Medical Dermatology - Part 3

Recent posts

How Do You Handle Spots?

Question From D in Seattle:
 
My husband has 2 spots, one on his chest and another on his back. The one on his chest has gotten worse and is starting to bleed. We feel they both need to be removed. When would be the next available appointment he can get? Thanks
 
Dear D, Thank you for your question.
 
We can see you within the next week.
 
Spots can mean anything from true moles or other benign “lesions” to skin cancer. The benign form of “spots” include such diagnoses as seborrheic keratoses (age spots), angiomas (tiny red collections of blood vessels), sebaceous hyperplasia (yellowish bumps that are collections of oil glands), warts, moles, etc. The way that we treat benign “spots” depends on what they are. We can often use an electrical heat device called cautery, or liquid nitrogen to freeze the spots away. Sometimes we need to use lasers. We have a laser for every “spot”.
 
Sometimes “spots” turn out to be skin cancers. The most common types are basal cell carcinoma and squamous cell carcinoma. Very dark or atypical “spots” may indicate a bad mole, or a melanoma. For basal cell carcinoma and squamous cell carcinoma, we will often surgically remove them. Dr Reichel specializes in a surgical treatment called "Mohs Micrographic Surgery”. Please read about Mohs surgery on our website. Dr Reichel is a member of the American College of Mohs Surgery. This requires a year of fellowship training after graduation from Residency in Dermatology. Because we specialize in both cosmetic procedures and skin cancer surgery – we will be able to help your husband from any angle.

Dr Reichel

I believe I have cherry angiomas, do you treat these?

Question: Hi, Can you explain what these tiny red dots on my skin are? Are they cherry angiomas? If so, how would you treat them and how much do you charge, at least a ballpark figure?

 Dear VN,

Thank you for your question. We do treat cherry angiomas. Cherry angiomas are little red spots on the skin. They are painless and benign, but are a nuisance cosmetically. They can develop anywhere, but are more common on the face, and the upper body. They consist of tiny pools of arterial blood cells and are certainly not needed for normal skin function. They can develop at any time, but are more common as people age. They are most common on lighter skin types.  Luckily, cherry angiomas are very easy to treat with the right laser. My favorite laser for treating angiomas is the KTP laser. It usually only takes one treatment, although sometimes more than one treatment is necessary. The laser focuses a very bright laser light directly onto the treatment sight, and will turn laser energy into heat that is targeted only at the color RED. The angioma will turn a dark brown/black, become a little scab and then fall off after a few days. The result is usually normal appearing skin. Possible risks would include incomplete treatment, pigmentation or white discoloration at the site. It is a fairly comfortable treatment and the patient can drive to and from the appointment.
Cost ranges depending on how many cherry angiomas you have and can be from 125$ for 1-3 angiomas up to $400 or $800 if you have a whole bunch.  We can almost always treat on the same day as your consultation. Please call 206-859-5777 to make an appointment at Pacific Dermatology & Cosmetic Center

Thank you,

Dr Jennifer Reichel


Do you treat Ear Keloids?

Dear Doctor:  I was wondering if you did laser scar removal, cortisone injections, or hormone injections on ear keloids?  I have a keloid scar from an ear piercing I got over 6 years ago, and would like to know how to go about curing it and even preventing it from further growth.  Thanks, TB

Dear TB:  We do treat keloids on ears.  If you have insurance, it will often times cover the cost for the treatments.  I would want to look at your ear - so the first step is to set up an appointment for evaluation.  If the keloid is small, then the injections might be the best option.  If it is large, then an excision is the best way to go.  I have had very good results with surgical removal of ear keloids.  For most patients, we have them also see a radiation oncologist because the best results combine surgical excision followed by 1-2 treatments of very low dose radiation.  We can discuss all of this further at your appointment, please call 206.859.5777 to schedule.

Thanks for your email. I look forward to seeing you, Dr. Jennifer Reichel


Can facial redness ever go away?

Dear Doctor Reichel, I have red cheeks and get embarrassed by them.  I was told I have rosacea.  I've tried some creams but they don't seem to work very well.  My cheeks are worse right now with this cold weather and they often feel  like they're "burning".  What can I do?  Linda J.

Dear LJ,

It sounds like you may have rosacea.  If you get acne like bumps along with the redness, then an oral medication may be helpful.  For the redness, the best option is going to be a combination of vascular laser treatments.  We have 3 lasers that treat facial redness; an intense pulse light, the Aura KTP laser, and the V-Beam pulsed dye laser.  It usually takes a series of treatments-so remember that the redness doesn't usually go away after just one.

For anyone with facial redness, it is best to come in for a consulation.  If you have insurance, it should cover your initial evaluation.

For skin care products, Skin Medica now has a new redness relief cream called REDNESS RELIEF CALMPLEX.  It contains the first and only ingredient proven to affect visible redness by inhibiting release of prostaglandins (which cause vessel dilation).  You  use it twice a day as your moisturizer.  I have been using it myself, and love it!  It is dispensed out of doctors offices and is great to use as a maintenance after you have had your redness laser treatments.

Thanks for your question, Dr. Jennifer Reichel


What can I do about my Rosacea?

Hi Dr. Reichel,  I'm a 30 year old male with rosacea on my left cheek from a few sunburns and stress.  I'm interested in VBeam to treat the redness.  I'm already taking Metrogel, Finacea and Oracea and it isn't enough.  Thanks, Eric

Hi Eric,

Thanks for your question.  It sounds like you are on good treatment for the papular (acne-like) components of rosacea.  Unfortunately, the creams and oral medications don't do much for the redness or broken blood vessels.  The Vbeam or the KTP laser are the strongest lasers for facial redness.  I sometimes like to use both, and can decide depending on what we see in your personal case.  It can sometimes take more than one treatment-so be prepared for that.  Otherwise, they are pretty easy to undergo and have very little treatment on the day of your consultation. 

Answered by Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center in Seattle.


Help! I'm Struggling With Acne!

Q:  I'm interested in finding out more about treatment for body/facial acne.  I'm a 25-year old female, and have struggled with acne for about 10 years.  I would like to know about the different options I have.

A:  Acne at any age is very frustrating, however we now have many different treatment options available.  These include prescription topicals, oral antibiotics, oral contraceptive pills, spironolactone, and in more severe cases isotretinoin.  A review of your past medical history and daily skin care regimen is important as well.  The various treatment options depend on your gender, severity of acne, and other factors that can be reviewed at the time of your evaluation.  Acne can be treated and we encourage early intervention to improve your quality of life and to prevent scarring. 

Answered by Andrea English our physicians assistant at Pacific Dermatology & Cosmetic Center in Seattle.


Can You Fix Old Piercing Holes?

Q: I'm interested in correcting a piercing hole I have from a previous belly button ring. It's a completely healed hole similar to ones in women's ears. I just want the hole closed up so it's not as visible. I realize this is probably considered a "cosmetic" procedure so I was hoping to get an estimate on price.

A: Yes we could do the procedure here. It would be an office surgery that would probably take about 45 minutes total time for you. We would remove the "tube" of skin around the piercing, and suture both sides. These would stay in for 10 to 14 days. You would have a little scar, but the hole would be gone. You’re correct in surmising this would be cosmetic, a treatment insurance would not pay for. The cost for this procedure is between $400 and $600.


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