Medical Dermatology

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Managing Melasma

Medical Dermatologists Renton, WASome skin conditions feel like an uphill battle that will require ongoing management. Melasma is one of them. Many people feel as if every step toward progress is met by an equal or greater setback. The slightest trigger may recreate the problem all over again. We understand how frustrating it can be to manage a chronic condition like melasma. Our staff works hard to develop individual treatment plans for each patient to reach the most effective follow-up program for clearer, healthier skin.

What is Melasma?

Melasma is a skin condition in which dark brown or gray spots appear on the face. Studies indicate that women are more susceptible to melasma and that the problem may be triggered by hormonal changes during pregnancy. Sun exposure is a contributing factor to melasma flare-ups. Often, pigment changes are seen on the cheeks, jawline, or above the lips.

Treating and Preventing Melasma Flare-ups

It is not impossible to live confidently when you have melasma. Healthy, clear skin can be supported with:

  • Vitamin C. This free-radical-fighting antioxidant provides meaningful support to the skin in a number of ways. In addition to encouraging collagen proliferation when taken orally (time-released is best), vitamin C stimulates optimal cellular turnover.
  • Laser treatments. There are several laser treatments available in our Renton and Seattle offices. Specific techniques, such as Fraxel and Clear + Brilliant lasers, are indicated for people with melasma. These treatments are gentle in their delivery of light, which keeps side effects and risks to a minimum. By targeting pigment in the skin as well as cellular turnover, laser treatments achieve improvements that include uniformity in pigment and texture.
  • Lightening agents. Medical-grade skin care products containing kojic acid or hydroquinone are ideal for melasma management, as each gently lifts discoloration from the skin.
  • Sun protection. SPF is a must for any person with melasma, seeing that sun exposure is a prominent trigger for flare-ups of unwanted spots. In addition to decreasing the chances of future melasma, the daily use of sunscreen also provides protection from premature aging and skin cancer.
  • Camouflage with Protection. Understandably, there is a desire to disguise melasma when discoloration is noticeable. The use of a mineral, powder foundation with SPF fills a dual-purpose of covering discoloration and also protecting the skin from unnecessary UV exposure.

Do you need help managing melasma? Contact us at 206-859-5777, where we can schedule a consultation for you in one of our friendly offices.

When a Rash Needs Medical Attention

Most people have experienced some type of skin rash in their lifetime. Technically, any degree of inflammation, redness, itching, or blistering is referred to in the medical world as dermatitis. The question that many people have is whether or not a rash needs medical care. This is a meaningful question to ask and one for which the answer relates to various factors. In many cases, a rash will improve on its own or with over-the-counter treatment. However, there are some types of dermatitis that can only be managed with appropriate prescription therapies.

How to Approach a Rash

If you or someone you love has developed a rash, home remedies may be administered as long as:

  • There is no sign of fever.
  • The rash is localized and is not rapidly spreading (rapid onset and spreading requires urgent medical care).
  • There is no sign of infection, such as redness or oozing.
  • The rash is not causing severe pain.

One of the prominent suggestions for treating a common rash is to pamper the skin with a gentle moisturizing. Hot baths and showers should be avoided as this will dry out the epidermis and degrade the skin’s natural protective barrier. Itching may be managed with an over-the-counter antihistamine. All chemicals should be avoided as much as possible. This may mean using soap and shampoo for sensitive skin until the rash improves.

When to see a Dermatologist

A dermatologist is a medical doctor whose post-doctoral education has focused on the hundreds of skin conditions that exist. A dermatologist is an optimal choice for care when a rash is severe or persistent because symptoms may indicate conditions such as atopic dermatitis, or eczema.

Dermatitis is treated based on type and severity. Minor cases of inflammation and itching may respond well to topical steroid medication. More severe dermatitis may require a short course of oral medication in combination with topical steroid cream. Some conditions, such as eczema, respond to treatment but may flare up periodically. Dermatologic care revolves around identifying triggers and managing optimal skin health through lifestyle recommendations and appropriate medical therapies.

Don’t wait to have a concerning rash examined. Call 206-859-5777 today to schedule an appointment in our Renton or Seattle office.

