Evaluating a Scalp Growth and Atopic Dermatitis in a 20-Year-Old Female — Village Dermatology Katy & Houston, Texas

By: Dr. Ashley Baldree

Young adults often present with a combination of dermatologic concerns involving both growths and inflammatory skin conditions. This case report highlights a 20-year-old female evaluated at Village Dermatology, serving Katy and Houston, Texas, for a scalp growth, eczema flares, and post-inflammatory hyperpigmentation (PIH).

Chief Complaints

1. Growth on the left central parietal scalp

2. Rash on the hands and left leg

The patient reported:

• A moderate, asymptomatic growth on the scalp

• Flaking rash on the hands and left lower leg

• Concern about dark discoloration (PIH) left behind after rashes

She had been previously treating eczema with triamcinolone.

Clinical Examination

A focused examination evaluated the:

• Scalp

• Face

• Hands

• Left lower leg

The patient was well-appearing, alert, and in no distress.
Findings included:

1. Scalp Lesion

A solitary lesion on the left central parietal scalp concerning for:

• Neoplasm of uncertain behavior

• Nevus

• Lipofibroma

2. Active Atopic Dermatitis

Erythematous, eczematous patches on:

• Left proximal pretibial region

• Left ulnar dorsal hand

• Right ulnar dorsal hand

3. Post-Inflammatory Hyperpigmentation

Ill-defined hyperpigmented patches in the same areas where eczema was present.

Diagnosis & Assessment

1. Neoplasm of Uncertain Behavior

Given the uncertain nature of the scalp growth, a biopsy was recommended.

Biopsy Procedure

• Shave biopsy of the lesion

• Local anesthesia with lidocaine + epinephrine

• Dermablade used to obtain specimen for H&E

• Hemostasis with Drysol

• Petrolatum applied post-procedure

The patient will be notified of results within 2 weeks.

2. Atopic Dermatitis

The patient had persistent eczema despite 2 months of topical steroid use.
She was experiencing an active flare.

Treatment Plan

• Fluocinonide 0.05% cream for the body

• Fluocinonide 0.05% solution for the scalp

• Daily moisturization with CeraVe cream

• Discussed long-term options:

  • Continued topical therapy

  • Dupixent injections (biologic therapy)

Steroid counseling included:

• Avoiding prolonged use

• Avoiding high-potency steroids on face, groin, or skin folds

• Possible side effects: atrophy, telangiectasias, hypopigmentation

3. Post-Inflammatory Hyperpigmentation (PIH)

PIH was present secondary to eczema flares.

Counseling Included:

• PIH fades naturally but may take months to years

• Strict sun protection recommended

• Goal is first to control active eczema, then address pigmentation

Patient Counseling

Topics reviewed during the visit:

Skin Care for Eczema

• Use lukewarm showers

• Apply moisturizers immediately after bathing

• Use unscented cleansers and detergents

• Avoid excessive hand washing

• Keep nails short to reduce scratching

When to Contact the Office

• Worsening rash

• Signs of infection (yellow crusts or cold sores)

• Darkening or spreading hyperpigmentation

Follow-Up

The patient will return in 1 month for evaluation of:

• Biopsy results

• Eczema response to treatment

• PIH improvement

Why Early Evaluation Matters

Young adults often overlook concerning skin growths or chronic rashes.
At Village Dermatology, serving Katy and Houston, we provide:

• Expert evaluation of suspicious lesions

• Personalized eczema treatment plans

• Guidance on pigmentary disorders such as PIH

This case highlights the importance of comprehensive dermatologic care in patients with overlapping concerns.

Managing Longstanding Melasma in a 50-Year-Old Female — Village Dermatology Katy & Houston, Texas

By: Dr. Caroline Vaughn

Melasma is one of the most common causes of facial discoloration in adult women and a frequent concern among dermatology patients across Katy, Texas and Houston, Texas. This case report highlights the evaluation and management of a 50-year-old female presenting with chronic cheek discoloration consistent with melasma.

Chief Complaint

The patient presented with asymptomatic facial discoloration, primarily on the:

• Right central malar cheek

• Left central malar cheek

She reported having this pigmentation for several years without any current treatment.

Clinical Examination

A focused facial examination was performed, including:

• Forehead

• Cheeks

• Nose

The patient appeared well-nourished, alert, and in no acute distress.
Hyperpigmented, ill-defined patches were noted in a malar and periorbital distribution, characteristic of melasma.

Diagnosis

Melasma

Melasma presents as patchy facial hyperpigmentation and is more common in women, often triggered by:

• Hormonal changes

• Birth control or pregnancy

• Sun exposure

• Heat and inflammation

The patient had a history of using compounded hydroquinone but experienced worsening pigmentation when tapering the strength.

Treatment Discussion

A comprehensive review of treatment options was provided, including:

1. Topical Treatments

• Tretinoin cream (refilled today)

  • Enhances skin turnover and improves discoloration

• Bleaching agents (HQ)

  • Effective but risk of pseudoochronosis with excessive or prolonged use

2. Oral Therapy

• Tranexamic acid

  • Reduces melanocyte activity

  • Helpful for stubborn or recurrent melasma

  • Risks discussed: small risk of blood clots, gastrointestinal upset

  • Patient confirmed no personal or family history of clotting disorders

3. Procedural Options

• Melanage chemical peel

• Non-ablative laser therapy (Fraxel)

Pricing for the chemical peel was provided.

4. Sun Protection

A critical component of treatment:

• Daily SPF 30+

• Tinted mineral sunscreen preferred for iron oxides, which protect against visible light

• Strict sun avoidance during peak UV hours

Plan

After extensive discussion, the patient elected to begin combination therapy:

Medications Prescribed:

• Tranexamic Acid 650 mg

  • Take ½ tablet PO BID

• Tretinoin 0.025% cream

  • Apply a pea-sized amount 2–3 nights/week, increasing as tolerated

Counseling Provided:

• Expected gradual improvement over months

• Importance of consistency with sun protection

• Instruction to contact the office if pigmentation worsens or if medication side effects occur

Follow-Up:
A 2-month targeted follow-up is scheduled to evaluate progress and consider peels or laser treatments.

Why Melasma Requires Expert Dermatologic Care

At Village Dermatology in Katy and Houston, we frequently help patients manage chronic melasma. Because this condition can worsen with heat, sun, inappropriate skincare products, or certain medications, professional guidance ensures safe and effective treatment.

Our approach combines:

• Personalized assessment

• Stepwise treatment plans

• Evidence-based procedures

• Long-term maintenance strategies

Managing Molluscum Contagiosum in a 7-Year-Old Patient — Village Dermatology in Katy & Houston, Texas

By: Dr. Caroline Vaughn

Molluscum contagiosum is one of the most common viral skin conditions seen in pediatric dermatology, yet it can still cause worry for parents when lesions begin to spread. At Village Dermatology, serving families throughout Katy, Texas and Houston, Texas, we frequently evaluate and treat molluscum in young children.

This case report highlights the presentation and management discussion for a 7-year-old male seen for rapidly spreading skin lesions on the back and left knee.

Chief Complaint

The patient presented as a new patient with skin lesions located on the:

• Back

• Left knee

The lesions were described as spreading and moderate in severity.

Clinical Examination

A comprehensive skin exam was performed, including evaluation of the:

• Face

• Abdomen

• Back

• Upper extremities

• Lower extremities

The child appeared well-nourished, alert, and in no acute distress.
A dermatoscope was used for enhanced evaluation. The patient's mother was present during the exam, along with the medical assistant.

Key Findings

Dermatoscopic and clinical evaluation revealed:

Pink, shiny, umbilicated papules with a central dell, consistent with molluscum contagiosum, distributed across:

• Right inferior upper back

• Left inferior upper back

• Left knee

• Right anterior upper arm

• Epigastric area

These findings confirmed the diagnosis.

Diagnosis

Molluscum Contagiosum

Molluscum contagiosum is a benign viral skin infection that often affects children. It spreads through:

• Skin-to-skin contact

• Shared surfaces or objects

• Water exposure (e.g., swimming pools)

Although harmless, lesions can spread and persist for months to over a year without treatment.

