Treating Papulopustular Rosacea and Facial Redness in a 33-Year-Old Female
A 33-year-old female with papulopustular rosacea was treated at Village Dermatology in Katy and Houston, Texas using customized topical therapy and comprehensive rosacea counseling.
Village Dermatology | Katy & Houston, Texas
Overview
A 33-year-old female presented to Village Dermatology as a new patient with a persistent facial rash characterized by flushing, redness, and acne-like bumps involving both cheeks. Symptoms had been present for several months and were gradually worsening, prompting evaluation by a board-certified dermatologist.
This case highlights the diagnosis and management of papulopustular rosacea, a chronic inflammatory skin condition that commonly affects adult women.
Clinical Evaluation
On examination, the patient demonstrated:
Diffuse facial redness
Inflammatory papules and pustules along the central cheeks
Background flushing consistent with rosacea
The patient appeared healthy, well-nourished, and in no acute distress. Dermoscopic evaluation was performed to further assess the skin findings.
Diagnosis: Papulopustular Rosacea
Based on the clinical presentation, the patient was diagnosed with papulopustular rosacea, a subtype of rosacea marked by redness, flushing, and acne-like lesions. At the time of the visit, the condition was considered inadequately controlled.
Rosacea is a chronic condition that can fluctuate over time and is often triggered by environmental and lifestyle factors.
Treatment Plan
After a detailed discussion of treatment options, a customized rosacea regimen was initiated.
Medical treatment included:
Initiation of a triple rosacea cream applied to the entire face
Continued use of gentle cleansers and moisturizers
The patient was advised to discontinue harsh or irritating skincare products and focus on skin barrier protection.
Patient Education & Counseling
Extensive counseling was provided regarding:
The chronic nature of rosacea
Common triggers, including sun exposure, heat, exercise, stress, alcohol, and spicy foods
The importance of daily sun protection
Expectations for improvement, which typically occurs gradually over several weeks
The patient was also informed that laser and light-based therapies, such as IPL (intense pulsed light) or Clear + Brilliant, may help reduce persistent redness and visible blood vessels in the future.
Cosmetic Concerns: Enlarged Pores
During the visit, the patient also expressed concern about enlarged facial pores. Cosmetic treatment options were reviewed, including microneedling, which stimulates collagen production and can improve skin texture and pore appearance. Pricing and expectations were discussed, and the patient elected to consider treatment at a later date.
Follow-Up Plan
The patient will return to the clinic in 6–8 weeks to assess response to therapy and adjust the treatment plan as needed.
Expert Rosacea Care in Katy & Houston
Rosacea can significantly impact quality of life when left untreated. At Village Dermatology, we offer personalized rosacea treatment plans, combining prescription therapies, skincare guidance, and advanced laser treatments to help patients achieve clearer, calmer skin.
If you are experiencing facial redness, flushing, or acne-like bumps, our dermatology team in Katy and Houston, Texas is here to help.
Case Report: Treating Severe Truncal Acne With Isotretinoin in a Young Adult Male
A 20-year-old male with severe truncal acne was successfully started on isotretinoin therapy at Village Dermatology in Katy and Houston, Texas, highlighting comprehensive acne evaluation, lab monitoring, and advanced treatment options.
by: Dr. Ashley Baldree
Patient Presentation
A 20-year-old male presented to Village Dermatology as a new patient with a long-standing history of moderate-to-severe truncal acne involving the chest, abdomen, and back. The acne had been present for several years and consisted of inflammatory papules, pustules, comedones, and cystic nodules, causing significant physical discomfort and concern for future scarring.
The patient was otherwise healthy and reported no systemic symptoms. Given the chronicity and severity of his acne, he sought dermatologic care to explore more effective treatment options.
Clinical Examination
A focused dermatologic examination was performed, including inspection of the chest, abdomen, and back, with dermoscopic evaluation. The patient appeared well-developed and well-nourished, was alert and oriented, and exhibited no signs of acute distress.
Findings included:
Numerous inflammatory papules and pustules
Open and closed comedones
Cystic and nodular acne lesions on the trunk
These findings were consistent with severe inflammatory acne vulgaris (L70.0).
Diagnostic Evaluation
Given the consideration of systemic therapy with isotretinoin (Accutane), baseline laboratory studies were ordered, including:
Hepatic Function Panel
Triglyceride levels
These tests are standard for patients starting isotretinoin due to its potential effects on liver function and lipid levels.
Treatment Plan: Isotretinoin (Accutane) Initiation
After an extensive discussion of treatment options, risks, and benefits, the patient elected to proceed with oral isotretinoin therapy, an FDA-approved medication for severe, scarring acne.
Treatment protocol included:
Isotretinoin 40 mg orally twice daily, taken with a fatty meal
Target dose of 1 mg/kg/day
Goal cumulative dose of 220 mg/kg
The patient was counseled extensively on:
Common side effects such as dryness, joint aches, photosensitivity, and mood changes
Rare but serious risks including elevated liver enzymes, triglyceride abnormalities, and increased intracranial pressure
Monthly laboratory monitoring and follow-up visits
iPLEDGE compliance and medication safety precautions
Although isotretinoin carries significant teratogenic risk in females, all patients—including males—must comply with monthly monitoring and follow-up visits, which was reviewed in detail.
Supportive Skin Care Counseling
The patient received education on proper acne skincare, including:
Use of non-comedogenic cleansers and moisturizers
Daily broad-spectrum sunscreen SPF 30+
Avoiding harsh or abrasive skin products
He was advised that improvement typically occurs over 2–3 months, with up to 60–80% reduction in acne severity during treatment.
Additional Diagnosis: Eruptive Vellus Hair Cysts
During the visit, the patient was also noted to have eruptive vellus hair cysts on the epigastric skin (L72.8). These benign cysts were discussed in detail.
Management options included:
Observation (often self-resolving)
Topical retinoids
Extraction or minor procedural removal if persistent
At this time, conservative management and reassurance were recommended.
Follow-Up and Monitoring
The patient will return in 1 month for:
Isotretinoin follow-up
Laboratory review
Side effect monitoring
Ongoing monthly visits are planned throughout the treatment course to ensure safety and optimal outcomes.
Why Early Treatment Matters
Severe truncal acne can lead to permanent scarring, pigment changes, and emotional distress if left untreated. At Village Dermatology, we offer evidence-based acne treatments—including isotretinoin therapy—to help patients achieve clear, healthy skin.
If you are struggling with persistent or severe acne in Katy or Houston, Texas, our board-certified dermatology team is here to help.
Case Report: Comprehensive Full-Body Skin Examination in a 73-Year-Old Male
A 73-year-old male underwent a comprehensive full-body skin exam at Village Dermatology in Katy and Houston, Texas, addressing benign lesions, family history of melanoma, and preventive skin care.
Village Dermatology | Katy & Houston, Texas
Overview
A 73-year-old male presented to Village Dermatology for a routine full-body skin examination, an essential preventive service—particularly for patients with a family history of melanoma. The patient reported several longstanding skin growths that were asymptomatic but wished to ensure none were concerning.
This visit highlights the importance of annual skin cancer screenings, early detection, and patient education in older adults.
Full-Body Skin Examination
A thorough dermatologic examination was performed, including evaluation of the:
Scalp and hair
Face, neck, chest, abdomen, and back
Upper and lower extremities
Nails, digits, groin, and buttocks
A dermatoscope was used to carefully assess pigmented lesions. Overall, the patient appeared healthy, well-nourished, and in no distress.
Key Findings & Diagnoses
Family History of Melanoma
The patient reported a family history of malignant melanoma, increasing his lifetime risk of developing skin cancer. While no suspicious lesions were identified during this visit, the patient was counseled on:
The importance of monthly self-skin exams
Monitoring for moles that change in size, shape, or color
Seeking prompt evaluation for any new or evolving lesions
Benign Nevi (Moles)
Several regular, symmetrical, evenly pigmented moles were identified on the back. These lesions showed no concerning features.
