Tuesday, August 5, 2014

Hair Loss

Hair Loss
American Academy of Dermatology

Hair has been called our "crowing glory". Society has placed a great deal of social and cultural importance on hair and hairstyles. Unfortunately, many conditions, diseases, and improper half care result in excessive hair loss. People who notice their hair shedding in large amounts after combing and brushing, or whose hair becomes thinner or falls out, should consult a dermatologist. With correct diagnosis, many people with hair loss can be helped.

Dermatologists, physicians who specialize in treating diseases of the hair and skin, will evaluate a patient's hair problem by asking questions about diet, medications including vitamins and health food taken in the last six months, family history of hair loss, recent illness and hair care habits. Hormonal effects may be evaluated in women by asking about menstrual cycles, pregnancies and menopause. After examining  the scalp and hair, the dermatologist may check a few hairs under the microscope. Sometimes blood tests or a scalp biopsy may be required for an accurate diagnosis. It's important to find the cause and whether or no the problem will respond to medical treatment.

Normal Hair Growth
About 90 percent of the hair on a person's scalp is growing at any one time. The growth phase lasts between two to six years. Ten percent of the hair is in resting phase that lasts two to three months. At the end of its resting stage, the hair is shed. When a hair is shed, a new hair from the same follicle replaces it and the growing cycle starts again. Scalp hair grows about one-half inch a month. As people age, their rate of hair growth slows. Natural blondes typically have more hair (140,000 hairs) than brunettes (105,000 hairs) or red heads (90,000 hairs). Most hair shedding is due to the normal hair cycle, and losing 50-100 hairs per day is no cause for alarm.

Causes of Excessive Hair Loss
Improper hair cosmetic Use/Improper Hair Care- Many men and women use chemical treatments on their hair, including dyes, tints, bleaches. straighteners and permanent waves. These treatments rarely damage if they are done correctly. The hair can become weak and break if any of these chemicals are used too often. Shampooing, combing and brushing too often can also damage hair, causing it to break. When hair is wet, it is more fragile, so vigorous rubbing with a towel, and rough combing and brushing should be avoided. Use wide toothed combs and brushes with smooth tips.

Hereditary Thinning or Balding- Hereditary balding or thinning is the most common cause of hair loss. The tendency can be inherited from either the mother's or father's side of the family. Women with this trait develop thinning hair, but do not become completely bald. The condition is called androgenic alopecia and it can start in the teens, twenties or thirties. There is no cure, although medical treatments have recently become available that may help some people. One treatment involves applying a lotion, minoxidil, to the scalp twice a day. Another treatment for men is a daily pill containing finasteride, a drug that blocks the formation of the active male hormone in the hair follicle.

When confronted with thinning hair or baldness, men and some women consider hair transplantation, which is a permanent form of hair replacement. Anyone who has suffered permanent hair loss may be a candidate for hair transplantation. The procedure of hair transplantation involves moving some hair from hair-bearing portions (donor sites) of the head to bald or thinning portions (recipient sites) and/or removing bald skin. Because the procedures involve surgery as well as time and money, they should not be undertaken lightly.

Your dermatologist will help decide which method or combination of methods is right for you.

Alopecia Areata- In this type of hair loss, hair usually falls out, resulting in totally smooth, round patches about the size of a coin or larger. It can, rarely, result in complete loss of scalp and body hair. This disease may affect children or adults of any age.

The cause of alopecia areata is unknown. Apart from the hair loss, affected persons are generally in excellent health. In most cases, the hair regrows by itself. Dermatologists can treat many people with this condition. Treatments include topical medications, a special kind of light treatment, or in some cases pills.

Childbirth- When a woman is pregnant, more of her hairs will be growing. However, after a woman delivers her baby, many hairs enter the resting phase of the hair cycle. Within two to three months, some women will notice large amounts of hair coming out in their brushes and combs. This can last one to six months, but resolves completely in most cases.

High Fever, Severe Infection, Severe Flu- Illnesses may cause hairs to enter the resting phase. Four weeks to three months after a high fever, severe illness or infection, a person may be shocked to see a lot of hair falling out. This shedding usually corrects itself.

Thyroid Disease- Both an over-active thyroid and an under-active thyroid can cause hair loss. Your physician can diagnose thyroid disease with laboratory tests. Hair loss associated with thyroid disease can be reversed with proper treatment.

Inadequate Protein in Diet- Some people who go on crash diets that are low in protein, or have severely abnormal eating habits, may develop protein malnutrition. The body will save protein by shifting growing hairs into the resting phase. Massive hair shedding can occur two to three months later. Hair can then be pulled out by the roots fairly easily. This condition can be reversed and prevented by eating the proper amount of protein and, when dieting, maintaining adequate protein intake.

Medications- Some prescription drugs may cause temporary hair shredding. Examples include some of the medicines used for the following: gout, arthritis, depression, heart problems, high blood pressure, or blood thinner. High doses of vitamin A may also cause hair shedding.

Cancer Treatments- Some cancer treatments will cause hair cells to stop dividing. Hairs become thin and break off as they exit the scalp. This occurs one to three weeks after the treatment. Patients can lose up to 90 percent of their scalp hair. The hair will regrow after treatment ends. Patients may want to get wigs before treatment.

Birth Control Pills- Women who lose hair while taking birth control pills usually have an inherited tendency for hair thinning. If hair thinning occurs, a woman can consult her gynecologist about switching to another birth control pill. When a woman stops using oral contraceptives, she may notice that her hair begins shedding two or three months later. This may continue for six months when it usually stops. This is similar to hair loss after the birth of a child.

Low Serum Iron-  Iron deficiency occasionally produces hair loss. Some people don't have enough iron in their diets or may not fully absorb iron. Woman who have heavy menstrual periods may develop iron deficiency. Low iron can be detected by laboratory tests and can be corrected by taking iron pills.

Major Surgery/Chronic Illness- Anyone who has a major operation may notice increased hair shredding within one to three months afterwards. The condition reverses itself within a few months but people who have a severe chronic illness may shed hair indefinitely.

Fungus Infection (Ringworm) of the Scalp-  Caused by a fungus infection, ringworm (which has nothing to do with worms) begins with small patches of scaling that can spread and result in broken hair, redness, swelling, and even oozing. This contagious disease is most common in children and oral medication will cure it.

Hair Pulling (Trichotillomania)-  Children and sometimes adults will twist or pull their hair, brows or lashes until they come out. In children especially, this is often just a bad habit that gets better when the harmful effects of that habit are explained. Sometimes hair pulling can be a coping response to unpleasant stresses and occasionally is a sign of a serious problem needing the help of a mental health professional.

See your dermatologist - Excess hair loss can have many different causes. Hair will regrow spontaneously in some forms of hair loss. Other forms can be treated successfully by a dermatologist. For the several forms of hair loss for which there is no cure at present, there is research in progress that holds promise for the future.


October 2013
Skin & Allergy News

Eye Treatment
Redermic R eyes is available from La Roche-Posay to improve the appearance of lateral canthal lines (Cow's Feet) and dark circles under the eyes and promote firmer, smoother skin tone. The product features 0.01% pure retinol, plus a unique retinol booster complex designed to increase the effectiveness of the retinol while minimizing skin irritation. In addition, the product contains 0.2% caffeine to provide additional antiwrinkle benefits and to mitigate the appearance of dark circles under the eyes and contact lens wearers.

