Medical & Surgical Adult and Pediatric Dermatology


Treatment for diseases of skin, hair, and nails, including acne, eczema psoriasis and rashes.

ACNE

Almost everyone experiences some problem with acne during their lifetime. This most commonly occurs during the teenage years, but it may occur at almost any age. As yet, there is no cure for acne, but most cases can be controlled. Treatment can lessen its severity, and therefore reduce the amount of scarring which could result if left untreated. Eventually acne goes away. The time at which this happens varies with each individual.

Although the exact cause of acne is unknown, several factors seem to be important. More than an average amount of skin oil is produced, probably as a result of both hereditary and hormonal factors. Pores get blocked with excess oil resulting in comedones (blackheads-whiteheads). Sometimes bacteria get trapped in these blocked pores resulting in inflammation (pimple-cysts). Emotional and physical stress can cause acne to worsen. Contrary to popular belief, diet does not seem to play an important role in the treatment of acne. However, if you have noticed flares consistently with a particular food, then by all means avoid it. Acne is not due to poor hygiene. Twice daily face washing in a normal fashion is sufficient. Using a washcloth is probably superior to using your hands, but harsh abrading agents should be avoided. Whether any one soap is better for acne than another is controversial, and therefore a matter of personal preference. Cosmetics, including moisturizers and cold creams may aggravate acne in some individuals, and a trial of stopping them may be worthwhile. Oil-free cosmetics may be less likely to cause a problem. Persons working around oil, greases, and solvents (cooks, mechanics, etc.) may notice that working conditions aggravate acne. The effect of ultraviolet light and sunlight on acne is controversial. Many patients "appear" to improve during the summer, but whether this is the camouflage effect of a nice suntan, or a real improvement is not known. There is no evidence that the light received in tanning parlors is helpful for acne, and may, in fact, be harmful to your skin in the long run.

There are many approaches to the treatment of acne. Antibiotics reduce the number of bacteria present, reduce skin inflammation, and may decrease oil gland secretion. They may be applied topically to the skin or taken orally. When they are given orally, they are most effective when taken on an empty stomach, that is, at least a 1/2 hour before, or 2 hours after consuming food, milk, dairy products, antacids, or vitamins containing zinc or iron. Although most antibiotics are well tolerated, they can have side effects such as upset stomach, diarrhea, headache, skin rash, sun sensitivity and, occasionally, vaginal yeast infections. If any of these problems arise, you should stop the medication and call your doctor. Some topical (used on the surface) medications are given to reduce blockage of pores. Examples of these are Vitamin-A Acid (Retin-A) and Benzoyl Peroxide, among others. To prevent itching and excess dryness from topical medications, they should not be applied for at least fifteen minutes after washing. It is advisable to begin application every other day, and gradually increase to daily use as tolerated. With particular reference to Vitamin-A Acid, it should only be used in the evening, as exposure to sunlight may result in severe redness. If itching, redness, or dryness develops with any topical medication, stop for a few days until the problem subsides, and then re-institute treatment with less frequent applications. Extraction of comedones by the dermatologist is another method to unplug pores. Squeezing with your fingers is to be avoided, as this could cause scarring. Injection of a small amount of cortisone directly into an acne cyst can reduce its size, tenderness, and likelihood of scarring. Birth control pills can affect oil gland secretion, and may improve or worsen acne, depending upon the type taken and the individual patient. Occasionally, it is advisable to stop, change, or prescribe birth control pills for acne control in female patients.

There are several special acne treatments. Accutane is an oral medication used to treat severe cystic acne and acne which has been unresponsive to conservative therapy. The beneficial results of this medication in selected patient has been gratifying; however, at the present time, it is not intended to be used as initial acne therapy. Blue light with or without Levulan (ALA) is a relatively new and novel treatment for acne which has not responded to conventional therapy. Filler injections for the treatment of certain types of acne scars is available. This may be used alone or in combination with chemical face peels and lasers for the treatment of residual acne scars.

