MEDICAL/ SURGICAL DERMATOLOGY

acne

mole

Hair and Scalp Disorders

Dr. Darling is an expert for Hair and Scalp Disorders both medical and surgical with hair transplants,

The Hair and Scalp Clinic at Missouri Hair Institute/ Total Skin Center is an advanced and highly specialized center for diagnosing and treating rare and common hair and scalp disorders that affect adolescents and adults.

This includes:

  • Male- and female-pattern baldness
  • Hair shedding (telogen effluvium)
  • Alopecia areata (totalis/universalis)
  • Scarring alopecia (lichen planopilaris, frontal fibrosing, central centrifugal)
  • Hair loss related to autoimmune disorders or other diseases
  • Hirsutism and hypertrichosis or excessive growth of the hair

Advanced Diagnostics for Hair and Scalp Disorders

We use the most advanced methods for diagnosing alopecia from a scalp biopsy.

Horizontally sectioned biopsies provide a wealth of information regarding the state of the hair follicles in patients with alopecia, yet few pathology laboratories perform this service. Horizontal sections are performed routinely at Missouri Hair Institute.

Dr. Darling utilizes an even more advanced method called the Vertical technique for diagnosing hair loss and other disorders from a scalp biopsy. The technique uses vertical testing approach that provides a greater amount of information to the referring physician.

Comprehensive Medical Assessment of Hair loss

Dr. Darling provides a thorough medical assessment of patients with hair loss with the goal of optimizing conditions for hair growth. Patients undergo a comprehensive assessment that may include:

  • Detailed personal and family history
  • Examination of the hair and scalp
  • Scalp biopsy
  • Blood tests
  • Nutritional assessment

Patients with hair and scalp disorders receive a thorough evaluation and an accurate diagnosis before formulation of an appropriate treatment plan.

Treatment

Treatment for Hair and Scalp related diseases can vary considerably.  Using comprehensive and state of the art techniques, a successful treatment plan will be designed for each patient both medical and or surgical hair transplant if desired.

Eyelash Analysis

Our Visia Photographic Camera System evaluates the results of lash improvement treatments with numerical assessments and graphic visualizations.

Skin Cancer

If not taken care of, skin cancer has the potential to be deadly and should be taken care of as soon as possible. Skin Cancer is the most common cancer in the United States. Basal Cell carcinomas and Squamous Cell Carcinomas, the two most common forms of skin cancer are highly curable if detected early and treated properly. They are far more common than melanoma. The vast majority of  skin cancer deaths are from melanoma.

Basal Cell Carcinoma (BCC) is the most common type of skin cancer. It is also the most commonly diagnosed cancer in the United States. It is estimated that 3.5 million cases are diagnosed every year. This skin cancer usually develops on sun exposed skin  including head, neck or back of the hands. BCC is very common on the face especially on the nose. While BCC often develops on skin that has had the most sun, it can also appear on any part of the body including the trunk, legs and arms. It usually appears as a pearly patch or shiny bump or pimple that will not go away and easily bleeds.

Squamous Cell Carcinoma typically appears as a red scaly patch or bump that never heals. It can also be tender to touch. Both Basal Cell and Squamous Cell Carcinomas are rarely deadly but if they are present for a long period of time can invade deeper structures of the skin and surrounding tissues that can lead to disfigurement. Squamous Cell Carcinoma can rarely spread.

The treatment for Non-Melanoma Skin Cancers is simple excision. Cancers on the Head and Neck are associated with the greatest risk of reoccurrence and occur in functional or cosmetically sensitive areas. In these cases Mohs Surgery is performed.

