Acne occurs when the pores become plugged. Blackheads, whiteheads, pimples, and deeper lumps (cysts or nodules), occur on the face, neck, chest, back, shoulders, and upper arms. Acne can cause stress, affect self-confidence, and when it is severe and untreated, may lead to permanent scarring. To avoid scarring, early acne treatment is important. Treatment takes time. Trial and error is the honest approach. SkinSpeaks: Advancements in Dermatology|Spa M.D. has an arsenal of acne treatments because every patient’s skin responds differently. If your acne has not improved after 6 to 8 weeks, we may need to change your treatment.
Prescription topical antibiotics, retinoids, and benzoyl peroxide in the form of creams, gels, or lotions help unblock the pores and reduce bacteria that cause acne. These products may cause some drying and peeling, but are highly effective.
Chemical peels rapidly exfoliate the skin, allowing dead skin cells to shed more effectively. By keeping dead skin cells and excess oil from clogging the hair follicle, pore blockages (comedones) and pimples can be drastically reduced. Because the outer layer of the skin peels off after the treatment, it may also help to reduce acne scarring.
The effectiveness of chemical peels for acne seems to depend on the type of acne, the severity of the acne or scarring, and your skin type. Chemical peels generally work best on fair-skinned people because darker skin may be more prone to discoloration after the peel. If there's a history of keloids or excessive scarring in your family, you may not be a good candidate for a chemical peel.
People with blackheads and other non-inflammatory blemishes often find regular facials help reduce the amount of breakouts they experience. An acne facial is a deep-cleansing facial, which generally incorporates a combination of thorough steaming, deep cleansing, extractions to remove pore-clogging sebum, and a healing mask and moisturizer. Salicylic and glycolic acids aimed at managing and thwarting acne flare-ups are often utilized. By extracting these impactions, the pores are cleared of excess oil and cellular debris. Blemishes are less likely to form. Best results are achieved and maintained if acne facials are performed regularly—every 4 to 6 weeks.
Kenalog (cortisone) injections can be done to get an acne flare up under control quickly. Injection into individual inflamed acne cysts will rapidly improve individual blemishes within 24-48 hours. Kenalog injections are available in our clinics if you have an outbreak at a sincerely inappropriate time and need to have your skin at it’s best in a hurry.
Antibiotics, such as Tetracycline, Doxycyline, Minocycline, or Bactrim, may be taken orally. Medication is often prescribed for moderate or severe cases, especially when acne is seen on the back or chest.
Photodynamic Acne Treatment
Photodynamic therapy is used to treat resistant acne as well as older acne scars, leaving skin smoother. A topical photosensitizing agent called Levulan (aminolevulinic acid) is applied to the skin, then activated with specific wavelengths of light.
The Levulan agent targets all acne glands and acne rosacea (redness) on the skin. This treatment decreases skin oiliness, and the appearance of pores is minimized. 3-4 treatments are recommended at 2-3 week intervals to obtain optimal results. Because PDT is a topical procedure, there are no systemic side effects.
Fraxel Dual Laser
The Fraxel Dual is the leading and only technology considered a pigment solution for patients suffering from melasma, post inflammatory hyperpigmentation (PIH), and significant sun damage. Groundbreaking pigment eradication – reaching the depth of 1927nm, referred to as Thulium, eliminates pigmentation. Plus, the Fraxel Dual has a built in cooling device that works simultaneously during treatment to offer more comfort.
Spironolactone (an anti-androgen) medication is used to target hormonal-related acne in females. Androgens stimulate the production of oil which creates a favorable environment for the bacteria that causes acne to grow. By decreasing androgens, oil production is decreased and, as a result, improves acne.
Isotretinoin (formerly known as Accutane) is used for acne that does not respond well to other treatments. Patients require education on the side effects of isotretinoin. Monthly follow-up visits are necessary to monitor side effects. This drug can cause severe birth defects if taken during pregnancy.
Eczema and dermatitis are terms used interchangeably to describe specific kinds of inflamed skin conditions. Signs and symptoms include red, blistering, oozing, scaly, brownish, or thickened skin accompanied by itching. Eczema is a chronic skin condition that requires proper diagnosis and treatment from an experienced dermatology provider.
