Vitiligo

1.    What is Vitiligo?

Vitiligo is a disorder of skin pigmentation caused by a decrease in the number of cells that create pigment in the top layer of the skin, also known as melanocytes.  This results in large, white patches throughout the body that can be both disfiguring and socially ostracizing to individuals, especially those who have darker skin tones.

2.    What Does Vitiligo Look Like?

Vitiligo is characterized by white, depigmented areas of the skin ranging from 5 millimeters to 5 centimeters in diameter, or more.  These patches may be either symmetrical on the body, or localized to one region, and may affect the hands, fingers, face, scalp, body folds, underarms, genitalia, and orifices such as the eyes, mouth, navel, and anus.

3.    Who Does Vitiligo Affect?

Vitiligo is common, affecting all races, all skin types, and both genders equally.   Most cases begin to appear on the skin before the age of 30.  Although the depigmented patches are much less obvious and often go untreated in very fair-skinned individuals, they are much more obvious and debilitating to darker-skinned individuals.  There is an increased association of vitiligo with autoimmune thyroid disease.

4.    What Causes Vitiligo?

In vitiligo patches, immune cells called T-cells are activated to destroy melanocytes, however, the ultimate cause of their activation is yet undetermined.  It is believed that their activation may be due to either an overactive immune system or by a signal given off by melanocytes that are creating abnormal, toxic substances during the synthesis of melanin, the main product of these pigment cells in the skin.

5.    What Triggers Vitiligo?

The onset of vitiligo may be attributed to physical trauma, illness, or emotional stress.  Patients with vitiligo often report that the death of a relative, a severe accident, or even a harsh sunburn had occurred directly preceding the appearance of their vitiligo.  More recently, data suggests a genetic link to certain types of vitiligo.

6.    How Can My Vitiligo Be Treated?

For mild vitiligo limited to small regions of the body topical steroids, non-steroidal topicals such as Elidel cream and Protopic ointment, and/or topical vitamin D-based treatments may be effective.  However, most people with vitiligo require narrow-band UVB light treatment, which can be administered 2-3 times per week until pigmentation returns.  While this therapy treats larger regions of the body, an Excimer laser may be used to target specific, localized regions of vitiligo.  This laser uses a carefully focused beam of light delivered through fiber optics, and allows higher doses of UVB light with minimal exposure of nearby, healthy skin.  For more information on these treatments for vitiligo, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Psoriasis

1.    What is Psoriasis?

Psoriasis is an inherited skin disease caused by an overactive immune system that stimulates a higher-than-normal turnover of skin cells.  This results in recurring red plaques with silvery scales, on either localized or generally dispersed regions of the skin.  A very difficult disease to treat, psoriasis often causes shame, embarrassment, and humiliation to individuals, and sometimes lasts throughout their entire lifetime.

2.    What Does Psoriasis Look Like?

Psoriasis is characterized by salmon-pink, round, well-bordered bumps and plaques with silvery scales on their outer layer.  Psoriasis plaques can either itch or feel sore.  The scales are loose and easily removed by scratching, which often results in minimal bleeding.   Psoriasis may be localized to one area such as the nails or genitals, dispersed to an entire region such as the scalp, or universally distributed to the skin throughout the entire body.  Common areas include the elbows, knees, palms, shins, nails, arches of feet, lower back, genitals, and anal folds.  Psoriasis may also cause a type of arthritis with joint pain, weakness, chills, and fever.

3.    Who Does Psoriasis Affect?

Psoriasis can begin at all ages, but most commonly begins near or around two age peaks of 23 years and 55 years, and occurs equally among males and females.  A significantly lower incidence occurs in people of Japanese, Eskimo, West African, North American Indian, or South American Indian descent.  Psoriasis is inherited through multiple genes, and having a parent with psoriasis gives an individual an approximate eight percent chance of inheriting the disease.

4.    What Causes Psoriasis?

Psoriasis begins in the immune system.  For reasons yet unknown, T cells are mistakenly activated and begin signaling skin cells to shorten their normal cell cycle duration.  This causes a much faster turnover of skin cells, and an increase of up to 30 times the normal production. Swelling and inflammation ensue.  The long-term result is a significant reddening, thickening and scaling of the affected region.

5.    What Triggers Psoriasis?

Certain triggers may exacerbate pre-existing psoriasis plaques, or cause a sudden onset of plaques, especially in areas that have been affected once before.  These factors include physical trauma such as rubbing and scratching, bacterial infections, alcohol consumption, smoking, stress, weather changes, dry climates, or certain medicines. 

6.    How Can My Psoriasis Be Treated?

Although management and control of psoriasis is very difficult, it is certainly possible and can be attained with a well-planned treatment regimen.  Phototherapy for psoriasis in the form of narrow band UVB phototherapy helps treat large areas of the skin without the side effects of oral or topical medications.  During narrow band UVB treatment, patients stand in a unit containing 48 fluorescent bulbs that emit UVB light at 311 nm.  For localized areas, patients place their hands or feet in a small light chamber, or use a light-emitting comb to treat the scalp.  This treatment is given two to three times per week until the psoriasis plaques subside.  In addition, the Excimer laser has been extremely successful in treating psoriasis.  This laser uses a carefully focused beam of light delivered through a sophisticated fiber optic device, and allows higher doses of UVB light with minimal exposure of nearby, healthy skin.  Other therapies may include topical steroids, emollients, and tar formulations.  Additionally, more systemic therapies include oral or intravenous drugs such as cyclosporine, retinoid drugs, methotrexate, and the most recent addition to the armamentarium, the  “biologic” agents that directly target a portion of the immune system that triggers psoriasis.  For more information on these treatments for psoriasis, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Alopecia Areata

1.    What is Alopecia Areata?

Alopecia areata is a disease that affects hair follicles, resulting in the loss of hair in distinct round or oval areas about the size of a quarter, without any evident inflammation of the affected epidermis or scalp.  Most cases involve a few patches of hair loss to the scalp; some involve a larger number, and rarely, the disease causes full hair loss on the head, face, and body.

2.    What Does Alopecia Areata Look Like?

Alopecia areata appears as patches of normal, bare skin in places where hair once grew; each patch usually approximating the size of a quarter.  The skin usually does not appear inflamed, swollen, or red, and no itching or pain is involved.  In some cases, patches of alopecia may spontaneously grow back, while new patches may form in other unaffected areas.  As the disease varies from person to person, there is no way of indicating whether or not hair will grow back, or whether other patches will continue to form.

3.    Who Does Alopecia Areata Affect?

Alopecia areata is a very common disease that affects about one percent of the population at least once in their lifetime.  It most commonly affects children and young adults under the age of 25, and is seen equally among males and females, except in certain countries (Italy and Spain) where it is seen twice as much among females than males.  Regrowth to the bare patches does often occur, and 80 percent of persons with alopecia beginning after puberty will eventually regrow hair at some later point in life.  However, to alleviate the social burden and anxiety associated with this condition, individuals often seek to manage their condition immediately through a variety of available treatments, many of which have proven to be effective.

4.    What Causes Alopecia Areata?

The actual cause of alopecia areata is yet unknown.  However, it is understood that alopecia is an autoimmune disease in which the immune system mistakenly attacks some part of the body as if it were foreign.  In alopecia, this attack is specifically targeted toward the hair follicles.