Management Discussion

During the visit, we discussed treatment options in depth with the patient's mother, including:

1. In-Office Treatment Options

• Cantharidin (“beetle juice”)

  • A painless application for children

  • Causes mild blistering to help lesions resolve

• Cryotherapy (liquid nitrogen)

  • Effective but may be uncomfortable for younger patients

2. At-Home Treatment Option

• Contagiawesome (Medrock Pharmacy)

  • A compounded topical therapy designed specifically for molluscum

After reviewing risks, benefits, and expected outcomes, the family elected to defer treatment for now.
They were encouraged to contact the office or message through Klara if they wish to initiate therapy later.

Counseling Provided

Parents often feel overwhelmed when molluscum lesions multiply. We provided reassurance and guidance, including:

What to Expect

• Molluscum is common, contagious, and benign

• Lesions may spread before improving

• Treatment is optional, but can speed resolution

Skin Care Tips

• Avoid scratching to prevent spread

• Do not share towels or sports equipment

• Avoid direct lesion-to-lesion contact with siblings

When to Reach Out

Parents were advised to contact Village Dermatology if:

• Lesions spread rapidly

• A widespread itchy rash develops

• Lesions persist or become irritated

Plan

• Follow-up: As needed

• Treatment: Deferred at family's request

• Education: Provided on natural course, spread, and treatment options

At Village Dermatology, families in Katy and Houston, Texas can expect compassionate, evidence-based dermatologic care for both routine and complex pediatric conditions.

A Case of Recurrent Psoriasis: Evaluation & Treatment of a 33-Year-Old Male | Village Dermatology Katy & Houston, TX

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently see patients who have been treating a rash unsuccessfully on their own or with medications prescribed for a different condition. Psoriasis is one such condition that can mimic other rashes early on, making professional evaluation critical.

This case features a 33-year-old male who presented with a spreading rash across his trunk. After a detailed review of history, appearance, and prior treatments, his condition was diagnosed as psoriasis, a chronic inflammatory skin disease.

Patient Overview

Chief Complaint

A pink and red rash on the trunk, moderate in severity, present for 3 weeks.

History

• Initially began on the right lower leg, then spread to the body

• Previously treated 6 months earlier with ketoconazole 2% cream for presumed ringworm

• Ketoconazole helped initially but no longer provides improvement

• No nail pitting or ridging

• No joint aches or stiffness (important in ruling out psoriatic arthritis)

Exam Findings

Clinical evaluation revealed:

• Psoriasiform plaques

• Micaceous (silvery) scale

• Distribution across the trunk and extremities

• No signs of tinea (fungal infection)

• No nail involvement

These findings were strongly consistent with plaque psoriasis.

Diagnosis: Psoriasis

Psoriasis is a chronic autoimmune condition characterized by:

• Red or salmon-colored plaques

• Thick, overlying scale

• Recurrent flares and remissions

Symptoms often worsen due to:

• Stress

• Infections (especially strep throat)

• Some medications

• Alcohol

• Cold, dry weather

Treatment Plan

After an in-depth conversation outlining treatment options, the patient elected to begin topical therapy, which is appropriate for mild to moderate psoriasis without joint involvement.

1. Calcipotriene 0.005% Cream

• A vitamin D analog

• Apply twice daily on weekends

• Helps regulate skin cell turnover

• Reduces plaque thickness and scaling

2. Triamcinolone 0.1% Cream

• A medium-strength topical steroid

• Use twice daily on weekdays for 2 weeks, then as needed for flares

• Reduces redness, itching, and inflammation

This “weekday steroid + weekend calcipotriene” rotation helps improve psoriasis while minimizing steroid overuse.

Counseling & Supportive Care

Patients were advised to incorporate:

• Emollients (thick moisturizers) daily

• Ambient sunlight exposure (brief, gentle exposure—not sunburn)

• Medicated shampoos containing tar, selenium, ketoconazole, or zinc pyrithione for scalp symptoms

• Avoid known triggers when possible

Long-Term Expectations

Psoriasis is a lifelong condition, with periods of remission and flare-ups.
Treatment aims to reduce symptoms, slow flare frequency, and improve quality of life.

Follow-Up

A 3-month follow-up was scheduled to reassess progress and adjust therapy as needed.

Dermatology Expertise in Katy & Houston, Texas

Whether your rash is new, persistent, or worsening, a board-certified dermatologist can help determine the right diagnosis and treatment plan. At Village Dermatology, we provide advanced care for psoriasis—from topical therapy to phototherapy to biologics like Skyrizi when appropriate.

We’re committed to helping you achieve long-term skin relief.

Case Report: Complex Fungal Rash and Arm Lesions in a 60-Year-Old Female | Katy & Houston, Texas

by: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently evaluate rashes that are persistent, worsening, or unresponsive to initial treatments. Fungal infections can present in multiple ways and may be complicated by prior steroid use, making accurate diagnosis and targeted therapy essential.

Patient Presentation

A 60-year-old female presented as a new patient with a painful, itchy, blistering rash on the left arm, which had been present for several weeks. She also reported a chronic rash involving the inner thighs and a new lesion on the right forearm that she believed may be a spider bite. The severity of symptoms prompted further evaluation.

Clinical Examination

A focused dermatologic examination of the right and left forearms was performed using dermoscopy. The patient was alert, well-nourished, and in no acute distress.

Multiple distinct skin findings were identified, leading to several diagnoses.

Diagnosis #1: Tinea Cruris (Jock Itch)

The patient reported a long-standing rash in the inguinal folds, which had worsened after using topical corticosteroids.

Exam Findings

• Erythematous, scaly plaques

• Serpiginous borders

• Located on the right anterior proximal thigh

A KOH preparation was performed and was positive for branching hyphae, confirming a fungal infection.

Treatment Plan

• Ketoconazole 2% topical cream

• Applied twice daily for two weeks

The patient was counseled that tinea cruris is a dermatophyte infection commonly seen in warm, humid climates like Houston and Katy, Texas. Cure rates are excellent, though recurrence is common.

Diagnosis #2: Majocchi’s Granuloma (Fungal Folliculitis)

The rash on the left forearm had failed to respond to topical steroids and showed features concerning for a deeper fungal infection.

Exam Findings

• Peri-follicular pustules

• Annular plaque formation

A KOH preparation was positive, supporting the diagnosis of Majocchi’s granuloma, a fungal infection that extends into hair follicles and often worsens with steroid use.

Treatment Plan

• Oral terbinafine 250 mg daily for 4 weeks

The patient was counseled that Majocchi’s granuloma requires systemic antifungal therapy. A punch biopsy will be considered at follow-up if there is inadequate improvement.

Diagnosis #3: Suspected Spider Bite – Right Forearm

The patient also presented with a painful lesion on the right distal dorsal forearm, suspected to be a spider bite.

Exam Findings

• Erythema with a central punctum

Treatment Plan

• Daily wound care

• Topical silver sulfadiazine (Silvadene) cream, applied twice daily until healed

The patient was counseled on signs of worsening infection or systemic symptoms that would require urgent medical evaluation.

Follow-Up

The patient is scheduled to return in four weeks to evaluate treatment response. Early improvement is expected, though fungal infections may require close monitoring.

Expert Rash Diagnosis & Treatment in Katy & Houston, Texas

At Village Dermatology, we specialize in diagnosing complex rashes, including fungal infections, steroid-modified eruptions, and inflammatory skin conditions. Accurate diagnosis using tools like KOH preparation and dermoscopy allows us to provide targeted, effective treatment.

📍 Serving Katy and Houston, Texas

A Common Benign Growth: Understanding Lipomas Through a 28-Year-Old Patient Case | Village Dermatology Katy & Houston, TX

By: Dr. Ashley Baldree

At Village Dermatology in Katy and Houston, Texas, we frequently evaluate patients for new skin or soft-tissue growths. Many of these lesions are completely benign, but determining that with certainty requires careful clinical evaluation.

This case highlights a 28-year-old female who presented with an asymptomatic growth on her left upper back, raising suspicion for a lipoma—a common benign fatty tumor. Through a detailed exam, counseling, and a structured diagnostic plan, we were able to guide her through next steps with clarity and reassurance.

