Medical Tip of the Month
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What's that dark spot that suddenly appeared on my forearm!?
July 2, 2019Solar purpura (SP) aka, senile purpura, actinic purpura are flat, purple marks that develop suddenly, typically on the hands and forearms of elderly people. While scary looking, they are nothing more than bruising due to thinning of the skin and fragility of blood vessels.
SP often develops with little or no known injury to the affected skin. The lesions may occur with open wounds that can be uncomfortable and may become infected requiring treatment with an antibiotic. Predisposing factors include sun exposure, prolonged use of topical steroid creams or oral steroids, and ingestion of blood thinning agents such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), apixaban (Eliquis), and dabigatran etexilate (Pradaxa), NSAIDs, such as ibuprofen and naproxen, and certain supplements, such as fish oils.
Preventative measures include sun protection (broad spectrum sun screen with minimal SPF 30 and clothing), avoidance of trauma and unnecessary blood thinning agents. Men’s tube socks with the feet cut off at the ankle can provide a layer of protection when around the house. Proven treatment options don’t exist but topical agents containing arnica and bromelain might be of some benefit. The lesions generally take several weeks to spontaneously resolve but may leave a residual brown stain.
Sunscreen Safety Update
June 5, 2019There is growing concern regarding potential adverse health and environmental impact of certain chemicals in sunscreens, oxybenzone in particular. In addition, a small pilot study published in the Journal of the American Medical Association found certain sunscreen chemicals were detected in the blood of study participants.
While there is no evidence that this causes harm, “The FDA is asking for more data on certain ingredients to find out to what extent the skin absorbs these ingredients and if absorbing sunscreen has any effects on the skin or body. This does not mean that the FDA is expressing concern about sunscreen ingredients, nor have they concluded that any of the sunscreen ingredients sold in the U.S. are unsafe.” Henry W. Lim, a former president of the American Academy of Dermatology, said, “What we do know is that all these (sunscreens) have been used for decades in the U.S. And, thus far, there have been no reported data of systemic, internal side effects from the use of sunscreen.
The FDA has determined that the mineral based sunscreens containing titanium dioxide and zinc oxide are generally recognized as safe and effective (GRASE) in protecting the skin from the sun,” Skin cancer is the most common cancer in the United States, and dermatologists see the impact it has on patients’ lives every day. Unprotected exposure to the sun’s ultraviolet rays is a major risk factor for skin cancer, including melanoma, the deadliest form.
The AAD encourages the public to continue to protect themselves from the sun by seeking shade; wearing protective clothing, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses; and generously applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to exposed skin. Please discuss any questions or concerns you have regarding sunscreens with your dermatologist.
Actinic keratoses, sensitive scaly red spots, are precancerous and shouldn’t be ignored!
May 1, 2019In a previous blog (September 2014) we discussed Actinic Keratoses (AKs) as an indicator of sun damage and a precursor to skin cancer. Since then, there is more data demonstrating an increased risk of developing Squamous Cell Carcinomas and Basal Cell Carcinomas in individuals with multiple AKs.
Fortunately, various treatment modalities exist to treat AKs including cryotherapy “freezing”, topical anti-cancer creams, and photodynamic therapy “PDT.” These and other modalities are sometimes used in combination treatments to combat this precancerous condition.
In addition to treatment, preventative measures including minimizing sun exposure, daily use of a broad spectrum sunscreen with minimum SPF 30, wearing hats, protective clothing, and UV protected sunglasses are key.
Skin Cancer Prevention: Update on Vitamin B3 (Nicotinamide)
April 1, 2019We reported on the use of vitamin B3 (nicotinamide) for the prevention of non melanoma skin cancer in our June 2015 blog. A recent review article supports the use of vitamin B3 for prevention of non melanoma skin cancer in high risk patients, defined as those who have had at least 2 non melanoma skin cancers in the past 5 years. Nicotinamide offers various photoprotective and anti-inflammatory effects, and may be able to protect against ultraviolet light induced immune suppression.
The vitamin has little to no side effects in people with normal kidney function. If you think you might benefit from this vitamin, please schedule an appointment to discuss with your dermatologist.
Prevent Wrinkles with Botox and Dysport
March 4, 2019Can regular periodic treatment with medications like Botox and Dysport really prevent wrinkles?
Some facial lines, including those on the forehead and around the eyes, are enhanced by repeated facial expressions. These lines may be evident even when the face is at rest.
Injections of Botox or Dysport relax the muscles involved to minimize the lines from getting as deep. Identical twin studies comparing a twin who has been treated regularly to her untreated twin confirm this.
The Effects of Nail Polish on Toenails
February 4, 2019Winter is the perfect time to give your toenails a break from nail polish. After months of continuous polish, nails can dry out, leaving white rough patches on the surface.
While some white patches may be a superficial fungal infection, nail polish can strip nails and cause keratin granules (the nail protein) to clump on nails.
The good news is that leaving polish off for a few weeks and applying oil to nails will fix this, leaving them ready for spring sandals.
