General Dermatology


Everyone loses hair. It is normal to lose about 50-150 hairs every day. If you see bald patches or lots of thinning, you may be experiencing hair loss. There are many reasons for hair loss. When hair loss begins suddenly, the cause may be due to illness, diet, medicine, or childbirth. If hair loss is gradual and becomes more noticeable with each passing year, a person may have hereditary hair loss. Certain hair care practices also can cause noticeable hair loss. Luckily, most causes of hair loss can be stopped or treated. Anyone troubled by hair loss should see a dermatologist.

Autoimmune Connective Tissue Disorders

The autoimmune connective tissue disorders may have both genetic and environmental causes. Genetic factors may create a predisposition towards developing these autoimmune diseases. They are characterized as a group by the presence of spontaneous overactivity of the immune system that results in the production of extra antibodies into the circulation. Collagen vascular diseases that may affect the skin include:

  • Systemic lupus erythematosus (SLE) – An inflammation of the connective tissues, SLE can afflict every organ system. It is up to nine times more common in women than men and strikes black women three times as often as white women. The condition is aggravated by sunlight.
  • Scleroderma – an activation of immune cells that produces scar tissue in the skin, internal organs, and small blood vessels. It affects women three times more often than men overall, but increases to a rate 15 times greater for women during childbearing years, and appears to be more common among black women.
  • Sjögren’s syndrome – also called Sjögren’s disease, is a chronic, slowly progressing inability to secrete saliva and tears. It can occur alone or with rheumatoid arthritis, scleroderma, or systemic lupus erythematosus. Nine out of 10 cases occur in women, most often at or around mid-life.
  • Mixed connective tissue disease – Mixed connective-tissue disease (MCTD) is a disorder in which features of various connective-tissue diseases can coexist and overlap. The course of the disease is chronic and usually milder than other CTDs. In most cases, MCTD is considered an intermediate stage of a disease that eventually becomes either SLE or Scleroderma.

A birthmark is a benign irregularity on the skin, which is present at birth or appears shortly after birth, usually in the first month. They can occur anywhere on the skin. There are two main types of birthmarks: pigmented (brown, blue, and black spots caused by excess pigment in the skin) and vascular (red and purple lesions caused by locally increased blood vessels). Most birthmarks are harmless and do not require treatment. Some resolve on their own over time while others require reduction or removal for cosmetic or functional reasons.

Blistering Diseases

Blistering skin diseases can range from relatively mild to extremely painful and debilitating. Both genetic as well as acquired (autoimmune, drug related, allergic, and infectious) forms of blistering can occur. Precise diagnosis of these diseases is extremely important and therapy of blistering diseases can be challenging but with the right combination of medications total disease control can be obtained. It is important to see your dermatologist for the proper diagnosis and management of blistering conditions.


Epidermoid and pilar cysts look like small smooth lumps under the skin surface. They are benign (non-cancerous) and usually cause no harm or problems. Occasionally, they may become infected (when they may become red, inflamed and painful), leak their contents if punctured or damaged, or become uncomfortable or cosmetically undesireable. If required, they can usually be removed easily by a small operation done under local anaesthetic.

Cold Sores (herpes)

Herpes simplex is a common viral infection. If you’ve ever had a cold sore or fever blister, you picked up the herpes simplex virus. Most cold sores are caused by herpes simplex virus type 1 (HSV-1). A closely related herpes simplex virus, HSV-2, causes most cases of genital herpes. But either HSV-1 or HSV-2 can cause a herpes sore on the face or genitals. During an outbreak, a dermatologist often can diagnose herpes simplex by looking at the sores. Suppression can be obtained with treatment and eventually all patient’s develop permanent immunity against the virus and no longer suffer from repeated outbreaks. Many people choose to treat herpes simplex because treatment can relieve symptoms and shorten an outbreak. Most people are treated with an antiviral medicine. An antiviral cream or ointment can relieve the burning, itching, or tingling. An antiviral medicine that is oral (pills) can shorten an outbreak of herpes. Taken daily, these medicines can lessen the severity and frequency of outbreaks. They also can help prevent infected people from spreading the virus.

