Actinic Keratosis Case Report: Treating a Precancerous Facial Lesion in a 92-Year-Old Patient

By: Dr. Ashley Baldree

At Village Dermatology, early detection and treatment of precancerous skin lesions is a critical part of caring for our aging population in Katy and Houston, Texas. Actinic keratoses (AKs) are common in older adults with cumulative sun exposure and require prompt evaluation to reduce the risk of progression to skin cancer.

Patient Presentation

A 92-year-old female presented as a new patient for evaluation of a changing skin lesion on the left cheek. The lesion had been present for several months and was described as darkening, enlarging, and irregular, raising concern for sun-related precancerous change. The lesion had not been previously treated.

The patient presented for full dermatologic evaluation and management.

Comprehensive Skin Examination

A full-body skin examination was performed, including the scalp, face, neck, trunk, upper and lower extremities, hands, and forearms. Dermoscopy was used to further evaluate the lesion.

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

On examination, there was a hypertrophic erythematous papule with hyperkeratotic scale located on the left medial malar cheek, clinically consistent with actinic keratosis.

Assessment

• Actinic Keratosis (AK) – L57.0

• Precancerous lesion on sun-damaged facial skin

Treatment Plan

Given the clinical appearance and risk factors, liquid nitrogen cryotherapy was recommended and performed during the visit.

Cryotherapy Details

• 1 lesion treated

• 3 freeze–thaw cycles

• Location: left medial malar cheek

Informed consent was obtained, including discussion of potential risks such as blistering, scabbing, pigmentary changes, scarring, infection, recurrence, and incomplete removal.

If the lesion does not fully resolve, shave biopsy may be considered at a future visit.

Patient Counseling & Education

The patient received thorough counseling regarding actinic keratoses, including:

Skin Cancer Prevention

• Daily use of broad-spectrum sunscreen SPF 30+

• Wearing sun-protective clothing

• Avoiding peak sun exposure when possible

Expectations

• Actinic keratoses are precancerous growths caused by long-term sun exposure

• While many AKs respond well to treatment, a small percentage may progress to squamous cell carcinoma if left untreated

When to Contact the Office

• If the lesion does not resolve

• If new or changing lesions appear

• If severe side effects occur, such as excessive crusting, tenderness, or redness

High-Quality Skin Cancer Prevention in Katy & Houston

This case highlights the importance of early recognition and treatment of precancerous lesions, especially in older adults. At Village Dermatology, we emphasize preventive care, patient education, and evidence-based treatments to help reduce the risk of skin cancer.

If you or a loved one has a new or changing skin lesion, our dermatology team is here to help.

Dog Bite to the Lip: Prompt Dermatologic Care in Katy & Houston, Texas

Dr. Ashley Baldree

Case Overview

A 55-year-old female new patient presented to Village Dermatology after sustaining a dog bite to the right lower lip earlier the same morning. She reported pain, redness, and moderate severity at the site of injury. Facial dog bites require prompt evaluation due to the risk of infection, scarring, and involvement of sensitive structures.

Clinical Examination

A focused examination of the head and face was performed using dermoscopy. The patient was well developed, well nourished, alert, oriented, and in no acute distress. Examination revealed puncture wounds on the right inferior vermilion lip, consistent with a recent dog bite. No signs of systemic infection were present at the time of evaluation.

Diagnosis: Dog Bite (Initial Encounter)

The patient was diagnosed with a dog bite to the lower lip, a common but potentially serious type of animal bite. Facial dog bites are carefully managed due to higher infection risk and cosmetic concerns.

Treatment Plan for Dog Bite Management

The patient was counseled extensively on wound care and infection prevention. Key components of the treatment plan included:

Infection Prevention

• Oral antibiotics: Amoxicillin-clavulanate prescribed twice daily for 10 days

• Topical antibiotic: Mupirocin ointment applied twice daily until healed

Dog bites are not sutured due to increased infection risk, especially when puncture wounds are present.

