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.

Too much sweat?

Question:  Is there such a thing as sweating too much? What can I do about it if I’m constantly soaking through my clothes? It’s so embarrassing, especially at work!

shutterstock_155697284Answer:   Yes, the condition definitely heats up during the summer months but can plague sufferers all year long with overly sweaty armpits, palms and even on soles of the feet. It  is called hyperhidrosis which just means “excessive sweating.”

Hyperhidrosis is simply abnormally heavy perspiration. Sweating is a normal bodily function, but some people may have overactive sweat glands that produce more sweat beyond what is required for regulation of body temperature. It can be most noticeable at the armpits because sweat can soak through clothing and become obviously embarrassing. Or you may also be aware your palms are often sweaty so you avoid shaking hands with others.  Hyperhidrosis can occur  in many parts of the body whether exposed to triggers such as heat, physical activity or exertion, embarrassment, stress or not.

How do we treat excessive sweating?

First, we’ll evaluate your excessive sweating for any potential causes of secondary hyperhidrosis (for example, an underlying disease that causes excessive sweating such as hyperthyroidism).

To gauge your sweating problem, we will try you on stronger prescription-grade antiperspirants which can also help block sweat glands to reduce sweating. Typical over-the-counter antiperspirants are 1-2% aluminum chloride but prescription products can contain up to a 20% solution of aluminum chloride hexahydrate or similar aluminum salts. While these can be irritating in those with sensitive skin and sweat glands, they do reduce perspiration, however they require continuous usage.

After a few weeks of trial, if the prescription products do not reduce your sweating problem well enough, we can now use Botox® (onabotulinumtoxinA), which is FDA approved for the treatment of excessive sweating of armpits. We also use Myobloc® (rimabotulinumtoxinB) or Dysport® (abobotulinumtoxinA) off-label as an alternative, especially for those who have excessive sweating on palms and soles of feet.

These injections work to temporarily de-nerve the sweat gland and results in a local reduction in sweating where injections have been administered for up 5 months. Injections must be repeated at regular intervals to keep excessive sweating at bay and you may still need to use an antiperspirant.

-Jodi

What to do about an inflamed, raised, hard scar

Question: I had an injury to my shoulder earlier this year and while the wound has mostly healed and is no longer scabby, the resulting scar is still painful, raised, hard and lumpy. It’s bigger and uglier than the original wound. What can I do?

Answer: There are two types of scars that resemble what you describe and there’s a lot we can do in the dermatologists office to help them look and feel better.

Keloid scar

Keloid scar

Keloids and Hypertrophic Scars

This type of scarring is usually after local skin trauma (e.g., laceration, tattoo, burn, vaccination or surgery) or as a result of an inflammatory skin disorder (e.g., acne, bites or abscesses).

Scars are composed of new connective tissue that replaces lost tissue in the dermis or deeper parts of the skin, as a result of injury. Their size and shape are determined by the form of the previous wound. The process of scarring is characteristic of certain inflammatory processes. A resulting scar can be thin (atrophic) or thickened, fibrous and overgrown. Some individuals and some areas of the body (e.g., anterior chest) are especially prone to scarring. Scars may be smooth or rough, pliable or firm, they can be pink or violaceous or become white. They can also be hyperpigmented (darkened). Scars are persistent and normally become less noticeable in the course of time.

At times though, and in certain anatomical locations (e.g., shoulders, sternum, mandible and arms) they can grow thick, tough and corded forming a hypertrophic scar or keloid. Under normal circumstances,  wound healing takes place through the rapid and repeated reproduction of fibroblasts (the most common cells of connective tissue) at the wound site. But when fibroblast activity continues unchecked and excessive collagen (protein found in connective tissue) is deposited at the site of injury, the scar gets too big and a hypertrophic scar or keloid is formed.

Hypertrophic Scar remains confined to the borders of the original wound and most of the time, retains its shape. It is characterized by hardness, redness and irritation compared to the surrounding skin and can take the form of a firm papule or nodule.

Conversely, a Keloid is an overgrowth of dense fibrous tissue that you’ll notice extending beyond the borders of the original wound. Like a hypertrophic scar, a keloid can be hardened, raised and often darkly discolored. Keloids do not regress, appear to get better or shrink over time on their own. Instead they grow in a pseudo tumor fashion and distort the size and shape of the original lesion.

If you know you have a hereditary predisposition toward keloid scarring, mention that to your dermatologist because then we will not try to surgically remove them (called excision) because keloids tend to recur.

The differences… A hypertrophic scar can occur at an any age and usually stays within the borders of the original wound, whereas a keloid commonly occurs in the third decade and enlarges beyond the area of the initial wounding with web-like extensions. Keloidal growth can also be triggered by pregnancy and compared with hypertrophic scars, a keloid can often be painful and super-sensitive.

How we treat stubborn keloids and hypertrophic scarring

We often use a 3-step process in the office to attack raised, hardened scars as soon as we notice a scar is exhibiting signs of hardening, as early as one month-post op, in the case of a scar due to surgery.  The earlier you treat a keloid or hypertrophic scar, the better your results will be.

