Medical and Surgical Dermatology

We also specialize in the surgical removal of skin cancers, cysts, fatty growths, unwanted moles, and the repair of torn earlobes.

Please visit our medical information website, http://fromyourdoctor.com/dscmd/patient/index.jsp for more in-depth information about your dermatologic condition.

Please call the office to schedule an appointment for you or a family member at 704-341-0090.

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Acne

Acne occurs when hair follicle pores are blocked by natural components of the skin.   This is the root of most acne lesions. Once blocked, inflammation and bacteria overgrowth occur leading to red bumps and cysts in the skin. Sebaceous or sweat glands of the skin can contribute excessive amounts of sebum into the plugged follicle increasing inflammation. Hormones can also play a role. Most teenagers are affected to some degree. Adults, often, get acne for the first time while others have suffered since the teenage years. Acne is not life-threatening, but it can cause physical disfigurement (scarring) and emotional distress if not treated early.

Treatment for acne varies depending on which of the above factors is causing your acne. This is different for each person. On average, results are visible in six to eight weeks.

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Rosacea

Rosacea is a chronic skin disease that causes redness and swelling on the face and also occasionally the scalp, neck, ears, chest, back and/or eyes. Although it can affect anyone, rosacea typically appears in light-skinned, light-haired adults aged 30-50. Symptoms range from red pimples, lines and visible blood vessels to dry or burning skin and a tendency to flush easily.   You may also have sebaceous hyperplasia (small white or yellow bumps) and/or telangiectasias or redness as part of your rosacea.

The acne component is manageable with creams and/ or oral medications.

Sebaceous hyperplasia is often minimized by the topical meds.   If not, cosmetic treatments of electrocautery can reduce the size of the glands.

The redness can be reduced by medication.   Any permanent fine red lines are best removed by laser if many or epilation if a few are present.   Avoid triggers that cause enlargement of the blood vessels will help to minimize the development of permanent enlarged vessels on the skin.   Triggers include hot and spicy foods, hot beverages, heat, sun, etc.  

It is not yet known what causes rosacea and the disease is not curable, although it can be managed in many ways, including topical and oral medications and laser surgery. Early detection and intervention are essential to minimize and controlling rosacea.

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Moles & Birthmarks

Known as nevi (singular "nevus"), moles and other birthmarks are benign pigmented spots or patches of skin that range in color from tan, brown and black (moles) to red, pink or purple (blood vessel nevi). Though most birthmarks are harmless, they may develop into cancer. Moles exhibiting any of the following warning signs should be examined by a dermatologist immediately:

• Larger than six millimeters.
• Itches or bleeds.
• Rapidly changes in color, size or shape.
• Multiple colors.
• Is located where it can't be easily monitored, such as on the scalp.

Monthly self skin checks and yearly checks with your dermatologist can monitor for the above worrisome changes.   Any worrisome moles need to be evaluated quickly.

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Eczema

Eczema is a term used to describe a group of inflamed skin conditions that result in chronic, relapsing and very itchy rashes. Eczema can be broken down in several distinct categories.

Atopic dermatitis is partially inherited and environmental.

Infantile atopic dermatitis occurs from two months to two years of age. The scalp (cradle cap), cheeks, neck, forehead, wrists and extremities, buttocks and diaper area are often involved.   Allergies to egg, peanut, milk, wheat, fish, soy and chicken may be causative.   Children usually outgrow this allergy. Avoid wool clothing as this may irritate the skin.

Childhood atopic dermatitis occurs in children from 2 to 10 years of age.   Sites of involvement include the elbow, knee bend, wrists, eyelids, face and neck.   Itching is prominent.   Scratching causes thickening of the skin and an increased likelihood of infection.   Children are less sensitive to foods but more sensitive to feather-containing objects, cat or dog hair, lacquer paint, nickel, neomycin and ragweed resin.

Adolescent and adult atopic dermatitis is defined as being present after age 10.    The dermatitis varies as localized scaly lesions to more generalized involvement involving the elbow and knee bends, neck, forehead, behind the ears, wrists and hands.   Itching is present.   Triggers for the rash include dry skin, rough clothing, wool irritation, foods (rarely) or tension.

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Allergic Contact Dermatitus
Allergic contact dermatitis or ACD develops when your skin has an allergic reaction to a substance placed on to the skin.   This can be due to antibiotic creams, soaps, shampoos, lotions, creams, perfumes, makeups, etc.   The skin reacts resulting in an itchy, red, scaling rash.   If severe, blisters and oozing of a straw colored fluid may occur.  Avoid the offending allergen, if known.   Medical treatments are available to control the symptoms.   Patch testing may be necessary to identify the offending allergen.  

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Psoriasis

Psoriasis encompasses a group of chronic skin disorders that cause an itching and/or burning sensation, scaling and crusting of the skin. Skin does not mature and piles up on the skin surface as thick plaques.   The most commonly affected areas are the scalp, elbows, knees, hands, feet and genitals.

Psoriasis cannot be cured but it can be treated successfully.  Treatment depends on the type, severity and location of psoriasis; the patient's age, medical history and lifestyle; and the effect the disease has on the patient's general mental health.  The most common treatments are topical medications, phototherapy, and oral or injectable medications (for severe symptoms).  All require consistent effort by the patient and can be very successful.

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Skin Cancer

Skin cancer refers to the abnormal, uncontrolled growth of skin cells. The most common skin cancers are basal cell carcinoma and squamous cell carcinoma. A rarer but more dangerous skin cancer is melanoma, the leading cause of death from skin disease. Risk factors for developing skin cancer include pale skin, family history of melanoma, history of blistering sunburns during childhood, freckling and regular sun exposure. Skin cancers vary in shape, color, size and texture, so any new, changed or otherwise suspicious growths or rashes should be examined immediately by a physician. Early intervention is essential to preventing the cancer from spreading.

