Dr. Steven Kern, MD

Physician Dermatology

Specializes in Dermatologic Surgery

Park City, Utah View map

Dr. Steven Kern, MD

Medical Expertise

acne, atopic dermatitis, psoriasis, skin cancer,

Tips & Wisdom

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. Learn More

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.

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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.

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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.

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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.

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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.

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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.

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. 

Primary Location

Park City
1790 Sun Peak Dr. , Ste A103
Park City, Utah, 84098

(435) 658-1013

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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