We Love You, Warts and All

Wart Removal Bend, ORMost people have some warts, usually when in their teens or as young adults. And none of them came from picking up a toad.

OK. So that’s out of the way.

Warts are caused by a virus, more specifically the human papillomavirus (HPV). While warts gave this virus its name (warts are clinically called papillomas), warts are the least of your worries when it comes to HPV. HPV is a group of more than 150 related viruses. Some cause warts, but others cause various cancers such as cervical, mouth, and others.

Why do people get warts?

When a person is infected with the HPV, usually through an area of broken skin, the virus causes the top layer of the skin to grow rapidly. The excessive cell growth creates the wart.

Warts can grow anywhere on the human body. Different types of warts grow in different places. Usually, they go away on their own within a few months or a couple of years. Sometimes, when the wart starts spreading or becomes painful, that’s the time to see Dr. Carter at Deschutes.

What are the different types of warts?

  • Common warts are dome-shaped, rough, and grayish-brown in color. They usually grow on the hands and arms.
  • Plantar warts are thick hard patches of skin that grow on the soles of the feet. When they get big enough, they need to be removed as they feel as if the person has a pebble in his or her shoe when walking.
  • Flat warts are small with flat tops. They are pink, brown, or yellow in color. They grow on the face, arms, and legs.
  • Filiform warts are skin-toned and appear to have threadlike growth sticking out of them. They grow around the mouth, nose, or the beard.
  • Periungular warts look like rough bumps with uneven borders and surfaces. They grow under the toenails and fingernails.

How do warts spread?

Kissing toads do not spread or create a wart, so princesses are safe. That is, unless they borrow a towel from a prince with a wart, or if they touch a wart on said Prince. After contact with the virus, it may take months before a wart sprouts.

When to beat up on a wart

Most warts can simply be ignored, kind of like your neighbor’s yapping miniature poodle. But if they become painful or start making baby warts, or if you don’t like the look of a wart, Dr. Carter can give them the business. She can use cryotherapy, electrosurgery, curettage, an injection, or even lasers to remove your warts. Usually, antibiotics need to be involved to keep the wart from returning; remember it is a virus that is responsible.

Have a wart you want Dr. Carter to make sleep with the fishes? Call her at 541-330-0900 and let’s take a look at it.

Posted in Warts | June 30, 2017

Keep the Shingles on Your Roof, Not Your Skin

Medical Dermatology Bend ORMany people know next to nothing about shingles beyond the type that cover your roof. But if you had chicken pox when you were a kid, you need to be aware of this viral infection that leads to a painful rash. At Deschutes, we offer shingles vaccinations and treatment.

What are shingles?

If you’re over 50, odds are you probably had chicken pox when you were a kid. There was no vaccine at the time, and it was very contagious. If you had chicken pox, you could develop shingles. The virus behind chicken pox, the varicella-zoster virus, is the culprit behind shingles. The virus resides in nerve tissue near the person’s brain and spinal cord but is dormant after the chicken pox outbreak. Then, particularly after the age of 50, it can rear its ugly head as shingles. Shingles will show itself as a painful rash on the skin, usually as a single strip of rash on the face or the body.

What are the symptoms of shingles?

The extreme pain that can be a part of shingles isn’t initially present. First, the person may begin to get headaches and become somewhat sensitive to light. Flu-like symptoms, without fever, come next.

You’ll wish you had those symptoms when the next phase comes on. The next stage will result in shooting or burning pain on one side of the body or face. This pain is also usually accompanied by itching and tingling sensations. The pain varies from person to person, but it can become severe. After two weeks, rashes may appear on the face or body. It most often appears as a single stripe of blisters that wraps around either the left or the right side of the torso. These rashes will usually heal in two to four weeks, but the pain can linger for weeks, months, even a couple of years.

Stress, illness, and certain medications that compromise the immune system can trigger a shingles outbreak. Once a person has a shingles outbreak, it usually won’t happen again.

How we treat shingles

At Deschutes, Dr. Carter treats shingles in a variety of ways. The best option, for those over 50, is to have the shingles vaccine. This vaccine lowers your chances of getting shingles and usually prevents chronic pain from developing after your other symptoms have subsided.

Once the virus has blossomed into full-blown shingles, Dr. Carter uses antiviral medicines and pain relievers to alleviate the pain. She’ll usually prescribe antiviral medication as soon as a person experiences early symptoms and before rashes develop. Topical creams will be used to decrease skin inflammation.

If you have any of the symptoms of shingles, and you had chicken pox as a child, don’t hesitate to call us at Deschutes, 541-330-0900.

Posted in Skin Conditions | June 15, 2017

Dealing with Suspicious Lesions

If you’re into crime fiction, you’re all too familiar with suspicious persons or persons of interest. At Deschutes, Dr. Carter is more concerned with suspicious lesions.

OK, most lesions don’t fall into the “suspicious” category. It’s not like they’ve been hanging around the crime scene, have definite motives, or have been known to use aliases. Most of them don’t require any special treatment. But Dr. Carter will weigh the evidence against said lesion, considering how long it’s been there, if it has changed in some way, if it has started bleeding, or is tender.

