Healthy Skin

Caring for the Skin of Our Aging Population: Skin Cancer

2011-02-14T09:58:00.001-05:00

Skin cancer is another common problem that interferes with the quality of life of aging Americans. Patients are often surprised to learn they have skin cancer, claiming they haven't been in the sun for years, however, they don't realize that it is common to have a 10-20 year delay from the time of exposure to the development of skin cancer. Another common question is “do I really need to have this examined and/or treated?” The answer is clearly "YES" as untreated cancer will continue to grow and damage nearby structures decreasing the quality of life. Furthermore, these spots can bleed and become infected and this always seems to happen at the worst time (weekends or holidays).

This leads to the next point—treatment of these cancers is also unique in this population due to underlying medical conditions and medications (like blood thinners) so it requires individuals with experience in geriatric dermatology. Specifically, less invasive methods like cryotherapy (local use of low temperatures in medical therapy or the removal of heat from a body part), curettage (the use of a small scoop to remove tissue) and desiccation (the process of extreme drying) are used in the place of aggressive surgery whenever possible. Furthermore, when surgery is performed the scope of the procedure is limited to only what is necessary.

In summary, geriatric dermatology requires a careful evaluation of all aspects of the patient and their medical history. Thus, all individuals in this population should be screened at least once per year to be sure they are not developing concerning issues. At Windsor Dermatology, our team of Board Certified dermatologists is prepared to address these issues for you and your family members. Call to make an appointment today.

Brian Robert Keegan, M.D., Ph.D, Board Certified Dermatologist - Prior to joining Windsor Dermatology, Dr. Keegan worked at the University of Miami and the Miami VA Hospital for 3 years.

Caring for the Skin of Our Aging Population: Bruising and Itching

2011-01-31T14:29:00.000-05:00

Americans are living longer than they ever have in history, thus, the geriatric population represents one of the fastest growing segments of the population. While their skin problems are not unique, there are several cutaneous problems that are more common in this population. Specifically, bruising, itching and skin cancer are much more prevalent.

Bruising is the result of multiple issues including, thinning of the skin, changes in the skin’s architecture and usage of blood thinners. Currently, it is difficult or impossible to reverse or avoid these problems so individuals should be warned to ignore products that make outrageous claims of treatment success. In addition, they should be educated on how to treat wounds when they do develop.

Itching is another common problem that can stem from multiple issues. Common culprits include: medications, underlying medical problems and dry or irritated skin. A complete assessment will entail a review of the patient’s medical issues including lab work, a review of their medications and a complete skin exam. If one is highly suspect of underlying medical issues or medications as a cause, every effort should be made to modify these factors in an attempt to stop the itch. Next, treatment options typically involve various topical medications including: emollients, steroids and menthol. If necessary, systemic medications or photo-therapy can also be helpful although care must be taken not to generate more troublesome side effects or interactions with other critical medications.

Next we will examine the difference in treating skin cancer for this age group.

Brian Robert Keegan, M.D., Ph.D, Board Certified Dermatologist - Prior to joining Windsor Dermatology, Dr. Keegan worked at the University of Miami and the Miami VA Hospital for 3 years.

More Amazing Patient Success Stories

2010-08-26T08:51:00.002-04:00

Recently, Dr. Judit O. Stenn, a key part of our team of physicians here at Windsor Dermatology, shared some amazing patient success stories. Dr. Stenn is an internationally recognized medical dermatologist and a member of the Attending Staff at the University Medical Center at Princeton. Specializing in hair-loss prevention and treatment in women, she is also Clinical Assistant Professor of Dermatology at UMDNJ-Robert Wood Johnson Medical School.

Uncovering a Hereditary Condition

The patient was a 62 year old male who with a history of basal cell carcinomas requiring yearly skin exams. He had known about biopsy-proven leiomyomas, benign smooth muscle tumors that are not premalignant, on his arms for many years. Because he disclosed information connecting hereditary renal cell carcinoma with multiple cutaneous leiomyomas, careful history was taken. We found the patient had a sister who died of renal carcinoma. Upon explaining this syndrome to him, he brought himself and his two daughters to NIH (National Institute of Health) for genetic testing. It turns out, they all carried the gene for this syndrome. The routine followup involved alternating yearly MRIs with ultrasound of the kidneys. With this careful followup on renal cell carcinomas (kidney cancer), if they develop, may be removed in time, helping to prevent a life-threatening situation.

Preparing for a High-Risk Pregnancy

The patient presented with common warts on her hands. At this time, she was 28-year-old woman and an examination of her hand found several nails showed dystrophy and triangular lunulae, the crescent-shaped whitish area of the bed of a fingernail or toenail. She also had absent patella of the knees (or kneecaps).

