Clear Skin and Hair Laser Center

Moles / Warts and Other

Moles / Warts and Other

Mole Treatment

Moles

A mole, the medical term is ‘nevi’, the most common pigmented skin growth, appear as small raised dark brown spot, though the skin color can range from pink to black.

The pigment-producing skin cells melanocytes are evenly spread throughout our skin, though they can grow in clusters thus forming moles. 

Moles can exist at birth or appear later. Generally, they appear during childhood and adolescence. Most adults have 10 to 40 moles.

Genetic predisposition and abnormal exposure to the sun play an important role. Hormonal changes during puberty and pregnant women can provoke melanocyte to develop moles.

Most moles are harmless, but in rare cases they become cancerous. However, monitoring of the existing moles and sudden multiple new eruptions is an important step detecting skin cancer, called malignant melanoma.

Most moles do not require treatment except for those cosmetically undesired, but some cases require removal of the mole.

Types of Moles

 •Congenital

Congenital moles are present at birth and are caused by melanocyte cells in the dermis-epidermis. These moles vary in size from small, medium, or giant. The giant congenital mole can turn cancerous as they ages to adult life.

•Acquired mole or Common mole

Acquired moles are those that you develop later in life. Most of these are brown to dark brown and are found in people regularly exposed to the sun. These are dome-shaped smooth, pigmented with a distinct shape, and 3-6 mm in diameter. These moles are less likely or not likely to turn into cancer. Mostly they develop lighter skin since they have lower levels of melanin.

Acquired moles or nevi are further differentiated depending on the location of involvement:

Junctional Melanocytic Nevi: Here the melanocytes accumulate or proliferate between the epidermis and dermis to form these moles. They are raised, uniformly pigmented with a diameter of 2-6mm, and have regular borders.

Compound Nevi: Here the melanocyte proliferates in the epidermis and migrates into the dermis with the maturation of the cells in the deep dermis. They are round or oval with slightly raised in the central part and have flattened distinct borders.  

Intradermal Nevi: They are located in the dermis and proliferate in deeper skin; hence they are not as pigmented as junctional or compound nevi. They are formed as we age and are flesh-colored, dome-shaped papule or nodule.

•Atypical mole: also called a dysplastic nevus. Atypical moles are often odd or irregular shapes, larger than a pencil end or eraser, and appear blurry with mixed color (brown, red, and pink). They are either raised or flat and look like melanoma. However, it is not melanoma but has a higher risk of forming melanoma or cancer. They can appear anywhere on the body, often seen on the trunk. Higher risk of getting melanoma with atypical mole:

· Four or more atypical moles.

· History of having melanoma

· First-degree relative or parents having melanoma ( brother, sister, or child) 

Let us know how to differentiate a ‘regular mole’ from an irregular mole or dysplastic or cancerous mole:

Regular mole or Benign mole                                              
Dysplastic or Cancerous mole
Appear  anywhere on your skin & below age of 20
Appear anywhere on your skin, preferably trunk & after 30
Smooth surface and  asymptomatic
Associated with itch or ooze or pain
Dark brown or black
Mixed color - brown, red and pink
Symmetrical in shape
Asymmetric shape
Regular Border and or distinct
Irregular border or ill-defined border
Evenly pigmented
Uneven pigmentation
Size 2-6mm
Size exceeding 6mm
Darken during puberty, pregnancy or with time
Evolving or change in shape, size, surface and color
Usually harmless & does not require removal, except cosmetic desire to remove
Usually harmless & does not require removal, except cosmetic desire to remove

The above table clearly differentiates the malignant change in a mole and a need for a doctor visit. Most moles are benign and harmless. Older people have a higher risk. Unusual changes in a mole or pigmented spots as ages into adulthood need for a check-up or doctor visit.

The main risk factor with a mole is Melanoma, a type of skin cancer developing from a mole.

Let us know a few high risks of getting melanoma in a mole are:

· Congenital mole: Born with large size mole > 5 cms, could potentially turn cancerous as the child ages in early adulthood.

· Atypical or dysplastic nevi or irregular mole: Having unusual-looking moles with a dark brown center and lighter uneven borders and even called ‘halo moles’ due to its characteristic appearance. Few types of atypical moles are genetically predisposed to form melanoma

· Large number of moles: Having more than 50 regular moles on your body or 20 moles on their arms, are prone to develop malignant melanoma and must take preventive measures. The higher numbers of moles in a woman have a direct link with the risk of breast cancer.

However, people born with several moles or unusual looking moles or large mole at birth have a higher risk of melanoma.

Let us know a few of the preventive measures in higher-risk groups:

· Sun protection: 

Physical by using wide-brimmed hats, and protective clothing (long sleeves or pants) 

Chemical by using water-proof sunscreens with SPF 50+ 

· Avoid overexposure to the sun between 9 a.m. to 4 p.m. 

· Regular examination of moles and sun-exposed skin on a monthly or quarter yearly basis, as of risk factors.

· Avoid suntan parlor 

Intervention treatment either skin biopsy or removal of a mole is required for the following conditions:

Most moles do not require skin biopsy and or removal.