Biological Treatment for Psoriasis
January 3, 2019Psoriasis has been around since antiquity. In fact, many people throughout history (and in the Bible) described with leprosy may have really had psoriasis. Psoriasis may also affect the joints leading to a crippling arthritis and has been associated with an increased risk for other medical conditions including type 2 diabetes and coronary artery disease.
For years, dermatologists relied on topical treatments many of which were messy and not that effective. Various forms of ultraviolet phototherapy can be beneficial for those with more widespread disease. Some systemic chemotherapy agents are also used but have a higher risk of serious side effects. We now have a whole new array of biologic treatments for psoriasis and psoriatic arthritis, which work by targeting over-active immune factors causing psoriasis. If you have been dealing with moderate to severe psoriasis, be sure to ask your dermatologist about these new treatment options.
Nearly 40% of Adults Do Not Know Shingles Vaccine Exists
December 3, 2018Shingles, a localized reactivation of the chicken pox virus, is a serious illness that can leave adults in severe pain, cause eye damage, lead to hearing problems, encephalitis and, in rare instances, death. A recent survey found that only 38% of adults in the U.S. knew a vaccine for shingles was available.
Shingrix, which received FDA approval last year, was found to be 97% effective in adults aged 50 to 69 years, and more than 90% effective in those 70 years of age as well as those past 80.
Adults older than 50 years — even those who have already had shingles, have been vaccinated against the disease with the older, less effective shingles vaccine, Zostavax, or are not sure if they have had the chickenpox — should receive two doses of Shingrix. The second dose is administered 2 to 6 months after the first one.
Patients should not get the Shingrix vaccine if they currently have shingles, have ever had a severe allergic reaction to any ingredient in the vaccine or after a dose of Shingrix, are not immune to the virus that causes chickenpox or are pregnant or breastfeeding.
Adverse events tied to the Shingrix vaccine include headache, feeling tired, muscle pain, shivering, fever, stomach pain or upset stomach, swelling, or redness at the injection site. These events are usually mild and go away within a few days.
Shingrix is available for administration at many pharmacies. It’s advisable to discuss any questions you have about this vaccine with your physician.
Make a Face for Rapid Botox Effect
November 1, 2018Wrinkles typically improve three to four days after treatment with Botox. While facial exercises, such as frowning and grimacing, have been advocated following Botox injections to enhance the benefit and/or onset of action, data has been lacking. A recent randomized controlled study comparing exercise vs no exercise has confirmed the benefit of facial exercises.
Forehead wrinkles were rated as looking better within just two to three days after the treatment if the injections were followed by facial exercises, compared with three to four days without the exercises. After two weeks, there was no difference between those who did or did not do facial exercises. The exercises also made no difference in how long the effects of treatment lasted. Based on this study, facial exercises after treatment with Botox make sense when a rapid benefit is desired.
October 4, 2018As microneedling has grown in popularity, the procedure has been used to treat a range of dermatologic applications, including pigmentary issues (such as melasma), as well as a potential tool for combating hair loss.
Microneedling has shown the most promise as a treatment for:
- Acne and surgical scars
- Skin rejuvenation and wrinkles
An article published in the journal of Dermatologic Surgery earlier this year found that microneedling produces substantial clinical improvement of scars, stretch marks and wrinkles with expedient recovery and limited side effects. The benefits appear to be due to controlled wounding of the skin with stimulation of healing leading to collagen production.
The authors conclude that microneedling is a safe, minimally invasive, and effective esthetic treatment for acne and other scars, wrinkles, and stretch marks. Given its quick post-treatment recovery, limited side effect profile, and significant clinical results, microneedling is a valuable alternative to more invasive procedures such as laser skin resurfacing and deep chemical peeling.
Sunscreens 2018, Part III: Sunscreen Use in Children Reduces Risk of Developing Melanoma
September 1, 2018Childhood sunburns increase the risk of developing melanoma, the deadliest form of skin cancer, later in life. An Australia study found that using sunscreen in childhood reduced the risk of developing melanoma by 40 percent in young adults.
Researchers at the University of Sydney analyzed data collected from nearly 1,700 Australians, ages 18 to 40. They looked at those who were regular users of sunscreen in childhood and compared to those who rarely used the products. The study showed that regular use of sunscreen protects against the damaging effects of sun exposure. As with most cancers, the risk of melanoma increases with age. But according to the American Cancer Society, melanoma is one of the most common cancers in young adults (especially young women).
It is estimated that in 2018, more than 91,000 people in the United States will be diagnosed with melanoma. In the last 10 years, rates for new cases of melanoma have been rising on average 1.5 percent each year, according to the U.S. Centers for Disease Control and Prevention.
To minimize exposure to damaging UV radiation, adopt the following measures:
- Stay in the shade, especially during midday hours (10am- 3pm).
- Wear clothing that covers your arms and legs.
- Wear a hat with a wide brim to shade your face, head, ears, and neck.
- Wear sunglasses that wrap around and block both UVA and UVB rays.
- Use sunscreen with a sun protection factor (SPF) of 30 or higher, and both UVA and UVB (broad spectrum) protection.
- Avoid indoor tanning.
Finally, examine your skin regularly to detect new or changing skin lesions, lesions that look unusual (the ugly duckling sign), and lesions that are irritated or non-healing. It’s also advisable to see your dermatologist periodically for skin exams.