Dry Skin

Dry skin is common. It can occur at any age and for many reasons. Using a moisturizer often helps repair dry skin. Sometimes people need a dermatologist’s help to get relief from dry skin.  Anyone can get dry skin. Skin becomes dry when it loses too much water or oil. Some people are more likely to have dry skin. Some causes of dry skin are:

  • Age: As we age, our skin becomes thinner and drier. By our 40s, many people need to use a good moisturizer every day.
  • Climate: Living in a dry climate such as a desert.
  • Skin disease: People who had atopic dermatitis (also called eczema) as a child tend to have dry skin as adults. Psoriasis also causes very dry skin.
  • Job: Nurses, hair stylists, and people in other occupations often immerse their skin in water throughout the day. This can cause the skin to become dry, raw, and cracked.
  • Swimming: Some pools have high levels of chlorine, which can dry the skin.

To find out whether your dry skin is a sign of a skin disease, a dermatologist will carefully examine your skin. The doctor also will ask questions, such as when the problem began. This information will help the dermatologist make the right diagnosis and determine the best treatment.


Hives (or urticaria) are welts on the skin that often itch. These welts can appear on any part of the skin. Hives vary in size from as small as a pen tip to as large as a dinner plate. Hives usually lasts less than 6 weeks. These hives are called acute hives. If hives last more than 6 weeks, they are called chronic hives. Acute hives often result from an allergy, but they can have many other causes. Things that commonly trigger hives include: foods, medicines. insect bites and stings, animals, pollen, recent illness. Often, no identifiable trigger for hives is found. Fortunately, most cases of hives are usually easily controlled with antihistamines. For most people, hives are not serious. In some people, though, hives may be a sign of an internal disease. Others can get a severe swelling with hives known as angioedema. If you have hives and trouble breathing or swallowing, get emergency care right away.

Hyperhidrosis (excessive sweating)

Excessive sweating happens when a person sweats more than is necessary. Many people who have hyperhidrosis sweat from one or two areas of the body. Most often, they sweat from their palms, feet, underarms, or head. While the rest of the body remains dry, one or two areas may drip with sweat. This excessive sweating can interfere with everyday activities. Hyperhidrosis can be controlled with prescription strength topicals, iontophoresis, and occasionally oral medications.

Infection of the Skin (Bacterial, Fungal, Viral)

Your skin helps protect you from germs, but sometimes it can get infected by them. Some common types of skin infections are

  • Bacterial: Cellulitis, impetigo, folliculitis
  • Viral: Shingles, warts, molluscum, and herpes simplex
  • Fungal: Athlete’s foot and yeast infections
  • Parasitic: Body lice, head lice, and scabies

Your dermatologist can help you diagnose and properly treat skin infections.


Keratosis pilaris is a common skin condition that causes rough patches and small, acne-like bumps, usually on the arms, thighs, cheeks and buttocks. Keratosis pilaris bumps are usually white or red, and generally don’t hurt or itch. Keratosis pilaris can be frustrating because it’s difficult to treat. However it isn’t serious and usually disappears by age 30. In the meantime, prescription medications and self-care measures can improve the appearance of keratosis pilaris. Topical creams and lotions are currently the most commonly used treatment for keratosis pilaris, specifically those consisting of moisturizing or keratolytic treatments, including: urea, lactic acid, glycolic acid, salicylic acid, tretinoin, Vitamin D, or topical retinoids. Steroid creams can also be used to reduce redness.

Melasma (chloasma)

Melasma causes brown to gray-brown patches, usually on the face. Most people get it on their cheeks, bridge of their nose, forehead, chin, and above their upper lip. It also can appear on other parts of the body that get lots of sun, such as the forearms and neck.

Wearing sunscreen every day is an excellent way to help prevent melasma, however other treatments may be necessary for long-term distress. These can include: hydroquinone, tretinoin and corticosteroids, other prescription topicals, oral tranexamic acid, and procedures such as chemical peels, microdermabrasion, and laser and/or light-based treatments. Dr. Ulmer and his staff can help determine what’s right for you.