Tips for Managing Acne-prone Skin

acneAcne can be a stubborn problem that feels impossible to resolve. The team at Pacific Dermatology offers patients from Seattle, Renton, and surrounding area the treatment options they need to feel better about their skin. Here, we will look at some of the top ways to manage skin that is prone to breakouts.

  1. Don't wait to get help. The idea that acne is a minor skin problem that will run its course is a huge myth. When a person has acne-prone skin that is highly irritable more often than not, there is a high likelihood that a mild breakout will quickly escalate into severe acne. In nearly every case, it is possible to avoid this with prompt, professional care.
  2. Professional assessment is a valuable tool for skin care. Have you ever tried an acne solution that you have heard rave reviews about? It seems to be working for everyone else, but it's not working for you. This can be frustrating, and may even cause you to feel hopeless. The problem is not you, it's just that your skin is unique. Consulting with a skin care professional, you can discover which products will soothe and nourish your skin.
  3. Be consistent. Clearing existing acne is one thing. Maintaining the skin long-term is another. If your skin is prone to acne or highly sensitive, your routine is vital to dermatologic health - and to your emotional well-being, too. This is another area in which professional care is valuable. We not only provide treatment to resolve an existing breakout, but we follow up with patients to ensure they have the proper tools to care for their changing skin. A visible breakout may not occur until 90 days after pores become clogged. So a healthy daily regimen is crucial.
  4. Be gentle. Acne is not something that can be scrubbed away, no matter how much you want it gone. If you have severe acne, be gentle with yourself. Acne is not your fault. Also, be gentle with your skin. It is in need of TLC, not aggressiveness. Using a mild cleanser may be a better solution than using a harsh acne product.

We can help you discover what your skin needs so the risk of future breakouts decreases. Schedule your visit with us today.

Phototherapy an Ideal Treatment for Some Cases of Psoriasis


The chronic inflammation and redness of psoriasis can be disruptive to your sense of confidence. The condition is not fully understood, though research has identified it as an autoimmune disorder rather than a clear dermatologic condition. The patches of skin that become noticeable are those on which cellular turnover occurs too quickly. T-cells, in particular, behave abnormally, leading to discomfort, itching, and embarrassment. In order to improve quality of life, it is important for the person with psoriasis to find solutions that will reduce inflammation and flare-ups.

PsoriasisAt Pacific Dermatology, patients receive care that is based on their unique condition. We consider the severity of psoriasis, the type, and its location and extent of coverage. The goal of treatment is to soothe irritation and promote healthier skin by reducing the risk of flare-ups. One of the ways we do this is with phototherapy, a modality that has shown promising results in clinical investigations. Treatment can be obtained in one of our comfortable Washington dermatology offices.

What is Phototherapy?

On a technical level, phototherapy is essentially light therapy. To treat psoriasis, narrow-band UVB light may be used. This is the same UV light that comes from sunshine, and the wavelength that produces the greatest positive effect on the skin. Many experts find narrow-band UVB ideal for patients with chronic plaque psoriasis.

Phototherapy is not the same as lying under the sun! This precision treatment is conducted at recommended intervals and for only short durations each time. The controlled delivery of specific wavelengths improves the condition of the skin without increasing the risk of skin cancer, like tanning or even certain other types of phototherapy. Narrow-band UVB is safe for patients of all ages, even children, and pregnant women.

How Phototherapy Works

The in-office phototherapy treatment is performed in a series. Depending on the condition, sessions may be scheduled every few days for a few weeks. Topical skin treatments may also be prescribed to improve skin health. During sessions, light waves target abnormal cells, slowing their growth. As a result, the existing flare-up has greater opportunity to heal, and further buildup of cells is reduced or prevented altogether.

To see the improvement you desire with your psoriasis, it is necessary to see a physician with specific expertise in the diagnosis and treatment of dermatologic conditions. To schedule a visit to Pacific Dermatology & Cosmetic Center, call 206-859-5777.


