Medical Dermatology

 

Acne
Acne is a common condition which affects the oil glands of the skin. It mainly affects adolescents but may persist or even worsen in adulthood.
Several types of acne exist: blackheads, whiteheads, cysts, small or larger red bumps. If not treated in a timely matter, the breakouts can result in scars.
Acne may be classified as mild, moderate or severe depending on the type and number of lesions. There is no cure for acne, so the goal is control.
Several treatment options exist. Topical therapies are used for milder forms of acne. For more severe cases, oral medicines such as oral antibiotics can be used. Another FDA approved treatment available is the Blulight. This is a safe and effective therapy that targets the bacteria that cause acne.
Isotretinoin, the strongest oral acne medication, is reserved for severe and resistant cases.
Peels (chemical peels) can be done to help reduce the blemishes, discoloration and scars caused by acne lesions.
Ask your provider about the various treatment options.

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Alopecia Areata
Alopecia areata is a health condition that usually involves a patchy hair loss from the scalp or face. The condition affects both males and females. Most cases of alopecia areata occur in healthy individuals. However, a minority of patients can have other immune related conditions such as asthma, allergies, eczema, and hypothyroidism.
The underlying skin is unscarred and looks normal. Alopecia areata most often affects the scalp and beard, but may occur on any hair-bearing part of the body. The hair tends to fall out over a short period of time.
Alopecia areata is usually diagnosed based on physically apparent features. A biopsy for microscopic examination of the underlying tissue is rarely needed to confirm the diagnosis.
The cause of alopecia areata remains unknown, but it is not contagious. The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth.
Effects of alopecia areata are mainly psychological (loss of self image due to hair loss). This can certainly cause some degree of emotional stress.
In most cases that begin with a small number of patches of hair loss, hair grows back after a few months to a year. In cases with a greater number of patches, hair can either grow back or progress to further hair loss.
Treatments include steroid injections, whereby a small amount of medication is injected in the affected areas. Typically, after a few visits, 3-4 weeks apart, new hair starts to grow back again. Other therapies include strong topical steroids, Minoxidil, and other topical or systemic medications.

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Basal Cell Cancers are the most common skin cancers. These are usually localized growths caused by excessive cumulative exposure to the sun. Although Basal cell cancers do not tend to spread or become life threatening they can become very large.
Basal cell carcinoma usually presents as a raised, smooth, pearly bump on the sun-exposed skin. Sometimes small blood vessels can be seen within the tumor. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly and with proper treatment can be fully eliminated.

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Biopsy
When a lesion is suspicious to be cancerous(malignant), a biopsy is warranted. A small amount of local anesthetic is injected near the lesion, the doctor will then remove the growth, which is subsequently sent to the lab for review. A shave excision removes superficial lesions. A punch biopsy removes a small but deeper portion of the growth. An excision removes the entire area when the growth is deep and sutures may be used to close the defect.
Scars could appear after removing any lesion regardless of the method. However, during your visit, our doctors will select and discuss the best biopsy method to minimize this risk.

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Dermatitis

Dermatitis is a general term that is used to describe an inflammation of the skin. Dermatitis is a non contagious and very common condition treated at our dermatology office.
There are several different types of dermatitis, including eczematous dermatitis, contact dermatitis, seborrheic dermatitis, and perioral dermatitis among others.
Each type of dermatitis has distinct signs and symptoms including redness, swelling, itching, and skin lesions.
A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can make dermatitis worse.

Eczema or eczematous dermatitis is a chronic itchy rash that tends to recur. This condition could occur with allergies and frequently runs in families in which members have asthma or seasonal allergies. It usually begins in infancy and may vary in severity during childhood and adolescence. Although the severity of this condition usually tends to decrease, eczema can still persist in adulthood. Possible causes include a combination of dry, irritable skin, a malfunction in the body’s immune system and/or a genetic tendency for allergic conditions such as asthma or allergies.

Contact dermatitis is a rash that results from direct contact with irritants or allergy-producing substances. Common irritants or allergens include: laundry soap, skin soaps or detergents, cleaning products, rubber, metals, such as nickel, jewelry, perfume and fragrances, cosmetics, weeds, neomycin, a common ingredient in topical antibiotic creams.

Seborrheic dermatitis is a common scalp and facial condition that often causes a red rash with scales, usually on the scalp and face. It’s common in people with oily skin or hair, and it may come and go depending on the season of the year.

Stasis dermatitis is caused by leakage of fluid under the skin of the legs due to weak or incompetent veins resulting in poor circulation.

