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ADVANCED DERMATOLOGY IN MUNICH

welcome to the
private dermatology practice
of
Claudia Graefe, M.D.

graefe_portraet_03

CLAUDIA GRAEFE, M.D.
dermatology / allergology / aesthetics

MORE THAN 20 YEARS OF EXPERIENCE

After completing medical studies I began my residency for becoming a medical specialist in dermatology and allergology at Klinikum Biederstein of Technische Universität Munich and at the practice of Prof. Luderschmidt, M.D. During that time I have gained valuable experience in my field of expertise.

As of 2003 I have opened up a private practice for dermatology and allergology in the city center of Munich. Together with my colleague Prof. Gress, M.D., a plastic surgeon, we pursue a holistic therapeutic concept.

I understand my activities in the field of medicine as a firm commitment to my patients’ needs and wishes. Your satisfaction and well-being are the top priority of my actions. I have had over 20 years of experience as a dermatologist, which allows me to tend to the individual needs of my patients in a very sophisticated manner using a patient-centered approach. In my private practice I offer the best possible medical care and aesthetic treatment as well as flexible appointments.

I look forward to seeing you at your next visit.

Yours sincerely,
Claudia Graefe, M.D.

CURRICULUM VITAE

Professional experience

2003 – present Private Practice: Dermatology / Allergology / Aesthetics, Munich, Germany

1999-2001 Dermatology practice Schmitz / Kaliebe, M.D.

1999 German board certification dermatology and allergology

1996-1999 Residency, Department of Dermatology, Technische Universität Munich, Germany, Professor J. Ring, M.D. (head of department)

1992-1993
Residency, Department of Internal Medicine, Rotkreuzkrankenhaus Munich, Germany, Professor Th. v. Arnim (head of department)

1989-1996 Residency, Dermatology practice Professor Luderschmidt, Munich, Germany


Education

1999 Medical license

1982-1988 Study of Medicine at the Faculty of Medicine, Ludwig Maximilians University, Munich, Germany

1982 Study of Physics at the Faculty of Physics, Ludwig Maximilians University, Munich, Germany

1980 Abitur (equivalent to A-levels)

Claudia Graefe, M.D.
Medical specialist for dermatology and allergology

PRIVATE PRACTICE

For Appointments Call +49 89 18 93 25 85

The private medical orientation of my practice allows me to take a highly individual approach to the needs of my patients and provide them with optimal medical care. Obviously you will receive a personal consultation and an individual treatment plan. Along with a flexible appointment schedule this forms the basic concept of a patient-centered treatment approach.

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My private practice is located in the elegant shopping mall “Fünf Höfe” in the city center of Munich. The treatment rooms have been designed to meet the highest aesthetic and technical requirements to create a special atmosphere for your visit. Our operating theatre, where our outpatient dermatologic and aesthetic procedures are performed, is equipped to the highest technical standards. In addition, I have different laser devices with which I can specifically extend the range of medical skin care in my practice.

On this website I will give you an overview of the treatment options and explain some of the more popular procedures.

Claudia Graefe, M.D.

dermatology

Trigger
The field of dermatology includes a wide range of diagnostics, treatments and prevention of various skin conditions. Below is a listing of our medical treatment options:

  • Birthmarks (preventive check-ups) – Imaging and computer based method
  • Surgical removal of benign and malignant skin lesions
  • Established treatment method for removing actinic keratoses with laser and / or photodynamic therapy and / or local therapy with immunomodulators
  • Laser surgery of vascular and skin color changes (warts, hemangiomas)
  • Treatment of scars of all kinds
  • Diagnosis and treatment of fungal infections (mycoses)
  • Therapy of acute and chronic skin diseases

Rosacea

Often mistakenly referred to as “senile acne”, rosacea mainly affects women with a fair complexion and usually becomes more visible with age. Rosacea is different from acne mainly by the absence of comedones and is often limited to the central facial area, but can also affect the whole face. Mostly areas around the cheeks and nose are affected of a widespread erythema, however, rosacea can also spread to the forehead and chin. The persistent redness of the face is caused by enlarged small blood vessels, called telangiectasias. There are various factors that promote rosacea and cause so-called flush symptoms. These include in particular UV light, hot drinks, spicy foods, alcohol, stress, hormonal influences and sudden temperature changes (e.g. sauna). Therapy is aimed at the clinical appearance and stage of the disease. In men, the disease can progress to a bulbous nose, the so-called “rhinophyma”, which can be surgically resected or treated with laser therapy.

