Medical Dermatology 2016-11-12T15:27:58+00:00

Acne Treatment

All types of acne — blackheads, whiteheads, pimples, and cysts — develop when pores in our skin become clogged. The culprit is sebum [see-bum], an oil in our skin and bacteria that feed off it. Our bodies make more sebum when our hormones surge. This is why teens get acne. This is why women often breakout before their periods. Since hormones fluctuate in the years leading up to menopause, many women in their 40s and 50s get acne.

Treatment for acne varies depending on the type and severity of lesions, as well as the patient’s skin type, age and lifestyle. Options include:

  • Topical Medications

  • Blackhead Extraction

  • Skin Care

  • Facials

  • Antibiotics

  • Microdermabrasion

  • Blu-U Light Treatments

  • Smoothbeam

  • Accutane

  • Photodynamic Therapy

  • Laser Treatments

Acne scarring can be treated in a variety of ways as well. These include:

  • Chemical Peels

  • Dermabrasion/ Microdermabrasion

  • Soft Tissue Fillers

  • Laser/Pulsed Light Treatments

  • Subcision, a surgical technique

Visit American Academy of Dermatology to learn more about Acne.

Full-Body Skin Exams

Full-body skin exams are an important tool in screening patients for benign or cancerous lesions that they may not have been able to see or recognize on their own.

From head to toe and back to front, we inspect the skin for any suspicious growths. This quick and painless preventive measure is an invaluable tool in the early detection of skin cancer as well as many other dermatological conditions.

Skin exams are especially important if you have several moles, a history of sun burns or excessive sun exposure, or a family history of skin cancer.

Visit American Academy of Dermatology to learn more about Full body skin exam.

Psoriasis

Psoriasis is a group of chronic skin disorders that cause itching and/or burning, scaling and crusting of the skin. Over seven million men and women in the U.S. of all ages have some form of psoriasis, which may be mild, moderate or severe. The most commonly affected areas are the scalp, elbows, knees, hands, feet and genitals.

Psoriasis cannot be cured but it can be treated successfully, sometimes for months or years at a time and occasionally even permanently.

Treatment depends on the type, severity and location of psoriasis; the patient’s age, medical history and lifestyle; and the effect the disease has on the patient’s general mental health. The most common treatments are topical medications, phototherapy, photochemotherapy (PUVA), and oral or injectable medication (for severe symptoms).

Visit American Academy of Dermatology to learn more about Psoriasis.

Rosacea

Rosacea is a common skin disease that frequently begins as a tendency to flush or blush easily. As rosacea progresses, people often develop persistent redness in the center of the face. This redness may gradually spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be affected.

What does Rosacea Looks Like

Tiny blood vessels, which many call spider veins, can develop. Some people see small red bumps. Usually appearing in crops, some of the red bumps may contain pus. Dermatologists call the pus-filled bumps pustules. If the bumps do not contain pus, they are called papules. These pustules and papules resemble acne, so people often refer to rosacea as adult acne. Unlike with acne, blackheads do not develop. Rosacea also can cause the affected skin to swell.

In more advanced cases, a condition called rhinophyma may develop. Caused by enlarged oil glands in the skin, rhinophyma makes the nose larger and the cheeks puffy. Thick bumps may develop on the lower half of the nose and nearby cheeks. Most people do not develop rhinophyma; those who do tend to be men.

Rosacea also can affect the eyes. About 50 percent of people with rosacea have eye involvement, also called ocular rosacea. This often causes dryness, burning, and grittiness of the eyes. Left untreated, ocular rosacea can lead to serious eye complications.

Treatment

To effectively manage rosacea, dermatologists usually recommend a combination of treatments tailored to the individual patient. This approach can decrease the number of flares, stop rosacea from progressing and sometimes reverses rosacea.

Many rosacea treatments are applied directly to the affected skin. Creams, lotions, foams, washes, gels, and pads that contain topical antibiotics, azelaic acid, metronidazole, sulfacetamide, benzoyl peroxide or retinoids may be prescribed. These topicals are effective, but improvement can take time. A slight improvement may be seen in the first three to four weeks. Greater improvement usually takes about two months.

Faster results may be seen with oral antibiotics. A dermatologist may prescribe an oral antibiotic to treat the papules and pustules.

Cortisone creams may be prescribed to reduce redness, but with improper use cortisone can cause thinning of the skin. It is therefore important to follow your physician’s directions and it is best to use these creams only under the direction of a dermatologist.

Persistent redness may be treated with a small electric needle (electrodessication) or laser surgery. Laser surgery can also reduce the background skin redness as well as the papules and pustules. Cosmetics also may be helpful. Green-tinted makeup may mask the redness.

For best results from a prescribed treatment plan, be sure to carefully follow the dermatologist’s instructions.

Visit American Academy of Dermatology to learn more about Rosacea.

Eczema

A common skin condition, atopic dermatitis is frequently described as “the itch that rashes.” Intensely itchy patches form. These patches can be widespread or limited to a few areas. Scratching often leads to redness, swelling, cracking, “weeping” of clear fluid, crusting, and scaling of the skin. Constant scratching can cause skin damage, infection, and sleep loss.

Ten percent to 20 percent of children and 1 percent to 3 percent of adults develop atopic dermatitis, making it the most common type of eczema. For 60 percent or more, atopic dermatitis begins during the first year of life, and at least 80 percent have the condition before age 5. While rare, atopic dermatitis can first appear at puberty or later.

Treatment

Physician who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. Other skin conditions can resemble atopic dermatitis. Without an accurate diagnosis, treatment can be ineffective. If the diagnosis is atopic dermatitis, a dermatologist can prescribe an appropriate treatment plan. Medical research continues to show that the most effective treatment plan involves treating the skin and making lifestyle changes.