·Cosmetic undesired normal moles can be removed with the biopsy punch or surgical excision or radiofrequency device or CO2 laser.

·Suspicious (could be skin cancer) like abnormal or atypical moles are not malignant, and may or may not need to be removed. If removed, proper stitches to be done and regular check-ups are required.

·Malignant moles or melanoma: These are cancerous moles and must be removed immediately. Surgical excision has to be performed. 

Skin Tags

Skin tags are small growths of soft, hanging skin supported by a thin stalk. They can appear anywhere on the body, commonly found in skin folds, in areas like the neck, armpits, groin, and eyelids. 

The medical term is acrochordon and some people call them “skin tags or warts.

Few other features of Skin tag:

They are common in both men and women, especially after age 50

They are usually harmless and painless but may become irritated from rubbing against clothing and jewelry or other skin. 

They may appear as a small flattened pin-head-sized bump, most tags small (2-5mm) and some may become large as 1cm or fig 5cm in diameter.

Obesity seems to be associated with skin tag development. 

Causes and risk factors:

The exact causes of skin tags are not clear, but it may occur when clusters of collagen and blood vessels become trapped inside thicker pieces of skin, could be skin rubbing against skin. Skin tags appear to be more common in:                                                Overweight and obese                                                                                              Pregnancy due to hormonal changes and high levels of growth factors                          Family history of skin tags                                                                                        Type II diabetes

Treatment 

The most common reason for removal is the cosmetic appearance due to unsightly growth causing self-image issues and in few, it can become irritated from rubbing against clothing and jewelry or other skin, may require removal. 

The procedure of removal is generally done under local anesthesia, after ensuring the area to be treated is numb, one of the following procedure is undertaken:

·Electrocautery: a high-frequency alternating electric current to cauterize and remove the skin tag.

·Cryosurgery: The skin tag is frozen off using a probe containing liquid nitrogen

·Ligation: Older day’s treatment, the blood supply to the skin tag is interrupted by tying a knot at the base of it.

·Excision: The tag is cut out with a scalpel or surgical scissors.

After the procedure, you may have to take analgesics and antibiotics to relieve pain and avoid infection respectively.

We at our Clear Skin Laser Centre use the most advance and best technique for skin tag removal electrosurgery by Ellman radiofrequency device, outpatient procedure with highest safety measures. Skin tag removal at home is not normally advisable, due to a risk of bleeding and possible infection.

Milia 

Milia are multiple tiny pearly white bumps, usually seen on cheeks, nose, eyes, forehead, neck, and chest areas. A milium (single milia) is a small cyst containing protein keratin. They are formed when keratin produced by the skin gets entrapped beneath the outer layer of the skin, forming a tiny cyst. An individual milium is formed at the base of a hair follicle or sweat gland. 

What are the causes & types of Milia formation?

Milia are found in all ages and both sexes. They most often arise on the face, predominantly on the eyelids and cheek, and occur elsewhere.

The cause depends on the variants of milia:

Neonatal milia: seen nearly in half of the newborn babies; and common over around eyes, cheeks, inside the mouth. They heal spontaneously within a few weeks of birth.

Primary milia: are formed directly from entrapped keratin and are usually found on the faces of infants and adults. They occur both in children and adults. These types of milia found in infants tend to heal on their own within several weeks and found in adults tend to be long-lasting.

Secondary milia or Traumatic Milia: occur at the site of injury or burn or blistering, as the skin heals. They are formed due to the clogging of eccrine sweat ducts.

Milia en plaque

Multiple milia are formed on an inflamed or reddened and elevated area on the eyelid, behind the ear, or jaw.plaque up to several centimeters in diameter; sometimes associated with other skin diseases such as discoid lupus erythematosus, lichen planus.

Multiple eruptive milia: appear as crops of numerous milia. Most often affect the face, upper arm, or upper trunk.

Juvenile milia: appear at birth or later in life; and associated with genetic disorders and epidermolysis bullosa.

Milia associated with drugs: rare seen to the use of topical medication, such as corticosteroid, hydroquinone, and 5FU.

Signs and Symptoms

Milia are neither itchy nor painful and appear as 1–2 mm pearly white, dome-shaped bumps.

The most common locations for primary milia:

· Around the eyes, cheeks, nose, and forehead in adults and infants

· Inside the mouth (gums & palate) of infants; and are called Epstein’s pearls.

The most common locations for secondary milia:

· Anywhere on the body where another skin condition exists, particularly on the backs of the hands

· On the faces of people who have had a lot of damage from sun exposure

What is the treatment of milia?

Milia do not need to be treated unless cosmetically undesired for the patient. They are usually harmless and with time resolve on their own. 

Medical treatment:

Topical retinoid cream such as tretinoin or adapalene may be helpful for widespread lesions.

Minocycline has been shown to improve milia en plaque.

Chemical peels or microdermabrasion or dermabrasion: series of sessions are required to be effective for very extensive milia.

Cryotherapy can be applied to destroy the lesions 

Surgical removal by de-roofing using a sterile needle or blade and the contents squeezed out.

The radiofrequency device can destroy the top layer of skin and later curettage the material.

Laser ablation by co2 or erbium YAG is a recent and effective method to remove extensive milia.