Prevention

One of the most important goals of dermatology is prevention. I reserve a lot of time for each patient’s scheduled appointment. To me the term “prevention” means early detection of all skin diseases that are visible to the naked eye. A special focus will be on early detection of melanoma. Each year, in Germany alone more than 20,000 people are diagnosed with melanoma. This is, in contrast to the non-melanoma skin cancer, due to a degeneration of pigment cells, where the “black” color comes from. However, a melanoma is not necessarily completely black. Also spots with various light and reddish brown zones are suspicious. They are often pigmented and checkered, show no boundaries and no more symmetry. Caution should be exercised in newly formed spots. Genetic factors, but especially long-term exposure to UV light is suspected to be the cause of malignancies. Also the number of moles (melanocytic nevi) increases the risk of developing a melanoma. A simple screening method can detect most of the new cases at an early stage and so avert an unfavorable course. From the age of 35 on, a biennial screening is recommended. In addition to that, you also have the opportunity to attend annual or biannual screenings and participate in our internal recall system to detect even small skin changes as early as possible. During your screening the entire body is scanned for suspicious moles and lesions. In my practice I use an imaging, computer-based method for cataloging your moles and to assess the progress for years to come. Optionally, suspicious moles can be removed surgically in our operating theatre. A subsequent histological examination is performed in an external laboratory.

In my private practice, you also have the opportunity to attend an annual or biannual screenings to detect even small skin changes as early as possible. If you want, you can also participate in our internal recall system and be automatically reminded of your next screening appointment. Please consult our receptionists on your next visit.

For the treatment of pigmented birthmarks or suspicious skin lesions laser methods are permitted and considered malpractice. The evaluation of pigmented birthmarks and skin changes necessarily belongs in the hands of a specialist in dermatology. Despite many years of experience I partake in training with a subsequent exam every year.

Acne

Acne refers to a disease that primarily affects boys and girls during puberty, which in severe cases persists in adults. It is a multifactorial process in which a combination of the following factors plays a major role: there is follicular keratinization and an increased sebum production by the influence of male sex hormones (so-called androgens). A secondary bacterial infection with the bacterium Propionibacterium acnes all adds up to an inflammatory reaction of the skin.

In acne vulgaris there are three major varieties:

Acne comedonica: located in the central facial area there are open (black) and closed (white) comedones.

Acne papulopustulosa: also located in the central facial area, in this form of acne pustules and papules can be found on the skin of the back or around the neckline.

Acne conglobata: refers to a severe form of acne with deep inflammatory nodes both on the face, chest and back. Especially often young men are affected.

A special form of acne in this case represents the acne inversa, which presents with frequent deep nodes and abscesses in the area of the armpits and groin, but also in the genital area and below the chest. It is extremely difficult to treat and in some cases requires an assessment of the hormonal status and a surgical intervention.

The treatment of acne vulgaris generally includes cosmetic treatment with scrubs; drug treatment depends on the severity of the inflammation. Frequently a combination of antibacterial creams and low-dose antibiotics is useful to reduce bacterial colonization as cause of the inflammatory response. In the further course, the use of vitamin A acid preparations are discussed in men; the use of hormones in women can be useful. I will gladly inform you of risks and benefits of each of the therapy options at your next appointment.

Mycosis (fungal infections)

Mycoses are very common in the field of dermatology and primarily have nothing to do with poor hygiene. Profuse sweating and oily skin, but also visiting public swimming pools, saunas and showers represent risk factors for fungal disease. In the following I will give a brief overview of the most common fungal infections.


