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sun Protection Supplements

Sunburn, Skin Cancer and Supplements

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sun Protection Supplements

Sunburn and Skin Cancer

Sunburn is inflammation of the skin caused by overexposure of ultraviolet (UV) light from the sun. Although sunburn often results in short term pain, redness, and dryness, the long term effects of sunburn can lead to serious consequences including skin cancer.

Non-melanoma skin cancer (NMSC) is considered to be the most common form of cancer in the United States and the incidence of NMSC is on the rise. The current methods available to protect against UV radiation include the use of hats and or protective clothing, sunscreens, avoidance of midday sun, and seeking shade. However, compliance with these methods is low due to the inconvenience of use, forgetting to reapply, desire to be tan, and protective clothing being too hot to wear. The introduction of an oral supplement as an adjunctive treatment for the protection against the harmful effects of UV exposure may provide a simple solution.

Oral Supplements as Sun Protection

Starr 050107-2831 Phlebodium aureum

Polypodium leucotomos extract and Nicotinamide (Vitamin B3) are two oral supplements that have proven to be effective photoprotective agents. Polypodium leucotomos extract is derived from a Central and South American fern plant.¹,² Studies have shown that it possesses properties ranging from antioxidant, anti-inflammatory, immunomodulatory and photoprotective.¹ In the U.S., it is currently marketed as an oral dietary supplement (Heliocare) with a recommended dose of one 240 mg capsule 30 minutes before sun exposure, followed by an additional 240 mg capsule 3 hours after prolonged sun exposure. It has proven to be well-absorbed, well-tolerated, with negligible risk of side effects, and no recognizable toxic effects.²

Nicotinamide’s photoprotective effects range from replenishing cellular energy after UV radiation, enhancing DNA repair, reducing UV-induced immune suppression, reducing number of actinic keratoses (precancerous lesions), and improving the skin barrier function. It’s recommended dosage is 500 mg two times per day. It has been found to be safe and well-tolerated even at high doses.3,4

 

Shop Heliocare from our Website

 

 

 

 

 

 

 

Sources:

Choudhry SZ, Bhatia N, Ceilley R, et al. Role of oral Polypodium leucotomos extract in
dermatologic diseases: a review of the literature.J Drugs Dermatol. 2014;13(2):148-153.

Winkelmann RR, Del Rosso J, Rigel DS. Polypodium leucotomos extract: a status report on
clinical efficacy and safety. J Drugs Dermatol. 2015;14(3):254-261.

Damian DL. Nicotinamide for skin cancer chemoprevention. Australas J Dermatol.
2017;58(3):174-180.

Chen AC Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide
for Skin-Cancer Chemoprevention. N Engl J Med. 2015;373:1618-1626.

PRP Therapy for Hair Loss

PRP Treatment for Hair Loss

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“You’re not imagining it: the pandemic is making your hair fall out,” says the NY Times. And in our practice, we can confirm that observation. After covid-19 infection, many patients experience post-viral hair loss known as telogen effluvium, beginning a few months after infection. Telogen effluvium can occur after the body is stressed by a high fever, surgery or childbirth—and usually reverses itself. It’s not surprising that we see more viral related hair loss. What is unusual is that even hereditary thinning known as androgenetic alopecia seems to be worsening this year.

Many patients have inquired about PRP (Platelet-Rich Plasma) for hair loss. There are no studies examining its use in post-covid hair loss patients; however, it can be very effective for patients with hereditary thinning — and possibly other types of hair loss.

Platelet-Rich Plasma (PRP) Treatments

Platelet-Rich Plasma is a type of regenerative medicine in which the injection stimulates or restores the body’s own repair mechanism. Physicians have used PRP injections to treat acute sports injuries, such as pulled hamstring muscles or knee sprains and after surgery to repair a torn tendon (such as a rotator cuff tendon in the shoulder) or ligaments (such as the anterior cruciate ligament, or ACL).

Chronic wounds have also responded to PRP and multiple studies are currently examining the practice for the treatment of dermal atrophy, wound healing, and other conditions.

More recently, however, PRP has emerged as an effective therapy for hair loss, which can be a challenging dermatologic problem to treat.

