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Acne

Acne Overview

Acne is a condition resulting from the action of hormones on the skin’s oil glands making them “overactive”, which leads to plugging of skin cells within the pores. Microorganisms can get into the pores, the result can be swelling, redness, and pus. Acne lesions usually occur on the face, neck, back, chest, and shoulders. Approximately 80% of all teens have acne nationwide with a noticeable jump in prepubescence. Although acne is not a serious health threat, severe acne can lead to low self-esteem, depression and permanent scarring.

At Abrams Dermatology, we understand how frustrating acne can be for teens and adults alike. We have a variety of treatment modalities available and will work with you to build a skin care regimen that treats your acne while helping to improve the overall health of your skin.

We realize that there is no single solution for all cases of acne and that each individual’s skin care needs change over time. We will evaluate your condition on a regular basis and adjust your treatment program as needed.

Acne Causes

There are four basic steps involved in the development of an acne lesion.

• Hair follicles become blocked with an overabundance of normal skin cells. These cells combine with sebum (an oily substance that lubricates the hair and skin), creating a plug in the follicle.
• The glands that produce sebum, known as sebaceous glands, enlarge during adolescence and sebum production increases. Numerous sebaceous glands are found on the face, neck, chest, upper back, and upper arms.
• The increase in sebum production allows for the overgrowth of bacteria that normally lives on the skin.
• Bacterial overgrowth causes local inflammation, which causes rupture of the follicle. This can lead to the formation of a red or tender pimple.

Acne Treatments

There is no single best treatment for acne, and combinations of treatments are sometimes recommended. Since acne lesions take at least eight weeks to mature, you should use a treatment for a minimum of two to three months before deciding if the treatment is effective.

Allergic Reactions

Eczema

Eczema Overview

Eczema, or dermatitis as it is sometimes called, is a group of skin conditions which can affect all age groups. The severity of the disease can vary. In mild forms the skin is dry, hot, and itchy, while in more severe forms the skin can become broken, raw, and bleeding. Although it can sometimes look unpleasant, eczema is not contagious. With treatment the inflammation of eczema can be reduced, though the skin will always be sensitive to flare-ups and may need extra care.

Eczema Causes

The cause of eczema is not completely understood, although hereditary factors appear to play a strong role. Atopic dermatitis is caused by dysfunction in the outermost layer of the skin (the epidermis). The epidermis is the first line of defense between the body and the environment. When the epidermis is intact, it keeps environmental irritants, allergens and microbes from entering the body.

Eczema Symptoms & Diagnosis

Most people with eczema develop their first symptoms before age five. Intense itching of the skin, patches of redness, small bumps, and skin flaking are common. Scratching can cause additional skin inflammation, which can further worsen the itching. The itchiness may be more noticeable at nighttime.

Features of eczema vary from one individual to another, and can change over time. Although eczema is usually confined to specific areas of the body, it may affect multiple areas in severe cases:

In infants, there may be red, scaly, and crusted areas on the front of the arms and legs, cheeks, or scalp. The diaper area is not usually affected.

In children and adults, eczema commonly affects the back of the neck, the elbow creases, and the backs of the knees. Other affected areas may include the face, wrists, and forearms. The skin may become thickened and darkened, or even scarred, from repeated scratching.

The skin can also become infected as a result of scratching. Signs of infection include painful red bumps that sometimes contain pus; a healthcare provider should be consulted if this occurs.

Other findings in people with eczema can include:

• Dry, scaly skin
• Plugged hair follicles causing small bumps to develop, usually on the face, upper arms, and thighs
• Increased skin creasing on the palms and/or an extra fold of skin under the eye
• Darkening of the skin around the eyes

There is no specific test used to diagnose eczema. The diagnosis is usually based upon a person’s medical history and physical examination.

Factors that strongly suggest eczema include long-standing and recurrent itching, a personal or family history of allergic conditions, and an early age when symptoms began. Other factors include worsened symptoms after exposure to certain triggers or any of the skin findings noted above.

