Last week this 22 year old girl visited our office for a rash she has had on her neck and chest for over 15 years. The rash did not bother her and had not changed from the time it first occurred. An area of the rash was biopsied and the biopsy results confirmed her condition to be syringomas.

Syringomas on the lower eye lid

Syringomas are harmless sweat duct tumors. They are skin colored or yellowish firm rounded bumps typically found clustered on eyelids but they may also arise elsewhere on the face, in the armpits, abdomen, upper chest and vulva. They can start to appear in adolescence and are more common in women than men. While Syringomas are not dangerous they usually do not go away on their own.

Although there is no perfect technology to remove the growths, there are treatment options that can make some improvement to the lesions. Laser treatment is an option, however pinpoint electrocautery may offer the best combination of results and healing. Prior to treatment the area is numbed with either topical lidocaine or an injection of lidocaine. Electrocautery involves the passage of an electrical current from a small metal tip to the syringoma effectively burning the lesion. After the treatment the areas become a little swollen and the syringoma may develop a scab for 5-7 days. Most patients have minimal social downtime and excellent healing. The lesions usually either clear up or shrink in size. If the syringomas are resistant to laser or electrocautery treatment your provider may consider excising them aka cutting them out. They may choose to cut out a large area that contains many syringomas or will use a small scalpel to cut and take out the syringoma one by one.

Our patient in the photo above had a condition called Generalized Eruptive Syringoma, a rare clinical presentation where many syringomas appear abruptly. It presents as groupings of small flesh-colored papules very suddenly and generally occurs in the peripubertal period.

This entry was posted on Monday, June 18th, 2012 at 2:12 pm and is filed under Skin Conditions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Check out my most recent episodes on The Doctor’s Show. Learn more about removing a “fanny pack” with Tickle Lipo, treating age spots, treating an aggressive form of acne and The Scar Treatment Trifecta.

Removing the “fanny pack” with Tickle Lipo

Age Spot Treatments

Treating Aggressive Acne

The Scar Treatment Trifecta

This entry was posted on Wednesday, May 30th, 2012 at 9:36 am and is filed under Acne, Cosmetic Procedures, Cosmetic Surgery, Skin Care, Video. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

This is grisly so you may not want to read it.

On Saturday, just off Miami’s MacArthur Causeway, Larry Vega was cycling along when saw a naked man eating another naked man’s face. Vega stopped and told him to get off the victim but “the other guy just kept eating the other guy away.” Vega spotted a Miami Police office nearby and waved him over to the scene.

The officer ordered the man to stop, but, Vega said, “The guy just stood, his head up like that with pieces of flesh in his mouth. And he growled.” The officer fired once, but the man showed no signs of stopping and the officer eventually killed him. The victim, miraculously, is alive but in critical condition.

Miami police officer Armando Aguilar told NBC 6: “Seventy-five to 80 percent of his face was missing, and he was actually swallowing pieces of the man’s face.”

The cannibal has been identified as 31-year-old Rudy Eugene, 31 is suspected to have been high on a drug known as “bath salts.” The dangerous drug, which is banned in many states, but so far has no specific federal ban, is available on the street and also at many tobacco and drug paraphernalia shops under names like Vanilla Sky, Ivory Wave, White China, Dynamite and Cloud 9.

Bath salts — a toxic cocktail of the amphetamines, Methylenedioxypyrovalerone (MDPV), mephedrone, and pyrovalerone. The Drug Enforcement Agency groups bath salts with mescaline and ephedrine, while dealers market the drug as a replacement for cocaine or a synthetic form of the hallucinogen LSD, according to CNN.

This entry was posted on Wednesday, May 30th, 2012 at 9:22 am and is filed under Celebrities, Video. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

My daughter in her typical outdoor attire

The temperature is heating up, and your kids are spending more time outdoors. They’re sweating; they’re swimming. They need extra sun protection—and so do you!

The sun’s ultraviolet (UV) rays are at their strongest during the summer, and unprotected skin can be damaged in as little as 15 minutes. While applying a SPF (sun protection factor) 30 sunscreen is important throughout the year, taking extra sun-safety precautions during the summer is especially important.