PRP Treatment for Hair Loss

PRP Treatment for Hair Loss

Understanding PRP begins with recognizing the function of platelets. Platelets are components of the blood that promote blood clotting as well as cell growth and healing. Normal concentrations of platelets in the bloodstream are between 150,000-450,000 per microliter of blood. However, when blood is spun down by a centrifuge machine, concentrations of platelets increase, leading to even greater benefits in wound healing and tissue regrowth.

While the exact mechanism is unknown, scientists theorize that PRP stimulates certain types of cells in the scalp that play an important role in hair growth. PRP also appears to keep hairs in the growing (anagen) phase of development longer than usual, resulting in a greater number of hairs on the scalp relative to shedding hairs.

How does it work?

First, a small amount of blood is drawn from a vein in your arm. This blood is spun down to separate the red blood cells from the plasma — where the highest concentration of platelets can be found. Using a small needle, the plasma is then injected into areas of the scalp where hair loss has occurred. For best results, a series of three-monthly treatments should be completed, followed by maintenance sessions every six months.

What are the risks?

First, PRP can be mildly painful. Small needles are used to insert PRP into specific areas of the scalp. Local numbing medicine, cold compresses and vibrational devices used to offset the sensation of pain can be helpful and may be utilized during treatment. Bruising may also occur, but typically resolves within one to two weeks. There is also a small risk of infection with the venipuncture used to obtain the sample.

What conditions can be treated with PRP?

Patients experiencing hair loss associated with genetics or age-related changes, known as androgenetic alopecia, are good candidates for PRP. This type of hair loss typically runs in families and presents with a widening part on the crown of the scalp. Additionally, new research suggests that PRP may have a role in other forms of alopecia, such as alopecia areata (autoimmune disease resulting in patchy hair loss) and scarring forms of alopecia (lichen planopilaris and frontal fibrosing alopecia).

Interested in PRP for hair loss? Contact us to schedule a consultation with a dermatologist to discuss treatment options for you.

 

 

 

 

 

 

 

 

 

Sources:

https://www.nytimes.com/2021/02/18/style/hair-loss-coronavirus-pandemic.html

https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/resources-related-regenerative-medicine-therapies

https://journals.lww.com/dermatologicsurgery/Fulltext/2017/05000/Regenerative_Medicine_and_Stem_Cells_in.2.aspx

Butt G, Efficacy of platelet-rich plasma in androgenetic alopecia patients. J Cosmet Dermatol. 2019 Aug;18(4):996-1001. doi: 10.1111/jocd.12810. Epub 2018 Nov 4. PMID: 30393988.

J Cosmet Dermatol

  • 2020 May;19(5):1071-1077.

doi: 10.1111/jocd.13146. Epub 2019 Sep 18

Cosmet Dermatol

  • 2019 Aug;18(4):996-1001.

doi: 10.1111/jocd.12810.

COVID Vaccination Information for Dermatologic Patients

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The Covid vaccines are here! As a part of the medical community, our staff has received their first dose. We report varying degrees of arm soreness and are otherwise extremely grateful to have started on the road to immunity.  Through vigilance, we have made it this far without anyone on the team becoming ill. Our infection control protocols remain firmly in place despite our vaccination status. So, if you come in for an appointment you will continue to see us practicing strict protection measures, just as we have since March.

The vaccine roll-out seems slower than promised, but at least it’s moving forward. Maryland moved into Phase 1B on Monday, January 18, which widened eligibility to residents 75 and older. The next phase, 1C, includes those over 65 and starts January 25.

You have probably noticed the plans for our area vary widely, by jurisdiction. To find out when and where to get vaccinated, these websites may be helpful to you:

Maryland: https://covidlink.maryland.gov/content/vaccine/

DC: https://coronavirus.dc.gov/vaccinatedc or call 856-363-0333

Virginia: https://www.vdh.virginia.gov/covid-19-vaccine/

MedStar Health: Current patients who meet the criteria, may be vaccinated by appointment at the four DC Medstar facilities. https://www.medstarhealth.org/mhs/about-medstar/covid-19-vaccine-information/

Important information, if you:

Are Immunocompromised or on immunosuppressive medications:  the CDC advises taking the Covid vaccination if there are no contraindications. (see below)

Are on Biologic treatment: Evidence to date suggests that most individuals on biologic treatment can be successfully immunized with no increased incidence of adverse effects.

