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Diagnosis

Acne vulgaris

Acne is an inflammatory disease of the skin, caused by changes in the hair follicles and sebaceous glands.

  • The typical acne lesions are comedones, papules, pustules, nodules and inflammatory cysts.
  • Several factors occur in combination to cause acne, including hormonal changes, a family history of acne, stress and diet.
  • Acne is usually associated with the teenage years, but the incidence of adult acne is on the rise.
  • There is no way to predict how long it will take for acne to disappear entirely.
TREATMENT FOR ACNE
  • Current treatments for acne (these are often used in combination for best results):
    • Topical antibacterial or anti-inflammatory medications (clindamycin, benzoyl peroxide, sulfacetamide, dapsone)
    • Topical retinoids (tretinoin, adapalene, tazarotene)
    • Oral antibiotics (minocycline or doxycycline)
    • Hormonal therapies including oral contraceptive pills and spironolactone
    • Isotretinoin (an oral retinoid medication)
    • For hyperpigmentation and scarring:
      • After resolution of acne lesions, prominent hyperpigmentation is common.  This temporary hyperpigmentation will fade with time and gentle skin care. Chemical peels, light and laser therapy can also help.
      • Permanent scarring can be addressed using surgical methods, fillers micro-needling and laser resurfacing.

Actinic keratoses (AKs) are common and may be characterized by rough, red, scaly patches, crusts or sores. They are often referred to as “precancers” of the skin. In approximately 10-15% of cases, they transform to a skin cancer called squamous cell carcinoma (SCC).

  • AKs are usually found on the face, lips, scalp, neck, forearms, and back of the hands – areas of chronic sun exposure.
  • Individuals with fair skin or poor immune systems are at greater risk for developing AKs.
  • AKs take years to develop, and while they are more commonly found on older individuals, even people in their 20s and 30s can develop AKs.
TREATMENT FOR ACTINIC KERATOSES

The goal of treatment of AKs is to prevent the development of skin cancer. There are a number of therapies are available:

  • In office cryotherapy (liquid nitrogen spray).
  • Topical medications for home use including tretinoin, diclofenac, 5-fluorouracil, imiquimod,  and ingenol mebutate (Picato).
  • In office photodynamic therapy after application of aminolevulinic acid (ALA-PDT).  PSDerm does not offer this procedure, but we are happy to refer you to our local colleagues.

The average person has up to 150,000 scalp hairs, and 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 a combination of certain illnesses, medications, dietary changes, stress, hormonal changes and other environmental and hereditary factors.

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 hairline, 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.

Atypical or dysplastic moles are generally larger than normal moles, variable in color, and have irregular borders compared to regular moles. Multiple atypical moles on the skin represent an increased risk for melanoma in that individual. When examining moles, consider the following “ABCDE” features:

  • Asymmetry – One half of the mole does not match the other half.
  • Border irregularity –ragged, notched or blurred borders instead of smooth round borders.
  • Color – The pigmentation/color of the mole is not uniform.
  • Diameter – moles larger than a pencil eraser (6mm) are more likely to be atypical.
  • Evolution or change.  It is not common to develop moles as an adult.  Moles should not change (evolve) appearance.  New itching or bleeding is also a warning sign that a mole may be abnormal.

**Moles that meet some or all of these criteria should be checked by a dermatologist.**

A yearly exam is recommended for persons with a family or personal history of atypical moles.

It is common for unusual, new or changing moles to be biopsied for microscopic evaluation.

Basal Cell Carcinoma (BCC)  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, and is associated with chronic sun exposure. Though BCC seldom spreads to other parts of the body, it can be disfiguring if not treated early. Basal Cell cancers are curable. Treatments include surgical procedures such as excision, electrodessication and curettage, or Mohs Micrographic Surgery, as well as non-surgical options such as photodynamic therapy or topical imiquimod. The type of treatment recommended will vary depending on the location, size and type of basal cell.

Immunobullous (blistering) diseases of the skin are autoimmune disorders. Any autoimmune condition involves the immune system “attacking” its own organs or tissues by producing autoantibodies (antibodies against the self). In the skin, there are proteins that attach epidermal cells to each other and proteins that attach the epidermis to the dermis. These proteins are the glue that keeps the skin intact. When these proteins are damaged by autoantibodies, the cells separate from each other and a blister appears. The two main forms of immunobullous disease of the skin are Pemphigus and Pemphigoid.

Pemphigus presents as blistering and raw sores inside the mouth or on the skin. In some people, both locations are affected. Pemphigus is derived from the Greek word pemphix meaning bubble or blister. In Pemphigus, autoantibodies attack proteins that connect each epidermal cell to each other. There are three main types: pemphigus vulgaris, pemphigus foliaceus, and paraneoplastic pemphigus.

