Sun & Aging
Also called “photoaging,” skin damage caused by the sun is partially preventable. We recommend SPF 15 for routine sun exposure, and higher if under heavy sun, for prolonged periods of time, or in equatorial climates. Existing wrinkles and freckles soften with vitamin-based creams, topical prescription creams, and in-office Chemical Peels. Deeper wrinkles improve with Filler injections, while forehead furrows and crows’ feet will reverse with Botox treatments. The physicians at Tribeca Skin Center also use various laser procedures or Microneedling to further reduce signs of sun damage, and aging skin.
Moles are called nevi (singular is nevus). The number of nevi can increase throughout life, influenced by genetics and sun exposure. A changing mole could be sign of melanoma. The criteria for clinical suspicion: ABCD, A for “asymmetry,” B for “border irregularity,” C for “color variation, D for “diameter greater than six millimeters.” Melanoma often arises from normal skin, not necessarily from a pre-existing mole. Removal of moles for solely cosmetic purposes must be undertaken judiciously, as the scar from removal might not be preferable.
Actinic keratoses are small, pink-red, tender, scaly, flaking spots of skin. Individual ones are usually found on areas of prior sunburns from childhood on the face, scalp, chest, back, or shoulders. They need to be evaluated for in-office liquid nitrogen treatment, also called cryotherapy. Extensive sun damage, multiple actinic keratoses, may benefit from prescription chemotherapy cream for home use.
Non-melanoma skin cancer is far more common and much less dangerous than melanoma. Non-melanoma skin cancers include basal cell or squamous cell carcinoma: bleeding and crusting, non-healing bumps of sun-exposed skin. After biopsy evaluation (see below), they can be treated and cured by different methods. Melanoma is a dark, black, irregularly shaped six millimeter or larger mole, growing noticeably and/or bleeding. Tribeca Skin Center recommends a yearly skin check, especially for fair-skinned & light-eyed individuals, people with a personal/family history of skin cancer or a history of numerous sunburns.
Skin biopsies are performed under local anesthesia to obtain microscopic evaluation. The most common type of biopsy is a “shave,” no stitches are involved. Wound care involves gentle cleansing with soap and water or dilute peroxide, and application of antibiotic ointment under a band-aid daily until healed. Redness is to be expected; healing may involve only minimal scarring depending on type and site of biopsy.
Face
Acne can occur at any age, and is incredibly common in women in their 20s-30s, often from a hormonal influence. Breakouts can occur from a combination of normal bacteria, sweat gland activity, and microscopic or visible pore clogging. We will customize therapy to your skin type and medical history, focusing on hydration, cleansing, correcting bacteria balance, and good exfoliation. Almost limitless treatment options include: topical prescription solutions and creams, various oral medicines from antibiotics to Accutane, at-home care and dietary modifications, and in-office procedures such as Deep Pore Cleansing Facial to Chemical Peels. To reduce scarring from acne, we also recommend Microneedling with PRP.
Rosacea is most common in northern European and Celtic skin types. Influenced by heredity, excess sun and hot water exposure, spicy foods, alcohol, and stress, rosacea starts with redness/”flushed” look of cheeks, nose or chin. Little red capillaries along nose creases or red bumps may develop as well. Treatment regime includes sunscreens, dietary changes, cool water to wash face, prescription creams, and oral antibiotics. Our V-Beam Laser and Excel V Laser dramatically reverse redness of rosacea and broken blood vessels, even when unresponsive to medicines.
Persistent flaking of eyebrows and sides of nose is called seborrheic dermatitis. It can be itchy, especially on the scalp and in and around the ears. Influenced by weather fluctuations (prevalent in the northeast United States and in frequent coast-to-coast travelers), anxiety or mood changes, and poor sleep habits, seborrhea comes and goes. The condition can become easy to manage through topical prescription creams and/or shampoos, and lifestyle changes.
Also called “pseudofolliculitis barbae” or “razor bumps,” ingrown hair annoy men and women alike. Patients often complain of them in the face, neck, or pubic area, where they can be the result of shaving, waxing, or plucking. Dark hair that is curlier can be more predisposed to ingrown hairs; at the nape of the neck it can resemble scarring acne. Topical creams, cortisone injections, antibacterial/antiseptic agents can help prevent further issues. Laser hair removal is a more definitive treatment option for some.
Imbalances of pigmentation are more troublesome in Black, Asian, and Hispanic skin types. Melasma is a condition of hyperpigmentation, especially of the cheekbones, forehead, and upper lip. It is more common in women, brought about by hormones including birth control, pregnancy, or sun exposure. Sunscreen is essential to prevent further discoloration. Bleaching agents and Chemical Peels can be very helpful. Vitiligo is a patchy loss of pigmentation of the face or body, sometimes symmetric and progressive; in some instances, medical treatments such as laser therapy can help.
