By: Farhan Khan, MD

Edited By: Karan Sra, MD

Herpes simplex virus type 2 (HSV-2) is the most common cause of genital herpes, a common sexually transmitted disease. Over 50 million individuals in the United States have genital HSV infection. Genital herpes causes chronic, recurrent episodes of painful genital ulcers. Individuals with genital herpes are at increased risk of HIV infection. Transmission of genital herpes usually occurs when infected individuals do not have any symptoms of infection. The strongest risk factor for genital herpes is the number of lifetime sexual partners.

Initially, HSV-2 infection may result in asymptomatic infection or cause symptoms of localized pain, burning, and itching lasting for two to 24 hours. There are red bumps on the external genitalia, around the anal area, buttocks or upper thighs. The lesions evolve into fluid filled blisters, pustules and ulcers. Eventually, there is crusting and healing without scarring. The initial skin lesions are present from two to six weeks.

During the initial infection, HSV becomes latent in the nerves and may subsequently reactivate to cause recurrent episodes of painful genital ulcers. There are several factors associated with reactivation of the virus, including stress, concurrent infection, immunosuppression, and menses. However, most recurrences have no identifiable cause. Recurrent episodes may present with pain, itching, tingling, and there are usually fewer skin lesions compared to the initial infection. The lesions usually last for one week.

Fortunately, there are oral antiviral medications i.e. acyclovir, valacyclovir and famciclovir that are used to treat genital herpes. Although the medications do not cure genital herpes, they significantly decrease the symptoms of infection. For patients who have mild and infrequent recurrences, treatment with antivirals for seven to ten days is used to treat symptoms and decrease infectivity. The medications are most beneficial when initiated as soon as the patient experiences symptoms. Individuals who have more than six recurrences per year should be considered for suppressive therapy, where they receive daily antiviral medications to decrease the number of recurrent episodes of painful genital ulcers.

By: Farhan Khan, MD

Edited By: Karan Sra, MD

Ever wonder how some women have especially attractive, thick eyelashes that catch everyone’s attention? It’s possible that they may be using LATISSE^® (bimatoprost ophthalmic solution), a popular prescription treatment for a condition called hypotrichosis.

Hypotrichosis is a medical term referring to abnormal hair patterns, most notably loss or reduction of hair. The condition may be congenital (present at birth) or acquired (occurring after birth). There are a variety of reasons that hypotrichosis may occur ranging from complicated genetic defects to simple nutrient deficiencies. When hypotrichosis occurs in the eyelashes it may become a cosmetic concern.

The active ingredient in Latisse is bimatoprost, which is a prostaglandin (chemical mediator) analog. Prostaglandin receptors are present in hair and are thought to be involved in the development and regrowth of the hair root by increasing the duration and percent of hairs in the growth phase. This leads to eyelashes that appear longer, darker and fuller.

Latisse is a once daily treatment that is applied to the base of the upper eyelashes. A noticeable difference can be seen in as little as eight weeks with full results visible in about 16 weeks. Continued treatment of Latisse is necessary to maintain full effect, if discontinued the eyelashes will gradually return to their previous state.

Bimatoprost was originally approved for use in the treatment of glaucoma and increased pressure in the eye. It was noted that as a side effect, patients experienced eyelash growth. Many studies have been done since then and it is well established that Latisse provides patients’ with aesthetically pleasing results with a good safety profile.

Come see one of our dermatologists to see if Latisse is right for you!

By: Marigdalia Ramirez-Fort, MD
Edited By: Karan Sra, MD

Androgenetic Alopecia is the most common form of hair loss, affecting both men and women. Androgenetic Alopecia is also known as Male Pattern Baldness (MPB) in men and Female Pattern Alopecia in women.

Androgenetic Alopecia, is caused by the effects of the sex hormone, dihydrotestosterone (DHT), on genetically susceptible hair follicles. DHT causes hair loss by shortening the growth phase of the hair cycle and decreasing the size of the hair follicles. The hair that is affected by DHT becomes shorter and finer until it eventually disappears. In men, DHT affects mainly the front, top, and crown of the scalp, sparing the back and sides. In women, the hair loss tends to be more generalized.

Treatment:

There FDA has approved two medications for hair loss, minoxidil (Rogaine) and finasteride (Propecia).

Minoxidil is applied directly to the scalp and can be purchased without a prescription. It is thought to work by increasing the length of time of the growth phase of thinning hairs. Minoxidil does not work in areas that are completely bald. The drug serves to thicken already existing hair, rather than to grow new hair. Minoxidil is applied directly to the affected areas of the scalp twice a day. The formulations come in a 5% solution or foam for men and 2% solution for women. The Minoxidil solution contains propylene glycol which may irritate the scalp and leave hair feeling sticky. The Minoxidil foam is in a glycerin and alcohol base and may cause less irritation with use. The development of facial hair can be a particular problem for female patients. Females should be careful when applying minoxidil to ensure that it does not drip down the temples and forehead. The full results of the medication may not be seen for 6 to 12 months.

