In the past, AKs were most commonly seen in people over the age of 60. However, changes in lifestyle and the environment are responsible for the increased incidence of AKs in individuals as young as 20. I feel it is
important for everyone to be aware of the significance of these lesions.

Actinic keratosis are small, scaly spots that develop on parts of the body that have been exposed to the sun. Commonly known as “sunspots,” AKs can have a variety of appearances. The earliest form may look like nothing more than a flat, red spot. As the lesion grows larger, it may become scaly and even thickened, much like a wart. AKs are most likely to occur on the face, lips, ears, scalp, neck, back of the hands, shoulders, forearms, and back.

AKs and most skin cancer develop as a result of sun exposure. Often my patients with AKs assure me they have had very little sun-exposure since the first 20 to 30 years of life. My explanation is that despite your sun avoidance as an adult, much of the damage has already accumulated from your sun exposure as a child.

Common treatments for AKs include surgical removal, cryosurgery ( freezing with liquid nitrogen), electrodesiccation (heat generated by an electric current), and patient-administered topical chemotherapy with one of the several available creams applied at home. A promising area of treatment is the use of a class of drugs which modify the immune system of the skin and stimulate the body’s own rejection of AKs. In addition, lasers, chemical peels, and dermabrasion are sometimes used to remove certain AKs.

Although it is possible to diagnose an AK on the basis of the clinical appearance of a lesion, it can be difficult sometimes to distinguish an actinic keratosis from a squamous cell carcinoma without doing a skin
biopsy.

To prevent AKs and skin cancer, a comprehensive sun protection program including wearing protective clothing and a wide-brimmed hat, avoiding the sun at midday when the sun’s ultraviolet rays are strongest, seeking shade whenever possible, and wearing a broad spectrum sunscreen with a Sun Protection Factor (SPF) of at least 15 is recommended. My hat is not very pretty, but it offers great sun protection. Patients with a history of skin cancer should wear the highest SPF sunscreen available. I personally wear a 45, 50, 60, 70, or 100 SPF sunscreen.

Remember, simple, early treatment can cure these pre-cancerous growths before they have a chance to become skin cancer and save patients from more extensive surgery. Early diagnosis and treatment is always best for the patient.

John J. Jones, Jr. M.D.

Poison ivy, poison sumac and poison oak are the group of plants that cause the most allergic reactions in the United States. Poison ivy rash is an allergic rash (dermatitis) caused by contact with an oil called urushiol, found in the sap of these plants. It is a colorless oil that oozes from any cut or crushed part of the plant, including the roots, stems and leaves. After exposure to air, urushiol turns brownish-black, making it easier to spot.

Poison ivy can be contracted in the following ways:

• Direct contact – by touching the sap of the toxic plant with your skin.
• Indirect contact – by touching something to which sap has spread. The sap can stick to the fur of animals, to garden tools , sports equipment, family members’ clothes or to any objects that have come into contact with a crushed or broken plant.
• Airborne- urushiol (sap) particles, such as from the smoke of burning plants, may come in contact with your skin. Avoid the burning plants. The smoke may cause severe systemic allergic reactions.

Once urushiol sap touches the skin, it begins to penetrate in minutes. In those who are sensitive, some of the reaction appears as a line or streak of rash, usually within 12 to 72 hours. Redness and swelling occur, often followed by blisters and severe itching. The average rash takes 10 days or longer to heal. More severe cases can take 20 to 25 days to run their course.

The rash can affect almost any part of your body. The rash does not spread, although it may seem to when it breaks out in new areas. Before blisters form, the rash is spread by urushiol on your hands, for instance, by scratching your nose or wiping your forehead. Scratching poison ivy blisters will not spread the rash. It is best, however, to avoid excessive scratching of your blisters, since your fingernails may carry bacteria that could cause an infection.