Counseling included:
Monthly self-monitoring
Sun protection with broad-spectrum SPF 30+ sunscreen
Reassurance that no treatment is required unless changes occur
Lentigines (Sun Spots)
The patient had light tan sun-induced macules on the forearms, consistent with lentigines.
Education included:
Lentigines are benign and related to cumulative sun exposure
Sun protection can prevent new lesions
Cosmetic treatments are available if desired
Seborrheic Keratoses
Benign, age-related growths were noted on the cheek and back. A courtesy liquid nitrogen (LN2) treatment was performed on a facial lesion for cosmetic reasons.
The patient was reassured that:
Seborrheic keratoses are non-cancerous
They often increase with age
Additional treatment options, including CO₂ laser, are available if needed
Cherry Angiomas
Small, bright red vascular growths were identified on the trunk.
Counseling emphasized:
These lesions are benign
Treatment is optional and cosmetic only
Laser or electrodesiccation can be performed if desired
Onychomycosis (Toenail Fungus)
The patient exhibited changes in the left great toenail consistent with fungal infection. After discussing treatment options, he elected to pursue topical therapy at this time.
Management plan included:
Prescription topical antifungal solution
Education on expectations and recurrence rates
Discussion of oral antifungal therapy as a future option if needed
Dilated Pore
A benign dilated pore was identified on the back. A courtesy extraction was attempted, and the patient was advised that minor surgical removal may be required if it becomes symptomatic.
Preventive Dermatology Matters
Regular full-body skin exams are critical—especially for patients with a family history of melanoma or significant sun exposure. Early detection allows for the most effective treatment and peace of mind.
At Village Dermatology, we provide comprehensive skin cancer screenings and personalized preventive care for patients throughout Katy and Houston, Texas.
Case Report: Managing Persistent Dandruff and Early Hair Thinning in a Young Male
A young male with chronic dandruff and early hair thinning was successfully treated at Village Dermatology in Katy and Houston, Texas using targeted therapy for seborrheic dermatitis and personalized hair loss counseling.
Village Dermatology | Katy & Houston, Texas
Overview
A 19-year-old male presented to Village Dermatology with ongoing concerns of persistent dandruff and scalp itching, along with early signs of hair thinning near the frontal hairline. These issues had been present for several months and were beginning to affect daily comfort and confidence.
This case highlights the importance of identifying seborrheic dermatitis as a chronic inflammatory condition while also addressing early androgenetic alopecia with appropriate counseling and treatment planning.
Clinical Findings
On examination, the scalp demonstrated:
Diffuse scaling and flaking
Areas of excoriation from scratching
Involvement of the scalp and central facial regions
Hair examination also revealed patterned thinning along the frontal hairline and posterior mid-parietal scalp, consistent with early androgenetic alopecia, a common hereditary form of hair loss in young men.
The patient was otherwise healthy, well-appearing, and in no acute distress.
Diagnosis
Seborrheic Dermatitis of the Scalp (L21.8)
Androgenetic Alopecia (L64.8)
Both conditions were discussed in detail, including their chronic nature and tendency to fluctuate with triggers such as stress, sweating, and seasonal changes.
Treatment Plan for Seborrheic Dermatitis
A comprehensive treatment regimen was initiated to reduce inflammation, itching, and flaking while maintaining long-term control.
Prescribed therapies included:
Ketoconazole 2% shampoo (used 1–3 times weekly for maintenance)
Fluocinonide topical solution for short-term use during severe flares
Ketoconazole and hydrocortisone creams for facial and neck involvement
The patient was counseled to:
Allow medicated shampoo to remain on the scalp for 5–10 minutes before rinsing
Avoid applying oils or heavy moisturizers directly to the scalp
Use topical steroids only during flares to prevent side effects
Education emphasized that seborrheic dermatitis is chronic but manageable with consistent care.
Hair Loss Evaluation and Counseling
The patient also reported gradual thinning along the frontal hairline, consistent with male-pattern hair loss. He had been using a compounded topical minoxidil/finasteride formulation for approximately one year.
During the visit:
The genetic and progressive nature of androgenetic alopecia was reviewed
Treatment options including topical and oral minoxidil were discussed
Expected timelines for improvement (at least 6 months) were explained
After reviewing potential side effects and long-term expectations, the patient chose to continue topical therapy at this time. Educational materials on hair loss and PRP therapy were provided for future consideration.
Follow-Up Plan
4-week follow-up to reassess seborrheic dermatitis control
6-month follow-up for hair loss evaluation and treatment progression
Expert Dermatology Care in Katy & Houston
Persistent dandruff and early hair thinning are common concerns in adolescents and young adults. At Village Dermatology, we provide individualized treatment plans that address both medical scalp conditions and cosmetic concerns, helping patients achieve healthier skin and hair.
If you are experiencing itchy dandruff, scalp flaking, or early hair loss, our dermatology team in Katy and Houston, Texas is here to help.
Case Report: Treating Diffuse Actinic Keratoses With Photodynamic Therapy (PDT) in Katy & Houston, Texas
A 67-year-old female with diffuse actinic keratoses was treated with red light photodynamic therapy (PDT) and liquid nitrogen at Village Dermatology in Katy and Houston, Texas.
At Village Dermatology in Katy and Houston, Texas, we frequently care for patients with sun-related skin damage, including actinic keratoses (AKs). These lesions are common in adults with cumulative sun exposure and are considered precancerous, making early detection and treatment essential.
Patient Background
A 67-year-old female presented for a follow-up visit for diffuse actinic keratoses of the face. She had previously been evaluated on November 17, 2025, at which time she underwent her first session of photodynamic therapy (PDT) using red light. She returned for continued evaluation and treatment due to the extent of sun damage and the presence of persistent precancerous lesions.
Clinical Examination
A focused skin examination of the face revealed:
Diffuse erythematous papules
Hyperkeratotic scaling
Lesions distributed across the face and middle sternum
These findings were consistent with diffuse actinic keratoses, a condition commonly seen in patients with long-term sun exposure in sunny climates like Houston and Katy, Texas.
Treatment Plan: Photodynamic Therapy (PDT) – Red Light
Given the number and distribution of lesions, photodynamic therapy (PDT) was selected as an effective field treatment.
PDT Treatment Details:
Treatment Number: 2
Medication Used: Ameluz (1 tube, applied without occlusion)
Incubation Time: 0 minutes
Light Source: 635 nm LED (Red Light)
Illumination Time: 30 minutes
Prior to application, hyperkeratotic lesions were gently curetted to enhance medication penetration. The skin was cleansed and prepped, and protective eyewear was applied. The patient tolerated the procedure well.
Medical Necessity:
Actinic keratoses are precancerous lesions that may progress to squamous cell carcinoma if left untreated. PDT allows treatment of visible and subclinical lesions across a broad area, making it ideal for diffuse sun damage.
Additional Treatment: Liquid Nitrogen Cryotherapy
In addition to PDT, one thicker lesion on the middle sternum was treated with liquid nitrogen cryotherapy, using three freeze–thaw cycles. Cryotherapy remains an effective option for isolated or resistant actinic keratoses.
Post-Treatment Care & Expectations
The patient was counseled on post-procedure care, including:
Avoiding sunlight for 48 hours
Using strict sun protection
Expecting temporary redness, discomfort, and possible scabbing
These effects are normal and indicate that the treatment is working.
Follow-Up
The patient will return for a follow-up visit in one month to assess response and determine if additional treatment is needed.
Expert Actinic Keratosis Care in Katy & Houston, Texas
At Village Dermatology, we offer advanced treatments such as photodynamic therapy, cryotherapy, and full skin cancer screenings to help prevent skin cancer and restore healthy skin. If you have rough, scaly patches or sun-damaged skin, early evaluation is key.
📍 Convenient locations serving Katy and Houston, Texas
Full Body Skin Examination Case Report: Identifying Benign Skin Lesions in a 62-Year-Old Male
A 62-year-old male underwent a full body skin exam at Village Dermatology in Katy and Houston, Texas, revealing benign moles, seborrheic keratoses, lentigines, cherry angiomas, and a cyst, with one lesion treated using liquid nitrogen.
