Melasma

Melasma, also known as chloasma, 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.

Melasma / chloasma

More images of melasma ...

What causes melasma?

There is a genetic predisposition to melasma. Triggers include:

• 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

Clinical features

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.

Type of melasma	Clinical features
Epidermal	Well-defined border Dark brown colour Appears more obvious under black light Responds well to treatment
Dermal	Ill-defined border Light brown colour Unchanged under black light Responds poorly to treatment
Mixed	Combination of light and brown patches Partial improvement with treatment

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.
• Use of a mild cleanser, and if the skin is dry, a light moisturiser. This may not be suitable for those with acne.
• Preventing new pigment formation. Bleaching creams inhibit the formation of melanin by the melanocytes. They include:
  • 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
  Sometimes a topical corticosteroid such as hydrocortisone is prescribed, which works quickly to fade the colour and has an additional benefit of reducing the likelihood of a contact dermatitis caused by other agents.
• Peeling off the pigment. Try:
  • Salicylic acid creams
  • Topical alpha hydroxyacids including glycolic acid and lactic acid, as creams or as repeated superficial chemical peels.
  • Topical retinoids, such as tretinoin. This works in several ways to improve skin colour, but can be hard to tolerate and might cause dermatiits. Do not use this during pregnancy.
  • Dermabrasion and 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.
• Destroying the pigment with pigment laser or intense pulsed light device – this is possibly the best treatment for a quick result but several treatments may be necessary.
• Applying cosmetic camouflage (make-up).

Results take time and the above measures are rarely completely successful. About 30% of patients can achieve complete clearance with a prescription agent that contains a combination of hydroquinone, tretinoin and a topical corticosteroid.

Unfortunately, even in those that get a good result from treatment, pigmentation may reappear on exposure to summer sun and/or because of hormonal factors

Age Spots

Freckles & Age Spots These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available. Dr. Rothfeld at NYC Dermatology board certified dermatologist treats many cases every week

Scars
Also called: Cicatrix, Keloid scar
A scar is a permanent patch of skin that grows over a wound. It forms when your body heals itself after a cut, scrape, burn or sore. You can also get scars from surgery that cuts through the skin, from infections like chickenpox, or skin conditions like acne. Scars are often thicker, as well as pinker, redder or shinier, than the rest of your skin.

How your scar looks depends on

How big and deep your wound is
Where it is
How long it takes to heal
Your age
Your inherited tendency to scar
Scars usually fade over time but never go away completely. If the way a scar looks bothers you, various treatments might minimize it. These include surgical revision, dermabrasion, laser treatments, injections, chemical peels and creams. Dr. Rothfeld board certified dermatologist at NYC Dermatology can evaluate you for the proper treatment.

NYC Dermatology headed by board certified Dermatologist Dr. Gary Rothfeld (212) - 644 - 9494

Cyst Removal: Cysts (also know as sebaceous cysts) are small closed sacs that contain fluid or solid material. A cyst is an infection and requires that the dermatologist drain the contents and sometimes surgically remove the cyst. Sebaceous cysts most often arise from swollen hair follicles. Skin trauma can also induce a cyst to form. A sac of cells is created into which a protein called keratin is secreted.

Cysts are usually found on the face, neck, and trunk. They are usually slow- growing, painless, freely movable lumps beneath the skin. Occasionally, however, a cyst will become inflamed and tender.

Symptoms of a Cyst Include:

- usually a nontender, small lump beneath the skin
- redness, tenderness, or increased temperature of the skin over the area may occur infection
- grayish white, cheesy, foul smelling material may drain from the cyst

The dermatologist removes cysts by the injection of steroid medications.

Fraxel Laser - NYC Dermatology - Dr. Gary Rothfeld - (212) -644 -9494

Laser - Fraxel laser

Filling a need

Fractional resurfacing is a breakthrough in improving the quality of the skin. This revolutionary treatment can be helpful in addressing many bothersome skin problems such as wrinkles, acne scars, scars, sun damage, brown spots and other skin problems. The true advantage of the technology is the ability to acheive great results with minimal downtime.

