Treatments
Chronic Skin Conditions
Management and treatment of chronic conditions such as psoriasis, seborrheic dermatitis, rosacea, and autoimmune diseases affecting the skin.
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Management and treatment of chronic conditions such as psoriasis, seborrheic dermatitis, rosacea, and autoimmune diseases affecting the skin.
Acne is one of the most common skin conditions. It affects approximately 85% of adolescents, but it does not necessarily end after puberty. Acne also remains common in adulthood, affecting around 20% of the adult population.
Although acne is sometimes regarded as merely a cosmetic concern, its impact can extend far beyond the skin. It may affect self-confidence, self-image, and quality of life, and can sometimes be accompanied by significant emotional distress. Inflammatory acne may also leave permanent scars, which is why it is important to treat it promptly rather than waiting for it to “go away on its own.”
Acne develops due to a combination of several factors, primarily the effect of sex hormones on the skin’s sebaceous glands. It therefore occurs mainly in areas rich in sebaceous glands—the face, chest, shoulders, and back.
In addition to hormonal and genetic predisposition, several other factors may trigger or worsen acne. These include stress, hormonal changes, polycystic ovary syndrome, certain skin or hair products, sweating, and friction. In some patients, particular dietary supplements—especially protein supplements and vitamin B12—may also be associated with worsening acne.
How is acne treated?
Fortunately, a wide range of effective acne treatments is available today, from topical preparations to oral medications.
The appropriate treatment is not the same for everyone. When selecting treatment, I consider the patient’s age, the severity of the acne, the type of lesions, the tendency to develop scarring, hormonal factors, and, of course, each patient’s individual preferences.
Patients who prefer to avoid oral medication can often be treated with prescription gels, creams, and other topical preparations.
For girls and women, I also consider hormonal factors. When appropriate, I assess whether there are signs suggesting a hormonal imbalance and whether hormonal treatment should be considered. Certain types of birth control pills may significantly improve acne, and spironolactone may also be considered in suitable cases.
When topical treatment is insufficient, oral treatment options are also available, including antibiotics when appropriate and isotretinoin (Roaccutane).
Isotretinoin is one of the most effective acne treatments available today, particularly for significant acne, acne that is likely to cause scarring, or cases in which other treatments have not provided sufficient improvement. It has the potential to produce prolonged remission, but requires structured medical monitoring because of its possible side effects and the follow-up required during treatment.
My goal is not simply to “get rid of the spots,” but to tailor a treatment that is effective, safe, and practical to maintain over time—while taking your lifestyle, preferences, and individual needs into account.
I recommend coming to your consultation with an open mind and readiness for a thorough discussion. Together, we will select the treatment that is best suited to you.
Actinic keratosis is a skin lesion caused by cumulative exposure to ultraviolet (UV) radiation from the sun. These lesions are sometimes described as “precancerous sun damage” because they reflect changes in skin cells that may, in some cases, progress to squamous cell carcinoma (SCC).
Actinic keratoses are most common in people with fair skin and on areas that have been exposed to the sun over many years, such as the face, scalp, backs of the hands, and forearms. They usually develop at an older age but may appear earlier, depending on skin type and the extent of sun exposure.
It is important to emphasize that not every actinic keratosis will develop into cancer. However, the presence of these lesions indicates cumulative skin damage and warrants evaluation by a dermatologist, appropriate treatment, and follow-up when necessary.
What does actinic keratosis look like?
Actinic keratosis usually appears as a small lesion measuring less than one centimeter, with a rough texture, a pinkish or reddish color, and scale attached to the skin’s surface. The lesion may sometimes feel spiky or tender to the touch.
Because these lesions may be subtle and not easily visible, they are sometimes easier to feel than to see.
They occur mainly on areas that have been exposed to the sun over a long period, particularly areas of the scalp where the hair has become thin or has been lost.
Another significant risk factor is suppression of the immune system, for example following an organ or bone marrow transplant. In these situations, the lesions may be more numerous, and the risk of developing skin cancer is higher.
Is actinic keratosis a form of skin cancer?
