A discussion of some common dermatologic problems
and the medicines available for treatment:

Acne:  Return to Top

Fortunately, the vast majority of teenagers with acne can be treated very effectively with prescription topical medicines or traditional oral antibiotics, such as tetracycline or minocycline. We find this to be true in our practice and we always start therapy with such medicines. However, some teenagers don't do well with these medicines and if acne is significant and potentially leading to scars, then we will sometimes consider Accutane.

Accutane is a medicine that has been available in the United States for more than 25 years, first approved in 1982. It has been a remarkably effective medicine for treating acne in teenagers, especially the more severe involvement that doesn't respond to traditional antibiotic based medicines. The amazing fact about Accutane is that it actually "cures" acne in about 75% of the teenagers who use it. After five months of Accutane therapy, the medicine is stopped and most teenagers find that they never have acne again or, if they do, it is very minor. About 25% of teenagers can experience acne again, but even in this group the acne is usually less severe than before the use of Accutane and more easily controlled. However, Accutane is a serious medicine and blood tests must be taken before and during therapy. Accutane is a medicine that can destroy a developing baby so it is essential that there be no chance of pregnancy for a month before, a month after, and during the time Accutane is used. There has also been concern that Accutane might cause depression in some few people who use it. It is important to be cautious with the medicine if there is a personal history of significant depression. We never use Accutane if a person is not comfortable with the medicine, but for those patients with severe acne it can be amazingly effective.

For more information on acne, please check our links page.

Psoriasis:  Return to Top

Psoriasis remains a difficult condition to treat, but several new medicines have become available in the last decade. Two of the best topical medicines are vitamin derivatives and steroid-free. Dovonex is similar to vitamin D. It is applied twice a day and can be remarkably effective over the long term for controlling localized psoriasis. Tazorac is a newer topical cream similar to vitamin A. It can also be very effective for some people. No medicine works for everyone with psoriasis, but these two medicines have been very helpful for many patients. We often use light therapy for psoriasis including natural sunlight in the summer and artificial lights in the winter. Light therapy can be very helpful for psoriasis and with judicious use can be used quite safely.

There are also several new oral medicines for this disease that can be helpful. Oral medicines always have potential side effects so we weigh carefully the risk of the medicine against the discomfort caused by the disease.

Recently, some new "biological" medicines have been approved for treatment of psoriasis and the arthritis that can sometimes occur with the disease. These medicines are man-made proteins that interfere in specific ways with the inflammatory process that causes psoriasis. These medicines are not pills, but shots that have to be given on a weekly basis.

They are incredibly expensive (one medicine costs $12,000 for a 3 month course!), but for some selected people they can be very effective and helpful in controlling psoriasis.

Check our links page for more information!

Eczema (atopic dermatitis):  Return to Top

Eczema is a persistent, itchy and often miserable skin disease of children that can be very difficult to treat. In the past, only steroid-based medicines were shown to be of much benefit, but in the last few years, new steroid-free medicines have been shown to be remarkably effective. Perhaps the best is elidel, a cream applied two times a day. Sometimes even within a few days children will show remarkable improvement. Again, this medicine doesn't work for everyone, but for many children, it can be quite effective.

Acne Rosacea:  Return to Top

Acne Rosacea is a common form of "adult acne" that often begins when a person is 40 or 50 years old. The blood vessels in the face become enlarged and thus impart a kind of redness. Pimples can occur and be a more troublesome part of the picture. In recent years this condition has been very effectively treated with topical metronidazole, a cream that is applied twice a day. The medicine doesn't work rapidly, but many people find their condition much improved in a few months time.

Poison Ivy:  Return to Top

Poison ivy is a common plant in Michigan and we often see dermatitis as a result of it. The problem with poison ivy is the severe itching that often occurs and the fact that the condition, untreated, can easily last 3-4 weeks. Over-the-counter lotions and creams can be effective for minor poison ivy, but if it is severe, and especially if it is blistering, only prescription medicines are of benefit.

Scabies:  Return to Top

Scabies is a fairly common infestation of children, although adults can certainly get the disease. It is characterized by a persistent, very itchy dermatitis that is often worse at night. Scabies is caused by a small mite that burrows into the skin and lays eggs. It is, therefore, contagious and often other family members will get the disease. Scabies always requires treatment with prescription medicines, but new topical creams are very effective for eradicating it.

Actinic Keratoses:  Return to Top

Sun-damaged skin is a very common problem today. Actinic keratoses are pre-cancerous spots that many people develop as a reflection of sun exposure they have had over their whole lives. These spots have a potential for becoming skin cancers so we always feel they should be treated when they develop. In recent years, several creams have been developed that when applied to the skin will cause actinic keratoses to peel off. While the process can be quite irritating sometimes in the short term, these medicines are very effective in the long term in leading to resolution of these lesions.

Skin Cancer:  Return to Top

There is much more concern in the United States and around the world about the increasing risk of skin cancer related to sun exposure. Skin cancers are being seen more often, even in people under the age of 40. Melanoma is the most serious and it is the skin cancer that can spread through the body and sometimes even cause death. Melanoma is usually black in color, slowly increasing in size and is most often found on the back or on the lower legs. Basal cell skin cancer, however, is the most common type and occurs most often on the face. Basal cell skin cancers do not spread through the body and are generally not a serious health threat, but they can grow locally and sometimes represent a difficult surgical problem for removal. Basal cell skin cancers are most often reddish in color and act like a "pimple" except that they don't heal after weeks and months. Finally, some people can get a squamous cell skin cancer, another kind that grows locally and usually doesn't spread through the body. All of these cancers are related to sun exposure, especially to sunburn.

Dermatologists constantly warn people to always have any "mole" evaluated if it seems to be enlarging, changing in size or color, or if it itches or bleeds.

There is much more information on skin cancer on our links page.