Acne is the most frequent skin condition in the United States. It is characterized by pimples that appear on the face, back and chest. Every year, about 80% of adolescents have some form of acne and about 5% of adults experience acne.

Acne is made up of two types of blemishes:

  • Whiteheads/Blackheads, also known as comedones, are non-inflammatory and appear more on the face and shoulders. As long as they remain uninfected, they are unlikely to lead to scarring.
  • Red Pustules or Papules are inflamed pores that fill with pus. These can lead to scarring.

Causes

In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance calledsebum. The sebum moves from the bottom to the top of each hair follicle and then spills out onto the surface of the skin, taking with it sloughed-off skin cells. With acne, the structure through which the sebum flows gets plugged up. This blockage traps sebum and sloughed-off cells below the skin, preventing them from being released onto the skin’s surface. If the pore’s opening is fully blocked, this produces a whitehead. If the pore’s opening is open, this produces blackheads. When either a whitehead or blackhead becomes inflammed, they can become red pustules or papules.

It is important for patients not to pick or scratch at individual lesions because it can make them inflamed and can lead to long-term scarring.

Treatment

Treating acne is a relatively slow process; there is no overnight remedy. Some treatments include:

  • Benzoyl Peroxide — Used in mild cases of acne, benzoyl peroxide reduces the blockages in the hair follicles.
  • Oral and Topical Antibiotics — Used to treat any infection in the pores.
  • Hormonal Treatments — Can be used for adult women with hormonally induced acne.
  • Tretinoin — A derivative of Vitamin A, tretinoin helps unplug the blocked-up material in whiteheads/blackheads. It has become a mainstay in the treatment of acne.
  • Extraction — Removal of whiteheads and blackheads using a small metal instrument that is centered on the comedone and pushed down, extruding the blocked pore.

Rosacea is a chronic skin condition that causes facial redness, acne-like pimples, visible small blood vessels on the face, swelling and/or watery, irritated eyes. This inflammation of the face can affect the cheeks, nose, chin, forehead or eyelids. More than 14 million Americans suffer from rosacea. It is not contagious, but there is some evidence to suggest that it is inherited. There is no known cause or cure for rosacea. There is also no link between rosacea and cancer.

Rosacea generally begins after age 30 and goes through cycles of flare-ups and remissions. Over time, it gets ruddier in color and small blood vessels (like spider veins) may appear on the face. If left untreated, bumps and pimples may form, the end of the nose may become swollen, red and bulbous and eyes may water or become irritated.

Rosacea occurs most often among people with fair skin who tend to blush or flush easily. It occurs more often among women than men, but men tend to suffer from more severe symptoms. Most patients experience multiple symptoms at varying levels of severity. Common symptoms include:

  • flushing
  • persistently red skin on the face
  • bumps or acne-like pimples
  • visible blood vessels on facial skin
  • watery or irritated eyes
  • burning, itching or stinging of facial skin
  • skin roughness and dryness
  • raised red patches
  • swelling (edema)

These symptoms may also appear on the neck, chest, scalp and ears.

Research conducted by the National Rosacea Foundation found that the leading triggers for rosacea are:

  • sun exposure
  • hot or cold weather
  • emotional stress
  • wind
  • alcohol
  • heavy exercise
  • spicy foods
  • hot baths
  • heated beverages
  • some skin care products
  • humidity
  • indoor heat

While there is no cure for rosacea and each case is unique, your doctor will probably prescribe oral antibiotics and topical medications to reduce the severity of the symptoms. When the condition goes into remission, only topical treatments may be needed. In more severe cases, a vascular laser, intense pulsed light source or other medical device may be used to remove any visible blood vessels and reduce excess redness and bumpiness on the nose.

To help reduce the incidence of flare-ups, a gentle daily skin care routine is recommended that includes the use of mild, non-abrasive cleansers, soft cloths, rinsing in lukewarm water (not hot or cold), and blotting the face dry (not rubbing). Additionally, individuals with rosacea need to protect themselves from sun exposure by using sunscreens with SPF 15 or higher and sunblocks that eliminate UVA and UVB rays. Patients are also encouraged to keep a record of flare-ups to try and determine the lifestyle and environmental triggers that aggravate the condition.

