From the minor to the severe, we offer a full range of medical skin care treatments, including advanced solutions for common skin conditions like acne, rosacea, hair loss, and psoriasis, as well as skin cancer screening and treatment, mole checks, treatment of precancerous lesions, and mole mapping. Located below are a few of the skin disorders and diseases that we treat at DeSilva Dermatology.
Fungal Infections of the Skin
Fungal infections of the skin or nails, also referred to as tinea, are quite common. Fungal infections are contagious and thrive in warm, moist areas. A comb, clothing, shower surface, or pool area can harbor tinea. Common fungal infections include: athlete’s foot (tinea pedis), jock itch (tinea cruris), ringworm (tinea corporis), scalp ringworm (tinea capitis), and nail fungus (onychomycosis, tinea unguium).
Moles
A mole or nevus is a dark, raised spot on our skin comprised of skin cells that have grown in a group rather than individually. These cells are called melanocytes and are responsible for producing melanin, the pigment (color) in our skin.
Moles can form from sun exposure, but we are also born with them, inheriting them genetically. Although number of moles varies from person to person, fair skinned people generally have more moles due to lower amounts of melanin in their skin, and the average adult has between 10 and 40 moles. Moles can even come and go with hormonal changes such as pregnancy or puberty.
Most people develop more moles on their skin naturally with age and sun exposure, and — most of the time — these moles are harmless. However, we need to conduct skin checks regularly (recommended monthly, especially if you have a relative with skin cancer, or at least every three months) to see if our moles have changed.
Types of skin moles
Not all moles are created equal. Here’s a quick guide to mole types and what they mean for our skin. It’s good to note that moles are categorized by multiple factors, including when they developed, where they are located in the skin and if they exhibit typical or atypical symptoms. That means moles are often described by multiple classifications. For instance, you can have a common acquired junctional nevus or an atypical congenital nevus.
A common mole is one that is usually about 5-6 mm in diameter, has distinct edges, a smooth, dome-like surface and even pigmentation. These moles are usually found on skin regularly exposed to the sun and have the potential to turn into skin cancer, but it is a rare occurrence.
Congenital Mole – When a person is born with a mole (ranging from small to large/giant) it is called a congenital mole (nevus). The large/giant congenital mole has been shown to carry a higher risk of developing melanoma and should be monitored as you enter adolescence and adulthood.
Atypical Mole – Also called dysplastic nevi, these moles are generally larger than average (bigger than a pencil eraser) and irregular in shape. They tend to have uneven color with mixtures of tan, brown, red, and pink. People with atypical moles have a greater chance to develop melanoma.
Acquired Mole – Acquired moles are moles that appear during childhood and adulthood. Most of these moles are benign and pose no risk, although sometimes they can turn into cancerous moles with age. This is the most common type of mole, and it is usually caused by repeated sun exposure.
Warning signs that a mole may be cancerous
Look for these indicators that your mole may be cancerous:
• A change in size (getting larger)
• A change in shape (especially with irregular edges)
• A change in color (especially getting darker or exhibiting multiple shades)
• A loss of symmetry (common moles will be perfectly round or oval and are usually symmetrical)
• Itchiness, pain or bleeding (maybe even forming a scab)
• Crustiness
• Inflammation
• Exhibiting three different shades of brown or black
• A change in elevation (thickening or raising of a flat mole)
If you notice any of these symptoms, contact a doctor to have your mole examined.
ABCDEs of Moles
It can be difficult to remember all of the things to look out for during a skin check. That’s why doctors advise using the ABCDE method to make things simpler. Check your skin for these signs during self-examinations:
• Asymmetrical – the mole is distinctly asymmetrical
• Border – the mole has uneven borders
• Colors – the mole contains at least two distinct colors
• Diameter – the mole is bigger than ¼ inch or 6 mm across
• Enlargement – the mole grows in size over time
Check your mole
The best way to decipher if a mole — of any type — is safe or at risk is to check them frequently. Any changes are usually a sign that the mole should be checked out by a doctor.
