General, Surgical, and Cosmetic Dermatology
   for Adult and Pediatric Skin, Hair, and Nails

   Call us at 301-620-2188 or 301-869-2126
   info@dermpractice.com

Services

All adult and pediatric skin problems

At Comprehensive Dermatology Center, we offer full range of dermatologic services from acne, dermatitis, to advanced surgical and cosmetic treatment. The listed are just a few of common medical skin conditions frequently encountered in our practice:

Acne

Acne is a most skin condition seen in dermatology practices. Most people develop acne during adolescence. Acne usually becomes less of a problem after the age of 25 years, although about 12% of women and 6% of men continue to have acne as adults. Treatment for acne varies depending on the type and severity, the induvidual's skin type, age, and life style.

The treatment options include: Topical and systemic antibiotics (such as Benzoylperoxide), Retinoids (such as Retin-A, Differin, Tazorac), or combination of Retinoids with other antibiotics (such as Epidua and Ziana). Isotretinoin is indicated for severe cystic acne. Oral contraceptives and Spironolactone can be effective for some types of acne in female patients. Chemical Peels, Microdermabrasion, and Laser and other light treatment can be beneficial for treating both acne and acne scars.

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Aging Skin

Aging Skin is caused by the genes we inherit (intrinsic) and environmental factors (extrinsic), such as exposure to the sun’s rays. Intrinsic aging begins in our mid-20s, within the skin, collagen production slows and the amount of elastin decreases, that leads to thinning and sagging skin and wrinkles. Extrinsic factors, specially the sun exposure, also called photoaging, can facilitate skin aging process. Other external factors include facial expressions, gravity, sleep positions, stress, and smoking.

A number of treatments are available for aging skin, including Botox, Restylane, Radiesse, Chemical Peels, Microdermabrasion, Laser resurfacing, as well as topical skin rejuvenating products.

Anti-Aging Treatments

Beyond prevention, in today's world there is a wide range of options for slowing down the affects of aging on the skin. See the Cosmetic Dermatology section of this website for more information about: Botox, Chemical peels, Dermabrasion, Fillers, Laser Resurfacing

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Dermatitis

Dermatitis is inflammation of the skin that results from a variety of different causes and has various types, such as eczema, irritant or and allergic contact dermatitis, seborrheic dermatitis, nummular eczema, etc.

The most important aspect of treatment is to identify and tackle the causes. Regular skin moisturizing for preserving and improving intact and functional skin barrier system is vitally beneficial; topical corticosteroids or non-steroidal agents are often helpful for mild to moderate dermatitis; systemic corticosteroids, immune suppressants, and phototherapy may be needed for severe dermatitis.

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Melasma

Melasma, appears as a blotchy, brownish pigmentation on the face that develops slowly and fades with time. The pigmentation is due to overproduction of melanin by the pigment cells, melanocytes.

The common triggers:

  • Pregnancy – the pigment often fades a few months after delivery.
  • Hormonal contraceptives, including oral contraceptive pills and injected progesterone
  • Sun exposure
  • Scented or deodorant soaps, toiletries and cosmetics – a phototoxic reaction
  • Unknown factors, when it arises in apparently healthy, normal, non-pregnant women

Melasma usually affects women; only one in twenty affected individuals are male. It generally starts between the age of 30 and 40. It is more common in people that tan well or have naturally dark skin compared with those who have fair skin. Melasma affects the forehead, cheeks and upper lips resulting in macules (freckle-like spots) and larger patches. Occasionally it spreads to involve the sides of the neck, and a similar condition may affect the shoulders and upper arms. Melasma is sometimes separated into epidermal (skin surface), dermal (deeper) and mixed types.

Treatment

Melasma can be very slow to respond to treatment, so patience is necessary. Start gently, especially if you have sensitive skin. Harsh treatments may result in an irritant contact dermatitis, and this can result in postinflammatory pigmentation. Generally a combination of the following measures is helpful.

  • Discontinuing hormonal contraception.
  • Year-round sun protection. Use a broad-spectrum very high protection factor sunscreen of reflectant type and apply it to the whole face. Alternatively, use a make-up containing sunscreen.
  • Hydroquinone 2-4% for 2 to 4 months. This sometimes causes stinging and redness; Azelaic acid can be used longterm and is safe even in pregnancy. It may sting; Kojic acid is mild fading agent.
  • Chemical Peeling including salicylic acid and glycolic acid can be effective
  • Topical retinoids, such as tretinoin.
  • Microdermabrasion should be undertaken very cautiously; damage to the melanocytes may increase pigment production and darken the melasma.
  • Laser resurfacing – results may be unpredictable. Newer fractional lasers may prove safer.
  • Applying cosmetic camouflage (make-up).

