Dr. Steven Kern, MD


Physician (MD, DO)
Dermatology

Specialty

Dermatologic Surgery

Provide Feedback
Park City Dermatology
1790 Sun Peak Dr.
Ste A103
Park City, Utah 84098 [MAP]
For an appointment, call (435) 658-1013
Learn More

About Me

Dr. Kern is a board certified dermatologist and dermatologic surgeon who was in private practice in San Diego, California, since 1991. He relocated to Park City, UT in 2006.

 
Dr. Kern is a member of numerous medical societies. His curriculum vitae and references are available upon request.

Conditions Treated

Acne
Aging Skin & Wrinkles
Allergic Contact Dermatitis
Atopic Dermatitis
Hair Loss (Balding)
Psoriasis
Rosacea
Skin Cancer
Warts
Acne Scars
Actinic Keratoses (AKs)

Procedures & Services

Botox® Cosmetic
Dermal Fillers (Soft Tissue Augmentation)

Tips & Wisdom

Seborrheic Keratosis
Seborrheic Keratoses (singular:  Seborrheic Keratosis) are harmless, common skin growths. They occur during adult life, gradually increasing in number. Some persons have a very large number of them. They are not caused by sun exposure. They should not be confused with Actinic Keratoses (also called Solar Keratoses). Actinic Keratoses are often pre-cancerous.

Seborrheic Keratoses are harmless. They begin as slightly raised, light brown spots. Gradually, they thicken and take on a rough, wart-like surface.   They slowly darken and may turn black. They typically look as if they were stuck on top of the skin.

Treatment

Removal of Seborrheic Keratosis is entirely optional if the doctor is certain of the diagnosis. Some insurance companies may consider the treatment to be “cosmetic” and therefore it may not covered. However, sometimes they itch, rub against clothes, or are cosmetically unpleasant. In these circumstances, they are often removed. This is very easy to do and does not leave a scar. However, the skin underneath may be lighter in color than the surrounding normal skin in some cases. The color difference may resolve with time. In almost all cases, the appearance after removal is better than before removal.
What is an AK?

What is an actinic keratosis?

“Keratosis” (plural keratosis) refers to a rough scaly spot. An actinic keratosis (sometimes called a solar keratosis) is a rough scaly spot caused by many years of repeated sun. These rough spots remain on the skin even if the crust or scale is picked off.

Why treat actinic keratosis?

Actinic keratoses are not skin cancers. However, they are often referred to as “pre-cancerous” because they may sometimes turn cancerous. It’s a good idea to remove them before this occurs. Since the treatment is much simpler, scars do not result from the treatment of the actinic keratosis. In fact, your skin will look much smoother after they are removed. On the other hand, if you wait too long and a skin cancer develops, a visible scar will result from its surgical removal.

Treatment

Treatment of actinic keratosis requires removal of the defective skin cells. They are usually treated by freezing the spots with liquid nitrogen. Freezing causes blistering and shedding of the sun-damaged skin. Sometimes we’re not sure whether or not the growth has progressed to a skin cancer. When there’s doubt, we cut the growth off and send it for microscopic analysis (biopsy). Healing after removal usually takes two to four weeks, depending on the size and location of the keratosis. Hands and legs heal more slowly than the face. The skin’s final appearance is usually excellent. Occasionally, the frozen spot may appear lighter than the surrounding skin.

When there are many actinic keratosis, a useful treatment is the application of 5-fluorouracil (5-FU). The medication is rubbed on the keratosis for several weeks. These medicines destroy sun-damaged skin cells. After three to five days the treated area starts to turn raw. The applications are continued until your physician determines that you have the needed results. Healing starts when the cream is stopped.

Can I prevent new actinic keratosis from developing?

The number of new spots can be decreased by limiting sun exposure. When exposure is necessary, sunscreen with high SPF (greater than 15) should be used. However, you may continue to develop pre-cancerous lesions due to the many years of sun exposure you have already had. These should be treated.

Elderly persons who totally avoid the sun and who use sunscreen may possibly become Vitamin D deficient (sunlight causes the skin to produce Vitamin D). Therefore, it is wise to drink three glasses of milk per day or to consume the recommended daily allowance of Vitamin D as a nutritional supplement.

What if I develop new spots in the future?

If you have severely sun-damaged skin, this therapy may need to be repeated as often as every 6 months in spite of sun avoidance from now on.

Future recurrences should not be self-treated with left over medication as you may be unknowingly treating skin cancers which should not be treated in this manner. Return to our office for an examination before re-starting treatment.

Tips to Avoid Itching

You can take some basic steps to reduce itching

Bathing

Bathe or shower with lukewarm or cool (not hot) water.

Lubrication

Within three minutes after drying after every bath or shower, apply a lubricant (moisturizer) to the entire body. It is important to apply this immediately after drying in order to trap any moisture remaining in your skin from bathing.

Greasy or oily lubricants such as Vaseline jelly, aquaphor, mineral oil, or “baby oil” are best, but many people do not like the greasy or oily feel. Good compromises that are more pleasant to use but still fairly effective are Eucerin cream or lotion and Nivea cream. There are a large number of other effective moisturizers. Examples include Nutraderm 30, LactiCare, Complex 15, Moisturel, Lac Hydrin Five, Purpose Dry Skin Cream, and many others. Find a moisturizer that you like to use and will use religiously.

If the skin is still dry, or itchy the rest of the day, apply moisturizing ointments, creams, or lotions as often as needed to maintain moist, supple skin. Keeping the skin well-lubricated is the most important part of your therapy. This will help reduce the itch sensation.

Many people find that Aveeno colloidal oatmeal (either oilated or non-oilated) (no prescription required) added to bath water reduces itching and also helps to moisturize skin. If the oilated form is used, a rubber bath mat must be used to avoid slipping. Even if the oilated form is used, a regular ointment or cream moisturizer should still be applied after the bath.

