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Why You Should Try Yoga

By Cynthia Wallace, PA-C

trying-yoga

I began the practice of yoga because, like so many of us, I struggled to balance the demands of my professional life as a physician’s assistant with responsibilities as a wife and mother of two. I never loved to exercise, and since there doesn’t seem to be enough hours in the day, taking care of myself was at the bottom of the list.

But that changed last Christmas when my husband gifted me with enrollment in a yoga class. I was a little skeptical, but he had already paid for it, so I had to go. It’s not an exaggeration to say that it was life-changing. At first I was a bit intimidated; everyone else in the class knew what to do when the instructor called out commands. I walked in not even recognizing child’s pose! And all the other participants looked incredibly fit and had much greater strength and flexibility than I’ve ever had. But I stuck with it. I kept going because even if was exhausted after a long day and had to drag myself to the studio, I was energized and calm after I left the class. I felt present when I was with family and not overwhelmed by my to do list. I even slept better.

Now that we are in the midst of this pandemic I feel the need to continue my practice more than ever — not just for myself but so that I can project peace and tranquility to my children – whose whole lives are upside down. I’m not able to join my class in the studio, but I have found the same sense of well-being as I stream on-demand sessions through my Peloton app. (Other great sites are: grokker.com, yogawithadriene.com, doyogawithme)

Yoga promotes  increased flexibility, weight reduction, and increased muscle strength. At this moment, I most value its mental health benefits which include reduction in anxiety, improved moods and clearer thinking. The list goes on. My family benefits from my practice as well. I am definitely a nicer person when I practice yoga!

When you need to find calm in your life, take some time for yourself and do a few minutes of yoga or at the least find a quiet place to breathe deeply and reflect peacefully (check out imcw.org or Headspace.com). Don’t be afraid to carve out your own time; it is best for everyone.

 

Stay Safe and Healthy!

 

Namaste,

Cynthia Wallace, PA-C

Tips for a Great Telemedicine Visit

by Kyleen Davis, NP-FNP

We are currently experiencing an unprecedented global crisis. The coronavirus (COVID-19) pandemic has changed the way we interact with others, how we shop, the types of items we purchase, and especially, how we take care of our health. With government leaders mandating social distancing and many states currently on lockdown, it is everyone’s best interest to reduce face-to-face medical examinations when possible. For the time being, we must come up with innovative solutions that allow us to address healthcare needs while avoiding the spread of infection.

At the Dermatologic Surgery Center of Washington, we are committed to being available to our patients in every way we can during this critical time. To that end, we have implemented creative solutions to allow patients’ needs to be addressed while minimizing personal contact. Telemedicine and photo-sharing visits are available, effective immediately, to evaluate any new or ongoing dermatologic concerns.

To get the most out of your telemedicine visit, here are some tips:

  • Ensure good lighting. If possible, sit near a window or have all lights turned on in the room you are in. Dim lighting can cast shadows, making it more difficult for us to see your skin.
  • Wear loose clothing. If the reason for your visit involves a rash or a skin lesion, be prepared to show the provider the area of concern. For example, if the lesion is on the upper arm, a T shirt or tank top would be a better than a bulky sweater.
  • Have your medication list ready. Your provider may need to know what medications you are currently taking or have taken in the recent past. This includes prescription medications, over-the counter medications, and all supplements.
  • Have a ruler handy. If you have one available, using a ruler during your visit can help us gauge the size of the lesion in question or approximate the area involved with a rash.
  • Attach photos.
    • Prior to your telemedicine visit, upload any photos you have taken since the onset of your symptoms. Photos delineating the progression of rashes on subsequent days can be helpful, as well as any photos before and after treatments applied.
    • Take a close up and a distant photo, if possible. Here are some photography tips for patients.

To make an appointment, go to https://mskelseydscw.azova.com/ or call our office at (301) 652-8081. We are in this together and we are here to take care of you in the best way we can!

Exercising Your Skin

Happy 2020! It’s a new year, a new decade, and a great time to cultivate habits that improve your health and well-being. If you’re like me, exercise is on your list of resolutions. There is tremendous evidence demonstrating the myriad benefits of physical activity: it’s vital for muscles, bone and cardiovascular system, improves mood and memory, decreases depression, helps with weight loss, increases energy levels and reduces risk of chronic disease.

