Mark posts with this category that you would like to have appear on the Blog page.

What is Melasma & How to Treat It

melasma example dark spots on cheek

In addition to wonderful memories, summer can leave behind unwanted darkening of the skin.  Persistent hyper-pigmentation of the face, called Melasma, occurs on the cheeks, bridge of nose, forehead, upper lip and occasionally the forearms.  It is similar in appearance to age spots, but the dark patches cover a larger area.

Melasma occurs in all skin types, but especially in skin of color.  East Asian, Southeast Asian, Hispanic and Blacks populations have the highest rates.  Up to 30 % of middle-aged Asian women exhibit Melasma.  In general, women are affected more frequently; the American Academy of Dermatology estimates that 90 % of Melasma sufferers are women.  Men are not immune; nearly 35 % of men from Central America – particularly Guatemala – develop the condition.

What causes Melasma?

Sunlight is the principal trigger.  The greater the sun exposure, the greater the risk.  Age increases the potential as does a history of vitiligo and the existence of multiple moles or birthmarks.

The second most important cause is female hormones.  Not only is Melasma more common in women, it’s also more severe.  It occurs during pregnancy (the “mask of pregnancy” or Chloasma) and with the use of oral contraceptives and hormone replacement therapy (HRT).  Unfortunately discontinuation of the medication doesn’t necessarily reverse the pigmentation.

Why does Melasma differ by ethnic group?

Skin color is determined by the density and distribution of melanin, or natural pigment, in the skin.  All ethnicities have a similar number of melanin producing cells, or melanocytes, in their skin.  What differs is the level of melanocyte activity and how closely the cells are grouped together.  Skin types with more melanocytic activity, or darker skin types, react to inflammation or UV exposure with more robust melanocytic activity, leading to hyper (increased) and sometimes hypo (decreased) pigmentation.

How is Melasma treated?

Sun protection is the cornerstone of Melasma prevention and treatment.  Daily use of a broad spectrum (at least SPF 30) sunscreen that blocks both UVA and UVB is critical.  These should be applied at least 20 minutes before and 30 minutes after sun exposure.  Products  should contain one or more of the following ingredients in order to protect against the long UVA wavelengths: Zinc Oxide, Titanium Oxide, Ecamsule and/or Avobenzone (Parsol 1789).  Protection can also come from wearing iron oxide-containing makeup.  Hats with a 2-3 inch brim along with sunglasses are helpful in reducing UV light exposure.  It’s important to remember that damaging sun rays penetrate through a car window.

Topical skin bleaching agents such as prescription-strength Hydroquinone, either alone or in combination with topical retinoids and steroids, are very useful in treating Melasma.  Their efficacy is enhanced when combined with a series of peels with either Glycolic Acid, Salicylic Acid or Trichloroacetic Acid.  Peels and topicals should be adjusted according to skin type for best results.

Other agents also have a role in reducing pigmentation including vitamin C and E, Azelaic Acid, licorice, Kojic Acid, Ellagic Acid and Arbutin.  Lasers are often promoted for Melasma treatment but they are not as effective as they are for solitary age spots or blood vessels.

Oral medications, such as Tranexamic Acid, are also helpful as an adjunct treatment for some patients.

Summary:

I find that a multi-modal approach, tailored to a patient’s ethnicity, location of pigment in the skin and underlying health status leads to significant and durable improvement in Melasma.  The good news is that if Melasma bothers you, it’s not something you have to live with!

Hair Treatments: Separating Fact from Fiction, Part I

Hair loss is one of the most complicated issues in Dermatology. There are numerous potential causes including auto-immune conditions, hormonal abnormalities, nutritional deficiencies, malignancies and heredity. In addition to the challenges of establishing a diagnosis, the remedies are neither fool-proof nor universally beneficial. Unlike many other areas in medicine, studies on hair growth medications and treatments are often not well-designed or double-blinded. End points are difficult to quantify. Growing hair can be elusive and determining if what you’re using is actually effective turns out to be even harder.

We know that half of all men and women over the age of 50 will experience hair loss. For those whose gradual hair thinning is a result of heredity or age and not a reversible condition– what options are scientifically based? Does anything really work? How much of what we believe about hair growth and hair care is just a myth?

Hair Loss Treatments

As of today, the only FDA-approved medications for the treatment of hair loss are topical Minoxidil and oral Finasteride.

Minoxodil is an over-the-counter solution or foam found in two different strengths: 2% and 5% . Although how it works is not entirely clear, minoxidil does seem to increase hair growth rate and hair follicle diameter.

What I have observed is that it increases hair growth in about 1/3 of patients, maintains hair in another third and doesn’t do much in the rest.

