Medical Dermatology

At Derma Skin Institute we treat a variety of OHIP insured Dermatological conditions; these include (to name a few):

  • Rashes: Psoriasis, Eczema, Lupus, Bullous Pemphigoid
  • Skin Cancers: Melanoma, Squamous Cell Carcinoma Basal Cell Carcinoma,
  • Pre-Cancerous and Preventative: Mole checks, Actinic Keratoses Nuisance
  • Lesions: Moles, Cysts, Skin tags, Hair Loss, Excess Sweating

In order to treat the Above we will need a referral from your Primary Care Physician / Family Doctor. This also unfortunately means that if you are sent to us for one condition, we may need another referral to treat an unrelated condition.





Rosacea

It is a common skin condition that causes redness on the face and can be associated with small, red bumps. Other patients often experience flushing of the skin, small vessels or capillaries on the face and less commonly a condition called rhinophyma. It typically presents with a period of flare ups and then settles own. It commonly affects middle aged women with fair skin but can affect anyone.

There is no definitive cause of rosacea it is often thought to be due to a combination of hereditary and environmental factors. Risk factors that can play a role include a family history of rosacea, history of long term sun exposure, light colored skin and triggers such as extreme temperatures, stress, exercise, cosmetics, and diet triggers including hot drinks, spicy foods, alcohol.

 

Many patients with rosacea experience a burning sensation with increased redness and flushing. In addition small red pimples can be painful to the touch. Rosacea can have an impact on self esteem and the quality of life. 

 
Rosacea is a lifelong condition with the goal of treatment being controlling symptoms that you may be experiencing. Dr. Sajic and his team will discuss options such as topical products to reduce redness, oral antibiotics, or Isotretinoin. Other options include intense pulse light and laser therapy for a faster, more prolonged reduction of the redness.
 




Eczema

A very common skin inflammation which causes inflamed, red, itchy skin. This is also called Dermatitis. This is a condition that cannot be cured but with the help of Dr. Sajic, he can provide a proper treatment plan to manage your eczema and minimize flare-ups.

 
Eczema is commonly caused by a combination of hereditary and environmental factors. Eczema can present as an allergic reaction to something touching the skin. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.
 
 

Patients with eczema often complain of dry and scaly patches on the skin that are described as intensely itchy. This condition is often described as having periods of time where the rash improves or clear ups but will then have a period of time wherein the rash flares up.

 
 
Currently, the field of medicine is still challenged to find a definitive cure for eczeme. Treatment is aimed at controlling symptoms, reducing flares and healing the skin. Depending on your age and the type of eczema as well as the severity of the disease, Dr. Sajic may decide on a topical corticosteroid or go further into systemic steroids, antibiotics, and antihistamines. Other options that can help with eczema include topical calcineurin inhibitors and phototherapy. Dr. Sajic and his team will discuss options such as topical products to reduce redness, oral antibiotics, or Isotretinoin. Other options include intense pulse light and laser therapy for a faster, more prolonged reduction of the redness.
 




Psoriasis

Psoriasis is a non-contagious, common, inflammatory skin condition wherein skin cells grow and shed at 10 times the normal rate. This causes chronic red, scaly patches on the skin.
 
 
Psoriasis cause is currently unknown but researchers believe it involves a combination of genetic, environmental and immune related factors. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.
Dry, red skin with silvery-white scales. Rashes and/or scaling on the scalp, genitals or skin fold. The most commonly involved sites include the elbows, knees, scalp, chest, and lower back. Other conditions may also arise like psoriatic arthritis which presents with joint pain, swelling or stiffness. Also be on the look out for nail abnormalities.
 
 
 
The medical advances in psoriasis are continuous and promising. Although no treatment exists to treat the disease, determining the most appropriate treatment for the type and severity of the disease is key in managing psoriasis. Each individual patient is different and finding that right dose and combination is key for optimizing treatment. There are numerous topical medications and ral medications, as well as UV therapy and a number of biologics to choose from. Dr. Sajic can definitely help find the right combination to achieve the best outcome for your skin.




