Medical Dermatology

ACNE

Acne appears when our pores become clogged with dead skin cells.  Normally, these dead skin cells rise to the surface of the skin to shed the cells.  However in acne, the body starts making lots of sebum (oil) and the dead skin cells stick together inside the pore.  When the pore is clogged with dead skin cells, this attracts bacteria named Propionibacterium acnes.  This bacteria flourishes in an oily environment and multiplies very quickly.  With bacteria trapped in the pore, your skin becomes red and tender. 

Acne is the most common skin condition in the United States and is the term for plugged pores (blackheads and whiteheads), pimples and deeper lumps (cysts or nodules) that occur on the face, neck, chest, back and shoulders.  While not a life threatening condition, acne can be upsetting and a source of emotional distress.  Acne can also lead to serious and permanent scarring.  Most people who have acne are teenagers or young adults, however acne can occur at any age. 

Aggravation of acne by food varies from person to person.  Many acne patients can eat chocolate without trouble; others find that even a few pieces of chocolate cause new pimples.  Chocolate, nuts, soft drinks, and dairy are the most common offenders.  A few people who drink large quantities of milk find that this worsens their acne.

Remember to keep your skin clean and wash with a mild cleanser twice daily.  Avoid harsh scrubbing and astringents.  Although sometimes difficult to do, don’t squeeze or pick at blemishes.  You may use oil free sunscreens and moisturizers, and choose skin care products labeled “non-comedogenic” which means the product won’t clog your pores.  The goal of acne treatment is to heal existing lesions, stop new lesions from forming and prevent acne scars.  Treatment options vary, depending on what type of acne you have.  Mild cases may respond to topical treatment alone.  Moderate and severe acne may be treated with oral antibiotics, injections of cortisone, oral contraceptives or spironolactone for women with acne, chemical peels, light treatment and laser surgery.  Isotretinoin is used in severe cases of acne refractory to treatment.  

Should acne scarring be already present prior to treatment or be a residual of treatment, your dermatologist can treat these scars by a variety of methods.  Combination skin resurfacing with lasers, dermabrasion, chemical peeling, and electrosurgery can improve scar appearance.  Soft tissue fillers, such as Restylane® or Juvederm®, can elevate scars.  Acne scars may also be revised by microexcision, subcision, and punch grafting.

ACTINIC KERATOSES

Repeated, prolonged sun exposure causes skin damage, especially in people with fair colored skin.  Sun damaged skin becomes dry and wrinkled, and may form rough, scaly spots, called actinic keratoses.  Treatment of actinic keratoses requires removal of the abnormal skin cells.  New skin then forms from the deeper skin cells, which have escaped sun damage.  They are very common on sites repeatedly exposed to the sun, especially the backs of the hands, scalp, nose, cheeks, upper lip, temples and forehead.  They appear as multiple flat or thickened, scaly or warty, skin colored or red lesions.  A keratosis may thicken and grow over time and develop into a cutaneous horn.  These lesions are considered precancerous and remain on the skin even though the crust or scale is picked off.  

The main concern is that actinic keratoses may give rise to a type of skin cancer called squamous cell carcinoma.  The risk of squamous cell carcinoma occurring in a patient with more than ten actinic keratoses is about 10 to 15%.  Actinic keratoses are usually removed because they are unsightly, uncomfortable, and because of the risk that skin cancer may develop in them.  If an actinic keratosis becomes thickened, painful or ulcerated, get it checked.  It may have developed into a skin cancer. Depending on the location, number and thickness of the lesion, treatment options include liquid nitrogen, curettage, excision, 5-fluorouracil cream, Imiquimod cream, chemical peels and photodynamic therapy.

The best defense against actinic keratoses is a comprehensive sun protection program that includes wearing sun protective clothing, avoiding midday sun, staying in the shade as much as possible, and wearing a broad–spectrum sunscreen with a sun protection factor (SPF) of at least 30.

ATOPIC DERMATITIS/ECZEMA

Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age.  It is also known as eczema and atopic dermatitis.  Atopic eczema usually occurs in people who have an ‘atopic triad’.  This means they may develop any or all of three closely linked conditions: atopic eczema, asthma and hay fever (allergic rhinitis).  Often these conditions run within families, and a family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic eczema in infants.  

Atopic eczema arises because of a complex interaction of genetic and environmental factors.  These include defects in skin barrier function making the skin more susceptible to irritation by soaps, other contact irritants, the weather, and temperature changes.  Atopic eczema affects 15-20% of children but only 1-2% of adults.  The onset of atopic eczema is usually before two years of age although it can manifest itself in older people for the first time.  Atopic eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens. 

