Medical Tip of the Month: Actinic Keratoses

Fall is the perfect time to refresh your skin! Microneedling stimulates your body’s natural collagen and elastin production, softening fine lines, improving texture, and minimizing pores. For even greater results, many patients choose to combine microneedling with platelet-rich plasma (PRP), which harnesses your body’s own growth factors to speed healing and enhance your glow.

For those looking for more dramatic improvement, Fraxel laser targets deeper wrinkles, sun damage, and scars with powerful results. While downtime may be a bit longer than microneedling, Fraxel often delivers more noticeable change in fewer sessions. Both treatments are excellent options for rejuvenating skin as we move into the cooler months.

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As part of our comprehensive dermatology offerings, we're excited to offer facials performed by our new aesthetician, Gloria!A facial is a non-invasive, non-surgical treatment that targets various skin concerns, from acne and hyperpigmentation to fine lines and dryness. Our aesthetician uses a combination of techniques, including gentle exfoliation, extractions, and nourishing masks, to leave your skin feeling refreshed, revitalized, and radiant.But did you know that facials are more than just a pampering treat? They also have real medical benefits! By deep cleansing pores and removing dead skin cells, facials can help prevent clogged pores and reduce the appearance of fine lines and wrinkles. They can also improve skin tone and texture, reduce inflammation, and even help manage skin conditions like acne and rosacea. Plus, our aesthetician works closely with our dermatologists to customize each facial to your unique skin concerns and needs.Contact us today to schedule your appointment and start glowing from the inside out!

Acne can affect both teens and adults alike. The relationship between diet and acne is confusing. There is evidence to suggest that certain dietary factors may influence acne; however, the exact mechanisms and specific dietary recommendations are still being elucidated. Some studies suggest that consuming high glycemic index (GI) foods, like sugary snacks and refined carbohydrates, can lead to increased insulin levels, exacerbating acne by boosting sebum production and inflammation.Additionally, certain dairy products, particularly skim milk, may influence acne development due to hormones and growth factors. Protein powders that contain milk-derived whey protein can also exacerbate acne. Diets high in omega-6 fatty acids, found in processed foods and some vegetable oils, may promote inflammation, while omega-3 fatty acids, found in sources like fatty fish, may have anti-inflammatory effects beneficial for acne-prone skin.We always recommend incorporating antioxidant-rich foods such as fruits and vegetables, as well as staying hydrated, to best support skin health. However, individual responses to dietary changes vary, so consulting with your dermatologist for personalized advice is recommended.

While sun protection is our main weapon against skin cancer, recent research offers another layer of defense: nicotinamide, a form of vitamin B3. Available as an oral supplement, nicotinamide, has shown impressive results in reducing the development of both skin cancers and actinic keratoses, precancerous lesions that often progress to cancer. Studies have found it can decrease the incidence of common skin cancers like basal cell carcinoma and squamous cell carcinoma by up to 23%, and reduce actinic keratoses by 15%. This translates to a powerful tool in our arsenal for protecting your skin from the sun's long-term damage.How does it work? Nicotinamide supports DNA repair after sun exposure, boosting your skin's natural defenses against UV damage. It also helps maintain a healthy immune response, another key factor in preventing skin cancer. While sun protection remains crucial, nicotinamide could be a valuable tool for high-risk individuals, such as those with a history of skin cancer or extensive sun exposure.While sun protection remains the cornerstone of skin cancer prevention, nicotinamide offers an additional layer of defense for individuals at high risk, such as those with a history of skin cancer or frequent sun exposure. We're excited to discuss this promising development with you at your next appointment and explore if it might be a good fit for your individual skin health needs.

Winter can bring about a variety of skin challenges, with one common issue being "winter itch" or dry skin. Cold temperatures, low humidity, and indoor heating can strip your skin of its natural moisture, leading to dryness, itching, and discomfort. Here are some tips to help you care for your skin during the winter.

1. Hydrate from the Inside Out:
   • Drink plenty of water to stay hydrated.
   • Consume foods rich in omega-3 fatty acids, like fish, flaxseeds, and walnuts.
2. Moisturize Regularly:
   • Use a thick, emollient moisturizer immediately after bathing.
   • Apply moisturizer at least twice a day, focusing on areas prone to dryness.
   • Look for moisturizers containing ingredients like hyaluronic acid, glycerin, or shea butter.
3. Gentle Cleansing:
   • Use a mild, fragrance-free cleanser to avoid further irritation.
   • Avoid hot water, as it can strip your skin of natural oils. Opt for lukewarm water instead.
4. Shorter, Lukewarm Baths or Showers:
   • Limit your bath or shower time to 10-15 minutes.
   • Use lukewarm water instead of hot water, as hot water can worsen dryness.
5. Humidify Your Home:
   • Use a humidifier to add moisture to the air, especially in bedrooms.
   • Aim for a humidity level between 30-50%.
6. Choose Winter-Friendly Fabrics:
   • Wear breathable, natural fabrics like cotton to prevent skin irritation.
   • Layer clothing to stay warm without overheating.
7. Protect Your Skin Outdoors:
   • Wear gloves, scarves, and hats to shield your skin from harsh winds and cold temperatures.
   • Apply a broad-spectrum sunscreen to exposed skin, as winter sun can still cause damage.
8. Avoid Irritants:
   • Choose fragrance-free and hypoallergenic products to minimize the risk of irritation.
   • Be mindful of harsh soaps, as they can exacerbate dryness.
9. Use Ointments for Severe Dryness:
   • For extremely dry areas, consider using an ointment rather than a lotion, as ointments are thicker and provide more protection.
10. Consult a Professional:
    • If your skin condition persists or worsens, consider a consult for personalized advice and treatment options.

