Medical Dermatology

Spring Street Dermatology is a comprehensive medical, surgical, and phototherapy treatment center.  Our goal is to help each of our patients achieve healthy, beautiful skin through surveillance, individualized treatment and proper skin care.

OUR TREATMENTS INCLUDE:

Acne
Acne is a skin condition with blackheads, whiteheads, red pimples and cysts. It usually affects the face, but can also involve the upper body. Acne affects people of all ages and in some, can leave dark marks or pitted scars.

Acne in teenagers is caused by the hormone testosterone, which increases during puberty and stimulates sebaceous glands of the skin to grow, make oil and plug pores. In adults, acne may be related to hormones, stress, childbirth, menopause, or medications. Diet, specifically certain dairy products and high glycemic index foods, may exacerbate acne in some patients.

In general, if you are prone to acne, you should wash your face with a mild cleanser and warm water daily. Washing too much or too vigorously can make acne worse. Any products used on the skin should say “non-comedogenic” on the bottle. This means they do not contain pore-clogging ingredients.

Treatment for mild acne starts with topical antibiotics, retinoids (vitamin A based topicals), anti-inflammatory agents and benzoyl peroxide. Cortisone injections may be utilized to rapidly shrink cystic lesions (same day appointments available when needed). Acne surgery may be performed to extract black and whiteheads. In more severe cases, antibiotic pills are often prescribed. In some women, hormonal treatments may also be recommended. If your acne doesn’t respond or is extremely severe and scarring, oral isotretinoin may be utilized. For those who want to avoid taking medications, an alternative available at Spring Street Dermatology is Blu-U blue light based photodynamic therapy.

Actinic Keratoses
Actinic Keratoses are precancerous skin lesions that may progress into squamous cell carcinomas. They usually occur in fair skinned individuals after years of sun exposure. Typical actinic keratoses are sandpaper-like rough, red spots that are more easily felt than seen. Most often, they are found on skin that receives the most sun: the forehead, ears, neck, arms, hands, lower lip and bald scalps.

Prevention of actinic keratoses begins avoiding prolonged sun exposure and using sunscreen. These measures should start in childhood, as the sun damage responsible begins in early life.
Various modalities are used to treat actinic keratoses. Cryosurgery, or freezing involved areas with liquid nitrogen, is the usual treatment for patients with few lesions. For widespread actinic keratoses, we offer Levulan Kerastick™ photodynamic therapy, a light based treatment, to efficiently eradicate these potentially precancerous lesions. Other options for field treatment include topical chemotherapeutics and immunomodulators.

Alopecia Areata
Alopecia Areata is a condition in which patients get small round patches of hair loss that usually grow back on their own, or may persist for years. It can happen to anyone, but is more common in people with a family history of the disease.

In alopecia areata, the body’s immune system attacks the root of the hair for unknown reasons. While most people get 1 or 2 small patches on their head, a rare minority of people can lose all of their scalp (alopecia totalis) and body hair (alopecia universalis). Nails may get tiny pinpoint dents. Alopecia Areata is not associated with any systemic health issues, but people with the disease may be more prone to allergies, asthma, eczema, thyroid dysfunction and vitiligo.

Alopecia Areata usually gets better by itself, but the timing is unpredictable. While there is no cure, the most common treatment is injection of corticosteroids into the affected areas to speed hair recovery. Other therapeutic options are also available in specific cases and can be discussed at the time of your visit.

Atopic Dermatitis
Atopic Dermatitis is a type of eczema known as the “itch that rashes.” Between 10-20% of people in the world are affected and, in most cases, it begins to appear very early in life.

In young children, atopic dermatitis presents with itchy, red, scaling patches on the scalp and on the cheeks. By adolescence, eczema tends to move to the inner arms and the back of the knees, but can also affect other areas of the body. In adulthood, atopic dermatitis looks like dry, thickened, scaly skin.

