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Cryosurgery, sometimes called cryotherapy, is not a surgical procedure that involves cutting of the skin. Rather, it is the use of extreme cold produced by liquid nitrogen to destroy abnormal tissue. Cryosurgery is typically used to treat precancerous lesions (actinic keratoses) and warts. The liquid nitrogen can be applied directly to the skin with a spraying device or a cotton swab. Mild blistering and tenderness are expected results and part of the normal process for destruction of abnormal tissue.
Allergic contact dermatitis can be the underlying cause of many chronic rashes. Patch testing (which differs from pinprick or blood allergy testing) involves applying pads that contain suspected allergenic substances from the North American Contact Dermatitis Society’s core allergen list to the entire surface of the back. These common chemicals can be found in jewelry, skin care products, soaps, cosmetics, fragrances, and clothing fabric. Patients are first assessed by a provider to determine if patch testing is appropriate for the type of rash, and then insurance authorization is obtained to determine out-of-pocket expenses for the testing.
Ultraviolet B (UVB) light is found in natural sunlight, along with other types of radiation. It penetrates the skin and slows the rapid growth of skin cells associated with certain skin disorders. When isolated and regulated, this modality is an effective treatment for psoriasis, atopic dermatitis (eczema), vitiligo, and other chronic skin conditions. Narrowband UVB treatments are not a permanent cure, but can effectively control and improve these conditions, sometimes for extended periods of time. The clinic at NE Knott Street houses a full-length Narrowband UVB booth for customized light treatment plans.
Excimer (Xtrac®) laser treatments utilize ultraviolet (UVB) light to treat various skin diseases, including psoriasis and vitiligo. Exposure to beneficial high energy UV light is applied to the affected areas for varying lengths of time, while the UV rays that cause burning are eliminated. Total number of treatments and clearing time will vary by patient and condition. Though not a cure, this treatment can effectively control and improve these conditions. Since its invention in 1970, patients have used this treatment successfully and are often able to maintain clearance of improved skin for extended periods of time.
Photodynamic Therapy (PDT) is a procedure used to treat actinic keratoses (precancerous lesions), certain types of skin cancer, and acne. The purpose of PDT is to create a chemical reaction that destroys only abnormal cells while leaving normal cells intact. The treatment consists of application of a sensitizing agent (aminolevulinic acid), which is left on the skin and allowed to absorb for approximately 1 to 2 hours, followed by exposure to intense light for 15 minutes. After a short healing period, new skin cells replace the abnormal cells.
Warts are caused by the human papilloma virus (HPV) that has over 80 different subtypes. The virus can be spread easily by human contact. Some people’s immune systems fight off wart virus well, while other people’s immune systems do not. Warts are typically located on the soles of the feet (plantar warts), the hands, and the genital region (condyloma). When they occur under a fingernail or toenail, they are called periungual warts.
There are several ways to treat warts: cryotherapy (applying liquid nitrogen with very cold temperatures), surgery, or electrocautery. Another way to treat warts is with an injection of common type of yeast called Candida. A prepared version of the yeast is injected into the wart which causes the skin to turn red in a few days. Injecting the yeast antigen into the wart stimulates the immune system to become active in the treated area and, in turn, attack the virus causing the wart.
Another type of wart treatment involves Cantharidin, a chemical compound made from secretions of blister beetles. In diluted form, it can be an effective way of treating warts or molluscum. Diluted cantharidin is applied with a cotton swab directly to the warts or molluscum lesions and triggers the body’s immune system to fight the virus. Several treatments may be required to clear the skin.
Full Skin exam
Full skin exams (FSEs) have become the standard of care for detection of skin cancers in their early stages, especially melanoma which can be life threatening. FSEs are relatively quick and require no special equipment, although sometimes a dermatoscope is used to magnify skin lesions to assist the provider with detection of abnormal features. FSEs are used in all dermatology practices and are endorsed by the American Academy of Dermatology (AAD).
A dermatology provider will ask questions about personal history of sun exposure, incidence of sunburn, as well as past skin issues and family history of melanoma. After the patient removes clothing and changes into a medical garment, the provider performs a thorough check of the entire surface of the skin (exposing only one body part at a time) from the scalp to the soles of the feet. Areas of concern can be documented with digital photography and then compared to photographs at a later exam to detect any changes in moles or other spots.
Acne is a common skin condition that affects people of all age groups. Anti-acne strategies include traditional oral and topical antibiotics, hormonal therapies, as well as isotretinoin (Acutane) medication managed by the iPledge program. Acne can also be treated with Forever Clear BBL™ treatments and Photodynamic Therapy (PDT)
Rosacea (rose-AY-sha) is a common skin disease that often begins with a tendency to blush or flush more easily than other people. The redness can slowly spread beyond the nose and cheeks to the forehead and chin.