Don’t pull a Tanning Mom on us. Try these tips on your next family trip to the beach, pool, playground, ballpark or amusement/water park.

1.  Sunscreen- Kids who are sweating or swimming need to reapply sunscreen more often. Remember that water, snow and sand can reflect UV rays and increase your child’s sun exposure and chance of getting a sunburn. A sunscreen with an SPF of at least 30 protects the skin from the sun. Apply one ounce of sunscreen (about the size of a ping pong ball) to all sun-exposed areas of the body. Don’t forget the ears, feet and behind the neck. Because sunscreen can take up to 30 minutes to go into full effect, it’s a good idea to apply it at home before you drive to the pool or beach.

2.  Lips and Eyes- Choosing the right sunglasses, hat and lip balm also can provide added UV protection for parents and kids. Apply a lip balm that offers SPF protection and reapply throughout the day. Choose wrap-around sunglasses that absorb at least 99% of UV rays to protect your eyes and the skin around your eyes. Choose a hat with a wide brim to give as much sun protection as possible.

3.  Wear sun-protective clothing- While most people usually know to use sunscreen and sunglasses, few are aware of the availability of sun-protective clothing. Many companies offer a variety of sun-protective clothing with as much as ultraviolet protection factor (UPF) 50. UPF indicates how much UV radiation can penetrate the fabric in clothing. For example, a shirt with UPF 30 means that just 1/30th of the sun’s UV radiation can reach the skin.

4.   Find or make shade- It’s always a good idea to have a place where you and your family can find shade from the sun. Plan ahead. Seeking shade is especially important between 10:00 a.m. to 4:00 p.m. when the sun’s ultraviolet (UV) rays are at their strongest. When outdoors choose parks with a covering over playgrounds, cary a large umbrella to the beach, put a tent up if you have space, or choose seating areas near trees.

5.  Make a travel size sun-safety kit- Summer time often leads to spontaneous plans. You never know what the day has in store. At the beginning of the summer, create a travel size kit with all the items you need to keep your family sun safe. Don’t leave home without it! Here are some basic, portable items to put in your kit:

• Sunscreen with SPF 30 or higher
• Lip balm with SPF 15 or higher
• Hat with a brim or cap
• Long-sleeved shirt
• Sunglasses with UV protection

Summer is a gorgeous time of year, especially here in Southern California. We’re not asking you to become a hermit when it comes to summer time. Practicing these Sun safety tips will keep your family happy and healthy. Who likes dealing with a painful sunburn anyways?

This entry was posted on Wednesday, May 23rd, 2012 at 10:24 am and is filed under Skin Cancer, Skin Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Follow these 6 tips to get the most out of your Dermatology appointment.

1. Know what medications you are taking– Often patients will come in and tell us, “My other Doctor gave me some cream and pills, I don’t know the name of them but they didn’t work”. Knowing what treatments did not work for you in the past can be very helpful to your provider. How upset would you be if you got home and discovered we gave you the same exact cream and pills you had in the past? Make sure you come prepared. Bring your medications with you or write down the names of them. I am a huge fan of technology so I love the idea of taking pictures of your medications and storing them in your phone. It only takes a few seconds and there is no extra bulk to carry around.

3. Write your questions down– It is very frustrating when you get to your car after your appointment and think to yourself, “Darn! I forgot to ask _____”. If you write your questions down you won’t forget them. While you should write down all of your questions make sure the list isn’t too long. If you have 20 questions about 10 different problems we won’t be able to give each topic the attention it deserves. Medical information can be overwhelming. If we are able to focus on a few topics it will enable you to have a better understanding of your conditions.

4. Get to your appointment early, do your homework and come prepared—If possible, schedule your appointment first thing in the morning or right after lunch to avoid the busier times. If you feel your appointment may require a little more time than usual tell the receptionist when scheduling to allow for sufficient time. Plan to arrive at least 15 minutes prior to your appointment time if you are a new patient to fill out any necessary paperwork. Our office has made forms available online so you can print them at home and bring them in filled out to save time.

