More Blog Posts
Full Body Skin Exams Twice as Likely to Detect Skin Cancer
Date: September 8, 2021Skin cancer is the most common cancer in the United States and approximately 5 million people are diagnosed each year. Risk factors include fair complexion, sun exposure over many years, a history of burns, and family history. Many people see their dermatologists for a new or changing skin lesion.
A study to be published in the International Journal of Womenís Dermatology this month revealed that a full body skin exam performed at the same appointment is twice as likely to detect skin cancer. More than half of the skin cancers discovered were not in the location the patient was concerned about. This included basal cell and squamous cell carcinomas, as well as life threatening melanomas. The authors advise that the best way to detect skin cancer in patients with a suspicious lesion or significant risk for skin cancer is to have a complete skin exam. With the end of summer approaching, this is an opportune time to schedule a complete skin exam with your dermatologist.
Sunscreen Safety Update: Benzene Contamination
Date: August 9, 2021Recent evaluation of multiple sunscreens by independent lab, Valisure, found benzene contamination in certain lots of sunscreens and after-sun products. More than three-quarters of the products are sprays. In response, Johnson and Johnson, recalled the incriminated products after independently confirming the test results. Benzene is not normally an ingredient in sunscreens and the source of the contamination is being investigated. Benzene is a known carcinogen and exposure should be avoided. It is believed that small cumulative exposure (primarily through inhalation of car exhaust, second hand smoke, etc.) over years and decades leads to increased risk of certain cancers. Valicom posted a list of tested sunscreens that were free of traces of benzene: Valisure. Exposure to the sunís ultraviolet rays is a predisposing factor for the development of skin cancers. Protect your skin by:
- Applying a broad spectrum sunscreen with minimum SPF 15 (30 for more prolonged exposure) to all exposed skin areas. For more info visit: SkinCancer.org.
- Wear sun-protective clothing. Many companies produce a variety of stylish options with light weight materials
- Wear a broad brim hat and UV protection sunglasses.
- Do outdoor activities early or late in the day. Avoid peak sun exposure between 10 am-3pm in spring/summer.
THEREíS NO NEED TO HESITATE OR PROCRASTINATE. PLEASE VACCINATE!In recent weeks the national death rate from COVID has been rising and is being called by the head of the CDC a ďpandemic of the unvaccinatedĒ. Unvaccinated Americans account for virtually all hospitalizations and deaths. Three vaccines approved for emergency use by the FDA, Pfizer-BioNTech, Moderna, and Johnson and Johnson, are safe and highly effective in preventing serious disease, hospitalization, and death from COVID-19 and their benefits outweighs their risks. Many steps have been taken to ensure that the vaccines are safe. For details please visit: Hopkins Medicine. If youíve been reluctant to receive a vaccine, please reconsider for your well being, the wellness and safety of your family, friends, co-workers, and community.
Platelet Rich Plasma (PRP) treatments for Hair Growth
Date: June 11, 2021Our April tip of the month featured laser hair removal and began with, ďExcess hair can cause psychological and emotional stress.Ē The same can be said for loss of scalp hair for both men and women. There are many products and treatments promoted to grow scalp hair but most lack supporting scientific data. Exceptions include topical minoxidil liquid and foam(Rogaine and others) available over the counter for men and women and oral finasteride (Propecia), by prescription, for men. The efficacy of various oral supplements and low level laser treatments is less well documented.
In recent years, many studies have shown that a series of PRP injections can stimulate scalp hair growth in both men and women. The treatments involve collecting a patientís blood in a sterile test tube. The tube is placed in a centrifuge to separate various components of blood. The component containing PRP is drawn into a syringe and small amounts are injected into scalp areas lacking hair.
A cold air cooling devise is held at the sites of injections to minimize discomfort. The entire process takes approximately 30 minutes. A series of 3 monthly treatments followed by treatments every 3 months during the first year then twice yearly to maintain the benefit is recommended. Studies have shown that PRP contains many growth factors that are activated following injection. These growth factors stimulate various mechanisms involved in hair growth. To determine if youíre a good candidate for PRP please schedule a consultation with your dermatologist.
Sunscreen Tips for Skin Cancer Awareness Month
Date: April 9, 2021Did you know that when the UV index is high, unprotected fair skin can burn in 10 minutes or less? So, itís important to cover up whenever possible and pick a broad-spectrum sunscreen with sun protection factor (SPF) of at least 30. Broad spectrum means protection from both UVA and UVB rays, which is critical to prevent sunburn and reduce sun damage.
