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Medical Dermatology

Actinic Keratoses

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About Actinic Keratoses

What is it?

Actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on the skin that develops from years of sun exposure. It’s often found on the face, lips, ears, forearms, scalp, neck, or back of the hands.
Also known as a solar keratosis, an actinic keratosis grows slowly and usually first appears in people over 40.
You can reduce your risk of this skin condition by minimizing your sun exposure and protecting your skin from ultraviolet (UV) rays.
Left untreated, the risk of actinic keratoses turning into a type of skin cancer called squamous cell carcinoma is about 5% to 10%.

What causes it?

Actinic keratoses vary in appearance. Signs and symptoms include:
  • Rough, dry or scaly patch of skin, usually less than 1 inch (2.5 centimeters) in diameter
  • Flat to slightly raised patch or bump on the top layer of skin
  • In some cases, a hard, wartlike surface
  • Color variations, including pink, red or brown
  • Itching, burning, bleeding or crusting
  • New patches or bumps on sun-exposed areas of the head, neck, hands, and forearms

Common Treatments?

  • Freezing (cryotherapy). Actinic keratoses can be removed by freezing them with liquid nitrogen. Your doctor applies the substance to the affected skin, which causes blistering or peeling. As your skin heals, the damaged cells slough off, allowing new skin to appear. Cryotherapy is the most common treatment. It takes only a few minutes and can be done in your doctor’s office. Side effects may include blisters, scarring, changes to skin texture, infection, and changes in skin color of the affected area.
  • Scraping (curettage). In this procedure, your doctor uses a device called a curet to scrape off damaged cells. Scraping may be followed by electrosurgery, in which the doctor uses a pencil-shaped instrument to cut and destroy the affected tissue with an electric current. This procedure requires local anesthesia. Side effects may include infection, scarring, and changes in skin color of the affected area.
  • Laser therapy. This technique is increasingly used to treat actinic keratosis. Your doctor uses an ablative laser device to destroy the patch, allowing new skin to appear. Side effects may include scarring and discoloration of the affected skin.
  • Photodynamic therapy. Your doctor might apply a light-sensitive chemical solution to the affected skin and then expose it to a special light that will destroy the actinic keratosis. Side effects may include redness, swelling, and a burning sensation during therapy.

Providers

Our approach & expertise

Our practice has skilled dermatologic experts who have the experience and knowledge to provide effective solutions for your particular needs and goals. Our focus on you as a person is what makes us different from others, and we’ll be with you each step of the way with empathy, advice, and support. Healthy skin is our passion. Contact us today if you have actinic keratosis so that we can help you.

Ear Lobe Repair

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Earlobe repair is a minor surgical procedure designed to correct and reconstruct the earlobes, which can be damaged or stretched due to various reasons. This procedure is typically performed to repair split, torn, stretched, or gauged earlobes, restoring their natural appearance.

Reasons for Earlobe Repair

  1. Torn Earlobes: Often caused by trauma, such as earrings being accidentally pulled or caught, resulting in a tear.
  2. Stretched Earlobes: Prolonged wearing of heavy earrings or plugs can stretch the earlobe.
  3. Split Earlobes: When the piercing hole is pulled through completely, resulting in a split.
  4. Gauged Earlobes: Correcting earlobes that have been intentionally stretched with gauges or plugs but are no longer desired.
  5. Keloids and Scarring: Removal of scar tissue or keloids from previous piercings or injuries.

Procedure for Earlobe Repair

  1. Consultation: The first step involves consulting a qualified plastic surgeon or dermatologist to evaluate the earlobe’s condition, understand the desired outcome, and discuss treatment options.
  2. Local Anesthesia: The procedure is performed under local anesthesia to numb the earlobe, ensuring comfort throughout the process.
  3. Repair Technique:
    • For torn or split earlobes, the surgeon will remove the damaged tissue and suture the edges back together using fine stitches.
    • For stretched earlobes, excess skin is removed, and the remaining tissue is reshaped and sutured.
    • For gauged earlobes, the surgeon excises the stretched skin and then reshapes the earlobe by suturing the edges together to form a more natural contour.
    • If there are keloids or scar tissue, they are carefully removed, and the skin is reconstructed to minimize scarring.
  4. Stitching: The earlobe is carefully stitched using fine sutures to ensure minimal scarring and a natural-looking earlobe shape. The sutures are typically removed after 5-7 days.
  5. Recovery and Aftercare:
    • The procedure is minimally invasive, with a short recovery period.
    • Patients may experience mild swelling, bruising, or discomfort, which can be managed with pain relievers and ice packs.
    • Keeping the area clean and avoiding heavy earrings or jewelry for several weeks is important.
    • Full healing generally takes 4-6 weeks, during which time any scarring will continue to fade.
  6. Re-Piercing: Re-piercing can be done after full healing, usually 2-3 months post-surgery, but it’s advisable to discuss this with the surgeon.

