Are you reluctant to undergo a skin biopsy because of the potential for a scar? We have good news. There is a new, non-invasive melanoma detection method to check suspicious dark moles. Read the story below by Dr. Maral Skelsey and learn more about DermTech, a “bladeless biopsy.”
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Have you ever been concerned about a dark mole on your skin, only to be told by your dermatologist that it’s not a mole but a seborrheic keratosis? We might tell you not to worry about it, but did you get a good explanation of what they are?
A seborrheic keratosis (SK) is a very common skin growth caused by a thickening of an area of the top skin layer. It usually appears as a brown, black, or light tan growth on the face, trunk or arms, and may have a waxy or scaly raised appearance. Despite the way they look, these growths are harmless. They do not usually cause any symptoms, but they may itch.
SKs typically occur in middle-aged and older adults and there may be a tendency in families to grow multiple lesions. SKs are not contagious.
Treatment Options for Seborhheic Keratosis
Treatment of SKs is usually not necessary, but may be desired for cosmetic reasons. Under local anesthesia, they may be removed with a scalpel, scraped off with a special instrument, or burned off with an electric current. The most common treatment for SKs is liquid nitrogen therapy. However, all of these treatments have the potential to leave behind a white mark or scar. Eskata is a new treatment that is able to remove the SKs without leaving a scar or affecting the pigment in the skin.
What is Eskata?
Eskata is an FDA-approved topical and non-invasive treatment that is indicated for raised seborrheic keratoses (SKs). It consists of a clear, colorless solution of 40% hydrogen peroxide intended for application by a healthcare provider in an office setting. We are happy to announce that we are one of the first practices in the Washington, DC region to be trained and certified in Eskata application.
How does it work?
We carefully apply the concentrated hydrogen peroxide liquid to the SKs four times, about a minute apart. The SKs may turn white initially and then form a scab. Over the next few days, the SKs should fall off without leaving a scar. Typically, two treatments are needed, about 3 weeks apart, to completely remove the SKs. Watch the video below to see an application.
What are the side effects of Eskata?
A tingling, burning, or itching sensation is common during the application process. Following the application of Eskata, patients may have redness and/or swelling that can last up to a week.
Is Eskata covered by my insurance?
Treatment with Eskata is considered cosmetic, and is not covered by insurance. One session will treat up to 7 SKs.
Contact us with any other questions or to make an appointment with a dermatologist.
A patient recently came to the office concerned about a new dark mole on her leg. During her full body skin examination, I noticed a pink bump on her back. I asked her about it and she said it was a bug bite that was taking a long time to heal. Because of the appearance of the lesion when I examined it with a dermatoscope, I recommended a biopsy. Unfortunately, the pink spot on her back turned out to be a melanoma. The mole on her leg was benign.
Most patients are concerned when they spot a new dark mole, but it’s not widely recognized that melanoma can present as a pink or colorless skin lesion. Amelanotic melanoma is a serious form of skin cancer where the cells do not make melanin or pigment. It is responsible for approximately 2-20% of melanoma cases1. Because of their lack of color, diagnosis of this type of melanoma may be delayed until it reaches an advanced stage.
One of the most obvious symptoms of amelanotic melanoma is the sudden appearance of a red, pink, or skin-colored spot on your body where it wasn’t before. Melanomas also grow and may change shape, becoming a larger bump over time. Amelanotic melanoma may not present with the classic ABCD criteria (Asymmetry, Border Irregularity, Color variation, and Large Diameter) that are typically associated with melanoma warning signs. Expanding the ABCD warning signs to include the 3 Rs (Red, Raised, Recent change) may help in the early detection of amelanotic melanoma2. It is also estimated that about 25% of melanomas of the nail are amelanotic, so checking your nails should be a regular part of self-skin examinations. It is important to note that melanoma may present differently in individuals of color, therefore regular self-skin examinations are essential in the early detection of these skin cancers.
Melanoma occurs when the DNA in your skin cells becomes damaged, which can cause the cells to grow out of control and become cancerous. Exposure to the sun for long periods of time can damage your skin cells and increase your risk for melanoma. This risk is increased in patients with fairer skin, individuals of European descent, those with many moles (especially 50 or more), a family history of melanoma, and patients with a weakened immune system from an existing condition3. The use of tanning beds has also been associated with an increased risk for melanoma and should be avoided4.
