Pre- & Post-Care

Wound Care Instructions (With Sutures)

1. Remove current bandage as instructed by provider. Clean gently with soap and water. Use a Q-tip to remove any dried blood from the wound.
2. After cleansing, apply Vaseline, Aquaphor healing ointment, or Cerave healing ointment. ** Avoid Neosporin or Triple antibiotic ointment **
3. Clean the area and re-dress twice a day for 1-2 weeks or until the wound has healed or sutures are removed. If your skin is sensitive, use gauze and paper tape. **If you are experiencing allergic reactions to band-aids or adhesives leave the area open as possible **
4. Please call our office if you see signs of infection such as:
   Increasing redness and swelling beyond the borders of the wound. (some redness around the border is normal) Draining or forming white/yellow pus.
   Increasing tenderness or soreness

*** “Oozing” may occur from the site, especially during the first 24-48 hours. If significant bleeding should occur, hold firm pressure over the wound without moving for 5-7 minutes. If the bleeding does not stop then call the office for further instructions.

*** Usually the site is only mildly tender; however, if you experience discomfort, take Tylenol as directed on the bottle. Avoid aspirin, Naprosyn and ibuprofen as it can cause and increase in bleeding. Applying an ice pack over a wet towel can also help pain.

*** Please contact our office right away if the stitches “pop” or if the wound appears to open. We may be able to re- close the area if it is done in a timely manner. Otherwise medication may need to be prescribed to lower the risk of infection.

Overall Guidelines

• Limit activity to allow healing. It is best to elevate the area above the heart as much as possible to prevent swelling. You may resume exercise 2 weeks after your suture removal.
• You may return to work the next day as long as you are not requiring pain medication and your job doesn’t require strenuous activity
• If you are taking pain medications, we recommend that you take a stool softener to minimize constipation. Do not drive while taking prescription pain medications.

Frequently asked questions:

What should the site look like after surgery?

Often, excision sites appear bumpy. This is expected to remove the tension on the wound and stitches. The appearance will gradually improve as the deep sutures dissolve over the next 2-3 months.

You may notice a tender bump near the excision site weeks to months after the procedure. This is a deep suture resurfacing, known as a “spitting suture.” They can resolve spontaneously, however if redness or tenderness persists for 2-3 days, call our office for evaluation. The suture may need to be removed.

Can I use anything to improve the appearance of the scar?

Two weeks after surgery, you may start using silicone scar gel available over the counter and sold as Serica gel or silicone scar sheets available on amazon or pharmacy to improve the final appearance of the scar. Use the products for 2 months.

Microsoft Word – Wound care without sutures.docx

Wound Care Instructions (Without Sutures)

Used for shave biopsy, shave removal, ED&C, Cryotherapy “Freezing”

1. Remove current bandage as instructed by provider. Clean gently with soap and water.
2. After cleansing, apply Vaseline, Aquaphor healing ointment, or Cerave healing ointment. ** Avoid Neosporin or Triple antibiotic ointment **
3. Clean the area and re-dress once a day for 1-2 weeks or until the wound has healed. If you have sensitive skin, use guaze and paper tape.
4. If you tend to heal slowly the doctor may recommend an Advanced healing band-aid. These are bandages that can be applied to the wound and left on for 2-3 days at a time to aid in the healing process.
5. Please call our office if you see signs of infection such as:
   • Increasing redness and swelling beyond the borders of the wound. (some redness around the border is normal)
   • Draining or forming white/yellow pus.
   • Increasing tenderness or soreness

*** “Oozing” may occur from the site, especially during the first 24-48 hours. If significant bleeding should occur, hold firm pressure over the wound without moving for 5-7 minutes. If the bleeding does not stop then call the office for further instructions.

*** Usually the site is only mildly tender; however, if you experience discomfort, take Tylenol as directed on the bottle. Avoid aspirin as it can cause and increase

Sensitive Skin Handout

• Do not bathe excessively, as this can dry out the skin
• Bathe or shower in warm, not hot water ad limit to no longer than 15 minutes.
• Gentle and fragrance free cleansers should be used. We recommend Free and Clear cleanser, Dove unscented bar soap, Cetaphil or Cerave cleanser.
• Bathe gently. Aggressive scrubbing irritates the skin.
• Pat dry and if instructed, apply a prescription topical while skin is still damp.

Instructions for topical prescription use:

• Apply ____________________twice daily to affected areas. At least once after bathing/showering. Avoid areas of skin such as face, underarms, groin, etc. Use for 2 weeks on the affected areas.
• Apply ____________________twice daily to sensitive skin areas on the face, underarms, groin etc. At least once after bathing. Use for 7-10 days on affected areas.
• Apply a heavy moisturizer or ointment. We recommend Aquaphor, Vanicream cream, Cerave healing ointment, Cerave moisturizing cream or Cetaphil moisturizing cream.
• To avoid further irritation, use fragrance free detergents and avoid fabric softener and dryer sheets. We recommend ALL free or Cheer free products.
• Consider fragrance free shampoos and conditioners. We recommend Free and Clear brands.
  

