Todays online dermatologist questions

Typical Online Dermatologist Questions during a day

PIGMENT NEVUS

Online Dermatologist Question

Dear Doctor, Please review photos of theses two moles. They are large moles on the back with slightly irregular edge. Patient is not clear on history as finds difficult to observe them as they are on the back. He noted some itching on the back but not clear on location. He likes spending time on the sun. There are some seborrheic warts nearby. there are 2 large over 6mm moles on the left/ There was no bleeding or rapid growth observed. I can send photo of the back if preferable Your sincerely Dr Petrenko

Received 2018-05-02 11:25
Given answer 2018-05-02 11:56

Online Dermatologist Answer
Dear colleague, thank you for sending your case. Based on the information and images, both look like benign PIGMENTNEVUS. Dermoscopy shows benign pigment networks with some slight irritation in the left mole probably due to itching. However, the patient should of course continue to keep an eye on these moles regarding any growth or other changes in the future.

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FORDYCE SPOTS

Online Dermatologist Question

Bumps/Rash/genital warts on both sides of shaft of penis and some on head of penis. I was seen by 2 NPs who were concerned for HPV and a PA who was convinced it was not HPV or sexually transmitted. PA thought it looked like fordyce spots but was confused by how the bumps were clustered. I tried coconut oil because I originally thought it was dry skin- no improvement. Bumps have been there for at least a year. No itchiness. Have been with the same sexual partner for the last 8 months. Have not had a definitive answer and was given a referral to see a dermatologist.

Received 2018-05-02 15:20
Given answer 2018-05-02 15:23

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images, these look like FORDYCE SPOTS. Fordyce Spots are small (1–5mm), slightly elevated yellowish or white papules that typically appear on the border of the lips, inside the mouth, or on the foreskin, shaft and/or glans of the penis. The bumps are usually painless. They usually appear in clusters and are thought to be normal sebaceous glands (oil glands). It is believed that Fordyce Spots are present at birth but it is not until puberty that they start to grow and become apparent. Although they affect as much as 80-95 percent of adult population, Fordyce Spots are not associated with any medical condition, are non-contagious, and require no treatment unless they are of cosmetic concern. If they grow, spread or become painful you should see a dermatologist for evaluation. I hope this has been helpful.

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SOLAR LENTIGO

Online Dermatologist Question

I want to remove the spots on my skin and have a sunscreen suitable for my skin

Received 2018-05-02 16:13
Given answer 2018-05-02 17:33

Online Dermatologist Answer
Thank you for submitting you case. Based on the information and photos you submitted this appears to be Solar Lentigo. Solar Lentigo is a harmless patch of darkened skin. It results from exposure to ultraviolet (UV) radiation, which causes local hyperpigmentation. Solar lentigos are also known as an “old age spot” or “senile freckle”. A solar lentigo is a flat, well-circumscribed patch. It can be round, oval or irregular in shape. Color varies from skin-colored, tan to dark brown or black, and size varies from a few millimetres to several centimetres in diameter. They can be slightly scaly. Solar lentigo are found as groups of similar lesions on sun-exposed sites, particularly the face or the back of hands. They occur in light and dark skin, but tend to be more numerous in fair-skinned individuals. Solar lentigo is often diagnosed on its clinical appearance. If left untreated, solar lentigo will most likely persist indefinitely. Cryotherapy and laser surgery can destroy them, but treatment may leave a temporary or permanent white or dark mark. Bleaching agents such as Hydroquinone are not effective. The best treatment option is to have a chemical peel from a Dermatologist (ie 50% TCA). I hope I have been of assistance.

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ROSACEA

Online Dermatologist Question

Last year after my 34 birthday I developed what I thought was a pimple on my forehead and right cheek. Close to the beginning of the year. Neither went away and grew in size. About six months ago it spread across my chin. It’s ugly and causes me great insecurity as I have never had skin issues before. I live in the mountains of Colorado at 10000 feet. I am healthy and drink lots of water and eat a vegetarian diet. Please help.

Received 2018-05-02 19:33
Given answer 2018-05-02 19:40

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images, this looks like ROSACEA. Rosacea is an inflammatory and non-contagious skin condition that is common in both men and women which usually appears after the age of 25. Small red lesions/spots can appear in the central part of the face (cheeks, nose and forehead). Flushing is also common. Sometimes a slight burning sensation or itching is felt with symptoms that can come and go. At times the condition gets worse due to different factors which vary greatly between individuals (eg, sun exposure, sudden temperature changes, spicy foods, alcohol, etc). This can be treated with different creams (for example Soolantra,Metronidazole or Azelaic acid) and/or oral antibiotics such as doxycycline. I recommend that you see a dermatologist to discuss these options as they require prescription. You can also discuss other laser treatments that can help to reduce the redness (v-beam). In the meantime, I recommend cerave hydrating cleanser twice daily (over the counter). I hope you have found this helpful.