“Rash” is a general term for a wide variety of skin conditions. A rash refers to a change that affects the skin and usually appears as a red patch or small bumps or blisters on the skin. The majority of rashes are harmless and can be treated effectively with over-the-counter anti-itch creams, antihistamines and moisturizing lotions.

Rashes can be a symptom for other skin problems. The most prevalent of these are:

  • Atopic Dermatitis, the most common form of eczema.
  • Bacterial Infections, such as impetigo.
  • Contact Dermatitis, a type of eczema caused by coming into contact with an allergen.
  • Chronic skin problems, such as acne, psoriasis or seborrheic dermatitis.
  • Fungal Infections, such as ringworm and yeast infection.
  • Viral Infections, such as shingles.

A rash may be a sign of a more serious illness, such as Lyme Disease, Rocky Mountain Spotted Fever, liver disease, kidney disease or some types of cancers. If you experience a rash that does not go away on its own after a few weeks, make an appointment to see one of our dermatologists to have it properly diagnosed and treated.

Psoriasis is a skin condition that creates red patches of skin with white, flaky scales. It most commonly occurs on the elbows, knees and trunk, but can appear anywhere on the body. The first episode usually strikes between the ages of 15 and 35. It is a chronic condition that will then cycle through flare-ups and remissions throughout the rest of the patient’s life. Psoriasis affects as many as 7.5 million people in the United States. About 20,000 children under age 10 have been diagnosed with psoriasis.

In normal skin, skin cells live for about 28 days and then are shed from the outermost layer of the skin. With psoriasis, the immune system sends a faulty signal which speeds up the growth cycle of skin cells. Skin cells mature in a matter of 3 to 6 days. The pace is so rapid that the body is unable to shed the dead cells, and patches of raised red skin covered by scaly, white flakes form on the skin.

Psoriasis is a genetic disease (it runs in families), but is not contagious. There is no known cure or method of prevention. Treatment aims to minimize the symptoms and speed healing.

Types of Psoriasis

There are five distinct types of psoriasis:

  • Plaque Psoriasis (Psoriasis Vulgaris) — About 80% of all psoriasis sufferers get this form of the disease. It is typically found on the elbows, knees, scalp and lower back. It classically appears as inflamed, red lesions covered by silvery-white scales.
  • Guttate Psoriasis This form of psoriasis appears as small red dot-like spots, usually on the trunk or limbs. It occurs most frequently among children and young adults. Guttate psoriasis comes on suddenly, often in response to some other health problem or environmental trigger, such as strep throat, tonsillitis, stress or injury to the skin.
  • Inverse Psoriasis — This type of psoriasis appears as bright red lesions that are smooth and shiny. It is usually found in the armpits, groin, under the breasts and in skin folds around the genitals and buttocks.
  • Pustular Psoriasis — Pustular psoriasis looks like white blisters filled with pus surrounded by red skin. It can appear in a limited area of the skin or all over the body. The pus is made up of white blood cells and is not infectious. Triggers for pustular psoriasis include overexposure to ultraviolet radiation, irritating topical treatments, stress, infections and sudden withdrawal from systemic (treating the whole body) medications.
  • Erythrodermic Psoriasis — One of the most inflamed forms of psoriasis, erythrodermic psoriasis looks like fiery, red skin covering large areas of the body that shed in white sheets instead of flakes. This form of psoriasis is usually very itchy and may cause some pain. Triggers for erythrodermic psoriasis include severe sunburn, infection, pneumonia, medications or abrupt withdrawal of systemic psoriasis treatment.

People who have psoriasis are at greater risk for contracting other health problems, such as heart disease, inflammatory bowel disease and diabetes. It has also been linked to a higher incidence of cardiovascular disease, hypertension, cancer, depression, obesity and other immune-related conditions.

Psoriasis triggers are specific to each person. Some common triggers include stress, injury to the skin, medication allergies, diet and weather.

Treatment

Psoriasis is classified as Mild to Moderate when it covers 3% to 10% of the body and Moderate to Severe when it covers more than 10% of the body. The severity of the disease impacts the choice of treatments.

