Dr. McKinley-Grant is Board Certified in both Internal Medicine and Dermatology and, therefore, diagnoses and treats many of the underlying conditions that can cause dermatological manifestations.

Systemic Disease

Problems with the skin may occur as a symptom of a systemic disease or as a side-effect of some drugs, medications, and other treatments. Diseases that frequently present in the skin include diabetes, Crohn's disease, lupus erythematosus, Lyme disease, pruritis, sarcoidosis, scleroderma, thyroid disease, vasculitis and some cancers. Treatment is geared toward both the skin symptoms and the underlying condition. Dr. McKinley-Grant specializes in Cutaneous T-cell Lymphoma and Sarcoidosis diagnosis and treatment.

Skin Cancer Diagnosis, Treatment and Surgery

Skin cancer is a disease in which malignant (cancer) cells form in the tissues of the skin.

The skin is the body’s largest organ. It protects against heat, sunlight, injury, and infection. Skin also helps control body temperature and stores water, fat, and vitamin D. The skin has several layers, but the two main layers are the epidermis (upper or outer layer) and the dermis (lower or inner layer). Skin cancer begins in the epidermis, which is made up of 3 kinds of cells:

• Squamous cells: Thin, flat cells that form the top layer of the epidermis.
• Basal cells: Round cells under the squamous cells.
• Melanocytes: Found in the lower part of the epidermis, these cells make melanin, the pigment that gives skin its natural color. When skin is exposed to the sun, melanocytes make more pigment, causing the skin to darken.

Acne and Acne Scars

Seventeen million Americans currently have acne, making it the most common skin disease in the country. Acne is not life-threatening, but it can cause physical disfigurement (scarring) and emotional distress. Treatment can include topical and oral medications, chemical peels, or surgical procedures varies depending on the type and severity of lesions, skin type, and the patient's age and lifestyle, but on average results are visible in six to eight weeks. Options include:

• Oral Medication
• Topical medication
• Chemical Peels
• Cyst removal
• Microdermabrasion
• Punch excisional surgery for deep "ice-pick" pitted scarring
• Dermabrasion and microdermabrasion

Bacterial and Fungal Infections

Bacterial infection of the skin, also called cellulitis, occurs when a break in the skin allows bacteria that normally live on the surface to enter the body, causing inflammation, redness, pain, warmth, fever/chills, fatigue, and muscle aches. The break itself may arise from trauma, an animal or insect bite or sting, after some surgeries, with the use of certain drugs, or from skin wounds due to medical conditions such as diabetes or peripheral vascular disease. Left untreated, bacterial infection can lead to tissue death (gangrene), sepsis, generalized infection, shock, meningitis (if cellulitis is on the face) and lymphangitis (inflammation of the lymph vessels). Treatment may require hospitalization, oral antibiotics, or analgesics to control pain.

Fungal infections of the skin are caused by microscopic organisms that live on the hair, nails (onychomycosis), mouth (angular cheilitis/oral thrush), and outer skin layers. They are quite common. The fungal infection cutaneous candidiasis, for example, which occurs in warm, moist crevices of the body, is the usual cause of diaper rash and vaginal yeast infections. Fungal infections are most likely to occur in people with diabetes, who are obese, or who take antibiotics or oral contraceptives. They are treatable (sometimes with difficulty) but often recur. Treatments include topical and systemic antifungal medications.

Bullous Diseases

Bullous diseases are characterized by large (>1 cm) blisters, or bullae, on the skin. These fluid-filled lesions are usually caused by inflammation in or under the surface layer of skin, called the epidermis. Other symptoms may include rashes, itchy or red patches, sores, pain or swelling. Treatment varies depending on the specific condition but is generally geared toward relieving symptoms, reducing inflammation with the use of topical steroids or immunosuppressants, and preventing or treating any infections that occur.

Eczema and Atopic Dermatitis

Eczema is the name of a group of skin conditions involving red rashes that become irritated, moist, oozing or bumpy when scratched. Atopic dermatitis, also called infantile eczema, is a common form that affects about 10 percent of children.

Atopic dermatitis is inherited and so cannot be prevented, but it is treatable. Since rashes are caused by exposure to allergens in the environment (as opposed to contact dermatitis, which worsens when the skin physically touches an irritant), known triggers such as heat, wool, hot water, certain foods or skin products, soaps and detergents should be avoided or removed from the home. A child or teen who has been diagnosed with Atopic dermatitis may be given steroid creams, antihistamines to relieve itching, and/or antibiotics to treat any infections caused by scratching. Trying not to scratch the area is also important and can reduce the likelihood of developing skin scales or lichenification (thickening).