Wound Care Instructions

• Clean the wound thoroughly with soap and water

• Perform vinegar soaks (1:1 ratio) for 5 minutes, up to three times daily

• Apply mupirocin ointment after soaks

• Monitor closely for signs of infection

The patient was instructed to seek emergency care if she develops fever, chills, increasing redness, swelling, or worsening pain.

Scar Prevention Counseling

The importance of meticulous wound care to minimize scarring was emphasized. The patient was advised to allow complete healing before pursuing scar treatments. Silicone-based scar therapy will be discussed at follow-up.

Additional Counseling for Animal Bites

The patient was educated on:

• The importance of identifying the animal involved

• Possible need for rabies evaluation if the animal cannot be observed

• Tetanus vaccination considerations

• When emergency department evaluation is necessary

Additional Finding: Verruca Vulgaris

During the visit, verruca vulgaris (common warts) were also noted on the left distal dorsal forearm. The patient was counseled on treatment options including topical therapies and cryotherapy, with expectations for resolution discussed.

Expert Dermatologic Care for Animal Bites in Katy & Houston

At Village Dermatology, we provide prompt evaluation and treatment of dog bites and facial wounds, focusing on infection prevention, proper healing, and minimizing long-term scarring. Our dermatologists serve patients throughout Katy and Houston, Texas, offering expert care for both urgent and routine skin concerns.

If you experience an animal bite or facial injury, early dermatologic evaluation is essential for the best outcome.

Facial Discoloration and Textured Skin: Treating Irritant Contact Dermatitis in Katy & Houston, Texas

By: Dr. Caroline Vaughn

Case Overview

A 30-year-old female new patient presented to Village Dermatology with concerns of facial discoloration affecting both cheeks. She also noted skin texture changes and intermittent breakouts. The patient had a prior history of completing an isotretinoin (Accutane) course and reported that her typical acne had remained well controlled since then.

Clinical Examination

A comprehensive facial examination was performed, including dermoscopic evaluation and palpation of the supraclavicular lymph nodes. The patient appeared well developed, well nourished, alert, oriented, and in no acute distress. Examination findings were consistent with irritant contact dermatitis, with associated post-inflammatory discoloration.

Diagnosis: Irritant Contact Dermatitis

Based on clinical findings, the discoloration and rough skin texture were attributed to irritant contact dermatitis (ICD). The patient reported using multiple over-the-counter serums and an exfoliator, which likely contributed to skin barrier disruption and irritation.

Patients with ICD often develop redness, texture changes, and discoloration when the skin is exposed to harsh or excessive skincare products. In this case, the discoloration was explained as post-inflammatory hyperpigmentation resulting from the underlying rash.

Treatment Plan: Simplifying Skincare

The patient was counseled extensively on simplifying her skincare routine to allow the skin barrier to heal. Key recommendations included:

Gentle Skincare Routine

• Avoid harsh chemicals, exfoliators, and overuse of active ingredients

• Use gentle cleansers and fragrance-free moisturizers

• Apply moisturizers regularly to reduce irritation

• Consider topical steroids if inflammation worsens

Patients were advised that irritant contact dermatitis may persist unless triggering products are eliminated, and patch testing may be considered if symptoms fail to improve.

Managing Hyperpigmentation

The patient was also diagnosed with post-inflammatory hyperpigmentation (PIH). Counseling emphasized that PIH may take months to years to fade but typically improves over time with proper care.