Once a treatment program for acne is begun, it usually takes six to twelve weeks before a definite improvement can be seen. However, it must be realized that individual responses to any one of these treatments is highly variable. What works for one patient may not help another. Different medications may need to be tried before the combination that works best for you is found. Remember that almost all cases can be controlled.

IT IS MANDATORY THAT AN APPROPRIATE METHOD OF BIRTH CONTROL (CONTRACEPTION) BE PRACTICED WHILE UNDERGOING ACNE TREATMENT; OTHERWISE, IF PREGNANCY IS POSSIBLE, NEITHER ORAL NOR TOPICAL MEDICATIONS SHOULD BE USED WITHOUT THE APPROVAL OF YOUR PHYSICIAN. THERE IS SOME CONCERN THAT ORAL ANTIBIOTICS MAY INTERFERE WITH THE CONTRACEPTIVE EFFECT OF BIRTH CONTROL PILLS. IF YOU DEVELOP IRREGULAR MENSTRUAL CYCLES, BLEEDING BETWEEN MENSTRUAL CYCLES, OR MISS A REGULAR MENSTRUAL CYCLE, YOU SHOULD STOP YOUR ANTIBIOTIC AND NOTIFY YOUR PHYSICIAN. ADDITIONALLY, SHOULD YOU BECOME PREGNANT, YOU SHOULD IMMEDIATELY STOP ALL ORAL AND TOPICAL ACNE TREATMENT AND NOTIFY YOUR DOCTOR.

(Revised 08/09)
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  • Acne Scar Treatment

  • ACTINIC KERATOSES

    Actinic keratoses are premalignant lesions. They are most commonly seen in fair-eyed, fair-skinned individuals and occur most commonly on sun-exposed areas, such as the balded scalp in men, face, neck, forearms, and the backs of the hands. They are due to long-term chronic sun exposure and may take many years to develop. Once they do develop, it is common to develop new lesions over time. They appear as red, scaly, and sometimes crusted areas which may bleed if picked. It is estimated that about 1 in 10 lesions, if left untreated, may become a skin cancer. On the other hand, if the skin is protected from the sun by wearing appropriate clothing, hat, and/or sunblock, they may get smaller and even disappear.

    There are many available treatments for actinic keratoses. One of the most common treatments is cryotherapy, a process of destruction using liquid nitrogen, which is a cold liquid and when applied, causes the keratosis to blister, crust, and fall off. Other treatments include topical chemotherapy, photodynamic therapy, chemical peels, or combinations thereof. Topical chemotherapy creams have the ability to seek out and destroy areas of sun damage which may or may not be clinically apparent. When applied, these creams may cause the affected areas to become red, crusted, and tender before the lesions heal. There are many different topical chemotherapy medications and treatment regimens. Photodynamic therapy, also known as ALA/Blu-U, is an insurance covered in-office procedure in which Levulan, a topical chemotherapeutic agent, is applied to the affected areas, left on for about an hour, and then exposed to Blu-U light for 8-16 minutes, depending upon your tolerance. Following treatment, it feels as though you had a sunburn with redness which lasts for several hours following which the actinic keratoses slowly respond over several weeks. Frequently, several treatments are required to obtain a satisfactory result. Chemical peels are also used to treat actinic keratoses in which a peeling solution is applied to the skin causing exfoliation and improvement in the lesions. These peels may need to be repeated at weekly to monthly intervals. Often, combinations of the different treatment modalities are employed to obtain the best results. Those lesions which do not respond may need more aggressive individual treatment including surgical removal.

    As noted above, there is no one method or treatment regimen which is likely to be completely successful. Furthermore, recurrent and new lesions are likely and monitoring on a regular basis by you and your provider is recommended. Sun protection including wearing a hat, protective clothing, and a sunblock on a regular basis is recommended.

    (Reviewed 08/09)
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    BLU-U/LEVULAN PHOTODYNAMIC THERAPY

    New England Dermatology & Laser Center is proud to be the first office in Western Massachusetts to offer the newest technology for the treatment of acne, precancerous skin lesions known as Actinic Keratoses and photoaged skin. Please ask us about this new exciting therapeutic option.

