Skin Growths Archives - Page 2 of 3 - Newport News Dermatologist

Pityriasis Rosea

What is Pityriasis Rosea?

Pityriasis rosea is a skin condition that causes a temporary rash of raised red scaly patches on the body. It is not contagious and usually goes away on its own within 6 to 10 weeks . The exact cause of pityriasis rosea is unknown, but it may be triggered by a viral infection or a reaction to certain drugs . The most common symptom of pityriasis rosea is a single large patch called the herald patch, which appears before the generalised rash of smaller oval patches . The rash may be itchy and may affect different parts of the body, such as the chest, back, abdomen, arms, and legs . Pityriasis rosea is diagnosed by examining the skin and sometimes by doing a skin biopsy or blood test . There is no specific treatment for pityriasis rosea, but some medications such as antihistamines or corticosteroids may help relieve the itching and inflammation . Pityriasis rosea usually does not cause any serious complications, but it may leave temporary spots of skin discoloration after the rash heals. Pityriasis rosea can affect anyone, but it is more common in young adults and middle-aged adults (20-49 year-olds).

What are the signs and symptoms of Pityriasis Rosea?

The signs and symptoms of pityriasis rosea are:

A single large patch of red scaly skin, called the herald patch, that appears before the generalised rash. The herald patch is usually round or oval and may be 2 to 10 cm in diameter. It may be located on the chest, back, abdomen, neck, or face .
A generalised rash of smaller patches of red scaly skin, that appear 1 to 2 weeks after the herald patch. The smaller patches are usually oval and may be 0.5 to 1.5 cm in diameter. They may be arranged in a pattern that follows the lines of the skin, called the Christmas tree pattern. The rash may affect different parts of the body, such as the chest, back, abdomen, arms, and legs .
Itching, which may range from mild to severe. The itching may be worse at night or after a hot shower or bath .
Other symptoms, such as fever, headache, sore throat, fatigue, nausea, or joint pain, which may occur before or during the rash. These symptoms are usually mild and short-lived .

Pityriasis Rosea in Pregnancy

Pityriasis rosea is a skin condition that causes a temporary rash of raised red scaly patches on the body. It is not contagious and usually goes away on its own within 6 to 10 weeks. However, pityriasis rosea in pregnancy may be associated with an increased risk of fetal loss and other complications. Therefore, if a pregnant woman develops pityriasis rosea, she should seek urgent medical attention and discuss the management options with her doctor. Some of the possible complications of pityriasis rosea in pregnancy are:

Premature delivery
Low birth weight
Congenital anomalies
Neonatal death
Placental insufficiency
Fetal distress
Intrauterine growth restriction

The exact mechanism of how pityriasis rosea affects pregnancy outcomes is not clear, but it may be related to the viral infection or the immune response that triggers the rash.

What treatments are available at the dermatologist for Pityriasis Rosea?

Some of the treatments that are available at the dermatologist for pityriasis rosea are:

Corticosteroids: These are anti-inflammatory drugs that can be applied as creams or ointments to reduce itching and swelling of the rash. They can also be taken orally or injected in severe cases.
Antihistamines: These are drugs that can help relieve itching by blocking the effects of histamine, a chemical that causes allergic reactions. They can be taken orally or applied as creams or lotions.
Antivirals: These are drugs that can help fight viral infections that may be associated with pityriasis rosea, such as herpesviruses 6 and 7, H1N1 influenza A, or COVID-19. They can be taken orally, such as acyclovir.
UVB phototherapy: This is a light treatment that involves exposing the skin to ultraviolet B (UVB) rays, which can help reduce inflammation and speed up healing of the rash. It is usually given in a dermatologist’s office under controlled conditions.

FAQ About Pityriasis Rosea

How is pityriasis rosea diagnosed?

In most cases, your health care provider can identify pityriasis rosea by looking at the rash. You might need a scraping or possibly a skin biopsy, which involves taking a small piece of the rash for testing. This test can help tell a pityriasis rosea rash from other, similar rashes.

Who is at risk of getting pityriasis rosea?

Pityriasis rosea can affect anyone, but it is more common in young adults and middle-aged adults (20-49 year-olds). It tends to occur more often in spring and autumn seasons.

What are some of the viral infections that have been associated with pityriasis rosea?

Herpesviruses 6 and 7, which are common viruses that usually do not cause any symptoms
H1N1 influenza A, which is a type of flu virus that can cause respiratory illness
COVID-19, which is a novel coronavirus that can cause severe acute respiratory syndrome

What are some of the drugs that have been linked to pityriasis rosea?

Hydrochlorothiazide, which is a diuretic that helps lower blood pressure
Captopril, which is an angiotensin-converting enzyme (ACE) inhibitor that helps treat heart failure and high blood pressure
Imatinib, which is a tyrosine kinase inhibitor that helps treat certain types of cancer

Is there a dermatologist near me in Newport News that offers treatment for Pityriasis Rosea?

Yes. At our Newport News dermatology office we offer treatment for Pityriasis Rosea to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Tick Bites

A tick bite is a wound caused by a tick that attaches to the skin and feeds on blood. Ticks are small, blood-sucking arachnids that can transmit various diseases to humans and animals, such as Lyme disease, Rocky Mountain Spotted Fever, and Tularemia. A tick bite can cause a small bump, swelling, redness, itching, or pain at the site of the bite. Some people may also develop a rash, fever, headache, fatigue, or joint and muscle pain after a tick bite. A tick bite should be removed as soon as possible with fine-tipped tweezers and the area should be cleaned with soap and water or rubbing alcohol. If you have any signs or symptoms of a tick-borne disease, you should contact your doctor immediately. You may need antibiotics or other treatments depending on the type of infection. To prevent tick bites, you should avoid areas where ticks live, such as wooded and grassy places, wear long sleeves and pants, use insect repellent, and check your body and clothing for ticks after being outdoors.

What are the signs and symptoms of Tick Bites?

Some of the signs and symptoms of tick bites are:

A small hard bump or sore at the site of the bite
Swelling, redness, itching, or pain around the bite
A rash, which can be circular, oval, or spotted, and may expand over time
Fever, chills, headache, fatigue, muscle and joint aches
Allergic reactions, such as difficulty breathing, chest pain, or swelling of the face or mouth
Neurological problems, such as paralysis, numbness, or tingling
Signs of infection, such as pus, red streaks, or warmth around the bite

What treatments are available at the dermatologist for Tick Bites?