Recommended Usage of Hair Loss Treatments

There are a lot of misconceptions about its use, however, and that leads to less than optimal results.  Patients will often stop using minoxidil if it doesn’t work within the first 2 months, believing that it’s not going to be effective for them. It turns out that many people won’t see results until 4- 6 months of daily use. I recommend continuing for a full year before giving up.

I also find that patients are reluctant to start Minoxidil because they think they must commit to it for the rest of their lives and if they stop their hair will all fall out. NOT TRUE! Like many things, such as sunscreen or hair spray, it’s only going to work when you use it. But that doesn’t mean someone has to apply it forever or that you’ll lose all your hair if you stop. You won’t. Your hair just goes back to where it was before you started Minoxidil.

Contrary to what some believe, Minoxidil will not cause hair loss to worsen. It can seem like it does for some people, because as new hair growth begins, resting or not-growing hairs are pushed out. This shedding can make it seem like hair is actually being lost; however overall hair count and the size of the hair shaft are actually increasing when this happens.

Suggested Hair Care for Those Experiencing Hair Loss

What about hair care? If you’re losing hair should you shampoo or brush less frequently, and stop dying your treating your hair?

Shampooing often enough to eliminate scale on the scalp helps optimize hair growth. Certain shampoos are better for this than others. However the frequency of hair washing will not make an impact on hair growth. You might be more aware of the loss when you shampoo, but there is no evidence linking hair loss to hair washing.

Similarly neither brushing your hair nor using chemical treatments such as dyes, perms or straighteners will cause you to lose your hair. What they can do, though, is make hair weaker and more susceptible to breakage, which can make hair loss more noticeable. So proceed with caution.

More Information

Hair loss is more than just having a bad hair day. It can signify a health problem and it can also be psychologically devastating for both men and women. We are exposed to a deluge of options regarding hair growth— only some of which are legitimate. Some treatments may turn out to be helpful, but data to support them is limited or non-existent.

In a future blog I’ll explore what we know and don’t know about the other approved medication, finasteride, along with supplements, hair lasers and PRP.


BOGO SALE

Buy one Nutrafol® vitamin for women or men and get a second one 20% off.*

* This promotion is valid during the month of August 2017.

Contact us with questions and to book your appointment.

 

Check out our July Specials

Treat your double chin!

KYBELLA® is the only FDA approved injectable treatment for men and women to improve the appearance and profile of moderate to severe fat below the chin (submental fat), also called “double chin.”

PROMOTION:
Purchase one KYBELLA treatment during the month of July and receive a free one to use within 12 months.

Call us at 301-652-8081 to book your appointment.

Buy 1 Sunscreen & Receive 20% Off SunBuddy or Protex

We offer a range of dermatologist recommended sunscreens, available at our office. Now through the month of July, purchase any sunscreen and receive 20% off  SunBuddy (sunscreen applicator for your back), or Protex (sun protective gloves).

Contact us with questions and to book your appointment.

Get your face ready for summer!

Say goodbye to aging lines!

Get any Restylane facial filler and receive a FREE product from the options below.

WHEN: Tuesday, June 20
RESERVATIONS:
Call us at 301-652-8081

Revision Finishing Touch
This serious facial exfoliation scrub removes dead, dehydrated surface cells from the skin for an immediate soft, smooth appearance.

Revision Black Mask
This intensive mask with a moist after-feel deep cleans the skin, ridding it of impurities and excess sebum.

Tinted Physical Sunscreen – SPF 50+

This next generation BB cream provides superior broad spectrum UVA/UVB protection with a skin perfecting tint that reduces the signs of aging and evens skin tone. Worn alone or under foundation, this matte finish, multi-tasking formula provides:

• Mattifying, all day oil control
• Breathable SPF 50+ protection
• Age defying antioxidant benefits
• Universal Pigment Technology to blend with all skin tones
• Sheer tint to conceal minor skin imperfections
• Gentle hydration for even the most sensitive skin

Sheer Physical Sunscreen Spray – SPF 50+

Sheer, broad spectrum UVA/UVB SPF 50+ sunscreen utilizes innovative and proprietary formulation technologies to deliver ultra-light, quick absorbing, non-whitening protection. A true sensitive skin formula free of chemical stabilizers, this anti-photoaging sunscreen is water resistant for 40 minutes and fortified with a blend of powerful antioxidants. The 360º spray is perfect for on-the-go, trips alone to the beach or as a refresher under or over make up.

Call us with any questions and to make your reservation: 301-652-8081

Why Rosy Cheeks are Not Always a Good Thing

Rosy cheeks are seen as a sign of a good thing when considering a beautiful blush, or a good workout.

