Board Certified Dermatologists - Dr. Rothfeld

Tar

What is tar and how does it work?

Tar used for medicinal purposes is derived from both coal and wood (e.g., juniper, pine). However, coal tar is the type used most commonly to treat psoriasis. Tar can help slow the rapid proliferation of skin cells and restore the skin's appearance. In addition, tar can help reduce the inflammation, itching and scaling of psoriasis.

How well does tar work?

Patients may see improvement within a couple of weeks of starting tar treatment, but it may take up to eight weeks to see the maximum benefit.

The best candidates for use of tar as a primary treatment are people with limited psoriasis or those with well-defined lesions.

When reading labels on tar products, including shampoos, keep in mind that generally the higher the concentration of tar, the more potent the product. Also remember that the greater the concentration of tar, the greater the odor and mess the product may cause.

How do you apply tar to the skin?

Tar can be applied directly to the psoriasis lesion, added to bath water or applied to the scalp. Follow the directions supplied on the tar medication or the instructions from your doctor. Tar medications are generally left on the skin for at least two hours.

Apply tar medications in the same direction the hair grows. Applying against the direction of hair growth can cause inflammation and pimple-like eruptions at the base of the hair follicles. This is called folliculitis.

Tar can stain clothing and bed linen. To help reduce staining, allow the medication to air dry on the skin before covering it with clothing.

Tar shampoos

Tar is sold in special shampoo formulations to treat scalp psoriasis. Medicated tar shampoo is normally left on the scalp for five to 10 minutes before being rinsed out, to allow the shampoo to penetrate the scales. If scaling is sufficiently heavy, pretreatment with a scale remover (known as a keratolytic) may help the tar shampoo better penetrate the lesions.

The tar shampoo can be followed by a more cosmetically pleasing shampoo or conditioner. Tar shampoos should primarily be considered a medication, rather than a hair cleanser.

Tar can stain bleached, light blond and gray hair. Because tar gels usually cause less staining, they may be a good alternative to other forms of tar products for people with light-colored hair.

Tar in the bath

Tar solutions can be added to bath water for a 15- to 30-minute soak. Tar bath solutions are generally considered ineffective at clearing psoriasis lesions, but they can reduce itching and scaling.

Side effects of using tar

Tar can irritate and redden the skin. Test a tar product on a small area of the skin first. If reddening occurs, try applying the tar on top of a moisturizer. Or, have a pharmacist mix 5%, 10% or 20% Liquor Carbonis Detergens (LCD), a prescription coal tar, with Aquaphor, an OTC moisturizing agent.

It may be more difficult to find OTC tar medications in California, due to state guidelines regarding tar products. As of January 2002, California requires OTC coal tar shampoos, lotions and creams that contain more than 0.5% coal tar to be labeled with cancer warnings. As a result, some companies have stopped selling their products in California or replaced coal tar with another active ingredient. However, the U.S. Food and Drug Administration (FDA) maintains that OTC products with coal tar concentrations between 0.5% and 5% are safe and effective for psoriasis and that no scientific evidence suggests that the coal tar in OTC products is carcinogenic.

Studies show some of the chemicals in coal tar may cause cancer, but only in very high concentrations, such as in coal tar used in industrial paving. Anyone using tar regularly should be aware of the signs of skin cancer and have a dermatologist recommend a skin cancer checkup schedule.

Using tar with other treatments

The Goeckerman regimen

In 1925, William H. Goeckerman, M.D., at the Mayo Clinic, proved the benefit of combining tar with ultraviolet light B (UVB) phototherapy to treat psoriasis. The combination of intensive tar and UVB treatment was named after him, and it remains a very effective treatment for severe psoriasis.

Used in a hospital or day treatment program, the Goeckerman regimen usually requires three or four weeks of treatment. It will clear psoriasis in more than 90 percent of people and can produce a lengthy remission, ranging from a few months to a year or more, depending on the individual case of psoriasis.

