Comedonal Acne in a 20-Year-Old Female: A Case from Village Dermatology, Katy & Houston, Texas

by: Ashley Baldree

Case Overview
A 20-year-old female presented to Village Dermatology for evaluation and management of persistent acne located on the face. She reported blackheads, whiteheads, and occasional pimples that had been present for several months. Her only prior and current treatment included benzoyl peroxide lotion.

Clinical Examination
A comprehensive skin examination, including scalp, face, ears, neck, and upper extremities, revealed:

• Primary findings: Open and closed comedones (blackheads and whiteheads)

• Additional findings: Mild inflammatory papules and pustules concentrated on the forehead, cheeks, and chin

• No evidence of cystic or nodular lesions

• Skin otherwise well-nourished, with no signs of infection or scarring

Diagnosis

• Comedonal Acne (L70.0) with mild inflammatory component

• Distribution: Face (forehead, nose, cheeks, and chin)

Treatment Plan
To enhance the patient’s current regimen and improve acne control, the following steps were recommended:

1. Continue benzoyl peroxide lotion for antimicrobial and anti-inflammatory benefits.

2. Add a salicylic acid cleanser to help exfoliate and unclog pores.

3. Initiate topical tretinoin microspheres 0.04% gel – apply a pea-sized amount nightly to the entire face to promote cell turnover and prevent new comedones.

4. Skin care counseling:

   • Use non-comedogenic cleansers and moisturizers.

   • Always apply broad-spectrum sunscreen SPF 30+ during the day.

   • Expect initial irritation and dryness, which can be minimized with moisturizer.

5. Follow-up in 4–5 months to monitor progress and adjust treatment as necessary.

Patient Counseling & Expectations

• Improvement typically occurs gradually, with 60–80% clearance expected within 2–3 months of consistent use.

• Avoid picking or squeezing lesions to prevent scarring.

• Monitor for excessive redness, peeling, or sensitivity and adjust use as needed.

Dermatology Insight – Katy & Houston Focus
Comedonal acne is one of the most common skin conditions we treat at Village Dermatology in Katy and Houston, Texas. Early intervention is key to preventing scarring and hyperpigmentation. Combining benzoyl peroxide, salicylic acid, and tretinoin is a proven regimen that addresses both pore blockage and skin turnover, leading to smoother, clearer skin.

Managing Androgenetic Alopecia in a 32-Year-Old Female: Dose Adjustment and Long-Term Hair Restoration Planning

by: Ashley Baldree

At Village Dermatology, serving Katy and Houston, Texas, we often see patients seeking long-term solutions for progressive hair thinning. This case features a 32-year-old female patient returning for follow-up care after her initial diagnosis of androgenetic alopecia (AGA) affecting the mid-frontal scalp and left superior parietal scalp.

Patient Background

The patient was first evaluated on March 12, 2025, and started on oral minoxidil 2.5 mg, with a gradual dose escalation plan beginning at ¼ tablet daily, increasing to ½ tablet daily. At her follow-up visit, she reported no significant side effects and noted that her hair loss appeared stable.

Clinical Findings

A thorough scalp examination with dermatoscopy revealed diffuse non-scarring hair loss and patterned thinning consistent with AGA. No scalp inflammation or scarring was observed.

Treatment Plan and Counseling

To further optimize results, the patient’s oral minoxidil dose was increased from ½ tablet to 1 full tablet daily. She was counseled on the potential side effects, including:

• Chest pain

• Ankle swelling

• Fluid retention

• Low blood pressure

• Dizziness or lightheadedness

• Unwanted hair growth

We also discussed additional hair restoration options, including:

• Oral spironolactone – for its anti-androgen effects in women

• ALMA TED – a non-invasive, in-office treatment designed to stimulate hair growth and improve scalp health

The patient elected to proceed with the higher minoxidil dose at this time and received an ALMA TED information handout for future consideration.

Education & Expectations

Patients with AGA are counseled that the condition is genetically pre-determined and slowly progressive. While treatments like minoxidil and spironolactone can help slow shedding and promote regrowth, results typically take 6 months or longer and require ongoing maintenance.

We also provided hair care guidance, recommending gentle shampooing, avoiding excessive heat styling, and ensuring proper scalp hydration.

Follow-Up

The patient will return in 6 months to evaluate treatment response and discuss whether to incorporate ALMA TED or other supportive therapies into her regimen.

Treating Genital Warts and Benign Facial Lesions: A 45-Year-Old Male Case in Katy & Houston, TX

by: Dr. Caroline Vaughn

At Village Dermatology, we provide both medical and cosmetic dermatologic care for a wide range of conditions. This case highlights a 45-year-old male from the Katy and Houston, Texas area who presented with genital warts and benign facial growths known as dermatosis papulosa nigra.

Patient Presentation

The patient came in for:

1. Genital warts – Located on the suprapubic area, penis, and proximal thigh, present for several years and recently spreading.

2. Brown facial lesions – Located on both cheeks, present for years without treatment.

He reported that:

• The warts had recurred after 7 years

• Over-the-counter cryotherapy did not help

• No personal or family history of skin cancer

• No family history of melanoma

Clinical Examination

Using a dermatoscope, we identified:

Facial Lesions: Dermatosis Papulosa Nigra

• Brown, small, verrucous papules

• Located on both cheeks

• Benign in nature

• Cosmetic removal possible via light electrodesiccation (patient declined treatment for now)

Genital Warts: Verruca Vulgaris (Condyloma)

• Multiple lesions on:

  • Suprapubic skin

  • Left dorsal shaft of penis

  • Base of penis

  • Right dorsal shaft of penis

  • Right anterior proximal thigh

• Associated mild inflammation

Understanding the Conditions

Dermatosis Papulosa Nigra
A benign skin growth common in people with darker skin tones. These lesions:

• Are harmless

• Do not require treatment unless for cosmetic reasons

• Can be removed with minor in-office procedures

Genital Warts (Condyloma Acuminata)
Caused by the human papillomavirus (HPV):

• Sexually transmitted

• Can recur even after treatment

• Linked to certain cancers, particularly cervical cancer in women

Treatment Plan

For Genital Warts

• Liquid nitrogen cryotherapy performed on 15 lesions during the visit

• Patient counseled on:

  • The possibility of recurrence

  • Preventing transmission through abstinence until cleared

  • Ensuring all sexual partners, especially females, receive regular Pap smears

For Dermatosis Papulosa Nigra

• Observation for now

• Option for cosmetic removal in the future if desired

Follow-Up Plan

• One-month follow-up for re-evaluation and additional cryotherapy if needed

• Patient advised to return sooner if:

  • Lesions worsen

  • New warts appear

  • Any changes in facial lesions are noticed

Why This Matters for Katy & Houston Residents

At Village Dermatology, we combine medical expertise and patient education to manage both health-related and cosmetic skin concerns. Whether it’s HPV-related genital warts or benign facial lesions, our approach focuses on:

• Accurate diagnosis

• Tailored treatment plans

• Preventive education to reduce recurrence and complications

If you live in Katy or Houston, Texas and have skin lesions that are spreading, changing, or causing concern, our team is here to help.