Sunscreens 2018, Part II: Common Myths
August 2, 2018Here are a few common sunscreen myths:
1. Sunscreen sprays offer better protection than lotions: FALSE. Sprays can be convenient but it’s easy to miss or skip exposed areas. It helps to apply to your hands first and then to exposed areas. To minimize inhaling, apply only while outdoors and never directly on the face.
2. Kids need special sunscreens: FALSE. The same ingredients are present in children’s products as in those marketed to adults. The difference is packaging! The same sunscreen can be used for the entire family. Sunscreens should be used starting at 6 months of age.
3. A little bit goes a long way. FALSE. Studies have demonstrated that most people apply less than the recommended amount significantly reducing the effectiveness of the sunscreen. For this reason, applying a sunscreen with a higher SPF value may help compensate. The general guidelines include the “teaspoon rule” for each exposed body part or a shot glass for the entire exposed body (see last months blog for details).
4. The SPF value noted on the product label is reliable: FALSE. Consumer Reports recently reported that most of the sunscreens they tested offered significant protection, however, they didn’t have as high an SPF as promoted.
5. Doubling the SPF of a sunscreen doubles the protection. FALSE. When applied properly, sunscreens with SPF values of 30, 50, and 100 convey 97%, 98%, and 99% protection from UVB rays. For those with very fair complexions, certain photosensitizing conditions, taking photosensitizing medications, or spending significant time outdoors, the difference can be significant.
July 2, 2018This past weekend’s Wall Street Journal (June 30-31) included an article titled, “Burning Question: How Much Sunscreen” highlighting the fact that most of us do not apply enough product to receive the full protection benefit. The general rule of thumb for an adult is to apply a shot glass full of product rubbed into the skin to cover exposed areas. This amount should be adjusted according to body size. Recent research suggests the “teaspoon rule”: Use more than half a teaspoon for each arm, or the face and neck, and more than one teaspoon for each leg, the chest and the back for a total of about 6 teaspoons, or 1 fluid ounce. (A shot glass holds 1.5 fluid ounces.)
What about SPF? The American Academy of Dermatology recommends using a broad based sunscreen (blocks UVA and UVB rays) with minimum SPF 30. It should ideally be applied at least 15-30 minutes before outdoor activity and reapplied every 2 hours and after water activity or heavy sweating. Sunscreens with SPF values above 50 were thought to be of no greater value but a recent study (paid for by Johnson & Johnson) found otherwise.
Keep in mind that sunscreen is one of the important measures for protecting yourself from overexposure to the sun. Others include wearing protective clothing, hats, sunglasses, and minimizing outdoor activities between the hours of 10am and 3pm.
Additional Advice on Skin Cancer Prevention
June 1, 2018UV Lights Used During Gel Manicures Can Increase Risk Of Skin Cancer.
Dr. Chris Adigun said in an American Academy of Dermatology report, “The UV dose that you receive during a gel manicure is brief, but it’s intense. Over time, this intense exposure can add up to cause skin damage.… For many patients, a gel manicure can be life-changing.” Dr. Carolyn Jacob, the director of Chicago Cosmetic Surgery and Dermatology, said, “Whether indoor tanning, UV lamp, outdoor tanning, all of those can cause aging of the skin and potential for skin cancers.”
Sunglasses Are Just As Important As Sunscreen.
Wind, dry weather (low humidity) and the sun can cause eye problems. The sun’s UV rays are particularly damaging, especially UV-B. Wearing the correct type of sunglasses can protect your eyes and help prevent skin cancer of the eyelids and surrounding skin. When shopping for sunglasses look for a UV label – blocking at least 99 percent of UV-A and UV-B rays.
Digital Mole Mapping
May 3, 2018A common question we’re asked by patients we see regularly for skin cancer screening exams is, “Hey Doc, did that mole change?” In reality, it’s often difficult to detect subtle changes without the benefit of a visual baseline. Digital Mole Mapping is a valuable tool that captures multiple clear images at a standard exposure. Photos taken at a later time can be compared side by side. In addition, our system has a software program that alerts us to new lesions and lesions that appear to have changed. Patients with multiple moles or atypical (irregular) appearing moles are excellent candidates for monitoring with mole mapping.
MAY IS SKIN CANCER AWARENESS MONTH:
See our blog from May 4, 2016: How to Detect Early Signs of Skin Cancer. If you haven't had one recently, this is a good time to schedule an appointment for a skin cancer screening exam: Call 310-626-4631 ext. 227
Men Want to Look Their Best
April 4, 2018Men are interested in looking healthy, young, and staying fit. They want to look as good as they feel. They desire cosmetic improvements that look natural. During the past decade there has been a significant increase in the number of non-invasive and minimally invasive cosmetic procedures performed on men. Men are also spending more money on skin care and grooming products. Common male cosmetic concerns include hollowness beneath the eyes (tear troughs), double chin, wrinkles surrounding the eyes (crow’s feet), and forehead lines. The most common concern among men, however, is hair loss. Men are generally less forthcoming about discussing cosmetic issues with their physician until they establish a rapport. The dermatologists of Dermatology Associates Medical Group have expertise in cosmetic treatments for men. If you have questions or would like to schedule a consultation, please call 310.626.4631, ext 227.