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    HYPERHIDROSIS

    Hyperhidrosis is excessive sweating. There are three types:

    • Primary focal (usually occurring on specific areas, on both sides of the body);
    • Generalized idiopathic (large areas of the body, usually treated with oral medication); and
    • Secondary generalized (usually caused by a medical condition, such as menopause, an overactive thyroid, diabetes or stroke).
    Primary focal hyperhidrosis may be treated with antiperspirants, iontophoresis, Botox (Botulinum Toxin Type A), oral medication, sympathectomy, or surgical intervention.

    If you feel that sweating is affecting your quality of life, or you are wondering if you sweat too much, take the self-assessment at Botox Severe Sweating Self-Assessment and share the results with your physician.

    If you have any questions, or for more information, evaluation and treatment, please feel free to ask your doctor, or call our Springfield office (413) 733-9600.

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    LIQUID NITROGEN TREATMENT

    • Liquid nitrogen is extremely cold (minus 320? F). When applied to skin, it causes rapid freezing which produces an instant and intense frostbite.
    • There is usually discomfort at the time of treatment and for a short time afterwards.  If discomfort persists, you may take Tylenol.
    • The treated site and surrounding skin may begin to swell within hours. Areas frozen on the face may result in marked swelling of the eyelids and/or cheeks.  This diminishes in several days.  Elevating the treated area above the heart and applying an ice bag for fifteen minutes every two hours for several days may reduce swelling and provide comfort.
    • You may bathe normally after treatment
    • Frequently, a blister develops which may be clear or filled with blood.  Over the next several days, the blister will gradually subside to form a crust.  If the blister persists and continues to be painful, call the office.  Do not break the blister yourself.
    • If the blister breaks and the wound is oozing, cleanse daily with hydrogen peroxide on a Q-tip or cotton ball.  Then, wash gently with soap and water, pat dry, apply Polysporin or another antibiotic ointment you have used, and cover with bandage.
    • Once a crust forms, it may take two to six weeks to fall off.
    • Several successive crusts may form before the final crust comes off.  You may apply an antibiotic ointment to soften the crust and promote healing.
    • Once the crust comes off, the underlying skin may be discolored. If so, apply a sunblock to minimize the chance of persistent discoloration. The color will usually return to normal over a period of several months.  Occasionally, loss of pigment will be permanent.
    • Do not use any cosmetics or cover-ups on the treated site until the scab has fallen off.
    • In most cases, only one treatment is necessary; however, occasionally a second treatment or re-treatment is required.  This is especially true when treating warts.

    (Reviewed 08/09)
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    PEDIATRIC DERMATOLOGY

    The Physicians at NEDLC are highly specialized and trained, board-certified, dermatologists taking care of skin, hair and nail diseases of all age groups. An integral part of training and continuing education is devoted to neonatal, pediatric and adolescent dermatology. We care for a complete range of skin diseases both common and unique to this age group including birthmarks, moles, acne, warts, eczema, skin infections, rashes and hereditary skin diseases. We are able to offer the same medical, surgical, cosmetic and laser services to this age group as we do with our adult population. One of the many advantages of a large single specialty group is that it allows us to draw upon our combined many years of clinical experience, knowledge and resources to address even the most difficult and challenging problems. We are sensitive to the special needs and concerns of our younger patients and their parents and we make every effort to treat them accordingly with the kindness, consideration, and respect they deserve.
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    SUN SAFETY