Acne

Acne is a common skin condition affecting teenagers in most cases, but currently a growing number of patients have been affected by adult-onset acne. One common misconception abut acne is that you have to let acne run its course. This is not always the best advice because of the possiblity of dark spots on the skin or permanent scars after the acne clears up.

 
 
 

Acne appears due to a clog in our skin pores from dead skin cells. Increased production of sebum, which is an oil we naturally produce to help keep skin from drying out, cause dead skin cells to become trapped inside and cause acne. A bacteria called p.acnes, commonly found on our skin also gets inside the clogged pores causing the pimple. The deeper the inflammation, the bigger, and deeper the acne becomes. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.

 
 

Acne can present as plugged pores (blackheads, whiteheads), to papules and pustules to something bigger and scarring called cysts and nodules. These can occur n the face, neck , chest, shoulders and back. Acne is a common cause of permanent scarring and thus be emotionally upsetting. Treating acne early is key to avoid this scarring. Other conditions may also arise like psoriatic arthritis which presents with joint pain, swelling or stiffness. Also be on the look out for nail abnormalities.

 

There are many effective treatments but this would need an extensive discussion with Dr. Sajic and his team. Not every acne treatment works for everyone and most acne treatments needs at least a 3 month duration of continuous use to see results. Controlling acne and maintaining a good skin regimen is key to prevent breakouts. Acne treatment can be topical, or something applied to the skin. These topical agents help kill the bacteria, reduce sebum (Oil) production, or help skin heal better to minimize acne related scaring. Topical products containing benzoyl peroxide, tretinoin, adapalene, tazarotene, salicylic acid, glycolic acid or antibiotics may be recommended. More severe cases of acne may require oral medication in the form of antibiotics, hormonal treatments if there is a hormonal source of the acne, or Accutane, the most potent acne medication to date. Other options include Blue Light therapy which destroys the bacteria that causes the acne inflammation. This is a good treatment option for those who do not want to take oral medication. Dr. Sajic and his team may also suggest a chemical peel for blackheads or whiteheads or do corticosteroid injections into nodules and cysts to help make acne heal faster. Dr. Sajic and his team will discuss options such as topical products to reduce redness, oral antibiotics, or Isotretinoin. Other options include intense pulse light and laser therapy for a faster, more prolonged reduction of the redness.





Hidradenitis Suppurativa

HS is an inflammatory follicular skin disease that looks like lumps or pimples on the skin but they appear in areas where pimples do not appear. The location of lesions are usually found in part of the body where skin tends to rub together and where sweat glands called apocrine glands are found like the underarms, under the breasts, buttocks and groin.  If HS worsens, these pimple-like bumps can grow deep and become very painful. They can also develop ito recurrent draining lesioins that will eventually lead to open wounds and significant scarring. This chronic, progressive and recurring disease is not contagious. It is however important to manage this condition as early as possible to decrease the chance of scarring and prevent worsening of the disease.

 
 
 
 

HS is a disorder due to defects within the hair follicle. HS likely develops when hair follicles clog with bacteria and become inflamed and infected. The exact cause remains unknown but the immune system over reacting  the blocked and inflamed hair follicle. Secondary involvement of the sweat glands called apocrine glands can also occur. A bacteria called p.acnes, commonly found on our skin also gets inside the clogged pores causing the pimple. The deeper the inflammation, the bigger, and deeper the acne becomes. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.

HS normally starts as redness in the involved area. Later on, lesions may develop into blackheads, abscesses, nodules, or fistulas and sinus tracts. Each individual is different and some symptoms will be different from person to person. Some of these skin lesions will be present at one time or another at varying stages especially because this is a relapsing chronic condition. Other conditions may also arise like psoriatic arthritis which presents with joint pain, swelling or stiffness. Also be on the look out for nail abnormalities.

 
 
 

The objective for treatment is management of the disease and prevention of the development of lesions as well as resolution of skin disease features like scarring or sinus tracts. Earliest form of treatment consists of topical and systemic antibiotic. This goes hand in hand with local hygiene, wearing loose-fitting clothing, and use of soaps and antiseptic and antiperspirant agents. Other options include laser hair removal. Medical anti-inflammatory or antiandrogen therapy and biologic therapy. Surgery may become necessary for significantly involved skin. Nonsurgical procedures are only supportive but its importance cannot be emphasized enough before or after surgery.





