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Immunotherapy for Melanoma

Melanoma is by far the deadliest skin cancer but recent advances in cancer treatment have significantly improved the prognosis.  More than one million Americans are living with melanoma. It is estimated that 91,270 invasive melanoma cases will be diagnosed in 2018, with invasive melanoma projected to become the fifth most common cancer in men and the sixth most common cancer in women in 2018.[1]

Melanoma is more likely than most cancers to spread to the brain, and once it gets there, fewer than 20 percent of patients survive within one year with traditional treatments.[2]  However, newer options utilizing the body’s own immune system hold promise for helping patients with advanced-stage melanoma.  You may have read about the recent Nobel Prize winner, Jim Allison from MD Anderson Cancer Center.  His discoveries laid the ground-work for a life-saving new treatment for melanoma.

Immunotherapy works by harnessing the body’s own immune system to recognize and destroy cancer cells more effectively. Within our immune system, there are regulatory molecules called immune checkpoints, which work to keep the immune system in a balanced state (homeostasis). Tumors from cancers like melanoma take advantage of this regulatory mechanism to avoid being eliminated by the immune system. [3]

A specific group of immunotherapy drugs, called checkpoint inhibitors, work by inhibiting these immune checkpoints to release the brakes and unleash a much stronger immune response to the tumor. While these drugs do not help everyone, they have demonstrated excellent results thus far and are an important part of the initial treatment plan for patients with advanced melanoma.

 

 

[1] American Academy of Dermatology. Skin Cancer; Incidence Rates. Available online at: https://www.aad.org/media/stats/conditions/skin-cancer.
[2] Grady, Denise (Aug 22, 2018). Immunotherapy Drugs Slow Skin Cancer That Has Spread To The Brain. The New York Times; A16.
[3] Grady, Denise (Aug 22, 2018). Immunotherapy Drugs Slow Skin Cancer That Has Spread To The Brain. The New York Times; A16.

what-is-your-skin-cancer-iq

Test your skin cancer IQ

Skin cancer is the most common cancer in the United States, and it is estimated that one in five Americans will develop this condition in their lifetime. Skin cancer is triggered by mutations or defects in DNA, leading to cells growing out of control to form malignant tumors.

Back to School Rash

I love September! To me, Back-to-school means clean notebooks, new horizons and the memory of a fresh box of Crayolas. My excitement is just another in a long list of quirks that my children find perplexing and irritating. I somehow haven’t completely transmitted the enthusiasm my own parents had for the start of the school year.

My dad, a college president who saw the potential student in almost everyone, looked upon the beginning of the semester like a child anticipates Christmas morning. His own education was a transformative gift, and he never got over his wonder and gratitude. My mother excitedly planned first-day-of-school outfits and staged multiple photos, but one year she got a little ahead of herself. As she pulled out of the elementary school driveway, having dropped me and my brothers off at the front entrance, the custodian waved down her speeding station; the first day of school wasn’t until the NEXT day. I get it; summer vacation can get too long when you have three kids underfoot.

In the wonderful world of dermatology, the fall also brings particular skin conditions. One of these back-to-school rashes is hand, foot and mouth disease.

Hand, foot, and mouth disease is a viral infection that causes sores in the mouth and a rash on the hands and feet. It is common among children under the age of 5, particularly in daycare settings, as it spreads by close contact with infected people. It’s not usually serious, and nearly all people recover within 10 days without medical treatment. (1)

Symptoms of Hand, Foot and Mouth Disease

● Fever
● Poor appetite
● Sore throat
● Rash – Small red bumps or blisters on the palms, soles of the feet, and sometimes the knees, elbows, buttocks, and genital area.
● Painful sores in the mouth

Symptoms typically appear 3-6 days after the initial infection (incubation period), with fever as the first sign, followed by a sore throat. (2)

Transmission

Hand, foot, and mouth disease spreads through contact with infected individuals’ nasal secretions, throat discharge, saliva, stool, or respiratory droplets after a cough or sneeze. It may also spread through contact with blisters on the skin.

