1. What do you do in the office for persistent rashes? How do you determine if the rashes are caused by skin allergy?
Testing for allergies in a dermatologist’s office is completely different from that in an allergist’s practice. In the latter, you may be tested for allergies to such substances as pollen, ragweed and various foods. Dermatologists test for allergies to substances you touch (nickel in watchbands, preservatives in creams and lotions, hair dyes, fragrances, etc.). Simply put, dermatologists do not test for allergies to things you consume or inhale. We test for allergies to things your skin comes in contact with.
In patch testing, several patches with multiple allergens (substances to which you may be allergic) are taped on your back. The area is marked for easy identification and taped to secure the patches in place. The patches are removed in 48 hours for the reading of preliminary results. Some allergies show up at a later time, hence a second visit 72 or 96 hours later is required. Patients cannot shower or wet the back for the duration of patch test.
If the chemical causing the allergic reaction is identified, your doctor will discuss the ways to avoid the offending substance and provide you with written materials on the topic. Unfortunately, there is no cure for skin allergies. Only careful avoidance of substances responsible for your allergies can make things better.
2. What treatments are available for excessive sweating? Will the treatments, such as Botox, be covered by my insurance?
Hyperhidrosis is sweating of the underarms, palms, soles, or facial region in excess of the amount needed to regulate body temperature. This condition sometimes results in severely impaired self-esteem and social functioning. And just like for any medical condition, treatments for hyperhidrosis, such as topical anti-perspirants, oral pills, and Botox injections are commonly covered by insurance.
3. What are the signs and symptoms of actinic keratosis? Can actinic keratosis turn into skin cancer?
Pink and red scaly spots on sun-exposed skin are frequent signs of actinic keratosis. They usually do not have any symptoms, such as pain or itching. These blemishes are pre-cancerous. They indicate that the skin has been damaged by the sun sometime during your lifetime. Often, the damage has been done decades ago. Over time they can turn into squamous cell carcinoma, which is a common type of skin cancer.
Some of the treatments for actinic keratoses include topical creams, freezing, scraping, and photodynamic therapy (PDT).
4. Could you tell us more about photodynamic therapy (PDT)?
Photodynamic therapy is one of my favorite treatments for actinic keratoses. The treatment is very effective and short in comparison to cream treatments. Creams usually have to be used for four to six weeks. PDT is a single session (which has to be repeated for some patients).
Some patients use PDT treatments for removal of pre-cancerous lesions (and in that case it is covered by insurance), other use it for reversal of sun damage and cosmetic improvement (in that case patients are responsible for payment).
The treatment requires patients to spend about an hour and a half in the office. A medication is applied onto the treated area. It is selectively absorbed by more rapidly dividing cells, such as pre-cancerous or sun-damaged cells. Thereafter, the patient is exposed to a light with a special wavelength to activate the medication absorbed into the patient’s skin. The interaction of the light and the medication causes the sun-damaged cells to slough off. Patients may expect some skin redness and scaling, like sunburn. The redness usually resolves within a week. And the newly rejuvenated skin is ready to show! What is especially impressive for PDT treatments is that there is no scarring. Compare this to cryotherapy (freezing), which I still use in the office for selected problems. Cryotherapy often leaves patients with white discolored spots.
