Seborrheic keratoses... Or what I like call "Wisdom spots"

Written by Dr. Wendy Myers

If you are over the age of 30 and have had a skin check with me, you may have heard me use the term "wisdom spot." What I am actually referring to are common lesions called seborrheic keratoses. Seborrheic keratoses or SKs are common benign skin lesions that often start developing in patients in their thirties, and continue to form as we age. I often like to joke with my patients that these are markers of their wisdom and maturity, as most patients do not want to hear that they are due to aging.

Patients often confuse SKs with "moles", but they are not. SKs are made of keratinocytes and not melanocytes which comprise true moles or nevi. They can develop on any part of the body except the palms and soles and can appear in many different ways: skin toned, pigmented, flat, or even quite raised, often resembling warts. 

The good news I always try to reinforce with my patients is that they are benign and require no treatment. They can be removed for cosmetic reasons or if they become irritated, inflamed, or itchy. There are various ways that this can be done in the office including cryotherapy (freezing lesion with very cold spray that results in the lesions peeling off), curettage (scraping lesion off after local anesthesia), or electrocautery (electric needle to burn lesion off, often with curettage).  Therapies are often determined by the size and location of the lesion. Treatment areas often heal well, but may hyper or hypo- pigmentation as a result. 

Suffering in Silence - The Ugly Truth About Hidradenitis Suppurativa

According to the Mayo Clinic, "Hidradenitis Suppurativa" (HS) is a chronic skin condition that features pea-sized to marble sized lumps under the skin.” HS develops when hair follicles become blocked and inflamed causing these lumps to form under the skin. While it’s not known why HS occurs, medical professionals have concluded that several factors contribute to HS including hormones, genetics, cigarette smoking and excess weight. 

The Mayo Clinic also states that those who have HS oftentimes suffer in silence due to embarrassment since the painful lumps typically form where skin usually rubs together such as the armpits, groin, between the buttocks and under the breasts. The condition occurs more in young adults and more often in women than men. 

“We see hundreds of patients a year with HS but I think many patients do not ask for help given the sometimes embarrassing location of the lesions,” said Dr. Wendy Myers, a board certified dermatologist with Windsor Dermatology. “Since HS is more common in females after the onset of puberty, it’s critical that those affected seek medical assistance so the disease doesn’t create further complications.”

If left untreated, HS can lead to scars and skin changes, restricted movement, obstructed lymph drainage along with social isolation, the Mayo Clinic advises.

According to Dr. Myers, potential treatments for HS are dependent upon the condition’s severity. Treatments can start with topical antibiotics and antibacterial cleansers for milder cases. More complicated cases often require treatment with oral antibiotics. Severe cases may require a surgical consultation for management of fistulas and sinus tracts. More severe cases may also respond to isotretinoin or biologic therapy.

“At Windsor Dermatology, we have experience with all degrees of HS and treatments plans can be individualized based on degree and comorbidities,” added Dr. Myers. 

Don’t suffer in silence. If you or someone you know has HS, call Windsor Dermatology to schedule an appointment.

5 More Facts About Skin Cancer You May Not Know

Matthew Halpern, MD

As summer kicks into high gear, skin cancer remains a concern among New Jersey residents—down the shore or elsewhere. Before you hit the beaches, the park or even the backyard, keep in mind these facts about skin cancer—it could save your life.

1.  Skin cancers can occur on non-sun exposed parts of the body.  Although the majority of non-melanoma skin cancers occur on areas of the body that receive extensive sun exposure, skin cancers can occur on parts of the body that receive little  to no sunlight such as the armpit and groin.  In addition, the most common location for melanoma skin cancers is on the chest and back for men and on the legs for women.  For this reason it is important for at-risk individuals to undergo regular full body skin exams with a board certified dermatologist. 

2.  Skin cancers can occur on patients with darker skin types.  Although non-melanoma skin cancers occur 70 times more frequently in lightly pigmented skin than darkly pigmented skin, they can occur in patients of all skin types. Squamous cell carcinoma is the most common skin cancer in darkly pigmented patients. Interestingly, two thirds of these develop in non sun-exposed sites such the lower extremities, old scars and the anus. 

3. Immune system impairment increases likelihood of skin cancer development. Individuals who have undergone organ transplantation or have any underlying condition that impairs their immune system have to be watched very carefully by a dermatologist for skin cancers which can behave more aggressive in this subset of patients.

4.  Sunscreen is important for adults as well as children. Although skin cancers result from childhood sun exposure, use of sunscreens now decreases the rate of occurrence and rate of progression of new skin cancers.

