Acne
Acne
Acne may be the single most common skin problem, and can occur at all ages.
There are 4 main causes of acne:
1) Oil
2) Blocked pores
3) Bacteria
4) Inflammation resulting from the buildup of oil and bacteria in the clogged pores
There are many ways to treat acne, including creams and lotions as well as oral medication. Dr. Gilman will thoroughly discuss with you all the options, and create a personalized skin care regimen that will help you achieve with your best outcome.
Actinic keratoses
Actinic keratoses
Actinic keratoses are precancerous growths that, if untreated, may progress to squamous cell carcinoma. Actinic keratoses are typically pink to red, flat, and rough or scaly on the surface. The presence of actinic keratoses shows that there is sun damage to the skin and indicates an increased risk for melanoma and non-melanoma skin cancers. Treatment of actinic keratoses may be performed easily at home with a prescription cream or in Dr. Gilman's office with a short, simple procedure.
Age spots
Age spots
Flat, light brown spots appear on sun-exposed skin of adults as a result of sun exposure over a person's lifetime. These are known as liver spots and age spots. These are benign growths but should be checked as part of an annual skin examination to ensure that they are not skin cancer. Treatment options include fading creams, chemical peels, and laser treatments. It is possible to decrease or prevent the appearance of future age spots by reducing sun exposure through the use of high-SPF sunscreens, protective clothing, and sun avoidance.
Alopecia areata
Alopecia areata
Alopecia areata is a condition where there is hair loss and the appearance of bald patches. It is an autoimmune disease that involves the hair follicles. It most commonly affects scalp hair but may involve body hair as well. The cause of alopecia areata is unknown, but there appear to be both genetic and environmental factors. Patients often have a family history of the disease, and the disease may appear or worsen with triggers such as stress or illness. Treatment typically involves a combination of topical medications (applied to the surface of the skin), injections of cortisone into the affected areas of skin, and sometimes oral medications.
Anti-aging
Anti-aging
The changes in the skin that are associated with aging have two main causes. One is our heredity, which we cannot change. The simple passage of time results in skin thinning, dryness, and wrinkling. There is overall volume loss and a face that was once full and round becomes flat and even hollow. These changes are independent of behavior and lifestyle, which are the second component of aging. Sun exposure, cigarette smoking, and poor diet are important factors that can accelerate skin aging. These habits lead to changes including skin roughness, broken blood vessels and skin redness, yellow discoloration, and even a pebbly texture to the skin.
Both types of aging can be addressed by Dr. Gilman. Topical (applied to the surface of the skin) retinoid creams, glycolic acids, and antioxidants help address the superficial signs of aging. Chemical peels exfoliate to reveal fresh, more vibrant skin. Lasers (VBeam® pulsed dye laser, Quantum intense pulsed light) treat redness, broken blood vessels, and brown spots. Botox and dermal fillers (Restylane®, Perlane®, Juvederm®, Radiesse®) help treat wrinkles, skin looseness, and loss of volume. Radiofrequency devices (Thermage) help to tighten loose or saggy skin.
Athlete's foot
Athlete's foot
Athlete's foot is a fungal infection of the skin called tinea pedis. It causes skin peeling and flaking between the toes or on the bottom or sides of the foot. Tinea pedis is most often treated with creams, but some cases may require the use of oral anti-fungal medications.
Basal cell carcinoma
Basal cell carcinoma
Basal cell carcinoma is the most common cancer in human beings, and is caused by exposure to ultraviolet light, usually sunlight. There are several types of basal cell carcinoma, but it usually appears as a small, pearly, skin colored or pink bump. It may look like a pimple that isn't healing, or it may be raised but blend in with the color of the skin. It may bleed easily. Basal cell carcinomas are typically slow growing tumors that spread outward through the skin and soft tissue, rather than spreading through the bloodstream to other parts of the body like other cancers. The danger lies mostly in the fact that they can become large, threatening nearby structures. Treatment is with surgical removal.
Broken blood vessels
Broken blood vessels
Over time, visible blood vessels may appear on the skin, particularly around the nose, cheeks, and chin. Sun exposure and smoking increases the likelihood and the number of these lesions, and people with rosacea have many more of these visible vessels. The best treatment for these "broken blood vessels" is with laser. The VBeam® pulsed dye laser removes these vessels in 1-3 treatments, depending on the number and severity. However, the laser treatment does not stop the causes of these visible vessels (aging, sun, smoking, etc). Over time your body will continue to develop new ones, eventually requiring additional laser treatments.