Reconstruction Process

Once the procedure is complete, the surgical site is ready for repair. The best method for repairing a wound from a Mohs surgery cannot be determined until after the procedure is complete. Dr. Darling will discuss with you the  best options for your particular case. These options include:

  • natural healing
  • stitches
  • skin graft
  • skin flap

Melanoma is far less common than Basal Cell Carcinoma or Squamous Cell Carcinoma. Melanoma rates in the United States have doubled from 1982 to 2011. Melanoma in Caucasian women younger than 44 years of age has increased 6.1% annually. If found early, melanoma is highly treatable with a cure rate approaching 100%. Melanoma that has spread to a distant site is unfortunately associated with a poor prognosis. Dr. Darling believes in the importance of sun protection with sun screen and sun protective clothing as well as regular self-examination of moles at home and annually in our clinic. Dr. Darling provides Total Body Skin Exams for skin cancer both non-melanoma and melanoma. He will also review your risk factors for melanoma and how to lower them.

Your skin is your first defense against the elements. It protects your body’s bones, muscles, and organs, and guards against infection. However, the skin is also vulnerable to damage, especially by the sun, which often results in premature aging and an increased risk for skin cancer.

The sun is the primary culprit of skin damage. When your skin is exposed to the harsh rays of the sun, the top layer of skin cells become uneven and scaly. Even after your skin heals, fine lines, wrinkles, and freckles may develop. Even if you don’t sunburn often, direct exposure to the sun generates free radicals that further damage your skin on the cellular level. Free radicals alter skin cell DNA, resulting in changes in skin texture and increasing your risk of cancer.

Skin damage can also result in premature aging. Your skin’s firmness and smoothness relies on an underlying layer of collagen that supports muscles and tissues. After sun damage occurs, collagen begins to break down, resulting in sagging or lumpy skin. Smoking and genetics also affects how your collagen develops and breaks down.

The best way to prevent damage to your skin from the sun is to wear sunscreen and re-apply often. Use sunscreen any time you will be outside for an extended period of time, even  during the winter. The more damaged your skin is, the harder your body has to work to repair your skin cells, so it is important to remain vigilant about protecting your skin. 

Taking care of your skin is an art. Dr. Darling customizes your treatment recommendations based on the cancer type, location, functionality of the treatment (how a treatment affects you) and your cosmetic outcome after treatment.

Acne

Acne is the most common skin condition in the United States. Although it’s common, accurate information about acne can be scarce. This can make it difficult to get clearer skin

Acne can present as whiteheads or blackheads, small red bumps known as papules and pustules. In the most severe form, deeper more severely inflamed lesions called nodules and cystic acne lesions can occur which are painful and even lead to scarring.

Acne can present in 3 phases of life. In the teenage years, acne presents typically as whiteheads and blackheads on the face more pronounced on the T-zone (forehead and nose region). In Adulthood, acne presents as reddish bumps on the face and even the lower jaw line and chin area. This is typically due to hormonal imbalances and may occur in the reproductive years or post-menopausal years.

Acne can affect patients self-image as well as confidence and can even lead to depression. Acne is irritating to the skin and can be painful with larger inflammatory lesions.

Acne is caused by abnormal function of the hair follicles and oil glands connected to them. When these factors are combined with excessive  bacterial overgrowth, acne occurs.

Oral and topical medications are very effective for most forms of acne. In severe forms, a medication know as “Accutane” can show good results. Other treatments that are successful include chemical peels, light based treatments with blue light, laser treatments and combination therapies.

Rashes

One of the most common reasons for a referral to a Dermatology Provider is a rash that fails to respond to therapies attempted by a Primary Care Provider (PCP). As a specialist, Dr. Darling is there to assist both the patient and PCP in diagnosing and controlling rashes.

Some rashes may be related to an allergic reaction (such as poison oak or nickel), while others are closely linked to irritation from excessive dryness. In every instance, it is important to know the underlying cause of the rash (diagnosis) in order to ensure the proper treatment is prescribed. Sometimes the wrong medication simply results in no therapeutic effect; in other cases, the wrong medication can cause severe worsening of the rash.

