Medical Care

To help you renew your skin and look and feel your best, we will address any concerns related to your skin, hair and nails. Some of the more common conditions we treat include:

Acne
Acne is a skin condition which has plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers get some form of acne, adults in their 20’s, 30’s, 40’s, or even older, can develop acne. Often, acne clears up after several years, even without treatment. Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent scars; these may be treated by your dermatologist in the future. To avoid acne scarring, treating acne is important.

Types of Acne and How Acne Forms
Acne is not caused by dirt. Testosterone, a hormone which is present in both males and females, increases during adolescence (puberty). It stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug the pores. Whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are present in teenage acne.

Early acne occurs before the first period and is called prepubertal acne. When acne is severe and forms deep “pus-filled” lumps, it is called cystic acne. This may be more common in males.

Adult acne develops later in life and may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle. Adult acne is not rosacea, a disease in which blackheads and whiteheads do not occur.

Cleansing
Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make your acne worse.

Diet
Acne is not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them.

Cosmetics
Wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are “non-comedogenic” (should not cause whiteheads or blackheads) or “non-acnegenic” (should not cause acne). Remove your cosmetics every night with mild soap or gentle cleanser and water. A flesh-tinted acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up.

Treatment
Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment your dermatologist recommends will vary according to the type of acne. Many non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.

Topicals

• Your dermatologist may prescribe topical creams, gels, or lotions with vitamin A acid-like
  drugs to help unblock the pores and reduce bacteria. These products may cause some drying
  and peeling. Your dermatologist will advise you about correct usage and how to handle side
  effects.
• Before starting any medication, even topical medications, inform your doctor if you are
  pregnant or nursing, or if you are trying to get pregnant.

Special Treatments

• Acne surgery may be used by your dermatologist to remove blackheads and whiteheads. Do
  not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more
  redness, swelling, inflammation, and scarring may result.
• Microdermabrasion may be used to remove the upper layers of the skin improving
  irregularities in the surface, contour, and generating new skin.
• Light chemical peels with glycolic acid help to unblock the pores, open the blackheads and
  whiteheads, and stimulate new skin growth.
• Injections of corticosteroids may be used for treating large red bumps (nodules). This may
  help them go away quickly.

Oral

• Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin
  are often prescribed.

Birth Control Pills

• Birth control pills may significantly improve acne, and may be used specifically for the
  treatment of acne. It is also important to know that oral antibiotics may decrease the
  effectiveness of birth control pills. This is uncommon, but possible, especially if you notice
  break-through bleeding. As a precautionary measure use a second form of birth control.

Treatment of Acne Scarring
The dermatologist can treat acne scars by a variety of methods. Skin resurfacing with laser,
dermabrasion, or chemical peels can make noticeable differences in appearance.

Proper Care is Necessary
No matter what special treatments your dermatologist may use, remember that you must
continue proper skin care. Acne is not curable, but is controllable; proper treatment helps
you to feel and look better and may prevent scars.

To learn more about acne and acne treatments see your dermatologist or login onto www.aad.org.

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Actinic Keratoses
Actinic Keratoses (AKs) are also referred to as solar keratoses and are considered the earliest stage in the development of skin cancer. They are common lesions of the epidermis (outermost layer of the skin), and are caused by long-term exposure to sunlight.

Chronic sun exposure damages skin cells in AKs called keratinocytes, the tough-walled cells that make up 90 percent of the epidermis and give the skin its texture. Changes in keratinocytes can be seen when the skin becomes rough, scaly, or mottled, and develops bumps or small horn-like growths. Further changes in cell growth can allow AKs to progress to squamous cell carcinoma, a type of skin cancer.

What Actinic Keratoses Look Like
Actinic Keratoses are found on chronically sun-exposed skin, most commonly on fair-skinned people. They are commonly found on the sides of the forehead, the ears, the scalp of bald men, and the backs of the hands. The typical AK lesion is a dry, scaly, and rough skin-colored to reddish-brown “bump”. AK lesions may range from the size of a pinhead to larger than a quarter. Skin-colored AK lesions may be noticed by touch and feel like sandpaper.

An Actinic Keratosis can also appear as a patch of skin on the lower lip that dries and cracks open. An actinic keratoses at any location may at times seem to disappear for weeks or months and then return at the same place. If they are picked off, they grow back.

Treatment of Actinic Keratoses
The basic types of treatment for Actinic Keratoses are:

• Cryosurgery – Liquid nitrogen “freezes” surface skin, which flakes off and is replaced by new skin.
  Skin redness is the main side effect, and a blister may occur. Cryosurgery is the most commonly used
  treatment.
• Topical Therapy – A topical anti-cancer cream or lotion (e.g., 5-fluoruracil, imiquimod, diclofenac
  sodium) is applied to the skin to remove actinic keratoses lesions. Localized red spots may remain for
  a while at the site of a treated AK. Your physician may recommend treating a larger region of affected
  skin as a preventive measure.
• Photodynamic Therapy – A natural chemical is applied to the skin; after a few hours, the skin is
  exposed to “blue” light that activates the chemical to destroy the Actinic Keratoses. Localized red
  areas develop in treated regions which fade after several days.

Research and development of other treatments for Actinic Keratoses is ongoing. No one therapy works on all Actinic Keratoses in all individuals.

Prevention of Actinic Keratoses
Prevention of AKs should begin early in life. Sun damage to unprotected skin begins in childhood and puts the child at risk for Actinic Keratoses and skin cancer later in life.

However, it is never too late to initiate prevention of new Actinic Keratosis lesions in adulthood. The basics of prevention are:

• Seek shade during peak sunlight hours (10 a.m. to 4 p.m.).
• Wear clothing that covers arms and legs, and wear a wide-brimmed hat.
• Use a sunscreen with a sun protection factor (SPF) of 15 or higher daily, and apply it at least
  20 minutes prior to sun exposure for maximum sun protection.
• Select a broad-spectrum sunscreen that provides both UVA and UVB protection, and reapply
  sunscreen every 2 hours when outdoors, even on cloudy days.

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Eczema / Atopic Dermatitis
A common skin condition, atopic dermatitis is frequently described as “the itch that rashes”. Intensely itchy patches form. These patches can be widespread or limited to a few areas. Scratching often leads to redness, swelling, cracking, “weeping” of clear fluid, crusting, and scaling of the skin. Constant scratching can cause skin damage, infection, and sleep loss.

Ten to 20 percent of children and 1 to 3 percent of adults develop atopic dermatitis, making it the most common type of eczema. For 60 percent or more, atopic dermatitis begins during the first year of life, and at least 80 percent have the condition before age 5. While rare, atopic dermatitis can first appear at puberty or later.

Infantile Eczema
When atopic dermatitis begins during infancy, it often is called infantile eczema. In infants, itchy patches tend to develop on the scalp, forehead, and face, especially on the cheeks. For
some children, the condition completely resolves by age two. If the condition does not resolve,
the childhood phase of atopic dermatitis begins. During the childhood phase, itchy patches
usually form on the back of the knee and the inside of the elbow. When atopic dermatitis
develops in an infant or young child, the child tends to get better with time.

