General Dermatology
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Dry skin is an irritating condition that can be caused by all manner of things. Most of the time, dry, itchy skin can be soothed with moisturizer, by switching up your soap and laundry detergent, or by adjusting the humidity in your home, which is something we have to learn to deal with here in the Cayman Islands.  However, dry skin isn’t always so easily fixed, and is sometimes caused by other health conditions[i] such as:

• Atopic dermatitis (AKA eczema)
• Skin infections

If you suffer with recurrent dry skin, either Dr Alison Duncan or Dr Davide Altamura, would be happy to discuss your symptoms. They will be able to identify the root of the problem and prescribe the treatment you need.

Itchy skin can have an almost endless list of causes, from chickenpox, to eczema, to psoriasis. Itching can also be caused by allergies, intolerance to certain detergents or perfumes, or even bug bites. While itching is usually due to a personal skin sensitivity, some causes of itching can be caused by infections. These may be contagious, meaning that the itchy individual must be kept out of contact with others until they have fully recovered.

The only way to truly get to the bottom of whatever is causing itching complaints is to book an appointment with a dermatologist. Both of our dermatologists here in Grand Cayman, Dr Alison Duncan and Dr Davide Altamura, are extremely experienced in differentially diagnosing the causes of itchiness.

Once specialists will be able to quickly identify the cause of the itching, can suggest an effective course of treatment to bring you relief.

Conditions that affect the pigmentation (AKA colour) of the skin can have a wide range of different causes. Some pigmentation issues (like birthmarks) are lifelong features of our skin, but certain conditions (like vitiligo, melasma, and loss of a pigment as a result of skin damage) can cause changes in the natural pigmentation of the skin. This may cause patches of skin to become darker or paler than they were before, and may affect small or large areas of the body.

Occasionally, changes in skin pigmentation issues can indicate a more serious, underlying health problem, such as those involving moles. If you have any concerns regarding issues with or changes in the pigmentation of your skin, do make an appointment with one of our dermatologists to discuss the matter further here in Grand Cayman with either Dr Alison Duncan or Dr Davide Altamura.

Vitiligo is a condition that causes smooth, white patches to appear on the skin. It is caused by the loss of melanocytes (pigment-producing cells in the skin), and is thought to be an autoimmune disorder.[i] It can affect anyone but is more noticeable in people with darker complexions, due to the contrast between white patches and natural skin tone.

The white patches caused by vitiligo don’t contain any melanin, so they are highly sensitive to sun damage. Therefore, it is important for people with vitiligo to keep white areas covered or protected with high-factor sunscreen, especially here in Cayman with intense heat.  Currently, there is no known cure for vitiligo. Treatment instead focuses on improving the appearance of affected areas of skin, and on protecting them from UV damage.

If you want to find out more about improving appearance or ensuring good sun protection, either Dr Alison Duncan or Dr Davide Altamura can advise. 

Melasma (AKA hyperpigmentation) causes broken or blue-grey patches or spots to appear on the skin. Melasma is very common^[i] and is caused when melanocytes (the melanin-producing cells of the skin) produce excess amounts of pigment. Melasma is especially common among pregnant women, and so is sometimes called the ‘mask of pregnancy.’

Besides pregnancy, melasma has many other possible causes^[ii] including sun damage, birth control pills, and hormones. Melasma may be prevented by wearing sunscreen and avoiding sun exposure. There are also various cosmetic treatments available that can help to lessen the appearance of dark spots.

Additionally, because of its similarity to one or two other skin issues, it can be useful to see a dermatologist to confirm melasma and rule out other causes. This is something that both of our dermatologists here in Grand Cayman are experienced at.  Contact either, Dr Alison Duncan or Dr David Altamura.

Photodamage (AKA damage from the sun) is the no.1 cause of skin aging, as excessive sun exposure can produce many changes in the texture and quality of a person’s skin. Fine and coarse lines, wrinkles, roughness, sun spots, and other changes in pigmentation all fall under the umbrella of photodamage,^[i] and all can contribute to a prematurely-aged appearance.

