Dermatologic Conditions
Acne
What is it?
Acne is the term for blocked pores (blackheads and whiteheads), pimples and deeper lumps (cysts or nodules) that appear chronically on the face, neck, chest, back, shoulders and upper arms as a result of abnormalities within the hair follicles and sebaceous glands.
What are the symptoms?
Pimples (recurrent red spots on the skin)
Whiteheads
Blackheads
Inflamed cysts
Scarring
Who gets it?
Nearly 17 million Americans are affected by acne. While this condition most often affects teenagers as a result of increased hormones and overactive sebaceous glands, adults of any age can have acne.
How is it treated?
The best treatment for acne depends on the type and severity of the condition. Many cases can be treated with prescription or over-the-counter topical medication, oral medication or a combination of the two. Results may take six to eight weeks to appear, and acne can sometimes get worse before it gets better.
More severe cases of acne may require stronger medications such as isotretinoin, an oral drug that helps reduce the size of the sebaceous glands and prevent new lesions from developing. Over 90 percent of acne cases can be successfully treated with isotretinoin.
Allergic Contact Dermatitis
What is it?
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.
What are the 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.
How is it treated?
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.
Alopecia Areata
What is it?
Alopecia areata is a common autoimmune disease that causes a person's hair to fall out as the immune system attacks the hair follicles. Hair often falls out in clumps and can be maintained in a small area or may lead to severe hair loss.
What are the symptoms?
- Hair loss on the scalp and other areas of the body
- Itching as the hair regrows
- Uneven regrowth of hair
Who gets it?
Anyone can be affected by alopecia areata, and nearly 2% of the American population will develop the disease at some point. Some people may have an increased risk if they have a family history of the disease or of other autoimmune disorders such as diabetes or lupus. Children and young adults are also commonly affected.
How is it treated?
Although alopecia areata cannot be cured, there are several treatment options available to help promote new hair growth and prevent further hair loss. Corticosteroids are often used to treat autoimmune diseases and may be administered as injections, pills or topical ointment to suppress the immune system from attacking the hair follicles.
Rogaine and other hair growth products can be used to help stimulate hair growth from areas that have been affected. A combination of these treatment options may improve their effectiveness, but there is no guaranteed treatment for alopecia areata.
Eczema
What is it?
Eczema refers to a group of inflamed skin conditions that cause chronic, relapsing, itchy rashes. It is also known as atopic dermatitis, and can be triggered by contact with coarse or rough materials touching the skin, excessive heat or sweating, or allergen triggers.
What are the symptoms?
- Rash
- Dryness
- Itching
- Scaling
- Leathery skin texture
Who gets it?
About 15 million people in the US suffer from some form of eczema, including 10 to 20 percent of all infants. It is most common in infants and children under the age of five. While there is no known cause for this condition, it appears to involve an overactive immune system in the presence of certain material. Many people with eczema also allergies, or have family members with the condition, or with allergic rhinitis or asthma.
Infants with eczema usually have itchy patches on the scalp and face, although the condition tends to go away on its own over time. Teenage and young adult patients with eczema often have itchy patches of skin on the elbows and knees, although they may also develop on the hands, feet, ankles, wrists and face.
How is it treated?
Although there is no cure for eczema, most cases can be effectively treated through home methods such as moisturizing lotions, cold compresses and by avoiding scratching. Your doctor may prescribe corticosteroid creams and ointments or antibiotics to treat infections. Ultraviolet (UV) light therapy may be recommended for severe cases.
Pruritus
What is it?
Pruritus is an unpleasant sensation that causes the urge to scratch the skin, and is often accompanied by other skin diseases. The cause of the sensation is unknown, but involves nerves that respond to chemicals released in the skin.
What are the symptoms?
- Itching
- Discomfort
- Symptoms from related skin conditions
Who gets it?
Pruritus often occurs in patients with other skin conditions, such as hives, chicken pox and eczema, as well as parasitic infections like lice. Different conditions may causing itching in different areas.
Itching may also be an indicator of a more serious internal condition such as kidney failure, hepatitis, lymphoma, anemia, pinched nerves and even HIV.