Village Dermatology | Katy & Houston, Texas
Regular full body skin examinations are a critical part of preventive dermatologic care—especially as we age. At Village Dermatology in Katy and Houston, Texas, we routinely evaluate patients for skin cancer and other concerning lesions while also providing reassurance when findings are benign. This case highlights the importance of annual skin checks, even when patients have no specific concerns.
Patient Presentation
A 62-year-old male, new to Village Dermatology, presented for a full body skin examination (FBSE). The patient reported no current concerns but undergoes annual skin monitoring for long-standing lesions. He noted several asymptomatic lesions on the abdomen and right upper back that have been present for years without noticeable changes.
Comprehensive Skin Examination
A thorough dermatologic examination was performed, including evaluation of the scalp, face, ears, neck, chest, abdomen, back, upper and lower extremities, hands, feet, and nails. A dermatoscope was used to closely examine pigmented lesions. The patient declined examination of the genital area, which was respected.
Overall, the patient appeared well, with normal mood and affect, and no signs of acute distress.
Key Dermatologic Findings & Assessment
1. Benign Nevi (Moles)
Multiple regular, symmetrical, evenly pigmented macules and papules were identified. These findings were consistent with benign nevi, requiring no treatment at this time.
Patient counseling included:
Monthly self-skin checks
Monitoring for changes in size, shape, or color
Contacting the office if lesions itch, bleed, or evolve
2. Irritated Seborrheic Keratosis
One inflamed, crusted seborrheic keratosis was noted on the left mid-upper back.
Treatment:
Liquid nitrogen cryotherapy
Two freeze–thaw cycles performed after informed consent
The patient was counseled on expected post-treatment effects, including scabbing or temporary pigment changes.
3. Seborrheic Keratoses (Non-Irritated)
Additional stuck-on, warty brown papules were identified and diagnosed as seborrheic keratoses.
These lesions are benign and common with aging
No medical treatment required
Cosmetic removal is optional
4. Lentigines (Sun Spots)
Light tan macules in sun-exposed areas were consistent with solar lentigines.
Counseling included:
Importance of daily broad-spectrum sunscreen (SPF 30+)
Sun avoidance and protective clothing
Discussion of cosmetic treatment options such as retinoids, chemical peels, and laser therapy
5. Cherry Angiomas
Several bright red vascular papules were noted.
Benign vascular growths
No treatment necessary unless cosmetically desired
6. Epidermal Inclusion Cyst
A subcutaneous cyst with a visible follicular opening was found on the left anterior lateral proximal thigh.
Benign and non-infected
No treatment needed unless painful, inflamed, or ruptured
Patient Education & Prevention
The patient received extensive education on:
Monthly self-skin exams
Sun protection strategies
Proper sunscreen use and reapplication
When to seek dermatologic evaluation
Follow-Up Plan
The patient was advised to return for a routine full body skin examination in one year, or sooner if any lesions change or become symptomatic.
Why Full Body Skin Exams Matter
Even when no symptoms are present, full body skin exams help detect early skin cancer, monitor existing lesions, and provide peace of mind. At Village Dermatology, our board-certified dermatology team proudly serves patients throughout Katy, Houston, and surrounding Texas communities with comprehensive skin cancer screenings and personalized care.
Perioral Dermatitis in a Young Adult Female
A 29-year-old female with a chronic itchy facial rash is diagnosed with perioral dermatitis at Village Dermatology in Katy and Houston, Texas and treated with topical metronidazole.
A Dermatology Case Report from Village Dermatology in Katy & Houston, Texas
Case Overview
A 29-year-old female presented to Village Dermatology as a new patient with a chronic, itchy, red facial rash localized around the mouth and nose. The rash had been present for several months and was moderate in severity. She reported partial improvement with cephalexin, but noted that a previously prescribed oral steroid worsened the eruption.
This clinical pattern raised concern for perioral dermatitis, a common yet often misdiagnosed inflammatory facial condition.
Dermatologic Examination
A focused facial examination was performed using dermoscopy. The patient appeared well-developed, well-nourished, and in no acute distress.
Clinical findings included:
Erythematous papules around the perioral and perinasal areas
Associated itching and irritation
Absence of systemic symptoms
Based on the patient’s history and exam, the findings were most consistent with perioral dermatitis rather than acne or eczema.
Diagnosis: Perioral Dermatitis (L71.0)
Perioral dermatitis is a chronic inflammatory condition that commonly affects young women and is frequently triggered or exacerbated by:
Topical or oral steroids
Cosmetics and makeup
Fluorinated toothpaste
Sun, wind, and environmental exposure
In this case, steroid use likely contributed to worsening symptoms—a classic presentation.
Treatment Plan
Because the patient is currently breastfeeding, treatment options were carefully selected to ensure safety.
Prescribed Treatment
Topical Metronidazole 0.75% Cream (MetroCream®)
Apply to the entire face once to twice daily
Daily Skin Care Regimen
Morning
Wash with a gentle cleanser
Apply metronidazole cream
Apply moisturizer with SPF 30+
Evening
Wash with a gentle cleanser
Apply metronidazole cream
Apply moisturizer on top
Patient Counseling
Minimize cosmetics and facial products
Avoid topical steroids on the face
Use only non-comedogenic skincare products
Understand that perioral dermatitis is chronic and prone to flares
The patient was advised to contact the office if symptoms worsened or failed to improve.
Coexisting Acne
The patient also exhibited comedonal and inflammatory acne. However, acne treatment will be deferred until the perioral dermatitis has resolved, as treating both simultaneously can worsen facial irritation.
Follow-Up
The patient will return in 1 month to assess response to treatment. If improvement is insufficient, topical tacrolimus may be considered.
Expert Facial Rash Care in Katy & Houston, Texas
At Village Dermatology, we specialize in diagnosing and treating complex facial rashes such as perioral dermatitis, acne, and inflammatory skin conditions. Proper diagnosis is essential—especially when steroid exposure complicates the presentation.
If you’re experiencing a persistent facial rash, our dermatology team proudly serves patients in Katy and Houston, TX with evidence-based, personalized care.
Full Body Skin Exam for a Patient with Family History of Melanoma
A 46-year-old male with a family history of melanoma undergoes a full body skin exam at Village Dermatology in Katy and Houston, Texas, including mole evaluation and biopsy of a suspicious lesion.
A Dermatology Case Report from Village Dermatology in Katy & Houston, Texas
Case Overview
A 46-year-old male presented to Village Dermatology as a new patient for a full body skin examination (FBSE) due to a family history of malignant melanoma. The patient denied any personal history of skin cancer or melanoma but sought proactive screening given his increased risk.
Family history is a critical risk factor for melanoma, making routine skin checks an essential part of preventive dermatologic care—especially in sun-exposed regions like Katy, Texas and Houston, Texas.
Comprehensive Skin Examination
A complete FBSE was performed, including evaluation of the scalp, face, neck, chest, abdomen, back, upper and lower extremities, genitalia, buttocks, and nails. The patient had Fitzpatrick Skin Type III and was in overall good health.
Dermatoscopic examination revealed several common benign lesions as well as one pigmented lesion requiring biopsy.
Key Findings and Diagnoses
1. Benign Nevi (Moles)
The patient had multiple benign nevi distributed across the body, including a 10 mm lesion on the inferior thoracic spine. These moles were symmetrical, evenly pigmented, and clinically benign.
Management:
Counseling on the benign nature of nevi
Monthly self–skin examinations
Clinical photography for future comparison
Routine observation
2. Lentigines (Sun Spots)
Scattered light tan macules consistent with lentigines were noted in sun-exposed areas.
Management:
Education on sun protection
Recommendation for broad-spectrum SPF 30+ sunscreen
Discussion of topical retinoids and cosmetic treatment options if desired
3. Seborrheic Keratosis
A classic “stuck-on” brown papule was identified on the epigastric skin.
Management:
Reassurance of benign nature
No treatment required
4. Actinic Damage
Evidence of sun-related skin damage was observed on the left medial superior chest.
Management:
Counseling on photoaging
Sun avoidance and daily sunscreen use
Consideration of topical retinoids to improve skin texture and tone
5. Cherry Angiomas
Multiple benign vascular growths were present throughout the body.