Patient Overview

Chief Complaint

• A moderate-sized growth on the left lateral upper back

• Present for several months

• No pain or drainage

• Attempted self-drainage with a needle (but no material expressed)

Exam Findings

A focused dermatologic examination of the back showed:

• A soft, mobile subcutaneous nodule

• No signs of active drainage

• Mild warmth to the touch

• No systemic symptoms

• Dermatoscopic evaluation supported a diagnosis of lipoma

The patient otherwise appeared well, alert, oriented, and in no distress.

Clinical Impression: Suspected Lipoma

A lipoma is a benign, non-cancerous tumor composed of fatty tissue. They are extremely common, often slow-growing, and typically harmless.

In this case, the attempted self-puncture introduced the possibility of local inflammation or early infection, explaining the mild warmth on examination.

Treatment Plan & Recommendations

1. Short Course of Antibiotics

To reduce any potential infection from the prior needle poke:

• Doxycycline 100 mg

• Taken twice daily for 2 weeks

• With food, and avoid lying flat for 30 minutes after swallowing

This helps calm inflammation and prevent deeper infection.

2. Ultrasound of the Upper Back

An ultrasound was ordered to:

• Confirm the diagnosis

• Determine the depth, borders, and size of the mass

• Assess whether the lesion is appropriate for in-office removal

• Help guide referral if needed

The patient was given instructions and the necessary form to complete the imaging study.

3. Surgical Options

Based on ultrasound findings:

• Small to moderate lipomas can often be excised in-office by our dermatologic surgeon

• Large or deep lipomas are referred to a general surgeon for removal under appropriate anesthesia

4. Patient Counseling & Education

During the visit, we reviewed:

What to Expect

• Lipomas are benign fatty tumors

• They typically stay stable or grow very slowly

• Removal is optional unless painful, enlarging, or bothersome

When to Call Us

• Rapid growth

• New pain, redness, or fever

• Drainage, bruising, or sudden changes

5. Follow-Up

Follow-up was recommended as needed (PRN) after completing her imaging results and antibiotic course.

Why Professional Evaluation Matters

Although lipomas are benign, other growths—such as cysts, infections, or rarely liposarcomas—can mimic their appearance.
A proper dermatologic evaluation ensures:

• Accurate diagnosis

• Appropriate imaging

• Safe removal when necessary

• Avoidance of complications from self-treatment

At Village Dermatology in Katy and Houston, we provide comprehensive care for skin growths, tumors, cysts, and soft tissue lesions with expert evaluation and advanced treatment options.

Case Report: Adult Female Acne Managed With Isotretinoin (Accutane) in Katy & Houston, Texas

by: Dr. Caroline Vaughn

At Village Dermatology, we provide comprehensive care for patients with persistent and treatment-resistant acne. Isotretinoin (Accutane) remains one of the most effective options for moderate to severe acne, particularly when other therapies have failed.

Patient Background

A 41-year-old female returned for a follow-up visit for facial acne. She was initially evaluated on November 21, 2025, at which time she began isotretinoin 40 mg twice daily (80 mg total daily dose), taken with a fatty meal. She presented today for focused monitoring while continuing therapy.

Clinical Examination

A focused facial examination was performed with dermoscopy. Findings included:

• Comedonal papules

• Inflammatory papules and pustules

• Two new acne breakouts involving the nose and cheek

Despite reaching her cumulative dose goal, the patient continued to experience mild active lesions.

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

Treatment Course & Management Plan

The patient reported no significant side effects from isotretinoin therapy. Given the presence of new breakouts, the decision was made to continue isotretinoin at 80 mg daily to further improve disease control.

Key Treatment Details:

• Medication: Isotretinoin 40 mg capsules

• Dose: 40 mg twice daily

• Month of Therapy: Month 5

• Protocol: 1 mg/kg until cumulative dose of 200–220 mg/kg

A urine pregnancy test was performed in clinic and confirmed to be negative. The patient was successfully confirmed in iPledge, and her prescription was sent.

Isotretinoin Counseling & Monitoring

Extensive counseling was provided, including:

• Use of two forms of contraception (secondary method: male vasectomy)

• Monthly pregnancy testing and lab monitoring

• Avoiding blood donation

• Avoiding elective surgery for six months after treatment completion

• Not sharing medication

• Monitoring for side effects such as headaches, fatigue, abdominal pain, rash, or vision changes

The patient verbalized understanding of all risks and benefits.

Skin Care Recommendations

To support treatment success, the patient was advised to use:

• Non-comedogenic cleansers

• Gentle moisturizers

• Broad-spectrum sunscreen SPF 30+

She was counseled that improvement continues over time, with 60–80% improvement typically seen by 2–3 months, and further clearing expected as therapy continues.

Follow-Up

The patient will return in one month for continued isotretinoin monitoring and acne management.

Expert Acne & Accutane Treatment in Katy & Houston, Texas

At Village Dermatology, we specialize in adult acne treatment, including safe and closely monitored isotretinoin therapy. Our dermatologists provide personalized care to help patients achieve long-term acne control and prevent scarring.

📍 Serving Katy and Houston, Texas

A Complex Case of Lipodermatosclerosis, Atrophie Blanche, Nail Fungus & Adult Acne: Comprehensive Dermatologic Care in Katy & Houston, Texas

By: Dr. Caroline Vaughn

At Village Dermatology in Katy and Houston, Texas, our dermatology team routinely manages complex cases involving multiple skin, nail, and vascular conditions. Today’s case report highlights a 45-year-old female who presented as a new patient with concerns about a chronic leg rash, discolored toenails, and asymptomatic bumps on the cheek. Her clinical history—including a prior deep vein thrombosis (DVT)—added complexity to her evaluation and treatment plan.

This case demonstrates the importance of thorough assessment, individualized treatment, and patient education in achieving long-term dermatologic improvement.

Patient Overview

Chief Complaints

1. Rash on the left leg

2. Nail disorder affecting both great toenails

3. Bumps on the left cheek

Relevant Medical History

• History of left-leg DVT (2010–2011)

• Known Factor V Leiden mutation

• Intermittent swelling of the left leg

• Previous use of clobetasol and sunflower/vitamin E oils

Clinical Findings

1. Lipodermatosclerosis with Atrophie Blanche (Left Lower Leg)

The patient reported worsening discoloration, burning sensations, occasional oozing, and long-standing swelling. Clinical exam showed:

• Scarring and fibrosis

• Hyperpigmentation

• Erythematous, tender plaques

• Classic “inverted champagne bottle” morphology

• Angular, white, depressed plaques characteristic of atrophie blanche

These findings were consistent with lipodermatosclerosis, a chronic inflammatory and sclerosing condition associated with venous insufficiency.

2. Onychomycosis (Toenail Fungus)

Both great toenails showed:

• Yellow and green discoloration

• Onycholysis (lifting of the nail)

• Subungual debris

3. Adult Acne (Comedonal & Inflammatory)

The patient also displayed:

• Comedonal papules

• Inflammatory papules and pustules

• Distribution across both malar cheeks

Treatment Plan

1. Lipodermatosclerosis & Atrophie Blanche Management

A structured management strategy was initiated:

• Discontinue oils (sunflower & vitamin E)

• Start Vaseline as a plain moisturizer

• Begin Triamcinolone 0.1% ointment, applied twice daily in 2-week cycles

• Apply Duoderm bandages daily to the superficial wound

• Daily compression stockings to support venous return

• Strong counseling on:

  • Leg elevation

  • Long-term expectations

  • Chronicity and irreversible fibrosis

The patient was advised to return in 6 weeks for follow-up.

2. Onychomycosis (Nail Fungus)

The patient declined oral antifungal therapy (terbinafine), so we recommended conservative management:

• OTC Gold Listerine foot soaks

• Education on:

  • Fungal longevity

  • Slow rate of nail improvement

  • High relapse rate

  • Differences between oral vs. topical treatment effectiveness

3. Acne Treatment Plan

To address comedonal and inflammatory acne:

• Start tretinoin 0.025% cream

  • Apply pea-sized amount at bedtime

  • Start 2–3 nights per week, increase to nightly as tolerated

• Use non-comedogenic skincare

• Emphasize expectations: acne may take 2–3 months to show significant improvement

Why Early Dermatologic Evaluation Matters

This case demonstrates how seemingly unrelated symptoms—rash, nail discoloration, facial bumps—can reflect deeper dermatologic or systemic processes. Conditions like lipodermatosclerosis often go untreated for years, leading to irreversible skin changes.

