May is Melanoma Awareness Month!

Posted on May 7, 2012 by admin

Should I Worry About This Spot?

by Erum Ilyas, M.D.

Everyone has spots such as freckles or moles on their skin. These spots are generally harmless and come in a range of shapes, sizes and colors. They are normally nothing to worry about, unless they start to change and develop unusual characteristics. That’s when it’s important to consult a doctor or a dermatologist since it may be an early sign of skin cancer.

Skin cancer is the most common of all cancers. Fortunately it can often be treated if detected early, which is why the American Academy of Dermatologists recommends regular skin examinations.  There are three major types of skin cancer — basal cell carcinoma, squamous cell carcinoma and melanoma.

The most common type is basal cell carcinoma.  These skin cancers are typically not life threatening but can cause significant skin erosion and disfigurement.  Basal cell carcinomas have a strong association with sun exposure.  They often present as a nonhealing lesion or pimple that just does not go away.

Squamous cell carcinoma is more aggressive and is prone to spread, or metastasize, to other areas. Sun exposure, chronic scars and burns are commonly associated with these cancers. Squamous cell carcinoma may present as a pink scaly or flaky spots that can be sensitive or even bleed.

Melanoma is not as common as basal cell carcinoma and squamous cell carcinoma, however it is the most serious. Melanoma has a high tendency to spread and can be fatal. It may present as a dark spot or mole that is changing or bleeding.

The fortunate thing about the skin is that it can be seen. The skin is the largest organ of the body and like other organs it requires care.

Examining the skin regularly, looking for any new spots as well as changes in those already present is a good place to start. Look for spots that are changing, symptomatic (such as bleeding, itching or tender), becoming darker, or are pink and inflamed. If there is a family history of atypical moles or skin cancer, or a large number of spots, regular skin evaluations performed by a dermatologist may be recommended.

In addition to regular self-examination, a full skin inspection by a dermatologist is important not just for identifying skin cancer but for a person’s overall health. During the exam, point out spots that look new or are changing. A dermatologist can also identify other health conditions by looking at the overall health and appearance of the skin, hair and nails.

With warmer weather fast approaching, it may be a good time to schedule a skin examination with a board certified dermatologist and make it part of routine health maintenance. And, most importantly, don’t forget to wear sun block!

- Erum N. Ilyas, MD, is a board-certified dermatologist on staff at Paoli Hospital.

Today is Melanoma Monday!  Make an appointment with a Dermatologist to get yourself checked for skin cancer.

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Lyme Disease

Posted on May 4, 2012 by admin

As the spring begins and we start to spend more time outdoors, it is worth remembering to be careful to check yourself and your children carefully for ticks. Some local reports suggest that in this area this year more deer ticks have come out earlier than normal due to our relatively mild winter.

Lyme disease is caused by a bacteria called Borrelia burgdorferi.  It is know to be transmitted to humans via deer ticks known as Ixodes scapularis in the Northeastern united states.  After an infected tick attached to human skin for at least 24-48 hours it can transmit the disease known as Lyme disease.

It is important to remember that Lyme disease is acquired through deer ticks in particular and has not been known to be associated with dog ticks or wood ticks. It cannot be spread from person to person or from pets directly. Pets and other people may serve as a vector to bring infected ticks in contact with others but the tick itself is responsible for transmitting the disease. They can be very small- <2 millimeters in size so it is very important to carefully inspect your skin.

Lyme disease can more commonly be seen as manifesting as fevers, arthralgias, headaches and a characteristic rash known as erythema migrans. When recognized early, treatment can be initiated in the form of antibiotics.  The duration of treatment and the regimen may vary based on the stage of disease, the age of the patient, or other variables such as allergies to medications.

The stages of Lyme disease are as follows:

Early localized: (within one month of infected tick bite) Lyme disease for most patients (roughly about 3 out of 4 people) will show a “bulls eye” rash known as erythema migrant at the site of the tick bite. This is not usually itchy. Having what may look more like a bug bite at the site of the tick bite that is itchy is not necessarily a sign of having Lyme disease. To be certain it is always better to have questionable areas looked at by your primary care physician or a Board Certified Dermatologist.  Patients in this stage will often show fevers, joint pains, headaches and malaise. Lymph nodes may also become enlarged.

