Case Report: Dermatographic Urticaria in a 67-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Dermatographic urticaria, also known as “skin writing,” is a form of physical urticaria where light scratching or pressure on the skin causes red, raised, itchy welts. While often benign and self-limiting, the condition can be bothersome and impact quality of life. At Village Dermatology in Katy and Houston, Texas, we evaluate and manage urticaria with individualized care plans to reduce discomfort and improve skin health.

Patient Presentation

A 67-year-old female presented with:

• An itchy, red rash on the right arm and right leg

• Moderate severity, ongoing for several months

• Rash appears intermittently and typically resolves within 30 minutes

• Past treatment included oral prednisone with limited improvement

Examination

A focused dermatologic exam revealed:

• Erythematous, linear, edematous plaques induced by scratching

• Findings consistent with acute urticaria with dermatographism

• No other concerning lesions identified

The patient was otherwise well-nourished, alert, and in no acute distress.

Diagnosis

• Dermatographic Urticaria (L50.3)

Management Plan

Medications

• Zyrtec (cetirizine): Patient was already taking 10 mg twice daily; dose increased to 20 mg twice daily as tolerated

• Triamcinolone acetonide 0.1% cream: Prescribed for application twice daily to affected areas for 2 weeks, with instructions to use as needed for flares

Counseling & Education

The patient was counseled on:

• Skin care: Use bland emollients to reduce scratching and maintain skin barrier health

• Expectations: Dermatographism affects 2–5% of the population and is often idiopathic; most cases are benign

• When to contact office: If symptoms worsen, fail to improve, or become more symptomatic

Follow-Up

• Return in 2 weeks for reassessment

• If symptoms persist beyond 6 weeks, initiation of Xolair (omalizumab) may be considered

Conclusion

This case illustrates the clinical presentation and management of dermatographic urticaria in an older female patient. At Village Dermatology in Katy and Houston, TX, we provide both immediate symptom relief with antihistamines and long-term strategies, including advanced therapies like Xolair, when needed.

Full Body Skin Exam in a 73-Year-Old Female: Benign Findings and Sun Protection Counseling

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we encourage patients of all ages to schedule routine full body skin exams. These comprehensive evaluations are an essential way to monitor for skin cancer, track changes in moles, and identify other skin conditions. This case highlights a 73-year-old female who presented for a preventive exam.

Patient Presentation

A 73-year-old female came to our clinic as a new patient for a full body skin examination. She reported new but stable lesions on the right and left upper back. The lesions had been present for several months, were moderate in severity, and had not changed recently.

She had no history of skin cancer but wanted reassurance and preventive counseling.

Dermatologic Examination

A head-to-toe exam was performed, including the scalp, face, trunk, extremities, nails, and mucosal surfaces. A dermatoscope was used to assess pigmented lesions.

Findings included:

• Benign Nevi (Moles): Symmetrical, evenly colored macules and papules throughout.

• Seborrheic Keratoses: Flat, waxy pigmented growths, common with aging.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas, consistent with sun damage.

• Cherry Angiomas: Bright red vascular papules scattered across the skin.

No suspicious or malignant lesions were detected during the exam.

Impression and Plan

Benign Nevi

• Stable, non-worrisome moles.

• Counseling: Monthly self-skin checks recommended.

• When to call the office: Any mole that changes in size, shape, or color, or begins to itch, burn, or bleed.

Seborrheic Keratoses

• Benign age-related growths.

• Counseling: No treatment necessary unless irritated or for cosmetic reasons.

Lentigines (Sun Spots)

• Result of chronic sun exposure and damage.

• Treatment options discussed: sunscreen, bleaching creams, retinoids, chemical peels, and laser therapy.

• Daily regimen recommended:

  • Broad spectrum SPF 30+ sunscreen

  • Vitamin C serum in the morning for added antioxidant protection

  • Lip balm with SPF

  • Wide-brimmed hats and sun-protective clothing for long outdoor exposure

Cherry Angiomas

• Small, benign blood vessel growths.

• Counseling: Treatment not required, but removal possible with laser or electrodesiccation if cosmetically desired.

Key Takeaway

This case demonstrates the importance of full body skin exams for older adults, even when lesions appear stable or benign. Routine evaluations provide reassurance, early detection of skin cancers, and personalized skin care guidance.

At Village Dermatology in Katy and Houston, TX, we specialize in comprehensive skin exams, mole evaluations, and preventive sun care counseling.

Case Report: Oral Minoxidil and PRP Therapy for Androgenetic Alopecia in a 41-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Androgenetic alopecia (AGA), also known as male pattern hair loss, is the most common cause of progressive hair thinning in men. Many patients initially try over-the-counter treatments like topical minoxidil without success. At Village Dermatology in Katy and Houston, Texas, we offer advanced therapies such as oral minoxidil and platelet-rich plasma (PRP) therapy to help slow progression and stimulate regrowth. This case highlights a 41-year-old male with longstanding hair loss.

Patient Presentation

The patient, a 41-year-old male, presented with:

• Generalized hair thinning on the scalp

• Symptoms present for 2 years, gradually worsening

• Prior trial of over-the-counter topical minoxidil, without significant improvement

He sought evaluation and treatment options for hair restoration.

Examination

A focused scalp examination revealed:

• Patterned thinning at the vertex and mid-occipital scalp

• No scarring or evidence of inflammatory alopecia

• Dermatoscopic findings consistent with androgenetic alopecia

The patient was otherwise well developed, alert, and in no acute distress.

Diagnosis

• Androgenetic Alopecia (L64.8)

Management Plan

Diagnostic Approach

A punch biopsy was recommended to confirm the diagnosis and rule out other causes of hair loss.

Treatment Options Discussed

The patient was counseled extensively on treatment choices:

• Medical therapies: oral minoxidil, oral finasteride, topical minoxidil, spironolactone

• Adjuncts: low-level laser therapy, nutritional supplements, hair transplantation

• Procedural options: platelet-rich plasma (PRP) injections and Alma TED therapy (cosmetic, not insurance-covered)

Risks, benefits, and expectations of each were reviewed in detail.

