Medical Dermatology Services

Molluscum Contagiosum

Molluscum contagiosum virus (MCV) is a common infection that causes small, almost clear, harmless bumps on the skin as a result of sexual contact with an infected person. This infection can spread through vaginal, anal or oral sex as a result of any skin contact with an infected area. Skin bumps with a central pore or donut-hole on the top usually appear two to seven weeks after exposure to infection, although in some patients it may take up to six months before symptoms are present.

In addition to sexual transmission, this infection may also spread through skin-to-skin contact and is common in children. MCV remains contagious until all bumps are gone.

Symptoms

Patients with MCV often experience small, raised, round bumps on the skin of the genital area that are filled with fluid and may appear pearly or skin-colored. They may become itchy, irritated or sore, especially if scratched. Since this infection is spread through skin contact, bumps may also appear on the face, neck, abdomen, thighs, buttocks and nearly any other area of skin exposed to the virus.

Diagnosis

Dr. Gaminchi can diagnose MCV by examining skin bumps. A sample of the bump may be taken to be analyzed under a microscope in order to confirm the diagnosis.

Complications

Most cases of MCV can be treated effectively and are not considered a serious health problem. Some patients may develop redness and inflammation in the bumps, which usually occurs as a result of an immune system reaction and can be handled. Scratching bumps can lead to other types of infection as well.

Treatment

We usually remove them with a small comedone expresser or they can be treated with liquid nitrogen. They are very contagious and thus should be treated when seen, since they can spread to other body parts and to other persons in contact with the affected patient. These procedures are usually performed using a topical anesthetic to reduce discomfort. Topical medications may also be used to help remove skin bumps. Dr. Gaminchi will recommend the best treatment or combination of treatments for you based on a thorough evaluation of your condition.

Patients with healthy immune systems generally find that molluscum contagiosum clears on its own within six to 18 months. Patients should try not to scratch the papules, or else they risk scarring and bacterial infection. If necessary, Dr. Gaminchi can remove individual lesions.

After treatment, it is important for patients to avoid scratching the treated area, and to keep the area clean in order to ensure proper healing and prevent the infection from recurring. Dr. Gaminchi will provide specific post-treatment instructions for you to help you return to your active and healthy life.

Prevention

Though it is easily spread, there are several steps you can take to prevent acquiring and spreading the MCV infection. Using condoms every time you have sex can reduce exposure to MCV during sexual contact, although this virus may be present in areas not covered by a condom. Covering the bumps with bandages or clothing can also help prevent the spread of MCV, as skin-to-skin contact will be significantly reduced.

Patients with active infections should wash their hands on a regular basis, avoid scratching skin growths and avoid sharing towels and washcloths with others. Dr. Gaminchi will help you develop a specific treatment and prevention plan to ensure that you and your partner are clear from infection and safe to resume sexual contact.

 


Nail Fungus Treatment

Nail fungal infections occur under the fingernail or toenail as a result of exposure to a warm, moist environment like sweaty shoes or shower floors. These fungal infections usually begin as a yellow or white spot under the nail, and develop into thickened, brittle and distorted nails. They may also turn your nails a darker color as a result of the debris building up. Nail fungal infections occur more frequently in toenails because they are more often confined to dark, moist environments.

Nail fungal infections should be treated immediately as they may cause permanent damage and are likely to recur. Treatment options include oral anti-fungal medications, anti-fungal nail polish or other topical medications. The nail may need to be removed in severe infections.


Patch Testing

Patch testing is a common diagnostic tool used to identify the specific substances that trigger contact dermatitis reactions. Contact dermatitis is a localized irritation of the skin in response to a certain substance that is otherwise harmless. Common trigger substances include cleaning solution, detergent, cosmetics, perfumes, latex rubber and poison ivy.

In allergic contact dermatitis, typically harmless substances cause an immune system reaction when they come in contact with the skin. These overreactions activate the body to produce antibodies against the allergen, which then help release chemicals and hormones known as mediators when the antibodies come in contact with the allergen. A common example of a mediator is histamine. The reaction to trigger substances causes localized symptoms about one to two days after exposure. These symptoms may include:

  • Redness
  • Rash
  • Blisters
  • Hives
  • Itching
  • Burning

These symptoms can last for up to four weeks, and can usually be treated at home through medications and topical creams. The best protection against contact dermatitis is to identify the specific triggers that cause reactions, so that patients can avoid these substances as often as possible.