Managing Chronic Scalp Psoriasis in Young Adults: A 24-Year-Old Male Case Study in Katy & Houston, TX

By: Dr. Ashley Baldree

Psoriasis is a chronic autoimmune condition that often affects the scalp, causing itching, redness, and thick scaling that can significantly impact quality of life. At Village Dermatology, we frequently treat patients in Katy and Houston, Texas, who have been living with psoriasis for years and are seeking lasting solutions. This case features a 24-year-old male with moderate scalp psoriasis who had previously tried multiple systemic and topical treatments without long-term success.

Patient Presentation

The patient reported:

• An 8-year history of scalp psoriasis

• Ongoing itching and redness, moderate in severity

• No family history of psoriasis

Despite long-standing efforts, his psoriasis had been difficult to control:

• Otezla was discontinued due to elevated liver enzymes

• Skyrizi provided good clearance but had to be stopped for the same reason

• He had also tried various topical steroids and medicated shampoos with limited results

Physical Examination

A detailed scalp and facial exam using a dermatoscope revealed:

• Red, scaly plaques located on the right superior forehead, consistent with psoriasis

• No signs of acute distress

• Patient was alert, healthy, and well-nourished

Diagnosis: Chronic Scalp Psoriasis

Scalp psoriasis is a common manifestation of chronic plaque psoriasis. It presents as:

• Well-demarcated red plaques

• Covered in silvery-white scale

• Located along the hairline, scalp, or behind the ears

• Associated with itching, burning, and social discomfort

Updated Treatment Plan

After a full review of his medical history, failed treatments, and lab results, we developed a new, tailored management strategy:

Topical Prescriptions:

• Ketoconazole 2% Shampoo –
  Lather on scalp for 5–10 minutes, use 3x per week.
  Helps reduce inflammation and yeast that may aggravate psoriasis.

• Fluocinonide 0.05% Topical Solution –
  Apply to scalp twice daily for 2 weeks, then PRN for flares.
  A potent steroid to calm active inflammation.

• Hydrocortisone 2.5% Ointment –
  Apply to facial areas twice daily for 2 weeks, then as needed.
  A lower-potency steroid for sensitive areas like the face.

Initiating Tremfya® (Guselkumab)

Given his systemic treatment failures, we recommended starting Tremfya, a biologic injection indicated for moderate-to-severe plaque psoriasis.

Tremfya Plan:

• Dosing: 100 mg subcutaneous at weeks 0 and 4, then every 8 weeks

• Monitoring:

  • Baseline TB test (PPD)

  • Annual TB re-screening

  • Liver enzyme monitoring

We discussed the risks and benefits, including rare risks such as infection, immunosuppression, and posterior leukoencephalopathy syndrome. The patient verbalized understanding and opted to begin Tremfya immediately.

Counseling Highlights

We educated the patient on:

• Chronic nature of psoriasis: flare-ups and remissions are expected

• Trigger management: stress, alcohol, strep infections, and certain medications may worsen symptoms

• Importance of ongoing monitoring during biologic therapy

The patient received a handout with his treatment regimen and will follow up in 2 months.

Why This Case Matters for Katy & Houston Residents

Scalp psoriasis can be physically uncomfortable and emotionally taxing, especially when resistant to treatment. At Village Dermatology, we offer advanced therapeutic options and personalized care plans for young adults and others suffering from chronic psoriasis. If you're located in Katy or Houston, TX, our expert team is ready to help you regain comfort and confidence in your skin.

Evaluating Skin Lesions in Young Adults: A Case of Benign Nevi in a 25-Year-Old Female

By: Dr. Caroline Vaughn

Skin health and sun protection are vital topics for all age groups—but especially for young adults who are beginning to understand the long-term importance of sun safety and skin surveillance. At Village Dermatology, we frequently provide full-body skin exams for patients in Katy and Houston, Texas, helping them take proactive steps against skin cancer and other dermatologic concerns. In this case, we evaluated a 25-year-old female who presented for an assessment of enlarging and itchy skin lesions she had noticed over several years.

Patient Presentation

This patient reported moderately itchy, enlarging lesions located throughout her body. The lesions had been present for years but had never been evaluated or treated. She also expressed interest in sun protection education and guidance for preventing future skin cancer or atypical mole development.

She had no personal or family history of melanoma or non-melanoma skin cancers.

Comprehensive Skin Exam

A thorough, head-to-toe dermatologic evaluation was performed using dermatoscopy, which included:

• Scalp and hair

• Face, ears, neck

• Trunk and extremities

• Hands, feet, nails

The only notable findings were:

• Regular, symmetrical, evenly pigmented macules and papules consistent with benign nevi (commonly known as moles), found on the:

  • Upper back

  • Left upper back

  • Right forearm

  • Right ventral proximal forearm

No suspicious or atypical features were identified.

Diagnosis: Benign Nevi

Benign nevi are common in young adults and represent clusters of pigment-producing cells (melanocytes) in the skin. They are typically uniform in shape, size, and color, and do not require treatment unless changes are observed.

In this case, the patient had no concerning lesions that warranted biopsy or removal.

Counseling and Education

Patient education is a key part of dermatologic care. We provided the following guidance:

Sun Safety & Skin Monitoring:

• Apply a broad-spectrum sunscreen (SPF 30 or higher) daily, especially on exposed areas.

• Perform monthly self-skin checks to monitor moles for changes in:

  • Size

  • Shape

  • Color

  • New symptoms (itching, bleeding, burning)

When to Seek Medical Attention:

• If any moles become asymmetric, change appearance, or develop symptoms, the patient was instructed to contact our clinic promptly for reevaluation.

No Immediate Treatment Necessary

Since the nevi were consistent with benign characteristics and the patient declined full disrobing, we opted for observation and education. The patient was advised to continue regular self-checks and schedule an annual skin exam unless earlier evaluation is needed.

Why This Case Matters for Katy and Houston Patients

Many young adults assume that mole checks and skin cancer screening are only necessary later in life—but early intervention and education are key. At Village Dermatology, we specialize in personalized skin assessments, ensuring peace of mind for our patients while equipping them with the tools to monitor and protect their skin long-term.

