General Dermatology - Patients ask, Dr. Ringpfeil answers
Please feel free to use the blog below to share information about General Dermatology or to ask Dr. Franziska Ringpfeil a question that might be of interest to others.
Philadelphia and Mainline Center of Dermatology and Cosmetic Surgery
Impetigo
Impetigo is a superficial bacterial infection of the skin caused by Staphylococcus aureus, group A Streptococcus, or a mixture of both. Staphylococcus aureus is the most common causative agent. The infection can either be primary, developing within minor breaks in the skin or secondary to another inflammatory skin condition. Common inflammatory skin conditions that can become secondarily impetiginized are atopic dermatitis, contact dermatitis, and less commonly psoriasis.
Chronic scratching causes disruption in the skin surface which can invite bacteria to invade. There are two types of impetigo: blistering (bullous) and not blistering. The non-blistering variety is by far more common and is characterized by the appearance of honey-colored crusts.
It is often seen on the face but can occur on any part of the body. Bullous impetigo is characterized by blisters that occur on normal-appearing skin. Bullous impetigo is seen primarily in children. Both forms are contagious and can quickly spread through skin-to-skin contact.
Diagnosis
Impetigo can be diagnosed by its characteristic appearance but a bacterial culture can be performed to confirm the diagnosis if needed. In older individuals, a biopsy of bullous impetigo may be necessary to differentiate it from other blistering diseases.
Management
Topical treatment includes cleansing the affected area with an antibacterial cleanser several times daily. In children, a mild antibacterial cleanser such as Cetaphil antibacterial is preferred. In localized disease, this should be followed by application of petrolatum, zinc paste, over-the-counter or prescription-strength topical antibiotic several times daily.
If the infection is widespread an oral antibiotic may be necessary. Due to the contagious nature of the infection, affected individuals should be cautious to avoid skin-to-skin contact with others and should not share personal hygiene products such as razors and towels.
Coping
Impetigo is usually asymptomatic but can be occasionally itchy. It is not painful. Treatment will usually eradicate the rash within days.
Prevention
Primary infection can be prevented by avoidance of close contacts that have impetigo. Sharing towels, washcloths, clothing, bed linens, and razors should be avoided. Secondary impetigo can be prevented through the management of underlying skin conditions such as atopic dermatitis and psoriasis and the avoidance of scratching.
People who get recurrent episodes of impetigo may be carriers of staphylococcus aureus bacterium in their nostrils or in skin folds. Removing the bacteria from this location may prevent future outbreaks. This may be accomplished by applying mupirocin cream to the inner nares for a 7 to 10-day period.
I got Dr. Ringpfeil’s name from the Hailey-Hailey disease yahoo group. Is she experienced in the care of HHD patients?
I have special qualifications in genetic disorders of skin and connective tissue. I have performed extensive research in a number of rare genetic skin diseases including Hailey-Hailey disease, Darier disease, pseudoxanthoma elasticum and cutis laxa. Through my in-depth scientific knowledge, I had the privilege to meet and treat many affected individuals. My expertise in these disorders resulted in a number of peer-reviewed scientific publications as well as text book chapters. In addition, I am listed on the expert panel of F.I.R.S.T. (Foundation for ichthyosis and related disorders) and I am on the advisory board for NAPE (National Aassociation for Pseudoxanthoma Elasticum).
Do you accept insurances?
We accept most insurances.
However, we do not accept the following insurances:
1. AmeriChoice
2. Health Partners
3. HMO of Horizon BCBS of NJ
4. Keystone Mercy
5. Pennsylvania Access
Hi: I was recommended to you by my sister in law. She is very satified with your services.
I would love to have my children and myself to be a patient of yours but unfortunately, you dont accept the insurance I have. I wish you would reconsider and accepted Keystone Mercy and Health Partners this could help alot of children and adults with skin problems. Good dermatologists are hard to find. Also, if you can refer a dermatologist that accept KSM or HP it would be highly appreciated. Thanks PS While filling out the online regstration form the word MISSING is spelled wrong (MESSING)
We apologize that we are unable to accept all insurance plans and for the inconvenience this causes. However, we do accept out of pocket pay. My understanding is that Jefferson University Physicians at Thomas Jefferson University still participate with Keystone Mercy and the UPenn system still provides service for Health Partners.
Hi,
Wondering what the copay with Blue Cross Personal Choice is for your office? I want to have a few moles removed (back) and a full skin check. Thanks
The copay for a specialist office is typically printed on your insurance card. Depending on your contract with Independence Blue Cross Personal Choice, you may have an annual deductable and posibly a co-insurance on procedures. To learn about your contract with your insurance, you may want to contact their insurance customer service.
Please also be aware that some elective procedures are not necessary covered by the insurance.
I am a physician and potential new patient with two sebaceous cysts that I’d like excised.
One is located over my mid-thoracic spine, and the other is in the groin.
Both are benign, uninfected lesions measuring about 1 cm that have been stable for several years.
There is no rash, no adenopathy, and no other associated findings.
Your receptionist stated that she cannot schedule the procedure until you first evaluate the lesions during an office visit to determine how much time to allow for the procedures.
I prefer to avoid a second visit, and another 3-week delay to await a schedule opening, and would like to discuss the specifics with you by phone in order to try to expedite scheduling the procedure.
Thank you for your prompt attention.
-CF
As a physician you understand that scheduling efficiency is paramount to provide excellent patient service. We often perform small procedures during an office visit. Larger procedures must be timed appropriately. If time allotted is too short, other patients scheduled that day may have unnecessary waiting time in the office. If procedures times are too long, waiting time for an appointment increases.