Seborrheic Keratoses (SKs)
March 12, 2018Seborrheic Keratoses (SKs),are common benign growths that may be seen on most parts of the body as one matures. According to one study, 83 million Americans have SKs making it as common as acne, rosacea, and psoriasis combined. They are typically described as wart like with a rough, scaly texture and can vary greatly in color, size, and shape. SKs may resemble other benign and malignant skin growths. In this regard, skin lesions with an unusual appearance should always be evaluated by a dermatologist. SKs can be treated with various modalities including cryotherapy (freezing), electrodessication (cautery), curettage (scraping) and scalpel shave removal. A new FDA approved product for the treatment of SKs, called ESKATA, will be available this spring. This hydrogen peroxide based solution is applied to SKs in a dermatologist’s office. The benefit of this treatment compared to other methods is that it doesn’t significantly discolor or scar the underlying skin. If you’d like more information about SKs and or ESKATA, please schedule a consultation with your dermatologist. Call 310.626.4631, ext 227
Cleansers Make a Difference
February 1, 2018Cleansers work by removing impurities, skin care products, and makeup from the skins surface. Some cleansers can enhance the penetration and therapeutic effect of topically applied medications. Many different types of cleansers are available and it's important to select a product that is best for your particular skin. For example, foaming cleansers containing sodium laurel sulfate work well for individuals with oily complexions and can enhance the penetration of other skin care products and medications. These type of cleansers are too harsh for dry or sensitive skin. Alpha hydroxy acid based cleansers gently exfoliate while moisturizing the skin and work well for dry and acne prone skin. They help the latter by lowering the pH of the skin thereby creating an environment that is hostile to the bacteria that play a role in acne. The exfoliating effect enhances penetration of medications applied after cleansing. Salycylic acid based cleansers penetrate the oil (lipid) layer of the skin and are the most effective for unplugging pores. They are ideal for patient's with oily skin and acne, rosacea, and seborrheic dermatitis but are generally too irritating for those with dry/sensitive skin. Antibacterial cleansers contain one of several active ingredients. For example, benzoyl peroxide containing cleansers are helpful for acne patients with the caveat that they are not well tolerated by patients with dry skin.
If you'd like assistance selecting a cleanser and/or would like to update your skin care regimen, please schedule an appointment with our aesthetician, Gloria Prince: 310.626.4631, ext 227
Beauty is in the Eye of the Beholder
January 11, 2018Appreciation of beauty and human aesthetics in particular dates back to antiquity. While ideas on beauty vary with personal preferences and cultural standards, there is a general agreement on the features that constitute human beauty. Researchers from Boston University School of Medicine and Harvard Medical School recently published a study that compared standards of beauty in People Magazine from 1990 to 2017. To test their hypothesis that standards of beauty had not changed over that time period, they compared the Worlds Most Beautiful list in the first issue (1990) with that in the 2017 issue. They evaluated the following: age at the time of the issue, sex, race, skin type, hair color, eye color, and visible dermatologic conditions. The results of the study were contrary to their hypothesis and found an increased inclusion of people with a wider variety of skin color and increased representation of older age groups. They point out that a recent consumer report from the American Society for Dermatologic Surgery found that 60% were considering a cosmetic procedure, and the top 3 reasons were to increase confidence, increase attractiveness, and look as young as they feel. The authors state that “ideals of beauty are particular to the beholder and determined by the norms of a society, culture, or historical period” and conclude that their findings suggest that standards of beauty are evolving as people integrate the effects of media with exposure to new cultures and different norms.
Beware of Intravenous Skin Lightening Agent
December 6, 2017Blotchy, discoloration is a common cosmetic problem that can be pronounced in people with darker skin color. Recently, intravenous glutathione injections have been promoted and administered in certain medi-spas as a treatment to diminish skin blotches and generally lighten skin color. Glutathione is an antioxidant found naturally in human cells. It may cause the skin to lighten by deactivating tyrosinase, the enzyme that helps produce melanin, the skin pigment. Intravenous glutathione is being promoted as an alternative to bleach creams that have limited benefits and potential side effects. There are no large-scale studies on the use of intravenous glutathione for skin lightening or its long term side effects. Evidence for its effectiveness comes from individual case reports or anecdotal experience. Unfortunately, a growing number of women around the world have been using this unproven treatment to reduce blemishes and for skin lightening. It’s wise to stay clear of this treatment that lacks evidence-based proof of safety and effectiveness.
Atopic Dermatitis (AD)
November 3, 2017ATOPIC DERMATITIS (AD) is the most common form of eczema and appears as an itchy skin rash that can vary in appearance. It commonly waxes and wanes and may clear for long periods. AD usually develops in early childhood but may occur at any age. While there is no cure for AD, it is typically managed by avoiding irritation of the skin from harsh soaps and fragrances, moisturizing the skin especially after showers or baths, and applications of medicated creams and ointments. Recently, two new breakthrough medications have become available for the treatment of AD. Eucrisa (crisaborole) is a steroid-free ointment for people with mild-to-moderate eczema and can be used on all skin areas, for adults and children as young as 2 years old. It blocks an inflammatory enzyme that is present in increased concentration in AD. Dupixent (dupilumab) is an injection treatment indicated for the treatment of adult patients with moderate to severe AD whose disease is not adequately controlled with topical prescription therapies and works by blocking the underlying inflammation in AD. These medications are important additions to our therapeutic options for treating AD.