Clothing

Avoid wool or acrylic clothing in contact with the skin. Cotton is usually tolerated the best. Rinse clothes thoroughly after washing.

Climate

Excessively dry or humid conditions should be avoided to the extent possible. Some people, however, improve when they leave a damp climate with wide variations in temperature and move to a warm, dry climate. Overall, Park City is a difficult climate (especially in winter) for sufferers of Atopic Dermatitis.

Emotions

Anxiety, anger, and frustration can directly provoke itching. If these feelings are a problem for you, resolution of these feelings are often of value in controlling your skin disease.

Other

Avoid anything else that you find causes itching or irritation of your skin (such as specific creams, makeup, or perfumes).    Keep fingernails trimmed short to reduce skin damage from scratching.

Tips for Dry Skin

What causes dry skin?

Several factors contribute to dry skin. Repeated exposure to soaps, solvents, hot water, and disinfectants are often at fault. These remove the lipid (oil) from the top layer of skin, allowing water to escapeLow relative humidity and dry, cold winds also “pull” water from the skin. For unknown reasons, certain people (particularly elderly persons) may be more prone to losing skin moisture.

Bathing

Bathe in lukewarm or cool water. Minimize soaping and scrubbing, limiting soap application to the face, feet, groin and armpits if possible. Use a mild soap such as Dove. More expensive glycerinated soaps are equally good.

Moisturizers (lubricants)

Within three minutes after every bath or shower, pat dry and apply a lubricant (moisturizer) to the entire body. It is important to apply this immediately after drying in order to trap any moisture remaining in your skin from bathing,

If the skin is still dry or itchy the rest of the day, apply moisturizing ointments creams or lotions as often as needed to maintain moist, supple skin.

Greasy or oily lubricants such as Vaseline jelly, Aquaphor, mineral oil, or “baby oil” are best, but most people do not like the greasy or oily feel. Good compromises that are more pleasant to use but still fairly effective are Eucerin cream or lotion and Nivea cream. There are a large number of other effective moisturizersExamples include Nutraderm, Complex 15, Moisturel, Purpose Dry Skin Cream, and many others. Find a moisturizer that you like to use and will use religiously. In any case, do not pick a moisturizer labeled “for oily skin. ”Pick one instead labeled “for dry skin. ”

Products containing glycolic acid or lactic acid are also very effective, particularly with severely dry or scaly skin. The strongest of these, M. D. Forte, Neostrata, and others are available in our office, or LacHydrin is available by prescription. These may cause a burning sensation after application. Other products with less lactic acid include LacHydrin Five, Epilyt lotion, LactiCare, and Nutraderm 30. As your skin improves, you may be able to switch to less expensive standard moisturizers.

It is not necessary to spend large sums of money on “designer brand” moisturizing creams. These provide no advantage over inexpensive brands. Do not be misled by extravagant claims of special “skin rejuvenating” ingredients such as vitamins, collagen, elastin, or amino acids. Such products are not better than standard, inexpensive products.

Bath Oils will also help lubricate the skin. They may be added to the bath water (about a tablespoonful) or applied directly to the skin immediately after bathing (about one teaspoonful mixed in 1/4 cup of warm water can be used as a rubdown). Mineral oil can be applied directly to the skin but does not mix well in the bath water as the commercial bath oils do.

Many people find that oilated colloidal oatmeal, such as Aveeno, (no prescription required) added to bath water reduces itching and also helps to moisturize skin.

If oils are added to the tub, use a rubber bath mat to avoid slipping!

If you have significantly dry skin, do not rely exclusively on bath oils. Also, use regular moisturizing lotions, creams, or ointments as described above.

Clothing

Avoid wool or acrylic clothing in contact with the skin if these provoke itching. Cotton is usually tolerated the best. Launder with bland soaps and rinse thoroughly.

If you have developed a rash secondary to dry skin (so-called “asteatotic eczema”):

Your doctor may prescribe a topical steroid (cortisone type medication). Apply a thin layer twice per day only where there is a rash. When the rash is gone, discontinue use. However, continue the lubrication suggestions above as long as you have dry skin.

What to do about Moles?

Moles are the familiar and normal tumors on the skin most people. They can come at any time and at any age. Most occur during one’s adult’s life they come in large numbers as a shower of lesions. It is thought that they tend to disappear spontaneously after a period of many years.

Moles consist of nevus cells, a cell thought to be related to both the nervous system and to the pigment –forming cells of the body. This latter relationship explains why a mole can become a melanoma, a very dangerous skin cancer. Perhaps not more than one mole in a million ever changes to cancer so there should be no such necessity to have moles removed to prevent cancer. Many melanomas arise without any relationship to moles.

The mole is strictly a tumor of the skin. The nevus cells are bunched together under the skin surface and sometimes, if there are many, they raise the surface of the skin producing the usual dome shaped configuration of a mole. The color of a mole varies from skin color, from light yellow to shades of brown or even bluish-black. They may be smooth or rough, and may be surrounded by redness, or even absence of pigment.

Generally, moles may be left untreated. Unsightly moles may be removed. It is always wise to have the doctor ask for microscopic examination of one or more of the most troublesome moles that are removed.

The average young adult will have about 40 moles. A mole may be dangerous if it changes in color, size or consistency, surface characteristic, of becomes itchy, painful or bloody. If new moles develop close to an old one, and particularly if there is swelling of the nearby lymph glands, the mole may be dangerous. Again, the mole that is fleshy, elevated, and hairy can usually go ignored except for cosmetic reasons. Moles should be removed if the person continually strikes or injures them. Similarly, tumors situated where the clothing rubs or cuts them, or where the razor cuts them should be removed. Some doctors advice removing all moles on the genitals, palms, and soles as well as in blue-black areas in the mouth.

