Bruce P.Robinson, MD
Hand Eczema is dry skin of the hands. It is more common in the winter when the air holds less moisture and the cold wind increases water loss from the skin. It is worsened by frequent hand washing, using harsh soaps, not using moisturizer, and not using cotton-lined rubber gloves when doing work with detergents.
Link to instruction sheet.
Genital warts affect the moist tissues of the genital area. They can look like small, flesh-colored and be flat or bumpy or have a cauliflower-like appearance. Some genital warts are so small they cannot be seen. They can cause pain, discomfort or itching. Genital warts, also known as venereal warts, or condylomata acuminata, are caused by the human papilloma virus (HPV). More than 100 types of HPV are known to exist. Low risk types (HPV 1, 2, and 3) cause warts on the hands, feet, and other parts of the body. The low risk strains - Types (6 and 11) can cause warts on the genitals or anus (genital warts), and other high risk strains - Types (HPV 16 and 18) can cause cancer of the cervix, external genitalia, vulva, and anus.
Genital warts are sexually transmitted disease (STD) and all partners should be checked thoroughly. They can also be seen in infants who have been delivered vaginally to mothers with HPV in their genital tracts; therefore, alternate methods of delivery should be considered.
Only a small percentage of people infected with HPV will develop genital warts. Many people are carriers of HPV who may never develop warts, but may still be able to pass HPV to their sexual partners. The incubation period from contracting HPV until the development of warts may be several months although some people may not develop warts for years after contact with HPV. People who have lower immunity due to cancer, AIDS, organ transplantation, immune suppressive medications, or certain other medications are more susceptible.
To diagnose this condition, your doctor will do the following:
Although HPV isn't curable in all cases, genital warts are treatable. You can also go extended periods of time without an outbreak, but it may not be possible to get rid of the warts forever. That's because genital warts are only a symptom of HPV, which may become a chronic, lifelong infection for some.
If you've developed genital warts, your doctor has a few options for treatment. The fastest way to remove them is through surgery or to freeze them off with liquid nitrogen. Some doctors might use an electric current or laser treatment to burn off the warts.
Genital warts can go away with treatment from your healthcare provider or with prescription medicine. If left untreated, genital warts may go away, stay the same, or grow in size or number. Cervical precancer treatment is available.
Your doctor may apply a mild acidic solution, called an acetowhite test, to your skin to help make genital warts more visible. It may cause a slight burning sensation.
If you have a vulva, your doctor may also need to perform a pelvic examination, because genital warts can occur deep inside your body.
While visible genital warts often go away with time, HPV itself can linger in your skin cells. This means you may have several outbreaks over the course of your life.
So managing symptoms is important because you want to avoid transmitting the virus to others. That said, genital warts can be passed on to others even when there are no visible warts or other symptoms.
You may wish to treat genital warts to relieve painful symptoms or to minimize their appearance. However, you can’t treat genital warts with over-the-counter (OTC) wart removers or treatments.
Your doctor may prescribe topical wart treatments that might include:
If visible warts don’t go away with time, you may need minor surgery to remove them. Your doctor can also remove warts through these procedures:
To help prevent genital warts, HPV vaccines, condoms, and other barrier methods are available:
If you think you have genital warts, talk with your doctor. They can determine if you have warts and what your best treatment options are.
In addition, it’s important to talk with your sexual partner. This may sound difficult, but being open about your condition can help you protect your partner from also getting an HPV infection and genital warts.
Genital warts are a complication of a low risk HPV infection that’s common and treatable. They can disappear over time, but treatment is essential in preventing their return and possible complications.
Laser treatment can be utilized for small facial areas or for the entire face. Recently, full face treatments have become increasingly popular. Many people suffer from larger broken capillaries on their nose and cheeks and will have medium and smaller vessels on other facial areas. A full-face treatment will improve the overall facial appearance by creating a more uniform skin color, and by smoothing the texture of the skin.
Light emitted from the handpiece safely passes through the outermost layers of skin in search of the targeted vascular or pigmented lesions. Without damaging the surrounding skin, the laser?s intense light is absorbed by the targeted lesion. The light energy is then converted to heat and this initiates the process of eliminating the lesion. The treated lesion will gradually fade or diminish. In many cases, smaller vessels or pigmentation spots are eliminated in 2 to 4 treatments. Medium or larger vessels may take additional treatments.
