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Condyloma Accuminata
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Genital Warts Genital warts are very common. They are caused by a virus, the human papillomavirus (HPV).
- There are at least 80 different types of HPV; 20 can infect the genital area.
- At least
75% of sexually active adults have been infected with at least one type of genital HPV at some time in their life.
-
Most do not develop visible warts; the infection may show up on a cervical smear. This is known as subclinical infection.
- Visible genital warts are often easy to diagnose by their typical appearance. They are usually due to HPV
Types 6 and 11.
- Some genital warts are often called squamous cell papilloma.
Genital warts may occur in the following sites: - Vulva
- Vagina
-
Cervix
- Urethra
- Penis
- Scrotum
- Anus
People may confuse normal anatomical structures as warts. These do not require any treatment. - Pearly
papules (these are in a ring around the glans of the penis )
- Sebaceous glands on the labia (known as "Fordyce spots")
- Vestibular papillae (the fronds found in the opening to the vagina)
Transmission
of HPV Visible genital warts and subclinical HPV infection nearly always arise from direct skin to skin contact:
- Sexual contact. This is the most common way amongst adults.
- Oral sex. HPV appears to prefer
the genital area to the mouth however.
- Vertical (mother to baby) transmission.
- Auto (self)
inoculation from one site to another.
- Fomites (i.e. from objects like bath towels). It remains very controversial
whether warts can spread this way.
Neonatal infection may arise by passing through an infected birth canal.
This can lead to rare complications, such as laryngeal papillomatosis i.e. warts in the throat. Because this complication
is unlikely, a caesarean section is rarely indicated simply because a pregnant woman has genital warts. In small
children, genital warts raise the possibility of sexual abuse but in many cases it is due to vertical transmission (see above).
Transmission is common as genital warts often go unnoticed. Subclinical infections can also be infectious.
Often, warts will appear three to six months after infection but latency periods of many months or even years have been
reported. Developing genital warts during a long-term relationship does not necessarily imply infidelity. Visible
warts are probably more infectious than subclinical HPV infection. Treating warts seems to decrease the chance of passing
on the infection. We cannot tell whether the immune system completely clears the virus from the body, or whether the virus
remains hidden but undetectable, capable of re-emerging years later if the immune system weakens. As a result, it is unclear
how long someone remains infectious. The risk of HPV transmission is extremely low if no warts recur a year after
successful treatment. Condoms Condoms provide a physical barrier and lower the risk of passing on HPV.
They do not, however, prevent all genital skin-to-skin contact. Use a condom to protect against other STDs, particularly
with new sexual partners. For couples in long-term monogamous relationships, the value of condoms is more debatable.
Treatment The primary goal of treatment is to eliminate warts that cause physical or psychological symptoms
such as: - Pain
- Bleeding
- Itch
- Embarrassment
-
A constant reminder of STD
The underlying viral infection may or may not persist if the visible warts
clear. If left untreated, warts may resolve, remain unchanged, or increase in size or number. Most
people have a small number of warts that clear with a course of treatment but no one treatment is ideal for everyone.
Options include: - No treatment at all.
- Self-applied treatments at home.
-
Treatment at a doctor's surgery or medical clinic.
Self-applied treatments To be successful
you must identify and reach the warts, and follow the application instructions carefully. - Podophyllotoxin solution (Condyline™, Wartec™) destroys the affected skin cells so the warts shrink or disappear. Podophyllotoxin
solution contains purified podophyllin in a more standardised form. It is not recommended for internal use or for extensive
warts (more than 10 square centimetres). It should not be used during pregnancy.
- Imiquimod cream (Aldara) enhances the body's immune response to the infection. Warts seem less likely to recur compared
to other treatments. Imiquimod is more effective for women than for men, probably because of differences in genital skin.
It may cause burning and even ulceration as it clears up the warts. Although annoying, the treatment can usually be continued.
Imiquimod is not currently recommended during pregnancy.
Treatment at the clinic - Cryotherapy with liquid nitrogen is effective for both dry and moist warts and can be used for external and internal warts.
It may be the best treatment during pregnancy. It is moderately painful and blistering sometimes occurs. Treating large warts
or large numbers of warts at one time can also be messy and unpleasant.