Have had:

  • Severe allergic reaction (e.g., anaphylaxis) after a previous dose of an mRNA COVID-19 vaccine or any of its components*;
  • Immediate allergic reaction of any severity to a previous dose of an mRNA COVID-19 vaccine or any of its components (including polyethylene glycol [PEG])*;
  • Immediate allergic reaction of any severity to polysorbate (due to potential cross-reactive hypersensitivity with the vaccine ingredient PEG)*;

If you have had any of the above, the CDC considers such history to be a contraindication to vaccination with both the Pfizer-BioNTech and Moderna COVID-19 vaccines.

*These persons should not receive mRNA COVID-19 vaccination at this time unless they have been evaluated by an allergist-immunologist and it is determined that the person can safely receive the vaccine (e.g., under observation, in a setting with advanced medical care available).

To read more, visit: https://www.cdc.gov/vaccines/covid-19/info-by-product/clinical-considerations.html#Patient-counseling

Cosmetic injectable fillers and the vaccine

There have been a few cases of facial swelling reported in Moderna vaccine trial. The localized swelling resolved itself after treatment with antihistamines or steroids in all three cases. In its report on the Moderna vaccine hearing, the FDA notes that “it is possible the localized swelling in these cases is due to an inflammatory reaction from interaction between the immune response after vaccination and the dermal filler.”

Patients already treated with dermal fillers should not be discouraged or precluded from receiving vaccines of any kind. Similarly, patients who have had vaccines should not be precluded from receiving dermal fillers in the future.  Our current recommendation is that you delay filler treatment if you are scheduled for the vaccine within 2 weeks.

Once Vaccinated

Once you do receive the vaccine, you may experience some malaise, soreness at the injection site, and even a mild fever, but these symptoms are transient and typically resolve in 24-48 hours. The symptoms are indicative of your body building immune defenses against the virus. Applying ice in the form of a bag of frozen peas as well as taking non-steroidal anti-inflammatory agents such as ibuprofen (Motrin) and acetaminophen (Tylenol) can help relieve discomfort.

If you have a reaction, I recommend registering in the CDC’s vaccine symptom tracker at: https://vsafe.cdc.gov/

And last, Inauguration Day Office Hours

Because of anticipated road and bridge closures and disruption in public transportation, we are not seeing patients on Inauguration Day, January 20. However, we will be answering phone calls from 10AM – 3PM.

End of Year Message From Dr. Maral Skelsey

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One of the most extraordinary achievements in medical history is the rapid development of the coronavirus vaccine.  With truly breathtaking speed, a novel technology has been harnessed to create a life-saving intervention. It will be several months, however, before most of us are vaccinated—and even longer before we can resume life as we knew it. This holiday season—like Thanksgiving- will not involve leaving town to visit extended family. I love to travel and am not excited about the prospect of another “staycation.” Who doesn’t want to get away and leave pandemic madness behind? But where is there to go? Like nearly everyone, I want to escape the drumbeat of bad news and the monotony of the same routine and landscape. A few weeks ago, as I walked along the river, I realized a boat could be the ticket out. Kayak rentals are now closed so I needed to buy one. I was a little worried about how much space it might take up—as city dwellers without a garage, that’s always an issue. But when I saw someone neatly fold up her kayak like origami, I learned about the world of foldable boats and headed straight to Amazon—the online version, not the one in South America.

It turned out that there are a lot of choices for portable kayaks; the priciest are collapsible. Since I only hit the water a couple of times a year in “before times” I thought it was a bit extravagant for my needs. But then I hit upon a very reasonable inflatable kayak that came with its own pump and backpack. Jackpot! I could see myself walking down to the river with my backpack for a peaceful sunset cruise.

After a few weeks I almost forgot about the order until a box the size of a small Volkswagen Bug arrived at my front door. I pulled out the massive plastic contents, which may have weighed as much as a VW. Maybe walking to the river with the kayak in a backpack was not going to be so easy. Perhaps I’d made a mistake. Perhaps I should reconsider and make sourdough bread instead. But I was committed- mainly because my family thought it was a crazy idea. I wasn’t going to let this end up in the basement with my other unused purchases like the pasta machine, bread maker, ice cream maker, waffle maker, fondue pot and sous vide machine. The last kitchen device I really embraced was the Easy Bake Oven, although I did start using the Instapot once I overcame my fear of causing a massive explosion.