Treating the skin may involve applying a corticosteroid or an immune-modifying medication, which can help reduce the inflammation and itch. Sometimes other medication such as an antihistamine can be beneficial. If the patient has an infection, which is common in patients with atopic dermatitis, an antibiotic will be prescribed. A dermatologist also may recommend ultraviolet (UV) light therapy or another treatment.

Lifestyle changes include frequently applying an appropriate moisturizer, avoiding certain clothing, and using eczema-friendly bathing techniques. A dermatologist can offer many other tips that can help.

If a patient has atopic dermatitis and also hay fever or asthma, a dermatologist can refer the patient to an allergist for testing. Identifying allergens or environmental factors can be beneficial. Sometimes eliminating allergens brings great relief when combined with appropriate treatment and lifestyle changes.

Visit American Academy of Dermatology to learn more about Eczema.

Cryosurgery

Applying or spraying liquid nitrogen onto the skin to freeze and destroy the tissue.

The most common treatment for AKs, cryosurgery, involves applying a cryogenic (extremely cold) substance, usually liquid nitrogen, to the lesion. This freezes the surface skin, causing the skin to flake off. New skin forms. The main side effect is skin redness; blistering may occur and sometimes skin color can lighten or darken.

Visit American Academy of Dermatology to learn more about Cryosurgery.

Skin Cancer Treatment

While some skin cancers can be treated with a cream, most treatment for basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma is surgical. Surgical treatment options include electrodessication and curretage, a ‘scrape-and-burn’ technique that is used for smaller nonaggressive types of BCC and SCC.

Larger and more aggressive skin cancers including melanoma are treated by excision, a treatment that includes one or more levels of stitches and a linear scar. Mohs Micrographic Surgery is a skin-sparing type of excision that is used when a skin cancer is excessively large, has difficult to determine borders, is a more aggressive type of cancer or is on an area of the body such as the head or neck where skin-sparing may be essential. Your dermatologist helps you decide which treatment option is best for your specific skin cancer.

Visit American Academy of Dermatology to learn more about Skin Cancer Treatment.

What Is Patch Testing?

Patch testing is used to identify causes of contact dermatitis. Contact dermatitis is an immunologic reaction to a particular substance; poison-oak (and poison-ivy and poison-sumac) is an example of such a reaction. Contact dermatitis is not a true allergy; therefore patch testing is performed in a very different way than allergy skin testing. There are no allergic antibodies involved in contact dermatitis; rather, various white blood cells entering into the skin cause the reaction.

How Is Patch Testing Performed?

Patch testing involves the placement of various chemicals onto the skin, usually held against the skin using a paper tape. The chemicals themselves are often contained within a small metal cup, usually smaller than a dime. Unlike allergy skin testing, patch testing does not involve the use of needles. Patch testing is available commercially in the United States as the T.R.U.E. test; some allergists and dermatologists order special chemicals from Europe or Canada to make up their own patch test panels (this is commonly done and is typically considered to be safe if the physician is trained in the performance of patch testing).

The tape (with attached chemicals contained within the metal cups) is applied to clean skin on the person’s back. The patch test remains on the skin for 48 hours. During this time, the person cannot get the tape wet; therefore, only a sponge bath can be taken, and excessive sweating should be avoided.

The patch test is removed by medical personnel after 48 hours (2 days), and an initial reading of the test is performed. A permanent or surgical marker is used to mark on the back where the tests were prior to removal, for an additional reading of the results at 72 to 96 hours (3 to 4 days) after the initial placement. Once the tape has been removed, the person can bathe as normal but should avoid scrubbing of the back in order to prevent removal of the ink marks showing where the various tests were originally placed.

Once the final reading of the test results are completed at 72 to 96 hours after initial placement of the patch test, the person can bathe normally.

Does Patch Testing Hurt?

No. Patch testing simply involves the placement of paper tape on the back, and does not involve the use of needles. Children can safely be patch tested; although in my experience patch testing is not often needed for children. A child is old enough for patch testing once they are old enough to understand that they cannot remove the tape themselves; this age may vary from child to child.

What Are the Possible Side Effects of Patch Testing?

Patch testing will actually cause a small area of contact dermatitis at the site of the substance that is thought to be causing the person’s original symptoms that required the testing in the first place. Therefore, the person’s back may become very itchy under the tape; even the tape itself may cause some minor irritation and itching. Once the patch test is removed after 48 hours, the skin may become even itchier even though the tape and chemicals have been removed. A positive test may show redness, bumps, mild swelling or even form a small blister.

Since contact dermatitis involves the immune system, patch testing may result in a memory response. This means that the immune system “remembers” where it encountered a chemical to which the skin reacted. The original area of skin that reacted to a particular chemical could again get red and itchy after that same chemical was applied using patch testing, even though the patch test was placed on a different area of skin! For example, a person with contact dermatitis of the eyelids from cosmetics may notice that the rash on their eyelids gets worse after the chemical from the cosmetics was placed into a patch test on the person’s back.

The memory response is a good sign that the culprit chemical has been identified.

Once all of the readings of the patch test are completed, the person may use a topical steroid on the back to reduce the resultant rash and itching. Using creams on the area of the patch test prior to the final reading may alter the results of the patch test, and should not be done unless the person is instructed to do so.

The topical steroid, or other prescribed anti-itch creams, can be used on the area of the body that experiences a memory response at any time during the test, as only the skin where the patch test was placed affects the results of the test.

Visit American Academy of Dermatology to learn more about Patch Testing.