If you think you’ve had a brush with poison ivy, poison oak or poison sumac, follow these simple steps:

• Wash all exposed areas with cold running water as soon as possible.
• Wash your clothing with a garden hose outside or in a washing machine with detergent. Because urushiol can remain active for months, wash camping, sporting, fishing or hunting gear that was in contact with the oil.
• Relieve the itching of mild rashes by taking cool showers and applying over-the-counter preparations like calamine lotion or Burrow’s solution. Over-the-counter hydrocortisone creams are not often strong enough to have an effect on poison ivy rashes.
• Seek medical help for moderate and severe cases, or if uncomfortable. I treat aggressively with systemic cortisone and topical medication (super-potent creams) when the itching prevents sleeping.

As you enjoy this beautiful summer season, be on the lookout for poison ivy plants.

John J. Jones, Jr. M.D.

Chemical peeling is used to treat fine lines and wrinkles caused by sun damage, aging, and hereditary factors. In addition, pigmentation of the skin in the form of sunspots, age spots, freckles, and blotchiness can be improved with this process.

An effective PCA professional treatment is the application of a solution to the damaged outer layers of the skin’s surface for the purpose of removing unwanted damaged skin. The chemical solution actually causes the upper layer of skin to exfoliate, allowing new skin to regenerate. The new skin looks younger, firmer, and tighter, with fewer lines, wrinkles and discolorations.

Every peel is different, unique to each patient. I will suggest the proper peeling agent based upon the type of skin damage present and desired results. One or more chemical solutions such as alpha hydroxy acid, trichloroacetic acid, salicylic acid, or carbolic acid (phenol) are used.

Alpha Hydroxy Acids (AHA’s) are those such as glycolic and lactic acids used for the mildest of the peel processes. These are quick, light peels for improved smoothness with a very short recovery period. This mildly invasive procedure only takes 10 to 20 minutes and requires no after-peel ointments or covering.

Salicylic acid is also used for mild peels. I use this solution for oily skin types, including individuals with acne, enlarged pores and overactive oil glands. Patients with thickened, oily skin of the nose and face will see improvement in the texture and appearance of their skin. There is no recovery period with this treatment.

Trichloroacetic acid (TCA) is most often used for medium-depth peeling. It treats surface wrinkles, blemishes, pigment problems, and pre-cancerous growths. The recovery period varies depending on the concentration used.

Phenol is used for the deepest of the peels. It treats coarse facial wrinkles, areas of blotchy or severely damaged skin caused by sun exposure and pre-cancerous growths. This peel is the most aggressive peel. There is a significant recovery period with this treatment.

Post-peel treatment will enhance the results of your chemical peel. It is very important that you wear sunblock after the deeper peels (since the new skin is fragile and more susceptible to injury) and that you use a tretinoin-based gel or cream on a regular basis. The tretinoin cream or gel is a vitamin A derivative approved for reducing the appearance of fine wrinkles, mottled darkened spots, and roughness in skin.

Microdermabrasions and Silkpeels can be used to enhance the effect of chemical peels when appropriate. Both remove the dead, outer layer of skin and in addition, the Silkpeel delivers a topical dermaceutical, which addresses the patient-specific skin condition.

My goal is achieving the maximum benefits with little or no downtime. Combining chemical peels, microdermabrasion or silkpeel and tretinoin cream or gel will leave the skin looking younger, smoother, and tighter.

John J. Jones, Jr. M.D.

Therefore, why not remove all moles? The answer is simple: It would not be practical or possible to remove all moles.

One or more of the following factors must be present before the decision to remove moles is made:

1. The individual with the mole thinks it looks unattractive or feels the mole is in an area of trauma, where clothing can irritate it.
2. The physician thinks the mole looks suspicious or unusual.
3. There is a history of change in the mole.

“Change” is the important word. Any change in size, shape, color, persistent itching, ulceration or bleeding constitutes a change. In addition, if a mole first appears when a person is past twenty, it should be checked.