Cold sores/herpes simples
Cold sores/herpes simples
The herpes simplex virus causes recurrent lesions on the skin that can look like redness, blisters, and scabs. There is usually also some skin numbness or tingling in the involved area, which may be noticeable even before the skin rash appears. There are two types of herpes simplex viruses. Type 1 typically affects the mouth and lips and type 2 typically affects the genital region. Most adults will test positive for herpes type one in a blood test, but not everyone gets outbreaks. Once a person has herpes simplex the virus can recur, especially after stress, illness, or exposure to the sun. The breakouts are often in the same location. Treatment is with oral medication.
Dandruff
Dandruff
Dandruff is shedding or flaking of the skin on the scalp. The most common causes of dandruff are eczema and seborrheic dermatitis. The skin may be itchy and flakes may accumulate on the scalp, shedding onto the clothing. Dandruff is not contagious however it is a chronic problem. That means that while it can be controlled with shampoos and lotions, it cannot be cured and the symptoms may recur.
Dry skin
Dry skin
The skin functions as a barrier, and when it gets dry its ability to function properly is impaired. Dry skin can be itchy, and is more likely to get irritated by simple things like clothing or soap. To prevent or treat dry skin, apply body lotion or moisturizer within 2 minutes of getting out of the bath or shower. Many people may need to moisturize a second or even a third time during the day, especially in the winter. Some people have thick skin flakes that do not get better with typical body creams. In these situations lotions with glycolic acid are used to help exfoliate the skin while keeping it hydrated. However, if you have red or itchy skin, you may need to see Dr. Gilman for prescription medication.
Eczema/Atopic dermatitis
Eczema/Atopic dermatitis
Eczema is a common disorder where there is inflammation of the skin characterized by redness, itching, and skin flaking. There is often a family history of the disease, and it has a tendency to recur. Eczema may occur anywhere on the body. Eczema flares may be provoked by stress, illness, and dry skin. People with eczema have more sensitive skin and may not tolerate fragrances or fragranced products. Most eczema is treatable with creams and lotions, however more severe cases may require oral medication.
Hair disorders
Hair disorders
Hair is located all over the body except for the lips, palms of the hands, and soles of the feet. Hair has a growing phase and a resting phase, which are separated by a brief intermediate phase. After the resting phase the hair is shed from the follicle. Normally, between 20 and 100 hairs shed from the scalp every day. There are many types of hair disorders. Some involve an undesired decrease in hair while others show an undesired increase in hair. The problem may be the hair follicle itself, a scalp disorder that involves the hair, or a problem within the body that causes changes in the hair. Most hair disorders are not dangerous, but are of cosmetic concern and therefore may cause great anxiety.
Hives
Hives
Hives (urticaria) are pink, raised, itchy patches of the skin that indicate an allergic reaction. The reaction may be to something eaten, inhaled, injected or that was applied to or came into contact with the surface of the skin. They may appear immediately or may take several hours to develop. New hives may appear, and last anywhere from 30 minutes to 2 days, while the old ones disappear. They can be the size of a pinpoint or one foot in diameter. Most cases of hives last only several days to a few weeks, but sometimes they can persist for months or years. Any food or food additive or preservative can cause hives, but the most common food causes are nuts, shellfish, berries, and eggs. Medications and over-the-counter vitamins and supplements may also cause hives. Chronic hives (chronic urticaria) may be due to an auto-immune disease or a defect in the immune system.
Treatment involves finding and eliminating the cause, which may be very difficult to do. It is important to pay very close attention to everything in the environment in order to identify any potential triggers. Sometimes the cause is never known. Sometimes blood tests are required. Treatment typically involves the use of cortisone and antihistamines.
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Hyperhidrosis
Hyperhidrosis
Hyperhidrosis is a medical problem where people sweat excessively, particularly under the arms and on the hands. This problem can be debilitating and cause a great deal of anxiety and stress.
Botox is FDA approved to treat hyperhidrosis of the underarms. The treatment takes less than 30 minutes and can last for 6 months.
Impetigo
Impetigo
Impetigo is a bacterial infection of the top layers of skin. It is most commonly caused by Staph and Strep bacteria. If caught and treated early, it usually heals with no marks or scarring. Untreated, it can spread to the deeper layers of the skin and can be very dangerous. Treatment is with antibiotic ointments and creams, and more severe cases may require oral antibiotics.
