Case Study: Epidermal Inclusion Cyst on the Neck in a 33-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often evaluate patients who present with long-standing nodules or growths on the skin. This case features a 33-year-old female who presented with a firm nodule on the posterior neck, ultimately diagnosed as an epidermal inclusion cyst.

Patient Presentation

A 33-year-old female presented for evaluation of a firm nodule on the right posterior neck, which had been present for 10 years. The lesion was moderate in severity but had not been previously treated.

She declined a full skin examination and requested evaluation only of the symptomatic area.

Dermatologic Examination

A focused exam of the head, lips, and neck was performed with dermatoscopy.

Findings included:

• Subcutaneous cyst with a prominent follicular pore, consistent with an epidermal inclusion cyst.

• Size: approximately 1.5 cm, located on the right medial trapezial/posterior neck region.

No other concerning findings were identified.

Impression and Plan

Epidermal Inclusion Cyst (L72.8)

• Counseling: Epidermal inclusion cysts are benign sacs beneath the skin filled with keratin.

• Expectations: They typically remain stable, though they can enlarge, rupture, or become tender if inflamed.

• Plan: Observation. No treatment required at this time.

• Instructions: Patient was advised to return if the cyst ruptures, becomes red, painful, or shows signs of infection.

Key Takeaway

Epidermal inclusion cysts are benign, slow-growing lesions that can often be managed conservatively. While removal may be considered for cosmetic reasons or if the cyst becomes inflamed, observation is appropriate when the lesion is stable and asymptomatic.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation and management of cysts, nodules, and other skin growths, offering both reassurance and treatment options tailored to patient needs.

Case Report: Hair Loss, Allergic Contact Dermatitis, and Seborrheic Dermatitis in a 44-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Patients often present to dermatology clinics with more than one skin or hair concern. At Village Dermatology in Katy and Houston, Texas, we take a comprehensive approach, addressing each condition with both medical treatment and patient education. This case highlights a 44-year-old female with generalized hair loss, seborrheic dermatitis of the scalp, and allergic contact dermatitis affecting her toes.

Patient Presentation

The patient is a 44-year-old female who sought a second opinion for hair loss. She had been on oral minoxidil (half a tablet daily) for three months without noticeable improvement. In addition, she reported:

• Recurrent rashes on her toes triggered by beach visits (suspected allergic contact dermatitis)

• Scalp scaling and itching consistent with seborrheic dermatitis

Examination

A focused exam revealed:

• Diffuse thinning of scalp hair, consistent with female pattern hair loss

• Well-demarcated, geometric eczematous patches on toes consistent with allergic contact dermatitis

• Scaling and erythema on the scalp, consistent with seborrheic dermatitis

The patient was otherwise well-developed, oriented, and in no acute distress. A dermatoscope was used for scalp evaluation.

Impressions & Treatment Plan

1. Allergic Contact Dermatitis (L23.9)

• Triggered by beach exposure, etiology unclear

• Prescribed clobetasol 0.05% cream, applied BID during flares (up to 2 weeks/month)

• Counseling provided on hypoallergenic products, potential need for patch testing, and steroid side effects

2. Seborrheic Dermatitis

• Chronic scalp condition with flares

• Prescribed ketoconazole 2% shampoo, used daily during flares and 1–3 times weekly for maintenance

• Prescribed fluocinonide 0.05% solution, BID PRN during flares

• Counseling on long-term management, stress as a trigger, and steroid side effects

3. Androgenetic Alopecia (Female Pattern Hair Loss, L64.8)

• Patient counseled that 3 months of oral minoxidil is too early for results (typically 6–12 months needed)

• Treatment plan updated:

  • Continue oral minoxidil

  • Add oral finasteride 5 mg daily

  • Discussed additional options: PRP (platelet-rich plasma), AlmaTED treatments, supplements (Nutrafol, Viviscal), and at-home red light therapy

• Counseling on expectations: Female pattern hair loss is genetically determined, slowly progressive, and typically presents with widened midline parting while maintaining the frontal hairline

Conclusion

This case highlights the importance of comprehensive dermatology care in managing overlapping skin and hair conditions. At Village Dermatology in Katy and Houston, TX, our specialists combine advanced medical treatments, patient education, and cosmetic options to provide tailored care for conditions like hair loss, seborrheic dermatitis, and allergic contact dermatitis.

Case Study: Androgenetic Alopecia in a 22-Year-Old Male and Treatment with PRP Therapy

by : Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we see many young men concerned about progressive hair loss. This case highlights a 22-year-old male presenting with diffuse scalp thinning, ultimately diagnosed with androgenetic alopecia (male pattern hair loss) and opting for platelet-rich plasma (PRP) therapy.

Patient Presentation

A 22-year-old male presented as a new patient for evaluation of generalized hair loss on the scalp. The hair thinning had been ongoing for 5 months, was moderate in severity, and had gradually worsened.

He had no prior treatments other than over-the-counter Nutrafol supplements.

Dermatologic Examination

A focused exam of the scalp and face was performed with dermatoscopy. Findings included:

• Diffuse non-scarring hair loss across the scalp.

• Patterned thinning in the vertex and frontotemporal regions, consistent with androgenetic alopecia (AGA).

Impression and Plan

Androgenetic Alopecia (Male Pattern Hair Loss)

• Diagnosis: Clinical findings consistent with AGA. Punch biopsy was discussed for further confirmation, but not pursued at this time.

• Treatment Options Reviewed:

  • Oral minoxidil

  • Finasteride

  • Spironolactone (off-label in men, rarely used)

  • Topical Rogaine (minoxidil)

  • Low-level laser therapy

  • Microneedling

  • Hair transplant surgery

  • PRP (platelet-rich plasma) therapy

• Side effects, benefits, and expectations were reviewed thoroughly.

Patient Decision

After an in-depth discussion, the patient elected to proceed with PRP therapy.

• Counseling included the fact that PRP is cosmetic and not covered by insurance.

• Patient was advised on what to expect from the procedure and the importance of follow-up.

Counseling

• Hair Care: AGA can be slowed with medications such as minoxidil and finasteride; hair transplantation is an option in advanced cases.

• Expectations: AGA is genetically pre-determined, slowly progressive, and most prominent in the vertex and frontal scalp.

