Swelling

WHEN TO SEE YOUR DOCTOR

* An unexplained or relatively small swelling persists for more than one day. (Larger swollen areas should be seen immediately.)

* The swelling is discolored or numb or hinders your movement.

* The swelling follows a bite from a spider, snake or insect.

* The swelling is caused by a burn that forms blisters or breaks the skin.

* See your doctor immediately if swelling occurs in your throat or neck, you have any trouble breathing or you feel dizzy or faint.

What Your Symptom Is Telling You

If you've ever been laughed at, picked on or made fun of, you know how easy it is for a personal insult to make your thoughts swell up in anger. When it comes to sensitivity, however, even the most delicate of egos can't compare with our skin. It, too, gets its fair share of insults of the physical type—anything from the trauma of a hard blow to a bee sting to some irritant that just rubs it the wrong way. But while you may bite your tongue and let an insult roll off your back, your skin is not so willing to turn the other cheek.

Your ticked off hide has no reservations about letting the world know that it's mightily peeved and wastes no time in responding with a quick and furious comeback. But instead of lashing out and screaming with rage, the skin vents its wrath by blowing up like a balloon.

Your once-peaceful skin becomes a hotbed of activity. "Insult to the skin triggers a variety of reactions as a self-defense mechanism," says William Dexter, M.D., assistant professor of clinical community and family medicine at the Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire. "Vessels and capillaries dilate and expand as the body tries to rush more blood to the area. Fluid can leak from these vessels and collect in the skin tissue. Cells also migrate to the site of the insult and release substances like histamines, which stimulate inflammation by attracting more cells. And the body's immune system goes into overdrive producing additional cells to fight off infection and repair damaged tissues."

What kinds of things stimulate this inflammatory process? Plenty! We've already discussed skin damage from trauma. Now imagine a more subtle sneak attack on the skin. "Anywhere there is a break in the skin, foreign agents like bacteria, fungi or viruses can invade and cause an infection called a cellulitis," says Kevin Ferentz, M.D., assistant professor of family medicine at the University of Maryland School of Medicine in Baltimore. "These can occur either at the site of entry or the invaders can migrate elsewhere throughout the skin."

Sometimes skin is hypersensitive to certain substances and mere contact is enough to send it into a tizzy. Dermatologists call this tizzy contact dermatitis. The resulting inflammation can be produced in two ways. An irritant dermatitis often results from exposure to or repeated usage of harsh soaps, detergents and other chemicals, usually on the hands. A contact allergy is an allergic response to anything from cosmetics to jewelry to plants like poison ivy.

The causes of atopic dermatitis or eczema are not so well known. This chronic, recurring eruption, accompanied by itchy, red, scaly patches, is believed to be inherited and may be related to eating certain foods.

Foods and medications can also cause some people to suddenly break out into a series of swollen, itchy skin lumps called hives or urticaria. These swollen patches, lasting minutes to hours, represent an allergic response to such drugs as aspirin and penicillin, and such foods as strawberries, tomatoes and shellfish. In it's most serious form, urticaria can develop into what is called anaphylaxis—a life-threatening emergency in which the throat and lungs swell and fill up with fluid.

Symptom Relief

Prolonged skin swelling can lead to tissue damage, so it is important to bring it under control quickly. Try these swell-stoppers.

Chill it and raise it. Cool baths, or a bag of ice applied to the swollen area for 15 minutes at a time several times a day will encourage blood vessels to constrict, says Jeffrey S. Dover, M.D., chief of dermatology at New England Deaconess Hospital in Boston and assistant professor of dermatology at Harvard Medical School. This constriction reduces most kinds of swelling. Also, keeping the swollen area elevated will help drain fluids and bring down the inflammation.

Apply heat for cellulitis. Warm, moist towels wrapped around the area of a cellulitis infection will bring more blood to the area and help control the spread of bacteria and other infectious microbes and may bring this type of swelling under control, says Dr. Ferentz. Heat should be applied for 15 to 20 minutes at a time and can be repeated every few hours.

Cream it with hydrocortisone. Most topical medications won't help much for swelling from contact dermatitis. The lone exception is a 0.5 to 1 percent hydrocortisone cream available in drugstores. The cream will help ease minor inflammation and itching, says Lawrence C. Parish, M.D., clinical professor of dermatology at Jefferson Medical College of Thomas Jefferson University in Philadelphia. But it should not be used if there is an infection present; it will only worsen it.

Double-check your shopping list. And your wardrobe. And your accessories. If you have any new products in your home or at work that are coming in contact with your skin, they may be causing a skin allergy and need to be replaced, says Stephen M. Schleicher, M.D., clinical instructor of dermatology at Temple University Medical School and Philadelphia College of Osteopathic Medicine and co-director of The Dermatology Center in Philadelphia. "Sometimes just stopping the contact is all that's needed to stop the swelling," he says.

Wear gloves. If you come into contact with a lot of chemicals and substances that can cause irritation, like detergents or industrial oils, put on some protective outer gear like rubber gloves, boots and aprons. But be careful: Sometimes these products are treated with formaldehyde or made of latex, both of which can be irritants.

Take an antihistamine. Many good over-the-counter oral medications are available that will bring down swelling, says Dr. Dover. Among the ones he recommends are the antihistamines Chlor-Trimeton and Benadryl.

Ask about oral antibiotics. Most skin infections do not respond to topical medications and will have to be treated by taking oral antibiotics as prescribed by your doctor, says Dr. Ferentz.

Avoid aspirin and anesthetics. Aspirin is considered an anti-inflammatory drug, but it can actually worsen swelling by encouraging bleeding, says Dr. Dexter. And topical anesthetics like benzocaine will only aggravate swelling.

Avoid scratching and rubbing. Further irritation to the area will worsen the swelling. Keep your hands off and try to wear loose clothing that won't rub against the swelling, says Dr. Ferentz.

Remove stinger and clean. A stinger or any other foreign object left in the skin will continue to cause the skin to swell until it is removed. If it's sticking out of the skin, remove the stinger with tweezers then wash the wound with soap and water, suggests Dr. Ferentz. If the stinger is in deep, see your doctor to have it removed.

Treat your sting like beef. Sprinkling some Adolph's Tenderizer on a bee sting or mosquito bite can reduce some of its swelling as well as pain and itch, according to Dr. Parish.