Mild to Moderate Psoriasis

Mild to moderate psoriasis can generally be treated at home using a combination of three key strategies: over-the-counter medications, prescription topical treatments and light therapy/phototherapy.

Over-the-Counter Medications

The U.S. Food and Drug Administration has approved of two active ingredients for the treatment of psoriasis: salicylic acid, which works by causing the outer layer to shed, and coal tar, which slows the rapid growth of cells. Other over-the-counter treatments include:

  • Scale lifters that help loosen and remove scales so that medicine can reach the lesions.
  • Bath solutions, like oilated oatmeal, Epsom salts or Dead Sea salts that remove scaling and relieve itching.
  • Occlusion, in which areas where topical treatments have been applied are covered to improve absorption and effectiveness.
  • Anti-itch preparations, such as calamine lotion or hydrocortisone creams.
  • Moisturizers designed to keep the skin lubricated, reduce redness and itchiness and promote healing.

Prescription Topical Treatments

Prescription topicals focus on slowing down the growth of skin cells and reducing any inflammation. They include:

  • Anthralin, used to reduce the growth of skin cells associated with plaque.
  • Calcipotriene, that slows cell growth, flattens lesions and removes scales. It is also used to treat psoriasis of the scalp and nails.
  • Calcipotriene and Betamethasone Dipropionate. In addition to slowing down cell growth, flattening lesions and removing scales, this treatment helps reduce the itch and inflammation associated with psoriasis.
  • Calcitriol, an active form of vitamin D3 that helps control excessive skin cell production.
  • Tazarotene, a topical retinoid used to slow cell growth.
  • Topical steroids, the most commonly prescribed medication for treating psoriasis. Topical steroids fight inflammation and reduce the swelling and redness of lesions.

Light Therapy/Phototherapy

Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Three primary light sources are used:

  • Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be in controlled, short bursts.
  • Excimer lasers. These devices are used to target specific areas of psoriasis. The laser emits a high-intensity beam of UVB directly onto the psoriasis plaque. It generally takes between 4 and 10 treatments to see a tangible improvement.
  • Pulse dye lasers. Similar to the excimer laser, a pulse dye laser uses a different wavelength of UVB light. In addition to treating smaller areas of psoriasis, it destroys the blood vessels that contribute to the formation of lesions. It generally takes about 4 to 6 sessions to clear up a small area with a lesion.

Moderate to Severe Psoriasis

Treatments for moderate to severe psoriasis include prescription medications, biologics and light therapy/phototherapy.

Oral medications. This includes acitretin, cyclosporine and methotrexate. Your doctor will recommend the best oral medication based on the location, type and severity of your condition.

Biologics. A new classification of injectable drugs, biologics are designed to suppress the immune system. These tend to be very expensive and have many side effects, so they are generally reserved for the most severe cases.

Light Therapy/Phototherapy. Controlled exposure of skin to ultraviolet light has been a successful treatment for some forms of psoriasis. Two primary light sources are used:

  • Sunshine (both UVA and UVB rays). Sunshine can help alleviate the symptoms of psoriasis, but must be used with careful monitoring to ensure that no other skin damage takes place. It is advised that exposure to sunshine be limited to controlled, short bursts.
  • PUVA. This treatment combines a photosensitizing drug (psoralens) with UVA light exposure. This treatment takes several weeks to produce the desired result. In some severe cases, phototherapy using UVB light may lead to better results.

Skin cancer is the most common form of human cancers, affecting more than one million Americans every year. One in five Americans will develop skin cancer at some point in their lives. Skin cancers are generally curable if caught early. However, people who have had skin cancer are at a higher risk of developing a new skin cancer, which is why regular self-examination and doctor visits are imperative.

The vast majority of skin cancers are composed of three different types: basal cell carcinoma, squamous cell carcinoma and melanoma.