On questioning, she recalls that several relatives had renal dialysis and some of them actually died of kidney disease. She also recalled that her mother took her to several dermatologists because of her missing shaven nails and was told that it is nothing to worry about. Her mother also had similar nail deformities. Both the patient and her mother was counseled about a syndrome for nail–patella syndrome, which had skin manifestations of abnormal nails or missing nails, triangular lunula, absent patella and the possibility that affected women would deliver babies with dislocated hips.

The patient was advised that since she was about to become pregnant, she was to be followed as a high risk pregnancy carefully. Her baby was, in fact, delivered with dislocated hips, but because they were able to prepare for it, there were no complications. The little girl also has nail–patella syndrome, which means it presented in all three generations

Leiomyomas Lead to Life-Saving Screenings

The patient is a 53 year old woman who was diagnosed years prior with multiple leiomyomas (benign smooth muscle tumors that are not premalignant) and who also had an early hysterectomy due to multiple fibroids (also leiomyomas). She was contacted to explain the hereditary multiple leiomyoma renal carcinoma syndrome (kidney cancer). She was told to have an ultrasound of her kidneys and to notify her siblings as well to be checked. At her follow-up exam, she reported that everything was fine with her kidneys and that she told her siblings to be checked, but that they refused to comply.

Two years later, I saw the patient and she reported that her one of her brothers was in a car accident and while undergoing CAT scans, they found that he actually had a renal cell carcinoma. The patient and both of her siblings are being followed by yearly MRIs and CAT scans.

Psoriasis Success Stories

2010-08-06T11:24:00.002-04:00

It's Psoriasis Awareness Month, so we'd like to share with you a few recent Windsor Dermatology success stories...

Bowler Gets Back to the Lanes

Recently a 47 year old male with psoriasis on 40% of body complained of hand stiffness and finger swelling secondary to psoriatic arthritis. He was depressed, stayed home, had difficulty working and couldn’t bowl anymore due to swollen fingers.

He was treated in a clinical trial with amazing results. His psoriasis cleared completely, his fingers improved and he could go work—and bowl again!

Jerry Bagel, M.D.

From Painful Psoriasis to Enjoyable Summer

One patient presented in our office suffering with over 20% of his body covered in painful psoriasis. He was treated three times a week with light treatments in combination with Humira. Within three months, he only has a small plaque on his lower back. The patient is so thankful to have regained his quality of life—pain free! He has since discontinued light treatments and is enjoying his summer. The patient is extremely happy, along with the physician and nurses.

Crystal Snyder, LPN

Research Trial Helps Fight Psoriatic Arthritis

A patient presented in our office with debilitating psoriatic arthritis. He had difficulty holding a pen and writing. Within four weeks of being on a Humira research trial, the patient was able to resume his normal daily living functions. He is extremely happy for the difference we made in his life.

Elise Nelson, Clinical Trials Coordinator

Patient Has New Outlook On Life

A 20 year old patient came in to our office with no insurance. She had severe plaque psoriasis covering 80% of her body surface. She was a definite candidate for the Enbrel clinical trial. Within 12 weeks, her psoriasis became 75% better. She has a new outlook on life.

Elise Nelson, Clinical Trials Coordinator

Welcome Our New Doctors – Dr. Brian Keegan and Dr. Wendy Myers

2010-07-23T14:48:00.001-04:00

Not only are we celebrating 25 years of medical care this month, we are also pleased to announce the addition of two new physicians. Brian Keegan, Ph.D, M.D. and Wendy Myers, M.D. will join the practice this summer, creating an all-physician staff.

Dr. Brian Keegan received his M.D. and PhD from New York University School of Medicine. He completed his dermatology residency at University of Miami School of Medicine. He brings with him expertise in geriatric dermatology and, skin cancer.

Brian’s wife, Debbra, is an OB-GYN who specializes in in-vitro fertilization. Because of this, Dr. Keegan has developed an interest/expertise in "dermatosis of pregnancy,” mainly rashes that occur in women while they are pregnant. Also, having trained in Miami, he has developed expertise in chronic solar damage, skin cancer and caring for the skin of the elderly. He has extensive experience with laser rejuvenation of chronic solar damaged skin and will bring that to Windsor Dermatology.

Dr. Brian Berman, Dr Keegan’s mentor at University of Miami said Dr. Keegan is a "doctor's doctor." His calm demeanor, comfort with patients and clear communication will make him an asset to our practice.

Dr. Wendy Anne Myers grew up in central New Jersey and returned home to complete her M.D. from UMDNJ in 2004. She completed her dermatology residency at University of Vermont.

Patients may find this interesting—she is the only full time female dermatologist between Princeton and Freehold. We believe that due to the sensitive self-esteem issues that often accompany skin conditions, female patients may be more comfortable with a female dermatologist. Dr. Myers will also help us be more accommodating to our patients’ time limitations by seeing patients in the evenings and on Saturdays.