Whether you're in Katy or Houston, now is the time to schedule a full-body skin exam and establish a baseline for your skin health.

Treating Nodular Basal Cell Carcinoma with ED&C: A 68-Year-Old Female Case Study

By: Dr. Ashley Baldree

Basal cell carcinoma (BCC) is the most common type of skin cancer, particularly in individuals with fair skin and a history of sun exposure. At Village Dermatology in Katy and Houston, Texas, we frequently evaluate and treat BCC with methods tailored to the size, depth, and location of the tumor. This case highlights the successful management of nodular basal cell carcinoma in a 68-year-old woman using electrodesiccation and curettage (ED&C).

Patient Overview

A 68-year-old woman returned for a follow-up evaluation after a shave biopsy was performed on July 3, 2025, for a pigmented lesion on the right mid-upper back. Biopsy results revealed nodular basal cell carcinoma, a slow-growing but locally invasive form of skin cancer.

What Is Nodular Basal Cell Carcinoma?

Nodular BCC is a subtype of basal cell carcinoma that typically presents as a pearly, dome-shaped papule with visible blood vessels (telangiectasias). Though rarely metastatic, BCC can cause significant tissue damage if left untreated.

Clinical Findings

Location: Right mid-upper back
Appearance: Pearly, telangiectatic papule
Size: 0.9 cm
Tools Used: Dermatoscope for lesion visualization

Treatment: Curettage and Destruction (ED&C)

ED&C is a non-surgical treatment for superficial and nodular BCCs, especially in low-risk locations. It involves scraping away the tumor with a curette, followed by cauterization to destroy remaining cancer cells.

Procedure Details:

• Anesthesia: Local lidocaine with epinephrine

• Cycles: 2 rounds of curettage and electrodesiccation

• Final Lesion Size Post-Curettage: 0.9 cm

• Post-Treatment Care: Wound was cleaned and dressed with a pressure bandage

• Post-Op Instructions: The patient was given detailed guidance on wound care, activity restrictions, and signs of complications

Informed Consent:

All risks, benefits, and alternatives were reviewed, including:

• Risks: Infection, scarring, bleeding, recurrence, nerve injury

• Alternatives: Surgical excision, radiation therapy (XRT)

Why ED&C Is a Trusted Option for Certain Skin Cancers

Electrodesiccation and curettage is often chosen for:

• Small to moderately sized BCCs

• Non-aggressive tumor types

• Patients who may not be ideal candidates for surgery

This technique is effective, relatively quick, and performed in-office with minimal downtime.

Outcome and Follow-Up

The patient tolerated the procedure well and left the clinic with a clear post-op plan. At Village Dermatology, we will monitor the area for healing and recurrence, with the goal of complete resolution and excellent cosmetic outcome.

Protecting Against Skin Cancer

While basal cell carcinoma is common, it is also highly preventable and treatable when caught early. Key prevention strategies include:

• Daily use of broad-spectrum SPF 30+ sunscreen

• Regular full-body skin exams

• Avoiding tanning beds and minimizing UV exposure

Concerned About a Skin Lesion?

If you’ve noticed a new, growing, or changing spot on your skin, especially one that looks shiny or pearly, don’t wait. Our board-certified dermatologists in Katy and Houston, Texas are here to help with timely diagnosis and treatment.

📍 Now accepting new patients in Katy & Houston
📞 Call today to schedule a full skin evaluation

Comprehensive Dermatologic Care: Cyst, Wart, and Actinic Keratosis Treatment in a 74-Year-Old Female

By: Dr. Caroline Vaughn

At Village Dermatology, we specialize in diagnosing and treating a wide variety of skin concerns in patients of all ages. In this blog, we highlight a recent case of a 74-year-old female who came to our clinic with three skin concerns: an enlarging cyst on the right shoulder, a wart on the right index finger, and a sun-induced precancerous lesion known as actinic keratosis on the nose.

Patient Overview

The patient, new to our clinic, had been living with these lesions for years. Recently, the cyst began to enlarge, prompting her visit. The wart was asymptomatic, and the actinic keratosis on her nose was noted during routine examination.

1. Epidermal Inclusion Cyst (Right Posterior Shoulder)

Epidermal inclusion cysts are benign sacs under the skin filled with keratin. Though typically harmless, they can become painful, inflamed, or cosmetically concerning as they grow.

Exam Findings:

• Location: Right posterior shoulder

• Size: 1.1 cm × 1.2 cm

• Appearance: Enlarging, firm, subcutaneous nodule

Treatment:

• Slit Excision under local anesthesia

• Entire cyst was removed and sent for pathology

• Wound closed with simple repair using sutures

• Patient was instructed to avoid heavy lifting or swimming for 14 days

• Suture removal planned in 2 weeks

Why this matters:
Even benign cysts can enlarge or become inflamed, making excision a preventive and therapeutic option—especially in older adults.

2. Verruca Vulgaris (Common Wart on Right Index Finger)

Warts are caused by the human papillomavirus (HPV) and are contagious through direct contact. This patient’s wart had been present for years and had begun to enlarge.

Exam Findings:

• Location: Right distal palmar index finger

• Symptoms: Asymptomatic but enlarging and slightly irritated

• Appearance: Classic cauliflower-like bump

Treatment:

• Cryotherapy with liquid nitrogen

• One lesion treated using two freeze-thaw cycles

• Patient education: Warts are contagious and may recur without continued treatment

Prevention Tip:
Avoid picking at warts and wash hands regularly to prevent spreading the virus.

3. Actinic Keratosis (Precancerous Lesion on Nasal Dorsum)

Actinic keratoses (AKs) are precancerous lesions that develop in sun-damaged skin. They can evolve into squamous cell carcinoma if left untreated.

Exam Findings:

• Location: Nasal dorsum (bridge of the nose)

• Appearance: Rough, scaly patch in sun-exposed area

Treatment:

• Cryotherapy with liquid nitrogen

• Patient was counseled on sun protection and SPF 30+ sunscreen

• Discussed long-term treatment options including topical 5-FU, imiquimod, or photodynamic therapy

Comprehensive Geriatric Dermatology at Village Dermatology

This case showcases how one visit can lead to the diagnosis and treatment of multiple skin conditions in a senior patient. At Village Dermatology, we provide full-spectrum dermatologic care tailored to the unique needs of older adults, from benign lesions to cancer prevention.

If you’re noticing enlarging bumps, persistent growths, or sun-damaged skin, schedule a visit with our dermatology team in Katy or Houston, Texas.