Eczema Treatments

Eczema is a chronic condition; it typically improves and then flares (worsens) periodically. Some people have no symptoms for several years. Eczema is not curable, although symptoms can be controlled with a variety of self-care measures and drug therapy.

Who treats eczema? — Many patients with atopic dermatitis can initially be treated by their primary care provider. However, a skin specialist (dermatologist) may be recommended in certain situations, such as if the condition does not improve with treatment, if certain areas of the body are affected (face or skin folds), and if another condition could be causing symptoms.

Eliminate aggravating factors — Eliminating factors that worsen eczema can help to control the symptoms. Aggravating factors may include:

• Heat, perspiration, dry environments
• Emotional stress or anxiety
• Rapid temperature changes
• Exposure to certain chemicals or cleaning solutions, including soaps and detergents, perfumes and cosmetics, wool or synthetic fibers, dust, sand, and cigarette smoke.

Keep the skin hydrated

Emollients — Emollients are creams and ointments that moisturize the skin and prevent it from drying out. The best emollients for people with atopic dermatitis are thick creams or ointments, which contain little to no water. Emollients are most effective when applied immediately after bathing. Lotions contain more water than creams and ointments and are less effective for moisturizing the skin.

Bathing — It is not clear if showers or baths are better for keeping the skin hydrated. Lukewarm baths or showers can hydrate and cool the skin, temporarily relieving the itching of eczema. An unscented, mild soap or nonsoap cleanser should be used sparingly. An emollient should be applied IMMEDIATELY after bathing or showering to prevent the skin from drying out as a result of water evaporation.

However, hot or long baths (greater than 10 to 15 minutes) and showers should be avoided since they can dry out the skin.

In some cases, health care providers may recommend dilute bleach baths for people with eczema. These baths help to decrease the number of bacteria on the skin which can cause infections or worsen symptoms. To prepare a bleach bath, ¼ to ½ cup of bleach is placed in a full bathtub (about 40 gallons) of water. Bleach baths are usually taken for five to ten minutes twice per week.

Treat skin irritation

Topical steroids — Prescription steroid (corticosteroid) creams and ointments may be recommended to control mild to moderate atopic dermatitis. Steroid creams and ointments are available in a variety of strengths (potencies); the least potent are available without a prescription (eg, hydrocortisone 1% cream). More potent formulations require a prescription.

Steroid creams or ointments are usually applied to the skin once or twice per day. These help to reduce symptoms and moisturize the skin. As the skin improves, a non-medicated emollient can be resumed. Strong topical steroids may be needed to control severe flares of eczema; however, these should be used for only short periods of time to prevent thinning of the skin.

Other skin treatments — Newer skin treatments for eczema include tacrolimus  and pimecrolimus. These are effective in controlling eczema, although they do not work as quickly as topical steroids. They are useful in sensitive areas such as the face and groin, and can be used in children over age two. Due to safety concerns, these treatments should only be used as instructed by a healthcare provider.

Oral steroids — Oral steroids occasionally are used to treat a severe flare of eczema, although this treatment is not usually recommended on a regular basis because of potential side effects.

Ultraviolet light therapy (phototherapy) — Ultraviolet light therapy (phototherapy) can effectively control atopic dermatitis. However, this therapy is expensive, may increase a person’s risk for skin cancer, and is therefore recommended only for people with severe eczema who do not respond to other treatments.

Immunosuppressive drugs — Drugs that weaken the immune system may be recommended for people with severe eczema who do not improve with other treatments. Treatment with these drugs can cause serious side effects, including an increased risk for infection.

Control itching

Oral antihistamines — Oral antihistamines sometimes help relieve the itching of eczema. The over-the-counter antihistamine diphenhydramine, and prescription antihistamines, such as hydroxyzine and cyproheptadine, are most effective for itching caused by eczema, although these drugs can cause drowsiness.