However, the use of this regimen has declined substantially as new and effective systemic treatments have been developed. Also, health insurance companies tend to view the energy- and time-intensive Goeckerman regimen as a less cost-effective treatment.

Day treatment programs are one alternate approach still available in a few cities around the United States. While in a day treatment program, the individual receives intensive light and tar treatments but returns home or to a temporary residence in the evening.

Also, less involved forms of the Goeckerman regimen, referred to as modified Goeckerman, are provided in a doctor's office. In these instances, a doctor may direct the patient to apply the tar at home and then come into the office or clinic for the light treatment. Tar is applied to the skin about two hours prior to exposure to UVB, then wiped off before UVB exposure.

Using low doses of UVB, a person will generally start out with a 30-second to 1-minute dose of light. These dose times are gradually increased until the psoriasis lesions clear or reach maximum improvement.

Tar can be combined with home phototherapy. However, given the possible risk of severe burning, a doctor must be consulted in devising a home-care regimen that combines tar and UVB.

For more information, see phototherapy.

What about tar and sun?

The light-sensitizing properties of tar make natural sunlight and tar a potentially dangerous combination. Be sure to use sunscreen and monitor your sun exposure to avoid a sunburn. Natural sunlight by itself can be helpful for psoriasis, but some dermatologists recommend completely avoiding sun exposure of tar-treated skin. Wash tar off thoroughly if your skin is going to be exposed to the sun. Be aware that tar remains active on the skin for at least 24 hours, and the increased risk of burning continues throughout this active period.

Talk to your doctor if you are interested in developing a carefully controlled treatment regimen that combines natural sunlight and tar. Together, you may be able to devise a sensible plan that utilizes the benefits of both while limiting the potential dangers.

Other considerations

For heavy applications of tar medication, occlusion with clothing such as pajamas or warm-up suits may help hold the medication in place and prevent staining of bedding and furniture. Cotton athletic socks can be helpful in covering arm or leg lesions. The toe of the sock can be cut away, and the sock pulled onto the limb to cover the medication. These kinds of wraps can be washed easily.

Occlusion of tar preparations on the scalp may be recommended to enhance the treatment's effectiveness. However, airtight occlusion of tar should be avoided, such as with plastic wrap, because it increases the risk of infection and folliculitis. Occlusion with products that breathe (cotton clothing, for example) may not cause infection or folliculitis.

Tar, particularly some tar gels and lotions that contain alcohol, can also dry the skin. To avoid its drying effects, mix with a moisturizer or an emollient. Apply the emollient in a thin layer over the tar to keep the skin well-lubricated.

Coal tar contains more than 10,000 ingredients, and only about 50 percent have been identified. Therefore, coal tar products can vary dramatically from brand to brand.

Yaz (drospirenone / ethinyl estradiol)

YAZ^® is one-of-a-kind

No two women are the same. But most women are alike in that they want to get on with the business of their lives. And they want to choose a birth control method that works with their lifestyle.

YAZ (drospirenone and ethinyl estradiol) is a combination birth control pill, the kind doctors prescribe most. Combination pills contain two types of hormones: an estrogen and a progestin. Most combination pills are low-dose, meaning they contain .035 milligrams (mg) or less of estrogen. Low doses of estrogen have been proven to be just as effective as high doses in preventing pregnancy and have the added benefit of reducing potential side effects. Since most low-dose combination pills have the same estrogen, the main difference between one brand and another is usually the progestin.

YAZ is unlike other birth control pills because:

It's the only birth control pill that's also approved by the FDA to treat emotional and physical premenstrual symptoms that are severe enough to impact the lives of women who choose the Pill for contraception. It's also proven to help treat moderate acne.

And it's the only 24/4-day pill with the unique hormone, drsp^®.