There is quite a variation in the appearance of atopic eczema between individuals.  From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches.  In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

Treatment of atopic dermatitis requires reduction of exposure to triggers when possible, regular use of moisturizers, and intermittent topical steroids.  Self skin care includes avoiding hot showers, bathing or showering for less than 10 minutes, using a mild soap such as Dove, and moisturizing after each shower.  In some cases, those with atopic dermatitis may benefit from topical calcineurin inhibitors, antibiotics, antihistamines, and light treatment.  For longstanding and severe eczema, we may consider systemic medications.

ATYPICAL “DYSPLASTIC” MOLE

Atypical nevi are moles with unusual features.  There are basically two types of atypical nevi, sporadically occurring atypical moles and familial (inherited) atypical moles.  The term atypical nevus is sometimes used to mean any funny-looking mole. However, strictly speaking, an atypical nevus is defined as a mole with at least 3 of the following features.

  • Size >5 mm diameter
  • Ill-defined or blurred borders
  • Irregular margin resulting in an unusual shape
  • Varying shades of color (mostly pink, tan, brown, black)
  • Flat and bumpy components

Clinically atypical nevi are sometimes called dysplastic nevi, but this is term is best used for a specific microscopic appearance. Only a minority of clinically atypical nevi fulfill microscopic criteria for dysplastic nevus.  Dysplasia may be mild, moderate or severe.  People with atypical nevi have a slightly higher risk than the general population of developing a skin cancer called melanoma, particularly if they have five or more atypical nevi.  In general, atypical nevi are actually harmless and do not need to be removed.  However, it is not always easy even for an experienced dermatologist to tell whether a lesion is an atypical nevus or a melanoma.  A suspicious or changing atypical nevus should be biopsied, and a pathologist will usually make the correct diagnosis.  If you have numerous moles you should visit your dermatologist regularly for a thorough skin check.

It is often helpful to keep photographic records of the moles with digital photos using a technique called mole mapping.  The close-up photographs should be repeated from time to time.  Dermoscopic views with a special hand held microscope enables your dermatologist to detect change early.  Careful sun protection, sun protective clothing, avoiding excessive sun exposure and using at least a SPF 30+ sunscreen is recommended.  Patients with numerous moles should also perform a monthly self skin exam.

BASAL CELL CARCINOMA

Basal cell carcinoma (BCC) is the most common form of skin cancer.  More than 2 million cases of BCC are diagnosed in the United States each year.  BCCs are becoming more common, perhaps because people are spending more time outdoors and the decrease in the ozone layer may be allowing more UV radiation to reach the earth’s surface.  This type of skin cancer typically develops in areas that get prolonged sun exposure, such as the scalp, face, neck and upper trunk.  People who have used tanning beds have a much higher risk of developing BCCs.  They also tend to get this cancer earlier in life.  BCCs tend to grow slowly over months to years, and rarely spread to other parts of the body.  Although they grow slowly, treatment is important because they can grow wide and deep, with potential of destroying skin tissue, muscle and bone.  BCCs may look like a sore that bleeds easily or won’t heal, oozes or crusts over, has a sunken center, or has visible blood vessels surrounding it. 

The treatment for a BCC depends on its type, size and location and the number to be treated.  We will consider many factors to determine which treatment will be best for you. There are several ways to treat BCC, including curettage, excision of the lesion, topical medicated creams, and Mohs micrographic surgery. Vismodegib is a new treatment for advanced or metastatic basal cell carcinoma, approved by the FDA in March 2012.  Studies show that a person who develops BCC has a 40% risk of getting a second BCC within 5 years.  Therefore, it is important to monitor and keep follow-up skin check appointments with your dermatologist.  Be alert to non-healing sores on the skin, use sunscreen daily, and follow a good sun protection regimen.

CYST

A cyst, also known as an epidermal inclusion cyst, is a benign growth derived from the upper portion of a hair follicle, encased in a thin layer of epidermis-like epithelium. Epidermal cysts are typically filled with keratin and lipid-rich debris. A cyst generally results from an occluded pilosebaceous (oil gland) unit. The rupture of the cyst contents into the dermis results in swelling, redness, and tenderness. This can be due to trauma or bacterial infection.

Most small uncomplicated cysts will not require treatment. However, the most effective treatment for any cyst is complete surgical excision to remove the cyst capsule. 

DANDRUFF/SEBORRHEIC DERMATITIS

Seborrheic dermatitis is a common, harmless, scaling rash affecting the face, scalp, ears and other areas where the skin is oily.  Dandruff is a form of seborrheic dermatitis located on the scalp.  Dandruff presents as scaly white flaky patches scattered within the scalp.  Seborrheic dermatitis may appear at any age, even in infancy.  In infants, it usually presents as cradle cap, but infantile seborrheic dermatitis may also affect skin creases such as armpits and groin.

