Rheumatology Services

Osteoarthritis

Osteoarthritis is a common “wear and tear” joint disease. It happens when the protective cartilage that cushions your joints breaks down. This can make your joints painful, stiff and swollen. Your knees, hips and small joints of your hands are most at risk.

As you get older you’re more likely to develop osteoarthritis. To make a diagnosis your rheumatologist will perform a physical examination and sometimes blood tests, x-rays and a joint aspiration test so that they can discard other possible causes.

Osteoporosis cannot be cured but it’s symptoms can be managed. Physical activity may reduce your pain whilst also helping you keep a healthy weight. You may be advised to lose weight if you're overweight or to wear alternative footwear and use support devices. Our physiotherapy team can offer advice on the best self-help strategies for your individual circumstances.

Prescription painkillers or steroid injections may be offered if your osteoarthritis is severe. If these don’t work, for example your hip or knee osteoarthritis is too painful to allow you to continue with your daily functions, then surgery may be advised.

Inflammatory arthritis

Inflammatory arthritis is a term used to describe a group of diseases that cause your joints and other tissues to become inflamed. The main chronic conditions are: rheumatoid arthritis, gout, psoriatic arthritis (causes painful inflammation and is often linked with psoriasis) and ankylosing spondylitis (long term inflammation of the joints of your spine).

Typical symptoms of inflammatory arthritis include: pain, swelling, tenderness and warmth in your joints. Your rheumatologist will take into consideration your medical history, a physical exam and sometimes other tests including blood tests, x-rays and scans to make a diagnosis.

Your treatment will depend on the type of inflammatory arthritis you have, how severe it is and your symptoms. Nonsteroidal anti-inflammatory drugs (NSAIDs) and physiotherapy may help relieve your pain. Your rheumatologist may prescribe disease-modifying anti-rheumatic drugs (DMARDs) or biologic agents to slow down or stop the disease progressing.

Rheumatoid arthritis

Rheumatoid arthritis is a chronic inflammatory condition that causes pain, stiffness and swelling most often in your hands, feet and wrists. It’s an autoimmune disease so called as your body’s immune system mistakenly attacks and damages the cells in your joints and surrounding tissues.

If diagnosed and treated early, rheumatoid arthritis can be prevented from worsening whilst also reducing the risk of other problems such as joint damage.

To monitor your condition and to diagnose the type of arthritis your rheumatologist may request imaging tests including an ultrasound or MRI scan.

Treatment often includes disease-modifying anti-rheumatic drugs (DMARDs) and biological treatments given by injection to reduce your bodies attack on your joints. Physiotherapy can help relieve some of the pain. Our physiotherapists may also offer advice to keep you mobile and able to do daily activities that are becoming difficult or are taking longer to complete. Podiatry is an option if you’ve foot problems. Painkillers may be recommended and vary in strength depending upon how much pain you’re experiencing. They range from paracetamol, through to nonsteroidal anti-inflammatory drugs (NSAIDs), to corticosteroid injections.

Despite these measures sometimes joint damage occurs and we can perform appropriate surgery including: finger, hand and wrist surgery, arthroscopy and joint replacement as required.

Gout

Gout is a type of inflammatory arthritis that can be extremely painful and, causes joints to become hot and swollen with red, shiny skin over it. Its onset is often rapid in the big toe and at night. Gout is caused by your body over making uric acid that forms crystals inside and around your joints.

It’s important to see your GP or a rheumatologist of you suspect you have gout. It’s likely your rheumatologist will take fluid from your swollen joint with a needle and examine it under a microscope to check for uric acid crystals.

You may be advised to try self-help remedies for a gout episode such as: resting and raising and keeping cool your affected joint. Over-the-counter painkillers may help or your doctor may prescribe stronger painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs), colchicine or corticosteroids.

Lifestyle changes may help prevent gout from returning, such as losing weight or changing your diet. Medications, such as allopurinol, can also lower your uric acid levels.

Osteoporosis

Osteoporosis is a gradual reduction in bone density and leads to weaker bones and an increased risk of fracture. One in two women (often postmenopausal) and one in five men over the age of fifty will break a bone due to osteoporosis. It’s a silent disease that’s often only diagnosed when a person falls and fractures their bone.

A DEXA scan is normally requested if you’ve had a fall or if you’re at risk of having osteoporosis to measure your bone density.

Treatment will be based on your DEXA scan results together with information about your age, sex, risk of fracture and previous injury history. You must ensure you're taking sufficient levels of calcium and vitamin D. There are medications that reduce your risk of broken bones by either slowing or stopping bone loss or rebuilding bone.

Regular exercise, stopping smoking and reducing alcohol consumption and, risk assessing your home may all help reduce the impact of osteoporosis and prevent fractures.

Connective tissue disorders

Your connective tissue holds your muscles, skin and bones in place. Connective tissue disorders occur when these tissues become injured or inflamed due to inherited diseases, autoimmune diseases and environmental factors. As these tissues are throughout your entire body, connective tissue disorders can be far reaching from your bones, skin, nervous system, eyes and lungs.

