Patient Resources

Cantharidin is a medicine that is an extract from a blister beetle. It is used to treat warts and molluscum.

The physician applies a small amount of medicine to the lesions to induce a blister to treat the condition.

Here is how to take care of the area:

1. Wash the treated area using soap and water, no longer than 8 hours after the medication was applied. If significant pain or discomfort occurs before this time, you may cleanse the treatment sites.
a. If the spots have been taped, remove the tape before washing.
2. Let the blisters form. It should naturally crust over and heal, but if it is large and painful, you may drain it with a sterile needle.
3. If there is discomfort from the treatment, you may take acetaminophen (Tylenol®).
4. If the area is open, please keep clean and apply petroleum jelly (Vaseline®/Aquaphor®) with a band aid.
5. The blisters will take about a week to heal. Reminder, it may take more than one treatment for the lesions to resolve, so remnants of the lesion may be noted. On average 3-6 treatments are needed for resolution of the lesions.
6. Post inflammatory pigment alteration after treatment with cantharidin typically will resolve over time, however there is a potential risk for scarring.

Please call our office at 704-784-5901 if you have any questions, feel like the blister is persisting for more than 7 days or if the area continues to drain and ooze.

After treatment, your skin will become red and swollen and may develop a blister. It may resemble a bug bite. There will be some discomfort for 24 hours.
Proper care after the procedure:
• Clean the treated area with soap and water as you normally would. It is fine to get the area wet; however, be gentle when cleaning.
• If necessary, you can open the blister with a sterilized needle.
• If a blister forms or opens, apply a thin layer of petroleum jelly (Vaseline® /Aquaphor® ointment to the site twice daily.
• If there is open skin, please keep it covered with a bandage.
• Skin will start to heal in 1-3 weeks. After treatment, you will notice post-inflammatory pigment alteration; a lighter or darker spot, compared to the surrounding skin. There is a potential risk for scar.
Note: The treated lesion can sometimes take several treatments to resolve in completion, especially warts. Therefore, if you feel that your lesion is persistent, please call our office to make another appointment for treatment.
If you have emergent questions AFTER HOURS (Monday-Thursday after 4:30pm, Friday after 11:30 am, Saturday or Sunday), please call 704-796-0031 to speak with the on-call dermatologist. During working hours call the office at 704-784-5901.

The Following Describes How to Care for Your Surgery Site
1) Please keep the original bandage on and dry for 24 hours or 48 hours or 1 week (your doctor will specify).
2) After 24 hours or 48 hours or 1 week remove the bandage.
3) Perform the following on a daily basis until healed (usually in 7-14 days)
A. Wash the area with warm water and antibacterial soap such as Dial soap
B. Gently pat the wound dry
C. Apply petroleum jelly (Aquaphor® or Vaseline®) to the wound bed using a clean cotton swab
D. Apply a new bandage using a non-stick gauze and paper tape.
i. Note: It is important to keep the wound moist with petroleum jelly and covered with a bandage as it will promote proper wound healing.
4) You should avoid any exercise (activity that causes you to be out of breath) and heavy lifting (greater than 7 lbs) for 2 weeks. These activities increase the risk of bleeding and reopening of the wound.
5) If the site is on your face or scalp, avoid bending over for at least 48 hours. Sit over or bend your legs if you need to pick something up. Additionally, do not shave over stitches.
6) Ibuprofen and/or Tylenol® can be taken if needed for pain.
7) If your stitches are not dissolvable, please be sure you have an appointment scheduled in 7-14 days for removal.
Concerned About Bleeding
i. 1) If the site is bleeding through the bandage, remove the original bandage and using a clean gauze or cloth, apply firm, constant pressure for 20 minutes.
b. a. During that time do not look at the wound, but instead hold firm direct pressure for 20 minutes. If the wound is still bleeding after 20 minutes, then repeat the procedure of holding 20 minutes of firm pressure to the wound. If bleeding stops, then carefully apply a new bandage. If bleeding continues, then please contact the office for further instructions.
Concerned About Infection?
a. 1) Redness, swelling and mild drainage are NORMAL signs of healing and should be expected for the first few days of healing.
b. 2) Wound infections are very unlikely within the first few days following a procedure. Wound infections are most common 4-10 days following a procedure.
c. 3) Signs of wound infection include expanding redness, swelling, increasing pain, thick white/yellow/green drainage, fever, and chills.
For most pathology results, we will contact you within 14 days with the results. If you do not hear from us within 14 days, please contact the office.
If you have emergent concerns AFTER HOURS, please call 704-796-0031 to speak with the on-call dermatologist. During working hours call the office at 704-784-5901.