Benefits of Earlobe Repair

  • Restores natural earlobe shape and appearance
  • Minimal scarring and downtime
  • Allows for the possibility of re-piercing in the future
  • Boosts self-confidence and aesthetics

Acne Scar Treatment

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Acne scar treatment involves various methods to reduce the appearance of scars left behind by acne. The type of treatment depends on the kind of scars, skin type, severity, and personal preferences. Acne scars can be of different types, including atrophic (depressed scars like icepick, boxcar, or rolling scars) and hypertrophic (raised scars), and each type responds differently to treatment.

Common Acne Scar Treatments

  1. Topical Treatments:
    • Retinoids: Prescription-strength retinoids (like tretinoin) help increase cell turnover, promote collagen production, and fade mild scarring and discoloration.
    • Alpha Hydroxy Acids (AHAs) & Beta Hydroxy Acids (BHAs): Help exfoliate the skin’s surface, unclog pores, and reduce mild acne scars.
    • Skin Lightening Agents: Ingredients like vitamin C, kojic acid, and niacinamide can help reduce hyperpigmentation associated with acne scars.
  2. Chemical Peels:
    • Peels like glycolic acid, salicylic acid, or TCA (Trichloroacetic Acid) peels can help exfoliate the skin, improve skin texture, and reduce the appearance of mild to moderate scars.
  3. Microneedling:
    • A procedure that uses tiny needles to puncture the skin, promoting collagen production and skin regeneration. Effective for atrophic scars, especially rolling scars.
  4. Laser Therapy:
    • Fractional CO2 Laser and Erbium YAG Laser are commonly used for resurfacing the skin and promoting collagen production. They are effective for all types of acne scars.
    • Non-ablative lasers (like Nd) stimulate collagen without removing the top layer of skin.
  5. Dermabrasion and Microdermabrasion:
    • Dermabrasion is a more intense treatment that removes the outer layer of skin using a rotating device, effective for deeper scars.
    • Microdermabrasion is a gentler exfoliation that improves mild scars.
  6. Fillers:
    • Dermal fillers (like hyaluronic acid, poly-L-lactic acid) can temporarily fill in atrophic scars, such as boxcar or rolling scars, giving the skin a smoother appearance.
  7. Subcision:
    • A minor surgical procedure where a needle is inserted under the skin to break up the fibrous tissue that causes depressed scars. It is effective for treating rolling scars.
  8. Punch Excision and Grafting:
    • Surgical methods that involve removing the scar tissue and either stitching it up or filling it with skin from another area. Effective for icepick and deep boxcar scars.
  9. Steroid Injections:
    • Used for treating hypertrophic or keloid scars by reducing inflammation and flattening raised scars.
  10. Radiofrequency (RF) Therapy:
    • Combines microneedling with radiofrequency energy to promote deeper collagen production and treat acne scars effectively.

Dandruff (Seborrhea)

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Seborrhea, also known as seborrheic dermatitis, is a common chronic inflammatory skin condition that primarily affects areas of the body rich in sebaceous (oil-producing) glands. It manifests as red, scaly, itchy patches and is often associated with dandruff when it occurs on the scalp.

Causes and Risk Factors:

  1. Overproduction of Sebum: Excessive oil production by sebaceous glands.
  2. Malassezia Yeast: An overgrowth of this yeast, which naturally lives on the skin, can trigger inflammation.
  3. Genetic Predisposition: A tendency to develop seborrhea can run in families.
  4. Environmental Factors: Stress, cold weather, and changes in humidity can exacerbate symptoms.
  5. Health Conditions: More common in people with certain neurological conditions (e.g., Parkinson’s disease) or immune system disorders (e.g., HIV/AIDS).

Symptoms:

  1. Scaly Patches: Greasy, yellow or white scales on the skin.
  2. Redness: Inflamed, red skin in affected areas.
  3. Itching: Itchy skin that can become quite uncomfortable.
  4. Affected Areas: Commonly affects the scalp (leading to dandruff), face (especially around the nose, eyebrows, and behind the ears), chest, and other areas with high oil gland concentration.

Diagnosis:

  • Clinical Examination: Based on the appearance and location of the symptoms.
  • Skin Biopsy: Rarely necessary but can be done to rule out other conditions.

Treatment:

  1. Medicated Shampoos: Anti-dandruff shampoos containing ingredients like ketoconazole, selenium sulfide, or zinc pyrithione.
  2. Topical Antifungals: Creams or lotions containing antifungal agents to reduce Malassezia yeast.
  3. Corticosteroids: Topical steroids to reduce inflammation and itching.
  4. Calcineurin Inhibitors: Topical medications like tacrolimus or pimecrolimus for sensitive areas such as the face.
  5. Hygiene and Skincare: Regular cleansing with gentle, non-irritating products.