Seborrheic Keratoses
Seborrheic keratoses (SK’s) are benign skin growths that can occur anywhere on the skin. Usually beginning as small, rough bumps, SK’s tend to eventually thicken and develop a warty surface. Most are brown, but these growths can range in color from light tan to black. Some SK’s can become as large as a half-dollar. What often distinguishes these growths from other lesions is a waxy, stuck-on appearance, similar to a drop of brown candle wax. Cryosurgery is a common treatment option for SK’s.
Tinea Versicolor
Tinea versicolor is a skin condition caused by an overgrowth of yeast on the skin’s surface. The yeast normally lives in the pores of the skin and can thrive in oily areas such as the neck, upper chest, and back. An overgrowth results in a fungal infection that causes uneven skin color, scaling, and sometimes itching. Treatments include topical cleansers, shampoos, creams or lotions, oral medications, and medicated cleansers.
Urticaria (Hives)
Urticaria (hives) are localized, pale, itchy, pink wheals (swellings) that can burn or sting. They may occur singularly or in groups on any part of the skin. They are part of an allergic reaction and are very common. Allergic reactions, chemicals in foods, or medications may cause hives; sometimes it is impossible to find out the cause. Antihistamines are prescribed to provide relief and work best if taken on a regular schedule to prevent hives from forming.
Vitiligo
Vitiligo is a medical condition that causes the skin to lose color, or pigment. Some people develop a few spots that may lighten or turn completely white while others can have widespread loss of skin color. Vitiligo develops when cells called melanocytes die or are destroyed by the body’s immune system. As the cells die, an area of skin or hair turns white because the cells no longer make pigment. Treatment options include light therapy & medications, narrow band ultraviolet B, or PUVA (UVA light).
Warts
Warts are non-cancerous skin growths caused by a viral infection in the top layers of skin. The virus that causes warts is called the human papilloma virus, or HPV. There are several different kinds of warts including: Common Warts (verruca vulgaris), Plantar/Palmar Warts (verruca plantaris/palmaris), Flat Warts (verruca-plana), and Genital Warts (condylomata acuminata). Cryotherapy (freezing) and laser treatments are common therapies used to treat the various types of warts.
Common Skin Growths
Many common growths develop on the skin. While the cause is often poorly understood, it is known that some are associated with aging, and others are inherited. Benign lesions are not life threatening, but people often have these lesions removed for cosmetic reasons. Examples include:
• Dermatofibroma
• Prurigo Nodularis
• Keratoacanthoma
• Pyogenic Granuloma
• Epidermoid and Pilar Cysts (Sebaceous Cysts)
• Milia
• Sebaceous Gland Hyperplasia
• Digital Mucinous Pseudocyst
• Lipoma
• Xanthelasma
• Syringoma
• Trichoepithelioma
• Neurofibroma
• Hemangioma (Cherry Angioma)
• Seborrheic Keratoses and Verrucous Acanthoma
• Nevi (moles)
For diagnosis and treatment for any of these lesions, please see your dermatologist.
Acne
Acne is a skin condition which causes clogged pores (blackheads and whiteheads), inflamed pimples (pustules), and deeper lumps (nodules). Acne occurs on the face, back, chest, neck, shoulders and upper arms. It is most common in adolescents but oftentimes adults in their 20’s, 30’s, 40’s and even older adults can develop acne. Untreated acne can leave permanent scars. Topical and/or oral antibiotics are often prescribed to treat acne. Chemical peels, laser treatments, injections of corticosteroids, birth control pills, and microdermabrasion are other common treatments for acne.
Actinic Keratosis
Actinic Keratosis (AK’s) are common skin lesions caused by years of sun exposure and are considered the earliest stage in the development of skin cancer. AK’s are also called “solar keratosis” or “sun spots.” Fair-skinned individuals are more susceptible, and AK’s tend to appear on skin that receives the most sun: the forehead, ears, neck, arms, hands, lower lip, bald scalp, and lower legs of women. Common treatments include cryosurgery, topical chemotherapy, topical immunotherapy, topical NSAID, and photodynamic therapy (PDT)
Allergic Contact Dermatitis
Allergic contact dermatitis is caused by a reaction to substances called allergens that come into contact with your skin. In susceptible people, these contact allergens can cause itching, redness, and blisters. Common allergens include: nickel, rubber, detergents, some skin care products, poison ivy and its relatives, chromates, hair dyes, and neomycin. Treatments available include topical steroid creams and/or oral antihistamines.
