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SKIN CLINIC  Delhi

SKIN CLINIC DELHI

Skin Clinic Delhi


Expertise for the Life of Your Skin

Acne and Rosacea
Acne
Rosacea
 
Aging Skin
Age Spots/Seborrheic Keratosis
Wrinkles
 
Benign, Non-contagious skin disorders
DermatofibromasGranuloma Annulare
Pityriasis Rosea
 
Common Childhood/
Adolescent Skin Disorders

Childhood EczemaImpetigoKeratosis Pilaris
Molluscum Contagiosum
Scabies
 
Dermatitis, Eczema, and Psoriasis
Allergic Contact Dermatitis     eyelid /facial contact dermatitis     poison oakAtopic Dermatitis/EczemaChildhood Eczema Nummular Dermatitis
Peri-Oral DermatitisSeborrheic Dermatitis
Psoriasis
 
Hair loss and thinning
Alopecia Areata
Telogen Effluvium
 


 
Infections
FolliculitisHead LiceImpetigo
Scabies
 
Leg Vein Disorders
Spider Veins
Varicose Veins
 
Pigmentation Disorders
Melamsa/Hyperpigmentation
Liver Spots Vitiligo

Rashes
Allergic Contact DermatitisHives (Urticaria)Insect BiteTinea Versicolor
 

Sun and Your Skin
Freckles


Skin Cancer
Actinic Keratosis
Basal Cell/Squamous Cell Carcinoma
Melanoma
 
Options for Skin Cancer Removal
 

Mohs Micrographic Surgery

 
Warts and Other Skin Viruses
Cold Sores (HSV)Common warts
Genital Warts
Molluscum Contagiosum
Shingles (Herpes Zoster)

Other Common Skin Disorders
AngiomasKeloid/Scar
Normal Moles

Skin Clinic Delhi

Dermatologist Clinic Delhi

Acne and Rosacea

ACNE

Acne is one of the most common of all skin problems.It affects most teenagers to some degree and even many adults. Acne presents in the form of whiteheads, blackheads, pimples, and in some people, deep painful bumps that look and feel like boils. Acne most commonly occurs on the face but can also appear on the back, chest, shoulders, and neck.

Acne usually begins around puberty, when members of both sexes experience an increase in the production of sex hormones called androgens. These hormones regulate the activity and size of the oil-producing, or sebaceous glands that reside in the pores or hair follicles of the skin. The increased production of these hormones causes the oil glands to get bigger in the areas where acne occurs.

The sebaceous glands make an oily substance called sebum. Sebum travels from the hair follicles to the surface of the skin. The lining of the wall of the hair follicle sheds skin cells, which then stick together with the sebum. The follicle gets clogged, plugging up the opening in the surface of the skin. Whiteheads and blackheads are the result of clogging of the pores. The sebum and cell debris together contribute to the growth of bacteria that live in your pores.

The body will naturally attempt to clear the clogged pores by sending in certain specialized cells that invade the follicle to help clean it up.   However, in the process, the wall of the follicle may weaken and rupture, emptying the contents of the follicle into the surrounding tissue.   When this occurs, swelling or redness can develop around the affected follicle, resulting in the larger bumps or pimples characteristic of acne.   These are known as papules and pustules and can sometimes cause scarring.   From the beginning until its disappearance, the life cycle of a pimple can take 8 weeks to run its course.   And it can take even longer for the darkened spots left by some acne pimples to fade completely.

Who gets acne?

It is estimated that as many as 70 million people in the U.S. suffer from acne. In most people, acne clears up after a few years. But at its worst, acne can cause permanent scarring of the skin. And even when there are few physical marks left, the emotional ones can be devastating.

Treatment

There are numerous treatment options for people who suffer from acne.   How you and your dermatologist decide to treat your acne will depend on the severity of your acne.  

Several lotions and creams are available without a prescription that are helpful in mild cases of acne. For more severe cases of acne, there are prescription creams and lotions. Some contain antibiotics to help get rid of the bacteria that contribute to the formation of acne pimples.   In some cases, oral antibiotics may be given. In many cases, a dermatologist will recommend a combination of two or more treatments for their patients with acne.

Other medications work to get rid of the pimples and help the skin to stay clear. A dermatologist can physically extract some kinds of acne pimples, especially blackheads. This kind of procedure should only be performed by a dermatologist or other skilled professional. Squeezing or picking at acne and pimples can result in infection and permanent scarring.

Some options for acne treatment are listed below:

  • Oral Antibiotics. Four to eight weeks of antibiotic therapy are required before improvement is seen in acne, however, treatment can be effective for many acne patients. There are a variety of oral antibiotics prescribedby physicians to treat acne. These include Minocycline*, Septra** and Doxycycline***.

With any antibiotic: If you develop signs of a yeast infection, i.e. vaginal discharge and itching, call our office. If you have had yeast infections before and are having similar symptoms, Monistat and GyneLotrimin are now available over the counter without a prescription.

Recently a large well designed study has shown that antibiotics do not decrease the effectiveness of the birth control pill if the two medications are given at the same time.   If you are on the “pill” or have it prescribed while you are taking antibiotics, please discuss this with your dermatologist.

  • Topical medications and topical antibiotics such as Differin, Duac, Benzaclin, Benzac AC Wash, Tazorac and Retin-A.

Retin-A, technically known as tretinoin or retinoic acid, is a prescription cream that began its life as an acne medication. This derivative of vitamin A fights acne by exfoliating the skin and unclogging pores, properties that make it useful for treating other skin problems as well. For instance, by increasing the shedding rate, it makes skin cells multiply faster, which helps pigmentation problems (like age spots) fade. Beyond that most dermatologist believe that tretinoin promotes collagen formation and thickens the epidermis (the top layer of skin) to lend a more youthful look to skin. New applications include preparing the skin for chemical peels and treating certain precancerous conditions.

  • Accutane . This oral medication is used to treat severe acne (nodular acne) which has not responded to other treatments, including topical medications and oral antibiotics. This synthetic oral form of vitamin A (Accutane) works by decreasing formation of oily plugs of sebum (the oil substance produced by sebaceous glands), reducing the formation of keratin (the tough outer layer of skin), and by shrinking the sebaceous glands. Isotretinoin cures or greatly reduces severe disfiguring acne in up to 80% of patients. The course of treatment usually runs four or five months, after which the condition may continue to improve at least two more months to a year. Sebum production then gradually returns to its pretreatment levels, but fewer than one-third of patients require a second course of the drug.

The physicians at the Cheyenne Skin Clinic have seen Accutane produce good results for the majority of their patients on the medication. However, Accutane is a serious medication and should be used only if other medications have failed. It is important to discuss the benefits and drawbacks of Accutane with your dermatologist if you think you are a good candidate for this treatment and before starting therapy.

  • AcneLight. The FDA has recently approved the use of high intensity "blue light" to destroy Propionibacterium acnes, the bacteria that is the primary cause of acne. The treatment does not require patients to take or apply any medication, and is free of side effects. Patients visit the Cheyenne Skin Clinic twice per week for four weeks to sit in front of our special blue light for 15 minutes. It is best suited for patients with mild to moderate acne with whom other treatments have failed or for those patients who don't like to take medication. For more information, please contact the Cheyenne Skin Clinic at (307) 635-0226 to speak with a dermatology nurse.

Can I prevent my acne from coming back?

A dermatologist can prescribe a regimen that will help get rid of active acne and pimples and also prevent new ones from appearing.   By using medications correctly and consistently, patients can prevent   new acne pimples from forming. Stopping medication or “spot treating” visible pimples may allow new pimples to grow and take weeks to clear again.   Medication should be applied in the same way every day as recommended by a dermatologist.

Can acne be cured?

There is no instant or immediate cure for acne, but it can be controlled.   Scarring may be prevented with proper care and treatment.   Again, correct and consistent use of acne medication and following a dermatologist’s instruction is the best bet.

*The most common side effect seen with Minocycline is dizziness which occurs two to three hours after taking the medicine. One can usually avoid this problem if you take your capsule at bedtime for the first two weeks.  A very few people will have continued dizziness on awakening and must discontinue the medication. Other reported side effects with Minocycline include: yeast infections, diarrhea, increased skin pigmentation, and allergic skin rashes. Rarely liver problems and lupus have been seen with Minocycline. People with decreased kidney function, women who are pregnant or breast feeding, and children less than eight years old should not take Minocycline. If there is a chance you may be pregnant, discontinue the medication. Although minocycline has been reported to increase sun sensitivity, although it is rare. If you think that you sunburn more easily while on Minocycline, apply a sunscreen with an SPF of 15 or higher.

**Septra should be taken with a large glass of water with or without food.  It may rarely cause stomach upset with nausea and vomiting. This is a sulfa medication and should not be taken by those who are allergic to Sulfa. A few people develop serious allergic reactions including severe skin rashes and hives. If you develop a rash while on Septra DS, stop the medication immediately and notify our office. Rarely, Septra DS may cause a decrease in the white blood cells, red blood cells, or platelet count.   We routinely do a blood test at the first office visit after starting the medication and every six months thereafter. Septra DS may cause an increased sensitivity to the sun. If you notice this, use a sunscreen with SPF 15 or higher. Septra DS may interact with other medications including: phenytoin (Dilantin), diuretics (thiazides), Coumadin, and Methotrexate. If you are prescribed any of these, please discuss this with your physician or call our office.

***Doxycycline is an oral antibiotic that is effective in the treatment of acne. Take your capsules with a large glass of water on an empty stomach at least one hour before a meal or two to three hours after you eat. Do not take within one hour of milk, dairy products, antacids, iron, or calcium containing preparations. If the Doxycycline is taken with food or milk, it is poorly absorbed and is much less effective. Reported side effects with Doxycycline include: stomach upset, heartburn, yeast infections, and increased sensitivity to the sun.   If you experience heartburn, take the tablet with a cracker or cookie and a large of water.   It is very important that the capsule or tablet not lodge in the esophagus.   If you have the feeling the Doxycycline is “stuck” in your throat or esophagus, discontinue the medication or and take an antacid.   People with decreased kidney nction, women who are pregnant or breast feeding, and children less than eight years old should not take Doxycycline.  If there is a chance that you may be pregnant, discontinue the medication. Doxycycline may cause increased sensitivity to the sun with severe sunburn developing from relatively short sun exposure. Sunscreen with SPF 15 or higher should be used on all sun exposed skin.

Skin Clinic Delhi

ROSACEA

Rosacea is a condition that affects the skin of the face, mostly the area where people blush. A number of symptoms accompany this condition and range from mild to more severe. Some characteristics include:

  • Redness. This can look like nothing more than a blush or a sunburn. It is caused by flushing when a large amount of blood vessels expand to handle the flow. If this continues to happen, over time, the redness becomes more noticeable and does not go away.
  • Pimples. As a result of continual flushing, the skin eventually becomes irritated and inflamed and pimples may appear on the face. These pimples may be papules (small, red, and solid) or pustules (pus-filled, like teenage acne). This is why rosacea is often referred to as “adult acne” or “acne rosacea.” But people with rosacea don’t have the comedones (blackheads or whiteheads) usually seen in teenage acne.
  • Broken or enlarged blood vessels. Doctors call this telangictasia. When people with rosacea flush, the small blood vessels of the face get larger-eventually showing through the skin. They may appear as spots or as thin wavy lines. Flushing, blushing, or redness may hide them, but they may become more visible as the underlying redness is cleared up by treatment.
  • Enlarged, bumpy nose. This condition is called rhinophyma, and is present in the more advanced stages of rosacea, especially in men. When rosacea isn’t treated early, small, knobby bumps may gradually appear on the nose, giving it a swollen appearance. This is the symptom that gives rise to the myth that rosacea sufferers are actually problem drinkers, which can substantially contribute to the emotional upset experienced by many patients.

How does it start, and how does it progress?

The first sign of rosacea is usually rosy cheeks. As it progresses, the face may get red in patches and stay red for hours or days at a time. Eventually, the redness doesn’t go away at all. At this stage, some or all of the symptoms mentioned previously may also appear. Rosacea is a chronic condition, and that means the symptoms may come and go in cycles and fluctuate in their degree of severity. Because of this, many people mistake their rosacea for things like sunburn, windburn, a complexion change, or acne and they don’t bother to see a doctor. However, in most cases, the earlier they see a dermatologist, the quicker their rosacea can be brought under control.

Who gets rosacea?

Rosacea is usually seen in adults. It can affect those in their 30s, all the way up to and including people in their 70s and 80s. While rosacea is most common in persons with fair complexions, it can affect people of all skin colors and skin types. Most people who get rosacea seem to flush or blush more often than the average person and may have parents or grandparents who have the same symptoms. Because they think it is just something that “runs in the family,” they often don’t seek help from a dermatologist.

Treatment

Rosacea can’t be cured, but the right treatment, used faithfully, can create much clearer skin and actually helps keep symptoms from coming back. A person shouldn’t treat rosacea themselves. Nonprescription acne medications may irritate dry, sensitive skin, and may contain ingredients that appropriate for rosacea.

A dermatologist can recommend the right care for your symptoms. In most cases, this would include oral antibiotics to control the papules and pustules and/or topical metronidazole like MetroGel topical gel, MetroCream topical cream, or MetroLotion topical lotion applied directly to the skin.

  • Oral antibiotics. Capsules or tablets can be taken by mouth, usually once or twice a day. Some of these such a Tetracycline, should be taken on an empty stomach. Patients should ask their pharmacist about milk and other foods that may keep the medication from being absorbed by the body.
  • Topical Steroids. Prescription and non prescription topical corticosteroid cream or gel is sometimes prescribed initially to get redness under control quickly. Steroids are not generally used as a long term treatment for rosacea because they can sometimes cause a flare up of symptoms.

Since rosacea cannot be cured, once the symptoms have cleared up patients need to continue using their medications. Without this regular (maintenance) therapy, the symptoms may return or get worse over time.

  • Laser therapy. Once blood vessels are visible, many people elect to have them removed with laser therapy. Surgery can also be used to correct a nose enlarged by rhinophyma.

 

Skin Clinic Delhi

Skin Clinic Delhi 

Following a regular cleansing and medication routine-twice a day or as prescribed by a doctor-will make treatment easier and more successful. How and what is used to cleanse and moisturize the face is also important. Here are some simple steps to follow:

  • Cleanse gently with a very mild cleanser. Avoid products that contain alcohol or other irritants. Dermatologists frequently recommend Cetaphil Gentle Skin Cleanser, a gentle soapless product available at most drugstores, that does an excellent job of cleaning without irritating.
  • Medicate according to the instructions of a dermatologist.
  • Protect with a sunscreen of SPF 15 or higher, even on cloudy days. Look for a non-comedogenic product that does not contain alcohol. Cetaphil Daily Facial Moisturizer with SPF 15 is an excellent choice, as well as Neutrogena or PreSun.
  • Moisturize with a good quality moisturizer as needed. If the treatment therapy includes a topical medication, the moisturizer should be applied after the medication has dried. The moisturizer should say “noncomedogenic,” meaning it won’t clog pores. The Cetaphil product line also includes a moisturizer, available in both lotion and cream forms that are specially formulated for sensitive skin.
  • Makeup can help hide rosacea while patients are in the process of getting their symptoms under control and afterward. Oil-free foundations with yellow (not pink) undertones are recommended, as are special green-tone products specifically designed to be worn under foundation to disguise facial redness.

Avoid rosacea triggers

Below is a list of things that can aggravate your rosacea symptoms. It is unlikely that a patient will react to everything on this list, but by being observant they can discover which ones apply to them to avoid flare ups in the future.

  • Weather (sun, strong winds, cold humidity)
  • Emotional influences (stress, anxiety)
  • Temperature-related (sauna, hot tubs, over-bathing, excessively warm environments)
  • Physical exertion (exercise, “lift and load” jobs)
  • Beverages (alcohol, especially red wine, beer, bourbon, gin, vodka, or champagne and hot drinks including hot cider, hot chocolate, coffee, or tea)
  • Foods (liver, dairy products, including yogurt, sour cream, and some cheeses, chocolate and vanilla, soy sauce and vinegar, vegetables including eggplant, tomatoes, spinach, lima beans, navy beans and peas, fruits including bananas, red plums, raisins, figs and citrus fruit, and hot and spicy foods.
  • Skin care products (some cosmetics and hair sprays, especially those containing alcohol, witch hazel, or fragrances, topical steroids, any substance that causes redness or stinging.)

Patients need to experiment to determine their own personal triggers. They may find it helpful to keep a daily diary of food consumption and activities to get a better idea of what causes their episodes of flushing. Once their own triggers have been identified, they should avoid them for a few days. If the patient notices a reduction in the frequency and severity of their flare-ups, they have probably identified what should be avoided to help keep their rosacea under control.

A conversation with all of the patient’s doctors, in addition to their dermatologist, may also be in order, especially if they have medications prescribed to them for other medical conditions.

Infections
skin clinic delhi

IMPETIGO

Impetigo is a skin infection caused by bacteria, usually staph or strep. Impetigo is contagious. The condition starts as a tiny, barely perceptible blister on the skin usually at the site of a skin abrasion, scratch, or insect bite. Over the next few days, red and itchy sores begin to ooze, leaving behind a sticky golden crust spots that grow larger day by day. The hands and face are the favorite locations for impetigo, but it often appears on other parts of the body.

Parents should keep a watchful eye

Parents should not let impetigo run its course, as it may continue indefinitely without treatment. In rare cases, impetigo can lead to a form of kidney disease known as acute glomerulonephritis.

Cuts and scrapes on a very young child will likely be noticed as the parent bathes the child. Unfortunately, after children reach a certain age and bathe alone, they tend to demand privacy for their bodies. It is important that parents teach their children to report any unusual rashes, bumps, or irritations to them so that care may be taken to avoid infection.

and is contagious.

How does one get impetigo?

While the germs causing impetigo may have been caught from someone else with impetigo it usually begins out of the blue without an apparent source of infection.

Contagion

Impetigo is contagious when there is crusting or oozing. While it’s contagious, take the following precautions:

  • Patients should avoid close contact with other people.
  • Children should be kept home from school for 1-2 days.
  • Use separate towels for the patient. His towels, pillowcases, and sheets should be changed after the first day of treatment. The patient’s clothing should be changed and laundered daily for the first two days.

All these measures are only needed during the contagious-crusting or oozing-stage of impetigo. Usually, the contagious period ends within two days after the treatment starts. Then children can return to school and special laundering and other precautions stopped. If the impetigo doesn’t heal in one week, please return for evaluation.

Treatment

Antibiotics taken by mouth usually clear up impetigo in four to five days. It’s most important for the antibiotic to be taken faithfully until the prescribed supply is completely used up. In addition, an antibiotic ointment should be applied thinly four times daily. Bacitracin, Polysporin of Bactroban ointment is advised. Bacitracin and Polysporin can be purchased without a prescription.

Keys to making treatment successful include:

  • Crusts should be removed before ointment is applied.
  • Soak a soft, clean cloth in a mixture of ½ cup of white vinegar and a quart of luke warm water.
  • Press this cloth on the crusts for 10-15 minutes three to four times a day as long as you see crusting or oozing.
  • Then gently wipe off the crusts and smear on a little antibiotic ointment.
  • You can stop soaking the impetigo when crusts no longer form.
  • When the skin has healed, stop the antibiotic ointment.

SCABIES

Scabies is a highly contagious, but curable, skin disease that affects nearly one third of a billion people worldwide. It is caused by a tiny mite, just barely visible to the naked eye, that spends nearly its entire life in or on the human skin.

Although more common in warm climates, scabies can occur anywhere and within all social and income levels. It affects men, women, and children of all ages.

