Medical Dermatology at DermWellesley
At DermWellesley, we treat the entire spectrum of skin conditions and concerns. Some of the more common medical dermatology problems we can evaluate and treat include (but are certainly not limited to):
Allergic Contact Dermatitis🤔WHO? Anyone!
🤷WHAT? Allergic contact dermatitis is a type of delayed hypersensitivity reaction that occurs after an exposure to an allergen. It usually presents as a rash on the skin about 24 to 48 hours after contact. Often, the skin eruption will be very geographic with sharp margins.
💁WHAT CAN YOU DO? Allergen avoidance is key to preventing contact dermatitis. If you do have contact dermatitis, based on the severity, your provider may recommend a cortisone cream or pills.
Acne🤔WHO? Acne affects all genders, races, and ethnicities. While it is most common in adolescents, acne also can affect adults. It is more common in adult women as compared to men.
🤷WHAT? Acne most commonly affects the face, back, and chest. Some types of pimples may look inflamed or cystic, while others may look like small blackheads or whiteheads.
🤷WHY? The cause of acne is multifactorial. There are several key factors that can lead to acne formation, including inflammation, bacteria, follicular hyperkeratinization, and sebum.
💁WHAT CAN YOU DO? There are many options for treating acne, including topical creams, oral antibiotics, hormonal manipulators, and isotretinoin. Lasers and peels can also be used to treat acne.
Actinic Keratosis🤔WHO? Actinic keratoses are more common as one ages, but can be seen in young people as well.
🤷WHAT? Rough, gritty and scaled growths that are common in sun exposed locations on the
body. These are consider “pre cancer” because it is possible that, if left untreated, these can
progress into non-melanoma skin cancer.
👉WHERE? Actinic keratosis present as gritty, rough spots in sun exposed locations.
🤷WHY? Actinic keratoses are caused by UV damage to the skin.
💁WHAT CAN YOU DO? Actinic keratosis should be evaluated by your doctor. There are several
treatment options available including liquid nitrogen therapy, treatment with a topical cream
and photodynamic therapy. Your doctor will discuss the risks and benefits of each.
Angiomas🤔WHO? While cherry angiomas are much more common in adults, they can be seen in young people as well.
🤷WHAT? A cherry angioma is a completely benign overgrowth of blood vessel cells. They are
called “cherry” angiomas because they are bright red like a cherry,
👉WHERE? These red dots can pop up anywhere!
💁WHAT CAN YOU DO? Angiomas are completely benign, so no treatment is needed. If your
angioma is bothersome to you cosmetically, you may be a candidate for the aerolase laser,
which can zap the spots quickly and painlessly and make them go away. If your angioma is
bleeding, ask your doctor about other treatment options.
Basal Cell Carcinoma🤔WHO? Anyone! Most common in adults and those with fair skin.
🤷WHAT?: Basal cell carcinoma is the most common type form of skin cancer. They can present in
a variety of different ways. Sometimes they are pink and scaled, sometimes, shiny, sometimes
raised and pearly appearing. They may bleed or get sore.
👉WHERE? These can pop up anywhere, but are more common in areas that have had a lot of
🤷WHY? Basal cell cancers are almost all due to high intensity ultraviolet light exposure. This can
be from the sun or from indoor tanning.
💁WHAT CAN YOU DO? If you see a new growth or sore on your skin or have an area that is not
healing, let your doctor perform a skin check and evaluate the area. If you are diagnosed with a
basal cell, your doctor will review treatment options with you depending on what type of basal
cell it is. Common treatments include surgical excision or Moh’s micrographic surgery, creams,
or a procedure called an electrodessication and curettage.
Eczema🤔WHO? Eczema is a very common skin condition seen in children and often presents before the age of one. According to the American Academy of Dermatolgy, 90% of people get eczema before their 5th birthday. It usually improves as the child ages, but may persist into adolescence or adulthood.
🤷WHAT? Eczema looks like dry, flakey, red and scaled patches that are often thickened from all of the scratching. It can be very uncomfortable for a child and can sometimes cause the skin to weep. Eczema can sometimes become infected.
