Pediatric and Adult Dermatology

Pediatric and Adult Dermatology

Pediatric and Adult Dermatology

Dermatology Associates of Western Pennsylvania provides comprehensive medical dermatology services to meet individual needs across all ages and skin types.

Dr. Brian Pucevich, Dr. Michael Osofsky, and Dr. Saba Ali are fully committed to their patients and are knowledgeable in the ongoing advancements in the field of dermatology.

Some of the most common dermatologic conditions are listed below. The information presented is not intended to provide diagnostic advice and is not comprehensive. Please make an appointment by calling 412-262-1064 for your specific skin care concerns, assessment and treatment.


Acne is a common skin condition that happens when clogged pores and bacteria create inflammation that causes blackheads and whiteheads, pimples, and deeper cysts or nodules that occur on the face, neck, chest, back, shoulders and occasionally the upper arms. Acne affects people of all ages from infancy up to adulthood. Common acne treatments include topical creams or gels, oral antibiotics and oral isotretinoin. Treatment is individualized based on the patient’s skin type and acne type. Acid cleansers, chemical peels, microdermabrasion and light therapy can also be used as effective treatments. When patients begin treatment it is important to realize that acne may temporarily get worse before it gets better. Improvement is seen after six to eight weeks of treatment, as is takes that long for skin cells to “turn over”.

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Actinic Keratosis

Actinic Keratosis, or AKs, are pre-cancerous skin growths with the potential to transform into squamous cell carcinoma. Actinic keratosis are caused by repeated and prolonged exposure to ultraviolet light from the sun and typically present as rough spots on areas of the skin that have received sun exposure.

The treatment for actinic keratosis depends upon the number and size of the lesions. If the growths are small and still in the pre-cancerous stage, they can be frozen with liquid nitrogen, treated with a topical chemotherapy cream, or with photodynamic therapy. You can prevent actinic keratosis by reducing sun exposure, especially avoiding sunlight during the peak hours of 10 a.m. to 3 p.m. Your daily skincare should include an SPF 30 or higher; if planning a full day outdoors, wear a sunblock with SPF 50 or higher as well as a hat and protective clothing. Sunblocks should be reapplied every 90 minutes to avoid sunburns and UV induced skin damage.

Photodynamic therapy sessions are available at our facility:

AMELUZ GEL (aminolevulinic acid HCl) for Topical Solution, 10% plus blue light illumination using the BLU-U® Blue Light Photodynamic Therapy Illuminator are used in combination for the treatment of minimally to moderately thick actinic keratoses of the face, scalp, and arms.

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Discolorations: Hyperpigmentation, Melasma, Dark Spots

Hyperpigmentation is the darkening of the skin and is caused by an increase in melanin, the substance in the body that is responsible for color (pigment). Hyperpigmentation is most commonly caused by over exposure to the sun, which provokes melanocyte production on the surface of the skin (sun exposure includes indoor tanning). Certain conditions, such as pregnancy or hormone changes, may also cause hyperpigmentation. Melasma is tan or brown patches, most commonly on the face, that often occur during pregnancy. Dark spots can also follow inflammation in the skin, as is commonly seen following acne in dark skinned patients. Treatments include topical creams, prescription products, chemical peels and cosmetic laser treatment. You can minimize hyperpigmentation by reducing sun exposure; especially avoiding sunlight during the peak hours of 10 a.m. to 3 p.m. Your daily skincare should include an SPF 30 or higher; if planning a full day outdoors, wear a sunblock with SPF 50 or higher as well as a hat and protective clothing. Sunblocks should be reapplied every 90 minutes to avoid sunburns and UV induced skin damage.


Atopic dermatitis (eczema) is a chronic, itchy inflammatory condition of the skin that is often associated with asthma or hay fever. Atopic dermatitis most often begins in childhood before age 5 and may persist into adulthood. For some, it flares periodically and then subsides for a time, even up to several years. Though the patches can occur anywhere, they most often appear on the hands and feet, in the front of the bend of the elbow, behind the knees, and on the ankles, wrists, face, neck and upper chest. Itching may be severe, and scratching the rash can make it even itchier. It can be exacerbated by irritating clothes, hand washing, chemicals, climate, emotions, skin infections, and food allergies. No one thing can control atopic dermatitis. Successfully managing this complex condition requires a multi-faceted approach. Avoiding scratchy materials using gentle cleansers, and moisturizing several times a day is of the utmost importance and can provide longer periods between flares and help reduce the length of flares. For flares oral anti-histamines, non-steroidal anti-inflammatory creams, steroid creams, and occasionally oral steroids can be prescribed. More severe cases may need light therapy or systemic immunosuppression. With proper skin care, frequent moisturizer application, using medication as directed, and avoiding common skin irritants such as wool clothing, most patients are able to control their eczema.