However, milia are found in the outer layers of skin and are difficult to remove. Do not make an attempt to remove them at home as it may leave a mark or scar. The best method of removal of milia is by Ellman radiofrequency device or laser.

DPN 

Dermatosis papulosa Nigra (DPN) commonly known as DPN; predominantly found in darker skin (African). They are smooth round black or dark brown, flat or papular lesion, occur prominently on the cheek and around eyes; also found over the lower part of the face, neck, chest, abdomen, and back. 

What causes it?

The cause of DPN is unknown. The darker skin is at high risk usually at puberty. The genetic predisposition and ultraviolet exposure (photoaging) have been proposed. 

Signs and Symptoms: 

· DPN is mostly characterized by black or dark brown, flat, or small bumps, occur prominently on the cheek and around eyes; also found over the lower part of face, neck, chest, abdomen, and back.

· They measure from 1-5 mm in diameter.

· They usually start during adolescence and over time they tend to grow bigger and increase in number.

· DPN may be itchy or irritating and cosmetically undesired.

Treatment 

DPN is harmless and doesn’t require treatment. However, if the bumps become itchy or irritating or increase in number and size will make you cosmetically undesired due to their appearance. 

There are many treatment options for dermatosis papulosa nigra as mentioned below; which are usually done with topical anesthesia.

Surgical procedures:

Curettage: This involves scraping the lesions with a small scooping instrument.

Electrocautery: This is using a small probe with an electric current to cauterize the skin tissue…

Cryosurgery: This involves freezing off the bumps using liquid nitrogen.

Laser treatments:

Laser therapy uses different lasers to remove the bumps. Lasers have promising results and can help to remove or reduce the appearance.

Carbon-dioxide laser: This produces a specific wavelength of light in the mid-infrared spectrum (10600 nm) and its energy is an effective option for DPN. 

Erbium Yag laser: is a solid-state laser and emits a wavelength of 2940nm and its wavelength is closer to top layers of skin or peak spectrum of water. It is the best, most effective, and almost painless option to remove DPN.

KTP laser: This method uses a potassium titanyl phosphate (KTP) crystal along with an Nd: YAG laser.

However, there are many treatment options for dermatosis papulosa nigra, but some have a risk of pigmentation changes in skin color and causing scar formation. The treatment will not stop from getting new lesions. It better to consult a reputed dermatology clinic with advanced laser technology, understands the unique properties and treatment outcomes of ethnic skin.

Warts

Warts are caused by infection of skin or mucosa by human papillomaviruses (HPV) and appear as small, fleshy growth or bumps, involving anywhere part of the body. The medical term called Verruca.

What are the types of warts?

HPV viruses cause the excessive and rapid growth of keratin, which is a hard protein on the top layer of the skin. There are different strains of HPV causing warts in different parts of the body.                                                                                                                                                     

Each type appears on a different part of the body and has a distinct appearance. The most common type of warts is mentioned below:

Common warts or Verruca Vulgaris: Common warts are most often on the back of hands, foot involving mainly fingers and toes, but can appear elsewhere. They are firm and have a rough surface, slightly grayer than normal skin. They are small from pinhead to a pea and size ranging from <1mm to 1cm in diameter. They may have black dots on the surface (like seeds), which are really tiny blood clots.

Plantar warts: Plantar warts grow on the soles of the feet. Unlike other warts, the pressure from walking and standing makes them grow into your skin. They are flat, tough, and tick with black dots on the surface and may appear as single or cluster. Plantar warts can make walking uncomfortable and may confuse with calluses. Multiple plantar warts in a large cluster called as mosaic warts.

Plane warts or Verruca plana: Flat warts tend to appear on children’s face, men’s beard areas, and women’s legs. They are very small with a flat top surface and are skin-colored to slightly brown or yellow.

Filiform Warts: They appear as thread-like and spiky or tiny brushes involving around the mouth, eyes, and nose or chin and can be irritating due to their involvement of sensitive areas of the face.

Genital Warts: They appear as small, scattered, skin-colored bumps or like a cluster of bumps (cauliflower) on your genitals. A few strains of HPV that may be passed sexually can cause warts in and around genitals can eventually lead to cervical cancer, a potentially fatal disease.                                                         

Periungual Warts grow around and under the toe or fingernails. They can be painful and affect nail growth.

Management of Warts includes: prevention & treatment

Prevention: Warts are highly contagious and mainly spread by direct skin contact. The best way to prevent is by stopping the spread of infection from one person to another and or from one part of the body to another in the same individual. HPV vaccine prevents cervical cancers and genital warts

DO’s and Don’ts for getting virus infected Warts:

DO
DON'T
Do try to get-rid of them at the earliest
Do not try to remove the wart by your own.
Do maintain good self-hygiene & keep your hand & feet dry
Do not pick or scratch your warts
Do keep your skin intact, if the skin has been cut or opened the virus is more likely to enter
Do not share towels, clothing, socks, or soaps with others
Do cover warts with a plaster or bandage
Do not walk bare-foot in public places, if you have a plantar wart
Do wash your hands regularly
Do not shave or do electrolysis where the wart are located
Do get warts evaluated promptly
Do not share your sports gear
Do check children’s feet frequently for warts
Do not bite your fingernails or the cuticles
Do consult the dermatologist
Do not try home-remedies
Do wear waterproof shoes or sandals (flip-flops) in public showers and pools or in a locker room
Do not have sexual contact if you have warts in the genital area

If left untreated, the wart may spontaneously clear at any time from a few months to a year, but in some cases, it may lead to spread of infection, secondary bacterial infection, involving the soft tissues causing pain and rarely malignancy in genital strains of HPV

Treatment: includes simple measures to limit the spread of infection, prevention, medication, and interventional treatments. Many people with a good immune system don’t require treatment as the lesions resolve spontaneously without medical intervention.