Onychomycosis (nail fungus)

Nail fungus, or scientifically known as onychomycosis, is a common diease in dermatology. It affects about 15% of all people in Germany and is very persistent and therefore requires a good patient compliance with the therapy. In three-quarters of all cases, the toenails are affected. The fungus often grows from the front edge of the nail under the nail plate. This leads to an increased keratinization of the nail bed and later to a thickening and yellowish discoloration of the nail. In the further course of infection the nail may also detach completely. First signs may consist of a yellowish, whitish or brown discoloration in the periphery of the nail. Also reduced shininess and transparency of the nail can be the first indication of a fungal infection. Common sources of infection are swimming pools, public showers and changing rooms.

The main therapeutic measures are consistent hygiene and avoiding moisture in footwear. Application of an antifungal nail polish on the affected nail is recommended. In severe cases a systemic drug therapy should be considered individually.


Tinea pedis (athlete’s foot)

Athlete’s foot is the most common fungal disease in dermatology. Above all, it can be found on the soles and between the toes, easily recognized by a localized redness and scaling of skin. Often the athlete’s foot is also accompanied by an itching sensation, through which it is noticed initially. Sources of infection represent pools, public showers and changing rooms. The main therapeutic measures are consistent hygiene and the avoiding moisture in footwear. In addition, an antifungal cream or in severe cases, systemic drug therapy should be considered.


Tinea versicolor (skin fungus)

This is a very common, harmless disease that is caused by yeast-like fungus. The infection mainly results in hypo- or hyperpigmentation of the affected area of skin, causing a more cosmetic problem. Small, round oval patches with a slight, subtle and dull scaling can be seen on the skin. Risk factors are oily skin or profuse sweating and should be treated or avoided. For treatment an antifungal cream and shampoo should be considered, since the scalp should always be treated as well.


Tinea corporis (ringworm)

Ringworm is also a common fungal infection that is caused by dermatophytes, especially tinea rubrum and T. mentagrophytes. Certain professional groups are affected more often as the average population, e.g. farmers, as they have frequent contact to animals. Other sources of infection are pets and the increasing use of gyms. The disease is indeed harmless, but often very persistent and requires systemic drug therapy.


Tinea capitis (head fungus)

Frequently this disease of the head, scalp and hair affects children; rarely can it be seen in adults. The strength and severity of symptoms depends strongly on the characteristics of the pathogen. There may be an acute, severe inflammatory reaction in the hair follicle with pustules, abscesses or even fistulas. The disease is often associated with hair loss, which may persist under certain circumstances. Treatment is always systemic due to the severity of the infection.

Condylomata acuminata (genital warts)

Genital warts are an infectious disease that can be transmitted primarily through sexual intercourse (STI). The most important pathogen is the human papillomavirus (HPV), especially HPV-6 and -11. Since 2006 there is a vaccination for young girls not only to the high-risk HPV strains 16 and 18, causative for the development of cervical cancer, but also the types 6 and 11 are included. Genital warts can affect both women and men and occur mainly in the anal or genital area, sometimes in the mouth and throat. Therapeutic measurements include surgical or laser-guided techniques of removal.

Claudia Graefe, M.D.

Allergology

Trigger

Allergology is concerned with the formation, expression, course and most of all the treatment of allergies and allergic conditions. In my practice, I offer the following procedures::

  • Diagnosis of all kinds of allergies
  • Skin prick test
  • Patch test
  • Eczema therapy (eczema, psoriasis, contact allergies)
  • Immunotherapy – allergy shots

Skin prick test

The skin prick test is a diagnostic method for the quantitative detection of allergies (immediate response). It can be applied as droplets to the skin of the forearm using standardized allergen solutions as well as a positive and a negative sample. Then the allergen solution is carefully brought into the top layer of the skin with a small needle. After 20 minutes, the test is compared to the controls for evaluation. During the test, reddening of the skin and an itching sensation may occur.

Patch test

The patch test is defined as a method for detecting type IV allergies. Unlike with the skin prick test standardized allergens are applied only to the outer skin. The test area is then covered with a special plaster. The evaluation is carried out after 48, 72 and 96 hours to assess a possible eczema.

