Acne is a common condition which affects the oil glands of the skin. It mainly affects adolescents but may persist or even worsen in adulthood. Acne can have severe emotional impact. Several types of acne exist: blackheads, whiteheads, cysts, small or larger red bumps. If not treated in a timely manner, the breakouts can result in scars. Acne may be classified as mild, moderate, or severe depending on the type and number of lesions. There is no cure for acne, so the goal is control. Several treatment options exist. Topical therapies are used for milder forms of acne. For more severe cases, oral medications such as oral antibiotics can be used. Another treatment available is the Red Light. This is a safe and effective therapy that targets the bacteria that cause acne. Isotretinoin, the strongest oral acne medication, is the most effective therapy for acne but is reserved for severe or resistant cases. Peels can be done to help reduce blemishes, discoloration and scars caused by acne. Ask your provider about the various treatment options.
Alopecia areata is a condition that usually involves patchy hair loss from the scalp or face. The condition affects both males and females. Most cases of alopecia areata occur in healthy individuals. However, a minority of patients can have other immune related conditions such as asthma, allergies, eczema, and hypothyroidism. The underlying skin is not scarred and looks normal. Alopecia areata most often affects the scalp and men’s beard but may occur on any hair-bearing part of the body. The hair tends to fall out over a short period of time. Alopecia areata is usually diagnosed based on physically apparent features. A biopsy for microscopic examination of the underlying tissue is rarely needed to confirm the diagnosis. The cause of alopecia areata remains unknown, but it is not contagious. The condition is thought to be an autoimmune disorder in which the body attacks its own hair follicles and suppresses or stops hair growth. Effects of alopecia areata are mainly psychological (impaired self- image due to hair loss). This can certainly cause some degree of emotional stress. In most cases the condition begins with a small number of patches of hair loss, but hair can spontaneously grow back after a few months to a year. In cases with a greater number of patches, hair can either regrow or progress to further hair loss. Treatments include Kenalog (steroid) injections, where a small amount of medication is injected in the affected areas. This is a fairly successful typically and after a few visits 3-4 weeks apart, new hair starts to grow back. Other therapies include strong topical steroids, Minoxidil, and other topical or systemic medications. Platelet rich plasma injections are also proving to be helpful and can be added to the treatment regimen.
Basal Cell Skin Cancer
Basal Cell Cancers (also called Carcinomas) are the most common type of skin cancers. It is very curable if treated properly. Although basal cell cancers generally grow slowly and do not tend to spread or become life threatening, they can become very large. Almost 3 million Americans are diagnosed with basal cell skin cancer every year. The numbers of diagnosed skin cancers are growing every year. People who are exposed to the sun for long periods and have light-colored eyes and hair are more prone to developing basal cell carcinoma. Even people with darker types of skin or eye color can develop skin cancer. Basal cell carcinoma usually presents as a raised, smooth, pearly bump or a pink patch on sun-exposed areas of skin. Sometimes small blood vessels can be seen within the bump. It is often mistaken for a sore that does not heal. This form of skin cancer is the least deadly. The most successful form of treatment to remove Basal cell cancer is the MOHS surgery. In this technique under local anesthesia, our dermatologists will remove the skin cancer and check margins in the office while the patient waits to make sure all the cancer is removed. Once the margins are free of cancer the wound is then repaired to preserve the beauty and function of the skin. Other options include topicals medications, destruction of the lesions with electrocautery or liquid nitrogen, radiation or for severe cases or an oral medication.
When a lesion is suspicious to be cancerous (malignant), a biopsy is warranted. A small amount of local anesthetic is injected near the lesion, the doctor will then remove the growth and it is then sent to a lab for review. A shave excision removes superficial lesions. A punch biopsy removes a small but deeper portion of the growth. An excision removes the entire area when the growth is deep. Sutures may be used to close the defect. Scars could appear after removing any lesion regardless of the method. Our doctors will select and discuss the best biopsy method to minimize the risks during your visit.
