TIP 1: Painlessly Removing Eyelid Milia
The eyelid is among the most sensitive areas of the human body. Contributing to this factor is the thinness of the skin in this area — it is approximately 1/50 as thick as skin located on the back. This thin quality accounts for the morphologic appearance of such eruptions as the pinched purpura of amyloidosis.
Common lesions appearing on the eyelids are milia. These lesions are among the most common on the faces of normal adults. The differential diagnosis of milia includes: molluscum, cutaneous cryptococcosis, (in immunocompromised patients) basal cell carcinoma (in older patients), fibrous papule of the face (especially around the nose), juvenile xanthogranuloma, keratoacanthoma, cysts and comedones. The cysts of milia are lined by one to four layers of stratified squamous epithelium with central collections of keratin and can resemble epidermal inclusion cysts.
To effectively remove milia on the eyelid, care must be taken to minimize trauma and pain. To minimize bruising and pain on the eyelid, milia can be removed with the nick of an 11 blade and then with lateral pressure applied to opposite edges of the milia with the small untoothed forceps.
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 2: Explaining to Patients How a Becker’s Nevus Is a Birthmark
Often, a patient with a Becker’s nevus will only first notice it at puberty, when there is hormonally driven darkening of the lesion and an increase in hair growth within it. When I try explaining to the patient that the Becker’s nevus is a form of “birthmark,” I am often met with resistance.
The patient tells me that there is absolutely no possibility that the nevus is a “birthmark” because it was not present at birth, nor during infancy or childhood, but only appeared recently. In this situation, I relate an analogy that I had read in a medical journal in which a Becker’s nevus was compared to a Polaroid photograph.
So this is what I tell my patients:
The moment the Polaroid photograph exits the Polaroid camera, the image is right there on the paper. However, the image is not visible right away, but rather takes about 5 minutes to appear. It was there all along right from the beginning, but only became visible to the human eye a few minutes after the photograph was shot. Similarly, the Becker’s nevus was there right at birth, but only became visible years later under the influence of hormones.
Norman Wasel, M.D., FRCPC
Edmonton, Alberta, Canada
TIP 3: Helping Patients Identify Sources of Chromium
A regular challenge in contact dermatitis post patch test is relaying the chemical interrelation of seemingly unrelated items to patients in a meaningful and memorable way.
One particularly difficult concept to grasp is that a product could, even on the first time used, cause a problem (if it contained the same chemical ingredient as another previously used product). Another difficult concept is that even if a product has been in use for years, it can now be the culprit (as the threshold for clinically expressing the reaction has now been reached).
To “drive this concept home” in clinic, we regularly ask patients what a paper clip, spinach, and our doorknob have in common. Invariably, once we receive the blank look, we explain to them that all the items contain a common ingredient — nickel. This helps to make it clear that each and every exposure from a wide range of sources counts. We explain that avoidance is the key to practicing the art of moderation.
Take a look at the pictorial puzzle on chromium, which was created for our clinic to simplify post-patch education. We give this to patients to help them remember their allergen and reinforce the idea that seemingly unrelated items may all contain one common chemical.
Can you identify all 10 sources of chromium in the items displayed in the above photo?
Solution:
1. Brewer’s yeast (Saccharomyces cerevisiae) is used in the beer brewing fermentation process and is a rich source of chromium (60 µg of chromium per tablespoon [15 grams]).
2. Green glass beer bottle. Chromium is one of the most powerful coloring agents used in the glassmaking industry. It is used to produce green glass in the form of chromic oxide or potassium dichromate.
3. Black pepper is a good food source of chromium in the diet, although it is consumed in small amounts.
4. Apple peel — 3.5 ounces contains approximately 27 µg of chromium.
5. Keys and other metal objects may contain chromium.
6. Multivitamins can contain between 2 µg and 150 µg of chromic chloride, chromium asporotate, chromium trivalent or chromium picolinate.
7. Mineral makeup may contain chromium oxide.
8. Chrome-tanned leather, which was invented in 1858, is tanned using chromium sulfate and other salts of chromium. The tanning process converts leather into a more durable, long-lasting and versatile material.
