We treat many common dermatologic diseases like acne, warts, fungal skin infections, eczema, actinic keratosis, abnormal moles, cysts, etc. Dr. Fivenson is an immunodermatologist and has particular expertise in many rarer or complicated conditions as well as more extensive cases of common skin diseases like atopic dermatitis and psoriasis. Below is a list of diseases Dr. Fivenson specializes in. Click on a title and more information and a small representative picture of the disease will open up.
- Phototherapy - We offer both narrow band UVB and UVA as well as hand/foot phototherapy for psoriasis, atopic dermatitis, vitiligo and other diseases.
- Patch Testing - We offer skin patch testing for common causes of contact dermatitis.
- Cryotherapy - This is a common destructive 'freezing' technique we use for common skin growths like warts and precancerous actinic keratoses ("AK").
Pemphigoid –Bullous pemphigoid, cicatricial pemphigoid, mucous membrane pemphigoid (BP, CP, MMP, other variants)- This is a group of autoimmune blistering disease that can affect the skin and/or mucous membrane of the eyes, nose mouth, throat or genitals. Therapy ranges from intermittent topical steroids to various systemic immunosuppressant drugs. Causes are not clearly known but some individuals may have disease triggered by medications or underlying other diseases. Read More »
Pemphigus -pemphigus vulgaris, pemphigus foliaceous (PV, PF, other variants) - PV is an autoimmune blistering disease that can affect the skin and/or mucous membrane of the eyes, nose mouth, throat or genitals. Therapy ranges from intermittent topical steroids to various systemic immunosuppressant drugs. Causes are not clearly known, some cases can be drug-induced or related to underlying diseases. PF is a variant with more superficial skin blisters and crusts. All forms can cause scalp lesions. Read More »
Dermatitis Herpetiformis -(DH) is a very itchy blistering disease that especially on the elbows, knees, shoulder blades and tailbone areas. It is related to other forms of celiac disease as it is caused by IgA antibody against gluten (gliadin). Diagnosis is by skin biopsy, direct immunofluorescence and lab work. Treatment is gluten avoidance completely and/or dapsone. There is a risk of GI lymphoma if untreated and continued gluten ingestion in this and other forms of celiac disease. Read More »
Linear IgA Bullous Dermatosis (LABD ) is an autoimmune blistering disease with IgA deposition in the epidermal-dermal junction. Most commonly seen as rings or groups of smaller blisters. Itching and burning can be associated with the eruption. Treatment can be dapsone or any of a variety of systemic immune suppressor drugs. Read More »
Lupus is an autoimmune disease that ranges from a scarring localized skin process (DLE), widespread scaling red patches to a multiorgan systemic disease with symptoms including sun-related rashes, hair loss, mouth sores, fever, pleurisy, blood clots, seizures, strokes, miscarriages, kidney disease, arthritis, etc. Smoking avoidance is important due to its cause of both decreased effectiveness of medications and increased risks for cardiac disease. Read More »
Dermatomyositis (DMS) is a multisystem autoimmune connective disease with many overlap features of lupus (especially the sun sensitivity and distribution of rashes to the sun-exposed skin) but also can involve the muscles and/or lungs. It can present with systemic or cutaneous manifestations. Most forms of DMS can have an increased risk for underlying cancers or lung disease.
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Scleroderma - is an autoimmune disease with skin findings include tightening of skin (especially face, mouth, fingers, wrists, and feet), Raynaud's, finger ulcers, calcium deposits and skin tears in stretch marks are also common. Systemic disease can affect the kidneys, GI tract, lungs and heart and can be fatal. Read More »
Morphea - is a localized condition of skin hardening that goes through 3 phases- red and tender, white and hard, brown and soft. It is sometimes called localized scleroderma but is not the true form of scleroderma and does not progress to organ toxicity and even death like scleroderma can. Treatments include topical steroids, topical vitamin D agents, UVA or UVA1 phototherapy, excimer laser, methotrexate, and others. Read More »
Sarcoidosis - is an autoimmune disease that is characterized by 'balls of inflammation' that can be in multiple parts of the body. Skin lesions can be flesh colored lumps, bumps along old scars or yellow-brown papules on the face or other body regions. There can be lung lesions, eye lesions, brain lesions or joint lesions. If skin only, it may be treated with topical or injected steroids, oral steroids, oral minocycline or methotrexate. Severe cases sometimes are treated with biologic drugs to block the signals to make the 'balls of inflammation'. Thus blood work, eye exam, chest X-ray, breathing tests and pulmonary evaluation are usually part of the initial workup. Read More »
Psoriasis is a red scaling rash that can be anywhere on the body (especially scalp, elbows, and knees). It is very common, with up to 3-4% of the general population affected. It can be triggered by various medications, stressors and sometimes runs in families. Associations between psoriasis and other systemic illness including diabetes and cardiovascular disease are well known. Treatments range from topical steroids and nonsteroidal creams to ultraviolet light to a variety of immune suppressor agents and a variety of newer biologic medications. Read More »
