Central centrifugal cicatricial alopecia (CCCA) is a very common cause of alopecia or hair loss in women of African descent. Hair loss from CCCA occurs primarily in the central (crown) part of the scalp. The hair loss radiates outward in a centrifugal or circular pattern and is usually gradual although some people experience a rapid progression of the hair loss. Symptoms of CCCA can vary and may include itching, burning, tingling, pain or no symptoms at all.  CCCA causes destruction of the hair follicles and scarring leading to permanent hair loss. CCCA is the most common type of cicatricial (scarring) alopecia.

What is the cause of CCCA?

The exact cause of CCCA is unknown. Though previously thought to be solely related to the use of hot combs, excessive heat and hot oils on the scalp, chemical relaxers, and excessive tension from braids, tight hair rollers, weaves or extensions, the current thought also points to heredity (genetics or family history) playing a role. When scalp samples (biopsies) from people affected by CCCA are examined under a microscope, inflammation and scarring is typically present around the hair follicles.

What treatments are available for CCCA?

It is best to treat CCCA early before permanent hair loss develops. As the disease progresses, hair follicles may scar beyond the point of repair. Treatment options include:

1. Topical anti-inflammatory medication, like steroid ointments.

2. Oral anti-inflammatory agents, like antibiotic pills.

3. Corticosteroid scalp injections- These will be performed once a month for up to 6 months.

4.  Topical minoxidil ( Rogaine) – In an ointment or solution that will be applied to the scalp once a day. This medication should be used long term, and may initially result in temporary shedding of the hair.

5. Hair Supplements

6. Platelet Rich Plasma (PRP)- is a cutting-edge procedure where your blood is drawn in office, the red blood cells are separated out, and the plasma containing platelets and growth factors are injected back into the scalp. Recommend at least a  series of three treatments spaced a month apart.

7. Hair transplantation – may be considered in patients with permanent hair loss in whom scalp inflammation is absent or well controlled.

*Gentle hair grooming practices such as natural (chemical and heat-free) hair styles, reduced frequency of relaxers, and limited styling products, are also recommended in order to prevent inflammation and further  hair breakage.

Melanoma is the most dangerous form of skin cancer. In its advanced stages, it can cause serious illness; if it spreads to the internal organs, it can even be life-threatening. Fortunately, melanoma rarely strikes without warning signs. Watch for them, because when melanoma is found early, it is almost always curable.

Moles, brown spots and growths on the skin are usually — but not always — harmless. Anyone who has more than 100 moles are at greater risk for melanoma. The first signs can appear in one or more of these moles. That’s why it’s so important to know your skin very well. Examine the skin all over your body once a month and have a physician check you over once a year.

DYSPLASTIC NEVI (atypical moles) are non cancerous moles that can look like melanomas. They usually have the following characteristics:

SHAPE: asymmetrical: A line drawn through the middle would not create matching halves.

BORDER: irregular and/or hazy—the mole fades into the surrounding skin. COLOR: variation and irregularity with shades of tan, brown, dark brown, red, blue, or black.

DIAMETER: generally larger than 6 mm (1/4 inch), the size of a pencil eraser, but may be smaller.

LOCATION: most commonly on the back, chest, abdomen and extremities; may also occur on areas such as the buttocks, groin, breasts, or scalp.

GROWTH: Enlargement of a previously stable mole or appearance of a new mole after ages 35-40 should raise suspicion.

SURFACE: Central portion often is raised, whereas the outer areas are usually flat, sometimes with tiny “pebbly” elevations.

APPEARANCE: greatly varied.

MELANOMA, the deadliest form of skin cancer, usually appears as an asymmetrical, irregularly bordered, multicolored or tan/ brown spot or lesion that grows over time. In rare instances, it may be clear.

1. Apply all topical medications and lotions to damp skin. Damp skin absorbs medication better and leaves skin moisturized.

2. Use mild soaps (ex. Unscented Dove White BAR, Cetaphil, Aveeno, Purpose, Neutrogena) when taking showers or baths.

3. Use lukewarm water (not hot) when taking baths or showers. Hot water strips moisture from the skin leaving it feeling dry and itchy.

