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

Global Skin Cancer Awareness Month

/in , /by

By Joan Pohutsky, DNP

It’s springtime in the District and the city is coming alive again! Residents are bidding farewell to the cold winter and welcoming the rejuvenating spring season. With this transition comes the month of May, synonymous with blossoming flowers. In the medical community, May also holds a more significant meaning as Skin Cancer Awareness Month.

Spring symbolizes renewal, growth, and the ability to rejuvenate and heal -similar to the natural abilities of human skin. Much like blossoming flowers, human skin cells divide and grow to shield us from external factors. When this growth goes awry, this can lead to conditions like skin cancer.

The Science Behind Your Suntan

As we venture outdoors more often to enjoy the beauty of spring, you might be tempted to work on a suntan. Before you do, however, let’s define what a suntan really is: an injury to the skin in response to two types of ultraviolet radiation (UV). Both types of ultraviolet rays damage the skin and can lead to skin cancer.

  • UV-A rays penetrate deeper into the skin to accelerate signs of skin aging such as wrinkles, sunspots, and leathery skin.
  • UV-B rays are responsible for sunburn. When skin is exposed to UVB rays, the outermost layer (the epidermis) thickens and produces excess melanin, causing the skin to darken in an attempt to prevent further damage to the vulnerable layers below.

Tanning Myths

There are several myths that should be dispelled about tanning:

  1. Tanning is NOT healthy.
  2. Tanning does NOT prevent sunburn.
  3. Tanning does NOT decrease the risk of skin cancer.

What’s the truth about tanning?

  1. Tanning DOES cause skin cancer.
  2. Tanning DOES increase wrinkles, dark spots, and other signs of aging.
  3. Tanning is a sign of injury to the skin and there is NO benefit to a “base tan.”

Supplements and Skin Health

Besides reducing your sun exposure by wearing sunscreen, seeking shade, and covering up, what else can you do to help prevent skin cancer?

Emerging research suggests certain nutrients may play a pivotal role in reducing risks of developing skin malignancies.

  • Nicotinamide (Vitamin B3): supplementation is associated with an overall lower rate of new nonmelanoma skin cancers and actinic keratoses (pre-skin cancers). Notably, a new study recently found that higher doses of similarly structured niacin can increase overall cardiovascular risks including irregular heartbeat and vascular inflammation. As holds true to considering any new medication or supplementation, we recommend that you consult with your primary care physician prior to beginning to use.
  • Antioxidants (Vitamins A, C, & E, plus selenium, polyphenols, lycopene, beta-carotene): prevent and slow damage to cells caused by free radicals, thus neutralizing effects of UV radiation (found in fruits and vegetables). Polypodium Leucotomus is one such antioxidant derived from a fern and plays a role in reducing inflammation and DNA damage in skin cells, thus reducing the risk of skin cancer and photoaging. Polypodium Leucotomus is the active ingredient in Heliocare supplementation.
  • Vitamin D: plays a role in controlling abnormal multiplication of skin cells (found in fortified dairy products, fatty fish, and supplements). While the sun is a natural source of vitamin D, it is safer and more reliable to obtain this from diet and supplementation due to prolonged sun exposure increasing cancer risk.

Nutrients and supplements can influence the overall health, aging, and appearance of our skin.

  • Omega 3 supplementation (fish, nuts, seeds, and vegetables): strengthens skin membranes to prevent moisture loss, has anti-inflammatory properties to reduce redness and swelling, and can aid in the healing process when skin is damaged.
  • Zinc (found in meat, fish, and seafood): acts as a physical barrier to reflect UV rays and decreases inflammation, thus playing a role in wound healing and skin integrity.
  • Metformin: a drug classically utilized for patients with type 2 diabetes, has antiaging properties including decreasing chronic inflammation and oxidative stress. There are observational studies to suggest that long-term use can be associated with reduced skin cancer risk.

A healthy diet and lifestyle contribute to skin health, but sun protection remains the cornerstone of skin cancer prevention. This includes applying broad spectrum sunscreens SPF 30 or higher and reapplying every two hours, seeking shade during peak sunlight hours, and wearing ultraviolet protection factor (UPF) rated sun clothing as well as wide-brimmed hats and sunglasses. Check your skin for new, changing, or suspicious lesions, and enjoy everything spring has to offer!

 

 

 

 

 

Sources

Chen A, Martin A, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention, 2015; New England Journal of Medicine; N Engl J Med 2015;373:1618-1626; DOI: 10.1056/NEJMoa1506197

Cruz RYMS, Arévalo SV, Rashid A, Jara MRA, Prado MSA. Antioxidant and photoprotective potential of Polypodium leucotomos. Explor Med. 2022;3:607–16. https://doi.org/10.37349/emed.2022.00117

Dong Y, Wei J, Yang F, Qu Y, Huang J, Shi D. Nutrient-Based Approaches for Melanoma: Prevention and Therapeutic Insights. Nutrients. 2023; 15(20):4483. https://doi.org/10.3390/nu15204483

El Mansouri M, Essaddouki S, Mouradi M, et al. Evaluation of the effectiveness and safety of combined oral and topical photoprotection with a standardized extract of Polypodium leucotomos (Fernblock®). Photodermatol Photoimmunol Photomed. 2023; 39: 607–612. doi:10.1111/phpp.12904

Ferrell, M., Wang, Z., Anderson, J.T. et al. A terminal metabolite of niacin promotes vascular inflammation and contributes to cardiovascular disease risk. Nat Med 30, 424–434 (2024). https://doi.org/10.1038/s41591-023-02793-8

Michalak M, Pierzak M, Kręcisz B, Suliga E. Bioactive Compounds for Skin Health: A Review. Nutrients. 2021; 13(1):203. https://doi.org/10.3390/nu13010203

Sahdeo Prasad, Subash C. Gupta, Amit K. Tyagi, Reactive oxygen species (ROS) and cancer: Role of antioxidative nutraceuticals, Cancer Letters, Volume 387, 2017, Pages 95-105,

ISSN 0304-3835, https://doi.org/10.1016/j.canlet.2016.03.042. https://www.sciencedirect.com/science/article/pii/S0304383516302026

Sami Raza, Firas Al-Niaimi, Faisal R Ali, A systematic review of the uses of metformin in dermatology, Clinical and Experimental Dermatology, Volume 48, Issue 2, February 2023, Pages 73–79, https://doi.org/10.1093/ced/llac027

How to Prevent Skin Cancer.  American Academy of Dermatology (2024). Retrieved from

https://www.aad.org/public/diseases/skin-cancer/prevent/how

Shining a Light on Rosacea

/in , /by

By Laura Monaghan, PA-C

April is Rosacea Awareness Month, dedicated to raising awareness about this common condition affecting around 16 million Americans. What exactly is rosacea, and what are its implications?