Management:
Education and reassurance
Cosmetic treatment options discussed, though not medically necessary
6. Pigmented Lesion of Uncertain Behavior
A darkly pigmented macule on the left buttock raised concern for a dysplastic nevus versus neoplasm of uncertain behavior.
Procedure Performed:
Shave biopsy to the level of the dermis
Local anesthesia with lidocaine and epinephrine
Specimen sent for histopathologic evaluation
Patient counseled on wound care and follow-up
Importance of Skin Checks with a Family History of Melanoma
Patients with a first-degree relative with melanoma have a significantly higher lifetime risk of developing melanoma themselves. Early detection through routine FBSEs can be lifesaving.
Recommendations Included:
Monthly self–skin exams
Daily use of broad-spectrum sunscreen
Sun-protective clothing
Annual professional skin examinations
Follow-Up Plan
The patient will return in one year for a routine full body skin exam, with earlier follow-up as needed depending on biopsy results.
Why Choose Village Dermatology in Katy & Houston, Texas?
At Village Dermatology, we specialize in skin cancer screening, mole evaluation, and preventive dermatology. Our board-certified dermatology team provides thorough, compassionate care tailored to patients with increased melanoma risk.
If you have a family history of melanoma or notice new or changing moles, schedule a full body skin exam with our expert dermatologists serving Katy and Houston, TX.
Managing Telangiectatic Rosacea With Facial Redness — Village Dermatology Katy & Houston, Texas
A 49-year-old female with telangiectatic rosacea was evaluated at Village Dermatology in Katy and Houston, Texas. Learn about rosacea triggers, redness management with Rhofade alternatives, and laser treatment options for long-term improvement.
Rosacea is a chronic inflammatory skin condition that commonly affects adults and can significantly impact self-confidence and skin comfort. At Village Dermatology, serving patients throughout Katy, Texas and Houston, Texas, we specialize in diagnosing rosacea subtypes and creating personalized treatment plans.
This case highlights the evaluation and management of a 49-year-old female with persistent facial and neck redness consistent with telangiectatic rosacea.
Chief Complaint
The patient presented for follow-up management of rosacea, involving the:
Face
Neck
Symptoms were described as moderate in severity and had been present for several months.
History of Present Illness
The patient reported:
Persistent redness on the cheeks and neck for approximately 6 weeks
Significant dryness of the skin
No improvement with previous anxiety medications
Notably, the patient is currently undergoing hormonal therapy with progesterone for endometriosis, which can contribute to flushing and skin sensitivity.
Clinical Examination
A focused facial examination was performed with the assistance of a dermatoscope.
Key Findings
Diffuse facial erythema
Prominent telangiectasias (visible blood vessels)
Dry, sensitive skin
The patient appeared well-nourished, alert, and in no acute distress.
Diagnosis
Rosacea – Telangiectatic Type
Telangiectatic rosacea primarily presents with:
Persistent facial redness
Flushing
Visible blood vessels
Dryness and skin sensitivity
Triggers commonly include:
Sun exposure
Heat
Stress
Alcohol
Spicy foods
Wind
Treatment Discussion
After reviewing treatment options, a stepwise approach was recommended.
Topical Therapy
Rhofade® (oxymetazoline)
Reduces facial redness by constricting superficial blood vessels
Can provide improvement for up to 8 hours
The patient elected to begin with an over-the-counter Rhofade alternative before prescription therapy.
OTC Rhofade Alternative (Counseled Regimen)
Mix:
CeraVe PM lotion (remove ⅓ of the bottle)
One full bottle of Afrin nasal spray
Apply to affected areas to temporarily reduce redness
Procedural Options (Discussed)
KTP laser
Laser therapy was discussed as a long-term solution for telangiectasias and persistent redness. The patient plans to schedule laser treatment if desired.
Patient Counseling
The patient received extensive counseling on:
Skin Care
Use gentle cleansers and moisturizers
Avoid harsh or fragranced products
Consider green-tinted moisturizers to neutralize redness
Expectations
Rosacea is chronic with periods of flare and remission
Redness and flushing can be managed but not cured
Laser treatments can significantly reduce visible blood vessels
When to Contact the Office
Worsening redness
Development of nodules or cysts
No improvement despite consistent treatment
Samples of gentle skincare products were provided.
Plan & Follow-Up
Begin topical redness control regimen
Consider laser therapy for long-term improvement
Follow up as needed based on symptom control
At Village Dermatology in Katy and Houston, we tailor rosacea treatments to each patient’s triggers, lifestyle, and skin sensitivity.
Managing Excessive Sweating (Hyperhidrosis) of the Hands, Feet, and Armpits — Village Dermatology Katy & Houston, Texas
A 42-year-old female with excessive sweating of the hands, feet, and armpits was evaluated at Village Dermatology in Katy and Houston, Texas. Learn about hyperhidrosis symptoms, diagnosis, and treatment options including iontophoresis and Qbrexza wipes.
By: Dr. Caroline Vaughn
Excessive sweating can significantly impact daily activities, confidence, and quality of life. At Village Dermatology, serving patients throughout Katy, Texas and Houston, Texas, we provide comprehensive evaluation and personalized treatment options for hyperhidrosis, a common but often underdiagnosed condition.
This case highlights the evaluation and management of a 42-year-old female presenting with long-standing excessive sweating affecting multiple areas.
Chief Complaint
The patient presented as a new patient with excessive sweating involving the:
Palms
Soles of the feet
Armpits (axillae)
She described the sweating as dripping, moderate in severity, and present for many years, noting that it negatively affected her quality of life.
Clinical Examination
A focused examination was performed of the:
Right and left axillae
Hands
Feet
The patient appeared well-developed, well-nourished, alert, and in no acute distress.
A dermatoscope was used during the exam.
Key Findings
Clinical findings were consistent with hyperhidrosis, with excessive sweating noted on:
Left thenar eminence
Right radial palm
Right and left dorsal feet
Right and left axillary vaults
Diagnosis
Hyperhidrosis
(ICD-10: L74.512 – Palmar, L74.513 – Plantar, L74.510 – Axillary)
Hyperhidrosis is a condition characterized by excessive sweating beyond what is necessary for temperature regulation. It most commonly affects the hands, feet, and armpits and can significantly interfere with social and professional activities.
Treatment Discussion
A detailed discussion was held regarding available treatment options, including:
Topical & Medical Options
20% aluminum chloride antiperspirants (applied at bedtime)
Qbrexza® (glycopyrronium) wipes
Oral glycopyrrolate (Robinul) for severe cases
Procedural & Device-Based Treatments
Iontophoresis (Dermadry device)
Botulinum toxin (Botox®) injections for axillary or palmar hyperhidrosis
After reviewing risks, benefits, and lifestyle considerations, the patient elected to try iontophoresis first using the Dermadry device. A prior authorization for the device was initiated during the visit.
Plan
Dermadry iontophoresis device: PA started
Qbrexza wipes: Sample provided (box of 5 single-use cloths)
Continue monitoring symptoms and response to treatment
Patient Counseling
The patient was counseled on:
Skin Care & Expectations
Hyperhidrosis is a chronic condition
Multiple treatment options exist, and therapy can be adjusted over time
Consistency is key for optimal symptom control
When to Contact the Office
If sweating persists despite treatment
If side effects develop from topical or systemic therapies
The patient expressed understanding and agreement with the treatment plan.
Follow-Up
Follow-up as needed (PRN)
Reassess symptom control and consider additional therapies if needed
At Village Dermatology in Katy and Houston, we focus on improving quality of life through customized hyperhidrosis treatment plans tailored to each patient’s needs.
Full Body Skin Exam for Patients With a History of Dysplastic Nevi — Village Dermatology Katy & Houston, Texas
A 51-year-old female with a history of dysplastic nevi underwent a full-body skin exam at Village Dermatology in Katy and Houston, Texas. Learn how dermatologists monitor benign moles, lentigines, seborrheic keratoses, and cherry angiomas while emphasizing skin cancer prevention.
