Skin Conditions

The links to handouts and different organizations are provided for the patients of East Valley Dermatology Center to use. We caution against their use for self-diagnosis and self-management. Their incorrect implementation might lead to misdiagnosis and unnecessary prolongation or worsening of the disease process (i.e. sole reliance on over-the-counter products for acne when prescription medications are needed to prevent new acne and scarring).

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An Atypical mole, also called a dysplastic nevus, is a benign growth that may share some of the clinical or microscopic features of melanoma, but is NOT a melanoma or any other form of cancer. However, the presence of atypical moles may increase the risk of developing a melanoma and is used as a marker for someone who is at risk of developing melanoma. This increased risk varies from very small for those with a single atypical nevus to higher for those with many.

Dysplastic nevi have some of the ABCD characteristics and can look like a melanoma. These features are:

  • Asymmetry – One half of the mole doesn’t match the other half.
  • Border irregularity – The edges are ragged, notched or blurred.
  • Color – The color is not uniform, shades of tan, brown, and black are present (rarely red, white & blue)
  • Diameter – The width is greater than six millimeters (size of a pencil eraser) or growing rapidly.

When dysplastic nevi are biopsied and looked at under a microscope, they have a certain pattern that allows the pathologist to make the diagnosis and exclude melanoma. Dysplastic nevi may occur anywhere on the body (even non-sun-exposed places), but are more prevalent on sun exposed areas of the body, back and legs.

What does it mean if I have a single atypical nevus?

The lifetime risk of a person in the U.S. developing melanoma is 1 in 70. A patient with one to four atypical nevi without a personal or family history of melanoma is at a slightly higher risk than the general population. Atypical nevi should be observed for changes, biopsied or conservatively excised.

What does it mean if I have many moles and atypical nevi?

The risk of developing melanoma is higher if a patient with many atypical nevi has a personal or family history of melanoma. If so, their family may have Familial Atypical Mole Syndrome. A person who fits this criteria has:

  • A relative (e.g., parent, sibling, child, grandparent, aunt, or uncle) with melanoma.
  • A large number of moles, more than 50, some of which are atypical.
  • Nevi that demonstrate certain microscopic features found during a biopsy.

Patients who fit this criteria have a higher risk for melanoma and need to do self skin exams (see below) every two to three months. They should have a complete skin exam by their dermatologist every 3 to 12 months. The goal is to permit early detection of melanoma, should it occur. The most important step you can take is to check your skin. If the appearance of a mole worries you or it changes suddenly, you should consult a dermatologist.

What can I do to prevent the development of melanoma?

Overexposure to sunlight is the main cause of melanoma. Although any race can get melanoma, fair skinned people living in sunny climates have a much higher risk (Arizona has the 2nd highest incidence of skin cancer in the world). Following these steps can help reduce your risk of developing melanoma.

  • Seek shade or stay indoors between 10am – 4pm
  • Wear light colored, tightly woven protective clothing and wide brim hats (3 inches)
  • Apply sunscreen with SPF of at least 15 – 30 to exposed areas. Reapply every hour. (Note: Sunscreens are not perfect and cannot block all the sunrays, so do not use them as an excuse to spend more time in the sun)
  • Perform self-skin exams every 2-3 months (see below)

Periodic Self-Examination – Prevention of melanoma/skin cancer is the best weapon against these diseases. But if a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion. The following is one way of self-examination that will ensure that no area of the body is neglected. To perform your self-examination you will need a full length mirror, a hand mirror and a brightly-lit room.

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If your dermatologist has advised you to take “bleach baths” to help you avoid skin infections, this handout explains what a bleach bath is and how to prepare one.

Scratching can create small breaks in your skin. If you have immune system changes from atopic dermatitis (eczema) or some other skin conditions, scratching increases your risk of skin infection from bacteria. You may be able to lower the number of infections and reduce the need for antibiotics by taking “bleach baths.”

Most swimming pools use chlorine to help reduce the bacteria and other germs in the water. With a bleach bath, you will make your very own swimming pool, right in the bathtub! This special water will help reduce the germs on your skin.

