Navigating Perioral and Seborrheic Dermatitis: A Case Study

By Dr. Ashley Baldree, Village Dermatology, Katy and Memorial Houston

At Village Dermatology, we often encounter patients dealing with challenging skin conditions that affect their confidence and comfort. Recently, a 35-year-old female visited our clinic with a two-month history of a painful, dry, and flaking rash on her face. After trying and failing treatments, including doxycycline, ketoconazole, and hydrocortisone, she sought a solution to regain control over her skin health.

Understanding the Diagnosis

Upon examination, the patient displayed signs of two conditions: perioral dermatitis and seborrheic dermatitis.

• Perioral Dermatitis: This chronic rash, characterized by inflamed areas around the mouth and nose, was identified on her chin, cheek, and upper lip. Common triggers for this condition include cosmetics, topical steroids, fluorinated toothpaste, and environmental factors like wind or sun exposure.

• Seborrheic Dermatitis: Additionally, the patient exhibited pink/orange scaly plaques on the glabella, consistent with seborrheic dermatitis—a chronic condition prone to flares triggered by stress.

Seborrheic Dermatitis

Tailored Treatment Plan

To address these concerns, we devised a comprehensive treatment strategy:

• Perioral Dermatitis:

  • Prescribed Soolantra 1% cream (or Metrocream as an alternative) for daily application.

  • Provided Rhofade sample for temporary redness management before events.

  • Recommended gentle cleansing with La Roche-Posay Toleriane and daily use of Tizo tinted sunscreen to prevent UV-induced flares.

  • Counseling on minimizing cosmetic use and avoiding triggers.

• Seborrheic Dermatitis:

  • Suggested moisturizers like Cetaphil, CeraVe, and La Roche-Posay Toleriane for gentle care.

  • Emphasized using shampoos with tar, selenium, or zinc pyrithione to improve scalp health.

Patient Education and Follow-Up

Patients with chronic skin conditions like these require education on long-term management. We counseled her on expectations, including the potential for periodic flares and the importance of regular sunscreen application. A follow-up was scheduled within 2-4 weeks to evaluate progress and fine-tune the regimen.

Empowering Skin Health

At Village Dermatology, we prioritize individualized care to help patients feel confident in their skin. If you're managing perioral or seborrheic dermatitis, visit our dedicated page on seborrheic dermatitis or contact us for an appointment. Let us guide you toward healthier skin today!

Expert Care for Basal Cell Carcinoma on the Nasal Dorsum: A Patient’s Story

By Dr. David Wang

At Village Dermatology, we are dedicated to providing compassionate, expert care for patients managing skin cancer, including basal cell carcinoma (BCC). Today, we share the story of an 80-year-old male patient who came to our Katy and Memorial Houston offices for Mohs surgery to treat nodular basal cell carcinoma on the nasal dorsum.

Basal Cell Carcinoma: Understanding the Diagnosis

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small, flesh-colored bump or a pearly nodule and often develops on sun-exposed areas, such as the face and neck. Nodular basal cell carcinoma, a subtype, is characterized by its rounded growth and potential for local tissue invasion. While BCC rarely spreads to other parts of the body, timely treatment is crucial to prevent deeper tissue damage.

For more about basal cell carcinoma, visit our Basal Cell Carcinoma page.

The Patient’s Case: A Personalized Approach to Care

The patient initially presented with a 0.4 cm x 0.4 cm lesion on the nasal dorsum, which was confirmed as nodular basal cell carcinoma through a biopsy. Due to the tumor’s location on the nasal dorsum, an area where tissue conservation is critical, Mohs micrographic surgery was determined to be the most appropriate treatment.

Why Mohs Surgery?

Mohs surgery is a precise, tissue-sparing technique that removes the cancerous tissue layer by layer while preserving as much healthy tissue as possible. This method is especially beneficial for high-risk areas like the nose, where maintaining functionality and appearance is essential.

Mohs Surgery: Procedure Overview

The procedure began with a detailed discussion about the risks, benefits, and alternatives of Mohs surgery. After obtaining the patient’s informed consent, Dr. Wang performed the surgery in one stage, removing the tumor completely.

• Preoperative Size: 0.4 cm x 0.4 cm

• Final Defect Size: 0.7 cm x 0.7 cm

• Depth of Defect: Muscle

Frozen section analysis confirmed that all cancerous cells were removed, and the surgical site was carefully repaired using a complex repair technique to minimize scarring and optimize healing.

Postoperative Care and Patient Education

Following the procedure, the patient received detailed postoperative instructions to promote healing and reduce complications:

• Keep the area clean and dry.

• Apply petrolatum and pressure dressing as directed.

• Avoid sun exposure and use broad-spectrum sunscreen to protect the healing skin.

For tips on protecting your skin from sun damage, visit our Sun Protection page.

Why Early Detection Matters

Basal cell carcinoma is largely preventable with consistent sun protection and regular dermatologic check-ups. Early detection allows for less invasive treatments and better outcomes.

Expert Skin Cancer Care at Village Dermatology

At Village Dermatology, we specialize in advanced skin cancer treatments, including Mohs surgery, and prioritize patient-centered care. Whether you’re concerned about a new lesion or managing a confirmed diagnosis, our team is here to guide you every step of the way.

For more information or to schedule an appointment, visit our Basal Cell Carcinoma page or contact us directly.

Exploring the Role of Patch Testing in Diagnosing Allergic Contact Dermatitis

By Dr. Ashley Baldree

At Village Dermatology, we frequently treat patients with complex skin conditions like allergic contact dermatitis (ACD). Today, we share the story of a 58-year-old male patient from our Katy and Memorial Houston offices who sought further evaluation for persistent dermatitis on his back. His journey highlights the importance of patch testing in diagnosing and managing ACD effectively.

The Patient’s Journey

This established patient initially visited our clinic for unspecified dermatitis, which was treated with Fluocinonide 0.05% ointment applied twice daily. Despite initial improvements, his dermatitis persisted, prompting a deeper investigation.

What is Allergic Contact Dermatitis?

ACD is a type of skin inflammation caused by exposure to allergens that trigger an immune response. Common symptoms include:

• Well-demarcated, itchy patches or plaques

• Redness and swelling

• Potential blistering or scaling

ACD is often linked to everyday exposures, including personal care products, metals, and environmental factors.

Diagnostic Approach: Patch Testing

To identify the allergens causing the patient’s dermatitis, patch testing was performed. This comprehensive method involves applying common allergens to the skin and observing reactions over several days.

Testing Procedure:

• 80 allergens were applied to the patient’s back using the Core ACDS Recommended Series.

• Common allergens tested included nickel sulfate, fragrance mixes, and paraben mix, among others.

Post-Care Instructions:

The patient was advised to:

• Avoid getting the back wet or sweating for 48 hours.

• Refrain from scratching the area.

• Remove the patches after 48 hours.

Follow-up was scheduled in four days to evaluate the test results.

Why Patch Testing Matters

Patch testing is a cornerstone for diagnosing ACD, especially for:

• Persistent or unexplained dermatitis.

• Dermatitis affecting high-risk areas like the hands, face, or feet.

• Conditions resistant to conventional treatments.

The insights gained from patch testing allow for targeted management, minimizing exposure to specific allergens and alleviating symptoms effectively.

Treatment and Management

At Village Dermatology, we develop personalized treatment plans based on patch testing results. These often include:

• Avoidance of identified allergens.

• Topical or systemic therapies to manage inflammation.

• Education on proper skincare routines to prevent future flares.

Conclusion

Allergic contact dermatitis can be challenging to diagnose and manage, but patch testing offers a reliable solution. This patient’s case underscores the value of thorough evaluation and personalized care in achieving optimal outcomes.

Understanding and Treating Warts in Children: A Success Story

By Dr. Caroline Vaughn

At Village Dermatology, we pride ourselves on offering comprehensive, compassionate care for skin conditions of all ages. Warts, though common, can significantly impact a child’s comfort and confidence. Today, we’re sharing a success story about a 10-year-old patient treated for warts at our Katy and Memorial Houston offices.

Case Overview

The young boy, an established patient at our practice, presented with pink, cauliflower-like papules on his right elbow and upper arm. These lesions, medically referred to as Verruca Vulgaris, were enlarging and had not been treated before this visit.

During the consultation, the child was cheerful and accompanied by his mother and our medical assistant. Upon examination, he appeared well-nourished, well-developed, and in no acute distress.

What Are Verruca Vulgaris?

Verruca Vulgaris, or common warts, are benign skin growths caused by the human papillomavirus (HPV). These rough, raised lesions often develop in children due to minor trauma to areas like the hands, knees, or elbows, which increases their vulnerability to HPV.

Treatment Approach: Cryotherapy

After evaluating the patient, we recommended cryotherapy, a trusted and effective method for wart removal. This treatment involves using liquid nitrogen to freeze and destroy the wart tissue, allowing the skin to heal naturally.

