Acne consists of comedones (whiteheads and blackheads), papules (“pimples”), nodules (large papules), and cysts. Teenagers and many adults have persistent acne.
Mild to moderate acne can be treated with topical creams and lotions that kill bacteria, open pores, and decrease inflammation. Severe or resistant acne can be treated with oral antibiotics, in addition to topicals. Women, including those whose acne persists beyond adolescence, can also be treated with hormones and medications to suppress the effects of hormones on the skin. Sometimes, extraction of comedones (acne surgery) and chemical peels can augment the medical treatment. For the most resistant acne in teenagers and adults, the oral vitamin A derivative isotretinoin (brand name Accutane) will give long-term remissions to the majority of people who use it. However, isotretinoin can cause birth defects in children born to women who are, or become, pregnant while taking this powerful medication. Isotretinoin can also cause reversible irritation of the liver, elevation of cholesterol and triglycerides, stomach upset and dryness of the skin and lips. Therefore, close monitoring, including frequent blood tests, is essential for all patients prescribed isotretinoin. Appropriate precautions to avoid pregnancy are essential for women taking this medication. Registration with the FDA is required if you take this medication.
Rosacea is a condition of redness, flushing, and inflammation affecting the face. Patients can also have inflammatory papules (which look like pimples) and dilated blood vessels. In more advanced cases, the skin of the nose can become swollen and overgrown (rhinophyma). Flushing is often set off by heat, spicy foods, and alcohol.
Mild Rosacea can be treated with topical prescription antibiotics, sulfur compounds, azeleic acid, and other anti-inflammatory compounds. Oral antibiotics may be used in more severe cases. Dilated blood vessels can be removed with laser or electric needle.
Almost all teenagers and adults have moles. They generally develop during childhood through young adulthood. They are made up of nevus (mole) cells growing in the skin. Normal moles are uniform in color and can be flat or symmetrically dome-shaped and raised.
Atypical Moles (also called Dysplastic or Clark’s Nevi)
Some people have atypical nevi. The cells in this type of mole are disorderly in growth, and can have some unusual features. These moles look atypical when examined pathologically (after a biopsy), and can look atypical to the eye. They may appear on parts of the body not exposed to the sun. Although atypical moles are not themselves cancerous, they are a marker of patients who tend to have other similar moles and are at higher risks for melanoma than patients with no atypical moles. Although melanoma can develop from an atypical mole, most atypical moles do not turn into melanoma. In general, if a clinically atypical mole is not changing and the patient and the practitioner do not suspect melanoma, it does not have to be removed (but easily can be removed if the patient is worried). If a biopsy is performed and the pathology report demonstrates an atypical mole, the majority of dermatologists would recommend that moles with moderate or severe atypia should be completely removed.
Seborrheic dermatitis is a common and often recurrent condition. It is a type of eczema, a general name for several skin conditions associated with inflammation--- in other words, redness and itching of the skin.
What are the symptoms, and where do they appear?
Depending on the severity of the condition, the symptoms of seborrheic dermatitis can vary. Usually, the affected skin itches and looks pink or red; it is often covered by scale. Mild cases may cause only flaking, but advanced cases may be accompanied by severe itching and even cracking of the skin.
Seborrheic dermatitis usually appears on the face, but may show up on the chest, back, in the skin folds, and even in the belly button and genital areas. It presents on the scalp as dandruff. It most often appears in skin areas that have many sebaceous (oil) glands. This is why it is common to see seborrheic dermatitis around the hairline, in the eyebrows, behind the ears, and around the nose.
What causes Seborrheic Dermatitis?
The exact cause is not known, but some researchers believe a common organism known as Pityrosporum ovale may play a role. Physical or emotional stress and climate may be factors as well; the condition tends to be worse in winter for many people. Seborrheic dermatitis is not contagious.
What is the treatment?
Daily shampooing with even a mild shampoo can be effective in controlling dandruff, although severe scaling often requires a medicated shampoo containing zinc, selenium sulfide, salicylic acid, sulfur, or coal tar. Prescription shampoos are also available. Your doctor may prescribe a topical steroid, a sulfur-based lotion, or antifungal creams to help control the condition. Many find it frustrating to live with a chronic condition that seems to flare-up again just when they thought it was gone for good. But remember to start treatment again as soon as redness or scale appears, and you usually can keep seborrheic dermatitis under control.
