Common warts are benign – that is, harmless, flesh colored, roughly textured bumps on the surface of the skin, most notably on the fingers, hands and face. Their shape and color can vary to some degree. The black dots that can sometimes be seen on a wart are tiny blood vessels.
Plantar warts, the second type of benign warts, appear on the bottom of the feet and are usually bigger than common warts. Often mistaken for calluses, plantar warts can, however, become quite painful. Walking barefoot in damp areas increases your risk of getting plantar warts.
Warts are produced by a virus, which causes skin cells to multiply rapidly. Although contagious, warts will more likely spread from one part of your body to another than from one person to another. Sometimes warts disappear on their own, but treatment will frequently shrink and remove these growths.
The most common procedures to treat warts are: cryosurgery (freezing with liquid nitrogen); electrodessication (burning with an electric current); acid applications; laser surgery and topical therapy with liquids, ointments and patches.
Chewed fingernails, dried-cracked skin and eczema may increase your risk for warts. Whereas children are more apt to get warts because they are prone to cuts and scratches, plantar warts are seen more frequently in adults. It also seems that some older people can become immune to the virus.
Genital warts are much more likely to be contagious and typically require more intensive therapy.
Vitiligo is a disease characterized by loss of pigment cells in the skin. One or more white patches can appear anywhere on the body and may be more noticeable in the summer when normal surrounding skin has tanned. The eyes can also be involved at times. Approximately two million people in this country are affected with vitiligo. The cause is not well understood, but recent findings indicate that pigment cells may be damaged by the body’s immune system.
Several different treatments are available. Most dermatologists will prescribe topical steroids (cortisone) as the first line of therapy. These medications are typically used for several months at a time. Some investigators believe oral anti-inflammatory medications (such as aspirin or ibuprofen) may also be useful. Ultraviolet light therapy administered with prescription pills (PUVA) can be very helpful, but many treatments are usually required. Surgical approaches are also being studied and include skin and pigment cell grafting. It is important to remember that affected skin does not tan and can be damaged by small amounts of sunlight. Sunscreens, which contain a sun protection factor (SPF) of at least 30, should be applied every day. It is best to consult with your dermatologist who can review the full range of treatment options.
Tinea versicolor is a benign and harmless fungus infection of the skin. The fungus that causes the rash of tinea versicolor is present in small amounts on everyone’s skin. For reasons that are not well understood, the fungus appears to grow more rapidly on some people’s skin and produces a scaling rash that usually occurs on the shoulders, chest, back and arms. The fungus can temporarily interfere with the pigment producing cells of the skin which will cause the rash to “lighten up”. In the summer, the affected skin may not tan properly.
It is important to remember that this fungus lives only in the top layer of the skin and does not spread internally.
Treatment for tinea versicolor is very effective. After the initial treatment has been completed, you will need to use Nizoral shampoo once a week for several months to prevent the fungus from growing back. Nizoral shampoo is now over-the-counter.
The skin cancer (basal cell carcinoma) for which you are being treated is common and curable. Basal cell cancers are the result of sun damage to the skin. Sunlight ages the skin cells, causing their growth to be disturbed. A basal cell cancer begins as a small spot that grows slowly and relentlessly until treated. Basal cell cancers enlarge steadily, on rare occasions invading underlying bone if not treated.
Microscopic examination is necessary to determine whether a growth is cancerous.
Skin cancers are most common on the face. They’re rarely found in areas such as the buttocks, which are protected from the sun by clothing. Skin cancers occur more often in people living in sunny areas. Fair skinned individuals are more prone to skin cancer than darker persons, since skin pigment protects the skin. Sun damage is cumulative and delayed – that is, skin cancer can occur years after sun damage.
Basal cell cancers are best treated early, when they are small, since it is simpler to remove a small growth than a large one. Generally, surgical removal of basal cell cancers is at least 97% curative.
Occasionally, a cancer will grow back. In order to detect this event, the treated area should be checked periodically for five years. If you become concerned about the treated area or if other skin growths appear, please call our office to schedule an appointment. It is important to keep follow up appointments so that if recurrences occur, they can be promptly treated.