I was ready to put this together. How hard could it be? I do surgery on complex skin cancers and operate sophisticated lasers. Surely I could put together a kayak that came with an illustrated instruction manual. And it was only 19 pages, two thirds of which were written in foreign languages that I am purported to speak. Easy peasy in comparison to a laser manual!

Most of the pages, however, were filled with  caution symbols  and dire warnings (“Paddle sports may involve serious injury or death”). DEATH? Although it sounded like inflating this thing might cause transformation into some kind of evil genie, I carried on. It was a beautiful Saturday and I loved the idea of paddling around, looking at some new scenery. Back to the manual- whose diagrams, unfortunately, bore no resemblance to the unwieldy folded plastic contraption in front of me. Instructions helpfully pointed out: “NOTE: the pump may look different from yours. It is for illustration purposes only.” Right about that. I carried on, inserting the pump into what I hoped was the right port as the manual was explicit that the “Floor chamber must be inflated before the main chambers.” I guessed that one of the 8 likely ports was the right one and started pumping away. EUREKA! It worked. With a little elbow grease, the kayak would be ready in no time. After fifteen minutes of strenuous action, however, and I had reached only about 10 % of my goal. This was definitely more than I bargained for. In a touching gesture of concern my son came outside and said, “I think you’d better stop before you have a heart attack.” I would have loved to have stopped but I remembered the shelf of partially read parenting books by my bed, admonishing parents to encourage Perseverance! Resilience! I wasn’t about to model a quitter. On the other hand, I recognized how embarrassing it would be for a teenager to admit that his mother dropped dead trying to inflate a plastic kayak, so I gave him a shot at the pump, rendering the last 90% a breeze.

And just like that I became a boat owner- ready for a quick getaway. Not exactly ready for an extended river cruise, but the entire process gave me a very welcome escape. Sometimes a box from Amazon can provide enough of a change of pace to refresh one’s outlook until a trip down the real Amazon is possible.

Stay safe, stay home and have a peaceful and happy holiday season.

face mask skin care tips

Wearing a Mask and Caring for Your Face

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While taking walks in Chevy Chase and Georgetown these days, I see most people wearing a face covering.  It is reassuring, as wearing a mask is critical to keeping your family, friends, co-workers and yourself safe from coronavirus. With long-term wear, however, masks can sometimes cause or exacerbate painful and troubling skin conditions. In the past few months, we have seen a significant increase in:

  1. “Mask-ne,” or an acne breakout in the area under and around the mask,
  2. Dry, itchy skin in the same areas on the face,
  3. Redness and pain behind the ears, from the mask straps.

Since there is no question wearing a mask is the right thing to do, here are some tips on how you can manage these conditions while continuing to keep yourself covered.

START CLEAN – washing your face

Masks retain dirt and oil on the skin, so cleaning your face (and your mask) properly before you put one on is even more important.

  • If you suffer from acne, use a non-comedogenic cleanser (one formulated so as not to cause blocked pores) twice a day. Also, use a gel moisturizer and oil-free make-up.
  • Stop using make-up entirely until your skin heals, if you can.
  • For irritated or dry skin use a gentle cleanser.
CHOOSE THE RIGHT SKIN PRODUCTS – moisturize and mitigate irritation
  • Choose products that are fragrance-free.
  • Look for moisturizers containing ceramides, hyaluronic acid or dimethicone.
  • For acne, use a gel, non-comedogenic moisturizer.
  • If you must wear make-up and you have acne, use oil-free, mineral-based products.
  • If your skin is dry or irritated, stop using retinoids, glycolic acids, salicylic masks, peels and scrubs.
  • If your ears are telling you they need a break, try moisturizing behind them to ease redness and discomfort from the mask straps.
MASK TYPES AND ROUTINE – Not all masks are alike

What a mask is made of and how you wear it has an impact on your skin.