Rosacea is a chronic inflammatory disorder that manifests as facial redness, flushing, acne-like bumps, skin thickening (rhinophyma), and eye redness or irritation. Many people experience facial sensitivity, dryness, and a burning feeling in the skin. Eye involvement can include light sensitivity, a foreign body sensation, and crust on the base of the lashes. A patient may have a combination of symptoms and these can vary over time.

Triggers vary and include spicy foods, alcohol, extreme temperatures, sun and wind exposure, exercise, emotional stress, and certain skincare and makeup products.1 It typically manifests between ages 30-50 and is more common in light-skinned individuals but has been diagnosed in Asians, Latin Americans, African Americans, and Africans.2 The central face is usually involved with men more susceptible to skin thickening. Early signs are often overlooked, delaying treatment, which can lead to worsening severity over time. Awareness is vital for timely detection and management.

Rosacea Myths

While rosacea does have many appearances, there are also many misconceptions to clarify:

  • Rosacea is NOT due to a lack of hygiene. In fact, heavy scrubbing and exfoliants can further irritate rosacea-prone skin and cause a flare.3
  • Rosacea is NOT infectious, despite the implication of Demodex mites. All humans have Demodex mites on their facial skin. Studies show that patients with rosacea tend to carry more Demodex, but there is no evidence that they are a direct cause of the condition.
  • Rosacea does NOT mean that a person is a heavy drinker. While alcohol can cause a temporary increase in symptoms, it is not a sole cause of the condition. 3
  • A diagnosis of rosacea does NOT mean that a patient is destined for thick, red, and bumpy skin on the nose (rhinophyma). This develops in a small subset of patients with severe untreated rosacea.

Nearly 90% of rosacea patients surveyed by the National Rosacea Society report that this condition has lowered their self-esteem. 41% have even canceled or rescheduled social engagements due to a flare. On the contrary, over 70% report that medical treatment has improved their emotional and social well-being. 3 So, what does treatment entail?

Treatments for Rosacea

A simple place to start is with sun protection and moisturizer as ultraviolet (UV) rays and disruption of the skin barrier are known triggers. Proper sun protection entails using a broad-spectrum SPF 30+ sunscreen and reapplying at least every two hours. Mineral sunscreens that contain zinc oxide or titanium dioxide are preferred because they act as physical blocks. This may help reduce the heat that exacerbates rosacea better than chemical sunscreens.

Gentle cleansers, fragrance-free facial moisturizers that contain niacinamide, and avoidance of irritants such as topical alcohol, witch hazel, and exfoliants can help maintain and repair the skin barrier.4 Some other common treatments include antimicrobial and antifungal agents such as sulfur products, topical ivermectin, topical azelaic acid, topical metronidazole, and oral doxycycline. Other agents including oxymetazoline, brimonidine, and oral beta blockers constrict blood vessels to improve redness.

For severe cases, isotretinoin, or Accutane, or another oral acne medication may also be used. Lasers such as the pulsed-dye laser target redness and dilated blood vessels, providing a longer-term solution. Lasers such as the CO2 and erbium YAG lasers have a role in correcting rhinophyma.5

New Rosacea Treatment Options

There are also several new and exciting rosacea treatments currently in development. First is a series of small injections of Botox® spaced evenly across the face. Preliminary studies show benefit not only in redness and flushing but also in acneiform bumps. Second is oral paroxetine, a selective serotonin reuptake inhibitor typically prescribed as an antidepressant. Evidence shows that serotonin can regulate blood vessel dilation and constriction. Finally, a topical low-molecular-weight heparin sulfate analog (blood thinner) has shown efficacy in reducing inflammation associated with rosacea. These developments are promising for the future of rosacea treatment.6 

If you think you may have rosacea, schedule an appointment for further evaluation. Early treatment is key for preventing progression.

 

 

 

 

Sources

  1. Mayo Foundation for Medical Education and Research. (2023, October 17). Rosacea: Symptoms & causes. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/symptoms-causes/syc-20353815
  2. Gallo RL, Granstein RD, Kang S, Mannis M, Steinhoff M, Tan J, Thiboutot D. (2017, January). Standard classification and pathophysiology of rosacea: The 2017 update by the National Rosacea Society Expert Committee. J Am Acad Dermatol. https://www.jaad.org/article/S0190-9622(17)32297-1/fulltext
  3. Tips for taking action during Rosacea Awareness Month. Rosacea.org. (2022, March 7). https://www.rosacea.org/blog/2022/march/tips-for-taking-action-during-rosacea-awareness-month
  4. Winter woes – tips for skin barrier maintenance. Rosacea.org. (2023, January 11). https://www.rosacea.org/blog/2023/january/winter-woes-tips-for-skin-barrier-maintenance-rosacea
  5. Mayo Foundation for Medical Education and Research. (2023, October 17). Rosacea: Diagnosis & treatment. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rosacea/diagnosis-treatment/drc-20353820
  6. McNamara, D. (2024, March). Rosacea: a neurotoxin, an antidepressant, and more emerging options for treatment. Dermatology News, pp. 1–32.

Treating Photoaging with PRP Microneedling

/in , /by

By Dr. Elena Allbritton 

What is photoaging?