Eczema Later in Life
Atopic dermatitis also can be a lifelong condition. Fortunately, for many it tends to become less severe with age. During the teenage and young-adult years, the itchy patches often develop on the elbows and knees. Other common sites for these patches are the hands, feet, ankles, wrists, face, neck, and upper chest. Patches are not limited to these areas; they can appear anywhere on the body, including around the eyes and on the eyelids.

In teen and adults, patches of atopic dermatitis are typically dry, may look discolored, and also may be scaly or have thickened skin.

Hand Eczema
Atopic dermatitis increases the risk of developing hand eczema. Some people who see their atopic dermatitis clear during adolescence develop hand eczema as adults. More than 50 percent of those who develop atopic dermatitis continue to experience skin rashes as adults, often in the form of hand eczema.

Hand eczema has many causes. Overexposure to irritant chemical trauma, such as soap and water or other solvents, and physical trauma such as digging in the garden with bare hands or handling large quantities of paper, can cause hand eczema or make pre-existing hand eczema worse. Persons with atopic dermatitis have sensitive skin often making them predisposed to other skin problems.

Without proper diagnosis and treatment, hand eczema can become chronic (long lasting), interfering with everyday activities and on-the-job tasks. Hand eczema can be stubborn. It may take months for the patches of red, scaly, and inflamed skin to heal. For hand eczema to resolve, patients must continue using the medication as directed, possibly change their daily hygiene and work habits, keep appointments with their dermatologist, and not get discouraged.

To lessen the risk of developing hand eczema, dermatologists recommend:

• Protect hands against harsh soaps, cleansers, and other chemicals by wearing gloves. If the gloves irritate your skin, see a dermatologist for recommendations.
• Use an automatic dishwasher as much as possible.
• Use lukewarm water and a mild soap when washing the hands and always apply a dermatologist-recommended ointment or cream immediately after washing.
• To keep hands soft and supple, apply the dermatologist-recommended product frequently throughout the day.
• When outdoors in cool weather, wear gloves to prevent dry, chapped skin.
• Protect your skin in the same way you would care for a fine silk scarf.

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Hair Loss
Normal Hair Growth
About 90 percent of the hair on a person’s scalp is growing at any one time. The growth phase lasts between two and six years. Ten percent of the hair is in a resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000) or redheads (90,000 hairs). Most hair shedding is due to the normal hair cycle, and losing 50-100 hairs per day is no cause for alarm. However, if you are concerned about excessive hair loss or dramatic thinning, consult your dermatologist.

Causes of Excessive Hair Loss
Improper Hair Cosmetic Use / Improper Hair Care – Many men and women use chemical treatments on their hair, including dyes, tints, bleaches, straighteners and permanent waves. These treatments rarely damage hair if they are done correctly. However, the hair can become weak and break if any of these chemicals are used too often. Hair can also break if the solution is left on too long, if two procedures are done on the same day, or if bleach is applied to previously bleached hair. If hair becomes brittle from chemical treatments, it’s best to stop until the hair has grown out.

Hairstyles that pull on the hair, like ponytails and braids, should not be pulled tightly and should be alternated with looser hairstyles. The constant pull causes some hair loss, especially along the sides of the scalp.

Shampooing, combing and brushing too often can also damage hair, causing it to break. Using a cream rinse or conditioner after shampooing will make it easier to comb and more manageable. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Don’t follow the old rule of 100 brush strokes a day – that damages hair. Instead, use wide toothed combs and brushes with smooth tips.

Hereditary Thinning or Balding – Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother’s or father’s side of the family. Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenetic alopecia and it can start in the teens, twenties or thirties. There is no cure, although medical treatments have recently become available that my help some people. One treatment involves applying a lotion, minoxidil, to the scalp twice a day. Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of the active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly. Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia Areata – In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age.

The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair grows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.

Childbirth – When a woman is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.

High Fever, Severe Infection, Severe Flu – Illness may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.

Thyroid Disease – Both an over-active thyroid and an under-active thyroid can cause hair loss.
Your physician can diagnosis thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.

Inadequate Protein in Diet – Some people who go on crash diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.

Medications – Some prescription drugs may cause temporary hair shedding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinner. High doses of vitamin A may also cause hair shedding.

Cancer Treatments – Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.

Birth Control Pills – Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding two to three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.

Low Serum Iron – Iron deficiency occasionally produces hair loss. Some people don’t have enough iron in their diets or may not fully absorb iron. Women who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.

Mayor Surgery / Chronic Illness – Anyone who has a major operation may notice increased hair shedding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.

Fungus Infection (Ringworm) of the Scalp – Caused by a fungus infection, ringworm (which has nothing to do with worms) begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medications will cure it.

Hair Pulling (Trichotillomania) – Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

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Hives / Urticaria
Hives are pink swellings called “wheals” that occur in groups on any part of the skin. Each individual wheal lasts a few hours before fading away, leaving no trace. New hives may continue to develop as old areas fade. They can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. When hives are forming they usually are very itchy, but may also burn or sting.

Hives are produced by blood plasma leaking through tiny gaps between the cells lining small blood vessels in the skin. A natural chemical called histamine is released from cells called “mast cells” which lie along the blood vessels in the skin. A number of different things including allergic reactions, chemicals in foods, or medications can cause a histamine release. Sometimes it’s impossible to find out why histamine is being released and hives are forming.

Hives are very common – 10-20 percent of the population will have at least one episode in their lifetime. Hives usually go away within a few days to a few weeks. Occasionally, a person will continue to have hives for many years.

When hives form around the eyes, lips or genitals, the tissue may swell excessively. Although frightening in appearance, the swelling usually goes away in less than 24 hours. Your dermatologist may use the term angioedema to describe this type of swelling. It’s also used to describe very deep large hives on other areas of the body.

Acute Urticaria
Hives are classified according to how long the attacks last and how frequently they occur. The term acute urticaria is used for hives lasting less than six weeks. With this type of hives, the cause or causes can usually be identified and eliminated. The most common causes of hives are foods, drugs or infections. Insect bites and internal disease may also be responsible. Other causes can be physical stimuli, including pressure, cold and sunlight.

Foods
The most common foods that cause hives are nuts, chocolate, fish, tomatoes, eggs, fresh berries and milk. Fresh foods cause hives more often than cooked foods. Food additives and preservatives may also be responsible.

Hives may appear within minutes or up to two hours after eating, depending on where the food is absorbed in the digestive tract.

Drugs
Almost any prescription or over-the-counter medication can cause hives. Some of those drugs include
antibiotics (especially penicillin), pain medications, sedatives, tranquilizers and diuretics. Antacids, vitamins, eye and ear drops, laxatives, vaginal douches, or any other non-prescription item can be a potential cause of hives. If you have an attack of hives, it’s important to tell your doctor about all of the preparations that you use to assist him/her in finding the cause.