And here is one more reason to add exercise to your list of resolutions: a healthy body translates into healthy skin.

Research shows that moderate exercise itself can act as an antioxidant[1]. Oxidative stress leads to chronic inflammation and collagen fragmentation, resulting in older looking skin[2].  Antioxidants help protect against these changes.

But did you know that exercising the skin itself might improve appearance? A Northwestern University study by Dr. Murad Alam studied the effects of at-home facial exercises. Women were trained by a certified instructor (www.happyfaceyoga.com) who specializes in resistance exercises for the muscles in the face.

The program, developed by Gary Sikorski of Providence, Rhode Island,  targets the muscles below the skin and fat layers in order to compensate for “age-related volume loss.” Blinded observers found that women who practiced 30 minute face yoga every day or every other day for 20 weeks had significant improvement in upper and lower cheek fullness[3]. The participants were consistently satisfied with their improvement.

This was a small study, limited to middle-aged women, and there was no control group. Nonetheless, it’s intriguing to consider that regular, specific facial exercises might increase muscle size and thus produce facial fullness. Exercising other parts of the body can tone and firm, why not on the face? All it takes is a little self-discipline. Probably easier said than done, but I’m going to give it a try!

 

 

 

 

 

[1] Gomez-Cabrera MC, Domenech E, Vina J “Moderate exercise is an antioxidant: upregulation of antioxidant genes by training.” Free Radic Biol Med 2008; 44 (2): 126-31.

[2] Kruk J, Duchnik E “Oxidative stress and skin diseases: possible role of physical activity.”  Asian Pac J Cancer Prev 2014: 15(2) 561-8.

[3] Alam MA, Walter AJ, Geisler A, Roongpisuthipong, W, Sikorski G, Tung R, Poon E “Association of Facial Exercise with Appearance of Aging.”.  JAMA Dermatol 2018: 154(3): 365-7.

Common Acne Myths

There are many myths surrounding the causes and treatment of acne. Let’s look at what’s actually true.

Your diet has nothing to do with your acne.

FALSE. There is increasing scientific evidence to support a relationship between acne and diet. Specifically, foods that are highly processed, such as chips, crackers, and cakes, along with “high glycemic foods”, such as white bread, soda, candy, and juice, should be avoided in patients prone to acne.

In addition, certain dairy products may also exacerbate acne-prone skin. A recent study published in The Journal of the American Academy of Dermatology demonstrated that consumption of skim and low-fat milk—but not full-fat milk—was positively associated with worsening acne.

Acne-fighting diets should have plenty of anti-inflammatory foods, including fruits, vegetables, whole grains, legumes, fatty fish, and nuts. Of course, diet alone cannot completely eradicate acne, and should be combined with proven medical treatments to ensure clear skin.

Tanning improves acne.

MAYBE TRUE. While the sun’s rays can temporarily clear up acne, tanning is NOT recommended due to the harmful effects of UV rays on the skin.

However, certain light treatments available at home and in the dermatologist’s office can work to effectively treat acne without the risk of UV damage. Studies have shown that the colonization of the P. acnes bacteria that contributes to acne is reduced when exposed to concentrated amounts of blue or red light. This type of treatment, termed photodynamic therapy (PDT), may also reduce the need for oral medications, like antibiotics, which can lead to unwanted side effects. A typical PDT course consists of 8 weekly treatments. For more severe acne, a topical medication called aminolevulinc acid HCl may be applied prior to sitting in front of the light and can reduce the amount of treatments required to achieve acne clearance.

Acne only affects individuals in their teenage years.

FALSE. Most patients think they will grow out of acne as an adult, yet adult acne—defined as acne over the age of 25—is a common concern encountered by dermatologists. Adult-onset acne is particularly common in females, due to the fluctuation of hormone levels around the menstrual cycle, during pregnancy, perimenopause, and after discontinuing oral contraceptive pills. This type of acne may require specific medications to treat effectively, thus it is best managed by your dermatologist.

Vigorous cleansing will improve acne.

FALSE. In individuals with acne-prone skin, it is important to cleanse the skin twice daily to remove dirt and oils. However, over-cleansing the skin with harsh ingredients can actually trigger more inflammation, making acne worse. A gentle cleanser is best, along with ingredients such as fragrance-free moisturizers, that are not irritating to the skin. While it may seem counterintuitive in patients with oily skin, moisturizers are actually an important part of an acne treatment regimen, as they allow the skin to better tolerate topical acne medications.