How is it treated?
The most effective treatment for pruritus is to treat the underlying cause of the itching. A blood test, skin scraping or biopsy may be performed to determine the cause. If the cause of the pruritus is unknown, topical steroid creams and oral antihistamines can often provide symptom relief. Moisturizing the affected area is also helpful in relieving the itching sensation.
Psoriasis
What is it?
Psoriasis is a group of chronic skin disorders that causes itching, burning and crusting of the skin as a result of constant inflammation of the skin. While skin usually replaces itself once every 30 days, patients with psoriasis have their skin replaced every three to four days. This condition most often affects the scalp, elbows, knees, hands, feet and genitals.
What are the symptoms?
There are five different types of psoriasis, each with its own set of symptoms:
-
Plaque psoriasis
- most common type of psoriasis"¨raised, thick patches of red skin covered by silvery-white scales
-
Pustular psoriasis
- pus-like blisters surrounded by red skin
-
Guttate psoriasis
- small, red spots on the skin"¨may begin as a sore throat but usually goes away on its own"¨most common on children and young adults
-
Inverse psoriasis
- red lesions that develop in the folds of the skin"¨most commonly found in the armpit, under the breasts and around the buttocks and genitals
-
Erythrodermic psoriasis
- redness, itching and pain all over the body
Who gets it?
Psoriasis affects over 4.5 million adults in the US, and can affect males and females equally. Many patients with psoriasis have a family history of the condition. Most cases develop before the age of 40, with some cases beginning during infancy or early childhood.
How is it treated?
While there is no cure for psoriasis, there are several treatment methods available to control symptoms for months or even years at a time. The best treatment for each case depends on the type, severity and location of the condition, but may include topical medication, phototherapy, photochemotherapy or injectable medication for more severe symptoms.
Rosacea
What is it?
Rosacea is a chronic skin condition that causes redness and swelling primarily on the face, but can also affect the scalp, neck, ears, chest, back or eyes. The symptoms of Rosacea tend to come and go over time, but can usually be treated.
What are the symptoms?
- Redness
- Pimples
- Swelling
- Dryness
- Burning
- Eye irritation
Who gets it?
Rosacea affects over 14 million Americans, and while anyone can develop this condition, it is most common in light-skinned, light-haired adults between the ages of 30 and 50. It also tends to run in families and affect people of Northern or Eastern European descent. The cause of Rosacea is unknown.
How is it treated?
The most effective treatment for Rosacea depends on each patient's individual case, as symptoms can vary from person to person. Your doctor will work with you to design the best treatment plan for you, which may include topical medication or oral antibiotics, laser treatments and lifestyle changes. Treatment may be needed on a long-term basis to help prevent flare-ups from occurring.
Seborrheic Dermatitis
What is it?
Seborrheic Dermatitis is a common condition that causes flaking of the skin, most commonly on the scalp as dandruff. It can also appear on the face, chest, arms, legs and groin, causing a greasy and scaly appearance of the skin.
What are the symptoms?
- Flaking
- Redness
- Scaling
- Itching
Who gets it?
Seborrheic Dermatitis is most common in infants younger than three months old, and in adults between the ages of 30 and 60 years old. In adults, men are more commonly affected than women. This condition is also common in people with oily skin or hair, and is often associated with acne or psoriasis as well.
How is it treated?
Treatment for Seborrheic Dermatitis depends on which area of the body is affected, as well as the patient's age. Dandruff can usually be treated with shampoo containing salicylic acid or prescription medication. On other areas of the skin, steroid lotions are often effective. In infants, Seborrheic Dermatitis can usually be treated with a mild, non-medicated shampoo and by brushing the scalp with a soft brush to loosen flakes.
Vitiligo
What is it?
Vitiligo is a common skin condition in which pigment cells are destroyed and white patches of skin appear on different parts of the body. Hair growing in these areas may turn white as well. Vitiligo can affect any area of the skin, but is most common on the face, lips, hands, arms, legs and genital areas.
What are the symptoms?