Body Art: Tattoos and Body Piercing
Date: October 3, 2017A report from the Pew Research Center revealed that 38 percent of millennials have at least one tattoo and 23 percent have a piercing somewhere other than an earlobe. There are, however, potential health and social implications that should be considered before acquiring a tattoo or body piercing. The American Academy of Pediatrics stresses the importance of hygienic practices in piercing and tattoo parlors, including making sure practitioners use new disposable gloves, needles from a sealed, sterile container, and fresh unused ink poured into a new disposable container with each client. Fortunately, in California, standards are set for sterilization, sanitation and safety for both tattooing and body piercing. Practitioners have to register with the state health department and are required to submit proof of hepatitis vaccination as well as take a yearly course in blood borne diseases and infection control. While infection is rare, concern about infectious diseases such as HIV, hepatitis and skin infections caused by Staphylococcus aureus (staph) bacteria remain.
Finally, one should carefully consider the social implications of tattoos on highly visible areas such as the hands, fingers, neck, and face. Certain professions are still very conservative regarding tattoos. Keep in mind that tattoo removal by laser is painful, difficult, expensive and only partially effective.
Beware When You Remove Hair Down There! Injuries from Pubic Hair Removal
Date: September 6, 2017Pubic hair removal has become more common in recent years. This is likely due to cosmetic concerns as well as the misconception that hair removal is more hygienic. A recent survey study published in JAMA Dermatology reported on the incidence and types of injuries sustained from removing pubic hair. The survey was sent to 7,570 adults, ages 18-65. Almost half of the people contacted declined to take part in the survey. Of the 52.5% who did take part:
- 66.5% of men said they had groomed their pubic hair, and 23.7% said they'd been injured while doing it.
- 85.3% of women had groomed their public hair and 27.1% had been injured.
- cuts (61.2%)
- burns (23.0%)
- rash (12.2%)
- infection (9.3%)
For women, those who reported waxing as their main method of hair removal were less likely to have repeated frequent injuries. For men (who were less likely to wax) the type of hair removal method made no difference to injury rate.
Pubic hair grooming frequency and degree of grooming (ie, removing all pubic hair) were independent risk factors for injury. Most of the reported injuries were minor with only 1.4% requiring medical attention.
The study has limitations but suggests that pubic hair removal is not without risk and that development of guidelines for safe practices to minimize the risk of injury are needed.
Are Sunscreens Safe?
Date: August 7, 2017Some of our patients continue to express concerns regarding the safety of chemical based sunscreens. We addressed this issue in a tip of the month a few years ago (reprinted below). The information and the message remain the same: sunscreens including chemical based sunscreens are safe and effective!
Here are the facts on sunscreens:
- Regular application of a broad spectrum sunscreen protects the skin from the damaging effects of ultraviolet light exposure. This reduces your risk of premature aging of the skin and skin cancer. For outdoor activity, it's best to use a sunscreen with an SPF of 30 or greater.
- The FDA regulates sunscreens. The ingredients in sunscreens must be shown to be safe and effective before being approved.
- Concerns have been raised about several ingredients found in certain sunscreens:
- Oxybenzone: Protects skin from harmful UVA and UVB rays. Approved in 1978 by the FDA. No data shows it causes hormonal abnormalities or any significant health problem in humans.
- Retinyl Palmitate: Protects skin from premature aging. Naturally found in our skin. There is no evidence it increases the risk of skin cancer in humans.
- Nanotechnology: Prevents active sunscreen ingredients from leaving a white residue on the skin. This leads to better coverage and improved protection from UV radiation. Nanoparticles do not enter the body through healthy or sunburned skin.
- In addition to the application of a broad spectrum sunscreen, wearing UV rated clothing, hats, and sunglasses are additional worthwhile protective measures. Finally, limiting midday outdoor activities (between 10 am and 4 pm in spring and summer) also reduces UV exposure.
Adopted from the American Academy of Dermatology web page, "Is Sunscreen Safe?". For more detailed information visit: http://www.aad.org/spot-skin-cancer/understanding-skin-cancer/how-do-i-prevent-skin-cancer/is-sunscreen-safe
Platelet Rich Plasma (PRP)
Date: July 11, 2017Last month we discussed microneedling treatments for skin rejuvenation, acne scars, dyschromia (skin discoloration) and hair loss. This month, we address PRP, a form of enriched blood obtained from routine venipuncture. The blood is centrifuged to separate a component that has a high concentration of platelets (cells involved in clotting) and growth factors that enhance healing. As a result, PRP has been used in maxillofacial surgery, orthopedics, cardiovascular surgery, and to treat soft tissue ulcers. It is being used alone and in combination with microneedling to enhance regenerative effects for skin rejuvenation, treatment of acne scars, and to treat genetic hair loss (androgenetic alopecia). Studies to date that demonstrate the benefits of PRP for dermatologic conditions are limited but promising. Stay tuned for updates on PRP!