Perioral dermatitis is a bumpy rash around the mouth. This type of dermatitis may mimic forms of skin disorders that include rosacea, adult acne or seborrheic dermatitis, involving the skin around the mouth or nose. Possible causes include: makeup, moisturizers, topical corticosteroids, and dental products containing fluoride.

Complications of dermatitis include infections and scar formation from repeated scratching.

Treatments for dermatitis
Dermatitis treatment varies, depending on the cause. Steroids and non steroidal creams are usually prescribed as a first line. To minimize side effects, such as thinning of skin, and to increase effectiveness, topical corticosteroids are generally used only short-term until rashes are under control. Other treatment options include medicated shampoos, use of antihistamines that can reduce itching, oral antibiotics for secondary infections or their anti-inflammatory effects, non steroidal topical medications.

Avoid scratching whenever possible. Cover the itchy area with a dressing, if you can’t keep from scratching it. Trim nails and wear thin cotton gloves at night.
Wear smooth-textured cotton clothing. This will help you avoid irritating the affected area.
Use a mild, unscented laundry detergent when washing clothes, towels and bedding.
Try using the extra-rinse cycle on your wash machine.

Prevention of dermatitis includes avoidance of known irritants including poison ivy, and harsh soaps. Try to identify and avoid triggers that worsen the inflammation or rash and itch.

Stress can often worsen some forms of dermatitis.

Avoiding dry skin may be one factor in helping you prevent future bouts of dermatitis. These tips can help you minimize the drying effects of bathing on your skin:

Limit the time of your shower and use warm, rather than hot, water.

Use only mild soaps, such as Dove that clean without excessively removing natural oils. Deodorant and antibacterial soaps may be more drying to your skin. If you have dry skin and the dermatitis involves the body, consider applying the Dermatologist’s Choice Prebath Oil 5 to 10 minutes prior to your shower. You may also apply a moisturizer after your shower and throughout the day.

Your doctor will discuss a personalized treatment for your dermatitis.

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Hives aka Urticaria

Hives are raised, often itchy, red welts on the surface of the skin.

Many substances, illnesses, or situations can trigger hives, including: Animal dander (especially cats), insect bites, medications, pollen, certain foods, emotional stress, extreme cold or heat, sun exposure, exercise, certain illnesses and auto immune diseases and infections. However, in most cases, the exact cause of hives cannot be identified.

Treatment may not be needed if the hives are mild. They may disappear on their own.
To reduce itching and swelling: Avoid hot baths or showers. Avoid irritating the area with tight-fitting clothing. Certain medications such as antihistamines can help relieve the symptoms. For more severe or persistent cases, stronger medications such as steroids can be prescribed.
If your reaction is severe, especially if the swelling involves your throat, you may require an emergency shot of epinephrine (adrenaline). Hives in the throat can block your airway, making it difficult to breathe.

Our doctors will further discuss your treatment.

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Melanoma is less common than both basal cell carcinoma and squamous cell carcinoma, but it is the most serious form of cancer and can be lethal. Most cases are caused by over-exposure to UV rays from the sun or sunbeds.
Most melanomas are brown to black looking lesions. Unfortunately, a few melanomas are pink, red or fleshy in color.
Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding.
An often-used memory tool to remember what to look for
is the “ABCDs”, where
A= asymmetrical (one side doesn’t match the other side),
B= “borders” (irregularly shaped),
C= “color” (changes or different shades of brown for example) and
D= “diameter” (larger than 6 mm—the size of a pencil eraser or increasing in size).

Skin cancers have many potential causes. Examples include:
1.Excessive Ultraviolet sun exposure or tanning beds
2.Smoking tobacco and related products can double the risk of skin cancer.
3.Chronic non-healing wounds, especially burns can develop into squamous cell carcinoma.
4.Genetic predisposition, including “Congenital Melanocytic Nevi Syndrome”. CMNS is characterized by the presence of “nevi” or moles of varying size that either appear at or within 6 months of birth. Larger size moles are at higher risk for becoming cancerous.
5.Human papilloma virus (HPV) is often associated with squamous cell carcinoma of the genitals, anus, mouth, pharynx, and fingers.
The risk of developing skin cancer can be reduced through a number of measures including:

Decreasing indoor tanning and mid day sun exposure and increasing the use of sunscreen.
Avoiding the use of tobacco products.
Reducing overexposure to ultraviolet (UV) radiation, especially in the early years of life (about 80% of a person’s lifetime UV exposure happens during the first 18 years of life).
Wearing protective clothing (long sleeves and hats) when outdoors.
Applying Broad-spectrum sunscreen that blocks both UVA and UVB radiation.
Reapplying sun block frequently.

