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Dermatology Service | Auckland | Te Toka Tumai | Te Whatu Ora

Public Service, Dermatology

Today

8:00 AM to 5:00 PM.

Description

Formerly Auckland DHB Dermatology Service
 
Dermatology is a branch of medicine dealing with the skin and its diseases.  A doctor of medicine who specialises in this is called a Dermatologist.
 
When you come to the Dermatology Outpatient Department you will be seen by a member of the Dermatology team who will ask questions about your illness and examine your skin to try to determine or confirm the diagnosis. Further tests may be ordered.  These include but are not limited to blood tests, skin biopsy or skin scraping. A biopsy is a minor procedure using local anaesthetic to remove a small piece of the skin for examination under a microscope in the laboratory. A skin scraping is a gentle scrape removing a layer of skin from the affected area for testing.  Sometimes these tests can all be done during one clinic visit, but for some conditions the diagnosis will take several follow-up appointments.  Occasionally some tests can be arranged even before you are seen at the clinic to try to speed up the process. Once a diagnosis has been made, the medical staff will discuss treatment with you. 
 

Consultants

Referral Expectations

If you have an urgent skin problem requiring immediate assessment you are referred urgently to the Dermatology Department where you will be seen at Greenlane Clinical Centre by the Registrar (a trainee specialist) who will decide treatment or whether you need to be admitted to Auckland City Hospital.  Investigations will be performed as required and the more senior members of the team involved where necessary.  It is best if you have somebody take you to this assessment as transport between Greenlane Clinical Centre and Auckland City Hospital may not be provided.   
 
If the problem is not urgent, the GP will be given advice to treat your condition or your GP will write a letter to the Dermatology Department requesting an appointment in the outpatient clinic.
 
Each month the Department receives more new referrals than can be seen at clinic. The Dermatology doctors working in the Department review the referral letters to determine who should be seen first, based on the information provided by the GP. Very urgent cases are usually seen within a month, and all patients are seen within four months. Routine cases are often returned to the GP with some management advice.  
 

Hours

8:00 AM to 5:00 PM.

Mon – Fri 8:00 AM – 5:00 PM

Common Conditions / Procedures / Treatments

Acne

Acne is a skin disorder that is characterised by pimples, blackheads, whiteheads, and, in bad cases, cysts (deeper lumps). Acne usually starts at puberty and is in response to our body’s production of hormones, called androgens. These hormones cause the sebaceous glands (oil-producing glands in the skin) to get bigger and produce more oil. The extra oil (sebum) mixes with dead skin cells and naturally occurring bacteria on the surface of the skin and blocks pores. Once a pore is blocked the bacteria multiply and cause inflammation, which produces the characteristic signs of acne. Acne commonly occurs on the face, neck, back and chest. Acne can lead to permanent scarring. Other causes of acne may include: genetics heavy makeup harsh and repetitive cleansing picking and squeezing certain medications rarely diet. Acne Vulgaris is the most common form of acne. Adult Acne occurs in about 30% of people at some stage in their adult life. It is thought that adult acne also has some hormonal influences. Acne Roseaca is similar to acne vulgaris, with oily skin and spots, but also has flushing or redness of the skin in the affected area. The flush may be set off by certain spicy food or alcohol. Treatment Usually acne can be treated successfully, but results do not happen overnight and what can work for one person may not work for another. It may take several months to see initial results, and once it significantly clears treatment is still required to keep it from coming back. Some medications for acne can only be prescribed by a dermatologist. When acne is treated early the results are very good and it also helps to reduce scarring. Over-the-counter products are available to treat mild-to-moderate acne, but check with a pharmacist which product is the best for your type of acne. In moderate-to-severe acne, treatment usually requires the help of a dermatologist and often more than one type of treatment. Treatments may include: antibiotic creams topical (apply to your skin) retinoids oral (take by mouth) antibiotics: these reduce the number of bacteria present on the skin which leads to a decrease in inflammation oral contraceptives: these reduce the amount of oil produced by the sebaceous glands. However, possible side effects must be taken into consideration before starting treatment over-the-counter acne products. Severe acne, with deep cysts, inflammation and scarring, should be treated by a dermatologist and in most cases can be successfully treated. Treatment may include: surgery: the deep cysts are removed and drained corticosteroid injection: used to treat the inflammation, promote healing of an acne cyst and help prevent scarring isotretinoin: an oral medication prescribed by a dermatologist that effectively works on all factors that cause acne. It can also have some side effects so you will need to be continually monitored whilst on this medication oral antibiotics oral contraceptives.

Acne is a skin disorder that is characterised by pimples, blackheads, whiteheads, and, in bad cases, cysts (deeper lumps).  Acne usually starts at puberty and is in response to our body’s production of hormones, called androgens. These hormones cause the sebaceous glands (oil-producing glands in the skin) to get bigger and produce more oil. The extra oil (sebum) mixes with dead skin cells and naturally occurring bacteria on the surface of the skin and blocks pores.  Once a pore is blocked the bacteria multiply and cause inflammation, which produces the characteristic signs of acne.
Acne commonly occurs on the face, neck, back and chest.  Acne can lead to permanent scarring.
Other causes of acne may include:
  • genetics
  • heavy makeup
  • harsh and repetitive cleansing
  • picking and squeezing
  • certain medications
  • rarely diet.
Acne Vulgaris is the most common form of acne.
Adult Acne occurs in about 30% of people at some stage in their adult life.  It is thought that adult acne also has some hormonal influences.
Acne Roseaca is similar to acne vulgaris, with oily skin and spots, but also has flushing or redness of the skin in the affected area.  The flush may be set off by certain spicy food or alcohol.
 
Treatment
Usually acne can be treated successfully, but results do not happen overnight and what can work for one person may not work for another.  It may take several months to see initial results, and once it significantly clears treatment is still required to keep it from coming back.
Some medications for acne can only be prescribed by a dermatologist.  When acne is treated early the results are very good and it also helps to reduce scarring.
Over-the-counter products are available to treat mild-to-moderate acne, but check with a pharmacist which product is the best for your type of acne.  In moderate-to-severe acne, treatment usually requires the help of a dermatologist and often more than one type of treatment.  Treatments may include:
  • antibiotic creams
  • topical (apply to your skin) retinoids
  • oral (take by mouth) antibiotics: these reduce the number of bacteria present on the skin which leads to a decrease in inflammation
  • oral contraceptives: these reduce the amount of oil produced by the sebaceous glands.  However, possible side effects must be taken into consideration before starting treatment
  • over-the-counter acne products.
 
