Our general dermatology clinic provides comprehensive services to keep your skin healthy and help you manage skin problems. Preventive services include full body skin cancer screening.
Managing skin problems involves gathering information about the condition and how it has responded to previous treatments; examining the skin and skin structures such as nails, hair and mucous membranes; performing tests such as biopsy or scraping of the skin; determining the diagnosis and discussing treatment options. Minor surgery may be performed to identify or treat some conditions. Our team works closely together and leverages our combined knowledge, experience, and expertise in solving complex cases.
As medical specialists, dermatologists go through an extensive training program that involves four years of internship and residency after receiving their medical degree. Dermatologists receive advanced education and training in treatment of skin, nails, and hair, which allows them to effectively treat many skin-related conditions. Dermatologists only receive their board certification after completing their training and passing a challenging multi-day exam.
A Physician Assistant or PA is a health care provider licensed by the state to practice medicine including gathering a medical history, conducting a physical exam, ordering or performing tests, making a diagnosis and developing a treatment plan as well as carrying it out. They receive board certification as Physician Assistants after completing training and passing a challenging exam in general medicine. Learning about the specialty of dermatology happens in the clinic with real patients under the close supervision of an experienced board certified dermatologist. This is just how dermatologists train in residency and our PAs were trained by our physicians in this office. Our PAs see the full range of dermatological conditions and involve the physicians when it is needed or requested.
Dermatology physicians and physician assistants can treat a wide range of conditions affecting the skin, hair and nails, including, but not limited to, acne, psoriasis, rosacea, skin cancer, wrinkles, sun spots, pigmentation problems, warts, rashes, bacterial or fungal skin and nail infections, spider and varicose veins, and sun damage. If you have a skin related problem, regardless of the part of the body it covers, a dermatology provider is the best choice for an accurate diagnosis and effective treatment as well as education.
As with any medical treatment, costs vary, depending upon the scale and severity of the condition, as well as the treatment method. However, many medical dermatology treatments are covered under insurance plans, and we will help ensure you receive maximum benefits. For treatments not covered, we also offer a range of convenient payment options. We will work hard to make sure that your skin treatments are affordable!
After conducting a thorough review of your medical history which may be supplemented by any available records, and an appropriate physical exam, your provider will make a diagnosis and then review the detailed treatment plan and education with you.
We encourage you to ask questions, and we will be glad to address any concerns you may have.
While your insurance plan may not require you to get a referral to see a dermatologist, our office REQUIRES NEW patients to have a referral from their primary care provider (PCP) to be in our systems before we can schedule them for an appointment . Please have your PCP send us a referral well ahead of you contacting us so the referral can have time to be processed in our system.
To our established patients: if your insurance plan requires you to have a referral in place, please make sure the referral is current. Some insurance plans require you to have a new referral every year.
We need to do several things to try to get your eczema better, but it really comes down to two things:
You should do some or all of the following, depending on the type of eczema you have: Reduce the amount of damaging things your skin is exposed to: Dust Mites: Get a mattress cover and pillowcase that will protect you from dust mites while you sleep. They have these at Target. Once you put them on, you can leave them on for a long time (years). You put your sheets and pillowcases over them and change them once a week Vacuum once a week in the bedroom. Allergens in the Air: Get at least two showers a day. The idea is that as you go through the day, especially when you go outside, allergens accumulate on the skin. When you get a shower, you rinse these allergens off of the skin. You only need to use soap (see below) for one of these showers everyday. You MUST APPLY CERAVE IMMEDIATELY AFTER EVERY SHOWER. Bacteria That Live on the Skin: Once a week you should fill the bathtub ½ full with water and add ¼ cup of bleach. This makes swimming pool water – you won’t be able to feel the bleach, but it kills the bacteria on your skin if you stay in for 15 minutes. After you get out, you need to make sure the towels you use to dry off have been freshly laundered so they don’t have bacteria on them from the last time you dried off. You should have freshly laundered sheets on the bed so they don’t have bacteria in them from the last time you slept in them. If you wear pajamas, they should be freshly laundered also so they don’t have bacteria on them from the last time you wore them. Yeast That Lives on the Skin: You should start washing your face, neck, and entire body with Head and Shoulders 2-in-1 Dry Scalp Care &use it as a bodywash). It helps to kill yeast that lives on the skin. Make Your Skin More resistant to the things it is exposed to: Make the Barrier Work Better After every shower or bath you must apply CeraVe Cream (found at Walgreens and Rite-Aid in the Olympia Area). You should turn off the water, reach outside the shower, get your towel and bring it back in, then dry off and apply CeraVe before you open the shower curtain or shower door. You may have two jars of CeraVe – one regular jar and one “medicated” jar. Make the medicated jar by adding one bottle of clobetasol (0.05% solution, 50cc) to a jar of CeraVe and mixing it up. You should apply the medicated CeraVe to any areas that are itching or broken out and the regular CeraVe to areas that are doing well. CeraVe works best (BY FAR) when it is applied immediately after bathing (either bath or shower). This is because, unlike other moisturizers, it must be absorbed into the skin so that it can stimulate the skin to produce more natural moisturizer. Make the Skin More Resistant to Bacteria: Start taking 4000 units of Vitamin D every day. This dramatically boosts the skin’s natural resistance to bacteria. It is a much higher amount of Vitamin D than is usually recommended.
Sunlight in the form of ultraviolet A and ultraviolet B light can cause the skin damage leading to wrinkles and cancers. Studies have shown that much of the harmful side effects of sun light which we are exposed to is additive, and early childhood sun exposure can cause problems, 10, 20, or 30 years later. Therefore, early sun protection is essential in avoiding problems such as skin cancers in adulthood.