The New York Times and Consumer Reports did an extensive review of sunscreens on the market. The NYT had four testers with different skin types and complexions test seven sunscreens over several weeks. Consumer Reports tested 48 different lotions and sprays. While less convenient, sunscreen lotion typically provides a more even coverage. And, spray sunscreens can easily be lost to the air. There is also a risk of inhaling a spray sunscreen during application, which can cause lung irritation. Mineral sunscreens work by deflecting UV rays, while chemical sunscreens absorb UV rays. While chemical sunscreens may be less likely to wash off, they are depleted as they absorb the rays and especially important to reapply frequently. Mineral sunscreens can be gentler on the skin.
While controversial, concerns have been raised regarding the safety of some components of chemical-based sunscreens and their environmental impact. There is agreement amongst most experts that more studies are needed to determine if these chemical components have adverse effects. Use one teaspoon for each uncovered area of your body such as the face, back or neck or neck. If you are wearing a swimsuit, this adds up to roughly a shot glass worth for enough protection.
Sunscreen should be reapplied every two hours, especially if you are sweating or swimming. Cover up with clothing, a hat, and sunglasses when out in the sun. And, if possible, seek shade or stay indoors between 10am and 4pm, when the sunís rays are the strongest!
Laser Hair Removal
Date: April 9, 2021Excess hair can be a source of psychological or emotional stress. While plucking, waxing, shaving, electrolysis, and depilatories can be effective for small areas and short term control of hair growth, they are often impractical for removing hair from large areas. Laser hair removal has been used successfully for several decades to achieve long term reduction of unwanted hair. The devices available today offer a high degree of safety, efficacy, and comfort. All lasers emit lights of different wavelengths and laser hair removal works by emitting light that selectively targets the pigment within hairs. The light energy is converted to heat which is transferred to the hair follicle thereby destroying it. Since pigmented (brown or black) hair is essential as a target for the laser light, individuals with blond, white, grey, and red hair arenít good candidates for this treatment.
While all skin types with appropriately colored hair can be treated, the best candidates are those with lighter skin color. The reason for this is that the skin also becomes a target for the laser light when greater skin pigment is present. Darker skinned individuals must be treated at lower energies requiring more treatments for hair reduction. Regardless of skin type, multiple treatments are required because only a certain percentage of hairs are destroyed during a given treatment. This has to do with the percentage of hairs that are in an active growth phase at the time of treatment.
If youíd like to schedule a consultation or learn more about laser hair removal, please call 310-626-4631.
CBD Treatment for Skin Conditions
Date: March 9, 2021CBD (cannabidiol) is a compound present in the marijuana plant, Cannabis sativa. Unlike, THC (tetrahydrocannabinol), it doesnít have psychoactive effects. CBD is most commonly ingested but is also available in topical products such as lotions and balms. While the alleged benefits of CBD include control of seizures, relief from pain, depression, anxiety, migraine, among others, only one drug containing CBD has been approved by the FDA to treat rare forms of childhood seizures.
Recent research has looked at cannabinoids for the treatment of various skin conditions including psoriasis, eczema, and wound healing. The most promising benefits have been found in the treatment of itch. Clinical studies have shown a reduction in itching for several dermatologic and internal conditions. These preliminary results support the need for controlled trials to confirm these benefits and standardize formulations and treatment regimens. Many CBD containing topical products are available but their ingredients and efficacy havenít been validated by the FDA since they arenít currently regulated as drugs. Hopefully this will change in the near future. In the meantime, CBD products might be considered in situations where conventional treatments have failed.
Stress and Your Skin
Date: February 2, 2021Life can be stressful and this past year has been uniquely challenging. The COVID pandemic has caused widespread illness and loss, social isolation, and economic devastation. Our country is deeply divided politically and struggling to deal with social/racial injustice. There is growing evidence that psychological stress aggravates many common skin conditions. Some inflammatory skin conditions known to be affected by stress include psoriasis, rosacea, acne, and atopic dermatitis (eczema). The degree to which stress plays a provocative role varies by condition. For example, it is a factor in virtually 100% of patients with hyperhidrosis (excessive sweating) while in 0% in patientís with skin cancers. Embryologically, the skin and brain originate from the same tissue, the ectoderm. While the exact mechanisms havenít been worked out, research has revealed a brain-skin connection involving a complex interplay of neurological, hormonal, and immune systems. The bottom line is that stress may increase inflammation through the release of cytokines, proteins that are important in our immune responses in health and disease.