Treatment Chosen

The patient elected to start:

1. Oral minoxidil 2.5 mg daily (with monitoring for low blood pressure)

2. PRP therapy, initiated during the visit, with additional sessions planned

Follow-Up

• 4–6 months for reassessment of response

• Baseline photos taken to document progress

• AGA handout and PRP pricing reviewed with the patient

Conclusion

This case highlights a comprehensive approach to male pattern hair loss, combining oral minoxidil with PRP therapy. At Village Dermatology in Katy and Houston, TX, we tailor treatment plans to each patient’s goals, offering both medical and procedural options for optimal hair restoration outcomes.

Full Body Skin Exam in a 56-Year-Old Male: Benign Findings, Actinic Keratosis, and Lipoma

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, annual full body skin exams are a cornerstone of preventive care. These visits allow for the monitoring of existing lesions and early detection of skin cancer or precancerous growths. This case highlights a 56-year-old male with multiple skin findings, including benign nevi, actinic keratosis, lentigines, cherry angiomas, and a lipoma.

Patient Presentation

A 56-year-old male presented for a full body skin examination as a new patient. He reported longstanding lesions on the right upper back and chest, which had been present for years and remained asymptomatic. His primary concern was preventive screening and reassurance.

The patient declined genital examination but agreed to a full inspection of all other body areas.

Dermatologic Examination

A comprehensive skin exam was performed, including dermatoscope evaluation. Findings included:

• Benign Nevi: Symmetrical, evenly pigmented macules and papules with no concerning features.

• Actinic Keratosis (AK): One precancerous lesion located on the left forehead.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas.

• Cherry Angiomas: Bright red vascular papules scattered on the trunk and extremities.

• Lipoma: A soft, 6 cm mass on the left posterior shoulder, consistent with a benign fatty tumor.

Impression and Plan

Benign Nevi

• Plan: Observation only.

• Counseling: Monthly self-skin checks recommended. Patient educated on the ABCDEs of melanoma (Asymmetry, Border, Color, Diameter, Evolution).

Actinic Keratosis

• Treatment: One lesion treated with liquid nitrogen cryotherapy.

• Risks explained: Crusting, blistering, pigment changes, incomplete removal, recurrence, and infection.

• Counseling: AKs are precancerous and should be treated promptly to prevent progression to squamous cell carcinoma.

Lentigines

• Plan: Sun protection counseling.

• Recommendations: Daily broad spectrum SPF 30+ sunscreen, reapplied every 2 hours during sun exposure. Suggested options included mineral sunscreens and lip balm with SPF.

• Optional treatments discussed: bleaching creams, retinoids, chemical peels, and laser.

Cherry Angiomas

• Plan: Observation only.

• Counseling: Removal with laser or electrodesiccation is optional if desired for cosmetic reasons.

Lipoma

• Findings: 6 cm soft tissue mass on left posterior shoulder.

• Plan: Referral to plastic surgeon Dr. Rodger Brown for surgical excision due to size and location.

• Counseling: Lipomas are benign and often stable, but removal can be considered for comfort or cosmetic reasons.

Key Takeaway

This case demonstrates the value of comprehensive annual skin exams. Even when lesions appear stable or benign, dermatology visits provide reassurance, allow for the treatment of precancerous conditions like actinic keratoses, and guide patients on cosmetic or surgical options for benign growths.

At Village Dermatology in Katy and Houston, TX, we provide expert full body skin checks, mole monitoring, cryotherapy, and referrals for surgical removal of large benign growths.

Case Report: Molluscum Contagiosum and Verruca Vulgaris in a 7-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin infections caused by viruses are common in children, with molluscum contagiosum and warts (verruca vulgaris) among the most frequent. These lesions may persist for years, spread to other areas, and cause parental concern. At Village Dermatology in Katy and Houston, Texas, we offer safe and effective treatments, including cantharidin therapy, to help children achieve clear skin.

Patient Presentation

The patient, a 7-year-old female, presented with:

• Growing warts on the right knee, present for years

• Shiny bumps on the abdomen and buttocks, suspected to be molluscum contagiosum

She had not received prior treatment for these lesions.

Examination

A focused dermatologic exam revealed:

• Verruca vulgaris (common warts): cauliflower-like papules on the right knee

• Molluscum contagiosum: pink, shiny, dome-shaped papules with central umbilication on the abdomen, right buttock, and left buttock

The patient was otherwise well-nourished, alert, and in no acute distress. A dermatoscope was used to confirm clinical features.

Diagnosis

• Molluscum Contagiosum (B08.1)

• Verruca Vulgaris (B07.8) with associated cutaneous inflammation

Treatment Plan

Molluscum Contagiosum

• Diagnosis discussed with the patient’s mother

• Cantharidin (Cantharone) applied to 2 enlarging lesions on the buttocks

• Counseling provided:

  • Lesions may blister before resolving

  • Spread occurs via direct contact or swimming pools

  • If lesions spread rapidly or cause a rash, return to clinic

Verruca Vulgaris (Common Warts)

• Cantharidin therapy applied to 3 inflamed warts on the right knee

• Counseling provided:

  • Warts are caused by human papillomavirus (HPV)

  • Can spread via direct contact

  • Other treatment options include salicylic acid, retinoids, Aldara cream, or cryotherapy

  • Warts may recur despite treatment

Post-Treatment Instructions

• Leave Cantharone on for 6–8 hours, then wash off thoroughly with soap and water

• Watch for possible side effects: blistering, scabbing, or pigmentary changes

• Follow-up as needed if lesions persist, spread, or recur

Conclusion

This case demonstrates the effective use of cantharidin therapy for treating molluscum contagiosum and warts in pediatric patients. At Village Dermatology in Katy and Houston, TX, we provide comprehensive and child-friendly dermatologic care for viral skin infections, helping families manage both the medical and cosmetic aspects of these conditions.