Seborrheic dermatitis is common within the eyebrows, on the edges of the eyelids, inside and behind the ears and in the creases beside the nose.  It can result in pale pink round or ring shaped patches on the hairline.  Sometimes it affects the skin-folds of the armpits and groin, the middle of the chest or upper back.  It may or may not be itchy and can be quite variable from day to day.  Seborrheic dermatitis is believed to be an inflammatory reaction related to a proliferation of normal skin yeast called Malassezia.  The yeast grows on nearly everyone, but some people are susceptible to an overgrowth that can lead to itching and dry, flaky skin.  Seborrheic dermatitis is not contagious or related to diet, but it may be aggravated by illness, psychological stress, fatigue, change of season and reduced general health. 

Seborrheic dermatitis in adults may be very persistent.  However, it can generally be kept under control with regular use of antifungal agents and intermittent applications of topical steroids.  Infantile seborrheic dermatitis usually clears up completely before the baby is six months old and rarely persists after one year.  Useful treatment options include mild emollients, hydrocortisone cream and topical ketoconazole.  For the scalp, medicated shampoos containing ketoconazole, ciclopirox, selenium sulfide, zinc pyrithione, coal tar, and salicylic acid may help.  Steroid scalp applications may reduce itching.  For the face and body, ketoconazole or ciclopirox cream and topical steroids may help control the itching and inflammation.  

DERMATOFIBROMA

 A dermatofibroma is a common benign fibrous skin lesion due to a growth of skin cells called histiocytes.  In some cases it arises at the site of a minor injury, especially an insect bite or plugged hair follicle.  

Dermatofibromas most often occur on the legs and arms.  Once developed, they usually persist for years.  They appear as firm nodules, often dark brown in color and may occasionally be painful.  In general, it is of cosmetic significance only and tends to persist long term.  Usually only reassurance is needed.  Sometimes the dark color can raise anxiety about melanoma; if there is any doubt about its nature, the lesion may be easily biopsied.

Dermatofibromas are benign lesions and may be left alone without treatment.  If they are painful or bothersome (for example, easily traumatized by shaving) they may be removed with surgery.  Other techniques include freezing the lump with liquid nitrogen to flatten it out.

DRY SKIN

Dry skin, also known as xerosis, is common and anyone can get dry skin.  Skin becomes dry when it loses too much water or oils in the skin that serve as a natural moisturizer.  As skin loses moisture, the surface cracks.  Dry skin has a tendency to run in families and is usually a recurring problem, especially in the winter when the weather is cooler and less humid.  Dry skin is often rough, scaly and itchy.  Cracks in the skin may bleed if severe. 

Causes of dry skin include increasing age, climate, certain skin conditions, jobs (for example nurses, doctors and people in occupations who often wash their hands or immerse their skin in water), excessive bathing and hobbies such as swimming.  

An important aspect of treatment is to identify any contributing factors.  Dry skin care includes reducing how often you bath or shower, using lukewarm water, short showers less than 10 minutes, using a mild soap or cleanser, and applying a moisturizer cream liberally and often.  The drier the skin, the thicker the cream should be, especially on the hands.  We may also recommend treating itchy patches with a topical steroid cream.

Atopic eczema is a chronic, itchy skin condition that is very common in children but may occur at any age.  It is also known as eczema and atopic dermatitis.  Atopic eczema usually occurs in people who have an ‘atopic tendency’.  This means they may develop any or all of three closely linked conditions: atopic eczema, asthma and hay fever (allergic rhinitis).  Often these conditions run within families, and a family history of asthma, eczema or hay fever is particularly useful in diagnosing atopic eczema in infants.  

Atopic eczema arises because of a complex interaction of genetic and environmental factors.  These include defects in skin barrier function making the skin more susceptible to irritation by soap and other contact irritants, the weather, temperature and non-specific triggers.  Atopic eczema affects 15-20% of children but only 1-2% of adults.  The onset of atopic eczema is usually before two years of age although it can manifest itself in older people for the first time.  Atopic eczema is often worst between the ages of two and four but it generally improves after this and may clear altogether by the teens. 

There is quite a variation in the appearance of atopic eczema between individuals.  From time to time, most people have acute flares with inflamed, red, sometimes blistered and weepy patches.  In between flares, the skin may appear normal or suffer from chronic eczema with dry, thickened and itchy areas.

Treatment of atopic dermatitis requires reduction of exposure to triggers when possible, regular use of moisturizers, and intermittent topical steroids.  Self skin care includes avoiding hot showers, bathing or showering for less than 10 minutes, using a mild soap such as Dove, and moisturizing after each shower.  In some cases, those with atopic dermatitis may benefit from topical calcineurin inhibitors, antibiotics, antihistamines, and light treatment.  For longstanding and severe eczema, we may consider systemic medications.

HERPES SIMPLEX

Herpes simplex virus (HSV) is a common viral infection that presents with focal blistering.  It most commonly affects the mouth, nose, genitals, and buttocks.  HSV infections can be very annoying because they may reappear periodically and the sores may be unsightly.  It affects most people on one or more occasions during their lives.  There are two main types of herpes simplex virus (HSV), although there is considerable overlap.