• Monitoring: The patient was instructed to return if hair loss worsens or fails to improve with therapy.

Follow-Up

The patient was scheduled to begin PRP therapy and will follow up in 4 months for re-evaluation.

Key Takeaway

This case underscores the importance of early diagnosis and treatment in male pattern hair loss. With a combination of modern therapies such as PRP, oral medications, and topical treatments, patients can often achieve significant improvement in hair density and quality.

At Village Dermatology in Katy and Houston, TX, we specialize in advanced hair restoration options, including PRP therapy, oral and topical treatments, and counseling for hair loss prevention.

Case Report: Punch Excision of an Epidermal Inclusion Cyst in a 39-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Epidermal inclusion cysts are among the most common benign skin lesions seen in dermatology. While often harmless, patients may choose removal for cosmetic, diagnostic, or preventive reasons. At Village Dermatology in Katy and Houston, Texas, we provide expert evaluation and removal of cysts with safe, in-office procedures. This case highlights a 39-year-old male who presented with a cyst on his upper back.

Patient Presentation

The patient, a 39-year-old male, reported a cyst on his right upper back/superior thoracic spine that had been present for nearly a year. The lesion was enlarging, moderate in severity, and persistent. The patient denied pain, drainage, or episodes of inflammation.

Examination

Focused exam of the back revealed:

• Well-nourished, well-appearing male

• Epidermal inclusion cyst measuring 1.6 x 1.2 cm on the superior thoracic spine

• No erythema, tenderness, or drainage at the time of evaluation

Diagnosis

• Epidermal Inclusion Cyst (L72.8)

• Associated cutaneous inflammation

Management & Procedure

Counseling

The patient was reassured that epidermal inclusion cysts are benign sacs containing keratin and do not require treatment unless inflamed, painful, or cosmetically concerning. He elected for removal. Risks, benefits, and alternatives were reviewed, including possible infection, recurrence, or scarring.

Punch Excision

• Location: Superior thoracic spine

• Size: 1.6 x 1.2 cm

• Anesthesia: Local infiltration with 1% lidocaine with epinephrine

• Procedure:

  • Skin prepped with Betadine and draped

  • A 4 mm punch tool was used to excise the cyst opening

  • Blunt dissection performed to remove cyst contents and capsule

  • Hemostasis achieved with electrocautery

  • Simple interrupted closure with 4-0 nylon sutures

  • Petrolatum and sterile dressing applied

• Estimated blood loss: Minimal

• Complications: None

Post-Procedure Care

The patient was instructed to:

• Avoid heavy lifting, exercise, or swimming for 14 days

• Keep the wound clean and apply petrolatum as directed

• Return for suture removal in 14 days

• Contact the office for fever, bleeding, severe pain, or signs of infection

Conclusion

This case demonstrates the successful punch excision of a benign epidermal inclusion cyst in an adult male patient. At Village Dermatology in Katy and Houston, TX, our dermatologists specialize in safe removal of cysts, moles, and skin growths, ensuring optimal cosmetic outcomes and patient peace of mind.

Case Study: Enlarging Growth on the Back – Lipoma in a 43-Year-Old Female

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, patients often present with new or enlarging growths that raise concern about skin cancer or other serious conditions. This case highlights a 43-year-old female with a darkening, enlarging growth on her upper back, ultimately diagnosed as a lipoma.

Patient Presentation

A 43-year-old female presented as a new patient for evaluation of growths on the right upper back. The lesions had been darkening, enlarging, and irregular in appearance for several months. They were moderate in severity and had not been treated in the past.

Her main concern was whether these growths represented something malignant, and she sought evaluation and management.

Dermatologic Examination

A full-body exam was performed, including the scalp, face, trunk, and extremities, with the assistance of a dermatoscope.

Findings included:

• Lipoma: A soft, subcutaneous, slow-growing mass measuring approximately 1.8 cm on the upper back.

No other suspicious lesions were noted.

Impression and Plan

Lipoma

The growth was determined to be a lipoma, a benign tumor made of fatty tissue.

Counseling and Education:

• Lipomas are noncancerous and slow-growing.

• They often remain stable but can gradually enlarge over time.

• No treatment is strictly necessary unless the lesion is bothersome, enlarging, or cosmetically concerning.

Treatment Recommendation:

• Surgical excision was recommended for definitive treatment and removal.

• The patient was offered referral to Dr. Vaughn or Dr. Armenta for the procedure.

The patient elected to proceed with surgical removal.

Key Takeaway

Not all enlarging or darkening skin growths are dangerous. Lipomas are benign fatty tumors, but professional evaluation is essential to rule out other possibilities. In this case, the patient was reassured, counseled, and scheduled for surgical removal.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation of growths, lumps, and skin lesions, offering both reassurance and treatment options tailored to each patient.

Case Report: Isotretinoin (Accutane) Initiation for Severe Acne in a 24-Year-Old Female | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Acne vulgaris is one of the most common dermatologic conditions affecting young adults. At Village Dermatology in Katy and Houston, Texas, we see many patients with acne that is persistent, hormonally influenced, and resistant to standard therapies. This case highlights a 24-year-old female whose acne worsened around her menstrual cycle and was inadequately controlled with prior treatments, leading to the initiation of isotretinoin (Accutane).

Patient Presentation

The patient is a 24-year-old female who presented for evaluation of acne on her face and back. She reported both comedonal papules and inflammatory papules/pustules, with flares around her menstrual cycle.

Examination

A focused skin examination of the face revealed:

• Comedonal papules

• Inflammatory papules and pustules

• Acne of moderate-to-severe nature with potential for scarring

The patient was otherwise well developed, oriented, and in no acute distress.