5. One treatment option for skin cancers is called Mohs micrographic surgery. For non-melanoma skin cancers on the head and neck, Mohs micrographic surgery is the treatment that offers the highest cure rate and minimizes scarring. Mohs surgery can also be performed for skin cancers that have certain high risk features or have recurred after more superficial treatments.

Find out more about preventative measures and treatment options by scheduling an appointment with Windsor Dermatology Board-certified physician. Call 609-443-4500.

Debunking Myths About Acne

By Brian Keegan, M.D., Ph.D.

Acne is the most common skincare problem seen by doctors—nearly everyone will deal with acne in their lifetime. Because of acne’s unsightly appearance, patients will turn to a number of seemingly fast and easy solutions. But let’s take a closer look at the real causes of acne and the right way to treat it.

Myth #1: “Acne is caused by eating chocolate.”

Truth: Acne is caused by sticky cells that don't exfoliate properly. This leads to clogged pores which are seen as comedones (skin colored bumps) and blackheads. When these pores are colonized with the bacteria P. acnes painful white heads and cysts will develop, which can lead to scarring. There are a few studies that suggest eating chocolate can enhance this process, however no solid evidence has led the medical community to make a decisive conclusion. It does, however, make logical sense that a healthy diet will contribute to healthy skin.

Myth #2: “Only teenagers get acne.” 

Truth: Hormones tend to accentuate the process by which acne appears, making its occurrence worse during teenage years. But, it is not exclusive to patients under 20. Many adults continue to experience acne, particularly women.

Myth #3: “All you need is a good over-the-counter treatment to cure acne.” 

Truth: We are all looking for quick, easy and effective treatments so we turn to over-the-counter products. These contain two active ingredients, salicylic acid to unclog pores and benzoyl peroxide to kill bacteria. But everyone’s skin is different. The best course of action is to schedule a consultation with a Windsor Dermatology physician to determine the treatment plan that’s right for your skin. 

Myth #4: “Acne medications are too harsh and have too many adverse side effects.”  

Truth: Historically, acne medications were very harsh to the skin or caused significant stomach irritation, however, significant improvements have been made with more recent medications. If your skin is irritated at first, you should see improvements after the first couple of weeks. Typical side effects associated with short-term and long-term use of medications are redness, scaling, dryness, stinging and burning where applied. A non-comedogenic moisturizer can help if your skin becomes dry. Unless major discomfort occurs, it’s best to keep using your medications to make sure you’re on the right path. Don’t hesitate to talk to your doctor if you have major discomfort or if you have any questions or issues. 

Our physicians have experience with the most up to date medications including:

Over-the-counter washes: Salicylic acid 2%  (Neutrogena Oil-Free Acne Wash), benzoyl peroxide (Clean and Clear Continuous Control, Proactiv)

·        Over-the-counter moisturizers: Cetaphil, CeraVe

·        Topical antibiotics: Aczone, Duac, Acanya, Plexion, Rosula

·        Topical retinoids: Ziana, Differin, Epiduo, Veltin, Tretin X, Tazorac, Atralin, Retin-A Micro

·        Oral Antibiotic: Solodyn, Doryx, Minocin, Oracea

·        Oral Retinoids: Accutane, isotretinoin (Amnesteem, Sotret, Claravis)

·        Oral Contraceptives: Orthotricyclin, Estrostep, Yaz

Myth #5: “If I just wash my face a lot and use a lot of medication, it will speed up the healing process.”

Truth: Use a mild, soap-free, fragrance-free cleanser and wash gently, morning and night. There’s no need to wash more than twice a day, and you don’t want to scrub hard. Also avoid alcohol-based cleansers, which can actually cause irritation and aggravate acne.

Using more won’t speed things up (sorry!), and it’s not a good idea to spot-treat. Stick with the right amount and stay consistent. It’s best to use your medications at the same time every day to help you stay in the routine and it’s important to not skip days. You should always follow your doctor’s instructions, but typically pumping a pea-sized amount onto your hand and spreading it evenly across your face works perfectly.

Myth #6: “If I pop the acne pimple, it will go away quicker.”

We know it’s tempting, but when you squeeze or pick at pimples, you can actually push the infection deeper into your skin and make matters worse. It can even cause scarring. Not good! Your best bet is to leave your pimples alone the best you can.

Let us help you figure out the best course of action to treat your acne. Schedule a consultation with a Windsor Dermatology physician today by calling 609-443-4500.