SPF – Look for an “SPF” or sun protection factor of 15 or higher. The SPF means the amount of time one can stay in the sun without getting burned. Water proof and water resistant sunscreens usually stay on for up to one hour in water, but also need to be reapplied frequently.
The following is a list of commonly found sunscreens but may change regularly. The most important thing to look for is full spectrum coverage that includes UVA as well as UVB coverage. For the best UVA protection: Read the labels and look for Zinc Oxide, Titanium Dioxide, Parsol 1789, or Avobenzone.
Facial Moisturizers, Noncomedogenic, Blocks UVA and UVB broad spectrum:
Factors to consider: Do you like how it feels? Does it need to be waterproof? Sweat proof? Rub proof? Liquids and sprays are good for hairy areas, such as scalp and arms. Sticks for forehead and eyebrows won’t run into your eyes if you sweat. Lip cover can be colored lipstick or no-color sunscreen. Apply often and liberally.
Until the 1980’s, the problem of genital warts was politely ignored. The explosive increase in the number of cases and the realization that most genital wart infections are sub clinical (not easily visualized) has kindled both research and clinical interest. I. WHAT CAUSES WARTS? Human Papilloma Virus (HPV). More than seventy distinct wart viruses have been identified. Types 6 and 11 are the most prevalent types in larger genital warts and types 16 and 18 are most commonly associated with genital cancer. II. WHO GETS GENITAL WARTS? It is estimated 60-80% of those whose sexual partners have warts also have evidence of HPV infection. 2% of routine Pap smears show signs of HPV infection and 25% of women will show signs of genital HPV infection during their lifetime. The peak age of onset in both sexes appears to be 20-24 years with males affected twice as often as females. III. HOW CAN I TELL IF I HAVE GENITAL WARTS? Probably only 1/2 of those men with HPV actually show signs of infection. The most common complaint is growths on the penis and around the rectum. Generally warts cause no symptoms although itching, irritation, bleeding, or bacterial infection of large lesions occasionally occurs. Visible infection may be of three types: (1) 70-85% are flesh-colored, pink or brown growths with a rough surface. (2) 20% are minimally elevated, flesh-colored or pink, with a smooth surface. (3) 7% are brown and flat. Unfortunately the great majority of HPV infection is sub clinical. Use of 5% acetic acid produces a white color on the surface of warts and may aid visual identification of affected skin. IV. WHERE DO WARTS APPEAR? Persons with genital warts often have evidence of infection at multiple sites. 65% on the penile shaft or head 23-35% at the opening of the urethra 9% rectal 6% on the scrotum V. HOW IS DIAGNOSIS OF HPV INFECTION MADE? Sexual partners of those with genital warts need to be evaluated. Women need a routine Pap smear and an exam by a gynecologist familiar with the use of the colposcope. Men need to be evaluated by someone familiar with the varied appearance of genital warts. Acetic acid and magnification may be employed to reveal sub clinical disease. Special tests exist to determine which type of HPV you may have; these are primarily research tools at this time. VI. HOW ARE WARTS TREATED? The standard therapy for genital warts has traditionally been destruction of visible warty tissue. The recognition of sub clinical disease and HPV with genital cancers is causing changes in treatment. Successful treatment requires an accurate determination of both visible and sub clinical components of the disease. Management must be appropriate to disease severity in individual patients. Therapy may be prolonged and it may be necessary to employ more than one type of therapy.
VII. HOW LONG MUST I TREAT? HOW DO YOU KNOW IF I’M CURED? No one knows for sure. We will attempt to achieve a six-month disease-free interval for both you and your sexual partner. The natural history of HPV infection beyond that time has yet to be defined. VIII. HOW CAN I PREVENT THE SPREAD OF HPV? During the time of treatment and until, at least, a six-month disease-free interval has been achieved; a condom and perhaps vaginal foam should be used. XI. WHY ARE GENITAL WARTS SUCH A SERIOUS PROBLEM? Children born to mothers with genital warts may acquire warts in their mouth and throat. Certain types of HPV have been directly linked with cancer of the cervix, penis, urethra, bladder and rectum. Risks may be higher for those who smoke.
