What is Alopecia Areata and How to Treat It

By Laura Monaghan, PA, MMS

Do you or a loved one suffer from patches of non-scarring hair loss? This type of hair loss, known as alopecia areata (AA), is considered a chronic autoimmune disorder. It affects about 300,000 people in the US annually. AA severity can range from one singular patch of hair loss to complete baldness. Patients may also suffer from loss of eyebrow, eyelash, facial, and body hair. Beyond physical implications, AA can also have a significant negative impact on mental health. Hair is often linked to self-identity, especially for women. Research supports the fact that AA causes psychologic distress, which can manifest as personal, social, and work-related problems.

Treatment Options for Alopecia Areata

There are multiple approaches to treating alopecia areata. A common and relatively simple treatment is the administration of intralesional steroid injections every 4-6 weeks. Other therapies include topical or oral steroids, topical minoxidil, anthralin, and topical immunotherapy with Diphenylcyclopropenone (DPCP), dinitrochlorobenzene (DNCB) or squaric acid dibutyl ester (SADBE). While some patients see hair regrowth with these treatments, others have been left feeling frustrated by lack of response.

JAK Inhibators for Hair Loss Treatment

In June of this year, the first oral medication gained FDA approval for treatment of alopecia areata, Baricitinib (Olumiant). Baricitinib is a JAK inhibitor, a class of medications traditionally used for treating rheumatoid arthritis and certain blood disorders. Patients with these rheumatologic conditions incidentally noticed hair regrowth, and subsequent clinical trials supported the efficacy of JAK inhibitors for treating AA.

The promise of JAK inhibitors, however, is not without some risk. Because JAK inhibitors target multiple cellular signaling pathways involved in the immune system, they can increase the risk of serious infection, heart attack, stroke, blood clots, cancer, and death. Yet data for these adverse effects is from patients with rheumatoid arthritis; it is unclear if these warnings apply equally to patients with AA. As long-term data is collected, we will gain a better understanding of the impact of JAK inhibitors on the AA population.

Given the demand for more effective AA treatment, two additional JAK inhibitors are expected to gain FDA approval in the near future. These exciting developments bring hope for patients suffering with alopecia areata.

 

Contact us to make an appointment for a hair loss consultation with a dermatologist. We can help diagnose the type of hair loss and find a treatment that’s best for you.

How to Protect Yourself from Ticks

By Laura Monaghan, PA, MMS

Summer is in full force, which means increased time outdoors and traveling for vacation. Whether this includes more backyard time with the family, hiking in Appalachia, or relaxing outside the lake house, increased outdoor time also means increased exposure to ticks and the diseases they carry. The most common tickborne illness in the U.S. is Lyme Disease. So just what are its implications?

Signs of Lyme Disease

Lyme Disease is traditionally associated with a bull’s-eye rash known as erythema migrans. Other common symptoms include a headache, fever, and fatigue. Lyme disease can also lead to more serious health problems such as heart disease, nervous system dysfunction, and joint disorders.

Lyme Disease Prevention

A previous Lyme Disease vaccine was available in the US from 1998-2002. However, it was voluntarily discontinued in 2002 due to low demand, perceived safety concerns, and weak Centers for Disease Control (CDC) and Advisory Committee on Immunization Practices (ACIP) recommendations. There are lessons to be learned from this failure. The success of a new vaccine will require a combined effort among the CDC and ACIP, healthcare providers, insurance companies, and government officials to generate adequate demand.

Today, there is a Lyme Disease vaccine developed by Pfizer and Valneva entering phase 3 human trials. This vaccine targets the bacteria’s outer surface protein (OspA) to inhibit its ability to leave the tick and infect humans. Phase 2 trials showed maximal efficacy of a three-dose regimen, with the second and third doses following the first after two and six months. Given that no vaccine-related serious adverse events have been observed, the vaccine passes safety and tolerability measures at this point. Looking ahead, this new vaccine could be seen as early as 2025.

Keep in mind that even in urban areas, ticks are active and prevalent in the summer months.

To lower the chance of tick exposure the CDC recommends:

  1. Apply products that contain permethrin 0.5% to clothing, shoes and camping gear. Apply in areas that are well ventilated; the repellant remains protective through several washings.
  2. Use EPA registered insect repellants containing DEET, picaridin, IR3535, Oil of Lemon Eucalyptus (OLE) para-menthane-diol (PMD) or 2-undecanona. Do not use products containing OLE or PMD on children under 3.
  3. Walk in the center of trails and avoid wooded areas with high grass.
  4. Check yourself  and clothing for ticks. Look under the arms, in and around ears, belly button, back of knees, between lets, around waist and in and around hair.
  5. Shower within 2 hours of coming indoors.
  6. Wash clothing in hot water. Tumble dry clothes in a dryer on high heat for 10 minutes will also kill ticks. Cold and medium temperature water will not kill ticks.

