Common Skin Diseases and Patch Testing
- Alopecia and Hair Loss
- Dry Skin
- Eczema and Dermatitis
- Hair Loss
- Poison Oak Ivy
- Sebaceous Cysts
- Skin Cancer
- Skin Infections
- Skin Rash
- Skin Tags
At our state-of-the-art facility serving the Monterey Peninsula area, we treat skin cancer and a variety of skin conditions. For your medical skin concerns, issues and treatments, please schedule an appointment with Dr. Javid at 831-293-8458.
Atopic Dermatitis is an inflammatory, chronically recurring, non-contagious skin disorder that is accompanied by itchiness. This is a form of eczema.
Patients with Atopic Dermatitis react abnormally to allergens such as environmental agents, irritants and food with flaky res and very itchy rash. It is a chronic condition that runs in families and often occurs with asthma, hay fever and allergic conjunctivitis.
Who is a Candidate?
Symptoms of Atopic Dermatitis vary with age.
- Infants with this condition usually have scaly, red, oozy and crusty areas on the cheek areas of their face; however, areas on their arms, legs and neck can also be affected. This condition normally will resolve by three years of age.
- Older children will display symptoms that include thick, dry and scaly skin with a very persistent itch.
Treatment of Atopic Dermatitisprimarilyinvolvesidentifying and avoiding the triggers that could include:
- Environmental insults such as dust and pet dander.
- Anger and stress
- Lack of sleep
- Excessive heat, humidity and coldness
- Extreme and sudden temperature changes
In some cases a prescription medication may be required. Dr. Roya Javid will examine and evaluate the atopic dermatitis and offer recommendations for improvement and management techniques as well as explain the risks and benefits of any procedure performed.
Eczema is a general term for an inflammation of the skin (dermatitis). The most common type of eczema is the form called atopic dermatitis. Atopic dermatitis is usually associated with a group of diseases that are often inherited, such as asthma and hay fever.
Eczema affects about 10 to 20 percent of infants and about three percent of adults and children in the United States. Some children outgrow eczema. For others, it is a chronic condition that continues throughout adult life.
The main symptom of eczema is pruritus or itchy skin. There are times, when a patient’s first symptom is itching with almost no obvious rash. Classic locations on the body for eczema are the face, back of ears, back of the knees, wrists, hands, or feet. Generally you will see red scaly patches that can crust, turn brown and either become hyper-pigmented or hypo-pigmented as the eczema heals.
The precise cause of eczema is unknown, but it is believed to be linked to an overactive response by the body’s immune system to an irritant. It is this response that causes the symptoms of eczema. Some forms of eczema can be triggered by substances that come in contact with the skin, such as soaps, cosmetics, clothing, detergents, jewelry, or sweat. Stress and changes of temperature or humidity can also worsen eczema.
There are different types of eczema ranging from atopic dermatitis, which is usually genetic and starts in childhood, to contact dermatitis, which is typically a reaction to an irritant such as nickel or poison ivy. Other forms of eczema are nummular eczema that occurs in round coin-shaped areas, and dyshidrotic eczema that appears predominantly on the hands and feet in the form of vesicles.
Dr. Javid will evaluate your medical history, physical exam, and family history. A biopsy of the skin or skin allergy testing may be advised to make the correct diagnosis.
Treatment for eczema is a combination of preventing itching, inflammation and worsening of the condition. Topical emollients, steroid creams, and oral antihistamines may be prescribed. Taking oatmeal baths and avoiding hot showers typically help this condition. Lifestyle modifications to avoid triggers for the condition are also recommended by Dr. Javid.
It’s said that about 1% of the population has hyperhidrosis (the technical term for excessive sweat), a condition in which the body produces extra sweat. Generally, it begins during adolescence but can start at any age and continue throughout our lifetime effecting areas such as the face, hands, armpits, feet, trunks and thighs; sweating can occur at random throughout the day along with night sweats.
Excessive sweating is a serious matter, especially when it occurs in front of others. Simply hiding your condition from others can cause a great deal of emotional distress which in turn increases the amount of sweat produced, thereby creating even more stress.
Stop the embarrassment, hassle, and expense of excessive sweating.
For excessive underarm sweating, the easiest treatment is Botox. A single treatment to both underarms will reduce sweat production by an average of 83.5% and last on average for 7.5 months.
Treatment Options for Sweating
1. Antiperspirants – High strength antiperspirants such as Hidrosol or Rexona available at your local pharmacy. These antiperspirants contain a higher concentration of aluminium salts than usual antiperspirants. Aluminium salts bind dead skin cells to form plugs which block the sweat pores. They are best applied to dry skin after a shower. The higher concentration products may irritate the skin. There is a limit to how much they can help.
