Patient Education & Frequently Asked Questions
How to Have a Rash-Free Summer:
By: Meghan Bramer, M.M.S., PA-C
Swimming is a popular past-time during the summer months for many families. Most kids enjoy spending the day out by the pool, but this can wreak havoc on the skin! While you’re using sunscreen to prevent sunburn, you may have also noticed that your child has developed dry itchy patches of skin, warts or even small little white blisters called molluscum. These are all common skin conditions that can be exacerbated by swimming.
If your child, or even yourself, has a history of eczema, swimming can cause this type of skin condition to flare. Water draws moisture out of the skin, making it more dry than usual. To prevent this, make sure to shower and apply a moisturizer to skin right after swimming, or at least as soon as possible. If necessary, apply moisturizer twice daily until dryness subsides. If your skin is especially itchy and red, even after using moisturizer, you may need a prescription topical steroid cream.
Warts and molluscum lesions arise more commonly from swimming in community pools rather than lakes or oceans. Both of these skin lesions are caused by a virus that is transmitted by contact. When the virus (which is spread more easily in water) comes in contact with the skin, it will cause those bumps. Warts and molluscum lesions are benign and can be cured easily by “freezing” with liquid nitrogen or by applying topical creams.
The summer months are a great time to be outdoors at the nearby lake or community pool. With the proper sun protection and education on possible skin rashes that can develop, this play time can be safe, fun, and stress-free!
By: Laura Collins, APN, DCNP
Onychoschizia is a diagnosis that may not sound very familiar; however it is a harmless condition that affects about 20% of the population at some point during their lives, most commonly women and older adults. Here is a hint; it usually affects our fingernails.Our fingernails perform many important functions for us in our day to day lives. They are the tools that help us to pick up small objects and manipulate other items. They also help to protect the ends of our fingers, assist with fine-touch sensation, and they can also enhance the esthetic appearance of our hands.
Most of us have experienced a nail that has separated at the edge, or has had the top portion peel off, only to reveal a thin layer left underneath that almost always tears away within a matter of minutes to hours. Onychoschizia is a cosmetic problem defined by peeling, splitting, or separation of the layers of the nail horizontally at the free edge of the nail. This weakens the tip of the nail and makes the nail fragile and more likely to chip and tear as described above.
Usually this is an occasional problem, and more of a nuisance than anything else. This condition commonly affects house cleaners, nurses, hair stylists, and other occupations that require frequent hand washing. Some of the factors that can cause this to happen would be nail exposure to irritants such as detergents and also excessive water exposure. Moisturizing regularly can help to prevent this from happening. Onychoschizia can also be caused by nail products such as hardening polish and polish removers as well as other exposure to various chemicals.
Most nail conditions take several months to resolve, usually with the growth that pushes the nail forward. Fortunately there is an over the counter supplement widely available to strengthen nails and make them less likely to split. You can take the B vitamin, Biotin, as directed daily. Most people notice improvement in the nail within 6 months of beginning treatment, and treatment should be ongoing to maintain the results as the nail continuously grows out.
Other ways to prevent this common condition are:
Acne and Pregnancy
Acne occurs in many women during pregnancy. The abundance of hormones are likely to blame, as they can cause an increase in oil production that may lead to a flare of acne. The good news is that there are a variety of treatment options that are considered safe with pregnancy.
General skin care is the first place to start in treating acne during pregnancy: Use a gentle cleanser twice daily such as Cerave Foaming Cleanser, NeoCleanse Exfoliating Cleanser with glycolic acid, or NeoCleanse Gentle Cleanser. Moisturize with an oil free facial lotion such as Cerave AM or PM Facial Moisturizer or Belleza Ultra Light Moisturizer. The Clarisonic Skin Cleansing Brush is another option for helping to keep the pores clean and free of excess oil and makeup. Avoiding picking, squeezing or popping pimples is essential in limiting scarring and minimizing inflammation. Finally, makeup should be oil free or mineral based.
Certain over the counter products should be avoided during pregnancy due to their unknown effects and safety. These include retinol, benzoyl peroxide and salicylic acid. These are often marketed for the treatment of acne or anti-aging.