While the cause of atopic dermatitis is not known, several factors are known to trigger or make it worse. In some children, for example, flares of eczema can occur after ingestion of specific foods. Other possible triggers include irritating soaps or detergents, wool clothing, jewelry and perfume. Atopic dermatitis tends to occur in people who are also prone to asthma and hay fever.

Patients with atopic dermatitis should adhere to the following “gentle skin care” guidelines:
1. Showering should be less than 10 minutes long only once daily with warm water, not hot.
2. Soap used in the shower should be mild and unscented.
3. After showering, pat dry and apply a mild, fragrance free moisturizer (either cream or ointment) to damp skin.
4. Use a hypoallergenic detergent to wash clothing, sheets and towels and avoid fabric softener.
5. Stay away from wool, perfume and body sprays.
6. Use a humidifier during dry winter months.

Treatment of atopic dermatitis usually begins with topical corticosteroids. Antihistamines may be used to decrease itch and enhance sleep, while antibiotics may be utilized if an infection is present. Allergy and patch testing may be a consideration in patients who also suffer from asthma, hay fever or sensitivity to products. Our office currently offers comprehensive patch testing using the 70 allergen North American Contact Dermatitis Group panel. For refractory or severe cases of atopic dermatitis, phototherapy with narrowband UVB is also available at Spring Street Dermatology.

Bed Bugs
Bed Bugs (Cimex lectularius) are blood-sucking insects that infest old furniture, box springs, mattresses and bedding. They come out at night to feed on human blood. As a result, skin reactions to the bites are usually found in the mornings on skin not covered by sleepwear. The rash appears as grouped, itchy, red or purple bumps, hives or even blisters. Because some people are not sensitive to the bed bugs, not everyone who is exposed gets the same skin reaction.

In urban areas like New York City, bedbugs have become so common that they are no longer associated with poor hygiene. If you suspect you have an infestation, you should check your bed in the middle of the night using a flashlight. Be sure to inspect all folds, seams and corner of your sheets, blankets, mattress and box spring. Bedbugs are 5-7 mm brown insects with a flat bottom and can be seen easily by the naked eye. If you find them, you must call an exterminator immediately. In the meantime, your dermatologist can prescribe topical corticosteroids to help with the symptoms.

Benign Growths
A variety of non-cancerous, or benign growths, can appear in the skin over time. The cause of these growths is poorly understood, however, some are associated with aging and others run in families. Treatment is generally not necessary, but removal is possible for cosmetic reasons or in cases where the lesion is irritating, increasing in size, causes pain or inflammation or might be suspicious.

Angiomas, also known as cherry hemangiomas, are harmless benign growths made of blood vessels. They are small, bright red, round growths that tend to appear in adults and may increase in number with age. Cosmetic removal can be accomplished with the pulsed dye laser.

Cysts in the skin can occur on the body (epidermoid cysts) or in the scalp (pilar cysts) when a region of skin invaginates and collects a cheesy material called keratin. Epidermoid cysts may appear yellow and have a central pore through which the material can be expressed. Pilar cysts are slightly deeper, so usually appear as movable bumps in the scalp. Cysts can become infected and require antibiotics. While treatment is not required, they can be easily removed with a small, in-office surgical procedure.

Milia are tiny epidermoid cysts. They appear most commonly as minute, yellowish bumps on the face. Milia do not require treatment, but can be easily extracted or electrodessicated (lightly burned) by your dermatologist.

Syringomas are small, 1-2 mm skin colored or whitish lesions commonly found around the eyes. They do not hurt, itch or grow but may increase in number over time. They can be treated with electrodessication (light burning).

Dermatofibromas are firm, pink or brown growths that are small (less than 1 centimeter) and will pucker or dimple when pressed. In a minority of patients,they can be slightly tender when touched. Dermatofibromas are thought to be a scar-like reactive process to bug bites or other skin trauma. Treatment options include surgical removal or cryosurgery (freezing).

