Managing Nummular Eczema and Allergic Contact Dermatitis: A Case Study from Village Dermatology

By: Dr. Caroline Vaughn

At Village Dermatology in Katy and Houston, Texas, our dermatology team treats a wide range of skin conditions, from chronic inflammatory rashes to pigment changes and allergic reactions. This case features a 59-year-old female returning for follow-up care after treatment for nummular eczema, with additional concerns of post-inflammatory hyperpigmentation, scar care, and a new rash consistent with allergic contact dermatitis.

Patient Overview

The patient was first seen on June 3, 2025, for nummular eczema involving multiple areas, including:

• Right knee

• Left anterior distal thigh

• Left and right popliteal areas

• Right and left radial dorsal hands

She was treated with triamcinolone acetonide 0.1% cream, applied twice daily to affected areas as needed for flare-ups. Today, she returned for follow-up and reported significant improvement in itchiness, with no active rash present.

1. Nummular Eczema – Improved with Topical Steroids

Exam Findings:
No active eczema lesions; only residual post-inflammatory hyperpigmentation (PIH) visible.

Plan:

• Discontinue triamcinolone cream for now

• Restart during future flare-ups only

• Skin care recommendations included:

  • Bathing with lukewarm water and gentle cleansers

  • Applying emollients 2–3 times daily

  • Avoiding scented detergents and fabric softeners

  • Keeping fingernails short to reduce scratching damage

Patient Education:
Eczema is chronic and may worsen with triggers such as dry weather, stress, certain soaps, and scratching. Ongoing moisturization is key to prevention.

2. Post-Inflammatory Hyperpigmentation (PIH)

Exam Findings:
Mild hyperpigmented patches on the right proximal pretibial region.

Plan:

• Minimize sun exposure

• Wear SPF 30+ broad-spectrum sunscreen daily

• Educated the patient that PIH often fades over months to years

3. Scar Care – Epigastric Area

Exam Findings:
Well-healed scar secondary to a recent shave biopsy.

Plan:

• Reassurance that scar color and texture may improve over time

• Monitor for changes such as raised texture or itchiness (possible keloid formation)

• Consider intralesional Kenalog (ILK) in the future if the scar becomes symptomatic

4. Allergic Contact Dermatitis (ACD) – New Rash on Buttocks

History:
Patient reported a mild rash on the gluteal cleft starting a few weeks ago, partially improved with one application of triamcinolone.

Exam Findings:
Well-demarcated, geometric eczematous patches in the buttocks area.

Plan:

• Hydrocortisone 2.5% ointment applied twice daily for 2 weeks (max 2 weeks/month)

• Switch to fragrance-free, hypoallergenic personal care products

• Avoid potential triggers such as scented wipes, soaps, detergents, or lotions

• Educated the patient on possible side effects of prolonged topical steroid use, including skin thinning and lightening

Key Takeaways for Skin Health

This case highlights how chronic skin conditions can be managed successfully with consistent care, trigger avoidance, and proper medication use. It also emphasizes the importance of differentiating between eczema flare-ups and new skin reactions like allergic contact dermatitis.

Do You Have Persistent Rashes or Skin Discoloration?

At Village Dermatology, we specialize in diagnosing and managing skin conditions like eczema, contact dermatitis, and pigment changes. We tailor every treatment plan to your needs, ensuring long-term control and skin health.

📍 Now accepting patients in Katy and Houston, Texas
📞 Call us today to schedule your skin evaluation

Androgenetic Alopecia and Telogen Effluvium in a 34-Year-Old Male: Comprehensive Hair Loss Care in Katy & Houston, TX

by: Caroline Vaughn

At Village Dermatology, many men in their 30s come to us with concerns about thinning hair, not realizing that more than one type of hair loss may be at play. In this case, a 34-year-old male presented with both androgenetic alopecia (male-pattern hair loss) and telogen effluvium (temporary excessive shedding).