Patients with a personal history of dysplastic nevi benefit greatly from routine, thorough skin examinations. At Village Dermatology, proudly serving Katy, Texas and Houston, Texas, we emphasize early detection, patient education, and long-term surveillance to reduce skin cancer risk.
This case highlights a 51-year-old female who presented as a new patient for a comprehensive full-body skin exam and counseling on sun exposure and suspicious skin lesions.
Chief Complaint
Evaluation of skin lesions throughout the body
Education regarding sun exposure and skin cancer prevention
The lesions were asymptomatic and moderate in severity.
Her medical history was significant for dysplastic nevi, with seven biopsies performed more than 10 years ago.
Comprehensive Skin Examination
A meticulous full-body skin examination was performed, including:
Scalp and hair
Face, eyelids, lips, ears, and neck
Chest, abdomen, back
Upper and lower extremities
Hands, feet, nails, and digits
Breasts, groin, and buttocks
The patient appeared well-nourished, alert, and in no acute distress.
A dermatoscope was used to enhance evaluation of pigmented lesions.
Assessment & Diagnoses
1. History of Dysplastic Nevi
Well-healed scars with no evidence of recurrence
No concerning changes noted on exam
Counseling Provided:
Importance of regular self-skin exams
Dysplastic nevi require ongoing monitoring due to melanoma risk
Prompt evaluation if moles change in size, shape, color, or symptoms
2. Benign Nevi
Regular, symmetric, evenly colored macules and papules
Distributed throughout the body
No suspicious features identified
Education:
Benign moles do not require treatment
Monthly self-exams recommended
Contact dermatology if lesions itch, bleed, or evolve
3. Lentigines
Light tan, reticulated macules in sun-exposed areas
Consistent with chronic sun exposure
Counseling:
Lentigines are benign
Can improve with:
Broad-spectrum sunscreen
Sun avoidance
Retinoids
Chemical peels
Laser treatments
4. Seborrheic Keratoses
Waxy, pigmented papules scattered on the body
Education:
Benign, age-related growths
No treatment required unless symptomatic or cosmetically bothersome
5. Cherry Angiomas
Benign vascular lesions distributed throughout the body
Counseling:
No medical treatment necessary
Can be treated with laser or electrodesiccation if desired
Sun Protection & Prevention Counseling
Given her history and findings, we emphasized:
Protective clothing and hats
Avoiding peak UV hours
Monthly self-skin exams using mirrors or partner assistance
Plan & Follow-Up
No biopsies needed at this visit
Continue vigilant monitoring
Annual full-body skin exam recommended
Return sooner if any lesions change or become symptomatic
At Village Dermatology in Katy and Houston, we partner with patients to provide proactive skin cancer prevention through expert evaluation and patient education.
Vitiligo Follow-Up Case: Treatment Adjustment and Expectations — Village Dermatology Katy & Houston, Texas
A 48-year-old female returns to Village Dermatology in Katy and Houston, Texas for vitiligo follow-up. Learn how treatment was adjusted from Opzelura to tacrolimus and clobetasol, and what patients should expect when managing vitiligo.
By: Dr. Ashley Baldree
Vitiligo is a chronic autoimmune skin condition that can require patience, consistency, and individualized treatment plans. At Village Dermatology, serving patients in Katy, Texas and Houston, Texas, we regularly follow patients with vitiligo to monitor response and adjust therapy as needed.
This case highlights a 48-year-old female returning for follow-up after initiating topical treatment for vitiligo affecting the hands and wrists.
Chief Complaint
Follow-up evaluation for vitiligo, initially assessed on August 21, 2025.
History of Present Illness
The patient returned for reassessment of vitiligo after previously starting:
Opzelura® (ruxolitinib) cream twice daily
Controlled sun exposure for 10 minutes, three times weekly
She reported using Opzelura for approximately one month without noticeable improvement. She also expressed concern about the cost of the medication and preferred a treatment option that was more affordable and covered by insurance.
Clinical Examination
A focused dermatologic exam was performed, including:
Scalp and hair inspection
Face
Hands and wrists
The patient appeared well-nourished, alert, and in no acute distress.
A dermatoscope was utilized during examination.
Key Findings
Depigmented patches involving:
Right radial dorsal hand
Left ulnar dorsal hand
Right ventral wrist
Left ventral wrist
Evidence of confetti-like pigmentation, suggesting early repigmentation activity
Diagnosis
Vitiligo
Vitiligo is an autoimmune condition in which the immune system targets melanocytes, leading to depigmented or white patches of skin. Disease course and response to treatment vary among patients, and improvement often requires several months of consistent therapy.
Vitiligo can be associated with other autoimmune conditions, including:
Thyroid disease
Pernicious anemia
Diabetes
Treatment Plan Adjustment
After reviewing treatment expectations and cost concerns, the patient elected to transition to a steroid-sparing combination topical regimen.
New Treatment Regimen
Tacrolimus 0.1% ointment
Apply twice daily Monday through Friday
Clobetasol 0.05% cream
Apply twice daily on weekends only
Controlled sunlight exposure
10–15 minutes, 3 times per week, without burning
Updated clinical photographs were obtained for future comparison.
Patient Counseling
The patient received extensive counseling regarding:
Treatment Expectations
Vitiligo treatments often take months to show visible improvement
Combination therapy improves outcomes while minimizing steroid side effects
Skin Care & Phototherapy
Vitiligo may respond to:
Topical steroids
Topical calcineurin inhibitors
Natural sunlight or phototherapy
Use broad-spectrum SPF 30+ sunscreen on unaffected skin
Medication Safety
Prolonged steroid use may cause:
Skin thinning (atrophy)
Visible blood vessels (telangiectasias)
High-potency steroids should be avoided on the face, groin, and skin folds
The patient demonstrated understanding of proper medication use and potential side effects.
Follow-Up Plan
Follow-up visit in 3 months
Reassess response to therapy and degree of repigmentation
Adjust treatment plan as needed
Why Follow-Up Is Essential in Vitiligo
Vitiligo management requires ongoing monitoring to ensure:
Appropriate response to treatment
Early identification of repigmentation
Safe long-term medication use
At Village Dermatology in Katy and Houston, we provide personalized, evidence-based vitiligo care tailored to each patient’s needs, lifestyle, and treatment goals.
Evaluating a Scalp Growth and Atopic Dermatitis in a 20-Year-Old Female — Village Dermatology Katy & Houston, Texas
A 20-year-old female presented to Village Dermatology in Katy and Houston, Texas with a scalp growth, eczema flare, and post-inflammatory hyperpigmentation. Learn how dermatologists assess suspicious lesions and manage chronic atopic dermatitis and PIH.
Young adults often present with a combination of dermatologic concerns involving both growths and inflammatory skin conditions. This case report highlights a 20-year-old female evaluated at Village Dermatology, serving Katy and Houston, Texas, for a scalp growth, eczema flares, and post-inflammatory hyperpigmentation (PIH).
Chief Complaints
Growth on the left central parietal scalp
Rash on the hands and left leg
The patient reported:
A moderate, asymptomatic growth on the scalp
Flaking rash on the hands and left lower leg
Concern about dark discoloration (PIH) left behind after rashes
She had been previously treating eczema with triamcinolone.
Clinical Examination
A focused examination evaluated the:
Scalp
Face
Hands
Left lower leg
The patient was well-appearing, alert, and in no distress.
Findings included:
1. Scalp Lesion
A solitary lesion on the left central parietal scalp concerning for:
Neoplasm of uncertain behavior
Nevus
Lipofibroma
2. Active Atopic Dermatitis
Erythematous, eczematous patches on:
Left proximal pretibial region
Left ulnar dorsal hand
Right ulnar dorsal hand
3. Post-Inflammatory Hyperpigmentation
Ill-defined hyperpigmented patches in the same areas where eczema was present.
Diagnosis & Assessment
1. Neoplasm of Uncertain Behavior
Given the uncertain nature of the scalp growth, a biopsy was recommended.
Biopsy Procedure
Shave biopsy of the lesion
Local anesthesia with lidocaine + epinephrine
Dermablade used to obtain specimen for H&E
Hemostasis with Drysol
Petrolatum applied post-procedure
The patient will be notified of results within 2 weeks.