- White patches
- Premature gray hair
- Spreading of white patches
Who gets it?
Vitiligo affects one to two million Americans, and usually begins before the age of 40, with about half of all patients developing the condition before the age of 20. This condition may run in families as well, although having parents with Vitiligo does not necessarily mean that a child will develop the condition. Some cases of Vitiligo are also linked to certain autoimmune diseases, including hyperthyroidism, alopecia areata and anemia.
How is it treated?
There are several treatment options available for patients with Vitiligo, although treatment may be required for 6 to 18 months in order for pigment to be restored to affected areas. Cortisone cream, laser treatments, intense pulsed light and skin grafting may be used to restore lost pigment. The most common treatment for Vitiligo is PUVA therapy, which combines ultraviolet A light treatment with a medication called psoralen.
UVB Light Therapy
What is it?
Ultraviolet light B (UVB) therapy is minimally invasive procedure used to effectively treat the itching, burning and crusting of psoriasis. By exposing the skin to an artificial UVB light source on a regular schedule, growth of abnormal skin cells is slowed and the condition slowly heals. In addition to treating psoriasis, UVB therapy can also be used to treat Vitiligo.
How does it work?
UVB therapy can be administered in the doctor's office or in the patient's home with a unit purchased with a doctor's prescription. The affected area is exposed to the UVB light for a certain amount of time, several times a week.
What are the different types of UVB treatments?
There are two different methods currently used for UVB treatment. Broad-band UVB is the most commonly used form of treatment and uses a broad range of light at shorter wavelengths to slow the growth of abnormal cells. Treatments are administered three to five times a week for several months
Narrow-band UVB is a newer treatment option that involves a more specific range of UV wavelengths and can often clear symptoms faster and provider longer remission periods. It also involves fewer treatment sessions. As the results of narrow-band UVB are proven over time, this treatment may be used much more frequently to help treat psoriasis. Narrow-band UVB can also be used as an alternative to PUVA.
Health Topics
We care about your skin's health and your emotional well-being. In this section we address conditions we treat frequently including:
- Skin Cancer
- Psoriasis and Psoriatic Arthritis
- Immunobullous Disorders
- Cutaneous Lymphoma
- Autoimmune Connective Tissue Disorders
The content is informational in nature to help people learn more about conditions they or their family members may have. It is not meant for self-diagnosis. If you have one of these conditions and are seeking treatment, please call us to schedule an appointment for a personalized consultation.
Skin Cancer
Skin cancer is the most prevalent of all types of cancer. It is a condition that occurs when damaged cells begin to divide and grow uncontrollably. It can appear anywhere on a person's body but tends to be more common on the face, neck, hands and arms or other areas that are frequently exposed to the sun.
Skin cancer can be caused by sunburn and UV light exposure that damages the skin. That doesn't mean that if someone gets sunburn they will inevitably get skin cancer. It also depends on heredity (a person's inherited genetic makeup) and environment.
There three types of skin cancer that account for nearly 100% of all diagnosed cases.
- Basal Cell Carcinoma - Basal cell carcinoma is the most common type of skin cancer, and, in fact, the most common malignancy in humans with about 1,000,000 new cases diagnosed in the US annually. It is found most often in those with fair-skin, but can also rarely be present in people with darker color. This type of cancer is usually limited to the skin, but if neglected, can lead to significant destruction of underlying tissue structures. It is exceedingly rare that basal cell carcinoma metastasizes to other areas of the body. If detected and properly treated, basal cell carcinoma has a cure rate of greater than 95 percent. Basal cell carcinoma is typically treated by surgical removal of the lesion or with localized destruction techniques.
- Squamous Cell Carcinoma - Squamous cell carcinoma is the second most common type of skin cancer, accounting for between 10-20% of all skin tumors. This type of skin cancer can metastasize or spread to other parts of the body. Those at highest risk for squamous cell carcinoma are persons with a substantial history of lifetime ultraviolet light exposure, or those persons who are immunosuppressed. If detected and properly treated, squamous cell carcinoma has a cure rate of 95 percent. Squamous cell carcinoma is typically treated by removing the lesion with surgery.
