CONDITIONS AND treatments
We treat a vast range of skin and hair conditions at the Camberwell Dermatology Centre. Call us and find out how we can support you and the full range of treatments that we provide.
Unequal or asymmetric moles should be treated as suspicious, whether shape, colour or border, and checked by your dermatologist.
What to look out for:
– Irregular, notched or scalloped borders.
– More than one colour or shade, including irregular shades of browns, blues, reds, whites and blacks.
– A mole that has a diameter larger than 6mm, or is enlarging.
– Any mole that is changing in appearance, whether colour, size or shape.- Oozing, crusting, ulceration or bleeding.
Moles (also called naevi) are usually harmless collections of pigmented cells called melanocytes in the skin. It can be important for patients (especially those at higher risk) to become familiar with the moles on their skin so as to be able to detect changes .
Melanomas also derived from melanocytes, but in the case of melanoma, these cells are cancerous. They have potential for spreading both locally, and systemically (metastases). Melanomas can occur in adults of all ages, but thankfully, these days, tumours are detected early and the cure rate is high.
Dermoscopy, or epiluminescence microscopy, is a non-invasive device that is used to assess moles and other skin lesions. It allows the in vivo evaluation of colours and microstructures of the epidermis, the dermoepidermal junction and the papillary dermis that is not visible to the naked eye.
While it is possible to diminish or remove moles by laser, it is generally not advisable, as this method does not allow for histological analysis. Although the pigment is removed from the mole, the cells remain, and have the potential to cause malignancy down the track. More importantly, it removes the signs that assist in monitoring changing moles for the purpose of melanoma surveillance.
Elliptical excision or shave removal are two commonly used techniques to surgically remove moles. Both methods allow for histological analysis of the naevi to ensure that the melanocytes are benign.
Moles and melanoma
In general, moles, or naevi, are harmless pigmented cells in the skin called melanocytes. It is important that you are familiar with the look of your skin, so that you pick up any changes that might suggest a developing skin cancer. This is particularly important for early detection of melanoma. Melanomas are also derived from melanocytes, but in the case of melanoma, these cells are cancerous. They can spread both locally and systemically (metastases). Melanomas occur in adults of all ages, but with early diagnosis the cure rate is high. When melanoma is diagnosed at an early stage, surgical excision of the tumor is generally the only treatment required.
If your doctor has referred you to one of our dermatologists for an assessment of a suspicious mole, please discuss this with our staff when making an appointment. If you are unsure about your moles, and would like a mole screening, we can assess and discuss appropriate management, and any follow up. A referral is not required.
Seborrhoeic keratoses are very common skin lesions that generally increase in frequency with age. They often have a rough, slightly oily (seborrhoeic) feel. Seborrhoeic keratoses can vary from a light brown colour, to a very dark brown. If irritated, they can appear red. Seborrhoeic keratoses are harmless and do not need to be removed. If you find them unsightly, you can discuss with your dermatologist how we may be able to reduce them for you. Treatment methods include cryotherapy (freezing), curettage (surgical scraping) or laser (pigment or resurfacing).
Skin tags are raised fleshy outgrowths of skin that are harmless. They tend to increase in number with age, but can be associated with areas of chaffing and also tend to increase in people who have diabetes or are overweight. Treatment methods include minor surgery, liquid nitrogen, fine wire diathermy or CO2 laser.
Café au lait macules
Common, coffee-coloured flat macules on the skin. Many children have one or two of these lesions, which is within normal limits, but if your child has six or more, an association with other genetic syndromes should be assessed and followed up with a dermatologist. Treatment method is Q-switched pigment lasers, which is effective in fading or completely removing café au lait macules.
Scars can develop following injuries, acne and surgical wounds. Keloid are firm to hard nodular scars, which enlarge beyond the size of the original injury or wound. They are often red, raised and unsightly. Individuals with a genetic tendency towards their formation, most often develop keloids on the shoulder, chest and upper back. Hypertrophic scars refer to surgical scars that have thickened and are often quite red. Over time, these scars tend to soften, fade and become less red.
There are a range of approaches for the treatment of keloid scarring, including:
- vitamin E and other natural oils
- silicone gel or patches
- corticosteroid injections (may need to be repeated)
- pulsed dye laser or intense pulsed light systems
- surgical excision (may risk forming larger keloid)
- superficial X-ray treatment soon after surgery.
