Burkitt’s lymphoma

Burkitt’s lymphoma

By Dr Salim Amour

What is Burkitt’s lymphoma?

Burkitt’s lymphoma is a type of high-grade non-Hodgkin lymphoma that develops from B lymphocytes (B cells). It is one of the fastest growing lymphomas. This means though that it is more likely to be cured by treatment than many other types of lymphoma.

Burkitt’s lymphoma is named after a doctor called Denis Burkitt’s. He first wrote about a form of this lymphoma after seeing children and young adults with it in Africa. The kind of Burkitt’s lymphoma he described is now called ‘African-type’ (or ‘endemic’) Burkitt’s lymphoma. Another kind (the ‘sporadic’ type) is more often seen in the Western world.

Who gets Burkitt’s lymphoma?

Burkitt’s lymphoma is not common: only 1 in every 30–50 people with a B-cell non-Hodgkin lymphoma will have this type of lymphoma.

Both children and adults can be affected by Burkitt’s lymphoma (sporadic type). It makes up over a third of all the lymphomas seen in children. It is quite common in adolescents and young adults too. The number of people over 60 who are diagnosed with this type of lymphoma is also increasing.

Men and boys are more likely to get Burkitt’s lymphoma – more than two-thirds of adults with Burkitt’s lymphoma are men.

What causes Burkitt’s lymphoma?

The endemic (African) type of Burkitt’s lymphoma is almost always linked to a previous infection with the Epstein–Barr virus (EBV). This is the virus that causes glandular fever.

In the type of Burkitt’s lymphoma seen in the UK – the sporadic type – the role of EBV is less certain. EBV is a common virus: blood tests show that 9 out of 10 adults in the UK have had this infection at some time in their life. It is not clear why a few people develop lymphoma while most do not.

Although this lymphoma is sometimes linked to a virus, it is important that you know:

Ø  You cannot catch lymphoma.

Ø  You did not inherit it from your parents.

Ø  You cannot pass it on to others.

Having a weakened immune system also makes some people more likely to develop Burkitt’s lymphoma. For example, this might affect people with HIV (human immunodeficiency virus) infection.

Most patients with Burkitt’s lymphoma will not have HIV infection, but everyone should have a blood test to rule this out. It would be very important to treat the HIV infection as well as the lymphoma if it was found.

What are the symptoms?

The symptoms of Burkitt’s lymphoma often come on over just a few weeks because the lymphoma cells are dividing so quickly. For the same reason, many people have this lymphoma in several places by the time it is diagnosed.

You will probably have:

Ø  Swelling of one or more groups of lymph nodes in different parts of your body.

You may also have:

Ø  Abdominal pain, sickness and/or diarrhea – Burkitt’s lymphoma commonly affects the bowel

Ø  A very swollen abdomen caused by a collection of fluid within your abdomen (called ‘ascites’)

Ø  More serious bowel problems such as bowel obstruction or bleeding from your bowel

Ø  lymphoma in an extra nodal site (outside the lymphatic system) – this is common, involving organs such as the liver, kidneys, ovaries and breasts – symptoms will depend on the site

Ø  other symptoms of lymphoma, including

o   drenching sweats, especially at night

o   tiredness or fatigue

o   fever and flu-like symptoms, and

o   loss of appetite and weight loss

Ø  low blood counts due to lymphoma in the bone marrow – this is common in Burkitt’s lymphoma and can lead to

o   anaemia, causing shortness of breath and tiredness

o   low platelets, making you more likely to bleed or bruise very easily

Ø  lymphoma cells seen on a blood sample when looked at under the microscope

Ø  lymphoma in your brain and spinal cord (known as your ‘central nervous system’ or CNS), which can cause many different symptoms including

o   headache

o   seizures

o   confusion

o   inability to concentrate.

In children with the endemic type, Burkitt’s lymphoma often affects the jaw. It seems to grow in the areas where the permanent teeth are forming. This rarely happens in the sporadic (Western) type.