Melanoma

Malignant melanomais the most serious form of skin cancer because of its potential to spread. Melanoma is highly treatable with early detection. Melanomas may appear as a new mole or can develop as an existing mole. A good guideline to follow when checking yourself is the ABCDE criteria of moles. Doing self mole checks is a good habit to get into and watching out for changes in Asymmetry, Border, Color, Diameter and Evolution (changes in color, size, shape or symptoms like itchiness, tenderness, or bleeding).

 
 
 
 
 

Exposure to sunlight and artificial UV light is a major risk factor. About 90% of melanomas are associated with severe UV exposure and sunburns over a lifetime. Risk factors include people who are fair skinned especially those with sun sensitive skin. Red or blond haired individuals are more prone to this. A close family history of melanoma or a personal history of melanoma is also a known risk factor. A bacteria called p.acnes, commonly found on our skin also gets inside the clogged pores causing the pimple. The deeper the inflammation, the bigger, and deeper the acne becomes. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.

Recognizing a changing mole is the best way to detect early melanoma. If you have a changing mole or a new mole or a mole that looks different than the rest of your moles, a consult with Dr. Sajic and his team is prudent in order to initiate treatment at the earliest possible time if it turns out that the lesion is a melanoma. Other conditions may also arise like psoriatic arthritis which presents with joint pain, swelling or stiffness. Also be on the look out for nail abnormalities.

Melanoma is highly treatable if found early. Dr. Sajic can teach you what to look for when you come in for a mole screen. How often you would need a skin exam would detect on the patient’s individual risk factors. If you have had a history of melanoma you should have a full body exam at least annually care of your doctr and perform a monthly self-exam for new and changing moles. Give your doctor a call if any changes concern you.





Skin Cancer

Skin cancers are the most common forms of cancer diagnosed in Canadians 2011. 90% of skin cancers are curable if detected in time. We offer screening, diagnosis, and treatment of skin cancers, including non melanoma skin cancers including basal cell carcinoma, squamous cell carcinoma, and melanoma. Risk factors include Fair-skinned people, people who have a history of severe and repeated sunburn, prior use of tanning booths and a personal or family history of skin tumors all lead to a higher incidence of skin cancer and early screening is essential.  Baal cell Cancer is the most common type of non melanoma skin cancer. They frequently appear as a recurring non healing lesions.  They can occur anywhere in the body but are frequently found in sun exposed areas of the head, especially the nose.  Basal cell is slow growing and rarely metastasizes but it can grow deeper into the skin and involve deeper parts of the tissue as well as the bone. Squamous Cell Carcinomas are another type of skin cancer and most evolves from precursor lesions of actinic keratosis (the earliest stage of skin cancer) and Bowen disease. The risk of metastasis is greater compared to basal cell carcinoma.

Exact etiology of BCC is unknown. Environmental factors particularly long-term exposure to the sun is a well established risk factor. Genetics also plays a role as a positive family history also increases the chances of developing skin cancer.

Usually patient complain of a persistent,non healing skin lesion especially in sun exposed areas. Dr. Sajic will assess the lesion and assess the need for biopsy and further treatment
 
Treatment options will depend on the type of skin cancer, its location, and its involvement. Dermatologic surgical options include electrodessication and curettage (ED&C), surgical excision, cryosurgery and Mohs micrographic surgery. Other options include topical chemotherapy and photodynamic therapy. Radiation therapy is an option if there are postsurgical  margins that are positive for cancer.




Actinic Keratosis

These red, crusty scaly growths usually found in sun exposed areas like the face, bald scalp, ear, shoulders, neck, and back of the hands and forearms. AKs are a sign of skin damage due to cumulative exposure to UV radiation. AKs appear on skin that has been frequently exposed to the sun or to artificial UV light like tanning beds. It is considered a precancerous lesion because about 10% of them have the potential to develop into skin cancer. AKs develop slowly and are usually first noticed by patients as a sandpaper-like rough texture on the skin. The lesions may disappear or flake off and then reappear later. The problem with these lesions is that there is no way to know ahead of time which ones are precursors to skin cancers. Fortunately, there are several options for treatment depending on severity and location of the lesions.
 