There are many other types of nevus cell tumors. One of these is the so-called giant nevus, or bathing trunk nevus, a brownish tumor that covers a large part of the body. These are important tumors; they show at birth, and they demand medical attention.

Another type of nevus is called the halo nevus. This tumor is surrounded by an area of decreased color and it too should be observed by a physician and probably should be removed.

The blue is a dome shaped blue tumor which is usually innocent, but which again should be observed by a physician from time to time. Some of the other unusual types of nevi that should be mentioned for completeness include the spindle-celled nevus, the pseudomelanomatous nevus, the balloon-cell nevus, and the nevus with globular melanin.

About 9% of people have nevi on the bottom of their feet and 6% have them on the palm of the hand. These may be removed safely, just as all moles can be safely removed.

Closely related to moles are freckles (ephelides), liver spots (senile lentigines), and while these lesions look alike to the eye, they show different changes microscopically. Neither one is serious, nor should both be ignored unless they show signs of change. It is possible to treat them for cosmetic reasons if desired.

The ordinary nevus should so that a good cosmetic result occurs. Complete excisions of these with subsequent suturing is not only unnecessary, but often produces an undesirable result. We attempt to produce the least amount of scar possible, no matter what area is involved.

It is almost always necessary to have follow-up visits after mole removal because we must check to see that the scar is smooth (a keloid will occasionally form, and this type of big scar is usually preventable if caught early). We also check to see if some pigment is reoccurring in the scar. If it does, this brown color can usually be destroyed with just the brief use of the electric needle.

Hairs and moles will not always be destroyed by the surgery because the hair root often goes deeper than the mole itself. If the hairs do come back after surgery, and if they are annoying they can be destroyed by a procedure called epilation of electrolysis.

Poison Oak & Ivy Treatment

Your doctor will recommend a treatment plan depending on the severity of the rash.

Never apply to the skin creams, lotions, ointments, or sprays containing benzocaine (examples: Solarcaine and others), antihistamines (examples: Benadryl, Caladryl, and others), or zirconium. These frequently produce allergic rashes.

Treatment options for mild to moderate rash:

Soaks: When the skin is weeping, oozing or crusted (or if bathing causes stinging or burning), use this technique:

1. Lie in a comfortable position, usually in bed, with a waterproof material over the mattress to prevent wetting the mattress.

2. Obtain dressings, which do not need to be sterile. These may be 2-4 inch wide Kerlix, soft gauze, or soft linen such as old sheeting or pillowcases, handkerchiefs, or shirts.

3. Moisten the dressings by immersing them in a solution of two Domeboro Blueboro tablets or packets per quart of lukewarm water. Alternatively, you may use a solution of ¼ cup of vinegar per quart of water.

4. Gently wring them out so they are sopping wet, but not dripping. Wrap loosely several layers on affected skin so that rapid drying does not occur. Cover with a towel.

5. Remove after ____ minutes. If dry, it may be necessary to re-moisten dressings to remove adherent crusts. Re-apply with the following frequency: __________.

6. Discard or launder dressing material daily

7. Do not treat more than one-third of the body at a time in order to avoid excessive chilling.

Baths: take baths with Aveeno colloidal oatmeal added to bathwater (one cup to ½ tub), 2-3 times per day.

Antihistamines: Itching can be reduced with the use of oral antihistamines. There are many effective medications in this class. These are typically started at a low dose and gradually increase until relief is obtained or intolerable side effects occur, which ever occurs first. Drowsiness is the most common side effect at higher doses. However, this and other side effects sometimes resolve after a few days even while continuing to take the medication.

Caution must be used when driving or performing sensitive tasks. Use of alcohol should be avoided or limited due to increased side effects and Never used before driving. Caution must also be used if other medications that can reduce one’s alertness are used (for example Valium, Librium, Xanax, and barbiturates. The combination of these medications may cause decreased alertness).

Calamine lotion: This is non-prescription item also reduces itching and is soothing. Apply as often as needed.

Topical corticosteroids: Immediately after bathing and also one other time during the day, apply to the involved skin. Wait until after the blisters have subsided before starting this treatment.

Treatment option for severe rash

Oral corticosteroid: Prednisone, a corticosteroid medication taken by mouth, is dramatically effective in treating a severe rash. It’s safe to take for a short period (three weeks). If taken for too short a time, a “rebound” effect may occur when it is stopped, where the skin suddenly gets worse. Thus it is important to precisely follow the instructions given. If you have a peptic ulcer, high blood pressure, or diabetes, you should inform your doctor.

Improvement in your rash should be prompt and steady. It depends on getting enough steroids. If you don’t improve steadily, please call your doctor so treatment can be modified.

Aging Skin & Wrinkles

QUESTIONS AND ANSWERS ON AGING SKIN

WHAT IS PHOTODAMAGE AND HOW CAN IT BE PREVENTED?

“Photodamage” is a term that encompasses all harmful interactions between sun and skin, both acute and chronic.  Virtually everyone is acquainted with the red, swollen, stinging experience of sunburn.  Yet, many are unaware that accumulated sun exposure may lead to a wide variety of delayed effects, such as skin cancers, scaly pre-cancers (actinic keratoses) and other effects, like facial wrinkling, which we commonly assume are due to aging.  Although the word “photo” simply means light, most skin researchers believe the effects seen with photodamage are caused by solar-generated long and short wave ultraviolet light (also know as UVA and UVB).

The prevention of photodamage is simple.  First, avoid sun exposure during the peak hours of 10 am and 3 pm.  Second, wear long sleeved clothing and broad brimmed hats.  Finally, since peak sun exposure may be unavoidable and because loosely woven fabrics may allow up to 50% penetration of ultraviolet light, apply a broad spectrum sunscreen that protects against UVA and UVB rays, such as SolBar.

