Medical Dermatology

Our physicians specialize in the diagnosis and treatment of a broad array of skin disorders. The most common problems addressed are skin cancers, benign skin growths, eczema, psoriasis, acne, mole evaluation, rosacea and rashes. In addition, we offer photodynamic therapy for the treatment of actinic keratosis.

Acne

Acne is a common skin condition characterized by white heads, black heads, pimples or cystic nodules that can involve the face, chest, back, shoulders and upper arms. Approximately 80% of adolescents and 10% of adults may be affected by some form of acne. While acne is not a dangerous or life threatening condition, it can lead to physical disfigurement, scarring, and emotional distress. Fortunately, there are several effective treatment options to help control acne and prevent future breakouts.

Causes of Acne

Acne develops when hair follicles or pores become clogged, often due to overproduction of oil, shedding of dead skin cells, and overgrowth of bacteria which can irritate the skin. When a pore becomes completely blocked by oil and dead skin cells, a whitehead is formed. When pores are open, a blackhead is formed. When there is overgrowth of bacteria with inflammation, a red papule or pimple is formed. If there is excessive buildup of oil and dead skin cells with severe inflammation, a red nodule or cystic lesion may develop.

The cause of acne and excess oil production may vary, and can be the result of hormones, bacteria, heredity or due to environmental factors. During or after puberty, increase in certain hormones in the body stimulates the production of oil that can contribute to acne. Acne can flare as a result of hormonal fluctuation as seen during puberty, menstrual periods or pregnancy. Environmental factors such as humidity, excessive use of cosmetic products, or certain medications can also influence acne. Acne is a medical condition, and patients should seek dermatologic treatment if their symptoms do not improve or do not respond to over-the-counter regimens.

Treatment of Acne

Treatment of acne is aimed at regulating the turnover of skin cells, decreasing the production of oil, and reducing inflammation to help prevent the formation of new blemishes. This can be done through a combination of topical treatments (creams or gels applied directly to the skin), oral antibiotics, isotretinoin, or hormonal medications. With the proper regimen, it may take four to six weeks to notice visible improvement of your skin.

  • Benzoyl Peroxide: Cleans and dries the skin, and helps reduce the blockage of pores.
  • Salicylic Acid: Helps exfoliate and resurface the skin.
  • Tretinoin (Retinoids): Regulate the turnover of skin cells, prevent the formation clogged pores, and help with whiteheads and blackheads.
  • Topical Antibiotics: Reduce the bacteria load on the skin and help reduce red bumps.
  • Oral Antibiotics: Often used to help reduce the bacteria load on the skin and because of their anti-inflammatory property helps reduce red bumps, pustules, and cystic lesions.
  • Hormonal Treatments: May be used for female patients with hormonal fluctuations or hormonally induced acne.
  • Isotretinoin (Accutane): May be prescribed for severe acne or acne that does not respond to other treatment methods. Isotretinoin works by reducing oil secretion and stabilizing the turnover of the skin. Treatment usually consists of a 5-month course with visual improvement starting after 1-2 months of therapy. Patients often experience a subtle flare of their acne during the first few weeks, but gradually have significant improvement over the course of their treatment.

Depending on your symptoms and skin type, our dermatologist can help determine what treatment options are best for you.

Actinic Keratosis

Actinic keratoses, also known as solar keratoses, are precancerous lesions caused by chronic sun exposure (ultraviolet radiation) over time. They commonly present as pink to tan or pink to red rough scaly spots on exposed areas such as the face, neck, ears and arms. While these lesions are not cancerous, they may progress to squamous cell carcinoma of the skin if left alone. Squamous cell carcinoma is a common skin cancer which can invade surrounding tissue and potentially spread to other organs if left untreated. Patients who develop rough scaly spots or non-healing lesions should consult a dermatologist for evaluation.

Treatment of Actinic Keratoses

There are a variety of treatment options for the treatment of actinic keratoses (AKs). Treatment can range from in-office procedures to topical creams and gels which can be used at home.

  • Cryotherapy (Cryosurgery): A common treatment option for actinic keratoses in which Liquid Nitrogen is used to “freeze” and destroy precancerous cells. Treatment often results in blisters which gradually heal and resolve in 2-3 weeks.
  • Chemical Peels: An in-office procedure in which a chemical or acid is applied to the skin and results in the destruction and sloughing of precancerous skin cells. Patients often experience redness and peeling of the skin that can last 1-2 weeks.
  • Photodynamic Therapy (PDT): An in-office procedure which uses a photosensitizing agent called Levulan (Aminolevulinic Acid 20%) along with a light source to help treat sun damage and precancerous lesions. Levulan is applied to the skin and incubated for approximately 60-90 minutes where precancerous cells absorb the medicine. Following incubation, the treated area is exposed to blue light which activates the medicine resulting in destruction of precancerous cells and rejuvenation of the skin.
  • Topical Chemotherapy: Creams or gels applied to the skin which treat and prevent the progression of actinic keratoses. These creams can often be used in addition to cryotherapy to help “clean up” sun damaged skin and remaining precancerous cells. Side effects include inflammation and irritation of the skin.

Depending on your skin type and degree of sun damage, our dermatologist can determine what treatment options are best for you. Because actinic keratoses are due to long term sun exposure, individuals who develop these lesions are more likely to develop them again and may need routine skin examinations.

Atopic Dermatitis / Eczema

Atopic dermatitis, also known as eczema, is a common inflammatory condition characterized by an inflamed rash with itching, scaling, and sometimes blisters. Atopic dermatitis can present anywhere on the body and tends to favor the face, arms, and legs. Itching and irritation of the skin are the most common symptoms, and severity can vary from one person to another. Patients with a history of asthma or allergies may experience more severe symptoms. Repeat scratching or rubbing of the skin can result in oozing, crusting and thickening of the skin. Individuals with severely dry skin may also develop painful cracks or fissures.