We inject  5-fluorouracil “5-FU” (used primarily as an anti-cancer drug but also used for the prevention of scars in glaucoma surgery for at least 15 years) combined with a specific low-dose corticosteroid (to reduce further inflammation and any pain) along with Pulsed Dye Laser treatments.

5-FU works to reduce skin’s metabolism rate and inhibits the over-production of the fibroblasts building up on and around the wound. We combine that with Kenalog (triamcinolone), the low-dose corticosteroid, and perform injections one to three times per week, at regular intervals such as Monday, Wednesday and Friday, depending on how red, hardened and inflamed the scar is.  Once the scar softens, injections can be reduced to two times per week, once a week and then every other week, monthly and finally, every six months. The Pulsed Dye Laser is used to decrease any redness, to normalize the wound surface and improve skin texture at the scar and to further blend scar into surrounding skin and we perform those treatments in intervals of four to eight months apart.

While any keloid or hypertrophic scar can be treated with this technique,  you’ll get the best results the younger the scar is. The more inflamed and symptomatic the scar, the better the response to treatment. Older scars that have been hardened for many years and are not inflamed, red, itchy or painful, will not respond as quickly or as thoroughly. Hypertrophic scars respond better than keloids, which frequently recur, although small isolated keloids (less than 2 cm in diameter) usually completely resolve with this technique without recurrence.

No matter what, keep all scars out of the sun for best healing, at least until the “pink” of new skin is gone because exposure to the sun only makes scars darker.

-Jodi

 

 

 

 

 

 

 

What good is coconut oil for hair and skin?

Question: I’ve been reading more and more about using coconut oil for hair and skin. Do you think this is a good idea? Can you tell me how to buy coconut oil and how to use it properly?

As a solid its an ointment or balm, warmed to a liquid a liquid its a moisturizing, conditioning oil

As a solid, its an ointment or balm, warmed to a liquid, its a moisturizing, conditioning oil

Answer: I love coconut oil as an added treat for hair and skin (as long as you are not allergic to nuts or coconut). But, I only recommend buying organic unrefined expeller-pressed virgin coconut oil (also called VCO).

I think VCO is a great addition to any hair and skin routine because:

  • It has no preservatives, additives, or color.
  • It’s available at any local health food store or online.
  • It’s affordable at $9 for a small 14 oz. jar.
  • It’s a multi-use beauty product:  Coconut oil is  a solid (like butter) at room temperature and ideal as an ointment or lip balm, but if you place the jar in  warm water, it melts into a liquid oil perfect for massaging, baths, a moisturizer or a hair mask.
  • That smell is like being on a desert island (refined VCO  does not retain its natural coconut aroma).

The real beauty of VCO for skin and hair is its natural, molecular composition

Not only does VCO have a high saturated fat content-composed of 90% saturated triglycerides, but its low molecular weight and straight linear chain (called a medium-chain fatty acid, in contrast to other saturated fats comprised of long chain fatty acids which make them larger molecules), it is able to permeate the hair shaft  and skin surface rather than just sitting on top. That’s what makes it so effective. If you use it at room temperature (when it is solid) it is the perfect ointment to relieve dehydrated, chapped, scaly and itchy skin and it can even improve symptoms of psoriasis and excema.

The medical literature supports my own observations of VCO as a healthful skin conditioner and moisturizer. Studies have shown that  VCO use may improve skin barrier function (protecting skin from bacteria and fungal intrusion) and  decrease trans-epidermal water loss (skin’s ability to retain moisture). Animal studies have shown that coconut oil use can improve wound healing and increase collagen production, too.

For hair, in addition to its high absorbability, VCO contains a high percentage of the saturated fat, lauric acid, which also is highly attracted to the protein in hair. Because VCO actually absorbs through the hair shaft, it has positive effects on the strength of hair while it prevents hair damage and protein loss from styling, brushing and even chemical treatments.

 A little coconut oil on your skin and hair goes a long way:

  • As a daily body moisturizer, after shower or bath
  • As a bath oil
  • As a skin exfoliator for skin and to help control dandruff in hair
  • As a cuticle conditioner
  • As a lip balm
  • As an intensive hair mask, from scalp to ends
  • As a scalp or body massage oil

Coconut oil can be greasy if applied too heavily, but don’t worry, it absorbs in a few minutes leaving behind that beachy smell and softer, healthier, smoother skin.

It can be applied on wet or dry skin. But only apply to dry hair because water limits the VCO from coating the hair properly and permeating the hair shaft. To remove VCO from hair, do not wet first. Simply lather up shampoo in your hands and apply directly and completely over hair and scalp, from roots to ends, then rinse thoroughly.

VCO can be applied in the same way to children and adults. Just be sure that you don’t use coconut oil at all if you are allergic to nuts or to coconut.

Have you tried virgin coconut oil yet? What’s your favorite way to use it?

-Jodi

 

Are you aware of this summer itch hazard?