Dermatologic Surgery
There are times when moles and other skin conditions need to be excised or biopsied for complete evaluation and diagnosis, or skin cancers need to be surgically removed. Dr. DeSilva is experienced in performing these surgical procedures when required to treat, or even just diagnose, diseases that affect the skin, hair, and nails.
Sun Exposure and Sun Protection
The ability of a sunscreen to block ultraviolet radiation is expressed as an SPF (sun protection factor). This factor represents the ratio of the amount of radiation required to induce redness through a thin layer of sunscreen (2 mg/cm2), compared to unprotected skin. The actual amount of sun protection most people are getting with sunscreen does not reach the rated SPF because most people apply too thin a layer of sunscreen.
There are two primary components of sunscreens: chemical and physical agents. Most broad spectrum sunscreens (which block UVA and UVB radiation) contain chemical and physical sunscreen components.
It is recommended that you select a sunscreen with one or more of the following four components because of their ability to absorb UVA radiation:
• Chemical
• Avobenzone (Parsol 1789)
• Ecamsule (Mexoryl)
• Physical
• Zinc oxide
• Titanium dioxide
The chemical ingredients listed are often found in combination with other UVB blocking agents to produce broad spectrum UV protection.
Daily application of a facial moisturizer with an SPF of 15 or greater is recommended. For outdoor activities, an SPF of 30 or greater is recommended. 1 ounce or 30 mL (two tablespoons) of sunscreen is required to cover all body areas. If you are applying less than that amount, you are not getting the degree of sun protection indicated by the SPF designation.
A dual application of sunscreen with the first application 20 minutes before and the second application 30 minutes after the start of sun exposure is recommended.
Hair Loss
The average person has up to 150,000 scalp hairs. It is normal to lose 100 or more scalp hairs each day. Hair cycles between 3 stages of growth: anagen, catagen and telogen. Many things can alter normal hair cycling and can promote hair loss and thinning. Hair loss (alopecia) can be caused by genetic or environmental factors, and often a combination of these factors. Hair loss can be caused by certain illnesses, medications, and diet also plays an important role in healthy hair growth.
There are many causes and types of alopecia. Hair diseases and disorders are varied and may be accompanied by the following signs and symptoms depending on the type of hair loss pattern:
• Non-scarring alopecia involves localized or diffuse loss of hair (scalp or other sites). Receding hair line, broken hairs, smooth scalp, inflammation, and possibly loss of lashes, eyebrows, or pubic hair may be features of this kind of hair loss. Some examples are Alopecia Areata and Telogen Effluvium.
• Scarring alopecia is limited to particular areas and involves inflammation at the edge and follicle loss toward the center of lesions, violet-colored skin abnormalities, and scaling. Some examples include discoid Lupus Erythematosus, Lichen Planopilaris and Central Centrifugal Scarring Alopecia.
• Hirsutism involves male-pattern “terminal hair” growth in women, irregular menstruation, lack of ovulation, acne, deepening of voice, balding, and genital abnormalities. However, terminal hair growth in a male pattern may also occur normally in some women with a genetic predisposition.
• Hair shaft disorders can begin at birth or may be acquired in adulthood. These disorders may involve split ends, dry, brittle, and coarse hairs, hair color changes and easy breaking of hairs.
Hyperhidrosis
Hyperhidrosis (Excess Sweating) is the condition characterized by abnormally increased perspiration, in excess of that required for regulation of body temperature.
Hyperhidrosis can either be generalized or localized to specific parts of the body. Hands, feet, axillae, and the groin area are among the most active regions of perspiration due to the relatively high concentration of sweat glands.