Atopic dermatitis (AD) can affect people of all ages and backgrounds. It is thought to be caused by an abnormality of the body’s immune system (often due to over-activity of a specific part of the immune system) and its interaction with the environment. This condition is very common in children and usually presents before the age of five. Although there are various treatment options, atopic dermatitis tends to be chronic and recurring with periodic flares. Patients often have sensitive skin which can be easily aggravated by environmental factors such dry weather, excessive moisture, household cleaning products, harsh soaps, plants & vegetation, etc. Approximately 60% of children may outgrow eczema by early adulthood, although it can persist into adulthood. Adults with eczema tend to have a more chronic and relapsing course. There are also different subtypes of eczema:

  • Asteatotic Dermatitis: Eczema which is often associated with dry skin. Patients may experience small cracks and fissures with inflammation of the skin. Often flares during the winter when the weather is dry and cooler.
  • Contact Dermatitis: Inflammation of the skin due to environmental allergens and irritants. Causes may include: perfumes & fragrances, household cleaning products & detergents, cosmetics, jewelry (often nickel), weeds & plants, fabrics, leather, and rubber. Sometimes patch testing may be needed to help identify a specific allergen.
  • Dyshidrotic Dermatitis: Eczema which may involve the sweat glands of hands and feet. Patients may experience inflamed skin with small vesicles which can itch severely. This condition may flare with repeat hand washing or excessive moisture.
  • Nummular Dermatitis: Common form of eczema which can present as round patches of inflamed itchy skin. Although this condition can present anywhere, it tends to favor the arms and legs, and usually flares during winter time. Nummular dermatitis is commonly mistaken for ringworm due to its round configuration.

Treatment of Atopic Dermatitis

Treatment of atopic dermatitis is aimed at reducing inflammation, irritation, and dryness of the skin. Mild cases may be controlled with over-the-counter hydrocortisone creams, moisturizers, and antihistamines. It’s important to avoid any known triggers or allergens that can irritate the skin. More persistent cases can be controlled with prescription medications including steroid creams & ointments, non-steroidal anti-inflammatory creams, corticosteroid injections or pills, light therapy, and other systemic medications. Steroid creams and ointments are considered the standard of care for the treatment of eczema, although there is the risk of thinning and atrophy of the skin with extended use of strong steroids. High potency corticosteroid creams should not be applied to the face, underarms or genitals where the skin is naturally thin. Lower strength steroid creams may be prescribed for such sensitive areas. In addition to topical corticosteroids, frequent moisturizing and avoiding triggers are key factors in controlling atopic dermatitis. It’s also important to avoid scratching or picking at the skin as this can exacerbate your condition and increase the risk of secondary infection. Instead of scratching, cool compresses (towel soaked in cool water) can be used on top of your medications to help soothe and calm the skin.

In more severe cases where prescription creams or ointments may not be enough, oral immunosuppressant medications may be prescribed. These medications work by suppressing the hyperactive immune response that is responsible for causing eczema. Although these medications are effective in controlling severe eczema, patients on these medications will need close monitoring due to potential risks and side effects. Depending on your skin type and the severity of your condition, a dermatologist can determine which treatment options are appropriate for you.

Alopecia Areata

Alopecia areata (AA) is a common autoimmune disease in which the body’s immune cells attack the hair follicles, resulting in hair loss. It often presents as distinct patches of hair loss that can affect any part of the body. In most cases the condition is self-limited with gradual regrowth of hair within 2 years. However, some patients may have a more resistant or aggressive form of the disease with progressive loss of hair on the scalp and different body parts. Although most patients experience limited hair loss, it is difficult to predict the course of the disease. This condition is not infectious and affects approximately 2% of the population.

Although there is no permanent cure for alopecia areata, there are a few different treatment options to help promote the regrowth of hair. Corticosteroids are often used to treat autoimmune diseases and may be administered as injections, pills, or topical creams in order to suppress the immune system from attacking the hair follicles. Injections have shown to be more effective than other forms of treatment. While injections may help with the areas treated, patients may still develop new areas of hair loss.

Rogaine and other topical products may also be used to help stimulate hair growth in affected areas. A combination of these treatment options may improve their effectiveness, but results may vary.

Cyst

Cysts on the skin are commonly referred to as epidermal cysts or epidermal inclusion cysts. These are benign (non-cancerous) growths that usually present as a firm bump or nodule directly underneath the skin. Epidermal cysts can occur anywhere on the body but tend to favor the face, neck and back. Epidermal cysts often result from a clogged pore or follicle with accumulation of dead skin cells and the formation of a squamous lining or sack.

Small lesions are often subtle and asymptomatic, and may be monitored. However, larger cysts may cause physical disfigurement, pain or discomfort. Patients should avoid picking, cutting or squeezing at cysts due to risk of secondary infection and inflammation. Treatment commonly consists of surgical excision in which the entire cyst, including the sack, is surgically removed and sutured. Most cysts can be removed in the office under local anesthesia. If a cyst is drained or the sack is not completely removed, there is a higher risk of recurrence. Although epidermal cysts are benign by nature, a definitive diagnosis can not be made until the lesion is removed and sent to pathology for examination. Patients who develop any changing or growing lesions, should consult a dermatologist for evaluation. Depending on the size, location and presentation of the lesion, our dermatologist can help determine the best treatment option for you.

Folliculitis

Folliculitis is a common inflammatory condition characterized by red bumps, pimples or pustules that can occur almost anywhere on the skin. Causes for folliculitis include excessive moisture, clogged pores, physical irritation (such as shaving or insect bites) and overgrowth of bacteria which can cause inflammation and irritation of the follicles. Although Staph aureus is the most common type of bacteria associated with this condition, other types of bacteria and fungi can also contribute to folliculitis.

Treatment is aimed at decreasing clogged pores, reducing inflammation and treating any associated bacteria. Treatment options include antiseptic or exfoliating washes, topical antibiotics, and oral antibiotics which help reduce inflammation and decrease the bacteria load on the skin. Sometimes a biopsy or culture may be needed to help confirm a diagnosis and identify a potential cause. Depending on your skin type and symptoms, our dermatologist can help determine the best treatment course for you.

Lipoma

Lipomas are benign fatty growths that present as soft nodules under the skin. They usually grow on the trunk, shoulders or arms, but can present almost anywhere on the body. Lipomas are typically slow-growing and painless, but can occasionally cause pain if pushing against a nerve or blood vessel.

Most lipomas are subtle and do not require treatment if not bothersome. Although lipomas are benign by nature, a definitive diagnosis can not be made until the lesion is removed and sent to pathology for examination. Lesions that are growing, symptomatic, or painful may be treated by surgical excision. Most lipomas can be easily treated in the office under local anesthesia. Larger lesions may be referred to a surgeon for further evaluation, and excision possibly with general anesthesia. Depending on the size, location and presentation of the lesion, our dermatologist can help determine the best treatment option for you.

