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Patient Education - Guides to prevention & Aftercare

The Dermatology Center of Williamsburg offers a library of dermatology information to help you understand your skin conditions supplemented by this website. Dr Corvette practices medicine based on the belief that knowledge is power and that the better her patients understand their skin conditions, the more effective she can be at healing them.

American Academy of Dermatology website
The Skin Cancer Foundation

Some of the external links below require free registration at emedicine.com.

• Aldara
• Biopsy Wound Care
• Efudex Treatment
• Liquid Nitrogen Treatment (Cryosurgery)
• Metastasis
• Milium
• Patch Testing - recommendations and schedule
• Seborrheic Keratosis
• Skin Cancer
• Sunscreen

Aldara

Studies have shown that Aldara cream can be effective treatment for pre-cancerous lesions when used as prescribed by your doctor. Previously, this medication was prescribed only for certain types of warts.

Instructions for Using Aldara

• Apply the cream to the entire affected full face area three times a week (usually at bedtime).
• Your doctor recommends that you wash the treatment area with mild soap and water approximately eight hours after the application (in the morning).
• Come to the office for a follow up visit for four weeks after beginning treatment.

Aldara's Possible Side Effects

• Usually the skin reactions that occur are mild to moderate. Redness, skin erosion (wearing away), flaking, swelling, itching/burning, scabbing might occur. If these reactions become too much of a problem for you, stop taking the medication until the flare-up is over.  Then, resume the medication again.   It’s fine to take a break from it during treatment.
• Report promptly: flu-like symptoms (fever, muscle aches) or rash.
• Use of a sunscreen is recommended.
• If you miss a dose, use it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not “double-up” the doses to catch up.
• Please call our office if you have any questions or concerns regarding your treatment with Aldara.

External Links:
More Aldara info at Wikipedia

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Biopsy Wound Care

Wash your hands with soap and water. Clean the biopsy site with a mixture of ½ hydrogen peroxide and ½ water daily.  Apply bacitracin ointment to the wound site.  Bacitracin is purchased over the counter and does not require a prescription.

If the wound becomes very itchy, you can assume that you are allergic to bacitracin. Substitute petroleum jelly (Vaseline) not Neosporin or triple antibiotic instead of bacitracin.  Don’t allow a crust to form in the wound or surgery site; gently remove the crust with a cotton swab and hydrogen peroxide. If the wound is kept moist daily with bacitracin or petroleum jelly, a crust will not form. Crusting and scabs delay wound healing.

Cover the wound daily with either a band-aid or non-stick pad. If any signs of infection appear (redness, pain, swelling, pus), I need to see you to treat you. Call us and let us know that you are coming in. If the clinic is not open, go to your primary care physician or urgent care for evaluation and treatment. If you are experiencing any problems with bleeding, apply sustained pressure to the wound for 30 minutes. If the bleeding does not stop, come in or go to your nearest emergency room or urgent care center. Always make me aware of any problems.

A biopsy is the removal of a small sample of skin, sometimes a stitch is placed. The piece of tissue is sent to a pathologist that examines the tissue under a microscope and renders a diagnosis. The pathologist will fax Dr. Corvette a copy of the report within 7 days. I have a “no news means no news” policy; If you do not hear from the office within 2 weeks, please call for the results. You never know if we have been trying to inform you and we have been unsuccessful. The results of the biopsy are reviewed with you in the clinic within 2 weeks after biopsy.

Billing

You will notice three fees:

1. Dr. Corvette’s fee for performing the biopsy.
2. Laboratory fee for the preparation of the biopsy.
3. Pathologist fee for the microscope reading of the tissue.

If you have any questions regarding fee #2 or #3; please contact the pathology laboratory.

Aftercare Following Stitch Removal

Once your sutures are removed, the surgical site generally needs no special treatment. You can stop covering the site with a Band-Aid or dressing. If the area remains a little crusty, apply petroleum jelly or bacitracin until the wound has healed. The surgical site will continue to heal over the next six to twelve months. Numbness may occur over the surgical site, and typically improves with time. The scar should flatten within 6 months.  Massage wound 3 times a day with any moisturizer. This will help to flatten the scar. If the scar does not flatten after 1 month (or if you have any concerns), see Dr. Corvette. Postoperative patients will always be worked into my clinic; just call the office and let us know that you are on your way.
Sunscreen is your friend.  Use an SPF 25 which blocks both UVA and UVB daily rain or shine, winter, summer, spring and fall.