Procedure Details:

• Six warts on the right elbow and upper arm were treated.

• Liquid nitrogen was carefully applied, causing controlled tissue damage to remove the warts.

• The patient’s mother provided informed consent after discussing potential side effects, including scabbing, blistering, pigmentation changes, and the possibility of recurrence.

Post-Treatment Care and Follow-Up

Following cryotherapy, it’s essential to ensure proper care to optimize healing and minimize complications. The family was advised to:

• Keep the treated area clean and dry.

• Avoid picking or scratching the scabs to prevent scarring or infection.

• Contact the office if signs of infection, like swelling or increased redness, occur.

A follow-up appointment was scheduled to evaluate the patient’s progress and determine if further treatments would be necessary.

Preventing and Managing Warts

Warts are highly contagious and can recur if preventive steps are not taken. We recommend the following:

1. Teach children to avoid picking at warts.

2. Practice good hygiene, including regular handwashing.

3. Cover warts with bandages in public settings, such as school or sports activities, to prevent spreading the virus.

Why Choose Village Dermatology?

At Village Dermatology, we provide expert care for warts and other skin conditions. Our treatments, such as cryotherapy, are safe and effective for children. We understand the emotional and physical challenges that come with skin conditions and strive to create a supportive, family-friendly environment.

Ready to Address Your Skin Concerns?

If your child has warts or other skin concerns, explore our dedicated page on warts to learn more about treatment options. Schedule an appointment with us today and let’s work together to ensure your child’s skin health and confidence.

Managing Pseudofolliculitis Barbae: A Patient's Journey

Written by Dr. Ashley Baldree

Pseudofolliculitis barbae, commonly known as razor bumps, is a chronic skin condition that can cause discomfort, inflammation, and frustration for those affected. It often occurs in areas where curly hair grows inward, leading to irritation and inflammation. This condition is particularly common in individuals with tightly coiled or curly hair.

In this blog, we’ll explore the case of a 30-year-old female patient managing pseudofolliculitis barbae, the treatments that have worked for her, and long-term strategies for success.

Understanding the Patient's Journey

Our patient, a 30-year-old female, initially sought care for persistent pseudofolliculitis barbae affecting the vulva area. She had experienced constant discomfort but found some relief through targeted therapies. Her initial treatment plan included:

• Benzoyl Peroxide Wash (10%): Used every three days to cleanse affected areas and prevent inflammation.

• Clindamycin Gel: Applied as needed for flare-ups, though she found limited success with this topical antibiotic.

• Waxing Avoidance: Counseling emphasized that waxing likely contributed to skin irritation.

Progress With Treatment

After following this regimen, the patient experienced notable improvement using doxycycline, an oral antibiotic prescribed for short-term use. She reported significant progress but was informed that doxycycline cannot be used as a long-term solution due to risks such as photosensitivity and potential adverse effects.

The patient also reduced her use of benzoyl peroxide to every three days to manage sensitivity, and she has been considering laser hair removal (LHR) for a more permanent solution to her condition.

Long-Term Management Recommendations

1. Benzoyl Peroxide (BPO):

   • The patient was counseled to continue using benzoyl peroxide for antibacterial and anti-inflammatory effects. She was advised to be mindful of potential irritation and to adjust usage frequency as needed.

2. Doxycycline for Flares:

   • The patient was provided with additional refills of doxycycline for flare-ups, with detailed counseling on avoiding prolonged use and understanding side effects like photosensitivity.

3. Laser Hair Removal (LHR):

   • As a long-term solution, LHR was recommended for reducing hair growth and minimizing the chances of future inflammation.

Skin Care Best Practices:

• Patients with pseudofolliculitis barbae should avoid shaving against the grain or cutting hair too short. Antibacterial soap or benzoyl peroxide wash can help maintain healthy skin.

Counseling and Education

Our counseling focused on ensuring the patient fully understands her treatment options and the potential side effects. Here are some key points:

• Benzoyl Peroxide Counseling: It may cause skin irritation and clothing discoloration. Reduce application frequency if irritation occurs.

• Doxycycline Counseling: Discussed risks such as photosensitivity, sunburn, and the importance of protective measures like sunscreen and clothing. The patient was also counseled on avoiding pregnancy during therapy due to potential birth defects.

• Topical Clindamycin Counseling: Explained the possibility of irritation and the need to adjust usage if necessary.

Outlook and Follow-Up

Pseudofolliculitis barbae is a manageable condition with proper care and a personalized treatment plan. While this patient has seen significant improvement, she has been advised to follow up in one month to evaluate the effectiveness of her regimen and make adjustments as needed. Patients experiencing similar issues are encouraged to consult a dermatologist to develop a tailored plan for their skin needs.

For more information about treating pseudofolliculitis barbae and other skin conditions, visit our dermatology page. If you’re in Katy or Memorial, Houston, and need personalized care, take the first step by becoming a patient with us today! Click here to get started.

Understanding and Treating Warts: A Case of a 10-Year-Old Patient

Written by Dr. Ashley Baldree

At Village Dermatology, we frequently see children for common skin concerns like warts, which can cause discomfort and emotional distress for both the child and their family. Today, we’re sharing the story of a 10-year-old boy, an established patient at our Katy and Memorial Houston offices, who came in for treatment of warts located on his right elbow and upper arm.

Case Overview

The young patient presented with enlarging, pink, cauliflower-like papules on his right elbow, distal lateral posterior upper arm, and lateral elbow. These lesions, medically referred to as Verruca Vulgaris, had not been previously treated. The patient appeared well-nourished, well-developed, and in no acute distress, with a cheerful demeanor during the visit. His mother and our skilled medical assistant were present throughout the examination.

What Are Verruca Vulgaris?

Verruca Vulgaris, or common warts, are benign skin growths caused by the human papillomavirus (HPV). They often appear as rough, raised bumps that can have a cauliflower-like texture. In children, warts frequently occur on the hands, elbows, or knees, areas prone to minor trauma, making the skin susceptible to HPV.

Treatment Approach: Cryotherapy

After evaluating the patient, we determined that cryotherapy with liquid nitrogen would be the best treatment option. Cryotherapy is a safe and effective way to freeze and destroy the wart tissue, allowing the skin to heal and regenerate.

Procedure Details:

• A total of six lesions were treated during the session.

• The liquid nitrogen was applied to the warts, causing controlled tissue damage to remove the lesions.

• We discussed the potential side effects, including crusting, scabbing, blistering, scarring, pigmentary changes, recurrence, incomplete removal, and infection. The patient’s mother provided informed consent for the procedure.

Post-Treatment Care and Follow-Up

After cryotherapy, it’s normal to see temporary redness, blistering, or scabbing in the treated area. We advised the family to:

1. Keep the area clean and dry.

2. Avoid picking or scratching the treated lesions to minimize the risk of infection or scarring.

3. Notify our office if signs of infection, such as increased redness, swelling, or pain, occur.

The patient’s next follow-up appointment will help us assess the progress of healing and determine if additional treatments are needed.

Managing and Preventing Warts

To prevent the recurrence or spread of warts, we recommend:

• Encouraging your child to avoid picking at warts.

• Practicing good hygiene, including washing hands regularly.

• Covering warts with bandages, especially in school or sports settings, to prevent spreading the virus.

Conclusion

Warts are a common and treatable skin condition in children. At Village Dermatology, we provide compassionate care and effective treatment options, such as cryotherapy, to help patients regain confidence and comfort in their skin.

If your child has warts or other skin concerns, visit our dedicated page on warts to learn more about treatment options, or contact us to schedule an appointment. Let’s work together to ensure healthy, happy skin for your child.

Blog Article: Managing Psoriasis with Advanced Treatments

By Dr. Caroline Vaughn

Psoriasis is a chronic autoimmune condition that affects millions of people worldwide. At Village Dermatology in Katy and Memorial Houston, we frequently see patients dealing with persistent symptoms like flaking, itching, and discomfort. One such patient presented with moderate psoriasis on the trunk that had been present for years, primarily managed with Otezla. Despite efforts, the treatment was not controlling her flares effectively, prompting a new approach.

Understanding Psoriasis

Psoriasis, specifically psoriasis vulgaris, is characterized by red, scaly patches that can appear on different parts of the body, including the trunk, scalp, and nails. It’s a lifelong condition with periods of remission and flares, often triggered by factors such as stress, infections, certain medications, or lifestyle factors like alcohol consumption. You can read more about psoriasis and its treatment options on our Psoriasis Overview page.

A Tailored Treatment Plan for our patient

This patient’s journey reflects the complexity of managing psoriasis. While Otezla, a systemic therapy, had been her primary treatment, its limitations in controlling her symptoms led us to explore other options. Following a consultation and clearance from an infectious disease specialist, we initiated treatment with Skyrizi. Skyrizi is a biologic therapy that provides targeted relief for patients with moderate to severe psoriasis who haven’t responded well to other systemic treatments.

