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Medical Dermatology

Acne

Acne is due to many factors (overactive sebaceous glands, hormones, follicular hyperkeratinization, and bacteria called P. Acnes). Treatment usually starts with a class of topical medications called retinoids along with benzoyl peroxide. If more severe, oral antibiotics can be helpful. Isotretinoin (Accutane) is used with great success in resistant cases. It will take 2-3 months for you to see a result after starting a new treatment plan.

If you notice scarring from acne, please make an appointment with Dr. Miller or another board certified dermatologist promptly to prevent further scarring.

Reproduced with permission from the American Academy of Dermatology. Copyright 2016. All rights reserved.

Eczema/Atopic Dermatitis

Atopic dermatitis/Eczema is a condition that usually resolves by adolescence. Patients with atopic dermatitis have a weakened skin barrier which means they lose moisture easily and are more prone to skin irritants and infections. The goal of therapy is to restore the patient’s skin barrier through moisturizers and bathing with a moisturizing soap. Topical steroids are often part of the therapy in eczema to control flares. Topical steroids have a risk of skin atrophy and very rarely adrenal suppression when used inappropriately. However, by using topical steroids consistently for a limited period of time (2-3 weeks), they can be very effective with a low risk of side effects. Extra caution is taken when using topical steroids on the face, groin, armpits, and around the eyes.

Helpful information can be found at eczemacenter.org, click on “Family resources” in left hand column.

Hemangiomas (Infantile)

Hemangiomas usually appear within 1-2 weeks of life and many will partially resolve over several years without treatment. Most carry no harm to your child. However, hemangiomas in certain locations carry additional risks and need more aggressive treatment with oral medications (propranolol) and sometimes with a laser treatment called pulsed dye laser (PDL). Treatment is most effective when started in the first few months of life. Below is an infant treated by Dr. Miller (eyes obscured to protect identity):

Hemangioma

After 5 months of oral medication.

After 2 laser treatments.

Keloids

Keloids are a type of scar that proliferate abnormally. Injections can significantly improve the appearance of keloids.  Excision is sometimes necessary but the patient must understand there is a risk of recurrence.  However, by injecting the area with a combination of prescription injections, Dr. Miller has been successful at reducing the rate of recurrences.

Milia

These are very small cysts that appear as firm white bumps on the face.  These can be treated in office but are not covered by insurance.

Molluscum Contagiosum

Similar to warts, this is caused by a virus (Pox virus) and is contagious. Treatment involves destruction with the application of a topical irritant by medical staff.

Reproduced with permission from the American Academy of Dermatology. Copyright 2016. All rights reserved.
Psoriasis

Psoriasis is due to inflammation in the skin leading to excessive proliferation of skin cells. However, it can also affect the joints. New research is showing a link between psoriasis, obesity, and cardiovascular disease. There are no medications that completely cure psoriasis but many very effective agents which can significantly improve the appearance of psoriatic skin.

Guttate psoriasis is a variant that can be related to strep throat. It can respond to antibiotics but narrow band ultraviolet B light administered in a medical office may also be used.

Rosacea

Rosacea has many varieties. Redness and flushing are best treated with laser treatments such as PDL that target blood vessels. Also, certain triggers such as sun, spicy foods, alcohol, and caffeine can exacerbate redness associated with rosacea.

Rosacea that involves pustules and red bumps on the face can respond to topical agents and sometimes short courses of oral antibiotics like doxycycline.

Scars

At times, scars from a surgery or trauma can be very firm or very red and can be cosmetically disfiguring. Injections and/or lasers can be effective. 

Sebaceous Hyperplasia

This is a benign growth of your sebaceous gland.  These growths appear as flesh colored bumps on the forehead and cheeks and can be cosmetically removed by Dr. Miller.

Seborrheic Keratoses

These are benign, usually brown growths. Treatment of seborrheic keratoses is usually NOT covered by insurance.

Reproduced with permission from the American Academy of Dermatology. Copyright 2016. All rights reserved.

Skin Cancer Screening

This involves an examination of the skin on the entire body looking for potentially cancerous growths.