The following describes how to care for your punch biopsy:
1) Please keep the original bandage on and dry for 24/48 hours.
2) After 24/48 hours remove the bandage and wash the area with warm water and soap. Gently pat the wound dry, then apply petroleum jelly (Aquaphor® or Vaseline®) to the wound bed and apply a new bandage
a. Note: It is important to keep the wound moist with petroleum jelly and covered with a bandage as it will promote proper wound healing.
3) If the site is on your face or scalp, avoid bending over for at least 48 hours. Sit over or bend your legs if you need to pick something up. Additionally, do not shave over stitches.
4) Ibuprofen and/or Tylenol® can be taken if needed for pain.
5) If your stitches are not dissolvable, please be sure you have an appointment scheduled in 7-14 days for removal.
Concerned About Bleeding?
1) If the site is bleeding through the bandage, remove the original bandage and using a clean gauze or cloth, apply firm, constant pressure for 20 minutes.
a. During that time do not look at the wound, but instead hold firm direct pressure for 20 minutes. If the wound is still bleeding after 20 minutes, then repeat the procedure of holding 20 minutes of firm pressure to the wound. If bleeding stops, then carefully apply a new bandage. If bleeding continues, then please contact the office for further instructions.
Concerned About Infection?
1) Redness, swelling and mild drainage are NORMAL signs of healing and should be expected for the first few days of healing.
2) Wound infections are most common 4-10 days following a procedure. Wound infections are very unlikely within the first few days following a procedure.
3) Signs of wound infection include expanding redness, swelling, increasing pain, thick white/yellow/green drainage, fever, and chills. Please call if you notice any of these signs worsening rather than improving.
For most pathology results, we will contact you within 14 days with the results. If you do not hear from us within 14 days, please contact the office.
If you have emergent questions AFTER HOURS (Monday-Thursday after 4:30pm, Friday after 11:30 am, Saturday or Sunday), please call 704-796-0031 to speak with the on-call dermatologist. During working hours call the office at 704-784-5901.

The following describes how to care for your shave biopsy/shave removal site:
1) Please keep the original bandage on and dry for 24/48 hours.
2) After 24/48 hours remove the bandage and wash the area with warm water and soap. Gently pat the wound dry, then apply petroleum jelly (Aquaphor® or Vaseline®) to the wound bed and apply a new bandage
a. Note: It is important to keep the wound moist with petroleum jelly and covered with a bandage as it will promote proper wound healing.
3) Repeat this process daily until the wound has healed (usually in 7-14 days).
4) If the site is on your face or scalp, avoid bending over for at least 48 hours. Sit over or bend your legs if you need to pick something up.
5) Ibuprofen and/or Tylenol® can be taken if needed for pain.
Concerned About Bleeding?
1) If the site is bleeding through the bandage, remove the original bandage and using a clean gauze or cloth, apply firm, constant pressure for 20 minutes.
a. During that time do not look at the wound, but instead hold firm direct pressure for 20 minutes. If the wound is still bleeding after 20 minutes, then repeat the procedure of holding 20 minutes of firm pressure to the wound. If bleeding stops, then carefully apply a new bandage. If bleeding continues, then please contact the office for further instructions.
Concerned About Infection?
1) Redness, swelling and mild drainage are NORMAL signs of healing and should be expected for the first few days of healing.
2) Wound infections are most common 4-10 days following a procedure. Wound infections are very unlikely within the first few days following a procedure.
3) Signs of wound infection include expanding redness, swelling, increasing pain, thick white/yellow/green drainage, fever, and chills. Please call if you notice any of these signs worsening rather than improving.
For most pathology results, we will contact you within 14 days with the results. If you do not hear from us within 14 days, please contact the office.
If you have emergent questions AFTER HOURS (Monday-Thursday after 4:30pm, Friday after 11:30 am, Saturday or Sunday), please call 704-796-0031 to speak with the on-call dermatologist. During working hours call the office at 704-784-5901.

