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Acne
Alopecia Areata (Hair Disorders)
Eczema
Pigment Abnormalities: Melasma
Pigment Abnormalities: Vitiligo
Psoriasis
Rosacea
Seborrheic Keratosis
Types of Skin Cancers
Warts
XTRAC Laser

Acne

Acne affects 85 percent of all teenagers and 20 percent of adults. It most commonly occurs on the face in teenagers and young adults, but can affect other areas such as the neck, trunk, arms and buttocks. The acne blemishes you see today formed several weeks ago. Deep within your pores, sebaceous glands produce sebum, an oil that hydrates skin and keeps it supple. Skin constantly renews itself, so old cells die and mix with your skin’s natural oils. Normally, these dead skin cells shed to reveal fresh, new skin.

But some cells shed unevenly and clump together to form a plug, that traps oil and bacteria inside the follicle, causing it to swell. Your body responds by attacking the bacteria with white blood cells and a few weeks later, a pimple pops out. Acne ranges from milder comedonal (blackheads and whiteheads) to moderate (pustular) to severe, cystic breakouts. In many cases,several or all of these forms of acne can be present at one time.

Central Carolina Skin & Dermatology will evaluate your acne condition to establish a specific and effective diagnosis, define and eliminate potential flare factors, and explain the appropriate treatment. Topical acne therapies include cleansers that remove excessive surface skin oil, retinoids that unlock plugs from within the follicle, and benzoyl peroxides and antibiotics that suppress bacterial overgrowth and inflammatory activity in the oil glands. Oral acne treatments consist of various antibiotics and hormonal preparations, including oral contraceptives and Accutane.

Alopecia Areata (Hair Disorders)

Alopecia areata is characterized by non-scarring hair loss of unknown etiology. Manifestations are most frequently limited to a few oval bald patches. However, a minority of individuals develop extensive areas of hair loss or even loss of all body hair (alopecia totalis or universalis). The cause or mechanics of alopecia areata are poorly understood. However, we do know that the reason for hair loss is due to inflammation of the hair follicle. The treatment is aimed at suppressing inflammation.

Eczema

Eczema, also known as atopic dermatitis, is a general term for a group of lifelong conditions that affect 1 in 18 people and cause the skin to become inflamed, red, dry and itchy. Patients with eczema have very sensitive skin and tend to have a lover threshold for allergies. In some cases of eczema, a rash might develop in one area or over the entire body. Patients with eczema tend to have “atopic tendencies”. This means they have developed any or all of three of the following closely linked conditions: atopic dermatitis, asthma and hay fever.

Adult eczema most often develops on hands, elbows and “bending” areas, such as the inside ofan elbow or back of a knee. In young children, eczema most often develops on the elbows, knees, face, neck and scalp.

Eczema’s exact cause is unknown, but evidence suggests it may be genetic because it often affects people who have a personal or family history of asthma, hay fever or other allergies. Eczema symptoms typically flare up when a person is exposed to certain triggers, which may include skin irritants, allergens, climate factors, the environment and stress.

Treatment varies depending on symptoms and triggers. No one treatment is best for everyone, and Central Carolina Skin & Dermatology’s objective is to prescribe medicine that reduces itching and discomfort, clears infections and prevents additional flare-ups. Treatment options consist of prevention, skin care, medication and phototherapy.

Pigment Abnormalities: Melasma

Melasma occurs when estrogen and/or progesterone stimulate pigmentation hormones to produce irregular-sized dark brown or grey patches on both sides of an adult’s face. These patches typically appear on the cheeks, bridge of the nose, forehead or upper lip, and occur most frequently in darker skinned women, although it also affects lighter skinned men and women. Individuals with a family history of melasma are more likely to develop the condition. Changes in hormonal status, such as pregnancy, may trigger melasma. Birth control pills and sun exposure are also known to activate melasma.

Sunscreen with an SPF of 30 or higher is one treatment for melasma because it protects against the sun’s UVA and UVB rays, which can trigger melasma during even limited outdoor activities such as walking down the street, driving a car or sitting next to a window. Bleaching creams also work well. These creams don’t bleach the skin, but rather decrease pigmentation production. Over-the-counter creams contain low concentrations of hydroquinone, the most commonly used de-pigmenting agent. At Central Carolina Skin & Dermatology, we may prescribe creams with higher concentrations of hydroquinone for melasma when appropriate, and it usually takes about three months to substantially improve the condition.

Melasma management requires a comprehensive and professional approach. Central Carolina Skin & Dermatology partners with melasma patients to provide close supervision, for a successful outcome.