Although allergic contact dermatitis is similar to other allergies in that it triggers an immune system response, these triggers are external rather than internal. So testing for this condition is also done externally, and does not require the use of any needles or injections.

Patch Test Procedure

Before undergoing patch testing, patients should stop using corticosteroids in the area to be tested, and should not expose the test area to the sun for at least three weeks. Your doctor may administer the T.R.U.E. test, a comprehensive patch testing exam that is pre-designed to test for 29 common allergens and provides fast and accurate results.

The patch testing procedure is simple and painless. In order to identify specific triggers, your doctor will tape small metal cups that contain various potential chemicals to the skin on the back. These chemicals are then left on the skin for 48 hours, and must remain dry during this time. Patients are advised to take only sponge baths and avoid excessive sweating. After 48 hours, the patch test is removed and an initial reading is taken to observe any reactions. An additional reading is taken after another 24 to 48 hours. Patients can bathe in between these readings, but should avoid scrubbing the back. Once the final results of the test have been read, normal bathing can be resumed.

When reading the results, your doctor may classify each spot on a scale from negative (meaning no reaction) to extreme reaction (meaning positive results for substance). Strong results may cause blisters or ulcers on the skin, which can be treated once the test is complete.

Once positive results have been determined, patients can take steps to avoid their triggers and prevent contact dermatitis from occurring. Your doctor will provide you with specific information on your individual triggers and how to prevent contact.

Side Effects

Although patch testing is considered a safe and effective diagnostic tool, these tests do cause a small area of contact dermatitis at the site of the substance, so patients often experience mild itching and irritation on the their back. Positive test results may cause an area of the skin to have redness, bumps, swelling or even a small blister. After the test is complete, patients can use a topical steroid on affected areas to help relieve symptoms. If this cream is used before the end of the test, results may be inaccurate.

Since contact dermatitis is an immune system condition, your body may react to the chemical substance where the original contact dermatitis occurred. As a result, patients may experience a mild recurrence of their original condition. These areas can be treated as needed during the test, as only the test area is examined afterwards.


Pediatric Dermatology

Pediatric dermatology involves comprehensive diagnosis and treatment services for the unique skin of infants, children and adolescents. While children and adults experience many of the same skin conditions, certain conditions are more prevalent in younger patients and require special care that takes into account the growing needs of these patients. Children are often at risk for fungal and bacterial infections of the skin, as well as a wide array of other acquired and congenital conditions.

Our treatments are gentle yet successful, allowing children to engage in their everyday activities while efficiently managing their skin ailment. Children with healthy skin can also be seen by our doctor for regular examinations to learn about proper skin care, including adequate sun protection. Early examination by a dermatologist can promote a lifetime of healthy skin for our pediatric patients.

Dr. Gaminchi is highly skilled and experienced in treating pediatric skin conditions and strives to provide a comfortable, safe and worry-free experience for both child and parent. We take the time to educate parents about their child's condition to help ensure proper treatment and home care so children can enjoy clear, healthy skin as they grow.

Some of the most common pediatric skin conditions treated by Dr. Gaminchi include:

Rashes

Rashes are areas of redness and inflammation that can appear on the skin after exposure to certain substances, including chemicals, soaps, cosmetics, poison ivy or other stimulants. There are many different conditions that cause rashes, which may be acute or chronic and tend to occur in young children.

Most rashes can be treated through simple home care practices such as avoiding soaps and bathing in warm water, while others may require moisturizing creams, prescription medications or more extensive treatment. Parents can help their child prevent rashes by avoiding the products that irritate their skin, washing hands frequently and receiving proper vaccinations.

Eczema

Eczema, also known as atopic dermatitis, refers to a group of inflamed skin conditions that result in chronic, itchy rashes and affect 10 to 20 percent of all infants. Children with eczema often experience an itchy rash that appears on the forehead, cheeks, arms and legs for a short amount of time after exposure to a trigger such as harsh soaps, dust mites, food allergies and certain clothing materials.