To Treat Itching

• Do not use alcohol, essential oils or other home remedies
• Use over the counter SARNA lotion or Cerave Anti-itch lotion frequently. Keep them in the refrigerator for a soothing feel.
• Over the counter antihistamines can help reduce itchiness and help with sleep. We recommend Zrytec or Xyzal in the morning and Benadryl at night.
• If instructed, use wet wraps on severe areas to reduce inflammation and irritation.
  • Wet Wrap Instructions: Apply the prescribed steroid cream or ointment to the affected areas and then wrap in warm, damp towels, long cotton pajamas, or gauze and cover with a second, dry layer like sweat pants and shirts. Socks with the foot cut off can serve as sleeves. Leave wet wraps in place for 1-2 hours.

Skin Cancer Prevention Recommendations

Unified Dermatology Skin Cancer Prevention Recommendations Form

Sun Protection

• Avoid the sun between the hours of 10 am – 2 pm
• Wear built in sunscreen clothing and swimwear, wide-brim hats, sunglasses, and thin gloves while driving. Search UPF clothing for retailers.
• Use a daily SPF with 30 or greater with zinc, titanium, or both listed in the ingredients
• If you’re in the sun, apply at least an spf 30 twenty minutes before going outside and reapply every 2 hours or after swimming, toweling off or sweatng.
• Sunscreens can be found in our online store.

Oral Supplements

Heliocare Advanced

Sold in our online store. This product contains Polypodium leucotomos (derived from an Austratioan fern) and nicotinamide. These ingredients are used to reduce the development of skin cancers and precancers by reducing the formation of free radicals. Take 2 capsules daily. In a study performed in 2015 called ONTRAC, nicotinamide reduced the incidence of skin cancer by 23%. The study included people who had a previous skin cancer.

Nicotinamide

This is a non-flushing form of vitamin B3 that was studied in the ONTRAC study resultng in reduction of skin cancer by 23% in patients who had a history of skin cancer. There are no side effects and the dosage is 500 mg twice a day. This can be purchased over the counter.

Reduction of Pre-Cancers

• Topical creams, such as 5-fluorouracil, imiquimod and Klysiri. A prescription is needed

History of Melanoma

• Studies have shown evidence of preventing future occurrences with a daily dose of a vitamin D supplement 1000-2000 IU daily.

Cantherone Post-Operative Care

Canthacur (Cantharidin 0.7%) is a blistering agent used to treat multiple skin diseases, such as warts and molluscum.

These instructions should be followed twice a day until the areas have been healed. If you have questions or concerns, please contact our office at 972-769-8180.

INSTRUCTIONS:

• Wash the Canthacur off the lesion in ____________hours/minutes. If a bandage was applied, you may soak the bandage off with warm, soapy water.
• You may use regular soap and water to gently cleanse the areas. It is very important to completely remove the gray or clear film from the lesions.
• If a painful blister occurs, you may pierce the blister with a straight or safety pin that has been cleansed with alcohol. Be careful not to tear the roof off the blister. Use a clean cotton-tipped applicator and gently express the fluid from the site.
• Apply a thick film of Polysporin, Bacitracin, Vaseline or Aquaphor to the wound. Avoid antibiotics containing neomycin such as Neosporin.
• You can either place a loose-fitting bandage on the area or leave the area open. It is recommended that you place a bandage on areas involving the hands.
• Discomfort can be relieved with Tylenol or Advil if not allergic.
• Do not allow the cantherone to spread or rub onto other areas of your body as every place that cantherone touches will blister. This can occur when you sweat or an untreated area of skin touches a treated area. Be especially careful if the treatment area is in a crease of your skin like the back of the knees or bend of the elbows.
• This method requires several treatments to fully resolve
• This treatment may cause lighter or darker appearance of the skin after healing which may improve with time.

Cryotherapy (Liquid Nitrogen) Wound Care Instructions

• Cryotherapy is used to treat actinic keratoses, warts, other types of lesions and irritated seborrheic keratoses. When treating actinic keratoses, follow up is necessary to monitor for recurrence, as there is the potential for actinic keratoses to turn into a form of skin cancer called Squamous Cell Carcinoma.
• Cryotherapy stings and may be painful during the procedure and for a short time afterward, typically anywhere from a few minutes to 20 minutes after the procedure.
• Immediate swelling of the area may occur. Taking oral aspirin or ibuprofen may relieve the swelling and discomfort.
• The treated area may blister within a few hours. Sometimes the blister is clear but can occasionally be red or purple because of bleeding beneath the surface of the skin. This is normal. Treatment near the eye may result in a puffy eyelid, especially in the morning. Sleeping propped up on two pillows may help.
• If a blister forms and it is painful, you may “pop it” with a clean needle or pin. Do not remove the top of the blister. Apply Vaseline or Polysporin ointment once to twice a day with a band aid, if needed. Avoid picking the lesion.
  If no blister develops within a few days, a “scab” forms and then the treated area will usually “fall off” after about two weeks.
• Usually no special attention is needed during the healing phase. The area may be gently washed with soap and water once to twice a day. A bandage is not necessary but can be applied if the area is rubbed by clothes or becoming irritated.
• Infection is uncommon after this treatment, however, if the area becomes more painful, red, or swollen please call the office.

Final Results

Cryotherapy may result in a white mark or scar in the area. This can be more noticeable if you have a darker skin color. The color change often improves but can be permanent.

Skin lesions may fail to clear and require additional cryotherapy treatments or other procedures. Please keep follow ups as scheduled for evaluation of treatment results. If you were not scheduled for a follow up and the lesion is persisting, please call the office for an appointment.