What is an Unna Boot?
An Unna boot is a special bandage used to wrap an extremity, normally the lower leg. The boot is composed of a zinc oxide-impregnated gauze and elastic wrap that is normally worn for an extended period, often 7 days at a time. Unna boots are applied for a variety of reasons including, but not limited to open wounds, swelling, and /or surgical treatment sites. The wrap reduces risk of infection, decreases tension on a wound, decreases healing time, prevents swelling, and does not require any patient-provided wound care.

Care of the Unna Boot
Keep the Unna dressing dry. If showering, you may cover with a heavy plastic bag taped at the top of the boot or purchase a cast cover from a pharmacy or home health supply store. If bathing in a tub, keep your boot out of the tub. If your boot gets wet or soiled, please contact us for further instructions.
You may continue normal daily activities, such as walking, but it is advised to AVOID heavy exertion or exercise. Keeping your legs elevated as much as possible when sitting will help with swelling.
The boot will begin to dry in 3-4 hours and may feel tighter. This is normal and will decrease as the boot dries completely.
It is normal to have some drainage on your Unna boot.
DO NOT place any objects inside your boot to relieve itching. This may cause infection or other wounds.
Do not remove the boot unless instructed to do so by your provider or their assistants.

When to Contact the Office
• Severe or increasing pain.
• Fever or chills
• Unna boot that continues to feel too tight or too loose
• Unna boot that becomes soiled, wet, or damaged
• Excessive drainage or drainage with an abnormal odor

If you have emergent questions AFTER HOURS (Monday-Thursday after 4:30pm, Friday after 11:30 am, Saturday or Sunday), please call 704-796-0031 to speak with the on-call dermatologist. During working hours, call the office at 704-784-5901.

Mohs Surgery Instructions

As our skin ages, wrinkles form, starting as dynamic wrinkles which slowly develop into static or “fixed” wrinkles. These wrinkles are from repeated muscle contraction, loss of collagen and elasticity, free radical damage, and UV damage to our skin. A combination approach targeting these causes will best achieve your rejuvenation goals. We call this the 4 R’s of facial rejuvenation.

4 R’s of Facial Rejuvenation
Relaxing muscle contraction can be achieved with Botox®.
Replacing volume loss can be achieved by soft tissue augmentation with dermal fillers and platelet rich plasma.
Resurfacing with chemical peels and a good skin care regimen can assist in repairing free radical and UV damage.
Redraping with plastic surgery is sometimes needed for extreme loss of collagen and elasticity.

What is Botox®?
Botox® cosmetic is derived from Botulinum toxin-A. It is a neuromodulator that is injected into the muscles of the upper and lower face and/or neck, relaxing these muscles, and therefore decreasing the appearance of wrinkles for 3-4 months. Botox® is not permanent and repeat treatments are needed for continued benefit. If you already have static wrinkles, Botox® will soften these lines, but will likely not completely erase them, however consistent Botox® treatments over time and adjunctive use with resurfacing and soft tissue augmentation is beneficial.

