Robin Fleck, M.D.  928-778-7000  Board Certified Dermatologist








Membership Articles

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Adult Acne Insect Bites Seborrheic Keratoses
Acne Infections Of Skin Should I Exfoliate?
Acne Scarring Keloid Shingles
Actinic Keratosis Lasers Skin Biopsy
ACTIVE FX Fractional CO2 Laser Lichen Planus Skin Cancer
Allergic Skin Reaction Lip Enhancement Skin Types
Athlete's Foot Liquid Nitrogen Treatment Skin Surgery
Basal Cell Carcinoma Melanoma Spider Veins
Birthmarks Melasma Spider Bites
Botox Men's Skin Care Stasis Dermatitis
Blackheads (Comedones) Moles Sun Spots (Age Spots)
Cysts Molluscum Contagiosum Sunscreen Advice
Dandruff Nutrition Teen Skin
Dermal Cosmetic Fillers Perioral Dermatitis Teenage Acne
Dermatitis Pigmentation Disorders Tinea Versicolor
Eczema Pityriasis Rosea Ulcer Of The Skin
Facial Wrinkle Reduction Premature Aging Varicose Veins
Granuloma Annulare Psoriasis Vitiligo
Hair And Nails Disease Rosacea Warts
Hives Scabies

Adult Acne

Many adults can develop an acne-like eruption on the face. The causes can be as varied as bacterial or fungal infection, true acne, medication-caused rash, rashes due to makeups or other applied products, skin allergies, perioral dermatitis, rosacea, industrial chemical exposure, or folliculitis. Examination by a board-certified dermatologist will allow for prompt diagnosis and therefore the correct treatment.   

The most common eruptions which produce adult "acne" are:

Acne vulgaris
Staphylococcal follitis
Perioral dermatitis
Fungal infections of the beard
Steroid dermatiitis...


What is acne?

Acne occurs when the skin's sebaceous glands overproduce oil and it becomes trapped in the sebaceous ducts leading to the skin's surface.  This initial lesion of a blocked sebaceous duct is called a comedone.  If the comedone is large, it is usually called a blackhead.  Many smaller comedones can usually be felt under the skin as hard bumps. Blackheads may be caused by other conditions as well as acne.

Acne is composed of a combination of comedones and pimples.  A pimple starts when the oil backs up and damages the duct.  The body's immune system tries to repair the damage and the area becomes swollen, red and sometimes painful.  Bacteria invade the area and can produce a pustule but these invaders are not the cause of acne.

A second cause of allergic skin rashes are ingested drugs, food chemicals...


Acne Scarring

What is acne scarring?

Many people who have acne confuse the purple or brown spots with acne scarring.   It is important to see a board certified dermatologist so the acne can be promptly treated with diet and medication, so that new lesions do not form.  When this is accomplished in three months or less, the brown or purple spots clear up.  They are not scars, but rather a condition called postinflammatory hyperpigmentation.

Acne scarring is an irregular texture of the skin caused by destruction of collagen in the dermis during the intense inflammation of cystic acne.  These textural changes can be quite disfiguring but now there is something that can be done to improve the pitting and scarring in the aftermath of cystic acne....

Actinic Keratosis

What are keratoses?

Keratosis refers to a scaly growth on the skin.  There are two forms: actinic keratoses and seborrheic keratoses.

What are Actinic Keratoses? 

Actinic Keratoses (AKs) are rough, scaly spots that occur on skin that has been exposed to the sun over a period of years.  These lesions are the result of damage to the skin by the sun's ultra violet radiation.  AKs are usually small – most are no bigger than a pencil eraser – but  some may be as big as a half-dollar in diameter.  They may be skin-toned, reddish brown, or yellowish in color.  They have scaly, irregular surfaces that are rough to the touch and sometimes a stinging sensation is noted.  The number of AKs ranges from one or a few to many.  People who have fair skin and light-colored hair and eyes are at the greatest risk of developing AKs...


ACTIVE FX Fractional CO2 Laser

Lasers have evolved over the past 20 years with substantial improvements in safety and effectiveness. Earlier lasers removed all the epidermis leading to long downtimes of 6-8 weeks with redness, pain and oozing. In addition, these lasers removed all the pigment cells leading to hypopigmentation, which was usually permanent.

In the past 5 years, lasers have been developed which pixellate or remove only tiny sections of skin and leave normal skin "bridges" in between.   Because the entire skin is not removed, it repairs itself and grows back in less than a week, including the pigment cells, so there is very little risk of permanent hypopigmentation.

There is a difference in outcomes depending on the type of laser used for resurfacing.  CO2 based lasers (Active FX) give a better result in only one treatment than other types such as erbium based lasers (Fraxel) which requires 3-5 treatments to give the same result...

Allergic Skin Reaction

Allergic skin reactions are due to several causes.  The most common cause is contact allergy which means that a chemical touching the skin has caused an allergy.  Poison ivy is the classic form of a contact allergic dermatitis.  Many other chemicals can also cause skin allergy by touching the skin such as occupational exposure, exposure to chemicals used in hobbies, other plant dermatitis, allergies to topically applied cosmetics or medications or contact with foods. 

