Question:

I am 33 years old and tried on my bathing suit for the opening of our community pool where I take my two small children. On my legs were all these broken blood vessels. My legs look like my mother’s legs, and she is over 55 years old. Is there a solution for my legs’ unsightly veins short of wearing long pants to the pool?

Answer:

Your broken blood vessels (spider veins) are known medically as telangiectasia and are not actually broken, but are dilated (swollen) skin capillaries.

Frequently there appears to be an inherited tendency for the condition. Generally, the telangiectasia (spider veins) is not associated with the larger varicose veins, but most people with varicose veins have some spider veins. Most medical insurance companies consider treatment of spider veins to be a cosmetic procedure and generally will not cover the cost.

There are individuals who complain of leg pain due to their spider veins without varicose veins. Many patients will benefit symptomatically from the treatment of spider veins.

There are various treatments for spider veins, however, sclerotherapy remains the most cost effective method. Sclerotherapy involves the injection of a solution that irritates the inner lining of the capillaries so they collapse and are unable to fill with blood. There is very little discomfort with the proper injection technique. Usually the vessels disappear over 2-4 weeks.

Patients with severe spider veins may require more than one treatment session spaced about six weeks apart. The goal is to produce 75 to 80 percent improvement.

One must remember that this is treating the problem, not the cause, which is related to hormones, lifestyle, leg trauma, pregnancy, and sun damage. This means that treatment in the future may be required. I have many patients who treat their spider veins once a year during the winter months and are extremely pleased with their results.

Make sure you seek out a well-trained physician for safe and effective treatments to eliminate the unsightly spider veins and the negative impact it has on your quality of life.

Question:

My husband is 54 years old and has scaly spots on his forehead and the sides of his face. He says it is just dry skin, but he will not apply moisturizer. Recently one began to bleed slightly and now has a scab. He claims it is because he picked at the spot. I think he should see a dermatologist, because I think he has skin cancer. Am I being an over-reactive wife?

Answer:

Repeated sun exposure can cause skin damage, pre-skin cancer growths, and skin cancer, especially in fair-skinned individuals. The typical aging signs of sun damage include rough skin texture, poor skin tone, large pores, blotchy skin color, brown spots, and wrinkles. Sun damage can produce rough, small (3-6 mm) scaly spots of abnormal cells on the surface of the skin, which represent pre-skin cancers called “actinic keratosis.” These spots remain on the skin, even if the scaly portion is picked off by the individual. The spots feel rough to the touch and may be painful if large or irritated by picking or rubbing or even pressure from hats. Actinic keratosis is very common among golfers and others who participate in outdoor sports without adequate sun protection. Susceptible persons usually have more than one keratosis on areas of their bodies that have the most sun exposure. It is important to see a dermatologist right away to address these pre-skin cancers, as some may turn cancerous over time.

There are many ways to remove pre-skin cancers. The goal is removal with as little residual skin discoloration or scarring as possible. In many cases, with small actinic keratosis, they can be treated with liquid nitrogen or creams that kill the abnormal or pre-skin cancer cells. Both treatments cause a scab-like phase of healing with resolution of the actinic keratosis when healed. The healing process takes 2-4 weeks, depending on the size and location of the actinic keratosis. For instance, the hands heal slower than the face. The skin’s final appearance is usually excellent. There are times when the size of the growth and/or the fact that it is bleeding requires a skin biopsy to make sure the growth is not a skin cancer. This is an easy, in-office procedure.

Sun damage is cumulative over one’s lifetime and sun exposure history. Safe sun exposure should be your goal, using a sunscreen with an SPF of at least 30, containing micronized zinc oxide or titanium dioxide, in addition to other sunscreen ingredients in the product.

Question:

I am 22 years old and developed a round, scaly patch on the left side of my stomach that was scaly around the edge and like normal skin in the middle. It was about the size of a silver dollar and did not itch. I looked on the internet, and my spot looked like ring worm. I tried over-the-counter clotrimazole twice a day. After two weeks, not only did it not go away, but I began to get a lot more spots, many on my trunk. I feel fine, but look bizarre; and my boyfriend said I need to go see the dermatologist. Do I really need to go spend the money if I feel fine?

Answer:

To be on the safe side, you should see the dermatologist. However, your rash may be pityriasis rosea, sometimes just called “PR” by medical personnel. It is a common, harmless skin disorder. The cause is unknown, and the rash is not contagious.

There is no evidence to suggest pityriasis rosea is caused by foods, medications or nerves. It usually begins with a single, scaly, round to oval spot called the “mother spot” or “herald patch.” It appears in as little as 2-3 days up to 2-3 weeks before the more generalized rash. The rash covers mainly the trunk, but may spread to the arms, legs, and neck. Pityriasis rosea usually avoids the face, palms, and soles. Untreated, the rash generally lasts 4-12 weeks. Should the rash persist greater than 12 weeks, consultation with a dermatologist is recommended. Resolution of the rash leaves the skin in its normal state with no scarring.