Some of the treatments that are available at the dermatologist for tick bites are:

Topical steroids and oral antihistamines to relieve itch and inflammation caused by tick bites.
Surgical removal of tick bite granulomas, which are small, hard lumps that form around the bite site.
Antibiotics or other medications to treat tick-borne diseases, such as Lyme Disease, Rocky Mountain Spotted Fever, or Tularemia, if diagnosed by tests.
Allergic reactions, neurological problems, or signs of infection after a tick bite may require emergency care or hospitalization.

How to Remove a Tick Safely and Effectively

The best way to remove a tick safely and effectively is to use clean, fine-tipped tweezers to grasp the tick as close to the skin’s surface as possible and pull upward with steady, even pressure. You should not twist or jerk the tick, as this can cause the mouth-parts to break off and remain in the skin. If this happens, you should remove the mouth-parts with tweezers or leave them alone and let the skin heal. After removing the tick, you should thoroughly clean the bite area and your hands with rubbing alcohol or soap and water. You should never crush a tick with your fingers or use folklore remedies such as nail polish, petroleum jelly, or heat to make the tick detach from the skin. You should dispose of a live tick by putting it in alcohol, placing it in a sealed bag/container, wrapping it tightly in tape, or flushing it down the toilet. You should also keep the tick in a plastic bag in case you develop any symptoms that may be caused by a tick-borne infection. If you have any signs or symptoms of a tick-borne disease, such as a rash, fever, headache, or joint pain, you should see your doctor as soon as possible and tell them about your recent tick bite. You may need antibiotics or other treatments depending on the type of infection.

The Dangers of Tick Bites

The dangers of tick bites are that they can cause allergic reactions, skin infections, and transmit various diseases to humans and animals, such as Lyme disease, Rocky Mountain Spotted Fever, Tularemia, and others. These diseases can have serious and sometimes life-threatening consequences if not treated promptly. Some of the symptoms of tick-borne diseases include fever, chills, headache, fatigue, rash, muscle and joint pain, and neurological problems. To avoid tick bites, it is important to prevent exposure to ticks by wearing protective clothing, using insect repellent, avoiding areas where ticks live, and checking and removing ticks from the body and clothing after being outdoors.

FAQ About Tick Bites

What do tick bites look like?

Tick bites can cause a small bump, swelling, redness, itching, or pain at the site of the bite.

Where do ticks bite people?

Ticks prefer warm, moist areas of the body, such as the armpits, groin, hair, back of the knees, belly button, ears, and waist.

How are tick-borne diseases diagnosed and treated?

Tick-borne diseases are diagnosed by your doctor based on your symptoms, history of exposure to ticks, physical examination, and laboratory tests. Some tests may include blood tests, skin biopsies, or spinal taps. Tick-borne diseases are treated with antibiotics or other medications depending on the type of infection.

Is there a dermatologist near me in Newport News that offers treatment for Tick Bites?

Yes. At our Newport News dermatology office we offer treatment for Tick Bites to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Lipomas

What are Lipomas?

A lipoma is a soft, fatty lump that grows under the skin. It is not cancerous and usually does not cause any pain or harm. It looks like a round or oval-shaped bump that can be moved with gentle pressure. Lipomas are more common in middle-aged and older people, and they can occur anywhere on the body, but they are most often found on the neck, shoulders, back, arms, thighs, or abdomen.

What are the signs and symptoms of Lipomas?

Some signs and symptoms of lipomas are:

A soft, movable lump that grows just under the skin.
A round or oval-shaped lump that feels doughy and can be moved with slight finger pressure.
A painless lump that is usually smaller than 2 inches in diameter, but can grow larger in some cases.
A lump that can occur anywhere on the body, but is most common on the neck, shoulders, back, arms, thighs, or abdomen.

What treatments are available at the dermatologist for Lipomas?

Some treatments that are available at the dermatologist for lipomas are:

Surgical removal: This is a procedure where the lipoma is cut out from the skin. It can leave a scar and cause bruising, but it can completely remove the lipoma. It is usually done in a doctor’s office or surgical center with local anesthesia.
Liposuction: This is a procedure where a needle and a large syringe are used to suck out the fatty tissue from the lipoma. It can reduce the size of the lipoma, but it may not remove it completely. It can also cause swelling and bleeding, but it can leave less scarring than surgery.
Steroid injections: This is a procedure where a steroid medication is injected into the lipoma to shrink it. It can be effective for small lipomas, but it may not work for larger ones. It can also cause side effects such as pain, infection, and skin discoloration.

FAQ About Lipomas

Are lipomas common?

Lipomas are quite common – one in 1000 people will develop a lipoma at some point in their lives.

Are lipomas cancerous?

Lipomas are benign and rarely turn into cancer. However, there is a rare type of cancer called liposarcoma that can grow within fatty tissue and resemble a lipoma

Can lipomas be contagious?

Lipomas are not contagious. They are not caused by an infection or a virus.

Is there a dermatologist near me in Newport News that offers treatment for Lipomas?

Yes. At our Newport News dermatology office we offer treatment for Lipomas to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Xanthomas

What is Xanthomas?

Xanthomas are fatty growths that develop under the skin or on internal organs due to high levels of blood lipids. They are often associated with medical conditions such as diabetes, high cholesterol, liver disease, etc.

What are the signs and symptoms of Xanthomas?

The signs and symptoms of xanthomas are fatty growths that develop under the skin or on internal organs. They may appear as small bumps that are reddish, yellowish, or orange in color. They may be itchy or tender to the touch. They can occur anywhere on the body, but they are most common on the joints, tendons, hands, feet, buttocks, and eyelids. Xanthomas are usually caused by high levels of blood lipids, such as cholesterol and triglycerides, which may be a symptom of an underlying medical condition. Some types of xanthomas may also have specific symptoms, such as:

Eruptive xanthomas: These are small shiny bumps that are typically 1–4 millimeters in size. They may cause pain in some cases.
Familial chylomicronemia syndrome (FCS): This is a rare genetic disorder that causes extremely high levels of triglycerides in the blood. People with FCS may have xanthomas as well as other symptoms, such as lipemia retinalis (milky appearance of retinal veins and arteries), neurological symptoms (such as forgetfulness, fatigue, or memory loss), and pancreatitis (inflammation of the pancreas).

