Expert Diagnosis and Treatment for Various Skin Conditions
The Pure Dermatology medical team consists of providers who are experts in the medical and surgical treatment of adults and children with conditions and diseases of the skin, mucous membranes, hair and nails.
Some of the more common skin conditions are detailed below.
Acne
Acne usually starts in the early teens with plugged pores on the central face. As the condition progresses pimples and larger cystic nodules can develop over the face, back and chest. Mild acne can be controlled with topical products. More advanced, potentially scarring acne requires treatment with oral antibiotics, hormone manipulation in women, and in extreme cases oral Accutane.
Atopic Dermatitis
Atopic Dermatitis usually occurs in individuals who have a personal or family history of Atopy or Atopic Diseases, such as hay fever, asthma, eczema, hives, bee sting allergy, latex sensitivity, food allergy, multiple medication allergy, etc. In infancy, atopic dermatitis may be precipitated by food allergy and can affect generalized areas of the face, torso, and extremities. Later in childhood the eczema may be localized to the face or flexor creases of the arms and legs. Some patients “outgrow” their eczema while in others it is a lifelong, incurable, but usually controllable condition.
Congenital Nevi
Congenital moles (brown or black “birthmarks”) are very common and are always larger than a pencil eraser. Most small congenital nevi (smaller than a quarter) require removal only if they show worrisome changes since the lifetime risk of transformation into melanoma is very small.
Contact Dermatitis
Contact Dermatitis usually results from a chemical irritant, eg. excess exposure to soap and water, or a substance which produces a true allergic reaction, such as the nickel in earnings or fragrances. Poison ivy grows along many Montana rivers and is a common cause of severe allergic contact dermatitis in the summer. Occasionally patch testing is performed to identify the source of allergic contact dermatitis.
Dyshidrotic Eczema
Dyshidrotic Eczema often presents as intensely itchy blisters between the fingers or toes. In many patients stress is a precipitation factor.
Dysplastic Nevi
The most common abnormal mole is the dysplastic nevus (DN). Most DN exhibit the “ABCDEs” and more than 50% of adults develop these harmless nevi. It is normal to develop DN throughout life. Since a TINY percent of DN patients develop a malignant melanoma, we consider these moles to be “atypical”. The DN patients at greatest risk for developing melanoma have numerous large (eg. bigger than a dime) moles which are changing. For such patients mole mapping (photographs plus measurement) may be recommended. Multiple DN in family members also increases the lifetime risk for developing a melanoma. 25% of new melanomas in DN patients develop in a pre-existent mole while 75% develop in normal skin. In general we recommend monthly self exam of all DN, preferably in comparison with mole map photos to detect new DN or change in pre-existent DN. We recommend an annual comprehensive dermatology exam for patients with multiple large DN. We biopsy or completely excise DN which are new or changing and have a worrisome appearance.
Lentigo
One of the most common pigmented lesions on the face, hands, and arms is the lentigo, aka “age spot” or “liver spot”. “Liver spot” refers only to the brown color. Lentigos have no relationship to the liver or liver disease. These are flat, brown lesions which are age-related and caused by sun exposure. They have no potential to become malignant, but occasionally a lentigo maligna (LM) or melanoma is situ can be mistaken for a harmless lentigo. LM is a slow growing lesion which usually has shades of black and brown. Lentigos can be removed for cosmetic reasons by freezing (cryotherapy) or with our Sciton Laser.
Lupus Erythematosis
This is an autoimmune disease caused by defective regulation of the immune system allowing self – or auto – antibodies to attack normal tissues such as the skin, joints, or internal organs. Discoid lupus is the most common category of lupus seen in dermatology. Red, scaly, burning or scaring lesions develop on the scalp, face, or arms as a result of sun exposure. Topical cortisone creams and an antimalarial drug, Plaquenil, provide effective control. Systemic lupus is less common, more serious, and can affect internal organs such as the brain, heart or joints.
Neurodermatitis
Neurodermatitis is caused by an itch-scratch-cycle involving localized areas of the skin, such as the nape of the neck, arms, or legs.
