney: I like the Serope anti-itch- Yeah ... with the pramoxine in it. That's what I, that's what I use. Yeah. I feel like that's such a lifesaver.
Yeah. And people don't know about it, but- Yeah ... b- it's better than Benadryl cream. It's better than- Mm ... hydrocortisone sometimes. It just takes the, the actual itch out of it. Yeah. You know?
Heather: I do think we see a lot of dermatofibromas on the legs from-
Courtney: Mm-hmm ...
Heather: like [00:25:00] mosquito bites, 'cause they're so itchy and you're scratching it all the time, and that can induce this like scar-like bump that is gonna be-
Dr. Zain Husain, MD: Yeah
Heather: likely permanent.
Dr. Zain Husain, MD: Yeah.
Courtney: What about tick bites?
Dr. Zain Husain, MD: Yeah, I see a lot of ticks. Yeah. I at least get one or two patients a year who think they have a new mole-
Courtney: Mm-hmm ...
Dr. Zain Husain, MD: and it's a tick.
Courtney: Mm.
Heather: I have... This is our second summer at our house. Um, we've had two ticks. Mm. One was on our dog, and the other one was on my husband.
Mm-hmm. Um, thankfully not attached, but-
Dr. Zain Husain, MD: Yeah ...
Heather: it... they're just... They're everywhere. They're everywhere. Yeah.
Courtney: Yeah. You really have to check yourself or, like, your kids coming in from really- Yeah ... anywhere because- Mm-hmm ... I mean, sometimes you're not even in, like, a super wooded area. Yeah. Yeah. Like, maybe you're at the park or- Yeah
anywhere that has, like, taller grass. Yeah. Yeah. It's not even, like, what you would normally think, and yeah, it's, it's bad.
Heather: Yeah.
Courtney: Yeah. I had one on my head that my dad had to pull out. Oof. Ew. Yeah. It was, it was disgusting, and then, you know, the thing is, like, sometimes, like, they're still, like, moving.
Dr. Zain Husain, MD: Yeah.
Courtney: Yeah.
Dr. Zain Husain, MD: Yeah.
Courtney: I think he ended up flushing [00:26:00] it down the toilet.
Dr. Zain Husain, MD: Mm.
Courtney: Like, hopefully that killed it. I feel like they survive anything.
Dr. Zain Husain, MD: Yeah. Yeah. And especially for, like, the deer tick, you know- Mm-hmm ... we're concerned about potential Lyme disease. Mm-hmm. Mm-hmm. Um, so if you see a targetoid rash, um, you see a- A
Courtney: bull's-eye.
Dr. Zain Husain, MD: Yeah.
Courtney: Yeah.
Dr. Zain Husain, MD: It is something that you wanna bring to your to your dermatologist's attention. Yeah. We can treat you with some oral antibiotics that is very helpful for treating potential Lyme disease.
Heather: Mm-hmm.
Dr. Zain Husain, MD: Yeah. Okay. All right. We're hot and sweaty. Heat rash, what is that called?
Heather: Miliaria?
Dr. Zain Husain, MD: Mm-hmm. Yeah.
So tell me a little bit more about miliaria.
Heather: Um, we see this a lot actually in, um, like, younger individuals because I think it's very easy for them to get, like, warm in certain areas and, um, not be able to cool down. But it's these, like, tiny little bumps that you can get. They're, um, [00:27:00] spontaneous. They kind of go away with temperature changes.
Um, sometimes they can be itchy, but, um, a lot of times they also kind of go away on their own, too.
Dr. Zain Husain, MD: Mm-hmm. And there's, like, different, um, classifications of them based on how superficial it is, so there's miliaria crystallina, miliaria rubra, miliaria profunda, so just kind of depending on the inflammation- Mm-hmm
that we see them in.
Heather: Mm-hmm.
Dr. Zain Husain, MD: And how do we treat it?
Heather: Um, usually it's supportive. Mm-hmm. Just, like, trying to cool down the skin. Yeah. Um, lightweight clothing. Yeah.