Please call 310-626-4631 ext. 227 to schedule a consultation with one of our physicians!
Microneedling, A Treatment for Many Conditions
Date: June 5, 2017Microneedling, also known as Percutaneous Collagen Induction, is a minimally invasive procedure that uses fine needles to puncture the top layers of the skin to stimulate the release of growth factors and stimulate collagen formation. Studies indicate that microneedling is effective for treating a variety of conditions including scars, acne, melasma, photodamage and for skin rejuvenation/wrinkle reduction. Recent work indicates that it can enhance the delivery and effectiveness of topically applied medications. The simple office procedure involves the application of a topical anesthetic followed by treatment with a sterile cartridge containing multiple micro needles attached to a hand held, electrically powered device. Generally, a series of 3-6 treatments (determined by the area and severity of the condition) every 4 weeks is advised. There is no significant downtime following the procedure. Typically mild to moderate transient redness, similar to a sunburn, is noted. Microneedling is suitable for most skin types and most areas of the body.
Please call 310-626-4631 ext. 227 to schedule a consultation with one of our physicians
Reverse Photoaging with Topical Retinoids
Date: May 3, 2017In last month’s newsletter (derm90210.com), we discussed the signs of photoaging secondary to chronic exposure to UV radiation from the sun and tanning beds. This month we address treatment. The first line of defense is minimizing exposure to the sun especially between 10 am and 4 pm and complete avoidance of tanning beds. It’s also important to apply a broad spectrum sunscreen with UVA/UVB protection and SPF 30. Reversal of photodamage can be achieved with regular application of Retinoid Creams. Over the counter products containing Retinol offer some benefits, but prescription creams such as Tretinoin and Tazarotene are more potent. Tretinoin has been investigated more than any other retinoid for the treatment of photoaging. Studies have shown a decrease in wrinkles, tactile roughness, and sallowness. Retinoids also bolster skins elasticity, slowing the breakdown of collagen (which helps keep skin firm), and lightening brown spots caused by sun exposure. With prescription retinoids, a patient might notice smoother, more even-toned skin in as early as 6 to 8 weeks.
May is Skin Cancer Awareness Month:
In addition to period evaluation by your dermatologist, it’s advisable to perform monthly self-skin exams to detect early signs of skin cancer. For simple helpful tips, see our May 2016 blog: How to detect early signs of skin cancer (derm90210.com)
Maintain Healthy and Attractive Skin by Avoiding Photodamage
Date: April 4, 2017It has been said that nature gives you the face you have at 20 but it's up to you to nurture the face you have at 50. The first priority should be to guard your skin from the sun's ultraviolet rays. Skin aging is influenced by genetics, environmental exposures, hormonal changes, and metabolic processes. These factors alter skin structure, function, and appearance. While changes, such as thinning and loss of elasticity occurs on sun protected skin with the passage of time, ultraviolet (UV) radiation from the sun and tanning beds leads to photodamage which is known to be the single major factor responsible for premature aging. This specific damage occurs with chronic exposure of the skin to UV light and is called photoaging. Visually, the skin becomes coarse and gradually thins. Laxity, sallowness with wrinkles, and irregular pigmentary (color) changes are also noted. The pores of the skin are larger and often clogged. There is also an increase in development of benign growths, premalignant and malignant growths on chronically sun exposed skin.
Living in Southern California, the sun’s UV rays are powerful for most of the year. Strategies for protecting your skin and information about the best product you can apply to your skin to reverse the signs of photoaging will be presented in our May newsletter. Stay tuned!
Tip of the Month: Prevent Acne Scarring
Date: March 3, 2017Our appearance, especially during childhood and adolescence, can significantly influence our confidence and self esteem. Acne can be painful physically and emotionally. The inflammation from this condition can create scars. In spite of the emergence of new treatment modalities, it is impossible to completely reverse scarring. A recent study found that while scars were more likely in those with severe acne, 69% of individuals with acne scars had mild or moderate acne. The risk factors that correlated with an increased likelihood of acne scars include acne severity, time between acne onset and first effective treatment, relapsing acne, and male gender. Acne is a condition that can last for many years and requires management to prevent scarring. The bottom line: to avoid acne scarring, see your dermatologist to institute early treatment for acne.
Please call 310-626-4631 ext. 227 to schedule a consultation with one of our physicians. Fore more news, updates, medical tips, and more, follow our brand new Instagram account @derm90210!
Tip of the Month: Avoid Tanning!
Date: February 1, 2017Our recent abundant rainfall and fewer days with sunshine may tempt some people to use tanning beds or lamps. Unfortunately, use of these devices, like exposure to the sun’s ultraviolet rays, leads to premature aging of the skin and increases the risk of developing skin cancer. A recent study of white women students at Indiana University found that while almost 80 percent did not believe that indoor tanning is safe or any safer than outdoor tanning about seven out of 10 said they like to get a tan even though they know tanning may harm their skin. Nearly 84 percent said tanning makes them feel more attractive.