The most common treatment for melanoma is surgical removal. However, melanoma can spread to the lymph nodes, necessitating the removal of one or more nodes. Advanced melanoma may need to be treated with chemotherapy and/or radiation. Biological therapy (or drugs that aid your immune system in killing cancer cells) as well as targeted therapy (medications that weaken cancer cells) are other common melanoma therapies. Patients with a history of a previous melanoma are 4 times more likely than the general population to develop a subsequent invasive melanoma, therefore full body skin examinations should be performed by a dermatologist every 3 months after a melanoma diagnosis.
1. Thomas, N.E., Kricker, A., & Waxweiler, W. Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas: A Population-Based Study. JAMA Dermatol. 2014;150(12):1306-1314. doi:10.1001/jamadermatol.2014.1348
2. Kim, S.J., Park, H.J., Lee, J.Y., Cho, B.K., A Case of Subungual Melanoma. Ann Dermatol. 2008 Mar; 20(1): 26–28. Published online 2008 Mar 31. doi: 10.5021/ad.2008.20.1.26
3. American Cancer Society. Risk Factors for Melanoma Skin Cancer. Available online at: https://www.cancer.org/cancer/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html
4. American Academy of Dermatology. Indoor Tanning. Available online at: https://www.aad.org/media/stats/prevention-and-care
Hyperhidrosis is a medical condition that causes excessive sweating that is not necessarily related to heat or exercise. Messages from your brain usually tell your body when to produce sweat, either to keep you cool in warm temperatures or as a reaction to anxiety. However, with hyperhidrosis, excessive sweating occurs regardless of the physical or emotional environment. This excessive sweating may interfere with daily activities and can cause significant social anxiety and embarrassment. Fortunately, several treatment options are available to help with this condition.
Treatments for Excessive Sweating
- Antiperspirants: Antiperspirants are the most common treatment for hyperhidrosis and may be purchased “over-the-counter” at your local drugstore or with a prescription from a medical professional. They work by plugging your sweat ducts so that the sweat does not reach the surface of your skin.
- Iontophoresis: This treatment uses a mild electrical current in a shallow tray of water to reduce excessive sweating of the hands and/or feet. It has been shown to reduce sweating by 81%1,2. Prescription iontophoresis machines cost under $1000 and insurance may cover some of the cost.
- Botox: Botox is a natural, purified protein that, when injected, can temporarily block the secretion of a chemical in your body that controls your sweat glands. When used to treat excessive underarm or hand sweating, it has been shown to reduce sweating by 80-90%, with improvement lasting from 4-12 months. The cost of Botox varies depending upon the size of the body area treated and whether insurance covers any of the cost.
- Oral medications: There are several classes of medications that may be used to treat excessive sweating, each having different side effects and precautions. Insurance usually covers the cost of this type of therapy.
- Laser therapy: A laser can be focused into a narrow beam of energy in order to target, heat, and destroy sweat glands in the underarm area. Side effects may include swelling, bruising, and numbness, but usually resolve after 1-2 weeks. In studies, 82% of patients receiving laser treatment for hyperhidrosis said their results were “good” or “excellent”3. Insurance may not cover the cost of laser treatment, which can be up to $3000.
- MiraDry: This device is used by a doctor to deliver microwave energy to the underarm skin, effectively destroying sweat glands. In research studies, MiraDry was shown to reduce underarm sweat by 90%4. Common side effects include swelling, redness, and tenderness lasting for several days. Best results are seen when two treatments are performed three months apart.
Other Causes of Excessive Sweating
Hyperhidrosis may be caused by an underlying medical condition such as menopause, diabetes, Alzheimer’s, tuberculosis, or cancer. Certain medications, such as antidepressants or anti-anxiety medications may also cause excessive sweating.
When sweating is caused by an underlying medical problem, this is called secondary hyperhidrosis. Unlike secondary hyperhidrosis, which has a sudden onset, primary hyperhidrosis tends to be a longstanding medical condition that typically begins prior to age 25 with no underlying cause.
If excessive sweating is a problem for you, consult with your physician.
1. Karakoç Y. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002;41:602-605.
2. Bouman HD, Grunewald Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. 1952;31:158-169.
3. Leclere FM, Moreno-Moraga J, Aleolea JM, Vogt PM, Rovo J, Corenjo P, Casoli V, Mordon S, Trelles MA. Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow up: a randomized blinded controlled trial. Lasers Surg Med. 2015; 47(2): 173-9.
