Actinic or Solar Keratosis (Pre-Cancer)

An actinic keratosis, is a rough, scaly patch on the skin that develops from years of sun exposure. It's often found on the face, lips, ears, forearms, scalp, neck or back of the hands. These represent pre-cancerous growths that can become skin cancer if left untreated.

If you find a spot or growth on your skin that you think could be an actinic keratosis (AK), it’s time for a thorough skin exam. Should you have an AK, an accurate diagnosis and treatment can:

• Reduce your risk of developing skin cancer
• Get rid of an AK, replacing it with new, healthy-looking skin
• Help ease symptoms, such as itch, pain, or tenderness

Most people who have AKs (or think they may have an AK) see a dermatologist. This is actually one of the most common conditions that dermatologists diagnose and treat.

How do dermatologists diagnose actinic keratosis?

When you see a board-certified dermatologist about AKs, your dermatologist will:

• Examine your skin carefully
• Ask questions about your health, medications, and symptoms

If you have one or more AKs on your skin, a board-certified dermatologist can often diagnose you by looking carefully at your skin. While examining your skin, your dermatologist will also look for signs of skin cancer. People who have skin that’s been badly damaged by ultraviolet (UV) light develop AKs and have a higher risk of getting skin cancer.

If you have one or more AKs, your dermatologist will talk with you about whether to treat these precancerous skin growths. Usually, treatment is recommended.

For a few people, a dermatologist may recommend frequent skin exams rather than treatment. Skin exams are recommended for patients who are frail and may find it hard to tolerate treatment. To be effective, treatment must destroy the AKs. When this happens, your skin will feel raw. It may be red and swollen for a brief time.

How do dermatologists treat actinic keratosis?

The treatment that is right for you depends on several considerations, including:

• How many AKs you have
• Where the AK(s) appear on your body
• What the AK(s) look like 
• Whether you’ve had skin cancer
• Your other medical conditions, such as living with a transplanted organ

If you have one or a few AKs, a procedure that your dermatologist can perform during an appointment may be the preferred treatment.

Procedures for treating actinic keratosis

You can often complete treatment in 1 or 2 office visits. The procedures that dermatologists use to treat AKs include:

• Laser skin resurfacing: Fraxel® Dual Laser was recently approved by the FDA for the treatment of actinic keratosis. This laser can achieve a very dramatic change in the skin with a treatment for both the epidermis (top layer) and the dermis (middle layer) of your skin. This may also be a treatment option for actinic cheilitis, a precancerous growth on the lip. It works by removing the surface layer of the skin. Read more on the Fraxel® Dual Laser here.
• Topical Creams and Gels: If you have several actinic keratoses, your health care provider might prescribe a medicated cream or gel to remove them, Approved medications include: 5-flurouracil ( (Carac®, Efudex®, Fluoroplex®). Creams can be messy and some require application up to twice daily for 4-6 weeks and may not be used in pregnancy.
• Cryosurgery: During cryosurgery, (liquid nitrogen - a very cold liquid gas) is applied to the growth with a cotton swab or spray gun to "freeze" it. A blister may form under the growth (this is normal and to be expected) which dries into a scab-like crust. The Keratosis usually falls off within a few weeks. Some AKs need more than one cryosurgery treatment before they fall off.  Your dermatologist can do this during an office visit while you remain awake with little to no discomfort.
• Chemical peel: This is a medical-grade chemical peel used to destroy the top layers of skin. You cannot get this type of chemical peel at a salon or from a kit sold for home use.
After a medical-grade chemical peel, the treated skin will be red, swollen, and sore. As the area heals, you will see new healthy skin. Learn more here ...
• Curettage: If you have an extremely thick AK, this may the best treatment. During this procedure, your dermatologist first scrapes the AK from your skin, using a technique called curettage. Your dermatologist may follow this with a electrodesiccation, which heats the treated area to destroy any remaining AK cells.
• Photodynamic therapy: This may be recommended for a patient who continues to get new AKs or has AKs that return after treatment. This procedure is a bit time-consuming because it consists of 2 parts.
During the first part of treatment, a solution that makes your skin extremely sensitive to light is applied to the area with AKs. You’ll sit in the office with this on your skin for about 60 to 90 minutes. Afterward, you’ll be treated with either a blue or red light.
The light activates the solution, which can destroy the AKs. As the treated skin heals, you’ll see new, healthier skin.
For 48 hours after treatment, you’ll need to avoid the outdoors during daylight. The UV light, even on a cloudy or snowy day, can cause a serious skin reaction. Your dermatologist will explain how to protect your skin so that you can get home.
Most patients with AKs need 2 PDT treatments, with the second treatment given 3 weeks after the first. 