  • Pemphigus vulgaris most commonly occurs in people between the ages of 40-60, often of Jewish or Mediterranean descent. Pemphigus vulgaris most often affects the inside of the mouth.
  • Pemphigus foliaceus is characterized by crusty sores that often begin on the scalp, and may move to the chest, back, and face. It is not as painful as pemphigus vulgaris, and is often mis-diagnosed as dermatitis or eczema.
  • In paraneoplastic pemphigus, painful sores appear on the mouth, lips, and the esophagus. This type of pemphigus is associated with underlying cancer. Paraneoplastic pemphigus usually results in fatal destruction of lung tissue (bronchiolitis obliterans).
  • The diagnosis of any pemphigus variant relies on visual examination of skin lesions, skin biopsy which must include direct immunoflourescence examination.
  • If not treated, pemphigus can be fatal, due to overwhelming systemic infection and fluid losses through the skin. Pemphigus can cause scarring in severe cases, or when secondary infections occur.
  • The most common treatment is the administration of oral corticosteroids, usually prednisone, in conjunction with “steroid sparing” agents or immunosuppressants. These drugs quiet the immune attack so that blistering stops and sores can heal.

There are two major forms of Pemphigoid, Bullous Pemphigoid and Mucous Membrane (Cicatricial) Pemphigoid. The type of Pemphigoid one has depends on the autoantibodies that are present.

Bullous Pemphigoid (BP) is a blistering disease of the skin caused by autoantibodies directed against skin proteins that connect the epidermis and the dermis. BP causes blisters, itching and sometimes pain. The majority of patients with BP experience remission within five years of initial diagnosis, but sometimes the disorder relapses. BP can often be treated with a combination of topical steroids and non-steroidal medications, but there are cases in which treatment with oral corticosteroids or immunosuppressants is required because of more severe or widespread blistering. BP blisters usually heal without scarring. Good wound care is important to promote healing and prevent infection and scarring.

Mucous Membrane Pemphigoid (MMP or Cicatricial pemphigoid) is a blistering disease than can arise on any mucous membrane surface including the nose, mouth, eyes, esophagus, larynx, urethra and anal mucosa. Scarring commonly occurs in affected areas and spontaneous improvements and remissions are rare. The affected organs dictate what treatment should be used. Systemic steroids are generally not adequate to control progression of MMP. Dapsone is drug that can be helpful in less severe cases of MMP. Azathioprine, mycophenolate mofetil and cyclophosphamide are immunosuppressant medications that are used in severe cases of MMP. It is important to treat this condition promptly to avoid scarring. Sometimes it is difficult to make the initial diagnosis of MMP; more than one biopsy may be needed to confirm the diagnosis and implement appropriate therapy.

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 (hand and/or foot) eczema, asteatotic eczema, contact dermatitis and hypersensitivity dermatitis.

  • All types of eczema can be itchy and red; some types may weep, crack, peel or blister.
  • 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. These irritants are substances that cause burning, itch and redness. Astringents and toners, alcohol or acid-containing skin products, acidic foods, detergents, fumes and industrial chemicals are a few examples of skin irritants.
  • 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.
  • Hypersensitivity dermatitis may be caused by medications, infections/infestations, and/or allergies.
  • Changes in climate and extremes of climate (excessive heat, humidity, cold or dry air) can trigger eczema flares.
  • Pediatric eczema can be particularly distressing for parents with young children.  Identifying triggers, developing preventative strategies and quickly treating flares is especially important in kids.

TREATMENT FOR ECZEMA

  • Medical moisturizers (also known as barrier repair creams or emollients) are now available to improve skin barrier function in people with eczema and atopic dermatitis.
  • Along with moisturizers, eczema can be treated with topical corticosteroids, topical calcineurin inhibitors, ultraviolet light therapy (nbUVB) , and immunosuppressant drugs in severe cases.

Hyperhidrosis 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.
  • Primary hyperhidrosis must be distinguished from secondary hyperhidrosis. The latter form may be due to a disorder of the thyroid or pituitary gland, diabetes mellitus, tumors, gout, menopause or certain drugs, and may start at any point in life. Primary hyperhidrosis is estimated at around 1% of the population, and is more common in women.
TREATMENT FOR HYPERHIDROSIS

  • The most common treatment is aluminum chloride (hexahydrate) solution.  A 15% aluminum chloride solution or higher usually takes about a week of nightly use to stop the sweating, with one or two nightly applications per week to maintain the results.
  • Iontophoresis is often effective in patients with hand or foot hyperhidrosis who do not respond to aluminum chloride. The hand or foot is placed in a device that has two pails of water, each with a conductor. The hand or foot acts like a conductor between the positively- and negatively-charged pails. As the low current passes through the area, the minerals in the water clog the sweat glands, limiting the amount of sweat released.
  • Oral medication: There are several prescription drugs available with varying degrees of success.
  • Botulinum toxin type A (trademarked as Botox®): Injections of the botulinum toxin are used to disable the sweat glands. The effects can last from 4-9 months depending on the site of injections. The procedure has been approved by the U.S. Food and Drug Administration (FDA).