As a general rule, nature will cure pityriasis rosea, however, sometimes very slowly. The rash may itch, can be irritated by certain soaps, and certainly does not look good if the areas involved are exposed. Treatment should include mild soaps and over-the-counter hydrocortisone cream 1% applied twice daily to eliminate the itching and speed the recovery of the rash. Ultraviolet light from the sun or artificial tanning beds generally shortens the duration of the rash. If conservative measures fail to improve the symptoms, there are prescription medications available that are very effective.

Question:

I was at the cosmetic counter recently, and they performed a skin analysis on my skin. I thought my skin was in pretty good shape, until they printed this picture that shows spots that represent sun damage. I had more spots than normal skin on my face! They suggested skin care programs to reverse sun-damaged and aging skin. I am 46 years old and believe that I have some sun-damaged skin, but am so confused regarding my home skin care regimen. Any suggestions on where to start?

Answer:

Recent research is trying to pinpoint the basis behind sun-damaged and aging skin. Aging is the slow breakdown of tissue caused by free radicals. These free radicals are produced by sun damage and chronologic aging. People with sun-damaged and aging skin have two battles to fight.

The first is repairing the damaged cells caused by ultraviolet rays, age, pollutants, and smoking. I think it is important to keep your skin care regimen simple, yet effective. There are cleansers and reparative creams which contain glycolic acid and alpha lipoic acid to repair damaged skin cells, improve skin cell growth, and restore normal skin exfoliation.

The second battle to address is neutralizing the damage caused by free radicals. Antioxidants can have a profound effect on protecting and repairing the skin from damage caused by free radicals. Stated in a different way, the skin relies on antioxidants for protection against free radicals. Since the skin receives the most free radical assault from ultraviolet light exposure, replenishing and increasing the antioxidant defense of the skin becomes an attractive strategy for sun protection and sun repair.

It has been demonstrated that the skin’s native antioxidant protection breaks down during excessive UV injury and aging (due to the fact that there are more free radicals created by the UV damage and cell metabolism than there are antioxidant molecules available in the body and skin). This allows free radicals to damage cells.

Although dietary supplementation can replenish internal antioxidants, there is a limit to the amount that can be absorbed and delivered to the skin. Vitamin C (L-ascorbic acid) is the most important water soluble antioxidant in the skin, and Vitamin E (tocopherol) is the most important fat soluble antioxidant in the skin.

Fruits and vegetables contain antioxidants. When they are exposed to light and air, the antioxidant molecules are neutralized and turn brown from oxidation. Formulation characteristics are critical for delivery, penetration, and biologic activity of antioxidants into the skin to restore and enhance the skin’s natural antioxidant activity. Your skin care professional should make sure that your skin care product has the correct pH, the correct ingredients and concentration of the ingredients, and proper packaging to prevent oxidation of the active ingredients.

A simple, home skin care program would consist of a reparative cleanser, an effective antioxidant product used in the evening (or at bedtime) along with a skin moisturizer, and a reparative cream used in the morning. Sun protection requires the daily use of a sunscreen, which blocks a broad spectrum of UV rays.

The clinical benefits of using a home skin care regimen (including a cleanser, reparative cream, antioxidant cream or serum, moisturizer and sunscreen - five total products) with antioxidants and reparative ingredients are improved skin texture, reduced brown spots, improved skin tone, and decreased appearance and prevention of fine lines and wrinkles. Products can make a difference, but make sure the products have the right active ingredients and proper pH balance.

Question:

I am a 37-year-old mother with three children. My middle child is 9 years old and recently got a wart on her hand. I heard that it is a virus infection. Do I need to worry that she is contagious to others? Are the over-the-counter medications any good?

Answer:

Warts are caused by a virus, are generally harmless, and can be on almost any part of the body. They can vary in size and number and can be painful, especially when located on the bottom of a foot or other sensitive area.

Since warts are caused by a virus, they are slightly contagious to people not immune to the wart virus, but only through direct skin contact. A person with a wart is obviously susceptible, and the warts may spread on their body. Scratching or picking at a wart, shaving or biting warts on fingers can lead to spreading.

Warts are difficult to prevent; however, going barefoot increases one’s chances of developing a plantar wart, if exposed. There are no effective vaccines or oral medications for warts, despite anecdotal reports to the contrary. People have been trying to cure warts for thousands of years. The success of some anecdotal treatments for warts is due to the fact that warts often disappear by themselves, especially in young children. That means there is a spontaneous cure rate of some warts, but it is less common in adults.

There is no single, perfect treatment for warts . Treatment is directed at killing the virus with the hope that the destroyed virus will not only go away, but will stimulate an immune response to prevent the return of the wart. There are over-the-counter medications containing salicylic acid that can destroy warts. If over-the-counter medications fail, see a dermatologist for evaluation and treatment. The treatment used by the dermatologist will depend on the location of the wart, its size, the age, and skin type of the patient, as well as the person’s activity level.

Sometimes new warts will form while existing ones are being destroyed. New warts can be treated only when they become clinically apparent. Some warts can be stubborn requiring different treatment modalities when a previous type of treatment has failed. Although frustrating, warts may return weeks or months after an apparent cure. There is no reason to be concerned if a wart recurs, but it will need to be treated again.