Dermatology by Board Certified Dermatologist Dr. Gary Rothfeld at (212) - 644 - 9494

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Dermatology

Chemical Peel   NYC Dermatology   Board Certified Dermatologist
Dr. Gary Rothfeld   Manhattan, New York

Chemical Peels (Glycolic, Beta and Alpha Hydroxy Acids)

Skin resurfacing through controlled chemical application

Chemical Peels have been a mainstay of Dermatology for decades. Only in recent years have lasers attempted to replace these trusted and effective methods of resurfacing your skin. Dr. Gary Rothfeld, a board Certified Dermatologist in NYC, Manhattan has experience with both methods which allows him to tailor a treatment regimen that precisely resolves skin surface irregularities and maintains smooth and luminous skin.

 
  • Pigmentation on the    face, arms, chest, hands.
  • Fine lines and wrinkles.
  • Acne
  • Clogged Pores
  • Rough skin
  • Dull skin
  • Discoloration
  • "How do Chemical Peels work?

    There are basically four major types of chemical peel solutions:

    • Alpha Hydroxy (Glycolic Acid - other fruit and sugar based acids)
    • Beta Hydroxy (Salicylic Acid)
    • Cosmelan
    • TCA (Trichloroacetic Acid)

    Chemical peels work by "ungluing" the top layer of damaged and discolored skin so it can peel away and reveal the fresh new skin beneath. By forcing the turnover of the cells, the old dull and damaged cells peel off much more quickly.

    Lighter superficial peels using Alpha Hydroxy acids such as Glycolic Acid can be very effective in a series of "no downtime" procedures. Your skin will have a light pink look and flaking or peeling may be unnoticeable. Superficial peels are ideal for improving pigmentation problems, fine wrinkles and sun damage. They can be used anywhere on the face and body.

    Special peels containing salicylic acid (beta hydroxy acid) are especially effective for those suffering from acne and oily skin. Salicylic acid has the ability to penetrate the pores as it is soluble in oil. Great for unclogging pores and improving acne. All peels can be adjusted to your skin type and condition, making them extremely customizable according to Dr. Rothfeld at NYC dermatology in Manhattan, New York

    Dr. Rothfeld is meticulous in the selection and application of your chemical peel.

    Cosmelan has become the treatment of choice for melasma and especially for sensitive skin types prone to hyperpigmentation from sun exposure, heat or blemishes. Cosmelan works by blocking the action of the process that causes hyperpigmentation.

    Cosmelan Advantages

    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. Effective in all kinds of melasma and chloasma.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. It can be used any time of the year.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. Compatible with all types of skin.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. It permits sun exposure without the risk of spots appearing.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. It is completely safe and does not include TCA or hydroquinone.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. There are minimal side effects (very little redness and flaking).
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. Beneficial for acne patients by regularizing sebaceous secretion.
    Right-click here to download pictures. To help protect your privacy, Outlook prevented automatic download of this picture from the Internet. Skin becomes bright and rejuvenated with lightening of spots and brown areas in just 10 days.

    Moderate medium-depth peels result in a temporary all-over peeling with deeper pink tone to your skin for several days to a week. These peels are more effective on moderate wrinkles, precancerous skin growths and more problematic pigmentation. Mostly used on the face, medium peels are typically TCA peels.

    Usually a TCA peel will produce enough peeling that you may wish to stay in for a few days. Discuss with Dr Gary Rothfeld at NYC Dermatologist  which peel level works into your lifestyle.

    What will a chemical peel feel like?

    Dr. Rothfeld, a board certified dermatologist at NYC Dermatology will first clean your skin of any oils. The chemical solution is either brushed on or applied with a pad. You may feel a slight stinging as the peel solution penetrates your skin.

    Once removed, your skin will be moisturized and you will be advised to wear a sunscreen. Your skin will feel tight and will look rosy for a few hours to several days. Your chemical peel will cause some flaking and peeling.

