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Florida Dermatologist FAQ’s: What is Atopic Dermatitis (Eczema)?

Atopic dermatitis or eczema refers to an inflamed skin condition that can impact adults, children, and infants. In the early phase, eczema is characterized by red, blistering skin. It may progress to cause a thickened, scaly, patchy skin that itches.

The condition usually manifests before the age of three, and a majority of patients will be free of the condition by the age of 25 years. In children, eczema may initiate on the cheeks and extend to the arms and legs.

Suncoast Skin Solutions, led by board certified dermatologist Dr. Christopher Ewanowski, provides safe and proven skin care treatments to patients in Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Palm Harbor, Central Florida, and surrounding locations in Florida.

Symptoms

Itchy, dry skin, which can rapidly get red and swollen, is a notable characteristic of eczema. It will typically get infected, and small blisters may develop and ooze fluid or become crusted. Symptoms such as dryness, scratching, itchiness, and swelling may come and go.

Over time, the patient may develop tough, thickened skin due to a persistent rash. Mild types of eczema will affect only a tiny skin area, while a severe condition may be widespread.

The body areas where the rashes manifest may be distinct for adults, children, and babies. A dermatologist will undertake a physical examination and review the patient’s medical history to diagnose atopic dermatitis. Certain patients may have to undergo an allergy test to determine the triggers for the rash.

Eczema in Infants

Infantile eczema necessitates the determination of the skin irritation triggers as well as avoiding them. The infant should not be exposed to extreme hot or cold temperatures. Prescription drugs may be necessary to treat an infection or improve a rash. The doctor may prescribe oral antihistamines for the patient’s comfort and to decrease nighttime itching.

When to Seek Treatment?

In the following cases, the patient should seek professional dermatology treatment for eczema:

Itching is leading to irritation or interfering with sleep or other routine activities.
Oozing sores, scratch marks, crusting, skin discoloration, or fever accompanying a rash develops on the skin.
Development of painful cracks in the fingers or hands.
Inflammation, pain, heat, or redness.
Pus discharge.

Prevention

A known eczema patient may follow a few precautions to minimize the symptoms of the condition. The delicate skin areas should be routinely moisturized to prevent dryness.

The patient should also avoid extreme or sudden temperature changes as far as possible. They should also avoid activities that lead to overheating of the body or increase stress levels.

In addition, the patient should avoid fabrics that may irritate the skin. The dermatologist may order allergy tests to identify unknown allergens so that the patient can eliminate them in food and other items as far as possible. Mild or medicated soaps and other cosmetics may be applied on the skin.

Dr. Ewanowski’s skin care clinic receives patients from Tampa, Brandon, Lutz, Seminole, Riverview, Brooksville, Winter Haven, Daytona Beach, Largo, St. Petersburg, Ocala, Sarasota, Palm Harbor, Central Florida, and nearby areas in Florida for advanced and innovative skin care procedures.

SunCoast Skin Solutions Dermatology offices are located in Tampa / Hillsborough, St. Petersburg / Pinellas County , Brandon, Lutz, Winter Haven, Largo, Riverview, Brooksville, Ocala, Sarasota, Palm Harbor and Daytona Beach Florida. Contact us at 1-844-786-3376 or click here.

Florida Dermatologist FAQ’s: Actinic Keratosis (AK) Treatment And Prevention

Early detection and prompt treatment can address almost all actinic keratoses (AKs) before they develop into skin cancer.

In case a doctor suspects an AK to be a pre-cancer, they may take some tissue for a biopsy by shaving off a portion of the AK with a scalpel or scraping the lesion with a curette (a surgical tool that has a sharp ring-shaped tip).

Additionally, the physician may use the curette to scrape off the base of the lesion. They will control the bleeding by applying trichloroacetic acid (TCA) or using an electrocautery needle. The patient will need local anesthesia for this procedure.