Skin Cancer

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About Skin Cancer

What is it?

Skin cancer is the most common form of cancer in the US, affecting around 20 percent of Americans. However, it does not have to be fatal, especially when caught early. That’s why you shouldn’t ignore unusual skin bumps, lesions, discolorations, and other irregularities when they appear. Although the causes of skin cancer vary, there are common risk factors to be aware of, which include chronic sun exposure, a family history of skin cancer, fair skin, multiple sunburns throughout your life, precancerous skin lesions, and sunny and/or high-altitude climates and locales.

What causes it?

Skin cancer is caused by mutations in the DNA of skin cells, which then spreads to adjacent cells. When the spread is rapid or uncontrolled, it can easily become malignant. Three types of skin cancer are prevalent. The first is squamous cell carcinoma, which is located in cells just beneath the skin surface. The second is basal cell carcinoma (the most common type of skin cancer) which develops in the layer beneath squamous cells. Lastly, there is melanoma, the most dangerous variant. Melanoma forms under the other two layers of cells. A precancerous lesion, actinic keratosis (AK), also is possible; it usually is not life-threatening, but it can become cancerous if ignored.

Common treatments

Our skin cancer experts have the experience and training to help you overcome this disease. We highly recommend regular skin cancer screenings, especially if you are prone to the above risk factors. If a carcinoma is found, we’ll discuss the best solution with you from among the following treatment options: excisional surgery, electrodesiccation and curettage (EC&D), cryotherapy, and Mohs micrographic surgery.

Providers

Our approach & expertise

We provide an assortment of treatment options that can be customized to suit your needs based on your goals, concerns, and opinions about which treatment is right for you. We’ll be with you throughout the process with compassionate care and support so you can have your life back and live it to the fullest. We understand that a diagnosis of skin cancer can be traumatic and painful, both physically and emotionally. As your community skin cancer specialists, we’re here to provide encouragement, advice, and answers to your questions should you ever receive such a diagnosis. What sets us apart is our focus on you as a person. Our warm, compassionate practitioners are ready to address your concerns to be here as an essential part of your support.

Eczema

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Eczema Treatment Q&A

What is eczema?

Eczema is a chronic condition that causes patches of flaky, itchy, dry skin. Also called atopic dermatitis, eczema often affects children, resolving by adulthood, but it can affect adults as well. Some people have eczema throughout their lives beginning in childhood, while others may develop eczema as adults. When scratched or rubbed, the dry, flaky patches of skin can becoming irritated, weeping and even bleeding, increasing the risk of skin infection. Often, a scaly, rough crust will form over the area. When the skin in the affected areas is repeatedly scratched, it can eventually become rough and leathery.

What causes eczema?

The underlying cause of eczema is unknown, but researchers believe it occurs as a result of an inflammatory response that occurs when the skin is exposed to certain triggers like soaps or detergents, cosmetics or facial care products, or from triggers like perspiration or extreme changes in temperature. People with a family history of eczema are more likely to have it themselves, and the condition is also more common among people with asthma and allergies.

Is eczema contagious?

No, eczema is not contagious, which means it cannot be passed from one person to another.

How is eczema diagnosed?

Eczema usually can be diagnosed during an office visit with a visual examination of the skin. In a few cases, a small sample of skin cells may be removed from the skin surface for further evaluation to rule out other conditions that can cause similar symptoms.

How is eczema treated?

Some milder symptoms of eczema can be relieved with a change in detergents, soaps and other products that come in contact with the skin. Taking shorter or cooler showers and avoiding long soaks in a tub or hot tub can also reduce symptoms and prevent flare-ups. Moderate to severe symptoms may require antihistamines or hydrocortisone creams to reduce inflammation and control itching. Prescription medications and therapies like UV light therapy can also be helpful in severe cases. Seeing a dermatologist for regular evaluations helps ensure eczema symptoms remain under control so patients can find long-term relief for itching and flaking.

Vein Treatments

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About Vein Treatments

What are they?

We understand that prominent veins on your face, hands, or legs can affect you, both physically and psychologically. That’s why we offer various vein treatment options to eliminate unwanted veins and rejuvenate your appearance with clearer, healthier-looking skin. Varicose veins and spider veins are unsightly veins that develop due to trauma, heredity, overexposure to the sun, obesity, changes in hormone activity, problems with circulation, and more. On the legs, they can be unsightly and painful, while on the face they can cause you to be self-conscious about your appearance. Vein treatment involves therapies that eliminate veins by destroying them and then flushing them from your body.