Early treatment is recommended to help prevent the disease from becoming worse. The more severe eczema becomes, the more difficult it is to control. A dermatology provider will create a treatment plan tailored to the patient’s needs. Medicine and other therapies may be prescribed as needed to:
Reduce skin inflammation (redness and swelling)
Loosen and remove scaly lesions
Reduce new lesions from forming
Many effective therapies are available to treat the different types of eczema. With proper treatment, most eczema can be controlled. Types of Eczema/Dermatitis include:
The most common type of eczema, atopic dermatitis, is frequently described as “the itch that rashes” and is often associated with asthma or seasonal allergies. Itching can become so intense that people often have trouble sleeping through the night. Atopic dermatitis is most common in children and many people outgrow it by early adulthood.
Contact with everyday objects — from shampoo and jewelry to food — causes this very common type of eczema. When the contact leads to irritated skin, the eczema is called irritant contact dermatitis. If an allergic reaction develops on the skin after exposure, the eczema is called allergic contact dermatitis.
Usually beginning on the scalp as oily, waxy patches, this common type of eczema (also known as dandruff) sometimes spreads to the face and beyond. A severe case, while rare, produces widespread lesions. Like most types of eczema, seborrheic dermatitis tends to flare in cold, dry weather.
Developing in the lower legs, this common eczema occurs when circulation becomes sluggish. Poor blood flow causes fluids to build up, and the legs swell. Over time, this build up of fluids affects the skin, causing a rash that usually itches, painful sores, as well as thinning and discolored skin. Effective treatment involves treating not only the dermatitis but the circulatory problem as well.
Imagine an itch so intense that no amount of scratching brings relief and you have some idea of what it feels like to have neurodermatitis. This common eczema develops when nerve endings in the skin become irritated, triggering a severe itch-scratch-itch cycle. Common causes of nerve irritation include an insect bite and emotional stress.
Some low-potency corticosteroid creams are available without a prescription, but you should always talk to a dermatology provider before using any topical corticosteroid. Side effects of long-term or repeated use can include skin irritation or discoloration, thinning of the skin, infections, and stretch marks on the skin.
You may need antibiotics if you have a bacterial skin infection or an open sore or fissure caused by scratching. A dermatology provider may recommend taking antibiotics for a short time to treat an infection or for longer periods of time to reduce bacteria on your skin and to prevent recurrent infections.
Oral antihistamines may help severe itching. Diphenhydramine (Benadryl) can make you sleepy and may be helpful at bedtime.
Oral Or Injected Corticosteroids
For more severe cases, your dermatology provider may prescribe oral corticosteroids, such as prednisone, or an intramuscular injection of corticosteroids to reduce inflammation and to control symptoms. These medications are effective, but can't be used long term because of potential serious side effects.
A class of medications called immunomodulators, such as tacrolimus (Protopic) and pimecrolimus (Elidel), affect the immune system and may help maintain normal skin texture and reduce flares of atopic dermatitis.
Light Therapy (Phototherapy)
The simplest and easiest form of phototherapy involves exposing your skin to controlled amounts of natural sunlight. Other forms of light therapy include the use of artificial ultraviolet A (UVA) or ultraviolet B (UVB) light including the more recently available narrow band ultraviolet B (NBUVB) either alone or with medications. However, long-term light therapy has many harmful effects, including premature skin aging and an increased risk of skin cancer.
Melasma (muh-LAZ-muh) primarily affects women. The symptoms of melasma are irregular patches of hyperpigmentation commonly found on the upper cheek, nose, lips, upper lip, and forehead. It also can appear on other parts of the body that get a lot of sun, such as the forearms and neck.
It is commonly associated with pregnancy, called the "mask of pregnancy." Birth control pills may also cause melasma. To see how deeply the melasma penetrates the skin, the dermatology provider may look at your skin under a device called a Wood’s light.