The nonsedating antihistamines such as cetirizine and loratadine  may relieve symptoms, and both are available without a prescription in the United States.

Wet dressings — Wet dressings help soothe the skin, reduce itching and redness, loosen crusted areas, and prevent skin injury from scratching. Dampened cotton garments may be worn over the affected area and covered with a dry garment. The person may wear these dressings overnight or change them every eight hours during the day.

Fungal Skin Infections

Fungal infections of the skin are very common and include athlete’s foot, jock itch, ringworm, and yeast infections.

Athlete’s Foot

Athlete’s foot, also called tinea pedis, is a fungal infection of the foot. It causes peeling, redness, itching, burning, and sometimes blisters and sores.

Athlete’s foot is a very common infection. The fungus grows best in a warm, moist environment such as shoes, socks, swimming pools, locker rooms, and the floors of public showers. It is most common in the summer and in warm, humid climates. It occurs more often in people who wear tight shoes and who use community baths and pools.

Jock Itch

Jock itch, also called tinea cruris, is a common skin infection that is caused by a type of fungus called tinea. The fungus thrives in warm, moist areas of the body and as a result, infection can affect the genitals, inner thighs, and buttocks. Infections occur more frequently in the summer or in warm, wet climates.Jock itch appears as a red, itchy rash that is often ring-shaped.

Ringworm

Ringworm, also called tinea corporis, is not a worm, but a fungal infection of the skin. It can appear anywhere on the body and it looks like a circular, red, flat sore. It is often accompanied by scaly skin. The outer part of the sore can be raised while the skin in the middle appears normal. Ringworm can be unsightly, but it is usually not a serious condition.

Yeast infections of the skin are called cutaneous candidiasis and are caused by yeast-like fungi called candida. They occur when yeast on the skin grows more actively and causes a red, scaling, itchy rash on the skin. Yeast infections are not contagious.

Yeast Infections

Yeast infections may affect nearly any skin surface on the body, but are most likely to occur in warm, moist, creased areas including the armpits and the groin. Candida infection is especially common among people who are obese or who have diabetes. People taking antibiotics are also at risk.

Candida can cause diaper rash in infants and can cause infections of the nail. Oral thrush is a form of candida infection that is found in the mouth. Candida also causes vaginal yeast infections.

Hair Loss

By far the most common form of hair loss (alopecia) is determined by our genes and hormones: Also known as androgen-dependent, androgenic, or genetic hair loss. It is the largest single type of recognizable alopecia to affect both men and women. It is estimated that around 30% of Caucasian females are affected before menopause. Other commonly used names for genetic hair loss include common baldness, diffuse hair loss, male or female pattern baldness.By far the most common form of hair loss (alopecia) is determined by our genes and hormones: Also known as androgen-dependent, androgenic, or genetic hair loss. It is the largest single type of recognizable alopecia to affect both men and women. It is estimated that around 30% of Caucasian females are affected before menopause. Other commonly used names for genetic hair loss include common baldness, diffuse hair loss, male or female pattern baldness.

The most common cause of hair loss is a medical condition called hereditary hair loss. About 80 million men and women in the United States have this type of hair loss. Other names for this type of hair loss are:

• Male-pattern baldness.
• Female-pattern baldness.
• Androgenetic alopecia.

Luckily, most causes of hair loss can be stopped or treated.

There are a variety of treatment options available for thinning hair depending upon the extent of hair loss and underlying cause. At Abrams Dermatology, we will review your medical history, examine your scalp, and help you to determine the treatment options that are most suitable for your needs and lifestyle. We offer various non-surgical treatments and can recommend superior transplant surgeons if you choose to explore that option.

Herpes and Shingles

herpes zoster (Also called shingles.) – a common viral infection of the nerves, characterized by a painful skin rash of small blisters anywhere on the body. It is a reactivation of chickenpox virus.

