🩺 Case Report: Evaluation of Acute Rash in a 54-Year-Old Female — Village Dermatology, Katy & Houston, Texas
A 54-year-old woman was evaluated at Village Dermatology in Katy and Houston, Texas for a right arm rash. A KOH test was negative, and the rash was treated as dermatitis with topical triamcinolone and follow-up in 3 weeks.
Patient Overview
A 54-year-old female presented to Village Dermatology as a new patient with a 2–3 week history of a rash on her right arm. The rash was asymptomatic, moderate in severity, and persistent despite a 7-day course of oral antibiotics previously prescribed at urgent care.
She also reported a small irritated spot on her right cheek.
Clinical Examination
A focused examination was performed on the face and right upper extremity, utilizing dermatoscopy.
The patient appeared well developed, well nourished, and in no acute distress.
Findings:
Right proximal dorsal forearm: Patches consistent with dermatitis vs arthropod assault
KOH test: Negative for fungal hyphae, decreasing likelihood of tinea corporis
Right cheek: Mild irritation, suitable for topical steroid spot therapy
Diagnosis
1. Dermatitis, Unspecified (L30.9)
Given the clinical appearance, negative KOH prep, and healing pattern, the rash was most consistent with a resolving arthropod bite reaction or nonspecific dermatitis.
Differential Diagnosis:
Dermatitis (most likely)
Arthropod bite
Tinea corporis (less likely due to negative KOH)
Treatment Plan
1. Topical Steroid Therapy
The patient was prescribed:
Triamcinolone acetonide 0.1% cream
Apply twice daily to affected areas for 2 weeks
Avoid using more than 14 days per month
For the spot on the right cheek:
Triamcinolone 0.1% for 3 days only, to avoid facial steroid overuse.
2. Skin Care Counseling
The patient was advised to:
Use regular emollients to support skin hydration
Avoid irritants and scratching
Monitor for spread, pain, or systemic symptoms
She was reminded that diagnosis is not fully definitive, and empiric therapy plus follow-up evaluation is appropriate.
When to Call the Office:
Fever develops
Rash worsens despite treatment
New symptoms such as drainage, blistering, or increased redness occur
3. KOH Preparation
A KOH prep was performed on the right forearm lesion:
Sample collected with a 15-blade scalpel
No hyphae visualized, reducing suspicion for dermatophyte infection
Follow-Up Plan
The patient will return in 3 weeks for reassessment.
At follow-up, clinicians will evaluate:
Rash resolution
Need for additional diagnostics
Possible switch to alternative therapy if symptoms persist
⭐ Takeaway
This case demonstrates a common scenario where an acute rash may mimic infection, dermatitis, or arthropod exposure. At Village Dermatology, serving Katy, Texas and Houston, Texas, precise diagnostic tools such as KOH prep and clinical dermoscopy help guide effective, evidence-based treatment decisions.
🩺 Case Report: Melasma & New Skin Lesion Evaluation in a 56-Year-Old Female — Village Dermatology, Katy & Houston, Texas
A 56-year-old female was evaluated at Village Dermatology in Katy and Houston, Texas for chronic melasma and a new red lesion on the forearm, treated with topical tretinoin and a shave biopsy for accurate diagnosis.
Patient Overview
A 56-year-old female presented to Village Dermatology as a new patient with two primary concerns:
Chronic facial discoloration on the cheeks, present for years
A new red lesion on the left forearm that appeared approximately six weeks ago
She sought expert evaluation and updated management for both concerns.
Clinical Examination
A focused dermatologic exam was performed, including the scalp, face, cheeks, and left forearm.
The patient appeared well-developed, well-nourished, and in no distress. A dermatoscope was used to closely examine both the hyperpigmented facial patches and the left forearm lesion.
Findings:
Melasma: Ill-defined hyperpigmented patches across the periorbital and malar (cheek) regions
Left forearm lesion: A red plaque on the ventral proximal forearm, suspicious for a neoplasm requiring biopsy
Diagnosis
1. Melasma (L81.1)
A chronic, hormonally and UV-triggered pigmentation disorder characterized by blotchy hyperpigmented facial patches.
2. Neoplasm of Unspecified Behavior (D49.2)
A new red plaque on the left forearm with differential diagnosis including:
Lichenoid keratosis
Actinic keratosis
Squamous cell carcinoma in situ
Benign neoplasm of uncertain behavior
Given clinical uncertainty, biopsy was recommended for definitive diagnosis.
Treatment Plan
1. Melasma Management
The patient received extensive education on sun protection and pigmentation triggers.
Although previously using hydroquinone, she declined restarting it and elected to begin tretinoin 0.025% cream, which was prescribed.
Key Counseling Points:
Apply a pea-sized amount of tretinoin at bedtime
Wait 30 minutes after washing the face before applying
Use a moisturizer if dryness occurs
Strict sun protection is essential
Reapply SPF 30+ sunscreen every 2 hours when outdoors
Avoid harsh bleaching agents, mercury-containing creams, resorcinol, or phenol-based products
Additional Treatment Options Reviewed:
Topical vitamin C
Glycolic acid
Tranexamic acid
Superficial chemical peels
Non-ablative Fraxel laser
Photographs were taken to monitor progress at the next visit.
2. Forearm Lesion: Shave Biopsy
Given the concerning appearance and differential, the patient proceeded with a shave biopsy.
Procedure Summary:
Location: Left ventral proximal forearm
Anesthesia: 0.5 cc lidocaine with epinephrine
Technique: Dermablade shave biopsy to the dermis
Hemostasis: Achieved with Drysol
Dressing: Petrolatum and bandage applied
Pathology: Specimen sent for H&E staining
Follow-up: Patient to be notified of results; instructed to call if not contacted within 2 weeks
The patient tolerated the procedure well.
Follow-Up
A follow-up appointment was scheduled in 3 months to:
✔ Reassess melasma with updated photos
✔ Review biopsy results and determine next steps
✔ Evaluate progress with tretinoin and sun protection routines
Patient Counseling & Education
The patient was advised to contact the office if:
Melasma worsens
She develops irritation from tretinoin
The biopsy site fails to heal or new lesions develop
She notices ulceration, bleeding, or rapid growth of any skin lesion
At Village Dermatology in Katy and Houston, Texas, we focus on early detection, personalized skin rejuvenation, and evidence-based treatment for all pigment and lesion concerns.
Case Report: Androgenetic Alopecia Management With Oral Minoxidil & Finasteride in a 30-Year-Old Male
A 30-year-old male from Katy, Texas presented with sudden-onset hair thinning consistent with androgenetic alopecia. Learn how Village Dermatology uses oral minoxidil and finasteride to treat hair loss for patients in Katy and Houston, TX.
Patient Presentation
A 30-year-old male presented to our dermatology clinic in Katy, Texas, with a chief complaint of generalized hair loss. The hair thinning began suddenly several months ago and has progressively worsened. The patient noted diffuse thinning across the scalp, with particular loss at the crown, a hallmark of male pattern hair loss.
He had not yet started any formal treatment prior to this visit.
Clinical Examination
A detailed examination of the scalp, face, head, and ears was performed using a dermatoscope. The patient was well-developed, well-nourished, and in no acute distress.
Findings included:
Diffuse, non-scarring hair thinning
Patterned hair loss over the vertex/crown
No signs of inflammation, scaling, or scarring alopecia
Based on clinical evaluation, the diagnosis was consistent with androgenetic alopecia (AGA).
During the exam, benign lentigines and a compound nevus were also noted.
Diagnoses
1. Androgenetic Alopecia (L64.8)
Diffuse non-scarring hair loss with vertex thinning.
2. Lentigines (L81.4)
Benign sun-induced pigmented lesions.
3. Compound Nevus (D22.62)
Benign flesh-colored papules on the skin.
Treatment Plan
1. Androgenetic Alopecia
An in-depth discussion covered all treatment options, including:
Oral minoxidil
Finasteride
Topical minoxidil (Rogaine)
Low-level laser therapy
Hair transplantation
PRP (Platelet-Rich Plasma)
AlmaTED hair restoration
Hair supplements
The patient elected to begin:
✔ Oral Minoxidil
Start ½ tablet daily for 1 month
If tolerated, increase to 1 full tablet daily
Counseled on temporary shedding during the first 8–10 weeks
Advised to stop and contact the office if experiencing:
Chest pain
Shortness of breath
Leg/ankle swelling
Fast heart rate
Dizziness
Low blood pressure
Headaches
✔ Finasteride 1 mg once daily
Reviewed risks, including sexual side effects
Discussed long-term stabilization and thickening benefits
A follow-up will assess tolerance, progress, and potential need for adjunctive therapies.