However, it justifies treating as it is a contagious disease; and can spread from one area to another in the same individual. 

Medication: 

Topical treatments are regarded as first-line therapy. Topical cream such as retinoic acid cream, salicylic acid preparations, 5-FU, podophyllotoxin cream (anogenital warts). diphencyprone (DCP) and imiquimod irritate the skin and encourage your immune system. 

Oral immunomodulators such as levamisole and zinc sulfate are used which have an effect on the immune system for any kind of warts. Antiviral cidofovir ( topical or intravenous or intralesional ) are used in very severe involvement of warts.

Occlusion: duct tape occlusion involves covering the wart with a small piece of duct tape for a period of 2 months. This therapy can be used for common or plantar warts, and in combination with topical therapy enhance the results.

Interventional therapy is advised if medical therapy fails to work or our body’s immune system does respond to the infection to heal on its own.

Intralesional immunomodulator, interferon is used to boost your immune system to fight against HPV, typically for genital warts. Intralesional cytotoxic agent bleomycin may stop infected cells to replicate. These intralesional therapies are used in recalcitrant warts.

Chemical cautery using high concentrated trichloroacetic acid, silver nitrate, phenol, cantharidin, formic acid. Cantharidin liquid is often used in young children, as it doesn’t cause pain. After application blister is formed underneath it, lifting it off the skin. 

Photodynamic therapy: topical or systemic aminolaevulinic acid is taken up by dividing cells, metabolized to protoporphyrin, and then photoactivated to produce damage effect on the cell in an infected area of wart.

Cryotherapy: involves freezing the wart with liquid nitrogen. Freezing causes a blister to form under and around wart which in due time lifts the wart away from the skin. The procedure is a little painful, probably need more than one session. It usually works well but can cause discoloration and scarring in dark skin. 

Surgery

Surgery is usually only considered if the above treatment doesn’t work. There are different surgical options for removing warts, usually done after giving local anesthesia and are mentioned below:

Curettage is scraping off the wart with a sharp knife. 

Electrosurgery: This is using a small probe with an electric current to cauterize the skin tissue. It works well for common warts, filiform warts, and foot warts.

Excision: surgical excision using a sharp blade and closure.

Laser surgery: by using ablative lasers such as co2 and erbium YAG laser to destroy warty tissue.

However, among these electro surgeries is the best method to remove or cauterize warts.

We at Clear Skin Centre use the simplest way to remove warts, by electrosurgery using the advance technology Ellman radiofrequency device. The procedure is done on an outpatient basis with the highest safety measures. We recommend the earliest intervention, with the appearance of a single lesion of a wart, as to avoid spreading from one area or person to another.

Molluscum Contagiosum 

What is Molluscum Contagiosum?

Molluscum contagiosum is a common contagious skin infection caused by a virus, and appears as non-itchy or painless, raised papules or nodules on the skin.                                                   

What are the signs and symptoms of molluscum contagiosum?

Molluscum contagiosum virus (MCV) of two variants:

MCV 1 is the most common type of virus which usually attacks children under the age of 15 years.

MCV 2 is sexually transmitted and occurs in adults.                                                                                                                                                                  

If you are infected with the molluscum contagiosum virus it takes about 2 to 8 weeks (maximum up to 6months) to see symptoms.

Molluscum bumps are neither itchy nor painful and appear as very small, shiny, firm, white to pink, dome-shaped with a dimple in the middle. The size between 2 to 5 mm and can occur anywhere, predominant over the face, arm, abdomen. Usually, the palms and soles are spared. The bumps appear in a small group or alone.

It can be a sign of HIV and many other immune disorders if the:                                                        

Bumps size of 15 mm.                                                                                                                   

Bumps appear first in the genital area and involving the face. (as a sexually transmitted disease)

Long-term effects of molluscum contagiosum infection:

If left untreated, this infection resolves itself within 4 to 12 months, but in some cases, it may lead to:

· Bacterial infections-get secondarily infected with bacteria.

· Eye involvement – if the bumps are near the eyes it causes conjunctivitis or keratitis. 

· Skin pigmentation or scar: once the lesions are healed it may leave cause discoloration or tiny scars

However, early treatment or removal and preventing measures help in the spreading of the disease.

Risk and Prevention                                                                                    

What are the risk factors for molluscum contagiosum?

Anyone can get infected with molluscum contagiosum virus by touching the lesions with bare hands since it is contagious. The following people are the increase risk factors of getting infected:

Weak immune system eg: organ transplants or cancer treatment.