Furthermore, when the skin becomes too dry, the body reacts by making more oil, which can clog the pores and lead to more breakouts. Balancing the skin’s natural barrier through gentle cleansing and noncomedogenic moisturizers is best to keep acne to a minimum.

Acne is caused by bacteria.

MAYBE TRUE. Most individuals believe acne is caused by an overgrowth of bacteria, but that is only one component of the pathophysiology of acne. Other causes of acne include inflammation, hormonal factors, and genetic susceptibility, all of which need to be treated in different ways. This is why multiple medications are often used to treat acne, and an acne treatment plan needs to be tailored to each individual.

Acne is not a serious health problem.

FALSE. Traditionally, acne has been thought of as purely cosmetic and not a serious health concern, however, studies have shown that acne can take a toll on patients’ mental health.

Research has revealed that acne can lead to depression, anxiety, and low self-esteem. Furthermore, stress has been shown to worsen acne, leading health professionals to struggle with determining whether a patient’s acne is causing his or her mental health problem or vice versa.

Our bodies respond to stress by producing more hormones (androgens), which can stimulate the oil glands and hair follicles in the skin, leading to more acne. Thus, for acne treatment to be effective, limiting stress and addressing the mental health of the patient is an important part of the treatment plan.

I can clear up acne using at-home treatments.

TRUE, but in-office treatments may be more effective. There are many effective over-the-counter products that can be used to treat acne, such as benzoyl peroxide, salicylic acid, and synthetic retinoids, like adapalene. However, if your acne has not cleared up with these treatments, it may be time to see your dermatologist.

A dermatologist can help tailor your treatment plan to your individual skin type and target specific causes of your acne. In addition, many in-office procedures have been shown to be very effective for managing acne. Chemical peels with ingredients like salicylic acid and retinol, help to reduce the number of new acne lesions as well as clear up the annoying post inflammatory redness acne leaves behind. These treatments are typically not covered by insurance and costs may vary.

Your hair has nothing to do with acne.

FALSE. Seborrheic dermatitis, or dandruff, is a skin condition that commonly overlaps with acne. It typically affects the areas of the body that are rich in oil glands, such as the face, scalp, chest, and back.

Symptoms include greasy scale along the forehead and around the nose, with scaling and itching of the scalp. Treating the hair with medicated shampoos containing ketoconazole, zinc, or sulfur several times a week can help improve the seborrheic dermatitis as well as clear up acne, and are also often an important part of the acne treatment plan.

Sunscreen can worsen acne due to clogged pores.

MAYBE TRUE. Certain chemical sunscreens can irritate the skin and worsen acne in susceptible individuals. However, physical sunscreens, such as those containing zinc oxide, can actually help acne due to their anti-inflammatory effects.

In addition, many sunscreens have other beneficial ingredients that have been shown to improve acne. For example, Elta MD UV clear sunscreen contains niacinamide and lactic acid, two acne-fighting ingredients that keep skin clear.  By carefully selecting a sunscreen, acne-prone patients can actually improve their skin while protecting it from the harmful rays of the sun.

If I have dry skin, I cannot get acne.

FALSE. Most individuals with acne have oily or combination skin, but that does not mean dry skin cannot be prone to breakouts. Dry skin can cause tiny breaks in the skin where bacteria can multiply, leading to inflammation.

Furthermore, the flaking associated with dry skin causes the pores to become clogged, leading to acne. Avoiding harsh, drying soaps and using moisturizers regularly can help to balance the skin and prevent acne in these individuals.

 

Visit a dermatologist who can help identify your skin type and put together a treatment plan for acne, customized for you. Click here to contact us for an appointment.

 

 

References

American Academy of Dermatology Association. Chemical peels: An overview. Retrieved from https://www.aad.org/cosmetic/younger-looking/chemical-peels-overview.

American Academy of Dermatology Association. Adult Acne. Retrieved from https://www.aad.org/adult-acne.

American Academy of Dermatology Association. Acne can affect more than your skin. Retrieved from https://aad.org/diseases/acne/acne-emotional-effects.

American Academy of Dermatology Association. Moisturizer: why you may need it if you have acne. Retrieved from https://www.aad.org/moisturizer.