Dermatosis Papulosa Nigra are small, darkly colored growths that commonly appear on the face, most commonly in skin of color. They are similar to seborrheic keratoses or skin tags and are likewise of no medical significance. Cosmetic treatment options include cryosurgery (freezing), currettage (scraping) or electrodessication (light burning).

Lipomas are soft, rubbery, 2 to 10 centimeter fatty masses that occur underneath the skin. They can occur randomly or may be associated with inherited syndromes or medications. Lipomas do not require treatment unless they are painful or increase in size. In most cases, removal can be accomplished with a small in-office surgery.

Seborrheic Keratoses are non cancerous skin growths that pop up anywhere and can sometimes be mistaken for warts. They are skin colored, brown or even black and have a pasted or “stuck on” appearance. Seborrheic Keratoses tend to run in families and become more numerous with advancing age. Unless many of them develop suddenly, there is no cause for concern. There is no cure for seborrheic keratoses and no way to prevent them, but there are several ways to get rid of them. Most often, they are treated with cryosurgery (freezing), curettage (scraping) and/ or electrosurgery (lightly burning).

Skin Tags are benign, skin colored or brown growths that are most commonly located on the neck, in the armpits or in the groin area. The cause of skin tags is thought to be friction. They are more common in people who are overweight or who have diabetes. Treatment is not necessary but removal for cosmetic purposes can be accomplished with surgery, cryosurgery (freezing) or electrosurgery (light burning).

Contact Dermatitis
Contact dermatitis is a type of eczema that occurs when something that touches skin causes a rash. It can happen immediately or appear up to several weeks later.

Irritant contact dermatitis is caused by a caustic substance or “irritant.” The reaction often happens right away and can sting or burn.

Allergic contact dermatitis, by contrast, occurs after several days to weeks after contact with the causative product. It is an immune reaction that itches rather than burns. Importantly, people can develop allergic contact dermatitis in response to commonly used products.

Both irritant and allergic contact dermatitis can be treated with avoidance, emollients and topical steroids. When the causative agent of allergic contact dermatitis cannot be determined, patch testing can be utilized.

Excimer
The excimer 308 nm wavelength light source is a targeted narrowband UVB (ultraviolet B) treatment option for localized eczema, psoriasis, and vitiligo. By targeting specific areas with an adjustable hand piece, light can be delivered to affected areas without exposing the whole body unnecessarily. This allows for the use of higher energy levels and access to hard to reach areas, such as the scalp.
Hair Loss
There are various types of hair loss with differing causes. Some examples include androgenic alopecia, alopecia areata, telogen effluvium, and scarring alopecia.

Androgenic alopecia, or hereditary balding, is the most common reason for hair loss. In men, this happens when the frontal hairline recedes and hair is shed at the top of the scalp. In women, the frontal hairline is preserved and hair loss occurs in a “fir tree” pattern along the central part. Treatment of androgenic alopecia includes vitamins, topical minoxidil, oral spironolactone and finasteride. A novel, alternative treatment option offered at Spring Street Dermatology utilizes platelet rich plasma (PRP) to stimulate hair growth.

Alopecia Areata is a condition in which patients get small round patches of hair loss. It can happen to anyone, but is more common in people with a family history of the disease. In alopecia areata, the body’s immune system attacks the root of the hair for unknown reasons. While most people get 1 or 2 small patches on the scalp, some people can lose all of their scalp (alopecia totalis) and body hair (alopecia universalis). Nails may get tiny pinpoint dents. Alopecia areata is not dangerous and poses no health risk, but may be associated with allergies, asthma, eczema, thyroid dysfunction and vitiligo. Alopecia areata usually gets better by itself, but the timing is unpredictable. While there is no cure, injection of corticosteroids into the affected areas may help speed hair recovery.

Telogen Effluvium refers to an increase in the amount of hair shedding, usually without discrete bald patches. This type of hair loss occurs in people who have had a significant stressor, such as illness, major surgery, thyroid disease, inadequate diet, low iron, medications, birth control pills, and traumatic events or cancer treatments. In most cases, telogen effluvium resolves without treatment after a few months.