Below is a patient who allowed treatment of one part of her surgical scar with 3 Fraxel sessions. The treated part of the scar has partially faded into the skin improving the appearance.

Below is a Dermatology patient before and after 3 Fraxel treatments for her acne scars.

Below are pictures of a Dermatology patient before and after two Fraxel treatments. Both wrinkles and uneven skin color are improved.

Below is a patient with acne scars and the effects of sun damage (brown spots and textural changes) after three Fraxel treatments

Below is a patient before and 6 months after 5 Fraxel treatments. Collagen remodeling is a slow process and the final result after Fraxel is best appreciated 6-12 months after the completion of the series. Although the lighting is slightly different (despite our best efforts), the pictures demonstrate improvement of the scars and pore size.

About the technology

Made possible by the advances in laser communication technology, 125 to 250 microscopic laser beams are delivered into the skin. Each beam heats both the epidermis and dermis, allowing both superficial and deep treatment. Although 1,000 to 2,000 pulses are delivered in each square centimeter, skin cells between the beams are not affected thereby allowing for incredibly quick healing. By treating a whole area such as the face with 3-6 sessions, the whole zone eventually is fully treated.

Side Effects

Most patients experience 1-2 days of swelling, 2-4 days of redness and 4-7 days of flaking. An annoying, but harmless side effect is a slight bluish tinge for 1-2 days from the remnants of a temporary blue dye that is applied to the skin immediately pre-treatment. There is minimal discomfort after treatment and patients may apply cosmetics immediately. The risks of scarring or skin discoloration are extremely low as this technology is very gentle on the skin.

Click to view healing of a patient undergoing Fraxel treatment.

Alternatives

Fraxel compares very favorably to other treatments in terms of effectiveness, tolerability and side effects. Alternative treatments exist, however and are good options for some patients, especially given the patient cost of a Fraxel treatment.

Intense Pulsed Light / Fotofacial
Pro: Great option to remove most redness and brown spots with minimal downtime. Lower cost of treatment.
Con: Much less wrinkle improvement than Fraxel.

Laser Resurfacing / Chemical Peels / Dermabrasion
Pro: Deep peels are of comparable effectiveness to Fraxel.
Con: Effectiveness related to depth of peeling. Deep peels are like deep skin burns and require 1-2 weeks of healing as the skin is raw and oozes. Increased risk of scars and infection.

Microdermabrasion
Pro: No downtime
Con: Minimal improvement. Minimal to zero long term results.

Fillers (Collagen, Restylane, etc.)
Pro: Immediate improvement of wrinkles.
Con: Temporary results. Not helpful for brown spots or redness. Side effects include bruising and allergic reaction.

Hand Rejuvenation - NYC Dermatology - Dr. Gary Rothfeld - (212) -644 -9494

Hand Rejuvenation

Frequently, people exert a lot of effort to make sure that their faces look good, but they neglect the appearance of their hands. When old-appearing hands are coupled with a more youthful face, there is a disconnect that tells the observer that something is not quite right.

There are a number of factors that contribute to an aged appearance of the hands. First of all, there is a loss of volume in the hands, as in other parts of the body. The hands may appear "bony" and the vessels more prominent. These "skeletonized" hands do not appear attractive. Previously we did not have a good treatment for this. Fat injections were attempted, but the hands looked puffy. Now, with the introduction of newer filling agents (Restylane, Juvéderm, and Radiesse), a youthful-looking hand structure can be created.

The appearance of the skin of the hands poses the second problem; older skin is often wrinkled, discolored, and sometimes rough. The Fraxel Laser has recently been shown to be both safe and effective in improving both the texture and discoloration of the hand. While other modalities such as intense pulsed light (IPL) or the Krypton laser can produce improvement in discoloration, they do not address skin texture. The Sciton Erbium-YAG laser and the Ultrapulse CO2 laser can also improve skin texture and discoloration, but they have significant associated downtime and an increased risk of complications.

All in all, it seems the combination of one of the newer fillers and the Fraxel Laser is the best way to go for hand rejuvenation. Schedule a consultation with Dr. Rothfeld for more information.