Introduction to Dermatoscopy

Ashley Miguel, PA-Cby Ashley Miguel, PA-C

After spending the past six months all bundled up, it makes sense to start a new season by having a full body skin exam. Many of us have a number of questionable skin growths that may have changed unnoticed over the winter months. At PD&CC Renton clinic, Dr. Erica Linnell and I both perform thorough head to toe skin exams utilizing a special instrument called a dermatoscope.

dermascopeThis hand held light device consists of a magnifier (typically x 10), by which questionable skin lesions can be examined in greater detail. The advantages of using a dermatoscope are numerous, but the most important is its enhanced accuracy for detecting melanoma. This means melanomas are found when smaller in size and earlier in their development, which correlates to a greater long term prognosis after treatment.

Dermatoscopes also help to rule out what does not need to be biopsied, thereby reducing unnecessary procedures on benign lesions. If you have any growths that have been changing in shape, border, color, size, or causing symptoms of itch, pain, or bleeding, I urge you to set an appointment to have a full body skin exam.

My name is Ashley Miguel, and I am a dermatology physician assistant with 5 years of experience using dermatoscopes as a daily part of my practice. I am currently accepting new patients and pride myself on in depth examinations and addressing all of my patient’s concerns. Make sure you are receiving the best care possible by seeing a dermatology medical professional who is trained in this technique.

You can contact our Renton office here or call 206-859-5777 to make an appointment.

Cosmetic Options for Acne Treatment

Acne is a Upload: July 31, 2015skin condition that results in cysts, pimples and lesions on your face, neck, back, chest, upper arms and shoulders. It is the most prevalent skin condition in the United States and it can affect anybody - from teenagers to adults. The problem, which is usually visible prominently, can be a source of self-consciousness as well as embarrassment and can lead to a tendency to avoid social occasions.

About Acne and its Treatment

  • Causes of acne: Acne is caused due to clogged pores. Pores of your skin may get clogged due to an increased amount of oil production, bacteria buildup, or irritation of your pores and hair follicles because shedding of the dead cells of your skin. Whenever this buildup happens in your hair follicles, a lesion develops. The reason for increased amounts of oil production is not known; it may be due to genetic factors, bacteria, hormones, or medications. It should be noted that chocolate do not actually result in acne, nor do other foods.
  • Symptoms: While the skin condition can usually be seen on the areas mentioned previously, it can also happen anywhere else on the body. Whiteheads, blackheads, pustules, redness, cysts, nodules, scarring, skin inflammation are some of the symptoms of acne. The symptoms may not always be there and they may flare up due to environmental factors, like very humid conditions, or hormonal changes in your body, like during menstruation and pregnancy. Certain cosmetic products can also cause a flare up of the symptoms as can some medications.
  • Treatment: The one thing you have to keep in mind is that there is no overnight cure for acne. It will take time, of the order of a few weeks, for any treatment to show its effects. Over-the-counter medications containing salicylic acid or benzoyl peroxide can help mild cases; severe cases will need prescription medications. Chemical peels, photodynamic therapy, and laser treatments may also be needed.

For More Information about Acne Treatment, Contact the Pacific Dermatology & Cosmetic Center.

If you need help with acne, contact Pacific Dermatology & Cosmetic Center. You may also call us at 206-859-5777 or visit our Seattle or Renton office.

Understanding Psoriasis

Despite affecting an estimated 7.5 million Americans, psoriasis is still a widely misunderstood condition. It develops as a result of an autoimmune disorder and involves the rapid buildup of skin cells, leaving patients with red patches of skin with silvery scales, dry or cracked skin, itching or burning, crusting and more. This chronic condition affects patients of all ages, and can appear anywhere on the body. To help get a better understanding of this condition, take a look at some of the lesser-known facts about psoriasis.

Five Facts about Psoriasis

  1. Psoriasis is not contagious. As psoriasis can leave skin red, raised and scaly, many think that it is an infection they can "catch" if they come into contact with it. However, this condition is not contagious and cannot be spread through any form of contact.
  2. There is no cure for psoriasis While there is currently no cure available for this condition, there are a number of treatment options aimed at reducing or eliminating the symptoms that accompany it. These can include oral medication, light therapies, topical treatments or any combination of these options.
  3. There are several different types of psoriasis. There are five forms of psoriasis -- plaque psoriasis, guttate psoriasis, pustular psoriasis, inverse psoriasis and erythrodermic psoriasis. Each type can bring about their own set of symptoms, and patients may sometimes experience more than one form of psoriasis.
  4. Psoriasis can bring about additional conditions. Those living with psoriasis are at an increased risk for additional health concerns, known as comorbidities. These include psoriatic arthritis, cardiovascular disease, diabetes and more.
  5. The cause is unknown. While the majority of researchers agree that psoriasis develops due to the immune system being mistakenly triggered, there is currently no known cause for this condition. Triggers can include stress, skin injury, the effects of certain drugs, smoking and more.
  6. To Learn More about Psoriasis, Contact Dr. Jennifer Reichel Today.