Keloids
Keloids
Keloids are a type of scar where the tissue is large and raised, and extends beyond the borders of the original injury. Keloids usually occur after trauma (a cut or a burn, for example) or a skin wound, but may occur after something as mild as acne or a bug bite. Keloids are common on the chest and shoulders, and may be seen on the earlobes after ear piercing. Keloids are usually pink to red, and may be itchy or painful. Treatment typically involves steroid injections and laser treatments, and even surgical removal. However, keloids have a tendency to recur after surgical removal.
Keratosis pilaris
Keratosis pilaris
Keratosis pilaris (KP) is a very common condition where the hair follicles are plugged with skin cells. The follicles feel rough and may look pink or red in color. It is most common on the backs of the upper arms, but may involve the cheeks, thighs, and buttocks. Treatment is with creams containing glycolic or lactic acid, and sometimes cortisone creams. Keratosis pilaris often recurs after treatment, but it usually improves over time.
Melanoma
Melanoma
Malignant melanoma is the most dangerous form of skin cancer. Every year there are more than 100,000 new cases of melanoma and 8000 deaths due to melanoma. Melanoma comes from the pigment-producing cells of the skin. It is curable through surgery if caught early, however it can be life-threatening if found or treated late. Melanoma is the most common cause of death from skin cancer.
The incidence of melanoma is increasing, but the survival rates are also increasing. Both of these statistics are likely due to increased awareness, increased surveillance, and improved detection. Early detection and treatment are the most important factors in surviving melanoma. The main cause of melanoma is damage to the skin through excess ultraviolet exposure from the sun or tanning beds. There are also genetic factors involved in melanoma, as not all melanomas are due to the sun and some occur on areas of the skin that have never been exposed to the sunlight. That is why it is very important to see Dr. Gilman for a yearly full skin examination.
Risk factors for melanoma include a family history of the disease, fair skin, blue or green eyes, and numerous moles, especially if they are atypical. A history of sun exposure, particularly blistering sunburns, is an important risk factor. Even one blistering sunburn during childhood doubles a person's lifetime risk for melanoma.
Signs to look for when examining your skin go by the acronym ABCDE:
- A stands for asymmetry: one half of the mole does not match the other half.
- B is for border: an irregular, blurry, or ragged border.
- C is for color: more than one color in the mole, a color that doesn't match any of the other moles you have, or a change in the color of the mole.
- D is for diameter: normal moles are usually smaller than 6 mm in diameter, which is the size of a pencil eraser.
- E is for evolution: a mole that is changing over time, that doesn't look the same as it used to.
Everyone should have a full skin examination at least yearly. It is also important to examine your skin at home and get familiar with your moles. You will be more likely to notice anything new or unusual, and early detection is the key to cure.
Melasma
Melanoma
Melasma is a common disorder where there is increased pigmentation of the skin, usually of the sun exposed areas of the face. It is most common in women with darker skin tones, and women who are on birth control pills, taking hormone replacement, or pregnant. The exact causes are unknown, but there are genetic factors at work and melasma is made worse by exposure to sunlight. It is very important for people with melasma to use sunscreen. Creams containing lightening agents ("skin bleach") may be helpful in treating melasma, as may chemical peels and laser therapy. However, melasma is difficult to treat and returns easily, especially after exposure to sunlight.
Moles
Moles
Most people think of moles as a small brown spot that they have had for their entire lives. However, moles may have a variety of different appearances. Only 1 in 100 people is born with moles, the rest of us develop our moles in the first 20 years of life. The largest number of moles will develop during puberty. In adulthood, most people continue to develop spots on their skin, but these are not necessarily moles. Moles can be light brown, dark brown, pink, or even skin colored. They have color because they are made of melanocytes, which are the pigment-producing cells of the skin. Moles typically start flat and may become raised over time. Some moles may disappear over time, and others may become more pronounced. Sun exposure usually causes moles to darken in color and increases the number of moles a person has.
Some moles are larger than usual and may appear irregular in shape or color. These are called dysplastic nevi. The tendency to develop dysplastic nevi may run in families, and the presence of dysplastic nevi may indicate that the person is at a higher risk for a type of skin cancer called malignant melanoma. People with more than 100 moles, or whose moles were present at birth, also have a higher risk of developing malignant melanoma.
Most moles are completely harmless. However, the changes that indicate cancer may be subtle and it is important to see Dr. Gilman for a full skin check every year. You should also perform a self-examination of your skin monthly, so that you will recognize any changes early.
Many people are interested in removing moles for cosmetic reasons. Most moles are easily removed by shaving them off or by cutting them out and stitching the area closed. The scars left after mole removal are usually minimal but there is always a risk of an unsightly scar, which looks worse than the mole did. Some people like to get rid of moles that are in a hairy area of the skin out of concern about shaving over the mole. Shaving can irritate a mole but does not make it turn cancerous. However, if the constant irritation is annoying, the mole can be easily removed.