Severe acne, with deep cysts, inflammation and scarring, should be treated by a dermatologist and in most cases can be successfully treated.
Treatment may include:
  • surgery: the deep cysts are removed and drained
  • corticosteroid injection: used to treat the inflammation, promote healing of an acne cyst and help prevent scarring
  • isotretinoin: an oral medication prescribed by a dermatologist that effectively works on all factors that cause acne. It can also have some side effects so you will need to be continually monitored whilst on this medication
  • oral antibiotics
  • oral contraceptives.
Bacterial Skin Infections

Our skin is our body’s first defence mechanism and even though many types of bacteria live on its surface, we still need a healthy, intact skin surface to maintain its defense. Any break in this defense, whether it is from a cut or a pimple, is a possible risk for a bacterial infection. Some diseases such as diabetes and HIV increase the risk of major infection when this barrier is broken, as these patients already have a faulty immune system. Impetigo This is a bacterial infection of the outer layers of the skin. It is infectious and is spread to others by direct contact, but can also spread to other areas on the body. It shows up as a crusty, weepy area and most often begins on the face or exposed areas of the arms and legs. The bacteria that causes it is commonly found around children and schools. Thus, impetigo is more common among children than adults and often occurs in spring and autumn. Impetigo is easily treated with oral or topical antibiotics. In some cases a child may require time off from school to prevent spread to others. Cellulitis This is a bacterial infection of the skin and underlying tissues that can happen in normal skin but often occurs in an area of skin damaged by a wound, insect bite, eczema, chicken pox etc. It usually involves the skin of the face, arms and legs. Bacteria spread and cause the following symptoms: swelling, pain and inflammation of tissue warmth and redness of skin fever aches and general unwellness red streaks from original cellulitis site. In someone with diabetes or someone who is taking medications to suppress the immune system, cellulitis can start in areas of intact skin. The bacteria that cause cellulitis are usually Streptococcus or Staphylococcus. Cellulitis responds rapidly to antibiotic treatment, either orally or through injections. Boil This is a tender, red, inflamed raised lump that has a pus-filled centre. A boil develops when a hair follicle becomes infected with bacteria. The usual bacteria that causes a boil is Staphylococcus. Common areas of infection are the neck and face, breast and buttocks. Boils are more prevalent in people who have a low immunity. Carbuncles This is the term for a cluster of boils. Folliculitis This is inflammation of the hair follicle, caused by the Staphylococcus bacteria. The inflammation produces pus-filled pimples around the follicle. It can occur on any area of the body but is more common in areas that are shaved or plucked. Treatment Often boils, carbuncles and folliculitis clear without any specific treatment. They may burst and release the pus. Keeping the skin clean with antibacterial wash can prevent infections and prevent the spread. Do not squeeze as this can spread and worsen the infection. Application of warm heat can help to relieve symptoms. Antibiotics can be prescribed in some cases.

Our skin is our body’s first defence mechanism and even though many types of bacteria live on its surface, we still need a healthy, intact skin surface to maintain its defense. Any break in this defense, whether it is from a cut or a pimple, is a possible risk for a bacterial infection.
Some diseases such as diabetes and HIV increase the risk of major infection when this barrier is broken, as these patients already have a faulty immune system.
 
Impetigo
This is a bacterial infection of the outer layers of the skin. It is infectious and is spread to others by direct contact, but can also spread to other areas on the body. It shows up as a crusty, weepy area and most often begins on the face or exposed areas of the arms and legs.  The bacteria that causes it is commonly found around children and schools.  Thus, impetigo is more common among children than adults and often occurs in spring and autumn.
Impetigo is easily treated with oral or topical antibiotics.
In some cases a child may require time off from school to prevent spread to others.
 
Cellulitis
This is a bacterial infection of the skin and underlying tissues that can happen in normal skin but often occurs in an area of skin damaged by a wound, insect bite, eczema, chicken pox etc. It usually involves the skin of the face, arms and legs.  Bacteria spread and cause the following symptoms:
  • swelling, pain and inflammation of tissue
  • warmth and redness of skin
  • fever
  • aches and general unwellness
  • red streaks from original cellulitis site.
 
In someone with diabetes or someone who is taking medications to suppress the immune system, cellulitis can start in areas of intact skin.
The bacteria that cause cellulitis are usually Streptococcus or Staphylococcus.
Cellulitis responds rapidly to antibiotic treatment, either orally or through injections.
 
Boil
This is a tender, red, inflamed raised lump that has a pus-filled centre.  A boil develops when a hair follicle becomes infected with bacteria.  The usual bacteria that causes a boil is Staphylococcus.  Common areas of infection are the neck and face, breast and buttocks.
Boils are more prevalent in people who have a low immunity.
 
Carbuncles
This is the term for a cluster of boils.
 
Folliculitis
This is inflammation of the hair follicle, caused by the Staphylococcus bacteria.
The inflammation produces pus-filled pimples around the follicle.  It can occur on any area of the body but is more common in areas that are shaved or plucked.
 
Treatment
Often boils, carbuncles and folliculitis clear without any specific treatment. They may burst and release the pus.
Keeping the skin clean with antibacterial wash can prevent infections and prevent the spread. Do not squeeze as this can spread and worsen the infection.
Application of warm heat can help to relieve symptoms. Antibiotics can be prescribed in some cases.
Eczema

There are several different types of eczema but all have a number of common symptoms, the main feature being red, inflamed, itchy skin. The skin can be covered with small, fluid-filled blisters that might ooze and form a scale or crust. Constant scratching can eventually lead to thickening and hardening of the skin. The several types of eczema are caused by a number of different things, such as irritant contact and allergies, or from unknown causes. Determining the cause can be very difficult. Atopic eczema This is the most common form of eczema. It often occurs in the first few months after birth and is a chronic condition (may last for many years). Atopic eczema is often associated with hay fever and asthma, and has a tendency to run in families. It is also known to disappear with age. Emotional stress, changes in climate or diet or certain fibers in clothing (especially wool) can be triggers for atopic eczema or can worsen the existing condition. Generally the eczema occurs in areas where the skin folds in upon itself, such as behind the knees, inside the elbows, the neck and eyelids. It is more likely to occur in winter. With uncontrolled itching the skin can become grazed and weepy and is a potential area for a secondary bacterial infection. As this is more common in young children, it is important to control scratching. There are no specific tests to diagnose atopic eczema, but a visit to the doctor is an important step. The diagnosis can be made once the rash has been viewed, based on its typical pattern and also whether an atopic tendency (i.e. eczema, hay fever or asthma) runs in the family. Symptoms are: redness and inflammation of the skin small fluid-filled blisters intense itching, especially at night dry scaly/cracked skin thickened skin as a result of continuous scratching. Treatment There is no cure, but the following actions can help control the symptoms: moisturising creams help soothe and heal dry skin soap substitutes prevent drying of the skin when washing corticosteroid cream/ointment relieves inflammation and controls itching. These should be used as directed by your doctor, nurse or pharmacist. non-steroidal creams that alter your body’s immune system response antibiotic creams can be used if a secondary infection is present avoidance of any known irritants oral antihistamines can also be prescribed for itchiness keep fingernails short to prevent damage to the skin from scratching. Seborrhoeic dermatitis This is an inflammation of the upper layers of the skin, which gradually results in dry or greasy scaling of the affected area. This type of dermatitis tends to be chronic and recurrent. It occurs in both infants and adults and tends to run in families. In infants, this condition is known as ‘cradle cap’ when it occurs on the scalp, but can also affect the nappy area to cause ‘nappy eczema’. In adults, the rash tends to occur around the nose, eyebrows and scalp. Treatment Infants: wash the scalp with mild shampoo. Oil can be applied to help comb scale out. Adults: regular use of an anti-dandruff shampoo is often all that is needed. Corticosteroids can also be applied, only 1% strength to the face. Ketoconazole 1% shampoo and cream are very effective. Contact dermatitis Contact dermatitis is inflammation of the skin caused by contact with a specific substance. This happens because of irritation or by an allergic reaction. Substances that can trigger this inflammation can include cosmetics, soaps, detergents, rubber, nickel (in jewellery) or specific chemicals used in skin creams or from plants. With an allergic reaction, it is not the first exposure that causes a reaction but may be the next exposure or, in some cases, it is possible to have contact with a substance for a number of years without any skin inflammation occurring. But once the skin has become sensitive, even a tiny amount of that substance can cause a reaction. Usually contact dermatitis affects only the area that has been in contact with the trigger or irritant (item that has caused the reaction). Symptoms can vary from a mild rash to a severe rash and blisters, with subsequent scaling and itching. The severity depends on the concentration of the irritant and how long the skin was exposed to it. Once the irritant is taken away, the redness and rash usually disappear over a few days. Treatment A dermatologist can perform patch testing to find out which substances are causing the allergic reaction. This is done by placing small discs (with possible allergen-causing substance on them) on the skin and removing them after 48 hours for examination. The patches are then examined again 2 days later, to check for delayed reactions. Once the trigger has been identified, it is important to avoid it as continued exposure may cause a persistent rash, which will be difficult to treat. Treatment involves the use of steroid creams to decrease the symptoms of the reaction. With severe contact dermatitis, oral steroids or a steroid injection may be given. Nummular Eczema This is also known as discoid eczema. This form of eczema is more common in older males, is associated with existing dry skin and is most common in the winter season. The cause is unknown. It is characterised by an itchy rash that forms in coin-shaped spots, sometimes with associated small blisters, scabs, scales and thickened skin on the forearms and elbows, the backs of hands, tops of legs and the feet. Nummular eczema can be confused with a fungal infection but diagnosis can be made from a skin biopsy (removing a small piece of skin for examination under a microscope). Treatment is usually with moisturisers, steroid creams and sometimes antihistamines, if required. Asteatotic eczema This is generally common in the elderly and is mainly caused by the dryness of the skin that accompanies older age. It is characterised by a scaly itching rash that can often be cracked and have a pattern to it. Dyshidrotic eczema This type of eczema is characterised by thickening of the skin accompanied by large numbers of blisters that tend to ooze. It usually affects the fingers, palms and soles of the feet. The cause is unknown.