👉WHERE? Eczema presents as dry, itchy patches and is commonly seen in different locations based on your age. In babies, it is common to see it on the face and in older children, it is more common on the backs of the legs and the inside of the elbows., the wrists, ankles and elbows. In some cases, if the eczema is severe, It can be seen more diffusely.
🤷WHY? There is still much to learn about all of the causes of eczema. The current thought is that it is multifactorial and has to do with environment, genetics, and the immune system.
💁WHAT CAN YOU DO? Optimize your skincare routine. Try to limit bathtime to 5-10 mins and keep the bath warm (not hot). NO bubble bath. Use a very gentle and pure cleanser that does not have any fragrance. After the bath, pat dry and, while still damp, apply any moisturizing ointment or balm from head to toe. If your doctor has given you a prescription to use for flared skin, use it first and then apply the moisturizing ointment on top. Your doctor may also recommend something called a bleach bath or discuss wet wraps with you
Hair loss🤔WHO? While hair loss is most common in the aging adult, it can be seen in any age group, including kids.
🤷WHAT? There are many different types of hair loss (also known as alopecia) that can be seen on the scalp and body. The specific type depends on the pattern of hair loss and the appearance of the follicle under the microscope. Your provider will review your history and evaluate your scalp and body hair to determine what category of hair loss you might have. On occasion, a biopsy may be performed to further classify your hair and scalp under the microscope. Combining all of the information, your provider will help to determine the type of loss you have and can recommend treatments.
👉WHERE? Hair loss is most common on the scalp, but loss can also be seen in the brows, lashes, and in body hair.
💁WHAT CAN YOU DO? There are many treatments for hair loss that can be discussed with you during your visit. The treatment that is best for you depends on your specific type of hair loss.
Keratosis Pilaris🤔WHO? Keratosis pilaris is incredibly common and can be seen in both children and adults. It is more common in those who have dry skin or eczema or who have a family history of keratosis pilaris.
👉WHERE? Keratosis pilaris is most common on the upper arms and can also be seen on the thighs, buttocks, face, or back.
🤷WHY? Keratosis pilaris is due to the retention of keratin in the follicular opening.
💁 WHAT CAN YOU DO? KP does not have a cure but may improve with age. Certain acid-based moisturizers or creams can be tried to smooth out the bumps.
Lichen Planus🤔WHO? Lichen planus can occur at any age but is more common in adults.
🤷WHAT? Typically, LP presents as small flat-topped purplish bumps that may be itchy.
👉WHERE? Lichen planus is most common on the wrists and legs but can also be more widespread. Some cases can affect the mouth or genitalia.
🤷WHY? LP is not contagious and the exact cause is still unclear. It has been suggested that perhaps certain allergens, medications, or viruses may be causative.
💁WHAT CAN YOU DO? In some cases, LP will improve with time; however, some cases can be more long lasting. Cortisone creams, light therapy, and oral therapies have all been used to improve lichen planus depending on the severity and symptoms.
Melanoma🤔WHO? Anyone can get melanoma, but it is most common in fair-skinned individuals and in those with who have experienced excessive sun exposure. It is also more common in those with a family history and many moles. While it is more typically seen in adults, it is one of the most common types of cancers in those under 30.
🤷WHAT? Melanoma is a life-threatening skin cancer that arises in the cells that produce pigment (melanocytes). It commonly presents as a new or changing mole on the skin, but some melanomas have little to no color.
👉WHERE? Melanomas can occur anywhere on the body but is most likely found on areas that experience excessive sun exposure. Men are more likely to develop melanoma on their head, neck, or trunk, while for women, melanoma is more common on the arms and legs.
💁WHAT CAN YOU DO? If you are worried about a new or changing mole, call your dermatology office immediately and ask to be seen urgently. Early diagnosis is essential for this aggressive type of skin cancer.
For more information about melanoma, melanoma education, or support after a diagnosis of melanoma, visit www.impactmelanoma.com.
