A Mysterious Rash Uncovered – Managing Dermatitis, Scabies & Nerve-Related Itching in Katy & Houston, TX

By: Dr. Ashley Baldree

Introduction

Skin rashes can have a variety of causes—from allergies and infections to nerve-related issues. At Village Dermatology, we pride ourselves on delivering a thorough and patient-centered approach to diagnosis and treatment. In this case, we saw a 70-year-old woman from the Houston area with an itchy, red rash across her legs and trunk—which evolved into a multidimensional diagnosis and treatment plan.

Case Overview: Itchy Rash of Unclear Origin

Patient: 70-year-old female
Symptoms: Itchy, red rash for 2 weeks, primarily on the legs and trunk
Initial Treatment: OTC topical steroids (clobetasol and hydrocortisone)

Despite prior treatment, the patient’s rash had not improved. Upon clinical evaluation, we identified multiple overlapping causes contributing to her symptoms.

Differential Diagnoses Considered

1. Urticaria (Hives) – Red, raised spots consistent with allergy or histamine response

2. Allergic Contact Dermatitis (ACD) – Possible reaction to recent change in laundry detergent

3. Scabies – Due to rash distribution and clinical suspicion, despite a negative KOH scraping

4. Notalgia Paresthetica – Nerve-related itching due to a history of spinal disc issues and recent back surgery

Step-by-Step Management Approach

✅ 1. Dermatitis/Urticaria Treatment

• Topical: Triamcinolone 0.1% cream applied twice daily

• Oral: Hydroxyzine 25mg tablets as needed for itch

• Lifestyle: Switch detergent to All Free & Clear

• Counseling: Advised against prolonged steroid use and explained risk of skin thinning and hypopigmentation

✅ 2. Scabies Treatment (Empiric)

• Despite a negative KOH skin scraping, treatment was initiated due to the possibility of early or atypical scabies.

• Prescription: Ivermectin 3mg (two doses, one week apart)

• Topical: Permethrin cream applied from neck to toes for 8 hours, repeated in 1 week

• Hygiene Education:

  • Isolate bedding and clothing for 72 hours

  • Wash items on high heat

  • Treat household contacts

✅ 3. Notalgia Paresthetica Relief

• Topical OTC: CeraVe or Sarna Anti-Itch Cream

• Education: Provided a handout on the nerve-related cause of itching

• Monitoring: Recommended further work-up if symptoms persist or worsen

Why This Case Matters in Katy & Houston, TX

With overlapping skin conditions and histories of nerve problems or allergy exposure, a single diagnosis isn’t always enough. This case highlights how Village Dermatology delivers thorough evaluations, considers all possible causes, and tailors treatment to each patient’s history and lifestyle.

Whether you’re dealing with rash, itching, or chronic skin issues, our dermatology team in Katy and Houston is equipped to help—from diagnostics to comprehensive care.

From Viral Rash to Nail Fungus – Treating Molluscum and Onychomycosis in Katy & Houston, TX

By: Dr. Ashley Baldree

Introduction

At Village Dermatology, we see a wide variety of skin conditions, from viral rashes to fungal nail infections. In this case, a 42-year-old man from Katy, Texas presented with two common dermatologic concerns: a bumpy rash in the underarm area and a chronic fungal nail infection. This blog post shares how our team accurately diagnosed and effectively treated both conditions using evidence-based, patient-focused care.

Case Overview

Patient: 42-year-old male
Complaints:

1. Rash in the axilla (underarm area) for 2 weeks

2. Toenail infection for over 1 year

He was not on any prescription medications, though he had attempted to self-treat the nail issue using over-the-counter antifungal products with limited success.

Diagnosis 1: Molluscum Contagiosum

The underarm rash was diagnosed as Molluscum Contagiosum, a viral skin infection caused by a poxvirus. It presents as pink, umbilicated (dimpled) bumps, often spread through skin-to-skin contact or shared water sources like pools. In this case, the patient’s children also had molluscum, supporting a diagnosis of household transmission.

Affected areas:

• Left axilla

• Rib cage

• Posterior axilla

• Lateral chest

Treatment: Liquid Nitrogen Cryotherapy

The patient chose cryotherapy with liquid nitrogen (LN2)—a quick and effective method to destroy molluscum lesions. We treated 57 lesions in total using two freeze-thaw cycles per site.

Post-treatment counseling included:

• Possible side effects: blistering, pigment changes, recurrence

• Hygiene and skin care tips

• What to do if lesions worsen or spread

Follow-up: Scheduled in 4 weeks to monitor progress and consider topical tretinoin if needed.

Diagnosis 2: Onychomycosis (Toenail Fungus)

The second complaint involved a discolored, dystrophic left toenail, which began after trauma during a softball tournament. Clinical exam revealed superficial onychomycosis, a common fungal nail infection.

Treatment Plan: Topical Tolcylen

Given the superficial nature of the infection, the patient was prescribed Tolcylen, a medical-grade topical antifungal that penetrates the nail plate. Oral medications offer higher cure rates but carry risks such as liver toxicity and bone marrow suppression.

Key patient education:

• Topicals often require prolonged use and may not always cure the infection

• Oral antifungals are more effective but not without potential serious side effects

• 50% of patients experience recurrence even after successful treatment

Follow-up: 4 weeks for reassessment of nail and skin conditions

Why This Matters in Katy & Houston, Texas

Common dermatologic issues like molluscum contagiosum and toenail fungus can easily be misdiagnosed or undertreated. At Village Dermatology, we provide accurate diagnostics, thorough patient education, and personalized care plans—from pediatric infections to adult fungal conditions.

Treating Squamous Cell Carcinoma with ED&C – A Dermatology Case in Katy & Houston, TX

Introduction

At Village Dermatology, we routinely diagnose and treat skin cancers in patients across Katy and Houston, Texas. This case highlights our care of a 76-year-old man with squamous cell carcinoma (SCC) on his lower leg. We’ll walk through his biopsy, diagnosis, and treatment using electrodesiccation and curettage (ED&C)—a non-surgical option for low-risk skin cancers.

Case Presentation: From Biopsy to Treatment

Patient: 76-year-old male
Location: Left distal pretibial region (front of the lower leg)
Chief Complaint: Follow-up for lesion diagnosed as a well-differentiated squamous cell carcinoma (SCC)

The patient initially visited us in April 2025 for a suspicious lesion on his lower leg. A shave biopsy confirmed the presence of well-differentiated SCC, a common but potentially invasive form of skin cancer caused by long-term sun exposure, radiation, or immune suppression.

Why ED&C?

For superficial, well-differentiated SCCs on the trunk or extremities, ED&C (electrodesiccation and curettage) offers a highly effective and minimally invasive treatment. While surgical excision or Mohs surgery remains the gold standard for many skin cancers, ED&C is an appropriate choice for:

• Low-risk or superficial SCC

• Patients with contraindications to surgery

• Those preferring faster recovery and lower costs

Procedure Details

On his return visit, the patient underwent the ED&C procedure at our Katy clinic. Here's how it was performed:

• Anesthesia: 2 cc of 1% lidocaine with epinephrine was injected locally.

• Technique: The tumor was removed using a curette (a surgical scraping instrument), followed by electrodesiccation to destroy residual cancer cells.

• Cycles: Two full cycles were performed to ensure complete removal of visible cancer.

• Final lesion size: 1.3 cm.

• Post-procedure: A pressure dressing was applied, and detailed wound care instructions were provided.

Counseling & Education

We always ensure patients understand their condition and options. This patient was educated on:

• Risk Factors: Sun exposure, radiation, immunosuppression, and HPV.

