General Dermatology

Acne

What is acne?

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms. Acne affects most teenagers to some extent. Untreated acne can leave lifelong scars.

Does cleansing help?

Yes. For the normal care of your skin, wash your face with soap and warm water twice a day. Washing too often may actually make your acne worse. Regular shampooing is also recommended. If your hair is oily, you may want to wash it more often.

How does acne form?

Rising hormone levels during adolescence (puberty) cause the oil (sebaceous) glands of the skin to get bigger. The glands are connected to a hair-containing canal called a follicle. The sebaceous glands make an oily substance called sebum which reaches the surface by emptying through the opening of the follicle on to the skin surface. The oil seems to stimulate the lining of the follicle. The cells from the lining shed more rapidly and stick together, forming a plug at the skin surface. The mixture of oil and cells also helps bacteria in the follicles grow. These bacteria make chemicals that can cause the wall of the follicle to break. Then sebum, bacteria and shed skin cells spill in to the skin causing redness, swelling and pus – a pimple.

Does diet make a difference?

Acne is not caused by the foods you eat. Some people find that certain foods seem to make their acne worse. If that's the case, foods that clearly worsen your acne should be avoided. It is always important to eat a well-balanced diet.

Will sunlight improve acne?

A tan can mask your acne, but the benefits are temporary. Since sunlight ages the skin and can cause skin cancer, you should avoid sunburns and the use of sunlamps. Choose a sunscreen that is oil-free, such as a gel sunscreen.

Do cosmetics increase the severity of acne?

If you wear a liquid foundation or use a moisturizer, look for ones that are oil-free and not just water-based. Remove your cosmetics every night with soap and water. Shield your face when applying hairsprays and gels. If the spray comes in contact with your facial skin, it can cause whiteheads and blackheads. Mineral-based cosmetics work well for acne prone skin.

How is acne treated?

There are several effective treatments for acne. Your dermatologist may prescribe topical creams or lotions such as vitamin A acid or benzoyl peroxide to help unblock the pores and reduce the bacteria. There are also antibiotics that are applied to the skin. These are used in less severe cases of acne. Antibiotics taken by mouth such as tetracycline, erythromycin or minocycline are often prescribed for moderate or severe cases. The antibiotics reduce the bacteria in the follicle and may also decrease the redness directly. When taking oral antibiotics some women develop a yeast infection. Women who are taking birth control pills may notice a significant improvement in their acne, and occasionally birth control pills are used specifically for the treatment of acne. It is also important to know that oral antibiotics may decrease the effectiveness of birth control pills. Another oral medication, isotretinoin is sometimes used for severe acne that has not responded to other treatments. Patients using isotretinoin must thoroughly understand the side effects of this drug. Frequent follow-up visits are necessary to monitor side effects. Prevention of pregnancy is a must, since the drug causes severe birth defects if taken during pregnancy. Don't pick, scratch, pop or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation and scarring may result. Control of acne is an ongoing process. All acne treatments work by preventing new acne. Existing blemishes must heal on their own. Improvement takes time. If your acne has not improved after 6 to 8 weeks, your dermatologist may need to change your treatment.

Eczema/Atopic Dermatitis

What is Eczema/Atopic Dermatitis?

A common skin condition, atopic dermatitis is frequently described as “the itch that rashes”. Scratching often leads to redness, swelling, cracking, “weeping” of clear fluid, crusting, and scaling of the skin. Intensely itchy patches form, which can be widespread or limited to a few areas. Atopic dermatitis can be a lifelong condition. Fortunately, it tends to become less severe with age.

Hair & Nail Disorders

Hair Loss - Seborrheic Dermatitis

This section is for adding content describing each Hair & Nail disorder.

Moles

What do moles look like?

Moles can appear anywhere on the skin, alone or in groups. They are usually brown in color and can be various sizes and shapes.

When do moles first appear?

Moles probably are determined before a person is born. Most appear during the first 20 years of a person's life, although some may not appear until later in life. Each mole has its own growth pattern. At first, moles are flat and brown or black in color, like a freckle. Over time, they usually enlarge, and some may develop hairs. As the years pass, moles usually change slowly, becoming raised and lighter in color. Most moles will slowly disappear, seeming to fade away. Moles may darken, which can happen after exposure to the sun. During the teen years and pregnancy, moles tend to become darker and larger and new ones may appear.

Can moles become cancerous?