Adverse effects:
• Facial asymmetry
• Eyelid Ptosis (drooping)
• Bruising
• Swelling
• Injection site pain

Botox® is not indicated for:
• Women who are pregnant or breastfeeding
• History of neuromuscular junction disease
• Active infection at injection site

What to expect:
• Your dermatologist will assess the optimal number of units of Botox® to inject to achieve your goals.
• After injection of Botox®, you will want to stay upright for 4 hours and no exercising for 24 hours
• Your Botox® onset of action is typically 3-4 days after injection, however it is best to allow up to 2 weeks.
• If you have concerns of asymmetry, quizzical appearance, or eyelid drooping, schedule a follow up appointment for assessment and correction within 2 weeks.
• Your Botox® will last 3-4 months.
• Price is $13 per unit

A superficial chemical peel is indicated for light resurfacing to help treat uneven pigmentation, acne, or fine lines and wrinkles. This kind of peel removes just the outer layer of the skin (epidermis) causing light exfoliation, and can result in a healthier glow. For maximum benefit, you can repeat these treatments at regular intervals to achieve your desired results. It often takes 4-6 peels to achieve the response.

Chemical peels should be combined with a skin care program including photoprotection, antioxidants, and retinoids. The degree of clinical improvement, recovery period, and risk of complications are proportionate to the depth of injury. Chemical peels are not indicated for deep wrinkles and furrows which originate in dermis. Adjunctive treatments with Botox® and filler are beneficial.

Before the peel:

You should not use prescription retinoids (tretinoin, Retin-A®), abrasive scrubs, or strong exfoliants 3-5 days before and after treatments. You should not expose your skin to prolonged sun exposure 2 weeks prior to or 2 weeks post treatments. You should use sun protection at least SPF 30 whenever outdoors and frequently reapply.

If you have an active cutaneous infection, your chemical peel may be postponed until clearance of the infection.

You should not get a chemical peel if you are currently taking or in the last 6 months took medications that are contraindicated to receiving a chemical peel. i.e. isotretinoin.

Please inform your doctor if you are pregnant as certain peels may not be possible to do.

What to expect the day of the chemical peel:

• Your face will be cleansed and de-greased using acetone.
• The chemical solution is applied to your skin and left on for a few minutes. You may feel some mild burning, stinging or itching. The depth of the peel will be proportional to the number of passes applied.
• Depending on the peel, the chemical peel may be washed off and neutralized.
• A moisturizing sun block is then applied to your skin.

Side Effects:

• It is possible to experience some redness, stinging, skin flaking and irritation from a superficial chemical peel. After repeated treatments, these side effects will likely subside.
• Hyperpigmentation – Avoid this by always using a high factor sunscreen every day.
• Delayed healing or scarring.
• Infection is rare, but if prolonged redness, swelling, pain or oozing is present, please call your doctor immediately.

DGOC superficial depth chemical peels

Very light chemical peel – GTZ acne peel

• Very light depth, injuring only the stratum corneum for mild exfoliation
• 15% glycolic acid, 15% Trichloroacetic acid, 2% zinc
• Cost is $35 per peel
• Peels can be done every 2 weeks
• Indications: Management of acne and post inflammatory hyperpigmentation and redness
• Speeds up medical acne treatment
• Mild stinging/burning during application. Minimal time (1-2 days) for recovery

Light chemical peels – Trichloroacetic acid 20%, Jessner’s, Salicylic Acid 30%

• Light depth injury to entire epidermis for regeneration of a new epithelium
• Cost is $125 per peel or a package is 6 total peels for $625.
• Peels can be done every 6 weeks
• Indications: Mild photoaging, epidermal lesions such as lentigines and keratoses as well as melasma and other pigmentary dyschromia
• Mild stinging/burning during application. Minimal time (7 days) for recovery

If you have questions during office hours (Monday-Thursday 7:30 AM – 4:30 PM, Friday 7:30 AM – 11:30 AM), please call 704-784-5901.

As we age, we experience mid-facial volume loss from collagen degradation, redistribution of facial fat, and skeletal changes. This volume loss drastically changes our facial shape, extenuating facial wrinkles and aging. Soft tissue augmentation with dermal filler is one of the ways to achieve your rejuvenation goals.

What is Filler:

Dermal filler is a gel-like substance that is injected below the skin to replace volume loss and remodel collagen. Fillers help to soften the appearance of wrinkles. They can help under eye circles, increase volume in the cheeks, smooth deeper facial lines, and recontour the face. Other indications of filler are correction of atrophic/traumatic scars, lip augmentation, and volumization of the face in areas of fat loss.