• Recurrence: ED&C has slightly higher recurrence rates compared to surgical excision but is still effective for specific low-risk cases.

• Warning Signs: To contact us immediately if new lesions appear, especially those that bleed, ulcerate, or fail to heal.

Why Early Treatment Matters in Katy & Houston

As Houston’s sun exposure and aging population contribute to rising skin cancer rates, early detection and treatment are essential. At Village Dermatology, we combine evidence-based procedures with personalized counseling to ensure optimal outcomes and peace of mind.

Follow-Up Care

The patient is scheduled for a follow-up visit in one month to evaluate healing and confirm no signs of recurrence. Ongoing monitoring will help ensure long-term success and skin health.

From Mystery Bump to Diagnosis – A Young Woman’s Dermatology Journey in Katy & Houston, Texas

By Dr. Caroline Vaughn

Introduction

At Village Dermatology in Katy and Houston, Texas, we frequently see patients concerned about new or changing skin lesions. While many skin bumps are benign, proper evaluation is crucial to ensure accurate diagnosis and treatment. In this case report, we highlight a 23-year-old woman’s experience with a persistent chest lesion and an unexpected facial rash—showcasing our patient-centered approach and expertise in general and medical dermatology.

Case Overview: Chest Lesion Evaluation

Chief Complaint: A brown lesion on the chest, present for six months, recently inflamed.

A healthy 23-year-old woman came to our clinic in Katy for a first-time dermatologic consultation. Her main concern was a moderately pigmented bump on her lower sternum that had started showing signs of inflammation within the past week. She had never received prior treatment and was understandably anxious about the sudden change in the lesion’s appearance.

Expert Examination & Diagnosis

Our board-certified dermatologists conducted a comprehensive skin exam, using a dermatoscope for close evaluation. Based on the lesion's location, features, and recent inflammation, two potential diagnoses were considered:

• Epidermal Inclusion Cyst (EIC): A benign sac filled with keratin that can become inflamed or rupture.

• Inflammatory Papule: A more general term for a raised, inflamed lesion.

After discussing treatment options and risks with the patient, including the possibility of surgical excision or anti-inflammatory therapy, she opted for a Kenalog (ILK) injection—a minimally invasive solution with minimal downtime.

Treatment Administered:

• Intralesional Kenalog (ILK) Injection: 4.0 mg/cc (0.1 cc total volume).

• Counseling: Education on lesion care, potential outcomes, and signs that warrant follow-up.

Unexpected Diagnosis: Perioral Dermatitis

During her visit, the patient also mentioned a facial rash she had been managing on her own. Our exam revealed redness and inflammation around the mouth and cheeks, characteristic of Perioral Dermatitis—a chronic inflammatory skin condition.

Treatment Plan:

• Topical Metronidazole 0.75% Cream: To be applied nightly.

• Lifestyle Modifications: Avoiding cosmetic products, using non-comedogenic skincare, and protecting the skin from wind and sun exposure.

• Patient Education: Triggers such as steroid creams, certain toothpastes, and environmental factors were discussed.

Follow-Up & Outcomes

We scheduled follow-ups at:

• 4–6 weeks for the chest lesion post-ILK.

• 6 months for reassessment of Perioral Dermatitis, with a backup plan for doxycycline therapy if needed.

This dual-case highlights the importance of seeing a qualified dermatologist—even for what seems like a “simple bump.” Accurate diagnosis, patient education, and personalized treatment are pillars of dermatologic care at Village Dermatology, serving Katy and Houston, TX.

Why This Matters in Katy & Houston, Texas

In growing urban and suburban communities like Katy and Houston, patients often delay seeing a specialist. This case underscores how early evaluation by an experienced dermatologist can save time, reduce anxiety, and lead to effective, tailored treatment plans. Whether you're dealing with a puzzling bump, persistent rash, or just want peace of mind, our team at Village Dermatology is here to help.

Comprehensive Skin Check Uncovers Common Skin Concerns in a 68-Year-Old Patient: A Case Report from Village Dermatology

By Dr. Caroline Vaughn

At Village Dermatology, serving Katy, Texas and Houston, Texas, we are committed to proactive skin health.
Today, we share the case of a 68-year-old woman who visited us for a full-body skin exam and evaluation of several long-standing skin lesions. Her history, including a personal diagnosis of basal cell carcinoma and a family history of melanoma, underscores the importance of annual skin checks — especially for patients at higher risk.

Patient Background

This new patient presented with brown lesions located on her upper back and left breast. These lesions had been present for years, but she had never sought treatment before. Her medical history was significant for:

• Basal cell skin cancer (previously treated)

• Family history of melanoma (mother)

• Family history of non-melanoma skin cancer (father)

In addition to evaluating her lesions, she sought education about sun exposure and advice on monitoring her existing moles.

Examination Findings

Using both clinical inspection and a dermatoscope, a thorough examination of her skin, scalp, nails, and mucosa was performed. Key findings included:

• Benign Nevi: Regularly shaped, evenly colored moles with no signs of malignancy.

• Lentigines: Light tan macules, common signs of sun damage, scattered throughout sun-exposed areas.

• Cherry Angiomas: Benign vascular growths across the body.

• Seborrheic Keratoses: Benign "warty" growths on the back and shoulders.

• Actinic Keratoses: Precancerous lesions on the forehead.

• Irritated Seborrheic Keratosis: Inflamed, crusted lesion behind the left ear.

Treatment Plan

The patient underwent cryotherapy (liquid nitrogen treatment) for:

• 9 seborrheic keratoses (upper back and shoulders)

• 2 actinic keratoses (right forehead)

• 1 irritated seborrheic keratosis (postauricular skin)

She was counseled extensively on:

• Sun protection: Regular use of broad-spectrum SPF 30+ sunscreen, sun-protective clothing, and lip balm with SPF.

• Self-exams: Monthly self-skin checks for any new or changing lesions or moles.

• Follow-up care: Importance of annual full-body skin exams.

The patient was advised that lentigines, cherry angiomas, and seborrheic keratoses are benign and treatment is optional unless they become symptomatic.

The Importance of Regular Skin Exams

This case highlights the need for yearly skin checks, especially for individuals with:

• A personal or family history of skin cancer

• Chronic sun exposure

• A history of precancerous lesions such as actinic keratoses

Early detection and preventive treatment can greatly reduce the risk of progression to squamous cell carcinoma or melanoma.

At Village Dermatology, we pride ourselves on thorough, compassionate care for every patient — whether addressing cosmetic concerns, precancerous changes, or skin cancers.

✅ If you live in Katy, Texas, or Houston, Texas, and you are due for your annual skin check or have noticed new or changing moles, we invite you to schedule an appointment with our expert dermatology team today!
Prioritize your skin health — early detection saves lives.

Treating Actinic Keratosis and Squamous Cell Carcinoma in Older Adults: A Real Patient Story from Houston and Katy

Article by Dr. Ashley Baldree

At Village Dermatology, we often see patients in their later years with skin changes due to sun exposure over a lifetime. One recent patient, an 88-year-old man, came to us with darkening, enlarging lesions on his scalp that had become irregular over time. These skin changes were concerning not just because of how they looked—but because they could be signs of precancerous or cancerous skin growths.

In this blog, I’ll share how we evaluated and managed his condition, and what this case can teach us about actinic keratosis (AK) and squamous cell carcinoma (SCC) in older adults.