Evaluation is usually necessary to make a diagnosis and assess the need for a procedure. Any surgeon will also discuss the specifics of a procedure such as expectations of outcome and scar formation or other side effects.
When we receive specific requests from referring physicians, we can often accommodate procedures during an initial encounter because of the detail provided and the confidence that benefits and side effects are understood.
Good Evening,
We have a 1 month old daughter with a collection of raised, yet flat skin in the middle of her forehead. We have had one appt at Dupont with a dermatologist who believed that this could be a collection of Milia or a Nevus Sebaceous. We are extremely concerned and becoming increasingly frustrated with the lack of willingness on the part of anyone to commit to a plan of action. Could you help??? We are just looking for an explanation to set some type of expectations. (6 months to get an appt to see anyone at CHOP!!!)
Regards,
Are you familiar with atrophoderma of Pierini & Pasini? My daughter was diagnosed with this and was told there is no treatment at all for this. Is this correct? Thank you.
Atrophoderma of Pierina and Pasini is a rare atrophy causing condition affecting connective tissue. While I am very familiar with it, I admit that there is no consistently effective treatment at this time.
Antibiotic treatment may work to prevent further lesions when diagnosed early. Certain lasers can help with color changes.
My 25yr old daughter has enlarged pores on her face or as she calls them”holes”. I have been searching on the Internet, i don’t know what can help her. She has seen several doctors, one even suggested Botox. But I am not sure that will be a good fix. What will help her? Isolaz, Frazel lasers, so much information I do not want to do the wrong thing. She has had microdermabrasions, uses retin-A, the highest salicilac acid… Please can you give me some guidelines on what we should do for her. Must be something out there to help her. Thank you for your time
I do understand your frustration which you share with many others. Large pores are extremely difficult to treat and this is the reason that you have not found the right answer. Unfortunately, there is no technology yet to eradicate large pores. During her many consultations your daughter has heard about non-ablative (Isolaz, Fraxel) and maybe about ablative (CO2 laser) devices to tighten the skin and thereby diminishing pore size. If in fact some of these pores are scars from past acne, CO2 laser is currently the best option to lessen these scars. Retin-A should be continued. Salicylic acid, glycolic acid and microdermabrasion are relatively weak compared to
CO2 laser, and Fraxel is better than the aforementioned but may not achieve the level of tightening that CO2 laser resurfacing with Deep FX technology can. However, miracles are not yet possible in enlarged pores.
I am a patient of yours. What is a good non-greasy sunscreen for face and/or body?
UVB protection is important for sunburn protection. It is measured in SPF.
For daily use without continuous sun exposure an SPF 15 is sufficient. When you are predominantly outdoors, an SPF of 30 or higher is recommended.
Sunscreen with a much higher SPF provides only insignificantly better protection against burns.
UVA protection is important to prevent skin cancer and accelerated aging. It also reduces tanning and the ability to develop freckles or sunspots. It is not yet measured. However, research has shown that Avobenzone combined with Mexoryl in some Anthelios products is the top technology to guard against UVA. Second on the market is Avobenzone stabilized by Helioplex technology in some Neutrogena sunscreens.
Zinc oxide is still an excellent all around sunscreen but has to be applied more frequently than every 2 hours when you are active outdoors.
Several choices are available for non-greasy sunscreens for face and body. I list them in descending order of overall efficacy against sunburn, skin cancer prevention and aging prevention.
Anthelios SX is a non-greasy facial moisturizer for daily use year-long. It has an SPF of 15 for burn protection and contains the powerful Mexoryl for UVA protection.
Anthelios 40 is non-greasy for face and body for outdoor use. It has an SPF of 40 for UVB (sunburn) protection and contains Avobenzone and Mexoryl. You can obtain it in our office and at the CVS pharmacy counter Neutrogena has a line called Ultra Sheer – Dry Touch. It is non-greasy and can be applied to face and body. It comes with a variable SPF for UVB protection and Helioplex technology for UVA protection. You can obtain it in nearly all drugstores.
Anthelios 60 for face and body contains an SPF of 60 for UVB protection and Avobenzone for UVA protection. You can obtain it at the CVS pharmacy counter.
Multiprotection moisturizer SPF50 is a non-greasy daily facial moisturizer for your-round use with an SPF of 50, Avobenzone for UVA protection and antioxidants for aging repair. You can obtain it in our office.
My child has a small (size of a pinky nail?) cafe au lait spot on her face and has asked about removal. We have been told not to but I really want her to have the choice. However, I would like her to know if it would cause scarring. Would you anticipate scarring?
Removal of cafe au lait macules is currently not recommended because of scar formation. The only technology currently believed to be safe to remove growths made from pigmented cells, such as cafe au lait macules or melanocytic nevi, is excision. With this technique, a scar is expected.
Hello – I have been diagnosed with Granuloma Annulare and I’ve had it for three 1/2 years. It is one raised, bumpy, reddish spot/lesion on my forehead. Topical steriod creams are not helping. My lesion is slowly increasing in size. From my research online, I believe what I have is Actinic Granuloma (could be a rare subset of granuloma annulare). Can you help treat this condition?
Granuloma annulare and actinic granuloma are benign chronic conditions that are very difficult to treat. Most of the time they regress spontaneously after a while but on occasion they can persist. When spots are in visible areas such as on the face, there is even more pressure to try alternative treatments if spontaneous resolution has not recurred. These alternatives should be carefully discussed with your dermatologist as you would want to be aware of all benefits and side effects.