Scarring Alopecia can occur as a result of inflammatory disorders, such as lichen planopilaris and discoid lupus, or after years of traumatic hair care practices. For inflammatory disorders, a biopsy may be done to confirm the etiology. Treatment focuses on stopping the spread of the inflammation. Hair care practices associated with scarring hair loss include dyes, tints, bleaches, relaxers, hot combs and permanent waves. Because there is scarring, recovery of hair may be difficult and, in some cases, not possible.

Hand Dermatitis
Hand Dermatitis (also known as hand eczema) is characterized by hands that are dry, chapped, red, scaly and fissured. Sometimes, there may also be small blisters underneath the skin’s surface. There are 3 types of hand eczema: Irritant Contact Dermatitis, Allergic Contact Dermatitis and Dyshidrotic Eczema. Hand eczema can occur in people of all ages regardless of gender.

Irritant Contact Dermatitis of the hands is caused by exposure to caustic products, such as soaps, detergents or harsh chemicals. This type of eczema occurs immediately after exposure to these products and is associated with a burning sensation. In general, anybody who is exposed to these irritating products can get irritant contact dermatitis.

In contrast, allergic contact dermatitis of the hands occurs only in predisposed individuals when they develop sensitivity to a product they have been using or have used in the past. Most patients with allergic contact dermatitis complain of itch rather than burning.

In dyshidrotic eczema, tiny blisters appear under the skin surface. This type of eczema is related to excessive water exposure or hand washing and is also characterized by itching.

In general, if you have hand eczema, you should limit hand washing and moisturize whenever possible. Any time you do wash your hands, make sure to use warm water and a very small amount of mild soap, then moisturize immediately, while your hands are still a little damp. When you are cleaning, handling food, gardening or washing dishes, you should wear white cotton gloves underneath vinyl gloves for protection. Rubber or latex gloves should be avoided. Hand eczema is not infectious or contagious. In some cases, patch testing (skin allergy) will be necessary to determine what you are sensitive to.

Treatment for hand eczema usually consists of topical corticosteroids, proper skin care and avoidance of triggers as discussed above. For patients who do not respond or cannot use topicals, Spring Street Dermatology offer excimer targeted narrowband UVB.

Herpes Simplex
There are 2 types of herpes simplex virus – I and II. Herpes Simplex Virus Type I usually causes cold sores, while Type II causes sexually transmitted genital ulcers.

Herpes infections present 2-20 days after contact with an infected person. Small painful blisters form on a red base, then burst leaving shallow ulcers which scab over. In general, a first episode can last between 7-10 days. However, the virus that causes the infection moves to the nerve cells where it enters a resting state. Recurrences vary among individuals but usually occur close to the area of the first episode and are preceded by a tingling, burning or itching sensation. Most people get type I infections from family members and close friends during childhood. Genital herpes is transmitted sexually.

To avoid transmitting the herpes viruses, it is necessary to avoid contact with active lesions or areas in which tingling, burning or itching occurs in a previously infected area. The herpes virus can be transmitted not only to others, but also to uninfected body parts. For those with genital herpes, condoms may help reduce the risk of transmission, but do not fully protect, as the virus may be on non-covered areas

Herpes virus outbreaks are generally annoying, but pose little threat to overall health. However, infections can be very dangerous if they involve the eye or if they occur in pregnant women, AIDS patients, people with cancer, organ transplant recipients and those with major illnesses. Swabs and blood tests may be done to confirm the diagnosis of herpes in certain cases. Antiviral therapy can be given as needed to treat outbreaks as they occur or as a daily dose for suppression.