Anyone who has had chickenpox can get shingles. After the chickenpox clears, the virus stays in the body. If the virus reactivates (wakes up), the result is shingles — a painful, blistering rash.

Shingles is most common in older adults. A vaccine, which can prevent shingles, is available to people ages 50 and older. We recommend this vaccine for everyone 50 and older.

If you get shingles, an anti-viral medicine can make symptoms milder and shorter. The medicine may even prevent long-lasting nerve pain. Anti-viral medicine is most effective when started within 3 days of seeing the rash.

Shingles is most common in older adults. A vaccine, which can prevent shingles, is available to people ages 50 and older. We recommend this vaccine for everyone 50 and older.

If you get shingles, an anti-viral medicine can make symptoms milder and shorter. The medicine may even prevent long-lasting nerve pain. Anti-viral medicine is most effective when started within 3 days of seeing the rash.

Signs and Symptoms

Shingles tends to cause more pain and less itching than chickenpox. Common signs (what you see) and symptoms (what you feel) are:

• The warning: An area of skin may burn, itch, tingle, or feel very sensitive. This usually occurs in a small area on 1 side of the body. These symptoms can come and go or be constant. Most people experience this for 1 to 3 days. It can last longer.
• Rash: A rash then appears in the same area.
• Blisters: The rash soon turns into groups of clear blisters. The blisters turn yellow or bloody before they crust over (scab) and heal. The blisters tend to last 2 to 3 weeks.
• Shingles: This patch of skin was very painful before the shingles appeared.
• Pain: It is uncommon to have blisters without pain. Often the pain is bad enough for a doctor to prescribe painkillers. Once the blisters heal, the pain tends to lessen. The pain can last for months after the blisters clear.
• Flu-like symptoms: The person may get a fever or headache with the rash.

Causes

Who gets shingles?

A person must have had chickenpox to get shingles. Some people who have had chickenpox have a higher risk of getting shingles. These people:

• Are 50 years of age or older.
• Have an illness or injury.
• Are under great stress.
• Have a weakened immune system.

Some illnesses and medical treatments can weaken a person’s immune system and increase the risk. These include:

• Cancer.
• HIV/AIDS.
• Some cancer treatments, such as chemotherapy or radiation.
• Medicine taken to prevent rejection of a transplanted organ.
• Cortisone when taken for a long time.

What causes shingles?

The virus that causes chickenpox also causes shingles. After a person gets rid of the chickenpox, the virus stays in the body. The virus travels to the nerves where it sleeps. Shingles appears when the virus wakes up. It is not clear what reactivates or “wakes up” the virus. A short-term weakness in immunity may cause this.

Shingles is much less contagious than chickenpox. But a person with shingles can still spread the virus. Anyone who has not had chickenpox can get this virus.

If the virus spreads to someone who has not had it, the person will get chickenpox — not shingles. Newborns and those with a weak immune system have the highest risk of getting the virus from someone who has shingles.

This virus spreads when the person has uncovered, open blisters and someone touches the blisters. Once the blisters form scabs, the person is no longer contagious.

TREATMENTS

Without treatment, the rash clears in a few weeks. Dermatologists, however, strongly recommend treatment. Without it, many people get pain, numbness, itching, and tingling that can last for months — or years.

It is best to get treatment immediately. Treatment can include:

• Pain relievers to help ease the pain: The pain can be very bad, and prescription painkillers may be necessary.
• Anti-viral medicine: This medicine may be prescribed when a doctor diagnoses shingles within 72 hours of the rash first appearing. The earlier anti-viral treatment is started, the better it works. Anti-viral medicines include famciclovir, valacyclovir, and acyclovir. These can lessen the pain and the amount of time the pain lasts.
• Nerve blocks: Given for intense pain, these injections (shots) contain a numbing anesthetic and sometimes a corticosteroid.
• Corticosteroids: To lower swelling and pain, some patients may get corticosteroid pills with their anti-viral medicine. This treatment is not common because it can make the rash spread.

