Skin conditions are unique among health issues. Other conditions, such as high blood pressure or diabetes, for example, can be kept private. But you can’t conceal acne, warts, or wrinkles. Conditions that affect the skin are visible to the outside world.
“That’s why skin conditions aren’t just medical conditions. They also have a psychological impact. I want to improve my patients’ quality of life and help them feel better about themselves,” says Kristina J. Liu, MD, MD, MHS, a dermatologist within the Department of Dermatology at Brigham and Women’s Hospital.
Skin cancer screening
An oddly shaped spot or mole on your skin can be worrying, especially if it’s painful or changing rapidly. The following ABCDE rule can help you tell a normal mole from one that might indicate signs of skin cancer.
- Asymmetry: One half of the mole does not match the other half.
- Border irregularity: The edges of the mole are ragged or irregular.
- Color: The mole has different colors in it. It may be tan, brown, black, or red. It may also have areas that appear to have lost color.
- Diameter: The mole is larger than six millimeters across, about the size of a pencil eraser. But some melanomas can be smaller.
- Evolving: A mole changes in size, shape, or color.
To check your body for signs of skin cancer or pre-cancer, a dermatologist can perform a skin cancer screening exam, known as a total body skin exam. This 15-minute procedure examines your skin from head-to-toe.
“Some spots can be potential life-threatening, so we want to catch them early. The earlier a skin cancer is caught the easier it is to treat, and the better the outcomes are for the patient,” says Dr. Liu.
There are three main types of skin cancer. Basal cell carcinoma and squamous cell carcinoma are more common and more treatable when caught early. Melanoma is a much less common, but is more likely to spread to other parts of the body. Each cancer has different features that a dermatologist is trained to identify.
The following factors may increase your risk of melanoma, the most dangerous type of skin cancer:
- A first degree relative who has had skin cancer
- Having had blistering sunburns
- The use of tanning beds
- Having many moles
- Fair complexion, especially light eyes and red hair
“The most important letter in the ABCDE rule is E for evolving. Many skin cancers arise suddenly, grow rapidly, and change quickly. Obvious symptoms of skin cancer include a painful spot or itching, but skin cancers don’t always produce symptoms,” says Dr. Liu.
If your dermatologist identifies a spot that warrants follow-up, they will perform a biopsy during the visit. The dermatologist will numb the area with anesthesia, and then remove a small piece of skin for a pathologist who will examine it under a microscope.
“How often a patient should have their skin screened depends on their risk factors. If a patient has had skin cancer, they should be screened at least once a year. If they have had a skin cancer in the last few years, they should have their skin checked several times a year,” says Dr. Liu.
Acne
Many patients aren’t bothered by acne. Those who visit their dermatologist are typically experiencing severe acne that may lead to scarring on the face, which can affect a person’s wellbeing.
“When I meet with an acne patient, I first get a sense of how long they have been experiencing acne, the types of treatments they have tried, what their goals are, and what types of treatments they might want to try,” says Dr. Liu.
A dermatologist will begin their evaluation by examining the face, chest and back. They look for different types of acne, such as blackheads, whiteheads, pimples, and cysts. They also examine the skin for “scars,” which fall into the following two categories.
- Post-inflammatory hyper-pigmentation: Reddish or dark marks where a pimple has been. These marks improve over time, but it can take several months.
- Contour irregularities: Scars can be raised or concave. Softening these scars often requires laser treatment, or resurfacing treatment.
Acne treatments must be tailored to the patient’s specific type of acne. A dermatologist may employ a combination of treatments, including topical medication (e.g., creams, gels and washes), and/or oral medications.
“Severe acne can be treated with Accutane (isotretinoin), an oral medication that can produce excellent and durable results, if used for approximately six months. It’s a strong medication, so it requires monthly visits and regular blood work, but it’s a great option for patients with severe acne, or for patients who are experiencing scarring,” says Dr. Liu.
If you are treating acne at home, it’s important not to spot-treat pimples with a gel or cream, according to Dr. Liu. Acne medications are most effective when used to treat the whole face. It’s impossible to predict where a new pimple will emerge. Treating the whole face helps prevent new acne from forming.