At Village Dermatology, we prioritize:

• Early identification

• Comprehensive evaluation

• Personalized treatment strategies

• Patient education for long-term success

Dermatology Care in Katy & Houston, Texas

Whether you’re experiencing chronic leg discoloration, toenail changes, acne, or other skin concerns, our board-certified dermatologists provide advanced, compassionate care tailored to your needs.

📍 Village Dermatology – Katy, TX
📍 Village Dermatology – Houston, TX

Treatment of Nasal Actinic Keratosis in an 81-Year-Old Female — Village Dermatology, Katy & Houston, Texas

By: Dr. Caroline Vaughn

Patient Overview

An 81-year-old female presented to Village Dermatology as a new patient with a skin lesion on the nose that had been present for several months. The lesion was bleeding, moderate in severity, and previously untreated. Because of its chronic nature and concerning symptoms, she sought evaluation and management.

A full examination of the face, scalp, ears, and upper extremities was completed using dermatoscopy.

Clinical Findings

1. Actinic Keratoses – Nasal Dorsum

The nasal lesion revealed erythematous patches with hyperkeratotic scale, consistent with actinic keratoses (AKs)—precancerous lesions caused by chronic sun damage.

Why This Matters:

• AKs are precancerous

• A small percentage can progress to Squamous Cell Carcinoma if untreated

• Early treatment reduces risk of skin cancer on cosmetically sensitive areas like the nose

Treatment: Liquid Nitrogen Therapy

A single AK lesion on the nasal dorsum was treated with cryotherapy (liquid nitrogen).
The patient was counseled on expected outcomes and potential side effects, including:

• Crusting

• Scabbing

• Blistering

• Temporary pigment changes

• Risk of recurrence

She tolerated the procedure well.

Sun Protection Counseling

She was advised to:

• Use broad-spectrum SPF 30+ sunscreen daily

• Wear hats and sun-protective clothing

• Reapply sunscreen every 2 hours outdoors

• Avoid peak sunlight hours

These measures help prevent recurrence and reduce development of future AKs.

Additional Dermatologic Findings

2. Benign Nevi – Right Cheek

Regular, symmetrical, evenly colored moles consistent with benign nevi were noted.

Recommendations:

• Monthly self-skin checks

• Report changes in size, shape, color, or new symptoms (itching, bleeding)

3. Seborrheic Keratoses

Benign, warty growths seen on:

• Right upper back

• Left inframammary crease

• Right lateral breast

• Right proximal calf

These require no treatment unless irritated or desired for cosmetic removal.

4. Cherry Angiomas

A benign vascular papule was found on the left upper mid-back.

Counseling provided:

• Can be removed with laser or electrodesiccation if cosmetically bothersome

• No medical treatment necessary

5. Lentigines

Sun-related pigment spots found on:

• Mid-back

• Forearms

• Upper sternum

Management options discussed:

• Sun protection

• Lightening creams

• Retinoids

• Chemical peels

• Laser procedures

Sunscreen Education (Detailed)

The patient was reminded:

• SPF 30 blocks 97% of UVB rays

• Apply sunscreen 15 minutes before sun exposure

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

• Use 1 ounce for full-body coverage

• Lip balm with SPF is recommended

• Sun-protective clothing is effective as long as it stays on the skin

6. Acrochordons (Skin Tags) – Cosmetic Option

Several skin tags were identified. The patient was informed she could have up to 10 removed for $150 if desired.

Skin tags are benign but may become irritated when caught on clothing or jewelry.

Follow-Up & Patient Counseling

The patient was advised to contact the office if she experiences:

• Worsening bleeding

• Non-healing spots

• New or changing lesions

• Severe irritation after cryotherapy

Regular skin checks were recommended due to her history of sun-related lesions.

⭐ Takeaway

This case highlights the importance of early diagnosis and treatment of Actinic Keratoses, especially when lesions begin to bleed or change. Through targeted therapy and thorough skin cancer screening, Village Dermatology provides comprehensive care to protect the skin health of patients in Katy and Houston, Texas.

Allergic Contact Dermatitis With Extensive Patch Testing in a 29-Year-Old Female — Village Dermatology, Katy & Houston, Texas

By: Dr. Ashley Baldree

Patient Overview

A 29-year-old female presented to Village Dermatology as a new patient with a chronic, itchy, red rash affecting the arms, hands, and right leg, present for several years. The patient reported that the rash significantly worsened over the past year, particularly on the hands, and often flared after exposure to cleaning products or during nail salon visits, raising concerns about possible allergies.

She had previously used triamcinolone and clobetasol without improvement.

Clinical Examination

A focused dermatologic exam was performed on the head, face, and back.
The patient appeared well developed, well nourished, alert, and in no distress.

Findings:

• Well-demarcated, geometric eczematous patches consistent with allergic contact dermatitis (ACD)

• Rash distribution and worsening with product exposure suggested a strong allergic trigger

• Given chronicity and treatment resistance, patch testing was indicated

Assessment: Allergic Contact Dermatitis

The patient’s clinical presentation was most consistent with allergic contact dermatitis of unknown/unspecified cause, with probable exacerbation from environmental and chemical exposures.

Because she had failed two high-potency topical steroids, the next step was comprehensive patch testing.

⭐ Patch Testing: Core ACDS Series (88 Allergens)

A full ACDS Core Patch Test Panel was applied to the patient’s back, totaling 88 allergens, including:

• Metals (Nickel, Cobalt, Gold compounds)

• Preservatives (MI/MCI, Parabens, Formaldehyde, Germall II, Bronopol)

• Fragrances (Fragrance Mix I & II, Balsam of Peru, Lavender Oil, Ylang Ylang, Peppermint Oil)

• Rubbers and adhesives (Carba mix, Thiuram mix, PPD, Epoxy resin, BPA)

• Surfactants (Cocamidopropyl betaine, Decyl glucoside, Oleamidopropyl dimethylamine)

• Antibiotics (Neomycin, Bacitracin, Polymyxin B)

• Sunscreen ingredients (Octinoxate, Benzophenone-4)

• Hair product allergens (Acrylates, DMAPA)

• Corticosteroid markers (Tixocortol, Budesonide, Clobetasol)

• Botanical allergens (Propolis, Tea tree oil, Shellac)

• And many others included in the ACDS Standard Series

Risks reviewed: itch, rash, allergic reaction, blistering, systemic reaction, rare anaphylaxis.
Verbal consent obtained.

Patient Instructions (Critical for Accuracy)

The patient was given strict instructions to ensure valid patch test results:

Back Care Instructions:

• Do NOT get the back wet (no sweating, showering, or humid environments for 96 hours)

• Avoid scratching or disturbing the patches

• Leave patches in place for 48 hours, then remove them at home

• Continue avoiding moisture until the 4-day follow-up visit

• Do not apply topical steroids or ice to the back

• May use OTC antihistamines (Zyrtec, Claritin, Allegra, Xyzal) if needed

At follow-up, she will receive a printed list of allergens to which she reacted.

Counseling Provided

The dermatologist discussed:

• The nature of Allergic Contact Dermatitis—a delayed hypersensitivity reaction

• Importance of identifying allergen triggers

• How avoidance leads to significant long-term improvement

• How irritant exposure (cleaners, salon chemicals) likely contributed to worsening symptoms

• Future skin-care planning after results are reviewed

Follow-Up

The patient will return in 4 days for:

• Patch test reading

• Allergen identification

• Personalized avoidance plan

• Updated treatment regimen for long-term eczema and ACD control

🌟 Takeaway

This case highlights the importance of patch testing in patients with chronic, treatment-resistant eczema, particularly when symptoms worsen with product exposure.
At Village Dermatology in Katy, Texas and Houston, Texas, we provide advanced diagnostic services such as patch testing to accurately identify allergens and create targeted, effective treatment plans.