    Chemical peels may be augmented with V Beam Laser for resolving broken blood vessels and IPL Fotofacial for removing encapsulated or resistant pigmentation

    NYC Dermatology by Board Certified  Dermatologist Dr. Gary Rothfeld, a dermatologist in NYC. Offices in New York City. Dr. Rothfeld is a licensed  Dermatologist with a  New York City office in Manhattan  providing expert skin care, dermatology, and cosmetic dermatology services.

    Skin resurfacing through controlled chemical application

    Chemical Peels have been a mainstay of Dermatology for decades. Only in recent years have lasers attempted to replace these trusted and effective methods of resurfacing your skin. Dr. Gary Rothfeld, a board Certified Dermatologist in NYC, Manhattan has experience with both methods which allows him to tailor a treatment regimen that precisely resolves skin surface irregularities and maintains smooth and luminous skin.

    Dermatology

     

     
    • Do you peer in the mirror each morning and play little face games?
       
    • Do you find yourself raising your brows, smiling wider, stretching wrinkles, pursing your lips, or lifting the droopy corners that weren’t there last month?
       
    • Are you exhausted from trying every TV promise out there to stop your acne and wonder “why me?”

    Who doesn’t find something they don’t like about the face in the mirror each morning? It’s human nature to want to look your best. Even royalty and celebrities find themselves sitting across from Dr. Rothfeld seeking the fix for that blemish, that sag or that brown spot.

    Dr. Gary Rothfeld , board certified dermatologist at NYC Dematology, having worked alongside several of the world's renowned dermatologists, has shaped a uniquely innovative approach in treating any skin problem you may have. Through cosmetic and medical dermatology, laser surgery and powerful combination treatment options, Dr. Gary Rothfeld quickly and effectively helps you see dramatic improvements in the appearance and health of your skin.

    Dr. Gary Rothfeld is well known for his particular expertise is in designing anti-aging, anti-acne, and anti-rosacea treatments with exceptional success and optimum cosmetic elegance. These particular conditions need specialized non-harsh therapies in order to be successful with minimal side effects. Over-treatment or overly aggressive treatment can backfire. Dr.Rothfeld makes sure that doesn’t happen to his patients.

    Dr. Rothfelds' main concern is that you receive an individualized skin treatment program that eliminates your problems without unnecessary side effects. This is attained by having one-on-one care with good old fashioned personal attention from Dr.Gary Rothfeld himself."



    The most common medical condition that Dr. Rothfeld treats is Acne and Acne Scarring. His comprehensive approach may include photodynamic therapy which will help restore your natural, radiant skin without the signs of acne. This treatment, which can consist of a combination of  blue light and laser, significantly diminishes your need for oral medications.

    His cutting-edge research in technology  initiated his interest and involvement in Laser Dermatology. He has the latest proven lasers to treat acne and acne scarring, broken blood vessles, and rosacea , wrinkles ,  and loose skin. These laser procedures provide tremendous results with little downtime. All laser procedures are performed personally by Dr. Gary Rothfeld at NYC Dermatology.

    As a sought-after expert in the successful use of Botox, he has trained many physicians in how to implement his unique technique in treating their own patients. Many of his patients refer to him as "the Botox artist". Wrinkles in the forehead, between the brows, and around the eyes are painlessly reduced. The results are night & day differences with no downtime or pain.

    One particularly exciting use of Botox is the non-surgical Brow Lift. This procedure elevates the brow and can also elevate droopy eyelid skin. He has helped countless patients avoid unnecessary plastic surgery with this procedure.

    Another well-appreciated application of Botox Cosmetic is in the treatment for excessive underarm sweating, which has been recently FDA approved. The Botox Cosmetic is non-diluted and prepared in such a way as to be completely painless!

    Rejuvenating peels are excellent treatment for the prevention of aging skin and acne. Light Peels and ipl fotofacial offer quick treatments that help improve skin texture and minimize fine lines. Cosmelan treats patchy brown hyperpigmentation.