Outcome for a patient with actinic keratosis 

Some people develop a few AKs, which can often be cleared with treatment. 

If you have many AKs, it’s a good idea to be under a dermatologist’s care. Your skin has been severely damaged by UV light, so it’s likely you’ll continue get new AKs. You may also develop skin cancer. Your dermatologist can watch for signs of new AKs and skin cancer. When found early and treated, skin cancer is highly treatable. 

Your dermatologist will tell you how often to return for check-ups. Some people need a check-up once or twice a year. If you have a weakened immune system or a rare condition that greatly increases your risk of developing AKs and skin cancer, you may need to see your dermatologist every 8 to 12 weeks.

Keep every appointment. If skin cancer develops, the sooner it is found and treated, the better your outcome.

Self-care also plays a key role in your outcome. The right self-care can help to prevent new AKs and skin cancer. 

Acne, Acne Scars and Acne Surgery

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.

Types of Acne and How Acne Forms

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.

Cleansing

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.

Diet

Acne is not caused by foods. However, if certain foods seem to make your acne worse, try to avoid them.

Cosmetics

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.

Treatments

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.

Topicals

• Your dermatologist may prescribe topical creams, gels, or lotions with vitamin A acid-like drugs, benzoyl peroxide, or antibiotics to help unblock the pores and reduce bacteria. These products may cause some drying and peeling. Your dermatologist will advise you about correct usage and how to handle side effects.
• Before starting any medication, even topical medications, inform your doctor if you are pregnant or nursing, or if you are trying to get pregnant.

Special Treatments

• Acne surgery may be used by your dermatologist to remove blackheads and whiteheads. Do not pick, scratch, pop, or squeeze pimples yourself. When the pimples are squeezed, more redness, swelling, inflammation, and scarring may result.
• Microdermabrasion may be used to remove the upper layers of the skin improving irregularities in the surface, contour, and generating new skin.
• Light chemical peels with salicylic acid or glycolic acid help to unblock the pores, open the blackheads and whiteheads, and stimulate new skin growth.
• Injections of corticosteroids may be used for treating large red bumps (nodules). This may help them go away quickly.

HydraFacial MD

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.

Oral

• Antibiotics taken by mouth such as tetracycline, doxycycline, minocycline, or erythromycin are often prescribed.

Acne Scars

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.

Cosmetic Surgical Excision of Cysts, Moles & Scars

A surgical excision is an in-office procedure in which a skin lesion is removed by a dermatologic surgeon. This technique involves the use of local numbing medicine which is injected into and around the target area and followed by sharp dissection of the lesion from surrounding normal tissue. The most common scenarios for utilization of this technique include: treatment of skin cancers, atypical or suspicious moles (nevi), and cysts.

Surgical Excision of Cysts

Cysts may remain asymptomatic, but if they continue to grow or become painful surgical excision is the treatment of choice. The cyst consists of a wall that makes the contents. To insure that the cyst does not return, it is best to completely excise it, including the wall, to prevent its recurrence.

Surgical Excision of Moles

Moles often become more raised over time. Occasionally they become irritated or are cut when shaving. A shave excision removes the raised portion of the mole. As a general rule, a complete excision is only performed if a mole is changing or when a complete excision will yield a better cosmetic result. Either of these treatments is performed under local anesthesia in our office. The shave excision takes less than a minute and a complete excision under a half hour. The functional and cosmetic results are excellent.

Surgical Excision of Scars

This option is typically for scars that are deeply pitted, raised, or for older surgical scars that did not heal properly. The scar tissue is removed, followed by careful stitching of the skin to leave a much smaller, thinner scar line or to change the scars shape and/or direction so it is less obvious.

Cosmetic Consultation Reimbursement Policy

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.

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.

Prevention

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

Intralesional Steroid Injections

What is intralesional steroid injection used for?