The skin damaging effects of sunlight are permanent and build up slowly over time. Although frequent sunburns cause the most skin damage, even frequent sun exposure and sunbathing will produce gradual skin damage over time. As many as 10, 20 or more years can pass between the time of sun exposure and the time the skin shows signs of sun damage. Thus teenage sun worshippers often pay for their deep tans when they reach their 40’s or 50’s.
With the passage of time, skin cancer patients are more likely to develop additional skin cancers. If you notice a new growth, or a sore that doesn’t heal or keeps coming back, be sure to have it examined.
You should use a sunscreen lotion or cream with a sun protection factor (SPF) of 15 or more from late spring to early fall. It is best to apply sunscreens one hour before going out. It is especially useful if you are going to be outside between the hours of 10:00 a.m. and 3:00 p.m. (when the sun is most intense). If you have acne or oily skin, use an oil free lotion rather than a cream.
Remember – staying in the shade or lying under an umbrella at the beach does NOT sufficiently protect you from the sun – always use a sunscreen when exposed for prolonged periods to intense sunlight.
Most brown crusty growths that develop as we get older are not actually moles but benign growths called seborrheic keratoses. These lesions are formed from the uppermost layer of skin called the epidermis. They can range in size from less than a quarter inch to more than two inches. These growths may become quite thick and can have a rough or warty surface. A portion of the lesion may fall off if rubbed hard, but this lesion will grow back if the base is not properly removed. Some people may have a few growths whereas other people have many. We unfortunately do not know why they appear and are unable to prevent more from developing. Some seborrheic keratoses may rub or catch on clothing and become irritated. Any growth that abruptly changes in size or color or bleeds should be promptly evaluated.
Unfortunately, there is no effective topical therapy that will remove these growths. Most often, seborrheic keratoses are surgically removed with a scalpel or blade and an instrument called a curette. Cryosurgery (removal using extremely cold temperatures) with liquid nitrogen is another common way to destroy these growths. It is possible to remove many seborrheic keratoses at one time. A new topical anesthetic cream (called EMLA) can be used to numb a large area of skin and can help to make this type of surgery almost pain free.
Seborrheic dermatitis is a chronic inflammatory condition of the skin producing red patches with yellow greasy scales. The rash develops most commonly in the areas of the body which contain the greatest number of oil glands. These areas include the scalp, eyebrows, sides of the nose, ears and chest.
The cause of seborrheic dermatitis is not known. The rash does not usually cause a great deal of itching. Seborrheic dermatitis usually improves in the summer months and may flare somewhat in the winter time. There are no means to prevent recurrences or permanently cure seborrheic dermatitis.
Seborrheic dermatitis usually responds well to topical creams, gels or lotions. The choice of medication is based on the location of the rash. The treatment is usually continued until the rash clears, then medication is gradually tapered and discontinued. Some people will need treatment for a longer period of time.
The treatment of seborrheic dermatitis of the scalp includes use of medicated shampoos. Shampooing should be performed daily or every other day until clearing occurs. The shampoo should be gently massaged into the scalp and left on for several minutes before rinsing.
Recommended shampoos include:
- Head and Shoulders
- Selsun Blue
- Vanseb (plain)
- XSeb Plus
If you are unable to find these shampoos at the pharmacy, please ask your pharmacist to order them for you.
Scabies also known as “the itch” is an intensely itchy rash caused by an allergic reaction to a tiny mite that lives in the uppermost part of the skin. Since it is only 1/60th of an inch long, the scabies mite is almost impossible to see with the naked eye.
The rash usually affects the hands, wrists, breasts, genital area, and waistline.
Scabies is contagious and can be transmitted by close personal contact. If any family members or friends are bothered by an intensely itchy rash, they should be examined for scabies.
Scabies is not associated with uncleanliness.
All affected sheets, towels, and clothing should be routinely cleaned and stored in plastic bags for two to three weeks. There is no need to do any sterilizing.
Psoriasis is a benign disease where the skin becomes inflamed and grows much more rapidly than it normally should. This results in red, thickened, scaling patches that can occur anywhere on the body surface. The scalp, knees and elbows tend to be the most commonly involved areas. The disease is fairly common and affects about 6 million people in this country alone. The cause of psoriasis is not known. Although there is no cure for psoriasis, there are many effective medications that are used to control the disease. No one medicine will work equally well on every person.
Cortisone applied to the skin surface is a very effective way to control psoriasis. There are many different preparations available and include ointments, creams and gels.