2. Oral Drugs – These are available from a doctor. Oxybutinin, beta blockers, diltiazem, and propantheline can reduce sweat production. They have side effects, especially dry mouth.
3. Iontophoresis – This treatment involves a mild electric current passed through water applied to the skin. Regular treatments are necessary. A full size machine is available at some hospital dermatology clinics.
4. Surgery – There are two types of surgery used to treat hyperhidrosis:
- Currettage involves cutting and scraping away the sweat glands. This leaves a large wound which then needs a skin graft or heals with a large scar.
- Endoscopic thoracic sympathectomy is more commonly performed. It involves telescopic surgery to cut the nerves inside the chest which control sweating. This is done through a number of small incisions made between the ribs. It works extremely well for palmar sweating, less so for the armpits where not everyone gets excellent results. Compensatory sweating (new areas of excessive sweating occurring in new body areas) can occur in about 30% of patients.
5. Botox® – Botox® is a purified form of Botulinium toxin. Botox® blocks the nerve signal which stimulates the sweat glands. The neurotransmitter involved, acetyl choline, is the same neurotransmitter which stimulates muscle contraction. Botox reduces excessive sweating.
Medical studies show that the average reduction in sweating has been shown to be 83.5%. The effects last an average of 7.5 months. Sweating slowly increases again and eventually the treatment will need to be repeated. So Botox tends to normalise sweating not abolish it and the effects wear off over time.
However, in one long term study 28% of patients were still happy 16 months after one treatment. In our experience, our worst result occurred in one woman who felt sweating return after two months and our best result was in a male chef whose results lasted three years. One important bonus of treatment is that patients develop a trust in how Botox is normalizing their sweaty area. Because they become less anxious that they will sweat, they sweat less.
There is a risk of local muscle weakness (Botox® paralyses muscles which is how it works in wrinkle reduction). No one has reported it happening in the armpit although it can occur in the hands making it hard for a while to open jars. Up to 5% of patients are said to get compensatory sweating elsewhere. It’s possible to get a bruise from the injections. Topical local anaesthetic reduces discomfort.
If you do decide that you want to consider Botox® then it’s best to come in and discuss your personal situation and treatment options in detail. Successful treatment means injecting the entire problem area so it helps if you can take note of exactly where your problem areas are. This information is used in addition to our medical tests to determine exactly where the sweating is coming from and therefore where to treat.
Lichen Planus is a rash that can develop on the skin, tongue, scalp, and oral mucosa. The typical rash of lichen planus has been described as the “5Ps”: pruritic, planar, purple, polygonal papules. The rash is common around the wrist and ankles and persists for weeks, often turning blue-black or dark brown in discolored patched on the skin.
The eruption may appear as papules, pruritic bumps, blisters, or rarely as erosive sores particularly in mucous membrane areas. The nails may be affected with ridging or grooves on the nails, with splitting or thinning or even loss of nails. The scalp may be affected with redness, irritation, and patchy hair loss or even scarring.
Lichen planus is most common in middle-aged adults. More women get lichen planus in their mouths than men. Lichen planus is believed to be an autoimmune disease. Some cases of lichen planus can be a complication of hepatitis C virus infection.
Various medications are used to treat lichen planus including oral and topical steroids, retinoids, tacrolimus ointment, antihistamines, and PUVA. Many cases of lichen planus resolve within two years. Dr. Green can prescribe lightening agents or laser therapy for the dark spots that sometimes remain after treatment.
If you’ve noticed a persistent or unusual rash on your skin, a prompt diagnosis followed by the right treatment can help.
Melasma, sometimes referred to as “chloasma” when it occurs during pregnancy, is a skin pigmentation disorder. The skin condition consists of patchy brown pigmentation on sun exposed areas, usually affecting the forehead, glabella (in between the eyebrows), cheeks, upper lip, and chin. Individuals affected are almost always female.
Melasma is caused by overproduction of pigment of melanocytes, the pigment producing cells in the skin. Exposure to ultraviolet light, in particular, makes these areas darker, even with minimal exposure to the sun. Female hormones seem to play a role, as pregnancy, hormone therapy, and birth control pills all aggravate melasma.
Treatment can vary and may consist of topical retinoids, bleaching agents such as hydroquinone and botanical derivatives, as well as BBL. Our medical-grade peels are extremely effective in treating the condition.
Strict sun protection and sunblock use is critical to controlling melasma.
A mole is a benign growth of the skin that is raised and normally round and brown, because it is made up of a collection of pigmented cells. The medical terminology for a mole is nevus.
An individual should seek medical attention if a mole changes in shape or color, bleeds or emits a discharge, becomes sensitive to touch or is itchy. Dr. Roya Javid will examine and evaluate the area of concern and provide recommendations regarding treatment.
