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What is Psoriasis? 

Psoriasis is a condition where the body makes new skin cells in days rather than weeks. The skin cells pile up on the surface of the skin leading to thick scaly plaques. These plaques can show up anywhere on the body but typically favor the scalp, knees, elbows and lower back. Without proper treatment, these plaques can cause intense itching, pain and burning.

Is psoriasis curable?

Most people who get psoriasis have it for life. Psoriasis is not curable, however, with appropriate treatment, psoriasis in controllable. By gaining control, you can see clearer (or clear) skin. Your dermatologist will work with you in educating you on triggers, routine skin care, lifestyle changes and how to use your prescribed medication. 

In addition, Psoriasis can increase your risk of developing certain diseases, such as psoriatic arthritis or diabetes. Your dermatologist can watch for early signs of disease. If you do develop another disease, early treatment helps to prevent the disease from worsening.

Sign and symptoms:

Dry, thick, and raised patches on the skin are the most common sign of psoriasis. These patches are often covered with a silvery-white coating called scale, and they tend to itch.

Types of psoriasis:

Plaque psoriasis: Plaques usually form on the scalp, elbows, knees, or lower back; however, they can develop anywhere on the skin. Scratching can cause the patches to thicken. 

Guttate psoriasis: With this type of psoriasis, tiny red bumps appear on the skin quite suddenly. The bumps tend to cover much of the trunk and extremities. 

Palmoplantar psoriasis: Occurs on the palms or soles of the feet and can make just about any activity that requires your hands or feet, such as typing or walking, unbearably painful.

Erythrodermic psoriasis: Serious and life-threatening, this type of psoriasis requires immediate medical care. When someone develops erythrodermic psoriasis, you may notice skin on most of the body looks burnt and constitutional symptoms such as fever and chills. The person may also be unable to keep warm, so hypothermia can set in quickly.

Psoriatic arthritis: If you have psoriasis, it’s important to pay attention to your joints. This is more likely to occur if you have severe psoriasis.

Nail Psoriasis: When psoriasis affects the nails, you may notice: dents in the nails, white/yellow discoloration, crumbling nails or nail lifting. 

How do we treat psoriasis? If you have psoriasis, a dermatologist can create a treatment plan to meet your individual needs. To create this plan, your dermatologist will consider the: Type(s) of psoriasis you have, places psoriasis appears on your body, severity of the psoriasis, impact psoriasis has on your life and other medical conditions you have. 


Common scalp issues and how to treat them

Scalp skin is unique on the body due to the bulk of hair follicles and high amount of sebum(oil) production. These features make it vulnerable to fungal conditions, parasitic infestation, and inflammatory conditions. Because these scalp conditions share similar signs and symptoms of scaling, inflammation, hair loss, and itching, getting the correct diagnosis is important. Let’s discuss the most common scalp conditions and the best methods for treatment.

1. Psoriasis: Pink plaques with silvery scales

Psoriasis is an autoimmune condition where the cells are in overdrive leading to a build up of skin cells creating scaly patches that can itch, hurt and even bleed. The treatment is about relieving symptoms as psoriasis is controllable not curable. The first line treatment is to start with steroids, while tougher situations may require injections called biologics that help to suppress what's causing the flare ups. But you should also take in account your hair care routine as many shampoos can improve the rash and heat treatments such as blow-drying can worsen your psoriasis.

2. Folliculitis: Scattered pus bumps

Folliculitis is an inflammation of the hair follicle. It can be caused by a bacteria infection, shaving, excessive sweating and tweezing. It will appear as small bumps scattered over the scalp like acne. They can cause soreness and itching. The treatment can vary depending on the cause of the rash. First line treatments include a topical (liquid) or oral antibiotic followed by a steroid cream to help if the inflammation persists.

3. Seborrheic Dermatitis: Greasy scale and dandruff

Seborrhea is one of the most common scalp conditions. Cradle cap in babies turns into itchy patches with greasy scale or dandruff in an adult. It isn't contagious but can be embarrassing. Unfortunately, it often comes and goes with triggers such as stress and seasonal changes (winter and early spring). Aside from the scalp, the face, ears, and chest can also be affected. Although no definitive cause has been identified, a yeast (fungus) called malassezia that is in the oil secretion on the skin, seems to be the most likely culprit. Some predisposing factors include Parkinson's, depression, diabetes, a weakened immune system, and obesity. We recommend treating early and aggressively to avoid complications such as hair loss. Often a prescription strength anti-yeast shampoo called ketoconazole will help in addition to a topical steroid if itching persists.