For more information:

      • http://www.aad.org/skin-conditions/dermatology-a-to-z/eczema
      • http://fromyourdoctor.com/

Excessive Sweating/Hyperhidrosis

Hyperhidrosis is a medical condition in which a person sweats excessively and unpredictably. People with hyperhidrosis may sweat even when the temperature is cool or when they are at rest. Those with hyperhidrosis appear to have overactive sweat glands. The uncontrollable sweating can lead to significant discomfort, both physical and emotional. Botox, prescription strength antiperspirants, and oral medications may be used for treatment. Botox treatments have been FDA approved and can be used to minimize hyperhidrosis. Botox works by blocking the chemical signals from the nerves that stimulate sweat production and is commonly used on hands/palms and armpits.

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Hair Loss

There are many reasons for hair loss including hereditary disorders, diseases, hormones and stress, diet or poor nutrition, medications and hair care. The most common cause of hair loss is a medical condition called androgenetic alopecia. About 80 million men and women in the United States have this type of hair loss. Other names for this type of hair loss are:

      • Male-pattern baldness
      • Female-pattern baldness
      • Hereditary hair loss

Most causes of hair loss can be stopped or treated. Hair loss treatments include over the counter medicines, prescription medicines, and procedures. Examination by a dermatologist to diagnose the cause of hair loss is recommended as early as possible, and includes blood tests to rule out underlying medical causes. Treatment may be more effective if caught early, before excessive hair loss occurs.

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Moles / Nevi

A mole is a common skin growth that can be raised or flat and may appear brown, flesh colored, or black. The medical name for a mole is a nevus. Most moles appear during the first two decades of life, but can appear later in life as well. Development of moles is mostly hereditary, but sun exposure can increase the amount of moles that a person develops. Melanoma is a serious, deadly skin cancer that can occasionally develop in or near moles, so it is important to examine your moles on a regular basis to look for any changes.

You can check your own moles at home once a month after you shower, and can use mirrors to look at your back. When checking moles, look for the ABCDE’s of Melanoma (Skin Cancer). If you see any signs of concern, tell your dermatologist immediately.

Moles / Nevi

A vast majority of moles are benign, however if they are irritated or changing they can be easily removed with either local surgical excision or shave removal. Moles that are removed will be sent to a pathologist for further investigation.

For more information:

      • http://www.aad.org/skin-conditions/dermatology-a-to-z/nevi

Nail Infections

Nails are susceptible to many of the conditions that affect skin, and are prone to a number of unique conditions. Fungal infections of the nails occur most often on toenails due to ill-fitting shoes and the warm, moist environment of closed footwear. These infections can cause nails to turn white or yellow, thicken, crumble or separate from the nail bed. The infection may be isolated to a single nail, or it may affect all nails. Infected nails may be uncomfortable or painful when wearing shoes, and may even cause serious physical and occupational limitations. Fungal infection of the nail may be treated with an oral antifungal and/or a topical treatment for any bacterial or fungal infection present on the foot. A wide range of other diseases can affect the nails, including contact dermatitis (allergy to nail hardener or adhesive), bacterial infection, psoriasis, eczema, trauma and chronic picking or biting. Once the nail is damaged or separates from the nail bed, a secondary infection is common, complicating the condition.

Non-healing Wounds or Ulcers

A non-healing or chronic wound or ulcer is defined as a wound that shows little or no improvement after four weeks or does not heal in eight weeks. A non-healing wound or ulcer poses the risk of infection, which can lead to a more serious condition. Some of the most common areas for non-healing wounds are the lower extremities such as feet, ankles, heels and calves. For those unable to walk, common places for non-healing wounds are hips, thighs and buttocks. Color, texture, odor and warmth in and around the wound area are all signs that an infection may exist.


Psoriasis is a non-contagious, chronic inflammatory skin disease which may have periods of relative remission and flares. Patients with psoriasis have a genetic predisposition for the disease, which develops due to a combination of immune, genetic and environmental factors. Certain cells of the immune system signal the top layer of skin, the epidermis, to grow too quickly and stop shedding properly. This causes the scaly buildup that most commonly affects the skin of the elbows, knees, scalp, lower back, buttocks and penis. The joints are also affected in up to 30% of patients, which can lead to deformity and disability if untreated. Injury to the skin, severe emotional stress, and infections (i.e. strep throat) can lead to a flare of psoriasis. Psoriasis is predominately a disease of adults, but can occur in childhood.

In addition to its physical impact on your skin, psoriasis can also affect your emotional, psychological and social well-being. This visible and lifelong disease may change how you view yourself and interact with others. Patients with psoriasis have higher rates of depression, and organizations such as the National Psoriasis Foundation can offer support.