Basal Cell Carcinoma

This is the most common form of skin cancer. Basal cells reside in the deepest layer of the epidermis, along with hair follicles and sweat ducts. When a person is overexposed to UVB radiation, it damages the body’s natural repair system, which causes basal cell carcinomas to grow. These tend to be slow-growing tumors and rarely metastasize (spread). Basal cell carcinomas can present in a number of different ways:

  • raised pink or pearly white bump with a pearly edge and small, visible blood vessels
  • pigmented bumps that look like moles with a pearly edge
  • a sore that continuously heals and re-opens
  • flat scaly scar with a waxy appearance and blurred edges

Despite the different appearances of the cancer, they all tend to bleed with little or no cause. Eighty-five percent of basal cell carcinomas occur on the face and neck since these are areas that are most exposed to the sun.

Risk factors for basal cell carcinoma include having fair skin, sun exposure, age (most skin cancers occur after age 50), exposure to ultraviolet radiation (as in tanning beds) and therapeutic radiation given to treat an unrelated health issue.

Diagnosing basal cell carcinoma requires a biopsy — either excisional, where the entire tumor is removed along with some of the surrounding tissue, or incisional, where only a part of the tumor is removed (used primarily for large lesions).

Treatments for basal cell carcinoma include:

  • Cryosurgery — Some basal cell carcinomas respond to cryosurgery, where liquid nitrogen is used to freeze off the tumor.
  • Curettage and Desiccation — The preferred method of dermatologists, this treatment involves using a small metal instrument (called a curette) to scrape out the tumor along with an application of an electric current into the tissue to kill off any remaining cancer cells.
  • Mohs Micrographic Surgery — The preferred method for large tumors, Mohs Micrographic Surgery combines removal of cancerous tissue with microscopic review while the surgery takes place. By mapping the diseased tissue layer by layer, less healthy skin is damaged when removing the tumor.
  • Prescription Medicated Creams — These creams can be applied at home. They stimulate the body’s natural immune system over the course of weeks.
  • Radiation Therapy — Radiation therapy is used for difficult-to-treat tumors, either because of their location, severity or persistence.
  • Surgical Excision — In this treatment the tumor is surgically removed and stitched up.

Squamous Cell Carcinoma

Squamous cells are found in the upper layer (the surface) of the epidermis. They look like fish scales under a microscope and present as a crusted or scaly patch of skin with an inflamed, red base. They are often tender to the touch. It is estimated that 250,000 new cases of squamous cell carcinoma are diagnosed annually, and that 2,500 of them result in death.

Squamous cell carcinoma can develop anywhere, including inside the mouth and on the genitalia. It most frequently appears on the scalp, face, ears and back of hands. Squamous cell carcinoma tends to develop among fair-skinned, middle-aged and elderly people who have a history of sun exposure. In some cases, it evolves from actinic keratoses, dry scaly lesions that can be flesh-colored, reddish-brown or yellow black, and which appear on skin that is rough or leathery. Actinic keratoses spots are considered to be precancerous.

Like basal cell carcinoma, squamous cell carcinoma is diagnosed via a biopsy — either excisional, where the entire tumor is removed along with some of the surrounding tissue, or incisional, where only a part of the tumor is removed (used primarily for large lesions).

Treatments for basal cell carcinoma include:

  • Cryosurgery Some basal cell carcinomas respond to cryosurgery, where liquid nitrogen is used to freeze off the tumor.
  • Curettage and Desiccation — The preferred method of dermatologists, this treatment involves using a small metal instrument (called a curette) to scrape out the tumor along with an application of an electric current into the tissue to kill off any remaining cancer cells.
  • Mohs Micrographic Surgery — The preferred method for large tumors, Mohs Micrographic Surgery combines removal of cancerous tissue with microscopic review while the surgery takes place. By mapping the diseased tissue layer by layer, less healthy skin is damaged when removing the tumor.
  • Prescription Medicated Creams — These creams can be applied at home. They stimulate the body’s natural immune system over the course of weeks.
  • Radiation Therapy — Radiation therapy is used for difficult-to-treat tumors, either because of their location, severity or persistence.
  • Surgical Excision — In this treatment the tumor is surgically removed and stitched up.

Melanoma

While melanoma is the least common type of skin cancer, it is by far the most virulent. It is the most common form of cancer among young adults age 25 to 29. Melanocytes are cells found in the bottom layer of the epidermis. These cells produce melanin, the substance responsible for skin pigmentation. That’s why melanomas often present as dark brown or black spots on the skin. Melanomas spread rapidly to internal organs and the lymph system, making them quite dangerous. Early detection is critical for curing this skin cancer.