5.    What Triggers Alopecia Areata?

Alopecia areata has been reported to follow sudden, prolonged, or excessive stress, physical or psychological trauma, post-surgery, bereavement, nervous breakdown, or even financial crisis.  While research has shown that these and other stress factors may trigger the condition, it is nearly impossible to predict or prevent future alopecia events or remissions.

6.    How Can My Alopecia Areata Be Treated?

Although no cure for alopecia areata is currently available, treatments do exist that are effective in stimulating varied amounts of regrowth for some individuals. Topical steroid creams or oral steroid medications may be prescribed to help decrease the autoimmune response and stimulate hair regrowth.  In addition, steroid injection to alopecia patches may be temporarily very effective.  A combined treatment called PUVA (Psoralen plus UVA light) involving medication and UVA light therapy to the alopecia patch may also be effective for some individuals.  For more information on these treatments for alopecia areata, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Eczema

1.    What is Eczema?

Eczema is a very common, inflammatory reaction of the skin to any of a wide number of causative agents.  Atopic dermatitis, the most common form of eczema,is a skin disorder involving an overly sensitive immune system reacting to otherwise normal substances that the skin or body contacts. Eczema may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, formation of pustules, dryness, peeling, or allergic-like reactions of the involved area.  While some cases of eczema are shorter lasting, others may continue for months or even years at a time. 

2.    What Does Eczema Look Like?

Eczema may display a variety of characteristics.  Eczema in its mildest form may appear as dry, itching, and flaking skin.  In addition, eczema may appear as red bumps forming entire plaques with indistinct borders, as well as dryness, itching, peeling and scabbing throughout the affected region.  Secondary bacterial infection can cause tenderness.  Chronic cases involve dull red, extremely itchy, cracking, thickened and leathery skin.  Eczema tends to occur in the flexural regions (backside of elbows, knees), neck, wrists, ankles, creases of the body, face and scalp (in infants).

3.    Who Does Eczema Affect?

Eczema is very common and affects many different types of individuals.  The prevalence of eczema is estimated at 15-20% among children, and 2-10% of all adults, with males slightly more affected than females.  Children of individuals with eczema have a 60% chance of being affected.  Eczema usually begins in infancy and may persist through childhood and into adult life.  Certain factors may elicit a response in children, such as certain protein-containing foods, dust mites, or microbial agents.  Other contributing factors include skin dehydration, pregnancy, menstruation, cold climates, irritating clothing, and most significantly, emotional stress.

4.    What Causes Eczema?

Eczema is caused by the immune system’s over-sensitive reaction to unidentifiable substances either foreign or regularly contacting the skin.  These “triggering” events often lead to a chronic cycle of exacerbations and remissions in the affected areas.  With each new exposure, the irritating or causative agent stimulates certain antibodies to cause an amplified release of inflammatory agents from immune system cells.  These agents promote the formation small red bumps, itching, swelling, and flaking of the skin.  The end result is a chronic inflammation of the skin, as well as a perpetual migration of blood cells and immune system cells to the affected location.  An eczema flare may often trigger other allergic-like reactions in individuals such as hay-fever, sinusitis and congestion.

5.    What Triggers Eczema?

Certain factors may trigger an eczema response, especially in children.  These include protein-containing foods such as eggs, milk, peanuts, soy products, fish, and wheat, as well as dust mites, airborne allergens, or microbial agents.  Other exacerbating factors include skin dehydration, pregnancy, menstruation, cold climates, wool and other irritating clothing, and of especially great importance, emotional stress.  Exposure to adverse climatic conditions may also trigger or worsen an eczema response.  In all cases of eczema, rubbing and scratching are behaviors that worsen the condition by introducing secondary bacterial infections to the involved areas.

6.    How Can My Eczema Be Treated?

Although childhood eczema frequently subsides before adulthood, adult eczema often lasts years at a time and requires special management. Topical anti-itch lotions may be given to control excessive itching and rubbing. Topical steroid creams may help reduce inflammation, and topical anti-bacterial lotions or oral antibiotics may be given to decrease secondary bacterial infections. Excimer Laser treatments may also be used to treat small areas including eczema of the hands and feet and Narrow Band Phototherapy for larger areas. Hydration using unscented moisturizing lotions is important in preventing dryness, and non-liquid soaps should be avoided. Finally, identification and reduction of emotional stress factors may help prevent unnecessary eczema flares. For more information on available treatments for eczema, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Irritant Contact Dermatitis

1.    What is Irritant Contact Dermatitis?

Irritant dermatitis is an irritated skin reaction to specific compounds or agents outside of the body that the skin contacts repeatedly, such as chemicals, detergents, or oils.  It may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, formation of clear vesicles, pustules, dryness, peeling, or allergic-like reactions of the involved area.  Irritant dermatitis may continue for months at a time. 

2.    What Does Irritant Contact Dermatitis Look Like?

Acute cases of irritant dermatitis may involve multiple small, clear fluid-filled blisters on well-bordered, raised, red patches.  These small blisters often burst and cause a yellow crust to form around the irritated region.  Irritant contact dermatitis lasting longer than one week may appear as red bumps forming entire plaques across the skin having indistinct borders, as well as dryness, itching, peeling and scabbing throughout the affected region.  Secondary bacterial infection may cause the formation of pustules, which may become tender and eventually burst.  Chronic cases involve dull red, extremely itchy, cracking, peeling, thickened and leathery skin.   Symptoms are localized only to areas in which the irritating chemical or causative agent has contacted.  

3.    Who Does Irritant Contact Dermatitis Affect?

Irritant dermatitis may affect individuals of all ages working with or around irritants such as abrasive substances, detergents, acids, alkaline agents, oxidants, reducing agents, plants, animals, enzymes, or particulate fibers such as fiberglass or wood dust. 

4.    What Causes Irritant Contact Dermatitis?

Irritant dermatitis is caused by the immune system’s reaction to chemical or mechanical damage to the skin.  With each new exposure, the irritating agent kills or damages skin cells, causing an amplified release of inflammatory agents from the immune system.  These agents promote itching, redness, and flaking.  The end result is a chronic inflammation of the skin, as well as a perpetual migration of blood cells and immune system cells to the affected location.

5.    What Triggers Irritant Contact Dermatitis?

Certain factors may trigger irritant dermatitis, especially in workers exposed regularly to chemicals, powders, or the irritating agents listed above.  Factors exacerbating the condition include continued exposure to the causative agent, previously diagnosed atopic eczema, and activities such as car maintenance, gardening, or hobbies causing repeated skin abrasion.  In all cases of irritant dermatitis, rubbing and scratching are behaviors that worsen the condition by introducing secondary bacterial infections to the involved areas.

6.    How Can My Irritant Contact Dermatitis Be Treated? 

Identification and reduction of exposure to specific irritant in an individual’s daily environment is the primary means of preventing irritant dermatitis.  For recurring flares, topical anti-itch lotions may be given to control excessive itching and rubbing.  Topical steroid creams may help reduce inflammation, and topical anti-bacterial lotions or oral antibiotics may be given to decrease secondary bacterial infections, reducing pustules at the site.  Laser treatments may also be used to treat small areas.  Hydration using unscented moisturizing lotions is important in preventing dryness, and non-liquid soaps should be avoided.  For more information on available treatments for irritant dermatitis, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Allergic Contact Dermatitis - Dr. Berman featured on ABC News' Dr. Dean Edell program

1.    What is Allergic Contact Dermatitis?

Allergic contact dermatitis is an allergic skin reaction from a single exposure to usually poison oak or poison ivy resin.  It may involve swelling, redness, itching, blistering, “weeping” clear fluid, crusting, formation of clear vesicles, pustules, dryness, peeling, or allergic-like reactions of the involved area.  Allergic contact dermatitis caused by poison oak or poison ivy is an acute condition, generally lasting less than a month.