Melasma can often fade on its own when the trigger causing it is taken away (the woman delivers the baby or stops taking the birth control pills). However some women have melasma for years. For persistent and stubborn cases, the following treatments are available:
Fraxel Dual Laser
The Fraxel Dual is the leading and only technology considered a pigment solution for patients suffering from melasma and significant sun damage. Groundbreaking pigment eradication – 1927nm, referred to as Thulium, eliminates pigmentation. Plus, the Fraxel Dual has a built in cooling device that works simultaneously during treatment to offer more comfort
The Candela VBeam Perfecta pulsed-dye laser treats brown patches without damaging the surface of the skin. The micro-pulse technology provides visibly effective treatment without any open wound, facial crusting, "purpura," or laser bruising, so patients can walk out the door without embarrassing side effects. No anesthesia is required, and no skin irritating "topicals," ointments or gels are applied.
IPL (intense pulsed light) is a safe and effective treatment for unwanted pigmentation. Areas of the skin that carry excess pigmentation absorb the light energy during treatment and become damaged. Those areas will darken initially, and then the body’s natural healing process takes effect to eradicate the discoloration. A single treatment or a series of IPL treatments may be required for optimal results.
Topical application of products that include hydroquinone and tretinoin suppress melanin production and increase cellular turnover making them very effective at treating melasma.
Alternatively, product lines such as VIVITÉ® Vibrance Therapy offer equivalent efficacy without the potential side effects of hydroquinone. For women who are pregnant, products with azelaic acid and kojic acid may be moderately effective.
The approach to treating melasma with chemical peels should be slow and steady to minimize skin inflammation that can actually worsen the hyperpigmentation. Keeping up with light chemical peels performed monthly in combination with skin lightening creams and sun protection is the best way to manage melasma over time. Three main chemical peels are used to even out melasma:
Salicylic Acid Peels
Glycolic Acid/ Aha Peels
Retinoic Acid Based Peels
In addition to the peels listed above, a mask type treatment like Melanage contains a potent combination of skin lightening agents such as hydroquinone and kojic acid. This is less of a peel and more of a potent mask that is administered in the office with follow-up products for home use.
Rosacea is a chronic, inflammatory skin condition that affects adults. It causes redness in your face and produces small, red, pus-filled bumps or pustules.
Left untreated, rosacea tends to be progressive, which means it gets worse over time.
Most people experience rosacea in cycles. This means your rosacea signs and symptoms may flare up for a period of weeks to months and then lessen for a while before flaring up again. Besides acne, rosacea can be mistaken for other skin problems, such as skin allergy or eczema.
Rosacea usually appears in phases:
Rosacea may begin as a simple tendency to flush or blush easily, then progress to a persistent redness in the central portion of your face, particularly your nose. This redness results from the dilation of blood vessels close to your skin's surface. This phase may sometimes be referred to as pre-rosacea.
As signs and symptoms worsen, vascular rosacea may develop — small blood vessels on your nose and cheeks swell and become visible (telangiectasia). Your skin may become overly sensitive. Vascular rosacea may also be accompanied by oily skin and dandruff.
Small, red bumps or pustules may appear and persist, spreading across your nose, cheeks, forehead and chin. This is sometimes known as inflammatory rosacea.
In severe and rare cases, the oil glands (sebaceous glands) in your nose and sometimes your cheeks become enlarged, resulting in a buildup of tissue on and around your nose — a condition called rhinophyma (ri-no-FI-muh). This complication is much more common in men and develops very slowly over a period of years.
Though there's no way to eliminate rosacea altogether, patients often find a combination of the following treatment options provide relief:
Topical medications applied to your skin once or twice daily may help reduce inflammation and redness. They may also be used along with oral medications or as part of a maintenance program to control symptoms. Common topical medications include antibiotics (metronidazole), tretinoin, benzoyl peroxide and azelaic acid.
Dermatology providers may prescribe oral antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. Oral antibiotics are also prescribed because they tend to work faster than topical ones. Common prescription oral antibiotics include doxycycline, minocycline and erythromycin.
Isotretinoin is a powerful oral medication sometimes used for severe cases of inflammatory rosacea if other treatment options fail to improve symptoms. Usually prescribed for cystic acne, isotretinoin works to inhibit the production of oil by sebaceous glands. People who take it need close monitoring because of the possibility of serious side effects.