La Roche-Posay

Formaldehyde concentrations in hair straightening products may be health treat



Formaldehyde concentrations in Brazilian keratin hair straightening products may be high enough to serve as a health hazard, a recent study reports. 
Researchers in South Africa measured formaldehyde concentrations in seven commercial Brazilian keratin treatments marketed in South Africa in 2012 using a high-performance liquid chromatography with ultraviolet light detection after derivatization with dinitrophenylhydrazine. 
While the maximum safe concentration set by the U.S. Cosmetic Ingredient Review Expert Panel is less than 0.2 percent, the researchers found that six of the brands studied, five of which were labeled “formaldehyde free”, actually had levels ranging five times higher than this recommended level (0.96 to 1.4 percent). 
The authors tested each brand three times.  
“Industry monitoring is needed to improve compliance and protection of hairdressers and consumers,” the authors concluded
DermatologyTimes 2/2014

FDA Looking at safety of antibacterial hand soaps

The Food and Drug Administration has proposed a rule that would require manufacturers of antibacterial hand soaps to demonstrate that their products are safe and effective.

The FDA is conducting an ongoing review of the active ingredients in antibacterial soaps to ensure they are safe for long-term daily use and whether they are more effective than plain soap and water for preventing illnesses and the spread of germs, according to a news release.

“Some data suggest that long-term exposure to certain active ingredients used in antibacterial products — for example, triclosan (liquid soaps) and triclocarban (bar soaps) — could pose health risks, such as bacterial resistance or hormonal effects,” the FDA stated.

The proposed rule does not impact hand sanitizers, wipes or antibacterial products used in healthcare settings. The FDA noted that nearly all soaps labeled as “antibacterial” or “antimicrobial” contain at least one of the antibacterial ingredients addressed in the proposed rule.

“Due to consumers’ extensive exposure to the ingredients in antibacterial soaps, we believe there should be a clearly demonstrated benefit from using antibacterial soap to balance any potential risk,” Janet Woodcock, M.D., director of the FDA’s Center for Drug Evaluation and Research, said in the news release.
DermatologyTimes 2/2014

The Value Of Cosmeceuticals

Dr. Levine: There is a lot of misinformation out there about so-called cosmeceuticals, what they can do for our patients and how we should promote them. Can you explain what is a cosmeceutical, how is it different from a drug and how is it different from a cosmetic?

Dr. Draelos: Actually there is no such thing as a cosmeceutical. The FDA (Food and Drug Administration) does not recognize this term. The term cosmeceutical, in their eyes, is another word for cosmetics. I think if you ask the dermatologists what is a cosmeceutical, they would tell you that it’s a product that enhances the skin in some manner, different from a cosmetic that traditionally is thought to only scent, color, and adorn the skin, but there is no such thing as cosmeceutical from a regulatory standpoint.

There are three categories: there are prescription drugs; there are over-the-counter (OTC) drugs, which include such things as sunscreen, antiperspirants, and toothpaste; and then there are cosmetics. Cosmetics are a category that is currently unregulated. The over-the-counter drugs are regulated through a monograph and we are all familiar with how the FDA regulates pharmaceuticals.

Cosmeceuticals is a relatively new category. It’s a contraction of the word cosmetic and pharmaceutical that was coined by Dr. Albert Kligman. There are countries around the world where cosmeceuticals are recognized, such as Japan. In Japan they call cosmeceuticals quasi-drugs. Cosmeceuticals are basically substances that perhaps might alter the skin, but the marketing claims that are used are identical to cosmetics and all ingredients that are used in cosmeceuticals must be considered GRAS (Generally Recognized As Safe) ingredients.

Dr. Levine: So by definition if these are cosmetics, my understanding is therefore they can have no medicinal value?

Dr. Draelos: Exactly. If you look at the claims that are made for the efficacy of cosmeceuticals, they are all appearance claims. A drug claim would be “gets rid of wrinkles;” a cosmeceutical or cosmetic claim would be “improves the appearance of wrinkles.” As you are reading packaging and trying to decide exactly what this particular formulation does, you will notice that it says “improves the appearance of fine lines,” “improves the appearance of pores,” “improves the appearance of facial redness,” “smoothes the skin,” “makes skin more radiant,” “makes skin more luminous.” Those are all referring to appearance changes that could be induced by the product when it’s applied to the skin.

Dr. Levine: So does that mean that we as dermatologists have some obligation not to differentiate cosmeceuticals from cosmetics, or can we go beyond what FDA is interpreting as cosmetic?

Dr. Draelos: I think we can go little bit beyond the FDA, because we are actually seeing the entry into dermatology of many substances that actually are cosmetic drugs. One of the first ones was approved by the FDA this year for a product that reduces facial redness. It is temporary, like a cosmetic. It reduces facial redness for several hours depending on the individual. It is given to the patient in a form of a prescription. It is purchased at the pharmacy, but instead of “curing or altering the disease process,” it simply improves the appearance of facial redness.

We are starting to see in dermatology the entry of substances that improve appearance but are truly drugs, which is one end of the spectrum of cosmeceuticals. And then we also see products that are entering the marketplace, for example, things that are called line blurs or wrinkle reducers, and those are products that are also temporary, but they are purchased over-the-counter and they contain silicone. The silicone base fills in the undulations of the skin surface where the wrinkles are present, and by filling those in, (it) improves skin smoothness and diminishes the appearance of wrinkles. So it’s interesting that we have — in two very different categories — products to achieve the same thing, which is a temporary improvement in appearance.

Dr. Levine: So what do we as dermatologists do to find out which ones have some value and which ones do not?

Dr. Draelos: There is actually a lot of testing that goes into cosmeceutical development. Companies test cosmeceuticals looking for an immediate benefit: that’s the smoothness and the softness, because when a consumer purchases a product, she wants to see something immediate, which is something that pharmaceuticals traditionally do not deliver.

We usually tell a patient — for example, when they are using a topical rosacea medication — that one will need to use this product for four to six weeks before one will see a reduction in papules and pustules. But in the cosmeceuticals realm, people want to see immediate improvement. That’s where the moisturizer comes in that makes the skin smooth and soft.

Then there are botanical anti-inflammatories that could be added into a cosmeceutical formulation that indeed over time might reduce redness, not perhaps to the degree that a pharmaceutical would, but it still has some beneficial effect. Most companies are looking for significant market share with their products and will build in short-term benefits and long-term benefits. The long-term benefits will not be to the level of a pharmaceutical, but still they are consumer perceivable benefits, which might result in some redness reduction because of a botanical anti-inflammatory, such as bisabolol, which is a chamomile extract with an anti-inflammatory topical effect.

Dr. Levine: Of all these hundreds of agents, can you pick out a few that you really think have value over and above the others?

Dr. Draelos: Probably the most important one is sunscreen. Because the new sunscreen guidelines allow companies to make anti-aging claims based on the inclusion of sunscreen, we are going to see an increase in anti-aging claims because of sunscreen inclusion. The idea is that sunscreens prevent DNA damage, and when you prevent DNA damage, you prevent aging.