Intralesional Steroid Injections, or Intralesional Kenalog is a common treatment used in dermatology & are a standard treatment for many skin diseases including: acne lesions, cysts, alopecia (bald spots) hair loss, eczema, abundant scar tissue (keloids, hypertrophic scars), psoriasis, lichen simplex chronicus, skin lupus, granuloma annulare, and more. Intralesional injections are extremely helpful, as they are able to bypass the outer defensive layers of the skin to reach an area that will make the greatest impact on your condition. It is common for a patient to need multiple injections, as different cases vary in severity. The goal of these injections is ideal for quick healing to reduce the inflammation within the skin, and relive pain and discomfort as well as improving the appearance. This treatment is usually reserved for tender, swollen acne nodules, or cysts that aren't responding to typical acne therapies. Prompt treatment with intralesional injections can often prevent scarring.

What are the side effects of Intralesional Steroid Injections?

• This injection is a form of steroid, which some may have an allergic reaction to. It is not very likely that you will be allergic, but it is possible may happen after injection.
• It is possible that the skin may become thinner in the area of injection (atrophy). This is not very likely, but could result in a dimpling of the skin. This tends to recover after some time.
• Bleeding may occur after any type of injection including intralesional steroids. It is also possible that the blood vessels surrounding the injection site may become more prominent after injection.
• Pigmentation can develop around the injection site.
• As with most injections, there is a chance that pain will be felt. Each area of the body has a different level of sensitivity for each individual, so discomfort is possible. Local anesthetics can be used if necessary to help with pressure or pain during the procedure.
• There is a slight possibility that a treatment may be ineffective, or that the condition may return after the injection.

Canthrone

Canthrone is an excellent treatment for warts, molluscum and other growths in the skin.  It is painless and therefore preferred by many of our pediatric patients and adults who are adverse to even a little discomfort.  It is usually applied with a Q-tip (for children we refer to it as a tickle stick) and then covered with paper tape or a bandaid.  Patients are instructed to wash it off between twenty minutes to one hour later.  Although several treatments may be required, Canthrone is the kindler and gentler treatment for these ailments.

Monkeypox

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 ... 

Transmission:

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.

Prevention:

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)

Symptoms:

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.

Treatment:

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 ... https://youtu.be/klkQ2YcJHaw

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.

How can I protect my
baby or toddler from the sun?

Ideally, parents should avoid exposing babies younger than 6 months to the sun’s rays.

The best way to protect infants from the sun is to keep them in the shade as much as possible, in addition to dressing them in loose fitting long sleeves, pants, a wide-brimmed hat that shields the face, ears, back of the neck and sunglasses with at least 99% UVA/UVB protection. If you can’t find shade, create your own using an umbrella, canopy, or the hood of a stroller. Make sure they do not get overheated and that they drink plenty of fluids. If your baby is fussy, crying excessively, or has redness on any exposed skin, take him or her indoors.

Minimize sunscreen use on children younger than six months old. However, if shade and adequate clothing are not available, The American Academy of Dermatology (AAD) recommends that all kids — regardless of their skin tone — wear sunscreen with an SPF of 30 or higher that is broad-spectrum and water resistant.

For babies older than 6 months, when outdoors, sunscreen should be applied to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into their eyes, wipe their eyes and hands clean with a damp cloth. Reapply sunscreen every two hours or immediately after getting out of the water. Sunscreens that use zinc oxide may cause less irritation and/or allergic reactions to their sensitive skin. If a rash develops please call our office.

Other elements of a sun safe strategy include: wearing clothing made with a tight weave. If you are not sure how tight a fabric’s weave is, hold it up to see how much light shines through, the less the better. You can also look for protective clothing labeled with Ultraviolet Protection Factor (UPF) and limiting your sun exposure between 10:00 a.m. and 4:00 p.m. when the UV rays are the strongest.  Remember to set a good example by practicing sun safety yourself.

The sun gives energy to all living things on earth, but it can also harm us. Its ultraviolet (UV) rays can damage skin and eyes and cause skin cancer. One-quarter of our lifetimes sun exposure happens during childhood and adolescence. Even one blistering sunburn in childhood or adolescence more than doubles your chances of developing Melanoma later in life. Since children spend a lot of time outdoors, especially in the summer, it's important to protect them from the sun. 

