Diagnosis

Diagnosis Reference Guide


Acne
Acne is a disease of genetic and hormonal nature afflicting the pilo-sebaceous unit (hair shaft, hair follicle, sebaceous gland). There are three main factors that cause acne: increased keratin production, increased oil production, and proliferation of bacteria. Acne normally appears around 14 years of age in girls, and around 16 in boys. There is also a significant increase in hormonal acne around the age of 30-35 in women. There are up to 400-900 sebaceous glands per square centimeter. The areas of highest concentration are: cheeks, forehead, chin, and anterior and posterior regions of the trunk. There are sebaceous glands located all over the body aside from the palms and soles.Patients have an increase of keratin production (protein of the skin surface), which leads to the blockage of the pilo-sebaceous opening, interfering with the elimination of sebum (oil that bathes the hair). We use treatments such as: Retin-A, Renova, Differin, and Tazorac to control keratin production.During puberty, and for women around the age of 30, there can be significant hormonal changes that result in increased sebum production. When the amount of sebum is too great and clogs the opening of the sebaceous gland, acne results. Treatments such a birth control pills, Spironolactone, Accutane and Photodynamic Therapy (PDT) mainly focus on reducing oil production in the sebaceous gland.Bacteria, such as Propriobacteria acnes, are also normally present. These can play a significant role in the inflammation process, and are part of the formation of pustules, although their exact role has not been delineated. Benzoyl peroxide and antibiotics are used to help decrease the bacterial numbers. Topical solutions such as Benzoclin have proven just as effective as oral preparations and are preferred due to less systemic side effects.

:: Photodynamic Therapy ::

Actinic Keratosis
Actinic keratosis (AK) are common precancerous lesions that are the result of UVB damage. This lesion is the principal precursor of squamous-cell carcinoma (SCC) and even some basal cell carcinomas. About 60% of all SCC develop from actinic keratosis. AKs occur more frequently in Caucasian populations with long exposure to ultraviolet radiation (UVB, 290-320 nm), which produces mutations in the p53 tumor suppressor gene. About 10% of all AKs will develop into cancer over a two year period.These lesions are chronic, small, scaly lesions, 2-6 mm in diameter, sometimes pink or brown hyperkeratotic plaques, and surrounded by atrophic skin, telangiectasia (broken blood vessels) and lentigines (brown spots). Most of the diagnosis is made by a feel. A dry or scaly patch in a sun exposed area that never seems to go away and may even bleed in patients over the age of 40, is very suspect for actinic keratosis.

Current treatment options include: cryosurgery (liquid nitrogen); 0.5-5%, topical 5-fluoruracil (5-FU) cream, applied once to twice daily for three to eight weeks; or 5% imiquimod cream applied daily or every other day for six to eight weeks, in one or several cycles. Photodynamic therapy, laser resurfacing, and medium-depth chemical peels can also be very effective if multiple lesions need to be treated.

:: Photodynamic Therapy ::

:: Cryotherapy / Cryosurgery ::

:: Active FX & Deep FX ::

Basal Cell Carcinoma
Basal cell carcinoma (BCC) is the most common type of skin cancer. This malignancy develops from cells in the basal layer of the epidermis. The incidence of BCC has risen rapidly in recent years due to the influence of excessive sun exposure in a generation that is now approaching its golden age. An estimated 1 million new cases are diagnosed in the U.S. annually.The most common presentation of basal cell carcinoma is of a smooth, pink, dome-shaped bump on the nose or other sun-exposed part of the body. Often, it is described as a scab that repeatedly heals over, breaks down, and will just not go away. Other, less common, presentations are of a long-standing scaly patch, ulcer, or scar. A diagnosis of BCC is established with a simple skin biopsy performed under local anesthesia in the office.BCCs grow slowly and have a very low risk of metastasis. However, they are a malignancy. They will never cease to grow on their own, so they must be treated at the earliest possible stage. This will ensure the best prognosis and the finest cosmetic outcome. Surgical excision remains the standard treatment. Mohs micrographic surgery should be employed in difficult locations, for large tumors, and when there is increased risk of recurrence or metastasis. For early or superficial lesions, other approaches such as cryosurgery, laser therapy, photodynamic therapy, or topical treatment with imiquimod or 5-flourouracil can be effectively employed.:: Cryotherapy / Cryosurgery :::: Active FX & Deep FX ::
Becker’s Nevus
Becker’s nevus is a skin lesion predominantly affecting males. Nevi by definition are benign, well-circumscribed, lesions of the skin. This nevus generally first appears as an irregular pigmentation on the torso or upper arm, and gradually enlarges irregularly, becoming thickened and often hairy. Although the lesion is benign, most patients seek treatment for cosmetic purposes. Laser hair removal and intense pulse light (IPL) can be effective in removing both the hair and pigmentation contained within the lesion.

