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The Basics

Acne

Acne Quiz

Which of the following statements apply to you?

  • My acne makes me shy; I’m embarrassed by my acne.
  • My acne involves the chest and/or the back.
  • My acne gets worse around my menstrual cycle every month.
  • I have painful, pus-filled lesions in addition to blackheads, whiteheads, and reddened spots on my skin.
  • I’m beginning to see scars after acne lesions clear.
  • I have dark skin, and a patch that is darker than my skin appears when an acne lesion clears.
  • None of the over-the-counter products and/or remedies I’ve tried have worked.
  • Some over-the-counter products seem to work at first; then my acne returns and will not stay clear.
  • I’ve tried some prescription medications, but they irritated my skin.
  • I’ve tried taking antibiotics but not with a daily morning and night acne topical regimen.

If you answered “yes” to any of these statements, you’re not alone. Acne is a common skin disease that affects teens and adults. We know how frustrating and difficult it may be to treat these symptoms. Over-the-counter and mail-order products that are readily available and heavily advertised can be misleading and may not be right for you. Most of these products are not prescription strength and nothing works “overnight.” That’s why we’re committed to offering our patients the latest and most complete treatment plans.

Acne Treatments

At Hopkins Dermatology, we’ll customize your treatment plan according to your acne symptoms and skin type. We’ll provide carefully selected prescriptions, often incorporating our advanced skin care products to establish a well-balanced regimen for you. Oral medications may also be prescribed including antibiotics, Accutane (for severe acne), and Yaz or Spironolactone (for hormonal acne).

Once you begin your treatment plan, it’s important to use the prescribed medications and/or recommended skin care products consistently as well as keep your follow-up appointments to achieve optimal results.*

We can also incorporate the following in-office treatments to further customize your regimen:

  • Mild chemical peel
  • Microdermabrasion with an acne facial treatment (for patients who want minimal downtime)
  • Blue light therapy (to kill bacteria and reduce inflammation)
  • Levulan® PDT (for patients with severe acne or scarring)

If you’re currently experiencing acne breakouts, don’t be discouraged. Call our office to schedule your initial evaluation or follow-up appointment today.

Acne

Skin Cancer

“Dear 16-Year-Old Me”

What is Skin Cancer?

Cancer develops when DNA, the molecule found in cells that encodes genetic information, becomes damaged and the body cannot repair the damage. These damaged cells begin to grow and divide uncontrollably. When this occurs in the skin, skin cancer develops. As the damaged cells multiply, they form a tumor. Since skin cancer generally develops in the epidermis, the outermost layers of skin, a tumor is usually clearly visible. This makes most skin cancers detectable in the early stages.

Types of Skin Cancer

Three types of skin cancer account for nearly 100% of all diagnosed cases. Skin cancers are divided into one of two classes—nonmelanoma skin cancers and melanoma. Melanoma is the deadliest form of skin cancer. Each of the cancers described below begins in a different type of cell within the skin and is named for the type of cell in which it begins.

Basal Cell Carcinoma (BCC)

BCC, the most common cancer in humans, develops in more than one million people every year in the United States alone. It can appear as a shiny, translucent or pearly nodule; a sore that continuously heals and then re-opens; a slightly elevated, pink growth; irritated, reddish patches of skin; or a waxy scar. Most BCCs appear on areas of the skin with a history of exposure to the sun, such as the face, ears, scalp, and upper trunk. These tumors tend to grow slowly and can take years to reach a half inch in size. While these tumors very rarely metastasize (i.e., cancer spreads to other parts of the body), dermatologists encourage early diagnosis and treatment to prevent extensive damage to surrounding tissue.

