Questions and Answers

  1. What causes warts?Warts are cause by an infection of the skin by a virus. The viruses that cause warts are in the family of viruses called Human Papilloma Virus (HPV). There are a hundred or more different types of HPV. Some of these cause severe diseases such as cervical cancer. The virus strains that cause warts on the hands, feet and body are not the ones that cause cancer. A few of the strains that cause genital warts are the ones that cause cancer. Warts live in the upper portion of the epidermis, which is far above where the immune surveillance cells travel. This protects the warts from being killed by our immune systems. Our destructive techniques eliminate warts by killing the cells that they have infected and hopefully exposing the viruses to our immune surveillance cells.


  1. What is the difference between “lose dose” antibiotics like Oracea and “regular dose” Doxycycline? How long do I have to be on them?Doxycycline and Minocycline are antibiotics with anti-inflammatory properties. The reason I use them in diseases such as rosacea and acne is for the anti-inflammatory properties, not to kill bacteria, since the process in these diseases is primarily inflammation. Oracea is a new “low dose” preparation of doxycycline. It has enough medicine to decrease inflammation, but never reaches the blood level that kills bacteria – thus no yeast infections, and more importantly, it does not breed resistant bacteria. The current emphasis is on developing medications that do not breed bacterial resistance.


  1. What is the benefit of “mineral” based sunscreen? Is it worth the extra money?There are two types of sunscreen – Chemical and Physical blockers. Physical blockers are made of Zinc Oxide and Titanium Dioxide. These are small fragments of minerals that reflect the light, thus are protective against both UVA and UVB radiation. Chemical blockers are composed of several different chemicals that each absorbs various wavelengths of UVA, UVB or a combination of both. They soak into the skin, thus need to be applied 20-30 minutes prior to turning the light energy into vibrational or “kinetic” energy, then release that energy as heat energy into the skin.

    As the molecules absorb light energy and vibrate, they gradually degrade or fall apart – therefore they need to be applied frequently. Occasionally, there are concerns raised about the safety of chemical sunblockers. Recently the Environmental Working Group (EWG) raised concerns about oxybenzone causing cancer after long term use. Although this may represent a theoretical concern for infants that have never been exposed to sunscreens before, for adults, we have been exposed to oxybenzone for years, thus “the horse is out of the barn” and the benefits of skin cancer prevention greatly outweighs any minimal risk of using oxybenzone. If you have a small child, you may want to consider using only physical blockers to avoid long term exposure to chemical sunscreens.


  1. What happens if I don’t treat a pre-cancer? Will it turn into a Melanoma?The most common lesion that dermatologists call “pre-cancers” are called actinic keratoses. These can occasionally turn into Squamous Cell Cancers. Usually, they are treated by freezing them with liquid nitrogen. Atypical moles (dysplastic nevi) can turn into Melanoma (a dangerous form of skin cancer). It is important to screen your skin monthly to make sure that your moles are not changing and that you do not have any funny looking moles that may be at risk for Melanoma. If you have any doubt, call to schedule a Full Skin Examination with Dr. Darst.


  1. How can I have a cancer in an area that was never exposed to the sun?Most skin cancers are caused by sun exposure. These can be Basal Cell, Squamous Cell or Melanoma skin cancers. Occasionally, people develop skin cancers in their armpits, on the soles of the feet, or on the buttocks. These are usually caused by gene mutations, which may be inherited from your parents. This is why it is important to check your entire body every month, including the soles of the feet, to make sure that a skin cancer does not go undetected.


  1. I’ve had two cysts on my back. How can I prevent more from forming?Some people develop many cysts. These are not usually caused by poor hygiene, but may be due to chronic trauma. Often when we excise (cut out) cysts, a new cyst will develop near the site of the original cyst. If the cyst does not bother you and does not become inflamed frequently, then nothing needs to be done. If you have surgery on the cyst, just be aware that you may develop a new cyst nearby.