Infections
Many infections can cause hives. Viral upper respiratory tract infections are a common cause in children. Other viruses including hepatitis B may also be a cause, as well as a number of bacterial and fungal infections.

Chronic Urticaria
Bouts of hives lasting more than six weeks are called chronic urticaria. The cause of this type of hives is usually much more difficult to identify than that of acute urticaria. In studies of patients with chronic
urticaria, the cause was identified in only a small percentage of patients. Your doctor will need to ask numerous questions in an attempt to find the possible cause.

Since there are no specific tests to determine the cause of hives, testing will vary depending on your medical history and based on a thorough examination by your dermatologist. Routine blood tests are of little or no value.

Physical Urticarias
Certain people can develop hives from sunlight, cold, pressure, vibration or exercise. Hives due to sunlight are called solar urticaria. This is a rare disorder in which hives come up within minutes of sun exposure on exposed areas and fade within one to two hours. Reaction to the cold is more common. Hives appear when the skin is warmed after exposure to cold. If the exposure to cold is over large areas of the body, large amounts of histamine may be released which can produce wheezing, flushing, generalized hives and fainting. A simple test for this type of hives can be done by applying an ice cube to the skin.

Cholinergic urticaria is tiny, about 1/8 inch bumps surrounded by a white or red halo which come on with exercise, heat or emotion. These bumps itch intensely. Anything which raises the skin temperature can cause these tiny hives – sweating, sunlight, hot baths, blushing or anger.

The most common of the physical urticarias is called dermatographism. It affects about 5 percent of the population. Most people with this condition are otherwise healthy. Hives form from firmly stroking or scratching the skin. These hives may be very itchy. This condition can also occur along with other forms of urticaria. If it is present along with hives, finding and eliminating the cause usually clears the dermatographism. Otherwise, it may persist for months or even years.

Treatment
The best treatment for hives is to find the cause and then eliminate it. Unfortunately, this is not always an easy task. While investigating the cause of hives, or when a cause cannot be found, antihistamines are usually prescribed by your dermatologist to provide some relief. Antihistamines work best if taken on a regular schedule to prevent hives from forming. No one antihistamine works best for everyone, so your doctor may need to try more than one or different combinations to find what works best for you.

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Moles
Everyone has moles, sometimes 40 or more. Most people think of a mole as a dark brown spot, but moles have a wide range of appearances.

Moles can appear anywhere on the skin. They are usually brown in color but can be skin colored and various sizes and shapes. The brown color is caused by melanocytes, special cells that produce the pigment melanin.

Moles probably are determined before a person is born. Most appear during the first 20 years of life, although some may not appear until later. Sun exposure increases the number of moles, and they may darken. During the teen years and pregnancy, moles also get darker and larger and new ones may appear.

Each mole has its own growth pattern. The typical life cycle of the common mole takes about 50 years. At first, moles are flat and tan like a freckle, or they can be pink, brown, or black in color. Over time, they usually enlarge and some develop hairs. As the years pass, moles can change slowly, becoming more raised and lighter in color. Some will not change at all. Some moles will slowly disappear, seeming to fade away. Others will become raised far from the skin.

Different Types of Moles
Recent studies have shown that certain types of moles have a higher-than-average risk of becoming cancerous. They may develop into a form of skin cancer known as malignant melanoma. Sunburns may increase the risk of melanoma. People with more moles than average (greater than 100) are also at risk for melanoma.

Moles are present at birth in about 1 in 100 people. They are called congenital nevi. These moles may be more likely to develop a melanoma than moles which appear after birth.

Moles known as dysplastic nevi or atypical moles are larger than average (usually larger than a pencil eraser) and irregular in shape. They tend to have uneven color with dark brown centers and a lighter, sometimes reddish, uneven border or black dots at the edge. These moles often run in families.

People with dysplastic nevi may have a greater chance of developing malignant melanoma and should be seen regularly by a dermatologist to check for any changes that might indicate skin cancer. They should also learn to do regular self-examinations, looking for changes in the color, size or shape of their moles, or the appearance of new moles. Sunscreen and protective clothing should be used to shield moles from sun exposure.

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Molluscum
What is Molluscum Contagiosum?
Molluscum contagiosum is a common non-cancerous skin growth caused by a viral infection in the top layers of the skin. They are similar to warts, but are caused by a different virus. The name molluscum contagiosum implies that the virus and the growths are easily spread by skin contact. The virus that causes molluscum contagiosum belongs to a family of viruses called poxviruses. This virus can enter through small breaks in the skin or hair follicles and can lead to the development of the molluscum lesions. It does not affect any internal organs.

What do molluscum look like?
Molluscum are usually small, flesh-colored or pink, dome-shaped growths. They may appear shiny and have a small indentation in the center. Molluscum are often found in clusters on the skin of the chest, abdomen, arms, groin, or buttock. They can also involve the face and eyelids. Because they can be spread by skin-to-skin contact, molluscum are usually found in areas of skin that touch each other such as the folds in the arm or in the groin. Often the molluscum may become red or inflamed. This tends to occur just before the growth is ready to go away on its own. Sometimes, the dermatologist might scrape some cells from the lesion and look at these under the microscope to confirm the diagnosis of molluscum. In people with diseases of the immune system, the molluscum may be very large in size and may involve the face.

How do you get molluscum?
The molluscum virus is transmitted from the skin of one person who has these growths to the skin of another person. Molluscum occur most often in cases where skin-to-skin contact is frequent. They often occur in young children, especially among siblings. Molluscum can also be sexually transmitted if growths are present in the genital area. It is also possible, but less likely, to acquire the molluscum virus from non-living objects. Molluscum may be spread between children in swimming pools.

Why do some people get molluscum and others don’t?
People that are exposed more often to the molluscum virus through skin-to-skin contact, have an increased risk of developing these lesions. It is common in young children who have not yet developed immunity to the virus. Children tend to get molluscum more than adults. Molluscum also seems to be more common in tropical climates as warmth and humidity tend to favor the growth of the virus. People with HIV infections are more susceptible to acquiring molluscum.

Do molluscum need to be treated?
Many dermatologists advise treating molluscum because they spread. However, molluscum will eventually go away on their own without leaving a scar. Because the growths are easily spread from one area of the skin to another, some growths may appear as others are going away. It may take from six months up to five years for all of the molluscum to go away on their own. They may be more persistent in people with a weakened immune system.

How do dermatologists treat molluscum?
Molluscum are treated in the same ways that warts are treated. They can be frozen with liquid nitrogen, destroyed with various acids or blistering solutions, treated with an electric needle
(electrocautery), scraped off with a sharp instrument (curette), treated daily with a home application of a topical retinoid cream or gel, treated with a topical immune modifier, or treated with a topical anti-viral medication. Some discomfort is associated with freezing, scraping, and the electric needle. Often these procedures are reserved for older children and adults. If there are many growths, multiple treatment sessions may be needed every three to six weeks until the growths are gone. It is also an option, especially with young children, not to treat, and to wait for the growths to go away on their own.