📍 Serving Katy and Houston, TX
📞 Call now to book your consultation or skin evaluation!

When Skin Lesions Raise Concern: A Case of Seborrheic Keratosis, Warts, and Notalgia Paresthetica in a 65-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often see patients who present with skin lesions that have changed in size, color, or texture. While many of these lesions turn out to be benign, timely evaluation is essential for diagnosis, peace of mind, and effective treatment. In this blog post, we review the case of a 65-year-old female who visited our clinic for assessment and management of multiple skin concerns, including suspicious lesions on the left shoulder and posterior neck.

Patient Overview

A 65-year-old woman came to our dermatology clinic as a new patient with a primary concern of enlarging, darkening lesions on her left shoulder and the back of her neck. These lesions had been present for several months and were moderately bothersome to her.

During her comprehensive full-body skin exam — including scalp, face, ears, chest, abdomen, back, and extremities — several dermatologic conditions were identified using a dermatoscope.

Diagnosis and Management

1. Seborrheic Keratosis (L82.1)

These common, benign growths often appear as waxy, "stuck-on" brown or black papules. The patient had several seborrheic keratoses on her body, consistent with age-related skin changes.

Plan:

• Counseling: These growths are harmless and do not require treatment unless irritated.

• Patient Education: We explained that these are benign and often increase with age.

2. Irritated Seborrheic Keratosis (L82.0)

In contrast to typical seborrheic keratoses, the patient had four inflamed lesions on her upper back. These showed signs of irritation, including crusting and tenderness.

Plan:

• Cryotherapy: Four lesions were treated with liquid nitrogen (2 freeze-thaw cycles).

• Patient Counseling: Discussed symptoms, treatment outcomes, and when to return if lesions persist or side effects occur.

3. Verruca Vulgaris (Common Warts, B07.8)

The patient had a cauliflower-like wart on her right anterior shoulder.

Plan:

• Cryotherapy: One lesion was treated with liquid nitrogen.

• Topical Treatment: Recommended salicylic acid for follow-up care.

• Counseling: Explained that warts are viral and may spread or recur.

4. Notalgia Paresthetica (R20.2)

The patient reported mild discomfort and itching on her trunk, attributed to notalgia paresthetica — a nerve-related condition.

Plan:

• Topical Hydrocortisone 2.5%: For flare-ups, applied twice daily for 2 weeks.

• Non-Medication Strategies: Recommended Sarna cream, capsaicin cream, and avoiding scratching.

• Counseling: This condition often relates to spinal nerve irritation and may need further evaluation if persistent.

Why Early Dermatologic Evaluation Matters

In this case, multiple types of skin lesions — both benign and symptomatic — were discovered during the initial evaluation. While none of the growths were cancerous, their appearance and evolution raised concern for the patient. Prompt assessment allowed for appropriate reassurance, treatment, and education.

Early dermatology visits help differentiate between harmless skin changes and those that need medical intervention. At Village Dermatology, serving Katy and Houston, Texas, we emphasize patient-centered care with thorough exams and evidence-based management.
Are You Concerned About Skin Lesions?

If you notice new or changing skin lesions, schedule an appointment with Village Dermatology. Whether it’s a common seborrheic keratosis or something more complex like notalgia paresthetica, our board-certified dermatologists are here to help.

📍Locations: Katy, TX and Houston, TX
📞 Contact us today to schedule your full-body skin exam and ensure your skin health is in expert hands.

Recognizing and Treating Allergic Contact Dermatitis: A Case from Village Dermatology in Katy & Houston, TX

By: Dr. Caroline Vaughn

At Village Dermatology, we’re committed to providing personalized skin care to patients throughout Katy and Houston, Texas. In this case report, we explore the diagnosis and treatment of a 51-year-old female patient who presented with a moderately severe rash on her face, neck, chest, and upper back. This case highlights the importance of early diagnosis and effective management of allergic contact dermatitis, a common condition we see in our Texas dermatology clinics.

Patient Presentation: Unexplained Facial and Neck Rash

Our patient, a healthy woman in her early 50s, reported a five-day history of bumpy, red, and itchy rash. It began with lip swelling and progressed to involve her cheeks, upper back, and chest. She denied introducing new skincare products, but reported recent use of Avene Cicalfate and a new lip gloss—notable because of her history of allergic reactions to lip products.

Clinical Evaluation and Diagnosis

A thorough full skin exam was performed, using a dermatoscope to evaluate the affected areas. Her skin exhibited well-demarcated, geometric eczematous patches, consistent with allergic contact dermatitis.

This condition occurs when the skin comes into contact with a substance that triggers an immune response. Common allergens include:

• Fragrances

• Cosmetics

• Lip products

• Metals (like nickel)

• Preservatives and sunscreens

In this case, the patient’s symptoms and history strongly suggested a reaction to her new lip gloss.

Treatment and Management Plan

The patient was prescribed a tapered oral prednisone regimen to reduce inflammation, along with triamcinolone acetonide 0.1% topical cream for application to the chest and back. She was counseled on avoiding high-potency topical steroids on the face or neck and educated about the potential side effects of corticosteroids, including:

• Skin thinning

• Pigment changes

• Increased risk of infection

• Mood changes or insomnia with oral prednisone

We also advised her to eliminate all potential allergens, including cosmetics, scented soaps, and hair or nail products. Hypoallergenic and fragrance-free alternatives were recommended.

Finally, we discussed patch testing, which can help identify the specific allergen, and advised her to follow up in one month for further evaluation once the acute inflammation resolves.

Why It Matters: Allergy Awareness and Skin Health in Texas

This case underscores how important it is for patients in Katy and Houston to be aware of the cosmetic and environmental products they use—especially those with a known history of sensitivity. Allergic contact dermatitis can mimic other skin conditions, so early and accurate diagnosis is essential.

At Village Dermatology, we empower our patients through education, individualized care, and evidence-based treatment options. Whether you’re dealing with chronic skin issues or sudden flare-ups, our board-certified dermatologists are here to help.

📍 Looking for a Dermatologist in Katy or Houston, TX?

Village Dermatology offers full-body skin exams, patch testing, and treatment for allergic contact dermatitis, eczema, acne, rosacea, and other skin conditions. Book your dermatology consultation today.

Full Body Skin Check Reveals Multiple Lesions in 55-Year-Old Female with Skin Cancer History

Case Report from Village Dermatology – Serving Katy and Houston, Texas

By: Dr. Caroline Vaughn

Overview

Skin cancer surveillance remains critical for patients with a history of non-melanoma skin cancers. This case report features a 55-year-old female patient seen at Village Dermatology in Katy, Texas, for full body skin evaluation due to a newly identified skin lesion on her left thigh and past history of squamous cell carcinoma (SCC).

