Medical Dermatology

Acne is one of the most common skin diseases in the United States. It is caused when the oil gland/hair follicle unit becomes clogged, mostly by an excess production of oil, dead skin cells, and bacteria. Acne comes in many varieties, including blackheads, whiteheads, and the more severe nodular acne and cystic variants. Although, acne is more prevalent in teenagers and young adults, acne can appear at any age. Causes of acne are usually a combination of the following:

• Genetics
• Hormones
• Prescribed medications
• Humidity and environmental pollutants
• Oil-based cosmetics
• Stress
• Physical irritation

When faced with acne, never resort to picking, popping, or squeezing, which might worsen common acne to lead to cystic lesions or permanent scarring. Treatment of acne is largely dependent on its severity, but over-the-counter topical medications containing benzoyl peroxide or salicylic acid are among the most common treatments, along with topical antibiotics, topical retinoids, oral medications, and hormonal therapies.

Source: American Academy of Dermatology

Vascular birthmarks, or hemangiomas, become apparent during a child’s first year but usually fade as the child ages. They are red in color due to the excess blood vessels in the skin, and are usually found on the head and chest, but can be on any part of the body. While adults can also develop birthmarks, they are much smaller and more superficial. The hemangioma can be in the top layers of the skin (capillary hemangioma), deeper in the skin (cavernous hemangioma), or a mixture of both.

Although hemangiomas are usually harmless, they can become symptomatic if they ulcerate and bleed. If they are symptomatic or if there is concern for interference in vision, breathing, or hearing, there are treatment options to shrink hemangiomas:

• Laser treatments
• Steroid cream
• Topicals that constrict blood flow
• Beta-blockers can be used for treatment of more complicated hemangiomas

Source: Mayo Foundation for Medical Education and Research

Lentigines, or liver spots, are benign lesions that commonly occur on the sun-exposed areas of the body, such as the backs of hands and face. These irregularly-shaped dark-colored spots can be as large as two centimeters and are caused by an increase in the number of pigment cells located in the superficial layers of the skin. The lesions tend to increase in number with age, making them common among the middle age and older population. A doctor will perform a physical examination to diagnose lentigines, and a biopsy will be necessary if it is irregular, to ensure it is not cancerous. There are many treatment options for people who choose to treat lentigines for cosmetic reasons:

• Cryotherapy
• Prescription bleaching creams
• Chemical peels
• Laser treatments

Diligent sun protection will decrease the risk of developing new lentigines, as well as their recurrence after treatment.

Source: American Osteopathic College of Dermatology

Epidermoid cysts are benign bumps under the outer layer of the skin. These bumps will enlarge slowly over time and should not be painful. They can appear anywhere on the skin, but are most common on the face, neck, and trunk. Epidermoid cysts are usually caused by a buildup of keratin, a protein that occurs naturally in skin cells, leaving the skin and hair follicle damaged. The damage can also be caused by acne or excessive exposure to the sun. Some genetic disorders or skin wounds may also increase risk.

Cysts can swell and itch, while appearing on the skin as small red bumps with tiny black openings through which an odorous substance can be emitted. Most do not cause problems or require treatment, but see a doctor if you have one that:

• Grows rapidly
• Ruptures, becomes painful, or gets infected
• Occurs in an area under constraint irritation
• Humidity and environmental pollutants
• Bothers you for cosmetic reasons

A doctor should be able to diagnose a cyst by sight, but may need to do a biopsy to diagnose more serious concerns. Treatment options include injections, incisions and drainages, minor surgery, and laser treatments.

Source: Mayo Foundation for Medical Education and Research

Contact dermatitis is inflammation of the skin that results from direct contact with a substance that irritates the skin or causes an allergic reaction. Anyone can develop contact dermatitis, but your risk may be increased if you are in regular contact with an irritant or allergen, or if you already have allergies to certain substances such as plants, chemicals, or medications. There are two types of contact dermatitis:

• Irritant contact dermatitis
• Allergic contact dermatitis

After determining what caused the rash, most people can avoid flare-ups by avoiding or lessening their exposure to the substance and treating the rash with antihistamine pills, moisturizers, and corticosteroid creams. Severe reactions may require stronger medication, but wet dressings and oatmeal baths can help soothe symptoms until the rash clears.

