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ACNE

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Acne is a very common condition amongst adolescents and adults, in particular adult females. Acne is individualized to the patient and can involve different types of lesions (blackheads, cyst-like, pimples, and whiteheads), different affected body parts (face, neck, chest, shoulders and back) and resolve in different ways (scars, redness and darker skin).    A customized treatment approach to your acne is what the healthcare providers and aestheticians at Advanced Dermatology specialize in. We understand that your acne affects more than your skin, it affects how you feel as a person. Come in today so we can get you back in your healthy, clear skin and restore your confidence in yourself.

Q: What causes acne?
A: Acne is not an infection of the skin, instead it is a multi-factorial inflammatory condition. Four factors involved include (1) hormones that lead to increased oiliness in the skin, and (2) altered skin turnover, which leads to clogged pores. (3) Normal bacteria on the skin, propionibacterium acnes, thrive in the clogged pores leading to (4) an inflammatory response.

 

Q: Is there anything I can eat or do to improve my acne?
A: There is conflicting information about the role of diet with acne. It is best to consume a healthy, well-balanced diet. Over-cleansing of the skin will not make acne go away faster or keep it away, and you should avoid picking, squeezing, scrubbing or scratching acne lesions. This can lead to longer healing times, skin infections, discoloration and scarring. Lastly, when applying any products to your acne areas, look for products that are oil-free and/or “non-comedogenic” (not acne causing).

 

Q: What treatments are available for my acne?
A: There are many treatments available for acne, including over-the-counter, prescription-strength and procedural therapies. Over-the-counter therapies are topical (including newer medicated soap bars) and include the ingredients benzoyl peroxide, glycolic acid, retinol, salicylic acid or sulfur. Additionally, sea coral has been used to treat acne. Prescription-strength therapies include topical medications (azelaic acid, clindamycin, dapsone, retinoids, sulfacetamide sodium) and oral medications (antibiotics, hormone regulators, retinoids). Procedural therapies include facials, chemical peels, laser and light therapy. Combining medical therapies with procedures often leads to better results.

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Psoriasis & Psoriatic Arthritis

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Psoriasis is a chronic, immune-mediated inflammatory skin condition affecting approximately 2% of the population. Along with genetic factors, several environmental factors play a role in causing this condition although at this time it is not completely understood. All areas of the skin can be affected, but is usually spares the mucous membranes.

 

Psoriasis is no longer thought to be a skin-only condition, as it has several associated comorbidities. It has a well-documented arthritis in up to 25% of patients, and is a risk factor for metabolic complications. Call today so your advanced dermatology medical provider not only can get your skin under control, but potentially save your life!

 

Q: Aside from heredity, what can cause psoriasis?
A: Currently known triggers of this condition include endocrine factors (pregnancy, calcium and vitamin D levels), psychogenic stress, trauma (medically termed “Koebnerization”), infections (in particular strep throat, also HIV), and certain medications. It is important to have all of your medications available for your provider at your appointment.

 

Q: What associations with psoriasis should I be worried about?
A: Psoriasis is associated with several significant conditions that can affect not just quality of life, but overall life expectancy. Psoriasis-associated arthritis is debilitating and the most common comorbidity, and is different from osteoarthritis (“wear-and-tear” type). Cardiovascular disease is the most prominent association with psoriasis, due to systemic inflammation. It can lead to heart attacks amongst other problems. Liver disease is also prevalent in psoriasis patients, so controlling your condition is very important.

 

Q: What kinds of treatments does my advanced dermatology provider have?
A: There are a whole host of therapeutic options for your psoriasis, depending on location, symptoms and severity. Basic techniques include moisturization and a healthy lifestyle (diet, exercise, stress reduction, etc). Topical therapies (steroids, vitamin D analogues, retinoids, anthralin, coal tar, calcineurin inhibitors, β-hydroxy acids, etc) light-based options (Narrowband-UVB phototherapy or PUVA) are exteral modalities, while oral medications (Methotrexate, Cyclosporine, Soriatane, Apremilast and Tofacitinib) and injectables (Enbrel, Humira, Remicade, Stelara and several upcoming options in clinical trials) are available systemic options. Make your appointment today!

