Lumps and Bumps On Your Skin | Dr Berj

[00:00:00]Do you have one of these? Because if you do and you have no idea what it is, then keep watching because in this video I'm going to go through the most common lumps and bumps people get on their skin. Let's go. By the way, if you're new here, my name is Dr. Berg and I'm a cosmetic and surgical dermatologist. And on this channel, I talk about skin care, skin health, and dermatic treatments without the hype. The first one I'm going to start off with is skin tags.

[00:00:28]Skin tags are those soft and floppy pieces of skin that are usually skin colored or slightly brown. They often show up around the neck, the armpits, eyelids, under the breast, groin folds, and other areas of friction. And in most cases, skin tags are quite small, usually in the range of millimeters. But once in a while, they can grow to be several centime wide. Even though they can kind of look odd sometimes, skin tags are basically just benign overgrowth of normal skin. If you look at them under a microscope, you're going to see that they basically have all the structures that normal skin has. While anybody can get these, they tend to be more common with age. They are also more common in people who have a family history of skin tags and can be associated with things like insulin resistance. When I see people with these in clinic, one of the most common questions I get is, "How can I get rid of them?" First of all, you don't have to get rid of them. These are completely benign. And the only scenario where I would recommend removing them is if one, they cause significant irritation based on their location, like if they're caught on clothing or something, or two, if they become necrotic, meaning for whatever reason, the skin tag died but is still attached. Of course, you can get them removed for cosmetic reasons as well. There are different ways that your doctors could do this for you. They could freeze it or they could just snip it. But in my practice, what I tend to do is inject a tiny little bit of numbing, take it off with a pair of surgical scissors, and then I just cauterize the roots with a tiny little buzz. And all of these different methods can work just fine if your doctor has done this many times before. What I would not recommend doing is using those tools that you can find on Amazon or Teimu where it's like the rubber band one or it's the one that you freeze off at home. I mean honestly I think in most cases those things work out just fine.

[00:02:40]But I have seen a few cases where patients have done that and then they came to clinic with an infection of the skin. So if possible get your doctor to remove it for you. The next one we're going to talk about is seereic kerattosis. Even if you haven't heard of this name before, you probably heard other people refer to it as age spots, wisdom spots, particles of time, or by another nickname, whatever you want to call them. Clinically, sebria kerattosis often look like brown and gray or black spots that look like they've been stuck onto your skin. They can be waxy, rough, crusty, bumpy, sometimes even smooth or wart-like. And in fact, that seems to be the most common thing that people mistake them for, is warts.

[00:03:30]While skin tags are a benign proliferation of the entire skin, including epidermis and dermis, sebria kerattosis are just benign proliferation of the epidermal cells only. And because of that, sometimes they just naturally fall off by themselves, or if they're small, they just accidentally get snatched off and don't even bleed because there's no blood vessels in the epidermis. The three main contributing factors to getting seric kerattosis are time, genetics, and UV exposure.

[00:04:05]Unfortunately, you can't stop time and you can't reverse genetics. So, if you want to prevent these, the best thing you can do is sun protection. Just like skin tags, these are totally benign and do not require treatment unless they are irritating or if you don't like the way they look. There are a ton of options of how these can be removed. Your doctor can use a blade, lasers, cottery, curitage, liquid nitrogen to freeze them off, or just a sharp instrument. If they are shallow and didn't really take deeper roots, the outcome can be honestly really good. In fact, in some cases, you wouldn't even notice that something was there before you had it removed. However, the bigger they are, the more likely they are to have deeper roots in the dermis. And when that happens, removal is likely to result in some form of a flat scar afterwards. Fun fact, if you have these in the scalp, removing them usually does not cause hair loss as long as it is removed properly because hair follicles sit in the dermis and seia kerattoses are epidermal in nature. Next, we're going to talk about dermatop fibramas. These are semi-permanent pigmented scar-like bumps that most commonly arise from irritated hair follicles. You can technically get these anywhere on the body, but the most common place to get them is on your legs. Because while any form of skin injury can technically cause dermatop fibramas, shaving seems to be one of the most common causes.

[00:05:44]If you feel them with your finger, these guys are actually quite firm. And because of that, some people report that they're itchy or painful, especially when they bump into something.

[00:05:55]Unfortunately though, there are not many great options for removing these. When people come to see me about dermatop fibramas in clinic, they tend to ask why I can't just freeze them off or laser them off. This is because both of those modalities tend to work better for superficial lesions, especially ones that are primarily epidermal, whereas dermatop fibramas are dermal and can be quite deep. In general, removing dermatop fibramomas is going to require a surgical excision. While these are extremely successful in completely removing them, I still don't recommend this method because you would essentially be trading a dermatop fibram for a surgical scar. And appearance-wise, depending on how big it is, it may not be an improvement.

