September 24th, 2012

Print out the following coupon (and bring into the office to redeem) and get 10% off your cosmetic procedure/product purchase for your birthday! (Offer valid for two months after date of birth)

May 10th, 2012

Four Points Dermatology is proud to announce the addition of Josh Embry, PA-C, to our practice. We are thrilled to introduce him to the community. Like Dr. Roopal Bhatt, board certified Dermatologist, Josh Embry is capable of managing a full spectrum of Adult, Pediatric, Surgical and Cosmetic Dermatologic needs.

Josh Embry, PA-C, certified Physician Assistant, earned a Master of Physician Assistant Studies (MPAS) from Towson University in Baltimore, Maryland. He was recognized for his academic achievements, and was nominated to the dean’s list.
Josh has received specialized training in Dermatology and has practiced Dermatology since 2006. He is qualified to perform a comprehensive Dermatological examination, diagnose, treat and prescribe appropriate medical therapy for all dermatologic needs. He takes a special interest in the diagnosis and treatment of skin cancers and pre-cancers. Josh is well experienced in performing medical procedures such as biopsies and excisions, as well as cosmetic procedures including Botox treatments, filler injections (Juvederm and Radiesse), laser treatment, etc..

Josh is certified by the National Commission of Certification for Physician Assistants and licensed through the Texas State Board of Medical Examiners. His professional memberships include the Society of Dermatology Physician Assistants and the American Academy of Physician Assistants. Josh continues to expand his knowledge base through regular Continued Medical Education.

June 26th, 2011

ABCD’s of Skin Cancer Detection

The American Academy of Dermatology recommends that you “Check your birthday suit on your birthday!”© After looking over your skin, call your austin dermatologists as soon as possible if any of your moles or pigmented spots exhibit:s

One half doesn’t match the appearance of the other half.

The edges are irregular, raged, or blurred.

The color or pigmentation is not uniform and/or has shades of tan, brown, or black; is sometimes white, red, or blue

The size of the mole is greater than 1/4 inch (6 mm), about the size of a pencil eraser.

The mole over time changes shape, size, color, etc.

***This information is for general educational uses only. It may not apply to you and your specific medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional. Communicate promptly with your physician or you local austin dermatologist with any health-related questions or concerns.

June 17th, 2011

Evolutionary speaking, our fat cells are fit. They perform their main function, for energy storage, without fail throughout our lifespan, while also insulating and cushioning our vital organs. Adipocytes, or fat cells, perform a variety of other functions, such as hormone/chemical secretion for certain regulatory and body developmental functions.

But in our society, too much of a good thing has villainized the humble adipocyte. Fat has become the social public enemy number one. There is a $60+ billion dollar industry developed now for weight loss to try to fight, trick, destroy, or cut out this unsightly layer of our bodies. Have we been underestimating the powers of this cell all along?

The average adult has about 30 billion fat cells, or about 30 pounds of fat. Adipocytes can hold up to four times their normal volume of triglycerides and/or cholesteryl esters before needing to divide. And we are horrified to realize that they do not decrease in number even when we lose the weight.

Fat is metabolically active. It does not lay dormant until its energy stores are suddenly needed. Rather, it constantly obtains and releases triglycerides from and into the blood stream to maintain a steady level of fatty acids in the bloodstream for energy for other body organs. In addition to a multitude of hormones and regulatory chemicals, fat is also a source of estrogen and leptin (a hormone that regulates appetite and energy metabolism) and plays a role in insulin homeostasis (for the regulation of blood glucose levels).

As our diets and lifestyles becomes “hypercaloric,” over 1.1 billion people in the world are now overweight, with almost 400 million people fitting the definition of obesity. We are newly amidst an intense epidemic of our own lifestyle-driven health issues, from heart disease to diabetes and its many complications.

Even our children are being affected by the “Diabesity” epidemic. Medically, there has been a sharp increase in the incidence of juvenile-onset diabetes, high cholesterol, early puberty in girls, hypertension, and cardiovascular disease. Psychosocially, poor self-image, body consciousness, eating disorders, and social ostracism is facing the younger overweight generation. Our children are getting mixed messages from the food industry and the entertainment industry – should they hide how much they are eating, eat nothing and become food- or exercise-bulimics, or eat only one hamburger all day as a compromise?

How do we get control back and fight this public health threat? As usual knowledge is power. Talk to your primary doctor to get started. Your physician can do basic blood work and vital sign measurements, with height and weight measurements to also ascertain the body mass index. Waist circumference above 35 inches for women and 40 inches for men, blood pressure above 130/85, triglyceride levels about 150mg/dL, “good” HDL levels below 40mg/dL for men and 50mg/dL for women, and fasting blood glucose level above 100mg/dL increase the risk for something called the Metabolic Syndrome (aka Insulin Resistance Syndrome). If you meet three of the above criteria, you may have the metabolic syndrome, which represents level of risk of an individual for coronary artery disease and diabetes.