Guttate Psoriasis in a 32-Year-Old Male: Case Study and Treatment with Light Therapy

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we treat a wide range of skin conditions, including psoriasis. This case highlights a 32-year-old male with guttate psoriasis, a form of psoriasis that often appears suddenly and can be triggered by infections such as strep throat.

Patient Presentation

A 32-year-old male presented for evaluation of red, flaky, itchy skin lesions. The psoriasis had been present for several months and was distributed across multiple areas of the body.

He reported no family history of psoriasis and had not previously tried biologic therapies or other systemic treatments. At presentation, he was using only a prescription topical steroid (triamcinolone cream).

Dermatologic Examination

A comprehensive skin exam was performed, including use of a dermatoscope.

Findings included:

• Guttate psoriasis: Multiple small, red, scaly papules scattered across the body.

• Body Surface Area (BSA) Involvement: Estimated at 20%.

• Skin type: IV (moderate brown skin).

No other significant abnormalities were detected.

Impression and Plan

Diagnosis: Guttate Psoriasis (L40.4)

This type of psoriasis is typically associated with an immune response, often following strep throat infections. It presents with numerous small, red, scaly spots resembling “raindrops” on the skin.

Treatment Plan

• Continue topical triamcinolone cream as needed.

• Initiate light therapy (phototherapy) to reduce inflammation, slow down excessive skin cell turnover, and promote clearance of lesions.

• Patient agreed to proceed with treatment.

Counseling

• Guttate psoriasis often resolves with treatment of the triggering infection.

• Other options include topical steroids, UV therapy, and systemic therapies (reserved for severe or persistent cases).

• Patients with a history of guttate psoriasis have an increased risk of developing chronic plaque psoriasis later in life.

• Advised to return if symptoms worsen or fail to improve after several months of treatment.

Key Takeaway

This case illustrates the importance of early recognition and treatment of guttate psoriasis. With proper dermatologic care, patients can achieve significant improvement through therapies such as topical treatments and phototherapy.

At Village Dermatology in Katy and Houston, TX, we provide comprehensive evaluation and treatment for psoriasis and other chronic skin conditions.

Case Report: Full Body Skin Examination in a 52-Year-Old Female with Multiple Benign Lesions | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Full body skin examinations are a vital part of preventive dermatology, particularly for patients with a history of tanning bed use or multiple skin lesions. At Village Dermatology in Katy and Houston, Texas, our dermatologists carefully evaluate the skin for concerning growths while providing patient education about sun safety and skin cancer prevention. This case highlights a 52-year-old female who presented for her annual skin examination.

Patient Presentation

The patient, a 52-year-old female, presented for a routine full body skin exam. She reported skin lesions on the chest that had been present for several months. They were asymptomatic and of moderate severity. She has a history of tanning bed use, which increases her risk of skin cancer.

Examination

A comprehensive full body skin exam was performed, including the scalp, face, trunk, extremities, nails, and groin (patient declined underwear removal). A dermatoscope was used for detailed mole evaluation.

Findings included:

• Benign nevi: Regular, symmetrical moles without concerning features

• Lentigines: Sun-induced pigmented lesions (sunspots)

• Cherry angiomas: Small vascular growths

• Seborrheic keratoses: Benign, warty growths

• Dermatofibromas: Firm nodules on right calf and left buttock

• Rash on right ear: Possible dermatitis, differential includes seborrheic dermatitis vs. eczema

• Neoplasm of uncertain behavior: Courtesy liquid nitrogen (LN2) treatment performed

The patient was otherwise well-appearing, alert, and in no acute distress.

Counseling & Management

1. History of Tanning Bed Use

• Counseling on increased melanoma, basal cell carcinoma, and squamous cell carcinoma risk

• Emphasized sun avoidance, sunscreen SPF 30+, and protective clothing

2. Benign Nevi (D22.9)

• No treatment required

• Patient educated on monthly self-skin checks and to return for changes in size, color, or symptoms

3. Lentigines (L81.4)

• Benign, but may be treated with sunscreen, retinoids, chemical peels, or laser if desired

• Counseling on consistent broad spectrum SPF 30+ use

4. Cherry Angiomas (D18.01)

• Benign vascular lesions, no treatment required

• May be removed with laser or electrodesiccation if cosmetic concerns arise

5. Seborrheic Keratoses (L82.1)

• Common, benign growths that increase with age

• No treatment needed

6. Dermatofibromas (D23.71, D23.5)

• Benign scar-like nodules

• Stable, but may be surgically removed if symptomatic or enlarging

7. Dermatitis, Unspecified (L30.9)

• Rash on right ear treated with over-the-counter hydrocortisone cream

• Patient advised to return if not improving

8. Neoplasm of Uncertain Behavior

• Treated with liquid nitrogen cryotherapy today

• Monitored for resolution; follow-up in 1 year

Conclusion

This case demonstrates the importance of comprehensive annual skin exams, especially in patients with risk factors such as tanning bed history. At Village Dermatology in Katy and Houston, TX, we provide thorough evaluations, identify both benign and concerning lesions, and counsel patients on skin cancer prevention and sun safety.

Case Study: Pilar Cyst, Benign Nevi, and Sun Damage in a 37-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we routinely evaluate patients for skin lesions to identify both benign and potentially concerning findings. This case highlights a 37-year-old female presenting for a comprehensive skin exam, with findings including a pilar cyst, benign moles, lentigines (sun spots), and seborrheic keratosis.

Patient Presentation

A 37-year-old female presented as a new patient for evaluation of brown skin lesions present throughout the body. The lesions had been present for years, were moderate in severity, and had not been treated in the past. She reported no personal history of skin cancer.

Dermatologic Examination

A full-body skin exam was performed with a dermatoscope. Key findings included:

• Pilar Cyst: A firm, subcutaneous cyst located on the mid-occipital scalp.

