Bruce P.Robinson, MD



Shingles causes a painful, blistering rash on your skin. If you get shingles, you may notice the following three stages:

Before the rash appears: For 1 to 2 days before the rash appears, you may have pain, burning, or tingling on an area of skin where the rash will develop. Some people have described an “electrical sensation” on their skin before getting the rash.

Rash appears: A painful, blistering rash appears. It usually appears on one side of your body, often on the torso; however, it can appear anywhere on your skin. Some people get more blisters after the rash appears, so it can seem that the rash is spreading.

Rash starts to clear: As the rash clears, the blisters may crack open, bleed, and scab over. For most people, the rash will clear within 2 to 4 weeks.

If you have a rash of blisters on your skin or a rash that looks like those shown below, schedule an appointment immediately for a diagnosis. If you have shingles, it’s important to get treatment, preferably within 1 to 3 days.

If you’ve had the rash for longer than 2 to 3 days, it’s still important to schedule an appointment!

Other signs and symptoms of shingles:

Along with a painful, blistering rash, some people can also have one or more of the following:

  • Fever
  • Headache
  • Muscle aches
  • Stomach pain
  • Vomiting

How do dermatologists treat shingles?

Rash: PLEASE call our office to schedule an appointment immediately or other health-care provider within 3 days of getting the rash. When treatment is started within 3 days, treatment can prevent possible complications, such as long-lasting nerve pain.

Receiving treatment after 3 days still has benefits, so you should still schedule an appoointment to see your doctor if you’ve had the rash for longer than 3 days.

Before taking any medication, it’s important to make sure that you have shingles.We will prescribe an antiviral medication. One of three antiviral medications is usually prescribed—acyclovir, famciclovir, or valacyclovi to:

  • Reduce the amount of time that you have a shingles rash
  • Decrease how severe the rash becomes
  • Lower your risk of developing long-lasting nerve pain and other health problems

Pain: Over-the-counter medication(s) can help, such as:

  • Acetaminophen
  • Ibuprofen

If you have severe pain, we may prescribe a medication that reduces inflammation, such as a corticosteroid.


Talk with your doctor about getting the shingles vaccine, Shingrix. You can get shingles again. A shingles vaccine that the U.S. Food and Drug Administration (FDA) approved in 2017 can greatly reduce your risk of developing shingles again. You can learn more about this vaccine at, Shingles Vaccine, CDC.

The CDC recommends that adults 50 years and older get two doses of the shingles vaccine called Shingrix (recombinant zoster vaccine) to prevent shingles and the complications from the disease. Adults 19 years and older who have weakened immune systems because of disease or therapy should also get two doses of Shingrix, as they have a higher risk of getting shingles and related complications.

Prevent others from getting sick:

Until the shingles rash clears, you are contagious.

Anyone who has not had chickenpox (or the vaccine for chickenpox) can catch the virus. This could cause chickenpox. To avoid infecting others, who could get chickenpox and later shingles, dermatologists recommend that you do the following until the rash clears:

  • Cover the rash
  • Avoid touching and scratching your rash
  • Stay away from pregnant women, babies 12 months old or younger, anyone who is sick, and everyone who has not had chickenpox

Pictures of a shingles rash

Having a shingles rash on your face is a medical emergency.
Even if the rash isn’t on your eye, it could still affect your eyesight. Immediately seeing a doctor for treatment could save your eyesight.

Insect Repellents

Not All Repellents Are The Same

The use of repellents can protect both your health and sanity.

While some bug bites leave bothersome, itchy bumps on your skin they can also pose a serious threat and sometimes deadly risk to your health. Insect-borne diseases, may transmit harmful pathogens that can cause dangerous diseases like Lyme disease, Malaria, Dengue fever, Zika, and West Nile.

To Help Prevent Bug Bites We Recommend The Following Tips:

  • If you are outdoors, cover exposed skin. Wear loose clothing, long sleeves and long pants, socks and closed toe shoes instead of sandals.
  • Place screens over windows.
  • Get rid of standing water that may be a breeding ground for mosquitos.
  • However, one of the best ways to protect yourself when you are outdoors & at risk of getting bitten is the use of repellents containing DEET.


We have options when it comes to choosing what type of repellent to use -- sprays and lotions, candles, coils and vaporizers to name a few.

These repellents interfere with a mosquito's sense of smell, taste or both. The repellent either blocks or over stimulates these senses.

Repellents That Don't Work:

Bracelets, wristbands and watches. Even if they are loaded with repellents, they can't protect your whole body from getting bitten.

Ultrasonic repellent devices don't work. These come as electrical plug-ins, free standing varieties or watch-like accessories that claim to emit a high frequency sound that deters bugs by mimicking bats.

Dietary Supplements -- vitamin B, garlic, and so on -- don't work.

Light based repellents don't work. These devices come as colored light bulbs and they don't attract insects that fly toward white light. This works well on months, beetles, and stinkbugs but not on mosquitos.

Repellents That Do Work:

DEET works! DEET, was developed in the 1950's by the US Army and is a well established bug repellent. The higher the percentage, the longer the protection time is -- up to six hours. Despite its sixty year history of use by consumers, how exactly DEET works to keep bugs at bay still isn't fully understood. It's likely that more than one mechanism is at play.