Actinic keratosis is considered a precancerous lesion, meaning that changes have developed in the skin cells as a result of cumulative UV damage.
Under microscopic examination, cells with abnormal features, known as dysplastic cells, can be identified. These changes do not necessarily indicate invasive cancer, but they reflect a process that may progress in some cases.
The course of actinic keratosis is not uniform. Some lesions remain stable for a long time, some regress spontaneously but may reappear, and others become thicker or progress to squamous cell carcinoma (SCC).
It is not possible to predict with certainty which lesion will progress or when. Therefore, once actinic keratosis has been diagnosed, it is important to assess the overall condition of the skin and establish an appropriate treatment and follow-up plan.
More than an isolated lesion: What is field cancerization?
An important principle in the treatment of actinic keratoses is that these lesions do not usually occur in isolation. They are often part of an entire area of skin that has been exposed to the sun for many years and has accumulated cellular damage, including areas where no obvious lesions are yet visible.
This phenomenon is known in medical literature as field cancerization—an area of skin with precancerous damage.
This means that a particular area, such as the scalp, forehead, or forearms, may contain visible actinic keratoses alongside areas with early changes that cannot yet be seen.
Therefore, when numerous lesions are present within a defined area, treating each lesion separately with liquid nitrogen may not always be sufficient. In suitable cases, treatment of the entire field may be recommended to address both the visible lesions and some of the early changes in the surrounding skin.
What treatments are available for actinic keratosis?
The choice of treatment depends on the number and location of the lesions, the extent of skin damage, the patient’s medical condition, and personal preferences.
An isolated lesion or a small number of lesions can often be treated by freezing them with liquid nitrogen. When numerous lesions or a large field of sun-damaged skin is present, treatment of the entire area may be considered.
5% 5-Fluorouracil (5-FU) – A topical treatment that acts against cells with abnormal changes. In a large comparative study, this treatment demonstrated the greatest effectiveness among four methods evaluated for reducing multiple actinic keratoses on the head over a 12-month follow-up period. Treatment usually continues for several weeks and may cause a pronounced local reaction, including redness, burning, peeling, and sometimes crusting.
5% Imiquimod – A topical treatment that stimulates an immune response in the skin against abnormal cells. It can be applied at home according to medical instructions, and the duration of treatment varies depending on the formulation and protocol. Treatment may cause redness and a local inflammatory reaction, and occasionally flu-like symptoms.
Photodynamic therapy (PDT) – A treatment performed in the clinic. A light-sensitive substance is applied to the skin, after which the area is exposed to light of an appropriate wavelength. This treatment can cover a relatively large field of damaged skin and generally provides a good cosmetic result. It is relatively brief compared with prolonged courses of topical treatment, although it may cause pain or a burning sensation during illumination. In suitable cases, a daylight-based protocol may also be used and may be associated with less pain.
Other treatment options are also available, depending on the condition of the skin and the medical indications. Treatment is selected individually, taking into account its expected effectiveness, duration, potential side effects, and convenience for the patient.
Why is it important to treat the entire affected area?
When multiple actinic keratoses are present, treating the affected field of skin may significantly reduce the number of lesions, improve the skin’s texture and appearance, and reduce the overall burden of precancerous lesions.
There is also evidence that some treatments may reduce the risk of developing skin cancer in the future. However, the degree of risk reduction varies between treatments, and complete prevention of skin cancer cannot be guaranteed.
In addition to treatment, it is important to maintain appropriate sun protection and undergo skin examinations according to your individual level of risk.
A lesion that grows rapidly, becomes thicker, bleeds, develops an ulcer, or becomes newly tender should be examined by a dermatologist and may require a biopsy.
In summary
Actinic keratoses are a sign of cumulative sun damage and often appear as part of a larger area of skin affected by prolonged exposure to ultraviolet radiation.
Assessing the entire area of affected skin, selecting an appropriate treatment, and maintaining regular follow-up make it possible to treat existing lesions while also addressing damage in the surrounding skin.
If you have been diagnosed with actinic keratoses, it is advisable to consult a dermatologist about the treatment that is most suitable for you and the follow-up plan you may need.
