Magan Medical Clinic, Inc.
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Dermatology

Magan Medical Clinic, Dermatology
420 W Rowland St, 2nd Floor
Covina, CA 91723

(626) 331-6411 Phone - General line
(626) 251-1500 Phone - Appointments (Open Mon-Fri, 7:30 am-5:30 pm)
(626) 251-1552 Fax

 

Dermatology Staff
Our wonderful dermatology staff. Board certified dermatologist
 Charles Chiang, M.D., F.A.A.D. is in the center

 

We provide quality dermatology care with compassion. Our specialty is medical dermatology, including:

  • Acne (both teenage and adult onset; we are enrolled in iPledge if Accutane is needed)
  • Eczema / atopic dermatitis (in both children and adults)
  • Psoriasis
  • Skin cancer / skin exams
  • Moles
  • Warts / molluscum
  • Rosacea
  • Pigmentation disorders
  • Alopecia areata (autoimmune non-scarring hair loss)
  • Scarring hair loss (autoinflammatory scarring hair loss)
  • Phototherapy (we have a nbUVB booth and Dr. Chiang completed a phototherapy fellowship at UCSF)
  • Hives
  • Itching (pruritus)
  • Nail disorders

  • Note: Cosmetic treatments are not performed in Dermatology but instead by Magan's Medical Aesthetics Laser Center.

If you have psoriasis or hair questions, Dr. Chiang possesses special expertise. He completed fellowships in both fields at University of California, San Francisco where he saw a wide spectrum of patients (including the most severe), performed clinical trials, and published research.

We take pleasure in serving our community including Covina, West Covina, San Dimas, Rancho Cucamonga, Baldwin Park, Azusa, Glendora, Upland, El Monte, Duarte, Monrovia, Arcadia, La Puente, and Diamond Bar.

Same day appointments often available. No referral is necessary if you have PPO insurance. We accept a wide range of insurance plans (unfortunately, we do not accept Medi-Cal as primary insurance, only as secondary insurance).

For appointments, please call (626) 251-1500. We look forward to serving you!


 

"What's New in..."

A monthly column by Dr. Chiang

 

October 2019

What's New in Melasma

What's new in Hidradenitis suppurativa

Melasma is a skin pigment disorder where darkened patches appear, especially on the sun-exposed areas of the face. The primary etiology is sun damage. Other potential factors include pregnancy, oral contraceptives, medications that increase the risk of sun damage, and genetics.

The primary medical treatment is sun avoidance and sun protection (sunblock and clothing).

The main cosmetic prescriptions from the doctor are primarily hydroquinone based products. When a patient requests this, I usually prescribe it as the brand Tri-luma (which also contains a topical steroid and retinoid) which patients almost always have to pay the full cash price of and is almost never covered by insurance. However, hydroquinone is a potential carcinogen and may not be worth the medical risk. In their favor, the American Society for Dermatologic Surgery Association states "There have been no reported incidences of cancer from topical application of hydroquinone in humans." Arguing against their usage is the fact they are banned in Europe, Japan, and Australia. In addition, hydroquinone seems to increase the risk of skin cancer in rodents when applied topically. It also had evidence of toxicity when taken orally (which humans should never do). The U.S. Environmental Protection Agency (EPA) states "There was some evidence of carcinogenic activity in orally-exposed rodents. Increased skin tumor incidence has been reported in mice treated dermally."

Another potential prescription agent is azelaic acid but I haven't personally seen good results with it.

There is increasing usage of non-prescription cosmeceuticals. Unfortunately, they tend to be expensive. The two that seem to be having the most enthusiasm seem to be:

- Cysteamine cream (Cyspera cream). It primarily inhibits both tyrosinase and peroxidase enzymes. It also has an antioxidant effect on superficial skin pigment, making it lighter in color. It is used once nightly for 12 weeks then twice weekly for maintenance. Generally speaking, the skin is NOT washed before usage, it's left on for 15-30 minutes, washed off, then a moisturizer is applied. The company reports a 68% reduction in the Melasma Area and Severity index compared to control patients. It should not be used in patients who are pregnant, breastfeeding, or have an autoimmune disease called vitiligo as it has not been studies in these groups.
- Lytera 2.0 Pigment Correcting Serum. Generally speaking, the skin is NOT washed before usage, it's left on for 20 minutes, washed off, then a moisturizer is applied. I do not recommend its usage in pregnant or breastfeeding patients. However, on the company's product webpage, they hedge and state "The safety of our products has not been established in vulnerable populations, including women who are pregnant" but also state "Lytera® 2.0 does not contain any known teratogenic ingredients, ingredients known to harm mother and/or baby. Therefore, pregnancy is not considered a contraindication for Lytera® 2.0." Again, at this time, I do not agree with the company that it is okay to use this product is pregnant or breastfeeding patients. I may change my mind if more data and/or expert consensus becomes available. Unfortunately, even the company clinical trial data has not been released to my knowledge and their webpage lists the data as "Data on file at SkinMedica."

Notes:

- My clinic is medical and I do not stock these products. I instruct patients to order online from reputable sources or to see if the Medical Aesthetics Laser Center (which does charge a consultation fee) carries these or other helpful cosmeceutical products.
- I do not recommend any cosmetic product be used if a patient may be pregnant, are pregnant, are breastfeeding, or have a medical condition called vitiligo.
- I am not aware of any serious side effects with the non-hydroquinone products but please check with your doctor or cosmetic center before using the products above.

If you have melasma or another skin condition, consider making an appointment for dermatology consultation at (626) 251-1500 to discuss your options.

Charles Chiang, MD, FAAD
Board Certified Dermatologist

References:

- Downie J, et al. New OTC Topicals Target Hyperpigmentation, Melasma. Practical Dermatology 2019
- Skinmedica, Lytera® 2.0 Pigment Correcting Serum, https://www.skinmedica.com/Products/Brighten/lytera2 Last accessed 101/4/19
- ASDS, Position on Topical Hydroquinone, https://www.asds.net/Portals/0/PDF/asdsa/asdsa-position-statement-hydroquinone.pdf Last updated August 2019 Last accessed 10/14/19
- EPA, Hydroquinone Hazard Summary https://www.epa.gov/sites/production/files/2016-09/documents/hydroquinone.pdf Last updated January 2000 Last accessed 10/14/19


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