Dermatology Information for Patients

An actinic keratosis is a pre-cancerous spot on the skin. Most people notice it as a small, rough spot that doesn’t go away. If left untreated, some actinic keratoses may go on to become a type of skin cancer called squamous cell carcinoma.

There are several ways to treat these pre-cancerous spots. Most commonly, they will be frozen with liquid nitrogen in a procedure called cryotherapy. You can also treat actinic keratoses at home with creams that you apply to your skin for a few weeks, or with a procedure done in the dermatology clinic called photodynamic therapy. With any of these treatments, you can expect your skin to become red and irritated before healing.

Sometimes it takes more than one treatment to get rid of an actinic keratosis, so if you still notice a rough spot after a few weeks, call 617-667-3753 to make a follow-up appointment. 

Dry skin (the medical term for this is xerosis) is often just an inconvenience, but it can be quite itchy, and if you break open the skin from scratching, you can develop an infection in the area. Dry skin can also trigger or worsen flares of eczema and other rashes, and it is especially important to treat dry skin if you have other skin conditions.

Dry skin is usually worst in the winter, when humidity is low and you are indoors near the heater, but you may notice it even when the weather is more mild. There are several ways you can fight dry skin:

• Bathe or shower in lukewarm water — hot water dries out your skin.
• Limit shower to 10-15 minutes.
• Use mild soaps such as Dove; unscented body lotion cleansers (e.g., Oil of Olay, Dove) can also be helpful. Minimize use of soap on areas that tend to get dry.
• Use lotion cleansers such as Cetaphil to wash your face.
• Use a facial moisturizer with sun block on a daily basis. Ultraviolet rays from the sun are still damaging to the skin even in the winter.
• Regular use of a lip balm with sun block is very helpful for chapped lips.
• When choosing a moisturizer, look for products that are fragrance free, especially if you have sensitive skin. Brands that you can find at the local pharmacy/drugstore are just fine. In general, ointments and creams are more effective than lotions.
• Apply moisturizers immediately after a bath or shower while your skin is still damp. Apply any prescription creams or ointments BEFORE you apply your moisturizer.
• Heavy ointments such as petroleum jelly, Aquaphor healing ointment, or hydrolated petrolatum are useful for severely dry areas such as the hands, feet, elbows, and knees. Wearing cotton gloves or socks over an ointment on hands and feet at bedtime can help with severe dryness and cracking.
• Use of a home humidifier is useful in preventing moisture loss from the skin.

Your moles were examined at your visit to the dermatology clinic, and we recommend that you also look at your moles at home every few months. The mnemonic device we use for remembering concerning features in moles is ABCDE:

• A = asymmetry (half of your mole looks different than the other half — normally, the two halves should look the same)
• B = border (look for an irregular or jagged outline)
• C = color (more than one color, including brown, black, red, white, blue, tan)
• D = diameter (larger than 6 mm)
• E = evolving (a new or changing mole, including one that develops symptoms such as pain, itching, or bleeding)

If you notice any spots showing these atypical features, please call us at 617-667-3753 to schedule an appointment for a new, unusual, or changing mole. 

A seborrheic keratosis is a very common skin growth; most people get them over time, and most people have more than one. No one knows why these benign skin growths happen, but they are not skin cancer and they are not contagious. At this time, there is no known way to prevent them from occurring.

A seborrheic keratosis does not need to be treated for medical reasons, but sometimes people wish to have them removed for cosmetic purposes. Insurance companies do not cover that cost, but if you are interested in cosmetic removal, this can be done for a fee at our Cosmetic Surgery and Laser Center at 25 Boylston Street in Chestnut Hill (call 617-754-0350 for more information). 

If you have a history of skin cancer, you should monitor your skin at home between visits to the dermatology clinic, for new concerning lesions. Skin cancers can appear as new bumps or spots on your skin that don’t go away after a few weeks, are painful, or bleed. If you notice any new spot on your skin that does not go away after four to eight weeks, call 617-667-3753 to schedule an appointment to have it checked. 

Warts are caused by infection with human papilloma virus (HPV) and can be contagious. There are several ways to treat warts; commonly used methods include freezing them with liquid nitrogen (a procedure called cryotherapy), and applying salicylic acid plasters to them.

