Medical Dermatologic Services
Bracciano Dermatology specializes in the treatment of many medical dermatologic conditions. Dr. Bracciano is always up to date on cutting edge advances for various dermatologic conditions.
A full body skin check or surveillance is important and necessary to conduct in order to ensure that nothing abnormal is present on your skin. Atypical moles, melanomas, skin cancers, and other malignant growths can be detected with a general body check. If a growth or lesion is found to be visually suspicious, then a quick biopsy is taken to diagnose the nature of that growth. If the lesion is found to be pre-malignant or malignant, different treatments are utilized depending on the type of growth. The most important preventative measure for skin cancers, sun damage, and premature wrinkling and aging of the skin is to wear sunscreen daily.
WARNING SIGNS OF ABNORMAL MOLES (the ABCDE’s of what to look for)
Asymmetry – Normally a mole should be symmetric but if the shape is lopsided, not symmetric, that is one of the warning signs.
Border Irregularity – A mole should have nice, crisp, sharp borders. If a mole has fuzzy, indistinct, jagged, irregular borders, this is a warning sign.
Color Variation – A mole ideally should have only one color (black, brown, tan,). However, if a mole is two-toned or has multiple colors, looks like a fried egg with a dark center, has a white halo around it, this is something to watch out for.
Diameter – If a mole is greater than 6 mm (about the diameter of the tip of pencil eraser), this is a warning sign.
Evolution – If there is a change in the appearance, size, shape, or color of a mole, for example a sudden elevation of a mole or a change in color of a mole, this may be a warning sign.
Finally, if a person has an abundant number of moles, any mole that stands out or jumps out visually, looks different whether it is darker, larger, more irregular compared to the rest of the moles is a warning sign. A mole that has a hair growing out of it usually means that is was present since birth or at a young age and is typically normal. If a mole is found to be abnormal by biopsy, it is excised out surgically under local anesthesia.
The only way to detect a melanoma is through a biopsy of the lesion. If a mole has any of the ABCDE’s that is more extreme than usual, the possibility of a melanoma needs to be excluded. Often times a relative such as a parent or sibling may have a history of melanoma or atypical moles and so a family history is a risk factor for melanoma.
Melanomas are treated with surgical excision, possible exploration of lymph nodes, and in more severe cases, with chemotherapy or immunotherapy. In addition, a chest x-ray and blood test to check for liver enzyme elevations is performed upon diagnosis of a melanoma. Once a diagnosis of melanoma is established, full body checks must be performed every 3 months for at least a year.
Skin Cancers & Pre-Cancerous Lesions
The most common cause of skin cancer is due to excessive sun exposure. Skin cancers do not occur immediately but start to develop 10 – 30 years later after chronic sun exposure. Typically, they become evident after the age of 40 but may occur in the 20’s and 30’s. Skin cancers and pre-cancerous lesions typically are present on sun exposed body areas such as the face, scalp, arms, chest, upper back, and lower legs, but can occur in any location. Some signs of skin cancers are a rough, red lesion that can be flat or raised, a growth that bleeds and does not want to heal, or a growth that is pink and has a pearly appearance to it.
Actinic keratoses are precancerous lesions that are rough and pink and treated by freezing with liquid nitrogen. Actinic keratoses need to be treated because they can become skin cancers if left untreated. Basal cell carcinomas and squamous cell carcinomas are common skin cancers. They rarely spread but if left untreated, can continue to grow and invade on the skin. These kinds of skin cancers are treated by surgical excision or Mohs micrographic surgery which are performed under local anesthesia.
Acne is a condition that affects anyone at all ages – teenagers and adults alike. Causes of acne include excessive oil production which results in clogged pores and the proliferation of bacteria that can results in cysts. Severe acne can result in scarring that may produce lifelong social embarrassment. Females with acne may have hormonal imbalances that contribute to acne formation.
Therapies for acne include topical retinoid creams such as Retin-A®, Differin®, or Tazorac®. Topical antibiotic creams containing clindamycin, benzoyl peroxide, erythromycin, and sodium sulfacetamide are effective in treating acne. For more moderate cases of acne, an oral antibiotic such as minocycline or doxycycline is valuable in treating inflammatory acne. For more severe cases of acne that can result in scarring, Accutane is taken for around 6 months to virtually eliminate the acne with a low chance of recurrence. Accutane does require monthly blood testing and females of childbearing potential must be on birth control because Accutane causes birth deformities. Finally, different lasers (pulsed-dye) and light sources (blue light) are effective in treating acne and are an exciting new trend in treating acne.