Infected individuals are typically most contagious during the first week of illness, but the virus can remain in the body for weeks after the signs and symptoms are gone, resulting in further transmission. Some people, particularly adults, can pass the virus without showing any signs of the disease. Outbreaks of the disease are common in the summer and autumn in the United States and other temperate climates. (3)

Treatment for Hand, Foot and Mouth Disease

There is no specific treatment for hand, foot, and mouth disease. Symptoms, such as fever, can be managed with over-the-counter analgesics, like Ibuprofen or Tylenol. It is important that infected individuals drink plenty of fluids to stay hydrated, particularly if fever is present. Complications of hand, foot, and mouth disease are rare, but may include viral meningitis or encephalitis. High fevers not relieved with analgesics, headache, stiff neck, or back pain warrant further evaluation by your physic.

 

 

 

(1) CDC (June 28, 2018). Hand, Foot, and Mouth Disease. Accessed online at:
https://www.cdc.gov/features/handfootmouthdisease/index.html .

(2, 3) Mayo clinic (July 26, 2017). Hand, Foot, and Mouth Disease . Accessed online at:
https://www.mayoclinic.org/diseases-conditions/hand-foot-and-mouth-disease/symptoms-causes/syc-20353035 .

Blue lagoon

The Benefits of the Blue Lagoon

Blue lagoon

If you haven’t been to Iceland yet, chances are you know at least a dozen people who have taken the short flight to Reykjavik and spent a few days among the volcanoes, glaciers and geysers.

Last year more than 2 million tourists went to the Island of Fire and Ice with many of them taking a mineral bath in the iconic Blue Lagoon. I hate to be a lemming, but I wanted to see what drove so many to this sparsely populated island and learn first-hand about the dermatologic potential of Iceland’s most famous destination.

I was surprised to discover that the Blue Lagoon is not one of Mother Nature’s best works, but a beautiful man-made spa utilizing naturally occurring geothermal energy in the form of super heated water extracted from a mile below the earth’s surface. It is an ingenious re-use of the excess water from an adjacent power plant. The water is a mix of fresh and seawater and, according to the spa website, the unique algae plants and high concentration of silica directly benefit the skin. They claim the anti-bacterial effects of silica improve psoriasis and eczema and that the mineral water prevents premature aging.

I had to try it, so we booked a day at the Blue Lagoon Retreat, touted as a “transformative journey into volcanic earth.” It’s definitely a transformative setting, with canals and pools of beautiful blue-white water snaking through volcanic cliffs, overlooking mountains and a starkly spectacular landscape. The experience is soothing and relaxing. Once I was able to pull myself out of the warm water I performed the signature “ritual” using scrubs of lava sand and salt, a cleansing silica mask and moisturizing algae oil. It was a sublime end to a memorable day.

Effects of Blue Lagoon Water

According to Icelandic dermatologist Jenna Huld Eysteinsdottir, research on the effects of the Blue Lagoon’s algae and silica on skin cells showed an increase in the genes that prevent skin aging. These were “in vitro” laboratory studies, however, and I am not aware of any that looked at actual patients. Additionally, there is a great deal of evidence that silica, the star ingredient in Blue Lagoon’s skin care line, is vital for healthy joints, skin, nails, teeth and bones. While it is less clear that applying large amounts of silica on the skin will result in reversal of aging, this pure white mineral is very effective in the absorption of oil and can have a positive role in masks for those with acne, eczema and psoriasis. It’s found in many cosmetic products because it improves the appearance of lines and pores, but as far as I know, only temporarily.

Seeking more “in vivo” evidence of the Blue Lagoon’s claims, I looked around at the Icelanders’ skin. With a population of a little more than 300,000 in a sea of tourists, spotting a native Icelander is almost as challenging as identifying one of the elves that are central to the Icelandic sagas and identity. There is no question though that most natives have exceptionally healthy skin – unlined and evenly pigmented. Lack of sunlight may play a role, however, as they live at a latitude with only 5 hours of daylight in winter.