:: Hair Removal ::

:: IPL ::

Bowen’s Disease
Bowen’s disease is a neoplastic skin disease, considered an early stage squamous cell carcinoma. Bowen’s disease typically presents as a gradually enlarging, well-demarcated, red plaque with an irregular border, and surface crusting or scaling. Bowen’s disease may occur at any age in adults, but is rare before the age of 30, and most patients are older than 60 years of age. Any site may be affected, although sun-exposed areas tend to be the most common. The incidence is highest in women (70-85% of cases). About three-quarters of patients have lesions on the lower leg (60-85%), usually in previously or presently sun-exposed areas of skin. Freezing, topical treatment such as 5-flurouracil, and laser surgery are the most common first line treatments.

:: Cryotherapy / Cryosurgery ::

:: Active FX & Deep FX ::

Cafe-au-Lait Spots
Café au lait spots are pigmented birthmarks that are light-brown in color. While café au lait spots are usually not associated with any medical problems, having many (three or more) such spots is linked with neurofibromatosis and the rare McCune-Albright syndrome. Also, having six or more spots greater than 5 mm in diameter (pre-pubertal) or greater than 15 mm in diameter (post-pubertal) is a cardinal diagnostic feature of Neurofibromatosis type I. Treatment for hyperpigmented areas consists of IPL of Q-Switched Ruby laser.

:: IPL ::

Cherry Angioma
Cherry angiomas also known as cherry hemangiomas, are cherry red papules on the skin containing an abnormal proliferation of blood vessels. They are the most common kind of angioma. They are also called senile angiomas or Campbell de Morgan spots. The frequency of cherry angiomas increases with age.Cherry angiomas are made up of clusters of tiny capillaries at the surface of the skin, forming a small round dome which may be flat topped. They range in color from bright red to purple. When they first develop, they may be only a tenth of a millimeter in diameter and almost flat, but they usually grow to about one or five millimeters across, and sometimes to a centimeter or more in diameter. As they grow larger, they tend to expand in thickness, and may take on a raised and rounded shape of a dome. Multiple adjoining angiomas are said to form a polypoid angioma. Because the vessels comprising an angioma are so close to the skin’s surface, they may bleed profusely if they are injured. These lesions can be removed in a single, short office visit with a vascular laser.

:: Varicose Vein Removal ::

Dermatofibroma
Dermatofibromas usually appear as a solitary, hard round nodule, about 0.5-1 cm in size that is brownish to tan in color. Although typical dermatofibromas cause little or no discomfort, itching and tenderness can occur. These lesions are composed of disordered collagen laid down by fibroblast. Historically attributed to some traumatic insult to the skin (eg insect bite), the cause of dermatofibroma is unknown. Because of its persistent nature, it is probably better categorized as a neoplastic process rather than a reactive tissue change. A study of eruptive DFs in families suggests that a genetic component may exist. In rare cases, basal cell carcinoma may develop in a dermatofibroma. Deep penetrating dermatofibroma may be difficult to distinguish, even histologically, from rare malignant fibrohistocyctic tumors like dermatofibrosarcoma protuberans. Dermatofibromas occur most often in women; the male to female ratio is about 1:4. Complete excision, including the subcutaneous fat, has the lowest rate of recurrence. Cryosurgery can be attempted for cosmesis or to decrease the symptoms; however, recurrences are more likely. Good results have also been achieved with CO2laser treatment.

:: Cryotherapy / Cryosurgery ::

:: Active FX & Deep FX ::

Ephelides (Freckles)
Freckles are clusters of concentrated melanin which are most often visible on people with a fair complexion. Freckles are also called known as ephelides. They are flat, light brown or red in color and fade in the winter. Ephelides are more common in those with light complexions and with the regular use of sunblock, they can be suppressed. Having freckles is genetic and is related to the presence of the dominant melanocortin-1 receptor gene. Freckles are often found in people with fair hair such as blondes but even more commonly in red heads. The formation of freckles is triggered by exposure to sunlight. Specifically exposure to UVB radiation activates melanocytes to increase the melanin production, which causes freckles to become darker and more numerous. Freckles are benign but most can be removed with one to two simple IPL procedures.