The Patient's Visit: Evaluation and Diagnosis

This gentleman had multiple lesions on his scalp and cheek that had changed in size and color. These are classic warning signs for sun-related skin damage. During his exam, we noticed scaly, red patches and thickened nodules—findings that led us to diagnose both actinic keratoses and biopsy-proven squamous cell carcinomas.

We used a dermatoscope, a special magnifying tool, to closely inspect the lesions. His overall health was good, and he was fully alert and oriented—key factors when planning treatment in older adults.

What Are Actinic Keratoses?

Actinic keratoses (AKs) are precancerous skin lesions caused by chronic sun exposure. They often appear as rough, red or pink patches and are common on the scalp, face, ears, and hands—especially in fair-skinned individuals.

These spots can turn into squamous cell carcinoma if left untreated, though not all do. That’s why it’s important to treat AKs early. For this patient, we treated 10 AKs using cryotherapy, where liquid nitrogen freezes the lesions, causing them to crust and fall off naturally over a few weeks.

We also counseled him on:

• Wearing broad-spectrum sunscreen SPF 30+ daily

• Using sun protective clothing

• Regular follow-ups to check for new or changing lesions

Learn more about AKs and skin cancer at Village Dermatology's Skin Cancer Education Page.

Diagnosing and Managing Squamous Cell Carcinoma (SCC)

This patient also had two areas on his scalp that were confirmed by biopsy to be well-differentiated squamous cell carcinomas. SCC is a common type of non-melanoma skin cancer and can become more serious if not addressed.

We discussed treatment options including:

• Mohs surgery (a highly precise surgical technique)

• Surgical excision

• Radiation therapy (XRT)

Although Mohs surgery is our standard for high-risk areas like the scalp (due to precision and low recurrence rates), the patient declined surgery and opted for radiation therapy instead. We coordinated with his primary care provider for referral to a radiation oncologist.

This type of shared care ensures that the patient gets treatment tailored to his preferences and health status while also addressing the seriousness of his diagnosis.

Learn more about SCC and treatment choices on our site:
Basal and Squamous Cell Carcinoma Treatments

Key Takeaways from This Case

✅ Sun damage is cumulative—what we did decades ago can show up now.
✅ Actinic keratoses are warning signs and should be taken seriously.
✅ Squamous cell carcinoma is treatable, especially when caught early.
✅ Radiation therapy can be an option for patients who can’t or prefer not to undergo surgery.
✅ Personalized care matters, especially in older adults with specific health goals.

At Village Dermatology in Katy and Houston, we’re committed to delivering expert, compassionate care for every age. If you have changing skin lesions or a history of sun exposure, schedule a skin cancer screening with us.

Early Detection, Expert Treatment: Managing Basal Cell Carcinoma on the Forehead

Blog Article by Dr. Caroline Vaughn

At Village Dermatology Houston, we understand that skin cancer screenings can be anxiety-provoking—but early detection paired with precise treatment can make all the difference. In this article, I want to share the case of a 68-year-old patient we first saw in March 2025, whose story highlights the value of thorough skin exams, patient education, and personalized care.

Initial Visit: A Concern for Suspicious Lesions

Our patient, a vibrant 68-year-old woman, came to our clinic as a new patient seeking evaluation for suspicious skin lesions on her right upper back and chest, as well as overall surveillance for skin cancer. She also wanted counseling on sun protection and help monitoring existing moles.

During her full-body skin exam, which included the use of a dermatoscope, we identified two areas of concern:

• A papule on her left dorsal forearm, which we suspected could be a seborrheic keratosis, squamous cell carcinoma, or a neoplasm of uncertain behavior.

• A darkly pigmented macule on the left forehead, which had features raising concern for basal cell carcinoma (BCC).

To evaluate these lesions further, shave biopsies were performed on both. The forehead lesion was later confirmed to be a nodular basal cell carcinoma, the most common—and fortunately, one of the most treatable—types of skin cancer.

Learn more about BCC in our Village Dermatology skin cancer overview and basal cell carcinoma guide.

Why Basal Cell Carcinoma Needs Prompt Attention

Basal cell carcinoma (BCC) is a slow-growing skin cancer that often appears in sun-exposed areas like the forehead, nose, and ears. Although BCC rarely spreads to other parts of the body, it can grow deep into the skin and cause significant tissue damage if left untreated.

The forehead is considered a high-risk area (Area M) for cosmetic and functional reasons. Given the tumor’s location and size (1.1 x 1 cm), Mohs micrographic surgery was the recommended and most appropriate treatment.

April 2025: Mohs Surgery & Complex Repair

Mohs surgery was performed in April 2025, with excellent results. The cancer was fully removed in just one stage, and no residual tumor cells were detected on frozen section analysis. The final defect measured 1.4 x 1.7 cm, extending into the adipose (fat) layer.

Due to the location and lack of surrounding skin laxity, we performed a complex layered repair with a Burow’s graft to ensure the wound was closed properly and healed with minimal scarring.

What is a Burow’s graft?
A Burow’s graft uses nearby healthy skin, shaped and repositioned to fill in the surgical defect. In this case, tissue from the adjacent forehead was used to create a natural closure with good cosmetic outcomes.

What to Expect After Mohs Surgery

Mohs surgery is a meticulous technique that removes skin cancer while preserving as much healthy tissue as possible. It’s especially valuable in cosmetically sensitive areas like the face.

Our patient experienced no complications, and the wound was closed with both deep sutures and a running epidermal stitch. She returned for a suture removal and wound check one week later.

Skin Cancer Prevention Tips

Our patient came to us not only for treatment but also to learn how to prevent future skin cancers. Here's what we recommend for all our patients, especially those in sunny areas like Katy and Houston:

• Apply broad-spectrum SPF 30+ sunscreen every day, even on cloudy days.

• Wear a wide-brimmed hat and protective clothing when outdoors.

• Schedule yearly full-body skin exams with a board-certified dermatologist.

• Check your skin monthly at home for new or changing moles or growths.

Final Thoughts

This case is a great example of why early detection and personalized treatment planning matter so much. Because our patient came in early and we were able to act quickly, her basal cell carcinoma was treated successfully with minimal tissue loss and an excellent cosmetic result.

If you’re in Katy or Houston and concerned about a skin lesion—or just want peace of mind through regular skin checks—schedule a visit with Village Dermatology Houston today. Whether it’s a new mole, a non-healing spot, or a general skin concern, we’re here to help you protect your skin and your health.

Managing Psoriasis Flares with Biologic Therapy: A Case Study from Village Dermatology

Blog Article by Dr. Caroline Vaughn
At Village Dermatology, we understand that psoriasis is a chronic and often unpredictable condition that requires consistent, personalized care. Today, I’m sharing the story of a 32-year-old male patient from our Katy and Memorial Houston offices who returned to clinic due to a psoriasis flare after being off his biologic medication, Taltz, for four months because of insurance issues.

Psoriasis: Chronic and Complex

Psoriasis is an autoimmune condition that causes skin cells to build up and form scaly, itchy plaques. This patient’s case was moderate in severity with symptoms like flaking and itching, primarily affecting the scalp and body. On examination, approximately 5–10% of his body surface area (BSA) was involved. Psoriasis is not only skin-deep; this patient also reported joint pain in his hands and knees, a possible sign of psoriatic arthritis.

The Role of Biologic Therapy

Biologic therapies, like Taltz (ixekizumab), target the immune pathways involved in psoriasis. Our patient had experienced improvement in both skin and joint symptoms while on Taltz. After discussing treatment expectations and the importance of monitoring for infections and immunosuppression, we reinitiated the process to restart his medication. A TB test was ordered to ensure safety prior to resuming therapy.

