General Services
General Dermatology
Our full-time and associated faculty provides patients from the state of Rhode Island and from the entire New England region with expertise in the diagnosis and management of skin disease in the pediatric and adult population. We take care of and consult on acute and chronic conditions, some of which are life-threatening or result in long-term pain, suffering, and disability. Dermatologists are highly trained and certified in the management of both pediatric and adult conditions, as well as the diagnostic tests used for diagnosis: KOH preparation (for yeast, fungi, herpes, and parasites); Wood’s light exam (for identification of pigment increase (hyperpigmentation or loss (vitiligo and/or marked hypopigmentation) and the level and extent of pigment problems in the skin; ankle/brachial index and Doppler exam (to determine whether there is enough blood supply to the lower leg; neuropathy (lack of sensation) testing, which is critical in the management of diabetes and leprosy; established hair pull testing to diagnose and manage hair problems; performance of biopsies and reading of the biopsy specimens for rapid and accurate diagnosis; the use of non-invasive visualization of the skin by specialized dermoscopy equipment to differentiate benign lesions and moles from malignant conditions including melanoma; the proper use of compression bandages for leg ulcers and the use of specialized equipment for monitoring the degree of pressure; accurate and dependable photographic documentation, critical to the management of many skin conditions, including melanoma, suspicious moles, and recurrent skin cancers.
Clinical Study Unit
Not all skin diseases are amenable to established treatment or medications. In some cases, more innovative approaches are required. Our experienced clinical study team and state of the art infrastructure enables us to approach difficult or intractable problems with new ways to diagnose and treat. The studies for which the Department has been known for have involved acne, psoriasis, the use of retinoids medication as well as biological treatments, acute and chronic wounds, eczema (or atopic dermatitis), morphea, digital ulcers due to systemic sclerosis (scleroderma), blistering diseases, aging, hair loss, impetigo and fungal infections, bioengineered skin and tissue engineering, skin cancer.
Collagen Vascular Diseases
Dermatologists at Roger Williams Medical Center have great expertise in diseases affecting the skin as well as the joints and other internal organs. Particular and internationally recognized expertise exists in the treatment of morphea, scleroderma, scarring conditions of the skin, lupus erythematosus, dermatomyositis, vasculitis and other types of inflammation of the blood vessels of the skin. Department’s physicians and scientists have pioneered the use of stem cells and bioengineered skin for the treatment of difficult inflammatory ulcers of the skin. The Department collaborates actively with other specialties of the Medical Center, in particular Rheumatology, in the care of these patients.
Contact Dermatitis
Expertise in the diagnosis and management of contact dermatitis is well recognized in the entire region. The latest comprehensive publication in North America on contact dermatitis of topical medications and bandages for wound care comes from our Center. Patients with contact dermatitis may present with a red, itchy rash caused by an irritant or allergic reaction in the skin from exposure to certain chemicals, medications, and products. Some of the chemicals are present in widely used creams, perfumes, and FDA-approved medications. When evaluated for contact dermatitis, either through casual contact or from hobbies or from industrial and occupational exposure, patients may undergo patch testing to identify the agent (allergen) that is causing the reaction in the skin. Our collection of allergens that are placed in small patches on the skin of patients to identify what is responsible for their problem is among the most comprehensive in the region and the nation. After the agent responsible for the rash is identified, a thorough report and discussion with the patient and the referring physician takes place, to diminish and avoid repeated exposure to the offending agent.
Cutaneous Lymphoma
Department faculty includes internationally renowned physicians and scientists in the identification and proper diagnosis of lymphoma of the skin and pre-lymphoma conditions. Interpretation of clinical exam, diagnostic tests, biopsies are critical. Treatments include topical and systemic agents, phototherapy, and photochemotherapy. The treatment of lymphoma is best done in a multidisciplinary framework, with additional reliance on proper referral for specialized treatment and management.
In-Patient Service: The Department is unique in its ability to care in the hospital for patients with skin conditions requiring intensive in-patient stay and treatment. In that regard, the Department is the only one in the New England area, and one of the few in the United States. Patients are admitted for intractable and serious psoriasis, leg and foot ulcers, infections, and other Dermatological problems that have not improved when cared for in the out-patient setting.
