hair loss treatments

Treatment for Androgenetic Alopecia in Men and Women

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:

3d illustration of a woman before and after acne treatment proce

Coping with Stress and Treating Acne

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.

 

 

 

 

 

 

Tips for a Great Telemedicine Visit

by Kyleen Davis, NP-FNP

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

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

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

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

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

Common Acne Myths

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

Your diet has nothing to do with your acne.

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

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

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

Tanning improves acne.

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

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

Acne only affects individuals in their teenage years.

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

Vigorous cleansing will improve acne.

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

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

Acne is caused by bacteria.

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

Acne is not a serious health problem.

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

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

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

I can clear up acne using at-home treatments.

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

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

Your hair has nothing to do with acne.

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

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

Sunscreen can worsen acne due to clogged pores.

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

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

If I have dry skin, I cannot get acne.

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

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

 

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

 

 

References

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

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

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

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

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

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

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

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

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

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

Trending Now: Collagen Supplements for Anti-Aging

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

What is collagen?

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

The science:

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

Can I benefit from taking a collagen supplement?

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

Bottom line:

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

 

 

References

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

How Dermatologists Use Lasers and Other Light-Based Devices

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

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

Uses for Laser, Light and Energy-based Devices

Remove unwanted hair

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

Do away with those age spots

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

Treat redness and broken blood vessels

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

Banish those breakouts

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

Refresh and rejuvenate

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

Soften the look of scars

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

Take care of that ‘turkey neck’

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

Rethink the ink

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

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

Progress Being Made in the Dermatology Field

The annual American Academy of Dermatology meeting took place in DC in March and I was thrilled to serve as faculty along at the Live Injection Course. My colleagues – leaders from around the country- and I demonstrated injection of fillers and toxin to a packed audience. This came right after our office hosted the International Peel Society workshop in which visiting dermatologists learned state-of-the-art peel techniques. Best part of all of this was how much I leaned from my colleagues!

The AAD meeting is the largest assemblage of dermatologists anywhere and it was full of cutting-edge research from around the world.

What We Learned

In the war on melanoma, continued progress in melanoma immunotherapy has vastly improved survival rates. Future melanoma treatment may consist of personalized therapy in which a vaccine is created based on the specific antigens most expressed on an individual patient’s tumor. In this way the patient’s immune system is encouraged to recognize and attack his or her own melanoma cells.

We also learned a lot about a new class of medications called “JAK” (Janus Kinase) inhibitors. These agents are game changers for alopecia areata, atopic dermatitis, vitiligo and psoriasis. These are systemic medications, taken by mouth, but even the topical cream version has been shown to be effective in children with alopecia areata.

And for melasma, the difficult to treat darkening of the skin, there was encouraging news. Tranexamic acid in pill and topical form along with a new agent reduce the pigment that is so resistant to treatment.

Progress is being made on nearly every front in our field!

Older woman's hands on keyboard, aging hands

What Can Be Done For Aging Hands?

Did you know that your hands can reveal your true age, well before other areas of the body begin show signs of aging? While aging of the hands typically begins by age 50, with the first signs being discoloration and age spots, hands can start to age sooner if individuals are frequently exposed to the sun without the proper protection. By age 50-60, people also tend to lose volume in their hands, making veins and tendons more prominent and further contributing to aging hands. The good news is there are treatments available that can slow or reverse some of the signs of aging hands. Treatments can be tailored to the individual, depending on their specific concern:

Age spots:

Pigment-specific lasers are used to treat dark brown spots on the hand by delivering a beam of light that penetrates the skin surface. Following treatment, brown spots appear darker for about a week and then will scab, fall off, and turn pink as the skin begins to heal. One to two treatments are usually needed before improvement is noted. Results can last for years as long as proper care is taken to avoid sun exposure to these areas.

Topical retinoids and bleaching creams, like hydroquinone, can also be used to diminish the appearance of dark spots. They can be used either alone, or in combination with lasers, to reduce the appearance of age spots.