Tests for Burkitt’s lymphoma

Burkitt’s lymphoma is usually diagnosed by a biopsy of a swollen lymph node or another affected tissue. In a few people, Burkitt’s lymphoma will be found first in the bone marrow or in tissues removed for other reasons – in this case, lymphoma may not have been suspected before.

Wherever the biopsy comes from, it will be examined by an expert pathologist to make the diagnosis. Other specialist laboratory tests on the biopsy may include looking for:

Ø  specific proteins on and within the cells

Ø  changes within the genes of the cell – in Burkitt’s lymphoma, a gene known as MYC changes position and overworks, which makes the cells divide very quickly.

Ø  It is important to identify Burkitt’s lymphoma correctly because it needs to be treated differently from most high-grade lymphomas.

Ø  As well as a biopsy, you will have other tests to find out more about:

Ø  your general health

Ø  The stage of your lymphoma – a guide to how many (and which) areas of your body are affected by the lymphoma.

Ø  Most people with Burkitt’s lymphoma will have blood tests, scans such as a CT scan, MRI scan or PET/CT scan, a bone marrow test and a lumbar puncture.

Ø  Further tests that are sometimes done can include:

Ø  An electrocardiogram (ECG), echocardiogram (often just called an echo) or MUGA scan to assess how well your heart is working

Ø  A 24-hour urine collection to assess how well your kidneys are working.

Staging of Burkitt’s lymphoma

The ‘stage’ of your lymphoma shows which parts of your body have been affected.

There are four stages, which are written with Roman numerals as stage I to stage IV. Your doctors will use one of two ways to work out the stage of your Burkitt’s lymphoma, either:  

·         The Ann Arbor system – the system used for most other lymphomas, particularly in adults
or

·         The St Jude/Murphy staging system – a system more often used for lymphomas in children.

Stage I

One site only, which can be either a group of lymph nodes or an extra nodal site
(unless, for the St Jude/Murphy system, the one site is in the chest or the abdomen – see stages II/III)

Stage II

Lymphoma on one side of the diaphragm but in two or more sites, which may be groups of lymph nodes or extra nodal sites or a mixture
(Lymphoma in the abdomen that has been completely removed by surgery is also stage II when using the St Jude/Murphy system)

Stage III

Lymphoma on both sides of the diaphragm, whether in groups of lymph nodes or extra nodal sites
(Lymphoma that started in the chest or alongside the spine and lymphoma in the abdomen that cannot be completely removed by surgery, when using the St Jude/Murphy system, are also stage III)

Stage IV

Lymphoma in the bone marrow or in the central nervous system 
(and, for the Ann Arbor system, lymphoma in the liver or in extra nodal sites that are not close to each other).

Using the stage, your doctors will decide whether to treat your Burkitt’s lymphoma as ‘favourable’ or not. Favorable lymphomas are stage I lymphomas (and some stage II lymphomas) that are not causing a rise in a blood test called ‘LDH’.

If your doctors use the Ann Arbor system, they will also look at:

·         How much you are able to do (known as your ‘performance status’), for instance whether you are up and about and able to carry out light work

·         Whether your lymphoma is in more than one extra nodal site.

Do not be alarmed if the doctors do not class your lymphoma as favourable. In fact, very few adults have favourable Burkitt’s lymphoma. The treatments usually work well for everybody with Burkitt’s lymphoma, but those with ‘favourable’ disease may need slightly less treatment.

Treatment of Burkitt’s lymphoma

Intravenous chemotherapy

Burkitt’s lymphoma is always treated with chemotherapy, even if the lymphoma is localized (early stage). The regimens used for Burkitt’s lymphoma involve:

Ø  Several different drugs that target the lymphoma cells in different ways

Ø  Drugs being given on several consecutive days.

This type of chemotherapy has the best chance of killing most of the lymphoma cells as quickly as possible. The regimens are typically given intravenously (into a vein) as an infusion (a drip).

