general dermatology Blog
Please feel free to use the blog below to share information about general dermatology, or to ask Dr. Ringpfeil a question that might be of interest to others.
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Dear Doctor:
I would like to consult you for my problem but am not sure whether it qualifies as cosmetic or general dermatology. I am a medium brown African American woman and have the remains of a chemical burn on my forehead. This was caused by a Clinique toner. However, the burn is not superficial and initially the whole forehead was black and the texture of tree bark. I have used a glycolic acid scrub and the “stain” seems to get lighter but if I get a tan it comes back. I have lived in 70 sunblock for several years now. The stain has shrunk but still persists. I also have spaces over my eyebrows that are light due to an 8% TCA “accident” (guilty of trying this when the forehead problem started and prescription Kligman’s solution did not help). The light spots have partially tanned in but look even lighter because of the dark strip. If the forehead could look more reasonable, a bit more even, I would be happy. I had laser treatments but when the doctor thought I was ready to switch to peels I lost my job and was unable to continue with her. That doctor has relocated to Chicago. Please let me know what you would suggest and whether I should make an appointment with your aesthetician or yourself.
Thank you,
Gail
Pigmentary changes can be very disturbing especially when they are located in visible areas. I am glad to hear that you take sun protection to this area seriously – this is the mainstay of pigment control. To date there is no laser that reduces post inflammatory hyperpigmentation perfectly and I have to agree with the recommendation you received from your previous dermatologist to continue with peels. Other options may include microdermabrasion or newer fading agents that are not in the Kligman formula. A combination is often more successful than just a single ingredient and these are likely to work better on the darker areas than on the lighter areas. I suggest you book a consultation with me to work out a plan.
Dr. Ringpfeil,
I am a 27 year old male experiencing redness on both my left and right cheekbones (upper corner close to my eyes). This appeared suddenly about 9 months ago. I was told by a few doctors that rosacea is extremely rare at my age. I have had one IPL treatment done. Prior to this I could see some small blood vessels on my right cheek but not my left cheek. Now, the redness is still there but I no longer see any signs of blood vessels. I am wary about having more IPL treatments done as they may not be helpful in my case.
This condition is quite embarassing and troubling for me and I would like to get to the bottom of what’s causing it before being blindly treated and prescribed topical medicine. I’ve already tried Finacea and Metro Gel and both did not solve the problem.
What I would like to know is whether you would be willing to do a skin biopsy on these patches in your office in order to get more information on the root cause?
Please advise. Thank you.
A skin biopsy is certainly possible especially if there is any doubt in the diagnosis of rosacea or if the confirmation of the diagnosis would reduce any anxiety on your part considerably. The benefit of the outcome of the biopsy must be weighed against the permanent small scar that a biopsy will cause.
Once a diagnosis is confirmed, a treatment plan can be designed.
Rosacea most commonly develops between 30-60 years of age, however, it can begin in childhood. My youngest patient with rosacea was 7 years at the age of onset. If in fact you have rosacea, I do not expect topical anti-inflammatory medications such as metronidazole (Metro Gel)or azelaic acid (Finacea) to reduce redness dramatically. These medications as well as oral anti-inflammatory agents work well when you are in an inflammatory flare where the skin forms little red bumps or even pus bumps in the affected areas. The background redness with or without visible blood vessels that is observed in about 85% of all people with rosacea is most effectively treated with a series of pulsed dye laser treatments (usually between 2-4) although ongoing intense pulsed light (IPL) treatments may achieve control eventually, too. There are medications that are currently in trial for topical control of the redness. They will work temporarily to provide relief from the redness for several hours.
Hello…
I have been suffering with some form of skin issue all my life… I do have active, oily skin. I have been on Accutane several times with no real result. The most recent problem has lasted for nearly 7 years now. I have also been to a few dermatologists & have no satisfaction…. anyway, I think I have a severe form of milia or cystic acne. I see little white things in my pores, mostly on my nose, but most recently on my cheek. Sometime I can squeeze it a bit (also relieves some pain) and some white stuff comes out but usually, it looks hard and I have to pull it out with pair of tweezers. It will scab over & then I will see many more little white things in the pores, bunched together, as though it multiplied in a day or 2…. then it starts all over, and I pull these little things out… sometimes they are very deep & shaped oddly, usually shaped like a whitish/clear grain of rice… what is this condition? Can it be helped? I feel as though I have tried everything… I am currently taking spironolactone twice a day…. I honestly do not see any results. I am embarrassed & depressed. Do you think you can help me? I wash my face regularly, eat healthy fruits & vegetables,take vitamins & probiotics…. I have had no real results…. If you can, please tell me what you think this may be, if you feel you can help me, I would like to make an appointment with you ASAP. Could this be a form of cystic acne? Sometimes I have pulled out what appear to be large globs of irregular shaped gunk… HELP!