You can learn more about psoriasis and its treatment options on our dedicated pages here:
👉 Psoriasis Overview
👉 Psoriasis Treatments

Personalized Care with Every Visit

At Village Dermatology, we work closely with patients to ensure they understand their condition and treatment options. By staying proactive with follow-up visits and high-risk medication monitoring, we aim to keep flares under control and improve overall quality of life.

Understanding Rash Diagnosis and Treatment: A Case of Pityriasis Rosea vs. Drug Eruption

Written by Dr. Caroline Vaughn

At Village Dermatology, we often see patients with sudden-onset rashes that can be confusing, uncomfortable, and distressing. One such recent case involved a 43-year-old male from the Katy and Memorial Houston area who came in with a red, bumpy, and itchy rash primarily on his left upper arm and trunk.

Patient Background and Symptoms
The patient reported that the rash began five days prior as a single lesion before spreading across his torso and arm. He described it as itchy and irritating but had only tried oral Benadryl with no significant relief. He also noted a recent sinus infection for which he had been prescribed amoxicillin.

Clinical Evaluation and Diagnosis
Upon thorough physical examination using a dermatoscope, the rash presented as well-distributed, erythematous papules on the upper back, epigastric area, and left arm. Based on the clinical presentation and patient history, the differential diagnosis included:

• Pityriasis Rosea – an inflammatory skin condition often preceded by a “herald patch,” common in younger individuals and typically self-limited.

• Drug Eruption – a potential reaction to recent antibiotic use, in this case, amoxicillin.

• Unspecified Dermatitis – a broad classification pending more definitive diagnosis.

Treatment Plan
The patient was prescribed topical triamcinolone 0.1% cream to be applied twice daily for up to two weeks. He was also advised to use antihistamines and soothing lotions like Sarna for itch relief.

Patient Counseling
We discussed the expected course of pityriasis rosea, including its self-limiting nature. The patient was educated on the risks of prolonged steroid use and instructed to avoid applying high-potency creams to sensitive areas like the face or groin.

Follow-Up
A follow-up visit is scheduled in three weeks to reassess the rash’s progression and determine if further intervention is needed.

If you’re experiencing a new rash or skin irritation, don’t wait—schedule an appointment with our board-certified dermatologists today.

Navigating Perioral and Seborrheic Dermatitis: A Case Study

By Dr. Ashley Baldree, Village Dermatology, Katy and Memorial Houston

At Village Dermatology, we often encounter patients dealing with challenging skin conditions that affect their confidence and comfort. Recently, a 35-year-old female visited our clinic with a two-month history of a painful, dry, and flaking rash on her face. After trying and failing treatments, including doxycycline, ketoconazole, and hydrocortisone, she sought a solution to regain control over her skin health.

Understanding the Diagnosis

Upon examination, the patient displayed signs of two conditions: perioral dermatitis and seborrheic dermatitis.

• Perioral Dermatitis: This chronic rash, characterized by inflamed areas around the mouth and nose, was identified on her chin, cheek, and upper lip. Common triggers for this condition include cosmetics, topical steroids, fluorinated toothpaste, and environmental factors like wind or sun exposure.

• Seborrheic Dermatitis: Additionally, the patient exhibited pink/orange scaly plaques on the glabella, consistent with seborrheic dermatitis—a chronic condition prone to flares triggered by stress.

Seborrheic Dermatitis

Tailored Treatment Plan

To address these concerns, we devised a comprehensive treatment strategy:

• Perioral Dermatitis:

  • Prescribed Soolantra 1% cream (or Metrocream as an alternative) for daily application.

  • Provided Rhofade sample for temporary redness management before events.

  • Recommended gentle cleansing with La Roche-Posay Toleriane and daily use of Tizo tinted sunscreen to prevent UV-induced flares.

  • Counseling on minimizing cosmetic use and avoiding triggers.

• Seborrheic Dermatitis:

  • Suggested moisturizers like Cetaphil, CeraVe, and La Roche-Posay Toleriane for gentle care.

  • Emphasized using shampoos with tar, selenium, or zinc pyrithione to improve scalp health.

Patient Education and Follow-Up

Patients with chronic skin conditions like these require education on long-term management. We counseled her on expectations, including the potential for periodic flares and the importance of regular sunscreen application. A follow-up was scheduled within 2-4 weeks to evaluate progress and fine-tune the regimen.

Empowering Skin Health

At Village Dermatology, we prioritize individualized care to help patients feel confident in their skin. If you're managing perioral or seborrheic dermatitis, visit our dedicated page on seborrheic dermatitis or contact us for an appointment. Let us guide you toward healthier skin today!

Expert Care for Basal Cell Carcinoma on the Nasal Dorsum: A Patient’s Story

By Dr. David Wang

At Village Dermatology, we are dedicated to providing compassionate, expert care for patients managing skin cancer, including basal cell carcinoma (BCC). Today, we share the story of an 80-year-old male patient who came to our Katy and Memorial Houston offices for Mohs surgery to treat nodular basal cell carcinoma on the nasal dorsum.

Basal Cell Carcinoma: Understanding the Diagnosis

Basal cell carcinoma is the most common type of skin cancer. It typically appears as a small, flesh-colored bump or a pearly nodule and often develops on sun-exposed areas, such as the face and neck. Nodular basal cell carcinoma, a subtype, is characterized by its rounded growth and potential for local tissue invasion. While BCC rarely spreads to other parts of the body, timely treatment is crucial to prevent deeper tissue damage.

For more about basal cell carcinoma, visit our Basal Cell Carcinoma page.

The Patient’s Case: A Personalized Approach to Care

The patient initially presented with a 0.4 cm x 0.4 cm lesion on the nasal dorsum, which was confirmed as nodular basal cell carcinoma through a biopsy. Due to the tumor’s location on the nasal dorsum, an area where tissue conservation is critical, Mohs micrographic surgery was determined to be the most appropriate treatment.

Why Mohs Surgery?

Mohs surgery is a precise, tissue-sparing technique that removes the cancerous tissue layer by layer while preserving as much healthy tissue as possible. This method is especially beneficial for high-risk areas like the nose, where maintaining functionality and appearance is essential.

Mohs Surgery: Procedure Overview

The procedure began with a detailed discussion about the risks, benefits, and alternatives of Mohs surgery. After obtaining the patient’s informed consent, Dr. Wang performed the surgery in one stage, removing the tumor completely.

• Preoperative Size: 0.4 cm x 0.4 cm

• Final Defect Size: 0.7 cm x 0.7 cm

• Depth of Defect: Muscle

Frozen section analysis confirmed that all cancerous cells were removed, and the surgical site was carefully repaired using a complex repair technique to minimize scarring and optimize healing.

Postoperative Care and Patient Education

Following the procedure, the patient received detailed postoperative instructions to promote healing and reduce complications:

• Keep the area clean and dry.

• Apply petrolatum and pressure dressing as directed.

• Avoid sun exposure and use broad-spectrum sunscreen to protect the healing skin.

For tips on protecting your skin from sun damage, visit our Sun Protection page.

Why Early Detection Matters

Basal cell carcinoma is largely preventable with consistent sun protection and regular dermatologic check-ups. Early detection allows for less invasive treatments and better outcomes.

Expert Skin Cancer Care at Village Dermatology

At Village Dermatology, we specialize in advanced skin cancer treatments, including Mohs surgery, and prioritize patient-centered care. Whether you’re concerned about a new lesion or managing a confirmed diagnosis, our team is here to guide you every step of the way.

