Ask the Dermatologist
Welcome to our Ask the Dermatologist page! We feel it is important for you to get the answers to your questions, and educate our patients at the same time. Feel free to ask a question below in the comment section. Dr. Arnold Oppenheim, M.D. will review your questions and re-post the answers right here on this page. If you have a personal question that you’d like to ask the Doctor in private, feel free to call our office at (757) 523-4800, or email us at aoppenheim@cox.net. We look forward to hearing from you!
One short question, does accutane thins or thickens the skin.
Most of the accutane users say that it it thinned their skin but the 3 studies that I’ve read say that it really thickens the epidermis and that the dermis stays about the same, so overall orally taken isotretinoin thickens the skin.
So what’s really the truth, does orally taken isotretinoin thins or thickens the skin.
Thanks
There are reports of permanent skin thinning. In fact this fact is in the package insert. The vast majority of patients are not going to notice any difference at all however. Essentially, Accutane thickens the basal cell layer is there is an increased proliferation of the keratinocytes. However, the stratum corneum is thinned. Arnold Oppenheim
Hi, two quick questions about isotretinoin.
1.) When taking low dose accutane, when it comes to the levels of isotretinoin in the blood and pharmacokinetics of accutane, is it the same to take 1x10mg pill every 4th day VS. 1×2,5mg pill every day?
2.) Is the hair losing side effect dose dependent, meaning higher dose worse hair loos, low dose minimum to non-existent hair loss?
Thanks for helping me out.
Hello Goran, As far as Accutane dosage, it is better to take one 2.5 mg. caplet every day. This gives a more even dosage. The hair loss problem tends to be dose dependent. I have only seen this side effect a few times though.
I got my skin tags sprayed with nitrogen on Tuesday. I feel like I have sunburn where I got them sprayed. Is there anything I can do for it? Thank you
Kelly,
As a prescription product, I fine Biafine best for this type of problem. If there is pain, lidomantle cream is excellent. OTC Eucerin calming cream or Aquaphor or Aveeno Ultra-Calming cream are all great products.
Hi, I have what seems to be adult acne predominently across my chin and temples and cheeks below my cheekbones; I’m 34. I’ve been to several dermatologists over the years and haven’t been able to get rid of it. I have sensitive, oily skin and most topical products irritate my skin, making it very red. I also flush easily and badly on my chest and face when I get upset or embarrased, so the redness thing is constantly an issue. Products that have oil control agents result in more sensitivity and more oil production. I’m allergic to glycolic acid and am sensitive to organic ingredients like fruit and sugars and also to fragrance and the sunscreens in liquid products – I get itchy red spots that look like acne. My last dermatologist prescribed Differin, which has not made a difference in 8 wks, rather has only made my skin more red, sensitive and shiny smooth, but still with acne. The only thing I have found to work is the Candela Smooth Beam laser, but I haven’t found anyone in Va Beach who uses it. Blue light treatments also seem to work, but require treatments on a regular basis and both options get expensive. Do you have any recommendations?
A few recommendations: Aczone gel is a newer medication and has a nice base which your skin might not find irritating. Also, nicomide ( niacinamide) is a very good product that is underrated in acne treatment. If you used Differin gel then a switch to cream might be in order. Also, Finacea would help with acne and somewhat control the erythema as would Aveeno ultra-calming cream. If you have pustules then an oral antibiotic such as Solodyn. If a number of cysts persists, and if you have irregular periods I would suggest a hormonal work up. As far as light devices: Blue light should be given twice a week for a month. Usually this is done as a package. Our office charges $450 for the package, but prices do vary. Adding Levulan improves the response rate, but increases costs by $130 per treatment ( the cost of the Kerastick). If you have nodulocystic acne though, this is not for you since the Blu-light might worsen the situation. Some physicians are using the red light, but this is less effective. The Smooth Beam is a 1450 Diode Laser. I will see who has this laser and let you know. Thank you for your question.
hi, i have a question about skin irritation, aka rash. I have one that is covering part of my neck. My brother thinks its bacterial, my mom thinks I’m sensitive to rusty metal (fell asleep wearing a rusty necklace). I’ve tried A+D baby cream, gold bond anti-itch, benedryl, cortizone. Its still there. Right now I’m using Clearasil on it, because it kills bacteria. Its red, kinda itchy, and i want it gone. I was looking online, and it kind of looks like eczema, but I’m hoping its just a regular rash that could be lingering because of wear I work and stress from there. I’d go to a dermatologist, but I work minimum wage. Um, help?