People having these regimens will need to be inpatients because:

Ø  Some of the drugs take several hours to give

Ø  You will need lots of fluids in your drip to keep your kidneys working well

Ø  The whole treatment takes several days to give

Ø  You will also need lots of tests after having the chemotherapy to check your kidneys and liver and your blood cell counts.

When you first start chemotherapy, many of the tests you will have will be done to look for signs of ‘tumour lysis syndrome’. This happens when lots of lymphoma cells are killed very quickly and is most likely to occur in very fast-growing lymphomas.

The chemicals that were in the lymphoma (tumour) cells spill out into the bloodstream. The body struggles to get rid of the extra chemicals through the kidneys and rebalance the salts in the blood. The extra fluids in your drip help with this, and the blood tests will show if any problems are starting to develop. Serious problems could occur if the levels of salts in the blood became very abnormal (these can affect the way the heart and kidneys work) or if the kidneys were overwhelmed by uric acid (one of the chemicals they need to get rid of).

Tumour lysis syndrome is a serious condition, which needs to be prevented if possible or treated at the first sign. Fortunately, the drug rasburicase (Fasturtec^®) can help if it does occur, or can be given to people at high risk of the condition to prevent it developing. In a way it should be thought of as a good sign, as it means the chemotherapy has already killed many of the lymphoma cells.

To make all this treatment easier, your doctors will probably recommend you have a tunnelled central line or possibly a PICC line (peripherally inserted central catheter).

Other treatments

You are likely to have many of these treatments too:

Ø  Rituximab (MabThera^®), usually given with chemotherapy to adults with Burkitt’s lymphoma

Ø  Mesna and folinic acid, to protect against some of the side effects of the chemotherapy drugs used in these regimens

Ø  Anti-sickness drugs (antiemetics)

Ø  Rasburicase (Fasturtec^®) initially and allopurinol in later cycles, to protect against tumour lysis syndrome

Ø  Prophylactic (preventive) antibiotics and antifungal, to reduce the risks of infection

Ø  Growth factors (G-CSF), to help your bone marrow recover quickly.

Intrathecal chemotherapy

In Burkitt’s lymphoma, treatment that targets the CNS (the brain and spinal cord) is also needed. You may hear this treatment called ‘CNS-directed therapy’ or ‘CNS prophylaxis’.

Some intravenous drugs will reach the CNS, but Intrathecal chemotherapy is another way to get drugs to the brain and spinal cord. It means giving chemotherapy directly into the cerebrospinal fluid (the fluid that bathes the brain and spinal cord). Only a few drugs can be given in this way (most often methotrexate and cytarabine).

Normally Intrathecal chemotherapy is given during a lumbar puncture. Sometimes a device called an ‘Ommaya reservoir’ is put in to avoid the need for lots of lumbar punctures.

Possible chemotherapy regimens

The exact treatment you have will depend on:

Ø  Your general health and usual level of fitness

Ø  Whether your doctors class your lymphoma as favourable or not (as explained in the section on staging)

Ø  How well you and your doctors think you will cope with the likely effects of the treatment.

Ø  No matter which chemotherapy regimen you have, your whole treatment will probably take several months. You should expect to spend days or even weeks at a time in hospital.

Ø  R-CODOX-M is one regimen that is commonly used for adults in the UK. It is made up of:

Ø  rituximab

Ø  cyclophosphamide – daily for 5 days

Ø  vincristine (Oncovin^®)

Ø  doxorubicin

Ø  methotrexate – given over 24 hours.

Ø  Three cycles of R-CODOX-M are usually given to people with ‘favourable’ Burkitt lymphoma. For most people, with less favourable Burkitt lymphoma, R-CODOX-M is alternated with R-IVAC – usually two cycles of each.

Ø  R-IVAC is made up of:

Ø  rituximab

Ø  ifosfamide – daily for 5 days

Ø  etoposide (VP-16 or VePesid^®) – daily for 5 days

Ø  cytarabine (Ara-C) – for the first 2 days.

