Thursday, July 31, 2014

Vascular Birthmarks

Vascular Birthmarks
American Academy of Dermatology

What Is a Vascular Birthmark?
Many babies have what are called "birthmarks" when they're born. In some cases they appear within the first few weeks of life. They can be brown, tan , blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. they can be flat or raises, pink, red, or bluish discoloration.

What Causes Birthmarks?
The exact causes are unknown. Most vascular birthmarks are no inherited, nor are they caused by anything that happens to the mother during pregnancy.

What Are the Different Types of Vascular Birthmarks?
There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified . the most common types of vascular birthmarks are macular stains, hemangiomas, and port wine stains. There are also many rare types of vascular birthmarks.

Macular Stains
Your physician will call faint, mild red marks macular stains. They are the most common type of vascular birthmarks. They are also called "angel's kisses," when they are located on the forehead or eyelids. When they are found on the back of the neck, they're called "stork bites". They may also occur on the tip of the nose, upper lip or any other body location. They are pink and flat. Angel's kisses almost always go away by age two, but stork bites usually last into adulthood. These birthmarks are harmless and require  no treatment.

The term "hemangioma" is used to describe many different kinds of blood vessel growths. Most dermatologists prefer to use hemangioma to refer to a common type of vascular birthmark. These marks do not usually appear immediately after birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: strawberry hemangiomas and cavernous hemangiomas.

A strawberry hemangioma is slightly raised, and bright red because the abnormal blood vessels are very close to the surface of the skin.

Cavernous hemangiomas have a blue color because the abnormal vessels are deeper under the skin. Hemangiomas are more common in females and in premature babies. They can be anywhere on the
face or body.

Complications of Hemangiomas
Occasionally, a hemangioma that's growing or shrinking rapidly can form an open sore or ulcer. These sores can be painful, and can become infected. It's very important to see your dermatologist who will decide if further treatment necessary and keep this sore clean and covered with antibiotic ointment and/or a dressing.

Treatment of Hemangiomas
There are several different types of treatments for hemangiomas that need care. No treatment is absolutely safe and effective. The potential benefits must be weighed against the possible risks.

The most widely used treatment for rapidly growing hemangiomas is corticosteroid medication. This is either injected or given by mouth. Long-term or repeated treatment may be necessary. Lasers can be used to both prevent growth of hemangiomas and remove hemangiomas. Hemangiomas with ores that will not heal can also be treated with lasers. New lasers are being developed and studied by dermatologists to treat this condition

Port-Wine Stains
The port wine stain is another type of vascular birthmark that occurs in 3 in 1,000 infants. It is sometimes called a nevus flammeus, or capillary hemangioma, But it should not be confused with a hemangioma. Port wine stains appear at birth. They are flat, pink, red, or purplish discolorations found most often on the face, neck, arms, or legs. They can be any size. Unlike hemangiomas, port-wine stains grow only as the child grows. Over time, port-wine stains may become thick and develop small bumps or ridges. Port-wine stains do not go away by themselves. They last a lifetime.

Complications of Port-Wine Stains
Port-wine stains on the forehead, eyelids or both sides of the face can be associated with glaucoma, and/or seizures. Glaucoma is increased pressure within the ye that, left untreated, can cause blindness these complications occur in less than one- fourth of those with port-wine stains of the forehead and eyelids. All infants with port-wine stain in those areas should have a thorough eye and brain examination.

Treatment of Port-Wine Stains
The use of cover-up makeup has been a common treatment for port-wine stains. Your doctor can provide you with more information about products that are made to cover up birthmarks. New types of laser have shown the best results with the least amount of risk and side effects. Laser treatment of port-wine stains is FDA-approved, and available at many centers around the country. For best results, treatment should begin as early as possible, even in infancy. Laser surgery is performed on an outpatient basis. Several treatments are usually required, given at two month intervals. Younger patients often require fewer treatments than adults. In about one-fourth of the patients, lasers can totally clear up the port-wine stain. Seventy percent will look better. For reasons that are not understood, a small number of patients will not respond well to laser therapy.

Monday, July 28, 2014

Changing moles? Get in QUICK!

April 2013

Sometimes I will go 6 months without seeing a melanoma but I have had three in the last month that I wanted to tell you about. I try to tell my patients " this is a partnership my eye will hopefully pick up anything unusual, but I need you to tell me if anything starts changing".

Anyway, three women, all between early 40's and early 50's, came to me with a lesion or mole that was changing. All had been there about 6 weeks. All were biopsied and found to be melanoma. What gives me goose bumps and the message I want to convey is, if you believe a mole is changing or even have a new lesion you are worried about, try to see me in a week or two because these things can grow quickly. Basal cell carcinomas are a different story we can watch something possibly suspicious over several months before we decide to biopsy and it only grows locally. As you know, as a rule of thumb, basal cells don't metastasize and kill. So, what can I do to help? I usually have openings within the next two weeks, although it may not be at our preferred time. However, even if I have a full schedule, if you are concerned about one changing mole or new lesion, I would rather see you at the end of the day thank think you waited because you could not get in. Just tell the front desk you have a changing mole and to schedule you at the end of the day! Now that I have said that, if you have a list of other issues, I may make you reschedule for those, BUT if I am suspicious about a mole, I will take it off that day.... After seeing these three cases, I just wanted to get this off my chest. Fortunately, these three cases I talked about are in the early stages and I think all will be well. I am not trying to make you paranoid or scared; I would just hate to see you blow something off for months. I did speak to the 2 of the women already about writing this to you, and they thought it was a good idea. Pass it on to a friend if you want.

