General Dermatology

Psoriasis

What is Psoriasis?
What causes Psoriasis?
What is the cycle of Psoriasis?
How does one live with Psoriasis?
What treatments are available for Psoriasis?

What is Psoriasis?

Psoriasis is a noncontagious skin disorder that most commonly appears as inflamed swollen skin lesions covered with silvery white scales. This most common type of psoriasis is called plaque psoriasis. Psoriasis comes in many different variations and degrees of severity. Different types of psoriasis display characteristics such as pus-like blisters (pustular psoriasis), severe sloughing of the skin (erythrodermic psoriasis), drop-like dots (guttate psoriasis) and smooth inflamed lesions (inverse psoriasis). The degrees of severity of psoriasis are divided into three important categories: mild, moderate and severe.

What causes Psoriasis?

No one knows what causes psoriasis, though it is generally accepted that it has a genetic component, recent studies have focused on cells called T-lymphocytes. The immune function of these cells are altered in psoriasis. Scientists believe that a person is born genetically predisposed to psoriasis. One in three people report a family history of psoriasis, but there is no pattern of inheritance. There are many cases in which children with no apparent family history of the disease will develop psoriasis.

Whether a person actually develops psoriasis may depend on something triggering its appearance. Examples of trigger factors include systemic infections such as strep throat, injury to the skin (the Koebner phenomenon), vaccinations, certain medications, and intramuscular injections or oral steroid medications.

Once something triggers a person's genetic tendency to develop psoriasis, it is thought that products of certain t-cells trigger the excessive skin cell reproduction.

What is the cycle of Psoriasis?

Skin cells are programmed to follow two possible programs: normal growth or wound healing. In a normal growth pattern, skin cells are created in the basal cell layer, and then move up through the epidermis to the stratum corneum, the outermost layer of the skin. Dead cells are shed from the skin at about the same rate as new new cells are produced, maintaining a balance. This normal process takes about 28 days from cell birth to death.

When skin is wounded, a wound healing program is triggered, also known as regenerative maturation. Cells are produced at a much faster rate, theoretically to replace and repair the wound. There is also an increased blood supply and localized inflammation. In many ways, psoriatic skin is similar to skin healing from a wound or reacting to a stimulus such as infection.
Lesional psoriasis is characterized by cell growth in the alternate growth program. Although there is no wound at a psoriatic lesion, skin cells (called keratinocytes) behave as if there is. These keratinocytes switch from the normal growth program to regenerative maturation. Cells are created and pushed to the surface in as little as 2-4 days, and the skin cannot shed the cells fast enough. The excessive skin cells build up and form elevated, scaly lesions. The white scale (called plaque) that usually covers the lesion is composed of dead skin cells, and the redness of the lesion is caused by increased blood supply to the area of rapidly dividing skin cells.

How does one live with Psoriasis?

Psoriasis can be very painful, but the pain is more than skin deep. The emotions suffer as well. It presents people with physical limitations, disfiguration, and its tedious, daily care always demands too much time. Embarrassment, frustration, fear, and depression are common. In extreme cases, a loss of self-esteem results in a complete withdrawal from society.

What treatments are available for Psoriasis?

Various kinds of temporary relief are available, and they work with varying degrees of success. A variety of topically applied medications can help control limited psoriasis. For more severe psoriasis, oral medications or the newer injected “biologic agents” can be prescribed. Sunlight exposure can also be effective. You can discuss treatment options during your office visit.

Please call our office at (650) 325-1511 to schedule a consultation.

Rosacea

What is Rosacea?
What are the symptoms of Rosacea?
Who is at risk for Rosacea?
How can I control my Rosacea?
What treatments are available for Rosacea?

What is Rosacea?

Rosacea Treatment | Palo Alto | Redwood City | San Mateo Rosacea, (rose-AY-sha) is a skin disease that causes redness and swelling on the face. Often wrongly referred to as adult acne, rosacea may begin with redness in the center of the face that gradually covers the cheeks and chin. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area.

Unlike acne, there are no blackheads or whiteheads. This disease affects mainly the forehead, the chin and the lower half of the nose.

When it first develops, rosacea may appear, disappear, and then reappear a short time later. When the skin does not return to its normal color and when other symptoms, such as pimples and enlarged blood vessels, become visible, it is best to seek advice from a dermatologist. The condition rarely reverses itself and may last for years. It will become worse without treatment.

What are the symptoms of Rosacea?

As rosacea progresses, pimples appear on the face in the form of small, solid red bumps and pus-filled bumps. These may be accompanied by a condition called telangiectasia (te-LAN-jek-TAY-sha) -- thin, red lines caused by enlarged blood vessels on the surface of the skin. Rosacea may also be accompanied by oily skin, and possibly dandruff.

In more advanced cases of rosacea, a condition called rhinophyma (ryno-fee-ma) may develop. This is characterized by a bulbous, enlarged red nose and puffy cheeks. It may also involve thick bumps that develop on the lower half of the nose, spreading to the nearby cheek areas. Rhinophyma rarely occurs in women .

The eyes may also become involved. Approximately half of all rosacea patients experience burning and irritation of the eyes - a condition commonly known as ocular rosacea.

Who is at risk for Rosacea?