Best Regards,
M
Although I cannot be absolutely sure without proper evaluation, your description raises the possibility of milia or even osteoma cutisas a result of longstanding acne. Evaluation will also be able to determine if physical removal may be an option to remove these.
Dear Dr. Ringfeil,
I have a friend in China who suffers from keloid and wants to come to the USA to get treatment. I am wondering if treatment of keloid is your specialty. If not, could you please recommend a specialist on keloid?
Thanks for your help.
Sincerely,
Z. Gu
Keloids are characterized by uninhibited scar formation. Medical and surgical (including laser) treatment is available and its efficacy and use depends on size and location of the keloid. While I have ample experience in the medical, surgical and laser treatment of keloids, I consider all dermatologists keloid specialists. Our office offers all aspects of keloid treatment.
I have keritosis pilaris on the backs for my upper arms and my thighs. I’ve tried many products like KP Duty and Lac-Hydron, etc. My skin is smoother but the redness remains. Is there something to get rid of the redness?
Thank you.
Keratosis pilaris is a benign genetic trait affecting the skin of 10% of the population. It can occur in childhood but most often becomes apparent in adolescence. It shows as rough, red or pink hair follicles on the back of the arms, which are most commonly affected, although the back, thighs, and sides of the cheeks may also show these changes. Treatment is cosmetic as it is typically asymptomatic. Eucerin plus cream with 4% alpha hydroxy acid, LacHydrin or AmLactin cream with 12% lactic acid may be used and if effective will smoothen the skin after 2 weeks. If not sufficiently softened after 2 weeks, formulations containing 17% glycolic acid or higher such as keratosis pilaris kit by Glytone or other vendors and even Problem Dry Skin by Neostrata can be applied. The key in reducing the rough hair follicles is continuous treatment. Once treatment is discontinued, the trait recurs.
In some people, redness or pinkishness around hair follicles persist despite meticulous and continuous treatment, which has rendered the skin very smooth. Under these circumstances, redness reduction through pulsed dye laser treatments is appropriate. It appears that you fit the latter approach.
My daughter has severe hand sweating. She has been to other doctors who have given her ointments and oral meds but nothing seems to help. Any new treatments available?
thank you, M
Sweating is not an easy problem to tackle whether it is localized to armpits, hands, feet or other body areas or all over the body. It is important to understand that we can exert control on several of our body functions using a technique called “Biofeedback”. While there are books available to teach this technique, I recommend learning it with the help of a therapist specializing in biofeedback. The average number of sessions needed to master this method is about 12. Topical, oral or injectable medicines can provide relief to some and can often be used safely for long periods of time. Surgery is a last resort but is not yet an option if hands are affected. Depending on the nature and circumstances of your daughter’s sweating of her hands, biofeedback may be the best way to correct the problem and provide her a medicine-free solution that will last for life.
Hi,
I’m a male with white marks, from genital wart treatment/removal, on the middle and lower shaft of the Penis. The marks are about 1cm wide. There is no other scaring, just discoloration or lack of pigmentation. Is there a treatment available to darken these spots to blend in with the surrounding skin?
There is no treatment currently available in the United States. Elsewhere, Re:Cell has shown excellent results for reintroducing color in white patches of skin and I believe it is a matter of time that it will be FDA approved.
I am a 34 yr old female. I have had small pimple like bumps on my cheeks, jawline and chin for about 8 months now. Sometimes there are a few red ones that itch and there is always a blanket of them that you can feel covering my cheeks. It will get a little bit better but then comes right back again from day to day. It seemingly came out of nowhere as I never really had acne before. I used Anthelios as my moisturizer and Vichi purette thermal for my face wash for about 3 years but I stopped because I thought my skin may have formed some kind of allergy to them. I started to use Aveeno as my moisturizer and face wash but haven’t really seen a difference. Another Dermatologist told me it may be due to a nickel allergy and I should stop touching my face after touching my cell phone. I have been consciously doing this for the past 6 weeks and it hasn’t helped. On the internet I read about an ingredient found in moisturizer called Kathon GC but I am not aware of any of my products containing it. I would like to come in for an evaluation as soon as possible if you think you can help me get rid of these stubborn bumps.