2. Lentigines
Education and counseling included:
Lentigines are benign sun-induced lesions
Improve with:
Daily SPF 30+ sunscreen
Sun avoidance
Retinoids
Chemical peels
Laser therapy (recommended for best cosmetic improvement)
3. Compound Nevus
Benign
No treatment required
Recommended monthly self-skin checks
Use SPF 30+ sunscreen daily
Report changes in size, shape, color, itch, or bleeding
Discussion
Understanding Androgenetic Alopecia
Androgenetic alopecia is the most common form of hair loss in men and is genetically predetermined. It typically presents with:
Thinning at the vertex (crown)
Recession at the temples
Progressive miniaturization of hair follicles
Modern therapy focuses on slowing hair loss, thickening existing hair, and stimulating regrowth.
Oral minoxidil + finasteride is one of the most effective combinations and continues to gain popularity for its convenience and strong clinical results.
At Village Dermatology in Katy and Houston, TX, Dr. Reena Jogi provides individualized hair loss management using evidence-based medical and procedural therapies, including PRP and AlmaTED.
Conclusion
This case highlights the management approach for a 30-year-old male with androgenetic alopecia. With oral minoxidil and finasteride, the patient is expected to see stabilization and regrowth over the next several months. Ongoing monitoring ensures both treatment success and safety.
Case Report: Cosmetic Removal of Neck and Facial Skin Tags in a 42-Year-Old Male
A 42-year-old male from Katy, Texas underwent cosmetic removal of multiple skin tags on the face and neck at Village Dermatology. Learn how Dr. Reena Jogi treats acrochordons and DPNs for patients in Houston and Katy, TX.
by: Dr. Caroline Vaughn
Patient Presentation
A 42-year-old male presented to our dermatology clinic in Katy, Texas with a chief complaint of multiple unsightly skin lesions on the left cheek, right cheek, and left eye area. These lesions were cosmetically bothersome, and the patient sought treatment for removal.
Clinical Examination
A focused dermatologic examination of the face and neck was performed.
Findings included:
Multiple pedunculated papules consistent with acrochordons (skin tags)
Distribution included:
Right superior and central lateral neck
Left central and superior lateral neck
Left medial canthus
Right and left clavicular neck
Left inferior anterior neck
The patient was well-developed, well-nourished, alert, and in no acute distress. Dermatoscopy was used to confirm the benign nature of the lesions.
Diagnosis
Acrochordon (Skin Tags) – (L91.8)
Multiple benign pedunculated lesions across the neck and periocular area.
Treatment Plan
1. Skin Tag Removal (Cosmetic)
After thorough discussion and written informed consent, the risks and benefits were reviewed, including:
Bleeding
Infection
Pain
Pigmentary changes
Scarring (rare)
Procedure Performed:
10 skin tags were removed using gradle excision
Local anesthesia achieved with 3cc of 1% lidocaine with epinephrine
Sites cleaned and prepared in sterile fashion
Hemostasis achieved without complication
2. Future Treatment for DPNs
Dermatosis papulosa nigra (DPNs) were observed, and the patient was counseled that:
These will be treated at the follow-up visit in 1 month
Electrodesiccation is the planned method
Strict sunscreen use is recommended to avoid post-inflammatory hyperpigmentation after treatment
Counseling & Education
Understanding Skin Tags
Acrochordons are benign, extremely common skin lesions
Often occur in areas of friction such as the neck, eyelids, and underarms
May become irritated by clothing or jewelry
Removal is cosmetic, not medically necessary unless inflamed
Post-Care Recommendations
Clean treated areas gently
Apply petroleum jelly or antibiotic ointment if mild crusting occurs
Avoid picking at healing sites
Use broad-spectrum SPF 30+ sunscreen daily to prevent pigmentation changes
Return for evaluation if lesions recur or new growth develops
Discussion
Skin tags are among the most frequent benign growths evaluated in dermatology clinics. While harmless, they can be cosmetically undesirable or physically irritating. Simple procedures like gradle excision provide immediate results with minimal downtime.
For patients with both skin tags and DPNs, a staged treatment approach is ideal—addressing skin tags first, followed by cosmetic removal of DPNs using electrodesiccation.
At Village Dermatology in Katy and Houston, Texas, we specialize in safe, effective removal of benign facial and neck lesions with excellent cosmetic outcomes.
Conclusion
This 42-year-old male underwent successful cosmetic removal of 10 skin tags across the neck and periocular area. He will return in one month for DPN treatment. With proper aftercare and sun protection, he is expected to heal well with excellent cosmetic results.
🩺 Case Report: Actinic Keratosis Treatment in an 81-Year-Old Female — Village Dermatology, Katy & Houston, Texas
An 81-year-old woman was treated at Village Dermatology in Katy and Houston, Texas for actinic keratoses on the nose using liquid nitrogen, with evaluation of multiple benign lesions and detailed sun protection counseling.
Patient Overview
An 81-year-old female presented to Village Dermatology as a new patient with a primary concern of a bleeding skin lesion on the nose, present for several months. The lesion had not been previously treated, and she sought evaluation and management.
A complete skin exam of the head, face, ears, upper extremities, and scalp was performed with dermatoscopic evaluation.
The patient appeared well-nourished, alert, oriented, and in no acute distress.
Clinical Findings
1. Actinic Keratoses (L57.0)
On examination of the nasal dorsum, erythematous patches with hyperkeratotic scale were noted—highly consistent with actinic keratoses (AKs).
Actinic keratoses are precancerous growths resulting from cumulative sun damage. A small percentage may progress to squamous cell carcinoma, making early treatment essential.
Treatment Plan: Liquid Nitrogen Therapy
The patient underwent cryotherapy for one lesion on the nose:
Liquid nitrogen was applied to destroy the precancerous cells
Risks discussed included blistering, scabbing, hypopigmentation or hyperpigmentation, infection, incomplete removal, and recurrence
She tolerated the procedure well.
Counseling for Actinic Keratoses
The patient was educated on:
Using broad-spectrum SPF 30+ sunscreen daily
Wearing sun-protective clothing and hats
Monitoring for lesions that bleed, ulcerate, or fail to heal
Treatment options such as cryotherapy, photodynamic therapy, imiquimod, and 5-fluorouracil
Additional Dermatologic Findings
2. Benign Nevi (D22.39)
Regular, symmetrical, evenly colored moles were noted on the right cheek.
These lesions were benign and required no treatment.
Counseling Included:
Monthly self-skin checks
Monitoring for changes in size, shape, color, itching, burning, or bleeding
3. Seborrheic Keratoses (L82.1)
Benign, waxy, warty growths found on:
Right upper back
Left inframammary fold
Right lateral breast
Right proximal calf
No treatment required unless for cosmetic reasons.
4. Cherry Angiomas (D18.01)
A benign vascular papule on the left mid-back.
Counseling included cosmetic removal options such as:
Electrodesiccation
Laser therapy
5. Lentigines (L81.4)
Sun-induced brown spots found on:
Dorsal forearms
Upper sternum
Mid-back
These are benign but responsive to:
Sunscreen
Topical lightening agents
Chemical peels
Retinoids
Laser therapy
She was again counseled in detail on proper sunscreen use, including reapplication every 2 hours and using at least 1 ounce for full-body coverage.
6. Acrochordons (Skin Tags) (L91.8)
Benign skin tags present on the body; cosmetic removal was offered:
Up to 10 lesions for $150
Follow-Up
The patient was encouraged to return for evaluation if:
Any lesion fails to heal
A treated AK becomes painful, enlarging, or bleeds
New suspicious lesions appear
Routine skin checks were recommended given her sun damage history and age.
🌞 Takeaway
This case highlights the importance of early detection and treatment of actinic keratoses, especially in older adults with significant sun exposure history. At Village Dermatology in Katy and Houston, Texas, we provide comprehensive evaluation, advanced treatments, and ongoing sun protection guidance to promote healthy skin at every age.
Case Report: Management of Chronic Scalp Psoriasis with Zoryve Foam in a 35-Year-Old Female
A 35-year-old female from Katy, Texas presented with chronic scalp psoriasis and persistent dandruff. After limited response to clobetasol, she began treatment with Zoryve Foam. Learn how Village Dermatology in Houston and Katy manages scalp psoriasis with modern, non-steroidal therapy.