Prevention Transmission

Scabies is highly contagious and easily transmitted from person to person through close physical contact, such as between family members, sexual partners, or children playing at school. An unproven, but possible method of transmission is via infested clothing, bedding and towels.  To avoid reinfestation, you doctor may recommend that all affected household members be treated at the same time with the same 24 hour period.

Although scabies mites can’t live long without a human host, there have been a few cases of apparent transmission through infested clothing and bedding. Even so, heroic cleaning efforts are generally unnecessary. Normal hot water laundering of towels, linens, and all clothing used within the previous 48 hours is typically sufficient to prevent reinfestation. Clean clothes or heavy winter jackets and sweaters need not be cleaned.

Treatment

Please see a physician or dermatologist for treatment options.

Aging Skin

As we grow older, we see and feel certain changes in our skin, the body’s largest and most visible organ. It becomes drier, more wrinkled and spots and growths appear. The skin tends to heal more slowly.

Some of these changes are natural, unavoidable and harmless. Others are itchy or painful, and some such as skin cancers, are serious and require immediate medical attention. Many problems can be prevented whether avoidable or not, health endangering or merely cosmetically undesirable, most unwanted aging-associated skin problems can be addressed by therapies now available.

 

AGE SPOTS

Age spots are small darkened patches on the skin of older adults who have been regularly exposed to the sun over many years. They are invariably found on the backs of the hands, and arise as a result of the skin's defense mechanism against long-standing sun exposure. As pigment pools in some spots to protect the skin, the brown spots form. Solar lentigines (or lentigo) is a medical name for this naturally occurring condition. It is usually light complexioned people with a tendency to burn, rather than tan, who develop age spots in later years.

Treatment

To help patients with age spots (hyperpigmentation) achieve more even skin tone, physicians may prescribe the use of skin bleaching products. Skin bleaches slow the production of melanin, causing dark spots to gradually fade and return to normal skin color. These skin medications must be applied regularly, usually twice a day to be effective. The skin lightening process may take several months to achieve the desired results.

The active ingredient in skin lightening products is called hydoquinone. The maximum prescription strength is 4% hydroquinone, which contains twice the amount of active ingredient as over-the-counter bleaches. Some hydroquinone products contain sunscreens or sunblock, so you don’t have to bother with applying a separate sun protection product. Hydroquinone may also be combined with glycolic acid for its skin moisturizing benefits. These creams, however, can neither prevent new spots from forming, nor are they effective at lightening most lesions

 

 

SEBORRHEIC KERATOSES

Seborrheic keratoses are harmless, common skin growths that first appear during adult life. As time goes by, more growths appear. Some people have a very large number of them. Seborrheic keratoses appear on both covered and uncovered parts of the body; they are not caused by sunlight. The tendency to develop seborrheic keratosis is inherited.

Seborrheic keratoses are harmless and never become malignant. They begin as slightly raised, light brown spots. Gradually they thicken and take on a rough, warty surface. They slowly darken and may turn black. These color changes are harmless. Seborrheic keratoses are superficial and look as if they were stuck on the skin. Persons who have had several seborrheic keratoses can usually recognize this type of benign growth. However, if you are concerned or unsure about any growth, consult a dermatologist.

Treatment

Seborrheic keratoses can easily be removed in the office. However, the only reason for removing a seborrheic keratosis is if it is irritated, itches, or annoys you by rubbing against your clothes.

Often patients are concerned whether Medicare or their insurance will pay for removal of seborrheic keratoses. If a lesion ever bleeds, has intense itching or pain, or shows signs of inflammation, with swelling or redness, insurance will consider removal a medical necessity. Also if a lesion has grown or changed and there is a question about the diagnosis, removal and pathology would be covered.

 

WRINKLES

As skin ages, it loses its elasticity. Collagen and elastin, the tissues that keep the skin supple, weaken. The skin becomes thinner and loses fat, so that it looks less plump and smooth. While all these changes are taking place, gravity is also at work, pulling at the skin, causing it to sag.

Can wrinkles be avoided?

How wrinkled your skin becomes depends largely on how much sun you have been exposed to in your lifetime. The sun is the major cause of unwanted changes in the skin with aging. Cigarette smoking can also contribute to wrinkles.   Wrinkles also depend on your parents-the tendency to wrinkle is inherited.

The good news is some wrinkles can be prevented. To avoid wrinkles caused by the sun, beginning in childhood, always wear a sunscreen with an SPF of at least 15, a hat with a brim, and other protective clothing when in the sun. Don’t deliberately sunbathe and limit sun exposure between 10am and 3pm. If you have already sun-damaged your skin, you will still benefit from beginning sun protection as an adult. Over-the-counter “wrinkle” creams and lotions may help dry skin and make it feel better, but they do little or nothing to reverse wrinkles.

Treatment

There are some promising treatments for aging skin.

  • Retinoic acid, a cream that has been used successfully in treating acne, has been shown to improve the surface texture of the skin, reduce irregular pigmentation, and increase dermal collagen. It is currently the only treatment approved by the FDA as safe and effective for reversing some of the effects of sun damage. Alpha hydroxy acids also show promise in reversing some of the effects of the sun. Creases caused by facial expressions such a squinting, frowning or smiling, can be treated by a dermatologist, using what are called “dermal fillers.”
  • A naturally produced protein called BOTOX ® Cosmetic can also be used to “relax” the small muscles and thus eliminate fixed expression lines like frown markers. A small amount is injected into the affected muscle with a very fine needle. Tiny facial muscles are relaxed while the overlying skin remains smooth and unwrinkled. There is minimal pain and normal daily activities are uninterrupted. Treatments last approximately 4-7 months.

 

None of these remedies can guarantee eternally youthful skin, but they can improve the overall appearance of your skin. Severely wrinkled skin can be improved with surgery and/or lasers. Discuss your options with your dermatologist.        

 

Adora Day spa offers FDA approved offers Restylane and Juviderm. The spa also offers Perlane and Radiesse for treatment of deeper facial wrinkles.

Lasers and intense pulsed light can also be useful in softening fine lines and wrinkles by stimulating collegan production under the skin. Adora Day spa offers V-Beam laser  treatments and Fotofacials. Both leave the skin with a softer more even appearance with little or no down time.

Thermage, the non-surgery face lift can help with sagging skin. While it doesen't help with individual wrinkles, it can help tighten your skin to give a more youthful appearance.

Leg Vein Disorders

SPIDER VEINS (SUPERFICIAL LEG VEINS)

Unwanted blood vessels-smaller ones are called spider veins-have a red or bluish color and appear on the surface of the body, particularly the legs and occasionally the face or elsewhere. They may be visible as short, unconnected lines each about the size of a large hair, they may be connected in a scraggly sunburst pattern, or they may resemble a spider web or tree with branches. In some people, they occur in a small area and are not particularly noticeable. In others, they may cover a large area of the skin and be quite unsightly.

A characteristic of unwanted blood vessels in some sufferers is occasional pain, ranging from a dull throbbing pain to a burning sensation.

Though the unwanted blood vessels do carry blood, the great majority, especially spider veins, are not necessary to the circulatory system. Thus, if their presence is distressing, they can be treated by injection of a solution that will cause them to disappear or at least become much smaller. The chance for a greatly improved appearance is about 80%, particularly if the nurse or physician is experienced in their treatment.

What causes spider veins?

Spider veins occur in both men and women, but more frequently in women. The hormone estrogen may play a role in their development, because puberty, birth control pills or pregnancy often seem to bring them on. During pregnancy, the enlarged uterus may restrict blood flow contributing to their development. They may also occur after a blow to a certain area of the body or as a result of wearing tight girdles or hosiery held up with tight rubber bands. In addition, spider veins may occur in association with underlying large varicose veins.

Can they be prevented?

There is no known method of prevention. Wearing support hosiery may prevent some unwanted blood vessels from developing in some people. Maintaining a normal weight and regular exercise may also be helpful. Protection from the sun is important to reduce the number of unwanted vessels on the face.

Treatment

In the majority of cases, a procedure called sclerotherapy is used, in which a solution, called a sclerosing solution, is injected with a very fine needle directly into the blood vessel. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to clot. Over a period of weeks, the vessel turns into scar tissue that fades from view, eventually becoming barely or not visible at all. Depending on the size, a single blood vessel may have to be injected more than once, some weeks apart, but in any one treatment session a number of vessels can be injected. The registered nurses at ADORA DAY SPA perform this treatment. For a complimentary consultation, please call (307) 773-8520.

Below are some common questions asked by patients:

  • Is sclerotherapy treatment painful?

Most patients report that they feel a very mild stinging when the sclerosing agent enters the vein. Some report a slight ache in their legs the evening after treatment.

  • How many treatments will I need?

The number of treatments depends on the number of veins you wish to have treated. While some veins disappear after only one injection; however studies show that the average vein will require three to four treatments. Fortunately, we can treat more than one area at each session. The minimum time between treatment of any specific vein is four weeks, but one may treat one leg at one session and then treat the opposite leg in two weeks. With this in mind, you may pick the veins to be treated designing your own treatment schedule.

  • What are possible side effects?

After the injections, there will be some bruising of the skin which usually disappears in several weeks. Rarely, it may last several months. The treated areas may heal with brown pigment which slowly clears over several months. Phlebitis (inflammation of the veins in the leg) is a rarely reported complication. If you note any pain, redness, or swelling, please call our office.

  • When may I exercise again?

We recommend no strenuous activity involving your legs for the first 24 hours after treatment. Then you can resume your usual fitness program.

  • How successful is sclerotherapy

After several treatments, most patients can expect a 50-80% improvement in treated vessels. However, the fading process is gradual and perfection is seldom achieved.

  • Will insurance cover the treatment?

The treatment of spider veins is rarely covered by insurance. Even if the veins are painful they rarely pay.   We require payment at the time of service.

  • Will treated veins recur?

Larger veins are likely to recur unless support hosiery is worn. Spider veins may recur. Often, however, it may seem that a previously injected vessel has recurred, when in fact a new spider vein has appeared in the same area.

 

VARICOSE VEINS

Larger unwanted blood vessels may be raised above the skin surface and serpentine; they may occur in association with spider veins. These large veins are called varicose veins, which frequently occur in association with a poorly working valve in a large vein.

Treatment

Surgery is most often indicated in the treatment of painful vericose veins. Please visit with a physician at the Cheyenne Skin Clinic about this condition and the possibility of having them removed.

Occasionally larger varicose veins underlie spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins, either by sclerotherapy followed by compression or by a surgical procedure.


ELVeS (Endo Laser Vein System)
Is a state-of-the-art laser treatment for lower extremity venous insufficiency which often leads to varicose veins. The procedure is performed at the Vein Treatment located at Cheyenne Skin Clinic. After a short visit, ELVeS will help you to begin enjoying life's pleasures again.

If unsightly and painful veins have been preventing you from living a full. life, these Questions & Answers offer new hope about treatment.

Q. What are the standard methods of treatment?
 

Besides compression therapy, The most common form of treatment is surgical ligation and stripping. At least two incisions are required, allowing the physician to tie off and pull out the faulty vein. It is and expensive surgery that requires general anesthesia , hospitalization, may leave scarring and requires a lengthy recovery period.

Another form of treatment is ultrasound-guided schlerotherapy -the injection of an irritant to close a vein. Schlerotherapy is effective on small veins. However, with larger veins it has a high reoccurrence rate.

Q. How does ELVeS laser treatment work?
  ELVeS is a minimally invasive procedure where laser energy is delivered to the faulty Great Saphenous vein, causing it to close. There are many veins in the leg. So, after treatment, the body simply re-routes blood-flow through other healthy veins.
Q. What is the actual procedure like?
  The ELVeS procedure takes about 45 minutes and is usually preformed in your physician's office. No general anesthesia is required, just a local anesthetic. Your physician will insert a thin flexible fiber through a sheath into the faulty vein. The laser light will then be emitted through the fiber. As thermal laser energy is administered, the vein will close from the inside. only minimal discomfort, if any, should experienced
Q. How soon will I be able to resume normal activities?
  Normal activities can be resumed immediately after ELVeS treatment, with the exception of rigorous exercise.
Q. Will my insurance cover it?
  Some policies will cover the procedure, at least partially, and others will not. Check your policy and call your insurance provider to find out what their exact coverage will be.
   
 
Don't let venous insufficiency keep you from enjoying life fully, it's time to do something about it. Ask your physician about the ELVeS procedure and find out if it's right for you.

Benign, Non-Contagious Skin Disorders

DERMATOFIBROMAS

Deramtofibromas are benign, relatively common skin nodules that may occur on any body surface, but appear most frequently on the lower legs. They form a firm, fibrous growth that feels like a small button or pea fixed to the skin surface. The cause is unknown, although trauma, such as insect bites, has been thought to induce some lesions.

Treatment

No treatment is necessary unless the lesions enlarge rapidly, become painful, or undergo repeated trauma, such as shaving the top off while shaving one’s legs. The lesions can be easily removed by minor surgical excision in a dermatologist's office. When considering removal, one should balance the present appearance of the dermatofibroma with the probable scar that will remain after the excision.

 

GRANULOMA ANNULARE

Granuloma annulare is a benign, non-contagious skin condition most commonly seen in children and young adults. It usually presents as skin colored, red-to-purple, dome shaped papules, often arranged in a complete or half circle. The most common location is on the backs of the hands, tops of the feet, ankles, wrists, elbows, arms, and legs. Because of the circular appearance, occasionally a fungus infection (ringworm) is mistakenly suspected. Usually the bumps do not itch or hurt.

When the appearance is not typical, a skin biopsy may be needed to establish the diagnosis. The biopsy shows a localized deterioration of the supporting collagen fibers in the dermis (the middle layer of skin).

Treatment

The cause of granuloma annular is not known, but we do know that the lesions usually resolve within two years. There are several treatments which may hasten the resolution in cases where appearance is a concern. In summary, granuloma annulare is an interesting skin condition, but it is neither serious nor contagious.

 

LIPOMAS

Lipomas are common, benign tumors, composed of mature fat cells, which grow under the skin and typically appear as round or oval lumps. These growths are generally harmless, and it is doubtful whether they ever undergo malignant changes. While they may occur anywhere on the body, they typically show up on the neck, trunk, abdomen, forearms, buttocks, and thighs.

How can you tell a lipoma from a potentially serious problem?

You can't. If you have a mysterious lump or new growth, it warrants professional examination. Some growths may be diagnosed visually, but for some, your dermatologist may need a biopsy to be certain. Skin cancers are among the most easily cured cancers if they are diagnosed and treated early.

Treatment

Treatment is usually not required unless there is a notable change in the lump. In such cases, a biopsy may be recommended. Generally, removal is only recommended if the lipoma causes pain, pressure, irritation, or if it is growing. Some people also choose to have a lipoma removed for cosmetic reasons. Liposuction and surgical excision are both effective means of removing lipomas.

 

PITYRIASIS ROSEA

Pityriasis rosea is a common, harmless skin disease. Pityriasis rosea often begins with the appearance of a scaly, large, pink, "herald" or "mother" patch on the chest or back. This is followed by more pink, oval patches on the body, arms, and legs within a week or two that may assume the outline of an evergreen tree with drooping branches.

The cause is unknown, but we do know that:

  • A single scaling spot often appears 1-20 days before the general rash. The rash covers mainly the trunk, but may spread to the thighs, upper arms, and neck. Pityriasis rosea usually avoids the face; sometimes a few spots spread to the cheeks.
  • Pityriasis rosea is not contagious.
  • Pityriasis rosea clears up in about three to six weeks, sometimes a little longer. When clear, the skin returns to its normal appearance. There will be no scars.
  • About half of those afflicted with pityriasis rosea also experience severe itching. Some experience tiredness and aching before the rashes fade.
  • Pityriasis rosea is not related to food, medicines, or nervous upsets.
  • Pityriasis rosea always disappears by itself.
  • While pityriasis rosea may occur at any age, it is most common between the ages of 10 and 35 years.
  • Second attacks of pityriasis rosea are rare.

Treatment

Nature always cures this disorder, albeit sometimes slowly. Treatment doesn’t speed the cure. The rash of pityriasis rosea is irritated by soap, so bathe or shower with plain water. This rash makes the skin dry. Therefore, it helps to put a thin coating of bath oil on your freshly dried skin after a shower or bath.

If the rash itches, treatment with a cortisone cream usually brings prompt relief. The cortisone treatments do not cure pityriasis rosea; it will only make you more comfortable while getting over the rash. In the rare instances where itching is severe, ultraviolet light treatments are often helpful.

Pigmentation Disorders

HYPERPIGMENTATION

The appearance of skin patches that are darker that the surrounding skin color is usually caused by natural body processes, and sometimes by external causes. The term for this skin darkening is epidermal hyperpigmentation. Epidermal refers to the upper layer of the skin. Hyperpigmentation means excess color.

Normal skin color is formed by melanin, a natural pigment that also determines eye and hair color. Epidermal hyperpigmentation occurs when too much melanin is produced and forms deposits in the skin. The condition is quite common and can affect the skin color of people of any race.

Is hyperpigmentation harmful?

Hyperpigmentation is not a medically harmful condition. It is advisable, however, to have darkened skin patches checked by a physician to make sure they are not a type of skin cancer. Usually people seek treatment for hyperpigmentation because it is cosmetically displeasing to them. Skin lightening products prescribed by a physician can reduce the unwanted excess color of hyperpigmented skin patches.

Types of epidermal hyperpigmentation.

Although all hyperpigmenation is a result of excess melanin, different names are used to describe it based on the cause of the excess melanin production and its appearance on the skin.

  • Melasma. Melasma is a skin coloration that appears as blotchy brown spots often occurring on the cheeks, forehead, or temples. The condition is usually associated with hormonal changes. Pregnancy, for example, can trigger over production of melanin causing the mask of pregnancy on the face and on the darkening of skin on the abdomen and other areas. This facial hyperpigmentation sometimes occurs with menopause too. Women who take birth control pills also may develop this type of hyperpigmentation because their bodies undergo the same kind of hormonal changes that occur during pregnancy. Another name for melasma is chloasma.
  • The "Mask of Pregnancy"

A new mother may find that moles and other pigmented lesions on her face may have gotten darker and enlarged during her pregnancy due to increased melanin production. While they may either retain their darkened color or fade over the six months following delivery, moles that look multipigmented or that have irregular borders should be examined to rule out skin cancer.

  • Age spots and liver spots. Age spots and liver spots are small darkened patches on the skin of older adults who have been regularly exposed to the sun over many years. Usually the face and the backs of the hands are most affected by these spots, which may have a somewhat depressed surface. Solar lentigines (or lentigo) is a medical name for this naturally occurring condition. It is usually light complexioned people with a tendency to burn, rather than tan, who develop age spots in later years.
  • Freckles. Freckles are small, flat, tan to brown spots that can by anywhere on the body. Often a hereditary characteristic, freckles can darken with sun exposure and fade when there is little exposure to sunlight.
  • Post inflammatory Hyperpigmentation. Post inflammatory hyperpigmentation may occur following any process that causes skin inflammation. For example, skin diseases such as acne or shingles may leave darkened spots after the condition clears up. Scars from skin injury or surgery may also become hyperpigmented. Cosmetic procedures such as chemical peels and dermabrasion may also leave the affected area darker that the normal skin color.

To avoid hyperpigmentation avoid the sun

Hyperpigmented skin patches may become more pronounced when skin is exposed to the sun. This happens because the skin’s pigment, melanin, absorbs the energy of the sun’s harmful ultraviolet rays in order to protect the skin from overexposure. Skin tanning occurs as a result of this process, causing hyperpigmented areas to become even darker.

