MEDICAL/ SURGICAL DERMATOLOGY

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

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.

I am text block. Click edit button to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

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.

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.

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.

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

I am text block. Click edit button to change this text. Lorem ipsum dolor sit amet, consectetur adipiscing elit. Ut elit tellus, luctus nec ullamcorper mattis, pulvinar dapibus leo.

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.

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.

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.

acne

Skin Conditions

The Total Skin Center located in the Kansas City area understands the emotional, physical, and mental pain skin disorders inflict on our patients. These ailments cause irritating aches, itching, discoloring, rashes, dryness, inflammation, and more, which all interfere with daily life.

Skin disorders stem from a range of causes. Some common ones are:

  • Stress
  • Hormonal imbalance
  • Anxiety
  • High carbohydrate diet
  • Food allergies
  • Poor hygiene
  • Lack of sleep
  • Acute or chronic illness
  • Low immunity and susceptibility to infections

We are here to help through the numerous services we offer to treat potential skin issues. Listed below are some common conditions and treatments, which will vary from patient to patient. Each condition has its own page where you can learn more about causes, treatments and symptoms.

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.

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.

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.

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 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.

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.