More Blog Posts
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
Face the Facts About Cosmeceuticals
March 3, 2020Cosmeceuticals are over the counter skin care products that contain biologically active ingredients. Underscoring their popularity, there’s been double digit annual growth of new products entering the marketplace over the past decade and it’s been estimated that the global market value of the cosmeceutical industry will be $73 billion by 2023! Cosmeceuticals typically contain lower concentrations of active ingredients than prescription products and are classified as cosmetics by the FDA. Consequently, they do not have to undergo the same level of scrutiny with regard to safety and efficacy before entering the marketplace. With so many options available, how does one select the right products? A recent review article in the International Journal of Dermatology evaluates data for some of the most commonly used active ingredients in cosmeceuticals and came to the following conclusions:
Retinols have strong evidence for improving lines/wrinkles, pigmentation, elasticity, firmness, brightness, and overall photo damage. The product should contain at least 0.25% retinol to be effective.
Vitamin C (ascorbic acid) has strong clinical evidence for improving discoloration/pigmentation and for fighting ultraviolet induced skin damage. Topical vitamin C is unstable and not all products are the same. It should be packaged in opaque airtight containers.
Glycolic Acid has strong clinical evidence to treat acne, fine lines, roughness, and pigmentation
Hyaluronic Acid has clinical support for improving skin hydration, elasticity, firmness, wrinkles, and roughness.
Collagen doesn’t have evidence to support its effectiveness topically. Collagen is a large molecule and is unlikely to penetrate the top layer of skin.
Keep in mind that formulations and stability can vary from product to product. Also, many claims are based on lab studies that don’t necessarily correlate with actual clinical results. Please schedule an appointment with your dermatologist if you have questions about your skin care products and routine.
February 3, 2020A newly released study by the FDA confirmed evidence of a recent smaller pilot study that certain chemical sunscreens can be detected in the blood following topical application. The specific ingredients evaluated include UV filters that screen out the sun's harmful rays: avobenzone, oxybenzone, octocrylene, homosalate, octisalate, and octinoxate. It did, however, find elevated levels of the chemicals for days and even weeks following application. It’s worth pointing out that the sunscreen products were applied to 75% of body surface area over 4 days. They were applied once on day 1 and four times during the remaining 3 days at 2-hour intervals. This study didn’t look for or find evidence of deleterious health issues. While research is needed before it can be determined if the absorption of sunscreen ingredients has any effect on a person’s health, these ingredients have been used for several decades without any reported internal side effects in humans.
So what should you do now if you want to protect yourself or your kids from the sun? Mineral based sunscreens with at least SPF 30 containing zinc oxide and/or titanium dioxide are safe and effective. Some of the newer formulations are aesthetically pleasing leaving minimal to no white film compared to earlier versions. Sun protective clothing and UV protected sunglasses are also very helpful. Minimize sun exposure between 10 am and 2 pm especially in spring and summer when UV radiation is at its peak. Skin cancer is the most common cancer in the United States and can significantly impact quality of life. Unprotected exposure to the sun’s harmful ultraviolet rays is a major risk factor for skin cancer and everyone should protect their skin by limiting exposure to the sun. If you have questions about sunscreens and sun protection measures please talk to your dermatologist.
Are Natural Skin Care Products Safer?
January, 8 2020Concern about the safety of product ingredients has led to a significant growth in the sale of natural skin care products. A recent editorial titled, “Natural Does Not Mean Safe—The Dirt on Clean Beauty Products” (JAMA Dermatol. 2019;155(12):1344-1345.) points out that science refutes many assertions by those who promote natural skin care/clean beauty products.
The FDA has failed to define clean and natural, leaving these labels open to interpretation by nondermatologist retailers, bloggers, and celebrities who have set out to define clean beauty for themselves. According to the article, hundreds of compounds have been arbitrarily demonized without scientific backing by the clean beauty movement. A couple examples include petrolatum, an excellent and economical moisturizer for severely dry skin, and parabens, which are some of the least allergenic preservatives available and were named 2019 nonallergen of the year by the American Contact Dermatitis Society. By contrast, many so-called natural products contain high concentrations of botanical extracts that are a leading cause of irritant or allergic contact dermatitis and photosensitization (sun sensitivity).
The Environmental Working Group’s (EWG), a powerful force driving the clean beauty dialogue, scores thousands of products based on the putative toxicity of their ingredients, but their method for assessing risk doesn’t seem to be backed by data and their claims are not always uniformly agreed on by a broad consensus of experts. The bottom line is that natural is a marketing term that does not necessarily mean safer or more effective. If you have questions regarding the safety of your skin care products please speak to your dermatologist during your next office visit.