    For more information psoriasis and the treatment options available, contact the Pacific Dermatology and Cosmetic Center in Seattle and Renton. To schedule an appointment, please call 206-859-5777. We look forward to meeting you.

Acne Scarring

Hi there Victoria.

Thank you for sending in a consultation request about treating acne scarring on your cheeks.

Acne Scarring affects so many people. I would love to be able to tell you that there a magic bullet that will cure scars - especially acne scars - since they affect so many people. Even I have dealt with them (on my temples). Maybe some day we will be able to completely erase them - with each decade (THAT'S A LOT OF TIME) we have improved options to help smooth acne scars.

I would love to see you in consultation to look at your skin and make a plan tailored just for you. There are many different safe and effective treatment options. We have treated so many patients in the past 12 years (1000's). I always sit down and talk with every patient in consultation to discuss what is right for you as an individual and to address your specific concerns and options.

Please call 206-859-5777 to make a cosmetic consultation appointment. I can also have my receptionist, Melissa, call you to book an appointment.

Thank you for your inquiry - please remember to say you found us on Realself, as the $80 consultation fee is then waived.

Thanks again.

Dr. Reichel
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center

Topical moisturizers not working for irritated skin?

My child has very dry, itchy, and red skin and topical moisturizers are not working anymore.  What should I do? -T

Dear T,

I am sorry to hear about your child but you have come to the right place!  There are several different skin conditions that could be causing these skin changes in your child, some common ones being eczema (atopic dermatitis), allergic skin reactions, psoriasis, dandruff (seborrheic dermatitis), and even dry skin (xerosis).  Over the counter moisturizer brands I like to recommend are CeraVe, Cetaphil, Eucerin, Neutrogena, Aveeno, and Vaseline.  When these are not working to control your child’s symptoms of itchy, dry, and red skin then it may be time to visit us here at our Renton dermatology clinic to properly diagnose your child’s skin condition and discuss stronger treatment options.

Megan Larson, PA-C

Pacific Dermatology & Cosmetic Center

Renton, WA

Laser treatment for Hidradenitis Supurativa?

Megan, I am a 34 year old female and have recently been diagnosed with hidradenitis suppurativa. Can laser hair removal help with my condition? -E

Dear E.

Thank you for asking Megan Larson, one of our wonderful PA-C’s at Pacific Dermatology & Cosmetic Center in Renton about Hidradenitis Supurativa and laser hair removal.

Here is Megan’s answer:

Yes, laser hair removal can be helpful for many patients with this condition. We use either Intense Pulse Light (IPL) or the LightSheer Duet Diode laser. It takes a series of treatment sessions, and should be used in combination with other forms of treatments.

Hidradenitis suppurativa, or acne inversa, is a chronic inflammatory condition that causes painful bumps and nodules in areas that rub, like the armpits and groin.  This condition affects mostly women between puberty and 40-years-old, and about 1-4% of the population has it.  The bumps and nodules can become swollen and painful, can become inflamed and leak pus, and can lead to scarring and disfigurement.  As one can imagine, this condition can cause significant psychological distress and can affect people’s self-esteem and the way they interact with others.  There are many treatments for hidradenitis suppurativa, and some people are able to attain full clearance while others suffer a more chronic and relapsing course.  A few of the treatment options include topical medications, oral medications, injections, surgery, and lasers.  At Pacific Dermatology and Cosmetic Center in NorthGate Seattle, or in Renton, we do everything we can to try and help our patients achieve full clearance and maintain it.  We tailor our treatment plans to the needs of the individual patient, and will work with them to attain their optimal result.

Megan Larson, PA-C

Pacific Dermatology & Cosmetic Center, Renton


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