The physicians of the Advanced Cosmetic Laser & Surgery Center are regular contributors to the Joliet Herald News with their Q & A column. All of the following questions were submitted by readers and were published in the Joliet Herald News. This contribution to the Joliet Herald News, as well as our regular medical column, are a part of our ongoing commitment to community education.

Theoretically, sound waves (ultrasound) could be utilized to create heat within the skin in order to stimulate skin tightening and new collagen growth, both of which would help diminish wrinkles.  Different varieties of electromagnetic waves such as visible and infrared light have been successfully and reliably used for many years to rejuvenate skin via laser technology.  Radio waves are another form of electromagnetic waves but have not been reliably shown to improve the appearance of skin.

I was diagnosed with skin cancer – squamous cell – and had it removed. Do I need to be concerned that it will return to the same place? What about other places? How often should I have check ups?


Squamous cell carcinoma of the skin is a common cancer. Chronic sun exposure and fair skin are the main risk factors. Although not as serious as melanoma, squamous cell does carry the possibility of spreading to other organs (metastasis).

As with any cancer, there is always a possibility that squamous cell of the skin may recur after treatment. Assuming that the cancer has not metastasized already, the likelihood that any one lesion of squamous cell carcinoma will either recur or metastasize is based mainly on two things - the type/location of the cancer, as well as the method of removal.

There is a greater rate of recurrence and metastasis for lesions that are greater than 2cm in size, penetrate deeply, are located on the lip or ear, and have an aggressive pattern when viewed under the microscope. Lesions developing in old scars and in patients on immune suppressive medications also carry a poorer prognosis.

In terms of methods of treatment, surgical excision is the most effective treatment for lesions that have not yet spread. Mohs micrographic surgery is a form of surgical excision that has the greatest cure rate and is frequently used for high risk lesions. Other methods of treatment such as electrodessication and curretage (scraping and burning), topical chemotherapy creams, and radiation can be employed for low risk lesions or patients who cannot undergo surgery, but they do carry higher recurrence rates.

Patients with one squamous cell should be monitored closely as they have a greater risk for developing a 2nd lesion. How frequently you are followed depends on several factors such as how high risk the initial lesion was and how many other risk factors are present. This may range anywhere from once a month to once a year.

I have a wart on my finger, with a growth coming out of the middle of it, kind of a stem. I have had it treated before with silver nitrate and it seams to be shrinking…. They want to hit it with silver nitrate once more. Is this going to be successful? Or should I have it surgically removed?

Warts can be treated with different modalities including silver nitrate sticks, salicylic acid preparations, liquid nitrogen cryotherapy, and lasers. One of the most important points to be stressed when treating warts is that NUMEROUS treatment sessions are usually needed. Treatment sessions are usually spaced between one to four weeks apart. It should also be clear that most warts will resolve spontaneously with time. Surgical excsision, CO2 laser ablation, or curretage and cautery of troublesome, resistant single warts can be attempted, but there is always risk of scarring and recurrence.

Over the counter skin care products such as cleansers and moisturizers are fine for routine skin care.  Many products make claims about their ability to reduce wrinkles and fine lines, however a moisturizer really can only moisturize the skin, and does not remove wrinkles.  Moisturizers can reduce the appearance of wrinkles primarily through increased skin hydration, but it cannot actually remove the wrinkles.  Cleansers are meant for washing the skin, they as well cannot wash away acne or wrinkles.  More expensive skin care products are not necessarily better than cheaper products.  A quality moisturizer or cleanser can be obtained from skin care lines at the drug store such as Dove, Aveeno, Cetaphil or Neutrogena.  The most expensive parts of any skin care product are the fragrance, the bottle and the packaging, and none of these things contribute to the product’s efficacy.  Ideally a moisturizer should also contain sunscreen to provide the added benefit of sun protection, which is really the most important factor in preventing wrinkles.  There are creams that are available that do actually remove wrinkles or acne, however they are only available by prescription through your dermatologist.

I have a mole which recently started to weep a clear fluid. Is this normal? Should I be concerned?

Most people think of a mole as a dark brown spot, but moles have a wide range of appearances. They are usually brown in color but can be skin colored and various shapes and sizes. Moles or growths that warrant medical concern are those that do something out of the ordinary. This includes any spot that changes in color, size, shape, bleeds, oozes, itches or becomes painful. If any of the above changes are noticed, you should see a dermatologist immediately for further evaluation and treatment. It is recommended to have an annual skin examination by a dermatologist, especially for adults with significant past sun exposure or a family history of skin cancer.