How safe is DEET? Since it was originally used in 1957 a broad scientific consensus still holds that the chemical is safe when used as directed on the label. Newer insect repellent active ingredients are however judged. These need more time to look at outcomes.

Picaridin works. This synthetic repellent can protect for up to six hours at a 20% concentration. This is a promising alternate to DEET.

Oil of lemon eucalyptus, or OLE, works. OLE, with the active ingredient PMD, is a plant-based alternative to DEET and Picaridin. It's repellent properties can last for up to six hours.

Citronella works, just not that great and for not that long.

Which Essential Oils Work Best?

An arm-in-cage experiment for different essential oils has been completed specifically for mosquitos. Complete protection times (in minutes) measured for lotions with a 10% concentration of each essential oil. The longer the complete protection time the better the repellent will protect against mosquitos.

If your planning to mix your own plant-based mosquito repellent, remember that essential oils are complex mixtures of plant-made chemicals that can cause skin irritation.

Our Recommendation:

Based on studies and efficacy we recommend using repellents with the active ingredient DEET that contains at least 20-30 percent DEET on exposed skin and clothing and re-apply as directed. If you are wearing sunscreen and DEET apply sunscreen first.

Sometimes, despite one’s greatest efforts, bug bites still happen. Fortunately, most bug bites and stings can be safely treated at home.

Treatment of Bug Bites and Stings at Home:

For painful bites, such as a bee sting, take an over-the-counter painkiller, such as acetaminophen or ibuprofen. For bites that itch, apply an ice pack or an over-the-counter anti-itch cream, such as hydrocortisone. Another option is to take an over-the-counter oral antihistamine. Always follow the directions on the label and use the correct dose. If these over the counter remedies do not work schedule an appointment to discuss treatment options that may yield better relief.

If you experience any serious symptoms after a bug bite, such as a rash, fever, or body aches, schedule an appointment immediately. Make sure you tell us about your recent bite so that we can examine you for a transmitted disease.

Watch Video ...

Sunburn Care

So You Have a Sunburn? No Judgement Here, Just Relief.

It is important to treat a sunburn as soon as you notice it.

The first thing you should do if you feel you have or are getting a sunburn is get out of the sun, preferably go indoors. Once indoors, these tips can help relieve the discomfort:

  • Frequent cool baths or showers can ease the pain.  Gently pat skin dry, with a little dampness left on the skin apply a moisturizer ‘cream or ointment”, preferably not a “lotion”.  The moisturizer will help trap the water in your skin and help ease the dryness. You can also place the cream or ointment in the refrigerator for extra coolness.
  • Use a moisturizer that contains aloe vera to help soothe sunburned skin. If a particular area feels especially uncomfortable, you may want to apply an over the counter hydrocortisone cream that you can buy without a prescription. Do not treat sunburn with “-caine” products (such as benzocaine), as these may irritate the skin or cause an allergic reaction.
  • Consider taking acetaminophen or ibuprofen to help reduce any swelling, redness and discomfort.
  • Drink extra water. A sunburn draws fluid to the skin’s surface and away from the rest of the body. Drinking extra water when you are sunburned helps prevent dehydration.
  • If your skin blisters, allow the blisters to heal. Blistering skin means you have a second-degree sunburn. You should not pop the blisters, as blisters form to help your skin heal and protect you from infection.  Once the blisters open you can apply an antibiotic ointment to prevent an infection.
  • Take extra care to protect sunburned skin while it heals. Wear clothing that covers your skin when outdoors. Tightly-woven fabrics work best. When you hold the fabric up to a bright light, you shouldn’t see any light coming through.

If you have fever, chills, headache or any questions about your sunburn please call our office to schedule an appointment. Although it may seem like a temporary condition, sunburn is a result of skin receiving too much exposure from the sun’s ultraviolet (UV) rays and can cause long-lasting damage to the skin. This damage increases a person’s risk for getting skin cancer.

Skin Cancer

Skin Cancer is the cancer you can see! Yet skin cancer often goes undetected. With over 5 million cases of skin cancer diagnosed in the U.S. each year, skin cancer is America's most common cancer. More people are diagnosed with skin cancer each year in the U.S. than all other cancers combined.

Types of skin cancers include: Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma and Merkel Cell  Carcinoma, they are mainly caused by UV exposure to ultraviolet (UV) radiation from the sun. However, skin cancer can form anywhere on the body even if it is not exposed to the sun. All ethnicities and skin tones are at risk.

Basal Cell Carcinoma is the most common skin cancer. It is also one of the easiest to spot and treat. Squamous Cell Carcinoma is the second most common skin cancer and Melanoma the third. Despite Melanoma being the third most common form of skin cancer, it accounts for 75% of all skin cancer deaths. 

Basal Cell Carcinomas are quite common, and the number of reported cases in the U.S. is steadily increasing. An estimated 3.6 million cases of Basal Cell Carcinomas are diagnosed each year in the U.S..

Squamous Cell Carcinoma is the second most common. An estimated 1.8 million cases are diagnosed each year in the U.S. which translates to about 205 cases every hour. SCC incidence has increased up to 200% in the past three decades.

Melanoma is the third most common and deadly cancers. Early detection is critical! In the past decade (2012-2022) the number of new invasive melanoma cases diagnosed annually increased by 31%. An estimated 197,700 cases of melanoma will be diagnosed in the U.S. in 2022 and 7,650 people will die of melanoma in 2022. (5,080 men & 2,570 women). 