What to expect

Our vein specialists utilize the following vein treatment options: sclerotherapy – the use of a solution that destroys veins before your body naturally flushes them from your system; IPL (Intense Pulsed Laser) therapy – gently dissolves troublesome veins with broadband light; PDL (Pulsed Dye Laser) therapy – safely erases unsightly veins with a dyed laser; and laser therapy – various types of minimally-invasive lasers that dissolve the targeted veins. Whichever therapy is used to eliminate facial or leg veins, you should expect to have clearer, smoother, less painful, and healthier-looking skin, but the overall number of treatments required depends on the extent of your vein issue and the therapy chosen.

After the procedure

Side effects vary from treatment to treatment, but some patients may experience mild and temporary side effects that include swelling, redness, itching, and tenderness. Most side effects subside within 10-14 days after treatment.

Providers

Our approach & expertise

Our dermatologists have the skill and experience necessary to perform a vein treatment that meets your aesthetic goals. What separates us from other practices is that we focus on you as a person, so we will tailor treatment to suit your unique case. Our compassionate practitioners will address your concerns and answer any questions to ensure your ease of mind.

Lumps, Bumps and Moles

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About Lumps, Bumps, and Moles

What are they?

“Lumps, bumps, and moles” is a general term that typically refers to warts, skin tags, vascular birthmarks, cysts, fat deposits, and more. Normally, these skin growths and irregularities are benign; however, they can have a negative bearing on your self-esteem because they often form on parts of your body that are easily visible, such as the face or neck. Other areas of the body that frequently develop lumps, bumps, and moles include the torso, back, arms, legs, and groin.

What causes them?

Since lumps, bumps, and moles can develop due to a multitude of reasons, it is important to schedule an appointment with a dermatologist who can properly identify and treat your particular condition.

Common treatments

Our skin experts have the training, knowledge, and experience to help you manage a variety of lumps, bumps, moles, warts, cysts, vascular birthmarks, and other skin irregularities. Treatment options include pulsed dye laser (PDL), Cutera Excel V laser, steroids, surgical excision, and prescription oral or topical medications. In some cases, such as with moles, only simple observation is necessary. However, since benign skin growths and irregularities vary from person to person, a consultation with your favorite skin specialist is the only to way to know which treatment is best for you.

Providers

Our approach & expertise

We understand that abnormal lumps or bumps in your skin may seem like nothing more than just a sign of aging, but they may actually be damaging the health and appearance of your skin. As your neighborhood skin specialists, we’re here to provide encouragement and advice about a variety of lumps, bumps, and moles. Our compassionate staff of experts is ready to answer your questions and address your concerns, so don’t hesitate to contact us today so we can manage these unwanted skin irregularities.

Nail Disorders

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About Nail Disorders

What are they?

Most nail disorders are characterized as fungal infections, also called onychomycosis or tinea unguium, and both toenails and fingernails are vulnerable. About 1 in 10 Americans are affected, and you’re at a higher risk of developing these infections the older you are. Symptoms can vary, but typically include nail pain or soreness, thickened nails, a distorted appearance, nail darkening, yellowish streaks, separation of nails from the nail bed, brittleness, or even foul smells.

What causes them?

Several different fungi can lead to a nail disorder, as the pathogens enter the skin through very tiny openings between the nail and nail bed. If the surrounding area is warm, moist, and unventilated, the fungi propagate quickly. Other contributing factors for nail disorders include family history, walking barefoot in public areas, or profuse sweating. Even poor health can contribute to the development of these conditions, as diabetes and poor circulation are known triggers.

Common treatments

If you suspect you have a nail disorder or infection, be sure to see a professional dermatologist, as he or she can perform a nail scrape for quick results. A dermatologist can also help differentiate between nail disorders and other conditions with similar symptoms (like yellow nail syndrome). There are multiple treatments for nail disorders, including over-the-counter (OTC) oral anti-fungal medications and topical OTC anti-fungal medications are also available. An effective solution offered by our dermatologists is laser nail treatment, which treats the infection or disorder completely and almost painlessly. In other, more extreme cases, complete removal of the nail may be necessary.

Providers

Our approach & expertise

We realize that nail disorders can be unpleasant and sometimes even painful, which is why we’re here to ease your concerns about how to address this particular issue. Our trained, experienced dermatologic specialists offer treatment options that can be customized the way you want, and you will always have a say in any treatment you receive. We’ll be by your side throughout your journey, from diagnosis to treatment to aftercare, to ensure that you’re receiving the best dermatology care possible.
Healthy skin is our passion. Contact an office today if you notice symptoms of a nail disorder that you believe needs attention, and we’ll help you manage it in a way that suits you best.