Medication or procedural treatment options are available if the acne does not improve
with a good skin care regimen. It is important to involve the obstetric team when
medical options are considered. Category B topical antibiotics such as clindamycin and
erythromycin, and topical azelaic acid gel are often prescribed. In severe cases, oral
antibiotics such as erythromycin may be considered. The Acleara Acne Clearing System,
Sun Protective Clothing
As dermatology providers we educate our patients regularly on the importance of wearing sunscreen. If you are someone who works outdoors, spends a lot of time in the sun, or are going on a vacation to a sunny place; then you may wish to give yourself the additional coverage of Sun Protective Clothing. This type of protection is now widely available for infants, children, and adults. It lends flexibility to the type of sun protection we, as active humans, need. Garments can include hats, beach cover ups, bathing suits, jackets, shirts, rash guards, swim trunks, and other clothing.
Items labeled “Sun Protective Clothing” are clothes that are designed specifically for that purpose. Such garments can be manufactured with certain types of fabrics, weaves, and dyes, etc. that work to shield a person from the damaging ultraviolet (UV) radiation of the sun. Unlike sunscreens, which utilize a Sun Protective Factor (SPF) rating to determine the level of protection, sun protective clothes are labeled with a UPF, or Ultraviolet Protection Factor. If you are searching for sun protective garments, look specifically at the UPF rating. Here is a guide to determine how well a piece will protect you:
UPF of 15-24 is considered “good” with 93-96% UV radiation blocked.
Another plus side to UPF protected garments is that the sun protection does not wash off, sweat off, or wear off when you are swimming or doing other activities outside as the SPF with sunscreens can. We do not suggest that you use sun protective clothing as an alternative to sunscreen, but rather to use them together to protect your skin from the damaging effects of the sun’s rays. If you would like more information on where you can find sun protective clothing, here are but a few trusted websites that offer reputable products:
So have fun and enjoy the sun . . . responsibly!
What is Perleche?
By: Laura Collins, DCNP
Have you ever experienced redness, scaling, crusting, or fissure like wounds at the corners of your mouth? If you have, it is possible that you may have had a condition known as Perleche, or angular cheilitis.
Perleche may affect anyone, young and old. It can be episodic or chronic. Young patients may be more at risk if they have a history of atopic dermatitis. Elderly patients may have an increased risk caused by aging and the weakening of the muscles of facial expression that surround the mouth. This can create more retention of saliva in the corners of the mouth during the day and while sleeping. A pooling of saliva such as this creates a medium for yeast and bacteria to grow which may result in redness and infection.
Some of the other risk factors include poor-fitting dentures, malocclusion of the teeth, absence of teeth, mouth breathing, lip licking in children, and orthodontic devices.
Perleche can be treated with a variety of medications. It is commonly treated with a combination of mild topical steroids and anti-yeast/anti-fungal medications. Barrier ointments may be recommended to protect and moisturize the area. Occasional other topical medications are recommended to treat chronic infection. If needed, a dental referral can be suggested to correct potential causative factors. In addition, sometimes the cosmetic use of injectable fillers (Restylane, etc.) into the skin folds has been beneficial in some patients.
If you believe that Perleche may be a condition you experience frequently, please do not hesitate to contact our office and see one of our experienced providers to evaluate your condition for treatment.
What is Rosacea?
By: Meghan Bramer, M.M.S., PA-C
Do you notice that your cheeks flush red when you get hot or are out in the sun? Do you flush or blush when eating spicy foods or after drinking a glass of wine? Do you have acne bumps, primarily just on your cheeks? Then, you might have rosacea.
Rosacea is a common skin condition that presents as redness, with or without pimples, to the cheeks, nose, and chin. It is often called “adult acne” because it usually starts many years after adolescence. Although there are many different thoughts on the cause of this condition, there are many different treatment options that can be very effective. Each treatment option is targeted to treat each of the different forms of rosacea – background redness and acne bumps.