This is a new treatment and is particularly good for treating pre-cancerous lesions and specific skin cancers, and offers an excellent alternative to surgery. A topical photosensitising combined with a specialised light, results in a ‘photodynamic reaction’ between the medicine, light source and oxygen molecules. It destroys the cancer cells instead of the healthy cells. For skin cancers, a second treatment within a fortnight is generally required to maximise effectiveness of the treatment. Your doctor will assess whether your skin lesion is suitable for photodynamic therapy treatment and outline the process with you.
Eczema or dermatitis
Eczema is the inflammation of the top layer of the skin, called the epidermis, and is also known as dermatitis. Genetic factors can make you susceptible to eczema, but also allergies and non-allergic factors, known as irritants.
Allergies to contact agents (nickel, fragrances, preservatives), certain foods, allergens and even forms of ultraviolet light are important to diagnose, but these are not common. Non-allergic factors (irritants) are, however, very common and need to be addressed in all patients with dermatitis. Common irritants to the skin include skin dryness, soaps/detergents, friction/scratching, solvents and industrial fluids.
We tailor your eczema management plan according to the cause(s), severity and personal preferences. Treatment approaches include topical agents (moisturisers, topical anti-inflammatory creams), antibiotics, phototherapy and systemic treatments (tablets), with the latter considered in more severe cases.
Psoriasis is distinguished by a thickened plaque of red skin, with silvery scaling on the surface. It is commonly found on the elbow, knees, lower back and scalp. However, it can occur anywhere on the skin surface, including the nails, face and genitalia. Psoriasis can be associated with joint inflammation (arthritis), which may not be recognised early in the course of the skin condition. Traditional medical treatments for psoriasis include topical therapies, phototherapy, and systemic therapies (tablets). Phototherapy is particularly useful where psoriasis doesn’t respond to topical therapies. New developments in psoriasis therapy are emerging all the time and include the use of ‘biologic’ agents.
Phototherapy, also called light therapy, means treatment with a special kind of light. The most common type of phototherapy is narrowband ultraviolet B (UVB) light, which is the best part of natural sunlight for treating a range of skin conditions, including atopic dermatitis, psoriasis, pruritus, vitiligo, and lichen planus. Phototherapy treatment is covered by Medicare Australia for Australian residents.
Excessive and uncontrollable sweating (hyperhidrosis) can interfere with daily life. It can also be a major source of embarrassment. Although excessive sweating can occur anywhere, the more common sites of excessive sweating include the armpits, palms, soles and the face. It can cause skin irritation, including secondary dermatitis and infection.
In many cases of hyperhidrosis, the cause is unknown. However, certain medical conditions (e.g. thyroid disease, diabetes, medications) can cause excessive sweating. It is important for your doctor to assess for these conditions with appropriate investigations if necessary.
Topical treatment methods include:
Chemist products – aluminium hexachloride is an effective anti-perspirant, in an unfragranced form.
Prescription products – compounded agents containing an agent helps to block the nerve endings.
Botulinum toxin injections – injecting the affected areas can considerably reduce sweating and is very effective.
Iontopheresisis gentle electrotherapy – a low electrical current that interferes with the sweat glands just below the outer layer of the skin. It is particularly effective with excessive sweating of the hands or feet). Please discuss this option with your dermatologist.
Medication – its use is limited by the adverse effects related to blocking the sympathetic nerves that drives sweating, such as blurred vision, dry mouth, constipation, dizziness and palpitations. A low dose of oral medication can complement topical and other therapies with excellent results.
Surgery – endoscopic thoracic sympathectomy is the most common form of surgery, where a specific nerve ending is cut, clamped or cauterised via endoscope. Although effective, there is a risk of compensatory sweating at other non-treated sites. Other more serious side effects are uncommon.
Hair loss is a distressing condition for sufferers, with many different causes. Fortunately, most cases of hair loss resolve, either with appropriate treatment, or spontaneously.
Alopecia Areara (AA)
Alopecia Areara is an autoimmune disease. Blood cells called lymphocytes (which normally fight infection) swarm around hair follicles, causing the hair shafts to fall out prematurely. Fortunately, they do not destroy or scar the hair follicle, and in many cases, hair growth returns. Treatment methods include topical therapies, intralesional injections, topical immunotherapies and oral medications.
Telogen Effluvium (T.E.)