What are dysplastic nevi? Typical (or common) nevi, also called moles, are pigmented skin growths, present in 85% of adults, regardless of skin color. Most typically appear after the first 6 months of life. Most nevi are harmless. Typical acquired nevi are raised bumps or flat spots, usually smaller than an uncooked lentil bean ( ). They have an orderly appearance, with uniform round borders, even and symmetrical brown, tan-pink or flesh coloration, with or without excess hair. Dysplastic nevi do not conform to the usual appearance of typical nevi. Dysplastic means “not of the usual mold” and implies a class of nevi that is atypical, intermediate between typical and cancerous. Dysplastic nevi are usually larger than a lentil bean, unevenly pigmented or very darkly pigmented or “target” in appearance with a dark center and light rim or light center and dark rim, relatively flat throughout or raised centrally with a flat component on the edge, often but not always with fuzzy or irregular margins. Dysplastic nevi are important to recognize because they are a marker of increased risk for developing melanoma anywhere on the skin, and individual dysplastic nevi are potential precursors of melanoma. The diagnosis of a dysplastic nevus may be suspected based on its naked eye appearance. The presence of one or more dysplastic nevi may be suspected in individuals who have prominent nevi. Dysplastic nevi are extremely rare in non-whites. What is melanoma? Melanoma of the skin is a potentially deadly tumor that usually arises as a change within a pre-existing nevus, or as a new spot on previously normal skin. People who have melanoma surgically removed in an early phase of development (when tumors are small and thin) are cured. When diagnosis is delayed (tumors thick or oozing), cancerous cells of melanoma may spread via blood vessels and lympatics to vital internal organs, resulting in illness and death. Melanoma is extremely rare before puberty. More than half of melanomas develop before the fifth decade of life. Conditions that may warrant an evaluation for melanoma include a new nevus on previously normal skin, a nevus that has changed or is changing, an unusual nevus, presence of prominent nevi, a nevus present at birth, one or more dysplastic nevi, a prior melanoma, and a family history of melanoma. The risk of melanoma in whites is about 1 in 50 by age 72 years. Melanoma risk in non-whites is about one-tenth as common as in whites. What causes dysplastic nevi? Melanoma and dysplastic nevi often occur in families as a genetic trait. This means that a parent may pass the trait of dysplastic nevi and/or melanoma to children. Sometimes, the dysplastic nevus trait will skip a generation. In other words, a parent may carry the gene for dysplastic nevi (and melanoma) but not express the trait, while at the same time, the trait is passed on to one or several children who eventually express the trait. Blood relatives of people who have dysplastic nevi (or melanoma) have an increased likelihood of having dysplastic nevi and thus and increased melanoma risk. When do dysplastic nevi first develop? If dysplastic nevi are going to develop, they are usually evident by age 20 years. Dysplastic nevi are commonly evident before puberty. Dysplastic nevi usually begin as one or more prominent nevi appearing first in early childhood. Over time, the prominent nevi become more irregularly pigmented with uneven or fuzzy outlines, or with a “target” pattern and smooth outlines, usually at least as large as this spot ( ). If someone has a trait of one or more dysplastic nevi, additional dysplastic nevi may continue to appear throughout life. People who have dysplastic nevi often have a pattern of many nevi and/or relatively large nevi. What is the melanoma risk related to dysplastic nevi? People who have even one dysplastic nevus have a significantly increased risk of developing melanoma, even in the absence of a personal or family history of melanoma. When melanoma develops in someone who has one or more dysplastic nevi, the melanoma can develop in a pre-existing dysplastic nevus or as a new spot on previously normal-appearing skin. The risk of developing melanoma by age 60 years is 50% if someone has dysplastic nevi and comes from a family in which two or more members have had skin melanoma (familial melanoma); the melanoma risk in the familial melanoma setting even applies to children and is markedly higher if a person has already had melanoma. In general, melanoma risk is rare before puberty if there is no family history or melanoma. What happens to dysplastic nevi in time? Not all changes in dysplastic nevi are cancerous, and relatively few dysplastic nevi ever become melanoma. Non-cancerous changes that may occur in any nevus include irritation from trauma, inflammation, and expansion related to overall body growth during childhood and puberty. Simply being aware of having the dysplastic nevus trait increases self-awareness of suspicious nevus changes and the chance of early melanoma detection in curable state of development. Surveillance is the key to early melanoma detection in someone at high risk. What is the treatment for dysplastic nevi? For people who have only one or two dysplastic nevi, surgical excision may be recommended to reduce the frequency of surveillance examinations. Sometimes, one or two of the most suspicious nevi are removed to establish the diagnosis and eliminate the melanoma risk related to those nevi. A pathologic diagnosis is not required to recommend surveillance examinations of people who have clinically apparent dysplastic nevi or a prominent nevus pattern. If dysplastic nevi have been diagnosed, periodic surveillance examinations are recommended at least yearly for life. Photographs of the total skin surface are often used to establish baseline and aid follow-up for persons who have (or had) dysplastic nevi (or melanoma). Excision of each and every nevus is not usually recommended for people who have dysplastic nevi or prominent nevi (or melanoma). New nevi may continue to appear over time, so people who are affected require periodic surveillance examinations, at intervals varying from 3 to 12 months, depending on how rapidly nevi are changing and whether or not melanoma has occurred in an individual or family member. While most changes in pre-existing nevi or the appearance of new nevi are not melanoma, suspicious changes require immediate consultations. Blood relatives of people who have dysplastic nevi or melanoma should be examined for atypical nevi and early melanoma. What changes in dysplastic nevi may indicate melanoma? The most common early signs in a nevus that could indicate melanoma include darkening (or occasionally lightening), overall enlargement, expansion in an edge, or surface elevation. While the majority of melanomas are the size of this spot or larger ( ), any nevus that is new or changing warrants evaluation, regardless of size. Persistent itching, pain, ulceration or oozing in a nevus also may indicate cancerous change. What about sun exposure? Avoid sun-bathing, becoming red in the sun, and exposure during peak hours of the sun intensity (between 10 AM and 4 PM in most temperature climates) from early spring through late fall. For unavoidable exposure, tightly woven clothing (and/or sunscreens with a sun-protection factor of 15 or greater for areas that cannot be covered by clothing) should be worn, particularly for people who burn easily and tan poorly. Sunscreens should not be used to prolong time spent in the sun. Excessive sun-exposure, particularly during the first 15 years of life, is an important risk factor for developing melanoma, epithelial skin cancer (basal cell cancer and squamous cell cancer), premature skin aging, cataracts, and suppression of the immune system. Excessive sun exposure and/or sun sensitivity may influence the development of atypical and dysplastic nevi, and may cause dysplastic nevi to devleop melanoma. What kinds of examinations are required? People who have dysplastic nevi should examine their skin monthly for new nevi and nevi that have changed in color, surface, size, and/or outlines. Family members and mirrors may be helpful in checking difficult-to-see areas, including the back, buttocks, anus, scalp, and genitalia. A friend or relative using a blow-dryer on the hairy scalp, or parting hair throughout the scalp after washing may help to detect hidden nevi. Though your doctor may have examined your scalp, repeat examinations are useful to detect hidden nevi by hair. Any nevi detected in “hidden” sites, or nevi that concern you for any reason, should be brought to your doctor’s attention. Encourage first degree blood relatives to be examined for dysplastic nevi and early melanoma when melanoma or dysplastc nevi have been detected in any family member. Can fatal melanoma be prevented? Periodic surveillance of people at high risk for devleoping melanoma leads to early detection of melanoma in a curable stage of development. Early recognition of nevi that have recently developed melanoma may be life-saving. Copyright, Arthur R. Rhodes, 1996
CAUSE: Herpes is caused by a virus which enters the body through broken skin and lives within nerve fibers. There are generally two types of herpes virus (Type I and Type II) which produce similar disease, usually around the mouth or in the groin.