Candela Vbeam® Perfecta pulsed dye laser is the most effective solution for vascular rosacea. V-beam attacks red pigment in your skin, in other words the small dilated blood vessels and red spots that are a hallmark of rosacea. V-beam targets just the red pigment, while sparing the rest of the skin. The treatment only takes 15 minutes to experience relief.
Psoriasis is a chronic, autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells. Psoriasis is not contagious. There are five types of psoriasis:
Plaque psoriasis is the most common form, and appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells, called scale. Psoriasis can occur on any part of the body and can be associated with other serious health conditions, such as diabetes, heart disease and depression.
Guttate [GUH-tate] psoriasis often starts in childhood or young adulthood, after an illness. This form of psoriasis resembles small, red, individual spots on the skin. Guttate lesions appear on the trunk and limbs. These spots are not usually as thick as plaque psoriasis.
Inverse psoriasis is found in the armpits, groin, under the breasts, and in other skin folds around the genitals and the buttocks. This type of psoriasis first shows up as lesions that are very red and usually lack the scale associated with plaque psoriasis. It may appear smooth and shiny. Inverse psoriasis is particularly subject to irritation from rubbing and sweating because of its location in skin folds and tender areas. It is more common and troublesome in overweight people and people with deep skin folds.
Erythrodermic psoriasis is a particularly inflammatory form of psoriasis that often affects most of the body surface. It may occur in association with pustular psoriasis. It is characterized by periodic, widespread, fiery redness of the skin, swelling and redness accompanied by severe itching and pain.
Pustular psoriasis is characterized by white pustules surrounded by red skin. The pus consists of white blood cells. It is not an infection, nor is it contagious. It may be localized to certain areas of the body–for example, the hands and feet. Pustular psoriasis also can be generalized, covering most of the body. It tends to go in a cycle–reddening of the skin followed by formation of pustules and scaling.
Treating your psoriasis is critical to good disease management and overall health. What works for one person might not work for another. So it's important to know the different treatment options and keep trying until the right regimen is found.
Topical medications are usually the first line of defense in treating psoriasis. Researchers believe psoriasis occurs when faulty signals in the immune system cause skin cells to grow too rapidly. Topicals slow down or normalize that excessive cell reproduction and reduce inflammation (redness) associated with psoriasis.
Corticosteroids ordinarily called "steroids," are the most frequently used treatment for psoriasis. Topical steroid medications are easy to use, work quickly and can be very effective in controlling mild to moderate psoriasis lesions.
Systemics are prescription medications that affect the entire body, and are usually reserved for patients with moderate to severe psoriasis.
Biologic drugs, or "biologics," are a relatively new class of treatment for psoriasis and psoriatic arthritis. They are given by injection. Biologics target specific parts of the immune system by blocking the action of specific immune cells or by blocking proteins in the immune system that are responsible for the development of psoriasis.
The herpes simplex virus (HSV) causes blisters and sores around the mouth, nose, genitals and buttocks, but can appear almost anywhere on the skin or mucous membranes. The predominant symptom of herpes is the outbreak of painful, itching blisters filled with fluid on and around the external sexual organs or, for oral herpes, on or very near the lip.
Many patients are able to anticipate an outbreak when they notice a warning sign (a tingling sensation, called a prodrome). Symptoms vaguely similar to those of flu may accompany these outbreaks. Painful urination and swollen and tender lymph glands in the groin are also possible.
Factors that can trigger an outbreak include stress, illness such as a cold, fever, fatigue, sunburn, menstruation or sexual intercourse. For patients with oral herpes and who have a history of cold sores, precaution should be taken when receiving certain cosmetic treatments. Laser treatments, dermal filler injections, and chemical peels can trigger an outbreak. The dermatology provider will prescribe an anti-viral treatment before or just following treatment to discourage any outbreak.
Herpes can be treated but not cured. The medication that will attack the virus while it lies dormant in the nerve cells will also damage the nerve cells. Treatment is available for acute outbreaks, which are anti-viral drugs such as Acyclovir, Valaclovir or Famcyclovir. Topical antiviral ointments also may be applied to prevent secondary bacterial infections.