Molluscum contagiosum
Molluscum contagiosum
Molluscum contagiosum is a viral infection of the skin. It is a benign condition and is not harmful or life-threatening. Molluscum contagiosum is most common in children but may occur in people of all ages. It causes skin-colored to pink bumps on the surface of the skin. The lesions are usually 1-2mm in diameter, but may grow to 1cm or larger. The virus is transmitted by direct contact with infected skin or through contact with towels or clothing that have been in direct contact with infected skin. Once a person has one lesion, more may appear because of skin-to-skin contact with the originally infected area.
While molluscum is not dangerous the lesions may itch, and they may become infected if the person scratches. Without treatment the lesions may persist for months or years before spontaneously disappearing. There are several methods of removing molluscum lesions, but all carry a risk of scarring. A liquid may be applied to the spot which causes a blister to form, or the spot may be removed by freezing or shaving it off the skin. There are some creams which may be helpful in some people, but the overall responses to these creams have been minimal. It is very important to prevent the spread of new spots. The affected areas should always be covered with clothing to prevent them from rubbing against uninfected, normal skin.
Nail fungus
Nail fungus
Nails are made of specialized skin cells and are hard because of the presence of a protein called keratin. Nails grow from a part of the finger called the nail matrix, which is located under the cuticle. The most common disease of the nails is infection with fungus or yeast: 50% of nail disease is due to these infections. Nail fungus is more common in adults than in children. There may be genetic factors that make some people more susceptible than others.
The infection involves the cells of the nail (the nail plate) and the toe or finger under the nail (the nail bed). It usually starts at the end or tip and over time spreads to involve more of the nail. The infection may eventually involve the entire nail plate and the entire nail bed. The nail plate may look yellow, brown, or white and may be thickened. There may be crumbly material underneath the nail.
If treatment is started while the infection is early and involves a small part of the nail, creams or liquids may be effective. However, many cases require oral antifungal therapy for complete clearance.
Poison ivy
Poison ivy
The rash seen after contact with poison ivy, poison oak, or poison sumac is an allergic reaction of the skin to contact with the oil of the plant. You can get the rash from direct contact with the plant itself, or from contact with clothing or with a pet that has been in contact with the plant. It is also possible to get poison ivy after burning the plants, when the particles go into the air and then land on the skin. The rash usually appears 1-3 days after contact with the plant, and new spots may appear over the course of several days. The oil can remain on pets and clothing and cause recurrences after each additional contact. Therefore, it is important to wash anything that may have been in contact with the plant. Treatment is with cortisone creams and oral steroids to alleviate the symptoms and speed the clearance of the rash.
Psoriasis
Psoriasis
Psoriasis is an inflammatory disease of the skin where the skin grows in very well-defined, thickened red patches with a scaly surface. Approximately 2% of Americans are affected by psoriasis of the skin, and 10% of those have psoriatic arthritis. Psoriasis is not contagious but does run in families. The precise cause is unknown, but there appear to be multiple genetic factors involved, combined with environmental triggers. Many people experience a flare after an infection, such as strep throat, during times of stress, or in the winter months. Some medications may cause a psoriasis flare.
Psoriasis most commonly affects the elbows, knees, and low back. However, any area of skin can be affected, as can the nails. While the scalp is often involved, it is uncommon for psoriasis to affect the face. Rarely, psoriasis involves most or all of the skin surface, which is a serious and potentially life-threatening situation.
Psoriasis can be treated with topical medications (applied to the surface of the skin). However, in people who have a large area of their skin involved, oral or injectable medications may be a better choice. There is no cure for psoriasis, and therapy is lifelong.
Rashes
Rashes
The skin is your body's largest organ. A rash is a change in the color or texture of the skin. It may have no symptoms or it may itch, hurt, sting, or bleed. It may affect only a small area or the entire body. Most rashes are harmless and require little or very mild treatment to clear. However, the skin is a reflection of the body's internal condition, and some rashes may indicate more serious problems. That is why it is important to have your rash evaluated by Dr. Gilman, especially if it is new or unusual.
Dr. Gilman is able to recognize subtle signs that differentiate one type of rash from another and combine those signs with the patient's description of its development in order to determine the problem. Often a skin biopsy is required to make or confirm the diagnosis. A skin biopsy is a simple office procedure where the area of skin is anesthetized and Dr. Gilman takes a small skin sample. That sample goes to the lab where it is looked at under a microscope, which allows for a more precise diagnosis.