Treatment Options

Various treatment options are available to address actinic keratoses, depending on the age and medical condition of the patient as well as the nature of the growth. These treatment options include the following:

Surgical Procedures

Cryosurgery: The doctor applies liquid nitrogen to the actinic keratosis to freeze the tissue. After this, the lesion and adjacent frozen skin may blister or develop a crust and fall off.
Curettage and desiccation: The doctor will shave off or scrape a part of the entire lesion. Then they will apply a chemical agent or heat to stop the bleeding and potentially remove any residual AK cells.
Laser surgery: The doctor will utilize a strong light to vaporize the tissue of the AK.

Topical Treatments

The doctor may prescribe a topical cream, gel, or solution for patients with numerous or widespread actinic keratoses. These can treat both visible and invisible lesions with minimal risk of scarring. This treatment is also called “field therapy” as the topical treatments can address a wide field of skin compared to targeting a single lesion.

5-fluorouracil (Carac, Efudex, Fluoroplex): A form of topical chemotherapy
Chemical peel: These peels are known for reversing signs of photoaging. But chemical peels can also eliminate some superficial AKs on the face, particularly when other techniques have not been effective. This procedure involves the application of trichloroacetic acid and/or similar agents to the face, which causes the superficial layers of skin to slough off.
Diclofenac (Solaraze) and hyaluronic acid: A combination topical therapy.
Imiquimod (Aldara, Zyclara): This form of topical immunotherapy encourages the immune system to produce interferon, which is a chemical that combats cancerous and precancerous cells.
Ingenol mebutate (Picato): This is a fast-acting topical treatment developed from plants. An immunologic mechanism of action has been proposed.

Photodynamic Therapy

Photodynamic therapy (PDT) is very effective on widespread lesions on the face and scalp. This dermatology procedure involves the application of a light-sensitizing topical agent to the lesion. After this, the doctor will use a strong light to activate the topical agent. This helps in the removal of actinic keratoses without any damage to the surrounding healthy tissue.

Combination Therapy

The treatment of AKs may involve the use of combined treatments for a span of time. The topical medications and PDT may be prescribed alternately every three months, six months, or one year, as adjudged by the doctor at the follow-up skin examination.

SunCoast Skin Solutions Dermatology offices are located in Tampa / Hillsborough, St. Petersburg / Pinellas County, Brandon, Lutz (2 locations), Winter Haven, Largo, Riverview, Brooksville, Ocala, Largo at Bardmoor, Daytona Beach, Sarasota, and Palm Harbor, Florida. Contact us at 1-844-786-3376 or click here.

Florida Dermatologist FAQ’s: What Causes Actinic Keratosis (AK)?

An actinic keratosis (AK), also called solar keratosis, refers to a scaly, crusty growth that occurs due to damage caused by ultraviolet (UV) radiation exposure. At the time of the initial consultation, the dermatologist will explain the various causes of AK to the patient.

Sun Exposure

Almost all actinic keratoses develop due to chronic sun exposure. The skin sustains cumulative damage due to sun exposure. Therefore, even short durations in the sun add to the lifetime total. In fact, even cloudy days are not safe as 70 to 80 percent of the sun’s UV radiation can pass through the clouds. This harmful radiation can bounce off snow, sand, and other reflective surfaces as well, creating extra exposure.

Older people and outdoor workers are at a higher risk as the chances of developing one or more AKs increase with the amount of time spent in the sun over the years.

As men tend to spend more time in the sun and use less sun protection in comparison to women, the incidence of actinic keratosis development is higher in men. While some people as young as in their 20s are impacted, AKs are much more common in individuals over the age of 50 years. According to experts, almost everyone over the age of 80 years has AKs.

The location also makes a difference as the proximity to the equator increases the likelihood of developing this dermatology condition.

Other Causes

The UV radiation emitted by the lamps in a tanning salon can be even more harmful and concentrated than the sun. Therefore, dermatologists warn patients against indoor tanning. The odds of developing AKs increase with tanning under these lamps.