9. Chromic gut surgical suture (by Ethicon Inc.) is an absorbable, sterile surgical suture composed of purified collagen derived from beef or sheep intestines. Collagen is treated with chromium salts to delay breakdown and provide greater resistance to absorption.
10. Green felt pool tables have been associated with “blackjack dermatitis” caused by exposure to chromium salts used for dying the green felt.
Mari Paz Castanedo Tardan, M.D.
Miami, FL
Sharon E. Jacob, M.D.
San Diego, CA.
TIP 4: Body Seborrheic Dermatitis
Seborrheic dermatitis can be treated using antidandruff shampoos as body soaps. The exact etiology of seborrheic dermatitis is elusive and involves inflammation and fungal (yeast) colonization. Seborrheic dermatitis can occur on body areas beside the face and scalp and can manifests in fashions besides dandruff including:
• Erythrodermic — generalized
• Hypopigmented — face
• Cradle cap (in children under 6 months of age) — scalp
• Annular or geographic petaloid — chest
• Pityriasis or nummular type — trunk groin and the neck
• Pityriasis amiantacea — scalp
• Seborrheic blepharitis — eyes.
Agents that are anti-inflammatory and agents that are effective against yeast can be used therefore to treat seborrheic dermatitis. Many types of antidandruff shampoos have good activity against seborrheic dermatitis. Zinc pyrithione (e.g., Head & Shoulder Classic Clean), selenium sulfide (e.g., Selsun Blue), salicylic acid (e.g., Beta Sal, T-Sal, DHS Sal), coal tar (e.g., T-Gel, DHS Tar, ZeTar) antifungal agent (e.g., Nizoril Shampoo, Loprox Shampoo), topical corticosteroids (e.g., Capex, Clobex), tea tree oil (e.g., Paul Mitchell Tea Tree Special Shampoo).
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 5: Discussing Surgical Risks with Patient
Our office strives to create a comfortable and nurturing environment for our patients. At times, however, patients can become quite apprehensive and nervous before a surgical procedure. This often makes it very difficult to discuss surgical risks without heightening a patient’s anxiety level.
I often begin my discussion of surgical risks by reminding patients that minor surgical procedures carry many of the same risks as shaving. I explain to them that much like cutting the skin while shaving, common occurrences include bleeding, irritation, prolonged scarring, and even infection. The severity of these occurrences, however, depends on the severity of the procedure. This often provides a comfortable introduction to a full discussion of risks.
Our patients seem to appreciate the analogy and are not as intimidated by the discussions of bleeding and infection. They are often less apprehensive about the risks because they can relate to them in their ordinary lives.
Raffy Karamanoukian, M.D.
Santa Monica and Beverly Hills, CA
TIP 1: Painlessly Removing Eyelid Milia
The eyelid is among the most sensitive areas of the human body. Contributing to this factor is the thinness of the skin in this area — it is approximately 1/50 as thick as skin located on the back. This thin quality accounts for the morphologic appearance of such eruptions as the pinched purpura of amyloidosis.
Common lesions appearing on the eyelids are milia. These lesions are among the most common on the faces of normal adults. The differential diagnosis of milia includes: molluscum, cutaneous cryptococcosis, (in immunocompromised patients) basal cell carcinoma (in older patients), fibrous papule of the face (especially around the nose), juvenile xanthogranuloma, keratoacanthoma, cysts and comedones. The cysts of milia are lined by one to four layers of stratified squamous epithelium with central collections of keratin and can resemble epidermal inclusion cysts.
To effectively remove milia on the eyelid, care must be taken to minimize trauma and pain. To minimize bruising and pain on the eyelid, milia can be removed with the nick of an 11 blade and then with lateral pressure applied to opposite edges of the milia with the small untoothed forceps.
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 2: Explaining to Patients How a Becker’s Nevus Is a Birthmark
Often, a patient with a Becker’s nevus will only first notice it at puberty, when there is hormonally driven darkening of the lesion and an increase in hair growth within it. When I try explaining to the patient that the Becker’s nevus is a form of “birthmark,” I am often met with resistance.
The patient tells me that there is absolutely no possibility that the nevus is a “birthmark” because it was not present at birth, nor during infancy or childhood, but only appeared recently. In this situation, I relate an analogy that I had read in a medical journal in which a Becker’s nevus was compared to a Polaroid photograph.