    See also Sweathelp.org     International Hyperhidrosis Society

Hyperpigmentation is darkening of the skin or nails that may be caused by sun damage, inflammation (such as acne), systemic diseases, hormonal causes (also called melasma) and skin injuries.

  • Various treatments are available for hyperpigmentation. Chemical peels can help. Topical prescription products that contain hydroquinone, tretinoin and steroids are very effective for hyperpigmentation if they are combined with aggressive sun protection behavior.
  • Sun protection with sunscreens (containing zinc oxide or titanium dioxide) AND protective clothing and hats is the most important aspect of hyperpigmentation therapy and prevention.
  • Certain laser and light treatments are also effective for hyperpigmentation.

    See how our Excel V Laser targets hyperpigmentation.

Keloid scars are large, raised scars that spread 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.

  • Surgical treatment is not always the best option, as keloids can recur and become even larger after surgery.
  • Vascular laser treatments are sometimes helpful for red, hypertrophic scars, a type of scar somewhat similar to keloids.  Injecting keloids with steroid can soften them and relieve itching.

Lichen planus is an inflammatory disease that usually affects the skin, the mouth and sometimes both. The cause of lichen planus is not known, however there are cases of lichen planus-type rashes (known as lichenoid reactions) occurring as allergic reactions to medications for high blood pressure, heart disease and arthritis.

  • Lichen planus has been reported as a complication of chronic hepatitis B and C virus infection, but it can occur for no reason and unrelated to any underlying viral condition.
  • The commonly affected sites are the buccal mucosa in the mouth (the inner lining of the cheeks) the wrist skin and the ankle skin. The rash tends to heal with prominent blue-black or brownish discoloration that can persist for a long time if not treated. Besides the typical lichen planus lesions, other varieties of the rash may occur.
  • The typical rash of lichen planus can be summarized with 5 “P’s”: Pruritic (itchy), Planar (flat surface, like a plateau), Purple, Polygonal (non-circular, straight edges) Papules (small raised skin bumps).
  • On the contrary, when lichen planus occurs inside the mouth, it looks like lacy white streaks that overly bright red oral tissues. Inside the mouth, the disease may present in the reticular form or in the erosive form. The reticular form is the more common presentation and manifests as white lacy streaks on the mucosa (known as Wickham’s striae). The lesions tend to be bilateral and are asymptomatic. The lacy streaks can also be seen on the gingiva (gums), the tongue, palate and lips.
  • Erosive lichen planus presents with red areas in the mouth or on the genital skin that are ulcerated and uncomfortable. A biopsy is necessary to differentiate lichen planus from other ulcerative conditions of the mouth.
  • Currently there is no cure for lichen planus but there are certain types of medicines used to reduce the effects of the inflammation (topical and oral steroids, hydroxychloroquine, dapsone, topical and oral immunosuppressant drugs). Lichen planus may go into a dormant state after treatment.
  • Lichen Planopilaris is the name given to lichen planus when it occurs on the scalp. Lichen Planopilaris may cause permanent, scarring hair loss (alopecia). It initially presents as a redness and scale around hair follicles. If left untreated scarring occurs and creates permanent hair loss. The treatments for lichen planopilaris are the same as those mentioned above for lichen planus.

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.
  • Excessive exposure to 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.
  • A family history of melanoma increases your risk of developing melanoma and annual full body skin checks are recommended.
  • 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.

Nails are composed primarily of keratin, a hardened protein also found in skin and hair. The nail itself consists of several different parts, including the nail plate, nail bed, matrix, lunula, cuticle and nail folds.

  • The average growth rate for nails is 0.1 mm each day; individual rates depend on age, time of year, activity level, and heredity.
  • Fingernails grow faster than toenails. Nails also grow more rapidly in the summer than in the winter.
  • Nails on a person’s dominant hand (right vs. left) grow faster, and men’s nails grow more quickly than women’s, except possibly during pregnancy and old age.
  • Nail growth is affected by internal disease, skin disorders, medications, nutritional status (vitamin, iron or protein deficiency), hormone imbalances, infections and the aging process.
  • See your dermatologist if you suspect a problem with nail growth or appearance; it can be a sign of internal disease, infection or inflammation.

