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CBD (cannabidiol) is a compound present in the marijuana plant, Cannabis sativa. Unlike, THC (tetrahydrocannabinol), it doesn’t have psychoactive effects. CBD is most commonly ingested but is also available in topical products such as lotions and balms. While the alleged benefits of CBD include control of seizures, relief from pain, depression, anxiety, migraine, among others, only one drug containing CBD has been approved by the FDA to treat rare forms of childhood seizures.Recent research has looked at cannabinoids for the treatment of various skin conditions including psoriasis, eczema, and wound healing. The most promising benefits have been found in the treatment of itch. Clinical studies have shown a reduction in itching for several dermatologic and internal conditions. These preliminary results support the need for controlled trials to confirm these benefits and standardize formulations and treatment regimens. Many CBD-containing topical products are available but their ingredients and efficacy haven’t been validated by the FDA since they aren’t currently regulated as drugs. Hopefully, this will change in the near future. In the meantime, CBD products might be considered in situations where conventional treatments have failed.

Life can be stressful and this past year has been uniquely challenging. The COVID pandemic has caused widespread illness and loss, social isolation, and economic devastation. Our country is deeply divided politically and struggling to deal with social/racial injustice. There is growing evidence that psychological stress aggravates many common skin conditions. Some inflammatory skin conditions known to be affected by stress include psoriasis, rosacea, acne, and atopic dermatitis (eczema). The degree to which stress plays a provocative role varies by condition. For example, it is a factor in virtually 100% of patients with hyperhidrosis (excessive sweating) while in 0% in patients with skin cancers. Embryologically, the skin and brain originate from the same tissue, the ectoderm. While the exact mechanisms haven’t been worked out, research has revealed a brain-skin connection involving a complex interplay of neurological, hormonal, and immune systems. The bottom line is that stress may increase inflammation through the release of cytokines, proteins that are important in our immune responses in health and disease.If you are experiencing stress and have a skin condition that is flaring, contact your dermatologist to discuss treatment strategies.

We are at war with the COVID-19 virus. Approximately 350,000 Americans have died as a result of illness from this scourge since the pandemic began. By comparison, approximately 420,000 servicemen and women lost their lives during WWII and 58,000 during the Vietnam War. Data strongly supports simple protective measures including wearing masks/face coverings in public, avoiding crowds, frequent hand washing and use of hand sanitizers. It’s a remarkable feat of science and technology that 9 months since the pandemic began, 2 safe and effective FDA-approved vaccines (Pizer/Biontec and Moderna) are being disseminated and several million Americans have received their first doses. Unfortunately, surveys have indicated that a significant percentage of the population is unwilling to take the vaccine. For those with safety concerns, please check the CDC’s website www.cdc.gov for detailed information that addresses this issue. I also suggest reading a short editorial by Kerry Kennedy Meltzer, M.D., an internal medicine resident at New York Presbyterian Hospital that was published last week: https://www.nytimes.com/2020/12/30/opinion/covid-vaccine-bobby-kennedy.htmlRecent reports of rare, facial/lip swelling (3 out of 15,184 participants) noted in the Moderna vaccine trial in participants who previously received fillers should not be a contraindication to vaccination. It appears the virus will be around for a while but we can defeat it. THE COVID VACCINES ARE SAFE AND EFFECTIVE. UNLESS YOU HAVE A MEDICAL CONTRAINDICATION, PLEASE GET VACCINATED AS SOON AS ONE BECOMES AVAILABLE TO YOU.

Interactions with physicians via video conferencing and by phone with evaluation of photos have been gaining momentum for years. These type of virtual visits, known as telemedicine, have grown significantly during the pandemic. They allow people with concerns about going out in public and those with underlying conditions that put them at high risk for serious illness if they became infected with COVID, to be evaluated by their physician. It also allows for more regular follow up, eliminates the time for driving round trip to the office, parking cost, and wait time to see your doctor. There are, however, limitations to the kind of issues that can be addressed. Procedures such as biopsies, surgeries, freezing of skin lesions, (at least for now) require an office visit. In dermatology, telemedicine works best for following chronic skin conditions, such as acne, rosacea, eczema, and psoriasis. While individual skin lesions can be evaluated, a full skin exam requires an office visit.To schedule a telemedicine appointment with your dermatologist please call 310-274-9954 or initiate your telemedicine consultation through your patient portal derm90210.ema.md. If you don’t have access to your portal please call the phone number listed above for assistance.