:: IPL ::

Hemangioma
Hemangiomas are a benign vascular tumor of the endothelial cells (these are the cells that line blood vessels) that will normally decrease in size after several years. These are the most common type of vascular tumors and occur in about 10% of the Caucasian population. They are also three to five times more common in females.Hemangiomas are filled with blood and their appearance depends on location. If they are on the surface of the skin they look like a bright red strawberry, if they are just under the skin they present as a bluish swelling. In about 50% of cases, hemangiomas will almost completely resolve over time, usually by about the age of 5-8 years old. Most commonly they are not present at birth but appear during the first few weeks of life starting off as a hypogimented area and then maturing into a colored vascular lesion. Treatment consist of corticosteroids and Pulsed Dye Laser.

:: PDL ::

Hirsutism
Hirsutism is defined as excessive hair growth in women where hair grows in locations where mature hair is usually either minimal or absent. Hirsutism only affects women, the medical term for excessive hair growth that affect both men and women is hypertrichosis, which mean excessive hair growth even in areas where hair growth is normal. Hirsutism is a symptom rather than a disease and can be a sign of underlying diseases such as Polycystic Ovarian Syndrome (PCOS), especially if it develops after puberty.The cause of hirsutism can be either an increased level of androgens (male hormones) or an oversensitivity of hair follicles to androgens. Male hormones such as testosterone stimulate hair growth, increase size and intensify the growth and pigmentation of hair. There is growing evidence that implicates the role of insulin in the development of hirsutism. This theory is consistent with the observation that those who are obese and likely have higher amounts of circulating insulin are at higher risk of becoming hirsute. Furthermore, treatments that lower insulin levels have been shown to improve hirsutism. It is thought that insulin, at high enough concentration, stimulates the ovarian theca cells to produce androgens which in turn stimulate the hair follicle. Treatment should involve a simple blood test to check insulin and hormone levels and light based hair removal.

:: Hair Removal ::

Hypertrophic Scars

Scars are areas of abnormal texture that contain fibrous tissue which has replaced normal skin after injury. This is a natural part of the healing process and with the exception of very minor lesions, almost every wound involves some degree of scarring. A hypertrophic scar results when there is an overproduction of collagen. This causes the scar to become raised and in many cases it rises several millimeters above the skin. These raised, red scars do not grow beyond the boundaries of the original wound (like a keloid). Although they will never completely resolve, they do tend to improve over the course of years.
The discoloration (redness and hyperpigmentation) that often follows an injury is not a scar but rather part of the repair process.This discoloration is generally not permanent. Both hypertrophic and keloid scars are more common on younger and darker-skinned people. Treatment for scars should consist of steroid injections and some combination of either Pulsed Dye Laser or CO2 resurfacing.

:: PDL ::

Hypopigmentation
Hypopigmentation means lightening of the skin. It is caused by a loss of melanocytes in the epidermis or a decrease in the amino acid tyrosine, which is used by melanocytes to make melanin. Damage to melanocytes that results in hypopigmenation can have many causes including: chronic sun exposure, damage from a laser procedures (picture at left), infection or autoimmune disease. Treatment is difficult but normally involves topical steroids and in severe cases camouflaging tattoos or melanocyte cell transfer.

:: Active FX & Deep FX ::

Keloid Scars
Keloids are a type of scar that results from an overgrowth of wounded tissue that grows beyond the boundaries of the original wound (unlike a hypertrophic scar). The keloid at left was the result of a simple vaccination shot. They are firm, rubbery lesions and can vary from pink to flesh-colored or red to dark brown in color. Most are associated with itchiness, textural changes and in some cases sharp pain. Keloids are composed of atypical fibroblasts with excessive deposition of extracellular matrix components, especially collagen, fibronectin, elastin, and proteoglycans. Most keloids have relatively acellular centers and thick, abundant collagen bundles that form nodules in the deep dermis. These lesions can cause significant pain, itching and physical disfigurement. Unlike hypertrophic scars, they are unlikely to improve with time. Keloids affect both sexes equally but there is a fifteen times higher frequency of occurrence in darker skin types. Treatment consists of surgical removal, steroid injections and Pulsed Dye Laser.