• Benign Nevi (Moles): Symmetrical, evenly pigmented macules and papules throughout, including a 4 mm mole on the left midback, documented for monitoring.

• Lentigines (Sun Spots): Reticulated, light tan macules distributed in sun-exposed areas.

• Seborrheic Keratosis: A pigmented, waxy papule and flat lesion on the right leg.

No evidence of skin cancer was noted.

Impression and Plan

Pilar Cyst

• Counseling: Pilar cysts are benign keratin-filled sacs that often run in families.

• Plan: No treatment required unless cyst becomes painful, red, or ruptures.

Benign Nevi

• Plan: Observation, with a 6-month recheck of the mole on the back.

• Counseling: Monthly self-skin checks recommended; patient advised to report any changes in size, shape, or color.

Lentigines (Sun Spots)

• Plan: Emphasis on sun protection with broad spectrum SPF 30+ sunscreen.

• Treatment options: Topical bleaching creams, retinoids, chemical peels, or laser for cosmetic improvement.

Seborrheic Keratosis

• Counseling: Benign, age-related growths that require no treatment unless irritated or cosmetically undesired.

Key Takeaway

This case illustrates the importance of regular skin exams for early detection and reassurance. While all findings were benign, the patient received counseling on sun safety, mole monitoring, and when to seek medical attention.

At Village Dermatology in Katy and Houston, TX, we specialize in comprehensive skin exams, mole monitoring, sun protection counseling, and cosmetic dermatology for both prevention and peace of mind.

Case Report: Atopic Dermatitis and Folliculitis in a 28-Year-Old Patient | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Chronic skin conditions like atopic dermatitis (eczema) and folliculitis can significantly affect quality of life if not properly treated. At Village Dermatology in Katy and Houston, Texas, our dermatologists specialize in evaluating persistent rashes, providing targeted treatment, and educating patients on long-term skin care strategies. This case highlights a 28-year-old patient presenting with eczema flare-ups and folliculitis.

Patient Presentation

The patient, a 28-year-old, presented with:

• Itchy, red rash on arms and left hand, present for several months

• History of childhood eczema

• New acne-like bumps on the buttocks, especially after wearing tight clothing

The patient was not on any treatment prior to evaluation.

Examination

A dermatologic examination revealed:

• Eczema patches: well-demarcated, eczematous, inflamed patches on the arms and hands

• Folliculitis: follicular-based pustules on the buttocks

The patient appeared well-nourished, alert, and in no acute distress.

Impressions & Treatment Plan

1. Atopic Dermatitis (Eczema, L20.89)

• History of flares since childhood

• Prescribed triamcinolone acetonide 0.1% cream, applied BID during flares for up to 14 days/month

• Advised on proper skin care:

  • Use lukewarm water with mild cleansers

  • Apply emollients (CeraVe, Cetaphil, Vanicream) 2–3 times daily

  • Avoid scented detergents and fabric softeners

  • Moisturize immediately after bathing

• Counseling on triggers: stress, scented soaps, detergents, dry skin, weather changes, and scratching

• Education on side effects of long-term steroid use, including skin thinning and hypopigmentation

2. Folliculitis

• Likely exacerbated by tight-fitting clothing and friction

• Patient already using benzoyl peroxide wash (Panoxyl bar)

• Prescribed clindamycin 1% gel, applied once to twice daily for prevention and treatment

• Counseled that post-inflammatory hyperpigmentation (brown spots) may remain temporarily but fade with time

• If resistant, future treatment may include oral doxycycline

Counseling & Education

The patient was instructed to:

• Continue moisturizers daily for eczema

• Use benzoyl peroxide wash and clindamycin for folliculitis

• Avoid overuse of topical steroids to minimize side effects

• Return for follow-up in 2 months or sooner if symptoms worsen

Conclusion

This case highlights the importance of personalized dermatologic care for patients with both eczema and folliculitis. At Village Dermatology in Katy and Houston, TX, our team provides tailored treatment plans combining medications, lifestyle guidance, and preventive care to ensure healthy skin and improved quality of life.

Case Study: Epidermal Inclusion Cyst on the Neck in a 33-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often evaluate patients who present with long-standing nodules or growths on the skin. This case features a 33-year-old female who presented with a firm nodule on the posterior neck, ultimately diagnosed as an epidermal inclusion cyst.

Patient Presentation

A 33-year-old female presented for evaluation of a firm nodule on the right posterior neck, which had been present for 10 years. The lesion was moderate in severity but had not been previously treated.

She declined a full skin examination and requested evaluation only of the symptomatic area.

Dermatologic Examination

A focused exam of the head, lips, and neck was performed with dermatoscopy.

Findings included:

• Subcutaneous cyst with a prominent follicular pore, consistent with an epidermal inclusion cyst.

• Size: approximately 1.5 cm, located on the right medial trapezial/posterior neck region.

No other concerning findings were identified.

Impression and Plan

Epidermal Inclusion Cyst (L72.8)

• Counseling: Epidermal inclusion cysts are benign sacs beneath the skin filled with keratin.

• Expectations: They typically remain stable, though they can enlarge, rupture, or become tender if inflamed.

• Plan: Observation. No treatment required at this time.

• Instructions: Patient was advised to return if the cyst ruptures, becomes red, painful, or shows signs of infection.

Key Takeaway

Epidermal inclusion cysts are benign, slow-growing lesions that can often be managed conservatively. While removal may be considered for cosmetic reasons or if the cyst becomes inflamed, observation is appropriate when the lesion is stable and asymptomatic.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation and management of cysts, nodules, and other skin growths, offering both reassurance and treatment options tailored to patient needs.

Case Report: Hair Loss, Allergic Contact Dermatitis, and Seborrheic Dermatitis in a 44-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Patients often present to dermatology clinics with more than one skin or hair concern. At Village Dermatology in Katy and Houston, Texas, we take a comprehensive approach, addressing each condition with both medical treatment and patient education. This case highlights a 44-year-old female with generalized hair loss, seborrheic dermatitis of the scalp, and allergic contact dermatitis affecting her toes.