What if the molluscum come back after treatment?
It is always possible for a person’s skin to get infected again with the molluscum virus. The condition may be easier to control if treatment is started when there are only a few growths. The fewer the growths, the better the chance for stopping their spread.

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Psoriasis
Psoriasis is a persistent skin disease that got its name from the Greek word for “itch”. The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back.

In some cases, psoriasis is so mild that people don’t know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Doctors can help even the most severe cases.

Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis
(four to five million people). Approximately 150,000 new cases occur each year.

What Causes Psoriasis?
The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. This causes the skin to shed itself too rapidly, every three to four days.

People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.

Types of Psoriasis
Psoriasis comes in many forms. Each differs in how bad it is, how long it lasts, where it is, and in the shape and pattern of the scales. The most common form begins with little red bumps. Gradually these grow larger and scales form. While the top scales flake off easily and often, scales below the surface stick together. When they are removed, the tender, exposed skin bleeds. These small red areas then grow, sometimes becoming quite large.

• Elbows, knees, groin and genitals, arms, legs, scalp, and nails are the areas most commonly affected
  by psoriasis. It will often appear in the same place on both sides of the body.
• Nails with psoriasis have tiny pits on them. Nails may loosen, thicken or crumble and are difficult
  to treat.
• Inverse psoriasis occurs in the armpit, under the breast and in skin folds around the groin, buttocks,
  and genitals.
• Guttate psoriasis usually affects children and young adults. It often shows up after a sore throat, with
  many small, red, drop-like, scaly spots appearing on the skin. It often clears up by itself in weeks or
  a few months.
• About seven percent of psoriasis patients also have arthritis, which fortunately is not too severe in
  most people. In some people, the arthritis is worst when the skin is very involved. Sometimes the
  arthritis improves when the condition of the patient’s skin improves.

How is Psoriasis Diagnosed?
Dermatologists diagnose psoriasis by examining the skin, nails, and scalp. They may need to take a skin biopsy to examine under the microscope.

How is Psoriasis Treated?
The goal is to reduce inflammation and to slow down rapid skin cell division. Moisturizing creams and lotions loosen scales and help control itching. Special diets have not been successful in treating psoriasis.

Treatment is based on a patient’s health, age, lifestyle, and the severity of the psoriasis. Different types of treatments and several visits to the dermatologist may be needed.

The doctor may prescribe medications to apply on the skin containing cortisone-like compounds, synthetic vitamin D, tar, or anthralin. These may be used in combination with natural sunlight or ultraviolet light. The most severe forms of psoriasis may require oral medications, with or without light treatment.

Sunlight exposure helps the majority of people with psoriasis but it must be used cautiously. Ultraviolet light therapy may be given in a dermatologist’s office, a psoriasis center or a hospital.

Types of Treatment
Steriods (Cortisone) – Cortisone creams, ointments, and lotions may clear the skin temporarily and control the condition in many patients. Weaker preparations should be used on more sensitive areas of the body such as the genitals, groin, and face. Stronger preparations will usually be needed to control lesions on the scalp, elbow, knees, palms and soles, and parts of the torso and may need to be applied under dressings. These must be used cautiously and with the dermatologist’s instruction. Side effects of the stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, and skin color changes. Stopping these medications suddenly may result in a flare-up of the disease. After many months of treatment, the psoriasis may become resistant to the steroid preparations.

Scalp Treatment – The treatment for psoriasis of the scalp depends on the seriousness of the disease, hair length, and the patient’s lifestyle. A variety of non-prescription and prescription shampoos, oils,
solutions, and sprays are available. Most contain coal tar or cortisone. The patient must take care to avoid harsh shampooing and scratching the scalp.

Vitamin D – A synthetic Vitamin D, calcipotriene, is now available in prescription form. It is useful for individuals with localized psoriasis and can be used with other treatments. Limited amounts should be used to avoid side effects. Ordinary Vitamin D, as one would buy in a drug store or health food store, is of no value in treating psoriasis.

Coal Tar – For more than 100 years, coal tar has been used to treat psoriasis. Today’s products are greatly improved and less messy. Stronger prescriptions can be made to treat difficult areas.

Light Therapy – Sunlight and ultraviolet light slow the rapid growth of skin cells. Though ultraviolet light or sunlight can cause skin wrinkling, eye damage, and skin cancer, light treatment is safe and effective under a doctor’s care. People with psoriasis all over their bodies may require treatment in a medically
approved center equipped with light boxes for full body exposure. Psoriasis patients who live in warm climates may be directed to carefully sunbathe. Seek the advice of a dermatologist before self-treating with natural or artificial sunlight.

Methotrexate is an oral anti-cancer drug that can produce dramatic clearing of psoriasis when other treatments have failed. Because it can produce side effects, particularly liver disease, regular blood tests are performed. Chest x-rays and occasional liver biopsies may be required. Other side effects include upset stomach, nausea and dizziness.

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Rosacea
Rosacea is a common skin disease that causes redness, pustules, papules, and swelling on the face. Often referred to as “adult acne”, rosacea frequently begins as a tendency to flush or blush easily. It may progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. The eyes, ears, chest, and back may also be involved. With time, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

When rosacea first develops, the redness may come and go, Some people may flush or blush and never form pustules or papules. Small dilated vessels also may be present due to prolonged sun exposure. However, when the skin does not return to its normal color, and when other symptoms such as pimples and enlarged blood vessels become visible, it is best to seek advice from a dermatologist. The condition may last for years, rarely reverse itself, and can become worse without treatment.

About 50% of people with rosacea have eye involvement (ocular rosacea). Some rosacea patients experience burning and grittiness of the eyes, a common condition known as conjunctivitis. If this condition is not treated, it can lead to more serious eye complications.

How to Recognize Rosacea
Small red bumps, some of which may contain pus, appear on the face. These may be accompanied by persistent redness and the development of many tiny blood vessels on the surface of the skin.

In more advanced cases, a condition called rhinophyma may develop. The oil glands enlarge causing a bulbous, red nose, and puffy cheeks. Thick bumps may develop on the lower half of the nose and nearby cheeks. Rhinophyma occurs more commonly in men.

Who is at Risk for Rosacea?
Fair skinned adults between the ages of 30 and 50 may develop rosacea. It affects men and women of any age, and even children. Since it may be associated with menopause, women are affected more often than men and may notice an extreme sensitivity to cosmetics. An occasional embarrassment or a tense moment also may trigger flushing.

Tips for Rosacea Patients

• Avoid triggers, including hot drinks, spicy foods, caffeine, and alcoholic beverages that make the face
  red or flushed. It is important to note that although alcohol may worsen rosacea, the condition may
  be just as severe in someone who does not drink at all; thus rosacea has been unfairly linked to
  alcoholism.
• Practice good sun protection. Seek shade when possible and limit exposure to sunlight, wear hats
  and use broad-spectrum sunscreens with SPF of 15 or higher; reapply every 2 hours.
• Avoid extreme hot and cold temperatures which may exacerbate the symptoms of rosacea. Exercise
  in a cool environment. Do not overheat.
• Avoid rubbing, scrubbing or massaging the face.
• Avoid cosmetics and facial products that contain alcohol. Use hair sprays properly, avoiding contact
  with facial skin.
• Keep a diary of flushing episodes and note associated foods, products, activities, medications or other
  triggering factors.