So this is what I tell my patients:
The moment the Polaroid photograph exits the Polaroid camera, the image is right there on the paper. However, the image is not visible right away, but rather takes about 5 minutes to appear. It was there all along right from the beginning, but only became visible to the human eye a few minutes after the photograph was shot. Similarly, the Becker’s nevus was there right at birth, but only became visible years later under the influence of hormones.
Norman Wasel, M.D., FRCPC
Edmonton, Alberta, Canada
TIP 3: Helping Patients Identify Sources of Chromium
A regular challenge in contact dermatitis post patch test is relaying the chemical interrelation of seemingly unrelated items to patients in a meaningful and memorable way.
One particularly difficult concept to grasp is that a product could, even on the first time used, cause a problem (if it contained the same chemical ingredient as another previously used product). Another difficult concept is that even if a product has been in use for years, it can now be the culprit (as the threshold for clinically expressing the reaction has now been reached).
To “drive this concept home” in clinic, we regularly ask patients what a paper clip, spinach, and our doorknob have in common. Invariably, once we receive the blank look, we explain to them that all the items contain a common ingredient — nickel. This helps to make it clear that each and every exposure from a wide range of sources counts. We explain that avoidance is the key to practicing the art of moderation.
Take a look at the pictorial puzzle on chromium, which was created for our clinic to simplify post-patch education. We give this to patients to help them remember their allergen and reinforce the idea that seemingly unrelated items may all contain one common chemical.
Can you identify all 10 sources of chromium in the items displayed in the above photo?
Solution:
1. Brewer’s yeast (Saccharomyces cerevisiae) is used in the beer brewing fermentation process and is a rich source of chromium (60 µg of chromium per tablespoon [15 grams]).
2. Green glass beer bottle. Chromium is one of the most powerful coloring agents used in the glassmaking industry. It is used to produce green glass in the form of chromic oxide or potassium dichromate.
3. Black pepper is a good food source of chromium in the diet, although it is consumed in small amounts.
4. Apple peel — 3.5 ounces contains approximately 27 µg of chromium.
5. Keys and other metal objects may contain chromium.
6. Multivitamins can contain between 2 µg and 150 µg of chromic chloride, chromium asporotate, chromium trivalent or chromium picolinate.
7. Mineral makeup may contain chromium oxide.
8. Chrome-tanned leather, which was invented in 1858, is tanned using chromium sulfate and other salts of chromium. The tanning process converts leather into a more durable, long-lasting and versatile material.
9. Chromic gut surgical suture (by Ethicon Inc.) is an absorbable, sterile surgical suture composed of purified collagen derived from beef or sheep intestines. Collagen is treated with chromium salts to delay breakdown and provide greater resistance to absorption.
10. Green felt pool tables have been associated with “blackjack dermatitis” caused by exposure to chromium salts used for dying the green felt.
Mari Paz Castanedo Tardan, M.D.
Miami, FL
Sharon E. Jacob, M.D.
San Diego, CA.
TIP 4: Body Seborrheic Dermatitis
Seborrheic dermatitis can be treated using antidandruff shampoos as body soaps. The exact etiology of seborrheic dermatitis is elusive and involves inflammation and fungal (yeast) colonization. Seborrheic dermatitis can occur on body areas beside the face and scalp and can manifests in fashions besides dandruff including:
• Erythrodermic — generalized
• Hypopigmented — face
• Cradle cap (in children under 6 months of age) — scalp
• Annular or geographic petaloid — chest
• Pityriasis or nummular type — trunk groin and the neck
• Pityriasis amiantacea — scalp
• Seborrheic blepharitis — eyes.
Agents that are anti-inflammatory and agents that are effective against yeast can be used therefore to treat seborrheic dermatitis. Many types of antidandruff shampoos have good activity against seborrheic dermatitis. Zinc pyrithione (e.g., Head & Shoulder Classic Clean), selenium sulfide (e.g., Selsun Blue), salicylic acid (e.g., Beta Sal, T-Sal, DHS Sal), coal tar (e.g., T-Gel, DHS Tar, ZeTar) antifungal agent (e.g., Nizoril Shampoo, Loprox Shampoo), topical corticosteroids (e.g., Capex, Clobex), tea tree oil (e.g., Paul Mitchell Tea Tree Special Shampoo).