2.    What Does Allergic Contact Dermatitis Look Like?

Cases of allergic contact dermatitis involve multiple small, clear fluid-filled blisters on well-bordered, raised, red patches.  These small blisters often burst and cause a yellow crust to form around the irritated region.  Secondary bacterial infection may cause the formation of pustules, which may become tender and eventually burst.  Symptoms are localized only to areas in which the resin has contacted.  

3.    Who Does Allergic Contact Dermatitis Affect?

Allergic contact dermatitis affects individuals working or recreating outdoors, where poison ivy or poison oak grows, throughout the United States and Southern Canada.  It is generally uncommon in young children. 

4.    What Causes Allergic Contact Dermatitis?

Allergic contact dermatitis is caused by the immune system’s hyper-sensitive reaction to the poison oak or poison ivy resin.  With an exposure, the irritating or causative agent stimulates certain antibodies to cause an amplified release of inflammatory agents from immune system cells.  These agents promote itching, redness, and vesicle formation.  The end result is inflammation of the skin, as well as a heightened migration of blood cells and immune system cells to the affected location

5.    What Triggers Allergic Contact Dermatitis?

Exposure to the poison oak or poison ivy resin is the main factor contributing to allergic contact dermatitis but other compounds in our environment can cause similar reactions.  New rashes on different body parts may be triggered if contact is made with the initial site of exposure before the resin has been completely washed off.  However, a thorough cleansing with liquid soap or detergent will remove the resin and prevent further spread.  In all cases of allergic contact dermatitis, rubbing and scratching are behaviors that worsen the condition by introducing secondary bacterial infections to the involved areas.

6.    How Can My Allergic Contact Dermatitis Be Treated? 

For allergic contact dermatitis, topical anti-itch lotions may be given to control excessive itching and rubbing.  Topical steroid creams may help reduce inflammation, and topical anti-bacterial lotions may be given to decrease secondary bacterial infections, reducing pustules at the site.  In addition, a small steroid injection may help lower the hyperactive state of the immune system and shorten the duration and spread of the rash.  For more information on available treatments for eczema, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Acne
 

1.    What is Acne?

Acne vulgaris is an inflammation of the sebaceous glands of the face, back, or other body regions, occurring most frequently in adolescents but often in adults as well.  A combination of genetic and environmental factors is thought to be the cause.  These include a given individual’s amount of sebaceous glands in the skin, hormone levels, skin sensitivity, emotional stress, and their diet’s glycemic index.  Acne can be both physically and psychologically devastating to an individual, and may contribute to embarrassment, anxiety, and even depression.  In addition, acne may leave scars that often burden an individual for life. 

2.    What Does Acne Look Like?

Acne may involve blackheads, whiteheads, red and inflamed pustules, nodules, or cysts, and primarily affects the face, chest, shoulders, back, and buttocks. 

3.    Who Does Acne Affect?

Acne is most common among males ages 14-19 and females ages 10-17 years, however, adult acne may begin from age 25 onwards.  It is more severe in males than in females, and affects all races, but is less common among Asians and blacks.  For most people, acne usually subsides by their thirties; however, some people continue to have acne into their forties and fifties.

4.    What Causes Acne?

Acne is caused by a combination of multiple factors and events.  The skin of the affected region is composed of thousands of small hair follicle units producing both seen and unseen hairs.  Each hair unit has adjoining sebaceous glands that release sebum (oil), into the follicle (canal) where the hair leaves the epidermis.  During puberty, menstruation, or other hormonally-fluctuating periods, the levels of sebaceous gland cells increase and sebaceous glands themselves enlarge, producing more sebum.   This extra sebum, along with the hair shaft and free-floating sebaceous gland cells can produce a comedone (plug) in the follicle that blocks the pore opening.  This causes further accumulation of sebum, on which bacteria can then grow.  If the plug reaches the skin surface, it opens up and its contents react with oxygen and turn dark, appearing as a black comedone (blackhead).  If it remains beneath the skin surface it stays fully plugged, and appears as a white comedone (whitehead).  Bacterial products then stimulate the recruitment of cells of the immune system; this produces the red, inflamed bumps and swelling involved in acne.  Occasionally, the walls of the follicle break and its contents leak below the epidermis, which provokes an even greater response and may lead to larger pimples, bumps, nodules, or cysts.  Intense inflammation or rupture often leads to scarring.

5.    What Triggers Acne?

Many factors may trigger and exacerbate acne flares.  Emotional stress has been shown to correspond with increased acne levels.  In addition, an increase in androgen (male hormone) levels during puberty occurring in both males and females may cause sebaceous glands to enlarge and sebum levels and acne to increase.  Similar hormonal changes such as pre-menstruation, pregnancy, or stopping birth control pills may also cause acne.  Another very important factor is continued pressure on the skin, caused by sports helmets, equipment, tight collars, or by leaning the face on the hands or on a telephone (acne mechanica).   Extensive exposure to grease from oily cosmetics, kitchens with fry vats, or other environmental sources may alter follicle cells to stick together and form acne plugs.  New data also suggests a link between acne flares and high glycemic index diets (diets high in simple sugars and low in complex carbohydrates).  Finally, rigorously scrubbing the skin, as well as squeezing or picking acne blemishes may significantly exacerbate acne flares.  Things that do not cause acne include “dirty skin”, or sexual behaviors.

6.    How Can My Acne Be Treated?

Acne is a very treatable condition. Providers at the Berman Skin Institute are committed to bringing every patient’s acne under control, and have a number of treatments available. For general acne flares, Photodynamic Therapy (PDT) has proven to be one of the most successful treatments. During PDT, a topical medicine is applied to the skin’s surface. After waiting a half hour or more, a blue light or laser beam is passed over the skin, activating the medicine. Once active, the medicine goes to work shrinking the sebaceous glands and killing off bacteria that cause acne. A series of treatments are usually performed. For black and white comedones, cysts, and large pustules, an aesthetician may perform gentle, surgical extractions to remove plugs and restore an environment in which the skin can heal without scarring. In certain cases topical or oral antibiotics are used often in combination with benzoyl peroxide gels and cleansers. Topical retinoids such as adapalene, tretinoin, tazorotene creams are effective in normalizing sebaceous cell growth as well as inhibiting inflammation, and may help decrease acne. Severe, cystic acne may be treated with oral retinoid medications, such as Accutane. Acne Laser Treatments have also been shown to improve acne, and reduce the dependence on oral medications. In addition, aestheticians may provide light glycolic acid and salicylic acid chemical peels, silk peels, or microdermabrasion to help loosen blackheads, exfoliate the outermost layer of skin, and stimulate collagen deep within the dermis to refresh and renew the skin. For more information on available treatments for acne, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Rosacea

1.    What is Rosacea?

Rosacea is a chronic disorder similar to acne involving prolonged redness, pimples, and thickening of the skin.  Rosacea mainly affects the skin of the face.  Rosacea is caused by a combination of factors such as genetics, involvement of the microscopic Demodex skin mites, and hyper-reactive superficial blood vessels that respond to heat and cause flushing.  Rosacea may also lead to enlargement of the nose and other facial features, and can be a significant cause of cosmetic disfigurement.  Ocular rosacea is a variant of rosacea that may appear as red, itchy eyes not improving with eye drops.