If a product contains a sunscreen, technically it does become an over-the-counter drug, but not only can SPF designations be placed on a label, companies can now make an anti-aging claim. You are going to see a whole new cadre of cosmeceuticals that have anti-aging claims, that may also contain sunscreen and mushroom extracts, but the sunscreen is the workhorse that’s providing the anti-aging benefit and the mushroom extract is along just for the ride. The product will say that it reduces the appearance of wrinkles substantiated by sunscreen inclusion, and then it will say contains mushroom extract.

When you make a claim that says “contains something,” that is basically a disclosure of the ingredient on the front of the package. They are not saying the mushroom extract does anything. But if you tell the consumer “this reduces the appearance of wrinkles and it contains mushroom extract,” sometimes the consumer will think mushroom extract is reducing the wrinkles, not the inclusion of sunscreen. This is an interesting area.

The second interesting area of ingredients is the introduction of retinol into products. Retinol, as you remember, is the vitamin version of vitamin A. It is a precursor to retinoic acid, which we know of as tretinoin. Retinol is actually a precursor of tretinoin and since tretinoin has anti-aging benefits, so does retinol. There are some studies that show that somewhere between 1 and 2 percent retinol can indeed improve the appearance of the skin by working through the retinoid receptor.

The third category to watch would be the anti-inflammatories. Now many of the new cosmetics that reduce redness and facial irritation actually contain 0.5 percent hydrocortisone, which makes them an over-the-counter drug. So it’s interesting that cosmetic formulations are tapping into OTC drugs to deliver some of their claims, but there are some licorice extracts such as Licochalcone A. There are some camomile extracts like I mentioned earlier such as bisabolol. There are also other plant sterols that are being used as anti-inflammatory agents and so anti-inflammatories is another category.

Certainly these are not anti-inflammatory agents that will reduce disease, such as facial dermatitis, but they might reduce redness and they might reduce some of the itching and stinging. Many of those ingredients like bisabolol are used in sensitive skin formulations and the idea is to include an anti-inflammatory that will allow people with sensitive skin to be able to wear those products.

Dr. Levine: Could you comment on the current rage about the use of the word “natural” in many of these products. What does that mean and is that important?

Dr. Draelos: The FDA actually has become very concerned about use of the word natural, because natural actually has no meaning whatsoever. “Natural” became a concern in food products because people were thinking that natural might somehow mean that these products didn’t contain any chemicals, they didn’t contain preservatives. In the cosmetics industry, people wanted to put “natural” on their products to imply that there weren’t any chemicals that were toxic, irritating, or might induce some other type of damage, such as the generation of reactive oxygen species.

Everything that is found on the earth is natural to this earth, whether it will be a pesticide or preservative or a celery extract, but not all those substances are beneficial to the skin. For example, celery extract actually contains a carcinogen and that is an area of controversy where many plants, in order to protect themselves from overgrazing by animals, will contain toxins. Those toxins will poison the animal so to speak if it overeats that particular product and that’s how the plant materials sustain themselves on the earth. There are many natural ingredients that could find their way into cosmetics that are not good for the skin.

For example, feverfew, which is an ingredient that is found in a number of facial products, actually has an allergen called parthenolide, The parthenolide had to be removed from the feverfew before it could be put in cosmetics. So, not everything that comes from plants is good for the skin. They are all natural, but natural is perhaps one of those words that doesn’t have a lot of scientific meaning, just like the word radiance. You will see a lot of topical cosmeceuticals say they improve skin radiance. Well, what is radiance? No one really knows. We think that it’s increased light reflection from the skin surface which is truly an optical effect, not implying any change in the skin itself, but if you tell someone you look natural and radiant, somehow those words have a connotation that make people feel they have an improved appearance.

Dr. Levine: Is there a way that we and consumers can sort out which manufacturers are reliable and which may not be reputable?

Dr. Draelos: Sorting out quality products can be difficult, but many cosmetic companies are now publishing the results of their research and those results are being published in dermatology journals, such as the one I edit which is the Journal of Cosmetic Dermatology. If you Google a new ingredient, you should be able to pull up some articles that actually substantiate the value of that ingredient. So looking in the dermatology literature for supportive articles can be helpful.

You will also see many companies that will put their data with their packaging. For example, their data will say “dermatologist tested,” and this is complemented by a bar graph that demonstrates efficacy. All cosmetic companies do some type of safety testing on their products, which is the Repeat Insult Patch Test (RIPT). This is done by the company or it could be done by the raw material supplier that provides the ingredients to the company.

Repeat Insult Patch Testing is where the product is applied to the back of volunteers to better understand if irritant contact dermatitis or allergic contact dermatitis might occur. RIPT testing is usually done not only on the raw materials that are put into the product, but also done on the final formulation. This type of testing is done routinely to prevent the introduction of products into the marketplace that could result in safety issues.

The second type of testing that is done is efficacy testing. Most of the large companies will do efficacy testing to prevent themselves from getting sued by the Federal Trade Commission over making false or misleading advertising claims. They will also do efficacy testing to prevent competitors from suing them and stating that they made false claims. So there are claims such as “dermatologist tested,” that now mean that some dermatologist who is board-certified in dermatology tested that product.
DermatologyTimes 2/2014

Thursday, July 31, 2014

Vascular Birthmarks

Vascular Birthmarks
American Academy of Dermatology

What Is a Vascular Birthmark?
Many babies have what are called "birthmarks" when they're born. In some cases they appear within the first few weeks of life. They can be brown, tan , blue, pink, or red. More than 10 in 100 babies have vascular birthmarks. These are made up of blood vessels bunched together in the skin. they can be flat or raises, pink, red, or bluish discoloration.

What Causes Birthmarks?
The exact causes are unknown. Most vascular birthmarks are no inherited, nor are they caused by anything that happens to the mother during pregnancy.

What Are the Different Types of Vascular Birthmarks?
There are different kinds of vascular birthmarks. Sometimes, the birthmark must be watched for several weeks or months before the specific type can be identified . the most common types of vascular birthmarks are macular stains, hemangiomas, and port wine stains. There are also many rare types of vascular birthmarks.

Macular Stains
Your physician will call faint, mild red marks macular stains. They are the most common type of vascular birthmarks. They are also called "angel's kisses," when they are located on the forehead or eyelids. When they are found on the back of the neck, they're called "stork bites". They may also occur on the tip of the nose, upper lip or any other body location. They are pink and flat. Angel's kisses almost always go away by age two, but stork bites usually last into adulthood. These birthmarks are harmless and require  no treatment.

The term "hemangioma" is used to describe many different kinds of blood vessel growths. Most dermatologists prefer to use hemangioma to refer to a common type of vascular birthmark. These marks do not usually appear immediately after birth, but become visible within the first few weeks of life. Hemangiomas are usually divided into two types: strawberry hemangiomas and cavernous hemangiomas.

A strawberry hemangioma is slightly raised, and bright red because the abnormal blood vessels are very close to the surface of the skin.

Cavernous hemangiomas have a blue color because the abnormal vessels are deeper under the skin. Hemangiomas are more common in females and in premature babies. They can be anywhere on the
face or body.

