Midlands Dermatology Omaha Acne in Adult Women

Acne in Adult Women

Though acne is most often seen as affecting teenagers, it is also a scourge for many adult women. Perhaps this is why acne in adult women does not receive adequate attention in dermatology.  It may also be the reason that many women can feel disappointed, embarrassed, and somewhat lost when they do have acne.  We understand this extremely well.

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Dermatology Specialists Mission & Care Philosophy

Dermatology Mission & Care Philosophy

Our doctors have previously written several articles describing what we do to continually improve technically—delivering the highest level of dermatological care. This article discusses ways Advanced Dermatology of the Midlands tries to improve our Mission & Care philosophy & administrative processes—demonstrating our commitment to delivering care in a personalized and compassionate environment.

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Splitting Fingertips (fissures)

Splitting Fingertips (Fissures)

It’s bad enough that it’s frigid outside and the weather is gloomy, but on top of that to have splitting fingertips (Fissures) makes everything that much worse and the winter seem that much longer.  Splitting (fissuring) of the fingertips is a very common problem affecting many of us, most often in the winter months. Splitting fingertips (Fissures) can cause substantial discomfort, particularly frequent pain.  This pain can make it difficult for us to do our normal daily activities. It also seems that those of us who tend to do the most activities with our hands, whether it be work related functions or recreational things, tend to suffer the most from fingertip splitting.Read more

Why We Are in the Field of Dermatology

Why We Are in the Field of Dermatology?

From Seinfeld Episode "The Slicer" (George Costanza and Jerry Seinfeld talking about Jerry's date with the dermatologist):

  • George-"...Saving lives? She's one step away from working at the Clinique counter!"
  • Jerry-"Dermatologist? Skin doesn't need a doctor."
  • George-"Of course not!  Wash it, dry it, move on..."

Despite those naysayers, dermatology is a very important specialty in the field of medicine.  The easiest way to see that is to consider this well-known fact:  the skin is the largest organ in the body!  If washing it then drying it was all that a person had to do, then our jobs would be pretty simple.

Why We Are in the Field of Dermatology?

As dermatologists in Omaha & Council Bluffs, IA, we care for conditions of the

  • skin
  • hair
  • nails
  • as well as providing care and treatments to make the best cosmetic appearance of these structures

One of the things that we most enjoy about this amazing field is being able to care for patients of all ages.  From seeing newborn babies with birthmarks to caring for those of advanced age with skin cancer, we get to care for as many as 3 or even 4 generations in some families!  We feel this is a great privilege, and an amazing perk of what we get to do.


As the skin is such a "visible" organ, problems in it can be readily apparent.  These problems can be something serious, such as a worrisome spot like melanoma skin cancer, or something of cosmetic concern like wrinkles or age spots.  We love what we do at Advanced Dermatology of the Midlands, and our days are filled with getting to work with our patients on the entire spectrum of skin, hair and nail issues. Being able to do all of these things requires intensive, in-depth training, which must be maintained and ongoing to enable us to be the best dermatologists.

What does it take to become a dermatologist or a dermatology physician assistant/dermatology nurse practitioner?

After college, dermatologists must complete 4 years of medical schooling, and at the end of that time apply to dermatology residency.  When we were in our training, we can recall our dermatology mentors telling us that they were happy they had already made it into the discipline of dermatology because from their perspective it was growing more and more competitive to get into a dermatology residency program all the time.  We can now see more than ever how true this is.  As statistics show, there were 31,000 residency positions available in the United States in 2018, across all specialties in the fields of medicine (primary care, OB/GYN, surgery, etc...).  Of all these positions, only 407 were available in dermatology residency programs! Look at it another way, just over 1% of all the available residency positions in the US are actually in dermatology.

After medical school

Dermatologists-to-be will spend 1 year in a general medical training, followed by 3 years of training specifically in all aspects of dermatology.  These aspects include:

  • adult and pediatric dermatology
  • surgical dermatology
  • dermatopathology
  • cosmetic dermatology

All of this training is geared towards the ultimate goal of producing the best dermatologists possible.

Advanced Dermatology of the Midlands Omaha & Council Bluffs

At Advanced Dermatology of the Midlands, our physician assistants and nurse practitioner started off with an intensely focused period of time spent working one-on-one with both of our dermatologists.  This time includes focused teaching sessions, as well as training in clinical, surgical, and cosmetic practice.  Similar to the dermatology residency training programs, our endpoint goal was to cultivate the abilities of the best dermatology advanced practice providers in the region.