  • Wear a mask made of natural breathable cotton fabric. Avoid synthetic nylon, polyester or rayon that can irritate and cause breakouts.
  • Make sure your mask is snug at the edges, but not too tight on your face. A mask that moves around a lot can abrade your skin surface and exacerbate inflammation. Plus, it is more likely you’ll touch your face to adjust it.
  • Rotate wearing different strap types and ear loops in order to cause less irritation behind the ears.
  • Purchase masks with long straps, or strap extenders, that wrap about the back of your head so that the strap does not rest on sensitive skin behind the ears.
  • Take a mask break for 15 minutes every 4 hours when you are in a safe environment such as alone in your car or outdoors six feet away from people.
CARE FOR YOUR MASK, TOO

It is important to regularly clean your mask, so that it is as inoffensive to your skin as it can be.

  • Wash a cloth mask daily in hot, soapy water, and rinse well, unless otherwise specified.
  • When washing cloth masks, use fragrance-free, hypoallergenic soap or mild laundry detergent and skip the fabric softener.
  • If you do not hang your mask to dry, avoid scented dryer sheets as these frequently cause itchy, inflamed skin.
  • If you are using a disposable surgical-type mask, how often you should start a new one depends on how much you use it, if you wear makeup and your specific skin condition. If it is visibly dirty, it is time for a new one.

For DIY help, our online store contains products that will allow you to care for your face during this unique time (mohs-md.square.site).  If your mask-related skin problem does not resolve after a few weeks, prescription medication may help. Call our office to make an appointment.

facial rejuvenation for men

A Guide to Looking Great

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Always Looking Our Best

The internet has become the primary mode of communicating who we are. Even pre-pandemic, it reached such dominance that nearly every professional has a presence on the web. On any given business’ website there is a tab highlighting “Our Team,” linking to bio’s and smiling head shots, with everyone trying to look their best. And now with ubiquitous video and webcam meetings, we are all examining our screen images with increased scrutiny. Projecting an attractive and healthy image unquestionably has advantages in the workplace. Men are increasingly recognizing this phenomenon and seeking facial rejuvenation procedures to improve appearance.

Facial Injections and Fillers

Our male patients want significant and totally natural results with minimal downtime – and injections can fit that criteria. This may be why cosmetic injections in men have increased by about 80% in the last 10 years. Men gravitate to injectables like Botox which work effectively but subtly to relax frown lines and crow’s feet around the eyes. Fillers have a role in softening the deep, etched lines of facial expressions.

Treatment Designed for Men

Facial rejuvenation using injections is not a one-size, or one-gender, fits-all process, however. I like to tailor treatments to address individual goals and anatomic structure. To achieve a natural look for a man, for instance, our approach to the patient may be entirely different than it is for a woman. With men, restoring a prominent jaw and chin line can be vital. Men’s eyebrows shouldn’t be overly arched, which can be feminizing. Likewise, men’s facial muscles may be larger in mass than women’s, requiring higher dosages.

Laser Treatments for Rejuvenation

Years of sun exposure can leave the face looking rough, wrinkled and with irregular pigmentation. Laser Skin Resurfacing generates entirely new skin and improved photodamage. Vascular lasers reduce blood vessels and even out a ruddy complexion better than any other treatment. An occasional side effect of some laser surgery is mild bruising, which is temporary and easily hidden with tinted sunscreen. We can also reduce the laser’s power, increase the number of treatments and minimize the side effects.

What is Microneedling?

RadioFrequency (RF) Microneedling results in dramatic skin tightening, wrinkle reduction and improvement of acne scars. Patients experience a sunburn-like redness but can return to work the next day, making this an ideal procedure for a busy professional. RF microneedling delivers energy into the skin with minute sterile needles, stimulating the natural growth of collagen and elastin. After three treatments spaced about a month apart, the jaw line becomes more defined and skin texture dramatically improved. A less tired look and vibrant healthy skin can be achieved without a lot of downtime.

How Dermatologists Can Help

While women have more frequently sought age reversing skin treatments, men are rapidly closing that gap. For both men and woman, we listen to our patients, understand their goals and work with their unique features to create a treatment plan that can help them look their best, most natural self. Contact us to schedule a consultation to discuss your facial rejuvenation treatment options.

hair loss treatments

Treatment for Androgenetic Alopecia in Men and Women

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By Kyleen Davis, FNP

Androgenetic alopecia (AGA) is the medical term used to describe a type of hormone-related hair loss that occurs in genetically-susceptible men and women. It is extremely common, affecting approximately 50 million men and 30 million women in the United States. Androgenetic alopecia can be significantly distressing to affected individuals and seriously impact their quality of life. Fortunately, multiple treatment strategies have been shown to help.