Ø  R-hyper-CVAD is another regimen that can be used for Burkitt lymphoma. It is made up of:

Ø  rituximab

Ø  frequent small doses of (hyperfractionated) cyclophosphamide – given over 3 days

Ø  vincristine

Ø  doxorubicin (Adriamycin^®)

Ø  dexamethasone – as tablets for 4 days.

Ø  This combination is alternated with high-dose methotrexate and cytarabine (given over 3 days). Typically four cycles of each will be given.

Ø  DA-EPOCH-R is another regimen that has been used in trials with some promising results. It is made up of dose-adjusted:

Ø  etoposide – infused continuously over 4 days (with the vincristine and doxorubicin)

Ø  prednisolone – tablets for 5 days

Ø  vincristine (Oncovin^®) – infused continuously over 4 days

Ø  cyclophosphamide

Ø  hydroxydaunorubicin (often called doxorubicin) – infused continuously over 4 days (in people who are well enough it may be possible to give this through a portable device as an outpatient treatment)

Ø  rituximab.

Ø  In children and adolescents, several different regimens, which formed part of the LMB96 trial, are combined. These include:

Ø  two cycles of COPADM, made up of

o   cyclophosphamide

o   vincristine (Oncovin^®)

o   prednisolone

o   doxorubicin (Adriamycin^®)

o   Methotrexate.

Ø  This is followed by other chemotherapy regimens, depending on how advanced the lymphoma is and how it responds to early treatment, such as:

Ø  CYVE – cytarabine and etoposide (VePesid^®)

Ø  CYM – cytarabine and methotrexate.

Recently, trials in young people, who are very likely to be cured, have looked at reducing treatment wherever possible to limit the long-term side effects.

What are the side effects of chemotherapy?

If you are having intensive chemotherapy, you may get a number of different side effects. There are lots of things that can be done to help prevent or relieve these. Do let people know how you are feeling and ask questions if you don’t know what is happening. Your hospital team will be there to support you through your treatment.

The most common side effects of the kind of chemotherapy usually used for Burkitt’s lymphoma include:

Ø  low blood counts, causing

o   Neutropenia (low white blood cells), making you much more prone to infections – your hospital team need to know at once if you have any signs of infection

o   Anaemia, making you short of breath or very tired – a blood transfusion may help

o   Low platelets, making you more likely to bleed or bruise very easily – you may need platelet transfusions to help stop you bleeding or to reduce the risk

Ø  Sore mouth (mucositis) or mouth ulcers – using mouthwashes regularly can help

Ø  Feeling sick or having diarrhea

Ø  Temporary hair loss – usually starting a couple of weeks after chemotherapy has begun and growing back from a month or two after it finishes

Ø  Fatigue

Ø  Peripheral neuropathy (damage to nerves, especially in the hands and feet), causing symptoms such as pins and needles, pain and numbness.

Ø  Long-terms side effects (late effects) that might affect you include:

Ø  Reduced fertility

Ø  An increased risk of second cancers

Ø  Heart disease.

Your doctors will discuss with you what your risks are and what can be done to help.

What happens if Burkitt’s lymphoma comes back?

If your lymphoma is not in complete remission after your treatment or if it comes back later (relapses), your doctors may offer you further treatment. What can be offered will depend on:

Ø  what your previous treatment was

Ø  how well you coped with your previous treatment

Ø  whether you are fit enough for more intensive treatments, which might include

o   High-dose ‘salvage’ chemotherapy, which is different from the first treatment you had

o   A stem cell transplant once your lymphoma has responded again to chemotherapy

o   Your thoughts about further treatment – your doctors and hospital team will help you to decide what is best for you.

Less common types of Burkitt’s lymphoma

Intermediate type

Sometimes a lymphoma appears to be like Burkitt’s lymphoma in some ways and like diffuse large B-cell lymphoma (DLBCL) in other ways. For example the lymphoma might look like a Burkitt’s lymphoma under the microscope but not have the usual change in the MYC gene. The official name doctors give these is ‘B-cell lymphoma, unclassified, with features intermediate between DLBCL and Burkitt’s lymphoma’.

