Education & Resources

At Wilmington Dermatology Center, we believe educating our patients is integral to providing outstanding care; that is why we are committed to the education of our patients and the community.   The information presented below is not comprehensive and is no substitute for a consultation with a physician.

Click here to watch the video series on eHow.com conducted by Dr. Rosalyn George which answers various skin care related topics.

For more information on these or additional topics Dr. George recommends the following websites:

Acne

Acne is the term for plugged pores (blackheads and whiteheads), pimples, and even deeper lumps (cysts or nodules) that occur on the face, neck, chest, back, shoulders and even the upper arms.  Acne affects mostly teenagers, however a significant number of adults continue to have breakouts or develop new onset acne. While not a life threatening condition, acne can be upsetting and disfiguring and can severely affect self-esteem.  When severe, acne can lead to serious and permanent scarring.  Even less severe cases can lead to scaring, luckily today virtually all cases of acne can be resolved. 

Treatment is designed to prevent formation of new lesions and aid the healing of old lesions. Treatment may consist of topical creams or gels containing retinoic acid, benzoyl peroxide, salicylic acid, topical antibiotics, oral antibiotics. It is important to remember that there is no quick fix for acne and not every patient will respond the same. It typically takes 6-8 weeks to see initial results and a combination approach is often necessary.  Severe or refractory cases may need treatment with isotretinoin or accutane® which is extremely effective, but has potentially serious side effects. Surgical intervention may include professional chemical skin peeling, laser or light treatments, removal and/or drainage of cysts, or intralesional cortisone injections.

Rosacea

Rosacea is a chronic inflammatory condition characterized by redness, flushing, small red bumps, and broken blood vessels.  It is usually seen in adults with light hair and fair skin.  It can be aggravated by alcohol, spicy foods, caffeine, extremes of temperature, wind, stress, strenuous exercise, or sun exposure. While not life threatening, rosacea can have a negative impact on self-image and many rosacea sufferers avoid social interactions.
 
Treatments include topical antibiotics such and metronidazole, topical azelaic acid, or oral antibiotics (tetracycline, doxycycline, minocycline) which can help to reduce papules, pustules, and mildly improve redness. Oral antibiotics are necessary to relieve symptoms of ocular rosacea. Redness in the skin is the most difficult aspect to treat. While topical treatments provide some improvement laser treatments are the most efficacious.  Most patients notice improvement with one treatment, but a series of treatment is often necessary as well as periodic maintenance treatments. 

Actinic Keratosis

Actinic Keratosis or AK’s are pre-cancerous skin growths with the potential to transform into squamous cell carcinoma (link to info). Actinic keratosis are caused by repeated and prolonged exposure to ultraviolet light from the sun and typically present as rough spots on areas of the skin that have received sun exposure.

The treatment for actinic keratosis depends upon the number and size of the lesions.  If the growths are small and still in the pre-cancerous stage, they can be frozen with liquid nitrogen, treated with a topical chemotherapy cream, or with photodynamic therapy.  You can prevent actinic keratosis by reducing sun exposure.  Especially avoid sunlight during the peak hours of 10 a.m. to 3 p.m.  If you do go outdoors, wear sunscreen with a SPF of at least 30, a hat, and protective clothing.

Basal Cell Carcinoma

Basal Cell Carcinoma is the most common form of skin cancer derived from cells found at the base of the outer skin layer or epidermis. It is estimated that 1 in every 3 adults will be diagnosed with a basal cell carcinoma in their lifetime.  Basal cells typically present as a shiny bump or nodule that is pearly, pink, brown or translucent, an open sore that bleeds, oozes, or crusts and does not heal, or a reddish scaly patch or irritated area.

Treatment options include electrodessication and currettage (simply creating a man made “brush burn”), topical chemotherapy creams, excision with stitches, Mohs micrographic surgery, and radiation. Treatment choice depends on the type of basal cell carcinoma, location, size, and age of the patient.

Squamous Cell Carcinoma

Squamous Cell Carcinoma is the second most common form of skin cancer which arises from the outermost portion of the skin, called the epidermis. Anyone with a substantial history of sun exposure can develop squamous cell carcinoma.  Older people with fair skin and light eyes are at the highest risk.  Also, people with occupations that require them to spend long hours outdoors or those who spend extensive leisure time in the sun are at high risk.  Immunosuppressed individuals, especially organ transplant patients, are at high risk of developing squamous cell carcinomas.

 Treatment options include electrodesiccation and curettage (the process of using a tool called a curette to scrape away cancerous cells and tissues as well as short, high frequency electric impulses to destroy any remaining cancerous cells and tissues), standard surgical excision, Mohs micrographic surgery, topical chemotherapy creams, and radiation. 