Diagnosis

• Acne vulgaris (L70.0), inadequately controlled

• Pattern consistent with hormonally influenced acne

• Risk of scarring identified

Management Plan

Counseling

The patient received detailed education about:

• Skin care: Use of gentle cleansers, non-comedogenic moisturizers, and cosmetics

• Treatment expectations: Improvement may take 2–3 months with a 60–80% reduction in acne lesions

• Warning signs: Return to clinic if acne worsens, new scars form, or cysts appear

Treatment Initiation: Isotretinoin (Accutane)

• Planned dose: 40 mg daily

• Indication: Severe acne with scarring, resistant to prior treatments

• iPledge program: Patient registered and counseled regarding strict pregnancy prevention requirements

• Contraception: Patient started Aviane oral contraceptive pill (OCP) in addition to condoms

High-Risk Medication Monitoring

• Patient counseled on potential side effects: dryness, headaches, blurry vision, muscle aches, mood changes, liver effects, lipid changes

• Monitoring: Monthly visits with blood work (hepatic function panel, triglycerides)

• Urine pregnancy test: Negative in clinic prior to starting therapy

Follow-Up

The patient will return in 31 days for repeat testing, counseling, and isotretinoin monitoring.

Conclusion

This case demonstrates a structured, safety-focused approach to Accutane initiation in young female patients. At Village Dermatology in Katy and Houston, TX, our dermatologists emphasize patient education, regular monitoring, and comprehensive acne treatment to achieve long-term skin health and reduce scarring risk.

Painful Neck Growth in a 41-Year-Old Male: Furuncle and Skin Tag Removal

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently evaluate patients with new or concerning skin growths. This case highlights a 41-year-old male who presented with a painful lesion on the back of his neck, as well as skin tags in the underarm area.

Patient Presentation

A 41-year-old male presented as a new patient with a growth on the posterior neck. The lesion had been present for 3 days and was initially painful. The patient had not tried any treatment prior to his visit.

He also noted multiple skin tags in the left axilla, which he wished to have removed.

Dermatologic Examination

A focused exam of the neck and left axilla was performed with the assistance of a dermatoscope. Findings included:

• Furuncle (Boil): Inflamed, tender lesion on the posterior neck.

• Skin Tags (Acrochordons): Multiple soft, pedunculated papules in the left axillary vault.

Impression and Plan

Furuncle

The lesion on the posterior neck was most consistent with a furuncle, a bacterial skin infection forming a small abscess.

Treatment Plan:

• Doxycycline 100 mg taken orally twice daily for 10 days.

• Mupirocin 2% ointment applied to the affected area three times daily for 10 days.

• Supportive care: warm compresses with diluted vinegar solution, gentle cleansing with Hibiclens wash, and use of benzoyl peroxide.

Counseling:

• Furuncles typically resolve with antibiotics but may occasionally require drainage.

• If the lesion worsens or fails to heal, culture may be needed to rule out MRSA (methicillin-resistant Staphylococcus aureus).

Skin Tags

Ten skin tags in the left axilla were removed for cosmetic reasons.

Procedure:

• Local anesthesia with lidocaine and epinephrine.

• Removal performed using gradle excision.

• Hemostasis achieved with Drysol.

Counseling:

• Skin tags are benign but can be irritating when caught on clothing or jewelry.

• Risks of removal, including bleeding, pigment changes, infection, or scarring, were reviewed with the patient.

Key Takeaway

This case demonstrates the value of dermatology evaluation for both infectious lesions (furuncles) and benign growths (skin tags). Early intervention with antibiotics and minor procedures can provide rapid relief and peace of mind.

At Village Dermatology in Katy and Houston, TX, we provide expert diagnosis and treatment of painful skin growths, infections, and cosmetic concerns.

Case Report: Evaluation of Skin Lesions in a 23-Year-Old Female with Dysplastic Nevus and Benign Moles | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin cancer prevention and mole monitoring are an important part of dermatology care, especially for patients with a history of dysplastic nevi. At Village Dermatology in Katy and Houston, Texas, we provide comprehensive skin exams, patient education, and treatment when concerning lesions are identified. This case highlights a 23-year-old female who presented for evaluation of multiple skin lesions and counseling regarding sun protection and mole monitoring.

Patient Presentation

The patient is a 23-year-old female who presented with multiple skin lesions on the body, present for several years. The lesions were asymptomatic and had not been previously treated. She also requested education regarding sun exposure, mole checks, and surveillance for suspicious growths. Her history is significant for dysplastic nevi biopsied at an outside dermatologist in Louisiana. She has no family history of melanoma.

Examination

A full-body skin examination was performed, including:

• Scalp, head, face, and neck

• Chest, abdomen, back

• Upper and lower extremities

• Digits and nails

• Groin and buttocks (underwear not removed at patient’s request)

A dermatoscope was used for detailed mole evaluation.

Findings included:

• Dysplastic Nevus with Severe Atypia (left upper back, previously biopsied)

• Benign Nevi: regular, symmetric, evenly-colored macules and papules on the back, left 5th toe, and left dorsal great toe

• Lentigines: pigmented sun-induced lesions

Impression & Plan

1. Dysplastic Nevus with Severe Atypia (D22.5)

• Previously biopsied, severe atypia confirmed

• Excision recommended for complete removal

• Patient counseled on self-skin checks and importance of monitoring for new or changing lesions

2. Benign Nevi (D22.5, D22.72)

• Multiple stable, non-concerning moles identified

• No treatment necessary

• Patient counseled to perform monthly self-skin checks and return if changes occur

3. Lentigines (L81.4)

• Related to sun exposure and sun damage

• Benign, but can be treated with sunscreen, bleaching creams, retinoids, chemical peels, or laser therapy

• Patient counseled on strict sun protection

Sun Protection Counseling

The patient received detailed sunscreen and sun safety education:

• Broad Spectrum SPF 30+ sunscreen recommended, applied 15 minutes before sun exposure

• Reapply every 2 hours, or every 45–60 minutes if swimming/sweating

• Use of sun protective clothing and hats encouraged

• Lip balm with SPF for lip protection

Conclusion

This case underscores the importance of regular dermatology skin checks for patients with a history of atypical moles. At Village Dermatology in Katy and Houston, TX, our team provides comprehensive care, including mole mapping, biopsy, excision, and ongoing patient education to prevent skin cancer and maintain healthy skin.

Eyelid Dermatitis in a Teenager: Case Study and Management Approach

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we care for patients of all ages presenting with rashes, skin lesions, and facial irritation. This case highlights an 18-year-old female with a persistent rash on the face, emphasizing the importance of accurate diagnosis and tailored treatment for eyelid dermatitis.