Minimizing your exposure to sunlight can help prevent further darkening of existing hyperpigmented patches, as well as the formation of new ones. This is especially important for women who take birth control pills or hormone supplements and for people who have had hyperpigmentation in the past. To protect your skin, dermatologists recommend the use of a sunscreen product with an SPF(sun protection factor) of at least 15 that protects against both UVA and UVB light. A sunscreen should be used year-round on areas of the skin that are regularly exposed to sunlight such as the face and hands. Many skin moisturizers and cosmetics contain sunscreens, providing an easy way to make sure your skin is protected. Wearing long-sleeved clothing, long pants, and hats can also block the effects of sunlight exposure.

Treatment

To help patients with hyperpigmentation achieve more even skin tone, physicians may prescribe the use of skin bleaching products. Skin bleaches slow the production of melanin, causing dark spots to gradually fade and return to normal skin color. These skin medications must be applied regularly, usually twice a day to be effective. The skin lightening process may take several months to achieve the desired results.

 

The active ingredient in skin lightening products is called hydoquinone. The maximum prescription strength is 4% hydroquinone, which contains twice the amount of active ingredient as over-the-counter bleaches. Some hydroquinone products contain sunscreens or sunblock, so you don’t have to bother with applying a separate sun protection product. Hydroquinone may also be combined with glycolic acid for its skin moisturizing benefits. Ask your physician about skin bleaching medications and whether one is right for treating your hyperpigmented skin patches.

 

VITILIGO

Melanin is the substance that normally determines the color of skin, hair, and eyes. It is the pigment produced in cells called melanocytes. If melanocytes cannot form melanin or if their number decreases, skin color will become lighter or completely white-as in vitiligo.

Vitiligo is a condition in which pigment cells are destroyed, resulting in irregularly shaped white patches on the skin. Any part of the body where pigment cells are present may be involved.

Common sites of pigment loss are:

  • Eposed areas-face, neck, eyes, nostrils, nipples, navel, genitalia
  • Body folds-armpits, groin
  • Sites of injury-cuts, scrapes, burns
  • Surrounding pigmented moles
  • Hair-early graying of hair on scalp, graying of hair in some areas of vitiligo other than the scalp.
 

Who gets vitiligo?

Vitiligo affects at least 1% of the population. About half the people who develop this skin disorder experience some pigment loss before they are 20 years old. About one fifth of all vitiligo patients say that other family members also have this condition.

Even though most people with vitiligo are in good general health, they face a greater risk of having:

  • Hyperthyroidism and hypothyroidism-increases or decreased thyroid function
  • Pernicious anemia-Vitamin B12 deficiency
  • Addison’s Disease-decreases adrenal gland function.
  • Alopecia areata-round patches of hair loss

What is the cause of vitiligo?

The cause of vitiligo is not known. Many people have reported a pigment loss shortly after suffering emotional stress or physical injury such as sunburn. There are three theories on the cause of vitiligo.

  1. Abnormally functioning nerve cells may injure nearby pigment cells
  2. The body may destroy its own tissue (an autoimmune reaction). Researchers speculate that the pigment in cells may be destroyed in response to a substance the body perceives as foreign.
  3. Some researchers believe that pigment-producing cells are self-destructive (autotoxic). While new skin cells form, the body produces highly toxic by-products which may destroy pigment cells.

How does vitiligo develop?

The beginning of vitiligo and the severity of pigment loss differs with each individual. Light skinned people usually notice the pigment loss during the summer as the contrast between the vitiligo skin and the suntanned skin becomes more distinct. People with dark skin may observe the onset of vitiligo any time. Individuals who have severe cases will lose pigment over their entire bodies, except for their eyes which do not change color. There is no way to predict how much pigment an individual will lose. Illness and stress can result in more pigment loss.

The degree of pigment loss can vary within each vitiligo patch which means that there may be different shades of pigment in a vitiligo patch. A border of darker skin may circle an area of light skin.

Can cosmetics be used to make vitiligo less noticeable?

Most patients, even those who are responding well to therapy, would like to make the vitiligo less obvious. Many find that a combination of cosmetics effectively de-emphasizes their skin disorder. Patients who are interested in dyes and stains should consult a dermatologist for the names of suitable commercial products.

Treatment

Vitiligo is probably caused by a variety of factors interacting in specific ways. Research has advanced the understanding of the physical and phychosocial aspects of vitiligo, but the cause and cure for this disease are unknown.

Common Childhood & Adolescent Skin Disorders

CHILDHOOD ECZEMA (atopic dermatitis)

Atopic dermatitis, often called eczema, or atopic eczema, is very common skin disease. It affects around 10% of all infants and children. The exact cause is not known, but atopic dermatitis results from a combination of family heredity and a variety of conditions in everyday life that trigger the red, itchy rash.

How do we know if it is atopic dermatitis?

  • Time of onset. This type of eczema usually begins during the first year of life and almost always within the first five years. It’s seldom present at birth, but it often comes on after six weeks. Other rashes also can start at that time, so it may be confusing at first but most rashes disappear within a few days to weeks. Atopic dermatitis tends to persist. It may wax and wane, but it keeps coming back.
  • Itching. Atopic dermatitis also is a very itchy rash. Much of the skin damage comes from scratching and rubbing that the child cannot control.
  • Location. The location of the rash also helps us recognize atopic dermatitis. In babies, the rash usually starts on the face or over elbows or knees, places that are easy to scratch and rub. It may spread to involve all areas of the body, although the moist diaper region is often protected. Later in childhood the rash is typically in the elbows and knee folds. Sometimes, it only affects the hand, and at least 70% of people with atopic dermatitis have had eczema at some time in their life. Rashes on the feet, scalp, or behind the ears are other clues that might point to atopic dermatitis.
  • Appearance. The appearance of the rash is probably the least helpful clue because it may be very different from one person to another.
  • Heredity. If other family members or relatives have atopic dermatitis, asthma, or hay fever, the diagnosis of atopic dermatitis is more likely.

What causes atopic dermatitis?

Atopic dermatitis is not contagious. People with atopic dermatitis cannot “give” it to someone else. Atopic dermatitis inflammation results from too many reactive inflammatory cells in the skin. Research is seeking the reason why these cells over-react. Patients with atopic dermatitis (or asthma or hay fever) are born with these over-reactive cells. When something triggers them, they don’t turn off as they should. We try to control atopic dermatitis by preventing the trigger factors that turn on the inflamed skin, or by “damping the flames” with anti-inflammatory therapies.

What triggers atopic dermatitis?

Trigger factors may be different for different people. Most children are worse when they have a cold or other infection. Most have worse problems in the winter; but others simply can’t stand the sweating during hot, humid summer weather. Let’s look at the trigger factors that seem to affect every child with atopic dermatitis.

  • Dry skin
  • Irritants
  • Stress
  • Heat and sweating
  • Infections
  • Allergens

How can you avoid triggers?

  1. Keep the skin barrier intact. MOISTURIZE
  2. Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material.
  3. If sweating causes itch, find ways to keep cooler. Such as:
  4. Reduce exertion, especially during times of flare.
  5. Layer clothing and adjust temperature settings.
  6. Don’t overheat rooms, especially the bedroom.
  7. Use light bedclothes.
  8. When itching from sweating, dust, pollen, or other exposures, take a cooling shower or tub bath.
  9. Learn to recognize signs of infection and treat early.

If you suspect food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat, and seafood, but any food can do it. Can you exclude the most likely offender for a week? Substitute hydrolysate for cow formula. Keep a food diary. When the skin clears up, try the food. Watch for signs if itching or redness over the next two hours. Do not try a suspect food if it causes hives or face swelling. Don’t exclude multiple food groups at the same time. It is rare to have more than one or two food allergies, and your child can get malnourished with prolonged avoidance of many foods.

With allergy-prone kids, furry animals are a risk. If you must have pets, keep    them outside or at least off beds, rugs, and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include covering pillows and mattresses, removing bedroom carpets and frequent washing of bedclothes in hot water.

Think about stress-causing events and ways to cope with them. Review problems with your doctor. Try to make atopic dermatitis treatments part of a daily, family routine. Encourage children with atopic dermatitis to do what they can on their own.

Treatment

  • Moisturizers. Ointments such as petroleum jelly (such a Vasoline) are best unless they are too thick and cause discomfort. Creams may be fine for moderately dry skin or in hot, humid weather. Apply them to wet skin, immediately after bathing. Lotions and oils are not rich enough and often have a net drying effect on atopic dermatitis on skin.
  • Corticosteroids. Often called topical (applied to the skin) steroids, these are cortisone-like-medications used in creams or ointments which your doctor may prescribe (Hydrocortisone, Desonide, Triamcinolone). They are not the same as the dangerous “steroids” some athletes misuse. Cortiscosteroid medicines are very helpful. Often they are the only treatment that can calm the inflamed skin.

Use of steroid ointments and creams requires good judgement and careful supervision. They come in strengths from mild to super-potent. Hydrocortisone is quite safe. The more potent ones can cause thinned skin, stretch marks, and other problems if used too many days in the same areas of the body. Parents should monitor the child’s use. Ask the doctor about potency and side effects of prescribed corticosteroid medicines.

  • Antibiotics. Oral or topical antibiotics reduce the surface bacterial infections that may accompany flares of atopic dermatitis.
  • Antihistamines. Often prescribed to reduce itching, these medicines may cause drowsiness but seem to help some children.
  • Tar preparations. Tar creams or bath emulsions can be helpful for mild inflammation.

When will my child outgrow atopic dermatitis?

For any given child, it is difficult to predict. The majority of babies with atopic dermatitis will lose most of the problem by adolescence, often before grade school. A small number will have severe atopic dermatitis into adulthood. Many have remissions that last for years. The dry skin tendency will remain. Most people learn to use moisturizers to keep their dermatitis controlled. Occasional episodes of atopic dermatitis may occur during times of stress or with jobs that expose the skin to irritants at work.

 

IMPETIGO

Impetigo is a skin infection caused by bacteria, usually staph or strep. Impetigo is contagious. The condition starts as a tiny, barely perceptible blister on the skin usually at the site of a skin abrasion, scratch, or insect bite. Over the next few days, red and itchy sores begin to ooze, leaving behind a sticky golden crust spots that grow larger day by day. The hands and face are the favorite locations for impetigo, but it often appears on other parts of the body.

Parents should keep a watchful eye

Parents should not let impetigo run its course, as it may continue indefinitely without treatment. In rare cases, impetigo can lead to a form of kidney disease known as acute glomerulonephritis.

Cuts and scrapes on a very young child will likely be noticed as the parent bathes the child. Unfortunately, after children reach a certain age and bathe alone, they tend to demand privacy for their bodies. It is important that parents teach their children to report any unusual rashes, bumps, or irritations to them so that care may be taken to avoid infection.

and is contagious.

How does one get impetigo?

While the germs causing impetigo may have been caught from someone else with impetigo it usually begins out of the blue without an apparent source of infection.

Contagion

Impetigo is contagious when there is crusting or oozing. While it’s contagious, take the following precautions:

  • Patients should avoid close contact with other people.
  • Children should be kept home from school for 1-2 days.
  • Use separate towels for the patient. His towels, pillowcases, and sheets should be changed after the first day of treatment. The patient’s clothing should be changed and laundered daily for the first two days.

All these measures are only needed during the contagious-crusting or oozing-stage of impetigo. Usually, the contagious period ends within two days after the treatment starts. Then children can return to school and special laundering and other precautions stopped. If the impetigo doesn’t heal in one week, please return for evaluation.

Treatment

Antibiotics taken by mouth usually clear up impetigo in four to five days. It’s most important for the antibiotic to be taken faithfully until the prescribed supply is completely used up. In addition, an antibiotic ointment should be applied thinly four times daily. Bacitracin, Polysporin of Bactroban ointment is advised. Bacitracin and Polysporin can be purchased without a prescription.

Keys to making treatment successful include:

  • Crusts should be removed before ointment is applied.
  • Soak a soft, clean cloth in a mixture of ½ cup of white vinegar and a quart of luke warm water.
  • Press this cloth on the crusts for 10-15 minutes three to four times a day as long as you see crusting or oozing.
  • Then gently wipe off the crusts and smear on a little antibiotic ointment.
  • You can stop soaking the impetigo when crusts no longer form.
  • When the skin has healed, stop the antibiotic ointment.

 

KERATOSIS PILARIS

Keratosis pilaris is a common skin disorder which may affect the sides of the upper arms, the anterior thighs and the face. It usually appears between the ages of two and three, but may only become noticeable later, usually in the wintertime. In fact, most people with keratosis pilaris notice that it improves in the summer and worsens in the winter.

Generally, the typical changes in the skin are rough-surfaced, slightly red bumps, each of which is at the opening of a hair follicle. This is probably an inherited trait just as some people inherit curly hair or blue eyes. It is really harmless, but may be somewhat unsightly and may occasionally itch slightly.

Treatment

Fortunately, the keratosis pilaris on the face almost always disappears within a year or two after the onset of puberty. The other areas may remain a problem for many years. Treatment is never rapidly effective, but is usually beneficial. Several different medications may need to be tried before the one that works best for you is found. Besides prescription medicines, you can help yourself by regularly using a good moisturizing cream or lotion on the affected areas.

 

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a virus-caused growth which appears as a small bump on the skin, often with a small, central, dimple-like depression. It may occur on any part of the body and there may be a single growth or as many as 50 or more.

As the name suggests, these growths are contagious and are spread from place to place on the body and to other people by physical contact. Sometimes they are spread by sexual contact and if this is the case, sexual partners should be examined for presence of lesions.

Treatment

Treatment consists of physically removing these superficial growths from the skin. This may be done by curettement (scraping them off with a special surgical instrument), application of various medicines to the growths or by freezing them with liquid nitrogen. Molluscum contagiosum lesions may also become infected with bacteria and may sometimes require antibiotic therapy. Since molluscum contagiosum lesions sometimes go away by themselves, treatment by cautery or surgery requiring stitches is avoided because of the scarring that results from these methods.

Sometimes new lesions keep appearing after treatment. This is probably because some growths were in an early stage at the time of the treatment and could not be seen with naked eye. Eventually, after all visible and incubating lesions have been destroyed the appearance of new molluscum contagiosum lesions will stop.

 

SCABIES

Scabies is a highly contagious, but curable, skin disease that affects nearly one third of a billion people worldwide. It is caused by a tiny mite, just barely visible to the naked eye, that spends nearly its entire life in or on the human skin.

Although more common in warm climates, scabies can occur anywhere and within all social and income levels. It affects men, women, and children of all ages.

Prevention Transmission

Scabies is highly contagious and easily transmitted from person to person through close physical contact, such as between family members, sexual partners, or children playing at school. An unproven, but possible method of transmission is via infested clothing, bedding and towels.  To avoid reinfestation, you doctor may recommend that all affected household members be treated at the same time with the same 24 hour period.

Although scabies mites can’t live long without a human host, there have been a few cases of apparent transmission through infested clothing and bedding. Even so, heroic cleaning efforts are generally unnecessary. Normal hot water laundering of towels, linens, and all clothing used within the previous 48 hours is typically sufficient to prevent reinfestation. Clean clothes or heavy winter jackets and sweaters need not be cleaned.

Treatment

Please see a physician or dermatologist for treatment options.

Pigmentation Disorders

ALLERGIC CONTACT DERMATITIS

Contact dermatitis is a condition in which people develop an allergy to a product or substance that comes in contact with the skin.  The condition is usually manifested as a rash on the skin and can occur on the face and eyelids, a condition called eyelid and facial contact dermatitis.

The usual suspect: Nickle

A common irritant responsible for allergies includes nickle. Nearly 6% of Americans are allergic to nickel, making the silver-white metal the second most common cause of allergic skin rashes, behind only poison ivy. The incidence of nickel sensitivity among women is higher than the average, probably around 10 percent. Other common cosmetic ingredients responsible for allergic contact dermatitis:

  • Preservatives (parabens, phenyl mercuric acetate, imidazolindnyl urea, quaternium-15, potassium sorbate)
  • Resins (colophony)
  • Pearlescent Additives (bismuth oxychloride)
  • Antioxidants (butylated hydroxyanisole, butylated hydroxytoluene, di-tert-butyl-hydroquinone)
  • Emollients (lanolin, propylene glycol)
  • Fragrences
  • Pigmented Contaminants (nickel)

An unusual suspect: Latex

Natural rubber latex is responsible for a recent and widespread outbreak of allergic skin reactions, ranging from mild irritation to anaphylactic shock. Latex reactions were rarely reported prior to 1970, but increasing numbers of reports since the late 1980's have led scientists to believe that increased exposure to latex products in recent years has caused more people to become sensitized. About a third of those who develop hives from contact with latex also develop such symptoms as asthma and even anaphylactic shock. This should lead people who suspect they are allergic to latex to have a professional diagnosis.

Finding the culprit

Finding the source of the allergy requires some good detective work. Have you recently changed fragrance? Have you use a new soap, shampoo, or laundry detergent? Has the same brand you've always used been reformulated? If you have recurrent problems, try keeping a diary of the products you use, and note when the symptoms start to appear and/or stop.

Should you develop a contact dermatitis, see your dermatologist for relief. He/she can perform a patch test to determine the irritating substance. If you suspect a nickel allergy, it is a good idea to have the dermatologist test for nickel sensitivity when considering having ears pierced. In any case, the piercing should be done with a stainless-steel needle. As a further precaution, stainless-steel or high-quality 18 karat gold studs should be worn as the first pair of earrings. Nickel sensitivity often does not result in a rash for weeks or months after contact with the metal. To further confuse the issue, a rash may not necessarily occur on the part of the body that makes contact with the metal.

 

HIVES (URTICARIA)

Hives are localized pink swellings (wheals) that occur in groups on any part of the skin. Each individual wheal lasts a few hours before fading away, leaving no trace. New hives may continue to develop as old areas fade. Hives can vary in size from as small as a pencil eraser to as large as a dinner plate and may join together to form larger swellings. When hives are forming they usually are very itchy, but may also burn or sting.

Hives are a very common medical condition; 10-20% of people will have at least one episode of hives in their lifetime. In most people, hives go away within a few days to a few weeks. Occasionally, however, a person will continue to have hives for many years.

When a hive forms around the loose tissues of the eyes, lips, or genitals, the tissue may swell excessively. Although frightening in appearance, the swelling goes away in less than 24 hours.

The most common foods that cause hives are:

1. Nuts                                 5. Chocolate

2. Fish                                 6. Tomatoes

3. Eggs                                7. Fresh Berries

4. Milk

Fresh foods cause hives more often than cooked foods. Food additives and preservatives such as tartrazine (yellow dye #5) may be responsible. Hives may appear within minutes or several hours after eating, depending on the site in the digestive track where the food is absorbed into the system.

Drugs

Virtually any medication (prescription or over the counter) can cause hives, but drugs that most commonly produce urticaria include antibiotics (especially penicillin), pain medications, sedatives, tranquilizers, and diuretics. It is important to realize that antacids, vitamins, eye and ear drops, laxatives, vaginal douches, or any other non-prescription item is a potential cause of urticaria. It is important for your doctor to be aware of all these preparations you use.

Infections

Many infections can cause urticaria. Viral upper respiratory tract infections are a common cause in children. Other viruses including Hepatitis B may also cause urticaria, as can a number of bacterial and fungal infections.

 

Chronic Urticaria

Bouts of hives lasting more than six weeks are termed chronic urticaria. The underlying cause of chronic urticaria is usually much more difficult to identify than that of acute urticaria. In many studies of patients with chronic urticaria, a cause can be identified in only a small percentage of patients. Your doctor will need to ask numerous questions in an attempt to identify a possible cause. You will also be asked to help in detective work. The amount of lab work performed by your doctor will vary with your history and examination. A patch test can be performed to determine the cause of hives. Lab work is may also be suggested.

