Patients with mild to moderate rosacea usually respond to topical medications.  Skin and eye manifestations of severe rosacea respond to oral antibiotics.  While some patients respond to topical medication and remain in remission, others may require long term suppression with oral antibiotics.  Sunscreens are an essential component of rosacea management.  Life style modifications that reduce stress and avoidance of hot beverages, spicy foods, and alcohol should help alleviate the symptoms.

If you have any signs or symptoms of rosacea, don’t worry; we are here to help you!  Please come see us!

Meera Pradeep, PA-C

Jay D. Geller, M.D

Reference:

Habif.Thomas, M.D.  Clinical Dermatology:  A Color Guide to Diagnosis and Therapy.  5^th ed.  Mosby 2010, 256-258

The new regulations also monitor claims. A broad spectrum sunscreen should protect against both UVA and UVB rays in an effort to help prevent skin cancer.  An SPF of 2 – 14 only protects skin from sunburns but not skin cancer.  The FDA developed a broad spectrum test in which all “broad spectrum” sunscreens (SPF15 or higher) must pass in order to be FDA approved. Sunscreens are also no longer able to claim “water-proof”, “sweat-proof” or “sun block” claims without submitting proof and FDA approval of the claim because it gives a consumer a false sense of protection.

For more information and questions about these new changes and regulations visit: www.fda.gov/sunscreen^..

Azalesha Abrahim PA-C

Jay Geller M.D

http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm258468.htm. Accessed October 4,2011.

Keratosis Pilaris (KP) is a very common skin condition.  It consists of small rough bumps most often occurring on the back of the upper arms and front of the thighs; however, KP can occur anywhere on the body excluding the palms and soles.  KP can occur in young children, but incidence peaks during adolescence.  More often KP occurs in people with atopic dermatitis, and it may improve with age.   Atopic dermatitis is a chronic, itchy inflammatory skin condition usually beginning in childhood and follows a waxing and waning course that may be worsened by infection, stress, climate changes, irritants, and allergens.  While there is no cure for KP, there are treatment options available.  First, stop picking at these bumps or using abrasive washes.  This will only cause further irritation and scarring.  When the bumps are red and irritated, we can prescribe cortisone to calm the inflammation.  Ammonium lactate lotion, salicylic acid lotion or stronger prescribed topicals such as urea cream or retinoids may be necessary to reduce the roughness.  Overall, not to worry, we are here to help you with your bumps!

-Cynthia Recca PA-C

-Jay D. Geller, MD

Habif, Thomas, MD.  Clinical Dermatology: A Color Guide to Diagnosis and Therapy.  5^th ed.  Mosby 2010, 154, 168.

• Exchange messages with our practice
• Review and pay billing statements
• Request appointments
• Review patient information and instruction sheets
• Print new patient forms and patient questionaire
• Review Personal Health Information
• Complete and update medical forms
• Update your profile and contact information
• Watch interactive Healthwise conversations on Healthy Eating, Getting Active, Health Weight and Sleeping Well
• Utilize Interactive Healthwise and Fitness Tools on numerous health issues
• Complete Personal Health Calculators
• Access a comprehensive Health Library  

DID YOU KNOW…

Most Americans are unaware of the seriousness of melanoma.

~If not caught early, melanoma is known to be the most deadly of all skin cancers.  Melanoma can be successfully removed and monitored by regular skin screenings in its early stages.  However, the disease is deadly in its most advanced stages as few treatment options exist.  The median lifespan for patients with advanced melanoma is less than one year.

The statistics around melanoma are astouding:

~One in 50 Americans has a lifetime risk of developing melanoma.

~In 2009 nearly 63,000 were diagnosed with melanoma in the United States, resulting in approximately 8,650 deaths.

~The projected numbers for 2010 are even higher with 68,130 diagnoses and 8,700 deaths.

This means that every eight minutes, someone in the United States will be given a melanoma diagnosis and that every hour someone will die from the disease.