Early disseminated: Lyme disease can occur after the initial stage is not treated and may occur as early as days to weeks after the tick bite. At this point many “bull’s eye” rashes may be seen in places other than at the site of the bite, and patients may experience headaches, neck stiffness, nerve palsies, palpitations, or other neurological symptoms. If by this stage treatment is not already started, it is true that these symptoms may resolve but there may still be a risk for further complications.

Late disseminated: Lyme disease can follow when not treated with most patients experiencing joint symptoms such as pain and swelling, as well as other neurologic concerns.

If you are concerned that you may have experienced a tick bite with resulting rashes, fevers, joint pains, neurologic or other symptoms, it is best to be evaluated by your doctor. In the first month (up to 4 weeks) after exposure, the laboratory testing may be negative. In this time period your primary doctor and/or Dermatologist will evaluate your case clinically to determine if initiating a course of antibiotics is worthwhile.  After the 4-6 week period, laboratory testing is more informative and helpful in establishing a diagnosis.
According to the CDC website, Montgomery County Pennsylvania reported 2718 cases of Lyme disease between 2002-6. chester county reported 3580 cases and Delaware county 1299 cases in the same time period.

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Levulan® Kerastick® Photo Dynamic Therapy for Actinic Keratosis

Posted on April 12, 2012 by admin

Montgomery Dermatology is proud to now offer a more effective, less painful option for treatment of actinic keratosis. The simple procedure is covered by most major insurances, but may require a copay depending on your specific insurance plan. The in-office 2 part treatment combines the Levulan® Kerastick® and the BLU-U® Blue Light Photodynamic Therapy Illuminator to treat moderately thick actinic keratosis of the face and scalp.

What are actinic keratosis?  

Often called “sun spots,” actinic keratosis are rough-textured, dry, scaly patches of the skin that can lead to skin cancer.  Occuring most often on sun exposed areas such as the face, scalp, or ears, they can range in color from skin toned to reddish brown.  These spots are usually treated by a Dermatologist using cryotherapy, or dry ice, to freeze them before they develop into anything more worrysome.

AK spots can now be treated more effectively and thoroughly using the combination treatment of Levulan® Kerastick® and BLU-U® Light Therapy.  By applying the solution to the whole affected area rather than just the visible AKs, we stand a better chance at eliminating the future spots that may be lurking just under the surface.

How does Levulan® Kerastick® work?

The Levulan® Kerastick® Topical Solution is applied to the face and/or scalp, depending on where precancerous spots are likely to occur for each individual patient. The solution is then left to absorb for 60 minutes, where it converts to a chemical that makes the cells extremely sensitive to light. When the AK cells are subsequently exposed to the BLU-U® Blue Light Illuminator, a reaction occurs which destroys the precancerous AK cells.

The treatment is convenient because there are no medications to purchase or remember to take, there is a low downtime after the treatment, no scarring reported to date, and the treatment is far less painful than cryotherapy.

What should I expect from my treatment?

After verifying coverage with your insurance provider, our office staff will schedule an appointment for your first 90 minute treatment. After applying the Levulan® Kerastick® solution, you will wait comfortably in our private waiting room, watching tv or reading while it absorbs into your skin.  After 60 minutes, the remaining solution will be wiped away, and you will sit in front of the BLU-U® Blue Light Therapy Illuminator for 17 minutes, wearing the protective eyewear provided by our office staff.

Afterward, you will leave wearing a protective hat provided by the office staff. Because the treatment will make the area very photosensitive, it is extremely important to avoid sunlight or bright indoor light for at least 40 hours after the treatment. Sunscreen will not provide enough protection from the sun during this photosensitive period, you must physically block the light by staying indoors and/or wearing a hat. Possible side effects include itching, stinging, scaling/crusting, redness or hyperpigmentation, or slight swelling of the treatment sites.

This therapy is most effective with a second treatment 8 weeks after the first.  You should schedule this second appointment ahead of time to ensure a time and date that works well for you.