Because 80% of a lifetime Sun exposure may be accumulated before the age of 20, the most effective prevention of photodamage is regular use of sunscreen by children and teens.  Fortunately, it’s never too late to start a regimen of protection.,  A dramatic improvement can be seen in the severely photodamaged skin of older patients who use a broad-spectrum sunscreen with an SPF of at least 15 every day. 

IS NORMAL AGING OF THE SKIN DIFFERENT THAN PHOTOAGING?

Yes, and this has been an area of fascinating research in the last decade.  Although skin does undergo some alterations with the passage of time, such as thinning, dryness and laxity, these aging changes are very mild in sun-protected skin.  In contrast, sun exposed skin undergoes both photoaging and intrinsic aging, resulting in the more dramatic finding we typically associate with coming of age:  wrinkles, laxity, mottling of pigmentation scaly-ness or dryness and accentuation of small blood vessels.  A simple way to illustrate this is to compare the skin on the back of the hand or the face with sun-protected skin such as the breast of abdomen.

WHAT CAUSES LIVER SPOTS?

“Liver Spots” are large flat or scaly brown spots that develop o the backs of the hands.  They are so named because they have a liver-like color, not because they result from liver disorder.  Most liver spots are simply large, sun-induced freckles.  The only way to avoid them is to use sun protection early in life.  These spots are of little medical consequence.  They are one of a large group of benign skin growths patients acquire with age an sun exposure.  A common brown, scaly growth known as keratosis may give the appearance of a liver spot when it arises in its flat form on the back of the hands.  The thicker, dark brown, scaly, “stuck-on” looking keratosis is often found on the torso of older adults.

WHY DOES MY SKIN SEEM TO GET DRIER AS I GET OLDER?

Once again the key to this question may lie in the difference between sun-exposed and sun-protected skin.  Sun-protected skin in older patients is only slightly drier than that in younger patients  Chronically sun-exposed skin cannot maintain itself as well as sun-protected skin.  This dryness should be controllable with the regular use of effective moisturizing creams and lotions.

HOW DO YOU KEEP THE SKIN ON THE SOLES OF THE FEET SOFT AS YOU AGE?

This is a common complaint of older patients  A hot topic of research in the treatment of dry skin has been the effect of creams containing. the alpha hydroxy acids.  These may not only moisturize the skin but cause it to grow in a more normal and less scaly fashion.

©2011 Park City Dermatology. Last updated March 24, 2011

Anthralin for Psoriasis

Anthralin Treatment of Alopecia Areata

What is anthralin?

Anthralin is a drug that will cause skin irritation.  In some cases, this will induce hair growth.  A mild degree of irritation is desired in order for it to have a beneficial effect on hair re-growth.

How to use it

Apply anthralin cream once per day to the areas of hair loss. Rub in well. Wipe off excess. Wash with soap and water after 15-30 minutes. If severe irritation or burning does not occur, the strength may be increased weekly. Start at .25%, then increase to .5% and finally 1%. Should intolerable irritation or burning occur, stop using the anthralin until this is better.  Then re-start at the next lower strength for several days before increasing the concentration again.  If the irritation is again intolerable, stop again until it is better.  Then re-start at the next lower strength and stay at this concentration permanently. Hair re-growth should start to occur within two to four months.  However, significant re-growth occurs in only a minority of patients.  Skin staining will occur. Do not attempt to scrub this away. It will clear in 1-2 weeks. 

Precautions

Plastic gloves will prevent hand staining.  If gloves are not used, wash hands after use.  DON’T RUB EYES!  Should accidental eye contact occur, irrigate immediately and continuously with water while keeping eyes open.  Anthralin will stain clothing so wash it off before putting on clothes (or wear old clothes).

Bathtub and clothing stain removal

Shower or bathtub: Rinse with hot water immediately after use.  Use a suitable cleanser such as Comet to remove any deposit that does not come off with hot water. 

White fabric: Soak for ten minutes in full-strength chlorine bleach such as Clorox, followed by a water rinse and air drying. 

Colored fabric: Dilute chlorine bleach 1:10. Test for color fastness.

©2011 Park City Dermatology. Last updated March 24, 2011

Boils and Carbuncles

RECURRENT BOILS

What causes boils?

Boils (furuncles) are painful swellings of the skin caused by a deep infection with staphylococcus bacteria.  The bacteria enter the skin from the outside, usually through a hair opening.  The source of the “staph” bacteria is not always known. However, many people carry staph bacteria in their nostrils without having any symptoms.  Sometimes, these may be transferred to the skin, causing a skin infection.  Other people in the family may have staph in their nostrils or on their skin even if they do not have boils.

How are boils treated?

Your doctor will mark the appropriate items, depending on the severity of your problem. Take the medication(s) prescribed. In addition to the antibiotic treatment, the doctor may incise (cut) and drain tense lesions since antibiotics alone often will not heal these types of boils.  Do not get pus on your hands. It is best to wear disposable gloves when changing the wound dressings to prevent this.  Wash hands thoroughly after changing dressings if gloves are not used. Dispose of wound dressings immediately.

Do not share towels, wash clothes, sheets, and clothing. Launder in boiling water and change daily.  Gentle heat (a heating pad, hot water bottle, or a lamp held close to the skin) for 20 minutes 3-4 times per day may speed healing.

Do not use handkerchiefs now or in the future.  Use paper tissues instead. This is because staph bacteria are frequently found in the nostrils in people with boils, even when the skin is clear. Tissues should immediately be thrown away.

Shower and shampoo daily with Hibiclens (can be purchased in a drug store without a prescription) instead of your regular soap and shampoo. Start now and continue for the period indicated.

If boils tense with pus, please return to the doctor so that these may be drained. If previously drained boils are not improving, you should also return to the doctor.