Immunotherapy – allergy shots

If you have an allergy affecting your everyday life, we should talk about this precedure. Immunotherapy – commonly referred to as allergy shots – is the only causally effective therapy in the treatment of allergies. Our body is exposed to a variety of allergy-causing substances, so-called allergens on a daily basis to which it reacts with the formation of immunoglobulins (IgG). The detection of immunoglobulin G in the blood alone does not confirm an allergy, but only states that we have at least once been exposed to a substance and the immune system replied by forming IgG molecules. With allergies the situation is similar, only that an IgE antibody in addition to the IgG immunoglobulins formed. These bring about cellular mechanisms releasing mediators, which cause the unpleasant symptoms of allergies. The best example is allergic rhinitis, better known as hay fever.

During immunotherapy the body is repeatedly exposed in certain intervals to initially low doses of allergens to which you have responded positively in the prick test. These allergens are administered mostly by injection into the shoulder muscle. Then you have to stay for about half an hour in the practice to monitor you for an allergic reaction. On these days, you should be healthy and not exercising. Immunotherapy takes place over a period of three years, each session scheduled in the allergy-free time of the year.

Claudia Graefe, M.D.

aesthetics

Trigger
A conscious use of resources and a detailed consultation in which the individual wishes and expectations of the patient are to be considered is a prerequisite for the successful and satisfactory treatment. In my practice I offer the following procedures for patients:

  • Chemical peels with salicylic acid, fruit acid treatments and LHA
  • Sclerotherapy of spider veins


Laser therapy

  • Removal of pigmented spots on the face and body
  • Gentle removal of veins on face and décolleté
  • Fractional photothermolysis for tightening the skin (face, neck) and treatment of scars
  • Removal of wrinkles with depth effect on the connective tissue


Treatment of wrinkles

In the treatment of wrinkles, I attribute great importance to a detailed consultation to find out about the wishes and ideas of my patients. When remodeling wrinkles in the face, careful and thoughtful use of the available resources in accordance with the patient’s individual wishes has utmost priority. Only thus natural and aesthetic results can be achieved.

  • Botulinumtoxin (“Botox”)
  • Hyaluronsäure
  • Mesotherapie

Chemical peels with salicylic acid, fruit acid treatments and LHA

Sclerotherapy

Spider vein sclerotherapy is an accepted and well-established procedure for minimally invasive outpatient removal of spider veins. With a fine needle, a sclerosing agent is injected into the spider veins. This leads via deliberate microthrombosis to connective tissue remodeling of the vessel (sclerosis). The vessel is no longer visible from the outside and a beautiful, aesthetic leg as target of spider vein sclerotherapy is achieved. Mostly several sessions are necessary for the spider veins to disappear completely.

Hyaluronic acid

Hyaluronic acid is an endogenous substance belonging to the group of glycosaminoglycans, which are the main component of connective tissue and are primarily responsible for its elasticity. Many wrinkles, especially in the area of the lower jaw or the upper lip are caused by age-related stress and dehydration of the skin. Hyaluronic acid stimulates not only the new formation of connective tissue, but effectively binds water, which gives your skin a new elastic force. Even larger wrinkles and scars may be treated with hyaluronic acid.

The procedure is carried out by applying a pain relieving ointment containing lidocaine prior to injection into the skin. So-called “fanning” denotes a technique with a blunt needle, through which hyaluronic acid can be applied to a wide area in the tissue, for example the cheeks. With a sharp needle smaller and larger wrinkles can be replenished purposefully. This technique is particularly well suited for the glabella. Frequently glabellar frown lines remain – albeit weakened – after treatment with botulinum toxin. This is not because of treatment failure, but results from deep tissue fractures that have already taken place. Using hyaluronic acid, these fractures are replenished and the connective tissue is stimulated to new growth. After treatment, there may be local redness and swelling, rarely a slight bruise can occur. However, these symptoms usually disappear within a few days.