I have age spots, can anything be done for them?

Without question, the safest and most effective means of removing benign pigmented skin lesions, also referred to as "age spots", is via laser technology. The most effective laser for treating such lesions is
either a KTP laser or a Q switched Nd:YAG laser. IPL technology and "photofacials" are less effective and have a greater risk of complication. Although lasers can provide the best results possible, scarring is still a possibility particularly if the wrong technology is utilized or your physician is not an expert in dermatology and dermatologic laser surgery.

When we are outdoors our skin comes into contact with many damaging elements, but the most damaging can be ultraviolet rays from the sun.  This is particularly harmful in those individuals with light skin, blond or red hair and blue eyes.  Pale skin does not have its own defense to protect from the sun’s harmful rays, so it needs extra help.  Sunscreen is important but it is also necessary to look for a sunscreen that is broad spectrum to filter out both UVA and UVB rays with an SPF of 30 or higher.  Sunscreen is frequently not enough, so hats with a wide brim and sun protective clothing are also helpful.  Don’t forget sunglasses to protect the eyes.  Even on cloudy days the sun can still get through so it’s important to protect yourself everyday.

• Regardless of ethnicity or skin color, if a person is going to be exposed to the sun for more than 20 minutes any time of the year, the American Academy of Dermatology recommends using a broad-spectrum sunscreen, protecting against ultraviolet A (UVA) and ultraviolet B (UVB) rays, with a sun-protective factor (SPF) of 15 or above. This includes cloudy days, since 80% of the sun’s rays penetrate the clouds.
  
  
• Uneven product application is a common problem. Sunscreen must be applied to all exposed areas, including the lips, ears, nose, neck and scalp. Apply enough sunscreen so that it forms a fine film when initially applied. Optimally, sunscreen must be applied about 20 to 30 minutes prior to sun exposure, and must be re-applied after swimming and vigorous activity even if it is considered water-resistant. Otherwise, re-application should occur every two hours at a minimum. Alcohol-based lotions, sprays, or gels provide easier application to hairy skin. Insect repellents reduce the SPF of sunscreen, so a higher SPF may be needed.
  
  
• Exposure to midday sun (10am to 4pm), should be reduced or avoided. Tanning beds must be avoided. I recommend self-tanning lotions as an alternative, but these do not significantly protect against the sun, so sunscreen must be used as well. Infants 6 months old and younger should be kept out of direct sunlight. Protective clothing, such as long sleeves and pants, wide-brimmed hats and sunglasses should be worn when possible. Special sun-protective clothing has been developed, labeled with an Ultraviolet Protective Factor (UPF), and can be a simple way to protect against the sun’s rays. Clothing labeled UPF 15 or above provides the most protection.

To learn more about skin cancer avoidance, contact your dermatologist or the American Cancer Society (ACS) at www.cancer.org or the American Academy of Dermatology at www.aad.org.

A friend has itchy, bleeding spots all over her skin and says her doctor has said it was nerves. Could this be possible?

We all develop different methods for coping with stress - some that are beneficial and some that are destructive. It is true that in some cases, chronic high levels of stress in some people can play a role in the development of bleeding sores of the skin. This is referred to as neurotic or psychogenic excoriation and is similar to biting ones nails or tugging ones hair. It is compulsive rubbing and digging of the skin. This may be initiated by a relatively minor skin condition such as dry skin, or itch, but then progresses to something much bigger.

The result is sores that develop only within arms reach (typically sparing the middle of the back) and seem to never heal, or, when they do, seem to be replaced by new ones. They often worsen in times of greater stress and more commonly develop in those with depression or anxiety disorders. Management of the stressors with the help of a mental health professional as well as local wound care helps improve this condition.

Any itching, bleeding skin lesion should be evaluated by a dermatologist. A biopsy may be performed to rule out another cause.

Will just any birth control pill help my skin or do I have to use the one advertised to help clear up skin?

Acne vulgaris is a skin condition affecting approximately 17 million adolescents and adults. For women, oral contraceptives have become a treatment option because they decrease the amount of hormones that are responsible for acne. Most oral contraceptives help improve acne and there is scientific proof of this. However, there are very few scientific studies comparing different oral contraceptives as to which product is more effective for acne and the results of these studies have been variable. Certain manufacturers have performed extra scientific studies to actually show proof that they are effective against acne. And because of this, they are able to make this claim in their package insert. One example of a birth control tablet that has been FDA approved for acne treatment is Ortho-TriCyclen.