Hirsutism
Hirsutism is the medical term for excess, male pattern hair growth in women. The cause may be high levels of circulating male hormone (testosterone) or increased sensitivity of hair follicles to the male hormone present. Some conditions associated with hirsutism include polycystic ovary syndrome, Cushing’s disease, tumors in the ovaries or adrenal glands and insulin resistance. Certain medications may also cause increased hair growth.

Management of hirsutism begins with blood work to check hormone levels. Any abnormal levels should be addressed by an endocrinologist (hormone specialist). Unwanted hair can then be permanently reduced using laser hair removal.

Hyperhidrosis
Hyperhidrosis means excessive sweating. In most people, it occurs symmetrically on specific areas of the body, such as the underarms, hands, feet or head. Hyperhidrosis can cause a great degree of emotional embarrassment and may affect the quality of a person’s life.

There are a variety of effective over the counter antiperspirants. A stronger formulation of the most common ingredient, aluminum chloride, is also available by prescription. For patients who do not respond to antiperspirants, botulinum toxin (botox) can be injected into the underarms, hands or feet to decrease the sweating. The effects of botox may last 3 to 6 months, at which time retreatment is necessary. For a more permanent solution, Spring Street Dermatology offers the miraDry™ procedure in which proprietary miraWave energy targets and destroys sweat and odor glands in your underarm.

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Lentigines (sun spots, liver spots)
Lentigines are small light brown spots that occur in sun exposed areas, like the back of the hands or face, and tend to increase in number with age. They are harmless, but must be differentiated from moles and skin cancers. Prevention begins with photoprotection from an early age. Treatment options for cosmetic purposes include topical medications, cryosurgery (freezing), trichloroacetic acid, laser and intense pulsed light.
Melasma
Melasma presents with brown patches on the cheeks, bridge of the nose, forehead and upper lip. It is most common in women of color and occurs more frequently in those with a family history of the condition.

The three major factors known to bring out or worsen melasma are (1) hormonal changes associated with pregnancy or birth control pills, (2) ultraviolet light from the sun or even from strong light bulbs and (3) skin irritation of any kind.

If you have melasma, the most important part of treatment is a daily sunscreen that protects against UVA and UVB with an SPF of 30 or higher. Irritating skin products should be stopped and alternatives to birth control pills should be considered. The mainstay of topical treatment is with bleaching creams that contain hydroquinone or with compound products that also include
a mild corticosteroid and a retinoid. In some patients, chemical peels and laser therapies may be recommended to accelerate improvement. It is important to remember that even minimal exposure to ultraviolet light can cause melasma to recur.

Molluscum
Molluscum contagiosum presents with skin colored bumps caused by a highly contagious virus. It is commonly encountered in school age children and, in adults, can also be spread by sexual contact. This virus easily spreads from person to person via skin-to-skin contact. Treatment of molluscum consists of destruction, surgical removal and/ or topical immunotherapy.
Nail Fungus
Nail fungus is also known as onychomycosis. It affects about 12% of all Americans, can run in families and is more common in toenails than in fingernails. Nails that are infected by fungus can appear thickened, discolored and may separate from the nail bed. Treatment of fungal infections usually requires oral anti-fungal medicines for 2-4 months. Improvement is very gradual due to the slow regrowth of nails. Topical options are available for select cases, but are not as reliable and may take longer to be effective.
Patch Testing
Patch testing is used for patients with dermatitis to find out whether substances coming into contact with the skin are causing or aggravating their condition. Potential causes of contact dermatitis include fragrances, preservatives, dyes, metals, plants and other chemicals. When an allergic patient comes into contact with an allergen they are sensitive to, they will develop an itchy eczema like rash that can appear anywhere from 2 days to 2 weeks later. This delayed onset makes identifying the causative agent of contact dermatitis very challenging based on history alone. In patch testing, small aliquots of potential allergens are applied to the skin of the back to replicate a localized allergic contact reaction. At the final reading, allergens that result in eczema are identified and instructions on avoidance are provided. Patch tests differ from skin prick tests, which are used to diagnose systemic allergy and are of limited use in dermatitis.
Perioral Dermatitis
Perioral dermatitis is a form of rosacea that presents with redness, peeling and small red bumps in the area around the mouth, nose or eyes. Most often, young women are affected. Perioral dermatitis may be caused or made worse by sunlight, corticosteroid creams and dental products that contain cinnamon or fluoride.