While fillers can be a variety of different compounds, the most common is hyaluronic acid. Below is a list of the most common fillers used, location of injection, and how long it typically lasts.
Lateral cheekbones, posterior jaw – Restylane® Lyft™ (1-1.5 years)
Posterior jaw, tops of hands – Radiesse® (1-1.5 years)
Nasolabial folds, marionette lines, lips – Juvederm® Ultra™ (6 months)
Fine lines, tear trough – Belotero® (6 months), Restylane® Silk™ (6 months)

Adverse Effects:
• Bleeding
• Pain
• Infection
• Hypersensitivity or allergic reaction
• Granuloma formation
• Contour irregularities
• Tyndall effect (blue-gray cutaneous bead under the skin from filler placed too superficial)
• Vascular occlusion (blocked blood vessel) leading to ulceration and blindness

You may not be able to get filler if:
Current oral herpes infection (cold sores)
Uncontrolled diabetes
Blood-clotting problems
Lupus or connective tissue disorders

Preparation for the filler:
It is best to schedule your procedure 2 weeks or more before any social event
One week before your scheduled procedure, we may ask you to stop taking medications that may increase risk of bleeding or bruising. These include aspirin for prophylactic use, NSAIDS, vitamin E, and fish oil. Please consult your doctor before stopping this.
Avoid alcohol 24-48 hours before your procedure
Avoid dental work within 2 weeks before your procedure and not to receive for 3 weeks after your procedure
Cost is $650 for 1st syringe and $550 for every additional syringe

What to expect the day of your filler:
Upon arrival, topical numbing may be applied to assist in your comfort during the procedure
Your skin will be cleansed with chlorhexidine, followed by alcohol pads
Your dermatologist will select a filler agent depending on size, depth, location of volume deficiency
The filler will be injected into dermis, subcutaneous fat, or supraperiosteal area by a variety of injection techniques chosen by your dermatologist
You may experience bruising, swelling, and pain after injection of filler. You will be provided an ice pack and are encouraged to ice on and off over the next 24 hours to help with any bruising and/or swelling
Your dermatologist may recommend topical vitamin K or arnica for bruising post procedure. Green tinted makeup works best at disguising bruises.

Platelet rich plasma (PRP) is an exciting treatment option for hair loss as well as facial rejuvenation. Platelet rich plasma (PRP) has been used in the medical community for many years, mainly in the specialties of orthopedic and plastic surgery, as it has shown great effectiveness in the process of wound healing and tissue rejuvenation.
How does PRP work?
PRP is an autologous platelet preparation in concentrated plasma that is prepared from a patient’s own blood. It is an enriched platelet solution that through centrifugation reverses the RBC to platelet ratio. PRP contains a high level of both cytokines and growth factors, which function to stimulate inactive stem cells within the hair follicles, promoting increased hair growth. These cytokines and growth factors can also be injected into the skin of the face to assist in collagen remodeling.

PRP Protocol: What to expect (Slight variations in protocol depending on your dermatologist and PRP system)
Eclipse PRP® System is an efficient and high-quality system for healthcare professionals to harvest and prep PRP. The procedure is designed to take about 30 minutes and only a small amount of the patient’s blood is required. We recommend three treatments, 4-6 weeks apart and maintenance treatments every 6-12 months.
The day of your visit,
1. Blood will be collected in a test tube.
2. The blood will be placed in a centrifuge to induce layered separation of whole blood. Plasma appears as a yellow serum at the top of the test tube, separated from the red blood cells at the bottom.
3. Platelet rich plasma will be injected into the target area of the scalp if being used for hair loss or into the face if being used for facial rejuvenation.
What are the side effects?
The side effect profile of PRP is relatively mild with only redness of the skin, bruising, and swelling, which usually last less than 12 hours. PRP is a natural substance derived from the patient’s whole blood, preventing the risk of developing an allergic reaction. Clean or sterile technique is often used to prevent the risk of infection. Tylenol can be taken prior to the procedure to limit discomfort.
We may not be able to treat you with PRP if you have:

A blood disorder, an autoimmune disease such as lupus, untreated thyroid disease, an active malignancy, untreated skin cancer on the scalp, rash on the scalp, untreated anemia, untreated thyroid disease, and if you have low platelets.