The hand piece quickly advances across the skin delivering pulses to the treatment site. A full-face treatment typically lasts anywhere from 20 to 40 minutes. Smaller areas, such as the nose, can be treated in 15 minutes. In some cases a topical anesthetic cream is first applied to numb the treatment area. For a short period of time following treatment, a cold compress may be applied to soothe the possible appearance of slight swelling or redness of the skin. Treatments on the face, chest, neck, hands, legs, and abdomen are all done safely and quickly with laser technology.
During your consultation, your skin's condition will be evaluated and a customized treatment program will be suggested. In some cases only one or two treatments are required. However, in many cases three to five or more treatments will be required to achieve premium results. The number of treatment sessions will depend on the type of lesion to be treated, the location of the lesion on teh body, and its size and color. In many cases, it is recommended that treatments applied to the face be repeated at 3 to 4 week intervalas. The time intervals of your treatments will be determined during the consultation, where many of these issues and concerns may be addressed.
Does your torn or expanding earring hole(s) cause you to worry about loosing an earring? If you are feeling limited because the hole is too big to accommodate some of your favorite earrings then Earlobe repair may be a solution for you. It is an easy in office procedure that restores your earlobe in about 30 minutes.
The dermatology practice of Bruce Robinson, M.D., offers advanced procedures including earlobe repair to not only improve your profile but restore self-confidence. If you would like to learn more about this exciting procedure or any of our other services, contact us today to schedule your initial consultation!
All patients have very distinctive reasons for considering earlobe repair. Accidents can occur at any given time in one’s life that may result in traumatized tissue. An earring could get caught up in a piece of clothing and cause a tear. Heavy or large jewelry can lead to stretched or enlarged earlobes with consistant wear. Whatever your reason may be, earlobe repair surgery can be performed to either remedy the earlobes natural appearance or to correct a tear, stretch, scar, or damage from a previous piercing or accident.
Usually 6 - 8 weeks you can re-pierce your ear(s). We offer ear piercing in our office.
We use the Coren PS ear piercer which painlessly pierces your earlobes and inserts a sterile, hypoallergenic, 24k gold ear stud.
Link to ear piercing instruction sheet
Dry skin (eczema) and Keratosis Pilaris, are common disorders of the skin. Keratosis Pilaris (KP) is characterized by rough epidermal regions and patches of small acne-like bumps that typically appear on the upper arms, thighs, buttocks, and cheeks. Doctors typically identify KP in patients who complain of the appearance of “gooseflesh,” “goose bumps,” or “chicken skin” on various body parts. These bumps can be white, tan, or red in color. The condition is caused by the keratinization (or cellular “hardening”) of the skin’s hair follicles.Keratosis Pilaris often runs in families. Although its poses no serious medical threat, KP is often considered cosmetically displeasing. During particularly violent outbreaks, many KP sufferers report persistent itching in the affected area. The disorder can affect people of all ages, but most patients find that the major symptoms of KP disappear completely by age 30.
Because the general public is unaware of KP as a medical condition, many individuals are diagnosed with the condition when visiting dermatologists and other medical professionals for unrelated skin conditions. KP is often seen in patients with other epidermal disorders such as dry skin and eczema. If moisturizing doesn't help make an appointment as prescription strength treatment may be needed.
Age spots are small, flat dark areas on the skin. They vary in size and usually appear on areas exposed to the sun, such as the face, hands, shoulders and arms. Age spots are also called sunspots, liver spots and solar lentigines.
Age spots can look like cancerous growths. True age spots don't need treatment, but they are a sign the skin has received a lot of sun exposure and are an attempt by your skin to protect itself from more sun damage. You can help prevent age spots by regularly using sunscreen and avoiding the sun.
Age spots may affect people of all skin types, but they're more common in adults with light skin. Unlike freckles, which are common in children and fade with no sun exposure, age spots don't fade.
Age spots:
Age spots don't require medical care. Have your doctor look at spots that are black or have changed in appearance. These changes can be signs of melanoma, a serious form of skin cancer.
It's best to have any new skin changes evaluated by a doctor, especially if a spot:
Age spots are caused by overactive pigment cells. Ultraviolet (UV) light speeds up the production of melanin, a natural pigment that gives skin its color. On skin that has had years of sun exposure, age spots appear when melanin becomes clumped or is produced in high concentrations.