    Your Health is Vital; Start with your Skin. The American Academy of Dermatology recommends yearly skin checks to examine moles and remove unusual ones that are often are high risk.

    Botox 
    Non-surgical treatment that softens wrinkles that have developed over time.
    Recovery time is immediate
    Duration of Results: 3-4 months
     
    Skin Resurfacing 
    Removal of the outer layer of the skin using abrasion, chemicals or a laser, resulting in smoother and less wrinkled skin.
    Recovery time is one to three weeks.
    Duration of Results: Generally permanent.
     
    Collagen Implant
    (Different from Collagen and Soft Tissue Augmentation)
     
    An injection of natural protein which puffs up and raises skin tissue to smooth out and make less visible wrinkles and scars.
    Recovery time is about three hours.
    Duration of Results: Repeated as needed.
     
    Skin Lesions 
    Skin blemishes, skin cancers, birth marks, scars and other skin growths can be removed or made less visible using various techniques such as hidden incisions or laser treatment.
    Recovery time is approximately seven to ten days.
    Duration of Results: Generally permanent.
     
    Scar Revision 
    Surgery to make scars less visible using various techniques such as Z-plasty or W-plasty.
    Recovery time is variable
    Duration of Results: Generally permanent  
     
    Acne 
    Acne is the term for plugged pores (blackheads and whiteheads), pimples, and deeper lumps (cysts or nodules), that occur on the face, neck, chest, back, shoulders and even the upper arms. Most teenagers have some acne. However, adults in their 20's, even into their 40's or older, can get acne. Acne often clears up after several years even without treatment, but you need not wait to outgrow it. Untreated acne can leave scars, which can be treated by your dermatologist as well.While not a life threatening condition, acne can be upsetting and disfiguring. Acne can also lead to serious and permanent scarring.
     
    Mole Removal 
    The majority of moles and other blemishes are benign (not-cancer). They will never be a threat to the health of the person who has them. Spots or blemishes that warrant medical concern are those that do something out of the ordinary-those that act differently from other existing moles. This includes any spot that changes in size, shape or color, or one that bleeds, itches, becomes painful, or first appears when a person is past twenty.

    Occasionally, a mole may become a cancerous growth. Therefore, it's best to get medical advice from Dr. Gary Rothfeld, Board Certified Dermatologist at NYC Dermatology if you notice a mole that does not follow the normal pattern. Dr. Rothfeld may be able to assure you that the mole is harmless. To accomplish this, he may study a sample of it under a microscope for an accurate diagnosis.
    He would then remove the mole, or part of it, so that thin sections from the mole can be cut and examined under a microscope. This is a simple and harmless procedure. If the growth was only partially removed and it is found to be cancerous, then the entire lesion and an extra margin of safety will need to be removed.

    A person may wish to get rid of moles that are in areas of trauma, where clothing can irritate them, or simply because they are unattractive. The most common methods of removal include numbing the spot and then shaving the mole off, or for some moles, cutting out the entire lesion and stitching the area closed.
    Most procedures used to remove moles take only a short time and can be performed in our office. Sometimes a mole will recur after it is removed. If a removed mole does begin to reappear, the patient should return to see Dr.Gary  Rothfeld. 
     
    Rashes, Eczema & Psoriasis 
    Psoriasis is a persistent skin disease that got its name from the Greek word for "itch." The skin becomes inflamed, producing red, thickened areas with silvery scales, most often on the scalp, elbows, knees, and lower back. In some cases, psoriasis is so mild that people don't know they have it. At the opposite extreme, severe psoriasis may cover large areas of the body. Our  Board Certified Dermatologist Dr. Gary Rothfeld can help even the most severe cases.

    Psoriasis cannot be passed from one person to another, though it is more likely to occur in people whose family members have it. In the United States two out of every hundred people have psoriasis (four to five million people). Approximately 150,000 new cases occur each year.