4. Keep skin moisturized with lotions and creams (ex. La Roche-Posay, Elta cream, Eucerin Calming/Smoothing lotion or cream, Aveeno cleanser lotion, Cetaphil restoraderm lotion,vanicream, Lubriderm, Clinical therapy lotion, Vaseline or Aveeno daily moisturizing lotion). Remember to apply to DAMP skin.

5. When having problems with severe itching take Aveeno oatmeal baths one or two times a day.

6. DO NOT use fabric softener when laundering clothes, Fabric softeners contain perfume which can irritate the skin.

7. Use “free” detergents when laundering clothes such as ALL free or Cheer Free laundry detergent. These detergents are free from perfumes, lanolins, and ingredients that may irritate the skin.

8. Use a cool mist humidifier in rooms that are stuffy or hot, and in the bedroom when sleeping, Humidifiers help keep moisture in the air.

9. Try not to scratch. The more you scratch the more you itch. Try to break the cycle. For small babies or children putting socks on the hands may be beneficial. Older children or adults try frozen gel packs or frozen vegetable bags for 3 minutes on and off.

10.Use prescribed medications AS DIRECTED. Keep follow up appointments with your doctor or dermatologist

Actinic keratosis (AK), also known as solar keratosis, is a common skin precancer, affecting more than 58 million Americans. People with a fair complexion, blond or red hair, and blue, green or grey eyes have a high likelihood of developing one or more if they spend time in the sun and live long enough. Chronic sun exposure is the cause of almost all AKs.

SHOULD I BE CONCERNED? Actinic keratosis is called a “pre cancer” because it can be the first step leading to squamous cell carcinoma (SCC). Up to 10 percent of AKs may advance to SCC, and 40-60 percent of SCCs begin as untreated AKs. About 2 to 10 percent of these SCCs spread to internal organs and become life-threatening. Another form of AK, actinic cheilitis, develops on the lips and may evolve into SCC.

Your Smartest Move: PREVENTION: The best way to prevent actinic keratosis is to make sun safety part of your daily health care routine.

When outdoors, seek the shade, especially between 10AM and 4PM.

Wear sun-protective clothing,including a wide-brimmed hat and UV-blocking sunglasses. Use a high-SPF, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher every day. For extended outdoor activity, use a water resistant, broad spectrum sunscreen with an SPF of 45 or higher.

Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or after swimming or excessive sweating.

For more information: SkinCancer.org © 2013 The Skin Cancer Foundation. All Rights Reserved.

What to expect:

Liquid nitrogen is applied to the top of the skin lesion. Freezing occurs throughout the area which extends slightly to the surrounding tissue. Freezing can cause stinging, burning pain that peaks about 2 minutes after the treatment is performed. Within minutes after freezing, surrounding skin will become red and begin to swell. In most cases a blister will actually form within 3-6 hours. Often there is a small amount of bleeding into the blister which will turn it dark purple of black. This is expected and should not be cause for concern. The blister usually flattens in 2-3 days and sloughs off in 2-4 weeks.

How to care for the treated area:

1. As the blister may be tender for the first few days, you may want to protect it with a band-aid. However, most often it may be left to the air.

2. You should gently cleanse the treated area daily with mild soap and water.

3. If the area is excessively uncomfortable, you may take an over-the-counter pain reliever such as acetaminophen (Tylenol) or ibuprofen.

4. Protect the area from sun exposure while it is healing to help prevent scar formation.

Follow-up:

Please be aware that warts, actinic keratoses, and seborrheic keratoses often require several treatments. If your skin lesion is still present after healing (usually 2 weeks), schedule a follow-up appointment; otherwise, return as instructed by Dr.Rodney.

Chemical Peel Aftercare Instructions For Face OR Body

1) Leave the peel on for 4-6 hours, then gently wash it off with warm water ONLY.

2) For the first 2 days, wash your face/body with warm water only, TWICE a day. Then apply moisturizer with sunscreen to face/body (AT LEAST SPF 44), as many times a day as needed.