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Eczema / Atopic Dermatitis

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Eczema is an extremely common condition that dermatologists treat in the office on a daily basis. It affects mostly young children, with most growing out of the condition by puberty. There is a significant group of people who have persistent disease into adulthood.

 

Intense itching (pruritus) is the main symptom associated with this condition. Some have renamed eczema as “the itch that rashes.” Eczema-like skin is dry (xerotic) and sensitive, requiring constant attention and care. Thankfully your Advanced Dermatology medical provider has extensive training in helping patients with this devastation condition.

 

Q: Why does eczema occur?

A: Eczema has several factors that cause it to flare, including genetic and environmental components. The most problematic issue with eczema is the “itch-scratch cycle”, where the itch sensation causes scratching, which in turn leads to more itching. Breaking that cycle is crucial to keeping control and preventing flares.

 

Q: Can I do anything to help prevent flares?

A: Avoiding certain environmental and physiologic triggers associated with flares and meticulous skin care is crucial to every successful treatment plan. Irritants (such as harsh soaps and juices), allergens (such as pets, pollens, dust mites and molds), foods (such as dairy, eggs, nuts and soy), certain temperatures (hot weather, high or low humidity, and perspiration), stress and hormones are some of the more common triggers to avoid.

 

Q: What treatment options are available for my eczema?

A: Therapy depends on the severity, symptoms, disability and patient preference. First-line treatments include lifestyle changes and over-the-counter therapies. Prescription-strength therapies include topical medications (mainly topical steroids), light-based treatments, oral medications (including steroids, antibiotics, anti-histamines and immunosuppressants) and alternative/natural therapies. Lastly, there are several treatments currently being investigated in clinical trials for eczema. Make an appointment today with your doctor and get your eczema under control.

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Rosacea

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Rosacea is a chronic inflammatory condition that typically begins with flushing and blushing of the cheeks and nose, but can also affect the chin, forehead and even the ears, neck, chest and back. Rosacea can progress into persistent erythema (redness), papules, pustules and even cystic nodules. More advanced cases can progress into rhinophyma, in which the oil glands of the skin become enlarged making the nose larger and the cheeks puffy. Some patients may never present with papules, pustules or cystic nodules and may only deal with the difficult to treat persistent erythema and telangiectasias (tiny blood vessels). About 50% of patients have eye involvement also called “ocular rosacea”. This can cause dryness, burning and grittiness of the eyes.

 

Anyone can develop rosacea even children, but the most common patient type is the fair-skinned adult between the ages of 30 and 50. Patients who have rosacea need to be cautious of what they use on their skin since some products may worsen their condition. This is why it is important to see your dermatologist if you feel you may be developing rosacea. Treatment regimens are customized to each individual to stop the progression of the disease and education on avoidance of triggers is also important.

 

TIPS FOR THE ROSACEA PATIENT

  • Practice good sun protection. Seek shade, cover up and apply a daily sunscreen of SPF 30 or higher. Remember to reapply every 2 hours. Heat and sun exposure can definitely trigger a rosacea flare.
  • Avoid spicy food, hot drinks, caffeine and alcoholic beverages.
  • Avoid extreme temperatures. Exercise in a cool environment, do not overheat and protect your skin from the cold and wind. · Avoid abrasive scrubs. Utilize gentle cleansers and moisturizers. Do not rub or use irritating washcloths.
  • Avoid cosmetics and skin care products with alcohol or irritating ingredients. Fewer products are better and allow your dermatologist to tailor your skin care regimen.
  • Consider laser therapy for that persistent erythema and telangiectasias.
  • Keep a log of what triggers your rosacea by writing down what foods, products, activities, medications and other things that cause your rosacea to flare. Work together as a team with your dermatology provider.