Merkel Cell Carcinoma is about three - five times more likely to be deadly than melanoma. Approximately 3,000 new cases of Merkel Cell Carcinoma are diagnosed annually in the U.S. 

The good news is that skin cancer can be prevented, and it can almost always be cured when it’s found and treated early.

A change in your skin is the most common sign of skin cancer. This could be a new growth, a spot that doesn’t look like others on your body, a sore that doesn’t heal, or a change in a mole. The “ABCDE rule” can be used as a guide. The “ABCDE rule” can be used as a guide (see below).

Skin cancer isn't going to check itself out. Therefore, an annual skin check by a board-certified dermatologist and a monthly skin check by you is vital to good skin care. See something NEW, keep an eye out for any New moles or blemishes that have popped up, CHANGING, a leopard's spots don't change and neither should yours, always check if your spots are Changing in color, size, shape, or texture, or UNUSUAL, one of these things is not like the others ... look for spots that are unusual in outline or continuously itch, hurt, crust or bleed for more than 3 weeks. It could be skin cancer.

When these skin cancers are detected early, treatment often results in a cure. Be sure to schedule an yearly skin exam with your dermatologist and more often if you have a family history of skin cancer.

Take these simple steps today to protect your skin:

  • Stay out of the sun as much as possible between 10 a.m. and 4 p.m.
  • Use a broad spectrum (UVA/UVB) sunscreen with SPF 30 or higher
  • Put on sunscreen every 2 hours and after you swim or sweat
  • Cover up with long sleeves and a hat
  • Check your skin regularly for changes
  • Report any unusual moles or changes in your skin to your doctor

The ABCDE's of Skin Cancer.

How To Check Your Skin ...

Here’s what you’ll need: a bright light, a full-length mirror, a hand mirror, two chairs or stools and a blow-dryer.

  • Examine your face: Especially your nose, lips, mouth and ears—front and back. Use one or both mirrors to get a clear view
  • Inspect your scalp: Thoroughly inspect your scalp using a blow-dryer and mirror to expose each section to view. Get a friend or family member to help, if you can.
  • Check your hands: Standing in front of the full-length mirror, begin at the elbows and scan all sides of your upper arms. Don’t forget the underarms.
  • Inspect your torso: Next, focus on the neck, chest and torso. Women should lift breasts to view the undersides.
  • Scan upper back: With our back to the full-length mirror, use the hand mirror to inspect the back of your neck, shoulders, upper back and any part of the back of your upper arms you could not view in step 4.
  • Scan lower back: Still using both mirrors, scan your lower back, buttocks and backs of both legs.
  • Inspect your legs?: Sit down; prop each leg in turn on the other stool or chair. Use the hand mirror to examine the genitals. Check the front and sides of both legs, thigh to shin, ankles, tops of feet, between toes and under toenails. Also examine the soles of your feet and heels.


Dr. Robinson is improving skin cancer treatments with less invasive treatments. No scarring, no bleeding, functional & cosmetic results are superior to cold steel excision & MOHS. Patients on anticoagulant therapy do not have to stop their medication before treatment, therefore not increasing their risk for stroke and/or heart attack, quick healing, & no risk of post-operative complications! This is especially helpful with Infirm or older patients, great for professionals who can't afford downtime or a scar.

Using non-ablative fractional laser therapy offers a Gentle Approach to Treating Pre-Cancerous Growths and Overall Healthier Skin.

Skin cancer is the most prevalent cancer in the United States. More than 3 million Americans are diagnosed with non-melanoma skin cancer(s), such as basal cell & squamous cell carcinoma each year. These two types of cancers are collectively known as keratinocyte carcinoma or (KC).

In individuals with a history of a prior KC, the risk of developing subsequent KC remains a significant concern. 

In our study using non-ablative fractional laser therapy, including 4 sessions spaced at 2-4 week intervals, w/ follow-up assessments, 1-3 months after the final treatment session 60% had greater reduction of the development of KC and had improved overall health of sun-damaged skin. There was also a lower recurrence rate of MOHS. Lowering the rate of infection directly related to lack of having an open wound.

Non-ablative fractional laser therapy has already demonstrated remarkable success with minimal downtime & discomfort as a gentle yet effective treatment of actinic keratosis (AK), the most common type of pre-cancerous skin conditions. Other benefits to using non-ablative fractional laser therapy is it's ability @ ameliorating photo damage, utilizing precise photothermolysis to stimulate collagen and elastin production, promote dermal wound healing & decreasing and improving hyperpigmentation, telangiectasias, skin tone, skin laxity, and tactile roughness. Now we can add treatment of certain skin cancers to the list.

Poison Ivy, Poison Oak, & Poison Sumac

Poison ivy, poison oak, and poison sumac are the most common cause of allergic reactions in the United States. Each year 10 to 50 million Americans develop an allergic rash after contact with these poison plants.

Poison ivy, poison oak, and poison sumac grow almost everywhere in the United States, except Hawaii, Alaska, and some desert areas in the Western U.S. poison ivy usually grows east of the Rocky Mountains and in Canada. Poison oak grows in the Western United States, Canada, Mexico (western poison oak), and in the Southeastern states (eastern poison oak). poison sumac grows in the Eastern states and southern Canada.

