Autoimmune + Inflammatory Conditions
In autoimmune skin diseases, the immune system targets the skin with inflammation that can be damaging. Whereas the immune system is meant to function with a regard for the body’s tissues as “self” and outside invaders such as bacteria or viruses as “non-self,” in autoimmune skin disease the immune system is abnormally triggered against the “self” as if it were “non-self.”
Lupus and scleroderma are autoimmune skin conditions that Dr. Sherber tends to see most frequently, but she sees patients with the full spectrum of autoimmune skin diseases. Her expertise stems from her extensive treatment of patients and through her research in autoimmune disorders of collagen such as morphea.
Accurate diagnosis is critical for effective management of autoimmune skin diseases, and Dr. Sherber works closely with dermatopathologists, rheumatologists, and other specialists as needed to ensure thorough evaluation and comprehensive multidisciplinary care for each patient.
Inflammatory skin conditions generally present with signs such as redness, itching, or bumpy areas. Inflammation can damage collagen, so early diagnosis and treatment of these conditions is key to preserving skin health in the long term. Whether for acne, rosacea, eczema, or dermatitis, Dr. Sherber customizes a regimen for each patient tailored to specific skin type and individual symptoms. A combination of over-the-counter and prescription medications may produce the most rapid and durable results, and Dr. Sherber adjusts each regimen carefully to optimize treatment over time.
SCLERODERMA
Scleroderma is a disorder that can take various forms: localized scleroderma (morphea), limited scleroderma (such as CREST syndrome), and systemic sclerosis. In each of the different forms of scleroderma, tissues develop fibrosis and harden due to targeted autoimmune activity. The most effective time to treat this condition is during the earlier stages when signs can be subtle. This is why it is extremely important to consult a doctor, like Dr. Sherber, promptly who is an expert in diagnosis and treatment. Dr. Sherber notably authored the skin chapter in the definitive textbook on scleroderma, now in second edition, and has cared for many patients with scleroderma.
Dr. Sherber approaches each case with a tailored plan – she works closely with rheumatologists and other specialists to ensure comprehensive mutidisciplinary care of her scleroderma patients, and may suggest that new patients with active disease have an evaluation with her colleagues at the world renowned Johns Hopkins Scleroderma Center. Our staff can facilitate coordinating additional consultations, and will ensure that your records are shared with your medical team to give you seamless multidisciplinary care.
Active inflammatory stages of scleroderma must be treated definitively, and Dr. Sherber prescribes various topical and systemic approaches as needed, with every effort made to limit the use of steroids to prevent problematic side effects.
RECOMMENDED TREATMENTS
The mat-like telangiectasias associated with some forms of scleroderma can be treated safely and effectively with the Nd:YAG laser. Pronounced skin wrinkling and facial volume loss, as a result of later stages of scleroderma skin disease, can be treated with injectable hyaluronic acid fillers or fat grafting. Broad spectrum sun protection, either with mineral-only or with a combination of mineral and chemical UV filters, is important for those with scleroderma as it acts to prevent hyperpigmentation in areas of active inflammation.
MORPHEA
Morphea, or localized scleroderma, is a skin-limited condition in which autoimmune-mediated inflammation causes hardening of the skin. It can occur in all age groups ranging from young children to adults.
Dr. Sherber focuses on tailoring a treatment plan that will be most effective for each individual case. Skin biopsies may be necessary to confirm the diagnosis. Typically, she recommends prescription treatment, such as with topical calcineurin inhibitors, or light therapy where appropriate, and avoids steroid treatments as much as possible. In certain cases, she may recommend for the patient to have an additional specialized evaluation with her colleagues at Johns Hopkins.
RECOMMENDED TREATMENTS
Micro-pulsed Nd:YAG Laser Genesis combined with Permea laser treatment can effective at fading hyperpigmentation and purplish discoloration around inactive lesions, and can help to soften fibrotic lesions through deep heating of the dermis (the skin’s collagen layer). Fractionated non-ablative laser treatments such as Perméa fade pigmentation left behind from active lesions and enhance absorption of topical treatments that can help with inflammation in the skin. Broad spectrum sun protection, either with mineral-only or with a combination of mineral and chemical sun filters, is important for those with morphea as it acts to prevent hyperpigmentation in areas of active inflammation.
