Medical Dermatology

Acne

Acne is a very common skin condition that has clogged pores, pimples, and even cystic nodules. It typically affects the face, neck, chest, and back of teenagers, however, some patients notice the onset of acne as an adult. Acne can be very frustrating to the patient and have negative effects on a patient’s self-image, especially when scarring occurs. Therefore, the treatment of acne is very important to prevent permanent scarring.

There are lots of common misconceptions about acne. It is not caused by foods or having a dirty face. It is important to wear non­comedogenic makeup (won’t clog pores) and wash the face twice daily with a gentle cleanser. Adult onset acne may be related to hormonal changes associated with childbirth, menopause, or stopping birth control pills. It is useful for women to note whether their acne flares around their monthly cycle.

There are many different treatment options for acne. It is important to remember that what works well for one person’s acne may not work for others. Depending on the severity and extent of skin lesions, Dr. Myers will provide you with a customized acne treatment plan to fit your personal skin type. Once your skin is clear, it is important to use maintenance treatments to prevent acne from returning. The emotional burden of acne can be profound, and our team of skin care professionals is committed to helping you attain the lifetime of clear skin you deserve.

Medical treatment options for acne treatment include:

  • Prescription topical creams
  • Oral Antibiotics
  • Isotretinoin
  • Levulan® with BLU­Light

Clinical Spa Treatment options for acne treatment include:

  • Glycolic or Salicylic acid products
  • Acne facial treatment
  • Extractions
  • Fruit acid peels

Actinic Keratosis

Actinic Keratosis (AKs) are dry, scaly patches that form on sun exposed areas of the skin, including the scalp, face, forearms, and back of the hands. Most people with one actinic keratosis (AK) lesion will develop multiple lesions during their lifetime. They may occasionally itch or become tender, especially after sun exposure. Actinic keratosis most often develops in people with light-colored skin and hair and have decades of excessive sun exposure. AKs are most common in men and women over 40 years old.

Actinic keratosis is considered precancerous by many physicians and has the potential to become a type of skin cancer called squamous cell carcinoma (SCC). In fact, 40% to ­60% of squamous cell skin cancers begins as untreated AKs. Fortunately, actinic keratosis is treatable when detected in the early stages. People at risk for actinic keratosis and skin cancer can reduce that risk by performing frequent skin self-exams at home and seeing their dermatologist for regular screenings. There are many successful and relatively simple treatment options.

Options for treatment of actinic keratosis include:

  • Cryotherapy with liquid nitrogen
  • Photodynamic therapy (Blu­U light)
  • Topical prescription creams

 

Allergic Contact Dermatitis

Allergic contact dermatitis is caused by a reaction to substances, known as allergens, that cause itching, redness, and blisters on skin contact. It can be a very annoying rash that affects a patient’s quality of life. With long-term exposure, the skin becomes thick and often cracks with painful fissures. It commonly affects the hands, but may involve any part of the body.

The patient history and distribution of the rash are often helpful clues to the potential allergen. The most common allergens include rubber, nickel, dyes, fragrances and preservatives in skin care products, poison ivy/poison oak, and chromates.

If the exact cause is still unclear, Dr. Myers may perform patch testing. This involves taping small amounts of the common allergens on the skin and evaluating for an allergic or irritant reaction two days later. A third reading occurs after another two days has passed. We offer a comprehensive approach to contact dermatitis diagnosis and treatment. It is important to avoid allergens that cause the rash, as well as the common cross reacting allergens. After completion of the patch testing, you will be provided a personalized, detailed analysis with recommendations on products that are safe to use.

Common treatment options may include:

  • Mild Personal Care Products
  • Topical Creams or Ointments
  • Oral or Injectable Steroids

Eczema

Eczema is also called atopic dermatitis. It currently affects 10­% to 20% of children and 1­3% of adults in the United States, and its prevalence there has more than doubled in the past three decades. The skin of a patient with eczema is sensitive and easily aggravated by environmental allergens and irritants. It is commonly said that it is the “itch that rashes” because the scratching the itchy skin causes redness, scaling, and thickening over time. The sites usually affected include the face of infants or the inner elbows and knees of older children.

Most patients with atopic dermatitis have symptoms within the first year of life, and almost 90% have symptoms by the age of 5. Eczema can often occur together with hay fever or asthma and is thought to be a familial, chronic disease. It is not contagious to other people.

The cause of eczema is unknown at this time. It is thought that an overactive immune response to normal environmental allergens may be the underlying cause. The natural course of atopic dermatitis is to improve or disappear as the patient ages. The primary treatment involves prevention, which includes avoiding or minimizing contact with known allergens. If eczema cannot be controlled with over-the-counter moisturizers and avoidance of allergens, it is important to see a Dermatologist to seek definitive diagnosis and treatment. With proper education about the condition and good skin care regimens, patients with eczema can be treated very effectively.