Skyrizi Counseling and Administration
We carefully discussed the potential benefits and risks of Skyrizi with the patient, including:

• Risks: Increased susceptibility to infections and potential injection site reactions.

• Monitoring: Annual tuberculosis testing and vigilance for any symptoms of infection.

The first dose of Skyrizi was administered during the visit, with follow-ups scheduled to monitor progress and address any concerns.

Comprehensive Care for Psoriasis

In addition to systemic therapy, we emphasized the importance of supportive skin care to enhance treatment outcomes:

• Skin Care Recommendations:

  • Use emollients and moisturizers to prevent dryness.

  • Incorporate shampoos with tar, selenium, or zinc pyrithione for scalp psoriasis.

  • Consider coal tar and topical keratolytics for persistent plaques.

• Topical Steroids: We prescribed clobetasol 0.05% scalp solution to help reduce inflammation, with thorough counseling on proper use and potential side effects like skin thinning or discoloration.

For patients struggling with nail psoriasis, we discussed the use of topical steroids, vitamin D analogs, or even intralesional injections if needed. Learn more about available therapies on our Psoriasis Treatment page.

What to Expect

We counsel all our patients to have realistic expectations about psoriasis management. While we aim to reduce symptoms and flares, psoriasis is a chronic condition with no definitive cure. With proper treatment and monitoring, many patients experience significant improvement and longer periods of remission.

Call to Action

If you’re dealing with persistent psoriasis that hasn’t responded to treatment, there’s hope. At Village Dermatology, we offer advanced therapies tailored to your specific needs. Visit our Become a Patient page to schedule your consultation today and take the next step toward clearer, healthier skin.

Follow-Up

For this patient, a follow-up is scheduled in six months to assess her progress and make any necessary adjustments to her treatment plan. With consistent care and monitoring, we’re confident she’ll see meaningful improvements in her quality of life.

References
For more information about psoriasis and its treatments, visit:

1. Psoriasis Overview

2. Psoriasis Treatment Options

Green Nail Syndrome: Understanding and Managing Pseudomonas Nail Infections

Written by Dr. Ashley Baldree

Introduction

Green Nail Syndrome (GNS), also known as chromonychia, is a nail condition caused by the bacterium Pseudomonas aeruginosa. This organism is known for its role in hospital-acquired infections and its ability to cause localized nail discoloration and damage. While not typically life-threatening, Green Nail Syndrome can be uncomfortable and frustrating for patients.

Case Overview

The condition often develops after trauma to the nail, as seen in a 50-year-old male who sustained an injury to his thumb while working in his garage six months ago. The affected thumb nail now presents with a persistent green discoloration, characteristic of GNS. Chronic onycholysis (separation of the nail plate from the nail bed) and prolonged exposure to water or moisture are common contributors to this condition.

What Causes Green Nail Syndrome?

The hallmark green color results from pigments, particularly pyocyanin and pyoverdine, produced by Pseudomonas aeruginosa. These pigments accumulate in the nail bed, leading to the distinct discoloration. Green Nail Syndrome typically occurs when the nail environment becomes favorable for bacterial growth, such as:

1. Nail Trauma: Injuries to the nail create openings for bacterial entry.

2. Prolonged Moisture: Frequent water exposure weakens the nail, promoting bacterial colonization.

3. Underlying Conditions: Conditions like fungal infections or psoriasis can predispose the nail to secondary infections.

Symptoms and Diagnosis

Patients with Green Nail Syndrome may notice:

• A green or bluish-green discoloration of the affected nail.

• Onycholysis, where the nail separates from the nail bed.

• Mild tenderness or discomfort around the nail.

Diagnosis is typically clinical based on the characteristic appearance, but confirmatory testing can include:

• Nail clippings for culture and sensitivity.

• Dermoscopic examination to identify bacterial pigments.

Treatment Options

Treatment for Green Nail Syndrome involves a combination of topical and systemic approaches, depending on the severity:

1. Topical Therapy:

   • Acetic acid (vinegar) soaks: Dilute 1:4 with water and soak the affected nail for 10 minutes, 2–3 times daily.

   • Antibacterial solutions: Options like sodium sulfacetamide or 4% thymol in chloroform.

   • Topical fluoroquinolones: Ciprofloxacin eye drops can be applied to the nail bed.

2. Nail Hygiene:

   • Keep nails dry and clean.

   • Avoid prolonged water exposure and wear gloves during activities involving water.

   • Use a hairdryer to ensure nails are completely dry after washing.

3. Systemic Therapy:

   • If topical treatments fail, oral antibiotics like ciprofloxacin (500–750 mg twice daily for 4 weeks) may be prescribed.

   • Persistent cases may require nail removal to facilitate healing.

Preventing Green Nail Syndrome

Preventative measures include:

• Avoiding trauma to the nails.

• Keeping nails trimmed and well-maintained.

• Minimizing moisture exposure to reduce bacterial growth.

• Treating underlying nail conditions, such as fungal infections, promptly.

Call to Action

If you’re experiencing persistent nail discoloration or other nail concerns, early intervention is key to preventing complications. Schedule an appointment with Dr. Ashley Baldree at Village Dermatology in Katy, Texas, to receive expert care and personalized treatment plans.

Become a Patient Today

References

1. Green Nail Syndrome: Insights into Causes and Treatments. Available at: National Library of Medicine.

2. Clinical Principles of Pseudomonas aeruginosa Management.

For more information about nail conditions like Green Nail Syndrome, visit Village Dermatology’s Nail Health Page.

Managing Telogen Effluvium: A Guide to Hair Restoration

By Dr. Reena Jogi, Village Dermatology

Telogen effluvium is a common cause of temporary hair shedding that often leaves patients feeling frustrated and anxious about their hair health. The condition, usually triggered by stress, illness, or underlying health issues, can disrupt the normal hair growth cycle, resulting in noticeable hair loss. Today, we’re discussing the case of a 34-year-old female patient who returned to our office to refill her prescription for oral minoxidil, which she has been using to manage her telogen effluvium.

Understanding Telogen Effluvium

Telogen effluvium is a form of hair shedding that occurs when a significant number of hair follicles shift prematurely from the growth phase (anagen) into the resting phase (telogen). This can result in diffuse hair shedding across the scalp and can be triggered by a variety of factors, including:

• Stress: Physical or emotional stress can impact hair growth cycles.

• Illness: Acute or chronic illnesses, especially those involving high fevers, can contribute to shedding.

• Nutritional Deficiencies: Iron deficiency and low levels of essential nutrients are common contributors.

• Thyroid Disease: Both hyperthyroidism and hypothyroidism can disrupt hair growth.

• Medications: Certain medications are known to cause hair shedding as a side effect.

Telogen effluvium is typically a self-limiting condition, meaning it often resolves on its own within a few months once the underlying cause is addressed. However, in prolonged cases, additional treatment may be beneficial to encourage hair regrowth.

Treatment Overview and Patient’s Current Regimen

Our patient was initially prescribed off label Minoxidil 2.5 mg in tablet form, with instructions to take half a tablet daily. Minoxidil is a well-known hair regrowth treatment that works by extending the growth phase of hair follicles. While commonly used as a topical solution, oral minoxidil can be effective in cases like this where patients experience more extensive shedding.

The patient reported no significant side effects from the oral minoxidil but expressed concern about its effectiveness after a year of use. In response, we discussed additional treatment options, including the following:

1. Topical Minoxidil 5% Solution: For some patients, adding topical minoxidil alongside oral minoxidil can provide added benefit and address any areas of concern.

2. Hair Growth Supplements: Supplements such as Viviscal or Nutrafol contain nutrients that support hair health and growth, particularly for those with nutritional deficiencies.

3. Low-Level Laser Therapy: Devices like Theradome use low-level laser therapy to stimulate hair follicles, promoting healthier hair growth.

4. Platelet-Rich Plasma (PRP) Therapy: PRP therapy is a promising treatment that involves injecting concentrated platelets into the scalp to promote hair regrowth.

Medication Counseling: Risks and Considerations of Oral Minoxidil

We reviewed the potential risks of oral minoxidil with the patient to ensure she felt informed and comfortable continuing treatment. Possible side effects include:

• Swelling of the Feet or Ankles: Minoxidil can sometimes cause fluid retention.

• Dizziness and Lightheadedness: Minoxidil may occasionally lead to blood pressure changes.

• Unwanted Hair Growth: Patients may experience hair growth in areas other than the scalp.

• Allergic Reaction: Rarely, patients may experience an allergic reaction.

• Cardiac Concerns: Although rare, there is an association with pericardial effusion and cardiac tamponade, so we monitor closely for any signs of heart-related side effects.

After discussing these risks, our patient understood the importance of monitoring for any symptoms and immediately reporting any adverse effects. At this time, she felt comfortable continuing oral minoxidil and opted not to add any new medications to her regimen.