Complications of Hemangiomas
Occasionally, a hemangioma that's growing or shrinking rapidly can form an open sore or ulcer. These sores can be painful, and can become infected. It's very important to see your dermatologist who will decide if further treatment necessary and keep this sore clean and covered with antibiotic ointment and/or a dressing.

Treatment of Hemangiomas
There are several different types of treatments for hemangiomas that need care. No treatment is absolutely safe and effective. The potential benefits must be weighed against the possible risks.

The most widely used treatment for rapidly growing hemangiomas is corticosteroid medication. This is either injected or given by mouth. Long-term or repeated treatment may be necessary. Lasers can be used to both prevent growth of hemangiomas and remove hemangiomas. Hemangiomas with ores that will not heal can also be treated with lasers. New lasers are being developed and studied by dermatologists to treat this condition

Port-Wine Stains
The port wine stain is another type of vascular birthmark that occurs in 3 in 1,000 infants. It is sometimes called a nevus flammeus, or capillary hemangioma, But it should not be confused with a hemangioma. Port wine stains appear at birth. They are flat, pink, red, or purplish discolorations found most often on the face, neck, arms, or legs. They can be any size. Unlike hemangiomas, port-wine stains grow only as the child grows. Over time, port-wine stains may become thick and develop small bumps or ridges. Port-wine stains do not go away by themselves. They last a lifetime.

Complications of Port-Wine Stains
Port-wine stains on the forehead, eyelids or both sides of the face can be associated with glaucoma, and/or seizures. Glaucoma is increased pressure within the ye that, left untreated, can cause blindness these complications occur in less than one- fourth of those with port-wine stains of the forehead and eyelids. All infants with port-wine stain in those areas should have a thorough eye and brain examination.

Treatment of Port-Wine Stains
The use of cover-up makeup has been a common treatment for port-wine stains. Your doctor can provide you with more information about products that are made to cover up birthmarks. New types of laser have shown the best results with the least amount of risk and side effects. Laser treatment of port-wine stains is FDA-approved, and available at many centers around the country. For best results, treatment should begin as early as possible, even in infancy. Laser surgery is performed on an outpatient basis. Several treatments are usually required, given at two month intervals. Younger patients often require fewer treatments than adults. In about one-fourth of the patients, lasers can totally clear up the port-wine stain. Seventy percent will look better. For reasons that are not understood, a small number of patients will not respond well to laser therapy.

Monday, July 28, 2014

Changing moles? Get in QUICK!

April 2013

Sometimes I will go 6 months without seeing a melanoma but I have had three in the last month that I wanted to tell you about. I try to tell my patients " this is a partnership my eye will hopefully pick up anything unusual, but I need you to tell me if anything starts changing".

Anyway, three women, all between early 40's and early 50's, came to me with a lesion or mole that was changing. All had been there about 6 weeks. All were biopsied and found to be melanoma. What gives me goose bumps and the message I want to convey is, if you believe a mole is changing or even have a new lesion you are worried about, try to see me in a week or two because these things can grow quickly. Basal cell carcinomas are a different story we can watch something possibly suspicious over several months before we decide to biopsy and it only grows locally. As you know, as a rule of thumb, basal cells don't metastasize and kill. So, what can I do to help? I usually have openings within the next two weeks, although it may not be at our preferred time. However, even if I have a full schedule, if you are concerned about one changing mole or new lesion, I would rather see you at the end of the day thank think you waited because you could not get in. Just tell the front desk you have a changing mole and to schedule you at the end of the day! Now that I have said that, if you have a list of other issues, I may make you reschedule for those, BUT if I am suspicious about a mole, I will take it off that day.... After seeing these three cases, I just wanted to get this off my chest. Fortunately, these three cases I talked about are in the early stages and I think all will be well. I am not trying to make you paranoid or scared; I would just hate to see you blow something off for months. I did speak to the 2 of the women already about writing this to you, and they thought it was a good idea. Pass it on to a friend if you want.

Getting back to sunscreens. Find one you actually like putting on in the am even if it is a few dollars more and you will most likely really do it. If the skin cancer threat doesn't get you to wear it, maybe vanity will! In the Times Picayune 6/5/2013 and USA today of the day prior, there is an article which shows that after 4 years of daily sunscreen use on the hands , participants were 24% less likely to show signs of increased aging.

For example, today I look out the window and it is raining. I realize my facial tinted sunscreen is on 'rain or shine'. We all really do get ultraviolet exposure (and therefore damage) all day long, through the windows as we are driving or while we're walking the dog after work.

Wearing sunscreen everyday is a habit that I developed in my 20's and have practiced since. Some people only put sunscreen on when they are at the beach or before playing tennis, etc., but so much of the harmful UV exposure is during the little times when you aren't even realizing it.

So find a sunscreen that you really like ... one that you look forward to putting on, whether it is tinted or not. Even the mineral powders have sunscreens in them. So if you are using powder, be sure to find out if it does have sunscreen protection in it and how much.

Some patients I talk to use a drugstore product (such as Neutrogena), others use something more high end ( such as Laura Mercier) in my office. In the office, we have some sunscreen products by Elta MD that I love! A while back I was interviewed on TV about sunscreens; I talked about how I actually visited stores like Earthsavers and found some sunscreens that I liked.

The key is, like your favorite shampoo, you may have to try some different sunscreen products before you find one that fits all your criteria. It is helpful if the place you are shopping lets you actually try some on or gives you samples to make sure you love it before you buy.

So what do you look for? I personally like ones with the micronized zinc oxide that disappears into my face quickly but also gives me at least a 30 SPF. The American Academy of Dermatology used to recommend a 15 SPF but increased it to a 30 when they realized that few of us put on the amount that we really need for that protection, so it kind of equals a 15!

Also, be careful in that one you like in the winter may be too moisturizing for you in the summer; you don't want to break out, do you? Its OK to have different ones for different climates. Lastly, the advantages of doing this form an early age are multifold. Your face will be a more even color with less splotchiness from the sun. If you have a problem like melisma, it is really mandatory for you to be diligent about sunscreen. Medically, you should have less of  chance of skin cancers.

Do you feel it is too late to start this now? It is never too late, but this should also be a wake up call to teach your children the basics of skin care.

Tuesday, July 15, 2014

Eczema could lower risk of skin cancer

Dermatology Times
May 2014

Defects in the skin that cause eczema may also help to lower the risk of skin cancer, recent research suggests.
    Researchers with King's College London used genetically engineered mice that lacked three skin barrier proteins to replicate skin defects often found in patients with eczema, according to a news release. They then compared the effects of two carcinogenic chemicals in both normal mice and the knock-out mice. The number of benign tumors in the knock-out mice was six times lower per mouse than in the normal mice.
   Both types of mice were equally susceptible to acquiring cancer-causing mutations, researchers noted, but the knock-out mice exhibited an exaggerated inflammatory reaction that resulted in enhanced shedding of potentially cancerous cells.
   "We are excited by our findings as they establish a clear link between cancer susceptibility and an allergic skin condition in our experimental model, " professor Fiona Watt, director of the Centre for stem cells and Regenerative Medicine and study co-author, said in the news release. They also support the view that modifying the body's immune system is an important strategy in treating cancer."