- Melanoma - Melanoma is found much less commonly than basal cell carcinoma or squamous cell carcinoma but it is the most deadly of all skin cancers because it more rapidly can spread to other parts of the body. Unfortunately, melanoma is 20 times more common today than 60 years ago, and the incidence continues to rise in young women. Melanoma can first be seen when an area on the skin starts to turn mixed shades of tan, brown and black, or a mole changes in shape or size, or develops symptoms such as bleeding, itching, or burning. Treatment for melanoma can include surgery to remove the tumor, chemotherapy, radiation therapy, biologic therapy, and/or chemoimmunotherapy.
People, particularly fair-skinned people, with a history of skin cancer in their family are at higher risk. It is important to monitor moles and have darker spots of skin checked by a dermatologist if they appear to change size, change color, change shape, ooze, or bleed or if they feel itchy, hard, lumpy, swollen or tender to the touch.
When detected early, treatment for skin cancer is typically very effective.
Psoriasis & Psoriatic Arthritis
Psoriasis is a common disease affecting about 2-5% of the population. Psoriasis is a disease that most oftentimes is localized to the skin, but in up to 30% of patients can also affect the joints, a disease called psoriatic arthritis. On the skin, psoriatic lesions appear as red, scaling plaques that most often involve the elbows and knees, but commonly also exist on the trunk, arms, legs, and scalp. Psoriasis is not contagious, but in some families psoriasis may be hereditary.
Psoriasis can be a very uncomfortable disease when the skin becomes extremely itchy and painful. It can crack and even bleed. In some cases when the psoriasis is severe, the pain makes everyday tasks unmanageable. Many psoriasis patients feel as though they never find relief from the discomfort. Psoriasis is also associated with a higher risk for heart disease, obesity, alcoholism, and depression.
While people with psoriasis can have good days and bad days, psoriasis is generally a chronic condition that requires at least some treatment for long periods of time until the disease goes into remission. Remission periods vary greatly. Some patients may need very limited ongoing care, while others may require more aggressive long-term management. Some things that cause psoriatic plaques to flare up include infection, reaction to medications, skin injury, stress, weather, and hormone fluctuations. Skin trauma - bites, bruises, cuts and scrapes, and other such traumas affecting the skin - can also cause flare-ups or stimulate the over-production of skin cells.
Despite the fact that psoriasis is one of the oldest recorded skin conditions, science is still figuring out the exact mechanisms involved in the risk factors for and development of disease. We know that psoriasis and psoriatic arthritis are the result of a misregulated immune system causing changes in the skin and joints. Some families carry genes that increase the risk for psoriasis and psoriatic arthritis. While there is still no cure for psoriasis or psoriatic arthritis, there are extremely effective treatments that limit disability and greatly improve patients' quality of life.
Immunobullous Disorders
Immunobullous disorders affect the skin by causing severe blistering in the skin and mucous membranes of the mouth, eyes, or genital areas. Immunobullous disorders occur when the body's immune system errantly makes antibodies to the skin proteins. Immunobullous disorders usually require a skin biopsy for diagnosis, and oftentimes blood work. Immunobullous disorders are not contagious.
Three of the more common Immunobullous disorders we see include bullous Pemphigoid, Pemphigus Vulgaris and Pemphigus Foliaceous. In general Immunobullous disorders are rare.
- Pemphigus Vulgaris - Pemphigus Vulgaris is the most common and most severe form of Immunobullous disorders. Typically a person has sores or blisters in their mouth, and oftentimes also blisters on the body. These blisters are soft and easily broken. It is most often found in people between 40 and 60 years of age although it can occur at any age. Pemphigus vulgaris can be quite painful.
- Pemphigus Foliaceus - Pemphigus Foliaceus is the least severe of these disorders. Typically the protein that causes the blistering is only found on the top (superficial) layer of skin. These blisters are soft and easily broken. They may begin on the scalp and move to other parts of the body including the chest, back and face.
