Dermatology – Ask A Doctor

Expert Advice for Most Common Questions

Dermatology

  • How is Psoriasis diagnosed?
    Diagnosis begins with a thorough history in which the physician may ask about family members with psoriasis, recent stressful events or illnesses, and initiation of new medications.  Next, he/she will perform a physical examination of the skin, hair, and nails to look for red, white, or silvery raised areas of thick, dry, flaky skin on the elbows, knees, trunk, scalp and other areas as well as characteristic nail abnormalities such as thickening, indentations, discoloration, loosening of the nail beds. Finally, to confirm the diagnosis, a biopsy may be performed to look at a small sample of skin under the microscope.
  • What types of sarcoid skin disease are there?
    Skin manifestations occur in nearly one-third of patients with systemic sarcoid, but can occur without systemic involvement.  Erythema nodusum, one of the most common sarcoid skin findings (thought not specific for the disease), appears as tender, red nodules usually on the front of the lower legs.  Lupus pernio, which is sarcoid-specific, appears as reddish/purplish, hard, raised lesions on the nose, ears, cheeks, lips and fingers.  Other skin manifestations include scar-like lesions and ulcers.  Because sarcoid can mimic many skin conditions, diagnosis can be challenging. To learn more about sarcoid skin disease, visit us at Madison Medical Group.
  • What is the Skin Pen?
    The Skin Pen is a medical needling device used to induce skin injury and then rejuvenation by stimulating collagen to form and provide new, younger replacement collagen in acne scars, stretch marks, chicken pox marks, and as part of a rejuvenation regimen to provide tighter, plumper skin.  Cost varies between providers, but we recommend a physician supervise your medical needling.  A complete course of treatment involves 2-5 treatments and the application of skin growth factors to stimulate collagen.  Slight skin oozing/bleeding may occur but this is expected as part of the stimulation/induction regimen.  Please contact us if you are interested in this exciting new procedure.
  • What can be dome for sun damaged skin?
    There are number of treatments that can be used to improve appearance and remove unwanted sun blemishes and sun-damaged pre-cancerous skin lesions.  One of the most popular and extensive treatments is the “blue light” or photodynamic therapy.  This treatment involves using a light sensitizing drug and special light exposure to remove the unwanted skin changes.  This is only offered by physicians and should be done only in a supervised setting.  Please contact us to schedule an appointment for screening and further explanation to see if you are a candidate.  In some cases, treatment may be reimbursable from your insurance.
  • Why should I get BOTOX?
    BOTOX is used for the improvement of facial lines and wrinkles, which works effectively for up to 3 to 6 months. Treatment consists of several small injections. BOTOX paralyzes small muscles which smoothes out the overlying skin. Good areas for treatment include the areas between the eyebrows, the forehead, and around the eyes (the crow's feet). There are virtually no side effects after treatment when administered by experienced operators. The results generally produce a more youthful, relaxed, and rested appearance. The dermatologists at Madison Medical and Belle Meade Medical are experienced with Botox.
  • What is erythema chronicum migrans?
    Erythema chronicum migrans refers to the distinctive skin rash that develops in the early stages of Lyme disease, a bacterial infection spread by ticks.  The rash is often described as a “bull’s eye” because it appears as a small red patch surrounded by a ring of normal skin which is further surrounded by an expanding red ring. This rash usually appears about 7-10 days after the tick bite and may be accompanied by flu-like symptoms. If treated early, erythema chronicum migrans and other symptoms of lyme disease usually resolve; however, if left untreated, arthritis and neurological complications can occur.  Lyme disease is very rare in Mississippi unless you have traveled outside of the state to an endemic area (the Northeast and upper Midwest tick areas)
  • What drug lengthens eyelashes?
    Latisse is marketed as a new use of an old medication to elongate and thicken eyelashes in those of us who have thin eyelashes.  The drug is an old glaucoma medication known as bimatoprost, which was observed to produce longer, thicker eyelashes during glaucoma treatment.  There can be a few side effects that are usually mild and supervision under a qualified physician is in order, but the results with continued use are typically very satisfactory in improving the cosmetic appearance of the eyes.
  • What doctors get special training in skin diseases?
    Board certified dermatologists are specialty trained physicians to diagnose and treat skin disease.  Several other providers treat the skin or advertise that they are skin specialists, but board certified dermatologists are trained in skin, hair, and nail diseases and treatment have completed 3 years of training in an accredited residency and passed a certifying examination in dermatology (not other medical specialties).  While others may state they have special training, board certified dermatologists are the skin experts.
  • I have facial scarring from teenage acne, can you help me?