4. Lupin M, Chih-Ho Hong H, O’Shaughnessy KF. A multi-center evaluation of the Miradry system to treat subjects with axillary hyperhidrosis. Am Soc for Laser Med and Surg. 2011; 79.
According to the 2017 National Diabetes Statistics Report there are 30.3 million people with diabetes (9.4% of the US population) including 23.1 million people who are diagnosed and 7.2 million people (23.8%) undiagnosed.
Patients with diabetes are more susceptible to skin infections, especially on the feet and on the skin of the ear. More than 75% of patients with diabetes will have skin lesions. The most common is xerosis or dryness. Dry skin affects 50% of those with type 1 diabetes. Keratosis pilaris, or rough spots on the sides of arms affect about 10% of patients. Itching of the skin, especially on the torso, is very common.
Also occurring are smooth yellow plaques on the front of the shins called Necrobiosis lipoidica. These lesions are usually painless and are 3 times as likely to occur in women than in men. They can be treated with topical creams as well as oral medications that improve circulation, such as low-dose aspirin, pentoxifylline, dipyridamole and nicotimamide.
70% of diabetic men over 60 will develop diabetic dermopathy or shin spots. Over time these become dark depressions in the skin.
Skincare Tips for Diabetes Patients
So how does one prevent or treat these irritations caused by diabetes? Besides keeping your diabetes under control, here are some tips you can follow for skin care.
- Moisturize daily with an unscented emollient such as Cerave, Cetaphil or Uradin 10 lotion. Apply when skin is still damp- within 3 minutes of getting out of the bath or shower.
- Use a moisturizing, fragrance-free cleanser such as Dove soap. Oatmeal baths can also help reduce itching.
- Thoroughly dry skin folds such as underneath the breasts or between toes. Trapped moisture is a breeding ground for yeast and fungal infections.
- Check your feet daily for sores or cuts and treat with a topical antibiotic and bandage. Seek medical attention for any sores that have not healed or are red, swollen, hot or draining pus.
- Don’t cut cuticles around your nails as this can lead to infection.
Note that not all-natural health and beauty products are 100% natural. Many include fragrance and other ingredients that can irritate sensitive skin. Be sure to read the labels.
If you are concerned about your skin or whether you have diabetes, consult a physician.
Sun exposure can cause discoloration of the skin as well as roughness and wrinkling. This damaged skin can be repaired to a large degree with a variety of rejuvenating treatments.
One of the methods that restores the skin’s natural beauty without significant downtime is a chemical peel. Peels are a great way to brighten the skin and reduce discoloration.
History of Chemical Peels
Interestingly these procedures have been performed for centuries. The ancient Egyptians used acids to peel the skin as early as 1550 B.C. Dermatologists have been doing the modern day version for more than half a century. The procedures we use today have been greatly refined, and so has our approach to using them.
Modern Chemical Peels
Peels can be tailored for skin type and the type of skin damage. It’s not a “one size fits all approach to anti-aging. Peeling agents include an alphabet soup of some combination of the following: salicylic, retinoic, mandelic, phytic, and tricholoracetic acids. We choose an agent or agents based on the tone and condition of the skin as well as the desired outcome.
Today’s chemical peels often infuse the skin with ingredients that encourage its own natural processes such as building collagen to diminish wrinkles and improve tone. They can also be combined with other procedures such as microneedling to enhance the penetration of active agents.
Different Types of Chemical Peels
Here’s a primer on peels. A light peel, commonly called a lunchtime peel, gently exfoliates only the outer layer of skin. This treatment can improve mild discoloration as well as refresh the face, neck, chest or hands. Regular light peels for acne work well with other treatments and can help reduce the need for prescription oral antibiotics. Light peels are also an excellent solution for patients of color looking to lighten the skin.
To get the results you seek from a light peel, you will need multiple treatments, depending on your goals. Melasma or hyperpigmentation on the face will require several sessions of chemical exfoliation to eliminate the pigment.
A medium peel penetrates the outer and middle layers of skin to improve age spots, fine lines and wrinkles, freckles and moderate skin discoloration. It also can be used to smooth rough skin and treat precancerous skin growths such as actinic keratoses.
Deeper peels are also designed to penetrate the middle layer of skin to remove moderate lines, age spots, freckles and shallow scars.