  • Type 1, which is mainly associated with facial infections (cold sores or fever blisters)
  • Type 2, which is mainly genital 

Both type 1 and type 2 herpes simplex viruses reside in a latent state in the nerves which supply sensation to the skin.  During an attack, the virus grows down the nerves and out into the skin or mucous membranes where it multiplies, causing the clinical lesion.  After each attack, the virus enters the resting state again.

Mild uncomplicated eruptions of herpes simplex require no treatment.  As sun exposure often triggers facial herpes simplex, sun protection is important.  Some infections may require treatment with an either a topical or oral antiviral agent. Antiviral drugs will stop the herpes simplex virus multiplying once it reaches the skin or mucous membranes but cannot eradicate the virus from its resting stage within the nerve. Repeated courses may be prescribed or the medication may be taken continuously to prevent frequent attacks.

HIVES/URTICARIA

Hives, or urticaria, are welts on the skin that often itch.  These welts may appear anywhere on the skin and vary in size and shape.  Most often, your hives will go away in 24 hours or less.  New hives may appear as older ones fade, so hives may last for a few days or longer.  A course of hives generally lasts less than 6 weeks.  If hives last more than 6 weeks, they are called chronic hives.  When larger welts occur deeper in the skin, the term is angioedema.  This can occur with or without hives, and often causes the eyelids or lips to swell.

Finding the cause of hives, especially chronic hives, can sometimes be difficult.  Acute hives often result from an allergic reaction.  Things that trigger an allergic reaction include foods (citrus fruits, milk, eggs, tree nuts, and shellfish are common culprits), medications, insect bites, pollen, latex allergies, and allergy shots.  Other causes include infections, illnesses, exposure to sun, heat, cold or water, exercise, stress, pressure on the skin, and contact with chemicals. 

Treatment depends on the type of urticaria, its severity and how long it has been present. If a medicine is thought to be the cause, it should be stopped.  The most common treatment for hives are non-sedating (does not cause drowsiness) antihistamines.  Antihistamines relieve symptoms, such as itching.  Occasionally, you may need a combination of multiple antihistamines to control the hives.

KERATOSIS PILARIS

Keratosis pilaris is a very common condition in which there are numerous tiny bumps usually found on the outer aspect of the upper arms, thighs, cheeks, forearms and upper back.  The bumps give a sandpaper type texture to the skin.  Keratosis pilaris is most common during the teenage years, and may also be present in babies and persist into adult life.  Keratosis pilaris tends to be more severe during the winter months or other times of low humidity when skin dries out.  Although unsightly at times and occasionally itchy, it is completely harmless.

Keratosis pilaris is a benign condition and treatment is typically only necessary for cosmetic reasons.  Moisturizing creams containing urea, salicylic acid or alphahydroxy acids may be effective in opening the plugged hair follicles by removing excess skin.  Topical retinoids and chemical peels may also help exfoliate the skin so the bumps become less noticeable.  Therapy must be continued on a regular basis or the bumps may recur.   

LIPOMA

A lipoma is a non-cancerous growth is made up of fat cells. It slowly grows under the skin in the subcutaneous tissue. A person may have a single lipoma or may have many lipomas. They are very common in people of all ages. The cause of lipomas is unknown. It is possible there may be genetic involvement as many patients with lipomas come from a family with a history of these growths. Sometimes an injury such as a blunt blow to part of the body may trigger growth of a lipoma. Most lipomas require no treatment and remain indefinitely without causing any problems. Occasionally, lipomas that interfere with the movement of adjacent muscles may require surgical removal.

MELASMA

Melasma appears as a symmetrical blotchy, brownish pigmentation on the face.  The pigmentation is due to overproduction of melanin by the pigment cells of the skin.  This condition may be upsetting and can lead to considerable emotional distress.

The cause of melasma is complex.  There is a genetic predisposition to melasma, with at least one-third of patients reporting other family members to be affected.  In most people, melasma is a chronic disorder.  Melasma is more common in women than in men, and in people that tan well or have naturally brown skin.  It generally starts between the age of 20 and 40, but can begin in childhood or middle-age.  Melasma presents as freckle-like spots commonly located on the cheeks, forehead, nose, chin, and above the upper lip. 

There are several known triggers for melasma.  More commonly, it arises in apparently healthy, normal, non-pregnant adults and persists for decades.  Exposure to the sun deepens the pigmentation because it activates the color producing cells of the skin.  Sun exposure is the most important avoidable risk factor.  Pregnancy may also induce or make melasma worse.  Birth control pills may cause melasma, however hormone replacement therapy used after menopause has not been shown to cause the condition.  Scented or deodorant soaps, toiletries and cosmetics may cause a phototoxic reaction triggering melasma that may then persist long-term.