Hyperpigmentation Treatment Recommendations

• Strict sun protection with broad-spectrum sunscreen SPF 30+

• Protective clothing and minimizing sun exposure

• Prescription hydroquinone applied nightly to affected areas for three months, followed by a one-month break before restarting if needed

Recommended Sunscreens for Sensitive Skin

To prevent worsening discoloration, the following facial sunscreens were recommended:

• EltaMD UV Clear (Tinted)

• Supergoop! Glowscreen

• InnBeauty Mineral Glow Screen

• ISDIN Eryfotona Actinica

• La Roche-Posay Anthelios Face Sunscreen

Recommended Moisturizers

To support barrier repair and reduce irritation:

• Vanicream Daily Facial Moisturizer

• CeraVe PM Facial Moisturizing Lotion

• La Roche-Posay Toleriane Double Repair

• Avène Cicalfate

• Kiehl’s Ultra Facial Cream

Expert Dermatologic Care in Katy & Houston

At Village Dermatology, we specialize in diagnosing and treating facial rashes, discoloration, and skin texture changes. Whether your concerns stem from sensitive skin, product reactions, or post-inflammatory hyperpigmentation, our dermatologists provide personalized treatment plans to restore healthy, even-toned skin.

If you’re experiencing persistent facial discoloration or irritation, schedule an evaluation with Village Dermatology in Katy or Houston, Texas for expert care.

Aging Face and Sun Spots: A Personalized Anti-Aging Consultation in Katy & Houston, Texas

By: Dr. Caroline Vaughn

Case Overview

A 42-year-old female established patient presented to Village Dermatology for evaluation of facial aging and sun spots. Her primary concerns included changes in skin texture, uneven tone, and visible signs of sun damage. She was interested in learning about effective anti-aging skincare products and cosmetic procedures to improve her overall appearance while maintaining natural-looking results.

Clinical Examination

A focused facial examination was performed. The patient appeared well developed and well nourished, alert, oriented, and in no acute distress. Findings were consistent with age-related skin texture changes and sun-related pigmentation, common concerns among patients seeking cosmetic dermatology care in Katy and Houston, Texas.

Treatment Discussion: Anti-Aging Options

During the visit, a comprehensive discussion was held regarding both topical and procedural anti-aging treatments:

Medical-Grade Topical Therapy

The patient was counseled on the benefits of topical retinoids for improving skin texture, fine lines, and sun damage:

• Tretinoin 0.025% cream was prescribed to be applied nightly as tolerated using a pea-sized amount for the entire face.

• If irritation occurs, the patient may transition to over-the-counter Differin (adapalene) as a gentler alternative.

Retinoids remain a cornerstone of anti-aging skincare, stimulating collagen production and promoting smoother, more even-toned skin.

Procedural Anti-Aging Options

Several in-office cosmetic procedures were discussed to address varying levels of skin aging:

• CO₂ Laser Resurfacing for more aggressive treatment of wrinkles, sun spots, and texture irregularities.

• Microneedling as a less aggressive option to improve collagen production and skin tone.

• Microneedling with PRP (Platelet-Rich Plasma) to enhance rejuvenation and healing.

• Dermal fillers to address under-eye volume loss and restore a refreshed appearance.

A pricing sheet was provided, allowing the patient to review options at her convenience.

Sun Protection & Skincare Counseling

Given the role of sun exposure in premature aging, the patient was counseled extensively on daily sun protection. Recommended facial sunscreens included:

• EltaMD UV Clear (Tinted)

• Supergoop! Glowscreen

• InnBeauty Mineral Glow Screen

• ISDIN Eryfotona Actinica

• La Roche-Posay Anthelios Face Sunscreen

Daily broad-spectrum sunscreen use is essential for preventing further sun damage and maintaining results from anti-aging treatments.

Additional Consideration: Rosacea

The patient also has a history of rosacea. Laser treatment options were discussed for redness and visible blood vessels; however, she elected to defer treatment at this time. Counseling emphasized:

• Regular sunscreen use

• Trigger avoidance (heat, spicy foods, alcohol, stress)

• Understanding that rosacea is a chronic condition that can be managed with appropriate care

Personalized Cosmetic Dermatology in Katy & Houston

At Village Dermatology, we offer individualized anti-aging and cosmetic dermatology solutions designed to address sun damage, skin texture changes, and facial aging. From prescription skincare to advanced laser treatments, our team helps patients in Katy and Houston, Texas achieve healthy, youthful-looking skin with confidence.