Treatment of skin cancer is dependent on the type of the cancer, location of the cancer, person’s age, and whether the cancer is primary or a recurrence. One should look at the specific type of skin cancer (basal cell carcinoma, squamous cell carcinoma, or melanoma) of concern in order to determine the correct treatment required.

Treatments for skin cancers of all types include surgical techniques including excision, Moh’s surgery, Cryotherapy (freezing technique) and electrodesiccation and curettage.
Mohs micrographic surgery is the most accurate and successful method
to remove the more common skin cancers. This technique involves removing the cancer and checking the margins during the same visit.
Non surgical treatments of some skin cancers include various creams, gels, and solutions, radiation therapy as well as the use of photodynamic therapy (The use of light combined with a specific chemical)
In the case of disease that has spread (metastasized), further surgical procedures, radiation, or chemotherapy may be required.

Make sure you have a skin cancer screening done at your next visit.

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Melasma

Melasma is a very common skin disorder that causes a dark discoloration that appears on sun-exposed skin of the face. Though it can affect anyone, young women are at greatest risk.
Although hormones appear to be involved, sun exposure is a the strongest risk factor.
Melasma doesn’t cause any other symptoms besides skin discoloration but may be of great cosmetic concern.
A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face).
Avoiding the sun and using sunscreen are key to preventing melasma.
Treatments include a bleaching cream called hydroquinone, tretinoin, kojic acid, azelaic acid, topical steroids, as well as chemical peels. Fraxel, an effective FDA approved laser for melasma which is offered at our laser center, can also be used to remove the dark pigmentations.
Ask our doctors about various treatment options for melasma.

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Patch testing(T.R.U.E Test)

Any individual with suspected contact dermatitis should consider having the patch test done.
Our doctor may conduct the T.R.U.E test to see which substances inflame your skin. T.R.U.E test is a simple patch test that is applied and left on your back for 48 hours. The doctor then removes the patch and checks to see which substances have caused an allergic reaction.
The chemicals included in this patch test kit are the offenders in over 80% of contact allergic eczema and include chemicals present in metals (e.g. nickel), rubber, leather, hair dyes, formaldehyde, lanolin, fragrance, preservative and other additives.
Sometimes the results can be inconclusive. And further testing is sometimes necessary. Patch tests may not always explain the cause of the dermatitis. However, if a specific chemical is found to cause the dermatitis, avoiding that offending agent will help reduce the risk of future breakouts.

If an allergic reaction is suspected to be the cause of your dermatitis, our doctor will discuss doing the T.R.U.E patch test

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Perioral Dermatitis

Perioral dermatitis is a skin disorder characterized by tiny bumps (papules) and redness around the mouth. It can be characterized by an uncomfortable burning or less commonly itching sensation. Rarely, the rash may appear around the eyes, nose, or forehead. Perioral dermatitis is thought to be related to acne and sometimes persists for months or years.
Treatments for perioral dermatitis include various creams clindamycin, and oral antibiotics such as doxycycline or minocycline.
Perioral dermatitis can be persistent and often requires several months of treatment.
Our doctors will recommend you the best therapies available for this condition.

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Psoriasis
Psoriasis is a common, chronic, scaly rash that affects people of all ages. It is characterized by red, scaly patches of skin, which usually have well defined edges. It is often symmetrical, affecting both sides of the body. The scale is typically silvery white. This typical scale may not be so obvious if the psoriasis affects a body folds such as the armpits or groin areas, in which case skin is more likely to be smooth and shiny.
Psoriasis tends to run in families and affects men and women equally. It can be influenced by many environmental factors, but it is not contagious and is not due to an allergy. The condition may or may not be itchy.
About 20% of those affected with psoriasis will also develop joint pain (psoriatic arthritis), which may involve one or several joints.
Exactly what causes psoriasis is not fully understood but there is a lot of active research into this area. The immune system is involved and appears to be overactive in a way that causes inflammation.
Physical and emotional stress, infections, and certain medications may precipitate psoriasis.
Most forms of psoriasis run a fluctuating course with periods of marked improvement and even complete clearance, only to relapse at a later time. There may be several years between relapses.
There is no cure for psoriasis, however, over the last few years there have been many new medications that can offer greatly successful treatment choices.
Treatment options for psoriasis include various types and strengths of topical medications, light and laser therapy (including the FDA approved X-tract Laser) oral or injectable medications.
The doctors will go over these therapy options during your visit.