Exposure of the skin to the sun’s rays can cause some short-term changes such as sunburns but eventually, it will take a toll on the skin and lead to more long-term consequences. Sun damage to the skin is referred to by several names, including photodamage, solar damage, and photoaging. When ultraviolet (UV) light from the sun or other light sources such as tanning booths, hits skin unprotected by sunscreen, DNA changes occur at a cellular level. Some of the changes happen in the deeper dermal layers of the skin and take years to become visible. Photoaging can also lead to skin cancer.  

Who is susceptible to photoaging?

The short answer is everyone is susceptible to photoaging. The amount of photodamage to the skin depends on skin type, geographical factors such as latitude, and the amount of unprotected sun exposure sustained over time. Individuals with lighter skin tones are more susceptible to photoaging and skin cancer than those with darker skin tones. However, people with darker skin tones can still sustain photodamage, and develop skin cancer and dyspigmentation such as melasma.  

What does the UV index have to do with photoagaing?

The UV index was created to help provide daily guidelines for safer sun exposure and is important in the assessment of harmful UV exposure. Geographical factors, cultural practices, and accessibility to UV protection all play a role in the amount of photodamage and photoaging an individual may experience.  

How to protect against premature aging and treat photodamage: 

  • Limit unprotected skin exposure. The American Academy of Dermatology recommends avoiding exposure during peak hours between 10am and 2pm, wearing broad spectrum mineral sunscreen that protects best against both UVA and UVB, and wearing sun-protective clothing (UPF40+) and sunglasses.
  • Pay attention to the UV index in your location.
  • Reduce inflammation and free radical formation through good nutrition. Antioxidants such as vitamins C and E, lipoic acid, and coenzyme Q scavenge oxidative free radicals generated by solar radiation. 
  • Practice good daily skin care using products containing medical-grade antioxidants, hyaluronic acid for hydration, and retinoids (tretinoin, tazarotene, and adapalene). ** See your dermatologist for a daily skin care regimen consultation to determine what products will work best for your skin.
  • There are many treatment options to improve photoaging. PRP with microneedling is a minimally invasive method of naturally regenerating facial skin. 

What is Platelet-rich plasma (PRP)?

A platelet-rich plasma (PRP) treatment is a relatively simple process that uses the patient’s own growth factors. The patient’s blood is centrifuged, or spun down, to increase the concentration of platelets and includes a mixture of cytokines and growth factors. There is no concern about rejection or disease transmission because it is manufactured from the patient’s own blood. This mixture has anti-inflammatory properties and can be used to stimulate healing.

PRP has been used for years to treat athletes with sports injuries, augment healing and speed recovery from surgery, and to treat degenerative conditions such as osteoarthritis. PRP is also being used to treat acne scars and hair loss such as androgenetic alopecia. It can also be used with microneedling for facial rejuvenation.  

PRP with microneedling

Platelet-rich plasma with microneedling is minimally invasive and rarely causes side effects. The most common side effects are discomfort or bruising at the injection sites. PRP treatments can have varying levels of success with different patients. This may be due in part to the concentration or health of the platelets and growth factors. It is advised to stop taking nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, aspirin, and naproxen, for 2 weeks in advance of PRP treatment because these medications can impair platelet function and increase bleeding risk.  

What is microneedling?

Microneedling is a safe technique that uses sterile needles for controlled micro-injuries to the skin which stimulate the natural healing process. Tiny micro channels are opened in the skin which allow the growth factors and platelets in PRP to penetrate deeper into the skin. When compared with microneedling alone, PRP plus microneedling can significantly improve the visual appearance of photoaged skin.

Animal studies using PRP show decreased oxidative stress, inflammation, and inhibition of skin cell death leading to improved skin photoaging. Growth factors in PRP stimulate fibroblasts and induce new collagen production. Patient satisfaction tends to be higher with the addition of PRP. Pigmentation, telangiectasias as well as wrinkles are improved which reduces the signs of photodamage.

What to expect when getting Microneedling with PRP

During the procedure, topical numbing cream is used so the patient experiences only mild discomfort. After treatment, there is some mild redness for 24-48 hours. It is recommended that patients avoid exercise for 24 hours after treatment. Mild peeling of the skin can occur several days after treatment. Most patients experience a healthy glow after the first treatment, especially when PRP is added. A series of 3-6 treatments is recommended for the best results. Optimal results occur after 2-3 months due to the production of new collagen and elastin.  

The main benefits of microneedling with PRP: 

  • Collagen production and skin tightening
  • Improvement in skin texture
  • Minimizing of fine lines and wrinkles
  • Improvement in skin tone and discoloration
  • Minimizing pore size
  • Reduction in acne scarring, the appearance of stretch marks, or other types of scars

Interested in microneedling with PRP? Book an appointment with us for a consultation to discuss the best treatment options for you and your skin. Give us a call at 301-652-8081.

 

 

Other resources for information: 