Atopic dermatitis

Live in tropical climates and crowded or densely populated area

Contact sports such as wrestling or football, 

How can molluscum contagiosum be prevented?

The best way to prevent getting molluscum contagiosum is to avoid touching the skin of the infected person. It spread by direct contact; it is advised to the patient to cover the infected area with a cloth or waterproof bandages. Following these suggestions can also help you prevent the spread of the infection:

•Wash hands with warm water and soap.

•Avoid sharing personal items such as towels, clothing, soaps, etc.,

•Avoid using shared sports gear that may have come in direct contact with someone else’s bare skin. 

•Avoid touching or picking the infected areas of your skin..

•Avoid shaving or using electrolysis where the bumps are located.

•Avoid sexual contact if you have bumps in the genital area.

•Avoid public lockers. 

•Avoid using equipment that has been used previously to an infected patient. 

How is molluscum contagiosum treated?

Medication and surgical treatments are available, but in most cases with a good immune system, you don’t require treatment as the lesions fade away without medical intervention.

However, it justifies treating as it is a contagious disease; and can spread from one area to another in the same individual. 

Medication therapy: Topical cream such as retinoic acid cream or imiquimod or podophyllotoxin cream and oral immunomodulators such as levamisole can be used. Antiviral cidofovir (topical or intravenous) is effective in extensive involvement. Antiretroviral therapy for the patient suffering from HIV and molluscum contagiosum, it can work to strengthen the immune system to fight the virus.

Interventional therapy is advised if medical therapy fails to work or our body’s immune system does respond to the infection to heal on its own.

Curettage, the doctor pierces the bump and scrapes it off the skin with a small tool.

Chemical therapy containing trichloroacetic acid or cantharidin which is applied by skin professionals

Cryotherapy: to freeze each bump with liquid nitrogen.

Electrosurgery: This is using a small probe with an electric current to cauterize the skin tissue. 

Laser treatment: ablative lasers such as co2 and erbium YAG laser to destroy each lesion.

The most effective treatments for molluscum contagiosum are the interventional therapy performed by a dermatologist.

Xanthelasma 

What is xanthelasma?

Xanthelasma is a soft, yellowish cholesterol-rich material deposited under the skin in various parts of the body. These deposited lesions are fat-rich or lipids, accumulated in the immune cells in the skin called macrophages and sometime in the fat beneath the skin.

These cutaneous manifestations of lipidosis, lipid accumulated in clusters within the skin, are associated with hyperlipidemias, both primary and secondary types.

Xanthelasma occurs most often on the upper eyelid near the inner canthus and lower lid. 

Xanthelasma is usually harmless. It may be an early sign of underlying disease hyperlipidemias and ischemic heart disease.                                 

A Xanthoma is a larger and nodular lesion that assumes tumorous proportions; different from xanthelasma and often classified as a subtype of xanthelasma. 

Types of xanthelasma: often classified as:

Xanthelasma Palpebrum: it is common xanthelasma that develops around the eyes with a demarcated soft yellowish discoloration. 

Xanthoma Planum or Plane xanthoma: appear as diffuse, flat, smear like lesion, and can occur anywhere on the body.

Palmar Xanthoma appears as orange-yellow lesions on the palmar creases and flexural surfaces of the fingers. These are flat macules or slightly elevated plaques, often with a central white zone that may be localized or generalize. It occurs with hyperlipoproteinemia type Il A and type lII and biliary cirrhosis. It is also associated with hypercholesterolemia.

Xanthoma Tuberosum or Tuberous Xanthoma: characterized by firm, yellow-red nodules over pressure areas or over the joints, commonly the elbows and knees

Xanthoma Tendinosum or Tendinous Xanthoma: typically presentation by papules and nodules over the tendons of the hands, feet, or heels. It is commonly associated with familial hypercholesterolemia.

Eruptive Xanthoma appears as multiple small, yellowish-orange to reddish-brown papules over the extensor surfaces of the body. It is commonly associated with high levels of triglycerides. Xanthoma diabeticorum is associated with severe diabetes.

Tubero-eruptive Xanthoma is characterized by red papules and nodules that tend to coalesce. It is considered to be the same disease spectrum of eruptive xanthomata.

Xanthoma Disseminatum: is a rare non-familial or non-X histiocytosis, characterized by the proliferation of histiocytic cells and the lipid deposition is secondary. It is associated with diabetes insipidus. The lesions appear as reddish, yellowish-brown papules predominantly involving the flexures (armpits and groins) and evenly spread on both sides of the face, trunk, and upper part of extremities. The small lesions coalesce to form sheets of thickened skin.

Verrucous Xanthoma or Histiocytosis is associated with papilloma of the oral mucosa and skin, and the connective tissue under the epithelium contains histiocytes.

Diffuse Plane Xanthomatosis Here multiple flat reddish-yellow xanthomatous macules and plaques develop over the face, neck, chest, buttocks, and skin folds. The lipid levels are normal and in almost half, the conditions have a malignancy of the blood such as leukemia or multiple myeloma.

Risk factors?

