FAQ, Questions and Answers

Listed below are some commonly asked questions along with their answers.  If you have further questions, please feel free to contact DeVore Dermatology and we'll be happy to assist you.

Q.   My child was born with a dark congenital nevus that the pediatrician is following.  I have been told different things concerning the possibility of melanoma developing in this lesion.  Could you elaborate?
Small congenital nevi or pigmented birthmarks are fairly common and usually of minimal medical significance.  As with any mole it needs to be followed by an astute parent, patient, and/or physician for signs of changing in size, color, or shape other than what may be a gradual increasing with the child as he grows.  The primary congenital nevi of concern are extremely large and generally referred to as bathing suit nevi.  These are rare, but do seem to have a definite link to melanoma.  Again, close follow-up with your pediatrician and dermatologist would be suggested.

Q.   I am on birth control pills and my dermatologist has recently recommended antibiotics, specifically tetracycline, for my acne.  Does this make my birth control pill less effective?
There have been reports of women getting pregnant on the combination birth control pills and antibiotics; however, they've been few and far between.  When one considers the number of women on birth control pills worldwide, who at some point or another are on antibiotics for one thing or another, the number of birth control failures presumably secondary to antibiotics is extremely low.  In fact, the birth control pill itself is only 97% effective as a contraceptive.  In general, if one can accept a 97% effective birth control pill, I do not believe there is a significant reduction in this number on the combination birth control pills and antibiotics.

Q.   I have been told I have rosacea and I have been online and am very concerned about the development of an enlarged nose from this condition.  Is this always an end result?
Like all diseases, rosacea has different forms and severities.  The end stage, enlarged, bulbous nose, a condition known as rhinophyma, is not the natural progression of all rosacea patients and is definitely more common in men than women.  However, rosacea is a chronic condition that in many people needs to be treated long term to minimize further progression.

Q.   I had a baby 5-6 months ago and have just recently started to lose a lot of hair.  My doctor tells me this is normal.  Is this so?
It sounds like you have classic telogen effluvium which is the accelerated loss of hair that is already in resting phase, usually following some type of stress such as labor & delivery, general anesthesia, high fever, or extreme stress.  Unlike hair loss that follows the beginning of chemotherapy, there is often a delay of 3-5 months before it begins.  Be assured this hair loss is usually reversible.

Q.   I have been told that I have hives.  I have seen many physicians including my family doctor, allergist, and dermatologist and no one seems to be able to tell me what the cause is.  Is that common?
Unfortunately, 97% of the time, hives are what we call "idiopathic", meaning we have no known cause.  Certainly when hives are acute and last less than 2 months, if no changes in an individual's life style, medications, or general health are detected, it is hoped that the hives will be self limited.  The hives are treated symptomatically, generally with antihistamines.  When hives go on for many months and it is difficult to get symptomatic relief, often the opinions of many doctors and specialists are obtained and it becomes a very frustrating condition both for the patient and for the physician.  Certainly, a more thorough, systemic evaluation may be in order, but again fortunately nothing serious is usually found to account for the hives.  Rarely individuals may suffer with hives for a year or more.

Q.   Are tanning beds a safe way to tan?
There is no such thing as a safe tan unless it is an artificial tan that comes out of a bottle.  The UVA light that is used in tanning beds actually is able to penetrate the epidermis and dermis to a deeper level than UVB light.  Although it may be more difficult to get a UVA sunburn than it is to get a UVB sunburn, it is certainly thought that UVA contributes significantly to the aging process and can also be carcinogenic.

Q.   How high of an SPF number do I need in my sunscreen, and isn’t anything over SPF 15 unnecessary?
The sun protection factor (SPF) is a relative value for the amount of time an individual can stay in the sun before he turns red.  For the average skin type with average sun exposure (whatever average really is) the daily application of an SPF 15 or greater sunscreen is probably adequate.  However, for those individuals who work outdoors, are on photosensitizing medications, have photosensitizing diseases like lupus or porphyria, have had a history of skin cancer, or just are extremely fair and burn and never tan certainly higher SPF values can be beneficial.  One should be aware that sunscreen is not a complete sun block and people will tan even with sunscreen on.

Q.   What causes acne?  Isn’t it the result of different foods like fried foods and chocolate or not drinking enough water and not practicing certrain daily skin care routines?
Acne is caused by a number of factors including bacteria, hormones, excessive plugging of the skin, and may have a hereditary or genetic basis.  It does not in general appear to be diet or hydration related.  Because it is multi-factorial, there is no one single approach to treating acne, nor one acne routine that works in every individual.  There are very good over-the-counter products available, particularly in the benzoyl peroxide line, but when these products are not effective in controlling an individuals’ acne, they may want to seek a medical opinion.

Q.   What are age spots and is there anything that can be done about them?
What are commonly called “age spots” or “liver spots” are actually actinic or solar lentigos.  They are caused by prolonged, chronic exposure to the sun and most commonly occur on sun exposed areas like the face and dorsal hands and forearms.  Although they are harmless, they can be unsightly and can be lightened or removed with bleaching creams, Retin-A, chemical peels, cryosurgery, and laser.  You should see your dermatologist to consider which method is best for you.

Q.   Can makeup actually block pores and cause acne, and is there any makeup that is actually good for the skin?
Most cosmetic companies test their facial products to make sure that they do not block pores, and their products are generally labeled “non-comedogenic” or “non-acnegenic”, however; some products can be irritating to the skin, and yes, block pores, especially theatrical makeups.  There are new lines of makeups that are mineral makeups, like Jane Iredale, that are considered the skin care makeups.  They do not block pores, they have no chemicals, preservatives, or fragrances, and some of the minerals themselves actually have anti-inflammatory properties that may be good for the skin and act as physical sunscreens. 

Q.   I have lots of broken red and purple blood vessels, particularly around my nose, that I find unsightly.  Is there anything that can be done for this?
The most effective way to treat large, dilated, telangiectatic blood vessels on the face is with a laser.  This is generally well tolerated, effective with one or two treatments, causes no unsightliness or down time, and does not scar.  Occasionally electrosurgery can also be used to treat smaller blood vessels.  Sclerotherapy, or the injection of substances into the veins causing them to clot off and scar down, is generally reserved for the bigger blood vessels on the lower extremities.

Q.   I have recently been hearing a lot about the use of lasers and heat for collagen stimulation and the reduction of fine wrinkles.  Can you elaborate on this?
Yes, laser technology usually uses light and its’ selective absorption by various colored materials to produce its effects.  However, the heat that is produced by laser can be used to subtly stimulate the collagen to thicken and increase.  This is basically the mechanism that happens when collagen is stimulated to replace itself and heal an injury in the form of a scar.  With repeated treatments of a laser with its thermal energy, this collagen can microscopically be shown to plump up and be increased which tightens the skin texture and tone and reduces fine wrinkling.

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