 

Exposure to sunlight and artificial UV light is a major risk factor. About 90% of melanomas are associated with severe UV exposure and sunburns over a lifetime. Risk factors include people who are fair skinned especially those with sun sensitive skin. Red or blond haired individuals are more prone to this. A close family history of melanoma or a personal history of melanoma is also a known risk factor. A bacteria called p.acnes, commonly found on our skin also gets inside the clogged pores causing the pimple. The deeper the inflammation, the bigger, and deeper the acne becomes. It may also be hereditary and is called Atopic Dermatitis. This immune mediated eczema starts in infants. These children have a higher chance of developing asthma and may have family who also have these problems.

Recognizing a changing mole is the best way to detect early melanoma. If you have a changing mole or a new mole or a mole that looks different than the rest of your moles, a consult with Dr. Sajic and his team is prudent in order to initiate treatment at the earliest possible time if it turns out that the lesion is a melanoma. Other conditions may also arise like psoriatic arthritis which presents with joint pain, swelling or stiffness. Also be on the look out for nail abnormalities.

Actinic Keratoses can be treated by any of the following options: Liquid Nitrogen Cryotherapy (“freezing”), topcal field therapy usually performed at home including imiquimod (Zyclara), or 5-fluorouracil (EFUDEX), Chemical peeling, Surgical excision or curettage or with PHOTODYNAMIC THERAPY. Photodynamic therapy is a proactive treatment since it targets both subclinical (lesions which can’t be seen or felt) and clinical lesions as well. This is a treatment option which you should consider if you are in your late 30s to early 40s as a good preventative measure as well.
 
 




Excessive Sweating

Excessive sweating, also called hyperhidrosis, is a common disorder that is often under reported. It interferes with many activities of daily living. It may cause embarassment and frustration especially in social and professional situations. There are three types of hyperhidrosis: Primary focal, generalized idiopathic and secondary generalized hyperhidrosis. Primary focal Hyperhidrosis usually involves palms, soles, underarms and to a lesser extent head, and groin regions. Symptoms begin in childhood or puberty. Hereditary component also plays a role with apporximately 1/4 of patients having a family history of the same problem.

 

Primary focal hyperhidrosis is not caused by a medical condition or medications. It is thought that an overactive autonomic nervous system contributes to the pathophysiology of this condition. This causes excessive sweat production by the eccrine sweat glands.

Excessive sweating that is bilateral and symmetric that impairs daily activities is the most common complaint. This excessive sweating can cause discomfort and skin irritation leading to a higher chance of bacterial and fungal infections. It also causes emotional embarrassment and is associated with depression and anxiety. Severity of the disease can range from intermittent, slightly moist palms and soles to daily sweating requiring frequent use of towels and necessitating a more than average change in clothing throughout the day.

Antiperspirants which contain aluminum chloride hexahydrate are the first line options. Product slike Drysol and Hydrosal are effective and are applied on dry skin at bedtime and washed off in the morning. There are oral medications such as Ditropan or Robinul which can be used if topical agents are not helpful or too irritating. These medications block the receptors in the glands preventing stimulation of sweat production. Beta blockers such as propranolol may also be used in stress-induced sweating. Dr Sajic can help you figure out which medication combination is right for you. Botox is another option offered by Dr. Sajic and requires injection of a dilutd form of botulinum toxin into the affected areas. This medication blocks the release of a neurotransmitter and is an effective treatment that lasts 4-12 months depending on which area is treated and your individual response to the medication. Most drug plans will pay for the entire cost of the medication. Alma SweatX is a new treatment offered in our clinic and works by delivering controlled thermal energy to the affected areas which then deactivates the sweat glands. The treatment is quick and painless with improvements seen after one treatment. Optimally 4 treatments are recommended. The treatment is dramatic and lasting reduction of sweat and associated body odor. After the treatment, follow up appointments will allow Dr. Sajic to assess whether additional treatment sessions are needed.
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