Some of these lymphomas will also have another change in their genes and are known as ‘double-hit’ lymphomas.

These lymphomas are not common. Often they will be treated in the same way as typical Burkitt’s lymphoma.

HIV-associated Burkitt’s lymphoma

Lymphomas are more common in people with HIV infection. Burkitt’s lymphoma makes up around 1 in 6 of the lymphomas seen in people with HIV. It can occur before the HIV infection starts to cause much immunodeficiency (weakening of the immune system).

Treating lymphoma in people with HIV carries more risk of complications, particularly infections. However, if the same chemotherapy can be tolerated, it often works just as well.  In addition, a recent trial using a form of DA-EPOCH-R chemotherapy, with a slightly lower dose for people with Burkitt’s lymphoma and HIV infection, has reported promising results.

Thank you

10 Common Skin Irritants

---

Irritated skin can itch, burn and frustrate your daily routine. Be aware of potential skin irritants around you. 

 

Chances are you've experienced a skin irritation at some point in your life. You may have had anything from a mild redness to frustrating swelling and itching to a severe case of blisters or sores. Your skin is your body's largest organ and its primary layer of defense, so it often takes the first blow against irritants in the world around you.

Dermatitis is the term used to describe a wide range of skin inflammation. Some categories of dermatitis are a result of internal conditions, and some chemical process in the body can trigger them. For example, eczema is usually hereditary, and outbreaks can be triggered by stress, allergies or asthma. Contact dermatitis, though, is a result of your skin's contact with some external irritant that creates an allergic reaction.
Because you come in contact with so many things on a day-to-day basis, it's sometimes hard to discover the exact cause of a rash or itch. You may have mild chafing from the wind or your clothes, or a case of contact dermatitis from household chemicals, poison ivy and even sunscreen. This article describes 10 common skin irritants, listed in no particular order, and what you can do to keep your skin protected.
No matter what skin irritation you have, you can treat the symptoms with lotions and over-the-counter medicated skin creams. If the irritation persists or worsens, you should see a health professional for a more precise diagnosis and treatment.

---

10

Plants

Poison oak leaves can prompt an allergic reaction similar to the rash shown here.

Campers, hikers, and gardeners may encounter some of nature's most common skin irritants: poison ivy, oak and sumac. Despite their ominous moniker, these plants create different reactions in people, none of which pose serious health risks.
If you encounter poison ivy, you might have red, itchy bumps or blisters that appear in the days following your encounter, and lasting about 2-3 weeks. This reaction is caused by an allergic reaction to a resin found in the plant called urushiol. If the rash is severe or in a particularly frustrating area, such as the face, a medical professional may prescribe a treatment of oral steroids to reduce the inflammation. Another treatment is the drug Bentoquatam, sold under the trade name IvyBlock, which has been shown to absorb urushiol, and to help prevent and relieve rashes from poison ivy, oak and sumac.

While you're avoiding urushiol, you may be voluntarily subjecting yourself to another irritating plant chemical: capsaicin. Capsaicin is the chemical that makes hot peppers "hot." Besides burning your tongue when you eat it, capsaicin can also create an intense burning sensation in your skin and eyes. Unless you have an allergic reaction to capsaicin, though, just washing thoroughly with soap and water should be sufficient treatment for your skin.
Your best prevention against skin irritation from plant contact is keeping your skin covered. Wear sufficient clothing to come between you and the plants when you're walking among natural brush. Also, wear protective gloves and use caution when handling the leaves of poison ivy or the pods of hot peppers.

9

Household Cleaners

Before your tackle your house cleaning, know what chemicals you're using that could potentially irritate or damage your skin.

