New York Dermatology

What are angiomas?

Angiomas are benign growths made up of small blood vessels. They can appear anywhere on the body. The three most common types are spider angiomas, angiokeratomas, and cherry angiomas.

Cherry angiomas are red or purplish in color and don't usually grow larger than 1/4-inch in diameter. They can appear alone or in clusters. They are not dangerous.

What causes cherry angiomas?

No one knows what causes angiomas. Since they commonly appear after the age of 40, they may be related to aging.

What is the treatment?

Occasionally angiomas may become irritated (such as from rubbing against clothing) and need to be removed to avoid further problems. However, since most angiomas are harmless, most people have them treated for cosmetic reasons.

There are three ways to have angiomas removed:

• Electrodessication uses an electric needle to destroy the blood vessels in the growth.
• Liquid nitrogen is a cold gas applied to the skin to freeze off the growth.
• Laser treatment uses a beam of intense, focused light to remove the growth.

If an angioma recurs after treatment, your physician can repeat treatment until it is gone for good.

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This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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Actinic keratosis

Actinic keratoses (AK) are pink, relatively poorly demarcated, scaly patches and plaques on the sun-exposed skin.

When markedly hyperkeratotic, they can be tender when palpated.

Actinic keratoses can spontaneously regress and can, without treatment, occasionally evolve into invasive squamous carcinoma.

Treatment:

• Liquid nitrogen cryotherapy is the treatment of choice for the isolated actinic keratosis.
• Multiple AK's respond to topical 5% 5-fluorouracil cream bid for three weeks, followed by a resolution of the inflammatory reaction and retreatment. Retreatment is important, if recurrences are to be reduced.
• 10% Masoprocol cream bid for four weeks is an alternative to 5% 5-fluorouracil.
• Imiquimod cream is shown to be effective
• Photodynamic therapy is another possible treatment
• As actinic keratoses are secondary to ultraviolet light damage, the use of broad spectrum sunscreens is recommended.

Herpes

Primary herpes simplex

Primary infections may be mild and unnoticed, but they are often more severe than recurrences. Initial infections with Type 2 virus are generally more marked than with Type 1 virus.

Herpetic gingivostomatitis
Herpetic gingivostomatitis (mouth infection) is the most common clinical manifestation of primary Type 1 infection. Most cases occur in children between the 1 and 5 years of age.

After an incubation period of 4 to 5 days the symptoms begin with fever, which may be high, restlessness and excessive dribbling. Drinking and eating are painful and the breath is foul. The gums are swollen and red and bleed easily. Vesicles (little blisters) occur in white patches on the tongue, throat, palate and insides of the cheeks. The white patches are followed by ulcers with a yellowish coating. The local lymph glands are enlarged and tender.

The fever subsides after 3-5 days and recovery is usually complete within 2 weeks.

Genital herpes
Infection with Type 2 HSV occurs after the onset of sexual activity and results in genital herpes. Penile ulceration from herpetic infection is the most frequent cause of genital ulceration seen in sexual health clinics. The ulcers are most frequent on the glans, foreskin and shaft of the penis. They are sore or painful and last for 2 to 3 weeks if untreated.

In the female, similar lesions occur on the external genitalia and the mucosae of the vulva, vagina and cervix. Pain and difficulty passing urine are common. Infection of the cervix may progress to a severe ulceration.

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llergic Reactions

Atopic dermatitis

Eczema or Neurodermatitis

A skin disorder involving hypersensitivity (allergy - related) reaction within the skin characterized by inflammation, itching, and scaling. See also lichen simplex chronicus.

Causes, Incidence and Risk Factors

Atopic dermatitis can occur in an infantile (children) or adult form. It is most common in infants, and at least half of those cases clear up by age 18 months. This is often a family history of asthma, hay fever, eczema, psoriasis, or other allergy-related disorders. In adults, it is generally a chronic or reoccurring condition.

Neurodermatitis is a form of atopic dermatitis characterized by a self-perpetuating scratch-itch cycle. Although symptoms increase in times of stress, physiological changes in the nerve fibers are also present.

A hypersensitivity reaction (similar to an allergy) occurs in the skin, causing chronic inflammation. The inflammation causes the skin to become itchy and scaly. Chronic irritation and scratching can cause the skin to thicken and become leathery-textured, although this is more pronounced in the localized form, lichen simplex chronicus.

Exposure to environmental irritants can worsen symptoms, as can dryness of the skin, exposure to water, temperature changes, and stress.

World Renown Dermatologist

World-renowned Dermatologist Warns Public of Botox Dangers

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Beverly Hills, CA: Dr. Arnold Klein, a world-renowned dermatologist is making it his mission to tell the public about the dangers of Botox, one of the most popular cosmetic treatments that almost everyone is familiar with in some form. Behind Viagra, Botox is the second-most popular prescription drug in the world and has served as a more cost-effective alternative to having cosmetic surgery.

Dr. Klein has stated that physicians need to be trained and educated on the proper use of Botox and that the FDA needs to be much tougher in protecting the public. There has been evidence of Botox being used improperly and he alleges that Allergan, the manufacturer of Botox, has misrepresented the data they have on the drug.

Dr. Klein reviewed a 2003 study that was submitted to the Dermatologic Surgery journal by foreign doctors doing work for Allergan. The review had to deal with diluting Botox. What the author of the review was trying to show was that certain levels of dilution not detract from the safety and efficacy of the product. However, a review of the paper showed some serious issues with the manuscript, which included graphs that showed worsening of wrinkles after the Botox wore off. The study was not published due to these various issues with the paper. At a later date, the same author submitted the same study with different results. When Dr. Klein alerted the editor of the journal, he was told that the issue would be resolved.

However, the same study still appeared two years later in an edition of Dermatology Surgery that was sponsored by Allergan. The study included the data that was altered despite the statement to Klein by the publications editor that the situation would be resolved. It may have been resolved at the moment, but did not have an impact when Allergan sponsored the review. Klein stated that he felt the data was altered to benefit the pharmaceutical company at the expense of the health of the patients.

Klein later shared his concern regarding the improper dilution of the drug causing serious risks to patients such as the drug spreading to unintended areas of the body, which could cause paralysis and even death. Shortly after Klein raised his concerns, the same foreign doctor who had conducted the study that appeared in the Dermatology Surgery journal, submitted another article about the drug Myobloc, which has also been suspected of causing paralysis and death. It is injected in the same manner as Botox. Dr. Klein and another doctor were named as the authors, although they said they had nothing to do with it and had never seen it prior to it being published.

Klein's main concern is that the use of Botox is becoming more and more prevalent and is being administered by doctors other than cosmetic surgeons. Many of these doctors have hardly any training or experience with the drug, so they believe that diluted Botox is safer because of published studies with suspected altered results. Klein feels that the FDA needs to make sure that future studies that are published in American medical publications be submitted by Physicians with US medical licenses. The physician who published the reviews on both Botox and Myobloc was not licensed to practice medicine within the United States.

In February, the FDA announced that Myobloc and Botox have both been associated with swallowing issues and respiratory issues. There has been at least one death. Public Citizen, an American watchdog group, found that there have been 180 severe reactions and 16 deaths associated with Botox use in a 9 year period. There has only been one cosmetic-related death.