The inciting chemical may be a known allergen in the case of nickel, or it may be a rare or unknown cause of allergies.  These chemicals do not cause allergies in most people who are exposed.  Another factor may be involved in the development of the allergic condition, such as hypoglycemia, which can trigger other allergic conditions such as hayfever and asthma...


Athlete's Foot

What Causes Athlete's Foot?

Tinea pedis is the medical name for athlete's foot fungus.  This organism prefers warm, moist skin; this is why the infection commonly occurs in the folds between the toes and is often worse in warm weather.  Not all skin rashes on the foot are due to fungus.  Eczema can appear very similar to a fungal infection .This fungus may stay in the skin indefinitely.

Even if the rash seems to have been cured, microscopic examination may reveal the fungus to be present.  While medicines will clear the rash, the fungus may be dormant, only to cause a recurrence several months later.  Eating a high sugar diet feeds the organism and low carb diets such as Atkins can improve scaling and itching....

Basal Cell Carcinoma

Basal cell carcinoma is a locally destructive skin cancer and is the most common form of skin cancer.  It destroys by extending inward from where it starts.  It does not spread through the body by means of the blood stream or the lymphatics like most cancers, therefore its growth is slow but relentless and eventually will cause death if not removed surgically.
Where do they usually occur?

Basal cell tumors usually occur one at a time.  They occur most often on the face between the upper lip and the eyebrows; however, they may occur on any part of the skin.  They are more frequent in sun-exposed individuals.  Occurrence after radiation therapy is common.  Tanning beds are an increasing cause of basal cell cancer.  When they occur in young people, it is a more serious situation and indicates a trend for the future since people with one basal cell cancer have a greater risk of developing others...



Birthmarks come in many types, colors, and shapes.   Generally a birthmark is present from birth but there are some types which develop later in childhood such as the common mole.   Many people believe that just because the skin lesion has been present since birth or childhood it will not be harmful to their health.  In some cases, this is not true.  For instance, moles which are flat and irregularly shaped may be melanoma at birth!  Any skin lesion which is unusual should be checked by your dermatologist to ensure that it is benign.

Treatment of a birthmark depends upon the type it is.  Some require surgical excision, others can be treated with laser.  In general, red or purple birthmarks can be treated with laser while most brown, tan or bluish birthmarks require surgical removal.

Hemangiomas: These can either be flat or raised....


What is Botox?

Botox, and its newer analogs, Xeomin and Dysport, are FDA approved drugs called neuromodulators which have been purified from a bacterial product.  Botox has been used safely for almost 20 years in the U.S. for a variety of medical problems and for the past 6 years to treat facial wrinkles.  All three neuromodulators are used to treat the vertical lines between the eyebrows that make us look worried or angry (glabella area).  Other areas of the face are also treated with Botox including the forehead, crow's feet, upper lip wrinkles and sometimes the jawline and neck.  Botox is also used to treat severe underarm sweating, migraine headaches, TMJ Syndrome and teeth clenching during sleep. Is it painful and does it cause bruising?

Each injection (which can sting) takes a few seconds,  and there may be 10-15 injection sites in a typical patient. Once the injection is over, there is usually no discomfort; however, bruising can occur since...


Blackheads (Comedones)

What causes blackheads?
Most of the time blackheads, also called comedones, are seen in people with acne . In this condition, overproduction of oil blocks the sebaceous ducts.
Another common cause of blackheads is ultraviolet damage from the sun or tanning beds. Injury of the sebaceous ducts traps oil which normally exits onto the skin. This also explains the dryness seen in ultraviolet damaged skin.
Contact with certain chemicals including isopropyl myristate, propylene glycol and some dyes (all of which may be found in cosmetics) are known promoters of blackhead formation.
Androgenic steroids taken by mouth (like testosterone) can lead to blackheads and acne.
Smokers may develop numerous blackheads. This is just one cause of premature aging...


Cysts are noncancerous, nodular lesions of the skin that can be filled with fluid, pus, or dead skin cells.

Cysts are common on the skin and frequently appear on the back, neck, face or scalp. They feel like large peas under the surface of the skin. Cysts can develop as a result of infection, clogging of sebaceous glands (oil glands), or around foreign bodies, such as earrings.

Skin cysts usually are slow-growing, painless and smooth to the touch.

A cyst forms after trauma to the skin such as an acne lesion.  During healing, part of the skin becomes trapped under the surface of the skin and a sac develops.  Dead skin cells exfoliate inside the sac causing it to fill with a cheesy material.

A sudden increase in size of the cyst associated with redness or pain can indicate that the cyst...



What is Dandruff?

Dandruff, also known as Seborrheic Dermatitis, is a common, scaling rash that often itches. It occurs usually in the scalp, eyebrows, around the nose and ears and in the mustache area. When present in the scalp, it appears as an oily type of dandruff. It may occur at any age, including infancy, and may last for months or years. Improvement in the summer months has been reported. Aggravation by certain drugs is well-known and it is more common in patients with Parkinson's Disease and HIV infection...