Melanoma

Melanoma is a skin cancer that originates from melanocytes or tanning cells. If caught early it is almost 100% curable, but if not treated promptly it can spread to other areas of the body and can be fatal.  Risk factors for melanoma include history of a lot of sun exposure including sunburns, fair skin, light hair, and blue eyes, many moles and freckles, and a family history of melanoma.  Excessive sunlight is the primary cause of melanoma.

Surgery is the only cure for melanoma.  An area of normal skin around the melanoma is excised to make sure all the cancer is removed.  Sometimes, lymph nodes are also biopsied.  If the cancer has metastasized, you may require further surgery, radiation, chemotherapy, or immunotherapy. 

Psoriasis

Psoriasis is a noncontagious, chronic skin disease which may have periods of relative remission and flares (similar to asthma). The cause of psoriasis is unknown but there appears to be a genetic predisposition. Injury to the skin, severe emotional stress, and infections (i.e. strep throat) can lead to a flare of psoriasis.  Psoriasis is predominately a disease of adults, but can occur in childhood. 10-20% of patients also have joint involvement which can lead to deformity and disablility of untreated.  In addition to its physical impact on your skin, psoriasis can also affect your emotional, psychological and social well-being. This visible and lifelong disease may change how you view yourself and interact with others.

While there is no cure for psoriasis, there are fantastic treatments which can control the disease. Treatment of psoriasis depends upon the extent and severity of your disease as well as the location of the plaques. Mild to moderate psoriasis may be treated with topical steroids, vitamin D or vitamin A derived topical treatments, and salicylic acid or coal tar preparations. Moderate cases usually respond to combination therapy with topicals and light treatments. More severe cases and those with associated arthritis may need systemic therapy. Choices include methotrexate, cyclosporine, or Soriatane®. These treatments are not without risk and must be monitored with labwork. It is imperative that you obtain the necessary labwork to monitor these drugs as liver damage, kidney damage or even death can occur if not properly managed.
Newer medications include the biologic meds such as Enbrel®, Amevive®, Raptiva®, Humira® and Remicade®. These medications work to suppress very specific inflammatory mediators (rather than suppressing the entire immune system). They are either injections or intravenous medications and require pre-treatment blood work, tuberculosis testing, and periodic monitoring during treatment. They are effective for both psoriatic skin disease and psoriatic arthritis. Dr. George has used all of these drugs and is comfortable prescribing and managing patients who need more aggressive therapy.

Keratosis Pilaris

Keratosis pilaris is a rash that is usually found on the outer areas of the upper arms, thighs, and cheeks.  It is characterized by flesh-colored to slightly red, rough, distinct bumps.  Keratosis pilaris is occasionally itchy, but otherwise it is only significant cosmetically.  It is caused by a plug of dead skin cells that forms around a hair follicle.  These plugs give the skin a sandpapery or a goose-flesh feeling.  Keratosis pilaris is usually worse during the winter months and is most commonly seen in children and young adults.  Often the surrounding skin is dry.

Keratosis pilaris is a benign condition and treatment is usually only necessary for cosmetic reason.  Lubricants may help with the dryness, but do not tend to clear the bumps.  Mild peeling agents are most effective in opening the plugged hair follicles by removing the excess skin.  Each affected person may respond differently to therapies, but urea preparations (such as Hydro 40 Foam), alpha hydroxy acid creams and washes (such as Amlactin or glytone) and Retin-A are the most commonly used therapies.  Effective therapy must be continued on a regular basis or the keratosis pilaris recurs.  For many, treatment is unnecessary. 

Eczema (Atopic Dermatitis)

Atopic dermatitis (eczema) is a chronic, itchy inflammatory condition of the skin that is often associated with asthma or hay fever.  It can be exacerbated by irritating clothes or chemicals, change in climate, emotions, skin infections, and food allergies. Atopic dermatitis is predominately a disease of childhood, usually beginning before age one. Most children outgrow their disease by adolescence.  Adults may continue to have atopic dermatitis manifested by patches of eczema on the hands, feet, and elsewhere.  The hallmark of atopic dermatitis is intense itching and dry skin.  While up to 1/3 of patients with atopic dermatitis have allergies, avoidance or exposure to these allergies is often unrelated to their skin disease, therefore allergy testing is not necessary for all patients. Allergy testing is usually reserved for those patients with severe or refractory disease. 