For more information or to schedule an appointment, visit our Basal Cell Carcinoma page or contact us directly.

Exploring the Role of Patch Testing in Diagnosing Allergic Contact Dermatitis

By Dr. Ashley Baldree

At Village Dermatology, we frequently treat patients with complex skin conditions like allergic contact dermatitis (ACD). Today, we share the story of a 58-year-old male patient from our Katy and Memorial Houston offices who sought further evaluation for persistent dermatitis on his back. His journey highlights the importance of patch testing in diagnosing and managing ACD effectively.

The Patient’s Journey

This established patient initially visited our clinic for unspecified dermatitis, which was treated with Fluocinonide 0.05% ointment applied twice daily. Despite initial improvements, his dermatitis persisted, prompting a deeper investigation.

What is Allergic Contact Dermatitis?

ACD is a type of skin inflammation caused by exposure to allergens that trigger an immune response. Common symptoms include:

• Well-demarcated, itchy patches or plaques

• Redness and swelling

• Potential blistering or scaling

ACD is often linked to everyday exposures, including personal care products, metals, and environmental factors.

Diagnostic Approach: Patch Testing

To identify the allergens causing the patient’s dermatitis, patch testing was performed. This comprehensive method involves applying common allergens to the skin and observing reactions over several days.

Testing Procedure:

• 80 allergens were applied to the patient’s back using the Core ACDS Recommended Series.

• Common allergens tested included nickel sulfate, fragrance mixes, and paraben mix, among others.

Post-Care Instructions:

The patient was advised to:

• Avoid getting the back wet or sweating for 48 hours.

• Refrain from scratching the area.

• Remove the patches after 48 hours.

Follow-up was scheduled in four days to evaluate the test results.

Why Patch Testing Matters

Patch testing is a cornerstone for diagnosing ACD, especially for:

• Persistent or unexplained dermatitis.

• Dermatitis affecting high-risk areas like the hands, face, or feet.

• Conditions resistant to conventional treatments.

The insights gained from patch testing allow for targeted management, minimizing exposure to specific allergens and alleviating symptoms effectively.

Treatment and Management

At Village Dermatology, we develop personalized treatment plans based on patch testing results. These often include:

• Avoidance of identified allergens.

• Topical or systemic therapies to manage inflammation.

• Education on proper skincare routines to prevent future flares.

Conclusion

Allergic contact dermatitis can be challenging to diagnose and manage, but patch testing offers a reliable solution. This patient’s case underscores the value of thorough evaluation and personalized care in achieving optimal outcomes.

Understanding and Treating Warts in Children: A Success Story

By Dr. Caroline Vaughn

At Village Dermatology, we pride ourselves on offering comprehensive, compassionate care for skin conditions of all ages. Warts, though common, can significantly impact a child’s comfort and confidence. Today, we’re sharing a success story about a 10-year-old patient treated for warts at our Katy and Memorial Houston offices.

Case Overview

The young boy, an established patient at our practice, presented with pink, cauliflower-like papules on his right elbow and upper arm. These lesions, medically referred to as Verruca Vulgaris, were enlarging and had not been treated before this visit.

During the consultation, the child was cheerful and accompanied by his mother and our medical assistant. Upon examination, he appeared well-nourished, well-developed, and in no acute distress.

What Are Verruca Vulgaris?

Verruca Vulgaris, or common warts, are benign skin growths caused by the human papillomavirus (HPV). These rough, raised lesions often develop in children due to minor trauma to areas like the hands, knees, or elbows, which increases their vulnerability to HPV.

Treatment Approach: Cryotherapy

After evaluating the patient, we recommended cryotherapy, a trusted and effective method for wart removal. This treatment involves using liquid nitrogen to freeze and destroy the wart tissue, allowing the skin to heal naturally.

Procedure Details:

• Six warts on the right elbow and upper arm were treated.

• Liquid nitrogen was carefully applied, causing controlled tissue damage to remove the warts.

• The patient’s mother provided informed consent after discussing potential side effects, including scabbing, blistering, pigmentation changes, and the possibility of recurrence.

Post-Treatment Care and Follow-Up

Following cryotherapy, it’s essential to ensure proper care to optimize healing and minimize complications. The family was advised to:

• Keep the treated area clean and dry.

• Avoid picking or scratching the scabs to prevent scarring or infection.

• Contact the office if signs of infection, like swelling or increased redness, occur.

A follow-up appointment was scheduled to evaluate the patient’s progress and determine if further treatments would be necessary.

Preventing and Managing Warts

Warts are highly contagious and can recur if preventive steps are not taken. We recommend the following:

1. Teach children to avoid picking at warts.

2. Practice good hygiene, including regular handwashing.

3. Cover warts with bandages in public settings, such as school or sports activities, to prevent spreading the virus.

Why Choose Village Dermatology?

At Village Dermatology, we provide expert care for warts and other skin conditions. Our treatments, such as cryotherapy, are safe and effective for children. We understand the emotional and physical challenges that come with skin conditions and strive to create a supportive, family-friendly environment.

Ready to Address Your Skin Concerns?

If your child has warts or other skin concerns, explore our dedicated page on warts to learn more about treatment options. Schedule an appointment with us today and let’s work together to ensure your child’s skin health and confidence.

Managing Pseudofolliculitis Barbae: A Patient's Journey

Written by Dr. Ashley Baldree

Pseudofolliculitis barbae, commonly known as razor bumps, is a chronic skin condition that can cause discomfort, inflammation, and frustration for those affected. It often occurs in areas where curly hair grows inward, leading to irritation and inflammation. This condition is particularly common in individuals with tightly coiled or curly hair.

In this blog, we’ll explore the case of a 30-year-old female patient managing pseudofolliculitis barbae, the treatments that have worked for her, and long-term strategies for success.

Understanding the Patient's Journey

Our patient, a 30-year-old female, initially sought care for persistent pseudofolliculitis barbae affecting the vulva area. She had experienced constant discomfort but found some relief through targeted therapies. Her initial treatment plan included:

• Benzoyl Peroxide Wash (10%): Used every three days to cleanse affected areas and prevent inflammation.

• Clindamycin Gel: Applied as needed for flare-ups, though she found limited success with this topical antibiotic.

• Waxing Avoidance: Counseling emphasized that waxing likely contributed to skin irritation.

Progress With Treatment

After following this regimen, the patient experienced notable improvement using doxycycline, an oral antibiotic prescribed for short-term use. She reported significant progress but was informed that doxycycline cannot be used as a long-term solution due to risks such as photosensitivity and potential adverse effects.

The patient also reduced her use of benzoyl peroxide to every three days to manage sensitivity, and she has been considering laser hair removal (LHR) for a more permanent solution to her condition.

Long-Term Management Recommendations

1. Benzoyl Peroxide (BPO):

   • The patient was counseled to continue using benzoyl peroxide for antibacterial and anti-inflammatory effects. She was advised to be mindful of potential irritation and to adjust usage frequency as needed.

2. Doxycycline for Flares:

   • The patient was provided with additional refills of doxycycline for flare-ups, with detailed counseling on avoiding prolonged use and understanding side effects like photosensitivity.

3. Laser Hair Removal (LHR):

   • As a long-term solution, LHR was recommended for reducing hair growth and minimizing the chances of future inflammation.

Skin Care Best Practices:

• Patients with pseudofolliculitis barbae should avoid shaving against the grain or cutting hair too short. Antibacterial soap or benzoyl peroxide wash can help maintain healthy skin.