Dermal Cosmetic Fillers

Dermal fillers are relatively new on the cosmetic scene, most having been introduced within the past 3-5 years.  The earliest filler was bovine collagen, however it is no longer used due to its tendency to produce allergic reactions and its short duration.

It's helpful to classify the fillers on the market into:
Short-acting: Hyaluronic acid fillers: Juvederm, Restylane, Perlane
Intermediate, 1-2 year duration: Radiesse, Sculptra
Long-acting, permanent: Silicone, Gore-Tex, Artefill

Hyaluronic acid-containing fillers are safe and effective when administered by a physician with adequate skill and experience.  However injecting these agents too superficially in the skin can lead to a bluish discoloration called the Tyndall Effect due to light refraction from the filler...



Dermatitis means "inflammation of the skin".   Inflammation can be caused by anything that injures the skin from burns to allergies or irritation from chemicals.  Usually, however, dermatitis refers to chemical injury to the skin producing redness, burning or itching and possibly blistering.

The two most common causes of dermatitis are due to irritating chemicals applied to the skin or allergic skin rashes.  Please see article entitled "Allergic Skin Reaction."

The other category of dermatitis, irritant dermatitis will be discussed here.
Unlike allergens, exposure to irritants almost always causes dermatitis in most people. 

Irritants include abrasive substances such as...


Eczema is a term nearly synonymous with dermatitis, which generally means inflammation of the skin. Eczema is a common condition related to dry skin.  Oil glands in the skin produce a high quality oil which holds the skin cells together.  Because of this oil, the skin is an effective barrier to chemicals, bacteria and ultraviolet light.  If the skin's integrity is compromised, either through inherited conditions, allergies or improper care,  eczema can result.

In common parlance, eczema refers to a skin rash which is recurrent over several months or years, and whose cause is not known.   A more precise term is "nummular" eczema, which refers to round or oval patches of skin rash found on the trunk, arms or legs, which is quite itchy, scaly, reddened and possibly blistered.

Occasionally small, itchy blisters along the sides of the fingers is seen as a type of eczema.  Eczema can also manifest as scaling or itching of the palms...


Facial Wrinkle Reduction

Billions of dollars are spent every year on products to prevent skin from aging, but keeping skin youthful takes more than applying a moisturizer. The "youthfulness" of a person's skin has less to do with aging than how it has been treated. Skin will lose collagen and elasticity, as well as develop wrinkles, unless a person starts preventing the damage. One can prevent the damage to their skin, as well as reverse and slow down the aging process, by following these guidelines.

1. Avoid ultraviolet (UV) light
No matter what age you are, the first preventive measure you can take to improve your skin is to reduce the amount of UV light you're exposed to. Many feel that if they wear SPF 15 or higher they are out of danger. This tends to give people a false sense of security because unfortunately, SPF sunblocks do not block UV-A radiation that comes from sunlight....

Granuloma Annulare

What is Granuloma Annulare?

Granuloma annulare is a raised, bumpy, or ring-shaped lesion, which occurs twice as often in women as in men.  It can be itchy or painful or have no symptoms at all.  A biopsy is sometimes required to make the diagnosis since the rash can mimic fungal infection or other more serious skin problems.
What can be done for this condition?

Topical cortisone creams are usually effective in clearing the lesions and the itching but they must be used for some time.  Occasionally, higher potency cortisone creams can cause skin...


Hair And Nails Disease

Hair and nail diseases encompass such a large number of disorders that entire subspecialties of dermatology are devoted to the diagnosis and treatment of these conditions.  Here, only a brief outline of these disorders can be provided.  Consultation with a board-certified dermatologist is recommended for definitive diagnosis and care.

Hair Loss, also called Alopecia
Hormonal alopecia
Genetic alopecia
Metabolic alopecia
Scarring alopecia
Alopecia caused by medication
Alopecia caused by infection
Alopecia caused by autoimmunity

Hormonal Alopecia, also called male or female pattern baldness results in thinning of the hair on the...


Hives, also called urticaria, is an allergic skin problem in which itchy, red, swollen welts appear anywhere on the skin.  It is usually due to exposure to ingested food or drug but sometimes hormonal imbalances around the menopause, or thyroid disorders can precipitate an episode of hives.  The treatment will depend on the cause of the episode. 

Any offending drugs or foods should be stopped immediately, if known. Over-the-counter antihistamines such as Benedryl or Claritin are usually effective within twenty minutes.

If the hives appear on the face, lips, tongue or throat, or breathing is affected, emergency care should be sought.  If the hives are widespread, affect the face or lips or are occurring repeatedly, professional care should be sought to assist in determining the cause of the allergic condition.  Blood or skin testing may be required to identify the cause...


Infections Of Skin

Infections of the skin include many common bacterial, viral and fungal causes as well as some unusual pathogens.   Most skin infections will present as reddened areas of skin, with or without pus, with pain and swelling.   A board-certified dermatologist is the best option for prompt diagnosis and treatment of these disorders.  A culture may be taken of the area to ensure the correct antibiotic is chosen.  The following are the most common skin infections.

Staph Infection
Molluscum contagiosum
Pityriasis rosea...