What are the causes of Xanthomas?

Xanthomas are caused by high levels of blood lipids, which are a type of fat. Blood lipids include cholesterol and triglycerides. The excess blood lipids can build up under the skin or on internal organs and form fatty growths. Xanthomas may be a symptom of an underlying medical condition that affects blood lipid levels, such as diabetes, high cholesterol, liver disease, thyroid disease, metabolic disorders, or certain cancers.

What treatments are available at the dermatologist for Xanthomas?

There are different treatments available at the dermatologist for xanthomas, depending on the type, size, and location of the growths.

Some of the possible treatments are:

Surgical removal: This involves cutting out the xanthoma with a scalpel or a sharp instrument. This may leave a scar or require stitches.
Laser surgery: This uses a high-energy beam of light to vaporize the xanthoma. This may cause some redness, swelling, or pain after the procedure.
Chemical treatment: This applies a strong acid, such as trichloroacetic acid, to the xanthoma. This may cause some burning, stinging, or crusting of the skin.

These treatments may not cure xanthoma completely, as the growths can return after treatment if the underlying cause is not addressed. Therefore, it is important to consult with your dermatologist in Newport News and follow the recommendations for managing your blood lipid levels and treating any medical conditions that may cause Xanthoma.

FAQ About Xanthomas

What do xanthomas look like?

Xanthomas can vary in size, shape, color, and location. They may appear as small bumps that are reddish, yellowish, or orange in color. They may be itchy or tender to the touch.

How are xanthomas diagnosed?

Xanthomas can be diagnosed by a doctor or a dermatologist. They may be able to make a diagnosis simply by examining the skin. A skin biopsy can confirm the presence of a fatty deposit beneath the skin and rule out cancer.

Is there a dermatologist near me in Newport News that offers treatment for Xanthomas?

Yes. At our Newport News dermatology office we offer treatment for Xanthomas to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Pyogenic Granulomas

What is Pyogenic Granulomas?

A Pyogenic Granuloma is a benign (noncancerous) growth of blood vessels on the skin or mucous membranes. It usually appears as a red, moist, and easily bleeding bump that may be triggered by injury, infection, hormones, or medications. It can occur anywhere on the body, but is more common on the face, mouth, hands, and feet.

What are the signs and symptoms of Pyogenic Granulomas?

Some signs and symptoms of Pyogenic Granuloma are:

A small red lump on the skin or mucous membranes that bleeds easily.
Often found at the site of a recent injury, infection, hormonal change, or medication use.
Grows rapidly over a few weeks, usually reaching 5–10 mm in diameter.
May be smooth or mushroom-shaped, with a moist surface.
May range in color from red to pink or purple, depending on the age of the lesion.
May be tender or painful, especially if located in the mouth or genitals.

What treatments are available at the dermatologist for Pyogenic Granulomas?

Some treatments that are available at the dermatologist for pyogenic granulomas are:

Surgery: This involves cutting off the lesion and stitching the wound. This method has a low recurrence rate, but may leave a scar.
Cryotherapy: This involves freezing the lesion with liquid nitrogen. This method is less invasive than surgery, but may cause pain, blistering, and pigmentation changes.
Laser therapy: This involves using a laser beam to destroy the lesion. This method is effective and cosmetically appealing, but may be expensive and require multiple sessions.
Topical medications: These include chemicals such as silver nitrate, phenol and trichloroacetic acid (TCA), or ointments containing corticosteroids. These help shrink or dry up the lesion, but may cause irritation, inflammation, or infection.

dermatologist-with-patient-with-hands-on-face

FAQ About Pyogenic Granulomas

How is a pyogenic granuloma treated?

A doctor can usually diagnose a pyogenic granuloma based on its appearance. Sometimes, a biopsy (a small sample of tissue) may be taken to confirm the diagnosis and rule out other conditions.

How can pyogenic granuloma be prevented or reduced in frequency?

There is no sure way to prevent or reduce the frequency of pyogenic granulomas. However, some possible measures that may help are avoiding trauma or irritation to the skin or mucous membranes (such as wearing gloves when handling sharp objects or maintaining good oral hygiene), treating any underlying infections or hormonal imbalances (such as using antibiotics for staph infections or adjusting birth control pills), and discontinuing any medications that may trigger or worsen the condition (such as antineoplastics, antiretrovirals, immunosuppressants, or retinoids).

How does pregnancy affect the development and management of pyogenic granuloma?

Pregnancy can increase the risk of developing pyogenic granulomas due to hormonal changes. Pyogenic granulomas that occur during pregnancy are often called pregnancy tumors or epulis gravidarum. They usually appear on the gums, but can also occur on other parts of the body. They tend to grow rapidly during the first and second trimesters, and may shrink or disappear after delivery. However, some may persist or recur after pregnancy. Treatment of pyogenic granulomas during pregnancy may be delayed or modified to avoid harming the mother or the fetus.

Is a pyogenic granuloma a tumor?

A pyogenic granuloma is a tumor made up of abnormal blood vessels, but it is not cancerous.

Is there a dermatologist near me in Newport News that offers treatment for Pyogenic Granulomas?

Yes. At our Newport News dermatology office we offer treatment for Pyogenic Granulomas to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Rosacea

What is Rosacea?

A chronic, inflammatory skin condition, rosacea affects more than 16 million Americans. Rosacea manifests itself as redness on the face that produces small, pus-filled bumps or pustules. Although rosacea is not contagious, some evidence suggests a genetic link to the condition.

Usually, most people first develop rosacea in their 30’s and then live with continuous cycles of flare-ups and dormancy. Without treatment, rosacea can have a negative impact on a person’s emotional, psychological and physical health.

rosacea-before-after-cosmetic-treatment-skin-disorders

What are the signs and symptoms of Rosacea?

Rosacea is a skin condition that causes redness and visible blood vessels in your face. It may also produce small, red, pus-filled bumps.

Some of the signs and symptoms of rosacea are:

Facial blushing or flushing that comes and goes
Visible veins on the nose and cheeks
Swollen bumps or pimples on the face
Burning or stinging sensation on the skin
Eye problems such as dryness, irritation, or redness
Enlarged nose due to excess tissue (rhinophyma)

What are the causes of Rosacea?