Although there is no cure currently available for eczema, there are several treatments available to help relieve symptoms, including topical steroids, antihistamines, immunomodulators, cold compresses and other home remedies.

Birthmarks

Birthmarks are benign pigmented patches of skin that can range in color from tan and brown to red, pink or purple and are present at birth. Although they are usually harmless, some birthmarks may develop into cancer and should be monitored regularly. Depending on their size and location, some patients may be bothered by the appearance of birthmarks and seek treatment to remove them.

Treatment for birthmarks depends on the age of the patient and the type of lesion, but may include laser surgery, pulsed light therapy, microdermabrasion or surgical excision.

Acne

Acne involves an abnormality within the oil glands that causes skin cells to reproduce and develop pimples, whiteheads and other lesions on the surface of the skin. This may occur as a result of hormones, heredity, cosmetics, stress, bacteria or other factors. Acne is most common in teenagers, but can affect patients of all ages.

Almost all teenagers have at least some acne, and as many as one in three seek treatment to correct this condition. Treatment for acne can vary depending on the type, severity and location of acne lesions, but may include topical or oral medications, over-the-counter creams, laser treatments, cortisone injections or Accutane® (isotretinoin). Your doctor will determine the most appropriate treatment for your child's individual condition based on a thorough examination.

To learn more about our Pediatric Dermatology services, please contact us today to schedule an appointment.


Photodynamic Therapy for Pre Cancerous Lesions

Photodynamic therapy (PDT), also known as photoradiation therapy, is a minimally invasive procedure used to treat skin cancer and other conditions such as acne, rosacea and actinic keratosis. PDT uses a topical photo sensitizer called Levulan along with a light energy source to destroy abnormal skin cells. The Levulan is applied to the skin and incubated for a certain amount of time before it is exposed to light energy to activate the medication and destroy the targeted cells.

Most people see successful results from PDT after three treatment sessions spaced two to four weeks apart. This procedure can be combined with other treatments, such as intense pulsed light, in order to maximize results and leave skin as healthy and beautiful as possible.

 

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Phototherapy

Phototherapy uses UVA or UVB light, depending on each patient's individual condition, to slow the growth of new skin cells. This minimally invasive treatment is customized for each patient and delivered solely to the targeted area to reduce damage to surrounding healthy cells.

This procedure is performed quickly and conveniently in your doctor's office, taking just a few seconds to treat unwanted conditions such as psoriasis, eczema and vitiligo and return skin to its original state. Localized areas of skin can be treated specifically to improve its appearance through a series of treatment sessions. Your doctor will decide whether or not this treatment is right for you after a thorough evaluation of your condition.

Narrow-band UVB phototherapy involves shining ultraviolet light on the skin to treat psoriasis and other chronic skin conditions. It is an easier and safer alternative to PUVA treatment (psoralen plus UVA phototherapy). As its name suggests, the light that is used in narrow-band UVB phototherapy is a very specific range of wavelengths in the ultraviolet spectrum - just 311 to 312 nm - that has been shown to most effectively slow the rapid growth of cells and improve the symptoms of psoriasis.

Patients generally receive narrow-band UVB phototherapy treatments three times per week for about 10 weeks. Exposure time begins at a few seconds and increases with each session. Session lengths are tailored to the patient's skin type and tolerance. After the skin has cleared, UVB phototherapy may be continued to prolong remission time, or patients may undergo other skin disorder treatments to minimize their exposure to ultraviolet light.

Psoriasis

For psoriasis, phototherapy is an effective treatment for patients who do not respond to topical medications alone. Psoriasis causes red or white patches of dead skin cells by rapidly creating new cells. Phototherapy exposes the affected skin to ultraviolet light that slows the growth of new skin cells. This may be done using UVA or UVB light, depending on each individual case. UVB light is often more effective for treating psoriasis, while UVA light is able to penetrate deeper for more severe cases.

Phototherapy is usually administered to psoriasis patients twice a week for four to five weeks. Results are often visible within two weeks and will continue to improve as treatment continues. Most patients see effective relief from this minimally invasive, FDA-approved treatment.

