Scalp Care

Itchy Scalp?

Have you found yourself scratching your head, wondering what’s going on up there? Are you embarrassed when flakes and scabs fall out with a gentle brush of your hair?

You are not alone! People of all ages commonly have various skin conditions on the scalp and unfortunately they are difficult to distinguish from the untrained eye.

Some common causes

  • Seborrheic Dermatitis is the most common condition on the scalp. Common symptoms are itching and “dandruff.” When naturally produced oils accumulate, it leads to over growth of Malassezia, which leads to the rash. 
  •  Psoriasis of the scalp is common and a challenging condition to manage. Typically one would notice pink plaques with silver scale and intense itching. The rash is due to a complex imbalance in the immune system which drives the formation of these plaques. 
  • Folliculitis is analogous to acne of the scalp. One typically experiences small pus bumps and crusted scabs that can be painful and mildly itchy. It’s usually due to bacterial infection of the hair follicles. 
  • Tinea Capitis, fungal infection on the scalp, is uncommon in adults and appears mostly in children. Typically there is scale, intense itching and even hair loss.

Many other scalp conditions exist, and it is important to have your dermatologist make a proper diagnosis and recommend appropriate therapy, which is typically a combination of prescription and over the counter medications and shampoos.

If you suffer from a scalp condition and need help, call TRUE Dermatology today for an appointment.



Melanoma: The Silent Skin Cancer

What is Melanoma?

Melanoma is a type of skin cancer originating from pigment producing cells called melanocytes. When these cells are damaged by radiation they can transform and behave abnormally. If there is enough permanent DNA damage, then these pigment cells can multiply and grow without regulation and become a cancer.  Unfortunately, this cancer is notorious for camouflaging amongst other skin lesions, and due to it’s lack of symptoms a melanoma can grow and metastasize in silence.

Who is at risk?

Melanoma occurs 1 in 40 people in lighter skin types and less frequently in darker skin types in all age groups. There are two major components of melanoma development: Genetic and Environmental Factors. Since hereditary plays a major role, knowing if you have a family history of melanoma is extremely important.  Additionally, environmental exposures can alter the normal biology. For example, exposing skin to radiation from the sun, tanning beds, and various occupations such as welding, radiology, outdoor work can lead to DNA damage resulting in melanoma or other skin cancers. 

Are all skin cancers melanoma?

NO.  There are several skin cancers of the skin, and melanoma is just one of the many types. Melanoma is the third most common skin cancer, preceded by basal cell carcinoma and squamous cell carcinoma.  It is important to distinguish between these cancers because melanomas are more aggressive and have an increased risk of metastasis-spreading to other organs. 

How to detect melanoma?

Since melanoma are discrete, they are very difficult to detect by the untrained eye. Additionally, it very difficult to self inspect one’s back, which is one of the most common sites for melanoma to occur. 

A guideline to help is the ABCDE‘s of melanoma. Moles with the following need to be professionally evaluated:

  • Asymmetry
  • Borders irregular
  • Color uneven
  • Diameter greater than 4mm
  • Evolution (changing) moles

If there is a concern about melanoma, it is important to have your skin checked head to toe by a Board Certified Dermatologist regularly.

Raj Patel, MD

Dry Skin


Dry Skin


The weather is cooling down, and many of us will suffer from dry skin over the next few months.


As the temperature drops, the humidity or moisture in the air decreases. This causes more water to evaporate from our skin leading to dryness, cracking and itching. Here are some TRUE tips to prevent dry skin.

  • Shower with luke warm water and limit to 5 minutes
  • Use Dove bar soap
  • Avoid wash cloths
  • Pat yourself dry
  • Moisturizer with unscented cream or Vaseline instead of lotions after showers
  • Stay hydrated and drink plenty of water
  • Wash clothes with Free and Clear detergents

Persistent dry skin can lead to significant irritation, infection, or rash that requires medical attention.  If so, please make your appointment for evaluation at TRUE Dermatology.  

Raj Patel, MD 

What is Moh’s Micrographic Surgery and What is the ACMS

Cure for Skin Cancer- 99% effective

Skin cancer is caused by radiation from the sun, and 50% of Americans who live to the age of 65 will be affected by skin cancers. This epidemic is spreading despite sun protection and awareness.

Typically, skin cancers have been treated by surgically removing large areas of skin. This results in leaving the patient with a sizable defect and possibly a long, wide scar.  Additionally, 1/10 patients would still have cancer left in the body, thus requiring them have to return for additional surgery weeks later. 

Now patients diagnosed with skin cancer can have a procedure called Moh’s Micrographic Surgery, which offers a greater than 99% clearance rate!  This state of the art surgery is a delicate and precise procedure that spares as much skin as possible, providing the most optimal cosmetic outcome. Most importantly, when the patient leaves the office, he or she is rest assured that all the cancer is removed!

How is this possible?

Once the cancer is removed, the final layer of tissue is processed by the surgeon’s specialized lab.  The surgeon also reads the microscopic slide under the microscope to assure there are no cancer cells remaining. Due to a different technique in processing the tissue, the doctor can evaluate 100% of the margin, compared to the 5% seen in typical cancer surgeries. 

Who is qualified to perform MOHs Micrographic Surgery?

Only a few surgeons in the state are truly qualified to perform this intricate surgery. Ask your surgeon if they have trained with the American College of Moh’s Surgeon, ACMS.  This is the most rigorous and and highly trained group of surgeons qualified to treat and manage skin cancers. 

Insurance companies approve this procedure, and the cost is similar to that of basic excisions. But how?

The doctor performing Mohs Surgery typically assumes the following roles:


Surgical Oncology


Plastic Surgery

The ACMS Moh’s surgeon combines 4 separate doctors of work into one. Additionally, these procedures are done in the office at True Dermatology; therefore, there is no burden of hospital or facility charges.


Does SPF Matter?


You have probably been to the drug store to pick up sun screen and been overwhelmed with the various brands, types and sun protective factor rating (SPF). Which one to pick?

Recently there has been more discussion surrounding SPF, particularly some folks who think it doesn’t matter which SPF you select.

I believe SPF DOES matter. In fact, I suggest using the highest SPF sun screen, and here’s why:

The Sun Protective Factor is an index that is directly related to how much ultraviolet radiation passes through the sun screen. Ultraviolet radiation is responsible for skin cancer and sun damage. To determine the SPF on the label, the FDA requires 2 grams of sun screen per cm2. That means to achieve that SPF on your skin you virtually have to use an entire tube of sun screen! You might as well just smear Desitin all over… just kidding.

The average person uses about a quarter of the recommended amount. Studies show that the amount of sunscreen applied exponentially affects the actual protection you get. What does this mean?

If you use an SPF 30 and apply 25% of the recommended amount, you are actually getting an SPF of 5. If you use an SPF of 70, then you would probably get an SPF of 25. That’s a significant difference!

So the next time you face a spectrum of SPFs, go with the higher one and enjoy being outside and safe in the sun. And remember, be sure to reapply every hour.

Stay tuned about tanning beds next!