Lasers in Dermatology - NYC Dermatology -Dr. Gary Rothfeld - (212) - 644 -9494

Lasers in dermatology

The first lasers used to treat skin conditions occurred over 40 years ago. Argon and carbon dioxide (CO₂) lasers were commonly used to treat benign vascular birthmarks such as port-wine stains and haemangiomas. Although these birthmarks could be effectively lightened, a side effect was the unacceptably high rate of scar formation. In the last 20 years major advances in laser technology has revolutionised their use in the treatment of many skin conditions and congenital defects, including vascular and pigmented lesions, and the removal of tattoos, scars and wrinkles.

Properties of laser light

‘Laser’ is an acronym: light amplification by the stimulated emission of radiation.

Lasers are sources of high intensity light with the following properties:

• Monochromatic i.e. the light is of a single wavelength
• Coherent i.e. the light beam waves are in phase
• Collimated i.e. the light beams travel in parallel

Laser light can be accurately focused into small spots with very high energy.

The light is produced within an optical cavity containing a medium, which may be a gas (e.g. argon, krypton, carbon dioxide), liquid (e.g. dye) or solid (e.g. ruby, neodymium:yttrium-aluminium-garnet, alexandrite). The process involves excitation of the molecules of the laser medium, which results in the release of a photon of light as it returns to a stable state. Each medium produces a specific wavelength of light, which may be within the visible spectrum (violet 400 through to red 700nm) or infrared spectrum (more than 700 nm).

Vascular skin lesions contain oxygenated haemoglobin, which strongly absorbs visible light at 418, 542 and 577 nm, whereas pigmented skin lesions contain melanin, which has a broad range of absorption in the visible and infrared wavebands. Infrared lasers are broadly destructive because they are absorbed by water in and between skin cells (these are composed of 70-90% water).

The aim is to destroy the target cells and not to harm the surrounding tissue. Short pulses reduce the amount that the damaged cells heat up, thereby reducing thermal injury that could result in scarring. Automated scanners aim to reduce the chance of overlapping treatment areas.

What types of lasers are there?

There are several types of lasers used in skin laser surgery. Older laser technologies such as the continuous wave (CW) lasers of CO₂ and argon have been largely replaced with quasi-CW mode lasers and pulsed laser systems. The wavelength peaks of the laser light, pulse durations and how the target skin tissue absorbs this, determine the clinical applications of the laser types.

Laser type	Laser source	Wavelength peaks
CW: emit a constant beam of light with long exposure durations	CO2	10,600 nm
	Argon	488/514 nm
Quasi-CW: shutter the CW beam into short segments, producing interrupted emissions of constant laser energy	Potassium-titanyl-phosphate (KTP)	532 nm
	Copper vapour/bromide	510/578 nm
	Argon-pumped tunable dye (APTD)	577/585 nm
	Krypton	568 nm
Pulsed*: emit high-energy laser light in ultrashort pulse durations with relatively long intervening time periods between each pulse	Pulsed dye laser (PDL)	585-595 nm
	QS ruby	694 nm
	QS alexandrite	755 nm
	QS neodymium (Nd):yttrium-aluminum-garnet (YAG)	1064 nm
	Erbium:YAG	2490 nm
	CO2 (pulsed)	10,600 nm
* Pulsed laser systems may be either long-pulsed such as PDL with pulse durations ranging from 450ms to 40millisec, or very short-pulsed (5-100ns) such as the quality-switched (QS) lasers.

What skin conditions can be treated with lasers?

Vascular lesions

Lasers have been used successfully to treat a variety of vascular lesions including superficial vascular malformations (port-wine stains), facial telangiectases, haemangiomas, pyogenic granulomas, Kaposi sarcoma and poikiloderma of Civatte. Lasers that have been used to treat these conditions include argon, APTD, KTP, krypton, copper vapour, copper bromide, pulsed dye lasers and Nd:YAG. Argon (CW) causes a high degree of non-specific thermal injury and scarring and is now largely replaced by yellow-light quasi-CW and pulsed laser therapies.