Pigment Abnormalities: Vitiligo

Vitiligo is a chronic skin disorder causing white patches of skin to appear on the body due to loss of pigment. This happens when pigment-making cells in the skin, called melanocytes, are destroyed. The cause of vitiligo is complex and not fully understood. Some evidence suggests a combination of autoimmune, genetic and environmental factors are to blame. Vitiligo usually develops before a person’s 40th birthday and can also affect mucous membranes and the eye area. Vitiligo’s course and severity differs with each person. Vitiligo is obvious year-round on darker skinned people, while fair-skinned people usually notice the contrast between vitiligo patches and suntanned skin only in the summer.

The degree of pigment loss varies within each vitiligo patch. Different shades of pigment may appear within a patch, or a border of darker skin may encircle an area of light skin. Vitiligo often begins with a rapid loss of pigment that may continue until, for unknown reasons, the process suddenly stops. Cycles of pigment loss may follow periods of inactivity and continue indefinitely. Sometimes the best treatment for vitiligo is no treatment at all. In mild cases, makeup and other camouflaging solutions may hide vitiligo patches. Fair-skinned people can blend in patches of vitiligo with normal skin by avoiding tanning. Safe stains that dye the skin can also help match white patches to normal skin color. Self-tanning compounds, which contain a chemical that does not require melanocytes to tan skin, can also help hide white patches. These compounds won’t change the condition, but can improve its appearance.

Dermatologists traditionally prescribe topical corticosteroid cream to treat vitiligo, which can effectively return pigment to white patches. However, these creams can thin the skin in certain areas and should be used only as prescribed. Research offers hope for new treatments but a cure has not yet been found.

The XTRAC Laser is an excellent treatment for Vitiligo as it produces a highly effective, safe, and painless therapy by delivering a targeted, super-narrow UVB band to affected areas, resulting in effective and rapid improvement without the worry of harmful side effects of invasive, systemic agents. Most insurance companies cover the XTRAC Laser Treatments for vitilago.

XTRAC Before and After Example:


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Psoriasis

Psoriasis is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and lesions form. About 80% of people living with psoriasis have plaque (plak) psoriasis, also called “psoriasis vulgaris.” Plaque psoriasis causes patches of thick, scaly skin that may be white, silvery, or red. Called plaques (plax), these patches can develop anywhere on the skin. The most common areas to find plaques are the elbows, knees, lower back, and scalp.

Psoriasis also can affect the nails. About 50% of people who develop psoriasis see changes in their fingernails and/or toenails. If the nails begin to pull away from the nail bed or develop pitting, ridges, or a yellowish-orange color, this could be a sign of psoriatic (sore-EE-at-ic) arthritis. Without treatment, psoriatic arthritis can progress and become debilitating. It is important to see a dermatologist if nail changes begin or joint pain develops. Early treatment can prevent joint deterioration. In the United States, nearly 7.5 million people have psoriasis and about 150,000 new cases are diagnosed each year. Studies indicate that psoriasis develops about equally in males and females. A family history of psoriasis seems to increase the risk of developing psoriasis. It is important to know that a family history of psoriasis does not guarantee that someone will develop psoriasis.

Psoriasis can begin at any age, from infancy through the golden years. There are, however, times when psoriasis is most likely to develop. Most people first see psoriasis between 15 and 30 years of age. About 75% develop psoriasis before they turn 40. Another common time for psoriasis to begin is between 50 and 60 years of age. Psoriasis is a life-long condition, it is important to take an active role in managing it. Learning more about psoriasis, seeing a dermatologist to discuss treatment options, and developing a healthy lifestyle can help people live life to the fullest.

The XTRAC laser is an excellent treatment for most plaque psoriasis patients who have not obtained satisfactory results with topical treatments. The XTRAC delivers a special wavelength of UVB light directly at the plaques, avoiding exposure to normal healthy skin. Each treatment is painless and takes only a few minutes. Treatments are generally given twice per week, and significant improvement is obtained in an average of 6 to 10 treatments. Most major insurance companies and medicare will cover these treatments. Please call our office for more information.
XTRAC Before and After Examples:


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Rosacea

Rosacea is a chronic skin condition that causes the facial skin to flush. Some individuals may also experience swelling and sores depending on the specific type a person has. Subtype 1, the least intense form of rosacea, consists of facial redness, flushing, and visible blood vessels. Subtype 2 causes acne-like breakouts, subtype 3 causes the skin to thicken, and subtype 4 causes eyes to become dry, itchy, and appear bloodshot.

Rosacea can affect anybody, but it typically occurs in fair-skinned individuals between the ages of 30 and 50 who have a family history of rosacea or severe acne. Scientists are unsure of what exactly causes people to experience rosacea and there is no known cure. Occasionally rosacea will clear up by itself after a few years, but some individuals will experience flare-ups for the rest of their life.

