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The Basics

Acne

Acne Quiz

  • None of the over-the-counter products and/or remedies I’ve tried has worked.
  • Some over-the-counter products seem to work at first then my acne returns and will not stay clear.
  • I have tried some prescriptions medications, but they seemed too irritating.
  • I have tried taking antibiotics but not with a daily morning and night acne topical regimen.
  • My acne gets worse around my menstrual cycle every month.
  • I have painful, pus-filled lesions in addition to blackheads and whiteheads, and reddened spots on my skin.
  • I am 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.
  • My acne makes me shy, and I am embarrassed by my acne.
  • My acne involves the chest and/or the back.

If you said “yes” to any of the above statements, it is time to schedule an appointment today for an evaluation. Virtually every case of acne can be successfully resolved. Not only can we help resolve your existing acne, we can also help prevent new lesions from forming and reduce your chance of developing disfiguring scars.

Acne is a common skin disease that affects teens and adults. We know that this can be a frustrating problem and is often difficult to treat. That is why at Hopkins Dermatology we are committed to offering our patients the latest and most complete treatment plans. The first step to controlling acne is to maintain a daily skin care regimen. Over-the-counter and mail order products that are readily available and heavily advertised can be misleading and may not be right for you. These products are not prescription strength and nothing works “overnight.”

At Hopkins Dermatology, we will individualize your treatment plan according to your type of acne and your skin type. We provide carefully selected prescriptions and will often incorporate our medical strength skin care products to find a well balanced skin care regimen for you.

Oral medications may also be prescribed including antibiotics and for severe acne, Accutane is used. For females with hormonal acne, Yaz or Spironolactone are prescribed to control breakouts.

Acne Treatments

We also can incorporate our in-office treatments to further customize your regimen. These treatments can include a series of mild chemical peels or for patients who want minimal down time, our Skin Care Treatments that include microdermabrasion with a acne facial treatment with soothing botanicals for acne. We can also incorporate a session under our BLU-U light. The BLU-U light uses a blue wavelength of light to kill bacteria and reduce inflammation.

For patients with more severe acne or scarring, we also offer a treatment with a topical medication called Levulan that is applied to the skin and absorbed by the oil producing glands and bacteria. Once this medication is absorbed, we activate it with our pulse dye laser that uses light to penetrate the skin, activating Levulan to reduce oil production, inflammation and bacteria. The laser also helps with post break-out redness and reduces acne scars by stimulating the body’s own collagen production.

Oral medications may also be prescribed including antibiotics and for severe acne, Accutane is used. For females with hormonal acne, Yaz or Spironolactone are prescribed to control breakouts.

Once you begin your treatment plan it is very important to use the skin care products daily and to keep your follow-up appointments to achieve optimal results.

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

Skin Cancer

“Dear 16-Year-Old Me”

Acne

What is Your Risk?

Anyone can develop skin cancer. However, the likelihood of developing skin cancer increases with age and when you have one or more of the risk factors on this checklist:

  • A – 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 will not look the same on both sides.
A - Asymmetry
  • B – Border: A mole or spot with blurry and/or jagged edges.
B - Border
  • C – 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
  • D – Diameter: If it is larger than a pencil eraser (about 1/4 inch or 6mm), it needs to be examined by a doctor. This is includes areas that do not have any other abnormalities (color, border, asymmetry).
D - Diameter
  • E – Elevation: Elevation means the mole is raised above the surface and has an uneven surface.
  • 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.
  • Had several sunburns or experienced severe, especially blistering, sunburns.
  • Live in a geographic region receiving high-intensity sunlight, such as Louisiana, Florida, Caribbean, or northern Australia.
  • Fair skin, especially when the person has blond or red hair and blue, green, or gray eyes.
  • Sun sensitive or tendency to burn or freckle rather than tan.
  • Close blood relative has/had melanoma, several more-distant relatives have a history of melanoma, or a family history of other skin cancers.
  • Personal history of skin cancer.
  • One or more atypical mole.
  • 50-plus moles.
  • Diagnosed with actinic keratoses.
  • Overexposure or long-term exposure to x-rays, including patients who received x-ray treatments for acne.
  • Long-term treatment with immunosuppressive medication, such as those used to prevent organ rejection or treat severe arthritis.
  • Weakened immune system caused by a disease, such as lymphoma or human immunodeficiency virus (HIV).