Psoriatic Arthritis - is an inflammatory single or multiple joint arthritis that is strongly associated with psoriasis, but usually lags 10 years behind the development of the skin symptoms. Read More »
Vascular Diseases and Wound Care
Stasis Dermatitis- is related to leaking varicose veins in legs which cause swelling and rash from superficial or deep leg veins. It is usually treated with leg elevation and compression, topical steroids and if not, can lead to ulcers and scarring of the legs. Sometimes a vascular surgeon can help by ablation (destroying) veins with a minor outpatient surgery. Read More »
Venous Leg Ulcer - These are related to chronic swelling related to varicose veins. Treatment is a combination of specialized dressings, leg elevation, infection control and compression wrap therapies in most patients. In persistent lesions, various advanced biologic dressings and skin grafts may also be used. >Read More »
Diabetic Foot Ulcers - These are pressure related ulcers in diabetics where altered sensation and foot shape results in chronic friction and wounds. Treatments are related to removal of pressure, improving blood supply and removal of unhealthy tissues. Unresponsive diabetic foot ulcers are the main precursor to limb amputation in diabetics. Read More »
Pressure Ulcers - These are wounds due to pressure over bony areas like the buttocks, hips and back in persons who have limited movement or spend prolonged times in bed. Treatments including a variety of advanced wound dressings, effective pressure reduction are key. Read More »
Vasculitis - is a group of diseases all related to an immune attack on the blood vessels. Smaller vessels, especially on lower legs, are common and present with tender purplish bumps which can ulcerate. Small vessel disease can occasionally affect the kidneys (blood in urine), gi tract (blood in stool, abdominal pain), lungs (shortness of breath or coughing up blood) or other organs rarely. Larger vessel disease can present with larger tender nodules or open sores on limbs, fingers, toes, etc Treatments are based on the severity and type of vasculitis and range from local topical agents to compression hose to systemic immune suppressors. Associated diseases can be infectious, autoimmune, medication reactions or underlying cancers. Read More »
Cutaneous Coagulopathies - These are a variety of diseases that result in tiny clots or occlusions of skin blood vessels resulting in crusts and sores on the legs. Often quite painful, they can be due to immune reactions or genetic diseases and treatment is variable, based on the underlying cause. Read More »
Pyoderma Gangrenosum- is an autoimmune process that results in painful, rapidly growing ulcerations of the skin from minimal trauma. It can be associated with inflammatory bowel diseases, lupus, rheumatoid arthritis, blood protein abnormalities or underlying cancers. About 50% of cases have no related diseases. Treatments include good wound care, cautious removal of dead tissue without sharp debridement that damages the wound margins and aggravates the disease. Immune suppression therapies from topical steroids and topical tacrolimus, to intralesional steroid injections, to systemic agents like prednisone, cyclosporine, mycophenolate or others may be required. Workup initially involves labs to evaluate for underlying diseases, sometimes tissue biopsies to help diagnose and cultures to rule out infections. Read More »
Calciphylaxis (calcific uremic arteriolopathy) is a condition caused by deposition of calcium in the small skin blood which can lead to ischemia, painful ulceration, and large areas of dead tissue in fleshy areas of the trunk and extremities. The most common form is related to advanced kidney disease, while rarer forms can be medication related. Read More »
Other Autoimmune Skin Disorders
Chronic Hives (urticaria )- is of unknown cause in about 50% of people. The other 50% have a variety of possible causes including low-grade infections, allergies, blood disorders, thyroid disorders as well are rarer autoimmune diseases or underlying systemic illnesses. Treatment is first various kinds of antihistamines either alone or in combination as well as medications like plaquenil, colchicine, cyclosporine, dapsone as well as many others. Read More »
Photosensitivity disorders - are a group of ultraviolet light-induced rashes. The prototype is polymorphous light eruption (PMLE) is an unusual allergy type reaction to UV light and worst early in summer seasons and tolerance to light slowly develops over time. Treatments can be steroids, UV desensitization, avoidance or Heliocare. Systemic lupus erythematosus (SLE) is also considered in this group. Read More »
Vitiligo - is an autoimmune attack on the pigment-forming melanocytes of the skin, forming distinct white patches or spots. It can be associated with thyroid disease and eye exam by an ophthalmologist is important at baseline due to rare involvement of the retina. Treatment is a combination of topical agents like steroids or tacrolimus with UV treatments like excimer laser or whole body UV light therapy.