Body
Eczema, otherwise called “atopic dermatitis” when it begins in childhood, manifests from sensitive skin as scaly, dry, red patches. It is not contagious, but it can worsen with very dry winter weather, long hot showers, drying heat in homes, fragrances, cat hair, cigarette smoke, wool and synthetic fabrics, and environmental irritants. Eczema is treated with emolliation, cortisone creams, humidifying the environment, and antihistamines to reduce itching and scratching. When on hands and feet, it can look like little blisters that then peel; this form is called “dyshidrosis,” and it often recurs in stressful periods or changes of seasons.
A genetic condition affecting millions of people, psoriasis is an immune system reaction in which the skin replicates too quickly. Silvery scaly red plaques, often symmetric, can be few or many, increasing with stress, infection, weather changes, and weight gain. It can involve scalp, nails, genitals, and joints. Multiple topical remedies are available for this chronic condition; systemic medicines carry different risks of toxicity. Most importantly, people have improvement with sunlight, saltwater, exercise, and dietary and lifestyle changes. Avoidance of alcohol, a low glycemic diet, nutritional supplements along with a regular exercise regimen are all recommended.
Tinea is the term for fungal and yeast infections. Various forms of tinea occur. Tinea versicolor affects the chest and back of sweaty/athletic young adults and can look like faint pink-white patches that leave behind temporary white discoloration, especially on dark-skinned individuals. Tinea capitis is a scalp infection, almost exclusively in children. Fungal infections of the rest of the body tend to occur in damp folds of skin (between toes, under breasts, around the groin); cool, loose cotton clothing, good aeration, and drying powder can help prevent them.
Caused by human papilloma virus, warts are an infection and can spread. Avoid walking barefoot in gyms’ locker rooms and showers to prevent infection. Smaller warts of hands and feet can be treated with over-the-counter medicine; larger ones can be “freeze-burned” in office with liquid nitrogen. Men with beard area warts can have quick light burning called “electrodessication”. To prevent chronic reinfection, razors should be kept in alcohol and changed frequently.
Fine red and blue veins of the legs are called “spider veins.” Predisposing factors include family history, jobs requiring standing, pregnancy and weight gain. Prevention involves good support socks/hose to facilitate circulation back to the heart. Varicose veins are deeper, and need evaluation by vascular surgeon. Cosmetic treatments for spider veins include Sclerotherapy and Excel V Laser therapy; both can be effective with multiple sessions.
Sexually Transmitted
Genital warts are caused by human papilloma virus (HPV). They are extremely common, passed through physical contact of exposed skin areas, can continue to spread once acquired, and do not pass to non-genital surfaces. Warts should be treated so as to reduce spread; virus then remains dormant, and may recur during periods of stress. Various classes of liquid prescription treatments are available for home use; in-office treatment with liquid nitrogen (cryotherapy) is most common, very effective, and less painful than anticipated.
Herpes Simplex Virus 1, HSV1, is called “cold sore” or “fever blister” and HSV2 is called “genital herpes.” HSV1 generally affects lips, but it can be passed to genital area. Herpes is transmitted during physical contact; over 20 million adults are affected. It appears as collection of little yellow-red blisters that initially tingle, then scab and heal, often recurrent. Excellent healing occurs if oral antiviral pills are taken early in outbreak, which puts the virus into remission. Lysine supplements (health food store item) have demonstrated value in reducing episodes.
Molluscum contagiosum, caused by human pox virus, are uniform small white bumps in the lower abdomen or upper pubic area. They spread easily, transmitted through intimate physical contacts in adults. Treated in the office through pinpoint physical destruction of individual lesions, molluscum are fairly easy to clear. Once gone they tend to not recur unless re-infected. Children sometimes get them from other children through picking/scratching; they usually disappear spontaneously within months.
Hair & Nail
Alopecia areata is recognizable through almost spontaneous hair loss in circular patches, generally in scalp or beard area. It is a completely benign condition, sometimes self-limited, as hair can grow back by itself. The immune system attacking hair follicles causes fallout, often brought on by stress or traumatic events. Patients occasionally opt for small cortisone injections into skin to suppress immune system locally and promote regrowth.
Nails that become distorted, with thickening, discoloration, and debris, may have fungal infection. Infection can spread from one nail to another and to adjacent skin. Topical creams and prescription nail lacquers applied daily can be effective; oral antifungal pills are more so, though they may require blood monitoring.
Persistent flaking of eyebrows and sides of nose is called seborrheic dermatitis. It can be itchy, especially on the scalp and in and around the ears. Influenced by weather fluctuations (prevalent in the northeast United States and in frequent coast-to-coast travelers), anxiety or mood changes, and poor sleep habits, seborrhea comes and goes. The condition can become easy to manage through topical prescription creams and/or shampoos, and lifestyle changes.
Also called “pseudofolliculitis barbae” or “razor bumps,” ingrown hair annoy men and women alike. Patients often complain of them in the face, neck, or pubic area, where they can be the result of shaving, waxing, or plucking. Dark hair that is curlier can be more predisposed to ingrown hairs; at the nape of the neck it can resemble scarring acne. Topical creams, cortisone injections, antibacterial/antiseptic agents can help prevent further issues. Laser hair removal is a more definitive treatment option for some.