If you have any of the above risk factors, it is important that you:

  • Perform regular self-examinations of your skin to check for suspicious moles and other lesions that may be skin cancer.
  • See a dermatologist for regular examinations.
  • Practice sun protection

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. Each of these three cancers begins in a different type of cell within the skin, and each cancer is named for the type of cell in which it begins. Skin cancers are divided into one of two classes – nonmelanoma skin cancers and melanoma. Melanoma is the deadliest form of skin cancer.

The different types of skin cancer are:

Basal cell carcinoma (BCC):

The most common cancer in humans, BCC develops in more than 1 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 pink slightly elevated growth, reddish irritated patches of skin, or a waxy scar. Most BCCs appear on 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 half inch in size. While these tumors very rarely metastasize (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 and elderly people who have had long-term sun exposure. It most often appears as a crusted or scaly area of skin with a red inflamed 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 keratoses, which are dry, scaly lesions that may be skin-colored, reddish-brown or yellowish-black. SCC requires early treatment to prevent metastasis (spreading).

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 due to the fact that they are less likely to heed the early warning signs. With early detection and proper treatment, the cure rate for melanoma is about 95%. Once its spreads, the prognosis is poor. Melanoma most often develops in a pre-existing mole or looks like a new mole, which is why it is important for people to know what their moles look like and be able to detect changes to existing moles and spot new moles.

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, dermatofibromasarcoma protuberans, Paget’s disease and cutaneous T-cell lymphoma.

Causes

Sun exposure is the leading cause of skin cancer. According to the American Cancer Society, “Many of the more than 1 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% and 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, blonde 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 also can have melanoma develop 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 1 million nonmelanoma skin cancers are diagnosed each year, and approximately one person dies from melanoma every hour.

If current trends continue, 1 in 5 Americans will develop skin cancer during their lifetime. Melanoma continues to rise at an alarming rate. 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 to 29.

Prevention and Early Detection Key

Sun protection can significantly decrease a person’s risk of developing skin cancer. Sun protection practices include staying out of the sun between 10 a.m. and 4 p.m. when the rays are strongest, applying a broad-spectrum (offers UVA and UVB protection) sunscreen with a Sun Protection Factor (SPF) of 30 or higher year-round to all exposed skin, and wearing a protective clothing, such as a wide-brimmed hat and sunglasses when outdoors.

Since skin cancer is so prevalent today, dermatologists also 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 (more frequently if at high risk) for an exam. Skin cancer is highly curable with early detection and proper treatment.

Moles

Moles are common. Almost everyone has a few, and some people develop hundreds. Individuals with light skin tend to have more moles, with the average ranging from 10 to 40.

Probably 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 has shown that certain moles have a higher-than-average risk of becoming cancerous. Anyone who has a mole that has a higher-than-average risk for developing melanoma should see a dermatologist regularly, perform skin self-exams, and practice sun protection.

Checking Moles: Skin Self-Exams

Performing regular skin self-exams helps people recognize the early warning signs of melanoma. Dermatologists recommend that everyone perform regular skin self-exams. When examining your moles, look for the ABCDEs of

Melanoma Detection:

A stands for ASYMMETRY; one half unlike the other half.

B stands for BORDER; irregular, scalloped, or poorly defined border.

C stands for COLOR; varied from one area to another; shades of tan, brown, and black; sometimes white, red, or blue.

D stands for DIAMETER; melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, but they can be smaller.

E stands for EVOLVING; a mole or skin lesion that looks different from the rest or is changing in size, shape, or color.