Patient Presentation
A 35-year-old female presented to our dermatology clinic in Katy, Texas, with a chief complaint of persistent dandruff accompanied by scalp itching and flaking. She described her symptoms as moderate in severity and had been struggling with the condition for several months.
The patient reported prior treatment with Clobetasol Solution, which initially improved her symptoms but lost effectiveness over time. She also used over-the-counter shampoos and apple cider vinegar, with minimal improvement.
Clinical Examination
A comprehensive dermatologic examination was performed, including evaluation of the scalp, ears, neck, and upper body. The patient appeared well-developed and well-nourished, alert, and in no acute distress.
On physical exam, the scalp showed erythematous, scaly plaques distributed over the left medial frontal and superior parietal scalp—consistent with scalp psoriasis. No signs of infection or folliculitis were present. A dermatoscope was used for detailed assessment.
Diagnosis
Scalp Psoriasis (L40.0) – Chronic, stable condition involving erythema, scaling, and plaques.
Treatment Plan
1. Medication: Zoryve Foam (Topical Roflumilast 0.3%)
The patient was prescribed Zoryve Foam, a once-daily topical phosphodiesterase-4 (PDE4) inhibitor designed for targeted control of psoriasis inflammation.
Instructions: Apply once daily to affected areas of the scalp, preferably at night.
Prescription Details:
Zoryve 0.3% Foam
Apply to scalp once daily
60g tube with 3 refills
Counseling and Expectations:
Skin Care: Use gentle, hydrating shampoos formulated with zinc pyrithione, tar, or selenium.
Expectations: Scalp psoriasis is chronic and often cycles between periods of remission and flare-ups. Stress, seasonal changes, and hair products can trigger flares.
When to Contact Office: If psoriasis worsens or fails to improve after several months of consistent use.
Side Effects: Mild local irritation or itching may occur but typically resolves with continued use.
The patient was educated on proper foam application and advised to maintain consistency with treatment. A follow-up visit in 3 months was scheduled to assess therapeutic response and tolerability.
Discussion
Scalp psoriasis is a chronic inflammatory skin condition characterized by thick, scaly plaques and redness of the scalp, often associated with itching, flaking, and embarrassment for patients.
Traditional treatments like topical corticosteroids or coal tar-based shampoos can lose effectiveness over time or cause irritation with long-term use.
The introduction of Zoryve Foam (roflumilast 0.3%) has provided a modern, non-steroidal option that targets the inflammatory cascade through PDE4 inhibition, reducing redness, scaling, and itch while minimizing steroid-related side effects.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi customizes treatment regimens using advanced topical and systemic options to restore scalp health and patient confidence.
Conclusion
This case demonstrates successful management of chronic scalp psoriasis using Zoryve Foam, offering an effective, steroid-free alternative for patients with persistent flaking and itching. With proper counseling and adherence, the patient is expected to achieve improved scalp health and long-term control of symptoms.
Case Report: Managing Hidradenitis Suppurativa in a 45-Year-Old Female with Chronic Axillary Flares
A 45-year-old female with chronic hidradenitis suppurativa (HS) affecting both underarms was successfully managed with oral doxycycline, clindamycin gel, and intralesional corticosteroid injections at Village Dermatology in Katy and Houston, Texas.
by: Dr. Caroline Vaughn
Introduction
At Village Dermatology, serving patients throughout Katy and Houston, Texas, we frequently see individuals struggling with hidradenitis suppurativa (HS)—a chronic inflammatory skin condition that can significantly impact quality of life. This case highlights the evaluation and management of a 45-year-old female with a one-year history of recurrent, painful lesions under both arms.
Case Presentation
A 45-year-old female presented as a new patient for evaluation of a persistent rash and painful swelling involving both axillae (underarms). The affected areas were red, swollen, tender, and draining fluid. The condition had persisted for about one year, and prior treatments with mupirocin ointment and ibuprofen (Motrin) offered minimal relief.
Her medical history included type 2 diabetes mellitus and hypertension, managed with metformin and lisinopril. She denied tobacco or alcohol use.
Clinical Examination
Examination of the right and left axilla revealed multiple inflammatory nodules, pustules, scarring, and sinus tracts, characteristic of advanced-stage hidradenitis suppurativa. The findings were consistent with a chronic, relapsing disease pattern.
Diagnosis
Hidradenitis Suppurativa (HS) – Stage II/III
ICD-10: L73.2
The presentation included weeping acneiform pustules and papules with scarring and sinus tract formation in both axillary vaults.
Treatment and Management
The patient was counseled on the chronic and recurrent nature of HS and educated on comprehensive treatment strategies, including:
Antibacterial cleansing with benzoyl peroxide wash
Topical antibiotic therapy with clindamycin 1% gel applied daily
Oral antibiotic therapy with doxycycline 100 mg twice daily for 3 months
Intralesional corticosteroid (Kenalog) injections administered to two inflamed nodules (5 mg/cc concentration, 1 cc total volume)
The risks of skin atrophy from steroid injections were discussed. She was also advised to practice gentle hygiene and wear breathable clothing to minimize irritation.
Long-Term Management Discussion
To reduce recurrence and disease progression, the patient was counseled on long-term options, including:
Spironolactone (for hormonal modulation)
Biologic therapy (such as adalimumab) for moderate to severe HS
Surgical excision for persistent or extensive sinus tracts
The patient was referred to Dr. Rodger Brown, Plastic Surgery (Houston, TX) for consultation regarding surgical management should she elect to pursue definitive treatment.
Follow-Up Plan
The patient will return in two months for reassessment of her response to oral and topical therapy. She was advised to contact the office sooner if she experiences worsening lesions or persistent drainage.
Discussion
Hidradenitis Suppurativa is a chronic inflammatory condition often mistaken for recurrent infections or acne. It typically affects areas with apocrine glands—such as the underarms, groin, or inframammary folds—and can lead to scarring, abscesses, and sinus tract formation over time. Early and consistent dermatologic care is essential for controlling inflammation, preventing complications, and improving quality of life.
At Village Dermatology, our team provides a comprehensive, individualized approach to HS management, combining medical, procedural, and lifestyle strategies tailored to each patient’s needs.
Comprehensive Skin Exam and Hair Loss Evaluation in a 40-Year-Old Female: Sun Damage, Anti-Aging, and Androgenetic Alopecia Management
A 40-year-old female in Katy, Texas received a full-body skin exam and hair loss evaluation at Village Dermatology. Learn how retinoids, sunscreen, and topical minoxidil can rejuvenate skin, treat photoaging, and promote healthy hair growth.
by: Dr. Caroline Vaughn
Case Overview
A 40-year-old female presented to Village Dermatology in Katy, Texas for a full-body skin examination. The patient denied any family history of melanoma but undergoes annual skin cancer screenings as part of her routine preventive care. Her main concerns included sun-related pigmentation, aging skin, and gradual hair thinning over the past several years.
Clinical Examination
A full skin examination was performed, including the scalp, face, neck, trunk, extremities, and nails.
The patient was well-developed, alert, and in no distress. A dermatoscope was used throughout the exam.
Findings revealed benign skin lesions and mild photoaging changes. No suspicious lesions for malignancy were noted.
Assessment and Plan
1. Benign Nevi (D22.5)
Multiple symmetrical, evenly pigmented moles were found on the upper back and abdomen.
Counseling:
No treatment necessary
Perform monthly self-skin checks for changes in size, color, or shape
Use broad-spectrum SPF 30+ sunscreen daily
2. Seborrheic Keratoses (L82.1)
Pigmented, waxy, stuck-on papules were observed on the periumbilical area and thoracic spine.
These are benign skin growths that often appear with age.
Plan: Observation and reassurance; optional cosmetic removal if desired.
3. Lentigines (L81.4)
Light tan, reticulated macules consistent with sun-induced lentigines were distributed on the upper sternum and left upper back.
Plan:
Sun protection: Apply SPF 30+ 15 minutes before sun exposure and reapply every 2 hours
Consider chemical peels, retinoids, or laser for cosmetic improvement
Encourage daily use of lip balm with SPF and sun-protective clothing
4. Cherry Angiomas (D18.01)
Bright red vascular papules noted on the mid-back and periumbilical skin.
Counseling:
These are benign vascular growths that can be treated with laser or electrodesiccation for cosmetic reasons.
