from the Fall 2001 issue
Red necks are a common sight in Sun Belt cities like Houston. Why? Because they are caused by chronic sun exposure. Typically the skin is reddish-brown on the sides of the neck and the chest, but whiter directly under the chin where it's shaded from the sun. The medical term for this sun-induced discoloration is poikiloderma of Civatte, named after Dr. Civatte, a French dermatologist.
The red part of the discoloration comes from a network of tiny blood vessels called telangiectasia, and the brown comes from an increase in the melanin pigment in the skin. In addition to the color changes, the skin is also thinner and wrinkled. To prevent poikiloderma from occurring, you should wear a broad-spectrum sunscreen daily on any exposed neck or chest skin. Look for ones that contain either zinc oxide, titanium dioxide, or avobenzone (Parsol 1789).
Several treatment options are available for poikiloderma on the neck and chest. Skin-care regimens that contain bleaching agents and either glycolic acid or vitamin A derivatives like tretinoin (Retin-A, Renova®) or tazarotene (Tazorac®) are helpful. The M.D. Forté® products and the Obagi Nu-Derm™ regimen are examples of good treatment programs for individuals with poikiloderma. Chemical peels such as the BETA-LIFT Peel™ or the Obagi Blue Peel™ can also help lighten the brown pigmentation and improve skin texture. Microdermabrasion, a process akin to “sand blasting” away the dead cell layer on top of the skin with small particles, can also help even out brown spots and smooth the surface of the epidermis.
Even though the above treatments can help improve the appearance of poikiloderma a great deal, the one part of the problem they don't address is the blood vessel component, called telangiectasia. Chemical peels and skin-care products have no effect whatsoever on eliminating the network of blood vessels that is creating the redness. The best way to reduce the redness is a series of treatments with intense pulsed light, known as the FotoFacial™ procedure. In addition to lightening the blood vessels, the Foto Facial helps to reduce brown spots and smooth skin texture.
Depending on an individual's needs, the FotoFacial can be done on face, neck, chest, or any combination of these areas. There is a stinging sensation with each flash of light, so most people opt to use an anesthetic cream called ELA-Max® prior to the procedure to eliminate the slight discomfort. Immediately after the procedure, the treated areas appear reddened and brown spots may darken slightly before they get lighter.
Molluscum contagiosum is another common viral infection of the skin that is similar to warts. Instead of a warty appearance, the lesions are smooth and shiny and are usually small. Like warts, they are not harmful but can continue to spread if left untreated. They can be treated with a blistering agent, curettage (scraping with a small round instrument), or cryotherapy. Again, pediatric dermatologists are experienced with the appropriate use of all of these methods in different age groups.
Diaper rash is usually an easily treatable problem, but some cases are
resistant to traditional therapy. These are the cases in which a ediatric
dermatologist can be very helpful. Different types of diaper rash can require different types of treatments, and sometimes more serious diseases can masquerade as diaper rash, so an evaluation by a pediatric dermatologist can be very important.
Birthmarks are not necessarily present at birth. Some can appear in the first few weeks of life and some in the first few years. Examples of common birthmarks are hemangiomas and port-wine stains, which are made up of blood vessels, and congenital moles, which can be very small or very large. Some birthmarks can have associated problems and should be evaluated. It is important that birthmarks be evaluated in the newborn period when present, because early intervention can be important. Sometimes watchful waiting is the answer.
Skin infections that pediatric dermatologists commonly treat include
impetigo, which is a bacterial infection of the skin, and tinea capitis, or
ringworm of the scalp, which is a fungal infection. Impetigo can be treated with either topical or oral antibiotics, depending on the severity. Tinea capitis must be treated with an oral antifungal. Scabies is a mite infestation that can cause an extremely itchy rash and is very contagious. This can be treated safely even in very young infants with a prescription cream.
Acne, of course, can be a major problem for teenagers. Acne treatment ranges from topical medicines to oral antibiotics to Accutane®, which is a medicine reserved for treatment of severe recalcitrant acne. There are many nuances in the treatment of acne, and it is important for the dermatologist to help the patient find a regimen that not only works, but that fits with his or her
lifestyle.
The conditions described above are just a sampling of the areas of expertise of a pediatric dermatologist. I look forward to treating you and your family members.
If you would like more information about the treatment of poikiloderma of Civatte, call us at 713.850.0240 to schedule a consultation.
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