Management of melasma requires a comprehensive approach by your dermatologist.  While there is no cure for melasma, many treatments have been developed.  Melasma can be very slow to respond to treatment, so don’t get discouraged if you don’t see immediate results.  General measures include year round strict sun protection with a very high SPF sunscreen applied to the affected areas daily, using a mild cleanser and light moisturizer, and cosmetic camouflage make-up is available to hide the pigment.  If you are on birth control or other hormones, stopping these medications may help fade the pigment. 

Bleaching creams, such as hydroquinone, is the mainstay of treatment.  It must be apply to the affected areas daily for at least 4 months.  Other topical therapies include azelaic acid, kojic acid, alpha hydroxy acid, vitamin C, tranexamic acid, and topical retinoids may help fade the pigment.  We may also recommend certain chemical peels and laser treatments such as intense pulsed light (IPL) if your melasma is persistent.  

MELANOMA

Malignant melanoma is a potentially serious type of skin cancer due to uncontrolled growth of pigment cells, called melanocytes.  It has a tendency to spread quickly to other parts of the body (metastasize).  Most melanomas appear as dark growths similar to moles, however some may be pink, red or skin color.  Melanomas can be very treatable when detected early, but can be fatal if allowed to spread throughout the body.  The goal is to detect melanoma early when it is still on the surface of the skin. 

The most common early signs of melanoma are a growing mole on the skin, unusual mole on the skin, non-uniform mole with an odd shape or different colors, or any mole that itches, bleeds or feels painful.  Some people have a higher risk of developing melanoma, including those with fair skin and light colored eyes, sun sensitive skin, and people with 50-plus moles.  Excessive sun exposure, especially severe blistering sunburns during childhood or use of tanning beds can cause melanoma.  Heredity also plays a role, as research shows that if a close blood relative (parent, child, or sibling) had melanoma, a person has a much greater risk of developing melanoma.  Early detection and treatment are critical to a successful recovery. 

We recommend protecting your skin from the sun and annual full body skin exams with your dermatologist.  When checking your own skin, you should look for the ABCDE’s of melanoma (Asymmetry, irregular Borders, varied Colors, large Diameter, and any lesion that is Evolving).  If you notice anything new or changing, you should see your dermatologist immediately.  If you are diagnosed with a melanoma, treatment depends on the size, how deeply it has grown into the skin, location of your cancer, and whether the melanoma has spread to other parts of your body.  

MOLES

Moles are common skin lesions.  They are due to a proliferation of the pigment cells of the skin, called melanocytes.  Moles are generally harmless in nature, but a skin cancer called melanoma may arise within a mole.  Moles may be flat or protruding. They vary in color from pink or skin colored to dark brown or black.  Although mostly round or oval in shape, they are sometimes unusual shapes.  They range in size from a few millimeters to several centimeters in diameter.  

Most moles arise during childhood or early adult life, and exposure to sunlight increases the number of moles.  It is often helpful to keep photographic records of your moles by using a technique called mole mapping.  These close-up photographs should be repeated from time to time.  Dermoscopic views with a special hand held microscope enables us to detect change early.  Careful sun protection, sun protective clothing, avoiding excessive sun exposure and use a SPF 30+ sunscreen is recommended.  Patients with numerous moles should also perform a monthly self skin exam.

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a common harmless viral skin infection.  It most often affects infants and young children but adults may also be infected.  Molluscum contagiosum presents as clusters of small round bumps especially in the warm moist places such as the armpit, groin or behind the knees.  They range in size from 1 to 6 mm and may be white, pink or skin colored.  They often have a small central pit and the virus is easily spread by skin contact.  As they resolve, they may become inflamed, crusted or scabby.  There may be few or hundreds of spots on one individual.  Molluscum contagiosum may persist for months or occasionally for a couple of years.  It frequently induces a rash in the affected areas, which can be dry, pink and itchy.  An itchy rash may sometimes appear on distant sites and represents an immune reaction to the virus.

Many dermatologists advise treating molluscum because they can spread to other parts of your body or to other people.  They can be treated with a topical blistering medication called canthacur, daily home application of retinoids, topical immune modifier creams, frozen with liquid nitrogen, treated with an electric needle, or scraped off with a sharp instrument.  If many lesions are present, multiple treatment sessions may be required every few weeks until growths are gone.

NAIL FUNGUS

Fungal infections of the fingernails and toenails are known as onychomycosis.  It is common with increased age and rarely affects children.  Toenails are the most vulnerable to fungal infections because shoes and socks trap moisture and promote the growth of fungi.  If left untreated, onychomycosis can lead to permanent nail damage.  

Fungal nail infections can appear as white of yellowed thickened nails that can be brittle with debris beneath the nail bed.  One of more nails may be involved, and often accompanies fungal infections of the skin of the feet (tinea pedis).  