I have done a lot of research on liposculpturing. It seems to be a very safe procedure. Since it is such a safe and effective procedure, why do people resort to other weight loss alternatives such as gastric bypass surgery?

Liposculpture is an exceptionally safe procedure only when it is done under local anesthesia using the “tumescent technique”. Tumescent technique liposculture is a revolutionary alternative to traditional liposuction surgery and was developed by, and is generally used by, dermatologists. It allows the procedure to be performed under local anesthesia, avoiding the risks and costs of general anesthesia. It also almost elimates bleeding. Liposculpture is a body shaping procedure, not a mechanism for weight loss. Removing large volumes of fat or “megaliposuction”, is not the samae as tumescent tehnique liposculpture and has far more risks. Liposuction or liposculpture should not be used as a weight loss technique.

I have problems with cold sores. Is there any really effective treatment for them?

Cold sores are caused by a virus, Herpes Simplex Virus 1 and are known as Herpes Labialis. It is estimated that 60 to 80% of us are infected with this virus. And, about a third of us suffer from recurrent Herpes Labialis. Lesions usually occur on or near the lips usually due to sunlight (UV rays), emotional streass, trauma, fatigue or fever/cold. Itching and burning at the site prior to the lesions erupting is common, followed by redness, elevation, blistering, crusting and finally healing - all in about one week. There is treatment, but no cure. Penciclovir cream applied every two hours for four days makes lesions clear more quickly, by 18 hours. This effect is seen whether treatment is begun early or after lesions appear. Valcyclovir pills taken twice a day for one day before lesions appear, when itching or burning is firts noted, cuts length of outbreak by 16% (1 day), lesions heal 20% (1.5 days) and pain ends 25% (0.7 days) sooner. If outbreaks occurs more than six times a year, suppressive treatment with acyclovir, famiciclovir or valacyclovir can theoretically help prevent outbreaks, though this has only been shown for genital, not labial herpes. In one such study, 44% had zero outbreaks while being treated with acyclovir. By using sunscreen on the lips daily, especially while on vacation, many outbreaks can be avoided altogether - quite possibly the simplest and most effective ‘treatment’.

My son has plantar warts on his foot. They have been removed several times, but keep coming back. Someone told me about a new treatment using a compound in human milk called Hamlet. It is experimental now. When will it be available?

The news media can be very misleading in its reporting of a single promising study of a new treatment for any given medical problem. A single study of 40 patients with warts was interesting and hopeful in the use of a molecular complex, Hamlet, from human milk. However, the road to commercial production, FDA approval and everyday use is very complex, long and expensive. In other words, don’t count on it appearing anytime soon. Maybe in the time course of a few years. The good news is that awe already have a multitude of safe and effective treatments for warts inccluding desstructive methods such as laser, cryosurgery and salicylic acid preparations. We may also use immunotherapy to help your own immune system eliminate the warts. Since the warts are caused by a virus that is living on your skin, they may eventually come back and no treatment is guaranteed to keep warts from returning. If you are persistent in treating warts with multiple, repeated, in office or at home therapies, then they can be eliminated and eventually will go away for good. We have successfully treated patients who had dozens of warts, had been treated by many physicians and had tried many different treatments.

I have a hard time curing “athlete’s foot”. Should I see a dermatologist for treatment?

People with persistent or recurrent “athlete’s foot” should see their dermatologist. It is true that “athlete’s foot” represents one of the most common forms of funal infections of the skin. Howeveer, it is not solely caused by fungus called Dermatophytes. Years and bacteria can complicate the infection as well as a hypersensitivity or reaction may be seen. These may be some reasons why “athlete’s foot” may be persistent or recurrent. It is helpful to control excessive foot sweating by using absosrbent socks, non-occlusive shoes and foot powder. Your dermatologist can prescribe a variety of topical and oral medications.

A friend had a procedure called microermabrasion and her face looks great. What’s this procedure.

Microdermabrasion is the latest technique in minimally invasive facial skin rejuvenation. Through the use of a diamond tipped wand, the outermost layer of your skin is gently polished away. These dead cells and other debris are simultaneously vacuumed off of your skin surface. The end result is a rejuvenating effect, leaving your skin with a reduction in fine wrinkles, a balanced skin color and a youthful glow. Microdermabrasion is a quick, easy, painless procedure with no down-time.