Patient Presentation

An 18-year-old female presented as a new patient with enlarging skin lesions on the left cheek, nose, and right cheek. The lesions had been present for several months, were moderate in severity, and had not been treated previously. She reported that the rash frequently recurred around her eyes.

Dermatologic Examination

A full exam of the scalp, face, ears, lips, and forearms was performed using a dermatoscope. Findings included:

• Facial Dermatitis (Unspecified): Patches of lighter, irritated skin around the eyes.

• The clinical appearance raised consideration of atopic dermatitis, seborrheic dermatitis, allergic contact dermatitis (ACD), or lupus.

No systemic symptoms were reported.

Assessment and Plan

The differential diagnosis included several causes of eyelid dermatitis. Since no definitive diagnosis could be made during the initial visit, treatment was focused on symptomatic relief and careful follow-up.

Treatment Initiated

• Tacrolimus 0.1% ointment: Apply twice daily to affected areas.

• Ketoconazole 2% cream: Apply twice daily for two weeks.

• Emollients were recommended to maintain hydration and support skin barrier function.

Counseling and Education

The patient was counseled regarding:

• The chronic and sometimes unclear nature of eyelid dermatitis.

• Avoiding potential irritants and allergens around the eyes (makeup, harsh cleansers, fragranced products).

• Monitoring for warning signs such as fever, worsening rash, or new systemic symptoms.

Follow-Up

The patient was scheduled for follow-up in 4 weeks. If symptoms persist, patch testing will be considered to identify possible allergens. Blood work for ANA (antinuclear antibodies) was also ordered to rule out autoimmune causes such as lupus.

Key Takeaway

Eyelid dermatitis in young patients can have multiple potential causes. Early dermatology evaluation, gentle treatment, and close follow-up are essential to achieve relief and prevent long-term complications.

At Village Dermatology in Katy and Houston, TX, we provide expert evaluation and customized treatment plans for patients with rashes, dermatitis, and facial skin conditions.

Case Report: Excision of a Compound Nevus with Severe Atypia in a 53-Year-Old Male | Village Dermatology Katy & Houston, TX

by: Caroline Vaughn

Introduction

Skin cancer prevention and early detection are central to dermatologic care. At Village Dermatology in Katy and Houston, Texas, we regularly evaluate and treat patients with atypical moles and skin lesions. This case highlights a 53-year-old male who presented with a concerning mole on his upper back, ultimately diagnosed as a compound nevus with severe atypia.

Patient Presentation

The patient was initially seen on August 14, 2025 for a neoplasm of uncertain behavior located on the left superior lateral upper back. At that visit, a shave biopsy was performed.

Pathology Results

The biopsy specimen was reviewed and returned with a diagnosis of:

• Compound Nevus with Severe Atypia

Given this result, surgical excision was recommended to ensure complete removal and reduce the risk of progression.

Follow-Up and Surgical Excision

The patient presented for definitive treatment via surgical excision.

Clinical Exam

• Healing biopsy site on the left mid-upper back

• No acute distress; patient well developed and nourished

Surgical Details

• Location: Left mid-upper back

• Pre-op size: 0.5 cm x 0.7 cm

• Margins: 0.5 cm

• Total excised diameter: 1.5 x 1.7 cm

• Final wound length: 5.4 cm

• Repair type: Intermediate layered closure

Anesthesia: Local infiltration with 1% lidocaine with epinephrine
Estimated blood loss: Minimal
Complications: None

The procedure involved a fusiform excision down to the adipose tissue, removal of the lesion, and layered closure to optimize healing and minimize scarring. The specimen was sent for histopathologic evaluation.

Post-Procedure Counseling

The patient was counseled on wound care and recovery:

• No heavy lifting, swimming, or exercise for 14 days

• Suture removal and wound check scheduled in 14 days

• Contact the office if experiencing fever, chills, bleeding, or severe pain

Conclusion

This case demonstrates the importance of timely biopsy and surgical management of atypical moles. At Village Dermatology in Katy and Houston, TX, our dermatologists carefully evaluate skin lesions, perform biopsies when necessary, and provide expert excision techniques to optimize both medical safety and cosmetic outcomes.

Comprehensive Skin Exam in a 25-Year-Old Male: Benign Nevi, Lentigines, and Sun Protection Counseling

by: Ashlee Baldree

At Village Dermatology in Katy and Houston, Texas, we emphasize the importance of routine skin exams for patients of all ages. This case highlights the evaluation of a 25-year-old male presenting with longstanding skin lesions and seeking education about sun protection, mole evaluation, and overall skin health.

Patient Presentation

A 25-year-old male visited our clinic for an evaluation of multiple skin lesions on the upper back and left breast. The lesions had been present for several years, were asymptomatic, and had never been treated. He also sought education about preventing skin cancer, recognizing suspicious growths, and protecting his skin from sun exposure.

The patient had no personal history of skin cancer.

Dermatologic Examination

A comprehensive skin exam was performed, including inspection of the scalp, face, trunk, extremities, nails, and mucosal surfaces. A dermatoscope was used to assess lesions. The exam revealed:

• Benign Nevi (Moles): Symmetrical, evenly colored macules and papules distributed throughout the body. No concerning features for malignancy were noted.

• Lentigines (Sun Spots): Light tan macules in sun-exposed areas, consistent with chronic sun damage.

• Seborrheic Keratoses: Waxy, pigmented growths present on the trunk and extremities, benign and age-related.

• Cherry Angiomas: Small, bright red vascular papules scattered across the skin.

• Post-Inflammatory Hyperpigmentation: Ill-defined hyperpigmented patches noted on the upper lip, secondary to a prior rash or trauma.

• Congenital Nevus: A stable pigmented lesion located near the periumbilical region.

No evidence of skin cancer was identified during this visit.

Counseling and Recommendations

The patient was counseled extensively on:

Sun Protection

• Broad Spectrum Sunscreen SPF 30+ applied daily, reapplied every 2 hours during sun exposure.

• Use of mineral-based sunscreens containing zinc oxide or titanium dioxide (recommended brands included Elta MD, ISDIN, Supergoop Mineral Sheerscreen, Cerave Mineral SPF 50, and Neutrogena Sheer Zinc).

• Protective clothing, wide-brimmed hats, and lip balms with SPF.

• Daily use of Vitamin C serum in the morning for antioxidant protection.