Yes. Moles that appear at birth occur in about 1 in 100 people. They are called congenital nevi. These moles may be more likely to develop into melanoma than moles which appear after birth. Moles known as dysplastic nevi or atypical moles are larger than average and irregular in shape. They tend to have uneven color with dark brown centers and lighter, uneven edges. These moles tend to be hereditary. Persons with dysplastic nevi may have a greater-than-average chance of developing malignant melanoma.

How do I recognize abnormalities in a mole?

Recognizing the early warning signs of malignant melanoma is important. Remember the ABCD's of melanoma when examining your moles.
  • A: stands for ASYMMETRY, when one half of the mole doesn't match the other half.
  • B: stands for BORDER, when the border or edges of the mole are ragged, blurred or irregular.
  • C: stands for COLOR, when the color of the mole is not the same throughout or if it has shades of tan, brown, black, red, white or blue.
  • D: stands for DIAMETER, if the diameter of a mole is larger than the eraser of a pencil.
    • If a mole displays any of these signs, it should be checked immediately by a dermatologist. The majority of moles and other blemishes are benign (non-cancerous). They will never be a threat to the health of the person who has them. The only spots or blemishes that warrant medical concern are those that do something out of the ordinary – those that act differently from other existing moles. This includes any spot that suddenly changes in size, shape or color or one that bleeds, itches, becomes painful, or first appears when a person is past his/her twenties.

How are abnormal looking moles treated?

The dermatologist will remove the mole, or part of it, so that thin sections from the tissue can be examined under a microscope. This is a simple and harmless procedure. Even if the lesion in question is cancer, cutting through it will not cause the cancer to spread. If the growth was only partially removed and it is found to be cancerous, the entire lesion and a margin of safety will need to be removed.

Psoriasis

What is Psoriasis?

Psoriasis is a persistent, inflammatory skin condition. Some cases of psoriasis are so mild that people don’t know they have it. Alternatively, severe psoriasis may cover large areas of the body. Dermatologists can help even the most severe cases.

Rosacea

What is acne rosacea?

Acne rosacea or rosacea is a skin disease that causes redness and swelling on the face. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area. When it first develops, rosacea may appear, disappear, and then reappear a short time later. The condition rarely reverses itself and may last for years. It will become worse without treatment.

What does rosacea look like?

As rosacea progresses, pimples appear on the face in the form of small, solid red bumps and pus-filled bumps. These are usually accompanied by telangiectasia which are enlarged blood vessels on the surface of the skin. This condition affects mainly the forehead, the chin and the nose. Rosacea may also be accompanied by oily skin, and possibly dandruff. Approximately half of all rosacea patients experience burning and grittiness of the eyes. If this condition is not treated, it can lead to even more serious complications that may threaten vision.

Who develops rosacea?

Those most likely to develop rosacea are fair-skinned adults, especially women, between the ages of 30 and 50. For some unknown reason, women get rosacea more often than men. Rosacea develops over a long period of time. It may first seem like a tendency to blush easily, a ruddy complexion, or an extreme sensitivity to cosmetics. Certain drugs may dilate the blood vessels in the skin and make rosacea worse. The exact cause of rosacea is still unknown, although studies have shown that many factors can irritate the condition.

What should patients with rosacea avoid?

  • Drinking too much alcohol of any type, spicy foods, hot drinks, caffeine, and smoking will dilate blood vessels and cause blood to rush to the affected areas.
  • Limiting exposure to sunlight, or extreme hot and cold temperatures will help relieve the symptoms of rosacea. Use a nonalcohol based sunscreen with an SPF of 15 or higher.
  • Rubbing or massaging the face should also be avoided because it will tend to irritate the reddened skin.
  • Avoiding irritating cosmetics and using hair sprays properly will help prevent redness and swelling.

What treatments are available for rosacea?

Topical antibiotic gels or creams such as metronitrozole will probably provide a slight improvement in the first three to four weeks of use. When applying these creams, the chances of irritation will be reduced if the face is freshly washed and dried. A great deal of improvement will be noticeable in two months. Oral antibacterial capsules or tablets tend to produce faster results than topical medications and are used in more severe cases. Steroid (cortisone) creams will often reduce the redness and help heal the bumps. Strong steroid creams used over a long period of time may aggravate or cause rosacea. Telangiectasias may be treated with a small electric needle or laser surgery to close off the dilated blood vessels. Content courtesy of the American Academy of Dermatology

Skin Cancer

What is skin cancer?

Skin cancer is a malignant condition caused by uncontrolled growth of cells in one of the layers of the skin.

What causes skin cancer?