    Acne scars occur from the body’s response to acne lesions or to picking/squeezing/popping of the lesion (zit).  Patients with mild acne scarring are good candidates for microdermabrasion, which exfoliates skin and stimulates new cell growth.   Chemical peels, laser resurfacing, dermabrasion, and skin fillers provide safe and effective treatments for deep acne scarring.  Acne scars are unique in their appearance and may have complex tissue characteristics.  Patients should consult with their dermatologist to determine an individualized treatment plan for the most successful results.
  • What is photodynamic treatment (PDT or blue light) used for?
    The “blue light” therapy or photodynamic therapy is a special treatment in which a chemical is applied to the skin and a specific wavelength of light is exposed to the skin to remove sun-damaged/precancers as well as to improve the youthful appearance of the skin.  This treatment is also used to treat acne. The treatment is relatively safe, but the patient must avoid sun exposure for several days after treatment.  It is an FDA approved treatment for actinic keratoses (pre-cancers), may be re-imburseable by your insurance, but must be applied in a physician’s office.  Please contact us for your evaluation and treatment.
  • What are the best treatments for Rosacea?
    Rosacea, also known as adult acne, may present as persistent facial redness without pimples. The redness with or without pimples generally occurs on the central face (nose, cheeks, forehead, chin) of fair-skinned adults. Early cases of rosacea may present as a tendency to flush or blush easily, but can progress to persistent enlarged blood vessels on the face. This is a chronic condition, meaning that it cannot be cured, but it can be effectively controlled by treatment(s) prescribed by your dermatologist. Such treatments may include topical and/or oral antibiotics and laser surgery.
  • I am wrinkling up, what can I do?
    Avoid sun damage and smoke. Over the counter products and TV advertised products containing retinols, alpha hydroxyl acids, anti-oxidants and moisturizing agents may temporarily improve the appearance of lines and wrinkles.  Topical products containing vitamins C and E can help cells repair damage caused by sun exposure.  Prescription tretinoin, a substance in the vitamin A family, has been shown to reduce fine wrinkles, splotchy pigmentation, and rough skin.  Tretinoin cream 0.02% and 0.05% are the only prescription treatments approved by the FDA for these indications and can be obtained from your dermatologist.
  • I have hair in places I don’t want, help me!
    There are a number of medical therapies that lighten hair or temporarily remove it, but the most permanent method of removing unwanted hair is laser therapy.   Shaving, depilatories, electrolysis, and laser therapy can remove unwanted hair.  Laser hair removal may be the preferred treatment.  Our YAG laser is used for hair removal from unwanted areas such as the back and neck line in men and bikini line, stomach, chest, and face in women.  Consult with your dermatologist regarding the most specific and successful method for you.
  • I have been to several doctors with a rash that no one can diagnose what should I do?
    Rashes (dermatitis) have many causes including allergies, friction, prolonged exposure to heat or moisture, or contact with irritants such as chemicals.  Allergic contact dermatitis causes itching and blistering and is commonly caused by nickel (used in jewelry), preservatives, fragrances, and poison ivy and other plants.  Eczema or atopic dermatitis is described as the “itch that rashes” with patches of dry red skin with scales that sometimes becomes infected.  This rash occurs on the face, neck, and creases of the elbows, knees, and ankles.  Effective treatment includes proper skin care, avoidance of triggering agents, and medications and may require the input of a dermatologist for the most accurate and effective treatment.
  • Why do people itch?
    Itching, which dermatologists call pruritus, is the sensation that provokes scratching. It can be localized, generalized, constant or episodic. It is thought that something in the body triggers a release of a body chemical, such as histamine, that causes itching.  At this time of year, it is most likely due to dry skin.  However, itching can be a symptom of dermatologic disease or a systemic disorder. Examples of skin disease which result in itching are extreme dryness, atopic dermatitis, psoriasis, bug bites and hives. Systemic conditions associated with itching include diabetes, hepatitis, pregnancy, thyroid disease, and kidney disease. Severe itching should be evaluated by a physician.  Mild itching may be treated with OTC hydrocortisone and anti-itch lotions such as Sarna.
  • What are there alternatives for treatment of skin cancer?
    Although surgery is the most commonly used therapy for skin cancer, other treatments include radiation therapy and chemotherapy. The most recent intervention, however, is immunotherapy which involves stimulation of the patient's white blood cells to kill the cancer. Recent reports from the National Cancer Institute indicate that immunotherapy does have potential for the most deadly skin cancer, melanoma. The most common skin cancer is basal cell carcinoma, followed by squamous cell carcinoma. Imiquimod (Aldara), a topical cream, is currently FDA approved to treat basal cell carcinoma and actinic keratoses.  If you think you may have skin cancer (e.g. a new growth or one bleeding easily or forming an ulcer or changing in size, shape, color, or any other change), call your dermatologist for an appointment
  • I have discolored, thickened toenails, what should I do?