Dermatitis (also known as Eczema)
Dermatitis is a general term that is used to describe an inflammation of the skin. Dermatitis is a non-contagious and a very common condition treated in our dermatology office. There are several different types of dermatitis, also known as eczema, including atopic dermatitis, contact dermatitis, dyshidrotic dermatitis, nummular dermatitis, seborrheic dermatitis, and stasis dermatitis. Each type of dermatitis has distinct signs and symptoms including redness, swelling, itching, and skin lesions. A number of health conditions, allergies, genetic factors, physical and mental stressors, and irritants can make dermatitis worse.
Atopic dermatitis or eczematous dermatitis is a chronic itchy rash that tends to recur. This condition often occurs with allergies and frequently runs in families in which members have asthma or seasonal allergies. It usually begins in infancy and may vary in severity during childhood and adolescence. Although the severity of this condition usually tends to decrease with age, eczema can persist into adulthood or develop in adulthood. Possible causes include a combination of dry, irritable skin, a malfunction in the body’s immune system, and/or a genetic tendency for allergic conditions such as asthma or allergies. An injectable medication called Dupixent is now available for Atopic Dermatitis. Our research team at Payson Dermatology actually conducted the clinical trial for this medication which subsequently was approved by the FDA for the treatment of Atopic Dermatitis. Ask for a consultation today.
Contact dermatitis is a rash that results from direct contact with irritants or allergy-producing substances. Common irritants or allergens include laundry detergents, soaps, cleaning products, rubber, metals, such as nickel, jewelry, preservatives, perfume and fragrances, cosmetics, weeds, and neomycin, a common ingredient in topical antibiotic creams. Symptoms of contact dermatitis commonly include redness, rash, burning or swelling and/or blisters that may drain or become crusty. Our medical team offers treatments for this condition and also offer a comprehensive patch testing with the eighty most common allergens as determined by the American Contact Dermatitis Society. See website section regarding patch testing. If the offending allergen can be determined through patch testing this condition is cured by avoiding that allergen.
Dyshidrotic dermatitis is a condition that causes small itchy blisters on the edges of the fingers, toes, palms, and soles of the feet. Allergies, stress, moist hands or feet, or exposure to metals in jewelry, glues or dyes used in processing shoes are among the common causes of this type of dermatitis.
Nummular dermatitis is a common type of eczema that can occur at any age. It is different from the other types of dermatitis because it forms coin-shaped spots on the skin which are usually very itchy. It can be more difficult to treat and require stronger medications.
Seborrheic dermatitis is a very common chronic scalp and facial condition that often causes a red rash with scales. It is common in people with oily skin or hair, and it may come and go depending on the season of the year. People often notice it worsens if they are under stress. There are many treatments available to help keep this condition under control.
Stasis dermatitis happens when there is a problem with blood flow in the veins and pressure develops causing fluid to leak out of the veins. The resulting stasis dermatitis presents with swelling around the ankles, redness, discoloration, scaling, itching and pain in the skin of the lower legs.
Complications of dermatitis include infections and scar formation from repeated scratching.
Treatments for dermatitis
Dermatitis treatment varies, depending on the cause. Steroids and non-steroidal creams are usually prescribed as a first line treatment. To minimize side effects, such as thinning of skin, and to increase effectiveness, topical corticosteroids are generally used only short-term until rashes are under control. Other treatment options include medicated shampoos, use of antihistamines that can reduce itching, oral antibiotics for secondary infections or their anti-inflammatory effects, non-steroidal topical medications. There is now an injectable medication proving very effective for atopic dermatitis called Dupixent.
Avoid scratching whenever possible. Cover the itchy area with a dressing if you can not keep from scratching it. Trim nails and wear thin cotton gloves at night. Wear smooth-textured cotton clothing. This will help you avoid irritating the affected area. Use a mild, unscented laundry detergent without dyes when washing clothes, towels and bedding. Try using the extra-rinse cycle on your washing machine.
Prevention of dermatitis includes avoidance of known irritants including poison ivy, and harsh soaps. Try to identify and avoid triggers that worsen the inflammation or rash and itch.