The International Agency for Research on Cancer (IRAC), part of the World Health Organization, added UV emitting tanning beds and lamps to the list of the most dangerous forms of cancer causing radiation. The IARC report cited research showing that tanning is especially hazardous to young people; those who use sunbeds before age 30 increase their lifetime risk of melanoma, the deadliest form of skin cancer, by 75 percent.
The bottom line is avoiding exposure to UV Radiation from the sun or tanning devices will help to make your skin look younger and healthier!
Tip of the Month: Earlobe Rejuvenation
Date: January 3, 2017Last month, we addressed rejuvenation of the aging lip and surrounding skin. If you aren't pleased with the way your earrings look when you wear them, it could be that your earring holes have elongated or your earlobes have lost volume and appear wrinkled, almost prune like. These alterations can make earrings look unflattering. Fortunately, there are remedies available to correct these issues. Torn or elongated earring holes can be surgically repaired and earlobe volume easily restored with hyaluronic acid based fillers (e.g. Juvederm, Restylane). If you'd like to discuss earlobe rejuvenation, please call 310-626-4631 ext. 227 to schedule a consultation with one of our physicians.
Tip of the Month: Lip Beauty
Date: December 1, 2016Full, well defined lips impart youth, vitality, and sexuality to the bearer. With age, lip volume decreases and the lips may become flat and thin. The lips also tend to droop and creases may develop in the skin around the lips and at the corners of the mouth extending along the sides of the chin. Fortunately, augmentation and correction with injectable hyaluronic acid based fillers (i.e.: Juvederm, Volbella, Restylane, and Restylane Silk) can help restore the aging lip and surrounding skin. These fillers stimulate the skin to produce collagen that may increase the longevity of the treatment. As with any cosmetic procedure, it is essential that the physician injector is well trained and experienced to achieve a natural result with minimal to no downtime. To learn more, schedule a consultation by calling 310-626-4631 ext. 227.
Tip of the Month: Photo Aging of the Neck and Chest
Date: November 2, 2016In earlier newsletters, we’ve addressed prevention and treatment of sun damage. Many of our patient’s complain of color and textural changes of the neck and chest. Common manifestations include blotchy brown pigmentation, redness from fine blood vessels, and thinning/crepey skin. Individuals with fair complexions and those who spend a lot of time in the sun are predisposed. The changes of the skin on the chest are particularly common in women due to “V” neck shirts and other clothing styles that lead to increased sun exposure. Fortunately, simple remedies are available. First, avoiding sun exposure and sun protection are of paramount importance. Daily application of a broad spectrum sunscreen with at least SPF 30 is advised. In addition, covering the exposed area when outside for prolonged periods with a scarf or other article of clothing is very beneficial. Photorejuvenation with Intense Pulsed Light is an excellent treatment for photo aging of the chest and neck. Finally, regular application of Tretinoin Cream is also helpful. To learn more, schedule a consultation by calling 310-626-4631 ext. 227.
Tip of the Month: MANtenance: Simple measures to help you look your best
Date: October 4, 2016Aging of the face is influenced by internal factors such as genetics and hormonal constitution and external factors including ultraviolet (UV) exposure from sunlight, pollution, cigarette smoke, repetitive muscle movements, and diet. The greatest external factors are smoking and exposure to UV light.
In general, men are more likely than women to engage in high-risk health behaviors that contribute to aging. Men also tend to underutilize preventive health care services including dermatology care compared with women.
Look better and stay healthy by avoiding exposure to the sun, especially between the hours of 10 am and 4 pm, wearing hats and sun protective clothing, applying a broad spectrum sunscreen with SPF 30, and refraining from smoking.
In addition, there are many non and minimally invasive treatment options for rejuvenating the aging face including topical skin care, photo rejuvenation, lasers, botulium toxin injections (Botox, Dysport), Filler injections, Kybella injections, and Coolsculpting. To learn more, schedule a consultation by calling 310-626-4631 ext. 227.
Tip of the Month: Is Your Sunscreen Effective?
Date: September 1, 2016
In a previous post we discussed sunscreen safety, but did not address sunscreen efficacy. A recent study of top rated sunscreens sold on Amazon.com revealed that 40% of the 65 top rated products didn’t meet all three of the American Academy of Dermatology’s (AAD) recommended criteria:
1. Sun Protection Factor (SPF) of 30 or greater
2. Broad Spectrum (UVA &UVB) protection
3. Water and/or sweat resistance
These components are particularly important when spending a significant amount of time outdoors.
It’s advisable to check your sunscreen’s label to confirm it satisfies the AAD criteria. In addition, The Skin Cancer Foundation’s website, www.skincancer.org, has lists of safe and effective sun protection products including sunscreens that carry its “seal of recommendation.”
It's important to apply enough sunscreen to optimally protect your skin. This means applying the equivalent of a shot glass (two tablespoons) of sunscreen to the exposed areas of the face and body –a nickel-sized dollop to the face alone. Finally, sunscreen should be reapplied every two hours, or more frequently after swimming, heavy perspiration, or toweling off.
