Treating a Variety of Medical Concerns like Eczema, Folliculitis, Melanoma, Rosacea and More.

Medical Procedures at Wall Street Dermatology

Acne is a common skin condition that approximately 40-50 million people1 in the United States alone.  Acne is frequently associated with teenagers and young adults, it can be observed in people across all ages.

Acne is caused by numerous factors. Genetics, hormone levels, diet, psychological stress, and environmental conditions all can contribute to skin outbreaks.  Acne formation begins with the clogged pore (comedone).  As we continuously shed dead skin cells and oil into our pores, the pore eventually becomes clogged with dead skin cells cemented with oil.  Bacteria called Propionibacterium acnes (P. acnes) grow in the pore and promote inflammation.  The combination of clogged pores and bacterial growth can cause the pore to rupture, resulting in the inflamed acne lesion.

Fortunately, there are many effective acne treatments, ranging from traditional medical acne treatment with topical creams and oral medicines to cutting-edge treatment like acne injections and lasers.  The exact type of treatment depends on a global consideration of many factors including but not limited to the patient’s medical history, acne severity, and skin type.  It is always important to treat acne early on because of the potential for discoloration and scarring if acne persists chronically without treatment.

Allergic contact dermatitis is a common skin condition resulting from a specific type of inflammatory reaction of the skin triggered by specific chemicals in the environment to which the skin is exposed.  The specific triggering substance may or may not be identifiable, but can include common substances such as the resins from poison ivy to nickel from earrings and belt buckles.

Allergic contact dermatitis often presents itself as an itchy pink rash that can be found anywhere on the skin, often depending on where and how long the exposure initially took place.   Treatment begins with identification and avoidance of the triggering chemical if possible.  Topical and oral medications are available treatments depending on the location and severity of the allergic contact dermatitis.   Patch testing is often performed when no known source can be easily identified.

Basal cell carcinoma is the most common skin cancer and cancer worldwide. Due to a variety of factors, its incidence continues to rise over recent decades.

Both genetic predisposition and environmental factors such as sun exposure are involved in basal cell carcinoma development.  People with fairer skin types are usually more at risk for developing this skin cancer.  However, people of all skin types are able to develop basal cell carcinomas.

Although basal cell carcinomas are associated with a lower spread (metastatic) rate to other parts of the body compared to squamous cell carcinomas and melanomas, basal cell carcinomas can grow quite large and cause extensive local structural damage and disfigurement.  This is particularly important for areas of the body such as the face and ears.  It is very important to diagnose and treat basal cell carcinomas at an early stage.

There are many treatments options for basal cell carcinomas including Mohs micrographic surgery and standard surgical excisions.  The exact choice of treatment will depend on a multitude of factors including but not limited to the basal cell carcinoma type, location, size, and the patients’ overall medical condition.  Once a person is diagnosed with basal cell carcinoma, regular skin checks are important to prevent recurrence and new growths of this skin cancer.

A birthmark is a term loosely used to encompass a variety of different skin lesions that are present at an early age.  Birthmarks can manifest itself as light brown spots such as café-au-lait macules, red spots such as vascular malformations and hemangiomas, or darker brown growths such as the congenital nevus and epidermal nevus.  Medical diagnosis of the birthmark will require a detailed consultation with your dermatologist.

Many birthmarks are benign but are considered a cosmetic nuisance.  Fortunately, there are many cosmetic treatment options available to improve the appearance of the birthmark.

Some birthmarks may be located in an area of the body that may require medical treatment to prevent damage of an important structure.   These require immediate treatment.

Some birthmarks have the potential to change to a malignant (cancerous) version.  If this is thought to be a possibility, your dermatologist may recommend monitoring and/or medical work-up for your birthmark.

Dry skin (medical term: xerosis) is a common concern for many people, especially those who live in colder, less-humid climates.  However, people who are genetically prone to dry skin may also develop it in hot humid climates as well.  Frequently, dry skin is a seasonal phenomenon.

Dry skin can be associated with scaliness, flakiness, and itchiness.  Areas where dry skin often occurs include face, arms, and legs.   Sometimes dryness can be caused by excessive or misapplication of skin products and cleansers.