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    CHOOSING A SUNBLOCK

    • Choose a broad-spectrum sunblock (one that protects against UVA and UVB) with a SPF (Sun Protection Factor) of at least 15.
    • The SPF refers to the ability of a sunblock to prevent sunburning due to UVB exposure; it says nothing about that product’s ability to prevent suntanning from UVA exposure.  To date, there is no rating system for UVA exposure protection.  There is no product that can completely prevent suntanning.
    • A product with a SPF 30 does not give twice the protection of a SPF 15.  SPF 15 absorbs 93% of the sunburning rays, and SPF 30 has a 95% absorption.  However, both products could be equal in their ability to retard tanning depending upon their ingredients.
    • The primary UVA absorbers are the Benzophenones, Anthranilates, and Avobenzone (Parsol 1789, Helioplex, and Mexoryl).  
    • The primary UVB absorbers are PABA derivatives, Salicylates and Cinnamates. 
    • Titanium Dioxide and Zinc Oxide protect against both UVA and UVB light.
    • The ingredient of a sunblock may be more important than the SPF number.  For example, a product with a SPF 45 will be excellent in preventing sunburn (UVB) but will likely be ineffective in preventing photoaging (UVA) unless it had the appropriate UVA blocking agents.  Likewise, a product with a SPF 15 may be adequate to prevent sunburning (UVB) but could be very good in preventing photoaging if it had the appropriate UVA blocking agent.
    • Most quality sunblocks combine multiple ingredients to yield a product with excellent photoprotection against both UVA and UVB exposure.  We recommend a SPF of 30 or higher which also contain an effective UVA block such as Avobenzone, titanium dioxide and/or zinc oxide.
    • Products containing titanium and zinc are more difficult to apply because of their thicker consistency, but are generally thought to be more protective than other products.  A useful hint in using these products is to apply a small pea-sized amount to multiple different areas and rub it in well, as opposed to applying a large quantity in a single area which will be much more difficult to spread.
    • Apply sunblock at least 30-minutes before sun exposure to face and all uncovered skin including ears, neck and backs of hands.  Reapply sunblock every two hours, even on cloudy days.
    • Use a waterproof sunblock when you swim or expect to be sweating and reapply afterwards.
    • If you have dry skin, use a cream-based sunblock.
    • If you have oily and/or acne prone skin, use a gel based on a noncomedogenic sunblock.  If you become irritated or allergic to sunblock chemicals, you might try using sunblocks which are labeled “chemical free”, “sensitive skin” or for babies.  Plain white zinc oxide ointment is an excellent sunblock but is quite messy to use. 
    • Protect your lips with either a lip balm containing a broad-spectrum sunblock and/or lipstick. 
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    INDOOR TANNING--POTENTIAL HEALTH RISK

    • Tanning with a sunlamp is not safer than sunlight. There is no such thing as a healthy tan. A tan is a sign of injury: The skin's response to an overdose of ultraviolet radiation.
    • Indoor tanning beds give only a small amount of burning rays - ultraviolet B (UVB) light - but provide an intense dose of ultraviolet A (UVA) that is 2-3 times as strong as outdoor light.
    • UVA light penetrates more deeply into the skin than UVB, damaging the skin's elasticity. 
    • Thirty minutes of an indoor tanning bed is equal to a day at the beach for UVA exposure. 
    • Some medications that you may be applying to your skin or taking internally may make you extra sensitive to ultraviolet light and cause you to develop a severe burn.
    • Indoor tanning, which is primarily UVA light, can cause photoaging including wrinkles, age spots and even skin cancers.
    • The most rapidly increasing incidence of skin cancer is in young women who have been indoor tanning.
    • UVA rays have suspected links to immune system damage and to potentially deadly melanoma skin cancer.
    • If you would like to have a tan, use one of the self-tanning creams, sprays or lotions. 
    • THE AMERICAN ACADEMY OF DERMATOLOGY, AMERICAN MEDICAL ASSOCIATION, CENTERS FOR DISEASE CONTROL AND PREVENTION AND THE FOOD AND DRUG ADMINISTRATION DISCOURAGE THE COSMETIC USE OF TANNING BEDS AND SUNLAMPS. 
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    SUN EXPOSURE

    Chronic long-term sun exposure, including sun tanning, indoor tanning and sunburns, contributes to the development of skin cancer, precancerous skin lesions (Actinic Keratoses), premature skin aging, wrinkling, brown spots and cataracts of the eyes. Sunburn has been linked to the subsequent development of melanoma, the most serious and potentially deadly form of skin cancer. Here are some suggestions to minimize damage from the sun:

    SUN PROTECTION TIPS

    • Try to avoid the sun between 10 a.m. and 4 p.m. when the sun's rays are the strongest.
    • Stay in the shade whenever possible and keep infants under six months of age out of the sun.
    • Wear protective clothing:  A long-sleeved shirt, pants, wide-brimmed hat and sunglasses which block UV light.  You might inquire about specially woven UV rated clothing.
    • Apply sunblock to face, ears, neck and hands when near window glass such as driving or sitting by a window, as UVA light passes through window glass causing photoaging and skin cancer.
    • Take special precautions when the National Weather Services daily ultraviolet (UV) radiation index predicts UV exposure levels of moderate and above (5-10+) or when near surfaces that reflect the sun's rays such as water, snow and sand.  Whenever possible, stay inside or in the shade.

    SUNLIGHT

    • Natural sunlight emits ultraviolet A (UVA) and ultraviolet B (UVB) radiation.
    • UVA rays cause tanning and are primarily responsible for photoaging including wrinkling, brown spots and more.  UVA light intensity is the same throughout the day, all year round and can even penetrate through window glass. 
    • UVB rays cause sunburn and are primarily responsible for skin cancer.  UVB intensity is greatest between the hours of 10 a.m. and 4 p.m. and during the summer months.  There is some overlap between UVA and UVB in causing photoaging and skin cancer.
    • It is true that sunlight is necessary to maintain good physical and mental health, but exposure in moderation and with appropriate protection is important.
    • The sun helps the skin to produce vitamin D, which the body otherwise does not naturally produce.  However, only 20 minutes of sunlight three times weekly is necessary to fulfill that requirement.  Additionally, many foods are now fortified with calcium and vitamin D. 
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    SURGICAL ADULT & PEDIATRIC DERMATOLOGY

    Surgical removal of skin cancer, moles, warts, cysts, and other growths.
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    WARTS

    A wart is a VIRAL infection of the outermost layer of the skin. One develops warts because of a lowered resistance to the wart virus, much like one who catches a cold, because of lowered resistance to the cold virus. Ordinary warts are benign and remain benign. Children are the most likely individuals to develop warts. Adults may develop them also, but this is less likely, probably because of the development of natural immunity.

    Warts are not harmful, but they are CONTAGIOUS and can be transmitted from person to person, as well as on oneself from place to place as in picking, scratching, or shaving. They are characterized by location and shape, and may occur anywhere on the body, but are most common on the hands and feet. Plantar warts cause the most trouble. These occur on the soles of the feet. Often they are painful because of their location. They are pushed inward by the pressure of the foot against the ground. They may be spread by walking barefoot in the shower, pool, and locker rooms. Genital warts are a problem because of their mode of transmission and the number of warts that tend to develop in these areas.

    Warts usually need to be treated only when they are uncomfortable or when they interfere with function. Often, people seek removal of warts for cosmetic reasons. The method of treatment depends upon the size of the wart, the number involved, location, and the patient's age. Cryosurgery (liquid nitrogen), heat cauterization, laser, and chemical application have all been employed. Some people believe that warts can be cleared by suggestion. This is the basis of many folk cures. The mechanism of action by psychological suggestion is unknown. If cryosurgery is used, you may develop a blister around the wart. The blistered wart will dry up and form a dark crust which will fall off in several weeks. If at this time any wart remains, another treatment may be necessary.

    Most warts can be treated successfully; however, no guarantee can be made that any single treatment will be curative or prevent recurrences. Not uncommonly, several office treatments given at approximately monthly intervals will be required to achieve satisfactory results. It should always be kept in mind that common warts are benign and therefore, approaches to treatment should be conservative. Additionally, it is well known that even if left untreated, warts can disappear in two to five years on average.

    There is a great deal of research being conducted regarding warts. Perhaps one day we will have a vaccine to help promote an immune response against this very common problem.

    Immunotherapy of Warts Informed Consent
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