The following factors and conditions to be considered are:

Abnormal high lipid profile

Obesity

Smoker

Middle age between 30 to 55 yrs 

Woman  

High blood pressure

Diabetes

Anyone can develop xanthelasma, but the above-mentioned condition or factors are more prone to get.

Treatment

Xanthelasma does not resolve on its own; it needs expert opinion and guidance. It is harmless and it can only spread if not treated.

Conservative measures such as an individual’s lifestyle, diet, and medication to reduce cholesterol play a major role. 

Avoid smoking and cut of alcohol. 

Reduce calorie intake in overweight individuals to lose weight.

Regular walking and exercise 

Reduce saturated fat intake, predominately found in butter, dairy products, palm oil, and meat.

Reduce intake of normal and refined sugars, soft drinks.

Consume more of fiber-rich vegetables, salads, etc.,

Medication: has proved to be a very effective alternative to surgery. It can be administered in combination to have effective results.

Drugs such as atorvastatin or simvastatin or bezafibrate are most commonly used and work by reducing cholesterol production by the liver, which in turn reduces LDL cholesterol, triglycerides level, and increase in HDL cholesterol. These drugs are to be taken under medical supervision.

Other drugs such as ezetimibe, nicotinic acid are also used to reduce total and LDL cholesterol.

Interventional Treatment: is required, if the conservative medication does not work for your xanthelasma; any one of the following treatment can be done: 

Chemical peels: with trichloroacetic acid (TCA) shown satisfactory to excellent results, but multiple sessions are required with an interval of 7 to 10days.

Cryotherapy: This involves freezing the xanthelasma with liquid nitrogen.

Radiofrequency device: an advanced radiofrequency device by Ellman technique is effective at eliminating or reducing xanthelasma. 

Laser surgery: ablative laser such CO2 and Erbium Yag either in conventional or fractional mode is effective in eliminating xanthelasma.

It is possible xanthelasma may reappear after treatment. However, it is extremely important to find out the cause and treat accordingly.

DO: Learn more moles.

DO: Watch your moles closely.

DO: Treat the mole in the initial stages itself.

DO: Maintain good self-hygiene and care.

DO: Use a broad-spectrum sunscreen.

DON’T: Pick at the mole.

DON’T: Ignore the mole.

DON’T: Share towels, socks, or gloves with others.

DON’T: Walk-in public places without your shoes.

Types of moles

1.Congenital naevus: Moles that are present at birth.

2.Atypical or dysplastic naevus: These moles are unusual in appearance and benign. Moreover, these may look similar to melanomas.

3.Junctional melanocytic naevus: Round, flat, and brown.

4.Dermal melanocytic naevus: Raised, hairy in some cases, pale or light brown.

5.Halo naevus:Skin in the area surrounding the mole loses pigmentation, thus forming a halo. Once the mole fades away, the skin regains its color.

Treatments of Moles

Sometimes, a mole is itchy, burns, is painful, bleeds or oozes, is crusty or scaly. Moreover, it can also suddenly change in color, elevation, size, or shape. Therefore, in such cases, one must consult a doctor immediately. 

There are several modalities to treat moles. They are as follows:     

1.Shave excision: In this treatment, the mole is cut off from the body using a small blade. Moreover, dermatologists carry out this process under the effects of local anesthesia. In fact, stitches are not necessary. Moreover, shave excision is effective for smaller malignant moles.

2.Excisional surgery or excision biopsy: In this treatment, the mole and the surrounding margin of healthy skin are cut out using a scalpel or a punch device. In fact, sutures are necessary.

3.Electrosurgery: In this treatment, the mole is burnt off with an electric current applied by a device with a metal tip. In fact, any hair growing on the mole will burn off too.

4.Laser: In this treatment, a high-intensity beam of light is used to reduce the pigmentation and get rid of any hair present on the mole too. 

Warts are growths with rough surfaces or flat and smooth surfaces. Moreover, these are white or Warts, or verrucas are growths with rough or smooth surfaces that are pale or white. In fact, they are a result of human papillomavirus. Moreover, they look like a solid blister or a small cauliflower.

Do & Don’t for Getting Warts

DO: Treat the wart in the initial stages itself.

DO: Maintain good self-hygiene and care.

DO: Use a broad-spectrum sunscreen every day.

DO: Exfoliate regularly.

DON’T: Pick at the wart or mole.

DON’T: Try to remove the wart yourself.

DON’T: Share towels, socks, or gloves with others.

DON’T: Walk-in public places without your shoes.

Types of Warts

Common warts: These are mainly found on fingers and toes. Moreover, these warts are rough, grainy, and have a rounded top. In fact, these are usually grey in color.

•Plantar warts:

These grow into the skin around the soles of the feet as opposed to on them. The growth of a plantar wart indicates a small hole in the bottom of the foot. Moreover, hard skin surrounds it.

•Flat warts:

These are found on the face, thighs, or arms. Moreover, flat warts are tiny growths that are flat on the top. They may be pink, brown, or slightly yellow in color.

•Filiform warts:

These grow on and around the mouth, neck, nose, or chin. In fact, they are small tags that are the same color as your skin.

•Periungual warts:

These are found under and around the toenails and fingernails. Moreover, they can be painful and affect healthy nail growth.

