The skin is the most visible part of the body. Unfortunately there are many chronic conditions that can afflict the skin. At Chevy Chase Dermatology, we not only properly diagnose these conditions, but provide up-to-date effective treatments that all of our patients expect and deserve.

Acne

Acne consists of blocked pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules) that can appear typically on the face, neck, chest, back, shoulders and upper arms. It is the most common skin disease in the country. While it affects mostly teenagers, and almost all teenagers have some form of acne, a significant increase in adult acne has been observed over the last several decades.

Treatment for acne varies depending on the type and severity of lesions, as well as the patient's skin type, age and lifestyle. Options include topical medications, oral antibiotics, blackhead extraction, microdermabrasion, antiandrogens, and others.

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Atopic Dermatitis

Atopic dermatitis is an intensely itchy, chronic skin disease that can affect all age groups. Symptoms almost always appear before the age of five, and ten to fifteen percent of children are affected. Thirty to eighty percent of atopic patients will continue to have intermittent exacerbations throughout life, often triggered by stress.

Therapy includes preventive measures in the patient's environment, topical corticosteroids, oral antihistamines, topical immunomodulatory drugs and phototherapy.

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Hyperhidrosis (Excessive Sweating)

When localized sweating is chronic, bilateral, long-lasting and impairs daily activities, it can be treated effectively with topical applications of aluminum chloride or if needed, injections of botulinum toxin (BOTOX®) into the affected areas. In the armpits, BOTOX^® injections are extremely effective and eliminate excessive sweating for six to seven months, usually after a single treatment.

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Irritant Dermatitis and Allergic Contact Dermatitis

For people with irritant dermatitis or allergic contact dermatitis, rashes are caused by exposure to irritants or allergens in the environment. Common irritants include soaps, detergents, solvents and wool. Common allergens include poison oak and ivy, topical medications, sunscreens, preservatives, metals, cosmetics, dyes, rubber etc. Patch testing is often necessary to determine the cause of allergic contact dermatitis. Prevention is essential in avoiding recurrence of the condition.

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Moles and Birthmarks

Moles and birthmarks are pigmented spots or patches of skin that range in color from tan, brown and black (moles) to red, pink or purple (vascular lesions, such as strawberry hemangiomas or port wine stains). Some may eventually develop into cancer. Any mole that has changed in color, size or shape, or that itches or bleeds, needs to be brought to medical attention immediately.

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Pre-cancerous Lesions such as Actinic Keratoses

Actinic keratoses (AKs) are lesions on the surface layer of the skin (epidermis) usually caused by chronic exposure to sunlight. AKs typically manifest as rough, pink, scaly patches that may eventually develop into cutaneous horns. They may appear anywhere on the skin surface exposed to sunlight, but common areas include the face (including ears and lips), neck, arms and hands. About one in six white Americans will develop at least one AK over a lifetime.

Actinic keratoses may progress into invasive squamous cell carcinomas. Depending on a number of factors such as the size, location and severity of lesions, as well as the patient’s age, health, medical history, occupation, expectations and preferences, treatment for AKs may take the form of cryosurgery (freezing), curettage (scraping), topical medications, laser treatment and photodynamic therapy.

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Rosacea

Rosacea is a chronic skin disease that causes redness, flushing and swelling on the face and may result in pustules, cysts and nose enlargement. Many people find that the emotional effects of rosacea – such as low self-confidence and avoidance of social situations – are more difficult to handle than the physical ones. Although it can affect anyone, rosacea typically appears in light-skinned, light-haired adults aged 30-50. It is not yet known what causes rosacea and the disease is not curable, although it can be effectively treated with topical and oral medications, laser treatments and intense pulsed light treatments.

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Ringworm

Ringworm is a contagious skin infection that manifests as itchy, scaly, ring-shaped red patches on the skin, bald spots in the hair or beard, or discolored, thickened nails. When we refer to “athlete’s foot,” we are really talking about ringworm.

Ringworm is caused by a fungal infection. It tends to occur in warm, moist areas of the body, and can be passed from person to person by touching the skin or an item that has been in contact with the infected area. Pets – especially cats – can also transmit the fungus. Many cases occur in children, although people of any age can be affected.

Use of anti-fungal powders or creams and keeping the skin clean and dry are often sufficient to treat the infection. However, if symptoms are severe, prescription anti-fungal medications may be required.

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Seborrheic Dermatitis

Seborrhea is a chronic skin condition of unknown origin which causes scaling, oiliness, redness and itching of the skin, most commonly on the scalp (in which case it is often referred to as dandruff), face, ears, and trunk. Therapies include various medicated shampoos, cleansing agents, topical steroids and anti-yeast creams.

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Seborrheic Keratoses and Skin Tags

Seborrheic keratoses are benign flesh-colored or tan waxy patches that eventually may become dark brown or black, greasy, rough and unsightly. They can easily be removed with liquid nitrogen, curettage, electrosurgery and laser surgery.

Skin tags are benign small protrusions of the skin commonly located on the sides of the neck, in the armpits, or on upper trunk of middle-aged and elderly people. They can be easily removed with liquid nitrogen, electrosurgery or simple surgical procedures.

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Skin Cancer

Skin cancer refers to the abnormal, uncontrolled growth of skin cells. One in five people will develop skin cancer in their lifetime, according to the American Academy of Dermatology. Fortunately, skin cancer is almost always curable if detected and treated early. All skin cancers appear to be related to sun exposure. Ultraviolet-A and ultraviolet-B both play a role.

The most common skin cancers are:

1. Basal cell carcinoma (BCC) – the most common of all skin cancers. It tends to be slowly growing and frequently appears as a pinkish, translucent, pearly “pimple” that does not go away on sun damaged skin. It can also look like a scaly patch or resemble a scar.

2. Squamous cell carcinoma – tends to be more rapidly growing than BCC. It may also spread especially if located on the ear, forehead, lip, and top of the hand. It presents as an enlarging scaly nodule with poorly defined borders that may ulcerate. It may arise from an actinic keratosis.

3. Malignant melanoma – it is the fastest growing cancer in the US; the incidence doubling every 10 years. Survival is directly related to early detection since prognosis depends on the tumor thickness. It may spread to the lymph nodes, lung, liver, brain and other skin areas if not discovered and removed surgically in time. Often, the patient will present with a change in existing mole or a new pigmented lesion which often shows irregular borders, varied colors, and recent enlargement.
   Click here to read an interview with Dr. Sommerville on skin cancer Melanoma and reducing your risk.

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Warts

Warts usually present as flesh-colored, raised, rough bumps that may show black specks of pigment representing punctuate bleeding points. They are caused by papilloma virus and may spread on contact with infected skin. Therapies include liquid nitrogen therapy (freezing), applications of such topical substances as salicylic acid and lactic acid or cantharidin derived from the blister beetle, electrosurgery, immunotherapy and other treatments.

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