You may have heard buzzwords such as personalized medicine or targeted therapy which hold the promise to better treatments for hard to cure diseases. In the case of melanoma, vemurafenib (Zelboraf®) has shown very promising results for advanced melanoma in a specific group of patients. Though not for everyone, the drug has been very successful in patients whose melanoma harbor a certain mutation. Instead of targeting rapidly dividing cells in general such as most traditional chemotherapy treatments, this medication is tailored towards a specific target in the melanoma cells. Although extremely promising, much work remains to be done. Most patients ill develop disease progression after a while when the melanoma cells figure out how to get around the vemurafenib. Thus, current research is focused on how to get around these methods of evasion by the melanoma.
Hair loss, referred to as alopecia by healthcare practitioners, causes a lot of distress for many people. There are common causes and not-so-common causes. In a previous article, we discussed the second most common cause for hair loss, telogen effluvium. In this recently published article on the site, we discuss one of the more rare, but increasingly recognized cause of hair loss -- frontal fibrosing alopecia. And in future articles, we will go over the most common cause for hair loss, androgenetic alopecia (male pattern baldness or female pattern hair loss) as well as a rare cause of hair loss, lichen planopilaris.
This month, we feature a two part series on morphea, aka localized scleroderma. Although this is a relatively rare inflammatory skin disease, it is definitely one that we see in dermatology clinic. Characterized by thickening of skin +/- fat, this disease can be very limited and not impact quality of life significantly, or can be more generalized, cause disfigurement, or limit joint mobility. Part I of the series reviews the definition, classification, mechanism and causes of morphea while Part II covers its manifestations, diagnosis and treatment.
While many of our posts have dealt with adult dermatologic conditions, Hand Foot and Mouth disease is one that predominantly affects children. Caused by a group of viruses called Coxsackie A viruses, Hand Foot and Mouth Disease manifests itself on the hands, feet and on the mouth. Beyond the findings related to the name, this disease can also manifest with fevers, sore throat and malaise. For most patients, the symptoms will go away on their own, although medications such as acetaminophen or ibuprofen can help. To learn more about Hand Foot and Mouth Disease, click here.
Many of my patients have erythematotelangiectatic rosacea. More simply, they have redness over their face related to rosacea. Previously, treatments were rather limited. One of the more effective treatments was to use the pulsed dye laser to treat this type of facial redness. However, costs were often prohibitive given that repeat treatments are often necessary and insurance does not cover these treatments.
However, a new medication, Mirvaso® (brimonidine) was just approved in 2013 for the background redness caused by rosacea. Although it may also not be covered by insurance, the buy-in price is likely lower than the laser treatments. As with any medication, there are side effects though. The most common side effects include irritation of the skin, and even worsening of facial redness. Learn more about Mirvaso® here.
In the next set of two articles, we discuss keloids. Keloids are abnormal scars that spill over the border of the original wound. While they may be unsightly to some, they may also cause irritation. Even minor trauma can bring about large keloids. For some individuals, these big scars occur after ear piercing, acne or skin surgery.
So what can you do about keloids? There are a number of treatments that are available. In the medical office, we often opt for injected corticosteroids. These injections can help soften and flatten the scar and get rid of irritating symptoms. However, the keloids can come back. Other treatments include other injected medications, silicone sheeting, radiation, and/or laser treatments. Treatments can sometimes be done in combination.
I frequently hear people say that melanoma is the most aggressive form of skin cancer. However, merkel cell carcinoma (MCC) are arguably more aggressive than melanomas as a group. Fortunately, it is also a rare form of skin cancer. These cancers are often forgotten about and can present inconspicuously. However, they can spread rapidly and even after cutting them out, they often recur. The first step is recognition of a suspicious growth which your physician can then biopsy. If the biopsy shows MCC, then further work-up occurs, often in conjunction with an oncologist. For a good intro to MCC, refer to our recent article here.
The second most common cause of hair loss (aka alopecia) is telogen effluvium. This diagnosis is quite a mouthful, but it literally means shedding of telogen hairs. Our hairs cycle through different phases and we normally have a scalp full of hair in different phases, with one of those phases being telogen. Telogen is the phase where hair is normally shed. In telogen effluvium, many hairs enter this telogen phase at the same time and are then shed at the same time. This condition often follows stressful situations. I've met patients who have gone through surgeries, traumatic accidents, hospitalizations, and stressful personal situations which led to this condition months afterwards. The good news is that telogen effluvium usually corrects itself if the underlying stressor is removed. There's a lot more to telogen effluvium, so if you want to learn more, check out this month's article on telogen effluvium here.
All of us will age. Hopefully we will age with grace and wisdom. But inevitably, with age also comes new blemishes and findings on our skin. One issue that becomes a concern are varicose veins and spider veins of the legs. Some of us are predisposed to these veins through genetics. Others through our occupations, or having carried children. Regardless, there are methods to eliminate varicose veins and spider veins. One of these methods is a procedure called sclerotherapy. It's important to seek out a consultation before embarking on this procedure. A knowledgeable surgeon will be able to determine whether you are a proper candidate for this procedure and how best to perform this procedure. Learn more about this procedure and whether it may be right for you through this article on sclerotherapy.
"1 in 5 Americans will be diagnosed with skin cancer." Thus runs a headline for the American Academy of Dermatology's SPOT Skin Cancer Initiative. One of the deadliest skin cancers is melanoma. You may wonder, what is the relationship between moles and melanoma? It turns out that individuals with many unusual (atypical) moles are at increased risk of melanomas. Furthermore, we know that around half of melanomas arise from preceding moles. Thus, dermatologists recommend regular skin checks with a knowledgeable skin health care provider and also regular self skin examinations. Knowing your skin empowers you to know when something is new, changing or otherwise unusual. Learn more and empower yourself by reading this article on atypical moles.