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Cynthia Golomb, MD | Dermatology Boutique

MD

The tragedy of misinformation

· COVID-19 · Comments Off on The tragedy of misinformation

Allure magazine wrote a good article about all the misinformation out there about dermal fillers and the COVID-19 vaccine.

I think it is a tragedy that many filler patients refused to get vaccinated because of the misleading reports in the news media.  Some reporting caused panic, confusion and concerns that were out of proportion to the actual, rare events that resolved quickly.

Yes, there have been a few, rare reactions to the COVID vaccine in filler patients, but these types of reactions are not new, nor are they unique to the COVID vaccine.

Click to read the Jan. 20, 2021 article:  “Why You Should Still Get the COVID-19 Vaccine Even If You Have (or Plan to Get) Dermal Fillers.”

 

Festoon Update

· Lasers · Comments Off on Festoon Update

Earlier I posted a video of the CO2 CoolPeel laser treatment to reduce the festoons under my eyes.  Now with these photos, you see what I looked like pre and post-procedure.

Festoons appear below the “eye bags” as a mound or bump around the cheekbones.  Or, a festoon could be sagging skin or folds of skin above the cheek.

I was red immediately after the laser treatment, but the CoolPeel has less downtime and less redness than older technology CO2 lasers.  The CoolPeel’s new technology delivers energy more precisely, without a lot of thermal damage to the skin, so recovery is faster.

The laser can be set to mild, moderate or aggressive and the downtime increases with the intensity of the treatment.

The treatment I had was moderate and addresses fine lines, superficial wrinkles, dark circles and festoons.  The cost for this treatment under the eyes is $850.  The downtime is 3 to 5 days.  You can begin wearing makeup in 2 to 3 days.

Laser resurfacing with a CO2 laser encourages the skin’s natural healing process and revitalizes the area by creating better support in the skin.  It also tightens the skin by “shrinking” tissue.

My CoolPeel CO2 laser can be customized to your unique needs — it is powerful, fast and gives fabulous results.  After your treatment, your skin will look smoother, tighter, fresher and more youthful.

Mohs Provides Higher Cure Rate for Skin Cancer

· Skin Cancer · Comments Off on Mohs Provides Higher Cure Rate for Skin Cancer

Immediately after Mohs surgery.

I performed Mohs surgery and then did a skin graft on this patient.  She had basal cell cancer on her ear.

Mohs surgery is a precise technique to remove skin cancers layer by layer resulting in a higher cure rate than standard excision or radiation therapy.

For example, basal cell carcinomas have a 97 to 99% cure rate.

Mohs also allows me to limit the size of removal and conserve normal skin to minimize scarring.  After removal, I treat the wound in a manner to promote good healing and preserve cosmetic results.

The Mohs procedure can be as short as one hour as in the case of this patient, or it can take several hours depending on the number of layers and type of repair, like a skin graft.  This patient’s skin graft took an additional hour.

This photo was taken 11 days after her Mohs surgery and skin graft.

I became very interested in Mohs during my residency and training at the University of Miami, and then later during my dermatopathology fellowship at Roger Williams Hospital at Boston University.  A dermatopathologist diagnoses skin disorders under a microscope.

Removing a tumor and examining the tissue immediately after removal was a natural for me because of my sub-specialty as a dermatopathologist.

Designed by Frederic E. Mohs, M.D., the surgery excises not only the visible tumor but also any “roots” that may have extended beneath the surface of the skin.

This procedure is most commonly used for the treatment of basal and squamous cell carcinomas, the two most common types of skin cancer, although it can also be used to treat melanoma and other types of cancer.

Mohs surgery is often recommended for recurring cancer because its results are so thorough.

My patient 3 1/2 months after Mohs and her skin graft. Her face mask is pulling the top of her ear forward in this photo.

It is ideal for treating cancer in cosmetically and functionally prominent areas such as the nose, eyelids, lips, hairline, ears, hands and feet.

Compared to other skin cancer treatments, Mohs surgery has a very high success rate. As I mentioned, basal cell carcinomas have a 97 to 99% cure rate, while squamous cell carcinomas are cured 94% of the time.