4. Alopecia: Hair loss

Hair loss can be due to several factors, including medications, genetics, inflammation and hormone issues. If you notice hair breaking/shedding or bald spots on your scalp, it is important to get evaluated by a medical professional. After an in-depth discussion, it is helpful to run blood work to evaluate for anemia, vitamin deficiency, thyroid abnormalities, hormone levels, and autoimmune markers.

If blood tests are all normal, other sources of stress such as the death, pregnancy and surgery can cause some shedding months after the incident. However, most of the time, it’s due to the aging process and hormone levels. Woman’s estrogen levels decrease, and often, so does our hair. It also may be the toll of years of bleaching, dyeing, straightening, perming, and wearing tight pony tails.

The treatment is geared to correcting any medical abnormalities if they present themselves. Underlying scalp conditions such as seborrheic dermatitis or psoriasis should be addressed. In the case of hormonal thinning, there are treatments such a Rogaine, a solution that thickens existing hair can help. Eating a well-balanced diet, filled with vitamins such as B12, folate, and biotin are also useful when experiencing hair shedding. Lastly, taking a break from over-processing your hair is encouraged. In extreme cases, hair transplant or PRP is an effective option.

5. Ringworm: Scaly rash and bald spots
Also called tinea capitis, its most common in children but occasionally occurs in adults. The most common ways we contract the fungus is: Human to human, animal to human (cats are a common source), and object to human (clothing, towels, bedding/ linens, combs, and brushes). The resulting rash is usually painful and scaly. It also can cause bald spots, broken hairs, and black dots. The most effective treatment is taking an antifungal pill. Treating or discarding infected sources can help to prevent re-infection.

Teen Acne Do's and Don'ts

Teen acne is a skin condition causing bumps on the face, back, and chest. Oil glands make a natural moisturizer for your skin, called sebum. In teen acne, sebum can clog the pores, which makes the skin "sticky" and difficult to shed. The combination of sebum, dead skin cells, and bacteria within a clogged pore causes a pimple.

Teen acne can affect a young person's outlook on life, social adjustment, and even school performance. Today we know that pimples can cause scarring not just on the skin, but also on the psyche. Recent studies show that teen acne can result in a loss of self-esteem and self-confidence, poor body image and social withdrawal, and, depression, anger, and frustration. Fortunately, we have improved our ability to manage and treat these patients.

Do’s & Don’ts

  • Do : make sure teens rinse with water that is warm. Use mild cleansers such as Cetaphil or Cerave.
  • Don’t: scrub with a washcloth; use fingertips and wash the face gently.
  • Do: use your acne medication only as directed by your doctor
  • Don’t: use over-the-counter acne treatments in addition to your prescriptions without checking with your doctor
  • Do: look for products that are non-comedogenic and oil-free
  • Don’t: use more makeup than you need. Do apply makeup after you put on your acne medication and remove your makeup every night with gentle cleansing
  • Do: take caution with applying hair products. If they get into contact with the face, they may further clog pores and make your acne flare. If you are a teen who has started to shave, use care to avoid nicking pimples; an electric razor may work better than a razor blade to avoid spreading the bacteria.


August Blog Image Acne
What is acne?

Acne, also known as acne vulgaris, is thought to be caused by multiple factors. Overproduction of a normal oil on the skin, increases under the influence of hormones. This, coupled with insufficient shedding of dead skin cells, plugs hair follicles. The plugged follicle can become inflamed and have increased growth of normal skin bacteria, Propionibacterium acnes.

Who’s at risk?

Acne affects 85–100% of people at some point in their lives, and it usually begins at puberty. Acne can persist into the 30s and beyond. In fact, 5% of people over 45 still have acne.

What are signs and symptoms of acne?

Acne results in a variety of lesions. The most common acne locations include the face, neck, chest, and back, where the most sebaceous glands are located. Along the jaw line is a common location in adults.

Acne can result in permanent scars, which can appear to be depressions in the skin or hyperpigmentation, which is dark red or brown flat marks where the acne lesions were.

When to seek professional help?

If you have moderate or severe acne that has not improved enough with self-care, seek medical help.

What are treatment options for my acne?

Topical (or external) treatments for acne include one or more creams, washes, or gels that include:

  • Antibacterial agents and antibiotics such as benzoyl peroxide, clindamycin, erythromycin, sulfur, sodium sulfacetamide, and azelaic acid.
  • Retinoids – vitamin A-derived products such as tretinoin, tazarotene, and adapalene.

Oral treatments may include:

  • Antibiotics such as tetracycline, minocycline, doxycycline, erythromycin, ampicillin, clindamycin, trimethoprim-sulfamethoxazole, azithromycin, or cephalosporins.
  • Oral contraceptives and spironolactone have been found to help regulate hormones.
    Isotretinoin, a strong drug with many side effects, for severe acne unresponsive to the above treatments.
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