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 5: Discussing Surgical Risks with Patient
Our office strives to create a comfortable and nurturing environment for our patients. At times, however, patients can become quite apprehensive and nervous before a surgical procedure. This often makes it very difficult to discuss surgical risks without heightening a patient’s anxiety level.
I often begin my discussion of surgical risks by reminding patients that minor surgical procedures carry many of the same risks as shaving. I explain to them that much like cutting the skin while shaving, common occurrences include bleeding, irritation, prolonged scarring, and even infection. The severity of these occurrences, however, depends on the severity of the procedure. This often provides a comfortable introduction to a full discussion of risks.
Our patients seem to appreciate the analogy and are not as intimidated by the discussions of bleeding and infection. They are often less apprehensive about the risks because they can relate to them in their ordinary lives.
Raffy Karamanoukian, M.D.
Santa Monica and Beverly Hills, CA
TIP 1: Painlessly Removing Eyelid Milia
The eyelid is among the most sensitive areas of the human body. Contributing to this factor is the thinness of the skin in this area — it is approximately 1/50 as thick as skin located on the back. This thin quality accounts for the morphologic appearance of such eruptions as the pinched purpura of amyloidosis.
Common lesions appearing on the eyelids are milia. These lesions are among the most common on the faces of normal adults. The differential diagnosis of milia includes: molluscum, cutaneous cryptococcosis, (in immunocompromised patients) basal cell carcinoma (in older patients), fibrous papule of the face (especially around the nose), juvenile xanthogranuloma, keratoacanthoma, cysts and comedones. The cysts of milia are lined by one to four layers of stratified squamous epithelium with central collections of keratin and can resemble epidermal inclusion cysts.
To effectively remove milia on the eyelid, care must be taken to minimize trauma and pain. To minimize bruising and pain on the eyelid, milia can be removed with the nick of an 11 blade and then with lateral pressure applied to opposite edges of the milia with the small untoothed forceps.
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 2: Explaining to Patients How a Becker’s Nevus Is a Birthmark
Often, a patient with a Becker’s nevus will only first notice it at puberty, when there is hormonally driven darkening of the lesion and an increase in hair growth within it. When I try explaining to the patient that the Becker’s nevus is a form of “birthmark,” I am often met with resistance.
The patient tells me that there is absolutely no possibility that the nevus is a “birthmark” because it was not present at birth, nor during infancy or childhood, but only appeared recently. In this situation, I relate an analogy that I had read in a medical journal in which a Becker’s nevus was compared to a Polaroid photograph.
So this is what I tell my patients:
The moment the Polaroid photograph exits the Polaroid camera, the image is right there on the paper. However, the image is not visible right away, but rather takes about 5 minutes to appear. It was there all along right from the beginning, but only became visible to the human eye a few minutes after the photograph was shot. Similarly, the Becker’s nevus was there right at birth, but only became visible years later under the influence of hormones.
Norman Wasel, M.D., FRCPC
Edmonton, Alberta, Canada
TIP 3: Helping Patients Identify Sources of Chromium
A regular challenge in contact dermatitis post patch test is relaying the chemical interrelation of seemingly unrelated items to patients in a meaningful and memorable way.
One particularly difficult concept to grasp is that a product could, even on the first time used, cause a problem (if it contained the same chemical ingredient as another previously used product). Another difficult concept is that even if a product has been in use for years, it can now be the culprit (as the threshold for clinically expressing the reaction has now been reached).
To “drive this concept home” in clinic, we regularly ask patients what a paper clip, spinach, and our doorknob have in common. Invariably, once we receive the blank look, we explain to them that all the items contain a common ingredient — nickel. This helps to make it clear that each and every exposure from a wide range of sources counts. We explain that avoidance is the key to practicing the art of moderation.
Take a look at the pictorial puzzle on chromium, which was created for our clinic to simplify post-patch education. We give this to patients to help them remember their allergen and reinforce the idea that seemingly unrelated items may all contain one common chemical.