Patient History

The patient reported:

• Gradual crown and temple thinning for 6 months

• Moderate severity hair loss

• History of 25-pound weight loss over 7 months

• Hair loss worsened after a car accident 4 years ago

• Family history of hair thinning but no complete baldness

• Currently using topical minoxidil

Clinical Examination

Using dermatoscopy, we found:

• Patterned thinning at the crown and temples consistent with AGA

• Positive hair pull test with telogen hairs, confirming TE

• Diffuse, non-scarring hair loss at the mid-parietal scalp

Diagnosis

1. Androgenetic Alopecia (AGA)

   • Chronic, genetically driven miniaturization of hair follicles

   • Gradual thinning in predictable patterns

2. Telogen Effluvium (TE)

   • Temporary increase in hair shedding

   • Triggered by stress, illness, or physical changes (e.g., weight loss)

   • Often self-limiting but can overlap with AGA

Treatment Plan

After reviewing options—including topical/oral minoxidil, finasteride, platelet-rich plasma (PRP), and AlmaTED—the patient chose oral minoxidil.

Prescribed:

• Oral Minoxidil 2.5 mg once daily (in addition to topical minoxidil)

• Education on side effects (low blood pressure, swelling, unwanted hair growth)

• PRP discussed as a potential future add-on for enhanced regrowth and shedding reduction

Counseling & Education

For AGA:

• Long-term maintenance is key; results take ~6 months to appear

• Discussed risks of finasteride (sexual side effects, mood changes)

For TE:

• Often resolves once triggers are addressed

• Nutritional supplements such as Nutrafol or Viviscal may support regrowth

• Minoxidil can help shorten the regrowth phase

• Advised gentle hair care and avoiding harsh products or styling

Follow-Up Plan

• Recheck in 4–6 months to assess response

• Consider PRP or AlmaTED if progress plateaus

• Maintain both oral and topical therapy for sustained improvement

Why This Matters for Katy & Houston Residents

Men experiencing hair loss should know that it’s common to have more than one type at the same time. Correct diagnosis—like in this case—ensures personalized, effective treatment. At Village Dermatology, we combine medical therapies, in-office procedures, and patient education to optimize long-term hair health.

MRSA Skin Infection and Congenital Nevus in a 14-Year-Old Male

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we treat a wide range of skin conditions in patients of all ages. In this case, we evaluated a 14-year-old male who presented with an itchy, red rash on his right leg that had been present for several months. The rash was moderate in severity and had not responded to prior home care.

Clinical Presentation

The patient and his mother reported persistent irritation and redness localized to the right lower leg. On examination, the rash displayed features consistent with impetigo, a superficial bacterial skin infection often caused by Staphylococcus aureus (including MRSA strains) or Streptococcus pyogenes. The lesions were crusted, and the patient admitted to scratching, which likely worsened the spread.

During the exam, we also identified a congenital nevus on the left forearm — a benign pigmented mole present since birth. While unrelated to the current rash, this finding was documented for ongoing monitoring.

Diagnosis

1. MRSA Skin Infection (Impetigo) — Common in children and highly contagious, often arising after minor skin trauma.

2. Congenital Nevus — A stable, benign mole with no current signs of malignancy.

Treatment Plan

For the MRSA skin infection, the following regimen was initiated:

• Oral doxycycline twice daily for 10 days.

• Topical mupirocin ointment applied three times daily for 5 days to the rash and inside the nostrils to reduce bacterial colonization.

• Bleach baths as an adjunct to help lower bacterial presence on the skin’s surface.

The patient’s mother was counseled on the contagious nature of MRSA, the importance of completing all medications, and hygiene measures to prevent spread within the household.

For the congenital nevus, no immediate treatment was required. We recommended monthly self-skin checks and the use of broad-spectrum sunscreen SPF 30+ to protect against UV-related changes.