Treatments for pain after the rash clears: Certain anti-depressants, pain relievers, anesthetic creams and patches, and anti-seizure medicines can help.

Outcome

Patients with shingles rarely need a hospital stay. But shingles can cause serious problems such as:

• Post-herpetic neuralgia (post-her-PET-ic noo-RAL-jah):
  This is the most common problem. It can cause pain, numbness, itching, and tingling. It can last for months — or even years. People who get this also may have fatigue, little appetite, and trouble sleeping. Sometimes they experience intense pain from something as harmless as a light touch. People over age 60 are most likely to have this complication.
• Eye problems: Shingles that involve the eye are called ocular shingles or herpes zoster ophthalmicus. Signs and symptoms of shingles in the eye are blisters around the eye or on the eyelid, swelling and redness of the eye or eyelid, and eye pain. Some people become sensitive to light.
  If blisters appear on the tip of the nose, it may be a warning of possible eye problems. Anyone who gets blisters on the nose should see a doctor immediately. Without treatment, permanent eye damage can result. Glaucoma, scarring, and even blindness are possible. People who have shingles in the eye also may have a higher risk for having a stroke.
• Bacterial infection: The blisters can become infected, which can slow healing. Lasting pain and redness warn of an infection. You may need antibiotic treatment. An infection can lead to scars without prompt treatment.

Tips for managing

Pain relief

To relieve the pain and itching of shingles, you can:

• Cool the rash with ice packs, cool wet cloths, or cool baths.
• Apply calamine lotion to the blisters.
• Cover the rash with loose, non-stick, sterile bandages.
• Wear loose cotton clothes around the body parts that hurt.

Prevention

A shingles vaccine is available for people ages 50 years and older. The benefits of getting this vaccine include the following:

• In one study, this vaccine lowered the risk of getting shingles by 50 percent.
• If you develop shingles after getting the vaccine, you are likely to have less pain.

Insect Bites and Stings

Although most bug bites and stings are harmless, some can be dangerous. This is especially true if you are allergic to the bug’s venom, or if the bug is carrying a disease.

In the United States, it’s common to experience a bite or sting from the following types of bugs:

• Mosquitoes
• Fleas
• Bedbugs
• Biting flies
• Mites
• Bees, wasps and hornets
• Spiders
• Ticks
• Fire ants

Most bug bites and stings can be safely treated at home with topical medication, such as hydrocortisone cream or ointment, or an oral antihistamine to reduce the itch. However, sometimes a bug bite or sting could turn into something serious – particularly if you have been bitten or stung by many insects at the same time.

Go to the emergency room immediately if you experience any of the following symptoms after a bug bite or sting:

• Difficulty breathing
• The sensation that your throat is closing
• Swollen lips, tongue or face
• Chest pain
• A racing heartbeat that lasts more than a few minutes
• Dizziness
• Vomiting
• A headache
• A red, donut-shaped rash that develops after a tick bite: This could be a sign of Lyme disease, which should be treated with antibiotics.
• A fever with a red or black, spotty rash that spreads: This could be a sign of Rocky Mountain spotted fever, a bacterial infection carried by ticks, which should be treated immediately.

Although most bug bites and stings do not turn into a severe or even fatal illness like Rocky Mountain spotted fever, it’s important to pay attention to your symptoms. If you feel tired all the time, you have a headache, fever or body aches, or you develop a rash after a bug bite.

Mole

A change in a mole can indicate a serious problem. A dermatologist should be seen if a mole or skin lesion becomes larger, changes color, or develops an irregular border. Other warning signs include itching, crusting, pain, and bleeding. Extensive and potentially disfiguring surgery can often be prevented by prompt surgical removal, by specialized freezing, by treatment with chemicals applied to the diseased tissue, or with the aid of a laser.

