Medical Dermatology Conditions in Beverly Hills

Roughly half of Dr. Zaks' practice is medical dermatology: conditions that need a diagnosis, not a treatment menu. Several of the most common — shingles, onychomycosis, seborrheic dermatitis, and vitiligo — are frequently misidentified and mistreated for months before a dermatologist sees them, and in at least one of them the delay directly costs the patient a better outcome.

Herpes zoster (shingles) is reactivation of latent varicella-zoster virus in a dorsal root ganglion. It presents as pain, burning, or itching in a single dermatomal band, followed within days by grouped vesicles on an erythematous base that do not cross the midline. Shingles is time-critical: antiviral therapy such as valacyclovir is most effective when started within seventy-two hours of rash onset, both for the eruption itself and for reducing the risk of postherpetic neuralgia. Involvement of the eye or the tip of the nose (Hutchinson's sign) suggests ophthalmic zoster and warrants same-day ophthalmology involvement. Dr. Zaks also discusses Shingrix vaccination for prevention in eligible adults.

Onychomycosis, or nail fungus, is a common infection of the nail plate and bed, usually caused by dermatophytes. It shows up as yellow-brown discoloration, thickening, debris under the nail, and the nail lifting away from the bed. Several other conditions can mimic this appearance, so Dr. Zaks examines the nail and reviews your history before starting treatment. Mild or limited disease is usually treated first with a topical prescription antifungal — Jublia® (efinaconazole) or Kerydin® (tavaborole) — applied directly to the nail. Oral terbinafine is considered if the infection does not improve with topicals or when multiple nails are affected. Because nails grow slowly, a toenail can take nine to twelve months to look normal again even after the fungus is gone.

Seborrheic dermatitis is a chronic inflammatory reaction to Malassezia yeast in sebum-rich skin: the scalp, eyebrows, nasolabial folds, ears, beard area, and central chest. It presents as greasy yellowish scale on pink skin, often itchy, and it flares with stress, cold dry weather, and illness. Treatment combines antifungal shampoos and creams — ketoconazole, ciclopirox, zinc pyrithione, selenium sulfide — with short courses of topical anti-inflammatories, using non-steroidal options such as topical calcineurin inhibitors on the face to avoid steroid atrophy. It is controllable and recurrent; maintenance antifungal shampoo two to three times weekly is what keeps it quiet.

Vitiligo is an autoimmune condition in which melanocytes are destroyed, producing sharply demarcated depigmented macules, commonly on the hands, face, around the eyes and mouth, and over joints. Diagnosis is clinical, with screening for associated autoimmune thyroid disease where indicated. Treatment aims to halt progression and stimulate repigmentation: topical calcineurin inhibitors such as tacrolimus for facial disease, topical corticosteroids for the body, narrowband UVB phototherapy for widespread involvement, and topical ruxolitinib cream (Opzelura®) — the first FDA-approved treatment for nonsegmental vitiligo repigmentation, a JAK inhibitor that interrupts the interferon-gamma signaling driving melanocyte destruction. Repigmentation is slow, best on the face and neck, and least reliable on hands and feet; sun protection of depigmented skin is essential because it has no melanin defense.

Dr. Zaks personally performs every injectable, laser, and procedural treatment at his Beverly Hills practice. Patients are never seen by rotating physician assistants, nurse injectors, or aestheticians for these procedures.