Surgeon General finally warns about Skin Cancer

Look how the sun hits your body while swimming and playing...

Look how the sun hits your body while swimming and playing…

This past Tuesday, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.

Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society,  more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.

“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said Acting Surgeon General Boris D. Lushniak, MD, MPH.

I say this all the time, but it bears repeating as often as possible:

“Most skin cancer is 100 percent preventable.” 

Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer,  basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps and the U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,

“Tanned skin is damaged skin.”

According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.

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How many times have you gotten a bad sunburn?

Reduce your risk of skin cancer for yourself and your children:

-Jodi, proud owner of a lily white complexion.

UV rays and location, location, location…

Question:  Is it true that the sun’s UV rays are stronger in the South?

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That big line on the globe is the equator – Do you live near it on either side?

Answer: Yes, this is true. The closer your location is  to the equator (the line that is equally distant from the South Pole and the North Pole which also separates the Northern Hemisphere from the Southern Hemisphere on a map or globe), the more potent the sun’s rays. This is because they hit the earth more directly for a greater part of the year which accounts for the higher skin cancer rates in  “sun belt” locations. People who live or vacation in the Southern United States  or in Central and parts of South America and Africa should be especially aware and diligant of the need for sunscreen, hats and protective clothing and eye glasses whenever outside.

You may see lots of tanner people in these locations and that’s because they are exposed so much more to the UV rays from the sun. Remember, there is no such thing as a healthy tan (no matter what society would lead us to believe) because tanning is the skin’s response to the sun’s damaging rays.

If you’re unsure how close you are to the equator, check this global equator map.

-Jodi

Want to be 25% less likely to get age spots?

Well, I’ve been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin’s natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, “Sunscreen and Prevention of Skin Aging,” has proven this to be true.

shutterstock_124869277Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients:

“If you want to keep spots and wrinkles at bay,  use sunscreen every day.”

Initially, the researchers weren’t sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both.

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned.

The sunscreen use findings:

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group.

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun’s rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes!

-Jodi

What moms must know about teens and indoor tanning

We now know that intense UVA exposure causes dangerous types of skin cancer and that the earlier the use, the higher the risk of melanoma

Question:  My teenage daughters love using tanning beds, especially now that its winter. Tell me once and for all, is this a dangerous practice leading to skin cancer or a safe way to get some color? I’ve read conflicting reports online…

Answer:  Did you know that 36 states currently restrict indoor tanning use by minors, and in October, 2011 California became the first state  to prohibit the use of indoor tanning devices for all children and adolescents under the age of 18? Also, in 2011, the American Academy of Pediatrics called for a ban on youth tanning and the American Academy of Dermatology  supports this ban. As a mom and a dermatology practitioner knowing what I know and seeing what I see every day in the office, I support this ban. But when teens want to do something its hard to persuade them of future danger as a reason not to do it…in this case, indoor tanning. You can only tell them the truth.

The use of tanning bed safety has been in debate since the first tanning bed came into use in the 1980’s. Since then there has been much research into the types of Ultraviolet (UV) rays emitted by tanning beds, in what concentrations as well as how they cause skin cell DNA mutations that lead to cancer. Currently, approximately 90 percent of all skin cancers are associated with exposure to UV radiation mostly from the sun.

But, in 2009, a group of 20 scientists from around the world convened for the International Agency for Research on Cancer (IARC), part of the World Health Organization, and added UV radiation from tanning beds to the IARC’s Group I list of the most carcinogenic (cancer-causing) forms of radiation.

The reason for the debate on tanning bed safety is that tanning devices use fluorescent lamps which emit mostly UVA rays (UVB rays represent less than 5 percent of the lamp’s output) to induce a quick tan. And, by the end of the 1980’s, scientists had documented the carcinogenic properties of UVB rays: That they caused pre-cancerous DNA cell mutations in skin, triggered growth of squamous cell carcinomas in rodents and that UVB rays were the primary cause of sunburn.  There was no proof yet of any link between UVA exposure and skin cancer. With only a low amount of UVB emitted from a tanning bed, tanning salons could argue that tanning bed use was safe (or even safer than outdoor sun exposure) when obtained in a salon.