Weight loss to decrease the BMI to below 25 via diets low in saturated and trans fats and cholesterol and routine exercise should dramatically decrease the risk of the metabolic syndrome by decreasing abdominal circumference, blood pressure, triglyceride and “bad” LDLs, and blood sugar levels. It is of course much easier said than done, but this is the month to start taking control.

Roopal Bhatt, MD is a dermatologist starting practice in the Four Points area.

For questions or more information, email her at contact@fourpointsdermatology.com and make an appointment with out local Austin dermatologist today.

June 16th, 2011

Trends come and go, sometimes even in Medicine. For the past thirty years, Dermatologists have been trained to deny an association between diet and acne, even though patients swear that chocolate or french fries or ketchup or ice cream caused their breakout. We’d attribute it to stress, hormones, genetics, sweating, oily skin care products, or just bad luck. Most previous studies exploring a causative link did not show a strong scientifically-based association, but as we look back at these older studies, there are faulty concepts that doctors are still trying to put into perspective. Newer studies, though still not perfect, are now supporting a possible contributory role of diet in acne.

Acne has a multifactorial origin – genetics, microanatomy of the skin, hormones, stress, certain medications, and now diet may contribute to that untimely and unsightly zit, regardless of age. As Dermatologists, we have noticed an increase of acne prevalence beyond adolescence into the 3rd, 4th, 5th and even 6th decades of life, and we do not have an exact reason for this. One hypothesis can be related to the change of the modern diet, which often includes high carbohydrate, high fat, high sodium, processed, low fiber foods. But, again, our food consumption cannot be the only factor, otherwise we’d all be one large pimple during the holidays(!)

In particular, two possible dietary culprits now include foods with a high glycemic load and milk products.

Glycemic load assesses the potential of a food to increase blood sugar or glucose. The glycemic load factors in carbohydrate quality and quantity. A high glycemic load diet increases the hormone insulin and an analog of it called insulin-like growth factor 1 (IGF-1). IGF-1, in lay terms, causes our pores to clog. It may also increase sebum, or oil, production. IGF-1 and androgens (“male” hormones found in both genders) can act synergistically to worsen acne.

Women who have polycystic ovarian syndrome (PCOS), an endocrine disorder where androgen and insulin and IGF-1 levels are elevated, can often have some combination of acne, irregular menses, hair loss on the scalp, excess facial and body hair, infertility, insulin-resistance, and obesity. We have noticed that medications that lower insulin and IGF-1 levels in these patients improve acne as well.

Next, milk’s exact role in the development of acne has long been debated. Two recent studies have found a relationship with acne, from either whole or skim milk. The thinking is that milk may directly increase IGF-1 levels. In addition, milk may contain excess hormones from the cow that affect acne. There are estrogens (“female” hormones), androgens, progesterones, other bioactive molecules, or even iodine in milk that could contribute to acne flares.

Well, we are still at a standstill in our debates. While practicality and real life experience suggest a positive correlation with high sugar or carbohydrate foods, we still cannot gather enough credible scientific evidence to absolutely prove a direct relationship.

There are flaws with old and current studies however, either in design or number of patients, and further more rigorous studies need to be done.

Those that can follow a “low carb” diet and avoid milk may see improvement, all other factors being equal, but there are many other confounding factors that can also contribute to acne. In those women with PCOS, dietary changes may play more of a role, and these patients should follow a low glycemic index diet to decrease insulin resistance for improvement in overall general health and as a bonus, in acne.

For those who swear by a food trigger, from chocolate to fried foods to citrus, by all means avoid that trigger as long as it still allows a good dietary practice. Diet is only part of the puzzle that we need to piece together for improving our skin appearance.
Roopal Bhatt, MD is a Dermatologist starting practice in the Four Points area.

For questions or more information, please contact her at contact@fourpointsdermatology.com

June 16th, 2011

Cryosurgery is a standard therapy for both benign and malignant conditions of the skin. This handout hopes to answer or anticipate any questions you have.

After The Procedure

You will note swelling and redness around the site. This is normal.

Your “sharp” feeling of discomfort will continue for a few more minutes, and then give way to more of a “sore” feeling. As the area begins to swell, some patients find that they continue to have this “sore” feeling for several days.

For this discomfort, you may take acetaminophen (Tylenol©) unless you have been instructed otherwise by your physician.

Over the next few days, you may develop a blister at the treated area, or the area may begin to weep or drain. If the blister is tense and uncomfortable, you can pop it with a sterile (heated under a flame or cleansed with alcohol) needle. If the blister does not bother you, no treatment is needed. However, do NOT peel off the top of the blister roof. It will act as a dressing on top of your wound.

Wound Care

You may bathe of shower as per your regular routine.

Cleanse the site twice a day with soapy water, and then apply a thin film of white petrolatum (Vaseline©).

You do not need to cover the area, but can if you prefer.

Do NOT allow the site to become dry of crusted, or attempt to dry it out with rubbing alcohol.