  1. https://www.mdanderson.org/publications/focused-on-health/what-s-the-difference-between-uva-and-uvb-rays-.h15-1592991.html
  2. Comprehensive Review of Ultraviolet Radiation and the Current Status on Sunscreens from PMC Labs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460660/
  3. Yan, B., & A., J. (2014). Ultraviolet Radiation, Aging and the Skin: Prevention of Damage by Topical cAMP Manipulation. Molecules, 19(5), 6202-6219. https://doi.org/10.3390/molecules19056202
  4. https://healthmatch.io/blog/top-20-skin-cancer-hot-spots-in-the-world-and-why-theyre-on-the-list
  5. Ultraviolet (UV) Radiation from the Aim at Melanoma Foundation: https://www.aimatmelanoma.org/melanoma-101/prevention/what-is-ultraviolet-uv-radiation/
  6.  American Academy of Dermatology. Prevent skin cancer. 2021. https://www.aad.org/public/diseases/skin-cancer/prevent/how. Cited 1 Oct 2021.
  7. Poon F, Kang S, Chien A. Mechanisms and treatments of photoaging. Photodermatol Photoimmunol Photomed 2015; 31: 65–74.
  8. Fisher GJ, Kang S, Varani J et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol 2002; 138: 1462–1470.
  9. Kang S, Fisher GJ, Voorhees JJ. Photoaging: pathogenesis, prevention and treatment. In: Gilchrest BA, ed. Geriatric dermatology. Philadelphia: WB Saunders, 2001, 643.
  10. Yaar M, Gilchrest B. Photoageing: mechanism, prevention and therapy. Br J Dermatol 2007; 157: 874–877.
  11. Sambandan D, Ratner D. Sunscreens: an overview and update. J Am Acad Dermatol 2011; 64: 748–758.
  12. Graf J. Antioxidants and skin care: the essentials. Plast Reconstr Surg 2010; 125: 378–383
  13. Charles-de-Sá L, Gontijo-de-Amorim NF, Takiya CM, et al. Effect of use of platelet-rich plasma (PRP) in skin with intrinsic aging process. Aesthet Surg J. 2018;38(3):321-328. 
  14. Alam M, Hughart R, Champlain A, et al. Effect of Platelet-Rich Plasma Injections for Rejuvenation of Photoaged Facial Skin. JAMA Dermatol 2018 Dec; 154(12):1447-1452.

Skin Changes that Signal Heart Problems

/in , /by

By Laura Monaghan, PA-C

While the stores are full of heart-shaped candies and flowery greeting cards, February is also a time to talk about heart health—and not just the Mediterranean diet and exercise routines.  Did you know that the first signs of an underlying heart condition might be in your skin?

Your skin can serve as a window into your overall health and give signs as to what may be going on inside. For example, it becomes dry when we are dehydrated, pale when we lack iron, and yellow from liver disease. Did you know that it can also show signs about potential heart health problems? This American Heart Month, we want you to be aware of what your skin is telling you about your cardiovascular health.

Changes in Skin that Signal Heart Issues

Swelling of Lower Extremities

When monitoring cardiovascular health on the surface, one sign to look for is swelling of the lower extremities, such as your feet, ankles, and lower legs. Over time, chronic swelling can lead to thickened skin, brawny discoloration, and even ulcers, which can be a sign of heart failure. This is when the heart does not pump enough blood to the body. It could also be a sign of chronic venous insufficiency, which is when the veins are unable to sufficiently carry blood against gravity in the legs. Anecdotally, this is one of the most common signs of cardiovascular disease we see in dermatology.

Yellow Bumps Around Eyes

Another potential sign of cardiovascular disease is the development of yellow waxy bumps in the skin, especially on the upper eyelids, called xanthelasma. Xanthelasma bumps are made up of cholesterol deposits. They can indicate elevated blood cholesterol levels, which lead to plaque buildup in blood vessels, blocked arteries, and increased risk for heart attack. Almost half of all patients with xanthelasma have abnormal lipid levels and many also have diabetes or thyroid abnormalities.

Fingers & Nails

Swollen fingers with clubbing, or downturned nails, can be a sign of a lack of oxygen due to cardiac infection, heart, or lung disease. Skin that is turning blue or purple in color, especially with swelling or a mottled pattern, can indicate an underlying blood clot.

Bumps and Lesions on Hands and Feet

Painful bumps and painless red hemorrhagic lesions on the hands and feet, called Osler nodes and Janeway lesions, can be a signs of endocarditis. Endocarditis is inflammation of the inner lining of the heart’s chambers and valves most commonly due to bacterial or fungal infection. Red or purple lines under the nails, called splinter hemorrhages, can also be a sign of endocarditis when paired with a fever and irregular heartbeat.

Psoriasis

Finally, psoriasis, which can present as silvery-white plaques with underlying redness, nail pitting, or psoriatic arthritis is also associated with heart disease. The inflammation from psoriasis can affect the heart; individuals with psoriasis are more likely to have metabolic syndrome, a combination of elevated blood glucose levels, high blood pressure, increased abdominal fat, and high cholesterol.

Signs of Cardiovascular Problems in Children

Another thing to keep in mind is that children can also be at risk of cardiovascular health problems and have their own signs to be aware of. The combination of a sore throat, fever, and a red rash called erythema marginatum can indicate Rheumatic fever. This is a leading cause of heart disease in children resulting from untreated strep throat. Additionally, a very high fever with swollen, cracked, bleeding lips/mouth can indicate Kawasaki disease, which causes blood vessel inflammation that can affect the heart.

Be aware of what your body is telling you, and if you or your sweetheart notice any of these signs, consult with your primary care provider or dermatologist. While keeping up with all the potential problems and concerns can sometimes feel overwhelming, your dermatologist can help you manage your health with annual skin checks. The best Valentine’s gift is good health!

 

 

 

Sources: 

Heart disease: 12 warning signs that appear on your skin. American Academy of Dermatology. (n.d.). https://www.aad.org/public/diseases/a-z/heart-disease-warning-signs

National Psoriasis Foundation. (n.d.). What we know about psoriasis and heart disease. What We Are Learning About Psoriasis and Heart Disease. https://www.psoriasis.org/advance/what-we-know-about-psoriasis-and-heart-disease-part2/

A New Purpose for an Old Hair Loss Therapy

/in , /by

By Kyleen Davis

If you are like many of our patients, you probably read the New York Times. Chances are that you or someone you know came across a recent article about a new and inexpensive treatment that can help grow your hair back. This article, entitled, An Old Medicine Grows New Hair for Pennies a Day, was published in the late summer of last year and quickly began trending. Many of you have brought up this article during your office visits to discuss hair loss.  Others may be curious about the validity of these claims. What are these new therapies? And do they actually work?

About Hair Loss

Unfortunately, hair loss is an extremely common condition, affecting an estimated 50 million men and 30 million women in the United States. The American Academy of Dermatology reports that over half of men will have moderate to severe hair loss by the age of 50. Similarly, more than 50% of women will develop some form of female pattern hair loss by age 79.