In doing what we do, caring for the skin, hair, and nails in the field of dermatology, we get the satisfaction of not only being able to make patients feel better but also look better.  We do get to save and prolong lives by diagnosing and curing skin cancer; we also get to enrich lives by making people feel better about their appearance through things as simple as removing unwanted spots and moles, or as complex as filling lines and relaxing wrinkles.

Again, the skin is the largest organ, and the science and art of dermatology continue to expand at a dramatic rate.  There are so many more treatments and procedures we have to offer now as compared to 5 years ago!  At Advanced Dermatology of the Midlands in Omaha & Council Bluffs, we stay on top of all of these advancements by frequent journal reviews and consistent round table discussions with all of our professional staff.


Despite all of that, the most important thing to us is this one thing—our patients.  At the end of the day, we feel that our patients are the most important one element of our work. Their good outcomes and successes bring us happiness and make us want to continue to improve and work to be the best dermatologists in Omaha and best dermatology advanced practice providers. Above all else, this is why we chose to work in the field of dermatology.

Our goal is to exceed our patients’ expectations while building a reputation as being the top dermatology practice in the Midlands. For any information or to make an appointment please contact us.

Warts Facts & Treatment

Warts Facts & Treatment

Veruca Salt I'm Veruca Salt. It's very nice to meet you, sir.

[does a curtsy] 

Willy Wonka I always thought a verruca was a type of wart you got on the bottom of your foot.


(Source: Imdb)

Despite that humorous reference from Charlie and the Chocolate factory, warts are no laughing matter!  Though they are more common in childhood, they can affect people of any age.  The common wart (aka verruca vulgaris) is a tremendous nuisance and cosmetic concern for millions of people.  Some individuals may be lucky to have just one wart, whereas others may have dozens.  As they grow and multiply, warts can cause numerous symptoms, including itching, pain, and bleeding.  In addition to all those unwanted sensations, they may cause embarrassment and social stigmatization—especially in children.  This can stem from both the appearance of the spots, as well as the concern from others about the potential for their contagious nature.

Warts Facts & Treatment

Let go of your fear and tune in, for there is hope—many options are available for treatment of the common wart.  First, before an overview of those options, there are some important warts facts to understand.

Warts Facts

  • Warts are caused by the human papillomavirus (HPV).  In fact, there are more than 100 types of HPV.  A handful of these can cause the common wart, with specific HPV types preferring certain areas of the body (for example, HPV type 1 is the most common type to cause warts on the feet).
  • The HPV viruses can be contagious to susceptible individuals.  A large subset of people (possibly half the population) are more predisposed to growing warts if they are exposed to the virus.  Kids are more likely than adults to have warts.  Either skin-to-skin contact or contact by inanimate objects can spread the HPV virus.  An example of "inanimate object spread" is picking up the virus by walking barefoot on a floor where someone else that carries the virus has recently walked.
  • They come in all shapes and sizes. Usually they are a flesh-colored scaly/rough bump.  On the face they may appear like a skin tag (this is called a filiform wart). The feet they may also group in clusters (called a mosaic wart).  On the backs of hands and in certain other areas of the skin they may be flat-topped rough bumps (called planar warts, aka flat warts).

Warts Treatment

FORTUNATELY, we have many different treatment options for warts...and it's very important to note that the very reason for that is because not one treatment works with 100% effectiveness or in 100% of cases!  Speaking from experience having treated thousands of warts at our practice, everyone wants them gone YESTERDAY....

Veruca Salt (waiting to enter the Chocolate Factory)  Daddy, I want to go in.

Mr. Salt It's 9:59, sweetheart.

Veruca Salt Make time go faster.

And UNFORTUNATELY, essentially all treatments take time to work, requiring a bit of patience. As we check out a basic overview of what can be done for warts, a simple way to look at these treatments is to break them down into medical options and surgical options.

Surgical Options

Right away, it's worth pointing out that so many patients want to have their (or their children's) warts surgically cut off the skin.  Now there are some surgical options but cutting them off is rarely done and is rarely the best treatment.  This will always leave a scar, and always involves some discomfort.  Two main alternative surgical options are cryosurgery and laser surgery.  Both can also cause some discomfort but are much less likely to scar.