Click Below for Before/After Treatment Photos:

http://www.dusapharma.com/lev-before-after.html

Visit the manufacturer’s website for further information:

http://www.dusapharma.com/levulan-photodynamic-therapy.html

Contact us today for more information

610-265-1166

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BLU-U® Blue Light Photodynamic Therapy for Acne

Posted on April 12, 2012 by admin

Montgomery Dermatology is very excited to announce that we now have a BLU-U® blue light photodynamic illuminator available to patients with facial acne. The BLU-U® light treatment is a great option for patients who have moderate acne and are uncomfortable taking antibiotics or are unsatisfied with the results of their current topical treatment regimen. This treatment is not currently covered by insurance, but is offered in our office at a very affordable rate of $50 per treatment.

How does it work?

The BLU-U® is not a laser or a device that emits UV light - it instead delivers a very effective scattered fluorescent light, that when used in a series of brief exposure sessions, provides a simple non-invasive acne treatment option. The narrow-banded blue light causes a photodynamic effect within the pilosebaceous gland that kills P.acnes, the primary bacteria that causes acne.

What should I expect?

You will sit comfortably in a chair, wearing the provided protective eyewear, with your face close to the blue light device as pictured to the right. Each exposure session for the BLU-U® light therapy luminator lasts approximately 17 minutes, and does not involve any topical products or medications.  Treatment sessions are typically scheduled once or twice a week, for about four to five weeks, depending on your individual response.

The most appealing of the BLU-U® light therapy illuminator is that it is safe and pain free! This treatment can be used as an alternative to pharmaceuticals and topicals, and may be something worth trying before exploring more invasive oral medications that are often prescribed for acne patients. BLU-U® can be used in addition to some existing skin care programs, but always consult your dematologist before making any changes to your prescribed acne treatment plan.

Examples of Before/After Acne Treatment:

 

 

 

Contact us today for a more information:

610-265-1166

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How Your Hair Care Professional Can Help Detect Skin Cancer

Posted on March 19, 2012 by admin
By: Erum Ilyas, MD
Hair stylists are in a unique position to see most of your scalp.  For Dermatologists,  getting a thorough look at the scalp can be a very difficult- even when performing a full skin examination.  Often the thickness of a patient’s hair, the way it is styled, or even product use can limit visibility.  Hair stylists, however, see your scalp when its often product-free and in the process of cutting your hair will separate out sections and have full visibility of your scalp. 
 
According to a recent survey in Boston, published in the Archives of Dermatology, although only less than a third of hair stylists are educated about skin cancer, they can still detect lesions or questionable spots in the scalp just knowing the basic ABCDEs of changing moles. Chances are that a hair care professional will point out a lesion that does not seem right.  It’s a good idea to simply ask before your next hair appointment if  your stylist can keep an eye out for suspicious areas on your scalp while cutting or styling your hair. 
 
Scalp and neck melanomas do account for up to 6% of all melanomas diagnosed according to most reviews.  However, 10% of melanoma deaths between 1973 and 2003 were a result of scalp and neck melanomas. This is most likley due to the fact they can be so difficult to detect during a routine skin cancer screening. 
 
Other benefits to having your hair care professional comment on the overall health of your scalp are the  potential skin conditions that may draw attention. Inflammatory conditions such as seborrhea and psoriasis, allergic contact dermatitis, acne keloidalis (keloid like scars that occur around the hair follicles in the back of the scalp), alopecia areata (hair loss in circlular patterns) are a few that could potentially be identified. A stylist may also notice suspicious lesions such as moles, freckles, precancerous spots, and cysts that you may be unaware of – the scalp can harbor a lot of skin conditions that should be addressed and treated by a dermatologist.  
 