Thank you
According to your description I must assume that you have acne or an allergic process or perhaps another condition called perioral dermatitis. Regardless, all are treatable. If the examination is suggestive of an allergic process, allergy patch testing can be performed in the office and we will have results after a few days. Pleases et up an appointment
I am very curious about laser treatment in the groin and vulvar area for Hailey Hailey disease. I have seen a dermatologist who does laser surgery but “full disclosure” she has never done it on a person with HHD. What are the procedures and what is the success rate? Will she be able to laser these areas just because she has laser experience, but not for HHD? I am concerned.
CO2 or Erbium YAG laser resurfacing appears to be a great treatment for your chronic Hailey-Hailey spots. From the first reports that came out more than
10 years ago we were able to deduce that results can be long lasting. If you think about it, it took your skin 30-40 years on average to show the changes. My experience is entirely based on CO2 laser technology to treat Hailey-Hailey spots. Wound healing is not impaired and therefore proceeds extremely well in areas without friction. The procedure on the trunk or buttock is similar to facial resurfacing. When treating skin folds or thin skinned areas, such as the neck, groin or vulva, much more care must be exercised. This may mean more than one treatment to achieve durable success and avoid scarring. However, scarring is at least a theoretical risk in these areas. If your dermatologist is well versed with the CO2 laser and feels comfortable to treat delicate skin, he or she may be capable of getting the results that you are looking for.
Hi, I am 35 and was wondering what my daily skin care routine should be. I am so overwhelmed by all the information and products out there. I use a moisturizer with SPF in the morning but what should I be doing at night? Im starting to see uneven skin and fine lines… And what brands do you recommend?
Thanks!
You are not the only one to be overwhelmed. Skin care is very individual and should be customized. One shoe does not fit all. Evaluation and providing recommendations is exactly what we do. You may book a consultation with our physicians or aestheticians. Meeting with our aestheticians is complimentary at this time.
I have patches of plaque psoriasis on my scalp. I just moved to the area and at my previous dermatologist I did 10 weeks of the Xtract Laser Treatments. I found this treatment to be the most effective on my scalp. Does your office offer this treatment?
I am not surprised to read that your psoriasis was well controlled with excimer laser treatments. It works very well for many people on the scalp.
Unfortunately, our office does not currently offer excimer laser treatments but several offices in the area do. Please contact the manufacturers “Photomedex” or “Ramed” to see if they can help you to locate a physician.
Hi,
I have had occasional acne. Now i seem to have really bad acne on my forehead. My mom thinks it’s cystic acne. Is there any treatment for this? I have used Proactiv, some Clinique products, clean&clear. Are there products that can help this problem?
Cystic acne can be treated. It will probably require an adjustment in your acne medicines as prescription medicines may work much quicker and can therefore prevent scarring. Over the counter products are often too weak to counteract the increased inflammation that leads to cystic breakouts.
I have had a keloid on my chest for about 4 years. Every year its increasingly painful and it seems to get bigger. I know treating keloids is very difficult. And I was wondering if there is something that can be done. When it first appeared I had three steroid injections that did nothing. I had another keloid and it was treated by steroid injection and it went away. Any feedback would be beneficial.
As you already mentioned, keloids can be tough to treat. As you may have heard, excision is not usually recommended tdue to high risk of the keloid recurring with a fear that it could be bigger than before. Injections with steroid or combination of steroid and 5 fluorouracil are currently accepted treatment strategies by most insurances. Additional treatment options (but not usually insurance covered) are a series of pulsed dye laser or CO2 laser treatments. Evaluation of the keloid is necessary to determine the best option for you.
Hi Dr Ringpfeil: I have very thin hair in my eyebrow and would like to try something that would help to grow thicker. I was wondering if I should try using Rogaine or Latisse or any recommended products? What is your recommendation?
