Acne vulgaris is a disorder of the pilosebaceous unit of the skin. The pilosebaceous unit is composed of the hair follicle and its associated sebaceous gland. Acne most commonly occurs in adolescence. However, it can sometimes continue into or start in adulthood. The face is the most common site affected, however, the chest and back may also be involved. Vanguard Dermatology offers a comprehensive array of treatment options including many different topicals, oral medications including accutane, photodynamic therapy or PDT, and chemical peels. The type of treatment will depend on the individual and their acne severity.
An actinic keratosis (AK) is a crusty or scaly lesion that forms on the surface of skin. Another name is a solar keratosis. They are caused by sun exposure and are more common in the older population and fairer skin types. They usually appear on sun exposed areas: face, ears, scalp, neck, backs of hands and forearms, and lips. Often, they can be recognized easier by touch rather than sight due to their crust or scale. We treat all actinic keratoses because they can be the first step in the development of skin cancer, and, therefore, are commonly referred to as precancers. Vanguard Dermatology offers a comprehensive array of treatment options including cryotherapy, topical creams, and photodynamic therapy or PDT.
Alopecia areata is an autoimmune disease in which an individual’s hair follicles are mistakenly attacked by their own immune system, causing arrest of hair growth. It can rarely be associated with other autoimmune diseases. Therefore, a thorough history, physical, and sometimes laboratory evaluation is needed. It appears as smooth, round, bald spots. It can be localized with just a few spots in the scalp and/or beard area or can progress to total hair loss of the scalp (alopecia totalis) or complete body hair loss (alopecia universalis).
Atopic dermatitis is a non-contagious, hereditary skin disorder characterized by chronically inflamed, itchy, dry patches of skin. It can begin in infancy or childhood, and progress into adulthood. The symptoms can wax or wane. Patients with atopic dermatitis are more sensitive to skin irritants and environmental allergens, which can contribute to a flare or “break out”. It often occurs together with other atopic diseases including asthma and seasonal allergies or hay fever. The most commonly affected areas are the inner parts of the elbows and knees. Disease may range from mild to severe. In addition to dry skin care and topical therapy, Vanguard Dermatology is also pleased to offer narrow band UVB light therapy as a treatment option for select patients.
There are many different types of birthmarks and treatment differs based on the type. Your dermatologist will evaluate the type of birthmark and explain treatment options.
Blistering diseases encompasses several different diseases such as bullous pemphigoid, pemphigus vulgaris, dermatitis herpetifomis and epidermolysis bullosa among others. These often have an autoimmune etiology and treatment depends on the disease type.
Bullous pemphigoid is an autoimmune skin disease usually affecting the older population. An individual’s own immune system mistakenly makes antibodies against certain components of their own skin causing itchy blisters to appear on the scalp, trunk, arms, and legs. It can also infrequently affect the mucous membranes (i.e. eyes and mouth). It may be localized to one area or be widespread and severity can vary among patients. Diagnosis is often made by a skin biopsy that is sent for pathology review and immunofluorescence. Treatment depends on severity of disease.
Blood vessels (Telangiectasias)
Telangectasias can appear anywhere on the skin. They very rarely can be a sign of an underlying disease. Many people have benign telangiectasias on their face as part of their rosacea. Treatment options include the Pulsed Dye Laser and sclerotherapy for blood vessels on the legs.
Brown spots (Lentigines)
There are different types and causes of lentigines. A common type are solar lentigines, which are seen after long term sun exposure in areas such as the face, chest/back, forearms, and top of the hands. They are usually very uniform and light brown to dark brown in color. Treatment is usually for cosmetic purpose and can include cryotherapy and/or laser removal. Although lentigines are benign (non-cancerous), they must be carefully examined by your dermatologist during your skin exam to differentiate them from early pigmented skin cancers.
Contact dermatitis can be divided into allergic contact dermatitis and irritant contact dermatitis. Allergic contact is caused when your skin comes into contact with an allergen that sets off an immune reaction in your skin that manifests as an itchy, sometimes blister-like, rash. The rash can sometimes appear hours to days after exposure to the allergen. Some examples are nickel allergy in earrings and poison ivy. Patch testing can be performed to help diagnose which allergen may be causing your contact dermatitis.