Squamous Cell Carcinoma (SCC)

About 16% of diagnosed skin cancers are SCC. It often develops in fair-skinned, middle-aged, elderly people who have had long-term sun exposure. SCC most often appears as a crusted or scaly area of skin with an inflamed, red base that resembles a growing tumor, non-healing ulcer, or crusted-over patch of skin. While most commonly found on sun-exposed areas of the body, it can develop anywhere, including the inside of the mouth and the genitalia. SCC may arise from actinic keratosis (AK), which are dry, scaly lesions that may be skin-colored, reddish-brown, or yellowish-black. SCC requires early treatment to prevent metastasis (i.e., spreading).

Other Nonmelanoma Skin Cancers

All other skin cancers combined account for less than 1% of diagnosed cases. These are classified as nonmelanoma skin cancers and include Merkel cell carcinoma, dermatofibrosarcoma protuberans (DFSP), Paget’s disease, and cutaneous T-cell lymphoma.

Melanoma

Accounting for about 4% of all diagnosed skin cancers, melanoma begins in the melanocytes—cells within the epidermis that give skin its color. Melanoma has been coined “the most lethal form of skin cancer” because it can rapidly spread to the lymph system and internal organs. In the United States alone, approximately one person dies from melanoma every hour. Older Caucasian men have the highest mortality rate. Dermatologists believe this is because they are less likely to heed the early warning signs. With early detection and proper treatment, the cure rate for melanoma is about 95%. However, once it spreads the prognosis is poor. Melanoma most often develops in a pre-existing mole or in what looks like a new mole. This is why it’s important for people to know what their moles look like, to be able to detect changes to existing moles, and to spot new moles.

Causes

Sun exposure is the leading cause of skin cancer. According to the American Cancer Society, “Many of the more than one million skin cancers diagnosed each year could be prevented with protection from the sun’s rays.” Scientists now know that exposure to the sun’s ultraviolet (UV) rays damages DNA in the skin. The body can usually repair this damage before gene mutations occur and cancer develops. When a person’s body cannot repair the damaged DNA, which can occur with cumulative sun exposure, cancer develops.

In some cases, skin cancer is an inherited condition. Between 5%-10% of melanomas develop in people with a family history of melanoma.

Who Gets Skin Cancer?

Skin cancer develops in people of all colors, from the palest to the darkest. However, skin cancer is most likely to occur in those who have fair skin, light-colored eyes, blond or red hair, a tendency to burn or freckle when exposed to the sun, and a history of sun exposure. Anyone with a family history of skin cancer also has an increased risk of developing skin cancer. In dark-skinned individuals, melanoma most often develops on non-sun-exposed areas, such as the foot, underneath nails, and on the mucous membranes of the mouth, nasal passages, or genitals. Those with fair skin can also develop melanoma in these areas.

Skin Cancer Rates Rising

While Americans now recognize that overexposure to the sun is unhealthy, the fact remains that most do not protect their skin from the sun’s harmful rays. As a result, skin cancer is common in the United States. More than one million nonmelanoma skin cancers are diagnosed each year, and approximately one person dies from melanoma every hour. In 1930, 1 in 5,000 Americans was likely to develop melanoma during their lifetime. By 2004, this ratio jumped to 1 in 65. Today, melanoma is the second most common cancer in women aged 20-29. If current trends continue, 1 in 5 Americans will develop skin cancer during their lifetime.

Be Proactive

Since skin cancer is so prevalent today, dermatologists recommend that everyone learn how to recognize the signs of skin cancer, use this knowledge to perform regular examinations of their skin, and see a dermatologist annually for an exam (or more frequently if at high risk). Skin cancer is highly curable with early detection and proper treatment.

What is Your Risk?

