Medical Dermatology

Acne & Rosacea

Acne is a chronic inflammatory disease consisting of blackheads, whiteheads, pimples, cysts and other lesions on the face, neck, chest, back, and upper extremities. Acne often begins at puberty but is not limited to any age group. Treatment for acne varies depending on the type and severity of lesions, as well as the patient’s skin type. Treatments include topical cleansers and lotions, topical medications, antibiotics, and isotretinoin (orAccutane®).

Acne

Rosacea or “adult acne” is a common, chronic skin disease commonly characterized by redness and swelling of the cheeks, though it may also affect the nose, forehead, neck, and chest. As rosacea progresses, other symptoms can develop, such as persistent redness, dilated superficial blood vessels, small bumps and pustules, and red irritated eyes. Typical treatment includes topical and oral medications.

Eczema & Rashes

Eczema refers to a group of inflamed skin conditions that result in chronic itchy rashes. Symptoms vary somewhat but generally include dry, red, itchy patches on the skin which develop into rashes when scratched. In many cases eczema appears along with allergies and asthma, indicating an overactive immune system. Some triggers for eczema flares include contact with rough or coarse materials, excessive heat or sweating, soaps, detergents, disinfectants, dust mites, animal saliva and dander, and stress.
RashesDifficult as it may be, a critical step in reducing eczema is to stop scratching. Moisturizers and nonprescription anti-inflammatory corticosteroid creams can help with the dryness and inflammation that leads to scratching. Prescription treatment tends to include stronger corticosteroids (topical or injected), antibiotics to combat infection, and antihistamines to reduce itching.

Hair Loss (Alopecia)

med-alopeciaAlopecia, or hair loss, is a common condition that affects men and women of all ages. It can occur as a result of aging, heredity, medications or an underlying medical condition. It ranges in severity from total baldness, to patches of bald spots or thinning hair, and may be confined to the scalp or affect other areas of the body. Treating alopecia can involve discontinuing certain medications, treating infections, or use of mediations that help promote hair growth.

Psoriasis

Psoriasis refers to a group of chronic skin conditions that can affect any surface on the body, but typically involves the scalp, elbows, knees, hands, fee, and genitals. The most common type of psoriasis features thick red scaly rashes; but other versions can have pus-like blisters, intense redness or swelling, or smooth red lesions. Psoriasis treatment varies significantly by the type, severity, and location of the psoriasis. Treatment options include topical medications, phototherapy, oral medications, and FDA approved injectable biologic therapy such as Enbrel or Humira.

Skin cancers

Cancer develops when cell DNA becomes damaged and the damaged cells begin to grow and divide uncontrollably. As the damaged cells multiply, they form a tumor that is generally visible on the skin. There are three types of skin cancers which are named for the type of cell in which they begin.
Cancer

  • Basal Cell Carcinoma: This is the most common type of skin cancer, representing about 80% of all skin cancers and affecting 1 million people every year in the US. BCCs develop in the basal cells, which are cells in the lowest layers of the skin. It can appear as a pearly nodule; a pink, elevated growth; a sore that continuously heals and re-opens; and a waxy scar.
  • Squamous Cell Carcinoma: SCCs represent about 16% of all skin cancers. They begin in the squamous cells, which are cells in the upper layer of the skin. These often appear as a crusty or scaly area of skin with an inflamed base. SCCs may arise from actinic keratoses, which are dry, scaly lesions that may be skin-colored, reddish-brown, or yellowish-black.
  • Melanoma: Melanomas represent about 4% of all diagnosed skin cancers. These lesions begin in the melanocytes, the cells which give skin its color. It is considered the most lethal form of skin cancer because of its ability to rapidly spread to other body systems. Melanoma generally develops in a pre-existing mole or may appear as a new mole. With early detection and proper treatment, the cure rate for melanoma is about 95%.

Who Gets Skin Cancer?

Cancer 2Skin cancer develops in people of all colors; however, it is most likely to occur in those who have fair skin, light-colored eyes, blonde or red hair, a tendency to burn or freckle when exposed to the sun, and a history of sun exposure. In dark-skinned individuals, melanoma most often develops on non-sun-exposed areas (e.g. the feet, under nails, and on the mouth, nasal passages, or genitals).

Diagnosis & Treatment

Dermatologists detect skin cancer through a visual examination of the skin. If a cancerous lesion is suspected during a skin examination, a biopsy is often performed to confirm the diagnosis. This involves removing either part of or the entirety of the lesion and examining it microscopically. Once malignancy (cancer) is established, treatment options include excisional surgery, electrosurgery, cryosurgery, or Mohs Micrographic Surgery. These options are weighed by their anticipated success of removing the cancer, reducing the chances of recurrence, preserving healthy skin tissue, and minimize scarring.

Mohs Micrographic Surgery

Mohs Micrographic Surgery is a procedure that was developed by Frederic E. Mohs in the 1930s. Mohs surgery is highly specialized surgical technique used to remove skin cancer. It involves repeated excision of the tumor at increasing depths. At each stage, the entire excised area is examined microscopically to see if any cancerous cells are present. If cells are found, another stage is performed.
Moh's SurgeryMohs surgery is most frequently used to remove basal and squamous cell carcinomas. Lesions that have already recurred or are likely to recur are often treated with Mohs surgery because of the procedure’s specificity. This precision makes Mohs surgery ideal for the removal of cancers in functionally critical areas, such as the face, hands, feet, and genitals.

As with any surgery, there is a risk of scarring; however, because Mohs surgery removes as little as possible, scarring is minimized. There may be temporary or permanent numbness or muscle weakness in the area. Though most patients do not experience residual pain, Tylenol or Acetaminophen is generally all that is required for relief.

We offer our patients an information sheet upon scheduling an appointment for Mohs surgery. Additional information may also be obtained from the American Society for Mohs Surgery.

Warts

Warts are small, rough growths that often occur on the hands and feet, but may occur on other parts of the body. Warts are caused by a viral infection in the top layer of skin. Because warts occur as a result of a virus, warts can be passed from person to person, sometimes indirectly. Warts can disappear without treatment; however, warts that are painful or rapidly multiplying should be treated. Numerous salicylic acid treatments are available over the counter. Common physician-performed treatments include application of cantharidin or liquid nitrogen, and excisions.