The pulsed dye laser is considered the laser of choice for most vascular lesions because of its superior clinical efficacy and low risk profile. It has a large spot size (5 to 10mm) allowing large lesions to be treated quickly. Side effects include postoperative bruising (purpura) that may last 1-2 weeks and transient pigmentary changes. Crusting, textural changes and scarring are rarely seen.

The new V-beam features provide ultra-long pulse duration so greater is energy directed at the target blood vessels over a longer period of time, resulting in more uniform blood vessel damage. This reduces the purpura seen with the earlier pulse dye lasers. The addition of dynamic cooling increases comfort during treatment enabling higher fluencies (energy) to be delivered safely and effectively, so fewer treatments are required.

Vascular malformations associated with smaller more superficial blood vessels respond better to treatment than deeper larger vessels (more often arising in older individuals). It is therefore best to begin treatment early. Fading by 80% occurs after 8 to 10 treatments on average. Further treatment may be necessary if the lesion recurs.

Treatment with quasi-CW lasers also produce effective outcomes but they are may be associated with higher incidences of scarring and textural changes. The most common side effects include mild erythema, oedema, and transient crusting.

Non-laser intense pulsed light devices can also be used for treating vascular lesions.

Pulse dye laser treatment

Bruises day after treatment

Pigmented lesions and tattoos

Melanin-specific, high energy, QS laser systems can successfully lighten or eradicate a variety of pigmented lesions. Pigmented lesions that are treatable include freckles and birthmarks including some congenital melanocytic naevi, blue naevi, naevi of Ota/Ito and Becker naevi. The short pulse laser systems effectively treat the lesions by confining their energy to the melanosomes, which are the tiny granules containing melanin inside the pigment cells. The results of laser treatment depend on the depth of the melanin and the colour of the lesion and is to some degree unpredictable. Superficially located pigment is best treated with shorter wavelength lasers whilst removal of deeper pigment requires longer wavelength lasers that penetrate to greater tissue depths. Caution is needed when treating darker-skinned people as permanent hypopigmentation and depigmentation may occur. Successfully treated lesions may recur.

Prior to any laser treatment of pigmented lesions, any lesion with atypical features should be biopsied to rule out malignancy. The treatment of congenital melanocytic naevi is a controversial issue. The long-term effect of using lasers on promoting melanoma is not known but the treatment is thought to be low risk.

The QS laser systems can selectively destroy tattoo pigment without causing much damage to the surrounding skin. The altered pigment is then removed from the skin by scavenging white blood cells, tissue macrophages. The choice of laser depends on the colour, depth and chemical nature of the tattoo ink. Two to ten treatments are often necessary. Yellow, orange and green colours are the most difficult to remove.

• Black: QS ruby, alexandrite or Nd:YAG
• Blue and green: QS ruby, alexandrite
• Yellow, orange, red: QS Nd:YAG or PDL

As with other laser treatments, pigmentary and textural changes including scars may occur.

Hair removal

Lasers can be used to remove excessive and cosmetically disabling hair due to hypertrichosis or hirsutism. Laser treatments remove dark hair quickly and it may take 3 to 6 months before regrowth is evident. Several treatment cycles are required with the spacing between treatments dependent on the body area being treated. Laser treatments are less painful and much quicker than electrolysis. Complications are rare but superficial burns, pigmentary changes and even scarring may occur. Increased growth of fine dark hair in untreated areas close to the treated ones has been reported.

Suitable devices include long-pulsed ruby and alexandrite lasers, diode (810nm), millisecond Nd:YAG and non-laser intense pulsed light.

Laser hair removal

Epilation

Temporary dark marks

Permanent white marks

Facial wrinkles, scars, and sun-damaged skin

Facial laser resurfacing uses high-energy, pulsed and scanned lasers.