2.    What Does Rosacea Look Like?

Rosacea involves frequent redness of the skin (flushing), excessive spider veins, and tiny pimples and nodules, with the absence of blackheads or whiteheads.  Most affected areas are central to the face, forehead, nose and front of cheeks.  As the disease progresses, chronic sebaceous gland enlargement and inflammation may cause thickening, swollenness, and disfigurement of the nose, forehead, eyelids, chin, or ears. 

3.    Who Does Rosacea Affect?

Rosacea is most common between ages 40 and 50.  While it predominates among females, the characteristic swelling and disfigurement of the nose is mostly seen among males.  Rosacea affects individuals of skin phototype I and II (very light-skinned) such as celtic persons and southern Italians, and is less frequent among darker-skinned individuals.  People with rosacea often have a history of blushing easily from changes in skin temperature, spicy foods, alcohol, or other factors.

4.    What Causes Rosacea?

Recent studies have shown rosacea to be a multi-factoral condition caused by a combination of genetics, inflammatory reactions of superficial blood vessels, and infestation of microscopic skin mites.  Although the exact mechanism of rosacea is not yet understood, it is believed that the progression to full rosacea begins in certain individuals having a genetic predisposition to a rapid expansion in superficial blood vessels.  This, in addition to a favorable environment and temperature of the face, may enable the skin mites Demodex follicolorum and Demodex brevis to thrive on the facial skin. These parasites of the epidermis live among hair follicles (folliculorum) and sebaceous glands (brevis), and are thought to further trigger an inflammatory reaction, which is manifested in rosacea’s tiny bumps, redness, and skin thickening.  Thus, physical changes or life events that cause an initial blood vessel expansion may induce the progression of rosacea.  Although rosacea does involve pimples of the hair follicles, it is not believed that bacterial growth in these areas is a significant factor causing the skin disorder, as in acne vulgaris.  However, recent studies have shown that a high percent of individuals with rosacea also have H. pylori, the causative bacterial agent in gastric ulcers. 

5.    What Triggers Rosacea?

Patients with rosacea claim a number of possible triggering factors for this skin condition.  Heat, heavy exercise, spicy foods, alcohol, sunlight, menopause, or events that cause flushing of the skin may be exacerbating factors.  In addition, high levels of emotional stress have shown to be significant in contributing to rosacea.

6.    How Can My Rosacea Be Treated? 

Rosacea may be managed with the right combination of treatments.  Photodynamic Therapy (PDT) has proven to be a successful treatment for rosacea.  During PDT, a medication is applied and the affected area is treated with blue light for 5-10 minutes. PDT is performed 1-2 times per month until the rosacea subsides.  Photofacial-Intense Pulsed Light treatment is also effective in treating rosacea, as well as V-Beam Pulse Dye Laser (PDL).  PDL involves a relatively painless laser treatment causing short-term bruising to the face. Performed once every four to six months, this procedure successfully clears rosacea and prevents further disfigurement of the nose or other facial features.  In addition to these procedures, topical antibiotics and anti-fungal creams may help to limit the amount of pimples caused by secondary infection.  Finally, elimination of alcohol, hot beverages, and other exacerbating factors from the diet and lifestyle may significantly help control rosacea in affected individuals.   For more information on available treatments for rosacea, or to schedule a visit, please call and speak with a representative at the Berman Skin Institute.

Seborrheic Keratoses

1.    What are Seborrheic Keratoses?

Seborrheic Keratoses are generally dark or brown wart-like growths appearing anywhere on the skin after the age of 30 and continuing throughout a lifetime.  The number of seborrheic keratoses varies from few to thousands per individual.  These growths may be due to sun damage, but also appear to be inherited.   Despite appearing dangerous, they are the most common benign growth of the skin.

2.    What Do Seborrheic Keratoses Look Like?

Seborrheic Keratoses begin as barely elevated, slightly bumpy, small plaques on the skin surface that may be either colored or not colored.  Over time, these grow into raised, warty plaques that appear as if “stuck on” to the skin surface, and are darkly pigmented or even black in darker individuals.  These later growths may be anywhere from 1 to 6 cm, and rarely may be itchy or tender. 

3.    Who Do Seborrheic Keratoses Affect?

Almost all individuals get sebhorreic keratoses, but they are rarely seen before age 30.  They are slightly more common among males than females.

4.    What Causes Seborrheic Keratoses?

Seborrheic Keratoses are caused by an increase in the production of skin cells, including pigment cells.  The result is a thickening of the skin and a darker pigmenting of the tissue, as melanocytes increase and their product, melanin, pigments the involved area. 

5.    What Triggers Seborrheic Keratoses?

Unlike actinic keratoses, seborrheic keratoses are not completely caused by sun exposure.  They appear predominantly as a result of genetics, and little can be done to prevent their occurrence.

6.    How Can My Seborrheic Keratoses Be Treated? 

Seborrheic Keratoses may be simply frozen off by applying liquid nitrogen, or shaven off if necessary with a short, painless procedure after numbing.  They may require multiple treatments with liquid nitrogen, but generally disappear after one or two applications.  After freezing, a blister may form over the wound, which may burst and crust while healing.  During a shave, only the elevated region and a few layers of skin beneath are removed, and rarely does the procedure result in an indent in the skin.  Differences in pigmentation are most often unobservable after the procedure.  For more information on treatments for seborrheic keratoses or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

Molluscum Contagiosum

1.    What is Molluscum Contagiosum?

Molluscum contagiosum is a contagious, viral infection characterized by raised, pearly bumps or nodules appearing mainly on the face, neck, armpits, arms, or genitals.  These may be spread by direct contact (in children) or by sexual contact (in adults), and may persist from a few months to a few years.  This skin infection produces no serious illness, and ultimately disappears in time without scarring.

2.    What Does Molluscum Contagiosum Look Like?

The lesions of molluscum contagiosum begin as small, flesh-colored, dome-shaped bumps which later raise up to become pearly or gray, soft nodules, often with a depressed dimple at the center.  Often these centers contain a plug of white, cheese-like or waxy material.  Bumps and nodules are often found in a line along the skin, where scratching and spreading of the virus has occurred.  In children, molluscum contagiosum commonly affects the arms, legs, body, or anywhere except the palms and soles.  In adults, the virus commonly affects the genitals, abdomen, and inner-thighs.

3.    Who Does Molluscum Contagiosum Affect?

Molluscum contagiosum occurs commonly in children, as well as sexually active adults.  It is seen more frequently among males than females, and is especially prevalent among HIV-infected individuals, who may have hundreds of mollusca on the body.  Despite its transmission, molluscum contagiosum resolves by itself over time, and is not a lifelong disease.