Stress can often worsen some forms of dermatitis.
Avoiding dry skin may be one factor in helping you prevent future bouts of dermatitis. These tips can help you minimize the drying effects of bathing on your skin:
- Limit the time of your shower and use warm, rather than hot water.
- Use only mild soaps, such as Dove that clean without excessively removing natural oils.
- Deodorant and antibacterial soaps may be more drying to your skin. If you have dry skin and the dermatitis involves the body, consider applying the Dermatologist’s Choice Pre Bath Oil 5 to 10 minutes prior to your shower. You may also apply a moisturizer after your shower and throughout the day.
Your doctor will discuss a personalized treatment for your dermatitis.
If you’re noticing thinning, shedding, or bald spots, our dermatologists’ can, in many cases, develop a plan to stop and reverse the hair loss.
Many conditions, diseases, and methods of hair care can result in excessive hair loss.
We specialize in treating diseases of the hair, skin, and nails. After examining the scalp and hair, blood tests or a scalp biopsy may be needed to accurately diagnose the cause of the hair loss and to determine if the problem will respond to medical treatment.
Hereditary thinning or baldness is the most common cause of hair loss. This can be inherited from either the mother’s or father’s side of the family. Women with this trait develop thinning hair, but do not become completely bald. Men can have both thinning hair and baldness. This condition is called androgenic alopecia. It can sometimes be noticed as early as the teen years, and twenties, or as late as the sixties or seventies. There is no cure for androgenic alopecia, but medical treatments that are proven effective are available. One treatment involves applying a lotion or foam to the scalp once or twice a day. Another treatment involves a daily pill containing a medication that blocks the effect of the active male hormone in the hair follicle. The most recent advances in health care for hair loss involves injecting a platelet rich plasma (PRP), obtained from the patient’s own blood, into the scalp. The platelet rich plasma (PRP) contains powerful growth factors that have proven helpful for rejuvenation of the hair follicle. Platelet rich plasma injections can be used for most forms of hair loss including androgenic alopecia and alopecia areata.
Our team of providers will help you decide which method or combination of methods is the best for you.
Hives are raised, often itchy, red welts on the surface of the skin.
Many substances, illnesses, or situations can trigger hives, including: Animal dander (especially cats), insect bites, medications, pollen, certain foods, emotional stress, extreme cold or heat, sun exposure, exercise, certain illnesses and autoimmune diseases and infections. However, in most cases, the exact cause of hives cannot be identified.
Treatment may not be needed if hives are mild. They may disappear on their own. To reduce itching and swelling, avoid hot baths or showers. Avoid irritating the area with tight-fitting clothing. Certain medications such as antihistamines can help relieve the symptoms. For more severe or persistent cases, stronger medications such as steroids or Xolair can be prescribed. Xolair is an injectable treatment for chronic hives and is effective in most cases that do not respond to conventional therapies. If your hives are severe, especially if the swelling involves your throat, you may require an emergency shot of epinephrine (Adrenaline). Hives in the throat can block your airway, making it difficult to breathe.
Our doctors will further discuss your treatment.
Melanoma is less common than both Basal Cell Carcinoma and Squamous Cell Carcinoma, but it is the most serious form of skin cancer and can be lethal. Most cases are caused by overexposure to UV rays from the sun or sun-tanning beds. However, some Melanomas can develop in non-sun exposed parts of the body, such as the bottom of the feet, armpits, groin, etc. Most melanomas are brown to black looking lesions. Unfortunately, a few melanomas are pink, red, or fleshy in color. Warning signs of malignant melanoma include change in the size, shape, color or elevation of a mole. Other signs are the appearance of a new mole during adulthood or new pain, itching, ulceration or bleeding. An often used memory tool to remember what to look for is the “ABCDEs” where
- A = asymmetrical — one side doesn’t match the other
- B = borders – irregularly shaped or blurred
- C = color — changes or different shades of brown, tan, or black, sometimes red, white or blue
- diameter larger than 6 mm – the size of a pencil eraser – But sometimes melanomas are smaller
- E = evolving – a mole that is changing in size, color, shape, or looks different from the rest
Make sure you have a skin cancer screening done at your next visit.