Pulsed CO₂ and erbium:YAG lasers have been successful in reducing and removing facial wrinkles, acne scars and sun-damaged skin. High-energy, pulsed, and scanned CO₂ laser is generally considered the gold standard against which all other facial rejuvenation systems are compared. Typically a 50% improvement is found in patients receiving CO₂ laser treatment. Side effects of treatment include post-operative tenderness, redness, swelling and scarring. The redness and tenderness last several weeks, while new skin grows over the area where the damaged skin has been removed by the laser treatments (ablative laser systems). Secondary skin infection including reactivation of herpes is also a potential problem until healing occurs. Extreme caution is needed when treating darker skinned individuals as permanent loss or variable pigmentation may occur longterm.

Erbium:YAG produces similar results and side effects to CO₂. Despite their side effect profile and long recovery time these ablative laser systems, when used properly, can produce excellent results.

Recently non-ablative lasers have been used for dermal modeling; 'non-ablative' refers to heating up the dermal collagen while avoiding damage to the surface skin cells (epidermis) by cooling it. Multiple treatments are required to smooth the skin.

Keloids and hypertrophic scars

Keloids and hypertrophic scars are difficult to eradicate and traditional treatments are not always successful. Vaporising lasers (CO₂ and erbium:YAG) have been useful as an alternative to conventional surgery. More recently PDL has been used to improve hypertrophic scars and keloids. This may require multiple treatment sessions or the simultaneous use of intralesional injections to gain good results. The PDL has been reported to reduce the redness as well as improving texture and pliability of the scar.

Other uses

Lasers are sometimes used to remove viral warts by vaporization (CO₂ laser) or destruction of the dermal blood vessels (PDL) but the evidence would suggest that this is no more effective than standard wart paints or even waiting for spontaneous clearance.

The CO₂ laser can be used to remove a variety of skin lesions including seborrhoeic keratoses and skin cancers by vaporization or in cutting mode. However, conventional surgery or electrosurgery can also be used and is generally less expensive.

Violet-blue metal halide light (407-420 nm) has been used to treat acne, because it has a toxic effect on the acne bacteria, Proprionibacterium acnes.

The Excimer laser uses noble gas and halogen to produce ultraviolet radiation (308 nm) that will clear psoriasis plaques. However the small spot size and the tendency to cause blistering makes treatment time-consuming and difficult to perform.

Laser safety

Safety precautions will depend on which laser system is used and in what setting. They should include:

• Thorough training of personnel
• Eye protection for the patient and clinic staff
• Warning notice outside the procedure room
• Use of non-reflective instruments
• Avoidance of flammable materials.

Adverse effects of laser

Laser treatments are basically burns, so it is not surprising that sometimes the following effects may occur.

• Temporary pain, redness, bruising, blistering and/or crusting
• Infection including reactivation of herpes simplex
• Pigment changes (brown and white marks), which may be permanent
• Scarring, which is luckily rare

Lip Lift - NYC Dermatology - Dr.Gary Rothfeld - (212) -644 9494

Lip Lift

The Lip Lift is a surgical procedure which can restore volume to the upper lip. It can also benefit people who have an elongated upper lip. Performed under local anesthesia, the Lip Lift involves removing a small strip of skin immediately beneath the nose. Surgery in this area tends to heal extremely well with a scar that is usually invisible. The benefits of the Lip Lift are that it shortens the upper lip and turns out more of the pink part of the lip, creating a more attractive and youthful appearance. This procedure can also be used to turn up the corners of the mouth, correcting the "downward smile" that occurs with aging.

Chemical Peels - NYC Dermatology - Dr. Gary Rothfeld - (212)-644 -9494

Chemical peels

A facial peel refers to the application of one or more chemicals to the face which 'burn' off damaged cells.

Trichloracetic acid peel

Chemical peels are sometimes applied to other sites such as the hands. They may be used to treat damage caused by exposure to the sun (photoageing), to remove pigmentation such as freckles and melasma and fine lines and wrinkles.

A peel removes several layers of sun damaged skin cells, leaving fresh skin which has a more even surface and colour. It may stimulate new collagen to be formed improving skin texture. Peels may result in superficial, moderate depth or deep skin injury.

A nurse or aesthetician (beauty therapist) may perform superficial peels. A dermatologist or plastic surgeon usually performs deeper peels.