:: PDL ::

:: Active FX & Deep FX ::

Keratosis Pilaris (KP)
Keratosis pilaris which is also known as follicular keratosis is an incredibly common hereditary condition that is characterized by rough bumps on the skin and commonly referred to as “chicken skin”. It is very commonly confused with acne but does not involve a bacterial infection. It is more common in women and usually appears on the upper arms. Keratosis pilaris affects more than 80% of the population at some time in their life. Keratosis pilaris occurs when excess keratin, a natural protein in the skin, accumulates within the hair follicles. This forms a hard plug (hyperkeratination), which caps off the hair follicle. Because of this, many of the follicles will contain an ingrown hair that was not able to grow out to the skin. When moisture levels fall, as they do during the winter, KP can be exacerbated. Although there are effective treatments, currently there is no cure for keratosis pilaris. Also, the condition often improves with age and can even disappear completely in adulthood. Hydration and decreasing hyperkeratinization are key to therapy. Treatment includes: microdermabrasion, intensive moisturizers, lac-hydrin, topical retinoids, alpha hydroxy acids, and urea containing lotions.:: Microdermabrasion ::
Melanoma
Melanoma is a malignant cancer composed of melanocytes. The severity of melanoma is judged by its thickness at diagnosis (Breslow thickness scale). It is more common in Caucasians that live in sunny climates. Malignant melanoma accounts for 75% of all deaths associated with skin cancer. Both genetic and environmental factors contribute to the likelihood of melanoma. Use of tanning beds has been linked to the development of melanoma. Any pigmented lesion that is asymmetrical, with irregular borders, multiple colors, that is more than 5 mm, and is changing in appearance, should be evaluated by a physician. The sole effective cure is surgical resection of the primary tumor before it achieves a depth greater than 1 mm. Lesions discovered that have a depth of less than 1 mm have a 95% survival rate whereas lesions that are more than 2 mm in depth have a less than 75% survival rate.
Melasma
Melasma is a skin condition that results in a darkening of the face. It is more common in females where there is an elevation of estrogen and exposure to UV light. Although the pathophysiology of melasma is uncertain, it is thought to be caused by the stimulation of melanocytes by estrogen and progesterone, which in turn produces more melanin when the skin is exposed to sun. Hence why melasma often appears during pregnancy and oral contraceptive usage. Melasma is also commonly a sign of mild ovarian or thyroid issues.The most important factor in the development of melasma is exposure to sunlight. Without the strict avoidance of sunlight, potentially successful treatments for melasma are doomed to fail. Ultraviolet radiation can cause peroxidation of lipids in cellular membranes, leading to generation of free radicals, which could stimulate melanocytes to produce excess melanin. Sunscreens that primarily block UVB radiation (290-320 nm) are unsatisfactory because longer wavelengths (UVA and visible radiation, 320-700 nm) also stimulate melanocytes to produce melanin. For this reason, patients with melasma should always use a broad spectrum sunscreen such as those that combine both titanium dioxide and zinc oxide. Melanin deposits in both the epidermis (upper layer of skin) and dermis (deeper layer of skin). The melanin can be localized to the epidermis or the dermis by use of a Wood lamp (wavelength, 340-400 nm). Epidermal pigment is enhanced during examination with a Wood light, whereas, dermal pigment is not.

Treatments include: bleaching agents (Hydroquinone and Azelaic acid 20% is as effective as 4% Hq), medium depth chemical peels, and IPL.

:: IPL ::

:: Active FX & Deep FX ::

Milia
Milia are asymptomatic, small, white or yellow papules that occur primarily on the faces of women and newborns. Milia are simply cystic collections of keratin just under the epidermal surface. Milia can sometimes be a result of harsh face washes or from repeated heat stress from hot showering on people with sensitive skin. They may also occur with porphyria cutanea tarda and other blistering diseases.Treatment usually consists of either local application of moderate-to-high strength acid (35% TCA) or incision followed by expression of cystic contents. The use of topical Retin-A may help to treat and prevent milia.