I have heard that use of sunscreen will prevent skin cancer. But, now I’m hearing that even if you don’t burn yu can still damage the skin and get skin cancer. Is this true?

Any sun exposure that causes darkening of the skin, red or brown, represents damage to the skin from the sun. Skin cancers most commonly develop as a result of cumulative sun damage over the years. The more severe the degree of damage and the more frequent the episodes of the damage, the greater the risk for skin cancer. The goal of sun protection is not to shoot for the unattainable (zero sun exposure), but rather to modify your habits to reduce sun damage whenever possible
without sacrificing your lifestyle. This includes using sunscreens and protective clothing. It is impoirtant to remember that some skin cancers may develop on areas without any history of sun exposure, such as the sole of the foot or inside the mouth. Any changing or non-healing spots should be evaluated by your doctor, regardless of history of sun exposure.

I recently read about a study that showed acne cream (Tazorac) can undo some of the damage from the sun to my skin. The study said it could reduce fine wrinkling and mottled pigmentation. Is this true?

Sun damaged skin is characterized by fine and coarse wrinkling, roughness, brown spots, discoloration, redness and prominent blood vessels such as spider veins. Topical retinoids have been shown to improve to some extent, the appearance of sun damaged skin. This is specifically seen by some improvement in fine wrinkling and by some evening out of the blotchy discoloration with prolonged use. Tazorac is but one example of a topical retinoid. Different kinds of lasers can target specific problem areas such as removing sunspots or irregular discolorataion and improving on redness and prominent vessels on the face. Lasers also stimulate dermal collagen growth resulting in improvement of wrinkles, skin texture, skin tone and pore size. Whatever the means a person chooses to decrease the signs of sun damage, the most important point that cannot be overemphasized is the regular use of sun protection. It should involve a broad-spectrum sun block that protects against UVA and UVB. And, it should be re-applied with prolonged sun exposure.

I have eczema and a friend says a new drug called Protopic really works. Is this true?

Yes, it is! Protopic and Elidel are two new topical, (applied to the skin), prescription medications that are known as calcineurin inhibitors. They are a welcome addition to our topical treatments for eczema. They are not corticosteroids and may be used at any location on the body and for extended periods of time without concern for thinning of the skin or the systemic effects of steroids. They may also be used in children as young as two years old. Some patients may experience temporary warmth, burning or irritation from these drugs, however, this is usually not much of a problem. Many patients use these drugs alternating with topical steroids or in specific situations or areas of the body. They are not a cure for eczema and routine maintenance and special care of your skin is still necessary to prevent flare-ups.

I've heard about some new substance which will protect my skin better, but is not yet approved. Is there something on the horizon that will protect against all kinds of sun rays?

Yes, there is a sunscreen ingredient, Mexoryl, which has been used in the rest of the world for years, that seems almost ideal. It is not approved by the FDA in this country, and therefore only available through Canadian pharmacies.

It offers much better protection for UVA light than currently available sunscreens which mostly offer UVB light protection. UVA light is present in sunlight, and used commercially in tanning beds. UVA is longer wavelength than UVB, and it penetrates deeper into the skin than UVB. Although UVA produces much less "sunburn" or redness, it is thought to produce more of the damage that we see as "aging." UVA may also contribute to the much higher and increasing rates of melanoma since it is not blocked well by presently available sunscreens.

Blocking UVA is important, and a broad spectrum UVB/UVB sunscreen is definitely the best product to use. Hopefully, this new sunscreen ingredient will be available in this country soon.

My 8 year old daughter recently developed multiple itchy bumps on her legs after a picnic which I thought were just bug bites. But now they have progressed to large itchy welts and blisters. Can these still be bug bites or are they something more serious?

Mosquitoes, black flies, gnats and horseflies are all biting insects which regularly cause problems for children and adults alike. For most, they simply result in a slight stinging sensation and a small itchy red bump. Some people develop sensitization to bug bites, which is similar to an allergic reaction to the bite. In these individuals, bites may result in very uncomfortable large welts, nodules, and even blisters. Treatment is usually conservative, with the use of cool compresses, Benadryl, and occasionally topical cortisone creams. The best treatment, however, is preventative with the regular use of insect repellent, avoidance of perfumes, and protective clothing in neutral colors.