As you examine your skin, it is important to know that not all moles look alike. Even in the same individual, moles can differ in size, shape, or color. Moles can be flat or raised. The most common colors range from tan to brown, but moles can be pink, black, blue, or even skin-toned. Moles can have hair. Some moles will change slowly over time, possibly even disappearing.

Be sure to examine your entire body. Moles can appear anywhere on the skin. Moles develop on the scalp, between the fingers and toes, on the soles and palms, and even 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.

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

Early Detection and Prevention are Essential

Routinely examining the skin for change helps to detect skin cancer early when it is most treatable. If a mole begins to change or a new mole appears, see a dermatologist. It also is wise to have an annual skin examination by a dermatologist. 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.

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. Here’s how to Be Sun SmartSM:

  1. 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.
  2. Wear protective clothing, such as a long-sleeved shirt, pants, a wide-brimmed hat, and sunglasses, where possible.
  3. 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.
  4. Protect children from sun exposure by playing in the shade, using protective clothing, and applying sunscreen.
  5. 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.
  6. 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 in 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. Skin cancer is very treatable when caught early.

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 is growing.

There are several different kinds of warts including:

  • Common warts
  • Foot (Plantar) warts
  • Flat warts

How do you get warts?

Warts are passed from person to person, sometimes indirectly. The time from the first contact to the time the warts have grown large enough to be seen is often several months. The risk of catching hand, foot, or flat warts from another person is small.

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

Some people get warts depending 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. Some people are just more likely to catch the wart virus than are others, just as some people catch colds very easily. Patients with a weakened immune system also are more prone to a wart virus infection.

Do warts need to be treated?

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.

Common warts

Warts may also be treated by “painting” with cantharidin in the dermatologist’s office. Cantharidin causes a blister to form under the wart causing it to peel away as it heals.

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

Many warts require more aggressive treatment with laser treatments. The laser uses light thearapy to target the blood supply of the wart to destroy it. Warts on the hands and feet often required this form of treatment.

Flat warts are often too numerous to treat with methods mentioned above. As a result, “peeling” methods using daily applications of salicylic acid, tretinoin, glycolic acid or other surface peeling preparations are often recommended. For some adults, periodic office treatments for surgical treatments are sometimes necessary.

What about the problem of recurrent warts?

Sometimes it seems as if new warts appear as fast as old ones go away. This may happen because the old warts have shed virus into the surrounding skin before they were treated. In reality new “baby” warts are growing up around the original “mother” warts. The best way to limit this is to treat new warts as quickly as they develop so they have little time to shed virus into nearby skin. Often multiple treatments are needed to insure the treated wart has resolved completely.

Birth Marks

Venual Malformations (Port Wine Stains) are always present at birth and can range from pale pink to dark purple in color. In the past these lesions were erroneously called “capillary hemangiomas.” Port Wine Stains occur in .3% of births and occur equally among males and females.

The 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 and blood will pool or collect in the affected area. The result will be a visible birth mark.

Dr. Hopkins treats birthmarks and hemangiomas with vascular lasers.

Rosacea

Do you have any of the following signs or symptoms?

  • Tendency to blush frequently or easily.
  • Noticeable flushing when you consume hot drinks, spicy foods or alcoholic beverages.
  • A redness or flushing that is more pronounced during extreme hot and extreme cold weather.
  • Extreme sensitivity when hairspray touches your face or when you use certain facial products, such as soap, moisturizers or cosmetics.
  • Persistent redness in the center of your face that has gradually involved the cheeks, forehead, chin and nose. Your ears, chest and back may also be affected.
  • Visible tiny blood vessels and pimples, without blackheads, on or around a reddened area on your face.

These are all early indications of rosacea. 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, the expert in skin, hair and nail conditions, is key to successful treatment. Rosacea rarely reverses itself and may last for years. It can become worse without treatment or when self-treated.

Rosacea is 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. This redness may gradually spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be affected.