5. Aging Skin (L90.8)
The patient expressed interest in improving fine lines and photoaging. She had previously obtained tretinoin 0.025% from an online dermatologist and planned to initiate treatment.
Plan:
Continue tretinoin 0.025% at bedtime (pea-sized amount, 2–3 nights weekly, increasing as tolerated)
Use Skinceuticals A.G.E. Eye Complex or SkinBetter AlphaRet Eye Cream for under-eye rejuvenation
Continue broad-spectrum SPF 30+ sunscreen daily
Counseling:
Discussed the role of retinoids in stimulating collagen, improving skin tone, and reducing fine lines.
Reviewed potential dryness or irritation and how to minimize side effects by introducing use gradually.
6. Androgenetic Alopecia (L64.8)
The patient reported gradual hair thinning consistent with female pattern hair loss. She is currently family planning and opted to avoid oral medications such as finasteride or dutasteride.
Plan:
Start topical minoxidil 5% foam daily to the scalp
Consider Nutrafol supplements or PRP (Platelet-Rich Plasma) therapy in the future
Monitor for improvement over the next 4–6 months
Counseling:
Discussed that androgenetic alopecia is genetically determined and slowly progressive. Early treatment can slow shedding and thicken existing hair.
Patient instructed to contact the office if hair loss worsens or if irritation develops from topical minoxidil.
Discussion
This case highlights the importance of annual dermatologic exams in women for early detection of benign and precancerous skin lesions while addressing aesthetic and hair health concerns.
At Village Dermatology, we combine medical dermatology and cosmetic expertise to manage conditions like photoaging, lentigines, and androgenetic alopecia comprehensively.
Patients in Katy and Houston, Texas can benefit from personalized skincare routines and advanced treatment options to maintain healthy, youthful skin and hair.
Conclusion
Comprehensive dermatologic care addresses both skin health and appearance. Through preventive screenings, sun protection, retinoid therapy, and targeted hair loss treatments, patients can achieve long-term skin and scalp wellness.
Residents in Katy and Houston, TX are encouraged to schedule annual full-body skin exams with Village Dermatology for expert evaluation and customized treatment.
Treatment of Ear Keloids in a 28-Year-Old Female: Intralesional Kenalog and 5-FU Therapy
A 28-year-old female in Katy, Texas, presented with earlobe keloids treated successfully with intralesional Kenalog and 5-fluorouracil injections at Village Dermatology. Learn about modern scar treatments and keloid management for lasting results.
by: Dr. Ashley Baldree
Case Overview
A 28-year-old female presented to Village Dermatology in Katy, Texas, with long-standing scars on both earlobes. The patient described the lesions as stable but cosmetically bothersome. She reported that the right earlobe keloid was larger than the left and had been present for several years.
The patient was a non-smoker, reported no unhealthy alcohol use, and had no systemic symptoms. She sought medical evaluation and treatment options for her bilateral ear keloids.
Clinical Examination
A focused examination was performed on both ears using dermatoscopy. The patient appeared well-developed and in no acute distress. On exam, there were firm, raised, telangiectatic nodules consistent with keloids on both anterior earlobes, with the right side more prominent.
Diagnosis
Keloid (L91.0) – A benign fibrous overgrowth of scar tissue extending beyond the original wound boundary, commonly caused by trauma, piercings, or previous surgery.
Management Plan
1. Intralesional Kenalog (ILK) with 5-Fluorouracil (5-FU)
After discussing multiple treatment options, including intralesional corticosteroid injections, surgical excision, topical imiquimod, and radiation therapy, the patient elected to begin treatment with intralesional Kenalog (triamcinolone acetonide) in combination with 5-fluorouracil (5-FU).
Medication: Kenalog (20 mg/cc) mixed with 5-FU
Total Volume Injected: 1.0 cc
Injection Sites: Right and left anterior earlobes
Administered by: AB
Procedure Details: The lesions were injected using sterile technique after discussing risks such as atrophy, hypopigmentation, and recurrence.
This Kenalog + 5-FU combination therapy works synergistically to reduce inflammation, soften keloid tissue, and prevent regrowth—offering superior outcomes compared to steroid injections alone.
2. Silicone Sheet Therapy
The patient was advised to apply silicone gel sheets daily to maintain pressure and hydration over the treated area. Silicone sheeting can help flatten and fade keloids over time by regulating collagen production.
3. Education and Counseling
The patient received detailed counseling regarding:
Nature of Keloids: Overactive scar formation that can cause thickened, itchy, or tender tissue.
Treatment Expectations: Gradual improvement over multiple sessions; some residual firmness may persist.
Future Considerations: Excision may be considered in the future, ideally in combination with ongoing ILK injections or postoperative radiation to reduce recurrence risk.
Follow-Up: Scheduled in 6 weeks for reassessment and possible repeat injections.
Discussion
Keloids are particularly common in individuals with ear piercings or previous trauma to the lobes. They can be cosmetically distressing and refractory to treatment if not managed with a multimodal approach.
At Village Dermatology in Katy and Houston, Texas, our dermatologists tailor treatment plans using intralesional corticosteroids, 5-FU, silicone therapy, and advanced surgical techniques to minimize recurrence and optimize cosmetic outcomes.
Conclusion
This case demonstrates the effective use of intralesional Kenalog with 5-FU in managing earlobe keloids. Early intervention, consistent follow-up, and patient adherence to silicone therapy are key to achieving long-term results.
Residents of Katy and Houston, TX experiencing thickened or painful scars can schedule a consultation at Village Dermatology for expert evaluation and personalized treatment.
Comprehensive Skin Exam and Biopsy for a 44-Year-Old Male in Katy, Texas
A 44-year-old male in Katy, Texas underwent a full-body skin exam at Village Dermatology, revealing benign lesions and one suspicious mole requiring biopsy. Learn how early detection, sun protection, and professional dermatologic care help prevent skin cancer and maintain healthy skin.
by: Dr. Ashley Baldrey
Case Overview
A 44-year-old male presented to Village Dermatology in Katy, Texas, for a full-body skin examination. As a new patient, he sought a comprehensive evaluation for new lesions that had developed over the past several months. The patient noted stable, moderately pigmented spots on his left cheek and superior forehead, prompting professional assessment and preventive care.
Clinical Findings
A full skin exam was performed, including inspection of the scalp, face, neck, trunk, extremities, and nails. The patient appeared well-developed and well-nourished, alert and oriented, with no acute distress. A dermatoscope was used to closely examine all lesions.
Key Dermatologic Findings and Management
1. Neoplasm of Unspecified Behavior – Left Posterior Neck
A darkly pigmented macule on the left posterior neck raised concern for a neoplasm of uncertain behavior, with differential diagnosis including lentigo versus lentigo maligna.
A shave biopsy was performed under local anesthesia (lidocaine with epinephrine) using a dermablade. Hemostasis was achieved with Drysol, and the site was dressed with Petrolatum and a sterile bandage.
The biopsy specimen was sent for histopathologic evaluation to rule out malignancy. The patient was instructed to follow up if biopsy results were not communicated within two weeks.
2. Benign Nevi
Multiple symmetrical, evenly pigmented nevi were observed across the body. The patient was counseled that these are benign and do not require treatment.
He was advised to perform monthly self-skin checks and to contact the office if any moles change in size, shape, color, or develop symptoms such as itching or bleeding.
3. Actinic Keratosis (AK)
The patient reported a history of actinic keratoses previously treated with Efudex (5-fluorouracil), with temporary clearance. Since he has undergone topical treatment in the past, photodynamic therapy (PDT) was discussed as a future treatment option for improved clearance of sun-damaged skin.
The importance of sun protection using broad-spectrum sunscreen SPF 30+, sun-protective clothing, and regular skin checks was reinforced.
4. Seborrheic Keratoses
Benign stuck-on, warty, brown papules were identified on the left clavicular neck and anterior shoulder. These are harmless growths associated with aging. The patient was reassured that treatment is unnecessary unless for cosmetic reasons.
5. Lentigines and Ephelides (Freckles)
Reticulated tan macules in sun-exposed areas were consistent with lentigines and ephelides. These are benign sun-induced pigment changes. The patient was counseled that improvement is possible with sun protection, topical brightening agents, chemical peels, or laser treatments.
6. Cherry Angiomas
Bright red vascular papules were noted and diagnosed as cherry angiomas. The patient was informed that these are benign blood vessel growths, treatable with laser or electrodessication if desired for cosmetic reasons.