These changes or “warning signs” are commonly described as the ABCDE’s:

A-Asymmetry-if you cut the mole in half, the two sides of the mole do not match.

B-Border-the border or edges of the mole are ragged, blurred or irregular.

C-Color-the mole has a variety of shades and colors.

D-Diameter- the diameter of the mole is larger than 1/4 inch (size of pencil eraser).

E-Evolving-any change in size, shape, or color.

As a melanoma develops, the asymmetry, irregularity, and other changes are recognized more easily. Our goal is to find the melanoma in its early stage when it can be cured by simple excision.

Some individuals are at higher risk for developing melanoma and tend to have one or more of the following risk factors:

1. a large number of moles (greater than 75-100 moles). Individuals with that many moles are at a greater risk for melanoma than people who have few moles or who tan, rather than burn, after sun exposure.
2. a strong family history of blood relatives who now have or have had melanoma.
3. a family history of “atypical” or “dysplastic” moles. These individuals, with one or more of these risk factors, should have any change in their moles evaluated by a dermatologist.

As a guide to mole removal, remember the following:

1. A “normal” mole should not exceed the size of a pencil eraser. If it is larger than an eraser, it should be evaluated by a dermatologist.
2. New moles in people over 20 also require evaluation, as they are uncommon.
3. Change of any kind in a mole should be considered a potential sign of trouble.
4. Suspicious pigmented lesions should be excised for histologicexamination.

Most moles cause no problems. But moles may be irritating, unattractive, or changing. Your dermatologist can determine if a mole is dangerous. Removal of a mole is painless and simple. And most importantly, the early removal of dangerous moles will save lives.

John J. Jones, Jr. M.D.

I instruct patients to apply sunscreens over all potentially exposed skin,not just specific spots. The higher the SPF number, the better the protection. Use the highest number you can find. Ideally, a thick layer should be applied half an hour before sun exposure, but it is never too late to use sunscreen. New studies show that many sunscreens start to lose some effectiveness after 2 hours. Reapplication is necessary every few hours or after intense activity, sweating or immersion in water.

Beach umbrellas and clothing can give a child additional protection from the sun. Long-sleeved shirts of a tightly woven fabric and broad-brimmed hats should be worn. Fair-skinned individuals can sunburn under some thin clothing.

It is also important to keep your child out of the sun from 10:000 a.m. to 3:00 p.m. and to avoid places with highly reflective surfaces, such as sand and water. Parents must remember that heat and brightness are not indicators of ultraviolet intensity. (It is hotter on August 15 than it is on April 15, but the UV light is equivalent.) In addition, rays are transmitted through clouds, and sunscreen should not be forgotten on cloudy days.

The fact that children rarely get skin cancers should not dissuade a parent from having a child examined if there is the slightest cause for suspicion. Parents must be alert to changes in moles and spots on the skin that look unusual or do not heal. Any spot on the skin that changes size, shape, color or bleeds should be brought to the attention of your dermatologist. Similarly, children who have a large number of moles or a family history of melanoma must be checked regularly by a dermatologist as well as by the parents. Several studies show that sunburns may cause normal moles to become precancerous or lead to melanoma. Therefore, children with a family history of melanoma or abnormal moles should be especially careful about overexposure to the sun.

A life free of skin cancer is the goal. Exposure to ultraviolet radiation occurs whenever one is outdoors, and skin damage is not limited to the beach. Therefore, sunscreen should be used not only for such recreational activities as swimming, but also for such outside chores as mowing the lawn. As an educated parent, you can play an important role in improving the health of all children.

John J. Jones, M.D.

Reviewing the common skin problems of children may lessen your anxiety if rashes or growths appear on your children.