On occasion, actinic keratoses can also develop due to extensive exposure to X-rays or various industrial chemicals.

Who is at Most Risk?

Most vulnerable to sun damage are individuals with fair skin, freckles, blonde or red hair and green, blue, or gray eyes. They have a higher chance of developing AKs if they spend time in the sun and live for long enough. Asians, African Americans, Hispanics, and others with darker complexions are not as prone as Caucasians to develop AKs, but skin cancer can occur in anyone.

In reality, partially due to later detection, skin cancers in African Americans and Hispanics are more likely to be diagnosed at an advanced stage compared to those found in Caucasians.

People who have a weakened immune system due to AIDs, cancer chemotherapy, organ transplantation or other reasons are less capable of fighting off the effects of UV radiation, and more likely to develop AKs. It is also notable that extensive UV exposure itself weakens the immune system, decreasing its ability to repair UV damage.

How to Spot Actinic Keratosis?

Actinic keratoses usually develop on the face, ears, lips, shoulders, neck, back, bald scalp, and back of the hands and forearms. They can range in size from a small spot to an inch in diameter. AKs typically seem like small scaly or crusty bumps or “horns.” The base can be light or dark skin-colored and may have other colors such as red, pink, or tan.

Patients should routinely examine their skin to look for actinic keratosis lesions. Many AKs have a different appearance. For this reason, patients should consult their doctor promptly if they detect any unusual or changing growth.

Florida Dermatologist FAQ’s: Acne Scar Treatments And Removal

Acne scars can have an adverse effect on the youthful appearance of the face. These scars can last for a lifetime if left untreated. It is possible to treat specific types of acne scars with non-surgical dermatology treatments.

Skin Resurfacing Treatments to Soften Acne Scars

Cutting-edge laser systems use ablative as well as non-ablative energy to improve the appearance of acne scars and resurface damaged skin.

Sublative rejuvenation systems powered by radio frequency (RF) energy can also be used to improve the appearance of acne and injury-related scarring. These treatments soften the appearance of scars as well as enhance the skin by improving textural irregularities.

RF-based systems are distinct from laser or light-based treatments. It involves delivering targeted fractionated bi-polar radio frequency (RF) heat energy to the inner skin layers (dermis) to rejuvenate the tissue in the region.

This treatment will effectively “jump-start” the healing process of the body and encourage the production of new collagen without causing harm to the superficial skin layer. Therefore, eMatrix involves minimal post-treatment downtime.

The fractionated laser technology used in laser-based skin resurfacing procedures improve the skin surface. Laser energy encourages the production of new skin cells to fill in sites of acne scarring. Ablative lasers work aggressively on the scar while non-ablative lasers promote the development of collagen without any damage to the surface of the skin.

IPL (intense pulsed light) photo facials can effectively improve raised and discolored scars as well as textural aberrations on the skin’s surface.

Injectable Dermal Fillers

Dermal filler injectables, such as Restylane, Juvederm, and Perlane, can help fill the pockmarks and depressions because of deep acne scars.

Juvederm Voluma XC (Voluma)

Innovative HA-based dermal filler Juvederm Voluma is the only FDA-approved filler which is designed to add fullness to depleted facial areas.

This is an excellent treatment for individuals who are unhappy with a tired-looking, gaunt face. Voluma is particularly effective in creating fullness in three regions of the mid-face and cheek, namely the apple, apex, and hollow of the cheek.

Chemical Peels

Chemical peels are non-invasive skin rejuvenation procedures that involve the use of chemical solutions to slow away discolored, damaged, and scarred skin to reveal smoother, radiant skin with more even texture and color.

Medium or strong chemical peels are typically used to treat uneven skin tone due to hyperpigmentation (melasma, skin darkening, sun spots) and other types of dyschromia (irregular pigmentation). This peel impedes the development of tyrosinase, which is an enzyme that helps in the production of melanin. Melanin offers the skin it’s color (pigment).