Keloids
Keloid scars are large, raised scars that spreads beyond the size of an original wound. Sometimes it is clear what causes a keloid (earrings, acne, a cut or scrape), but they may arise without any known trauma to the skin. The most common areas for keloids to develop are the ears, mandible (jawline), shoulders and upper back. Surgical treatment is not always a good option, especially because keloids can recur and become even larger after a surgery. If surgery is performed, the chance of developing a new keloid can be minimized by using immunomodulatory creams, steroid injections (into the surgery site) or radiation therapy. Vascular laser treatments are sometimes helpful for red, hypertrophic scars, a type of scar somewhat similar to keloids.
Melasma
Melasma is a disorder of pigmentation that most commonly afflicts women during the reproductive years (90% of all cases) and presents with brown patches on the face. The brown pigmentation most commonly occurs on the cheeks, around the eyes, the bridge of the nose and forehead. The disease has a predilection for darker-skinned individuals, particularly Hispanics, Asians and individuals from the Middle East and northern Africa.
What causes melasma?
People with a family history of melasma are more likely to develop melasma the condition. A change in hormonal levels may cause melasma. For example, use of birth control may trigger melasma. The term chloasma or the “mask of pregnancy” is melasma that occurs with pregnancy. Hormone replacement therapy after menopause has not been shown to cause the condition.
Other factors that can worsen melasma include:
• Sun exposure: ultraviolet light can stimulate the pigment-producing cells of the skin to produce pigment.
• Irritation of the skin.
• Exposure to warm environments.
• Photosensitizing medications.
Rosacea
Rosacea is a common condition characterized by persistent redness of the cheeks, nose, and less commonly the brows and chin. Prominent blood vessels, flushing, pimple-like bumps and pustules may be present. It is most common in women in their 30s and 40s, but frequently occurs in men as well.
The cause of rosacea is unknown. Chronic sun exposure worsens the condition. Other potential triggers may include:
• Heat/Cold
• Stress
• Spicy foods
• Hot drinks
• Exercise
• Alcohol
• Caffeine withdrawal
• Certain medications
Skin Cancer
Skin cancer is the most prevalent of all types of cancers. Fair-skinned individuals who sunburn easily have the greatest risk to develop skin cancer. Other important risk factors include use of tanning devices, family history, repeated medical and industrial x-ray exposure, immunosuppression, scarring from diseases or burns, and occupational exposure to compounds such as coal, tar and arsenic. You should develop a regular routine to inspect your entire body for any skin changes. If a growth, mole, sore, or skin discoloration appears suddenly or begins to change, see your dermatologist.
Skin cancer occurs in three main forms: Basal Cell Carcinoma, Squamous Cell Carcinoma and Melanoma. Of the more than one million new cases of skin cancer diagnosed in the U.S. each year, approximately 80% will be basal cell carcinoma (BCC), 16% will be squamous cell carcinoma (SCC), and 4% will be melanoma.
Basal Cell Carcinoma is a skin cancer that develops in the basal layer of the skin—deeper than the surface layer. Basal cell carcinoma is the most common form of cancer worldwide. It is associated with chronic sun exposure. Basal cell carcinoma seldom spreads to other parts of the body, but can be disfiguring if not treated early. Basal cell cancer should be treated promptly by your dermatologist because they can grow locally and destroy surrounding tissues. Basal Cell cancers are curable, and are treated with surgical procedures (excision, electrodessication and curettage, Mohs Micrographic Surgery), Photodynamic therapy or Imiquimod cream, depending on the type of cancer, its location and its size.
Squamous cell carcinoma: Squamous cell carcinoma (SCC) is the second most common cancer of the skin. Squamous cell carcinoma arises in the outer layer of the skin (the epithelium). Middle-aged and elderly persons, especially those with fair complexions and frequent sun exposure, are most likely to develop SCC.. Squamous cell carcinomas often arise from small sandpaper-like growths called solar or actinic keratoses. It is rare for SCC to spread to local lymph nodes and internal organs, but metastasis can happen when high-risk SCC is not promptly diagnosed and treated. Squamous Cell cancers are curable, and are treated with surgical procedures (excision, electrodessication and curettage, Mohs Micrographic Surgery), Photodynamic therapy or Imiquimod cream, depending on the type of cancer, its location and its size.