To amplify the capabilities of the Psoriasis Treatment Center of Central New Jersey, Wendy has done clinical research in psoriasis under the direction of world-renowned psoriasis expert Dr. Alice Gottlieb.

Clearing Up Psoriasis with the Excimer Laser

2010-07-08T13:21:00.001-04:00

The safest treatment for moderate to severe psoriasis is narrowband UVB treatment. Utilizing a monochromatic ultraviolet wavelength, the patient stands in a light box three times per week for 12 weeks. Each treatment takes less than five minutes! The success rate for clearing the psoriasis is 70% and patients stay clear for six months or longer 40% of the time.

Although the treatment uses UVB rays, there is no increased risk of skin cancer. Since normal skin burns quicker than psoriatic plaques, the amount of phototherapy administered is limited by the normal skin burning and one can only increase the dosage by 10-15% of the previous dose.

By utilizing this laser treatment to localized plaques, one can increase the dose by 30% of the previous dose and clear plaques in 16 treatments. The treatment is only administered to psoriatic plaques and spares other areas of otherwise normal skin.

Utilizing the Pharos Excimer laser, we have been able to clear psoriatic plaques in 16 treatments (twice per week for eight weeks) each treatment taking less than 10 minutes. In addition, due to the small spot size of the apparatus, we can treat areas of the body that were not accessible in the UVB booths, such as the scalp and groin, as well as other localized areas of psoriasis such as the hands and feet, with remarkable success.

Laser treatment for psoriasis is covered by most major insurance plans. Call us today to find out more about the various treatment options available at Windsor Dermatology, home of the Psoriasis Treatment Center of Central New Jersey.

Jerry Bagel, M.D.
David Nieves, M.D.

The Key to Healthy Skin – Treat it Well!

2010-06-24T12:25:00.001-04:00

The old saying goes “you get what you pay for,” but not always. Expensive skin creams do not necessarily translate into healthier skin. Remember, the basics hold true for everyone. First, always be gentle on the skin in the following ways.

In the shower: Use lukewarm water in the shower, not hot water which irritates the skin. Longer showers or better yet, lukewarm baths are best, so the epidermis can absorb more water and become more hydrated.

Toweling off: This can be followed by the gentle absorption of water with a towel, being careful not to be too rough.

Always moisturize: Make sure you use a moisturizer lotion, or if the skin is extremely dry (especially in the winter months when the ambient humidity tends to be low and forced heat dries the skin out), apply moisturizer cream while the skin is still damp to help trap the moisture, making skin plumper. This ultimately gives it a more youthful appearance and more importantly allows the cells to be maintained in their proper pH to mature. Normally the moisturizers I recommend patients apply once or twice a day are Cetaphil, Eucerin, acid mantle cream and Neostrata, but it depends upon the dryness or oiliness of the skin.

Sun protection: Sunscreen is essential for prevention of chronic solar damage and skin cancer prevention. Most of our sun exposure is before the age of 20 hence we must apply and advocate sunscreen utilization in children. It is necessary to use a sunscreen that blocks ultraviolet (UV) rays (the most harmful are classified as UVA and UVB) and has an SPF greater than 30. It should be applied 20 minutes prior to sun exposure to give the sunscreen time to penetrate throughout the epidermis and prevent UVA and UVB rays from being absorbed by pigment producing cells called melanocytes, which can result in life threatening melanoma. Even non-aggressive types of melanoma destroy collagen and elastin fibrin in the dermis, which results in chronic skin damage in the form of wrinkling.

So think twice before buying into expensive creams and treatments that don’t finish the job. Treat your skin well everyday and keep your skin healthy!

Jerry Bagel, M.D.
David Nieves, M.D.

Welcome to Healthy Skin!

2010-05-10T15:08:00.003-04:00

The entire Windsor Dermatology staff welcomes you to Healthy Skin, the Windsor Dermatology blog. Going forward, this will be the place to learn about new trends in dermatologic treatment, events happening at the practice and tips for maintaining healthy skin overall. You can also visit our newly-launched website www.windsordermatology.com for more information about our expertise and treatment.

With most of our readers living in the New Jersey area, I must remind each and every one of you to protect yourself against the sun's damaging rays this summer as you make the weekend trek "down the shore." It's important to use sunscreen, perform self examinations of your skin and get regular screenings to monitor any irregularities ALL YEAR ROUND. Early treatment of skin cancer increases the chances of successful treatment.

Read more about skin cancer prevention and treatment in our print newsletter. Send a request to windsordermatology@windsordermatology.com to be added to our mailing list.

Jerry Bagel, M.D.
David Nieves, M.D.