Thin eyebrows can be a genetic trait or can result from underlying conditions such as thyroid disorders. Regardless of cause, treatment with a hair growth stimulator is possible. Minoxidil (Rogaine) and bimotoprost (Latisse) and 17-phenyl trinor PGS20 (Revitalash) are the most commonly used preparations. None of them is FDA approved for the treatment of eyebrows but are believed to be safe in this area. I prefer Latisse or Revitalash because of the way they are currently dispensed and applied. Latisse is a solution that can be so sparingly applied that it will not run. Revitalash is a gel that will not run down to your eyes but has the slowest time to success compared to the others. If Rogaine 2% solution was applied with a fine brush, it could probably also be used safely. However, it is not currently packaged with a set of fine brushes and therefore you would need to purchase brushes in a beauty supply store. All of these substances are used continuously to maintain results.
For six months, after exposure from a resident, I have had extreme itching to scalp and if not for bathing in dilute bleach my symptoms extend to my body, stinging and then lesions appear. What ever it is it is not visible with the naked eye. I am sure it is not bed bugs. The stinging and biting occurs at work and at home. I have lesions on my back, back of neck, shoulders and arms. I have been to 3 dermatologists and they say I am cleared but I still have extreme symptoms and lesions when not activley using the permethrin. When I do use permethrin on my scalp the mites come out and bite me on the face and neck more so than if I don’t use it. In spite of this it seems to give temporary relief. None of the three have done scraping or biopsies. I have been treated with permethrin cream and Ivermectin. I am a health care worker and am sure I contracted this at work. Some of my residents suffer with the same symptoms. My residents are treated locally at a dermatologist with permethrin (skin scrapings have been negative). They will do well for a while and them break out again. I know I cannot help them unless I am able to determine what I have. I am convinced what ever the mite is it hides in the shaft of my hair (making them impossible to see upon examination) and then periodically comes out to feed. It has to be some type of parasite. Does this sound like anything you might have seen in your practice?
The scenario that you describe is not entirely uncommon. Your description is certainly very suggestive of an infestation with a bug or parasite. Some bugs can be difficult to find or eradicate, some people’s immune system overreacts to bug bites and recreates a bug bite like reaction for several weeks or months after an initial event although bugs are no longer present and sometimes bugs are not to be blamed at all. It sounds as if a biopsy could help narrow the diagnosis.
Yes, I am 20 years of age and I have finel ines around my mouth is there any over the counter cream I can use tht would. Be effective
At age 20, an over the counter moisturizing cream with sunscreen should help with fine lines. Peptide technology such as “Neocutis Bioserum Pen” may be used in addition. It is available through physician offices such as ours.
My 16 year old daughter has what look like track marks on her leg. Our pediatrician wants her evaluated for possible lichen striatus. Is there a treatment for this condition?
The diagnosis should be confirmed by evaluation or, if needed, by biopsy.
Treatment for lichen striatus is limited yet the condition goes away spontaneously and typically leaves no marks behind. Other conditions that resemble lichen striatus may be considered during an in-office examination and may have specific treatment options.
Hello,
Do you use UVB therapy for vitiligo as well as the XTRAC laser? what other forms of treatment do you use?
Some forms of vitiligo respond to light treatment. Currently, narrowband UVB treatment appears to be the light treatment that is most efficacious and has the best safety profile. IF many areas of the skin are involved narrowband UVB is delivered in a UVB treatment box. If the area is small or the scalp is affected, an excimer laser is used instead to deliver the narrowband UVB ray. Other treatments include devices in the visible light range as well as topical medications. The type of treatment depends on the type of vitiligo, the body area affected as well as the extent of the body area affected.
While assessment for treatment is routinely performed in our office, we do not currently offer narrowband UVB or excimer laser treatments but works closely with tertiary care centers that offer one or the other.
Is there a directory of dermatologist that have the excimer laser. My dermatologist prescribed one for me, but the only place that I have found that has one is Penn Radnor, and I am in Philadelphia with no car!
There are two manufacturers for excimer lasers that are relevant. If you look for them on the internet, their website may indicate a dermatology office in your zip code area that may provide these treatments.
You can also try to call them. The companies are Photemedex and Pharaos.
Hi. I am having a bad flare up of my eczema. While living in FL until 2002 I was able to get injections for flares; however, I have not been able to find a dermatologist in NJ who does injections for eczema. I am currently using Diprolene and Clobex. I take lukewarm showers, use All Free, Dove for senstivie skin and CeraVe Creme. I was wondering if you do injections for eczema.
Thank you.