In addition, the peel develops a more even skin tone and has been shown to improve the appearance of acne and injury-related scarring on facial skin.

Pharmaceutical Strength Skincare Products

Patients may consider advanced at-home scar treatments that are available only through cosmetic surgeons and dermatologists. These effective treatments consist of active ingredients that prevent the development of scars while greatly improving the appearance of existing scars.

These treatments are made with robust ingredients to improve textural unevenness such as scarring while toning, brightening, and smoothing skin at the same time.

Florida Dermatologist FAQ’s: Acne Treatment And Prevention

Today various dermatology treatments are available to improve or eliminate acne conditions. To accomplish safe and effective outcomes, patients should work with an experienced dermatologist with specialization in acne treatments.

Prescription Medications

Retinoids

These medications are available in the form of lotion, cream, and gel. Retinoids are a derivative of vitamin A and include adapalene, tretinoin, and tazarotene. The application starts slowly, around three times a week and then daily as the skin acclimatizes to it. Retinoid medications work by preventing the clogging of hair follicles.

Topical Antibiotics

Antibiotics will eliminate excess bacteria and resolve redness. In the initial few weeks or months, the patient may have to use retinoids combined with antibiotics. The antibiotics are typically combined with benzoyl peroxide to reduce the risk of developing antibiotic resistance.

Oral Antibiotics

The dermatologist may prescribe oral antibiotics to treat harmful bacteria and fight swelling in the case of moderate to severe acne.

The treatment options for addressing acne include tetracyclines, such as doxycycline and minocycline. After the symptoms begin to subside or if it is obvious that the medication is not working, the dermatologist will taper off the drugs.

Combined Oral Contraceptives

These drugs help in treating acne in women and teenage girls. The FDA has given the nod to a few medications that combine estrogen and progestin. These medications may lead to mild side-effects for a temporary duration.

Anti-androgen Agent

In case oral antibiotics are ineffective, the dermatologist may prescribe the medication spironolactone for women and adolescent girls. This drug impedes the effect of androgen hormones on the sebaceous glands, which control excess oil production in the skin to minimize the development of acne.

Oral Isotretinoin

This medication is highly effective but has significant potential side-effects. If a patient chooses this treatment, they will have to be monitored closely by the dermatologist.

Non-Drug Therapies

Cosmetic dermatology offers various solutions, such as light-based therapies, laser resurfacing, and chemical peels, to treat certain types of acne conditions. These procedures can be undertaken in-office and have minimal risk and side-effects. Patients will need to avoid sun exposure for a few weeks following the treatment and wear a sunscreen of SPF 30 or higher.

Prevention of Acne

Keep your face thoroughly clean

Regardless of whether a person has acne or not, it is vital to wash the face twice daily to remove dead skin cells, impurities, and extra oil from the surface of the skin. It is not necessarily better to wash the face more often than twice daily, as it may do more harm than good.

The use of harsh soap, such as deodorant body soap, can further irritate already inflamed skin. It is also important to avoid scrubbing the skin vigorously with a washcloth.

Moisturize your face

Many acne products comprise components that dry the skin. Therefore, it is advisable to use a moisturizer that minimizes skin peeling and dryness. The use of “noncomedogenic” products may be helpful as these do not cause acne. There are moisturizers developed for dry, oily, or combination skin.

Florida Dermatologist FAQ’s: What causes acne?

Acne refers to undesirable blemishes that develop on the face and may occur at any time for various reasons. Acne breakouts usually occur at a younger age.

But now acne is increasingly becoming an issue even among adults. Stubborn acne problems require an individualized treatment approach to accomplish long-lasting outcomes.

