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Medical Dermatology

At Dr. Ali Al Tukmatchy Clinic, we are committed to providing the highest quality of expert medical care to patients with conditions involving skin, hair, nails and mucous membranes. Diagnosis and management of skin conditions including infectious, immunologic, degenerative, neoplastic and sexually transmitted diseases is provided to patients of all ages. We also practice Aesthetic Dermatology to manage cosmetic disorders of the skin, including hair loss, scars and the skin changes associated with aging.

Our clinic is equipped with liquid nitrogen, electrocautery machines and the use of Laser therapy for skin resurfacing and hair removal. Other cosmetic procedures such as mesotherapy, various peeling processes and cosmetology related surgeries are also performed. The following minor surgical procedures are administered using the advanced technologies:

  • Dermabrasion
  • Botox injection&filling
  • Skin biopsy for skin diseases and skin tumors
  • Cytological smears
  • Electrosurgery and chemocautery for benign skin tumors
  • Cryotherapy for skin conditions
  • Chemical peeling treatment for pigmentation disorder and for skin rejuvenation
  • PUVA therapy for vitiligo
  • Psoriasis and other skin diseases
  • Intralesional injection for conditions like alopeciaareata and other skin diseases

Acne Treatment

Acne is a common medical condition that affects up to 80 percent of adolescents and adults at some point in their lives. Adult onset acne has become a growing concern for people in their 20’s, 30’s, and 40’s.  Although acne is not a grave disease, it can leave permanent scarring on the skin, and negatively impact an individual’s self-esteem. Clearing up acne can help relieve these issues, but many people don’t realize that something can be done.

Acne is one of the most common of all skin problems, characterized by whiteheads, blackheads, pimples and, in some people, deep painful bumps that look and feel like boils. When it’s severe, acne can cause permanent scarring of the skin.

There are many factors which contribute to the development of acne, including hormones and genetics. The most common reason is due to hormones.  As we age, the levels of hormones in our body fluctuate.  The most notable instances of a significant hormone increase associated with an outbreak of acne are during puberty and pregnancy. These hormones have an effect on the activity and size of the sebaceous glands – glands in the skin that produce an oily substance called sebum to protect the hair follicles and the skin. When hormones surge during puberty or pregnancy, the sebaceous glands enlarge in the areas where acne occurs. Acne has also been associated with the use birth control pills. The variation in hormone levels from starting and stopping birth control might cause acne.  There is also a genetic component involved with acne.  Individuals may inherit an increased chance of suffering from acne if their parents did.

Rosacea

Rosacea is a common problem associated with redness appearing across the face, mainly over the cheeks, chin, and nose. The redness can persist and become darker and is linked with the development of noticeable blood vessels. A bumpy appearance can develop along with pimples if this condition is not treated. This condition is frequently made worse by certain trigger factors; most commonly smoking, consuming alcoholic beverages, and consuming caffeinated beverages. Individuals who are experiencing Rosacea should seek treatment as the condition may worsen and become disfiguring. A variety of topical and oral treatments are available. These are especially effective against the papules and pustules associated with Rosacea. The redness and blood vessels are more difficult to treat. IPL/Laser systems can effectively treat these problems as well. Photorejuvenation treatments can be used to even skin tone and texture and to remove the blood vessels.

Eczema

There are a variety of types of eczema as well as causes. Eczema is associated with very dry, itchy skin. It can become red and bleed, particularly if the area becomes broken from scratching. Eczema is not contagious and can be treated. Mild cases can usually be treated with topical remedies and a mild skin care routine. More advanced cases may require oral medications. Your physician will determine the appropriate treatment plan for you. Atopic Dermatitis, also called Atopic Eczema, is the name given to a stubborn, itchy rash that occurs in certain persons with sensitive or irritable skin. Eczema is common in infants and young children, and may disappear before adulthood. Eczema may clear for years, only to reappear later-often on the hands.

Psoriasis

Psoriasis is a chronic, autoimmune disease that appears on the skin. It occurs when the immune system sends out faulty signals that speed up the growth cycle of skin cells.  Pain, itching, and burning are common symptoms.  Psoriasis is not an infection and therefore is not contagious.

There are several forms, or types, of psoriasis. The most common form, plaque psoriasis, appears as raised, red patches or lesions covered with a silvery white buildup of dead skin cells, called scale. Psoriasis can occur on any part of the body and is associated with other serious health conditions, such as diabetes, heart disease and depression.

According to the National Institutes of Health, as many as 7.5 million Americans have psoriasis.  Its cause is not known, but certain genes are suspected to play a role in developing the disease.  Although a cure is not yet available, many treatments are available to help control your psoriasis.  Your doctor can help identify which treatment is right for you, keeping in mind that what works for one patient might not work for another.

