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What is a Dermatologist?

 

A Dermatologist is an M.D. (Medical Doctor) who is specially trained to diagnose and treat conditions of the skin, the hair, and the nails. Dermatologists are physicians who complete a four-years college degree, then four years of medical school, then at least a one year internship, then a three-years residency in Dermatology.

What do Dermatologists treat?

Dermatologists treat skin conditions both with medicines (Medical Dermatology) and with surgery (Procedural Dermatology). There are over 300 different skin diseases, the most common of which are acne, eczema (atopic dermatitis), psoriasis, and growths of the skin – including different types of moles, precancerous skin growths (solar keratoses), and skin cancers, including basal cell skin cancer, squamous cell skin cancer, and melanoma.

 

When should I see a Dermatologist?

Dermatologists generally work as part of your healthcare team, seeing some patients directly and some patients by referral from their primary care physicians. Depending upon your situation, our Dermatologist at Rheumatology and Dermatology – Dr. George Woodbury – can offer an outline of treatment recommendations to you and your primary care doctor – or he can simply give you a set of treatment options to get your care started right away. Be sure to bring results of any lab tests that have been done to your appointment, to speed up getting your condition diagnosed.

 common conditions faq

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How is my skin affected by sun exposure?

Both UVA and UVB rays are dangerous to the skin and can cause skin cancer, including melanoma. Blistering sunburns in early childhood increase risk, but cumulative exposure is another factor.  Skin cancer is more prevalent in regions with increased sunlight

Should I avoid tanning beds and booths?

Both tanning beds and booths should be avoided. They raise your exposure to UV rays, increasing the risk of developing melanoma and other skin cancers.

What is Cryotherapy?

Cryotherapy is application of very cold liquid nitrogen to a skin lesion or lesions to cause them to blister, allowing the skin to heal. Cryotherapy is a very helpful treatment when the underlieing diagnosis of the skin condition is clear. If that diagnosis is possibly in question, we often go into doing what’s called a skin biopsy, whereby a skin lesion is removed completely or partially to have it analyzed by the dermatopathology laboratory. Skin biopsy results often take less than a week, but the turn-around time can be longer if special tests have to be done.

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What is Acne?

Acne: acne is a type of sensitive skin condition due to a clogging of the openings of the oil glands (the pores) to the surface of the skin. Acne is divided into:

1.comedonal acne – which is blackheads and whiteheads;

2.papulopustular acne – which involves raised bumps and pus-filled pockets called pustules;

3.nodulocystic acne – with larger bumps that can leave scars.

Accutane

The care path that applies to you depends upon which type of acne you have, from use of topical medicines (medicines which you use “on top of” your skin) to oral antibiotic pills, to courses of oral pills – spironolactone or isotretinoin (Accutane).

Dermatologists often craft care plans for acne from one or more of five categories of topical medicines, including benzoyl peroxide gels and washes, salicylic acid, retinoids (Retin A®, Adapalene or Differin®, Tazarotene Gel or Cream, Azelaic Acid (Azelex®) or Finacea®, or Aczone® Gel (Dapsone Gel).

For the more severe papulopustular acne, possible treatment options may include oral antibiotics, such as oral doxycycline, oral sarecycline (Seysara), oral erythromycin, and oral Trimethoprim-sulfa.

More severe cases of acne – or recurrent cases – which tend to keep coming back after completing courses of oral antibiotics – may be treated with oral spironolactone tablets – or an oral drug called isotretinoin (Accutane) – but isotretinoin must be avoided in women who may become pregnant during the five to six months’ treatment with isotretinoin – because major birth defects can occur. Isotretinoin however is very helpful, because it is one of the few options that can put acne into remission, meaning the patient can often come off of the treatment, and stay clear or almost clear for some months to several years.

Many Dermatologists practice what’s called Integrative Dermatology – meaning that they pull from traditional prescription therapy options to over-the-counter medicines. Our Dermatologist at Rheumatology and Dermatology – Dr. George Woodbury - has a special interest in what could be called “Organic or Natural” cleansers and moisturizers for his acne patients – compounded through Big River Silk Skincare (www.Bigriversilkskincare.com), including AmberSoy Soap Gel and GlycoShea Facial&Neck Cream.

Young man applying hand cream iStock-637
 

What is an “allergen” in relation to dermatology?

As dealt with in dermatology, allergens are chemicals that cause allergic reactions when they make contact with skin. There are over 2300 chemicals that one can become allergic to in the skin, including preservatives, fragrances, components of latex, dyes, metals, and components of latex. Many of these are chemicals that we come into contact with on a daily basis, and identifying which chemical you may be reacting to can help you to effectively manage your skin condition, by avoiding that chemical. Our Dermatologist at Rheumatology and Dermatology offers Extended Allergy Patch Testing, testing for over 80 chemicals that people can react to. This type of testing is to be distinguished from prick testing or RAST® testing, which is offered by allergists and which is more applicable to molds, danders, and mildews that can affect one’s sinuses or respiratory system.

How are Contact Allergens detected? 

We perform Allergy Patch Testing.  This determines the cause of the allergic rash by placing ointments containing common causes of these rashes on your skin. In about 70% of patients tested, we can find a relevant item that the patient is allergic to. The patient can then avoid the allergen(s).    