4.    What Causes Molluscum Contagiosum?

Molluscum contagiosum is caused by a virus that invades and colonizes cells of the skin and of the hair follicles.  It is transmitted by skin contact and by sexual contact among healthy individuals, but once transmitted, persists longer and causes larger lesions among individuals with compromised immune systems, such as HIV.  

5.    What Triggers Molluscum Contagiosum?

Continued skin contact with affected individuals increases the risk of contracting molluscum contagiosum.  Most transmission occurs among siblings, or in places of high skin-to-skin contact, such as swimming pools.  It also spreads more readily in tropical climates, where heat and humidity favor the viral cycle.  In addition, continued scratching, rubbing, or shaving over the nodules can spread the virus and cause new mollusca to form nearby.  For molluscum contagiosum of the genitalia, sexual contact with infected individuals increases the risk of contraction.  While wearing condoms is advised to prevent other STD’s from spreading, the molluscum contagiosum virus is frequently located on areas of the epidermis not covered by a condom.  Total abstinence is therefore the only foolproof way to avoid sexually contracting the virus. 

6.    How Can My Molluscum Contagiosum Be Treated? 

A number of treatments may be used to control Molluscum contagiosum.  Aldara anti-viral cream may be applied regularly to help the body shed the virus and to eradicate lesions.  Another treatment is liquid nitrogen, which, after multiple treatments, may completely destroy the infected tissue.  After freezing, a blister may form over the wound, which may burst and crust while healing.  Rarely, a slight difference in pigmentation may still be seen after the procedure.  Small mollusca may also be removed with a small curette with little discomfort or pain.  For more information on treatments for molluscum contagiosum or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

Tinea Versicolor

1.    What is Tinea Versicolor?

Tinea Versicolor is a chronic skin infection characterized by multiple, peeling, well-bordered patches of variable coloration, occurring most commonly on the chest and back.  This infection is caused by the overgrowth of a common skin-dwelling fungus.

2.    What Does Tinea Versicolor Look Like?

Tinea Versicolor, or Pityriasis versicolor, appears as a number of peeling, sharply bordered, round or oval patches of various size, and either light brown on light-skinned individuals, or off-white on dark-skinned individuals.  These patches most often occur on the chest and back, and occasionally they become itchy or irritable.   In time, individual patches may enlarge, merge, or form extensive areas of depigmentation.

3.    Who Does Tinea Versicolor Affect?

Tinea Versicolor occurs in young adults, and less commonly in older adults and the elderly.  It affects individuals of all races, and is especially prevalent among tropical climates.  In temperate regions, the infection may arise during the summer and fade during cooler months.  However, physically active individuals in these regions often maintain higher body heat and humidity levels, and may have Tinea versicolor year-round. 

4.    What Causes Tinea Versicolor?

Tinea Versicolor is caused by the excessive overgrowth of a normal, skin-inhabiting fungus, named Pityrosporum ovale.  The overgrowth of this fungus in its hyphae form produces an enzyme which then oxidizes the fatty acids that normally occur in epidermal tissue.  The products of this oxidation event inhibit the activity of melanocytes and thereby cause discoloration in the epidermis.  

5.    What Triggers Tinea Versicolor?

Factors that may contribute to or exacerbate a Tinea versicolor infection include high humidity, elevated rates of skin oil production due to hormones (ie. during puberty), or application of greases such as cocoa butters or oily lotions.  In addition, individuals having Cushing’s syndrome, or having high levels of cortisol due to glucocorticoid medication, may be at an increased risk for developing Tinea versicolor.

6.    How Can My Tinea Versicolor Be Treated? 

Tinea Versicolor is a very treatable skin condition.  Generally, topical anti-fungal medications are given for the eradication of the causative fungus.  If necessary, anti-fungal shampoos may be administered as well.  For more information on treatment for Tinea Versicolor, or to schedule a skin check, please call and speak to a representative at the Berman Skin Institute.

Warts

1.    What are Warts?

Warts are non-cancerous, viral infections of the skin characterized by bumpy or flat, raised, flesh-colored growths appearing mainly on the hands, fingers, feet, beard area, or genitals.  Four main types of warts exist.  Plantar warts (verruca plantaris) are usually on the soles of the feet and often are not raised.  Flat warts (verruca plana) are smaller and smoother than normal warts and generally occur in large numbers on the face, or shaving regions such as the beard area and legs.  Common warts (verruca vulgaris) usually grow on knees, fingers, hands, and areas where the skin has once been broken such as the hangnails.  Genital warts (condyloma acuminatum), which arethe most prevalent sexually transmitted disease,come from a strain of the wart virus affecting mucous membranes of the genitalia, and may be transmitted with sexual contact.  Generally, warts produce no serious illness and may disappear in time without scarring; however, bothersome or painful warts should be treated.

2.    What Do Warts Look Like?

Common warts appear as firm, flesh-colored, bumpy, cauliflower-like growths anywhere from 1 to 10 mm, which disrupt the normal line of fingerprints on the fingers or hand.  Some may have red or brown dots caused by small blood vessels.  Plantar warts appear as small, shiny, well-bordered bumps that may grow into rough plaques on the feet, and may also have red or brown spots.  They may occur in clusters, and are often pushed back into the skin from the pressure of walking and are therefore not usually raised.  Flat warts appear as flesh-colored or brown, well-bordered, “flat”-surfaced, thick bumps on the face, beard area, shins, and back of hands.  Sometimes these grow in linear patterns caused by re-infection from scratching or shaving abrasions.

3.    Who Do Warts Affect?

Warts are very common and occur frequently in all races, and equally among males and females.  Common warts occur in up to 20 percent of all school children; plantar warts are more common in older children and young adults; and flat warts occur in children and adults.  Flat warts may occur more commonly in butchers, meat packers, and fish handlers.  Warts may be more aggressive or multiply faster among individuals with compromised immune systems.

4.    What Causes Warts?

Warts are caused by many different strains of a DNA virus called the Human Papillomavirus (HPV) that invades and colonizes cells of the skin and mucous membranes.  The virus is transmitted by skin contact and by sexual contact among healthy individuals, however, the risk of catching hand, foot, or flat warts from another individual is relatively small. 

5.    What Triggers Warts?

Warts may be triggered or may “seed” in areas where the skin frequently breaks or abrasion frequently occurs.  This explains why warts grow more commonly among children who bite their nails or pick at hangnails, and why warts occur near other warts in frequently-shaved areas.  In addition, continued scratching, picking, or shaving over warts can trigger the spread of the virus and cause new warts to form nearby.  Certain individuals are more prone to having warts than others, just as some individuals are more prone to catching the common cold.  Most transmission occurs among small groups such as households or school gym classes.  A greater risk of acquiring warts is observed among immunocompromised individuals such as HIV patients or organ transplant patients. 