Patient Presentation

The patient is a 44-year-old female who sought a second opinion for hair loss. She had been on oral minoxidil (half a tablet daily) for three months without noticeable improvement. In addition, she reported:

• Recurrent rashes on her toes triggered by beach visits (suspected allergic contact dermatitis)

• Scalp scaling and itching consistent with seborrheic dermatitis

Examination

A focused exam revealed:

• Diffuse thinning of scalp hair, consistent with female pattern hair loss

• Well-demarcated, geometric eczematous patches on toes consistent with allergic contact dermatitis

• Scaling and erythema on the scalp, consistent with seborrheic dermatitis

The patient was otherwise well-developed, oriented, and in no acute distress. A dermatoscope was used for scalp evaluation.

Impressions & Treatment Plan

1. Allergic Contact Dermatitis (L23.9)

• Triggered by beach exposure, etiology unclear

• Prescribed clobetasol 0.05% cream, applied BID during flares (up to 2 weeks/month)

• Counseling provided on hypoallergenic products, potential need for patch testing, and steroid side effects

2. Seborrheic Dermatitis

• Chronic scalp condition with flares

• Prescribed ketoconazole 2% shampoo, used daily during flares and 1–3 times weekly for maintenance

• Prescribed fluocinonide 0.05% solution, BID PRN during flares

• Counseling on long-term management, stress as a trigger, and steroid side effects

3. Androgenetic Alopecia (Female Pattern Hair Loss, L64.8)

• Patient counseled that 3 months of oral minoxidil is too early for results (typically 6–12 months needed)

• Treatment plan updated:

  • Continue oral minoxidil

  • Add oral finasteride 5 mg daily

  • Discussed additional options: PRP (platelet-rich plasma), AlmaTED treatments, supplements (Nutrafol, Viviscal), and at-home red light therapy

• Counseling on expectations: Female pattern hair loss is genetically determined, slowly progressive, and typically presents with widened midline parting while maintaining the frontal hairline

Conclusion

This case highlights the importance of comprehensive dermatology care in managing overlapping skin and hair conditions. At Village Dermatology in Katy and Houston, TX, our specialists combine advanced medical treatments, patient education, and cosmetic options to provide tailored care for conditions like hair loss, seborrheic dermatitis, and allergic contact dermatitis.

Case Study: Androgenetic Alopecia in a 22-Year-Old Male and Treatment with PRP Therapy

by : Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we see many young men concerned about progressive hair loss. This case highlights a 22-year-old male presenting with diffuse scalp thinning, ultimately diagnosed with androgenetic alopecia (male pattern hair loss) and opting for platelet-rich plasma (PRP) therapy.

Patient Presentation

A 22-year-old male presented as a new patient for evaluation of generalized hair loss on the scalp. The hair thinning had been ongoing for 5 months, was moderate in severity, and had gradually worsened.

He had no prior treatments other than over-the-counter Nutrafol supplements.

Dermatologic Examination

A focused exam of the scalp and face was performed with dermatoscopy. Findings included:

• Diffuse non-scarring hair loss across the scalp.

• Patterned thinning in the vertex and frontotemporal regions, consistent with androgenetic alopecia (AGA).

Impression and Plan

Androgenetic Alopecia (Male Pattern Hair Loss)

• Diagnosis: Clinical findings consistent with AGA. Punch biopsy was discussed for further confirmation, but not pursued at this time.

• Treatment Options Reviewed:

  • Oral minoxidil

  • Finasteride

  • Spironolactone (off-label in men, rarely used)

  • Topical Rogaine (minoxidil)

  • Low-level laser therapy

  • Microneedling

  • Hair transplant surgery

  • PRP (platelet-rich plasma) therapy

• Side effects, benefits, and expectations were reviewed thoroughly.

Patient Decision

After an in-depth discussion, the patient elected to proceed with PRP therapy.

• Counseling included the fact that PRP is cosmetic and not covered by insurance.

• Patient was advised on what to expect from the procedure and the importance of follow-up.

Counseling

• Hair Care: AGA can be slowed with medications such as minoxidil and finasteride; hair transplantation is an option in advanced cases.

• Expectations: AGA is genetically pre-determined, slowly progressive, and most prominent in the vertex and frontal scalp.

• Monitoring: The patient was instructed to return if hair loss worsens or fails to improve with therapy.

Follow-Up

The patient was scheduled to begin PRP therapy and will follow up in 4 months for re-evaluation.

Key Takeaway

This case underscores the importance of early diagnosis and treatment in male pattern hair loss. With a combination of modern therapies such as PRP, oral medications, and topical treatments, patients can often achieve significant improvement in hair density and quality.

At Village Dermatology in Katy and Houston, TX, we specialize in advanced hair restoration options, including PRP therapy, oral and topical treatments, and counseling for hair loss prevention.

Case Report: Punch Excision of an Epidermal Inclusion Cyst in a 39-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Epidermal inclusion cysts are among the most common benign skin lesions seen in dermatology. While often harmless, patients may choose removal for cosmetic, diagnostic, or preventive reasons. At Village Dermatology in Katy and Houston, Texas, we provide expert evaluation and removal of cysts with safe, in-office procedures. This case highlights a 39-year-old male who presented with a cyst on his upper back.

Patient Presentation

The patient, a 39-year-old male, reported a cyst on his right upper back/superior thoracic spine that had been present for nearly a year. The lesion was enlarging, moderate in severity, and persistent. The patient denied pain, drainage, or episodes of inflammation.