Tear trough filler treatment

Have you frequently heard people saying “You look tired”? Often dark circles under your eyes are the first signs of fatigue. But they can also occur with age or be hereditary. With age there is a decrease of subcutaneous fat, in particular under the eyes, which causes a relative hypovolemia and may form “dark circles”. As a result, puffiness can also be caused by a relaxation of the lower eyelid muscle, letting them emerge or look even bigger than they obviously are. Through tear trough filler treatment with hyaluronic acid this relative volume depletion can be compensated and thus your eye bags appear visually mitigated. I use specially developed, high-quality hyaluronic acid, which has a low swelling potential. However injections with hyaluronic acid is no causal treatment of eye bags. This procedure gives patients an obviously fresher look and brings a new shine to the eyes. A visual effect can already be seen immediately after treatment and usually lasts up to 12 months. Optionally, a second session is necessary.

After the treatment, there may be bruising in the area of the tear trough that will have disappeared in a maximum of 14 days.

Botulinum toxin (“botox”)

Probably the most widely used product in aesthetic dermatology is botulinum toxin. Long known as a potent muscle relaxant, it has a large scope of application such as in the treatment of wrinkles caused by muscular hyperactivity or also for treatment of excessive sweating (hyperhidrosis). Botulinum toxin has been an approved drug for many years and is widely used beyond the boundaries of aesthetics and dermatology. In neurology it has been used for decades, for example, to relieve muscle spasms. Contrary to frequent voices in the tabloids, etc. it is one of the most actively studied substances in the world. Properly applied, it is a very safe drug. After local application of a pain-relieving ointment containing lidocaine, botulinum toxin is applied with extremely fine needles directly into the muscle. In many people, the prominent pronounced frown lines are a result of excessive muscle activity in the forehead muscles or can also arise from habit. The application of botulinum toxin here is ideal because it not only lowers the tone of the overactive muscles, but also leads to a slight shrinking of the muscle, a so-called “hypotrophy”. Immediately after application there may occur a slight reddening and swelling at the injection sites, which disappears within one or two days in most cases. The duration of action of botulinum toxin varies individually, but usually lasts about 4 to 6 months. In general, the treatments become less frequent with the number of sessions.

Mesotherapy

Mesotherapy is a technology developed by the French doctor Michel Pistor and a complementary medical approach to skin tightening and regeneration as well as for the treatment of hair loss and cellulite, which has been used successfully for over 50 years. Here a special drug mixture is inserted into the skin using very small needles (microneedling) or injected into the middle (meso) layer of the skin. Microcirculation is improved and thus the nutrient supply in the dermis, which in addition leads to regeneration and firming of the skin. Mesotherapy can also be used for wrinkle therapy and as anti-aging treatment. Cosmetic products often do not penetrate deep enough into the skin. With the help of mesotherapy, however, the substances can have their full effect directly at the target site in the deep tissue. Due to application of a local anesthetic (Emla®) the treatment is usually not painful. Afterwards local redness and individual small bruises can occur, but subside within a short period of time.

Anti-Aging

Take action before it’s too late! This procedure aims at all women over 30 who want to prevent skin aging.

The notion of “anti-aging” in its proper sense derives from prevention, i.e. to actively prevent aging. Over time, your skin loses elasticity and moisture, which can be genetic on one hand, but on the other hand, is also related to the exposure to sunlight. The collagenous connective tissue loses its firmness and the dwindling subcutaneous fat gives the appearance of sunken skin. With the help of mesotherapy not only pre-existing damage to the skin, but also the aging process can be mitigated. A revitalizing anti-aging cocktail of growth factors, moisturizing hyaluronic acid and antioxidants is brought into the skin via microneedling. There, the growth factors lead to cell regeneration and proliferation of new connective tissue, which tightens the skin and makes you look younger and fresher simultaneously. Hyaluronic acid on the other hand provides your skin with the necessary moisture and thus provides new radiance. This process is supported by the use of antioxidants and vitamins that slow down and mitigate the aging process of your skin. The procedure includes multiple sessions, which are individually scheduled with you. A visible effect can already be seen after a few weeks.