There are several different types of eczema but all have a number of common symptoms, the main feature being red, inflamed, itchy skin.  The skin can be covered with small, fluid-filled blisters that might ooze and form a scale or crust.
Constant scratching can eventually lead to thickening and hardening of the skin.
The several types of eczema are caused by a number of different things, such as  irritant contact and allergies, or from unknown causes.  Determining the cause can be very difficult.
 
Atopic eczema
This is the most common form of eczema.  It often occurs in the first few months after birth and is a chronic condition (may last for many years). Atopic eczema is often associated with hay fever and asthma, and has a tendency to run in families.  It is also known to disappear with age.
Emotional stress, changes in climate or diet or certain fibers  in clothing (especially wool) can be triggers for atopic eczema or can worsen the existing condition.
Generally the eczema occurs in areas where the skin folds in upon itself, such as behind the knees, inside the elbows, the neck and eyelids.  It is more likely to occur in winter.
With uncontrolled itching the skin can become grazed and weepy and is a potential area for a secondary bacterial infection.  As this is more common in young children, it is important to control scratching.
There are no specific tests to diagnose atopic eczema, but a visit to the doctor is an important step. The diagnosis can be made once the rash has been viewed, based on its typical pattern and also whether an atopic tendency (i.e. eczema, hay fever or asthma) runs in the family.
Symptoms are:
  • redness and inflammation of the skin
  • small fluid-filled blisters
  • intense itching, especially at night
  • dry scaly/cracked skin
  • thickened skin as a result of continuous scratching.
 
Treatment
There is no cure, but the following actions can help control the symptoms:
  • moisturising creams help soothe and heal dry skin
  • soap substitutes prevent drying of the skin when washing
  • corticosteroid cream/ointment relieves inflammation and controls itching.  These should be used as directed by your doctor, nurse or pharmacist.
  • non-steroidal creams that alter your body’s immune system response
  • antibiotic creams can be used if a secondary infection is present
  • avoidance of any known irritants
  • oral antihistamines can also be prescribed for itchiness
  • keep fingernails short to prevent damage to the skin from scratching.
 
Seborrhoeic dermatitis
This is an inflammation of the upper layers of the skin, which gradually results in dry or greasy scaling of the affected area. This type of dermatitis tends to be chronic and recurrent.  It occurs in both infants and adults and tends to run in families. In infants, this condition is known as ‘cradle cap’ when it occurs on the scalp, but can also affect the nappy area to cause ‘nappy eczema’. In adults, the rash tends to occur around the nose, eyebrows and scalp.
Treatment
Infants: wash the scalp with mild shampoo. Oil can be applied to help comb scale out.
Adults: regular use of an anti-dandruff shampoo is often all that is needed.
Corticosteroids can also be applied, only 1% strength to the face.  Ketoconazole 1% shampoo and cream are very effective.
 
Contact dermatitis
Contact dermatitis is inflammation of the skin caused by contact with a specific substance.  This happens because of irritation or by an allergic reaction.
Substances that can trigger this inflammation can include cosmetics, soaps, detergents, rubber, nickel (in jewellery) or specific chemicals used in skin creams or from plants.
With an allergic reaction, it is not the first exposure that causes a reaction but may be the next exposure or, in some cases, it is possible to have contact with a substance for a number of years without any skin inflammation occurring.  But once the skin has become sensitive, even a tiny amount of that substance can cause a reaction.
Usually contact dermatitis affects only the area that has been in contact with the trigger or irritant (item that has caused the reaction).
Symptoms can vary from a mild rash to a severe rash and blisters, with subsequent scaling and itching. The severity depends on the concentration of the irritant and how long the skin was exposed to it.  Once the irritant is taken away, the redness and rash usually disappear over a few days.
Treatment
A dermatologist can perform patch testing to find out which substances are causing the allergic reaction.  This is done by placing small discs (with possible allergen-causing substance on them) on the skin and removing them after 48 hours for examination.  The patches are then examined again 2 days later, to check for delayed reactions. Once the trigger has been identified, it is important to avoid it as continued exposure may cause a persistent rash, which will be difficult to treat.
Treatment involves the use of steroid creams to decrease the symptoms of the reaction. With severe contact dermatitis, oral steroids or a steroid injection may be given. 
 
Nummular Eczema
This is also known as discoid eczema.  This form of eczema is more common in older males, is associated with existing dry skin and is most common in the winter season. The cause is unknown. It is characterised by an itchy rash that forms in coin-shaped spots, sometimes with associated small blisters, scabs, scales and thickened skin on the forearms and elbows, the backs of hands, tops of legs and the feet.
Nummular eczema can be confused with a fungal infection but diagnosis can be made from a skin biopsy (removing a small piece of skin for examination under a microscope).
Treatment is usually with moisturisers, steroid creams and sometimes antihistamines, if required.
 
Asteatotic eczema
This is generally common in the elderly and is mainly caused by the dryness of the skin that accompanies older age.  It is characterised by a scaly itching rash that can often be cracked and have a pattern to it.
 