    We have had great success in the treatment of the condition you described which is termed onychomycosis, which is a fungal infection involving the nails and nail bed. This is the same fungus that causes Athlete's foot in individuals. Typically topical treatments do not help or only help temporarily.  The most effective treatment requires the use of oral medications (e.g Lamisil) over a 3-4 month period but you may need a specific diagnosis and close monitoring of laboratory (liver tests) for successful treatment without side effects.
  • What can lasers do for me?
    Laser Technology has brought us many new treatments over the past few years. The field is exciting and filled with rapid change. There are current therapies to remove pigmented lesions (such as brown spots on the back of hands), vascular lesions (such as facial blood vessels), tattoos, and even systems which remove unwanted hair (such as the bikini line).  There are also laser treatments for acne and acne scars.  Laser treatment may be performed by a physician or trained staff under the supervision of a physician.  All patients should be evaluated by a physician prior to any laser procedure to insure appropriate use of lasers and avoid erroneous treatment of cancerous lesions.  The Mississippi State Medical Board states that a physician should be present during laser treatments.  If you have any questions, see your dermatologist.
  • What is the most effective treatment for severe acne?
    Currently, the most effective treatment for severe acne, cystic and scarring, is isotretinoin (formerly known as Accutane) under the supervisions of a dermatologist.  While the side effect profile must be considered and it is a high risk medication that must be used cautiously; however, the results are typically outstanding. Consult with us today if you have additional questions regarding your acne and its treatment.
  • I have funny brown patches on my leg. My doctor said it might be due to my heater I use at my desk, could this be right?
    Yes, it is not uncommon to develop a red, brown lacy patch on a leg or a back from chronic heat exposure due to such items as space heaters, heating pads, heating blankets, heated car seats, and even lap tops.  The condition is called erythema ab igne, which means "from fire." The discoloration may fade if one discontinues use of the causative heat source.
  • What are topical chemotherapy creams and how are they used?
    Chemotherapy creams are topical medications used to treat precancerous and some cancerous skin growths.  Additionally, they may also be used to treat certain viral infections of the skin, such as warts and molluscum.  5-Fluorouracil, Imiquimod, diclofenac sodium and ingenol mebutate are some of the most common topical chemotherapy creams prescribed by dermatologists.  Some degree of irritation and redness of the skin are caused by the medication as it treats the precancerous or cancerous skin growths.  Additionally, sun sensitivity may occur during treatment and appropriate sun protection is advised.
  • What is scarring hair loss and is there a treatment for it?
    Scarring hair loss or “cicatricial alopecia” refers to the permanent destruction of the hair follicle resulting in an inability for new hair to grow.  There are numerous skin disorders that result in scarring hair loss and many of them are treatable.  However, there is no cure and once the hair is lost it cannot be brought back except in cases where hair transplant is available.   Scarring hair loss is usually diagnosed by a dermatologist with a skin biopsy.  The Cicatricial Alopecia Research Foundation website (www.carfintl.org ) offers more information for those interested. I have received pedicures and manicures for years will exposure to UV nail lamps cause cancer? A recent study from Brown University looked at the amount of UV radiation produced by UV nail lamps commonly used to dry manicures.  They determined the amount of radiation was insignificant over a lifetime and that these driers are safe.
  • What is Lamisil?
    Lamisil is an oral antifungal medication that that treats nail fungus and is taken daily for at least three months.  While taking this medication most physicians recommend having blood work performed to monitor liver function.   The majority of patients tolerate this medication well with no liver abnormalities.  There is talk out now about lasers used to treat nail fungus and while this might be new treatment option we believe this treatment technique needs more time to evaluate the outcomes and possible side effects.  Lamisil is still the mainstay treatment for nail fungus.  Not all “funky nails” are fungus nails, so a correct diagnosis is prudent.
  • Does diet play a role in acne?
    We have always been told "too much chocolate, coke, and chips will break out your face.  However there is little direct evidence linking particular foods to worsening of acne.  Recent studies have looked at milk especially skim milk and "chocolate binges" possibly contributing to increased number of acne lesions but the jury is still out. We currently do not recommend dietary changes but encourage a balanced diet.
  • Where do I go for a skin cancer screening?
    Skin cancer screenings are conducted every day by dermatologists.  To schedule a screening, simply call your dermatologist’s office and ask to schedule a full body skin exam.  Many dermatologists also offer free skin cancer screenings to the public.  Current estimates are that more than 3.5 million new cases of skin cancer will be diagnosed in the United States this year.  May is “Melanoma Awareness Month”, and is a popular time for these skin cancer screenings to be offered.  Check the American Academy of Dermatology website (www.aad.org) for more information on where to find a free skin cancer screening in your area.
  • Are birth control pills safe for teenage girls with acne?
    Although there are risks to all medications, births control pills are generally safe in most teenage girls.  Birth control pills can be a great treatment option for hormonal female acne, presumably by helping regulate the monthly cycle and the hormonal effects on oil glands that may lead to acne.
