Medical Dermatology

Medical Dermatology

One in four Americans—approximately 84.5 million people—is affected by skin disease. These conditions may cause everything from reduced self-esteem to missed days from school or work, to even permanent disability and death. Prompt and skilled treatment is important to ensure a successful outcome.

Other Skin Conditions We Treat

Keratosis Pilaris

This is a common, benign skin condition that causes tiny bumps on skin (often compared to goosebumps). The bumps feel rough and often appear on upper arms and thighs. They may be more pronounced with dry skin and during cold winter weather.  Keratosis Pilaris also tends to occur more frequently in girls, but may clear on their own in their 20’s. There is also an increased chance in developing this condition if a patient has a close relative with it. Also, patients who already have eczema, dry skin, hay fever, or even excess body weight can experience Keratosis Pilaris. The condition itself is harmless, but if excessive itching becomes bothersome, there are some remedies that may help alleviate it. Treatments include: exfoliating skin with a loofah while bathing and applying a thick moisturizer after every shower or bath when the skin is still damp. There are also some over-the-counter and prescription medications containing the following ingredients that can be useful:

  • Alpha hydroxyl acid
  • Glycolic acid
  • Lactic Acid
  • Retinoid
  • Salicylic Acid
  • Urea

Molluscum Contagiosum

            Molluscum contagiosum is a common viral skin infection. The virus spreads through skin to skin contact or even touching something that is infected with the virus. It is especially common in wrestlers, gymnasts, or anyone using shared clothing, towels, or athletic equipment. Lesions may also be spread by sexual activity. Picking and scratching at the lesions may also cause them to spread.  A person with a lowered immune system is more susceptible to molluscum contagiosum. It is also often seen in children and people who live in a tropical climate, as it thrives in warm and humid conditions. The virus usually first appears as small pink or flesh colored dome-shaped bumps that usually have a dimple in the center. They may be filled with a thick white cheesy or waxy substance. Although the bumps are usually painless, they can itch and turn red. Lesions most commonly appear on the face, neck, arms, hands, armpits, abdomen, genitals or inner thighs. Most cases of molluscum contagiosum will resolve on their own within 6 months. There are several different treatments which may speed resolution. These include:

  • Cryosurgery-the bumps are frozen off with liquid nitrogen
  • Curettage-the bumps are scraped from the skin using a tool called a curette
  • Topical Therapy-various acids and blistering solutions are applied to destroy the bumps
  • Topical retinoid creams
  • Topical anti-viral creams

 

Pityriasis Rosea

            Pityriasis rosea is a very common skin disease that causes a patchy pink-red rash that may last 6-8 weeks before resolving on its own. The condition may be related to a viral infection.  Due to its appearance, pityriasis rosea may be confused as eczema or ringworm. It is common with people of all ages and skin color but is most likely to occur between the ages of 10-35 and during pregnancy. (If you do develop this rash during pregnancy, it is important to let your doctor know right away).

The first sign of pityriasis rosea is called a “mother” patch and it tends to be larger (2-3-inch diameter) and appear approximately two weeks before the other rashes appear. Daughter patches tend to be smaller in size and often appear on the chest, back, arms, and legs. These patches can also form on the neck and face, sometimes even in the mouth. If many patches begin to form, they may assume a “Christmas tree” pattern on the back. Patches may be scaly and itch.

As noted above, the rash will often resolve on its own within 2 months. Symptoms from itch may be addressed with the use of over-the-counter anti-histamines and anti-itch creams. Some prescription anti-viral medications may also speed clearance of the rash.

 

Merkel Cell Carcinoma (MCC)

            Merkel cell carcinoma (MCC) is a rare and aggressive form of skin cancer. Factors that contribute to an increased risk for developing MCC include older age, fair skin, weakened immune system, and extensive sun exposure. Some lesions may be associated with viral infection. Early lesions often appear harmless and may be mistaken for pimples, insect bites, and cysts. They rarely itch, hurt, or bleed. Tumors typically often feel firm and may quickly expand. While lesions may develop anywhere on the body, they are more frequently diagnosed on sun-exposed areas of the body.