You can’t avoid the sun completely, especially here in the Cayman Islands, but you can reduce your risk of photodamage by applying sunscreen whenever you leave the house, and by not lying in the sun for prolonged periods of time. Certain cosmetic treatments can also help to rejuvenate the skin and reverse some of the damage caused by sun exposure.

Obviously, some of the damaging effects of the sun can be dangerous too, and so if you have visible damage, it is important to consider if you need to have your skin assessed for more serious skin damage complaints e.g., melanoma, and consider ensuring you are up to date with your fully body mole mapping as part of your melanoma early detection regime.  Do contact one of our dermatologists for an appointment – Dr Alison Duncan or Dr Davide Altamura.

Sunspots (also known as liver spots) are flat, brown spots that develop on skin that is exposed to sunlight. As their name suggests, they develop as a result of long-term sun exposure, and most show up on the hands. Sunspots are not considered dangerous, nor are they an indication of cancer. However, if their appearance bothers you, there are home remedies (like aloe, apple cider vinegar, green tea, or vitamin C) you can try to help them fade. Professional treatments (such as microdermabrasion, micro needling, chemical peels, and laser resurfacing) can all also significantly reduce the appearance of sunspots.  Do contact one of our dermatologists here in Grand Cayman, Dr Alison Duncan or Dr Davide Altamura, if you feel uncertain about a spot that has appeared or changed in any way.

Acne is a very common skin complaint, especially amongst adolescents. Acne is thought to affect over 90% of teenage boys and 80% of teenage girls, and a large number of people continue to battle pimples well into adulthood.

Acne is such a common problem that there are seemingly limitless treatments to choose from. However, effective acne care often requires a more detailed understanding of its exact causes, as these can vary from person to person. For some people, a cleansing skincare routine is the only treatment necessary. Others may need to use topical or oral medications to combat flare-ups and get their acne under control. The best way to put together an acne treatment plan that works for you is to speak with one of our doctors about the possible causes and remedies.  Dr Alison Duncan, Adult & Paediatric Dermatologist or Dr Davide Altamura, Dermatologist and Dermatosurgeon will be happy to help you here in Grand Cayman.

Rosacea is a condition that most commonly affects the face, where it causes blushing and flushing of the skin. Rosacea can become more intense and noticeable over time and, eventually, small blood vessels may become visible on the face. Occasionally, rosacea may also show up on the scalp and chest, ears, or neck. If left untreated, rosacea can lead to the development of solid, red bumps and pimples that can lead to secondary complications, such as eye irritation.

Rosacea is more likely to affect people with paler complexions and is usually seen in people over the age of 30. There is currently no known cure for rosacea, though topical and oral treatments can help to control symptoms and keep the condition in remission.

Often it is the appearance that causes those with rosacea the most distress, sometimes to the point of individuals isolating themselves.

If this is something that is worrying you, please do not hesitate to make an appointment with one of our dermatologists in Grand Cayman.

Warts and verruca’s are small, rough bumps that grow on the skin. They can show up anywhere on the body but are most common on the knees, hands and feet; when they appear on the hands they are known as warts, and those on the soles of the feet are called verruca’s.

Warts and verruca’s are both caused by the human papilloma virus (HPV). They are very common, and most people get at least one at some point in their lives. Warts and verruca’s are completely harmless and usually go away by themselves eventually, but they can be removed by a doctor or dermatologist if they’re bothering you

Some more malignant problems can look a little like warts and vice versa. If unsure, it is worth having a dermatologist just confirm for you. Additionally, if you have warts that are painful or bleeding, it would be advisable to contact one of our dermatologists, Dr Alison Duncan or Dr Davide Altamura here in Grand Cayman.

Skin tags are small, fleshy flaps of skin that usually develop around the neck, armpits, groin, and under the breasts. They are small, soft, and skin-coloured and (unlike warts) are non-contagious. Anyone can develop skin tags, but they are more common among older people, obese people, pregnant people, or those with type II diabetes.

Skin tags are usually painless and are unlikely to cause discomfort, but they can become a nuisance if they begin to snag on clothes or jewellery. Fortunately, they are very easy to remove.

