Patient Resources and Useful Links
From time to time, we will add to this database information that may be of use to you. Please note that these resources are a supplement to your office experience. They are NOT meant to replace a proper office consultation with our physician or physician assistant. There is no substitute for a physicial examination, diagnosis, and treatment plan tailored by your professional.
Wound Care instructions
Forget how to care for that spot that was frozen or biopsy that was performed? View online or print the PDF
| PWD Wound Care Instructions |
If you are expecting the results of a biopsy or an excision and have not heard within 2 weeks, please call our office to inquire. It is our policy that all patients are notified, regardless of results.
Wound Care Instructions
Cryotherapy (Freezing of a growth with liquid nitrogen)
The targeted growth was treated by spraying a cold liquid that evaporates at -321° F (-196° C). The frost creates a blister that will become a scab and may be tender for a few days. The edges of the scab will curl up, indicating that it is beginning to separate from the underlying new skin. Once the scab lifts away, the growth goes along for the ride. Depending on location and the size of the lesion, it may take from 7 – 21 days to complete this process. On thick-skinned areas such as the palms or the soles, you may not see a blister, but it may simply be swollen and dusky. New, “baby” skin is usually very smooth and pink and will gradually blend with the surrounding skin. If the surrounding skin, however, is tanned or sun-damaged, there may be a slight contrast as the new skin has not been exposed to the sun and is therefore lighter in color. The only type of growth that you may try to peel off prematurely would be a wart; otherwise it may try to re-establish itself at the base of the wound. Any blister fluid from a wart should be thoroughly washed as it may contain infectious viral particles. Thick growths and warts may require multiple treatments. If you suspect the lesion is still there, please return for examination and possibly additional treatments after one month.
Shave Removal / Biopsy or Curettage and Desiccation (Scraping and cautery)
These shallow wounds are the result of shaving off a growth (wart, keratosis, mole, etc) or from the treatment of shallow skin cancers through the process of scraping off the tumor and heat cauterization of the base using a blunt electric probe. Generally they are about as deep as finger-nail scratches to skinned-knees. Ideal wound care consists of daily cleansing during your bathing routine or rubbing alcohol followed by application of unscented petroleum jelly (Vaseline) and a small bandage. Neosporin is unnecessary and may occasionally cause contact allergy. Delaying the formation of a scab as long as possible results in the best-appearing wound as it prevents the “iceberg” from settling in the middle and inhibiting skin cells from migrating to each other. Once a dry scab has formed, however, daily wound care may cease. See the above tips for dealing with scabs. Total healing time depends on the body location with faces healing as quickly as 10 days to legs taking up to 6 weeks.
Excisions (Cutting out and closing the wound with stitches)
Excisions are often performed to remove tumors that extend deep into the skin or sometimes to achieve the best cosmetic results for shallow lesions. Depending on size and location, some wounds are closed with just superficial stitches and some require an added underlying layer of dissolving sutures for extra strength. Generally, stitches on the face are removed in a week. Neck and scalp sutures are removed in 10 days. Regions below the collarbone require at least 14 days to properly settle before sutures are removed. It is highly recommended to limit activity for at least one week. As a rough guide, if your wound feels tight, then you are putting too much tension on the sutures and may result in it becoming undone, bleeding or infected. Just as in shave removals, daily cleansing with mild soap and water or rubbing alcohol followed by generous applications of petroleum jelly and a bandage is often all that is required. If you are sensitive to adhesives, then bandages may be customized using non-adherent (“Telfa”) pads followed by gauze and paper tape. It is critical that you continue daily applications of the petrolatum as it will accelerate wound healing, improve its cosmetic outcome, and prevent the skin from trying to pull the stitches below the surface. If this occurs, the dry wound must be explored in order to remove the sutures, resulting in discomfort. Pain is best managed with extra-strength Tylenol. Alcohol and non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen are blood-thinners and may result in bleeding complications. Most bleeding complications occur within the first 48 hours and are usually temporary. Apply firm, steady pressure with gauze for 5 minutes at a time and recheck. Infections, while rare, do not occur before 48 hours. If your dressings are soaking through or the wound is warm, reddened beyond an inch around the incision, swollen, dark, firm, or progressively tender to the touch, do not hesitate to call our office or seek urgent medical attention.