Melanoma is the fastest growing cancer in the United States and worldwide.

~The American Cancer Society estimates that the risk of developing invasive melanoma in the United States is 1 in 41 and 1 in 61 for men and women, respectfully.

~The incidence of people under 30 developing melanoma is increasing faster than any other demographic group, soaring by 50 percent in young women since 1980.

~Melanoma primarily affects individuals in the prime years of life and is the most common form of cancer for young adults 25-29 years old and the second most common cancer in adolescents and young adults 15-29 years old.

~Although melanoma is most common in Caucasians, melanoma can strike men and women of all ages, all races and all skin types.  The mean age for diagnosis of melanoma is 50, while for many other cancers it is 65-70 years old.
SOURCE:  www.melanoma.org

Isotretinoin acts by primarily by inhibiting and atrophying the sebaceous (oil) glands.   This in turn reduces oil production.  Propionibacterium acnes is a bacterium that plays a critical role in acne and requires oil from sebaceous glands to thrive.  Decreased numbers of Propionibacterium acnes coupled with diminished output of sebum (oil) from sebaceous glands inhibit the process responsible for the development of inflammatory acne. ^[1]

Patients can expect to take isotretinoin for an average period of 5-6 months.  The medication typically is started at a lower dose and gradually increased over time.   Since isotretinoin decreases sebaceous glands size and output, side effects involve the skin and mucous membranes (ex:  lips and nasal lining) and are dose dependent.  The most common side effect is dryness with frequent drying of the skin, eyes, and nasal passages that can lead to nose bleeds.   “Myalgias (muscle pain) are the most common neuromuscular complaint seen with isotretinoin use.  They occur in approximately 15% of patients on therapy.” ^[1] Other side effects include temporary elevation of cholesterol and triglyceride levels, decreased night vision, nausea, vomiting, photophobia, anorexia, and headache.  More serious and rare side effects are benign intracranial hypertension (pseudotumor cerebri), pancreatitis, and premature closure of epiphyseal plates (“growth plate”), a complication seen primarily in children^.[1] Depression / suicide and inflammatory bowel disease have been associated with isotretinoin use, but to date there has been no proven causality from Accutane. ^[3,4,5]

“Isotretinoin is teratogenic and must not be used by pregnant women. Women should not become pregnant while taking isotretinoin or for 1 month after therapy is discontinued. A patient who becomes pregnant during treatment should stop taking isotretinoin and immediately contact her prescriber.^[“2] “Women of childbearing must practice effective contraception for 1 month prior to therapy, during therapy, and for 1 month after completing therapy. To afford a sufficient safety margin, a 1-month post-therapy contraceptive period is mandatory because plasma concentrations of isotretinoin return to physiologic levels within 10 days of completing therapy.”^[6]

“Because of isotretinoin’s teratogenicity (risk of severe birth defects), isotretinoin is approved for marketing only under a special restricted distribution program approved by the Food and Drug Administration. This program is called iPLEDGE.”  The iPLEDGE program will be reviewed in detail before you or your daughter commence isotretinoin.^[2]

While on Isotretinoin (Accutane), a patient will require an office visit every 30 days. During each visit, side effects will be reviewed and the severity of the acne will be evaluated for the appropriate dosage for the following month.  Patients will be instructed to obtain their monthly blood work prior to filling their prescription for the following month.  The blood work will include tests for blood counts, liver and kidney function, cholesterol and triglyceride levels, and pregnancy status in females.  The prescription can only be filled up to 7 days after the prior office visit.

For any additional information on Isotretinoin (Accutane) please visit: www.ipledgeprogram.com.

References:

1-Bolognia, Jean, Joseph L. Jorizzo. “Acne Vulgaris.”  Dermatology. Mosby/Elsevier, 2008.  Expert Consult.  Online Version.