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Removing Benign Lesions
Unwanted benign (non cancerous) growths such as skin tags (small soft bumps), angiomas (red bumps) , warts, and other moles can be removed using a variety of methods. These growths usually do not need to be removed except if they become symptomatic, like itchy or sore, or if you do not like their cosmetic appearance. Several methods exist for the removal of the lesions such as freezing, cauterizing, scrapping off followed by application of a solution, or shaving off after using local anesthetics. If there is any doubt that the growth can be malignant, then a biopsy is performed. Scars could appear following the removal of any lesion regardless of the method used.
Our doctors will discuss the best way to remove your unwanted skin growths.

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Rosacea
Rosacea is a condition that causes a red facial rash. Sometimes this redness is accompanied with pimples.
Although the cause of rosacea is unknown, it may get worse by sun exposure, stress, changes in temperature (both heat and cold), alcohol consumption, certain foods such as spicy foods, and some topical creams.
Characteristics of Rosacea may include: red bumps and pustules, mainly on the face, frequent blushing or flushing, red face and prominent blood vessels, dry flaky skin, red sore eyelids or eyeballs. Rhinophyma refers to a form of rosacea that causes the nose to become enlarged and bulbous.
Treatments for Rosacea may include: avoiding trigger factors, topical treatments, oral antibiotics, other oral medications, and laser therapy.
Rosacea may be brief and short-lived, recurrent or persistent.
Ask the doctors about the treatment options.
Rosacea is a condition that causes a red facial rash. Sometimes this redness is accompanied with pimples.
Although the cause of rosacea is unknown, it may get worse by sun exposure, stress, changes in temperature (both heat and cold), alcohol consumption, certain foods such as spicy foods, and some topical creams.
Characteristics of Rosacea may include: red bumps and pustules, mainly on the face, frequent blushing or flushing, red face and prominent blood vessels, dry flaky skin, red sore eyelids or eyeballs. Rhinophyma refers to a form of rosacea that causes the nose to become enlarged and bulbous.
Treatments for Rosacea may include: avoiding trigger factors, topical treatments, oral antibiotics, other oral medications, and laser therapy.
Rosacea may be brief and short-lived, recurrent or persistent.
Ask the doctors about the treatment options.

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Skin Cancer
The most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma.
Skin cancer is the most common form of cancer and every year millions of cases are diagnosed. The number of newly diagnosed skin cancer is on the rise.
There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, ulcering in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.

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Skin Checks & Self Examination
Over 2 million Americans are affected by skin cancers each year, making it the most common form of cancer. Additionally, Arizona ranks #2 in the World in skin cancer incidence rates (Only Australia beats us!). It is therefore recommended that you periodically have a full body skin check by a dermatologist to detect suspicious lesions. It is also extremely important that everyone perform frequent self examinations of their skin to detect skin cancers. Early detection is key to having a high cure rate. If not done yet, call to set up an appointment for your yearly skin cancer check.

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Squamous cell carcinoma(SCC) is commonly a reddish, scaling, thickened patch on sun-exposed skin. Some become firm hard and dome shaped. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous cell cancer is the second most common skin cancer. It can spread and become dangerous, but it is not nearly as dangerous as a melanoma.

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Warts

Warts, also called Verrucae are small growths on the skin caused by a virus called human papillomavirus (HPV). They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet).
The different types of warts include:
Common warts have a rough or spiky surface and usually appear on the hands, but can occur anywhere.
Flat warts are smaller, smoother and are generally found on the face and forehead. They can spread from shaving if they occur on the legs or the neck.
Genital warts(condyloma) are usually found on the genitals, in the pubic area, and in the area between the thighs, but they can also appear inside the vagina and anal canal. A small percentage of these warts can cause cervical and anal cancer.
Plantar warts are found on the soles of the feet and can become painful. These warts are more difficult to treat and typically require multiple treatment sessions.
Subungual and periungual warts appear under and around the fingernails or toenails. These warts may also be more stubborn and require multiple treatments.
While some warts disappear without treatment, most can persist for a longtime and will require some form of therapy. Since they are contagious, warts can spread from one part of your own body to another.
Several methods exist to removes warts. Some over the counter medications exist that could help remove smaller warts. However, unfortunately these medications do not work too well for larger or thicker warts, like the ones on the feet, for example.
Our doctors will discuss the various therapies that would work the best at eliminating your warts. These include topical medications, scrapping and applying a topical solution, freezing or cauterizing method or other therapies.

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