The targeted growth was treated by spraying a cold liquid that evaporates at -321° F (-196° C). The frost creates a blister that will become a scab and may be tender for a few days. The edges of the scab will curl up, indicating that it is beginning to separate from the underlying new skin. Once the scab lifts away, the growth goes along for the ride. Depending on location and the size of the lesion, it may take from 7 – 21 days to complete this process. On thick-skinned areas such as the palms or the soles, you may not see a blister, but it may simply be swollen and dusky. New, “baby” skin is usually very smooth and pink and will gradually blend with the surrounding skin. If the surrounding skin, however, is tanned or sun-damaged, there may be a slight contrast as the new skin has not been exposed to the sun and is therefore lighter in color. The only type of growth that you may try to peel off prematurely would be a wart; otherwise it may try to re-establish itself at the base of the wound. Any blister fluid from a wart should be thoroughly washed as it may contain infectious viral particles. Thick growths and warts may require multiple treatments. If you suspect the lesion is still there, please return for examination and possibly additional treatments after one month.
Shave Removal / Biopsy or Curettage and Desiccation (Scraping and cautery)
These shallow wounds are the result of shaving off a growth (wart, keratosis, mole, etc) or from the treatment of shallow skin cancers through the process of scraping off the tumor and heat cauterization of the base using a blunt electric probe. Generally they are about as deep as finger-nail scratches to skinned-knees. Ideal wound care consists of daily cleansing during your bathing routine or rubbing alcohol followed by application of unscented petroleum jelly (Vaseline) and a small bandage. Neosporin is unnecessary and may occasionally cause contact allergy. Delaying the formation of a scab as long as possible results in the best-appearing wound as it prevents the “iceberg” from settling in the middle and inhibiting skin cells from migrating to each other. Once a dry scab has formed, however, daily wound care may cease. See the above tips for dealing with scabs. Total healing time depends on the body location with faces healing as quickly as 10 days to legs taking up to 6 weeks.
Excisions (Cutting out and closing the wound with stitches)
Excisions are often performed to remove tumors that extend deep into the skin or sometimes to achieve the best cosmetic results for shallow lesions. Depending on size and location, some wounds are closed with just superficial stitches and some require an added underlying layer of dissolving sutures for extra strength. Generally, stitches on the face are removed in a week. Neck and scalp sutures are removed in 10 days. Regions below the collarbone require at least 14 days to properly settle before sutures are removed. It is highly recommended to limit activity for at least one week. As a rough guide, if your wound feels tight, then you are putting too much tension on the sutures and may result in it becoming undone, bleeding or infected. Just as in shave removals, daily cleansing with mild soap and water or rubbing alcohol followed by generous applications of petroleum jelly and a bandage is often all that is required. If you are sensitive to adhesives, then bandages may be customized using non-adherent (“Telfa”) pads followed by gauze and paper tape. It is critical that you continue daily applications of the petrolatum as it will accelerate wound healing, improve its cosmetic outcome, and prevent the skin from trying to pull the stitches below the surface. If this occurs, the dry wound must be explored in order to remove the sutures, resulting in discomfort. Pain is best managed with extra-strength Tylenol. Alcohol and non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen are blood-thinners and may result in bleeding complications. Most bleeding complications occur within the first 48 hours and are usually temporary. Apply firm, steady pressure with gauze for 5 minutes at a time and recheck. Infections, while rare, do not occur before 48 hours. If your dressings are soaking through or the wound is warm, reddened beyond an inch around the incision, swollen, dark, firm, or progressively tender to the touch, do not hesitate to call our office or seek urgent medical attention.
5-fluorouracil ("efudex") treatment guide
Considering the cream that may "reset" the sun damage to your skin?
| PWD Efudex Treatment Guide |
Patients’ Guide to 5-Fluorouracil (Efudex) Therapy
When a patient has many precancers (Actinic Keratoses) on a certain area of the body, topical field therapy like 5-Fluorouracil cream (Efudex, Carac) is sometimes recommended. This has the benefit of treating subclinical lesions that are often undetectable, and allows extensive lesions to be treated without the discomfort of cryotherapy.