What are the signs of a lesion being “suspicious?”

A skin lesion is a part of the skin that has an abnormal growth or appearance compared with the skin surrounding it. They are broken into two categories: primary or secondary. Primary skin lesions are abnormal skin conditions that are either present at birth (a birthmark, for instance) or are acquired during a person’s life. Secondary skin lesions are the result of irritated or manipulated primary skin lesions. Crusting and scaling are common secondary skin lesions.

Dr. Carter usually is suspicious of skin lesions that are showing signs of skin cancer

  • Basal cell carcinomas will show signs of bleeding, ulceration, and will be locally destructive. They don’t usually spread, but are removed for the patient’s safety.
  • Squamous cell carcinomas occur mainly on the areas of the skin that receive tons of sun: the head, arms, back of the hands, and the back of the neck. Squamous cell carcinomas can spread to other parts of the body, so their diagnosis and removal is key.
  • Melanoma doesn’t necessarily occur on areas of enduring sun exposure. Research shows that the risks of melanoma rise dramatically due to the number of “extreme” sunburns a person has had. They also have a genetic trend, and occur in people with large numbers of moles. Melanoma is the most dangerous skin cancer, as it can spread to all parts of the body and metastasize there.

How does Dr. Carter interrogate “suspicious lesions?”

We’ve covered this in another blog on melanoma, but the ABCDs are important for diagnosing precancerous or cancers lesions.

A — Asymmetry: Does half of the lesion look different from the other half?

B — Border irregularity: Are the edges of the lesion uneven, ragged, or blurred?

C — Color: Does the lesion have a variety of colors?

D — Diameter: With is the size of the lesion?

Removing suspicious lesions

If Dr. Carter is wary of a particular lesion, she will excise it along with 2mm of healthy tissue surrounding it. This tissue will then be biopsied.

Do you have a suspicious skin lesion? Don’t call Harry Bosch; call Dr. Carter at 541-330-0900.

Posted in Skin Cancer, Skin Lesions | May 30, 2017

How Does Sunscreen Work?

Everyone knows that the sun’s ultraviolet rays and human skin don’t get along. That’s even more so at the 3,623-foot altitude of Bend. With less atmosphere to get in the way, the UV rays are even more intense.

Sunscreens are a given today. We know that if we’re going to be out for a hike on the Sisters, skiing at Bachelor, or playing golf at Sunriver that putting on sunscreen is as important as the equipment such as hiking boots or a sand wedge.

But it wasn’t always that way. If you’re in your upper 50s or 60s now, you probably remember when the first sunscreens were introduced. The first true sunscreen was called Glacier Cream and later became Piz Buin (which still makes sunscreen lotions today), and it was developed in 1946 by a Swiss chemist. But when Coppertone (the name says it all) came on the market in the 50s, sunscreen lotion began to grow. Of course, it’s estimated now that the early Glacier Cream and Coppertone products had an SPF of 2! Not much protection there.

Today’s sunscreens have come a long way. Now they’re waterproof (for awhile) with effective SPFs of 50 (it’s thought that any SPF over that doesn’t provide any more protection).

Since we’re big fans of protecting your skin at Deschutes, here’s a little primer on how your sunscreen blocks the sun from damaging your skin.

Inorganic versus organic

Sunscreens come in sprays, lotions, gels, or waxes, and are made of a mix of chemicals. Inorganic chemicals in sunscreen can reflect or scatter the light away from the skin. Organic (carbon-based) chemicals can absorb UV rays so that your skin doesn’t.

Some of the early inorganic chemicals included minerals such as zinc oxide and titanium dioxide, and they acted as physical sunblocks. To be effective, they had to be covering the skin, hence the white noses of people on the beach in the 80s and 90s. The minerals reflected the sun’s UV rays back off the skin just as white paint reflects light. Today’s inorganic particles are much smaller, so users don’t have to look as if they’re covered with white frosting.

Organic chemicals used in sunscreens have names such as avobenzone and oxybenzone. These chemicals don’t reflect or deflect the UV rays; they absorb them. They do this with chemical bonds. As the bonds absorb UV radiation, the components of the sunscreen slowly break down and release heat. This is why these sunscreens have an effective time limit at which point the user would need to reapply.


The sun is delivering two types of ultraviolet rays onto your skin, UVA and UVB rays. UVB rays cause sunburns. For a long time, these were the only rays that sunscreens protected against, as their effects were obvious on the lobster-red skin. UVB rays affect the epidermis, the skin’s outer layer.

More recently, the effects of UVA rays have come into focus. UVA rays penetrate the epidermis into the dermis, the skin’s second layer. It’s thought that UVA rays damage the skin longer term with premature wrinkling, age spots, and other issues. UVA rays don’t cause sunburn, though, so they’re not as obvious.