The exact cause of rosacea has not been identified, but the environment and genetics may play a role. If you have light skin, a family history of rosacea or experience frequent blushing, you may have an increased tendency toward developing rosacea. More women than men tend to have rosacea but men experience more severe symptoms.

Certain factors can aggravate rosacea by increasing blood flow including:

Harsh soaps or abrasive cleanser
Alcohol
Corticosteroids
Extremes in temperature
Exposure to sun
Hot baths and saunas
Medications that dilate blood vessels, including certain blood pressure medications
Spicy foods
Stress, anger or embarrassment
Very hot foods or beverages
Vigorous exercise

What treatments are available at the dermatologist for Rosacea?

There are different treatments available at the dermatologist for rosacea, depending on the type and severity of your condition. Some of the treatments are:

Topical drugs that reduce flushing, such as brimonidine (Mirvaso) and oxymetazoline (Rhofade). These drugs work by constricting blood vessels and need to be applied regularly.
Topical drugs that help control the pimples of rosacea, such as azelaic acid (Azelex, Finacea), metronidazole (Metrogel, Noritate, others) and ivermectin (Soolantra). These drugs may take several weeks to show noticeable improvements.
Oral antibiotics, such as doxycycline (Oracea, others), for moderate to severe rosacea with bumps and pimples. These drugs help reduce inflammation and infection.
Oral acne drug, such as isotretinoin (Amnesteem, Claravis, others), for severe rosacea that doesn’t respond to other therapies. This drug helps clear up acnelike lesions of rosacea, but it can cause serious side effects and birth defecte.
Laser therapy, such as pulsed dye laser (PDL) or intense pulsed light (IPL), for enlarged blood vessels and redness. These therapies use light energy to shrink the blood vessels and reduce the redness. They may cause temporary swelling and bruising.

Rosacea vs Acne

Rosacea usually affects people older than 30, while acne is more common in teenagers and young adults.
Rosacea only affects the face and eyes, while acne can also affect the chest, neck, back, and shoulders.
Rosacea does not cause blackheads or whiteheads, which are typical features of acne.
Rosacea is triggered by factors such as hot drinks, spicy foods, alcohol, temperature extremes, sunlight, wind, emotions, exercise, cosmetics, or certain medications. Acne is caused by clogged pores due to excess oil and dead skin cells.
Rosacea has no cure, but it can be treated with medications, laser therapies, and lifestyle changes. Acne can be treated with topical and oral medications, as well as skin care products.

woman-with-rosacea-face-dermatological-problems

FAQ About Rosacea

Who is at risk for rosacea?

Rosacea is most common in fair-skinned people of Northern European descent, and is more common in women than in men. However, anyone can develop rosacea. People with a family history of rosacea may be more likely to develop the condition. It usually appears after age 30 and it affects more women than men.

How is rosacea diagnosed?

A dermatologist can diagnose rosacea by examining the skin and asking about symptoms. There is no specific test for rosacea. The diagnosis is based on the presentation of the skin, and also the patients’ symptoms, history and triggers.

What are some triggers for rosacea?

Triggers for rosacea can include sun exposure, heat, stress, alcohol, and certain foods. Common food triggers include spicy foods, hot drinks, and alcohol. Certain skin care products and cosmetics can also irritate the skin and trigger a flare-up.

Can rosacea lead to other health problems?

In some cases, rosacea can lead to eye problems such as conjunctivitis and blepharitis. These eye problems can cause redness, itching, and burning of the eyes, and can lead to loss of vision if left untreated.

How can I prevent rosacea flare-ups?

To prevent rosacea flare-ups, it is important to avoid known triggers, protect the skin from the sun by using a sunscreen with an SPF of at least 30, and maintaining a healthy lifestyle. Avoiding alcohol and spicy foods, practicing good skincare routine, and managing stress can also help prevent flare-ups. Additionally, it’s important to see a dermatologist regularly to monitor the condition and adjust treatment as needed.

Is there a dermatologist near me in Newport News that offers treatment for rosacea?

Yes. At our Newport News dermatology office we offer treatment for rosacea to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Psoriasis

What is Psoriasis?

An estimated 7.5 million Americans suffer with psoriasis, a non-contagious, chronic skin condition. Often identified by patches of red, scaly skin, psoriasis occurs when the immune system sends out incorrect signals that cause skin cells to grow too quickly. With psoriasis, cells build up on the top layer of skin, creating patches of itchy, dry skin. The most common locations for psoriasis are on the elbows, knees, or trunk, but it can develop anywhere on the body.

Psoriasis is thought to be an autoimmune disease, which arises from an overactive response by the body towards substances and tissues normally present in the body. In the case of psoriasis, white blood cells, called T cells, attack healthy skin as if to fight off infection or heal a wound. Instead of new cells moving to the outermost layer of skin in a normal manner, they develop more rapidly. The dead skin can’t slough off fast enough to keep up, so thick, scaly areas form on the skin’s surface.

Usually, the first occurrence of psoriasis happens sometime between ages 15 to 35. However, approximately 20,000 children under age 10 also live with psoriasis. Although psoriasis seems to have a genetic component, not everyone with that gene develops the disease.

What are the signs and symptoms of Psoriasis?

Each case differs based on the individual, but people with psoriasis often experience at least one of the following symptoms:

Burning, itching, or soreness
Cracked, dry skin that can bleed
Patches of red skin with silvery scales
Pitted, ridged, or thickened nails
Stiff, swollen joints

If you think that you could have psoriasis, contact your doctor and schedule a complete exam.

Triggers
Because psoriasis is chronic, anyone with the condition will live with a cycle of flare-ups and remissions over a lifetime. Typically, patients with psoriasis may develop initial symptoms or experience flare ups because of various triggers, including

Certain medications
Cuts, scrapes, burns, or other damage to the skin
Diet
Excessive alcohol use
Other infections such as strep throat
Smoking
Stress
Weather

What are the different types of Psoriasis?

There are six main types of psoriasis:

1) Plaque Psoriasis (Psoriasis Vulgaris)
About 80 percent of people diagnosed with the disease have plaque psoriasis, or psoriasis vulgaris. Plaque psoriasis often appears as on the elbows, knees, and lower trunk in the form of raised, red lesions topped with silvery scales.