Warts can also disappear on their own, and not everyone chooses to have them treated. If you have chosen to try therapy, remember that it may take several treatments and some time for warts to go away, and not all warts respond to therapy. Warts can also occasionally grow back after apparently successful treatment.

Doxycycline is an antibiotic that can be used for many different conditions, including acne, rosacea, and infections. Any medication can cause an allergic reaction, so if you notice any new symptoms such as hives or other skin rashes, difficulty breathing or swallowing, or swelling of your face, lips, or tongue, stop taking the medication immediately and call us at 617-667-3753.

More commonly, people notice stomach upset when taking doxycycline, so we recommend that you take it with food. Do not lie down immediately after taking the medication (wait at least one to two hours), as this may cause heartburn. Many people find they are much more sensitive to the sun when taking doxycycline, so be very careful to protect yourself whenever you are out in the sun. If you become pregnant, stop using this medication immediately. Do not use if you are breastfeeding.

If you were prescribed steroids to put on your skin follow the directions you were given closely for applying the steroids. Risks of using steroids on your skin include thinning of the skin (it can even develop stretch marks), or lightening of the skin color. For this reason, we recommend that you only apply the steroids to the affected areas, and use the steroids only for the length of time discussed. Remember to wash your hands after applying so that you do not accidently spread the medication to other areas of your body.

Tretinoin can be irritating to your skin at first, so closely follow the directions you were given for applying the tretinoin. Most people start by using it every other night or every third night; when your face is used to it, you can use it every night. You may need to put a moisturizer on over the tretinoin to help with the irritation; look for a moisturizer that says “non-comedogenic” or “does not clog pores.”

This medication may make you more sensitive to the sun, so be very careful to protect yourself from sunburn. If you are using tretinoin for acne, be aware that occasionally people feel that their acne flares slightly when they begin using tretinoin; if that happens, keep using the medication as the acne generally improves over time. If you become pregnant, stop using this medication immediately.

Cryotherapy is a procedure in which liquid nitrogen is used to freeze cells; it is often used to treat pre-cancers and non-cancerous changes in your skin. After you have cryotherapy, you can expect to see redness and swelling of the treated skin, and a scab or blister may form. No special care is required; you can wash your skin as usual and use makeup and other cosmetics.

The skin usually heals within three weeks, leaving healthy new skin. If the spot for which you had cryotherapy does not go away after treatment, please call us at 617-667-3753 to have it examined again and possibly retreated.  

If you had a skin biopsy at your visit to the dermatology clinic, please closely follow the instructions you were given for caring for the biopsy site. If you notice increasing pain, redness, or swelling, or if the biopsy site becomes hot to touch, please call us at 617-667-3753 as these symptoms can sometimes indicate that an infection has developed.

Biopsy results are usually available within two weeks; if you have not heard from our clinic after three weeks, please call 617-667-3753 to speak with someone regarding your results.

Protecting yourself from the sun is important to decrease your risk of skin cancer. It can also slow down the appearance of aging. There are several things you can do to protect yourself from the sun. If possible, avoid being out in the sun when it is at its strongest (usually between 10 a.m. to 4 p.m.).

For sunblock, choose a brand you like that says “broad-spectrum” or “UVA/UVB,” and look for a sun protection factor (SPF) of 30 or higher. Follow the instructions for application closely — one application to your entire body will take about 3 ounces (one shot glass), and the most common error in sunscreen use is simply not applying enough. You should apply the sunscreen half an hour before going outside, and you should reapply as directed on the bottle (at least every two hours, and sooner if you have been sweating heavily or have been in the water).

Don’t forget to protect all your exposed skin — people often forget about their neck, ears, feet, and (if your hair is thin) the scalp. Sun protective clothing is also a good option to consider — many companies make clothing with sun protection built in, including such brands as Coolibar, Solumbra, and REI. You can also wash sun protection into your own clothing at home using your washing machine and a product called SunGuard. Hats are a good way to protect your head and neck, and broad-brimmed hats are better for this than baseball caps, which leave your ears and the back of your neck exposed.