Treatment of perioral dermatitis usually consists of topical metronidazole and/or an oral antibiotic. While recurrences may occur, most patients achieve significant improvement within a couple of months of therapy.

Photodynamic Therapy
Photodynamic therapy (PDT) is a procedure that uses a photosensitizing drug (Levulan Kerastick™ – aminolevulinic acid HCl) to apply light therapy selectively to target precancerous lesions, acne and sun damage.

PDT can help clear actinic keratoses which are common premalignant lesions found in sun exposed areas. It is also very effective for moderate to severe acne. A series of treatments of PDT alternating with blue light alone can put acne into remission for months and even help with scarring. PDT can also help improve the appearance of sun damaged skin over time.

It is important to note that PDT makes the skin sensitive to sunlight for 48 hours after treatment. For patients with extensive actinic keratoses, significant redness and peeling can occur after treatment and last for up to a week.

Phototherapy
Phototherapy, or light therapy, involves exposing the skin to ultraviolet light on a consistent basis and under medical supervision. Present in natural sunlight, narrowband ultraviolet B (nbUVB) is a small range of ultraviolet light that effectively treats inflammatory skin diseases such as psoriasis, eczema, vitiligo, pruritus/ prurigo, polymorphous light eruption, mycosis fungoides and lichen planus. Candidates for phototherapy are patients who do not respond to topicals or who have wide areas of affected skin. Phototherapy is safer than systemic therapy and can be used in pregnant women. Most people require approximately 30 sessions for optimal results. For resistant, localized skin disease, Spring Street Dermatology also offers targeted excimer phototherapy.
Pityriasis Rosea
Pityriasis Rosea is a common rash that usually begins with a single, large scaly pink patch on the chest or back (the ‘herald patch’). Within a couple of weeks, additional lesions appear, often in a formation that looks like a Christmas tree over the back. In some patients, the rash can be more widespread and itchy.

The cause of Pityriasis Rosea is thought to be a virus. It does not seem to be contagious and is not associated with any internal disease or allergy.

Pityriasis Rosea most commonly occurs in the spring and fall. It can last from several weeks to several months and usually resolves by itself without scarring. Treatment is not necessary in most cases, but topical corticosteroids and ultraviolet light may be used to decrease itch and speed up resolution in some cases.

Psoriasis
Psoriasis is a chronic skin disorder characterized by raised lesions with silvery scale that most often occur on the scalp, elbows, knees and lower back. It can range from a very mild, hardly noticeable rash to a severe eruption that covers large areas of the body. In some patients, psoriasis causes nail changes and joint pain (psoriatic arthritis). Psoriasis affects 2% of people and is not contagious, but may be inherited.

The cause of psoriasis is not fully understood but has to do with a hyperactivity of white blood cells (T-cells) that trigger inflammation in the skin and cause increased turnover. The skin starts to “pile up” in certain areas resulting in the lesions of psoriasis. Flares of psoriasis may occur in the winter, during times of stress, after trauma to the skin (this is called a Koebner Phenomenon), after an infection like strep throat, and with certain drugs such as beta-blockers, lithium and anti-seizure medications.

Treatment of psoriasis depends on a patient’s overall health, presence of joint pain and severity of skin involvement. In mild cases, topical corticosteroids and vitamin D analogues are prescribed. Targeted excimer or full body narrowband UVB is usually helpful for those with more resistant or extensive skin disease. For patients who do not respond to phototherapy or who have psoriatic arthritis, immunosuppressive and biologic medications are an option.

Psoriasis is not curable, but is controllable. No single approach works for everyone. Therapy is individually tailored and based on your health, goals and a careful assessment of potential risks and benefits of treatment.