What Rosacea Looks Like

Tiny blood vessels, which many call spider veins, can develop. Some people see small red bumps. Usually appearing in crops, some of the red bumps may contain pus. Dermatologists call the pus-filled bumps pustules. If the bumps do not contain pus, they are called papules. These pustules and papules resemble acne, so people often refer to rosacea as adult acne. Unlike with acne, blackheads do not develop. Rosacea also can cause the affected skin to swell. Some over-the-counter treatments can worsen rosacea.

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 also can affect the eyes. About 50 percent of people with rosacea have eye involvement, also called ocular rosacea. This often causes dryness, burning, and grittiness of the eyes. Left untreated, ocular rosacea can lead to serious eye complications. Some over-the-counter treatments can worsen rosacea.

Treatment

To effectively manage rosacea, dermatologists usually recommend a combination of treatments tailored to the individual patient. This approach can stop rosacea from progressing and sometimes reverses 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 pustule 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 make up such as MD Minerals is also helpful due to the anti-inflammatory properties in the minerals.

Tips for Rosacea Patients

Many everyday things can cause rosacea to flare. Anything that causes a flare-up is called a trigger. To help patients decrease flare-ups, dermatologists often 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 (offers protection from UVA and UVB rays) sunscreen with 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 and cold temperatures. These can exacerbate rosacea. Exercise in a cool environment. Do not overheat. Protect your face from cold and wind with a nonirritating scarf or ski mask.
  • Avoid rubbing, scrubbing, or massaging the face.
  • 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. Fewer products are better.

Note flushing episodes. The above are common triggers, but what causes rosacea to flare in one person may not trigger it in another. By writing down what foods, products, activities, medications, and other things cause your rosacea to flare, you will learn your triggers.

Rosacea is 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. This redness may gradually spread beyond the nose and cheeks to the forehead and chin. Even the ears, chest, and back can be affected.

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. Psoriasis is 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 to 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 are a candidate for the latest systemic therapy. If you score 50 or more, call Dr Hopkins office today to schedule an appointment. Please print out your assessment and bring 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 that is known as allergic contact dermatitis.

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

Discovering the Cause

Careful review of the materials that your skin encounters everyday and at work is helpful in identifying the allergen. Most contact dermatitis is diagnosed by distribution of the rash. Sometimes the cause cannot be identified by history or physical examination and you may need PATCH TESTING.

Patch tests are a safe and easy way to diagnose contact allergies. Patch tests are different from injection or scratch skin tests because they test for different allergens. In patch tests, small amounts of the possible common allergens are applied to the skin on strips of tape and then removed after two days. A positive allergy test shows up as a small red spot at the site of the patch.

Common allergens include nickel, rubber, dyes, preservatives, medications, fragrances, poison ivy, poison oak, and related plants.

Treatment

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

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 and chemicals that cross-react with it. Your dermatologist can help you identify items
    to avoid.
  • Substitute products that do not cause reactions. Your dermatologist can suggest sources for these products.

Eczema

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

Pre and Post Op Surgical Procedures

  1. Discontinue aspirin, aspirin products, Plavix, all herbal products and all vitamins 10-14 days prior to the procedure. Coumadin should be stopped three days prior to procedure.
  2. Please check with your prescribing physician prior to stopping any medications.
  3. Avoid alcohol, ibuprofen products and NSAID medications 2 days prior to procedure. These include some arthritis medications and over-the-counter Motrin, Aleve, Naproxen, etc.
  4. You may start Arnica supplements and start drinking pineapple juice 1-2 days prior to the procedure. (Can purchase these at Fiesta Nutrition or any health food store).
  5. If you have a history of fever blisters, please contact our office so we can call in a Valtrex prescription for you to begin three days prior to your treatment.
  6. If you plan on taking narcotics/sedatative, please arrange for a driver.
  7. There could be bruising, swelling and redness after the procedure from 3-7 days.

*Results may vary by individual.