Tar preparations help slow the rate of the growth of skin and are used quite frequently in combination with cortisone preparations. Tar preparations are usually brown in color and their intensity varies with the concentration of tar in the medication.
Anthralin is a derivative of tar and works in a similar fashion. The “short contact” method is an excellent way to treat patients with psoriasis. This means that the Anthralin is left on the skin for a short period of time every day, and then is washed off. The treatment is very simple and is usually quite effective. The treatment procedure is as follows:
- Gently wash the affected areas with lukewarm water. Please do not use soap as this can irritate the skin. Pat dry with a soft cotton towel.
- Gently apply the Anthralin only to the psoriasis. You should be careful not to put it on normal skin.
- For the first week you should leave the Anthralin on for no more than 10 minutes a day. This allows the skin to get used to the medication. Increase the time to 20 minutes a day for the second week, and finally 30 minutes a day for the third week and thereafter.
- If the Anthralin burns or stings for more than one minute or two, you should wash it off immediately. Irritation from Anthralin rarely happens.
- After the desired time is reached, you should gently wash the medication off with lukewarm water. Again, please do not use any soap.
- Anthralin usually causes psoriasis to flatten and recede. This takes several weeks of daily applications. Anthralin sometimes turns the skin a darker color. This is only temporary and will fade when the Anthralin is stopped.
- Anthralin usually stains clothes and you should be careful not to get it in contact with any clothing for the short amount of time that you are using it.
Ultraviolet light (sunlight) is frequently very helpful in controlling psoriasis. The most important thing to remember is that sunburn will damage the skin and can make the psoriasis worse. Slow tanning is the best way to get sun. Begin with no more than 5 minutes of sun a day (if you burn very easily, start with 1 or 2 minutes). You can increase the amount of sun exposure by a minute or so every other day until you reach about 10 or 15 minutes of time. If you are going to be out in the sun for an extended period of time, please use a number 15 sunscreen lotion or cream to prevent burning. Tanning beds are not helpful in controlling psoriasis. It is important to be VERY gentle with your skin. It is quite common for a new patch of psoriasis to develop in skin that has been injured whether through sunburn or through frequent scratching. When your psoriasis does clear continue to treat your skin very gently. If it begins to feel dry use a bland moisturizer such as Eucerin cream, Moisturel lotion or Lubriderm lotion. Also, try to avoid harsh deodorant soaps and instead use mild moisturizing soaps such as Dove, Basis or Oilatum.
Pityriasis rosea is a common, harmless skin disease. The cause is unknown, but we do know that:
- Pityriasis rosea clears up in about three to six weeks, sometimes a little longer. When clear, the skin returns to its normal appearance. There will be no scars.
- Pityriasis rosea is not related to foods, medicines, or nervous upset.
- Pityriasis rosea always disappears by itself.
- A single scaling pink spot often appears 1 to 20 days before the general rash. The rash mainly affects the trunk but may spread to the thighs, upper arms, and neck. Pityriasis rosea usually spares the face, although sometimes a few spots spread to the cheeks.
- Second attacks of pityriasis rosea are rare but can occur.
- If the rash itches, treatment with a mild cortisone preparation usually brings prompt relief. The cortisone does not clear pityriasis rosea; it will only make you more comfortable while getting over the rash.
- The rash of pityriasis rosea can be irritated by soap bathe or shower with plain water. The skin may become dry and scaly it helps to put a thin coating of moisturizer (such as Eucerin Cream or lotion, Moisturel Lotion or Lubriderm Lotion) on your rash shortly after you finish taking a shower or bath.
Malignant Melanoma Q & A
Q. What is malignant melanoma?
A. Malignant melanoma is a very serious skin cancer characterized by the uncontrolled growth of pigment-producing tanning cells. Melanomas may suddenly appear without warning, but can also develop from or near a mole. They are found most frequently on the upper back of men and women, on legs of women, but can occur anywhere on the body.
Q. Is melanoma a serious disease?
A. Yes. In later stages, malignant melanoma spreads to other organs and may result in death. But if detected in the early stages, melanoma can usually be treated successfully.
Q. How many people will develop malignant melanoma this year?
A. An estimated 40,300 new cases of malignant melanoma are expected to be diagnosed in 1997 in the United States and 7,300 people are expected to die from the disease – 4,600 will be men and 2,700 will be women. Melanoma is more common than any non-skin cancer among people 25 to 29 years old.