Self-Skin Exams

• Perform monthly self-checks for changes in size, shape, or color of moles.

• Seek medical evaluation if lesions become painful, itchy, bleeding, or rapidly changing.

Expectations

• Benign Nevi, Seborrheic Keratoses, Cherry Angiomas, and Congenital Nevi require no treatment unless cosmetic removal is desired.

• Lentigines may improve with sunscreen, topical agents, chemical peels, or laser treatments.

• Post-Inflammatory Hyperpigmentation often resolves gradually but may take months to years.

Follow-Up

The patient was advised to return in 1 year for a routine full-body skin check or sooner if new or changing lesions appear.

Key Takeaway

This case underscores the importance of early skin evaluations for patients—even young adults with no history of skin cancer. Education on sun protection, skin self-exams, and preventive dermatology plays a vital role in long-term skin health.

At Village Dermatology in Katy and Houston, TX, we provide expert care for patients seeking reassurance about their moles, sun spots, and other skin concerns.

Case Report: 23-Year-Old Female with Chronic Acne Managed at Village Dermatology in Katy & Houston, Texas

by: Caroline Vaughn

Introduction

Acne is one of the most common dermatological conditions seen in young adults, particularly affecting the face. At Village Dermatology, serving patients in Katy, Texas and Houston, Texas, we frequently evaluate patients who have struggled for years with breakouts and are looking for safe and effective solutions. This case highlights the management of a 23-year-old female with a chronic facial rash consistent with acne that had been present for two years.

Patient Presentation

The patient, a 23-year-old female, presented with a chief complaint of a bumpy rash on the face. The rash was moderate in severity and persistent for the past two years. She had not previously received structured treatment and was concerned about both the cosmetic and long-term impact of her acne.

Examination Findings

A focused skin examination of the face revealed:

• Comedonal papules

• Inflammatory papules and pustules

• Distribution across the central and lateral face

The patient appeared well-developed, alert, and in no acute distress. A dermatoscope was used during the exam to aid in evaluation.

Diagnosis

Based on clinical findings, the patient was diagnosed with acne vulgaris (L70.0), consisting of both comedonal and inflammatory lesions.

Management Plan

The patient and her care team reviewed several treatment options, including topical therapy, oral antibiotics, and isotretinoin (Accutane). Since the patient currently relies on condoms as her sole method of birth control and is not interested in starting oral contraceptive pills or an IUD, isotretinoin was not recommended at this time due to safety guidelines.

Instead, a comprehensive acne treatment plan was initiated:

Morning Routine (AM)

1. Wash with a gentle cleanser

2. Apply clindamycin 1% gel to the entire face

3. Apply a moisturizer with broad-spectrum SPF 30+ sunscreen

Evening Routine (PM)

1. Wash with a gentle cleanser

2. Apply a pea-sized amount of tretinoin 0.025% cream (gradual introduction)

3. Apply a moisturizing cream (brands such as CeraVe, Cetaphil, Vanicream, or La Roche-Posay recommended)

Oral Medication

• Doxycycline 100 mg, one capsule twice daily with food and water.

Counseling & Education

The patient was counseled that improvement may take 2–3 months, with an expected 60–80% reduction in acne lesions. She was advised to contact the office if acne worsened, scars developed, or cysts appeared. Detailed instructions were provided on medication safety, skin care routines, and expectations.

Follow-Up

The patient will return in 31 days for reevaluation. If topical and oral therapies do not provide sufficient improvement, isotretinoin may be reconsidered under appropriate contraceptive conditions.

Conclusion

This case illustrates a thoughtful, stepwise approach to acne management at Village Dermatology in Katy and Houston, Texas. With patient education, prescription therapy, and consistent follow-up, most patients can achieve significant improvement in both the appearance and impact of acne.

Case Report: Treatment of Persistent Verruca Vulgaris and Actinic Keratosis in a 76-Year-Old Male

by: Caroline Vaughn

At Village Dermatology in Katy and Houston, Texas, we frequently treat patients with both common skin conditions and precancerous lesions. This case highlights the importance of follow-up care and the role of cryotherapy in dermatologic treatment.

Patient Presentation

A 76-year-old male presented for follow-up of a verruca vulgaris (common wart) on the left proximal dorsal forearm. The patient had previously undergone liquid nitrogen (cryotherapy) on July 24, 2025. While some improvement was noted, the lesion persisted, prompting today’s visit for repeat cryotherapy.

Additionally, two other concerns were evaluated:

• Subungual hematoma on a fingernail, which was healing appropriately.

• Actinic keratosis on the left nasal root, requiring cryotherapy.

Examination Findings

• Verruca Vulgaris: Inflamed, persistent lesion on the left proximal dorsal forearm.

• Subungual Hematoma: Minimal residual discoloration; nail growing out normally.

• Actinic Keratosis: Single rough, scaly lesion on the left nasal root, consistent with chronic sun damage.

Treatment & Management

1. Verruca Vulgaris

   • A second round of cryotherapy with liquid nitrogen was performed on the forearm wart.

   • Patient was counseled on alternative therapies including topical retinoids, imiquimod (Aldara), and salicylic acid.

   • Education included the viral nature of warts, potential for spread, and the expectation of gradual resolution with treatment.

2. Subungual Hematoma

   • Determined to be healing well with no intervention required.

   • Patient was advised that discoloration would continue to grow out with the nail over several months.

3. Actinic Keratosis

   • One lesion on the nasal root was treated with liquid nitrogen cryotherapy.

   • The patient was counseled that actinic keratoses are precancerous skin lesions that may progress to squamous cell carcinoma if untreated.

   • Sun protection measures were emphasized, including broad-spectrum SPF 30+ sunscreen and protective clothing.

Patient Counseling

• Warts: Viral, contagious, and may require multiple treatments.

• Subungual Hematomas: Typically resolve as the nail grows out; treatment only if painful or persistent.

• Actinic Keratoses: Regular skin checks are important for early detection and prevention of skin cancer.

Conclusion

This case underscores the importance of ongoing dermatologic care for both benign and precancerous skin conditions. At Village Dermatology in Katy and Houston, Texas, we use evidence-based treatments such as liquid nitrogen cryotherapy to help patients achieve the best possible outcomes.