7. Lichenoid Keratosis
A pink scaly papule on the left upper back was consistent with lichenoid keratosis, a benign inflammatory lesion. The lesion was pared and treated with liquid nitrogen cryotherapy (two freeze-thaw cycles). The patient was informed of expected healing and potential temporary changes in pigmentation.
Sunscreen and Skincare Recommendations
To prevent recurrence of sun-induced skin lesions, the following broad-spectrum SPF 50+ sunscreens were recommended:
Face:
Neutrogena Sheer Zinc Face SPF 50
EltaMD UV Clear
La Roche-Posay Toleriane UV
Supergoop Unseen Sunscreen
Body:
La Roche-Posay Melt-In Milk
Supergoop Play Everyday Lotion
EltaMD UV Sport
HEB Mineral Sunscreen
Discussion
This case highlights the importance of annual full-body skin examinations, especially for patients in sunny climates like Katy and Houston, Texas. Chronic UV exposure contributes to the development of actinic keratoses, lentigines, and other precancerous lesions.
Through early detection and preventive counseling, dermatologists can effectively manage benign and potentially malignant skin changes while emphasizing long-term sun protection and self-surveillance.
Conclusion
Routine skin evaluations play a vital role in maintaining skin health and detecting early signs of skin cancer. Patients in the Katy and Houston areas are encouraged to schedule regular dermatology visits with Village Dermatology for personalized care, preventive guidance, and treatment of sun-induced skin conditions.
Post-Inflammatory Hyperpigmentation and Scar Management in a Teen Patient: A Case from Katy, Texas
A 15-year-old female from Katy, Texas was treated at Village Dermatology for dark knee scars caused by post-inflammatory hyperpigmentation. Learn how tretinoin, silicone therapy, and sun protection can help restore clear, even skin tone.
by: Dr. Caroline Vaughn
Case Overview
A 15-year-old female presented to Village Dermatology in Katy, Texas, accompanied by her mother, for evaluation of discoloration and scarring on both knees. The scars, moderate in severity, had been present for several years and were noted to be darkening over time.
The patient reported no recent trauma or new symptoms but expressed cosmetic concern over persistent pigmentation. She had been using vitamin E oil with minimal improvement.
Clinical Examination
A focused examination was performed on the right and left lower legs, including both knees.
The patient appeared well-developed, alert, and in no distress. A dermatoscope was used during evaluation.
Findings revealed ill-defined hyperpigmented patches on both knees, consistent with post-inflammatory hyperpigmentation (PIH) secondary to prior trauma.
Assessment and Plan
1. Post-Inflammatory Hyperpigmentation (L81.0)
PIH occurs when excess melanin is produced following skin injury or inflammation, leading to dark spots or discoloration. The knees and legs are particularly prone to prolonged pigmentation due to thicker skin and slower healing.
Management Plan:
Topical Tretinoin 0.025% Cream: Apply to affected areas 2–3 nights weekly, increasing to nightly as tolerated
Sun Protection: Use broad-spectrum sunscreen SPF 30+ and protective clothing daily
Moisturizers: Apply CeraVe moisturizing cream and Dove Sensitive Skin wash to maintain barrier repair
Scar Management: Begin silicone gel or silicone sheets for smoothing texture and improving discoloration
Counseling:
The patient and her mother were educated on the slow nature of pigment fading and the importance of consistency and sun avoidance. Results may take months to years, depending on depth and skin tone.
Potential side effects of tretinoin, such as dryness or mild irritation, were reviewed, and the patient verbalized understanding.
2. Scar (L90.5)
Scars on both knees were consistent with post-traumatic remodeling—flat, stable, and showing hyperpigmentation but no keloid or hypertrophic features.
Recommendations:
Continue silicone gel and SPF 30+ sunscreen to prevent further darkening
Keep fresh wounds moisturized with Vaseline or Aquaphor to minimize scarring
Monitor for any raised or discolored changes, which could indicate hypertrophic scarring
Counseling:
Discussed that scars are permanent skin changes but often fade and flatten over time. Encouraged patience and consistent skin care for optimal cosmetic improvement.
Discussion
Post-inflammatory hyperpigmentation is a common cosmetic concern in adolescents, particularly in darker skin types and on knees, elbows, or legs following trauma. The combination of tretinoin, moisturizers, and strict sun protection provides safe, gradual improvement.
At Village Dermatology, patients in Katy and Houston, TX benefit from evidence-based care focused on both medical and cosmetic skin restoration. Early dermatologic intervention helps prevent chronic discoloration and improves self-confidence in younger patients.
Conclusion
This case highlights the successful management of knee hyperpigmentation and scarring in a teenage patient through gentle retinoid therapy, silicone scar treatment, and sun protection.
For patients in Katy or Houston, Texas, Village Dermatology offers comprehensive care for pigmentation, scars, and skin health across all ages.
Irritated Seborrheic Keratosis on the Upper Back Treated with Cryotherapy
A 60-year-old male presented to Village Dermatology in Katy and Houston, TX, with an irritated seborrheic keratosis on the upper back. Learn how cryotherapy was used to safely remove this benign but inflamed skin growth.
At Village Dermatology in Katy and Houston, Texas, we frequently treat patients with benign but bothersome skin growths such as seborrheic keratoses. While these lesions are noncancerous, they can become irritated, itchy, or inflamed, prompting treatment for comfort and cosmetic reasons. This case highlights a 60-year-old male with an irritated seborrheic keratosis successfully treated with liquid nitrogen.
Patient Presentation
A 60-year-old male presented as an established patient with a new lesion on the left upper back. The lesion had been present for one week, was moderate in severity, and caused irritation and itching. He reported no prior treatment.
He attended the visit accompanied by his wife.
Dermatologic Examination
A focused examination of the back was performed using a dermatoscope.
Findings included:
Irritated Seborrheic Keratosis: Inflamed, crusted papule located on the left superior medial upper back.
Associated pruritus and mild inflammation in the surrounding skin.
No suspicious or malignant lesions were noted.
Impression and Plan
Diagnosis: Irritated Seborrheic Keratosis (L82.0)
Seborrheic keratoses are common, benign, wart-like growths that may appear anywhere on the body. Although harmless, they can become symptomatic due to friction, trauma, or inflammation.
Treatment:
Cryotherapy with liquid nitrogen was performed on the symptomatic lesion.
One lesion was treated on the left medial upper back.
Consent obtained after reviewing risks including blistering, pigment changes, incomplete removal, and infection.
Counseling:
The patient was informed that irritated seborrheic keratoses can be effectively treated with cryotherapy.
Advised that mild crusting or redness is normal during healing.
Instructed to contact the office if the lesion fails to resolve or if there are concerning symptoms such as persistent tenderness or infection.
Key Takeaway
This case highlights the effectiveness of cryotherapy for treating irritated seborrheic keratoses. Even though these lesions are benign, treatment can provide relief from discomfort and improve skin appearance.
At Village Dermatology in Katy and Houston, TX, we offer expert evaluation and treatment for a variety of benign skin growths, including seborrheic keratoses, cherry angiomas, and lentigines.
Evaluation and Biopsy of a Pigmented Skin Lesion in a 38-Year-Old Female — Village Dermatology, Katy & Houston, Texas
A 38-year-old female patient underwent evaluation and biopsy of a new pigmented lesion under the arm at Village Dermatology in Katy and Houston, Texas, emphasizing early detection and sun protection counseling.
Patient Overview:
A 38-year-old established female patient presented to Village Dermatology in Katy, Texas for the evaluation of a new skin lesion on her left shoulder and right shoulder, as well as a mole under her left arm (axilla) that appeared three weeks prior. The patient reported that the lesion was not painful, bleeding, or changing in size or color, but wanted it evaluated for reassurance and appropriate care.
She also requested education and counseling regarding sun exposure and skin cancer prevention.
Clinical Examination
A comprehensive skin examination was performed, including the scalp, face, shoulders, and both axillae. The patient appeared well-developed, well-nourished, and in no acute distress.
Findings:
A darkly pigmented macule was identified in the left axillary vault.
No signs of ulceration, bleeding, or irritation were present.
A dermatoscopic evaluation revealed irregular pigmentation but no overtly malignant structures.
Differential Diagnosis
The primary considerations included:
Neoplasm of Unspecified Behavior
Dysplastic Nevus (Atypical Mole)
Lichenoid Keratosis
Because of the lesion’s new onset and pigmented appearance, a biopsy was recommended for definitive diagnosis.
