Medical Conditions We Treat

 

Acne Treatment
Acne is the term for the blocked pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that can appear typically on the face, neck, chest, back, shoulders and upper arms. Seventeen million Americans currently have acne, making it the most common skin disease in the country. While it affects mostly teenagers, and almost all teenagers have some form of acne, adults of any age can have it. Acne is not life-threatening, but it can cause physical disfigurement (scarring) and emotional distress.
Treatment for acne varies depending on the type and severity of lesions, as well as the patient's skin type, age and lifestyle. Options include:

  • Topical Medications
  • Antibiotics
  • Accutane
  • Blackhead Extraction
  • Microdermabrasion
  • Photodynamic Therapy
  • Skin Care
  • Blu-U Light Treatments
  • Laser Treatments

Acne scarring can be treated in a variety of ways as well. These include:

  • Chemical Peels
  • Dermabrasion/Microdermabrasion
  • Soft Tissue Fillers
  • Laser/Pulsed Light Treatments

Actinic Keratosis
An actinic keratosis, also known as a solar keratosis, is a common premalignant skin lesion. An actinic keratosis occurs when the cells that comprise 90 percent of the epidermis, the keratinocytes, change their size, shape or organization in a process called cutaneous dysplasia. This alters the texture of the skin surface and may extend deeper, into the dermis.
Depending on the location and severity of the lesion, an actinic keratosis may be treated in a number of ways. The patient and doctor will decide on methodology in consultation. These may include:

  • Cryotherapy, or freezing
  • Curettage, or scraping
  • Application of cream or ointment
  • Chemical peeling
  • Photodynaminc therapy using laser light

Allergic/Contact Dermatitis
Allergic contact dermatitis is a skin condition caused by allergic reaction to a certain material that comes in contact with the skin. The reaction appears on the skin as a rash several hours or several days after contact.
Symptoms

  • Rash
  • Itching
  • Swelling
  • Blistering
  • Redness
  • Cracked skin

Who gets it?
Anyone can be affected by allergic contact dermatitis, which involves sensitivity to certain allergens that seem otherwise harmless, such as nickel, rubber, medications, fragrances, poison ivy and other plants.
Treatment
Most cases of allergic contact dermatitis will go away on their own, but medications can be taken to relieve symptoms. Corticosteroids and antihistamines are often effective in relieving the symptoms of a reaction by reducing inflammation.
The best defense against this condition is to avoid contact with the trigger substance, which can help prevent symptoms from occurring. It is important to identify the individual trigger that caused your symptoms, so that it can be more easily avoided.


Athlete’s Foot
Athlete's foot is a kind of fungal infection that causes cracked red patches to form on the feet, usually between the toes. The affected areas may itch, burn, flake or ooze. Athlete's foot and other fungal infections may spread to the toenails (onychomycosis), causing them to change color, thicken, or crumble. Fungi grow fastest in warm, moist conditions; accordingly, risk factors for contracting fungal infections include keeping the feet wet for long periods of time, walking barefoot in wet public places such as pools or showers, wearing closed shoes that do not allow the feet to "breathe," and having sweaty feet.
Fungal infections may be mild or severe, last a short or a long time, clear on their own or require professional treatment. They may recur over time. They may also develop into more significant problems such as bacterial infection, especially if a person scratches at the infected areas. People with diabetes should be especially attentive.


Burns
Burns that penetrate below the superficial layer of the skin, or epidermis, can leave patients with scars and disfigurements. Serious scarring not only results in negatively altered appearance, but often has detrimental psychological consequences. When burns are severe enough, they damage muscular, bone or nerve tissue, affecting mobility, strength and sensation. Physicians can do much to repair the damage suffered by burn victims through a variety of procedures, including burn reconstruction.
Types of Burn Reconstruction
Burn reconstruction is performed to improve the patient aesthetically and psychologically. Most burn scars become less noticeable over time, but serious burns may leave scars that are unattractive, draw unwanted attention, or are disfiguring. Burn treatments typically involve skin grafting and cosmetic reconstruction. While some may be performed in an emergency setting soon after the damaging event, many treatments will take place after the original burn has healed, as much as 9 months to 1 year later.
Compression Bandages
After a serious burn, tight bandages are often required in order to prevent heat and moisture from escaping from the wound, decrease sensitivity, collect wound drainage, prevent infection, and keep the area in an appropriate position for healing.
Skin Grafts
Burn reconstruction may involve grafting of skin or other tissue, creation of skin flaps or the use of injectable fillers to normalize the appearance of the skin. Such methods may also correct functional problems, enabling the patient to move more freely. Skin for skin grafts may come from the patient or may be harvested from pigs or from the donated skin of cadavers. Skin grafts are sometimes only temporary to keep fluids in place until further healing takes place.
Debridement
Debridement is the medical removal of dead, or necrotic, tissue, in order to promote healing. Debridement may be done surgically or with the help of chemicals.
Surgical Cutting
A burn scab, or eschar, that completely surrounds a limb causes tightness, impeding blood circulation. An eschar that goes completely around the chest, for example, can make breathing difficult. In such a case, surgical cutting of the eschar in several places is required to relieve pressure and increase mobility.
Plastic Surgery
In addition to any surgery necessary to repair damaged skeletal, muscular or neurological tissue, plastic surgery if often necessary after a serious burn injury. Plastic surgery can improve the appearance of burn scars and increase the flexibility of joints affected by scarring. Plastic surgeons use various techniques, such as laser resurfacing, microdermabrasion and chemical peels to smooth out scarred tissue and normalize its appearance.
Patient Aftercare for Burns
In addition to the medical care and physical therapy necessary after serious burns, patients can assist in their own aftercare. It is important for patients to continue to be active and to exercise affected areas since otherwise they may suffer a contracture, a tightening and thickening of scar tissue that impedes mobility. The application of various ointments and creams may also be helpful in keeping the affected skin well-hydrated.