Permanent redness, however, is evidence a of chronic skin disorder called rosacea.  

Rosacea is very common and yet many people don’t know they have it.  Worst of all it can spread if left untreated — from the nose and cheeks to the ears, eyes, forehead and chin — even to the shoulders and back. It can be disfiguring when accompanied by pimples and thickened skin.

Rosacea is divided by dermatologists into four Subtypes:

Subtype 1:  FACIAL REDNESS – persistent flushing and visible blood vessels.

Subtype 2:  BUMPS AND PIMPLES – often seen with facial redness.

Subtype 3:  SKIN THICKENING – usually around the nose.

Subtype 4:  EYE IRRITATION – watery or red eyes with swollen, irritated eyelids.

Researchers are still trying to discover what causes rosacea. While there is currently no cure we do know that by treating the dilated blood vessels associated with rosacea it can be effectively managed. Recent advances in technology make this possible.

Treatment

Laser therapy has the unique ability to selectively target and treat these dilated blood vessels without adversely affecting the surrounding tissue. The most effective laser available for rosacea is VBeam Perfecta. A course of three or four treatments, each a month apart, can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

During VBeam Perfecta treatment, the mild discomfort associated with all laser procedures, similar to a snapping rubber band on the skin, is countered by a cooling stream of air directed at the area. This cooling also helps to prevent temporary bruising, an unwanted side effect of earlier laser technology. Light pink patches may appear that last for approximately a day. VBeam Perfecta is so safe and effective that it has been fully approved by the FDA for the treatment of infants.

The aesthetic improvements from laser treatments can be dramatic.

Rosacea Subtype 1 – Facial Redness

A course of three or four treatments scheduled a month apart can usually achieve very effective results with all subtypes. Even the scarring from acne rosacea can be removed.

 

With the availability of VBeam Perfecta there is no longer a need to suffer the psychological side effects, such as depression and low self-esteem, which affect many victims of Rosacea. This advanced laser can also greatly improve many other unsightly conditions including angiomas, port wine stains, stretch marks, stubborn warts, bruises and sun damage on the neck and chest.

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.

 

Spring is the Best Time for Sclerotherapy: Spider Vein Treatment

Spring is in the air! As you clear out your closet of winter clothes and try on your new summer wardrobe, check to see if your legs are ready for short skirts and bathing suits. If you notice that you’ve got some red and blue veins that make you reluctant to show your legs, now is the time to do something about it. The good news is that if you treat your spider veins today, you’ll see terrific improvement by the Fourth of July.

When do Spider Veins Generally Occur?

Spider veins can occur at any age and result when the valves in the blood vessels become leaky and fail to prevent the blood from pooling in the feet and ankles. This is a result of a combination of factors including heredity, hormones, puberty, pregnancy, and weight. While women are most susceptible, a quarter of all leg vein sufferers are men.

Although a sun tan can temporarily camouflage these vessels, in the long run the sun will make leg veins more prominent and unsightly as it breaks down collagen. Minor spider veins can be the precursors to varicose veins, which tend to be thicker, lumpy and purple and may lead to swelling and uncomfortable achiness or heaviness in the legs.

How to Treat Spider Veins

Sclerotherapy is a safe and effective procedure used to reduce spider veins. It involves the injection, using a very fine needle, of a small amount of solution into the veins. The solution then irritates the lining of the vein, causing it to collapse. As these veins are a superfluous, “alternate route” for the blood, the body doesn’t miss these vessels and blood returns to the heart via the main thoroughfares.

Who can be treated for spider veins?

With a few exceptions, most healthy people are good candidates for sclerotherapy. If you are pregnant or have had a blood clot you shouldn’t be treated. If your veins are very tiny or too large you might not be treated.

Is Sclerotherapy Painful?

Most patients experience little or no discomfort during the procedure, which does not require any anesthesia. There might be a slight stinging as the solution is injected and the areas that were treated can become red, raised and itchy. You may also experience bruising which can last for several weeks.

How to Prepare for Sclerotherapy

Prior to sclerotherapy, you should discontinue over-the-counter supplements that cause bleeding, such as ginkgo, ginseng, and vitamin E as well as anti-inflammatory medications like ibuprofen and aspirin. Bring heavy compression stockings with you as you will need to wear them after the procedure for at least 48 hours. You will also need to avoid hot baths, whirlpools or saunas, and direct sunlight exposure on the areas treated for at least 2 days.

Usually at least half of all veins injected will disappear with sclerotherapy in 3- 6 weeks. Depending on the number of veins, some people will need multiple treatments. In about 10% of all cases the veins don’t respond and another solution can be tried.