Dyshidrotic eczema
This type of eczema is characterised by thickening of the skin accompanied by large numbers of blisters that tend to ooze. It usually affects the fingers, palms and soles of the feet. The cause is unknown.
Fungal Skin Infections

Bacteria and a number of types of fungi live on the surface of the skin. Fungi generally live in moist areas of the body, thus these are the areas where fungus tends to overgrow and create a fungal infection. A type of fungi that occur naturally in the gastrointestinal tract (mouth, oesophagus, stomach, intestines) and moist skin areas are yeasts. Fungal infections are named according to the type of fungi and area of infection. Common fungal infections: Athletes Foot (Tinea pedis) – a tinea fungal infection of the foot and between the toes that is more common in males. Ringworm (Tinea corporis) – the same type of infection as athletes foot. Ringworm of the Scalp (Tinea capitis) – a tinea fungal infection characterised by raised bumps that form in a circular pattern on the scalp. This may result in bald patches. Jock Itch (Tinea cruris) – a tinea infection that affects the inner thighs, bottom and genital area. Pityriasis Vesicular – a yeast infection of the skin resulting in lighter patches in areas of skin. Candida Infection – a yeast infection that occurs on the skin’s surface or within mucous membranes especially when they are damaged. Yeast infections require a humid, moist environment and grow rapidly when your immune system is not working properly. Antibiotics can also cause yeast infections by killing off the normal flora (bacteria) and allowing growth of the yeast. Yeast infections occur in: skin folds tummy button vagina (thrush) penis (thrush) mouth (inside and outer) skin surrounding and under nails. Symptoms of Candida infections depend upon the area involved and can include: itchiness/burning redness general irritation and tenderness skin splits dry scaly skin discharge (thrush). Treatments Generally over-the-counter products are enough to treat mild-to-moderate fungal skin infections. If symptoms persist, it is important to see a doctor.

Bacteria and a number of types of fungi live on the surface of the skin.
Fungi generally live in moist areas of the body, thus these are the areas where fungus tends to overgrow and create a fungal infection.  A type of fungi that occur naturally in the gastrointestinal tract (mouth, oesophagus, stomach, intestines) and moist skin areas are yeasts. Fungal infections are named according to the type of fungi and area of infection.
 
Common fungal infections:
Athletes Foot (Tinea pedis) – a tinea fungal infection of the foot and between the toes that is more common in males.
Ringworm (Tinea corporis) – the same type of infection as athletes foot.
Ringworm of the Scalp (Tinea capitis) – a  tinea fungal infection characterised by raised bumps that form in a circular pattern on the scalp. This may result in bald patches.
Jock Itch (Tinea cruris) – a tinea infection that affects the inner thighs, bottom and genital area.
Pityriasis Vesicular – a yeast infection of the skin resulting in lighter patches in areas of skin.
Candida Infection – a yeast infection that occurs on the skin’s surface or within mucous membranes especially when they are damaged.  Yeast infections require a humid, moist environment and grow rapidly when your immune system is not working properly.  Antibiotics can also cause yeast infections by killing off the normal flora (bacteria) and allowing growth of the yeast.  Yeast infections occur in:
  • skin folds
  • tummy button
  • vagina (thrush)
  • penis (thrush)
  • mouth (inside and outer)
  • skin surrounding and under nails.

Symptoms of Candida infections depend upon the area involved and can include:
  • itchiness/burning
  • redness
  • general irritation and tenderness
  • skin splits
  • dry scaly skin
  • discharge (thrush).
 
Treatments
Generally over-the-counter products are enough to treat mild-to-moderate fungal skin infections.  If symptoms persist, it is important to see a doctor.
Psoriasis

Psoriasis is a common, recurring (keeps coming back) skin condition that is hard to treat. It is characterised by raised patches of skin (known as plaques) that are red, thickened and scaly that commonly occur on the elbows, knees and scalp, but can affect any parts of the body. Psoriasis usually starts out as a small spot that is excessively flaky and that gradually enlarges, then other plaques start to appear. Sometimes the flaking can be mistaken for dandruff. These areas are not always itchy. It is unusual in children and more common in adults. Psoriasis happens when new skin cells are produced at a faster rate than the dead skin cells are removed, thus excess skin cells form in thick scaly patches on top of the skin. The reason this happens is unknown, but it is known that: it may run in families; it may be triggered by infection, injury or stress; it is associated with the use of certain medications; and it is associated with psoriatic arthritis. There are different types of psoriasis and a person can have more than one type at a time. Plaque psoriasis – the most common type, which keeps recurring, or coming back, over a lifetime. It can develop at any age. Symptoms are: plaques on the elbows, knees, nails, scalp, and behind the ears. This condition can be itchy at times. When it occurs on the nails, it is associated with discolouration and pitting of the nail. Guttate psoriasis – this type is more common in children and young adults and often follows a bacterial throat infection. It appears as many coin-shaped pink scaly plaques usually covering the back and chest. It can be itchy. Guttate psoriasis usually disappears over time and does not recur, although if someone has guttate psoriasis they are more likely to go on to get other types of psoriasis at a later stage. Pustular psoriasis – a rare and potentially fatal condition that generally affects adults. Symptoms are: small pus-filled blisters on palms of hands and soles of feet, with areas of skin that are painful, red and inflamed. Some scaling and thickening may be seen. Inverse psoriasis – this commonly affects the elderly. It is characterised by large moist reddened areas of skin occurring in skin folds such as the groin area, armpits and under the breasts. This type of psoriasis is easily treated, but is also recurring. Psoriasis can be hard to diagnose as other conditions have similar symptoms. To confirm a diagnosis a skin biopsy (small sample of skin is removed for examination) can be taken. Treatment Treatment can begin once a diagnosis is made and usually involves both topical (applied to the skin) and generalised treatments. There is no cure for psoriasis but treatment can control symptoms. Topical treatments: skin creams and ointments to lubricate and soften the skin corticosteroids vitamin D cream coal tar preparations salicylic acid preparations. Oral medications such as etretinate, retinoids, methotrexate or cyclosporin can be prescribed, under the guidance of a dermatologist. A generalised treatment such as ultraviolet light therapy may be effective and can be combined with an oral medication, which makes the skin more sensitive to the effects of light. This treatment is called PUVA or UVB and is given under the direction of a dermatologist.

Psoriasis is a common, recurring (keeps coming back) skin condition that is hard to treat. It is characterised by raised patches of skin (known as plaques) that are red, thickened and scaly that commonly occur on the elbows, knees and scalp, but can affect any parts of the body.
Psoriasis usually starts out as a small spot that is excessively flaky and that gradually enlarges, then other plaques start to appear.  Sometimes the flaking can be mistaken for dandruff.  These areas are not always itchy. It is unusual in children and more common in adults.
Psoriasis happens when new skin cells are produced at a faster rate than the dead skin cells are removed, thus excess skin cells form in thick scaly patches on top of the skin. The reason this happens is unknown, but it is known that: it may run in families; it may be triggered by infection, injury or stress; it is associated with the use of certain medications; and it is associated with psoriatic arthritis.
 
There are different types of psoriasis and a person can have more than one type at a time.
 
Plaque psoriasis – the most common type, which keeps recurring, or coming back, over a lifetime.  It can develop at any age. Symptoms are: plaques on the elbows, knees, nails, scalp, and behind the ears. This condition can be itchy at times.  When it occurs on the nails, it is associated with discolouration and pitting of the nail.

Guttate psoriasis – this type is more common in children and young adults and often follows a bacterial throat infection. It appears as many coin-shaped pink scaly plaques usually covering the back and chest. It can be itchy. Guttate psoriasis usually disappears over time and does not recur, although if someone has guttate psoriasis they are more likely to go on to get other types of psoriasis at a later stage.