Skin Cancer Detection and Treatment

Actinic Keratosis (AK) or precancers

Precancers develop when the squamous cells of the skin become atypical and begin to overgrow their boundaries.   AKs are defined as involving only a few layers of the epidermis with this atypical growth.

This can progress into a squamous cell skin cancer.   Treatment is necessary to remove the base of atypical cells to prevent progression to cancer.

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Basal Cell Carcinoma (BCC)

BCC arises from the basal cells of the epidermis.   They grow out of control leading to a non healing skin lesion that can eventually ulcerate causing local destruction.

It rarely spreads beyond the skin, but can with a long period of time.   Treatment is necessary to stop this local invasion and possible future spread.

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Squamous Cell Carcinoma (SCC)

SCC arises from the squamous cells of the skin.   If the atypical cells are confined to the epidermis, a squamous cell in situ is present.   Local treatments may be curative.

If the atypical cells extend into the dermis, an invasive SCC is present. This is a skin cancer that locally grows, but can spread to lymph nodes and internally if not treated.

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Melanoma

Melanoma is a skin cancer of the melanocytes or pigment producing cells of the skin. A melanoma has cells that grow out of control, eventually going to your lymph nodes and then throughout your body.   It is fatal if not caught early.

Melanoma grows over a relatively short period of time.   Look for changes over a 1-2 month period.   Look for asymmetry, an irregular border, color changes, particularly black, and growth in size.   A melanoma can arise in moles or on any portion of the skin.  

If caught early, the melanoma can be excised alone with an excellent prognosis.   If the melanoma is > 1mm in depth, an evaluation of your lymph nodes is recommended to determine the likelihood of spread.   Referral to an oncologist may be necessary if spread is suspected.

Early detection is key.   You must check your skin monthly for any changes and notify us to evaluate any suspicious lesions.  

Dyplastic Nevi (DN)

These are moles with some atypical features within them. This is not a melanoma. The presence of DN is considered a risk factor for melanoma. You will need closer monitoring for melanoma.   Careful surveillance of skin is the best way to identify an early melanoma, as early detection and removal is often curative.   You should check your skin monthly for any changes and notify our office of any suspicious changes.   Your skin should be examined by the dermatologist every 6 months.

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Skin Cancer Facts

You are at increased risk for Melanoma and Skin Cancer if you have any of the following:

• Blonde or red hair, fair complexion, light eyes
• Tendency to burn easily in the sun
• Presence of freckles or atypical moles
• Any outdoor occupation or sports
• Family history of skin cancer
• Intense sun exposure during the first 18 years of life or cumulative sun exposure over time
• Previous family or personal history of melanoma
• History of tanning bed use

To Minimize Your Risk of Skin Cancer

Protect yourself from exposure to Ultraviolet light (sunlight):

• Avoid "peak" sunlight hours -- 10:00 a.m. until 4:00 p.m. -- when the sun's rays are most intense.
• Wear protective clothing, including a hat with a wide brim and long-sleeved shirt and pants during prolonged periods of sun exposure.    A tight weave fabric is best.   Special protective clothing is available through several companies including:
• Apply a broad spectrum sunblock with a Sun Protection Factor (SPF) of at least 15 in winter and 30 in summer.   Apply 15 - 30 minutes before going outdoors and reapply every two hours, especially when playing, gardening, swimming or doing any other outdoor activities.   Sunscreens/sunblocks should not be used to increase the time spent in sunlight.
• No shadow... seek the shade! If your shadow is shorter than you are, the damaging rays of the sun are at their strongest and you're likely to sunburn.
• Avoid use of tanning beds as they are just as damaging as sunlight.
• Obtain Vitamin D in foods or vitamins.

Sunscreen Recommendations

Choose your sun protection based on the product's ingredients rather than the name brand.   Check labels.

• A Physical Sunblock is best as it reflects sun off your skin.
  • Zinc oxide (Now transparent)
  • Titanium Dioxide
• Chemical sunscreens interact with the sun's rays after they touch your skin.   Broad spectrum products help to protect you from UVA and UVB light, both known to contribute to skin cancer and aging.    
  • Parsol 1789/ Avobenzone provides the best broad spectrum coverage. Stabilization of this sunscreen provides optimal protection.
  • Meroxyl
  
  

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Hives

Urticaria or hives occur when your immune system over reacts to a stimulus, releasing mast cells' histamine into the skin.   This causes a very itching swelling of the skin called hives.   Treatment involves identifying the causative agent and avoiding if possible.   If this is not possible, antihistamines may be needed to minimize the effect of the released antihistamine.   Many external factors can cause hives including the cold or heat, exercise, bathing, pressure, prolonged sitting, vibration, rubbing or scratching, friction or clothing contact.   Certain medications commonly cause hives including aspirin.   Food is often the culprit.

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Excessive Underarm Sweating (Hyperhidrosis)

Excessive sweating most commonly occurs on the palms, soles, armpits, and groin area.   This is often triggered by anxiety, anguish or fear.   It can limit daily functions and interfere with work.

Fortunately, a   number of treatment methods are available including prescription antiperspirants, iontophoresis, BOTOX® injection, oral medications and surgery.  

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Warts

Warts, including molluscum, are caused by viruses.   To date, there is no cure for viral disease.   Treatment is aimed at removing the external wart and, most importantly, stimulating your own immune system to contain the virus. This can be accomplished with painless topical solutions, freezing the warts and laser treatments.  All treatments usually require multiple treatment sessions.

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