Skin Conditions and Diseases

SKIN SURVEILLANCE

A full body skin check or surveillance is important and necessary to conduct in order to ensure that nothing abnormal is present on your skin.  Atypical moles, melanomas, skin cancers, and other malignant growths can be detected with a general body check.  If a growth or lesion is found to be visually suspicious, then a quick biopsy is taken to diagnose the nature of that growth.  If the lesion is found to be pre-malignant or malignant, different treatments are utilized depending on the type of growth.  The most important preventative measure for skin cancers, sun damage, and premature wrinkling and aging of the skin is to wear sunscreen daily.

WARNING SIGNS OF ABNORMAL MOLES (the ABCDE’s of what to look for)

Asymmetry -  Normally a mole should be symmetric but if the shape is lopsided, not symmetric, that is one of the warning signs.

Border Irregularity – A mole should have nice, crisp, sharp borders.  If a mole has fuzzy, indistinct, jagged, irregular borders, this is a warning sign.

Color Variation – A mole ideally should have only color (black, brown, tan,).  However, if a mole is two-toned or has multiple colors, looks like a fried egg with a dark center, has a white halo around it, this is something to watch out for.

Diameter – If a mole is greater than 6 mm (about the diameter of the tip of pencil eraser), this is a warning sign.

Elevation – If a mole was previously flat and suddenly became elevated, this is a warning sign.  An elevated mole to begin with is okay if none of the other warning signs are present.

Finally, if a person has an abundant number of moles, any mole that stands out or jumps our visually, looks different whether it be darker, larger, more irregular compared to the rest of the moles is a warning sign.  A mole that has a hair growing out of it usually means that is was present since birth or at a young age and is typically normal.  If a moles is found to be abnormal by biopsy, it is excised out surgically under local anesthesia.

MELANOMA

The only way to detect a melanoma is through a biopsy of the lesion.  If a mole has any of the ABCDE’s that is more extreme than usual, the possibility of a melanoma needs to be excluded.  Often times a relative such as a parent or sibling may have a history of melanoma or atypical moles and so a family history is a risk factor for melanoma. Melanomas are treated with surgical excision, possible exploration of lymph nodes, and in more severe cases, with chemotherapy or immunotherapy.  In addition, a chest x-ray and blood test to check for liver enzyme elevations is performed upon diagnosis of a melanoma.  Once a diagnosis of melanoma is established, full body checks must be performed every 3 months for at least a year.

SKIN CANCERS AND PRE-CANCEROUS LESIONS

The most common cause of skin cancer is due to excessive sun exposure.  Skin cancers do not occur immediately but start to develop 10 – 30 years later after chronic sun exposure.  Typically, they become evident after the age of 40 but may occur in the 20’s and 30’s.  Skin cancers and pre-cancerous lesions typically are present on sun exposed body areas such as the face, scalp, arms, chest, upper back, lower legs, but can occur in any location.  Some signs of skin cancers are a rough, red lesion that can be flat or raised, a growth that bleeds and does not want to heal, or a growth that is pink and has a pearly appearance to it.  Actinic keratosis are precancerous lesions that are rough and pink and treated by freezing with liquid nitrogen.  Actinic keratosis need to be treated because they can become skin cancers if left untreated.  Basal cell carcinomas and squamous cell carcinomas are common skin cancers.  They rarely spread but if left untreated, can continue to grow and invade on the skin.  These kinds of skin cancers are treated by surgical excision or Mohs micrographic surgery which are performed under local anesthesia.

ACNE

Acne is a condition that affects anyone at all ages – teenagers and adults alike.  Causes of acne include excessive oil production which results in clogged pores and the proliferation of bacteria that can results in cysts.  Severe acne can result in scarring that may produce lifelong social embarrassment.  Females with acne may have hormonal imbalances that contribute to acne formation.  Therapy for acne include topical retinoid creams that help exfoliate your skin, unclog the pores, and reduce excessive oil production.  Topical antibiotic creams containing clindamycin, benzoyl peroxide, erythromycin, and sodium sulfacetamide are effective in treating acne.  For more moderate cases of acne, an oral antibiotic such as minocycline or doxycycline are valuable in treating inflammatory acne.  For more severe cases of acne that can result in scarring, there is an oral agent called isotretinoin that is taken for around 6 months to virtually eliminate the acne with a low chance of recurrence.  Accutane does require monthly blood testing and females of childbearing potential must be on birth control because Accutane causes birth deformities. Finally, procedures such as lasers, light sources, and facials are effective in treating acne as well as microdermabrasion to reduce acne scarring.

ROSACEA

Rosacea is a medical condition is which persistent redness and the development of telangiectasias (broken capillaries) appear on the cheeks, forehead, nose, and chin.  Rosacea is most common in fair skinned individuals and has varying degrees of severity ranging from only redness and broken capillaries of different intensities, to the appearance of acne-like cysts, red bumps, and pustules, and in more extreme cases, the enlargement of the nose (rhinophyma).  Rosacea is managed in several ways.  Topical creams containing metronidazole, azelaic acid, minocycline, and sodium sulfacetamide products are commonly used.  For more inflammatory rosacea, topical antibiotics such as doxycycline or minocycline area prescribed.  A very common and effective treatment modality for rosacea is the pulsed dye laser and intense pulsed light.  Both devices are effective in decreasing the redness and telangiectasias seen in rosacea.