Source: American Academy of Dermatology

Source: American Academy of Allergy, Asthma, and Immunology

Eczema is a condition where skin becomes dry and irritated, causing it to crack and sometimes bleed. While doctors are unsure of the exact cause of eczema, it is thought to be combination of genetics, immune dysfunction, and environmental exposure. While children are more at risk for eczema, anyone with asthma, hay fever, and certain allergies is more prone to eczema. Someone who has a family member with eczema is also likely to have it. Eczema can make the skin:

• Itchy
• Dry
• Cracked with fluid discharge at times
• Red with clusters of bumps

Eczema cannot be cured, but it can be managed with certain medicated ointments or creams, or antibiotics. A patient can lessen the severity of their symptoms by avoiding the allergens that cause the irritation to their skin, such as using fragrance-free and sensitive skin self-care and laundry products, and avoiding the use of aerosol sprays and alcohol-based products.

Source: National Eczema Society

Source: American Academy of Allergy, Asthma, and Immunology

Excessive sweating is a medical condition called hyperhidrosis. Focal hyperhidrosis limits the sweating to one area of the body, such as underarms, hands, face, or feet. Generalized hyperhidrosis is present over all parts of the body. Hyperhidrosis is normally an indicator or result of another disorder or condition in the body, but can be hereditary. This includes but is not limited to:

• Menopause
• Obesity
• Nerve Disorders

If everyday activities are difficult due to sweating, the skin peels due to being damp with sweat too often, or skin infections are a constant problem, hyperhidrosis may be the cause. There are several treatments that a doctor may suggest such as antiperspirants, and Iontophoresis or Botulinum toxin injections. Medication may be prescribed or surgery may be considered in some cases.

Source: American Academy of Dermatology

Source: Canadian Dermatology Association

Folliculitis happens when a hair follicle becomes inflamed due to shaving, rubbing against clothing, or other activities that cause friction against the skin. In most cases, the damaged hair follicles become infected with fungus or Staphylococcus, a type of bacteria. These areas can present themselves as acne pimples or non-healing sores. Certain factors make people more susceptible to the condition, including:

• Underlying medical conditions
• Acne or dermatitis
• Previous skin damage
• Prescribed medications
• Being overweight
• Clothes that trap heat and sweat
• Shaving, waxing, or hair-plucking

Folliculitis resembles either acne pimples or non-healing crusty sores, which are typically accompanied by an itchy rash. Short-term infections are often bacterial in nature and can be resolved with oral antibiotics or topical antibiotic creams. Chronic or recurring infections require stronger doses along with some prevention methods to prevent infection. Avoid tight clothing, shaving, hot tubs, and pools, while keeping the area clean to prevent folliculitis.

Source: American Academy of Dermatology

Source: American Osteopathic College of Dermatology

Source: Mayo Foundation for Medical Education and Research

Source: US National Library of Medicine

The fungus causing tinea is a microscopic organism that grows in the outer skin and prefers moisture. Common infections include foot fungus (tinea pedis), groin rashes (tinea cruris), and body rashes (tinea corporis). Tinea often comes back, but prescription creams, ointments, lotions, sprays, powders, or shampoos can help attack the fungus infection. Warmth and moisture encourage the fungus to grow, but recurrences can be prevented by:

• Drying thoroughly after bathing
• Wearing loose cotton underwear
• Dusting the skin with an absorbent powder once or twice a day
• Avoiding wet swimsuits
• Wearing ventilated shoes
• Wearing clean, absorbent cotton socks
• Changing socks frequently
• Keeping the infected area dry

Scalp ringworm, also known as tinea capitis, infects hair deep down into the roots causing flaking, pustules, and loss of hair. With fungal infection of the scalp or body, towels, combs, and clothing of the infected person should be kept separate from those of other household members. Because the infection is deep in the hair roots, only oral prescribed medications and shampoos can help cure it.