Atopic dermatitis (eczema): the childhood form of eczema may start at any age, but often has its onset between 2-10 years with the development of itchy red areas on the wrists and ankles and on the flexural surfaces of the arms and legs (elbows and knees). The skin may be thickened, shiny and oozing and is usually very dry. Treatment requires daily use of moisturizers and prescription steroid creams during breakouts. This is often a chronic problem that will continue to improve with careful treatment adjustment by parents properly instructed by their dermatologist on the safe and effective use of their medication. Medication by mouth may be needed in most severe cases.

Impetigo: Also known as Indian fire. A skin infection caused by a bacteria that begins as a tiny red bump and quickly turns into a honey-colored crusted plaque. It is most commonly found around the nose, but can occur on any area of skin that has been damaged. Impetigo is treated with antibiotics. For minor infections a topical antibiotic cream can be used, but more extensive cases will require an oral antibiotic.

Infections: rashes are commonly associated with many different types of viral infections, including roseola (causes high fever for 3-5 days and then once the fever goes away, small red bumps appear on the trunk that spread all over the body), fifth disease (causes red cheeks and then a fine lace-like red or pink rash on the arms), and chickenpox (causes small red bumps that turn into blisters that crust over).

Keratosis pilaris: causes small pinpoint size red bumps and rough and dry skin on the cheeks and the back of the upper arms and legs. It is a chronic condition that is easy to treat with properly adjusted topical lubricants, keratolytics, and steroid creams.

Molluscum contagiosum: this is a type of wart caused by a virus. The rash consists of small flesh colored, dome shaped bumps with a crater in the center. They can be grouped on any skin surface, but are usually located on the head, neck, trunk and underarms. Treatment is simple and optional. This type of wart will go away on its own over several months to years. When treatment is desired, warts can be treated with a medication applied to the wart in the doctor’s office.

Many simple treatment options are available for these skin problems. The treatment results, mainly relief of discomfort and anxiety, will lead to a happier child and a more productive school year. As an educated parent, you can play an important role in improving the health of all children.

Dr. John Jones is a board certified dermatologist and an Associate Professor of Dermatologic Surgery and Dermatology at LSU Medical Center in New Orleans.

John J. Jones, Jr. M.D.

Shingles may occur anywhere on the body, even in the eye. The first symptom of shingles is a burning pain or tingling and extreme sensitivity in one area of the skin. This may be present for one to three days before a red rash occurs. There also may be a little fever or headache. The rash soon turns into groups of blisters that look a lot like chicken pox. Great care must be taken if the blisters involve the eye region because permanent eye damage can result.

The blisters generally last for two to three weeks. During that time pus may collect in the blisters. The blisters will then crust over and begin to disappear. Severe pain can linger for months or years as a condition called post-herpetic neuralgia. This problem is of most concern to me because it is avoidable for most patients by early, aggressive treatment.

The shingles virus is contagious. Shingles can be passed on to others who have not had chicken pox, but they will develop chicken pox, not shingles. Shingles may be passed on to people who suffer certain illnesses and those who have weakened immune systems.

Anti-viral drugs taken by mouth should be prescribed for all cases of shingles. Severe shingles requires early, more aggressive treatment with systemic steroids and sometimes nerve block injections. Combination treatments are often needed for the more painful shingles. I often use tricyclic antidepressants like amitriptyline ( Elavil) and anticonvulsants like gabapentin (Neurontin) at adjusted dosages. Most of these medications should be started early, at low doses, then increased quickly to achieve maximum benefit. Medicines taken within 1 to 3 days of the onset of shingles work best and may stop the progression of shingles completely.

Zostavax, the shingles vaccine made by Merck and licensed by the FDA in May of 2006, will reduce the risk of shingles in adults 60 and over. Zostavax is given as a single dose by injection. In clinical trials, the vaccine prevented shingles in about half of people 60 years of age and older.

The problem I see most in my office is that patients wait too long to seek treatment, because they do not recognize the pain and rash as shingles until later in its course. Remember, shingles treatment works best when begun immediately. Please get help quickly.