Follow-Up

The patient will return in one month for reassessment of the rash and to ensure complete resolution of the infection. Long-term monitoring of the congenital nevus will continue during routine visits.

Key Takeaways

• Early diagnosis of MRSA skin infections is important to prevent spread and complications.

• Combination therapy with oral and topical antibiotics, along with decolonization strategies, can be highly effective.

• Even unrelated skin findings, like congenital nevi, should be documented and monitored for any changes.

Inflamed Epidermal Inclusion Cyst on the Upper Back – A 67-Year-Old Female Case in Katy & Houston, Texas

by: Ashley Baldree

Case Overview
A 67-year-old female presented to Village Dermatology in Katy, Texas, with an inflamed, enlarging skin lesion on the left upper back. The lesion, present for approximately two weeks, was moderately painful, red, and swollen.

The patient reported a unique history — over 20 years ago, she sustained a thorn injury at the same location. She suspected that part of the thorn may still be embedded under the skin. Despite previous evaluations by other dermatologists, no definitive treatment had been provided.

Clinical Examination

• Location: Left lateral upper back

• Size: Approximately 2.5 cm

• Appearance: Inflamed, tender, and erythematous lesion

• Diagnostic tools: Dermatoscopic examination to assess lesion borders and skin changes

The findings were consistent with an inflamed epidermal inclusion cyst, likely exacerbated by localized irritation or possible infection.

Diagnosis

• Epidermal Inclusion Cyst (L72.8)

• Benign, non-cancerous growth consisting of keratin-filled sac beneath the skin

• Current presentation complicated by inflammation and pain

Treatment Plan
The patient’s treatment plan included:

1. Antibiotic therapy – Doxycycline 100 mg by mouth twice daily for 14 days to address inflammation and potential secondary bacterial infection.

2. Definitive treatment – Cyst excision scheduled for the following week to remove the lesion entirely and prevent recurrence.

3. Skin care guidance – No special topical skin care required, but patient was advised to monitor for changes.

Patient Counseling

• Epidermal inclusion cysts are benign and not cancerous.

• They can become inflamed or infected, particularly if irritated.

• Complete excision is the most effective long-term solution.

• Warning signs of worsening inflammation include increased redness, swelling, drainage, or pain.

Dermatology Insight – Katy & Houston Focus
At Village Dermatology in Katy and Houston, Texas, we commonly treat epidermal inclusion cysts. While many are harmless and can be left alone, inflamed cysts often require antibiotics and eventual surgical removal. This case illustrates how early dermatology intervention can prevent worsening infection and recurrence.

Follow-Up Skin Lesion Care and Cryotherapy Treatment in Katy and Houston, Texas

by: Caroline Vaughn

At Village Dermatology, we often see patients for ongoing monitoring and treatment of benign skin lesions. This case highlights a 47-year-old male patient from the Houston/Katy area who returned for follow-up of a skin lesion on his left upper back and right ear.

Case Overview

The patient’s primary concern was a persistent lesion on the right ear and an additional skin growth on the foot. Both lesions had been present for months and had not resolved since his last visit. The ear lesion was identified as seborrheic keratosis, a common and benign skin growth that tends to increase in number with age. While seborrheic keratoses do not require treatment, patients often choose removal for cosmetic reasons.

After discussing treatment options, the patient elected to undergo liquid nitrogen cryotherapy for the ear lesion. Cryotherapy works by freezing the lesion, causing it to blister and eventually fall off. The patient was counseled on the expected healing process, post-treatment care, and the potential for temporary pigment changes.

Second Concern: Lesion on the Foot

During the visit, a separate lesion was noted on the right plantar forefoot overlying the fourth metatarsal. This growth was a pink papule, and the differential diagnosis included:

• Neoplasm of uncertain behavior

• Wart

• Amelanotic melanoma (AMM)

• Poroma

To determine the exact nature of this lesion, a shave biopsy was performed. The procedure involved local anesthesia, a sterile dermablade, and immediate hemostasis. The tissue sample was sent to pathology for analysis, and the patient was advised to expect results within two weeks.