The onset of AGA is typically between the ages of 20 to 40 years old, but can start as early as a person’s teens. The risk of developing this condition increases later in life. Men are more commonly affected than women and may present in different ways. In males, recession of the frontal hairline is noted early on, followed by a gradual thinning at the temples and crown, forming an “M” shape. In females, the frontal hairline is preserved with a generalized thinning of the hair and widening of the part. AGA rarely leads to complete baldness in women. Other common features of AGA include gradual onset of hair loss, increased hair shedding, and a transition from large, thick, pigmented hairs to thin, short, wispy hairs.

Medication-hair-loss

Nhtindia / CC BY-SA

Diagnosing Androgenetic Alopecia

Patients with suspected AGA should be evaluated by an experienced dermatologic provider. A careful medical history and physical examination of the hair, scalp, and nails should be obtained, along with laboratory testing to rule out underlying diseases or vitamin deficiencies. A biopsy of the scalp is occasionally necessary to differentiate AGA from other types of alopecia.

Treatment of Androgenetic Alopecia

Once a diagnosis of AGA is established, treatment may be initiated with one of the following medications:

  • Minoxidil:
    • Available in 2% or 5%, topical minoxidil is the most commonly recommended treatment for AGA. Patients need to use this medication continuously for one year before determining if it will work for them. At the beginning of treatment, individuals may notice a temporary increase in hair loss, which stops as the hair begins to regrow. Common side effects include dryness, scaling, and/or itching of the scalp. Occasionally, excessive hair growth in unwanted places, like the cheeks or forehead, may occur as a result of taking this medication.
  • Prescription medications:
    • Finasteride is an FDA-approved medication used to treat AGA in men. It has been shown to halt the progression of hair loss while also leading to regrowth of hair in many cases. A commonly reported side effect is sexual dysfunction, which is reversible once the medication is stopped.
    • Spironolactone is often used in women with female-pattern hair loss. This medication acts to suppress the effects of certain hormones, and can be particularly useful in polycystic ovarian syndrome (PCOS) and hirsutism—defined as excessive hair growth on the body.
  • Vitamins:
    • Many supplements containing biotin, folic acid, and antioxidants have helped patients with thinning hair.  It is important to mention any supplements you are taking to your physician prior to laboratory testing as they may affect results.
  • Shampoos:
    • One prescription shampoo, ketoconazole, has been shown to increase hair thickness in several studies. In addition, other over-the-counter shampoos can help hair hold moisture, making it appear thicker and fuller, as well as reduce breakage.
  • Laser therapy:
    • The FDA has approved low-level laser devices to treat hair loss at home. These lasers emit a low level of light that has been shown to help grow hair in a limited number of studies.
  • Platelet-rich plasma therapy:
    • Platelet-rich plasma therapy (PRP) uses a person’s own blood to stimulate cells to grow hair. After the blood is drawn, it is spun down in a machine, separating it into different components. The plasma is then injected into the scalp. PRP therapy is a relatively new therapy with studies currently underway to help determine its safety and efficacy.

If you suspect you have AGA, it is important you see your dermatologist as soon as possible to discuss the treatment options that are best for you. Treatment works best when started at the first sign of hair loss.

 

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References:

temperature screening dermatology

We’re Here for You

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As our region enters the next phase of re-opening, we are very happy to welcome you back to the office for an in-person appointment. We thank you for your patience during the past few weeks when we could not accommodate non-urgent office visits.

When making an appointment to be seen by your favorite provider, rest assured our first priority is your health and safety. We would like to update you on new protocols that assure you are seen in the safest possible environment.  Our procedures are in strict compliance with guidelines from the CDC, and the Maryland and Montgomery County health departments, which we continuously monitor for updates. Everyone entering our office, including all patients and staff, are required to follow these measures.  

Updated Appointment Protocols

After making your appointment and in order to limit your time in the office, we ask that you print and complete any necessary paperwork at home and bring it with you. If you are a new patient or you have not been seen in 2020, you can access those forms by clicking here. To update and verify your insurance information, we ask that you email pictures of the front and back of your insurance cards to front.desk@mohs-md.com.  