Prolonged and/or intermittent overexposure to ultraviolet radiation from the sun is the primary cause of skin cancer. Ninety percent of all skin cancers occur on parts of the body that are unprotected by clothing, and in individuals who spend long hours in the sun. Less common causes include overexposure to x-rays or certain chemical carcinogens such as arsenic. Genetics or familial tendency can also contribute to the development of skin cancers.

Are all skin cancers alike?

No, there are several different kinds of skin cancer. The three most common types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and the most serious, malignant melanoma.

What is the most common form of skin cancer?

Basal cell carcinoma is the most common form. Basal cell and squamous cell carcinomas are frequently referred to as non-melanoma skin cancers. According to American Cancer Society statistics, about one million Americans develop non-melanoma skin cancers each year. Around 800,000 of these skin cancers are basal cell carcinomas while about 200,000 are squamous cell carcinomas.

What is the most serious form of skin cancer?

Malignant melanoma can be fatal. If untreated, it can spread throughout the entire body. 2009 annual estimates by the American Cancer Society suggested that just under 69,000 new cases of melanoma would be diagnosed and nearly 8700 people would die due to melanoma. Malignant melanoma is responsible for over 80 percent of all skin cancer deaths. Another 2,000 deaths will be caused annually by non-melanoma skin cancers.

How many people get skin cancer?

Over 1 million Americans get skin cancer each year, making it the most common form of cancer in the United States. More than one in six Americans will develop some form of skin cancer in his/her lifetime.

Who gets skin cancer?

Skin cancer can affect anyone, but some people are at greater risk than others. Individuals who:
  • have fair skin and sunburn easily;
  • work outdoors and are exposed to considerable sunlight;
  • have had severe childhood or adolescent sunburns;
  • have a higher-than-average number of moles;
  • have many atypical moles or dysplastic nevi (unusual moles);
  • have genetic diseases characterized by sunlight intolerance (such as albinism);
  • live in the South and Southwest where the sun's rays are most intense;
  • have a family history of skin cancer;
  • are at increased risk of skin cancers.

Can skin cancer be prevented?

Yes. Experts believe that approximately eighty percent of all skin cancers can be prevented if simple precautions against the sun's ultraviolet radiation are taken.

Can skin cancer be cured?

Yes, when detected and treated early, most skin cancers can be successfully treated and often cured. Dermatologists recommend regular skin self-examinations and physical examinations, especially for persons in high-risk groups, to detect changes to existing moles and blemishes.

How are skin cancers treated?

A variety of effective treatment options are available including:
  • Excisional surgery: A physician removes the entire growth and a small border of normal skin.
  • Curettage: Cancerous tissue is scraped away with a sharp surgical instrument. This treatment is sometimes followed by electrodessication which is the application of a high frequency current applied through a needle electrode.
  • Laser Surgery: The cancerous tissue is vaporized by a laser beam.
  • Mohs surgery: Thin layers of cancerous tissue are removed and examined under a microscope to make sure that all malignant cells are removed.
  • Cryosurgery: Cancerous tissue is destroyed by the applications of intensely cold liquid nitrogen.
  • Radiation therapy: High energy x-rays or another source of ionizing radiation are directed at the cancer site to destroy the malignant tissue.
  • Topical chemotherapy: Creams, ointments, or lotions containing the anti-cancer agent 5-fluorouracil or imiquimod are applied directly to the skin. This therapy is useful in treating pre-cancerous lesions.

How do I recognize the signs of skin cancer?

Skin cancer, especially in the early stages, may not look like a growth; it can appear as a discoloration of the skin. For this reason, you should not ignore any unusual or persistent skin condition. Pay particular attention to any changes in the size, color, shape or thickness of pre-existing moles, new moles or growths. Learn the signs of skin cancer, and make it a habit to inspect your skin periodically for any new growths or changes and for any alterations in old growths. The best protection is to take nothing for granted. If you have the slightest doubt, see your doctor or dermatologist.

How are sun exposure and Vitamin D related?

Vitamin D is an important vitamin that is obtained from food and made by the body as a result of skin exposure to UV light. Vitamin D is important to bone health and levels of this vitamin are linked to numerous other aspects of our health. The scientific community has found that many Americans have low levels of vitamin D. Because sunlight can damage DNA and lead to skin cancer, sun protection is still very important. The Skin Cancer Foundation recommends that people who practice sun protection or avoidance should increase their vitamin D intake with supplements and Vitamin D rich food. Consult your dermatologist or your primary care physician if you are concerned that you may have low vitamin D levels based on your sun protection practices.

How do I prevent skin cancer?