Melasma

Melasma is a common skin condition which presents as tan to brown pigmented patches often on the face. Melasma is caused by overproduction of pigment by melanocytes (pigment producing cells) within the skin. Unlike moles, there is not an increase in the number of melanocytes, but only the pigment which is produced by melanocytes. Multiple factors have been implicated in the cause of melasma including: hormonal fluctuations, sunlight/ultraviolet radiation, as well as genetic factors. Melasma is commonly seen during or after pregnancy as well is in patients who are on birth-control or hormonal therapy. Sun exposure can exacerbate the condition and make it more obvious.

Treatments for melasma include:

  • Hydroquinone cream: Bleaching cream which helps reduce the production of pigment by melanocytes.
  • Tretinoin cream: Increases the turnover of cells and helps resurface the skin. Tretinoin often works best when combined with a bleaching product such as hydroquinone.
  • Sunscreen: Protection from the sun and liberal use of sunscreens is equally important in the treatment of melasma as prescription medications. Because the sun and UV radiation also stimulate the production of pigment, it is very important to protect your skin from the sun. Despite proper treatment, melasma can return with exposure to sun light and UV radiation.
  • Azelaic acid: Has also been shown to decrease the activity of melanocytes, although less effective than hydroquinone.
  • Phototherapy/Laser therapy: Laser and light therapy have shown to be very effective in the treatment of melasma, especially when bleaching creams don’t help.
  • Discontinuation of birth control: Stopping hormonal therapy such as birth control can help with melasma, although risks and benefits must be considered.

Depending on your skin type and clinical symptoms, our dermatologist can help determine the best treatment option for you.

Moles (Nevi)

Moles, also called “nevi”, are pink to brown growths that can be flat or raised, and can appear anywhere on the skin. They are caused by an increase in the number melanocytes (pigment producing cells) in the skin which cluster together. Patients may start developing moles during early childhood and can continue to develop new lesions into their 30’s. The average adult may have 20-40 moles on their body. Most moles are harmless, but changes in shape, color or size may be indicative of cancerous changes and should be evaluated by a physician.

Congenital Nevus

Congenital nevi are moles that are present at birth or appear during early childhood. These moles are usually benign and may gradually grow in size with an individual as they grow older. Large moles or moles that are changing may be at risk of becoming cancerous and should be evaluated.

Intradermal Nevus

Intradermal nevi are benign moles that commonly present as pink to skin colored bumps that can present anywhere on the skin. These moles are typically harmless and don’t require treatment unless they are irritated, itching or bleeding.

Dysplastic Nevus

Dysplastic nevi are atypical moles that are larger than average, with color variation and irregular borders. These moles need to be followed for changes and may need to be biopsied due to increased risk of becoming cancerous. Patients with multiple atypical moles may be at increased risk of developing melanoma and may need routine skin checks at home and professionally by their doctor. The American Academy of Dermatology has developed the “ABCDEs of Melanoma” as a guideline to monitor moles:

  • Asymmetry: Part of the mole is different from the other half in shape, size, and color.
  • Border: The edges of the mole are uneven and irregular.
  • Color: Mole with color variation or different colors.
  • Diameter: The mole is usually greater than 6mm in size or growing in diameter.
  • Evolving: A mole or lesion that is different from other moles on the body or changing in size, shape, and color.

Treatment of Moles

Suspicious or bothersome moles may be biopsied or removed in the office by a shave procedure in which a razor is used to shave off the lesion, or by surgical excision where the lesion is surgically excised and sutured. Shave removal is often appropriate for smaller lesions, whereas larger moles may require surgical excision. People who develop any suspicious lesions that are changing, growing, or not healing should consult a dermatologist for evaluation. Depending on the size, location, and presentation of the lesion, our physician can help determine the best treatment option for you.

Photodynamic Therapy (PDT)

Photodynamic therapy (PDT) is an in-office procedure which uses a photosensitizing agent called Levulan (Aminolevulinic Acid 20%) along with a light source to help treat skin conditions such as actinic keratoses (precancerous lesions), sun damage, and acne. Levulan is applied to the skin and incubated for approximately 60-90 minutes where precancerous cells and inflammatory cells involved with acne absorb the medicine. Following incubation, the treated area is exposed to blue light which activates the medicine resulting in destruction and improvement of precancerous cells and acne. Treatment also causes rejuvenation of sun damage resulting in a smoother and more even skin.

Most people experience successful results from PDT after 2 treatment sessions approximately 2-4 weeks apart. This procedure can sometimes be combined with other treatments, such as intense pulsed light (IPL), in order to maximize results and leave the skin healthy and beautiful. If you have sun damaged skin or refractory acne, our physician can help determine if Photodynamic Therapy is an appropriate treatment option for you.

Psoriasis

Psoriasis is a common inflammatory condition of the skin which presents as red patches with thick silvery scales. It can present anywhere on the body but favors the scalp, elbows, knees, and lower back.

Psoriasis can affect people of all ages but is more common in adults, with an average age of onset between 30-35 years. It is thought to be caused by over-activation of a specific part of the body’s immune system which results in inflammation and thickening of the skin. Some patients may also develop nail changes such as pitting, thickening, or discoloration of the nails. Common symptoms include inflammation, itching and irritation of the skin, but up to 30% of patients may also experience arthritis with joint pain. Psoriasis is not contagious, but a chronic condition which can wax and wane over time. There are a variety of environmental factors that can affect or trigger psoriasis, such as infections, injury to the skin, stress, smoking, alcohol consumption, and certain medications.