Melasma is a common skin disorder that causes a dark discoloration that appears on sun-exposed skin of the face. Women are affected more commonly than men. Although hormones appear to be involved, sun exposure is the strongest risk factor. Melasma doesn’t cause any other symptoms besides skin discoloration but may be of great cosmetic concern. A uniform brown color is usually seen over the cheeks, forehead, nose, or upper lip. It is most often symmetrical (matching on both sides of the face). Avoiding the sun and using sunscreen are key to preventing melasma.
Treatments include a bleaching creams like Hydroquinone, Tretinoin, Kojic acid, Azelaic acid, topical steroids (ask us about our pharmacy compounded Bleaching Emulsion ), lasers as well as chemical peels.
Patch testing/Comprehensive (American Contact Dermatitis Society top allergens)
Any individual with suspected contact dermatitis should consider having the patch test done.
Our doctor, nurse practitioner, or physician assistant may conduct the patch test to see which substances inflame your skin. The patch test checks for the most common allergens in the United States today as determined by the American Contact Dermatitis Society. Patches are applied and left on your back for 48 hours. The patches are then removed and skin is checked to see which substances have caused an allergic reaction.
The chemicals included in this patch test are the offenders in over 85% of contact allergic eczema and include chemicals present in metals (e.g. nickel, gold, and cobalt), rubber, leather, hair dyes, formaldehyde, preservatives, lanolin, fragrances, and other common product ingredients.
Sometimes the results can be inconclusive and further testing may be necessary. Patch tests may not always explain the cause of the dermatitis. However, if a specific chemical is found to cause dermatitis, avoiding that offending agent will help reduce the risk of future breakouts.
If an allergic reaction is suspected to be the cause of your dermatitis, our providers will discuss doing patch testing.
The common reasons to do patch testing include:
- Persistent dermatitis
- Frequent dermatitis
- Hand dermatitis/eczema
- Facial dermatitis (not seborrheic)
- Discoid dermatitis
- Atypical allergic symptoms
- No improvement with treatment
- Appears suddenly/no past history
- Contact with a known allergen
- Unusual distribution or pattern
- Indeterminate cause
- Leg dermatitis
- Foot dermatitis
- Perianal or perineal dermatitis
- Chronic otitis externa
- Dermatitis or urticarial reactions after ingestion of suspected allergens
Perioral dermatitis is a bumpy reddish rash around the mouth or nose. This type of dermatitis may mimic forms of skin disorders that include rosacea, adult acne or seborrheic dermatitis. It often causes an uncomfortable burning or less commonly itching sensation. Rarely, the rash may appear around the eyes, or forehead(this is called periorbital dermatitis).
Perioral dermatitis is thought to be related to acne and sometimes persists for months or years.
Possible causes include makeup, moisturizers, overuse of topical corticosteroids, and dental products containing fluoride.
Treatments for perioral dermatitis include various creams and oral antibiotics such as doxycycline or minocycline.
Perioral dermatitis can be persistent and often requires several months of treatment.
Our doctors will recommend the best current therapies available for this condition.
Psoriasis is a common, chronic, scaly silvery rash with well defined edges. This typical scale may not be so obvious if the psoriasis affects a body folds such as the armpits, under the breasts or groin areas, in which case skin is more likely to be red, smooth and shiny. Psoriasis can run in families and affects men and women equally. More than 8 million Americans have psoriasis. It can be influenced by many environmental factors, but it is not contagious and is not due to an allergy. About 30% of those affected with psoriasis will also develop joint pain (psoriatic arthritis), which may involve one or several joints. Let our doctors know if you also have joint pain.
A great deal of research is being conducted in the field to understand the exact cause of psoriasis, we now know that the hyperactivity of certain cells in the immune system is responsible for the development of this disease.