If Your Surgery Was Due to Cancer

Expect another skin cancer. You will be asked to schedule dermatology appointments twice a year-I will perform a full body skin examination. If you notice a non-healing spot, new bump or changing mole in the interim; come in for an evaluation. Please don’t diagnose yourself.

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Efudex Treatment

Efudex (abbreviated 5-FU) has the ability to destroy pre-cancerous skin cells. Applying 5-FU to the skin removes the rough spots resulting form sun damage (Actinic Keratosis). The skin is then smoother and more youthful looking.

Apply 5-FU two times a day to the skin needing treatment. You may feel stinging or burning when you put 5-FU on your skin. This is normal. Three to five days after you start using 5-FU, your sun-damaged skin will become red and irritated. As you continue the treatment, sores and crusts will appear. These raw areas results from the destruction of defective skin cells. They are a necessary part of 5-FU treatment. The treatment usually continues for 2-4 weeks.

You should be seen 10-12 days after starting treatment to check on your progress and determine how long to continue using 5-FU. When treatment is stopped, your skin will heal rapidly; in 2-3 weeks healthy new skin will have replaced the sun-damaged skin destroyed by the 5-FU. After healing, the treated areas will be redder then normal; this redness will gradually fade in the next few months.

Directions for Using efudex

• Two times daily, apply the medicine very thinly to the treatment area with your fingertip and massage it in well.
• Afterward, wash your finger thoroughly with water.
• Do not get 5-FU in your eyes, and do not use it on your eyelids.
• Keep 5-FU off your eyelids.
• Use 5-FU with care in the area between the nose and cheeks since the medicine may irritate the folds around your nostrils.
• Do not sunbathe while using 5-FU. The sun tends to intensify your skin’s reaction to this medication. You want to avoid this.
• If your wish, you may wash the area that is to be treated with plain water before applying 5-FU.
• You may use makeup. Be sure to apply the 5-FU before applying makeup.
• If you notice an unusual or severe reaction, stop the medicine and contact the office.
• After you've been instructed to stop using 5-FU, apply plain white petroleum jelly (Vaseline) thinly to red and crusted areas at bedtime. This helps healing. Stop the petroleum when crusts and scabs have healed.
• CAUTION: 5-FU is a powerful, destructive medication and must be used exactly as directed. Keep it away from eyes and mouth. Keep your 5-FU locked so other people can not mistakenly use it.
• Once your skin is completely healed, we recommend using a sunscreen every day with an SPF of 25 or higher (rain or shine) to prevent further skin damage.

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Liquid Nitrogen Treatment (Cryosurgery)

Liquid nitrogen is a cold, liquid gas with a temperature of 196 degrees below zero Celsius (-321 Fahrenheit). It is used to freeze and destroy superficial skin growths such as warts and keratoses. Liquid nitrogen causes stinging and pain while the growth is being frozen and then thaws. The discomfort can last minutes to hours depending on the thickness of the lesion. If many areas are frozen, you may wish to take Tylenol, aspirin, or a medication like Advil just before or after treatment.

Some hours after liquid nitrogen treatment, your skin will become swollen and red; later on it may blister. Then a scab (crust) will form. It will fall off by itself in one to three weeks. The skin growth will come off along with the scab, leaving healthy, new skin.

If your growth requires deep freezing to remove, there may be considerable blistering and swelling, especially if your hands or eyelids were treated. The blisters and swelling are part of the treatment and will gradually heal by themselves.

No special care is needed after liquid nitrogen treatment. If blisters form, apply Bacitracin ointment to each area for about a week. You can wash your skin as usual and use makeup or other cosmetics. If clothing irritates the area, you may cover it with a small bandage (Band-Aid).

Sometimes liquid nitrogen treatment fails. If the growth is not cured by liquid nitrogen, please schedule a follow-up appointment.