If you or a loved one has a persistent wart, actinic keratosis, or other concerning skin lesion, schedule an appointment with our dermatology team today. Early treatment not only improves results but also helps prevent complications such as skin cancer.

Case Report: Severe Acne Management in a 36-Year-Old Male Patient

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently see patients struggling with acne that has persisted for years despite over-the-counter treatments. Acne can affect not only the face but also the back, chest, and shoulders, often causing both physical discomfort and emotional distress.

Patient Case Overview

A 36-year-old male presented for follow-up management of severe acne involving his back and face. Previously, his treatment regimen included:

• Topical regimen: benzoyl peroxide wash, clindamycin lotion, gentle cleansers, and moisturizers with SPF 30+.

• Oral antibiotic: doxycycline 100 mg twice daily.

Despite consistent use, his acne remained severe, with inflammatory papules, pustules, and comedonal lesions.

Considering Treatment Options

Given the persistence of his acne, the patient and dermatologist discussed escalation to isotretinoin (Accutane)—a highly effective therapy for severe, scarring acne.

Benefits of Isotretinoin:

• Significant long-term clearance of acne.

• Reduced risk of permanent scarring.

• Addresses the root causes of acne: oil production, clogged pores, bacteria, and inflammation.

Risks and Counseling Provided:

The patient was counseled in detail about possible side effects, including dryness, joint aches, mood changes, and photosensitivity. Rare side effects such as abnormal cholesterol and liver function were also reviewed. Because isotretinoin is a high-risk medication, monthly follow-up visits and blood tests are required to monitor safety.

The patient initially agreed to proceed with isotretinoin, but later reconsidered. Alternative options such as acitretin, intralesional Kenalog (ILK) injections, or surgical excision of affected areas (with surgical clearance) were discussed.

Why Acne Requires Expert Dermatology Care

Acne is often dismissed as a cosmetic nuisance, but in reality, severe acne can:

• Cause permanent scarring.

• Impact self-esteem and mental health.

• Require advanced medical therapy when standard treatments fail.

At Village Dermatology, our board-certified dermatologists specialize in tailoring treatment plans to each patient’s needs, whether that involves topical therapies, oral medications, or advanced options like isotretinoin and intralesional injections.

Takeaway

This case highlights the importance of specialist care for severe acne. For patients in Katy and Houston, Texas, Village Dermatology offers comprehensive evaluation and treatment to achieve long-lasting results and minimize the risk of scarring.

If you or a loved one is struggling with persistent acne, schedule a consultation today at Village Dermatology to explore your options.

Case Report: Full Body Skin Examination in a 45-Year-Old Male

by: Caroline Vaughn

At Village Dermatology in Katy and Houston, Texas, we emphasize the importance of annual full body skin examinations. Regular screenings help detect both benign and potentially concerning skin conditions early, ensuring patients receive the right care at the right time.

Patient Presentation

A 45-year-old male presented for a comprehensive skin examination. The patient undergoes annual skin checks due to multiple long-standing pigmented lesions. While the patient is overall healthy, he expressed concerns regarding brown spots that have been present for years.

Examination Findings

A full body examination was performed using a dermatoscope. The following findings were noted:

• Benign Nevi (Moles): Symmetrical, evenly pigmented moles scattered across the skin, consistent with benign nevi. No suspicious features observed.

• Scar: A well-healed scar on the left dorsal index finger joint. No evidence of recurrence or concerning changes.

• Seborrheic Keratoses (SKs): Benign, wart-like growths located on the back, upper arm, and forehead. Patient was reassured these are common with age and noncancerous.

• Lentigines (Sun Spots): Brown sun-induced pigmentation on the shoulders, forehead, and cheeks. These are benign but cosmetically treatable.

• Cherry Angiomas: Small, red vascular growths on the upper and mid-back, which are harmless.

Patient Counseling & Recommendations

1. Sun Protection

   • Daily use of broad-spectrum sunscreen SPF 30+.

   • Reapplication every 2 hours when outdoors, and more frequently when sweating or swimming.

   • Emphasis on sun-protective clothing and use of SPF-containing lip balm.

2. Skin Monitoring

   • Perform monthly self-skin checks to track changes in moles.

   • Contact the office immediately if any mole changes in size, shape, or color, or if it begins to itch, bleed, or burn.

3. Cosmetic Options

   • Lentigines (sun spots) may improve with treatments such as bleaching creams, retinoids, chemical peels, or laser therapy.

   • Cherry angiomas and seborrheic keratoses can be removed if cosmetically bothersome.

Conclusion

This case highlights the importance of routine skin examinations, especially in patients with multiple pigmented lesions or a history of sun exposure. Early identification of benign vs. suspicious lesions provides peace of mind and helps prevent skin cancer.

At Village Dermatology in Katy and Houston, Texas, we encourage all patients to schedule regular skin exams to protect their skin health and address any cosmetic concerns.

Case Report: Treating Nose Lesions Caused by Staphylococcus Aureus and Acne

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often evaluate patients with skin lesions that appear suddenly and persist for weeks to months. Some lesions are due to common skin conditions such as acne, while others are triggered by bacterial infections like Staphylococcus aureus (Staph).

Patient Case Overview

A 42-year-old male presented with red, inflamed lesions on his nose that had been present for several months. The breakouts were not painful but had worsened in appearance, prompting him to seek treatment.

During his evaluation, a dermatoscope exam revealed small inflamed papules consistent with a Staphylococcus aureus skin infection, as well as concurrent acne-related breakouts.

Staphylococcus Aureus Skin Infections

Staphylococcus aureus (Staph) is a common bacteria that lives on the skin. In some cases, it can cause infections when it enters through minor cuts, hair follicles, or inflamed pores. These infections may appear as:

• Red, inflamed bumps

• Pustules or small boils

• Localized irritation and swelling

Some strains, such as MRSA (Methicillin-resistant Staph aureus), require stronger oral antibiotics. However, in most mild cases, topical treatments can resolve the infection.

Treatment Plan for Staph Lesions:

• Benzoyl peroxide washes to reduce bacterial load.

• Mupirocin ointment applied three times daily for 10 days.

• Skin hygiene counseling to prevent reinfection.