When you arrive for your appointment, our suite door is locked and you must ring the bell. You will be screened for Covid-19 symptoms and fever before entering (with a touchless thermometer pictured here). You must wear a mask at all times when in the office. When checking in at the reception desk, you will notice a large plexiglass sneeze guard has been installed. The waiting area has been reconfigured to promote social distancing, although we have reduced the number of patients being seen so your wait time will be minimal. 

All clinical staff have received COVID-19 infection control training and they wear masks, eye shields, hair bonnets and shoe covers. You will find HEPA/UVC air purifiers in each exam room and the reception area that continually clean the air. All surfaces are continuously cleaned throughout the day with CDC- and EPA-approved disinfectants and the entire office is deep cleaned each evening.

You won’t see some of our wonderful office staff as Margrit and Kim are still working remotely, but feel free to leave them a message as they would love to hear from you!

The entire office appreciates your cooperation in following to these new safety measures. The upside of this crisis is that these improvements will become our new standard of care for infection control. Our team is committed to taking care of you in the safest possible environment. We look forward to seeing you!

Should you have any questions or concerns, please contact us at front.desk@mohs-md.com.

How to Properly Examine Skin for Signs of Cancer

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Peace of Mind During Pandemic

May is Melanoma Awareness Month, and while you don’t need another thing to worry about these days, it’s important to learn about melanoma and understand its risks. Approximately 200,000 melanoma cases will be diagnosed in the U.S. in 2020 and it’s estimated that the number of new melanoma cases diagnosed will increase by almost 2 percent this year. Men age 49 and under have a higher chance of developing melanoma than any other cancer, and women age 49 and under are more likely to develop melanoma than any other cancer except breast and thyroid cancers.

The good news is that the vast number are curable, especially when diagnosed in the earliest stages. The estimated five-year survival rate for patients whose melanoma is detected early is about 99 percent.

How to Check Your Skin for Cancer

You can stop worrying about melanoma by taking a good look at your skin once a month. Look for anything new, changing or unusual on both sun-exposed and sun-protected areas of the body. Melanomas commonly appear on the legs of women, and the number one place they develop on men is the trunk. Keep in mind, though, that melanomas can arise anywhere on the skin, even in areas where the sun doesn’t shine, including the groin, genitalia, the bottom of your feet and in or around your nails.

What to Look for During Skin Screening

I recommend comparing a suspicious spot to surrounding moles to determine if it looks different from its neighbors. These “ugly ducklings,” or outlier lesions, can be larger, smaller, lighter or darker compared to surrounding moles. A solitary lesion without any surrounding moles for comparison are also considered ugly ducklings. About 20 to 30 percent of melanomas develop in existing moles, while 70 to 80 percent arise on seemingly normal skin.

Not every melanoma is dark or pigmented. Amelanotic melanomas are missing the dark pigment melanin that gives most moles their color. These melanomas may be pinkish, reddish, white, the color of your skin or even clear and colorless, making them difficult to spot.

Look out for any new moles or freckles that arise on your skin, a sore or spot that does not heal, a change in any existing mole (growing, swelling, itching) or any spot, mole or lesion that looks unusual.

You might find lots of things that suggest a lesion of concern, but another encouraging bit of information is that many lesions that meet these criteria are benign, and can be diagnosed while you are in the comfort of your own living room.

Non-invasive Biopsy from Home

Through telemedicine, I see many dark spots that are actually benign. Seborrheic keratoses, benign sun spots, and even ticks can look like melanoma. During this past month I am gratified to be able to reassure patients who are concerned about new lumps and bumps. Only on a few occasions have I determined that a spot needs further evaluation. What happens then? Does that mean you need to come into the office? Not necessarily.

DermTech PLATechnology has advanced to a degree that we can assess a pigmented mole through an innovative genomic test that can be done by you at home. The DermTech Pigmented Lesion Assay (PLA), which comes in a kit sent to a patient’s home, can determine if a mole is benign or if it has the genomic risk factors of melanoma and needs to be biopsied. The PLA has an adhesive patch that sticks to a mole like tape and is peeled off painlessly to collect skin cells. When administering the test, you draw a circle on the tape to highlight the location of the lesion (as seen in the picture). Skin cells that stick to the adhesive patch are analyzed in a specialized laboratory where the cells are examined for two genes that can indicate the presence of melanoma. This gene expression analysis enables DermTech to accurately distinguish between melanoma and non-melanoma.