Source: Connecticut Dermatology Group

Everyone loses hair. In fact, it is normal to lose about 50 to 100 hairs per day. While there are many causes for hair loss, the most common cause is hereditary hair loss, also known as male-pattern baldness, female-pattern baldness, or androgenetic alopecia.

Alopecia areata is an autoimmune disorder resulting in hair loss on the scalp and body. Another type, cicatricial alopecia, is a rare disease that destroys a person’s hair follicles. And lastly, there’s central centrifugal cicatricial alopecia, which primarily affects women of African descent. It begins in the center of the scalp and radiates out from the center as it progresses. There are many factors which contribute to hair loss including:

• Underlying medical conditions
• Illness
• Certain cancer treatments
• Ringworm
• Trichotillomania
• Hormonal changes
• Stress
• Weight loss
• Vitamin A deficiency
• Protein or iron deficiency
• Eating disorders
• Inadequate hair care and certain hair styles

Effective treatments include medications, steroid injections, surgical procedures, laser hair rejuvenation, hair transplant, scalp reduction, medical tattooing, and wigs or hairpieces.

Source: American Academy of Dermatology

Source: National Alopecia Areata Foundation

Melasma, or chloasma, is a skin condition that presents itself on the body as gray or brown spots. It is not a harmful disease, but it can severely affect a person’s cosmetic appearance. While the cause of melasma is not certain, too much sun, changes in hormones, and certain cosmetic products will irritate the condition. Women, individuals with darker skin tones and those with affected family members, are most at risk for developing melasma. It may also develop in persons taking:

• Oral contraceptives
• Hormone replacement therapy
• Excessive sun exposure

While there is no real prevention for melasma other than proper skin care, such as wearing sunscreen and practicing other forms of safe skincare, there are treatments available. Melasma may not always need treatment as some spots will go away in time or with the change of hormones. However, if necessary, a doctor can prescribe certain topical creams and medications. If this does not work, a dermatological procedure, such as a chemical peel or dermabrasion, may be performed. Some laser treatments can also reduce the effects of melasma.

Source: American Academy of Dermatology

Onychomycosis is an infection of the nails caused by fungus, most commonly appearing with thickened nails and yellow discoloration of the nails. Onychomycosis typically affects adults, and accounts for 20% of all nail diseases. It is spread by direct contact with the fungus, and is typically most common in warm, moist environments. A person may have onychomycosis if one or more nails are:

• Thickened
• Brittle, crumbly, or ragged
• Distorted in shape
• Dull, with no shine
• A dark color, caused by debris build-up under the nail

With a more severe condition called onycholysis, infected nails may also separate from the nail bed, accompanied by pain in the toes or fingertips, and a slightly foul odor. To help avoid contracting onychomycosis, allow shoes to rest between wearing, use anti-fungal creams, change socks daily, trim nails, and keep feet dry.

Options for treatment may include filling, trimming, or removal of the nail, topical application of antifungal medications, oral medication, and laser treatments.

Source: American Academy of Dermatology

Source: Galderma, S.A.

Psoriasis is an autoimmune disease that causes raised, red, and scaly patches to appear on the skin. Psoriasis is a chronic disease, but it is not contagious. There are five types of psoriasis:

• Plaque Psoriasis is the most common form of the disease and appears as raised, red patches covered with a silvery white buildup of dead skin cells, which usually appear on the scalp, knees, elbows, and lower back.
• Guttate Psoriasis appears as small, dot-like lesions, often starting in childhood or young adulthood. Sometimes triggered by a strep infection, it is the second-most common type of psoriasis as it affects about 10% of psoriasis sufferers.
• Inverse Psoriasis appears as very red lesions in body folds, typically behind the knee, under the arm or in the groin, and it may appear smooth and shiny. It often accompanies another type of psoriasis simultaneously.
• Pustular Psoriasis is accompanied by white pustules or blisters surrounded by red skin. The pus contains white blood cells, but it is not an infection, nor is it contagious. It most commonly occurs on the hands and feet.
• Erythrodermic Psoriasis is a severe form that leads to widespread, fiery redness over most of the body. It can cause severe itching and pain, while the skin may come off. Although, it generally appears on people who have unstable plaque psoriasis, it is rare, occurring only in 3% of psoriasis sufferers.