Returning to Full-Service Appointments

· COVID-19 · Comments Off on Returning to Full-Service Appointments

I am happy to let you know that I have returned to full-service appointments.  That includes cosmetic procedures and full-body skin checks.  But things will be a bit different.  See below.  I look forward to seeing you soon!

COVID-19 tips: wearing masks, gloves and a trick to keep your phone clean

· COVID-19 · Comments Off on COVID-19 tips: wearing masks, gloves and a trick to keep your phone clean

On Earth Day I recorded this video to provide tips on safety for using masks and gloves, as well as a trick to protect your cell phone.

For example, use a paper towel, tissue or coffee filter to make your mask last longer. After your mask becomes damp from respiration, it is less effective.

While you are wearing your mask, or when taking it off, don’t touch the outside of your mask – that’s the contaminated side.


Stay safe!

Viruses, Your Skin and Vaccines

· COVID-19, In the News · Comments Off on Viruses, Your Skin and Vaccines

Many viruses like herpes simplex, chicken pox, measles, and now COVID-19, have prominent cutaneous physical findings.

Measles is a virus that is on the rise again in the United States because of decreased adherence to vaccination programs. Measles is spread by respiratory droplets and has a long incubation period of 10-12 days. Fever, conjunctivitis and malaise begin before the rash.  The skin manifestations are red blotchy patches that typically start on the face around the ears, cheeks and neck then spread to involve the body.  One key feature is called Koplik’s spots — tiny blue white dots inside the mouth.

Erythema infectiosum (Fifth disease)

One of the easiest viral rashes to identify is Erythema Infectiosum (Fifth Disease).  It is caused by human parvovirus B19.  After about the 10th day of asymptomatic infection, there is a mild fever, malaise and headache.  The rash begins a few days later with a strikingly red raised patches over the cheeks (likened to slapped cheeks). It is followed by red patches over the buttocks, arms and legs.  Adults have more symptoms like fever and not feeling well.  When in doubt, antibody testing is very reliable.  IgM, the initial antibodies, help me to confirm the case and last only a few months.  Long term antibodies are the IgG and can last a lifetime.

Chicken Pox (Varicella) is caused by the same virus as Shingles (Herpes Zoster), a herpes virus (DNA virus) also spread by respiratory droplets.  Interestingly the incubation period can be as long as 23 days for chicken pox. Again fever and malaise for a few days followed by crops of blisters predominately on the face and scalp.  The rash is very itchy.  Chicken pox can cause lots of complications like encephalitis and varicella pneumonia.

The second stage of chicken pox typically presents in adulthood, although children can get it also. There is no convincing evidence that shingles can be contracted from another individual.  The virus is an opportunist and reactivates when an individual is immunosuppressed, or when a purely personal event allows the virus to resurrect.  Most of you are aware that shingles follows one side of the body and corresponds to a dermatome (skin surface along a nerve branch).  Shingles can be mild or extremely painful with complications like facial palsy, involvement of the eye and postherpetic long-lasting pain.

Herpes simplex, warts and molluscum contagiosum are other viral diseases of the skin.  There are numerous others.

Hives

The most recent health care crisis with COVID-19 has brought us a variety of skin presentations.  Reports are now storming the medical journals with skin rashes from COVID-19.  Early reports suggest about 20% of patients have skin findings including generalized hives, small bruise-like rashes, frostbite-like changes in the fingers and toes and a red lacelike rash known by dermatologists as “livedo reticularis.”

Livedo reticularis

Rashes start at the onset of COVID-19 symptoms or shortly thereafter. The rashes most commonly affect the trunk with itch that was mild or absent and resolved after a few days.  The earliest reports of frostbite or purple fingers and toes were most commonly seen in those who were critically ill.  Now, the dermatologic registry is expanding and most COVID toes are reported in younger patients, 20-30, who are recovering.

I have not encountered skin findings of COVID-19 as of yet with any of my patients.

I hope and pray that one of the good things that comes out of this crisis is that more and more people will realize the necessity of vaccination to prevent the spread of disease in the community.  More than ever, I have encountered parents who refuse to vaccinate their children because they believed propaganda that vaccines are pushed on us for big pharma to make profits.  Now there are concerns that vaccination rates are dropping further as more kids are missing vaccines due to the pandemic.