Medical
Cold Sores/Herpes Simplex
Cold sores, also known as fever blisters, are among the most common oral lesions, occurring on the lips or around the mouth. These sores, which are often painful, are caused by the herpes simplex virus. There are two types of herpes simplex virus, HSV-1 and HSV-2. Cold sores are usually caused by HSV-1, while HSV-2 is usually the cause of genital herpes.
The same virus that causes cold sores may also result in other symptoms, including fever, sore throat and swollen glands. Cold sores are normally diagnosed through physical examination alone, unless the physician suspects another variety of lesion.
Cold sores are highly contagious. Usually, the herpes virus affects the body when infected fluid enters a break in the skin. This typically happens through saliva contact, either through kissing or the use of shared eating utensils. Once an individual is infected, the virus can spread to other parts of the body. It is also possible for a person to have the herpes virus without visible cold sores.
There is no cure for cold sores, but they frequently go away after a few days without treatment. If a cold sore opens, lymph, a clear fluid, may drain from it. The cold sore will then typically form a scab. The cold sore scab normally heals within a few days to 2 weeks. Once an individual has contracted the virus, however it remains in the body and may precipitate subsequent outbreaks.
Outbreaks of cold sores tend to happen when the immune system is weakened: during or after an illness, during menstruation, or when an individual is under great stress. There are several topical treatment options available over-the-counter to hasten healing and lessen pain.


Dandruff
Dandruff is a chronic skin disorder that causes itching and flaking of the scalp. Fortunately, there are treatments to effectively control dandruff as it can be a nuisance since the itching is uncomfortable and the flaking visible.
Mild cases of dandruff can usually be managed with an over-the-counter dandruff shampoo. More stubborn cases may need a prescription-strength shampoo. Although dandruff is chronic, it can be controlled by managing stress, shampooing often and cutting back on styling products.


Diaper Rash
Diaper rash is a skin inflammation that appears as red splotches on your baby's bottom. In addition to red marks on the bottom, your baby may have a diaper rash if he or she is suddenly uncomfortable during diaper changes.
Causes of Diaper Rash
Some babies develop a diaper rash as a result of the following:

  • Changes in diet
  • Taking antibiotics
  • Not being changed often enough
  • Diarrhea
  • Frequent bowel movements
  • Reactions to cleanser
  • Diapers that are too tight

Treatment of Diaper Rash
Most cases of diaper rash can be managed at home with over-the-counter diaper rash ointments and ensuring that your baby's diaper is changed more often. If your baby's diaper rash doesn't improve within a few days or your baby also has a fever, contact their doctor, as these may be signs of an infection. In such cases, your baby's doctor will usually prescribe hydrocortisone or an antifungal cream to relieve symptoms.


Drug Reactions
A medication allergy is a condition that causes a person to experience some type of adverse reaction initiated within the immune system after taking a particular medicine. Medication allergies are fairly common and they can be elicited by many kinds of drugs, both prescription and over-the-counter. The patient may experience a wide range of symptoms that can be mild,moderate or even potentially deadly.
The symptoms produced by a reaction to a medication allergy can vary widely in both their nature and their severity. Some of the common symptoms a patient may experience include a rash on the skin, itchiness of the skin or eyes and the development of hives. In other cases, the patient may begin wheezing or portions of the face or tongue may become swollen.
The most severe type of reaction is known as anaphylaxis, which can be very dangerous and requires prompt medical attention. An anaphylactic allergic reaction causes extreme symptoms that may include:

  • Nausea and vomiting
  • Hives that spread across the body
  • Dizziness or fainting
  • Breathing difficulties
  • Abdominal pain
  • Rapid pulse and heartbeat