Dr. John Jones is an Associate Professor of Dermatology and Dermatologic Surgery at LSU Medical Center in New Orleans, a board certified dermatologist, and has offices in Thibodaux and Raceland.

John J. Jones, Jr. M.D.

Rosacea is a very common acne-like skin disease affecting an estimated 14 million Americans. Skin affected by rosacea has one or more of the following features:

• a redness that looks like a blush
• pimples
• lumps on the nose
• thin red lines due to enlarged blood vessels

Beyond its physical effects, rosacea often inflicts significant emotional and social damage because of its conspicuous impact on personal appearance.

Rosacea typically first appears after age 30 as a flushing or redness on the cheeks, nose, chin or forehead that may come and go. Over time, the redness becomes more persistent, and small, dilated blood vessels (telangiectasia) may appear. Because it can look much like teenage acne, it has been called “adult acne” or acne rosacea. Without treatment, bumps and pimples often develop, and in severe cases, the nose may become swollen from excess tissue. This condition is called rhinophyma. (The most famous rosacea sufferer with rhinophyma was W.C. Fields, the comedian.)

The cause of rosacea is unknown. Foods and beverages that cause facial flushing, such as alcohol, spicy foods, hot soups and drinks like coffee, may make rosacea temporarily more noticeable. Additionally, since the sun is a strong trigger for many rosacea sufferers, a non-irritating sunscreen used daily is important. I encourage my patients with rosacea to identify their own aggravating factors and attempt to avoid them whenever possible.

In rare cases, rosacea can be confused with other skin diseases. An excellent example of a skin condition mimicking rosacea is the severe infestation of microscopic skin mites known as Demodex folliculorum.

These tiny mites are normal inhabitants of human skin. Studies have found an elevated incidence of Demodex in rosacea patients. The diagnosis can be confirmed with a brief scrape test, and eradicating the mites can clear the condition.

Rosacea develops slowly over time and will often gradually worsen, but it can be treated. Antibiotics taken by mouth are usually effective in controlling rosacea. Treatment may also need to be changed over a period of time depending on the response. Treatments such as topical Metrogel and systemic low dose Accutane are available when needed. Adjusting medications periodically may be necessary for best control. Once clear on medications, adjustment of the medications is usually best to attempt to remain clear on the least amount of medicine possible.

I now use ILP laser treatment to can easily erase the red blood vessels and the facial reddness that most rosacea patients want removed. IPL also stimulates new collagen to form in the skin thereby reducing fine lines, minimizing pore size and acne scars, and reducing wrinkles.

Remember: The good news is that, while rosacea cannot be cured, it can be markedly improved with medical therapy and IPL laser treatments.

John J. Jones, M.D.

Moderate to severe acne can cause embarrassment, self-esteem problems, and sometimes depression.

Acne is caused by a combination of many factors, including genetics, hormones, friction, cosmetics, stress and skin contactants. Most important is the genetic factor. Most people inherit the tendency to develop dysfunctional oil glands at a time in life when certain normal hormones affect the oil glands. Changing hormone levels cause production of abnormal oil from genetically predisposed dysfunctional oil glands. This abnormal, thick oil clogs the pores allowing the backup of oil and increasing pressure, which then causes the gland and oil ducts to leak or rupture under the skin. Once ruptured, inflammation and then infection can occur. When acne is severe, it can lead to serious and permanent scarring.

Treatment for acne depends upon its severity. It consists of using medications which chemically unclog pores, reduce infection and inflammation, and normalize abnormal oil gland production. Topical preparations (creams, gels or lotions) may be prescribed to help unclog the pores and reduce the amount of harmful bacteria.

In mild cases, I prescribe a tretinoin gel which unplugs clogged pores and prevents future breakouts. Tretinoins may be used alone or in combination with erythromycin, Cleocin, or benzoyl peroxide. These medicines may require weeks or months of use and work best when adjusted carefully by a dermatologist. Many patients give up too soon. Antibiotics taken by mouth are often prescribed for moderate or severe cases. Most acne requires 4-8 months of treatment for a complete cure. Special formulated medical facial peels can speed the healing of acne lesions in most cases.