Treatment

The best treatment for hives is to find the cause and then to eliminate it. Unfortunately, this is not always possible. While investigating the cause of urticaria, or when a cause cannot be found, antihistamines are given for relief. Antihistamines work best if taken on a regular schedule to prevent hives from forming. In severe cases of hives, an injection of epinephrine (Adrenalin) may be given. Oral cortisone preparations may also bring dramatic relief in severe cases, but their administration must be limed to short periods of time.

 

LYME DISEASE

Lyme disease is an infection that is caused by a corkscrew-shaped bacterium known as a spirochete. Unlike a lot of other infections, Lyme Disease may not be confined to one area of the body. It may begin as a simple skin rash but, if left untreated, can spread to the nervous system, the heart, and the joints.

Lyme Disease was first identified in 1975 in the town of Lyme, Connecticut. Since then, it has been found throughout most of the United States.

How do I get it?

Lyme Disease is spread by tick bites. These ticks live in or near wooded areas, tall grass, or brush areas. They hitch rides on household pets or other animals, which then bring the ticks into our own backyards. The ticks are always on the lookout to feed off birds, mice, deer, or humans.

The threat of Lyme Disease lasts from spring to fall, summer being the high-risk season. There are three regions of the country where most of the cases have been reported: Northeast, the upper Midwest, and the Northwest.

How do I know if I have Lyme disease?

Probably the most noticeable sign of early Lyme disease is a rash the often looks like a bull’s-eye, or an expanding red circle with lighter area in the center (where the bite occurred). This sometimes burning or itchy rash is called erythema chronicum migrans (chronic migrating red flush), or ECM for short. It often appears on the thigh, in the groin, or in the armpit. ECM doesn’t always look like a bull’s-eye; it sometimes appears as a single red rash or many small rashes.

Other signs of early Lyme Disease are flu-like symptoms such as malaise, fatigue, chills, fever, headache, and sore throat and enlarged glands. If the disease is not treated promptly, it may ultimately involve the heart, the nervous system, and the joints. Symptoms involving the heart include lightheadedness, fainting, rapid heartbeat, and difficult or labored breathing. Nervous system symptoms include headache, stiff neck, difficulty concentrating, poor memory, dizziness, earache, numbness, or visual disturbances. Lyme disease can cause arthritis in the joints-most often in the knees-and can sometimes, but rarely, leave permanent damage.

Important: Not everyone gets every symptom. Some may develop late disease symptoms such as arthritis without ever having experienced early disease symptoms such as ECM and fatigue.

How can I prevent Lyme Disease?

The old adage “an ounce of prevention is worth a pound of cure” bears keeping in mind. If you don’t let the ticks bite you, you can’t get Lyme disease. Here are some ways to prevent tick bites.

  • Stay clear of wild animals
  • Stay clear of tall grass, shrubs, trees, and other potentially tick-infested areas.
  • You may wish to consider using insect repellents containing DEET (listed as diethyl-meta-toluamide). Repellents containing permethrin are also effective.
  • Wear long pants, a long sleeved shirt, and a hat-all light colored (easier to spot ticks)-when going into “risky area.” Also, make sure pants are tucked into socks.
  • Make body checks after any outdoor activity, and look for “moving freckles,” especially on children.
  • Get tick collars for dogs and cats. Also inspect pets regularly for ticks.

Treatment

Lyme disease can be treated very effectively in the early stage. Certain oral antibiotics (tablets or capsules) have been shown to be effective for adults. Pregnant women and children are usually treated with Penicillin. Patients in later stages of Lyme Disease may require antibiotics injected into muscles or veins. Although antibiotics play an important role in treating Lyme Disease once it occurs, prevention is really the best treatment.

 

PITYRIASIS ROSEA

Pityriasis rosea is a common, harmless skin disease. Pityriasis rosea often begins with the appearance of a scaly, large, pink, "herald" or "mother" patch on the chest or back. This is followed by more pink, oval patches on the body, arms, and legs within a week or two that may assume the outline of an evergreen tree with drooping branches.

The cause is unknown, but we do know that:

  • A single scaling spot often appears 1-20 days before the general rash. The rash covers mainly the trunk, but may spread to the thighs, upper arms, and neck. Pityriasis rosea usually avoids the face; sometimes a few spots spread to the cheeks.
  • Pityriasis rosea is not contagious.
  • Pityriasis rosea clears up in about three to six weeks, sometimes a little longer. When clear, the skin returns to its normal appearance. There will be no scars.
  • About half of those afflicted with pityriasis rosea also experience severe itching. Some experience tiredness and aching before the rashes fade.
  • Pityriasis rosea is not related to food, medicines, or nervous upsets.
  • Pityriasis rosea always disappears by itself.
  • While pityriasis rosea may occur at any age, it is most common between the ages of 10 and 35 years .
  • Second attacks of pityriasis rosea are rare.

 

POISON IVY, SUMAC, AND OAK RASHES

Poison ivy rash is really an allergic contact dermatitis caused by a substance called urushiol, found in the sap of poison ivy, poison oak, and poison sumac. Urushiol is a colorless or slightly yellow oil that oozes from any cut, or crushes part of the plant, including the stem and the leaves.

You may develop a rash without ever coming into contact with poison ivy, because the urushiol is so easily spread. Sticky and virtually invisible, it can be carried on the fur of animals, on garden tools, or sports equipment, or on any objects that have come into contact with a crushed or broken plant. After exposure to air, urushiol turns brownish-black, making it easier to spot. It can be neutralized to an inactive state by water.

Once it touches the skin, the urushiol begins to penetrate in a matter of minutes. In those who are sensitive, a reaction will appear in the form of a line or a streak of rash (sometimes resembling insect bites) within 12-48 hours. Redness and swelling will be followed by blisters and severe itching. In a few days, the blisters become crusted and begin to scale. The rash will usually take about ten days to heal, sometimes leaving small spots, especially noticeable in dark skin. The rash can affect almost any part of the body, especially areas where the skin is thin; the soles of the feet and palms of the hands are thicker and less susceptible.

Recognizing poison ivy

Identifying the plant is the first step toward avoiding poison ivy. The popular saying “leaves of the three, let them be” is a good rule of thumb, but it’s only partially correct. Poison oak or poison ivy will take on a different appearance depending on the environment. The leaves may vary from groups of three, to groups of five, seven, or even nine.

Poison oak is found in the West and Southwest, poison ivy usually grows east of the Rockies, and poison sumac east of the Mississippi River. The plants grow near streams and lakes and wherever there are warm humid summers.

Poison ivy grows as a low shrub, vine, or climbing vine. It has yellow-green flowers and white berries. Poison oak is a low shrub or small tree with clusters of yellow berries and the oak-like leaves. Poison sumac grows to a tall, rangy shrub producing 7-13 smooth-edged leaves, and cream colored berries. These weeds are most dangerous in the spring and summer. That’s when there is plenty of sap and urushiol content is high, and the plants are easily bruised. Although poison ivy is usually a summer complaint, cases are sometimes reported in winter, when the sticks may be used for firewood, and the vines for Christmas wreaths. The best way to avoid these toxic plants is to know what they look like in your area and where you work, and to learn to recognize them in all seasons

Treatment

If you think you’ve had a brush with poison ivy, poison oak or poison sumac, follow this simple procedure:

  1. Wash all exposed areas with cold running water as soon as you can reach a stream, lake or garden hose. If you can do this within five minutes, the water will neutralize or deactivate the urushiol in the plant’s sap and keep it from spreading to other parts of the body. Soap is not necessary and may even spread the oil.
  2. When you return home, wash all clothing outside, with a garden hose, before bringing it into the house where resin could be transferred to rugs or furniture. Handle the clothing as little as possible until it is soaked. Since urushiol can remain active for months, it’s important to wash all camping, sporting, fishing or hunting gear that may also be carrying resin.
  3. If you do develop a rash, avoid scratching the blisters. Although the fluid in the blisters will not spread the rash, fingernails may carry germs that could cause infection.
  4. Cool showers will help ease the itching and over-the-counter preparations, like calamine lotion, or Burrow’s solution, will relieve mild rashes. Soaking in a lukewarm bath with an oatmeal or baking soda solution is often recommended to dry oozing blisters and offer some comfort. Over-the-counter hydrocortisone creams will not help. Dermatologists say they aren’t strong enough to have any effect on poison ivy rashes.

In severe cases, prescription corticosteroid drugs can halt the reaction if taken soon enough. If you know you’ve been exposed and have developed severe reactions in the past, be sure to consult your dermatologist.   She may prescribe steroids, or other medications, which can prevent blisters from forming.

 

TINEA VERSICOLOR

Tinea Versicolor is a common rash usually found on the upper body and arms in the form of slightly scaly discolored spots and patches. It is caused by a fungus which is found on nearly everyone’s skin, but causes a rash only on certain people. Why one person gets the rash and another person does not is unknown. Exposure to the sunlight or perspiration may make the rash worse, but it is very uncommon for it to spread to the face. It usually does not produce itching or other symptoms.

Preventing Recurrences

Since the fungus is very common, it is quite possible to develop the rash again. Vigorously scrubbing the upper body and arms once a week with a selenium sulfide shampoo (Selsun Blue) or a zinc-pyrithione shampoo (Head and Shoulders) or a similar brand may prevent recurrences. If the rash develops again in spite of this measure, please see a dermatologist.

Treatment

The Cheyenne Skin Clinic offers two common treatments:

  • Oral medications. Antifungal medications are the most effective method to kill the fungus. Be aware that even if the fungus has been killed, a blotchy discoloration may persist for several months.
  • Topical treatment . A topical treatment with selenium sulfide is available. The over the counter strength is not usually strong enough, but a prescription strength is available. After an evening shower apply the selenium sulfide lotion to the skin of the trunk from the neck down to the waist or knees and on the arms and wrists. Allow it to dry and wash it off in the morning in the shower. Repeat this application once a week for one month. Also use the lotion to shampoo the scalp once a week.

Sun and Your Skin

INTRODUCTION TO SUN DAMAGE

Soaking up the sun’s rays used to be considered healthy…before we learned about the dangers of ultraviolet rays. Sunlight can be used to treat some skin diseases, but we all need to avoid overexposure to the sun. Too much sun can cause wrinkles, freckles, skin texture changes, dilated blood vessels, and skin cancers.

The sun’s rays

The sun produces both visible and invisible rays. The invisible rays, known as ultraviolet A (UVA) and ultraviolet B (UVB), cause most of the problems. Both cause suntan, sunburn and sun damage. There is no safe UV light.

Harmful UV rays are more intense in the summer, at higher altitudes, and closer to the equator. The sun’s harmful effects are also increased by wind and reflections from water, sand, and snow. Even on cloudy days UV radiation reaches the earth.

Protection from the sun

While sun damaged spots and skin cancers are almost always curable when detected and treated early, the surest line of defense is to prevent them in the first place. Here are some sun-safety habits that should be part of everyone’s healthcare:

  • Avoid unnecessary sun exposure, especially during the sun’s peak hours (10am to 4pm).
  • Seek the shade.
  • Cover up with clothing, including a broad-brimmed hat, long pants, a long sleeved-shirt, and UV-blocking sunglasses.
  • Wear a broad-spectum sunscreen with a sun protection factor (SPF) of 15 or higher. Apply 20 minutes before going outdoors and reapply after 20 minutes and then every two hours after swimming or strenuous activity.
  • Avoid tanning parlors and artificial tanning devices.
  • Examine your skin from head to toe every month.
  • Have a professional skin examination annually.

Harmful effects of the sun

  • Sunburn. Your chances of developing a sunburn are greatest between 10AM and 4pm, when the sun’s rays are strongest. It is easier to burn on a hot day, because the heat increases the effects of UV rays.

Sun protection is also important in the winter. Snow reflects up to 80 percent of the sun’s rays, causing sunburn and damage to uncovered skin. Winter sports in the mountains increase the risk of sunburn because there is less atmosphere the block the sun’s rays.

If skin is exposed to sunlight too long, redness may develop and increase for up to 24 hours. A severe sunburn causes skin tenderness, pain, swelling, and blistering. Additional symptoms like fever, chills, upset stomach and confusion indicate a serious sunburn and require immediate medical attention. If you develop a fever, your dermatologist may suggest medicine to reduce swelling, pain and prevent infection. Unfortunately, there is no quick cure for minor sunburn. Wet compresses, tub baths and soothing lotions may provide some relief.

  • Tanning. A tan is often mistaken as a sign of good health. Dermatologists know better. A suntan is actually the result of skin injury. Tanning occurs when UV rays enter the skin and it protects itself by producing more pigment or melanin. ndoor tanning is just as bad for your skin as sunlight. Most tanning salons use ultraviolet-A bulbs and studies have shown that UVA rays go deeper into the skin and contribute to premature wrinkling and skin cancer.
Dermatitis, Eczema and Psoriasis

ALLERGIC CONTACT DERMATITIS

Contact dermatitis is a condition in which people develop an allergy to a product or substance that comes in contact with the skin.  The condition is usually manifested as a rash on the skin and can occur on the face and eyelids, a condition called eyelid and facial contact dermatitis.

The usual suspect: Nickle

A common irritant responsible for allergies includes nickle. Nearly 6% of Americans are allergic to nickel, making the silver-white metal the second most common cause of allergic skin rashes, behind only poison ivy. The incidence of nickel sensitivity among women is higher than the average, probably around 10 percent. Other common cosmetic ingredients responsible for allergic contact dermatitis:

  • Preservatives (parabens, phenyl mercuric acetate, imidazolindnyl urea, quaternium-15, potassium sorbate)
  • Resins (colophony)
  • Pearlescent Additives (bismuth oxychloride)
  • Antioxidants (butylated hydroxyanisole, butylated hydroxytoluene, di-tert-butyl-hydroquinone)
  • Emollients (lanolin, propylene glycol)
  • Fragrences
  • Pigmented Contaminants (nickel)

An unusual suspect: Latex

Natural rubber latex is responsible for a recent and widespread outbreak of allergic skin reactions, ranging from mild irritation to anaphylactic shock. Latex reactions were rarely reported prior to 1970, but increasing numbers of reports since the late 1980's have led scientists to believe that increased exposure to latex products in recent years has caused more people to become sensitized. About a third of those who develop hives from contact with latex also develop such symptoms as asthma and even anaphylactic shock. This should lead people who suspect they are allergic to latex to have a professional diagnosis.

Location, location, location: Dermatitis on eyelids and faces

The skin of the face and especially the eyelid is the thinnest skin on the body and is the most susceptible to irritant and allergic contact dermatitis. Frequently, the cause is a reaction to cosmetics, either applied to the face, eyes, or in the case of nail polish, to the nails. It may be necessary to do standard patch resting and to do individual testing on the specific products that one uses.

Finding the culprit

Finding the source of the allergy requires some good detective work. Have you recently changed fragrance? Have you use a new soap, shampoo, or laundry detergent? Has the same brand you've always used been reformulated? If you have recurrent problems, try keeping a diary of the products you use, and note when the symptoms start to appear and/or stop.

Should you develop a contact dermatitis, see your dermatologist for relief. He/she can perform a patch test to determine the irritating substance. If you suspect a nickel allergy, it is a good idea to have the dermatologist test for nickel sensitivity when considering having ears pierced. In any case, the piercing should be done with a stainless-steel needle. As a further precaution, stainless-steel or high-quality 18 karat gold studs should be worn as the first pair of earrings. Nickel sensitivity often does not result in a rash for weeks or months after contact with the metal. To further confuse the issue, a rash may not necessarily occur on the part of the body that makes contact with the metal.

Treatment

  • Discontinue all facial cosmetics, previously prescribed topical medications, fragrances, and toiletries for two weeks. You may wash with plain water, Cetaphil, or Spectroderm cleansers.
  • Eliminate all sources of eyelid skin friction, such as rubbing the eyes and eyeglasses.
  • Once the dermatitis is improved, add one facial cosmetic of low allergenic potential per week in the following order: lipstick, face powder, powder blush, foundation.
  • Eyelid cosmetics should be individually tested by applying them to a one inch square area behind the right ear nightly for five nights. If no irritation develops, then the cosmetic preparation should be applied to a one inch square area lateral to the eye for five nights. They should be tested in the following order: mascara, eyeliner, eyebrow pencil, and eye shadow.
  • Over the counter treatment products and other miscellaneous skin care products designed for leave-on use should be individually tested by applying them nightly, for at least five nights to a one inch square area lateral to the eye.
  • Ask your dermatologist about new topical non-steriod medications, such as Elidel, which could improve your condition.

Tips for selecting cosmetics for sufferers of eyelid dermatitis:

  • When possible, powder cosmetics should be selected over cream or lotion formulations.
  • All cosmetics should be easily removed by water. No waterproof cosmetics should be selected.
  • Old cosmetics should be discarded and fresh product purchased.
  • Eyeliner and mascara should be selected in the color black.
  • Pencil forms of eyeliner and eyebrow cosmetics should be used.
  • Eye shadows should be selected from the light earth tones; colors such as cream and tan. Deep colors, such as blues, purples, and greens should be avoided.
  • Select cosmetics without chemical sunscreen agents (PABA, methoxycinnamates, etc.) Usually titanium dioxide can be tolerated.
  • Purchase cosmetic products with no more than ten ingredients, if possible.
  • Facial foundations should be of the cream/powder variety or, if of the liquid type, based on silicone derivatives (cyclomethicone, dimethicone).
  • Avoid nail polishes.

Dermatitis goes outside: Poison Ivy, Sumac, and Oak Rashes

Poison ivy rash is really an allergic contact dermatitis caused by a substance called urushiol, found in the sap of poison ivy, poison oak, and poison sumac. Urushiol is a colorless or slightly yellow oil that oozes from any cut, or crushes part of the plant, including the stem and the leaves.

You may develop a rash without ever coming into contact with poison ivy, because the urushiol is so easily spread. Sticky and virtually invisible, it can be carried on the fur of animals, on garden tools, or sports equipment, or on any objects that have come into contact with a crushed or broken plant. After exposure to air, urushiol turns brownish-black, making it easier to spot. It can be neutralized to an inactive state by water.

Once it touches the skin, the urushiol begins to penetrate in a matter of minutes. In those who are sensitive, a reaction will appear in the form of a line or a streak of rash (sometimes resembling insect bites) within 12-48 hours. Redness and swelling will be followed by blisters and severe itching. In a few days, the blisters become crusted and begin to scale. The rash will usually take about ten days to heal, sometimes leaving small spots, especially noticeable in dark skin. The rash can affect almost any part of the body, especially areas where the skin is thin; the soles of the feet and palms of the hands are thicker and less susceptible.

Recognizing poison ivy

Identifying the plant is the first step toward avoiding poison ivy. The popular saying “leaves of the three, let them be” is a good rule of thumb, but it’s only partially correct. Poison oak or poison ivy will take on a different appearance depending on the environment. The leaves may vary from groups of three, to groups of five, seven, or even nine.

Poison oak is found in the West and Southwest, poison ivy usually grows east of the Rockies, and poison sumac east of the Mississippi River. The plants grow near streams and lakes and wherever there are warm humid summers.

