Infectious, Inflammatory & Immunological Dermatology Services

Eczema (AKA atopic dermatitis) is a condition that causes skin to become red and itchy. It is more common among children than adults, and is thought to affect up to 20% of infants in the USA. There is no specific data for the Cayman Islands but we see a similar incidence. Generally, the condition improves or disappears completely as children get older.

Eczema, however, can affect people at any age. It is considered a chronic condition (meaning it is long-term and there is no specific cure), and tends to flare up periodically. Eczema flare-ups can be caused by different triggers, so it can be useful for individuals to track their symptoms in order to gain a better understanding of how to manage the condition. There are also several treatments available that can improve the symptoms of eczema during a flare-up.

The quickest and easiest way to learn how to effectively manage your eczema is to speak with one of our dermatologists, who can find the most appropriate prevention and treatment plan for you.

Dermatitis is a collective term for a group of conditions that cause irritation and inflammation of the skin. Common examples of different types of dermatitis include:

• Atopic dermatitis (AKA eczema)
• Contact dermatitis (caused by direct contact with irritants or allergens)
• Seborrheic dermatitis (more commonly known as dandruff)

Different types of dermatitis have different triggers and can appear on different parts of the skin. For example, dandruff typically affects the skin on the scalp, whereas atopic dermatitis is more often found in the creases of the body. The symptoms of dermatitis may also vary depending on the type and location of the irritation, but often causes skin to become red, rashy, dry, and itchy. Sometimes, skin affected by dermatitis can become blistered and oozy, or it may crust and flake off. We see a lot of dermatitis in the Cayman Islands, especially across our expat population who find themselves exposed to triggers not always found at home.

The best way to pinpoint to exact type and cause of your dermatitis is to speak with one of our dermatologists, who will be able to recommend the best course of treatment for the specific type of dermatitis and symptoms you may have.

The severity of psoriasis varies a lot from person to person; for some, psoriasis is nothing more than an occasional irritation whereas, for others, the disorder significantly affects their quality of life. Psoriasis is a chronic (i.e., long-lasting) condition. Patients will often have long periods where their symptoms are mild or non-existent, followed by flare-ups of far more severe symptoms.

As psoriasis is a chronic condition, treatment is usually focused on improving the symptoms. Many people find that their symptoms flare up in response to certain triggers, so identifying those triggers can be key for managing the condition. Some of those may be triggers that you don’t have in your home country too.

By working with our dermatologist team, you can then find the treatment strategy that works best for you. Both Dr Alison Duncan, Paediatric & Adult Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, are highly experienced in the care and treatment psoriasis and psoriasis symptoms.

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Pyoderma gangrenosum is a rare, autoinflammatory disorder in which large, painful, non-healing ulcers develop on the skin. The ulcers can appear anywhere on the body, but are most likely to develop on the legs. They usually start as a small, painful bump which eventually grows into a large, open sore.

Pyoderma gangrenosum is thought to be an autoimmune condition, and is not infectious or contagious. Treatment of the condition is usually focused on reducing inflammation, managing pain, and encouraging ulcers to heal. The treatment you receive will depend on several factors, including your overall health and the severity of your condition.

If you think you have pyoderma gangrenosum, it is important that you make an appointment with your dermatologist to discuss your treatment options. These may include the use of various oral or topical medications, wound care and, in more extreme cases, surgery.

Autoimmune disorders are conditions in which the body’s immune system mistakenly attacks its own healthy cells and tissues. There are several autoimmune disorders that affect the skin, including:

• Vitiligo (which causes smooth, white patches to appear on the skin)
• Scleroderma (which causes the skin and connective tissues to harden and tighten)
• Lupus (which can lead to a skin disease called cutaneous lupus erythematosus)
• Psoriasis (which causes the growth of excess skin cells)
• Vasculitis (which causes inflammation of the blood vessels and lesions in the skin)

Autoimmune conditions are usually chronic, and treatment is typically focussed on symptom management. However, different autoimmune skin disorders manifest different symptoms, so the first step towards treatment is to consult a dermatologist for an expert diagnosis. Once you know exactly what you are dealing with, your dermatologist will be able to recommend an effective treatment plan that is tailored for your particular needs.