CLINICAL COURSE: The initial infection may be silent or present 3 to 20 days after acquiring the virus, as a mild to extensive painful blistering with associated swollen lymph nodes and occasionally with fever, generalized aching and joint discomfort. This may last 7 to 21 days.
Recurrent disease may be precipitated by any number of events (local trauma, sunshine, illness, stress) anywhere from twice monthly to less than once a year.
CONCERNS: It is important that your obstetrician or family physician know you have had herpes. Infections at the time of delivery of a child may necessitate delivery by Cesarean section.
Resources for reliable information include www.aad.org
Psoriasis affects between one and four percent of the population.
Generally, psoriasis consists of red, scaling patches of skin.
There are many theories as to why this happens. No one knows the cause for sure. Presently we believe an overactive immune system may release very potent immune stimulators followed by a cascade of events which culminate in the overproduction of otherwise normal overlying skin.
Although you may have psoriasis anywhere, most individuals have only a few spots at one time. Many sites commonly involved include the elbows, knees, scalp, belly button, and the lower back. The nails may also show lifting and pitting.
Most patients have some evidence of disease all the time, but the extent of the disease may vary.
No. You are not contagious. You can touch and be touched without fear.
While no one knows the exact cause of psoriasis, we are aware of many contributing factors. To some extent, psoriasis is hereditary; one fourth of patients have a family member with the disease. Triggering factors may include streptococcal infections, injury to skin (Koebner phenomena), low humidity, emotional stress, and some medications (lithium, beta blockers).
Generally the answer to this question is No. But patients with significant widespread psoriasis, associated arthritis, obesity, hyperlipidemia and hypertension warrant special more aggressive attention to address these problems and more specifically there general health.
While psoriasis cannot be “cured” with present technology, it can usually be controlled with careful medical supervision and some modifications in lifestyle.
RESERVED FOR MORE SEVERE DISEASE
Psoriasis is a chronic skin condition that affects 1% to 2% of the people in the United States. Approximately 50% of people with psoriasis have involvement of the scalp, ranging from areas of mild scaling to thick crusted plaques over the entire scalp.
Scalp psoriasis is like psoriasis elsewhere on the body. Skin cells are reproduced to quickly, and are shed conspicuously from the surface. The scales accumulate and form silvery patches on the skin. In scalp psoriasis, both scale removal and treatment are complicated by the presence of hair.
Scalp psoriasis is occasionally accompanied by alopecia (hair loss). Also, it is often misdiagnosed as chronic seborrheic dermatitis.
Most over the counter treatments for scalp psoriasis center on the use of coal tar. Coal tar is commonly used in concentrations between 1% and 5%, although higher concentrations are sometimes used. Refined coal tars, such as T/gel, Ionil T +, and Van Seb T have less odor and may cause less staining. Unfortunately, the refined tars are less potent.
The use of keratolytics, such as salicylic acid, may improve the coal tar treatment by removing thick scales of the psoriatic lesions before the coal tar is applied. Removal of scale is commonly achieved through a gentle regimen of mineral oil or other lotion, foam, cream, or ointment applied to a damp scalp and combed through with a round-toothed comb. It is important to apply lubrication to a damp scalp. After the lubrication is applied, it should be allowed to set. Lubricating agents and keratolytic agents work better if a hat, cap, or hot towel is placed on the head over them.
Keratolytic agents are used if it is necessary to break up a tough layer of scale buildup. Salicylic acid is the most commonly used keratolytic agent in the treatment of scalp psoriasis. It is generally applied as a 2% to 10% preparation. Patients receiving tratment with the higher concentrations should be cautioned to expect some irritation. It is important to watch for signs of salicylate toxicity, especially in children. Examples of over-the-counter keratolytics include Baker’s P&S Liquid, T/Sal, and Salac 6%. Some prescription compounds contain citric acid, lactic acid, and urea in a cream base.
The scalp is treated with a preparation by parting the hair and holding it in place while dribbling the preparation on the scalp, or if it is a foam or cream, rubbing it in. The preparations should be used sparingly and thoroughly massaged into the scalp. All affected areas, including around the ears and hairline, should be treated.
The amount of time that the preparation should remain on the scalp will vary from product to product. After a suitable amount of time, scales can be removed by coming gently with a round-toothed comb.
Too vigorous scale removal can lead to infection, and can break the hair off at the scalp. New psoriasis can form at the site of scratching or scraping injury (Koebner phenomenon). For these reasons, gentle scale removal is essential.