Poison ivy grows as a low shrub, vine, or climbing vine. It has yellow-green flowers and white berries. Poison oak is a low shrub or small tree with clusters of yellow berries and the oak-like leaves. Poison sumac grows to a tall, rangy shrub producing 7-13 smooth-edged leaves, and cream colored berries. These weeds are most dangerous in the spring and summer. That’s when there is plenty of sap and urushiol content is high, and the plants are easily bruised. Although poison ivy is usually a summer complaint, cases are sometimes reported in winter, when the sticks may be used for firewood, and the vines for Christmas wreaths. The best way to avoid these toxic plants is to know what they look like in your area and where you work, and to learn to recognize them in all seasons

Treatment

If you think you’ve had a brush with poison ivy, poison oak or poison sumac, follow this simple procedure:

  • Wash all exposed areas with cold running water as soon as you can reach a stream, lake or garden hose. If you can do this within five minutes, the water will neutralize or deactivate the urushiol in the plant’s sap and keep it from spreading to other parts of the body. Soap is not necessary and may even spread the oil.
  • When you return home, wash all clothing outside, with a garden hose, before bringing it into the house where resin could be transferred to rugs or furniture. Handle the clothing as little as possible until it is soaked. Since urushiol can remain active for months, it’s important to wash all camping, sporting, fishing or hunting gear that may also be carrying resin.
  • If you do develop a rash, avoid scratching the blisters. Although the fluid in the blisters will not spread the rash, fingernails may carry germs that could cause infection.
  • Cool showers will help ease the itching and over-the-counter preparations, like calamine lotion, or Burrow’s solution, will relieve mild rashes. Soaking in a lukewarm bath with an oatmeal or baking soda solution is often recommended to dry oozing blisters and offer some comfort. Over-the-counter hydrocortisone creams will not help. Dermatologists say they aren’t strong enough to have any effect on poison ivy rashes.
  • In severe cases, prescription corticosteroid drugs can halt the reaction if taken soon enough. If you know you’ve been exposed and have developed severe reactions in the past, be sure to consult your dermatologist. He or she may prescribe steroids, or other medications, which can prevent blisters from forming.

 

ATOPIC DERMATITIS

Atopic dermatitis is a disease that causes itchy, inflamed skin and typically affects the insides of the elbows, backs of the knees, and the face. Often, however, it covers most of the body. Atopic dermatitis falls into a category of diseases called atopic, a term originally used to describe the allergic conditions asthma and hay fever. Atopic dermatitis was included in the atopic category because it often affects people who either suffer from asthma and/or hay fever or have family members who do. Physicians often refer to these three conditions as the “atopic triad.”

Is eczema the same as atopic dermatitis ?

Although the term eczema is often used for atopic dermatitis, there are several other skin diseases that are eczemas as well. Eczema is a general term for all types of dermatitis. Dermatitis is a medical term meaning “inflammation of the skin.”

 

Atopic dermatitis tends to be the most severe and chronic (long lasting) kind of eczema. Often, people with atopic dermatitis have other skin conditions as well, especially dry skin, ichthyosis, occupational dermatitis, contact dermatitis, or hand eczema. This overlap of atopic dermatitis with other conditions makes atopic dermatitis even more difficult to control.

What substances trigger atopic dermatitis?

People with atopic diseases are unusually sensitive to certain agitating substances. Some of these substances are irritants and others are allergens. When people with atopic dermatitis are exposed to an irritant or allergen to which they are sensitive, cells that produce inflammation come into the skin. There, they release chemicals that cause itching and redness. Further damage is done when the person then scratches and rubs the affected area.


Some triggers are:

  • Irritating substances (irritants and allergens)
  • Dry skin
  • Low humidity
  • Skin infections
  • Heat, high humidity, and sweating
  • Emotional stress

Treatment

Sufferers of atopic dermatitis always have very dry, brittle skin. The external layer of skin called the stratum corneum acts as a barrier, protecting what lies underneath. When the stratum corneum cracks because of dryness, irritants can reach the sensitive layers below and cause a flare up of atopic dermatitis .

To prevent dry skin, the best and safest treatment is the use of moisturizers. Moisturizers provide a layer of oil on the surface of the skin, trapping water beneath and thus making the skin more flexible and less likely to crack.

Researchers have found that the most effective moisturizer is a petroleum based product such as Vasoline. Next best is a skin cream. Some heavy creams can be softened for application by warming in a microwave oven.

Generally, lotions (which have a high water content) actually dry the skin more than moisturizing it, and are therefore not recommended for sufferers of atopic dermatitis . People with atopic dermatitis need not avoid bathing or the use of soaps (which can dry the skin) as long as they:

  1. Use warm (not hot) water
  2. Avoid excessive use of soap, scrubbing, and toweling
  3. Apply a moisturizer to the skin within three minutes after bathing

What if I get an infection?

People with atopic dermatitis are prone to skin infections, especially staph and herpes. In general, infections are hard to prevent. However, many-including staph and herpes-can and should be treated promptly to avoid aggravating the atopic dermatitis .

Signs to watch for include:

  • Increased redness
  • Pus-filled bumps (pustules)
  • And cold sores or fever blisters

Sometimes viral “colds” or “flu” cause flare-ups of atopic dermatitis . With extra skin care for a few days while the virus runs its course, severe worsening can be avoided. If these signs appear, see a physician.

When atopic dermatitis flares up, what can be done?

As mentioned, the best line of defense against Atopic dermatitis is prevention. However, it is not likely that all flare-ups can be avoided. Once inflammation begins, prompt treatment as directed by a physician is needed. Bathing or wet compresses may ease the itch. Cortisone “steroid” creams, applied directly to the affected area, are helpful and a mainstay of therapy. Overuse of highly potent steroids can be damaging. Cortisone pills or shots are sometimes used, but they are not safe for long-term use. Many companies are testing new and safer drugs that control the itch and inflammation.

 

CHILDHOOD ATOPIC DERMATITIS

Atopic dermatitis, often called eczema, or atopic eczema, is very common skin disease. It affects around 10% of all infants and children. The exact cause is not known, but atopic dermatitis results from a combination of family heredity and a variety of conditions in everyday life that trigger the red, itchy rash.

How do we know if it is atopic dermatitis?

  • Time of onset. This type of eczema usually begins during the first year of life and almost always within the first five years. It’s seldom present at birth, but it often comes on after six weeks. Other rashes also can start at that time, so it may be confusing at first but most rashes disappear within a few days to weeks. Atopic dermatitis tends to persist. It may wax and wane, but it keeps coming back.
  • Itching. Atopic dermatitis also is a very itchy rash. Much of the skin damage comes from scratching and rubbing that the child cannot control.
  • Location. The location of the rash also helps us recognize atopic dermatitis. In babies, the rash usually starts on the face or over elbows or knees, places that are easy to scratch and rub. It may spread to involve all areas of the body, although the moist diaper region is often protected. Later in childhood the rash is typically in the elbows and knee folds. Sometimes, it only affects the hand, and at least 70% of people with atopic dermatitis have had eczema at some time in their life. Rashes on the feet, scalp, or behind the ears are other clues that might point to atopic dermatitis.
  • Appearance. The appearance of the rash is probably the least helpful clue because it may be very different from one person to another.
  • Heredity. If other family members or relatives have atopic dermatitis, asthma, or hay fever, the diagnosis of atopic dermatitis is more likely.

What causes atopic dermatitis?

Atopic dermatitis is not contagious. People with atopic dermatitis cannot “give” it to someone else. Atopic dermatitis inflammation results from too many reactive inflammatory cells in the skin. Research is seeking the reason why these cells over-react. Patients with atopic dermatitis (or asthma or hay fever) are born with these over-reactive cells. When something triggers them, they don’t turn off as they should. We try to control atopic dermatitis by preventing the trigger factors that turn on the inflamed skin, or by “damping the flames” with anti-inflammatory therapies.

What triggers atopic dermatitis?

Trigger factors may be different for different people. Most children are worse when they have a cold or other infection. Most have worse problems in the winter; but others simply can’t stand the sweating during hot, humid summer weather. Let’s look at the trigger factors that seem to affect every child with atopic dermatitis.

  • Dry skin
  • Irritants
  • Stress
  • Heat and sweating
  • Infections
  • Allergens

How can you avoid triggers?

  1. Keep the skin barrier intact. MOISTURIZE
  2. Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material.
  3. If sweating causes itch, find ways to keep cooler. Such as:
  4. Reduce exertion, especially during times of flare.
  5. Layer clothing and adjust temperature settings.
  6. Don’t overheat rooms, especially the bedroom.
  7. Use light bedclothes.
  8. When itching from sweating, dust, pollen, or other exposures, take a cooling shower or tub bath.
  9. Learn to recognize signs of infection and treat early.

If you suspect food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat, and seafood, but any food can do it. Can you exclude the most likely offender for a week? Substitute hydrolysate for cow formula. Keep a food diary. When the skin clears up, try the food. Watch for signs if itching or redness over the next two hours. Do not try a suspect food if it causes hives or face swelling. Don’t exclude multiple food groups at the same time. It is rare to have more than one or two food allergies, and your child can get malnourished with prolonged avoidance of many foods.

With allergy-prone kids, furry animals are a risk. If you must have pets, keep    them outside or at least off beds, rugs, and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include covering pillows and mattresses, removing bedroom carpets and frequent washing of bedclothes in hot water.

Think about stress-causing events and ways to cope with them. Review problems with your doctor. Try to make atopic dermatitis treatments part of a daily, family routine. Encourage children with atopic dermatitis to do what they can on their own.

Treatment

  • Moisturizers. Ointments such as petroleum jelly (such a Vasoline) are best unless they are too thick and cause discomfort. Creams may be fine for moderately dry skin or in hot, humid weather. Apply them to wet skin, immediately after bathing. Lotions and oils are not rich enough and often have a net drying effect on atopic dermatitis on skin.
  • Corticosteroids. Often called topical (applied to the skin) steroids, these are cortisone-like-medications used in creams or ointments which your doctor may prescribe (Hydrocortisone, Desonide, Triamcinolone). They are not the same as the dangerous “steroids” some athletes misuse. Cortiscosteroid medicines are very helpful. Often they are the only treatment that can calm the inflamed skin.

Use of steroid ointments and creams requires good judgement and careful supervision. They come in strengths from mild to super-potent. Hydrocortisone is quite safe. The more potent ones can cause thinned skin, stretch marks, and other problems if used too many days in the same areas of the body. Parents should monitor the child’s use. Ask the doctor about potency and side effects of prescribed corticosteroid medicines.

  • Antibiotics. Oral or topical antibiotics reduce the surface bacterial infections that may accompany flares of atopic dermatitis.
  • Antihistamines. Often prescribed to reduce itching, these medicines may cause drowsiness but seem to help some children.
  • Tar preparations. Tar creams or bath emulsions can be helpful for mild inflammation.

When will my child outgrow atopic dermatitis?

For any given child, it is difficult to predict. The majority of babies with atopic dermatitis will lose most of the problem by adolescence, often before grade school. A small number will have severe atopic dermatitis into adulthood. Many have remissions that last for years. The dry skin tendency will remain. Most people learn to use moisturizers to keep their dermatitis controlled. Occasional episodes of atopic dermatitis may occur during times of stress or with jobs that expose the skin to irritants at work. 

 

NUMMULAR DERMATITIS          

Nummular dermatitis gets its name from the Latin word nummulus, which means coin-like or coin-shaped. It is a very common skin rash in which patients report the onset of round, coin shaped, itchy lesions on a background of dry skin. They are frequently located on the lower leg, but may also be found on the arms and the trunk, especially the back. It most commonly affects men and women in the 50s and 60s, but also may affect younger people, even children in especially dry climates and in the winter.

The cause of nummular dermatitis is not known. It is related to dry skin and is aggravated by wool, soaps, frequent bathing, and many over the counter topical medications. Up to 90% of patients have Staph aureus colonizing the lesions. This suggests that nummular dermatitis may be a hypersensitivity reaction to the bacteria. Alcohol abuse has been reported to be associated with nummular dermatitis, and it may be that alcohol suppresses the immune response making those patients more susceptible to bacterial infection.

Treatment

There is no cure for nummular dermatitis, but it can be controlled. Topical steroids are the mainstay of therapy. Frequently, a very potent steroid ointment is applied initially, and then a less potent one is used if maintenance therapy is needed. Often a course of oral antibiotics is given if there are signs of infection. Long term prevention involves hydrating the skin by using a nondrying cleanser such as Cetaphil, Spectroderm, or Oil ition, applying a moisturizing oil within three minutes after a bath or shower will hold the moisture in the skin.

 

PERI-ORAL DERMATITIS          

This is an acne like eruption which usually occurs in women aged 25 and over, many of whom never had problems with their complexions when they were younger. It may occur in children and in men but less frequently.

There are pimple like bumps on the chin and around the mouth or lower ose areas. Frequently there is some redness to the skin in these areas.

The cause of this condition in uncertain, but it may occur after stopping birth control pills or during or after pregnancy. Recently studies have implicated excess fluoride as a cause: either fluoride toothpaste, mouthwash, or in strong cortisone-containing creams or ointments applied to the area.

Treatment

Treatment of peri-oral dermatitis includes the use of an oral or topical antibiotic and an additional prescription medication for the skin. During the one to two months of therapy it is also recommended that one avoid any fluoride toothpaste, mouthwash, or creams. Toothpaste without fluoride is difficult to find. Sensadyne without fluoride is one acceptable toothpaste.

Most cases respond well to treatment, but it may be necessary to continue treatment and supervision for several months before gradually discontinuing the medications which helped clear the skin.

 

SEBORRHEIC DERMATITIS

Seborrheic dermatitis is a common, harmless, scaling rash that sometimes itches. Dandruff is seborrheic dermatitis of the scalp. Seborrheic dermatitis may also occur on the eyebrows, eyelid edges, ears, the skin near the nose and such skin-fold areas as the armpits and groin. Sometimes seborrheic dermatitis produces round, scaling patches on the midchest or scales on the back.

What causes seborrheic dermatitis?

Seborrheic dermatitis results from skin not growing properly. The cause is not known. Seborrheic dermatitis is not related to diet and is not contagious. Nervous stress and any physical illness tend to worsen seborrheic dermatitis, but do not cause it.

Seborrheic dermatitis may appear at any age, either gradually or suddenly. It tends to run in families. Seborrheic dermatitis may last for may years and may disappear by itself. Often, it gets better or worse without any apparent reason.

Treatment

There is no cure for seborrheic dermatitis. However, we can keep this nuisance under control. The treatment of seborrheic dermatitis depends on what part of the body is involved. Dandruff, seborrheic dermatitis, of the scalp can usually be controlled by washing your hair often with medicated shampoos. Sometimes it is necessary to use lotions or gels containing tar or cortisone. In areas of smooth skin such as the face and ears, cortisone containing creams, lotions, or ointments are effective. Cortisones applied to limited areas of the skin do not affect your general health.

Once seborrheic dermatitis is under control, gradually use your medicines less and less. It may even be possible to stop the medicines completely, but usually occasional treatment is needed. Seborrheic dermatitis has a way of returning. If it does, resume the original treatment. If your seborrheic dermatitis is not controlled by the treatment prescribed, please return for further evaluation.

 

PSORIASIS

Psoriasis is a chronic skin disorder that is not contagious. It is more likely to occur in individuals whose family members have it. In the United States two out of every one hundred people have psoriasis (three to four million persons). There will be approximately 150,000 new cases of psoriasis each year.

Psoriasis got its name from the Greek word meaning “itch.” It is caused by an overproduction of sin cells. This leads to thickening of the skin and scaling. The disease appears as red areas with silvery scales that occur most often on the scalp, elbows, knees, and lower back.

In some cases, psoriasis is so mild that people never know they have it. In rare cases, others have such severe psoriasis that it resists therapy. At its worst, the disease can cover the entire body with redness and scales. Fortunately, this is rare. There are helpful treatments available for even the most severely affected patients.

What causes psoriasis?

The cause of psoriasis is unknown. Scientists speculate that a biochemical malfunction triggers skin cells to over-produce. In a person with psoriasis a skin cell matures in three to four days instead of the normal 28-30 days. People often experience their first attack or flare up about 10-14 days after the skin is cut, scratched, rubbed or severely sunburned. Psoriasis can also be triggered by some infections, such as strep throat, and by certain drugs.

Special diets have not been successful in preventing recurrences or improving existing psoriasis. People who live in cold weather climates often have flare ups in the winter due to dry skin and a lack of available sunlight.

What are the types of psoriasis?

Psoriasis occurs in a variety of forms that differ in their severity, duration, location and the shape and pattern of scales. The most common form begins with little red bumps. Gradually they grow larger and silvery scales form. While the top scales flake off easily and often, those below the surface stick together so that when they are removed, bleeding occurs. The small red areas grow, sometimes becoming quite large. They may be shaped like a small doughnut with a clear center, a coin or a rough oyster shell.

Elbows, knees, the groin, arms, legs, scalp, and nails are the most commonly affected areas. The psoriasis will often appear on both sides of the body in the same areas.

 

Treatment

The exact treatment recommended by a dermatologist will be based on a person’s overall health, age, lifestyle and the severity of the psoriasis. Different types of treatments and several visits to the dermatologist may be needed before the psoriasis comes under control. The goal of treatment of psoriasis is to ease discomfort and slow down rapid skin cell division. Moisturizing creams and lotions can improve the patient’s appearance and can also control itching.

Some forms of treatment are discussed below:

  • Light therapy. Sunlight and ultraviolet light, type B (UVB), help psoriasis by slowing down the rapid growth of skin cells. Long term use of either form of light can cause premature aging of the skin, eye damage and skin cancer. However, given under a doctor’s care, this treatment can be safe. People with psoriasis all over their bodies may prefer treatment in a medically approved center equipped with UVB light boxes for full body exposure. An average of 40 whole body treatments is usually needed before the lesions subside or disappear. People who live in areas with year-round warm climates may be able to sunbathe for a prescribed number of hours. However, dermatologists warn people with psoriasis to seek advice about their medical condition before treating themselves.
  • PUVA. A treatment called PUVA is used for patients who have not responded to other methods or who have more than 30% of their bodies covered with psoriasis. It is effective in 85 to 90% of the patients. Patients are given a drug called psoralen before being exposed to a carefully measured amount of ultraviolet light, type A (UVA), in a light box. PUVA treatments must be carefully monitored by a doctor. About 25 treatments are given over a two or three month period before clearing occurs. Then, the patient usually requires “maintenance therapy” or around 30 treatments a year.

PUVA treatments over a long period of time increase a person’s risk of skin aging, freckling, and skin cancer. Those who probably should not have this treatment are patients under the age of 18, pregnant women, patients with previous exposure to arsenic or ionizing radiation, and patients with skin cancer or certain types of sever eye disease.

  • Methotrexate. Methotrexate is an oral anti-cancer drug that can produce dramatic clearing of psoriasis. However, it is not used unless other treatments have failed because it can produce serious side effects, notably liver disease. Periodic tests for liver and kidney function, liver biopsies, and chest x-rays are required. For the first two months of therapy, a patient should have weekly blood tests and at less frequent intervals thereafter. Other side effects include an upset stomach and lightheadedness. Psoriasis can recur when treatment is stopped.
  • Retinoids. Vitamin A derivatives, particularly etretinate, may be prescribed for severe cases of psoriasis. This oral medication may be used in combination with ultraviolet light or alone.

 

A synthetic retinoid, Tazarotene, improved symptoms in clinical tests in 70% of those who had psoriasis on as much as 20% of their bodies. It is speculated that these synthetic retinoids accomplish this improvement by normalizing the speed at which skin cells produce and shed, as well as by reducing inflammation. And, unlike most topical treatments, tazarotene requires only one application daily. Patients who have many scaly patches scattered over their bodies find the once-daily regimen to be very appealing.

These drugs are usually reserved for severe cases of psoriasis because of the side effects. These include dry skin and eyes, elevation of fat levels in the blood, and formation of bony spurs in the spine. Because severe birth defects result in pregnant women who take these medications, it should not be used by young women of child-bearing age. This medication requires close monitoring by a dermatologist.