If you’re noticing sun spots, fine lines, or changes in skin texture, schedule a cosmetic consultation to explore the best options for your skin.

Pediatric Wart Removal Case: Treating Verruca Vulgaris in a 12-Year-Old Patient

At Village Dermatology, we commonly treat viral warts (verruca vulgaris) in children and adolescents. Warts are benign but often persistent skin growths caused by the human papillomavirus (HPV) and may spread with contact or minor skin trauma. This case highlights effective in-office treatment and at-home management for pediatric warts in Katy and Houston, Texas.

Patient Presentation

A 12-year-old female presented as a new patient for evaluation of a flat wart on the right knee that had been present for several months. The lesion was first noticed by her mother during a field hockey tournament and persisted despite observation. The patient was referred by her pediatrician for dermatologic evaluation and possible removal.

Clinical Examination

A focused examination of the right lower extremity was performed using dermoscopy. The patient appeared well-developed, well-nourished, and in no acute distress.

On exam, there were two pink, cauliflower-like papules consistent with verruca vulgaris located on:

• Right knee

• Right proximal pretibial region

• Right medial proximal pretibial region

Assessment

• Verruca vulgaris (common warts)

Treatment Plan

After reviewing the diagnosis, etiology, and treatment options with the patient and her mother, liquid nitrogen cryotherapy was recommended and performed during the visit.

• Cryotherapy Details:

  • 2 lesions treated

  • 2 freeze–thaw cycles per lesion

  • Locations: right knee and right medial proximal pretibial region

Informed consent was obtained, including discussion of possible side effects such as blistering, scabbing, pigmentary changes, scarring, recurrence, incomplete removal, and infection.

At-Home Wart Care & Counseling

The patient and her mother were counseled extensively on wart management and prevention:

Treatment Options

• Cryotherapy

• Salicylic acid preparations

• Retinoids

• Aldara® (imiquimod), when appropriate

Home Care Instructions

• Apply over-the-counter maximum strength salicylic acid bandages nightly for two weeks between monthly visits

• This helps reduce wart size and may decrease the need for repeated in-office treatments

Education & Expectations

• Warts are caused by a viral infection

• They can spread through direct skin contact

• With consistent treatment, most warts resolve successfully

Patients were advised to contact the office if:

• Warts spread

• Lesions recur

• There is no improvement with treatment

Follow-Up

• Return visit scheduled in 4 weeks for reassessment and possible repeat treatment

Expert Pediatric Wart Treatment in Katy & Houston

This case demonstrates the importance of early treatment and patient education when managing pediatric warts. At Village Dermatology, we offer safe, effective wart removal for children and teens using evidence-based therapies in a comfortable, family-friendly setting.

If your child has persistent warts or other skin concerns, our dermatology team is here to help.

Pediatric Eczema Follow-Up Case: Improving Chronic Atopic Dermatitis in a 5-Year-Old Patient

At Village Dermatology, we frequently care for children with eczema (atopic dermatitis), a chronic but manageable skin condition that can significantly affect quality of life for both patients and their families. This case highlights the importance of consistent skin care, medication optimization, and long-term management for pediatric eczema patients in Katy and Houston, Texas.

Patient Presentation

A 5-year-old female returned to our clinic for a follow-up evaluation of eczema affecting the right hand and trunk. She was initially seen in August 2024 and started on triamcinolone acetonide 0.1% topical cream, applied twice daily during flares with a maximum of 14 days per month.

At this visit, her father reported overall improvement with treatment; however, the child continued to experience intermittent flares and nighttime itching, prompting further evaluation and adjustment of her treatment plan.