Exploring Additional Treatment Options: Dutasteride

We also discussed the possibility of introducing Dutasteride to her regimen, a medication that reduces levels of dihydrotestosterone (DHT), which can contribute to hair loss. However, Dutasteride is not recommended for women who are actively family planning or may become pregnant, as it can affect fetal development. After learning about these considerations, the patient decided to continue with her current regimen and hold off on Dutasteride for now.

Recommendations for Ongoing Care

For optimal hair health and to support her recovery from telogen effluvium, we recommended the following:

1. Daily Self-Care: Avoiding hairstyles that put tension on the scalp and minimizing heat styling can prevent further damage.

2. Dietary Supplements: Incorporating supplements like Nutrafol to provide essential nutrients that support hair strength and growth.

3. Regular Monitoring: Monthly self-exams of the scalp can help the patient monitor hair regrowth progress.

4. Follow-Up Visits: Scheduling follow-ups every 3–6 months allows us to assess the effectiveness of the treatment and adjust as necessary.

Conclusion

Telogen effluvium can be distressing, but with the right treatments and supportive care, many patients experience a return to normal hair growth within months. At Village Dermatology in Katy, TX, we work closely with patients to create customized treatment plans, using a combination of proven medications, supplements, and lifestyle recommendations to address hair loss concerns.

If you’re dealing with hair shedding or other hair health concerns, schedule a consultation with our team. Our approach is centered around understanding each patient’s unique needs and providing effective, individualized care. For more information on telogen effluvium, visit our Telogen Effluvium Treatment page.

Evaluating and Treating Skin Lesions: A Case Study in Cosmetic Shave Removal

By Dr. Ashley Baldree, Village Dermatology

Skin lesions can appear for various reasons and may vary greatly in appearance and texture. When a lesion's nature is uncertain, dermatologists often recommend biopsy or removal to ensure an accurate diagnosis and appropriate care. Today, I’ll share a case of a 50-year-old female patient who came to our office with a lesion on her thigh, leading to a careful evaluation and cosmetic shave removal procedure.

Case Overview

Our patient, a 50-year-old woman, presented with a moderately severe, asymptomatic lesion on her left anterior proximal thigh. The lesion had been present for several months but had not received any prior treatment. Given the uncertain nature of this growth, our differential diagnosis (DDx) included several possibilities: Neoplasm of Uncertain Behavior, skin tag, wart, and seborrheic keratosis (SK).

After thorough evaluation, we determined that a cosmetic shave removal would be the best approach. This allowed for both the removal of the lesion and histologic evaluation to confirm its nature.

Diagnosis: Neoplasm of Uncertain Behavior

"Neoplasm of Uncertain Behavior" is a term used when a lesion’s exact diagnosis is unclear, and it requires further examination to rule out potential concerns. While many lesions in this category are benign, the uncertainty warrants removal and biopsy to ensure there are no underlying risks.

Procedure Details: Cosmetic Shave Removal

Once the patient consented to the procedure, we reviewed the risks and benefits, which include:

• Infection

• Scarring

• Bleeding

• Prolonged Wound Healing

• Incomplete Removal

• Allergic Reactions to Anesthesia

• Nerve Injury

• Recurrence of the Lesion

Procedure Steps:

1. Preparation: The area was prepped with alcohol to maintain sterility, and 1% lidocaine with epinephrine was used as a local anesthetic to numb the area.

2. Removal: Using a scissors technique, a cosmetic shave removal was performed to remove the lesion. This method minimizes scarring and is ideal for benign or low-risk lesions.

3. Hemostasis: Drysol was applied to control bleeding.

4. Post-Procedure Care: After the shave removal, we applied petrolatum and a bandage to the wound and provided wound care instructions.

Post-Procedure Care and Follow-Up

After the procedure, we reviewed the following wound care instructions with the patient:

• Keep the area clean and apply a fresh bandage daily.

• Apply petrolatum to keep the wound moist, which aids in healing and reduces scarring.

• Avoid sun exposure on the treated area until fully healed, as sun exposure can cause pigment changes.

We informed the patient that she would be contacted with biopsy results, typically within two weeks. If she hasn’t heard from our office by then, we encouraged her to call us for an update.

Importance of Skin Lesion Evaluation

This case highlights the importance of evaluating new or changing skin lesions, especially when there is uncertainty about the lesion’s nature. Even when a lesion appears harmless, a biopsy can provide peace of mind and help rule out any underlying concerns. Patients should perform regular self-exams and schedule yearly skin checks with their dermatologist to monitor for new or changing lesions.

If you have concerns about a skin lesion or would like to discuss treatment options, visit us at Village Dermatology in Katy, TX. Our team is here to help you understand your skin health and provide the best care options for your needs.

Understanding Skin Cancer Risk and Prevention: A Guide for Patients with Family History

By Dr. Caroline Vaughn, Village Dermatology

For patients with a family history of non-melanoma skin cancer, understanding skin care and prevention is essential. This article explores the case of a 65-year-old male patient who visited our Katy office with concerns about his risk of skin cancer and several longstanding lesions on his cheek and elbow. Our discussion focused on skin cancer prevention, recognizing potential warning signs, and creating a personalized plan for ongoing skin monitoring.

Case Overview

Our patient came in for an evaluation due to his family history of non-melanoma skin cancer, such as basal cell carcinoma and squamous cell carcinoma. He was concerned about two asymptomatic lesions that had been present for years and wanted to understand his risk factors. The lesions, one on his right cheek and another on his left elbow, were moderate in severity but had not changed recently. After a thorough examination, we determined these were benign nevi—harmless, symmetrical moles that do not require treatment.

Importance of Sun Protection for Skin Cancer Prevention

Patients with a family history of skin cancer are at a higher risk of developing similar conditions, even if they haven’t experienced skin cancer themselves. Sun exposure remains a significant factor in skin cancer risk, so I recommended that the patient adopt the following protective measures:

• Broad-Spectrum Sunscreen: Daily use of SPF 30+ sunscreen, even on cloudy days, helps reduce UV exposure, which is crucial for preventing non-melanoma skin cancers.

• Sun-Protective Clothing: Long sleeves, wide-brimmed hats, and UV-blocking sunglasses offer additional protection, especially during peak sun hours (10 a.m. to 4 p.m.).

• Avoiding Tanning: Direct sun exposure and tanning beds increase the risk of skin cancer. Staying in the shade or using alternative tanning products, such as self-tanners, is a safer choice.

For more on sun protection and its role in skin cancer prevention, visit our Sun Protection page.

Self-Skin Exams: A Crucial Habit for High-Risk Patients

Given his family history, I advised the patient to perform monthly self-skin checks to detect any changes in existing moles or the appearance of new lesions. Early detection plays a vital role in managing skin cancer risks. During these checks, he should look for:

• New Growths: Pay attention to any new spots, especially those that do not heal or seem to grow over time.

• Changes in Moles: Watch for changes in size, shape, or color, particularly if a mole becomes asymmetrical or develops uneven borders.

• Symptoms: Report any moles or spots that itch, burn, bleed, or become painful, as these can be signs of more concerning growths.

I provided a guide for performing thorough self-exams, advising him to use a mirror for hard-to-see areas and to ask a partner or family member for assistance if needed.

Understanding Benign Nevi and When to Contact Your Dermatologist

During the examination, we observed multiple benign nevi throughout his body. These are regular, symmetrical moles with even pigmentation, which are generally harmless. While benign nevi do not require treatment, it’s essential to monitor them for any signs of transformation over time, particularly in high-risk patients.

Key Points for Benign Nevi:

• Monthly Monitoring: Regularly inspect moles for changes, as even benign lesions can change over time.

• When to Contact Us: If a mole changes in size, shape, or color, or if it begins to itch, burn, or bleed, it’s important to consult with a dermatologist.

Routine Dermatologist Visits for Lifelong Monitoring

In addition to self-exams, patients with a family history of skin cancer should schedule annual professional skin exams. During these exams, dermatologists can assess any suspicious spots and discuss any changes noted since the previous visit. With our patient, we agreed on a schedule for routine visits to ensure he receives consistent care and monitoring.

Takeaway: Preventive Skin Care for Patients at Risk

This case highlights the importance of preventive care for individuals with a family history of skin cancer. By integrating sun protection, self-skin exams, and regular dermatological check-ups into his routine, the patient can significantly reduce his skin cancer risk and catch potential concerns early.

If you have a family history of non-melanoma skin cancer or are concerned about your skin health, schedule a consultation with our Katy office at Village Dermatology. Our team is here to provide personalized care and educate you on effective skin cancer prevention.