Lipolysis

Lipolysis is a part of mesotherapy. Surgical removal of stubborn fat deposits through liposuction is not always necessary, and often associated with a long recovery period. A worthwhile alternative to this provides the injectable lipolysis. It is made of ingredients containing phosphatidylcholine and deoxycholic acid and is administered by injection into the treatment areas. Particularly suitable for therapy are stomach and thighs. The cause of these stubborn fat deposits, which you often can’t get rid off by exercise, is the body’s inability to break down the fatty acids in the fat cells of the adipose tissue. The fatty acids are virtually trapped in the fat cells. Due to the ingredients of the injectable lipolysis, there is a so-called “emulsification” of fatty acids, which can be freed from the fat cell and better transferred to the metabolism, where they are degraded. To see a marked effect, several sessions are usually required. A cream containing an anesthetic is applied locally to the treatment area. Thus, the injection should not be painful.

Hair loss

Hair loss (androgenetic alopecia) is a common problem not only in men but also in women. Mesotherapy is used to treat diffuse and androgenetic alopecia extremely effective. An active ingredient mixture of copper peptides, coenzyme Q10, hyaluronic acid and vegetable stem cell activators is injected via microneedling into the scalp. Androgenetic alopecia is caused by an overproduction of testosterone in the hair follicles. Testosterone is converted to its biologically highly active form, dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase (5-AR). This phenomenon affects men as well as women in menopause. Copper peptides inhibit the activity of 5-AR and thus lead to reduced hair loss.
The vegetable stem cell activators are obtained from extracts of green pea and promote hair growth. This unique effect is additionally supported by the moisturizing properties of hyaluronic acid.

Coenzyme Q10 in addition to microneedling promotes blood circulation in the scalp and supports hair growth.

Of course, each patient receives his personal microneedling roller at the beginning of the treatment, which can be used in any other session. Several sessions are recommended in order to achieve a visible effect.

Upper arms / Cellulite

Mesotherapy can also be used as a form of anti-aging for skin firming to treat the upper arms or cellulite. A special ingredient mixture mitigates the effects of cellulites; stimulation of blood circulation and firming the skin is introduced via microneedling or injection into the treatment area. The ingredients L-carnitine and caffeine initiate the breakdown of fatty acids, the so-called “lipolysis”. In addition, caffeine and other herbal ingredients act as a strong local diuretic, because cellulite is often due to water retention. In contrast organic silicium stimulates the formation of new collagen in the deep tissue and thereby leads to an additional tightening of the skin

Chemical peels

In aesthetic dermatology skin peels of fruit acids (glycolic acid / salicylic acid) are mainly used. These are always freshly prepared and depend individually on the skin type. During treatment you do not need to cut back on your daily activities. A peel is easily performed even during your lunch break. After thoroughly cleansing the face, the fruit acid peel is applied for several minutes. Even after this short time you experience an immediate effect. By removing old layers of skin, the formation of new cells is stimulated. Finally, after multiple treatments, there is a visibly refined complexion and a more youthful appearance.

After exfoliating the skin should be treated with a moisturizing cream and protected from sunlight. Concomitant use of vitamin A preparations is not recommended and should be discussed individually. A slight redness and burning may occur at short notice during and after the treatment, but disappears after a short period of time. Usually several sessions are recommended at weekly intervals, to achieve an optimal result.

Polylactic acid (décolleté)

Polylactic acid is excellent for tightening wrinkled skin especially in the area of the décolleté. With age, our skin loses its elasticity. On one hand this is due to slackening of tissue, on the other, decreasing subcutaneous fat is a major cofactor. This predisposition is partly genetic, but is also related to intensive sunlight exposure. Especially the female neckline is one of the known body surfaces that are often exposed to sunlight, which causes the skin to age faster and wrinkle earlier. The reason for this loss of elasticity is age and with time a decrease in tissue collagen fibers, which form the connective tissue. Through their ability to store water, they tighten the skin. With polylactic acid the formation of new collagen fibers is stimulated and so the newly formed connective tissue can help to retrieve lost volume. Polylactic acid is applied by means of injection with a very fine needle. A pain-relieving gel is applied to the treatment area 30 minutes prior to injection.