Treatments of Warts

There are several treatment modalities for treating warts. The objective of the treatments available is to remove the wart. Moreover, it is also to enable the immune system to effectively fight the virus. 

•Cryosurgery:

In this treatment, dermatologists use liquid nitrogen to freeze warts, under local anesthesia. Moreover, this treatment may require several sessions. Lastly, cryosurgery causes little to no scars.

•Electrosurgery:

In this treatment, an electrical charge burns the wart tissue. As a result, this causes the tissue to dry and fall off. Moreover, electrosurgery is effective for a single wart or a small area. However, it could leave scars for large areas of warts. 

•Curettage:

In this treatment, the wart is surgically removed using a scalpel or sharp spoon-shaped tool.

•Laser Treatment:

In this treatment, the wart tissue is destroyed with an intense beam of light or laser. Infrared coagulators are an alternative to lasers.

•Chemical Peels (Acids):

In this treatment, different acids are applied directly on warts and used to peel off the top layers. It is more effective when combined with cryotherapy. 

Skin tags are small growths on the skin. A thin stalk supports them. The main cause of skin tags is friction in skin folds in areas like the neck, armpits, and groin. Moreover, they rarely cause irritation 

Milia are small, keratin-filled cysts. They appear individually or in clusters, known as milium or milia, respectively. Milia occur when the dead skin cells get trapped beneath the skin instead of getting exfoliated. They appear as white dots.

They become tiny cysts and usually disappear on their own. However, at times they do require intervention. They occur anywhere on the body. However, one sees them most often around the cheeks, nose, eyes, eyelids, forehead, and chest. A milia is similar to a whitehead because it also appears as a small white bump. However, it feels more firm, almost like a tiny ball under the skin.

Do & Don’t for Getting Milia

DO: Cleanse your face regularly with warm water and a gentle face wash.

DO: Exfoliate regularly to remove dead cells.

DO: Use a broad-spectrum sunscreen with SPF >30.

DO: Keep the skin oil-free.

DON’T: Overexpose yourself to the sun.

DON’T: Use irritant skin products and heavy facial cosmetics.

DON’T: Consume high cholesterol foods (especially cheese), and supplement your diet with niacin and biotin.

DON’T: Squeeze, scrape, poke the milia.

Who is at risk?

· Milia can occur in men and women of all ages and of any ethnicity. 

· Milia often occurs in newborn babies.

· However, it also occurs in people of any age.

· In infants, these appear as tiny, firm, and pale bumps on the cheeks or around the nose and eyes. 50% of all infants are at risk of developing milia.

· Adults develop milia on the face as well, especially in the area surrounding their eyes. The arms and hands are susceptible as well.

· Especially in the case of older patients as their skin faces more exposure to the sun.

· Even individuals that use heavy makeup are at risk.

Causes of Milia

1.Comedogenic or pore-clogging skin care products: They prevent the skin from naturally exfoliating.

2.Sun damage: It is a major contributor to milia. This is because it thickens the epidermis. Thus, it becomes more difficult for skin cells to find their way out of the glands.

3.Certain skin diseases: particularly blistering disorders such as Porphyria Cutanea Tarda may be a causative factor.

4.Genetic predisposition

5.Overconsumption of dairy

Types of Milia

There are different types of milia:

•Neonatal milia: 

This type is seen in young babies. They are quite common. One sees this type of milia around the nose area. It may also occur on the scalp, cheeks, upper body, and inside the mouth.

•Primary milia:

This type of milia can occur in both adults and children.

•Secondary milia:

These occur usually as a result of injury to the skin in form of burn, cut, blister, etc.

•Milia en plaque:

This type of milia is extremely rare. It usually develops on a raised and inflamed patch of skin known as a plaque. This plaque may be several centimeters across. Milia en plaque generally occurs behind the ears, on the eyelids, the cheeks or jaw area. Middle-aged women have a higher tendency to develop this type of milia.

•Multiple eruptive milia:

The milia appear in patches that develop over a period of weeks or months. The patches usually appear on the face, the upper arms and the upper trunk. Milia of this type are also extremely rare.

Treatments for Milia

Since milia normally clear by themselves. They usually do not need any treatment. However, some people find milia unsightly. Therefore, they may want to treat it to improve cosmetic appearance. One shouldn’t squeeze Milia. This could result in skin damage, scarring, or infection. 

Here are some of the treatments for Milia: 

•Topical applications:

Topical applications such as retinol and retinoid creams may be prescribed by the doctor. Retinol creams cause less irritation to the skin. However, they are less effective than retinoid creams. Retinoic acid is the active ingredient responsible for exfoliation. These creams increase susceptibility to sun damage. Therefore, one must use them either at night or with a sunblock (SPF>30). 

•Minocycline:

This is an oral antibiotic. One uses it to treat certain types of milia, such as milia en plaque.

Exfoliation:

Exfoliation removes the dead skin cells, unclogs pores, and promotes cell turnover. Therefore, this keeps the skin smooth and thin. Moreover, this helps to remove milia and prevents them from recurring. In fact, dermatologists may prescribe products that contain retinol and alpha hydroxy acids (AHA). Glycolic acid is the most common AHA. They improve the skin’s general condition, texture, and tone. Chemical peels can also effectively exfoliate milia. 