LUPUS
The diagnosis of lupus requires careful investigation, since signs and symptoms are often subtle and laboratory evaluations can be complex. One in five women will have a positive ANA, which is a commonly used screening test, and so an accurate diagnosis hinges on context clues.
Dr. Sherber is expert at the most up to date screening techniques for diagnosing lupus, and treats the skin manifestations of systemic lupus as well as the forms of skin-limited conditions that fall under the family of lupus diseases.
OUR APPROACH
Dr. Sherber will spend time developing a thorough understanding of the history of your symptoms, as well as a complete list of medications since some forms of lupus are related to medication exposure.
Dr. Sherber approaches each case with a tailored plan – she works closely with rheumatologists and other specialists to ensure comprehensive care of her lupus patients, and often suggests that new patients with active disease have lab work and skin biopsies to gather additional important diagnostic information.
For skin symptoms, she typically recommends topical or systemic approaches that may be combined or tried individually, with an emphasis on limiting the use of steroids in order to avoid their long term effects. Broad spectrum sun protection, either with mineral-only or with a combination of mineral and chemical sun filters, is important for those with photosensitive forms of lupus since it blocks even visible light.
ECZEMA
Eczema is a skin condition that can present with anything from chronically dry skin that’s difficult to keep moisturized, to itchy red rough skin that’s actively inflamed. It is something that runs in families and is associated with abnormalities in the filaggrin protein that is integral to the skin’s barrier function. Oftentimes it is inherited with a tendency for food allergies and/or asthma, called the “topic triad.”
RECOMMENDED TREATMENTS
When skin is eczema-prone, it is important to use skincare products that do not further inflame eczematous skin. Keeping the skin well moisturized is also essential in symptom management of eczema as eczema is known in classic dermatology textbooks as “the itch that rashes.” Dr. Sherber typically recommends vegetable oil-based moisturizers since they can work better than those that are mineral oil-based, and topical ceramides help to reinforce the skin’s barrier that holds water in.
Particularly for infants and small children, Dr. Sherber recommends skincare products without synthetic fragrance and with a focus on simple ingredients, and minimizing use of prescription medications. Bleach baths outlined by the American Academy of Dermatology, can sometimes prove to be beneficial in reducing bacterial colonization that can worsen itching and inflammation. As for adults, Dr. Sherber may also explore whether skin allergies or underlying conditions are playing a role. During pregnancy, eczema may flare up requiring specialized treatment regimens designed to avoid certain medications and topical active ingredients.
For very severe or stubborn cases, newer systemic immunomodulatory treatments may be indicated to reduce disease activity.
ALLERGIC DERMATITIS
Allergic contact dermatitis is a skin condition that is often seen in individuals with highly reactive skin and who are prone to intense allergic reactions. Other skin types with allergic dermatitis may not be prone to frequent allergic reactions but may develop subtle signs of acute or chronic allergy. Allergic reactions ranging from itchy red rashes to acne-like bumps to blisters, can also be commonly induced by the use of topical or systemic exposures.
One particular type of contact dermatitis, called phytophotodermatitis, occurs when the skin is exposed to lime juice or other plants and foods like celery that contain compounds called furanocoumarins, and then sunlight. Sometimes called “lime disease,” this phytotoxic reaction can cause redness and even blisters, and can leave stubborn hyperpigmentation behind.
RECOMMENDED TREATMENTS
Dr. Sherber approaches each case with a tailored plan – she spends time tracing back through exposure histories and evaluating the skin for subtle clues, and may recommend a biopsy to clarify the cause of skin symptoms relating to allergy. She commonly prescribes a “skin diet” to eliminate potential allergens in your skincare products, makeup, or haircare.
For allergies relating to medications, supplements, or dietary sources, Dr. Sherber may involve an allergist to assist in getting to the root cause of the problem. In some cases, prescription medications may be needed in the short term to calm an allergic reaction.