With the PLA, there is a less than 1% chance of missing melanoma. It results in fewer unnecessary biopsies, and allows us to limit in-office visits. Plus, it’s painless and doesn’t leave a scar.

What’s the process?

Schedule a telehealth appointment by calling our office at (301) 652-8081 to discuss your skin cancer concerns. If it’s advised that you need to have any lesions further evaluated, we may suggest the DermTech PLA. A kit is sent to your home and we supervise the application of the adhesive sticker via a telehealth visit. Results are available in approximately one week, which means that peace of mind, a rare commodity these days, might just be a week away.

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Coping with Stress and Treating Acne

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By Cynthia H. Cameron, NP

Everyone is cooped up at home listening to dire news reports with limited access to many of the activities that help us reduce stress. There are no organized sports for teenagers, no going to the movies with friends, nor trips to the gym. Anxiety is a normal reaction to the conditions we’re all facing. All that stress takes a toll on our bodies, and the effects on our skin are readily visible.

The Relationship Between Stress and Acne

Both teenagers and adults can experience flares of acne as a result of stress. Research shows that in response to negative emotions, our bodies produce more hormones called androgens. These androgens stimulate oil glands and inflammatory cytokines which set the immune system into overdrive and trigger acne flare-ups.

Stress can also lead to repetitive behaviors such as skin picking or touching your face (which we need to avoid to reduce the risk of covid-19 infection). Squeezing pimples and skin picking can lead to infections and scarring which may worsen depression and anxiety.

Many people avoid socializing (even on Zoom!) when their acne flares, leading to further isolation. Studies show  that treating acne can boost mood and self-esteem.

Treating Acne through Telehealth

Over the past few weeks, I’ve seen an increase in severe acne in my telemedicine visits. The good news is that virtually everyone who is conscientious about using the medications and treatments we prescribe sees improvement after a relatively short period of time.

During my visit with a patient, which is performed on a secure HIPAA compliant platform, I take a complete health history, identify possible triggers and inquire about a patient’s diet. In doing so, I am better able to identify and recommend possible dietary changes that may help address the worsening of the patient’s acne. Patients who keep a food diary or record their food intake are often able to identify what foods tend to trigger breakouts.

Diet and Acne

There is also data to suggest that following a low-glycemic diet may reduce acne. Low-glycemic foods include most fresh vegetables, some fresh fruits, beans, and steel-cut oats. Check out these 8 principles of low-glycemic eating. It can also be helpful to minimize intake of sugar and processed carbohydrates and to consider discontinuation of whey protein supplements; milk (but not necessarily all dairy) can exacerbate acne in some individuals.

Tips for Treating Acne Breakouts

In addition to prescription medications that may be applied to the skin or sometimes taken orally, I recommend the following:

  • Wash your face twice a day and after sweating.
  • Use your fingertips to apply cleanser as washcloths and mesh sponges can irritate the skin.
  • Shampoo regularly. If your hair is oily, shampoo daily. Medicated shampoos can help too.
  • Don’t pop, pick or squeeze your acne, which can cause scars.
  • Don’t “spot treat” with your acne medicine. Apply a thin layer to the entire area in order to prevent new blemishes.
  • Use sunscreen that is designed for acne and labeled non-comedogenic or non-acnegenic.
  • If you have acne on the back, avoid using anything that rubs against your back, such as a backpack.
  • Bring all of your skin and hair care products to your televisit so we can review what might aggravate your acne.

Coping with Stress for our Health

When we are stressed, our self-care often takes a back seat. Our diet, sleep quality and quantity, and skin care regimen all play a role in our mental and physical health, including our skin.

During this difficult time, consider the following coping mechanisms:

Nobody needs to live with severe acne nor suffer from permanent scarring. With a combination of evidence-based dermatologic treatment, proper skin care and a healthy lifestyle, you can achieve clearer skin—even in the midst of a pandemic.

Click here to learn more about our telehealth platform and to request an appointment.