Spider Vein, Varicose Vein Therapy

American Academy of Dermatology
Spider Vein, Varicose Vein Therapy

Spider veins are dilated small blood vessels that have a red or bluish color. They appear mostly on the legs, occasionally on the face or elsewhere, and may often be unwanted. Larger dilated blood vessels called varicose veins may be raised above the skin surface. They may occur along with spider veins.

What Causes These Blood Vessels to Become Visible?
The cause of spider veins is not known. In many cases they seem to run in families. Identical twins can be affected in the same area of the body and to the same extent. The condition can very occasionally occur as part of an internal disease.

Spider veins can appear on both men and women the hormones of estrogen and progesterone may play a role in their development. Puberty, birth control pills, pregnancy or hormone replacement therapy often seem to bring them out. They may also appear after an injury or as a result of wearing tight girdles or hosiery held up with tight rubber bands. Spider veins may also occur with large varicose veins.

Spider veins on the nose or cheeks of fair skinned persons may be related to sun exposure.

Can Spider Veins Be Prevented?
Spider veins can't always be prevented. Wearing support hose may prevent some unwanted blood vessels from developing. Keeping one's weight at a normal level and exercising regularly may also be helpful. Sun protection is important to limit the number of unwanted vessels on the face.

How Are Unwanted Blood Vessels on the Legs Treated?
A procedure called sclerotherapy is used to treat unwanted blood vessels. One of several kinds of solutions called sclerosing solution is injected with a very fine needle directly into the blood vessel. This procedure has been used since 1930 and before that for longer veins. The solution irritated the lining of the vessel, causing it to swell and stick together and the blood to clot.  

Over a period of weeks, the vessel turns into scar tissue that fades, eventually becoming barely noticeable or invisible.

A single blood vessel may have to be injected more than once, some weeks apart, depending on its size. In any one treatment session a number of vessels can be injected.

How Successful is Sclerotherapy?
After several treatments, most patients can expect a 50 to 90 percent improvement. Scelerotherapy can be used on all skin types. Side effects of sclerotherapy is stinging or pain at the sites of injection, swelling of the ankles or feet or muscle cramps which almost always occur when the injection takes place in the ankle areas. These usually go away within 10 to 15 minutes after injection. Red, raised areas at the sites of injection which should disappear within a day or so. Bruises at the site where the needles went into the skin which disappears in a few weeks and are probably related to the thinness of blood vessel walls. Other treatment methods new lasers may hold promise for treating blood vessels, but currently vessels in the legs do not respond uniformly to laser treatment.

How are Spider Veins on the Face Treated?
There are several ways to treat spider veins on the face. Lasers have been used successfully, alone or in the combination with electric needle therapy.

What Do I Do After Treatments?
Physicians may differ in their after treatment instructions to patients. Depending on certain factors, such as size of the blood vessels injected, patients may be instructed to put their legs up for an hour or then and then walk. Others are asked to walk immediately. All patients are instructed to walk a good deal in the days following to procedure so that blood will be pushed through other vessels.

Some Physicians bandage the injected areas and instruct patients to "compress" the treated vessels by wearing support hose. This may help seal the treated vessels, keep the blood from collecting under the skin and reduce the number of treatments necessary, and the possibility of recurrence. Other put tape dressings on the areas and do not use compression unless the veins are large or have other characteristics.

Between treatments, many physicians recommend the use of compression of support hose. this may particularly recommend  for people who spend a lot of time on their feet.


Wednesday, April 16, 2014

Q&A Uncovering The Cause Of Armpit Irritation

Cosmetic Dermatology
Dermatology Times January 2014

Zoe Diana Draelos, M.D., is a Dermatology times editorial adviser and consulting professor of dermatology, Duke University School of Medicine, Durham, N.C.

Q: Why do antiperspirant/deodorant cause skin irritation?

A: Antiperspirants and not deodorants are the culprit in skin irritation. The antiperspirant decreases sweating while the deodorant simply provides a pleasant scent to the armpit.
   The active ingredient in all widely marketed antiperspirants is an aluminum salt possibly mixed with a zirconium salt. The aluminum salt is very irritating to the skin, especially in high concentration. As a matter of fact, the aluminum salt functions to decrease the release of perspiration from the armpit by coagulating protein in the eccrine and apocrine sweat ducts, and it may also coagulate the stratum corneum protein lining the armpit as well. More modern antiperspirant formulations minimize this irritation by incorporating dimethicone, listed on the skin protectant monograph.
   For patients that experience irritation from antiperspirant/deodorant and wish continue using these products, it is possible to offer some advice. The antiperspirant/deodorant should be applied at night since the armpit is at rest with less sweat and will work better. In the morning, a thin dimethicone-based moisturizer could be applied to the armpit. This provides a compromise between sweat reduction and skin irritation.

Q: Do lipsticks protect against lip sun damage?

A: Lipsticks provide excellent photo protection if they are completely opaque. As a matter of fact, opaque lipsticks provide better photo protection than SPF- containing lip balms because they have an unlimited SPF and excellent substantivity. Substantivity is the ability of the lipstick to remain in the place on the lip. Products that stay on better provide superior longer-lasting photo protection. The best lip sunscreen for female patients with actinic cheilitis is an opaque lipstick.

Q: Do lipsticks contain lead?

A: The presence of lead in lipsticks has created a stir on consumer websites. Indeed, there are some dyes, especially red dyes, which are used in lipsticks that may contain trace amounts of lead. Remember that the government regulates the pigments used around the mouth, where ingestion may occur. This regulation is necessary to prevent safety issues. The trace amounts of lead that may be found in lipsticks are not felt to be health issue and indeed the amounts are very small compared to the lead contamination possibilities from old lead based paints.

Q: Which sunscreens are more likely to cause acne?

A: Many patients claim that they do not wear sunscreens because they cause acne. I do not believe that it is the organic and inorganic filters that cause acne, but rather the vehicle in which the sunscreens are suspended. It is even unclear that the vehicles contain ingredients that cause acne.
  Most patients that complain of acne within 48 hours of applying sunscreen probably are not experiencing true acne with follicular contact dermatitis or possibly miliaria rubra and miliaria pustulosa. The irritant contact dermatitis could be due to the emulsifier in the formulation and the miliaria rubra or miliaria pustulosa could be due to occlusion of the ecrrine sweat units with the sunscreen film.
  It is hard to generalize as to which sunscreen formulations are more likely to cause acne-like skin problems, but thicker creamier products are probably the culprits. It may be worthwhile to suggest to patients who claim that sunscreens cause acne-like eruptions to consider a spray formulation.