Use of commercial tanning lamps and beds also can cause age spots.
To help avoid age spots and new spots after treatment, follow these tips for limiting your sun exposure:
If you are tired of looking older or want the spots removed, schedule a laser consultation and restore your skin to its natural beauty. Our Cosmetic Consultation Reimbursement policy is offered to all patients. Schedule an office visit to discuss your concerns and skincare goals with Dr. Robinson and the office visit cost will be applied to the future cost for the "consulted procedure". The "consulted procedure" must be completed within 30 days of your consult visit.
Birthmarks are abnormalities of the skin that are present when a baby is born.
A birthmark can be red or brown.
A red or vascular birthmark is made up of dilated blood vessels. Two types are hemangiomas and port-wine stains. Although they can resolve spontaneously on their own, some can cause deformities and become more purple in color. With the advent of laser treatment, the Nevus Flameus can be cleared and subsequent deformities prevented.
A Nevus of Ota, Nevus of Ito and Mongolian spot are brown to bluish birthmarks that usually occur around the eye, shoulder and trunk respectively. Given their size and location patients often consider them cosmetically unacceptable, using the Medlite Nd:Yag laser these birthmarks can be treated effectively with excellent results.
An atypical nevus or dysplastic nevus (mole) is a benign growth that may share some of the features of a melanoma, but is NOT a melanoma or any other form of cancer. The presence of an atypical nevus, however, may increase the risk of developing a melanoma, or be a marker for it. A single atypical nevus may indicate a small risk; this risk increases with the number of atypical nevi present.
An atypical nevus can vary in appearance. Since it has the ABCDE features of a melanoma, it is important ot have a dermatologist examine all moles.
Asymmetry - One half does not match the other half in size, shape, color, or thickness.
Border irregularity - The edges are ragged, scalloped, or poorly defined.
Color - The pigmentation is not uniform. Shades of tan, brown, and black are present. Dashes of red, white, and blue add to the mottled appearance.
Diameter - While melanomas are usually greater than 6mm in diameter (the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others, or one which changes, itches, or bleeds (even if it is small), you sould see a dermatologist.
The lifetime risk of a person in the United States developing melanoma is 1 in 75. A patient with one to four atypical nevi without a personal or family history of melanoma is at a slightly higher risk than the general population. The risk of developing melanoma is higher if a patient with atypical nevi has a personal or family history of melanoma. A patient who has multiple atypical and normal nevi (moles) may have Familial Atypical Nevus Syndrome, and is at an increased risk for developing a melanoma, especially if a relative had melanoma.
Where and when do atypical nevi occur?
Atypical nevi begin to appear at puberty and can occur anywhere on the body, but are more common in sun-exposed areas, the back, and the legs.
Since an atypical nevus is not the same as a melanoma, it does not need to be treated aggressively but should be observed for changes, biopsied, or conservatively excised.
Familial Atypical Nevus Syndrome
The National Institute of Health Consensus Conference defines the Familial Atypical Nevus Syndrome as those persons meeting the following criteria:
It is important for people with Familial Atypical Nevus Syndrome to have a full body screening from a dermatologist every three to twelve months beginning with the onset of puberty. The dermatologist might also recommend regular ophthalmologic examinations, baseline skin photography, or regular screenings of relatives to permit early detection and treatment of melanoma since detection in the early stages has a much higher cure rate.
People with Familial Atypical Nevus Syndrome should also examine their own skin every month. When performing self-examinations, be aware of any lesions that appear to change in size, color, and/or shape. If a change has occurred, bring this to the attention of a dermatologist immediately. Information on the early signs of melanoma is available from the dermatologist or the American Academy of Dermatology.
Prevention of Melanoma
Alopecia areata (AA) causes hair loss in small, round patches that may go away on their own, or may last for many years. Nearly 2% of the U.S. population (about four million people) will develop AA in their lifetime. Some people with AA (about 5%) may lose all scalp hair (alopecia totalis) or all scalp and body hair (alopecia universalis). It is an autoimmune disease, in which for unknown reasons your immune system attacks your own hair follicles, (where the hair grows from), resulting in damage that leads to hair loss anywhere on the body. Typically, it affects small patches of hair so, it may go completely unnoticed. However, more patches of hair loss could develop close together, making it more noticeable.