2. Atopic Dermatitis
The patient had persistent eczema despite 2 months of topical steroid use.
She was experiencing an active flare.
Treatment Plan
Fluocinonide 0.05% cream for the body
Fluocinonide 0.05% solution for the scalp
Daily moisturization with CeraVe cream
Discussed long-term options:
Continued topical therapy
Dupixent injections (biologic therapy)
Steroid counseling included:
Avoiding prolonged use
Avoiding high-potency steroids on face, groin, or skin folds
Possible side effects: atrophy, telangiectasias, hypopigmentation
3. Post-Inflammatory Hyperpigmentation (PIH)
PIH was present secondary to eczema flares.
Counseling Included:
PIH fades naturally but may take months to years
Strict sun protection recommended
Goal is first to control active eczema, then address pigmentation
Patient Counseling
Topics reviewed during the visit:
Skin Care for Eczema
Use lukewarm showers
Apply moisturizers immediately after bathing
Use unscented cleansers and detergents
Avoid excessive hand washing
Keep nails short to reduce scratching
When to Contact the Office
Worsening rash
Signs of infection (yellow crusts or cold sores)
Darkening or spreading hyperpigmentation
Follow-Up
The patient will return in 1 month for evaluation of:
Biopsy results
Eczema response to treatment
PIH improvement
Why Early Evaluation Matters
Young adults often overlook concerning skin growths or chronic rashes.
At Village Dermatology, serving Katy and Houston, we provide:
Expert evaluation of suspicious lesions
Personalized eczema treatment plans
Guidance on pigmentary disorders such as PIH
This case highlights the importance of comprehensive dermatologic care in patients with overlapping concerns.
Managing Longstanding Melasma in a 50-Year-Old Female — Village Dermatology Katy & Houston, Texas
Learn how Village Dermatology in Katy and Houston, Texas evaluated and treated a 50-year-old woman with longstanding melasma. Review treatment options including tranexamic acid, tretinoin, chemical peels, and laser therapy.
Melasma is one of the most common causes of facial discoloration in adult women and a frequent concern among dermatology patients across Katy, Texas and Houston, Texas. This case report highlights the evaluation and management of a 50-year-old female presenting with chronic cheek discoloration consistent with melasma.
Chief Complaint
The patient presented with asymptomatic facial discoloration, primarily on the:
Right central malar cheek
Left central malar cheek
She reported having this pigmentation for several years without any current treatment.
Clinical Examination
A focused facial examination was performed, including:
Forehead
Cheeks
Nose
The patient appeared well-nourished, alert, and in no acute distress.
Hyperpigmented, ill-defined patches were noted in a malar and periorbital distribution, characteristic of melasma.
Diagnosis
Melasma
Melasma presents as patchy facial hyperpigmentation and is more common in women, often triggered by:
Hormonal changes
Birth control or pregnancy
Sun exposure
Heat and inflammation
The patient had a history of using compounded hydroquinone but experienced worsening pigmentation when tapering the strength.
Treatment Discussion
A comprehensive review of treatment options was provided, including:
1. Topical Treatments
Tretinoin cream (refilled today)
Enhances skin turnover and improves discoloration
Bleaching agents (HQ)
Effective but risk of pseudoochronosis with excessive or prolonged use
2. Oral Therapy
Tranexamic acid
Reduces melanocyte activity
Helpful for stubborn or recurrent melasma
Risks discussed: small risk of blood clots, gastrointestinal upset
Patient confirmed no personal or family history of clotting disorders
3. Procedural Options
Non-ablative laser therapy (Fraxel)
Pricing for the chemical peel was provided.
4. Sun Protection
A critical component of treatment:
Tinted mineral sunscreen preferred for iron oxides, which protect against visible light
Strict sun avoidance during peak UV hours
Plan
After extensive discussion, the patient elected to begin combination therapy:
Medications Prescribed:
Tranexamic Acid 650 mg
Take ½ tablet PO BID
Tretinoin 0.025% cream
Apply a pea-sized amount 2–3 nights/week, increasing as tolerated
Counseling Provided:
Expected gradual improvement over months
Importance of consistency with sun protection
Instruction to contact the office if pigmentation worsens or if medication side effects occur
Follow-Up:
A 2-month targeted follow-up is scheduled to evaluate progress and consider peels or laser treatments.
Why Melasma Requires Expert Dermatologic Care
At Village Dermatology in Katy and Houston, we frequently help patients manage chronic melasma. Because this condition can worsen with heat, sun, inappropriate skincare products, or certain medications, professional guidance ensures safe and effective treatment.
Our approach combines:
Personalized assessment
Stepwise treatment plans
Evidence-based procedures
Long-term maintenance strategies
Managing Molluscum Contagiosum in a 7-Year-Old Patient — Village Dermatology in Katy & Houston, Texas
A 7-year-old patient presented to Village Dermatology in Katy and Houston, Texas with spreading molluscum contagiosum. Learn how pediatric dermatologists diagnose and manage this common viral skin condition and what treatment options are available for children.
Molluscum contagiosum is one of the most common viral skin conditions seen in pediatric dermatology, yet it can still cause worry for parents when lesions begin to spread. At Village Dermatology, serving families throughout Katy, Texas and Houston, Texas, we frequently evaluate and treat molluscum in young children.
This case report highlights the presentation and management discussion for a 7-year-old male seen for rapidly spreading skin lesions on the back and left knee.
Chief Complaint
The patient presented as a new patient with skin lesions located on the:
Back
Left knee
The lesions were described as spreading and moderate in severity.
Clinical Examination
A comprehensive skin exam was performed, including evaluation of the:
Face
Abdomen
Back
Upper extremities
Lower extremities
The child appeared well-nourished, alert, and in no acute distress.
A dermatoscope was used for enhanced evaluation. The patient's mother was present during the exam, along with the medical assistant.
Key Findings
Dermatoscopic and clinical evaluation revealed:
Pink, shiny, umbilicated papules with a central dell, consistent with molluscum contagiosum, distributed across:
Right inferior upper back
Left inferior upper back
Left knee
Right anterior upper arm
Epigastric area
These findings confirmed the diagnosis.
Diagnosis
Molluscum Contagiosum
Molluscum contagiosum is a benign viral skin infection that often affects children. It spreads through:
Skin-to-skin contact
Shared surfaces or objects
Water exposure (e.g., swimming pools)
Although harmless, lesions can spread and persist for months to over a year without treatment.
Management Discussion
During the visit, we discussed treatment options in depth with the patient's mother, including:
1. In-Office Treatment Options
Cantharidin (“beetle juice”)
A painless application for children
Causes mild blistering to help lesions resolve
Effective but may be uncomfortable for younger patients
2. At-Home Treatment Option
Contagiawesome (Medrock Pharmacy)
A compounded topical therapy designed specifically for molluscum
After reviewing risks, benefits, and expected outcomes, the family elected to defer treatment for now.
They were encouraged to contact the office or message through Klara if they wish to initiate therapy later.
Counseling Provided
Parents often feel overwhelmed when molluscum lesions multiply. We provided reassurance and guidance, including:
What to Expect
Molluscum is common, contagious, and benign
Lesions may spread before improving
Treatment is optional, but can speed resolution
Skin Care Tips
Avoid scratching to prevent spread
Do not share towels or sports equipment
Avoid direct lesion-to-lesion contact with siblings
When to Reach Out
Parents were advised to contact Village Dermatology if:
Lesions spread rapidly
A widespread itchy rash develops
Lesions persist or become irritated
Plan
Follow-up: As needed
Treatment: Deferred at family's request
Education: Provided on natural course, spread, and treatment options
At Village Dermatology, families in Katy and Houston, Texas can expect compassionate, evidence-based dermatologic care for both routine and complex pediatric conditions.
A Case of Recurrent Psoriasis: Evaluation & Treatment of a 33-Year-Old Male | Village Dermatology Katy & Houston, TX
A 33-year-old male presented with a spreading red rash on the trunk, diagnosed as psoriasis after ketoconazole failed. Learn how Village Dermatology in Katy & Houston, TX treated his condition with topical steroids and calcipotriene.