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Cold Sores / Fever Blisters

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Cold sores, also known as fever blisters, are caused by an infection of the Herpes simplex virus. This same virus can infect any area of the skin, including the genitals. After an initial infection, the virus goes into a dormant phase beneath the skin.

 

Periodically, the virus reappears in the same area. The typical lesion appears as a cluster of tiny blisters which break, leaving a sore that heals in about one week. New medications can now greatly speed healing or, if taken regularly, can prevent a reoccurrence.

 

Shingles

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Shingles, also known as zoster, is another viral infection. Although this condition can occur at any age, it is more common in advancing years. The lesions appear as a trail of painful blisters that extend around one half of the body without ever crossing the mid-line. The rash will clear after several weeks but pain may linger over the area. If medication is taken early during this condition, the rash will heal quickly with less chance of persistent pain.

 

Skin Rashes

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A “rash” is a general term for inflammation of the skin. There are many causes of a rash, including, but not limited to, allergic or irritant dermatitis, autoimmune disease, infections, medications, and rarely cancer of the skin.

 

Allergic contact dermatitis is a skin condition that arises after contact with a chemical from which you have developed an allergy. Common allergens are found in makeup, soaps, detergents, colognes, various plants such as poison ivy, or other chemical that may be found at home or in the workplace. It is sometimes necessary to do allergy testing to determine which chemical may be causing the rash.

Irritant contact dermatitis is similar in appearance to allergic contact dermatitis, although the etiology is different. It is caused by contact to various chemicals that we use every day for cosmetic or cleaning purposes, as well as from chemicals in the workplace. These chemicals cause the skin to become inflamed from direct irritation, but not due to an allergic reaction.

 

Autoimmune disease of the skin is caused by an abnormal response by the immune system. These diseases are often exacerbated by sun exposure. Some examples of autoimmune disease include Psoriasis and Lupus. It is important to evaluate these diseases to ensure that other organs are not involved.

 

Infection of the skin can cause a rash as well. Bacteria, fungi, and viruses can all affect the skin. Bacterial diseases generally appear as pustules, tender crusted areas, or in ring like patches (Lyme disease).

 

Fungal diseases such a ringworm or athletes foot are also very common.

 

Viral diseases can present as rashes, either directly such a herpes, chicken pox, and shingles, or indirectly as a rash appearing during a viral illness, such as roseola.

 

Medications are a frequent cause of rash. Basically, any medication can cause a rash to develop in any person. Common medications that cause a rash include antibiotics, and medications for high blood pressure and cholesterol.

 

Rarely, cancer of the skin can present as a skin rash. Superficial skin cancers, such as basal cell or squamous cell carcinoma can present as scaly pink patches. Lymphoma of the skin can present as a scaly rash on the body.

 

Many of these rashes look the same to the untrained eye, therefore it is important to consult a dermatologist, a specialist in this area, when you have a skin condition that is not going away.

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Warts

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Warts are benign skin growths that form anywhere on the body, including in the mouth and genital areas. Children, sexually active and immunosuppressed adults tend to get several lesions. They develop when a virus, the human papillomavirus, infects the top layers of the skin.

 

Most of the time they have no symptoms, they are occasionally itchy or painful (especially the bottom of the feet). It is important to treat these lesions because they are contagious, as they can spread from direct contact.

 

Q: Do warts need to be treated?

A: There is data to suggest that most warts will resolve on their own by 2-3 years. However, with their contagious nature, potential for symptoms and cause for social embarrassment, it is recommended to have these lesions treated by your provider. Rarely, mostly in immunosuppressed patients, warts can transform into skin cancers.

 

Q: What kinds of treatments are available for warts?