External Links:
More Cryosurgery info at Wikipedia

Metastasis

More Metastasis info at Wikipedia

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Milium

Milium (plural, Milia) is the medical name for the whitehead, which is a small, round, white skin growth. Milia are usually found on the face and are common and harmless. Milia may appear after a superficial skin injury such as a burn or scrape. However, we usually don’t know why people grow milia. They tend to appear in adults, especially in those who had considerable sun exposure over the years. Sometimes they appear in crops in young people. They are not related to diet, cosmetics, or how you clean your skin. Many persons ignore their milia; others find them a cosmetic nuisance and wish to have them removed.

Treatment:

The milium is a small sac growing within the upper part of the skin. Because it is in the skin-and not on top of it- it can not be scratched, scraped or rubbed away. Milia can be removed by using a hypodermic needle to gently open the overlying skin and then flicking out the small sac. Some patients successfully “pop out” their milia with a sterile needle. However, most patients prefer to have a physician remove them’. If milia are large, I usually inject a local anesthetic (Xylocaine) and then the milium can be carefully removed without discomfort. Small milia are usually removed without anesthesia because the sting of the anesthetic may be worse than the pinprick required to remove the milium.

External Links:
More Milia info at emedicine
More Milia info at Wikipedia

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Patch Testing

Patch tests are often used to determine whether a person has an allergy to substances in the external environment. The method our Skin Test Laboratory uses is the Finn Chamber. The Finn Chamber consists of an aluminum disc, fastened onto Scanpor tape that is taped securely to the skin. Occlusion is essential for reliable results.  The patches remain in place for forty-eight hours. If you are allergic to one of the substances tested you will develop signs of skin irritation (redness, itching, and sometimes blistering) in the area where the material was applied.  The test areas have been marked with a marking pen so that the location of each test is known.  Do not remove the markings.

Recommendations for Patch Test Care:

• Please stop taking all antihistimines 5 days prior to application.  Ie: Allegra, Benadryl, Clarinex, Singulair, Atarax, Nasonex or any type of anti-itch/seasonal allergy medications.  Do not apply any type of ant-itch creams or lotions.
• Keep the entire patch area dry for the entire 5-day procedure!  Do not take a bath or shower until the test is over. You may sponge bathe, but do not wash your back.
• Do not engage in strenuous activity while the test is in progress.  Any activity in which considerable sweating occurs should be avoided, as this may cause the tape to loosen.
• At bedtime, it is preferable to wear a t-shirt to avoid catching the edges of the tape on the bed sheets.
• A positive test will itch.  Please refrain from scratching your back, since this may affect our interpretation.
• If any patch test site itches or burns severely remove it at once and notify our office.  There will, of course, be a little mild discomfort or itching associated with having tape on your skin or positive reaction.
• A positive test reaction may take several weeks to subside.

Patch Testing Schedule

• Monday : Patch test application in our office
• Wednesday : Remove the patch test yourself, at home
• Friday : You will come into office to have the results read

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How To Apply Retin-A

While your skin adapts to acne therapy with RETIN-A, you may experience some discomfort such as irritation, redness, and peeling. The following instructions may help minimize occurrence of these conditions.

• RETIN-A should be applied once nightly, or directed by your physician.
• Gently wash the face with a mild cleanser, such as PURPOSE Gentle Cleansing Soap, and dry. Wait 20 minutes for the face to fully dry.
• Apply only one capful to the entire face, avoiding the more sensitive areas around the eyes, nose, and corners of the mouth.
• Discontinue use of any astringents or drying agents.
• Apply a noncomedogenic moisturizer each morning. Daily sun protection is also important. Ortho Pharmaceutical Corporation recommends PURPOSE Dual Treatment Moisturizer with Sunscreen SPF 12, an elegant, noncomedogenic moisturizer with the added benefit of PABA-free sunscreens for everyday sun protection.
• For prolonged sun exposure, swimming, or heavy exercise, use an effective Waterproof sunscreen. Ortho recommends SUNDOWN Sunscreen, which is compatible with therapy with RETIN-A.
• Since RETIN-A nay make you more susceptible to sunburn, exposure to sunlight should be minimized. If you are sunburned, stop using RETIN-A until fully recovered.

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Seborrheic Keratosis

What Causes Seborrheic Keratoses?