Evaluation of Darkening Forehead Lesion, Acne, and Rosacea in a 37-Year-Old Female — Village Dermatology, Katy & Houston, Texas

By: Dr. Ashley Baldree

Patient Overview

A 37-year-old female presented to Village Dermatology as a new patient with a primary concern of a skin lesion on the right forehead. The lesion had been darkening and enlarging over several months and had not received prior treatment. She sought full evaluation and guidance on management.

A comprehensive skin exam was performed, including dermatoscopic evaluation of the face, scalp, and upper extremities. The patient appeared well-nourished, alert, and in no acute distress.

Clinical Findings

1. Acne 

Examination revealed comedonal papules, inflammatory papules, and pustules distributed across the face, consistent with mixed acne (inflammatory + comedonal).

2. Rosacea

The patient also exhibited erythematous papules and pustules, facial redness, and features consistent with rosacea, especially sensitivity to heat, sun, spicy foods, and alcohol.

3. Dermatofibroma

A firm, scar-like nodule was noted on the right pretibial region, consistent with a dermatofibroma, a benign skin growth.

Treatment & Management

1. Acne Management

The patient was counseled extensively on acne triggers, skincare, and expected outcomes.

Counseling Overview:

• Use only non-comedogenic cleansers, moisturizers, and cosmetics

• Acne improvement typically takes 2–3 months, with a 60–80% improvement expected with consistent care

• Avoid picking or squeezing lesions to prevent scarring

Recommendations:

• Daily broad-spectrum sunscreen SPF 30+

• Non-comedogenic moisturizers

2. Rosacea Treatment

The diagnosis of rosacea was reviewed in detail. The patient was educated on known triggers, including:

• Sun exposure

• Heat

• Spicy foods

• Alcohol

• Stress

• Exercise

• Masks or wind exposure

She was advised to avoid topical steroids on the face, as these can worsen rosacea.

Treatment Initiated:

• Azelaic acid topical therapy, applied once daily

• Green-tinted moisturizers may help neutralize redness

• Strict SPF 30+ sunscreen use daily

Long-Term Outlook:

Rosacea is chronic, but flare-ups can be well-managed with lifestyle adjustments and topical therapy.
Laser therapy may help reduce telangiectasias.

3. Dermatofibroma

The dermatofibroma on the lower leg was reviewed with reassurance.

Counseling:

• Dermatofibromas are benign and do not pose danger

• Surgical removal is optional and typically reserved for symptomatic lesions (pain, irritation, growth)

No treatment was needed at this time.

Forehead Lesion

Although the case narrative does not specify the diagnosis for the darkening, enlarging forehead lesion, it was closely examined using a dermatoscope. The absence of a biopsy plan in the medical note suggests no immediate suspicion for malignancy; however, monitoring or follow-up may be needed depending on evolution.

Follow-Up

The patient was instructed to contact the office if:

• Acne or rosacea worsens

• New nodules or cysts appear

• Any lesion changes rapidly in size, shape, or color

• The forehead lesion continues to darken or enlarge

She will begin her new treatment regimen and follow up as needed.

🌟 Takeaway

This case highlights the complexity of diagnosing and treating overlapping dermatologic conditions such as acne, rosacea, and benign lesions, while also addressing concerns about a new darkening skin lesion.
At Village Dermatology in Katy and Houston, Texas, we provide comprehensive evaluation and customized treatment plans for patients with multi-layered skin concerns.

Evaluation of Acute Rash in a 54-Year-Old Female — Village Dermatology, Katy & Houston, Texas

by: Dr. Caroline Vaughn

Patient Overview

A 54-year-old female presented to Village Dermatology as a new patient with a 2–3 week history of a rash on her right arm. The rash was asymptomatic, moderate in severity, and persistent despite a 7-day course of oral antibiotics previously prescribed at urgent care.

She also reported a small irritated spot on her right cheek.

Clinical Examination

A focused examination was performed on the face and right upper extremity, utilizing dermatoscopy.
The patient appeared well developed, well nourished, and in no acute distress.

Findings:

• Right proximal dorsal forearm: Patches consistent with dermatitis vs arthropod assault

• KOH test: Negative for fungal hyphae, decreasing likelihood of tinea corporis

• Right cheek: Mild irritation, suitable for topical steroid spot therapy

Diagnosis

1. Dermatitis, Unspecified (L30.9)

Given the clinical appearance, negative KOH prep, and healing pattern, the rash was most consistent with a resolving arthropod bite reaction or nonspecific dermatitis.

Differential Diagnosis:

• Dermatitis (most likely)

• Arthropod bite

• Tinea corporis (less likely due to negative KOH)

Treatment Plan

1. Topical Steroid Therapy

The patient was prescribed:

• Triamcinolone acetonide 0.1% cream

  • Apply twice daily to affected areas for 2 weeks

  • Avoid using more than 14 days per month

For the spot on the right cheek:

• Triamcinolone 0.1% for 3 days only, to avoid facial steroid overuse.

2. Skin Care Counseling

The patient was advised to:

• Use regular emollients to support skin hydration

• Avoid irritants and scratching

• Monitor for spread, pain, or systemic symptoms

She was reminded that diagnosis is not fully definitive, and empiric therapy plus follow-up evaluation is appropriate.

When to Call the Office:

• Fever develops

• Rash worsens despite treatment

• New symptoms such as drainage, blistering, or increased redness occur

3. KOH Preparation

A KOH prep was performed on the right forearm lesion:

• Sample collected with a 15-blade scalpel

• No hyphae visualized, reducing suspicion for dermatophyte infection

Follow-Up Plan

The patient will return in 3 weeks for reassessment.
At follow-up, clinicians will evaluate:

• Rash resolution

• Need for additional diagnostics

• Possible switch to alternative therapy if symptoms persist

⭐ Takeaway

This case demonstrates a common scenario where an acute rash may mimic infection, dermatitis, or arthropod exposure. At Village Dermatology, serving Katy, Texas and Houston, Texas, precise diagnostic tools such as KOH prep and clinical dermoscopy help guide effective, evidence-based treatment decisions.

🩺 Case Report: Melasma & New Skin Lesion Evaluation in a 56-Year-Old Female — Village Dermatology, Katy & Houston, Texas

BY: Dr. Ashley Baldree

Patient Overview

A 56-year-old female presented to Village Dermatology as a new patient with two primary concerns:

1. Chronic facial discoloration on the cheeks, present for years

2. A new red lesion on the left forearm that appeared approximately six weeks ago

She sought expert evaluation and updated management for both concerns.

Clinical Examination

A focused dermatologic exam was performed, including the scalp, face, cheeks, and left forearm.
The patient appeared well-developed, well-nourished, and in no distress. A dermatoscope was used to closely examine both the hyperpigmented facial patches and the left forearm lesion.

Findings:

• Melasma: Ill-defined hyperpigmented patches across the periorbital and malar (cheek) regions

• Left forearm lesion: A red plaque on the ventral proximal forearm, suspicious for a neoplasm requiring biopsy

Diagnosis

1. Melasma (L81.1)

A chronic, hormonally and UV-triggered pigmentation disorder characterized by blotchy hyperpigmented facial patches.

2. Neoplasm of Unspecified Behavior (D49.2)

A new red plaque on the left forearm with differential diagnosis including:

• Lichenoid keratosis

• Actinic keratosis

• Squamous cell carcinoma in situ

• Benign neoplasm of uncertain behavior

Given clinical uncertainty, biopsy was recommended for definitive diagnosis.

Treatment Plan

1. Melasma Management

The patient received extensive education on sun protection and pigmentation triggers.
Although previously using hydroquinone, she declined restarting it and elected to begin tretinoin 0.025% cream, which was prescribed.

Key Counseling Points:

• Apply a pea-sized amount of tretinoin at bedtime

• Wait 30 minutes after washing the face before applying

• Use a moisturizer if dryness occurs

• Strict sun protection is essential

• Reapply SPF 30+ sunscreen every 2 hours when outdoors

• Avoid harsh bleaching agents, mercury-containing creams, resorcinol, or phenol-based products

Additional Treatment Options Reviewed:

• Topical vitamin C

• Glycolic acid

• Tranexamic acid

• Superficial chemical peels

• Non-ablative Fraxel laser

Photographs were taken to monitor progress at the next visit.