Treatment of fungal nail infections may be difficult, and recurrence is common.  Most antifungal creams are not very effective because they cannot penetrate the hard nail surface.  Oftentimes, an oral antifungal medication is needed.  Make sure the infected area is clean and dry, thus less suitable for the fungus to grow.  Wear light and airy shoes, as non-ventilated shoes that don’t breathe cause your feet to remain moist, providing an excellent area for the fungus to breed.  Absorbent socks that wick water away from your feet such as cotton socks will help.  A medicated foot powder can help keep feet dry.

PEDIATRIC DERMATOLOGY

If your child has a condition that affects the skin, hair or nails, your child may need to see a dermatologist.  Some diseases that affect the skin, hair or nails are more common in children, and some of these conditions only occur in children.  Conditions a dermatologist is likely to treat include atopic dermatitis (eczema), birthmarks, molluscum, port wine stains, psoriasis, skin infections, vitiligo, and warts. 

PERIORAL DERMATITIS

Perioral dermatitis is a common facial skin problem that mostly affects adult women and children.  It rarely occurs in men.  Groups of itchy or tender small red papules (bumps) appear most often around the mouth. There can be mild redness and irritation of the skin.  They spare the skin bordering the lips (which then appears pale) but develop on the sides of the chin, upper lip and cheeks.  The surrounding skin may be pink, and the skin surface often becomes dry and flaky.  Often the skin around the nose is affected, and occasionally around the eyes (periocular or periorificial dermatitis).

The exact cause of perioral dermatitis is not understood.  Some dermatologists believe it is a form of rosacea or seborrheic dermatitis.  Use of topical steroid creams appears to be the most frequent cause of perioral dermatitis.  The more potent the steroid cream, the more rapid and severe the perioral dermatitis.

Luckily perioral dermatitis responds well to treatment.  If you are using a topical steroid, there may be a brief flare-up when the creams are stopped.  An oral antibiotic, such as tetracycline or doxycycline, is the most common treatment for perioral dermatitis.  For milder cases or pregnant women, a topical antibiotic cream may be used.  Azelaic acid may be of benefit, and may be used during pregnancy.

PILAR CYST

A pilar cyst, also known as a trichilemmal cyst, is a keratin-filled cyst that originates from the outer hair root sheath. Keratin is the protein that makes up hair and nails. Trichilemmal cysts are most commonly found on the scalp and are usually diagnosed in middle-aged females. Most small uncomplicated pilar cysts will not require treatment. However, the most effective treatment for any cyst is complete surgical excision to remove the cyst capsule. 

PSORIASIS

Psoriasis is a common chronic skin disease that develops when a person’s immune system sends faulty signals that tell skin cells to grow too quickly.  The body has difficulty shedding these excess skin cells, and they pile up on the surface of the skin, causing patches of psoriasis to appear.  It can cause red, thick scaly patches on the elbows, knees, trunk, scalp and buttocks, although can occur anywhere on the skin.  The rash of psoriasis goes through cycles of improving and worsening.  Psoriasis comes in many forms, and each differs in severity, duration, location, shape and pattern.  The most common form is called plaque psoriasis.  

People who get psoriasis usually have one or more people in their family who have psoriasis.  Most people get psoriasis between the ages of 15 and 30 years, however it may develop anytime.  Triggers of psoriasis include a stressful event, Strep throat, certain medications, cold weather, and trauma to the skin or joints.  

Treatment of psoriasis can improve a person’s quality of life and some people may see their skin completely clear of psoriasis. Although there is currently no cure for psoriasis, there are multiple treatments available.  Your dermatologist may prescribe topical steroids, synthetic vitamin D analogues, retinoids, tar or anthralin.  Other treatments include light treatment, excimer laser, oral medications, injectable medications and other systemic medications.

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 of the central face.  It most often affects those aged 30 to 60.  Although most commonly located on the face, the redness may gradually spread and affect the scalp, neck, ears, chest, and eyes.  It is common in those with fair skin, blue eyes and of Celtic origin.  Although the cause of rosacea remains unknown, it appears to involve a combination of genetics and environmental factors.  Rosacea can be disfiguring if left untreated and a source of emotional distress. 

Characteristics of rosacea include frequent blushing or flushing, persistent redness, prominent blood vessels, red bumps that look like acne, and dry flaky skin.  Most patients will say their skin is aggravated by sun exposure, emotional stress, alcohol consumption and hot and spicy foods.  Patients with rosacea will say their skin is sensitive, and may have red or sore eyes.  If left untreated, patients can develop enlarged unshapely noses with prominent pores, firm swellings of the eyelids, and persistent redness.  Treatment is important as is may slow down or halt progression of rosacea.  Your dermatologist may encourage avoiding certain triggers and protecting your skin from the sun.  To effectively manage rosacea, your dermatologist usually recommends a combination of treatments tailored to your skin.  Treatment options include topical creams, lotions, gels, foams, or washes that contain antibiotic, azelaic acid, metronidazole, or sulfacetamide.  Faster results may be seen with oral antibiotics and laser therapy to reduce the background skin redness.