Rashes run a wide range of common causes such as:

  • Infectious (i.e. tinea versicolor (“ringworm”); shingles; measles; hand, foot, mouth disease)
  • Autoimmune (i.e. lupus, psoriasis)
  • Allergic (i.e. atopic dermatitis, contact dermatitis)

To the untrained eye, all rashes may look alike and seem easily treatable with over-the-counter oral antihistamines or hydrocortisone cream. However, this is not always the case. Rashes can appear as blotches, welts or blisters; they can be red, itchy, scaly, or dry; and they can occur in one area of skin or all over the body. In addition, some rashes may come and go, while others never seem to go away. Although most rashes are not life-threatening, some rashes can be a sign of a more serious underlying disease.

Sun Damage / PreCancers

Actinic keratosis (AK) are precancerous skin lesions due to chronic, prolonged sun exposure. Classically, AKs are considered to be a pre-cancerous form of Squamous Cell Carcinoma. When present, patients describe AKs as rough, scaly, flat sand-paper feeling growths. If left untreated, these lesions may progress to non-melanoma skin cancer known as  squamous cell carcinoma. Early intervention can help in the progression of the disease, as well as making the skin appear more healthy and youthful.

Traditionally each individual lesion is treated with liquid nitrogen (“freezing” or “burning”).

Photodynamic Therapy, often referred to as “blue light” or Photodynamic Therapy, is an office based procedure with long lasting suppression of actinic keratosis lesions. Photodynamic Therapy is minimally painful, non-invasive, and requires little effort or discomfort on the part of the patient.

Dr. Darling can instruct you on prevention of Sun Damage and Precanerous lesions with our Visia Photographic analysis with UV photography. Please call today for your skin sun damage assessment.

Sun Spots

The appearance of sunspots are very common as we age. Sunspots or lentigines are discrete, flat brown lesions in areas that have had significant sun exposure – typically the face, backs of hands, upper chest, and forearms. To help minimize your risk of developing sunspots, we strongly recommend the daily use of a broad-spectrum sunscreen. The American Academy of Dermatology and the American Cancer Society recommend a minimum of SPF 30 applied regularly, every 90 minutes to achieve the best protection.

To treat these cosmetically concerning brown spots, various treatments including prescription strength bleaching creams, and cosmeceuticals are effective. Laser treatment will often result in complete resolution of sun spots. Remember, while sun spots themselves are not dangerous they are a marker for the extent of past sun exposure over your lifetime and represent skin damage from sun exposure. Be careful.

Rosacea

Rosacea is a common condition typically in Caucasians in their 30’s, 40’s and  50’s which is characterized by flushing or redness with or without pimples, predominantly over the face. Many Rosacea patients tend to have sensitive skin, and often describe stinging, tingling or burning sensations, especially on exposure to certain chemicals, products, or sunlight. As this sensitivity and flushing worsens over time, small blood vessels (telangectasias) develop in the prominent regions of the nose and cheeks. In other patients, prolonged pimples and bumps (papules) result in sebaceous hyperplasia or marked thickening and growth of oil glands of the skin structure of the nose creating a “cauliflower” appearance known as Rhinophyma. Rhinophyma can not only disfigure the nose and patient’s self-image, but can be very uncomfortable. Many medications can greatly diminish papules and pimples in most patients, though the redness and blood vessels can be just as concerning and are less affected by medications. For more permanent, lasting resolution of redness and flushing, laser or light therapy can often help a patient maximize their goals of therapy.

Birthmarks

Birthmarks can be present at birth or develop shortly after in the first few months of life. There are two major types of birthmarks, vascular or pigmented lesions. Vascular birthmarks, such as hemangiomas and port wine stains, are often red in color and either flat or bulbous in appearance. While hemangiomas typically go away with time, port wine stains tend to darken and thicken over time, making distinction between these two lesion types important. The appearance of Pigmented birthmarks such as café-au-lait spots, Nevus of Ota and Becker’s nevus can sometimes be improved with laser treatments. In certain instances surgical excision for a congenital mole (nevus) is sometimes appropriate; if there is doubt, have the lesion evaluated by our clinic.