  • What are these warty growths I have on my back?
    Seborrheic keratoses are growths that can be found anywhere but are commonly found on the trunk.  They are sometimes called "barnacles" or "age spots" - we do not know why this are formed and they aren't sun related.  This benign growth can be removed, usually by liquid nitrogen spray.  Our new laser is very effective for facial lesions, the area will look red or brown and scaly for a few days to a week before the lesion peels and falls off. There is very little down time with treating these lesions and most patients have a great cosmetic outcome.  If you have brown spots you want removed please call our office for a consult today.
  • What is this flaky rash I have on my face and scalp?
    Although there can be many causes of flaky rashes one of the most common causes is seborrheic dermatitis.  This rash is thought to be caused by an overgrowth of yeast on the skin.  It is most commonly found on the scalp, ears, and nose and in the beard area for men –is slightly yellow and may itch.  Treatment options include cream or shampoos.  If the area is very red and inflamed, we may prescribe a mild steroid cream for short periods of time.  Over the counter, we recommend Selsun Blue or Nizoral shampoo to use daily for maintenance treatment.
  • I have red scaly patches on my face and arms are these skin cancers?
    Sometimes red scaly patches can be a sign of skin cancer however they can also be a sign of precancerous lesions called actinic keratosis.  Actinic keratoses are red scaly spots usually found on the face, arms, and hands.  They are caused by sun damage over time.  Most patients have multiple spots at one time.  These spots are important to treat because they have the ability to turn into squamous cell carcinoma if left untreated over time.  Treatment options range from liquid nitrogen to topical chemotherapy creams, or a light treatment called photodynamic therapy.
  • Is there any treatment for yellow thick nails?
    When the nails are discolored there can be many reasons, one of the more common reasons is a nail fungus.  This condition usually does not cause any health problems however if it is left untreated the fungus can spread to other toe nails and to the skin.  The nail usually appears thickened and yellow with debris underneath the nail.  Treatment options for nail fungus can range from topical medication to oral medicine.  The topical medicine is applied directly to the affected nail for six to nine months and the nail cannot be painted during that time. Laser treatment has been effective however we recommend a definitive diagnosis of fungus be made by a dermatologist before laser is instituted for yellow thickened nails.
  • What are the types of skin cancer?
    Basal cell and squamous cell carcinomas are the most common forms of skin cancer.  They occur on sun-exposed areas of the body (face, nose, lips, neck, and forearms).   Skin cancers may begin as a scaly area or a bump that persists, grows, and bleeds.   Early medical or surgical treatment may prevent disfiguring surgery or scarring.  There is a 97% cure rate with early detection.  Melanoma is a deadly form of skin cancer that appears as a dark blue/black irregular mole that may bleed. Melanomas can spread (metastasize) rapidly, so early detection is crucial.
  • Are tanning beds safer than "laying out" in the sun?
    No, any tanning may be harmful. Long-term exposure to ultraviolet (UV) radiation is known to cause skin cancer, including malignant melanoma. Both tanning beds and natural sunlight expose you to UV radiation. The only safe way to darken your skin is with the use of spray on tans or sunless tanners that are applied at home. It is important to know that darkening of your skin with these products does not protect you from sunburn. If you have had significant sun exposure, blistering sunburns, or have used tanning beds please see your dermatologist for a skin exam.
  • What is Latisse?
    Latisse is marketed as a new use of an old medication to elongate and thicken eyelashes in those of us who have thin eyelashes.  The drug is an old glaucoma medication known as bimatoprost, which was observed to produce longer, thicker eyelashes during glaucoma treatment.  There can be a few side effects that are usually mild and supervision under a qualified physician is in order, but the results with continued use are typically very satisfactory in making your lashes long for those long summer nights!
  • Can you help me with facial scarring from teenage acne?
    Acne scars occur from the body’s response to acne lesions or to picking/squeezing/popping of the lesion (zit).  Patients with mild acne scarring are good candidates for microdermabrasion, which exfoliates skin and stimulates new cell growth.   Chemical peels, laser resurfacing, dermabrasion, and skin fillers provide safe and effective treatments for deep acne scarring.  Acne scars are unique in their appearance and may have complex tissue characteristics.  Patients should consult with their dermatologist to determine an individualized treatment plan for the most successful results.
  • Do I have “spider veins” or varicose veins?
    Spider veins are formed by enlargement of small groups of blood vessels close to the surface of the skin and are commonly found on the face and legs.  Varicose veins are abnormally swollen and weak leg veins that may be painful.  The exact causes of spider and varicose veins are unknown but family history, pregnancy, obesity, and hormonal changes may be contributing factors.  Treatments include laser surgery that uses high intensity light to destroy the blood vessels.  Sclerotherapy utilizes injection techniques to eliminate the blood vessels.  Surgical phlebectomy (vein removal) may be required for large, severe varicose veins.