Cerman, A., Aktas, E., Altunay, I., Arici, J., Tulunay, A., Ozturk, F. (2016). Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris. Journal of the American Academy of Dermatology, 75(1), 155-162.

Gupta, M., Mahajan, V., Mehta, K., Chauhan, P. (2014). Zinc therapy in Dermatology: A review. Dermatology Research and Practice. Http://dx.doi.org/10.1155/2014/709152.

Ismail, N., Manaf, Z., Azizan, N. (2012). High glycemic load diet, milk, and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatology, 16(12), 13.

LaRosa, C., Quach, K., Koons, K., Kunselman, A., Zhu, J., Thiboutot, D., Zaenglein, A. (2016). Consumption of dairy in teenagers with acne. Journal of the American Academy of Dermatology, 75(2), 318-322.

Rosania, K., Mateja, L., & Weiss, M. Acne Overlaps. Retrieved from https://www.the-dermatologist.com/article/9046.

Singam, V., Rastogi, S., Patel, K., Lee, H., Silverberg, J. (2019). The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample. Clinical and Experimental Dermatology, 44(7); 766-772.

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What do Eyes Have to do With It?

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You might not think of an eye exam as part of your annual skin check visit to the dermatologist, but there are several serious conditions, including cancers of the eyelids, that can be easily missed without a thorough examination. Your annual skin check should include a visualization of the upper and lower eyelids for tumors, assessment of hair distribution along the lash line to check for alopecia, as well as evaluation of eye symptoms, such as eye irritation or a gritty sensation, which can be associated with skin conditions like rosacea.

If a suspicious skin growth is found on or near the eyelid region, a biopsy should be performed to determine the type of lesion present. The most common malignant growths of the eye area are basal cell carcinoma and squamous cell carcinoma. Other less common types of eyelid cancers are sebaceous carcinoma, Merkel cell carcinoma, and intraocular melanoma. Risk factors for eyelid skin cancers include fair skin (blue eyes and red or blonde hair), immunosuppression, and history of previous radiation to the face.

Types of eyelid skin cancers

Basal Cell Carcinoma (BCC): The eyelid skin is extremely vulnerable to damage from the sun’s ultraviolet rays, making non-melanoma skin cancers, like BCC, quite common. While BCCs rarely spread to the bloodstream, they can grow large and cause disfigurement and sometimes even loss of the eye; this necessitates prompt removal with Mohs surgery, which is sometimes performed in consultation with an oculoplastic surgeon. To prevent BCCs of the eyelids, I recommend that you wear UV blocking sunglasses and don a hat — the wider the brim the better. And of course, always wear sunscreen. Stick Sunscreens for sensitive skin are generally well-tolerated around the eyes.

Squamous Cell Carcinoma (SCC): SCCs make up a smaller portion of eyelid cancers, but have a slightly higher risk of metastasis than BCCs. Prevention and treatment of eyelid SCC is similar to BCC.

Melanoma: Intraocular melanoma is the most common type of cancer that can develop within the eye in adults, yet it is still very rare. It can be found in the back of the eye in the pigmented layer of the eyeball, known as the uvea. This area is not visible to eye doctors during a regular eye exam, therefore it is crucial for individuals with a personal or strong family history of melanoma to undergo yearly dilated eye exams with an ophthalmologist. It is unclear how intraocular melanoma develops, although there are individuals who are genetically predisposed. Anyone with light hair and eye color is at a higher risk of developing eye melanoma, as are welders — either through increased occupational ultraviolet radiation exposure or other environmental causes. Melanoma is a serious diagnosis due to its ability to spread to the bloodstream and other organs. Treatment of intraocular melanoma may include surgery, radiation, and chemotherapy.

Bottom line: Check your eyelids for new growths and protect your eyes from UV exposure. Your eyes are not impervious to skin cancer!

 

 

 

References

Bain, J. (September 25, 2018). Focus on Eyelid Skin Cancers: Early Detection and Treatment. The Skin Cancer Foundation. Available online at: https://www.skincancer.org/blog/eyelid-skin-cancers/

Katella, K. (July 24, 2018). For Eye Cancer, Exams are Crucial. Yale Medicine. Available online at: https://www.yalemedicine.org/stories/eye-cancer-prevention/

Mayo Clinic Staff (September 18, 2018). Eye Melanoma. Available online at: https://www.mayoclinic.org/diseases-conditions/eye-melanoma/diagnosis-treatment/drc-20372376.