Melanoma is also curable when detected early, but it can be fatal if it is not detected at an early stage. Melanoma is a cancer of the pigment-producing cells in the skin, known as melanocytes.
Melanoma occurs when melanocytes transform into cancer cells that multiply and invade other tissues.
• The overall incidence of melanoma is rising at an alarming rate.
• In 2005, one in 62 Americans have a lifetime risk of developing invasive melanoma, a 2000% increase from 1930. When non-invasive melanoma is included, one in 34 Americans have a lifetime risk of developing melanoma.
• The American Academy of Dermatology urges everyone to examine their skin regularly. If there are any changes in the size, color, shape or texture of a mole, the development of a new mole, or any other unusual changes in the skin, see your dermatologist immediately.
• Excessive exposure to ultraviolet sunlight is the most preventable cause of melanoma. Melanoma has also been linked to excessive sun exposure in the first 10 to 18 years of life.
• Not all melanomas are sun related – other possible causes include genetic factors and immune system deficiencies. Melanoma can strike anyone. Caucasians are ten times more likely to be diagnosed with melanoma.
Basal Cell Carcinoma
Basal Cell Carcinoma is a skin cancer that develops in the basal layer of the skin—deeper than the surface layer. Basal cell carcinoma is the most common form of cancer worldwide. It is associated with chronic sun exposure. Basal cell carcinoma seldom spreads to other parts of the body, but can be disfiguring if not treated early. Basal cell cancer should be treated promptly by your dermatologist because they can grow locally and destroy surrounding tissues. Basal Cell cancers are curable, and are treated with surgical procedures.
Melanoma
Melanoma is a cancer of the pigment-producing cells in the skin, known as melanocytes. Melanoma occurs when melanocytes transform into cancer cells that multiply and invade other tissues. Melanoma is also curable when detected early, but it can be fatal if it is not detected at an early stage. The overall incidence of melanoma is rising at an alarming rate.
• In 2005, one in 62 Americans have a lifetime risk of developing invasive melanoma, a 2000% increase from 1930. When non-invasive melanoma is included, one in 34 Americans have a lifetime risk of developing melanoma.
• The American Academy of Dermatology urges everyone to examine their skin regularly. If there are any changes in the size, color, shape or texture of a mole, the development of a new mole, or any other unusual changes in the skin, see your dermatologist immediately.
• Excessive exposure to ultraviolet sunlight is the most preventable cause of melanoma. Melanoma has also been linked to excessive sun exposure in the first 10 to 18 years of life.
• Not all melanomas are sun related – other possible causes include genetic factors and immune system deficiencies. Melanoma can strike anyone. Caucasians are ten times more likely to be diagnosed with melanoma than other races.
Monthly Skin Cancer Self-Check Tips
Some tips for a thorough self-check include:
• Examine yourself in a well-lit room after shower or bath.
• Rough, dry patches that are red or pink
• Ask a friend or spouse to check hard-to-see areas, such as your back.
• Look at all of your skin, even those areas not regularly exposed to sun.
What are you looking for?
• Smooth, waxy, or pearly lumps
• Rough, dry patches that are red or pink
• Moles that are: unfamiliar, growing, asymmetrical, blurry or frayed, various shades, crusty, and/or bleeding
• Look at all of your skin, even those areas not regularly exposed to the sun.
Sun Protection
Sun Protection is important to prevent the short and long-term damaging effects of sunlight. Sunscreens should be used in conjunction with protective clothing for optimal sun protection. Long-term overexposure can cause wrinkles, freckles, age spots, dilated blood vessels, changes in the texture of the skin, and skin cancers. The American Academy of Dermatology recommends that you avoid deliberate sunbathing, wear a wide-brimmed hat, sunglasses, and protective clothing. When you are exposed to sun, use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 15 even on cloudy days. A broad-spectrum sunscreen is one that protects against both ultraviolet-A (UVA) and ultraviolet-B light (UVB).
Eczema
Eczema is a general term for any type of dermatitis (inflammation of the skin). Skin diseases that are “eczemas” include atopic dermatitis, nummular eczema, dyshidrotic eczema, asteatotic eczema, contact dermatitis and hypersensitivity dermatitis. Hypersensitivity dermatitis may be caused by medications, infections/infestations and/or allergies.