While there is no cure for psoriasis, there are fantastic treatments which can control the disease. Treatment of psoriasis depends upon the extent and severity of your disease as well as the location of the plaques. Mild to moderate psoriasis may be treated with topical steroids, vitamin D or vitamin A derived topical treatments, and salicylic acid or coal tar preparations. Moderate cases usually respond to combination therapy with topicals and light treatments. More severe cases and those with associated arthritis may need systemic therapy, which may include pills or injections. Oral therapies include methotrexate, cyclosporine, or Soriatane®. These treatments are not without risk and must be monitored with lab work. Your dermatologist will order this lab work to monitor these drugs.

Newer injectable medications called biologics specifically target the immune system, and include Stelara®, Enbrel®, Humira®, and Remicade®. These medications work to suppress very specific inflammatory mediators (rather than suppressing the entire immune system). They are either injections or intravenous medications and require pre-treatment blood work, tuberculosis testing, and periodic monitoring during treatment. They are effective for both psoriatic skin disease and psoriatic arthritis.

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Skin rashes can occur from a variety of factors, including bug bites, infections, heat, contact with chemicals, allergens or plants and immune system disorders. Rashes may occur as a symptom of a chronic skin problem such as eczema or psoriasis, or a more serious disease, such as liver disease or kidney disease. Some medicines can cause a rash as a side effect. Skin rashes may cause discomfort or pain, as well as embarrassment about the appearance of your skin. Some skin rashes clear up on their own, while others, may require medical treatment. It is important to see your dermatologist if you have a rash that is unexplained, symptomatic or does not resolve.


Rosacea is seen as inflammation and redness of the central face that causes symptoms similar to acne. There can be pimples, pustules and cysts, but there are no blackheads or whiteheads. Flushing is seen in virtually all patients with rosacea. Certain foods, heat, caffeine, alcohol and exercise can worsen rosacea. While there are many prescription treatments used to control rosacea, there is no known cure. Prescription treatments used to control the inflammation include oral antibiotics such as Oracea. Common topical treatments for rosacea include Metrogel, Finacea and sulfur based products. Laser treatment can be used to reduce the flushing and blushing of rosacea caused by breakage of small blood vessels. Makeup and skin care are extremely important in treating rosacea. Patients with rosacea have very sensitive skin so toners, alcohol based products and scrubs are not recommended. These products will flare your sensitive skin and the rosacea. Ingredients like green tea, copper and benzoyl peroxide can be used safely instead. Daily skincare should include a gentle cleanser, moisturizer, and SPF 30 or higher. If planning a full day outdoors, patients should wear a sunblock with SPF 50 or higher as well as a hat and protective clothing. Sunblocks should be reapplied every 90 minutes to avoid sunburns and UV induced skin damage. Avoiding activities and food or beverages that cause flushing can help slow the progression of rosacea.

For more information:

      • http://fromyourdoctor.com/

Skin Checks / Cancer Screening

Your skin is the largest organ of your body, and can reveal much about your overall health and wellbeing. Dermatologists and skin care professionals, unlike other specialists or general practitioners, are trained to read the early signs of what your skin may be trying to tell you about your overall health. A good way to ensure early detection of possible health concerns is with a yearly full body examination. During your exam, a medical professional will examine every part of your body from your head to your toes, looking for discolored areas, bumps, unusually shaped freckles, and spots with irregular borders. Many of these problems are caused by sun exposure or sun burns. Most skin conditions, if caught early, can be cured. If a skin lesion looks suspicious, a skin biopsy will be performed, where we will numb the area and remove a portion to send to a laboratory.

During your appointment, our medical professionals will make you feel as comfortable as possible. You will be covered, and only the area being examined will be exposed. The whole examination takes only 15 minutes, and that 15 minutes may just save your life.


Warts are growths that are caused by the human papilloma virus (HPV). There are several types of warts that affect different parts of the body. The common wart is found on the hands or body. The plantar wart derives its name because it is located on the sole or plantar surface of the foot. Genital warts or condyloma acuminatum involve the genital region and are often transmitted sexually. In females with genital warts, annual pap smears should be performed because there are forms of HPV that cause cervical cancer. Treatment of warts requires the destruction of the skin that harbors the wart virus. There is no perfect treatment for warts, and most treatments have to be performed several times before the wart is cleared. Because the wart virus can infect the normal surrounding skin without being visible, it is not surprising that recurrence is frequent requiring follow-up treatment. The most common treatments include Cryotherapy, Cantharidin (blister beetle juice), Candida antigen injection, DPCP, laser and surgical removal. The use of over the counter Clearaway between treatments performed by your dermatologist may clear the wart with fewer doctor visits.

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Information presented here in is not intended to provide diagnostic advice or comprehensive information. Please make an appointment with our dermatologists for your specific skin care concerns, assessment and treatment.