Anyone can develop skin cancer—however, the likelihood increases with age as well as with the more risk factors you experience. Be proactive and ask yourself the following questions:

  • Do I have a history of exposure to UV rays from the sun, tanning beds, or sun lamps (whether intermittent or year-round), even if the exposure was years ago?
  • Am I sensitive to the sun? Do I tend to burn or freckle rather than tan?
  • Have I had several sunburns or experienced severe sunburns (especially blisters)?
  • Have I been overexposed or had long-term exposure to x-rays, including x-ray treatments for acne?
  • Do I live in a geographic region receiving high-intensity sunlight, such as Louisiana, Florida, the Caribbean, or northern Australia?
  • Do I have fair skin, blond or red hair, and/or blue, green, or gray eyes?
  • Do I have 50 or more moles?
  • Do I have any atypical moles, freckles, or spots? If yes, think through the ABCs of their appearance:
  • Asymmetry – Normal moles or freckles are completely symmetrical. If you were to draw a line through a normal spot, you would have two symmetrical halves. In cases of skin cancer, spots do not look the same on both sides.
A - Asymmetry
  • Border – A mole or spot with irregular, jagged, scalloped, or poorly defined edges should be examined by a doctor.
B - Border
  • Color – A mole that is more than one hue is suspicious and needs to be evaluated by a doctor. Normal spots are usually one color. This can include lightening or darkening of the mole.
C - Color
  • Diameter – If it is larger than a pencil eraser (about 1/4 in. or 6 mm.), it needs to be examined by a doctor. This includes areas that do not have any other abnormalities (i.e., asymmetry, border, color, etc.).
D - Diameter
  • Elevation/Evolution – Elevation means the mole is raised above the surface of the skin and has an uneven surface. Evolution refers to observing moles or skin lesions that look different from the rest or continue to change in size, shape, or color.
  • Does my family have a history of skin cancer?
  • Have I been diagnosed with actinic keratosis (AK)?
  • Have I been on long-term treatment with immunosuppressive medication, such as that used to prevent organ rejection or treat severe arthritis?
  • Has my immune system been weakened by a disease, such as lymphoma or human immunodeficiency virus (HIV)?

Early Detection Is Key

If you’ve experienced any of the above risk factors, it’s important that you…

  • Perform self-examinations of your skin regularly to check for suspicious moles and other lesions that may be skin cancer. Routinely examining your skin for changes helps to detect skin cancer early, when it is most treatable.
  • See a dermatologist for regular examinations at least once a year. This is especially important for adults who have risk factors for skin cancer, such as a family history of skin cancer, or for those who have had lots of sun exposure.
  • Practice proper sun protection regularly.

Contact our office today for more information.

Prevention is Essential

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. As unprotected sun exposure is thought to increase the number of moles, reducing sun exposure is an easy way to reduce your risk for skin cancer. Follow these tips to Be Sun Smart:

  • Generously apply a broad-spectrum water-resistant sunscreen with a sun protection factor (SPF) of 30 or more to all exposed skin. Broad-spectrum provides protection from both ultraviolet A (UVA) and ultraviolet B (UVB) rays. Reapply approximately every two hours, even on cloudy days, and after swimming or sweating.
  • Wear protective clothing, such as a long-sleeved shirt, a wide-brimmed hat, pants, and sunglasses, where possible.
  • Seek shade when appropriate, remembering that the sun’s rays are strongest between 10 a.m. and 4 p.m. If your shadow is shorter than you are, seek shade.
  • Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
  • Use extra caution near water, snow, and sand because they reflect the damaging rays of the sun, which can increase your chance of sunburn. Get vitamin D safely through a healthy diet that may include vitamin supplements. Don’t seek the sun for vitamin D.
  • Avoid tanning beds. Ultraviolet light from the sun and tanning beds can cause skin cancer and wrinkling. If you want to look like you’ve been kissed by the sun, consider using a sunless self-tanning product, but continue to use sunscreen with it.
  • Check your birthday suit on your birthday! If you notice anything changing, growing, or bleeding on your skin, see a dermatologist.

Moles

Moles are common—almost everyone has a few, and some people develop hundreds. Individuals with fair skin tend to have more moles, with the average ranging from 10-40. The most important thing to know about moles is that melanoma, the deadliest type of skin cancer, can develop in or near a mole. Research shows that certain moles have a higher-than-average risk of becoming cancerous. Anyone with a mole that has a higher-than-average risk for developing melanoma should perform skin self-exams, practice sun protection, and see a dermatologist regularly.