Irritant contact dermatitis produces a similar itchy rash but is caused by excessive contact with irritants, rather than an allergy. Irritants include frequent hand washing and water, detergents, soaps, solvents, acids, alkalis, and friction. Irritant contact dermatitis may affect anyone, provided they have had enough exposure to the irritant, but those with atopic dermatitis are especially sensitive. Most cases of hand eczema are due to contact with irritants.
Vanguard Dermatology’s Dr. Michael Shapiro is a member of the American Contact Dermatitis Society and the practice offers patch testing to our patients.
Eczema is a broad term that includes rashes that appear as dry, scaly, itchy patches. Eczema and dermatitis are interchangeable terms. Atopic dermatitis, contact dermatitis, dry skin (asteatotic eczema), and nummular dermatitis all can fall under the term eczema. An important part of treatment is to identify the triggers and contributing factors that cause or worsen eczema. Treatment often involves dry skin care and topical creams that your dermatologist will go over in detail with you during your appointment.
Fungal infections of skin, nail, and hair
Your dermatologist can diagnose these infections clinically and can also do a skin scraping or skin biopsy for further diagnosis. Treatment can be with topical or oral medication.
There are many causes and contributing factors to hair loss. Often a thorough history and physical, and sometimes laboratory work, is needed to identify the cause(s) of hair loss. Treatment depends on the type of hair loss you are experiencing and requires identifying any causative factors. Vanguard Dermatology offers hair restoration as a treatment option for suitable patients.
Hemangiomas are benign growths of endothelial cells (the cells that line blood vessels). The most common type is infantile hemangioma, which occurs in infants and appears shortly after birth. They tend to grow in size and then eventually shrink after an average number of years. Treatment depends on their location, size, and how the hemangioma affects the patient.
Hyperhidrosis (Excessive sweating)
Hyperhidrosis is defined as excessive sweating and can affect the axilla (armpits), palms, and soles. Often, patients complain that their hands and feet are always moist or that they sweat more than average in their axilla, with regular anti-perspirants not helping. Primary hyperhidrosis means that there is not an underlying condition causing the excessive sweating. Treatments for primary hyperhidrosis varies and can include topical medication, iontophoresis, and Botox® injections.
There are many different types of insect bites treated in our clinic including mosquito, bed bugs, fleas, and spider bites.
Keloids are a type of scar that usually grows in excess of the boundaries of the original wound. They can arise soon after the wound was created or many months later. A common site is the earlobes after ear piercing. Treatment includes intralesional steroid injection to soften or flatten the keloid, or surgical excision. There is a risk of recurrence of the keloid after surgical excision.
Lupus is an autoimmune disease that can affect multiple organs of the body. The skin can be affected in systemic lupus erythematous or can be the only system affected such as in chronic cutaneous lupus erythematous (CCLE) and subacute cutaneous lupus erythematosus (SCLE). History, physical, laboratory evaluation, and skin biopsy can aid in the diagnosis. Treatment varies depending on severity of skin involvement and can be in conjunction with a rheumatologist.
Malignant melanoma is a type of skin cancer that arises from the pigmented cells of the skin, called melanocytes. Melanocytes also exist in the eyes and leptomeninges (part of your spinal cord) in addition to the skin. It is the most serious type of skin cancer and as with all cancers, early detection is key. Risk factors for developing melanoma include sun exposure, particularly during childhood, fair skin that burns easily, history of blistering sunburn(s), personal or family history of melanoma, large numbers of moles (especially if there are more than 100), and history of abnormal moles (called dysplastic nevi). It is recommended that if you have any risk factors, you undergo periodic full body skin screenings. You should also perform self- exams. Dermatologists often recommend using the ABCDE mnemonic for checking moles.
A: Is the mole asymmetric?
B: Is the border of the mole irregular or blurry or not well demarcated?
C: Is the color of the mole black or is it darker than the rest of your moles?
Does it have different colors within the mole?
D: Is the diameter of the mole larger than 6mm or the diameter of a standard pencil eraser?