Dr. Zain Husain, MD: It goes away typically. Yeah. Yeah. All right. Now we're swimming. Swimmer's itch, tell me about that, Courtney.
Courtney: Um, it's kind of gross actually. Um, it's basically kind of, like, these little microscopic parasites that, you know, mistakenly burrow into human skin.
Um, it's usually after, like, fresh water. Um, luckily, they can't [00:28:00] survive in humans, so it is, like, a uncomfortable rash, but it's temporary. But it's just, um, yeah, kind of nasty to think about just kind of, like, the... It reminds me of, like, the mites, you know, the Demodex mites on our-
Heather: Yeah ... on our face. Yeah.
Dr. Zain Husain, MD: Yeah.
Courtney: But they don't die. They're there. Yeah.
Dr. Zain Husain, MD: Mm-hmm. And treatment of choice for that?
Heather: Um, supportive care. Yeah.
Dr. Zain Husain, MD: Yeah. Yeah. A lot of these things are supportive care.
Heather: Mm-hmm.
Courtney: Yeah.
Dr. Zain Husain, MD: All right. So what are some warning signs that you should see your dermatologist, um, for any skin concerns during the summertime?
Heather: Um, I think if you're getting systemic symptoms- Mm
so, like, fever, flu-like symptoms, if it's blistering or if it's spreading pretty rapidly, I think you definitely should see somebody. I think a lot of times it's easy to get into urgent care. Um, I've seen a, a couple people recently who were just at urgent care, and, you know, they were told it was something completely different, and it's- I [00:29:00] think it's just hard and frustrating because it's easy to get into urgent care.
Mm-hmm. Um, but a lot of times we're just kind of throwing stuff at it.
Courtney: Yeah. Especially the... You know, and the problem with that especially is when you talk about things like fungus- Mm-hmm ... where it could be worsened by doing a different treatment. Mm-hmm. So for example, a steroid, you can w- you know, worsen fungus.
And- Mm-hmm ... I mean, what happens? You go in, and they're like, "Oh, it's just eczema." yeah. Yeah. And then they give you the steroid, and now it's spreading. Yeah. Now it's worse. Yeah. So yeah, I, I definitely agree. I think the, the convenience is there, but then y- in the long run, you end up spending more time and money- Yeah.
Yeah ... um, and frustration, you know.
Dr. Zain Husain, MD: Yeah.
Heather: Yeah.
Dr. Zain Husain, MD: Um, any other warning signs?
Courtney: The bull's-eye. I mean, if you're seeing- Yeah ... a bull's-eye- Yeah ... get in, you know? Yeah.
Heather: Yeah. If it's got pus- Mm-hmm ... or any sort of, like, drainage.
Dr. Zain Husain, MD: Yeah.
Courtney: Extensive blistering or... Yeah, I think, you know, pain is never-
Dr. Zain Husain, MD: Yeah ...
Courtney: never a good sign.
Heather: Yeah.
Dr. Zain Husain, MD: Okay. So this was a pretty comprehensive episode on [00:30:00] the types of rashes and skin conditions we typically see in the summer. So some key takeaways, obviously we're not telling you not to go outside, just be smart and be safe about it. Protect yourself from the sun. Make sure that you're mindful of your environment, and, you know, cover up if you need to.
Um, be careful about checking your body, um, after being in, say, wooded areas or after coming out of the water. So those are key reminders I give my patients. What about you guys?
Courtney: Do as I say, not as I do.
Dr. Zain Husain, MD: That- That's your motto. That's for lack of nail. Yeah,
Courtney: yeah.
Dr. Zain Husain, MD: Plus- Don't do according to us ... plus,
Heather: yeah. Learn what, um, poison ivy looks like.
Courtney: Yeah, yes. Top of the
Dr. Zain Husain, MD: list. I'm gonna Google it
Courtney: after. All
Dr. Zain Husain, MD: right. Well, I hope this episode was helpful and practical. Um, if you guys have any questions, please feel free to ask, but until next time, Skin Side
Heather: out.
[00:31:00]