The treatment duration of Efudex cream is twice daily for 2-4 weeks, during which time you should expect to have an erosive reaction causing redness and scabs on the precancerous spots. Skin not damaged by UV rays does not typically react to the cream. For some, the scabbing will begin within a few days; for others it will take up to two weeks and should be completed after two weeks from the onset of symptoms. Wash with a gentle cleanser like Cetaphil or Dove during treatment, and you may moisturize each day with Cetaphil or Eucerin lotion. Always wash your face before applying Efudex, however. This is an example of a woman (not a patient of PWD) who has the expected response to Efudex:
The treatment duration of Efudex cream is twice daily for 2-4 weeks, during which time you should expect to have an erosive reaction causing redness and scabs on the precancerous spots. Skin not damaged by UV rays does not typically react to the cream. For some, the scabbing will begin within a few days; for others it will take up to two weeks and should be completed after two weeks from the onset of symptoms. Wash with a gentle cleanser like Cetaphil or Dove during treatment, and you may moisturize each day with Cetaphil or Eucerin lotion. Always wash your face before applying Efudex, however. This is an example of a woman (not a patient of PWD) who has the expected response to Efudex:
|
You should continue to treat until lesions have a rust-colored scab on them. Once this occurs, you should discontinue the medication and apply Vaseline liberally to start the healing process. You should avoid sun exposure during the entire treatment and recovery period.
Your prescriber will advise you to follow-up one month after completion of the treatment or at your usual six month check-up. If you have any questions during the course of therapy, please call the office at (571) 261-1234. |
methotrexate medication guide
This medication is generally used for the treatment of inflammatory disorders such as psoriasis and eczema.
| Methotrexate Guidelines |
Methotrexate Guidelines for Patients
Methotrexate is an effective chemotherapeutic and immunosuppressive medication that has been used for the chronic treatment of psoriasis and other inflammatory disorders for more than 30 years. It treats both the skin and joint manifestations of the disease. Most patients note improvement after one month of treatment and reach a steady state after three.
Methotrexate is taken only once per week. It may be taken with or without food.
Levels of methotrexate in the blood can be influenced by the ingestion of other drugs. Do not take aspirin, non-steroidal anti-inflammatory medicine [such as ibuprofen (Advil, Motrin), Aleve, or Celebrex], sulfonamides (Bactrim, Septra), tetracyclines, barbiturates, or dilantin, with methotrexate. You should let your doctor know that you are taking methotrexate when you are prescribed a new medication.
Blood tests to monitor blood cell counts and liver function are necessary:
Avoid excess alcohol consumption as it can increase the risk of liver inflammation.
Folic acid supplements of 1 mg/day should be taken daily as they help prevent some of the gastrointestinal (nausea, vomiting, loss of appetite, diarrhea, mouth sores), and hematologic (low blood counts) side effects sometimes seen with methotrexate. However, do not take folic acid on the day that you take your methotrexate dose because it may decrease its effectiveness.
Women who can become pregnant must use effective contraception, as methotrexate can affect the development of an unborn child. It also can induce a miscarriage. Men who use methotrexate will have decreased and possibly defective sperm production, and should avoid impregnating a woman while on the medication.
Other side effects may include mild hair loss, headaches, fatigue and dizziness. Sun sensitivity while on methotrexate has been described. Rarer side effects include allergic reaction, redness of palms and soles, and fibrosis of the lungs. Long-term therapy (years) of methotrexate may need evaluation by a gastroenterologist of the overall health of the liver. Chronic liver damage may lead to cirrhosis.
Methotrexate is taken only once per week. It may be taken with or without food.
Levels of methotrexate in the blood can be influenced by the ingestion of other drugs. Do not take aspirin, non-steroidal anti-inflammatory medicine [such as ibuprofen (Advil, Motrin), Aleve, or Celebrex], sulfonamides (Bactrim, Septra), tetracyclines, barbiturates, or dilantin, with methotrexate. You should let your doctor know that you are taking methotrexate when you are prescribed a new medication.