Counseling and Education

Our counseling focused on ensuring the patient fully understands her treatment options and the potential side effects. Here are some key points:

• Benzoyl Peroxide Counseling: It may cause skin irritation and clothing discoloration. Reduce application frequency if irritation occurs.

• Doxycycline Counseling: Discussed risks such as photosensitivity, sunburn, and the importance of protective measures like sunscreen and clothing. The patient was also counseled on avoiding pregnancy during therapy due to potential birth defects.

• Topical Clindamycin Counseling: Explained the possibility of irritation and the need to adjust usage if necessary.

Outlook and Follow-Up

Pseudofolliculitis barbae is a manageable condition with proper care and a personalized treatment plan. While this patient has seen significant improvement, she has been advised to follow up in one month to evaluate the effectiveness of her regimen and make adjustments as needed. Patients experiencing similar issues are encouraged to consult a dermatologist to develop a tailored plan for their skin needs.

For more information about treating pseudofolliculitis barbae and other skin conditions, visit our dermatology page. If you’re in Katy or Memorial, Houston, and need personalized care, take the first step by becoming a patient with us today! Click here to get started.

Understanding and Treating Warts: A Case of a 10-Year-Old Patient

Written by Dr. Ashley Baldree

At Village Dermatology, we frequently see children for common skin concerns like warts, which can cause discomfort and emotional distress for both the child and their family. Today, we’re sharing the story of a 10-year-old boy, an established patient at our Katy and Memorial Houston offices, who came in for treatment of warts located on his right elbow and upper arm.

Case Overview

The young patient presented with enlarging, pink, cauliflower-like papules on his right elbow, distal lateral posterior upper arm, and lateral elbow. These lesions, medically referred to as Verruca Vulgaris, had not been previously treated. The patient appeared well-nourished, well-developed, and in no acute distress, with a cheerful demeanor during the visit. His mother and our skilled medical assistant were present throughout the examination.

What Are Verruca Vulgaris?

Verruca Vulgaris, or common warts, are benign skin growths caused by the human papillomavirus (HPV). They often appear as rough, raised bumps that can have a cauliflower-like texture. In children, warts frequently occur on the hands, elbows, or knees, areas prone to minor trauma, making the skin susceptible to HPV.

Treatment Approach: Cryotherapy

After evaluating the patient, we determined that cryotherapy with liquid nitrogen would be the best treatment option. Cryotherapy is a safe and effective way to freeze and destroy the wart tissue, allowing the skin to heal and regenerate.

Procedure Details:

• A total of six lesions were treated during the session.

• The liquid nitrogen was applied to the warts, causing controlled tissue damage to remove the lesions.

• We discussed the potential side effects, including crusting, scabbing, blistering, scarring, pigmentary changes, recurrence, incomplete removal, and infection. The patient’s mother provided informed consent for the procedure.

Post-Treatment Care and Follow-Up

After cryotherapy, it’s normal to see temporary redness, blistering, or scabbing in the treated area. We advised the family to:

1. Keep the area clean and dry.

2. Avoid picking or scratching the treated lesions to minimize the risk of infection or scarring.

3. Notify our office if signs of infection, such as increased redness, swelling, or pain, occur.

The patient’s next follow-up appointment will help us assess the progress of healing and determine if additional treatments are needed.

Managing and Preventing Warts

To prevent the recurrence or spread of warts, we recommend:

• Encouraging your child to avoid picking at warts.

• Practicing good hygiene, including washing hands regularly.

• Covering warts with bandages, especially in school or sports settings, to prevent spreading the virus.

Conclusion

Warts are a common and treatable skin condition in children. At Village Dermatology, we provide compassionate care and effective treatment options, such as cryotherapy, to help patients regain confidence and comfort in their skin.

If your child has warts or other skin concerns, visit our dedicated page on warts to learn more about treatment options, or contact us to schedule an appointment. Let’s work together to ensure healthy, happy skin for your child.

Blog Article: Managing Psoriasis with Advanced Treatments

By Dr. Caroline Vaughn

Psoriasis is a chronic autoimmune condition that affects millions of people worldwide. At Village Dermatology in Katy and Memorial Houston, we frequently see patients dealing with persistent symptoms like flaking, itching, and discomfort. One such patient presented with moderate psoriasis on the trunk that had been present for years, primarily managed with Otezla. Despite efforts, the treatment was not controlling her flares effectively, prompting a new approach.

Understanding Psoriasis

Psoriasis, specifically psoriasis vulgaris, is characterized by red, scaly patches that can appear on different parts of the body, including the trunk, scalp, and nails. It’s a lifelong condition with periods of remission and flares, often triggered by factors such as stress, infections, certain medications, or lifestyle factors like alcohol consumption. You can read more about psoriasis and its treatment options on our Psoriasis Overview page.

A Tailored Treatment Plan for our patient

This patient’s journey reflects the complexity of managing psoriasis. While Otezla, a systemic therapy, had been her primary treatment, its limitations in controlling her symptoms led us to explore other options. Following a consultation and clearance from an infectious disease specialist, we initiated treatment with Skyrizi. Skyrizi is a biologic therapy that provides targeted relief for patients with moderate to severe psoriasis who haven’t responded well to other systemic treatments.

Skyrizi Counseling and Administration
We carefully discussed the potential benefits and risks of Skyrizi with the patient, including:

• Risks: Increased susceptibility to infections and potential injection site reactions.

• Monitoring: Annual tuberculosis testing and vigilance for any symptoms of infection.

The first dose of Skyrizi was administered during the visit, with follow-ups scheduled to monitor progress and address any concerns.

Comprehensive Care for Psoriasis

In addition to systemic therapy, we emphasized the importance of supportive skin care to enhance treatment outcomes:

• Skin Care Recommendations:

  • Use emollients and moisturizers to prevent dryness.

  • Incorporate shampoos with tar, selenium, or zinc pyrithione for scalp psoriasis.

  • Consider coal tar and topical keratolytics for persistent plaques.

• Topical Steroids: We prescribed clobetasol 0.05% scalp solution to help reduce inflammation, with thorough counseling on proper use and potential side effects like skin thinning or discoloration.

For patients struggling with nail psoriasis, we discussed the use of topical steroids, vitamin D analogs, or even intralesional injections if needed. Learn more about available therapies on our Psoriasis Treatment page.

What to Expect

We counsel all our patients to have realistic expectations about psoriasis management. While we aim to reduce symptoms and flares, psoriasis is a chronic condition with no definitive cure. With proper treatment and monitoring, many patients experience significant improvement and longer periods of remission.

Call to Action

If you’re dealing with persistent psoriasis that hasn’t responded to treatment, there’s hope. At Village Dermatology, we offer advanced therapies tailored to your specific needs. Visit our Become a Patient page to schedule your consultation today and take the next step toward clearer, healthier skin.

Follow-Up

For this patient, a follow-up is scheduled in six months to assess her progress and make any necessary adjustments to her treatment plan. With consistent care and monitoring, we’re confident she’ll see meaningful improvements in her quality of life.

References
For more information about psoriasis and its treatments, visit:

1. Psoriasis Overview

2. Psoriasis Treatment Options

Green Nail Syndrome: Understanding and Managing Pseudomonas Nail Infections

Written by Dr. Ashley Baldree

Introduction

Green Nail Syndrome (GNS), also known as chromonychia, is a nail condition caused by the bacterium Pseudomonas aeruginosa. This organism is known for its role in hospital-acquired infections and its ability to cause localized nail discoloration and damage. While not typically life-threatening, Green Nail Syndrome can be uncomfortable and frustrating for patients.