Procedure: Shave Biopsy
After obtaining written informed consent, the area was prepped and anesthetized with 0.5% lidocaine with epinephrine.
A shave biopsy to the level of the dermis was performed using a Dermablade, and the specimen was sent for histopathologic evaluation (H&E staining).
Hemostasis was achieved with Drysol, and the site was dressed with petrolatum and a bandage.
The patient tolerated the procedure well without complications.
Post-Procedure Counseling
The patient was counseled on biopsy site care, including gentle cleansing and application of ointment to promote healing.
She was advised to contact the office if she does not receive biopsy results within two weeks.
In addition, sun protection education was provided, including:
Use of broad-spectrum SPF 30+ sunscreen daily
Avoidance of tanning beds
Regular self-skin checks and annual full-body skin exams
Clinical Insight
Pigmented lesions in sun-protected areas, such as the axilla, can represent a range of benign and atypical growths. While most are non-cancerous, early evaluation and biopsy are critical in distinguishing dysplastic nevi or melanoma from benign entities.
At Village Dermatology, we prioritize thorough skin cancer screening and patient education to promote early detection and lifelong skin health.
Follow-Up
The patient will be contacted once biopsy results are available. Depending on pathology, management may include simple observation, re-excision, or monitoring for recurrence.
Takeaway
This case highlights the importance of evaluating new or changing moles, even when they appear benign. Early dermatologic evaluation allows for accurate diagnosis and peace of mind.
At Village Dermatology in Katy and Houston, Texas, our board-certified dermatologists provide expert care for all skin lesions — from routine moles to complex skin cancers — with compassion and precision.
📞 Schedule your skin check today at Village Dermatology in Katy or Houston, TX, and take the first step toward proactive skin health.
Managing Acne Keloidalis Nuchae in a 31-Year-Old Male — Village Dermatology, Katy & Houston, Texas
A 31-year-old male with chronic Acne Keloidalis Nuchae was successfully managed at Village Dermatology in Katy and Houston, Texas, with oral doxycycline, topical clindamycin, and lifestyle counseling to reduce inflammation and scarring.
Patient Overview:
A 31-year-old male presented to Village Dermatology as a new patient for evaluation of skin lesions located on the posterior neck, posterior scalp, and hairline. The lesions were described as darkening, enlarging, and irregular in shape. They had been progressively worsening over several years, with more rapid change over the past month.
The patient denied prior treatment and sought a comprehensive dermatologic evaluation and management plan.
Clinical Examination
A focused skin examination was performed, including the scalp, posterior neck, face, and ears. The patient appeared well-developed and well-nourished, and was alert and oriented. A dermatoscope was used to closely inspect the lesions.
Findings revealed follicular-based papules and pustules coalescing into keloid-like plaques distributed along the mid-occipital scalp and posterior neck — findings consistent with Acne Keloidalis Nuchae (AKN), a chronic inflammatory scarring condition.
Diagnosis: Acne Keloidalis Nuchae (AKN)
Acne Keloidalis Nuchae is a chronic inflammatory disorder of the hair follicles, most commonly affecting men with curly or coarse hair. It typically presents as persistent papules, pustules, and firm scars on the back of the scalp and neck. AKN may worsen with shaving, tight collars, helmets, or other forms of mechanical irritation.
If left untreated, it can lead to permanent scarring alopecia and cosmetic disfigurement.
Treatment Plan
At Village Dermatology, the patient’s management plan focused on both inflammation control and prevention of further scarring.
1. Oral Doxycycline (100 mg, twice daily for 6 weeks):
To reduce inflammation and control bacterial colonization. The patient was counseled on potential side effects including gastrointestinal upset and sun sensitivity.
2. Topical Clindamycin 1% Solution (twice daily):
To reduce surface bacterial activity and inflammation in the affected areas.
3. Benzoyl Peroxide Wash:
Recommended as an adjunctive antibacterial wash to lower follicular bacterial load.
4. Safe Grooming Practices:
The patient was advised to avoid close shaving, tight clothing, or friction against the affected area.
If improvement is limited, intralesional Kenalog (ILK) injections will be considered at follow-up visits to further flatten hypertrophic lesions and decrease inflammation.
Patient Counseling
The patient was counseled that Acne Keloidalis Nuchae is a chronic and progressive condition, often requiring long-term maintenance to prevent recurrence. Regular dermatology follow-ups in our Katy and Houston, Texas offices were recommended to monitor progress and adjust therapy as needed.
Takeaway
This case underscores the importance of early diagnosis and intervention in Acne Keloidalis Nuchae to prevent scarring and improve quality of life. Through a combination of oral antibiotics, topical treatments, and lifestyle modifications, significant improvement can be achieved.
At Village Dermatology, our board-certified dermatologists in Katy, Texas and Houston, Texas specialize in treating complex scalp and skin conditions like Acne Keloidalis Nuchae with compassionate, evidence-based care.
If You’re Experiencing Similar Symptoms
If you notice bumps, scarring, or irritation on the back of your scalp or neck, it’s important to seek evaluation before permanent scarring develops.
Contact Village Dermatology today to schedule your appointment at our convenient Katy or Houston locations.
📞 Call us or book online today to begin your personalized treatment journey.
Allergic Contact Dermatitis from Poison Ivy in a 49-Year-Old Male Patient Presentation
A 49-year-old male from Katy, Texas developed an itchy red rash on his leg and groin after yard work. Diagnosed with allergic contact dermatitis from poison ivy, he was treated with a prednisone taper at Village Dermatology. Learn how Dr. Reena Jogi treats skin allergies in Houston and Katy, TX.
A 49-year-old male presented to our dermatology clinic in Katy, Texas, with a one-week history of a red, itchy rash on the right leg, groin, and left arm. The rash developed after spending time doing yard work, and the patient suspected possible contact with poison ivy. The rash was described as moderate in severity and had not improved with any over-the-counter treatments.
Clinical Examination
A focused dermatologic examination was performed, including inspection of the face, arms, legs, and genital area. The patient declined a full-body skin exam.
On examination, there were well-demarcated, geometric, eczematous patches distributed across the left arm, penis, and right leg, consistent with allergic contact dermatitis. No evidence of secondary infection or vesiculation was noted.
The patient was well-developed, well-nourished, alert, and oriented, and appeared in no acute distress. A dermatoscope was utilized during the evaluation for lesion assessment.
Diagnosis
Allergic Contact Dermatitis (L23.9) – secondary to likely exposure to poison ivy during yard work.
Treatment Plan
After confirming the clinical impression, the patient was counseled regarding appropriate skin care and environmental precautions to prevent recurrence.
Medications:
Prednisone 20 mg tablets – Tapering course:
Take 2 tablets (40 mg) once daily for 5 days
Then 1 tablet (20 mg) once daily for 5 days
Then 1 tablet (20 mg) every other day for 10 days
Total: 20 tablets
Counseling and Recommendations:
Skin Care:
Use gentle, fragrance-free, hypoallergenic cleansers.
Avoid scented soaps, detergents, and personal care products.
Apply fragrance-free moisturizers to support skin healing.
Environmental Precautions:
Avoid further exposure to poison ivy and wash all clothing or gear that may have contacted plant oils.
Clean tools and pets that may have come into contact with contaminated vegetation.
Prednisone Counseling:
The patient was counseled extensively on the risks and precautions associated with systemic corticosteroid use, including:
Short-term effects: increased appetite, mood changes, insomnia.
Long-term risks (with extended use): weight gain, osteoporosis, high blood pressure, and glucose elevation.
The patient verbalized full understanding of the tapering schedule and potential adverse effects.
Follow-up Plan:
Follow up as needed (PRN) if the rash fails to improve or recurs.
Consider patch testing in the future if recurrent or chronic allergic dermatitis is suspected.
Discussion
Allergic contact dermatitis (ACD) is a common inflammatory skin reaction caused by exposure to allergens such as poison ivy, nickel, fragrances, or topical products. The characteristic linear or geometric patterns are often diagnostic clues.
Poison ivy dermatitis results from contact with urushiol, an oil that triggers a delayed-type hypersensitivity reaction. Prompt washing with soap and water after exposure can minimize severity.
In moderate to severe cases involving widespread areas or sensitive regions like the genitalia, a prednisone taper is often required to control inflammation and prevent rebound flares.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi and her team specialize in diagnosing and treating allergic skin conditions with tailored medical therapy, environmental guidance, and patient education.