Blood tests to monitor blood cell counts and liver function are necessary:
- 1 week after initial test dose (2 pills taken together)
- Every 2 weeks for the first 6 weeks
- 1 week after any dosage changes, then monthly once stable
Avoid excess alcohol consumption as it can increase the risk of liver inflammation.
Folic acid supplements of 1 mg/day should be taken daily as they help prevent some of the gastrointestinal (nausea, vomiting, loss of appetite, diarrhea, mouth sores), and hematologic (low blood counts) side effects sometimes seen with methotrexate. However, do not take folic acid on the day that you take your methotrexate dose because it may decrease its effectiveness.
Women who can become pregnant must use effective contraception, as methotrexate can affect the development of an unborn child. It also can induce a miscarriage. Men who use methotrexate will have decreased and possibly defective sperm production, and should avoid impregnating a woman while on the medication.
Other side effects may include mild hair loss, headaches, fatigue and dizziness. Sun sensitivity while on methotrexate has been described. Rarer side effects include allergic reaction, redness of palms and soles, and fibrosis of the lungs. Long-term therapy (years) of methotrexate may need evaluation by a gastroenterologist of the overall health of the liver. Chronic liver damage may lead to cirrhosis.
a primer about acne medications
| Acne Primer |
A Guide for Acne Medications
We have tailored a combination of prescription and non-prescription medications that will help to improve your complexion—provided that you consistently comply with our protocol and don’t consider these as “spot” treatments. In general, acne medications take about a month to show initial effects. Should side effects occur, it is imperative that you call our office so that we can address any serious problems. Should you become pregnant, discontinue your medications and contact us for safety instructions. These are guidelines only and are not meant to replace scheduled appointments in which we may be able to adjust a regimen tailored for you.
Oral antibiotics
Tetracycline, Doxycycline, Minocycline, Trimethoprim / Sulfamethoxazole, Erythromycin
Systemic antibiotics target both the bacteria (propionobacterium Acnes) and the inflammation that it elicits to reduce the amount of deep acne (“pimples”, “zits”) that you develop. It is generally safe to take these oral antibiotics for several months continuously, but the low risk of bacterial resistance is possible. We usually start these medications with a goal to taper to a much lower (sub-antimicrobial) dose or to discontinue altogether once your acne is well controlled. Side effects may consist of heartburn, nausea, dizziness, headaches, sun sensitivity, predisposition to yeast colonization, and allergic hives. One may consider taking them with food to buffer from GI side effects, although dairy products may bind to the medication, reducing its potency.
Topical antibiotics
Clindamycin, Sodium Sulfacetamide & Sulfur, Benzoyl Peroxide, Azelaic acid
These surface antibiotics help with mild cases of inflammatory acne described above, but are often prescribed in combination with the oral versions for synergy and long-term maintenance. Benefits also include risk reduction for bacterial resistance when combined with oral antibiotics. Side effects, while uncommon, include dryness, irritation, and allergic rashes. Reducing to smaller amounts and lower frequencies combined with a neutral moisturizer often eliminates this problem. It should be noted that benzoyl peroxide may bleach colored fabrics, so rinse the cleansers off well and consider using white linens.
Topical Retinoids and Salicylic Acid
Adapalene gel, Tretinoin, Tazarotene
Retinoids are cousins of vitamin A designed to target both deep inflammatory acne and surface, comedonal acne (“blackheads”, “whiteheads”) by gradually opening up the narrow, clogged pores. Salicylic acid comes in the form of cleansers and gels to dissolve the plugs, acting synergistically with retinoids. Side effects are sun sensitivity, dryness, and irritation. A chemical peel may ensue if overzealous applications of retinoids are used. You are advised to gradually acclimatize your skin to the benefits of retinoids over 4 to 6 weeks. A pea-sized amount is sufficient for the entire face and should be applied with dots placed symmetrically over the forehead, temples, cheeks, nose, jaw line, and chin before rubbing gently into the skin. Moisturizers may be immediately applied to reduce irritation. Start by applying the preparation two nights a week and gradually increase to every other night. You should be able to use this medication every night within 2 months. While it may initially appear that your complexion is worsening, the long term benefits will become apparent within 2 to 6 months.