As part of  maintining overall health, be sure to see your Board Cerified Dermatologist for your annual skin examination.  Ask your hair professional if there are any lesions that your Dermatologist should be made aware of before your next skin exam.
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Brittle Nails

Posted on March 16, 2012 by admin
by: Erum Ilyas, MD
A common problem that we often see in our nails as we get older is that they become less flexible and/or brittle.  Brittle nail syndrome is a result of less overall moisture in the nail plate.  Often patients that complain of brittle nails overlook the fact that the skin on their hands is dry as well.  Caring for the hands and nails equally can help improve the overall skin and nail integrity. Here are some easy methods that can help:
 
1. Using moisturizers more routinely can help alleviate much of the brittle factor by contributing to the moisture of the nail plate itself as well as to the moisture in the nail matrix (at the base of the nail).  This ensures that the new nail growiing in maintains better integrity.  If this is not already a part of your daily habit, it is worth findig a moisturizer (any brand that you like) and using it routinely.
 
2. Avoid excessive hand washing, and remembering to use a moisturizer after each time you wash your hands will help as well.  It is a good idea to keep a bottle of moisturizer right next to your hand soap. 
 
3. Try to use gloves while washing dishes and while in the garden.
 
4. Try to avoid “over manicuring” your nails- nail polish can help as a protective film over your nails, however, frequently changing nail polish or using products that damage your nails can be counter productive.  Try to use formaldehyde free nail polish and acetone free nail polish removers to help decrease the drying effects.  Try to avoid using acrylics and gel based nail polishes – although they do not need to be changed frequently, the process of removal and the consistent use has been related to numerous nail issues that can result in permanent damage to the nailplate.  It is best to take a break for a few months after each use to avoid cumulative damage to your nails. 
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Basal Cell Carcinoma

Posted on February 27, 2012 by admin

Upwards of 2 million Americans may be diagnosed with Basal Cell Carcinoma (BCC) each year.  This makes it not only the most common form of skin cancer, but also the most  common form of cancer.

Basal cell carcinoma begins as rapidly developing cells in the epidermis, or outermost layer of the skin.  The development of BCC is strongly related to ultraviolet light exposure, although other factors such as genetics and environmental exposures also play a role.  They appear as non-healing ulcers or sores, bleeding sores, pearly or translucent papules, or pink scaling plaques.  They are often found on sun exposed areas, however they may present anywhere on the skin.  The most common areas to find a BCC are be on the face, back, and arms.

If left untreated, BCC can often grow and become disfiguring.  It has rarely been
associated with spreading to other parts of the body.  When BCCs occur on the face they are often treated by Mohs surgery.  Mohs surgery is an outpatient procedure performed under local anesthesia whereby which the Mohs surgeon, a specialty trained Dermatologic surgeon, removes the skin cancer in a tissue sparing approach.  The surgeon ensures
that the margins are clear by careful processing and review of the specimen which allows for lower rates of recurrence.  There are a variety of other treatment options available that can and should be reviewed with your Dermatologist.  Other treatment options include wide excision, curettage (scraping), topical immunomodulators (creams that stimulate the immune system to treat the skin cancer), radiation therapy, etc.  The choice of treatment should be made after weighing the risks and benefits of each, but this is often a choice that is based on the type and location of the skin cancer, patient preference, and risk of  recurrence.

Our best method of detecting BCC and other skin cancers is by examining our skin.  Full skin examinations are recommended on an annual basis.  BCCs are not common in children but have been diagnosed in teenagers and are seen with increasing frequency in patients in their 20’s.  Patients with a strong history of sun exposure and/or family history of BCC or any type of skin cancer should have full skin examinations performed on an annual basis by their Board Certified Dermatologist.  It is also highly recommended to check your own skin on a monthly basis from head to toe to ensure that no unusual or non-healing growths are present.

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The XTRAC Laser

Posted on February 3, 2012 by admin

We are proud to announce that we now have an XTRAC laser, which is used in the treatment of psoriasis and vitiligo. Using a carefully focused beam of light delivered through a sophisticated liquid light guide device, the XTRAC excimer laser system allows the physician to deliver high dose of monochromatic UVB right to the spot of the problem for fast, effective treatment of psoriasis and vitiligo while minimizing the risk of exposure to  healthy skin.*

The XTRAC laser is an excellent treatment for most plaque psoriasis patients who have not obtained satisfactory results with other treatments.  The XTRAC targets a specific type of light directly at the plaques, avoiding exposure to normal skin.  Each treatment is painless, and takes only a few minutes. Treatments are generally given two or three times per week, and dramatic results are often obtained in an average of 6 to 10 treatments.  Clearance of symptoms usually occurs around 10-20 treatments on average, and remission can last for 6 months or longer.  Most major insurance companies, including Medicare, will cover XTRAC laser treatments.