2) Guttate Psoriasis
Usually found on the limbs or trunk, guttate psoriasis primarily appears in patients younger than age 30. Guttate psoriasis presents as small, water-drop-shaped sores and can occur because of an illness or injury to the skin.

3) Inverse Psoriasis
With inverse psoriasis, patients develop smooth, shiny lesions that are bright red in color. Most often seen in people who are overweight, inverse psoriasis strikes the armpits, around the genitals, near the groin, and under the breasts.

4) Pustular Psoriasis
When you have pustular psoriasis, white blisters filled with pus and surrounded by red skin will appear either in localized areas or all over your body. Because the pus is made of white blood cells, it is not contagious. Certain things can trigger pustular psoriasis, such as irritating topical treatments, infections, overexposure to ultraviolet radiation, and stress.

5) Erythrodermic Psoriasis
Characterized by a fiery red rash coupled with extreme burning or itching, erythrodermic psoriasis is the least common kind of psoriasis. Triggers for erythrodermic psoriasis include severe sunburn, corticosteroids, other medications, or another type of psoriasis that has flared up.

6) Psoriatic Arthritis
In addition to causing pitted, discolored nails, psoriatic arthritis also presents with the swollen, painful joints that often accompany arthritis. Usually psoriatic arthritis isn’t as crippling as other forms of arthritis, but it can cause stiffness and progressive joint damage.

What treatments are available at the dermatologist for Psoriasis?

Currently, no cure exists for psoriasis. Treatments are designed to minimize discomfort and encourage healing. When determining the best treatment, your doctor will take into account the severity of the psoriasis. Mild to moderate psoriasis covers 3 to 10 percent of your body, while psoriasis is considered moderate to severe when it covers more than 10 percent.

Treating Mild to Moderate Psoriasis
If you have mild to moderate psoriasis, your doctor will likely recommend a combination of over-the-counter medications, prescription topical treatments, and light therapy/phototherapy.

Over-the-Counter (OTC) Medications
The two active ingredients in over-the-counter medications approved by the FDA for psoriasis are coal tar, which inhibits the quick overgrowth of cells, and salicylic acid, which makes the outer layer of skin shed. Other OTC treatments may help, like:

Scale lifters to loosen and eliminate scales so that medicine can penetrate the sores
Bath solutions, such as Epsom salts, Dead Sea salts, or oilated oatmeal, that reduce itching and remove scaling
Occlusion, which covers the areas treated with topical treatments applications, to improve absorption and effectiveness
Anti-itch products like calamine lotion or hydrocortisone creams
Moisturizers to keep skin hydrated, reduce symptoms, and encourage healing

Prescription Topicals
Designed to inhibit the overgrowth of cells and lessen inflammation, prescription topicals include:

Anthralin, which reduces the skin cell growth related to plaque
Calcipotriene will flattens lesions, removes scales, and slow cell growth. Often used in treatment of psoriasis on the scalp and nails.
Calcipotriene and Betamethasone Dipropionate. By combining Calcipotriene with betamethasone dipropionate, this treatment addresses the itch and inflammation common to psoriasis as well as flattening lesions, removing scales, and minimizing cell growth.
Calcitriol, an active form of vitamin D3, helps limit extraneous skin cell production
Tazarotene, a topical retinoid that slows down cell growth
Topical steroids are the most commonly used medications for psoriasis, and they work by reducing inflammation, swelling, and redness

Phototherapy (light therapy)
Exposure to ultraviolet light can provide relief from psoriasis. With careful monitoring, the UVA and UVB rays from the sun can reduce symptoms. Excimer lasers treat specific areas affected by psoriasis, while pulse dye lasers provide not only targeted treatment, but also destroy the blood vessels that promote the development of psoriasis.

Treating Moderate to Severe Psoriasis
For patients with moderate to severe psoriasis, treatment involves prescription medications, biologics and phototherapy (light therapy).

Prescription Medications
Based on the location, severity, and type of psoriasis, your doctor will prescribe an oral medication, such as acitretin, cyclosporine and methotrexate.

How does psoriasis affect your nails, eyes, and joints?

Nails: Psoriasis can cause changes in the appearance and structure of the nails, such as pitting, discoloration, thickening, loosening, or crumbling. These changes can affect the function and comfort of the nails, as well as the self-esteem of the person with psoriasis.
Eyes: Psoriasis can cause inflammation in the eyes, leading to a condition called uveitis. Uveitis can cause symptoms such as eye pain, redness, blurred vision, sensitivity to light, or floaters. If left untreated, uveitis can damage the eye and impair vision.
Joints: Psoriasis can cause inflammation in the joints, resulting in a type of arthritis called psoriatic arthritis. Psoriatic arthritis can cause symptoms such as joint pain, stiffness, swelling, reduced range of motion, or deformity. Psoriatic arthritis can affect any joint in the body, but it is more common in the fingers, toes, spine, and pelvis. Psoriatic arthritis can also affect the tendons and ligaments that attach to the bones.

FAQ About Psoriasis

Can psoriasis affect other parts of the body besides the skin?

Psoriasis can affect other parts of the body besides the skin, such as the nails, scalp and joints. In some cases, it may also be associated with other conditions such as psoriatic arthritis.

Can certain foods trigger psoriasis?

Certain foods, such as processed foods, alcohol, and gluten-containing foods, may trigger psoriasis in some individuals. It’s important for people with psoriasis to work with a dermatologist or a dietitian to identify any specific food triggers and to develop a diet plan that works best for them.

When should I see a dermatologist for psoriasis?

If you have symptoms of psoriasis, such as red, scaly patches on the skin, it’s important to see a dermatologist for proper diagnosis and treatment. A dermatologist can also help to develop an individualized treatment plan and provide guidance on how to manage the condition. If your symptoms persist or worsen, you should also consult with a dermatologist.

Is there a dermatologist near me in Newport News that offers treatment for psoriasis?

Yes. At our Newport News dermatology office we offer treatment for psoriasis to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Warts

What are Warts?

Warts are small, rough growths on the skin that are caused by human papillomavirus (HPV) infections. They can appear anywhere on the body and can have a flat or raised appearance. Warts are generally benign and are usually not a serious health concern, but they can be unsightly or painful in some cases. There are various treatments for warts, including over-the-counter creams, freezing therapy, and prescription medications. It’s important to consult a doctor for the best treatment options for your individual case.

