Skin Diseases Require Skilled Diagnosis
From the office of Dr. Charles Sexton
Nov. 21, 2004, Orange County Register, Health &
Each year, countless visits are made to the doctor's office
in order to diagnose and treat skin diseases. The past
decade has seen a shortage of dermatologists develop at
a time when information regarding skin disorders has skyrocketed,
making it a challenge for even a specialist to keep abreast
of the field.
"I can recall that before formal training in
my specialty, I received only two weeks of lectures
on diseases of the skin in medical school," said
Dr. Charles Sexton, a dermatologist working in Irvine.
"I also believe that it was on average one of
the poorest attended lecture series in the program."
Since that time, however, numerous influences have
changed the relationship between skin diseases, the
patients they afflict, and the caregivers who treat
them. What hasn't changed is the need for patients with
skin diseases to get the best care available and for
continued effort to minimize suffering that accompanies
"There are relatively few diseases that make
up the bulk of dermatology visits to caregivers, but
even mastering those requires a great deal of knowledge
and information," Dr. Sexton said.
"For example, psoriasis, a hereditary disorder
that affects an estimated 2 to 5 percent of the population,
can actually be triggered for the first time, or occultly
perpetuated by choice of medications for blood pressure,
eye diseases and even vaccinations.
"I have seen numerous cases of disease flares
in patients whose skin was stable, but then developed
hypertension, the subsequent treatment of which triggered
a downward spiral of their psoriasis. The same process
will occur rather predictably if one elects to utilize
certain systemic antiinflammatory medications to control
psoriasis, and their use should be avoided in patients
with this disease."
Acne is another disease that is often inadequately
treated due to concerns about systemic treatments and
possible side effects of the medications available.
Even topical medications are often ineffectively used
due to over emphasis of potential side effects that
can theoretically occur, but which rarely do.
"I have seen practicioners recommend use of agents
that worsen the acne itself in order to avoid side effects
that haven't even occurred," Dr. Sexton said. "Unfortunately,
it is easier to prevent acne scarring than to treat
it, and it is urgent that patients who are unresponsive
to one regimen be closely monitored and switched in
time to prevent this unfortunate consequence.
"This monitoring requires knowledge of timing
of expected results and intimate detail in the correct
application as well as minimization of side effects
predictable with each agent.
"Above all, it requires constant monitoring at
regular intervals until the disease process is under
Along similar lines, Dr. Sexton has noted a large
number of patients with chronic rashes affecting their
feet and groin which are frequently diagnosed as "athlete's
foot" and "'jock itch."
"If athletes foot is present, then a simple in-office
test can confirm this in under five minutes," Dr.
Accurate diagnosis is essential, as it can avoid months
of inappropriate usage of medicines that can actually
worsen the condition and even cause irreversible damage
to the skin.
"Some forms of treatment attempt to combine active
ingredients so that accurate diagnosis seems unnecessary,
similar to using anti-histamines and decongestants in
combination for cold preparations," Dr. Sexton
"I have found that the antifungal agents have
little effect on the growth of the fungus in these diseases,
and what is worse is that use of these agents for jock
itch commonly causes permanent stretch marks and rashes
from the presence of higher strength steroids in the
preparation," Dr. Sexton said. "The bottom
line, if you have been given combo (more than one active
ingredient listed) therapy for a disorder in these locations,
and they are still present after several weeks' use,
it would be best to discontinue them and re-evaluate
From these examples, Dr. Sexton points out that the
care of your skin, while often marginalized for more
pressing medical problems, requires expertise and knowledge.
This general principle is simply demonstrated with these
If you have a skin disease or desire cosmetic treatments
for your skin, contact Dr. Sexton from 8 a.m. to 5 p.m.
for an appointment. His office is at 15825 Laguna Canyon
Road, Suite 203, Irvine. The phone number is 949-679-6900.
His Web site is www.drsexton.net.