Pustular psoriasis – a rare and potentially fatal condition that generally affects adults.  Symptoms are: small pus-filled blisters on palms of hands and soles of feet, with areas of skin that are painful, red and inflamed. Some scaling and thickening may be seen.

Inverse psoriasis – this commonly affects the elderly.  It is characterised by large moist reddened areas of skin occurring in skin folds such as the groin area, armpits and under the breasts. This type of psoriasis is easily treated, but is also recurring.
 
Psoriasis can be hard to diagnose as other conditions have similar symptoms.  To confirm a diagnosis a skin biopsy (small sample of skin is removed for examination) can be taken.
 
Treatment
Treatment can begin once a diagnosis is made and usually involves both topical (applied to the skin) and generalised treatments. There is no cure for psoriasis but treatment can control symptoms.
 
Topical treatments:
  • skin creams and ointments to lubricate and soften the skin
  • corticosteroids
  • vitamin D cream
  • coal tar preparations
  • salicylic acid preparations.
 
Oral medications such as etretinate, retinoids, methotrexate or cyclosporin can be prescribed, under the guidance of a dermatologist.
 
A generalised treatment such as ultraviolet light therapy may be effective and can be combined with an oral medication, which makes the skin more sensitive to the effects of light. This treatment is called PUVA or UVB and is given under the direction of a dermatologist.
Scabies

Scabies is a very common skin infection that is caused by a mite that burrows under the top layer of skin and lays its eggs. The eggs hatch in a few days. The skin then becomes very itchy and a red, raised rash may appear. Itching is worse at night and can occur before the rash appears and can continue after the rash disappears. Sometimes the burrows can be seen; they appear as wavy brownish lines. The areas most affected are: between the fingers; between the toes; palms; heels; wrists and groin. Scabies is more common in children and young adults. Scabies is highly contagious (easy to catch) and is spread via physical contact (person to person). It is more common in overcrowding situations. The sooner it is treated, the sooner the spread is stopped. Treatment The presence of mites can be confirmed by taking a scraping from the burrows and examining it under a microscope. However, a negative scraping does not rule out the possibility of scabies. An antiparasitic lotion is used to kill the mites and this should be applied over the whole body (excluding the face). A hydrocortisone cream can also be used to reduce the itching. It is important that all family members and close contacts also be treated at the same time as the initial patient. This helps prevent the spread.

Scabies is a very common skin infection that is caused by a mite that burrows under the top layer of skin and lays its eggs.  The eggs hatch in a few days.  The skin then becomes very itchy and a red, raised rash may appear.  Itching is worse at night and can occur before the rash appears and can continue after the rash disappears.  Sometimes the burrows can be seen; they appear as wavy brownish lines. The areas most affected are: between the fingers; between the toes; palms; heels; wrists and groin. Scabies is more common in children and young adults.
Scabies is highly contagious (easy to catch) and is spread via physical contact (person to person).  It is more common in overcrowding situations.  The sooner it is treated, the sooner the spread is stopped.
 
Treatment
The presence of mites can be confirmed by taking a scraping from the burrows and examining it under a microscope. However, a negative scraping does not rule out the possibility of scabies.
An antiparasitic lotion is used to kill the mites and this should be applied over the whole body (excluding the face).  A hydrocortisone cream can also be used to reduce the itching. It is important that all family members and close contacts also be treated at the same time as the initial patient.  This helps prevent the spread.
Skin Cancer

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun. Risk factors for developing skin cancer are: prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds. There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. Basal Cell Carcinoma (BCC) This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body. Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore. BCCs occur more commonly on the face, back of hands and back. They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour. Treatment Often a BCC can be diagnosed just by its appearance. In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis. Removal of a BCC will require an appointment with a doctor or surgeon. It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal. Squamous Cell Carcinoma (SCC) This type of skin cancer also affects areas of the skin that have exposure to the sun. The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body. The spreading (metastasising) can potentially be fatal if not successfully treated. A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges. SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown. Sometimes it can appear like a recurring ulcer that does not heal. All SCCs will need to be removed, because of their potential for spread. The removal and diagnosis is the same as for a BCC. Malignant Melanoma This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease. A melanoma usually starts as a pigmented growth on normal skin. They often, but not always, occur on areas that have high sun exposure. In some cases, a melanoma may develop from existing pigmented moles. What to look for: an existing mole that changes colour (it may be black, dark blue or even red and white) the colour pigment may be uneven the edges of the mole/freckle may be irregular and have a spreading edge the surface of the mole/freckle may be flaky/crusted and raised sudden growth of an existing or new mole/freckle inflammation and or itchiness surrounding an existing or new mole/freckle. Treatment It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading. A biopsy or removal will be carried out depending on the size of the cancer. Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required. If the melanoma has spread more surgery may be required to take more of the affected skin. Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread. Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer). A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread. Sun Protection Information (PDF, 650.4 KB)

New Zealand has a very high rate of skin cancer, when compared to other countries. The most common forms of skin cancer usually appear on areas of skin that have been over-exposed to the sun.
Risk factors for developing skin cancer are:  prolonged exposure to the sun; people with fair skin; and possibly over-exposure to UV light from sun beds.
 
There are three main types of skin cancers: basal cell carcinoma, squamous cell carcinoma and malignant melanoma.
 
Basal Cell Carcinoma (BCC)
This is the most common type and is found on skin surfaces that are exposed to sun. A BCC remains localised and does not usually spread to other areas of the body.  Sometimes BCC’s can ulcerate and scab so it is important not to mistake it for a sore.
BCCs occur more commonly on the face, back of hands and back.  They appear usually as small, red lumps that don’t heal and sometimes bleed or become itchy. They have the tendency to change in size and sometimes in colour.
 
Treatment
Often a BCC can be diagnosed just by its appearance.  In other cases it will be removed totally and sent for examination and diagnosis, or a biopsy may be taken and just a sample sent for diagnosis.
Removal of a BCC will require an appointment with a doctor or surgeon.  It will be termed minor surgery and will require a local anaesthetic (numbing of the area) and possibly some stitches. A very small number of BCCs will require a general anaesthetic (you will sleep through the operation) for removal.
 
Squamous Cell Carcinoma (SCC)
This type of skin cancer also affects areas of the skin that have exposure to the sun.  The most common area is the face, but an SCC can also affect other parts of the body and can spread to other parts of the body.  The spreading (metastasising) can potentially be fatal if not successfully treated.
 
A SCC usually begins as a keratosis that looks like an area of thickened scaly skin, it may then develop into a raised, hard lump which enlarges.  SCCs can sometimes be painful. Often the edges are irregular and it can appear wart like, the colour can be reddish brown.  Sometimes it can appear like a recurring ulcer that does not heal.
All SCCs will need to be removed, because of their potential for spread.  The removal and diagnosis is the same as for a BCC.
 
Malignant Melanoma
This is the most serious form of skin cancer. It can spread to other parts of the body and people can die from this disease.
A melanoma usually starts as a pigmented growth on normal skin.  They often, but not always, occur on areas that have high sun exposure.  In some cases, a melanoma may develop from existing pigmented moles.
 
What to look for:
  • an existing mole that changes colour  (it may be black, dark blue or even red and white)
  • the colour pigment may be uneven
  • the edges of the mole/freckle may be irregular and have a spreading edge
  • the surface of the mole/freckle may be flaky/crusted and raised
  • sudden growth of an existing or new mole/freckle
  • inflammation and or itchiness surrounding an existing or new mole/freckle.
 