Poison Oak

In the West, this plant may grow as a vine but usually is a shrub. In the East, it grows as a shrub. It has three leaflets to form its leaves.

Poison Ivy

Grows as a vine in the East, Midwest and South. In the far Northern and Western United States, Canada and around the Great Lakes, it grows as a shrub. Each leaf has three leaflets.

Poison Sumac

Grows in standing water in peat bogs in the Northeast and Midwest and in swampy areas in parts of the Southeast. Each leaf has seven to 13 leaflets.

A Poison Plant Rash

Poison Plant rash is an allergic contact dermatitis caused by contact with oil called urushiol. Urushiol is found in the sap of poison plants like Poison Ivy, Poison Oak, and Poison Sumac. It is colorless or pale yellow oil that oozes from any cut or crushed part of the plant, including the roots, stems, and leaves. After exposure to air, urushiol turns brownish-black. Damaged leaves look like they have spots of black enamel paint making it easier to recognize and identify the plant. Contact with urushiol can occur in three ways:

  • Direct contact - touching the sap of the toxic plant.
  • Indirect contact - touching something on which urushiol is present. The oil can stick to the fur of animals, to garden tools or sports equipment, or to any objects that have come into contact with it.
  • Airborne contact - burning poison plants put urushiol particles into the air

When urushiol gets on the skin, it begins to penetrate in minutes. A reaction appears usually within 12 to 48 hours. There is severe itching, redness, and swelling, followed by blisters. The rash is often arranged in streaks or lines where the person brushed against the plant. In a few days, the blisters become crusted and take 10 days or longer to heal.

Poison plant dermatitis can affect almost any part of the body. The rash does not spread by touching it, although it may seem to when it breaks out in new areas. This may happen because urushiol absorbs more slowly into skin that is thicker such as on the forearms, legs, and trunk.

Who is sensitive and who is not?

Sensitivity develops after the first direct skin contact with urushiol oil. An allergic reaction seldom occurs on the first exposure. A second encounter can produce a reaction which may be severe. About 85 percent of all people will develop an allergic reaction when adequately exposed to poison ivy. This sensitivity varies from person to person. People who reach adulthood without becoming sensitive have only a 50 percent chance of developing an allergy to poison ivy. However, only about 15 percent of people seem to be resistant.

Recognizing Poison Plants

Identifying the poison ivy plant is the first step in avoiding the rash. The popular saying "leaves of three, beware of me" is a good rule of thumb for Poison Ivy and Poison Oak but is only partly correct. A more exact saying would be "leaflets of three, beware of me," because each leaf has three leaflets. Poison sumac, however, has a row of paired leaves. The middle or end leaf is on a longer stalk than the other leaves. This differs from most other three-leaf look alikes.

Poison Ivy has different forms. It grows as vines or low shrubs. Poison Oak, with its oak-like leaves, is a low shrub in the East and can be a low or high shrub in the West. Poison sumac is a tall shrub or small tree. The plants also differ in where they grow. Poison Ivy grows in fertile, well-drained soil. Western Poison Oak needs a great deal of water, and Eastern Poison Oak prefers sandy soil but sometimes grows near lakes. Poison Sumac tends to grow in standing water, such as peat bogs.

These plants are common in the spring and summer. When they grow, there is plenty of sap and the plants bruise easily. The leaves may have black marks where they have been injured. Although Poison Ivy rash is usually a summer complaint, cases may occur in winter when people are cleaning their yards and burning wood with urushiol on it, or when cutting Poison Ivy vines to make wreaths.

It is important to recognize these toxic plants in all seasons. In the early fall, the leaves can turn colors such as yellow or red when other plants are still green. The berry-like fruit on the mature female plants also changes color in fall, from green to off-white. In the winter, the plants lose their leaves. In the spring, Poison Ivy has yellow-green flowers.

Prevention of Poison Ivy

Prevent the misery of Poison Ivy by looking out for the plant and staying away from it. You can destroy these plants with herbicides in your own backyard, but this is not practical elsewhere. If you are going to be where you know poison ivy likely grows, wear long pants, long sleeves, boots, and gloves. Remember that the plant's nearly invisible oil, urushiol, sticks to almost all surfaces, and does not dry. Do not let pets run through wooded areas since they may carry home urushiol on their fur. Because urushiol can travel in the wind if it burns in a fire, do not burn plants that look like Poison Ivy.

Barrier skin creams such as a lotion containing bentoquatum offer some protection before contact with Poison Ivy, Poison Oak, or Poison Sumac. Over-the-counter products prevent urushiol from penetrating the skin. Ask your dermatologist for details.


If you think you've had a brush with Poison Ivy, Poison Oak, or Poison Sumac, follow these simple ste

  • Wash all exposed areas with cold running water as soon as you can reach a stream, lake, or garden hose. If you can do this within five minutes, the water may keep the urushiol from contacting your skin and spreading to other parts of your body. Within the first 30 minutes, soap and water are helpful.

Common Myths about Poison Ivy

Scratching Poison Ivy blisters will spread the rash.
False. The fluid in the blisters will not spread the rash. The rash is spread only by urushiol. For instance, if you have urushiol on your hands, scratching your nose or wiping your forehead will cause a rash in those areas even though leaves did not contact the face. Avoid excessive scratching of your blisters. Your fingernails may carry bacteria that could cause an infection.

