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Cosmetic Dermatology Dermatologists Dermal Filler Anesthesia
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Adolescent DermatologyTeen Acne Acne is a chronic inflammatory disease of the sebaceous glands and hair follicles. Each follicle contains a tiny hair and multiple sebaceous glands. Under normal circumstances, sebum, the oily substance made by the sebaceous glands, travels up the hair follicle and out to the skin's surface. However, with acne, the sticky cells form a plug, sebum is trapped within the follicle and skin bacteria multiply within the clogged pores. Acne develops on those areas of the skin where sebaceous glands are most numerous: the face, scalp, neck, chest, back, and upper arms and shoulders. Acne typically begins in adolescence, although onset in the twenties or thirties is common.Hidradenitis suppurativa is a subset of acne that produces acne-like cysts of apocrine glands in the underarms and groin. This can be successfully treated by Hughes Dermatology. See Treatment options for Teen Acne Hughes Dermatology is a participant in the new cumbersome FDA iPledge program for isotretinoin (Accutane) prescribing. This is a new (March 1, 2006) mandated risk-management program for isotretinoin prescribing. Adolescent Mole ManagementIf a mole is abnormal according to the ABCD rule, it should be examined by Dr. Hughes or Dr. Tichy with a dermatoscope. If it is irregular under the dermatoscope, it should be biopsied. Malignant melanoma can occur in adolescence. Usually this biopsy can be done via a cosmetically elegant shave biopsy right at the time of the initial visit. Hughes Dermatology recommends annual whole body skin cancer checks in order to identify a malignant melanoma at an early and curable stage. If a mole is malignant Warts and Molluscum ContagiosumWarts are contagious benign tumors that involve the skin, oral mucosa, genital anal areas. The etiologic agent is a double-stranded DNA virus called human papillomavirus. Warts are generally classified by their clinical features and morphology (e.g., common, flat, filiform) or by location (e.g., genital, plantar, respiratory papillomatosis). Molluscum contagiosum is another common DNA virus-induced contagious tumor. Scar ManagementAcne scars can be improved by medical or surgical methods. Topical Retin A products and chemical peels slowly produce some scar remodeling. Box car scars can be "resurfaced" with the erbium:YAG laser. Recently, scar improvement has been documented with laser rejuvenation using our long-pulsed Nd:YAG laser. We are pleased that our patients with shallow facial acne scars have seen nice improvement with this long-pulsed Nd:YAG laser rejuvenation. This consists of a series of no-downtime treatments that slowly "plump up" the skin by causing collagen and ground substance production. Depressed scars can be filled with autologous fat (fat transfer) or dermal fillers such as Restylane. Hughes Dermatology is experienced with all these modalities.
The picture on the left demonstrates acne scarring treatment using Erbium: YAG laser resurfacing. The picture on the right was taken 10 weeks after laser treatment.
Acne scarring before (left) and after (right) laser rejuvenation with the long-pulsed Nd:YAG laser. A new study, published in the August 2005 Dermatologic Surgery journal, demonstrated 28% objective acne scar improvement with this nonablative "laser rejuvenation" (using our same Lyra-i laser), a nice result! The patients themselves evaluated the improvement at 37%. An important critical dermasurgical fact is that surgical, traumatic or dog bite scars of the face should be resurfaced 4 to 6 weeks after they occur! Don't wait longer. With the Er:YAG laser, they can often be practically "erased" if resurfaced early. Once hypertrophic scars or keloids develop, treatment is more difficult but still helpful. These latter scars are treated with the pulsed dye laser in conjunction with intralesional steroids or 5-FU. New: It was recently discovered that keloids can be excised and then the site treated with imiquimod cream topically for 3 months to prevent recurrence. Hughes Dermatology has had success with this new method.
Stretch MarksNew red stretch marks (striae rubra) can be successfuly reduced or nearly eradicated with early 585nm pulsed dye or Nd:YAG laser treatment in conjunction with topical retinoid applications. Older white stretch marks (striae alba) are more difficult, but they can be improved as well.
Hyperhidrosis Hyperhidrisis is excessive sweating, usually of the palms and underarms. This is an inherited condition. Although it usually responds to topical prescription medication, this embarrasing malady can now be successfully treated with Botox injections if the first-line treatment fails! The good news is the results are fairly longlasting, sometimes for one year. Using topical cream anesthesia and our Zimmer Cryo 5 cold air anesthesia machine, these palm and underarm injections are made comfortable at Hughes Dermatology. (Some other offices use nerve block injections in the wrists for anesthesia which are uncomfortable and can produce serious side effects.) Surgical procedures, especially sympathectomy, should be considered only as a very last resort, because of operative risks and the development of excessive sweating elsewhere (compensatory hyperhidrosis).In October 2007, Dr. Hughes will appear as a medical expert in a British documentary on hyperhidrosis. Stay tuned! Please make an appointment with Dr. Hughes or Dr. Tichy for evaluation and treatment. |
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(a malignant melanoma is shown here), prompt surgical excision is done in our office surgery suite. New: Topical immune modulators (imiquimod) are used at the cancer site for 3 months post surgery to eliminate any cells that may have been left behind.