After treatment with the lubricating and the coal tar preparation, shampooing with a cleansing shampoo is recommended. A coal tar shampoo can also be used. The coal tar shampoo should be left on the scalp for the time indicated by the directions. Thorough rinsing is important.
These treatments can cause drying of the hair and scalp. Moisturizing lotions or conditioners may be helpful.
There are many other prescription options available for treatment of scalp psoriasis. They include special topical vitamin A and vitamin D preparations, various cortisones, antifungals, and antibiotics.
If you are not satisfied with the results of your efforts, let us know. We will investigate other options.
“Scalp Psoriasis”, PHARMACY NEWS, Vol. 5, Issue 1, pp. 1-2, NATIONAL PSORIASIS FOUNDATION, March 1998, Portland, Oregon.
What is melanoma? Melanoma of the skin is a potentially deadly cancer that develops as an unusual or “ugly” mole, a new mole, or a mole that changes. Melanoma is curable if detected and surgically removed in an early stage of development, before cancer cells have had a chance to spread to vital internal organs via lymphatic and blood vessels in the skin. Melanoma can occur anywhere on the skin or mucous membranes, in any racial group, and at any age, but it occurs most commonly on the skin of white adults. Melanoma is extremely rare before age 12 years. The life-time risk of developing melanoma is about 1-2% for whites. (Melanoma is one-tenth as common in non-whites.) When melanoma occurs in non-whites, about half the time it appears as a black spot (or occasionally a pink or red growth) on palms, soles, nail beds, or mucous membranes.
What are the most important risk factors for developing melanoma? The following melanoma risk factors are listed in decreasing order of importance:
Copyright, Arthur R. Rhodes, 1996
Skin cancer is not one disease. The most common type of skin cancer is epithelial skin cancer, which includes basal cell cancer and squamous cell cancer. Epithelial skin cancer is rarely deadly and usually appears as a persistent pink bump, a sore that does not heal, a scaling red patch, or a warty growth. The less common but more serious form of skin cancer is melanoma. Melanoma is a potentially deadly cancer that develops as an unusual mole, a new mole, or a mole that changes. Melanoma and epithelial skin cancers are curable if removed at an early stage of development. More than half of all melanomas are discovered by patients. You can help in early detection. The following information will help you take personal responsibility for early detection of melanoma and epithelial skin cancer.
Epithelial skin cancer (basal cell carcinoma and squamous cell carcinoma) is mostly caused by excessive exposure to sun or artificial sources of ultraviolet radiation, mostly in white adults.
Epithelial skin cancer risk is increased several-fold if you have one or more of the following:
Not all epithelial skin cancers are caused by excessive sun exposure. Other predisposing factors for developing epithelial skin cancer include the following:
Melanoma occurs mostly in white adults. However, anyone can develop melanoma, regardless of gender, race, or age. Melanoma is extremely rare before puberty and tends to increase with age.
Your melanoma risk is markedly increased if you have one or more of the following:
The above traits do not guarantee that you will develop melanoma but justify your seeking medical advice.
Your melanoma risk is slightly to moderately increased if you have one or more of the following:
The following signs and symptoms may indicate a developing skin cancer:
These signs and symptoms do not guarantee that you have a skin cancer, but justify your seeking medical advice.
Some people avoid or delay seeking medical advice because their information is misleading or false. The following are some of the more common misconceptions about skin cancer:
Melanoma is always deadly. Some people believe that melanoma is not treatable. Not true! Melanoma is curable if detected and treated in an early stage of development. Currently, 94% of people whose melanoma shows no sign of spread at the time of diagnosis are without signs of cancer 5 years later. Timely detection and surgical excision of melanoma usually result in cure.
Don’t touch a mole that is changing because you will cause cancer to spread. This myth started 50 years ago when patients delayed seeking medical advice until melanomas were large, oozing, and painful. Neglected tumors have a greater chance of spreading to vital internal organs. Once the cancer cells of melanoma are removed, these cells can no longer do harm. If cancer cells of melanoma have not spread elsewhere before surgical removal, the cure is guaranteed.
All skin cancers are the same. Melanoma is the least common but potentially most deadly of the main types of skin cancer. The more common epithelial skin cancers, basal cell cancer and squamous cell cancer, are curable at least 98% of the time. Epithelial skin cancers cause local destruction of tissue but rarely spread to vital internal organs. Some squamous cell cancers can spread to lymph nodes and vital internal organs, particularly when developing in scarring skin disease and skin sites exposed to x-ray (radiation) therapy and in patients whose immune system is suppressed by medication or disease. When diagnosed early, epithelial skin cancer is usually able to be treated with less complicated therapy and with a minimum of destruction of involved tissues.
Only whites develop melanoma and epithelial skin cancer. While non-whites rarely develop melanoma and epithelial skin cancer, the same warnings signs and symptoms apply. Melanoma can appear anywhere on the skin of non-whites, but in about half the cases, melanoma appears on the palms of the hands, soles of the feet, nail beds, or mucous membranes (inner eyelids, nose, mouth, anus, and genitalia), usually as a new or changing black spot and sometimes a pink or red patch. Epithelial skin cancer rarely occurs in non-whites unless there has been exposure to x-ray (radiation) therapy that has been used to treat disease; a chronic ulcer related to burn or scarring skin disease; a chronic draining sinus; excessive exposure to natural sunlight or artificial sources of ultraviolet radiation; or within areas of pigment loss.
A physician will usually offer to examine your entire skin surface. In addition to areas exposed to the sun, melanoma and epithelial skin cancer can occur on skin sites not commonly exposed to the sun, such as palms, soles, hairy scalp, genitalia, anal area, between toes and fingers, and nail beds.