  1. What is the difference between exfoliating my skin and “dermaplaning?”Dermaplaning is a treatment that uses a sharp blade to remove the superficial layer of the skin (stratum corneum). Along with this, it shaves facial hair off at the skin layer. Exfoliation is removing the top layer of the skin (the stratum corneum) which makes the skin look much brighter and youthful. This can be achieved by exfoliating scrubs that you can apply with your hands or scrub pads, or by medical procedures such as microdermabrasion or a superficial chemical peel.


  1. What can I do to prevent unwanted hair growth on my chin, upper lip, etc.?There are many causes of unwanted hair growth but only two or three solutions. The causes may be a hormonal imbalance such as in Polycystic Ovarian Syndrome (PCOS) or after menopause. Some people are predisposed by heredity to have darker hair. Some medications cause excessive hair growth. In any case, you should be examined by a physician and evaluated for hormonal imbalance. A prescription drug, Vaniqa, will slow the growth of unwanted hair with a twice daily application. I tell patients this is like not watering your yard in August – the grass will still grow, just not as fast.

    Shaving, plucking or waxing are effective treatments – they will not cause your hair to grow in thicker and darker. Just think about your underarms – you would have hair three inches thick by now if shaving made hair thicker. Laser hair reduction is a pricy, but effective way of decreasing hair growth. 80% of hair is in a growing phase at any time. Laser will kill off 25% of growing hairs per treatment. Thus, 5-6 treatments will eliminate most of the hair in an area. For just a few hairs, I recommend my patients consider electrolysis, where a thin metal wire is inserted down the hair follicle and a battery current applied which generates a chemical reaction that kills the unwanted hair.


  1. What can I do to prevent ingrown hairs that I get from shaving?Ingrown hairs are often caused by hair that is cut too short. Inside the hair follicle, the hair is protected from the body’s immune system – it ignores the hair. However, if the hair is cut off below the surface of the skin and the hair curves and pierces the hair follicle and sticks into the skin, the body acts like it is a foreign body, like a splinter, and causes irritation and inflammation. The best way to prevent this is by using a shaving lotion recommended by your razor’s manufacturer, shaving with the grain of the hair (not against the grain) and using a multi-blade razor (Venus for women, for men – Gillette Fusion or other multiple blade razors).


  1. How do I prevent spider veins on my legs?Spider veins are usually caused by pregnancy or trauma (e.g. getting hit with a softball). During pregnancy, your blood volume increases by 20%. That means there is a lot more blood to go through the same sized vessels, so they expand (dilate). In the leg veins, there are little “check valves” every few inches that keep the blood moving up and not running back down the vein. When the veins dilate, it puts a lot of pressure on the valves and sometimes they fail. Once they fail, they never work properly again. This causes increased pressure on the veins below the valve and those valves can fail too. This can put too much strain on the veins under the skin, which can cause spider veins.


  1. How can I get rid of stretch marks?Stretch marks usually come from gaining a lot of weight quickly, such as in pregnancy or weightlifters. Sometimes they occur in young thin people for no apparent reason. Usually they are pink for several weeks or months then turn to flesh colored. While they are fresh and pink, vascular lasers can help with the redness. When they are flesh toned, resurfacing lasers may help remodel the stretch marks. However, no treatment will return the area to its original smoothness.


  1. Why is a biopsy not enough treatment for a skin cancer? It looks like it’s all gone.A biopsy is performed to diagnose what the lesion is. The purpose of the biopsy is not to clear the lesion. Sometimes, most of the cancer is removed with the biopsy; however you can never be sure it is gone. The biopsy will tell what kind of cancer it is, or if it is a premalignant mole. This will tell us whether it can be left alone or if it is abnormal, how far around the lesion we need to cut to make sure it is gone.


  1. Is there a vaccine for poison ivy?No, there is no vaccine for poison ivy. Avoidance is the best prevention against the rash we get from coming in contact with poison ivy or its cousins, poison oak and poison sumac. We are not born with an allergy to poison ivy. After exposure to the oil on the leaf of the poison ivy plant, our body develops an allergy to the oil. This may take as little as one exposure or many exposures. Because it can take several exposures, you will meet people who brag that they can roll around in it and it does not affect them.