ROUTINE SKIN CHECKS

The Skin Cancer Foundation recommends that adults see a dermatologist at least once a year, or more often if at high risk for skin cancer, for a full-body professional skin exam. Dr. Berthelot has extensive experience with performing skin checks for the detection of skin disorders and cancer. In addition, all individuals should regularly examine their skin to look for concerning skin moles and promptly seek medical treatment when necessary.

SEBORRHEIC KERATOSIS

Seborrheic keratoses are very common harmless skin lesions that appear during adult life.  The cause of seborrheic keratoses is not known, however is generally regarded to be related to aging and maturity of the skin.  They become more numerous with time and some people inherit a tendency to develop a very large number of them.  A variant of seborrheic keratoses is a condition called dermatosis papulosa nigra, where one gets small dark brown papules commonly found on the face and neck.

Seborrheic keratoses begin as slightly raised, brown spots anywhere on the skin.  Gradually they thicken and develop a rough, warty surface.  They slowly darken and may turn black.  They appear to stick on to the skin like barnacles.

Some skin cancers are sometimes difficult to tell apart from seborrheic keratoses, so if you are concerned or unsure about any skin lesion consult your dermatologist.  Seborrheic keratoses can be easily removed.  Occasionally, they can become unsightly, itch or rub against your clothes.  Methods used to remove seborrheic keratoses include liquid nitrogen, curettage, laser surgery and shave biopsy. 

SHINGLES/HERPES ZOSTER

Shingles, or herpes zoster, is a painful blistering rash caused by the same virus that causes chickenpox virus.  The chickenpox virus remains in a resting phase in nerve cells for years before it is reactivated and grows down the nerves to the skin to produce shingles (herpes zoster).  Anyone who has previously had chickenpox may subsequently develop shingles.  This can occur in childhood but is much more common in adults, especially the elderly.  In general, it is more common in older adults and tends to be more severe in this group.

Shingles typically starts as a rash on one side of the face or body.  The rash starts as grouped blisters that scab after a few days and clears within 2-4 weeks.  Before the rash develops, there is often pain, itching or tingling in the area where the rash will develop.  Patients may feel systemically ill with fever, headache, chills and tender lymph nodes.  For approximately 20% of patients, severe pain can continue even after the rash clears.  This pain is called post-herpetic neuralgia.  

Shingles is not contagious (one person will not give another person shingles); however the virus can be spread to anyone who has not had chickenpox.  The exposed person will develop chickenpox, not shingles.  Patients with shingles should keep the rash covered, not touch or scratch the rash, and wash their hands frequently to prevent the spread of the virus.

Patients with shingles should see their doctor immediately to get on antiviral medications that will help shorten the duration and severity of the illness.  Medications may also be used to help those with post-herpetic neuralgia. 

SKIN TAG

A skin tag is a common soft harmless lesion that appears to hang off the skin. It is also described as an acrochordon or papilloma. Skin tags develop in both men and women as they grow older. They are typically skin colored, and range in size from 1mm to 5cm. They are most often found in the skin folds (neck, armpits, groin). Skin tags can be removed by the following methods: freezing (cryotherapy), cautery, and surgical removal.

SQUAMOUS CELL CARCINOMA

Squamous cell carcinoma (SCC) is the second most common skin cancer.  This skin cancer tends to develop in areas that have been exposed to the sun for years.  It is most frequently found on the head, neck, ears, lips, arms and hands.  Women frequently get SCC on their lower legs.  Middle-aged and elderly people, especially those with fair skin and frequent sun exposure, are most likely to be affected. 

SCCs are usually slowly-growing, tender, scaly or crusted lumps.  The lesions may develop sores or ulcers that fail to heal.  They vary in size from a few millimeters to several centimeters in diameter.  Sometimes they grow to the size of a pea or larger in a few weeks, though more commonly they grow slowly over months or years.  Any lesion, especially those that do not heal, grow, bleed or change in appearance, should be evaluated by a dermatologist.  

The majority of cutaneous SCCs are due to exposure to ultraviolet radiation, and they most often arise from precancers or actinic keratoses.  Other risk factors for invasive SSC include inherited predisposition to skin cancer, smoking, thermal burn scars, longstanding ulcers, and imunosuppression.  SCCs are usually locally destructive.  However, if left untreated SCCs can destroy surrounding tissue, muscle and even bone.  Aggressive SCCs, especially those of the lips or ears, can spread to other parts of the body like the lymph nodes.

Treatment options vary and depend of the location of the tumor, size, characteristics, and health of the patient among other factors.  Surgical excision to remove the entire cancer is the most commonly used treatment.  Other treatments include Mohs micrographic surgery, electrodesiccation and curettage, topical creams, light treatments, and laser surgery.  Sun exposure avoidance is the primary form of prevention and is important at all ages.  Your dermatologist may recommend sunscreens with a SPF 30 or greater, sun protective clothing, avoidance of the sun during midday hours and seeking shade when possible.