Treatment for rosacea depends on the subtype and often includes the application of a topical medicine, lasers and other light treatments, and antibiotics. Rosacea resulting in thickened skin is treated by dermatologists with lasers, dermabrasion, and electrocautery. Rosacea in the eyes is treated with a prescribed eye medicine and wash. To best avoid flare-ups, it’s important to try to learn what triggers them and avoid those triggers.

Seborrheic Keratosis

Seborrheic keratoses are dark skin growths that appear in adulthood. Although they may be large and grow quickly, they are benign. They are not caused by sun damage so they may be typically found on areas both covered and uncovered by clothing. Seborrheic keratoses tend to run in families. Initially, they appear as slightly raised, light brown spots and evolve into darker, thicker lesions with rough, warty surfaces.

Seborrheic keratoses are generally harmless, and there aren’t many treatments beyond removing them. Some people choose to have them removed if the growths become unsightly, itch, or become irritated from rubbing against clothing. Removal methods include cryotherapy, shave biopsy, laser surgery, and curettage and cautery. Because of their appearance, seborrheic keratoses can be confused with other skin growths, such as warts, moles, and the more worrisome actinic keratosis (AKs) and melanoma. See your doctor if you have concerns about such growths on your skin.

Dermatologists traditionally prescribe topical corticosteroid cream to treat vitiligo, which can effectively return pigment to white patches. However, these creams can thin the skin in certain areas and should be used only as prescribed. Research offers hope for new treatments but a cure has not yet been found.

Types of Skin Cancers

Actinic keratoses (AK) patches or lesions mark the earliest stage of skin cancer development. These small, scaly spots typically occur on the face, ears, neck, scalp, hands, arms and legs of people who have experienced significant sun exposure. AKs can form above or below the skin’s surface, are only a few millimeters in size, and can be flat or raised. They are typically harmless, but 20 percent of them may become cancerous, and patients can have up to 10 times as many undetected AKs under the skin’s surface as visible ones.

Basal cell carcinoma (BCC) is the most common type of skin cancer and appears frequently on the head, neck and hands as a small, fleshy bump, nodule or red patch. These slow-growing tumors do not spread to other areas of the body, but if left untreated they often begin to bleed, crust over, heal and repeat the cycle. Basal cell carcinoma can also extend below the skin to bones and nerves, causing considerable local damage.

Squamous cell carcinoma (SCC) is the second most common skin cancer and typically appears as a bump or red, scaly patch on the face, lips, mouth or rim of the ear. Squamous cell carcinoma can invasively develop into large masses, then spread to other parts of the body. Therefore, it’s very important to seek early treatment.

Malignant melanoma is the most deadly of all skin cancers, but is completely curable when found and treated early. Melanoma tumors grow from melanocytes – cells that make pigment in the skin – and are typically tan, brown, black, white or even red. Melanoma may appear suddenly or begin in or near a mole or other dark spot in the skin. It’s important to know the location and appearance of moles on the body to detect changes as early as possible. A dermatologist should examine any mole that changes, since early melanoma can be removed while still in its curable stage.

Warts

Warts are growths on the skin caused by the human papillomavirus (HPV). They are very common, particularly in school-age children. Warts spread by direct contact to other parts of the body, or to others. They are painless unless they appear on the soles of the feet. Warts are sometimes described by their appearance or location.

Common Warts (verruca vulgaris) can appear anywhere on dry skin, but they are more commonly seen on the hands. They can appear in clusters.

Flat Warts are often on the face or legs. They are smaller and can be difficult to see.

Plantar Warts (foot warts) are located on the soles of the feet. The weight of the body pushes them into the deeper tissues, which can make them painful.

The virus is very common. Most people who are exposed to the virus do not develop warts. This is because their body’s immune system recognizes the HPV virus and attacks it before it can start a growth. The HPV virus enters the skin through a small scratch or wound. This explains why warts often appear around fingernails where the skin is often dry or cracked. After the skin becomes infected by the HPV virus, skin cells to start reproducing more rapidly. This creates small bumps where the skin becomes a bit thicker than the surrounding skin. The infected skin may also have a slightly different color. It can take 12 months for the growths to appear after an infection with the virus.

XTRAC Laser

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Since receiving FDA clearance in 2000, XTRAC Lasers have come to be recognized by dermatologists worldwide as the market leader in the treatment of psoriasis and vitiligo. XTRAC Lasers produce a highly effective, safe, and painless therapy by delivering a targeted, super-narrow UVB band to affected areas, resulting in effective and rapid improvement without the worry of harmful side effects of invasive, systemic agents. XTRAC Laser treatments are covered by ALL major insurance companies, including Medicare for psoriasis, and many cover XTRAC for the treatment of vitiligo.

Applications:
Psoriasis, Vitiligo, Atopic Dermatitis (eczema), Leukoderma


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