Peels can be repeated as necessary; some people have superficial peels every few weeks. It is wise to wait 3 to 6 months before repeating a moderate depth peel.

Glycolic acid, salicylic acid and Jessner peels result in superficial skin injury and are well tolerated - the 'lunchtime' peel. They remove thin lesions on the skin surface, reducing pigment and surface dryness. The result of the first peel may be disappointing, but after repeated peels, significant improvement is usually evident.

Trichloracetic acid (TCA) is the most common chemical used for a medium depth peel. The results depend on its concentration, usually 20 to 35%. The treatment is painful and treated areas are swollen, red and crusted for the next week or so. It can lead to an impressive improvement in skin texture with a reduction in blotchy pigmentation, freckling and solar keratoses (dry sunspots). Although fine wrinkles and some acne scars are less obvious, the TCA peel has no effect on deep furrows.

Phenol results in deep skin injury. It is rarely used for facial peels nowadays because of the risk of scarring and because of its toxicity. Absorption of phenol through the skin results in potentially fatal heart rhythm disturbances and nerve damage. However, it is very effective at improving both surface wrinkles and deep furrows. After a phenol peel, the treated skin is pale and smooth but it may be waxy and "mask-like".

Before the peel

Pre-treatment creams are applied to the face at night for several weeks prior to the peel. By exfoliating the skin and reducing pigmentation themselves, they improve the results seen from chemical peeling. They may also reduce the time needed for healing. The creams usually include one or more of the following:

• Tretinoin
• Alpha hydroxy acid e.g. glycolic or lactic acid
• Hydroquinone for tanned or dark skinned patients or those with melasma

Broad spectrum SPF 30+ sunscreen should be used during the day.

The peel

Superficial chemical peels are a minor procedure and no special arrangements are needed. But you may need painkillers, sedation, local anaesthetic or even a general anaesthetic for deeper peels.

First the face is thoroughly washed to remove surface oil. The peeling agent is then applied for several minutes. It stings - how badly and for how long depends on the chemical, its concentration, whether you've had pre-treatment with aspirin, and individual factors. A fan can help. The peel is then neutralised, and the burning sensation lessens.

Individual treatments may include peels with several agents on the same occasion, with the aim of improving results and reducing risks.

Antibiotics and oral antiviral agents may be recommended after deeper peels.

Afterwards

Superficial peels result in mild facial redness and occasional swelling which usually resolve within 48 hours. The peeling is similar to sunburn. Most people can continue their normal activities. Make-up can be applied a few hours after the procedure.

Moderate depth peels result in intense inflammation and swelling, which resolve within a week. The peeling is more marked. Mild redness can persist for several weeks. Most people take a week off from work after a moderate depth peel.

Looking after the skin after the peel

• Keep treated areas cool (use a water spray).
• Do not pick! Picking delays healing and causes scarring
• Moisturise - use light preparations after a superficial peel, thicker moisturisers after a deeper peel
• Protect from the sun - especially for the first 6 months
• If advised to do so, continue to use tretinoin, glycolic acid and/or hydroquinone at night long term

Complications

Complications are uncommon if the health professional performing the peel is properly trained.

• Comedones (blocked pores) or acne may result from the peel itself or from thick moisturisers used afterwards; ask your dermatologist for treatment.
• Infection due to bacteria (Staphylococcus aureus), yeast (Candida albicans), or virus (Herpes simplex); you may need antibiotics.
• Scarring may result from infection or picking the scabs, and can be permanent.
• Blotchy pigmentation is most likely in those with darker skin or who had a pigmentation problem before the peel; keep out of the sun and use hydroquinone.
• Persistent solar keratoses may require treatment. Your dermatologist may choose cryotherapy, 5-fluorouracil cream or biopsy a lesion in case it is skin cancer.