There are a few distinct types of psoriasis with different clinical presentations and symptoms:

  • Plaque Psoriasis: The most common type of psoriasis that affects about 80% of patients. Classically presents as inflamed thick scaly patches on the skin.
  • Guttate Psoriasis: Common form of psoriasis which appears as small red scaly spots usually on the trunk and extremities. Guttate psoriasis is more common in children and younger adults, and typically has a sudden onset following infections such as strep.
  • Inverse Psoriasis: Presents as inflamed red patches in skin folds such as the armpits, genitals, and under the breasts. Inverse psoriasis is often exacerbated by moisture, sweating, and friction.
  • Pustular Psoriasis: Uncommon form of psoriasis which presents as white blisters or pustules surrounded by inflamed red skin. Triggers for pustular psoriasis include stress, overexposure to ultraviolet radiation, infections, and certain medications.
  • Erythrodermic Psoriasis: Least common form of psoriasis that presents with severe inflammation and scaling of the skin that can involve most of the body. Patients can experience severe itching and systemic symptoms. Triggers include severe sunburn, infections, and medications (including withdrawal of certain medications).

Treatment of Psoriasis

Psoriasis is classified as mild to moderate when it affects 3-10% of the body, and severe when it covers more than 10% of the body. Depending on the type and severity of disease, there are a variety of treatment options aimed at reducing inflammation and controlling the symptoms of psoriasis. Treatment can range from topical creams to systemic medications such as injections or pills.

Topical Medications: Creams & Ointments

  • Topical Corticosteroids: Steroid creams and ointments are the most commonly used medications for the treatment of psoriasis. They are applied directly to the affected area and help reduce inflammation, itching, and scaling of the skin. When using topical steroids, it’s best to take periodic breaks to prevent the body from getting used to the medicine. In addition to topical corticosteroids, frequent moisturizing and avoiding triggers are also important in controlling psoriasis. Potent topical steroids can cause thinning of the skin, it is important to talk to your doctor about ways to prevent this from occurring.
  • Calcipotriene: Topical medication derived from vitamin D which helps regulate the turnover of skin cells and reduce scaling and inflammation. Combining Calcipotriene with a topical steroid often provides better control of psoriasis.
  • Tazarotene: Topical retinoid cream which helps regulate turnover of skin cells and reduce scaling and thickening of the skin.
  • Moisturizers: Moisturizing the skin regularly helps reduce dryness that can aggravate psoriasis. Using a moisturizer with alpha-hydoxy acid, such as Amlactin, helps soften the skin and reduce scaling.

Light Therapy / Phototherapy

Light therapy consists of exposure to ultraviolet radiation or lasers which help reduce inflammation of the skin. Phototherapy may be an effective treatment option for patients with moderate to severe psoriasis.

  • Natural Sun (UVA & UVB): Controlled exposure to ultraviolet radiation from the sun helps reduce inflammation associated with psoriasis. It’s important to adjust and control exposure to sunlight as it also increases the risk of sunburn and skin cancer.
  • Narrowband UVB Therapy: Utilizes light with a specific wavelength of ultraviolet radiation (310-312 nm) to treat inflammatory conditions such as psoriasis. Multiple regular treatments are often needed to see improvement.
  • Excimer Laser: Laser which emits a high-intensity beam of light to targeted areas of psoriasis. May be an appropriate treatment option for patients with a few “hard to treat” areas. Repeat treatments are often needed to see improvement.

Systemic Therapy

Systemic therapy for psoriasis is often reserved for patients with moderate to severe psoriasis who do not have sufficient improvement with topical therapy. Patients with psoriatic arthritis may also benefit from certain systemic medications.

  • Oral Medications: Acitretin, Cyclosporine, and Methotrexate are systemic medications taken as pills which help with moderate to severe psoriasis.
  • Biologics (Humira, Enbrel, Stelara): New class of injectable medications that work by suppressing a specific part of the immune system associated with psoriasis. These medications are also effective in treating and preventing the progression of psoriatic arthritis.

Although systemic therapy is effective in controlling moderate to severe psoriasis, patients on these medications will need regular monitoring and lab-work due to potential risks and side effects. Depending on your skin type and the severity of your condition, our doctor can determine which treatment options are best for you.

Ringworm (Tinea)

Ringworm is a general term used to describe fungal infections of the skin. Contrary to its name, ringworm is not an infection by a worm, but due to fungus that can infect and thrive on the skin. The medical term used for ringworm is “Tinea” and the condition may be further classified depending on the location of the infection. Fungal infections commonly present as round inflamed scaly patches that may spread over time. There are different clinical variations depending on the type of fungus and location of the infection.

  • Tinea corporis: Most common form of fungal infection which can affect the trunk, arms and legs. Usually presents as round scaly patches.
  • Tinea pedis: Also referred to as “athlete’s foot.” This type of fungal infection affects the feet and can present as generalized scaling of the feet or inflamed red scaly patches between the toes.
  • Tinea manuum: Affects the hands and can present as generalized scaling of the palms.
  • Tinea cruris: Also referred to as “jock itch” and involves the groin area. Presents as large inflamed scaly patches that may gradually expand. Patients often have simultaneous infection of the feet. The most common cause of Tinea cruris is fungal infection of the feet which gradually spreads to the groin.
  • Tinea facei: Fungal infection of the face that can present as round scaly patches with raised borders. More common in children and treatment often consists of antifungal creams or gels. If there is involvement of hair follicles, oral antifungals may be necessary for appropriate treatment.
  • Tinea capitis: Fungal infection of the scalp. More common in children and presents as scaly patches on the scalp. Patients may also have associated hair loss. Treatment often involves oral antifungals for 6-8 weeks. Creams or gels are often insufficient for fungal infections of the hair and nails.
  • Tinea unguium: Also referred to as “onychomycosis” is fungal infection of the nails. Infection of the toenails is more common than fingernails, and commonly presents as yellow thickened scaly nails (although there are different variations). Creams or gels are often insufficient, and treatment consists of oral antifungals which are taken for up to three months. Despite three months of therapy, it can take six to nine month to notice improvement because the affected nails have to grow out.

Despite the classic presentation of Tinea (ringworm) with round scaly patches, there are multiple other inflammatory conditions of the skin (nummular dermatitis, pityriasis rosea, guttate psoriasis, contact dermatitis, etc.) that can have a similar presentation. Different tests such as scraping of the skin or a biopsy may be necessary to help confirm a diagnosis. Treatment can vary from topical therapy to systemic medications depending on the type and location of your infection. Subtle involvement of the skin can often be managed by topical antifungal creams or gels. However, a severe infection of the skin or involvement of the hair and nails often need systemic therapy for complete resolution.

Depending on your skin type and symptoms, our dermatologist can help determine the appropriate treatment for you.