The treatment of a medication allergy typically begins with discontinuing the usage of the drug that caused the reaction. After that point if symptoms are still present, the patient may need to take a different type of medication to obtain relief from the allergy symptoms. Antihistamines are often effective for reducing itchiness, hives and rashes. More pronounced reactions often respond to corticosteroid treatment that can be applied topically, taken orally or provided intravenously. If wheezing is occurring, a bronchodilator medication may be used to open the airways and make breathing more comfortable.
In the case of an anaphylactic reaction to a medication, an injection of epinephrine will need to be administered as quickly as possible to ;stop the symptoms from worsening. At that point the patient will be monitored and some combination of the above-mentioned treatments will be used in order to alleviate the symptoms.
Medical
Eczema/Dry Skin
Dry skin, also known as xeroderma, is a common skin condition that can be uncomfortable and unattractive. Individuals troubled by dry skin experience redness and itchiness in the affected area. In most cases, dry skin can be symptomatically controlled with simple treatments.
Causes of Dry Skin
Aging, and its resulting changes in hormone levels, is a common cause of dry skin. In addition, certain diseases or environmental factors may cause the skin to become excessively dry.
Disease Conditions That Cause Dry Skin
Skin dryness may be caused by several skin disorders, including contact dermatitis, atopic dermatitis, a form of eczema, psoriasis, and ichthyosis, a genetic disorder causing a dry scaly appearance to the skin. There may be difficulty at first in distinguishing early symptoms of these conditions from more ordinary dry skin.
Eczema can usually be diagnosed because of the locations of the affected areas which are usually on the face, sides of the neck, and the backs of the elbow and knees. Psoriasis and ichthyosis, on the other hand, present as accumulations of rough scaly skin cells on many areas of the body. All three skin disorders result in more severe symptoms than simple dry skin and often cause psychological problems, due to altered appearance, as well as medical ones.
Other diseases, such as certain endocrine or autoimmune disorders may also result in dry skin. These include hypothroidism, diabetes and Sjogren's disease. Certain medications may also cause dry skin.
Treatments for Dry Skin
For most people, the tightness, itchiness and general discomfort of dry skin are relatively easy to alleviate. Simple lifestyle changes, like covering oneself appropriately against cold weather, wearing protective sunscreen, avoiding hot showers or baths, using moisturizing creams, particularly immediately after bathing, and humidifying the surrounding air, can be sufficient. Products with petroleum jelly are especially useful in eliminating dry skin since they provide an effective barrier to moisture. Products with fragrance are to be avoided since they may further dry out the skin.
If a particular substance, material or medication is found to be causing the skin irritation, avoiding it can make a tremendous difference. For more severe cases of skin dryness, stronger creams or ointments may be prescribed by the physician. There is also some scientific evidence that taking a fish oil supplement may improve the condition of dry skin.


Genital Warts (Condyloma)
Condyloma, commonly known as genital warts, is a common type of sexually transmitted disease caused by the human papilloma, or HPV virus. The virus causes small bumps to appear in the genital area. After sexual contact with an infected partner, patients can develop symptoms within three months of contact, although it may take years after contact for some cases to develop. If left untreated, patients may continue to infect others and may experience complications such as cancer or problems during pregnancy.
Condyloma can develop anywhere in the genital region, as well as in the mouth or throat, and appear as small, flesh-colored bumps that may cause itching, bleeding and discomfort. Some patients may not experience any symptoms from this condition, and may not even notice warts when they are present.
Many cases of condyloma will heal on their own with no need for treatment, however, there are several treatment options available to relieve symptoms. Topical medication may be prescribed to help boost immunity or to destroy the infected tissue. Larger warts that do not respond to medication may require surgical treatment for removal. Surgical methods to removal genital warts may include:

  • Cryotherapy
  • Electrocautery
  • Surgical excision
  • Laser treatment

Surgery to remove the genital warts may also be recommended for women who are pregnant in order to prevent exposing the baby to the condition during delivery.
As no cure for condyloma currently exists, the most effective prevention against the condition is to avoid sexual contact, especially with partners who have an active infection. It is also recommended use a condom during sexual intercourse to reduce the risk of contracting an infection. There is currently a vaccination available for males and females between the ages of 9 and 26 that prevents the specific strains of HPV that may lead to condyloma. These vaccinations are administered as three separate injections over the course of six months.


Hair Loss/Alopecia
Hair loss, or alopecia, is a common condition which may be a consequence of natural aging, a side effect of medication, or a manifestation of a health disorder. It can result in total baldness, thinning of the hair, or patchy bald spots and may be confined to the scalp or affect other areas of the body. Hair loss may be temporary or permanent, depending on its cause. Some of the causes of hair loss include:

  • Male pattern baldness
  • Fungal infections of the scalp
  • Severe infections or high fevers
  • Poor nutrition
  • Certain medications
  • Traumatic stress
  • Trichotillomania, a psychiatric disorder involving compulsive hair-pulling
  • Thyroid or pituitary disorders
  • Certain skin disorders, such as eczema or psoriasis
  • Autoimmune diseases, such as lupus or polycystic ovary syndrome
  • Chemotherapy or radiation therapy
  • Alopecia areata, an autoimmune disorder
  • Telogen effluvium, in which too many hair follicles remain in a resting state