If you do find a tick, follow the CDC Guide for Tick Removal: https://www.cdc.gov/ticks/removing_a_tick.html

You can enjoy the outdoors. But be sure to take some care to identify uninvited guests on your body and clothing to reduce the likelihood of coming in contact with Lyme Disease!

 

 

Sources:

Gomes-Solecki, M., Arnaboldi, P. M., Backenson, P. B., Benach, J. L., Cooper, C. L., Dattwyler, R. J., Diuk-Wasser, M., Fikrig, E., Hovius, J. W., Laegreid, W., Lundberg, U., Marconi, R. T., Marques, A. R., Molloy, P., Narasimhan, S., Pal, U., Pedra, J., Plotkin, S., Rock, D. L., Rosa, P., … Schutzer, S. E. (2020). Protective Immunity and New Vaccines for Lyme Disease. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 70(8), 1768–1773. https://doi.org/10.1093/cid/ciz872

Shen, A. K., Mead, P. S., & Beard, C. B. (2011, February 1). Lyme disease vaccine-A public health perspective. Infectious Disease Society of America. Retrieved July 13, 2022, from https://academic.oup.com/cid/article/52/suppl_3/s247/444695

U.S. Department of Health & Human Services. (2022, May 13). \ Tick removal. Centers for Disease Control and Prevention. Retrieved July 13, 2022, from https://www.cdc.gov/ticks/removing_a_tick.html

U.S. Department of Health & Human Services. (2022, May 13). Tick Bite Prevention: Centers for Disease Control and Prevention U.S. Department of Health & Human Services. HTTPs: //www.cdc.gov/ticks/avoid/on_people.html

Post-COVID Hair Loss

Post-COVID Hair Loss

Post-COVID hair loss? It’s very much real.

Post-COVID Hair Loss

Did you have an uninvited holiday guest named COVID this year? If so, you’re not alone. Given the extraordinarily high levels of the Coronavirus in the Washington, DC area, nearly everyone had COVID or knew someone who did. As our vaccination and booster rate is very high, most people emerged with minimal or moderate symptoms.

Post-COVID Condition: Hair Loss

Even with only a mild COVID infection, however, it’s common to experience post-COVID conditions, such as hair loss. The phenomenon called telogen effluvium is not limited to COVID infections but can occur 2-3 months after any severe illness, high fever, surgery, or child birth, to name a few.

Why Does Post-COVID Hair Loss Occur?

It’s not completely understood, but the physical or psychological stress can induce hair follicles to prematurely move into the telogen or resting phase.

Normally 90% of scalp hair is in the growth or anagen phase, which lasts 2-6 years. The hair then regresses and stops growing. Approximately 1% of hair is in this regressing or catagen phase. In acute telogen effluvium, a larger than normal percentage of hairs move to the resting phase and are lost “at the root” with a club visible on the end. More than 100-150 hairs may be lost each day. Up to 50% of the scalp hairs may be affected but complete hair loss does not occur. The hair does grow back, but it may take 6-12 months.

If there is itching, scaling skin or pustules, it is likely that the hair loss is attributable to another cause and it’s important to be evaluated. Telogen effluvium can also sometimes unmask other conditions such as androgenetic or hereditary hair loss and can co-exist with other types of alopecia.

Treatments for Post-COVID Hair Loss

Telogen effluvium doesn’t usually require treatment, although there are some topical and oral regimens that may accelerate regrowth. Don’t be alarmed if you have some shedding 2- 3 months after an episode of COVID, but if the shedding is associated with other changes in your scalp or does not seem to be resolving, schedule a consultation with a dermatologist.

Contact us to schedule and appointment.

PRP Therapy for Hair Loss

PRP Treatment for Hair Loss

“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

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.

face mask skin care tips

Wearing a Mask and Caring for Your Face

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.

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.

 

Shop hair care products now on our online shop.

 

 

 

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.
  • Send photos.
    • Prior to your telemedicine visit, it can be very helpful to share with us photos you have taken since the onset of your symptoms, especially those delineating the progression of rashes on subsequent days, as well as any showing before and after treatments applied.
    • Please contact our Front Desk Team at Front.Desk@Mohs-MD.com, to find out how to share your photos securely.
    • Take a close up and a distant photo, if possible. Here are some photography tips for patients.

To make an appointment, 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.