Trending Now: Collagen Supplements for Anti-Aging

If you read beauty blogs and magazines, chances are you have heard of the latest craze to hit the anti-aging market — collagen supplements. Collagen supplements claim to make the skin look younger, may help with brittle nails, and may even reduce the appearance of cellulite. But do they really work? We examined the current scientific literature to determine if collagen supplementation can transform your skin and make you look years younger.

What is collagen?

Collagen is the most abundant protein in the body and is responsible for the structure, stability, and strength of the underlying tissues. The deposition of collagen into the skin gradually decreases over time as the skin ages, but it can be accelerated due to photoaging from excessive sun exposure. Aside from aging, the biggest reason individuals are deficient in collagen is a poor diet. Consuming animal and vegetable sources that are protein-rich, such as beef, chicken, fish, beans, eggs, and dairy products can help ensure adequate intake of collagen.

The science:

Several limited studies have shown promising results in individuals taking collagen supplements for their skin. These studies have noted benefits in transepidermal water loss (skin hydration), skin elasticity, roughness, and wrinkles. Two separate studies showed a possible benefit of collagen supplementation in patients who have brittle nail syndrome as well as in women who suffer from moderate cellulite. Animal studies further revealed that administering collagen hydrolysates to mice for 6 months led to significantly increased collagen content and density of the skin.

Can I benefit from taking a collagen supplement?

If you are eating a healthy diet and feeding your body all of the nutrients it needs to make collagen, you probably do not need a supplement. However, as the body ages, you may no longer absorb or synthesize nutrients as efficiently as you used to. Taking a collagen supplement can make up for a deficiency if it is present. A 2017 study in the Journal of Agriculture and Food Chemistry showed that collagen hydrolysates can be transferred through the bloodstream directly to the skin, which explains the probable pathway for the beneficial effects of taking a supplement. However, some scientists postulate that the skin is a much lower priority to the body than major muscles, like the heart, diaphragm, and brain, where collagen will be distributed first. Therefore, only patients with a significant deficiency will likely benefit from taking collagen supplements. In addition, the cost and bulk of supplementation may be prohibitive for patients. Supplements in pill form require swallowing six a day to get a 6-gram dose. Powders are often double the price of pills, running from $15-$40 for a month’s supply.

Bottom line:

Limited studies on the benefits of collagen supplements have shown some promise, however, questions remain regarding which patients will benefit and how much collagen is actually absorbed into the skin. Cost and administration may be factors in compliance. It should be noted that for individuals who wish to add more collagen to their diet, bone broth—while not in hydrolysate form—offers six grams of collagen-rich protein and may be a tastier way to get your collagen fix.

 

 

References

  1. Jhawar, N., Wang, J. & Saedi, N. Oral collagen supplementation for skin aging: a fad of the future? Journal of Cosmetic Dermatology, August 14, 2019. https://doi.org/10.1111/jocd.13096
  2. Choi, F.D., Sung, C.T., Juhasz, M., Mesinkovska, N.A. Oral collagen supplementation: A systematic review of dermatological applications. Journal of Drugs in Dermatology. 2019; 18(1): 9-16.
  3. Vollmer, D.L., West, V.A., & Lephart, E.D. Enhancing skin health by oral administration of natural compounds and minerals with implications to the dermal microbiome. J. Mol. Sci.201819(10), 3059.
  4. Hexsel, D., Zague, V., Schunck, M., Siega, C., Camozzato, F. & Oesser, S. Oral Supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. Journal of Cosmetic Dermatology; August 2017, available online at: https://doi.org/10.1111/jocd.12393.
  5. Krieger, E. Collagen supplements show early promise for skin and joints, but don’t stock up yet. March 26, 2018, The Washington Post. Available online at: https://www.washingtonpost.com/lifestyle/wellness/collagen-supplements-show-early-promise-for-skin-nails-and-joints/2018/03/23/1cd480e2-27d6-11e8-bc72-077aa4dab9ef_story.html
  6. Schunck, M. Zague, V., Oesser, S., & Proksch, E. Dietary supplementation with specific collagen peptides has a body mass index-dependent beneficial effect on cellulite morphology. Journal of Medicinal Food. Dec 17, 2015: Available online at: https://doi.org/10.1089/jmf.2015.0022
  7. Cruel, J. Does drinking collagen supplements actually do anything for your skin? Self, August 22, 2017. Available online at: https://www.self.com/story/collagen-supplements.