Since then, data has mounted and strengthened the evidence for a causal relationship between high doses of UVA exposure, indoor tanning and skin cancer, especially melanoma of the skin and eyes.  Be wary of any safety or health claims made by indoor tanning salons, the American Suntanning Association or the Indoor Tanning Association:

  • No scientific evidence supports a claim of a protective effect from tanning bed use against future sun damage (getting a “base tan”), as you may have heard.
  • There is no such thing as a “safe” tan because a tan, and especially a sunburn, is skin’s reaction to damage caused by UV radiation (whether from the sun or a tanning bed) and it causes DNA changes in the skin cells.
  • The tanning industry jumped all over the news that Vitamin D from sun exposure is necessary for health, and that it was safer to get that Vitamin D from a tanning salon rather than outdoors. It is not.

Here are 5 strong findings from June 2009 IARC monograph that put tanning beds in the classification of most carcinogenic forms of radiation:

  1. UVA causes similar but deeper skin damage: The cancer-causing mechanisms of UVB differ, but often overlap those of UVA rays. Sun exposure causes a specific cell mutation pattern that was thought to be caused by UVB rays, but researchers have now tested and found the same pattern in the skin of UVA-exposed mice (the Tp53 gene of UVA or UVB-induced skin tumors of hairless mice and the TP53 gene in human actinic keratoses -precancerous sun spots- and malignant skin tumors). UVA rays actually penetrate the skin more deeply than UVB and can damage cells (including melanocytes, those that produce the skin pigment in a “tan”) deep in the dermis whereas UVB rays cause damage to the epidermis, skin’s outermost layer.  UVB rays cause DNA mutations directly and UVA rays cause more indirect damage. For example, recent evidence found that the body’s repair and removal of damaged DNA is impaired when caused by UVA rays.
  2. Time span of  tanning bed use increases melanoma risk: Experiments in human volunteers show that tanning lamps produce the types of skin DNA damage associated with sun exposure but that the excess UV exposure in the stronger tanning beds used more often than routine sun exposure, over time, can weaken the immune system and increase vulnerability to cancer and other diseases.
  3. Intensity of  tanning beds increases melanoma risk:  We now know  that tanning bed units may be 10-15 times stronger than midday sunlight on the Mediterranean Sea, which subjects indoor tanners to UVA doses above those experienced during daily life or even when specifically tanning or active outdoors. Reviews of epidemiological (specific population) studies provide strong evidence that the intermittent, intense sun exposure (the type from outdoor weekend activities or sunny vacations) which leads to sunburn, is the main environmental risk factor for melanoma (the most dangerous form of spreading skin cancer) and that this pattern of over-exposure is simulated by indoor tanning bed use designed to induce a quick tan.
  4. Youth tanning bed use increases melanoma risk: Tanning beds have greater potential to cause melanoma at younger ages than even chronic sun exposure. Currently, 30 million people tan indoors every year in the U.S. and 2.3 million of them are teenagers, like yours. Also, melanoma is now the most common form of cancer for young adults aged  25-29. Although epidemiological studies have not consistently shown that tanning bed use is always a risk factor for melanoma that starts in the skin, a 2006 IARC meta-analysis (review of many studies) found a significant increase in melanoma risk (40-228% increase) when indoor tanning bed use started as a teen or young adult. An overall 75% increase in melanoma risk was found when indoor tanning bed use began before age 35.
  5. Not just skin cancer, but dangerous eye cancer, too:  Even scarier, 4 case-controlled studies consistently reported an increased risk for ocular (eye) melanoma with a clear causal relationship among indoor UV tanners and an even greater risk for subjects who started indoor tanning before age 20. Eye cancer is a risk even with goggle use because the rays can get in around the goggles.

All the recent research on UV rays substantiated a role for both UVA and UVB in human skin cancer development and especially melanoma, the most dangerous form of cancer that starts in the skin and can spread. So, the entire UV spectrum and UV-emitting tanning devices were classified as carcinogenic to humans.

It’s true that teenagers think they are impervious to danger. But at least you can provide them with the current scientific facts…and a reason to check their bodies for any suspicious, new or changing freckles, moles or scabs or spots that could be pre-cancerous or more.

If anyone has found a way to get their teens to stop indoor tanning, please share it here!

Does minoxidil cause facial wrinkles?

Question: I have been using Rogaine for 6 months and I have recently noticed several deep wrinkles forming under my eyes, specifically the side I sleep on.  I know there are some testimonies on the internet and on Wikipedia about minoxidil causing collagen depletion so I’m wondering if this is true or just an internet rumor?