What are the causes of Warts?

Warts are caused by infections with human papillomavirus (HPV), which are highly contagious. They are usually spread through direct contact with the skin of an infected person, or by coming into contact with a surface that has been contaminated with the virus. People with weakened immune systems, such as those with HIV/AIDS, are more susceptible to developing warts. Additionally, factors like skin injuries, cuts, and scrapes can increase the likelihood of developing warts, as they can provide an entry point for the virus.

What are the symptoms of Warts?

Warts typically appear as raised, flesh-colored growths on the skin that can be smooth or rough in texture. They can be flat or raised, and sometimes they have tiny black dots on the surface, which are small blood vessels. Warts can appear anywhere on the body and may be itchy, painful, or bleed. The symptoms and appearance of warts can vary depending on the type of HPV that caused the infection and the location of the wart. Common wart types include plantar warts (on the feet), flat warts (on the face), and genital warts. It’s important to have any unusual growths on the skin evaluated by a doctor to determine if they are warts or a different condition.

What treatments are available for Warts?

There are several treatment options available for warts, including:

Over-the-counter topical treatments: These include creams and gels that contain salicylic acid, which can be applied directly to the wart.
Cryotherapy: This involves freezing the wart with liquid nitrogen, causing it to blister and eventually fall off.
Surgical removal: This involves cutting or burning off the wart, which can be performed by a dermatologist or doctor.
Cantharidin: This is a chemical that is applied to the wart to cause a blister, after which the wart can be removed.
Electrosurgery: This involves using an electrical current to burn off the wart.
Laser therapy: This involves using a laser to destroy the wart.

How to Help Prevent Warts

Here are some steps you can take to help prevent warts:

Wash your hands frequently: This will help reduce the spread of the human papillomavirus (HPV) which is the virus that causes warts.
Keep your skin clean and dry: Warts thrive in moist environments, so keeping your skin clean and dry can help prevent the growth of warts.
Don’t bite your nails: Biting your nails can cause tiny cuts in your skin, which can provide an entry point for the virus that causes warts.
Avoid sharing personal items: Don’t share towels, razors, or other personal items with others, as these items may be contaminated with the virus.
Wear protective footwear: Wear protective footwear, such as sandals or flip flops, in public areas such as locker rooms or swimming pools, where you may come into contact with the virus.
Avoid touching warts: If you see a wart on someone else, avoid touching it, as the virus can be transmitted from person to person.

It’s important to keep in mind that warts can be easily spread, so it’s important to take precautions to help prevent their spread. If you already have warts, it’s important to avoid touching them, as this can spread the virus to other parts of your body or to others.

FAQ About Warts

Can warts be spread from person to person?

Yes, warts can be spread from person to person through direct contact or through contact with contaminated items such as towels or razors.

Can warts be painful?

Warts are typically not painful, but they may become uncomfortable or irritated if they are located in an area that rubs against clothing or footwear.

Can warts go away on their own?

Warts can sometimes go away on their own, but it can take several months to several years for this to happen.

Are warts contagious?

Yes, warts are contagious and can be spread from person to person through direct contact or through contaminated items.

Can warts reoccur?

Yes, warts can reoccur after they have been treated, especially if the person’s immune system is weakened.

Is there a dermatologist near me in Newport News that offers treatment for warts?

Yes. At our Newport News dermatology office we offer treatment for warts to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Seborrheic Keratosis

What is Seborrheic Keratosis?

Seborrheic keratosis is a common skin condition that results in the formation of raised, scaly, waxy or wart-like growths on the skin. These growths are noncancerous (benign) and usually appear in middle-aged or older individuals. They can range in color from light tan to dark brown and can be found on any part of the body, including the face, neck, chest, and back. Seborrheic keratosis is caused by an overgrowth of skin cells, but the exact cause is unknown. They are often harmless, but may be removed for cosmetic reasons or if they become irritated or catch on clothing.

What are the symptoms of Seborrheic Keratosis?

Seborrheic keratosis usually appears as raised, scaly growths on the skin. The growths can range in size from a few millimeters to several centimeters and can appear anywhere on the body. They are typically:

Brown, black, or tan in color
Waxy or wart-like in texture
Stuck-on appearance, as if they are pasted onto the skin
Smooth or slightly scaly
Round or oval in shape

Seborrheic keratosis is a benign (noncancerous) condition and typically does not cause any symptoms or discomfort. However, some individuals may experience itching or irritation in the affected area. If this occurs, it is important to have the growth evaluated by a dermatologist or skin care professional.

What treatments are available for Seborrheic Keratosis?

Treatment for seborrheic keratosis is not usually necessary as it is a benign (noncancerous) condition. However, some individuals may choose to have their seborrheic keratosis removed for cosmetic reasons. If a seborrheic keratosis becomes irritated or catches on clothing, it may also need to be removed. The following are some of the most common treatments for seborrheic keratosis:

Cryotherapy: This involves freezing the growth with liquid nitrogen, causing it to blister and eventually fall off.
Curettage: This involves scraping the growth off with a curette, a sharp, spoon-shaped instrument.
Electrosurgery: This involves using an electric current to remove the growth.
Excision: This involves cutting the growth out with a scalpel.

The choice of treatment will depend on the size, location, and number of growths, as well as the patient’s preference. The dermatologist will help determine the best treatment option.

How to Help Prevent Seborrheic Keratosis

The exact cause of seborrheic keratosis is unknown, so there is no guaranteed way to prevent it. However, the following may help reduce the risk of developing seborrheic keratosis:

Follow these tips as well:

Limit sun exposure: Wear protective clothing and use a broad-spectrum sunscreen with a high SPF when spending time outside.
Avoid tanning beds: UV radiation from tanning beds can increase the risk of developing seborrheic keratosis.
Maintain a healthy diet: Eating a diet rich in antioxidants and anti-inflammatory foods may help reduce the risk of developing seborrheic keratosis.
Avoid smoking: Smoking has been linked to an increased risk of skin cancer, including seborrheic keratosis.
Monitor skin changes: Regularly check your skin for any new growths or changes in existing moles, and have any suspicious growths evaluated by a dermatologist.