Treatment will depend on the type of connective tissue disorder. Heritable connective tissue disorders are less common and include Marfan’s syndrome, Ehlers-Danlos syndrome and Loeys Dietz syndrome. Autoimmune disorders are due to your body attacking its own cells and tissues. They include: scleroderma (affects your skin), systemic lupus erythematosus (SLE, affects your skin, joints, kidneys, heart, brain and red blood cells), rheumatoid arthritis (most often affects your joints), dermatomyositis (muscle inflammation and skin rash) and polymyositis (muscle inflammation and skin problems).

As connective tissue disorders cause inflammation, the most common treatments are anti-inflammatory medications to relieve swelling, redness and pain.

General Dermatology Services

 

Our practice can treat your entire family from the pediatric to the elderly. We care for children and their skin care needs with conditions such as eczema, teenagers with acne and also adults with sun damage and skin cancers. We focus not only on effective treatment strategies for skin conditions but also on sun protection and prevention of skin cancers before they arise.

We specialize and have years of experience treating common skin problems and also those that are hard to diagnose. We offer treatment for all types of dermatologic conditions affecting both children and adults including:

acne treatments

 

acneAcne is a very common skin condition, which affects almost all of us  especially in our teenage years.  It usually starts in adolescence and young adulthood, however, it may continue into the adult years.   Acne is thought to be caused by overactive oil glands, which produce too much oil and combine with skin cells to plug pores.  In the plugged pores a bacterium called p.acnes increases in number and leads to the skin lesions.  Hormones, heredity and stress are factors that can also worsen acne.  Approximately twenty percent of patients who have acne will have severe acne that results in scarring.

At VH, we offer a variety of different acne therapies.  Mild to moderate acne can be treated topically with prescription creams and gels.  Oral therapy can also be used including antibiotics in men and women and hormonal treatments in women.  For more severe cystic acne, isotretinion (Accutane) can be prescribed. For patients who would like to augment their prescription therapy, or for those patients who would prefer to try non-prescription therapies, we offer BLU-U Blue Light (photodynamic) therapy  and Acleara (light and vacuum)  along with aesthetic services such as chemical peels, microdermabrasion and comedone extractions. If you have acne scarring, a few sessions of Fraxel laser therapy can help to improve your skin texture and decrease acne scarring.

Dyshidrotic eczema: Overview

What is dyshidrotic eczema?

Dyshidrotic (dis-hi-drah- tic) eczema (DE) is a common group of skin conditions in which the skin cannot protect itself as well as it should, so the person often gets itchy, dry skin).

DE causes itchy, dry skin. People also develop small, deep-seated blisters, usually on their hands. It’s also possible to develop blisters on your feet.

Whether on your hands, feet, of both, the blisters are often very itchy and painful.

When the blisters clear (usually in 2 or 3 weeks), the skin tends to be red, dry, and cracked.

There is no cure for DE, so people can have flares. For many people, DE flares when they’re under a lot of stress, temperatures rise (such as in spring or summer), or their hands stay wet for long periods of time.

DE flares range from mild to debilitating. A severe flare on your feet can make walking difficult. Having many blisters on your hands can make it difficult to work and perform everyday tasks like shampooing your hair and washing dishes. 

This common skin disease has many names, including:

  • Cheiropompholyx (affects the hands)
  • Dyshidrosis
  • Dyshidrotic dermatitis
  • Foot-and-hand eczema
  • Pedopompholyx (affects the feet)
  • Pompholyx
  • Vesicular eczema
  • Vesicular palmoplantar eczema

 

Also called nevi

Moles are common. Almost every adult has a few of them. Adults who have light skin often have more moles. They may have 10 to 40 moles on their skin. This is normal.

Most moles appear on the skin during childhood and adolescence. Moles will grow as the child (or teen) grows. Some moles will darken, and others will lighten. These changes are expected and seldom a sign of melanoma, the most-serious skin cancer.

For adults, new moles and changes to existing moles can be a sign of melanoma. Caught early, melanoma is highly treatable.

Here are 3 facts that can help you find melanoma early and get treatment:

  • A change to a mole or a new mole is often the first sign of melanoma.
  • You can find melanoma early by checking your own skin.
  • If you see a mole or other spot that's growing, itching, bleeding, or changing in any way, immediately make an appointment to see a dermatologist.

 

There are also times when a dermatologist should examine a child's mole. You'll find pictures and descriptions of moles on a child's skin that should be examined at:

 

Skin Cancer Screening

 

Skin cancer is the most common type of cancer in the world. One in five Americans will develop some form of skin cancer in their lifetime. Basal cell and squamous cell carcinomas are the most common types of skin cancer and are referred to as non-melanoma skin cancers. These usually occur in sun-exposed areas including the face, ears, scalp, neck and hand. While generally they spread very slowly, if left untreated they may involve surgical removals, which may be disfiguring.

collage_of_basal_cell_carcinoma

Actinic keratosis are precancerous lesions that are commonly found on sun-damaged skin. These are more common in people with fair skin and occur more often in people over the age of 40.  Actinic keratosis can be treated in a variety of different ways including using liquid nitrogen, with topical creams and with light therapy. At Dermatology Services, we offer BLU-U PDT  photodynamic treatment as an option in the treatment of actinic keratosis.