Molluscum🤔WHO? Children are most likely to get molluscum, specifically children under the age of ten. Children who live in warmer climates can fall victim to molluscum. Also, those in overcrowded areas can catch it. Adults can also get this infection, but it is more common in younger generations.
🤷WHAT? Molluscum is a common viral skin infection. This condition forms localized clusters of epidermal papules (elevated skin lesions) called mollusca. These are flesh-colored or pearly in appearance.
👉WHERE? The virus tends to form in moist places of the body. Some common areas include the armpits, behind the knees, and in the genital areas.
🤷WHY? Molluscum is caused by a poxvirus. It can be spread through means of:
- Sexual transmission
- Skin-to-skin contact
- Indirect contact with shared items
- Being in environments such as pools and baths with others who are infected
💁WHAT CAN YOU DO? Laser therapy and cryotherapy can be used to address molluscum. Other means such as antiseptics like hydrogen peroxide and products that contain salicylic acid can make a drastic difference in their appearance. Though it is a self-resolving condition, it is often better to seek treatment to prevent transmission.
Nevi🤔WHO? This condition can impact anyone. About 1% of people are born with one or more nevi. Nevi, or moles, tend to impact fair-skinned people more often than those with deeper complexions. Moles that appear on children tend to be permanent. They can also appear later on in life due to sun exposure. Also, people with numerous moles have a family history of this issue.
🤷WHAT? Nevi are skin lesions that may appear in multiple forms. They may be flat or raised, they can vary in color, and their size can vary.
👉WHERE? Moles appear anywhere on the surface of the skin.
🤷WHY? The exact reason for moles is unknown. Their formation is impacted by genetic factors, sun exposure, and immune-system health.
💁WHAT CAN YOU DO? Nevi tend to be harmless. People remove them in order to:
- Ensure they aren’t a result of cancer
- Prevent irritation by clothing, combs, and razors
- Make an area look more aesthetically pleasing
Perioral Dermatitis🤔WHO? Those who are impacted by perioral dermatitis vary in age. This condition is most evident in women from ages fifteen to forty-five. This condition is not common in men.
🤷WHAT? Perioral dermatitis appears in the form of a rash on the skin.
👉WHERE? This condition affects the area around the mouth and the nostrils. It can also affect the regions around the genitals and the eyes.
🤷WHY? The cause of perioral dermatitis is unknown. This condition may be related to epidermal barrier dysfunction, activation of the innate immune system, bacteria, and altered cutaneous microflora. This condition can be triggered by topical steroids, nasal steroids, face creams, and neglecting to wash the face.
💁WHAT CAN YOU DO? This particular dermatitis responds well to topical therapy. Some topical therapy methods include erythromycin, clindamycin, metronidazole, and azelaic acid.
Pityriasis Rosea🤔WHO? Pityriasis rosea most often impacts teens and young adults. However, it can affect anyone at any age.
🤷WHAT? Pityriasis rosea is a rash that typically presents first as a single scaled raised pink-to-red patch (called the “herald patch”) and is then followed by numerous red circular patches. These may be itchy or may be asymptomatic.
👉WHERE? PR is most commonly found on the skin of the chest, back, thighs, neck, or upper arms.
🤷WHY? The exact cause is still unclear, but it is thought that perhaps there is an association with herpesvirus 6 and 7.
💁WHAT CAN YOU DO? PR is self-limiting, which means that it will resolve on its own without any treatment. Occasionally, if you are very itchy, treatment can be provided by your dermatologist.
Psoriasis🤔WHO? Psoriasis affects two to three percent of people worldwide. It can present at any age and is a chronic condition that may be lifelong.
🤷WHAT? Psoriasis is a chronic inflammatory skin condition that typically presents as scaly rough red plaques with an overlying silvery scale. The edges of the plaques are usually well-defined and sharply demarcated. Some patients with psoriasis may develop a type of arthritis called psoriatic arthritis.