Most rashes are treatable with topical medications (applied to the surface of the skin). Some go away quickly and do not come back, while others recur and flare over time.
Red spots
Red spots
Red spots may appear on the skin for many reasons. Some may be completely harmless but cosmetically bothersome, while others may indicate the presence of infection or an internal problem. Red typically indicates the presence of blood or of inflammation. Red skin spots may be due to infection or irritation, or may be due to collections of blood vessels within the skin. Dr. Gilman will evaluate your problem based on the location, size, and behavior of the red spots and determine the best course of action.
Ringworm/Tinea
Ringworm/Tinea
Ringworm is the common word for a fungal infection of the skin. When it affects the body it is called tinea corporis. Fungal infections of the feet are called tinea pedis and fungal infections of the hands are called tinea manum. These types of fungal infections may be transmitted directly by skin-to-skin contact, or they may be transmitted indirectly by contact with clothing, towels, etc that has been in contact with infected skin. A person who has a tinea infection may spread it to another part of their body through contact with the original infected location. It is also possible for animals and pets to transmit fungal infections to humans. Most tinea infections are treatable with topical medications (applied to the surface of the skin), however fungal infections of the nails or scalp usually require oral medication.
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Rosacea
Rosacea
Rosacea is a common skin condition that affects the skin of the face. It is often called "adult acne" but it is not acne. Rosacea is characterized by redness, flushing, acne-like bumps, and broken blood vessels on the skin. It most often affects the central face (cheeks and nose), but the forehead, chin, ears, neck and eyes may also be involved. Eye involvement may manifest as redness, burning, stinging, light sensitivity, or the sensation that something is in the eye. Rosacea is most common in people with fair skin but can occur in people of all skin types. It is unusual in children, and typically begins around age 30.
There are often triggers for rosacea that make the symptoms worse. These include extremes of temperature, hot food or beverages, spicy foods, sunlight, alcoholic beverages, and sometimes cosmetics. People with rosacea should try to identify the triggers that make them worse and take care to avoid those triggers. It is also very important for people with rosacea to limit their sun exposure by wearing sunscreen every day. Some sunscreen ingredients may actually be irritating, so people with rosacea should look for sunscreens that contain zinc oxide or titanium dioxide as the active ingredient(s). Mild facial cleansers should be used instead of soap, which may be irritating and exacerbate rosacea.
The treatment of rosacea depends of the symptoms that a person has. Most people are able to successfully treat their rosacea with topical medications (applied to the surface of the skin). However, some people may need oral medications in order to minimize their symptoms and reduce their flares. Oral medications may be used for a short period of time or for many months. The goal of treatment is to stop the progression of rosacea and reduce or eliminate flaring. However, rosacea is a chronic condition and without treatment it will worsen over time. People with rosacea will require lifelong therapy, and will experience periodic flares throughout their lifetime.
Lasers have an important role in rosacea treatment, and are used in conjunction with topical and oral medications. The development of broken blood vessels on the face, especially around the cheeks and nose, occurs in all people but is worse in people with rosacea. Once broken blood vessels have appeared on the skin they will not go away with topical or even oral medication alone. Laser treatment is required to remove these red marks, and also reduces overall facial redness. This laser treatment is a quick office procedure that destroys these broken blood vessels without wounding or damaging the skin. Typically, two to three treatment sessions are required. However, over the years new blood vessels will form requiring further treatment.
Seborhheic keratoses
Seborhheic keratoses
Seborrheic keratoses are benign growths on the surface of the skin. They are the most common benign growths of the skin, and increase in number with time. There is a genetic predisposition to whether a person will develop these growths, and they are more common on sun exposed skin. They appear skin colored to tan to brown, and start flat but may become thickened, rough, or scaly. They are most common on the face, scalp, chest, abdomen, and back but may occur on any part of the body. Some seborrheic keratoses may itch or get irritated by clothing. Some may look very similar to certain types of skin cancer, and a biopsy may be performed to confirm that they are harmless. Usually, however, there is no medical reason to remove these growths but many people wish to do so for cosmetic reasons. The removal is a simple office procedure and healing is usually complete in one week.
Seborrheic dermatitis
Seborrheic dermatitis
Seborrheic dermatitis is a chronic skin disorder that manifests with redness, yellow scale, itching, and/or increased oiliness of the skin. The symptoms may be mild and limited to a small area, or severe with large patches of involved skin and significant itching. Seborrheic dermatitis occurs in infancy and again in adulthood but is uncommon in children or young adults. The areas affected include the scalp, ears, eyebrows, mid face, and chest. It may involve the skin folds of the groin or under the arms, especially in infants. Seborrheic dermatitis is not contagious, but it is a chronic condition that requires treatment in order to control the symptoms.