2-The ipledge program. “Guide to best practices for isotretinoin”. www.ipledgeprogram.com. Accessed February 16, 2011

3- James F Blanchard, et al. “Isotretinoin is not associated with inflammatory bowel disease: a population-based case-control study.” The American Journal Of Gastroenterology 104.11 (2009): 2774-2778. MEDLINE. EBSCO. Web. 20 Jan. 2011.

4- Michael D Kappelman, et al. “A Causal Association Between Isotretinoin and Inflammatory Bowel Disease Has Yet to Be Established.” American Journal of Gastroenterology 104.10 (2009): 2387-2393. Academic Search Complete. EBSCO. Web. 20 Jan. 2011.

5- Michael D. Kappelman, et al. “Isotretinoin Use and the Risk of Inflammatory Bowel Disease: A Case–Control Study.” American Journal of Gastroenterology 105.9 (2010): 1986-1993. Academic Search Complete. EBSCO. Web. 20 Jan. 2011.

6- Bolognia, Jean, Joseph L. Jorizzo. “Retinoids.”  Dermatology. Mosby/Elsevier, 2008.  Expert Consult.  Online Version.

Azalesha Abrahim PA-C

Jay D. Geller MD

We’ve seen a handful of patients recently complaining of sudden patchy hair loss. Understandably, this can be a highly upsetting situation for any man, woman or child, so we figured we’d post some information for those out there who may be experiencing alopecia areata.

Alopecia areata is common, affecting 0.1% to 0.2% of the United States population (Habif 932). Generally, several 1- to 4- cm areas of hair loss suddenly appear on the scalp, beard area, eyelashes, and rarely to other parts of the body.  These patches can be smooth or contain short stubby hairs, which can grow out white or gray.  Sometimes there are even changes in the nails.

The cause of alopecia areata is unknown.  In fact, many times we never know why it occurs; however, there are some labs that can be drawn that may give some insight into an underlying associated condition.   Some associated conditions are asthma, autoimmune thyroid disease, vitiligo, inflammatory bowel disease, and type I diabetes (Bolognia 995).  Genetic factors and stress may also contribute to this condition.  A skin  biopsy may also be done to rule out other hair loss conditions.

On the cellular level, T-lymphocytes, a type of white blood cell (WBC), play a primary role in the pathogenesis of alopecia areata, interacting and causing inflammation around the hair follicles (Bolognia 992).  This is why immunosuppressive agents such as cortisone injected directly into the affected areas work well, effectively reducing these WBCs and subsequently restoring hair growth.

The path of alopecia areata is unpredictable.  There may be several episodes of hair loss and re-growth.  Most patients will entirely re-grow their hair within one year; however, 10% may never re-grow the hair (Habif 933).  Overall, the smaller surface area affected, the better chance of total re-growth.

It is important to seek medical help for alopecia areata sooner rather than later since treating this condition earlier may increase the chance of full re-growth of hair.

Treatment options:

-Topical Steroids

-Steroid injections

-Topical Rogaine

-Other prescribed medications targeting underlying conditions

Please schedule an appointment if you need a professional to evaluate your hair loss.  As always we’re here to help!

Bolognia, Jean L. MD; Jorizzo, Joseph L. MD; Ropini, Ronald P. MD. “Section Eleven, Hair, Nails and Mucous Membranes.” Dermatology. 2^nd ed. Mosby Elsevier, 2008. 992-995.  Print edition.

Habif, Thomas P. MD.  ”Hair Diseases.”  Clinical Dermatology: a Color Guide to Diagnosis and Therapy. [Edinburgh]: Mosby, 2010. 932-935.  Print edition.

Cynthia Recca PA-C

Jay D. Geller, MD

Treatments:

-Cantharone (Cantharidin 0.7%) is a topical blistering agent.  Widespread infection often requires multiple applications every 2 weeks.  It is safe and effective, and the application is painless, making it the ideal treatment for children.   Children frequently also have a rash or dermatitis surrounding their molluscum lesions and that can be easily treated with topical medications.