Delay in seeking help is responsible for the majority of skin cancer deaths. Denial of a problem is your greatest enemy, second only to ignorance of the meaning of the usual signs and symptoms that could indicate a developing cancer. If you have questions about skin cancer and its warning signs, or if you have any of the signs or symptoms or risk factors listed above, take action by consulting your dermatologist or general physician.
Copyright, Arthur R. Rhodes, 1996
Warts are a very common skin condition, with the following characteristics:
Common and Plantar Warts
Treatment is indicated to prevent spread, to reduce cosmetic disfiguring, and for painful foot warts. Three methods are available:
Liquid nitrogen is a very cold (-196ºC) liquid applied by Q-tip or sprayed from a thermos directly onto the warts for 10 to 30 seconds, then after a thawing period, re-frozen again. Temporary discomfort for 5 to 30 minutes after freezing is expected and can be treated with Tylenol. A blister is expected to form within several hours to days. If needed, puncture the blister with a sterile (flamed) needle to express the fluid and promote healing. The blister may contain some blood, this is perfectly normal. This procedure may leave a scar behind. Several treatments are needed, average is 4-5 freezes 2-3 weeks apart. 50-60% successful
After a blister is punctured, apply antibiotic ointment (Bacitracin, Polysporin, Neosporin, etc) at least once daily and cover with a bandaid during the day. After a scab forms, the wart should completely fall off with the scab. Frequently, re-freezing is necessary to completely clear warts, especially when they are located on the feet or around fingernails. An average of 5 to 6 freezes is often necessary for thicker warts.
Blistering agent. 40 % successful.
Perhaps 60-80%successful for a few warts. When there are numerous or very large warts present, cure rate decreases.
Chemotherapy. Injected into warts about every 3 weeks with an anticipated 80% cure after 3 injections 3 weeks apart.
Patient is made allergic to DNCB, and then DNCB is applied to warts with an 80% cure rate. Used for the patient with numerous or very large warts which may have failed other therapy.
High dose for 2 months is very effective for children with lots of warts.
PLEASE CALL IF YOU HAVE QUESTIONS or are not sure it looks the way it should and we will schedule a time to check it sooner if necessary.
PATIENT INFORMATION REGARDING ELIDEL (pimecrolimus) CREAM and PROTOPIC (tacrolimus) OINTMENT On 3/10/05 the FDA issued a Public Health Advisory informing the public about potential safety concerns associated with the use of two eczema drugs, Elidel and Protopic. As a result, you may have some questions about these medications. In addition to having a conversation with your doctor, here is some additional information about this issue. If you have questions, please speak with your doctor. Elidel Cream and Protopic Ointment have ben shown in human clinical trials to be safe and effective treatment options for patients 2 years and above with mild to moderate atopic dermatitis (eczema). You can use Elidel or Protopic for short or intermittent long periods of treatment. Intermittent means starting and stopping repeatedly, as directed by your doctor. You can use it on all affected areas of your skin, including your face and neck. Elidel is an important treatment option for patients who have had an inadequate response to other therapies or in cases where other therapies are deemed inappropriate. Novartis and Fujusawa have conducted extensive human clinical studies with Elidel Cream and Protopic Ointment. In clinical studies started over 8 years ago and involving more than 19,000 patients worldwide, including more than 9,000 children, these medicines were found to be effective with a favorable safety profile. Long-term trials are underway with a pediatric registry that will track the long-term safety of the use of these medicines in children ages 2 to 17 years. The current Elidel Cream and Protopic Ointment product labels were the result of extensive clinical trials and discussions with the FDA and work continues with the FDA to ensure that physicians and patients have the information they need to effectively treat eczema. We believe the current label provides a thorough explanation of the risks and benefits of these medicines. Patient safety is of paramount concern to Novartis and Fujisawa and they are committed to working with the FDA to make sure that physicians and patients have the information they need to treat eczema safely and effectively. The clinical data in humans do not show any evidence of an increased risk of cancer. The Public Health Advisory referred to animal studies designed to look for cancer formation. In one study in particular, animals swallowed very high doses of an experimental form of the drug (not the approved topical cream form) over a long period of time. Some of those animals developed lymphomas. The drug levels in these animals could not be achieved using Elidel or Protopic applied to the skin. There has been no cause and effect shown between Elidel or Protopic and cancer in humans. Because Elidel Cream and Protopic Ointment are applied to the skin, very low amounts enter the bloodstream. In clinical studies, most blood levels of Elidel or Protopic were too low to measure. If you have further questions or concerns, please talk to your doctor. When you and your doctor find other treatments don’t work for you, there’s concern about risks of other treatments, or you simply can’t tolerate them, your doctor may prescribe Elidel or Protopic. These are for adults and for children as young as 2. The most common side effects are a feeling of warmth or burning where applied for the first few days; headache, cold-like symptoms, such as sore throat and cough; and rarely, viral skin infections. As a Precaution, when using Elidel or Protopic you should avoid unprotected exposure to the sun or sun lamps. Adapted from Novartis and Fujisawa informational Leaflets 6/05.
Normal Hair Behavior: Each person is born with about 100,000 hair follicles on their head. Hairs cycle through resting and growing phases.
Waking up in the morning and getting a shower removes the oil and allows the water to start escaping from the skin. To prevent this from happening, YOU MUST PUT ON CERAVE CREAM, EUCERIN PLUS INTENSIVE REPAIR CRÈME, OR NEUTROGENA NORWEGIAN FORMULA HAND CREAM within ONE Minute after drying the hands after showering in the morning. YOU MUST RE-APPLY WITHIN ONE MINUTE OF DRYING THE HANDS EVERY TIME YOU WASH THEM THROUGHOUT THE DAY.