How to Create a Bleach Bath

Follow these steps to prepare your bleach bath:

  1. Add lukewarm water to fill the tub, as you would for a normal bath (about 40 gallons)
  2. Put ¼ to ½ cup of common liquid bleach (such as Clorox) into the bath water. Check the label on the bleach to make sure the concentration of bleach (sodium hypochlorite) is about 6 %.
  3. Stir the water, making sure to mix the bleach in well. This will create a solution of diluted bleach (about 0.005%), which is just a little stronger than swimming pool water.
  4. Soak in your bleach bath for about 15 minutes.
  5. After the bath, take a shower to rinse the bleach off your skin, Make sure to rinse well.
  6. As soon as you are done rinsing, pat your skin dry. Do not rub dry – rubbing is the same as scratching!
  7. Apply any prescribed medicines and/or ointments to your skin right away.

Take a bleach bath 2 to 3 times a week, or as recommended by your dermatologist.

Cautions

  • Do not put undiluted bleach directly on your skin. It can damage your skin.
  • Do not use bleach baths if you have many breaks or open areas in your skin. Bleach can make damaged skin sting and burn.
  • Do not take bleach baths if you are allergic to chlorine.

Warnings

  • Bleach baths may make your skin dry or irritated. To prevent this, apply your medicine right away after patting dry.
  • Bleach will change the color of any fabric it touches, such as your clothes, bath towels, and bath mats. Take precautions, such as using a white towel. And, be careful not to splash the bleach on your skin or clothing when you are adding it to the tub.
  • Bleach may also affect the finish of a ceramic tub over time.

Your questions are important. Please call our office if you have any questions or concerns.

As our skin ages, we develop new skin growths. These growths are benign and do not turn into skin cancers. They may be bothersome because of rubbing on clothing or jewelry. Unless the growths are causing problems, removal of them is considered cosmetic and not medically necessary to remove.

Seborrheic Keratosis (barnacle)

  • Scaling, warty or flat growths that appear to be “stuck on the skin”
  • They may be skin-colored, white, light to dark brown in color
  • They tend to occur mostly on the trunk on sun exposed skin
  • Stucco Keratoses are whitish and grow on forearms or lower legs
  • Dermatoses Papulosa Nigrans (DNP) – small brown bumps on cheeks

Lentigo (age spots, liver spots)

  • Light brown to dark brown spots that do not fade over time
  • They appear in sun exposed areas of the skin, such as the face or back of the hands
  • If you have them, it increases your risk for skin cancer (means you have had a lot of sun exposure)

Cherry Angioma (cherry spots)

  • Bright red or purple small bumps on the trunk, usually on the chest and abdomen
  • They are an overgrowth of blood vessels

Skin Tags / Polyps

  • Tag-like growth found around the neck, armpits and the groin
  • Can be skin-colored, pink or brown

Dermatofibroma

  • A firm bump, usually on the legs, can develop secondary to a trauma (insect bite or ingrown hair)
  • Can be skin-colored, pink or brown and feel like a BB under the skin

Sebaceous Hyperplasia

  • Yellow small donut-shaped bumps on the face
  • It is an overgrown oil gland

Keratosis Pilaris

  • Very small rough bumps on the upper arms caused by plugging of the follicles

Milia

  • Very small white ball under the skin, usually on the face
  • They are very small cysts, made up of a wall-filled with oil and dead skin

Cyst

  • Larger and deeper than a milia, they are skin-colored movable bumps under the skin
  • Occur on the scalp, neck, face and back
  • Filled with white, cottage-cheese like material

Lipoma

  • Soft movable, skin-colored growths under the skin
  • Can be 1-2 inches wide, are made of fatty tissue and are only rarely bothersome

Website for more information: www.evderm.com; www.aad.org; www.dermnetNZ.org

The Arizona desert can be harsh on the skin. Dry skin can be worsened by low humidity, operation of heaters in the winter, bathing more than once a day, and over-use of soap. Hot water and soaps can remove the essential oils from the skin, which leads to dryness and itching. Dry skin or irritation also aggravates many skin conditions. Small changes in how you cleanse your skin can improve your symptoms and skin condition.