Don't Worry, Get Botox

The New York Times
March 2013

Don't Worry, Get Botox

FEELING down? Smile. Cheer up. Put on a happy face. No doubt you've dismissed these bromides from friends and loved ones because everyone knows that you can't feel better just by aping a happy look.
      Or perhaps you can. New research suggests that it is possible to treat depression by paralyzing key facial muscles with Botox, which prevents patients from frowning and having unhappy-looking faces.
      In a study forthcoming in the Journal of Psychiatric Research, Eric Finzi, a cosmetic dermatologist, and Norman Rosenthal, a professor of psychiatry at Georgetown Medical School, randomly assigned a group of 74 patients with major depression to receive either Botox or saline injections in the forehead muscles whose contraction makes it possible to frown. Six weeks after the injection, 52 percent of the subjects who got Botox showed relief of depression, compared with only 15 percent of those who received the saline placebo.
     (You might think that patients would easily be able to tell whether they got the placebo or Botox. Actually, it wasn't so obvious: Only about half of the subjects getting Botox guessed correctly. More important, knowing which treatment was received had no significant effect on treatment response.)
     Other studies over the past several years have found similar effects of Botox on mood. Micheal Lewis at Cardiff University reported that non depressed patients at a cosmetic dermatologist clinic receiving Botox injection about the eyes frowned less and felt better than those who did not receive this injection. And M. Axel Wollmer at the University of Basel Found that Botox injection was superior to a placebo in a group of depressed patients.
     Is paralyzing the muscles involved in frowning truly enough to make depressed patients feel better? The notion that your expression can exert a powerful influence on your mood turns our sense of psychological causality on its head. After all, we smile because we feel happy, and cry because we feel sad, not the other way around, right?
    Not necessarily. The idea that facial expressions may feed information back to our brain and influence our feelings goes back to a theory of emotion first proposed by Charles Darwin. In "The expression of the Emotions in Man and Animals, " Darwin posted that the control of facial expression causes a liked effect on subjective emotions. William James took the idea further and proposed that emotions were the result, not the cause, of various bodily sensations, suggesting that "we feel sorry because we cry, angry because we strike, afraid because we tremble, and not that we cry, strike, or tremble, because we are sorry, angry, or fearful, as the case may be."
   We are used to thinking of the brain, not the body, as the prime mover of our emotional states. Consider the field of so called psychosomatic medicine, which emphasizes a mischievous flow of information from brain to body: hence, the psychosomatic stomachache, headache and the like. You can literally worry yourself sick.
   The Botox studies, by contrast, suggest a circuit between the brain and the muscles of facial expression in which the brain monitors the emotional valence of the face and responds by generating the appropriate feeling. (Obviously, information flows in both directions, as you can think yourself into practically any emotional state and then have the face to match it.)
   There are other treatments for depression that appear top use facial feedback in a similar way. Light therapy stimulates the retina and excites the optic nerve, which sends signals directly to the brain and effectively treats seasonal depression. And the direct electrical stimulation of the brain's vagal nerve has antidepressant effects.
   Botox for depression is part of a long tradition of "outside-in" somatic therapies- many of dubious efficacy- that manipulate the body with the aim of altering the brain and mind, for instance by using cold wet sheet packs to treat severe agitation or acupuncture for anxiety.
  In a broad sense, these Botox studies underscore one of the biggest challenges in treating people with depression. They might think that the reason they are depressed is that they have little interest in the world or their friends- a mistaken notion that is the result, not the cause, of their depression. They insist that only once they feel better will it make sense for them to rejoin the world, socialize and start smiling. Their therapists would be well advised to challenge their invested sense of causality and insist that they will start feeling better after they re-engage with the world.
  Whether Botox will prove to be an effective and useful antidepressant is as yet unclear. If it does prove effective, however, it will raise the intriguing epidemiological question of whether in administering Botox to vast numbers of people for cosmetic reasons, we might have serendipitously treated or prevented depression in a large number of them.

Friday, March 28, 2014

Dermatologic Treatments

Cooper University Hospital

Chemical Peels

Thousands of chemical peels are performed each year. Dermatologic surgeons have agents for the last 100 years and are experts in performing multiple types of chemical peels public's increasing interest in rejuvenating skin and slowing effects of the aging process which has emerged as an exciting supplement to a total skin care program. Dr. Lawrence will evaluate before embarking upon a chemical peel.

Melasma, Acne, Skin aging, sun damage, wrinkles (depends on peel solution)

Melasma is a brown discoloration of the face most often seen in women. This change can get worse in the summer when exposed to the sun's harmful rays and often fades. Pregnancy is the most common cause of melasma.

The Center for Dermatologic Surgery treats melasma with prescription bleaching topical in addition to a series of chemical peels. Since sunlight is a major factor in the melasma, it is imperative top continue to avoid the sun, wear protective clothing and apply sunscreen.

  • Superficial: Freshens skin, makeup goes on nicer, may decrease some fine lines.
  • Medium Depth: Chemical peeling is often used to treat fine lines under the eye and mouth. Wrinkles caused by damage, aging, and hereditary factors can often be eliminated with this procedure. However, sags, bulges and more severe wrinkle peeling and may require other kinds of cosmetic surgical procedures. Dr. Lawrence determines the most appropriate treatment for your needs.
Mild scarring and certain types of acne can be treated with chemical peels. In addition, in the form of sun spots, age spots, liver spots, freckles, blotchiness, due to taking birth control that is dull in texture and color may be improved with chemical peeling . Areas of sun damage precancerous keratosis and scaling patches may improve after chemical peeling. Follow lesions or patches are less likely to appear.

Age spots, also known as sun spots, are flat, brown discoloration of the skin which usually is around the neck, hands, and other areas of the skin exposed to the sun over many years.

A German Study Underscores the Benfits Of Full-Body Screenings

Skin Cancer World News Round-Up
Skin Cancer Foundation Journal 2013

Since its inception in 1979, The Skin Cancer Foundation has recommended that everyone have an annual full-body skin exam performed by a physician. In 2012, A German skin cancer screening study- The largest ever conducted-found that regularly having total-body skin exams can cut melanoma deaths by more than 50 percent.
    Over the course of this year-long program in the German state of Schleswig-Holstein, doctors have found more melanomas than had been detected prior to the start of the program. This was not expected, since screenings typically lead to identification of greater numbers of skin cancers. What was more striking was how much earlier the melanomas were bring found. According to the researchers, this early identification slashed the melanoma death rate in half--very likely because tumors were thinner. As a general rule, the thinner the lesion, the easier to treat. Melanoma killed 43 men and 45 women in Schleswig-Holstein in the three years before the study, but just 23 men and 21 women in the post-study follow-up from 2006 to 2008.
    The results were so impressive that in 2008, Germany began a national skin cancer screening program, offering people ages 35 or older a total-body skin exam every two years. The authors suggested that such large-scale screening programs are feasible and advisable around the world, and have "the potential to reduce skin cancer burden, including mortality."

Tanning Machines Are Twice as Dangerous As the Midday Mediterranean Sun

Skin Cancer Foundation 2013

In their recent research into the dangers of ultraviolet (UV) tanning, British investigators didn't just crunch numbers. They also compared the "controlled dose" of UV radiation emitted by tanning machines with the intense midday Mediterranean sun -and refuted tanning salons operators' claims about the so-called "safety" of indoor tanning. The researchers found that the average indoor tanning machine in England is 2.3 times more cancer-causing than the midday Mediterranean sun, and some tanning machines are up to six times as dangerous. A 2003 study suggests that US tanning beds are about as dangerous as their English counterparts. Researchers determined that nine out of 10 tanning beds in England emit more UV radiation than recommended by British and European safety standards, typically, almost double the recommended amount. These excessive levels are especially worrisome considering that any UV tanning causes DNA damage that ages the skin and can ultimately cause skin cancers.