At Village Dermatology in Katy and Houston, Texas, we frequently see patients who have been treating a rash unsuccessfully on their own or with medications prescribed for a different condition. Psoriasis is one such condition that can mimic other rashes early on, making professional evaluation critical.
This case features a 33-year-old male who presented with a spreading rash across his trunk. After a detailed review of history, appearance, and prior treatments, his condition was diagnosed as psoriasis, a chronic inflammatory skin disease.
Patient Overview
Chief Complaint
A pink and red rash on the trunk, moderate in severity, present for 3 weeks.
History
Initially began on the right lower leg, then spread to the body
Previously treated 6 months earlier with ketoconazole 2% cream for presumed ringworm
Ketoconazole helped initially but no longer provides improvement
No nail pitting or ridging
No joint aches or stiffness (important in ruling out psoriatic arthritis)
Exam Findings
Clinical evaluation revealed:
Psoriasiform plaques
Micaceous (silvery) scale
Distribution across the trunk and extremities
No signs of tinea (fungal infection)
No nail involvement
These findings were strongly consistent with plaque psoriasis.
Diagnosis: Psoriasis
Psoriasis is a chronic autoimmune condition characterized by:
Red or salmon-colored plaques
Thick, overlying scale
Recurrent flares and remissions
Symptoms often worsen due to:
Stress
Infections (especially strep throat)
Some medications
Alcohol
Cold, dry weather
Treatment Plan
After an in-depth conversation outlining treatment options, the patient elected to begin topical therapy, which is appropriate for mild to moderate psoriasis without joint involvement.
1. Calcipotriene 0.005% Cream
A vitamin D analog
Apply twice daily on weekends
Helps regulate skin cell turnover
Reduces plaque thickness and scaling
2. Triamcinolone 0.1% Cream
A medium-strength topical steroid
Use twice daily on weekdays for 2 weeks, then as needed for flares
Reduces redness, itching, and inflammation
This “weekday steroid + weekend calcipotriene” rotation helps improve psoriasis while minimizing steroid overuse.
Counseling & Supportive Care
Patients were advised to incorporate:
Emollients (thick moisturizers) daily
Ambient sunlight exposure (brief, gentle exposure—not sunburn)
Medicated shampoos containing tar, selenium, ketoconazole, or zinc pyrithione for scalp symptoms
Avoid known triggers when possible
Long-Term Expectations
Psoriasis is a lifelong condition, with periods of remission and flare-ups.
Treatment aims to reduce symptoms, slow flare frequency, and improve quality of life.
Follow-Up
A 3-month follow-up was scheduled to reassess progress and adjust therapy as needed.
Dermatology Expertise in Katy & Houston, Texas
Whether your rash is new, persistent, or worsening, a board-certified dermatologist can help determine the right diagnosis and treatment plan. At Village Dermatology, we provide advanced care for psoriasis—from topical therapy to phototherapy to biologics like Skyrizi when appropriate.
We’re committed to helping you achieve long-term skin relief.
Case Report: Complex Fungal Rash and Arm Lesions in a 60-Year-Old Female | Katy & Houston, Texas
A 60-year-old female with persistent fungal rashes, including tinea cruris and Majocchi’s granuloma, treated at Village Dermatology in Katy and Houston, Texas.
At Village Dermatology in Katy and Houston, Texas, we frequently evaluate rashes that are persistent, worsening, or unresponsive to initial treatments. Fungal infections can present in multiple ways and may be complicated by prior steroid use, making accurate diagnosis and targeted therapy essential.
Patient Presentation
A 60-year-old female presented as a new patient with a painful, itchy, blistering rash on the left arm, which had been present for several weeks. She also reported a chronic rash involving the inner thighs and a new lesion on the right forearm that she believed may be a spider bite. The severity of symptoms prompted further evaluation.
Clinical Examination
A focused dermatologic examination of the right and left forearms was performed using dermoscopy. The patient was alert, well-nourished, and in no acute distress.
Multiple distinct skin findings were identified, leading to several diagnoses.
Diagnosis #1: Tinea Cruris (Jock Itch)
The patient reported a long-standing rash in the inguinal folds, which had worsened after using topical corticosteroids.
Exam Findings
Erythematous, scaly plaques
Serpiginous borders
Located on the right anterior proximal thigh
A KOH preparation was performed and was positive for branching hyphae, confirming a fungal infection.
Treatment Plan
Ketoconazole 2% topical cream
Applied twice daily for two weeks
The patient was counseled that tinea cruris is a dermatophyte infection commonly seen in warm, humid climates like Houston and Katy, Texas. Cure rates are excellent, though recurrence is common.
Diagnosis #2: Majocchi’s Granuloma (Fungal Folliculitis)
The rash on the left forearm had failed to respond to topical steroids and showed features concerning for a deeper fungal infection.
Exam Findings
Peri-follicular pustules
Annular plaque formation
A KOH preparation was positive, supporting the diagnosis of Majocchi’s granuloma, a fungal infection that extends into hair follicles and often worsens with steroid use.
Treatment Plan
Oral terbinafine 250 mg daily for 4 weeks
The patient was counseled that Majocchi’s granuloma requires systemic antifungal therapy. A punch biopsy will be considered at follow-up if there is inadequate improvement.
Diagnosis #3: Suspected Spider Bite – Right Forearm
The patient also presented with a painful lesion on the right distal dorsal forearm, suspected to be a spider bite.
Exam Findings
Erythema with a central punctum
Treatment Plan
Daily wound care
Topical silver sulfadiazine (Silvadene) cream, applied twice daily until healed
The patient was counseled on signs of worsening infection or systemic symptoms that would require urgent medical evaluation.
Follow-Up
The patient is scheduled to return in four weeks to evaluate treatment response. Early improvement is expected, though fungal infections may require close monitoring.
Expert Rash Diagnosis & Treatment in Katy & Houston, Texas
At Village Dermatology, we specialize in diagnosing complex rashes, including fungal infections, steroid-modified eruptions, and inflammatory skin conditions. Accurate diagnosis using tools like KOH preparation and dermoscopy allows us to provide targeted, effective treatment.
📍 Serving Katy and Houston, Texas
A Common Benign Growth: Understanding Lipomas Through a 28-Year-Old Patient Case | Village Dermatology Katy & Houston, TX
Learn how Village Dermatology in Katy & Houston, Texas diagnosed and managed a 28-year-old woman’s upper-back lipoma. Discover symptoms, evaluation steps, imaging, and treatment options for benign fatty tumors.
At Village Dermatology in Katy and Houston, Texas, we frequently evaluate patients for new skin or soft-tissue growths. Many of these lesions are completely benign, but determining that with certainty requires careful clinical evaluation.
This case highlights a 28-year-old female who presented with an asymptomatic growth on her left upper back, raising suspicion for a lipoma—a common benign fatty tumor. Through a detailed exam, counseling, and a structured diagnostic plan, we were able to guide her through next steps with clarity and reassurance.
Patient Overview
Chief Complaint
A moderate-sized growth on the left lateral upper back
Present for several months
No pain or drainage
Attempted self-drainage with a needle (but no material expressed)
Exam Findings
A focused dermatologic examination of the back showed:
A soft, mobile subcutaneous nodule
No signs of active drainage
Mild warmth to the touch
No systemic symptoms
Dermatoscopic evaluation supported a diagnosis of lipoma
The patient otherwise appeared well, alert, oriented, and in no distress.
Clinical Impression: Suspected Lipoma
A lipoma is a benign, non-cancerous tumor composed of fatty tissue. They are extremely common, often slow-growing, and typically harmless.
In this case, the attempted self-puncture introduced the possibility of local inflammation or early infection, explaining the mild warmth on examination.
Treatment Plan & Recommendations
1. Short Course of Antibiotics
To reduce any potential infection from the prior needle poke:
Doxycycline 100 mg
Taken twice daily for 2 weeks
With food, and avoid lying flat for 30 minutes after swallowing
This helps calm inflammation and prevent deeper infection.
