Dermatology Definitions & Terms

The skin cells that produce pigment (melanocytes) sometimes group together to form moles. Melanocytes can form abnormal moles, also called atypical moles. These moles are not malignant themselves, but their presence is a warning of an inherited tendency to develop melanoma.

Having numerous moles, whether atypical or normal, is a risk factor for melanoma. Don’t wait for more serious warning signs of melanoma to appear, such as:

• Itching
• Pain
• Elevation
• Bleeding
• Crusting
• Swelling
• Oozing
• Ulceration
• Bluish-black color

Acne is a very common skin problem that shows up as outbreaks of bumps called pimples or zits. Acne usually appears on the face, neck, back, chest and shoulders. Acne can be a source of emotional distress, and severe cases can lead to permanent acne scars.

Acne can be categorized by its severity:

• Mild acne describes a few scattered comedones (whiteheads or blackheads) with minimal inflammation (no pustules).
• Moderate acne describes a denser collection of comedones as well as red, inflamed, pus-filled lesions (pustules).
• Severe acne, also called nodular or cystic acne, describes widespread and deep lesions that are painful, inflamed and red. This form of acne is likely to lead to scarring if left untreated.

Epidermoid cysts are slow-growing, small bumps that develop beneath the skin. They are usually painless and tend to occur on the face, neck, trunk and sometimes the genital area.

Epidermoid cysts have the following characteristics:

• Size: They range in size from less than 1/4 inch to nearly 2 inches in diameter.
• Shape and mobility: The cysts are round bumps that easily move under the skin when felt with the fingers.
• Color: The cysts are usually white or yellow, though people with darker skin may have pigmented cysts.
• Other: The cyst may have a central opening plugged with a blackhead. This is the remnant of a hair follicle. A thick, cheese-like material can sometimes be expressed through the opening.

Other Types of Cysts

• Sebaceous cysts: Epidermoid cysts are often called “sebaceous cysts” because they appear very similar and are often treated in the same manner. However, a true sebaceous cyst is less common and arises from cells that make up the sebaceous gland instead of the cells that form the epidermis.
• Pilar Cyst. A small bump that appears on the scalp may look like an epidermoid cyst but is likely to be a “pilar cyst” or “trichilemmal cyst”, which usually have thicker walls and a different lining than an epidermoid cyst.

Cyst Treatment:

• Corticosteroid Injection. A cyst that is inflamed, but not uninfected, may be injected with a corticosteroid (triamcinolone) to reduce inflammation.
• Incision and drainage. In this procedure, your doctor makes a small cut in the cyst and expresses the contents. Although incision and drainage are relatively quick and easy, cysts often recur after this treatment.
• Excision. If required, the cyst can usually be easily removed by a simple operation. The surrounding skin is first ‘numbed’ with a local anesthetic (lidocaine). Then, a small incision (cut) is made over the cyst. Typically, the whole cyst, including the walls, can be extracted. The wound is then stitched up with sutures that are removed after about 1-2 weeks. A small scar will result. Sometimes, after the removal of a cyst, it gradually regrows in the same site under the scar. This is unusual but, if it occurs, it can be removed again. Your doctor may recommend treatment with antibiotics, steroids or incision and drainage and then wait to perform excision 4-6 weeks after inflammation resolves.

Eczema and dermatitis are similar terms used to describe an itchy rash with inflamed skin.

A variety of eczema medications are available that can be categorized as follows:

• Topical corticosteroids
• Calcineurin inhibitors (Elidel®, Protopic®)
• Antihistamines
• Antibiotics
• Oral corticosteroids (prednisone)
• Immunosuppressants (cyclosporine)

Hair loss is a common complaint among our patients, both men and women.

Although is it normal to shed hairs each day, excessive hair loss can lead to a thinning hairline and areas of baldness.

There are hair loss treatments that help promote hair growth or hide hair loss. For some types of hair loss, hair growth may return without any treatment.