Preventing acne involves maintaining good facial hygiene. This includes washing your face regularly, especially after sweating. Women should remove makeup before bed, and choose skin care products that are oil-free and water-based. Look for makeup labeled “noncomedogenic,” which doesn’t clog pores.
“There’s no strong evidence to prove a relationship between food and acne. Eating a well-balance diet has many health benefits, but I don’t advise people to change their diet or avoid specific foods to help with their acne,” says Dr. Liu.
Rosacea
An estimated 15 million people in the United States have rosacea, a common chronic skin condition that causes redness, flushing, and dilated blood vessels in the face. Some patients may also experience eye symptoms, such as stinging, dryness, or redness.
Many factors can trigger a flare-up of rosacea. The causes are both genetic and environmental. The main environmental risk factor is sun exposure, so patients with rosacea should wear sunscreen whenever possible. Other risk factors may include alcohol, caffeine, chocolate, or spicy food.
A dermatologist will tailor a treatment to your specific condition. Redness and flushing can be treated with redness-relief creams. Redness can also be reduced with a laser therapy that targets blood vessels. Acne-like bumps can be treated with a topical medication that reduces inflammation in the skin. For severe rosacea, a dermatologist may recommend oral antibiotics.
Warts
It’s important to visit your dermatologist, if warts are growing in number, are painful, or appear in a sensitive location, such as the face, or on the bottom of the feet.
“Warts can go away on their own and many people aren’t bothered by them. For example, if I find a wart incidentally during a skin exam and the patient isn’t bothered by it, I’m not bothered by it,” says Dr. Liu.
Treatment for warts depends on the size, number, and location. A common treatment is to spray warts with liquid nitrogen. The extreme cold destroys wart-infected cells on the skin.
Another option is to inject medicine directly into the wart. A common injectable medication called Candida antigen can help the immune system recognize and fight warts. A dermatologist may also prescribe medicated creams, which patients can use at home.
Patients can use prescribed wart treatments in combination with at-home treatments, such as over-the-counter liquids, sticks, or plasters, many of which contain salicylic acid, a common wart treatment.
Warts are transmitted by a strain of HPV virus. The HPV strain that causes warts on the hand or feet is not the same virus that causes oral or genital herpes, or genital warts. Warts are contracted by coming into contact with the wart virus, but the virus is ubiquitous in our environment. If you have a wart on your hand, you aren’t contagious and shouldn’t be afraid of passing it on to others.
Wrinkles
Many patients visit their dermatologist looking to combat the effects of aging. They may notice bags under their eyes, crow’s feet, or sagging cheekbones. Such changes, including the appearance of wrinkles, can affect how youthful or beautiful you feel.
“I can’t reverse 20 years with a cosmetic treatment, but I can help make a patient look more refreshed by softening lines, or plumping up the skin in certain places. I want to help a patient feel better, but still look like themselves,” says Dr. Liu.
There are numerous commercial creams available to help treat wrinkles. Tretinoin is a FDA-approved anti-wrinkle cream used to treat fine lines. Another commonly used treatment for wrinkles is Botox®, which softens wrinkles by relaxing facial muscles. A Botox treatment typically lasts three-to-four months. Your dermatologist may also recommend filler injections that can plump up the skin and restore facial volume.
“It’s important that these treatments be performed by a board-certified dermatologist who regularly performs these procedures. You want to get the best cosmetic outcome, but also make sure your treatments are performed in the safest way possible,” says Dr. Liu.
Same/Next-day Dermatology Appointments
If you are concerned about a skin condition, you most likely want to see a dermatologist right away. The Department of Dermatology at the Brigham recently expanded availability for general dermatology appointments.
“We pride ourselves on making time available for patients who are concerned about an issue with their skin and want to be seen quickly. We don’t want patients waiting for days, or weeks. Our dermatologists are compassionate, empathic physicians who put patients first,” says Dr. Liu.
To make an appointment with a dermatologist at the Brigham, please call (617) 525-9496, or email at bwhdermappointments@partners.org.
– Dustin G.