Q. What causes melanoma?
A. Excessive exposure to the ultraviolet radiation of the sun is the most important preventable cause of melanoma. People in southern regions, where the sunlight is more intense, are more likely to develop melanoma than those in northern regions. Other possible causes include genetic factors and immune system deficiencies. Malignant melanoma has also been linked to past sunburns and sun exposure at younger ages.
Q. Who gets melanoma?
A. While malignant melanoma can strike anyone, Caucasians are at far greater risk than those of other races. Among Caucasians, certain individuals are at higher risk than others. For example:
- Your chances are increased by nine times if you’ve already had one malignant melanoma.
- You have a substantially increased risk of developing melanoma if you have many moles, large moles or atypical moles (unusual moles).
- Your risk is increased if your parent, child or sibling has melanoma.
- If you are a Caucasian with fair skin, your risk is twice as great as a Caucasian with olive skin.
- Redheads and blondes have a two-fold to four-fold increased risk of developing melanoma.
- Excessive sun exposure in the first 10 to 15 years of life increases your chances of developing melanoma three-fold.
Q. What are atypical moles?
A. Most people have moles (nevi). Atypical moles are unusual moles that are generally larger than normal moles, variable in color, often have irregular borders and may occur in far greater number than regular moles. Atypical moles occur most often on the back and also commonly occur on the chest, abdomen and legs in women, but they may occur anywhere. The presence of atypical moles may mark a greater risk of malignant melanoma developing in a mole or on apparently normal skin.
Q. Should atypical moles be removed before they become cancerous?
A. Dermatologists are divided on the value of preventative removal of atypical moles. Because they can occur in large numbers (sometimes more than 100), their removal may be expensive and cosmetically unsatisfactory. Many dermatologists recommend careful and regular monitoring of these moles and surgical removal of lesions suspicious for melanoma.
Q. What does malignant melanoma look like?
A. Melanoma generally begins as a mottled, light brown to black flat blemish with irregular borders. The blemish is usually at least ¼ inch in size and may turn shades of red, blue and white, crust on the surface and bleed. They frequently appear on the upper back, torso, lower legs, head and neck. A changing mole, a new mole or a mole that is different or “ugly” or begins to grow requires prompt medical attention.
Q. Can melanoma be cured?
A. When detected early, surgical removal of thin melanomas can cure the disease in most cases. Early detection is essential; there is a direct correlation between the thickness of the melanoma and survival rate. Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance, especially changes in existing moles or blemishes. Additionally, patients with risk factors should have a complete skin examination annually. Anyone with a changing mole should be examined immediately.
Q. Can melanoma be prevented?
A. Yes. Because overexposure to ultraviolet light is thought to be a primary cause of malignant melanoma, dermatologists recommend the following precautions:
- Avoid “peak” sunlight hours – 10 AM to 3 PM – when the sun’s rays are most intense.
- Apply a sunscreen with a Sun Protection Factor (SPF) of at least 15, apply 15-30 minutes before going outdoors and reapply it every two hours, especially when playing, gardening, swimming or doing any other outdoor activities.
- Wear protective clothing, including a hat with a wide brim and long-sleeved shirt and pants during prolonged periods of sun exposure.
Intertrigo, or chafed skin develops when two areas of skin rub against each other causing superficial inflammation and redness. The most commonly affected portions of skin include the abdominal folds, groin area (especially in men) and underarm area. Intertrigo can affect anyone at any age but is more common in overweight individuals and during periods of hot humid weather. This rash may become infected by yeast or bacteria due to the warm, moist environment.
The most important part of therapy is to keep the involved skin dry. Frequent washing or rubbing may lead to further irritation. Drying powders can sometimes be helpful. Weight loss can be especially beneficial for obese individuals. Tight fitting clothing should be avoided. When this rash becomes more severe, dermatologists may treat with low strength topical steroid creams. If secondary infection is suspected, anti-yeast or antibiotic creams may also be added. Since many prescription medications are available, your doctor may recommend a new cream if your rash persists.