Accutane(isotretinoin) will be considered for severe, resistant, and/or difficult cases which have not improved satisfactorily during other treatments. Accutane is the only drug that “shuts off” and shrinks oil glands that cause acne. Accutane actually normalizes abnormal, dysfunctional oil glands. It will decrease overactive oil gland production, diminish scars and completely clear acne. Treatment with Accutane takes an average of 6-8 months. New methods of dosage adjustment diminish the unwanted side effects to a minimum. The recent concerns of side effects are greatly exaggerated by those who do not understand Accutane and its proper use. All side effects can be completely avoided by proper dosing. This must be explained to patients and parents before treatment begins.

I prescribe Accutane in much lower doses to completely avoid all side effects. Lower doses, properly adjusted, make Accutane the best acne medication available when used in this manner. Remember, your neighbor or friend who experienced side effects from Accutane could have avoided those side effects by decreasing the dose.

Most importantly, all acne is curable with proper treatment and adjustment of medications under the supervision of a dermatologist. Untreated acne can leave lifelong scars that can affect your self-image. There is no need to wait months or years for your acne to clear. It is best to initiate treatment early, before scarring occurs.

John J. Jones, Jr. M.D.

The overall incidence of melanoma is rising at an alarming rate. Advanced melanoma spreads to internal organs and may result in death. Fortunately, most skin cancers, including melanoma, can be cured if detected early.

Melanoma, a very serious skin cancer, is characterized by the uncontrolled growth of pigment-producing tanning cells, melanocytes. Melanomas may suddenly appear without warning, but can also develop from or near a mole. They are found most frequently on the upper backs of men and women or on the legs of women, but can occur anywhere on the body.

Melanoma can strike anyone. However, certain individuals are at higher risk than others. For example:

• Your chances increase significantly if you’ve already had one melanoma.
• You have a substantially increased risk of developing melanoma if you have many moles, large moles or atypical (unusual) moles.
• Your risk is increased if your parents, children or siblings have had melanoma.
• If you are a Caucasian with fair skin, your risk is four times as great as a Caucasian with olive skin.
• Redheads and blondes have a twofold to fourfold increased risk of developing melanoma.
• Excessive sun exposure in the first 10 to 25 years of life increases your chances of developing melanoma.

Recognition of changes in the skin is the best way to detect early melanoma. If you notice a mole on your skin, you should follow the simple ABCD rule which outlines the warning signs of melanoma:

• Asymmetry – One half does not match the other half.
• Border irregularity – The edges are ragged, notched or blurred.
• Color – The pigmentation is not uniform. Shades of tan, brown or black are present. Dashes of red, white, and blue add to the mottled appearance.
• Diameter – The width is greater than six millimeters (about the size ofa pencil eraser). Any growth of a mole should be of concern.

When detected early, surgical removal of thin melanomas can cure the disease in most cases. Early detection is essential; there is a direct correlation between the thickness of the melanoma and survival rate.

Dermatologists recommend a regular self-examination of the skin to detect changes in its appearance. Additionally, patients with risk factors should have a complete skin examination by a dermatologist every 6 to 12 months.

Since sun exposure is the most preventable risk for melanoma, follow these sun protection guidelines:

• Avoid outdoor activities between 10 a.m. and 4 p.m. when the sun’s rays are the strongest.
• Seek shade whenever possible.
• Wear a broad-spectrum sunscreen with a Sun Protection Factor (SPF) of 15 or higher and re-apply every two hours. I wear sunscreen with a 45 to 55 SPF.
• Wear sun-protective clothing and accessories, such as wide-brimmed hats and sunglasses. My hat is not pretty, but offers great sun protection.

John J. Jones, Jr. M.D.