State-of-the-Art Medical/Surgical Dermatology with a Personal Touch

Onsite Dermatopathology Services

NEW! Excimer Laser for Psoriasis

Rid yourself of dry, itchy and unsightly psoriasis lesions with our new Excimer Laser. This fast, effective treatment delivers a carefully focused beam of laser light to targeted areas in only a few minutes. No anesthesia is required. If you have mild to moderate psoriasis and are unhappy with your current treatment, consider Excimer Laser for fast, effective relief.

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Acne

Acne is the term for the blocked pores, pimples, and deeper lumps that appear typically on the face, neck, chest, back, shoulders, and upper arms. Acne is the most common skin disease in the country. While it affects mostly teenagers, adults of any age can have acne. The causes of acne are multifactorial and include inheritance, hormonal influences, skin care products, and stress. Acne is not life-threatening but it can cause physical disfigurement (scarring) and emotional distress.

Treatment for acne varies depending on the type and severity of lesions, as well as the patient's age, skin type, and lifestyle. Medical treatment options include topical medications, antibiotics, oral isotretinoin (Accutane), and individualized skin care regimens. Alternative treatments also exist and there are a variety of cosmetic treatments for acne scarring.

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Allergic Rashes and Reactions

Allergic rashes may be triggered by an externally applied or contacted agent known as an allergen. After repeated exposure to an allergen, a susceptible individual may develop a skin rash that looks red, itches, blisters, and even gets wet and weepy. Avoidance of the trigger allergen can often relieve the rash completely. Patch testing is a special type of allergy testing done by dermatologists that may determine what the offending agent is.

Other allergic reactions that present in the skin may be induced by food, medication or other substances taken into the body. Diagnosing these recurrent rashes may be challenging and testing including skin biopsies and bloodwork may be helpful. Our dermatologists will work with your primary care doctor and any other consultants to treat these reactions and prevent them in the future.

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Eczema/Dermatitis

Eczema, which is also called dermatitis, is a term used to describe a group of inflamed, itchy skin conditions that typically present as dry, red, swollen areas on various parts of the body. About 15 million people in the United States suffer from some form of eczema including 10-20 percent of infants. There is no single cause for eczema but it is felt to be related to an overactive immune system in the presence of trigger factors, many times in individuals susceptible to other allergic tendencies including asthma, allergic rhinitis, environmental allergies, and food allergies.

The most critical step in treating eczema is controlling the itch and preventing scratching. Moisturizing creams and lotions, compresses, and nonprescription corticosteroid creams and ointments can be helpful. For more severe cases, physicians can prescribe stronger corticosteroid creams and ointments, nonsteroidal creams and ointments, antibiotics to treat infections, or antihistamines. Phototherapy can help reduce the itch and rash, and tar treatments may be helpful though messy. For the most severe cases, oral medications are available. The mainstay of any treatment plan is a basic skin care routine consisting of reinforcing the skin's barrier function and minimizing itch.

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Moles and Birthmarks

Moles and other birthmarks are benign pigmented spots or patches of skin that range in color from tan, brown, and black (moles) to pink, red, or purple (lesions consisting of blood vessels). Though most birthmarks are harmless, they may develop into skin cancer. Moles exhibiting any of the following warning signs should be examined by a doctor.

Suspicious characteristics include the ABCDE's of melanoma. The A is for asymmetry, B is for border irregularities, C is for color discrepancies, D is for a diameter greater than 6mm (1/4 inch or the size of a pencil eraser head), and E is for evolution or change. Suggestions for other moles that should be evaluated include any that itch or bleed, rapidly change, or are located where they cannot be monitored (eg. scalp).

Suspicious moles and birthmarks may be removed surgically (biopsied) and sent for microscopic examination and diagnosis.

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Malignant Melanoma

Malignant melanoma is a potentially life-threatening skin cancer derived from pigment cells. Melanoma has a higher fatality rate than basal cell carcinoma and squamous cell carcinoma. It accounts for more than 80 percent of all deaths from skin cancer. The causes are not yet known. Suspected risk factors include a family history of melanoma, numerous moles or atypical moles, overexposure to ultraviolet light, fair skin, and previous history of melanoma.