Cryosurgery as you may have guessed involves freezing warts.  This truly is a very old technique, yet in experienced hands can lead to great results in some cases.  At Advanced Dermatology of the Midlands, we utilize liquid nitrogen for freezing warts, in most cases delivering it to the warts with use of a device called a Cryac.  This liquid is supercooled, and with a temperature of -321 degrees Fahrenheit delivers a thermal punch to a wart that can blast it away.

Laser surgery

Laser surgery has come a very long way in dermatology in general in the last few decades, most notably for the treatment of warts.  Formally, the CO2 laser was often used to treat them.  However, this laser is very traumatic to skin, and resulted in long healing times and a high rate of scarring after wart treatment.  Over the last few decades, a different laser known as the pulsed dye laser has gained much more favor for the treatment of warts.  It is less traumatic to the skin tissue, and results in much less pain and more rapid healing after treatments.

Both cryosurgery and laser surgery may require repeat sessions for optimal results.  These treatment sessions are usually spaced at 1-month intervals.  

Medical Options

Don't forget, we have medical options to treat warts as well.  There is one medication taken by mouth that we may prescribe at times for warts.  In children this can be particularly effective if taken for a few months.  Certain prescription applied medications may also be extremely reliable in patients of all ages.

Alternative Options

Finally, in particularly tough cases, there are still some alternative options that may be considered.  At our clinics in both Nebraska and Iowa, our professional provider staff at Advanced Dermatology of the Midlands have extensive knowledge and experience in the diagnosis and management of warts.  We also have the pulsed dye laser available at our Omaha office.  We know warts can be very frustrating and give lots of grief.  Come visit one of our dermatology providers—we work with the best dermatologists in the region and would love to work with you.

(Source: IMDb)

Advanced Dermatology of the Midlands

Our vision is to deliver the highest level of dermatological care, using the most advanced technology and evidenced-based medicine in a personalized and compassionate environment. We are a patient-centered team committed to being the best place to work while also providing the highest quality of dermatology care. Our goal is to exceed our patients’ expectations while building a reputation as being the top dermatology practice in the Midlands. For any information or to make an appointment please contact us.

How to Slow the Aging of Your Skin?

Slow the Aging of Your Skin

It's almost easier to look at this question by looking at the opposite of it—how do you accelerate the aging of your skin? Two major and numerous minor factors can speed this process. Ultraviolet light from the sun, tanning beds, and a few other sources as well as cigarette smoke are the two major factors that can strongly speed the aging process in the skin.

The more minor factors can include various things, such as not maintaining good hydration of the skin through moisturization or exposure to products that dry out the skin.

How to Slow the Aging of Your Skin?

Top dermatologists offer many recommendations and treatments to offset these negative factors that age the skin, to slow or reverse their detrimental effects.

  • Sun Protection

First and foremost, we at Advanced Dermatology of the Midlands feel that sun protection is essential year-round. To protect your skin, seek shade, use sun protective clothing, and use a sunscreen that is broad-spectrum, SPF 30-50 (or higher), and water-resistant. You should apply sunscreen every day to all skin that is not covered by clothing. We specifically recommend two applications, spaced 20 minutes apart before expected sun exposure. The sunscreen should be reapplied every 2 hours.

  • Tanning Bed

Never use a tanning bed. If you want to look tanned, use a sunless tanner.

  • Smoking

If you smoke, stop smoking! Avoid exposure to second hand smoke. The chemicals in smoke are well-known to cause increased wrinkling, yellow discoloration, fine cysts, and other pigment irregularities in the skin.

  • Facial Expressions

Repetitive facial expressions should be avoided. These expressions cause creasing of the skin triggered by the underlying muscles. Repetitive creasing eventually leads to what we refer to as "etched lines" (these are a type of wrinkling in the skin). Perhaps the most avoidable repetitive facial expression is squinting which causes crow's feet next to the eyes. Using sunglasses can help with this problem, and that can help slow the aging process in your skin.

  • Eating

Eating well can also help slow the aging process. A well-balanced diet is beneficial for your skin. The skin needs many different nutrients to have the best health. Research studies suggest that a diet with lots of sugar or other refined carbohydrates can speed aging.