  • What is a Physician Assistant?
    Physician Assistants are mid-level medical providers that provide medical care in all areas of medicine.  PA's are trained in a master’s level program which normally last 28 months.  PA's see their own patients, write prescriptions and can perform procedures in the office such as biopsies and surgeries.  PAs always work as a part of the medical team with a physician, whereas nurse practitioners often work without a physician.  The quality of care provided by PAs and NPs can vary widely.  It is important to know the background and supervision of your health care provider.
  • How do I keep my nails healthy?
    Dermatologists treat nail problems.  Half of all nail disorders are caused by fungal infections.  Nail changes may also signal other disease such as liver and kidney disease, anemia, diabetes, or other illnesses.  Keep nails clean and dry, cut nails straight across with slight rounding in the center, wear proper fitting shoes dusted with antifungal powder.  Tight shoes may produce ingrown toenails.  Infected ingrown toenails frequently require antibiotic treatment.  If you get frequent manicures or pedicures, be aware of cleanliness and consider bringing your own instruments to avoid nail infections.  Elimination of nail fungal infections requires 3-6 months of prescription oral medication with close follow-up.
  • Can I prevent wrinkles?
    Wish we could, but not really and any cream or anyone saying they can is …  well not keeping it real.  However, you can delay their appearance and reduce their severity.  Avoid sun damage and smoke. Retinols, alpha hydroxyl acids, anti-oxidants and moisturizing agents may temporarily improve the appearance of lines and wrinkles.  Topical products containing vitamins C and E can help cells repair damage caused by sun exposure.  Prescription tretinoin, a substance in the vitamin A family, has been shown to reduce fine wrinkles, splotchy pigmentation, and rough skin.  Tretinoin cream 0.02% and 0.05% are the only prescription treatments approved by the FDA for these indications and can be obtained from your dermatologist.
  • How do I get rid of unwanted hair?
    Excessive hair in women typically begins during the childbearing years.  Excessive facial hair has been shown to cause low self-esteem, and may indicate  hormonal disorders.  Once serious medical conditions have been excluded, treatment may include oral contraceptives, spironolactone, lasers (which are specifically selected for skin with color), and elfornithine (Vaniqa) topical cream.  Shaving, depilatories, electrolysis, and laser therapy can remove unwanted hair.  Hair loss/baldness can be genetic or  associated with a number of medical disorders)  or genetics.  There are a number of medical (Rogaine, Propecia) and surgical treatments now available to grow hair.  Let us help manipulate your hair patches.  Consult with your dermatologist regarding the most specific and successful method for you.
  • What cosmetic procedures are available to improve appearance?
    Several treatments offered by dermatologists may improve appearance.  Microdermabrasion smoothes the skin.  Chemical peels remove the aged, discolored, and irregular outer skin layers.   Dermal fillers are injected into facial lines and wrinkles and produces a plump, youthful appearance.  Laser stimulates skin cell growth and a younger appearance.  Botulinum toxin (Botox) is injected into the skin to paralyze facial muscles causing frown lines, crow’s feet and other wrinkles.  Photodynamic or blue light therapy can remove unwanted pre-cancers and improve and appearance.  There are a variety of cosmetic surgery procedures to improve appearance, just be sure to check the background and experience of your provider before proceeding. If you looked in the mirror today and were scared  - or if mobs with torches and pitchforks are gathering outside your house, let us help!!  Belle Meade Medical has a variety of medical and cosmetic procedures combined with a broad array of experience to help you avoid that old joke “see you don’t have to get a mask for Halloween, you’re wearing it!”  Have fun, be safe, and let us help!!
  • What questions should I ask regarding cosmetic procedures?
    One of the most important factors when considering a procedure is to choose an experienced provider.  What are the doctor’s credentials?  Are they board-certified? Is the physician on the premises during the procedure? How many procedures has the provider performed? What results can be expected? What are the risks? What is the cost?  Answers to these questions should help you select the physician or provider that will produce the most successful and satisfactory results.  Seek several opinions to determine if the provider just wants your money or do they really care about making you look and feel better.
  • I think I have Psoriasis, what can be done for it?
    Psoriasis is a serious medical condition frequently associated with cardiovascular disease, hypertension, and diabetes.  There are several forms of psoriasis, but plaque psoriasis is the most common form.  Typically there are patches of raised, reddish skin covered with silvery white scale on the scalp, knees, elbows, hands and feet.  Treatment options include topical steroid or vitamin D-like compounds, light therapy, methotrexate, retinoids (Soriatane), and newer biologic drugs (etanercept, adalimumab and alefacept).  Laser therapy is also effective treatment for localized lesions.  As always, accurate diagnosis is the key to successful therapy.  Board certified dermatologists are the psoriasis experts.