Treatment
Many people with rosacea do not recognize it in its early stages. Identifying the disease is the first step
to controlling it. Self diagnosis and treatment are not recommended since some over-the-counter skin
products may make the problem worse.

Dermatologists often recommend a combination of treatments tailored to the individual patient. These
treatments can stop the progress of rosacea and sometimes reverse it.

Creams, lotions, foams, washes, gels, and pads that contain various topical antibiotics, metronidazole, sulfacetimide, benzoyl peroxide, and retinoids may be prescribed. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months.

Oral antibiotics tend to produce faster results than topical medications. Cortisone creams may reduce the redness of rosacea; however, they should not be used for longer than two weeks since they can cause thinning of the skin and flare-ups upon discontinuation. It is best to use these creams only under the direction of a dermatologist.

The persistent redness may be treated with laser surgery to close off the dilated blood vessels. Cosmetics also may be helpful. Green-tinted makeup may mask the redness.

The key to successful management of rosacea is early diagnosis and treatment. It is important to follow all of the dermatologist’s instructions. When left untreated, rosacea will get worse and may be more difficult to treat.

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Seborrheic Keratoses
Seborrheic Keratoses (SKs) are common skin growths. These benign (non-cancerous) growths can occur almost anywhere on the skin. Some people get just one; others develop many. Having many SKs is more common.

Usually beginning as small, rough bumps, SKs tend to eventually thicken and develop a warty surface. Most are brown, but these growths range in color from light tan to black. Some SKs measure a fraction of an inch; others are larger than a half-dollar. A SK can be flat or raised. Sometimes the surface feels smooth.

What often distinguishes these growths from other lesions is a waxy, pasted-on-the-skin appearance. A SK can look like a dab of warm, brown candle wax on the skin. It also may resemble a barnacle attached to a ship. Either way, SKs tend to have that stuck-on-the-skin appearance.

Causes
While the exact cause remains unknown, researchers have discovered some key findings. SKs seem to run in families, and it appears that some people inherit a tendency to develop many SKs. Although these growths develop on both sun-exposed and non sun-exposed skin, some studies suggest that sun exposure may play a role. The exact cause is unknown. And while SKs may seem to multiply and spread to other areas, they are not contagious.

Those at Risk
While anyone may develop SKs, these growths generally first appear in middle age or later.

Where They Appear
Most often forming on the chest and back, SKs also can be found on the scalp, face, neck, or almost anywhere on the skin. They do not develop on the palms or soles.

When Treatment is Needed
Since SKs are benign, treatment is generally not necessary. There are times, though, when these lesions should be examined by a dermatologist. Sometimes a SK grows quickly, turns black, itches, or bleeds, making it difficult to distinguish from skin cancer. Such a growth must be biopsied (removed and studies under a microscope) to determine if it is cancerous or not.

Treatment may be recommended if the growth is large or easily irritated by clothing or jewelry. Sometimes, a SK is treated because the patient considers it unsightly. In these last two cases, there are a few treatment options.

Treatment Options
Cryosurgery, electrosurgery, and curettage are the most common options for removing SKs.

• Cryosurgery – Liquid nitrogen, a very cold liquid, is applied to the growth with a cotton swab or
  spray gun. This “freezes” the growth. The SK usually falls off within days. Sometimes a blister
  forms under the SK and dries into a scab-like crust that falls off. After the growth falls off, a small
  dark or light spot may appear on the skin. This usually fades over time. A permanent white spot
  is a possible side effect of this treatment.
• Electrosurgery and Curettage – Electrosurgery involves anesthetizing (numbing) the growth and
  using an electric current to cauterize (burn) the growth. A scoop-shaped surgical instrument, a
  curette is used to scrape off the treated lesion. This is a curettage. Stitches are not necessary.
  There may be minimal bleeding, which is controlled by applying pressure or a blood-clotting
  chemical. Sometimes only electrosurgery or curettage is necessary.

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Skin Cancer
BASAL CELL CARCINOMA – Basal cell carcinoma (BCC) is the most common form of skin cancer. It also is the most common cancer in the world, and the number of cases continues to rise. The reason for this rise may be that people are receiving more unprotected exposure to the harmful ultraviolet (UV) rays of the sun.

The likelihood of developing BCC also increases when you have one or more of the following risk factors:

• Fair skin
• Blond or red hair
• Blue or green eyes
• Family history of skin cancer
• Weakened immune system
• Received radiation therapy
• Exposure to coal tar, pitch, creosote, or arsenic

Age is another risk factor. While BCC can occur at any age, the risk of developing this skin cancer increases significantly with age.

What they look like
The BCC tumor appears in many shapes and sizes. It often looks like a small, dome-shaped, pimple-like growth that has a pearly color. Blood vessels may be seen on the surface. In a very early stage, BCC may be a shiny, pinkish patch on the skin. BCC also can appear as a sore that seems to repeatedly heal and return. A less common form, morpheaform, looks like a smooth white or yellowish waxy scar.

Most BCCs develop on sun-exposed areas such as the head, neck, trunk, and legs, but BCC can appear anywhere on the body. A dermatologist should examine all new growths and changes to your skin.

Basal Cell Carcinoma is Serious
While BCC rarely spreads to other areas of the body, it can invade and destroy surrounding tissue, causing permanent disfigurement. When a BCC tumor develops near an organ such as an eye, ear, or nose, or grows near a nerve, this can be especially concerning. Complications such as loss of an eye can arise if the cancer invades. Early diagnosis and proper treatment can prevent this.

Diagnosis
A biopsy is required to diagnose skin cancer. A dermatologist can perform this simple procedure in the office by numbing the area and then removing the suspicious lesion (or a portion of it). The removed tissue is examined under a microscope to see if cancer is present.
Treatment

When the diagnosis is BCC, the dermatologist has a number of surgical and non-surgical options. The appropriate treatment depends on the size, location, and characteristics of the tumor, as well as the overall health and needs of the patient. Most BCCs are treated with one of the following:

• Simple Surgical Excision – The dermatologist cuts out the tumor and some of the surrounding
  healthy tissue. The removed tissue is examined under a microscope to see if all of the skin cancer
  has been removed.
• Mohs Micrographic Surgery – Performed by a specially trained dermatologic surgeon, Mohs involves
  removing the visible tumor and then successive layers of skin one at a time until cancer cells are no
  longer found.
• Electrodesiccation & Curettage – The dermatologist removes the tumor by scraping or “curetting”
  it and then burning the base with an electric needle. The latter is “electrodessication”.
• Topical Therapy – The dermatologist prescribes a cancer-fighting medication, such as imiquimod or
  5-fluorouracil, which the patient can apply to the skin cancer at home.