Patient Background

The patient, a well-nourished and alert 55-year-old woman, presented for evaluation of a skin lesion on her left thigh. She had previously undergone Mohs surgery for SCC performed by Dr. Wang in May 2025. She reported no symptoms such as pain or bleeding but wanted an evaluation due to her personal history of skin cancer.

Clinical Findings

Upon examination by our dermatology team, several findings were noted:

• Left Thigh: A small lesion identified and monitored; associated with her history of SCC.

• Right Labium Majus: An irritated seborrheic keratosis (SK) presenting as a crusted, inflamed papule. The lesion was frequently rubbed by clothing, causing discomfort and itching.

• Right Plantar Foot: A verruca plantaris (plantar wart), a common but stubborn viral lesion often resistant to treatment.

• Right Anterior Thigh: A cyst measuring 1.7 x 1.5 cm, asymptomatic and currently under observation.

• Suspected Insect Bite: A small area of swelling and itching on the lower extremity was noted. Over-the-counter hydrocortisone was recommended.

Treatment & Recommendations

• Cryotherapy: Liquid nitrogen was used to treat the seborrheic keratosis and plantar wart. Risks including blistering, pigmentary changes, and recurrence were reviewed with the patient.

• Observation: The epidermal cyst was not inflamed and did not require removal unless it became bothersome.

• Education: Given her history of SCC, the patient was counseled on:

  • Monthly self-skin checks.

  • Broad-spectrum SPF 30+ sunscreen.

  • Avoidance of prolonged sun exposure.

  • Watching for lesion recurrence or new, non-healing spots.

Why Full Body Exams Matter

For patients like this, regular full body skin exams are essential. Past skin cancers increase the risk of developing new ones. Catching lesions early—before they progress—can dramatically reduce complications and treatment complexity.

At Village Dermatology, we prioritize long-term skin health and personalized patient care, especially for high-risk individuals in Katy and Houston, Texas.

Annual Skin Exam in Katy, Texas: Early Detection of Benign Lesions & Sun Damage in a 42-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, early detection of skin concerns remains a cornerstone of our commitment to long-term skin health. In this patient case, a 42-year-old female presented for a routine full-body skin exam — a vital preventive measure that plays a critical role in identifying both benign and potentially concerning skin lesions.

Patient Presentation

This new patient visited our Katy dermatology clinic for a full-body skin examination. While she reported no personal or family history of skin cancer, she sought ongoing monitoring due to a variety of skin lesions that had developed over the years. These lesions were spread across the body, and her primary concern was ensuring they remained non-cancerous.

Comprehensive Skin Exam Findings

A meticulous examination was performed, covering all areas of the body — from the scalp to the soles of the feet. A dermatoscope was used to enhance lesion visualization, allowing for in-depth assessment of pigmentation patterns and structural features.

Key dermatological findings included:

• Benign Nevi (moles) with uniform globular patterns:

  • 4mm nevus in the left inframammary crease

  • 7mm nevus on the left midfoot

  • 5mm nevus on the right buttock

• Lentigines (sun spots) were also observed, presenting as reticulated light tan macules across the trunk — consistent with cumulative sun damage.

• History of tanning bed use noted on the inferior thoracic spine, which increases long-term risk for melanoma and non-melanoma skin cancers.

Treatment & Preventive Counseling

Although all lesions were deemed non-malignant, this visit offered an excellent opportunity for preventive counseling:

• Sun Protection: The patient was educated on the use of broad-spectrum SPF 30+ sunscreen and encouraged to wear sun-protective clothing.

• Tanning Bed Risks: Counseling addressed the well-documented carcinogenic impact of tanning beds, emphasizing their role in skin aging and cancer development.

• Monthly Self-Skin Checks: The patient was advised to monitor her moles for any changes in size, shape, color, itching, or bleeding.

Next Steps

The patient was advised to return annually for full-body skin checks or sooner if changes are noticed. No biopsies were needed at this time, but her comprehensive screening ensures early intervention, should any lesion become suspicious in the future.

Persistent Neck Rash for Over 15 Years: Diagnosing a Complex Dermatologic Case in a 42-Year-Old Male

By: Dr. Caroline Vaughn

At Village Dermatology in Katy and Houston, we understand that chronic skin conditions can deeply impact quality of life. Today, we're sharing the story of a 42-year-old male patient who presented with a long-standing rash on his neck—an issue he has battled for over 15 years without relief.

Patient Background

This patient arrived as a new consult, seeking answers for an itchy, persistent rash localized on the right inferior posterior neck and extending to parts of the upper back and trunk. He had previously consulted multiple providers and been prescribed topical and oral steroids, with minimal to no improvement. The prolonged nature of his symptoms and failure to respond to prior treatment made this a particularly challenging dermatologic case.

He expressed frustration with the lack of clarity surrounding his diagnosis and proactively requested a biopsy to identify the exact cause before pursuing additional treatments.

Clinical Examination

A focused dermatologic examination was performed, including the:

• Neck and trunk

• Face, eyelids, and lips

Although a full body skin check was offered, the patient declined. The skin revealed chronic patches on the mid posterior neck and upper back with characteristics that suggested several possible conditions.

Using dermatoscopy, we noted the rash had a nonspecific appearance, raising a differential diagnosis of:

• Chronic Dermatitis (L30.9)

• Lichen Simplex Chronicus (LSC)

• Macular Amyloidosis

Next Steps: Punch Biopsy and Counseling

Given the chronicity and diagnostic uncertainty, a 4mm punch biopsy was performed on the mid posterior neck to obtain a tissue sample for histological examination. The area was numbed using local anesthesia and closed with 4-0 Nylon sutures.

During this visit, the patient received detailed counseling:

• Moisturizers and emollients were recommended for skin hydration

• We discussed phototherapy as a non-steroidal option pending biopsy results

• He deferred further steroid use until a definitive diagnosis is made

What This Case Highlights

This case is a perfect example of how long-term, unresolved rashes require a stepwise and evidence-based approach. Biopsy is a critical tool when first-line treatments fail or diagnosis is unclear. Conditions like macular amyloidosis or lichen simplex chronicus may appear similar clinically but differ significantly in treatment strategies.

At Village Dermatology, we provide thorough evaluations for patients across Katy and Houston, ensuring that even long-standing skin concerns are met with clarity and compassion.