Patient Education and Follow-Up

At Village Dermatology, patient education is a key part of care. This patient was counseled on:

• Sun protection to reduce future skin damage

• Avoiding picking or scratching treated areas

• Applying Vaseline to any crusted or healing skin

• Monitoring for changes in moles, growths, or healing sites

Follow-up will be arranged as needed based on pathology results or further cosmetic concerns.

Why Choose Village Dermatology for Skin Lesion Treatment in Katy & Houston

Whether you’re concerned about a benign growth, suspicious mole, or want cosmetic lesion removal, our dermatology team in Katy and Houston provides thorough evaluations, advanced treatment options, and compassionate care. From cryotherapy to biopsies, we ensure every patient receives personalized attention and education for optimal skin health.

Follow-Up Care for Nummular Eczema and Hypertrophic Scar: A 37-Year-Old Female Case in Katy & Houston, TX

by: Caroline Vaughn

At Village Dermatology, patient care doesn’t stop after the initial diagnosis. Follow-up visits are crucial for monitoring skin conditions, adjusting treatments, and ensuring optimal long-term results. This case involves a 37-year-old female from the Katy and Houston, Texas area who returned for follow-up after a confirmed diagnosis of nummular eczema and evaluation of a hypertrophic scar.

Patient History

On June 3, 2025, the patient presented with itchy, inflamed skin lesions on her right upper arm and right thigh. A punch biopsy confirmed the diagnosis of nummular eczematous dermatitis. At that time, she was prescribed triamcinolone ointment and given detailed skin care instructions.

The patient also had a biopsied spot on her right upper arm that developed into a thickened, itchy scar—later identified as a hypertrophic scar.

Follow-Up Visit Findings

At her one-month follow-up:

• Nummular eczema:

  • Significant improvement

  • No new lesions reported

  • Some hypopigmentation present in treated areas

• Hypertrophic scar:

  • Still thickened and itchy

  • Intralesional corticosteroid injections (ILK) discussed but deferred due to pregnancy

Understanding Nummular Eczema

Nummular eczema (also called discoid eczema) is a chronic condition that presents as:

• Round, coin-shaped patches of inflamed skin

• Itching and discomfort

• Often triggered by dry skin, fragrance-containing products, and cold weather

In this case, consistent use of triamcinolone ointment and adherence to moisturizing routines led to marked improvement.

Skin Care Recommendations

The patient was counseled to:

• Bathe in lukewarm water for 10 minutes or less

• Use gentle cleansers such as Dove Sensitive Skin

• Moisturize 2–3 times daily with cream-based moisturizers

• Avoid scented detergents, fabric softeners, and harsh soaps

• Keep fingernails short to reduce scratching damage

Understanding Hypertrophic Scars

A hypertrophic scar is a thickened, raised scar that develops after skin injury or surgery.
Treatment options include:

• Intralesional steroid injections (ILK) to reduce thickness and itching

• Topical high-potency steroids

• Pulse dye laser therapy for redness and vascularity

Since the patient is currently pregnant, ILK injections will be reconsidered after delivery.

Plan Moving Forward

• Continue triamcinolone ointment as needed for eczema flares

• Maintain a strict moisturizing routine

• Monitor scar and reassess for possible ILK treatment postpartum

• Follow up as needed for any recurrence or worsening of symptoms

Why This Case Matters for Katy & Houston Residents

Chronic skin conditions like eczema require ongoing care and tailored treatment plans. At Village Dermatology, we focus on:

• Accurate diagnosis

• Patient education

• Safe treatment options, even during pregnancy

• Cosmetic and functional scar management

Whether you’re managing eczema, scars, or other skin concerns, our dermatology team in Katy and Houston, TX provides compassionate, expert care.

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.