A: Common methods for treating warts including duct tape, over-the-counter salicylic acid products, liquid nitrogen, cantharidin (“beetlejuice”), electrosurgery (burning) and curettage (scraping) or excision. Other treatment options include prescription topical medications (aldara, retin-A, podophyllin, etc), laser therapy, chemical peels, immunotherapy and rarely oral retinoids.

 

Q: Can warts be cured?

A: Yes and no. With treatments as described above, one can get rid of the clinically obvious warts. However, they can recur or develop new ones at any time in the future. Continued follow-up with your Advanced dermatology provider for treatment and detection of future lesions is essential.

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Common Skin Growths

As our skin progresses through our life, it has a tendency to accumulate different types of spots. Many of these spots are commonplace and easily recognized during your evaluation. The following is a list of some of these common skin lesions managed and treated by your advanced dermatology provider.

  • Dermatofibroma: there are several medical synonyms this benign lesion has had over the years. Most of the time these “scar balls” occur on the legs of women from trauma. They are benign and only require treatment if they develop problems or change. 
  • Prurigo nodularis: these are intensely itchy bumps on the skin that arise from an unknown reason. There are several different treatment modalities for these lesions that your provider can provide at your appointment.
  • Keratoacanthoma: these are low-grade tumors that generally arises on sun damaged, hair-bearing skin. These lesions can grow quite rapidly causing serious concern.
  • Pyogenic granuloma: these are completely benign lesions that arise most commonly in children, pregnant patients and in patients taking certain medications. These lesions also can grow quite rapidly over a few weeks, can bleed and look concerning.
  • Cysts (epidermoid, pilar, other): these are abnormal, dilated sac-like structures under the skin that contain different components. They can occur anywhere on the skin and can become tender and problematic.
  • Milia: these benign lesions occur mostly on the face in newborns and more mature adults, especially females. They are pinpoint white “milk spots” that are stubborn to go away. Your advanced dermatology aestheticians and medical providers both treat these spots.
  • Sebaceous hyperplasia: these are benign overgrowths of the oil-producing glands on the face of middle-aged to elderly people. They can look like Basal Cell skin cancers, so it’s important to have your Advanced Dermatology provider evaluate these today.
  • Digital mucinous pseudocyst: these benign lesions are also called digital mucous cysts. They develop on the ends of the fingers and sometimes the toes. They are usually not bothersome but can grow and cause nail problems, which is a reason to visit your Advanced dermatology provider today.
  • Lipoma: these are usually small, benign fatty overgrowths located just under the skin. They tender to feel doughy or rubbery. They arise at any age but are most common in older adults. Since they can grow and become problematic, these should be evaluated by your provider.
  • Xanthelasma: these are benign, yellow lesions around the eyes that develop in adults, more often females. They are sometimes associated with internal problems with cholesterol and can become disfiguring. Treatments are available.
  • Adenxal Lesions (Syringoma, trichoepithelioma, etc): these generally benign growths encompass a large group of lesions that can grow anywhere on the body, many on the face. It is important to have these evaluated by your provider as rare cancerous changes can occur in these lesions.
  • Neurofibroma: these benign nerve-based tumors tend to develop around puberty anywhere on the body. While they can be isolated, there are systemic conditions associated with these lesions. Occasionally these can develop problems and be treated by your medical provider.
  • Angioma: commonly called cherry angioma due to their red color, these benign spots can grow anywhere on the body in adulthood. Occasionally these can become problematic and require treatment from your provider.
  • Seborrheic keratoses: these benign overgrowths have been called many things including liver spots, age spots, and barnicles on the ship of life. Occasionally these can change and become problematic, and be hard to tell apart from a skin cancer. An evaluation of these lesions is very important to ensure they are benign.
  • Verrucous acanthomas: these are large, thick versions of seborrheic keratoses (see above).
  • Moles: these lesions can be pigmented or flesh-colored, can be present at birth or develop thru adulthood, and not cause trouble or become a problem. These lesions are important to your advanced dermatology medical provider, because they can be associated with Melanoma.