Post Treatment
After receiving treatment for BCC, follow-up appointments are scheduled. These appointments are essential because studies show that a person who develops BCC has an increased risk of developing
another BCC or other form of skin cancer, including melanoma. Follow-up visits also are important because BCC can return after treatment. Cure rates and survival rates are highest with early detection and treatment.

You also should perform regular self-examinations of your skin as this can help detect skin cancer in its earliest stage. Be alert to any non-healing sore and other changes to your skin.

Prevention

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF) of
  30 or more to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A (UVA)
  and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days, and
  after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses,
  where possible.
• Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and
  4 p.m. If your shadow is shorter than you are, seek shade.
• Protect children from sun exposure by playing in the shade, using protective clothing, and applying
  sunscreen.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can
  increase your chance of sunburn.
• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don’t seek the
  sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and
  wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning
  product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding on
  your skin, see a dermatologist. Skin cancer is very treatable when caught early.

SQUAMOUS CELL CARCINOMA – Squamous cell carcinoma (SCC) is the second most common type of skin cancer. Together with basal cell carcinoma, the most common skin cancer, these two cancers are collectively referred to as nonmelanoma skin cancer.

Of the more than 1 million cases of skin cancer that will be diagnosed in the United States this year, approximately 20% will be SCC. Most cases of SCC will be caused by exposure to the sun’s harmful
ultraviolet (UV) rays. The risk of developing SCC increases when a person also has one or more of these risk factors:

• Fair skin
• Blond or red hair; blue or green eyes
• History of indoor tanning
• Diagnosed with actinic keratoses (pre-cancers)
• Family history of skin cancer
• Weakened immune system (immunosuppression)
• Received radiation therapy
• History of exposures to coal tar products or arsenic

The risk of developing SCC also increases with age because each exposure to harmful UV rays causes more damage to the skin. As this damage accumulates, the risk of developing skin cancer grows.

What it looks like
SCC usually looks like a red crusted or scaly patch on the skin, a non-healing ulcer, or a firm red nodule.
Generally appearing on sun-exposed areas such as the head, neck, ears, trunk, and arms, SCC also can develop on other areas of the body. Some SCCs develop from small sandpaper-like lesions called actinic keratoses, which also are caused by exposure to sun’s UV rays.

Squamous Cell Carcinoma is Serious
With early detection and proper treatment, SCC is curable. Allowed to progress, SCC can invade and destroy much of the tissue surrounding the cancerous tumor, which can be disfiguring.

Some SCCs such as those that develop on a lip or an ear can be particularly aggressive. Left untreated, aggressive SCCs have a greater risk for metastasis (spreading) to the lymph nodes and other internal organs. This makes early diagnosis and treatment of SCC essential.

A dermatologist should examine any lesion that looks like a red crusted or scaly patch or a non-healing sore.

Diagnosis and Treatment
Before SCC can be treated, the diagnosis must be confirmed with a biopsy. This simple procedure can be performed in the office and involves removing a small amount of tissue so that it can be examined under a microscope. If the diagnosis is SCC, a variety of surgical and non-surgical treatment options are available. The dermatologist will choose an appropriate treatment after considering the location of the tumor, size, microscopic characteristics, health of the patient, and other factors.

Most treatment options are relatively minor office-based procedures that require only local anesthesia. These include:

• Simple surgical excision – Removes the cancer and some of the surrounding healthy tissue. The
  removed specimen is examined under a microscope to determine if all of the skin cancer has been
  removed.
• Mohs Micrographic Surgery – Performed by a specially trained dermatologic surgeon, Mohs allows
  the surgeon to spare as much normal skin as possible while simultaneously removing the cancer.
• Electrodesiccation & Curettage – Removes the cancerous tumor by scraping (curetting) it off. The
  base of the tumor is burned (cauterized) with an electric needle (electrodesiccation).
• Topical Therapy – Medications such as imiquimod and 5-fluorouracil can be applied at home to treat
  the cancer.

Follow Up
Most patients with localized (cancer confined to the tumor and has not spread) SCC have an excellent prognosis. Cure rates range from 85% to 95% or greater.

Even so, follow-up appointments with a dermatologist are essential. SCC can recur, and studies show that individuals who develop SCC have an increased risk of developing future skin cancers, including melanoma. The recommended follow-up may include a full-body skin examination at least once a year to check for abnormal moles or lesions. Patients also should perform regular skin self-examinations
and be alert to any non-healing sores and other changes that develop on the skin. If any of these are spotted, make an appointment to see a dermatologist.

Prevention

• Generously apply a broad-spectrum water-resistant sunscreen with a Sun Protection Factor (SPF)
  of 30 or more to all exposed skin. “Broad-spectrum” provides protection from both ultraviolet A
  (UVA) and ultraviolet B (UVB) rays. Re-apply approximately every two hours, even on cloudy days,
  and after swimming or sweating.
• Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat and sunglasses,
  where possible.
• Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and
  4 p.m. If your shadow is shorter than you are, seek shade.
• Protect children from sun exposure by playing in the shade, using protective clothing, and applying
  sunscreen.
• Use extra caution near water, snow and sand as they reflect the damaging rays of the sun which can
  increase your chance of sunburn.
• Get vitamin D safely through a healthy diet that may include vitamin supplements. Don’t seek the
  sun.
• Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and
  wrinkling. If you want to look like you’ve been in the sun, consider using a sunless self-tanning
  product, but continue to use sunscreen with it.
• Check your birthday suit on your birthday. If you notice anything changing, growing, or bleeding
  on your skin, see a dermatologist. Skin cancer is very treatable when caught early.

MELANOMA – Melanoma is a cancer of the pigment producing cells in the skin known as melanocytes.
Cancer is a condition in which one type of cell grows without limit in a disorganized fashion, disrupting
and replacing normal tissues and their functions, much like weeds overgrowing a garden. Normal melanocytes reside in the outer layer of the skin and produce a brown pigment called melanin which is responsible for skin color. Melanoma occurs when melanocytes become cancerous, grow, and invade other tissues.

Melanoma begins on the surface of the skin where it is easy to see and treat. If given time to grow,
melanoma can grow down into the skin, ultimately reaching the blood and lymphatic vessels, and spread around the body (metastasize), causing a life-threatening illness. It is curable when detected early, but can be fatal if allowed to progress and spread. The goal is to detect melanoma early when it is still on the surface of the skin.

What causes it ?

It is not certain how all cases of melanoma develop. However, it is clear that excessive sun exposure, especially severe blistering sunburns early in life, can promote melanoma development. There is evidence that ultraviolet radiation used in indoor tanning equipment may cause melanoma. The risk for developing melanoma may also be inherited.

Who gets it ?

Anyone can get melanoma, but fair-skinned, sun-sensitive people are at a higher risk. Since ultraviolet radiation from the sun is a major culprit, people who tan poorly, or burn easily are at the greatest risk.