Options for treatment of eczema include:

  • Moisturizing Lotions or Creams
  • Cortisone Medications
  • Other Topical Prescriptions
  • Antibiotics
  • Antihistamines
  • Light therapy

 

Hair Loss (Alopecia)

Hair loss (alopecia) can have many different underlying causes and often causes significant emotional distress to the patient. Common causes of alopecia including genetic influences, stress, hormonal changes, medical conditions, and oral medications. There is one form of hair loss that presents with bald smooth patches usually of sudden onset. With thorough evaluation and proper early treatment, most forms of hair loss can be identified and corrected. We are dedicated to partnering with our patients to reverse hair loss through a customized plan for hair regrowth.

Options for treatment of alopecia include:

  • Oral prescription medications
  • Topical prescription strength medication
  • Vitamin supplementation
  • Medicated shampoos
  • Cortisone scalp treatments

 

Hyperhidrosis

Excessive underarm sweating is a medical condition that involves production of sweat in excess of what your body needs to maintain its temperature. The excessive sweating can occur even in cool temperatures and without physical exertion. People with the condition often change clothes frequently, put absorbent material under clothing, and have tried numerous topical anti­perspirants without success. Stress can aggravate the symptoms. This condition can cause anxiety and feelings of self-consciousness.

BOTOX® is FDA­approved for severe underarm sweating when topical agents don’t work. BOTOX® treatment helps control this situation by temporarily inhibiting the sweat glands. During the procedure, a small amount of Botox is injected through a very fine needle into the affected underarm area. This procedure is a quick and very effective in office procedure with no downtime. Results typically last 7­18 months and require repeat treatments for the effects to be maintained. Some insurance plans may cover this procedure.

Mole Checks

The medical term for a mole is a nevus. Congenital nevi are moles present at birth and acquired nevi may develop anytime later. Any change in the growth pattern, color, surface texture or onset of pain, bleeding, or itching are concerning symptoms. These should prompt a thorough evaluation by a Dermatologist to exclude the diagnosis of melanoma.

Congenital Nevi

Only a few babies, 1 in 100, are born with what is known as a congenital nevus. These can vary in size from being less than 1/4 inch to covering almost the entire body. Large nevi can vary greatly in size, shape, color, surface texture, and hairiness. Some are reddish tan; others are almost black. Most are shades of brown. Congenital moles will grow in proportion to body growth.

Giant congenital nevi are those that measure 10 cm or more at birth and occur in about one in every 20,000 children. It is recommended that a Dermatologist examine these particular nevi on a yearly basis.

Acquired Nevi

Most moles that are acquired during life are usually less than 1/4 inch in size. Many moles that begin in childhood and early adult life are now thought to be due to sun damage. We often think of a mole as a brown spot, but moles have many other appearances. They can be flat or raised and range in color from normal skin to dark brown. The presence of hair in a mole does not make it more dangerous.

Moles may darken under certain circumstances, especially with sun exposure and pregnancy. Moles that appear after age 50 should be examined carefully with suspicion.

Atypical Moles (Dysplastic Nevi)

An estimated 1 in 10 Americans has at least one atypical mole. These moles are often larger than common moles, with irregular and poorly defined borders. Atypical moles also vary in color, ranging from tan to dark brown shades. They may fade into surrounding skin and include a flat portion level with the skin. These are some of the features that one sees when looking at a melanoma. A Dermatologist is an expert skilled at differentiating atypical nevi from melanoma.

How to examine your skin:

It is important to look for the warning signs of melanoma. Use the method of ABCDE’s of melanoma detection for skin exams: Asymmetry, Borders, Color, Diameter, and Evolving (changing). If a mole has any of these signs, a Dermatologist must check it promptly.

A ­ Asymmetry
One half is unlike the other half.

B ­ Border
Irregular, scalloped, or poorly circumscribed border.

C ­ Color
Different in one area compared to another; shades of tan and brown, black; sometimes white, red or blue.

D ­ Diameter
While melanomas are usually greater than 6mm in diameter (the size of a pencil eraser) when diagnosed, they can be smaller.

E ­ Evolution (changing)
If you notice a mole different from others (the “ugly duckling sign”), or new changes such as rapid growth, itching, or bleeding, you should see a Dermatologist.

 Patch testing

In allergic contact dermatitis, typically harmless substances cause an immune system reaction when they come in contact with the skin. For those patients who suffer with chronic dermatitis (eczema), not responding to normal treatment options, we often recommend patch testing. We have extensive expertise in patch testing both adult and pediatric patients. Common symptoms in contact dermatitis may include:

  • Redness
  • Blistering
  • Fissures
  • Itching
  • Hives
  • Burning sensation

These symptoms can last for weeks and can usually be treated at home through medications and topical creams. The best protection against contact dermatitis is to identify the specific triggers that cause reactions, so that patients can avoid these substances to prevent skin irritation. A patch test may help identify the trigger. It does not require the use of any needles or injections and is a simple test to perform.

