Skin Changes that Signal Heart Problems

By Laura Monaghan, PA-C

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

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

Changes in Skin that Signal Heart Issues

Swelling of Lower Extremities

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

Yellow Bumps Around Eyes

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

Fingers & Nails

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

Bumps and Lesions on Hands and Feet

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

Psoriasis

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

Signs of Cardiovascular Problems in Children

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

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

 

 

 

Sources: 

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

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

A New Purpose for an Old Hair Loss Therapy

By Kyleen Davis

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

About Hair Loss

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

Treatments for Hair Loss

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

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

New Type of Hair Loss Treatment

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

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

 

 

 

References

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

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

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

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

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

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

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

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

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

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

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

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

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

Seasonal Affective Disorder and Your Skin: Understanding the Connection

By Elena Hardy Allbritton, MD

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

What is Seasonal Affective Disorder (SAD)?

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

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

Symptoms of Seasonal Affective Disorder

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

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

Coping Strategies for Healthy Skin for People with SAD:

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

Grassroots Health Nutrient Research Institute

Conclusion

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

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

 

Resources for Further Reading

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

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

 

 

Sources

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

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

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

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

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

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

Excessive Sweating Cause and Treatments

Cause of Excessive Sweating

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

Who is Affected by Hyperhidrosis?

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

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

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

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

 

 

Sources:

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

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

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

How to Identify Poison Ivy and Treatments

By, Caroline Glick, PA-C

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

How to identify poison ivy

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

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

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

Click here to see what the rashes look like.

Treating exposure to poison ivy, oak, and sumac

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

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

 

 

Sources:

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

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

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.