Preparing for a Chemical Peel
Preparation for a peel is as important as the peel itself. You may be given instructions on a skin care plan- especially if you have darker skin tones- for the 2-4 weeks preceding a peel. After your peel you we will tell you how to care for your skin, when it’s safe to begin wearing makeup and what you should be using to maintain the benefits of your peel.
Peels are a customizable approach to healthy anti-aging and a natural aesthetic.
In addition to wonderful memories, summer can leave behind unwanted darkening of the skin. Persistent hyper-pigmentation of the face, called Melasma, occurs on the cheeks, bridge of nose, forehead, upper lip and occasionally the forearms. It is similar in appearance to age spots, but the dark patches cover a larger area.
Melasma occurs in all skin types, but especially in skin of color. East Asian, Southeast Asian, Hispanic and Blacks populations have the highest rates. Up to 30 % of middle-aged Asian women exhibit Melasma. In general, women are affected more frequently; the American Academy of Dermatology estimates that 90 % of Melasma sufferers are women. Men are not immune; nearly 35 % of men from Central America – particularly Guatemala – develop the condition.
What causes Melasma?
Sunlight is the principal trigger. The greater the sun exposure, the greater the risk. Age increases the potential as does a history of vitiligo and the existence of multiple moles or birthmarks.
The second most important cause is female hormones. Not only is Melasma more common in women, it’s also more severe. It occurs during pregnancy (the “mask of pregnancy” or Chloasma) and with the use of oral contraceptives and hormone replacement therapy (HRT). Unfortunately discontinuation of the medication doesn’t necessarily reverse the pigmentation.
Why does Melasma differ by ethnic group?
Skin color is determined by the density and distribution of melanin, or natural pigment, in the skin. All ethnicities have a similar number of melanin producing cells, or melanocytes, in their skin. What differs is the level of melanocyte activity and how closely the cells are grouped together. Skin types with more melanocytic activity, or darker skin types, react to inflammation or UV exposure with more robust melanocytic activity, leading to hyper (increased) and sometimes hypo (decreased) pigmentation.
How is Melasma treated?
Sun protection is the cornerstone of Melasma prevention and treatment. Daily use of a broad spectrum (at least SPF 30) sunscreen that blocks both UVA and UVB is critical. These should be applied at least 20 minutes before and 30 minutes after sun exposure. Products should contain one or more of the following ingredients in order to protect against the long UVA wavelengths: Zinc Oxide, Titanium Oxide, Ecamsule and/or Avobenzone (Parsol 1789). Protection can also come from wearing iron oxide-containing makeup. Hats with a 2-3 inch brim along with sunglasses are helpful in reducing UV light exposure. It’s important to remember that damaging sun rays penetrate through a car window.
Topical skin bleaching agents such as prescription-strength Hydroquinone, either alone or in combination with topical retinoids and steroids, are very useful in treating Melasma. Their efficacy is enhanced when combined with a series of peels with either Glycolic Acid, Salicylic Acid or Trichloroacetic Acid. Peels and topicals should be adjusted according to skin type for best results.
Other agents also have a role in reducing pigmentation including vitamin C and E, Azelaic Acid, licorice, Kojic Acid, Ellagic Acid and Arbutin. Lasers are often promoted for Melasma treatment but they are not as effective as they are for solitary age spots or blood vessels.
Oral medications, such as Tranexamic Acid, are also helpful as an adjunct treatment for some patients.
I find that a multi-modal approach, tailored to a patient’s ethnicity, location of pigment in the skin and underlying health status leads to significant and durable improvement in Melasma. The good news is that if Melasma bothers you, it’s not something you have to live with!
Hair loss is one of the most complicated issues in Dermatology. There are numerous potential causes including auto-immune conditions, hormonal abnormalities, nutritional deficiencies, malignancies and heredity. In addition to the challenges of establishing a diagnosis, the remedies are neither fool-proof nor universally beneficial. Unlike many other areas in medicine, studies on hair growth medications and treatments are often not well-designed or double-blinded. End points are difficult to quantify. Growing hair can be elusive and determining if what you’re using is actually effective turns out to be even harder.
We know that half of all men and women over the age of 50 will experience hair loss. For those whose gradual hair thinning is a result of heredity or age and not a reversible condition– what options are scientifically based? Does anything really work? How much of what we believe about hair growth and hair care is just a myth?
Hair Loss Treatments
As of today, the only FDA-approved medications for the treatment of hair loss are topical Minoxidil and oral Finasteride.