How Dermatologists Use Lasers and Other Light-Based Devices

Rocket projected onto the Washington Monument during the celebration of the 50th anniversary of Apollo 11.

As we celebrate the spectacular achievement of the moon landing 50 years ago, we can reflect on the technological advances that have had an impact on dermatology. In the half century since Dr. Leon Goldman pioneered the medical application of lasers, they have become integral to state-of-the- art dermatology practices. So how do dermatologists use lasers and other light-based devices?

Uses for Laser, Light and Energy-based Devices

Remove unwanted hair

Lasers remove unwanted hair from the face and body by targeting the pigment of the hair and damaging its follicle so that hair growth is slowed. In order for lasers to be effective, the hair must be treated while in its “active growth” phase. This is why multiple (usually six to eight) treatments, spaced four weeks apart on the face, and as much as eight weeks apart on the body, are needed to achieve good results. The same lasers are also effective for excessive sweating or hyperhidrosis. Note: Only specific lasers are appropriate for darker skin types, and those with tanned skin should avoid the treatment.

Do away with those age spots

Sun damage and aging can result in unwanted brown spots, called lentigines, on sun-exposed areas such as the face, chest and hands. Those spots can successfully be treated with Q-switched lasers and IPL (Intense Pulsed Light) devices. Several treatments may be required to achieve optimal results.

Treat redness and broken blood vessels

Lasers are effective at treating skin redness from conditions such as rosacea as well as benign vascular growths such as angiomas and broken blood vessels that can occur from sun damage. The treatment works because lasers at certain wavelengths can target hemoglobin that is found in blood. Typically one to a few treatments may be needed for optimal results. It is important to use a broad-spectrum sunscreen after the treatment.

Banish those breakouts

Lasers and light-based devices can successfully treat mild to moderate acne. While conventional methods to get rid of acne include topical and oral medications, such as antibiotics and retinoids, the use of photodynamic therapy can be effective in achieving long-lasting clear skin. Photodynamic therapy combines the use of a photosensitizing chemical that is absorbed both by the oil glands and the bacteria that produce acne – followed by a light source or laser to activate the chemical. This results in shrinkage of the oil glands and killing of the bacteria.

Refresh and rejuvenate

A newer generation of devices today allows for skin resurfacing that removes the top layer of skin to eliminate signs of aging and photodamage such as fine lines, wrinkles, crepiness and brown spots as well as reducing enlarged pores – all with minimal downtime.

Soften the look of scars

Lasers can improve the appearance of scars – whether they were caused by acne, trauma or surgery. Some devices – like the pulsed dye laser – can help reduce the redness associated with scars. Fractional resurfacing lasers can successfully improve a scar’s texture and tone. Depending on which device is used, there may be a period of downtime following the treatment and a need for several treatments.

Take care of that ‘turkey neck’

With age comes a loss in collagen, which can result in loose skin on the neck and under the chin – affectionately known as “turkey neck.” Fortunately, there are non-invasive technologies that utilize ultrasound and radiofrequency to stimulate collagen production – resulting in skin tightening and lifting. These treatments also can be used for wrinkles on the décolletage, that crepe-paper look on the upper chest.

Rethink the ink

Fortunately there are options for those 20 percent of people who experience tattoo regret. Q-switched lasers have been used for decades to heat up and destroy the tattoo ink particles, usually over multiple treatments. Newer technology using ultra-short bursts of energy can achieve the same results in fewer treatments.

If you think one of these treatments could be right for you, contact us to schedule a consultation. Located in Chevy Chase, MD, our dermatology office serves the greater Washington D.C. area.

Choosing the Right Sunscreen

I love France! The food, the wine and …  the sunscreen! This week I’m writing about two of my favorite topics in one blog post: Sun Protection and the South of France!