Carol
Luckily, the number of dermatologists who treat eczema (atopic dermatitis) with monthly intramuscular steroid injections has gone down dramatically.
The stakes have been too high for a number of patients treated in such fashion as they have developed serious life long side effects. Atopic dermatitis is challenging but treatment is usually possible using appropriate topical or, if severe, oral preparations that have more predictable side effects than intramuscular steroids. I strongly recommend that you chose a dermatologist who can work with you effectively and safely to treat your atopic dermatitis.
Hello. Do you have experience treating skin of color? I’m worried about scarring and hyperpigmentation from extractions or other procedures for acne.
Your concern about hyperpigmentation with several procedures on darker shades of skin is very justified. We are worried about these also, as they could occur more frequently with improper treatment. We treat skin of all colors and through experience we are able to avoid any preventable hyperpigmentation.
hi, I have minor active acne and many acne scars from the past. I was just wondering if C02 total FX are right for me,since I still have a bit of active acne?
Mild acne is not a contraindication to CO2 laser resurfacing. It should be well controlled even with help of medications such as topical retinoids before performing the CO2 laser procedure. Sometimes, CO2 laser treatments can flare acne and then treatment in the postoperative period is necessary.
When acne is not controlled or acne is still moderate to severe, CO2 laser resurfacing should be postponed until control has been achieved.
I have hypopigmentation from scars on my face and arm. I recently heard that Relume Laser Treatments can help restore pigment to skin that has been scarred. What are your thought on this and do you offer this treatment?
ReLume is a phototherapy device that can repigment hypopigmented scars very similar to other phototherapy modalities such as excimer laser and conventional medical phototherapy. In initial studies, 80% of treated individuals had improvement in scar pigment after 14 treatments.
Phototherapy has only few side effects if a limited number of treatments is needed for correction of a condition. The excimer laser technology which contains only a specific wavelength of the phototherapy spectrum (narrow band UVB) is currently deemed the safest phototherapy device. Both ReLume phototherapy and excimer laser deliver the light only where it needs to be, avoiding unnecessary exposure of adjacent skin. Both are reasonable for hypopigmented scars. At this time, we do not offer these treatments.
I have been having small bumps in my scalp that are sore like pimples. When I have people look at them, they tell me that the bumps are causing bald spots and the spots are darker than the rest of my scalp. Do you have any idea of what this can be? So far, I only get the bumps in,the back of my head/scalp. Do you know if there are any measures I can take on my own, or should I schedule an appointment?
Unfortunately, your description does not allow me to make a diagnosis.
Rather than speculating, you should be evaluated by a dermatologist. Most conditions can be identified simply through examination by a professional.
Once a diagnosis is made, treatment and strategies for prevention can be discussed.
hi, im 33 years old i have a little brown spots in my face since i was a child, i tried a cream called be white advanced by vichy. it worked i mean thos spot become light.but they come back and im really not happy whit this. so i heard about a laser technology so i want to know please.im a male.thanks
Brown spots on the face can be treated by laser as long as the surrounding skin is fairly light. If the surrounding skin is darker other treatments including peels can be used to safely remove them. You need an evaluation to learn about the options that are most effective and safe for you.
Hi
I have had red bumps on my cheeks and sometimes near my mouth, off and on for several years. This condition flares when I am overheated: yoga, running, in the sun at a beach. I was diagnosed with eccrine hydrocystomas- through a facial biopsy. I was prescribed sevral topical creams but have had zero improvement and am deeply frustrated. I work in TV business so these bumps are troublesome on camera with my line of work.
Is there anything else I can try? I have heard perhaps Botox? Any thoughts are greatly appreciated.
Best regards,
AS
Any condition that causes bumps on the skin, especially the face, can be very disturbing. As you know, there is no specific treatment for eccrine hydrocystomas. Yet, a number of anecdotal reports reveal treatment success with several modalities. With the exception of treatment of the upper lip and chin, Botox must be very carefully used on the lower half of the face, but depending on the extent of the hydrocystomas it may be an option. Other modalities we had success with are diode laser treatment (Smoothbeam) or CO2 laser treatment. Please make an appointment to find out if these are options for you.
I have a red face all day long. i don’t know what to do any more. i’ve done my research and think it may be rosacea, but since i am not a doctor i am not sure. What are your recommendations for reducing redness on my dry face. Also,do you accept Keystone health plan east?