- Podophyllin resin 10%-25%
suspension in benzoin tincture contains a number of agents, including podophyllotoxin. Preparations vary greatly in their
concentration of active components and contaminants, the shelf life and stability of podophyllin resin are unknown, and well-standardised
preparations are not available. As a result, it is no longer commonly used in New Zealand. Podophyllin is not recommended
for use on wart areas of more than 10 square centimetres, as it can be toxic. It must not be used in pregnant women.
-
Trichloroacetic acid (TCA) solution is a caustic agent. It must be applied sparingly and carefully or
it may "run", damaging normal tissue. It is not commonly used to treat warts in New Zealand.
- Electrocautery
or diathermy physically destroys the warts by burning them. Local or general anaesthesia can be used.
- Curettage and scissor or scalpel excisions directly remove the warts. Suturing is rarely required. Some pain is likely. Secondary bacterial infection is an
occasional complication.
- Laser ablation is sometimes recommended for extensive infection, or
difficult-to-reach areas such as the cervix, but it is not widely available in New Zealand.
- 5% fluorouracil cream cream (Efudix) is currently a specialist-only medication in New Zealand. It is a cytotoxic agent i.e. it destroys
abnormal cells. It can result in very painful erosions so it is not recommended for routine treatment of warts and should
not be used in pregnancy.
- Vaccine development is an area of active research, and several different
approaches are being tested in animal models, including "therapeutic" vaccines that might help those already infected.
Other therapies - Interferon is an antiviral agent that is effective when
it is injected into genital warts. Side-effects are common e.g. a flu-like illness and pain at the injection site. Interferon
injections are generally only used for those who have not responded to other treatments and are not currently licensed in
NZ. Systemic and topical interferon have not been found to be helpful for genital warts.
- 5-fluorouracil/epinephrine-gel
implant contains the same drug as in 5% fluorouracil cream, together with a vasoconstricting agent and a stabilising gel. The mixture is injected into the genital skin, near the warts.
It can result in very painful erosions so it is not recommended for routine treatment of warts and should not be used in pregnancy.
It is not currently licensed in NZ.
- Cidofovir is a newly developed antiviral drug that is being
investigated for treatment of genital warts.
Genital warts & cancer The HPV types that
cause external visible warts (HPV Types 6 and 11) rarely cause cancer. Other HPV types (most often Types 16,
18, 31, 33 and 35) are less common in visible warts but are strongly associated with penile and vulvar intra-epithelial neoplasia (pre-cancerous changes) and squamous cell carcinoma (SCC) of the genital area especially cervical
cancer and less frequently invasive vulvar cancer. However, only a very small percentage of those infected will develop genital cancer. This is because HPV infection
is only one factor in the process; cigarette smoking and the immune system are also important. Cervical smears,
as recommended in the National Cervical Screening guidelines, detect early abnormalities of the cervix, which can then be
treated. If these abnormalities were ignored over a long period, they could progress to cancer. If your skin problem
is troublesome and/or persistent, seek the advice of your general practitioner, dermatologist or a sexual health physician.
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Dear Friends Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a variety of options including a treatment
plan that I believe will give them the best results. We also support our patients with a very fine medical staff . Please
take a moment to explore our top of the line winning website. My philosophy is simple…Experience Counts
and Quality Matters. Please allow me to solve your skin problems. After all, at NYC Dermatology , our
philosophy is if you look great you will feel great with gorgeous skin.” Best Regards, Dr.
Rothfeld
 How Acne starts
Acne affects almost everyone — more than 90% of all adolescents, nearly
50% of all adult women and 25% of all adults. Crossing gender lines as well as national borders, it's one of the most
widespread medical conditions in the world. Yet there's still no cure.