Conclusion
This case illustrates a classic presentation of allergic contact dermatitis secondary to poison ivy exposure, successfully managed with a prednisone taper and detailed counseling on allergen avoidance and gentle skincare practices. With proper care, the patient’s rash is expected to resolve completely within several weeks.
Management of Toenail Fungus and Neck Skin Tags in a 43-Year-Old Male
A 43-year-old male from Katy, Texas presented with toenail fungus and neck skin tags. At Village Dermatology, fungal nail testing and skin tag removal were performed safely and effectively. Learn about advanced dermatologic treatments in Houston and Katy, TX.
Patient Presentation
A 43-year-old male presented to our dermatology clinic in Katy, Texas, with two main concerns:
Yellow, thickened toenails that had progressively worsened over the past 1–2 years.
Multiple skin tags on both sides of the neck that had become irritated by clothing and daily activities.
The patient was seeking evaluation, diagnosis, and treatment options for both conditions.
Clinical Examination
A comprehensive examination was performed, including inspection and palpation of the digits, toenails, and neck. The patient was alert, well-nourished, and in no acute distress. A dermatoscope was used for enhanced visualization.
Findings:
Toenails: Both great toenails showed yellow discoloration, thickening, and subungual debris, consistent with onychomycosis (fungal nail infection).
Neck: Several small, soft, pedunculated skin tags (acrochordons) were identified along the left and right anterior and lateral neck areas.
Diagnosis
Onychomycosis (B35.1) – fungal infection of the toenails, primarily affecting the right great toenail.
Acrochordons / Skin Tags (L91.8) – benign skin growths distributed bilaterally on the neck.
Treatment Plan
1. Onychomycosis
A nail clipping from the right great toenail was obtained and sent for PAS (Periodic Acid–Schiff) staining to confirm fungal involvement. Pending confirmation, the treatment plan includes initiating oral terbinafine—an effective systemic antifungal medication.
Because the patient reported a history of possible fatty liver disease, baseline liver function tests (LFTs) were ordered prior to starting therapy.
Patient Counseling:
Oral antifungal agents offer a higher cure rate than topical treatments, though recurrence is possible.
Possible side effects: liver toxicity, rash, and rare bone marrow suppression.
Instructions: Contact the office immediately if side effects such as nausea, fatigue, or jaundice develop.
Plan:
Await PAS results and lab confirmation.
Begin terbinafine therapy (typically 12-week course) upon clearance.
2. Skin Tag Removal
Given the patient’s cosmetic concern and mild irritation, in-office removal was performed during the visit.
Procedure Details:
Anesthesia: 3 cc of 1% lidocaine with epinephrine for local numbing.
Technique: Gentle gradle excision of five skin tags.
Locations: Left and right anterior and lateral neck.
Outcome: Minimal bleeding, no complications.
Post-procedure care:
Keep the area clean and dry for 24 hours.
Apply petroleum jelly or antibiotic ointment to prevent crusting.
Avoid friction from jewelry or collars.
Discussion
This case highlights two common dermatologic conditions—onychomycosis and skin tags—frequently seen in adult patients.
Onychomycosis is a fungal infection that affects both the appearance and integrity of the nail plate. Oral antifungal therapy, such as terbinafine, remains the most effective treatment option, especially in long-standing or severe cases.
Skin tags are benign and often removed for cosmetic reasons or due to irritation. In-office excision is a quick and effective treatment with minimal downtime.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi and her team combine advanced diagnostic tools and safe procedural care to address both medical and cosmetic skin concerns.
Conclusion
The patient underwent successful skin tag removal and is pending laboratory confirmation for toenail fungus before starting oral antifungal therapy. With proper follow-up and adherence to the care plan, excellent outcomes are anticipated for both conditions.
Hypertrophic Scar After Nose Piercing Treated with Intralesional Kenalog
A 31-year-old female developed a hypertrophic scar after a nose piercing. At Village Dermatology in Katy, Texas, the scar was treated with intralesional Kenalog and topical mupirocin. Learn how Dr. Reena Jogi manages facial scars, milia, and benign moles in Houston and Katy, TX.
Patient Presentation
A 31-year-old female presented to our dermatology clinic in Katy, Texas, with a raised scar on her left nasal sidewall following a recent nose piercing. The patient reported that the piercing was done approximately three months ago, and she had been instructed by her piercer not to remove the jewelry for six months. She was concerned about the thickened appearance around the site and sought treatment for the developing scar.
Clinical Examination
A detailed facial examination revealed a firm, raised, pink scar consistent with a hypertrophic scar located at the piercing site on the left nasal sidewall. The lesion was mildly thickened but not tender or pruritic.
The patient appeared well-developed, well-nourished, and in no acute distress. A dermatoscope was used to assess the lesion, confirming no signs of infection, ulceration, or keloidal overgrowth.
Additional Findings
Milia (L72.0): Small yellow-white cystic papules on the right malar cheek, benign and superficial.
Benign Nevi (D22.4): Multiple evenly pigmented moles scattered throughout the body.
Diagnosis
Hypertrophic Scar (L91.0) – Left nasal sidewall (post-piercing)
Milia (L72.0) – Right malar cheek
Benign Nevi (D22.4) – Diffuse
Treatment Plan
1. Hypertrophic Scar Management
The patient was counseled regarding the nature of hypertrophic scars and treatment options, including:
Intralesional corticosteroid injections (Kenalog)
Silicone gel or silicone sheets
Pulse dye laser for vascular improvement
After informed consent, Intralesional Kenalog (ILK) was administered:
Concentration: 5 mg/cc (diluted from 10 mg/mL)
Volume: 0.1 cc
Injection Sites: 1 (left nasal sidewall)
Administered by: AB
The risks of skin atrophy and pigment alteration were discussed, and the patient tolerated the procedure well.
To prevent infection, mupirocin 2% ointment was prescribed:
Sig: Apply to affected area once to twice daily until healed
Quantity: 15 grams, 1 refill
2. Milia
Counseling included reassurance that milia are benign keratin-filled cysts, often resolving spontaneously or with gentle exfoliation. Treatment options reviewed:
In-office extraction if persistent or bothersome
3. Benign Nevi
Patient education included monthly self-skin checks to monitor for any changes in size, color, or shape.
Recommendations included:
Regular dermatologic full-body exams every 6–12 months
Discussion
Hypertrophic scars commonly occur at sites of trauma, piercings, or surgical incisions and result from excessive collagen deposition during wound healing.
Intralesional corticosteroid therapy, particularly Kenalog (triamcinolone acetonide), is highly effective in flattening and softening hypertrophic scars. Combining ILK injections with silicone-based therapy often improves long-term outcomes.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi and her team emphasize a personalized, evidence-based approach to treating scars, milia, and benign skin lesions. This ensures both cosmetic improvement and skin health maintenance.
Conclusion
The patient’s hypertrophic scar from a recent nose piercing was successfully treated with intralesional Kenalog and topical mupirocin. She was counseled on scar care and follow-up options, including silicone therapy and laser treatments for refinement. The patient will return in 6–8 weeks for reevaluation.
Management of Acne Rosacea in a 34-Year-Old Female with Doxycycline and Compounded Triple Rosacea Cream
A 34-year-old female from Katy, Texas, presented with chronic rosacea. Treatment with oral doxycycline and a compounded triple rosacea cream provided effective control of redness and pimples. Learn how Village Dermatology in Houston and Katy offers customized rosacea care.
Patient Presentation
A 34-year-old female presented to our dermatology clinic in Katy, Texas, with a chronic facial rash characterized by persistent pimples and redness. The patient reported that symptoms had been present for several years and were moderate in severity. She has a known history of rosacea, having previously undergone intense pulsed light (IPL) therapy, a course of isotretinoin (Accutane), and multiple topical treatments.
Clinical Examination
A focused facial examination revealed erythematous papules and pustules primarily distributed across the cheeks, nose, and chin—consistent with acne rosacea (L71.8).
The patient appeared well-developed, well-nourished, and in no acute distress. Dermatoscopic evaluation showed superficial telangiectasias and scattered inflammatory papules. No nodules or cystic lesions were observed.
Diagnosis
Acne Rosacea (L71.8) – distributed on the face and subxiphoid region.
The patient was counseled regarding the chronic nature of rosacea and the importance of trigger avoidance, sun protection, and consistent skincare.
Treatment Plan
After a detailed discussion of options, including laser therapy, topical agents, and oral medications, the patient elected to begin combination therapy consisting of oral doxycycline and a compounded triple rosacea cream.