Talk with your dermatologist if you have any questions about sun protection for your child.

Psoriasis

Psoriasis is a common, chronic, long term, relapsing skin condition where the skin cells are made to quickly often resulting in itchy silvery scaling patches that causes a rash, most commonly on the knees, elbows, trunk and scalp. It can be painful, interfere with sleep and make it hard to concentrate. The condition tends to go through cycles, flaring for a few weeks or months, then subsiding for a while. 

Symptoms

Common signs and symptoms of psoriasis include:

• A patchy rash that varies widely in how it looks from person to person, ranging from spots of dandruff-like scaling to major eruptions over much of the body
• Rashes that vary in color, tending to be shades of purple with gray scale on brown or Black skin and pink or red with silver scale on white skin
• Small scaling spots (commonly seen in children)
• Dry, cracked skin that may bleed
• Itching, burning or soreness
• Cyclic rashes that flare for a few weeks or months and then subside

Types of psoriasis

There are several types of psoriasis, each of which varies in its signs and symptoms:

• Plaque psoriasis. The most common type of psoriasis, plaque psoriasis causes dry, itchy, raised skin patches (plaques) covered with scales. There may be few or many. They usually appear on the elbows, knees, lower back and scalp. The patches vary in color, depending on skin color. The affected skin might heal with temporary changes in color (post inflammatory hyperpigmentation), particularly on brown or Black skin.
• Nail psoriasis. Psoriasis can affect fingernails and toenails, causing pitting, abnormal nail growth and discoloration. Psoriatic nails might loosen and separate from the nail bed (onycholysis). Severe disease may cause the nail to crumble.
• Guttate psoriasis. Guttate psoriasis primarily affects young adults and children. It's usually triggered by a bacterial infection such as strep throat. It's marked by small, drop-shaped, scaling spots on the trunk, arms or legs.
• Inverse psoriasis. Inverse psoriasis mainly affects the skin folds of the groin, buttocks and breasts. It causes smooth patches of inflamed skin that worsen with friction and sweating. Fungal infections may trigger this type of psoriasis.
• Pustular psoriasis. Pustular psoriasis, a rare type, causes clearly defined pus-filled blisters. It can occur in widespread patches or on small areas of the palms or soles.
• Erythrodermic psoriasis. The least common type of psoriasis, erythrodermic psoriasis can cover the entire body with a peeling rash that can itch or burn intensely. It can be short-lived (acute) 

Psoriasis triggers

Many people who are predisposed to psoriasis may be free of symptoms for years until the disease is triggered by some environmental factor. Common psoriasis triggers include:

• Infections, such as strep throat or skin infections
• Weather, especially cold, dry conditions
• Injury to the skin, such as a cut or scrape, a bug bite, or a severe sunburn
• Smoking and exposure to secondhand smoke
• Heavy alcohol consumption
• Certain medications — including lithium, high blood pressure drugs and antimalarial drugs
• Rapid withdrawal of oral or injected corticosteroids

Risk factors

Anyone can develop psoriasis. About a third of instances begin in childhood. These factors can increase the risk of developing the disease:

• Family history. The condition runs in families. Having one parent with psoriasis increases your risk of getting the disease. And having two parents with psoriasis increases your risk even more.
• Smoking. Smoking tobacco not only increases the risk of psoriasis but also may increase the severity of the disease.

Complications

If you have psoriasis, you're at greater risk of developing other conditions, including:

• Psoriatic arthritis, which causes pain, stiffness, and swelling in and around the joints
• Temporary skin color changes (post-inflammatory hypopigmentation or hyperpigmentation) where plaques have healed
• Eye conditions, such as conjunctivitis, blepharitis and uveitis
• Obesity
• Type 2 diabetes
• High blood pressure
• Cardiovascular disease
• Other autoimmune diseases, such as celiac disease, sclerosis and the inflammatory bowel disease called Crohn's disease
• Mental health conditions, such as low self-esteem and depression

When to see a doctor

If you suspect that you may have psoriasis, see your health care provider. Also seek medical care if your condition:

• Becomes severe or widespread
• Causes you discomfort and pain
• Causes you concern about the appearance of your skin
• Doesn't improve with treatment

What Does Psoriasis Look Like?