General Dermatology

Dermatology is a specialty that focuses on the health and diseases of the skin, hair and nails. Since the skin is readily examined, the specialty as such has existed for over 3000 years. The skin is the largest organ of the body and reflects the overall health of an individual.

A dermatology consult and examination can include discussion of a patient’s general health issues and nutrition as well as an assessment of breakouts, rashes, lumps and bumps.

It can also involve discussion of how these skin changes can impact the individual’s overall functioning and self-image. A treatment plan will typically include and address all these factors.

Click the sections below to learn more about each skin disorder. (They may contain pictures.)

Acne

Acne is a disorder of the hair follicle and its associated oil gland. It usually starts around puberty and can persist for many years. Individuals usually notice black heads and white heads, red pimples and/or cysts. These lesions tend to come on the face, torso, and shoulders. They can persist for days and sometimes months. Symptoms associated with breakouts include itching, pain and burning.

Often, acne can be disfiguring and upsetting to the patient. It can also leave scars which may be prevented by appropriate treatment early in the course of the diseases. Treatments are usually tailored to the needs of the individual patient. They typically include a combination of topical creams, gels or lotions with oral medications such as antibiotics, hormonally active agents (like birth control pills), and Isotretinoin, a synthetic form of Vitamin A.

Actinic Kerastoses

Actinic kerastoses is the name given to sun-induced precancerous spots. These spots occur typically in sun exposed areas such as the face, arms, chest and hands. They are usually small flaky spots without substance other than scale. May actinic keratoses will come and go on their own. Some keratoses can sting, itch, or even thicken and ultimately develop into a skin cancer.

Treatments can include: observation or several different removal methods such as prescription creams, photodynamic therapy and liquid nitrogen.

Age Spots

As we grow older, our skin changes. Our skin texture becomes less elastic and more fragile. Dry skin is also more common with increasing age and hormonal changes. Age spots include “liver spots” (seborrheic keratoses or lentigoes), sun spots (actinic keratoses), and friction spots (skin tags). Most of these spots are harmless but can be worrisome as they can grow fast or sometimes change. Treatment of the precancerous spots (AK’s) usually recommended. It may include removal with liquid nitrogen, photodynamic therapy or creams. These harmless spots can also be removed especially if they are located in bothersome areas.

Eczema

Eczema is a hypersensitivity of the skin that is seen in people of all ages. It can be seen in people who also suffer from asthma and/or seasonal allergies. Typically, a patient complains of an itchy, red rash that is either patchy and can involve the creases or that is spotty. Many will say that the itching precedes the rash and so eczema is also called the itch that rashes. Eczema can differ in appearance depending on the age of the patient, on the location and length of the eruption as well as the treatments that have been tried. Treatments usually include topical creams (over the counter and by prescription) but can sometimes require oral medications, injections and ultraviolet light treatments to name a few.

Hair Loss

Hair loss is a condition that is usually evaluated and treated in a dermatologist’s office. It can have many causes including hormonal changes, a recent history of a severe illness, a recent history of surgery, inherited factors and infections. The hair on the scalp usually reflects the overall health of a person, and hair loss evaluations usually include a thorough history of the illness, an examination of the patient and lab work. Many hair loss conditions can be effectively treated if the patient is appropriately evaluated and a specific treatment plan is developed to address that particular patient’s problem. Treatments can include topical creams or solutions, oral medications and light treatments.

Hives

Hives, or urticaria, is a condition that affects about 20% of the population at some point in their lives. It consists of itchy red spots or patches that usually come and go within a 24-hour period of time. A hive reaction can be triggered by many different causes, among those are exposure to foods, pollens or infections. A severe hive outbreak can be dangerous because it could cause a person to have difficulty breathing, go into shock and possibly die. Treatments for hives will usually include oral antihistamines but also oral steroids or steroid injections.

Nail Disorders

Examination of a patient’s nails can provide clues about his or her general health or specifically about the status of his or her skin. Many skin conditions can affect a person’s nails, including psoriasis, eczema or alopecia. When someone has had a recent illness, the nails can change in their growth or shape. Other conditions affecting nails can include infections and allergic reactions. Dermatologists are trained to use clues gathered in the examination of a patient’s nails to determine the cause of the changes and the most appropriate treatment.

Moles

Moles are usually brown or flesh toned colored raised bumps that people can be born with or that can develop during someone’s lifetime. Although we don’t understand all the factors that can lead to mole development, moles seem to run in families and sometimes are brought on by increased sun exposure. Most moles are harmless, but Melanoma is a dangerous skin cancer that can initially look like a mole. The suspicious elements in a mole include A for asymmetry (not perfectly round or oval), B for borders (feathery or irregular), C for color (more than one color and in an unusual or unpredictable configuration), D for diameter (larger than 6mm or a pencil eraser size) and E for evolution (recently appeared or changed). If you or someone you know has a suspicious mole, it is extremely important to get to a dermatologist right away as Malignant Melanoma (the type of skin cancer that looks like a mole) can be a life threatening condition if left to develop but can be easily cured if found and treated early.

Psoriasis

Psoriasis is a common skin condition seen in a dermatologist’s office. It affects approximately 3% of the population. It usually consists of red bumps or patches on the skin with thick, silvery scaling that usually arises on prominent areas like the elbows or the knees. Psoriasis can also commonly affects the scalp and the umbilicus (belly button) but can come up in other areas such as the genitals, the hands or the feet. It is usually a lifelong condition that goes through periods of improvement and worsening. Treatments can include topical creams and ointments, ultraviolet treatments and oral or inject-able medications.

Rashes

Rashes are common skin conditions that are frequently seen in a dermatologist’s office. They vary widely in appearance and can be raised, flat, blistery, red, purple, or brown. Dermatologists are the detectives of the skin and usually can come up with the diagnosis for the rash based on the history, location and morphology (shape and form) of the spots. An initial evaluation of a rash usually includes taking a thorough history of the development of the problem in the context of the patient’s general health and performing a thorough physical exam. It can also include taking a biopsy (sample of the skin) and sometimes lab work. Treatments are tailored to the patient’s specific problems and can include topical creams and ointments and oral medications.

Rosacea

Rosacea is an adult-onset acne that usually occurs in light complected individuals. It is a disorder that affects the skin’s barrier function and the skin’s oil glands. There are typically variables that define each case of rosacea. Some patients have vascular rosacea – they tend to blush, flush, and can ultimately develop prominent broken blood vessels (telangiectasias). Occasionally, patients have inflammatory rosacea – red to violaceous pimples, without a head, breakout on the central facial area. Rarely, patients with rosacea will develop abnormal growth and thickening of the oil glands that can even more rarely distort the facial features (especially the nose).

Treatments for rosacea are tailored to the individual patient’s needs but typically include topical cleansers, gels or creams. Some patients may need oral medications such as antibiotics. Other treatments that have been shown to be helpful include special cosmetics, moisturizers, chemical peels, photodynamic therapy with blue light and laser treatments.

Warts

Warts are growths caused by viruses. They can grow at any age and in any location. They are usually raised spots with small finger-like projections. They can grow in size and in number. Warts can be disfiguring and can interfere with daily activities such as walking.

Many treatments are available for warts but none of they have a one hundred percent cure rate. Effective treatments therefore require frequent follow-up and sometimes adjustments to the treatment plan. Possible treatment of warts includes use of prescription creams, destruction of warts by freezing, cutting off, laser and injections.