Poison Ivy rash is "catchy."
. The rash is a reaction to urushiol. The rash cannot pass from person to person; only urushiol can be spread by contact.

Once allergic, always allergic to Poison Ivy.
A person's sensitivity changes over time, even from season to season. People who were sensitive to Poison Ivy as children may not be allergic as adults.

Dead Poison Ivy plants are no longer toxic.
Urushiol remains active for up to several years. Never handle dead plants that look like Poison Ivy.

Rubbing weeds on the skin can help.
Usually, prescription cortisone preparations are required to decrease the itching.

One way to protect against poison ivy is by keeping yourself covered outdoors.
However, urushiol can stick to your clothes, which your hands can touch, and then spread the oil to uncovered parts of your body. For uncovered areas, barrier creams are sometimes helpful. Learn to recognize poison ivy so you can avoid contact with it.

  • Relieve the itching of mild rashes by taking cool showers and applying over-the-counter preparations like Calamine Lotion or Burow's Solution. Soaking in a lukewarm bath with an oatmeal or baking soda solution may also ease itching and dry oozing blisters. Over-the-counter hydrocortisone creams are not strong enough to have much effect on poison ivy rashes. Prescription cortisonecan halt the reaction if used early. If you know you have been exposed and have developed severe reactions in the past, consult your dermatologist. He or she may prescribe cortisone or other medicines that can prevent blisters from forming. If you receive treatment with a cortisone drug, you should take it longer than six days, or the rash may return.
  • Wash your clothing in a washing machine with detergent. If you bring the clothes into your house, be careful that you do not transfer the urushiol to rugs or furniture. You may also dry clean contaminated clothes. Because urushiol can remain active for months, wash camping, sporting, fishing, or hunting gear that was in contact with the oil.

All About Bug Bites

"OUCH! What Bit Me?"

Sometimes it’s easy to tell what bit you: maybe you reach down to swat at the bug and catch a glimpse of it. Sometimes though, it’s harder to tell. You might not notice the bite as it’s happening. Instead you don’t even realize you’ve been bitten until the spot starts to itch.

Although most bug bites and stings are harmless, some can be dangerous. This is especially true if you are allergic to the bug’s venom, or if the bug is carrying a disease. Most bug bites and stings can be safely treated at home with topical medication. However, sometimes a bug bite or sting could turn into something serious – particularly if you have been bitten or stung by many insects at the same time.

In the United States, it’s common to experience a bite or sting from the following types of bugs:

  • Mosquitoes
  • Fleas
  • Bedbugs
  • Biting flies
  • Scabies Mites
  • Bees, wasps, and hornets
  • Spiders
  • Ticks
  • Fire ants


When weather permits, wear long sleeves and pants. They can add an extra layer of protection between you and your exposed skin. Light-colored clothing makes ticks easier to spot. Do a quick clothing and body check for ticks once you get inside.

Remember, insect repellants are your friend. The best ones contain DEET, like DEEP Woods OFF or ones that contain picaridin. Be sure to use any insect repellants according to the directions on the label.

How do you treat summer bug bites?

For insect bites and stings that itch, you can put an ice pack on the spot and/or use an over-the-counter itch cream; for example, hydrocortisone. You may choose to instead take an oral antihistamine. Ice packs can also reduce swelling.

It’s important to pay attention to your symptoms. If you feel tired all the time, you have a headache, fever or body aches, or you develop a rash after a bug bite, see a board-certified dermatologist immediately.

Go to the emergency room immediately if you experience any of the following symptoms after a bug bite or sting:

  • Difficulty breathing
  • The sensation that your throat is closing
  • Swollen lips, tongue, or face
  • Chest pain
  • A racing heartbeat that lasts more than a few minutes
  • Dizziness
  • Vomiting
  • A headache
  • A red, donut-shaped rash that develops after a tick bite. This could be a sign of Lyme disease, which should be treated with antibiotics.
  • A fever with a red or black, spotty rash that spreads. This could be a sign of Rocky Mountain spotted fever, a bacterial infection carried by ticks, which should be treated immediately.

Lyme Disease

You're more likely to get Lyme disease if you live or spend time in grassy and heavily wooded areas where ticks carrying Lyme disease thrive. It's important to take common-sense precautions in tick-infested areas.

Risk factors

Where you live or vacation can affect your chances of getting Lyme disease. So can your profession and the outdoor activities you enjoy. The most common risk factors for Lyme disease include:

  • Spending time in wooded or grassy areas. In the United States, deer ticks are found mostly in the heavily wooded areas of the Northeast and Midwest. Children who spend a lot of time outdoors in these regions are especially at risk. Adults with outdoor jobs also are at increased risk.
  • Having exposed skin. Ticks attach easily to bare flesh. If you're in an area where ticks are common, protect yourself and your children by wearing long sleeves and long pants. Don't allow your pets to wander in tall weeds and grasses.
  • Not removing ticks promptly or properly. Bacteria from a tick bite can enter your bloodstream if the tick stays attached to your skin for 36 to 48 hours or longer. If you remove a tick within two days, your risk of getting Lyme disease is low.

Early signs and symptoms

A small, red bump, similar to the bump of a mosquito bite, often appears at the site of a tick bite or tick removal and resolves over a few days. This normal occurrence doesn't indicate Lyme disease.