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Psoriasis

Psoriasis is a common, chronic, itching rash that affects about 3% people of all ages. Although there is a genetic predisposition, it is not a genetic disease. It is considered as skin autoimmune condition with excessive production of cytokines such as interleukin and TNF, leading to overgrowth and dilation of blood vessels (skin redness) and increased turnover of the skin cells (scaly and thickened skin).

So far there is no cure for psoriasis except for Guttate type (usually caused by bacterial infection) or drug induced type. The wide range of treatments are available, including topical steroids or non-steroidal agents (such as Calcipotriol and Tacrolimus). Narrow-band UVB can be effective for generalized psoriasis. Biologics such as Humira, Stelara, and Remicade can be quite effective for moderate to severe psoriasis.

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Rosacea

Rosacea is a facial skin inflammation that most often affects those aged 30 to 60, especially those with fair skin, blue eyes and of Celtic origin. It may be transient, recurrent or persistent. The cause of rosacea is unknown, genetic, environmental, vascular hypersensitivity to external factors (such heat and cold), and Demodex folliculorum may be involved in the pathogenesis of Rosacea.

Treatments include topcial agents such as Metronidazole and Azelaic Acid, and oral antibiotics such as Doxycycline. Isotretinoin may be used for severe rosacea. Vascular Laser or IPL can be effective for treating persistent telangiectasia.

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Skin Care Basics

The skin is the body's largest organ and accounts for roughly 18% of an adult's weight. It serves as a protective outer layer that keeps in moisture and keeps out invasive organism (like infections). It protects our organs against injury. It also helps regulate the body's temperature and has self-healing capabilities.

The best way to maintain healthy skin is to prevent skin damage from occurring in the first place. Wrinkles, age spots and leathery patches are all the result of skin damage from overexposure to ultraviolet radiation from the sun. But the aging process for skin is unavoidable. As we age, skin becomes dryer and thinner. Repeated movements of facial muscles, such as frowning, smiling or squinting, cause wrinkles over time. Stress, gravity and obesity also contribute to aging skin. And because the skin is thinner, it is more susceptible to bruising.

The premature aging of the skin from ultraviolet light exposure is called photoaging. Photoaging occurs when ultraviolet radiation penetrates deep into the dermis, damaging collagen fibers and causing the increased production of abnormal elastin. This breakdown in fundamental skin structures leads to deep wrinkles, fine lines, discoloration of the skin (age or liver spots), leatheriness and sagging skin.

Skin Care Routine

A healthy skin care routine throughout life can reduce the symptoms of aging in the skin:

  • Wash your face using a gentle cleanser and lukewarm water twice a day.
  • Pat skin dry; don't rub it dry.
  • Exfoliate the skin twice a week to remove dead cells.
  • Apply a moisturizer to skin immediately after a shower or bath.
  • Wear sunscreen with a SPF of at least 15 every day.
  • For women who wear makeup, be sure to leave time each day when the skin is clean and free of makeup.
  • Do not use tanning beds.
  • Maintain a healthy diet and drink lots of water.
  • Get an adequate amount of sleep every day.
  • Quit smoking.
  • Avoid stress.
  • Conduct a monthly self-examination of your skin to detect any changes that might lead to cancer.
  • See your dermatologist once a year.

Warts

Warts are growths of the skin caused by infection with Human Papillomavirus (HPV). Warts are particularly common in childhood and are spread by direct contact or autoinocculation. This means if a wart is scratched, the viral particles may be spread to another area of skin. It may take as long as twelve months for the wart to first appear.

Treatment

  • Topical creams such as Imiquimod, Effudex, Cantheradine can be helpful. Duct tape may be beneficial in some cases.
  • The most common treatment for wart is freezing with liquid nitrogen repeatedly, at one to three week intervals. This is uncomfortable for a few minutes and may result in blistering for several days. Success is in the order of 70% after 3-4 months of regular freezing.
  • Electrosurgery is used for particularly large and annoying warts.
  • Other treatments for recalcitrant warts include intralesional bleomycin injection, intralesional candida injection, laser vaporization.

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Skin Cancer

Most of the skin cancers occur as a result of chronic and intense sun exposure. Skin cancer generally develops in the top layers of skin, and is usually easily visible. This makes most skin cancers detectable in the early stages. Three types of skin cancer account for nearly 100% of all diagnosed cases, the most common type, Basal Cell Carcinoma (about 80%) is typically locally destructive, Melanoma (about 4%) however is a most lethal type with potential of early metastasis, Squamous Cell Carcinoma (about 16%) is often locally aggressive with some metastatic potential specially on the head and neck areas.

Treatment for skin cancer varies according to the type, location, extent, aggressiveness of the cancer, and the patient's general health. The surgical excision is still most effective, alternatively, Cryosurgery, Electrosurgery, or sometimes topical chemotherapeutic agents can be used.

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