General Dermatology

Acne

Acne is a common skin problem that starts during puberty and can continue into adult life. In women, it is not uncommon for acne to start after puberty. Stressful situations, menstruation, the application of cosmetics on the skin and the intake of certain medicines (cortisone, Lithium, epilepsy medication) can worsen acne. Acne can last for years; therefore, it is important to see your dermatologist on a regular basis to avoid complications such as scars.

Treatment

The treatment of acne can be in the form cream, tablets, or a combination of both. Your dermatologist will choose the best treatment suited for you depending on your age, the severity of your acne, whether you are pregnant or breastfeeding and whether you have other medical problems.

 


Hair Shedding

Hair shedding is a common condition in both men and women. It occurs after a stressful situation such as child birth, surgery, high grade fever, crash dieting, and emotional stress. This type of hair loss occurs 3 months after the stressor and lasts around 2 months. Fortunately, it is totally reversible. Your dermatologist can diagnose this condition after clinically examining you and excluding any other associated factors such as anemia or thyroid problems.

Hair Thinning

Hair thinning is characterized by decreased density of hair on the scalp. This is noted as a widened part or decreased coverage of the scalp, making it visible. Several conditions can lead to hair thinning such as aging, intake of certain medications, chronic medical problems, and genetic predisposition. Your dermatologist will examine you and ask you about your medical history and whether you take any medications. You may be asked to do blood tests to check if you suffer from iron deficiency anemia, hypo or hyperthyroidism or a hyperandrogenic state.

In regards to treatment, local application of minoxidil solution helps to restore some density; however, it has to be used for at least 6 months before noting any change. Men may also benefit from oral finasteride, a medication that is prescribed for prostatic hypertrophy. For resistant cases, hair follicle illusion or hair transplantation can be considered. Your dermatologist will discuss with you the pros and cons of each therapeutic option.

Patchy Hair Loss

Patches of hair loss on the scalp can be due to fungal infection, alopecia areata, or a scarring type of alopecia.

Fungal infections of the scalp are more common in children; however, they can occur in adults. They present with areas of hair loss accompanied by scaling and itching. Usually there is a history of contact with kittens or puppies. The diagnosis can be confirmed by performing a KOH smear on the affected hairs. This is a simple procedure that can be done in the office with immediate results. The treatment of fungal infections of the scalp is oral antifungal pills. These have to be taken for at least 2 months. In addition, washing the hair with a prescription anti-fungal shampoo helps in preventing the shedding of fungal spores to other members of the
family.

Alopecia areata is another condition that presents with sudden onset of patchy hair loss. It can occur in both men and women. More than half of the patients have their first episode before the age of 20. The exact cause is unknown. The patches in alopecia areata are usually round and the underlying skin is totally normal without crust or scale.

Alopecia areata can be localized to a few patches on the scalp; it can also be so severe to involve the whole scalp as well as body hair. The progress or regrowth of hair in alopecia areata is unpredictable and the recovery can be complete or partial. When the patches are confined to one discrete area the likelihood of total regrowth is good. In patients with more severe hair loss, the chance of recovery without treatment is little.

It is important to realize that despite full recovery, the disease may still be active and manifest as new bald spots. Therefore, the treatment is warranted for as long as the disease is active. Your dermatologist will discuss with you the best treatment for you, depending on the extent of hair loss, your age, and whether you are pregnant or breast feeding.

Scarring alopecia is a type of patchy hair loss that is irreversible. In this type of alopecia, there is inflammation around each hair follicle. The inflammation leads to destruction of the hair follicles. The hair follicles in the destroyed area cannot regenerate and are replaced by a permanent scar. Scarring alopecia can mimic alopecia areata. Therefore it is very important to present to a dermatologist who will be able to diagnose the condition. A skin biopsy is sometimes helpful to distinguish the two conditions. Treatment of scarring alopecia is chronic and is administered to stop the progression of the condition. Your dermatologist will discuss with you the different options, since it differs depending on the extent or hair loss, your age, and whether you are pregnant or breast feeding.

 


Moles

Moles or melanocytic are benign pigmented lesions that can occur on any part of the body. Some moles are present at birth while others are acquired during childhood and adolescence. Individuals with lighter skin complexion (blonde hair, blue/green eyes, burn easily in the sun) have the tendency to develop many moles, especially on sunexposed areas. It is important to observe these moles; sometimes they can change into a cancer called malignant melanoma.

If you have many moles, it is good to seek the opinion of your dermatologist who will give you a full skin exam using a dermatoscope. This is a hand held magnifier that helps identify early changes in moles. Your dermatologist may also take photos of your moles to store in the computer for comparison during follow up visits.

Any mole that exhibits the ABCDE (Asymmetry, irregular Borders, many Colors, Diameter more than 5mm, recent Elevation) will either be observed or removed surgically. Any mole that appears after the age of 40 should be looked at by your dermatologist.

 


Psoriasis

Psoriasis is a chronic inflammatory disease of the skin that is not contagious. It can occur at any age. The cause of psoriasis is not known, but it is partly genetic and can be triggered by external factors such as stress, infections, and some medications. Psoriasis is characterized by the appearance of red patches covered with a thick silvery scale. The affected areas are mainly located on the elbows and knees, but lesions may also involve the scalp, palms, and soles.

Treatment of psoriasis depends on the severity and extent of your lesions. For mild and localized disease, creams with cortisone, vitamin D, salicylic acid or urea are helpful. For more severe disease, your dermatologist may suggest ultraviolet light therapy, or pills such as methotrexate, acitretin or cyclosporine. Recently, biologics, a new category of injectable therapy has been introduced into the market.

It is important to understand that the currently available treatments reduce and even clear symptoms, but they do not cure the disease. The disease can recur after stopping the treatment. Therefore, it is important to follow up with your dermatologist.

 


Vitiligo

Vitiligo is a disease that makes the skin lose its normal color. Vitiligo is not contagious, however, it can be cosmetically devastating, especially in darkly pigmented individuals. We are not sure what causes vitiligo, but it could be related to a disorder of the immune system or genetic factors.

The goal of treatment in vitiligo is to stop the progression and to re-pigment the affected areas. Options include cortisone based creams, ultraviolet light therapy, or depigmentation in patients who have more than half of their body surface involved. Your dermatologist will choose the best treatment suited for you depending on your age, the extent of vitiligo and whether you are pregnant or breastfeeding.

 


Warts

Warts are benign growths of the skin. They can appear anywhere on the body including the genital area. Warts are caused by a virus called Human Papilloma Virus (HPV). This virus can be present on the human skin as well as on inanimate objects. Once there is a cut or injury in the skin, the virus can enter the skin through the cut and grow there causing the wart. Warts can also spread from person to person by direct contact or from one location to another in the same person. Genital warts appear after sexual contact with an infected person.

The treatment of warts includes local application of acids or Imiquimod cream. Office based therapy includes cryotherapy or electrocautery. Your dermatologist will choose the best treatment suited for you depending on your age, the number of warts present, their location, and how you tolerate pain.

 


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