Medical Dermatology

Acne is a very common skin condition that results from a combination of oil production and bacteria in a clogged pore (also known as blackheads and whiteheads). When this goes one step further and there is inflammation in that clogged pore, it becomes a red pimple or pustule and can even grow larger into a nodule or cyst. This is referred to as nodulocystic acne.

Whiteheads and blackheads are generally treated by creams containing Retin A and benzoyl peroxide while larger pimples and nodules require oral antibiotics or even Accutane. We will use our expertise to come up with the best acne treatment plan for your needs starting with cleansers, moisturizers, exfoliating brushes if necessary along with topical creams and oral medication if needed. In some cases, other modalities such as comedone (whitehead and blackhead) extraction, and chemical peels can be performed by the aesthetician to expedite clearer skin. We also offer lasers to help with acne scarring.

Acne Rosacea or Rosacea as its more commonly known, is also a common skin condition of the central face that presents with redness and dilated blood vessels with or without pimples, pustules and nodules. Rosacea can also rarely involve the eyes with redness, irritation and swelling of the eyelids, this is called Ocular Rosacea. More commonly in men, chronic Rosacea can result in a thickened, bumpy, enlarged appearance of the nose called Rhinophyma.

Rosacea is more common in women, and can run in families. There are many triggers that exacerbate Rosacea and the common ones include stress, alcohol such as red wine, caffeine, hot, spicy foods, hot, sunny days and cold, dry, windy days.

Different presentations of Rosacea can be treated with a variety of treatment regimens from topical creams to oral antibiotics to even pulse dye lasers. A daily sunscreen SPF 30 or higher is also a must. We will carefully personalize a treatment regimen to treat your Rosacea based on your unique presentation and your skin’s needs.

If left untreated, AKs can progress into skin cancer. AKs can be prevented by regular use of a SPF 30 or higher sunscreen and sun protective clothing and hats.

We will examine your skin very carefully during full body exams for any AKs and treat them appropriately. Treatment will depend on the number of AKs you have and what part of the body they are on. They can be treated with a topical cream or by freezing with liquid nitrogen.

It can be part of a triad involving Asthma and Allergic Rhinits (Hayfever/allergies). These children may have food allergies as well. In childhood it often presents on the cheeks, scalp and chest. In later years, it can go on to involve flexural areas such as the neck, backs of the knees, skin in front of the elbows, wrists and ankles. Atopic Dermatitis is a chronic condition that has episodic flare ups. These flare ups can be caused by irritants and allergens that are ingested, airborne or that may come in contact with the skin. A flare up of Atopic Dermatitis can present with red, itchy, dry, crusted and scaly bumps and patches. Sometimes if these areas become infected, they can also be oozy and weepy with drainage.

We will come up with a comprehensive plan of action that will not only treat your flare up but also prevent you from having flare ups. These treatments can include gentle soap free cleansers, moisturizers and creams that help with skin barrier repair, antibiotic creams and pills for infection if needed and lastly topical creams with and without steroids to calm down the redness and itching. We sometimes have to use oral steroids or a steroid injection if the flare up is severe enough. We also now have a new injectable drug that can be used to treat tough cases of Atopic Dermatitis.

There are other types of Eczema or Dermatitis that patients can develop including Hand Dermatitis, Allergic Contact Dermatitis such as from Poison Ivy, Nummular Dermatitis which presents usually with circular red, itchy and scaly patches on the lower legs and even Stasis Dermatitis which causes red, itchy, scaly and crusted patches on the lower legs in the setting of venous varicosities and fluid retention.

If we suspect a skin cancer, a skin biopsy to test the lesion may be necessary. We recommend routine annual full skin exams. Dr. Bahl will use her Dermlite to magnify and closely examine any lesions of concern so you can rest peacefully. We will also photograph and measure any moles we want to follow closely. We will also address benign growths such as Seborrheic Keratoses, Cherry Angiomas, Freckles and Sun/Liver spots or Solar Lentigines which generally do not require treatment, but can be treated if you are bothered by them.

Androgenetic Alopeica (also known as male pattern baldness), Alopeic Areata (an autoimmune mediated hair loss that causes loss of hair in round bald smooth patches) and Telogen Efluvium (which is excessive hair shedding that results in hair loss and thinning mainly in women). The causes of these different types of hair loss can be genetics, hormones, stress, underlying medical problems (thyroid problems, anemia), medications (as taken for chemotherapy) and even certain hair care practices.

Because of the many causes and presentations of hair loss, a hair loss appointment needs to be made separate from all other appointments. We will take a very careful and detailed history and perform a thorough clinical examination to determine the type of hair loss or alopecia you have, whether its scarring or nonscarring, and will then decide on appropriate treatment. Sometimes a small piece of skin from the affected area in the scalp needs to be tested to determine the type of hair loss. This is called a scalp biopsy. Hair loss can also often be multifactorial (caused by multiple things) and one patient can even have two types of hair loss at the same time, although this is not very common. Treatment of hair loss consists of topical creams, steroid injections, oral medications, most recently injection of Platelet Rich Plasma also known as PRP, and the first and only FDA approved LED cap - Revian Red.

Psoriasis presents with red, scaly, sometimes extremely itchy bumps and patches. The scale can be somewhat silvery white and thick. Psoriasis can present as dandruff as well as thick scaly red patches in the scalp. It can also affect the nails and joints. When it affects the joints, it is called Psoriatic Arthritis. We can help you distinguish if your symptoms are those of Osteoarthritis or Psoriatic Arthritis, this is important since they are treated differently. Psoriasis can be associated with other medical conditions such as Type 2 Diabetes, High Blood Pressure, Abdominal Obesity so it is important to seek the right treatment early. Flare-ups of Psoriasis most often occur from stress and dry weather causing dry skin and less often from certain blood pressure medications. Strep throat can also cause an outbreak of a type of Psoriasis known as Guttate Psoriasis which presents with small scaly bumps predominantly on the chest, abdomen, back, arms and legs. Oral antibiotics are used to treat this type of Psoriasis flare. We will carefully devise a plan to treat your unique presentation of Psoriasis. Localized Psoriasis can generally be treated with creams and ointments while more generalized cases will require systemic drugs which may include pills or self-injectable medications falling under a larger class called Biologics. These drugs have shown great success in almost clearing some patients of their Psoriasis and have allowed Psoriasis patients to have an amazing quality of life. Many of these drugs will benefit Psoriatic Arthritis as well.

Tinea Cruris is an infection of the groin, also known as jock itch, and Tinea Pedis is an infection of the feet also known as Athlete’s Foot. Tinea presents with red, extremely itchy, scaly and often ring shaped patches. They are usually clear in the center with an active border, sometimes there can even be some blistering along the border. Tinea capitis can present with a scaly, red patch associated with itching and hair loss and some forms of Tinea can present with just scaling such as seen on the hands (Tinea manum) or feet. Tinea is highly contagious and it is very important to differentiate it from other skin conditions such as eczema so appropriate treatment can be given. A skin scraping or biopsy may be performed to confirm this diagnosis. Topical creams or oral antifungals are used to treat different types of Tinea depending on involvement in the skin.

Warts can occur anywhere on the body but are most commonly found on the hands and feet. They are highly contagious so the affected areas should be kept covered at all times. Genital warts are generally spread through sexual intercourse. Treating warts can require multiple treatments and these treatments can range from freezing with liquid nitrogen, to injecting medication into the wart, to applying different types of topical medication. For the ones resistant to the common forms of treatment, we may even use lasers. Routine follow up when treating warts is extremely important. We will fiind the best treatment method based on the patient’s age, number of warts, location and response to different treatment modalities.