:: Chemical Peels ::

Poikiloderma
Poikiloderma of Civatte is a very common, benign condition affecting the skin on the neck. The term poikiloderma refers to the combination of textural changes, dilated capillaries, and darkening pigmentation that occur in the affected area. Poikloderma is more common in women and caused by chronic sun exposure. This is why it characteristically spares the shaded area under the chin. Like roseaca on the face, sun exposure over a certain area causes the characteristic changes. Treatment depends on severity but usually includes Pulsed Dye Laser, IPL and sometimes laser resurfacing.

:: PDL::

:: IPL ::

:: Active FX & Deep FX ::

Port-Wine Stain
A port-wine stain or nevus flammeus is a vascular birthmark consisting of dilated capillaries and venuoles in the skin. This produces a red/purple discoloration of the skin. Port-wine stains fall under the category of vascular malformations. Port-wine stains are present at birth and persist throughout life. The area of skin affected grows in proportion to general growth. They usually occur on the face but can appear anywhere on the body. During early development, they are normally flat and usually light in color. As they mature the color darkens and they become thicker. During adulthood, small lumps may develop and the lesion may be disfiguring. Port-wine stains occur in about 3 out of 1,000 people and may be part of a larger group of symptoms such as Sturge-Weber Syndrome or Klippel-Trenaunay-Weber Syndrome. Therapy consists of multiple treatments with a Pulsed Dye Laser.

:: PDL ::

Pseudofolliculitis Barbae
Pseudofolliculitis barbae (PFB) is a medical term for ingrown hairs that cause persistent inflammation caused by shaving. PFB is most common when shaving an area that has tight curly hair. Curly hair tends to curl into the skin instead of straight out of the follicle when it grows back after shaving. This leads to an inflammatory reaction that shows the characteristic red bumps over the shaved area. In many cases these papules become infected forming pustules causing additional discomfort to the area.PFB is most common in African men, and if left untreated can cause keloid scarring in the beard area. To resolve active inflammation, stop shaving the area for at least a few weeks and use a mild prescription cortisone cream each morning. As a preventative measure, only shave every other day and use a razor with a single or double blade to keep from shaving too closely. When you do shave, soften the beard first with a hot, wet washcloth for five minutes. The most effective and long term treatment is hair removal.:: Hair Removal ::
Pyogenic Granuloma
Pyogenic granulomas are solitary, often pedunculated, erythematous papules or small nodules that are often friable and bleed easily with minor trauma. Sites of predilection include the fingers, face, and lips.Pyogenic granulomas develop rapidly (over the course of several weeks), and the sudden occurrence can be quite alarming to the patient. They probably represent a reactive neovascularization, potentially in response to injury. Pyogenic granulomas are common in pregnancy; termed granuloma gravidarum, they usually arise on the gingival mucosa. 

:: Cryotherapy / Cryosurgery ::

Rosacea
Rosacea is a very common skin condition that causes diffuse redness over the cheeks, nose and chin. It is estimated to affect more than 45 million people worldwide most of whom are from north-western European descent. Although rosacea affects both sexes, it is almost three times more common in women. There is a very strong genetic component to rosacea but equally important is the exposure to UV radiation, which is why it does not normally show up until the third decade of life.Rosacea normally begins to show in the early thirties as facial flushing over the cheeks, nose and chin. During the fourth decade, it progresses so there is background redness over the same areas even at rest, and small vessels (telangiectasia) begin to develop. By the fifth decade, there are normally multiple dilated vessels and consistent background redness. In more severe cases this can be accompanied by breakouts and disfigurement of the nose. Treatment consists of antibiotics for acute infection, and Pulsed Dye Laser for redness.

:: PDL ::

Sebaceous Hyperplasia
Sebaceous hyperplasia is a common, benign condition of sebaceous glands in adults of middle age or older. Lesions can be single or multiple, and manifest as yellowish, soft, small papules usually over the nose, cheeks, and forehead. A decrease in cellular turnover results in crowding of sebocytes within the sebaceous gland. This causes the enlargement of the gland resulting in hyperplasia. This is particularly apparent in the areas where sebaceous glands are concentrated, such as the face. Despite growing up to 10 times their normal size, they secrete very little sebum. In contrast to normal sebocytes that are engorged with lipid, the hyperplastic sebaceous glands contain small, undifferentiated sebocytes with large nuclei and scant cytoplasmic lipid. Therapy includes localized topical acids such as TCA, photodynamic therapy and laser resurfacing.