3) From days 3-5, wash with a gentle cleanser (such as Cetaphil or Dove, no fragrance), followed by sunscreen.

4) From day 6-10 you may wash (with either a gentle cleanser or Eternal Clarifying Polish) TWICE a day, followed by sunscreen in the daytime.

5) Resume normal skin care routine on day 10 after your chemical peel, or when all the peeling has subsided.

***Call the office immediately if you have any issues after the procedure (301) 679-5772.

AFTER YOUR PEEL: It is crucial to the success of your peel that these guidelines be followed:

– Do not go swimming for at least 24 hours post-treatment.

– No exercise that causes sweating, Jacuzzi, sauna, or steam baths until the skin is healed.

– Do not use makeup for 24 hours post- treatment.

– If Retinoic Acid is used as part of your treatment, your skin will have a light yellow tinge immediately after the procedure. This is temporary and will fade in 1 to 2 hours. It is recommended to wait until the evening to wash your face, however if you should choose to wash it sooner, please wait at least 2 hours.

– It is important that you avoid direct sunlight for at least 1 week, and make using a sunscreen with at least SPF40 a long term part of your daily routine.                      

– Patients with sensitivity to the sun should take extra precautions to guard against sun exposure following the procedure as they may be more sensitive following the peel.

– Your skin may be more red than usual for 2-3 days.

-Approximately 24-48 hours after the treatment, your skin will start to peel. This peeling will generally last 2 to 7 days. DO NOT PICK OR PULL THE SKIN.

-Apply a light moisturizer with sunscreen as often as needed to relieve dryness and tightness.

-Do not have any other facial treatments for at least two weeks after your peel.

LACK OF PEELING: Although most people experience peeling of their facial skin, not every patient notices visibly peeling after a Chemical Peel procedure. Lack of peeling is NOT an indication that the peel was unsuccessful. If you do not notice actual peeling, please know that you are still receiving all the benefits of the peel, such as: unclogging of pores, stimulation of collagen production, increased cell turnover, improvement of skin tone and texture, and diminishment of fine lines, wrinkles and dark spots.

Laser treatments can be an effective way to remove hair, superficial blood vessels, and some dark spots as well as improve the appearance of various scars; however, there are things you should know before your first appointment

General laser requirements

1. Avoid excessive sun or UV exposure 1 week before your appointment – excessively tanned skin can absorb more of the laser energy leading to prolonged redness and darkening and even blistering of the skin

   1. For the above reasons, patient’s with sunburns or those who use sunless tanning products will have their appointments rescheduled

2. Please make sure there are no products on the treatment area the day of your laser appointment

   1. This includes make-up, tinted sunblock, or other products

   2. Numbing cream and regular sunscreen are acceptable, but will be removed with alcohol wipes before your treatment

3. Please avoid chemical peels, facials, etc. to treatment area for two weeks before and after your appointment

   1. Avoid all alpha and beta hydroxy products (AHA/BHA), Hydroquinone, Retinols/Retinoids, Tazorac, Tretinoin and Differin for 14 days (2 weeks) before treatment (unless otherwise stated by your provider)

   2. Additionally, please tell your provider if you are Accutane as this will require your treatment to be rescheduled.

   3. If a topical numbing aesthetic is provided, please apply to the treatment area 30 minutes to 1 hour before your appointment as it takes time for medication to take effect.

Laser hair reduction requirements

1. Please stop waxing or tweezing 3 weeks prior to treatment

   1. Hair within the skin is required for laser reduction to be effective

2. Please shave the area to be treated the night before your scheduled appointment

   1. Your appointment will be rescheduled if hair visible over skin

      1. Visible hair can absorb more of the laser energy leading to prolonged redness and darkening and even blistering of the skin

   2. Of note, only pigmented hairs can be treated with laser (very blonde, white, and gray hairs cannot be targeted by the laser)

PLEASE TELL YOUR PROVIDER IF YOU ARE PRONE TO COLD SORES, ARE PREGNANT, OR HAD AN ADVERSE REACTION TO PREVIOUS LASER TREATMENTS