Examination

Focused exam of the back revealed:

• Well-nourished, well-appearing male

• Epidermal inclusion cyst measuring 1.6 x 1.2 cm on the superior thoracic spine

• No erythema, tenderness, or drainage at the time of evaluation

Diagnosis

• Epidermal Inclusion Cyst (L72.8)

• Associated cutaneous inflammation

Management & Procedure

Counseling

The patient was reassured that epidermal inclusion cysts are benign sacs containing keratin and do not require treatment unless inflamed, painful, or cosmetically concerning. He elected for removal. Risks, benefits, and alternatives were reviewed, including possible infection, recurrence, or scarring.

Punch Excision

• Location: Superior thoracic spine

• Size: 1.6 x 1.2 cm

• Anesthesia: Local infiltration with 1% lidocaine with epinephrine

• Procedure:

  • Skin prepped with Betadine and draped

  • A 4 mm punch tool was used to excise the cyst opening

  • Blunt dissection performed to remove cyst contents and capsule

  • Hemostasis achieved with electrocautery

  • Simple interrupted closure with 4-0 nylon sutures

  • Petrolatum and sterile dressing applied

• Estimated blood loss: Minimal

• Complications: None

Post-Procedure Care

The patient was instructed to:

• Avoid heavy lifting, exercise, or swimming for 14 days

• Keep the wound clean and apply petrolatum as directed

• Return for suture removal in 14 days

• Contact the office for fever, bleeding, severe pain, or signs of infection

Conclusion

This case demonstrates the successful punch excision of a benign epidermal inclusion cyst in an adult male patient. At Village Dermatology in Katy and Houston, TX, our dermatologists specialize in safe removal of cysts, moles, and skin growths, ensuring optimal cosmetic outcomes and patient peace of mind.

Case Study: Enlarging Growth on the Back – Lipoma in a 43-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, patients often present with new or enlarging growths that raise concern about skin cancer or other serious conditions. This case highlights a 43-year-old female with a darkening, enlarging growth on her upper back, ultimately diagnosed as a lipoma.

Patient Presentation

A 43-year-old female presented as a new patient for evaluation of growths on the right upper back. The lesions had been darkening, enlarging, and irregular in appearance for several months. They were moderate in severity and had not been treated in the past.

Her main concern was whether these growths represented something malignant, and she sought evaluation and management.

Dermatologic Examination

A full-body exam was performed, including the scalp, face, trunk, and extremities, with the assistance of a dermatoscope.

Findings included:

• Lipoma: A soft, subcutaneous, slow-growing mass measuring approximately 1.8 cm on the upper back.

No other suspicious lesions were noted.

Impression and Plan

Lipoma

The growth was determined to be a lipoma, a benign tumor made of fatty tissue.

Counseling and Education:

• Lipomas are noncancerous and slow-growing.

• They often remain stable but can gradually enlarge over time.

• No treatment is strictly necessary unless the lesion is bothersome, enlarging, or cosmetically concerning.

Treatment Recommendation:

• Surgical excision was recommended for definitive treatment and removal.

• The patient was offered referral to Dr. Vaughn or Dr. Armenta for the procedure.

The patient elected to proceed with surgical removal.

Key Takeaway

Not all enlarging or darkening skin growths are dangerous. Lipomas are benign fatty tumors, but professional evaluation is essential to rule out other possibilities. In this case, the patient was reassured, counseled, and scheduled for surgical removal.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation of growths, lumps, and skin lesions, offering both reassurance and treatment options tailored to each patient.

Case Report: Isotretinoin (Accutane) Initiation for Severe Acne in a 24-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Acne vulgaris is one of the most common dermatologic conditions affecting young adults. At Village Dermatology in Katy and Houston, Texas, we see many patients with acne that is persistent, hormonally influenced, and resistant to standard therapies. This case highlights a 24-year-old female whose acne worsened around her menstrual cycle and was inadequately controlled with prior treatments, leading to the initiation of isotretinoin (Accutane).

Patient Presentation

The patient is a 24-year-old female who presented for evaluation of acne on her face and back. She reported both comedonal papules and inflammatory papules/pustules, with flares around her menstrual cycle.

Examination

A focused skin examination of the face revealed:

• Comedonal papules

• Inflammatory papules and pustules

• Acne of moderate-to-severe nature with potential for scarring

The patient was otherwise well developed, oriented, and in no acute distress.

Diagnosis

• Acne vulgaris (L70.0), inadequately controlled

• Pattern consistent with hormonally influenced acne

• Risk of scarring identified

Management Plan

Counseling

The patient received detailed education about:

• Skin care: Use of gentle cleansers, non-comedogenic moisturizers, and cosmetics

• Treatment expectations: Improvement may take 2–3 months with a 60–80% reduction in acne lesions

• Warning signs: Return to clinic if acne worsens, new scars form, or cysts appear

Treatment Initiation: Isotretinoin (Accutane)

• Planned dose: 40 mg daily

• Indication: Severe acne with scarring, resistant to prior treatments

• iPledge program: Patient registered and counseled regarding strict pregnancy prevention requirements

• Contraception: Patient started Aviane oral contraceptive pill (OCP) in addition to condoms

High-Risk Medication Monitoring

• Patient counseled on potential side effects: dryness, headaches, blurry vision, muscle aches, mood changes, liver effects, lipid changes

• Monitoring: Monthly visits with blood work (hepatic function panel, triglycerides)

• Urine pregnancy test: Negative in clinic prior to starting therapy

Follow-Up

The patient will return in 31 days for repeat testing, counseling, and isotretinoin monitoring.

Conclusion

This case demonstrates a structured, safety-focused approach to Accutane initiation in young female patients. At Village Dermatology in Katy and Houston, TX, our dermatologists emphasize patient education, regular monitoring, and comprehensive acne treatment to achieve long-term skin health and reduce scarring risk.

Painful Neck Growth in a 41-Year-Old Male: Furuncle and Skin Tag Removal

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently evaluate patients with new or concerning skin growths. This case highlights a 41-year-old male who presented with a painful lesion on the back of his neck, as well as skin tags in the underarm area.