In addition to excessive sun exposure throughout life, people with many moles are at an increased risk to develop melanoma. The average person has around 30 moles, and most are without significance; however, people with more than 50 moles are at a greater risk. In addition to the number of moles, some people have moles that are unusual and irregular looking. These moles (nevi) are known as dysplastic or atypical moles. People with atypical moles are at an increased risk of developing melanoma. Melanoma also runs in families. If a relative such as a parent, aunt or uncle had melanoma, other blood relatives are at an increased risk for melanoma. The following factors help to identify those at risk for melanoma:

• Fair skin

• A history of sunburns

• More than 50 moles

• Atypical moles

• Close relatives who have had melanoma

Anyone can develop melanoma, but people with one or more of the risk factors are more likely to do so. Periodic skin examinations by a dermatologist can truly be life saving.

What to look for?
Melanoma can occur anywhere on the skin or the nails, even in places not directly exposed to the sun like the eyes, mucous membranes (mouth and genitals), or internal organs. It is most common on the backs of men and legs of women. Melanoma is usually brown or black in color, but sometimes, though rare, may be red, skin-colored, or white. It can arise from a pre-existing mole, or appear on previously
normal skin. Melanomas grow slowly; therefore, growing, changing, or irregular lesions should arouse suspicion. When looking at a spot on the skin it is helpful to apply the ABCD rules:

A is for asymmetry.
Draw an imaginary line through the middle of the lesion, either up and down or side-to-side. Are the two sides the same size and shape (symmetric) ? Melanomas are usually asymmetric, meaning one side is unlike the other. Melanomas can also be flat or raised.

B is for border.
The edge or border of a melanoma is usually irregular. The border can be ragged, notched, scalloped, blurred, or poorly defined.

C is for color.
Benign (not cancerous) moles can be any color, but a single mole will be only one color. Melanomas
usually vary in shades of tan, brown, or black. Sometimes they can be white, red, or blue. They often have a variety of hues and colors within the same lesion.

D is for diameter.
While melanomas are usually greater than 6 millimeters in diameter (the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others, or which changes, itches, or bleeds (even if it is small) you should see a dermatologist.

What treatment is available?
The best treatment is early detection. A quick look from a dermatologist can confirm whether a lesion is suspicious for melanoma. If so, the next step is to perform a biopsy. This involves numbing the area and removing the entire lesion, or a portion, which can be examined under a microscope. This simple, quick procedure is performed in the dermatologist’s office. If a melanoma is detected, treatment is guided by how deep the melanoma penetrates the skin.

Treatment for melanoma begins with the surgical removal of the melanoma and some normal-looking skin around the growth. Removal of the normal-looking skin is known as taking margins, and is done to be sure no melanoma is left behind. Early melanoma limited to the outermost layer of the skin (the epidermis) is known as melanoma in situ (in place), and simple surgical removal produces virtually a
100 percent cure rate. If left untreated, the melanoma grows deeper in the skin and is more likely to produce a life-threatening situation.

Deeper melanomas are more likely to reach a blood vessel or lymphatic channel and spread. When a melanoma spreads, it goes to the lymph nodes first. The lymph nodes are part of the lymphatic system, a series of vessels throughout the body that are responsible for cleaning the body’s tissue. Different lymph nodes serve different parts of the body. It may be possible to find the melanoma in the lymph node before it goes any further. A procedure called a sentinel lymph node biopsy is a way of identifying and testing the first lymph node into which the melanoma drains. The decision to perform a sentinel lymph node biopsy is based on how deep the melanoma is in the skin, and how likely it is to have spread.

Once the melanoma has spread (metastasized) and the nodes have been evaluated, it requires a different treatment plan which may include surgical removal, chemotherapy, immunotherapy, or radiation therapy.

What can be done for protection?
Since excessive exposure to ultraviolet radiation is one contributing factor to melanoma, it makes common sense to use sun protection. Avoid sun exposure from 10 a.m. through 4 p.m. when the sun is the strongest. Wear a broad-spectrum sunscreen, one that blocks both types of ultraviolet light (UVA and UVB), and reapply every two hours. Wear a wide-brimmed hat, sunglasses, and tightly-woven clothing that will block ultraviolet light. White cotton shirts only block 50% of the sun’s rays. Avoid
indoor tanning.

Early detection remains the best treatment. Therefore, looking for irregular lesions that are growing and changing and skin self-examinations should be performed monthly. Remember to use the ABCD rules, and to see a dermatologist periodically for a complete skin examination. If a mole is changing, see a dermatologist immediately.

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Tinea Versicolor
Tinea versicolor is a common skin condition due to overgrowth of a skin surface yeast. This overgrowth results in uneven skin color and scaling that can be unsightly and sometimes itch. The yeast normally lives in the pores of the skin and thrives in oily areas such as the neck, upper chest, and back.

What does tinea versicolor look like and how do you recognize it?
Tinea versicolor has small, scaly white-to-pink or tan-to-dark spots which can be scattered over the upper arms, chest, and back. They may sometimes appear on the neck and the face. On light skin, tinea versicolor may be faint or can appear as tan-to-pink spots, while on dark skin tinea versicolor may be light or dark. The fungus grows slowly and prevents the skin from tanning normally. As the rest of the skin tans in the sun, the pale spots, which are affected by the yeast, become more noticeable, especially on dark skin.

What are the symptoms?
Tinea versicolor usually produces few symptoms. Occasionally, there is some slight itching that is more intense when a person gets hot.

Who may get this rash?
Most people get tinea versicolor when they are teenagers or young adults. People with oily skin may be more susceptible than those with naturally dry skin.

The yeast is normally present in small numbers on everyone’s skin. Anyone can develop an overgrowth of yeast. During the summer months when the temperature and humidity are high, the yeast can increase. The excess yeast on the skin prevents the normal pigmentation process, resulting in light and dark spots.

How is tinea versicolor diagnosed?
Although the light or dark colored spots can resemble other skin conditions, tinea versicolor can be easily recognized by a dermatologist. In most cases, the appearance of the skin is diagnostic, but a simple examination of the fine scales scraped from the skin can confirm the diagnosis. Scales are lightly scraped onto a slide and examined under a microscope for the presence of the yeast.

How is it treated?
Tinea versicolor is treated with topical or oral medications. Topical treatment includes special cleansers including some shampoos, creams, or lotions applied directly to the skin.

Several oral medications have been used successfully to treat tinea versicolor. Because of possible side effects, or interactions with other medications, the use of these prescription medicines should be supervised by your dermatologist. After any form of treatment, the uneven color of the skin may remain several months after the yeast has been eliminated until the skin repigments normally.

Tinea versicolor may recur. Special cleansers may decrease episodes when used once or twice a month, especially during warm humid months of the year.

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Vitiligo
Vitiligo is a skin condition resulting from loss of pigment which produces white patches. Any part of the body may be affected. Usually both sides of the body are affected. Common areas of involvement are the face, lips, hands, arms, legs, and genital areas.

Who Gets Vitiligo
Vitiligo affects one or two of every 100 people. About half the people who develop it do so before the age of 20; about one-fifth have a family member with this condition. It may be an autoimmune process (the body makes antibodies to its own pigment cells). Most people with vitiligo are in good general health, although vitiligo may occur with other autoimmune diseases such as thyroid disease.