Seborrheic dermatitis may be exacerbated by emotional stress and stressful medical conditions. Hospitalized patients, people with Parkinson's Disease, and people with suppressed immune systems are more likely to have seborrheic dermatitis.
Treatment of seborrheic dermatitis involves the use of topical (applied to the surface of the skin) medications.
Shingles
Shingles
Shingles, also called Herpes Zoster, is a painful skin rash that often has redness and blisters. It usually appears on one side of the face or body and may last from two to four weeks. There may be fever, headache, chills, and upset stomach. However, the main symptom is pain, which may be quite severe. There is usually pain, tingling, or a burning sensation in the skin that starts before the appearance of the rash. Some people only have this discomfort and do not ever get the shingles rash. Some people have pain that persists long after the rash has cleared. This is called post-herpetic neuralgia.
Shingles is caused by the Varicella Zoster virus, the same virus that causes chickenpox. The virus stays in the body and can reappear years later as shingles. Only a person who has had chickenpox or gotten the chickenpox vaccine can get shingles. A person who has never had chickenpox can catch chickenpox from someone who has shingles, but you cannot catch shingles from someone with shingles.
In 2006 the FDA approved Zostavax as a shingles vaccine. The vaccine is a weakened form of the Varicella Zoster virus. It is indicated for adults over 60 years of age, to prevent shingles. The vaccine has been proven to reduce the risk of developing shingles. Receiving the vaccine does not guarantee that you will not get shingles, but studies have shown that those people who do develop shingles despite having had the vaccine have a much shorter lasting rash and much less pain. The vaccine is not indicated for the treatment of shingles or post-herpetic neuralgia.
Skin cancer
Skin cancer
Skin cancer is the most common type of cancer that occurs in humans. Up to 50% of people will have at least one skin cancer by age 65. Risk factors for skin cancer include fair skin, light eyes, a history of sunburn, and a family history of skin cancer. The most important factor in the development of skin cancer is exposure to ultraviolet rays from the sun and/or tanning beds.
There are several types of skin cancer. The most common form is basal cell carcinoma. This type of skin cancer is rarely life-threatening, but can grow large in size and can be very disfiguring. Basal cell carcinoma usually appears as a small skin colored to pink bump on sun exposed skin, and can bleed easily or have a scab. Basal cell carcinomas are most often found on the head, chest, back, or arms. Treatment options include surgical removal and destruction of the growth through the use of electrical current and physical scraping of the lesion.
The second most common type of skin cancer is squamous cell carcinoma. Squamous cell cancers also can grow very large and be very disfiguring. Unlike basal cell carcinoma, squamous cell carcinoma can spread to other parts of the body. Therefore, early detection is crucial for prevention and treatment. Most squamous cell carcinomas are caused by ultraviolet radiation, and it is therefore most commonly found on sun exposed skin. Treatment options for squamous cell carcinoma include surgical removal and radiation therapy.
Many squamous cell carcinomas begin as precancerous growths called actinic keratoses. Actinic keratoses are usually pink to red, rough or scaly, flat or slightly raised spots on the skin. Actinic keratoses are not only precursors to squamous cell carcinomas, but their presence indicates that a person is at a higher risk for developing any of the types of skin cancer. It is important to examine your skin regularly and have a full skin check by a dermatologist yearly, to screen for precancerous and cancerous growths. Early detection is the key to cure.
Malignant melanoma is the most dangerous form of skin cancer. Every year there are more than 100,000 new cases of melanoma and 8000 deaths due to melanoma. Melanoma comes from the pigment-producing cells of the skin. It is curable through surgery if caught early, however it can be life-threatening if found or treated late. Melanoma is the most common cause of death from skin cancer. The incidence of melanoma is increasing, but the survival rates are also increasing. Both of these statistics are likely due to increased awareness, increased surveillance, and improved detection. Early detection and treatment are the most important factors in surviving melanoma. The main cause of melanoma is damage to the skin through excess ultraviolet exposure from the sun or tanning beds. There are also genetic factors involved in melanoma, as not all melanomas are due to the sun and some occur on areas of the skin that have never been exposed to the sunlight. That is why it is very important to see Dr. Gilman for a yearly full skin examination.
Risk factors for melanoma include a family history of the disease, fair skin, blue or green eyes, and numerous moles, especially if they are atypical. A history of sun exposure, particularly blistering sunburns, is an important risk factor. One blistering sunburn during childhood doubles a person's lifetime risk for melanoma.