Most household chemicals, such as cleaning products, have clear messages on their labels, like "do not swallow" and "avoid contact with eyes." Many of these products can also irritate, or even damage, your skin. You can avoid exposure by wearing protective gloves while you're using the products.
Here are some of the cleaners you may have around the house that can irritate your skin:

• All-purpose cleaners can include ammonia, trisodium phosphate (TSP) and other hazardous chemicals designed to break up grease and remove stains from porous surfaces. While limited skin exposure to these chemicals may not seem to affect the skin, prolonged exposure can have caustic effects, drying and breaking down your skin's surface.
• Window and glass cleaners typically include ammonia and isopropanol. Not only can these be caustic to the skin, but they can also irritate your eyes and nasal passages and should be used in a well-ventilated area.
• Dishwashing detergents can leave your hands dry and flaky with significant use, but usually aren't harmful to the skin. The more concentrated detergents for automatic dishwashers are more harmful and can cause your skin to burn and itch.
• Toilet cleaners and mold and mildew removers have pesticides that are highly caustic, sometimes including bleach, which also has dangerous fumes.
• Drain cleaner main ingredients include lye and sulfuric acid, which are highly caustic and cause dangerous fumes.

Scientists have studied the health impact of these cleaners, and researched alternative cleaners that are not as harmful to your body. Some products now contain alternative chemicals reported to be less harmful and, sometimes, more environmentally safe.

8

Laundry Detergents

Laundry detergent can leave small amounts of chemicals in your clothes that could possibly irritate your skin.

Laundry detergent can have caustic affects with prolonged exposure to your skin. What this section covers, though, is the effect of remnants of the laundry detergent and fabric softener left in your clothes when you wash them. Laundry detergent includes ingrediants such as:

• Surfactants dissolve in water and "lift" dirt and oils from the laundry.
• Builders aid the surfactants by softening hard (mineral-rich) water to make the detergent more effective.
• Enzymes are designed to break down stains made up of organic proteins, such as blood and grass.
• Chlorine bleach removes color from fabrics while also disinfecting and deodorizing the laundry.
• Oxygen bleach will bleach clothes, but is less powerful and safer for fabrics than chlorine bleach.
• Whiteners (optical brighteners) absorb invisible forms of light and re-emits it as blue light, making clothes seem brighter.
• Fragrance can mask the chemical smell of the detergent and produce an emotional response when using the product.

Builders and bleaches are caustic out of the box or bottle, but are readily rinsed away in the wash. The detergent's surfactant, as in other soaps, is low in toxicity, but could give you dry, itchy skin if your clothes are not thoroughly rinsed. The more notable irritants are the dyes and fragrances, which are left on clothes even after they are rinsed. These culprits can produce itching and rash for people with sensitive skin or specific dye or fragrance allergies. Fragrance and dyes in fabric softener can produce similar allergic reactions.
Many manufacturers have responded to their sensitive and allergic consumers, creating fragrance-free and dye-free detergents and fabric softeners. Without the fragrance, you can still smell the detergent's other ingredients. When your laundry is finished, though, all potential irritants should be rinsed away.

7

Sunscreen

If you have sensitive skin or allergies, try different sunscreens with different ingredients until you find one that works best for your skin.

When you apply sunscreen, your goal is usually to protect your skin from harmful ultraviolet rays from the sun. Physical sunblocks can include zinc oxide and titanium oxide, which reflect all ultraviolet (UV) radiation before it gets to your skin. More commonly marketed, though, are chemical sunblocks, which absorb into the skin, and then in turn absorb some of the UV radiation before it can affect your skin. Both physical and chemical sunscreens are marketed in both dedicated lotions, and as part of other cosmetics such as facial moisturizers, hand creams, and foundation makeup. The American Academy of Dermatology (AAD) recommends a sunscreen that includes as much of the UV spectrum as possible, with a sun protection factor (SPF) of at least 15 [source: AAD].
Suncreen has specific chemicals that could provoke allergic reactions in some people. The FDA has approved more than 16 compounds as UV filters for sunscreens sold in the United States, so there's a wide variety of ingredients for manufacturers from which to choose. The University of California, San Francisco, recommends that if you have an allergic reaction to a specific sunscreen, such as severe itching or a rash, try another sunscreen with a different combination of chemicals [source: UCSF].