Treatments for Hair Loss

The good news is that there are many treatment options available for patients who are struggling with hair loss. Determining the type of hair loss is crucial to tailor the treatment plan to the patient’s specific needs. In dermatology, we can diagnose the type of patient hair loss with a careful history, physical examination, and close-up inspection of the hair follicles, a process known as trichoscopy. Lab work or scalp biopsy may also be ordered to confirm the diagnosis. While multiple types of hair loss, or alopecia, exist, androgenetic alopecia (male and female pattern hair loss) is the most common cause of hair loss in the United States.

Androgenetic alopecia (AGA) has traditionally been treated with topical minoxidil (Rogaine) since the Food and Drug Administration (FDA) approved the 5% solution for men in 1988 and the 2% solution for women in 1991. Prior to its approval, minoxidil’s side effect of hypertrichosis (excessive hair growth) was found incidentally when patients taking this medication at doses of 10-40 mg daily for high blood pressure started to grow more hair. For many years the oral form of minoxidil was avoided as a therapeutic option for hair loss due to potential adverse effects and because topical minoxidil was effective.

New Type of Hair Loss Treatment

That is, until recently when an Australian physician named Dr. Rodney Sinclair conducted a study showing that a fraction of the standard dose of minoxidil could help grow hair with less risk of side effects. Since that time, multiple studies have been conducted on the use of oral minoxidil in the treatment of hair loss. Most studies have demonstrated that low-dose oral minoxidil (LDOM) at doses ranging from 0.25 mg to 2.5 mg per day was generally safe and highly efficacious for the treatment of alopecia, especially for AGA. While a significant portion of patients taking LDOM developed hair growth of the sides of the face and temples, this did not typically result in discontinuation of the medication.

There are several treatments for androgenetic alopecia, including other oral agents, topical therapy, platelet rich plasma (PRP), low level laser therapy, and vitamin supplements. Many of them work well together and each has a specific risk benefit profile that should be considered for an individual patient. The great news is that thinning hair can be improved!

 

 

 

References

American Academy of Dermatology. (2022). What is male pattern hair loss, and can it be treated? Available online at: https://www.aad.org/public/diseases/hair-loss/treatment/male-pattern-hair-loss-treatment.

Beach, R., McDonald, K., & Barrett, B. (2021). Low-dose oral minoxidil for treating alopecia: A 3-year North American retrospective case series. Journal of the American Academy of Dermatology, 84(3), 761-763.

Fabbrocini, G., Cantelli, M., Masara, A., Annunziata, M., Marasca, C., & Cacciapuoti, S. (2018). Female pattern hair loss: A clinical, pathophysiologic, and therapeutic review. International Journal of Women’s Dermatology, 4(4), 203-211.

Heymann, W. (2022). Coming full circle (almost): low dose oral minoxidil for alopecia. American Academy of Dermatology, Dermatology World Insights and Inquiries, 4(1). Available online at: https://www.aad.org/dw/dw-insights-and-inquiries/archive/2022/low-dose-oral-minoxidil-alopecia.

Jimenez-Cauhe, J., Saceda-Corralo, D., Rodrigues-Barata, R., Moreno-Arrones, O., Ortega-Quijano, D., Fernandez-Nieto, D., Jaen-Olasalo, P., & Vano-Galven, S. (2020). Safety of low-dose oral minoxidil treatment for hair loss. A systematic review and pooled-analysis of individual patient data. Journal of Dermatology Research and Therapy, 33(6), e14106.

Kolata, G. (2022). An old medicine grows new hair for pennies a day, doctors say. The New York Times. Available online at: https://www.nytimes.com/2022/08/18/health/minoxidil-hair-loss-pills.html.

Pfizer (Pharmacia & Upjohn Company). (2015). Loniten ™ minoxidil tablets, USP, package insert. Available online at: https://www.accessdata.fda.gov/drugsatfda_docs/label/2015/018154s026lbl.pdf.

Rajab, F. (2022). Low-dose oral minoxidil for hair growth. Dermatology Times, 43(11).

Ramos, P., Sinclair, R., Kasprzak, M., & Miot, H. (2020). Minoxidil 1 mg oral versus minoxidil 5% topical solution for the treatment of female pattern hair loss: A randomized clinical trial. Journal of the American Academy of Dermatology, 82(1), 252-253.

Randolph, M. & Tosti, A. (2021). Oral minoxidil treatment for hair loss: A review of efficacy and safety. Journal of the American Academy of Dermatology, 84(3), 737-746.

Rhodes, T., Girman, C., Savin, R., Kaufman, K., Guo, S., Lilly, F., Siervogel, R., & Chumlea, W. (1998). Prevalence of male pattern hair loss in 18-49 year-old men. Dermatologic Surgery, 24(12), 1330-1332.

Sharma, A., Michelle, L., Juhasz, M., Ramos, P., Mesinkovska, N. (2020). Low dose oral minoxidil as treatment for non-scarring alopecia: a systematic review. International Journal of Dermatology, 59(8), 1013-1019.

Sinclair, R. (2018). Female pattern hair loss: A pilot study investigating combination therapy with low-dose oral minoxidil and spironolactone. International Journal of Dermatology, 57(suppl 65). Available online at: https://www.researchgate.net/profile/Rodney-Sinclair/publication/321756113_Female_pattern_hair_loss_A_pilot_study_investigating_combination_therapy_with_low-dose_oral_minoxidil_and_spironolactone/links/5a81583fa6fdcc0d4bacaa59/Female-pattern-hair-loss-A-pilot-study-investigating-combination-therapy-with-low-dose-oral-minoxidil-and-spironolactone.pdf?origin=publication_detail.

Seasonal Affective Disorder and Your Skin: Understanding the Connection

/in , /by

By Elena Hardy Allbritton, MD

As the temperature drops and the days grow shorter, some people experience a dip in their mood, energy levels, and overall sense of well-being. This phenomenon is commonly referred to as Seasonal Affective Disorder (SAD). While SAD is primarily associated with mood changes, it can also have surprising effects on your skin. In this blog post, we will explore the relationship between Seasonal Affective Disorder and your skin, and offer some healthy ways to combat its effect including some strategies to help you maintain healthy skin during the winter months.