Hair Loss & Thinning

Hair Loss and Thinning

Introduction

Normal hair growth

Shedding 50 to 100 hairs a day is considered normal. When a hair is shed, it is replaced by a new hair from the same follicle located just below the skin surface. Hair is mostly made up of a form of protein, the same material found in fingernails and toenails. Everyone, regardless of age, should eat an adequate amount of protein to maintain normal hair production. Protein is found in meat, chicken, fish, eggs, some cheese, dried beans, tofu, grains, and nuts.

Causes of abnormal hair loss

Abnormal hair loss can be due to many different causes. People who notice their hair shedding in large amounts after combing or brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. It’s important to find to find the cause and whether or not the problem will respond to medical treatment.

A dermatologist will evaluate a patient’s hair problem by asking questions about diet, medications taken within the last six months, family history of hair loss, any recent illness, and hair care habits. The dermatologist may ask a female patient about her menstrual cycles, pregnancies and menopause. After examining a patient’ scalp and hair, she may check a few hairs under the microscope. Laboratory tests may be required which sometimes include examining a small sample of scalp under a microscope.

Common causes of hair loss include:

  • Childbirth
  • High fever, severe infection, severe influenza
  • Thyroid disease
  • Inadequate protein in diet
  • Medications
  • Cancer treatment drugs
  • Birth control pills
  • Improper hair cosmetic use/improper hair care

 

Some forms of hair loss will regrow. Other forms can be treated successfully by a dermatologist. For the several forms of hair loss for which there is no cure at present, there is research in progress that looks promising for the future.

Alopecia Areata

Description

In alopecia areata round patches of hair loss appear suddenly. The hair loss is often discovered by a barber or hairdresser. The hair-growing tissue stops making hair, and the hair then falls out from the roots. Why this happens is a mystery. Alopecia areata is not contagious, not caused by foods, and not the result of nervousness. It sometimes runs in families. Some patients with alopecia areata also have thyroid gland abnormalities. If a blood test of thyroid function has not been done within the past month, we recommend one.

Alopecia areata has three stages. First there is sudden hair loss. Then the patches of hair loss may enlarge. Last, new hair grows back. This takes months, sometimes more than a year.

Treatment

Hair usually grows back by itself, but slowly. Sometimes the new hair is temporarily gray or white, but after a while the original color usually returns. The natural regrowth of hair can often be speeded up injecting a cortisone medicine into the area of hair loss. The cortisone is injected into the skin. It acts only in the area where it has been injected. Unfortunately, there is no way of preventing new areas of hair loss. However, if new areas of hair loss appear, regrowth may be helped by injecting cortisone.

Dermatology Update

Recent News about Hair Loss

M en are not the only ones who experience hair loss due to male pattern baldness. Both men in women who are predisposed to "androgenetic alopecia" inherit a genetic sensitivity to male hormones, which are produced by both sexes. The male hormone testosterone is converted to the hormone DHT, which triggers genetically susceptible follicles to slowdown or cease hair production. While men with male pattern baldness tend to lose hair mostly on the front and top of their heads, women's hair generally thins out all over. Their hair never becomes as sparse as men's, nor do women become completely bald, because they're protected from excessive hair loss by the way in which they metabolize hormones.

 

A side from the topical treatment of minoxidil, men with male-pattern baldness have a new way to treat their hair loss. It comes in pill form and goes by the name finasteride. This drug was originally approved for the treatment of enlarged prostates, but researchers began studying its potential for hair growth after some prostate patients with male-pattern baldness noticed hair regrowth while they were taking the drug. In clinical studies, 80% of the men who took finasteride noticed either slight-to-moderate hair regrowth or a cessation of hair loss. Unfortunately, the drug is not appropriate for women with thinning hair because it causes birth defects. Additionally, a small percentage of men who took finasteride experienced diminished sexual drive and impotence as side effects, which disappeared once they stopped taking the drug. Finasteride must be taken indefinitely to sustain its effects.

A s with any drug, caution is advised. There are some possible side effects, and finasteride is not appropriate for all men. If you are experiencing male-pattern baldness and wish to learn more about this treatment, please speak with your dermatologist.

Telogen Effluvium

Description

Telogen effluvium is a common type of excessive hair loss which can occur without warning in men and women of any age. Ordinarily, the human scalp has about 100,000 hairs and, of these, around 50-100 are lost every day. In telogen effluvium the daily loss ranges from 120-400 hairs. The hair loss can occur for many reasons, but whatever the reason there is almost always complete regrowth of the lost hair without treatment.

Common causes of telogen effluvium include: normal pregnancy and delivery, surgery, fever, certain drugs, stress, chronic illness, thyroid disorders and crash dieting. In most cases the hair loss becomes noticeable between two and four months after delivery of a baby, after surgery, illness, stress, or the onset of any other causative factors.

Treatment

It is important that you not be overly concerned about this hair loss. Telogen effluvium always self-corrects, but the anxiety you generate worrying about it may prolong the course. Try to concentrate on maintaining good general nutrition and on good scalp care and you should expect to see regrowth of your hair within a few months.

 

Mohs Micrographic Surgery

MOHS MICROGRAPHIC SURGERY
Introduction
Our goal at the Cheyenne Skin Clinic and Center for Dermatologic Surgery is to provide you with the highest quality care for the treatment of your skin cancer. One of the treatment methods we offer is Mohs micrographic surgery. This information is designed to explain the procedure in detail and answer questions commonly asked by patients.
What is Mohs Micrographic Surgery?
A skin cancer that has been biopsied often resembles a “tip of an iceberg” with more tumor cells growing downward and outward into the skin, like roots of a tree. These “roots” are not visible with the naked eye, but can be seen under a microscope. Mohs micrographic surgery is a treatment for skin cancer in which cancerous cells are removed in stages, one tissue layer at a time. Once a tissue layer is removed, its edges are marked with specially colored dyes, and a map of the specimen is created. The tissue is then processed onto microscope slides by a trained Mohs surgery histotechnician in our on-site laboratory. These slides are carefully examined under the microscope by our Mohs surgeon so that any microscopic roots of the cancer can be precisely identified and mapped. When cancer cells are seen, an additional tissue layer is removed only in areas where the cancer cells are still present, leaving normal skin intact. This allows the Mohs surgeon to save as much normal healthy skin as possible
The term “Mohs” refers to Dr. Frederic Mohs, Professor of Surgery at the University of Wisconsin, who developed this surgical technique in the early 1940s. The technique has undergone many refinements and has come to be known as “Mohs surgery” in honor of Dr. Mohs.
What are the Advantages of Mohs Micrographic Surgery?
Mohs micrographic surgery is safe, reliable, and has a significantly higher cure rate than any other available treatment, even when dealing with difficult cases and those that have failed other forms of treatment. In addition, Mohs surgery is a “tissue-sparing” technique, which allows for selective removal of cancerous tissue while preserving as much normal skin as possible. Mohs surgery is done as a same-day outpatient surgical procedure that eliminates the need for general anesthesia and hospital fees. Mohs surgery is performed by a physician who is both the surgeon and the pathologist and has received specialized training in this technique.
With standard skin cancer excision, only a portion of the removed tissue is sampled and examined microscopically by a pathologist to determine whether the cancer is completely removed. Mohs micrographic surgery allows for examination of the entire underside and edges of the tissue which results in a higher cure rate while minimizing the removal of normal tissue.
Because Mohs surgery is a highly specialized technique, not all skin cancers require this treatment. Skin cancers that have “come back” after previous treatment, a tumor with microscopic features suggesting it may be aggressive or have extensive roots, and a skin cancer on the nose, eyelids, ears, fingers or other areas in which sparing of normal tissue is essential.
About Our Staff
Our Mohs Micrographic Surgery Center is staffed by a team that includes a Mohs micrographic surgeon, Dr. Julie Neville; surgical technicians who will assist in surgery, respond to your concerns, help answer questions, and instruct you in wound care following your surgery; and laboratory histotechnicians who work in our on-site laboratory preparing the tissue slides which are examined by Dr. Neville under a microscope. Our front office staff is available to answer any questions relating to appointment scheduling, insurance forms, and payments.
How Do I Prepare for the Day of Surgery?

  1. Please plan to spend at least six hours at the office. Since most of the time will be spent waiting while we study the tissue, it is helpful to have a book to read. You may also want to bring one other person to stay with you during the wait.
  2. If you are on doctor-prescribed aspirin , Coumadin or Plavix, please continue to take it.
  3. Unless doctor-prescribed, do not take aspirin or aspirin-containing medications (Alka-Seltzer, Anacin, Excedrin, Aleve, Bufferin, Emprin Compound, Ecotin and many “cold pills”) or Motrin, Advil, Nuprin, and ibuprofen for two weeks before and five days after surgery. Tylenol or acetaminophen are acceptable to take during this period.
  4. Please do not take any vitamin E, gingko, ginsing, garlic, fish oil, herbal supplements, or anti-inflammatory pain medications (such as ibuprofen, Advil, Motrin, Alleve, Nuprin and others) for two weeks prior to your surgery. These also cause thinning of the blood, which can result in increased bleeding during your surgery. These medications and supplements may be resumed 48 hours after your surgery.
  5. Smoking causes changes in the bloodstream that interfere with the process of normal wound healing; this can negatively affect the cosmetic outcome of your surgery and limit our options for repairing your wound. Please make every attempt to quit smoking for at least 2 days before and two weeks after surgery.
  6. On the morning of surgery, eat a normal breakfast. Take any medication that you normally take.
  7. If you have been given an antibiotic to take before surgery, be sure to take it as directed one hour before surgery. Failure to do so may result in cancellation of the surgery.  If you do not have a prescription, please call us as soon as possible before your surgery date so that we may call in a prescription to your pharmacy
  8. Wear a button down shirt or blouse if the surgery is on the face or head. For surgery on legs, wear pants with loose fitting legs or a skirt if possible. Wear loose comfortable shoes for surgery on the feet.
  9. Do not apply cosmetics if the surgery is going to be performed on your face.
  10. It is helpful to have Extra Strength Tylenol (or acetaminophen) at home prior to the date of surgery as well as bandaging supplies such as non-stick bandages (Telfa) and paper tape.
  11. If you have taken any anti-anxiety medications before surgery, you must have someone available to drive you to and from surgery.

  
What happens on the day of surgery?
You should plan on spending most of the day with us. The area around the site of your skin cancer will be anesthetized (numbed) with a local anesthetic. Once the area is numbed, a thin layer of tissue will be removed and any bleeding will be controlled. The tissue will be mapped, color-coded, and sent to our on-site Mohs laboratory to be processed onto microscope slides. A bandage will be placed over the wound, and you will return to the Mohs surgery waiting area or general dermatology waiting area.
On average, it takes 1 to 1½ hours for the slides to be prepared and studied. Occasionally, tissue requires special attention and may take longer for processing or examination. If there is cancer still present, an additional layer, or stage, is taken. Most Mohs surgery cases are completed in two or three stages. Therefore, Mohs surgery is generally completed in one day. Occasionally, however, a tumor may be extensive enough to necessitate continuing surgery a second day. Once the tumor has been cleared, surgical repair of the skin will require additional time.
What Happens After the Tumor Has Been Removed?
After the skin cancer has been completely removed, you will have a surgical wound. Dr. Neville will discuss your options with you and make recommendations. At this point, optimizing the wound healing and final cosmetic result of your surgery becomes our highest priority. The wound can be treated in one of several ways:

  1. Healing by "secondary intention" (see below)
  2. Closing the wound in a straight line with stitches.
  3. Closing the wound with a skin flap. A skin flap uses nearby skin to help fill in the wound. Flaps can be used when simpler repair options (second intention healing or a linear wound closure) will not adequately heal the wound with a good result.
  4. Closing the wound with a skin graft. A skin graft is skin borrowed from a different area to fill in the wound. Skin grafts are used when simpler repair options will not adequately heal the wound with a good result.
  5. In special cases, a consultation with one of several reconstructive surgeons may be necessary.

What is “Healing By Secondary Intention?”
Occasionally, a wound is allowed to heal in by itself without stitches. This is referred to as “healing by secondary intention.” In certain areas of the body, nature will heal a wound as nicely as a surgical procedure involving stitches. In other areas of the body, healing by secondary intention is avoided since unacceptable scars can result. Use of this option for healing will depend on the size and location of your wound following surgery.
If a wound is allowed to heal by itself, often a porcine (temporary) graft is placed on the area to help stimulate wound healing.  This graft will fall off on its own in 1 to 2 weeks.  The area needs to be cleaned daily and kept moist with Vaseline and a bandage.  The surgical staff will teach you how to change the dressing and will give you printed instructions. If a wound is allowed to heal by secondary intention, it usually heals in four to eight weeks, depending on the size of the wound and on how quickly an individual tends to heal.
What Happens if the Wound is Closed with Stitches?
Wounds are often closed with stitches. This speeds healing and can optimize the cosmetic result. For example, a scar can be camouflaged into a facial line or wrinkle line. The resulting line of stitches tends to be longer than the length of the original wound. This is done to avoid unnatural puckering and dimpling of the skin that would occur if the incision were not lengthened.
The surgical staff will teach you how to change the dressings daily and provide you with printed instructions. You will be given specific activity restrictions. The stitches will need to be removed in 5 to 14 days, depending on the location.
What Can I Expect After the Surgery?
Following your surgery, we will discuss postoperative care with you, and you will be given detailed written instructions on the care of your wound. Swelling and slight bruising are common following Mohs surgery. A “black eye” is common with surgery around the eye, or on the forehead. These symptoms usually subside within 5 to 7 days after surgery and may be reduced by sleeping with your head slightly elevated and by using an ice pack for short periods of time during the first 24 hours.
Restrictions: Depending on the size and location of the wound, Dr. Neville may recommend restrictions in your physical activity following the surgery. Details will be discussed with you after the surgery is complete. Depending on the extent of your surgery and the requirements of your occupation, you may wish to take off one or more days from work following your surgery. Many patients are able to return to work the day after surgery.  If the surgery is on the lips or mouth, we recommend eating soft foods while the stitches are in.
Pain: In most cases, patients experience very little discomfort after Mohs surgery. We request that you do not take aspirin or ibuprofen-containing drugs for pain control. Tylenol (acetominophin) does not contribute to increased bleeding and can be used for discomfort. Additional pain medication may be prescribed.
Potential Complications:
Bleeding: Mild bleeding or oozing at the surgical site is fairly common following Mohs micrographic surgery. When it occurs, bleeding is typically a slow ooze at the wound edges and is best controlled through the use of pressure. If you experience bleeding, you should move to a seated position and apply constant pressure on a gauze pad over the bleeding point for 20 minutes (timed); do not lift up or release the pressure at all during that period of time. If bleeding persists after continued pressure for 20 minutes, remain seated and repeat the pressure for another 20 minutes. If this fails, call our office or phone numbers provided on your postoperative instructions.
Infection: Infection following Mohs surgery is uncommon. A small amount of drainage on the bandage is to be expected. In addition, a small red area may develop around your wound. This is normal and does not indicate infection. However, if the redness worsens and the wound becomes tender, warm or begins to drain pus, you should notify our office immediately.
Allergic reaction: Itching and redness around the wound can indicate allergy to bandage materials such as tape adhesive or antibiotic ointment. Following your surgery, you will be given specific instructions for wound care to minimize this risk. If you experience itching or a rash on the rest of your body after you have started an oral antibiotic or pain medication prescribed by Dr. Neville, this may indicate a medication allergy. If this occurs, please discontinue the medication and immediately call our office or Dr. Neville.
Numbness: It is common for the area around the surgery site to feel numb to the touch. This area of numbness may persist for several months before returning to normal or near normal. In rare instances, the area stays numb permanently. In addition, some areas may be sensitive to temperature changes (such as cold air) following surgery. This sensitivity improves with time.
Itching: Patients frequently experience itching after their wounds have healed. This occurs because the new skin that covers the area does not have as many oil glands as previously existed. Plain petroleum jelly will help relieve the itching.
Will There Be a Scar?
Yes. Any treatment for skin cancer will leave a scar. Mohs surgery preserves as much normal skin as possible to maximize options for repairing the area where the skin cancer had been. Once Dr. Neville has removed your skin cancer completely, optimizing the final cosmetic result of your surgery becomes our highest priority. In general, a postsurgical scar improves with time and can take up to one year or more to fully mature. As your surgical site heals, new blood vessels can appear to support the healing changes occurring underneath the skin. This can result in a red appearance of the scar. This change is temporary and will improve with time. In addition, the normal healing process involves a period of skin contraction, which often peaks at 4-6 weeks after the surgery. This may appear as a bumpiness or hardening of the scar. On the face, this change is nearly always temporary and the scar will soften and improve with time. If you have a history of abnormal scarring, such as hypertrophic scars or keloids, or if there are problems with the healing of your scar, injections or other treatments may be used to optimize the cosmetic result. Dr. Neville is available for you throughout the healing process to discuss any concerns that arise.
How Often Will I Return For a Follow-Up Visit?
If you have sutures, you will need to return for suture removal. You may also need to return within one to three months after the surgery to ensure that the healing process is progressing smoothly. If you have questions or concerns, please call our office or schedule a return appointment at any time.
Can My Skin Cancer Come Back?
The goal of Mohs micrographic surgery is to remove your skin cancer while preserving your normal healthy surrounding skin. The cure rate for Mohs surgery is very high, even for the most difficult tumors. The cure rate is approximately 99 percent for new skin cancers and 95 percent for recurrent skin cancers (those which have been treated in the past and have come back.) However, no one can guarantee a 100 percent cure rate with any treatment method.
Will I Develop More Skin Cancers?
Studies have shown that once you develop a skin cancer, there is an increased risk of developing others in the years ahead. For this reason, it is important for you to continue seeing your dermatologist at regularly scheduled intervals and to schedule an appointment if you are concerned about new or changing growths on your skin. The best way to minimize your risk of developing more skin cancers is to protect your skin from the sun’s damaging rays.
If you have additional questions or concerns regarding your upcoming surgery, please contact our office

Warts and Other Skin Viruses

Warts are a surface infection caused by human papilloma virus (HPV). They may occur on any area of the skin, including around the nose, mouth, and genitalia. Children frequently have warts, but they occur in adults as well. They are mildly contagious and may be spread from person-to-person by touching or from one part of the body to another by scratching. Warts are in the very top layer of skin and so they do not effectively trigger the body’s immune system. One can be a completely healthy person and still have warts.

 

COMMON WARTS

 

Treatment

There is no perfect way to treat warts, and no one can guarantee the success of wart treatment. Warts are stubborn and frequently more than one or two treatments are needed. Treatments vary depending on the area of skin or mucous membrane involved, the age of the patient, and the number of warts.

  • Liquid nitrogen. This treatment involves a a very cold liquid that is sprayed or applied to the warts causing a small controlled area of frostbite. The frozen area usually develops a blister (sometimes a blood blister) that heals in about two weeks. Freezing is painful. It hurts for the 10-15 seconds it takes to freeze the warts and for the minute or two afterwards while the area thaws. Often children can tolerate having one or two warts frozen, but even the toughest adult may not be able to stand having many warts frozen. The Cheyenne Skin Clinic almost never freezes warts on the bottom of the foot, as this is extremely painful.
  • Bleomycin. A dilute form of chemotherapy agent injected into the wart kills cells which are growing more rapidly, like those with the wart virus in them. The injection itself hurts, and there is usually a little pain afterward.
  • Diphenciprone (DPCP) immunotherapy. DPCP has been useful when other treatments have been unsuccessful or when a child has had several warts and cannot tolerate other treatments. A small amount of medicine is applied to the skin and left on for two hours. Treatment begins by applying a small bandaid with medicine on it to the hip.   An area of skin covered by clothing is used because often there is a brown mark that remains for several months. A rash develops in the area indicating the body’s immune system recognizes the medication.