Seborrheic keratoses are harmless, common skin growths that first appear during adult life. As time goes by, more growths appear. Some persons have a number of them. The tendency to develop seborrheic keratoses are inherited. Seborrheic keratoses are not caused by sunlight, however, long-term sun damage stimulates their growth. These growths are more numerous on the face, chest, and back than on the buttocks or other sites not exposed to sunlight.

Seborrheic keratoses are harmless and never become malignant. They begin as slightly raised, light brown spots. Gradually, they thicken and take on a rough, wart like surface. They slowly darken and may turn black. These color changes are harmless. Seborrheic keratoses are superficial and look as if they were stuck on the skin. Persons who have had several seborrheic keratoses can usually recognize this type of benign growth. However, if you are concerned or unsure about any growth, consult a dermatologist.

Treatment

Seborrheic keratoses can be removed easily in the office. The only reason for removing a seborrheic keratosis is your wish to get rid of it - if it is unsightly, itches, or annoys you by rubbing against your clothes.

External Links:
More Seborrheic Keratoses info at Wikipedia
More Seborrheic Keratoses info at emedicine

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Skin Cancer

Skin cancer is one of the most common cancers in humans and is becoming more common. It occurs most often in light-skinned patients who tend to sunburn easily. Exposure to the sun is most often associated with skin cancer. It is also the cause that is the easiest to control. Each time skin is exposed to the sun, damage is caused. This damage accumulates over time. Childhood sunburns may show up as skin cancer twenty years later.

There are three common types of skin cancer:

1. Basal cell carcinoma
2. Squamous cell carcinoma
3. Malignant melanoma

Basal Cell Carcinoma

This is the most common type of skin cancer. It usually appears as a small, transparent or pearly bump. As time passes, it will slowly grow and may crust and bleed. It can have other appearances. On the trunk of the body it can be a red, scaly, persistent patch. Some tumors can have pigment (turn brown or black) and some can resemble cysts. Rarely, they can look like a slowly enlarging scar. These tumors almost never spread to other areas of the body (metastasize). They can, however, grow locally and cause considerable problems.

Squamous Cell Carcinoma

This is the second most common type of skin cancer. Chronic sun exposure is the most common cause, but X-ray, arsenic exposure, and many other factors can cause squamous cell carcinoma. The tumors appear as persistent, crusted and scaly bumps. They usually grow faster than basal cell carcinomas. They can also scab or become an open sore. Squamous cell carcinomas that occur on sun-damaged skin seem to be less serious than those that arise from other causes and rarely spread to other areas of the body. Most studies indicate that only 1 in 200 cases will spread. However, eases of the lip, in the mouth, or on the genital area are more serious and have a higher rate of spreading.

Malignant Melanoma

This is the least common of the three most common skin cancers. It is the most serious. It is a fairly rare tumor but is becoming more common. If you are white-skinned, the present lifetime risk is 1 in 130. The rate of melanoma has been doubling every ten years. Currently, there are about 6,000 deaths from melanoma every year in the USA. For comparison, the lifetime risk for a woman having breast cancer is 1 in 10.

Many people falsely believe that a diagnosis of melanoma is a death sentence. This is absolutely not true. This is a very curable disease when diagnosed and treated early. Most melanomas will grow on the top of the skin for months or years before they begin to grow down. If they are diagnosed and treated while still thin, less than 1 mm thick, the cure rate exceeds 95%.

50% of melanomas appear as new moles and 50% occur in existing moles. When watching for mole changes, remember the ABCD’s of melanoma:

1. Asymmetry: One half unlike the other half.
2. Border: Irregular, scalloped or notched borders.
3. Color: Variable colors (tan, brown, black, red, etc.).
4. Diameter: Greater than 6mm; the diameter of a pencil eraser.

If one or more of these symptoms exist, please make an appointment with a dermatologist today.

External Links:

Basal cell carcinoma info at emedicine.com
Squamous cell carcinoma info at emedicine.com
Malignant melanoma info at emedicine.com

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Sunscreen

Dr. Corvette sincerely recommends that everyone wear a sunscreen of SPF-25 or greater, rain or shine. The sunscreens we provide do not have the ingredients which some suspect can increase the risk of melanoma.

External Links:
More information on what sunscreens are and how they work from The Skin Cancer Foundation
Sunscreen protection calculator
More sunscreen info at Wikipedia

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