What is Seasonal Affective Disorder (SAD)?

Seasonal Affective Disorder is a form of depression sometimes referred to as “winter depression” because it typically occurs during the fall and winter months when daylight hours are shorter. Women are more commonly affected than men and it typically manifests in younger adults age 18-35. It impacts about 5% of adults or roughly 10 million people in the USA annually.

The decrease in daylight hours is believed to cause a disturbance in the circadian rhythms of the body, which regulates sleep, mood, and other physiological processes. Researchers believe that people with SAD have reduced activity of a brain neurotransmitter called serotonin, which helps regulate mood. Other findings suggest that the overproduction of melatonin, a hormone that is crucial for maintaining normal sleep-wake cycles contributes to the increased sleepiness in patients with SAD. A third factor is lower levels of vitamin D in patients with SAD. Vitamin D and vitamin D responsive elements are found in higher concentrations in the hypothalamus, a region of the brain that contains the circadian rhythm circuitry.

Symptoms of Seasonal Affective Disorder

The most common symptoms of SAD include fatigue, changes in appetite, craving carbohydrate-rich food, weight gain or loss, irritability, difficulty concentrating, and lack of interest in usual activities. However, SAD can also impact your skin in various ways.

Effects of SAD on the Skin:
  1. Dry Skin: During the winter months, low humidity levels and indoor heating systems can lead to dry, flaky, itchy skin. Individuals with SAD may be more prone to dry skin due to hereditary factors and their ability to retain moisture.
  2. Eczema and Psoriasis Flares: SAD can trigger or exacerbate some skin conditions such as eczema and psoriasis. Stress, which is often linked to SAD, can weaken the immune system and lead to flare-ups of these conditions which can further worsen the psychosocial impact of SAD. Patients with psoriasis sometimes experience seasonal depression similar to patients with SAD.
  3. Reduced Collagen Production/Premature Aging: Some Vitamin D is derived from our diets however most vitamin D is produced in the skin when it is exposed to sunlight. Vitamin D is important for the immune system, helps boost serotonin activity, and plays an important role in collagen production. Vitamin D levels in the central nervous system affect the production of serotonin and dopamine, an important neurotransmitter for memory, sense of pleasure/reward, and motivation. Collagen along with Elastin is a key factor responsible for maintaining the skin’s elasticity and preventing premature aging. Individuals with SAD may have lower vitamin D levels which in turn impacts their skin’s overall health and appearance.
  4. Acne: SAD-induced stress can lead to hormonal imbalances and increased sebum production, which may increase the likelihood of acne breakouts.

Coping Strategies for Healthy Skin for People with SAD:

  • Get Adequate Sunlight: Yes, your Dermatologist approves some healthy exposure to natural sunlight, especially for those affected by SAD. While it may be more challenging when the temperatures plummet, try to spend some time outdoors during the daylight hours. Early morning activities in the natural sunlight are preferable to exposure between 10am and 2pm. Even brief exposure such as 20 minutes daily can boost your mood and help your skin get the essential vitamin D that it needs.
  • Use Artificial Light Therapy: Using a lightbox to emulate exposure to natural sunlight can alleviate SAD symptoms in just a few days. The gold standard for light therapy is bright white light (color temperature of 5,000 – 10,000 lux). This type of light helps regulate the body’s internal clock. Red LED light therapy, also known as photobiomodulation or low-level laser therapy, has shown promise in the treatment of various conditions, but its role in addressing SAD is still being debated. Red LED light might positively impact people with SAD by having a positive impact on mood and reducing stress. Red light exposure in the evening may help regulate circadian rhythms by influencing melatonin production.
  • Moisturize: Combat dry skin with a good-quality moisturizer containing ceramides to repair the lipid barrier of the skin and hyaluronic acid to help retain moisture in the skin. Hyaluronic acid also helps promote collagen production.
  • Manage Stress: Stress causes elevated cortisol (“fight-or-flight hormone”) and can weaken the immune system. Finding effective stress management techniques, such as meditation, deep breathing exercises, yoga, hiking outdoors, socializing with others, and talking with a therapist or friend can help reduce the negative impact of stress on your skin.
  • Stay Hydrated: Drinking adequate water is crucial for maintaining overall skin health. Hydration from the inside out can help fight dryness and keep the skin more supple.
  • Eat a Balanced Nutrient-Rich Diet: Vitamins A, C, and D are important for collagen production. Foods rich in antioxidants (berries, citrus fruits, and broccoli) and tryptophan (turkey, bananas) can help alleviate some symptoms.
  • Use Sunscreen: Even on cloudy winter days, UV rays can still harm your skin. Protect yourself when spending time outdoors by applying sunscreen with at least SPF 30. Mineral sunscreens containing zinc or titanium oxide offer more broad spectrum protection against damaging UVA and UVB rays.
  • Seek Professional Help: If your skin conditions worsen during the winter months and it is affecting your quality of life, consult your dermatologist. We can provide targeted advice, customized skin regimens, and treatments for your skin issues.

Grassroots Health Nutrient Research Institute

Conclusion

Seasonal Affective Disorder can have a surprising impact on your skin, from dryness and eczema flare-ups to reduced collagen production and premature aging. To combat these effects, it is important to take steps to care for your skin and your overall wellness during the winter months.

By managing stress, maintaining good skincare habits, and seeking professional help when necessary, you can keep your skin healthy and radiant even in the darkest of seasons. Some people may find that changing geographical locations to be closer to the equator is necessary, however, most people can find relief by adopting certain changes. Remember that your skin is not just an external reflection of your health; it can also be an indicator of your emotional well-being.