[00:06:44]My advice for removing dermatop fibramomas is to first identify the trigger and to try your best to remove the trigger first. Whether that's constant friction, repeated picking, really tight clothing that's constantly rubbing against your skin, or anything else, and then only get your doctor to remove them if they really bug you. All right. Now, we're going to talk about millia. Millia look like tiny yellowish white firm bumps that are underneath the skin. And the most common thing that they are confused with is white heads because honestly they look kind of similar. And this is also why a lot of people try to pop or squeeze them at home. But I'm telling you now, it doesn't work. A white head has sebaceous content that's collecting in a naturally existing hair follicle where the opening just happens to be closed. So the key point is that there is a natural opening and technically if you squeeze hard enough the contents can come out. But Amelia is different. These are actually tiny cysts in the superficial part of the skin and may not be affiliated with a hair follicle at all. This means that they have no natural opening and that there's a sack that contains the contents of the millia. Even if you physically broke the outer surface of the skin on top of the millia and you nicked the sack and you got all the contents out, the millia is likely to grow back because the sack is still going to be there. While anybody can technically get these anywhere on their body, millia are most frequently found around the eyes and cheeks of individuals who are prone to getting them as well as in people who recently had some type of disruption to their skin like minor trauma, a burn or laser resurfacing. The good news with millia is that you can reduce your risk of getting them with regular usage of retinoids and gentle chemical exfoliants. The bad news is that once you get them, skininc care products alone aren't likely going to be that useful. I find that the best way to extract these in clinic is to make a tiny little nick in the skin just above the millia and then pull the entire sack out. This way, the risk of it growing back is actually quite low, although you can always technically get a new one right next to it. Now, let's talk about sebaceious hyperplas.

[00:09:16]These can look like small yellowish to skin colored or slightly pink bumps with a fairly smooth surface. It's usually a small divot in the center. These are most commonly seen in areas of high sebaceous gland density like your cheeks, your forehead or your nose because ideologically these are just enlarged oil glands. Hence the name sebaceous meaning sebum in nature and hyperplasia meaning overgrowth. In fact, if you look at these under a magnifying glass, you might actually see little yellowish circular structures, which are actually the enlarged sebaceous glands.

[00:09:58]Technically, anybody can get these because we all have sebaceous glands on our faces, but they are way more common in people with oilier skin and tend to occur more frequently with age. So, how do we treat sebaceous hyperplas? Because the nature of these lesions is enlarged oil glands, your doctor can actually easily remove these with just a tiny little zap of electrocottery. The heat generated from this procedure, even at a very, very low setting, can literally melt those little glands and in most cases successfully remove these lesions without any scarring. But just like everything we've talked about before this, I don't recommend trying to remove these at home yourself. One interesting note though is that the most common thing that I see sebaceous hyperplas being confused with in clinic is actually a common type of skin cancer called basilc cell carcinoma. Most dermatologists would be able to tell the difference almost right away with just a glance, but I totally understand how most people would get these two confused, especially if they don't have a ton of experience looking at skin lesions. So, my point is it never hurts to get your doctor to have a look if you're worried about a lesion that looks like this. So while sebaceous hyperplas are definitely more common in adults, what happens if you see a very similar lesion but in kids? Well, there's actually a good chance that those are mlescum contagiosum.

[00:11:39]Just like sebaceous hyperplasia, these look like small, smooth, pearly or skin colored bumps with a little central divot. But the difference is that these tend to appear in clusters and are more commonly seen in skin folds like the armpits, groin, behind the knees, and on the inside of your elbows. They are also usually seen in kids as opposed to adults. This is one of those conditions that kids tend to get once and then never get again because these are caused by a virus called the MC virus that spread by physical contact. So, usually one kid would have them, then they go to school and would be in a playground or a daycare or something with a bunch of other kids and because they're playing tag or something else that requires physical contact, they would spread it to each other. For most kids, unless they're immuno compromised, they would naturally and slowly fight these off by themselves, even if we did nothing. But most doctors who see this in clinic would still offer treatment, including myself, because they are extremely itchy. And what happens to kids that are extremely itchy? They scratch. And when they scratch, they spread this lesion to a new place. And like I said, your body would eventually mount an immune response and fight all of these lesions off, but it can be quite uncomfortable until you get there. There are lots of ways to treat this in clinic, but the most common way that I've seen pediatricians and pediatric dermatologists treat this is with blister beetle juice, also known as canththerin. Fun fact, this substance is actually derived from a beetle that naturally produces a defensive substance that creates blisters on your skin when you come into contact with it. To make this medication, the manufacturers actually harvest these beetles, freeze dry them, then crush them, and dissolve them into a liquid. Crazy, right?

[00:13:47]When your doctor applies a tiny drop of this on the molescum, it causes a blister in the epidermis and as a result, the molescum bump, which sits only in the epidermis, breaks and falls off. This process also speeds up your body's immune response to the virus. So, it works in two different ways. Next up, we have Venus lakes. These are soft blue purplish spots that are usually found on the lower lip, the upper part of the ear, or another sunexposed area of the face. And you know these are likely Venus lakes if they partially or completely disappear when you apply pressure or squeeze the skin they're on.