General advice

• Ensure your doctor's instructions are carefully followed
• If you don't understand, ask!
• Let your doctor know promptly if there are any problems - complications are easier to deal with early than late

Stretch Marks - NYC Dermatology - Dr. Gary Rothfeld - (212) - 644 - 9494

Stretch Marks

Stretch marks are caused by rapid expansion of tissue, typically occur in puberty, pregnancy and a burst of obesity. It has historically been a difficult problem to treat; expensive creams, various gadgets have produced little or no results. Fraxel laser SR1500 treatments AND chemical peel treatments have produced visible inprovement. Fraxel laser works by fractionally removing the stretchmarks, penetrating deep into the skin to stimulate collagen to self repair; there is no visible superficial skin injury, therefore, the risk of sacrring and change of skin colour is highly unlikely. It is a well known fact that the off-face skin takes longer to heal therefore the best cosmetic result will take a longer time to achieve.

Benefits

Stretchmarks bother many people; in my experience, for the first time, Fraxel laser and chemical peels are able to improve the appearance of stretch marks so that people can wear swimming costumes with confidence and it is a big breakthrough in cosmetic laser surgery. The end result is largely dependent on the severity and the quality of the skin and the age of the stretch marks.

Recovery

As there is no visible injury on the surface of the skin there is no dressing required; most stretchmarks are in the concealed parts of the body so there is no interruption to daily life. There is some swelling and redness of the skin in the treated areas which will recover in 7-14 days.

BEFORE

AFTER

BEFORE

AFTER

Urticaria - NYC Dermatology - Dr. Gary Rothfeld - (212) 644 -9494

Urticaria (Hives)

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Urticaria, or hives, is a common skin reaction in which itchy red welts (called wheals) develop on the skin. The welts are often the result of an allergic reaction to food or medicine. They vary in size, color, and shape and may be accompanied by swelling, especially of the eyelids. Hives can be acute or chronic.

The welts may enlarge, spread, and join together to form larger areas of flat, raised skin. They can also change shape, disappear, and reappear within minutes or hours. The welts tend to start suddenly and resolve quickly.

What Causes an Outbreak of Hives?
Many substances can trigger hives:

• Medications
• Shellfish, fish, nuts, eggs, milk, and other foods
• Pollen
• Animal dander (especially cats)
• Insect bites

Hives may also develop from:

• Infections like mononucleosis or illness (including lupus and leukemia)
• Emotional stress
• Extreme cold or sun exposure
• Excessive perspiration

How Are Hives Diagnosed and Treated?
Your doctor can tell if you have hives by the appearance of your skin. If you have a history of an allergy, then the diagnosis is even more obvious. Occasionally, skin or blood tests are performed to confirm that this was an allergic reaction and to test for the substance that caused your allergic response.

Many cases of hives can be treated with antihistamines. For more persistent outbreaks, your doctor may recommend oral steroids, amitriptyline, or other medications. However, if the hives are mild, treatment may not be needed. They may disappear on their own. To reduce itching and swelling:

• Avoid hot baths or showers.
• Avoid irritating the area with tight-fitting clothing.
• Apply calamine lotion.
• Take antihistamines.

If your reaction is severe, especially if the swelling involves your throat, you may require an emergency shot of epinephrine (adrenaline, Epipen) or steroids. Hives in the throat can obstruct your airway, making it difficult to breathe.

When Should I Contact a Medical Professional for Hives?
If you have a history of hives or other strong allergic reactions, call 911 if you experience:

• Tightness in your throat
• Shortness of breath
• Tongue or face swelling
• Fainting
• Wheezing

Call your health care provider if the hives are severe, uncomfortable, and do not respond to self-care.

How Can I Prevent Hives?
Track and avoid any substances that give you allergic reactions. Don't wear tight-fitting clothing, and avoid hot baths or showers just after an episode of hives. These can cause the hives to return.

Reference: NIH

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

Rhinophyma - NYC Dermatology - Dr. Gary Rothfeld - (212) - 644 9494

Rhinophyma

definition

A manifestation of severe ACNE ROSACEA resulting in significant enlargement of the nose and occurring primarily in men. It is caused by hypertrophy of the sebaceous glands and surrounding connective tissue. The nose is reddened and marked with numerous telangiectasias.

synonyms

Rhinophyma

UMLS

Hypertrophic rosacea, Rhinophyma, Rhinophymas

images

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