The patient was also counseled on MRSA awareness, as nasal carriers can sometimes harbor resistant strains.

Coexisting Acne

In addition to Staph infection, the patient also had acne with inflammatory papules, pustules, and comedones. Acne in this setting may worsen due to bacterial overgrowth and skin inflammation.

Acne Treatment Plan:

• Clindamycin 1% + Benzoyl Peroxide 5% topical gel, applied once daily.

• Daily use of non-comedogenic cleansers and moisturizers.

• Broad-spectrum SPF 30+ sunscreen to prevent hyperpigmentation and sun damage.

• Education that improvement may take 2–3 months, with expectations of 60–80% reduction in acne lesions.

Why Dermatology Expertise Matters

This case demonstrates how skin infections and acne can overlap, making accurate diagnosis critical. Without proper treatment, Staph infections may worsen or spread, while untreated acne can lead to scarring and long-term skin damage.

At Village Dermatology in Katy and Houston, our dermatologists create personalized treatment plans that address both bacterial infections and acne simultaneously, ensuring faster recovery and healthier skin.

Takeaway

Nose lesions may look like simple acne but can sometimes represent a Staph aureus infection. Proper diagnosis and targeted treatment are essential for effective healing.

If you have persistent skin lesions, redness, or breakouts, schedule an appointment with Village Dermatology for expert evaluation and treatment in Katy and Houston, Texas.

Case Report: Cosmetic Removal of Skin Tags and Treatment for Photoaging in a 38-Year-Old Female

by: Caroline Vaughn

At Village Dermatology in Katy and Houston, Texas, we often see patients seeking both cosmetic dermatology services and medical evaluation for concerning growths. This case highlights the treatment of skin tags, dermatosis papulosa nigra, and photoaging, along with the importance of biopsy for uncertain lesions.

Patient Presentation

A 38-year-old female presented as a new patient with two main concerns:

1. Cosmetic removal of growths on the neck.

2. Cosmetic consultation for management of oil glands and photoaging.

The growths had been present for several years, were bothersome, and occasionally irritated by clothing and jewelry.

Examination Findings

A focused dermatologic exam of the face and neck revealed:

• Dermatosis Papulosa Nigra (DPNs): Multiple small, brown, verrucous papules distributed on the cheeks and neck.

• Skin Tags (Acrochordons): Numerous pedunculated papules located throughout the anterior, lateral, and trapezial regions of the neck.

• Pruritus: Localized itching on the left posterior neck, associated with skin tags.

• Neoplasm of Uncertain Behavior: A papule on the left posterior neck requiring biopsy for diagnosis.

• Photoaging: Pigmented changes and early fine lines noted on the forehead, cheeks, and chin.

Treatment & Management

1. Skin Tag Removal (Cosmetic)

   • After informed consent, 20 skin tags were removed from the neck using gradle excision under local anesthesia.

   • Patient was counseled regarding risks including pigment changes, scarring, bleeding, and infection.

   • Pruritus was managed with triamcinolone cream as needed.

2. Dermatosis Papulosa Nigra (DPNs)

   • Planned for future cosmetic treatment with cryotherapy or light electrodesiccation at $250 for up to 20 lesions.

3. Neoplasm of Uncertain Behavior

   • A shave biopsy was performed on the posterior neck to rule out atypical nevus or other pathology.

   • Patient will be notified of pathology results within 2 weeks.

4. Photoaging (Dermatoheliosis)

   • Initiated tretinoin 0.025% cream, starting with 2–3 nights per week and gradually increasing as tolerated.

   • Counseling provided on sun protection, retinoid use, and adjunctive options such as chemical peels and laser treatments.

Patient Counseling

• Skin Tags & DPNs: Benign, common, and removable for cosmetic purposes.

• Biopsy: Necessary for any lesion of uncertain behavior.

• Photoaging: Prevented and improved with broad-spectrum sunscreen, retinoids, and cosmetic procedures.

• Self-Monitoring: Patient was advised to return if new or changing lesions develop.

Conclusion

This case highlights how dermatology can address both medical and cosmetic concerns in the same visit. At Village Dermatology in Katy and Houston, Texas, we provide expert care in treating benign growths like skin tags and DPNs, while also helping patients achieve healthier, younger-looking skin through cosmetic treatments.

If you’re seeking cosmetic removal of skin tags, treatment for photoaging, or evaluation of new skin lesions, schedule a consultation with our dermatology team today.

Case Report: Managing Allergic Contact Dermatitis, Hemorrhoids, and Warts in a 37-Year-Old Male

by: Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently see patients presenting with skin conditions that are not only uncomfortable but also affect daily routines and quality of life. This case highlights the management of allergic contact dermatitis, external hemorrhoids, and a facial wart in the same patient.

Patient Case Overview

A 37-year-old male presented with multiple concerns, including:

• Itchy rash in the underarms (axillae)

• Chronic hemorrhoid discomfort

• Facial wart on the left cheek

1. Allergic Contact Dermatitis (ACD)

The patient reported a persistent, itchy rash in both armpits that developed after using deodorant. On exam, the rash was well-demarcated, red, and consistent with allergic contact dermatitis.

Treatment Plan:

• Discontinue use of the current deodorant.

• Begin hydrocortisone 2.5% cream applied twice daily.

• Switch to hypoallergenic, fragrance-free skin care products.

• Counseling provided on avoiding common triggers (fragrances, cosmetics, scented soaps, metals).

If symptoms persist, patch testing may be recommended to identify allergens.

2. External Hemorrhoid

The patient also reported ongoing hemorrhoid irritation. Exam revealed a flesh-colored varicosity on the right perianal skin, consistent with an external hemorrhoid.

Treatment Plan:

• Continue hydrocortisone cream for inflammation.

• Increase dietary fiber (e.g., Metamucil).

• Avoid wipes, which may worsen irritation.

• Warm baths to soothe discomfort.

If bleeding develops, further evaluation for internal hemorrhoids would be warranted.

3. Wart (Verruca Vulgaris)

On the left cheek, the patient had a viral wart. These common growths are caused by the human papillomavirus (HPV).

Treatment Plan:

• Cryotherapy with liquid nitrogen was performed during the visit (two freeze-thaw cycles).

• Counseling provided regarding risks (blistering, pigment changes, recurrence).