Managing Lichen Planus: A Holistic Approach to Skin Care

By Dr. Ashley Baldree, Village Dermatology, Katy Office

Lichen planus is a chronic inflammatory condition that affects the skin and often appears as itchy, red-to-purple, flat-topped bumps. While the exact cause of lichen planus is unknown, potential triggers include immune system reactions, liver conditions, and exposure to certain medications. At Village Dermatology in Katy, TX, we work closely with our patients to provide personalized treatment plans that align with their preferences, including more holistic approaches when possible. Today, I’ll discuss a recent case of a 30-year-old male with lichen planus on his foot, who is seeking a balance between conventional and holistic treatments.

Case Overview

Our patient presented for follow-up after a biopsy confirmed lichen planus on his right lower foot. He had initially reported itching and discomfort in the area, which led us to perform a biopsy to determine the cause. Following the diagnosis, he expressed interest in managing his condition conservatively.

Treatment Plan: Topical Steroids and Light Therapy

To reduce inflammation and control symptoms, we prescribed clobetasol 0.05% cream, a potent topical steroid commonly used to manage flare-ups of lichen planus. This cream is applied twice daily to the affected areas for up to two weeks, followed by intermittent use as needed for future flares. However, since overuse of potent steroids can thin the skin, we advised him to limit clobetasol application to no more than two weeks per month.

Skin Care Tips:

• Apply clobetasol sparingly to avoid overuse.

• Limit steroid use to two weeks at a time, with a break between treatments.

For more details on managing lichen planus with topical treatments, visit our Lichen Planus page.

Embracing a Holistic Approach

Given the patient’s preference for conservative treatments, we discussed a few holistic methods that can complement his regimen:

1. Sun Exposure: Natural sunlight can sometimes help alleviate lichen planus symptoms. We recommended 10 minutes of sunlight on each affected area daily, while being cautious about overexposure.

2. Light Therapy: At-home light therapy was another option we discussed. Controlled exposure, similar to natural sunlight, can reduce inflammation and itching in lichen planus.

3. OTC Antihistamines: Since itching is a primary symptom, we suggested over-the-counter Claritin, which the patient could safely take up to two pills a day if needed.

For patients looking for alternatives to medication, incorporating these holistic options can offer some relief from symptoms. It’s essential to follow professional guidance to avoid skin irritation or sunburn.

Understanding Lichen Planus: Symptoms, Causes, and Treatment Expectations

Lichen planus can be persistent, often lasting for months, but it typically responds well to treatment. Patients should be aware that:

• Lichen planus is an immune-mediated condition: The exact cause is unknown, but it is sometimes linked to conditions such as viral hepatitis and chronic liver disease. Certain medications, including anti-malarials and some metals, have also been associated with lichen planus.

• Treatment aims to manage symptoms, as the condition often resolves over time.

• Managing flare-ups is essential to maintain comfort and reduce the appearance of new lesions.

Monitoring and Follow-Up Care

We advised the patient to perform regular skin checks and to contact our office if he experiences worsening symptoms or if the lesions spread to new areas. Monitoring for changes is key to managing lichen planus effectively and ensuring the treatment plan remains suitable over time.

Our patient will return in 3-4 months for a follow-up evaluation, during which we’ll assess the treatment’s effectiveness and explore any necessary adjustments.

When to Seek Further Medical Attention

While most cases of lichen planus respond to topical treatments and sunlight exposure, some cases may require additional interventions. Patients should contact their dermatologist if:

• New lesions appear or existing ones worsen.

• Symptoms persist despite treatment.

• Lesions become painful or interfere with daily activities.

Conclusion

At Village Dermatology in Katy, TX, we understand that each patient’s journey with skin conditions like lichen planus is unique. By offering personalized, flexible treatment plans that incorporate both conventional and holistic options, we empower our patients to manage their conditions in a way that aligns with their values and preferences.

If you’re dealing with lichen planus or another chronic skin condition, our team is here to provide expert guidance and support. For more information on lichen planus and treatment options, please visit our Lichen Planus page or schedule an appointment with our Katy office.

Treating Warts Effectively: A Case Study

By Dr. Ashley Baldree, Village Dermatology

Warts, or verruca vulgaris, are a common skin issue caused by human papillomavirus (HPV) infections. These small, rough bumps can be stubborn and spread through direct contact. Today, I’ll share the case of a 37-year-old patient who came in with a wart on his left index finger and discuss effective treatment options and preventive care.

Case Overview

Our patient, a 37-year-old male, presented with a rough, mildly irritating wart on the left proximal radial dorsal side of his index finger. The wart had been present for several months without any active treatment, and he expressed interest in finally addressing it. After evaluating the lesion, I recommended cryotherapy as an initial treatment and counseled him on additional options for warts if further intervention is needed.

For more on what warts are and how we treat them, visit our Warts Treatment page.

Skin Care and Treatment Options for Warts

Warts can be persistent, but various treatments can help remove them and prevent their spread. I explained several options to the patient, including:

• Retinoids: These vitamin A derivatives help disrupt skin cell growth, potentially breaking down warts.

• Aldara (Imiquimod): An immune response modifier that can stimulate the body to fight the viral infection within the wart.

• 5-Fluorouracil (5-FU): This topical treatment disrupts cell growth and is sometimes used for stubborn warts.

• Salicylic Acid: Often found in over-the-counter products, this exfoliating acid helps soften and peel away wart tissue.

• Cryotherapy: Freezing the wart with liquid nitrogen, which was selected as the treatment for this visit.

• Bleomycin: An injected medication sometimes used for warts that resist other treatments.

• Candida Antigen Injections: This involves injecting an antigen to stimulate the immune system’s response to the wart.

Expectations and Aftercare

I explained that warts often appear as cauliflower-like growths and can easily spread to other parts of the body or even to other people. Since HPV, the virus that causes warts, spreads through direct contact, it’s important to keep the area clean and avoid picking at or touching the wart.

After the cryotherapy treatment, I advised him to monitor the area and expect some possible side effects, such as:

• Crusting or Scabbing: This is a normal response to freezing and should resolve on its own.

• Blistering: Blisters may form as the frozen tissue heals.

• Pigmentary Changes: Temporary or permanent lightening or darkening of the skin is possible.

• Scarring: Although rare, scarring can sometimes occur after cryotherapy.

The patient was instructed to contact our office if he notices any new warts, spread of the wart, or unusual healing reactions, such as excessive redness, pain, or infection.

Procedure and Next Steps

The cryotherapy procedure was quick and well-tolerated. After discussing the possible risks, the patient provided consent, understanding the benefits and potential side effects. If the wart persists or recurs, we may explore additional treatment options, or, if needed, perform a biopsy to rule out any other conditions.

If you or someone you know is struggling with warts, visit our Village Dermatology Warts page for more information on available treatments and how we can help. Regular dermatology check-ups are essential for monitoring skin health and addressing any concerns promptly.

Follow-Up on Tinea Versicolor: A Case Study by Dr. Caroline Vaughn

By. Dr. Caroline Vaughn

Introduction

in November 2023, I evaluated a 29-year-old female patient presenting with tinea versicolor. This common fungal infection, caused by an overgrowth of yeast on the skin, was localized to the left inferior anterior neck, middle sternum, and superior thoracic spine. During her initial visit, I prescribed a comprehensive treatment plan aimed at tackling the infection from both systemic and topical angles. Today, we will review her progress, reinforce key aspects of her treatment, and provide further counseling on managing this condition.

Initial Treatment Plan Recap

To address the widespread nature of her tinea versicolor, the following regimen was prescribed:

• Fluconazole 200 mg tablets:

  • Two tablets taken weekly with an acidic drink (e.g., orange juice), followed by an hour of sweating to enhance medication absorption.

  • Duration: 4 weeks.

• Ketoconazole 2% Topical Cream:

  • Applied once daily to affected areas for 2 weeks.

• Ketoconazole 2% Shampoo:

  • Used once weekly, applied to the rash and left on for 3-5 minutes before rinsing.

This multi-faceted approach was designed to combat the infection locally and systemically, ensuring maximum effectiveness.

Follow-Up Findings and Continued Management

During today’s follow-up, the patient reported some improvement but noted that mild discoloration and itching persist. We reviewed her adherence to the treatment plan, and she confirmed compliance. To ensure complete resolution and prevent recurrence, I advised the patient to continue with the following:

• Fluconazole 200 mg tablets: Continue the weekly regimen as outlined, ensuring proper hydration and following each dose with an acidic beverage for optimal absorption.

• Ketoconazole 2% Shampoo: Maintain weekly application to manage the yeast on the skin's surface.

• Ketoconazole 2% Topical Cream: Resume for another 2-week course if any residual rash persists.

Patient Counseling and Education

Understanding Tinea Versicolor
I explained to the patient that tinea versicolor is a common condition, especially in young adults, often triggered by heat, humidity, and excessive sweating. While easily treatable, it can recur, particularly in individuals prone to sweating or those living in warm climates.

Preventative Skin Care
Patients are encouraged to incorporate medicated shampoos containing zinc pyrithione, selenium sulfide, or ketoconazole into their skincare routine, even after the rash clears. These can be used weekly to help prevent recurrence.

