Resources

Sensitive, dry, flaky skin is common, particularly in mature individuals. These findings are signs of a disrupted skin barrier. Skin barrier dysfunction also appears to play a role in certain conditions including rosacea, eczema, psoriasis and acne. Many factors come into play including genetics, environment, and skin care products. The skin barrier contains the acid mantle, the protective film of natural oils, amino acids and sweat that covers your skin.Skin grows more alkaline as we age, activating enzymes that break down collagen. Barrier problems are exacerbated by damage from too much scrubbing or alkaline washes. Frequent applications of salicylic, glycolic and/or lactic acid containing products and physical damage from overuse of scrubs and abrasive procedures (eg microdermabrasion) can also play a role.The solution? Reduce the frequency of abrasive procedures (weekly or less for normal to dry skin and 3 times weekly for oily skin). Avoid using multiple products and especially alkaline cleansers with a pH greater than 7(most super-foamy and lathery face washes). Apply moisturizers after cleansing that contain ingredients such as ceramides, glycerin, petrolatum, and hyaluronic acid that help repair the skin barrier and retain moisture.

There is research that has demonstrated an increased risk of developing melanoma in people who regularly drink alcohol. While the mechanism for this isn’t clear, alcohol consumption increases an individual’s likelihood of getting sunburned, a risk factor for skin cancer. While, those who drink may spend more time in the sun and be less likely to apply/reapply sunscreen, there appear to be other factors involved. A recent study of men from Germany demonstrated that after drinking alcohol, the amount of UV light it took to burn the skin was significantly less.The researchers also measured the concentration of carotenoids in the study participants' bodies. Carotenoids are the yellow, orange and red pigments that are produced by plants. When we consume carotenoids from fruits and vegetables, these pigments exert an antioxidant effect in our bodies that may help protect against the damage done by the UV light. In the study, the men's carotenoid levels were lower after they consumed alcohol, so the researchers speculate that this decline in antioxidants may make the skin more vulnerable to the adverse effects of the sun.More research is needed but it appears that the increased tendency to sunburn when drinking alcohol is a contributing factor to developing skin cancer. The bottom line is: moderate drinking and minimize sun exposure.

Solar purpura (SP) aka, senile purpura, actinic purpura are flat, purple marks that develop suddenly, typically on the hands and forearms of elderly people. While scary looking, they are nothing more than bruising due to thinning of the skin and fragility of blood vessels.SP often develops with little or no known injury to the affected skin. The lesions may occur with open wounds that can be uncomfortable and may become infected requiring treatment with an antibiotic. Predisposing factors include sun exposure, prolonged use of topical steroid creams or oral steroids, and ingestion of blood thinning agents such as aspirin, clopidogrel (Plavix), warfarin (Coumadin), apixaban (Eliquis), and dabigatran etexilate (Pradaxa), NSAIDs, such as ibuprofen and naproxen, and certain supplements, such as fish oils.Preventative measures include sun protection (broad spectrum sun screen with minimal SPF 30 and clothing), avoidance of trauma and unnecessary blood thinning agents. Men’s tube socks with the feet cut off at the ankle can provide a layer of protection when around the house. Proven treatment options don’t exist but topical agents containing arnica and bromelain might be of some benefit. The lesions generally take several weeks to spontaneously resolve but may leave a residual brown stain.

There is growing concern regarding potential adverse health and environmental impact of certain chemicals in sunscreens, oxybenzone in particular. In addition, a small pilot study published in the Journal of the American Medical Association found certain sunscreen chemicals were detected in the blood of study participants.While there is no evidence that this causes harm, “The FDA is asking for more data on certain ingredients to find out to what extent the skin absorbs these ingredients and if absorbing sunscreen has any effects on the skin or body. This does not mean that the FDA is expressing concern about sunscreen ingredients, nor have they concluded that any of the sunscreen ingredients sold in the U.S. are unsafe.” Henry W. Lim, a former president of the American Academy of Dermatology, said, “What we do know is that all these (sunscreens) have been used for decades in the U.S. And, thus far, there have been no reported data of systemic, internal side effects from the use of sunscreen.The FDA has determined that the mineral based sunscreens containing titanium dioxide and zinc oxide are generally recognized as safe and effective (GRASE) in protecting the skin from the sun,” Skin cancer is the most common cancer in the United States, and dermatologists see the impact it has on patients’ lives every day. Unprotected exposure to the sun’s ultraviolet rays is a major risk factor for skin cancer, including melanoma, the deadliest form.The AAD encourages the public to continue to protect themselves from the sun by seeking shade; wearing protective clothing, including a lightweight, long-sleeved shirt, pants, a wide-brimmed hat and sunglasses; and generously applying a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher to exposed skin. Please discuss any questions or concerns you have regarding sunscreens with your dermatologist.

In a previous blog (September 2014) we discussed Actinic Keratoses (AKs) as an indicator of sun damage and a precursor to skin cancer. Since then, there is more data demonstrating an increased risk of developing Squamous Cell Carcinomas and Basal Cell Carcinomas in individuals with multiple AKs.Fortunately, various treatment modalities exist to treat AKs including cryotherapy “freezing”, topical anti-cancer creams, and photodynamic therapy “PDT.” These and other modalities are sometimes used in combination treatments to combat this precancerous condition.In addition to treatment, preventative measures including minimizing sun exposure, daily use of a broad spectrum sunscreen with minimum SPF 30, wearing hats, protective clothing, and UV protected sunglasses are key.

We reported on the use of vitamin B3 (nicotinamide) for the prevention of non melanoma skin cancer in our June 2015 blog. A recent review article supports the use of vitamin B3 for prevention of non melanoma skin cancer in high risk patients, defined as those who have had at least 2 non melanoma skin cancers in the past 5 years. Nicotinamide offers various photoprotective and anti-inflammatory effects, and may be able to protect against ultraviolet light induced immune suppression.The vitamin has little to no side effects in people with normal kidney function. If you think you might benefit from this vitamin, please schedule an appointment to discuss with your dermatologist.

Can regular periodic treatment with medications like Botox and Dysport really prevent wrinkles?Some facial lines, including those on the forehead and around the eyes, are enhanced by repeated facial expressions. These lines may be evident even when the face is at rest.Injections of Botox or Dysport relax the muscles involved to minimize the lines from getting as deep. Identical twin studies comparing a twin who has been treated regularly to her untreated twin confirm this.

Winter is the perfect time to give your toenails a break from nail polish. After months of continuous polish, nails can dry out, leaving white rough patches on the surface.While some white patches may be a superficial fungal infection, nail polish can strip nails and cause keratin granules (the nail protein) to clump on nails.The good news is that leaving polish off for a few weeks and applying oil to nails will fix this, leaving them ready for spring sandals.

Psoriasis has been around since antiquity. In fact, many people throughout history (and in the Bible) described with leprosy may have really had psoriasis. Psoriasis may also affect the joints leading to a crippling arthritis and has been associated with an increased risk for other medical conditions including type 2 diabetes and coronary artery disease.For years, dermatologists relied on topical treatments many of which were messy and not that effective. Various forms of ultraviolet phototherapy can be beneficial for those with more widespread disease. Some systemic chemotherapy agents are also used but have a higher risk of serious side effects. We now have a whole new array of biologic treatments for psoriasis and psoriatic arthritis, which work by targeting over-active immune factors causing psoriasis. If you have been dealing with moderate to severe psoriasis, be sure to ask your dermatologist about these new treatment options.