Hand dermatitis (hand eczema is another name for the same thing) is a common problem. Hand rashes usually result from a combination of (1) sensitive skin and (2) irritation or allergy
from materials touched. Everyone’s hands routinely come in contact with water and irritating soaps and detergents several times a day. Add the raw foods, solvents, paints, oils, greases, acids, glues, and so on that most of us touch at work or in the home, and you can see that the skin of your hands takes a beating.
Some people have skin that is sensitive and is more easily damaged. The result is dermatitis. Your skin can’t be toughened, but effective treatment is available to heal your dermatitis.
Skin protection is an important part of treatment. These instruction give you detailed directions on how to protect your hands – please read them carefully.
- Protect your hands from direct contact with soaps, detergents, scouring powders, and similar irritating chemicals by wearing waterproof, heavy duty vinyl gloves. Buy four or five pairs so they can be conveniently located in the kitchen, bathroom, and laundry areas. If a glove develops a hole, discard it immediately! Wearing a glove with a hole is worse than wearing no gloves at all.
- The waterproof gloves may be lined or unlined. In any case, you should buy thin cotton “derm gloves” to wear inside of the vinyl gloves to protect your hands from your own sweat.
- Wear waterproof gloves while peeling and squeezing lemons, oranges, or grapefruit, peeling potatoes, and handling tomatoes.
- Wear leather or heavy-duty fabric gloves when doing dry work and gardening. Dirty your gloves – not your hands. If you keep house for your family, scatter a dozen pairs of cheap cotton gloves about your home and use them while doing dry housework. When they get dirty, put them in the washing machine. Wash your gloves – not your hands.
- If you have an automatic dishwasher, use it as much as possible. If you don’t, let a member of your family do the dishes until your rash clears up. Do your laundry by machine, not by hand.
- Avoid direct contact with turpentine, paint thinner, paints, and floor, furniture, metal, and shoe polishes. They contain irritating solvents. When using them, wear heavy-duty water- proof vinyl gloves.
- When washing your hands, use lukewarm water and very little soap. Never use “deodorant” soap. Rinse the soap off completely and dry gently, always with a cotton towel.
- Rings often worsen dermatitis by trapping irritating materials beneath them. Remove your rings when doing housework and before washing your hands.
Dry skin is skin that lacks water. When this occurs, scaling, peeling and cracking can develop which can lead to itching and eczema. Normally, the skin makes chemicals which trap water in its outer layer. Cold, dry weather and frequent washing damage the skin and make it unable to hold water.
Who gets dry skin?
Dry skin can develop in any person if the skin is injured or damaged by frequent washing or wet work. Soaps, detergents and hot water tend to remove natural oil from the skin. Some individuals have sensitive skin and are more prone to develop dry skin. People who work outdoors are likely to develop problems when the weather turns bad. Dry skin is more common during the winter months and in older people.
How do I treat dry skin?
The best way of treating dry skin is to protect it.
- Avoid frequent exposure to water, soaps and detergents. Use super fatted or oil based soaps. Deodorant soaps may be too irritating to use.
- Dress sensibly in cold weather.
- Moisturizers help by coating damaged skin and will also trap water beneath the skin surface. The most effective ingredient in moisturizers is petrolatum. Moisturizers come in several different forms – lotions, creams and ointments. Lotions are easy to apply and absorb into the skin quickly. Lotions contain the least amount of petrolatum. People with very dry skin may find lotions too weak. Ointments are the most effective moisturizers, but can be greasy to use. Creams usually fall midway between lotions and ointments in effectiveness. Moisturizers are most effective when they are applied within minutes after bathing. They can also be applied throughout the day when needed.
- Avoid using wash cloths and scrubbing when bathing.
Blepharitis is a chronic inflammation of the eyelids which causes irritation, itching, and occasionally a red eye. Blepharitis can begin in early childhood producing “granulated eyelids” and may continue throughout life as a chronic condition. It may also develop later in life.
Blepharitis is characterized by redness of the lids, scales, flaking around the eyelashes and is often associated with dandruff of the scalp. There can be a loss of eyelashes and distortion of the margins of the eyelids which can cause chronic tearing. In some forms of Blepharitis the glands deep in the lid are involved. The following program describes the treatment of Blepharitis when associated with gland involvement.
How is Blepharitis treated?
In view of the long-term nature of the condition, strict lid hygiene is necessary. It is recommended to begin treatment with an initial regimen outlined below. Then after condition seems to have subsided, the maintenance schedule below should be followed.