One of my earliest childhood memories is receiving the polio vaccine as a child with all of my family. A heartfelt thanks to Jonas Salk, the physician that ended the terror of polio by developing the polio vaccine released on April 12, 1955.  He was a viral expert recruited by my undergraduate alma mater, the University of Pittsburgh.  I attended pharmacy school classes in Salk Hall.

I have a very strong feeling about the importance of vaccination and I hope that this latest pandemic will help more people realize we need to vaccinate to prevent disease.

Get dermatological care without leaving home

· Telehealth · Comments Off on Get dermatological care without leaving home

I can now continue your care during these uncertain times with Telehealth appointments.  You can use your iPhone, iPad or Android device.

You could use your computer if you have a webcam and microphone (with Google Chrome or Mozilla Firefox as the browser), however if you want to show me a rash or lesion that is somewhere other than your face, a phone or tablet would be better.

This is what the Pocket Patient app looks like in the Apple App store.

If you’re going to use your mobile phone or tablet, you’ll need to download an app from my electronic health records system called “Pocket Patient.”  It is in the App store you use on your device.

The app is free.

When using a computer, you will sign into the patient portal.

Below are links to some videos to help you get the app and prepare for your Telehealth visit:

PocketPatient™ for iPhone

 PocketPatient™ for Android

 Telehealth using the Patient Portal on a computer

Make your appointment for a Telehealth visit by calling the office and you will be given a time for our virtual visit.  You will receive an email confirming your appointment with instructions.  The email will be from “Telemedicine Service” with an email address that includes “modernizingmedicine.com.”  If you have not used my patient portal before, the first step will be to activate your access to the portal.

If you have used my patient portal before, use that ID and password to login to the “Pocket Patient” app.  It may ask you to change your password after you log in.  There is a “forgot password” feature if you can’t remember your password.  If you have difficulty resetting your password, call the office and we will help you.

Sign onto the app a few minutes before your appointment.  In the email confirmation you received, the “practice” listed (dermatologyboutique.ema.md) is what you will enter in the top box above your ID and password in the app, if it is not already filled in.

The sign on page of the iPhone app.

It is best to be ready for our e-visit by sitting in one position during our appointment.  This keeps the phone from moving around.

If I need to see a rash or skin lesion, sometimes it helps if a family member can hold the phone over the area.  When using a phone or iPad, the app allows you to switch between the front and rear camera on your device.  When using the rear camera, you can also use the phone’s flashlight to illuminate the area you are trying to show to me.

Remember that when you use the rear camera, it is usually in one corner of the phone.  Be sure the camera is over the area that I need to evaluate.

If you get disconnected during our visit, just log back into the app and re-join the call.

I’m looking forward to helping you with your skin issues during virtual visits.

If you have a more serious condition, such as a large cut that needs stitches or a painful cyst that needs to be drained, I am still doing in-person, office visits.  The idea is to keep you out of an urgent care or an emergency room where you could be exposed to COVID-19 patients seeking treatment.

Your health & safety — our priority

· COVID-19 · Comments Off on Your health & safety — our priority

We’re taking extra measures to keep our office safe for you with enhanced cleaning.

We are diligently wiping frequently touched surfaces with disinfectant in the waiting room and exam rooms.

Pardon us when we don’t shake your hand or hug.

We also ask that you use our hand sanitizer in the waiting room before you are escorted to an exam room.

Not feeling well?  Recently travel to a COVID-19 hot spot?  Please call and postpone your appointment to a later date.

We are open and are ready to attend to your dermatological needs.

Fabulous Results After One CO2 CoolPeel Laser Treatment

· Lasers · Comments Off on Fabulous Results After One CO2 CoolPeel Laser Treatment

Bottom right: Day of treatment. Upper right: One day after treatment. Left: Five days after treatment.

 

Mylene just had her first CO2 CoolPeel laser treatment.  Here’s what she had to say:

“The large pores on my nose look so much better after just one treatment!  My acne scars are less noticeable and my skin is overall refreshed for the holidays.  My skin looks amazing!”

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