Physical and emotional stress, infections, and certain medications may precipitate psoriasis.
Most forms of psoriasis run a fluctuating course with periods of marked improvement and even complete clearance, only to relapse at a later time. There may be several years between relapses. Although there is no cure for psoriasis at this time, over the last decade there have been revolutionary new effective medications discovered that can offer successful treatment choices.
Treatment options for psoriasis include various types and strengths of topical medications, light and laser therapy (including XTRAC Laser) oral medications, injectable medications(called Biologics). At Payson Dermatology, you are in good hands with our experienced medical team. We are proud to have expert physicians in the field of psoriasis who have co-authored numerous articles and are actively involved in clinical trials in psoriasis. To date Dr Jazayeri and his dedicated team of research colleagues have successfully conducted over 50 clinical trials. Many of the currently available psoriasis medications and such as Cosentyx, Taltz, Tremfya, Stelara, Skyrizi, Cimzia have had clinical trials conducted at Payson Dermatology. Many other upcoming trials on oral and injectable medications are currently being conducted at our office.
Dr Jazayeri and his team are also actively involved with and are collaborating with the National Psoriasis Foundation‘s(https://www.psoriasis.org/) and their Corrona Registry which helps collect long term data on patients who are on biologic medications.
Our knowledgeable doctors will go over best available therapy options for your psoriasis during your visit.
Removing unwanted skin growths
Unwanted and unsightly benign (non cancerous) skin growths such as skin tags (small soft bumps), angiomas (red bumps) , warts, and other moles can be removed using a variety of methods. These growths usually do not need to be removed except if they become symptomatic, like itchy or sore, or if you do not like their cosmetic appearance. Several methods exist for the removal of lesions such as freezing, cauterizing, scraping off followed by application of a solution, or shaving off after using local anesthetics. If there is any doubt that the growth can be malignant, then a biopsy is performed. Scars could appear following the removal of any lesion regardless of the method used. Cosmetic removal of skin growths start at $99 to $131. Our doctors will discuss the best way to remove your unwanted skin lesions.
Rosacea is a condition that causes a red facial rash. Sometimes this redness is accompanied with pimples. Although the cause of rosacea is unknown, it may get worse by sun exposure, stress, changes in temperature (both heat and cold), alcohol consumption, certain foods such as spicy foods, and some topical creams.
Characteristics of Rosacea may include: red bumps and pustules, mainly on the face, frequent blushing or flushing, red face and prominent blood vessels, dry flaky skin, red sore eyelids or eyeballs. Rhinophyma refers to a form of rosacea that causes the nose to become enlarged and bulbous. Rosacea may be brief and short-lived, recurrent or persistent.
Treatments for Rosacea may include: avoiding trigger factors, topical treatments, oral antibiotics, other oral medications, and laser therapy.
Ask the doctors about the treatment options including our pharmacy compounded prescription products for rosacea.
The most common malignant skin cancers are basal cell cancer, squamous cell cancer, and melanoma.
Non Melanoma Skin Cancers (Basal and Squamous Cell Carcinoma) are the most common form of cancer and every year more than 3 million cases are diagnosed in the US. The number of newly diagnosed skin cancer is on the rise every year.
There are a variety of different skin cancer symptoms. These include changes in the skin that do not heal, bleeding, ulcers in the skin, discolored skin, and changes in existing moles, such as jagged edges to the mole and enlargement of the mole.
Skin cancers have many potential causes. Examples include:
- Excessive Ultraviolet sun exposure or tanning beds.
- Smoking tobacco and related products can double the risk of skin cancer.
- Chronic non-healing wounds, especially burns can develop into squamous cell carcinoma.
- Genetic predisposition, including “Congenital Melanocytic Nevi Syndrome”.
CMNS is characterized by the presence of “nevi” or moles of varying size that either appear at or within 6 months of birth. Larger size moles are at higher risk for becoming cancerous.
Human papillomavirus (HPV) is often associated with squamous cell carcinoma of the genitals, anus, mouth, pharynx, and fingers.