While wearing masks in public are critically important to prevent the spread of the coronavirus, they can also induce or aggravate various skin conditions including acne “maskne”, rosacea, eczema, and irritation dermatitis.Fortunately, there are simple measures one can take to treat these conditions:

1. For sensitive, easily irritated skin, wash with a gentle, fragrance free cleanser and apply a moisturizer immediately after washing. Ideally, the moisturizer should contain one or more of the following ingredients: ceramides, hyaluronic acid, dimethicone. It’s a good idea to use non-comedogenic moisturizers, especially if you have acne-prone skin. You can choose between gels, lotions, and creams (lighter to heavier respectively) based on whether your skin is oily, normal, or dry.
2. If your skin is irritated, avoid chemical peels, exfoliants including salicylic acid, and retinoids that can exacerbate dry skin.
3. Wear the correct mask the correct way. Two layers of a breathable material such as cotton is best. Avoid synthetics. Masks should be snug but comfortable. If the mask fits too tight or too loose it’s more likely to cause irritation.
4. Remove your mask for 15 minutes periodically when in a safe place.
5. Have a supply of masks to rotate wearing and wash masks after each use according to instructions. Use a fragrance-free hypoallergenic laundry detergent.
6. If you have or develop acne, avoid wearing makeup. If necessary, use only products that are non-comedogenic (won’t clog pores). Continue the treatment plan from your dermatologist.
7. For more information regarding selecting masks visit CDC.gov/coronavirus.

The COVID Pandemic has forced closure of indoor gyms and pushed those who crave regular exercise to shift to other options. Fortunately, Southern California is an ideal location for year round outdoor activities (air quality allowing) such as walking, hiking, and running. It’s not unusual, however, for enthusiasts to develop certain skin conditions. Some of the most common include:

1. 1. Blisters may develop on the feet due to excessive friction. Risks factors include poorly fitting shoes, heat, moisture, and overdoing it. Blisters can be prevented with proper fitting shoes, wearing moisturizer wicking sports socks, use of topical antiperspirants, and bandages at pressure points.
   2. Jogger’s nipples occur secondary to chaffing in men who wear shirts made of coarse fabrics and women who run without a bra. This painful condition can be prevented by silk or other soft fiber shirts and use of topical antibiotic ointment, petroleum jelly, or patches while running to prevent rubbing/irritation.
   3. Jogger’s toe is a blue black discoloration typically found on the longest toe/toenail. This manifestation of repeated trauma is especially common in those who run downhill. It’s prevented by wearing proper fitting shoes and trimming toenails short.
   4. Talon noir is blue black discoloration of the heel and is cause by repetitive shearing forces on the heel leading to damage of the underlying capillaries. This, too, can be prevented by wearing proper fitting shoes and cushioned socks.
   5. Athlete’s foot (tinea pedis) and fungal infection of the toenail (onychomycosis) are more common in active individuals. Predisposing factors include trauma, occlusion, sweating (all occur to varying degrees while exercising while wearing shoes), and use of communal showers. Prevention includes well ventilated shoes and socks, removing shoes and socks promptly following exercise, wearing sandals in showers and other communal areas.
   6. Sun burn and skin cancer risk are elevated with increased exposure to UV radiation from the sun. The cumulative amount of UV exposure in a lifetime increases the risk for basal cell carcinoma, squamous cell carcinoma, and melanoma. Exercising early or late in the day, application of broad spectrum sunscreen with minimum SPF 30, wearing sun protective clothing, hats, and sunglasses can significantly reduce risk.