During the day, if your hands start to get dry, painful, and/or stiff, run them under warm water for long enough to make them soft and relieve the pain, then pat them dry, then immediately put on more of one of the above. You can do this as often as necessary during the day.
GRAINS TO AVOID: Whole wheat bread, multigrain breads, multigrain cereals, wheat bran, wheat germ, whole wheat pasta, oats, OATMEAL, buckwheat, seeds
VEGETABLES TO AVOID: BEANS, LENTILS, PEAS, SOYBEANS, SOY PRODUCTS, (TOFU, SOY SAUCE), bean sprouts, brussel sprouts, asparagus, broccoli, cauliflower, spinach, CANNED vegetables
FRUITS TO AVOID: CANNED fruit cocktail, pears, bananas, CANNED fruits
MILK & DAIRY TO AVOID: Chocolate Milk
MEATS TO AVOID: Shellfish, processed meats with fillers or coatings, CANNED meats or fish
OTHER SOURCES OF DIETARY NICKEL TO AVOID:
WAYS TO PREVENT YOUR BODY FROM ABSORBING THE NICKEL YOU EAT:
Methotrexate (mtx) is a very effective drug for the treatment of psoriasis, arthritis and selected other skin diseases. There are many side effects, however, some of which are made worse by other medications. The following is a list of medications which may interact with methotrexate and must be avoided while taking methotrexate.
|Azathioprine (Imuran)||Increases the bone marrow toxicity of Imuran|
|Trimethoprime Sulfamethoxazole (Septra, Bactrim, TMPX)||Increases level of mtx with resultant bone marrow suppression|
|Etretinate (Tegison)||May increase liver injury|
|Acitretin (Soriatane), Accutane||May increase liver injury|
|Alcohol||Increases liver injury|
|Probenecid (Benemid, ColeBENEMID)||Increases levels of mtx with possible bone marrow suppression and liver injury|
|Nonsteroidal Anti-inflammatory drugs – NSAID’S (Nalfon, Ansaid, Motrin, Advil, Ibuprofen, Clinoril, Anaprox, Phenylbutazone, Naproxen, Daypro, Voltaren, Codeine, Indocin, Tolectin, Feldene, Meclomen, Relafen)||Conflicting data available. May increase levels of mtx with possible liver, bone marrow and GI problems.|
|Aspirin (Bayer, Anacin, and all others)||Increases levels of mtx with possible bone marrow, liver, and gastrointestinal problems.|
|Cholestyramine (Questran) and Colestipol Hydrochloride (Colestid)||Bile acid sequestering resins bind to and may decrease the absorption of mtx|
|Carbenicillin (Geocillin)||Elevated serum mtx levels have been reported in patients receiving high doses of Carbenicillin with possible bone marrow, liver and gastrointestinal problems.|
|Cytarabine (Cytosar)||Increases the side effects of Cytarabine|
|Chloramphenicol||May decrease the absorption of mtx|
|Dilantin||May increase serum levels of mtx|
|Tetracycline and Phenothiazines||Increase toxicity|
Common findings of molluscum:
Any temporary discomfort may be treated with Tylenol.
New bumps that were too small to be detected may appear after treatment. Call to schedule a follow-up appointment if you desire these to be treated.
Scabies is a skin disease caused by an almost invisible “itch mite” called Scarcoptes scabiei. This disease has plagued man for thousands of years and has recently been increasing in incidence. It is acquired by close personal contact and is somewhat contagious. It may spread rapidly among school children due to their close contact. Only rarely, can it be spread by exchanging clothing or towels. The mite does not “jump” from one person to another, and it does not survive more than a few days off the human body.
Yes, and the treatment is effective. The medicine prescribed should be used ONLY as directed and no more. Usually the entire family is treated because of the contagious nature of the disease, even though all family members are not itching.
At the end of the applications of cream, change clothing and bed linen which has been used the previous three days. Wash these clothes in HOT water and if possible, dry them in a hot dryer. It is not necessary to boil clothing. For blankets, have them dry cleaned, or simply place them in a closed bag for three days. The mite cannot survive off the body for any longer time.
Apply a thin layer of cream or lotion to the entire body from the neck down to the toes – top of the head to the tip of the toes on children under two years of age. Be sure not to forget finger webs, bottoms of feet, under fingernails, armpits, belly button, genitals, and groin. Do not wash hands after applying. Leave cream on overnight. Shower or bathe to remove the cream. At the time of the shower, wash clothing and bed linen used in the previous three days in the hot cycle of the washer. Remember that itching may persist to a lesser degree for several weeks. ALL individuals must be treated at the same time.
Oral medication used for severe, resistant, or epidemic cases of scabies. You are to take ______ tablets and repeat in one week.
As soon as you can tolerate it, begin using your Acne medicine or Retin-A or hydroquinone and glycolic acid or Lac-Hydrin.
Mix a solution of 1 part of Psoralen 1% solution in 9 parts of water. Soak hands and/or feet for 20 minutes, then expose to light.
After soaking, expose your hands and/or feet to the lights beginning with 30 seconds and increasing by 30 seconds each time. Expose your hands and/or feet 2-3 times per week.
For the 24 hours following exposure, protect your hands and/or feet from sun exposure using gloves or socks or one of the suggested sunscreens.