The weather report from the outside world to us office-dwellers is that it’s been wonderful out there: sunny and not as humid as a typical Washington summer. That helps explain why I am being asked constantly for a recommendation for the best sunscreen. There is of course another reason for needing guidance: there are so many sunscreen options available. Standing in the aisle at CVS trying to pick the right one hasn’t been made any easier with the recent headline: “Sunscreen enters bloodstream after just one day of use, study says…”

That health alert was but a blip in the news cycle, but it was important and I am glad that my patients are still asking about it. The study, published in the medical journal JAMA, showed that four sunscreens when applied in maximal use scenarios (four times daily, on 75% of the body) resulted in measurable amounts of the chemical sunscreen agent passing through the skin to the bloodstream. It sounds alarming, but the study stopped short of looking at the health impact of the discovery and thus additional studies are underway. It’s important to note that all of the chemicals identified in the study are FDA-approved and have been in use for many years, without showing any harm. Likewise, there is strong evidence that regular sunscreen use helps reduce the risk of cancer and premature skin aging, so there is no justification for abandoning sun-safe behavior.

So, what should we slather on in the meantime?

Getting to that answer involves a quick look at the science behind how sunscreens work. There are two general classes of sun protection agents that differ in their method of action. SunSCREENS are those that rely on active chemical agents (with names like oxybenzone) that absorb harmful UV radiation and release its latent energy as heat on the skin surface. This was the class included in the study.

SunBLOCKS work entirely differently. They employ extremely fine-grained minerals, zinc oxide and titanium dioxide, to provide a physical barrier at the skin surface. These inert minerals reflect or scatter the radiation, preventing the rays from ever reaching the skin. In days past, they were the magic in the greasy white paint lifeguards smeared on their noses. Today, these minerals have been refined and formulated in to sheer creams, lotions and sprays that are invisible when worked in to the skin and pleasant to the touch.

Okay, let’s talk about France! 

American dermatologists and others interested in the topic have known for years that you can buy a much wider array of UV-stopping products in Europe. Why is that? This answer requires a brief look at government regulation. European consumer product rules are focused on the accuracy of manufacturers’ claims, which in the case of sunscreens and blocks is about their ability to stop or absorb UV rays. In the US, the Food and Drug Administration assesses manufacturers’ claims of efficacy. However, the FDA is concerned with potential toxicity of the same chemicals within the human body and environment, thus setting a higher bar of regulation. Meeting the FDA’s testing requirements takes considerable time for which many European manufacturers do not have the appetite. Several European brands have cleared this high bar, though, bringing a few sunscreen formulations to the US that have been used in Europe for years. In the meantime, there are many more choices available throughout Europe.

All this explains why on a recent sunny weekend in the south of France an American dermatologist (moi) was SLOWLY browsing a wide array of sun screen products in a charming pharmacy. Even for me, the process was daunting!

So at last, my best sun protection product advice: when reading a product label, be it in France or CVS, use sunblocks that rely on zinc oxide or titanium dioxide and have an SPF 30 or higher. These active ingredients have not been found to cross in to the blood stream, they are non-toxic, they stop UVA and UVB from reaching your skin and some formulations have become so sheer that you don’t even notice you have them on. These “physical” sunblocks are widely available. For years, my office has only carried sunscreens that have fewer chemicals and rely on non-reactive ingredients. If you are heading to the south of France or the south side of your neighborhood pool, you can pick them up on your next visit, or call and we can ship to you.

Helping Armenia’s Angels Smile

I just spent one of the most rewarding weeks of my career in Armenia.  I was a member of a delegation from the “Face of Angel” nonprofit organization started by Drs. John Poochigian, Christine Avakoff and Lilit Garibyan in 2019, whose mission is to establish state-of-the art medical laser clinics in Armenia and train Armenian physicians how to use these lasers to treat patients with life-altering birthmarks and severe scars.  I accompanied Drs. Lilit Garibyan and Rox Anderson of Mass General Hospital, Harvard Medical School who organized this trip.  In 2013 they teamed up with Dr. Christine Avakoff and Dr. John Poochigian to establish two clinics in the capital city of Yerevan – Arabkir Hospital and the Armenian-American Wellness Center.  These facilities provide high quality medical care through the use of lasers to anyone in need, regardless of economic status.  The laser equipment was donated by Candela Laser Corp and Quanta Laser companies.  

Our mission was to help as many patients as possible, as well as train local doctors in the use of the advanced laser devices in managing debilitating scars and vascular anomalies. We were fortunate to also have on the team Branko Bojovic, M.D., chief of plastic surgery at Shriners Hospitals for Children, Boston.  Over four days, our team treated dozens of pediatric and adult patients and trained the leading local plastic surgeons.