In cases of vitiligo, the XTRAC laser treatments are generally given two or three times per week, and dramatic results are often obtained in 30 treatments or less.  Your healthcare provider will usually be able to see signs of successful repigmentation beginning after 5 to 10 treatments.  Clinical studies have shown that the best repigmentation rates are usually obtained in the face and neck areas, followed by the “mid-body” areas.

Here are some examples of patients who have had success with the XTRAC Laser treating psoriasis and vitiligo:

To schedule a consultation and to discuss XTRAC Laser treatments, contact Montgomery Dermatology today @ 610-265-1166.

Watch the XTRAC Laser in action on an episode of “The Doctors,” aired in March 2011 here: http://www.thedoctorstv.com/videolib/init/833

*To find out more about the XTRAC Laser visit the PhotoMedex, Inc website here:  http://www.xtraclaser.com/

Posted in Lasers, Psoriasis | Leave a comment

Molluscum

Posted on January 30, 2012 by admin

Molluscum contagiosum is a viral infection that presents as  bumps on the skin. These bumps are caused by a virus on the skin known as the molluscum contagiosum virus.   The bumps are contagious and can be spread by contact with a lesion or something that the lesion came into contact with (such as a towel).  They often start off as pinhead-sized discreet bumps or papules on the face, neck, trunk, arms and/or legs. These tiny papules can become larger over time, growing to several millimeters in size. Often times they can also be associated with itching.  Children commonly present with these, however they can be seen in any age group.

What Happens if I don’t treat it?

As this virus is not harmful often times parents would like to know whether to treat these areas.  Without treatment, most children will resolve within a year, however some may find that the bumps may spread to more areas over time, or that the affected areas become itchy.  Most decide on treatment based on whether or not the areas affected are symptomatic or visible.

Will it spread?

It is difficult to say if you will have a handful of lesions or if they will spread. If it is noted that spread is occurring it is best to be seen by your Dermatologist to evaluate treatment options.

How can it be treated?

There are a number of treatment options for molluscum contagiosum, including a number topicals, as well as directly treating these lesions by freezing, scraping, nicking, cautery, etc. It is always best to review these options with your Dermatologist to determine the best treatment course.

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Acne Vulgaris

Posted on January 17, 2012 by admin

by Erum Ilyas, MD

One of the most common reasons to visit the Dermatologist is acne.  It can begin as early as the age of 6 or 7 and can appear at any point in your life.  It primarily starts as clogged pores- also known as comedones. This is a good word to learn as many products may be labeled as “non comedogenic” which essentially means “non pore clogging”.  Comedones can be open or closed; i.e., blackheads or whiteheads.  Clogged pores are the result of excess oil production, known as sebum, and from lack of exfoliation at the opening of the pore.  After the pores begin to clog, bacteria by the name of  Propionibacterium acnes (P acnes), can overgrow and lead to significant inflammation.

Types of Acne

Clogged Pores

Comedonal acne, primarily seen as whiteheads and blackheads, can often be treated in its initial stages with over the counter products.  Many of these products contain Salicylic acid of up to 2% concentration, or Benzoyl peroxide in varying concentrations up to 10%.   These products both remove extra oil and dead skin cells to prevent pore clogging from taking place, but salicylic acid is often less irritating.  Any product containing benzoyl peroxide will also kill bacteria on the surface of skin that could have otherwise caused further acne.  It is important to be careful of the concentration of Benzoyl peroxide in products that you choose, as some of the higher concentrations can be very irritating to some skin types.

If you have comedonal acne that has not responded well to traditional over the counter  products, prescription products from your Dermatologist will prove very helpful.
The most successful treatments for comedonal acne are retinoid products containing ingredients such as adapalene, tretinoin or tazarotene.  It is important to be under the care of a Dermatologist when using these products, as they can produce significant irritation in some skin types, especially in the first weeks of use.  They are often more successful in combination with topical products containing benzoyl peroxide, and/or topical antibiotics.