If the buttocks are involved with frequent episodes, the following may help prevent recurrences:

  • Wear loose fitting clothing
  • Wear loose-fitting trousers
  • Apply Xerac-AC to totally dry buttock skin at bedtime.  (Use cool air from a blow dryer of fan if necessary to completely dry the skin.  The medication needs to have skin contact for 6-8 hours when you are not sweating in order to work.  While you are sleeping is the best time for this.  In the morning, wash off.)
  • Apply Zeasorb powder during the daytime

If the face is involved:

  • Soak beard with hot water for 5 minutes prior to shaving
  • Discard blades daily
  • As an aftershave, use alcohol
  • Leave razor in alcohol between shaves or boil for 5-10 minutes prior to shaving
  • Soak electric razor heads in alcohol for 1-2 hours between shaves 

Should family members receive any treatment?

Yes. The skin and nasal secretions of family members may sometimes be a source of re-infection even when these people have no visible evidence of infection. This is the reason for the following recommendations.

Family members living with you and others with close contact:

Shower with Hibiclens for at least five days (during the same week that you do so).
Instill Bactroban ointment (prescription required) with cotton-tipped applicator into the front part of the nose once per day for two weeks.


 ©2011 Park City Dermatology. Last updated March 24, 2011

Coal Tar for Psoriasis

WHAT IS COAL TAR USED FOR?

Coal tar is often used in the treatment of psoriasis and sometimes in the treatment of eczema (dermatitis).  It may be used alone (described here) or combined with ultraviolet light treatments (described in another information sheet).

WHAT TYPES OF COAL TAR ARE THERE?

Crude coal tar is messy, stains a lot, and requires a prescription.  Refined coal tar is much less messy, stairs less, and does not require a prescription.  Examples include Estar Gel, Baker’s P&S Plus, Psorigel and T-Derm Tar Oil. Bath solutions are generally weaker than coal tar applied directly to the skin, but they can reduce itching and scaling.  Shampoos containing tar are described in a separate information sheet called Therapy for scalp psoriasis.

INSTRUCTIONS

  • At bedtime, apply small amounts of a refined coal tar and rub thoroughly into the skin.  THE TAR SHOULD BE APPLIED IN THE DIRECTION THE HAIR IS GROWING.  Stroking the tar against the direction of hair growth may allow more tar penetration into the hair follicle causing inflammation and pimple-like eruptions around the hair.
  • Wait for at least 5-15 minutes to allow air drying of the tar before putting on old pajamas.  This will reduce staining of these clothes.
  • If desired, cotton socks or panty hose with the toes cut out can be used to cover the tar on arm or leg lesions.  Do not cover with plastic.
  • Leave on overnight. If this is not feasible, leave it on for at least two hours per day.  The longer it is left on, the quicker it will work.
  • Improvement would begin within a couple of weeks.  Maximum improvement will take up to two months.
  • Avoid sun exposure of coal tar treated skin unless advised by your dermatologist.  He or she may advise sun or ultraviolet treatments after you apply the coal tar will increase sensitivity to the sunlight.


Keep the skin well lubricated by doing the following:  

Within three minutes after bathing and patting dry, apply a lubricant or moisturizer to the affected areas.  It is important to apply these immediately after bathing in order to trap moisture in your skin.  Greasy or oily lubricants such as Vaseline, Aquaphor, mineral oil, or baby oil are best, but many people do not like the greasy feel of these  A good compromise that is more pleasant to use but still fairly effective would be Eucerin cream or lotion or Nivea cream.  There are a large number of other effective moisturizers.  Find one that you like to use.

If the skin is still dry or itchy the rest of the day, apply moisturizing ointments, creams or lotions as often as needed to maintain moist, supple skin.

MAY I CONTINUE TO USE OTHER PSORIASIS MEDICATIONS?

In many cases, you will also be instructed to use a topical steroid cream or ointment in the morning.

DO NOT USE ANTHRALIN WHILE USING TAR.

WHAT SIDE EFFECTS DOES TAR HAVE?

Tar can irritate the skin.  If this occurs, try a different brad of tar.  If the sensitivity persists with other brands, try applying the tar on top of a very thin layer of a moisturizer such as Vaseline Petroleum Jelly, Aquaphor, or Eucerin.

Prolonged use of the tars for years may increase the risk of skin cancer.

©2011 Park City Dermatology. Last updated March 24, 2011

Facial Flushing

Flushing may have multiple causes.  It is most often due to an increased sensitivity of your blood vessels to substances produced by your body.  It may be aggravated by various substances found in certain foods or certain medications.  Even if flushing is aggravated by some of these factors, if it is serious and unremitting, blood and urine tests will be performed to be certain there is no underlying treatable illness causing the flushing.

Please circle any item if you have you noticed any association with flushing.

Foods

Coffee
Tea
Mushrooms
Cheese
Chocolate
Spicy foods, especially red chili peppers 

If you have alcohol-associated flushing, are you exposed to any of the following industrial solvents?  (Circle if yes)

Trichloroethylene-N
N-dimethylformamide
N-butyraldoxime 

If you have alcohol-associated flushing, do you use or eat any of the following? (Circle if yes)

Disulfiram (Anabuse)
Metronidazole (Flagyl)
Chlorpromade (Diabinese)
GriseofulvinCalcium carbamideMushrooms
Cephalosporin antibiotics
Cephalexin (Keflex)
Cephradine (Anspor, Velocef)
Cefadroxil (Duricef, Ultracef)
Cefaclor (Ceclor)
Cefuroxime axetil (Ceftin)

Circle if you have noted an association with:

Frankfurters, bacon, salami, ham (nitrites)
Fresh fruits and vegetables, especially in restaurant salad bars (sulfites)
Monosodium glutamate seasoning often used in Chinese cooking (“Accent”)

Medications (circle any you use)

NitroglycerinHydralazine (Apresoline)
Minoxidil (Loniten)
Prazosin (Minipress)
Terazosin (Hytrin)
Nifedipine (Procardia)
Verapamil (Calan)
Diltiazem (Cardizem)
Nicardipine (Cardene)
TheophyllineFlecaininde (Tambocor)
Quinidine
Nicotinic acid (sometimes in vitamin complex pills)
Cyclosporine (Sandimmune)
Bromocriptine in Parkinson’s DiseaseMorphine