6.    How Can My Warts Be Treated? 

A number of treatments may be used to eradicate warts.  Liquid nitrogen may be applied to freeze off the infected tissue.  After freezing, a blister may form over the wound, which may burst and crust while healing.  Warts may also be removed by electrosurgery using a small curette, with little discomfort or pain.  The V-Beam Pulse Dye Laser (PDL) has been shown to be very effective in eradicating warts and is especially good for recalcitrant warts on the bottom of the foot.  Lastly, Bleomycin injections and topically-applied DNCB immune therapy have a very high success rate, and can be used for the most stubborn cases. For more information on treatments for warts or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

“Moles” and Melanoma

1.   What are moles and melanoma?

Moles (known medically as “nevi”) are flat or raised benign growths appearing anywhere on the skin, usually brown, although sometimes pinkish, skin-colored or even bluish in color. Nevi are composed of skin cells that specialize in producing pigment (melanocytes) localized in either in the outer skin layer (epidermis) or within the underlying skin layer (dermis).  The natural history of a nevus is to fade in color and to become more raised over a person’s lifetime.  Malignant skin cancer (melanoma) may arise in a pre-existing nevus or may appear as a “new” nevus.  The number of melanoma cases worldwide is increasing faster than any other cancer. The annual increase in incidence rate varies between populations, but in general has been in the order of 3-7% per year for fair-skinned Caucasian populations. The estimates suggested a doubling of melanoma incidence every 10-20 years.   In Australia, melanoma of the skin is the fourth most common cancer among males (after prostate cancer, bowel cancer and lung cancer) and the third most common cancer among females (after breast cancer and bowel cancer). Since certain types of nevi have a higher risk of becoming cancerous, individuals of all skin type should visit a dermatologist at least once a year for a thorough skin examination.  If a new nevus or a change in a pre-existing nevus is noticed, a dermatologist should be seen right away for evaluation and possible biopsy for microscopic diagnosis.  In addition, all individuals should know the ABCD’s of skin cancer, listed below.

2.   What do nevi and melanoma look like?

Nevi generally begin as tan, pink, brown, black or bluish, flat, round, skin growths that resemble freckles.  They tend to arise in a random pattern on the body. In time, moles slowly grow larger, and often grow hairs or become raised and fleshy and can appear tag-like. Certain nevi may appear surrounded by a halo of lighter colored skin. 

Research has shown that certain types of nevi have a greater risk for developing into malignant melanoma, a dangerous cancer that can be deadly.  An individual exposed to one or multiple severe, blistering sunburns may have a greater risk for melanoma.  Individuals with greater than 100 moles may also have a higher chance of developing melanoma.  In addition, moles present at birth or shortly after birth that are larger than 8 inches in diameter also carry an increased risk of developing melanoma in a person’s lifetime.  The following ABCD’s for assessment of nevi and melanoma may help distinguish whether a nevus should be evaluated by a dermatologist.

The ABCDE’s of Melanoma

All individuals should understand and recognize the early signs of melanoma.  A nevus should be checked promptly by a dermatologist if any of these characteristics are observed:   A:  Asymmetry, when there is asymmetry, or a difference in the shape of one side of the nevus compared to the other.  B:  Border, or Bleeding, when the borders or edges of the nevus are blurred, inconsistent, ragged, or irregular.  Also, when bleeding of the nevus is observed.  Nevi that bleed due to nicking during regular hair-shaving are not associated with any increase in melanoma; however, removal may be desired to reduce discomfort or irritation in concerned individuals.  C:  Color, Changes, or Concern, when there are color spots, or a difference in coloration throughout the nevi such as different shades of tan, brown, black, blue, red, or white.  A mole with any changes such as itching, pain, bleeding, or discomfort should be checked by a dermatologist.  In addition, if an individual is frequently concerned or feels uncomfortable about the presence of a nevus, then it should be checked.  D:  Diameter, when the diameter of the nevus is larger than 6mm (approximately the diameter of a pencil eraser). E: Evolving.  This latest addition to the ABCD’s recognizes evolving lesions (i.e. lesions that change over time).  The parameter E has been included to emphasize the importance of evolving pigmented lesions in the natural process of melanoma progression. Evolving lesions are defined as those which change in respect to size, shape and symptoms, surface or shades of color. Changes in size, elevation and color taken together is the most probable pointer to melanoma malignancy, other symptoms being bleeding, itching, tenderness and ulceration. Lesions that are enlarged and non-uniform are four times more likely to be melanomas than those which did not meet these criteria.

Lesions that may look like melanoma

Other harmless, pigmented growths that are not nevi may appear on the skin.  Freckles are very common, pea-size or smaller, brown or tan spots that darken with sun exposure and may completely fade during the winter.  Unlike nevi, freckles are generally limited to the sun-exposed skin.  Seborrheic Keratoses are brown, dome-shaped, wart-like growths on the face or trunk that appear waxy or “stuck-on” to the skin.  These are harmless, but may be removed if they regularly become irritated from chafing against clothes or jewelry.  Solar lentigines, or “sun spots,” are gray-brown flat growths caused by sun exposure that generally do not fade during winter.

3.   Who gets nevi and melanoma?

Most nevi appear during the first 20-30 years of life.  Nevi are seen equally among males and females, and new nevi are seen more commonly among fairer-skinned individuals.  In addition, melanoma is more prevalent among fair-skinned individuals, however, melanoma is known to occur in all skin types, even African-American skin.  Melanoma may arise in as many as 1 – 5% of very large congenital nevi (present at birth).   In addition, individuals with family histories of skin cancer of any kind have a greater risk of developing melanoma.

4.   What causes nevi and melanoma?

Nevi consist of small clusters of melanocytes, which continue to proliferate and spread into the lower layers of the skin (dermis), and sometimes even deeper, along hair follicles.  Over many years, these cells differentiate and become mature, unchanging cells.  It is when these cells become “atypical,” and begin proliferating without differentiating or maturing, that malignant melanoma can occur.

5.   What Triggers nevi and melanoma?

Nevi may appear, darken, or enlarge with exposure to sunlight, birth control pills and some other medications, or other hormonal changes, such as during pregnancy.  A higher risk for melanoma is also seen among individuals with numerous nevi (100 or greater).   

6.   How can nevi and melanoma be treated?

If a nevus is “suspicious” to a dermatologist, or if an individual desires its removal, it may be excised for evaluation under a microscope.  A shave excision or a deeper excision may be performed depending on the appearance of the nevus.  Both of these procedures are painless procedures after a simple numbing shot is given.  If a melanoma or “atypical” nevus is diagnosed after microscopic examination (“biopsy”), the dermatologist may perform a deeper and wider re-excision to make certain that all the involved tissue is fully removed.  This may leave a fine-line scar at the site of the excision, however the procedure itself is painless after numbing is administered.  For more information on nevus removals or to schedule an annual skin examination, please call and speak with a representative at the Berman Skin Institute.

Actinic Keratoses (Pre-Cancerous Growths), Disseminated Superficial Actinic Porokeratosis and Squamous Cell Carcinoma

1.    What are actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma?

Actinic keratoses and disseminated superficial actinic porokeratoses (DSAP) or pre-cancerous skin growths, are small, pinkish or skin-colored rough spots most commonly found on sun-exposed skin.  These lesions have the potential of becoming squamous cell carcinomas, and if not treated, these cancers can become dangerously invasive and spread to nearby lymph nodes and/or throughout the body.  Approximately 5% of actinic keratoses may evolve into squamous cell carcinoma.

2.    What do actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma look like?

Actinic keratoses appear as “sandpapery” rough pink or skin-colored growths that do not seem to heal.  They may thicken, and become “horn-like.”  Alternatively, actinic keratoses may become eroded or develop a central crust or “scab.”   A skin growth that persists as an open wound for over a month should be evaluated immediately, as it may be a squamous cell skin carcinoma.  Actinic keratoses occur mainly on the face, scalp, tips of the ears, nose, lips, backs of the hands, forearms, and DSAP also occurs most often on sun exposed skin, frequently on arms or legs, and more often in women.  If left untreated, squamous cell skin cancers may develop into large masses, and although rare, may metastasize into surrounding tissue and lead to significant disfigurement upon excision.