Case Overview

The condition often develops after trauma to the nail, as seen in a 50-year-old male who sustained an injury to his thumb while working in his garage six months ago. The affected thumb nail now presents with a persistent green discoloration, characteristic of GNS. Chronic onycholysis (separation of the nail plate from the nail bed) and prolonged exposure to water or moisture are common contributors to this condition.

What Causes Green Nail Syndrome?

The hallmark green color results from pigments, particularly pyocyanin and pyoverdine, produced by Pseudomonas aeruginosa. These pigments accumulate in the nail bed, leading to the distinct discoloration. Green Nail Syndrome typically occurs when the nail environment becomes favorable for bacterial growth, such as:

1. Nail Trauma: Injuries to the nail create openings for bacterial entry.

2. Prolonged Moisture: Frequent water exposure weakens the nail, promoting bacterial colonization.

3. Underlying Conditions: Conditions like fungal infections or psoriasis can predispose the nail to secondary infections.

Symptoms and Diagnosis

Patients with Green Nail Syndrome may notice:

• A green or bluish-green discoloration of the affected nail.

• Onycholysis, where the nail separates from the nail bed.

• Mild tenderness or discomfort around the nail.

Diagnosis is typically clinical based on the characteristic appearance, but confirmatory testing can include:

• Nail clippings for culture and sensitivity.

• Dermoscopic examination to identify bacterial pigments.

Treatment Options

Treatment for Green Nail Syndrome involves a combination of topical and systemic approaches, depending on the severity:

1. Topical Therapy:

   • Acetic acid (vinegar) soaks: Dilute 1:4 with water and soak the affected nail for 10 minutes, 2–3 times daily.

   • Antibacterial solutions: Options like sodium sulfacetamide or 4% thymol in chloroform.

   • Topical fluoroquinolones: Ciprofloxacin eye drops can be applied to the nail bed.

2. Nail Hygiene:

   • Keep nails dry and clean.

   • Avoid prolonged water exposure and wear gloves during activities involving water.

   • Use a hairdryer to ensure nails are completely dry after washing.

3. Systemic Therapy:

   • If topical treatments fail, oral antibiotics like ciprofloxacin (500–750 mg twice daily for 4 weeks) may be prescribed.

   • Persistent cases may require nail removal to facilitate healing.

Preventing Green Nail Syndrome

Preventative measures include:

• Avoiding trauma to the nails.

• Keeping nails trimmed and well-maintained.

• Minimizing moisture exposure to reduce bacterial growth.

• Treating underlying nail conditions, such as fungal infections, promptly.

Call to Action

If you’re experiencing persistent nail discoloration or other nail concerns, early intervention is key to preventing complications. Schedule an appointment with Dr. Ashley Baldree at Village Dermatology in Katy, Texas, to receive expert care and personalized treatment plans.

Become a Patient Today

References

1. Green Nail Syndrome: Insights into Causes and Treatments. Available at: National Library of Medicine.

2. Clinical Principles of Pseudomonas aeruginosa Management.

For more information about nail conditions like Green Nail Syndrome, visit Village Dermatology’s Nail Health Page.

Managing Telogen Effluvium: A Guide to Hair Restoration

By Dr. Reena Jogi, Village Dermatology

Telogen effluvium is a common cause of temporary hair shedding that often leaves patients feeling frustrated and anxious about their hair health. The condition, usually triggered by stress, illness, or underlying health issues, can disrupt the normal hair growth cycle, resulting in noticeable hair loss. Today, we’re discussing the case of a 34-year-old female patient who returned to our office to refill her prescription for oral minoxidil, which she has been using to manage her telogen effluvium.

Understanding Telogen Effluvium

Telogen effluvium is a form of hair shedding that occurs when a significant number of hair follicles shift prematurely from the growth phase (anagen) into the resting phase (telogen). This can result in diffuse hair shedding across the scalp and can be triggered by a variety of factors, including:

• Stress: Physical or emotional stress can impact hair growth cycles.

• Illness: Acute or chronic illnesses, especially those involving high fevers, can contribute to shedding.

• Nutritional Deficiencies: Iron deficiency and low levels of essential nutrients are common contributors.

• Thyroid Disease: Both hyperthyroidism and hypothyroidism can disrupt hair growth.

• Medications: Certain medications are known to cause hair shedding as a side effect.

Telogen effluvium is typically a self-limiting condition, meaning it often resolves on its own within a few months once the underlying cause is addressed. However, in prolonged cases, additional treatment may be beneficial to encourage hair regrowth.

Treatment Overview and Patient’s Current Regimen

Our patient was initially prescribed off label Minoxidil 2.5 mg in tablet form, with instructions to take half a tablet daily. Minoxidil is a well-known hair regrowth treatment that works by extending the growth phase of hair follicles. While commonly used as a topical solution, oral minoxidil can be effective in cases like this where patients experience more extensive shedding.

The patient reported no significant side effects from the oral minoxidil but expressed concern about its effectiveness after a year of use. In response, we discussed additional treatment options, including the following:

1. Topical Minoxidil 5% Solution: For some patients, adding topical minoxidil alongside oral minoxidil can provide added benefit and address any areas of concern.

2. Hair Growth Supplements: Supplements such as Viviscal or Nutrafol contain nutrients that support hair health and growth, particularly for those with nutritional deficiencies.

3. Low-Level Laser Therapy: Devices like Theradome use low-level laser therapy to stimulate hair follicles, promoting healthier hair growth.

4. Platelet-Rich Plasma (PRP) Therapy: PRP therapy is a promising treatment that involves injecting concentrated platelets into the scalp to promote hair regrowth.

Medication Counseling: Risks and Considerations of Oral Minoxidil

We reviewed the potential risks of oral minoxidil with the patient to ensure she felt informed and comfortable continuing treatment. Possible side effects include:

• Swelling of the Feet or Ankles: Minoxidil can sometimes cause fluid retention.

• Dizziness and Lightheadedness: Minoxidil may occasionally lead to blood pressure changes.

• Unwanted Hair Growth: Patients may experience hair growth in areas other than the scalp.

• Allergic Reaction: Rarely, patients may experience an allergic reaction.

• Cardiac Concerns: Although rare, there is an association with pericardial effusion and cardiac tamponade, so we monitor closely for any signs of heart-related side effects.

After discussing these risks, our patient understood the importance of monitoring for any symptoms and immediately reporting any adverse effects. At this time, she felt comfortable continuing oral minoxidil and opted not to add any new medications to her regimen.

Exploring Additional Treatment Options: Dutasteride

We also discussed the possibility of introducing Dutasteride to her regimen, a medication that reduces levels of dihydrotestosterone (DHT), which can contribute to hair loss. However, Dutasteride is not recommended for women who are actively family planning or may become pregnant, as it can affect fetal development. After learning about these considerations, the patient decided to continue with her current regimen and hold off on Dutasteride for now.

Recommendations for Ongoing Care

For optimal hair health and to support her recovery from telogen effluvium, we recommended the following:

1. Daily Self-Care: Avoiding hairstyles that put tension on the scalp and minimizing heat styling can prevent further damage.

2. Dietary Supplements: Incorporating supplements like Nutrafol to provide essential nutrients that support hair strength and growth.

3. Regular Monitoring: Monthly self-exams of the scalp can help the patient monitor hair regrowth progress.

4. Follow-Up Visits: Scheduling follow-ups every 3–6 months allows us to assess the effectiveness of the treatment and adjust as necessary.