Because it can take a few weeks for the veins to disappear,  it’s a good idea to have sclerotherapy before the start of summer!

APRIL 2017 SPECIAL:

Receive a FREE Revision Black Mask purifying facial mask or Microdermabrasion Finishing Cream with every Sclerotherapy treatment during the month of April.

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.

Look Your Best This Spring – March Cosmetic Specials

Get a Dysport Injection (abobotulinumtoxinA) and receive 50% off Revision DEJ Face Cream.

Dysport is an injection to temporarily improve the look of moderate to severe frown lines between the eyebrows.DEJ Face Cream by Revision Skincare is a product containing a proprietary ceramide blend, specialized herbal extracts and a unique peptide combination for improvement in smoother skin texture and brightness. This product also helps to reduce the appearance of fine lines and wrinkles.

Schedule your appointment today, this offer is only valid during the month of March!


Special on March 10th Only!

Buy 1cc of Restylane, Get a Second for 50% Off

Restylane dermal facial filler can be used for facial wrinkles and folds and to fill thin lips.

Don’t wait, this offer is only valid on March 10, 2017.

 

Contact us with questions or to schedule your appointment.

Call us at 301-652-8081.

sid-australian-emb-2016

SKIN CHECK AT AUSTRALIAN EMBASSY

Sid-2016-Dr-Skelsey-and-team

Dr. Skelsey and her team were invited to take part in a sun safety program at the Australian Embassy on June 3 where Sid the Seagull, the famous mascot of Australia’s Sun Smart campaign, entertained Embassy families and reminded everyone to “Slip, Slop, Slap, Seek and Slide” to protect against skin cancer. Sid-Event-postersDr Skelsey and her team provided skin cancer screenings as well as gift bags with some of the latest and best sun screens, sun glasses and UV bracelets.

ballet-screening-2016

THE WASHINGTON BALLET IS ON ITS TOES WHEN IT COMES TO SKIN CANCER…

Dr.-Skelsey-Ballet-examines-armOn Friday, May 6, 2016, The Washington Ballet took a proactive approach to keeping its performers healthy by offering skin cancer screenings. Dr. Skelsey, who is a member of The Washington Ballet Board of Directors, performed the highly recommended, annual full body skin cancer screening on the dancers and other members of the ballet company utilizing new, state of the art, non-invasive, diagnostic technology, DermTech®. A simple adhesive patch is used to detect the presence of cancer in suspicious lesions.

The new Washington Ballet Health and Wellness Fund is committed to making services available to its dancers that protects their health, safety and wellbeing. Under the auspices of the health and Wellness Fund Dr. Maral Skelsey, a member of TWB board of directors, provided skin cancer screenings for the company during Melanoma Awareness Month in May.

sid-seagull-2015

BATTLING SKIN CANCER IN A HIGH RISK POPULATION

The Dermatologic Surgery Center of Washington helps to battle skin cancer in one of the world’s most vulnerable populations. Each year Dr. Skelsey and her staff volunteer at the Australian Embassy Health Fair where they do skin cancer screenings for embassy personnel.

sid-seagull-2015

Australia and New Zealand have one of the highest incidence and mortality rates of melanoma in the world, according to Australia’s Department of Health and Aging. Fair-skinned populations that migrated from Britain and Europe to areas with high levels of solar ultraviolet radiation like Australia and New Zealand, have experienced a jump in the incidence of both melanoma and non-melanoma skin cancers.*
This year Physician’s Assistant Cynthia Wallace performed more than 30 full body scans at the October 30 fair.

Australians battle skin cancer on their own turf with ongoing research and a preventative program worth noting here in the US: Australian researchers recently released a study abstract revealing that Nicotinamide, a form of vitamin B3, significantly reduces the incidence of nonmelanoma skin cancers among people who have had a previous basal cell carcinoma or squamous cell carcinoma.

One of the most successful health campaigns in Australia’s history was launched by Cancer Council Australia in 1980. Sid the seagull, wearing board shorts, t-shirt and a hat, tap-danced his way across TV screens singing a catchy jingle to remind viewers of three easy ways of protecting against skin cancer.

Slip, Slop, Slap! It sounds like a breeze when you say it like that Slip, Slop, Slap! In the sun we always say “Slip Slop Slap!” Slip, Slop, Slap! Slip on a shirt, slop on sunscreen and slap on a hat, Slip, Slop, Slap! You can stop skin cancer – say: “Slip, Slop, Slap!”

*National Centre for Epidemiology and Population Health at the Australian National University