Medical Dermatology

Acne affects almost everyone at some point in their lives. Acne is not exclusive to teenagers! Adults can have acne into their 30s and beyond, especially adult women. We offer a number of treatments that can help with acne and acne scarring.

• Topical medications (Clindamycin, Retin-A, Tazorac, Differin, Aczone, Epiduo, Clenziderm, glycolic products)
• Oral medications, including oral antibiotics, Accutane and hormonal therapy (spironolactone and birth control).
• Acne extractions (sometimes covered by insurance)
• Chemical Peels
• Microdermabrasion
• Cortisone injections for large acne cysts (perfect before big events like weddings or proms!)

Actinic Keratoses ("AKs") are considered pre-cancerous growths and the earliest stage in the development of skin cancer. They are caused by long-term exposure to sunlight. The typical AK looks like a dry, scaly, and rough skin-colored to reddish-brown bump. They are commonly found on sun-exposed skin, such as the face, ears, scalps of bald men, and backs of the hands and forearms. AKs can progress to squamous cell carcinoma, a type of skin cancer.

Treatment options, depending on the number and location of your AKs:

• PREVENTION with sunscreen and sun protection early in life!
• Freezing or cryosurgery (most common treatment)
• Prescription topical treatment, such as Fluorouracil (Efudex, Carac), Imiquimoid (Aldara, Zyclara), and Picato.
• Photodynamic Therapy (Blue Light with Levulan)  – offered at our office

Hyperhidrosis of the armpits, palms, and soles afflicts millions of people (approximately 3% of the population) but because of lack of awareness, most people are never diagnosed or treated for their symptoms. Treatment options include:

• Drysol (Rx Aluminum Chloride antiperspirant)
• Botox Injections (FDA-approved, lasts 6 months, amazing results)
• Anti-cholinergic pills (Robinul or Ditropan)
• MiraDry®

Melasma is a common skin condition presenting as brown patches on the face, is seen mostly in women, and is related to hormones and sun exposure. This condition is frequently worsened during pregnancy ("mask of pregnancy") with the use of oral birth control. The most common sites of involvement are the cheeks, bridge of nose, forehead, and upper lip. Melasma may disappear after pregnancy, or it may remain for many years, or a lifetime. While there is no cure for melasma, there are effective treatments.

• Sunscreens and wide-brim hats are the MOST IMPORTANT treatments.
• Bleaching creams with Hydroquinone such as Tri-Luma or Obagi and SkinMedica Lytera (Non-Hydroquinone). Hydroquinone 4% and 6% are available in our office.
• Chemical Peels such as Vitalize Peel
• Microdermabrasion
• Alpha-hydroxy acid, Retin-A, azeleic acid, and kojic acid also have been shown to be helpful.

Also known as Nevus.  Normal moles are symmetric and have one color and a shape that is round or oval.  They also look the same from month to month.  Most moles can be perfectly normal and never change into melanoma.  People often want to know how they can tell a mole from a melanoma.  Here is a general rule for atypical moles and melanomas, known as ABCDE of Melanoma:

• Asymmetry:  One half is unlike the other half.
• Border:  Irregular, scalloped or poorly-defined borders.
• Color:  More than one color in the same mole (tan, brown, black, red, white, even blue).
• Diameter:  Usually greater than 6mm (size of pencil eraser).
• Evolution:  A mole that looks different than the rest OR is changing in size, shape, or color.

Melanoma—If you see a mole or new spot that has any of the ABCDE of melanoma, see a dermatologist immediately.  If caught early, melanoma can be cured.  Without treatment, melanoma can spread and be deadly.  At Roseville Dermatology, we recommend and perform full body skin exams for all of our patients. Patients with a history of skin cancer should have complete skin exams regularly by a dermatologist and report any changes in moles or lesions.

Moles in children—It is normal for new moles to develop in young children and teenagers.  Moles will grow as the child grows and some will darken or become raised or develop hairs.  These signs are expected and seldom a sign of melanoma.

Most moles do not require treatment.  A dermatologist will remove a mole that is suspicious for cancer, bothers the patient, or for cosmetic reasons (if cosmetic, not covered by insurance).  A mole can be removed by shave removal, punch removal, or surgical excision, depending on the size and location.  We do NOT freeze moles.

Molluscum are small pearly, flesh-colored skin bumps caused by a virus and are commonly found on young children. They can be itchy and the skin around the growths may develop eczema. The bumps last from 1 month to 2 years, and will eventually go away by themselves. Molluscum may be spread from person to person by direct contact. Although molluscum will eventually resolve, lesions may spread easily, become infected, or may be itchy. For these reasons, they are often treated.

• Cantharone is our treatment of choice for children. It is a blistering topical agent (“beetlejuice”), which is applied with a Q-tip to the bumps by your dermatologist. A small blister forms in a few hours. When the scab falls off, the growth is gone. Best of all, the treatment is not painful.
• Freezing with liquid nitrogen
• Curettage (scraping the bump)
• Imiquimod cream, Veregen gel, Retin-A or Tazorac cream

Phototherapy is the controlled use of ultraviolet (UV) light to treat psoriasis, as well as eczema and vitiligo.  At Roseville Dermatology, we use Narrow-Band UVB light, which exposes you to only one wavelength of light that work for treating psoriasis.  We also offer Hand/Foot PUVA (psoralen medication with UVA light) to treat severe hand/foot psoriasis and eczema (including dyshidrotic eczema).  Partial to full skin clearing occurs after an average of 20 clinic treatments, which are done 2 to 3 times per week.