Hyperhidrosis is a chronic medical disorder that results in excessive sweat production. Common areas where patients seek treatment are the palms of the hands, underarms, and the soles of the feet. This condition is a contributing cause of depression and frustration. Experiencing excessive sweating can be embarrassing and interfere with normal daily activities, both socially and professionally.
SkinSpeaks is excited to offer miraDry®
miraDry® is a safe, clinically proven, FDA-cleared solution for permanent elimination of underarm sweat and odor glands. miraDry is non-invasive and works by delivering precisely controlled electromagnetic energy to the underarm area. SkinSpeaks offers a new, highly effective one-time treatment method that elimates sweat and odor. miraDry is a sweat-stopping solution for all — from those with uncomfortably high sweat production, to those simply wanting to shelve the daily deodorant drill. This procedure has minimal to no downtime, and patients notice a reduction in sweat immediately after treatment. Want to find out more about miraDry? No sweat.
Drysol is a prescription only medication, which is moderately effective in treating hyperhidrosis. However it may cause severe skin irritation. Initial success rates are good but long-term results are less satisfactory.
Robinul is an oral medication that works by decreasing the of sweat glands. However, since the effects of this medication are not localized, side effects such as dry mouth, dry eyes, headache, and others are possible.
Botox Therapeutic treatment involves the injection of Botulinum toxin type A (Botox) under the skin below the dermis to reduce sweating. The injections temporally block the neurotransmitters that stimulate glands to produce sweat. Treatment results average 6 months. Botox® Therapeutic treatments may be covered by your insurance in very rare instances. Paperwork and criteria required by insurance companies may vary. SkinSpeaks: Advancements in Dermatology|Spa M.D. will happily assist you with this process.
Nail fungus infection starts when fungi reside in one or more of a patient's nails. The condition usually begins with a yellowish spot under the edge of a fingernail or toenail. The infection can spread and cause discoloration, thicker nails and crumbling of the nails. This condition can be exacerbated by certain environmental conditions and personal habits.
Nail fungus is often difficult to treat and patients can be prone to repeat infections. Non-prescription treatments options exist but most are ineffective. Treatment of nail fungus can take a few different forms.
Oral medications like Terbinafine, Fluconazole and Itracanazole can help grow new infection-free nails that replace the infected portions over the course of a few weeks. This method often requires an extended period of time (often months) to fully clear up the infection symptoms.
Sometimes, topical medications are prescribed for use in conjunction with oral medications. Anti-fungal lacquer such as ciclopirox can be applied to the nails once daily to treat mild - moderate infections. Unfortunately, lacquer requires diligent use for a long period and for curing infection, it has a relatively low rate of success.
Vitiligo is a skin condition characterized by the loss of melanin, which commonly results in a whitish patch on the skin surface. Melanin is a pigment that controls your skin color and hair color.
When the cells in the body that produce melanin die, vitiligo is the result. It is believed that millions of Americans have vitiligo, and it affects people of all races.
Treatment of vitiligo usually aims to equalize skin tone by restoring natural color or wiping out all the skin's pigment. The approach will vary depending on the patient's skin type and the severity of the condition.
Re-Pigmentation With Corticosteroids
These drugs include cortisone, and they work particularly well when applied early in the progression of the disease. A cream gets applied to the white patches of skin for a few months and results could be seen within several months.
Fading the skin to equalize the white areas is a practical option when more than half the body is affected by vitiligo. However, the result is permanent and can often result in skin that is overly sensitive to sunlight.
Earlobes are susceptible to stretching and tearing over time as a result of wearing heavy earrings or ear gauges and plugs. Naturally elongated or misshapen earlobes may also be reduced with earlobe surgery.
Earlobe repair surgery usually involves cutting away small areas of skin between torn or stretched earlobes and then sewing the two raw earlobe sections together in a straight line on the front and back of the earlobe. This allows the earlobes to heal and naturally close the previous wound.
The procedure to surgically repair or reconstruct the earlobes and may be performed in clinic with only local anesthesia. The entire earlobe repair procedure takes about 20 minutes per ear to perform. There is very little discomfort and downtime experienced after earlobe repair surgery. Patients can expect to see final earlobe repair results within 6-8 weeks.