The skin is much more than an outer covering. It is the largest organ in the body and serves as the first line of defense against harmful agents, thanks to an intact skin barrier and an active immune system within the skin.
In atopic dermatitis, also known as “skin asthma,” two major mechanisms are disrupted: the first is impaired skin-barrier function, and the second is overactivity of the immune system in the skin, which causes an inflammatory response.
The condition usually begins in infancy, sometimes as early as the first few months of life. It may be associated with other allergic conditions, such as food allergies, asthma, and allergic rhinitis, although not every child with atopic dermatitis will develop these conditions.
What does atopic dermatitis look like?
The hallmark of the condition is significant and persistent itching, accompanied by an inflammatory skin rash. The itching may occur throughout the day, worsen at night, and substantially affect quality of life.
The location of the rash varies with age. In older children and adults, it frequently appears in skin folds, such as the creases of the elbows and knees and the neck. However, it can occur anywhere on the body, including the face. In infants, the face and the outer surfaces of the arms and legs are commonly affected.
In adults, the condition may also affect less typical areas, such as the hands, face, and nipples.
Persistent itching can have significant consequences. It may disrupt sleep and impair concentration and daily functioning. In children, it may also affect mood, behavior, and performance at school or preschool. In severe cases, prolonged disruption of sleep and daily functioning may also affect development.
How is atopic dermatitis treated?
Because the condition involves both impairment of the skin barrier and inflammatory activity of the immune system, treatment should address both components.
Restoring the skin barrier: Regular use of moisturizers helps reduce water loss from the skin, improve its barrier function, and relieve dryness and irritation. This is a fundamental part of treatment, even during periods when the rash is not active.
Treating inflammation: Depending on the severity of the condition, the location of the rash, and the patient’s age, topical treatments such as anti-inflammatory ointments and creams may be used. When the condition is widespread, severe, or does not respond adequately to topical treatment, additional options are available, including phototherapy and systemic treatments administered orally or by injection. Systemic options also include biologic therapies and other targeted treatments, which can significantly improve both itching and the rash.
Treatment is selected individually according to the characteristics of the condition and the patient’s needs.
Does atopic dermatitis go away with age?
In many children, the condition improves over the years and may sometimes resolve completely. However, in some patients it continues into adolescence and adulthood, often with periods of flare-ups and improvement.
There is therefore no reason to wait for spontaneous improvement when a child or adult is experiencing itching, sleep disturbance, or a significant rash. A wide range of treatments is now available, allowing therapy to be tailored to the severity of the condition and the patient’s age while substantially improving quality of life.
If you or your child suffers from atopic dermatitis, it is advisable to consult a dermatologist for an evaluation and an individually tailored treatment plan. The condition can be treated at any age, and there is no need to accept itching and discomfort that can be relieved.
Management and treatment of chronic conditions such as psoriasis, seborrheic dermatitis, rosacea, and autoimmune diseases affecting the skin.
Treatments designed to improve skin quality and texture, combining advanced technologies, including laser treatments, to achieve optimal aesthetic results while maintaining a natural appearance.
What is a mole examination?
A mole examination is an external, non-invasive procedure during which a dermatologist examines the patient’s entire skin surface, both visually and with a dermatoscope.
A dermatoscope is a specialized magnifying instrument that allows the dermatologist to examine moles and other skin lesions in greater detail. It helps identify subtle features that cannot be seen with the naked eye and may therefore contribute to the early detection of skin cancer.
Early diagnosis is extremely important. When a cancerous lesion is detected at an early stage, it may be possible to remove it with a smaller excision. This is particularly significant for facial lesions, where a smaller excision may result in a smaller scar and less noticeable cosmetic impact. In general, early detection and treatment may also improve the chances of recovery.
What types of skin cancer are there?
Skin cancers are generally divided into melanoma and non-melanoma skin cancers.
Melanoma is a malignant skin tumor with the potential to invade nearby tissues and spread to distant organs. It is therefore particularly important to diagnose melanoma at an early stage.
Non-melanoma skin cancers frequently appear in areas that have been exposed to sunlight over many years. The two most common types are:
Who should have a mole examination?