• Discussed at-home adjunct options such as topical salicylic acid or OTC cryotherapy if lesions recur.

Why Dermatology Evaluation is Important

This case demonstrates how multiple skin conditions can occur simultaneously. Without expert evaluation, patients may misinterpret symptoms—leading to ineffective treatment or worsening conditions.

At Village Dermatology in Katy and Houston, our board-certified dermatologists provide comprehensive, individualized care, whether for rashes, infections, growths, or chronic skin concerns.

Takeaway

• Allergic contact dermatitis often results from fragrances or chemicals in deodorants or skin products.

• External hemorrhoids can be managed conservatively with topical medications and lifestyle adjustments.

• Warts can be treated effectively with in-office procedures such as cryotherapy.

If you’re struggling with persistent rashes, skin growths, or irritation, contact Village Dermatology in Katy and Houston, Texas for expert diagnosis and treatment.

Managing Early Signs of Facial Aging in a 27-Year-Old Female

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we often see patients in their 20s and 30s who are starting to notice early signs of facial aging. Wrinkles, fine lines, and changes in skin tone or texture can feel concerning, especially when they appear earlier than expected. Today’s case highlights a 27-year-old female patient who presented with concerns about facial wrinkles and skin changes due to sun exposure.

Patient Presentation

The patient, a 27-year-old woman, reported visible wrinkles and facial creases that had developed gradually over several months. While her overall health was excellent, she was bothered by these cosmetic changes, which she described as moderate in severity.

Clinical Examination

A full skin examination was performed, including the scalp, face, lips, ears, and upper extremities. Findings included:

• Fine lines and wrinkles consistent with early photoaging (dermatoheliosis)

• Reticulated light tan macules (sunspots)

• Evidence of solar elastosis, a condition in which sun damage weakens skin elasticity

The patient appeared well-nourished, alert, and in no distress.

Diagnosis

The findings were consistent with:

• Photoaging (L57.8) due to chronic sun exposure

• Cosmetic concerns related to aging face (Z41.9)

Treatment Plan

The following management strategies were discussed:

1. Prescription Therapy

The patient was started on tretinoin microspheres 0.04% topical gel, applied 2–3 nights per week and gradually increased to nightly use as tolerated. Retinoids like tretinoin are considered the gold standard in anti-aging skincare, as they help:

• Stimulate collagen production

• Improve fine lines and wrinkles

• Brighten skin tone

• Smooth skin texture

2. Cosmetic Procedures

We recommended a consultation with our cosmetic team to explore additional anti-aging treatments, including:

• Botox® for dynamic wrinkles caused by repeated facial movements

• Microneedling to stimulate collagen and improve overall skin texture

3. Skin Care & Lifestyle Counseling

• Daily broad-spectrum sunscreen SPF 30+

• Sun avoidance during peak hours

• Consistent moisturizing and gentle cleansing

• Discussion of long-term expectations, as photoaging is chronic and best managed with ongoing care

Follow-Up

The patient was referred for a cosmetic consult with our aesthetic team and will continue tretinoin therapy with reassessment in several months.

Takeaway for Patients in Katy & Houston

This case underscores that facial aging can begin as early as your 20s, especially in sunny climates like Texas. The good news is that early intervention with prescription topicals, sunscreen, and minimally invasive cosmetic treatments can dramatically slow the aging process and restore confidence.

If you’re noticing wrinkles, sunspots, or other early signs of photoaging, our dermatology team at Village Dermatology in Katy and Houston, TX offers both medical and cosmetic solutions tailored to your skin.

Managing Melasma in a 51-Year-Old Female Patient

By: Ashley Baldree

At Village Dermatology, serving patients across Katy and Houston, Texas, we frequently evaluate and manage pigmentation disorders, including melasma. This case highlights the journey of a 51-year-old female patient who presented for a follow-up evaluation of persistent melasma.

Patient History

The patient has been managing melasma affecting her left inferior lateral malar cheek and right inferior central malar cheek. Her initial treatment regimen included:

• Gentle cleanser for daily skin care

• Moisturizer with SPF 30+ applied every morning

• Hydroquinone (applied to dark spots at night for two months)

• Tretinoin (a pea-sized amount applied nightly to the entire face)

At follow-up, she reported ongoing use of hydroquinone and tretinoin but noted limited improvement. She also mentioned using niacinamide, which we recommended she reserve for morning application, separate from prescription medications.

Due to her hormone replacement therapy, she was not a candidate for tranexamic acid, a treatment sometimes used for resistant melasma. Instead, we advised continuing and optimizing her topical therapy, with careful cycling of hydroquinone use—three months on, followed by one month off—to minimize side effects.

Examination and Findings

• Hyperpigmentation consistent with melasma was observed on both cheeks.

• No evidence of secondary complications such as pseudoochronosis (a rare side effect of hydroquinone use).

• The patient was otherwise in good health, alert, oriented, and not in acute distress.

Treatment Plan

Our treatment plan for this patient included:

• Continuation of topical hydroquinone (compounded prescription strength).

• Nightly tretinoin to improve skin cell turnover and enhance pigment fading.

• Daily broad-spectrum sunscreen SPF 30+, reinforced as essential in preventing worsening hyperpigmentation.

• Patient education regarding triggers of melasma, such as sun exposure, hormonal changes, and heat.

She will return for a follow-up evaluation in four months to assess progress.

Patient Counseling

We discussed the following with the patient:

• Expectations: Melasma is a chronic skin condition that requires consistent management. While improvement is expected, recurrence is common, especially with sun exposure.

• Side Effects: Hydroquinone may cause dryness, irritation, or rare paradoxical darkening of the skin. Retinoids can cause dryness and peeling, especially when first started.

• Sun Protection: Daily sunscreen use, sun-protective clothing, and minimizing direct sun exposure are critical for long-term improvement.

Conclusion

Melasma can be frustrating, but with the right combination of topical treatments, sun protection, and patient education, many patients achieve meaningful improvement. At Village Dermatology in Katy and Houston, Texas, our team tailors treatment plans to each individual’s needs while providing guidance on safe and effective long-term skin care.

If you are struggling with melasma or other pigmentation concerns, schedule a consultation with us to explore your treatment options.