Laser Treatment
Dermatologists in our Department perform specialized treatment of significant conditions by using specific lasers. State of the art equipment is used. Laser Hair Removal is performed in patients who seed the elimination or reduction of unwanted hair. Vascular Treatment (blood vessel associated) addresses such significant problems as birthmarks, and capillaries/varicose veins (treatment occasionally supplemented by medical means or small injections). Pigment Management is focused on the reduction of excessive pigmentation of the face and other skin areas.
Phototherapy Center
Fully aware of the need for these services in different geographic areas, the Department has established two centers. One is at Roger Williams Hospital (Tel. 401-456-2315) and the other is in the East Greenwich satellite office (401-886-5663). Both centers comprise state of the art phototherapy equipment for the treatment of psoriasis, eczema and atopic dermatitis, and other disorders that are responsive to light therapy. We have a broad range of ultraviolet phototherapy equipment and units, including ultraviolet B light therapy (both narrow- and broad-band, PUVA (psoralen + ultraviolet light A), and a hand-foot unit for hand and foot involvement. During the week, to facilitate treatment, patients can simply walk in without a specific appointment for that day. The centers also treat patients who are otherwise being managed and continue to be managed by other outside Dermatologists in private practice.
Psoriasis
Psoriasis is an inflammatory and common skin condition (2% of Americans) that affects more severely the skin, but can also commonly involve the joints. Recent evidence suggests that the cardiovascular system is adversely affected by psoriasis. The condition is presently thought to be an autoimmune disorder, and typically responds to anti-inflammatory and immunosuppressive medications. It affects both sexes equally and also children. Typically, the disease occurs either in the late teens and twenties, or in the 50’s. Lesions are symmetric, scaly, and can be extremely itchy and painful. Elbows, knees, scalp, nails are commonly affected. The treatments provided in our Department may consist of one or more of the following: phototherapy, topical steroids, vitamin D ointments and creams, retinoids (vitamin A derivatives), tar products including anthralin, and immunosuppressive drugs, such as cyclosporine. A very promising treatment is the use of the eximer laser. For very extensive disease and/or certain clinical circumstances and indications, our center makes use of biological agents, which can be highly effective against psoriatic skin and joint problems.
Quality of Life Procedures
These can be considered to be cosmetic procedures, but are in fact meant to improve the quality of life and sense of well-being of patients. The Department has a focused approach to quality of life lesions resulting from congenital abnormalities, long-standing acne, wrinkles and aging, internal medicine disease complications, etc. The Department regularly offers the following treatments: blue light and photodynamic therapy, Botox, brown spots removal, blood vessel management, chemical peels, filler substances to improve wrinkles (doctors can make available Collagen, Captique, Cosmaderm, Cosmaplast, Hylaform and Hylaform Plus, Radiesse, Restylane, Sculptra, Zyderm, Zyplast), laser treatments for hair removal, laser surgery, photo-rejuvenation, red spots removal, sclerotherapy, tattoo removal. It is important that the treatment be individualized, depending on the needs of the patient.
Wound Healing and Chronic Wounds
The Department is internationally renowned for the treatment of skin ulcers that are difficult to heal and become chronic. Examples of these non-healing wounds are those due to diabetes and abnormal veins (or venous insufficiency). Department faculty and its chairman (Dr. Vincent Falanga) have pioneered and clarified many concepts in wound healing, including the proper use of topical and systemic agents to improve the wound bed, tissue engineering products or constructs, and the use of bone marrow-derived stem cells to accelerate and jump-start the healing process. The Department has a very extensive infrastructure to benefit patients with non-healing ulcers. FDA recognition for the use of stem cells in wound healing was recently obtained, backed by specialized laboratories to handle bone marrow-derived stem cells (Good Manufacturing Practice, or GMP). Many of the advances in the treatment, research, and understanding of wound healing over the last 20 years have been made by Department physicians. There is extensive expertise in the management of inflammatory ulcers, such as those due to vasculitis, pyoderma gangrenosum, and other ulcerations associated with internal conditions. For more information