:: Active FX & Deep FX ::

Scarring
Acne Scarring
The pathogenesis of acne scarring is much like that of any other scar. An injury is caused by the body’s inflammatory response to the combination of sebum, bacteria and dead cells in the plugged sebaceous follicle. The body rushes to repair the injury. During this process, white blood cells and an array of inflammatory molecules enter the infected area. They help resolve the infection, but also leave a slightly messy repair site in the form of fibrous scar tissue and/or eroded tissue. Acne scars such as ice-pick and box car scars need laser resurfacing for best results.

:: Active FX & Deep FX ::

Spider Veins
Spider veins, also know as reticular veins, are vessels that are greater than 1 mm and have competent valves (they do not bulge). They are normally red, purple and blue in color, and can be located anywhere on the body. There are a number of factors that predispose a person to spider veins such as: heredity, occupations that involve a lot of standing, obesity, hormonal influences (during pregnancy, use of birth control pills or hormonal replacement), any condition that causes increased pressure in the abdomen including (tumors or constipation), trauma, previous vein surgery, and exposure to UV radiation.

:: Vein Removal ::

Squamous Cell Carcinoma
Squamous Cell Carcinoma (SCC) is a slow-growing type of skin cancer which involves the malignant transformation of normal epidermal keratinocytes. Twenty percent of all skin cancers are squamous cell carcinoma, making it the second most common skin cancer and one of the most common cancers overall in the United States. Well-known factors that have been shown to promote the development of SCC include UV radiation, immunosuppression, and infection with human papillomavirus (HPV). Primary surgical excision and Mohs micrographic surgery are the two primary treatment options for SCC.

:: Photodynamic Therapy ::

Stretch Marks
Stretch marks or striae are actually a form of scarring. They are caused by tearing of the dermis as a result of rapid stretching of the skin. They first appear as reddish or purple lines, but tend to gradually fade to a lighter color. The affected areas often feel spongy to the touch. Stretch marks can appear anywhere on the body, but are most likely to appear in places where larger amounts of adipose tissue are stored. The hormones responsible for the development of stretch marks affect the epidermis by preventing the fibroblasts from forming collagen and elastin fibers, necessary to keep rapidly growing skin taut. This creates a lack of supportive material, as the skin is stretched and leads to dermal and epidermal tearing. If the epidermis and the dermis has been penetrated, laser will not remove the stretch marks. Between 75% and 90% of women develop stretch marks to some degree during pregnancy. The sustained hormonal levels as a result of pregnancy usually means stretch marks may appear during the sixth or seventh month. Only one randomized controlled study has been published which claimed to test whether oils or creams prevent the development of stretchmarks. This study found a daily application of a cream (Trofolastin) containing vitamin E and collagen-elastin hydrolysates was associated with fewer stretch marks during pregnancy. Another study, though lacking a placebo control, examined a cream (Verum) containing vitamin E, panthenol, hyaluronic acid, elastin and menthol. It was associated with fewer stretch marks during pregnancy versus no treatment. Various treatments are available for the purpose of improving the appearance of existing stretch marks, including laser treatments, dermabrasion, and prescription retinoids. Fractional laser resurfacing offers a novel approach to treating striae. Using fractionated light creates microscopic wounds, which result in the production of new collagen and epithelium. In a 2007 clinical trial, 5-6 treatments resulted in striae improving by as much as 75 percent.

:: PDL ::

:: Active FX & Deep FX ::

Sturge-Weber syndrome
Sturge-Weber syndrome is an extremely rare, congenital disorder that involves both the skin and neurological system. It is often associated with port-wine stains of the face, glaucoma, seizures, mental retardation, and ipsilateral leptomenigeal angioma. It is caused by an arteriovenous malformation that occurs in the cerebrum of the brain on the same side as the physical signs described above. Normally, only one side of the head is affected. Treatment is symptomatic. Pulsed Dye laser treatment may be used to lighten or remove the birthmark and anticonvulsant medications may be used to control seizures.

:: PDL ::

Sun Spots (Solar Lentigo)
Lentigines are hyperpigmented macules (flat smooth lesions that can been seen but not felt) or patches that may resemble nevi (moles). Usually pale-tan to brown in color, they typically appear in Caucasian adults and increase in number with age.