Acne Factors

Four main dermatology factors that contribute to acne are as follows:

Blocked pores
Excess oil production in the skin
Dead skin cells
Bacteria build-up

Acne usually develops on the face, chest, neck, back, and shoulders. These areas have the highest number of sebaceous glands that generate oil. Acne develops when the hair follicles get clogged with dead skin cells and oil. Hair follicles and oil glands are connected. The skin and hair receive lubrication from the secretion of these glands.

This secretion is known as sebum, and it usually travels along the hair shafts and through the openings of the hair follicle onto the surface of the skin.

When there is excessive sebum production, it can combine with dead skin cells to accumulate in the hair follicles. This creates a soft plug and an optimal environment for bacteria to thrive. If the bacteria infect the plugged pores, inflammation will occur.

The follicle wall may bulge due to the blocked pore, causing a whitehead or a blackhead. Acne appears as elevated red spots with a while center, which develops when inflammation or infection occurs within the clogged hair follicles. Inflammation and blockages that develop deep within hair follicles create cyst-like lumps underneath the skin’s surface.

Factors that Aggravate Acne

Hormones

Both boys and girls experience an increased production of androgen hormones during puberty. Due to this hormone, the sebaceous glands become enlarged, and there is an increased production of sebum.

Certain Types of Medications

Some drugs containing androgens, corticosteroids, or lithium can make acne worse.

Diet

Several research studies indicate that certain dietary factors, including dairy products and carbohydrate-rich foods, may trigger acne. Chocolate has long been thought to worsen acne. In a research study with 14 men with acne, it was found that eating chocolate was associated with an increase in acne.

Stress

Increased levels of stress or emotional upheavals may also worsen acne.

What does not Cause Acne?

Many individuals wrongly believe that oily or greasy foods, dirty skin, or cosmetics cause the development of acne. However, consuming greasy or oily food has little or no effect on acne. Also, dirt in the skin does not cause acne.

In fact, it is important for patients to avoid scrubbing the skin vigorously or cleansing with harsh soaps as skin irritation may make acne worse. It’s also prudent to use makeup that is oil-free to avoid pore blockage.

Florida Dermatologist FAQ’s: Acanthosis Nigricans Causes And Treatment

Various medical factors can lead to acanthosis nigricans (AN). But, it can also develop in otherwise healthy people.

This condition occurs most commonly in people of African descent. Some cases are genetically inherited as an autosomal dominant trait. In fact, only one parent needs to have an abnormal gene for the child to inherit this dermatology condition.

Diabetes is a medically-related factor that causes acanthosis nigricans. Obesity, which causes diabetes and other endocrine disorders, is also a medically-related cause.

Certain medications such as human growth hormone or oral contraceptives can be a cause as well. Cancers of the gastrointestinal or genitourinary tract or lymphoma have been known to cause severe cases of AN.

Affected Populations

Acanthosis nigricans may manifest at any age. Many benign types develop during childhood or puberty. However, the onset of malignant AN usually occurs after the age of 40 years. But there have been a few rare instances in which malignant AN developed during childhood.

The frequency of occurrence of acanthosis nigricans in the US is not well known. However, a study of over 1400 children showed that around 7.1 percent displayed signs of AN. In another study of obese adults who weighed at least twice their optimal body weight, it was found that over 50 percent showed signs of AN.

Treatment

Acanthosis nigricans treatment is focused on the specific symptoms that are apparent in each patient. Such treatment may require the coordinated efforts of a skilled dermatologist.

Treatment direct towards correcting or managing an underlying disease or other causative condition may resolve AN, such as suitable hormone replacement therapy for those with specific endocrine disorders; removal of meds that may lead to drug-induced AN, if possible; and/or other measures to help decrease insulin resistance.

Additionally, in certain cases, such as those with insulin resistance related to diabetes mellitus, disease management may include measures such as making necessary dietary modifications; routinely monitoring blood levels; taking certain drugs orally (by mouth), receiving suitable insulin replacement therapy; and/or other measures.