However, these signs and symptoms can occur within a month after you've been infected:

  • Rash. From three to 30 days after an infected tick bite, an expanding red area might appear that sometimes clears in the center, forming a bull's-eye pattern. The rash (erythema migrans) expands slowly over days and can spread to 12 inches (30 centimeters) across. It's typically not itchy or painful but might feel warm to the touch.
  • Erythema migrans is one of the hallmarks of Lyme disease, although not everyone with Lyme disease develops the rash. Some people develop this rash at more than one place on their bodies.
  • Other symptoms. Fever, chills, fatigue, body aches, headache, neck stiffness and swollen lymph nodes can accompany the rash.
  • Seek immediate treatment If the tick has been attached for more than 24 hours, or you see a red, bullseye spot emerge at the site or anywhere on the body or experience flu-like symptoms

Later signs and symptoms

If untreated, new signs and symptoms of Lyme infection might appear in the following weeks to months. These include:

  • Erythema migrans. The rash may appear on other areas of your body.
  • Joint pain. Bouts of severe joint pain and swelling are especially likely to affect your knees, but the pain can shift from one joint to another.
  • Neurological problems. Weeks, months or even years after infection, you might develop inflammation of the membranes surrounding your brain (meningitis), temporary paralysis of one side of your face (Bell's palsy), numbness or weakness in your limbs, and impaired muscle movement.

Less common signs and symptoms

Several weeks after infection, some people develop:

  • Heart problems, such as an irregular heartbeat
  • Eye inflammation
  • Liver inflammation (hepatitis)
  • Severe fatigue

When to see a doctor ...

If you've been bitten by a tick and have symptoms, only a minority of tick bites lead to Lyme disease. The longer the tick remains attached to your skin, the greater your risk of getting the disease. Lyme infection is unlikely if the tick is attached for less than 36 to 48 hours.

If you think you've been bitten and have signs and symptoms of Lyme disease — particularly if you live in an area where Lyme disease is common — contact your doctor. Treatment for Lyme disease is more effective if begun early. 

Visit your doctor even if signs and symptoms disappear — the absence of symptoms doesn't mean the disease is gone. Untreated, Lyme disease can spread to other parts of your body for several months to years after infection, causing arthritis and nervous system problems. Ticks can also transmit other illnesses, such as babesiosis and Colorado tick fever.


The best way to prevent Lyme disease is to avoid areas where deer ticks live, especially wooded, bushy areas with long grass. You can decrease your risk of getting Lyme disease with some simple precautions:

  • Cover up. When in wooded or grassy areas, wear shoes, long pants tucked into your socks, a long-sleeved shirt, fitted at the wrists, a hat, tuck in hair if possible and gloves.
  • Wear white or light-colored clothing to make it easier to see ticks.
  • Try to stick to trails and avoid walking through low bushes and long grass. Keep your dog on a leash.
  • Wear shoes, no bare feet or sandals.
  • Use insect repellents. Apply insect repellent with a 20% or higher concentration of DEET to your skin. We recommend Deep Woods Off. Parents should apply repellant to their children, avoiding their hands, eyes and mouth.
  • Keep in mind that chemical repellents can be toxic, so follow directions carefully. Apply products with permethrin to clothing or buy pretreated clothing.
  • Do your best to tick-proof your yard. Clear brush and leaves where ticks live. Mow your lawn regularly. Stack wood neatly in dry, sunny areas to discourage rodents that carry ticks.
  • Check your clothing, yourself, your children and your pets for ticks. Be especially vigilant after spending time in wooded or grassy areas. Deer ticks are often no bigger than the head of a pin, so you might not discover them unless you search carefully.
  • It's helpful to shower as soon as you come indoors. Ticks often remain on your skin for hours before attaching themselves. Showering and using a washcloth might remove unattached ticks.
  • Don't assume you're immune. You can get Lyme disease more than once.
  • Remove a tick as soon as possible with tweezers. Gently grasp the tick near its head or mouth. As close to the skin as possible. Don't squeeze or crush the tick, but pull carefully and steadily. Once you've removed the entire tick, dispose of it by placing it in a container marked with the name of its host, area location, and the place of attachment on the body. 
  • Then call your physician to determine if treatment is warranted. Most doctors will send the suspect on to a state lab for analysis at no charge

What is the Best Sunscreen?

It's the one that you'll wear.

You want to use a sunscreen that offers to help protect your skin from sunburn, early skin aging and skin cancer.

Dr. Robinson recommends the following tips:

  • Use a Sunscreen with SPF 30 or higher.
  • Look for a "broad-spectrum" sunscreen that can protect you from both types of harmful rays. UVA, which causes premature aging and UVB, which causes sunburns.
  • Use enough sunscreen to provide proper protection ... in most cases, a tablespoon of sunscreen for the face and about two ounces – two shot glass size - for the rest of the body.
  • Look for "water-resistant". Not all sunscreens are water resistant and there is no such thing as waterproof sunscreen.

Sunscreens need to be reapplied every two hours and immediately after swimming or exercising. No sunscreen can filter out 100% of the suns damaging UVB/UVA rays, however, using an SPF of 30 or higher can block out 97% of the sun's UVB rays.