Eczema

Eczema is a term used to describe a group of inflamed skin conditions that result in chronic, relapsing and very itchy rashes. About 15 million people in the United States suffer from some form of eczema. There is no known cause for the condition, but it appears to involve an overactive immune system in the presence of certain materials and often occurs in people susceptible to allergies.

Phototherapy is effective in treating symptoms of eczema by exposing the skin to controlled amounts of natural or artificial UVA or UVB light. This procedure is often performed in conjunction with medication to provide the longest-lasting relief from eczema symptoms.

Vitiligo

Vitiligo is a common skin condition in which pigment cells are destroyed and white patches of skin appear on different parts of the body. Hair growing in these areas may turn white as well. Vitiligo can affect any area of the skin, but is most common on the face, lips, hands, arms, legs and genital areas.

The most common treatment for vitiligo is PUVA therapy, which combines ultraviolet A light treatment with a medication called psoralen. Psoralen increases the skin's sensitivity to the ultraviolet light to enable more absorption. The medication should be taken approximately one-and-a-half to two hours before each phototherapy session.

Phototherapy is a widely used, highly effective form of treatment for a number of types of skin conditions. However, phototherapy has been linked to several potential complications, including premature aging of the skin and an increased risk of skin cancer. It is essential that anyone undergoing phototherapy receive regular full-body examinations for indications of skin damage or cancer.


PSEUDOFOLLICULITIS

Pseudofolliculitis, commonly known as razor bumps, is a form of folliculitis that develops in men around the beard and neck area after shaving.  Patients with this condition experience irritation as a result of hairs that penetrate the skin before being removed from the follicle.

Treatment for pseduofolliculitis usually involves applying a warm compress to the area and removing ingrown hairs with tweezers.  Your doctor may prescribe topical hydrocortisone or antibiotic cream in order to relieve inflammation.  Patients should let hair grow out before shaving the area again, or can permanently remove hair through electrolysis or laser treatment.


Psoriasis

Psoriasis is a common, chronic skin condition that involves a rapid production of skin cells that build up on the surface of the skin and form scales, patches and other unwanted symptoms. Over seven million people in the US are affected by psoriasis, including men, women, and children of all ages.

This condition develops as a result of an autoimmune disorder, in which skin cells replace themselves every three to four days, rather than every 30 days, creating a buildup of cells and causing symptoms to develop on the scalp, elbows, knees, hands, feet and genitals. While there is no cure currently available for this chronic condition, there are several treatment options available to effectively relieve the symptoms of psoriasis.

Cause of Psoriasis

Psoriasis is caused by an immune system disorder involving a type of white blood cell called a T lymphocyte or T cell. While these T cells usually travel through the body to fight off viruses and other foreign substances, in patients with psoriasis they attack healthy skin cells instead, causing an increased production of healthy skin cells and more T cells that build up on the surface of the skin and cause the scaling and patches associated with this condition.

The symptoms of psoriasis can worsen as a result of certain triggers, which may include:

  • Infections
  • Injury to the skin
  • Stress
  • Smoking
  • Alcohol consumption
  • Certain medications

Patients can prevent a flare up of symptoms by avoiding these triggers.

Types of Psoriasis

There are five different types of psoriasis, each causing different symptoms. While patients usually only have one type of psoriasis at any given time, another type can appear once the first has cleared. The five types include:

  • Plaque psoriasis - the most common type of psoriasis that affects about 80 percent of psoriasis patients, causing raised red lesions that are covered with silvery white scales, usually appearing on the elbows, knees, scalp and back.
  • Guttate psoriasis - usually begins during childhood or early adulthood and causes small red spots to appear on the skin of the torso, arms and legs as a result of a bacterial infection such as strep throat.
  • Inverse psoriasis - develops within the armpits, groin, under the breasts or other skin folds causing bright red lesions as a result of irritation from rubbing and sweating. This is most common in overweight patients.
  • Pustular psoriasis - causes white blisters filled with pus surrounded by red areas of skin, often triggered by medications, UV light, pregnancy or infection and is most common in adults.
  • Erythrodermic psoriasis - the least common type of psoriasis that often causes redness and scaling across the whole body, and may lead to serious illness if left untreated.