2. Forearm Lesion: Shave Biopsy

Given the concerning appearance and differential, the patient proceeded with a shave biopsy.

Procedure Summary:

• Location: Left ventral proximal forearm

• Anesthesia: 0.5 cc lidocaine with epinephrine

• Technique: Dermablade shave biopsy to the dermis

• Hemostasis: Achieved with Drysol

• Dressing: Petrolatum and bandage applied

• Pathology: Specimen sent for H&E staining

• Follow-up: Patient to be notified of results; instructed to call if not contacted within 2 weeks

The patient tolerated the procedure well.

Follow-Up

A follow-up appointment was scheduled in 3 months to:
✔ Reassess melasma with updated photos
✔ Review biopsy results and determine next steps
✔ Evaluate progress with tretinoin and sun protection routines

Patient Counseling & Education

The patient was advised to contact the office if:

• Melasma worsens

• She develops irritation from tretinoin

• The biopsy site fails to heal or new lesions develop

• She notices ulceration, bleeding, or rapid growth of any skin lesion

At Village Dermatology in Katy and Houston, Texas, we focus on early detection, personalized skin rejuvenation, and evidence-based treatment for all pigment and lesion concerns.

Case Report: Androgenetic Alopecia Management With Oral Minoxidil & Finasteride in a 30-Year-Old Male

by: Dr. Ashley Baldree

Patient Presentation

A 30-year-old male presented to our dermatology clinic in Katy, Texas, with a chief complaint of generalized hair loss. The hair thinning began suddenly several months ago and has progressively worsened. The patient noted diffuse thinning across the scalp, with particular loss at the crown, a hallmark of male pattern hair loss.

He had not yet started any formal treatment prior to this visit.

Clinical Examination

A detailed examination of the scalp, face, head, and ears was performed using a dermatoscope. The patient was well-developed, well-nourished, and in no acute distress.

Findings included:

• Diffuse, non-scarring hair thinning

• Patterned hair loss over the vertex/crown

• No signs of inflammation, scaling, or scarring alopecia

Based on clinical evaluation, the diagnosis was consistent with androgenetic alopecia (AGA).

During the exam, benign lentigines and a compound nevus were also noted.

Diagnoses

1. Androgenetic Alopecia (L64.8)

Diffuse non-scarring hair loss with vertex thinning.

2. Lentigines (L81.4)

Benign sun-induced pigmented lesions.

3. Compound Nevus (D22.62)

Benign flesh-colored papules on the skin.

Treatment Plan

1. Androgenetic Alopecia

An in-depth discussion covered all treatment options, including:

• Oral minoxidil

• Finasteride

• Topical minoxidil (Rogaine)

• Low-level laser therapy

• Hair transplantation

• PRP (Platelet-Rich Plasma)

• AlmaTED hair restoration

• Hair supplements

The patient elected to begin:

✔ Oral Minoxidil

• Start ½ tablet daily for 1 month

• If tolerated, increase to 1 full tablet daily

• Counseled on temporary shedding during the first 8–10 weeks

• Advised to stop and contact the office if experiencing:

  • Chest pain

  • Shortness of breath

  • Leg/ankle swelling

  • Fast heart rate

  • Dizziness

  • Low blood pressure

  • Headaches

✔ Finasteride 1 mg once daily

• Reviewed risks, including sexual side effects

• Discussed long-term stabilization and thickening benefits

A follow-up will assess tolerance, progress, and potential need for adjunctive therapies.

2. Lentigines

Education and counseling included:

• Lentigines are benign sun-induced lesions

• Improve with:

  • Daily SPF 30+ sunscreen

  • Sun avoidance

  • Retinoids

  • Chemical peels

  • Laser therapy (recommended for best cosmetic improvement)

3. Compound Nevus

• Benign

• No treatment required

• Recommended monthly self-skin checks

• Use SPF 30+ sunscreen daily

• Report changes in size, shape, color, itch, or bleeding

Discussion

Understanding Androgenetic Alopecia

Androgenetic alopecia is the most common form of hair loss in men and is genetically predetermined. It typically presents with:

• Thinning at the vertex (crown)

• Recession at the temples

• Progressive miniaturization of hair follicles

Modern therapy focuses on slowing hair loss, thickening existing hair, and stimulating regrowth.
Oral minoxidil + finasteride is one of the most effective combinations and continues to gain popularity for its convenience and strong clinical results.

At Village Dermatology in Katy and Houston, TX, Dr. Reena Jogi provides individualized hair loss management using evidence-based medical and procedural therapies, including PRP and AlmaTED.

Conclusion

This case highlights the management approach for a 30-year-old male with androgenetic alopecia. With oral minoxidil and finasteride, the patient is expected to see stabilization and regrowth over the next several months. Ongoing monitoring ensures both treatment success and safety.

Case Report: Cosmetic Removal of Neck and Facial Skin Tags in a 42-Year-Old Male

by: Dr. Caroline Vaughn

Patient Presentation

A 42-year-old male presented to our dermatology clinic in Katy, Texas with a chief complaint of multiple unsightly skin lesions on the left cheek, right cheek, and left eye area. These lesions were cosmetically bothersome, and the patient sought treatment for removal.

Clinical Examination

A focused dermatologic examination of the face and neck was performed.
Findings included:

• Multiple pedunculated papules consistent with acrochordons (skin tags)

• Distribution included:

  • Right superior and central lateral neck

  • Left central and superior lateral neck

  • Left medial canthus

  • Right and left clavicular neck

  • Left inferior anterior neck

The patient was well-developed, well-nourished, alert, and in no acute distress. Dermatoscopy was used to confirm the benign nature of the lesions.

Diagnosis

Acrochordon (Skin Tags) – (L91.8)

Multiple benign pedunculated lesions across the neck and periocular area.

Treatment Plan

1. Skin Tag Removal (Cosmetic)

After thorough discussion and written informed consent, the risks and benefits were reviewed, including:

• Bleeding

• Infection

• Pain

• Pigmentary changes

• Scarring (rare)

Procedure Performed:

• 10 skin tags were removed using gradle excision

• Local anesthesia achieved with 3cc of 1% lidocaine with epinephrine

• Sites cleaned and prepared in sterile fashion

• Hemostasis achieved without complication

2. Future Treatment for DPNs

Dermatosis papulosa nigra (DPNs) were observed, and the patient was counseled that:

• These will be treated at the follow-up visit in 1 month

• Electrodesiccation is the planned method

• Strict sunscreen use is recommended to avoid post-inflammatory hyperpigmentation after treatment

Counseling & Education

Understanding Skin Tags

• Acrochordons are benign, extremely common skin lesions

• Often occur in areas of friction such as the neck, eyelids, and underarms

• May become irritated by clothing or jewelry

• Removal is cosmetic, not medically necessary unless inflamed

Post-Care Recommendations

• Clean treated areas gently

• Apply petroleum jelly or antibiotic ointment if mild crusting occurs

• Avoid picking at healing sites

• Use broad-spectrum SPF 30+ sunscreen daily to prevent pigmentation changes

• Return for evaluation if lesions recur or new growth develops

Discussion

Skin tags are among the most frequent benign growths evaluated in dermatology clinics. While harmless, they can be cosmetically undesirable or physically irritating. Simple procedures like gradle excision provide immediate results with minimal downtime.

For patients with both skin tags and DPNs, a staged treatment approach is ideal—addressing skin tags first, followed by cosmetic removal of DPNs using electrodesiccation.

At Village Dermatology in Katy and Houston, Texas, we specialize in safe, effective removal of benign facial and neck lesions with excellent cosmetic outcomes.

Conclusion

This 42-year-old male underwent successful cosmetic removal of 10 skin tags across the neck and periocular area. He will return in one month for DPN treatment. With proper aftercare and sun protection, he is expected to heal well with excellent cosmetic results.

🩺 Case Report: Actinic Keratosis Treatment in an 81-Year-Old Female — Village Dermatology, Katy & Houston, Texas

by: Dr. Caroline Vaughn

Patient Overview

An 81-year-old female presented to Village Dermatology as a new patient with a primary concern of a bleeding skin lesion on the nose, present for several months. The lesion had not been previously treated, and she sought evaluation and management.