Definitive diagnosis of MCC requires a biopsy. Once diagnosed, initial evaluation often includes checking to see if the cancer has spread to other parts of the body. Clinical examination, CT/ MRI/ PET-CT, and sentinel lymph node biopsies are methods to assess the extent of involvement.  Depending on what tissues the MCC involves (skin only, nearby lymph nodes, or internal organs) will determine the stage of the cancer as well as guide future treatments.

Appropriate treatment for MCC requires coordinated multi-disciplinary care including a dermatologist, medical oncologist, surgical oncologist, and radiation oncologist. Treatment often includes removing the tumor and involved lymph nodes, as well as delivering post-operative radiation. In addition, patients may benefit from recently approved immune-based therapies as well as participation in clinical trials.

 

Dermatofibrosarcoma Protuberans

            Dermatofibrosarcoma protuberans (DFSP) is an uncommon type of skin cancer that rarely spreads to other parts of the body, but frequently recurs following excision. Without early treatment, the cancer can invade deep into fat, muscle and even bone. The cancer tends to form on the trunk (chest, back, abdomen, shoulders, buttocks) and arms or legs. People of all ages can get DFSP, with most being diagnosed between the ages of 20-50 years old. One of the first signs of DFSP tends to be a small bump on the skin that resembles a deep-seated pimple or rough patch on skin, which has no pain or tenderness. The lesion will enlarge and may begin to itch or become tender. The bumps range in color from a reddish brown to a violet color. While it is not known what causes DFSP, it has been noted that DFSP can sometimes begin on skin that has been previously injured, such as from a burn or prior surgery. A biopsy is required to confirm the diagnosis of a DFSP.  Surgical excision is the mainstay of treatment for DFSP; it may be performed with a wide local excision, Mohs surgery, or a modified “slow Mohs” procedure. In addition, doctors may recommend treatment with radiation or imatinib mesylate (Gleevec).

 

Solar Lentigines

            Solar lentigines are also known as “liver spots” or “age spots.” They are benign flat brown spots most commonly associated with prolonged sun exposure. Parts of the body with most chronic sun exposure—face, shoulders, arms, and upper back—are most likely to develop solar lentigines. In addition, the spots are more common in older patients. Solar lentigines should not itch, hurt, or bleed. Furthermore, they should not change in size, shape, or color. If any of these features are present, you should contact your dermatologist.

Using a dermatoscope (a type of hand-held microscope), most dermatologists can confirm the diagnosis of a solar lentigine. In some cases, however, a skin biopsy may be necessary to confirm the diagnosis.

While solar lentigines are not dangerous, several cosmetic treatment options exist. Prescription bleaching creams containing hydroquinone, Kojic acid, benzoyl peroxide, and tretinoin may help lentigines fade over time. Some physicians also find that cryotherapy (spraying with liquid nitrogen) is helpful. Chemical peels and laser treatments are two additional effective treatment options to consider.

 

Seborrheic Keratoses

            A common skin growth that can look like a wart or even a skin cancer, seborrheic keratoses are benign waxy, warty, gray to brown growths. They appear more frequently as individuals age and appear to have some genetic component. If your parents had seborrheic keratoses, then you would also be more likely to develop them. Seborrheic keratoses may grow anywhere on the body, but they seem to develop more frequently on the face and the trunk. Lesions are typically brown, gray, black, or even tan. They are usually raised and have a warty, waxy, or “stuck-on” appearance.  Lesions are not contagious. Most dermatologists are capable of diagnosing seborrheic keratoses without a biopsy—sparing unnecessary biopsies or treatments. However, it’s important that an experienced dermatologist examine the area to avoid missing a more serious diagnosis. Treatment for seborrheic keratoses is indicated only if a patient finds the lesions cosmetically displeasing.