Our time spent with patients and families was always touching.  It was common for an entire extended family – perhaps eight or nine members – to accompany a child who was being treated. One of the Armenian doctors explained that when a youngster made the trip from the countryside, in addition to the parents it was customary that aunts, uncles, siblings and a trusted elder would also be part of the entourage.  These children were very well looked after!

Some of the children had been treated before and were returning for follow-up.  The results were frequently profoundly positive.  The mother of a young girl who had undergone laser surgery the year before for a large birthmark on her face said her daughter’s life had been absolutely transformed. She described 9-year-old Lianna as having been extremely shy, to the point of being unable to look anyone in the eye or to make friends.  She was overjoyed that her daughter, who smiled at me with beautiful eyes, was now bubbling over with enthusiasm for school and her classmates.

Armenia is an ancient nation, in 301 AD becoming the first in the world to adopt Christianity as its state religion. Once a part of the former Soviet Union, this country of 3 million people, 98% of whom are ethnically Armenian, declared independence in 1991. Although it had been one of the most developed and economically robust of the former Soviet republics, it suffered a dramatic drop in Gross Domestic Product (GDP) after independence. While the literacy rate is close to 100%, the economic situation is tenuous but improving. Per capita GDP rose from $886 USD in 1993 to $4200 in 2017.

Medical resources in Armenia are generally very limited but physicians across the country are well-trained and enormously dedicated to elevating the care of their patients.  I learned a great deal from them as I did from my fellow members of our very collaborative delegation.  It was inspiring to be a part of this mission to improve the lives of patients whose injuries and birthmarks have significantly diminished their quality of life. In order to accomplish its mission of establishing fully functioning and sustainable medical laser clinics in Armenia, the “Face of Angel” organization is planning to take more lasers to the country and organize more trips to train and teach Armenian physicians. The team encourages those interested in  supporting these plans to contact  lgaribyan@mgh.harvard.ed 

The “Face of Angel” organization is truly life-changing for all those it has touched and I am indebted to its founders for allowing me participate and give back.

 

fotofinder washington dc dermatologist

Early Detection Just Got VERY High Tech

FotoFinder Automated Total Body Mapping Studio

“Early detection” is something I talk about a lot.  That is for good reason: skin cancer is not only the most common form of cancer in the United States, it is also the most curable – that is, IF it is detected early.  This is why I talk just as much about the importance of regular full body exams.

May is Skin Cancer Awareness Month, so this is an especially good time to mention a powerful new early detection tool I’ve just added to my practice:  FotoFinder.  This breakthrough technology is truly one of the most impactful medical devices I have seen in my career.

FotoFinder combines the very best photographic equipment and German robotic engineering in a way that superbly augments the dermatology professional during full body exams.

Here’s how it works: The computer-controlled machine captures highly detailed photographs of the entire skin surface and merges them into a comprehensive Total Body Map.  It then employs artificial intelligence to meticulously compare current skin conditions to earlier “baseline” images.  If it “sees” new moles, or even minute changes in existing moles, it automatically flags them for detailed follow up by the professional.  The mapping and analysis process take just 20 minutes.  It is amazing technology that will greatly advance early detection of skin cancer.

Baseline: FotoFinder Total Body Map

Follow Up: Updated Body Map, with moles highlighted for further examination

When I saw this sophisticated device in action, I knew immediately I need to bring this to our patients.  The Dermatologic Surgery Center of Washington is the first and only practice in the Washington, DC region to install this significant advancement in the science of early detection.

Since we installed the system in January, I am often asked who should consider FotoFinder early detection technology?  If you can answer yes to any of these questions, I recommend we discuss if FotoFinder is right for you:

  • Do you have a history of melanoma or other skin cancer?
  • Do you have a family history of skin cancer?
  • Do you have many moles – more than 50?
  • Do you have large moles – 2 inches in diameter or larger?
  • Do you see changes in a mole or have new moles?
  • Do you have a history of a severe, blistering sunburn as a child or adolescent?
  • Do you have very light skin?
  • Are you exposed to strong sunlight on a regular basis?

Skin Cancer Awareness Month is a great time to make an appointment with one of our talented dermatology professionals for your next full body exam – and create your baseline Total Body Map with FotoFinder.

Click here to make an appointment online or call us at 301-652-8081.

 

All the photos used are courtesy: FotoFinder Systems, Inc.