👉WHERE? Psoriasis can impact any area of the body. It is most common to find psoriasis on the knees, elbows, and scalp, but plaques can be widespread.
💁WHAT CAN YOU DO? Many patients use topical methods like cortisones and moisturizers to treat their psoriasis. There are also systemic treatment options available, including injectable agents and oral agents. Light therapy is also a popular treatment.
Rosacea🤔WHO? Rosacea is most common in women with fair skin, age 30-60 years old, but can be seen in both women and men of all skin types.
🤔WHAT? Rosacea is persistent or transient redness and visible vessels of the skin, and in some cases red pimple-like bumps can be present as well.
👉WHERE? Most commonly noted on the cheeks, nose, and chin.
🤔WHY? The redness caused by rosacea is due to dilated blood vessels close to the skin surface. The exact cause is unknown but there may be both hereditary and environmental components.
💁WHAT CAN YOU DO? Some people notice certain triggers can cause their rosacea to flare, such as caffeine, alcohol, chocolate, and spicy foods. Avoiding these triggers may help reduce rosacea symptoms. Your dermatologist can prescribe topical and/or oral medications that can help with the symptoms as well.
Seborrheic Dermatitis (Seb Derm)🤔WHO? Anyone, at any age.
🤔WHAT? Persistent red, oily, scaley, flakey, itchy patches of skin.
👉WHERE? Seb derm is most common on the scalp and is most commonly referred to as dandruff in adults, or “cradle cap” in infants. Seb derm may also affect the ears, the face around the corners of the nose, eyebrows, and eyelids.
🤔WHY? The cause of seborrheic dermatitis is unknown, but there may be a fungal component.
💁WHAT CAN YOU DO? For some, seb derm resolves on its own or with regular use of over the counter dandruff shampoo. Your dermatologist may recommend a prescription shampoo or topical cream.
Seborrheic Keratosis (SK)🤔WHO? You can develop an SK at any age, but people typically start to develop more of them as they age.
🤔WHAT? SKs are round light tan, brown, or dark brown non cancerous skin growths. They can be flat or raised and warty-looking. Some people refer to them as “barnacles”, we prefer the term “wisdom spots”.
👉WHERE? They can arise on any area of the body, with the exception of palms and soles.
🤔WHY? The exact cause of the condition is unknown, but the number of SKs you develop (whether you get 1 or 100) seems to be hereditary.
💁WHAT CAN YOU DO? There is no method to prevent SKs from developing, and because they are benign, they do not require treatment. Some people do seek treatment because their SKs become itchy, irritated, or they wish to have them removed for cosmetic reasons. Your dermatologist will evaluate your SKs and discuss the most appropriate options for removal with you.
Shingles🤔WHO? Anyone who has had the chickenpox virus can develop shingles, but it is most common in people over the age of 50, and those with weakened immune systems.
🤔WHAT? Shingles, also known as herpes zoster, is localized blistering and a painful rash.
👉WHERE? The blisters can occur anywhere on the body. They most typically show up in a linear pattern on one side of the body that does not cross the midline.
🤔WHY? Shingles is caused by reactivation of the varicella-zoster (chickenpox) virus. Various triggers can cause shingles to flare, such as stress, or a weakened immune system (which may be due to natural aging, cancer treatment, immunosuppressants). Shingles is not contagious to those who have had the chickenpox, and the virus is not reactivated by coming in contact with another person who has shingles.
💁WHAT CAN YOU DO? If you develop shingles your dermatologist can prescribe antiviral medications, topical creams to help healing blisters resolve. Those at high risk for shingles should discuss having the shingles vaccine with their primary care provider. If you have not had the chickenpox virus, or vaccine, you should avoid direct contact with active shingles blisters.
Squamous Cell Carcinoma (SCC)🤔WHO? Anyone can get a SCC, although they are more common in those with fair skin.
🤔WHAT? This is a cancer that specifically affects the squamous cells of the skin. SCC typically appear as a red flat patch of skin, or a red raised bump that is scaly, crusty, and tender.