It is important to keep in mind that while these steps may help reduce the risk of developing seborrheic keratosis, they do not guarantee prevention. Regular skin checks and prompt evaluation of any suspicious growths are essential for early detection and treatment of skin conditions.

FAQ About Seborrheic Keratosis

What does Seborrheic Keratosis look like?

A: Seborrheic Keratosis appears as a raised, scaly, or wart-like growth on the skin with a brown, black, or light-brown color.

Is Seborrheic Keratosis contagious?

A: No, Seborrheic Keratosis is not contagious.

Are there any home remedies for Seborrheic Keratosis?

A: No, there are no proven home remedies for Seborrheic Keratosis. Consult a dermatologist for treatment options.

Can Seborrheic Keratosis turn into skin cancer?

A: No, Seborrheic Keratosis is a benign growth and does not turn into skin cancer.

Is Seborrheic Keratosis painful?

A: No, Seborrheic Keratosis is usually not painful, but removal procedures may cause some discomfort.

Is there a dermatologist near me in Newport News that offers treatment for Seborrheic Keratosis?

Yes. At our Newport News dermatology office we offer treatment for Seborrheic Keratosis to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Moles

What are Moles?

A mole is a type of skin lesion that is caused by the growth of pigment-producing cells called melanocytes. Moles can appear anywhere on the skin and can be various shapes, sizes, and colors, including black, brown, or flesh-colored. Some moles are present at birth, while others may develop over time. Most moles are benign, but in rare cases, moles can develop into skin cancer, so it’s important to monitor any changes in their appearance and have any suspicious moles evaluated by a dermatologist or skin care professional.

What are the causes of Moles?

Moles are caused by the overgrowth of pigment-producing cells called melanocytes. The exact reason for this overgrowth is not fully understood, but a combination of genetic and environmental factors is believed to play a role, including:

Genetics: The tendency to develop moles can be inherited.
Sun exposure: Prolonged exposure to UV rays from the sun can increase the risk of developing moles.
Hormonal changes: Hormonal changes, such as during pregnancy or puberty, can cause the growth of new moles or changes in existing moles.
Age: Moles are more common in younger people and tend to fade or disappear as people age.
Skin type: People with fair skin and lighter hair are more susceptible to developing moles.

It’s also worth noting that some moles can develop as a result of injury or irritation to the skin, such as from friction or rubbing.

What treatments are available for Moles at the dermatologist in Newport News?

The treatment for moles depends on various factors, such as the type, size, and location of the mole, as well as any changes in its appearance. Some common treatments include:

Observation: If a mole is benign and not causing any symptoms, a dermatologist may recommend monitoring it for any changes over time.
Surgical removal: Moles can be surgically removed by a dermatologist or skin care professional, either by cutting them out (excision), shaving them off (curettage), or using a laser.
Cryotherapy: Cryotherapy involves freezing the mole with liquid nitrogen, which causes the mole tissue to blister and eventually fall off.
Topical medications: In some cases, topical medications, such as imiquimod, may be used to treat moles by encouraging the immune system to attack the mole cells.
Laser therapy: Laser therapy uses light energy to destroy the mole cells without damaging the surrounding skin.

It’s important to note that any changes in a mole’s appearance, such as itching, bleeding, or changes in color, shape, or size, should be evaluated by a dermatologist or skin care professional as soon as possible, as these may be signs of skin cancer.

How to Help Prevent Moles?

There is no guaranteed way to prevent moles, but there are steps you can take to reduce your risk of developing new moles or changes in existing moles:

Protect your skin from the sun: Wear protective clothing, such as long-sleeved shirts and wide-brimmed hats, and use a broad-spectrum sunscreen with at least SPF 30.
Seek shade: Avoid being in direct sunlight for prolonged periods, especially between 10am and 4pm when the sun’s UV rays are strongest.
Avoid tanning beds: Tanning beds emit UV rays that can increase the risk of developing moles and skin cancer.
Check your skin regularly: Get into the habit of regularly checking your skin for any new or changing moles, and have any suspicious moles evaluated by a dermatologist or skin care professional.
Be aware of your family history: If you have a family history of skin cancer, you may be at a higher risk of developing moles, so it’s important to take extra precautions to protect your skin.

By following these steps, you can reduce your risk of developing moles and increase the likelihood of early detection and treatment if needed.

FAQ About Moles

Are moles harmful?

Most moles are benign, but in rare cases, moles can develop into skin cancer, so it’s important to monitor any changes in their appearance and have any suspicious moles evaluated by a dermatologist or skin care professional.

Can moles be removed?

Yes, moles can be surgically removed by a dermatologist or skin care professional, either by cutting them out, shaving them off, or using a laser.

Is it safe to remove a mole?

Removing a mole is generally safe, but it’s important to have the procedure performed by a qualified dermatologist or skin care professional to minimize the risk of complications.

How can I tell if a mole is cancerous?

Changes in a mole’s appearance, such as itching, bleeding, or changes in color, shape, or size, may be signs of skin cancer, and should be evaluated by a dermatologist or skin care professional as soon as possible.

Can moles return after removal?

In some cases, moles can return after removal, but this depends on various factors, such as the type, size, and location of the mole, as well as the method of removal.

Is there a dermatologist near me in Newport News that offers treatment for moles?

Yes. At our Newport News dermatology office we offer treatment for moles to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Actinic Keratosis

What is Actinic Keratosis?

Actinic keratosis is a skin condition characterized by the appearance of rough, scaly patches on the skin that have been damaged by repeated exposure to the sun’s ultraviolet (UV) rays. These patches are usually red, pink, or skin-colored, and may be precancerous, meaning that they can develop into skin cancer if left untreated. Actinic keratosis is commonly found on sun-exposed areas of the skin, such as the face, neck, hands, and arms.

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What are the causes of Actinic Keratosis?

Actinic keratosis is caused by damage to the skin from exposure to the sun’s ultraviolet (UV) rays. UV radiation from the sun can cause changes in the skin cells, leading to the development of rough, scaly patches. People who have had a lot of sun exposure over their lifetime, especially those who have fair skin, are at a higher risk of developing actinic keratosis. Additionally, factors such as advancing age, certain medical conditions, and taking certain medications can increase a person’s risk of developing this condition.

What are the symptoms of Actinic Keratosis?