For full effect one to four sessions are required, which take place at intervals of 4-6 weeks. Results cannot be seen immediately; please allow up to six weeks for visible improvement. After treatment, the areas should be cooled and a moisturizing cream should be applied several times a day. Direct sunlight must be avoided.

Nu Skin® – Anti Aging of the stars

Nu Skin® galvanic is an innovative device used for the treatment of wrinkles, which works with a galvanic current. During the session blood circulation is stimulated and anti-aging ingredients are brought into the skin. Eye shadows and blemishes disappear and your skin will look visibly more rested and radiant.

The treatment is carried out in two phases with a self-regulated direct current. In phase one, the device and the cleansing agent are negatively charged. Since same charges repel each other, the cleansing agent is brought into the skin where it binds dirt particles. During the second phase, the device is now positively charged and an also positively charged anti-aging gel is applied to the skin. So this time the anti-aging gel is brought into the tissue, while the negatively charged dirt particles of phase one are withdrawn from the skin. You will feel merely a slight tingling sensation.

The treatment is not painful and should be repeated over a period of 4-5 weeks in sessions twice a week.

TREATMENTS

An individual consultation is of highest priority to me for assessing my patients’ needs. Only an involved patient can make a decision for therapy with a good and confident feeling. Therefore, I will elaborate on some of the more popular procedures. Please do not hesitate to ask me about them at your next scheduled appointment.

PHOTODYNAMIC THERAPY

Photodynamic therapy (PDT) has been an established treatment method for over 15 years in effectively dealing with precursors of non-melanoma skin cancer (actinic keratoses) and superficial basal cell carcinoma with light in combination with a photosensitizer.

The PDT is particularly well suited for the treatment of actinic keratoses, which are a frequent precancerous condition of squamous cell carcinoma (SCC). This is mainly caused by chronic UV light damage to the skin and is the most important risk factor for squamous cell carcinoma. In contrast to surgical excision, photodynamic therapy provides the advantage of being less invasive and causing less damage to the skin.

In the first session excess tissue is removed and the affected skin areas are perforated by using a fractional laser to improve uptake of the photosensitizer. After that a cream or gel, the so-called “photosensitizer” will be applied for 3 hours. The photosensitizing cream penetrates the skin cells, making them more sensitive to the subsequent 8-minute irradiation with cold red light. If at all, a second treatment is required after several weeks to months.

PDT is not suitable for the treatment of malignant melanoma.

LASER THERAPY

Of course all of the listed treatments I carry out myself. As a dermatologist I am not to delegate invasive methods, especially not in aesthetics. Only trained specialists should perform the treatment of skin lesions with lasers.

Laser methods are not suitable for the treatment of pigmented birthmarks (moles) or skin lesions suspicious of malignancy.


Erbium laser

Unwelcome skin color changes, warts and scars can be treated with the erbium laser. The laser works with little to no scarring at all. Therefore this method is particularly suitable for face, neck and hands, but also any other part of the body. On one hand, using lasers is a very gentle process by ablating only superficial layers of skin; on the other hand, there is also depth effect on the connective tissue. There, a new formation of collagen is stimulated, resulting in skin tightening and thus a more youthful appearance of the skin. The tissue penetration of the laser beam influences medium deep wrinkles particularly well. Another advantage of the erbium laser therapy is the relatively short healing period compared to other laser systems. Also, there is less reddening than with other laser methods.

Laser treatment of veins in the face (telangiectasias) or hemangiomas is carried out with the KTP laser (ND YAG laser), which has already proven itself very effective in countless procedures.


KTP laser (ND YAG Laser)

For many years the KTP laser has proven to be an excellent and safe method. Due to its low penetration depth it is particularly suitable for cosmetic treatment of superficial skin changes such as pigmentation spots, broken capillaries, hemangiomas, port-wine stains (nevus flammeus), etc. Overall duration varies individually, but usually requires more than one session. After treatment the affected skin areas should be treated with the utmost care. Direct exposure to UV light should be avoided for 4 weeks after the session.