    The cause is unknown. However, recent discoveries point to an abnormality in the functioning of key white cells in the blood stream triggering inflammation in the skin. Because of the inflammation, the skin sheds too rapidly, every three to four days.
    People often notice new spots 10 to 14 days after the skin is cut, scratched, rubbed, or severely sunburned. Psoriasis can also be activated by infections, such as strep throat, and by certain medicines. Flare-ups sometimes occur in the winter, as a result of dry skin and lack of sunlight.
     
    Freckles & Age Spots 
    These flat, brown areas are called lentigines. They have nothing to do with the liver - they are caused by the sun and usually appear on the face, hands, back and feet. They are generally harmless. They may look like melanoma and therefore may require evaluation. Commercial "fade" creams will not make lentigines disappear, but effective prescription medications and surgical resurfacing treatments are available.  Dr. Rothfeld at NYC Dermatology board certified dermatologist treats many cases every week.  
     
    Seborrheic Keratoses 
    These brown or black raised spots or wart-like growths look like they were stuck on the skin surface. They are not cancerous and are very common in older people. If annoying, they can be easily removed by a dermatologist. 
     
    Cherry Angiomas 
    These are harmless, small, bright red raised bumps created by dilated blood vessels. They occur in more than 85 percent of middle-aged and elderly people, usually on the trunk. Electrocautery, laser surgery, or other surgical therapies remove these spots.  
     
    Wart Removal 
    There are several different lasers used for the treatment of warts. Laser therapy is used to destroy some types of warts. Lasers are more expensive and require the injection of a local anesthesia to numb the area treated.

    Another treatment is to inject each wart with an anti-cancer drug called bleomycin. The injections may be painful and can have other side effects. Immunotherapy, which attempts to use the body's own rejection system is another method of treatment. Several methods of immunotherapy are being used. With one method the patient is made allergic to a certain chemical which is then painted on the wart. A mild allergic reaction occurs around the treated warts, and may result in the disappearance of the warts.

    Warts may also be injected with interferon, a treatment to boost the immune reaction and cause rejection of the wart. There are some wart remedies available without a prescription. However, you might mistake another kind of skin growth for a wart, and end up treating something more serious as though it were a wart. If you have any questions about either the diagnosis or the best way to treat a wart, you should seek your dermatologist's advice.
     
    Birthmarks 
    Many babies have what are called "birthmarks" when they're born. In some cases they may appear within the first few weeks of life. They can be brown, tan, blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. They can be flat or raised, pink, red or bluish discolorations.

    The exact causes of birthmarks are unknown. Most vascular birthmarks are not inherited, nor are they caused by anything that happens to the mother during pregnancy.

    There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified. The most common types of vascular birthmarks are macular stains, hemangiomas, and port wine stains. There are also many rare types of vascular birthmarks. 
     
    Rosacea  
    Rosacea, (rose-AY-sha) is a common skin disease that causes redness and swelling on the face. Often referred to as "adult acne," rosacea may begin as a tendency to flush or blush easily, and progress to persistent redness in the center of the face that may gradually involve the cheeks, forehead, chin, and nose. It also may involve the ears, chest and back. As the disease progresses, small blood vessels and tiny pimples begin to appear on and around the reddened area; however, unlike acne, there are no blackheads.

    When it first develops, rosacea may come and go on its own. When the skin doesn't return to its normal color and when other symptoms, such as pimples and enlarged blood vessels, become visible, it's best to seek advice from a dermatologist. The condition rarely reverses itself and may last for years. It can become worse without treatment.

    Many people with rosacea are unfamiliar with it and do not recognize it in its early stages. Identifying the disease is the first step to controlling it. Self-diagnosis and treatment are not recommended, as some over-the-counter skin applications may make the problem worse.