One “hallmark” symptom of rosacea is the flushing or blushing of the cheeks when exposed to certain triggers. These triggers can be anything from food or drinks, to environmental factors like cold or hot weather. This flushing is actually the blood vessels in the superficial layers of the skin becoming larger and giving the skin a more reddish hue. After many years of this frequent flushing, the blood vessels will actually stay dilated and the skin will stay permanently red. There are topical gels and creams that can be used to help minimize flushing and prevent the redness from worsening, however it will not get rid of the redness that is already present. This will require a cosmetic laser treatment. Over 2-3 treatments, this laser treatment can be very effective. The laser is a quick, in-office procedure and requires no downtime. This treatment can be performed by any of the physicians in our office.
Another common symptom of rosacea is the acne bumps that can accompany the background redness. These bumps usually come and go, but can often be deep, painful lesions that stick around for a few weeks at a time. These can be treated with a combination of topical gels or creams, and if necessary oral antibiotics, and are generally very effective.
There is no reason to suffer with rosacea any longer! There are very many effective treatments that can be used to control flares and get rid of acne bumps. See a dermatologist to discuss the most appropriate treatment option for you.
What Causes Red and Tender Nail Folds?
By: Laura Collins, DCNP
Acute paronychia is the term used to describe a sudden inflammation of the nail folds surrounding either a finger or toenail. This condition usually results from an infection caused by staphylococcus aureus, streptococci, or pseudomonas bacteria. The most common symptoms associated with acute paronychia include a sudden onset of redness and tenderness to usually one side of a nail fold. Pus may or may not be visible within the nail fold. Usually only one nail is affected at a time.
The most common causes of acute paronychia include trauma or manipulation of the nail fold resulting from manicures, hang nail removal, or nail biting. Some cases may occur spontaneously with no obvious cause. If you experience symptoms of a red and tender nail fold we encourage you to make an appointment for evaluation. Treatment may include obtaining a bacterial culture of the area and topical or oral antibiotic treatment depending on the severity. In more severe cases, a minor surgical procedure called an “incision and drainage” can be performed in the office to relieve pain and reduce swelling.
What Can Be Done for Cracked Heels?
Do you have dry, cracked skin on the bottom of your feet?
Many people suffer from this chronic and uncomfortable condition, which can worsen during the winter. It usually occurs with severely dry skin, and causes thick, hard, and deeply cracked skin on the heels of the feet. Once the skin gets rough enough, it can also be painful and irritating. This cracked skin can also increase your risk of infection, making it much more challenging and important to treat.
There are some things that you can do at home to help. Start by taking quick, warm showers (instead of long, hot showers), and then exfoliate the bottom of your feet using a pumice stone. The pumice stone will help to remove the dead skin cells making your feet softer and allow a moisturizer to be more effective. After getting out of the shower, pat dry your skin and apply a thick emollient cream while the skin is still damp, like CeraVe Moisturizing Cream or Aquaphor Ointment. Then cover your feet with socks.
If these measures are taken and you are still not seeing results, it may be time to see a dermatology provider. There are other prescription medications that can be used for further treatment. Also, it is important to get this evaluated because it could be another condition, like a plantar wart or athlete’s foot that may need a different kind of treatment.
Remember, once the rough skin is gone, it is important to keep up with your exfoliating and moisturizing regimen so it doesn’t come back next winter!
What can itchy stretch marks during pregnancy mean?
By: Lauren King, PA-C
One of the most common pregnancy-related skin diseases is a condition called Pruritic Urticarial Papules and Plaques of Pregnancy (PUPPP). The skin eruption is characterized by intensely itchy, red-colored bumps that generally form within abdominal stretch marks. Over the course of several days the lesions may multiply, group together and spread symmetrically. Areas most frequently involved are the abdomen, buttocks and thighs.
This disease most often affects women who are pregnant for the first time, and recurrences with subsequent pregnancies are uncommon. It has been noted that women who develop PUPPP average more weight gain and greater abdominal circumference during pregnancy compared to women who do not develop the disease. Therefore, women carrying twins or triplets are more frequently affected. Most cases begin late in the third trimester and last an average of 6 weeks.