Is the Blue Lagoon Worth it?

So, what’s the upshot? After a few hours of soaking and scrubbing in the ethereal waters of the Blue Lagoon I felt absolutely fantastic and renewed.  From a dermatologist’s perspective there is not yet enough science to support its skin anti-aging claims, but I would still recommend the experience, if only for the restorative powers to one’s psyche. There will be undoubtedly more data on the horizon, and I will be on the lookout. In the meantime, if you have the chance, check the Blue Lagoon out for yourself.

 

Takk Fyrir!

 

bride on beach

A Breakthrough In Melanoma Detection

Are you reluctant to undergo a skin biopsy because of the potential for a scar? We have good news. There is a new, non-invasive melanoma detection method to check suspicious dark moles. Read the story below by Dr. Maral Skelsey and learn more about DermTech, a “bladeless biopsy.”

What is Seborrheic Keratoses?

Have you ever been concerned about a dark mole on your skin, only to be told by your dermatologist that it’s not a mole but a seborrheic keratosis? We might tell you not to worry about it, but did you get a good explanation of what they are?

A seborrheic keratosis (SK) is a very common skin growth caused by a thickening of an area of the top skin layer. It usually appears as a brown, black, or light tan growth on the face, trunk or arms, and may have a waxy or scaly raised appearance. Despite the way they look, these growths are harmless. They do not usually cause any symptoms, but they may itch.

SKs typically occur in middle-aged and older adults and there may be a tendency in families to grow multiple lesions. SKs are not contagious.

Treatment Options for Seborhheic  Keratosis

Treatment of SKs is usually not necessary, but may be desired for cosmetic reasons. Under local anesthesia, they may be removed with a scalpel, scraped off with a special instrument, or burned off with an electric current. The most common treatment for SKs is liquid nitrogen therapy. However, all of these treatments have the potential to leave behind a white mark or scar. Eskata is a new treatment that is able to remove the SKs without leaving a scar or affecting the pigment in the skin.

What is Eskata?

Eskata is an FDA-approved topical and non-invasive treatment that is indicated for raised seborrheic keratoses (SKs). It consists of a clear, colorless solution of 40% hydrogen peroxide intended for application by a healthcare provider in an office setting. We are happy to announce that we are one of the first practices in the Washington, DC region to be trained and certified in Eskata application.

How does it work?

We carefully apply the concentrated hydrogen peroxide liquid to the SKs four times, about a minute apart. The SKs may turn white initially and then form a scab. Over the next few days, the SKs should fall off without leaving a scar. Typically, two treatments are needed, about 3 weeks apart, to completely remove the SKs. Watch the video below to see an application.

What are the side effects of Eskata?

A tingling, burning, or itching sensation is common during the application process. Following the application of Eskata, patients may have redness and/or swelling that can last up to a week.

Is Eskata covered by my insurance?

Treatment with Eskata is considered cosmetic, and is not covered by insurance. One session will treat up to 7 SKs.

 

Contact us with any other questions or to make an appointment with a dermatologist.

melanoma

Amelanotic Melanoma: Symptoms, Causes, Treatment

melanomaA patient recently came to the office concerned about a new dark mole on her leg. During her full body skin examination, I noticed a pink bump on her back.  I asked her about it and she said it was a bug bite that was taking a long time to heal.  Because of the appearance of the lesion when I examined it with a dermatoscope, I recommended a biopsy. Unfortunately, the pink spot on her back turned out to be a melanoma. The mole on her leg was benign.

 

Most patients are concerned when they spot a new dark mole, but it’s not widely recognized that melanoma can present as a pink or colorless skin lesion. Amelanotic melanoma is a serious form of skin cancer where the cells do not make melanin or pigment. It is responsible for approximately 2-20% of melanoma cases1. Because of their lack of color, diagnosis of this type of melanoma may be delayed until it reaches an advanced stage.