Clinical Examination

A focused skin examination was performed, including the chest, bilateral forearms, and lower legs. Dermoscopic evaluation revealed coin-shaped (nummular) eczematous patches on the right hand and trunk. The patient appeared well-developed, well-nourished, and in no acute distress.

Assessment

• Atopic dermatitis (eczema), chronic with flares

• Coin-like eczematous patches on the right hand and trunk

Treatment Plan & Counseling

Given the persistent flares, the treatment plan was optimized to improve symptom control while minimizing long-term steroid exposure:

• Continue triamcinolone acetonide 0.1% cream for flares (refill provided)

• Initiate Vtama® (tapinarof) 1% topical cream, applied once daily to affected areas

• Start cetirizine (Zyrtec®) at night to help reduce itching and improve sleep

• Follow-up scheduled in 2 months

Extensive counseling was provided to the patient’s family, emphasizing:

Skin Care Routine

• Bathe with lukewarm water using a gentle, fragrance-free cleanser

• Apply moisturizer immediately after bathing

• Use thick emollients 2–3 times daily

• Avoid scented detergents, soaps, and fabric softeners

Expectations & Education

Families were counseled that eczema is chronic and relapsing, often triggered by:

• Dry skin

• Weather changes

• Scratching

• Stress

• Scented products

• Skin infections

Parents were advised to contact our office if symptoms worsen, fail to improve, or if signs of infection such as yellow crusting or painful sores develop.

Medication counseling included discussion of:

• Possible mild burning with topical non-steroidal treatments

• Safe use of topical steroids and avoidance of high-potency steroids on the face, groin, or skin folds

• Potential side effects of prolonged steroid use, including skin thinning and discoloration

All questions were addressed, and the family demonstrated understanding of the treatment plan.

Comprehensive Pediatric Eczema Care in Katy & Houston

This case underscores the importance of personalized eczema management for children. At Village Dermatology, we offer expert care using the latest treatments—including steroid-sparing topical therapies—to help children achieve long-term skin comfort and healthier skin.

If your child is struggling with eczema or recurrent rashes, our board-certified dermatology team is here to help.

Painful Skin Abscess Treated With Incision and Drainage in a 28-Year-Old Male

By: Dr. Caroline Vaughn

Village Dermatology | Katy & Houston, Texas

Overview

A 28-year-old male presented to Village Dermatology with a painful skin infection on the back of his left thigh. The area had become increasingly tender and inflamed over the course of several days despite oral antibiotic therapy, prompting further evaluation and treatment.

This case highlights the importance of timely incision and drainage (I&D) for skin abscesses that do not adequately respond to antibiotics alone.

Clinical Evaluation

Focused examination of the left posterior thigh revealed a localized, inflamed lesion consistent with a cutaneous abscess. The patient was otherwise healthy, well-appearing, and in no acute distress.

Findings were concerning for a collection of pus beneath the skin, a condition that often requires procedural intervention to achieve full resolution.

Diagnosis: Skin Abscess

The lesion was diagnosed as a skin abscess, a localized bacterial infection that forms a pocket of purulent material. Abscesses commonly cause:

• Pain and tenderness

• Redness and warmth

• Swelling and pressure

Because abscesses can be caused by bacteria such as Staphylococcus aureus, including MRSA, culture and drainage are often necessary for effective treatment.

Treatment Plan

Given the patient’s persistent pain and incomplete response to antibiotics, incision and drainage was recommended and performed during the visit.

Treatment included:

• Incision and drainage of the abscess under local anesthesia

• Expression of purulent contents

• Application of a pressure dressing

• Bacterial culture to guide ongoing treatment

The procedure was medically necessary due to infection, pain, redness, and failure of conservative measures.

Post-Procedure Care & Counseling

The patient was counseled on:

• Proper wound care and dressing changes

• Use of antibacterial cleansers such as benzoyl peroxide or chlorhexidine to reduce bacterial load

• The importance of completing prescribed antibiotics

• Monitoring for warning signs such as fever, chills, worsening pain, or spreading redness

Warm compresses were also recommended to promote continued drainage and healing.