  • Alcohol

If you drink alcohol, do so in moderation. Alcohol is harsh for the skin. It can cause dehydration of the skin, and this in turn may age the skin more rapidly over time.

  • Exercise

Exercise is also good for your skin. Studies suggest that exercise can improve circulation and the immune system. This can help achieve a more youthful appearance in the skin.

  • Cleanse

Cleanse your skin gently. Good skin hygiene is important but remember to be gentle. Harsh scrubbing is damaging to the skin, and this too may age the skin prematurely over time. Use a gentle cleanser, such as Dove or Vanicream soap.  It is a good idea to wash your face twice a day. This removes excess oils and other undesirable environmental chemicals that may be harmful to the skin.

  • Daily moisturizer

Daily moisturizer use on your face is very important. By locking in moisture in the skin, you can achieve a more youthful appearance. Some moisturizers are superior to others. There are different skin types, and your skin type may impact the best choice of moisturizer for you. Try experimenting with different moisturizers to find one that meshes best with your skin. Moreover, there are many prescription and nonprescription products that have been engineered through extensive testing for optimizing the appearance of the skin, protecting the skin, and reversing some of the effects of aging. We at Advanced Dermatology of the Midlands have extensive experience in the rapidly evolving field of anti-aging skin care and can work with you to find the best regimen and products!

Advanced Dermatology of the Midlands

Our vision is to deliver the highest level of dermatological care, using the most advanced technology and evidenced-based medicine in a personalized and compassionate environment. We are a patient-centered team committed to being the best place to work while also providing the highest quality of dermatology care. Our goal is to exceed our patients’ expectations while building a reputation as being the top dermatology practice in the Midlands. For any information or to make an appointment please contact us.

winter dry skin

Winter Dry Skin

James M Shehan, MD FAAD

February 27, 2017

Key Points: The best ways to combat the problem of winter dry skin involve minimizing factors that will further irritate the skin and aggressive use of moisturizers.

  1. First, it is important to limit the length of showers and baths, and avoid using extremely hot water.
  2. Hot tub and/or swimming pool usage in the winter should be limited as well. ° If you use either the hot tub or the swimming pool, it is important to rinse the chlorinated water off immediately.
  3. No matter what, use of moisturizers is critically important. We have found that most patients need to use these twice a day throughout the winter months.

Winter Dry Skin

Dry skin is a troublesome problem, particularly in the Midwest, in the winter months. Dry air in the wintertime, both inside and outside, is a major contributor to this. Also, taking longer and warmer baths and showers in the colder months of the year can further dry out the skin. Particularly as we get older our skin is more susceptible to dryness.


In most cases, those of us suffering from dry skin will have dry, flaking skin in certain areas of the body, most commonly on the back and legs. Most of the time, there are no symptoms. However sometimes the patient may experience itching, which can be quite severe. We have seen numerous patients with this problem over the years, and it seems to be particularly common at the end of the winter or near the spring when we have suffered through all of the months of winter and our skin is maximally dry.


There is good news: in most cases this condition can be easily treated. You may have heard that drinking more water is a solution. This, however, is somewhat of a misconception. The issue is not dehydration throughout the body, but rather dehydration in your skin. As far as the moisturizers go, the heavier the moisturizer, the better it works. Ointments are best, but in most cases are far too greasy and messy to use on a regular basis. For this reason, creams tend to be the most ideal, as lotions are useful but less effective.

In our practice the two moisturizers that we prefer are:

  • Vanicream
  • CeraVe

However there are many other products on the market which can also be beneficial. Even with regular use of moisturizers, it can sometimes take a few weeks for the dryness to subside and the itching to go away.
Perhaps the most important thing to recognize is your skin is susceptible to dryness, and this may worsen in upcoming years. For this reason, regular maintenance use of moisturizers may be of great benefit to you. If you have persistent ongoing issues with dryness and itching, please consider scheduling a visit in our clinic as you may need further evaluation and prescription treatments.

Advanced Dermatology of the Midlands

Our vision is to deliver the highest level of dermatological care, using the most advanced technology and evidenced-based medicine in a personalized and compassionate environment. We are a patient-centered team committed to being the best place to work while also providing the highest quality of dermatology care. Our goal is to exceed our patients’ expectations while building a reputation as being the top dermatology practice in the Midlands. For any information or to make an appointment please contact us.