6. Outsmart your rash– When it comes to skin we know rashes come and go. We hear almost every day “It looks a lot better today, but yesterday it was so much worse!”  In Dermatology a physical examination of your skin is the most important component of our evaluation.  If your rash tends to come and go take a good, quality picture of your condition when it is at it’s worse.  Make sure the picture is a well lit, clear, close-up and detailed picture. Printing them up for us to view is very helpful, it enables us to see the detail better. If you do have it stored on your phone make sure you have it pulled up ready to go. As fun as it might be to see your snapshots from your latest Vegas trip your rash pictures will be much more helpful. If you wake up the day of your appointment and your rash is no where to be found still make it to your appointment but know there is probably not much we can do.  We may be able narrow down your diagnosis to a few options but may not be able to give you a firm diagnosis. What your visit will do is “open the case” for your condition. Our office makes an effort to squeeze established patients in same day when their rash appears for evaluation.

This entry was posted on Thursday, May 17th, 2012 at 8:36 am and is filed under Office Life, Skin Care. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

image courtesy of aad.org

What is Melanoma Monday? “Melanoma Monday” is observed on the first Monday of May and it is also termed as May Melanoma Skin Cancer Month. This day is also known as National Skin Self-Examination Day. People are advised and encouraged to undergo the examination of their skin for skin cancer. Of the different types of skin cancer, melanoma is the most deadly and accounts for about 75% of all skin cancer fatalities. Melanomas can also develop in other areas of the body such as the eye, underneath nails and inside the nose and mouth.

Melanoma Warning Signs: ABCDE

A – Asymmetry: is the mole asymmetrical? If you imagine a line drawn across the center of the mole, if the two halves do not match then they are considered asymmetrical.

B – Border: does the border or edge of the mole look uneven?

C – Color: is the mole one uniform color? If there are several colors or shades of a color within a mole this could be a warning sign.

D – Diameter: how big is the mole? Melanomas often have a diameter of 6mm (1/4inch) or more (diameter is the length across the mole).

E – Evolving: has the mole changed in shape, size or color? Have you noticed any other changes such as bleeding, itching or puss coming from the mole? These may be signs of a malignant mole so seek medical assistance.

Early Detection Is Crucial For Treatment Success
As with many other types of cancer, treatments are more successful when there is early detection. However, unlike most cancers, melanoma does normally not respond well to chemotherapy, radiotherapy or medication. When melanoma is at a later stage and has metastasized (spreading to other parts of the body), treatment options are limited and palliative care is the main course of action. Drug treatments for melanoma, when successful, do not provide a cure. They may extend life for a time measured in months not years. There will always be exceptions and some people with metastatic (stage 4) melanoma will live for many years after diagnosis. However, the prognosis for advanced melanoma is normally not good hence early detection is critical for success.

This entry was posted on Monday, May 7th, 2012 at 9:21 am and is filed under Skin Cancer. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

A New Jersey woman has been charged with felony child endangerment after she allegedly took her five-year-old daughter into a tanning booth, where the child suffered serious burns. Even Snooki, the tanning queen herself, does not approve.

The investigation of Krentcil began after cops were summoned to the elementary school attended by the kindergartener, who was in pain due to what appeared to be a severe sunburn. The subsequent probe determined, cops allege, that Krentcil took her child into a tanning booth at a Nutley parlor a week prior to her April 24 arrest.

State law bars children under the age of 14 from using a tanning facility. Investigators contend that Krentcil brought her daughter into a stand-up tanning booth without the knowledge of parlor employees.

Putting a 5 year old in a tanning bed is horrible for any child but would be especially dangerous for this beautiful little girl. The risk of melanoma is more than 10 times higher for whites than for African Americans. Whites with fair skin, freckles, or red or blond hair have a higher risk of melanoma. Red-haired people have the highest risk. There’s no such thing as a “healthy” tan. The damage to the skin is irreversible. Children are particularly vulnerable. Yet because tanning is thought of as a sign of health, affluence and beauty in our culture, people don’t take the risks seriously.