Skin Self-Exams: Checking Moles

Performing regular skin self-exams helps you recognize the early warning signs of melanoma. When examining your moles, think through the ABCs of their appearance (i.e., Asymmetry, Border, Color, Diameter, and Elevation/Evolution). Keep in mind, not all moles look alike. Even in the same individual, moles can differ in size, shape, or color. The most common colors range from tan to brown, but moles can be pink, black, blue, or even skin-toned. They can be flat or raised; they can have hair. Some moles may change slowly over time, possibly even disappearing.

Be sure to examine your entire body. Moles can appear anywhere on the skin, including between the fingers and toes, on the soles and palms, and under the nails. A dermatologist should examine any mole that stands out from the rest. This includes any spot that changes in size, shape, or color, and any lesion that bleeds, itches, or becomes painful.

Promptly make an appointment with a dermatologist if a mole is worrisome, displays one or more of the ABCs, or is new and looks unusual. A biopsy, which involves removing the mole or other suspicious lesion and examining it under a microscope, is the only way to confirm whether a lesion is skin cancer. Removing a mole is a simple, safe procedure that can be performed using local anesthesia.

Warts

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. Viruses that cause warts are called human papillomavirus (HPV). Warts are usually skin-colored and feel rough to the touch, but they can be dark, flat, and smooth. The appearance of a wart depends on where it’s growing.

There are several different kinds of warts:

  • Common (hand) warts
  • Plantar (foot) warts
  • Flat warts

How do you get warts?

Warts are passed from person to person, sometimes indirectly. Several months may pass from the time of first contact to the time the warts have grown large enough to be seen. However, the risk of catching hand, foot, or flat warts from another person is minimal.

Why do some people get warts and others don’t?

People tend to develop warts based on how often they are exposed to the virus. Wart viruses occur more easily if the skin has been damaged in some way, which explains the high frequency of warts in children who bite their nails or pick at hangnails. But some people are simply more likely to catch the wart virus than are others, just as some people catch colds more easily than others. Patients with a weakened immune system are also more prone to a wart virus infection.

Do warts need to be treated?

It depends on the case. In children, warts can disappear without treatment over a period of several months to years. However, warts that are bothersome, painful, or rapidly multiplying should be treated. Warts in adults often do not disappear as easily or as quickly as they do in children.

How do dermatologists treat warts?

Dermatologists are trained to use a variety of treatments, depending on the age of the patient and the type of wart.

Warts may be treated by “painting” with cantharidin which causes a blister to form under the wart, prompting it to peel away as it heals.*

Cryotherapy (freezing) is another option. It’s not too painful and rarely results in scarring. However, repeated treatments at one-to-three-week intervals are often necessary. Electrosurgery (burning) is another good alternative treatment.*

Many warts require a more aggressive approach with laser treatments, using light therapy to target the blood supply of the wart to destroy it. Warts on the hands and feet often require this method.*

Flat warts are typically too numerous to treat with the aforementioned options. As a result, “peeling” methods using daily applications of salicylic acid, tretinoin, glycolic acid, or other surface-peeling preparations are usually recommended. For some adults, periodic office visits for surgical treatments are necessary.*

What about the problem of recurrent warts?

In some cases, new warts appear as fast as the old ones go away. This may happen if the old warts shed virus into the surrounding skin before they were treated, causing new “baby” warts to grow around the original “mother” warts. The best way to limit this is to treat new warts as quickly as they develop. Multiple treatments may be needed to insure the treated wart has resolved completely.

Contact our office today for more information.