Hi Dr., I was in to see you about a month ago and I’ve been using Ziana for what looks like it could be an acne break out on the right side of my chin and right of my mouth. You mentioned it might not be acne, but rather something else. There has been no change in the condition and I’m wondering if it could be a skin infection instead of acne? And if so, what do I do next? I have another appointment scheduled on 4/19 was the earliest opening, but thought I’d check to see if there’s anything I can do before then on my own. Thank you! PS. the Ziana has worked wonderfully on the other areas that do appear to be acne.
do you have plans to start using the Zeltiq Cryolipolysis procedure anytime soon?
We have been investigating this device and the Zerona. In fact we recently discussed the Zerona with the CEO and developer of the machine. However, I am still perusing the literature to ensure that the results are worthwhile and satilsfactory. We will keep you informed.
Hi Dr,
I’m a 23 year old guy who has never really had a problem with my skin. I have started to notice “bruising” around my eye. It’s on the side of my nose and halfway around the bottom of my eye. It’s a dark purple color and I can feel the slight bruising around my eyes. It makes me look as if I’m tired or had too much to drink from the night before. It almost seems like the blood isn’t flowing to that part of my face? I’ve done some research, and I thought it was caused by not eating enough vegetables or drinking enough water. I have since started taking a multi-vitamin and drinking more water but it hasn’t helped. I’ve also used lotions around my eyes as well. What causes this? What can fix this problem? Is it hereditary? I get more than enough sleep and don’t touch that part of my face often.
Do you perform IPL for rosacea patients? How effective are the treatments?
Yes, we do perform IPL for Rosacea. We use the Harmony. We find it quite effective, in conjunction with other therapies. I would not expect 100% resolution with IPL, but you should have significant improvement.
We do provide IPL blue light treatment and photodynamic therapy treatment with Levulan for acne. Feel free to call our office for details if you are interested at 757-523-4800.
We offer blue light IPL treatment and photodynamic treatment for acne. The lasers we have, while used sometimes for acne, are not ideal for acne treatment. I frankly use the above light treatments in patients who are afraid of or have failed Accutane. I would rather go for a cure rather than a temporary solution if a patient’s acne is that bad.
Happy holidays to you too Alexandra. Usually, facial cysts can be removed quite easily surgically. The incision made is quite a bit smaller than the actual cyst so there should be a limited scar. The scar on most facial cysts is also small because the cyst itself has stretched the skin. Scars are made worse by pulled skin and since the skin has been stretched by the cyst, it is more lax and leaves less of a scar. Laser is an obliterative procedure and would offer no benefit. I would be happy to look at it for no charge. Arnold Oppenheim
Sorry for the delay Alexandra. We were having trouble with the comment section.
The lasers we have are for psoriasis, vitiligo, removing spider blood vessels and hair removal.
Lasers cannot remove cysts. Surgery is the only solution to this problem. I would recommend excision before the cyst becomes too large. By the way, sebaceous cyst is a misnomer that even some physicians mistakenly use. These are cysts, but are not lined by sebaceous glands, plus their contents consist of keratin and not sebum. There is a true sebaceous cyst called a steatocystoma multiplex in which these criteria are met.
I hope you like the field. We are quite enthusiastic in our office when it comes to cosmetic treatments. We do have an excellent, experienced master aesthetician Stephanie Bazner. However, it would be a good idea to meet us, and then if we hear of anything we can relay to that person that we have met you. Stephanie can also give you a world advice regarding the field. Good luck. Arnold Oppenheim
Alisha,
Sorry, our office does not need an esthetician presently. You might ask me intermittently in case of I hear of an opening. I do see my colleagues quite often, so I might hear of a position.
He should be examined by a dermatologist since he most likely has something besides a fungus infection. Many hand rashes are caused by psoriasis, atopic dermatitis (eczema), allergic or irritant contact dermatitis. I have also seen two cases of T- Cell lymphoma which began in the hands….both cases had been missed for years. Treatments vary depending on the etiology. He made need a short course of oral steroids, a Vitamin D ointment, or topical steroid creams. Often an antibiotic by mouth will help. One tip: smoking makes these rashes worse. Feel free to ask me more questions.