Allergy Patch Testing

Allergy patch testing generally involves coming to the office three times, often on a Monday, Wednesday, and Friday basis, during which time the Patch Testing is placed upon the patient’s back, in the form of different ointments under patches. Our Dermatologist at Rheumatology and Dermatology, Dr. George Woodbury, is a member of the American Contact Dermatitis Society, so he has access to the nation-wide cosmetics and toiletries database – called CAMP – for “Contact Allergen Management Program”– which tracks what chemicals are in the thousands of products that we come into contact with on a daily basis. So once a patient completes allergy patch testing – we can run a CAMP search to try to identify cosmetics and toiletries that are free of the culprit chemicals.   

Birthmark

What is Eczema?

(Atopic Dermatitis): eczema or atopic dermatitis is a type of genetically sensitive skin condition that runs in families along with asthma, hay fever, and food allergies. About 6-10% of Americans suffer from Eczema, which can develop in either childhood or adulthood, with scaly, often dry and itchy areas of the arms, the legs, the body, and the face and/or scalp. Our Dermatologist at Rheumatology and Dermatology, Dr. George Woodbury, is a member of the National Eczema Association, so he pulls treatment options from both prescriptions (often topical medicines – because they’re placed “on top of” the skin) and from holistic or natural therapy. Since March 28th, 2017, we have had the option of an injectable medication for Eczema called Dupixent® (dupilumab), for people aged six years and older who have eczema that is not well-controlled with topical medicines.

What is Atopic Dermatitis?

Atopic Dermatitis is the most common of many types of eczema that usually occur in people who have an “atopic tendency,” or a predisposition to develop any or all of three closely linked conditions: atopic dermatitis, asthma and hay fever. It is a chronic disease which leads to intense pruritus, lichenfication and other skin features such as papules and ichthyosis. The condition seems to result from a combination of genetic (hereditary) and environmental factors.

What is Seborrheic Dermatitis?

Seborrheic dermatitis is a type of sensitive skin condition (a type of eczema) that tends to occur in the scalp or on the face, with frequently itchy, dry, flaky areas that can contribute to hair loss or alopecia. Seborrheic dermatitis is often managed with prescription topical shampoos and/or lotions or solutions. If we want to better soft our the cause of the condition, we sometimes take a skin specimen to be sent off to the Dermatopathology Laboratory, called a biopsy, and we sometimes perform skin allergy patch testing to try to identify trigger chemicals that may be contributing to the itching.

 
Milk Bath
 

What is Psoriasis?

Psoriasis is a type of sensitive skin condition that can develop either in childhood or adulthood that tends to occur on the arms, legs, body, and scalp. Lesions can be itchy or simply dry and scaly, and they often respond to treatment with topical steroids. Our Dermatologist at Rheumatology and Dermatology, Dr. George Woodbury, is a member of the National Psoriasis Foundation, and he often uses a combination of topical steroid medications to treatment psoriasis, sometimes with injectable steroids, and sometimes with courses of oral or injectable medicines, such as methotrexate, azathioprine, or one of the biologic therapies, such as Enbrel®, Humira®, Stelara®, Cosentyx®, Ilumya,® Taltz®, Otezla®, or Remicade®.

Woman with Hand on Face
 

What is Rosacea?

Rosacea: rosacea, sometimes also called acne rosacea, is a type of sensitive skin condition that tends to occur in certain families, with red bumpy areas of the face and/or neck which can develop in childhood or adulthood. Some cases of rosacea can be labelled “Perioral Dermatitis,” which is an overlap of rosacea and sensitive skin (a type of eczema). Care plans can involve topical and/or oral antibiotics, sometimes with a new topical medication for the flushing that can occur with rosacea, called Mirvaso® Topical Gel. We sometimes consider a new topical anti-mite medication called Soolantra® (Ivermectin) Topical Cream.

Female Model
 

What is Skin Cancer?

skin cancer is a serious public health problem in the United States, with the number of cases continuing to climb, now affecting up to several million Americans each year. Our Dermatologist at Rheumatology and Dermatology, Dr. George Woodbury, is a member of both the American Society for Dermatologic Surgery, the Skin Cancer Foundation, and the American Society for Mohs Surgery. The most common types of skin cancer are basal cell skin cancer, squamous cell skin cancer, and melanoma, and these contribute to one American death every 26 minutes or so, but they are very treatable and manageable if caught early.

 

The first step in management is often taking a specimen of skin under local anesthetic to be sent off to the Dermatopathology Laboratory, for a skin biopsy. If the person has a skin cancer, the lesion is often removed under local anesthetic with a margin of normal skin around it, to allow the site to heal. If the lesion is a basal cell skin cancer of a squamous cell skin cancer on the face, neck, scalp, hands, feet, or genital area, or if the skin cancer is recurrent (meaning that it’s grown back after prior treatment), or if it is a high-risk sub-type of skin cancer, at Rheumatology and Dermatology we often schedule what’s called Mohs Surgery, otherwise known as Micrographic Surgery, whereby the specimen can be processed through our in-office Mohs Laboratory to check the margins, prior to sending the patient home. This tends to allow a better long-term cure rate from the skin cancer, and it also allows us to remove smaller areas of skin, hopefully leaving less scarring.

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