Some sunscreen products are also available in combination with moisturizers. However, while these products are convenient, remember that sunscreen needs to be reapplied every two hours.  Unfortunately, cosmetics/foundations with sunscreen, sit on top of the skin, and do not always allow the active ingredients in the sunscreen to deliver their full protection. 

Sunscreen may also be sold in combination with an insect repellent. The AAD recommends purchasing and using these products separately. The reason for this is, when combined in a single product, the insect repellent can reduce the effectiveness of the sunscreen.  It is recommended by the the CDC, that sunscreen should always be applied first followed by insect repellent. 

However, keep in mind, sunscreen alone cannot fully protect you. In addition to wearing sunscreen, we recommend taking the following steps:

Seeking shade, wearing protective clothing — including a lightweight, tight-weave, long-sleeved shirt & pants, a wide-brimmed hat, and sunglasses with UVA & UVB protection — and using an adequate amount of sunscreen are all important behaviors to reduce your risk of skin cancer.


As the United States declares Monkeypox outbreak a public health emergency, NYC declares a local state of emergency due to the outbreak.  The American Academy of Dermatology & The World Health Organization have put together a Task Force to address the growing outbreak of Monkeypox (orthopoxvirus) in the US.  Monkeypox is a contagious disease caused by the Monkeypox virus. US Map and case count on the 2020 outbreak here ... 


Anyone can get Monkeypox.  It is primarily spread through close, physical contact between people.  In the current outbreak, the Monkeypox virus is spreading mainly during oral, anal and vaginal sex and other intimate contact, such as rimming, hugging, kissing, biting, cuddling and massage.

Previous outbreak experience elsewhere suggests that the elderly, those with weakened immune systems, pregnant people, and children under 8 years of age may be at heightened risk for severe outcomes. Smallpox vaccine may help protect you against Monkeypox. Although, immunity may wain with age, it is estimated that the smallpox vaccine can be over 80% effective in preventing Monkeypox. Howevver, the vaccine for smallpox was discontinued in 1972 when it was eradicated in the United States. So therefore, anyone who is 49 years of age or younger most likely did not receive a smallpox vaccine.


The best way to protect yourself from Monkeypox is to avoid sex and other intimate contact with multiple or anonymous partners. 

If you choose to have sex or other intimate contact, the following can help reduce your risk:

  • Reduce your number of partners, especially those you do not know or whose recent sexual history you do not know.
  • Ask your partners if they have Monkeypox symptoms or feel sick. If you or your partners are sick, especially if you or they have a new or unexpected rash or sore, do not have sex or close physical contact.
  • Avoid sex parties, circuit parties and other spaces where people are having sex and other intimate contact with multiple people.
  • If you choose to have sex or other intimate contact while sick, cover all rashes and sores with clothing or sealed bandages. This may reduce spread from contact with the rash or sores, but other methods of transmission may still be possible.
  • Since it may be possible the virus can be transmitted through semen, use latex condoms during sex.
  • Do not share towels, clothing, fetish gear, sex toys or toothbrushes.
  • Wash your hands, fetish gear and bedding. Sex toys should be washed after each use or sex act.

How to Protect Yourself and Others from Monkeypox (PDF)


Most cases are mild. Symptoms usually start within two weeks of exposure, but in some cases they may not appear for up to 21 days. If you have a new, unexplained skin rash or lesion(s)/bump(s) on your skin and you don’t know what caused it and think you may have Monkeypox, it is important to see your dermatologist quickly to prevent exposing more people. Eligible New Yorkers who may have been exposed to Monkeypox can now get vaccinated to stay safe and slow the spread.

Some symptoms include:

  • Lesions on the face, hands, feet and body as well as inside the mouth, genitals or anus. They can be extremely itchy and painful and may interfere with daily activities. 
  •  Some people also have flu-like symptoms. These symptoms can occur before or at the same time as the rash or bumps. Flu-like symptoms include: 
  •  Swelling of the lymph nodes
  •  Fever
  •  Chills
  •  Muscle aches
  • Headache
  • Back pain
  • Weakness/Fatigue

If  You Have Symptoms:

A person is contagious until all sores have healed and a new layer of skin has formed, which can take two to four weeks.

If you start experiencing symptoms, isolate at home immediately, ideally stay in a separate area away from other family members and pets and talk to your dermatologist. 

The following may increase your risk for severe disease if you are infected: HIV; other conditions that weaken your immune system; and a history of atopic dermatitis or eczema. If you have one of these conditions, it is especially important to see a provider right away, if you have symptoms.

To protect others while you are sick:

  • Avoid sex, being intimate or having skin to skin contact with anyone until you have been checked by your dermatologist.
  • Stay home and separate from other people in your household. 
  • If you cannot fully separate from others in your household and avoid physical contact. Wear clothing that covers your lesions when in shared spaces.
  • If you must leave home for essential needs or medical care, cover your lesions with clothing.
  • Do not share or let others touch your clothing, towels, bedding or utensils. Do not share a bed. 
  • Do not share dishes, food, drink or utensils. Wash dishes with warm water and soap or in a dishwasher.
  • Wash your hands frequently with soap and water and clean shared surfaces, such as countertops and doorknobs, often. Household members should also wash their hands often, especially if they touch materials or surfaces that may have come in contact with lesions.