Follow-Up Plan

The patient was instructed to follow up if:

• The abscess does not improve

• Symptoms worsen

• Systemic signs of infection develop

Prompt follow-up ensures proper healing and reduces the risk of recurrence.

Expert Abscess Treatment in Katy & Houston

Skin abscesses can become serious if not treated appropriately. At Village Dermatology, we provide same-day evaluation and procedural care, including incision and drainage, to relieve pain and prevent complications.

If you have a painful, swollen skin infection, our dermatology team in Katy and Houston, Texas is here to help.

Multiple Pilar Cysts of the Scalp in a 36-Year-Old Female

By: Dr. Caroline Vaughn

Village Dermatology | Katy & Houston, Texas

Overview

A 36-year-old female returned to Village Dermatology with concerns about several firm bumps on her scalp that had slowly developed over the past few months. She reported a history of similar scalp cysts that were previously removed, prompting evaluation to confirm the diagnosis and discuss management options.

This case highlights the diagnosis and treatment planning for pilar cysts, a common benign scalp condition.

Clinical Evaluation

A focused scalp examination was performed with dermoscopic evaluation. The patient appeared healthy, well-nourished, and in no acute distress.

On examination, three discrete, firm, subcutaneous nodules were identified on the scalp. These lesions were smooth, non-inflamed, and consistent with benign cysts arising from the hair follicle.

Diagnosis: Pilar Cysts

Based on clinical findings and patient history, the lesions were diagnosed as pilar cysts—benign keratin-filled cysts that commonly occur on the scalp and may be multiple or recurrent. Pilar cysts often have a genetic predisposition and are more frequently seen in women.

The cysts measured approximately:

• 0.5 cm on the right frontal scalp

• 0.7 cm on the left frontal scalp

• 0.6 cm on the left parietal scalp

Treatment Plan

The benign nature of pilar cysts was reviewed in detail. Because the lesions were bothersome and the patient had a prior history of cyst excisions, she elected to proceed with surgical removal.

Management plan included:

• Scheduling an in-office cyst excision

• Counseling on the minor surgical procedure, healing expectations, and scarring

• Reassurance that no specific skincare or medical treatment is required prior to excision

Patient Education & Counseling

The patient was counseled that:

• Pilar cysts are non-cancerous

• They may slowly enlarge over time

• Treatment is optional unless cysts become painful, inflamed, or cosmetically bothersome

She was advised to contact the office if any cyst becomes red, tender, or ruptures, which may indicate inflammation or infection.

Expert Scalp Care in Katy & Houston

Scalp cysts are a common concern and can often recur without proper evaluation. At Village Dermatology, we offer expert diagnosis and in-office surgical treatment for benign scalp lesions in a safe, comfortable setting.

If you have bumps on the scalp or recurrent cysts, our dermatology team in Katy and Houston, Texas is here to help.

Treating Papulopustular Rosacea and Facial Redness in a 33-Year-Old Female

By: Dr. Ashley Baldree

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

• Daily broad-spectrum sunscreen SPF 30+

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

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

by: Dr. Caroline Vaughn

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

by: Dr. Caroline Vaughn

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

by: Dr. Ashley Baldree

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

by: Dr. Ashley Baldree

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

by: Dr. Caroline Vaughn

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

1. Wash with a gentle cleanser

2. Apply metronidazole cream

3. Apply moisturizer with SPF 30+

Evening

1. Wash with a gentle cleanser

2. Apply metronidazole cream

3. 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

by: Dr. Ashley Baldree

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

By: Dr. Caroline Vaughn

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

• VBeam 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

• Daily broad-spectrum SPF 30+ sunscreen

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

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

By: Dr. Ashley Baldree

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:

• Broad-spectrum SPF 30+ sunscreen daily

• 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

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.