Both Dr Alison Duncan, Paediatric & Adult Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon are experienced across the range of dermatology autoimmune conditions, including the use of advanced treatments like biologics.

Our skin is the physical barrier that separates our insides from the outside world, so it is under constant assault from all kinds of irritants and allergens. For some people, these allergens can cause skin irritation known as an allergic reaction. The most common allergic skin conditions are: 

• Eczema (AKA atopic dermatitis)
• Contact dermatitis (caused by direct contact with an allergen or irritant)
• Hives
• Swelling

Allergic reactions in the skin can produce a variety of symptoms, including redness, swelling, itching, scaling, flaking, raised bumps, or even cracking of the skin. Skin allergies can be caused by a seemingly endless list of irritants including dust, pet dander, pollen, poison ivy, or certain foods, insects, or drugs. With such a wide range of possible causes, the best way to determine the trigger of your skin allergy is by speaking with a dermatologist.

Dr Alison Duncan, Adult & Paediatric Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, are both highly experienced in the identification and treatment of all common allergic skin conditions. Once your particular allergy has been identified, the best course of treatment, or advice on how to avoid the allergen, can be recommended to you.

Cold sores are tiny, fluid-filled blisters that develop in clusters on and around the lips. Once they burst, they will form a scab that stays in place for several days. Cold sores usually clear up by themselves, but they can take a few weeks to go away completely.

Cold sores are caused by a common viral infection called the Herpes simplex virus, and are usually passed on by kissing or sharing drinking receptacles. They can be uncomfortable, and may cause symptoms such as:

• Tingling
• Itching
• Burning
• Oozing and crusting

Cold sores can’t be cured, but there are treatments available to manage the symptoms and speed up recovery time. Cold sores are not generally considered harmful, but they are contagious and can become a problem if you experience frequent or severe outbreaks. If you are often affected by cold sores, consult your doctor or dermatologist about potential treatment options and how to prevent or reduce recurrent outbreaks.

Fungal infections are a very common skin complaint; they can affect anyone, and they can appear anywhere on the body. Some of the most common fungal skin infections include:

• Athlete’s foot (which can affect the skin of the feet, hands and nails)
• Jock itch (which affects the skin of the groin)
• Ringworm (an infection of the scalp and skin)
• Yeast infection (a fungal infection that can affect the mouth, gastrointestinal tract, skin, urinary tract, or genitals)

The symptoms of fungal skin infections can vary depending on what type of infection you have, and where you have it. However, they often cause redness, itching, pain, swelling, blisters, burning, rashes, and flaking or cracking skin.

The only way to effectively treat a fungal skin infection is to first identify what type you have and then match the treatment to it. If you notice a persistent skin problem, make an appointment with our dermatology team to discuss your symptoms in more detail. Both Dr Alison Duncan, Adult & Paediatric Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, have lots of experience in the diagnosis and treatment of common fungal skin infections (and some not so common ones!)

There are few things better for your health than spending time outdoors, but certain creatures are better avoided. Some plant and other wildlife species can cause a skin reaction if you accidently (or not so accidentally) come into contact with them.

Plenty of plants can cause contact dermatitis (i.e., a skin rash) if you brush up against them, and can cause itching, burning, swelling, and other signs of skin irritation. The Cayman Islands has some fairly dangerous and skin irritant plants, some of which can cause really nasty symptoms.

Certain other wildlife species can cause a skin reaction if you encounter them. These are typically stinging insects, and include:

• Bees
• Wasps
• Hornets
• Fire ants

Most of the time, contact dermatitis caused by an encounter with wildlife is not serious. The obvious exception to this is in the event of severe allergy, in which a person can go into shock (anaphylaxis) if they don’t receive immediate medical treatment, or a species like Maiden Plum that can cause very nasty welts and soreness over many weeks.