Three weeks later, the patient has a follow up appointment with the Cheyenne Skin Clinic for the physician or nurse to apply a dilute concentration of the DPCP to the warts. Ideally, a mild irritation develops around the warts, and they slowly go away over a period of 2-3 months. Frequently, several visits spaced every 3-4 weeks are needed. Sometimes the irritation is more pronounced, and the skin becomes very inflamed. If this occurs, one has to decrease the use of medicine tiering the amount used with the amount of irritation. This is a slow approach, but is inexpensive, a relatively painless, and can be used on any new warts that arise during the course of treatment.

  • Carbon dioxide laser. This laser can be used to vaporize the stubborn warts. First the area is numbed with an injection of local anesthetic, which in itself is somewhat painful. Next the laser destroys the wart and surrounding skin leaving an ulcer which slowly heals in over a period of two to four weeks. For the first week the ulcer is often painful, and there is usually a scar when healing is complete.
  • Topical Acid. This treatment comes in the form of either a liquid, gel, or pad that can be applied to the wart. This peels off the top layers of the skin where the wart lives. This is a slow approach to taking an average of one to two months, but is inexpensive, relatively painless, and can be used on any new warts that appear during the course of treatment.

 

GENITAL WARTS

Genital warts, caused by human papilloma virus (HPV), are moderately contagious and may be spread from person-to- person by sexual contact. Warts are in the very top layer of skin and thus do no effectively trigger the body’s immune system. One can be a completely healthy person and still have warts.

Treatment

It is very important to treat genital warts, as research shows there has been an increase in cervical carcinoma in some patients with genital warts.

  • Podophyllin. This medicine is derived from   a brown liquid plant extract that kills cells that are growing rapidly. It is usually applied to warts on mucous membranes like that in the vulvar and perianal region. After the first treatment, the medication should be removed by bathing after two to four hours. (The medication will work better if it is left on longer after subsequent treatments.) Podophyllin stings a little when first applied and the areas may become more painful over the next two to three days. It can only be applied in our office as it can cause serious reactions, including seizures, if it is applied too generously.
  • Condylox (podophyllotoxin). This treatment can be applied at home. The medication is applied for three days in a row followed by four days of rest, repeating this each week for four weeks.
  • Liquid nitrogen. This very cold liquid is sprayed or applied to the warts causing a small controlled area of frost bite. The frozen area usually develops a blister (sometimes a blood blister) that heals in about two weeks. Freezing is painful. It hurts for the 10-15 seconds it takes to freeze the warts and for the minute or two afterwards while the area thaws.
  • Carbon dioxide laser. With this treatment , the area is numbed with an injection of local anesthetic, which in itself is somewhat painful. Next the laser destroys the wart and surrounding skin leaving an ulcer which slowly heals in over a period of two to four weeks. For the first week the ulcer is often painful and there is usually a scar when healing is complete.
  • Aldara Cream. This prescription cream is applied to the warts Monday, Wednesday, and Friday at bedtime for up to 12 weeks.   Unfortunately, this is a very expensive medication.

 

HERPES SIMPLEX (COLD SORES AND GENITAL HERPES)

Herpes is a name used for some 50 related viruses. Herpes simplex is related to the viruses for infectious mononucvleosis (Epstein-Barr Virus) and for chicken pox and shingles (varicella zoster virus). The herpes simplex virus can cause blister-like sores almost anywhere on a person’s skin. It usually occurs around the mouth and nose or the buttocks and genitals. HSV infections can be very annoying because they can reappear. The sores may be painful and embarrassing. For some chronically ill people and newborn babies, the viral infections can be serious but rarely fatal.

There are two types of HSV-Type 1 and Type 2.

  • Type 1. Studies show that most people get Type 1. It affects the lips, mouth, nose, chin or cheeks during infancy or childhood. They usually catch it from close contact with family members or friends who carry the virus. If can be transmitted by kissing or by using the same eating utensils and towels. A rash or cold sores in the mouth and gums appear shortly after exposure. Symptoms may be barely noticeable or may need medical attention for relief of pain.
  • Type 2. It most often appears following sexual contact with an infected person. It has reached epidemic numbers, affecting anywhere between 5 and 20 million persons in the United States, or up to 20% of all sexually active adults.

Herpes Simplex Type 1

Called fever blisters or cold sores, HSV Type 1 infections are tiny, clear, fluid filled blisters most often seen on the face. Type 1 infections may also, less often, occur in the genital area. Type 1 may also develop in wounds on the skin. Nurses, physicians, dentists, and other health care workers sometimes contract a herpetic sore after HSV enters a break in the skin of their fingers

The number of blisters varies from one to a whole cluster. Before the blisters appear, the soon-to-be affected skin may itch or become very sensitive. The blisters then break by themselves or as a result of minor injury, allowing the fluid inside the blisters to ooze. Eventually, crusts form and fall off, leaving slightly red skin. Though the primary infection heals completely, rarely leaving a scar, the virus that caused it remains in the body. It migrates to nerve cells where it remains in a resting phase

Hot news about cold sores

Some individuals suffer from "sun blisters" that develop on their lips after exposure to the sun. Boating, beaching, gardening, or bicycling are activities frequently associated with this problem in the summer. The eruption is caused by the herpes simplex virus. Its appearance may be heralded by itching, burning, or swelling of the lips, followed by the rapid outbreak of groups of blisters. The rash, which can be painful, can spread to the face, and might take one to two weeks to resolve. In some cases, infection with bacteria can complicate the problem. Professional evaluation by a dermatologist is a wise idea since other conditions can produce blisters on the lips. Treatment can include oral medications and antiviral cream. The regular use of high SPF sunscreens on the lips can help prevent outbreaks of sun blisters.

Many products that women use cosmetically now contain sunscreen. But what about men? Men need not wear lipstick to protect their lips from UV light; there are many natural looking, non-greasy lip balms that contain sunscreen. And there is no reason for men not to use a plain moisturizing lotion containing sunscreen on a daily basis.

 

Herpes Simplex Type 2

Infection with herpes simplex virus Type 2 usually is below the waist, on the buttocks, penis, vagina, or cervix, two to twenty days after contact with an infected person. Sexual intercourse is the most frequent means of contracting the infection. Symptoms of both primary and repeat attacks can include a minor rash or itching, painful ulcers, fever, aching muscles, and a burning sensation during urination. HSC Type 2 can also occur in locations other than the genital area.

As with Type 1, sites and frequency of return bouts vary. The initial episode can be so mild that a person does not realize that he or she has a herpetic infection. Years later, when there is recurrence of HSV, it may be mistaken for an initial attack. This can lead to unfair accusations by a sexual partner.

After the initial attack, the virus moves to nerve cells near the brain or spinal cord remaining there until set off again by a menstrual period, fever, physical contact, stress or something else. Pain or unusual tenderness of the skin may begin between one to several days before both primary and recurrent infections may develop. This is called prodrome.

How are the HSV infections diagnosed?

The appearance of HSV is often so typical that no further testing is necessary to confirm an HSV infection. However, if the diagnosis is uncertain, as it may be in the genital or cervix areas, a specimen may be taken and sent to the laboratory for analysis.

How do you prevent transmission?

Between 200,000 and 500,000 persons “catch” genital herpes each year and the number of Type 1 infections is many times higher. Prevention of this disease, which is contagious before and during an outbreak, is important.

If tingling, burning, itching, or tenderness-signs of recurrence-occur in an area of the body where you had a herpes infection, then that area should be kept away from other people. With mouth lesions, one should avoid kissing and sharing cups or lip balms. For persons with genital, this means avoiding sexual relations and oral and/or genital contact during the period of symptoms or active lesions. Towels should not be shared nor clothing exchanged. Studies have shown viral shedding between attacks.

Other serious implications of HSV

  • Eye infections
  • Infections in babies
  • HSV and the seriously ill

Treatment

There is no vaccine that prevents this disease from occurring. Oral anti-viral medications, acyclovir and valacyclovir, have been developed for severe or frequently recurring infections. Low doses of medications are helpful in reducing the number of herpes attacks in people with frequent outbreaks.

 

MOLLUSCUM CONTAGIOSUM

Molluscum contagiosum is a virus-caused growth which appears as a small bump on the skin, often with a small, central, dimple-like depression. It may occur on any part of the body and there may be a single growth or as many as 50 or more.

As the name suggests, these growths are contagious and are spread from place to place on the body and to other people by physical contact. Sometimes they are spread by sexual contact and if this is the case, sexual partners should be examined for presence of lesions.

Treatment

Treatment consists of physically removing these superficial growths from the skin. This may be done by curettement (scraping them off with a special surgical instrument), application of various medicines to the growths or by freezing them with liquid nitrogen. Molluscum contagiosum lesions may also become infected with bacteria and may sometimes require antibiotic therapy. Since molluscum contagiosum lesions sometimes go away by themselves, treatment by cautery or surgery requiring stitches is avoided because of the scarring that results from these methods.

Sometimes new lesions keep appearing after treatment. This is probably because some growth were in an early stage at the time of the treatment and could not be seen with naked eye. Eventually, after all visible and incubating lesions have been destroyed the appearance of new molluscum contagiosum lesions will stop.

 

(HERPES ZOSTER)

Herpes Zoster, also known as shingles or zoster, is a viral infection caused by the same virus that causes chicken pox. Anyone who has had chicken pox can develop develop herpes zoster. The virus remains dormant or inactive in certain nerve root cells of the body and only when it reactivates does herpes zoster occur. About 20% of those people who have had chicken pox will get zoster at some time during their lives. Fortunately, most people will get zoster only once.

It is not clear what prompts the virus to reactivate or “awaken” in healthy people. A temporary weakness in immunity ( the bodies ability to fight infection) may allow the virus to multiply and move along nerve fibers toward the skin. Although children can get zoster, it is more common in people over age 50. Illness, trauma, and stress may trigger a zoster attack.

What are the symptoms of Zoster?

The first symptom of zoster is burning pain, tingling, or extreme sensitivity in one area of the skin usually limited to one side of the body. This may be present for one to three days before a red rash appears at that site. There may also be fever or headache. The rash soon turns into groups of blisters that look a lot like chicken pox. The blisters generally last for two to three weeks. The blisters start out clear but then pus or dark blood collects in the blisters before they crust over (scab) and begin to disappear. The pain may last longer. It is unusual but possible to have pain without blisters or blisters without pain.

Where does zoster usually appear on the body?

Zoster is most common on the trunk and buttocks but it can also appear on the face, arms, or legs if nerves in these areas are involved. Great care is needed if the blisters involve the eye because permanent eye damage can result. Blisters on the tip of the nose signal possible eye involvement. A dermatologist will usually refer the patient to an ophthalmologist (eye specialist) immediately.

What are the complications of zoster?

Post-herpectic neuralgia is constant pain or periods of pain that can continue after the skin has healed. It can last for months or even years and is more common in older people. The use of medication in the early stages of the zoster may help prevent this complication. A bacterial infection of the blisters can occur, and can delay healing. If pain and redness increase or reappear, you should return to the dermatologist. Antibiotic treatment may be needed.

Another complication is the spread of zoster all over the body or to internal organs. This can also happen with chicken pox. It occurs rarely and most often in those with weakened immunity.

How is zoster diagnosed?

The diagnosis is based on the way blisters look and a history of pain before the rash on one side of the body. The dermatologist may scrape skin cells from a blister onto a glass slide for examination. The glass slide is then examined under a microscope for changed characteristic of zoster. If there is any doubt, blister fluid containing virus can be sent to the laboratory for special testing.

Is zoster contagious?

The virus that causes zoster can only be passed on to others who have not had chicken pox and then they will develop chicken pox, not zoster. Zoster

s much less contagious than chicken pox. Persons with zoster can only transmit the virus if blisters are broken. Newborns or those with decreased immunity are at the highest risk for contracting chicken pox from someone who has zoster. Patients with zoster rarely require hospitalization.

Treatment

Herpes usually clears on its own in a few weeks and seldom recurs. Pain relievers and cool compresses are helpful in drying the blisters. If diagnosed early, oral anti-viral drugs can be prescribed to decrease both viral shedding and the duration of skin lesions. They are routinely prescribed for severe cases of zoster -with eye involvement for example- or for those with decreased immunity.

Corticosteriods, sometimes in combination with anti-viral drugs, also are used for severe infection such as in the eyes and to reduce severe pain. Nerve blocks can also help to control pain.

Now, two new drugs appear to be more effective than the old standby medication for shingles, acyclovir, in slowing the virus down before it can do permanent nerve damage. For maximum effect, famciclovir should be taken within 3 days after acute pain begins. It, like valaciclovir (another recently approved drug), seems to work well to reduce the pain of shingles and slow its progression. Also, a new vaccine call Zostavax is available for persons age 60 and over. The vaccine decreases the incidence by 2/3 and those who do get shingles, the severity is decreased by 2/3 too.

Other Common Skin Disorders

Scars and Keloids

Description

A essential part of the body’s natural healing process, scars are the result of the skin’s repair of wounds caused by accident, disease, or surgical incision. The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar. Typically, a scar will become increasingly prominent at first, then will gradually fade; many disfiguring marks which seem unsightly at three months may heal quite satisfactorily if given more time.

A scar’s visibility will depend on a number of factors, including its color, texture, depth, length, width or direction. How the scar forms will also be affected by an individual’s age and by its location on the body or face. Younger skin, for instance, makes strong repairs and tends to overheal, resulting in larger, thicker scars called keloids. Skin over a jawbone is tighter than skin on the cheek and will tend to increase a scar’s prominence. If it is depressed, it will make skin seem shaded, and if it is higher than surrounding skin, it will cast a shadow. A scar that crosses natural expression lines will be visually striking because it will not follow a natural pattern, and a scar that is wider than a wrinkle will stand out because it is not a naturally occurring line.

Any one, or a combination of these factors may result in a scar that, although healthy, may be improved functionally or cosmetically by treatment.

Treatment

Several techniques performed today by dermatologists can alter or camouflage the appearance of a scar. Most of these procedures are performed routinely in a dermatologist’s office under local anesthesia. Only severe scars, such as burns over a large part of the body, require general anesthesia and a hospital stay. Typically, methods of scar treatment are not traumatic or life-disrupting and do not involve major surgery.

Modern scar revision techniques can change the length, width, or direction of a scar, raise depressed scars, or lower elevated scar. However, no scar can ever be completely erased and no magic technique can be expected to return skin to its pre-scar appearance. A scar’s color cannot be altered; as it gets older, it usually fades and can often be concealed effectively with make-up, but a certain difference in pigmentation will usually remain.

The most important step in the treatment of scars is careful consultation between patient and dermatologist-analyzing what bothers a patient most about a scar and effectively determining the technique best suited to its treatment.

Methods of scar treatment

1. Steroid injection

2. Punch grafts

This is the best procedure for the treatment of deep “ice pick” scars.

3. Microdermabrasion

Microdermabrasion, is a method of treating acne scars, fine scars or minorirregularities of surface skin, and improving the look of some surgical scar revisions. The treatment involves using power driven instrument is used to remove the top layers of the skin. Most effective in the treatment of facial scars, dermabrasion used on other parts of the body has tended to result in slower healing, greater redness and an increased chance of post-operative scarring.

4. Chemical peels

Most commonly used on the face, this treatment removes the top layer of the skin with a chemical in order to smooth depressed areas and give the skin a more even tone.

5. Collagen injections

Injectable collagen, a natural animal protein, is one of the most popular “filter materials” used in the treatment of soft, superficial scars. Injected into a scar, it will fill in depressions, raising them to the level of surrounding skin.

Microdermabrasion, chemical peels, and collagen injections are available Day Spa. For a complementary consultation, please call

 

Recent News about Scars

When a pierced earlobe develops a hard lump that seems to be spreading and swelling, it is probably a keloid. This type of scar forms when the skin overcompensates during the healing process to produce excess scar tissue. When the skin is injured, cells called fibroblasts are activated to produce skin tissue (primarily collagen) to fill in the hole. Normally, the body signals when to stop the healing process. Sometimes, however, the signal malfunctions and collagen production continues, which causes the scar to thicken. Keloids most often form in people with darker skin. And, they can develop in response to practically any trauma to the skin. Steroid injections or compression may help control keloid growth. Generally, it does not help to have keloids surgically removed because they tend to recur after excision.

If you are prone to making keloids when you scar, you should use extra care to avoid damage to your skin that can lead to scar production. One way to minimize keloids is to avail yourself of professional help sooner than later when your skin is in trouble; prompt care can make a difference.

Scleroderma

Description

S cleroderma, which literally means "hard skin" is a general term for several chronic autoimmune conditions. The disease typically begins between the ages of 30 and 60 as a thickening and hardening of the skin (initially on the fingers, hands, or face), which occurs due to an overproduction of collagen (the protein that imparts strength and elasticity to normal skin). The typical scleroderma patient is a women in her 30s or 40s whose hands and feet were abnormally sensitive to cold for many years before she developed thickening skin on her hands and face.

Tight, shiny, and thick skin on the face and fingers, with puckering around the mouth, may lead to a mask-like appearance. Collagen that proliferates elsewhere can disrupt function of the gastrointestinal tract, lungs, kidneys, and heart.

Treatment

While there is no effective treatment of scleroderma, some studies indicate that the drug penicillamine helps reduce skin thickening and prevents internal complications.

Although sensitivity to cold is a frequent precursor to scleroderma, there are a number of other reasons why some individuals have this symptom.

If you have, however, any questions about any unexplained changes in your skin, or if you have the symptoms described above, it is a good idea to let your dermatologist examine, diagnose, and decide on an appropriate course of treatment for you.

Onychoschizia (shale nails)

Description

Onychoschizia (shale) is the medical term for the superficial splitting and layering in the free ends of the nail plates. This condition, which strikingly resembles shale, can result from trauma or prolonged exposure to hot liquids, solvents, or caustic substances. Over time, repeated insult to the nail plates causes them to dry out, become brittle, and peel off in layers.

By examining the nails, the dermatologist might find clues to certain internal body disorders such as anemia, kidney, lung, liver, or thyroid disease, as well as skin conditions such as psoriasis and some forms of hair loss.

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Treatment

Easily identified by the dermatologist, the problem can be treated with special lubricants; however, it is important to limit the damage by wearing gloves when in water or chemicals. And, as nail polish removers and solvents in polish can contribute to the condition, it is helpful to reduce the frequency of polish changes when faced with "shale nail."

Other Nail Conditions

W hile vertical ridges and other flaws on fingernails are common, some unusual nail features may be indicative of underlying disease or conditions. For instance, pitting, spooning (upcurled nails), and separation of the nail from its bed may be caused by such diseases as anemia, hypothyroidism, and psoriasis. Rounding and expansion of both the nails and the ends of the fingers can be indicative of such serious conditions as lung cancer and inflammatory bowel disease. The horizontal furrow known as "Beau's line" can result from heart attack or serious illness that slows nail growth abruptly. The line eventually grows out. Because the nails often provide clues to various disorders, the dermatologist will not want to overlook them during comprehensive exam.

T here seem to be many more reported cases of nail fungus among women who have "sculptured" nails. The fake nails or tips that are applied over the natural nail in order to enhance length, beauty, and/or strength of the natural nails, rely on even bonding of the nails' surfaces. When this bond loosens and allows moisture to get into the space between the nail and the acrylic, the warm, dark location encourages the growth of fungus. Thick, distorted nails (especially on the toes) often indicate a fungal condition that, in most cases, responds to oral antifungal drugs.