If you are fair-skinned, or if you have relatives who have had skin cancer, avoid unnecessary sun exposure. If you spend time in the sun, be especially careful to cover up whenever possible. Wear protective clothing with a tight weave, long-sleeved shirts, and wide brimmed hats to help reduce the penetration of ultraviolet rays. Avoid direct exposure between 10AM and 4PM when the sun's rays are strongest. Infants should always be kept out of the sun, and young children should be taught sun protection at the earliest possible age. Use a sunscreen with a sun protection factor (SPF) of at least 35.

Vitiligo

What is Vitiligo?

Vitiligo (vit-uh-lie-go) causes the skin to lose color. Patches of lighter skin appear. Some people develop a few patches. Others lose much more skin color.

What does Vitiligo look like?

Vitiligo usually affects the skin, but it can develop anywhere we have pigment. Patches of hair can turn white. Some people lose color inside their mouths. Even an eye can lose some of its color.

Who gets Vitiligo?

People of all races and ethnicities get vitiligo.

Is Vitiligo contagious?

Vitiligo is not contagious. It is not life-threatening. But, vitiligo can be life-altering. Some people develop low self-esteem, no longer want to hang out with friends or develop serious depression. Most people have vitiligo for life, so it’s important to develop coping strategies. A coping strategy that helps many people is to learn about vitiligo. Another helpful strategy is to connect with others who have vitiligo.

Warts

What are warts?

Warts are skin growths caused by a viral infection in the top layer of the skin or mucous membranes. The appearance of a wart depends on where it is growing.

How many kinds of warts are there?

There are several different kinds of warts including:
  • Common warts
  • Plantar warts
  • Flat warts
  • Genital warts
Common warts usually grow around the nails, on the fingers and on the backs of the hands. Plantar warts grow on the bottom (plantar surface) of the feet. Most plantar warts do not stick up above the surface like common warts because the pressure of walking flattens them and pushes them back into the skin. Plantar warts have a bad reputation because they can be deep and painful, feeling like a stone in the shoe. Flat warts are smaller and smoother than other warts. They tend to grow in great numbers, 20 to 100 at any one time. In adults they are often found in the beard area in men and on the legs in women. Genital warts look different than other warts because of their location. These warts tend to be small and flat but can be thin and tall. These are soft and are not rough or scaly like other warts. Certain genital warts have been linked to cancer of the genital area.

How do you get warts?

Warts probably are passed from person to person. The risk of catching hand, foot and flat warts is small. Genital warts seem to be more contagious. It is important to use precautions to limit the spread of genital warts to one’s sexual partner.

Why do some people get warts and others don’t?

Some people are just more likely to catch the wart virus than are others, just as some people catch colds very easily. Wart viruses enter the skin more easily if cuts, cracks or hangnails have damaged the skin.

Do warts need to be treated?

In children, warts often disappear without treatment after several months to years. However, since warts can be spread to others and can be spread to new areas, it is reasonable to treat most children, especially if the warts are painful. Warts in adults often do not disappear as easily or as quickly as they do in children. There is increased possibility of skin cancer at the site of long-standing genital warts. Women with genital warts also have an increased risk of cervical cancer. Women should have regular PAP tests, even after treatment. All adults with genital warts should be treated.

How do dermatologists treat warts?

Common warts in young children can be treated at home by their parents on a daily basis by painting on a low strength salicylic acid. There is usually little discomfort but it can take many weeks of treatment. Frequent "painting" with cantharidin in the dermatologist’s office causes a blister to form under the wart. For adults and older children cryotherapy (freezing) is generally preferred. This treatment is not too painful and rarely results in scarring. However, repeat treatments at one to three-week intervals are often necessary. Another option for the treatment of stubborn warts is injection with Candida antigen. This is a yeast protein that stimulates the immune system to fight the warts. Plantar warts are difficult to treat because the bulk of the wart lies below the skin surface. Treatments include the use of salicylic acid plasters, applying other chemicals to the wart, or one of the surgical treatments including cryotherapy or laser surgery. Flat warts are often too numerous to treat with methods mentioned above. As a result, "peeling" methods using daily applications of salicylic acid, tretinoin or other surface peeling preparations are often recommended. Genital warts are perhaps the most difficult to treat. First, all warts must be located. This may require an examination of the vagina and cervix in women and the rectum in both sexes. Periodic office treatments with acids and freezing may be needed to get rid of the visible warts. Genital warts can be very difficult to cure. The dermatologist may prescribe a form of podophyllin that can be used at home. Recently topical immunotherapy has become available. With very stubborn or very large genital warts, surgical removal may be needed. The patient’s sexual partner should also be examined for warts by a dermatologist.

Content courtesy of the American Academy of Dermatology.