Insect Bites

Insect bites cause a hive-like swelling which can be very itchy in many people.  The bump can be small or quite large.  Most bumps are pink or red.  Some ant bites, such as from fire ants, can cause a pustule to form.
What does an insect bite look like?
Common insect bites result from mosquito or fleas.   Most people have experienced one or more mosquito bites in their lifetime.  Flea bites are similar itchy bumps that usually occur on the legs in a linear arrangement, and a history of owning a pet with fleas or sitting on the grass may be noted.
Treatment is to de-flea the pet or the household or yard and treat the bumps for a few days with topical cortisone cream until the itch disappears.
Less frequently seen bites are from ticks, scabies and bedbug infestations...



A keloid is a greatly enlarged scar that projects above the skin surface.  Skin heals by formation of scar tissue, which at first is often red and somewhat prominent.  As the months pass, a scar usually becomes flat and white.  Unfortunately, sometimes scars enlarge to form firm, smooth, hard growths called keloids.

What causes keloids?

No one knows why keloids form.  While most persons never form keloids, others develop them after minor injuries and even after insect bites or pimples.  Keloids may form on any part of the body, although the upper chest, upper arm, and back are especially prone to keloid formation.  Dark-skinned persons form keloids more easily than Caucasians.  General information about treatment.

There is no completely satisfactory treatment for keloids.  Even after an apparent cure, they sometimes return.  If this happens, it will usually occur within one to two years.  Treatment is easiest for...


has really only come "of age" in the past 5 years.  Prior to that, lasers were mostly used in academic research centers and only a very few people had access to their benefits.
cNowadays it is ommon to have laser procedures and just in the last 3 years, the number 1 requested cosmetic procedure in the US has become laser hair removal.  Laser procedures include:

Laser hair removal
Laser wrinkle reduction
Laser age spot removal
Laser or IPL facial redness reduction
Laser spider vein removal (face)
Laser spider vein removal (legs)
Laser eyelid lift
Laser neck tightening
Laser hand rejuvenation
Laser liposuction
Laser varicose vein procedure (EVLA)
Laser tattoo removal...


Lichen Planus

What is lichen planus?

Lichen planus is a skin disease of unknown cause which appears as a purplish flat or raised grouping of lesions, especially on the wrists and ankles.  It can occur anywhere on the skin, scalp, nails, inside the mouth or on the genitals.  The rash of lichen planus is very itchy or causes burning especially in the mouth or genitals.
While most cases occur without a known cause, some patients who are taking certain medications for high blood pressure or arthritis can develop lichen planus.  If these are stopped, the lichen planus eruption may clear within a few months.  Patients with Hepatitis C are also more likely to have this skin condition...

Lip Enhancement

What is used for lip augmentation?

Restylane, Perlane and Juvederm are cosmetic fillers derived from hyaluronic acid, a natural substance found in the skin.  All three  have been used for several years in the U.S. for lip augmentation and filling wrinkles around the mouth.
Is the procedure painful?

For lip augmentation, the client is premedicated with dental anesthesia by injecting lidocaine around the nerves which supply the mouth and lower jaw.  Numbness usually occurs within 20 minutes and when this is complete, filler is injected into the lips to give the desired fullness.  Usually one or two syringes are required.
Are there side effects?...


Liquid Nitrogen Treatment

What is liquid nitrogen used for?
Liquid nitrogen produces a localized freezing of growths and a small area of surrounding skin.  The full effect of the freezing will be most noticeable in one to three days, although the skin defrosts moments after the initial application. This modality is used to treat Actinic Keratoses, Seborrheic Keratosis, warts, genital warts, Molluscum Contagiosum and many other conditions.
Is the treatment painful?

There will be pain or a stinging sensation lasting from 5 to 30 minutes following the actual freezing.  There may be some redness and swelling.  Once this pain stops, you should have no further pain, but the area may itch or be tender for several days.  Topical Vitamin C serum and Vitamin E lotion applied as soon as possible after the liquid nitrogen and twice daily can speed resolution of the treated lesions.
What can I expect after treatment?
By one to two days a blister may form in the treated area...


Malignant melanoma is one of the most deadly of all cancers.  It begins in the melanocytes, those skin cells that produce the brown pigment, melanin, which makes the skin tan.  The malignant cells still produce the melanin pigment so the tumor usually is a mixture of tan, brown or black.  Melanoma can spread to distant organs, making early detection and treatment essential.

How can I tell if I have melanoma?

Melanoma may begin in a mole or arise on normal skin.  The most worrisome moles are flat or only slightly raised but many people call these freckles.  If you have moles, you should check them each month to be certain there are no changes in size, color, shape or sensation such as itching.  In addition, a dermatologist should check your moles at least once a year or when you detect a change in a mole.  Early melanoma is curable with a simple office surgery...



Melasma, also called "Mask of Pregnancy," occurs as brown patches on the face and forehead.  It occurs most often during pregnancy, with oral contaceptive use, and sometimes at menopause, especially after administration of estrogen.  Occasionally the use of the drug, Dilantin, may also cause melasma.

After pregnancy, melasma usually clears within a few months.  After stopping oral contraceptives, several years may be required before spontaneous improvement is noted.  Sometimes melasma is permanent. Therapy will be much more effective if oral contraceptives or estrogen are discontinued.