3.    Who gets actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma?

Actinic keratoses are relatively common, especially in middle-aged, fair-skinned adults, and rarer in African-American, Asian, or other darker skin types.  In Australia or southwestern United States, where there is more sun exposure, fair-skinned adults may develop actinic keratoses at younger ages, such as the later 20s or 30s.  Actinic keratoses occur more frequently among outdoor workers, sportspersons, and lifelong tanners.  These groups also have a higher risk of developing squamous cell skin cancers.  

4.    What causes actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma?

Actinic Keratoses are caused by exposure to ultraviolet radiation from the sun.  DNA of the skin cells is damaged and, if this damage is not repaired by the body’s innate DNA-repair system, these cells may transform into cancer.  Sun exposure / UV radiation also reduces the body’s immune system, making the skin more susceptible to damage and cancerous transformation.

5.    What triggers actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma?

There are many factors that may trigger or enable actinic keratoses and squamous cell cancers to form.  These include repeated sun or other UV exposure (such as tanning beds), chronic ulcers or burn scars, working with industrial carcinogens such as fuel oils, pitch, or tar, infection with HPV (wart) virus types 16, 18, or 31, or a compromised immune system.  The resulting actinic keratoses and squamous cell skin cancers in these individuals may be much more aggressive.

6.    How can my actinic keratoses, disseminated superficial actinic porokeratosis and squamous cell carcinoma be treated?

Although they may be dangerous if left alone, pre-cancers or squamous cell cancers can be successfully removed with minimal further tissue damage when treated by a dermatologist.  Actinic keratoses and DSAP may require multiple treatments, but generally disappear after one or two treatments with liquid nitrogen cryotherapy.  After freezing, a blister may form over the lesion, which may crust (scab) while healing.  Rarely, a slight difference in pigmentation, either darker or lighter, may be seen after the treatment.  Other treatments for these lesions include Photodynamic Therapy, in which photosensitizing medication is applied and the skin is treated under blue light or intense pulsed light laser, topical chemotherapy with prescription creams, and Laser Skin Resurfacing, in which a laser removes the outer layers of the skin.  For squamous cell skin cancers, an excision will be performed to ensure full removal of the involved tissue.  This procedure is relatively painless after a brief, numbing injection, and will leave a line scar at the site of the lesion. For more information on treatments for actinic keratoses or squamous cell carcinomas, or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute.

Basal Cell Carcinoma and Superficial Basal Cell Carcinoma

1.    What are basal cell carcinoma and superficial basal cell carcinoma?  

Basal cell carcinoma is the most common type of cancer in humans and the most common skin cancer.  A basal cell carcinoma typically begins as a painless “pimple-like” bump that can be pink or skin-colored.  This lesion will grow very slowly over time until a point when it may suddenly grow more quickly.  Often the lesion will be very fragile and will bleed easily.  It may appear to heal, but never entirely resolves. Basal cell carcinoma can arise in all skin types, although is most common in fair-skinned individuals who have had a great amount of sun / ultraviolet exposure throughout their lifetime.  Although basal cell carcinoma rarely spreads to lymph nodes or other areas of the body, it can spread locally and destroy soft tissue and cartilage, resulting in significant disfigurement and possible infection.  Very few cases of death due to basal carcinoma are reported.

2.    What do basal cell carcinoma and superficial basal cell carcinoma look like?

Basal cell carcinomas may take on a number of forms.  They may appear as bleeding, oozing, open sores that persistently crust yet remain unhealed for over three weeks.  This is a very common, early sign of basal cell carcinomas.  They may also appear as red patches on the arms, legs, shoulders, or chest, which may have either itchiness, pain, or may not feel irritated at all.  The latter are typically the superficial basal cell carcinoma type.  Other types of basal cell carcinomas appear as pearly, shiny bumps or nodules of white, tan, black, or brown coloration.  These may be confused with nevi, especially in darker-skinned individuals.  Another form of basal cell carcinoma may appear as a pinkish growth with raised outer borders and depressed crusted or eroded centers.  These may grow larger and begin to show tiny blood vessels just underneath the pearly surface.  Finally, a less common form of basal cell carcinoma may appear as a whitish scar-like growth with very undefined borders.  These types of cancer may be very aggressive.  Any growth resembling a basal cell carcinoma should be evaluated by a dermatologist to determine its identity and determine the best treatment plan.  If left unchecked, basal cell carcinomas that arise near the eyes, nose, or ears are capable of invading deeply and causing significant damage, even extending into important blood vessels and tissues of the brain.    

3.    Who gets basal cell carcinoma and superficial basal cell carcinoma?

Basal cell carcinomas are extremely common, generally affecting adults over age 40, although they may occur earlier in individuals who have had extensive sun / ultraviolet exposure (tanning beds) or in those with a lowered immune system.  These cancers are especially prevalent among fair-skinned, outdoor workers or sportspersons in the sunniest areas of the United States, and in adults with a history of heavy sun exposure before age 18.  They can also arise in darker-skinned individuals.  Albinos of all races are especially susceptible to basal cell carcinomas.

4.    What causes basal cell carcinoma and superficial basal cell carcinoma?

Basal cell carcinomas are caused by chronic exposure to the sun and other sources of ultraviolet and / or x-ray radiation.

5.    What triggers basal cell carcinoma and superficial basal cell carcinoma? / What can make them worse?

Prolonged sun exposure among individuals with poor tanning capacity increases the risk for acquiring basal cell carcinomas.  Other factors contributing to a higher risk for basal cell carcinoma include previous x-ray therapy for facial acne, or having some history of ingestion of arsenic-containing substances during childhood.

6.    How can my basal cell carcinoma and superficial basal cell carcinoma be treated?

Superficial basal cell carcinomas may resolve with topical chemotherapy cream or scraping and electrocautery.  Basal cell carcinomas of the head and neck area, especially near the eye, nose, lips and ears are most effectively cured using a specialized type of surgery called Mohs Micrographic Surgery, originally developed by Dr. Frederick Mohs in the 1950s.  The cure rate for basal carcinomas using the Mohs technique is over 99%.  If a basal cell carcinoma recurs after being treated, it tends be more aggressive, so Mohs is the preferred treatment in cosmetically-sensitive areas such as the face. The Berman Skin Institute has a board-certified, fellowship-trained Mohs surgeon, Dr. Jennifer Baron, on staff.   For more information on basal cell carcinoma treatments or to schedule a skin check, please call and speak with a representative at the Berman Skin Institute. 

Telangiectasia or “Broken Blood Vessels”

1.    What are telangiectasias?

Telangiectasias are small dilated capillaries and slightly larger blood vessels which are visible in the skin because they are located very superficially.  They can occur on the face, usually most prominent around the nostrils and cheeks, and also on the thighs and legs.  Individuals prone to flushing or blushing easily, those with very fair skin and sun-damaged skin, and those with rosacea are more prone to developing telangiectasias.  Over-use of topical steroid creams may also result in visible telangiectasias.  Larger vessels, deep to the skin, often “feed” telangiectasias, making the treatment more difficult.