Symptoms

One of the most obvious symptoms of amelanotic melanoma is the sudden appearance of a red, pink, or skin-colored spot on your body where it wasn’t before. Melanomas also grow and may change shape, becoming a larger bump over time. Amelanotic melanoma may not present with the classic ABCD criteria (Asymmetry, Border Irregularity, Color variation, and Large Diameter) that are typically associated with melanoma warning signs. Expanding the ABCD warning signs to include the 3 Rs (Red, Raised, Recent change) may help in the early detection of amelanotic melanoma2. It is also estimated that about 25% of melanomas of the nail are amelanotic, so checking your nails should be a regular part of self-skin examinations. It is important to note that melanoma may present differently in individuals of color, therefore regular self-skin examinations are essential in the early detection of these skin cancers.

Causes

Melanoma occurs when the DNA in your skin cells becomes damaged, which can cause the cells to grow out of control and become cancerous. Exposure to the sun for long periods of time can damage your skin cells and increase your risk for melanoma. This risk is increased in patients with fairer skin, individuals of European descent, those with many moles (especially 50 or more), a family history of melanoma, and patients with a weakened immune system from an existing condition3. The use of tanning beds has also been associated with an increased risk for melanoma and should be avoided4.

Treatment

The most common treatment for melanoma is surgical removal.  However, melanoma can spread to the lymph nodes, necessitating the removal of one or more nodes. Advanced melanoma may need to be treated with chemotherapy and/or radiation. Biological therapy (or drugs that aid your immune system in killing cancer cells) as well as targeted therapy (medications that weaken cancer cells) are other common melanoma therapies. Patients with a history of a previous melanoma are 4 times more likely than the general population to develop a subsequent invasive melanoma, therefore full body skin examinations should be performed by a dermatologist every 3 months after a melanoma diagnosis.

 

References:
1.         Thomas, N.E., Kricker, A., & Waxweiler, W. Comparison of Clinicopathologic Features and Survival of Histopathologically Amelanotic and Pigmented Melanomas: A Population-Based Study. JAMA Dermatol. 2014;150(12):1306-1314. doi:10.1001/jamadermatol.2014.1348
2.         Kim, S.J., Park, H.J., Lee, J.Y., Cho, B.K., A Case of Subungual Melanoma. Ann Dermatol. 2008 Mar; 20(1): 26–28. Published online 2008 Mar 31. doi:  10.5021/ad.2008.20.1.26
3.         American Cancer Society. Risk Factors for Melanoma Skin Cancer. Available online at: https://www.cancer.org/cancer/melanoma-skin-cancer/causes-risks-prevention/risk-factors.html
4.         American Academy of Dermatology. Indoor Tanning. Available online at: https://www.aad.org/media/stats/prevention-and-care

excessive sweating

Hyperhidrosis Could be the Cause of Too Much Sweat

hyperhidrosis

Hyperhidrosis is a medical condition that causes excessive sweating that is not necessarily related to heat or exercise. Messages from your brain usually tell your body when to produce sweat, either to keep you cool in warm temperatures or as a reaction to anxiety. However, with hyperhidrosis, excessive sweating occurs regardless of the physical or emotional environment. This excessive sweating may interfere with daily activities and can cause significant social anxiety and embarrassment. Fortunately, several treatment options are available to help with this condition.