  1. Bathe / Shower in lukewarm water.
  2. Avoid over-bathing (once daily, less than 10 minutes is fine).
  3. When bathing, LIMIT the use of SOAP to the face, armpits, groin and feet. Use hands only; no luffa or wash clothe needed.
  4. Use a gentle cleanser such as: Cerave, Cetaphil, Dove Bar, Vanicream Bar.
  5. Avoid soaps such as Ivory, Irish Spring, or Dial.
  6. Pat dry after bathing. Within 0-2 minutes, apply prescribed medication. Apply to any red or itchy areas, then apply a CREAM based moisturizer (Cerave cream, Vanicream, or Eucerin cream).
  7. Try to lower the temperature in the house, and use a humidifier.
  8. Rubbing and scratching your skin worsens the itching, so you can use ice packs for the spots that are itching and/or apply more moisturizer.

Your skin will begin to improve and heal over the next 3-4 weeks.

Everyone has moles. Most people think of a mole as a dark brown spot, but moles have a wide range of appearances. Moles can appear anywhere on the skin, even in areas that have not been exposed to the sun. Most appear during the first 20 years of life, although some may not appear until later in life. The number of moles you have is determined by family history and the amount of sun exposure during childhood (more sun = more moles).

Each mole has its own growth pattern. At first, moles are flat and tan, pink, brown or black. Over time, they usually enlarge and rise up from the skin forming a bump, some even develop hairs. The color usually lightens. The lifecycle of a mole takes about 50 years. Moles may darken with exposure to the sun or if women are on birth control or pregnant. Most moles cause no problems, but there are few types that need closer attention.

Recent studies have shown that some moles have a higher-than-average risk of becoming cancerous. One is congenital nevi, which are moles present since birth. Congenital nevi tend to be larger, darker, and hairier. When a congenital nevus is more than 8 inches across, it poses the greatest risk for developing melanoma.

The other type of mole at risk of becoming cancerous is dysplastic nevus, also called “atypical mole”. They are larger than average (bigger than a pencil eraser) and irregular in shape. Their color can be uneven with dark brown centers and lighter, sometimes reddish, uneven borders or black dots/speckles at the edge. Someone with dysplastic nevi may have a greater-than-average chance of developing malignant melanoma. These people should be seen regularly by a dermatologist to check for any changes that might indicate skin cancer. They should also learn to do regular self-skin exams (see below), looking for changes or new moles. They also need to be more aggressive with sun-protection by using sunscreen and protective clothing.

The most important step you can take is to check your skin. If the appearance of a mole worries you or if it changes suddenly, you should consult a dermatologist.

Use the ABCD’s to monitor changes:

  • Asymmetry – One half of the mole doesn’t match the other half.
  • Border irregularity – The edges are ragged, notched or blurred.
  • Color – The color is not uniform, shades of tan, brown, and black are present (rarely red, white & blue)
  • Diameter – The width is greater than six millimeters (size of a pencil eraser) or growing rapidly.

Prevention / Protection

Overexposure to sunlight is the main cause of skin cancers. Although any race can get skin cancers, fair skinned people living in sunny climates have a much higher risk (Arizona has the 2nd highest incidence of skin cancer in the world). Following these steps can help reduce your risk of skin cancer or of getting second skin cancer.

  • Seek shade or stay indoors between 10am – 4pm
  • Wear light colored, tightly woven protective clothing and wide brim hats (3 inches)
  • Apply sunscreen with SPF of at least 15 – 30 to exposed areas. Reapply every hour. (Note: Sunscreens are not perfect and cannot block all the sunrays, so do not use them as an excuse to spend more time in the sun)
  • Perform self-skin exams every 3-4 months (see below)

Periodic Self-Examination – Prevention of melanoma/skin cancer is the best weapon against these diseases. But if a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion. The following is one way of self-examination that will ensure that no area of the body is neglected. To perform your self-examination you will need a full length mirror, a hand mirror and a brightly-lit room.

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Skin cancer is the most prevalent of all cancers. It is estimated that more than one million Americans develop skin cancer every year. Early detection is the surest way to a cure. Develop a regular routine to inspect your body for skin changes. If any growth, mole, sore, or skin discoloration appears suddenly, or begins to change, see your dermatologist.

Precancers or Actinic Keratosis – are small, scaly spots that keep peeling and do not heal. They are commonly found on the face, lower arms, and back of the hands. They occur in light skinned people with extensive sun exposure. If not treated, these can become a skin cancer. Treating them early with cryotherapy (freezing), by applying a prescription chemotherapy cream, or with chemical peels will remove them and prevent the advancement to skin cancer.