Conclusion

Telogen effluvium can be distressing, but with the right treatments and supportive care, many patients experience a return to normal hair growth within months. At Village Dermatology in Katy, TX, we work closely with patients to create customized treatment plans, using a combination of proven medications, supplements, and lifestyle recommendations to address hair loss concerns.

If you’re dealing with hair shedding or other hair health concerns, schedule a consultation with our team. Our approach is centered around understanding each patient’s unique needs and providing effective, individualized care. For more information on telogen effluvium, visit our Telogen Effluvium Treatment page.

Evaluating and Treating Skin Lesions: A Case Study in Cosmetic Shave Removal

By Dr. Ashley Baldree, Village Dermatology

Skin lesions can appear for various reasons and may vary greatly in appearance and texture. When a lesion's nature is uncertain, dermatologists often recommend biopsy or removal to ensure an accurate diagnosis and appropriate care. Today, I’ll share a case of a 50-year-old female patient who came to our office with a lesion on her thigh, leading to a careful evaluation and cosmetic shave removal procedure.

Case Overview

Our patient, a 50-year-old woman, presented with a moderately severe, asymptomatic lesion on her left anterior proximal thigh. The lesion had been present for several months but had not received any prior treatment. Given the uncertain nature of this growth, our differential diagnosis (DDx) included several possibilities: Neoplasm of Uncertain Behavior, skin tag, wart, and seborrheic keratosis (SK).

After thorough evaluation, we determined that a cosmetic shave removal would be the best approach. This allowed for both the removal of the lesion and histologic evaluation to confirm its nature.

Diagnosis: Neoplasm of Uncertain Behavior

"Neoplasm of Uncertain Behavior" is a term used when a lesion’s exact diagnosis is unclear, and it requires further examination to rule out potential concerns. While many lesions in this category are benign, the uncertainty warrants removal and biopsy to ensure there are no underlying risks.

Procedure Details: Cosmetic Shave Removal

Once the patient consented to the procedure, we reviewed the risks and benefits, which include:

• Infection

• Scarring

• Bleeding

• Prolonged Wound Healing

• Incomplete Removal

• Allergic Reactions to Anesthesia

• Nerve Injury

• Recurrence of the Lesion

Procedure Steps:

1. Preparation: The area was prepped with alcohol to maintain sterility, and 1% lidocaine with epinephrine was used as a local anesthetic to numb the area.

2. Removal: Using a scissors technique, a cosmetic shave removal was performed to remove the lesion. This method minimizes scarring and is ideal for benign or low-risk lesions.

3. Hemostasis: Drysol was applied to control bleeding.

4. Post-Procedure Care: After the shave removal, we applied petrolatum and a bandage to the wound and provided wound care instructions.

Post-Procedure Care and Follow-Up

After the procedure, we reviewed the following wound care instructions with the patient:

• Keep the area clean and apply a fresh bandage daily.

• Apply petrolatum to keep the wound moist, which aids in healing and reduces scarring.

• Avoid sun exposure on the treated area until fully healed, as sun exposure can cause pigment changes.

We informed the patient that she would be contacted with biopsy results, typically within two weeks. If she hasn’t heard from our office by then, we encouraged her to call us for an update.

Importance of Skin Lesion Evaluation

This case highlights the importance of evaluating new or changing skin lesions, especially when there is uncertainty about the lesion’s nature. Even when a lesion appears harmless, a biopsy can provide peace of mind and help rule out any underlying concerns. Patients should perform regular self-exams and schedule yearly skin checks with their dermatologist to monitor for new or changing lesions.

If you have concerns about a skin lesion or would like to discuss treatment options, visit us at Village Dermatology in Katy, TX. Our team is here to help you understand your skin health and provide the best care options for your needs.

Understanding Skin Cancer Risk and Prevention: A Guide for Patients with Family History

By Dr. Caroline Vaughn, Village Dermatology

For patients with a family history of non-melanoma skin cancer, understanding skin care and prevention is essential. This article explores the case of a 65-year-old male patient who visited our Katy office with concerns about his risk of skin cancer and several longstanding lesions on his cheek and elbow. Our discussion focused on skin cancer prevention, recognizing potential warning signs, and creating a personalized plan for ongoing skin monitoring.

Case Overview

Our patient came in for an evaluation due to his family history of non-melanoma skin cancer, such as basal cell carcinoma and squamous cell carcinoma. He was concerned about two asymptomatic lesions that had been present for years and wanted to understand his risk factors. The lesions, one on his right cheek and another on his left elbow, were moderate in severity but had not changed recently. After a thorough examination, we determined these were benign nevi—harmless, symmetrical moles that do not require treatment.

Importance of Sun Protection for Skin Cancer Prevention

Patients with a family history of skin cancer are at a higher risk of developing similar conditions, even if they haven’t experienced skin cancer themselves. Sun exposure remains a significant factor in skin cancer risk, so I recommended that the patient adopt the following protective measures:

• Broad-Spectrum Sunscreen: Daily use of SPF 30+ sunscreen, even on cloudy days, helps reduce UV exposure, which is crucial for preventing non-melanoma skin cancers.

• Sun-Protective Clothing: Long sleeves, wide-brimmed hats, and UV-blocking sunglasses offer additional protection, especially during peak sun hours (10 a.m. to 4 p.m.).

• Avoiding Tanning: Direct sun exposure and tanning beds increase the risk of skin cancer. Staying in the shade or using alternative tanning products, such as self-tanners, is a safer choice.

For more on sun protection and its role in skin cancer prevention, visit our Sun Protection page.

Self-Skin Exams: A Crucial Habit for High-Risk Patients

Given his family history, I advised the patient to perform monthly self-skin checks to detect any changes in existing moles or the appearance of new lesions. Early detection plays a vital role in managing skin cancer risks. During these checks, he should look for:

• New Growths: Pay attention to any new spots, especially those that do not heal or seem to grow over time.

• Changes in Moles: Watch for changes in size, shape, or color, particularly if a mole becomes asymmetrical or develops uneven borders.

• Symptoms: Report any moles or spots that itch, burn, bleed, or become painful, as these can be signs of more concerning growths.

I provided a guide for performing thorough self-exams, advising him to use a mirror for hard-to-see areas and to ask a partner or family member for assistance if needed.

Understanding Benign Nevi and When to Contact Your Dermatologist

During the examination, we observed multiple benign nevi throughout his body. These are regular, symmetrical moles with even pigmentation, which are generally harmless. While benign nevi do not require treatment, it’s essential to monitor them for any signs of transformation over time, particularly in high-risk patients.

Key Points for Benign Nevi:

• Monthly Monitoring: Regularly inspect moles for changes, as even benign lesions can change over time.

• When to Contact Us: If a mole changes in size, shape, or color, or if it begins to itch, burn, or bleed, it’s important to consult with a dermatologist.

Routine Dermatologist Visits for Lifelong Monitoring

In addition to self-exams, patients with a family history of skin cancer should schedule annual professional skin exams. During these exams, dermatologists can assess any suspicious spots and discuss any changes noted since the previous visit. With our patient, we agreed on a schedule for routine visits to ensure he receives consistent care and monitoring.

Takeaway: Preventive Skin Care for Patients at Risk

This case highlights the importance of preventive care for individuals with a family history of skin cancer. By integrating sun protection, self-skin exams, and regular dermatological check-ups into his routine, the patient can significantly reduce his skin cancer risk and catch potential concerns early.

If you have a family history of non-melanoma skin cancer or are concerned about your skin health, schedule a consultation with our Katy office at Village Dermatology. Our team is here to provide personalized care and educate you on effective skin cancer prevention.