Finger tip fissures, commonly known as cracked or split skin of the fingertips, can be both painful and cause functional impairment. Simple tasks such as grasping objects or buttoning a shirt may be difficult. Many people suffer from fingertip fissures during cool dry winter weather. Other potential aggravating factors include excessive water exposure (especially hot water), chemicals in household cleaning products, and underlying skin conditions, including eczema and psoriasis.Treatment involves avoiding exposure to aggravating factors, wearing gloves when washing dishes and other wet exposure work, and moisturizing frequently with products that are occlusive and contain dimethicone, such as Aveeno Therapy Itch Relief Balm. For deeper fissures, liquid bandage products, such as NuSkin or Bactine applied once or twice daily are often helpful.Finally, if the above measures are inadequate, your dermatologist may prescribe a potent topical steroid and/or topical antibiotic ointment.

Have you noticed rough, wart-like growths popping up on your skin? While they might be concerning, the good news is they're likely just seborrheic keratoses, and not something to fret about.What are Seborrheic Keratoses?These common skin growths are completely harmless, and incredibly common, especially as we age. They typically appear as small, raised bumps with a waxy or scaly surface. Colors can range from brown and black to tan and yellow, and they often have a rough, stuck-on appearance. While they can appear anywhere on the body, they favor the chest, back, shoulders, and face.Why See a Dermatologist?While seborrheic keratoses are harmless, it's important to have them checked by a dermatologist, especially if they're new, changing, or causing you any discomfort. This is because they can sometimes resemble other, more concerning skin conditions like skin cancer. A quick examination by a trained professional can give you peace of mind, and rule out any underlying issues.Schedule Your Skin Exam Today!

Dry skin is sometimes only a cosmetic issue, but many patients with dry skin complain of irritation and itching. Some develop cracks and fissures that can lead to skin infections. There is a common misconception that dry skin is due to decreased oil production, but it's actually a result of water loss due to changes in the skin that occur as we age. That’s why there’s a plethora of creams and lotions promoted as “moisturizers”. Most of these products contain oil in water to add moisture and keep it on the skin. The key ingredients to look for in an effective moisturizer include:

1. Occlusives: These ingredients prevent water loss by blocking evaporation, eg: petrolatum, lanolin, mineral oil, silicones
2. Humectants: Pull water into the top layer of skin (stratum corneum), eg: Hyaluronic Acid (see last month’s blog), glycerin, urea, panthenol
3. Emollients: Make the skin feel soft and smooth, eg: dimethicone, cyclomethicone, jojoba oil

The ingredients are listed on the products package label in decreasing order of concentration and those noted above should be near the top. Here are some additional tips for dealing with dry skin:

• Take shorter showers or baths with warm water. Avoid long exposure to hot water that can strip your skin of oils.
• Use soap primarily on areas of the body that require it and minimize it’s use elsewhere. Moisturizing soaps, eg, Dove, Oil of Olay or soap free cleansers, eg, Cetaphil, Ceravé are good choices. Avoid deodorant soaps and products with fragrance.
• Wash with your hands instead of wash cloths, brushes, and sponges or use them lightly to avoid irritation and blot skin dry gently when toweling.
• Apply a moisturizer immediately after shower or bath to lock in moisture.
• Consider using a humidifier in your bedroom during winter time.

Hyaluronic acid (HA) is a natural substance found in the skin that helps retain moisture, keeping it plump and hydrated. Over time, the production of hyaluronic acid (along with collagen and elastin) decreases. Consequently, our skin loses volume and moisture.When used in skincare products, HA acts as a powerful humectant, attracting and holding water in the skin. Its ability to maintain skin hydration is especially beneficial for individuals with dry or aging skin, as it replenishes moisture and revitalizes the skin's texture.Allergic reactions or irritation of sensitive skin isn’t common with HA. It’s safe to use on the skin during pregnancy and while breastfeeding, making it a versatile ingredient in skincare formulations.It’s important to understand that topical HA contains molecules that are large and provide hydration on a surface level, not deep within the skin. In order to add volume and diminish wrinkles, dermal fillers that contain HA are available for injection into the skin. These products work by lifting and filling areas such as the cheeks, the folds around the mouth and chin, and the lips as well as other areas.

A recently published New York Times article discusses the benefits of over the counter Retinol products for the skin. For those who have tried retinol containing products and would like to try something stronger, prescription products like tretinoin (Retin A) or tazarotene (Tazorac) should be considered.These FDA approved medications have been shown to improve the texture and color of the skin and fade fine lines when used consistently over time. The end result is smoother, younger appearing skin. Side effects include potential skin irritation and sun sensitivity so it’s important to apply sunscreen on a daily basis. Waxing for hair removal should be avoided or the product must be held for at least a week before waxing. Retinoids should not be used by pregnant or nursing women.These products are generally applied nightly but should initially be applied 2-3 times weekly at night to minimize the risk of irritation then gradually increased to nightly as tolerated. If you’d like to try one of these medications please schedule an appointment with your dermatologist.