But there is hope. While acne is not curable, it
is treatable. We now know more about controlling this condition than ever before. The secret to managing acne is prevention
— stopping this condition before it exhibits visual symptoms. Once you have found an acne treatment that helps you
accomplish this, it's important to stick with it. Even after pimples disappear, you may need to continue treatment
to keep new blemishes at bay. It's also crucial to begin treatment as soon as the first signs appear; the
sooner you address your acne, the less likely you are to experience permanent damage to your skin. Of course, in order
to stop acne, we must first find out how it starts. What causes acne? One of the most important things
you can learn about acne is this: It's not your fault. Contrary to popular belief,
acne is not caused by anything you're doing — what you eat, how often you wash your
face or work out — but by a combination of factors at work far beneath the surface of your skin. A healthy follicle
 A blemish begins approximately 2–3 weeks before it appears on your skin's surface. It starts in your sebaceous hair
follicles — the tiny holes commonly called pores. Deep within each follicle, your sebaceous glands are working to produce
sebum, the oil that keeps your skin moist and pliable. As your skin renews itself, the old cells die, mix with your skin's
natural oils, and are sloughed off. Under normal circumstances, these cells are shed gradually, making room for fresh new
skin. But sloughing is different for everyone. Some people shed cells evenly; some don't.
Uneven shedding causes dead cells to become sticky, clumping together to form a plug — much like a cork in a bottle.
This plug, or comedo, traps oil and bacteria inside the follicle. A plugged follicle
 The plug traps oil and bacteria within the follicle, which begins to swell as your skin continues its normal oil production.
Your body then attacks the bacteria with a busy swarm of white blood cells. The whole process takes 2–3 weeks, culminating
in a pimple.
An inflamed acne lesion
 Why me? There is no one simple "cause" of acne — the condition is influenced
by many factors, many which are out of your control. The regularity with which you shed skin cells can change throughout your
life. The rate at which you produce sebum is affected by your hormone balance, which is often in flux — especially for
women. Research has also shown that genetics play a big part in the development and persistence of acne, so your family history
is a valuable prediction tool as well when considering the various causes of acne. One of the best weapons in the fight against
acne, however, is knowledge; if you know what causes acne, it's easier to formulate a good plan
of attack. There are five primary culprits contributing to this process. Each of these factors may vary dramatically between
individuals. While you don't have control over these factors, understanding them can help you in your search for the proper
acne treatment. Acne Causes - Culprit #1: Hormones.
For the majority of acne sufferers, the trouble begins at puberty, when the body begins to produce hormones called androgens.
These hormones cause the sebaceous glands to enlarge, which is a natural part of the body's development. In acne sufferers,
however, the sebaceous glands are overstimulated by androgens, sometimes well into adulthood. Androgens are also responsible
for acne flare-ups associated with the menstrual cycle and, on occasion, pregnancy. Acne Causes - Culprit #2: Extra
sebum. When the sebaceous gland is stimulated by androgens, it produces extra sebum. In its journey up the follicle
toward the surface, the sebum mixes with common skin bacteria and dead skin cells that have been shed from the lining
of the follicle. While this process is normal, the presence of extra sebum in the follicle increases the chances of clogging
— and can cause acne. Acne Causes - Culprit #3: Follicle fallout.
Normally, dead cells within the follicle shed gradually and are expelled onto the skin’s surface. But in patients with
overactive sebaceous glands — and in nearly everyone during puberty — these cells are shed more rapidly. Mixed
with a surplus of sebum, the dead skin cells form a plug in the follicle, preventing the skin from finishing its natural process
of renewal. Acne Causes - Culprit #4: Bacteria. The bacterium
Propionibacterium acnes, (P. acnes for short) is a regular resident of all skin types; it’s part of the skin’s
natural sebum maintenance system. Once a follicle is plugged, however, P. acnes bacteria multiply rapidly, creating the chemical
reaction we know as inflammation in the follicle and surrounding skin. Acne Causes - Culprit #5: Inflammation.
When your body encounters unwanted bacteria, it sends an army of white blood cells to attack the intruders. This process is
called chemotaxis; or, simply put, the inflammatory response. This is what causes pimples to become red, swollen and painful.
The inflammatory response is different for everyone, but studies have shown that it is especially strong in adult women.
What can I do?
Fortunately, you have options! There are many kinds of acne treatments available today. But first, you should
try to determine the type and severity of your condition. Acne, like a person, is highly individual — it can take
many forms, and have a highly variable response to treatment. The more you know about your specific form of acne,
the more likely you are to find a treatment that works for you.
NYC Dermatology Board Certified Dermatologist
Dr.