Moisturizers
Cetaphil, CeraVe, Neutrogena, Purpose, Dove, Oil of Olay, Clinique, DML, others
While we do not endorse any one product over another, the above-branded moisturizers are affordable and are neutral in pH. Used immediately after applications of topical acne preparations will significantly reduce irritation. Should you have questions regarding an unlisted product, look for terms such as “oil-free”, “water- based”, or “non-comedogenic” as a guide. Of course, if you don’t suffer from any dryness or irritation, there is no need to use a moisturizer—simplicity is the name of the game!
Isotretinoin, Oral contraceptives, Spironolactone
These medications, while being safe and effective, are not first-line treatments for acne and require a consultation to discuss their risks and benefits. They are outside of the scope of this guide.
Oral antibiotics
Tetracycline, Doxycycline, Minocycline, Trimethoprim / Sulfamethoxazole, Erythromycin
Systemic antibiotics target both the bacteria (propionobacterium Acnes) and the inflammation that it elicits to reduce the amount of deep acne (“pimples”, “zits”) that you develop. It is generally safe to take these oral antibiotics for several months continuously, but the low risk of bacterial resistance is possible. We usually start these medications with a goal to taper to a much lower (sub-antimicrobial) dose or to discontinue altogether once your acne is well controlled. Side effects may consist of heartburn, nausea, dizziness, headaches, sun sensitivity, predisposition to yeast colonization, and allergic hives. One may consider taking them with food to buffer from GI side effects, although dairy products may bind to the medication, reducing its potency.
Topical antibiotics
Clindamycin, Sodium Sulfacetamide & Sulfur, Benzoyl Peroxide, Azelaic acid
These surface antibiotics help with mild cases of inflammatory acne described above, but are often prescribed in combination with the oral versions for synergy and long-term maintenance. Benefits also include risk reduction for bacterial resistance when combined with oral antibiotics. Side effects, while uncommon, include dryness, irritation, and allergic rashes. Reducing to smaller amounts and lower frequencies combined with a neutral moisturizer often eliminates this problem. It should be noted that benzoyl peroxide may bleach colored fabrics, so rinse the cleansers off well and consider using white linens.
Topical Retinoids and Salicylic Acid
Adapalene gel, Tretinoin, Tazarotene
Retinoids are cousins of vitamin A designed to target both deep inflammatory acne and surface, comedonal acne (“blackheads”, “whiteheads”) by gradually opening up the narrow, clogged pores. Salicylic acid comes in the form of cleansers and gels to dissolve the plugs, acting synergistically with retinoids. Side effects are sun sensitivity, dryness, and irritation. A chemical peel may ensue if overzealous applications of retinoids are used. You are advised to gradually acclimatize your skin to the benefits of retinoids over 4 to 6 weeks. A pea-sized amount is sufficient for the entire face and should be applied with dots placed symmetrically over the forehead, temples, cheeks, nose, jaw line, and chin before rubbing gently into the skin. Moisturizers may be immediately applied to reduce irritation. Start by applying the preparation two nights a week and gradually increase to every other night. You should be able to use this medication every night within 2 months. While it may initially appear that your complexion is worsening, the long term benefits will become apparent within 2 to 6 months.
Moisturizers
Cetaphil, CeraVe, Neutrogena, Purpose, Dove, Oil of Olay, Clinique, DML, others
While we do not endorse any one product over another, the above-branded moisturizers are affordable and are neutral in pH. Used immediately after applications of topical acne preparations will significantly reduce irritation. Should you have questions regarding an unlisted product, look for terms such as “oil-free”, “water- based”, or “non-comedogenic” as a guide. Of course, if you don’t suffer from any dryness or irritation, there is no need to use a moisturizer—simplicity is the name of the game!
Isotretinoin, Oral contraceptives, Spironolactone
These medications, while being safe and effective, are not first-line treatments for acne and require a consultation to discuss their risks and benefits. They are outside of the scope of this guide.