Medication Regimen:
Morning Routine:
Wash with a gentle, non-irritating cleanser
Apply a broad-spectrum SPF 30+ moisturizer
Evening Routine:
Wash with a gentle cleanser
Apply the compounded triple rosacea cream (containing ivermectin, metronidazole, and azelaic acid)
Follow with a light moisturizer
Oral Therapy:
Doxycycline monohydrate 100 mg taken twice daily with food and a tall glass of water for 4 weeks
Counseling Provided:
Sun Protection: The patient was instructed to wear daily SPF and avoid direct sunlight to prevent photosensitivity associated with doxycycline.
Trigger Avoidance: Flare-ups can be provoked by alcohol, spicy foods, hot beverages, sun exposure, stress, and exercise.
Medication Effects:
Doxycycline: May cause sun sensitivity or gastrointestinal upset.
Ivermectin (Soolantra): Possible mild burning or stinging on application.
Metronidazole: May cause a metallic taste or transient redness.
Azelaic Acid (Finacea): Possible mild tingling or dryness.
The patient verbalized full understanding of the treatment plan and was scheduled for follow-up in six weeks to evaluate clinical response and tolerance.
Discussion
Rosacea is a chronic inflammatory skin condition that primarily affects the central face, often leading to persistent redness, papules, and visible blood vessels. Management focuses on controlling inflammation, reducing Demodex mite proliferation, and minimizing triggers that exacerbate symptoms.
At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi utilizes a comprehensive treatment approach, combining oral anti-inflammatory therapy, custom-compounded topical formulations, and laser or light-based therapies when appropriate. This personalized care model helps patients achieve long-term remission and confidence in their skin health.
Conclusion
This case demonstrates effective management of chronic acne rosacea using a short course of oral doxycycline and a compounded triple rosacea cream. With adherence to skincare, trigger avoidance, and follow-up care, the patient is expected to experience a marked improvement in redness and inflammatory lesions.
Treatment of Verruca Vulgaris (Common Warts) with Cryotherapy in an 18-Year-Old Male
An 18-year-old male from Katy, Texas, was treated for multiple warts on his hand, elbow, and knee with cryotherapy. Learn how Village Dermatology in Houston and Katy effectively treats verruca vulgaris with liquid nitrogen and other advanced options.
By: Dr. Caroline Vaughn
Patient Presentation
An 18-year-old male presented as a new patient to our dermatology clinic in Katy, Texas, with multiple irregular skin lesions on his right hand and right elbow. The lesions had been present for several months and were moderately symptomatic, with intermittent itching and inflammation. He presented today for cryotherapy treatment.
Clinical Examination
A focused examination of the right forearm and hand revealed multiple verrucous papules consistent with verruca vulgaris (common warts). The lesions were distributed on the right elbow, right anterior distal thigh, right knee, right thenar eminence, and right radial palm.
The patient appeared well-developed and well-nourished, in no acute distress, and was alert and oriented. Dermatoscopic evaluation confirmed characteristic features of viral warts, including thrombosed capillaries and irregular surface texture.
Diagnosis
Verruca Vulgaris (B07.8)
Associated findings included mild pruritus and cutaneous inflammation at the affected sites.
Treatment Plan and Counseling
The diagnosis and treatment options were reviewed in detail. The patient was informed that resolution of viral warts may require three to four sessions of cryotherapy. Alternative treatment options such as topical salicylic acid, retinoids, Imiquimod (Aldara), Candida antigen injections, or Cantharidin were discussed for future consideration if cryotherapy proves insufficient.
Procedure: Liquid Nitrogen Cryotherapy
A total of 8 lesions were treated using liquid nitrogen, located on:
Right elbow
Right anterior distal thigh
Right knee
Right thenar eminence
The procedure was performed after informed consent, discussing potential risks including blistering, scarring, pigmentary changes, recurrence, incomplete removal, and infection. The patient tolerated the procedure well.
Post-Treatment Instructions:
Expect mild redness, swelling, or blistering for a few days.
Avoid picking or scratching the treated areas.
Apply a gentle moisturizer or petroleum jelly as needed.
Contact the office if lesions spread or become painful.
The patient was scheduled to follow up in one month for reassessment and potential retreatment.
Discussion
Verruca vulgaris is a benign but contagious viral infection caused by the human papillomavirus (HPV). It is commonly seen in teenagers and young adults, particularly on the hands, knees, and elbows due to frequent microtrauma and skin contact.
At Village Dermatology in Katy and Houston, Texas, cryotherapy remains a first-line, effective, and well-tolerated treatment for common warts. By freezing the lesion and destroying virally infected keratinocytes, cryotherapy can lead to clearance over several sessions while minimizing scarring.
Alternative treatments such as Candida antigen immunotherapy can be considered for resistant cases, leveraging the body’s immune response to clear both treated and distant warts.
Conclusion
This case highlights the successful initial management of verruca vulgaris using liquid nitrogen cryotherapy in an adolescent male. With consistent follow-up and adherence to post-treatment care, the patient’s prognosis for full resolution is excellent.
Evaluation and Management of a Suprapubic Cyst and Nasal Scar in a 34-Year-Old Female
A 34-year-old female from Katy, Texas presented with enlarging abdominal lesions and a nasal scar. Dermatologic evaluation revealed an epidermal inclusion cyst and residual nasal scar, both managed with intralesional Kenalog. Learn how Village Dermatology provides expert, customized care for cysts, scars, and acne in Houston and Katy, Texas.
Patient Presentation
A 34-year-old female presented to our dermatology clinic in Katy, Texas, for evaluation of enlarging, irregular skin lesions located on the abdomen. The lesions had been present for several weeks and were described as new and progressively enlarging. She also expressed ongoing cosmetic concerns regarding a previously treated scar on her nasal dorsum.
Clinical Examination
A focused dermatologic exam was performed, including evaluation of the abdomen and nasal region. The patient was well-developed, well-nourished, and in no acute distress. Using dermatoscopic assessment, two primary findings were noted:
Residual Nasal Scar (L90.5):
The patient has a history of prior intralesional Kenalog (ILK) and CO₂ laser therapy to the nasal dorsum for scarring, with significant improvement noted. However, she reported persistent mild discoloration and slight depression of the scar. No evidence of recurrence or abnormal pigmentation was observed.
Plan: The patient was counseled that scars naturally become less noticeable over time but remain permanent features of the skin. Follow-up with her cosmetic surgeon was advised to explore potential refinements for residual cosmetic concerns.Epidermal Inclusion Cyst (L72.8) – Left Suprapubic Skin:
On physical examination, a 1 × 1.8 cm firm, subcutaneous nodule was identified on the left suprapubic region. The lesion was consistent with an epidermal inclusion cyst. Management options—including observation, oral antibiotics, intralesional corticosteroid injection, and surgical excision—were discussed.
After reviewing the benefits and potential for post-procedural scarring, the patient elected to proceed with intralesional Kenalog (ILK) treatment.
Procedure:Lesions injected: 2
Medication: Kenalog 10 mg/mL diluted to 4 mg/cc
Total volume injected: 0.1 cc
The risks of cutaneous atrophy and pigment alteration were reviewed, and the patient tolerated the procedure well. She was advised to monitor for redness, tenderness, or rupture.
Acne Vulgaris (L70.0):
The patient also reported mild inflammatory and comedonal acne. She prefers to focus on non-pharmacologic management, including dietary modification and stress reduction. We discussed evidence-based skincare approaches, including:Gentle, non-comedogenic cleansers and moisturizers
Broad-spectrum sunscreen SPF 30+
Topical retinoids for long-term acne control
Consideration of hormonal therapy (spironolactone) or isotretinoin if future exacerbations occur.
The patient was advised that visible improvement may take up to 2–3 months and to return if symptoms persist or worsen.
Discussion
This case highlights a multidisciplinary dermatologic approach addressing both medical and cosmetic concerns—a common scenario seen in dermatology clinics across Houston and Katy, Texas. Intralesional Kenalog remains a versatile treatment option for both cystic lesions and scar modulation, offering effective results with minimal downtime. Ongoing patient education and individualized treatment planning remain essential for achieving optimal outcomes.
Conclusion
The patient’s cyst was effectively treated with intralesional corticosteroid injection, and her nasal scar continues to improve post-CO₂ laser therapy. With continued observation and adherence to a gentle skincare regimen, her prognosis remains excellent.