An evaluation by a dermatologist will be able to confirm if in fact you have rosacea. Facial redness is common in rosacea, a chronic condition in which additional flushing can be triggered by sun exposure, heat, exercise, red wine etc. Facial redness occurs because of widened superficial blood vessels. A series of laser treatment can reduce the number of blood vessels for many years.
We do take Keystone health plan east.
Hi I’m 23 and have had these bumps on the back of my neck for atleast 8 years now. I’ve been to many different dermatologists and they said I had folliculitis etc. I’ve been given creams, clindagel etc. One derm told me it was just ingrown hairs and to stop getting low hair cuts. Nothing seems to make them go away some of the stuff they prescribed made them get smaller but never eradicated them. I’ve been doing alot of research on the net and it seems like there is no real permanent solution. The bumps are little and hard and I sometimes pop them or scratch them off. Sometimes they bleed other times they just give off a clear liquid. Plz help!
From your description and history, it appears that you are suffering from a chronic skin condition called pseudofolliculitis. On the back of the neck it can sometimes lead to minute scars in the area of ingrown hair and is then called acne keloidalis nuchae. This may be the reason for your folliculitis not fully resolving but just getting smaller. When scars occur, the condition is indeed very difficult to treat and may require injections or other surgical procedures. Close hair cuts are responsible for new breakouts and should therefore be avoided.
I am 26 and concerned about the deep wrinkles already appearing on my face. I prevent with daily sunscreen, but nothing seems to work and they keep multiplying. I do not want to get cosmetic surgery, but have talked to other dermatologists who say there is nothing else to do. Should I invest in an anti-wrinkle night cream – any that you suggest or that I should look for? Please help!
Significant sun exposure early in life, smoking as well as certain genetic causes can lead to aging / wrinkle formation even in younger years. The most important pillar of anti-aging is sunprotection, which you are already using. Make sure it has excellent UVA protection (zinc oxide as a physical block or Avobenzone paired with Mexoryl, Cellox-shield or Helioplex technology). For UVB protection apply at least an SPF of 15 for daily use and an SPF of 30 or higher for outdoor use. Peptide technology is currently viewed as one of the best to halt ageing. It can be combined with antioxidants such as stabilized vitamin C for even better results. Many other options may be available if you want to avoid surgery and specific recommendations can be made with proper evaluation by your dermatologists as long as they provide aesthetic services.
I have a problem with nail fungus on two of my fingers and am very reluctant to use an oral anti fungal medication such as Lamisil. Is there anything you can suggest which is effective?
Nowadays there are several safe options available for treatment of a nail fungus, such as laser treatment, topical solutions and oral medication.
However, the most important is to first establish the correct diagnosis.
Nail changes can be due to various infections including fungi, yeast and bacteria; they can be due to trauma and other causes. Treatment must be tailored to the underlying cause.
the type of insurance i have is not accept by your practice, i wanted to know how much it would cost me out of pocket for very bad acne scars i my face. how much is the medication.
The consultation for acne scars without insurance coverage is $115. The treatment depends on your scars, your goals and the specifics of your skin.
A wide variety of treatment options is available. Without examination, it is unfortunately not possible to discuss pricing of any medication or treatment but treatment may range from several hundred to several thousand dollars.
Note: We apologize for the inconvenience that we do not participate with your insurance. While insurances cover the evaluation of acne scars, they do typically exclude coverage of the treatment of acne scars.
Franziska Ringpfeil, MD
Hello – I have minor milia on my face but they bother me. I have tried exfoliating but it doesn’t seem to help. Do you offer solutions for this condition?
Most of the time milia cannot be removed through exfoliation They need to be physically removed one by one by a trained aesthetician. We offer a facial that is geared to extraction of milia. During this time you will also learn about ways to avoid milia formation in the future depending on the specifics of your skin and lifestyle.
Hello – I have been diagnosed with Granuloma Annulare and I’ve had it for three 1/2 years. It is one raised, bumpy, reddish spot/lesion on my forehead. Topical steriod creams are not helping. My lesion is slowly increasing in size. From my research online, I believe what I have is Actinic Granuloma (could be a rare subset of granuloma annulare). Can you help treat this condition?
Granuloma annulare and actinic granuloma are benign chronic conditions that are very difficult to treat. Most of the time they regress spontaneously after a while but on occasion they can persist. When spots are in visible areas such as on the face, there is even more pressure to try alternative treatments if spontaneous resolution has not recurred. These alternatives should be carefully discussed with your dermatologist as you would want to be aware of all benefits and side effects.