    (FYI- not the best idea!) Some homeopathic physicians and naturopaths claim that you can become desensitized to poison ivy by taking small doses of it by mouth. These preparations are not standardized and could cause a severe allergic reaction. I do not recommend them. Besides, the poison ivy oil would travel all the way through your GI system. All the way. Think about that before you put it in your mouth. Since the oil causes the rash, as soon as you wash the skin with soap and water, the oil is gone. After washing, you cannot “spread” the rash by scratching. The rash breaks out first in areas that had a large amount of the oil deposited, or where it stayed on the skin for a longer time before being washed off, it takes longer for it to break out in areas with little dose or a short contact time. Thus, it may appear that the rash is “spreading.” The liquid in the blisters is your own serum (like the plasma portion of blood) – it is not infectious or allergenic.

    After working in the yard, or being out in the woods, make sure that you wash all your tools and clothing that was exposed to the poison ivy – the oil can remain on them for a long time and cause a rash next time you handle them. Also, be aware that your dog may come in contact with the plant and carry the oil on his coat and expose you to it.


  1. How can I have an allergy to a medication I’ve taken for years?It takes from one month to several years to develop an allergy to a medication, if you will develop one at all. Many medications cause increased sun sensitivity. Be sure to wear sunscreen when on these medication. It should be marked on your pill bottle. Common ones in Dermatology are oral antibiotics and retinoid (Retin-A, etc.) used for acne.


  1. I’ve always heard that you should expose wounds to air and let them scab up. Why do you want me to keep it covered?Laboratory studies show that wounds heal faster when occluded. The skin cells actually release form their adjacent cells and walk across the base of the wound to close the wound quicker. When there is a scab, the wound takes twice as long to heal. There are new anti-scar creams such as BioCorneum that form a silicone barrier over the wound, supplying occlusion for faster healing and the silicone helps minimize scarring.


  1. What can I do to even out my skin tone? The older I get the more I have little, uneven pigmented spots on my face?It is not unusual to have uneven pigment tone as we get older. To prevent the problem, we should use sunscreen daily from a young age. If the damage has already occurred, then retinol products can help to turn over the skin faster, decreasing the time the skin has to build up uneven pigment. Bleaching creams can decrease the production of excess pigment as well. Chemical peels can help turn the skin over much faster and lift the pigment up and peel it off.


  1. What is the benefit of using Vitamin C as a cream? I take a multivitamin every day with Vitamin C in it.Vitamin C acts as an antioxidant in the skin. Oral vitamin C does not reach the skin in enough amounts to stop free radical production. Free radicals are formed when the sun’s rays hit cholesterol-like compounds in the skin and change them. These free radicals have an extra electron that can be released to damage our DNA when the free radicals migrate into the nucleus of the skin cells. Vitamin C neutralizes these extra electrons and prevents skin cancer over time.


  1. Why do I have to stay out of the sun after a Blu-U treatment?Photodynamic therapy works by using a chemical that is absorbed into rapidly dividing cells (precancerous cells). We paint on the chemical and it soaks into the precancers, and is activated by exposure to blue light. Blue light is part of the visible light spectrum like Red, Orange, Yellow, Green, Indigo and Violet. Thus, it is contained in sunlight. If you go out in the sun in the 48 hours after the treatment, the chemical undergoes uncontrolled activation, which will cause excessive irritation and inflammation.


  1. Is MC contagious? Should I keep my child out of school while being treated?Molluscum Contagiosum is a common childhood ailment and is contagious. It is spread from human to human by skin contact and rubbing, like wrestling with each other. In adults, it is primarily confined to the groin area and is spread through sexual contact. The molluscum virus is a member of the pox virus family, which is somewhat like the human papilloma virus family that causes common warts.