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URTICARIA or HIVES

Online Dermatologist Question

My daughter has horrible hives all over her body. We have considered everything and went to the primary doctor last night. The prescribed prednisolone and it’s not working. Any ideas?

Received 2018-05-02 21:19
Given answer 2018-05-02 21:29

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images, this is possibly an URTICARIA: Urticaria or “Hives” is commonly caused by medication, infection, heat, cold, pressure on the skin or an external irritant for example. This results in the release of the substance histamine in the skin, which causes local inflammation with swelling and gives rise to itching or burning, raised, red skin lesions known as wheals. These lesions have a tendency to move around and disappear within 24 hours only to appear again in other places. Over-the-counter antihistamine pills (e.g. Desloratadine 5 mg, one to four daily) are recommended to alleviate itching. Most often this will pass within a matter of days or weeks. If no improvement or if it spreads see a dermatologist in person for a new evaluation and testing. The condition is considered chronic hives if the welts appear for more than six weeks and recur frequently over months or years. Often, the cause of chronic hives is not clear. The drug omalizumab (Xolair) is very effective against a type of difficult-to-treat chronic hives. It’s an injectable medicine that’s usually given once a month. I hope I was to your assistance. Kind regards.

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CONFLUENT AND RETICULATED PAPILLOMATOSIS

Online Dermatologist Question

I got this rash about a month ago. It was about a quarter of the size at first. Noticed after a run and it was really itchy. After a few days it didn’t go away so I went to the doctor. They thought it was contact dermatitis and prescribed clobetasol propionate. I used for the past month and it helped with some itching and the rash went a way a little in some areas but kept reactivating right near the original rash. I went back to the doctor yesterday and he thought it was hsv-1. Prescribed valacyclovir and acyclovir ointment. I took both medications yesterday and this is The rash today. It was about a third this size yesterday morning. I didn’t use the clobetasol yesterday but I’ve missed a couple days here and there of that and the rash never got much worse.

Received 2018-05-02 21:54
Given answer 2018-05-02 22:26

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images, this looks like CONFLUENT AND RETICULATED PAPILLOMATOSIS. This may also represent pityriasis versicolor. Confluent and Reticulated Papillomatosis (CARP for short) is a chronic, non contagious condition that presents with brownish grey, hyperkeratotic (scaly) bumps on the trunk including chest and back, sometimes extending onto the abdomen. The cause of this condition is unknown. CARP can be treated with prescription medications such as oral minocycline and/or topical tretinoin. Unfortunately, there are no effective over the counter treatments. If you desire treatment for this condition, I recommend you see a dermatologist for prescriptions with the above treatment options. As mentioned, this may also represent pityriasis versicolor. I hope this has been helpful.

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Cystic acne

Online Dermatologist Question

isotretinoin is the only cream I have used to help my skins helps with my acne and my acne scars …when I use it my face is so clear but when I do t use it breaks out n then scars appear then never leave

Received 2018-05-03 00:56
Given answer 2018-05-03 05:04

Online Dermatologist Answer
Thanks for submitting your case. Based on the information provided and the photographs it appears that you have cystic acne. Cystic acne is severe acne that can affect people of all ages, not just teenagers. A lot of women in their 20s and 30s suffer from this condition. Sometimes it can be linked with a hormonal condition called PCOS, but usually hormone levels are normal in most patients. There are various options for treatment and I suggest you see a dermatologist in person to talk them through. Low dose oral isotretinoin can be an excellent option for many people, but cannot be taken if you are pregnant or planning to get pregnant in the next 6 months. Other options include the birth control pill, and a drug called spironolactone. Usually creams alone are not enough to control cystic acne which is scarring. I suggest you arrange to see a dermatologist. Best wishes

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GENITAL WARTS

Online Dermatologist Question

It itches and bleeds frequently. I’m not sure how it got on my behind but I have only ever been to bed with women. I’ve had it for about three years. I believe it is getting bigger now.. thank you very much.