My child has a small (size of a pinky nail?) cafe au lait spot on her face and has asked about removal. We have been told not to but I really want her to have the choice. However, I would like her to know if it would cause scarring. Would you anticipate scarring?
Removal of cafe au lait macules is currently not recommended because of scar formation. The only technology currently believed to be safe to remove growths made from pigmented cells, such as cafe au lait macules or melanocytic nevi, is excision. With this technique, a scar is expected.
I am a patient of yours. What is a good non-greasy sunscreen for face and/or body?
UVB protection is important for sunburn protection. It is measured in SPF.
For daily use without continuous sun exposure an SPF 15 is sufficient. When you are predominantly outdoors, an SPF of 30 or higher is recommended.
Sunscreen with a much higher SPF provides only insignificantly better protection against burns.
UVA protection is important to prevent skin cancer and accelerated aging. It also reduces tanning and the ability to develop freckles or sunspots. It is not yet measured. However, research has shown that Avobenzone combined with Mexoryl in some Anthelios products is the top technology to guard against UVA. Second on the market is Avobenzone stabilized by Helioplex technology in some Neutrogena sunscreens.
Zinc oxide is still an excellent all around sunscreen but has to be applied more frequently than every 2 hours when you are active outdoors.
Several choices are available for non-greasy sunscreens for face and body. I list them in descending order of overall efficacy against sunburn, skin cancer prevention and aging prevention.
Anthelios SX is a non-greasy facial moisturizer for daily use year-long. It has an SPF of 15 for burn protection and contains the powerful Mexoryl for UVA protection.
Anthelios 40 is non-greasy for face and body for outdoor use. It has an SPF of 40 for UVB (sunburn) protection and contains Avobenzone and Mexoryl. You can obtain it in our office and at the CVS pharmacy counter Neutrogena has a line called Ultra Sheer – Dry Touch. It is non-greasy and can be applied to face and body. It comes with a variable SPF for UVB protection and Helioplex technology for UVA protection. You can obtain it in nearly all drugstores.
Anthelios 60 for face and body contains an SPF of 60 for UVB protection and Avobenzone for UVA protection. You can obtain it at the CVS pharmacy counter.
Multiprotection moisturizer SPF50 is a non-greasy daily facial moisturizer for your-round use with an SPF of 50, Avobenzone for UVA protection and antioxidants for aging repair. You can obtain it in our office.
I do understand your frustration which you share with many others. Large pores are extremely difficult to treat and this is the reason that you have not found the right answer. Unfortunately, there is no technology yet to eradicate large pores. During her many consultations your daughter has heard about non-ablative (Isolaz, Fraxel) and maybe about ablative (CO2 laser) devices to tighten the skin and thereby diminishing pore size. If in fact some of these pores are scars from past acne, CO2 laser is currently the best option to lessen these scars. Retin-A should be continued. Salicylic acid, glycolic acid and microdermabrasion are relatively weak compared to
CO2 laser, and Fraxel is better than the aforementioned but may not achieve the level of tightening that CO2 laser resurfacing with Deep FX technology can. However, miracles are not yet possible in enlarged pores.
My 25yr old daughter has enlarged pores on her face or as she calls them”holes”. I have been searching on the Internet, i don’t know what can help her. She has seen several doctors, one even suggested Botox. But I am not sure that will be a good fix. What will help her? Isolaz, Frazel lasers, so much information I do not want to do the wrong thing. She has had microdermabrasions, uses retin-A, the highest salicilac acid… Please can you give me some guidelines on what we should do for her. Must be something out there to help her. Thank you for your time
I do understand your frustration which you share with many others. Large pores are extremely difficult to treat and this is the reason that you have not found the right answer. Unfortunately, there is no technology yet to eradicate large pores. During her many consultations your daughter has heard about non-ablative (Isolaz, Fraxel) and maybe about ablative (CO2 laser) devices to tighten the skin and thereby diminishing pore size. If in fact some of these pores are scars from past acne, CO2 laser is currently the best option to lessen these scars. Retin-A should be continued. Salicylic acid, glycolic acid and microdermabrasion are relatively weak compared to
CO2 laser, and Fraxel is better than the aforementioned but may not achieve the level of tightening that CO2 laser resurfacing with Deep FX technology can. However, miracles are not yet possible in enlarged pores.