For the majority of people, rashes caused by contact with plants and wildlife can easily treated using topical remedies. If you have a mystery rash that you have difficulty treating, or one that is especially painful, contact our dermatologists for a more detailed examination of your symptoms.

Some skin rashes are caused by inflammation, which happens when the body’s immune system is activated in response to an injury, infection, or allergic reaction. Inflammatory skin rashes can also be caused by autoimmune conditions, in which the body’s own immune system mistakenly attacks healthy cells and tissues. Sometimes, skin inflammation can be caused by sun exposure or extreme heat.

The most common causes of skin rash inflammation are:

• Allergic reactions
• Viral, fungal, or bacterial infections
• Exposure to irritating substances
• Autoimmunity (i.e., a dysfunction of the immune system)
• Photosensitivity
• Heat

Skin inflammation can lead to rashes that are red, bumpy, swollen, warm, raised, blistered, or cracked. The affected skin may be itchy, burning, or painful, and may flake, crack, or bleed.

Determining the precise cause of an inflammatory skin rash is best done with the help of an experienced dermatologist. Once the cause of the inflammation has been established, your dermatologist will be able to recommend the best treatment plant to ease your symptoms. We see rashes in both children and adults almost every day.

Shingles (sometimes referred to as herpes zoster) is a viral infection that causes a rash of painful blisters. This rash can appear anywhere on the body, but usually forms a single stripe that appears on one side of the torso, face, or neck.

Shingles is caused by the varicella-zoster virus, which is the same virus that causes chickenpox. People may experience an outbreak of shingles when the varicella-zoster virus (which can lie dormant in your system for years) is reactivated.

The first symptoms of shingles are usually pain and burning of the skin, often followed by the appearance of a rash. The colour of the rash varies depending on the skin colour of the patient and may be red, dark pink, purplish, or dark brown. The rash is often itchy, and may be covered in tiny, fluid-filled blisters that pop easily. You may also experience other symptoms, such as:

• Fever
• Chills
• Fatigue
• Muscle weakness
• Headache

Although most cases of shingles clear up by themselves within a few weeks, the condition can also cause serious complications if not treated correctly. If you think there is a possibility you have shingles, make an appointment with one of our dermatologists, Dr Alison Duncan or Dr Davide Altamura, to discuss your symptoms and treatment options.

Hives (AKA urticaria) are raised, itchy bumps on the skin that are usually triggered by exposure to an allergen. Hives may also be red or painful, and they may sting. Most of the time, hives are a temporary problem and usually clear up by themselves.

If, however, your hives are severe, you have hives frequently, and you don’t know exactly what is causing them, it is important that you enlist the help of a dermatologist in getting to the root of the problem. Hives can be caused by a variety of other triggers besides allergies, including:

• Illness
• Infections
• Tight clothes
• Exercise
• Stress
• Excessive sweating
• Excessive exposure to extreme (hot or cold) temperatures

Once your dermatologist has determined the cause of your hives, they can provide you with the appropriate treatment. Both Dr Alison Duncan, Adult & Paediatric Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, are highly experienced in the diagnosis and treatment of irritant skin complaints. We see a great deal!

Hidradenitis suppurativa (HS) is a chronic skin condition that causes painful, pea-sized lumps to form under the skin. These boil-like lumps usually form in places where the skin rubs together, such as the armpits, breasts, buttocks, and groin. In some cases, these lumps disappear by themselves; in others, they rupture and leak pus for a period of hours or days.

Often, new lumps will then form in a nearby area, and will also rupture and leak. Over time, tunnels (called sinus tracts) can form under the skin, which can also leak pus and lead to further scarring. HS is often very painful and can be emotionally distressing to live with, as the abscesses left by ruptured lumps can be painful, itchy and have an unpleasant odor.

Treatments for recurrent boils and abscesses caused by HS usually focus on managing and reducing symptoms. HS is easiest to manage if it is caught in its earlier stages so, if you think you have symptoms of the condition, book a consultation with one of our dermatologists.