There are 4 subtypes of rosacea:
1. Erythematotelangiectatic rosacea: Redness, flushing, visible blood vessels
2. Papulopustular rosacea: Redness, swelling, and acne-like breakouts
3. Phymatous rosacea: Skin thickens and has a bumpy texture
4. Ocular rosacea: Eyes red and irritated, eyelids can be swollen, and person may have what looks like a sty.
Treatment for rosacea focuses on controlling signs and symptoms. Most often, this requires a combination of skin care and prescription treatments. The type of medication prescribed depends on what signs and symptoms are being experienced. Prescription drugs for rosacea include medications that constrict blood vessels, oral antibiotics, and isotretinoin (Acutane). The duration of treatment depends on the type and severity of the symptoms. Recurrence is common. Intense Pulsed Light therapy may also help reduce the redness of enlarged blood vessels.
Atypical moles are unusual-looking benign (noncancerous) moles, also known as dysplastic nevi (the plural of nevus). Atypical moles may resemble melanoma, and people who have them are at increased risk of developing melanoma in a mole or elsewhere on the body. The formation of atypical moles tends to run in families, especially in Caucasians. Those who have atypical moles plus a family history of melanoma (2 or more close blood relatives with the disease) have a very high risk of developing melanoma. People who have atypical moles, but no family history of melanoma, are also at higher risk of developing melanoma, compared with the general population. All high-risk individuals should practice rigorous daily sun protection, perform a monthly skin self-examination head to toe, and seek regular professional skin exams. Atypical moles will usually be biopsied to rule out melanoma and/or will be removed with excisional surgery to prevent changing and spreading over time.
Seborrheic keratosis vs Actinic Keratosis
Seborrheic keratosis (seb-o-REE-ik ker-uh-TOE-sis) is one of the most common noncancerous skin growths in older adults. A seborrheic keratosis usually appears as a brown, black or light tan growth on the face, chest, shoulders or back. The growth has a waxy, scaly, slightly elevated appearance. Seborrheic keratoses do not become cancerous and are not thought to be related to sun exposure, but they can look like skin cancer. Seborrheic keratoses are normally painless and require no treatment. The provider may decide to remove them if they become irritated by clothing or daily activity.
An actinic keratosis (ak-TIN-ik ker-uh-TOE-sis) is a rough, scaly patch on the skin that develops from years of exposure to the sun. It is most commonly found on the face, lips, ears, back of the hands, forearms, scalp, or neck. Also known as a solar keratosis, an actinic keratosis enlarges slowly and usually causes no signs or symptoms other than a patch or small spot on the skin. These patches take years to develop, usually first appearing in people over 40. Risk of actinic keratoses can be reduced by minimizing sun exposure and protecting the skin from ultraviolet (UV) rays. If left untreated, some of these spots may progress to squamous cell carcinoma (a type of cancer that usually is not life-threatening with early detection.) If treated early, most actinic keratoses can be cleared or removed before they develop into skin cancer. Actinic keratoses are typically treated with liquid nitrogen sprayed directly on the area.
Melanoma is the most dangerous form of skin cancer. Melanomas are cancerous growths that develop when damage to skin cells (most often caused by ultraviolet radiation from exposure to the sun or tanning beds) triggers mutations (genetic defects) that cause the skin cells to multiply rapidly and form malignant tumors. Melanomas often resemble moles, and some can develop from atypical moles.
Most melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue, or even white. People with fair skin and light eyes are genetically predisposed to the disease. If melanoma is recognized and treated early, it is usually curable. However, if left untreated, the cancer can advance and spread to other parts of the body, where it becomes hard to treat and can be fatal. Regular self-examination and medical full skin exams are highly recommended for surveillance and early detection.
Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer. It is caused by abnormal, uncontrolled growths or lesions that arise in the basal cells, which line the base of the outer layer of the skin. BCCs often look like open sores, red patches, pink growths, shiny bumps, or scars and are usually caused by a combination of cumulative and intense ultraviolet (UV) radiation from the sun. These lesions never fully heal and often recur in cycles, because the damaged cells cannot repair themselves. For BCC on the face and some parts of the arms and legs, the most effective treatment is Mohs surgery. Mohs surgery is accepted as the single most effective technique for removing Basal Cell Carcinoma. BCCs that occur on certain parts of the body can also be removed with excisional surgery.
Squamous Cell Carcinoma
Squamous cell carcinoma (SCC), the second most common form of skin cancer, is an uncontrolled growth of abnormal cells arising from squamous cells in the outer layer of the skin. SCCs often look like scaly red patches, open sores, warts or elevated growths with a central depression, and they may crust or bleed. They can become disfiguring and sometimes fatal if allowed to grow. Daily year-round exposure to ultraviolet (UV) radiation from the sun and indoor tanning devices all add to damage that can lead to SCC.
SCCs are most common in areas frequently exposed to the sun, such as the rim of the ear, lower lip, face, balding scalp, neck, hands, arms and legs. These lesions never fully heal and often recur in cycles because the damaged cells cannot repair themselves. For SCC on the face and some parts of the arms and legs, the most effective treatment is Mohs surgery. Mohs surgery is accepted as the single most effective technique for removing Squamous Cell Carcinoma. SCCs that occur on certain parts of the body can also be removed with excisional surgery.
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