How YAZ^® works

YAZ (drospirenone and ethinyl estradiol), a combination pill, contains two types of hormones: an estrogen and a progestin. Combination pills are the type of birth control pills most commonly prescribed by healthcare professionals. They work in two ways:

• The body is "tricked" into thinking it is pregnant. This prevents the release of an egg (ovulation). Without an egg to be fertilized, you can't become pregnant.
• The cervical mucus is thickened, making it hard for sperm to travel toward the egg and fertilize it, in case an egg is released.

Beyond contraception, YAZ also has other benefits.

• YAZ is the only birth control pill that's also approved by the FDA to treat emotional and physical premenstrual symptoms that are severe enough to impact your life, for women who choose the Pill for contraception.
• Not only is YAZ less likely to upset your skin, it is also proven to help treat moderate acne.¹ Nearly all birth control pills are made up of a combination of estrogen and progestin hormones. The progestin in YAZ actually blocks the male sex hormones (androgens) that cause acne.²
• A 24/4-Day Design: YAZ has a 24/4-day dosing schedule, meaning that with YAZ, you take active (hormone) pills for 24 days and inactive (sugar or placebo) pills for four days. Taking active pills for three additional days, versus the traditional 21/7-day regimen, helps your hormone levels stay even. To learn more about what three additional days of active pills may mean for you, please consult your healthcare professional.
• The unique hormone, drsp^®. While most estrogens are the same, YAZ contains the progestin drsp, or drospirenone (pronounced dros-peer-eh-known). While other combination pills have a progestin made from the male hormone testosterone, the drsp in YAZ is an analogue of the aldosterone antagonistspironolactone and exhibits mild antimineralocorticoid properties, similar to natural progesterone. Ask your healthcare professional about the unique properties of drsp.

YAZ contains a different kind of hormone, drsp, which may increase potassium. Therefore, you should not take YAZ if you have kidney, liver, or adrenal disease, because this could cause serious heart and health problems. Tell your doctor if you are on daily long-term treatment for a chronic condition such as cardiovascular disease or chronic inflammatory disease. Women who take certain drugs (see Safety Information) should have their potassium level checked in the first month of taking YAZ.

Botulinum Toxin (Botox): Cosmetic

Botulinum toxin is a medication that is injected into the muscles beneath the skin to improve the appearance of fine lines and wrinkles. “Botox” is the brand name for a type of botulinum toxin.

Botulinum toxin is a safe, non-surgical alternative to other anti-aging treatments. A treatment takes only a few minutes in a doctor’s office.

Botulinum toxin weakens the muscle into which it is injected. When a muscle normally contracts, such as when someone squints or frowns, it causes the skin above to crease. A botulinum toxin-weakened muscle leaves the skin smoother and less prone to wrinkling. The lines that result from frequent muscle contractions gradually fade, and in some cases, disappear.

Botulinum toxin is frequently used for the following:

• Frown lines between the eyebrows
• Horizontal forehead creases
• Crow's feet around the eyes
• Lines on the upper lip caused by pursing the lips
• Downturned corners of the mouth
• Neck wrinkles and bands

Your doctor will determine where to inject and how much medication to use. Following treatment, you will see start seeing results in about 3-5 days, with peak results in 7-10 days.

Over a period of 3-5 months, the botulinum toxin slowly wears off, and the affected muscles regain their ability to contract fully. Repeat injections are performed when muscle function returns.

Side effects of botulinum toxin injections include minor discomfort, redness, and occasional bruising at the injection site. These usually resolve in a few hours to a few days. Rarely, temporary drooping of an eyebrow may occur. This usually resolves after a few weeks.

You may wish to discuss potential side effects with your doctor.

Although botulinum toxin has been FDA-approved and used safely for fine wrinkles, the treatment has received some bad press due to occasional poor outcomes or dangerous results. Keep in mind that these unfortunate events were primarily due to the medication’s use by unqualified individuals (non-physicians) or the use of a non-FDA approved source of botulinum toxin. Tell your doctor if you have any concerns about receiving botulinum toxin treatments.