AA occurs world-wide in both genders and in every ethnic group. Children and young adults are most frequently affected, but persons of all ages are susceptible. One in five persons with AA has a family member who also has the disease.
AA usually begins with one or more small, round, coin-size, bare patches. It is most common on the scalp, but can involve any hair-bearing site on the body including eyebrows, eyelashes, and beards. Hair may fall out and regrow with the possibility of full hair regrowth always present. AA usually has no associated symptoms, but there may be minor discomfort or itching prior to developing a new patch. Nails may have tiny pinpoint dents, ridges, become brittle and may, in rare instances, become distorted.
AA is not contagious. It is an autoimmune disease in which the body's immune system attacks itself, in this case, the hair follicles. The cause is not known. A person's particular genetic makeup combined with other factors triggers AA.
The main types are:
Alopecia areata: Alopecia is the medical term for bald. Areata means patchy. This patchy baldness can develop anywhere on the body, including the scalp, beard area, eyebrows, eyelashes, armpits, inside your nose, or ears.
Alopecia totalis: The person loses all hair on the scalp, so the scalp is completely bald.
Alopecia universalis: The person loses all hair, leaving the entire body hairless. This is rare.
Although your dermatologist may know by examining your scalp that you have AA, occasionally, a scalp biopsy is helpful in confirming the diagnosis.
Because there are so many reasons for hair loss, testing is sometimes necessary to make sure alopecia areata is the cause of your hair loss.
A blood test can look for other diseases caused by the immune system. Sometimes, other tests are necessary.
AA is not a symptom of a serious disease and usually occurs in otherwise healthy individuals. Persons with AA may have a higher risk of atopic eczema, asthma, and nasal allergies, as well as other autoimmune diseases such as thyroid disease (Hashimoto's thyroiditis), and vitiligo. Family members may also have atopic eczema, asthma, nasal allergies, or autoimmune diseases (i.e. insulin-dependent diabetes, rheumatoid arthritis, thyroid disease, or systemic lupus erythematosus).
Yes, it is likely that the hair may regrow, but it may fall out again. The course of the disease varies from person to person, and no one can predict when the hair might regrow or fall out again. This unpredictability of AA, and the lack of control over it, makes this condition frustrating. Some people lose a few patches of hair, the hair regrows, and the condition never returns. Other people continue to lose and regrow hair for many years. The potential for full regrowth is always there, even in people who lose all the hair on their scalp and body (alopecia totalis/universalis). Hair could regrow white or fine, but the original hair color and texture may return later.
There is no cure for AA. While treatments may promote hair growth, new patches of hair loss may continue to appear. The treatments are not a cure. Only the body, itself, can eventually turn off the condition.
Corticosteroids are anti-inflammatory drugs that suppress the immune system. They can be given as injections into the areas of hair loss, rubbed topically into affected areas or taken orally as pills.
Minoxidil can help maintain the regrowth after you stop applying the corticosteroid. It has few side effects, so it’s considered a good option for children. Minoxidil 5% solution applied twice daily to the scalp, brow, and beard areas may promote hair growth in both adults and children with AA. New hair growth may appear in about 12 weeks.
is a synthetic tar-like substance that alters immune function in the affected skin. It is applied for 20 to 60 minutes (short contact therapy) and then washed off to avoid skin irritation. Irritation is not needed in order to stimulate hair regrowth in AA.
To get the best results, you’ll also use minoxidil & Anthralin in combination to add to the effectiveness. Hopefully, new hair growth will appear in 8 to 12 weeks.
PRP (platelet-rich plasma) therapy for hair loss is a three-step medical treatment in which a person’s blood is drawn, processed, and then injected into the scalp.
PRP injections trigger natural hair growth and maintain it by increasing blood supply to the hair follicle and increasing the thickness of the hair shaft. Sometimes this approach is combined with other hair loss procedures or medications.
PRP therapy is a three-step process. Most PRP therapy requires three treatments 4–6 weeks apart.
Maintenance treatments are required every 4–6 months.
Your blood is drawn — typically from your arm — and put into a centrifuge (a machine that spins rapidly to separate fluids of different densities).