Hair Loss Causes
The most common cause of hair loss among men is called male-pattern baldness, or androgenic alopecia. Men who have this type of hair loss usually have inherited the trait. Men who start losing their hair at an early age tend to develop more extensive baldness. With male-pattern baldness, hair loss typically results in a receding hair line and baldness on the top of the head (vertex).

Women may develop female-pattern baldness. With this form of hair loss, the hair can become thin over the entire scalp. Female-pattern baldness is much more common than is recognized.

Other less common causes of hair loss include:

• Alopecia areata. Alopecia areata is an autoimmune disease, in which the body’s immune system mistakenly attacks the hair follicles leading to hair loss. In most cases the hair falls out in small, round patches about the size of a quarter. More severe cases can involve the entire scalp or other parts of the body.
• Extreme stress. 3-4 months after a severely stressful event, such as an illness or major surgery, a large amount of hair may be lost. The stress caused the hair follicles to cease the growing phase prematurely. This stress-induced hair loss is temporary, and the hair usually grows back.
• Hormonal problems. Hypothyroidism or hyperthyroidism can lead to hair loss, as can imbalances in androgens (males hormones) and estrogen. For instance, anabolic steroids taken by athlete’s for performance enhancement can lead to premature hair loss. The correction of hormonal imbalances can, in some instances, return hair growth to normal.
• Post-partum hair loss. Many women experience hair loss 3-4 months after having a child. This hair loss is also related to hormonal changes due to pregnancy. Elevated levels of certain hormones during pregnancy lead to the hair follicles staying in growth phase longer than normal. When the hormones return to pre-pregnancy levels, those follicles enter the resting phase and start to fall out 3-4 months later.
• Certain Medications. Some medicines, such as blood thinners (Coumadin), antihypertensives, antidepressants and birth control bills can lead to excessive hair loss. This type of hair loss usually improves when the medication is stopped.
• Fungal infections. Fungal infections of the scalp can cause hair loss in children. The infection is easily treated with antifungal medicines.
• Excessive tension on the hair. Wearing tight pigtails or cornrows or using tight hair rollers, can pull on the hair and damage the hair follicle. This can lead to a type of hair loss called traction alopecia. The hair can grow back normally, if the pulling is stopped before scars develop.

Hives, also called urticaria, is an allergic reaction that appears on the skin as a red, bumpy and very itchy rash. The bumps may be referred to as “welts” or “wheals” and can arise anywhere on the body. Most people complain of hives because of the itch, which may also feel like burning or stinging.

Acute vs. Chronic Hives
Hives are categorized as “acute” if they last less than six weeks, or “chronic” if they last more than six weeks.

Treatment for Hives
When the cause of hives is known, the most important step is to eliminate the trigger.

Antihistamines provide the first step in medical treatment. Antihistamines are very effective when used properly. However, an antihistamine may not provide sufficient relief if the particular medication is not strong enough, the medication is not taken in sufficient doses or the medication is not taken long enough to suppress symptoms.

Psoriasis is a chronic skin disorder that causes red, scaly patches on the limbs, trunk, scalp and other parts of the body. It is not contagious. Arthritis (joint pains) can occur along with psoriasis, so it is important to inform your dermatology provider if you have both psoriasis and arthritis.

Treatment of Plaque Psoriasis
In general, mild psoriasis can usually be treated effectively with a variety of psoriasis treatments.

Topical medications are usually recommended as a first-line treatment for mild cases where there is limited area to be treated.

Commonly prescribed topical medications include the following:

• Anthralin
• Coal tar
• Topical corticosteroids, particularly potent or superpotent formulations. These are the most commonly prescribed medication for psoriasis.
• Topical retinoids (Tazorac®)
• Vitamin D derivatives (Taclonex®, Vectical®)
• Localized plaques on the hands or feet may not respond to topical medications and may be treated with laser light.

Biologics are a class of medications that have become an important treatment option for psoriasis.

A biologic medication may be prescribed for a person whose psoriasis is:

• moderate to severe
• cannot be controlled effectively with other psoriasis treatments, or
• cannot tolerate the side effects of other psoriasis medications.