Dermatology Update

Recent News about Nail Health

The dermatologist can sometimes detect internal illnesses on the basis of certain features on the fingernails. For instance, asthma and tuberculosis can cause "yellow nail syndrome" while congestive heart failure turns nails red. Renal failure can lead to "half-and-half nails" in which half of the nail is normal colored and half is white. Nails that are all white may indicate chronic hepatitis. And, hemachromatosis (a disorder in which excess iron is deposited in the organs) is associated with gray, blue, or brown nails. How a disease specifically affects a nail is not always clear. And, while no one is suggesting that a diagnosis can be made solely on the basis of the condition of the nails, they can provide a clue of an underlying problem.

Not only is your skin your "outer wrapper," it is also the largest organ in your body. Many people think of skin problems as superficial because we think of "skin deep" as being synonymous with superficiality, but our skin is also important as the body's primary barrier against infection and intrusion by all sorts of chemical agents and biological invaders. Caring for one's skin is as important as protecting the well being of one's internal organs.

 

 

Laser Hair Removal Delhi  
  • Accredited by Gold Skin Care Centre ,USA
  • In technical collaboration with Lumenis, USA (the pioneers of laser technology)
  • Under the supervision of Dermatologists & laser technicians
  • Introducing Hi-speed LightSheer Duet from Lumenis, USA for faster treatment. Enables treatment of complete back and legs in just 15 minutes
  • Combination of Nd:Yag & Diode Lasers, lasers from America and US : FDA approved for Indian skin type.
  • Safer, faster and painless.

The root of the problem

Hair grows in cycles, and many factors influence its growth, Age, ethnicity, medications, hormones levels, and even location of the hair on the body influence the length, coarseness and colour of hair .

  • Anagen is the active growing phase in which the hair bulb is intact. The hair grows in both directions, upward and downwards
  • Catagen is the regression phase when the lower part of the hair stops growing but is not shed, and the body absorbs the lower third of the follicle.
  • Telogen is the resting phase. The hair bulb is no longer present and is now a club hair which will fall out or be pushed out of the follicle by the new anagen growing hair .
SKIN CLINIC  Delhi 

Laser roots it out for good

Laser hair removal is a non invasive procedure, by which unwanted hair are removed from any part of the body by utilizing a long pulsed laser.

The laser parameters are carefully defined by studying the anatomy of the hair follicle and precisely matching the laser light and pulse duration to the follicle size, depth and location to inhibit the re-growth of the hair. Laser hair removal technique helps in facial hair removal and permanent hair removal.

Laser hair removal is performed by a specially - trained laser technician or a doctor, who directs the light of a long pulsed laser onto the skin. Since other hair will enter their growth cycle at different times, several sessions are necessary to destroy all the follicles in a treatment area.

SKIN CLINIC  Delhi

Suitable for all

Both men and women seek laser hair removal to get unwanted hair removed. Hair removal is commonly done on the hairline, eyebrow, top of the nose, side burn, upper & lower lip, chin, ear lobe, face, neck, nape, shoulders, back,, underarm, abdomen, buttocks, public area, bikini lines, thighs, breast, arms, legs, hands, and toes.

Lasting reduction

The US : FDA has approved the process as "Permanent Reduction" which means that one shouldn't expect laser to remove every single hair from an area. Some might need touch up treatments once or twice a year after the initial set of treatments for any new growth the body may develop.

Hair less but not careless

Following precautions are expected from a patient during the course of the entire treatment.

  • No waxing or removing hair from the root by any other way.
  • After treatment is completed, aloe vera should be applied to soothe the skin.
  • Exfoliating and/or scrubbing gently in the shower with a loofa after the treatment may help speed up the shedding process of hair.

How long before I can flaunt my new look?

The number of treatments depends on the skin and hair colour, density and coarseness of the hair as well as the specific area to be treated. On an average , 5 - 7 treatments, scheduled 4 to 6 weeks apart will approximately reduce hair growth by 70 - 90 % .

Additional session might be required to eliminate the hair that come out of the dormant phase and become active later.

Will there be any side effects?

There are no lasting side effects of laser hair removal on a healthy body. However , one might experience the following immediately after the treatment:

  • Normal itching during the treatment
  • Temporary Redness
  • Temporary Swelling
  • Pain, Tingling or Feeling of Numbness

How about reducing the density of the hair and not completely removing them?

Yes, This can be achieved. Please contact our doctors who will help you with the process and consult accordingly.

Services
 

DR.RAJNISH ANAND

The Visionary zeal of social service to help people improve their own self image prompted the Founder Director, DR. Rajnish Anand to launch AURA Skin & Laser Clinic.Dr.Anand has undergone Advanced training in Light Sheer Surgical Technology from California,USA.He is a member of the Royal European Society of Laser Surgery. He is also a member of American Society of Cosmetic Dentistry,Indian Dental Assiociation. Dr. Rajnish Anand was one of the first Doctors in India to introduce Light Sheer Diode Laser System.

DR. SUNIL DHAR, M.S. (COSMETIC LASER SURGEON)
Choosing the Right Cosmetic Surgeon for your needs is a major decision.We offer Procedures that are safe and effective.Dr.Sunil Dhar offers various surgical procedures i.e.Scar Removal, Eyelid Surgery, Lip Augmentation, Breast Augementation, Breast Reduction, Male Breast Reduction, Abdominoplasty(Tummy Tuck). We at Aura offer our patients a warm, personal, Atmosphere, Comprehensive Care,and genuine commitment to your happiness.

DR.AVDESH MEHTA
In case you are not happy with the shape, size or angle of your nose, ears, lips or cheeks - we can improve them through our surgical and non-surgical methods. Senior ENT surgeon of our team, Dr Avdesh Mehta can help you to get the desired improvement in your appearance.

• Introduction
• Is Laser Hair Removal Safe?
• How the LightSheer Laser works?
• What Can You Expect ?
• Pre Treatment
• Post Treatment



Introduction


The LightSheer diode laser is the most fantastic, state of the art system specifically designed to remove unwanted hair fast. There is less discomfort and the laser itself is the most reliably compared to any other laser around and it permanently reduces your unwanted hair.

Best of all, you will need fewer sessions to get the job done than with any other laser around.

The LightSheer was the first diode laser that has been approved by the FDA for permanent hair reduction.


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Is Laser Hair Removal Safe?

Yes, it is safe. By now, there have been more studies done with the LightSheer laser than any other laser around.

The LightSheer was developed from years of research at the Massachusett's General Hopsital's Wellman Laboratories of Photomedicine, one of the world's leading research institutions. The laser parameters were carefully designed to inhibit the regrowth of hair by studying the anatomy of the hair follicles. The actively cooled sapphire hand piece was designed to conduct heat away from the skin before, during and after each pulse. Proper eye protection is an important feature during any laser treatment.
For safety, laser hair removal is not recommended when pregnant.
People treated commonly experience reddening of the skin, follicular swelling and histamine/hive reactions. Most skin reactions resolve within 1 to 2 hours but can last up to 24 - 48 hours after the treatment. Other temporary adverse side effects like hyperpigmentation (darkening of the skin) or hypopigmentation (lightening of the skin) is possible, but not common.
It is important thata you lower your risks of pigmentationn changes by following the pre and post treatment instructions. Avoid sun exposure, suntan beds and self-tanning lotions. It is important that you protect your skin by wearing a sunscreen or a sunblock.


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How the LightSheer Laser works ?

A laser produces a beam of highly concentrated light. The light emitted by the LightSheer diode laser is well absorbed by the pigment (melanin) in the hair follicles. Prior to the procedure, the treatment area has to be shaved. During the procedure the upper layer of the skin is compressed and cooled with the special cooling handpiece. This procedure protects the skin and makes the procedure more effective. Then the laser pulses light for a fraction of a second, just long enough to heat up the hair and destroy the follicle's ability to re-grow.
The result - permanent hair reduction in the treated area.

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What Can You Expect ?

The length of a laser treatment may last anywhere from a few minutes to an hour or more, depending on the size of the area being treated. It is important to know that the hairs in an active growth phase (referred to as Anagen) are most affected by the laser. As all hairs are not in this phase at the same time, more than one treatment will be necessary to achieve the best result.

Most individual's permanent hair loss will be between 50 - 85% after 3 treatments. Most people need 4 - 6 treatments in total. The hair that is left is usually lighter and finer than the original hair.

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Pre Treatment

Very Important! 6 weeks prior to Laser Hair Removal do NOt wax or tweeze, No threading, No electrolysis.

• ONLY SHAVING is allowed!

• Do not tan the areas to be treated for 4 weeks prior to the treatment.

• Do not apply moisturizers or makeup on the skin to be treated.

• You need to be freshly shaven on the area(s) your want to have lasered.

Apply EMLA, a topical anaesthetic cream to the area you want to have treated approximately 2 hours before the treatment.
Apply Emla about 1/8 inch thick to the area. Like icing a cake.
For bigger areas you will need 30 - 60 gr of Emla.
Apply the cream so that it is still white on the skin, wrap Saran wrap over it to keep the cream moist and effective. We will remove the cream in the salon before the treatment.
Wear comfortable loose clothing.

Take a pain medication 20 - 30 minutes before the treatment is you have a problem with pain.

We offer our clients a more efficient topical anesthetic that we apply for you in the salon in which case you need to come in 20 minutes earlier. That service is a choice we offer and is not included in the laser hair removal cost.


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Post Treatment

Some redness and swelling in the area after the treatment is normal. It may feel similar to a sunburn. This usually resolves within a few hours after the treatment. For some people it may take a few days.
You can cool treated areas with a cold face cloth.
DO NOT use chemical packs.
Apply a soothing Aloe Vera or Vitamin E Gel to the treated area twice a ay for 5 to 7 days after the treatment, or until the sunburned feeling has subsided.
Clean the area gently twice a day.
Clients should use the highest factor sunblock and sunscreen. You must protect the treated area from exposure to sunlight, sunbed or other artificial tanning between the treatments.
Avoid irritants (glycolic acid, retinoids, chemical peels etc) for 7 days after the treatment.
Avoid perfumes, strong soaps, makeup and deodorants until any stinging has subsided.
Avoid hot baths, hot tubs and working out for 24 hours after Laser Hair Removal.
Do not pluck or wax after your treatment.
You may shave the treated area to keep it tidy if need be.


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LightSheer Tip Contact Cooling Cartoon

Laser Hair Removal Clinic In Delhi and NCR 

 


Hair Transplant DELHI

 

Hair Clinics Delhi offer FUE hair transplant Delhi, facial body hair transplant, facial hair clinics Delhi, follicular hair transplant, FUE hair transplantation Delhi

Hair Transplantation Delhi

   
 
Follicular Hair Transplantation The best technique for Hair Replacement in bald areas
 
FREQUENTLY ASKED QUESTIONS ON HAIR TRANSPLANTATION
 

What is Hair Transplantation?

Hair transplantation is a surgical procedure in which hair from the back and sides of the scalp is moved to the bald areas. 

When Can a Hair Transplant Be Done?

A Hair Transplant can be done in the early stages of hair loss when the hair is just beginning to thin, as well as in the later stages when baldness is more apparent. 

In What Type of Baldness Has This Treatment Been Helpful?
It is most commonly used to treat male pattern baldness.  Hair Transplantation has, however, been

Hair Transplantation Treatment Delhi, Hair Transplantation Clinic India
performed with excellent results in the treatment of genetic hair loss in women, as well as in scars resulting from face lifts and other facial surgery, burns, accidents, or as a result of various hair loss diseases.  This surgery is also done to help replace thinning eyebrows and eyelashes.   
 
How Long Will the Transplanted Hair Last?
Transplanted hair should grow normally in the recipient area as long as it would in the donor site from which it was taken. 
 
Do All Transplanted Hair Grafts Grow?

In almost all cases, the vast majority of transplanted grafts should yield growing hair.  Pre and postoperative instructions are provided to minimize the risk of graft injury and subsequent compromised growth.  It is important to realize that the number of hairs growing from each graft will vary, depending on the density of the hair at the donor site and on the size of the graft selected. 

 
How is this Surgical Hair Restoration Procedure Performed?

Hair Transplantation is a long office procedure, which requires only local anesthetic.  There is initially some discomfort associated with the administration of the anesthesia, but this is of very short duration. We have developed techniques to reduce this discomfort, and most patients tolerate this brief period very well.

 
The donor area (the back or sides of the scalp) as well as the recipient area (the bald or thinning area) are made numb with the local anesthetic.  Up until several years ago, round grafts (plugs) were always used throughout the hair transplant process.  The desired number of round grafts were removed from the donor area and then transferred to the bald area.  Today these larger grafts have been mostly replaced by smaller grafts (follicular units, micro, mini or slit grafts), since these grafts produce a much more natural transition from thinning or baldness to increased hair growth.  In most cases where very small grafts are used, this surgery can be accomplished almost undetectably.  Specific recommendations are discussed at a personal consultation.
 
When smaller grafts are to be transplanted, the following technique is used:
 
The hair to be transplanted is trimmed close to the scalp, and the desired amount of donor skin and hair are then removed.  This donor site is then sutured closed, resulting in a fine scar which is only detectable on close inspection.  The donor hair-bearing skin is then divided into very small pieces which generally contain 1-3 hairs.  These grafts are then rapidly inserted into small openings made in the recipient area.
 
When there is a Large Area of Baldness, is it Possible to cover the Entire Bald Area?
This depends on the size of the bald area as well as on the donor area.  When there is extensive baldness, a procedure called a scalp reduction may be useful in order to decrease the size of the bald area.  Subsequently, grafting is done as described above. 
 
How Many Sessions are required in a Hair Transplant?

The number of sessions varies, and will depend on the:

  • Area of scalp treated
  • Number and size of grafts used
  • Density of hair desired by the patient
  • Individual characteristics such as coarseness or fineness of hair
  • Current stage of hair loss and future rate of hair loss
  • Timeframe in which patient wishes to replace lost hair
Is There a Minimum or Maximum Time Period that is Allowed Between Individual Hair Replacement Surgery Sessions?
Minimum time intervals will depend upon individual circumstances.  However, there is no maximum interval between sessions.  Certainly, the shorter the intervals between sessions the more rapidly the hair transplant is completed.
 
How long does it take for Transplanted Hair to Grow?
The transplanted hair generally sheds within the first 2-3 weeks after the procedure and new hair begins to grow approximately 2-4 months later.  The hair then grows at the normal rate of 1/2 inch each month.  The transition from thinning or baldness to greater fullness of hair is very gradual.
Follicular Hair Transplantation The best technique for Hair Replacement in bald areas
 
What is a Scalp Reduction?
A scalp reduction is a procedure, which is performed under local anesthetic in which a large bald area of skin is removed.  This leaves a scar on the scalp which must later be camouflaged by grafting directly into the scar.
 
What is Scalp Flap Surgery?
Scalp flap surgery is a procedure in which an entire segment of hair-bearing scalp is transferred into a bald area.  This is a relatively uncommon surgery and few surgeons perform it. The risks include improper hair direction at the hairline, as well as the more serious risk of partial or complete loss of survival of the flap and the hair within it.
 
Why Have I Seen Hair Transplants That Have a Pluggy Look?
In the past, hair transplant surgery often resulted in a very artificial look sometimes referred to as a pluggy, doll's head or corn row look.  This was usually seen in the intermediate stages between hair transplant sessions, or if a person decided not to complete the
Hair Transplantation Treatment Delhi, Hair Transplantation Clinic India
required number of surgeries. With the advent of the tiny grafts being used today, the result can be very natural even after a single surgery.
 
Are Lasers Used in Hair Transplantation?

Laser hair transplantation has been used with some success.  To date, results with lasers have been shown to be inferior to those obtained with traditional non-laser hair transplant surgery. For this reason, they are not in common use.

 
How Long After a Hair Transplant Would I Be Able to Go Back to Work?

Depending on the type of procedure you have done and the type of work you do, it is often possible to go back to work in one or two days.

 
What are the Risks of Hair Transplant Surgery?
Hair transplantation is an extremely safe out-patient procedure that is generally without significant risks or complications.  However, as is the case in any surgery, there are risks, and these are always presented and discussed in detail at your personal consultation with the doctor.
 
What Type of Preparation is required prior to Hair Restoration Surgery?
All patients must have normal results to standard pre-operative blood tests prior to confirming a surgery date and arranging travel plans.  Detailed pre-operative and post-operative instructions are forwarded to each patient prior to the surgery date.  Patients also complete Consent for Surgery form prior to the surgery.

 

Definition of FUE

Follicular Unit Extraction (FUE) is the most scientific & advanced technique of hair restoration. In this procedure:

  • Hair follicles are extracted individually from the back side of the head, beard or other body parts with the help of special micropunches (size varying from 0.7mm - 1.3mm).
  • Implanted in the bald area of scalp, beard, moustache, eyebrows or chest.
  • These transplanted hair grow, you can get a hair cut and style them in whatever way you want.
Consultation for Hair Loss

Advantages of FUE

  • Stitchless
  • No linear visible scar
  • No infection or reaction to sutures
  • The patient can wear short hair
  • Virtually painless

 

 

Follicular Unit Extraction Technique (FUE)

Consultation for Hair Loss

Donor Area

The hair in the scalp are arranged in the form of groups called grafts. Each graft consists of 1-5 hair. These grafts are removed from the permanent zone of back and sides of the head. The hair in these grafts do not have a receptor in the area of the hair root and do not respond to the male hormone, testosterone. Also other sources of hair include: beard, chest, abdomen, legs. The surgeons at AK Clinics are routinely using the other body parts for patients who require higher number of grafts.

Consultation for Hair Loss

Recipient Area

These hair are then implanted in the recipient area. The surgeons at AK Clinics take a lot of care to implant the right kind of grafts at the right place to give it a natural look.

Growth of transplanted hair after surgery

Growth of transplanted hair after surgery

The transplanted hair grow for 2-3 weeks, then the hair shafts fall off, the roots remaining in the scalp and the shafts start coming back after 2-3 months of surgery.

The hair come back at a very slow pace and a great deal of patience is required during this period. About 40-50% hair come back after 6 months and 75% after 9 months and about 90% of transplanted hair come back after 1 year of surgery.

FUE Post OP Instructions

FUE Post OP Instructions
  • After the surgery, you will have minimal discomfort but not that much to keep you awake all night. It is advisable to lie down in supine position and keep the towel at the back of your head while sleeping.
  • Painkillers will be prescribed which you would require for first 3-4 days only.
  • Please do the forehead massage starting from the middle of your head towards outside 10- 15 times a hour or 100-150 times in a day for 5 days.
  • Please remove the back bandage (of donor area) on the 3rd day after surgery. You can do this yourself. After removal start applying antibiotic cream for 7 days.
  • Bandages on the forehead must not be removed till the swelling goes off(may be 5-6 days).
  • Eat a healthy diet - ( high protein )
    Non - Vegetarian :- Fish, chicken, eggs
    Vegetarian :- Soyabean, paneer, daals, almonds, (with skin, 5-6 daily)
  • Avoid direct sun light, sweat for 2-3 weeks. No upper body exercise/ heavy exercises (Gym) till 3 weeks.
  • You can follow your routine activity from the next day onwards.
  • Please use the spray to moisten the transplanted area, every 2 hourly for the first 2 days, then 4 hourly for next 3 days.
  • You can have shower on 5th day without hands, without shampoo.
  • On 7th day, have shower with baby shampoo, but no hands to be used.
  • On 10th day onwards, normal shower with baby shampoo can be done by using hands.

Microfollicular Hair Transplant Procedure
Skin Clinic Delhi provides the best facilities for various Skin treatments.  Skin laser treatment, Skin treatment, skin clinic delhi,skin care clinic, Skin Doctor in delhi, Skin Doctor website,


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