  • Why should I choose a dermatologist to administer my cosmetic procedures?
    Dermatologists receive 3 years of skin specific training beyond medical school to become experts in skin, hair and nail disorders. Dermatologists have developed and introduced most of the innovative cosmetic procedures in the last fifty years. These include treatments for acne scarring, sun damage, wrinkles, fine lines, brown spots, Mohs micrographic surgery for skin cancer, dermabrasion, hair transplantation, chemical peels, laser surgery, sclerotherapy for leg veins, fat transfer, Botox, fillers like collagen, Restylane and Juvederm, laser resurfacing, facial rejuvenation, and vein treatments. While other physicians and non-physicians offere these treatments, shouldn't you trust your skin to the experts – the dermatologists?
  • What laser treatments are available for skin?
    Laser technology has brought us many new treatments over the past few years. The field is exciting and filled with rapid change. There are current therapies to remove pigmented lesions (such as brown spots on the back of hands), vascular lesions (such as facial blood vessels), tattoos, and even systems which remove unwanted hair (such as the bikini line).  There are also laser treatments for acne and acne scars.  Laser treatment may be performed by a physician or trained staff under the supervision of a physician.  All patients should be evaluated by a physician prior to any laser procedure to insure appropriate use of lasers and avoid erroneous treatment of cancerous lesions.  The Mississippi State Medical Board states that a physician should be present during laser treatments.  If you have any questions, see your dermatologist.
  • In winter I have itchy, flaky scalp and ears?
    This is most likely seborrheic dermatitis also known as cradle cap in early childhood?  This is an inflammation of the top layers of the skin.  Treatment may be simple with over the counter medications such as medicated shampoos and soaps.  More aggressive treatment includes anti-yeast medications and topical steroids or sulfur/sulfacetamide preparations.  Flare-ups may be triggered by stress, recent illness, and underlying medical conditions. It is generally a benign condition but can cause significant cosmetic distress.
  • I have thin, unattractive eyelashes, any suggestions?
    Eyelash extenders are available in some salons, but there is a newly improved drug known as Latisse, which is topically applied and with continued use thickens and elongates the eyelashes with very satisfactory cosmetic results.  This medication requires a prescription and in most situations should physician dispensed.  Please see us if you have questions regarding this exciting new treatment of those of us who are eyelash challenged!
  • My family doctor says I have rosacea, what should I do?
    Rosacea, also known as adult acne, may present as persistent facial redness without pimples. The redness with pimples generally occurs on the central face (nose, cheeks, forehead, chin) of fair-skinned adults. Early cases of rosacea may present as a tendency to flush or blush easily, but can progress to persistent enlarged blood vessels on the face and made be made worse by the sun. This is a chronic condition, meaning that it cannot be cured, but it can be effectively controlled by treatment(s) prescribed by your dermatologist. Such treatments may include topical and/or oral antibiotics and laser therapy available at Belle Meade Medical Dermatology.
  • I have excessively dry skin in the winter, do you have any suggestions?
    Yes. Bathing with mild soaps and cleansers, such as Dove, Cetaphil, Cerave, in addition to using mild, non-fragrant emollients.  Also, minimize hot shower time, moisturize heavily after bating.  Occasionally prescription medications such as Amlactin or low potency topical steroids are required.  Please see us if you have a resistant case.
  • Should I wear sunscreen in the winter?
    Sunscreen use is important for all seasons. The winter months may be times of significant UV exposure. For individuals heading to the mountains, the increased altitude reduces the amount of atmosphere that would normally absorb UV radiation. For this reason, individuals at altitude have a higher exposure to UV radiation and increase their risk of sunburn. For those going to snow covered areas, snow reflects UV radiation and increases UV exposure up to an additional 20%. While it is not as hot during the winter, there is sufficient UV radiation to cause burns if your skin is not protected
  • What are the most common drugs that cause skin rashes?
    The most common drugs to cause skin rashes are antibiotics, particularly the commonly used – tetracyclines and sulfur drugs.  Other medications commonly associated with skin rashes are diuretics (fluid pills), blood pressure medications, and oral hypoglycemic agents for diabetes, although the likelihood is low in an individual patient, dermatologists see these rashes more commonly because these drugs are frequently used and there are large number of hypertensive and diabetic patients.  A trial of stopping the offending medication in consultation with the prescribing physician is in order.
  • What are the differences between an actinic keratosis and a seborrheic keratosis?
    An actinic keratosis is a rough scale or horn-like patch found typically on sun-exposed areas of the skin.  Actinics are the result of sun damage and may progress to a squamous cell cancer.  Treatments for actinic keratoses include freezing and desiccation, topical prescription medications (such as Aldara or Carac), or surgical removal.  A relatively new treatment to treat multiple actinic is photodynamic “blue light” therapy.  Seborrheic keratoses are “stuck-on” wax-like appearing skin growths occurring primarily on the trunk.  They are not cancerous but may be removed due to appearance or irritation with bleeding.