Symptoms of Psoriasis

Symptoms may vary depending on each patient's individual condition, but often include:

  • Red patches of skin covered with silvery scales
  • Crusting
  • Dry, cracked skin
  • Itching or burning
  • Soreness
  • Thickened nails

While many cases of psoriasis are merely a cosmetic annoyance, some also cause severe pain, especially when associated with arthritis. Symptoms usually come and go as psoriasis is a cyclic disorder with remissions and flare ups throughout the patient's life.

Treatment of Psoriasis

Treatment for psoriasis aims to help clear the skin of current symptoms and to interrupt the abnormal cycle that has caused an increased production of skin cells in order to prevent future symptoms from forming. This can be done through topical treatment, oral medication, light therapies or a combination of the three.

Topical treatment for psoriasis is usually in the form of corticosteroids, vitamin D or topical retinoids, which can target inflammation, skin cell growth and DNA activity to effectively treat the symptoms of mild to moderate psoriasis. Light therapy may be used in combination with topical treatments to slow the production of skin cells and improve the overall appearance of the skin, and can be done through exposure to natural sunlight, narrowband UVB therapy or excimer laser therapy. Oral medications may be prescribed for severe cases of psoriasis or those that are unresponsive to other types of treatment, and may include retinoids, methotrexate or cyclosporine.

Patients with psoriasis can help relieve symptoms at home by keeping the skin clean and moisturized, covering the affected areas while sleeping and avoiding triggers such as stress, smoking and alcohol. By adhering to the treatment plan designed by your doctor and following the life remedies recommended for psoriasis patients, many people can seek effective relief from the symptoms of this condition.


Rashes

A rash is a change in the skin's color or texture. Simple rashes are called dermatitis, which means the skin is inflamed or swollen. Contact dermatitis is caused by touching an irritating substance such as clothing materials and dyes, latex, cosmetics, soaps or certain plants like poison ivy. Seborrheic dermatitis forms red patches and scaling, usually on the face and head, where it is more commonly known as dandruff or cradle cap. Other common rashes include eczema, psoriasis, impetigo, shingles, chicken pox, measles, scarlet fever, insect bites and those caused by medical conditions such as lupus or rheumatoid arthritis.

Rashes can be caused by contact with plants, animals, soaps, chemicals, as well as being one of many viral or bacterial skin diseases, like impetigo, pityriasis rosea, seborrheic dermatitis, secondary syphilis and many others. Dr. Gaminchi and his staff pride themselves on sorting out these many possible causes of "rash" and then giving the patient the appropriate treatment. Sometimes a biopsy is needed to confirm the diagnosis. Dr. Gaminchi is usually able to take a very small, almost painless piece of skin to do this, and the excellent independent dermatopathology laboratory will often have the result back in two working days or less.

Some of the most frequently-occurring types of rashes we treat are:

Heat Rash

These small red spots or bumps can be very itchy. They develop when the sweat ducts in the skin are clogged and perspiration cannot properly take place. Wearing loose, lightweight clothing can help prevent this type of rash. Cooling the skin through air conditioning or use of cold compresses and hydrocortisone creams should alleviate the itching if you are stricken with heat rash.

Polymorphous Light Eruption (PMLE)

Caused by too much exposure to either the sun or UV lights in tanning beds, PMLE typically results in itchy red areas on the chest, arms, neck or thighs. Use sunblock regularly to avoid this rash. Over-the-counter anti-inflammatories, hydrocortisone cream and cold compresses can provide relief of symptoms until the rash goes away.

Poison Ivy/Poison Oak

These plants can trigger a reaction in many people that results in blistering, itchy, swollen skin. For those who enjoy camping and hiking, try to avoid any plants with leaves growing in groups of three. If you do come into contact with poison ivy or oak, cleanse the skin with soap and water immediately. Once the rash has formed, you will most likely require a prescription medication to counter the symptoms.

 


Skin Flaps / Skin Grafts

Many patients with facial wounds seek reconstructive treatment after an injury, disease or surgery to restore the appearance and function of the skin in prominent areas such as the lips, nose, and eyelids. These treatments cover up unsightly scars and wounds, while also restoring flexibility to areas that may have stiffened as a result of scar contractures.