For more information, click on Narrow Band UVB Phototherapy Handout or Hand/Foot PUVA Handout

Propecia (Finasteride 1mg/day) is FDA-approved to maintain or increase hair in most men. In clinical studies in men ages 18-41 with mild to moderate hair loss, 9 out of 10 men maintained their hair, and 2 out of 3 men regrew visible hair, whereas all men not taking Propecia lost hair.  Propecia has been proven to:

• Prevent further hair loss
• Regrow natural visible hair

Psoriasis is a very common chronic inflammatory condition. Typically, psoriasis appears as patches of raised, reddish skin covered by silvery-white scale, usually on the elbows, knees, lower back, and scalp. Although currently there is no cure for psoriasis, we have many treatment options that can improve psoriasis.

• Topical (Cortisone, Vitamin D cream, Tazorac, Coal Tar)
• Systemic (Otezla, Methotrexate, Soriatane)
• Phototherapy—NarrowBand UVB & Hand/Foot PUVA are both available at Roseville Dermatology
• Biologics (Enbrel, Humira, Stelara, Cosentyx, Taltz)

Rosacea is a common skin condition that is characterized by redness, pimples, flushing, and broken blood vessels on the face. It is more common in fair-skinned individuals and is often mistaken for adult acne. There is no cure but rosacea can be treated with topical and oral medications, avoidance of triggers, and sun protection.

• Rosacea Triggers: Sun exposure, emotional stress, hot weather, wind, heavy exercise, alcohol, spicy foods, hot baths.
• Topical treatment (Metronidazole, Finacea, Soolantra, Sodium sulfacetamide/sulfa)
• Anti-Redness gel (Mirvaso Gel)
• Oral antibiotics (doxycycline, minocycline, Oracea)
• Laser and Intense Pulse Light (IPL) for redness and broken blood vessels

Rosacea is a common skin condition that is characterized by redness, pimples, flushing, and broken blood vessels on the face. It is more common in fair-skinned individuals and is often mistaken for adult acne. There is no cure but rosacea can be treated with topical and oral medications, avoidance of triggers, and sun protection.

• Rosacea Triggers: Sun exposure, emotional stress, hot weather, wind, heavy exercise, alcohol, spicy foods, hot baths.
• ŸTopical treatment (Metronidazole, Finacea, Soolantra, Sodium sulfacetamide/sulfa)
• ŸAnti-Redness gel (Mirvaso Gel)
• ŸOral antibiotics (doxycycline, minocycline, Oracea)
• ŸLaser and Intense Pulse Light (IPL) for redness and broken blood vessels

Seborrheic keratosis (“SKs” or “barnacles”) is a VERY COMMON non-cancerous growth that is slightly raised and has a warty surface.  SKs are typically tan/brown but can range from white to black and sometimes look like moles or warts.  They appear in middle-age and increase in number and size as you get older.  SKs can appear almost anywhere on the skin.  Because SKs are harmless, they often do not need treatment.  However, if they are bothersome or easily irritated, SKs can be removed by freezing them or scraping them off.   
Warning:  Many if not all insurance classify SKs as cosmetic and do not pay for their removal.

Skin cancer is the most prevalent of all types of cancers.  Fair-skinned people who sunburn easily are at higher risk for developing skin cancer. The three types of skin cancers are Basal Cell Carcinoma (the most common), Squamous Cell Carcinoma, and Melanoma (the most aggressive).

At Roseville Dermatology, we recommend and perform full body skin exams for all of our patients. Patients with a history of skin cancer should have complete skin exams regularly by a dermatologist and report any changes in moles or lesions. Fortunately, skin cancer is treatable if caught early. Treatment depends on the type of cancer, its location, and the needs of the individual.

• Surgical excision
• Curettage & Electrodessication (C&D, “scraping and burning”)
• Mohs surgery
• Prescription topical chemotherapy such as Aldara and Efudex
• Radiation therapy

Skin tags are very common benign skin growths that look like small, soft/fleshy bumps of hanging skin.  They tend to occur on the neck, armpits, groin folds, under breasts, and eyelids. A person may have anywhere from one to hundreds of skin tags.  They are more common in overweight people.  Although skin tags are harmless and usually do not need to be treated, they can be annoying or undesirable cosmetically.  We can easily remove them by cutting them off or freezing with liquid nitrogen.  Removing them will not cause more tags to grow.  Rather, most people will continue to develop new skin tags periodically. 

Warning:  Many insurance classify skin tags as cosmetic and do not pay for their removal.

Warts are skin growths that are caused by a virus called human papillomavirus (HPV).  There are several types of warts, including common warts, plantar warts (on the feet, most difficult to treat), and flat warts.  We have several methods to treat warts, depending on the size, number, and type of wart as well as the age of the patient.  Warning:  Most warts require MULTIPLE repeated treatments every 3 weeks.  In addition, there is no cure for the wart virus, which means that warts can return at the same site or appear in a new spot, even if they have been treated before.

• Freezing (Cryotherapy)—the most common treatment
• Cantharidin Plus
• Electrosurgery and Curettage (“scraping and burning”)
• Bleomycin injections
• Contact Immunotherapy (Squaric Acid)—using the patient’s own immune system to get rid of the warts by triggering a allergic reaction to the warts