E: Evolution: Is the mole changing?
Please note that this is a gross rule of thumb. If your moles fit any of these criteria, you should have your moles checked by a dermatologist. It is highly recommended that every new patient to Vanguard Dermatology undergo a full body skin screening whether or not they have any risk factors. In addition, your dermatologist will give advice on proper sun protection including sun protective clothing and sunscreens.
Melasma is caused by overproduction of melanin in the skin. It usually appears as brown or hyperpigmented patches, usually in sun exposed areas and most often on the face. It is more common in people who tan easily or have darker skin, rather than fair skin types. It may have certain triggers. Sun protection and sunscreen are important aspects of treatment. Other treatment options include topical creams and chemical peels.
Moles (nevus for singular and nevi for pleural) are common proliferations of pigmented cells, otherwise known as melanocytes. Most often, moles are benign (not cancerous). Infrequently, they may be precursor lesions to melanoma, a type of skin cancer. Please see above section under melanoma for screening recommendations for moles. Moles can be removed for cosmetic purposes or biopsied if they are atypical.
Morphea is also known as localized scleroderma and is an uncommon skin condition, in which areas of the skin become thickened and/or hardened. It is caused by excessive collagen deposition and can be localized or widespread. Treatment varies depending on severity of disease.
Mycosis fungoides is a type of cutaneous T cell lymphoma. Cutaneous T-cell lymphoma is characterized by abnormal or neoplastic proliferations of the T-cell subtype of the immune system within the skin. Clinical appearances of the disease include chronic eczema-like patches, tumors, or widespread redness termed erythroderma. Diagnosis is usually made by skin biopsy, although other tests may be needed. Vanguard Dermatology’s Dr. Michael Shapiro completed a fellowship in cutaneous T-cell lymphoma with Dr. Alain H. Rook at the University of Pennsylavnia Health System.
Cutaneous T-cell lymphoma
Mycosis fungoides is a type of cutaneous T-cell lymphoma. Cutaneous T-cell lymphoma is characterized by abnormal or neoplastic proliferations of the T-cell subtype of the immune system within the skin. Clinical appearances of the disease include chronic eczema-like patches, tumors, or widespread redness termed erythroderma. Diagnosis is usually made by skin biopsy, although other tests may be needed. Vanguard Dermatology’s Dr. Michael Shapiro completed a fellowship in cutaneous T-cell lymphoma with Dr. Alain H. Rook at the University of Pennsylvania Health System.
A widespread array of nail conditions are evaluated and treated including fungal infections, ingrown toenails, infections of the nail, and pigmented streaks. Nail biopsies may be performed depending on the condition being evaluated.
Common pediatric skin conditions seen and evaluated at Vanguard Dermatology include various birthmarks, hemangiomas, atopic dermatitis or eczema, molluscum contagiosum, acne, warts, diaper rashes, and other rashes. All ages ranging from neonates to teenagers are welcome and seen in our practice.
Pemphigus vulgaris is an autoimmune skin disease in which an individual’s immune system mistakenly makes antibodies against certain components of their own skin causing fragile blisters and erosions on the scalp, trunk, arms, and legs. It can also affect the mucous membranes (i.e. eyes, mouth, and genital regions) leaving painful erosions. Diagnosis is often made by a skin biopsy that is sent for pathology review and immunofluorescence. Treatment depends on severity of disease.
Port Wine Stain
Port Wine Stain or nevus flammeus is a type of vascular birthmark known as a capillary malformation. It is present at birth and persists through life. It occurs most commonly on the face. A port wine stain may uncommonly be a part of an underlying syndrome or commonly is an isolated occurrence. One treatment option includes the Pulsed Dye Laser.
Psoriasis is an immune-mediated, genetic disease that affects the skin and/or the joints. According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis. The most common form is plaque psoriasis, in which patches of skin become inflamed and are covered by silvery white scale. Psoriasis can be limited to just a few lesions or can involve larger areas of skin. Vanguard Dermatology offers a comprehensive array of treatment options ranging from topical therapy, narrow band UVB and hand foot PUVA light therapy, and systemic medications including Soriatane, methotrexate, Humira, Enbrel, Remicade, and Stelara.