Treatment for Hair Loss
Treatment for hair loss is usually based on the cause of the condition. When hair loss results from a fungal infection, it may be treated with anti-fungal medication. Hair loss that results from cancer treatment is usually temporary. For other types of hair loss, one of the following treatments may be considered:

  • Hair transplant surgery, hair plugs, scalp reduction
  • Over-the-counter medications, such as Rogaine or Nizoral
  • External laser comb
  • Hair-stimulating treatments

For some patients, wigs or hairpieces may be useful in creating an attractive appearance and reducing self-consciousness about hair loss.
Medical
Hidradenitis Suppurativa
Hidradenitis suppurativa (HS) is a chronic skin condition that involves the presence of blackheads and lesions that continually enlarge, open and drain pus, often leaving scars on the skin. HS is considered to be a very severe form of acne that often occurs in the area of the sweat glands and tends to worsen over time.
While there is no cure for HS, there are several treatment options available to help manage the symptoms and prevent new lesions from occurring. Certain antibiotics, anti-inflammatory medications or oral retinoid medications can help prevent this condition from worsening. Severe lesions may need to be removed, which can be done through making an incision and draining it or through surgical removal. Each case of HS is different, so it is important to discuss your condition with your doctor in order to find out which treatment option is best for you.


Hives
Hives are a common skin condition that may be caused by allergic reactions to medication, food, an insect bite or infection. Hives are swollen, itchy welts on the skin that can appear and disappear suddenly. They can sometimes burn or sting as well. Hives tend to be harmless and disappear on their own, but can be relieved by applying calamine lotion or taking antihistamines if needed.


Hyperhidrosis/Excessive Sweating
Hyperhidrosis is a condition that causes excessive sweating on the hands, feet, armpits, face and genital area, or all over the entire body. The exact cause of this condition is unknown, although it often runs in families and begins during childhood.
Patients with hyperhidrosis may sweat all over their body or in certain areas. Their skin may become white and wrinkled or red and irritated as a result of the constant moisture, and it may develop an odor as well. Living with hyperhidrosis often causes patients to feel embarrassed, awkward and self-conscious, especially during social situations.
Causes of Hyperhidrosis
If the hyperhidrosis is caused by an underlying condition, it is known as secondary hyperhidrosis. These underlying conditions may include:

  • Anxiety
  • Diabetes
  • Heart disease
  • Hormonal changes
  • Gout
  • Blood sugar problems

Certain medications may also cause hyperhidrosis. In some cases, there may be no known cause for this condition, although one theory is that nerves overreact, causing excessive sweating. Hyperhidrosis that has no specific cause and is not caused by an underlying medical condition is known as primary or focal hyperhidrosis. This condition tends to affect both sides of the body and can occur on the hands, feet, underarms, head and face.
Treatment for Hyperhidrosis
Treatment for hyperhidrosis depends on the severity of the condition, but may include prescription-strength antiperspirant or medication to help control sweating or stop the stimulation of the sweat glands. Botox® injections in the armpits block the nerves that cause sweating and can effectively treat hyperhidrosis for up to six months for each injection.
In severe cases, surgery may be required to remove the nerves that control the sweat glands, or the actual glands themselves. This procedure is usually considered a last resort to be used only after conservative methods have failed. Patients who undergo surgery may develop more intense sweating, a condition known as compensatory sweating, later in life.


Itching/Pruritis
Itching (pruritus) is a tingling, irritating sensation on the surface of the skin that provokes scratching. While incidental itching may be resolved by scratching, persistent itching is often only worsened by this response. Itching may be confined to one area on the body or may be an encompassing condition. When confined to a specific area, itching is usually the result of a localized contact with an irritant. When it involves the whole body, it is more likely the result of a systemic disorder and may necessitate medical diagnosis through blood tests or skin biopsy. Severe itching is experienced as akin to pain.
Causes of Itching
There are a great many causes of itching which include:

  • Allergic reactions to food or medications
  • Dry skin
  • Skin disorders, such as eczema or psoriasis
  • Contact dermatitis
  • Insect bites or stings
  • Sunburn
  • Irritating chemicals
  • Parasites, such as lice
  • Pregnancy, in some women
  • Rashes from diseases like measles or chicken pox
  • Certain systemic disorders like diabetes or leukemia or kidney failure

