Back to School Rash

I love September! To me, Back-to-school means clean notebooks, new horizons and the memory of a fresh box of Crayolas. My excitement is just another in a long list of quirks that my children find perplexing and irritating. I somehow haven’t completely transmitted the enthusiasm my own parents had for the start of the school year.

My dad, a college president who saw the potential student in almost everyone, looked upon the beginning of the semester like a child anticipates Christmas morning. His own education was a transformative gift, and he never got over his wonder and gratitude. My mother excitedly planned first-day-of-school outfits and staged multiple photos, but one year she got a little ahead of herself. As she pulled out of the elementary school driveway, having dropped me and my brothers off at the front entrance, the custodian waved down her speeding station; the first day of school wasn’t until the NEXT day. I get it; summer vacation can get too long when you have three kids underfoot.

In the wonderful world of dermatology, the fall also brings particular skin conditions. One of these back-to-school rashes is hand, foot and mouth disease.

Hand, foot, and mouth disease is a viral infection that causes sores in the mouth and a rash on the hands and feet. It is common among children under the age of 5, particularly in daycare settings, as it spreads by close contact with infected people. It’s not usually serious, and nearly all people recover within 10 days without medical treatment. (1)

Symptoms of Hand, Foot and Mouth Disease

● Fever
● Poor appetite
● Sore throat
● Rash – Small red bumps or blisters on the palms, soles of the feet, and sometimes the knees, elbows, buttocks, and genital area.
● Painful sores in the mouth

Symptoms typically appear 3-6 days after the initial infection (incubation period), with fever as the first sign, followed by a sore throat. (2)

Transmission

Hand, foot, and mouth disease spreads through contact with infected individuals’ nasal secretions, throat discharge, saliva, stool, or respiratory droplets after a cough or sneeze. It may also spread through contact with blisters on the skin.

Infected individuals are typically most contagious during the first week of illness, but the virus can remain in the body for weeks after the signs and symptoms are gone, resulting in further transmission. Some people, particularly adults, can pass the virus without showing any signs of the disease. Outbreaks of the disease are common in the summer and autumn in the United States and other temperate climates. (3)

Treatment for Hand, Foot and Mouth Disease

There is no specific treatment for hand, foot, and mouth disease. Symptoms, such as fever, can be managed with over-the-counter analgesics, like Ibuprofen or Tylenol. It is important that infected individuals drink plenty of fluids to stay hydrated, particularly if fever is present. Complications of hand, foot, and mouth disease are rare, but may include viral meningitis or encephalitis. High fevers not relieved with analgesics, headache, stiff neck, or back pain warrant further evaluation by your physic.

 

 

 

(1) CDC (June 28, 2018). Hand, Foot, and Mouth Disease. Accessed online at:
https://www.cdc.gov/features/handfootmouthdisease/index.html .

(2, 3) Mayo clinic (July 26, 2017). Hand, Foot, and Mouth Disease . Accessed online at:
https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035 .

What is Seborrheic Keratoses?

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.

excessive sweating

Hyperhidrosis Could be the Cause of Too Much Sweat

hyperhidrosis

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.

Contact us with questions and to book your appointment.

 

 

 

 

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.

Skincare Tips for Diabetes Patients

5 Skin Tips for People with Diabetes

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.

  1. 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.
  2. Use a moisturizing, fragrance-free cleanser such as Dove soap. Oatmeal baths can also help reduce itching.
  3. Thoroughly dry skin folds such as underneath the breasts or between toes. Trapped moisture is a breeding ground for yeast and fungal infections.
  4. 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.
  5. 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.

Contact us with questions and to book your appointment.

melasma example dark spots on cheek

What is Melasma & How to Treat It

melasma example dark spots on cheek

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.

Summary:

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 Treatments: Separating Fact from Fiction, Part I

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.

More Information

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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Buy one Nutrafol® vitamin for women or men and get a second one 20% off.*

* This promotion is valid during the month of August 2017.

Contact us with questions and to book your appointment.

 

Why Rosy Cheeks are Not Always a Good Thing

Rosy cheeks are seen as a sign of a good thing when considering a beautiful blush, or a good workout.

Permanent redness, however, is evidence a of chronic skin disorder called rosacea.  

Rosacea is very common and yet many people don’t know they have it.  Worst of all it can spread if left untreated — from the nose and cheeks to the ears, eyes, forehead and chin — even to the shoulders and back. It can be disfiguring when accompanied by pimples and thickened skin.

Rosacea is divided by dermatologists into four Subtypes:

Subtype 1:  FACIAL REDNESS – persistent flushing and visible blood vessels.

Subtype 2:  BUMPS AND PIMPLES – often seen with facial redness.

Subtype 3:  SKIN THICKENING – usually around the nose.

Subtype 4:  EYE IRRITATION – watery or red eyes with swollen, irritated eyelids.

Researchers are still trying to discover what causes rosacea. While there is currently no cure we do know that by treating the dilated blood vessels associated with rosacea it can be effectively managed. Recent advances in technology make this possible.