Continue this regimen until the area is pink and healed. Depending on the size and location of your cryosurgery site, and you own body’s ability to heal, this may take two to three weeks.

The area may continue to be pink for several weeks, and over the next few months the area may become darker or lighter than the surrounding skin. This may be a permanent change.

Signs Of An Infection

Your wound may continue to ooze or drain for several days, and a small rim of redness around the site is normal.

Symptoms of infection include a large area of surrounding redness, white pustular drainage, swelling, or pain that is not controlled by over-the-counter pain medication.

If you have questions about your cryosurgery treatment site, please don’t hesitate to call the office (478-3376).

June 16th, 2011

The advent of vaccines, antibiotics, and antiseptic techniques has saved our millions of our children from pneumonia, meningitis, kidney, heart, and liver damage, upper respiratory infections, and paralysis. Some of the pediatric viral and bacterial killers of as recent as 20 years ago, have become almost extinct thanks to the miracles of modern Medicine and public health measures.

However, the “bugs” physicians now see affecting children’s skin have changed. Rare are the cases of measles, German measles, mumps, etc., which had distinctive skin appearances but were untreatable. These illnesses now are replaced by cases of Staphylococcus aureus and Group A Streptococcus bacterial manifestations, and some common viral diseases mentioned below. These can be harder to diagnose because of their variable appearance, but some are treatable with antibiotics and anti-inflammatory medications, though some still may be deadly.

About 20% of Pediatrics visits involve skin manifestations of viral, bacterial, or other infectious agents. Here is a list of just some of the relatively common rashes that the Pediatrician, Family Practitioner, or Dermatologist sees, from the more mundane to those that require immediate medical attention:

• Impetigo – from a toxin that Staph or Strep bacterial species produces causing localized “honey-colored” crusts typically around the nose, mouth, or eyes (but can be on any skin site). It is contagious but treatable with topical and/or oral antibiotics. In children less than 5 years, if the rash spreads with fever, this may be “Staphylococcal Scalded Skin Syndrome” and needs immediate attention.

• Tinea Capitis – a fungal infection of the hair of the scalp causing hair loss, scale, & itch. It more often involves African-American children due to hair texture. If on the skin of the body, it is termed “ringworm” or tinea corporis.

• Head Lice – small 6-legged arthropods that lay eggs on the hair shaft and go to the skin of the scalp to feed on blood. Head lice is mainly seen in Caucasian- or Asian-type hair textures. It is highly contagious.

• Scabies – another small arthropod that burrows under our skin and lays eggs. Causes intense itching with a rash at the armpits, genitals, hands, and buttocks. Also is highly contagious.

• Pityriasis Rosea – from the HHV-7 virus. Rash can start off as one larger skin lesion (a “herald patch”) with a spread of the small scaly plaques on the back and chest in a “Christmas tree” distribution. It is not thought to be contagious and does not usually require treatment.

• “Slapped Cheeks” – aka Erythema Infectiosum, is caused from Parvovirus B19, where the child gets bright red cheeks and then a lacy red pattern on the arms and rarely joint pain. Parvovirus infection can be dangerous to the fetus if transmitted to pregnant women in the second trimester.

• Chicken Pox – though much less common because of the Varicella vaccine, there are breakthrough cases of “atypical” chicken pox still seen. Classically, there are small, red, itchy blisters that start on the chest or back and spread outward in crops to the face, arms, etc. . This very itch rash is highly contagious unless the receiving individual is properly immunized

• Scarlet Fever – from a toxin that Strep pyogenes (from strep throats) causing fever, red “strawberry” tongue, a sandpapery rash, and a rash on the inner elbows or sides of groin. The kidneys can be affected.

• Kawasaki’s Disease – often in children less than 5 years old with at least five days of fever, hand and foot skin changes, lymph node swelling, red eyes. Child must be treated in the hospital with anti-inflammatory medications, and will need a cardiac evaluation.

• Erythema Multiforme– usually a skin reaction from the Herpes Virus (or various medications) causing fever, skin pain, and “bulls-eye” lesions on the palms and soles. If these blisters go on to affect larger areas of the skin or the mouth, eyes, or genitalia, the child needs immediate medical attention.

As parents, caregivers, and teachers, you should worry if the child has a new rash associated with a persistent fever (e.g. a rectal temperature of over 100.4˚F if less than three months old or above 101-103˚F otherwise). Fever is just part of the equation, so if your child seems listless and difficult to wake up, with poor appetite, severe nausea, vomiting, and/or diarrhea, headaches, neck stiffness, light sensitivity, gets sudden seizures, has difficulty breathing or sleeping, and “just doesn’t seem right,” call your Doctor or 911, or go to the Emergency Room.

Roopal Bhatt, MD, is a Dermatologist now practicing in the Four Points Area.

If you have questions about this topic or others, please contact her at contact@fourpointsdermatology.com

December 7th, 2010

November 12th, 2010

October 15th, 2010