Most dermatologists use the TRUE Test, which is a very good screening tool but is limited to testing 28 chemicals. At Myers Dermatology, we offer an expanded patch testing for what is called the North American Series of Allergens, which include up to 70 allergens known to cause skin rashes in North America. This more comprehensive testing can be very valuable information for those who suffer with allergic contact dermatitis.

The patch testing procedure is simple and painless. In order to identify specific triggers, we will tape several patches that contain various potential chemicals to the skin on the back. These chemicals are then left on the skin for up 48 hours and must remain dry during this time. Patients are advised to take only sponge baths and avoid excessive sweating. After 48 hours, the patch test is removed and an initial reading is taken to observe any reactions. An additional reading is taken after another 24­48 hours. Patients can bathe in between these readings, but should avoid scrubbing the back. Once the final results of the test have been read, normal bathing can be resumed. Before undergoing patch testing, patients should stop using oral and topical corticosteroids in the area to be tested, avoid oral antihistamines, and should not expose the test area to the sun for at least three weeks.When reading the results, your doctor may classify each spot on a scale from negative (meaning no reaction) to extreme reaction (meaning positive results for substance). Once positive results have been determined, patients can take action to avoid their triggers and prevent contact dermatitis from reoccurring. At Myers Dermatology, our team of professionals will provide you with detailed, specific information on your individual triggers and how to prevent future contact. Call our office or contact us online to request a consultation with Dr. Jennifer Myers for patch testing.

Phototherapy (narrowband UVB)

Previously, many different wavelengths (misspelled) of light (broad band) in the ultraviolet B spectrum were given to treat skin diseases. However, it was found that giving only very limited narrowband wavelengths of light was just as or more effective as broadband. It also offers a better side effect profile in the form of less burning, skin damage, and possibly skin cancer. Narrowband UVB is the administration of light to treat various skin diseases including psoriasis, eczema, and vitiligo. Call our office today for more information, or to schedule your phototherapy consultation.

Psoriasis

Psoriasis is a common inflammatory skin condition with persistent red patches covered with thick, silvery scale. It typically affects the elbows, knees, trunk, scalp, palms and soles. It can also affect the nails. The cause is not known; however it tends to run in families and may be due to an overactive immune response. It is not an infection or contagious to other people.

Psoriasis is often triggered or worsened by several factors. These include stress, strep infection, and oral medications. It tends to flare or worsen during the winter due to low humidity, cold air, and lack of sunlight exposure. Some psoriasis patients notice the Koebner phenomenon, which refers to the appearance of new skin lesions at sites of skin trauma.

It is estimated that 10­30% of psoriasis patients also develop painful, stiff, or swollen joints called psoriatic arthritis. It can develop at any time, but it appears between the ages of 30 and 50 in most patients. It is important to tell your Dermatologist if you experience these symptoms because early recognition and treatment can prevent progressive joint deformity.

Dr. Myers can create a treatment plan personalized to specific needs and disease severity. New therapeutic advances are giving new hope to patients who suffer from this disease.

Psoriasis treatments include:

  • Topical Creams and Ointments
  • Occlusive skin wraps
  • Oral Medications (Otezla, Soriatane, Methotrexate)
  • Narrowband UVB Phototherapy
  • Biologic Injectables (Stelara, Cosentyx, Humira, Enbrel)

Rosacea

Rosacea is a chronic skin condition characterized by redness, flushing pimples, and, in advanced stages, thickened skin. Rosacea usually occurs on the face, and presents with flushing on the nose, cheeks, forehead and chin. Adult women are afflicted more often than men by rosacea, and its onset might be accompanied by a burning sensation or sensitivity. Rosacea is a chronic disorder and is typically characterized by relapses and remissions. It may also make the skin more sensitive to lotions or make­up.Treatment for rosacea may include medical therapy and lifestyle modifications. A broad-spectrum SPF is recommended daily, as well as skin care products that do not contain harsh chemicals or ingredients that may irritate or cause a rosacea flare. Depending on the severity of your symptoms, a topical prescription cream or oral medication may be recommended. Also, we advocate watching for triggers, which may not be the same from one person to the next, and continuing therapy seem to help prevent recurrence of symptoms. Common triggers include stress, sun exposure, hormonal changes, alcohol intake, and spicy foods.

In addition to medical treatment, many rosacea sufferers also seek cosmetic treatments to treat signs and symptoms of the disorder. IPL is the most popular cosmetic procedure performed on rosacea sufferers to treat and remove visible blood vessels or reduce redness. Please click here to read more about IPL photo facial treatments.