Pityriasis rosea (pih-tih-RY-uh-sus ROH-zee-uh) is a skin rash that is often preceded by an upper respiratory tract infection. The first sign is often a “herald” patch, which is a single 2- to 10-cm oval red patch that typically appears on the abdomen. Often several days after the original patch, multiple smaller red scaly oval-shaped patches appear on the trunk and sometimes on the extremities. The distribution on the back has been called a “Christmas-tree” distribution because of its characteristic outline.
The initial rash may be asymptomatic or accompanied by intense itching. At times the rash may be accompanies by low-grade fever, nausea, headache, and fatigue.
The cause of pityriasis rosea is believed to be viral. No treatment is required. Oral antihistamines and topical emollients and steroids can provide relief from the pruritus (pro͝oˈrīdəs). Direct sunlight has also been shown to hasten the resolution of the rash.
Poison oak, ivy, or sumac can develop a pruritic red itchy rash that often blisters. The rash is caused by the urushioloil found in the plants. The itchy, blistering rash often begins 12 to 72 hours after one comes into contact with the oil.
The rash is not contagious to another person. When the rash seems to spread, this is often caused by a delayed sensitivity reaction. You can spread the oil on your skin after direct exposure by touching other parts of your body. Urushiol can stick to almost anything including pet’s fur, gardening tools or clothing. It is important to clean all surfaces and objects that may have the oil on it.
Topical and oral steroids as well are effective in treating poison ivy. Oatmeal baths, topical emollients, and antihistamines can lessen the symptoms as well. You can also prevent a poison ivy rash in the first place if you wash skin immediately with lukewarm water and soak if you suspect exposure to the plant. Wash all clothing or objects that may have been exposed to urushiol oil.
Psoriasis, which presents as thick scaly patches on the skin, is a chronic skin condition that causes cells on the skin to grow abnormally fast. In normal skin, cells grow and fall off after about four weeks. When the skin sheds off, new cells then grow in place of the cells that have flaked off. When you have psoriasis, those new skin cells come to the skin’s surface much quicker—in days as opposed to weeks. This buildup of patches is referred to as plaques. Psoriasis can be an extremely embarrassing condition—especially during swimsuit season.
Management of psoriasis includes:
- Topical agents such as bath solutions, moisturizer and mineral oil as well as medicated ointments and lotions.
- Phototherapy that limits the abnormality fast production of cells.
- Systemic agents (pills and injections)
- Alternative therapy such as modification of lifestyle with improved stress management, no alcohol or tobacco and diet modification may be helpful.
For relief of psoriatic symptoms, Dr. Roya Javid will examine you and gather a medical and genetic history. She will evaluate this information as well as provide and explain treatment recommendations that will assist in alleviating your condition and relieving your symptoms.
Rashes are a reflection of the body’s way of telling you that something is wrong. Common causes of rashes are allergies to topical or environmental allergens, viruses, poison ivy, or as side effects of oral medications.
If a rash is persistent or accompanied by a fever, it’s important to come in for an exam by Dermatologist Dr. Roya Javid. Determining the correct diagnosis for any rash on your body is part of proper skin care to ensure an accurate diagnosis so the right course of treatment can be determined.
Skin tags and cysts are extremely common occurrences on the body and face but are easily removed. These sebaceous cysts and skin tags are benign and can be easily removed quickly and simply on an outpatient basis.
What is involved in the removal of the cyst or skin tags?
A local anesthetic is used to numb the area of the skin. The skin tags or cysts are removed by simple shave excision. There is little or no recuperation and the procedure takes no more than fifteen minutes.
While they may be thought of as a harmless physical blemish, warts are actually caused by viruses called papillomaviruses. Warts are classified both by type and location and can be very painful, especially when located on the bottom of your feet. Proper skin care for warts is important both to ensure patient comfort and to prevent multiplication and spreading.
Please don’t hesitate to contact us online today or call 831-293-8458 if you’re ready to learn more about effective wart treatment. Dr. Roya Javid practices the latest techniques at the forefront of skin care to give you the health that you deserve.
Warts are small, rough skin growths that look like a solid blister or cauliflower. They’re most commonly seen on the extremities like the hands and feet, but can occur anywhere on the body. Scientists have identified as many as 10 different varieties of warts; although many are harmless, some may be symptomatic of a more serious condition such as HPV.
Although warts are contagious, they are also easily treatable. In general, warts tend to disappear on their own without any additional treatment after a month or two. Warts can disappear and recur throughout the course of your lifetime. For more persistent warts, medical skin treatment may be needed.
There are a variety of treatment options when it comes to wart removal, ranging from drugstore kits to medical-grade topical medications. One urban legend even suggests that applying duct tape to the area will eliminate your wart, although this claim hasn’t been backed up by any scientific evidence.