This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

Seborrheic Dermatitis

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Seborrheic dermatitis is a very common, scaling rash that tends to occur in areas where the skin is oily. Commonly affected areas include the scalp (dandruff), eyebrows, eyelids (blepharitis), ears, nasal folds, armpits, and groin. It is a chronic condition that can appear any time after puberty, fluctuates in severity, and may persist indefinitely.

It is believed that seborrheic dermatitis is caused by an overabundance of a normally harmless skin yeast (malassezia). The yeast produces toxic substances that irritate the skin and make it itch. Stress and physical illness can lower an individual’s resistance to the yeast.

Seborrheic dermatitis is not contagious, but it appears to run in families.

On the scalp, seborrheic dermatitis appears as dry pink or flesh-colored patches with a yellow scaly surface. The patches may spread to the entire scalp.

Infantile seborrheic dermatitis (“cradle cap”), seen in babies up to 6 months of age, is thought to possibly be the same condition. The scalp, armpits, and groin are typically affected.

Treatment options for seborrheic dermatitis include topical steroids, tar cream, and antifungal agents, often in the form of medicated shampoos. Cradle cap can be treated by using daily shampoos with a gentle cleanser and massage with mineral oil. Cases that do not resolve at times require a prescription topical medication.

NYC Dermatologist

Allergy: Latex

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What is a latex allergy?

Latex is a rubbery material used to make toys, exam gloves, surgical tubing, condoms, and other everyday items. It is made from the sap of a rubber tree and contains naturally occurring proteins that some people are allergic to. If you have a latex allergy, your body mistakes latex for a harmful substance.

Latex allergy may cause reactions ranging from sneezing or a runny nose to anaphylaxis, a potentially life-threatening condition. Your doctor can help determine if you have a latex allergy or if you're at risk of developing one.

The best way to avoid an allergic reaction is to know the common sources of latex and the allergic symptoms to watch for.

What are the most common products containing latex?

Common household items containing latex include:

• Dishwashing gloves
• Carpeting
• Elastic waistbands
• Balloons
• Rubber toys
• Hot water bottles
• Baby bottle nipples
• Disposable diapers
• Sanitary pads
• Rubber bands
• Erasers
• Condoms
• Diaphragms
• Swim goggle straps
• Racket handles and bicycle handgrips

In health care settings, latex gloves are often used as a barrier to prevent the spread of disease, but with the rise of latex allergy, many medical staff now use non-latex gloves. However, latex can still be found in these medical products:

• Blood pressure cuffs
• Stethoscopes
• Intravenous tubing
• Syringes
• Respirators
• Electrode pads
• Surgical masks

What are the symptoms of latex allergy?

People who are allergic to latex usually have a reaction immediately after being in contact with latex (such as by wearing latex gloves). These are the most commonly reported symptoms:

• Contact dermatitis -- this is a skin rash that sometimes appears a day or two after someone has worn latex gloves
• Stuffy nose
• Cough
• Hives
• Itchy, watery eyes
• Breathing difficulty

Anaphylaxis

The most dangerous allergic reaction to latex is anaphylaxis, which can be life-threatening. Anaphylactic reactions develop immediately after latex exposure in highly sensitive people and cause the airways (bronchi) to constrict, making it difficult to breathe. Blood pressure may drop to dangerously low levels, causing the person to feel dizzy or lose consciousness. Other serious signs and symptoms include:

• Wheezing
• Confusion
• Slurred speech
• Rapid or weak pulse
• Blueness of your skin, including your lips and nail beds
• Diarrhea
• Nausea and vomiting

Seek emergency medical care if you think you're having an anaphylactic reaction.

Are some people more likely to have latex allergies?

Some people are more likely to develop a latex allergy than others. The amount of exposure to latex is a key factor in developing a latex allergy, so healthcare workers, and patients (especially children) who undergo multiple surgeries are at risk.