Psoriasis

Rash

Rosacea

Rosacea is a skin condition characterized by redness, pimples, thickened tissue on the nose and or tiny vessels on the face. Rosacea is usually limited to the face but eyes can be involved as well. The true cause of Rosacea is elusive. Therefore, multiple modalities are sometimes needed to treat it.

Rosacea most often affects people with fair skin. Flushing with or without a burning sensation of the center of the face is a common complaint.

Types of Rosacea:

•  Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels.
• Papulopustular rosacea: Redness, swelling, and acne-like breakouts.
• Rhinophyma rosacea: Skin thickens and has a bumpy texture of the nose
• Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.

Skin Hygiene:

Wash your face no more than twice daily using a gentle non-soap facial skin cleanser and warm (not hot) water. We recommend avoiding use of a washcloth or loofah, and instead using the hands to wash the face. Vigorous washing or scrubbing can worsen acne and damage the skin’s surface. Wait 5 minutes and use toner on a cotton ball to remove remaining oil and to rebalance your PH.

Skin Cancers

Sun Damage

Spot

Wart

Procedures

Biopsy

 Biopsy are performed to diagnose skin cancer and other skin diseases

When it is necessary to accurately diagnose a skin condition a biopsy will be suggested. This will be done on suspicious lesions or to definitively diagnose a skin condition.

After performing a biopsy, the suspicious specimens will be sent to a laboratory approved by your insurance for processing. Results are communicated to you by phone within a 7 days. Some results can take up to 2 weeks if special stains are requested by the pathologist.

During a biopsy the area is numbed with a local anesthetic and a small piece of tissue from the area to be analyzed is removed. Minimal to no bleeding is expected, any oozing will be dealt with using topical product or electric cautery.

There are three types of biopsies that we perform in our office based on the type, location, and size of the lesion. They are shave, punch, and excisional biopsy.

When performing a punch biopsy we utilize a small device with a sharp circular edge to obtain a slightly deeper sample of tissue. Punch biopsies are used to analyze tissue below the visible skin surface. A few stitches might be required for this type of biopsy. The site is anesthetized with lidocaine and a 2 to 3mm punch biopsy instrument is used to extract the skin sample. The subject feels a slight pressure, but no pain. The sample is removed and preserved in a fixative. Antibiotic ointment and a band-aid are sufficient.

When performing a punch biopsy we utilize a small device with a sharp circular edge to obtain a slightly deeper sample of tissue. Punch biopsies are used to analyze tissue below the visible skin surface. A few stitches might be required for this type of biopsy. The site is anesthetized with lidocaine and a 2 to 3mm punch biopsy instrument is used to extract the skin sample. The subject feels a slight pressure, but no pain. The sample is removed and preserved in a fixative. Antibiotic ointment and a band-aid are sufficient.

To perform an excisional biopsy, a surgical scalpel is used to excise a small portion of the tissue for analysis. Excisional biopsies are used for larger, deeper lesions. Stitches are required for this type of biopsy.

Wound Care instructions following a biopsy (Link To file in PATIENT RESOURCES)

Destruction

Excision

Photo-Dynamic Therapy

Shave Removal

Shave removal is a technique where we use a razor blade and numb up and shave off the mole (we shave it flat) or any benign lesions such as skin tags.  The shave removal offers the best cosmetic result as long as the mole is raised enough an easy to shave off. This procedure is recommended for benign lesions as it offers the best cosmetic results. No stitches are needed and the scar is barely noticeable.

Shave removal doesn’t prevent the mole or lesion from coming back although it may take years. Sometimes, the mole heals as a dark but flat mole but it can fade away overtime.

Regardless of the procedure, biopsies or shave removals, the tissue removed will be send to a pathology lab to be examine to make sure it is benign.

Skin Surgery

The four main reasons for performing skin surgery are to:

1. Establish a definite diagnosis with a skin biopsy;
2. Prevent or provide early control of disease;
3. Improve the skin’s appearance by removing growths, discolorations, or damaged skin caused by aging, sunlight, or disease;
4. Cosmetic skin improvement.