  • What is melanoma?
    Melanoma, the most deadly form of skin cancer, tends to spread, making early diagnosis and treatment essential.  Melanoma may develop suddenly and without warning and can develop from a mole.  Occurring anywhere on the body, it is found commonly on the upper backs of men and the legs of women.  Melanoma is the most common cancer in young adults.  One American dies from melanoma every 62 minutes.  Diagnosis is made by biopsy.  Primary treatment is removal.  May is Melanoma Awareness Month, get screened today!
  • How can I tell if a mole I have a melanoma?
    Look for the ABCDEs.  In melanoma A stands for asymmetry. Draw an imaginary line down the center of the mole. If both halves created by this line are not similar, then the mole is asymmetric and worrisome. B stands for border irregularity. Are the borders of the mole fuzzy, notched or blurred? C stands for color change or multiple colors. D is for diameter of greater than 6 millimeters.  E is for evolution, if the mole is changing colors or size, this is abnormal. For moles with any of these features, visit a dermatologist for an evaluation.
  • What is the best insect repellent to use?
    The most effective insect repellents are those that contain Deet. Concentrations of 30% Deet are probably adequate for most adults and a concentration of 10% or less works well for most children. It is important to follow the proper use recommendations on the label of products containing Deet and to ask your pediatrician before applying Deet to children <2yrs of age. When using sunscreen, we recommend that the sunscreen be applied first followed by the insect repellent containing Deet. Combination products that contain both Deet and sunscreen are not advised, as sunscreen often needs to be reapplied more frequently than the repellent.
  • What can I do for poison ivy?
    Poison ivy is an allergic contact rash caused by the urushiol oil from sap of poison ivy, oak and sumac. This occurs by touching the plant, or touching something that has this oil on it like a pet or tool. The rash usually occurs within 12-48 hours after contact but may take two weeks to occur. Approximately 85% of people have poison ivy allergy. Poison ivy rash cannot be spread to another area or person unless the oil is spread. Urushiol oil can be eliminated simply by washing. The rash is best treated by prescription corticosteroids early in the course of the rash in addition to cool soaks and topical medications.
  • What can be done about excessive sweating?
    Excessive sweating is known as hyperhydrosis and most commonly affects the armpits, palms, and soles.  Over the counter drying agents (Certain-Dri) can be used or prescription strength agents (Drysol) may be required.  Oral medication such as Robinal may be tried.  Botox has been used very successful and is FDA approved to treat axillary (armpit) hyperhydrosis, is longer lasting, and may be covered by insurance.  Consult with your dermatologist to determine if you are a candidate for this treatment
  • What is the “blue light” therapy?
    The “blue light” therapy or photodynamic therapy is a special treatment in which a chemical is applied to the skin and a specific wavelength of light is exposed to the skin to remove sun-damaged/precancers as well as to improve the youthful appearance of the skin.  This treatment is also used to treat acne. The treatment is relatively safe, but the patient must avoid sun exposure for several days after treatment.  It is an FDA approved treatment for actinic keratoses (pre-cancers), may be re-imburseable by your insurance, but must be applied in a physician’s office.  Please contact us for your evaluation and treatment.
  • I have a number of unusual moles and freckles – should I be worried?
    Most moles and freckles are harmless – they make us unique.  Some moles or “freckles” occasionally change into pre-cancerous or cancerous lesions.  Patients with multiple moles that have unusual characteristics may have dysplastic nevus syndrome, a condition that has a high rate of conversion into melanoma.  Patients with excessive sun exposure may develop new skin changes that are actinic keratoses (scaly pre-cancerous lesions) or more serious squamous cell or basal cell cancers or melanomas.  Unfortunately, and in many cases, there is no substitute for an experienced dermatologist examination and biopsy to identify those patients at risk.
  • What are “liver spots”?
    Age spots or “liver spots” are flat, brown areas called lentigines, and have nothing to do with your liver, but are “liver” colored.  They are caused by sun exposure and appear commonly on the back of the hands but also occur on the face, back, chest, and the tops of the feet.  People who have a family history of age spots should avoid excessive sun exposure.  Treatments include topical prescription medications, freezing with liquid nitrogen, laser therapies, and chemical peels.  Contact us for an examination and institution of appropriate treatment.
  • Can you help me with facial scarring from teenage acne?
    Acne scars occur from the body’s response to acne lesions or to picking/squeezing/popping of the lesion (zit).  Patients with mild acne scarring are good candidates for microdermabrasion, which exfoliates skin and stimulates new cell growth.   Chemical peels, laser resurfacing, dermabrasion, and skin fillers provide safe and effective treatments for deep acne scarring.  Acne scars are unique in their appearance and may have complex tissue characteristics.  Patients should consult with their dermatologist to determine an individualized treatment plan for the most successful results.