Vaccinations and Health
December 4, 2019Flu season is here and our office patient evaluation questionnaire includes questions about vaccination history, specifically flu and shingles. We’ve found that many patients don’t receive their recommended vaccines. The development of vaccines has been one of the major advances in modern medicine for protection against certain serious diseases, preventing spread of these diseases, and saving lives.
According to the Centers for Disease Control and Prevention (CDC), Vaccines are recommended for children, teens, and adults based on different factors like age, health conditions, lifestyle, jobs, and travel. CDC and other medical experts update vaccine recommendations every year based on the latest research and science.
Vaccination is a critical step in protecting those that are most vulnerable to illness – infants and young children, the elderly, and those with chronic conditions and weakened immune systems. Vaccination is important because it not only protects the person who gets the vaccine, but also helps to keep diseases from spreading to others, like family members, neighbors, classmates, and other members of your communities.
Like any medication, vaccines can cause side effects. In most cases, side effects are mild (e.g., soreness where the shot was given) but go away within a few days. Severe, long-lasting side effects from vaccines are rare.
For additional information about vaccines check the CDC website, www.cdc.gov, and discuss vaccines with your primary physician.
November 1, 2019Itching, that annoying, sometimes persistent problem can actually be a very complicated symptom. When accompanied by a rash, the problem is usually a bit easier to diagnose but itching without a rash can be more difficult.
Dry skin, especially in fall and winter, is generally the most common cause of itching, followed by a number of medications.
Some underlying diseases such as thyroid, kidney or liver disease, anemia, diabetes, cancer, certain nerve conditions, and some mental health conditions can be an underlying cause of itching.
Your dermatologist can evaluate you to determine the cause of your itching and offer suggestions for relief.
Rejuvenate with Superficial Skin Peels
October 9, 2019In our September newsletter, we discussed the importance of the skin barrier’s acid mantle protective layer and how excessive and or harsh cleansing agents may be. This can cause dry, flaky, sensitive skin and may aggravate various underlying skin conditions.
On the other hand, an occasional light chemical peel might be a good supplement to your regular skin care regimen. This involves the application of a chemical solution to remove top skin layers leading to growth of new, smoother, and younger looking skin.
Removing only the outer layers of skin, this exfoliation can help uneven pigmentation, dryness, acne and fine wrinkling. These procedures take only 15 minutes, and the downtime is minimal. We offer various kinds of light peels including Beta Lift, VIPeels and mild strength TCA peels. Talk to your doctor about the right peel for you.
Skin Care: Sometimes Less is More
September 5, 2019Sensitive, dry, flaky skin is common, particularly in mature individuals. These findings are signs of a disrupted skin barrier. Skin barrier dysfunction also appears to play a role in certain conditions including rosacea, eczema, psoriasis and acne. Many factors come into play including genetics, environment, and skin care products. The skin barrier contains the acid mantle, the protective film of natural oils, amino acids and sweat that covers your skin.
Skin grows more alkaline as we age, activating enzymes that break down collagen. Barrier problems are exacerbated by damage from too much scrubbing or alkaline washes. Frequent applications of salicylic, glycolic and/or lactic acid containing products and physical damage from overuse of scrubs and abrasive procedures (eg microdermabrasion) can also play a role.
The solution? Reduce the frequency of abrasive procedures (weekly or less for normal to dry skin and 3 times weekly for oily skin). Avoid using multiple products and especially alkaline cleansers with a pH greater than 7(most super-foamy and lathery face washes). Apply moisturizers after cleansing that contain ingredients such as ceramides, glycerin, petrolatum, and hyaluronic acid that help repair the skin barrier and retain moisture.
Don't get burned from drinking too much alcohol!
August 1, 2019There is research that has demonstrated an increased risk of developing melanoma in people who regularly drink alcohol. While the mechanism for this isn’t clear, alcohol consumption increases an individual’s likelihood of getting sunburned, a risk factor for skin cancer. While, those who drink may spend more time in the sun and be less likely to apply/reapply sunscreen, there appear to be other factors involved. A recent study of men from Germany demonstrated that after drinking alcohol, the amount of UV light it took to burn the skin was significantly less.
The researchers also measured the concentration of carotenoids in the study participants' bodies. Carotenoids are the yellow, orange and red pigments that are produced by plants. When we consume carotenoids from fruits and vegetables, these pigments exert an antioxidant effect in our bodies that may help protect against the damage done by the UV light. In the study, the men's carotenoid levels were lower after they consumed alcohol, so the researchers speculate that this decline in antioxidants may make the skin more vulnerable to the adverse effects of the sun.
More research is needed but it appears that the increased tendency to sunburn when drinking alcohol is a contributing factor to developing skin cancer. The bottom line is: moderate drinking and minimize sun exposure.
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.