    Dr. Gary Rothfeld, board certified dermatologist in Manhattan, New York often recommends a combination of treatments tailored to the individual patient. Together, these treatments can stop the progress of rosacea and sometimes reverse it. Gels and creams may be prescribed by a dermatologist. A slight improvement can be seen in the first three to four weeks of use. Greater improvement is usually noticed in two months. Oral antibiotics tend to produce faster results than topical medications.

    Cortisone creams may reduce the redness of rosacea. However, they should not be used for longer than two weeks and strong preparations should be avoided. It is best to use these creams only under the direction of Dr. Rothfeld.
    The persistent redness may be treated with a small electric needle or by laser surgery to close off the dilated blood vessels. Cosmetics may offer an alternative to the more specific treatment. Green tinted makeup may mask the redness.
     
    Sclerotherapy of Leg Veins 
    The injection method, a procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions, called sclerosing solution, is injected with a very fine needle directly into the blood vessel. This procedure has been used for spider veins since the 1930's and before that for larger veins. The solution irritates the lining of the vessel, causing it to swell and stick together and the blood to thicken. Over a period of weeks, the vessel turns into scar tissue that is absorbed, eventually becoming barely noticeable or invisible.

    A single blood vessel may have to be injected more than once, some weeks or months apart, depending on its size. In any one treatment session a number of vessels can be injected.

    The solutions available are slightly different and the choice of which solution to use depends on several factors including the size of the vessel to be injected. our dermatologist will choose a solution that is best for your particular case.

    Occasionally larger varicose veins are underneath or associated with the spider veins. In such cases, some physicians believe these vessels should be treated before the spider veins. This can be done by sclerotherapy, intravascular laser, or radiofrequency, followed by compression. After several treatments, most patients can expect a 50 percent to 90 percent improvement. However, fading is gradual, usually over months. Disappearance of spider veins is usually achieved, but similar veins may appear in the same general area. 
     
    Scar & Keloid Treatments 
    Several techniques can minimize a scar. Most of these are done routinely in the dermatologist's office. Only severe scars, such as burns over a large part of the body may require general anesthesia or a hospital stay.

    Surgical scar revision can improve the way scars look by changing the size, depth, or color. However, no scar can ever be completely erased; and no magic technique will return the scar to its normal uninjured appearance. Surgical scar revision typically results in a less obvious mark. Because each scar is different, each will require a different approach.

    The most important step in the treatment of scars is careful consultation between the patient and the dermatologic surgeon Dr. Gary Rothfeld - finding out what bothers a patient most about a scar and deciding upon the best treatment.
    Based on the ability of the skin to stretch with time, surgical scar revision is a method of removing a scar and rejoining the normal skin in a less obvious fashion. The surgical removal of scars is best suited for wide or long scars, those in prominent places, or scars that have healed in a particular pattern or shape. Wide scars can often be cut out and closed, resulting in a thinner scar, and long scars can be made shorter. A technique of irregular or staggered incision lines, rather than straight-line incisions, to form a broken-line scar that is much more difficult to recognize may be used. Sometimes, a scar's direction can be changed so that all or part of the scar that crosses a natural wrinkle or line falls into the wrinkle, making it less noticeable. This method can also be used to move scars into more favorable locations, such as into a hairline, or a natural junction (for instance, where the nose meets the cheek). Best results are obtained when the scar is removed and wound edges are brought together without tension or movement (pull) on the skin.
     
    Skin Cancer
    (MOHS Micrographic Surgery) 
    MOHS micrographic surgery is a highly specialized procedure for the removal of skin cancer. It was originally developed in the 1930’s by Dr. Frederic MOHS and has been refined since, gaining substantial application only in the past decade. Although this procedure is very precise, its major drawback is that it is very time consuming and requires specialized training, personnel and equipment. Consequently, only a few major medical centers can provide this type of therapy.