After about 10 minutes in the centrifuge, your blood will have separated into in three layers:
The platelet-rich plasma is drawn up into a syringe and then injected into areas of the scalp that need increased hair growth.
There hasn’t been enough research to prove whether PRP is effective. It’s also unclear for whom — and under what circumstances — it’s most effective.
Wigs, caps, hats, or scarves are important options. Wearing a head covering does not interfere with hair regrowth. This may be a good choice for people with extensive scalp hair loss who do not have enough hair to cover it.
The emotional aspects of living with hair loss can be challenging, especially in a society that regards hair as a sign of youth and good health. It is reassuring that alopecia areata does not affect general health, and should not interfere with your ability to achieve all of your life goals at school, in sports, in your career, and in raising a family.
The National Alopecia Areata Foundation, the NAAF, is a great resource for support, treatment & education.
Schedule an appointment to see which treatment or combination of treatments is the best choice for you.
Acne is a skin condition which has plugged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, as well as the neck, chest, back, shoulders, and upper arms. Although most teenagers get some form of acne, adults in their 20's, 30's, 40's, or even older, can develop acne. Often, acne clears up after several years, even without treatment. Acne can be disfiguring and upsetting to the patient. Untreated acne can leave permanent scars; these may be treated by your dermatologist in the future. To avoid acne scarring, treating acne is important.
Acne is not caused by dirt. Testosterone, a hormone which is present in both males and females, increases during adolescence (puberty). It stimulates the sebaceous glands of the skin to enlarge, produce oil, and plug the pores. Whiteheads (closed comedones), blackheads (open comedones), and pimples (pustules) are present in teenage acne.
Early acne occurs before the first period and is called prepubertal acne. When acne is severe and forms deep "pus-filled" lumps, it is called cystic acne. This may be more common in males. Adult acne develops later in life and may be related to hormones, childbirth, menopause, or stopping the pill. Adult women may be treated at the period and at ovulation when acne is especially severe, or throughout the entire cycle. Adult acne is not rosacea, a disease in which blackheads and whiteheads do not occur.
Acne has nothing to do with not washing your face. However, it is best to wash your face with a mild cleanser and warm water daily. Washing too often or too vigorously may actually make your acne worse.
Acne is not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them.
Wear as little cosmetics as possible. Oil-free, water-based moisturizers and make-up should be used. Choose products that are "non-comedogenic" (should not cause whiteheads or blackheads) or "non-acnegenic" (should not cause acne). Remove your cosmetics every night with mild soap or gentle cleanser and water.
A flesh-tinted acne lotion containing acne medications can safely hide blemishes. Loose powder in combination with an oil-free foundation is also good for cover-up.
Shield your face when applying sprays and gels on your hair.
Control of acne is an ongoing process. All acne treatments work by preventing new acne breakouts. Existing blemishes must heal on their own, and therefore, improvement takes time. If your acne has not improved within two to three months, your treatment may need to be changed. The treatment your dermatologist recommends will vary according to the type of acne.
Occasionally, an acne-like rash can be due to another cause such as make-up or lotions, or from oral medication. It is important to help your dermatologist by providing an updated history of what you are using on your skin or taking internally.
Many non-prescription acne lotions and creams help mild cases of acne. However, many will also make your skin dry. Follow instructions carefully.
Re-think your skin health. Hydrafacial MD, - * Acne Facial, is highly effective for anyone suffering from oily and/or acne-prone skin. It visibly reduces redness, enlarged pores, hyperpigmentation, utilizing LED blue light killing acne causing bacteria. HydraFacial MD - Hydradermabrasion is the latest, non-invasive, "gentle" skin resurfacing and complexion treatment. The immediate, noticeable, long lasting results are achieved with zero downtime and without any discomfort. You can return to school, work, social life, or exercise right after your procedure. HydraFacial MD uses a uniquely shaped spiral tip and patented vortex fusing technology to gently cleanse, exfoliate, and extract, removing impurities and dead skin cells while hydrating the skin and adding antioxidant protection simultaneously.
Acne scars no longer have to be lived with forever. Often occurring on the face, back and chest these scars can now be treated with a variety of lasers (Fraxel®, V-Beam), subcission or chemical peels. These treatments require no social downtime and can be performed on all skin colors.