Accutane for Hormonal Acne: A Case Study in Katy & Houston, TX

At Village Dermatology, we frequently see patients struggling with acne that has resisted over-the-counter solutions for years. A recent case involves a 34-year-old female who presented with persistent, moderate facial acne marked by comedonal papules, inflammatory pustules, and scarring—especially around her menstrual cycle. With no prior treatments tried and increasing psychosocial impact, she was ready to pursue a definitive solution.

Initial Evaluation & Hormonal Acne History

This new patient visited our Katy, TX dermatology office seeking answers for her acne, which had been affecting her self-esteem and skin health for years. Her flare-ups worsened cyclically with her menstrual periods—an indicator of hormonal acne. At the time of consultation, she was not using any acne medications or skincare routine targeting her breakouts.

A full facial examination confirmed moderate acne consisting of:

• Blackheads and whiteheads

• Inflamed pimples

• Post-inflammatory hyperpigmentation and scarring

The acne distribution was limited to the face, with no signs of nodulocystic activity, but the patient expressed concern about ongoing scarring.

Why Accutane Was Chosen

After a thorough evaluation and discussion of treatment options—including topical retinoids, oral antibiotics, and hormonal therapy—we determined that Isotretinoin (Accutane) would offer the most effective long-term results. This decision was based on:

• Acne present for years

• Lack of prior treatment response

• Worsening around menstrual cycle

• Early scarring

We discussed the risks and side effects of Accutane extensively, including dry skin, mood changes, lab monitoring, and teratogenic risks requiring iPledge enrollment and monthly pregnancy tests. The patient was also educated on expected outcomes: approximately 60-80% improvement after 2-3 months of treatment.

Lab Testing and Next Steps

Before starting Accutane, the patient completed her initial lab testing:

• Urine Pregnancy Test (negative)

• Liver Function Panel

• Triglycerides

She was also counseled on skincare routines to support her treatment, including:

• Non-comedogenic cleanser and moisturizer

• Broad spectrum sunscreen SPF 30+

• Avoiding skin-picking and harsh exfoliants

The patient understood the process and agreed to begin Accutane in 31+ days, after completing the iPledge protocol.

Empowering Patients with Acne in Houston and Katy

This case demonstrates the importance of personalized acne care. At Village Dermatology, our team is committed to educating patients and creating tailored plans for long-term results. Whether you’re experiencing hormonal acne, cystic breakouts, or adult-onset acne, we offer expert solutions from board-certified dermatologists.

Pediatric Dermatology Case: Treating Verruca Vulgaris on the Thumb of a Young Patient in Katy, TX

By: Dr. Ashley Baldree

Case Overview

At Village Dermatology, we routinely care for patients of all ages—especially children experiencing common dermatological concerns. One recent case involved a 4-year-old boy from the Katy and Houston, Texas area, who presented with a skin lesion on his left thumb. The lesion had been enlarging over several months, prompting concern from the family. This case highlights the importance of early intervention and education around pediatric viral skin conditions like verruca vulgaris (common warts).

Clinical Presentation

The young patient, otherwise healthy, had a moderate-sized wart on the distal radial side of the left thumb. His family reported the lesion had been present for months and was continuing to grow. There was no prior treatment history, and the child was brought in specifically for evaluation and potential management.

During the full physical exam, the dermatology team noted that the lesion had the classic cauliflower-like appearance typical of verruca vulgaris. A dermatoscope was used to confirm the diagnosis.

Diagnosis: Verruca Vulgaris

Verruca vulgaris, or the common wart, is a viral skin infection caused by the human papillomavirus (HPV). In children, warts are very common and often appear on the hands, fingers, and feet. They are contagious, can spread to other areas of the body or to others, and while benign, can cause discomfort, embarrassment, or functional limitation if left untreated.

Treatment Plan

To address the thumb lesion, the following steps were taken:

• Cryotherapy with Liquid Nitrogen: The wart was treated with 2 freeze-thaw cycles of liquid nitrogen, a standard and effective therapy for many pediatric patients. Consent was obtained from the family prior to the procedure.

• Salicylic Acid Topical Therapy: As part of ongoing home care, the patient was also prescribed topical salicylic acid, a proven adjunct therapy that helps soften and dissolve the wart over time.

• Parental Counseling: The dermatology team counseled the family on proper wart care, including:

  • Avoiding direct contact with the lesion to prevent spread

  • Applying topical treatments consistently

  • Monitoring for recurrence or changes in appearance

Follow-Up Recommendations

The patient and family were instructed to monitor the area for healing or new lesions, and to follow up if:

• The wart spreads to new locations

• It fails to improve after several weeks of treatment

• There is any change in color, size, or discomfort

Why Early Pediatric Wart Treatment Matters

While many warts in children can resolve on their own, professional evaluation ensures that no concerning features are missed, such as rapid growth, bleeding, or signs of other skin conditions. Early treatment also helps prevent spreading to other children—especially in shared environments like schools and playgrounds.

At Village Dermatology in Katy and Houston, TX, we specialize in compassionate, evidence-based pediatric dermatologic care that keeps families informed and involved.

When Chest Cysts Become Painful: A Dermatology Case Study in Katy & Houston, TX

By: Dr. Ashley Baldree

At Village Dermatology, we regularly treat patients experiencing complex skin conditions, including inflamed epidermal inclusion cysts. In this case report, we highlight a 65-year-old male patient from the greater Houston area who presented with a painful, enlarging cyst on his chest — a common but often underestimated condition.

Patient Background and Initial Concerns

The patient, a 65-year-old male, came to our clinic for evaluation of a persistent cyst located on the right medial superior chest. He reported that the lesion had been present for several months but had recently become painful, enlarged, and inflamed, prompting his visit. The patient had no history of treatment and initially hoped for conservative options like hot compresses.

Clinical Examination and Diagnosis

A focused dermatologic exam confirmed the presence of a painful, erythematous nodule, consistent with an inflamed epidermal inclusion cyst. These cysts often mimic infections when inflamed, displaying redness, swelling, and tenderness. Although non-cancerous, they can become acutely bothersome or infected if untreated.

Immediate Intervention: Incision and Drainage

Due to the severity of symptoms — including swelling, redness, and discomfort — a minor surgical procedure was indicated. The lesion was treated with an incision and drainage (I&D) procedure to relieve pressure and remove the contents of the cyst. Local anesthesia was administered, and the wound was carefully drained, cleaned, and dressed.

This procedure was medically necessary, as conservative measures had failed, and the condition presented signs of infection and significant discomfort.

