Frequently Asked Questions

Mole Spot Check

At what age should someone go to the dermatologist to get all of her moles checked?

Even newborns should have their moles checked by the pediatrician. As we go through life, up to about the age of 30, we form new moles. It is best to perform skin self-exams every month or two, to be sure that no mole has changed or that a new and unique mole has not formed on your body.

In my 20-plus years of practice, the youngest patient who needed excision of an abnormal mole was five years old. The issue of when someone should go to the dermatologist for a mole check (instead of just relying on self-exams or exams from the general physician), has more to do with the quality and number of moles, than with age. It also has a lot to do with family history.

If any of these factors make you think it might be wise to have a dermatologist check your moles, don't think twice-make the appointment, and be sure you get a total body exam!

Weighing the Differences (Collagen, Botox, etc.)

Which is better? Collagen injections, Botox injections, Dermalogen, Autologen, or Gortex. Are any of these permanent? Are there any major drawbacks to any of these modalities? Who is the best candidate for each?

First of all, we usually divide treatment of the facial wrinkles into treatment of the top versus the lower face. Botox so far has proven the better treatment for treatment of crow's feet, frown lines (so-called "glabellar creases"), and forehead lines. The worst side effect that rarely may be experienced after Botox treatment is a ptosis (drooping eyelid), which is transient and should resolve within a couple of weeks of treatment. Botox is not permanent, and lasts from four to six months. It is usually administered in two treatment sessions, set two weeks apart. Patients must realize that it may take about eight days before they see the effects of a treatment.

Collagen is a bovine (cow) derived collagen, whereas Dermalogen and Autologen are human collagen products. All of these are best used in the lower half of the face-for nasolabial folds, Marionette lines, lip enhancement, and lip lines, or to fill in depressed acne scars. The major risks here are allergy developing to the product (more likely in the bovine collagen product than in human, which is considered next to impossible) or bruising upon injection. There are rare cases where bruising from collagen injections has resulted in the necrosis and sloughing of overlying skin, and scar formation. Collagen treatments are also not permanent, and they need to be repeated every four to six months. In the case of human collagen products, they usually need to be administered in two to four treatment sessions, whereas the bovine product is usually just a one-time treatment session.

Patients undergoing any of these treatments must understand that they will leave a treatment session slightly swollen, and the final results really are seen for 24 hours after treatment.

Gortex, a synthetic material, is the only treatment that is permanent. It can be used to fill defects such as nasolabial creases. I am not impressed with this treatment, as it seems to have a high rate of moving and extruding out of the skin. Unfortunately, patients who have had Gortex implants sometimes have to have them surgically removed.

Eczema and Psoriasis

Eczema and psoriasis seem to be very similar skin conditions. Are the treatments the same? As an esthetician, what should I keep in mind when I come across a client with either type of condition?

It is true that eczema and psoriasis have a similar appearance. Both are characterized by red, dry patches on their skin. Both can have a hereditary basis, and treatment for both is generally use of topical cortisone preparations. If someone has a more moderate to severe case of either problem, however, they should see a dermatologist who will probably begin a therapy that is more tailored to the specific diagnosis.

As far as reminders for you, should a client have one of these conditions, remember that people with eczema tend to have allergies to things like fragrance and preservatives, and you should proceed with caution in the use of products on their faces, including masks and other products applied during a treatment. Also, eczema patients are more likely to get itchy and dry on their facial skin, so you should begin a procedure with more hydrating products.

Patients with psoriasis, as a general rule, can tolerate products better, and are less prone to developing allergic reactions. The major warning for patients with psoriasis (which rarely affects the face) is that the psoriasis may develop wherever the skin is traumatized. During a facial, be gentle when extracting comedones, since an aggressive skin puncture could possibly bring on the psoriasis in that area.

Puva Safety Concerns

PUVA therapy is sometimes prescribed to psoriasis patients, but isn't that bad for their skin in terms of UV exposure? What do you recommend?

PUVA therapy involves taking a photosensitizing pill (Psoralen) two hours before going into an ultraviolet box which has long wavelength ultraviolet (UVA) rays. When it was first developed nearly 25 years ago, it was felt that the UVA rays were probably not as dangerous as normal sunlight, since UVA doesn't cause sunburn (it is responsible for tanning). Unfortunately, this is only partially true. If patients have a small number of PUVA treatments, it does seem safe. However, patients who have had many PUVA treatments are at a much higher risk for developing more aggressive skin cancer, such as squamous cell carcinoma and melanoma.

It is important to realize that the lights used in tanning salons are the UVA lights also. Although they were originally considered less dangerous, we now realize that tanning under bulbs is potentially dangerous. When I see a young person with many dark moles and almost black freckles, I ask if they have been to tanning parlors. Often people with darker, more ominous looking moles and freckles have a tanning parlor history. Also, I have had a number of patients who used tanning parlors in their late teens and early twenties who then developed skin cancers at a young age (twenties and thirties).

If a person has severe psoriasis, they may profit from a very limited number of PUVA treatments. It is certainly dangerous to go under UVA bulbs for any extended period of time, whether the exposure is for treatment of a skin disease or just for a desire to look tanned.