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Dr. Perri is a featured contributor on Acne Treatment, Mole Removal and other cosmetic dermatology treatments on RealSelf.

Dr. Perri's Blog

Entries in Dermatology Tomball (255)

Thursday
Apr072011

Eccrine Neoplasms - Poromas

Eccrine Poromas are benign eccrine neoplasms that I occasionally encounter in my The Woodlands dermatology and Conroe dermatology offices.  Eccrine Poromas have histological variants called Hidroacanthoma Simplex and Dermal Duct Tumors.  Eccrine Poromas are most often found on the soles of the feet and appear as a red/brown nodule that may be encased in a cup shaped depression.  Most Eccrine Poromas are solitary but there is a variant in which a patient may develop hundreds of lesions called Eccrine Poromatosis.  As Eccrine Poromas may develop malignant degeneration, it is recommended that they be completely surgically excised.

Eccrine Poroma (http://dermimages.med.jhmi.edu/images/Eccrine_Poroma_2_050725.jpg)

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Tuesday
Apr052011

Eccrine Neoplasms - Spiradenoma

Spiradenomas are rare benign sweat gland tumors that usually occur on the chest, neck, face and scalp and I occasionally encounter them in both my The Woodlands dermatology and Conroe dermatology clinics.  Spiradenomas typically occur as solitary 1cm or larger nodules.  The skin covering Spiradenomas appears normal as the lesion is very deep in the skin.  Some Spiradenomas are painful but they may be asymptomatic.  The most common age range of Spiradenomas is between early teens and age 40.  Occasionally, Spiradenomas are hereditary and can be multiple.  Treatment for Spiradenomas is surgical excision. 

Spiradenoma (http://www.dermis.net/bilder/CD193/550px/img0171.jpg)

 

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Monday
Apr042011

Eccrine Neoplasms - Syringomas

Syringomas are a common benign skin lesion that arises from sweat ducts and I occasionally encounter them in both my The Woodlands dermatology and Conroe dermatology offices.  Syringomas appear as yellowish small papules on the eyelids and upper face but can be found in other anatomic areas.  There is rare variant of eruptive syringomas in which many occur at once.  Syringomas can be seen as a hereditary trait in some families and is also seen in higher incidence in Down Syndrome patients.  On histology, syringomas have a unique pattern where they resemble tadpoles.  Treatment is very difficult and some options include shave removal, electrodessication and laser ablation.

Syringomas (http://www.skinsight.com/images/dx/webAdult/syringoma_43578_lg.jpg)

Syringomas histology (http://www.pathologyoutlines.com/images/skintumorsyringoma1.jpg)

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Sunday
Apr032011

Psoriasis - Biologics (TNF alpha Inhibitors)

There is a relatively new class of medicines collectively called the Biologics which work on the chemical mediators of Psoriasis. Tumor Necrosis Factor alpha (TNF alpha) is an important mediator of Psoriasis which induces the inflammation of Posriasis and there is a class of Biologics called the TNF alpha inhibitors which include Enbrel, Humira and Remicade.  These Biologics are indicated for moderate to severe Psoriasis and Psoriatic Arthritis.  Enbrel is a fusion protein that blocks TNF alpha and is administered as a subcutaneous injection by the patient twice a week.  Remicade is a monoclonal antibody, which is administered by an IV in a physicians office every one to two months.  Humira is a monoclonal antibody which is administered as a subcutaneous injection by the patient every two weeks.  TNF alpha inhibitors are contraindicated in the following patients: Patients with active infections, being treated for an infection, have or had Hepatitis B infection, take the medicine Kineret (anakinra), have TB or have been in close contact with someone who has TB, have HIV, have multiple sclerosis or Guillain Barre Syndrome, have heart failure or heart conditions, are scheduled for major surgery, are pregnant, plan to become pregnant or breastfeeding, if a patient is allergic to rubber or latex (for Humira and Enbrel as the needle cover of the syringe/pen contains dry natural rubber.  The side effects of TNF alpha inhibitors include but are not limited to the following: Immunosuppression- these medicines work by suppressing the immune system so there is an increased risk of infections and cancers including leukemia and lymphoma in patients taking these medicines.  The risk of skin cancer is also increased. Re-activation of a previous infection or cancer is also a risk.  Vaccines- Do not receive live vaccines while on these medicines.  Lupus like Syndrome-This can develop while taking the Biologics.  Skin side effects- injection site reactions, rash, skin cancer can occur.  Joints- Joint pain may occur.  Hematologic- Cell blood counts should be obtained routinely to ensure no problems with the blood lines occur.  Caveat- These medicines have undergone extensive clinical trials and have been approved by the FDA; however, they have been on the market a relatively short time so side effects may exist that are not currently known.

Remicade (http://1.bp.blogspot.com/_MTxmQmQ6nNM/SflrqB6ZP2I/AAAAAAAABec/yNFtaLMtDvY/s400/remicade.jpg)

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Saturday
Apr022011

Psoriasis - Psoriatic Arthritis

Psoriatic Arthritis occurs in 5% of patients with Psoriasis and I commonly encounter this disease in both my The Woodlands dermatology and Conroe dermatology offices.  Pustular Psoriasis is the most common type of Psoriasis in which patients experience Psoriatic Arthritis.  Approximately 50% of patients have the HLA-B27 genetic marker which is seen in other forms of inflammatory arthritis, but Psoriatic arthritis is a seronegative type of arthritis in which there is not a specific biologic marker that can be tested.  Thus, Psoriatic Arthritis can be confused with Rheumatoid Arthritis as there are many overlapping features of both diseases.  The distal interphalangeal joint involvement is unique to Psoriatic Arthritis and 95% of patients will experience peripheral joint disease, whereas only 5% of patients will have axial spine involvement.  There are 5 types of Psoriatic Arthritis: 1. Assymetric Oligoarthritis 2. Symmetrical Polyarthritis 3. Distal Interphalangeal Arthritis 4. Arthritis Mutilans 5. Spondylitis with or without Sacroilitis.  Assymetrical Oligoarthritis is the most common type of Psoriatic Arthritis.  Patients develop dactylitis in which the fingers and toes develop a "sausage" like appearance.  The tendons can also be affected resulting in an esthenitis.  A larger joint such as the knee can also be involved.  Symmetrical Polyarthritis is very similar to Rheumatoid Arthritis involving the hands, feet, wrists and ankles.  It is one of the more common types of Psoriatic Arthritis as well.  Distal Interphalangeal Arthritis is a very characteristic form of Psoriatic Arthritis in which the joint near the nail bed is affected. Patients can develop inflammation of the nail fold called paronychia as well.  Arthritis Mutilans is very rare but can lead to bone loss in which a "pencil in cup" deformity occurs on x-ray.  Spondylitis with or without Sacroilitis occurs in which the vertebrae of the spine are affected.  Treatment of Psoriatic Arthritis usually involves a rheumatologist and the use of systemic therapy such as Methotrexate and/or the Biologics.

Psoriatic Arthritis (http://cdn2.kevinmd.com/blog/wp-content/uploads/psoriaticarthritissymptoms3.jpg)

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