Psoriasis is an immune-mediated skin disease, which can also affect the joints in some individuals. The prevalence of psoriasis in Western populations is estimated to be around 2-3%. It affects both sexes equally and occurs at all ages.

  • Psoriasis can be physically and psychosocially limiting. Depending on the severity and location of psoriasis outbreaks, individuals may also experience physical discomfort and disability. Itching and pain can interfere with self-care, walking, and sleep.
  • Psoriasis skin variants include plaque, pustular, guttate, erythrodermic and flexural psoriasis. Psoriasis can also involve or be limited to the scalp or nails. Plaques on the hands and feet can limit daily activities.
  • Psoriatic arthritis is most common in the joints of the fingers and toes but may also affect the hips, knees and spine (spondylitis). About 10-20% of people who have skin psoriasis also have psoriatic arthritis.

TREATMENT FOR PSORIASIS

  • Topical therapies for psoriasis includes moisturizers, corticosteroid creams and ointments, zinc shampoo, salicylic acid lotions and shampoos, coal tar lotions and shampoos, anthralin, a vitamin D analog called calcipotriol and tazarotene cream, a topical retinoid.
  • Ultraviolet light therapy (NbUVB phototherapy) requires 2 to 3 sessions per week for a few months, followed by maintenance sessions 2 to 4 times per month to maintain clearance. This phototherapy can be combined with topical products (coal tar, calcipotriol, topical corticosteroids or topical retinoids) or systemic retinoids (acitretin) for faster results.
  • Oral therapies for psoriasis include methotrexate (taken weekly), acitretin (taken daily) and cyclosporine (taken daily and used mainly as a “bridge drug” to long-term therapies).
  • Newer injectable agents for psoriasis, also called biologic therapies are given by subcutaneous injection, infusion or intramuscular injection. The frequency of injection or infusion depends on the drug and the severity of the psoriasis.
  • With all systemic psoriasis drugs (whether oral or injectable) tuberculosis testing (PPD and chest X-ray) must be negative before beginning therapy. Some therapies also require other blood work and monitoring prior to and during therapy.

    For more information visit the National Psoriasis Foundation website at https://www.psoriasis.org.

Rosacea is a common condition characterized by flushing and redness in the central face.

  • As rosacea progresses, other symptoms may develop such as permanent redness, red bumps (some with pus), red gritty eyes, burning and stinging, small blood vessels visible near the surface of the skin and, in some men, a bulbous nose.
  • Rosacea affects both men and women and occurs in all races, but most often in lighter-skinned individuals.
  • Triggers that cause episodes of flushing and blushing play a part in the development of rosacea such as exposure to temperature extremes, strenuous exercise, heat from sunlight, severe sunburn, stress, cold wind, moving to a warm or hot environment from a cold one.
  • There are also some foods and drinks that can trigger flushing, these include alcohol, foods high in histamine and spicy food.

There are four identified rosacea subtypes: erythematotelangiectatic, papulopustular, phymatous and ocular rosaceas. An individual may have an overlap of multiple subtypes.

  • Erythematotelangiectatic rosacea is characterized by permanent redness with a tendency to flush and blush easily, small blood vessels visible near the surface of the skin, and burning or itching sensations including sensitivity to many topical products.
  • Papulopustular rosacea is characterized by permanent redness with red bumps and pustules, all lesions that are easily confused with acne.
  • Phymatous rosacea is usually characterized by sebaceous gland enlargement on the nose.
  • Ocular rosacea is characterized by red, dry and irritated eyes and eyelids, as well as foreign body sensations, itching and burning of the eyes.

TREATMENT FOR ROSACEA

The treatment of rosacea is varied and depends upon the specific symptoms of each individual.  Treatment  options include topical antibiotics and topical anti-inflammatory medications, oral antibiotics, isotretinoin.

Excel V Laser treatment for the redness associated with rosacea is popular in our office



For more information visit the National Rosacea Society website at https://www.rosacea.org.

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 than other races.

Squamous cell carcinoma (SCC) is the second most common cancer of the skin. 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 actinic keratoses. While it is rare for SCC to spread to local lymph nodes and internal organs, metastasis can happen when high-risk SCC is not promptly diagnosed and treated. Squamous Cell cancers are curable. Treatments include surgical procedures such as excision, electrodessication and curettage, or Mohs Micrographic Surgery, as well as non-surgical options such as photodynamic therapy, topical imiquimod or 5-Fluorouracil cream. The type of treatment recommended will vary depending on the location and size.