Received 2018-05-03 12:17
Given answer 2018-05-03 12:41

Online Dermatologist Answer
Thank you for using our internet service and sending your case. Based on the information and the (blurred, un-focused) images of your genital lesion, I can’t rule out that the skin lesion possibly is a CONDYLOMA, commonly referred to as GENITAL WART. This disease is one of the most common sexually transmitted infections. The disease is caused by a virus called Human Papilloma Virus (HPV) and can cause harmless warts in any part of the genital area. Most have no physical discomfort from the warts, however you may experience itching, burning or a small bleeding during intercourse. The virus infects through sexual contact and the infection may be transmitted even when there are no visible symptoms. It usually takes a few weeks from infection until the warts start to develop, but sometimes the virus can lie resting in the body for months or years. To avoid further spread of the virus, condom use during sexual intercourse is strongly recommended. Genital warts can be treated in many ways. A common technique is to have them removed by freezing with liquid nitrogen. I recommend that you see a dermatologist or a visit to a STI-clinic to confirm (or rule out) the diagnosis, to exclude any other venereal disease and to discuss the most appropriate treatment option in your particular case.

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SEBORRHEIC KERATOSIS

Online Dermatologist Question

Patient has had lesion for 3-4 months Knocked top off and bled and does bleed 1.5cm diameter and no previous treatment

Received 2018-05-03 12:00
Given answer 2018-05-03 12:34

Online Dermatologist Answer
Dear colleague, Thank you for using our service and sending your case. Based on the information and images of this scalp lesion it could be an inflamed SEBORRHEIC KERATOSIS, but I can’t exclude a BASAL CELL CARCINOMA. Therefore, I recommend a biopsy and/or a referral to a dermatologist in order to confirm (or rule) out the diagnosis and discuss the most appropriate treatment option in this particular case.

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ATOPIC DERMATITIS

Online Dermatologist Question

Our son started getting rosy cheeks in the fall when the winter got colder and it never really cleared up. It has been various stages of ok to bad but has never fully resolved. We tried various creams and ointments (borage oil, coconut oil, hydrocortisone, etc.), all with various degrees of impact and only effective if applied 4-5 times per day. Now that he is outside again more and in the cold and wind, it is back in full effect and looks more scaly and feels incredibly dry to the touch. He is allergic to penicillin and had a reaction last Christmas 2018 to it, not sure that’s at all related or relevant but thought I would mention it. Otherwise no known allergies.

Received 2018-05-03 11:33
Given answer 2018-05-03 12:25

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images of your son´s cheek, this is possibly a ATOPIC DERMATITIS: Also called atopic eczema is very common in children but can persist into adulthood in some cases.This condition causes itchy inflammation of the skin with red, dry patches which sometimes lead to cracking of the skin. In some cases, multiple small blisters can appear. Bacterial infections can also worsen the problem. At-home treatment options include: avoiding substances that may be irritants (e.g. excessive showering/bathing), applying over-the-counter 1% hydrocortisone cream (twice daily for a week, then once daily for another week and then every other day for 2 weeks) plus frequent application of a moisturizing cream. If it doesn’t improve with hydrocortisone you can see a dermatologist in person since more potent steroid creams requiring a prescription may be needed. Tacrolimus creme can also be very effective on atopic dermatitis but it requires prescription as well. I hope this was to your help. Kind regards.

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PERIORAL DERMATITIS

Online Dermatologist Question

I’ve had it for 10+ weeks now, I’ve been to the doctors a few times and first they prescribed fucidin cream, this didn’t work then they gave me trimovate cream, this seemed to improve it slightly but not clear it up, then they gave me aciclovir cream that I only used for a couple of days but it made it worse now they’ve given me aciclovir tablets that I finish today and it’s more sore than it was and spreading further. Please could I have some advice. Thanks

Received 2018-05-03 09:38
Given answer 2018-05-03 10:23

Online Dermatologist Answer
Thank you for sending your case. Based on the information and images of your face, this is possibly PERIORAL DERMATITIS: A variety of causes of Perioral Dermatitis have been proposed, including exposure to topical corticosteroids and/or fluoride in water and toothpaste, but the cause is unknown. Is a rash that normally occurs around the mouth. The eruption classically starts at the nasolabial folds and spreads periorally, sparing a zone around the vermilion border of the lips but sometimes it´s only localized on one side as in your case. Perioral dermatitis treatment is to stop fluorinated dental products and topical corticosteroids (if being used) and then use topical antibiotics (eg, Erythromycin 2% or Metronidazole 0.75% gel or cream twice daily) or oral Tetracycline 250 to 500 mg twice daily (between meals) for 4-6 wk.

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