Molluscum Contagiosum

Molluscum contagiosum presents itself as clusters of small round bumps (papules) usually in warm moist places such as the armpit, groin, or behind the knees. They often have a waxy, pinkish look with a small central pit (umbilicated). As they resolve they may become inflamed, crusted, or scabby. Molluscum contagiosum is caused by the Pox virus the largest virus to infect the human body.  It is easily treated with electrosurgery, cryotherapy, and topical medications including salicylic acid and Cantharone (cantharidin).

Nail Disorders

Diseases and disorders of the nails may affect the texture of the nail plate surface, the nail color, the cuticle or nail fold, or the overall shape of the nail. Some conditions may cause loss of nails or lesions to grow around the nails. Some nail disorders are simply cosmetically undesirable, while others may represent a more serious underlying disease or drug reaction. Various fungal infections include both dermatophytes and yeast. Psoriasis can also lead to nail disorders. Treatments include topicals and oral medications as required depending on your diagnosis. We can help you determine the cause of your nail disorder and the treatment options that are right for you.


A rash is not a specific diagnosis. It is a general term that means an outbreak of skin inflammation and discoloration that change the way the skin looks and feels.

Contact dermatitis is a rash that is brought on either by contact with substances/chemicals to which a person is uniquely allergic or with a substance that directly irritates the skin, such as poison sumacpoison oak, and even jewelry containing nickel.

Rashes can also be caused by an underlying medical condition, hormonal cycles, fungal and bacterial infections, and even stress.

Treatment depends on the underlying cause of the rash. Rashes lasting more than a few days that are unexplained should be evaluated by a doctor. If you have a new rash and you have a fever or some other generalized illness associated with it, you should contact a dermatologist.


A mite causes this common skin condition. Called the human itch mite, this eight-legged bug is so small that you cannot see it on the skin. People get scabies when the mite burrows into the top layer of skin to live and feed. When the skin reacts to the mite, an extremely itchy rash develops. This mite can travel from the infected person to another person. Most people get scabies from direct, skin-to-skin contact. Less often, people pick up mites from infested items such as bedding, clothes, and furniture. The mite can survive for about 48 to 72 hours without human contact. Anyone can get scabies. It strikes people of all ages, races, and income levels. People who are very clean and neat can get scabies. It tends to spread easily in nursing homes and extended-care facilities. Fortunately, it is easily treatable with creams or pills from your dermatologist.

Seborrheic Dermatitis (dandruff)

Seborrheic Dermatitis causes an itchy rash that can appear red in color and typically on the scalp. Seborrhea is a common skin disease that appears similar to eczema, psoriasis, or even an allergic reaction. Dandruff and cradle cap are common names for this condition. Sometimes Sebhorrhea can clear up itself or the use of good skin can can help prevent outbreaks of the condition.

Solar (Actinic) Purpura + Solar Elastosis

A common condition of increased bruising and fragility in aging, photodamaged skin. It appears as purple, red, or blue patches on the back of the arms and hands and the skin can have a tendency to tear easily. Retin-A (tretinoin) has been observed to reverse many of the changes that occur with photodamage. Daily use of a broad spectrum sunscreen can prevent further damage and patients should avoid certain products that increase bruising such as blood thinners, aspirin, vitamin E, etc.

Tinea Versicolor

A common fungal infection caused by an overgrowth of yeast on the skin. Tinea Versicolor is most common in teens and young adults. This condition is not contagious and treatment options such as antifungal creams, lotions and shampoos are usually effective. It can also be treated with oral medications such as nizoral and itraconazole.


Vitiligo is a disease that can cause a loss of skin color in blotches. Each patient experiences loss in skin color at different rates and in different parts of the body. When melanin stops being produced this is when Vitiligo begins. Treatment for vitiligo may restore color but does not prevent continued loss of skin color ongoing.