Additionally, prominent ones can cause people to be distressed about their appearance, especially in more intimate locations.  If your skin tags are causing you distress, speak with one of our dermatologists about having them burned, frozen, or surgically removed.  Dr Alison Duncan or Dr Davide Altamura in Cayman will be happy to advise.

The term ‘skin growth’ can cover a dozen different lumps and bumps. The only sure way to know what you are dealing with is to take your problem to a dermatologist, who will be able to expertly identify the growth. Common benign (non-dangerous) skin growths include:

• Warts and verruca’s
• Skin tags
• Moles
• Freckles
• Lipomas
• Keratoacanthomas
• Scars and keloids
• Freckles
• Dermatoid cysts
• Dermatofibromas

If you have any queries about your skin health, make an appointment with either Dr Alison Duncan, Adult & Paediatric Dermatologist or Dr David Altamura, Dermatologist & Dermatosurgeon to discuss your symptoms here in Grand Cayman.

Cysts are fluid or air-filled pockets of membranous tissue that can grow almost anywhere on your body. They may also grow just beneath the surface of your skin. There are lots of different types of cysts, most of which are harmless. However, a cyst may need to be removed if it causes pain or discomfort or becomes infected or inflamed. Cysts may also need treatment if they are growing larger or putting pressure on other body structures.

Some cysts will eventually go away on their own, but others must be lanced and drained to stop them from growing larger.

If you have a cyst that is a concern to you, do speak to one of our dermatologists to discuss a possible treatment plan here in Grand Cayman.  You can make an appointment with either Dr Alison Duncan, Specialist Dermatologist or Dr Davide Altamura, Dermatologist & Dermatosurgeon.

Scars develop when the body repairs itself from an injury, like a deep cut. Scar tissue is made up of cells and a protein called collagen, which covers the site of the injury and knits the skin back together.

Keloids develop when this scar tissue becomes overgrown. When keloids develop, the scar generally grows much larger than the wound itself and may continue to get bigger over time. Keloid scars are generally flesh-coloured, pink, or red, and may be lumpy or ridged. They are not usually harmful, but they can be itchy. They may also cause irritation or discomfort if they develop in areas where they rub against clothing, or jewellery. Keloids that develop in visible locations may also cause cosmetic concerns and psychological distress.

If your keloids are bothering you, it is important to speak with one of our dermatologists about a possible treatment plan.  Dr Alison Duncan, Specialist Dermatologist or Dr Davide Altamura, Consultant Dermatologist & Dermatosurgeon in Cayman.

The delicate skin that covers the genitals can easily become irritated or inflamed. Male genital and vulval skin conditions are very common and can cause itching, pain, and general discomfort. Most skin conditions that affect the genitals are easy to treat; however, the real challenge is in identifying them.  Obviously in the Cayman Islands, our warm and humid conditions can add to the discomfort experienced too.

Common vulval skin conditions include:

• Eczema
• Lichen planus
• Psoriasis
• Lichen sclerosus
• Folliculitis
• Contact dermatitis
• Lichen simplex chronicus

The male genitals can also be afflicted by a variety of skin complaints, including:

• Jock itch
• Diaper rash
• Yeast infection
• Molluscum contagiosum
• Balanitis
• Contact dermatitis
• Psoriasis
• Lichen planus

The only way to accurately determine the type and cause of genital skin conditions is to consult a medical professional. Both Dr Alison Duncan, Adult & Paediatric Dermatologist, (special interest in vulva dermatology) and Dr Davide Altamura, Dermatologist and Dermatosurgeon, (special interest in genital disorder) are experienced in the diagnosis and treatment of male genital and vulval dermatology.

Some Cayman, hopefully most parents will be aware before their baby is born that they may have a congenital or genetic condition. Our own OBGYNs, Dr Lisa Joels and Dr Madhavi Manoharan work closely with our neonatal team to ensure everybody is aware and prepared. We are also fortunate that Dr Madhavi Manoharan is an specialist in fetal-maternal medicine, meaning she can assess any direct concerns with the baby.