I would take your father to a dermatologist if his problem has not cleared up by now. He may have psoriasis or a contact dermatitis with a so-called “id” reaction. It would be very unusual for a fungus to affect all these areas at the same time. He may do well with light therapy and some of the newer creams for psoriasis.
Two suggestions: a culture should be done to rule out either a bacterial or fungal infection. However, the fact that it responded to steroids and not to an antibiotic would imply that it is not a folliculitis, but more likely a contact dermatitis or eczema. I would recommend a dermtologist evaluate your daughter to get to the root of the cause.In the meantime, I would recommend something like Prax Lotion, or Aveeno anti-itch moisturizer. She most likely needs a strongish topical steroid and an anti-eczema regimen.
Yes, this type of scarring can be difficult to treat. I am a little surprised aht this organism was able to cause such damage since it is not the staph aureus that sends fear into physicians’ hearts. I would find the doctor in your area who cleans up other doctor’s messes. Off hand another laser procedure is usually most effective,. but this should be done by very experienced hands.
ou should be cultured for a fungal organism (ringworm of the scalp). Some people have this without knowing it. Psoriais of the scalp or seborrheic dermatitis can also cause quite an itch. In this case Derma Smoothe FS oil is very effective. My recommendation would be to have the scalp cultured and closely examined by a dermatologist.
Hello Cindy,
My suggestion would be to have this treated with a mild steroid ointment such as Desonide ointment 0.05%. Creams have more ingredients since they are water based and require more preservatives ( bacteria grow well in water, but not in oil…creams are water based and ointments are oil based.) If you break out again, rather than continually use steroids which might thin the skin, you should be patch tested. Discs are placed on the back and we look for redness or even blister formation which means you are allergic to the agent being tested. Then you can avoid that ingredient.
The skin around the eye is the thinnest on the female body ( the scrotum is the thinnest on males), and is prone to sensitivities where other areas are resistant.
It is really up to the patient whether they would like the consultation first. If there is time, I am happy to do the injections at the time of the visit. We do like to apply our topical anesthetic for 30-40 minutes before injections. We do not charge for consultations. Our fees: Restylane L ( with lidocaine) Restylane, and Perlane L and Perlane are all $325 a cc. Restylane 2 cc syringe is $600. Medicis is running a rebate program with $50 off per cc.
Juvederm Ultra costs $350 a cc and Juvederm Ultra Plus is $375 a cc. Add $25 each for the Juvederm XC ( which has lidocaine). If we are doing lip augmentation, I really like to use a dental block. We do not charge an additional fee for this.
We look forward to meeting you too.
This would be an unusual application of Botox. It can be used commonly on the chin, but most physicians will stay well below the mental crease. Many of us will inject the area next to the vermilion border (the area between the lip and skin) but few of us are brave ( or foolhardy) enough to inject the muscles inferior to this. These muscles are used for eating, and speaking. Drooling, aside from babies (and I am not sure about that), is not a cute thing.
Hopefully I have answered your question. Basically fillers are fine and work great in this area, but Botox is far too tricky.
Of course I do not have the advantage of viewing your rash, but going by history I would certainly consider an entity called Hydroa Aestivale. This is a rather rare condition in which vesicles (small water bumps) develop with sun exposure. It often starts in childhood so that would fit the picture. Also, the skin around the vesicles is usually red.
Another possibility, though even more rare, is erythopoeitc protoporthyria ( EPP). This usually causes marked pain. Some years ago, I diagnosed EPP in a set of 16 year old twins. They had failed PE being dubbed as shirkers since they complained of severe pain when asked to go out in the sun. They had had the condition from age 8 and had seen a host of physicians. Some thought they were hypochondriacs.
It does sound like your dermatologist should do a biopsy to nail down the diagnosis. It might be something as simple as a photoallergic contact dermatitis but who knows until a biopsy is done.
Hypoallergenic does not mean non-allergenic. It is just a term to imply that most of the known common allergens have been eliminated from the product. My favorite sunscreen for people with sensitive skin would be Vanicream’s sunscreen. We will be discussing sunscreens soon on our radio show on http://www.blogtalkradio.com. I think they should be individualized depending on what a person wants out of them, rather than a blanket recommendation.
We have the Harmony by Alma for our IPL. We also have their 1064 hand piece for a laser.