Genetic factors also play a role in who gets a latex allergy. People who have other allergic conditions (such as allergy-induced asthma, eczema, hives, or insect allergy) are at increased risk for developing an allergy to latex. Anyone who has experienced a reaction after eating bananas, kiwis, avocado, potatos, strawberries, peaches, or chestnuts is also more likely to develop a latex allergy.

How is latex allergy diagnosed?

Diagnosis will begin with a detailed medical history. The doctor will ask lots of questions about the nature of the reaction, where and when it occurs, etc. Since allergy may be genetic, expect some questions about other family members who may be allergic.

Once the detailed medical history is taken, skin or blood tests may be performed. Skin tests are far more common and accurate than blood tests. The doctor will make a diagnosis based on the test results, and the medical history.

How is latex allergy treated?

The only "cure" for allergy is to avoid items containing latex, if possible. Health care workers may find this to be difficult, although there are alternatives to latex gloves, such as nitrile gloves.

For non-healthcare professionals, it is important to let medical staff know about all allergic conditions during a checkup or medical procedure. This is especially important in the case of surgery.

Take these steps to avoid and manage latex allergy:

• Avoid airborne latex such as that from powdered latex gloves.
• Bring your own non-latex gloves to any medical appointment just in case your caregiver doesn’t have them.
• Check product labels. Hypoallergenic does not necessarily mean "no latex."
• Tell your health care provider about your latex allergy.
• Wear a med-alert bracelet or necklace describing your allergy just in case you ever need emergency care.
• Carry an injectable epinephrine pen (such an EpiPen, Twinject device) in case of an anaphylactic reaction.

If you do come into contact with latex and suffer a reaction, get immediate medical attention if you show symptoms of anaphylaxis. For less severe reactions, your doctor may prescribe antihistamines or recommend skin creams for uncomfortable allergic symptoms.

Can latex allergy be prevented?

The best way to prevent latex allergy is to avoid latex. Continued exposure increases your chances of developing the allergy. If you work in health care or other settings where latex products are commonly used, choose latex alternatives (such as nitrile gloves) and ask coworkers not to used powdered latex gloves (the latex mixes in with the powder, creating a dust that can be allergenic when inhaled).

Acne Scars NYC

Acne Scars

Millions of people have scars from the long-lasting inflammation caused by acne. Scars occur most frequently in those with moderate to severe acne. It remains unknown why some people develop scars when others don’t.

Many treatment options are available to diminish the scars’ appearance. Depending on the type and severity of scarring, improvement can be seen in 4 to 6 weeks.

Types of Acne Scars

• Icepick. These deep pits in the skin are a classic sign of acne scarring. They are the most common type of acne scar and usually occur on the cheek. They may be shallow or deep and may be hard or soft to the touch.
• Boxcar. These depressed, crater-like scars are larger than icepick scars.
• Rolling scars. These are curved indentations on the skin.
• Hypertrophic scars. These are elevations or areas of skin thickening. Large hypertrophic scars may be referred to as "keloids" and tend to run in families.

The recommended treatment will depend upon the type of scar being treated, your skin type, your tendency to scar, and cost. Different treatments may be combined for optimal effect.

Treatment options

Topical medications (retinoids). Some medications applied to the skin can help smooth out very superficial acne scars but may not be effective for deeper scars.