Keratoses

Actinic keratoses appear on the sun exposed areas of the skin and are the result of chronic sun exposure. They are considered pre-cancerous and should be treated as early as possible. Seborrheic keratoses, often called age spots, can appear anywhere on the body. These growths are always benign, but can mimic pre-cancers and skin cancer. Evaluation and treatment of these growths is essential in the early detection of skin cancer.

Surgical Removal of Moles

Moles that cannot be treated with laser or pulsed light treatments may be frozen or numbed and surgically excised.

Preventative Dermatological Care A few precautions on your part and regular examinations by a dermatologist can prevent you from getting some skin conditions and ensure that any developing problems are detected and treated early. Good skin care includes wearing sunscreen of at least SPF 15 when outdoors, keeping the skin clean, avoiding tanning booths and other sources of intense ultraviolet light, not scratching or picking at rashes or pimples, and seeing a medical professional for evaluation if you suspect a problem, or about once a year for older patients.

Psoriasis

Psoriasis cannot be cured but it can be treated successfully, sometimes for months or years at a time and occasionally even permanently. Treatment depends on the type, severity and location of psoriasis; the patient's age, medical history and lifestyle; and the effect the disease has on the patient's general mental health. The most common treatments are topical medications, phototherapy, photochemotherapy (PUVA), and oral or injectable medication (for severe symptoms).

Rashes, Allergies, and Irritations

There are a variety of skin irritations including common problems such as poison ivy or reactions to various environmental irritants. A dermatologist is trained to identify these ailments and provide medical relief.

Ringworm Ringworm is a contagious skin infection that manifests as itchy, scaly, ring-shaped red patches on the skin, bald spots in the hair or beard, or discolored, thickened nails. It is caused by a fungus, not a worm. The most commonly infected areas of skin are on the scalp, body, groin or foot. When we refer to "jock itch" and "athlete's foot," we're really talking about ringworm. Use of antifungal powders or creams, keeping the skin dry, and washing sheets and nightclothes daily are often sufficient to treat the infection. If rashes persist for more than four weeks, however, or if symptoms are severe or a bacterial infection occurs, the patient should see a physician for more aggressive treatment. Antifungal pills, prescription antifungal medications, or antibiotics may be prescribed.

Rosacea

Rosacea is a chronic skin disease affecting about 14 million Americans. It causes redness and breakouts on the face and also occasionally the chest and neck. It can also affect the eyes, causing redness and irritation. Although it can affect anyone, rosacea typically appears in light-skinned, light-haired adults aged 30-50. Symptoms range from pimples, red lines and visible blood vessels to dry, burning, or sensitive skin and a tendency to flush easily. Although it is not yet known what causes rosacea and the condition is not curable, it can be treated in many ways, including topical and oral medications, intense pulsed light therapy and laser surgery. Early detection and intervention are essential to achieve the most effective results and reduce the severity of symptoms if rosacea has already progressed.

Sarcoidosis

Sarcoidosis is a disease that causes tissues in the body to swell and produce lumps. Therapy is aimed at improving symptoms and organ function, usually with a medication that suppresses the immune system. Steroid drugs such as prednisone have been shown to reduce swelling and shrink granulomas over a course of several months to one or two years.

Seborrheic Dermatitis

Seborrhea is a chronic skin condition of unknown origin, which causes scaling, oiliness, itching and redness of the skin, most commonly on the scalp (and known as dandruff), face, ears, and chest. Although symptoms imply that skin is dry, seborrhea actually involves excess oil production in the glands. For this reason, self-treatment methods such as moisturizing often prove ineffective and may even worsen the condition. Professionally recommended treatments such as cortisone or sulfur containing creams and lotions and reduction of yeast on the skin surface, in combination with frequent gentle washing and avoidance of harsh or perfumed soaps, can alleviate symptoms.

Warts

Warts are normally non-contagious skin growths caused by viruses. Different warts respond to different treatments. Some go away on their own. Salicylic acid products (in the form of drops, gels, pads, and bandages) can help self-treatment of many warts by dissolving the keratin protein that makes up the wart and the dead skin above it. Other warts can be removed via liquid nitrogen freezing or electrical stimulation. Surgery may be recommended for painful or large warts that do not respond to these treatments.