Treatment and Medication

Following the I&D procedure, the patient was prescribed doxycycline monohydrate 100 mg to address potential underlying infection. He was counseled about:

• Photosensitivity precautions: Avoiding sun exposure and using sunscreen.

• Proper medication usage: Taking doxycycline with meals and avoiding lying flat for at least an hour after taking the pill.

The patient was advised to follow up in 4 weeks for potential cyst excision to prevent recurrence.

Educational Points for Patients in Katy & Houston, TX

Epidermal inclusion cysts are common in dermatology and are usually benign. However, when they become inflamed or infected, they require medical attention. Key takeaways include:

• Early evaluation can prevent worsening symptoms.

• Warm compresses may help initially, but infected or enlarging cysts often need intervention.

• Incision and drainage is a safe, effective procedure when performed in a medical setting.

• Follow-up care ensures resolution and helps prevent recurrence.

Dermatology Expertise Close to Home

At Village Dermatology, we provide expert dermatologic care to patients in Katy and Houston, Texas. If you or a loved one experiences any unusual skin growths, painful lumps, or cysts, contact our clinic for professional evaluation and treatment.

A Complex Case of Acne and Chronic Rash in a Young Adult Female: Village Dermatology Katy & Houston Case Study

By: Dr. Caroline Vaughn

Patient Background

A 20-year-old female from the Houston area presented to Village Dermatology for evaluation and treatment of two persistent dermatological conditions: moderate acne and a chronic, itchy rash on the legs and trunk. She had been using over-the-counter acne products with little relief and was currently applying a topical antifungal cream for her rash without significant improvement.

Clinical Findings

On physical examination, she had:

• Comedonal and inflammatory acne lesions across the face, arms, and trunk.

• Scaly, erythematous rash patches on the thighs, trunk, and sternum—especially itchy on the chest.

• Negative KOH prep for fungal elements, ruling out active tinea.

Her acne had been long-standing and resistant to standard topical treatments. Her rash, present for several months, appeared consistent with pityriasis rosea (PR) though other conditions such as contact dermatitis and nummular eczema were considered.

Diagnosis & Differentiation

• Severe acne (L70.0): The presence of scarring and lack of response to OTC treatments led to the decision to initiate isotretinoin (Accutane) therapy.

• Dermatitis (L30.9): Due to the non-specific nature and chronicity of the rash, the working diagnosis was dermatitis of unspecified cause, pending further response to treatment.

Treatment Plan

Acne:

• Isotretinoin (Accutane) initiation at 40mg/day following iPledge compliance procedures.

• Monthly lab monitoring (hepatic panel, triglycerides) and pregnancy tests.

• Aviane oral contraceptive prescribed for dual contraception during isotretinoin therapy.

• Thorough counseling on risks: dry skin, joint aches, photosensitivity, mood changes, and teratogenicity.

Dermatitis:

• Triamcinolone 0.1% cream applied twice daily for two weeks.

• Skin care instructions: regular moisturization, use of emollients, and avoiding application of steroids to the face and groin.

• Follow-up in 1 month to assess response.

Patient Education & Compliance

Detailed counseling was provided:

• The patient understood the long-term commitment and follow-up required for isotretinoin therapy.

• Education on the importance of sunscreen use, gentle cleansers, and avoiding triggers for dermatitis was emphasized.

Follow-Up Plan

• Monthly visits during isotretinoin therapy for acne management and monitoring.

• 1-month follow-up for reassessment of dermatitis response to triamcinolone.

Conclusion

This case highlights the importance of personalized dermatological care in managing complex skin conditions in young adults. At Village Dermatology, we provide expert acne treatment and rash evaluation in Katy and Houston, Texas, ensuring every patient receives tailored care that targets the root causes of their skin concerns.

Evaluation of Skin Lesions in a 53-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology, we prioritize comprehensive skin evaluations, especially for patients with a personal or family history of skin abnormalities. This case highlights the importance of regular skin checks and timely biopsies in the early detection and management of potentially harmful lesions.

Patient Background

A 53-year-old established female patient presented to our clinic for evaluation of brown, moderate skin lesions. These lesions were located on the left hand, left forearm, and right zygoma. Her medical history was notable for dysplastic nevi, a condition that requires vigilant monitoring due to an increased risk of skin cancer.

Clinical Findings

On physical examination, the patient appeared well-nourished and in no acute distress. The evaluation, which included dermatoscopic inspection of the head, face, left forearm, and hand, identified multiple pigmented lesions.

1. Benign Nevi
   These pigmented nests of cells were observed across various body sites without any signs of malignancy. No immediate intervention was necessary.

2. Papule on the Left Dorsal Middle Finger
   A suspicious papule raised concern for a neoplasm of unspecified behavior. Differential diagnoses included cyst, dermatofibroma (DF), or blue nevus.

   • Procedure: A shave biopsy was performed under local anesthesia and sent for histopathological examination.

3. Papule on the Left Ventral Proximal Forearm
   Another suspicious lesion was identified on the inner forearm. Differential considerations included congenital nevus or melanoma.

   • Procedure: A shave biopsy was also completed on this site under sterile conditions.

Dermatologic Interventions

Each biopsy was done using a Dermablade after administering lidocaine with epinephrine. Drysol was applied for hemostasis, and post-procedural care included Petrolatum and bandaging. The patient was thoroughly counseled on signs of complications and instructed to contact the clinic if results were not communicated within two weeks.

Patient Counseling & Prevention

• Monthly Self-Skin Exams were emphasized to help the patient monitor for changes in size, color, or shape of moles.

• Sun Protection: Use of a broad-spectrum SPF 30+ sunscreen was recommended daily.

• Skin Cancer Awareness: Education was provided on warning signs such as itching, bleeding, or rapid growth of lesions.

The patient plans to return in six months for a full-body skin screening, reinforcing the value of ongoing dermatologic surveillance.

Managing Moderate Atopic Dermatitis with Rinvoq | Village Dermatology Katy & Houston, TX

By: Dr. Caroline Vaughn
Introduction

Atopic dermatitis (eczema) can persist well into adulthood, impacting both comfort and confidence. At Village Dermatology, we offer advanced treatment options like Rinvoq (upadacitinib), a JAK inhibitor approved for moderate to severe eczema. This case highlights the progress of a 56-year-old woman after four months of Rinvoq therapy.