Depending on what has been found on antenatal scan a decision may be made to deliver baby in a tertiary centre overseas. Despite advances in antenatal scanning some babies are born in Cayman with an unexpected congenital or genetic problem. Our 3 paediatricians all have significant expertise in this area but by working together as a team can help with making the correct diagnosis, ensure the input of the correct specialists and provide on going support for you child.

The hair, scalp, and nails can be affected by dozens of different dermatological issues with a huge variety of causes.  If you notice a marked change in the appearance or texture of your hair, skin, or nails, it is vital that you make an appointment with one of our dermatologists to discuss your symptoms.

Possible causes of problems relating to the hair, scalp, and nails include:

• Infection
• Allergies
• Nutrient deficiencies
• Insect bites and stings
• Hormonal imbalances
• Other underlying medical conditions

The only way to get to the root of your hair, scalp, and nail problems is to take the issue to an expert. Both Dr Alison Duncan, Adult & Paediatric Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, in Cayman, have years of combined experience in the diagnosis and treatment of hair, scalp and nail conditions, including skin cancers that can hide in these locations, and our practice is equipped with some of the latest diagnostic equipment for these sites.

Blisters are fluid-filled bubbles that pop up on the surface of the skin. They may contain pus, blood, or a clear, watery fluid. They usually appear as a result of injury (for example, a burn, extreme cold, or a friction injury). However, blisters may also be caused by certain skin complaints that result from infection, rather than injury. Common skin conditions that cause blisters  to form include:

• Contact dermatitis
• Atopic dermatitis
• Chickenpox
• Shingles
• Hand, foot, and mouth disease
• Herpes simplex

Blisters that are caused by injuries don’t usually require medical attention, as long as they are kept clean and dry as they heal. Blisters that seemingly pop up on their own, however, will need to be taken to a dermatologist. Blistering disorders of the skin are often caused by infections and may require an expert diagnosis and medication to treat.  Our dermatologists are on hand to treat you so do not hesitate to contact either Dr Alison Duncan, Adult & Paediatric Dermatologist or Dr Davide Altamura, Dermatologist and Dermatosurgeon.

A skin rash is a patch of irritated skin that may be swollen, itchy, painful, or otherwise uncomfortable. A skin rash may feature blisters, redness, raw patches of skin, welts, or hives, and could have dozens of possible causes. Rashes can be a result of infection, an allergic reaction, a bug bite or sting, or contact with an irritant substance.

Some common types of skin rashes include:

• Contact dermatitis
• Atopic dermatitis
• Pityriasis rosea
• Heat rash
• Lichen planus
• Psoriasis
• Ringworm
• Rosacea
• Shingles
• Cercarial dermatitis

If you have a persistent rash, it is essential that you make an appointment with one of our dermatologists. The only way to treat a rash is to first determine the cause and, as there are so many different types of rashes, this is something only a medical expert can do. Both Dr Alison Duncan, Adult & Paediatric Dermatologist, and Dr Davide Altamura, Dermatologist and Dermatosurgeon, are highly experienced in the diagnosis and treatment of the full range of common skin complaints, including those more common in the Cayman Islands.

For some people, skin rashes can develop as a result of direct sun exposure. This may be due to a condition called photosensitive dermatitis, in which the patient’s skin reacts unusually to UV exposure. This can cause lesions to develop on parts of the skin that are exposed to the sun, which can look like severe sunburn.  For some people, skin rashes can develop as a result of direct sun exposure, and of course Cayman is very blessed with sunshine.

Although photosensitive rashes may develop due to an unusual sensitivity to sunlight, they may also be caused by certain medications, such as:

• Antibiotics
• Antifungals
• Antihistamines
• Cholesterol-lowering medications
• Diuretics
• Non-steroidal Anti-inflammatory Drugs (NSAIDs)
• Oral contraceptives
• Psoralens
• Retinoids
• Certain cosmetics ingredients

The juices of certain fruits and vegetables can also cause a photosensitive rash if dripped onto skin which is then exposed to sunlight. Therefore, sunlight-induced rashes can have a wide variety of causes and can always be discussed with either Dr Alison Duncan, Adult and Paediatric Dermatologist or Dr Davide Altamura, Consultant Dermatologist.