👉WHERE? SCC can occur anywhere on the skin, but most commonly develop in sun exposed areas, such as the face, ears, arms, and chest.
🤔WHY? Risk factors for developing SCC are fair skin, excessive sun exposure, sunburns, tanning bed use, and weakened immune system.
💁WHAT CAN YOU DO? The best thing people can do take preventative measures: wear sunscreen, hats, sun protective clothing, and do not use tanning beds. If you develop a SCC, most are easily cured with a minor outpatient surgery.
Skin Cancer Screenings
Tinea Versicolor (TV)🤔WHO? Anyone can develop TV, but it is most common in teens and young adults.
🤔WHAT? TV is a fungal infection of the skin that affects pigment; it causes patches skin to become lighter or darker.
👉WHERE? Although it can appear anywhere on the body it is most common on the shoulders, neck, chest, and back.
🤔WHY? Heat and humidity, hormonal changes, or a weakened immune system can all allow for an overgrowth of yeast/fungus on the skin.
💁WHAT CAN YOU DO? If you are prone to developing TV, you can try to prevent flares by using an antifungal shampoo/body wash (e.g. Selsun, ketoconazole). For active TV infections, your dermatologist may prescribe antifungal creams and/or oral medication.
Vitiligo🤔WHO? Vitiligo occurs in people of all races, and is estimated to affect 0.5-1% percent of the population worldwide. Vitiligo equally affects both men and women.
🤔WHAT? Vitiligo looks like light or white patches of skin or hair due to the loss of pigment in the skin and hair.
👉WHERE? Vitiligo can affect the skin and/or hair on any part of the body. Common places affected by vitiligo are the armpits, near moles and other areas that have been affected by sunlight, and even the eyelids.
🤔WHY? This happens when the cells (called melanocytes) that produce pigment (called melanin) stop functioning or die. The cause can be autoimmune (the immune system starts attacking its own cells), hereditary, or due to an external trigger such as a sunburn, chemical burn, or stress.
💁WHAT CAN YOU DO? There is not a cure for vitiligo, but there are therapies that can help restore pigment. Your dermatologist may recommend topical creams, light therapy, or a combination of bothto help treat vitiligo.
Common Warts🤔WHO? Anyone can get a wart, but they are most common in children, young adults, and people with weakened immune systems.
🤔WHAT? Warts typically look like small bumps that are flesh, white, or tan in color. They often have a rough, cauliflower-like texture and may have small brownish-red dots (which is a vascular supply).
👉WHERE? Warts can appear anywhere on the body but are most common on the hands, feet, and genitals.
🤔WHY? Warts are caused by human papillomavirus (HPV). The virus is extremely common and is spread by direct contact; but because everyone’s immune system is different, not every person who comes in contact with the virus will develop a wart.
💁WHAT CAN YOU DO? Some warts can be successfully treated with over the counter over-the-counter topical medications, such as salicylic acid. If warts are not resolved with over the counter treatments, seeing a dermatologist may be necessary to discuss other treatment options. Other treatment options include laser treatment, cryotherapy, or the use of other acids.
Xerosis🤔WHO? Xerosis can affect people of all races and ages.
🤔WHAT? Xerosis is the medical term for “dry skin”. Dry skin can cause a range of symptoms, such as a feeling of skin tightness, itching, scaling, flaking, redness, peeling, or cracking.
👉WHERE? Skin anywhere on the body can become dry but xerosis commonly affects the hands, elbows, and knees.
🤔WHY? Dry skin becomes much more common as you age. Certain external factors can also contribute to an increase in xerosis; for example, people who live in cold weather, work in fields that require frequent hand washing, or swim in chlorinated pools regularly tend to have more significant symptoms of xerosis.
💁WHAT CAN YOU DO? Moisture can be restored to skin by regularly applying over the counter creams, lotions, and ointments. Xerosis can be prevented by doing your best to avoid, or limit the environmental factors that make skin dry. If xerosis persists, your dermatologist may suggest prescription treatment.