Ringworm
Ringworm is a very common fungal infection of the skin or hair. When ringworm occurs on the body, it is called tinea corporis. On the scalp, it is tinea capitis. Ringworm is contagious and can be picked up from direct contact with an infected person, pets or contaminated objects, such as combs, brushes, hats or scarves. Poor hygiene and excess sweating can make it easier for people to catch ringworm.

On the skin, ringworm appears as an itchy, red, ring-shaped patch with scale around the edge. On the scalp, it may appear as scaly patches of hair loss. Scalp ringworm, or tinea capitis, is more common in children. The hair loss is not permanent. Once the fungal infection is treated, the hair should grow back normally.

Ringworm is treated either with anti-fungal creams or pills. Sharing of clothing, towels, brushes, hats and scarves should be avoided until treatment is complete.

Rosacea
Rosacea is a common skin disease that causes redness and red pimple-like breakouts on the face. It begins with a tendency toward “flushing and blushing” and may then progress to a persistent redness of the central face. With time, small blood vessels and tiny pimples appear, but there are no black or whiteheads (open or closed comedones). Rosacea is most common in fair skinned adults between the ages of 30 and 50. Triggers include hot drinks, spicy food, caffeine, alcohol, extreme temperatures, alcohol based skin products and sunlight.

Treatment of rosacea includes a variety of topical medications, washes and antibiotics. Laser therapy, called pulsed dye laser (PDL) can effectively treat telangiectasias and intense pulsed light (IPL) can reduce redness.

Scabies
Scabies is an infestation of tiny mites that burrow under the skin. Within weeks, an allergic reaction with severe itching occurs. Itching is usually worst at night. On the skin, little red bumps develop in the skin folds, between the fingers, around the belt line and in the genital region.

In most cases, scabies is contracted from a close contact. Diagnosis can be made clinically or with a skin scraping. Most commonly, Permethrin Cream and/or Ivermectin tablets are prescribed. Treatment of everyone in the household is required to get rid of the infestation.

Seborrheic Dermatitis
Seborrheic dermatitis usually appears as a red, scaly, itchy rash on the scalp, in the eyebrows and on the sides of the nose. In infants, seborrheic dermatitis is called cradle cap. Cradle cap usually resolves on its own within the first year of life. In older individuals, seborrheic dermatitis may occur more commonly in hospitalized patients, those in nursing homes and those with nervous system or immune system diseases.

Gentle shampooing with a mild product can be helpful for children with cradle cap. Seborrheic dermatitis in adults is treated with a topical anti-fungal or steroid creams in addition to medicated shampoos. When seborrheic dermatitis overlaps with scalp psoriasis, excimer narrowband UVB can be a helpful adjunct to topical therapy.

Skin Cancer
Skin Cancer is the most common type of cancer in the United States. Light skinned individuals who burn easily are at greatest risk. The 3 most common types of skin cancer are: Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma.

Basal Cell Carcinoma is the most common type of skin cancer in fair individuals. It is usually found on the head and neck, but may occur anywhere. Basal Cell Carcinomas rarely metastasize (spread) but may cause damage to tissue as they grow.

Squamous Cell Carcinomas are primarily found in fair individuals but are also the most common type of skin cancer in skin of color. Typically, they are located on the head and neck in light skinned people and on the leg in darker skin types. Patients with actinic keratoses are at higher risk of developing squamous cell carcinomas. Because squamous cell carcinomas have greater
potential to metastasize than basal cell carcinomas, early treatment is necessary.