Patient Presentation

A 41-year-old male presented as a new patient with a growth on the posterior neck. The lesion had been present for 3 days and was initially painful. The patient had not tried any treatment prior to his visit.

He also noted multiple skin tags in the left axilla, which he wished to have removed.

Dermatologic Examination

A focused exam of the neck and left axilla was performed with the assistance of a dermatoscope. Findings included:

• Furuncle (Boil): Inflamed, tender lesion on the posterior neck.

• Skin Tags (Acrochordons): Multiple soft, pedunculated papules in the left axillary vault.

Impression and Plan

Furuncle

The lesion on the posterior neck was most consistent with a furuncle, a bacterial skin infection forming a small abscess.

Treatment Plan:

• Doxycycline 100 mg taken orally twice daily for 10 days.

• Mupirocin 2% ointment applied to the affected area three times daily for 10 days.

• Supportive care: warm compresses with diluted vinegar solution, gentle cleansing with Hibiclens wash, and use of benzoyl peroxide.

Counseling:

• Furuncles typically resolve with antibiotics but may occasionally require drainage.

• If the lesion worsens or fails to heal, culture may be needed to rule out MRSA (methicillin-resistant Staphylococcus aureus).

Skin Tags

Ten skin tags in the left axilla were removed for cosmetic reasons.

Procedure:

• Local anesthesia with lidocaine and epinephrine.

• Removal performed using gradle excision.

• Hemostasis achieved with Drysol.

Counseling:

• Skin tags are benign but can be irritating when caught on clothing or jewelry.

• Risks of removal, including bleeding, pigment changes, infection, or scarring, were reviewed with the patient.

Key Takeaway

This case demonstrates the value of dermatology evaluation for both infectious lesions (furuncles) and benign growths (skin tags). Early intervention with antibiotics and minor procedures can provide rapid relief and peace of mind.

At Village Dermatology in Katy and Houston, TX, we provide expert diagnosis and treatment of painful skin growths, infections, and cosmetic concerns.

Case Report: Evaluation of Skin Lesions in a 23-Year-Old Female with Dysplastic Nevus and Benign Moles | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin cancer prevention and mole monitoring are an important part of dermatology care, especially for patients with a history of dysplastic nevi. At Village Dermatology in Katy and Houston, Texas, we provide comprehensive skin exams, patient education, and treatment when concerning lesions are identified. This case highlights a 23-year-old female who presented for evaluation of multiple skin lesions and counseling regarding sun protection and mole monitoring.

Patient Presentation

The patient is a 23-year-old female who presented with multiple skin lesions on the body, present for several years. The lesions were asymptomatic and had not been previously treated. She also requested education regarding sun exposure, mole checks, and surveillance for suspicious growths. Her history is significant for dysplastic nevi biopsied at an outside dermatologist in Louisiana. She has no family history of melanoma.

Examination

A full-body skin examination was performed, including:

• Scalp, head, face, and neck

• Chest, abdomen, back

• Upper and lower extremities

• Digits and nails

• Groin and buttocks (underwear not removed at patient’s request)

A dermatoscope was used for detailed mole evaluation.

Findings included:

• Dysplastic Nevus with Severe Atypia (left upper back, previously biopsied)

• Benign Nevi: regular, symmetric, evenly-colored macules and papules on the back, left 5th toe, and left dorsal great toe

• Lentigines: pigmented sun-induced lesions

Impression & Plan

1. Dysplastic Nevus with Severe Atypia (D22.5)

• Previously biopsied, severe atypia confirmed

• Excision recommended for complete removal

• Patient counseled on self-skin checks and importance of monitoring for new or changing lesions

2. Benign Nevi (D22.5, D22.72)

• Multiple stable, non-concerning moles identified

• No treatment necessary

• Patient counseled to perform monthly self-skin checks and return if changes occur

3. Lentigines (L81.4)

• Related to sun exposure and sun damage

• Benign, but can be treated with sunscreen, bleaching creams, retinoids, chemical peels, or laser therapy

• Patient counseled on strict sun protection

Sun Protection Counseling

The patient received detailed sunscreen and sun safety education:

• Broad Spectrum SPF 30+ sunscreen recommended, applied 15 minutes before sun exposure

• Reapply every 2 hours, or every 45–60 minutes if swimming/sweating

• Use of sun protective clothing and hats encouraged

• Lip balm with SPF for lip protection

Conclusion

This case underscores the importance of regular dermatology skin checks for patients with a history of atypical moles. At Village Dermatology in Katy and Houston, TX, our team provides comprehensive care, including mole mapping, biopsy, excision, and ongoing patient education to prevent skin cancer and maintain healthy skin.

Eyelid Dermatitis in a Teenager: Case Study and Management Approach

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we care for patients of all ages presenting with rashes, skin lesions, and facial irritation. This case highlights an 18-year-old female with a persistent rash on the face, emphasizing the importance of accurate diagnosis and tailored treatment for eyelid dermatitis.

Patient Presentation

An 18-year-old female presented as a new patient with enlarging skin lesions on the left cheek, nose, and right cheek. The lesions had been present for several months, were moderate in severity, and had not been treated previously. She reported that the rash frequently recurred around her eyes.

Dermatologic Examination

A full exam of the scalp, face, ears, lips, and forearms was performed using a dermatoscope. Findings included:

• Facial Dermatitis (Unspecified): Patches of lighter, irritated skin around the eyes.

• The clinical appearance raised consideration of atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis (ACD), or lupus.

No systemic symptoms were reported.

Assessment and Plan

The differential diagnosis included several causes of eyelid dermatitis. Since no definitive diagnosis could be made during the initial visit, treatment was focused on symptomatic relief and careful follow-up.

Treatment Initiated

• Tacrolimus 0.1% ointment: Apply twice daily to affected areas.

• Ketoconazole 2% cream: Apply twice daily for two weeks.

• Emollients were recommended to maintain hydration and support skin barrier function.