Thursday, March 6, 2014

The Best Sun Shield for Car, Home and Office

Window Film
Skin Cancer Foundation 2013

The Best Sun Shield for Car, Home and Office

Whether you're driving, at home gazing out at your garden, or sitting by a window at work, you actually may be suffering continual skin damage. While everyday windows block most of the sun/s ultraviolet B (UVB) rays, they allow much of its ultraviolet A (UVA) rays to pass right through. UVA penetrates deep into the skin, causing DNA damage that can accelerate skin aging and lead to skin cancer.
If you frequently sit by windows, the single best safeguard against UV damage is transparent window film, sometimes referred to as window tint, which has been treated to screen out both UVA and UVB rays. Installing protective film on your windows will keep you virtually UV-free on the road, at home, or at the office.

Curing Car Trouble
In cars, only the laminated windshield comes with both UVB and UVA protection. The side and back windows allow in more than 60 percent of UVA rays. Research has shown that UV damage is more extensive on the side of the body closer to the window; long-time drivers also have rougher, slacker, more wrinkled skin on their window side. Babies and young children — who have little protective skin pigment — often sit in back, where none of the glass (even darker glass found in SUVs and mini-vans) offers adequate UVA protection. Fortunately, UVA-filtering window film can go a long way to prevent skin damage. Combining UVA absorbers in varying strengths, the transparent films are available from clear to dark tints for vehicles’ side and back windows in all 50 states; it screens out more than 99 percent of UVA and UVB without reducing visibility.

  • Drivers in the US have more skin cancers on the left side of their faces: drivers in Australia have more skin cancers on the right.
Alternative Measures For Sun Protection While Driving
'It's wise to practice the following sun safety strategies everyday:
  • Cover up with clothing. Long-sleeve shirts help prevent UV damage to the drivers' window-side arm, and long pants protect your legs.
  • Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher. Don't forget often-missed spots like the top of the head, neck, hands and ears.
  • Take extra precautions in convertibles and cars with sunroofs. Wear a wide-brimmed hat and wraparound, UV-blocking sunglasses.
UV-absorbing auto window film reduces skin cell death 93 percent.

Sun Protection Indoors

Indoor workers stationed near windows have significantly more wrinkled, rough-textured, and sagging skin on the side of the face closer to the window.
Today, however, UV-screening residential and commercial film is available for home and office. UV absorbers are added to clear or tinted polyester or vinyl to create film, which comes in varied tints, allowing 30-80 percent of visible light to get through. The installers apply it on the interior glass surface of the windows from flat sheets.

Window film will help prevent sunburn and skin cancer, as well as the brief daily UV exposures that accelerate skin aging over time.

Chronic exposure to UVA rays through windows may accelerate skin aging by 5 to 7 years.

More than 90 percent of skin cancers and the visible signs of skin aging, are caused by the sun.

Advantages of Window Film
  • In hot weather, it cuts down heat within the vehicle or home, reducing air conditioning expenses.
  • In cold weather, some films reflect interior heat back into the house, reducing heating costs.
  • It helps keep sunshine from fading car upholstery and home furnishing.
UV-protective window film is available worldwide. For professional installation, look online or in the yellow pages under "glass tinting" or "glass coatings."

Several companies now carry The Skin Cancer Foundation's Seal Of Recommendation, offering assurance of safety and effectiveness.



Thursday, January 30, 2014

Skin Cancer Rates Soar in US Hispanics

Sun & Skin News
Skin Cancer Foundation
Winter 2013

Skin Cancer Rates Soar in US Hispanics

Skin cancer rates among Hispanics are skyrocketing in the US. New research shows that in the past two decades alone, melanoma incidence among Hispanics has risen almost 20 percent.
Hispanics are the fastest-growing population in the US, with a 43 percent increase in their numbers from 2000 to 2010. It is estimated that by 2050, the Hispanic population will exceed 100 million, representing more than 24 percent of the total population. Unfortunately, as the number of Hispanics has risen, so have their instances of skin cancer: From 1992 to 2008, their annual melanoma incidence increased by 19 percent. Too little use of sun safety techniques (such as seeking shade, wearing protective clothing, and using sunscreen) may have contributed to this rapid rise in melanoma and other skin cancers among Hispanics.

The Risk Is Real
One reason for this underuse of sun protection strategies may be the widespread misconception that people with darker skin are not at risk of skin cancer, according to a recent survey by L’Oreal Paris. Other studies point to the lack of skin cancer education campaigns provided for Hispanics and the need for their dermatologists and general physicians to emphasize skin cancer dangers. The authors of a study published this June in JAMA Dermatology said their findings highlighted “the importance of developing culturally appropriate, tailored interventions to reduce the risk of skin cancer among Hispanics.” These studies all concluded that raising awareness among Hispanics will save lives. Culturally sensitive materials, customized interventions, and stronger public health messages were all suggested as ways to combat the growing skin cancer epidemic among Hispanics.

Deadly Results
Making matters worse for Hispanics, those with melanoma have poorer survival than non-Hispanic patients, often due to being diagnosed at a later stage. One study in JAMA Dermatology found that while initial melanoma diagnoses were late-stage in 16 percent of white patients, the number jumped to 26 percent for Hispanics. This trend towards later diagnosis among Hispanics reinforces the need for greater skin cancer education and awareness. These findings underscore the urgency for year-round sun protection, regular skin self-examinations, and annual visits to a dermatologist for everyone, no matter what their ethnicity or skin tone.

BCC or SCC? The Value of Pain
Pain is a potential diagnostic tool for non-melanoma skin cancers. In a study from Wake Forest University Baptist Medical Center in North Carolina, squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) patients reported fairly comparable levels of itching at the cancer site. However, a far higher percentage of SCC patients (39 percent) than BCC patients (17 percent) reported pain at the tumor site. Thus, pain may be an important factor distinguishing the two cancers. Left untreated, SCC, in particular, can be fatal: About two percent of SCC patients—between 3,900 and 8,800 people—died from the disease in the US in 2012. It is therefore vital for dermatologists to differentiate SCC from BCC early in the lesion’s development to determine the best treatment.

Percentage of patients reporting itching or pain as a symptom
Dangerous Tanning Habits Persist in Young Women

Despite the now well-established dangers of indoor tanning, teenage and young adult women continue to use tanning beds at an alarming rate, according to the Centers for Disease Control and Prevention’s recent survey study of more than 15,000 subjects. In the 12 months before being surveyed, the study found:

  • Over 29 percent of non-Hispanic white female high school students engaged in indoor tanning at least once, and almost 17 percent did so at least 10 times.
  • Nearly 25 percent of non-Hispanic white women ages 18 to 34 engaged in indoor tanning at least once, and over 15 percent did so at least 10 times.
These findings reinforce past research, notes California dermatologist Melanie Palm, MD, spokeswoman for The Skin Cancer Foundation. “A disproportionate number of girls and young women use tanning beds,” she says. “There’s a cultural disconnect between the risk and the desire for a ‘healthy glow.’”
       The new study’s findings highlight the need for greater understanding among young women about the dangersof indoor tanning. Since physical appearance may mean more to them than long-range health effects, the study authors advise making teenagers and young adults aware that tanning causes not just skin cancer, but age spots, wrinkling, and other negative cosmetic affects. The FDA is also working to help solve the problem: in March 2013 it issued a proposal to raise the classification of tanning beds from Class 1 (low to moderate risk) devices to Class II (moderate to high risk) devices; that proposal is currently under review.
        The Skin Cancer Foundation recommends that people of all ages, genders, and ethnic backgrounds avoid indoor tanning and take precautions in the sun by limiting outdoor time between 10 am and 4 pm, seeking the shade when outdoors, using SPF 15+ sunscreen (SPF 30+ sunscreen for extended stays outdoors), and wearing protective clothing, including wide-brimmed hats and UV-blocking sunglasses.