AFTER-Care INstructions for LASER or CAUTERY PATIENTS
| Post Treatment Instructions |
Post-Treatment Instructions
General
For Hair Removal
For Pigmented Lesion Treatment
For Vascular Lesion Treatment
- A mild sunburn-like sensation is expected. This usually lasts 2-24 hours but can persist up to 72 hours. Mild swelling and/or redness may accompany this, but it usually resolves in 2-3 days.
- Apply ice or cold packs to the treatment area for 10-15 minutes every hour for the next few hours, as needed. An oral analgesic, such as acetaminophen or ibuprofen, may be taken to reduce discomfort. Use according to manufacturer’s recommendations.
- In some cases, prolonged redness or blistering may occur. An ointment such as petroleum jelly or Aquaphor may be applied to the affected areas twice a day until healed.
- Bathe or shower as usual. Treated areas may be temperature-sensitive. Cool showers or baths will offer relief. Avoid aggressive scrubbing and use of exfoliators, scrub brushes, and loofah sponges until the treatment area has returned to its pre-treatment condition.
- Until redness has completely resolved, avoid all of the following:
- Applying cosmetics to treated areas.
- Swimming, especially in pools or hot tubs with chemicals such as chlorine.
- Activities that cause excessive perspiration.
- Sun exposure to treated areas. Apply an SPF-30 or greater sunscreen to prevent development of new pigmented lesions.
For Hair Removal
- Appearance of hair growth or stubble will continue for 7-30 days post-treatment. This is not new hair growth, but the treated hairs being expelled from the skin.
- In patients with fine, fuzzy hair there may be a temporary stimulation of regrowth before the expected response.
For Pigmented Lesion Treatment
- The lesion may initially look raised and/or darker with a reddened perimeter.
- The lesion will gradually turn darker over the next 24-48 hours. It may turn dark brown or even black.
- The lesion will progress to scabs/crusting and will start flaking off in 7-14 days. Do not pick, scratch, or remove scabs.
- The lesion is usually healed in 21-30 days. It will continue to fade over the next 6-8 weeks.
For Vascular Lesion Treatment
- The vessels may undergo immediate graying or blanching, or they may exhibit a slight purple or red coloring. The vessels will fully or partially fade in about 10-14 days. Do not pick, scratch, or remove scabs.
- Repeat treatments may be performed within 2 weeks if skin has fully recovered.
Instructions for using compresses
| Compress Handout |
Compresses
Compresses are one of the oldest treatment methods used in dermatology. They accomplish several goals: (1) softening of the skin to aid penetration of prescribed creams, ointments, or lotions; (2) prevention and/or reduction of secondary infection; (3) relief of pain or itching.
SOLUTIONS
SOLUTIONS
- Burow’s Solution (1:40): dissolve 1 packet of Domeboro in 1 pint (16 oz.) of cool or warm water
- Baking Soda: dissolve 1 teaspoon of baking soda in 1 pint (16 oz.) of cool or warm water
- White vinegar: add 1 tablespoon of vinegar to 1 pint (16 oz.) of cool or warm water
- Epsom Salts: dissolve 1 tablespoon of Epsom salts in 1 pint (16 oz.) of coool or warm water
- Bath Oil: add 1 capful of bath oil (e.g. Alpha Keri) to 1 pint (16 oz.) of cool or warm water (or add the bath oil to one of the solutions recommended above)
- Wet a towel with the solution, wring out slightly, and wrap soaked towel around affected area. For hands or feet, white cotton socks or white dermal cotton gloves sold in pharmacies or beauty supplies stores work well.
- Compress for at least 15 minutes daily or as instructed by us.
- Dry area gently and apply any prescribed medication if so recommended.
Vivacare Database
Vivacare maintains a curated database of common skin diseases and terms we may use during your office visit. This is meant as a guide only. If you have specific questions about your conditions that need clarification, please call the office.
The American Academy of Dermatology
The official word from the governing body of the American Academy of Dermatology. Useful information about diagnoses and public events.
The Skin Cancer Foundation
Useful information about treatment and prevention of the most common cancers in human beings.
National Psoriasis Foundation
A skin disease affecting more than a million Americans.