 

Q: Are all of these lesions treated the same?

A: No. Your advanced dermatology provider is knowledgable about the treatment modalities available to take care of these spots at your evaluation. Each lesion is different and a treatment plan needs to be made between you and your provider.

 

Q: Why is my skin getting these spots?

A: A lot of these spots occur because of ageing, while others arise from well-known common causes. As long as your advanced dermatology provider evaluates your skin, these spots can be managed as they arise.

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– Hives

The medical term for hives is urticaria. They are welts (wheals) on the skin that are usually quite itchy. They can vary in size from a small as a pencil eraser to as large as a baseball cap. Individual lesions usually appear suddenly and resolve without a trace by 24 hours (“here today and gone tomorrow”), during which time other lesions can form.

 

There are two categories of hives depending on how long lesions continue to develop, acute (less than 6 weeks) and chronic (more than 6 weeks). Many times a trigger is not able to be elucidated that caused it to start. Make an appointment today with your physician and stop living this annoying, itchy rash!

 

Q: What causes this to occur?

A: Most of the time hives occur when a stimulus causes an inappropriate release of histamine from a kind of immune system cell in your skin called a mast cell. A few common triggers include medications (new and dose changes to current ones), sunlight, foods (citrus fruits, milk, eggs, peanuts, shellfish), insect bites/stings, infections (usually the common cold), stress, exercise and pressure.

 

Q: Are hives dangerous?

A: Yes and no. While most of the time hives are an isolated finding, there are some associated conditions that your medical provider should evaluate. If you start to develop lip or tongue swelling, you could be developing angioedema which is a medical emergency. It is important to schedule an appointment with your Advanced Dermatology medical provider today.

 

Q: What kinds of treatments are available?

A: There are several available treatments for hives, the most important being avoiding whatever triggers them (if known). First-line treatment usually includes around-the-clock, non-sedating antihistamines in combination with skin soothing lotions. Many times it takes a combination of more than one anti-histamine to maintain control. When these fail, other treatment options include steroids (topical, oral and injectable), oral medications (singulair, cyclosporine, dapsone, methotrexate), phototherapy and a recently approved injection (omalizumab).

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– Itchy Skin

Pruritus, or the sensation of itch, is the most common symptom dermatology patients suffer thru. It is a complex sensation resulting from multiple pathogenic mechanisms that usually cannot be attributed to one specific cause or disease. It can be totally devastating affecting the total quality of life.

 

We understands how serious itchy skin is and can ensure you we will offer a thorough evaluation and treatment plan. We want you to stop being frustrated with your skin and start to enjoy it again.

 

Q: What causes itchy skin?

A: There are many causes of itchy skin, including skin-only causes (environmental exposures, excessive dryness, infestations/bites&stings, inflammatory skin disease, infections, neoplastic skin disease and hereditary conditions) and itching from secondary causes (infections, medications, neuropsychiatric causes, pregnancy and serious underlying disease). Your advanced dermatology provider will help you at your appointment to deal with your itching.

 

Q: What can I do to potentially help at home?

A: Avoid long, hot showers and be sure to always moisturize with a thick moisturizer immediately after bathing. Keep your fingernail short and if possible, avoid scratching to relief itch. Use only fragrance free, hypoallergenic, mild products in your skin care (including shampoo’s, soaps, laundry detergent, moisturizers, beauty products, etc). Wear only soft, breathable clothing. Different soothing topical products are available over-the-counter containing menthol, camphor and capsaicin.

 

Q: What kinds of treatments are available?

A: Aside from the above listed measures to help with your itching, your provider has several therapeutic options to help control your skin. Prescription strength moisturizers are available along with prescription topical medications (steroids, immunomodulators, coal tars, anesthetics and anti-histamines). Oral therapy includes anti-histamines, leukotriene inhibitors, steroids and immunosuppressive medications. Phototherapy has been employed successfully, along with psychological approaches.

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