Mole removal

Mole removal is important for you to have if your physician is suspicious of a mole or moles which have appeared on your body. Skin cancer is a rapidly spreading problem and catching it in time makes all the difference, before it has time to spread even further and to avoiding more problems with it in the future.

Acquired Nevi

The size of most moles is usually less than ¼ inch in size, anything bigger should be looked at by your physician. Most people think of a mole as being a dark brown spot, but moles can come in any shape, size and color (usually brown). They can be raised from the skin and very noticeable, or they may contain dark hairs. Moles can appear anywhere on the skin, alone or grouped.

Facial moles are probably determined before a person is born. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion and checked out. Sun exposure can cause a mole to darken in color, also during pregnancy and therapy with certain steroid drugs can cause a mole to darken.

Surgical excision of nevi should be done where cancer is a reasonable concern. Another reason may be to improve cosmetic appearance, but all surgery leaves some scarring. Smaller nevi can be “shaved off”. Larger ones can be cut out directly and the wound edges stitched. Much larger nevi may be excised in stages by taking a little more out each time until the entire nevus is removed. When this is done, the area that has been worked on is too big to be sewn together so a skin graft is done using healthy skin from another part of your body. Usually after this has healed, the skin is thinner than the rest of your skin.

Warts

Warts are common problems that have likely been around since the dawn of man. It is estimated that warts affect many millions of individuals. Warts are caused by the Human Papilloma virus, or HPV, of which there are numerous subtypes that cause a variety of warts. Warts are potentially contagious, spreading to other body areas on a person or to other individuals. Warts may spontaneously resolve, but they may persist in individuals for years while increasing in numbers and possibly spreading to other individuals or family members. There is no single, certain remedy or cure for warts.

The most commonly utilized methods to treat warts are destructive in nature and include applying liquid nitrogen, acids, or blistering agents to regularly remove wart tissue. Persistent removal of wart tissue every few weeks is critical to achieve resolution of a wart. Warts located on the hands and feet on average require 5 to 7 serial treatments every few weeks.

Persistence is absolutely critical in getting rid of warts. After wart treatment some discomfort is inevitable as tissue is destroyed and often a blister results. We generally avoid more painful techniques of wart removal in younger children. Cantharone, a blistering agent, causes minimal discomfort and is often used repetitively for younger individuals. Additional methods are used for individuals who have many warts where destructive means are poorly tolerated or prohibitive due to the sheer number of warts. Tagamet, or Cimetidine, is often used successfully in these individuals, but in much higher doses than typically used to treat stomach problems. For very refractory warts there are additional measures that can be undertaken. These can be considered and discussed as the need arises.

Skin Cancer

How is skin cancer treated?

Once a skin cancer is discovered, there are several treatment options which are based on on several factors:

  • The type of cancer (basal cell, squamous cell, melanoma, or other)
  • The size of the cancer—treatments that may be effective for small cancers may not be optimal for larger cancers
  • The location of the cancer (face vs. trunk)
  • Your past history and family history of skin cancers

What are the various types of treatment?

Cryosurgery—A small amount of liquid nitrogen is used to “freeze” away the lesion.  Cryosurgery is usually reserved for treating small pre-cancers such as actinic keratoses.

Topical therapy—is best for pre-cancers (actinic keratoses) and some physicians may recommend it for non-aggressive forms of skin cancer such as superficial basal cell carcinoma. Examples of topical therapies are Efudex cream (5-fluourouracil) and Aldara cream (imiquimod). The primary advantage of using topical therapy is avoidance of surgical procedures. However, topical therapies have lower cure rates than surgery and often require application of creams that irritate the skin for weeks or months. Another potential problem is that topical therapy may only remove the superficial portion of the tumor and mask deeper tumor roots.  Its use is strictly limited to very superficial forms of non-melanoma types of skin cancer (superficial basal cell carcinomas).

Curettage-electrodessication—a procedure where the tumor is scraped off using a sharp-edged device called a curette. The surrounding skin is then cauterized (heated) to prevent bleeding and further remove the tumor. This destruction technique is best for non-aggressive types of skin cancer that are very thin or superficial or for non-aggressive forms of skin cancer on the arms or trunk.

Excision—The tumor is surgically removed along with a small portion of surrounding skin. This usually requires stitches to control bleeding and close the wound.

Radiation and chemotherapy—may be recommended in cases when the cancer has spread, or when other medical conditions prevent the use of other treatments.

If you are diagnosed with a skin cancer, your doctor will discuss with you which option or options are best suited for you and individually tailor a treatment course based on the varying factors listed above.