Treatments for Excessive Sweating

    • Antiperspirants: Antiperspirants are the most common treatment for hyperhidrosis and may be purchased “over-the-counter” at your local drugstore or with a prescription from a medical professional. They work by plugging your sweat ducts so that the sweat does not reach the surface of your skin.
    • Iontophoresis: This treatment uses a mild electrical current in a shallow tray of water to reduce excessive sweating of the hands and/or feet. It has been shown to reduce sweating by 81%1,2. Prescription iontophoresis machines cost under $1000 and insurance may cover some of the cost.
    • Botox: Botox is a natural, purified protein that, when injected, can temporarily block the secretion of a chemical in your body that controls your sweat glands. When used to treat excessive underarm or hand sweating, it has been shown to reduce sweating by 80-90%, with improvement lasting from 4-12 months. The cost of Botox varies depending upon the size of the body area treated and whether insurance covers any of the cost.
    • Oral medications: There are several classes of medications that may be used to treat excessive sweating, each having different side effects and precautions. Insurance usually covers the cost of this type of therapy.
    • Laser therapy: A laser can be focused into a narrow beam of energy in order to target, heat, and destroy sweat glands in the underarm area. Side effects may include swelling, bruising, and numbness, but usually resolve after 1-2 weeks. In studies, 82% of patients receiving laser treatment for hyperhidrosis said their results were “good” or “excellent”3. Insurance may not cover the cost of laser treatment, which can be up to $3000.
    • MiraDry: This device is used by a doctor to deliver microwave energy to the underarm skin, effectively destroying sweat glands. In research studies, MiraDry was shown to reduce underarm sweat by 90%4. Common side effects include swelling, redness, and tenderness lasting for several days. Best results are seen when two treatments are performed three months apart.
    • Obrexza: This non-invasive FDA-approved treatment is intended to treat axillary hyperhidrosis (underarm excessive sweating). One wipe is applied topically to both underarms once per day. It is approved for patients 9 years old and older.

    Other Causes of Excessive Sweating

    Hyperhidrosis may be caused by an underlying medical condition such as menopause, diabetes, Alzheimer’s, tuberculosis, or cancer. Certain medications, such as antidepressants or anti-anxiety medications may also cause excessive sweating.

    When sweating is caused by an underlying medical problem, this is called secondary hyperhidrosis. Unlike secondary hyperhidrosis, which has a sudden onset, primary hyperhidrosis tends to be a longstanding medical condition that typically begins prior to age 25 with no underlying cause.

    If excessive sweating is a problem for you, consult with your physician.

    Contact us with questions and to book your appointment.

     

     

     

     

    1. Karakoç Y. Safe control of palmoplantar hyperhidrosis with direct electrical current. Int J Dermatol. 2002;41:602-605.
    2. Bouman HD, Grunewald Lentzer EM. The treatment of hyperhidrosis of hands and feet with constant current. Am J Phys Med. 1952;31:158-169.
    3. Leclere FM, Moreno-Moraga J, Aleolea JM, Vogt PM, Rovo J, Corenjo P, Casoli V, Mordon S, Trelles MA. Efficacy and safety of laser therapy on axillary hyperhidrosis after one year follow up: a randomized blinded controlled trial. Lasers Surg Med. 2015; 47(2): 173-9.
    4. Lupin M, Chih-Ho Hong H, O’Shaughnessy KF. A multi-center evaluation of the Miradry system to treat subjects with axillary hyperhidrosis. Am Soc for Laser Med and Surg. 2011; 79.

    Skincare Tips for Diabetes Patients

    5 Skin Tips for People with Diabetes

    According to the 2017 National Diabetes Statistics Report there are 30.3 million people with diabetes (9.4% of the US population) including 23.1 million people who are diagnosed and 7.2 million people (23.8%) undiagnosed.

    Patients with diabetes are more susceptible to skin infections, especially on the feet and on the skin of the ear. More than 75% of patients with diabetes will have skin lesions. The most common is xerosis or dryness. Dry skin affects 50% of those with type 1 diabetes. Keratosis pilaris, or rough spots on the sides of arms affect about 10% of patients. Itching of the skin, especially on the torso, is very common.

    Also occurring are smooth yellow plaques on the front of the shins called Necrobiosis lipoidica. These lesions are usually painless and are 3 times as likely to occur in women than in men. They can be treated with topical creams as well as oral medications that improve circulation, such as low-dose aspirin, pentoxifylline, dipyridamole and nicotimamide.