Signs to look for when examining your skin go by the acronym ABCDE:
- A stands for asymmetry: one half of the mole does not match the other half.
- B is for border: an irregular, blurry, or ragged border.
- C is for color: more than one color in the mole, a color that doesn't match any of the other moles you have, or a change in the color of the mole.
- D is for diameter: normal moles are usually smaller than 6 mm in diameter, which is the size of a pencil eraser.
- E is for evolution: a mole that is changing over time, that doesn't look the same as it used to.
Everyone should have a full skin examination at least yearly. It is also important to examine your skin at home and get familiar with your moles. You will be more likely to notice anything new or unusual, and early detection is the key to cure.
Skin care
Skin care
Proper skin care is essential to keeping your skin healthy and looking its best. A good skin care regimen does not have to be complicated. The basics include mild, non-soap cleansers, daily sunscreen, and gentle moisturizers. Sunscreen is the single most important thing you can do for healthy skin and is essential to every good skin care routine. Ultraviolet radiation from the sun (and from tanning beds) damages the skin leading to discoloration, wrinkles, and skin cancer.
It is important to moisturize regularly to help the skin maintain healthy function. When the skin gets dry it can be itchy and easily irritated. Dry skin is more prone to eczema and contact dermatitis.
As we age, the skin gets thinner and loses collagen and elastic fibers. This leads to wrinkles, skin sagging, and texture changes. An important weapon against aging is the use of retinoids. Retinoic acid comes from vitamin A and promotes the formation of new collagen within the skin, improving the texture of the skin and smoothing fine lines and wrinkles.
Antioxidants are also an important skin care product. Antioxidants inactivate free radicals, which are in ultraviolet light, environmental pollution and cigarette smoke. Free radicals break down the collagen in the skin leading to skin wrinkles, broken blood vessels, and discolorations. There are a variety of creams and serums that contain antioxidants that you can easily integrate into your daily routine.
Depending on your skin type and your individual needs, you may also choose to use a product containing glycolic acid or salicylic acid. These ingredients help to exfoliate the surface of the skin, improving wrinkles and skin texture, and are anti-acne, as well.
Skin rejuvenation
Skin rejuvenation
We can't stop aging, but we can slow it down and we can minimize the signs. Aging is a complex process involving changes on the surface as well as in the deeper tissues. As we age, the skin gets thinner and loses collagen and elastic fibers. This leads to wrinkles, folds, skin sagging, and texture changes. A youthful face is a full face, and as time passes the face loses volume leading to flatness or even hollows in areas that were once full and round. In addition, a lifetime of exposure to the sun leads to discoloration, rough texture, and broken blood vessels. Skin rejuvenation involves erasing some of the existing signs of aging as well as making changes that slow down the ongoing aging process.
Dermatologists are skin experts, and have the knowledge, experience, and expertise to keep skin looking young and healthy. There are a variety of skin rejuvenation methods, ranging from the daily applications of skin creams to simple in-office procedures such laser treatments and fillers. There is much you can do to fight aging before turning to surgical procedures. It is important that your skin be evaluated in its current state and in the context of your past experiences, lifestyle, and habits.
Some of the currently available skin rejuvenation techniques include:
- Retinoids are the cornerstone of anti-aging treatments. Retinoids are derived from vitamin A and the regular daily application of retinoid creams or serums will promote new collagen production in the skin. This leads to the smoothing of fine lines and improves the texture of your skin. Retinoids also exfoliate the surface of the skin, making it looks more vibrant and youthful.
- Chemical peels remove the top layers of skin cells that naturally come off easily when we are young, but stay on the skin surface longer as we get older. Chemical peels smooth the texture of the skin and improve discolorations. The skin looks tighter and refreshed. Most chemical peel treatments have no downtime.
- Broken blood vessels and visible capillaries can only be effectively treated with laser therapy. The VBeam® pulsed dye laser is a quick, in-office treatment that requires no downtime.
- Botox treatments smooth away wrinkles by relaxing the muscles that cause the wrinkle to form. The results are seen several days to weeks after the treatment depending on the location and depth of the wrinkle and how long it has been noticeable. This is not a permanent solution, and repeat treatments are needed to maintain the results.
- Fillers are used to replace lost volume in the skin and face, the loss of which has led to lines and hollows. Fillers are also used to restore fullness and volume around the mouth and in the mid-face that is lost with age. Lip enhancement is performed with fillers, to plump up the lips. There are several different types of fillers. You and Dr. Gilman will determine which filler is best for you based on your skin type and your particular needs.