How is melasma treated?
Treatment involves two equally important facets: 1) the use of bleaching medications, and 2) avoidance of sun exposure.

Bleaching Medication:
Fading of melasma can often be accomplished by the use of medications applied...

Men's Skin Care

Face it, the first thing people see is your skin and it makes an impression.  You may not want to admit it, but you want to look as young as you feel and not age any faster than you have to.  The tips here will keep you looking healthy, comfortable and well-groomed.

  • Acne
  • Acne scarring
  • Blackheads
  • Oily Skin
  • Botox and Cosmetic Fillers
  • Dark circles under the eyes
  • Wrinkles
  • Laser hair removal
  • Shaving
  • Ingrown hairs...



Moles are the familiar and normal tumors on the skin of most persons. They come at any age, usually starting in the second year of life.  Occasionally in adult life they come in large numbers.  It is thought that they tend to disappear spontaneously after a period of many years.

Moles consist of nevus cells, a cell thought to be related to both the nervous system and to the pigment forming cells of the body.  This latter relationship explains why a mole can become a melanoma, a deadly form of skin cancer.  However, many melanomas arise without any relationship to moles.

The mole is strictly a benign tumor of the skin.   The nevus cells are bunched together under the skin surface and can be flat or raised.  The color of moles varies from skin color to light yellow, to shades of brown or even blue-black.  They may be smooth or rough, and may be surrounded by redness or even absence of pigment...

Molluscum Contagiosum

What is Molluscum contagiosum?

Molluscum contagiosum is a virus that causes a skin infection appearing as small white or pink bumps. It is generally a benign infection.
Is it contagious?

Yes, it can be spread by human to human contact in daycare centers or it can be a sexually transmitted disease. If a person has the virus, they can also spread the infection to other parts of their own body by touching a lesion and then touching another part of their body, or by using contaminated towels.
How do I know if I have it?

Diagnosis is made by a dermatologist...



Too many men and women on-the-go dispense with breakfast.  The reason: they aren't hungry or they're too busy.  Studies have shown that breakfast is the most important meal of the day because your brain hasn't received any glucose during the night. So how do you expect to function at your best with partially starved brain cells?  What you consume is equally important: eating a breakfast of bacon and eggs will keep you from being hungry much longer than granola and yogurt.  In just a week of eating a daily breakfast of animal protein and fats, your appetite will resume and you will look forward to breakfast.

In today's society, many people skip breakfast and lunch, getting by on coffee or diet colas until dinnertime.  This explains why so many are hypoglycemic.  Hypoglycemia has protean manifestations...

Perioral Dermatitis

What is Perioral Dermatitis?

Perioral dermatitis is a condition that occurs around your mouth, nose, eyes and many times only on the chin. The condition is very common and it tends to come and go over time. It is caused from a combination of eczema and an infection. Both components must be treated at the same time. With appropriate treatment, it can be cured.

The eczema component is a localized allergic reaction that occurs when irritating products are used on the facial skin. This process leads to poor barrier function and allows infection by organisms that reside on your skin. Many people treat the condition for two weeks and it comes right back because it takes at least a month to allow the skin to normalize.
What causes perioral dermatitis?

It is, many times, aggravated by stress...


Pigmentation Disorders

What is melanin?

The brown pigment, melanin, is responsible for the color of our skin from fair to tan or brown. Injury or diseases of the skin can cause this pigment to become darker or lighter. Sometimes the pigment change is permanent but most of the time the coloration will normalize in a few months after the cause has been removed.
What are some of the disorders of pigmentation?

There are many disorders of skin pigmentation. In some, the causes are known, like melasma, while in others, we are just learning about the cause as in vitiligo.

The most common type of pigment problem is called post-inflammatory hyperpigmentation. "Hyper" means too much pigment is formed. This can happen after the skin is cut, or suffers a burn or abrasion, or following surgery or liquid nitrogen cryotherapy. An example of this is when an acne pimple starts to go away...

Pityriasis Rosea

What is pityriasis Rosea?

Spring and fall are the peak seasons to see pityriasis rosea (PR), a common but little known skin rash. PR is now believed to be caused by one of the Herpes virus group. Pityriasis rosea is probably spread from coughing and sneezing but is not very contagious since few family members ever develop the rash.
What does the rash look like?

The eruption of pityriasis rosea typically arises after an upper respiratory infection type of illness. Most, but not all patients will develop a "herald patch" or "mother spot". This lesion is usually larger than the others...


Premature Aging

Can I stop premature Aging?

Scientists believe the normal human lifespan is 120 years!  Our environment has become so degraded that very few people will ever live past 80.  If a few precautions are taken, it is still possible to jump these environmental minefields and maintain some control over your health.

What Causes Premature Aging?
Are There Procedures to Reverse Aging?
Dietary Prevention of Aging
Environmental Pollutants Causing Aging

What Causes Premature Aging?

A number of factors contribute to skin aging and aging in general.  These include:Exposure to ultraviolet light in tanning beds and from the sun Exposure to cigarette smokeThe accumulation of free radical damage from toxins in food, water and air...