Other

Have you had a spinal cord injury or disease?  No  Yes
Do you have a weakness or numbness of arms or legs?  No  Yes
Have you injured your parotid gland or jaw?   No  Yes
Have you had stomach surgery?   No   Yes

Circle if you have:

High blood pressure
Severe headaches
NauseaVomiting
Chest pain
Abdominal pain
Profuse sweating
Diarrhea
Wheezing
Bloody or black tarry stools
Abnormal heart rhythm
 

©2011 Park City Dermatology. Last updated March 24, 2011

Hydroquinone

PRESCRIPTION STRENGTH HYDROQUINONE PRODUCTS

 

Opaque with partial sunblock

  • Eldopaque Forte*

 

Non Opaque

  • Eldoquin Forte* Cream
  • Melanex Solution
  • Soloquin Forte* Cream or Gel

 

Sun Protection

Absolutely strict sun avoidance or protection is imperative since the ability of the sun to darken melasma is much greater than the ability of bleaching medications to lighten it.  The following sun protection measures apply both on sunny and cloudy days because ultraviolet skin-darkening rays of sun reach your skin even through clouds.

Hats and Non-Opaque Sunscreens:

Every day that you are outdoors for even a few minutes, apply a non-opaque sunscreen.  The label of sunscreens includes an SPF (Sun Protection Factor).  Pick one with an SPF of 30 or greater.

Extra protection can be obtained by wearing a hat that shades your face.  Do not rely exclusively on hats, however, because reflected light will still reach your face while wearing a hat.

Opaque Sunblocks:

When significant outdoor exposure is unavoidable, the best method of protection is an opaque sunblock.  Opaque sunblocks contain large amounts of zinc oxide, titanium dioxide, or red petrolatum.  Examples include the following trade names:  Afil cream, Maxafil cream, RVPaque, and Zinka cream.

Opaque Cover-up Cosmetics:

These also act as effective sunblocks if applied thickly.  This gives a “made-up” appearance.  Examples include:  Dermablend (by Dermablend), Covermark (by Lydia O’Leary), Continuous Coverage (by Clinique), Pan-Stick and Pan-Cake.  The first two provide the heaviest coverage.  If these are used, separate sunscreen products are necessary.  A separate information sheet is available about these products.

*Eldopaque Forte brand of hydroquinone contains a partial opaque sunblock.  However, an additional sunscreen should be used with it, since it is not a totally opaque sunblock.

**Solaquin Forte brand of hydroqinone contains a non-opaque sunscreen.  If this brand is used, it should be supplemented with a regular high SPF sunscreen that will provide better sun protection.

 

©2011 Park City Dermatology. Last updated March 24, 2011

Intertrigo

Your doctor will mark the treatments that are appropriate for your particular situation.

Follow these general techniques to keep the body folds as dry as possible. Continue these suggestions indefinitely to prevent recurrences, particularly during hot weather.

  • Living and working areas should be cool and dry. Use air conditioning or fans if possible. When feasible, expose the involved areas to a fan or cool blow dryer at various times during the day
  • If necessary, separate the involved folds with cotton sheets or other absorbent material dusted with a talc powder (such as Zeasorb). Do not use corn powder.
  • Avoid wool, nylon, and synthetic fibers. Clothing should not be tight. Bras should provide good support. Avoid prolonged sitting.
  • Wash, rinse, dry involved areas at least twice per day.
  • Incontinence of stool or urine must be controlled. Drying powders may be helpful (Zeasorb powder).

 

Specific medication

After washing and drying, apply a thin layer of the following medication(s):_________________  

 

______________________________________________________________________________.

Stop using this medication after the skin is back to normal.

In cases of extreme sweating or the presence of stool and/or urine, creams may not remain active for long.  In these situations, apply Nystatin ointment (prescription required) or zinc oxide paste* over the prescribed creams.

If skin is weeping, a washcloth, towel, or gauze bandage should be soaked in a solution of two Domeboro* of Bluboro* tablets or packets per quart of water.  Wring out the cloth or bandage just enough so that it is still very wet, but not dripping wet.  Apply to the involved area ___________ times per day for 15-30 minutes.  If it dries out, re-soak it.  When finished, thoroughly dry the area and apply the above medication.

*no prescription required

 

©2011 Park City Dermatology. Last updated March 24, 2011

 

Keratosis Pilaris

This disorder causes the formation of small rough spiny elevations of the skin similar to gooseflesh over large areas such as the upper arms and thighs.  It is most prominent in cold weather and less prominent in warm summer weather.  It also varies with the humidity. 

Keratosis pilaris often begins around age two and persists for years extending into adulthood, but many people do outgrow the disease.  Other conditions that give a somewhat similar appearance are vitamin A deficiency, an extremely rare problem, and eruptions due to iodine, kelp, irritating clothing, etc. Although it may be familial, keratosis pilaris is not “catching” or contagious.

Treatment does not cure the problem but it does not help it.  Different forms of lubrication such as mild glycolic acid lotions or creams, mild corticosteroids, and mild tar preparations can be helpful, particularly when there is itching.  Another lotion available without a prescription is Lacticare and one that does require a prescription is LacHydrin Lotion. When the skin is wet following a bath or shower, it is helpful to apply bath oil or other lubricants.  An irritant that helps at times is Retin A, a prescription cream, gel or lotion.  Frequency of use with this product must be spaced so as not to produce significant distress, but just enough benefit.  Constant irritation prolongs and aggravates the problem.