A complete skin exam of the head, face, ears, upper extremities, and scalp was performed with dermatoscopic evaluation.

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

Clinical Findings

1. Actinic Keratoses (L57.0)

On examination of the nasal dorsum, erythematous patches with hyperkeratotic scale were noted—highly consistent with actinic keratoses (AKs).

Actinic keratoses are precancerous growths resulting from cumulative sun damage. A small percentage may progress to squamous cell carcinoma, making early treatment essential.

Treatment Plan: Liquid Nitrogen Therapy

The patient underwent cryotherapy for one lesion on the nose:

• Liquid nitrogen was applied to destroy the precancerous cells

• Risks discussed included blistering, scabbing, hypopigmentation or hyperpigmentation, infection, incomplete removal, and recurrence

She tolerated the procedure well.

Counseling for Actinic Keratoses

The patient was educated on:

• Using broad-spectrum SPF 30+ sunscreen daily

• Wearing sun-protective clothing and hats

• Monitoring for lesions that bleed, ulcerate, or fail to heal

• Treatment options such as cryotherapy, photodynamic therapy, imiquimod, and 5-fluorouracil

Additional Dermatologic Findings

2. Benign Nevi (D22.39)

Regular, symmetrical, evenly colored moles were noted on the right cheek.

These lesions were benign and required no treatment.

Counseling Included:

• Monthly self-skin checks

• Monitoring for changes in size, shape, color, itching, burning, or bleeding

3. Seborrheic Keratoses (L82.1)

Benign, waxy, warty growths found on:

• Right upper back

• Left inframammary fold

• Right lateral breast

• Right proximal calf

No treatment required unless for cosmetic reasons.

4. Cherry Angiomas (D18.01)

A benign vascular papule on the left mid-back.

Counseling included cosmetic removal options such as:

• Electrodesiccation

• Laser therapy

5. Lentigines (L81.4)

Sun-induced brown spots found on:

• Dorsal forearms

• Upper sternum

• Mid-back

These are benign but responsive to:

• Sunscreen

• Topical lightening agents

• Chemical peels

• Retinoids

• Laser therapy

She was again counseled in detail on proper sunscreen use, including reapplication every 2 hours and using at least 1 ounce for full-body coverage.

6. Acrochordons (Skin Tags) (L91.8)

Benign skin tags present on the body; cosmetic removal was offered:

• Up to 10 lesions for $150

Follow-Up

The patient was encouraged to return for evaluation if:

• Any lesion fails to heal

• A treated AK becomes painful, enlarging, or bleeds

• New suspicious lesions appear

Routine skin checks were recommended given her sun damage history and age.

🌞 Takeaway

This case highlights the importance of early detection and treatment of actinic keratoses, especially in older adults with significant sun exposure history. At Village Dermatology in Katy and Houston, Texas, we provide comprehensive evaluation, advanced treatments, and ongoing sun protection guidance to promote healthy skin at every age.

Case Report: Management of Chronic Scalp Psoriasis with Zoryve Foam in a 35-Year-Old Female

by: Dr. Ashley Baldree

Patient Presentation

A 35-year-old female presented to our dermatology clinic in Katy, Texas, with a chief complaint of persistent dandruff accompanied by scalp itching and flaking. She described her symptoms as moderate in severity and had been struggling with the condition for several months.

The patient reported prior treatment with Clobetasol Solution, which initially improved her symptoms but lost effectiveness over time. She also used over-the-counter shampoos and apple cider vinegar, with minimal improvement.

Clinical Examination

A comprehensive dermatologic examination was performed, including evaluation of the scalp, ears, neck, and upper body. The patient appeared well-developed and well-nourished, alert, and in no acute distress.

On physical exam, the scalp showed erythematous, scaly plaques distributed over the left medial frontal and superior parietal scalp—consistent with scalp psoriasis. No signs of infection or folliculitis were present. A dermatoscope was used for detailed assessment.

Diagnosis

Scalp Psoriasis (L40.0) – Chronic, stable condition involving erythema, scaling, and plaques.

Treatment Plan

1. Medication: Zoryve Foam (Topical Roflumilast 0.3%)

The patient was prescribed Zoryve Foam, a once-daily topical phosphodiesterase-4 (PDE4) inhibitor designed for targeted control of psoriasis inflammation.
Instructions: Apply once daily to affected areas of the scalp, preferably at night.

Prescription Details:

• Zoryve 0.3% Foam

• Apply to scalp once daily

• 60g tube with 3 refills

Counseling and Expectations:

• Skin Care: Use gentle, hydrating shampoos formulated with zinc pyrithione, tar, or selenium.

• Expectations: Scalp psoriasis is chronic and often cycles between periods of remission and flare-ups. Stress, seasonal changes, and hair products can trigger flares.

• When to Contact Office: If psoriasis worsens or fails to improve after several months of consistent use.

• Side Effects: Mild local irritation or itching may occur but typically resolves with continued use.

The patient was educated on proper foam application and advised to maintain consistency with treatment. A follow-up visit in 3 months was scheduled to assess therapeutic response and tolerability.

Discussion

Scalp psoriasis is a chronic inflammatory skin condition characterized by thick, scaly plaques and redness of the scalp, often associated with itching, flaking, and embarrassment for patients.

Traditional treatments like topical corticosteroids or coal tar-based shampoos can lose effectiveness over time or cause irritation with long-term use.
The introduction of Zoryve Foam (roflumilast 0.3%) has provided a modern, non-steroidal option that targets the inflammatory cascade through PDE4 inhibition, reducing redness, scaling, and itch while minimizing steroid-related side effects.

At Village Dermatology in Katy and Houston, Texas, Dr. Reena Jogi customizes treatment regimens using advanced topical and systemic options to restore scalp health and patient confidence.

Conclusion

This case demonstrates successful management of chronic scalp psoriasis using Zoryve Foam, offering an effective, steroid-free alternative for patients with persistent flaking and itching. With proper counseling and adherence, the patient is expected to achieve improved scalp health and long-term control of symptoms.

Case Report: Managing Hidradenitis Suppurativa in a 45-Year-Old Female with Chronic Axillary Flares

by: Dr. Caroline Vaughn

Introduction

At Village Dermatology, serving patients throughout Katy and Houston, Texas, we frequently see individuals struggling with hidradenitis suppurativa (HS)—a chronic inflammatory skin condition that can significantly impact quality of life. This case highlights the evaluation and management of a 45-year-old female with a one-year history of recurrent, painful lesions under both arms.

Case Presentation

A 45-year-old female presented as a new patient for evaluation of a persistent rash and painful swelling involving both axillae (underarms). The affected areas were red, swollen, tender, and draining fluid. The condition had persisted for about one year, and prior treatments with mupirocin ointment and ibuprofen (Motrin) offered minimal relief.

Her medical history included type 2 diabetes mellitus and hypertension, managed with metformin and lisinopril. She denied tobacco or alcohol use.

Clinical Examination

Examination of the right and left axilla revealed multiple inflammatory nodules, pustules, scarring, and sinus tracts, characteristic of advanced-stage hidradenitis suppurativa. The findings were consistent with a chronic, relapsing disease pattern.

Diagnosis

Hidradenitis Suppurativa (HS) – Stage II/III
ICD-10: L73.2
The presentation included weeping acneiform pustules and papules with scarring and sinus tract formation in both axillary vaults.

Treatment and Management

The patient was counseled on the chronic and recurrent nature of HS and educated on comprehensive treatment strategies, including:

• Antibacterial cleansing with benzoyl peroxide wash

• Topical antibiotic therapy with clindamycin 1% gel applied daily

• Oral antibiotic therapy with doxycycline 100 mg twice daily for 3 months

• Intralesional corticosteroid (Kenalog) injections administered to two inflamed nodules (5 mg/cc concentration, 1 cc total volume)

The risks of skin atrophy from steroid injections were discussed. She was also advised to practice gentle hygiene and wear breathable clothing to minimize irritation.

Long-Term Management Discussion

To reduce recurrence and disease progression, the patient was counseled on long-term options, including:

• Spironolactone (for hormonal modulation)

• Biologic therapy (such as adalimumab) for moderate to severe HS

• Surgical excision for persistent or extensive sinus tracts

The patient was referred to Dr. Rodger Brown, Plastic Surgery (Houston, TX) for consultation regarding surgical management should she elect to pursue definitive treatment.