It is important to have your skin evaluated by a dermatologist before deciding on a skin rejuvenation plan. Not every treatment is right for every person. Dr. Gilman can determine which treatments are best for your individual needs.
Squamous cell carcinoma
Squamous cell carcinoma
The second most common type of skin cancer is squamous cell carcinoma. Squamous cell cancers can grow to large sizes and be very disfiguring. Squamous cell carcinoma can even spread to other parts of the body and can be life threatening. Therefore, early detection is crucial for prevention and treatment. Most squamous cell carcinomas are caused by ultraviolet radiation, and are most commonly found on sun exposed skin. Treatment options for squamous cell carcinoma include surgical removal and radiation therapy.
Many squamous cell carcinomas begin as precancerous growths called actinic keratoses. Actinic keratoses are usually pink to red, rough or scaly, flat or slightly raised spots on the skin. Actinic keratoses are not only precursors to squamous cell carcinomas, but their presence indicates that a person is at a higher risk for developing any of the types of skin cancer. It is important to examine your skin regularly and have a full skin check by a dermatologist yearly, to screen for precancerous and cancerous growths. Early detection is the key to cure.
Sunscreen
Sunscreen
Sunscreen and sun avoidance are the most important things you can do to prevent skin cancer and fight aging. Sunlight contains harmful ultraviolet radiation, which is a known human carcinogen and causative factor for skin cancer. Over time, exposure to the sun or tanning beds causes changes in the DNA of skin cells that leads to the development of skin cancer and causes wrinkles, discoloration, and rough skin texture. Even small amounts of sun exposure add up over time. A SPF (sun protection factor) of 30 or higher is best to ensure adequate protection. It is also important to apply sunscreen generously and cover all exposed skin.
Telangiectasias
Telangiectasias
Over time, visible blood vessels may appear on the skin, particularly around the nose, cheeks, and chin. Sun exposure and smoking increases the likelihood and the number of these lesions, and people with rosacea have many more of these visible vessels. The best treatment for these "broken blood vessels" is laser. The VBeam® pulsed dye laser removes these vessels in 1-3 treatments, depending on the number and severity. However, the laser treatment does not stop the causes of these visible vessels (aging, sun, smoking, etc). Over time your body will continue to develop new ones, eventually requiring additional laser treatments.
Tinea versicolor
Tinea versicolor
Tinea versicolor is a common skin condition caused by overgrowth of a yeast that naturally lives on the skin. The overgrowth may be triggered by warm weather and usually occurs on the chest, abdomen, or upper back. There may be light or dark spots on the skin and the surface may look dry or scaly. In people who are tan, the spots may be more noticeable because the spots do not tan but the normal surrounding skin does tan. Tinea versicolor may or may not be itchy. People who get tinea versicolor tend to get recurrences, usually triggered by warm or humid weather. Most people are successfully treated with topical medications (applied to the surface of the skin), however some people may require treatment with oral antifungal medication.
Vitiligo
Vitiligo
Vitiligo is a condition where the skin cells do not produce pigment. People with vitiligo have patches of skin that are white in color. The most commonly involved areas are the hands and fingers, feet, genitals, and the areas around the eyes, nose, and mouth. Many people with vitiligo have a relative who also has the disease, but it is not always an inherited condition. Vitiligo is seen in men and women and usually begins before age 30 but may occur at any age. Treatment involves the use of topical medications (applied to the surface of the skin), lasers and light treatments. Treatment is not always successful, and the course of vitiligo may be unpredictable. Some people have very minimal disease, while others may have large areas of involvement.
Warts
Warts
Warts are skin growths caused by an infection with a virus called human papillomavirus. There are many types of human papillomavirus. Some cause warts on the soles of the feet, some cause warts on the hands or fingers, others cause warts on the face, and still other types cause genital warts. The wart's appearance varies according to where on the body it is located. Warts on the feet are usually flat, warts on the hands are typically raised, and warts on the face may be perfectly flat, raised and smooth, or raised and rough. Warts are not dangerous, but they are unsightly and can be uncomfortable, especially on the feet. The virus that causes warts is passed from person to person, but not everyone who is exposed to the virus gets warts. Some people are more prone to warts than others, and people with impaired immune systems are more likely to have warts. The treatment varies according to the location and appearance of the wart, as well as the age of the patient. Some warts are treated with a light chemical peel, others require freezing with liquid nitrogen, and some warts require surgery for complete removal. Laser treatments with the pulsed dye laser may also successfully treat some warts.
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