Do Biotin Supplements help hair and nail growth?
Date: August 2, 2016
Biotin, also referred to as Vitamin B7 or Vitamin H, is one of the B complex vitamins, important in the metabolism of carbohydrates, proteins, and fats.
While there is no recommended daily allowance of biotin in the United States, most people ingest enough biotin through their diet. Biotin is found in brewer's yeast; cooked eggs (especially egg yolk), sardines, nuts (almonds, peanuts, pecans, walnuts) and nut butters, soybeans, other legumes (beans, blackeye peas), whole grains, cauliflower, bananas, and mushrooms. In addition, bacteria in our intestines produce biotin. Biotin deficiency is usually recognized by its symptoms, including hair loss, dry scaly skin, cracking in the corners of the mouth, swollen and painful tongue, dry eyes, loss of appetite, fatigue, insomnia, depression, and tingling of the arms and legs. Aside from certain medical conditions/medications (alcoholism, some epileptic drug therapies, individuals with kidney failure who are on dialysis, individuals with Crohn’s Disease and overconsumption of raw egg whites which binds biotin), biotin deficiency is rare. Regarding its use in healthy individuals, there is weak evidence to suggest that biotin supplements may improve thin, splitting, or brittle toe and fingernails, as well as hair. According to the National Institutes of Health, there is not enough evidence to recommend biotin for hair loss.
Tip of the Month: Protection from Mosquito Bites
Date: July 5, 2016Summer travel may take you to areas where mosquitos are carriers of disease inducing viruses including Zika, Dengue, or Chikungunya. To minimize the risk of mosquito bites, it's important to choose an insect repellent that works well and that you are comfortable with. Use an Environmental Protection Agency (EPA)-registered insect repellent with one of the following active ingredients. When used as directed, EPA-registered insect repellents are proven safe and effective, even for pregnant and breastfeeding women.
DEET: Some brand names: Off!, Cutter, Sawyer, Ultrathon
Picaridin, also known as KBR 3023, Bayrepel, and icaridin : Some brand names: Skin So Soft Bug Guard Plus,
Oil of lemon eucalyptus (OLE) or para-menthane-diol (PMD): Brand: Repel
IR3535 : Some brand names: Skin So Soft Bug Guard Plus Expedition, SkinSmart
Additional protective measures include:
Covering up: Wearing long-sleeved shirts and long pants.
Keep mosquitoes outside: Stay in places with air conditioning or that use window and door screens. If you are not able to protect yourself from mosquitoes inside your home or hotel, sleep under a mosquito bed net.
If you're bitten, try to avoid scratching. For itch relief, apply a hydrocortisone cream or calamine lotion to the bite several times daily. Ice or cold pack applications may be helpful as well as oral antihistamines such as diphendydramine (Benadryl and Cetirizine (Zyrtec). If mosquito bites are associated with more-serious warning signs including fever, headache and body aches, contact your doctor.
Adopted from http://www.cdc.gov/features/stopmosquitoes/
Tip of the Month: How Much Sunscreen Should I Apply?
Date: June 1, 2016We’re often asked how much sunscreen should be applied to protect the skin from the damaging effects of ultraviolet (UV) exposure. To achieve the SPF (Sun Protection Factor which protects against the sun’s UV radiation) listed on a bottle of sunscreen, an average sized adult should use the equivalent of a shot glass (two tablespoons) of sunscreen to the exposed areas of the face and body – a nickel-sized dollop to the face alone. Remember that sunscreen needs to be reapplied every two hours, or more frequently after swimming, heavy perspiration, or toweling off. The SPF should be 30 or higher for extended time spent outdoors and there is no evidence that using a sunscreen with an SPF higher than 50 conveys more protection. Newborns should be kept out of the sun and it is advisable to apply sunscreen to children over 6 months of age.
In addition to using sunscreen, seek shade whenever possible, minimize the hours spent in the sun (especially between 10 am and 4 pm), wear sunprotective clothing, broad-brimmed hats, and UV-blocking sunglasses.
Tip of the Month: How to Detect Early Signs of Skin Cancer
Date: May 4, 2016May is skin cancer awareness month. In addition to periodic examinations by your dermatologist, monthly self skin exams can also pick up early signs of skin cancer. Our patient's often comment that they have difficulty recognizing the particular features of skin cancer (see www.skincancer.org for photos and descriptions of melanoma and the more common and generally less serious non-melanoma skin cancers.) Here are a few simple tips:
- If a skin lesion is new or changing, schedule an appointment with your dermatologist for evaluation.
- Skin lesion(s) that appears significantly different from your other skin lesions should be evaluated by your dermatologist. This is commonly referred to as the "ugly duckling sign" or "funny looking mole sign."
- Any skin lesion with bleeding, crusting, scaling, or irritation that doesn’t heal within a couple of weeks should be evaluated by your dermatologist.
We also recommend that you protect your skin from the damaging effects of the sun’s ultraviolet radiation by using sunscreen (more on this next month), seeking shade whenever possible, minimizing the hours spent in the sun (especially between 10 am and 4 pm), wearing sun-protective clothing, broad-brimmed hats, and UV-blocking sunglasses.