Rosacea

Rosacea is a common inflammatory condition of the skin characterized by acne-like pimples or pustules with a background of facial redness. Some patients may also experience dryness and irritation of the eyes. Approximately 14 million Americans are affected by some form of Rosacea. While this is not a dangerous or life threatening condition, rosacea can cause irritation of the skin, physical disfigurement, and emotional distress.

Rosacea can affect anyone, but is more common after the age of 30. It has a gradual onset with a chronic course which can wax and wane over time. Women are more likely to be affected, but men tend to have more severe symptoms. Symptoms include flushing of the face, red skin with small visible blood vessels, acne-like pimples or pustules, raised red patches, swelling, burning or stinging of the face, dry & irritated eyes, and enlargement of the nose (usually seen in men). Symptoms may vary and can also spread to the head, neck, and chest. While the exact cause of rosacea is unknown, it’s thought to be due to a combination of hereditary and environmental factors. Known triggers or aggravating factors for rosacea include:

  • Hot or spicy foods
  • Hot beverages
  • Alcohol consumption
  • Extreme temperatures
  • Sunlight
  • Stress
  • Strenuous exercise
  • Certain medications

While there is no permanent cure for rosacea, there are several effective treatment options which help control the symptoms and progression of the disease. Treatment is aimed at reducing inflammation and can vary depending on your symptoms. Topical medications such as clindamycin, metronidazole, sulfacetamide sulfur, or Azelaic acid may be used to help reduce local inflammation. Oral antibiotics may be used for patients with multiple red bumps, pimples, or pustules. Systemic isotretinoin (Accutane) is reserved for severe rosacea that does not respond to other medications. Persistent redness and dilated vessels often do not respond to systemic or topical therapy, and may require laser/light therapy for improvement.

In order to help prevent flare-ups, we recommend a gentle skin-care routine using mild cleansers without benzoyl peroxide or salicylic acid, rinsing with warm water (not hot or cold), and gently dabbing the face dry (instead of rubbing). In addition, patients are encouraged to protect their skin from the sun which can exacerbate rosacea. Using a gentle moisturizer with sunscreen SPF 15+ as part of your daily routine is a simple and effective way to protect your skin and prevent the progression of rosacea. Green tinted products tend to help cover the redness, you may look for Eucerin redness relief products over the counter to use as a concealer.

Depending on your skin type and symptoms, our dermatologist can help determine what treatment options are right for you.

Seborrheic Dermatitis

Seborrheic Dermatitis is a common inflammatory condition that can cause redness, scaling, and flaking of the skin. It has a predilection for the scalp, face, and chest, and can affect up to 5% of the population. It commonly presents as redness and scaling on the scalp and central face (usually around the brows and nose). Patients may also experience irritation and itching of the skin. While the exact cause of seborrheic dermatitis is unknown, it may be due to a combination of environmental and genetic factors with overproduction of oil (sebum) in the skin and subsequent inflammation. Some studies suggest that it may involve an inflammatory reaction to a type of yeast that grows on oily skin, although this has not been proven. Seborrheic dermatitis can also be aggravated by illness, emotional stress, changes in weather, and certain medications.

While there are a variety of treatment options for seborrheic dermatitis, it tends to have a chronic and recurring course with periodic flares. Treatment options include:

  • Medicated Shampoos: Over-the-counter shampoos containing coal tar, salicylic acid, zinc pyrithione, and selenium sulfide have proved to be effective in reducing inflammation and flaking associated with seborrheic dermatitis. Certain anti-fungal shampoos such as ketoconazole have also shown to be effective.
  • Topical Corticosteroids: Steroid creams and ointments are effective in reducing inflammation and itching of the skin. When using topical steroids, it’s best to take periodic breaks to reduce the risk of steroid atrophy(thinning skin) and to prevent the body from getting used to the medicine.
  • Non-steroidal Creams: There are a new class of non-steroidal anti-inflammatory creams which help reduce the symptoms of seborrheic dermatitis without the risks of topical steroids. However, these medications can be more expensive.
  • Topical Antifungal Creams: Certain antifungal creams and shampoos have been shown to help by reducing the overgrowth of yeast on oily skin.

A combination of these medications and shampoos can be very effective in controlling seborrheic dermatitis. Depending on your skin type and symptoms, our dermatologist can help determine what treatment options are right for you.

Seborrheic Keratosis

Seborrheic keratoses (SKs) are common non-cancerous lesions that grow on the outer layer of the skin. They present as tan to brown warty growths that appear “pasted” onto the skin. Individual lesions can be rough and scaly, or waxy in texture. These lesions commonly develop after the age of 30, and it’s more common to have several lesions than just one or two. Seborrheic keratoses can present on any part of the body, but typically exclude the palms and soles of the feet. Unlike warts, these lesions are not due to a virus and are not contagious. They are considered to be hereditary and harmless.

Seborrheic keratoses are usually asymptomatic growths that don’t require treatment unless they are bothersome or cosmetically disfiguring. Occasionally, these lesions can itch or become irritated by clothing or jewelry. If bothersome, common treatment options include cryotherapy, where the lesions are frozen with liquid nitrogen, or shave excision, where they are shaved off with a thin flat razor. Although SKs are benign by nature, they need to be differentiated from other potentially concerning lesions if changing or growing.

Any skin lesion that is changing, growing or becoming symptomatic should be evaluated by a physician. Please contact our office if you have any new or concerning lesions. Our dermatologist can help educate and guide you in the right direction.

Shingles (Herpes Zoster)

Shingles is a painful condition that usually presents as a localized rash with blisters and burning on one side of the face or body. It commonly presents after the age of 50, although people of all ages can be affected. Shingles is caused by a re-activation of the chicken pox virus which is acquired during childhood. After recovering from chicken pox, the virus resides in the spinal cord and can become reactivated as “shingles” later in life. Risk factors for shingles include: age greater than 50 years, stress, illness and a compromised immune system. Signs and symptoms associated with shingles include:

  • Pain, burning, and irritation of the skin localized to one side of the body or face
  • A rash that appears shortly after the pain
  • Grouped blisters or vesicles within the rash that can weep or crust
  • Occasionally, people can have pain and burning without developing a rash

Shingles can be contagious and may cause chicken pox in someone who has not been vaccinated or has not had chicken pox (although most people today receive the chicken pox vaccine during childhood). It’s important to avoid direct contact with skin lesions for anyone who has not had chicken pox or has not been vaccinated. However, shingles is not contagious to someone who has already had chickenpox (or has been vaccinated) and contact does not increase the risk of developing shingles in those individuals.