Getting back to sunscreens. Find one you actually like putting on in the am even if it is a few dollars more and you will most likely really do it. If the skin cancer threat doesn't get you to wear it, maybe vanity will! In the Times Picayune 6/5/2013 and USA today of the day prior, there is an article which shows that after 4 years of daily sunscreen use on the hands , participants were 24% less likely to show signs of increased aging.

For example, today I look out the window and it is raining. I realize my facial tinted sunscreen is on 'rain or shine'. We all really do get ultraviolet exposure (and therefore damage) all day long, through the windows as we are driving or while we're walking the dog after work.

Wearing sunscreen everyday is a habit that I developed in my 20's and have practiced since. Some people only put sunscreen on when they are at the beach or before playing tennis, etc., but so much of the harmful UV exposure is during the little times when you aren't even realizing it.

So find a sunscreen that you really like ... one that you look forward to putting on, whether it is tinted or not. Even the mineral powders have sunscreens in them. So if you are using powder, be sure to find out if it does have sunscreen protection in it and how much.

Some patients I talk to use a drugstore product (such as Neutrogena), others use something more high end ( such as Laura Mercier) in my office. In the office, we have some sunscreen products by Elta MD that I love! A while back I was interviewed on TV about sunscreens; I talked about how I actually visited stores like Earthsavers and found some sunscreens that I liked.

The key is, like your favorite shampoo, you may have to try some different sunscreen products before you find one that fits all your criteria. It is helpful if the place you are shopping lets you actually try some on or gives you samples to make sure you love it before you buy.

So what do you look for? I personally like ones with the micronized zinc oxide that disappears into my face quickly but also gives me at least a 30 SPF. The American Academy of Dermatology used to recommend a 15 SPF but increased it to a 30 when they realized that few of us put on the amount that we really need for that protection, so it kind of equals a 15!

Also, be careful in that one you like in the winter may be too moisturizing for you in the summer; you don't want to break out, do you? Its OK to have different ones for different climates. Lastly, the advantages of doing this form an early age are multifold. Your face will be a more even color with less splotchiness from the sun. If you have a problem like melisma, it is really mandatory for you to be diligent about sunscreen. Medically, you should have less of  chance of skin cancers.

Do you feel it is too late to start this now? It is never too late, but this should also be a wake up call to teach your children the basics of skin care.

Tuesday, July 15, 2014

Eczema could lower risk of skin cancer

Dermatology Times
May 2014

Defects in the skin that cause eczema may also help to lower the risk of skin cancer, recent research suggests.
    Researchers with King's College London used genetically engineered mice that lacked three skin barrier proteins to replicate skin defects often found in patients with eczema, according to a news release. They then compared the effects of two carcinogenic chemicals in both normal mice and the knock-out mice. The number of benign tumors in the knock-out mice was six times lower per mouse than in the normal mice.
   Both types of mice were equally susceptible to acquiring cancer-causing mutations, researchers noted, but the knock-out mice exhibited an exaggerated inflammatory reaction that resulted in enhanced shedding of potentially cancerous cells.
   "We are excited by our findings as they establish a clear link between cancer susceptibility and an allergic skin condition in our experimental model, " professor Fiona Watt, director of the Centre for stem cells and Regenerative Medicine and study co-author, said in the news release. They also support the view that modifying the body's immune system is an important strategy in treating cancer."

Spider Vein, Varicose Vein Therapy

American Academy of Dermatology
Spider Vein, Varicose Vein Therapy

Spider veins are dilated small blood vessels that have a red or bluish color. They appear mostly on the legs, occasionally on the face or elsewhere, and may often be unwanted. Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins.

What Causes These Blood Vessels to Become Visible?
The cause of spider veins is not known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition can very occasionally occur as part of an internal disease.

Spider veins can appear on both men and women the hormones of estrogen and progesterone may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them out. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur with large varicose veins.

Spider veins on the nose or cheeks of fair skinned persons may be related to sun exposure.

Can Spider Veins Be Prevented?
Spider veins can't always be prevented. Wearing support hose may prevent some unwanted blood vessels from developing. Keeping one's weight at a normal level and exercising regularly may also be helpful. Sun protection is important to limit the number of unwanted vessels on the face.

How Are Unwanted Blood Vessels on the Legs Treated?
A procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions called sclerosing solution is injected with a very fine needle directly into the blood vessel. This procedure has been used since 1930 and before that for longer veins. The solution irritated the lining of the vessel, causing it to swell and stick together and the blood to clot.  

Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks apart, depending on its size. In any one treatment session a number of vessels can be injected.

How Successful is Sclerotherapy?
After several treatments, most patients can expect a 50 to 90 percent improvement. Scelerotherapy can be used on all skin types. Side effects of sclerotherapy is stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps which almost always occur when the injection takes place in the ankle areas. These usually go away within 10 to 15 minutes after injection. Red, raised areas at the sites of injection which should disappear within a day or so. Bruises at the site where the needles went into the skin which disappears in a few weeks and are probably related to the thinness of blood vessel walls. Other treatment methods new lasers may hold promise for treating blood vessels, but currently vessels in the legs do not respond uniformly to laser treatment.

How are Spider Veins on the Face Treated?
There are several ways to treat spider veins on the face. Lasers have been used successfully, alone or in the combination with electric needle therapy.

What Do I Do After Treatments?
Physicians may differ in their after treatment instructions to patients. Depending on certain factors, such as size of the blood vessels injected, patients may be instructed to put their legs up for an hour or then and then walk. Others are asked to walk immediately. All patients are instructed to walk a good deal in the days following to procedure so that blood will be pushed through other vessels.

Some Physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the number of treatments necessary, and the possibility of recurrence. Other put tape dressings on the areas and do not use compression unless the veins are large or have other characteristics.

Between treatments, many physicians recommend the use of compression of support hose. this may particularly recommend  for people who spend a lot of time on their feet.