Finasteride, a DHT blocking medication taken orally is more effective than minoxidil in treating hair loss. The major benefit of Finasteride is its ability to slow down or even halt hair loss. Finasteride does not grow hair in areas that are completely bald and works best in areas of thinning hair. Although the long-term ability of finasteride to maintain one’s hair is unknown, the majority of men find that after 5 years the medication is still working.

Rocky Mountain Spotted Fever (RMSF) is an infectious disease caused by Rickettsia rickettsii, a gram negative bacteria transmitted by Dermacentor variabilis, the American dog tick and by Dermacentor andersoni, the Rocky Mountain wood tick. RMSF is one of the most common tick-related infections in the USA, with the highest prevalence in North Carolina, Oklahoma, Tennessee, Arkansas, South Carolina, Maryland and Virginia. Texas is the second most common state affected. 

RMSF is a curable disease if diagnosed and treated early, however it carries a high risk of fatality with late treatment and/or diagnosis. Risk of infection is highest in individuals who are actively outdoors with potential exposure to ticks (hiking, camping, gardening). The first symptoms are usually fever (as high as 103 F), headache and rash. The rash is maculo-papular (raised and flat lesions) and starts on the wrists and ankles with later extension to the trunk, palms and soles. Skin findings occur an average of 3-6 days after initial symptoms, and can sometimes include petechia  (small bruise-like rash). Other symptoms include nausea, vomiting, fatigue, and abdominal pain. It is important to note that only 10-15% of patients develop a rash, and any combination of the mentioned symptoms may occur.

If untreated, RMSF can cause serious complications such as heart failure, shock, encephalitis, coma and/or death. The diagnosis is made clinically by your physician, but labs (particularly blood antibody tests) can be checked to confirm the diagnosis. The treatment is antibiotic therapy for 10-14 days, but treatment may last longer in some cases. Due to the deadly nature of the disease, antibiotics are usually started quickly in any patient with suspicious symptoms. Although many non-infectious ticks exist, patients with history of known tick exposure should contact their doctor and preserve the tick for further evaluation if possible. If any of the above symptoms develop, RMSF could be a possibility. Prevention of RMSF can be achieved by use of insecticides, wearing of protective clothing, checking body for ticks, and early removal of ticks.

Since its introduction in 2002, the BOTOX name has become synonymous with youth and beauty.

BOTOX (onabotulinumtoxinA)  is the brand name for an injectable drug that is produced by the bacterium Clostridium botulinum.  The pharmaceutical grade form of this toxin temporarily weakens the injected muscle by intermittently blocking the release of neuro-transmitters at the junction between the nerves and the muscles. This effect is temporary and usually lasts 3-4 months.

BOTOX is used by doctors in small doses to treat wrinkles but it is also used in a number of other medical conditions including excessive sweating, uncontrollable blinking and misaligned eyes.

As we age, there are many factors that cause the skin to look older and wrinkled. There are changes on the molecular level that involve damage from free radicals, hormone loss and decreased collagen. The changes appear after years of muscle contractions as the wrinkles linger even after the muscle rests.

Cosmetically, BOTOX is injected in the area between the brow lines and in the frown lines. This relaxes the muscles in those areas and reduces the appearance of wrinkles. It can take years off the appearance of an individual without any painful cosmetic surgery.

The procedure causes little discomfort and is known to be minimally invasive. It can be done in an outpatient office visit and there is no recovery time.

The celebrities in Hollywood have been using BOTOX for years, schedule an appointment and find out why!

By: Marigdalia Ramirez-Fort, MD

Grover’s disease (GD) is rash, found mostly in men older than 60 years of age. The rash presents as numerous itchy, red, scaly bumps on the chest, shoulders, and upper abdomen. Lesions may even begin as tiny blisters, which then become scaly. The rash typically worsens during the winter months. The cause of GD is not exactly known, but may be associated with eczema, dry skin, sweating, ultraviolet radiation, and occlusion (i.e. clothing). GD has also been found to occur in association with other conditions such as chronic kidney disease.

Although Grover’s disease may be itchy, irritating and bothersome, it is a benign condition. Under the microscope, the cells in the outer-most layer of the skin are poorly connected to one another. This finding in histology is called “acantholysis”, which is why GD may also be referred to as “acantholytic dermatosis”.

Treatment:
GD is most commonly treated with moisturizers, topical corticosteroid creams and behavioral modification including control of sweating. Light therapy, isotretinoin and systemic (oral) corticosteroids are also used to manage more severe symptoms.

References:
Casanova JM, Pujol RM, Taberner R et al. Grover’s disease in patients with chronic renal failure receiving hemodialysis: Clinicopathologic review of 4 cases. J Am Acad Dermatol 1999;41:1029-33.