One of the most common allergic reactions to sunscreens is to para-aminobenzoic acid, or PABA. Though PABA is an essential nutrient in some animals, its internal benefits for humans are still under research. Topically, though, it is known to be an effective sunscreen. If you experience rash when using a sunscreen that has PABA, stop using it and try one of the "PABA-free" sunscreens to see if your allergic reaction is prompted by the PABA.

6

Bugs and Bug Repellent

Mosquito

Whether or not you're an outdoor enthusiast, you have likely encountered bugs, and perhaps attempted to repel those bugs to avoid bites, stings and general unpleasantness. Both the bugs and the repellents are potential skin irritants.
Most bugs are harmless to your skin unless they bite or sting you. Some bugs, such as mosquitoes, ticks and bedbugs, bite with the objective to feast on your blood. Others, such as bees, ants and spiders, attempt to defend or attack with a venom of amino acids, peptides and proteins. While only some of the world's bugs have potentially lethal venoms, all bug bites and stings can produce allergic reactions ranging from a mild swelling and itching to a violent rash with blisters or sores.
When you're trying to avoid the pesky critters, one of your options is to apply a repellant lotion or spray to your exposed skin. These products usually contain N-diethyl-meta-toluamide (DEET) and other chemicals known to be effective at preventing bites from several types of insects. The Environmental Protection Agency has concluded from toxicity testing that DEET does not present a health concern for most people. However, the EPA recommends sparing use, washing it off thoroughly when you return indoors, and discontinuing use if you have any adverse reactions.
Your skin's best protection against bugs is clothing. When exposed skin is vulnerable, and applying a repellent to the skin is risky, long sleeves and trousers may be your healthiest option. You can even apply the repellent to the clothing for an extra layer of defense. If you spend a significant amount of time outdoors, you might even consider special insect-repellent clothing.

5

Heat

Hot, humid weather is just one cause of the skin irritation known as heat rash.

In hot, humid weather, you may experience a skin irritation known as a heat rash. Despite its name, the heat is only an indirect cause of the rash. Heat rash is an outbreak of blisters or red lumps in the skin resulting from excessive sweating. The bumps are created when sweat ducts get blocked and trap perspiration under your skin.
Heat rash usually clears up on its own, but you can relieve its swelling, itching and prickly feeling by cooling your skin and moving to a place where you won't continue to sweat. You can try to prevent heat rash by keeping cool on hot, humid days. Even with prevention, though, some people are more prone to heat rash than others, including newborns and those taking certain medications.
Heat rash can also defy weather conditions. Any time your body overheats or lacks sufficient exposure to sweat normally, heat rash may be a risk. This includes bundling up a lot in the winter, using heavy ointments or creams, or being confined to a bed for long periods.

4

Shaving and Hair Removal

Facial shaving is a daily ritual for many men.

Shaving can irritate your skin when you haven't sufficiently lubricated the skin's surface. For lubrication, you can use a commercial shaving cream, or just a generous lather from soap. Without lubrication, the razor may have too much friction as it travels over your skin, and it can catch and scrape at the skin's surface. This can result in welts on the skin that burn and itch, called razor burn.
As an alternative, there are also many hair removal, or depilatory, creams on the market. Test each product on a small patch of skin before using it on larger areas. Depilatory users have reported allergic reactions and chemical burns with symptoms such as itching, rash, blisters, burning and peeling. If you experience any of these reactions when testing a depilatory, wash the area thoroughly to remove the cream, and avoid using that particular product.
Waxing removes the entire hair shaft from its follicle for a longer-lasting effect. Because the wax adheres to both skin and hair, the fast rip of the waxed strip can leave your leave your skin red, burning, itching and possibly bumpy for a few hours as it recovers from the trauma. Some waxing products can help reduce this, as can lotions and anti-inflammatory medications.
Permanent hair removal can be a tempting long-term solution to the skin irritation and other inconveniences of regular shaving and waxing. Both electrolysis and laser hair removal can give you a temporary stinging pain at the treatment site. Your skin can be slightly red and swollen for a short time following these procedures, and you can treat this with medicated ointments. Though rare, some who have had laser procedures have reported blistering, scarring, and a change in skin pigmentation 

 

 

 

3

Cosmetics

Foundations and color cosmetics can contain ingredients that prompt an allergic response for some users.