PUPPP is not associated with any harmful effects to either the mother or unborn child. However, it is important to note that this skin condition may mimic other diseases that can be harmful during pregnancy and it is best to have evaluated by a health care professional.
How do you treat PUPPP?
The goal of treatment is to control the eruption and relive the itching with topical steroids, anti-itch lotions and antihistamines. The condition ultimately resolves within 1 week of delivery. Consider making an appointment with us so that an appropriate treatment plan can be put in place, essentially keeping you comfortable and safe during pregnancy.
When it’s more than just dry skin…
By: Chris Arico MS, PA-C
Many patients, especially this time of year, come into our office seeking help for their dry skin. They often complain about redness and cracking to their elbows, knees and back. When we are inspecting these spots, the redness and white scale tip us off to the real issue: Psoriasis.
Psoriasis affects 7.5 million Americans, which represent about 3% of our total population. That’s more than just a handful of people!
We don’t always know why Psoriasis rears its ugly head. We do know there is a hereditary component, which can be rather strong. Some people who have this family predominance may come down with a simple infection such as strep throat and only a few weeks later, their psoriasis symptoms can start appearing.
The hallmark symptoms of psoriasis are thick, white scale on a red base that can range in size from smaller than a dime to the size of a hand and larger. These plaques usually start on the elbows, knees, and lower back, but can present anywhere on the body including the face, hands, and feet.
The skin symptoms of Psoriasis can also include nail changes such as formation of small pits and separation of the nail from the bed below. Also, patients can sometimes notice new-onset or worsening arthritis symptoms.
Although Psoriasis cannot be cured, the great news is we have many ways to treat psoriasis ranging from the simple: topical creams and ointments, to the complex: injectable medications and light therapy. Each treatment plan is customized to the type and extent of the Psoriasis being treated.
Patient with Psoriasis tend to notice their symptoms get better during the summer months due to increase amount of the sunlight they are getting. But during the winter, their symptoms can flare pretty significantly.
If you have noticed new “dry patches” to any body areas, you should get them checked…they may represent Psoriasis and not just dry skin.
What are Cherry Angiomas
By Laura Collins, APN DCNP
Red spots are a common concern during patient visits; however, there is one red spot that is usually of very little significance. Cherry angiomas are small benign growths of small blood vessels that occur in almost all patients over the age of thirty. They can be as small as only1-2 millimeters in diameter, or range in size up to a centimeter. Cherry angiomas may appear flat, or may become raised over time. Sometimes a patient may have only one lesion, or patients can have dozens of them. Most of the time, patients will notice the development of these lesions on the scalp, face, trunk, and extremities. Cherry angiomas can range in color from a bright cherry red to a dark, almost purple color, commonly seen in older patients and with larger lesions. They are almost always asymptomatic unless they have been traumatized, for instance, being cut when shaved over, etc.
Once the lesions appear, they are permanent. Cherry angiomas are usually red and smooth, with even borders. They should not rapidly increase in size, scab, scale, or bleed. Lesions that exhibit these symptoms should be promptly evaluated by a dermatology provider. Many patients are unsatisfied with the appearance of these lesions either due to the location or the color. Fortunately, there are several treatment options available for removal of these lesions, however, treatment is usually considered cosmetic.
If you believe that you have cherry angiomas and you would like them evaluated, please do not hesitate to contact our office for an appointment.
What is Severe Underarm Sweating and What Can Be Done for It?
Many people have a very common medical condition called hyperhidrosis, or excessive sweating. Severe underarm sweating involves overactive sweat glands that normally regulate body temperature. In primary axillary hyperhidrosis the sweating exceeds what the body needs for cooling.
For those affected with this condition, it can have devastating psychological and emotional effects as the try to modify their lifestyle to cope. Clothes are changed frequently, certain fabrics and fabric colors are avoided, and new clothing must be purchased more often. Wardrobe choices are limited as some fabrics and colors reveal the condition as opposed to hiding it. It can be disabling in one’s professional and social life, and may lead to causing constant embarrassment.