Treatment

Laser therapy has the unique ability to selectively target and treat these dilated blood vessels without adversely affecting the surrounding tissue. The most effective laser available for rosacea is VBeam Perfecta. A course of three or four treatments, each a month apart, can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

During VBeam Perfecta treatment, the mild discomfort associated with all laser procedures, similar to a snapping rubber band on the skin, is countered by a cooling stream of air directed at the area. This cooling also helps to prevent temporary bruising, an unwanted side effect of earlier laser technology. Light pink patches may appear that last for approximately a day. VBeam Perfecta is so safe and effective that it has been fully approved by the FDA for the treatment of infants.

The aesthetic improvements from laser treatments can be dramatic.

Rosacea Subtype 1 – Facial Redness

A course of three or four treatments scheduled a month apart can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

 

With the availability of VBeam Perfecta there is no longer a need to suffer the psychological side effects, such as depression and low self-esteem, which affect many victims of Rosacea. This advanced laser can also greatly improve many other unsightly conditions including angiomas, port wine stains, stretch marks, stubborn warts, bruises and sun damage on the neck and chest.

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.

 

Spring is the Best Time for Sclerotherapy: Spider Vein Treatment

Spring is in the air! As you clear out your closet of winter clothes and try on your new summer wardrobe, check to see if your legs are ready for short skirts and bathing suits. If you notice that you’ve got some red and blue veins that make you reluctant to show your legs, now is the time to do something about it. The good news is that if you treat your spider veins today, you’ll see terrific improvement by the Fourth of July.

When do Spider Veins Generally Occur?

Spider veins can occur at any age and result when the valves in the blood vessels become leaky and fail to prevent the blood from pooling in the feet and ankles. This is a result of a combination of factors including heredity, hormones, puberty, pregnancy, and weight. While women are most susceptible, a quarter of all leg vein sufferers are men.

Although a sun tan can temporarily camouflage these vessels, in the long run the sun will make leg veins more prominent and unsightly as it breaks down collagen. Minor spider veins can be the precursors to varicose veins, which tend to be thicker, lumpy and purple and may lead to swelling and uncomfortable achiness or heaviness in the legs.

How to Treat Spider Veins

Sclerotherapy is a safe and effective procedure used to reduce spider veins. It involves the injection, using a very fine needle, of a small amount of solution into the veins. The solution then irritates the lining of the vein, causing it to collapse. As these veins are a superfluous, “alternate route” for the blood, the body doesn’t miss these vessels and blood returns to the heart via the main thoroughfares.

Who can be treated for spider veins?

With a few exceptions, most healthy people are good candidates for sclerotherapy. If you are pregnant or have had a blood clot you shouldn’t be treated. If your veins are very tiny or too large you might not be treated.

Is Sclerotherapy Painful?

Most patients experience little or no discomfort during the procedure, which does not require any anesthesia. There might be a slight stinging as the solution is injected and the areas that were treated can become red, raised and itchy. You may also experience bruising which can last for several weeks.

How to Prepare for Sclerotherapy

Prior to sclerotherapy, you should discontinue over-the-counter supplements that cause bleeding, such as ginkgo, ginseng, and vitamin E as well as anti-inflammatory medications like ibuprofen and aspirin. Bring heavy compression stockings with you as you will need to wear them after the procedure for at least 48 hours. You will also need to avoid hot baths, whirlpools or saunas, and direct sunlight exposure on the areas treated for at least 2 days.

Usually at least half of all veins injected will disappear with sclerotherapy in 3- 6 weeks. Depending on the number of veins, some people will need multiple treatments. In about 10% of all cases the veins don’t respond and another solution can be tried.

Because it can take a few weeks for the veins to disappear,  it’s a good idea to have sclerotherapy before the start of summer!

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.

WP-Skelsey-heat-rash-2015

HEAT RASH

WP-Skelsey-heat-rash-2015

When it’s hot and humid, sweat glands can become blocked by excess perspiration, trapping sweat beneath the skin and causing a red, bumpy, prickly rash — heat rash. It’s more common among babies, whose sweat glands are immature, and among people who aren’t accustomed to heat and humidity, says Maral Skelsey, a clinical associate professor of dermatology at Georgetown University Medical School. Skelsey says tight-fitting clothing can further encourage the rash to develop by trapping sweat against the skin instead of allowing it to evaporate.

In babies, Skelsey says, the condition tends to resolve on its own; keeping a baby cool and lightly dressed — or even naked if the temperature is warm enough — is usually all that’s required. Adults, she says, may wish to treat the rash with over-the-counter topical steroid cream (to calm the itch), calamine lotion or anhydrous lanolin, an over-the-counter balm that can help keep skin ducts from getting blocked. Avoid getting overheated in the first place by taking breaks from outdoor heat in air-conditioned spaces when possible. As your body gets acclimated to summer’s hot and muggy weather, Skelsey adds, it will become less prone to heat rash.