[00:14:31]This is because they are literally lakes of veins or dilated blood vessels that usually happen from minor trauma or chronic sun exposure. These don't naturally go away by themselves and in some cases can slowly get a little bit bigger. Anybody can get these, but they tend to be more common in people with sun damage.

[00:14:53]Venus lakes don't really need to be treated because they are completely benign. But if you do want to treat them, a vascular laser like a pulse diler or electrocotteryer can work beautifully. Another common benign vascular bump that you see on the skin is cherry angiomas. These are super common and usually look like small bright red smooth dome-shaped bumps that sit on the skin. They most commonly show up on the chest, abdomen, back, arms, and shoulders, but you can technically get them anywhere on the body. Unlike Venus lakes, which are usually just a dilated blood vessel, cherry angiomas are usually a collection of numerous small blood vessels. While time and genetics are two major risk factors that determine whether you're going to get these or not, anybody can technically get one or two somewhere on their body.

[00:15:50]Cherry angiomas are completely harmless.

[00:15:53]And even if you see a whole bunch of them crop up on your body, that usually doesn't mean that there's anything wrong internally. Treating these is actually extremely easy and very satisfying.

[00:16:04]Actually, though, it is not something that I would recommend you try at home.

[00:16:09]Your doctor would just apply a little bit of numbing and then use electrocottery at a very low setting, zap, and basically cauterize the tiny little blood vessels. And it heals beautifully.

[00:16:22]Of course, this is a treatment and not prevention. And unfortunately, there isn't really a great way of making sure you don't get more of these over time.

[00:16:33]Okay, now we're on to the last one that we're going to talk about today, which is warts. Warts are due to infection by a family of viruses called human papilloma virus, HPV, that spreads by direct contact. And depending on the exact strain of the virus that you get or where on your body you get it, the wart can have all sorts of shapes and sizes. The most common warts that we tend to see appear on the soles of the feet and are called plantar warts. These are often thick, rough, hard, callous-like spots on the soles. And because you're constantly standing and walking on them, they can be quite uncomfortable, like you're walking on a pebble. There are two ways that you can generally determine whether this is a wart or a callus. The first is that warts tend to have black dots in the middle. These are actually pinpoint hemorrhages from blood vessels connecting to the base of the wart. You wouldn't see these in calluses. Another finding is that the natural lines on your skin called dermatoglyphics, which are the same lines that make your fingerprints, will run over your calluses, but will run around your warts. This is because a callous is thickening of normal skin. Whereas a wart is a growth in the middle of your skin that pushes your normal skin away.

[00:18:02]While warts are benign, I generally recommend treating them if possible.

[00:18:06]This is because they can last for years and can cause significant discomfort. I personally had a wart on my foot for about 7 years before and it took a lot of effort to finally get rid of it.

[00:18:20]Warts are also contagious. So, it's possible that if you leave one alone, it can spread to other people or even to other parts of your own body. The problem with treating warts is that it can be very difficult and takes a lot of effort and consistency. If you look at our dermatology textbooks, they're going to list around 20 different treatments for warts. And anytime something has 20 different treatments, it usually means that none of them are that great. Things that you can do at home include using a wart cream, which usually contains a higher concentration of salicylic acid.

[00:18:59]Your salicylic acid body wash or your Caravee salicylic acid body cream is not going to be enough for warts. Those generally have about a 2% concentration.

[00:19:11]Whereas wart creams usually contain 20% or higher concentrations of salicylic acid. I personally really like those doughnut shaped patches that you see in brands like Dr. Scholes with the salicylic acid pad in the middle that you can simply place on the foot. it stays in place and keeps the treatment localized. These tend to work really well in my experience. But if you prefer using a salicylic acid liquid or cream, you can also keep it in place by applying duct tape over the wart to seal the medication against the skin.

[00:19:46]Sometimes, if you're lucky, the wart will disappear after a couple of weeks.

[00:19:51]But honestly, for many people, it's going to take months, if not years, to completely get rid of it.

[00:19:59]Most dermatology offices offer multiple inoff treatment options. And some dermatology clinics, like my own, for example, even have a dedicated wart clinic that treats only patients with planter warts. When treated in the office, we have access to options such as liquid nitrogen, electrocottery, sharp pairing, chemical peels, vascular lasers, and even ablative lasers. So, if you're tired of trying treatments at home or they're simply not working for you, definitely go see your dermatologist because they'll have many more tools available to help get that wart out of your life much more quickly.

[00:20:38]All right, thank you guys for watching.

[00:20:39]If you found this video helpful, make sure you like and subscribe and leave a comment below letting me know what you'd like to see next or if there are more lumps and bumps that you want me to cover. Until next time.