Lotions, deodorants, acne treatments and other products can cause skin irritation if you have an allergic reaction to the chemicals, or if the chemicals break down into potentially hazardous substances. The first potential culprit is the active ingredients in a cosmetic product. Some antiperspirants, for example, can cause an allergic reaction, making you itch or, even worse, break out in a rash. Cosmetics can contain strong active ingredients, like alpha-hydroxy acids, that can irritate or even damage the skin if they are not paired with proper use and protective products such as sunscreen. Test each new cosmetic product carefully, and use it as directed. Discontinue using any product if you have skin irritations or other adverse reactions.

Other potential culprits are additives, such as colors and fragrances and preservatives. For some people, these can also cause allergic reactions. Fortunately, manufacturers have responded to people with allergies and sensitive skin by putting out fragrance-free cosmetics and other products that are free of additives and, sometimes, preservatives.
Though some cosmetics contain preservatives to give them a longer shelf life, they can change composition over time or when exposed to heat or bacteria. For example, foundation makeup with sunscreen is limited to the shelf-life of the sunscreen (about two to three years), can lose its sunblock quality if exposed to high temperatures, and can spread bacteria if you use your finger or a reusable applicator to scoop it from the bottle. To prevent skin irritation, acne and other harmful effects, only use a cosmetic product for its manufacturer-recommended shelf-life (some have expiration dates printed on them), and follow instructions on the label for proper storage. Also, keep makeup applicators clean with soap and hot water to remove bacteria.

2

Soap

Irritated skin can itch, burn and frustrate your daily routine. Be aware of potential skin irritants around you.

Your favorite soap may be one that smells good, lathers well, or just leaves your skin squeaky clean. Can it be irritating your skin? If you have itchy, dry skin between showers, you might want to consider whether the soap you're using is the culprit.
Soap is a surfactant, a substance that, when mixed with water, can remove dirt and oil from a surface to leave it clean. Soap is the natural result of a chemical reaction between an alkaline solution and a fat or oil, yielding alkali salts of fatty acids (the soap) plus glycerin. In contrast to soap, detergents are made without the fats and oils in an effort to avoid soap scum.
Soap can irritate the skin in a couple of ways. First, you can have an allergic response to a fragrance or dye added to the soap. Even if you have used the same soap for years, you could develop the allergy and suddenly respond to the soap in a way you hadn't before. The other way soap can irritate your skin is by stripping it of too much of the natural oils needed to keep your skin soft and elastic. If you suspect your soap is making you itch or drying out your skin, be sure to rinse well each time you wash, and consider choosing a different body cleanser such as mild cleansing product that isn't actually soap.

1

Clothing

Clothing can cause skin irritation from the abrasiveness of the fabric against your skin, or from allergic reactions to the fabric.

While many of the skin irritants in this article are avoidable, you aren't likely to avoid wearing clothes. Clothing itself can be a skin irritant for a variety of reasons:

• The abrasiveness of the fabric itself
• Allergic responses to dyes, metal fasteners, appliqués or chemical additives used in processing the fabric
• Scratching from tags, fasteners and seams
• Chafing from frequent movement against the fabric
• Heat rash or bacterial infections from fabric that does not allow the skin to breathe or dry quickly

You may have some difficultly determining that your skin irritation is from your clothing. First, you want to eliminate other things, such as your soap, laundry detergent and toiletries and cosmetics applied directly to your skin. Then, you want to examine where the irritation is occurring, and see if you can clearly identify something in or on a particular article of clothing that is coming in contact with the irritated skin.
If you're itching to learn more, go on to the next page to link to more great resources about your skin and skin irritants.