The risk of developing skin cancer can be reduced through a number of measures including:
- Decreasing indoor tanning and mid day sun exposure and increasing the use of sunscreen.
- Avoiding the use of tobacco products.
- Reducing overexposure to ultraviolet (UV) radiation, especially in the early years of life (about 80% of a person’s lifetime UV exposure happens during the first 18 years of life).
- Wearing protective clothing (long sleeves and hats) when outdoors.
- Applying Broad-spectrum sunscreen SPF 30 or above that blocks both UVA and UVB radiation.
- Reapplying sunscreen frequently.
Treatment of skin cancer is dependent on the type of cancer, the location of the cancer, a person’s age, and whether the cancer is primary or a recurrence. Our doctors will look at the specific type of skin cancer (basal cell carcinoma, squamous cell carcinoma, or melanoma) in order to determine the correct treatment.
Treatments for skin cancers of all types include surgical techniques including excision, MOHS surgery, Cryotherapy (freezing technique) and electrodesiccation and curettage.
MOHS micrographic surgery is the most accurate and successful method to remove the more common skin cancers. This technique involves removing the cancer and checking the margins during the same visit.
Non surgical treatments of some skin cancers include various creams, gels, and solutions, radiation therapy as well as the use of PDT or photodynamic therapy (The use of light combined with a specific chemical)
In the case of disease that has spread (metastasized) or more advanced cancer, further surgical procedures, radiation, some oral medications or chemotherapy may be required.
Skin Checks & Self Examination
Over 3 million Americans are affected by skin cancers each year, making it the most common form of cancer. Additionally, Arizona ranks #2 in the World in skin cancer incidence rates (Only Australia beats us!). It is therefore recommended that you periodically have a full body skin check by a dermatologist to detect suspicious lesions. It is also extremely important that everyone perform frequent self examinations of their skin to detect skin cancers. Early detection is key to having a high cure rate. If not done yet, call to set up an appointment for your yearly skin cancer check.
During your skin check visit our staff will provide you with a skin cancer pamphlet that contains useful information on skin examination and shows pictures of some of the skin cancers. If you have had excessive sun exposure or have suspicious moles or history of skin cancers, ask us for a skin cancer screening.
Squamous cell carcinoma
Squamous cell carcinoma(SCC) is commonly a reddish, scaling, thickened patch on sun-exposed skin. Some become firm hard and dome shaped. Ulceration and bleeding may occur. When SCC is not treated, it may develop into a large mass. Squamous cell cancer is the second most common skin cancer. If left untreated, SCC can spread and become dangerous. MOHS surgery is often the best surgical treatment for most SCCs of the skin.
Warts, also called Verrucae are growths on the skin caused by a virus called human papillomavirus (HPV). They are generally harmless. However, warts can be disfiguring and embarrassing, and occasionally they itch or hurt (particularly on the feet). Warts are contagious.
The different types of warts include:
- Common warts have a rough or spiky surface and usually appear on the hands, but can occur anywhere.
- Flat warts are smaller, smoother and are generally found on the face and forehead. They can spread from shaving if they occur on the legs or the neck.
- Genital warts(condyloma) are usually found on the genitals, in the pubic area, and in the area between the thighs, but they can also appear inside the vagina and anal canal. A small percentage of these warts can cause cervical and anal cancer.
- Plantar warts are found on the soles of the feet and can become painful. These warts are more difficult to treat and typically require multiple treatment sessions.
- Subungual and periungual warts appear under and around the fingernails or toenails. These warts may also be more stubborn and require multiple treatments.
While some warts disappear without treatment, most can persist for a longtime and will require some form of therapy. Since they are contagious, warts can spread from one part of your own body to another.
Several methods exist to remove warts. Some over the counter medications exist that could help remove smaller warts. However, unfortunately, these medications do not work too well for larger or thicker warts, like the ones on the feet, for example.
Our doctors will discuss the various therapies that would work the best at eliminating your warts. These include topical medications, scraping and applying a topical solution, freezing or cauterizing method or other therapies.