No one thing can control atopic dermatitis. Successfully managing this complex condition requires a multi-faceted approach. Skin care is of the utmost importance and can provide longer periods between flares and help reduce the length of flares.  The hallmarks of good skin care are using gentle cleansers, moisturizing frequently, avoiding scratchy materials. For flares steroid creams and occasionally oral steroids are necessary. Other treatments can consist of non-steroidal anti-inflammatory creams like Protopic® (tacrolimus) and Elidel® (pimecrolimus) may be prescribed. More severe cases may need light therapy or systemic immunosuppression. Oral anti-histamines may be necessary to control the itch. With proper skin care, using medication as directed, and avoiding common skin irritants such as wool clothing most patients are able to control their eczema.

Warts

Warts are growths that are caused by a virus infecting the skin.  There are several types of warts with different names based on their location.  The common wart is found on the hands or body.  The plantar wart derives its name because it is located on the sole or plantar surface of the foot.  Venereal warts or condyloma acuminatum involve the genital region and are often transmitted sexually.  In females with venereal warts, periodic pap smears should be done since these warts may cause cervical cancer.

Treatment of warts requires the destruction of the skin that harbors the wart virus.  This is accomplished by a number of ways and is successful about 80% of the time.  Because the wart virus can infect the normal surrounding skin while being inapparent to examination, it is not surprising that recurrence is frequent requiring follow-up treatment.  The most common treatments include Cryotherapy, Acid treatments, Laser or Routine Surgery, Podophyllin and others such as Cantharidin (blister beetle juice), Bleomycin, or Squaric acid.

Seborrheic dermatitis (cradle cap)

Seborrheic dermatitis is a common skin disorder which is characterized by red, scaly, itchy patches most commonly seen in oil producing arease such as the scalp, sides of the nose, eyebrows, eyelids, skin behind the ears, and middle of the chest.

Gentle shampooing with a mild shampoo is helpful for infants with cradle cap. Cradle cap generally resolves on its own, however mild cortisone creams and lotions, or anti-fungal topicals may also be applied to the affected areas of skin. Adult patients may need to use a medicated shampoo and a stronger corticosteroid preparation. Non-prescription shampoos containing tar, zinc pyrithione, selenium sulfide, ketoconazole, and/or salicylic acid may be recommended by a dermatologist, or a prescription shampoo, cream gel, or foams containing cortisone may also be used.

Botox

BOTOX® Cosmetic is a simple, nonsurgical treatment that can temporarily smooth wrinkles. Wrinkles which are commonly treated with botulinum toxin include glabellar lines (worry lines between the brows), forehead lines, and crows feet. Such wrinkles are caused by repeated contraction of the muscles perpendicular to the wrinkles.

BOTOX® Cosmetic is a purified protein produced by the Clostridium botulinum bacterium, which relaxes the muscles responsible for wrinkle formation.  Botulinum toxin therapy involves the injection of a small amount of the medication into the target muscles which decrease in the wrinkle’s appearance. The effects of botulinum toxin therapy with BOTOX® Cosmetic become apparent within 1-2 weeks and will last for 3-4 months.  With repeated treatments, the effects may last even longer.  Persons with a history of a neuromuscular disorder such as myasthenia gravis or amyotrophic lateral sclerosis should not pursue this therapy.  Likewise, pregnant or lactating females should not receive botulinum toxin.

Soft tissue augmentation

In soft-tissue augmentation, a substance that is compatible with the patient’s body tissues is injected under the skin to elevate irregularities such as wrinkles, pits and scars. The most commonly used substances are collagen, Hyaluronic acid (Restylane®, Juvederm®), and Calcium hydroxyapetite (Radiesse®). The hyaluronic acid products are made from the same substance that helps lubricate our joints. The hyaluronic acid attracts water which plumps the skin. Results last upwards of 6 months.  Calcium hydroxyapetite (Radiesse®) Made of calcium-based microspheres suspended in a water-based gel, Radiesse is injected into the skin through a simple and minimally invasive procedure giving you immediate, visible improvement of folds and wrinkles, and providing long-lasting (12 months) results. As the gel breaks down, the tiny calcium spheres stimulate the production of new collagen growth.  The tiny microspheres provide a scaffolding into which your body's own tissue can grow making sure the correction feels and looks completely natural.

Spider Veins

Spider veins are formed by the dilation of small blood vessels near the surface of the skin. They can appear on any part of the body, but are commonly found on the face and legs. The characteristic appearance of spider veins is a "sunburst" pattern of reddish to purplish small veins. They are not a health hazard but they can be a cosmetic concern.

Treatments include sclerotherapy where a chemical solution is injected into the veins, which irritates their inner walls causing them to collapse. More than one session may be necessary. Other options include laser surgery or surgical removal. Sclerotherapy remains the most effective treatment.  Post-treatment it is important to use compression hose to help hold the vessels flat so that the walls of the vessel seal together. This helps with the efficacy of the treatment and may eliminate the need for additional treatments.