Extreme caution to avoid excess light exposure must be used when treating with topical PUVA therapy. If you have any questions, please call our office.
|Neutrogena (for sensitive skin)||Zinc Oxide|
|Sol Bar||50||Paba free|
|Copertone Spectra 3||50||Triple protection|
*SPF = Sun Protection Factor (How many times longer you can stay in the sun without burning.)
**Looking for Avobenzone, Parsol 1789, Titanium Dioxide, or Zinc Oxide as an active ingredient.
Your biopsy or surgery specimen will be sent to a lab for processing into slides for the pathology physician to read. The slides are then sent to the physician who reads them and prepares a report of results. This physician may be located in Washington, Oregon, Pennsylvania, or another state depending on the type of specialization needed to read the slides. You will see a separate charge sent to your insurance for the processing and pathology reading which is separate from your biopsy or surgery charge at our office. If you have any questions about this when it comes through, please do not hesitate to call our office or the office of the reading pathologist directly.
Duoderm Extra Thin is found at medical supply stores, such as Kirk’s, or larger drug stores. It comes in many different sizes of sheets. Start with a clean, dry wound, cut the Duoderm to a size large enough to cover the wound along with some normal skin around it. This will prevent leaks when bathing. You do not need to use antibiotic ointment when using Duoderm. Change the Duoderm every 2 to 4 days or sooner as needed. When ready to change the dressing, remove the old Duoderm, wash the wound with soap and water, dry, and reapply a new piece if needed. Wound fluid often collects beneath Duoderm. This is expected and alright. If the fluid drains, a new dressing should be applied.
It is best to avoid exposure to sun on all surgery, biopsy, and liquid nitrogen areas for 4 months. Newly healed skin is very sensitive to sunlight and will remain red if overly exposed to sunlight. After the wound has healed, #15 or higher sunscreen can be used over the treated area for 4-6 months after surgery when exposure to sun is anticipated.
SIGNS OF INFECTION: Swelling increasing after the first 36 hours, heat/fevers, excessive tenderness, pus drainage from the wound, expanding redness or red streaks.
Dr. Richert is a recipient of the William Baker meritorious service award for excellence in teaching at the University of Washington. Having grown up in the Columbia River gorge, Dr. Richert is happy to be living in the Northwest with her family.
Dr. Elm is a graduate of University of Hawaii, John A Burns School of Medicine. He is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery, and the American Medical Association.
Dr. Elm is board certified by the American Board of Dermatology.
Dr. Elm’s philosophy on cosmetic dermatology is to uncover, revitalize, and restore one’s existing beauty, in order to maintain a natural appearance
She became interested in dermatology when she started working as medical assistant for Dr. Mark Bauer in 1989. After 6 years working with Dr. Bauer, with his encouragement, she left to attend the University of Washington School of Medicine's Physician Assistant program. After nearly two years practicing primary care, she returned to practice dermatology with Dr. Bauer. She now has over 20 years of experience in dermatology.
Jennifer is a Diplomate of the Society of Dermatology Physician Assistants and is active in this PA specialty organization, sitting on 2 committees. She has published an article for the Journal of the American Academy of Physician Assistants and has been involved with the development of continuing medical opportunities for dermatology PAs. This includes editing chapters and writing questions for the Comprehensive Review Notes in Dermatology for the Physician Assistant.
Sarra quickly learned English, and after high school, pursued a career in medicine. She finished nursing school in 1994 and enjoyed working in various specialties including cardiology and dermatology.
While assisting in dermatology, she again was intrigued to pursue a higher degree. Sarra attended the University of Washington School of Medicine's physician assistant program and graduated with honors at the top of her class.
Currently, Sarra lives in the Tacoma area with her husband and six daughters.
She is an active member of the American Academy of Physician Assistants (AAPA), the Society of Dermatology Physician Assistants (SDPA), and the Washington Academy of Physician Assistants (WAPA). She attends conferences and meetings hosted by the South Puget Sound Dermatology Society, Seattle Dermatological Society, Washington Academy of Physician Assistants, and the American Academy of Physician Assistants to stay well informed on the latest dermatologic treatments and to stay informed on new changes in medicine.
Dr. Richert provides mainly general dermatology services. She is a board certified dermatologist and is also a volunteer faculty at the Univ. of Washington. She is a native of the Pacific Northwest.
Dr. Elm is our general and cosmetic dermatologist. He is a board certified dermatologist, and is a preceptor for the St. Peter’s Family Medicine residency.
Dr. Myer graduated from New York University medical school and completed her dermatology residency at the University of Arizona. She is a board certified dermatologist.
Jennifer has worked with Dr. Mark Bauer since 1989. She enjoys all aspects of patient care including preventive and surgical care and the management of chronic conditions.
Sarra has over 20 years of experience working in the medical field and over 10 years as a dermatology PA. Sarra is committed to providing the best possible care for patients of all ages
Samantha is a board certified physician assistant. She grew up in Washington and trained as physician assistant at the University of Washington.
Andrea “Dre” graduated from the University of Washington and is Board Certified by the National Commission on Certification of Physician Assistants. He is a proud US Army veteran.
We are located at the water edge on the west side of downtown Olympia. Coming from downtown Olympia, take the first right off the second round-about. If you are coming from West Olympia through Harrison Avenue, take the 2nd right off the first round-about. Use Google Map below for turn-by-turn directions.
The entrance to our offices is at the street level on West Bay Dr. Our offices are under the parking lot. You can park in our parking lot or at the street. Walk into the building entrance (has the number 304 on the front) and take the elevator to level 3. Our cosmetic and general dermatology office is on your left as you exit the elevator.