Atopic dermatitis - (also known as AD) is a condition that makes your skin red and itchy. It's common in children but can occur at any age. Atopic dermatitis is long-lasting (chronic) and tends to flare periodically. It may be accompanied by asthma or hay fever. Prolonged disease results in thickened, crusty skin and secondary skin infections are common. Treatments include aggressive skin moisturization, topical steroids and non-steroid medications, UV light treatments, and several types of immune-suppressing systemic medications. Read More »
Seborrheic Dermatitis- is related to an overgrowth of normal yeast that lives on our scalp and face, resulting in redness and flaking in the scalp (dandruff) ears and central face. Treatment is combination of anti-yeast shampoos and creams as well as steroid creams or liquids to control inflammation. Read More »
Granuloma Annulare- is a red papule or round ring-like eruption that is of unknown cause. It may be triggered by some infections but none in particular. Most commonly it starts with red rings on the wrists or ankles. The generalized form can be widespread small red papules or flesh-colored papules. Treatments vary from topical steroids to oral steroids to UV light to a variety of oral medications. Read More »
Necrobiosis Lipoidica (Diabeticorum)- is an atrophic yellow-red-brown plaque usually on the lower legs but can be elsewhere. It can sometimes ulcerate and be painful. It is associated with diabetes in 70-90% of cases and is thought to be related to microvascular damage. Treatments include topical and intralesional steroids, support hose and sometimes internal medications such as rental or actors. Support stockings 20/30mm Hg or higher are also helpful. Read More »
Lichen Planus – (LP) often starts as itchy purplish bumps on wrists and/or ankles but can be widespread. Oral and genital variants of the disease can cause painful ulcers and scarring and these areas have an increased risk for a form of cancer called squamous cell carcinoma developing if untreated. There is an association with chronic hepatitis C infection in up to 10% of LP cases in USA. Another version affecting the hair can cause scarring hair loss and is called lichen planopilaris (see hair loss section). Read More »
Lichen Sclerosis et Atrophicus- (LSetA) is a scarring, inflammatory skin condition that usually affects the genitalia and can cause damage that interferes with sexual relations and even urination. Extragenital LSetA can occur anywhere on the body but is usually seen in areas of skin friction (buttocks, under breasts, armpits, etc.). Without treatment, scarring, deformity and an increased risk of skin cancer is seen. Treatments include intermittent use of high potency topical steroids, nonsteroid topical preparations, excimer laser, UVA-1 light therapy, oral vitamin A derivatives or even immunosuppressives like methotrexate. Read More »
Hidradenitis Suppurativa - (HS) is a chronic inflammatory condition that causes boils and abscesses in fold areas like armpits, groin, buttocks and under the breasts. It is often secondarily infected but the primary process is felt to be an autoimmune reaction that damages hair follicles in sweaty areas of the body. It can cause painful scarring and chronic draining lesions. Treatment is a combination of surgical drainage, intralesional steroid injections, chronic anti-inflammatory and antibiotic medications and good wound care. Smoking and obesity are factors which make it more likely to develop or harder to treat. Read More »
Hair Loss/Alopecia – Alopecia Areata (AA) is an autoimmune disease that typically causes patches of hair loss but can also involve any or all hair-bearing parts of the body. Some cases resolve spontaneous but usually it is treated with steroid topicals, minoxidil (to wake up hair follicles) and steroid injections. More severe cases are sometimes treated with oral steroids, cyclosporin, methotrexate, UV light treatments or other immunosuppressive agents. There is a slight association with thyroid disease. Other forms of Alopecia we treat include sudden, temporary hair loss known as telogen effluvium (TE) ; scarring hair loss due to lichen planopilaris (LPP)which is related to lichen planus ; lupus and other connective tissue disease-related hair loss and other miscellaneous causes for hair loss. The most common form of alopecia is male pattern balding (MPB). Read More »
Mycosis Fungoides - (MF) is a chronic, low grade form of cutaneous T cell lymphoma (CTCL). MF/CTCL is an indolent white blood cell cancer where the atypical T cells home into the skin. It can start with scaly or wrinkly patches (which can be present for many years before diagnosis) and can proceed to plaques, tumors and/or lymph node involvement if untreated or unresponsive. Various topial and systemic treatments options including topical steroids, nitrogen mustard, UV light therapy, vitamin A derivatives and interferons are used depending on the extent of disease and prior responses to treatment. Progressive disease may eventually need chemotherapy. Erythrodermic MF and Sezary syndrome may be treated with extracorporeal photopheresis. Read More »
Acne - is the most frequent skin condition seen by medical professionals. It consists of pimples that appear on the face, back and chest. About 80% of adolescents have some form of acne and about 5% of adults experience acne. In normal skin, oil glands under the skin, known as sebaceous glands, produce an oily substance called sebum. Read More »
Rosacea- is a chronic skin condition that causes facial redness, acne-like pimples, visible small blood vessels on the face, swelling and/or watery, irritated eyes. This inflammation of the face can affect the cheeks, nose, chin, forehead or eyelids. More than 14 million Americans suffer from rosacea. It is not contagious, but there is some evidence to suggest that it is inherited. There is no known cause or cure for rosacea. There is also no link between rosacea and cancer. Read More »