Psoriasis is a skin condition consisting of scaly, inflamed patches of skin often on the elbows, knees, and scalp. It may also be on other areas and may be associated with arthritis. Although the exact cause of psoriasis is unclear, imbalance of the immune system appears to play a role. There can be a genetic component in psoriasis. It is not infectious. Stress may aggravate psoriasis.
Topical treatments include prescription cortisone creams, tar creams, and topical medications derived from vitamins D and A. Patients can come for light therapy in Montgomery. Internal medications include immunosuppressive agents, vitamin A related medication, and immuno-biologic agents.
Dermatitis refers to inflammation of the skin. Eczema is a condition in which patients develop inflamed, itchy patches on the skin, most often the extremities, trunk, and face. Atopic eczema can be associated with asthma, hay fever, and allergies in the patient or family members. The cause of eczema is not known. Eczema can affect all ages, including babies.
Treatment includes avoiding triggering factors, such as dry skin, irritating substances and infection. Additionally, cortisone creams, emollients and the newest topical immunomodulating medications (such as Elidel and Protopic) can be used. Ultraviolet light and systemic medications, such as oral cortisone and immunosuppressives, are used for the most resistant cases.
Contact dermatitis is an allergic or irritant reaction to a substance that has touched the skin. This can be a cream, lotion, cosmetic, plant, metal, dye, shoe or clothing component, soap or detergent, etc. The classic example of contact dermatitis is poison ivy.
Identifying the cause of the contact dermatitis can be straightforward, or may require extensive detective work or patch testing. Until the source of dermatitis is found and avoided, treatment can be with cool compresses, cortisone creams or pills, protective clothing, and moisturizing creams and lotions.
Fungus and yeast can infect the skin, nails, and hair. Fungal infections may be circular patches or scaling areas between the toes or in the groin. Infected nails are usually yellow or white and thickened or crumbly. Sometimes it is called “ringworm.”
Topical antifungal creams and lotions are usually the first line of treatment. If these are ineffective, oral medications such as Lamisil, Sporanox or griseofulvin can be prescribed.
Easy bruising and bleeding into the skin of the hands and forearms occurs in many middle-aged and older people, especially if their skin is fair.This easy bleeding, which can occur without any apparent injury, is a result of the skin being made thin and fragile by years of sunlight exposure. It is not the result of a blood disorder or internal disease. The fact that bleeding occurs only on the sun-damaged areas of the hands and forearms, and never on the covered parts of the body, clearly, shows that it results from local skin damage. Sun exposure over the years, even without sunburning, thins the skin and damages its supporting fibers. These sun-damaged fibers can no longer adequately support the skin and its blood vessels. This releases blood into the skin and leaves purplish marks. Sometimes medicines, such as aspirin, cortisones, and blood thinners, may make this worse
Fragile skin bleeding is a harmless nuisance. The skin damage produced by sunlight is permanent and, for that reason, there is no treatment for this condition. You can prevent further sun damage by using sun-protective measures, such as sunscreen, hat, and protective clothing.
Warts (also called verrucae) are caused by human papilloma virus infection of the skin. Warts can affect any part of the skin and mucous membranes. They are not malignant, but can be very annoying and persistent. Some strains of the papilloma virus can cause pre-cancerous wart growths, in particular in the groin mucosa and cervix.
Many treatments are available for warts, the simplest being the over-the-counter patches and solutions. In-office treatment can include freezing or applying different destructive solutions. Prescriptions for home treatment include creams to boost the local immune system to fight off the wart virus. Warts usually need multiple treatment visits for total resolution.
Unusual rashes can be bumps looking like tumors, areas that look like burns, blistering conditions, conditions over joints or around the eyes associated with internal problems, such as fever, joint pains, headaches, muscle aches and pneumonia. The actual diagnosis for patients may turn out to be lupus, pemphigoid, pemphigus, granuloma annulare, erythema nodosum, to name a few. If you end up having these types of conditions, your practitioner will discuss the diagnosis with you. Workups, usually including blood tests and skin biopsies, are usually necessary to find the cause of these unusual rashes. We are often asked by other physicians to consult and evaluate these very interesting patients.
Bacterial infections of the skin may result in pustules, boils, crusted areas, painful red patches, or sometimes cysts.
Identifying an infection and determining the appropriate antibiotic is usually done at the initial visit. Bacterial cultures are performed if the type of organism or its sensitivity to antibiotics is in question.
Copyright 2008 by Dermatology Associatesof Montgomery, LLC