There are currently six FDA-approved biologics approved for psoriasis:

• Adalimumab (Humira®)
• Etanercept (Enbrel®)
• Infliximab (Remicade®)
• Ustekinumab (Stelara®)
• Secukinumab (Cosentyx®)
• Izekizumab (Taltz®)

How Are Biologics Different from Other Psoriasis Medications?
Most medications are synthesized from chemicals. Biologics, however, are derived from natural proteins found in living cells. Currently, all biologics used for the treatment of psoriasis must be injected. They cannot be taken by mouth because the protein molecules are too large to be absorbed by the intestine or are too fragile to withstand the stomach acid.

Biologics work by targeting the underlying cause of psoriasis, excessive skin cell growth due to an overactive immune system. Although they can often provide long periods of clear skin, biologics are not a cure for psoriasis and ongoing treatment remains necessary.

Rosacea is a chronic skin condition that causes redness and swelling of the face that can also affect the scalp, neck, ears, chest and back. Eye symptoms (ocular rosacea) are also reported by half of people with rosacea.

Those afflicted with rosacea may first notice a tendency to flush or blush easily (facial flushing). The condition progresses to persistent redness, pimples and visible, threadlike blood vessels (telangiectasias) in the center of the face. These skin changes can eventually spread to the cheeks, forehead, chin and nose.

Skin cancer is a disease in which malignant (cancerous) cells form in the tissues of the skin.

Most skin cancers develop on the visible outer layer of the skin (the epidermis), particularly in sun-exposed areas (face, head, hands, arms and legs). They are usually easy to detect by examining the skin, which increases the chances of early treatment and survival.

Basal Cell Skin Cancer
Basal cell carcinoma (also called BCC) comes from the basal cells in the lowest part of the epidermis. 80-85% of skin cancers are basal cell carcinomas.

Melanoma Skin Cancer
Melanoma comes from skin cells called melanocytes, which create pigment called melanin that gives skin its color. 5% of all skin cancers are melanoma. Although less common, melanomas are a very dangerous type of skin cancer and are the leading cause of death from skin disease.

Squamous Cell Skin Cancer
Squamous cell carcinoma (also called SCC) comes from the skin cells (keratinocytes) that make up the top layers of the skin. About 10% of skin cancers are SCC.

Warts are growths on the skin caused by the human papillomavirus (HPV). They are very common, particularly in school-age children.

Warts can spread by direct contact to other parts of the body, or to others. They are painless unless they appear on the soles of the feet.

• Common warts (Verruca Vulgaris) can appear anywhere on dry skin, but they are more commonly seen on the hands. They can appear in clusters.
• Flat warts are often on the face or legs. They are smaller and can be difficult to see.
• Plantar warts (foot warts) are located on the soles of the feet. The weight of the body pushes them into the deeper tissues, which can make them painful.

Wart Treatment
These commonly used treatments remove warts more quickly:

• Occlusion—covering the wart with a bandage or strip of tape
• Over the counter medications (salicylic acid)
• Cryotherapy (freezing)
• Electrosurgery
• Prescription medications
• Warts have a tendency to return, so repeated treatments may be necessary.

• BOTOX® & Dysport^® target and prevent expression lines on the face
• Common sites treated are the forehead, crow’s feet and glabellar lines between your eyes

• Anti-aging products
• Products for delicate/sensitive, problematic and acne-prone skin

• JUVÉDERM^® & Restylane^®
• Restore facial volume in the nasolabial folds, marionette lines and vertical lip lines
• Restore lip volume

• Permanent hair reduction
• Treatment plans available for patients with lighter skin tones

• Fraxel laser treatments target age spots, sun spots and acne scars
• VBeam laser treatments target rosacea, small blood vessel discoloration, scars, redness and warts

• Improves skin texture and discoloration

• Targets dull/rough skin texture
• Reduces the appearance of fine lines
• Improves overall texture, tone and clarity