    There are three surgical steps to MOHS micrographic surgery:

    • The surgical removal of the visual portion of skin cancer with excision or scraping. 
    • The surgical removal of a thin layer of tissue at the bed of the cancer. 
    • The examination of the excised tissue layer under the microscope.

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    Our goal at NYC Dermatology is to be the Tiffanys of Skin
    Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. My goal is, quite simply, to provide the type of dermatologic care which I  would seek for my own family. This is a very important point, since physicans often use the phrase "Doctor's Doctor" to refer to those individuals who typically are selected by physicians themselves for personal care. I am confident that my practice fully meets that definition. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment plan that I believe will give them the best results. We also support our patients with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts and Quality Matters. Please allow me to solve your skin problems.  After all, at NYC Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.”
     
    Best Regards,
     
    Dr. Rothfeld
     
     
     
     
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    Dermatologists are physicians specializing in the diagnosis and treatment of diseases and tumors of the skin and its appendages. There are medical and surgical sides to the specialty. Dermatologic surgeons perform skin cancer surgery (including Mohs' micrographic surgery), laser surgery, photodynamic therapy (PDT) and cosmetic procedures using botulinum toxin (Botox), soft tissue fillers, sclerotherapy and liposuction. Dermatopathologists interpret tissue under the microscope (histopathology). Pediatric dermatologists specialize in the diagnoses and treatment of skin disease in children. Immunodermatologists specialize in the diagnosis and management of skin diseases driven by an altered immune system including blistering (bullous) diseases such as pemphigus. In addition, there is a wide range of congenital syndromes managed by dermatologists. Physician assistants and nurse practitioners with specialized training or extensive experience in dermatology also work in this specialty.

    Subspecialties

    The skin is the largest organ of the body and the most visible. Although many skin diseases are isolated, some are manifestations of internal disease. Hence, a dermatologist is schooled in aspects of surgery, rheumatology (many rheumatic diseases can feature skin symptoms and signs), immunology, neurology (the "neurocuteaneous syndromes", such as neurofibromatosis and tuberous sclerosis), infectious diseases and endocrinology. The study of genetics is also becoming increasingly important.

     Venereology and phlebology

    Venereology, the subspecialty that diagnoses and treats sexually transmitted diseases, and phlebology, the specialty that deals with problems of the superficial venous system, are both part of a dermatologist's expertise.

     Cosmetic dermatology

    Cosmetic dermatology has long been an important part of the field, and dermatologists have been the primary innovators in this area. In the 1900's dermatologists employed dermabrasion to improve acne scarring and fat microtransfer was used to fill in cutaneous defects. Dermatologists specializing in cosmetic dermatology typically use non-invasive procedures to reverse the signs of aging. Botox has been used since it was FDA approved for the treatment of wrinkles. It is used to minimize wrinkles such as frown lines and crow's feet. Fillers are used to "fill in" lines on the face and to minimize the appearance wrinkles. Brand names of fillers include Restylane, Perlane, Juvederm, Radiesse and Cosmoplast among many others. Dermatologists are also the pioneers of energy based treatments for the skin and these include lasers, intense pulsed light, radiofrequency, infrared light and photodynamic treatments.

     Dermatologic surgery

    Dermatologic surgery (dermasurgery) is performed by all dermatologists. Surgery is an integral part of dermatology residency training; thus all dermatologists are well trained in cutaneous surgery. In North America specialized training through a 1 year dermatologic surgery fellowship is available upon completion of the dermatology residency, and usually focuses on training in Mohs' micrographic surgery. Most dermatologic surgeons who have a special interest in this field apply for fellowship status with the American College of Mohs Micrographic Surgery and Cutaneouis Oncology; or the American Society for Dermatologic Surgery.

    Techniques available to a dermatologic surgeon include lasers, traditional scalpel surgery, electrosurgery, cryosurgery, photodynamic therapy, liposuction, blepharoplasty (cosmetic eyelid surgery), minimally-invasive facelift surgery (e.g., the S-lift), and a variety of topical and injectable agents such as dermal fillers including fat transfer and hyaluronic acid. Some specially trained dermatologic surgeons perform Mohs' surgery, which can be an effective method for the treatment of recurrent, indistinct, or difficult skin cancers.