Birthmarks

Port wine stains (vascular malformations) may be present at birth and can range from pale pink to dark purple in color. They occur in 0.3% of births, equally among males and females. In the past, these lesions were erroneously called “capillary hemangiomas.”
Their cause has been recently associated with a deficiency or absence in the nerve supply to the blood vessels of the affected area. These nerves control the diameter of the blood vessels. If the nerves are absent or defective, the vessels will continue to dilate, pooling blood within the affected area. The result is a visibly distinct birthmark.

Dr. Hopkins treats birthmarks and hemangiomas with vascular lasers.

Rosacea

Do you experience any of the following signs or symptoms?

  • I tend to blush frequently or easily.
  • I notice flushing when I consume hot drinks, spicy foods, or alcoholic beverages.
  • I have redness or flushing that is more pronounced during extreme hot/cold weather.
  • I’m extremely sensitive to hairspray touching my face as well as certain facial products (ex. soap, moisturizers, or cosmetics).
  • I notice persistent redness in the center of my face that has gradually involved my cheeks, forehead, chin, and nose.
  • I see tiny blood vessels and pimples, without blackheads, on/around a reddened area on my face.

These symptoms are all early indications of rosacea—a common skin disease that frequently begins as a tendency to flush or blush easily. As rosacea progresses, people often develop persistent redness in the center of the face, which gradually spreads beyond the nose and cheeks to the forehead and chin. (Even the ears, chest, and back can be affected.)

When it first develops, rosacea may come and go on its own, and you may have only one or a few indications. However, early intervention by a dermatologist is key to successful treatment. Rosacea rarely reverses itself and may last for years. It can become worse without treatment or when self-treated.

What does rosacea look like?

Tiny blood vessels, which many call spider veins, may develop with rosacea. Some people see small red bumps (papules), usually appearing in crops, and some of the red bumps may contain pus (pustules). These papules and pustules resemble acne, so people often refer to rosacea as adult acne. Unlike acne, blackheads do not develop.

Rosacea can cause the affected skin to swell. In more advanced cases, a condition called rhinophyma may develop. Caused by enlarged oil glands in the skin, rhinophyma makes the nose larger and the cheeks puffy. Thick bumps may develop on the lower half of the nose and nearby cheeks. Most people do not develop rhinophyma; those who do tend to be men.

Rosacea can also affect the eyes. About 50% of people with rosacea have eye impact, also called ocular rosacea. This often causes dryness, burning, and grittiness of the eyes. Left untreated, ocular rosacea can lead to serious eye complications.

Treatment

To effectively manage rosacea, dermatologists usually recommend a combination of treatments tailored to the individual patient, which can stop rosacea from progressing and, sometimes, reverse rosacea.

Many rosacea treatments are applied directly to the affected skin. Creams, lotions, foams, washes, gels, and pads that contain a topical antibiotic, azelaic acid, metronidazole, sulfacetamide, benzoyl peroxide, or retinoids may be prescribed. These topicals are effective, but improvement can take time. A slight improvement may be seen in the first three to four weeks; greater improvement usually takes about two months. Faster results may be seen with oral antibiotics to treat the papules and pustules. However, be cautious when choosing treatments—some over-the-counter solutions can worsen rosacea.*

Persistent redness may be treated with a small electric needle (electrodessication) or laser treatments. Laser treatments can also reduce the background skin redness (telangiectasias) as well as the papules and pustules. Cosmetics such as pure mineral makeup (ex. MD Minerals) are also helpful due to the anti-inflammatory properties in the minerals.*

Tips for Rosacea Patients

Everyday things can cause rosacea to flare—these are called triggers. To help patients decrease flare-ups, dermatologists recommend the following:

  • Practice good sun protection. Sun exposure seems to be the most common trigger. Seek shade when possible, limit exposure to sunlight, wear protective clothing, and use nonirritating broad-spectrum sunscreen (that offers protection from UVA and UVB rays) with an SPF of 30 or higher. Reapply sunscreen every two hours.
  • Avoid certain foods and drinks. Spicy foods, hot drinks, caffeine, and alcoholic beverages are common rosacea triggers. Although alcohol can worsen rosacea, the condition can be just as severe in someone who does not drink alcohol. Rosacea has been unfairly linked to alcoholism.
  • Protect your skin from extreme hot/cold temperatures. Extreme temperatures can exacerbate rosacea. Exercise in a cool environment. Beware of becoming overheated. Protect your face from cold and wind with a nonirritating scarf or ski mask.
  • Avoid rubbing, scrubbing, or massaging the face. The less contact with your face, the better.
  • Avoid cosmetics and skin care products that contain alcohol or other irritating substances. Use hair sprays properly, avoiding contact with facial skin.
  • Keep your skin care routine simple. The fewer the products, the better.
  • Keep a record of flushing episodes. What causes rosacea to flare in one person may not trigger it in another. Make a list of the foods, products, activities, medications, and other things that cause your rosacea to flare, so you can learn your triggers.

Contact Dr. Hopkins’ office for more information on treatments for rosacea.

Psoriasis

Psoriasis is a chronic, genetic, noncontagious skin disorder that appears in many different forms and can affect any part of the body, including the nails and scalp. It’s categorized as mild, moderate, or severe, depending on the percentage of body surface involved and the impact on the patient’s quality of life (QOL). Psoriasis may be one of several types: plaque psoriasis, pustular psoriasis, erythrodermic psoriasis, guttate psoriasis, or inverse psoriasis. A dermatologist can help you determine what type of psoriasis you may have.

If psoriasis is a concern in your daily routine, click here to take a patient self-assessment to determine if you’re a candidate for the latest systemic therapy. If you have a score of 50 or more, call Dr. Hopkins’ office today to schedule an appointment. Please print your assessment and bring it to your appointment.

Contact Dermatitis

Allergic Contact Dermatitis

Allergic contact dermatitis is caused by a reaction to substances, called allergens, that come into contact with your skin. In susceptible people, these contact allergens can cause itching, redness, and blisters, resulting in a condition known as allergic contact dermatitis.

Allergic contact dermatitis can be difficult to distinguish from other rashes. In initial severe (acute) cases, such as poison ivy, the skin gets red, itchy, and swollen and develops tiny blisters which may break, leaving crusts and scales. The skin eventually becomes thick, red, and scaly with long-term (chronic) exposure to an allergen. Later, the skin may darken and become leathery and cracked.

Discovering the Cause

Careful review of the substances your skin encounters every day is helpful in identifying the allergen. Most contact dermatitis is diagnosed by the distribution of the rash. Sometimes the cause cannot be identified by history or physical examination; in those cases, you may need patch testing.

Patch tests are a safe and easy way to diagnose contact allergens. In these tests, small amounts of the possible common allergens are applied to the skin on strips of tape and then removed after two days. Common allergens include nickel, rubber, dyes, preservatives, medications, fragrances, poison ivy, poison oak, and related plants. A positive allergy test shows up as a small red spot at the site of the patch.

Treatment

Mild rashes that occur from allergic contact dermatitis usually respond to topical steroid creams and/or oral antihistamines that your dermatologist can prescribe. It may also be necessary to apply moist compresses to blistered areas and to keep these areas covered for a few days.*

Severe rashes may need to be treated with systemic methods such as oral and injectable corticosterioids, antibiotics, or other anti-inflammatory and immunologic agents.

People with allergic contact dermatitis should avoid the allergen that causes the reaction, as well as any chemicals that cross-react with it, and find substitute products that do not cause reactions. Your dermatologist can help you identify which items to avoid and can suggest sources for substitute products.

Eczema

Eczema is a general term encompassing various inflamed skin conditions. One of the most common forms of eczema is atopic dermatitis (atopic eczema). Approximately 10%-20% of the world population is affected by this chronic, relapsing, itchy rash at some point during childhood. Fortunately, many children with eczema find that the disease clears and often completely disappears with age.

Contact our office for more information.

*Results may vary by individual.