Rosacea, which is rare in childhood, develops over a long period of time. It may first seem like a tendency to blush easily, a ruddy complexion, or an extreme sensitivity to cosmetics.

Those most likely to develop rosacea are fair-skinned adults, especially women, between the ages of 30 and 50. The disease may affect men or women of any age. For some unknown reason, women get rosacea more often than men. Some cases of this disorder have been associated with menopause.

Certain drugs may dilate the blood vessels in the skin and make rosacea worse. Strong steroid-containing creams may also cause or aggravate rosacea.

How can I control my Rosacea?

Drinking too much alcohol of any type, spicy foods, hot drinks and smoking will cause blood to rush to the affected areas and aggravate flushing. It's important to note, that although alcohol may worsen a case of rosacea, symptoms may be just as severe in someone who doesn't drink at all. This condition has been wrongly linked to alcoholism, harming many innocent people. (Unfortunately, comedian W.C. Fields had a severe case of rosacea resulting in rhinophyma and he often drank.)

Limiting exposure to sunlight, or extreme hot and cold temperatures will help relieve the symptoms of rosacea.
Rubbing or massaging the face should also be avoided because it will tend to irritate the reddened skin.
Avoiding irritating cosmetics and using hair sprays properly will help prevent redness and swelling.

What treatments are available for Rosacea?

Many people affected by rosacea are unfamiliar with it, so identifying the disease is the first step to controlling it.

Dermatologists recommend a combination of treatments. Each will be tailored to the individual patient. Together, these programs can stop the progress of rosacea and sometimes reverse it. Self diagnosis and treatment are not recommended, as some over-the-counter skin applications may make the problem worse.

Please call our office at (650) 325-1511 to schedule a consultation.

Skin Cancer

Skin cancer is the most prevalent of all types of cancer. It is estimated that more than one million Americans develop skin cancer every year. Fair-skinned people who sunburn easily are at a particularly high risk for developing skin cancer.

The most common types of skin cancer include basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and malignant melanoma (MM). Even more common than these cancers is actinic keratoses (AK), which usually presents as multiple rough scaly skin lesions and are considered pre-malignant growths appearing on sun exposed skin areas. These lesions have the potential to progress to squamous cell carcinoma.

Basal Cell Carcinoma (BCC) is the most common type of skin cancer, but also the least aggressive with very little potential to spread to other areas of the body. However, if left untreated, they may enlarge, ulcerate, bleed and destroy local tissue in the area. They appear as shiny bumps or scaly, red patches predominantly in area of the body that has received significant sun exposure.

Squamous Cell Carcinoma (SCC) is the second most common type of skin cancer. These grow more rapidly than basal cell carcinoma and have potential to metastasize (spread to other areas of the body). They appear more commonly on sun exposed sites as tender red enlarging lumps.

Malignant Melanoma is the most deadly of all skin cancers. The incidence of this cancer is increasing, and every year, over 8,000 Americans will die from melanoma. The death rate has been kept in check because melanoma is usually curable when detected in its early stages and patients are seeking help sooner. Melanoma may appear suddenly or begin in or near a mole. Melanomas often appear as pigmented lesions that are asymmetrical with irregular borders, variegated color, and larger than 6 mm in diameter. Other warning signs include:

Changes in the surface of a mole.
Scaliness, oozing, bleeding, or appearance of a new bump in a mole.
Spread of pigment from the border of a mole into the surrounding skin.
Change in sensation including itchiness, tenderness, or pain in a mole.

ABCD's of Melanoma
Skin Cancer | Palo Alto | Redwood City | San Mateo

Source: NCI Visuals Online. Skin Cancer Foundation.
http://visualsonline.cancer.gov/about.cfm

Treatment of Skin Cancer

If the dermatologist is suspicious of a skin cancer, usually a biopsy of the lesion will be performed. If a skin biopsy reveals cancer, the dermatologist has an array of medical and surgical procedures as treatment, depending on the type of cancer, the size and location, and the needs of the individual. Actinic keratoses are usually treated by freezing them with liquid nitrogen, topical creams, or photodynamic therapy (PDT). It is most important to remember that early detection is the surest way to a cure.

Please call our office at (650) 325-1511 to schedule a consultation.

Warts

Warts are non-cancerous skin growths caused by a viral infection in the top layer of the skin. Viruses that cause warts are called human papilloma virus (HPV). Warts are usually skin colored and feel rough to the touch, but they can be dark, flat, and smooth. The appearance of the wart depends on where it is growing and the sub-type of HPV.

There are several different kind of warts including:

Common warts
Foot (Plantar) warts
Flat warts
Genital warts

All these types of warts are passed form person to person, sometimes indirectly. The time from the first contact to the time the warts have grown large enough to be seen is often several months. Some people get warts depending on how often they are exposed to the virus. Wart viruses more easily take hold in skin that has been damaged or injured to some degree. Some people are more resistant to getting warts because of their innate immunity to the virus.

Treatment of warts

There are a variety of methods dermatologists use to treat warts depending on the type of warts or there location on the body. These methods include freezing with liquid nitrogen, destruction with laser or electrosurgery, application of certain chemicals or immunotherapy. Your dermatologist will usually discuss the options in each individual case before embarking on a specific treatment.

Please call our office at (650) 325-1511 to schedule a consultation.