Treatment
It is important that any suspect moles or freckles are checked by a GP or a dermatologist. The sooner a melanoma is treated, there is less chance of it spreading.
A biopsy or removal will be carried out depending on the size of the cancer.  Tissue samples will be sent for examination, as this will aid in diagnosis and help determine the type of treatment required.  If the melanoma has spread more surgery may be required to take more of the affected skin.  Samples from lymph nodes that are near to the cancer may be tested for spread, then chemotherapy or radiotherapy may be required to treat this spread. 
Once a melanoma has been diagnosed, a patient may be referred to an oncologist (a doctor who specialises in cancer).
 
A melanoma that is in the early stages can be treated more successfully and cure rates are much higher than one that has spread.
Mohs Micrographic Surgery

Mohs micrographic surgery is a highly effective and advanced treatment for skin cancer. It offers the highest potential for cure (up to 99%) because the tumour is precisely removed and analysed layer by layer under the microscope during your appointment, and prior to reconstruction of the wound. Your surgeon is also the pathologist, providing a powerful and effective combination to accurately remove the skin cancer cells. An important additional benefit is its ability to minimise the removal of normal tissue surrounding the tumour, leading to a smaller defect and a superior cosmetic outcome. The visible part of a skin cancer is very often only the "tip of the iceberg"; so-called thin roots of cancer cells unseen by the naked eye may spread deep and wide and only be visible to examination under a microscope. What are the advantages of Mohs surgery? By aiming to evaluate 100% of the surgical margin, it provides the highest assurance that all the cancer cells are removed during surgery. The amount of normal tissue loss is minimised and, as a result, the functional and cosmetic outcome can be maximised. The pathology (microscopic evaluation) is performed on the day by your Mohs surgeon, so there is no waiting for results following surgery. It can cure skin cancers where other methods have failed. Auckland is unique and fortunate to have this type of surgery available in the public health sector. It is provided by Dr Todd Gunson and Dr Bob Chan. If your family doctor or another specialist feels Mohs surgery may be best for you, you will be given a consultation appointment. After assessment at this appointment, you will be allocated to a waiting list for the surgery if it is the most appropriate treatment. Further information about Mohs surgery provided by Dr Gunson, can be found at www.thedermatologist.co.nz What should I expect on the day? The nursing staff will discuss this with you over the telephone prior to your appointment. You will generally be expected to arrive in the early morning, and should be prepared to spend the majority of the day in the department. Because a number of cases are performed on the same day, and because of the sometimes unpredictable nature of tracking the tumour microscopically, waiting is an inevitable part of the procedure. Please bring a book, magazine, knitting, or other activities to keep you amused, as well as a packed lunch and snacks. Tea, coffee, and water will be provided. The surgery is all performed under local anaesthetic, and therefore fasting is not required. Unless specifically told otherwise, have a good breakfast and take all your normal medications on the day of your surgery.

Mohs micrographic surgery is a highly effective and advanced treatment for skin cancer. It offers the highest potential for cure (up to 99%) because the tumour is precisely removed and analysed layer by layer under the microscope during your appointment, and prior to reconstruction of the wound. Your surgeon is also the pathologist, providing a powerful and effective combination to accurately remove the skin cancer cells. An important additional benefit is its ability to minimise the removal of normal tissue surrounding the tumour, leading to a smaller defect and a superior cosmetic outcome.  The visible part of a skin cancer is very often only the "tip of the iceberg"; so-called thin roots of cancer cells unseen by the naked eye may spread deep and wide and only be visible to examination under a microscope.

What are the advantages of Mohs surgery?

  • By aiming to evaluate 100% of the surgical margin, it provides the highest assurance that all the cancer cells are removed during surgery.
  • The amount of normal tissue loss is minimised and, as a result, the functional and cosmetic outcome can be maximised.
  • The pathology (microscopic evaluation) is performed on the day by your Mohs surgeon, so there is no waiting for results following surgery.
  • It can cure skin cancers where other methods have failed.

Auckland is unique and fortunate to have this type of surgery available in the public health sector.  It is provided by Dr Todd Gunson and Dr Bob Chan.  If your family doctor or another specialist feels Mohs surgery may be best for you, you will be given a consultation appointment.  After assessment at this appointment, you will be allocated to a waiting list for the surgery if it is the most appropriate treatment.

Further information about Mohs surgery provided by Dr Gunson, can be found at www.thedermatologist.co.nz

What should I expect on the day?
The nursing staff will discuss this with you over the telephone prior to your appointment.  You will generally be expected to arrive in the early morning, and should be prepared to spend the majority of the day in the department.  Because a number of cases are performed on the same day, and because of the sometimes unpredictable nature of tracking the tumour microscopically, waiting is an inevitable part of the procedure.  Please bring a book, magazine, knitting, or other activities to keep you amused, as well as a packed lunch and snacks.  Tea, coffee, and water will be provided.  The surgery is all performed under local anaesthetic, and therefore fasting is not required.  Unless specifically told otherwise, have a good breakfast and take all your normal medications on the day of your surgery.

Patch Testing and Contact Dermatitis

The Dermatology Service at Greenlane Clinical Centre provides a patch testing service. Dermatologists apply patch tests to patients with dermatitis to find out whether their condition might be caused or aggravated by a contact allergy. Many substances are able to be patch tested. Nearly every patient has a standard series of patch tests applied to their skin, together with extra tests appropriate to the individual patient. The patch tests are left in place on the skin for generally 2 days, after which they are removed and readings to detect positive reactions are performed. Patch tests do not always explain the cause or find aggravating factors for dermatitis. Patch tests are not the same as skin prick tests. If you are having patch tests, ask your dermatologist to explain the tests. Further information is available on www.dermnetnz.org

The Dermatology Service at Greenlane Clinical Centre provides a patch testing service.  Dermatologists apply patch tests to patients with dermatitis to find out whether their condition might be caused or aggravated by a contact allergy.  Many substances are able to be patch tested.  Nearly every patient has a standard series of patch tests applied to their skin, together with extra tests appropriate to the individual patient.  The patch tests are left in place on the skin for generally 2 days, after which they are removed and readings to detect positive reactions are performed.  Patch tests do not always explain the cause or find aggravating factors for dermatitis.  Patch tests are not the same as skin prick tests.  If you are having patch tests, ask your dermatologist to explain the tests.  Further information is available on www.dermnetnz.org