     Diagnosis

    Any mole that is irregular in color or shape should be examined by a dermatologist to determine if it is a malignant melanoma, the most serious and life-threatening form of skin cancer. Following a visual examination and a dermatoscopic exam (an invaluable new instrument that illuminates a mole without reflected light), a dermatologist may biopsy a suspicious mole. If it is malignant, it will be excised in the dermatologist's office.

    Medical history

    The first step of any contact with a physician is the medical history. In order to classify a cutaneous eruption, the dermatologist will ask detailed questions on the duration and temporal pattern of skin problems, itching or pain, relation to food intake, sunlight, over-the-counter creams and clothing. When an underlying disease is suspected, an additional detailed history of related symptoms will be elicited (such as arthritis in a suspected case of lupus erythematosus).

     Physical examination

    Dermatology has the obvious benefit of having easy access to tissue for diagnosis. Physical examination is generally done under bright light and preferably involves the whole body. At this stage, the doctor may apply Wood's light, which may aid in diagnosing types of mycosis or demonstrate the extent of pigmented lesions, or use a dermatoscope which enlarges a suspected lesion and visualizes it without reflected light. The dermatoscope is helpful in differentiating a benign naevus from melanoma or a seborrheic keratosis from a mole. A morphological classification of dermatological lesions is important in the diagnosis of dermatological disorders. Dermatologic diagnosis is often dependent upon pattern recognition of lesions and symptoms.

     Microbiology

    Culture or Gram staining of suspected infectious lesions may identify a pathogen and help direct therapy.

     Biopsy

    If the diagnosis is uncertain or a cutaneous malignancy is suspected, the dermatologic surgeon may perform a small punch biopsy (using a local anesthetic) for examination under the microscope by the dermatologist who is a trained dermatopathologist.

    Therapy

    The skin is obviously accessible to topical local therapy. Antibiotic creams can help eliminate infections, while inflammatory skin diseases (such as eczema and psoriasis) often respond to steroid creams or topical anthralin. Dermatologists are innovators of new immune enhancing treatments, like topical imiquimod for superficial cancers and injection immunotherapy for warts as discussed below.

     Topical medications

    Topical medications treat many dermatological diseases, but dermatologists also use oral medications. Antibiotics and immune suppressants or immune enhancing agents (injection immunotherapy or topical imiquimod) for dermatological diseases or tumors. Isotretinoin ("Accutane") is used for severe cystic acne vulgaris and often produces a lifetime remission of this disfiguring disease. Isotretinoin prescribing in the U.S. is now controlled by a cumbersome FDA governmental website called iPLEDGE. Various new modalities of treatment are in the foray; with the advent of laser technology things are quite promising.

     Photomedicine

    Photomedicine involves the use of ultraviolet light, often in combination with oral or topical agents, to treat skin disease (e.g., psoriasis or mycosis fungoides).

    Surgical therapies

    Surgical intervention by a dermatologic surgeon may be necessary, for example, to treat varicose veins or skin cancer. Varicose veins can be treated with sclerotherapy (injecting an agent that obliterates the vein) or the long-pulsed Nd:YAG laser. Skin cancers can be managed with excision (including Mohs cancer surgery), cryosurgery, x-ray, or with the recent topical immune enhancing agent imiquimod. (See above section on "Dermatologic Surgery" for more details.)

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    NYC Dermatology - Manhattan Dermatology - Skin Institute of New York - Skin Cancer Doctor- NYC Cosmetic Dermatology-  Cosmetic Dermatological Surgery - New York City - Board Certified Dermatologist

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     Dr. Gary Rothfeld
    NYC Dermatology - Board Certified Dermatologist - New York, NY
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