Our staff of professional providers is passionate about rosacea care. There are several simple ways to calm and treat rosacea. Dr. Jennifer Myers and her staff specialize in the treatment of rosacea and helping our patients establish a custom treatment plan for all types of rosacea.For more information about rosacea, please visit www.rosacea.org for a wealth of information and patient education materials. Also, the National Rosacea Society has a Facebook page you may like.

Clinical Spa Treatment options for Rosacea treatment include:

  • Redness neutralizing facial treatment
  • Salicylic acid peels
  • IPL (photodynamic therapy)
  • Levulan® with BLU­Light

Skin Cancer

Skin cancer is an abnormal growth of malignant skin cells. The American Academy of Dermatology estimates that 1 in 5 people will develop skin cancer in their lifetime. More than 1 million new cases of skin cancer will be diagnosed this year. People with fair skin, frequent sun exposure, history of sunburns, and a family history of skin cancer are at greatest risk.If detected early, the prognosis is excellent with a 95% cure rate. The key to early detection is for everyone to perform periodic self-examinations and see their Dermatologist regularly. Having a partner help you with this is a good idea.

The most common skin cancers include:

1. Basal cell carcinoma ­ 85% of all skin cancers. Basal cell carcinomas usually occur on sun­ exposed skin of fair skinned people. This includes the head, neck and upper body in fair skinned people. If detected early, it is easily treated with excellent cure rates. However, if neglected for many years, basal cell carcinoma may invade deeply and cause extensive tissue destruction in the muscle and bone or very rarely death.

2. Squamous cell carcinoma – 10% of all skin cancers. Squamous cell carcinomas are also typically found in fair skinned people in sun exposed areas. This type of skin cancer can become invasive and spread (metastasize) to other parts of the body without the proper treatment. With early diagnosis and surgical excision, the cure rate is over 95%. Treatments vary depending on the location and type of tumor.

Treatment options include:

  • Mohs Micrographic Surgery
  • Excision
  • Electrodessication and Curettage
  • Cryosurgery with Liquid Nitrogen
  • Topical Creams
  • Levulan® with BLU­Light

3. Melanoma ­ 5% of all skin cancers. Melanoma, the most serious form of skin cancer, is highly curable when found and treated early. However, it can be deadly if undetected as more than 75% of skin cancer deaths are due to melanoma. 1 in 58 men and women will be diagnosed with melanoma during their lifetime.Melanoma may appear suddenly on normal skin or begin within an existing mole. If you see any changes in your existing moles or appearance of a new mole, a Dermatologist must examine it. See the ABCDE’s of melanoma detection below. You can also visit the website skincancer.org.

When to see a Dermatologist:

Dermatologists are experts in visually examining the skin to detect skin cancer. A dermatologist should regularly examine everyone who has had skin cancer in the past or risk factors for developing skin cancer.

If a worrisome lesion is found, a biopsy may be necessary to examine it under the microscope. You can be assured that Dr. Myers and her staff will ensure your comfort and address all concerns you may have when visiting our office.

Vitiligo

Vitiligo occurs when the skin loses melanin, which is the pigment that determines skin, hair and eye color. This results when the cells that produce melanin are damaged or destroyed and can no longer produce natural pigment. It presents with gradually enlarging white patches on the skin. We offer several treatment options, including topical therapies as well as phototherapy with narrow band ultraviolet B light (NB­UVB). Schedule an appointment at Myers Dermatology to discuss the best treatment options and establish a custom treatment plan for your vitiligo. Repigmentation of the skin is the ideal goal of treatment. We have years of expertise treating both adults and children with vitiligo.

          Warts and molluscum

Warts and molluscum are common skin growths that are not harmful but are often bothersome to those affected. It has been estimated that up to 1 in 20 school age children will have warts.

Common warts usually affect the hands of children or adults with significant water exposure at work.

Plantar warts occur on the soles of the feet and may be annoyingly painful with walking.

Flat warts tend to be very small and appear in large numbers. They can appear on the face of children, but are also seen on the beard area of men and legs of women due to shaving. Molluscum contagiosum is very common amongst school aged children and presents with smooth, skin colored bumps often accompanied by skin irritation. Both warts and molluscum are contagious and spread from one person to another with skin contact.

The natural course of warts and molluscum is to disappear without treatment over months to years. If warts are troublesome to the patient, painful, or spreading rapidly, the patient should see a Dermatologist. Warts in adults may not go away without proper treatment. Dr. Myers is very skilled in the most advanced techniques for wart and molluscum removal. There are several painless options, which are especially important for children.

Treatments include:

  • Cryotherapy (Freezing with Liquid Nitrogen)
  • Topical “peeling” agents such as prescription salicylic acid
  • Immunotherapy (injection of Candida yeast antigen as a monthly treatment series to boost your innate immune system’s defense against wart virus)