-Cryosurgery (direct or cotton-tipped) application of liquid nitrogen (−196°C or -320°F) to lesions to freeze virus; may cause blister formation.

-Immunomodulatory agent (such as Aldara) drug application medication stimulates the immune system to attack the virus; may cause redness and irritation.

-Curretage is manual extraction of the lesions. A curette is used to pierce the molluscum core and a pus-like fluid is expressed. This can be performed with or without local anesthesia.

-Shave biopsies will entirely remove the lesions.  A #15 blade scalpel is used under local anesthesia.  Risk of scarring is increased so this should be avoided in cosmetically important areas.

If you have questions about molluscum lesions or any other skin concerns, please do not hesitate to contact us or make an appointment!

References

Bolognia, Jean MD. et al.  Dermatology. 2^nd edition. Mosby Elsevier, online version.

Habif, Thomas P. MD. Clinical Dermatology: A Color Guide to Diagnosis and Therapy. Fifth Edition. Hanover: Mosby Elsevier, 2010. 428-430.

Kathryn Gilbert, PA-C

Jay D. Geller, MD

Warts are benign growths caused by human papillomaviruses (HPV).  They are very common, especially amongst children.  In fact, viral warts rank among the three most common dermatoses in children and occur with equal frequency in both sexes.  They can, however occur at any age.  They are often found on the hands, around the nails, and on the palmar surfaces, however they can occur anywhere on the body.  Infection of the anogenital tract with HPV is one of the most common sexually transmitted infections (STI) among adolescents and adults—“in the US, an estimated 20 million people have genital HPV infections at any one time” (Bolognia et al 2008). The majority of warts will regress spontaneously within 1-2 years, but others may last years and take several treatments to cure.

Transmission-How does one acquire a wart?

Warts are passed most commonly via direct person-to-person skin contact, or indirectly through contaminated surfaces and objects (e.g. a swimming pool, gymnasium).  Genital warts are spread most commonly by intimate contact with individuals who already have been infected with the human papillomavirus, whether or not he/she actually has a visible lesion.

Types

Common:

-Most commonly found on the hands

-Begin as smooth, fleshy-colored bumps and evolve into dome-shaped, gray-brown growths with black dots on the surface.  These black dots are the blood supply of the growth.

Filiform and digitate:

-Most commonly around the mouth, beard, eyes, nose

-Few fingerlike, flesh-colored projections coming from base

Flat:

-Commonly on forehead, around the mouth, back of hands, and shaved areas (beard/lower legs)

-Pink, light brown, or light yellow slightly elevated, flat-topped bumps

Plantar:

-Found on soles

-Thick, painful callus forms

Subungual and periungual:

-Under or adjacent to nail

Genital:

-Found on the external genitalia and the perineum, perianally, or in adjacent areas

-One to several millimeters in diameter, discrete, smooth-surfaced bumps that may be skin-colored, brown or whitish

Treatment

-Physical removal, then electrocautery: metal wire heated by electricity to burn the residual viral cells

-Cryosurgery (direct or cotton-tipped) application of Liquid nitrogen (−196°C) to lesions to freeze virus; may cause blister formation

-Salicylic acid application-gradually sloughs off lesion

-Immunomodulatory drug application: medication stimulates the immune system to attack the virus; may cause redness and irritation

References

Bolognia, Jean, Joseph L. Jorizzo, and Ronald P. Rapini. “Human Papillomavirus.”  Dermatology. Mosby/Elsevier, 2008.  Expert Consult.  Online Version.

Habif, Thomas P. “Warts, Herpes Simplex, and Other Viral Infections.”  Clinical Dermatology: a Color Guide to Diagnosis and Therapy.  Mosby/Elsevier, 2010.  454-64. Print.

Cynthia Recca, PA-C

Jay D. Geller, MD