Gary Rothfeld Manhattan, New York 
Trained in Dermatology, NYC Dermatolgy by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld
possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding Dermatologist
in NYC , Manhattan , New York at NYC Dermatology by Board Certified Dermatologist. Top New York City Dermatologist,
Dr. Rothfeld in Manhattan treats the most difficult cases until the problem clears.- Do you peer in the mirror each morning and play little face
games?
- Do you find yourself raising your brows, smiling wider, stretching wrinkles, pursing your lips,
or lifting the droopy corners that weren’t there last month?
- Are you exhausted
from trying every TV promise out there to stop your acne and wonder “why me?”
Who doesn’t find something they don’t like about the face in
the mirror each morning? It’s human nature to want to look your best. Even royalty and celebrities find themselves sitting
across from Dr. Rothfeld seeking the fix for that blemish, that sag or that brown spot.
Dr. Rothfeld, having worked alongside several of the world's renowned dermatologists, has shaped a uniquely innovative approach in
treating any skin problem you may have. Through cosmetic and medical dermatology, laser surgery and powerful combination treatment
options, Dr. Rothfeld quickly and effectively helps you see dramatic improvements in the appearance and health of your skin.
Dr. Rothfeld is well known for his particular expertise is in designing
anti-aging, anti-acne, and anti-rosacea treatments with exceptional success and optimum cosmetic elegance. These particular
conditions need specialized non-harsh therapies in order to be successful with minimal side effects. Over-treatment or overly
aggressive treatment can backfire. Dr. Rothfeld makes sure that doesn’t happen to his patients.
| Dr. Rothfeld has a main concern is that you receive an individualized
skin treatment program that eliminates your problems without unnecessary side effects. This is attained by having one-on-one
care with good old fashioned personal attention from Dr. Rothfeld himself." |
Dr. Rothfeld is featured as a Top Dermatologist in
Black and White Photography of New York. Dr. Rothfeld is known for "innovative
treatments for Acne, Aging and Rosacea as administered with good old-fashioned attention.. Dr.
Rothfeld has exceptional skill in performing Laser and Botox procedures.
The most common
medical condition that Dr. Rothfeld treats is Acne. His comprehensive approach may include
Photodynamic Therapy which will help restore your natural, radiant skin without the
signs of acne. This treatment, which can consist of a combination of blue light and
laser, significantly diminishes your need for oral medications.
His cutting-edge technology at NYC Dermatology
has initiated his interest and involvement in Laser Dermatology. He has the latest proven lasers to treat Acne
& Acne Scars , Facial Blood Vessels Rosacea , Unwanted
Hair , Wrinkles , Age and Brown Spots & Sun
Damage , and Loose Facial Skin . These laser procedures provide tremendous results
with little downtime. All laser procedures are performed personally by Dr. Rothfeld.
One particularly
exciting use of Botox is the non-surgical Brow Lift. This procedure elevates the brow and can also elevate droopy eyelid skin.
He has helped countless patients avoid unnecessary plastic surgery with this procedure.
Another well-appreciated application of
Botox Cosmetic is in the treatment for excessive underarm sweating , which has been
recently FDA approved. The Botox Cosmetic is non-diluted and prepared in such a way as to be completely painless!
Rejuvenating Peels are excellent treatment for the prevention
of aging skin and acne. Light Peels and IPL Fotofacial offer quick treatments that
help improve skin texture and minimize fine lines. Cosmelan treats patchy brown hyperpigmentation.
Your Health is Vital; Start with your Skin. The American Academy of Dermatology recommends yearly
skin checks to examine moles and remove unusual ones that are often overlooked by patients. Since we live with a high risk
of skin cancer with its almost year-round exposure to the sun, skin checks are especially important. Dr. Rothfeld, a Board Certified Dermatologist
at NYC Dermatology in Manhattan, New York is caring, detailed, and meticulous and will never give up until the problem
is cleared. Dr. Rothfeld, a board certified dermatologist in nyc who practices Dermatology in Manhattan, New
York has treated many patients in the entertainment and music industry is caring, detailed and meticulous and will not give
up until the condition resolves. Dr. Rothfeld is recognized as one of the best Dermatologists in NYC by the entertainment
industry.NYC Dermatology is under
the medical supervision of Dr. Gary Rothfeld, a Board Certified Dermatologist.