  • How do spray tans work and are they safe?
    Sunless tans are a popular and safe way to “tan.”  According to the American Academy of Dermatology the best sunless tanning products contain an ingredient called DHA, this ingredient causes the dead skin cells to turn brown.  Those dead skin cells shed constantly so the color will fade over five to seven days.  DHA is not absorbed into the body and has no known toxicity.  DHA is cleared and regulated by the FDA and is a better alternative to the sun damage cause by repeated and excessive sun exposure.
  • Are getting mani/pedis safe?
    If you choose to get manicures or pedicures in a nail salon you may be at risk for nail fungus, bacterial infection, plantar warts, and viruses.  To decrease the risk of infection ask the nail technician how the instruments are cleaned and sterilized.  Also consider buying your own instruments to take to your appointment.  The cuticle is a nail protection barrier and should not be pushed back, which can cause damage and increase risk of infection or nail ridges.  Another way to increase safety is do not allow razor blades, callus graters, and cuticle cutters to be used on your nails.
  • Why does blonde hair turn green in the pool and can I prevent it this summer?
    Oxidized copper, not chlorine is what turns blonde hair green.  Oxidized copper can be high because of increased copper content in local water or because of pool water.  To prevent your hair from turning green, you can decrease exposure by decreasing time in the pool or protect it with a swim cap.  You can increase the protection by applying a conditioner the hair prior to applying the cap.  If you choose not to wear a swim cap you can decrease some risk by applying the conditioner prior to getting into the pool or rinsing the hair after each “dip” in the pool.  There are over the counter shampoos that contain ethylenediamene tetracetic acid (EDTA), these shampoos work to decrease the hair discoloration.
  • I have thin, unattractive eyelashes, any suggestions?
    Eyelash extenders are available in some salons and several eye lash serums OTC.  The Obagi skin care line now offers Nucil eyelash and eyebrow serums that are non prescription but dispensed through a medical office.  These serums promote growth of the eyelashes and brows.  In addition, the prescription drug, Latisse, is available and applied topically to elongate lashes.  Results are dependent on continued use but very satisfactory.
  • I think I have psoriasis, what can be done about it?
    Psoriasis can be a serious medical condition frequently associated with arthritis, cardiovascular disease, hypertension and diabetes.  There are several forms of psoriasis, but plaque psoriasis is the most common form.  Typically there are patches of raised, reddish skin covered with a silvery white scale on the scalp, knees, elbows, hands and feet.  Treatment options include topical steroids, vitamin D-like compounds, retinoids, tapinarof, roflumilast. Ultra violet light therapy has been and is still a viable treatment option for some patients. For more severe disease and psoriatic arthritis, systemic agents such as methotrexate or a biologic drug (etanercept, adalimumab, isekizumab, guselkumab, risakizumab, apremilast, and several others) are indicated with great clearance results of the skin manifestations.  Several of these medications are approved for children. Some blood work and monitoring may be needed.
  • What are topical chemotherapy creams and how are they used?
    Chemotherapy creams are topical medications used to prevent precancerous and some cancerous lesions.  5 Fluorouracil, imiquimod, diclofenac sodium, and Klisyri (tirbanibulin) creams may be used for varying lengths of time and will incite some degree of irritation and redness of the skin being treated.  Typically resolution of the skin cancer or precancerous lesion will occur with no scarring.  These creams are very potent and patients should be monitored closely during the treatment duration.
  • What can be done about excessive sweating
    Excessive sweating is known as hyperhidrosis and most commonly affects the armpits, palms, and soles.  Over the counter drying agents (Certain-Dri) can be used or prescription strength agents (Drysol) may be required.  Oral medication such as Robinal may be tried.  Qbrexza (gylcopyrronium cloth) is a prescription topical agent with good control of axillary sweating. Botox has been used very successful and is FDA approved to treat axillary (armpit) hyperhidrosis, is longer lasting, and may be covered by insurance.  Consult with your dermatologist to determine if you are a candidate for this treatment.
  • What cosmetic procedures are available to improve appearance?
    Several treatments offered by dermatologists may improve appearance.  Microdermabrasion smoothes the skin.  Chemical peels remove the aged, discolored, and irregular outer skin layers.   Dermal fillers are injected into facial lines and wrinkles and produces a plump, youthful appearance.  Laser stimulates skin cell growth and a younger appearance.  Botulinum toxin (Botox) is injected into the skin to paralyze facial muscles causing frown lines, crow’s feet and other wrinkles.  Photodynamic or blue light therapy can remove unwanted pre-cancers and improve and appearance.  There are a variety of cosmetic surgery procedures to improve appearance, just be sure to check the background and experience of your provider before proceeding.
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