STRETCH MARKS

Stretch marks, also known as striae, are fine lines on the body that occur from tissue under your skin tearing from rapid growth or over-stretching.  It is a common condition that does not cause any significant medical problems but can be of cosmetic concern.  Other names for stretch marks are striae distensae, striae atrophicans, striae rubra (which are red) and striae alba (which are white).  Stretch marks are very common, affecting 70% of adolescent girls and 40% of young men.  They occur in certain areas of the body where skin is subjected to continuous and progressive stretching, such as the abdomen, breasts, thighs, buttocks, and shoulders.  Stretch marks can also occur from prolonged use of topical or oral steroids. 

Stretch marks usually are only a cosmetic problem.  Stretch marks occurring in adolescents become less visible over time and generally require no treatment.  In other cases, if stretch marks are a cause of concern then treatments such as topical retinoids, chemical peels, and certain lasers may be used, however most treatments have disappointing results.  

SURGICAL DERMATOLOGY

Dermatologic surgery is the repair and improvement of the function and cosmetic appearance of skin, hair and nails.  A skin biopsy or excision is when your dermatologist removes a piece of skin and sends it to a pathology laboratory where a dermatopathologist looks at it under the microscope.  Skin biopsies are performed to help with the diagnosis of your skin condition.  Sometimes, different skin conditions can look similar to the naked eye so additional information is required.  This is obtained by looking at the structure of the skin under the microscope after the cells have been stained with special colored dyes.  To obtain more detailed information on some of the more common conditions we treat please feel free to contact us to schedule a consultation.  

  • Shave Biopsy.  A shave biopsy may be used if the skin lesion is suspected to only affect the top layers of the skin (epidermis and dermis).  The dermatologist will take a very superficial piece of skin from the area affected with a scalpel, Dermablade or razor blade.  There are usually no stitches required after a shave biopsy but there will be a small scab that should heal in 1-2 weeks depending on the skin lesion involved.
  • Punch Biopsy.  Punch biopsies are quick, convenient and usually only produce a small wound.  They allow the pathologist to get a full thickness view of the skin.  More than one punch biopsy may be required depending on the condition being investigated.  The punch biopsy blade takes a small round core of tissue ranging from 2mm-8mm in diameter.  If the wound is small, it may heal adequately without a stitch, however a stitch is usually required to close the wound.
  • Excisional and Incisional Biopsy.  Incisional biopsies are used when a larger piece of skin is needed to make a correct diagnosis.  The dermatologist will cut out a piece of skin with a scalpel blade.  Stitches are usually required after this type of procedure. We commonly remove cysts and lipomas by excisional technique.
  • Electrodessication and Curettage.  Electrodessication and curettage is a destruction procedure in which your dermatologist scrapes off a skin lesion and subsequently applies heat to the skin surface.
TINEA VERSICOLOR

Tinea versicolor is a common skin condition in which flaky discolored patches appear mainly on the chest and back.  It is caused by a yeast that normally lives on our skin.  Whenever this yeast overgrows, it can cause a rash called tinea versicolor.  This yeast is not contagious.  The first sign of tinea versicolor are often pink or coppery brown scaly spots on the skin.  The rash tends to appear on the upper back, shoulders, arms and chest.  It may occasionally involve the face and beard area.  The rash becomes more noticeable during the summer months when the skin tans, as the yeast prevents the involved skin from tanning.  Tinea versicolor may be associated with excessive sweating and patients with this condition may notice it comes back or worsens during hot, humid summer months.  

Depending on where the rash is located and how much of the skin is affected, your dermatologist may prescribe a combination of therapies.  Treatments may consists of antifungal medications applied to the skin, medicated shampoos, and in the case of persistent tinea versicolor, oral antifungal medications may be recommended.  With treatment, the yeast is easily eradicated.  The skin, however, will stay lighter or darker for weeks to months.  The skin will eventually return to its normal color.  

WARTS

Warts are growths of the skin caused by infection with Human Papillomavirus (HPV).  More than 70 HPV subtypes are known.  Warts are particularly common in childhood and are spread by direct contact or autoinoculation.  This means if a wart is scratched, the viral particles may be spread to another area of skin. 

Warts have a hard ‘warty’ or ‘verrucous’ surface.  They grow most commonly on the fingers, around the nails, and on the backs of the hands.  You can often see tiny black dots in the middle of each scaly spot, and may look like seeds (often called “seed” warts).  In children, even without treatment, 50% of warts disappear within 6 months; 90% are gone in 2 years.  They are more persistent in adults but they clear up eventually.

Dermatologists are trained to use a variety of treatments, depending on the age of the patient and type of wart.  Treatment options include cantharidin, liquid nitrogen, electrosurgery and curettage, and excision.  If the warts are difficult to treat, your dermatologist may treat with special lasers, topical retinoids, chemical peels, bleomycin, and immunotherapy

Return to Top