Question 1

Wound Care After Excision

Accepted Answer

Keep the area clean and dry for 24 hours, covered in a bandage/dressing.
After 24 hours, wash your hands with soap and water for at least 20 seconds. 
Remove the bandage gently. 
Clean your wound. Gently wash the wound and surrounding skin with mild soap and water. It’s important that the soap be mild and fragrance-free, not antibacterial.
Rinse thoroughly. Gently let the water run over the wound for 1 minute. 
Pat the wound and the skin around the wound dry with a clean cloth or paper towel.  Avoid touching the wound with your hands. Even after washing your hands, germs from your hands could end up on your wound.
Using petroleum jelly that comes in a squeeze tube, squeeze out enough to cover your wound. Gently apply the petroleum jelly to the wound. This will keep the wound moist. A moist wound heals faster and avoids a scab.
Cover the wound with an adhesive bandage or sterile gauze and paper tape. 
Repeat the above steps every day for as long as your dermatologist recommends.

Question 2

Wound Care After Biopsy

Accepted Answer

Wash your hands with soap and water for at least 20 seconds. 
Remove the bandage gently. 
Clean your wound. Gently wash the wound and surrounding skin with mild soap and water. It’s important that the soap be mild and fragrance-free, not antibacterial.
Rinse thoroughly. Gently let the water run over the wound. You want to thoroughly rinse. 
Pat the wound and the skin around the wound dry with a clean cloth or paper towel.  Avoid touching the wound with your hands. Even after washing your hands, germs from your hands could end up on your wound.
Using petroleum jelly that comes in a squeeze tube, squeeze out enough to cover your wound. Gently apply the petroleum jelly to the wound. This will keep the wound moist. A moist wound heals faster and avoid a scab.
Cover the wound with an adhesive bandage or sterile gauze and paper tape. 
Repeat the above steps every day for as long as your dermatologist recommends. Most wounds from a skin biopsy heal in 7 to 10 days. Some spots take considerably longer.

Question 3

Bleeding

Accepted Answer

Apply firm and steady pressure for 20 minutes, using a sterile gauze pad. Keep applying the pressure for 20 minutes continuously. Don’t stop to check.
If the wound is still bleeding after 20 minutes, call your dermatologist’s office.

Question 4

Pain

Accepted Answer

You may have some discomfort after a skin biopsy.
If you’re in pain, you can take acetaminophen.
Place an ice pack over the bandage which can help relieve swelling/discomfort.
If the pain worsens, call your dermatologist’s office.

Question 5

Infection

Accepted Answer

Worsening pain, increased swelling, warmth, drainage with pus, yellow or golden crusts, or fever are signs of an infection. If you develop any of these, call right away.

Question 6

After your wound heals...

Accepted Answer

After your wound heals, think sun protection. If you have questions after reading this sheet, please call us at 802-864-9522. Thank you for entrusting us with your care. It is our honor to serve you.

Question 7

How to treat...

Accepted Answer

Treating acne during pregnancy can be very safe for both mama and baby when it is done with knowledge and dutiful care. Mamas deserve our best at every point in the long journey to the puerperium. First step is arming ourselves with the best information, based on evidence. And why do we treat acne? We do it to reduce the inflammatory burden, to reduce the risk of permanent scarring and to improve quality of life, among other reasons. 
The Journal of the American Academy of Dermatology recently published a paper (Jan 2024) reviewing the safety of medications in this special time of life.

Question 8

Here’s what the authors had to say about our acne therapeutics:

Accepted Answer

Topicals like clindamycin, metronidazole, glycolic acid and azelaic acid are safe when used appropriately in localized areas (eg twice daily to the face). Benzoyl peroxide has historically been considered one of our safe drugs for decades! However the FDA is re-evaluating it as of 3/24, due to concerns about heating some versions of it. When heated to over 120 degrees Fahrenheit, some versions of it released benzene, which is toxic. This is unlikely to be true for all versions, but we don’t have all the data yet. If you do use benzoyl peroxide, store it in a cool place and don’t let the container get to hot. For instance don’t leave it in the sun or on top of an appliance that gets too hot.
Topical (and oral) dapsone should not be used in most circumstances due to concern for hemolytic anemia.
Topical retinoids should be avoided. Oral retinoids are contraindicated and should never be used in pregnancy due to mutagenic properties. Topical tazarotene is contraindicated. Larger studies have not shown considerable risk with topical tretinoin or topical adapalene, but case reports remain of potential concern. There will be much more information available for these widely used topical medications, but for now, avoid use in pregnancy.
Beta lactam antibiotics (e.g. amoxicillin, penicillin) can be used as well as many cephalosporins. 
Macrolides like azithromycin and erythromycin (except for estolate for which there is data on liver toxicity) are often considered safe and used.
Tetracyclines should be avoided due to staining of permanent teeth, irreversible. They are contraindicated in second and third trimesters. Trimethoprim -Sulfamethoxazole should be avoided in third trimester of pregnancy.
Selenium sulfide topically should be avoided due to risk of selenium toxicity. 
Topical salicylic acid can be used in percentages less than 2% and less than 20 grams per week.
Topical clascoterone should be avoided as there is a lack of clinical data in pregnancy. Generally, spironolactone should be avoided due to animal data risk and potential hormonal impact on a male fetus though there is limited human data.
As more info comes up, I’ll be sharing. The goal is improve outcomes through education, and take care of mama, which also means taking care of baby.

Question 9

Where to Focus (WTF)

Accepted Answer

Acne can be safely treated in pregnancy. Ask your provider about the safest options available, and bring this list if you need.
If you don’t have a provider, consider only using topical products known to be safe and available over the counter. There are several products in this category such as azelaic acid. Routine is key.
Use a gentle cleanser once to twice daily, and pat lesions dry. Avoid scrubbing or picking to limit scars. You may need a light moisturizer and know that acne sometimes looks worse before better.

FAQ

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