To enhance every aspect of your skin
care, Dr. Rothfeld has personally created a superb line of cosmetic procedures.. NYC Dermatology
by Board Certified Dermatologist Dr. Gary Rothfeld is a board certified NYC Dermatologist
with a New York City office in Manhattan, New York providing expert skin care, dermatology, and
cosmetic dermatology services. A board certified dermatologist in NYC specializing
in dermatology and dermatologic surgery including state-of-the-art cosmetic surgical procedures, Dr. Gary Rothfeld is
known for his attention to body symmetry and his dedication to meeting patients’ personal goals. His specialties include
full body liposuction using the tumescent technique, facial fat transplantation, Botulinum injection into facial lines and
laser resurfacing. NYC dermatology specializes in chemical peels, vein injections, laser, restylane, Perlane,
Botox injections, JUvederm, non-surgical facelifts, collagen implantation and treatment of skin cancer.
As an expert in the field of dermatology and cosmetic dermatologic
surgery, Dr. Rothfeld is has appeared on national television shows. Dr. Rothfeld has also been quoted in many high
profile national magazines.
Our goal at the manhattan office of Board Certified Derrmatologist , Dr.
Gary Rothfeld is to create an atmosphere of professionalism, trust and complete patient satisfaction at the NYC Dermatology
and Cosmetic Surgery Center in Manhattan, New York. Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board
Certified Dermatologist at NYC Dermatology who has treated many patients in the entertainment industry. Schedule an appointment at
our office which provides top of the line expert skin care, dermatology, cosmetic dermatology services,
and advanced dermatology laser treatments for cosmetic needs and medical skin conditions. We offer a full range of services
including surgery for skin cancer, laser hair removal, Botox®, the Fractionated Resurfacing laser, Titan laser, and acne
photodynamic treatments. Our main goal is to provide you with the most effective and advanced treatment. Join the NYC Laser
Center NYC Dermatology Mailing List Our periodic newsletters include exclusive offers, educational articles, as well
as free treatment & product drawings! Email: nycdermatologist@aol.com in our Media office and including different offers and many more. We offer a variety of services from
Botox® to Liposuction . Please contact us with any questions you may have or schedule an appointment online or by phone for
a consultation. Beauty Is Forever! and Dr. Rothfeld
at NYC Dermatologist has over 20 years of experience with his beauty tips.
.
During
your office consultation and examination you will be provided with a detailed plan of the treatments that will benefit
you most. NYC Laser Center NYC Dermatology top laser dermatology center offering skin care, dermatolgy,cosmetic
dermatology services, and laser treatments for sun damaged skin, acne, acne scars, rosacea, pigmentation, laser
hair removal, broken blood vessels, as well as superficial and deep wrinkles. We offer patients in Manhattan,
services including general dermatology, wrinkle fillers such as Restylane®, Captique, Perlane,Cosmoderm and Cosmoplast, Radiance® (radiesse) and Sculptra. We also offer Botox®,
Cosmelan, Velasmooth, Fotofacial, Titan laser, Refirme, and the Fractionated Resurfacing laser. in the treatment of acne,
rosacea, skin cancer and surgery. Dr. Rothfeld has taught numerous other physicians on the proper use of Botox®, medical
hair transplants, and lasers in the country. Acne Photodynamic Treatment
- Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser - Cosmelan Depigmentation Treatment - Glycolic
Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction
- - Surgery - Minimal Scar Technique - Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy
- Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments
- Velasmooth Our cosmetic surgeon includes Dermatologist Dr. Gary Rothfeld Board Certified Dermatologist
at NYC Dermatology. Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical
skin conditions. We offer our services to Manhattan , Brooklyn, Bronx, Queens locations through our Manhattan
office in NYC
Open 7 Days A Week — Se Habla Español
NYC Dermatology - Manhattan Dermatology - Skin Institute of
New York - Skin Cancer Doctor- NYC Cosmetic Dermatology- Cosmetic Dermatological Surgery - New York City -
Board Certified Dermatologist
Manhattan Office
Dr. Gary Rothfeld
NYC Dermatology
- Board Certified Dermatologist - New York, NY
30 E. 60th St. Ste. 805
Manhattan, New York 10022
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