Skin grafts involve removing skin from another part of the body to be placed over the site of the wound. The graft is excised through a minimally invasive procedure and then secured in place over the wound with stitches. In some cases, a graft may be created at the site of the wound and moved to a less prominent location. Flaps involve similar treatment, but may also include transplantation of the underlying muscle and cartilage, and may stay attached to original blood vessels when performed using microsurgery.

These treatments help to reduce or eliminate the appearance of scars and expedite the healing process so that patients do not have to live with unsightly and often disfiguring wounds on their face. While some scarring will likely be visible, it will be much less noticeable than if the wound was not treated at all. Your doctor will determine which type of treatment is best for you after a thorough evaluation of your condition.

 


Rosacea

What is rosacea?

Rosacea is a chronic skin disease that causes slight redness on various parts of the face and, less commonly, on the neck, scalp and chest. Rosacea is widely considered a cosmetic concern or a medical condition, unless it affects the eyes, in which case certain medicines are immediately employed. Rosacea can also cause other cosmetic ailments such as rhinophyma. It is commonly triggered by specific environmental and behavioral prompts.

What are the symptoms?

The characteristic symptom of rosacea is redness of the skin. However, other common symptoms include:

  • Dryness
  • Swelling
  • Burning sensation
  • Eye irritation
  • Pimple-like blemishes
What causes rosacea?

Although there is no known definitive cause for rosacea, doctors have hypothesized it can be related to hypersensitivity of certain sensory neurons. This, combined with overactive intestinal bacteria that are otherwise benign, may cause a chain of events which lead to the display of rosacea as we know it. In addition, patients with rosacea have elevated levels of certain enzymes which are inactivated by several antibiotics that have been deemed effective against rosacea.

What can trigger rosacea?

The most common triggers for rosacea are:

  • Alcohol
  • Caffeine
  • Foods high in histamine
  • Spicy food
  • Sunburn
  • Cold wind
  • Sudden changes in temperature
  • Strenuous exercise
  • Emotional stress
How is rosacea treated?

Most mild cases of rosacea are left untreated, especially if they aren't cosmetically noticeable. Simply avoiding the triggers and taking extra care with the skin around one's eye is sufficient in these situations. If the redness gets worse or manifests on the eyelid, antibiotics like tetracyclines and metronidazole or more serious medication like isotretinoin may be prescribed. Lasers can be very effective at removing the redness associated with rosacea by vaporizing the blood vessels that cause it. This tissue is then reabsorbed by the body with no permanent damage. This procedure must be repeated periodically to destroy newly forming vessels.


Seborrheic Keratosis

Seborrheic keratosis is a noncancerous skin growth that commonly affects the elderly. Its exact causes are unknown, although it tends to be hereditary. Seborrheic keratosis is a painless condition that requires no treatment; many individuals, however, choose to have the growth(s) removed for cosmetic purposes.

A seborrheic keratosis typically appears on the head, neck, or trunk. It is usually round or oval shaped, and it may vary in color. In some cases, seborrheic keratosis may itch. Medical attention may be necessary if numerous seborrheic keratoses develop in a short period of time, the seborrheic keratoses interfere with clothing, or other abnormal skin changes occur.

Seborrheic keratosis is diagnosed by inspecting the affected area. A biopsy may be taken to rule out skin cancer. Seborrheic keratoses require no treatment. If removal is requested for cosmetic purposes, it may be achieved through cryosurgery, curettage, or electrocautery.


Skin Allergies

There are three major groups of skin diseases caused by allergy: eczema, allergic contact dermatitis and hives. Eczema occurs most commonly in children and involves red, thickened, swollen patches of skin on the cheeks, scalp, neck and trunk that itch and can be painful. Allergic contact dermatitis describes the onset of a rash; swelling, blistering or other effect after the skin touches an irritating substance such as clothing materials and dyes, latex, cosmetics, soaps, perfumes or certain plants like poison ivy. Sometimes the reaction is triggered by exposure to ultraviolet light (called photoallergy), for example putting on sunscreen and stepping outside. Hives, also called urticaria, are itchy rashes with bumps resembling insect bites. They can occur in small patches or all over the body, and last anywhere from a few minutes to several months.

 

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818-592-6005

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Suite 340
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