As stated above, people with pseudoacanthosis nigricans may experience an improvement in certain AN-related skin conditions with adequate weight loss under a doctor’s guidance. But the pigmentary changes may persist. Additionally, for some people with AN, recommended treatment may include the use of specific synthetic, vitamin A-like compounds (retinoids) taken by mouth or applied to the skin (topically).

Disease management in the case of malignant acanthosis nigricans involves treatment by oncologists (cancer specialists).

The form, grade, and stage of the malignancy and other factors will determine the recommended treatment which may include the surgical removal of cancer; administration of specific anti-cancer medications (chemotherapy); radiation therapy, and/or other measures.

At times, genetic counseling may be beneficial to affected people and their families (such as those with hereditary benign AN, or other underlying genetic reasons for AN development). Other treatment for this condition is supportive and symptomatic.

Florida Dermatologist FAQ’s: What is Acanthosis Nigricans?

Acanthosis nigricans is a fairly common skin pigmentation disorder. Patients should consult with an experienced dermatologist to determine the right treatment approach for their condition.

Signs and Symptoms

Dark patches of skin with a thick, velvety texture are the most notable sign of acanthosis nigricans. The impacted skin areas may also be itchy or have an odor:

These patches may develop on skin folds and other regions, including:

Groin
Armpits
Soles of the feet
Knuckles
Neck
Elbows
Knees
Lips
Palms

Acanthosis nigricans may sometimes indicate a more serious medical condition, such as prediabetes. The most successful treatments focus on identifying and resolving medical conditions that may be causing this symptom. After the root condition is treated successfully, these patches usually disappear.

Who is at Risk for Acanthosis Nigricans?

Acanthosis nigricans may develop in both men and women. It occurs most commonly in individuals who are overweight, have darker skin and diabetes or prediabetic conditions. Children who develop acanthosis nigricans experience a higher risk of developing type 2 diabetes later in life.

The frequency of acanthosis nigricans differs between various ethnic groups. The American Academy of Dermatology reports that individuals of African, Caribbean, or Hispanic heritage are also at a higher risk. In case the body mass index (BMI) is well above normal, all ethnic groups are equally at risk of developing acanthosis nigricans.

What causes Acanthosis Nigricans?

Acanthosis nigricans skin patches develop when epidermal skin cells start reproducing rapidly. High levels of insulin in the blood most commonly trigger this abnormal skin cell growth. In rare instances, the increase in skin cells may occur due to cancer, drugs, or other medical conditions.

How is Acanthosis Nigricans Diagnosed?

Acanthosis nigricans is easily recognizable by sight. The doctor may want to examine the patient for diabetes or insulin resistance as the cause. These tests may include fasting insulin or blood glucose tests.

In addition, the doctor may review the patient’s medications to see if they are contributing to this condition. The doctor may also perform other tests, such as a small skin biopsy, to eliminate other possible causes.

How is Acanthosis Nigricans Treated?

Acanthosis nigricans is not a disease. It is a symptom of another condition that may necessitate medical care. The treatment is primarily focused on addressing the condition behind it. In case the patient is overweight, the doctor will advise them to lose weight. The doctor may also prescribe meds to bring their blood sugar under control.

In case the condition has developed due to drugs or supplements, the doctor may ask the patient to stop using them or recommend substitutes. The discolored skin patches will typically disappear upon identifying and controlling the cause.

Cosmetic Treatments

Patients who are concerned about the appearance of their affected skin may consider cosmetic treatments, such as:

Skin lighteners, such as Retin-A, 20 percent urea, alpha hydroxy acids, and salicylic acid
Antibacterial soaps
Oral acne meds
Laser therapy

While these treatments cannot cure the condition, they can improve the appearance of acanthosis nigricans.

Ongoing Care and Prevention

In general, following a healthy lifestyle can typically prevent acanthosis nigricans. Losing weight, consuming a balanced diet, and adjusting any medications that are contributing to the condition are all vital steps.