Consistent moisturization with the right skincare product is essential to relieving dry skin. However, many skin conditions can mimic dry skin, thereby being unresponsive to simple moisturization.  Therefore, anyone with persistent dry skin needs to be evaluated by a dermatologist to determine whether his/her condition is truly due to dry skin.

The topic of the dysplastic nevus is highly complex and even controversial amongst experts.  However, to provide a simplified overview of the topic, the dysplastic nevus can be thought of as an atypical mole. Its diagnosis and degree of atypical change is usually revealed through the results of a specialized test called a skin biopsy.

Depending on the degree of atypical changes in the mole as revealed through the skin biopsy, the dysplastic nevus can be classified under mild, moderate, and severe categories.  Management of the dysplastic nevus depends on the degree of atypical changes.   Dysplastic nevi may need to be excised or re-excised completely in certain cases.

Some people may have hundreds of dysplastic nevi.  People with this condition are at thought to be at higher risk for melanoma and are recommended to have regular skin checks with their dermatologist.  Full body digital photography may be useful to keep careful track of these moles in these individuals.

Eczema is the term commonly used to refer to atopic dermatitis, which we will discuss here, although it is more accurately a collection of different inflammatory skin conditions that share similar microscopic patterns.

Atopic Dermatitis is a common, chronic and relapsing condition that can affects people of all ages but can usually be found starting at an early age.  It is a condition influenced by both genetics and the environment.  People who are diagnosed with atopic dermatitis may also have allergies and asthma.   These individuals should take careful steps to avoid triggers in the environment.

The presentation of atopic dermatitis varies amongst different people.  Symptoms of atopic dermatitis can include itchiness, scaliness, and redness of the skin.  Presentation depends on age, but in adults, common areas where the rash affects the skin may include the creases of the arms and back of the legs.

Although there is no known cure for atopic dermatitis, many treatments are available to help the symptoms associated with this chronic condition.  In addition to lifestyle changes, topical medications and oral medications are often effective.   The exact treatment will depend on many factors, so it is important to be evaluated by your dermatologist first.

Folliculitis is a common condition of the skin resulting from inflammation of the hair follicles. Folliculitis appears as small pink bumps centered on the hair follicle. This condition can be present anywhere on the skin where hair follicles are present. Areas frequently involved include the back, chest, and buttocks.

The diagnosis of folliculitis is usually based on clinical exam. In some instances, further testing may be needed to rule out other skin conditions that look like folliculitis.

There is a condition called pseudofolliculitis, commonly referred to as “razor bumps”, that often develop in people with thicker and curlier hair. The ends of the cut hair re-enter the skin and cause an inflammatory reaction, resembling folliculitis. Pseudofolliculitis often occurs in the beard area in men and on the legs of women. There are many strategies to help alleviate this condition, including proper hair trimming technique and treatment with topical medications. Laser hair removal can be a permanent solution for this condition. Pseudofolliculitis is just one example of a condition that closely mimics folliculitis. Numerous other examples exist.

Although folliculitis is usually not a serious condition, folliculitis can be a source of distress to patients because of its appearance. Fortunately, there are many treatments that can help reduce its severity. It may even be important to find out whether there is a triggering source for the folliculitis. Your dermatologist will help evaluate whether you have folliculitis and determine the best treatment plan for you.

Fungal infection of the skin is a common problem for people worldwide. Terms such as “ringworm”, “athlete’s foot”, and “jock itch” can be confusing, because they all refer to fungal infection of the skin. Although fungal infections occurs at a higher rate in hot and humid climates, it can develop in people who live in colder, drier environments as well.

Fungi and their spores are present everywhere in the environment including other living animals. There are numerous types of fungi and a variety of types are capable of infecting humans. In general, growth is favored in dark, humid, and warm conditions. Hence, the groin and the feet are often areas prone to fungal infection. However, any part of the body can be infected. Fungal infection can spread to other parts of the body and can be transmitted to other people. Pets can be the source of fungal infection for humans.

Fungal infections may present as rashes that are itchy, scaly, and red. It can easily be mistaken for other types of rashes. Hence it is important to see your dermatologist for a proper evaluation of the condition, so that the right treatment is given. Sometimes, diagnosis of a fungal infection will require specialized tests.