Shingles is generally a self-limited condition and most patients recover within 2 to 3 weeks without any problems. Up to 15% of patients (usually after the age of 50) may develop “post-herpetic neuralgia,” which is pain and burning that can persist after improvement of the rash. Diagnosis and early treatment of shingles helps accelerate the healing process and minimizes the risk of post-herpetic neuralgia. Treatment consists of antiviral medications which help suppress the virus, and medications to help control the pain and irritation of the nerves. Early detection and treatment is critical in reducing the risk and severity of post-herpetic neuralgia. If you develop any symptoms that are consistent with shingles, it’s best to contact a dermatologist for evaluation and treatment. Our physician can help guide you in the right direction in the event of any concerns.

Skin Cancer

Skin cancer is the most common form of cancer in the United States with more than three million cases diagnosed each year. According to the American Academy of Dermatology, approximately one in five Americans will develop skin cancer at some point in their life. Skin cancer may develop anywhere on the body but is most common on sun exposed areas such as the face, neck, ears, and extremities.

The majority of skin cancers are composed of either basal cell carcinoma, squamous cell carcinoma, or melanoma. These cancers are named after the type of skin cells from which they originate. Basal cell carcinomas originate from the bottom layer of the epidermis called basal cells. They are the most common and least aggressive form of skin cancer. Squamous cell carcinomas originate from the top layers of the epidermis called squamous cells. These cancers are less common than basal cell carcinomas but are more aggressive with the potential to spread (metastasize). Melanomas originate from pigment producing cells in the epidermis called melanocytes. While melanomas are the least common form of skin cancer, they are the most aggressive with a high risk of metastasis if left untreated.

Common risk factors for skin cancer include: fair skin, sun exposure, tanning beds, increased age, suppressed immune system, as well as multiple atypical or large moles. While skin cancers are common, they are highly curable if caught early and treated appropriately. Treatment depends on the type, size and location of the tumor.

Basal Cell Carcinoma

Basal Cell Carcinoma (BCC) is the most common type of skin cancer and accounts for approximately 65% of skin cancers in the United States. It commonly presents as a slow growing pink pearly growth, sometimes with crusting or bleeding. This type of cancer rarely spreads to other body parts and tends to grow locally in the same area. Common risk factors for basal cell carcinoma include fair skin color, sun exposure, increased age, and exposure to other forms of UV radiation such as tanning beds. There are also rare genetic conditions which increase the risk of developing basal cell carcinomas at an earlier age.

A skin biopsy is usually required to confirm the diagnosis of basal cell carcinoma. Depending on the size and location of the lesion, there are different treatment options. The most common treatment for basal cell carcinoma consists of surgical excision in which the tumor is surgically removed and stitched up. Larger tumors or lesions on cosmetically sensitive areas may require Mohs Micrographic Surgery, a tissue-sparing procedure in which the tumor is excised in layers and mapped out. Other options include curettage and electrodesiccation in which the lesion is shaved, scraped and burned with an electrical needle. Topical chemotherapy creams can also be used for superficial basal cell carcinomas in patients who are not surgical candidates. Depending on your skin type, size and location of the lesion, a dermatologist can help determine which treatment option is best.

Patients who develop any suspicious lesions that are changing, growing, bleeding or not healing, should consult a dermatologist for evaluation. Patients with a history of sun damage, precancerous lesions, or skin cancers may need routine skin examinations. Not all basal cell carcinomas are created equal some types have more aggressive and destructive growth patterns.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) is the second most common type of skin cancer and accounts for 15-20% of skin cancers in the United States. Approximately 250,000 Americans are diagnoses with squamous cell carcinoma of the skin every year. It commonly presents as a pink, scaly, crusted lesion on sun exposed areas such as the head, face, neck and extremities. However, other areas of the skin can also be affected including the mouth and genitals. Risk factors for squamous cell carcinoma include fair skin, sun exposure, immunosuppression, increased age (more common after the age of 50), smoking & chewing tobacco (SCC of lips and mouth), and exposure to other sources of UV radiation such as tanning beds. Unlike basal cell carcinoma, squamous cell carcinoma has a higher risk of spreading (metastasizing) to lymph nodes and other organs. Size, location, and duration of the tumor often determine the risk of metastasis. The larger the lesion and the longer it’s been present, the higher the risk of metastasis.

Like other skin cancers, a biopsy is required to confirm the diagnosis of squamous cell carcinoma. Depending on the size and location of the lesion, there are different treatment options.

  • Curettage & Electrodessication: The lesion is shaved, scraped, and burned with an electrical needle. The resulting wound is allowed to heal on its own over time.
  • Surgical Excision: in which the lesion is surgically excised with appropriate margins and the wound is sutured.
  • Mohs Micrographic Surgery: A tissue-sparing procedure in which tumor is excised in layers and mapped out in the lab while the patient waits. Following excision, the defect may be closed with sutures or repaired with a skin graft or flap. This is the preferred method of treatment for large cancers or tumors on cosmetically sensitive areas.
  • Topical Chemotherapy: Less invasive treatment option which can be used for superficial SCCs (squamous cell carcinoma in-situ). Usually requires several days to weeks of treatment.
  • Radiation Therapy: Treatment option for difficult to treat tumors or patients that can not tolerate surgical excision.

Patients who develop any suspicious lesions that are changing, growing, bleeding or not healing, should consult a dermatologist for evaluation. Patients with a history of sun damage, precancerous lesions, or skin cancers may need routine skin examinations. Our physician can help determine the right treatment course for you.

Melanoma

Melanoma is the third most common type of skin cancer and accounts for approximately 10% of skin cancers. Although less common than other skin cancers, melanomas are the most aggressive and can spread to other organs if left untreated. Melanomas can be life-threatening with a fatality rate higher than basal cell and squamous cell carcinoma combined. Early detection and treatment is critical for curing this type of cancer.