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).

SMART SUN PRACTICES

  • Vitiligo is caused by a combination of autoimmune, genetic and environmental factors.
  • Vitiligo is the loss of skin color following the destruction or loss of skin melanocytes which produce melanin (pigment).
  • The onset of vitiligo is often before age 20.
  • Depigmented (white) patches of skin may grow or remain constant in size. Spontaneous repigmentation may occur.
  • Vitiligo can have a significant effect on psychological well being, especially in skin of color, because the contrast between pigmented and depigmented areas can be drastic.

TREATMENT FOR VITILIGO

  • Repigmentation therapies to remove the white patches include corticosteroids (topical and intralesional), calcineurin inhibitors, ultraviolet light, and skin “transplantation” procedures.
  • Light treatments such as narrowband ultraviolet-B light (NB-UVB) can also help.

For every wound or ulcer, there are a few standards of care that must be followed closely to ensure proper and timely healing:

  • Maintain a moist wound environment. Contrary to popular belief, it is not helpful to let a wound “dry out”. Keep an ointment like Vaseline or Aquaphor in place on a wound at all times.
  • Gently wash a wound or ulcer with water, saline or a gentle cleanser. Antibacterial cleansers are fine if they are not alcohol based. Avoid cleansers that dry out the wound.
  • Remove necrotic or infected tissue. This is called debridement. Debridement should be done by a physician or a nurse specialist. Enzymatic debridement creams are sometimes used to help remove minor amounts of necrotic tissue.
  • Infection control with antibiotics (Polysporin ointment, dilute vinegar soaks or systemic antibiotics, for example) is very important. The proper antibiotic approach for each wound should be determined by a physician.
  • Nutritional support of a wound includes eating a balance diet. Remember, the best wound care in the world cannot heal a wound if there is underlying malnourishment. For diabetics, there must be adequate caloric intake and strict control of blood glucose levels.

Diabetic ulcers are caused when the foot skin looses sensitivity (peripheral neuropathy) or when the skin circulation is impaired (ischemia). Peripheral neuropathy can lead to wounds that a diabetic person can’t feel. There is no cure for loss of sensitivity in the feet, but careful glucose control can prevent progression. Peripheral neuropathy can cause skin ulcers and also infection of the underlying bone (osteomyelitis), which can eventually lead to lower limb amputation if, in addition, the circulation in the feet and legs is poor.

  • Prevention of diabetic ulcers is crucial.
  • Close control of blood glucose level.
  • Maintain proper body weight.
  • Avoid smoking, it damages the circulation in the feet.
  • Foot inspection should be performed daily.
  • Wear comfortable well-fitting shoes.
  • Regular washing and thorough drying of the feet (between toes!) is encouraged.
  • Sensory neurological examination should be performed to monitor sensation.
  • Nails should be kept trimmed; cutting them too short should be avoided.
  • Avoid weight bearing on a diabetic foot ulcer. Weight bearing relief can come from the use of contact casts, shoe inserts, special shoes, and even crutches.
  • Referral to a specialist in foot shoes may be recommended by your physician.
  • Bed rest or foot elevation during the day may be required to keep pressure off the foot, heels, ankles and toes.
  • Off-loading (relief of pressure) is the most important aspect of treating diabetic foot ulcers. Special fitting shoes and casting of the ulcerated foot are helpful.
  • Not taking a diabetic ulcer seriously early may lead to amputation later.

Venous Ulcers are one of the most common forms of leg ulcers. Small valves that normally prevent blood from pooling in the legs become damaged. As a result, the legs swell. This swelling can eventually cause breaks in the skin that lead to ulceration. Compression therapy is the most important aspect of venous ulcer therapy Unna Boots or other compression bandages can be helpful to heal venous ulcers. Long-term use of compression stockings is recommended after a venous ulcer has healed to prevent recurrences.

Pressure ulcers arise when pressure inhibits blood flow to the skin (ischemia). The pressure is usually over a bony prominence like the side of the foot, an ankle or the sacrum (lower back bones). A bedsore is an example of a pressure ulcer. With prolonged pressure (sometimes even a few minutes), the skin changes to red, blue or black, signifying destruction of skin cells over the bony area. Pressure ulcerations are usually very painful. On the feet and legs, pain is worse when the leg is elevated, and this type of pain is often relieved by dangling the foot over a bedside. Off-loading all pressure and strict prevention of secondary infections are the most important aspects of pressure ulcer therapy. Special fitting shoes, casting and frequent turning of a bedridden person can prevent bedsores (decubitus ulcers) or other pressure induced ulcers.