• When people with atopic and dyshidrotic dermatitis are exposed to an irritant or allergen to which they are sensitive, their immune system is stimulated to produce inflammatory cells that enter the skin and release chemicals that cause itching and redness.
• All types of eczema can be itchy and red; some types may weep, crack, peel or blister. Atopic dermatitis very often occurs together with other atopic diseases like hay fever, seasonal or pet allergies, dust mite allergy, asthma and conjunctivitis. It is a chronic condition that can worsen or disappear over time. Atopic dermatitis may sometimes be mistaken for psoriasis.
Psoriasis
Psoriasis is an immune-mediated disease that causes raised, red, scaly patches to appear on the skin. In some people it also affects the joints. The prevalence of psoriasis in Western populations is estimated to be around 2-3%. It affects both sexes equally and occurs at all ages.
While scientists do not know what exactly causes psoriasis, we do know that the immune system and genetics play major roles in its development. Usually, something triggers psoriasis to flare. The skin cells in people with psoriasis grow at an abnormally fast rate, which causes the buildup of psoriasis lesions.
Men and women develop psoriasis at equal rates. Psoriasis also occurs in all racial groups, but at varying rates. About 1.9 percent of African-Americans have psoriasis, compared to 3.6 percent of Caucasians.
Psoriasis often develops between the ages of 15 and 35, but it can develop at any age. About 10 to 15 percent of those with psoriasis get it before age 10. Some infants have psoriasis, although this is considered rare. Psoriasis is not contagious. It is not something you can “catch” or that others can catch from you. Psoriasis lesions are not infectious.
It typically affects the outside of the elbows, knees or scalp, though it can appear on any location. Some people report that psoriasis is itchy, burns and stings. Psoriasis is associated with other serious skin conditions, such as diabetes, heart disease and depression.
If you develop a rash that doesn’t go away with an over-the-counter medication, you should consider contacting your dermatologist.
Warts
Warts are a common and annoying infection of the skin. They are caused by a virus called human papillomavirus (HPV). The strain of HPV depends in part on the body area affected and the subtype of wart.
Wart subtypes include:
• Verruca vulgaris (common warts): common between the ages of 5 and 20. Frequent contact of hands with water increases the risk of developing common warts. Butchers are also at higher risk.
• Flat warts: Most common on the face, neck, backs of hands, elbows, knees. Men who shave their beards can spread the wart virus, resulting in many flat warts in a beard distribution.
• Plantar warts: most often occur on pressure points of the feet.
• Genital warts: the most common sexually transmitted disease. This type of HPV infection is linked with cancer of the cervix, penis and anus.
• There are very large, rare, wart-like growths called giant condyloma acuminatum that are not warts at all. They are actually slow-growing but aggressive skin cancers.
Will my warts go away on their own?
Common warts and flat warts have high rates of spontaneous remission. In children, the rates of spontaneous clearance of common warts is approximately 50% at 1 year and 70% at 2 years.
What can I do to prevent the spread of my warts?
If you are a nail-biter and have warts on the fingers, you should try to stop this habit because you are spreading the wart from finger to finger. Warts also should not be picked at because the virus can transfer. For men with warts on the face who need to shave, an electric razor is preferred over a razor blade.
What treatments are available for warts?
Numerous treatments exist for warts because no individual treatment works for everyone. The goals of wart therapy are not only to remove the wart, but also to avoid scarring and prevent recurrences.
An important component of wart treatment is persistence. Any individual treatment should not be abandoned too quickly.
Nail Fungus & Common Disorders
While uncommon in children, nail disorders affect a large number of older adults. As we age, nails thicken and become more susceptible to fungal nail infections. Circulatory problems and use of medications, which also tend to increase as we age, raise the risk of developing a nail condition. Common nail fungi and disorders include: white spots, splinter hemorrhages, ingrown toenails, fungal infections (onychomycosis), bacterial infections, tumors and warts, mucinous cysts, dark spots.