 2.    What do telangiectasias look like?

Telangiectasias are painless visible tiny vessels close to the skin’s surface.  They are usually red and may be star-shaped or matted.  They can also be purplish, especially those around the nostrils and on the thighs.

 3.    Who gets telangiectasias?

Telangiectasias may occur in individuals prone to flushing or blushing easily, those with very fair skin and sun-damaged skin, and those with rosacea

4.    What causes telangiectasias?

Sun exposure over time tends to worsen telangiectasias, especially of the face and chest areas.  If untreated, telangiectasias tend to worsen, becoming more noticeable and involving larger areas of skin.

5.    What triggers telangiectasias?

Telangiectasias do not resolve without treatment.

6.    How can my telangiectasias be treated?

Successful treatment of telangiectasias can be achieved with a variety of lasers.  The intense pulsed light and broad band light lasers are very effective at treating widespread facial rosiness and discrete visible vessels of the nose, cheeks, forehead, chin, neck, chest and many other areas of the body.  Multiple treatments are recommended for the best results.  The pulsed-dye laser is also very effective at treating the larger or more persistent vessels, especially around the nostrils; this laser may cause temporary bruising.  Multiple treatments are sometimes necessary.  Telangiectasias of the thighs and legs tend to be more resistant to laser treatment and often require injection sclerotherapy, a relatively painless procedure that irritates the lining of the vessels and causes them to seal off and disappear about 6 – 8 weeks following treatment.  Multiple treatments may be required.

Urticaria (Hives)

1.    What is urticaria?

Urticaria (hives) is extremely common.  Approximately 15 – 25% of the general population experiences an episode of urticaria at some pint in their lifetime.  Urticarial lesions result from a vascular reaction to an internal external trigger.

2.    What does urticaria look like?

Urticarial lesions first appear as “wheals” (like mosquito bites) surrounded by a red halo and are severely itchy, stinging and / or pricking.  They may then clear centrally so that they have a circular pattern on the skin.

3.    Who gets urticaria?

Urticaria can affect anyone and, in fact, a large number of people have suffered from urticaria.  There are two types of urticaria:  1) acute urticaria, which evolves over days to weeks, producing lesions that last up to 12 hours and then completely resolve within 6 weeks and 2) chronic urticaria, which lasts more than 6 weeks. Chronic urticaria is twice as common in women as in men.

4.    What causes urticaria?

There are three categories of triggers of urticaria:  immunologic (allergic hypersensitivity, certain inflammatory protein deficiencies, and vasculitis), non-immunologic (certain drugs such as aspirin, ibuprofen, and morphine), and “idiopathic” (cause unknown).  Physical triggers cause up to 17% of chronic urticaria; these include scratching, cold, heat, water, sun, vibration and exercise.

5.    What triggers urticaria?

Additional triggers of urticaria include:  penicillin antibiotics, penicillin-contaminated milk, beer (penicillin in fermentation products), aspirin, intravenous contrast dye, mite-contaminated wheat flour, chocolate, shellfish, nuts, peanuts, tomatoes, strawberries, melons, pork, cheese, garlic, onions, spices, eggs, milk (especially in children), yeast, infections of the tonsils, teeth, sinuses, gallbladder, prostate, bladder and kidney, emotional stress, menthol, certain cancers, certain viruses and parasites, and alcohol.

6.    How can my urticaria be treated?

Antihistamines (such as Claritin, Zyrtec, Allegra, etc.) are the primary treatment of urticaria and avoidance of the trigger triggers.  It can sometimes be very difficult to identify the trigger, and sometimes no trigger can be found (so-called idiopathic urticaria).  Occasionally, for severe episodes, oral steroids will be prescribed for a short burst (4 days) to provide relief.  In addition, warm / cool baths with oatmeal (such as Aveeno Colloidal Oatmeal), Sarna lotion and Pramoxine cream (over the counter) can be helpful.

Xerotic Dermatitis

1.    What is xerotic dermatitis?

Xerotic dermatitis is also known as asteatotic dermatitis, eczema craquelae, or “winter itch”  Xerotic dermatitis is a very bothersome whole-body itchiness that is usually worse on the arms and shins.

2.    What does xerotic dermatitis look like?

The affected skin is usually dry, flaky, cracked and red.  Blisters are not seen.  Sometimes the area affected looks like a well-defined plaque (usually on the shins).  Occasionally the cracked skin can become infected with bacteria and it will then become crusted and swollen.

3.    Who gets xerotic dermatitis?

Elderly individuals are most often affected since the skin loses its ability to maintain its normal water barrier.

4.    What causes xerotic dermatitis?

Frequent and lengthy hot showers and baths with harsh soaps also lead to xerotic dermatitis, especially in the wintertime when homes are usually over-heated and have less humidity.

5.    What triggers xerotic dermatitis?

As discussed above.

6.    How can my xerotic dermatitis be treated?

Clear understanding of the causes of xerotic dermatitis are important in preventing it from occurring, i.e. not bathing as frequently and not using harsh soaps.  Soapless cleanser such as Cetaphil cleanser is recommended as an alternative.  Also, immediate application of thick emollients, such as Cetaphil or Eucerin creams (NO LOTIONS as they are too watery and dehydrate the skin) or Aquaphor or plain Vaseline ointments all over the body after bathing so as to seal in moisture.  This means slathering on the creams within the first FIVE MINUTES after bathing.  Sometimes, mid-potency topical steroid creams are recommended for 1 to 2 weeks for relief.

Sebaceous Hyperplasia

1.    What is sebaceous hyperplasia?

Sebaceous hyperplasia is benign over-growth of normal oil glands (sebaceous glands) of the skin, usually seen on the forehead, temples and cheeks.  They typically appear skin-colored or yellowish and have a central “pore” or follicular opening.  They can sometimes look like an early skin cancer, such as a basal cell carcinoma.  Any lesion with this description that bleeds easily or grows over time should be evaluated immediately by a dermatologist.

2.    What does sebaceous hyperplasia look like?

Sebaceous hyperplasia is typically painless and does not itch.  It is mostly a cosmetic nuisance.  It tends to be genetically predetermined and there is usually a family history of this condition.

3.    Who gets sebaceous hyperplasia?

Fair-skinned individuals are most often affected.

4.    What causes sebaceous hyperplasia?

Sebaceous hyperplasia is not caused by infection or oily skin.  It is an inherited tendency or the skin and usually seen in families.  The oil glands of the skin are abnormally enlarged around a tiny hair follicle of the facial skin.

5.    What triggers sebaceous hyperplasia?

Sebaceous may become more pronounced over an affected person’s lifetime.  This is not a precancerous condition, but caution must be taken to make sure that the lesion is correctly diagnosed.  Sometimes sebaceous hyperplasia can mimic the appearance of a skin cancer, such as basal cell carcinoma.

6.    How can my sebaceous hyperplasia be treated?

Sebaceous hyperplasia can be effectively treated with fine-needle electrocautery, a painless procedure that may or may not require local numbing injections.  Occasionally, slightly lighter or darker pigmentation may occur at the treated areas, this usually resolves over time.  Darker pigmentation can be lightened with fading creams.  Laser Skin Resurfacing, in which a laser removes the outer layers of the skin is also effective for removing sebaceous hyperplasia and leaving the skin smooth and rejuvenated.