Skin Cancer Treatment

Once a skin cancer is diagnosed, treatment often involves in-office surgical excision but in some cases, skin cancer can also be removed through electrodessication and curettage. Less commonly, certain topical agents can be used in select cases.

Nail Fungus (onychomycosis)

Fungal infection of the nails can be a particular problem for patients with diabetes. Treatment can involve newer topical agents as well as oral medications.

Warts

Warts are caused by HPV, a type of virus, and can be very difficult to treat while waiting on the patient’s immune system to respond to the virus. Treatment involves topical agents, destructive procedures such as cryotherapy with liquid nitrogen, and  injections.

Multiple monthly visits are often required to eradicate warts.

Reproduced with permission from the American Academy of Dermatology. Copyright 2016. All rights reserved.

Cosmetic Dermatology

Acne Scarring

Without early intervention, severe acne can produce lifelong scars.  These scars can improve with treatment and Dr. Miller will work with you toward this goal but realistic expectations are important.

Dr. Miller uses a variety of techniques depending on the type of acne scar (rolling, icepick, boxcar).  Subcision is effective for rolling scars.  Dr. Miller first numbs the skin and then uses a long needle under the skin to loosen adherent
scar tissue.

The CROSS technique uses 80-100% TCA for icepick scarring.  By inducing a controlled injury to the focal scars, collagen production increases to fill the deep scar.

Finally, microneedling uses a motorized pen with tiny needles to smooth the surface of both rolling scars and boxcar scars.Finally, microneedling uses a motorized pen with tiny needles to smooth the surface of both rolling scars and boxcar scars.

Chemical Peels

Chemical peels can be a helpful treatment for anti- aging as well as for acne. The full benefit is achieved after 4- 6 treatments spaced every 3-4 weeks. If you don’t have time for a series of peels, a single chemical peel with salicylic acid can help brighten the appearance of your skin. We use superficial peels which have almost no downtime so that you don’t have to miss work or school.

Salicylic Acid Peels

Fillers (hyaluronic acid)

Fillers typically contain hyaluronic acid which works by absorbing water in your skin and plumping up the tissue.  Belotero is a filler that works well for fine lines around the mouth, tired eyes, and lip enhancement.

Laser Treatment

A LASER is a type of concentrated light which can specifically target various components of the skin leading to improvement in the appearance of discoloration, scars and hemangiomas. Dr. Miller uses a pulsed dye laser (PDL) in the treatment of dilated blood vessels (telangiectasia) on the face, scars, hemangiomas, and overall redness on the face caused by rosacea.  Below are some of Dr. Miller's patients.

Lentigo/Sun Spots

These are brown, flat spots that develop on the hands and face from years of sun exposure.  There are numerous treatment options including bleaching agents, cryotherapy, and laser therapy. 

Melasma

Melasma is a condition most often in women that presents with darker patches of skin on the face.  It is due to many factors and can be difficult to treat.  Hormones, pregnancy, sun, and heat are all contributory.  Certain bleaching agents can be helpful in minimizing the effects of melasma.  There are also certain sunscreens that are more effective for Melasma than what you may be currently using.  Please contact our office for a consultation.

Reproduced with permission from the American Academy of Dermatology. Copyright 2016. All rights reserved.
Microneedling

Microneedling is an excellent option for certain acne scars and for tightening saggy skin that develops as we age.  By creating a controlled injury, microneedling stimulates the skin to increase collagen production.  By prepping with a topical numbing cream, it is relatively painless and very well tolerated.  Three to four treatments are recommended for optimal results. 

In addition to being a relatively comfortable procedure for the patient, there is minimal downtime and patients can expect a return to normal activities within 1-2 days. 

Neuromodulators (Botox, Xeomin)

This class of medications includes brands such as Botox or Xeomin which work by partially decreasing the activity of over-expressive muscles on the face.  The result is not a frozen look but rather a softening of the face.  Your friends will not know exactly what is different when they see you except that you look refreshed.  Below is one of Dr. Miller's patients who did not like the wrinkles areound her eyes.

Skin Tag Removal

This is a quick in-office procedure that is NOT covered by insurance companies.