My dermatologist didn't do a very thorough exam, what should I expect in an exam?
When I went for my first dermatological exam, the doctor looked at red spots on my hands and said they were actinic keratosis. Then she said where is my liquid nitrogen lets get rid of them. I said wait, aren't you going to examine the rest of my body? Also what are my treatment options. She spend maybe 10 minutes with me. She wrote a prescription for Efudex 5 percent, but didn't really discuss what was the best option. On doing research I learned that the liquid nitorgen leaves white scars, but that the Efudex makes the skin very red and irritated. I have very sensitive skin because I am prone to have ezcema. So far I haven't filled the prescription. I have had these red spots for years and do want to treat them, but really do not feel confident in the doctor. I am thinking of trying a different doctor, but I want to know what I need to look for in an examination.
Thanks so much fo ryour question Sharron and I'm sorry this has been more difficult than it might have been. It is so important to have a good relationship with you physician. Open communication is key - you NEED to understand what is happening to you.
Our Expert Dr. Berman has provided a GUIDE for people if they have been diagnosed. This may help you with your search for a new doctor and the right questions to ask.
Hope this helps and good luck with a new doctor.
All the best, sue (moderator)
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Dear Sharon,
Surprisingly, it doesn't take long for a board certified dermatologist to perform a complete skin examination to screen for skin cancer. A multicenter study reported in the April issue of the respected dermatology journal, Archives of Dermatology [Arch Dermatol. 2008;144:509-513.] found that experienced dermatologists take an average of 1 minute and 10 seconds to perform a complete skin examination. If dermoscopy, a method of skin examination with use of a noninvasive optical instrument, is added, the complete skin examination takes an average of 2 minutes and 22 seconds. So the bottom line is not how long your dermatologist takes, but whether you feel comfortable that he or she checked you all over. The examination should include not only your skin but also your scalp, hair, mouth and nails. If you feel that the examination was not through and your dermatologist was not responsive when you stated this, then I do suggest you consult another dermatologist. Perhaps you can get a word-of-mouth recommendation from someone who is happy with their dermatologist. Besides freezing with liquid nitrogen, treatment options for actinic keratoses include heat treatment (electrodesiccation) and prescription creams such as Efudex (5-fluorouracil) and Aldara. I prefer Aldara because some studies have shown it to be more effective than Efudex. Aldara contains the active ingredient, imiquimod, which specifically stimulates your skin's immune system to destroy the actinic keratoses. It tends to cause less skin irritation than Efudex and, unlike Efudex, it does not cause sun sensitivity.
Hope this helps!
Dr. Hema
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