Nummular Dermatitis
Nummular Dermatitis literally means “coin-like” patches of rash in a generalized distribution. Although dry skin is a common cause, occasionally “internal diseases” can be associated with this type of eczema.
Psoriasis
Psoriasis causes red, scaly patches on the scalp, torso, and extremities in approximately 3% of the population. 30% of patients with psoriasis have a positive family history and 10-20% have co-existent psoriatic arthritis. Psoriasis is caused by a defect in the immune system which allows tumor necrosis factor to cause excessive skin turn over. Localized psoriasis is easily controlled with topical cortisone ointments, tar ointments, topical vitamin D-3, or UV light treatments. Widespread psoriasis is best controlled with systemic medication such as methotrexate or injections of “biologicals” such as Enbrel.
For more information, visit www.aad.org or www.psoriasis.org.
Rosacea
Rosacea occurs in adults and starts as “easy blushing” or persistent facial redness. As the disease progresses, pimples develop over the nose and central face. In severe, untreated, cases disfiguring nasal enlargement, the so-called W.C. Field’s nose or rhinophyma, can develop. Trigger factors for rosacea include alcohol, hot beverages, spicy foods, and sun light.
For more information, visit www.aad.org or www.rosacea.org.
Seborrheic Dermatitis
Seborrheic Dermatitis is an itchy condition characterized by redness and scaling of the scalp, ear canals, central face skin, eye lashes, or chest. It probably represents a “sensitivity” to a normal yeast found on all human’s skin. It is made worse by stress or neurological conditions, such as Parkinson’s disease or stroke. Seborrhea is a chronic and incurable condition but it can be controlled with medicated shampoos, cortisone salves, or anti-fungal medications.
Seborrheic Keratosis
Patients often consult their dermatologist regarding changing brown growths. The majority of these lesions are seborrheic keratosis (SKs) which are harmless pigmented (light tan, brown, or even black) warty growths which may exhibit the “ABCDEs” of melanoma. They are not caused by sun damage and have no chance to become cancer. An experienced dermatologist can easily make an accurate visual diagnosis (i.e. no biopsy needed) of these benign growths. SKs are hereditary and increase in number and size with advancing age. Removal of SKs is “medically necessary” if they are irritated or symptomatic, although some patients desire removal for cosmetic concerns. Cryotherapy or freezing is the most popular way to destroy these growths, but very thick lesions are most reliably removed by a minor surgical procedure.
Stasis Dermatitis
Stasis Dermatitis occurs from poor circulation in the lower extremities. Red or brown scaly and itchy areas develop on the shins and ankles. In people with varicose veins, chronic leg ulcers can develop.
Generally speaking, the various types of eczema can be controlled with topical cortisone creams plus emollients. Rarely expensive immunomodulators such as Protopic or Elidel are needed to control difficult cases of eczema.
For more information, visit www.aad.org or www.nationaleczema.org.
Urticaria or Hives
20% of the population develops urticaria (itchy welts or hives) or angioedema (itchy red swelling of the face, hands, or feet) at some point in live. Red itchy welts affect widespread areas of the body and usually fade after a few hours, but appear in new areas in cyclic patterns. This is an “internal allergy” caused by a circulating complex molecule, e.b. penicillin, peanut protein, or a viral particle, which causes the blood vessels in the skin to dilate and leak serum into the skin or deeper tissues. Most cases of acute urticaria are caused by a new food, medication, or a viral infection, This type of hives clears within 4-6 weeks. Chronic urticaria by definition lasts more than 8 weeks and rarely my last for years. Most cases of chronic urticaria have no specific cause despite any amount of laboratory testing. In some patients stress is the cause of this type of hives. Other patients have physical urticaria such as dermatographism (hives produced by skin stroking or writing). Other people have physical urticaria produced by vibration, pressure, exertion, or exposure to cold. Topical medications have no effect on hives. Oral antihistamines, cortisone, and other medications are needed to “break the cycle” of hives.