Wound Care Following a Dermatology Procedure using Local Anaesthetic

It is important to follow the instructions the nurse has discussed with you and read the written information for wound care following skin surgery using local anaesthetic. If you have been instructed to leave all dressing in place, then DO NOT remove any dressings and do not get the dressings wet. You will not be able to bath or shower during this time. Bathing / Showering: Generally, after most skin procedures, you will be going home with a dressing covering the wound in two layers. Adhesive strips (Steri-strips) have been placed on the wound and a pressure dressing as the second layer. Leave all the dressings in place for 48 hours. Do not get the dressing wet during this time. If the nurses have recommended you remove the dressing after 48 hours, carefully remove the second dressing layer. The Steri-strips should stay in place, but sometimes they lift off the skin. This is not a concern. Remove the Steri-strips if they are moist or coated in dry blood. You may now shower or bath as usual. Pat the wound dry with a clean towel. Replace the Steri-strips if necessary after showering as instructed. They cover the stitches and act like a dressing, so you do not need to apply anything else. Keep a bandage on leg wounds and change the dressing if it gets wet. Wounds which are constantly wet tend to become easily infected. Swimming is not permitted. Pain Relief: Local anaesthetic wears off in 2-3 hours. Paracetamol (Panadol) or Panadeine should be suitable for any discomfort. Take 2 tablets at breakfast, lunch, dinner and before bed. Do not take more than 8 tablets in a 24-hour period. Please seek advice from your dermatologist or GP before taking other pain medications, as some may increase the likelihood of bleeding. If you have stopped Aspirin or Warfarin, restart on your doctor's instructions, General Care Instructions: Bruising may occur around the procedure site. Avoid excessive movement or exercise, which will put a strain on the wound. For hand or lower arm surgery keep the area elevated as much as possible. Use the sling if provided. For surgery on the face, keep your head elevated. Avoid bending down or lifting. Sleep with your head elevated on 1 or 2 extra pillows for 48 hours. If your surgery is on the lower leg, it is very important to minimise activity for AT LEAST one week. Activity should be limited to around the house and keep the leg elevated above hip level when sitting. No excessive walking or exercise. Avoid bending and stretching after a lesion is removed from the back. Smoking and Alcohol: Both of these can increase complications after a procedure. Avoid or reduce smoking and drinking alcohol for 10 days after a procedure. If there is any sign of wound infection, for example redness, swelling, discomfort not relieved by regular Panadol or Panadeine, pusy discharge or any other unexpected circumstances, please contact the Dermatology Department at Greenlane Clinical Centre or your GP. If the wound has been stitched the nurse will have informed you to either return to the department or your GP to have the stitches removed.

It is important to follow the instructions the nurse has discussed with you and read the written information for wound care following skin surgery using local anaesthetic. If you have been instructed to leave all dressing in place, then DO NOT remove any dressings and do not get the dressings wet. You will not be able to bath or shower during this time.

Bathing / Showering: Generally, after most skin procedures, you will be going home with a dressing covering the wound in two layers. Adhesive strips (Steri-strips) have been placed on the wound and a pressure dressing as the second layer. Leave all the dressings in place for 48 hours.  Do not get the dressing wet during this time. If the nurses have recommended you remove the dressing after 48 hours, carefully remove the second dressing layer. The Steri-strips should stay in place, but sometimes they lift off the skin. This is not a concern.  Remove the Steri-strips if they are moist or coated in dry blood. You may now shower or bath as usual. Pat the wound dry with a clean towel. Replace the Steri-strips if necessary after showering as instructed. They cover the stitches and act like a dressing, so you do not need to apply anything else. 

Keep a bandage on leg wounds and change the dressing if it gets wet. Wounds which are constantly wet tend to become easily infected. Swimming is not permitted.

Pain Relief: Local anaesthetic wears off in 2-3 hours. Paracetamol (Panadol) or Panadeine should be suitable for any discomfort. Take 2 tablets at breakfast, lunch, dinner and before bed.  Do not take more than 8 tablets in a 24-hour period. Please seek advice from your dermatologist or GP before taking other pain medications, as some may increase the likelihood of bleeding. If you have stopped Aspirin or Warfarin, restart on your doctor's instructions,

General Care Instructions: Bruising may occur around the procedure site. Avoid excessive movement or exercise, which will put a strain on the wound. For hand or lower arm surgery keep the area elevated as much as possible. Use the sling if provided. For surgery on the face, keep your head elevated. Avoid bending down or lifting. Sleep with your head elevated on 1 or 2 extra pillows for 48 hours. If your surgery is on the lower leg, it is very important to minimise activity for AT LEAST one week. Activity should be limited to around the house and keep the leg elevated above hip level when sitting. No excessive walking or exercise. Avoid bending and stretching after a lesion is removed from the back.

Smoking and Alcohol: Both of these can increase complications after a procedure. Avoid or reduce smoking and drinking alcohol for 10 days after a procedure.

If there is any sign of wound infection, for example redness, swelling, discomfort not relieved by regular Panadol or Panadeine, pusy discharge or any other unexpected circumstances, please contact the Dermatology Department at Greenlane Clinical Centre or your GP.

If the wound has been stitched the nurse will have informed you to either return to the department or your GP to have the stitches removed.

Phototherapy Treatment with UVA

Ultraviolet radiation (UV) provided by artificial light has been used with good results for a long time. It is a recognised treatment ordered by a doctor for numerous skin conditions. PUVA stands for Psoralen and Ultraviolet Light, Type A. It involves the combined use of a prescription psoralen medication called Oxsoralen and long wave ultraviolet light (UVA). Oxsoralen is taken two (2) hours before PUVA treatment WITH FOOD. If you feel nauseated after taking Oxsoralen, change to taking half the dose two (2) hours before treatment then the other half 30 minutes later, e.g. take ½ dose at 10am then the other half at 10.30am. An anti-nausea tablet can be prescribed if necessary. Pregnancy must be avoided. Treatments: All treatments are supervised and given in a cabinet you stand up in. The cabinet contains vertical fluorescent bulbs. Men: Unless the genitals are being treated we recommend men protect this area. Use a jock strap, clean sock or something similar during treatment. Eyes: Wear wrap around UVA blocking sunglasses the whole 24 hour day of taking Oxsoralen except when asleep. You also need to wear goggles to protect your eyes while you are in the cabinet. Jewellery: Rings, necklaces and watches must be removed during treatment to prevent sunburn to these areas. Hair: Avoid radical changes of hairstyle while you are being treated to avoid burning. Face: Always apply a 30+ SPF Broad Spectrum sunscreen (unless your face requires treatment) 30 minutes before treatment. Avoid the sun: Do not sunbathe for 24 hours before treatment or 48 hours after treatment. Do not go into direct sunlight and avoid sunlight through glass or on a cloudy day for 8 hours after taking Oxsoralen. Wear appropriate clothing and apply sunscreen. Creams and Ointments: Continue with topical creams and ointments as prescribed. Use plenty of moisturiser often. Treatment: At the beginning of treatment you will be in the cabinet for a short time, about 1-2 minutes. Time in the cabinet will be adjusted gradually and could reach 12-15 minutes. Depending on the doctor’s instructions and how your skin responds, treatment will be twice a week for 6 to 8 weeks. You will have a follow-up clinic appointment with your skin doctor shortly after this last treatment time. Possible side effects: Burning of your skin } Itchy skin } use moisturiser Skin dryness } What will my skin look like after each treatment? Your skin may look mildly red later in the day of treatment. If you have uncomfortable sunburned or itchy skin, tell the phototherapy technician at the next treatment time. The time in the cabinet will be adjusted to avoid this. Appointment times: IMPORTANT. You must always arrive on time for your treatment. The time will be the same for each treatment. There are many people having the same treatment as you each day and they are affected if you are late. If you frequently do not come and do not contact us, your treatment will be stopped.

Ultraviolet radiation (UV) provided by artificial light has been used with good results for a long time. It is a recognised treatment ordered by a doctor for numerous skin conditions.

PUVA stands for Psoralen and Ultraviolet Light, Type A. It involves the combined use of a prescription psoralen medication called Oxsoralen and long wave ultraviolet light (UVA). Oxsoralen is taken two (2) hours before PUVA treatment WITH FOOD. If you feel nauseated after taking Oxsoralen, change to taking half the dose two (2) hours before treatment then the other half 30 minutes later, e.g. take ½ dose at 10am then the other half at 10.30am.  An anti-nausea tablet can be prescribed if necessary.