Any moles exhibiting ABCDE's of malignant melanoma (see Moles and Birthmarks above) should be evaluated by a physician. A biopsy is performed to confirm the diagnosis. Treatment is based on the tumor's location, thickness, and progression as well as the patient's age, health, medical history, and preferences.

Early detection and treatment greatly increase the likelihood of total cure. Self-examination in front of a mirror is the best way to find melanoma early.

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Non-Melanoma Skin Cancer

Skin cancer refers to the abnormal, uncontrolled growth of skin cells. One in five people will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Risk factors include fair skin, family history of melanoma, being over 40 years old, and regular sun exposure. Fortunately, non-melanoma skin cancer is almost always curable if detected and treated early.

The most common skin cancers are basal cell carcinoma and squamous cell carcinoma. Basal cell carcinoma accounts for 80-85 percent of all skin cancers. Squamous cell carcinoma accounts for about 10 percent of all skin cancers.

Skin cancers vary in shape, color, size, and texture so any new, changed, or non-healing growth you are suspicious of should be examined by a physician. Early intervention is essential to preventing the cancer from progressing. For patients who have had skin cancer in the past, routine skin cancer screenings by a dermatologist are advised. For more information about skin cancer, see Melanoma above.

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Pre-Cancerous Skin Lesions

Pre-cancerous skin lesions are called actinic keratoses. People who are fair-skinned and have spent extensive time in the sun are susceptible to these lesions. They typically occur on sun-exposed areas of the skin including the head, ears, scalp, forearms, and hands. Risk factors are genetics and skin type. These lesions are very slow to develop and are therefore more commonly found in older individuals.

Actinic keratoses are treated in order to prevent progression to a type of skin cancer called squamous cell carcinoma. It is felt that nearly 40 percent of squamous cell carcinomas begin as actinic keratoses. There are various methods for treating these lesions including surgery, cryosurgery with liquid nitrogen (freezing), electrodessication, topical medications, photodynamic therapy, chemical peels, among others. Sun safety measures including avoidance are successful in preventing these skin cancer precursors.

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Psoriasis

Psoriasis is a red, scaly, skin rash that generally appears in the teen to adult years though there are cases of childhood psoriasis. Many cases of psoriasis are familial. Some are triggered by infection or incited by certain medications.

Psoriasis may be mild, moderate, or severe. Though there is no cure for psoriasis, many therapies exist. The most common treatments are topical medications, phototherapy, and oral or injectable medications reserved for more severe cases.

The treatment of psoriasis and its associated arthritis is an active area of research within dermatology. New therapies are in the pipeline of research and development, and therefore on the clinical horizon.

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Rashes

A rash is a change in the skin's color or texture. Simple rashes are called dermatitis, which means the skin is inflamed, swollen, and usually itchy. Common rashes include psoriasis, impetigo, shingles, chicken pox, other viral rashes, reactions to medications, insect bites, and those caused by medical conditions such a lupus or rheumatoid arthritis.

There are numerous other conditions that fit into this category and a dermatologist is able to make a diagnosis and determine appropriate treatment by looking at you and asking questions about accompanying symptoms. Some rashes require further testing such as tissue examination by scraping or biopsy or through laboratory evaluation such as bloodwork.

Mild rashes can often be treated with simple skin care and over-the counter remedies. Others may require prescription medications and more extensive treatment.

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Skin Cancer Screening

As members of the American Academy of Dermatology, the physicians at South Shore Dermatology Physicians encourage their patients to disrobe and have a full skin examination. New patients are strongly urged to take advantage of this opportunity. Any patient, at any visit, may benefit from a skin cancer screening. During this examination, the doctors will scan and evaluate the skin for any suspicious birthmarks, moles or growths. It is prudent for the patient to point out any areas of concern while the examination is taking place. This way, questions may be addressed in a timely fashion. Many times lesions that have not been noted by the patients themselves can be detected and treated early.