Can you identify all 10 sources of chromium in the items displayed in the above photo?
Solution:
1. Brewer’s yeast (Saccharomyces cerevisiae) is used in the beer brewing fermentation process and is a rich source of chromium (60 µg of chromium per tablespoon [15 grams]).
2. Green glass beer bottle. Chromium is one of the most powerful coloring agents used in the glassmaking industry. It is used to produce green glass in the form of chromic oxide or potassium dichromate.
3. Black pepper is a good food source of chromium in the diet, although it is consumed in small amounts.
4. Apple peel — 3.5 ounces contains approximately 27 µg of chromium.
5. Keys and other metal objects may contain chromium.
6. Multivitamins can contain between 2 µg and 150 µg of chromic chloride, chromium asporotate, chromium trivalent or chromium picolinate.
7. Mineral makeup may contain chromium oxide.
8. Chrome-tanned leather, which was invented in 1858, is tanned using chromium sulfate and other salts of chromium. The tanning process converts leather into a more durable, long-lasting and versatile material.
9. Chromic gut surgical suture (by Ethicon Inc.) is an absorbable, sterile surgical suture composed of purified collagen derived from beef or sheep intestines. Collagen is treated with chromium salts to delay breakdown and provide greater resistance to absorption.
10. Green felt pool tables have been associated with “blackjack dermatitis” caused by exposure to chromium salts used for dying the green felt.
Mari Paz Castanedo Tardan, M.D.
Miami, FL
Sharon E. Jacob, M.D.
San Diego, CA.
TIP 4: Body Seborrheic Dermatitis
Seborrheic dermatitis can be treated using antidandruff shampoos as body soaps. The exact etiology of seborrheic dermatitis is elusive and involves inflammation and fungal (yeast) colonization. Seborrheic dermatitis can occur on body areas beside the face and scalp and can manifests in fashions besides dandruff including:
• Erythrodermic — generalized
• Hypopigmented — face
• Cradle cap (in children under 6 months of age) — scalp
• Annular or geographic petaloid — chest
• Pityriasis or nummular type — trunk groin and the neck
• Pityriasis amiantacea — scalp
• Seborrheic blepharitis — eyes.
Agents that are anti-inflammatory and agents that are effective against yeast can be used therefore to treat seborrheic dermatitis. Many types of antidandruff shampoos have good activity against seborrheic dermatitis. Zinc pyrithione (e.g., Head & Shoulder Classic Clean), selenium sulfide (e.g., Selsun Blue), salicylic acid (e.g., Beta Sal, T-Sal, DHS Sal), coal tar (e.g., T-Gel, DHS Tar, ZeTar) antifungal agent (e.g., Nizoril Shampoo, Loprox Shampoo), topical corticosteroids (e.g., Capex, Clobex), tea tree oil (e.g., Paul Mitchell Tea Tree Special Shampoo).
Noah Scheinfeld, M.D.
Chief of Pediatric Dermatology
Chief of Clinical Trials in the Department of Dermatology at Metropolitan Hospital/New York Medical College
Assistant Clinical Professor of Dermatology at Columbia University
Assistant Attending at Beth Israel Medical Center, St. Luke’s Roosevelt Hospital Center and the New York Eye and Ear Infirmary
New York City, NY
TIP 5: Discussing Surgical Risks with Patient
Our office strives to create a comfortable and nurturing environment for our patients. At times, however, patients can become quite apprehensive and nervous before a surgical procedure. This often makes it very difficult to discuss surgical risks without heightening a patient’s anxiety level.
I often begin my discussion of surgical risks by reminding patients that minor surgical procedures carry many of the same risks as shaving. I explain to them that much like cutting the skin while shaving, common occurrences include bleeding, irritation, prolonged scarring, and even infection. The severity of these occurrences, however, depends on the severity of the procedure. This often provides a comfortable introduction to a full discussion of risks.
Our patients seem to appreciate the analogy and are not as intimidated by the discussions of bleeding and infection. They are often less apprehensive about the risks because they can relate to them in their ordinary lives.
Raffy Karamanoukian, M.D.
Santa Monica and Beverly Hills, CA