- Bullous Pemphigoid - Bullous Pemphigoid causes severe blistering on the surface of the skin. Blisters in bullous pemphigoid are firm and do not break easily. People with bullous pemphigoid experience intense itching and burning in their skin. This disease can be mild but also chronic (meaning that there is no cure).
It is important to detect and diagnose Immunobullous disorders early. When the disease lingers for long periods of time untreated, the sores can become infected. If the disease is found early, treatment can be effective. For most people these diseases can be managed and medications may eventually be discontinued. It typically entails steroids and immunosuppressive drugs.
Cutaneous Lymphoma
Cutaneous lymphoma is the term used to describe lymphomas of the skin. Cutaneous lymphomas are rare. Lymphoma is a type of cancer that originates in lymphocytes, a type of white blood whose role is to direct other white blood cells to fight infection.
There are two types of cutaneous lymphoma: cutaneous T-cell lymphoma and cutaneous B-cell lymphoma.
- Cutaneous T-cell Lymphoma -Cutaneous T-cell lymphoma (CTCL) is caused by a mutation in T cells that normally function as part of the skin's immune system. Oftentimes, CTCL begins as a pink scaly rash occurring in clothing covered areas of the body. If left untreated, and sometimes de novo, CTCL can grow into large tumors on the skin. Mycosis Fungoides is the earliest stage of disease where plaques are limited to the skin. This is the most common type of CTCL. When tumor growth occurs, it is more common for CTCL to spread (metastasize) to other parts of the body.There is no cure for cutaneous T-cell lymphoma but there are several treatment options to limit spread of the disease within the body and improve a person's quality of life. Treatments can range from steroids and other oral medications, to phototherapy, photopheresis, and radiation therapy depending on the severity of the disease.
- B-cell Lymphoma - Cutaneous B-Cell lymphoma is less common than T-cell lymphoma. About 20 percent of people diagnosed with cutaneous lymphoma have this type. B-cell lymphoma presents on the skin typically as a cluster of tumors or nodules. They can be red or bluish-red and most often appear on the head, neck, back, abdomen or legs. These tumors, although slow to grow, can rarely spread (metastasize) to other parts of the body.The cause of cutaneous B-cell lymphoma is unknown but may be related to the carriage of cancerous viruses. Early diagnosis is important for appropriate and effective therapy. B-cell lymphoma can be treated with surgery, radiotherapy, or chemotherapy, depending upon the extent of disease.
Autoimmune Connective Tissue Disorders
Autoimmune connective tissue disorders are a result of abnormalities in the immune system where cells begin to attack internal body proteins, including those that are present in the skin. Autoimmune connective tissue disorders are more common in women than in men.
Connective tissue diseases can affect many parts of the body. In the skin, we most often treat these disorders:
- Discoid Lupus - Discoid lupus causes sores with inflammation and scarring. The sores typically appear on the face, ears, and scalp although they can appear on other body areas as well. They present as red, inflamed patches that are scaly and crusty. Systemic lupus can also cause disease of the skin, heart, lungs, kidneys, joints, and nervous system. On the skin, these lesions can give you intense redness with a burning, stinging sensation when exposed to the sun, or scaling red plaques. Mouth sores are another common feature of systemic lupus.
- Dermatomyositis - Dermatomyositis usually presents as a reddish-colored, raised or scaly rash. It may cause the hands and face to swell, a purplish discoloration of the upper eyelids, red plaques on the knuckles, and a pink discoloration to the upper chest and back. Dermatomyositis can occur suddenly and severely and is usually accompanied by muscle pain or weakness.
- Scleroderma - Scleroderma causes the skin to become hard and tight. It can be limited to one specific area of the skin, or it can tighten skin diffusely causing significant disability by immobility and reduction in the ability to expand the chest to breathe. While there are good treatments for scleroderma, at this time there is no clear cause or cure.
As with all of the disorders we discuss on this site, early detection is key to lessen damage that may be caused to a person's body. Autoimmune connective tissue disorders are typically treated with steroids, anti-inflammatory drugs and immunosuppressive drugs. If the disease is well managed, a person with these disorders can live a productive and fulfilling life.