When to Contact the Office
The patient was advised to reach out if:

• The infection spreads despite adherence to the treatment plan.

• New symptoms, such as severe itching or discomfort, develop.

• Signs of an allergic reaction or adverse medication effects arise.

Medication Counseling

Ketoconazole
I discussed the importance of pairing oral antifungals with acidic drinks to improve absorption and highlighted potential side effects, such as:

• Mild: Headache, nausea, upset stomach.

• Rare but severe: Liver function abnormalities, including possible liver failure.

The patient understands the need for periodic liver function tests (LFTs) if prolonged treatment is required.

Fluconazole
Similarly, we reviewed the possible side effects of fluconazole, including gastrointestinal discomfort and headache. Rare but severe risks like liver or kidney issues were emphasized, with the patient agreeing to contact the office if any unusual symptoms occur.

Next Steps

The patient received refills to complete the prescribed course of treatment:

• Fluconazole 200 mg tablets: 8 tablets for the 4-week course.

• Ketoconazole 2% Topical Cream: 60 g with 1 refill for extended use if needed.

• Ketoconazole 2% Shampoo: 120 mL with 11 refills for maintenance therapy.

The patient left today’s visit well-informed and confident in her treatment plan. We will continue to monitor her progress and provide additional support as needed.

Conclusion

Tinea versicolor is a manageable condition with the right combination of medications and preventative care. By adhering to treatment and maintaining healthy skin practices, patients can effectively control this condition and reduce the likelihood of recurrence. For any concerns or questions, I’m always here to guide my patients toward healthier skin.

Dr. Caroline Vaughn

Understanding Cherry Angiomas: Causes, Treatment, and Prevention

By Dr. Reena Jogi, Village Dermatology

Cherry angiomas are small, bright red bumps that often appear on the skin as we age. Although they’re benign and harmless, cherry angiomas can be a cosmetic concern for some. Here at Village Dermatology, we often receive questions about what causes these red spots, if they need treatment, and what options are available to reduce or remove them. Let’s dive into everything you need to know about cherry angiomas.

What Are Cherry Angiomas?

Cherry angiomas are small, round, red growths on the skin. They can vary in size and may be flat or slightly raised. These spots, also known as senile angiomas, are composed of clusters of blood vessels and typically form on the torso, arms, and legs. While they can appear at any age, they are most commonly seen in individuals over 30 and tend to increase in number with age.

What Causes Cherry Angiomas?

The exact cause of cherry angiomas is still unclear, but they are thought to be associated with genetics, age, and certain environmental factors. Research suggests that as we age, changes in skin blood vessels may contribute to the formation of these growths. Additionally, some studies have hinted that exposure to certain chemicals and hormonal changes may play a role.

Are Cherry Angiomas Dangerous?

Cherry angiomas are benign, meaning they are non-cancerous and do not pose a health risk. They generally don’t require treatment unless they become bothersome, start to bleed, or you want them removed for cosmetic reasons. However, if you notice any sudden changes in appearance, such as rapid growth or bleeding without trauma, it’s a good idea to consult a dermatologist to rule out other conditions.

For more on identifying and monitoring skin lesions, visit our Skin Lesions page.

Treatment Options for Cherry Angiomas

While no treatment is necessary for cherry angiomas, many patients seek removal for aesthetic reasons or if the angiomas are in locations where they are easily irritated. Here are some common methods for treating cherry angiomas:

1. Laser Therapy
   Laser therapy is a popular choice for removing cherry angiomas. The laser targets the blood vessels within the angioma, causing it to shrink and fade. This method is minimally invasive and typically requires no downtime.

2. Electrodesiccation
   Electrodesiccation involves using a small electric current to dry out the blood vessels in the cherry angioma, which causes it to shrink. This procedure is quick and effective, and like laser therapy, is minimally invasive.

3. Cryotherapy
   This method uses extreme cold to freeze and destroy the cherry angioma. Cryotherapy is a simple and effective procedure, though it may require multiple treatments depending on the size and location of the angioma.

4. Surgical Removal
   In rare cases, cherry angiomas can be surgically removed. This may be considered if the lesion is large or in an area where it frequently gets irritated. Surgical removal is a quick procedure but may leave a small scar.

If you’d like more details on treatment options, visit our Cherry Angioma Treatment page.

Prevention and Skin Care Tips

While cherry angiomas cannot be entirely prevented, good skin care practices can help maintain your skin’s overall health. Here are a few tips to keep in mind:

• Sun Protection: Use broad-spectrum sunscreen with SPF 30+ daily, as UV exposure can contribute to skin changes and aging. Regular sunscreen use protects not only against cherry angiomas but also against more serious conditions like skin cancer.

• Healthy Lifestyle: Eating a balanced diet, staying hydrated, and avoiding smoking can promote skin health and reduce premature aging, which may help limit the appearance of angiomas and other skin growths.

• Regular Skin Exams: Schedule regular check-ups with your dermatologist to monitor any skin changes, especially if you have a family history of skin issues. Early detection and treatment are key to maintaining skin health.

When to See a Dermatologist

Although cherry angiomas are typically harmless, it’s essential to consult with a dermatologist if:

• You notice rapid growth or a sudden increase in cherry angiomas.

• An angioma begins to bleed or becomes painful without any trauma.

• There are any changes in color, size, or shape.

At Village Dermatology, we specialize in diagnosing and treating various skin conditions, including cherry angiomas. Our team is here to help you understand your options and develop a personalized treatment plan if desired.

If you’re interested in learning more about cherry angiomas or would like to discuss treatment options, don’t hesitate to reach out to us or visit our Cherry Angioma page for more information.

Conclusion

Cherry angiomas are a natural part of aging and generally don’t require treatment. However, for those who find them bothersome or unsightly, several safe and effective treatment options are available. Protecting your skin from the sun, maintaining a healthy lifestyle, and getting regular skin check-ups are all part of a proactive approach to skin health. If you have questions or concerns about cherry angiomas or other skin lesions, the team at Village Dermatology is here to help guide you.

Follow-Up Care for Actinic Keratosis: A Case Study in Sun Safety and Treatment Options

By Dr. Neda Nosrati, Village Dermatology

Actinic keratosis (AK) is a common skin condition among older adults, often resulting from years of sun exposure. While these lesions are usually harmless, they are considered precancerous and have the potential to develop into squamous cell carcinoma if left untreated. Today, I’d like to share the follow-up care plan for a 70-year-old male patient with an actinic keratosis lesion on his forehead. This case highlights our approach to AK management, from topical treatments to preventive skin care.

Case Overview: Initial Evaluation and Treatment

The patient, a 70-year-old non-smoker with no family history of melanoma, first presented with a brown lesion on his left forehead in June 2024. Given the nature of the lesion, we started him on a treatment plan with fluorouracil (5-FU) combined with calcipotriene, a topical therapy designed to target precancerous cells in sun-damaged areas.

Treatment Instructions: He was instructed to apply the 5% fluorouracil compound twice daily for 7–10 days. This medication works by targeting abnormal skin cells, which results in crusting and scaling as the skin clears. He returns now for follow-up, having used the cream for five days.

Follow-Up Evaluation and Current Findings

Upon examination, the treated area showed flaking and minimal residual scaling, indicating that the fluorouracil was working as intended. We recommended that he use desonide ointment, a mild topical steroid, to reduce any remaining irritation and scaling over the next two weeks.

For further support, he was counseled on continuing broad-spectrum sunscreen with SPF 30+ daily to protect his skin from additional sun damage. For more on protecting against sun damage, visit our Sun Protection page.

Preventative Skin Care for Actinic Keratosis

To prevent the formation of new AKs, we advised the patient to take additional preventive measures, including:

• Wearing sun-protective clothing: Long sleeves, wide-brimmed hats, and UV-blocking sunglasses can shield the skin from harmful UV rays.

• Applying sunscreen: Daily use of broad-spectrum sunscreen, especially on exposed areas like the face, is key to reducing the development of AKs.

For more information on actinic keratosis, check our Actinic Keratosis page.

Understanding Actinic Keratosis and Treatment Options

Actinic keratosis represents abnormal skin cell growth due to UV exposure. Although not all AKs become cancerous, a small percentage may progress into squamous cell carcinoma, a common type of skin cancer. In addition to 5-FU, other treatment options include:

• Cryotherapy: Freezing the lesion to destroy abnormal cells.

• Photodynamic therapy: Using light-activated chemicals to treat large or numerous lesions.

• Imiquimod: Another topical cream that stimulates the immune system to target abnormal skin cells.

If you’re interested in learning more about these treatment options, visit our Actinic Keratosis Treatments page.

When to Contact the Dermatologist

We instructed the patient to return to our office if he experiences severe side effects from the 5-FU, such as:

• Unbearable redness, crusting, or tenderness

• Persistent flaking beyond the treatment period

• New lesions that do not heal, ulcerate, or bleed

Monitoring these symptoms is essential, as early intervention can prevent complications. We also discussed the possibility of a biopsy if the lesion fails to improve.