Melanomas originate from melanocytes, which are pigment producing cells in the skin. Consequently, most melanomas present as pigmented lesions with color variation or dark pigment. In rare cases, some cancers may present as pink to red growths without pigment called “amelanotic melanoma”. Unlike BCCs and SCCs which are common on sun-exposed skin, melanomas are more common on the back in men and legs in women. A melanoma can present as a cancerous lesion by itself or can originate from a pre-existing mole. That is why it’s important for people to examine their skin regularly and monitor their moles for any changes, growth, or symptoms.

Risk factors for melanoma include:

  • Presence of multiple moles, large or atypical (unusual-looking) moles
  • First degree family member with melanoma
  • Overexposure to sunlight
  • Exposure to other sources of UV radiation, such as tanning beds
  • Fair skin and sun sensitivity
  • Immune system deficiency due to disease or organ transplantation
  • Previous melanoma

A biopsy is often required to confirm the diagnosis of a melanoma. Treatment depends on size, depth, and location of the tumor. Surgical excision with appropriate margins and regular skin exams are often appropriate for superficial melanomas less than 1mm (0.1 cm) in depth. Larger or deeper lesions may require sentinel lymph node biopsy and adjuvant therapy in addition to surgical excision. People who develop any suspicious lesions that are changing, growing, bleeding or not healing, should consult a dermatologist, as early detection greatly increases the likelihood of a cure.

Preventive Measures

Since the majority of skin cancers are due to UV radiation, sun protection and smart skin care are key factors in maintaining healthy skin and reducing the risks of skin cancer. According to the Skin Cancer Foundation, using a sunscreen with an SPF 15 or higher is an important part of a healthy skin regimen. However, sunscreen alone is not enough. The following guidelines help protect and care for your skin:

  • Stay out of the sun during peak hours, from 10 am to 4 pm.
  • Use a broad spectrum (UVB/UVA) sunscreen with SPF 30+ as part of your daily regimen. For extended outdoor activity, use a broad spectrum sunscreen with SPF30+ and reapply every two hours. It’s best to apply sunscreen half an hour before going outdoors.
  • Remember, sunscreen does not make you immune to the sun. It only delays the time it takes to burn! Seek the shade when possible.
  • Cover up with clothing, including a broad-brimmed hat and sunglasses.
  • Avoid tanning in the sun and tanning beds.
  • Keep newborns out of the sun. Start using sunscreens on babies over the age of six months.
  • Examine your skin monthly and contact your dermatologist if you notice any changes. For couples, its best to create a buddy system in which you examine your partner’s skin routinely.

Get regular skin examinations. It’s recommended that adults over the age of 40 get an annual skin exam by their dermatologist.

Sun Spots (Solar Lentigenes)

Sun spots, also known as “solar lentigenes,” present as tan to brown spots on sun exposed areas such as the face, neck, chest, upper back and arms. Solar lentigenes are caused by an increase in the production of pigment (melanin) and melanocytes (pigment producing cells) as a response to UV radiation. Unlike moles where the melanocytes are clustered together, melanocytes in lentigenes are evenly dispersed along the epidermis. Lentigenes are benign but can be a reflection of sun damage. Patients with solar lentigenes should take preventive measures to protect their skin from further UV exposure. Treatment is similar to melasma and consists of aggressive sun protection along with other options:

  • Hydroquinone cream: Bleaching cream which helps reduce the production of pigment (melanin) by melanocytes.
  • Tretinoin cream: Increases the turnover of cells and helps resurface the skin. Tretinoin often works best when combined with a bleaching product such as hydroquinone.
  • Sunscreen: Protection from the sun and liberal use of sunscreens is equally important in the treatment of solar lentigenes as prescription medications. Despite proper treatment, lentigenes can return with exposure to sun light and UV radiation.
  • Azelaic acid: Has also been shown to decrease the activity of melanocytes, although less effective than hydroquinone.
  • Phototherapy/Laser therapy: Laser and light therapy have shown to be very effective in the treatment of lentigenes, especially when bleaching creams don’t help.

Unlike melasma, solar lentigenes are not influenced by hormonal fluctuations. Lesions that are changing or growing should be evaluated by a dermatologist to rule out potentially concerning growths. A biopsy may be performed on atypical lesions to rule out lentigo maligna melanoma, a type of melanoma that results from excessive sun damage. Depending on your skin type and clinical symptoms, our dermatologist can help determine which treatment options are best for you.

Urticaria (Hives)

Hives, also known as urticaria, is a common inflammatory condition that can present as pink to red whelps anywhere on the skin. Symptoms include inflammation, itching, and swelling of the skin. People may also experience swelling around the eyes or swelling of the lips. In rare severe cases, some patients may experience difficulty breathing due to swelling of the throat and airway. As with most inflammatory conditions, urticaria is due to an over-activation of the immune system. This can be either due to an allergic reaction which stimulates the immune response or an intrinsic problem with a gradual onset.

There are multiple potential causes for hives and can often be difficult to pinpoint an exact cause. Hives are broadly categorized as either “acute urticaria” or “chronic urticaria” depending on how long the symptoms persist. Acute urticaria is hives that resolves in less than six weeks and is typically due to an allergic reaction. Multiple allergic triggers have been implicated in hives, including certain foods (commonly shellfish & nuts), medications, infections, and other environmental factors. Chronic urticaria is hives that continue to persist after six weeks. The cause of chronic hives is often very difficult to obtain and is usually idiopathic (unknown). Recent studies suggest that chronic urticaria may be an autoimmune reaction in which the body’s immune system becomes sensitized and remains over-activated. The underlying cause is unknown. Chronic urticaria can be frustrating and debilitating due to persistent hives that continue to come and go.

Other common and rare environmental factors that can cause recurrent hives include: certain medication and foods, heat, cold, pressure, sunlight, exercise, and even water!