Fungal infection can be treated with a number of different topical and oral medications. Your dermatologist can help determine the most appropriate treatment for your condition. Treatment can be difficult, especially for fungal infections of the feet, as any remaining fungus in a shoe can reinfect the skin. Treatment of fungal infections often takes patience and persistence.

There are numerous different growths that can develop anywhere on the skin. As people age, more growths may develop. A consultation with your dermatologist can help establish the diagnosis of the skin growth and most importantly whether it is considered non-cancerous, pre-cancerous, or cancerous. Sometimes, when the diagnosis is not clear based on the clinical exam, a biopsy procedure may be recommended by your dermatologist to clarify the diagnosis.

Examples of common benign growths include seborrheic keratoses, nevi (mole), angiomas, and milia.

An example of a common precancerous growth is an actinic keratosis. These should be treated to prevent potential development into skin cancers.

Examples of common cancerous growths include basal cell carcinoma, squamous cell carcinoma, and melanoma. These should be treated in a timely fashion to prevent local tissue destruction, spread to other parts of the body, and death.

If you have a new, changing, or any suspicious growth, you should see your dermatologist for an evaluation of that growth.

Melanoma, also referred to as malignant melanoma, is a serious form of skin cancer that can be life-threatening if not treated in a timely fashion. It has been found that the incidence of melanoma has been increasing in fair skinned populations worldwide in recent decades. Melanoma should be a concern for people of all ages.

Melanoma cells represent the cancerous change of the pigment-producing cells (melanocyte) of the body. In the skin, pigment-producing cells give us the natural color of our skin and also form the moles (nevi) on our skin. When these normal pigment-producing cells undergo a cancerous change, whether caused by ultraviolet radiation or other factors, melanoma develops.

The development of melanoma is influenced by genetic and environmental factors. Some people have specific genes that place them more at risk for developing melanoma. Family history of melanoma is often useful in identifying these at-risk individuals. Exposure to ultraviolet radiation from the sun or tanning beds is also known to be a risk factor. Although usually associated with people with fair skin, melanoma occurs in all races and skin types.

Frequent monitoring of the skin and timely detection is key to the diagnosis and management of melanoma. In fact, people with a history of melanoma are strongly recommended to undergo frequent and routine skin checks with their dermatologist. Any mole that appears different from other moles, any mole that is new, or any mole that is changing needs to be evaluated by a dermatologist. Because melanoma can have varied presentations, the diagnosis of melanoma can be challenging from multiple levels. Diagnosis of melanoma needs to be confirmed with a tissue sample (biopsy).

The recommended treatment for melanoma depends on many factors including the stage of the melanoma, the type of melanoma, and the location of the melanoma. Early stage melanomas are often successfully treated with a standard surgical excision and in some instances Mohs micrographic surgery. Your dermatologist will make the most appropriate recommendations for management of your melanoma.

Although moles are commonly thought of as any brown growth of the skin, moles really refer to a specific type of brown growth arising from the pigment producing cells (melanocytes) of the skin. The medical term that dermatologists use is “nevus”.

Moles are benign (non-cancerous) growths of the skin. Moles can appear anywhere on the body, but are more numerous in sun exposed areas. Sometimes they can be a cosmetic concern for patients who may wish to have them removed, but sometimes they may require additional medical evaluation.

Diagnosis of a mole should be made by your dermatologist. Although moles are benign, you should always have a trained professional distinguish between a regular mole, an atypical mole (dysplastic nevus), and a melanoma, which is cancerous and potentially life-threatening growth. Even though melanomas are not moles, melanomas may look like an irregular mole. Your dermatologist is the trained professional who will decide whether your mole is benign or whether it needs additional evaluation.

Depending on the size and depth of the mole, it can be easily removed by a surgical excision and in some instances a more minor shave procedure.

The term “precancer” is often used to refer to what dermatologists call “actinic keratosis” or “solar keratosis”. Precancerous skin lesions are not skin cancers, but are skin growths that are atypical and may give rise to skin cancers in the future. Specifically, actinic keratoses have the potential to change into squamous cell carcinomas, a common type of skin cancer.

