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 was recommended Accuntane to treat my acne. I have an extremely difficult time swallowing pills. Is there another way to take Accutane that does not require swallowing a pill? For example, can I chew and swallow the pill/crush it up/etc?
There is no other safe and effective way.
I would like to know if you have any experience with Fox Fordyce disease and if so. What treatment do you offer?
Fox Fordyce disease is a benign obstruction of specific sweat ducts. It is challenging to treat because no known remedy exists to date. We use CO2 laser treatment when treatment is desired. It achieves about 50% reduction of the visible bumps.
Hello, wanted to know do you accept Health Partners Plan insurance?
you will find and extensive list of insurance companies we participate with at the bottom of this page: https://www.ringpfeildermatology.com/about-us.php. Our office accepts Health Partners of Minnesota. Unfortunately, we do not participate with the Health Partners Plan that covers Medicaid, Medicare, and CHIP in Philadelphia county and its surrounding counties.
Hello, I am losing lots of hair everyday for the past 3 months. Hair doesn’t hold moisture and when I add any product (oils, moisturizers) it soaks it up like a sponge but in a few minutes the products are released and running down my face. The hair also swells when proct is added giving the illusion that I have more hair than I really do. The hair is dull, brittle, costantly breaking, splitting and falling. I have just about lost all my hair on crown of head except for a small thin patch. My hair in the back is patchy and also thinning and falling. I have some itching in scalp at times. At one point, I was experiencing a burning sensation at the nape of my neck. I had blood work done about 4 months ago for Thyroid, CBC and lupus and results were negative. I had one steroid / antibiotic scalp injection in May. I chose not to get another shot because my hair was still falling tremendously and the doctor really had no clue as to why I was losing my hair. I want to desperately save what little hair I have left and I am hopeful to find an explanation for my hair loss and a solution to regrow my hair. I am African American and need answers and hoping for a solution. Please HELP ME!
You will probably need a scalp biopsy and perhaps additional work up pending biopsy results. I recommend that you speak to your dermatologist about additional studies.If your dermatologist does not perform scalp biopsies or does not work with laboratory that is equipped to prepare the biopsy specimen per the current state of the art protocol, you may schedule an appointment at our office.
I have calcinosis due to scleroderma. For 20yrs. It has been confined to my fingers, but now ( within the last year) is affecting the soles of my feet, making it very difficult to walk; etc..what type of treatment ( if any) would be helpful
Sometimes, certain types of blood pressure medications are helpful with calcinosis cutis, but treatment is somewhat limited. I recommend that you discuss treatment with your rheumatologist or the specialist who helps you manage your scleroderma.
I have what I think is a dermatofibroma on my shoulder\back. It’s dark brown on my light brown skin. It’s also hard to the touch. It gets itchy and has grown slightly over time. Do you treat for this?
Dermatofibroma is a reaction of our skin to an insect bite or an inflamed hair follicle. It can last many years, but it can resolve on its own. In the first 6 months, it is often itchy or can grow. Itch from a dermatofibroma can be treated with liquid nitrogen, short term steroid application or steroid injection. If a dermatofibroma continues to be symptomatic, it can be excised. Excision trades the dermatofiborma for a true permanent scar. The location of the excision determines what the scar might look like. On the back, a scar can spread as the back is under a lot of movement during the healing period. Please schedule an appointment with one of our dermatologists so that you can learn about your options.
I have recently been diagnosed with having
Discoid(Chronic) Lupus Erythematosis.
I am due for a treatment of 250 units of Botox for Spasmodic Torticollis on Tuesday May 15th. I am concerned this might cause a flare up of the Lupus, therefore I am considering canceling my appointment.
Dear doctor, do you specialize in treating people with this condition? If so I would like to schedule an appointment to have you evaluate me.
I am waiting for the outcome of blood work I had done Friday May 11th.
Please respond to me. Thank you kindly.
Many procedures go along with delayed wound healing in individuals with auto-immune connective tissue disease including lupus. Botulinum toxin injections help weaken an overactive muscle, such as torti collis, and do not start a wound healing response. I have treated many patients who have lupus with cosmetic doses of botulinum toxin, which are typically smaller than those used in torti collis, and I have not yet seen exacerbation of lupus. Our practice treats many patients with discoid and systemic lupus. We specialize in skin and not only in lupus. Our patients with systemic lupus also require the involvement of rheumatology, nephrology or cardiolgy.
I believe what I want requires an ocular-plastician, however I’ll ask anyway. Do you treat malar bags with laser resurfacing? I want to avoid surgery on the upper and lower eyelids if possible. I just want the pouches that have formed under the eyelid, on top of the cheek bone, to be smoothed out. I understand that to remove those pouches can be quite tricky. Any chance that you deal with malar pouches?
You are correct, what you describe requires a surgical blepharopalsty. This is usually performed by an oculopastic or facial plastic surgeon.
Hi, Is there a cure for melasma? Does hydroquinone cause cancer?
There is treatment for melasma as well as prevention but cure does not yet exist. Hydroquinone might be associated with cancer formation and therefore it is banned in Japan, the European Union and Australia. The FDA still approves prescription and over the counter sales in the US because it does not regard the data pertaining to its danger as sufficient. Safe alternative options for for treatment and prevention are arbutin, kojic acid and many others.
Hi are does some insurances cover acne facial and what all is done during theach acne facial?
Acne surgery is the physical treatment of painful cysts or painful acne lesions. It is a bit unpleasant but not intolerable and you will have visible marks for 4-7 days after. We submit acne surgery to insurance. Most insurances cover this service. Please note that removal of blackheads cannot be charged to insurance.