Counseling and Education

The patient was counseled regarding:

• The chronic and sometimes unclear nature of eyelid dermatitis.

• Avoiding potential irritants and allergens around the eyes (makeup, harsh cleansers, fragranced products).

• Monitoring for warning signs such as fever, worsening rash, or new systemic symptoms.

Follow-Up

The patient was scheduled for follow-up in 4 weeks. If symptoms persist, patch testing will be considered to identify possible allergens. Blood work for ANA (antinuclear antibodies) was also ordered to rule out autoimmune causes such as lupus.

Key Takeaway

Eyelid dermatitis in young patients can have multiple potential causes. Early dermatology evaluation, gentle treatment, and close follow-up are essential to achieve relief and prevent long-term complications.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation and customized treatment plans for patients with rashes, dermatitis, and facial skin conditions.

Case Report: Excision of a Compound Nevus with Severe Atypia in a 53-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin cancer prevention and early detection are central to dermatologic care. At Village Dermatology in Katy and Houston, Texas, we regularly evaluate and treat patients with atypical moles and skin lesions. This case highlights a 53-year-old male who presented with a concerning mole on his upper back, ultimately diagnosed as a compound nevus with severe atypia.

Patient Presentation

The patient was initially seen on August 14, 2025 for a neoplasm of uncertain behavior located on the left superior lateral upper back. At that visit, a shave biopsy was performed.

Pathology Results

The biopsy specimen was reviewed and returned with a diagnosis of:

• Compound Nevus with Severe Atypia

Given this result, surgical excision was recommended to ensure complete removal and reduce the risk of progression.

Follow-Up and Surgical Excision

The patient presented for definitive treatment via surgical excision.

Clinical Exam

• Healing biopsy site on the left mid-upper back

• No acute distress; patient well developed and nourished

Surgical Details

• Location: Left mid-upper back

• Pre-op size: 0.5 cm x 0.7 cm

• Margins: 0.5 cm

• Total excised diameter: 1.5 x 1.7 cm

• Final wound length: 5.4 cm

• Repair type: Intermediate layered closure

Anesthesia: Local infiltration with 1% lidocaine with epinephrine
Estimated blood loss: Minimal
Complications: None

The procedure involved a fusiform excision down to the adipose tissue, removal of the lesion, and layered closure to optimize healing and minimize scarring. The specimen was sent for histopathologic evaluation.

Post-Procedure Counseling

The patient was counseled on wound care and recovery:

• No heavy lifting, swimming, or exercise for 14 days

• Suture removal and wound check scheduled in 14 days

• Contact the office if experiencing fever, chills, bleeding, or severe pain

Conclusion

This case demonstrates the importance of timely biopsy and surgical management of atypical moles. At Village Dermatology in Katy and Houston, TX, our dermatologists carefully evaluate skin lesions, perform biopsies when necessary, and provide expert excision techniques to optimize both medical safety and cosmetic outcomes.

Comprehensive Skin Exam in a 25-Year-Old Male: Benign Nevi, Lentigines, and Sun Protection Counseling

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we emphasize the importance of routine skin exams for patients of all ages. This case highlights the evaluation of a 25-year-old male presenting with longstanding skin lesions and seeking education about sun protection, mole evaluation, and overall skin health.

Patient Presentation

A 25-year-old male visited our clinic for an evaluation of multiple skin lesions on the upper back and left breast. The lesions had been present for several years, were asymptomatic, and had never been treated. He also sought education about preventing skin cancer, recognizing suspicious growths, and protecting his skin from sun exposure.

The patient had no personal history of skin cancer.

Dermatologic Examination

A comprehensive skin exam was performed, including inspection of the scalp, face, trunk, extremities, nails, and mucosal surfaces. A dermatoscope was used to assess lesions. The exam revealed:

• Benign Nevi (Moles): Symmetrical, evenly colored macules and papules distributed throughout the body. No concerning features for malignancy were noted.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas, consistent with chronic sun damage.

• Seborrheic Keratoses: Waxy, pigmented growths present on the trunk and extremities, benign and age-related.

• Cherry Angiomas: Small, bright red vascular papules scattered across the skin.

• Post-Inflammatory Hyperpigmentation: Ill-defined hyperpigmented patches noted on the upper lip, secondary to a prior rash or trauma.

• Congenital Nevus: A stable pigmented lesion located near the periumbilical region.

No evidence of skin cancer was identified during this visit.

Counseling and Recommendations

The patient was counseled extensively on:

Sun Protection

• Broad Spectrum Sunscreen SPF 30+ applied daily, reapplied every 2 hours during sun exposure.

• Use of mineral-based sunscreens containing zinc oxide or titanium dioxide (recommended brands included Elta MD, ISDIN, Supergoop Mineral Sheerscreen, Cerave Mineral SPF 50, and Neutrogena Sheer Zinc).

• Protective clothing, wide-brimmed hats, and lip balms with SPF.

• Daily use of Vitamin C serum in the morning for antioxidant protection.

Self-Skin Exams

• Perform monthly self-checks for changes in size, shape, or color of moles.

• Seek medical evaluation if lesions become painful, itchy, bleeding, or rapidly changing.

Expectations

• Benign Nevi, Seborrheic Keratoses, Cherry Angiomas, and Congenital Nevi require no treatment unless cosmetic removal is desired.

• Lentigines may improve with sunscreen, topical agents, chemical peels, or laser treatments.

• Post-Inflammatory Hyperpigmentation often resolves gradually but may take months to years.

Follow-Up

The patient was advised to return in 1 year for a routine full-body skin check or sooner if new or changing lesions appear.

Key Takeaway

This case underscores the importance of early skin evaluations for patients—even young adults with no history of skin cancer. Education on sun protection, skin self-exams, and preventive dermatology plays a vital role in long-term skin health.

At Village Dermatology in Katy and Houston, TX, we provide expert care for patients seeking reassurance about their moles, sun spots, and other skin concerns.