Fractional laser therapy

Fractional laser therapy or photothermolysis is an excellent, new method for treating sun damage to the face, especially the small wrinkles on the lower eyelids. It is also suitable for the neck and décolleté. A particular advantage of this method is that it can be performed using a local anesthetic ointment containing lidocaine. General anesthesia is no longer required. Fractional laser therapy is very suitable for reducing excessive or gaping scars. For the first time also melasma, a hormone or sunlight-induced skin darkening can be treated with great success and low complication rate. A previously defined skin area is treated with so-called microscopic treatment zones (MTZ) at each session. These denote microscopic columnar zones where a thermal effect penetrates the skin and stimulates the deep connective tissue to proliferate. The epidermis remains intact and acts as a natural bandage. To achieve the desired result usually several sessions are required. After treatment, a visit to the sauna or the gym should ideally be avoided for two to three days. Strict sun protection is recommended. This method is ideal for working professionals. Visit our practice on Friday and use the weekend for recuperating as skin rejuvenation over the weekend.

For complete healing and peeling of crusts it is important to note that treatments around the neck and on the face take about one week while the décolleté will take about 2 weeks. Treatment of the eyes, however, can be done over the weekend.


Ruby laser – removal of pigmented lesions and tattoos

For the removal of pigmented lesions and tattoos the ruby laser is ideal. The process is called “selective photothermolysis”, referring to selectively targeting and removing of pigment in the skin cells. These pigments are thereby fired at with ultra short laser pulses, whereby the color particles in the cells are destroyed with a shock wave. The laser pulses are too short to damage the surrounding tissue and destroy only, i.e. “selectively” pigment contained in cells. On one hand the color residues are removed from the body by the bloodstream and the lymphatic system, on the other hand they are eliminated by forming a superficial crust on the skin, which later peels off.

This method is suitable particularly for the removal of blue and black colored tattoos. Not possible is the destruction of yellow, orange, red and green pigment. These colors don’t disappear but merely change their color to black.

To completely remove a tattoo several treatments are usually needed, by which the tattoo starts fading more and more from session to session until becomes blurred and vanishes. Ruby laser therapy should be repeated at intervals of 4-6 weeks. When treating pigmented stains such as age spots, melasma, lentigines or cafe au lait spots fewer sessions are usually required. However, this has to be decided in each individual case. A removal of pigmented birthmarks (melanocytic nevi) with the laser is not possible. Please also take a look at the section called “prevention”.

 

PREVENTION – SKIN CANCER SCREENING

Each year, about 20,000 people in Germany are diagnosed with melanoma. This is, in contrast to non-melanoma skin cancer, due to a degeneration of pigment cells whereby the “black” color is created. However, a melanoma is not necessarily completely black. Also spots with various light and reddish brown zones are suspicious. They are often pigmented and checkered, show no boundaries and have lost their symmetry. Caution should be exercised in newly formed spots. Genetic factors, but especially long-term exposure to UV light is suspected to be the cause of skin malignancies. Also the number of moles (melanocytic nevi) increases the risk of developing a melanoma. A simple screening method can detect most of the new cases at an early stage and so avert an unfavorable course. From the age of 35 on, a biennial screening is recommended. In addition to that, you also have the opportunity to attend annual or biannual screenings and participate in our internal recall system to detect even small skin changes as early as possible. During your screening the entire body is scanned for suspicious moles and lesions. In my practice I use an imaging, computer-based method for cataloging your moles and to assess the progress for years to come. Optionally, suspicious moles can be removed surgically in our operating theatre. A subsequent histological examination is performed in an external laboratory.

For the treatment of pigmented birthmarks or suspicious skin lesions laser methods are permitted and considered malpractice. The evaluation of pigmented birthmarks and skin changes necessarily belongs in the hands of a dermatological specialist. Despite many years of experience I partake in training with a subsequent exam every year.

CONTACT

private dermatology practice
CLAUDIA GRAEFE, M.D.
dermatology / allergology / aesthetics
Salvatorstrasse 3
Munich DE-80333
phone: +49 89 18 93 25  85
fax: +49 89 24 22 39 23
by appointment only
e-Mail: info@derma-graefe.de

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