A mole examination may be appropriate for anyone interested in periodic skin checks. It is particularly recommended for people with many moles or skin lesions, fair skin, significant cumulative sun exposure, or a history of repeated sunburns.
Regular monitoring should also be considered by people with a personal or family history of melanoma or skin cancer, those with atypical moles, or anyone who notices a new lesion or a change in an existing mole.
Changes that deserve attention include changes in a mole’s size, shape, or color; the appearance of several colors within one mole; irregular borders; bleeding; itching; or a lesion that does not heal.
When should you schedule an examination?
There is no need to wait for symptoms before having a mole examination. Periodic examinations can help identify changes even before the patient notices them.
You should arrange an examination if you notice a new mole or skin lesion, a change in an existing mole, a lesion that bleeds without an obvious reason, a wound that does not heal, or any skin change that causes concern.
The appropriate frequency of follow-up is different for each person. It is determined according to age, skin type, the number and characteristics of the moles, history of sun exposure, and personal and family medical history. Depending on the findings, the dermatologist may recommend periodic follow-up examinations.
How long does the examination take?
The duration of the examination varies from one patient to another. It depends, among other factors, on the number of moles and lesions that need to be examined and the extent of the examination required.
During the examination, the skin is reviewed systematically. Lesions that require closer inspection are examined with a dermatoscope. When necessary, the dermatologist may recommend continued monitoring, documentation of a specific lesion, a repeat examination, or removal of a lesion for histopathological examination.
How should you prepare for the examination?
No special preparation is required for a mole examination. It is advisable to wear comfortable clothing because different areas of the skin will need to be exposed for a thorough examination.
It is important to know that skin cancer can occur anywhere on the body, including areas that are not regularly exposed to sunlight, such as the scalp, palms, soles, and intimate areas. A complete skin examination should therefore include the entire skin surface.
What happens if a suspicious lesion is found?
If a lesion with features requiring further investigation is identified during the examination, the dermatologist will recommend the appropriate next step according to its appearance and the level of concern.
In some cases, monitoring and a repeat examination after a defined period may be sufficient. In other cases, removal of the lesion or collection of a tissue sample for histopathological examination may be recommended.
Histopathological examination makes it possible to determine the nature of the lesion more accurately and decide whether any additional treatment is required.
Evaluation of the causes of hair loss and alopecia, treatment of fungal nail infections, and management of conditions affecting the skin appendages.
Psoriasis is a relatively common chronic inflammatory skin disease that has been known to humanity for thousands of years. The condition has a genetic basis, with the immune system playing a central role in its development, while various environmental factors may trigger or worsen it. Known triggers include infections, particularly strep throat caused by Streptococcus bacteria, which may lead to an outbreak of guttate psoriasis.
The disease usually appears as thickened red plaques covered with scales and may affect different areas of the body. Its severity and location vary considerably between patients, so treatment is individually tailored.
Topical treatment
When only a limited number of plaques are present, they can usually be treated with topical medications. Treatment may include topical corticosteroids, vitamin D analogues, and non-steroidal preparations, depending on the area being treated and the characteristics of the disease.
Phototherapy
When psoriasis affects many areas of the body and topical treatment becomes technically difficult, phototherapy (light therapy) may be considered. This is a well-established and effective treatment that allows large areas of skin to be treated without systemic medication.
Phototherapy is particularly effective in cases of guttate psoriasis—a sudden outbreak of numerous small lesions that often occurs following a respiratory infection or streptococcal throat infection.
Systemic treatments
When psoriasis is widespread, when topical treatment is insufficient, or when the patient prefers to avoid phototherapy, many systemic treatment options are now available in the form of tablets or injections.
These treatments include:
Individually tailored treatment
Today, many effective treatment options are available for psoriasis. Treatment is selected individually according to the severity of the disease, type of psoriasis, location of the lesions, impact on quality of life, underlying medical conditions, patient preferences, and other relevant factors.
The goal is not only to improve the appearance of the skin, but also to achieve effective, long-term control of the disease and improve quality of life.
I invite you to schedule a consultation for an assessment of your skin condition and selection of the treatment best suited to your needs.