 

©2011 Park City Dermatology. Last updated March 24, 2011

Perioral Dermatitis

PERIORAL DERMATITIS INSTRUCTION SHEET

You have a condition that occurs around your mouth and many times only on your chin, that is known as Perioral Dermatitis, or Rosacea-like Dermatitis. This is a combination of an irritation from acne and eczema.  This condition is very common and it tends to come and go in many people over time.  With appropriate treatment, it can be kept under excellent control.  Some people have to keep treating the skin properly for many years to keep this condition from coming back.

The oil glands are irritated and plugged up, giving the acne redness, pimples, and bumps. The eczema is a localized allergic reaction that comes from within your body that causes the dry scaling, burning, and red look to the skin. This process may be triggered by yeast and mite organisms that normally live in oil glands and hair follicles. 

It is, many times, aggravated by stress, tension, changes in the weather, sun, the wrong make-up, and many other factors of which we are not aware.  The wrong types of medications, soaps, colognes, perfumes, and touching the area will aggravate the chin.  We find that consistently, products made by Lancôme, Clinique, and Noxzema are bad for this condition and should not be used.

Do not use any other medications or soaps, cleansing agents or astringents, sunscreens, etc, on this area except what the doctor instructs you to or give you. You may use your own make-up, or the Max Factor panstick foundations tend to be an excellent sunblock for this area and it is also a good cosmetic cover-up that does not cause acne or irritate the skin.

Try to keep your hands away from the area except when you wash your face. The face should be washed at least two or three times a day with water and a mild soap, such as Dove, Purpose, or a glycerin or oatmeal soap.

This condition responds very well to a low dose of Tetracycline-type medication.  Some people have to take a few of these pills a week for many months in order to keep this from recurring.  There is no harm in taking this medication long term as long as you are not pregnant or breastfeeding.  Topical anti-yeast and anti-mite creams will also be prescribed to maintain clearing.

Topical fluorinated cortisone creams are very bad for this condition.  You must not use strong cortisone creams on your face for long periods of time, as they will temporarily help this condition but, in the long run, tend to perpetuate it or aggravate it.  If you have been using any type of wrong cortisone cream on your chin, your skin has become addicted to it and will go through a temporary withdrawal when it is stopped.  You must stop the cream and you might notice a temporary flare-up in the first week to ten days.  This will then calm down and do very well long-term.

If you have any questions, please do not hesitate to call our office.

©2011 Park City Dermatology. Last updated March 24, 2011

Shingles (Herpes Zoster)

What causes shingles?

Shingles (Herpes zoster) is a nerve infection caused by the chicken pox virus.  Shingles results from activation of chicken-pox virus that has remained in your body since you had chicken –pox perhaps many years ago.  The virus activation is limited to a nerve root.  That accounts for the pattern of the rash, which usually stops at the body’s midline.  The nerve involvement explains the stinging, burning, or pain common in shingles.  Some patients have discomfort before the rash appears.

The rash of shingles begins as red patches that soon develop blisters.  The blisters may remain small or can become large.  They heal in two to four weeks and may leave some scars.

May patients mistakenly believe that “nervousness” causes shingles. This is incorrect.  Shingles is a viral infection of a nerve and has nothing to do with being “nervous”.

Is it contagious?

You don’t have to quarantine yourself.  Until your rash has healed, however, you should keep away from persons who have never had chicken-pox, are ill, or are unable to fight infection because of a disease or a medication.. Persons who have not had chicken-pox can occasionally catch chicken-pox from someone with shingles.. Contact with healthy adults appears safe.

Treatment

Acyclovir (Zovirax) pills can help to control the skin eruption if started early enough after the rash first appears.

The pain can be reduced with aspirin, Tylenol, or Ibuprofen.  If these are insufficient, your doctor can prescribe something stronger.  Pain is often difficult to control and may persist for weeks or months after the blisters have healed.

While blisters and oozing are present, cool compresses will make you feel more comfortable.  Mix ¼ cup of white vinegar into two quarts of water. Soak a washcloth or towel in the solution. Then lightly wring out the towel so it is not dripping. Apply this to the blisters for 10 minutes several times per day.  Stop when the blisters have dried up.

If the trunk or extremities are affected, pain may be reduced by covering with cotton and the wrapping firmly with an elastic (ACE) bandage.

 