Psoriasis is a chronic, scaly skin condition that affects at least 4 million people in the U.S.  A recent study demonstrated a clear link between smoking and development of psoriasis. Genetic predisposition seems to play an important role in who gets psoriasis.

Psoriasis can involve any area of the skin including the palms, soles, and scalp.  It can be limited to one small patch or it can involve nearly the entire skin.  When the disease is extensive, it can be very difficult to treat and may require newer chemotherapy-like drugs for control, the tumor necrosis factor blockers.  Widespread disease is also more likely to be associated with other serious problems like arthritis or heart disease. 

Psoriasis, limited to a few patches on the body or scalp, can be treated successfully by your dermatologist with a combination of prescription Dovonex and a topical cortisone cream in about three months.  It's important to stop smoking if you have been...



What is rosacea?

Rosacea is a chronic red condition of the facial skin which is comprised of a vascular component and an infection.

What causes rosacea?

Certain foods or drinks may trigger the redness of the face which is due to opening up of capillaries.  The most common of these are alcohol and spicy foods.  Drugs such as those used for high blood pressure and topical cortisone creams can also cause dilation of the capillaries.  Ultraviolet light from the sun and frequent overheating, hot baths, saunas, and stress can all cause or aggravate the redness.   Over time, small facial spider veins form and become permanent due to the chronic dilation of the blood vessels.

The infection component is not always present but when it is, it pimples or pustules appear usually on the nose, cheeks and chin.  These can be brought under control with prescription oral antibiotics like Doxycycline and maintained with prescription...


What is Scabies?

Scabies is an intensely itchy rash caused by a tiny bug called a mite. The mite is too small to be seen without magnification. The rash usually involves the finger webs, the wrists, breasts, genital area, elbows, armpits and buttocks. It is transmitted by close personal contact. All members of your family and any sexual partners should be treated at the same time, regardless of whether they have a rash.
How Should I Take the Medication?

Ivermectin (prescription required). Your physician will let you know the number of pills to take based on your size and weight.   These are usually taken in a single dose. Each family member needs to take...


Seborrheic Keratoses

Seborrheic Keratoses (singular: Seborrheic Keratosis) are harmless common skin growths.  They occur during adult life, and may gradually increase in number.  Some persons have very large numbers of them.  While the cause is unknown, most experts believe they are not caused by sun exposure.  Under clothing and around the neck they may be due to irritation of the skin.

They should not be confused with Actinic Keratosis which is cancerous or age spots. If you are not sure which type you have, ask your Dermatologist who can usually recognize the difference without a biopsy.  In unusual cases, a shave or punch biopsy may be necessary to distinguish the two types.

What do they look like?

Seborrheic keratoses begin as slightly raised light brown or pink spots...

Should I Exfoliate?

Function of the Stratum Corneum: The Skin's Natural Barrier

The skin is composed of several layers, each of which serves a particular function. The topmost layer, called the stratum corneum, is actually composed of dead cells glued together with an oil our skin produces called sebum. Because this layer is the one exposed to the elements, it can easily become damaged, thinned, rough and discolored. The function of the stratum corneum is essentially to act as a barrier between the environment and deeper layers of our skin which are in fact alive. The environment contains such harmful things as chemicals, ultraviolet light, and bacteria. Thus the stratum corneum protects us from exposure to these harmful agents.

Over the past 20-30 years, it has become popular to exfoliate and use abrasives on our skin to effect a smoother, more radiant complexion...



Shingles (Herpes zoster) is a nerve infection caused by the chicken-pox virus.  Shingles results from activation of chicken-pox virus that has remained in your body since you had chicken-pox perhaps many years ago.  The virus activation begins in a nerve root.  That accounts for the pattern of the rash, which usually stops at the body's midline.  The nerve involvement explains the stinging, burning, or pain common in shingles.  Some patients have discomfort before the rash appears.

The rash of shingles begins as red patches that soon develop blisters.  The blisters may remain small or can become large.  They will follow the path of the affected nerve and remain limited to either the left or the right side of the body.  The rash may form on the scalp, face, neck, arm, leg or trunk.  It may occur before, after or at the same time the patient notices the nerve pain and many times.  Patients often don't realize the rash and the pain are...

Skin Biopsy

A biopsy is the removal of a sample of tissue from the skin for examination. The tissue will be examined under a microscope by a pathologist to make the diagnosis. Therefore, only very small samples are needed.

Occasionally a growth on the skin must be biopsied to determine if it is malignant (basal cell carcinomas, squamous cell carcinomas, warts, moles or melanomas).  In other situations, a skin rash develops and the dermatologist must distinguish between several different causes.  Special stains can be utilized to diagnose certain infections, types of cancer and other unusual skin disorders.

How is a biopsy performed?

There are three procedures for taking a skin biopsy, a shave biopsy, a punch biopsy and an excisional biopsy.  First, a local anesthetic is injected with a tiny needle around the growth or the sample to be taken...