Prescription anti-perspirants such as Drysol are sometimes effective. However, they may also cause severe skin irritation. Drysol is applied to the affected area at night and left on for 6 hours while the patient sleeps. It is then washed off in the morning. Initial success rates are usually good but less satisfactory in the long term.
Botox is a medication that works well for hyperhidrosis. It temporarily blocks the signal that stimulates sweat production. A decrease in sweating is noted after the injections. The injections may typically need to be repeated approximately every 6 months. Ask your dermatologist if Botox may right for you.
What is Causing My “Dry Scalp”?
By: Meghan Bramer, M.M.S., PA-C
Have you noticed flakes or greasy scales on your scalp? Do you experience itching to your scalp on most days of the week? You may have a condition called Seborrheic Dermatitis, also known as dandruff. This condition affects many adults and children and most commonly appears on the scalp, as well as around the eyebrows and nose area.
This condition is believed to be caused by a yeast that normally lives on the surface of the skin. In especially oily parts of the body, such as the scalp and face, this yeast can over grow and cause redness, flaking, and itching. Although it can occur in all ages, it is most common in newborns, then in adolescents and adults.
Although Seborrheic Dermatitis can be irritating and unsightly, there are many effective types of treatments to keep the symptoms under control. The most common treatments are antifungal and anti-inflammatory shampoos, such as over the counter productions like Head and Shoulders, Selsun Blue, T-Sal, and Nizoral 1% Shampoo, as well as prescription shampoos. Each of these shampoos contain different medications that suppress this specific yeast, so it can be beneficial to alternate two or three of these shampoos. There are also many other prescription foams, solutions, and ointments that can be used to suppress the itch and decrease flaking.
These treatments can be very effective, however this condition can be chronic, so once you stop using the medications, the symptoms may return. With seborrheic dermatitis, you may need to continue your treatments occasionally, like once a week, to prevent the condition from flaring.
The symptoms of Seborrheic Dermatitis can also resemble symptoms from other conditions that may require alternative treatments. If you are experiencing any of these symptoms, see any provider in dermatology to get the most appropriate treatment options for you.
What is Melasma?
Melasma is a very common skin discoloration that most often ccurs on the sun exposed areas of the face. Hormones and sun exposure tend to trigger melasma which is most prevalent in women. Melasma appears as brown to gray- brown patches usually seen on the cheeks, forehead, and upper lip. It can also appear on other parts of the body which get a lot of sun exposure such as the forearms and neck. It is so common in pregnancy that it is often called the mask of pregnancy.
Melasma can be stubborn to treat and treatments can include therapy with hydroquinones and tretinoins to lighten the skin, chemical peels, and in severe cases laser treatments.
Under the care of a dermatologist, people with melasma can have a good outcome. It may take months of treatments to see improvement so it is important to follow the advice of your dermatologist. After your melasma clears, your doctor may place you on a maintenance therapy to prevent the melasma from returning. You can help prevent melasma by wearing sunscreen and reapplying the sunscreen every two hours, and wearing a wide brimmed hat everyday.
WHAT ARE AK’S OR ACTINIC KERATOSES?
Actinic keratoses are UV light induced lesions of the skin that occur on areas repeatedly exposed to the sun such as the back, chest and legs. In the U.S, actinic keratoses represent the second most frequent reason for patients to visit a dermatologist. An actinic keratosis may follow one of three paths; it may regress, it may persist unchanged, or it may progress to an invasive skin cancer called a squamous cell carcinoma. Actinic keratoses begin as small rough patches that are easier felt than seen, often described as similar to rubbing sandpaper. With time the lesions enlarge usually becoming red and scaly. Treatment consists of two broad categories; surgical destruction and medical therapy. The appropriate treatment is chosen normally based on the number of lesions present and the efficacy of the treatment. Additional variables such as patient age, history of skin cancer, and tolerability of the treatment choice are taken into consideration. To avoid these lesions common sense sun safety should be practiced such as using a broad spectrum sunscreen, SPF 50, limiting outdoor activity during the peak sun hours of 10:00 – 3:00, and wearing protective clothing.
How can I tell if an existing mole is a melanoma, and what are the signs and symptoms for all types of skin cancer?