PSORIASIS

Psoriasis is common skin disorder affecting approximately 7 million Americans.  People afflicted with psoriasis often have scaly, red, itchy, thickened plaques on their elbows, knees, scalp, trunk, extremities, and any other body areas.  Up to a third of patients report someone on their family having psoriasis.  In addition, up to 30% of patients with psoriasis develop psoriatic arthritis which commonly affects the fingers, toes, spine, and other joints.  In addition, there has been a clear association between cardiovascular disease and psoriasis (obesity, hypertension, diabetes, high cholesterol which result in heart attacks and strokes).  People with psoriasis are embarrassed with their condition and are often socially isolated and depressed.  For this reason, it is important that patients with psoriasis seek medical attention.  Although there is no permanent cure for psoriasis, there are effective treatment modalities.  These include topical creams that contain cortisone but also there are effective non-steroidal topicals. For more severe cases of psoriasis, ultraviolet light therapy and laser are used.  Several oral agents are effective in treating psoriasis.  Finally,  a wide variety injections called biologic agents are very safe and effective to treat psoriatic disease. 

ATOPIC DERMATITIS

Atopic dermatitis is a form of eczema which is a skin condition that affects approximately 20 million Americans.  Frequently it begins in childhood and can persist into adulthood but also can start in adults.   Atopic dermatitis typically is a scaly, itchy, red rash that occurs on any body area.  Common locations are  front of the elbows, behind the knees, and on the face and neck.  Atopic dermatitis frequently is associated with asthma and hay fever.  Because of the intense itching, sleep is often disrupted. Atopic dermatitis is treated with moisturizers, cortisone and non-cortisone creams, anti-itch lotions, antihistamines, and if there is a skin infection, antibiotics and bleach baths are used.  Similar to psoriasis, there are many oral agents and biologic agents to treat atopic dermatitis which are safe and effective.

SEBORRHEIC DERMATITIS

Seborrheic dermatitis is medical term for dandruff of the scalp and the skin.  Malassezia furfur is a naturally occurring yeast organism on the skin that is associated with this condition.  Seborrheic dermatitis of the scalp is treated with medicated shampoos (prescription or non-prescription strength) and for more moderate flaking and itching, cortisone based foams and solutions are used.  Seborrheic dermatitis of the face typically affects the “T-zone” (eyebrows and around the nose) and the ears.  Redness and flaking are common symptoms.  Cortisone, non-hydrocortisone, and antifungal creams are commonly prescribed to control seborrheic dermatitis.

WARTS

Warts are caused by the human papilloma virus (HPV) and transmitted from skin to skin contact.  Typical affected areas are the soles, hands, face, genital areas, and almost any other body area.  Common treatment modalities for warts are freezing with liquid nitrogen, pulsed-dye laser, laser resurfacing, excision, and the application of various topical agents that contain salicylic acid and imiquimod.

ALOPECIA (HAIR LOSS)

The two most conditions that dermatologists treat for hair loss are androgenetic alopecia and alopecia areata.  Androegenetic alopecia (pattern hair loss - male and female) is the most type of hair loss that progresses with aging.  Common treatments are minoxidil (both topical which is over the counter and the pill form which requires a prescription) and finasteride which is pill indicated only for men.  Female hair loss can be associated with a hormonal imbalance and may be correctable with hormonal agents.  In addition, both physical and mental stress can contribute to a temporary hair loss condition called telogen effluvium. Alopecia areata is an autoimmune condition whereby there is abrupt patchy hair loss on various areas of the scalp.  Alopecia areata can occur on other body areas such as the eyebrows, eyelashes, beard area, and the whole body.  If the alopecia areata is minor, it is typically treated with cortisone injections at the site of the hair loss and with topical agents.  For more widespread forms of alopecia areata, systemic oral agents such as JAK inhibitors.

BIRTHMARKS

Birthmarks such as port-wine stains, café-au-lait macules (tan patches), Becker’s nevus (tan patches with excessive course hair which can worsen at puberty), Nevus of Ota, and Mongolian spots are amenable to different types of lasers treatments.

NAIL DISORDERS

Fungus of the nails (onychomycosis) is common and often caused by athelete’s foot.  It is treatable with various oral agents and topical agents.  Splitting of the nails and ridging can be treated with prescription strength or over the counter nail moisturizers.  Nail pitting can occur with skin conditions such as psoriasis and alopecia areata.

VITILIGO

Vitiligo is an autoimmune disease whereby the pigment in the skin is destroyed by the body’s own immune system leading to the development of white patches on the body, typically in a symmetric pattern.  Vitiligo can be a devastating condition emotionally and may be associated with a thyroid disorder, diabetes, anemia, or Addison’s disease.  Vitiligo is treated with topical anti-inflammatory creams (cortisone and non-cortisone based) and ultraviolet light therapy and ultraviolet lasers.  There is only one FDA approved agent to treat vitiligo topically which is a JAK inhibitor.