Precancerous skin lesions are very common and often appear as scaly pink spots on the skin and are sometimes mistaken for spots of dry skin by patients. Common areas for precancerous skin lesions include sun-exposed areas such as the face, the arms, the scalp, and the legs. Precancerous skin lesions occur most frequently in lighter skinned individuals and older individuals, but may occur in anyone with enough sun damage to the skin.

Precancerous skin lesions are treatable by a number of different methods including liquid nitrogen, topical medications, and other procedures. Your dermatologist will determine the extent of precancerous change on your skin and determine the best treatment for your needs.

A rash, also called “dermatitis” by dermatologists, is a generic term used for inflammation of the skin due to any number of reasons. Rashes are a popular reason to visit the dermatologist, who attempts to establish the exact diagnosis for the rash.

Although rashes may all appear similar to the untrained eye, the diagnosis of a skin rash can be a complex and challenging process of data gathering and interpretation, requiring numerous years of specialty medical training. Diagnosis is a complex synthesis of available medical history verbalized from the patient, physical examination, and sometimes a biopsy or other test procedure. Fortunately, there are also certain rashes in which the diagnosis is more straight-forward with no need for additional testing.

Because there are hundreds to thousands of different rashes, depending on method of classification, different rashes have different features, symptoms, causes, severity, treatments, and prognoses. Rashes can vary from a minor cosmetic nuisance to a life-threatening condition. If you are experiencing a rash, it is important for you to visit your dermatologist for an evaluation. The diagnosis of the rash will be more easily made if the rash is present during the time of the visit with your dermatologist.

Rosacea is a common condition of the skin that can present as red bumps, inflamed pustules, diffuse redness, fine blood vessels, irritated eyes, or a combination thereof. Rosacea is more commonly found in fair skinned individuals between the third and fourth decade of life. Because of its similarity with acne, it may sometimes be difficult to distinguish between the two.

The exact cause of rosacea is not well known, but it is thought to involve some degree of hyperactive blood vessels. Sources that trigger rosacea flares may include sunlight, heat, and consumption of alcohol, caffeine, and spicy foods. Individuals with rosacea are often encouraged to make lifestyle changes to avoid these triggers.

The treatment for rosacea depends on the type and severity of the rosacea. Some cases can be effectively treated with standard creams and/or oral medication. However, the blood vessel and diffuse redness form of rosacea, usually a cosmetic concern for patients, may only be responsive to laser. Your dermatologist will determine the most appropriate treatment for your condition.

Squamous cell carcinoma is the second most common type of skin cancer in the United States. It develops from the cancerous transformation of the keratinocyte cells from the top-most layer of the skin (epidermis).  A squamous cell carcinoma that is confined to the epidermis is referred to as a squamous cell carcinoma in situ (SCCis).  This is considered an early stage for squamous cell carcinoma.  When the cancerous cells break through the epidermis and grow more deeply, it is referred to as an invasive squamous cell carcinoma.  A recent staging system has been developed for squamous cell carcinomas and takes into account the size, depth, location, nerve involvement, spread, and other tumor characteristics.   As with basal cell carcinoma, squamous cell carcinomas can also cause local tissue destruction.  However, depending on its stage and a variety of other factors, squamous cell carcinomas are thought to have a higher chance of life-threatening spread to the rest of the body than basal cell carcinomas.

Squamous cell carcinoma can be found anywhere on the skin, but is most common on sun-exposed areas.  Ultraviolet radiation exposure from sunlight and tanning beds are common risk factors for developing squamous cell carcinomas.  Other causes of squamous cell carcinomas include contact with certain toxic chemicals, a suppressed immune system, and infection with certain subtypes of the Human Papilloma Virus (HPV).

The diagnosis of a squamous cell carcinoma will require a biopsy.  Many treatment options are available, including but not limited to topical medications, Mohs micrographic surgery, and standard surgical excisions.  The most appropriate treatment option will be determined by your dermatologist based on a number of factors including the stage of the squamous cell carcinoma, its location, and other personal medical conditions.

Following Mohs surgery, reconstructive surgery is common to close open holes.