In summary, PRP appears to be a promising therapy for the restoration of alopecia and collagen remodeling. Schedule a consultation with your dermatologist to discuss if PRP is the right choice for you!

What is Sclerotherapy:

Sclerotherapy is considered the treatment of choice for superficial spider veins of the legs. A sclerotherapy agent is injected into the superficial spider veins to destroy the vessel wall by dehydration and cell wall disruption. The effect is very localized and systemic toxicity is minimal. Injection sclerotherapy can be successful in resolving 90% or more of treated vessels. It is well tolerated, rapid, and has a relatively low side effect profile.

Adverse Effects:

• Bruising
• Local ulceration if extravasated (“leaks”)
• Superficial phlebitis
• Post-sclerotherapy hyperpigmentation (should improve after 6-12 months)
• Telangiectatic matting (Self-resolving)

What to Expect:

• Hypertonic saline (23.4%) will be diluted 50/50 into 1 cc syringe with 0.9% normal saline
• Approximately 4-6 one cc syringes per treatment are required for bilateral upper, lower, anterior and posterior legs.
• Injections can be painful
• Focal pressure will be applied over the treated veins with cotton balls, tape, and Coban™
• Legs will be wrapped with ACE bandages in office providing needed compression
• You will need to purchase compression stockings to wear after the procedure.
• o Compression should be worn continuously for at least 24 hours after injection and for at least 10–14 days thereafter to help the healing process and limit pain and post-inflammatory hyperpigmentation. This will also increase treatment efficacy.
• Follow up office visit will be scheduled 6-8 weeks after injection sclerotherapy
• Additional veins in other areas can be treated 1-2 weeks later, but retreatment of any single area should be delayed for 6–8 weeks to allow the treated veins to fully heal.
• Cost of sclerotherapy is $600 for a 30-minute session.

Please call us at 704-784-5901 to make a cosmetic consultation or for further questions.

Have you ever wondered what skin care product dermatologists use most to prevent fine lines and wrinkles? Vitamin A derivatives, called retinoids, are the secret. When applied topically, any deficiency in collagen that exists in the skin is partially improved. Topical tretinoin, commonly known as Retin-A®, is a topical retinoid that has a variety of benefits in dermatology. Prescription strength retinoids teach our skin to shed appropriately by regulating numerous transcription factors within the nucleus of cells, signaling these cells to regulate epithelial cell growth and rate of proliferation. It is like giving yourself a micro-peel every single night. In general, tretinoin is best to use at night, as sun exposure during the day can decrease the efficacy in some topical retinoid formulations.

When applied consistently, it smooths and evens skin tone from hyperpigmentation, prevents breakouts from acne, and improves appearance of pore size by keeping pores clean and small. Tretinoin tightens and brightens facial skin! With the exception of sun block, it is the miracle cream for your face. Tretinoin is the most widely used topical therapy for photo-aging. UV exposure damages the dermal matrix of the skin, leading to rapid aging. Topical tretinoin plays a role in preventing and slowing further degradation and photo-aging from UV damage. After using faithfully, your skin will achieve a beautiful, smooth, and creamy glow that you have always wanted!

In addition, tretinoin can also be used in numerous other dermatologic conditions such as psoriasis, keratosis pilaris, melasma, post-inflammatory hyperpigmentation, and even in some skin cancers like Kaposi sarcoma and cutaneous T-cell lymphoma.

Topical tretinoin is known to be irritating. Because of the way it works in normalizing follicular keratinization, irritation upon initial use is common. You may experience burning, redness, and dryness. We recommend starting slow, using only one night the first week. Tretinoin is best used in a pea size amount, dab into each quadrant of the face, and use a gentle moisturizer.

Schedule your appointment today with one of our board-certified dermatologists to discuss adding a topical retinoid to your daily skin care routine.