    70% of diabetic men over 60 will develop diabetic dermopathy or shin spots. Over time these become dark depressions in the skin.

    Skincare Tips for Diabetes Patients

    So how does one prevent or treat these irritations caused by diabetes? Besides keeping your diabetes under control, here are some tips you can follow for skin care.

    1. Moisturize daily with an unscented emollient such as Cerave, Cetaphil or Uradin 10 lotion. Apply when skin is still damp- within 3 minutes of getting out of the bath or shower.
    2. Use a moisturizing, fragrance-free cleanser such as Dove soap. Oatmeal baths can also help reduce itching.
    3. Thoroughly dry skin folds such as underneath the breasts or between toes. Trapped moisture is a breeding ground for yeast and fungal infections.
    4. Check your feet daily for sores or cuts and treat with a topical antibiotic and bandage. Seek medical attention for any sores that have not healed or are red, swollen, hot or draining pus.
    5. Don’t cut cuticles around your nails as this can lead to infection.

    Note that not all-natural health and beauty products are 100% natural. Many include fragrance and other ingredients that can irritate sensitive skin. Be sure to read the labels.

    If you are concerned about your skin or whether you have diabetes, consult a physician.

    Contact us with questions and to book your appointment.

    How Chemical Peels Rejuvenate the Skin

    Sun exposure can cause discoloration of the skin as well as roughness and wrinkling. This damaged skin can be repaired to a large degree with a variety of rejuvenating treatments.

    One of the methods that restores the skin’s natural beauty without significant downtime is a chemical peel. Peels are a great way to brighten the skin and reduce discoloration.

    History of Chemical Peels

    Interestingly these procedures have been performed for centuries.  The ancient Egyptians used acids to peel the skin as early as 1550 B.C. Dermatologists have been doing the modern day version for more than half a century. The procedures we use today have been greatly refined, and so has our approach to using them.

    Modern Chemical Peels

    Peels can be tailored for skin type and the type of skin damage. It’s not a “one size fits all approach to anti-aging. Peeling agents include an alphabet soup of  some combination of the following: salicylic, retinoic, mandelic, phytic, and tricholoracetic acids. We choose an agent or agents based on the tone and condition of the skin as well as the desired outcome.

    Today’s chemical peels often infuse the skin with ingredients that encourage its own natural processes such as building collagen to diminish wrinkles and improve tone. They can also be combined with other procedures such as microneedling to enhance the penetration of active agents.

    Different Types of Chemical Peels

    Here’s a primer on peels.  A light peel, commonly called a lunchtime peel, gently exfoliates only the outer layer of skin. This treatment can improve mild discoloration as well as refresh the face, neck, chest or hands. Regular light  peels for acne work well with other treatments and can help reduce the need for prescription oral antibiotics. Light peels are also an excellent solution for patients of color looking to lighten the skin.

    To get the results you seek from a light peel, you will need multiple treatments, depending on your goals. Melasma or hyperpigmentation on the face will require several sessions of chemical exfoliation to eliminate the pigment.

    A medium peel penetrates the outer and middle layers of skin to improve age spots, fine lines and wrinkles, freckles and moderate skin discoloration. It also can be used to smooth rough skin and treat precancerous skin growths such as actinic keratoses.

    Deeper peels are also designed to penetrate the middle layer of skin to remove moderate lines, age spots, freckles and shallow scars.

    Preparing for a Chemical Peel

    Preparation for a peel is as important as the peel itself.  You may be given instructions on a skin care plan- especially if you have darker skin tones- for the 2-4 weeks preceding a peel. After your peel you we will tell you how to care for your skin, when it’s safe to begin wearing makeup and what you should be using to maintain the benefits of your peel.

    Peels are a customizable approach to healthy anti-aging and a natural aesthetic.

    Contact us with questions and to book your appointment.