Follow-Up Plan

The patient will return in two months for reassessment of her response to oral and topical therapy. She was advised to contact the office sooner if she experiences worsening lesions or persistent drainage.

Discussion

Hidradenitis Suppurativa is a chronic inflammatory condition often mistaken for recurrent infections or acne. It typically affects areas with apocrine glands—such as the underarms, groin, or inframammary folds—and can lead to scarring, abscesses, and sinus tract formation over time. Early and consistent dermatologic care is essential for controlling inflammation, preventing complications, and improving quality of life.

At Village Dermatology, our team provides a comprehensive, individualized approach to HS management, combining medical, procedural, and lifestyle strategies tailored to each patient’s needs.

Comprehensive Skin Exam and Hair Loss Evaluation in a 40-Year-Old Female: Sun Damage, Anti-Aging, and Androgenetic Alopecia Management

by: Dr. Caroline Vaughn

Case Overview

A 40-year-old female presented to Village Dermatology in Katy, Texas for a full-body skin examination. The patient denied any family history of melanoma but undergoes annual skin cancer screenings as part of her routine preventive care. Her main concerns included sun-related pigmentation, aging skin, and gradual hair thinning over the past several years.

Clinical Examination

A full skin examination was performed, including the scalp, face, neck, trunk, extremities, and nails.
The patient was well-developed, alert, and in no distress. A dermatoscope was used throughout the exam.
Findings revealed benign skin lesions and mild photoaging changes. No suspicious lesions for malignancy were noted.

Assessment and Plan

1. Benign Nevi (D22.5)

Multiple symmetrical, evenly pigmented moles were found on the upper back and abdomen.
Counseling:

• No treatment necessary

• Perform monthly self-skin checks for changes in size, color, or shape

• Use broad-spectrum SPF 30+ sunscreen daily

2. Seborrheic Keratoses (L82.1)

Pigmented, waxy, stuck-on papules were observed on the periumbilical area and thoracic spine.
These are benign skin growths that often appear with age.
Plan: Observation and reassurance; optional cosmetic removal if desired.

3. Lentigines (L81.4)

Light tan, reticulated macules consistent with sun-induced lentigines were distributed on the upper sternum and left upper back.
Plan:

• Sun protection: Apply SPF 30+ 15 minutes before sun exposure and reapply every 2 hours

• Consider chemical peels, retinoids, or laser for cosmetic improvement

• Encourage daily use of lip balm with SPF and sun-protective clothing

4. Cherry Angiomas (D18.01)

Bright red vascular papules noted on the mid-back and periumbilical skin.
Counseling:
These are benign vascular growths that can be treated with laser or electrodesiccation for cosmetic reasons.

5. Aging Skin (L90.8)

The patient expressed interest in improving fine lines and photoaging. She had previously obtained tretinoin 0.025% from an online dermatologist and planned to initiate treatment.

Plan:

• Continue tretinoin 0.025% at bedtime (pea-sized amount, 2–3 nights weekly, increasing as tolerated)

• Use Skinceuticals A.G.E. Eye Complex or SkinBetter AlphaRet Eye Cream for under-eye rejuvenation

• Continue broad-spectrum SPF 30+ sunscreen daily

Counseling:
Discussed the role of retinoids in stimulating collagen, improving skin tone, and reducing fine lines.
Reviewed potential dryness or irritation and how to minimize side effects by introducing use gradually.

6. Androgenetic Alopecia (L64.8)

The patient reported gradual hair thinning consistent with female pattern hair loss. She is currently family planning and opted to avoid oral medications such as finasteride or dutasteride.

Plan:

• Start topical minoxidil 5% foam daily to the scalp

• Consider Nutrafol supplements or PRP (Platelet-Rich Plasma) therapy in the future

• Monitor for improvement over the next 4–6 months

Counseling:
Discussed that androgenetic alopecia is genetically determined and slowly progressive. Early treatment can slow shedding and thicken existing hair.
Patient instructed to contact the office if hair loss worsens or if irritation develops from topical minoxidil.

Discussion

This case highlights the importance of annual dermatologic exams in women for early detection of benign and precancerous skin lesions while addressing aesthetic and hair health concerns.
At Village Dermatology, we combine medical dermatology and cosmetic expertise to manage conditions like photoaging, lentigines, and androgenetic alopecia comprehensively.

Patients in Katy and Houston, Texas can benefit from personalized skincare routines and advanced treatment options to maintain healthy, youthful skin and hair.

Conclusion

Comprehensive dermatologic care addresses both skin health and appearance. Through preventive screenings, sun protection, retinoid therapy, and targeted hair loss treatments, patients can achieve long-term skin and scalp wellness.
Residents in Katy and Houston, TX are encouraged to schedule annual full-body skin exams with Village Dermatology for expert evaluation and customized treatment.

Treatment of Ear Keloids in a 28-Year-Old Female: Intralesional Kenalog and 5-FU Therapy

by: Dr. Ashley Baldree

Case Overview

A 28-year-old female presented to Village Dermatology in Katy, Texas, with long-standing scars on both earlobes. The patient described the lesions as stable but cosmetically bothersome. She reported that the right earlobe keloid was larger than the left and had been present for several years.

The patient was a non-smoker, reported no unhealthy alcohol use, and had no systemic symptoms. She sought medical evaluation and treatment options for her bilateral ear keloids.

Clinical Examination

A focused examination was performed on both ears using dermatoscopy. The patient appeared well-developed and in no acute distress. On exam, there were firm, raised, telangiectatic nodules consistent with keloids on both anterior earlobes, with the right side more prominent.

Diagnosis

Keloid (L91.0) – A benign fibrous overgrowth of scar tissue extending beyond the original wound boundary, commonly caused by trauma, piercings, or previous surgery.

Management Plan

1. Intralesional Kenalog (ILK) with 5-Fluorouracil (5-FU)

After discussing multiple treatment options, including intralesional corticosteroid injections, surgical excision, topical imiquimod, and radiation therapy, the patient elected to begin treatment with intralesional Kenalog (triamcinolone acetonide) in combination with 5-fluorouracil (5-FU).

• Medication: Kenalog (20 mg/cc) mixed with 5-FU

• Total Volume Injected: 1.0 cc

• Injection Sites: Right and left anterior earlobes

• Administered by: AB

• Procedure Details: The lesions were injected using sterile technique after discussing risks such as atrophy, hypopigmentation, and recurrence.

This Kenalog + 5-FU combination therapy works synergistically to reduce inflammation, soften keloid tissue, and prevent regrowth—offering superior outcomes compared to steroid injections alone.

2. Silicone Sheet Therapy

The patient was advised to apply silicone gel sheets daily to maintain pressure and hydration over the treated area. Silicone sheeting can help flatten and fade keloids over time by regulating collagen production.

3. Education and Counseling

The patient received detailed counseling regarding:

• Nature of Keloids: Overactive scar formation that can cause thickened, itchy, or tender tissue.

• Treatment Expectations: Gradual improvement over multiple sessions; some residual firmness may persist.

• Future Considerations: Excision may be considered in the future, ideally in combination with ongoing ILK injections or postoperative radiation to reduce recurrence risk.

• Follow-Up: Scheduled in 6 weeks for reassessment and possible repeat injections.

Discussion

Keloids are particularly common in individuals with ear piercings or previous trauma to the lobes. They can be cosmetically distressing and refractory to treatment if not managed with a multimodal approach.

At Village Dermatology in Katy and Houston, Texas, our dermatologists tailor treatment plans using intralesional corticosteroids, 5-FU, silicone therapy, and advanced surgical techniques to minimize recurrence and optimize cosmetic outcomes.

Conclusion

This case demonstrates the effective use of intralesional Kenalog with 5-FU in managing earlobe keloids. Early intervention, consistent follow-up, and patient adherence to silicone therapy are key to achieving long-term results.

Residents of Katy and Houston, TX experiencing thickened or painful scars can schedule a consultation at Village Dermatology for expert evaluation and personalized treatment.