Minoxodil is an over-the-counter solution or foam found in two different strengths: 2% and 5% . Although how it works is not entirely clear, minoxidil does seem to increase hair growth rate and hair follicle diameter.
What I have observed is that it increases hair growth in about 1/3 of patients, maintains hair in another third and doesn’t do much in the rest.
Recommended Usage of Hair Loss Treatments
There are a lot of misconceptions about its use, however, and that leads to less than optimal results. Patients will often stop using minoxidil if it doesn’t work within the first 2 months, believing that it’s not going to be effective for them. It turns out that many people won’t see results until 4- 6 months of daily use. I recommend continuing for a full year before giving up.
I also find that patients are reluctant to start Minoxidil because they think they must commit to it for the rest of their lives and if they stop their hair will all fall out. NOT TRUE! Like many things, such as sunscreen or hair spray, it’s only going to work when you use it. But that doesn’t mean someone has to apply it forever or that you’ll lose all your hair if you stop. You won’t. Your hair just goes back to where it was before you started Minoxidil.
Contrary to what some believe, Minoxidil will not cause hair loss to worsen. It can seem like it does for some people, because as new hair growth begins, resting or not-growing hairs are pushed out. This shedding can make it seem like hair is actually being lost; however overall hair count and the size of the hair shaft are actually increasing when this happens.
Suggested Hair Care for Those Experiencing Hair Loss
What about hair care? If you’re losing hair should you shampoo or brush less frequently, and stop dying your treating your hair?
Shampooing often enough to eliminate scale on the scalp helps optimize hair growth. Certain shampoos are better for this than others. However the frequency of hair washing will not make an impact on hair growth. You might be more aware of the loss when you shampoo, but there is no evidence linking hair loss to hair washing.
Similarly neither brushing your hair nor using chemical treatments such as dyes, perms or straighteners will cause you to lose your hair. What they can do, though, is make hair weaker and more susceptible to breakage, which can make hair loss more noticeable. So proceed with caution.
Hair loss is more than just having a bad hair day. It can signify a health problem and it can also be psychologically devastating for both men and women. We are exposed to a deluge of options regarding hair growth— only some of which are legitimate. Some treatments may turn out to be helpful, but data to support them is limited or non-existent.
In a future blog I’ll explore what we know and don’t know about the other approved medication, finasteride, along with supplements, hair lasers and PRP.
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Treat your double chin!
KYBELLA® is the only FDA approved injectable treatment for men and women to improve the appearance and profile of moderate to severe fat below the chin (submental fat), also called “double chin.”
Purchase one KYBELLA treatment during the month of July and receive a free one to use within 12 months.
Call us at 301-652-8081 to book your appointment.
Buy 1 Sunscreen & Receive 20% Off SunBuddy or Protex
We offer a range of dermatologist recommended sunscreens, available at our office. Now through the month of July, purchase any sunscreen and receive 20% off SunBuddy (sunscreen applicator for your back), or Protex (sun protective gloves).
Say goodbye to aging lines!
Get any Restylane facial filler and receive a FREE product from the options below.
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Revision Finishing Touch
This serious facial exfoliation scrub removes dead, dehydrated surface cells from the skin for an immediate soft, smooth appearance.
Revision Black Mask
This intensive mask with a moist after-feel deep cleans the skin, ridding it of impurities and excess sebum.
Tinted Physical Sunscreen – SPF 50+
This next generation BB cream provides superior broad spectrum UVA/UVB protection with a skin perfecting tint that reduces the signs of aging and evens skin tone. Worn alone or under foundation, this matte finish, multi-tasking formula provides:
• Mattifying, all day oil control
• Breathable SPF 50+ protection
• Age defying antioxidant benefits
• Universal Pigment Technology to blend with all skin tones
• Sheer tint to conceal minor skin imperfections
• Gentle hydration for even the most sensitive skin
Sheer Physical Sunscreen Spray – SPF 50+
Sheer, broad spectrum UVA/UVB SPF 50+ sunscreen utilizes innovative and proprietary formulation technologies to deliver ultra-light, quick absorbing, non-whitening protection. A true sensitive skin formula free of chemical stabilizers, this anti-photoaging sunscreen is water resistant for 40 minutes and fortified with a blend of powerful antioxidants. The 360º spray is perfect for on-the-go, trips alone to the beach or as a refresher under or over make up.
Call us with any questions and to make your reservation: 301-652-8081