Melanomas look like moles and often do grow inside existing moles. That’s why it is important for people to conduct regular self-examinations of their skin in order to detect any potential skin cancer early, when it is treatable. Most melanomas are caused by overexposure to the sun beginning in childhood. This cancer also runs in families.

Melanoma is diagnosed via a biopsy. Treatments include surgical removal, radiation therapy or chemotherapy.

What to Look For

The key to detecting skin cancers is to notice changes in your skin. Look for:

  • Large brown spots with darker speckles located anywhere on the body.
  • Dark lesions on the palms of the hands and soles of the feet, fingertips toes, mouth, nose or genitalia.
  • Translucent pearly and dome-shaped growths.
  • Existing moles that begin to grow, itch or bleed.
  • Brown or black streaks under the nails.
  • A sore that repeatedly heals and re-opens.
  • Clusters of slow-growing scaly lesions that are pink or red.

The American Academy of Dermatology has developed the following ABCDE guide for assessing whether or not a mole or other lesion may be becoming cancerous.

Asymmetry: Half the mole does not match the other half in size, shape or color.

Border: The edges of moles are irregular, scalloped, or poorly defined.

Color: The mole is not the same color throughout.

Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.

Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.

If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine if it is or isn’t cancerous.

Prevention

Roughly 90% of nonmelanoma cancers are attributable to ultraviolet radiation from the sun. That’s why prevention involves:

  • Staying out of the sun during peak hours (between 10 a.m. and 4 p.m.).
  • Covering up the arms and legs with protective clothing.
  • Wearing a wide-brimmed hat and sunglasses.
  • Using sunscreens year round with a SPF of 15 or greater and sunblocks that work on both UVA and UVB rays. Look for products that use the term “broad spectrum.”
  • Checking your skin monthly and contacting your dermatologist if you notice any changes.
  • Getting regular skin examinations. It is advised that adults over 40 get an annual exam with a dermatologist.

Moles are brown or black growths, usually round or oval, that can appear anywhere on the skin. They can be rough or smooth, flat or raised, single or in multiples. They occur when cells that are responsible for skin pigmentation, known as melanocytes, grow in clusters instead of being spread out across the skin. Generally, moles are less than one-quarter inch in size. Most moles appear by the age of 20, although some moles may appear later in life. Most adults have between 10 and 40 moles. Because they last about 50 years, moles may disappear by themselves over time.

Most moles are harmless, but a change in size, shape, color or texture could be indicative of a cancerous growth. Moles that have a higher-than-average chance of becoming cancerous include:

  • Congenital Nevi
    Moles present at birth. The larger their size, the greater the risk for developing into a skin cancer.
  • Atypical Dysplastic Nevi
    Irregularly shaped moles that are larger than average. They often appear to have dark brown centers with light, uneven borders.
  • Higher frequency of moles
    People with 50 or more moles are at a greater risk for developing a skin cancer.

In some cases, abnormal moles may become painful, itchy, scaly or bleed. It’s important to keep an eye on your moles so that you can catch any changes early. We recommend doing a visual check of your body monthly, including all areas that don’t have sun exposure (such as the scalp, armpits or bottoms of feet).

Use the American Academy of Dermatology’s ABCDEs as a guide for assessing whether or not a mole may be becoming cancerous:

  • Asymmetry: Half the mole does not match the other half in size, shape or color.
  • Border: The edges of moles are irregular, scalloped, or poorly defined.
  • Color: The mole is not the same color throughout.
  • Diameter: The mole is usually greater than 6 millimeters when diagnosed, but may also be smaller.
  • Evolving: A mole or skin lesion that is different from the rest, or changes in size, shape, or color.

If any of these conditions occur, please make an appointment to see one of our dermatologists right away. The doctor may do a biopsy of the mole to determine if it is or isn’t cancerous and/or may surgically remove it.