Case Overview

Patient: 56-year-old female
Condition: Moderate atopic dermatitis
Treatment Duration: 4 months on Rinvoq 30mg daily
History: Atopic dermatitis localized to scalp, with persistent patches on neck, face, shoulder, and forearm

Treatment Progress with Rinvoq

The patient reported:

• Significant symptom improvement

• No side effects from Rinvoq

• Ongoing use of topical medications only for small, resistant areas

📈 Breakthrough Symptoms:

• Mild itchy bumps on face and posterior neck

• Differential included breakthrough eczema vs. contact dermatitis

Updated Treatment Plan

To manage these residual symptoms and maintain control:

💊 Systemic Therapy (Continued):

• Rinvoq 30mg daily

  • Monitoring risks discussed: infections, cardiovascular events, shingles, malignancy

  • High-risk medication counseling emphasized

🧴 Topical & Supportive Therapies:

• Ketoconazole 2% shampoo – 2–3x/week for scalp and face

• Clobetasol shampoo – for flare-ups on scalp

• Hydrocortisone 2.5% cream – short-term use on face

🧼 Skin Care Counseling:

• Lukewarm water bathing

• Gentle cleansers (unscented)

• Moisturizing 2–3 times daily

• Avoiding scented detergents, handwashing, and scratching

Patient Education

We provided detailed counseling about:

• Rinvoq safety: infection risks, cardiovascular monitoring, and need for regular lab testing

• Flare-up triggers: stress, seasonal changes, irritants

• When to call: if symptoms worsen or signs of infection (e.g., crusting, yellow discharge) occur

Why This Matters in Katy & Houston, TX

Rinvoq is transforming the lives of patients with chronic eczema in areas like Houston and Katy, where humidity and heat often aggravate the condition. Our dermatologists provide comprehensive management, from high-risk medication monitoring to tailored topical therapy.

Follow-Up Plan

The patient will return in 6 months for a routine evaluation and medication monitoring.

Evaluating Bleeding Chest Lesions in Older Adults | Biopsy for Neoplasm of Uncertain Behavior

By: Dr. Caroline Vaughn

Introduction

Skin lesions that bleed, ulcerate, or change over time warrant thorough evaluation—especially in patients with a history of skin cancer. At Village Dermatology, we regularly assess suspicious growths using advanced tools and precise biopsy techniques. This case describes a 77-year-old woman presenting with chronic, bleeding papules on her chest and a past history of squamous cell carcinoma (SCC).

Case Presentation: Longstanding, Bleeding Chest Lesion

Patient: 77-year-old female
Chief Complaint: Bleeding, irritated lesion on the chest
Duration: Several years
Past Medical History: Squamous cell carcinoma
Concern: Potential recurrence or malignant transformation

Physical Exam Findings

On examination, an erythematous papule was noted on the right lateral superior chest. The lesion was:

• Moderately inflamed

• Chronically present

• Unresponsive to prior self-care

Given its bleeding nature and the patient’s SCC history, we considered the following differential diagnosis:

• Neoplasm of Uncertain Behavior

• Squamous Cell Carcinoma (SCC)

• Irritated Seborrheic Keratosis (ISK)

• Hypertrophic Actinic Keratosis (HAK)

Next Step: Shave Biopsy

To reach a definitive diagnosis, we performed a shave biopsy, which is a safe and minimally invasive technique for sampling superficial lesions.

🩺 Procedure Details:

• Location: Right lateral superior chest

• Technique: Shave biopsy to the dermis using a Dermablade

• Anesthesia: 0.5 cc of 1% lidocaine with epinephrine

• Hemostasis: Controlled with Drysol

• Post-procedure Care: Petrolatum and dressing applied

The sample was sent to pathology for H&E staining to confirm diagnosis.

Patient Counseling & Safety Measures

We discussed:

• Risks of biopsy: scarring, bleeding, infection, incomplete removal

• Importance of follow-up for pathology results

• When to call: If the lesion worsens or if results are not received within 2 weeks

Why This Matters in Katy & Houston, TX

As people age, the risk of skin cancer increases, particularly in sun-exposed areas like the chest and shoulders. This case underscores the need for early dermatologic evaluation—especially in patients with a cancer history or persistent, symptomatic lesions.

Treating Facial Melasma with Prescription Therapy | Village Dermatology Katy & Houston, TX

By: Dr. Ashley Baldree

Introduction

Melasma is a common skin condition that causes brown to gray-brown patches on the face, especially among women. At Village Dermatology, we understand that skin discoloration can be frustrating, especially when it's mistaken for other conditions like vitiligo. In this case, we helped a 42-year-old woman who had been struggling with light and dark patches on her face for over a year.

Case Summary: Facial Discoloration Concerns

Patient: 42-year-old female
Primary Concern: Discoloration on the face
Duration: 1 year
Distribution: Right cheek, left cheek, and forehead
Medical History: Family history of vitiligo (aunt); patient is a smoker

Clinical Findings & Diagnosis

We performed a comprehensive facial exam, including a Wood’s lamp test (used to differentiate pigmentation disorders). The lighter areas appeared to reflect the patient's natural baseline skin tone, while the darker, ill-defined hyperpigmented patches were consistent with melasma—not vitiligo.

Diagnosis: Melasma (L81.1)
Distribution: Periorbital and malar regions (under eyes and cheeks)

Treatment Plan for Melasma

Melasma can be challenging to treat, especially with long-term sun exposure or hormonal triggers. We created a treatment plan combining prescription therapy and sun protection:

🧴 1. Tri-Luma Cream (Hydroquinone + Tretinoin + Fluocinolone)

• Application: At bedtime for 3 months, then paused for 1 month

• Purpose: Targets pigmentation at the cellular level

• Counseling: Discussed risk of irritation, dryness, and rare side effect of pseudoochronosis (bluish skin discoloration)

💊 2. Oral Tranexamic Acid (650mg)

• Dose: Half a tablet twice daily

• Purpose: Reduces melanin production via hormonal pathways

• Counseling: Avoid smoking and hormonal contraceptives; discussed small risk of blood clots

☀️ 3. Daily Tinted Broad-Spectrum Sunscreen (SPF 30+)

• Essential for preventing recurrence and protecting sensitive skin during treatment

Lifestyle Guidance & Expectations

• Triggers of Melasma: Sun exposure, heat, pregnancy, and birth control pills

• Skin Care Recommendations: Non-irritating cleansers, sun avoidance, and daily SPF use

• Patient Education: Counseling provided on medication risks, expectations for gradual improvement, and the importance of treatment breaks

Photos were taken to monitor progress, and the patient will return in 3 months for a skin check and evaluation of treatment efficacy.

Why This Matters in Katy & Houston, TX

Sun exposure in Houston and Katy's warm climate can worsen melasma, especially for individuals with medium-to-darker skin tones. Our team at Village Dermatology provides evidence-based treatments with personalized education to help patients manage pigmentation safely and effectively.