Volume loss:

Injecting fillers into the back of the hand is a quick, in-office procedure that can be achieved by using a non-allergic product called calcium hydroxylapatite. Results are immediate and can last for 1-2 years.

Applying a lotion or cream after washing your hands helps to trap water in your skin, and can provide a temporary plumping effect.

Rough, scaly patches:

If you have fair skin and spent a lot of time in the sun, you may notice rough spots or patches on your hands. These rough patches may be actinic keratoses (AKs), which are pre-cancerous growths that need to be evaluated and treated by a dermatologist. Liquid nitrogen (cryotherapy) can treat the individual AKs, while topical medicated creams or photodynamic therapy can treat the entire area at once.

Wrinkly “crepey” skin:

Applying sunscreen to your hands every day can prevent wrinkly skin on your hands. To treat wrinkles that are already there, your dermatologist may recommend a lotion containing retinol or glycolic acid or light chemical peels.

Radiofrequency treatments, which use heat directed deep into the skin, can help tighten loose skin. Most people only need 2-3 treatments on their hands to see results.

Brittle nails:

Brittle, aging nails typically present as lines running lengthwise on your nails, appearing like ridges. You may also notice that your nails peel or break easily. Certain activities such as cleaning with harsh chemicals or spending a lot of time with wet hands, can cause brittle nails, so it is important to wear rubber gloves when cleaning and doing dishes.

It is also important to moisturize the hands regularly with a urea- or petrolatum-containing moisturizer, preferably after every hand washing and before bed.

The nails reflect overall health. Changes in nail color or shape can signify a systemic problem that should be evaluated by a dermatologist.

Follow up:

It is important to follow up with your dermatologist after your treatments to help maintain your results as long as possible. Sun protection is essential at all times, and can be achieved by using a broad spectrum water-resistant sunscreen with SPF 30 or higher and reapplying regularly throughout the day. UV-protective driving gloves are also helpful in blocking out the sun’s harmful rays.

References:

American Academy of Dermatology. “What can make my hands look younger?” Available online at: https://www.aad.org/public/skin-hair-nails/anti-aging-skin-care/younger-looking-hands

American Academy of Dermatology (August 2012). “Busy moms deserve a hand: Dermatologists offer tips to prevent premature aging of the hands.” Available online at: https://www.aad.org/media/news-releases/busy-moms-deserve-a-hand-dermatologists-offer-tips-to-prevent-premature-aging-of-the-hands

 

Frequently Asked Questions Regarding Infini Wrinkle Reduction

Infini is a technology developed for surgical scar improvement that can also enhance and rejuvenate aging skin, providing consistent results and low downtime.

One of the many benefits of Infini is that it can be used at any time of the year and on any skin. Infini does not directly affect the epidermis. It is a non-invasive procedure that addresses both post-operative scars and the skin laxity such as wrinkles and textural changes that are a consequence of sun exposure.

Q: What is this procedure good for?
A: Overall skin rejuvenation; fine lines and wrinkles, improving tone and textural changes- especially “crepey skin”, sagging skin, acne scarring

Q: What parts of the face/ neck can it improve?
A: Brows, crows feet, upper lip, neck and chest

Q: How does it work?
A: Energy delivered into the skin stimulates the natural growth of collagen and elastin—natural  “scaffolding.”

Q: Why is radio-frequency an important addition to microneedling?
A: The radio-frequency delivered via gold-plated microneedles is a powerful stimulant for new collagen production.

Q: What preparation is involved?
A: Application of a topical numbing cream in the office for approximately 2 hours

Q: How long is the procedure?
A: About 30 min

Q: What is the downtime?
A: There is redness and swelling for approximately 48 hours, which may take up to a week to resolve. Make-up may be applied after 48 hours

Q: How quickly will I see results?
A: It takes a few weeks to begin to see results. Improvement continues over a period of up to 6 months

Have questions or want to make an appointment at Dermatologic Surgery Center of Washington? Click here to contact us.

Back to School Rash

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

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

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

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

Symptoms of Hand, Foot and Mouth Disease

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

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

Transmission

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

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

Treatment for Hand, Foot and Mouth Disease

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

 

 

 

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

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