According to one study that examined the results of several clinical trials, topical treatment using salicylic acid was the most effective, showing a 75 percent cure rate compared to less than 50 percent cure rate with placebos. However, each patient will respond to treatment differently, and what works best for one may not be the preferred option for another.
Dr. Javid may suggest a prescription cream or ointment to diminish the size and appearance of your wart, or may surgically remove it. Warts can also be frozen off using cryosurgery or treated with a pulse dye laser.
If you’re concerned about the appearance of warts and home remedies haven’t given you the relief you hoped for, there’s a solution that can help. Call us at 831-293-8458 to learn more about whether Dr. Javid’s combination approach toward wart treatment may be right for you.
Some Skin Diseases are Caused by Allergies
There are many types of skin disease and one of the most difficult to cure is eczema, which is also known as dermatitis. There are many things that flare dermatitis, such as stress, “nerves”, dry skin, genetic factors and skin allergies. Sometimes we are unable to find the cause of the dermatitis; therefore, we simply have to treat the symptoms. The ideal situation, however, is to try to find the cause of the problem and figure out a way to remedy the problem by removing the cause.
Patch Testing Can Help Diagnose Skin Allergies
Often we may suspect that a person’s dermatitis is caused by an allergy to something that comes in contact with the skin. A person may come in contact with the substance (called an allergen) at work, in taking care of the home, or just in the course of day-to-day living. In industry, for example, machine tool operators may become allergic to certain cutting oils. In the home, skin care products, i.e., cosmetics, lotions and soaps, as well as other items that we touch every day like rubber and metal, are all common causes of allergic dermatitis. The first step in determining the cause of an individual’s dermatitis is to try to identify any possible substances that the person is exposed to and is likely to be allergic to. Then we can perform patch testing to look for a reaction.
Patch testing is a simple, painless procedure. Certain chemicals and other substances are placed on a small aluminum disc, which is attached to a piece of special tape. The discs are taped on the back and left in place for two days.
The patches are removed in the office and any allergic reaction will be visible on the skin. When we first remove the tape, we are usually unable to be totally certain about whether the reaction is positive or not and therefore we will need to have the patient return in 2 to 5 more days for one final checkup. During this time there are no further patches placed on the back and the patient can go back to normal activities. During the time that the patient wears the patches, the back must be kept dry. This includes bathing and also perspiration. Therefore, during these 2 days the patient will need to avoid sporting activities or strenuous exercise, and if the patient is in a work situation where perspiration is common, he or she may need to be placed on light duty. We will discuss this with the individual at the time of testing.
The chemicals or substances used in patch testing depend on the type and location of the patient’s dermatitis. We keep hundreds of materials in our office for testing that are common causes of skin allergy. In addition, we ask that the patient bring in samples of any substance, either from the home or the work place, that he or she is suspicious may be contributing to the dermatitis.
Like any medical test, patch testing is not 100% accurate. There is a small chance of a false-negative or false-positive reaction. For this reason, it is essential to correlate the patch test results with a thorough history and examination of the skin. Only then can we be sure that the reaction is significant.
If you suspect that your skin problem may be caused by an allergy, then patch testing should be done. In addition, many cases of dermatitis or eczema without an obvious cause may turn out to be due to an unsuspected allergy. This is particularly frequent with hand eczema.
Please feel free to discuss the need for patch testing with Doctor Javid. 831-293-8458
When you call the office, please tell the receptionist you are scheduling a patch test. Because of the complexity of the procedure we need to do our testing on certain days. We usually apply the patches on Monday and then have the patient return on Wednesday for removal of the patches and readings. Then the patient will need to return on the following Friday or Monday. Plan on 30 – 60 minutes in the office on both the Monday and Wednesday, with a shorter amount of time required for the third visit. If you are coming from out of town, we will be glad to recommend a local hotel facility.
There are several things that are very important that the patient should remember when scheduling patch testing:
- We usually need to wait at least four weeks after a person has been given a cortisone (Kenalog) shot. If the patient was given a lesser strength shot, we may be able to do the testing after a shorter period of time.
- If the patient is on Prednisone or other oral cortisone-type medications, then he or she should be off the medications at least three or four days before testing.
- The back must be free of any active dermatitis at the time of testing.
- Topical cortisone-type creams or lotions should not be used on the back for one week before testing. They may be used elsewhere on the body, however.
- The patient should not have any sun exposure to the back for at least one week prior to testing.Usually antihistamines and other medications do not interfere with testing, so these can continue to be taken before and during patch testing.
- Please wear a shirt that is dark colored or “old” on Wednesday when the patches are removed. We mark the back with ink that occasionally rubs off on clothing.