Diagnosis -- Where To Get Tested:

Not every rash is Monkeypox. Dr. Robinson can make a diagnosis of Monkeypox by looking at the pattern on the skin and where the rash appears. Please let the office know ahead of your visit that you have a "new unexplained rash or lesions" and think you may have monkeypox. If Dr. Robinson suspects Monkeypox may be the cause of the rash, he will swab the rash and send it to a lab, where a polymerase chain reaction test will be performed.


There is treatment approved for Monkeypox. Most people get better on their own without treatment. However, antiviral medication(s) (TPOXX) may help. Your provider will help you find out if you are eligible for antiviral treatment. They may be able to prescribe medicine and provide information about symptom relief.

Vaccine Information:

Vaccination after possible exposure ... Eligible New Yorkers who may have been recently exposed to Monkeypox can get the JYNNEOS TM vaccine. Vaccine is free and available regardless of immigration status.  Information about eligibility for the vaccine and appointments can be found here.

Getting vaccinated after a recent exposure may reduce the chance of you getting Monkeypox and it can reduce the symptoms if you do get it. 

People should get two doses, at least four weeks apart. 

Information about eligibility for the vaccine clinic and appointments can be found here.

JYNNEOS Vaccine for Monkeypox: Frequently Asked Questions (PDF)

Additionally, here is a link to a letter published in the Journal of the American Academy of Dermatology (JAAD) that explains the symptoms and features of monkeypox. For more information about monkeypox, visit the AAD website.

Molluscum Contagiosum

Tips For Managing Molluscum Contagiosum

Molluscum Contagiosum bumps, as the name suggests, are very contagious.

Molluscum Contagiosum rarely causes pain and will eventually clear on its own if you have a healthy immune system.  They may go away without a trace, but this takes time, during which they can spread. On average, the bumps clear in 6-18 months without treatment. Sometimes, this takes longer and they can re-occur.

Avoid spreading molluscum to other parts of your body by:

  • Avoid scratching and picking at the bumps. Scratching and picking can spread the virus to other parts of your body. If your skin breaks open, you are more likely to get an infection. This can be painful and require treatment.
  • Treat the molluscum bumps if your dermatologist recommends doing so. If you try to remove the bumps on your own or squeeze out the fluid inside, you risk spreading the virus to other parts of your body, infection and scaring.
  • Keep the bumps clean and wash your hands after touching the molluscum. Washing your hands helps to remove the virus and prevents you from your re-infecting other areas of your skin.
  • Use 2 towels when drying off. When you or your child has molluscum, it helps to use 2 clean towels to dry off. You’ll use one towel to dry the skin with molluscum. Use the other clean towel to dry the skin without molluscum. This approach helps to reduce the risk of spreading the virus to other parts of the body. Use new, clean towels after each body washing.
  • Skip shaving skin with molluscum bumps. Shaving can spread molluscum to other areas of your body. If you must shave the skin with molluscum, use two razors. Shave the skin with molluscum with one razor. The other razor you’d use to shave the skin without molluscum. One could also consider laser hair removal.
  • Postpone electrolysis while you have molluscum bumps on your skin. Electrolysis can spread the molluscum from one area to another.

Until the molluscum bumps go away, take precautions to help prevent spreading the molluscum virus to others. Watch what the American Academy of Dermatology recommends here ...

Dr. Robinson also recommends:

  • Covering the bumps with clothing, a bandage, or medical tape during school or work. This helps prevent spreading the infection to other people. When you won’t be around others and before going to bed, remove bandages and medical tape.
  • When a child has molluscum bumps, as the name suggests, this virus is very contagious. You can reduce the risk of another child getting molluscum by: 1) Bathing the children separately, and 2) Using different towels to dry each child.
  • Wash your hands thoroughly after you touch your own molluscum bumps (or your child’s). You want to use soap and water, washing for as long as it takes you to sing the “Happy Birthday” song.
  • Avoid shared baths, swimming pools, hot tubs, & saunas.
  • Cover all molluscum bumps before participating in any sport. High school athletes get molluscum contagiosum during sports, such as wrestling, basketball, and football. To prevent spreading molluscum to others:
    • Cover all molluscum bumps with clothing or waterproof bandages.
    • Avoid sharing gear, such as pads, helmets, and baseball gloves. If it’s likely that a waterproof bandage will come off during a sport and expose someone else to the virus, such as during a wrestling match, stop the sport until the bumps clear.
  • Let a child with molluscum sleep alone. It’s easy for the molluscum virus to spread when children sleep together in the same bed.
  • Make sure children with molluscum have their own personal items, such as towels, washcloths, bedding, and clothes. This helps prevent spreading the virus from one child to another.
  • Stop sharing personal items. People can get molluscum from skin-to-skin contact and when they touch infected items. When the person who has molluscum stops sharing clothes, razors, towels, washcloths, and other personal items, this reduces the risk of spreading the virus to others. 
  • If molluscum bumps appear in the genital area, stop sexual activity and see a board-certified dermatologist.. In adults, molluscum is often spread through sexual contact — but not always. Treatment is usually recommended for anyone who has molluscum bumps in the genital area (on or near the penis, vulva, vagina, or anus). Your dermatologist can tell you when you can have sexual activity again.

Dr. Robinson offers these tips and others every day to help his patients feel more comfortable in their own skin.

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Copyright © 2024 Bruce Robinson, MD • All Rights Reserved
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