Answer:  So, I dug down to the research for your answer. Minoxidil has been shown in cell culture (outside of the body, also called, in vitro) studies to have range of inhibitory effects on skin fibroblasts (a type of cell that produces collagen). It has also been reported that minoxidil hinders collagen synthesis and inhibits the effects of specific growth factors, substances that are capable of stimulating cellular growth, in cultured hair dermal papilla of rats (yes, rats, not humans!) But applying these results obtained in cell culture studies or rats to the use of minoxidil in humans is uncertain.

There are no human studies demonstrating that minoxidil causes collagen depletion or wrinkles as a side effect (and there are many studies of minoxidil effects on humans). Even though there are anecdotal reports online stating this, minoxidil has been used for over 25 years and there are no real complaints or published reports in clinical practice (with patients).

You are smart to ask a professional when faced with internet rumors, especially when it comes health issues, because side effects of medications and even over-the-counter products are largely personal. Also, facial wrinkles are known to form in response to repetitive muscle movements such as facial expressions and patterns over time, such as the side you sleep on. A good idea would be to schedule an appointment with a dermatological practitioner to review your age, medical history, lifestyle (such as sun exposure) and skin and hair loss condition as well as your usage of minoxidil to see if any alterations (a weaker percentage or foam instead of liquid) or additions to your treatment plan need to made.

 

Dry eye relief

Help for dry eyes is just a "blink" away

Suffer from dry eyes? There is help! See below for some useful tips:

Artificial Tears are beneficial for the  stinging or burning associated with dry eyes. Made of ingredients that temporarily restore moisture to eyes (e.g., glycerin and oils), you can use one or two drops in each eye when they feel uncomfortable.

 

If you need to use more than 3 or 4 times a day, see your ophthalmologist; and if you use drops frequently, try switching to preservative-free drops.

Omega 3’s help reduce the inflammation that can contribute to dry-eye syndrome (DES). Studies have shown that patients who take daily supplements of omega-3 fish-oil supplements plus flaxseed oil produce more tears. You can increase your intake byadding a few servings of salmon to your weekly diet or by taking fish-oil and flaxseed supplements after discussing them with your practitioner.

There are prescription medications for treating chronic DES. Restasis® is a prescription eye drop that contains cyclosporine, which can help increase natural tear production. Use it twice a day as directed by your ophthalmologist.

Warm Compresses are helpful for when your eyes just don’t have enough tears! Tears are your eyes’ lubrication and are made up of water and oil. The oil is produced by glands along the eyelid; if the cells in the glands harden and the openings of the glands become plugged, the oil in the tears may be reduced. Without the oil, the water in tears evaporates too quickly, leaving your eyes feeling dry. Warm compresses can liquefy the plugs so the oil can flow into the tears.

Eyelid Washes are helpful when dry eyes have accompanying flaking along the eyelids (a sign of blepharitis–“dandruff” and inflammation of the eyelash follicles). Because of the overproduction of oil (the same concept as dandruff on the scalp), cells near and around the eyelids stick together, causing inflammation. Too much oil can clog the glands and cause tears to evaporate too rapidly. An OTC eye wash contains mild cleansing agents to dissolve the oil and remove the flakes (as well as irritants and allergens). If the symptoms persist for more than 2-3 days, see an ophthalmologist.

Eye Inserts are a new treatment option that can be used when all other remedies fail. Available only by prescription, Lacrisert®ophthalmic inserts are tiny cellulose beads that you place within the pouch of your lower lids. These beads dissolve slowly and mix with your own tears and provide ongoing lubrication throughout the day. Use once or twice a day as directed by your ophthalmologist.

 – Jodi

Inaugural post … and croissants!

Wow…today is the inaugural blog…I don’t really know what to say. I guess, Welcome! Welcome to my blog! I will certainly try to give you my honest opinion, feedback and of course, answers to your skin care concerns and questions. Anything having to do with skin, hair and nails are up for grabs here…so ask away! Additionally, I will try and keep you up to date with the latest news and media reports on dermatology. I hope you enjoy it all!

BTW…today is National Croissant Day! In addition to being a skin care guru, I’m also a foodie. At our office, we love to celebrate anything having to do with food. No food holiday goes unnoticed!