  • Medication-induced urticaria: Almost any medication can cause an allergic reaction with hives. Common medications known to cause hives include antibiotics and non-steroidal anti-inflammatory medications (Aspirin, Ibuprofen, Motrin, Aleve, etc.).
  • Food-induced urticaria: Shellfish and nuts are the most common food allergens which can induce hives, although other foods can also be implicated.
  • Heat-induced urticaria: Hives triggered by continued application of heat onto the skin. Lesions begin to appear within five minutes of exposure and can last minutes to hours. Lesions are usually confined to exposed areas.
  • Cold-induced urticaria: Triggered by exposure of the skin to extreme cold conditions and is common in young adults. Patients may experience hives on the face, neck or hands after exposure to cold weather. In rare forms, patients may experience generalized hives a few hours after exposure to cold temperatures.
  • Cholinergic urticaria: More common form of hives that can develop after exercising, exposure to heat, stress or any activity that raises the body’s core temperature. Usually presents as small red itchy spots that can last minutes to hours.
  • Solar Urticaria: Sun-induced hives that develops shortly after exposure of skin to sunlight. There are various subtypes of solar urticaria depending on the wavelength of light involved. Lesions typically last minutes to hours and fade.
  • Pressure-induced urticaria: Hives that may develop in response to vibration or pressure on the skin. Lesions can present right after exposure to the stimulus or can present hours later.
  • Dermatographic-induced urticaria: Development of whelps or hives after the skin is scratched or firmly stroked. This is a very common form of chronic hives which can affect up to five percent of the population. Lesions present shortly after stroking the skin and usually resolve in less than half an hour.
  • Infection-induced urticaria: Hives may be triggered by certain viral or bacterial infections as the body mounts an immune reaction to the infection. Certain parasitic infections have also been known to cause hives.
  • Aquagenic urticaria: Very rare form of hives which develops in response to exposure of the skin to water. While patient’s can drink water, exposure of their skin to water can result in a hive-like reaction within minutes of exposure.

Treatment and management of urticaria is often dependent upon the underlying cause. Acute urticaria can often be treated with oral antihistamines and removal of potential allergens. Systemic corticosteroids such as prednisone or a Kenalog injection may be used for severe outbreaks. Topical corticosteroid creams and moisturizers with menthol often help reduce inflammation and soothe the skin. Patients are also encouraged to keep a diary of potential allergens or triggers that can cause a flare of their skin.

Management of chronic urticaria can often be challenging with limited effectiveness. Despite extensive clinical workup and lab-work, an underlying cause may be difficult to obtain. Patients that don’t respond to topical therapy and oral antihistamines may need systemic immunosuppressant therapy to help calm the over-active immune response that may be responsible for their hives.

Depending on your skin type and clinical symptoms, our physician and help provide a treatment plan that’s appropriate for you.

Vitiligo

Vitiligo is a common pigmentary disorder which results in loss of pigment within the skin. Patients present with well demarcated white, pink to white, or depigmented patches that can affect any part of the body. Vitiligo can affect people of ages and backgrounds, but is more noticeable in people with darker or tanned skin. It is thought to be an autoimmune disease in which the body’s immune cells attack pigment-producing cells within the skin called melanocytes. Other than physical discoloration of the skin, patients usually don’t experience other symptoms such as itching or irritation of the skin. Because vitiligo is caused by a malfunction of the immune system, patients may sometimes have other autoimmune disorders such as diabetes or hypothyroidism.

Treatment of vitiligo can often be challenging with limited improvement. The most common treatment options include topical corticosteroid creams or immunomodulatory creams aimed at suppressing the immune response locally. Unfortunately, results are often mild and limited, and do not prevent the appearance of new lesions elsewhere on the body. Other treatment options include light therapy and skin grafts. Light therapy has shown to be effective in some patients, but there is also an increased risk of burning and skin cancer. Skin grafts from healthy un-involved skin have shown limited improvement in some patients, but the process can be tedious and not commonly offered in a clinical setting.

Depending on your skin type and symptoms, our physician can help discuss the best options for you.
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Warts

Warts are common lesions that frequently grow on the hands and feet, but can affect any part of the body. They can be subtle and smooth, or large with a rough cauliflower-like surface. Warts are caused a by an infection of the Human Papilloma Virus (HPV) and can affect people of all ages and backgrounds. There are various strains of the human papilloma virus which can have different presentations on the skin. Different types of warts include:

  • Common warts: Also referred to as “verruca vulgaris.” Present as rough pebbly growths that commonly appear on the hands and knees, but can affect any part of the body. Patients may have one or multiple lesions.
  • Filiform warts: Warts with “finger-like” projections that usually present on the face, especially near the eyelids and lips.
  • Flat warts: Small skin-colored warts with a smooth flat surface.
  • Plantar warts: Thick rough warts that are found on the bottom of the feet. These warts can often be painful as they press against the bottom of the foot.
  • Genital warts: Soft pebbly bumps that are found around the genital and pubic areas. These lesions are sexually transmitted and can be highly contagious.

The HPV virus is acquired through physical contact and causes localized infections of the skin only. It does not circulate in the blood. However, touching or picking at these lesions can spread them to other body parts which is why it is important to avoid picking at warts. Females with warts on their legs should avoid shaving until all lesions are completely resolved, otherwise they can spread the virus across their legs. Warts can go away on their own over time, but may also spread to other body parts from repeat contact. Treatment options for warts include:

  • Cryotherapy (Cryosurgery): Very common treatment in which Liquid Nitrogen is used to “freeze” and destroy affected skin. Treatment often results in blisters which gradually crust and heal in 2-3 weeks. Warts may often require a few treatments before complete resolution. Lesions that are on the palms or bottom of the feet tend to be more resistant and may require multiple treatments.
  • Cantharidin: Chemical derived from a type of beetle which is applied to the skin and results in blistering and destruction of the affected area. Similar to cryotherapy, blisters gradually crust and heal in 2-3 weeks.
  • Electrosurgery: Electrical current is used to destroy the lesion.
  • Surgical excision: The lesion is anesthetized and surgically excised. Often reserved for larger or hard-to-treat warts.
  • Bleomycin injection: Chemotherapy injection which is injected into the lesion and causes direct destruction of the affected area.
  • Candin injection: Yeast extract which is injected into the skin. Works by drawing the body’s immune system to the wart, helping the body fight the wart. Results may vary.
  • Imiquimod cream: A topical cream that helps the body’s immune system fight the wart. Often a good treatment option for genital warts. Side effect incudes inflammation and irritation of the skin.
  • Salicylic acid: Over-the-counter and prescription-strength salicylic acid preparations can be applied directly to warts which cause resolution and peeling of the lesion. Often requires multiple daily treatments.

Depending on the size and location of the lesion, repeat treatments may be necessary for complete resolution. Most warts require multiple treatments to treat. Our dermatologist can help determine which treatment options are best for you.