Occasionally, some patients may find their treatment options limited due to skin sensitivity and irritation.  In these cases, it is extremely helpful to visit your Dermatologist as there are less irritating options out there for you! Some of the more mild products may include azaleic acid or sulfa, among others.  It is important to also be aware that what may
look and seem like acne may actually be the result of rosacea or seborrhea, or some
patients may have a combination of causes that require a completely different approach to treatment.

Inflammatory Acne

The next stage of acne after comedonal is inflammatory.  This type of acne occurs when pores have become clogged and the bacteria P acnes is causing inflammation in these  reas.  The resulting breakout will be more pink, occasionally tender or painful, and may come to a head as a pustule or pus filled area. This stage of acne will be harder to treat with topical therapies alone, as the level of inflammation is deeper than many topical products are able to reach.  The most common and most effective antibiotics used are Doxycycline and Minocycline.  These are often prescribed for extended periods of times, most often in 6 to 12 week regimens, and often times longer when needed.  There are some less often
used antibiotics that are still effective.  It is always important to be under the care of a Board Certified Dermatologist when undergoing oral therapy for acne.  It is always important to recognize that this stage of acne has a risk of scarring, and it is important to follow up with your Dermatologist as instructed as they may be able to intervene and prevent scarring.

Nodulocystic Acne

Cystic acne can be very frustrating and painful, and can lead to significant scarring if not treated.  If you suspect that your acne is this severe, please see your Dermatologist as often oral antibiotics may be used initially, and for resistant or more severe cases a discussion with your doctor about using Isotretinoin, known as Accutane in the past, may be warranted.

 

Commonly Asked Questions

Why hasn’t anyone checked my hormones?

Hormonal testing in acne cases is not routinely recommended unless other signs of hormonal problems are present.  The majority of acne patients will most likely not have hormonal testing performed.  If you feel as though you have other signs of hormonal excess, such as irregular periods or excess hair growth, please inform your Dermatologist.

Should I try birth control pills for my breakouts?

This is a question that should always be discussed with your Dermatologist and Gynecologist.  As with any medication by mouth, the risks and benefits of taking a medication that will be used long term should be reviewed with your doctor.

What about my diet?

This is a great question that is difficult to answer.  There have been several attempts to link diet and acne, and population studies conducted to see if links between diet and acne are present.  Unfortunately, the studies available suggest links between acne and diet but do  not consistently show this to be the case.  There are undoubtedly going to be more studies and attempts to link the two, however based on reviewing the studies available, it is not routinely recommended to make any dietary changes other than maintaining a healthy well balanced diet.

Should I pop my pimples?

Another great question! Although there are not many studies that support removing blackheads and whiteheads directly, it is still routinely performed, and can be beneficial in
helping improve to the overall appearance of acne.

Should I get a chemical peel or microdermabrasion?

This is not a well-studied method of treating acne, despite being widely used.  These  therapies may be helpful in some patients, and especially for comedonal acne.  If any element of inflammatory acne is present, it is best to ask your Dermatologist prior to obtaining a chemical peel or microdermabrasion treatment.  Occasionally, some patients find that their breakouts become worse in the initial weeks after a treatment, and may require prescription strength topical or oral medications to help.

When should I see my Dermatologist?

As mentioned above, often the earliest stages of acne can be well controlled with over the counter preparations.  When choosing acne products, be sure to look primarily at the active ingredients listed, and less at the ads that support their use.  So many patients end up with boxes of slightly used products and have not realized just how much money they have spent.  When looking through these boxes they find out that almost all had exactly the same active ingredients, just different brand names and inactive ingredients.  If a product is helping but is irritating or difficult to use, choose another brand name with the same active ingredient.  This may help offset some of the irritating effects of the inactive
ingredients, which vary from product to product. If you have tried over the counter products without success, worry that you may have inflammatory or cystic acne, or suspect that you may have a hormonal disorder, please see your Dermatologist to review your treatment options.

Please check back for future posts on adult acne, acne for women over the age of 20, rosacea, and specific posts on topical and oral therapies!!

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