•Extraction: 

Extraction is a quicker solution than exfoliation. Dermatologists do a manual extraction with a sterile needle and comedone extractor or tweezer. In fact, they combine it with cryotherapy sometimes. Moreover, it is important for a dermatologist to do this procedure. This helps prevent scarring & hyperpigmentation. 

•Microdermabrasion: 

Microdermabrasion is a process in which a device abrades the top layers of skin. This method gently sloughs off the offending layer of skin, releasing clogged oil. Therefore, this encourages cysts to pop out & promotes cell rejuvenation and creates new, flawless skin. 

•Electrolysis:

This is a painless, non-invasive procedure in which a fine probe sends a current into the milia. In fact, this breaks down the fatty tissue or keratin build-up so that it can be reabsorbed into the skin. It is a quick and easy procedure. However, only a dermatologist should conduct it. It is effective for permanent milia removal. 

•Laser therapy:

Laser therapy breaks down the fatty tissue and allows it to be reabsorbed into the skin using an intense beam of focused light.

•Cryotherapy:

In this treatment, dermatologists freeze the milia off with liquid nitrogen. This may cause blistering or swelling. However, this should disappear within a few days.

•De-roofing:

In this treatment, dermatologists use a sterile needle or blade to remove the milia. Moreover, a dermatologist must do this procedure. 

•Curettage:

In this treatment, dermatologists numb the area of milia. Then, they scrap or scoop off the milia. After this, they seal the skin with a hot wire.

Dermatosis papulosa Nigra (DPN) appears as small brown or black spots on the skin. Generally, these spots are seen around the cheekbones and eyes. However, they are also seen on the face, neck, chest, and back. Some people with DPN have a few, isolated spots while others have hundreds of spots. The spots are neither cancerous nor dangerous to your health. However, they may be itchy, irritating, or cosmetically unappealing.

Do & Don’t for Getting DPN

DO: Consult a doctor who specializes in treating patients with ethnic skin.

DO: Keep realistic expectations from the treatment.

DO: Use a broad-spectrum sunscreen daily.

DO: Use face washes that have glycolic or salicylic acid.

DON’T: Leave the house without sun protection.

DON’T: Ignore the initial stages of any skin condition.

DON’T: Scrub your skin too roughly.

Appearance

The spots may either be flat or hang off the skin from a stalk or peduncle. Usually, the bumps caused by DPN are round.

Size

They range in size from 1 to 5 millimeters. The bumps tend to grow bigger and increase in number as the individual ages.

Texture

The bumps are initially smooth. However, the bumps can become rougher looking over time.

Causes of DPN

Usually, the cause is genetics. However, it may also be a result of the natural aging process. Additionally, many believe that it is due to a developmental defect of hair follicles.

People at risk

African Americans are at high risk of the condition. Usually, this condition is more common in women. Generally, the spots appear after puberty.

Treatment for DPN

Dermatosis papulosa nigra (DPN) is not a health concern and is not life-threatening, However, many people consider removing the spots for aesthetic reasons. It is important to have realistic expectations from the treatment. Treatment may not be able to completely remove spots. Hence, the goal of treatment should be to minimize the appearance of spots rather than to remove them completely.

Additionally, the fact that the condition occurs mostly in the skin of color patients complicates treatment for DPN. These individuals are at a higher risk of developing pigmentation defects (lightening or darkening of the skin). Moreover, they are also prone to scarring following treatment. These scars or discolored patches may also be cosmetically undesirable.

·Surgical removal: 

The DPN bumps or spots can be surgically removed through the following techniques usually done with topical anesthesia:

1.Scissor excision: In this technique, your doctor will grab the DPN spot with a small forceps and lightly pull it up. Then he will use small, curved scissors to carefully cut around and under the lesion. This technique treats DPN spots that rise above the skin.

2.Shave excision: In this treatment, the mole is cut off from the body using a small blade. This procedure does not require stitches.

3.Curettage: Curettage involves scraping away the bumps with a small scooping instrument.

4.Electrocautery: Electrocautery involves using a small probe with an electric current to burn away the bumps.

5.Cryosurgery: Cryosurgery involves freezing off the bumps using liquid nitrogen.

6.Electrodesiccation: Electrodesiccation involves dehydrating the superficial tissue to destroy it. 

These treatments may cause scarring. Moreover, they also won’t stop new bumps from appearing.

2.Laser treatments:

Laser therapy uses different wavelengths and frequencies to remove the DPN growths. Some of the lasers that can help to remove or reduce the appearance of DPN growths are:

1.Carbon-dioxide laser: This type of laser therapy is a safe and effective option for DPN. Moreover, after CO2 treatment, DPN has a low chance of recurrence.

2.Long-pulsed neodymium-doped yttrium aluminum garnet lasers (Nd: YAG lasers): This laser uses a wavelength of 1064nm that is safe for dark skin. It stops the blood supply to the growth. Additionally, it also coagulates melanin in the dark spots. This treatment is slightly painful. However, it also has minimal side effects.

 

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