New Breakthroughs In Melanoma Treatment
Two new oral drugs, dabrafenib (TafinlarTM) and trametinib (MekinistTM), have been FDA approved for stage IV melanoma patients. Like its predecessor vemurafenib, dabrafenib inhibits a defective gene called BRAF, thereby slowing or stopping production of melanoma cells. Trametinib is the first drug to inhibit another defective gene, MEK, also slowing or stopping production of melanoma cells. Both medicines have been found to hold back disease progression and increase survival by months or even years, and even greater results are expected when they are tried in combination with other drugs.

2013 Road to Healthy Skin Tour: More Skin Cancers Found, More Lives Saved
The Skin Cancer Foundation’s annual Road to Healthy Skin Tour, presented by Rite Aid, has wrapped up its sixth cross country journey, bringing free skin cancer screenings and prevention information to communities across America.
Over a four-month period, the 2013 Tour traveled 14,000 miles and held 53 events in 13 states. Seventy dermatologists donated their time to perform exams in the Tour’s customized 38-foot RV, equipped with two private exam rooms.
During this year’s Tour, volunteer dermatologists detected 788 suspected precancers and cancers, including 29 suspected melanomas. Since 2008, the Foundation’s volunteer dermatologists have potentially saved 324 lives; 324 melanomas have been detected since the Tour began. By finding suspected skin cancers, often in early stages, the Tour and its volunteer dermatologists have made a vital contribution to communities across the country.

A Message From the President

    With winter just around the corner, do we still have to worry about skin cancer prevention? In a word—yes. While the sun’s ultraviolet B (UVB) rays (the sunburn-causing rays) are strongest in summer, UVA rays remain constant throughout the year. UVA can penetrate into deeper layers of the skin, causing wrinkles, brown spots, and other signs of skin aging. It also can cause skin cancer.
     Winter vacations add to your skin hazards. Snow and ice reflect up to 80 percent of UV rays, meaning that the rays hit you a second time. Furthermore, at higher altitudes (if you’re skiing in the mountains, for example), UV radiation exposure increases 4 to 5 percent with every 1,000 feet above sea level. Even in winter outerwear, your face and neck—where the majority of skin cancers occur—remain at least partially exposed. If you vacation in a sunny climate this winter, beware—intense sun exposure, the kind of exposure that typically leads to sunburn on a sunny vacation, greatly increases your risk of developing melanoma.
With these risks in mind, here are some key items you’ll need to stay sun-safe this winter:
Sun-protective clothing: Long sleeves, long pants, and gloves not only keep you warmer, but protect your arms, legs and hands against UV. A winter hat also pulls double duty, keeping your head warm and protecting your scalp, ears, and part of your face from the sun.
Sunglasses: Skin cancers of the eyelids account for 5-10 percent of all skin cancers, so sunglasses are essential. Look for a pair that locks 99-100 percent of UV rays, in a wraparound style that also offers protection on the sides. Try them on in the store to ensure a close fit so they don’t end up slipping down your nose, allowing UV rays to creep in.
Sunscreen: Clothing doesn’t protect all of your face, so keep a bottle of broadspectrum (UVA/UVB) sunscreen with an SPF of 15 or higher (SPF 30+ for extended outdoor exposure) where you’ll remember to use it all winter. Additionally, a significant percentage of all cancers are on the lips, so use a lip balm with a comparable SPF.
       One thing not to do when the weather turns cold is turn to tanning beds. Recent research shows that more than 170,000 cases of non-melanoma skin cancer in the US each year are linked to indoor tanning. If you simply must have darkened skin, use a self-tanning product. Better yet, embrace the healthy, natural glow and radiance of your own skin. Remember to protect your skin throughout winter—while driving, playing with your children, skiing, or shoveling snow. Even though the seasons are changing, your commitment to skin cancer prevention should remain the same.

By Laurie Jacobson,MD
Laurie Jacobson, MD is a fellowship-trained Mohs surgeon and a member of the American College of Mohs surgery, Dr. Jacobson practices in Seattle, WA. She specializes in Mohs surgery, dermatologic and laser surgery, cosmetic surgery and skin cancer surveillance. Dr. Jacobson has authored textbook chapters and published widely in peer-reviewed journals. She is contributing editor for the peer-reviewed journal Dermatologic Surgery.

Q: Why is seeing a dermatologist for annural skin screening so important?
A. An early skin cancer diagnosis can be the difference between life and death. Early-stage skin cancers are almost always curable; those found later are harder to treat.

Q: Will have to undress completely? What does a full body exam entail?
A. You will fully undress but wear a gown. Ask a nurse or assistant to be present if you’re uncomfortable undressing with just your doctor in the room. Sometimes my patients leave socks on, or have their hair in an up-do where I can’t access their scalp. But you can develop skin cancer anywhere you have skin—between toes, behind your ears, on your buttocks, groin, or genitalia. Women should not wear makeup or nail polish to the appointment. Wear your hair loose so that your doctor can access your scalp. Your visit should take 15 to 20 minutes. The doctor will examine each part of your skin, and may use a special magnifying glass with a light—called a dermatoscope—to examine certain marks or lesions.

Q: What questions will I be asked?
A. The doctor will want to know if you or any close family members have a history of skin cancer, which would increase your risk of developing the disease. You might also be asked if you’ve ever used tanning beds and how frequently, as well as how regularly you use sunscreen and other sun protection. You might be asked what medications you take, since some increase sun sensitivity and sunburn risk, or suppress the immune system, predisposing you to skin cancer. The more honest you are, the more you’ll get out of your exam.

Q: What happens if the doctor sees something out of the ordinary? Will he/she automatically do a biopsy?
A. When you come for your exam, be prepared for the possibility of a biopsy that day. It’s a quick, simple procedure. We use local anesthetic and take a small tissue sample, which is then examined under a microscope. The purpose is to diagnose the condition, not treat it, so once the biopsy site heals up, if the biopsy revealed skin cancer, the remainder of the growth will beremoved. If any atypical cells are found, they will be removed if deemed necessary, or the doctor might photograph them and have you come back weeks or months later to see if they have grown or changed in any way. 

Q: What can I do at home to make sure I catch skin cancers early?
A. We recommend that you perform a self-skin check once a month to look for any new or changing moles or marks. Have a partner help if possible: my friend’s nine-year-old daughter helped her examine her back, and discovered a basal cell carcinoma.
       Learn more about self-skin exams at SkinCancer.org/selfexam.