2. Ultrasound of the Upper Back
An ultrasound was ordered to:
Confirm the diagnosis
Determine the depth, borders, and size of the mass
Assess whether the lesion is appropriate for in-office removal
Help guide referral if needed
The patient was given instructions and the necessary form to complete the imaging study.
3. Surgical Options
Based on ultrasound findings:
Small to moderate lipomas can often be excised in-office by our dermatologic surgeon
Large or deep lipomas are referred to a general surgeon for removal under appropriate anesthesia
4. Patient Counseling & Education
During the visit, we reviewed:
What to Expect
Lipomas are benign fatty tumors
They typically stay stable or grow very slowly
Removal is optional unless painful, enlarging, or bothersome
When to Call Us
Rapid growth
New pain, redness, or fever
Drainage, bruising, or sudden changes
5. Follow-Up
Follow-up was recommended as needed (PRN) after completing her imaging results and antibiotic course.
Why Professional Evaluation Matters
Although lipomas are benign, other growths—such as cysts, infections, or rarely liposarcomas—can mimic their appearance.
A proper dermatologic evaluation ensures:
Accurate diagnosis
Appropriate imaging
Safe removal when necessary
Avoidance of complications from self-treatment
At Village Dermatology in Katy and Houston, we provide comprehensive care for skin growths, tumors, cysts, and soft tissue lesions with expert evaluation and advanced treatment options.
Case Report: Adult Female Acne Managed With Isotretinoin (Accutane) in Katy & Houston, Texas
A 41-year-old female continues isotretinoin therapy for persistent facial acne under close monitoring at Village Dermatology in Katy and Houston, Texas.
At Village Dermatology, we provide comprehensive care for patients with persistent and treatment-resistant acne. Isotretinoin (Accutane) remains one of the most effective options for moderate to severe acne, particularly when other therapies have failed.
Patient Background
A 41-year-old female returned for a follow-up visit for facial acne. She was initially evaluated on November 21, 2025, at which time she began isotretinoin 40 mg twice daily (80 mg total daily dose), taken with a fatty meal. She presented today for focused monitoring while continuing therapy.
Clinical Examination
A focused facial examination was performed with dermoscopy. Findings included:
Comedonal papules
Inflammatory papules and pustules
Two new acne breakouts involving the nose and cheek
Despite reaching her cumulative dose goal, the patient continued to experience mild active lesions.
The patient appeared well-developed, well-nourished, alert, and in no acute distress.
Treatment Course & Management Plan
The patient reported no significant side effects from isotretinoin therapy. Given the presence of new breakouts, the decision was made to continue isotretinoin at 80 mg daily to further improve disease control.
Key Treatment Details:
Medication: Isotretinoin 40 mg capsules
Dose: 40 mg twice daily
Month of Therapy: Month 5
Protocol: 1 mg/kg until cumulative dose of 200–220 mg/kg
A urine pregnancy test was performed in clinic and confirmed to be negative. The patient was successfully confirmed in iPledge, and her prescription was sent.
Isotretinoin Counseling & Monitoring
Extensive counseling was provided, including:
Use of two forms of contraception (secondary method: male vasectomy)
Monthly pregnancy testing and lab monitoring
Avoiding blood donation
Avoiding elective surgery for six months after treatment completion
Not sharing medication
Monitoring for side effects such as headaches, fatigue, abdominal pain, rash, or vision changes
The patient verbalized understanding of all risks and benefits.
Skin Care Recommendations
To support treatment success, the patient was advised to use:
Non-comedogenic cleansers
Gentle moisturizers
Broad-spectrum sunscreen SPF 30+
She was counseled that improvement continues over time, with 60–80% improvement typically seen by 2–3 months, and further clearing expected as therapy continues.
Follow-Up
The patient will return in one month for continued isotretinoin monitoring and acne management.
Expert Acne & Accutane Treatment in Katy & Houston, Texas
At Village Dermatology, we specialize in adult acne treatment, including safe and closely monitored isotretinoin therapy. Our dermatologists provide personalized care to help patients achieve long-term acne control and prevent scarring.
📍 Serving Katy and Houston, Texas
A Complex Case of Lipodermatosclerosis, Atrophie Blanche, Nail Fungus & Adult Acne: Comprehensive Dermatologic Care in Katy & Houston, Texas
A 45-year-old female presented with chronic leg rash due to lipodermatosclerosis, nail fungus, and adult acne. Learn how Village Dermatology in Katy & Houston, Texas diagnosed and treated her complex dermatologic conditions using a comprehensive and personalized care plan.
At Village Dermatology in Katy and Houston, Texas, our dermatology team routinely manages complex cases involving multiple skin, nail, and vascular conditions. Today’s case report highlights a 45-year-old female who presented as a new patient with concerns about a chronic leg rash, discolored toenails, and asymptomatic bumps on the cheek. Her clinical history—including a prior deep vein thrombosis (DVT)—added complexity to her evaluation and treatment plan.
This case demonstrates the importance of thorough assessment, individualized treatment, and patient education in achieving long-term dermatologic improvement.
Patient Overview
Chief Complaints
Rash on the left leg
Nail disorder affecting both great toenails
Bumps on the left cheek
Relevant Medical History
History of left-leg DVT (2010–2011)
Known Factor V Leiden mutation
Intermittent swelling of the left leg
Previous use of clobetasol and sunflower/vitamin E oils
Clinical Findings
1. Lipodermatosclerosis with Atrophie Blanche (Left Lower Leg)
The patient reported worsening discoloration, burning sensations, occasional oozing, and long-standing swelling. Clinical exam showed:
Scarring and fibrosis
Hyperpigmentation
Erythematous, tender plaques
Classic “inverted champagne bottle” morphology
Angular, white, depressed plaques characteristic of atrophie blanche
These findings were consistent with lipodermatosclerosis, a chronic inflammatory and sclerosing condition associated with venous insufficiency.
2. Onychomycosis (Toenail Fungus)
Both great toenails showed:
Yellow and green discoloration
Onycholysis (lifting of the nail)
Subungual debris
3. Adult Acne (Comedonal & Inflammatory)
The patient also displayed:
Comedonal papules
Inflammatory papules and pustules
Distribution across both malar cheeks
Treatment Plan
1. Lipodermatosclerosis & Atrophie Blanche Management
A structured management strategy was initiated:
Discontinue oils (sunflower & vitamin E)
Start Vaseline as a plain moisturizer
Begin Triamcinolone 0.1% ointment, applied twice daily in 2-week cycles
Apply Duoderm bandages daily to the superficial wound
Daily compression stockings to support venous return
Strong counseling on:
Leg elevation
Long-term expectations
Chronicity and irreversible fibrosis
The patient was advised to return in 6 weeks for follow-up.
2. Onychomycosis (Nail Fungus)
The patient declined oral antifungal therapy (terbinafine), so we recommended conservative management:
OTC Gold Listerine foot soaks
Education on:
Fungal longevity
Slow rate of nail improvement
High relapse rate
Differences between oral vs. topical treatment effectiveness
3. Acne Treatment Plan
To address comedonal and inflammatory acne:
Start tretinoin 0.025% cream
Apply pea-sized amount at bedtime
Start 2–3 nights per week, increase to nightly as tolerated
Use non-comedogenic skincare
Emphasize expectations: acne may take 2–3 months to show significant improvement
Why Early Dermatologic Evaluation Matters
This case demonstrates how seemingly unrelated symptoms—rash, nail discoloration, facial bumps—can reflect deeper dermatologic or systemic processes. Conditions like lipodermatosclerosis often go untreated for years, leading to irreversible skin changes.
At Village Dermatology, we prioritize:
Early identification
Comprehensive evaluation
Personalized treatment strategies
Patient education for long-term success
Dermatology Care in Katy & Houston, Texas
Whether you’re experiencing chronic leg discoloration, toenail changes, acne, or other skin concerns, our board-certified dermatologists provide advanced, compassionate care tailored to your needs.
📍 Village Dermatology – Katy, TX
📍 Village Dermatology – Houston, TX