What Determines Skin Color?
Melanin, the pigment that determines color of skin, hair, and eyes, is produced in cells called melanocytes. If these cells die or cannot form melanin, the skin becomes lighter or completely white.

How Does Vitiligo Develop?
Typical vitiligo shows areas of milky-white skin. However, the degree of pigment loss can vary within
each vitiligo patch. There may be different shades of pigment in a patch, or a border of darker skin may circle an area of light skin.

Vitiligo often begins with a rapid loss of pigment. This may continue until, for unknown reasons, the process stops. Cycles of pigment loss, followed by times where the pigment doesn’t change, may continue indefinitely.

It is rare for skin pigment in vitiligo patients to return on its own. Some people who believe they no longer have vitiligo actually have lost all their pigment and no longer have patches of contrasting skin color. Although their skin is all one color, they still have vitiligo.

The course and severity of pigment loss differ with each person. Light-skinned people usually notice the contrast between areas of vitiligo when their skin is suntanned in the summer. Year round, vitiligo is more obvious on people with darker skin. Individuals with severe cases can lose pigment all over the body. There is no way to predict how much pigment an individual will lose.

How is Vitiligo Treated?
Sometimes the best treatment for vitiligo is no treatment at all. In fair-skinned individuals; avoiding tanning of normal skin can make areas of vitiligo almost unnoticeable because the (no pigment) white skin, of vitiligo has no natural protection from sun. These areas are easily sunburned, and people with vitiligo have an increased risk to skin cancer. They should wear a sunscreen with a SPF of at least 30 on all areas of vitiligo no covered by clothing. Avoid the sun when it is most intense to avoid burns.

Disguising vitiligo with make-up, self-tanning compounds or dyes is a safe, easy way to make it less
noticeable. Waterproof cosmetics to match almost all skin colors are available. Self-tanning compounds contain a chemical called dihydroxyacetone that does not need melanocytes to make the skin a tan color. The color from self-tanning creams slowly wears off. None of these change the disease, but they can improve appearance.

If sunscreens and cover-ups are not satisfactory, your dermatologist may recommend other treatment. Treatment can be aimed at returning normal pigment (repigmentation) or destroying remaining pigment (depigmentation). None of the repigmentation methods are permanent cures.

Treatment of Vitiligo in Children
Aggressive treatment is generally not used in children. Sunscreen and cover-up measures are usually the best treatments. Topical corticosteroids can also be used, but must be monitored.

Repigmentation Therapy
Topical Corticosteriods – Creams containing corticosteroid compounds can be effective in returning pigment to small areas of vitiligo. These can be used along with other treatments. These agents can thin the skin or even cause stretch marks in certain areas. They should be used under your dermatologist’s care.

PUVA
PUVA is a form of repigmentation therapy where a type of medication known as psoralen is used. This chemical makes the skin very sensitive to light. Then the skin is treated with a special type of ultraviolet light called UVA. Sometimes, when vitiligo is limited to a few small areas, psoralens can be applied to the vitiligo areas before UVA treatments. Usually, however, psoralens are given in pill form. Treatment with PUVA has a 50 to 70% chance of returning color on the face, trunk, upper arms, and upper legs. Hands and feet respond very poorly. Treatments are required twice a week for at least a year. PUVA must be given under close supervision by your dermatologist. Side effects of PUVA include sunburn-type reactions. When used long-term, freckling of the skin may result and there is an increased risk of skin cancer. Because psoralens also make the eyes more sensitive to light, UVA blocking eyeglasses must be worn from the time of exposure to psoralen until sunset that day to prevent an increased risk of cataracts. PUVA is not usually used in children under the age of 12, in pregnant or breast feeding women, or in individuals with certain medical conditions.

Narrow Band UVB (NBUVB) – This is a form of phototherapy that requires the skin to be treated two, sometimes three, times a week for a few months.

Other Treatment Options
Other treatment options include a new topical class of drugs called immunomodulators. Due to their safety profile they may be useful in treating eyelids and children.

Is Vitiligo Curable?
At this time, the exact cause of vitiligo is not known, however, there may be an inherited component. Although treatment is available, there is no single cure. Research is ongoing in vitiligo and it is hoped that new treatments will be developed.

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Warts
What are warts ?
Warts are non-cancerous skin growths caused by a viral infection in the top layers of skin. The virus that causes warts is called the human papilloma virus, or HPV. Warts are usually skin-colored and feel rough
to the touch, but they can be dark, flat, and smooth. The appearance of a wart depends upon 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 (verruca vulgaris) usually grow on the fingers, around the nails, and on the backs of the hands. They are more common in skin that has been broken, such as areas where fingernails have been bitten or hangnails have been picked. These are often called “seed” warts because the blood vessels to the warts produce black dots that look like seeds.

Plantar warts (verruca plantaris) are common warts located on the soles of the feet. Warts on the palms (verruca Palmaris) would be called palmar warts. When many small plantar warts grow in clusters, they are known as mosaic warts because they fit together like mosaic tiles, making them more stubborn to treat. 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. Black dots may also be seen in these warts. Plantar warts can be very painful.

Flat warts (verruca-plana) are smaller and smoother than other warts. They tend to grow in large numbers – 20 to 100 at any one time. They can occur anywhere, but are most common on the face, in the beard area in men, and on the legs in women. Irritation or microscopic cuts in the skin from shaving probably contribute to them.

Genital warts (condylomata acuminata) are usually sexually transmitted and can be spread from close physical contact and repeated exposures. They are also seen in infants who have been delivered vaginally to mothers with HPV in their genital tract. Genital warts are flesh-colored, and may be rough or smooth. They can be large or small and found as a single growth or in groups. Genital warts appear on the genitals, inside the vagina, on the cervix, or around the anus.

Why do some people get warts and others do not ?
Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails. Just as some people catch colds very easily, some people are more likely to catch the wart virus than others.

Do warts need to be treated?
In children, warts can disappear without treatment over a period of several months to years. However,
warts that are bothersome, painful, or multiplying rapidly should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat warts?

• A variety of treatments are available depending upon the age of the patient, the location of the wart, and the type of wart.
• Salicylic acid gels, solutions, or plasters may be prescribed for daily home treatments. There is usually
  little discomfort but it can take many weeks-months of treatment to obtain results.
• Cantharidin is a chemical that can be applied in the dermatologist’s office. It causes a blister to form
  under the wart. The dermatologist can then clip away the dead part of the wart in the blister roof in
  a week or so, and re-treat the remaining wart of necessary.
• Cryotherapy is freezing with a cold liquid gas called liquid nitrogen. This treatment causes a blister to
  form which can be clipped in a week; repeat treatment at one to three week intervals is usually
  required. Cryotherapy may be painful, and can result in scarring.
• Laser treatment can also be used for resistant warts that have not responded to other therapies.
• Surgery or cutting may be used to remove the wart.
• Imiquimod is a cream that causes an inflammatory response which makes the wart go away. It
  may be applied at home and is especially good for genital warts.

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