 

Resources for Further Reading

American Academy of Dermatology: https://www.aad.org/

National Institute of Mental Health – Seasonal Affective Disorder: https://www.nimh.nih.gov/health/topics/seasonal-affective-disorder/index.shtml

 

 

Sources

12 notable seasonal Affective disorder statistics. HRF. September 4, 2014. Accessed October 30, 2023. https://healthresearchfunding.org/seasonal-affective-disorder-statistics/.

Seasonal affective disorder: Symptoms, causes, diagnosis and treatments. Msn.com. Accessed October 29, 2023. https://www.msn.com/en-us/health/condition/Seasonal-affective-disorder/hp-Seasonal-affective-disorder?source=conditioncdx.

Seasonal Affective Disorder. National Institute of Mental Health. NIH Publication No. 20-MH-8138. https://www.nimh.nih.gov/health/publications/seasonal-affective-disorder.

Stewart, Alan E et al. “Possible contributions of skin pigmentation and vitamin D in a polyfactorial model of seasonal affective disorder.” Medical hypotheses vol. 83,5 (2014): 517-25. doi:10.1016/j.mehy.2014.09.010

Seasonal affective disorder. Mayo Clinic. December 14 2021. https://www.mayoclinic.org/diseases-conditions/seasonal-affective-disorder/symptoms-causes/syc-20364651

How is vitamin D made by the sun different from vitamin D in supplements? Grassroots Health Nutrient Research Institute. May 8 2023. https://www.grassrootshealth.net/blog/vitamin-d-made-sun-different-vitamin-d-supplements/

jimmy-buffet-cancer

The Cancer that Killed Jimmy Buffett

/in , /by

jimmy-buffet-cancer

By Laura Monoghan, PA-C

Jimmy Buffett, the songwriter known for “Margaritaville,” “Cheeseburger in Paradise,” along with many others, recently died after a 4-year battle with Merkel Cell Carcinoma (MCC). His untimely death has increased awareness of this rare but aggressive form of skin cancer, whose origins are the Merkel cell, a sensory receptor cell in the top layer of the skin.

Who is at risk for Merkel Cell Carcinoma?

According to the American Cancer Society, approximately 90% of cases occur in people over age 50, and incidence increases with age. It is slightly more common in men (60%), and significantly more common in Caucasians (95%). Interestingly, 80% of cases in North America are associated with a virus, the Merkel Cell Polyomavirus. This virus is very common and often cleared by a healthy immune system. However, several factors can increase the risk of developing MCC, including:

  • Immunosuppression (including organ transplantation, chronic lymphocytic leukemia, HIV infection)
  • Increased sun exposure
  • PUVA therapy

merkel cell carcinomaWhat does this skin cancer look like?

MCC commonly presents as a fast-growing, painless red to purple nodule on sun-exposed skin. However, it can also present as a metastatic disease without evidence of a primary nodule. The most likely spots are on the head or neck. The area can grow quickly and is usually painless. Although more common in fair-skinned individuals, Black patients may also develop these tumors and they may occur on the legs. They may be mistaken for a cyst, insect bite, or pimple.

How is it diagnosed?

MCC is typically diagnosed by a biopsy. This involves numbing the skin and taking a small sample of tissue to send to the lab for testing. Imaging such as a CT, MRI, or PET scan, as well as a lymph node biopsy, may be ordered to look for evidence of metastasis.

How is it treated?

The primary nodule is typically removed surgically, followed by radiation therapy. Also utilized for some patients is immunotherapy, which helps boost the immune system’s defense against the cancer, and chemotherapy which limits the spread of cancer cells.

How to prevent Merkel Cell Carcinoma

  • Use sunscreen of at least SPF 30 every day, re-apply every 2 hours, and after swimming or perspiring
  • Wear a wide-brimmed hat, sunglasses, and sun-protective clothing with UPF of 50
  • Limit outdoor activities or seek shade between 10 am and 4 pm
  • Look for changes in your skin

If you have any concerns or notice any changes in your skin that persist for more than 6 weeks, make an appointment to be examined.

 

 

 

Sources:

Bolognia, Jean, L. et al. Dermatology. Available from: Elsevier eBooks+, (4th Edition). Elsevier – OHCE, 2017.

James, William, D. et al. Andrews’ Diseases of the Skin. Available from: Elsevier eBooks+, (13th Edition). Elsevier – OHCE, 2019.

The American Cancer Society medical and editorial content team. (n.d.). Key statistics for Merkel cell carcinoma. American Cancer Society. https://www.cancer.org/cancer/types/merkel-cell-skin-cancer/about/key-statistics.html

Excessive Sweating Cause and Treatments

/in , /by

Cause of Excessive Sweating

Do you avoid shaking hands because of excessive sweating? Do you need to change your shirt multiple times a day because of sweating? Sweating beyond the usual amount can interrupt both professional and social life. This excessive sweating is called Hyperhidrosis, a condition where the body’s mechanism for cooling itself (sweating) is overactive – so much so that a person could sweat four or five times more than necessary.2

Who is Affected by Hyperhidrosis?

Hyperhidrosis affects millions of people around the world, nearly 5% of the world’s population.2 This condition’s onset typically occurs between the ages of 14 and 25, although children can be affected as well. It can impact dating and career choices as well as patients’ mental and emotional health.3 Children may avoid school because other kids don’t want to hold their hands, papers and crayons become wet and hard to handle, or they may not be able to grip the climbing bars and bicycle handles.

A study was conducted to further understand the connection between mental health and hyperhidrosis. People with hyperhidrosis have a higher likelihood to have anxiety, depression, and attention deficit disorder, regardless of gender or age.1 “Of the 500 hyperhidrosis patients involved in the study, 13.8 percent had anxiety, 12.4 percent had depression and 6.4 percent had ADD — all rates higher than those reported in the general population. While the severity of patients’ hyperhidrosis and the body location involved didn’t impact the likelihood of having a mental health condition, there was a correlation with the number of body locations affected by hyperhidrosis.” 1 In a separate, international study, it was determined that “the prevalence of anxiety and depression was 21.3% and 27.2%, respectively, in patients with hyperhidrosis compared with 7.5% and 9.7% in those without the disease.”3

Constant sweating leads to physical and emotional discomfort for many patients, but we now have multiple effective treatment options for all ages. Addressing hyperhidrosis can significantly improve quality of life.