Telogen effluvium is a scalp disorder characterised by the thinning or shedding of hair resulting from premature entry of hair in the telogen phase. Common triggers include illness (surgery, infection, fever, trauma), childbirth, severe emotional stress, weight loss (significant), new medications. The trigger can precede the period of hair shedding by two to three months and the increased rate of hair shedding can sometimes last quite a few months. The term ‘Chronic telogen effluvium’ is used in some cases, indicating increased hair shedding for an extended period, without obvious triggers. Neither acute nor chronic forms of telogen effluvium cause baldness. In the majority of cases, hair growth completely returns to its previous state.
Both men and women can suffer from gradual thinning of their scalp hair with age. The speed at which the thinning occurs varies. In males, a genetically determined sensitivity to the effect of a hormone calleddihydrotestosterone (DHT) is thought to be the cause of premature thinning in affected individuals. DHT is an enzyme that can cause the gradual miniaturisation of hair follicules. Researchers have shown that 5-alpha reductase is an enzyme that regulates production of DHT. The effect of this enzyme can be blocked by oral medications.
Melasma is a common skin concern. It causes brown to gray-brown patches, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.
One of the most common treatments for melasma is sun protection. This means wearing sunscreen every day and reapplying it regularly. Dermatologists also recommend wearing a wide-brimmed hat when you are outside, as sunscreen alone may not give you the protection needed. Our intense pulsed light (IPL) therapy and Q-switched duolite laser are both suitable to treat pigmentation.
Rosacea and facial capillaries
The most common signs of rosacea include redness, facial capillaries, red lumps and pustules (inflammatory rosacea), and rhinophyma (late stage rosaceacan can lead to lumpiness of the nose). The inflammation of rosacea can usually be managed with topical and/or oral antibiotics, but if ineffective alternative medications can be used. Diffuse redness of the face and fine capillaries can be treated with vascular lasers and/or intense pulsed light (IPL) machines. The appearance of rhinophyma can be effectively improved with the use of resurfacing lasers.
Tips for preventing or managing rosacea
- Minimise exposure to hot or spicy foods and alcohol.
- Minimise hot showers/baths and warm rooms.
- Avoid or minimise any other individual factors that make you flush.
- Minimise thick oil-based face creams and make-up, opt water-based make-up.
- Wear hats and apply oil free sunscreen to protect your face from the sun.
Vascular birth marks
Sherry angiomas, or Campbell de Morgan spots, are common, harmless spots. Often bright red in colour, but can also be shades of blue to black, these spots can develop anywhere on the body, most commonly on the torso. The cause is unknown, but we do know that there can be a genetic basis to them, and they tend to be more common with increasing age.
Spider qngiomas (or telangiectasia) are similar to angiomas, but have a larger central vessel at the skin surface, with ‘spider’ capillaries feeding off to the sides of the central vessel. They are also harmless, but larger numbers can be seen with pregnancy and liver disease.
Treatment methods include electrocautery and laser or intense pulse light treatment.
Acne, commonly known as pimples or spots, is most often seen on the face, chest and back. You can develop acne when the pores on your skin become clogged up with oil, dead skin and bacteria. If you’re aged between 15 and 24, more than 8 out of 10 of you will be affected by acne. The good news is, it can be effectively treated by a dermatologist.
Camberwell Dermatology Centre uses a number of treatments for acne, tailored to your skin type and its severity. It is important to treat acne early on as it can have a significant impact on an individual’s self-esteem, in particular in the teenage years.
Acne can cause scarring, which can improve with time, but for some acne scars can be lasting. It is important to find effective treatments for acne early on, reducing the risk of scarring.
Hypertrophic acne scarring and cysts can improve with intralesional injections, while atrophic scars are amenable to minor surgical techniques to improve the textural defect. Resurfacing lasers can improve the overall texture created by acne scarring.
Newer fractional technology has reduced the downtime of laser acne scarring treatments. Your dermatologist will offer you advice on the best treatment for any scarring.
The sooner a skin cancer is identified and treated, the better your chance of avoiding surgery or, in the case of a serious melanoma or other skin cancer, potential disfigurement or even death.
It is a good idea to talk to your doctor and dermatologist about your level of risk and for advice on early detection. It is important that you are familiar with the look of your skin, so you pick up any changes that might suggest a skin cancer. Look for:
- any crusty, non-healing sores
- small lumps that are red, pale or pearly in colour
- new spots, freckles or any moles changing in colour, thickness or shape over a period of weeks to months (especially those dark brown to black, red or blue-black in colour).
Australia has one of the highest rates of skin cancer in the world, with the majority of skin cancers caused by exposure to UV radiation in sunlight.
Source: Cancer Council Australia