If you are experiencing stress and have a skin condition that is flaring, contact your dermatologist to discuss treatment strategies.
The FDA Approved COVID Vaccines Are Safe And Effective
January 8, 2021
We are at war with the COVID-19 virus. Approximately 350,000 Americans have died as a result of illness from this scourge since the pandemic began. By comparison, approximately 420,000 servicemen and women lost their lives during WWII and 58,000 during the Vietnam War. Data strongly supports simple protective measures including wearing masks/face coverings in public, avoiding crowds, frequent hand washing and use of hand sanitizers. Itís a remarkable feat of science and technology that 9 months since the pandemic began, 2 safe and effective FDA approved vaccines (Pizer/Biontec and Moderna) are being disseminated and several million Americans have received their first doses. Unfortunately, surveys have indicated that a significant percentage of the population is unwilling to take the vaccine. For those with safety concerns, please check the CDCís website www.cdc.gov for detailed information that addresses this issue. I also suggest reading a short editorial by Kerry Kennedy Meltzer, M.D., an internal medicine resident at New York Presbyterian Hospital that was published last week: https://www.nytimes.com/2020/12/30/opinion/covid-vaccine-bobby-kennedy.html
Recent reports of rare, facial/lip swelling (3 out of 15,184 participants) noted in the Moderna vaccine trial in participants who previously received fillers should not be a contraindication to vaccination. It appears the virus will be around for a while but we can defeat it. THE COVID VACCINES ARE SAFE AND EFFECTIVE. UNLESS YOU HAVE A MEDICAL CONTRAINDICATION, PLEASE GET VACCINATED AS SOON AS ONE BECOMES AVAILABLE TO YOU.
Stay Connected with Telemedicine
December 10, 2020
Interactions with physicians via video conferencing and by phone with evaluation of photos have been gaining momentum for years. These type of virtual visits, known as telemedicine, have grown significantly during the pandemic. They allow people with concerns about going out in public and those with underlying conditions that put them at high risk for serious illness if they became infected with COVID, to be evaluated by their physician. It also allows for more regular follow up, eliminates the time for driving round trip to the office, parking cost, and wait time to see your doctor. There are, however, limitations to the kind of issues that can be addressed. Procedures such as biopsies, surgeries, freezing of skin lesions, (at least for now) require an office visit. In dermatology, telemedicine works best for following chronic skin conditions, such as acne, rosacea, eczema, and psoriasis. While individual skin lesions can be evaluated, a full skin exam requires an office visit.
To schedule a telemedicine appointment with your dermatologist please call 310-274-9954 or initiate your telemedicine consultation through your patient portal derm90210.ema.md. If you donít have access to your portal please call the phone number listed above for assistance.
Masks and Skin Problems (adapted from AAD.org)
November 3, 2020While wearing masks in public are critically important to prevent the spread of the coronavirus, they can also induce or aggravate various skin conditions including acne ďmaskneĒ, rosacea, eczema, and irritation dermatitis.
Fortunately, there are simple measures one can take to treat these conditions:
- For sensitive, easily irritated skin, wash with a gentle, fragrance free cleanser and apply a moisturizer immediately after washing. Ideally, the moisturizer should contain one or more of the following ingredients: ceramides, hyaluronic acid, dimethicone. Itís a good idea to use non-comedogenic moisturizers, especially if you have acne prone skin. You can choose between gels, lotions, and creams (lighter to heavier respectively) based on whether your skin is oily, normal, or dry.
- If your skin is irritated, avoid chemical peels, exfoliants including salicylic acid, and retinoids that can exacerbate dry skin.
- Wear the correct mask the correct way. Two layers of a breathable material such as cotton is best. Avoid synthetics. Masks should be snug but comfortable. If the mask fits too tight or too loose itís more likely to cause irritation.
- Remove your mask for 15 minutes periodically when in a safe place.
- Have a supply of masks to rotate wearing and wash masks after each use according to instructions. Use a fragrance free hypoallergenic laundry detergent.
- If you have or develop acne, avoid wearing makeup. If necessary, use only products that are non-comedogenic (wonít clog pores). Continue the treatment plan from your dermatologist.