Check out this article to learn more about hyperhidrosis treatment options, and give us a call to book an appointment to discuss which treatment is best for you.

 

 

Sources:

American Academy of Dermatology. Research Suggests Connection Between Excessive Sweating and Mental Health Conditions. Newswise. 26-Feb-2019. https://www.newswise.com/articles/research-suggests-connection-between-excessive-sweating-and-mental-health-conditions. 1

Defining Hyperhidrosis. International Hyperhidrosis Society. https://www.sweathelp.org/home/defining-hyperhidrosis.html. 2

Lenefsky M, Rice ZP. Hyperhidrosis and Its Impact on Those Living With It. American Journal of Managed Care. 2018; 24:-S0. https://www.ajmc.com/view/hyperhidrosis-and-its-impact–on-those-living-with-it. 3

How to Identify Poison Ivy and Treatments

/in , /by

By, Caroline Glick, PA-C

The neighborhood pools are opening, the birds are singing, and the smell of grilling on the barbeque is in the air: summer is finally here! Most of us already know to apply sunscreen and bug spray to protect our skin before venturing outside. But it is also important to know what to do when summer fun is disrupted by uncomfortable rashes after contact with poison ivy.

How to identify poison ivy

Poison ivy is most common east of the Rocky Mountains, poison oak can be found west of the Rockies, and poison sumac tends to be located in the Southeast. Poison ivy and poison oak can be identified by three leaflets with flowering branches arising from one stem. Other plants that can cause a similar rash include the cashew nut tree and the mango tree.  This website has great photo examples to help you identify poison ivy.

Eastern Poison Ivy as Ground Cover – poison-vy.org

Poison ivy, poison oak, and poison sumac contain an oil called urushiol, which causes an itchy, sometimes blistering rash when it comes into contact with the skin. After the skin is exposed to urushiol, symptoms can occur within 12 to 48 hours.

Click here to see what the rashes look like.

Treating exposure to poison ivy, oak, and sumac

If a person has been exposed to a plant with urushiol, a mild soap can wash off a significant amount of urushiol. Clothing, and even our pets that might have urushiol on them, should also be washed. Pets usually do not have a reaction to poison ivy, but urushiol can be on their fur and then rub off on a person’s hands when petting them.

Calamine lotion, hydrocortisone cream, and cool, wet compresses can help with the discomfort and the itch of the rash. Mild rashes can be treated at home. Dermatologists and health care providers can also prescribe topical and oral medications to help. The rash will usually resolve within one to three weeks without treatment, or faster with treatment.

 

 

Sources:

American Academy of Dermatology. Poison Ivy, Oak, and Sumac: How to treat the rash. Retrieved 24 May 2023, from https://www.aad.org/public/everyday-care/itchy-skin/poison-ivy/treat-rash

Prock, L., & McGovern, T. (2022, February). Poison Ivy (Toxicodendron) dermatitis. UptoDate. https://www.uptodate.com/contents/poison-ivy-toxicodendron-dermatitis?search=poison%20ivy&source=search_result&selectedTitle=1~57&usage_type=default&display_rank=1

Melanoma and Skin Cancer Awareness Month

/in /by

by Laura Monaghan, PA-C

 

May brings warm weather, prom season, and spending time poolside. In the world of dermatology, May also brings Melanoma and Skin Cancer Awareness Month. Skin cancer is the most common cancer in the United States, and melanoma is the second most common form of cancer in females ages 15-29. Melanoma rates have doubled from 1982 to 2011, and on average one American dies of melanoma every hour. So, what exactly is melanoma? And what can you do about it?

 

What is Melanoma?

Melanoma is a form of cancer that originates in melanocytes, the cells that produce skin pigment. Damage to the cell’s DNA allows the melanocytes to grow uncontrollably. This can present as a changed mole, a new dark spot, or even a pink nodule on the skin. There are multiple factors that can increase your risk of developing melanoma, which includes:

  • Family history of melanoma 
  • Tanning bed use
  • Sun exposure 
  • Increased age 
  • More than 50 moles, large moles, or atypical moles 
  • Fair skin and light hair/eye color 
  • Personal history of melanoma or other skin cancer 
  • Personal history of other cancers 

Base Tan

Despite the popular idea of getting a “base tan” to kickstart the summer, there is no such thing as a safe tan. In fact, according to the Skin Cancer Foundation, just one indoor tanning session before age 35 increases the risk of developing melanoma by 75%. The risk increases with every subsequent use.

How to prevent skin cancer

Prevention and early detection are key goals of melanoma care. This includes avoiding the sun during the highest UV index hours (10AM-4PM) and wearing SPF 30+ sunscreen, sun-protective clothing and hats, and sunglasses. Routine full-body skin exams with your dermatologist and monitoring your skin at home are also recommended for early detection. Click here to learn what to signs to look for during your skin exam.

Check out this video of Dr. Skelsey and one of her melanoma patients.

​

 

 

Sources:

American Academy of Dermatology. (2018-2020). Key Messages.

Chien, A., & Jacobe, H. (2022, July). Tanning & Your Skin. The Skin Cancer Foundation. Retrieved May 7, 2023, from https://www.skincancer.org/risk-factors/tanning/#:~:text=Indoor%20Tanning%20Dangers&text=increased%20risk%20of%20developing%20life,a%20sign%20of%20skin%20damage.

Indoor tanning. American Academy of Dermatology. (2021, June 21). Retrieved from https://www.aad.org/media/stats-indoor-tanning#:~:text=Using%20tanning%20beds%20before%20age,risk%20increases%20with%20each%20use.&text=Women%20younger%20than%2030%20are,melanoma%20if%20they%20tan%20indoors

© 2026 Dermatologic Surgery Center     |     Website Design: Everett Design