Skin Cancer

Skin cancer usually refers to those cancers of the skin due to exposure to ultraviolet light, however there are other less common types of cancer of the skin.   Skin cancer can be classified into these types:

Basal Cell Carcinoma
Squamous Cell Carcinoma
Malignant Melanoma
Cancers of sweat and oil glands
Merckel cell tumor
Dermatofibrosarcoma protuberans (DFSP)
Metastatic carcinoma to skin
B-cell lymphoma
T-cell lymphoma
Basal cell carcinoma is the most common cancer in the US.  It is typically found on sun exposed areas of the skin, but can be found anywhere on the skin even in children...

Skin Types

Skin color is determined by the amount of the brown pigment, melanin, in our skin.  Fitzpatrick classified skin color into six types. These gradations rate the amount of melanin pigment in a person's skin, i.e. the higher the skin type, the more melanin that is present.  Higher skin types are found in equatorial regions, whereas lower skin types are found at higher latitudes.  This is believed to be an adaptation that allows maximal ultraviolet energy protection where the sun's rays are the strongest, since melanin pigment absorbs ultraviolet energy and renders it harmless.  Otherwise, inhabitants of equatorial regions would be prone to skin cancer.   At higher latitudes, where ultraviolet light is less intense, evolutionary decreases in melanin pigment have occurred to allow for vitamin D conversion by the limited ultraviolet exposure...


Skin Surgery

Skin cancers including basal cell carcinoma, squamous cell carcinoma, and melanoma can be surgically removed right in your dermatologist's office with just a few injections of local anesthesia.  Other lesions such as birthmarks, moles, keloid scars, cysts,and hemangiomas are also surgically removed under local anesthesia. You will be able to drive home after the procedure.

Before your Surgery:Please eat normally and take all your regularly prescribed medications.  If you have an allergy to lidocaine, epinephrine, or antibiotics, please alert your physician before the scheduled surgery.

Patients with prosthetic joints or heart disease, including valve replacements or mitral valve prolapse, should take antibiotics before the surgery to prevent infection from starting on the joint or heart valve.In addition, please tell your physician if any of these apply to you:You are taking aspirin, ibuprofen, Coumadin, Plavix, other blood thinners, or herbs that cause bleeding...

Spider Veins

Sclerotherapy is the preferred method for eliminating spider veins (telangiectasia) and smaller varicose leg veins. For small, faint spider veins, NdYAG laser therapy may also be used. 

Multiple injections of a dilute sclerosing agent are injected into the abnormal red, blue or purple spider veins of the involved leg. Injecting the unwanted veins with the sclerosing solution causes the target vein to immediately shrink, and then dissolve over a period of weeks as the body naturally resorbs the treated vein.

The patient's leg is then compressed with prescription stockings that are worn for 1 week after treatment. Patients are encouraged to walk regularly during that time. The patient usually requires at least 2-3 treatment sessions separated by several weeks to significantly improve the appearance of their leg veins...


Stasis Dermatitis

What is stasis dermatitis?

This condition is also known as eczema.  In this setting, the eczema only occurs on the legs, usually below the knee.  It can appear on one or both legs and is most common around the middle of the ankle.  It can also appear over the course of a varicose vein.

Stasis dermatitis appears as a scaly red rash with sharp borders sometimes called nummular eczema.  It can itch or burn and can improve without treatment only to relapse in a few weeks or months.  In severe cases, blisters can form and ooze a yellowish fluid.

What causes it?

The cause is believed to be chronic venous hypertension due to varicose veins.  The veins in the legs have one-way valves to prevent the backward (downward) flow of blood toward the feet which physicians call "reflux."  If the valves become damaged...

Sun Spots (Age Spots)

An age spot or liver spot, also called a lentigo, is a flat, round, brown or black patch of skin found on the face, arm or back of the hand. These can occur over large areas of the skin on the face and hands and are usually found in middle-aged or older people who have spent too much time in the sun.   Thought by most physicians to be of cosmetic concern only, there is some literature suggesting that ingestion of polyunsaturated oils leads to free radical damage of the skin in the form of age spots.  Age spots are not cancerous, nor do they lead to skin cancer.  On sun damaged skin , however, age spots may be accompanied by AKs and skin cancers.  All these blemishes should be evaluated by a dermatologist.

Can age spots be prevented?

Age spots are one sign of premature aging which can be prevented by avoiding the suspected causes, including excessive sun exposure...


Spider Bites

What does a spider bite look like?

While almost all spiders are poisonous, most spider bites contain too weak or too little venom to do much harm. Two small holes where the fangs have entered may be seen. The skin reaction to the bite can be slight redness to a swollen, red area involving a large body area.

What symptoms are caused by a black widow spider bite?

Black widow spider bites are rarely fatal. The most common symptoms after a bite (besides the pain of the bite itself) are muscle soreness or cramps, abdominal pain and mental irritation.
What treatment is there for black widow spider bite?
See your physician or go to the emergency room. The symptoms will be treated,...

Sunscreen Advice

No sunscreen or sunblock applied to the skin will completely block all the damaging rays. Think of them as an extra aid which should be used with common sense, sun avoidance and protective clothing.