Lentigines tend to occur on the sun-exposed skin of the face, neck, upper trunk, forearms, and hands. Unlike freckles, solar lentigines are the result of epidermal hyperplasia and a proliferation of melanocytes. Lentigines are benign, but on rare occasion may transform into lentigo maligna (superficial melanoma). If any changes occur within a spot such as rapid growth, change in color or surface contour, a dermatologic evaluation is warranted and a biopsy may be necessary. Many lentigines are indicative of excessive photo-damage and increased risk of sun-induced skin cancer.

Treatment options include: IPL, cryotherapy, chemical peels, laser resurfacing.

:: IPL ::

:: Cryotherapy / Cryosurgery ::

:: Chemical Peels ::

:: Active FX & Deep FX ::

Sunburn
A sunburn is a tissue burn caused by the overexposure of UV radiation. Usual symptoms are red skin that is hot to the touch and tender. An excess of UV-radiation can be life-threatening, and is the leading cause of skin cancers such as basal cell and squamous cell carcinoma. Importantly, sunburn and the increase in melanin production are both triggered by direct DNA damage. The use of sunscreen is known to prevent the direct DNA damage that causes sunburn and the two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma. However, if sunscreen penetrates into the skin, it promotes the indirect DNA damage, which cause the most lethal form of skin cancer, malignant melanoma. This is why we recommend physical sunscreens that contain only titanium dioxide and zinc oxide.
Syringoma
Syringomas are benign, sweat duct tumors that are typically found clustered on eyelids. They are skin-colored or yellowish, firm, rounded bumps usually 1-3 mm in diameter. Syringomas are located mostly in the superficial dermis. They are composed of numerous small ducts and can be effectively be removed with CO2.

:: Active FX & Deep FX ::

Telangiectasia
Telangiectasia are veins that are less than 1 mm in diameter. They are normally red, purple and blue in color, and usually located on the face or legs. There are a number of factors that predispose a person to telagiectasia, the most important of which are heredity and sun exposure. Telangiectasia are often related to rosacea.

The best treatment options are either Pulsed Dye or Nd:YAG laser. Although IPL can be somewhat effective, is it very inefficient and vessels tend to come back sooner.

:: Pulsed Dye Laser ::

:: Vein Removal ::

Varicose Veins
Varicose veins are veins that have become enlarged due to backflow of blood away from the heart through incompetent valves. Most commonly, they occur in the legs but can occur elsewhere. Veins have leaflet valves to prevent blood from flowing backwards (retrograde flow). Leg muscles pump the veins to return blood to the heart. When veins become enlarged, the leaflets of the valves no longer meet properly, and the valves don’t work. Varicose veins are common in the superficial veins of the legs, which are subject to high pressure when standing. Besides cosmetic problems, varicose veins are often painful, especially when standing or walking. Non-surgical treatments include sclerotherapy, compression stockings, and endovenous laser ablation.

:: Varicose Vein Removal ::

Venous Lake
A venous lake is an asymptomatic, soft, compressible, dark blue papule usually about 0.2-1 cm in size. They are commonly found on sun-exposed surfaces of the vermilion border of the lip, face and ears. Venous lakes represent a form of vascular dilatation. This group of diseases also includes angiomas and telangiectasia. A capillary aneurysm is considered a precursor or variant of a venous lake. The development of venous lakes is believed to be exacerbated by solar exposure and damage. One theory is that chronic solar damage injures the vascular adventitia and the dermal elastic tissue, permitting dilatation of superficial venous structures. Treatment is normally a simple treatment with Nd:YAG laser.

:: Vein Removal ::

Vitiligo
Vitiligo is a chronic skin disease that causes loss of skin pigment. This results in irregular pale patches of skin. The exact cause of vitiligo is not fully understood but there is good evidence that it is a combination of both environment and genetic factors. It is most common over extensor aspects of extremities, on the face or neck, and in skin folds. It normally appears before the age of 20. Traditional treatment regiments include topical corticosteroids and phototherapy. Phototherapy involves long-wave UVA used together with Psoralen, called PUVA therapy.
Warts
Warts are generally small, rough tumors located typically on hands and feet, that can resemble a solid blister. Warts are caused by a viral infection of human papillomavirus (HPV) and are contagious. It is also possible to get warts from skin-to-skin contact, and using towels or other objects that are contaminated by the virus. They typically disappear after a few months, but can last for years and commonly reoccur. Treatment is either by cryotherapy (liquid nitrogen) or Pulsed Dye Laser.

:: Pulsed Dye Laser ::

:: Cryotherapy / Cryosurgery ::