Actinic keratosis typically presents as small, rough, scaly patches on the skin that are red, pink, or skin-colored. They are usually found on sun-exposed areas of the skin, such as the face, neck, arms, and hands. Other symptoms of actinic keratosis include:

A dry, scaly texture to the affected skin
A rough, gritty feeling when rubbing the skin
A slightly raised or flat appearance
A sore that does not heal
A discolored area that is different from the surrounding skinIt’s important to note that not all actinic keratoses are visible or have symptoms. Some may be detected during a routine skin examination.

It’s important to note that not all actinic keratoses are visible or have symptoms. Some may be detected during a routine skin examination.

What treatments are available for Actinic Keratosis?

There are several treatment options available for actinic keratosis, including:

Topical creams and gels: Medications applied directly to the skin can help to remove actinic keratoses. Some of these medications cause the skin to peel, while others are designed to destroy the abnormal cells.
Cryotherapy: This involves freezing the affected skin with liquid nitrogen, causing the actinic keratosis to peel off.
Surgical procedures: In more severe cases, actinic keratosis may be removed with a surgical procedure such as curettage (scraping) or electrodessication (burning).
Light-based treatments: Photodynamic therapy (PDT) is a procedure that uses a photosensitizing medication and a special light source to destroy actinic keratosis cells.
Systemic therapy: In rare cases, a doctor may prescribe oral medications to help treat actinic keratosis.

The choice of treatment will depend on several factors, including the size, number, and location of the actinic keratoses, as well as the overall health of the patient. A dermatologist or skin care professional can help to determine the best treatment plan for each individual case.

How to Help Prevent Actinic Keratosis?

There are several steps you can take to help prevent actinic keratosis:

Protect your skin from the sun: Wear protective clothing, such as long-sleeved shirts and pants, and a wide-brimmed hat. Use a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of 30 or higher and reapply it every two hours, especially after swimming or sweating.
Seek shade: Avoid spending too much time in direct sunlight, especially during the peak hours of 10 am to 4 pm, when the sun’s rays are the strongest.
Avoid tanning beds: Tanning beds emit UV radiation that can damage your skin and increase your risk of actinic keratosis and skin cancer.
Get regular skin exams: Early detection and treatment of actinic keratosis can help to prevent the development of skin cancer. It’s important to have regular skin exams by a dermatologist or skin care professional.

By following these preventive measures, you can reduce your risk of developing actinic keratosis and protect your skin from further damage.

FAQ About Actinic Keratosis

Who is at risk for actinic keratosis?

People who have had a lot of sun exposure over their lifetime, especially those with fair skin, are at a higher risk of developing actinic keratosis.

Can actinic keratosis turn into skin cancer?

Yes, actinic keratosis can develop into skin cancer if left untreated.

What should I do if I have actinic keratosis?

If you have actinic keratosis, it’s important to see a dermatologist or skin care professional for a proper diagnosis and treatment plan.

Is actinic keratosis contagious?

No, actinic keratosis is not contagious and cannot be spread from one person to another.

Is there a dermatologist near me in Newport News that offers treatment for actinic keratosis?

Yes. At our Newport News dermatology office we offers treatment for actinic keratosis to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.

Hives (Urticaria)

What are Hives?

Hives are raised red bumps (welts) or splotches on the skin that are usually very itchy. They are a type of swelling on the surface of your skin that happen when your body has an allergic reaction to something.

What are the signs and symptoms of Hives?

Individual hives can take from 30 minutes to 36 hours to disappear. Chronic hives, referred to as urticaria, last longer than six weeks to go away, but frequently reoccur. If swelling occurs below the surface of the skin, a condition called angioedema, you should seek medical attention because angioedema can affect the internal organs.

Signs of hives include:

Developing in batches
Often raised
Small, round rings or large patches with a red flare
Usually itch

What are the causes of Hives?

Hives develop when mast cells release histamine and other chemicals into your bloodstream, causing small blood vessels to leak. Generally, hives are an allergic reaction to a food, animal or medication. Sun exposure, stress, excessive perspiration and other more serious conditions, like lupus, can bring on hives.

What treatments are available at the dermatologist for Hives?

Our dermatologist may recommend various treatments and strategies to help manage and alleviate hives, depending on the severity and underlying causes.

Here are some common treatments available at the dermatologist’s office:

Antihistamines: Non-prescription (over-the-counter) antihistamines like cetirizine (Zyrtec), loratadine (Claritin), or fexofenadine (Allegra) can help relieve itching and reduce the severity of hives. Dermatologists may also prescribe stronger prescription antihistamines.
Corticosteroids: Topical corticosteroid creams or ointments can be applied directly to the affected skin to reduce inflammation and itching. Oral corticosteroids may be prescribed for severe cases of hives or when topical treatments are not effective.
Epinephrine (EpiPen): In rare cases of severe hives accompanied by anaphylaxis or difficulty breathing, an epinephrine auto-injector (EpiPen) may be prescribed to quickly relieve symptoms.
Immune-suppressing medications: For chronic or severe cases of hives that do not respond to other treatments, dermatologists may prescribe medications that suppress the immune system, such as cyclosporine or omalizumab (Xolair).
Triggers identification and avoidance: Dermatologists may work with patients to identify and avoid triggers that can exacerbate hives. Common triggers include certain foods, medications, insect stings, physical stimuli (like heat, cold, or pressure), and stress.
Physical therapies: For certain types of hives, such as cold urticaria or pressure urticaria, dermatologists may recommend physical therapies like cold packs or pressure-reducing strategies to manage symptoms.
Allergy testing: If an allergic trigger is suspected, allergen testing may be conducted to identify specific allergens responsible for hives. This can help with avoidance strategies.

FAQ About Hives

Are hives contagious?

Hives are not contagious and cannot be spread from person to person through direct contact.

How long do hives last?

Hives can last anywhere from a few minutes to several days or even weeks. They can be chronic, or recurring, in some cases.

Can hives lead to more serious conditions?

In some cases, hives can be a symptom of a more serious allergic reaction, such as anaphylaxis. If hives are accompanied by difficulty breathing, swelling of the face or throat, or a rapid heartbeat, it is important to seek immediate medical attention.

Is there a dermatologist near me in Newport News that offers treatment for hives?

Yes. At our Newport News dermatology office we offer treatment for hives to patients from Newport News and the surrounding area. Contact our office today to schedule an appointment.