Are you familiar with atrophoderma of Pierini & Pasini? My daughter was diagnosed with this and was told there is no treatment at all for this. Is this correct? Thank you.
Atrophoderma of Pierina and Pasini is a rare atrophy causing condition affecting connective tissue. While I am very familiar with it, I admit that there is no consistently effective treatment at this time.
Antibiotic treatment may work to prevent further lesions when diagnosed early. Certain lasers can help with color changes.
Good Evening,
We have a 1 month old daughter with a collection of raised, yet flat skin in the middle of her forehead. We have had one appt at Dupont with a dermatologist who believed that this could be a collection of Milia or a Nevus Sebaceous. We are extremely concerned and becoming increasingly frustrated with the lack of willingness on the part of anyone to commit to a plan of action. Could you help??? We are just looking for an explanation to set some type of expectations. (6 months to get an appt to see anyone at CHOP!!!)
Regards,
I am a physician and potential new patient with two sebaceous cysts that I’d like excised.
One is located over my mid-thoracic spine, and the other is in the groin.
Both are benign, uninfected lesions measuring about 1 cm that have been stable for several years.
There is no rash, no adenopathy, and no other associated findings.
Your receptionist stated that she cannot schedule the procedure until you first evaluate the lesions during an office visit to determine how much time to allow for the procedures.
I prefer to avoid a second visit, and another 3-week delay to await a schedule opening, and would like to discuss the specifics with you by phone in order to try to expedite scheduling the procedure.
Thank you for your prompt attention.
-CF
As a physician you understand that scheduling efficiency is paramount to provide excellent patient service. We often perform small procedures during an office visit. Larger procedures must be timed appropriately. If time allotted is too short, other patients scheduled that day may have unnecessary waiting time in the office. If procedures times are too long, waiting time for an appointment increases.
Evaluation is usually necessary to make a diagnosis and assess the need for a procedure. Any surgeon will also discuss the specifics of a procedure such as expectations of outcome and scar formation or other side effects.
When we receive specific requests from referring physicians, we can often accommodate procedures during an initial encounter because of the detail provided and the confidence that benefits and side effects are understood.
Hi,
Wondering what the copay with Blue Cross Personal Choice is for your office? I want to have a few moles removed (back) and a full skin check. Thanks
The copay for a specialist office is typically printed on your insurance card. Depending on your contract with Independence Blue Cross Personal Choice, you may have an annual deductable and posibly a co-insurance on procedures. To learn about your contract with your insurance, you may want to contact their insurance customer service.
Please also be aware that some elective procedures are not necessary covered by the insurance.
Do you accept insurances?
We accept most insurances.
However, we do not accept the following insurances:
1. AmeriChoice
2. Health Partners
3. HMO of Horizon BCBS of NJ
4. Keystone Mercy
5. Pennsylvania Access
Hi: I was recommended to you by my sister in law. She is very satified with your services.
I would love to have my children and myself to be a patient of yours but unfortunately, you dont accept the insurance I have. I wish you would reconsider and accepted Keystone Mercy and Health Partners this could help alot of children and adults with skin problems. Good dermatologists are hard to find. Also, if you can refer a dermatologist that accept KSM or HP it would be highly appreciated. Thanks PS While filling out the online regstration form the word MISSING is spelled wrong (MESSING)
We apologize that we are unable to accept all insurance plans and for the inconvenience this causes. However, we do accept out of pocket pay. My understanding is that Jefferson University Physicians at Thomas Jefferson University still participate with Keystone Mercy and the UPenn system still provides service for Health Partners.
I got Dr. Ringpfeil’s name from the Hailey-Hailey disease yahoo group. Is she experienced in the care of HHD patients?
I have special qualifications in genetic disorders of skin and connective tissue. I have performed extensive research in a number of rare genetic skin diseases including Hailey-Hailey disease, Darier disease, pseudoxanthoma elasticum and cutis laxa. Through my in-depth scientific knowledge, I had the privilege to meet and treat many affected individuals. My expertise in these disorders resulted in a number of peer-reviewed scientific publications as well as text book chapters. In addition, I am listed on the expert panel of F.I.R.S.T. (Foundation for ichthyosis and related disorders) and I am on the advisory board for NAPE (National Aassociation for Pseudoxanthoma Elasticum).