Melanoma is the most deadly form of skin cancer. It can occur anywhere on the body, but its most common locations include the upper back, trunk, lower legs, and neck. Early detection is critical because it can commonly spread to the lymph nodes and internal organs. It is very important to recognize any new, rapidly growing lesion or lesions that bleed or have changed in color as these could be early warning signs of melanoma or other skin cancers.

People who are at the highest risk for developing skin cancer are those who are fair skinned and have light hair and eyes and have had exposure to ultraviolet radiation either outside or from indoor tanning. Risk factors for melanoma include: fair skin, greater than 50 moles or large or atypical moles, a family history of melanoma and a history of melanoma or non-melanoma skin cancer.

 

Skin Cancer Screening

 

Skin cancer is the most common type of cancer in the world. One in five Americans will develop some form of skin cancer in their lifetime. Basal cell and squamous cell carcinomas are the most common types of skin cancer and are referred to as non-melanoma skin cancers. These usually occur in sun-exposed areas including the face, ears, scalp, neck and hand. While generally they spread very slowly, if left untreated they may involve surgical removals, which may be disfiguring.

collage_of_basal_cell_carcinoma

Basal Cell Carcinoma

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Squamous Cell Carcinoma

AK

Actinic Keratosis

Actinic keratosis are precancerous lesions that are commonly found on sun-damaged skin. These are more common in people with fair skin and occur more often in people over the age of 40.  Actinic keratosis can be treated in a variety of different ways including using liquid nitrogen, with topical creams and with light therapy. At Dermatology Services, we offer BLU-U PDT  photodynamic treatment as an option in the treatment of actinic keratosis.

Melanoma is the most deadly form of skin cancer. It can occur anywhere on the body, but its most common locations include the upper back, trunk, lower legs, and neck. Early detection is critical because it can commonly spread to the lymph nodes and internal organs. It is very important to recognize any new, rapidly growing lesion or lesions that bleed or have changed in color as these could be early warning signs of melanoma or other skin cancers.

People who are at the highest risk for developing skin cancer are those who are fair skinned and have light hair and eyes and have had exposure to ultraviolet radiation either outside or from indoor tanning. Risk factors for melanoma include: fair skin, greater than 50 moles or large or atypical moles, a family history of melanoma and a history of melanoma or non-melanoma skin cancer.

product-anti-aging

 

 

SUN DAMAGE COURT OF CHRIS GIBSON

Photo courtesy of Chris Gibson

As you age, your skin’s collagen and elastin break down faster than your body can rebuild them. The decreased production of these skin-tightening proteins causes the skin to thin, droop and loose elasticity. Regularly scheduled facial services can temporarily stimulate collagen and elastin, increase circulation, decrease wrinkle depth/size, reduce the appearance of pores, help reduce/control breakouts, and even skin tone.

Psoriasis

 

The most common type of psoriasis is plaque psoriasis, which is characterized by red patches on the skin that are covered by a silvery-white scale.  These plaques occur commonly on the elbows knees and scalp.  Although the cause of psoriasis is not completely understood, it is an inflammatory disease of the immune system and it appears to involve abnormal T cell function.  There is a hereditary component to this skin problem and it can also be influenced by environmental factors.  Forty percent of the people who have psoriasis may also experience some arthritis associated with it, a condition called psoriatic arthritis.

psoriasis

At Dermatology Services, we offer a variety of treatment options for psoriasis, as what may work for one patient may not work effectively for another.  For more limited disease, psoriasis can be treated with prescription creams that are applied topically.  Office based treatments are available including phototherapy in our Narrow Band UVB booth  for more extensive disease and the Pharos EX-308 Excimer laser  for more localized psoriasis plaques.  For more severe psoriasis, oral therapies and biologic drugs can be prescribed.

product-Rosacea

 

ROSACEA - COURT OF ZIZAI DERMATOLOGY

Photo courtesy of ZiZai Dermatology

 

Rosacea is a common facial eruption that occurs in patients over the age of 30, which is characterized by redness, telangiectasia, flushing, and acne papules and pustules. The skin lesions usually occur on the forehead, cheeks, and nose. Hot foods and drinks, alcohol, caffeine, heat, sunlight, and topical medications including some anti-wrinkle creams and chemical peels can exacerbate rosacea. The treatment of rosacea includes avoiding its exacerbating factors and also the use of prescription topical and systemic antibiotics.

Products that can be used to treat rosacea and sensitive skin other than prescription medications include:

  • Antirougeurs Anti-Redness Dermo-Cleansing Fluid (Avéne)
  • Thermal Spring Water (Avéne)

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