• Dermabrasion. During this procedure, the skin is cleansed, numbed, and then vigorously rubbed with a high-speed brush to remove the top layer of skin. This results in a small injury, or "abrasion," that heals over several weeks. The healing process reshapes the skin. This method is effective for superficial scars and reduces the severity of deeper scars, but it is ineffective for icepick scars. The skin may burn or feel sore and appear pink until healing is complete. The results are long-lasting. In darker-skinned people, the procedure may cause changes in skin color that require additional treatments.
• Microdermabrasion. This procedure, lasting about 10-20 minutes, uses a machine to propel small crystals through a vacuum tube onto the skin. This removes superficial layers of the skin, stimulating new skin cell growth and improving skin tone. There are few side effects and almost no recovery time, but it can only treat superficial scars. As many as six treatments may be required, 1-2 weeks apart.
• Excision and punch replacement graft. A scar, or cluster of small scars, is removed with a scalpel. The resulting "hole" is either sewn together or replaced with a patch of normal skin from elsewhere on the body. This treatment is particularly effective for ice-pick or boxcar scars.
• Subcision. The skin is made numb and a probe is inserted beneath the scar, which loosens it from the surrounding tissue. This allows the scar to be elevated to the level of the normal skin. This is used for depressed scars such as a boxed scar or rolling scar.
• Dermal fillers. Different types of “fillers” can be injected beneath a depressed scar to elevate it to the level of the surrounding skin. This treatment is most effective for rolling scars. The benefit from soft tissue fillers usually lasts 3 to 18 months, depending on the material used. Treatment must be repeated to maintain the appearance.
• Chemical peels. Chemicals are applied to the skin to remove the top layer and generate new skin growth beneath the scars. This lifts the scar to the level of the surrounding skin, minimizing its appearance. In general, "medium" or "deep" peels are used to treat acne, meaning that the peel is designed to affect the deeper layers of the skin. Deep peels may cause lightening of the skin and a change in skin texture. Bandages may be required for several days.
• Laser skin resurfacing. This removes the top portion of the scars and creates heat in the deeper layers of the skin. This heat causes the skin to tighten and smooth out the scar. The result is the smoothing out of the skin. Laser resurfacing is particularly helpful for boxcar scars and further improvement of scars treated by other methods. In some cases, only a single treatment is required; however, final results may not be seen for 12-18 months. Redness following treatment may last for several months.

If you are concerned about the appearance of acne scars, speak to your doctor about choosing an appropriate treatment for you.

Chemical Peels

Chemical Peels

During a chemical peel, chemical solutions of varying strengths are carefully brushed onto the skin. The chemicals remove skin cells on the surface of the skin and stimulate the production of new skin cells below. This leaves the skin smoother, less wrinkled, and more youthful in appearance.

Chemical peels can be used effectively for a wide range of skin conditions including:

• Fine lines and wrinkles
• Uneven pigmentation
• Shallow acne scars
• Sun-damaged skin
• Age spots
• Freckling

Chemical peeling can be performed on the face, neck, chest, hands, arms, or legs. It is most effective at changing the appearance on the surface of the skin. Effects of aging in deeper tissues, such as drooping eyelids and loose skin below the chin, must be treated with other procedures.

Chemical peels are categorized by how deeply the chemicals penetrate the skin: superficial, medium, or deep. Superficial peels use mild chemicals, such as alpha-hydroxy acids, which penetrate only the uppermost layer of the epidermis. Medium and deep peels use stronger agents.

A superficial chemical peel is usually sufficient to treat fine lines and wrinkles around the eyes and mouth. Patients with minimal skin damage often respond best to a series of superficial peels combined with a skin care regimen, including topical retinoids and daily sunscreen use.

A medium-depth peel is more effective for patients with moderate skin damage, including age spots, freckles, and actinic keratoses. It may be combined with another treatment such as laser resurfacing for maximum effectiveness.

Deeper peels may require bandages to be applied for 1-3 days following treatment. In addition, ointments and creams may be recommended to keep the skin moist. Cosmetics can be applied after about two weeks.

During treatment, most patients experience a warm sensation for about ten minutes, followed by some stinging. Anesthesia may be recommended for deep peels.

In general, the deeper the peel, the longer the recovery. A superficial peel produces redness similar to mild sunburn and lasts 3 to 5 days. Medium or deep peels can make the skin look severely burned, sometimes with blistering and peeling for 7 to 14 days. You may be prescribed pain relievers to reduce the discomfort following a deep peel.

Following a treatment, treat your skin gently. Avoid sun exposure because the renewed skin will be tender and susceptible to injury.

Following a chemical peel, your new skin will be tighter, smoother, and perhaps slightly lighter in color than before surgery.