Treatment of Itching
Patients experiencing itching are advised to avoid scratching, since this simply exacerbates the problem, and to wear loose, non-irritating fabrics against the skin. Simple itching may be helped by moisturizing creams, oral antihistamines and topical corticosteroids. Cold compresses and lukewarm baths, particularly with a colloidal oatmeal solution, may also be helpful. Where itching is severe or persistent, it is important to seek medical assistance in determining the underlying cause of the problem.
Complications of Itching
When itching is followed by scratching that breaks the skin, there is danger of infection. When such skin breaks become hot, red or swollen, or when they are accompanied by fever or swollen glands, a physician should be consulted since antibiotic treatment is usually required. Similarly, when red lines emanating from the site appear, this indicates an involvement of the lymphatic system and should not be ignored. Severe or persistent itching requires medical consultation since it may be a symptom of a more serious underlying medical disorder. When allergic itching is combined with any breathing or swallowing difficulty, it constitutes a medical emergency.
Medical
Keloids
Keloids are an overgrowth of scar tissue that forms after a skin injury such as a surgical incision or wound. A keloid may be red, pink or flesh-colored and forms over the site of the injury as a nodular or ridged growth. The cause of keloids is unknown, but they are believed to be a result of the body's failure to end the healing process and stop repairing skin. They may be hereditary as well.
Treatment for keloids is not usually necessary since they are harmless and may disappear over time. However, for cosmetic purposes, cryotherapy, steroid injections or laser treatments may be used to remove the keloid.


Moles
Moles are growths on the skin that are usually brown or black. They may be located, alone or in groups, anywhere on the body. A birthmark is a colored mark that appears soon after a baby's birth. Although many moles and birthmarks are completely benign and pose no health risk, some people choose to remove them because they consider them unattractive.
Depending on its depth, location and color, as well as factors that include the patient's skin type and age, treatment for a benign but unattractive mole or birthmark includes:

  • Laser or pulsed-light therapy
  • Microdermabrasion
  • Surgical removal

Treatment of Irregular Moles
If a mole is irregular and needs to be evaluated further, either the entire mole is removed, or a small tissue sample taken, in order to biopsy it. If only a small section of tissue is taken and it is diagnosed as malignant, the entire mole will be removed, along with a margin of normal skin around it. Cutting into a malignant mole will not cause cancer to spread. If the malignancy is caught early enough, this may be the only treatment needed.
A melanoma that has spread beyond the skin requires more aggressive treatment, which may include:

  • Surgery to remove affected lymph nodes
  • Radiation therapy
  • Chemotherapy
  • Biological therapy to boost the immune system
  • Targeted therapy (attacks vulnerabilities in cancer cells)

Depending on the type and severity of the malignancy, a combination of treatments may be used.


Molluscum Contagiousum
Molluscum contagiosum virus, also known as MCV, is a viral skin infection, that causes small painless bumps on the skin. Skin bumps usually appear anywhere on the body two to seven weeks after exposure to infection, although in some patients it may take up to six months before symptoms are present. While it is more common in children, MCV can affect adults with a compromised immune system. Adults affected with MCV in the genital area are diagnosed with a sexually transmitted disease. MCV can be spread through vaginal, anal or oral sex as a result of skin contact with an infected area.
Bumps will usually go away on their own if left untreated, although this can take up to two years, during which time patients can still spread the infection to others. For this reason, most patients have the bumps removed by their doctor.
Treatment for MCV may include:

  • Scraping (curettage)
  • Freezing (cryotherapy)
  • Laser therapy to remove skin growths and clear the infection
  • Topical over-the-counter medication
  • Prescription anti-viral cream

These procedures are usually performed using a topical anesthetic to reduce discomfort. Your doctor will recommend the best treatment or combination of treatments for you based on a thorough evaluation of your condition.
After treatment, it is important for patients to avoid scratching the treated area, and to keep the area clean in order to ensure proper healing and prevent the infection from recurring. Specific post-treatment instructions will be provided for you to help you return to an active and healthy lifestyle.


Nail Disorders
There are several different diseases that affect the nails, often as a result of a fungal or bacterial infection. Ingrown toenails are the most common nail ailment, involving the corners of the nails digging into the surrounding soft tissue, causing irritation and swelling. Fungal infection commonly affects the toenails (and sometimes the fingernails as well), as a result of exposure to a warm, moist environment, and cause thick, brittle and distorted nails.
Treatment for nail diseases may include oral or topical medications. The nail may need to be removed for severe infections. Patients can prevent nail conditions from developing by keeping the feet clean and dry, wearing shoes that fit well and clipping toenails straight across.


Patch Testing for Skin Allergies
Skin testing is a common diagnostic tool used to identify the specific allergens that trigger contact dermatitis and, occasionally, systemic allergic reactions. Common trigger substances include cleaning solutions, detergents, cosmetics, perfumes, latex rubber and poison ivy.
In this method of allergy testing, many patches are taped to the skin, usually the skin of the upper back. Unlike the two previous methods of allergy skin testing, patch tests necessitate that the patches be left in place for 48 hours during which the area must be kept dry. As with the other forms of allergy skin testing, patients must be alerted to the possibility of a severe reaction so they can remove any patch that is causing serious problems, such as wheezing, and notify their physician immediately.
Medical
Poison Ivy
Poison ivy is a common plant known to cause allergic reactions in a large percentage of people. These allergic reactions usually manifest as unsightly and uncomfortable rashes on the skin. Skin rashes from poison ivy, like those from poison oak and poison sumac, are precipitated by an oily substance called urushiol found in the leaves, stems and roots of the plant. Poison ivy is found growing all over the continental United States, so rashes from poison ivy are very common.
As with other allergens, individuals may build up an intolerance to urushiol over repeated exposures, believing themselves to be immune to the substance until they develop a severe reaction. Poison ivy only develops from direct contact with urushiol and is not contagious through contact with affected individuals or blister fluid.
While the poison ivy rash normally disappears on its own, when larger areas of the body are affected, recovery may take longer. Recommended home treatments for the itchy rash may include:

  • Taking baths in colloidal oatmeal
  • Applying hydrocortisone cream to the affected areas
  • Taking over-the-counter antihistamines
  • Taking over-the-counter pain relievers

Psoriasis
Psoriasis is a term that encompasses a group of chronic skin disorders that affect any part of the body from the scalp to the toenails, but most frequently affect the scalp, elbows, knees, hands, feet and genitals. Over seven million men and women in the U.S. of all ages have some form of psoriasis, which may be mild, moderate or severe. In addition, it may be categorized into different types: plaque, pustular, erythrodermic, guttate or inverse psoriasis. Most forms involve an itching and/or burning sensation, scaling and crusting of the skin.Type-specific symptoms include:

  • Plaque psoriasis (the most common type): raised, thickened patches of red skin covered with silvery-white scales;
  • Pustular psoriasis: pus-like blisters;
  • Erythrodermic psoriasis: intense redness and swelling of a large part of the skin surface;
  • Guttate psoriasis: small, drop-like lesions;
  • Inverse psoriasis: smooth red lesions in the folds of the skin.

While the cause of psoriasis has yet to be discovered, suspected triggers include emotional stress, skin injury, systemic infections and certain medications. There is a possibility that susceptibility to psoriasis is inherited.
Normally the outer layer of skin, which consists of keratinocytes, is replaced unnoticeably, about once a month. This process is faster in people with psoriasis; keratinocytes reach the skin surface too quickly, before they can be properly incorporated into surrounding tissue or even before they are fully mature. As a result, the skin flakes off. This sped-up process is called parakeratosis.
Psoriasis cannot be cured but it can be treated successfully, sometimes for months or years and occasionally even permanently. Treatment depends on the type, severity and location of psoriasis; the patient's age, medical history and lifestyle; and the effect the disease has on the patient's general mental health. The most common treatments are topical medications, phototherapy, photochemotherapy (PUVA), and oral or injectable medication (for severe symptoms).
Medical
Rashes
Rashes are changes in the skin's color or texture. Simple rashes are called dermatitis, which means the skin is inflamed or swollen. Some rashes are independent symptoms, but many cause itching, burning or other discomfort. There are a great many reasons for individuals to develop rashes.
Types of Rashes
Rashes occur for a variety of reasons, some relatively benign, some extremely serious. Many rashes look similar to one another so their causes may be difficult to diagnose.

  • Contact Dermatitis
  • Allergic Rashes
  • Seborrheic Dermatitis
  • Viral or Bacterial Skin Conditions
  • Systemic Diseases
  • Rashes Caused by Sun or Heat
  • Stress Rashes

Treatment of Rashes
When a rash is caused by an underlying condition or disease process, the patient must be treated for the pervasive disorder. When a rash is the result of a bacterial infection, it is treated with antibiotics. When a rash stems from a virus, it may be treated with antiviral medication. Allergic rashes are normally treated with antihistamines and, when more severe, with corticosteroids. In many cases, avoidance of contact with the irritating substance or material may be sufficient to help the rash abate.
Almost all rashes that cause itching can be treated symptomatically with one or more of the following: antihistamines, soothing lotions like Calamine, topical or oral corticosteroids, baths with colloidal oatmeal, moisturizing creams or cold compresses. Wearing soft, loose clothing and taking over-the-counter pain relievers may also provide relief.