Rash is a broad term describing pink or red, sometimes itchy or scaly, patches on the body. There are many different causes of a rash and evaluation by a dermatologist is needed to identify the type of rash you may be experiencing.
Rosacea is a common condition clinically characterized by facial redness, often affecting the central face, cheeks, nose and forehead. It can be composed merely of dilated blood vessels (telangiectasias) with associated redness (erythema) or can have acne-like lesions with it also. It commonly occurs in fairer skin types. Severity can vary and treatment options include sunscreen, various topical creams, and oral medication. The eyes can also be affected.
There are some treatment options for scars depending on the type and symptoms associated with a scar. For example, if a scar is raised or itchy, intralesional steroid injection (meaning injection right into the lesion) may help flatten, soften, or decrease the itching associated with a scar. Pulsed Dye Laser may also help diminish the redness associated with a scar. There is also the option of surgical removal for select scars.
Seborrheic dermatitis or seborrhea is a common scaly rash affecting the scalp and/or face. It most often occurs in “oily” areas and has a predisposition for the area of the face between the eyebrows, in the nasolabial folds, and behind the ears. It can be itchy. Treatments most often include medicated shampoos and topical creams.
Seborrheic keratoses are very common, benign skin growths that usually appear as people age. They are commonly known as “age spots”, “wisdom spots”, or “barnacles” and can appear anywhere on the body. They vary from skin colored to tan to very dark and can appear stuck or pasted on the skin. They vary from a flat to a warty appearance. They are one of the most common reasons for a visit to the dermatologist. Some people inherit a tendency to develop many of them. They can also be itchy and irritating, especially when they are in areas of friction such as the braline or waistband. Although seborrheic keratoses are completely harmless, a nevus or melanoma can look similar; therefore, a dermatologist should examine them.
Known as the most type of cancer in the world, there are many causes and contributing factors to skin cancer. Often a thorough history and physical, and sometimes laboratory work, is needed to identify the cause(s) of skin cancer. Often warning signs can occur as uneven moles, change in skin coloring, and development of skin sores. Examinations are decremented at the first signs of suspicious conditions due to ability of this cancer to spread rapidly. Treatment depends on the type of symptoms experienced and identifying causative factors. Vanguard Dermatology offers skin cancer screenings for patients.
Skin infections are often caused by fungus, yeast, or bacteria and less commonly by other organisms. This needs to be evaluated by a dermatologist and treatment depends on the organism and severity of infection.
Skin tags are also called acrochordons and are benign growths that can appear as we age. They can be irritating due to friction with jewelry or clothing and are often found on the neck and axilla (armpits). They can be removed for cosmetic purposes using different methods.
Treatment of ulcers involves a through history and physical to elucidate the underlying condition predisposing the patient to an ulcer. Treatment depends on the ulcer and underlying condition.
Varicose veins can occur alone or be a sign of underlying venous insufficiency and are commonly located on the thighs and lower legs. Treatment includes evaluating for underlying venous insufficiency, compression stockings, and sclerotherapy for the right candidates.
Vitiligo is a type of autoimmune disease in which an individual’s immune system attacks the cells (melanocytes) that make pigment. It can rarely be associated with other autoimmune disease. Therefore, a thorough history, physical, and sometimes laboratory evaluation is needed. It manifests as irregular white or hypopigmented patches on the skin. It can be progressive, chronic, and difficult to treat. Treatment options include topical creams and narrowband UVB therapy.
Warts (also known as verruca), are common growths caused by the human papillomavirus. They are contagious when in contact with the skin of an infected person. There are many different types of human papillomavirus. Most commonly, people get warts on their hands and feet. This problem affects all ages. People can also contract genital warts, and genital warts are a type of sexually transmitted disease. Treatment options depend on the type of warts and location, and includes cryotherapy, cantharidin, topical creams, surgery, pulsed dye laser, and intralesional injection.
There are many different modalities of treatment for wrinkles. These include topicals, chemical peels, microdermabrasion, laser resurfacing, Botox, and injectable fillers. Please see our cosmetic dermatology section for more information.