- For more information regarding selecting masks visit CDC.gov/coronavirus.
How to Exercise Safely During a Pandemic
October 4, 2020The COVID Pandemic has forced closure of indoor gyms and pushed those who crave regular exercise to shift to other options. Fortunately, Southern California is an ideal location for year round outdoor activities (air quality allowing) such as walking, hiking, and running. Itís not unusual, however, for enthusiasts to develop certain skin conditions. Some of the most common include:
- Blisters may develop on the feet due to excessive friction. Risks factors include poorly fitting shoes, heat, moisture, and overdoing it. Blisters can be prevented with proper fitting shoes, wearing moisturizer wicking sports socks, use of topical antiperspirants, and bandages at pressure points.
- Joggerís nipples occur secondary to chaffing in men who wear shirts made of coarse fabrics and women who run without a bra. This painful condition can be prevented by silk or other soft fiber shirts and use of topical antibiotic ointment, petroleum jelly, or patches while running to prevent rubbing/irritation.
- Joggerís toe is a blue black discoloration typically found on the longest toe/toenail. This manifestation of repeated trauma is especially common in those who run downhill. Itís prevented by wearing proper fitting shoes and trimming toenails short.
- Talon noir is blue black discoloration of the heel and is cause by repetitive shearing forces on the heel leading to damage of the underlying capillaries. This, too, can be prevented by wearing proper fitting shoes and cushioned socks.
- Athleteís foot (tinea pedis) and fungal infection of the toenail (onychomycosis) are more common in active individuals. Predisposing factors include trauma, occlusion, sweating (all occur to varying degrees while exercising while wearing shoes), and use of communal showers. Prevention includes well ventilated shoes and socks, removing shoes and socks promptly following exercise, wearing sandals in showers and other communal areas.
- Sun burn and skin cancer risk are elevated with increased exposure to UV radiation from the sun. The cumulative amount of UV exposure in a lifetime increases the risk for basal cell carcinoma, squamous cell carcinoma, and melanoma. Exercising early or late in the day, application of broad spectrum sunscreen with minimum SPF 30, wearing sun protective clothing, hats, and sunglasses can significantly reduce risk.
You Are What You Eat: Your Diet and Aging
September 10, 2020Recent studies have shown that diet can affect certain skin conditions such as acne and rosacea. There is now some evidence that aging of the skin can be slowed with a healthy diet. For example, a diet rich in vegetables, fish, foods with high vitamin C content, carotenoids, and olive oil are associated with decreased wrinkles. A Dutch population based study published in the Journal of the American Academy of Dermatology last year looked at the association of a diet and facial wrinkles in an elderly population. The diet included daily consumption of at least 200 grams (approximately 7 ounces) of vegetables, at least 200 grams of fruit, 90 grams of brown bread, whole meal bread, or other whole grain products, and at least 15 grams (0.5 ounce) of unsalted nuts. Also one serving of fish per week, and little to no diary, alcohol, red meat, cooking fats, and sugar was recommended. The study found that better adherence to the diet was associated with fewer wrinkles in women but not men. Women who ate more animal meat, fats, and carbohydrates had more wrinkles than those on a fruit dominant diet.
Various mechanisms including oxidative stress and elevated skin and gut inflammation caused by an unhealthy diet may lead to increased wrinkle formation. On the other hand, the nutrients in fruits and vegetables stimulate collagen repair and reduce oxidative stress on the skin. In addition to a healthy diet, measures that reduce ultraviolet exposure from the sun including minimizing mid day sun exposure, applying sunscreen with a minimum SPF of 30 and wearing sun protective clothing, hats, and sunglasses are essential to minimizing wrinkles and reducing ones risk of developing skin cancers.