According to researchers, sunscreen does not protect against melanoma, the most dangerous form of skin cancer.  Although most sunblocking agents seem to prevent burning, they are not very good at blocking the UVA that causes skin cancer and premature aging.  Unfortunately, they are effective at blocking UVB, the wavelengths our bodies need to produce vitamin D.  In addition, because you aren't receiving enough UVB to cause a sunburn, you gain a false sense of security because you are receiving much more UVA by remaining longer outdoors. Sunscreens sometimes contain toxic chemicals that can cause allergies and may even increase your risk of disease such as multiple sclerosis and breast, colon and ovarian cancers...


Teen Skin

Teen skin is prone to several problems including:

oily skin
keratosis pilaris
dry skin
molluscum contagiosum
atypical moles

Acne occurs when the skin's sebaceous glands overproduce oil and it becomes trapped in the sebaceous ducts.  This initial lesion of a blocked sebaceous duct is called a comedone.  If the comedone is large, it is usually called a blackhead...

Teenage Acne

What is acne? 

Acne occurs when the skin's sebaceous glands overproduce oil and it becomes trapped in the sebaceous ducts leading to the skin's surface.  This initial lesion of a blocked sebaceous duct is called a comedone.  If the comedone is large, it is usually called a blackhead.  Many smaller comedones can usually be felt under the skin as hard bumps. Blackheads may be caused by other conditions as well as acne.

Acne is composed of a combination of comedones and pimples.  A pimple starts when the oil backs up and damages the duct.  The body's immune system tries to repair the damage and the area becomes swollen, red and sometimes painful.  Bacteria invade the area and can produce a pustule but these invaders are not the cause of acne.

Many teenagers produce lots of oil without developing...


Tinea Versicolor

What is tinea versicolor?

Tinea Versicolor is a fungal infection of the skin in which small, oval, white, reddish brown or tan patches are spread over the upper trunk, abdomen, arms and legs. It is not caused by the ringworm fungus but rather by a yeast organism.  Most patients complain of cosmetically disturbing, abnormal pigmentation and failure to tan in the summer leading to a spotted appearance.  Occasionally, mild itching is also noted.  The infection is not contagious but the organism is present on the skin of almost everyone, and about 20% of the population is genetically susceptible to the infection.   The organism thrives in warm, moist conditions and in the presence of skin oils, therefore, young adults are more commonly affected....

Ulcer Of The Skin

A skin ulcer is an open sore that can be superficial or deep.  Oozing or drainage of blood or fluid is usually present.  There are many reasons the skin can ulcerate.  Diabetes, nerve damage, varicose vein disease, arterial disease, infections, cancer, pressure, burns and injury are typical causes.

The most common location for an ulcer is on the foot or leg.  Usually there is associated pain unless the ulcer is a result of diabetes or nerve injury. A rash, redness, brown discoloration of the skin, or dry, scaly skin may accompany an ulcer.  Leg and foot ulcers are usually not cancerous however longstanding ulcers may develop a cancer called squamous cell carcinoma.

Causes of leg or foot ulcers:

The most common cause of a leg ulcer is varicose vein disease. Also called venous stasis ulcer, this is common in patients...


Varicose Veins

What are varicose veins? What causes varicose veins?Are varicose veins a threat to my health or are they just cosmetic?Are all varicose veins visible from the outside? Can varicose veins develop in one leg and not the other? What treatments are available for varicose veins? Do these treatments cure varicose veins? Will my varicose vein treatment be very painful?Are there any side effects of the treatments?How long after laser treatments will I be able to return to my normal routine?Does insurance cover the procedures? What are varicose veins?

The circulatory system is made up of the heart, veins, and arteries. Arteries carry oxygen-rich blood from the heart to nourish your tissues, while veins have one-way valves which channel oxygen-depleted blood back toward the heart. If these valves are damaged, the blood pools in the leg veins and leads to feelings of fatigue, heaviness, aching, burning, itching, cramping, restlessness, swelling and even eczema and leg...


What is vitiligo?

Vitiligo is a condition in which pigment cells are damaged resulting in irregular shaped white patches on the skin. Any part of the body where pigment cells are present may be involved. Common areas of pigment losses are: sun-exposed areas, especially the face, neck, around the eyes, nostrils, nipples, navel and genitalia, body folds, armpits and groin, and any site of injury. Early graying of hair on the scalp can also occur.
Who gets vitiligo?

Vitiligo affects at least 1% of the population. It usually begins before the age of 20. Most people with vitiligo are in good health. Sometimes they have a greater incidence of thyroid problems or vitamin B-12 deficiency and hair loss. Your dermatologist will check for these issues at your first visit.

A substance known as melanin determines your skin color....



All warts are caused by specific types of viruses that have an attraction for skin.  They can grow on just about any part of the body.  Their appearance depends on their location.  Warts are slightly contagious and may spread from one part of the body to another or from one person to another.  We do not understand why some people seem to be resistant to developing warts while others grow warts very easily.

Warts often resolve spontaneously without any treatment, especially in children.  While the majority of warts can be successfully treated, some warts are extremely difficult to eradicate (especially those around the fingernails and on the bottom of the foot). Sometimes new warts will form while existing ones are being destroyed.  At other times, untreated warts will disappear when other warts are treated.  Warts may also return after an apparent cure.  Do not be alarmed as this is very common.  These can be treated more vigorously...