Pregnancy must be avoided.

Treatments: All treatments are supervised and given in a cabinet you stand up in. The cabinet contains vertical fluorescent bulbs.

Men: Unless the genitals are being treated we recommend men protect this area. Use a jock strap, clean sock or something similar during treatment.

Eyes: Wear wrap around UVA blocking sunglasses the whole 24 hour day of taking Oxsoralen except when asleep. You also need to wear goggles to protect your eyes while you are in the cabinet.

Jewellery: Rings, necklaces and watches must be removed during treatment to prevent sunburn to these areas.

Hair: Avoid radical changes of hairstyle while you are being treated to avoid burning.

Face: Always apply a 30+ SPF Broad Spectrum sunscreen (unless your face requires treatment) 30 minutes before treatment.

Avoid the sun: Do not sunbathe for 24 hours before treatment or 48 hours after treatment. Do not go into direct sunlight and avoid sunlight through glass or on a cloudy day for 8 hours after taking Oxsoralen. Wear appropriate clothing and apply sunscreen.

Creams and Ointments: Continue with topical creams and ointments as prescribed. Use plenty of moisturiser often.

Treatment: At the beginning of treatment you will be in the cabinet for a short time, about 1-2 minutes. Time in the cabinet will be adjusted gradually and could reach 12-15 minutes. Depending on the doctor’s instructions and how your skin responds, treatment will be twice a week for 6 to 8 weeks. You will have a follow-up clinic appointment with your skin doctor shortly after this last treatment time.

Possible side effects:

Burning of your skin  }
Itchy skin                 } use moisturiser
Skin dryness            }

What will my skin look like after each treatment? Your skin may look mildly red later in the day of treatment. If you have uncomfortable sunburned or itchy skin, tell the phototherapy technician at the next treatment time. The time in the cabinet will be adjusted to avoid this.

Appointment times: IMPORTANT. You must always arrive on time for your treatment. The time will be the same for each treatment. There are many people having the same treatment as you each day and they are affected if you are late. If you frequently do not come and do not contact us, your treatment will be stopped.

Phototherapy Treatment with UVB

Ultraviolet radiation (UV) provided by artificial light has been used with good results for a long time. It is a recognised treatment ordered by a doctor for numerous skin conditions. Before beginning phototherapy: A small area of skin will be tested for the smallest amount of UV before it becomes slightly red. This Minimal Erythema Dose (MED) information is used to calculate a starting dose for treatment. You will need to return to clinic 24 hours after testing to measure the results. Do not use any moisturiser or sunblock on the day of MED testing. Treatments: All treatments are supervised and given in a cabinet you stand up in. The cabinet contains vertical fluorescent bulbs. Men: Unless the genitals are being treated we recommend men protect this area. Use a jock strap, clean sock or something similar during treatment. Eyes: You need to wear goggles to protect your eyes while you are in the cabinet. Jewellery: Rings, necklaces and watches must be removed during treatment to prevent sunburn to these areas. Hair: Avoid radical changes of hairstyle while you are being treated to avoid burning. Face: Always apply a 30+ SPF Broad Spectrum sunscreen (unless your face requires treatment) 30 minutes before treatment. Creams and Ointments: Continue with topical creams and ointments as prescribed. Use plenty of moisturiser often. Treatment: At the beginning of treatment you will be in the cabinet for a short time, about 1-2 minutes. Time in the cabinet will be adjusted gradually and could reach 12-15 minutes. Depending on the doctor’s instructions and how your skin responds, treatment will be 2 to 3 times a week for 6 to 8 weeks. You will have a follow-up clinic appointment with your skin doctor shortly after this last treatment time. Possible side effects: Burning of your skin } Itchy skin } use moisturiser Skin dryness } What will my skin look like after each treatment? Your skin may look mildly red later in the day of treatment. If you have uncomfortable sunburned skin, tell the phototherapy technician at the next treatment time. The time in the cabinet will be adjusted to avoid this. Appointment times: IMPORTANT. You must always arrive on time for your treatment. The time will be the same for each treatment. There are many people having the same treatment as you each day and they are affected if you are late. If you frequently do not come and do not contact us, your treatment will be stopped.

Ultraviolet radiation (UV) provided by artificial light has been used with good results for a long time. It is a recognised treatment ordered by a doctor for numerous skin conditions.

Before beginning phototherapy: A small area of skin will be tested for the smallest amount of UV before it becomes slightly red. This Minimal Erythema Dose (MED) information is used to calculate a starting dose for treatment. You will need to return to clinic 24 hours after testing to measure the results. Do not use any moisturiser or sunblock on the day of MED testing.

Treatments: All treatments are supervised and given in a cabinet you stand up in. The cabinet contains vertical fluorescent bulbs.

Men: Unless the genitals are being treated we recommend men protect this area. Use a jock strap, clean sock or something similar during treatment.

Eyes: You need to wear goggles to protect your eyes while you are in the cabinet.

Jewellery: Rings, necklaces and watches must be removed during treatment to prevent sunburn to these areas.

Hair: Avoid radical changes of hairstyle while you are being treated to avoid burning.

Face: Always apply a 30+ SPF Broad Spectrum sunscreen (unless your face requires treatment) 30 minutes before treatment.

Creams and Ointments: Continue with topical creams and ointments as prescribed. Use plenty of moisturiser often.

Treatment: At the beginning of treatment you will be in the cabinet for a short time, about 1-2 minutes. Time in the cabinet will be adjusted gradually and could reach 12-15 minutes. Depending on the doctor’s instructions and how your skin responds, treatment will be 2 to 3 times a week for 6 to 8 weeks. You will have a follow-up clinic appointment with your skin doctor shortly after this last treatment time.

Possible side effects:

Burning of your skin  }
Itchy skin                } use moisturiser
Skin dryness           }

What will my skin look like after each treatment? Your skin may look mildly red later in the day of treatment. If you have uncomfortable sunburned skin, tell the phototherapy technician at the next treatment time. The time in the cabinet will be adjusted to avoid this.

Appointment times: IMPORTANT. You must always arrive on time for your treatment. The time will be the same for each treatment. There are many people having the same treatment as you each day and they are affected if you are late. If you frequently do not come and do not contact us, your treatment will be stopped.

Photodynamic Therapy with Metvix PDT

Click here for information on Photodynamic Therapy with Metvix PDT. PDT using Metvix. Consumer Medicine Information (PDF, 87.2 KB) New Zealand Consumer Medicine Information for Metvix PDT.

Click here for information on Photodynamic Therapy with Metvix PDT.

Contact Details

Greenlane Clinical Centre

Central Auckland

8:00 AM to 5:00 PM.

Outpatient appointments and procedure booking enquiries:
(09) 630 9943 ext 26459
GP Help Desk:
(09) 307 2800

214 Green Lane West
One Tree Hill
Auckland 1051

Information about this location

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Street Address

214 Green Lane West
One Tree Hill
Auckland 1051

Postal Address

Private Bag 92 189
Auckland Mail Centre
Auckland 1142

This page was last updated at 8:33AM on February 12, 2024. This information is reviewed and edited by Dermatology Service | Auckland | Te Toka Tumai | Te Whatu Ora.