SKIN, THE BODYíS ARMOR AND FINDING THE RIGHT MOISTURIZER
August 7, 2020The skin is our largest organ and has many important functions including regulating body temperature, acting as a barrier and preventing harmful microorganisms and toxins form getting inside the body. The first layer of skin is called the epidermis. The top layer of the epidermis is called the stratum corneum which consists of flat, dead protein filled cells mixed with fat and water to create a brick and mortar like structure. This layer is responsible for retaining moisture and protects us from toxins, bacteria, and ultraviolet rays. Unfortunately, our skin weakens and becomes thinner as we age. Older skin has less water content, less fat and elasticity. Sun exposure and certain medications, such as steroids (topical, oral and inhaled) can also adversely affect the integrity of the skin. Soap and solvents including alcohol can dry and damage the skin by stripping away fats. We are all washing and cleansing our hands more now because of the COVID Pandemic which can cause the skin of our hands to be dryer with cracks and tears. While COVID isnít contracted through the skin, certain bacteria can cause infections requiring antibiotics and occasionally hospitalization. The simple remedy is to apply the right type of moisturizer regularly. The best moisturizers have three main components to help restore the skinís integrity including:
- Occlusives for barriers to limit water loss from the stratum corneum (eg: petrolatum, mineral oil, lanolin)
- Emollients provide softness and smooth texture (eg: dimethicone, cyclomethicone, jojoba oil)
- Humectants promote water absorption from the dermis and environment into the stratum corneum ( eg glycerin, hyaluronic acid, sodium and ammonium lactate)
Moisturizer ingredients are listed in decreasing order of concentration on the product package. The items noted above should be present within the first 5 ingredients. Other valuable ingredients include various fats, anti-oxidants, and sunscreens. Fortunately, there are many reasonably priced OTC moisturizers available from reputable companies. Finally, drinking excessive amounts of water doesnít help to hydrate the skin!
Are dietary supplements safe and effective for skin conditions?
July 1, 2020Many patients ask if taking a vitamin or supplement would be beneficial for their skin condition. Vitamins and supplements arenít regulated in the same way as prescription medications by the Food and Drug Administration (FDA) and can be marketed without undergoing rigorous assessment. A recent review article in the Journal of the American Academy of Dermatology found overall, very few dietary supplements had been evaluated in largescale randomized clinical trials. Safety and efficacy evidence were limited.
Few adverse events were recorded for any supplement, making safety analyses difficult. In addition, the lack of standardized dosing across trials prevented any pooled statistical analyses to demonstrate benefit. While some studies support the use of nicotinamide to prevent nonmelanoma skin cancers and precancerous actinic keratoses, further studies are needed to support the use of zinc, biotin, vitamin D, and polypodium.
If you have questions about the use of supplements to treat or prevent skin conditions please schedule an appointment to speak to your dermatologist.
Could your sunscreen be hurting the environment?
June 8, 2020There are now a number of laboratory studies that associate certain UV filters in chemical-based sunscreens - specifically oxybenzone and octinoxate Ė with the bleaching of coral reefs. While the lab setting may have limitations, there is agreement amongst most experts that more studies are needed. Many states are now considering legislation to ban the sale and use of chemical sunscreens that contain the incriminated ingredients. What should one do in the meantime for protection from the sun? Fortunately, there are many effective mineral-based sunscreens on the market - containing zinc oxide and/or titanium dioxide. Also remember to seek shade, wear protective clothing, and limit sun exposure between 10am and 3pm. Additional information on sunscreens and sun protection is available at www.aad.org/sunscreen
COVID TOES: Is it truly a skin manifestation of the disease?
May 5, 2020Painful, swollen, red, or purple skin lesions on the toes and feet have been reported in some patients with COVID-19 infections. This eruption appears similar to a condition typically seen in cold weather, known as chilblains. The good news is that this eruption is usually seen in younger patients with mild forms of the disease, and seems to portend a good prognosis. Other types of skin eruptions have been reported in COVID-19 patients, but their relationship to the disease is currently unclear. The American Academy of Dermatology has established an international registry to develop a better understanding of skin eruptions in COVID patients.
Dry Skin From Hand Washing
April 9, 2020
Now that frequent hand washing has become the new norm, many patients are complaining about dry, red, burning skin. This condition, irritation dermatitis, is treated with regular applications of moisturizers such as Aveeno Eczema Therapy Balm, Vanicreme, and Cerave Cream among others. More severe cases require a prescription topical steroid cream or ointment.
On the subject of hands, the long-standing custom of hand shaking may become a thing of the past even after the pandemic ends. Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious disease recently stated, “I don’t think we should ever shake hands ever again, to be honest with you,” he added later. “Not only would it be good to prevent coronavirus disease; it probably would decrease instances of influenza dramatically in this country.”
Our office remains open for urgent dermatologic conditions, and we also offer telemedicine appointments. If you have any questions or would like to schedule an appointment, please call 310-274-9954 or email us: email@example.com