SPF is how you can judge the protection level of a sunscreen. It stands for Sun Protection Factor, and it refers to how well the sunscreen protects the user against UVB rays. Obviously, SPF came before UVA rays were understood. Now, any sunscreen worth a thing is labeled “broad spectrum,” and it protects against both UVB and UVA rays.

It’s recommended to use the broad-spectrum sunscreen with SPF between 15 and 50. A sunscreen with SPF 15 protects against about 93 percent of the sun’s UVB rays; SPF 30 blocks 97 percent. No sunscreen provides a 100 percent block.

So, there’s some sunscreen information from your friends at Deschutes Dermatology. Put on that sunscreen and get out there in our beautiful Oregon outdoors. But remember to get your skin checked for skin cancer with Dr. Carter here once a year. Call us at 541-330-0900 to make your appointment.

Posted in Skin Cancer, Skin Care | May 15, 2017

Attacking Acne

acne treatmentThe school year may be winding down, but the breakouts on the face of your teenager are still going strong. Acne continues to be one of the more misunderstood conditions; people still believe it is caused by eating chocolate, potato chips, greasy foods, and the like.

Uh, no.

Acne is caused by the P.acnes bacteria and the sebaceous glands. The sebaceous glands are located at the bottom of the hair follicles and are responsible for producing and releasing the oil (sebum) that keeps our skin and hair moist.

The problem is puberty. During puberty the raging hormones coursing through your teenager make the sebaceous glands overproduce oil. This overproduction leads to clogging of the glands. The P.acnes bacteria that live in the glands normally now are locked in, and they get busy, reproducing like rabbits. This tells the body to send white blood cells to the area, leading to inflammation and, you guessed it, a breakout.

At Deschutes, we have a variety of approaches to treating acne, depending on the severity and type. Mild acne can be addressed with products containing these ingredients:

  • Benzoyl peroxide
  • Salicylic acid
  • Resorcinol
  • Retin-A
  • Sulfur
  • Azelaic acid

Certain chemical peels can be effective for mild acne, as well.

More severe cases, particularly if it is cystic acne (scarring), demand more aggressive treatment. Dr. Carter may use corticosteroid injections, oral antibiotics, topical antimicrobials, even oral contraceptives to address the excess sebum production and the P.acnes bacteria.

If your teenager is suffering from acne, the days of simply riding it out are over. Today, we can deal with the causes better than when you were a teen. Call us at 541-330-0900 and let’s take a look.

Posted in Acne | April 30, 2017

You Don’t Need to Be Embarrassed by Your Psoriasis

Psoriasis treatmentMost people only know of the word “psoriasis” from television, thanks to the large ad budget of Head & Shoulders Shampoo. Forever linked with eczema and seborrhea in those commercials, psoriasis is a term most people have at least heard.

But what is it?

Psoriasis is a skin condition that is known more for its potential embarrassment of the sufferer rather than pain or discomfort. Dr. Carter and the team at Deschutes don’t want you to be irritated or embarrassed by your psoriasis, so we have different ways to treat it.

What is it?

Psoriasis is chronic skin disorder that causes patches of red, silvery scales to develop on the skin. When behaving normally, skin grows at a consistent, gradual rate. Old skin cells are typically shed every four weeks. But when a person has psoriasis, they have abnormal lymphocytes that cause this skinning process to happen at an accelerated rate, resulting in thick patches with dry flakes. It usually shows itself on the elbows, scalp, hands, lower back, and knees. It is not contagious. Psoriasis affects roughly 2% of Americans, over seven million men and women.

Psoriasis is very common in adults, but many people don’t even know they have it because it may just show itself in a little patch here or there. But for others, severe psoriasis can leave red, thick scaly skin across much of their body. Sufferers end up avoiding showing their skin in shorts, summer dresses, and swimsuits. But with all of the outdoor fun here in Bend, who wants to stay all covered up?

What causes psoriasis?

The exact causes of psoriasis are still somewhat of a mystery, but there are similarities with allergies. It is believed that an overreaction in the immune system causes the skin to react with the rapid cell turnover that leads to inflamed, flaky skin. Genetic and environmental factors seem to be involved, as well. Cold, dry weather tends to make psoriasis reappear or worsen. Also, stress, infections, and certain medications can exacerbate psoriasis.


At the Deschutes, we treat psoriasis differently for each patient. Topical treatment is our first option:

  • Topical corticosteroids
  • Vitamin D analogs
  • Coal tar
  • Anthralin
  • Salicylic acid
  • Lubricants
  • Bath solutions

Light therapy — The controlled delivery of synthetic UV light may be effective in the treatment of psoriasis. Depending on the case, this may involve either ultraviolet B phototherapy or ultraviolet A phototherapy.

Systemic treatment — In severe cases of psoriasis, medicines taken internally can be prescribed. These can include methotrexate, retinoids, cyclosporine, and biologic response modifiers.

With today’s available treatments for psoriasis, there’s no reason to simply suffer through its embarrassing red patches. Call us at Deschutes Dermatology, 541-330-0900, and let’s see how we can help.


Posted in Psoriasis | April 15, 2017

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