Melasma

Melasma, known also as “the mask of pregnancy” is best known as patchy dark lesions (hyperpigmented patches) on the face. Classically, melasma is most frequently seen in patients during periods of hormonal changes and/or significant sun exposure that includes teenage years and in reproductive life when planning a family. Oral contraceptives and pregnancy are known to exacerbate this condition. Ultraviolet A radiation (UVA) typically has a direct role in the worsening of melasma. For patients at risk for melasma, or with a history of hyperpigmentation, sun protection is essential to both the prevention and treatment of melasma. Treatment of melasma consists of topical agents (over the counter and prescription), chemical peels, and some laser and light treatments to achieve optimal results.

Photodynamic therapy (PDT)

Photodynamic therapy (PDT) utilizes a photosensitizing agent (aminolevulinic acid or ALA) and a light source (Blu U) in order to treat a wide range of skin conditions ranging from inflammatory acne and sebaceous hyperplasia to precancerous lesions (actinic keratoses).

For our PDT protocol treating Actinic Keratoses, ALA is applied to the skin and allowed to incubate 90 – 200 minutes, depending on the treatment site. During incubation, the ALA is selectively absorbed by precancerous cells and by the bacteria that inhabit the skin and can cause acne. Once absorbed within those cells, a photochemical reaction occurs converting ALA into protoporphyrin IX, a light sensitive agent. Now that the target cells have “smart bombs” inside primed for activation by light, the Blu U light source is applied to the treatment area for 20 minutes, activating the medication.

While our patients experience minimal discomfort and achieve amazing results with our PDT protocol, it is very important to conduct strict light avoidance for 36 to 48 hours following treatment. Many patients will note a mild, sunburn-like reaction lasting for two to four days, the length of medication incubation time.

Skin Cancer Screening

Dr. Darling’s primary interest is the prevention, diagnosis and treatment of skin cancer. To better ensure the best results of your total body skin exam (TBSE), we ask that you please remove all of your make-up as well as any nail polish. He will check you from head-to-toe, utilizing a tool called a dermatoscope to better visualize your individual lesions. Our nursing Staff will ask you to disrobe, but you may choose to keep on undergarments, if you prefer. If  a lesion of concern during your exam warrants further evaluation, Dr. Darling may recommend a skin biopsy. To help ensure each patient has the full time allotted for his or her exam without excessive waiting, biopsies may be scheduled at follow-up appointments.

Skin Surgery for Cysts, Lump’s and Bump’s

While benign, multiple types of growths in or on the skin and soft tissues can be aesthetically displeasing, painful, or cause decreased quality of life.

These include:

  • Cysts
  • Lipomas
  • Giant comedomes

These masses are frequent reasons for patients seeking dermatologic care and are easily addressed. We ask patients to note that minor surgeries for these lesions require preparation of both staff and resources, and are not performed on the same day.

Vascular Lesion Removal

Vascular lesions can be congenital (at birth or near birth) or acquired (senile angioma). There are multiple, mild therapies from hyfrecation to laser and light sources that are very effective at diminishing or altogether eliminating these lesions, which include hemangiomas, capillary vascular malformations, spider angiomas, broken blood vessels and scars, among others. Virtually all of the vascular lesion removal procedures are well tolerated and almost always performed without any anesthesia and virtually no downtime or post-procedural discomfort. Some patients may note post-treatment swelling or transient darkening of the lesion(s), however this is less common and resolves typically within two to four days.

Spider veins on the legs are treated cosmetically with multiple modalities including sclerotherpay, radiofrequency and/or laser. Dr. Darling has a special interest in treating cosmetically sensitive leg veins. Often an ultrasound is required to map the area to be treated. Please schedule your consultation with Dr. Darling for treatment of your leg veins.