Ringworm
Ringworm is a contagious infection of the skin caused by a fungus called tinea, not a worm as one might infer from its name. Ringworm presents as itchy, scaly, ring-shaped red patches on the skin, bald spots in the hair or beard, or discolored, thickened nails. The most commonly infected areas of skin are on the scalp (tinea capitis), beard (tinea barbae), body (tinea corporis), groin (tinea cruris, jock itch or diaper rash) or foot (tinea pedis or athlete's foot). Ringworm tends to occur in warm, moist areas of the body, and can be passed by touching the skin of an infected person or by making contact with an contaminated item, such as a towel, hairbrush, or pool or shower surface. Pets, especially cats, can also transmit the fungus. Skin that is wet from sweat or the environment, or that is compromised by a minor injury, is more susceptible to an invasion of ringworm fungus.
The skin patches of ringworm have sharply defined borders and may present as rings, darker red at the perimeter and skin-toned within. Crusty or oozing blisters may also be present. When ringworm affects the scalp, there may be bald patches. When it affects the nails, the nails may discolor, thicken or even begin to decompose. Ringworm is generally diagnosed by a simple physical examination. Other methods of detection include lighting the skin with a blue light which causes the fungus to glow, administering a KOH exam during which a skin scraping is microscopically examined, or taking a skin culture or biopsy.
Once ringworm has been diagnosed, it is usually treated with over-the-counter antifungal powders or creams. It is also necessary to make sure the skin is kept clean and dry and that clothing and sheets are washed often to prevent reinfection. In especially resistant cases of ringworm, where the condition doesn't respond or worsens after treatment, or where a bacterial infection develops, more aggressive treatment is required. At this time, stronger antifungal medications, either topical or oral, will be prescribed. In order to prevent a recurrence of ringworm, the skin should continually be kept clean and dry, irritating clothing should be avoided, and antifungal powders or creams should be used prophylactically.
Medical
Rosacea
Rosacea is a chronic skin condition that causes redness and swelling on the face. Symptoms range from red pimples, lines and visible blood vessels to dry or burning skin and a tendency to flush easily. While there is no cure for rosacea, there are plenty of effective treatments available.
First and foremost, daily use of sunscreen is essential to reduce the likelihood of rosacea flare ups. Topical treatments such as Metrogel, Finacea and sulfur creams or washes can successfully decrease the appearance of symptoms. There are also cosmaceuticals, such as Avene's Diroseal, which feature a green tint that can neutralize redness and minimize swelling. Oracea is an oral medication that helps reduce the bumps and blemishes so common in rosacea. For more persistent cases, the Vbeam pulsed dye laser can safely, comfortably and effectively treat rosacea, virtually eliminating the redness and lesions associated with this condition.


Shingles
Shingles is a disease caused by the varicella-zoster virus, the herpes virus responsible for chickenpox. Once an individual has been infected with chickenpox, this virus lies dormant within the body's nerve tissue. Years later, the virus may reactivate as shingles, often after another illness or during a period of great stress. Advancing age and immune deficiency disorders are also risk factors for shingles.
Shingles most commonly presents as a painful rash of fluid-filled blisters wrapping around the back and chest, typically affecting only one side of the body. It is possible, however, for patients to have shingles with only a very mild rash or even no rash at all. Early treatment for shingles may minimize symptoms and prevent complications.
Since shingles affects the nerves, patients may experience a wide variety of sensations at the affected site, including shooting pain, itching, burning and numbness. Additional symptoms of the disorder may include headache, fever, fatigue and body aches. The shingles rash usually lasts for several weeks to as much as a month. For most individuals, the pain lessens as the rash heals. Some unfortunate patients, however, experience long-term nerve pain after a case of shingles, pain which may linger for more than a year.
Normally the doctor diagnoses shingles by an examination of the rash and a discussion of the patient's symptoms. If blisters are present at the time of the examination, the doctor may take a sample of fluid for a laboratory culture. Treatment of shingles consists of the use of analgesics and antiviral medications. The former provide symptom relief and the latter may shorten the course of the illness or lessen the severity of the symptoms.
While shingles is not a life-threatening disease, it can be extremely painful and interfere greatly with normal activities and quality of life. A shingles vaccine is now available and recommended for individuals over the age of 60. While not preventative of the reactivation of the shingles virus in all cases, it has been demonstrated to greatly reduce the risk of an outbreak, as well as to lessen the severity of the disease should it occur.


Seborrheic Keratosis
Seborrheic keratosis is a noncancerous skin growth that commonly affects the elderly. Its exact causes are unknown, although it tends to be hereditary. Seborrheic keratosis is a painless condition that requires no treatment; many individuals, however, choose to have the growth(s) removed for cosmetic purposes.
A seborrheic keratosis typically appears on the head, neck, or trunk. It is usually round or oval shaped, and it may vary in color. In some cases, seborrheic keratosis may itch. Medical attention may be necessary if numerous seborrheic keratoses develop in a short period of time, the seborrheic keratoses interfere with clothing, or other abnormal skin changes occur.
Seborrheic keratosis is diagnosed by inspecting the affected area. A biopsy may be taken to rule out skin cancer. Seborrheic keratoses require no treatment. If removal is requested for cosmetic purposes, it may be achieved through cryosurgery, curettage, or electrocautery.
Medical
Skin Cancer
Skin cancer refers to the abnormal, uncontrolled growth of skin cells. One in five people will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Risk factors include pale skin, family history of melanoma, being over 40 years old, and regular sun exposure. Fortunately, skin cancer is almost always curable if detected and treated early.
The most common skin cancers are basal cell carcinoma, squamous cell carcinoma and melanoma. Most skin cancers, 80-85%, are basal cell, affecting the uppermost layer of the epidermis. Squamous cell carcinoma occurs in 10% of all skin cancer patients and affects cells in the middle layer of the epidermis. The most serious, and most rare, of skin cancers are melanomas. Melanomas are dangerous since they can metastasize quickly. Melanomas are the leading cause of skin cancer deaths.
Skin cancers vary in shape, color, size and texture, so any new, changed or otherwise suspicious growths or rashes should be examined immediately by a physician. Early intervention is essential to preventing the cancer from spreading.