Basal Cell carcinoma (BCC) – This skin cancer usually appears as a small, fleshy bump or nodule on the head, nose, neck, back or hands. It is the most common and easily treated skin cancer. They occur in light skinned people with extensive sun exposure. These tumors do not spread quickly and take months to grow. If untreated, they will begin to bleed, crust over, heal and then the cycle repeats. They rarely metastasize, but spread locally invading deeper structures.

Squamous Cell Carcinoma (SCC) – This skin cancer may appear as a bump, or as a red scaly patch on the rim of the ear, face, lips, arms, and hands. It is the second most common skin cancer in fair skinned people. Unlike basal cell, it can metastasize. When found early and treated properly, both BCC and SCC have a 95% cure rate.

Melanoma – This is the most deadly of all skin cancers and the least common, although 1 in 70 people are estimated to get melanoma. Melanomas can appear anywhere, but in men they are most commonly on the back and in women on the legs. It occurs in the skin cells that make pigment (that tan the skin) and mostly are dark brown to black (rarely red or white) spot or bump. Melanomas can appear suddenly without warning, in/near an existing mole, or in a large congenital mole. Like BCC and SCC’s, if caught early and treated, it is almost always curable. Melanomas tend to spread or metastasize, so early treatment is essential. The most important step you can take is to have any changing mole examined by a dermatologist.  Use the ABCD’s to monitor changes:

  • Asymmetry – One half of the mole doesn’t match the other half.
  • Border irregularity – The edges are ragged, notched or blurred.
  • Color – The color is not uniform, shades of tan, brown, and black are present (rarely red, white & blue)
  • Diameter – The width is greater than six millimeters (size of a pencil eraser) or growing rapidly.

Risk factors for melanoma are 1.) Family history of melanoma; 2.) Fair skinned, blue eyed person who does not tan; 3.) Person with greater than 50 moles or atypical moles; 4.) Having 3 blistering sunburns in childhood; 5.) having extensive freckling over the shoulders; 6.) Working an outside summer job as a teen.

Prevention / Protection

Overexposure to sunlight is the main cause of skin cancers. Although any race can get skin cancers, fair skinned people living in sunny climates have a much higher risk (Arizona has the 2nd highest incidence of skin cancer in the world). Following these steps can help reduce your risk of skin cancer or of getting a second skin cancer.

  • Seek shade or stay indoors between 10am – 4pm
  • Wear light colored, tightly woven protective clothing and wide brim hats (3 inches)
  • Apply sunscreen with SPF of at least 15 – 30 to exposed areas. Reapply every hour. (Note: Sunscreens are not perfect and cannot block all the sunrays, so do not use them as an excuse to spend more time in the sun)
  • Perform self-skin exams every 2-3 months (see below)

Periodic Self-Examination – Prevention of melanoma/skin cancer is the best weapon against these diseases. But if a melanoma should develop, it is almost always curable if caught in the early stages. Practice periodic self-examination to aid in early recognition of any new or developing lesion. The following is one way of self-examination that will ensure that no area of the body is neglected. To perform your self-examination you will need a full length mirror, a hand mirror and a brightly-lit room.

Why Bother?

There are 2 types of UV (Ultraviolet) Light rays: UVA (think Anti Aging – rays that cause wrinkles and make you too age more rapidly) and UVB (Burning).  Both of these rays are responsible for causing skin cancer such as Melanoma, Basal Cell Carcinoma and Squamous Cell Carcinoma.

How to Best Protect Yourself

  • DO NOT BURN!  Use a sunscreen on the face on a daily basis with an SPF of at least 30.
  • Highly Recommended: Use products that contain the active ingredients ZINC OXIDE or TITANIUM DIOXIDE
  • For extended outdoor activity, use a water-resistant, broad spectrum (meaning protection against UVA & UVB rays) with an SPF of at least 30.
  • Avoid the sun when possible when the sun is most intense, especially between 10am and 4pm. Seek shade.
  • Wear sun protective clothing, including a broad 3-4 inch brimmed hat and UV-blocking sunglasses. (Coolibar; Sunday Afternoons; Tilley; Columbia offer sun protective wear)
  • Avoid tanning and tanning beds – better to fake it than bake it!  Self tanning lotions or spray tans are ok.
  • Apply 1 ounce or 2 tablespoons of sunscreen to your entire body 30 min before going outside and reapply every 2 hours or immediately after swimming or excessive sweating.
  • Examine your skin head to toe every month.
  • Every year, see your physician for a complete skin exam, unless directed to more frequently.