James WD, Berger TG, and Elston DM. “Chronic Blistering Dermatoses.” Andrews’ Diseases of the Skin. 10th Ed. Saunders:Canada, 2006, 459-78.

Scheinfeld N and Mones J. Seasonal variation of transient acantholytic dyskeratosis (Grover’s disease). J Am Acad Dermatol 2006;55:263-8.

By: Marigdalia Ramirez-Fort, MD

Pseudofolliculitis Barbae is a common chronic inflammatory disorder occurring most often in regions of thick hair growth after shaving. Pseudofolliculitis Barbae is frequently referred to as ingrown hairs, razor bumps, shave bumps, barber’s itch. It favors those of African descent with darkly pigmented skin and tightly curled hair. However, it may also develop in other shaved areas, in women, and in any racial group. Pathogenesis involves creating a sharp tip by shaving, allowing the thick hairs pierce back into the skin.As the hairs grow, they coil underneath the skin’s surface, causing an inflammatory reaction.

Presentation:
Ingrown hairs irritate and inflame the skin causing lesions that range from pus bumps to firm, red bumps. This irritation may lead to darkening of the skin and eventual scarring in the affected areas. Commonly, the cheeks, chin, jawline, neck and groin areas are affected.

Treatment:
The only way to cure the disease is to stop shaving, or to use alternate hair removal techniques. These techniques include waxing or laser hair removal. Laser hair removal provides more long-term results, although it is still possible for hair to regrow. Shaving techniques can also be optimized by avoiding close shaving, using a sharp single blade razor, shaving daily, and shaving in the direction of hair growth (not against it). The strokes should be short and even (do not shave back and forth over the same areas). Plucking is not a recommended method of hair removal. Various prescription strength topical creams may be of some help to reduce the overall inflammation and secondary infection that may occur. These medications include benzoyl peroxide, hydrocortisone, tretinoin, and eflornithine.

Reference:
Bolognia JL, Jorizzo JL, Schaffer JV. Dermatology. 3^rd ed. New York: Saunders, 2012. Print.

Taylor SC. Brown Skin. New York, HarperCollins Publishers Inc., 2003.

Edited by: Karan Sra, MD

Many people have now heard of skin resurfacing and it has become a popular procedure in the field of cosmetic dermatology.  Skin resurfacing is a controlled injury to your skin and as your skin heals, the goal is to form “good” scar tissue that evens out the surface of the skin. This reduces the appearance of wrinkles and scars. Skin resurfacing can be done at any age.

The skin is composed of the superficial epidermis and the deeper dermis. Within the dermis are two layers; the papillary and reticular dermis. Both of these layers are constructed of long fibers called collagen that loosen and stretch with age and sun damage. If the deepest reticular layer is damaged, scars result, while the upper papillary layer of the dermis heals from injuries without scarring.

Skin resurfacing can be used for:

• wrinkled or sun-damaged facial skin
• “crow’s feet” lines around the eyes
• brown spots or blotchy skin coloring
• acne or chicken pox scars

The following are some of the common techniques for skin resurfacing:

Chemical Peels:

Chemical Peels are topically applied and create a uniform and controlled shedding of the top layers of the skin. Chemical Peels can reduce blotchy, uneven pigmentation, fine lines and wrinkles, age spots, sun damage, superficial acne scarring and acne.

Microdermabrasion:

Microdermabrasion  is a gentle resurfacing procedure using a diamond tipped device that mechanically exfoliates with gentle suction to remove the uppermost layer of dead skin cells from the skin surface. This technique has been remarkably effective in removing excess oil, blackheads and bacteria in acne patients by essentially “vacuuming up” dead skin cells, bacteria, blackheads and skin surface oils. Superficial pigmentation problems can also be improved, as can fine lines, wrinkles and irregular skin texture. It is a mild treatment and therefore results are subtle and include a freshening in the appearance and improvement in the texture of the skin, and a reduction in the appearance of fine lines or wrinkles.

Laser Resurfacing:

There are two forms of laser resurfacing. In the first form, laser resurfacing creates a uniform injury to your skin, similar to deeper chemical peel or dermabrasion. In the second form, the laser “drills” tiny holes into deeper layers of your skin, or “fractional resurfacing.” Many clinicians feel the first form of laser treatment gives greater control for the depth of injury than seen with dermabrasion or chemical peel. In fractional resurfacing, the majority of the skin surface is not injured. Your skin then tightens by “connecting the dots,” where your collagen contracts between the tiny laser holes. The benefit of fractional treatment is less surface injury. The risk is that there is a greater depth of injury.

The technique chosen depends on the the desired results and a thorough assessment by the professional performing the procedure.

To try out some of these procedures for a fresh new look click here to see current offers.