This entry was posted on Thursday, May 3rd, 2012 at 5:16 pm and is filed under Celebrities, Skin Cancer. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

At the most recent annual meeting of The American Contact Dermatitis Society, Acrylates were crowned the  Contact Allergen of the Year for 2012. Acrylates are plastic materials found in paints, adhesives, inks, resins and artificial fingernails. Acrylates are also used in a number of medical devisesincluding contact lenses, hearing aids and bone cements for orthopedic endoprostheses. Acrylates were bestowed this this year’s honor because they are “everywhere in the environment” said Dr. Donald V. Belisto, who announced the winner at the meeting.

We commonly see patients with allergic reactions on their skin, however it is very difficult to pinpoint what caused the allergy. Think about it… you come in contact with hundreds of items every day and any of those products could potentially cause an allergy. A common area we see allergic reactions are on the face. Many people start thinking about their make-up, face lotion, face wash, ect…as to what could have caused the allergic reaction. When you have a reaction on your face it is more commonly something you transfer from your hand to your face (i.e acrylic nails or nail polish).

Treatment for contact allergens commonly include topical cortisone treatment or oral prednisone. Most importantly is avoidance of the allergen, however this can be difficult if you don’t know what it is. Patch Testing can be done to attempt to establish the allergen. Patch Testing is an in-office procedure where large adhesive patches impregnated with various allergens are placed on the skin, typically the back. The adhesive patches are left on the skin for a few days and when removed the skin is examined for any reaction to the test. If a positive reaction is found we try to determine where the patient is coming in contact with the allergen.

If your face is burning and itching let your nails go au natural, you could get some relief.

This entry was posted on Wednesday, May 2nd, 2012 at 9:49 am and is filed under Skin Conditions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

Lip dryness is, at a minimum annoying, and, at worst, painful. Dry lips may crack, become scaly and even bleed. One way to keep the lips moist is by licking them. As the skin around the mouth gets irritated, many will begin to lick at it, which makes it even more red and irritated. This leads to the classic lip licker’s dermatitis we see often in the winter.

The most important treatment is to stop licking your lips. This sounds easy, but it is hard for someone with dry lips. Regularly applying a bland moisturizer, as often as hourly, is necessary so you won’t feel the need to lick your lips. At bed time, a larger amount is needed to lessen lip licking while sleeping. In some cases prescription medications are required. With proper treatment, lip licker’s dermatitis goes away in a couple of weeks with no scarring or permanent skin damage.

Tips for treating Lip Licker’s Dermatits:

This entry was posted on Thursday, April 19th, 2012 at 1:35 pm and is filed under Skin Conditions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

TMZ  recently reported that Kim Kardashian was spotted sporting that telltale mark of love: a hickey. It makes sense considering it was spotted the day after her movie date with Kanye West. We’re calling PUBLICITY STUNT here at our office. What can Kim do to improve the appearance of her love bite? Unfortunately, there isn’t much you can do about this affliction. A hickey is nothing more than a bruise, and like all bruises it just needs some time to heal. You can, however, try a few tricks to make it fade faster.

1. A cold compress such as an icepack or a bag of frozen peas should be applied to the affected area for 20-30 minutes in order to speed healing and reduce swelling by constricting the underlying blood vessels in response to the cold. Do not apply ice directly to the skin. Wrap the icepack in a towel.
2. Avoid aspirin because aspirin slows the blood from clotting and may, in fact, prolong the bleeding.
3. After about 48 hours, heat in the form of a warm washcloth applied to the bruise for 10 minutes or so two or three times a day may increase blood flow to the bruised area, allowing the skin to reabsorb the blood more quickly. Ultimately, the bruise will fade in color.
4. Rub a little tincture of arnica or arnica gel onto the bruise. Arnica (Arnica montana) comes from a plant in the daisy family that grows in the Rocky Mountains, and may be helpful for bruises and sore muscles.
5. Apply concealer in a shade that’s lighter than your natural skin color and discreet enough to fend off unwanted attention.
6. The best treatment for a hickey: wear scarf and wait it out.

This entry was posted on Monday, April 9th, 2012 at 9:06 am and is filed under Celebrities, Skin Care, Skin Conditions. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.