Our dermatologists have participated in the American Academy of Dermatology's voluntary free nationwide skin cancer screenings on a yearly basis. These events occur mostly in the spring at local hospitals in the surrounding communities. These screenings are not meant to take the place of a skin examination performed by a physician in the office setting as they provide a rapid screening.

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Skin Infections

Infections of the skin and associated tissues may be caused by bacteria, fungus, viruses, or yeast. They generally occur through an area where there is a change or break in the normal skin environment though there are other ways to contract these infections.

Bacterial infections at the surface of the skin are known as impetigo. These are most commonly due to overgrowth of the streptococcal or staphylococcal species of bacteria. When a skin infection goes deeper than the surface, it may be known as cellulitis.

Any bacterial skin infection can cause redness, itching or pain, swelling, warmth, fevers or chills, fatigue or muscle aches. Bacterial infections can vary in their presenting signs and symptoms as well as severity. Antibiotics are used to treat these infections. Depending on the extent of skin involvement, topical, oral, and sometimes intravenous antibiotics may be prescribed.

Fungal and yeast infections are caused by microscopic organisms that live on the hair, nails, mouth, and outer skin layers. They can be quite common. Organism overgrowth usually takes place in warm, moist, skin fold settings or where there may be a break in the skin. These infections are treatable but may also recur in predisposed individuals. Treatments include topical and oral antifungal agents.

Viral infections of the skin are very varied and therefore this is not an exhaustive list. They may be self-limited such as the common childhood eruption molluscum contagiosum. These lesions tend to stay in localized clusters and often disappear without treatment. Herpes viruses can cause troubling recurrent groups of painful, sore, or itchy blisters around the mouth or genital area.

Chicken pox (varicella) and shingles (herpes zoster) are also part of the group of viral infections. Viral exanthems are generalized rashes associated with a viral infection elsewhere in the body such as an upper respiratory infection or gastrointestinal infection. When appropriate, antiviral treatment is prescribed. Many times, the symptoms are treated to give patients relief while the skin is healing.

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Sun Damage

Sun damage is a term used by dermatologists to describe visible skin changes caused by ultraviolet light exposure. Ultraviolet light can come from the sun, tanning lamps, or tanning beds. It is known that exposure to ultraviolet light in any of these forms can lead to development of skin cancers and suppression of the immune system. Non-cancerous changes induced by exposure include thickened, discolored, leathery textured skin appearance. The sun is responsible for many signs of premature aging and wrinkles. The best defense against photoaging of the skin is sun avoidance, sunblock and sunscreen use 30 minutes before planned exposure. Use sunscreen with an SPF 30 or higher and reapply every couple of hours. In addition, wear protective clothing, UV protective sunglasses, and a wide-brimmed hat to minimize exposure when outdoors. Routine skin self-examinations also are recommended to catch problems early.

Fortunately in this era when a youthful appearance is highly sought after, dermatologic medical and aesthetic advances strive to correct sun damage and reverse the signs of aging. This field is a busy area for research and development with many therapeutics and devices in the pipeline.

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Warts

Warts are benign skin growths caused by human papilloma virus. Warts occur most commonly in children. Most will heal spontaneously over an unpredictable period of time (months to years).

Treatments for warts range from over-the-counter salicylic acid preparations (drops, gels, pads, bandages) and freezing applications to in-office procedures utilizing liquid nitrogen, electrosurgery, application of topical acids, and rarely excision. In some cases, a prescription cream called imiquimod can be used. Wart treatment can be less than satisfactory and recurrences are common.

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Dermatopathology Services

Dermatopathology is the microscopic interpretation of skin biopsy and excision specimens to aid in the diagnosis of skin disorders including skin cancers, inflammatory skin disorders, soft tissue tumors, cutaneous lymphoma, and metastatic tumors.

South Shore Dermatology Physicians’ onsite interpretation of skin biopsy and excision specimens allows Board certified experts in dermatopathology and dermatology to work side-by-side to obtain accurate diagnoses and provide appropriate follow-up treatments.

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