Malignant Melanoma is a cancer of melanocytes, the pigment producing cells of the body, and is the most deadly type of skin cancer. Melanomas are usually pigmented and appear as irregularly bordered, asymmetric moles with mixed colors. Fair skinned individuals are at higher risk, but patients with dark skin are not entirely protected. During self-examinations, suspicious moles can be recognized using the ABCDEs of melanoma:

A is for asymmetry, meaning a mole is not the same on one side as the other
B is for border irregularity, which refers to a border that is not straight
C is for color variation, meaning more than one color in the same mole
D is for diameter greater than 6mm, roughly the size of a pencil head eraser
E, perhaps the most important, stands for evolution – a changing mole is a cause for concern.

For all types of skin cancer, prompt detection is the key to good outcomes. The cure rate for basal cell carcinomas and squamous cell carcinomas found and treated early approaches 95%. For melanomas, identification of lesions while they are still thin offers the best chance of cure. All patients should conduct periodic self-examinations of their own skin and should have a professional complete a skin physical at least once a year. Any suspicious lesion, especially ones that do not heal, grow, bleed spontaneously or change should be brought to the attention of a dermatologist.

Sun Damage
Repeated and prolonged exposure to the sun results in sun damage. Skin damaged by the ultraviolet rays of the sun appears mottled, with uneven pigmentation and redness from dilated blood vessels. Freckles and liver spots, or lentigines, become more numerous. Damage to the deeper connective tissue results in fine lines, wrinkling and loose, sagging skin.

Prevention of sun damage begins early in life with sunscreen, limiting sun exposure and avoiding tanning beds. Irregular pigmentation can be reduced with laser surgery or intense pulsed light. Botox and fillers can be used to address wrinkling and sagging skin.

Tinea Versicolor
Tinea versicolor looks like small, scaly, white, pink or brown spots and usually occurs on the upper arms, chest, back, neck or face. Because the fungus prevents the skin from tanning normally, the rash is usually most noticeable in the summer and on dark skin patients.

The cause of tinea versicolor is an overgrowth of yeast on the skin. This type of yeast favors the pores of oily skin and grows best in hot, humid weather. It is most common in teenagers and young adults, but can affect any age. A diagnosis of tinea versicolor is usually based on its clinical appearance.

Treatment of tinea versicolor is usually with topical anti-fungal creams or, occasionally, with oral medications. Shampoos that contain selenium sulfide or pyrithione zinc may also be recommended for use on the body. It is important to remember that the yeast is easy to kill, but it can take weeks to months to regain normal skin color.

Vitiligo
Vitiligo is a skin disease which presents as symmetric white patches, most commonly on the face, lips, hands, arms, legs and genitals. Half of those affected are under the age of 20, and 1 in 5 have a family member with the condition.

The cause of vitiligo is thought to be autoimmune, meaning that the body attacks its own pigment producing cells. Most patients with vitiligo are otherwise healthy. Occasionally, vitiligo may occur with other disease such as thyroid disease or alopecia areata.

The course and severity of pigment loss differ with each person. There is no way to predict how much color an individual will lose. In general, because of the contrast in color, vitiligo appears more obvious in patients with skin of color.

Treatment of vitiligo begins with topical corticosteroids and calcineurin inhibitors. For best results, at Spring Street Dermatology, we often utilize these agents along with full body or excimer targeted narrowband UVB.

Warts
Warts are noncancerous growths caused by an infection of the top layers of the skin by the human papilloma virus. There are several different types of wart and their appearance varies depending on their location.

Genital warts, known as condyloma accuminata, are sexually transmitted. They are usually skin colored, may be rough or smooth, and can appear on any area of the genital region. In women, some types of genital warts are associated with an increased risk of cervical cancer while, in men, perianal warts may carry a risk of squamous cell carcinoma. Careful follow up with a gynecologist or a proctologist, respectively, is necessary in these cases.

There are a variety of modalities utilized in the treatment of warts. Most commonly, warts are destroyed using cryosurgery (freezing), electrosurgery (burning), or application of an acid. An alternative approach is immunotherapy, in which the body’s immune system is triggered to fight the wart using a variety of agents (e.g. imiquimod, cantharidin, candida antigen). Regardless of the modality employed, repeat treatments are usually required.