Psoriasis is believed to be hereditary, with most people developing the disease due to external factors working in conjunction with genetics. There are many different ways to treat psoriasis, including biologic medications, systemic medications, UVB phototherapy, excimer laser therapy, pulsed dye laser treatments, and topical medications. The best way to prevent flare ups is to avoid known triggers such as stress, infections, and certain medications.

Source: American Academy of Dermatology

Source: National Psoriasis Foundation

Poison Ivy, Oak, and Sumac are poisonous plants that can cause a burning, itching rash to appear on the skin. When there’s physical contact with any part of the plant, or an object, animal, or item of clothing that came in contact with the urushiol oil contained in the plant, a rash will appear on the skin. More than 80% of people are susceptible to this kind of rash, which may appear with:

• Itching
• Hives
• Red, swollen skin
• Blisters

Prescription medications and steroid ointments are available to treat rashes that result from contact with poison oak, ivy, and sumac urushiol oils. The only way to prevent them is to avoid physical contact with these plants.

Source: American Academy of Dermatology

Rosacea is a disease that affects the skin of the face. Most common symptoms include blushing and persistent facial redness, a blotchy red facial rash, or pimple-like lesions resembling acne. Rosacea affects the eyes in many patients as well, causing a watery or bloodshot appearance, burning, stinging, or swollen eyelids.

The cause of rosacea is unknown, but some factors that can make it worse include sun exposure, cold weather, spicy foods, alcohol, and caffeine. Topical creams or oral therapies may be prescribed, as well as laser or light therapies. Saline and prescription eyedrops, and oral antibiotics are often needed to alleviate ocular rosacea. Rosacea sufferers should avoid anything that irritates the skin, look for hypoallergenic products, and use sunscreen daily. Green-tinted cosmetics may help mask the condition.

Source: American Academy of Dermatology

Source: National Rosacea Society

Shingles is a rash on the skin that affects the nervous system and can irritate and cause pain. The varicella-zoster virus, the same virus that causes chickenpox, also causes shingles. People over the age of 50 are at higher risk for contracting shingles. Those enduring certain procedures or stressful situations with a weakened immune system are more susceptible to contracting shingles. Having had chickenpox also puts a person at risk for contracting shingles. Some symptoms include:

• Headaches
• Nausea
• Fever
• Painful, burning, itching sensations
• A ring of the rash that will most likely form around the waist
• Rash with a series of blisters filled with fluid, before scabbing

Antiviral drugs are prescribed to speed recovery from shingles. Although shingles itself cannot be prevented, the chickenpox vaccine prevents chickenpox and therefore decreases the likelihood that a vaccinated individual will later develop shingles.

Source: National Shingles Foundation

Source: National Institute of Neurological Disorders and Stroke

Warts are benign skin growths that appear on the skin when the human papillomavirus (HPV) infects the skin. Wart viruses are contagious and can spread by contact with a wart or something that touched a wart. They can appear on any part of the body and are often skin-colored and feel rough, but can also be dark, flat, and smooth. Anyone can contract warts, but some are more prone than others including children, teens, people who pick at or bite their nails, or people with a weakened immune system.

Some common treatments for warts are cryotherapy (including over-the-counter freezing treatments), salicylic acid (over-the-counter Compound W and the like), candida antigen immunotherapy, Aldara cream, and surgical removal. If self-treatments do not work after a period of 4 to 12 weeks, contact our dermatologist. We will assess your warts and recommend the best option.

Source: American Academy of Dermatology

Source: Mayo Foundation for Medical Education and Research

Actinic keratosis, also called solar keratosis, is a type of cancer where scaly, crusty growths (lesions) are caused by damage from the sun’s ultraviolet (UV) rays. It is a potential pre-cancerous lesion. It typically appears on sun-exposed areas such as the face, bald scalp, lips, and the back of the hands. The growths often:

• Appear elevated
• Are rough in texture
• Resemble warts
• Become red, tan, pink, or flesh-toned

If left untreated, up to ten percent of AKs develop into squamous cell carcinoma (SCC), which is the second-most common form of skin cancer. In rarer instances, AKs may also turn into basal cell carcinomas (BCC), the most common form of skin cancer.