Rosacea is a medical condition is which persistent redness and the development of telangiectasias (broken capillaries) appear on the cheeks, forehead, nose, and chin. Rosacea is most common in fair-skinned individuals and has varying degrees of severity ranging from only redness and telangiectasias of different intensities, to the appearance of acne-like cysts, red bumps, and pustules, and in more extreme cases, the enlargement of the nose (rhinophyma).
Rosacea is managed in several ways. Topical creams such as metronidazole (Metrogel®, Noritate®), azelaic acid (Finacea®), and various sodium sulfacetamide products are commonly used. For more inflammatory rosacea, topical antibiotics such as doxycycline or minocycline are prescribed. A very common and effective treatment modality for rosacea is the pulsed dye laser. The pulsed dye laser is effective in decreasing the redness and telangiectasias seen in rosacea as well reducing the inflammatory cysts and pustules.
Psoriasis is a common skin disorder affecting approximately 7 million Americans. People afflicted with psoriasis often have scaly, red, itchy, thickened plaques on their elbows, knees, scalp, trunk, extremities, and other body areas. Up to a third of patients report someone on their family having psoriasis. In addition, approximately 30% of patients with psoriasis develop psoriatic arthritis which commonly affects the fingers, toes, spine, and other joints. Although psoriasis usually is not life threatening, this disease severely impacts the quality of one’s life in terms of job performance, schooling, and relationships.
People with psoriasis are embarrassed with their condition and are often socially isolated and depressed. For this reason, it is important that patients with psoriasis seek medical attention. Although there is no permanent cure for psoriasis, there are effective treatment modalities. These include topical creams such as hydrocortisone, Dovonex®, and Tazorac®. Oral agents such as methotrexate, cyclosporine, and Soriatane® are effective in treating psoriasis. Finally, newer agents called biologic agents are very safe and effective to treat psoriatic disease. These are injections comprised of monoclonal antibodies and fusion proteins. We use the latest biologic agents to treat psoriasis and psoriatic arthritis including Enbrel® and Humira®.
Eczema & Seborrheic Dermatitis
Eczema is a skin condition which may be present since childhood (atopic dermatitis). Eczema typically is a scaly, itchy, red rash that occurs on any body area. Atopic dermatitis frequently is present in front of the elbows, behind the knees, and on the face and may or may not be associated with asthma. Eczema and atopic dermatitis are treated with moisturizers, topical anti-inflammatory creams such as prescription strength hydrocortisone and non-hydrocortisone creams, and oral and topical antihistamines. Eczema and atopic dermatitis tend to recur when the weather gets too dry or if a certain allergen triggers the condition. Seborrheic dermatitis is simply dandruff of the scalp and the skin.
Seborrheic dermatitis of the scalp is treated with medicated shampoos (prescription or non-prescription strength) and for more moderate flaking and itching, cortisone based foams and solutions are used. Seborrheic dermatitis of the face typically affects the “T-zone” (eyebrows and around the nose) and the ears. Redness and flaking are common symptoms. Hydrocortisone and non-hydrocortisone creams are effective in controlling seborrheic dermatitis.
Other Dermatologic Conditions
Warts – these are caused by the human papilloma virus (HPV) and transmitted from skin to skin contact. Typically affected areas are the soles, hands, face, genital areas, and other body areas. Common treatment modalities for warts are freezing with liquid nitrogen, and the application of various topical agents such as salicylic acid, Aldara®, and tape.
Hair Loss – Male pattern hair loss is treated with Rogaine® and/or Propecia®. Female hair loss can be associated with a hormonal imbalance and may be correctable with hormonal agents. Both physical and mental stress can contribute to a temporary hair loss condition called telogen effluvium. Alopecia areata is a condition whereby there is abrupt patch of hair loss on various areas of the scalp. Sometimes, alopecia areata can occur on other body surface areas such as the eyebrows, eyelashes, beard area, but rarely the whole body. Alopecia areata in most instances is mild and is a common skin disorder which is typically treated with cortisone injections at the site of the hair loss and with topical agents. For more aggressive forms of alopecia areata, systemic agents and topical chemical formulations may need to be used.
Nail Disorders – Fungus of the nails (onychomycosis) often associated with athelete’s foot is treatable with oral agents (Lamisil®, Sporanox®) and topical agents. Biotin, a naturally occurring vitamin, is beneficial for strengthening brittle nails.
Vitiligo – Vitiligo is an autoimmune disease whereby the pigment in the skin is destroyed by the body’s own immune system leading to the development of white patches on the body, typically in a symmetric pattern. Vitiligo can be a devastating condition emotionally and may be associated with a thyroid disorder, diabetes, anemia, or Addison’s disease. Vitiligo is treated with topical anti-inflammatory creams (cortisone and non-cortisone based).