Recent studies have shown that diet can affect certain skin conditions such as acne and rosacea. There is now some evidence that aging of the skin can be slowed with a healthy diet. For example, a diet rich in vegetables, fish, foods with high vitamin C content, carotenoids, and olive oil are associated with decreased wrinkles. A Dutch population-based study published in the Journal of the American Academy of Dermatology last year looked at the association of a diet and facial wrinkles in an elderly population. The diet included daily consumption of at least 200 grams (approximately 7 ounces) of vegetables, at least 200 grams of fruit, 90 grams of brown bread, wholemeal bread, or other whole grain products, and at least 15 grams (0.5 ounces) of unsalted nuts. Also, one serving of fish per week, and little to no dairy, alcohol, red meat, cooking fats, and sugar were recommended. The study found that better adherence to the diet was associated with fewer wrinkles in women but not men. Women who ate more animal meat, fats, and carbohydrates had more wrinkles than those on a fruit-dominant diet.Various mechanisms including oxidative stress and elevated skin and gut inflammation caused by an unhealthy diet may lead to increased wrinkle formation. On the other hand, the nutrients in fruits and vegetables stimulate collagen repair and reduce oxidative stress on the skin. In addition to a healthy diet, measures that reduce ultraviolet exposure from the sun including minimizing mid-day sun exposure, applying sunscreen with a minimum SPF of 30, and wearing sun-protective clothing, hats, and sunglasses are essential to minimizing wrinkles and reducing one's risk of developing skin cancers.

The skin is our largest organ and has many important functions including regulating body temperature, acting as a barrier and preventing harmful microorganisms and toxins form getting inside the body. The first layer of skin is called the epidermis. The top layer of the epidermis is called the stratum corneum which consists of flat, dead protein filled cells mixed with fat and water to create a brick and mortar like structure. This layer is responsible for retaining moisture and protects us from toxins, bacteria, and ultraviolet rays. Unfortunately, our skin weakens and becomes thinner as we age. Older skin has less water content, less fat and elasticity. Sun exposure and certain medications, such as steroids (topical, oral and inhaled) can also adversely affect the integrity of the skin. Soap and solvents including alcohol can dry and damage the skin by stripping away fats. We are all washing and cleansing our hands more now because of the COVID Pandemic which can cause the skin of our hands to be dryer with cracks and tears. While COVID isn’t contracted through the skin, certain bacteria can cause infections requiring antibiotics and occasionally hospitalization. The simple remedy is to apply the right type of moisturizer regularly. The best moisturizers have three main components to help restore the skin’s integrity including:

• Occlusives for barriers to limit water loss from the stratum corneum (eg: petrolatum, mineral oil, lanolin)
• Emollients provide softness and smooth texture (eg: dimethicone, cyclomethicone, jojoba oil)
• Humectants promote water absorption from the dermis and environment into the stratum corneum ( eg glycerin, hyaluronic acid, sodium and ammonium lactate)

Moisturizer ingredients are listed in decreasing order of concentration on the product package. The items noted above should be present within the first 5 ingredients. Other valuable ingredients include various fats, anti-oxidants, and sunscreens. Fortunately, there are many reasonably priced OTC moisturizers available from reputable companies. Finally, drinking excessive amounts of water doesn’t help to hydrate the skin!

Many patients ask if taking a vitamin or supplement would be beneficial for their skin condition. Vitamins and supplements aren’t regulated in the same way as prescription medications by the Food and Drug Administration (FDA) and can be marketed without undergoing rigorous assessment. A recent review article in the Journal of the American Academy of Dermatology found overall, very few dietary supplements had been evaluated in largescale randomized clinical trials. Safety and efficacy evidence were limited.Few adverse events were recorded for any supplement, making safety analyses difficult. In addition, the lack of standardized dosing across trials prevented any pooled statistical analyses to demonstrate benefit. While some studies support the use of nicotinamide to prevent nonmelanoma skin cancers and precancerous actinic keratoses, further studies are needed to support the use of zinc, biotin, vitamin D, and polypodium.If you have questions about the use of supplements to treat or prevent skin conditions please schedule an appointment to speak to your dermatologist.