©2011 Park City Dermatology. Last updated March 24, 2011

Patient Education Resources

Acne Treatment
  What causes acne? Acne is caused by plugged oil glands.  At puberty, the oil glands in the skin start producing an oily material called sebum.  This is discharged onto the skin’s surface.  Sometimes the wall of the oil gland breaks and spills the sebum underneath the skin’s surface.  The sebum irritates the skin tissues and causes redness, swelling, and pus.  This is a pimple.  At other times, the gland is blocked, but does not become inflamed.  This results in either a “blackhead” or a “whitehead.”  The tendency for oil glands to become plugged is partly an inherited feature that is “built into” you.  However, certain factors may affect acne. Factors that may worsen acne Physical factors:  Pressure, friction, rubbing, and squeezing should be avoided.  For example cradling the chin in one’s hands or prolonged friction from masks, musical instruments, athletic...
Atopic Dermatitis Triggers & Tips
What is Atopic Dermatitis? Atopic dermatitis (atopic eczema) is a fairly common skin disease that affects about 3% of the U.S. population.  It tends to occur in families who have asthma, hay fever, or other allergies.  It occurs most commonly in infants and young children and frequently disappears before adulthood.  It may reappear later, often on the hands.   What causes it? The cause is not known, although a genetic predisposition seems likely.  It is not contagious.  The skin is dry and easily irritated by soap, detergents, wool, and other environmental factors such as extremes of temperature.  These factors cause an abnormal itch sensation, causing the patient to scratch excessively, which accounts in large for the rash.  In rare cases, the itch may be aggravated by specific allergies.  In about 1% of cases, specific foods may worsen Atopic Dermatitis.    What treatments are available? No permanent cure...
Dermatofibroma
What is a dermatofibroma? A dermatofibroma is a slowly-growing, round to oval, brownish to purple, firm skin growth that is usually dome-shaped, but may be depressed below the skin surface.  The most common locations are the legs and arms.  Dermatofibromas contain scar tissue. What causes a dermatofibroma? Trauma or old insect bites cause some dermatofibromas.  In other cases, the cause is unknown. Treatment Dermatofibromas are best ignored since they are harmless.  However, if removal is desired, this can be accomplished surgically.  Unfortunately, when on the leg, the resulting scar may look as undesirable as the original growth. One alternative is simply to flatten the dermatofibroma.  This can be accomplished by freezing it with liquid nitrogen.  This technique destroys only the upper part of the growth.  The remaining lower part may therefore regrow after several years.  Usu...
Poison Ivy and Poison Oak Overview
What causes poison ivy or poison oak rash? Poison ivy and poison oak rashes are caused by allergy to a substance called urushiol found in these plants.  Since urushiol is found in all parts of the plant (leaves, stems, and roots), contact with any of these will induce a rash.  Urushiol can even reach your skin indirectly when you touch items such as clothing, tools, or pets that have been exposed.  These objects may remain capable of transmitting the urushiol to humans for years until they are washed with soap and water. In contrast, human skin (usually hands) will transmit urushiol for only a very short time. What does poison oak look like? Poison oak is the plant found in California, while poison ivy is found in most other states.  They look very much alike. Both have three leaflets arising from a node on the stem.  A few other perfectly safe plants also have leaflets in clusters of three, but to play it safe, it is wise to a...
Psoriasis of the Scalp Treatment
 Use the medication selected by your dermatologist.  The choices will depend on the severity of your scalp involvement. Tar Shampoo: Wet the scalp thoroughly in the shower.  Then apply a shampoo containing tar (Polytar, T-gel, Ionil T,) one containing tar ( polytar, T-gel, Zetar, Ionil T, Denorex, DHS tar gel, Neutragena T/Gel, Tegrin, and others) or one containing tar plus salicylic acid (Beta Tar Gel, Sebutone, Van-Seb T, X-Seb T, Neutragena T-Sal, Ionil-T-Plus, and others). None of these require prescriptions. Rub vigorously for at least 5 minutes.  Do not use fingernails since scratching can induce new lesions of psoriasis. Longer periods of application are even more effective.  After 5 minutes of rubbing, it is best to cover the hair with a warm moist towel, wait 15 minutes, then rinse.  Since the coal shampoo is mainly to treat the scalp, you may wish to use your normal shampoo to clean your hair.  The use ...
Psoriasis Overview
 What is psoriasis? A chronic skin disorder that affects at least 4 million people in the United States. What causes psoriasis?  No one knows. Skin injury, emotional stress and some forms of infections are said to trigger its development. Who gets psoriasis? Men and Women in equal numbers at any age, but most often between the ages of 15 to 35. Psoriasias has been diagnosed for the first time in people of advanced age.  It also strikes children. About 150,000 new cases of psoriases are diagnosed each year. Is Psoriasis contagious? No Is anyone ever safe from psoriasis?  Everyone is a potential victim, but hereditary factors are thought to play an important part, however, the pattern of inheritance has not been clearly established. How serious is Psoriasis?  There are many clinical variations of the disease. Skin involvement can range from a few psoriatic plaques, or lesions, to involvement of large areas of the body.&n...
Tinea Versicolor
What Causes Tinea Versicolor? Tinea Versicolor is a harmless skin disorder caused by a yeast-like organism living on normal skin.  Usually, this yeast, which all of us have on our skin, grows sparsely and is not visible.  In some individuals, for unknown reasons, it grows more actively.  This causes the slightly scaling patches on the trunk, neck, or arms known as Tinea Versicolor is a pink to coppery tan rash.  On tanned skin, the Tinea Versicolor patches are lighter, since tanning doesn’t occur in the rash areas.  The failure to tan is temporary; the skin tans normally within a few months after the rash has cleared up. Tinea Versicolor is not contagious.  It is more common in hot, humid climates and often comes back in the summertime. Treatment While many treatments will temporarily clear Tinea Versicolor, we do not have a permanent cure.  Tinea Versicolor, being caused by a normal skin inhabitant...
Tretinoin
Tretinoin (RETIN-A) Therapy for Acne What Is Tretinoin? Tretinoin (trade name Retin A) is a very effective drug against acne.  It is similar to Vitamin A in structure.  It acts by preventing the plugging of oil glands in the skin. How Long Does It Take To Work? Clearing or marked improvement should occur within 2-3 months.  However, during the first few weeks, the skin may look worse.  Don’t stop using it!  The long-term results will be well worth it.  In the unusual event that it does not cause sufficient improvement, additional or different therapy will be prescribed. Is It Irritating? The goal of therapy is to achieve only mild redness and peeling.  More severe irritation can be avoided by carefully noting the following directions.  In addition, a less irritating concentration of Retin-A is now available (0.025% cream).  Even if irritation occurs initially, the skin ofte...

Education & Training

Dr. Kern, a native southern Californian, graduated Summa Cum Laude and Phi Beta Kappa from the University of Colorado at Boulder. He attended the University of Southern California School of Medicine for medical school training and Internal Medicine residency, then spent a year in Boston, studying the mechanism of skin aging at the U.S.D.A. Human Nutrition Research Center on Aging. His research has led to several publications. He attended the Dermatology and Dermatologic Surgery residency at the University of California at San Diego where Dr. Kern served as Chief Resident.

Park City Dermatology

When you have skin conditions or concerns you want to turn to a dermatologist who listens and responds. An experienced doctor who knows the field and can effectively diagnose and treat your needs. A friendly physician who counsels you on the best ways to maintain and improve your health. Dr. Steven Kern and staff meet all these criteria. You will receive the individualized attention you deserve from a dedicated team of trained and caring professionals.