SUNSCREEN

What is SPF?  It is a measure of a sunscreens ability to prevent UVB from damaging the skin.   For example, it takes about 20 min for your unprotected skin to start turning red.  Using an SPF 15 sunscreen will lengthen that 15 times.  In terms of percentages, think of an SPF 15 as filtering out about 93% of all incoming UVB rays; a SPF 30 filters about 97% and an SPF 50 keeps out 98 percent.

The problem with SPF is that it doesn’t measure the amount of UVA protection; hence the need to pick out a BROAD-SPECTRUM SUNSCREEN.  An SPF 15 or greater, which can be found in many after-shave lotions, moisturizers and makeup, is sufficient for everyday activities with a few minutes here and there in the sun.  However, if you are spending a lot of time outside, you need stronger, water-resistant sunscreen that can be reapplied every 2 hours.  Sunscreen should be applied 20-30 min before sun exposure to allow the ingredients to fully bind to the skin, and reapplied every 2 hours and immediately after swimming, toweling off or sweating a lot.

Over The Counter Recommendations:

Face:    Eucerin Face, Cetaphil, Vanicream, Olay Sensitive Zinc 30

Body:   Neutrogena Ultrasensitive, Badger, Solbar Zinc or Shield

Kids:    9 out of 10 kids are allergic to octocrylene which photo stabilizes avobenzone. Use Zinc Oxide or

Titanium.         Babies / Faces – Neutrogena; Coppertone Waterbabies – Zinc Formula

FACTS

  • The risk of developing melanoma doubles if a person has had 5 or more sunburns.  It doubles when a child has just one blistering sunburn!
  • Suntans and sunburns result from DNA damage that can lead to skin cancer.
  • Up to 40% of the sun’s UV rays reach the earth on a completely cloudy day.  Some of the most serious sunburns are received on these days, due to a lack of any protection.

RECOMMENDED SUNSCREEN PRODUCTS

FACE

Obagi Nu-Derm                     SPF 50                        10.5% Zinc Oxide          3fl oz              Matte finish, applies

Sun Shield                      UVA/PA+++       7.5% Octinoxate                                  sheer, non-allergenic.                                                                                                                                                  Available in untinted

or Tinted (warm or cool)

EltaMD Daily Tinted            SPF 40                        9% Zinc Oxide              1.7 oz                          Antioxidant protection,

absorbs quickly, tinted

EltaMD UV Clear                 SPF 46                        9% Micronized             1.7fl oz            Contains Niacinamides –

Zinc Oxide                                        good for acne, rosacea or men

EltaMD UV Physical                        SPF 41                        9% Zinc Oxide                3fl oz             Tinted – good for women

7% Titanium

EltaMD UV Aero                  SPF 45                        9.3% Zinc Oxide             6 oz                Continuous spray, water-

resistant, oil-free

Anthelios                                SPF 40                        2% Avobenzone            1.7fl oz             Great for photosensitizing

3% Ecamsule                                        skin disorders (PMLE,

10% Octocrylene                                    Lupus, Solar Urticaria)

5% Titanium

Blue Lizard Face                   SPF 30                        8% Zinc Oxide               3 oz –               Antioxidant enriched, oil-

5 oz                 free, Gel-formulated daily                                                                                                                                       moisturize

Colorescience Mineral          SPF 50                        24.1% Zinc Oxide                                  Apply over make-up, hint of

Powder Sunscreen                                  23.9% Titanium Dioxide                              color for all day touch-ups

Jane Iredale Powder-Me      SPF 30                    17% Titanium Dioxide                              Chemical-free powder for                                                                                                         face, body and scalp, tinted            

LIPS

Vanicream Lip Protectant    SPF 30                   2% Dimethicone 6%Titanium           0.35 oz

EltaMD Lip Balm                 SPF 31                       5% Zinc Oxide              0.28 oz

Jane Iredale LipDrink          SPF 15                       1.75% Titanium Oxide

BODY

Blue Lizard                            SPF 30                        10% Zinc Oxide             9fl oz

Sensitive Skin                        5% Titanium Dioxide

** Please ask your provider for further details on additional skin care products **

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