Skin Infections
Bacterial infection of the skin, also called cellulitis, occurs when a break in the skin allows bacteria that normally live on the surface to enter the body, causing inflammation, redness, pain, warmth, fever/chills, fatigue and muscle aches. The break itself may arise from an animal or insect bite or sting, after some surgeries, with the use of certain drugs, or from skin wounds due to injury, diabetic or ischemic ulcers, or if the patient has peripheral vascular disease. Left untreated, bacterial infection can lead to tissue death (gangrene), sepsis, generalized infection, shock, meningitis (if cellulitis is on the face) and lymphangitis (inflammation of the lymph vessels). Treatment may require hospitalization, oral antibiotics or analgesics to control pain.
Fungal infections of the skin are caused by microscopic organisms that live on the hair, nails (onychomycosis), mouth (angular cheilitis/oral thrush) and outer skin layers. They are quite common; the fungal infection cutaneous candidiasis, for example, which occurs in warm, moist crevices of the body, is the usual cause of diaper rash and vaginal yeast infections. Fungal infections are most likely to occur in people with diabetes, who are obese, or who take antibiotics or oral contraceptives. They are treatable (sometimes with difficulty) but often recur. Treatments include topical and systemic antifungal medications.


Skin Tags
Skin tags are little pieces of skin that stick out from the surface of the skin. Usually found on the neck, the underarms, under the breasts and in folds of skin in the groin or belly, these common skin growths are often the result of clothing rubbing against the skin. Most skin tags are acquired, although some people are born with them. Skin tags typically occur in people over the age of 40 and those who are overweight or have diabetes. They are also more common in women than men.
While skin tags are not cancerous and don't cause problems unless they are continuously irritated, many people nevertheless choose to have these painless growths removed for precautionary or cosmetic purposes. Patients are often bothered by them due to itching and sometimes even bleeding, since they can get caught in zippers, clothes, or necklaces and jewelry. Their removal is an easy, common procedure often done daily in our office.
Occasionally, the skin tag will fall off on its own. More likely, though, it will remain where it is unless you decide to have it removed. If the skin tag is taken off, it is rare to experience regrowth. However, you may very well develop new skin tags nearby or on other areas of the body.
There are several different ways to effectively remove skin tags, including freezing, burning and removing with scissors. Small tags may be removed without the use of anesthesia, while larger ones may require a local anesthetic. These treatments are usually effective in removing the growth, but may cause temporary skin discoloration or bleeding. Dr. Kleydman will help you decide which treatment option is best for you.

Medical
Sun Spots
Sun damage can affect any area of your skin as a result of long-term exposure to the ultraviolet (UV) rays of the sun. Sun damage most commonly occurs on the face, hands and arms, and may lead to sun spots, age spots, rough skin and wrinkles. Years of sun exposure can also lead to premature aging and skin cancer.
The best treatment against sun damage is preventing it from occurring in the first place. It is important to wear sunscreen lotion on a daily basis and avoid excessive exposure to the sun, especially during mid-day hours when the sun is strongest. Existing sun damage can be treated through skin procedures like BOTOX®, chemical peels, microdermabrasion and intense pulsed light therapy.


Vitiligo
Vitiligo is a skin condition involving a loss of melanin that occurs when the cells that produce this substance die or malfunction, resulting in increasing areas of depigmentation on the skin and hair. The specific cause of this condition is unknown, but is linked to immune system disorders, hereditary factors or single instances of emotional distress.
In order to diagnose vitiligo, your doctor may perform a blood test or remove a small sample (biopsy) of affected skin in order to detect any abnormalities within the area. While there is no cure for vitiligo, there are several treatment options available to slow to progression of the condition and allow patients to once again feel confident and happy about the way they look.
Treatment for vitiligo may vary depending on the severity of the condition, and some patients may not require any treatment at all, other than protecting the skin with sunscreen and applying cosmetic camouflage cream if desired. There are several topical creams and oral medications available to restore pigment to the affected areas, while ultraviolet therapy and oral photochemotherapy may also be effective in treating patients with severe vitiligo.
Surgical procedures such as skin grafts or tattooing can improve the appearance of affected skin as well. Your doctor will determine which type of treatment is most appropriate for your individual condition.


Warts
Warts are skin growths caused by viruses. Different warts respond to different treatments; some go away on their own. Salicylic acid products (in the form of drops, gels, pads and bandages) can help self-treatment of many warts by dissolving the keratin protein that makes up the wart and the dead skin above it. Others can be removed via liquid nitrogen freezing or electrical stimulation. Surgery may be recommended for painful or large warts that do not respond to these treatments.

 

 


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