MEDICAL DERMATOLOGY

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Medical Dermatology

We evaluate and treat all dermatologic conditions.  Among the most commonly seen conditions are:

Acne  The tendency to acne is genetic and although the incidence peaks in the teen years and early twenties, it sometimes persists well into middle age. Contrary to popular opinion, it is not aggravated by having dirty skin because it is primarily hormonal.  We are often asked if diet plays a role in acne and the answer is basically no, although some studies show that hormones from cattle in milk products could provoke a slight aggravation. It has also been noted that in cultures where there is little or no sugar consumption, acne seems to be absent.  But for the vast majority of Americans, the onset and occurrence of acne is beyond their immediate control.

As regards treatment, vitamin-A derivatives called retinoids (Retin-A, Tazorac, Differin, Isotretinoin) are usually prescribed, except in the mildest of cases, where a benzoyl peroxide cleanser or topical agent might suffice.  In the past oral antibiotics over a prolonged period of time were often prescribed.  There are two reasons why this is no longer considered appropriate: 1) oral antibiotics are merely a stop-gap measure and have no curative potential, and 2) the overuse of oral antibiotics is of great concern regarding bacterial resistance throughout the world.  Given its curative potential and its ability to completely shut down acne, especially scarring acne, we advocate the use of Isotretinoin (Accutane, Absorica, Clarivis, etc.) wherever appropriate.  In certain cases, oral contraceptives and/or spironolactone may be effective instead.

We are often asked about chemical peels, facials and laser treatments for acne.  The benefits of these treatments are minimal, short lived, not covered by insurance, and not scientifically proven.

Rosacea   Rosacea tends to run in families and is most common in northwestern Europeans.  It is a complex condition and may consist merely of redness, but can also manifest with red papules (bumps) or even cysts.  It is oftentimes psychosocially embarrassing.  While the exact cause(s) are not completely worked out it is invariably aggravated by over cleansing of the skin and sunlight.  There are various oral and topical agents available for treatment.  There are a subset of patients in whom traditional therapy is not effective and we offer such patients low-dose isotretinoin.  After years of struggle, these patients turn out to be among our happiest.

Skin Cancer  A great deal of our practice involves the diagnosis and treatment of skin cancer.  We strive to detect these at the earliest possible stage and to treat them as simply and efficiently as possible.  As such, we adhere to the guidelines laid down by the American Academy of Dermatology, doing our utmost to avoid large, unnecessary procedures.

Moles  The surveillance of moles is integral to any dermatology practice.  Our goal is to remove any moles that are suspicious for cancer and leave the remaining ones alone unless patients object to their cosmetic appearance.   In an attempt to detect a cancerous mole at its earliest stage, we rely on the use of dermoscopy for examination of all patients.  This is the technique that not only magnifies but peers deep into the mole to examine its “inner workings”.  This greatly reduces the number of biopsies we perform and allows us to detect melanomas in their earliest stages.

Eczema  Eczema (atopic dermatitis) for the most part is genetic and in most people is more common in the winter than in summer, though there is a subset of people whose eczema flares in the presence of heat and humidity.  At your visit, you will be instructed in what we consider to be good skin care and prescribed emollients and possibly a topical cortisone.  It is becoming increasingly apparent that the common bacteria Staph that lives on all of us plays a major role in the development of this condition.  In some patients we recommend special Chlorox baths to decrease the level of this common bacterium on the skin. We will also discuss the importance of adequate Vitamin D levels, as this can also be a factor in the severity of ongoing, uncontrolled eczema.  There is even a recent study that suggests that in some patients that addition of oral Asian Ginseng can improve eczema.  For those whose eczema is debilitating, oral drugs such as Methotrexate and Cyclosporine can be prescribed.

Psoriasis   Psoriasis is genetic and though seen in all races is most common in northern Europeans.  Psoriasis can be associated with psoriatic arthritis and we now know that moderate to severe psoriasis raises the risk of metabolic syndrome—heart disease, diabetes, hypertension, and obesity.  This association is independent of skin disease.  Treatments in the past have centered on light therapy, topical cortisones and topical vitamin D derivatives.  Oral agents include Methotrexate, the vitamin A derivative Soriatane, Cyclosporine, and Otezla. The new biologic agents have revolutionized the treatment of this potentially life altering skin disease.  We utilize all of these agents and for stubborn areas use the Xtrac laser.

Warts  The tendency to get warts is genetic, which explains why some people get them and others do not.  In young patients we advise tincture of time, as these will most likely spontaneously clear as patients grow older.  We employ a variety of agents to clear warts including liquid nitrogen, electrodessication, and lasers.  We often use immunotherapy, which involves the injection of a small amount of yeast (Candida) into warts.  This is minimally painful and can work “like magic” in some patients.

Cysts

Nail Disease

Hair Loss/Disease

Melasma  

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