Warts are small, harmless growths that appear most frequently on the hands and feet. Sometimes they look flat and smooth, other times they have a dome-shaped or cauliflower-like appearance. Warts can be surrounded by skin that is either lighter or darker. Warts are caused by different forms of Human Papilloma Virus (HPV). They occur in people of all ages and can spread from person-to-person and from one part of the body to another. Warts are benign (noncancerous) and generally painless. They may disappear without any treatment. However, in most cases eliminating warts takes time.

The location of a wart often characterizes its type:

  • Common warts can appear anywhere on the body, although they most often appear on the back of fingers, toes and knees. These skin-colored, dome-shaped lesions usually grow where the skin has been broken, such as a scratch or bug bite. They can range in size from a pinhead to 10mm and may appear singly or in multiples.
  • Filiform warts look like a long, narrow, flesh-colored stalk that appears singly or in multiples around the eyelids, face, neck or lips. They are sometimes called facial warts. They may cause itching or bleeding, but are easy to treat with over-the-counter medications.
  • Flat (plane) warts appear on the face and forehead. They are flesh-colored or white, with a slightly raised, flat surface and they usually appear in multiples. Flat warts are more common among children and teens than adults.
  • Genital warts appear around the genital and pubic areas. It is also possible to get genital warts inside the vagina and anal canal or in the mouth (known as oral warts). The lesions start small and soft but can become quite large. They often grow in clusters. They are both sexually transmitted and highly contagious. In fact, it is recommended you generally avoid sex with anyone who has a visible genital wart. Genital warts should always be treated by a physician.
  • Plantar warts appear on the soles of the feet and can be painful since they are on weight-bearing surfaces. They have a rough, cauliflower-like appearance and may have a small black speck in them. They often appear in multiples and may combine into a larger wart called a mosaic wart. Plantar warts can spread rapidly.
  • Subungual and periungual warts appear as rough growths around the fingernails and/or toenails. They start as nearly undetectable, pin-sized lesions and grow to pea-sized with rough, irregular bumps with uneven borders. Subungual and periungual warts can impede healthy nail growth. Because of their location, they are difficult to treat and generally require medical attention.

Most warts respond to over-the-counter treatments, including:

  • Cryotherapy, which freezes off the wart using liquid nitrogen or nitrous oxide.
  • Electrosurgery, which sends an electric current through the wart to kill the tissue.
  • Laser surgery, which essentially heat up the wart until the tissue dies and the wart eventually falls off.
  • Nonprescription freezing products (dimethyl ether), aerosol sprays that freeze the warts and cause them to die off.
  • Salicylic acid preparations, which dissolve the protein (keratin) that makes up the wart and the thick layer of skin that covers it. It comes in gels, pads, drops and plasters and takes 4 to 6 weeks to eradicate the warts.
  • If self-treatments don’t work after a period of about 4 to 12 weeks, contact our dermatologist. We’ll assess your warts and recommend the best option.

Always contact the dermatologist if a wart is causing pain, changes in color or appearance and for all genital warts.

Wrinkles are a natural part of the aging process. They occur most frequently in areas exposed to the sun, such as the face, neck, back of the hands and forearms. Over time, skin gets thinner, drier and less elastic. Ultimately, this causes wrinkles – either fine lines or deep furrows. In addition to sun exposure, premature aging of the skin is associated with smoking, heredity and skin type (higher incidence among people with fair hair, blue-eyes and light skin).

Treatment for wrinkles runs the gamut from topical creams and moisturizers to cosmetic procedures. The most common medical treatments are:

  • Alpha-hydroxy acids, preparations made from “fruit acids” that produce subtle improvements in the appearance of wrinkles.
  • Antioxidants, creams consisting of Vitamins A, C and E and beta-carotene that improves the appearance of wrinkles and provides some additional sun protection.
  • Moisturizers, which temporarily reduce the appearance of wrinkles.
  • Vitamin A Acid, which helps alleviate some of the signs of aging, including mottled pigmentation (e.g., liver spots), roughness and wrinkling.

Cosmetic procedures include:

  • chemical peels
  • dermabrasion
  • fillers
  • laser resurfacing
  • plastic surgery

The best prevention for wrinkles is to keep the skin moisturized and use sunscreen and sunblock to prevent additional damage from the sun.