A dermatologist will select a treatment type such as immunotherapy, cryosurgery, chemotherapy applied to the skin, chemotherapy, photodynamic therapy, radiation therapy, or surgical treatment. A person can prevent skin cancer by regularly applying sunscreen and avoiding sun exposure when possible.

Source: American Academy of Dermatology

Source: Skin Cancer Foundation

Basal cell carcinoma is the most common type of skin cancer. It can appear anywhere on the body, but most often appears on skin that is often exposed to the sun, such as the face, scalp, neck, hands, and arms. Basal cell carcinoma typically grows slowly. It may look like a:

• Reddish patch of dry skin that does not heal
• Flesh-colored, pink, red, or brown pearl-shaped lump
• Pimple that does not clear
• Sore that bleeds, heals, and then returns
• Scar that feels waxy and is skin-colored, white, or yellow
• Group of slow-growing, shiny pink or red-growths that look like sores (often scaly and bleed easily)
• Flat or sunken growth that feels hard and may be white or yellow

A dermatologist will carefully examine growths, moles, and dry patches. After careful consideration, treatment plans such as immunotherapy, cryosurgery, chemotherapy applied to the skin, chemotherapy, photodynamic therapy, radiation therapy, or surgical treatments can be pursued. A person can prevent skin cancer by regularly applying sunscreen and avoiding sun exposure when possible.

Source: American Academy of Dermatology

Source: Skin Cancer Foundation

Squamous cell carcinoma is a very common type of skin cancer. It often appears on skin that gets lots of sun, such as the face, ears, bald scalp, neck, or arms, but it can appear elsewhere – even inside the mouth, on the lips, or genitals. Too much sun is often the cause, but it is not the only one. Squamous cell carcinoma can appear on skin that was badly burned, had lots of radiation, such as x-rays, or was exposed to strong chemicals. Squamous cell carcinoma often has a reddish color and can grow deeply if left untreated. The cancer can spread to other parts of the body and it can be deadly. It often looks like a:

• Hard (scaly or crusty) reddish bump, patch, or pearl-shaped growth
• Open sore that itches and bleeds; it can heal and return
• Scaly patch on the lip; the skin on the lip can get thick

If the dermatologist finds something that looks like skin cancer, the dermatologist will remove it (or part of it). The removed skin will be sent to a lab and diagnosed. There are many effective treatments for skin cancer, such as immunotherapy, cryosurgery, chemotherapy applied to the skin, chemotherapy, photodynamic therapy, radiation therapy, or surgical treatments can be pursued. A person can prevent skin cancer by regularly applying sunscreen and avoiding sun exposure when possible.

Source: American Academy of Dermatology

Source: Skin Cancer Foundation

Melanoma often appears in an existing mole or looks like a new mole. By knowing where you have moles on your skin, you can find melanoma when it first appears. Here is what to look for:

• A mole on the skin that is growing, changing shape, or changing color
• A mole that looks scaly, oozes, or bleeds
• New dark spot on the skin that looks like a mole, but grows quickly
• Pain, itch, or bleeding in a new spot on the skin
• Streak (usually brown or black) underneath a fingernail or toenail
• Bruise on the foot that does not heal

Your treatment depends on how deeply the melanoma has grown into your skin, whether the melanoma has spread to other parts of the body, and your overall health.

Treatment often starts with surgery, and while the melanoma is in stage 0—growing in the outer layer of skin—the cure rate is nearly 100%. Treatment may also involve immunotherapy, radiation therapy or chemotherapy.

Sun exposure is the most preventable risk factor for all skin cancers. Regularly apply sunscreen, wear protective clothing, and avoid sun exposure when possible.

Source: American Academy of Dermatology

Source: Skin Cancer Foundation