Next Steps: Planning Future Care

While the patient expressed a preference to delay further interventions, such as a biopsy, until after the holidays, we emphasized the importance of ongoing skin care and self-monitoring. Regular follow-up visits allow us to monitor his response to treatment and ensure any new or concerning lesions are managed promptly.

This case reinforces the value of preventive care, effective treatment, and close follow-up in managing actinic keratosis. With proper attention to sun safety and regular skin evaluations, patients can greatly reduce the risk of progression and maintain healthier skin.

For more information on protecting your skin and managing actinic keratosis, visit our Village Dermatology Skin Conditions page.

Comprehensive Skin Health in Older Adults: A Case Study on Managing Skin Lesions

By Dr. David Wang, Village Dermatology

Skin health is essential as we age, especially with the increased likelihood of developing benign or concerning skin lesions. In this article, we discuss the case of a 71-year-old female patient who came in for a full-body skin exam to address new skin lesions on her lower leg and monitor existing growths. This case highlights the value of regular skin exams and provides insights into different types of common skin lesions, their characteristics, and recommended management practices.

Case Overview: Full-Body Skin Exam and Lesion Evaluation

Our patient presented with brown, moderate-intensity lesions on her left leg, which had been present for several months. After a detailed, head-to-toe examination, including dermatoscope use, we identified various lesions. Each lesion was carefully evaluated, allowing us to categorize them and create a personalized management plan.

Diagnoses and Treatment Recommendations

Below is a summary of the lesions identified, along with guidance on their management:

1. Benign Nevi

• Description: Symmetrical and evenly pigmented moles found throughout the skin.

• Management: These pigmented nevi are benign, and no intervention is required unless there are changes in size, shape, or color.

• Patient Advice: We recommended monthly self-skin exams and annual professional evaluations to monitor for any changes. For more on nevi, refer to our Mole Removal and Management page.

2. Cherry Angiomas

• Description: Small, bright red vascular growths that commonly appear with age.

• Management: Cherry angiomas are benign, but they can be removed with laser treatment or electrodesiccation for cosmetic reasons.

• Patient Advice: Since they are harmless, treatment is optional unless they are bothersome. Learn more about vascular lesions like cherry angiomas on our Skin Lesions page.

3. Lentigines

• Description: Light brown or tan spots, also known as "sun spots," that often appear on sun-exposed areas.

• Management: Lentigines can be managed with sunscreen, retinoids, chemical peels, or laser therapy to reduce their appearance.

• Patient Advice: We advised daily application of broad-spectrum sunscreen with SPF 30+ to protect against sun exposure, as UV rays can worsen lentigines.

4. Dermatofibroma

• Description: Firm, dome-shaped pink-tan nodules, usually on the lower legs, that dimple when pinched.

• Management: Dermatofibromas are benign and only require removal if they are symptomatic or increase in size.

• Patient Advice: Since these lesions are stable, removal is generally not necessary unless the patient experiences discomfort.

5. Seborrheic Keratosis

• Description: Warty, stuck-on lesions with a greasy or waxy texture.

• Management: These benign growths are common with age and do not require treatment unless desired for cosmetic reasons.

• Patient Advice: We assured the patient that seborrheic keratoses are harmless. For more about their management, refer to our Seborrheic Keratosis page.

6. Neoplasm of Uncertain Behavior

• Description: A darkly pigmented papule on the suprapubic area with an uncertain diagnosis.

• Management: Neoplasms like this may be observed, biopsied, or surgically removed depending on clinical suspicion.

• Patient Advice: We advised monitoring and instructed her to report any changes, including non-healing, bleeding, or ulcerating lesions. If needed, we can conduct a biopsy to further evaluate. Learn more on our Skin Cancer Screening page.

Sun Protection and Skin Monitoring Recommendations

To reduce the risk of further skin damage and new lesions, we recommended:

• Daily use of SPF 30+ broad-spectrum sunscreen

• Monthly self-skin exams to detect changes early

• Annual professional skin exams to monitor any new or evolving lesions

Our patient received comprehensive education on self-care and monitoring for changes in her skin. For those seeking more guidance, our Skin Cancer Prevention page provides detailed information on protective measures and the importance of routine check-ups.

Conclusion

Regular skin examinations are essential for detecting and managing both benign and potentially concerning lesions, especially as we age. At Village Dermatology, we are committed to educating patients on skin health and providing personalized care plans. Whether you're managing benign growths or monitoring suspicious lesions, our team is here to support your journey to optimal skin health.

For more information or to schedule your annual skin exam, visit Village Dermatology.

Managing Moderate Acne in Adolescents: A Case Study

By Dr. Ashley Baldree, Village Dermatology

Acne is a common concern for many teenagers, and while it’s a typical part of adolescence, it can significantly impact self-esteem and quality of life. Today, I’d like to share insights from a recent visit with a 14-year-old patient who is battling moderate acne on her cheeks. This case sheds light on the treatment plan we developed, along with the education provided to her and her family regarding care expectations, safety measures, and the journey ahead with isotretinoin.

Case Overview

Our patient, an established young teenager, came to us with moderate acne on both cheeks, featuring pimples and areas of early scarring. After careful evaluation, we discussed a multifaceted approach to target the active acne and reduce the potential for further scarring.

Skin Care Essentials

The foundation of any acne regimen is a consistent and suitable skincare routine. We emphasized using non-comedogenic cleansers, moisturizers, and cosmetics. Non-comedogenic products are less likely to clog pores, which is essential for anyone prone to acne. Consistency in these basics will help create an environment that’s less likely to aggravate acne.

For more information on acne-specific skincare, visit our Acne Care page.

Setting Realistic Expectations

It’s important to remember that acne treatments do not work overnight. I explained that she could expect to see a 60-80% improvement over the next 2-3 months if she follows the regimen closely. Patience is key, as acne treatments often need time to show results.

Treatment Plan: Isotretinoin

Due to the scarring and severity of her acne, we decided to initiate isotretinoin therapy. This powerful medication can dramatically reduce acne by decreasing oil production, but it requires careful monitoring and adherence to specific guidelines.

For a deeper look at how isotretinoin works, see our Acne Treatment page.

Dosing and Safety Protocols

Her starting dose will be 1 mg/kg until a cumulative dose of 120-150 mg/kg is reached, which is standard for maximizing efficacy. Given isotretinoin’s potency, we discussed in detail the importance of regular blood tests to monitor liver enzymes and lipid levels, and we reviewed monthly urine pregnancy tests for safety, as isotretinoin has known risks of severe birth defects.

Counseling on Side Effects and Preventive Measures

I thoroughly discussed potential side effects, including dryness, sensitivity to sunlight, joint aches, and rare but serious mood changes. Other important instructions included:

• Sun Protection: She should apply a broad-spectrum sunscreen with SPF 30+ daily.

• Hydration and Moisturization: Regular use of moisturizers is crucial to counter the skin’s tendency to dry out on isotretinoin.

Our Hormones and Acne page further explores how hormonal changes can impact skin and influence treatment results.

Birth Control and Abstinence Counseling

While the patient has chosen abstinence as her method of birth control, we reviewed the need to remain vigilant and fully understand the commitment to avoid pregnancy during and after treatment. We also reiterated the need for dual forms of birth control should her situation change.

Additional Counseling Points and Support Resources

We covered several essential safety points:

• Avoiding Blood Donation: Due to isotretinoin’s teratogenic potential, blood donation is prohibited during and shortly after therapy.

• Driving Precautions: If she notices any night vision issues, she should avoid driving at night.

• Emotional Monitoring: We discussed the possibility of mood changes, emphasizing that any signs of depression should be promptly reported.

For more insights into potential causes of acne and how lifestyle factors can influence treatment, visit our Causes of Acne page.

Follow-Up and Ongoing Support

We’ll see her back in one month to assess progress, review blood test results, and provide additional guidance as needed. The patient has clear instructions to contact us if she notices any severe side effects, including headaches, vision changes, mood changes, or abdominal pain. Regular follow-ups are vital to ensure safe, effective treatment.

By working closely together and following this structured plan, we aim to help our young patient achieve significant improvement in her acne and prevent further scarring. We’re here to support her through each step of her journey to clearer skin.

For more information on how we treat acne and support our patients at Village Dermatology, please visit our comprehensive Acne Care page.

Understanding and Managing Prurigo Nodularis: A Case Study of Persistent Itchy Rash

By Dr. Caroline Vaughn, Village Dermatology

At Village Dermatology, we often treat patients with chronic skin conditions that significantly impact their quality of life. Recently, an 80-year-old patient came to our Katy office with a chief complaint of a persistent, itchy rash that had been troubling him for years. The rash affected his legs, back, and buttocks and was moderate in severity but persistent and bothersome.

After a thorough examination, we diagnosed the condition as prurigo nodularis, a chronic skin disorder characterized by intensely itchy, raised nodules or bumps on the skin. In this article, I’ll share insights into prurigo nodularis, discuss treatment options, and provide advice on managing symptoms effectively.

What is Prurigo Nodularis?

Prurigo nodularis is a chronic skin condition that typically presents with hard, itchy nodules or bumps. It often affects areas like the legs, arms, and trunk, and the constant itching can lead to scratching, which, in turn, worsens the condition. The exact cause of prurigo nodularis is not fully understood, but it is often associated with other underlying conditions, such as chronic itching disorders, eczema, or immune system dysregulation.

For our patient, the primary symptoms included itchy, raised bumps on the legs, back, and buttocks. These symptoms are common in prurigo nodularis, and without appropriate treatment, the cycle of itching and scratching can continue indefinitely, worsening the skin’s appearance and causing discomfort.

Treatment Plan: Managing Symptoms and Reducing Itchiness

In managing prurigo nodularis, the goal is to break the itch-scratch cycle and reduce inflammation, which can help improve the skin’s condition over time. For this patient, we discussed a two-part treatment approach focusing on topical therapies and potential systemic options if necessary.

1. Topical Treatment with Fluocinonide Ointment

• The primary treatment involves fluocinonide ointment, a potent topical steroid that reduces inflammation and itching. This medication is applied directly to the affected areas to provide targeted relief, helping to calm the itching and prevent further scratching.

2. Gentle Skincare Products

• To prevent irritation, we recommended that the patient use gentle skincare products, such as Dove Sensitive Skin Wash. Harsh soaps and cleansers can further irritate the skin, so using products formulated for sensitive skin is essential for maintaining a healthy skin barrier.

3. Intralesional Steroid Injections (ILK)

• In areas of severe itching, we opted to administer intralesional corticosteroid (ILK) injections. These injections help reduce itching and inflammation directly within the affected nodules, providing relief for persistent areas that may not fully respond to topical treatment alone.

Considering Advanced Treatment: Dupixent

In addition to topical treatments, I also discussed Dupixent (dupilumab) with the patient. Dupixent is an injectable medication that can help manage chronic skin conditions like prurigo nodularis by modulating the immune response. This medication can be especially effective for patients with severe, treatment-resistant prurigo nodularis.

While Dupixent is promising, I reviewed potential side effects with the patient, including mild injection site irritation, to ensure he was fully informed. The patient expressed interest but decided to start with the topical treatments first to see how well they manage his symptoms. This approach allows us to explore additional options like Dupixent if the topical treatments alone are not sufficient.

Follow-Up and Monitoring

Managing prurigo nodularis requires ongoing care and monitoring to adjust the treatment plan as needed. I advised the patient to follow up in one month so we can assess his progress and determine if additional treatments or adjustments are necessary.

During the follow-up, we will evaluate:

• The effectiveness of fluocinonide ointment in reducing itching and inflammation.

• The condition of the injected areas to see if further ILK injections may be beneficial.

• Any new or worsening symptoms that may require a change in treatment.

Key Takeaways for Managing Prurigo Nodularis

For patients dealing with prurigo nodularis or other chronic, itchy skin conditions, consistent care and management are essential. Here are a few takeaways based on this case:

• Use prescribed topical treatments as directed to reduce inflammation and itchiness.

• Opt for gentle skincare products to avoid aggravating sensitive skin.

• Consider advanced therapies like Dupixent for long-term management if topical treatments are insufficient.

• Follow up regularly with your dermatologist to monitor progress and make adjustments as needed.

Conclusion

Chronic skin conditions like prurigo nodularis can be challenging to manage, but with a comprehensive treatment plan, patients can find relief from persistent itching and discomfort. At Village Dermatology in Katy, we are committed to providing personalized care for each patient, addressing their unique needs and guiding them through effective treatment options.

If you’re struggling with chronic itching or other skin concerns, schedule a consultation with us today. Together, we can create a treatment plan that supports healthier, more comfortable skin.

About the Author:

Dr. Caroline Vaughn is a board-certified dermatologist at Village Dermatology, specializing in comprehensive skin care for patients of all ages. Dr. Vaughn is dedicated to providing compassionate and effective treatments for chronic skin conditions in Katy and the surrounding areas.

This article is intended for informational purposes only. For personalized medical advice, please consult a qualified healthcare provider.

The Importance of Regular Skin Examinations: A Case of Actinic Keratosis and Monitoring Non-Melanoma Skin Cancer

By Dr. Tony Nguyen, Village Dermatology

At Village Dermatology’s Katy office, we understand that skin health becomes increasingly important as we age, particularly for those with a history of skin cancer or pre-cancerous lesions. I have seen a 62-year-old patient for her annual full-body skin examination. With a history of basal cell carcinoma and actinic keratoses (AKs), this patient is closely monitored to manage her skin health and address any emerging concerns.

In this post, I’ll discuss the findings of her examination, the treatments provided, and essential recommendations for those with a history of skin lesions or significant sun damage.

Patient Background and History

This patient’s medical history includes:

• A previous basal cell carcinoma removed from her forehead four years ago.

• A history of actinic keratoses, pre-cancerous lesions commonly associated with cumulative sun damage. Learn more about actinic keratosis and its risks.

During this visit, her skin showed several areas of concern. Actinic keratoses lesions, common on sun-exposed areas, were found on her left central cheek, left inferior forehead, right neck, superior thoracic spine, and left upper back. Given her history and the appearance of these lesions, we treated the AKs immediately using liquid nitrogen.

Actinic Keratosis Treatment and Follow-Up Care

Actinic keratoses are often a precursor to squamous cell carcinoma if left untreated. While the risk of progression is low, regular treatment and monitoring are essential. During this visit, we applied cryotherapy (liquid nitrogen) to five actinic keratosis lesions, a standard treatment that freezes abnormal cells, causing them to slough off.

For patients with extensive actinic damage like this patient, topical treatments such as Efudex (5-fluorouracil) and calcipotriene may be recommended for long-term care. These topical agents help treat existing lesions and prevent new ones from forming. The patient was advised to apply these treatments to her lower legs, arms, hands, chest, and face, which have shown significant sun damage over time. You can read more about our actinic keratosis treatment options here.

Expected Outcomes and Precautions

Patients undergoing treatment for AKs should monitor their skin closely. While cryotherapy and topical treatments are highly effective, some lesions may be persistent or resistant. We instructed the patient to contact our office if:

• The lesions fail to heal after treatment.

• She experiences severe side effects, such as extensive crusting, scabbing, or redness.

For added protection, broad-spectrum sunscreen (SPF 30+), protective clothing, and limiting sun exposure are essential. In particular, patients with a history of non-melanoma skin cancers benefit significantly from daily sun protection.

Monitoring for Recurrence of Non-Melanoma Skin Cancers

Given her history of basal cell carcinoma, this patient was also advised to monitor any scars from previous excisions for signs of recurrence. Any discoloration, changes, or new bumps in these areas should be evaluated immediately, as they can signal recurrence or new growth.

During this visit, we identified an erythematous pearly papule on her left neck, a lesion of uncertain behavior that raised concerns for basal cell carcinoma. After obtaining consent, we performed a biopsy using the shave method to obtain a tissue sample for pathology. The biopsy process involved:

• Preparing the area with alcohol.

• Administering local anesthesia.

• Using a Dermablade to perform a shave biopsy to the dermal level.

• Applying Drysol for hemostasis and bandaging the area.

We will follow up with the patient regarding biopsy results within two weeks. However, we instructed her to contact our office if she has not received communication by that time.

Key Takeaways for Skin Health

1. Regular Skin Examinations: For patients with a history of non-melanoma skin cancer, annual or even biannual skin checks are crucial to identify any new or recurring lesions.

2. Sun Protection: Sunscreen (SPF 30+) and sun-protective clothing are essential for preventing new actinic keratoses and reducing the risk of skin cancers.

3. Monitoring Post-Excision Scars: Patients should monitor any scars from previous excisions for changes, as these could indicate recurrence.

4. Diet and Lifestyle: A healthy lifestyle, including limiting sun exposure, can help reduce the risk of skin cancer progression.

Conclusion

The patient’s annual examination highlights the importance of consistent skin monitoring and proactive treatment in preventing skin cancer progression. For patients in Katy, Village Dermatology offers comprehensive skin evaluations, personalized treatment plans, and ongoing guidance to help manage and protect skin health. If you have a history of sun damage or skin cancer, schedule your consultation with us today and take control of your skin health.

About the Author:

Dr. Tony Nguyen is a board-certified dermatologist at Village Dermatology, specializing in skin cancer prevention, treatment, and comprehensive skincare. Dr. Nguyen is dedicated to providing compassionate, expert care to patients in Katy and surrounding areas.

This article is intended for informational purposes only. For personalized medical advice, please consult with a qualified healthcare provider.