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Fiberglass: Up close and personal. These little fiberglass fibers, when they become exposed and loose, can get lodged in your skin if you touch them and cause intense itching!

Question:  I was working outside doing pool and yard chores and all of a sudden I got this intense itching and burning on my upper, inner arms. What is it and how can I get rid of it?

Answer: This is a true story and it can easily happen to you the more time you spend on outdoor summer activities.

This patient came into the office in a panic about what was itching on her upper arms. I noticed some redness and scratch marks where she had been itching and asked her what she was doing that day. After she told me she was doing yard work and pool chores I had a sneaking suspicion that she was a victim of fiberglass intrusion. This tough material is a fiber-reinforced polymer made of a plastic matrix reinforced by fine fibers of glass. You can come in contact with fiberglass in boats, oars and boating equipment, pool equipment, insulation, storage tanks, cars, bikes,  bath tubs, hot tubs and surf boards just to name a few. I shined the light upwards on the reddened area and looked with a magnifying glass and there they were:  Hundreds of small, hairy spicules of fiberglass that had penetrated her skin.

That’s when the light went on in her eyes and she told me how she had wrapped her arms around the fiberglass pool filter canister to twist it loose. Over time and with unrelenting sun and weather exposure, uncovered fiberglass degrades and the needle-like fibers on the surface can come loose which can get lodged in skin that comes in contact. this intrusion causes intense itching and burning (we clinically call it contact dermatitis because its caused by coming in contact with the substance, in this case, fiberglass) and will continue to itch and burn until the fiberglass “spicules” fall out or are removed.

How to get fiberglass out of your skin

Wash skin exposed to fiberglass as soon as possible by letting water run downward over the area (never rub upwards as this pushes the spicules further in or causes them to break off in your skin). You can try running a wet washcloth downward under downward running water to help dislodge strands.  Gently dry in a downward motion also. When skin is dry treat remaining area with a dusting of talcum powder which causes the fibers to slide out of and off the skin. Itching may continue for a day or so until all strands are dislodged, but no lasting effects should be seen.

If after washing your skin you are still itchy and uncomfortable, a trip to the dermatology office is necessary. The irritation can be treated with topical anti-inflammatory creams so the itching and redness are decreased.

Have you ever been the victim of a fiberglass intrusion?

Can I use perfume as a deodorant?

Q.  I ran out of my usual deodorant, so in a pinch I sprayed my favorite perfume under my arms. Is that bad?

A. Possibly. Because underarms, especially in the summer, are more sensitive when susceptible to wetness from sweat, humidity, friction and heat. Your underarm skin could have a different reaction to a perfume you normally spray elsewhere like neck, hair and back of knees, so keep perfume away from delicate areas such as armpits and genital areas.

Can antiperspirant/deodorant cause itchy armpits?

Question: I’ve noticed that every time I use my antiperspirant/deodorant my armpits start itching the next day and they keep itching even if I stop using the product for a few days. Eventually it stops itching. Could my antiperspirant/deodorant be causing my itchy armpits?

Answer: Yes. It’s highly possible in both men and women.

What it’s like to be an armpit on a hot August summer day: There’s a thicker-than-usual amount of antiperspirant/deodorant on freshly-shaven skin to avoid sweat marks and odor. As you go rushing about your day, damp armpit skin rubs together along with some sweat, oil and your clothing. But underarm skin is sensitive from the shaving too and sweat glands are mostly blocked by irritating chemicals and perfumes in addition to the fabric, laundry detergent (and possibly chlorine bleach) from your shirt. What if you added sand, salt water and chlorine to that mix?

How antiperspirant/deodorant works: Underarm odor is not caused by the watery sweat that wets your shirt which is secreted by your eccrine sweat glands to lower your temperature through evaporation. The odor is caused by bacteria that break down fats secreted by your apocrine sweat glands.  An antiperspirant contains an aluminum salt chemical to block the watery secretion from the eccrine glands which can be a primary irritant, especially when skin is more vulnerable  in the summer or freshly shaven.  But, It’s deodorant that controls the odor with perfumes and sometimes an antibacterial chemical to inhibit bacterial growth such as triclosan, also a common skin irritant.

You can now see how your antiperspirant/deodorant could be exacerbating an already sticky situation in your armpits!

5 steps to avoid itchy armpits

Don’t worry. You don’t have to wing it like Matthew McConaughey or Julia Roberts, who both reportedly abstain from wearing deodorant. Just experiment with different ingredients and formulas until you find one that does not cause you itchy armpits.

1.  Read labels and switch underarm products, formulas. Many antiperspirant products contain a percentage (14-17) of the highly irritating ingredient aluminum zirconium tetrachlorohydrex GLY. Read product labels looking for a product in the lower percentage or for the least irritating antiperspirant ingredient, aluminum chlorhydrate. If excessive sweat is not your primary problem, switch solely to a deodorant to see if it was the sweat-gland blocking antiperspirant that caused your itching. If the deodorant product still causes itching, try an all-natural brand such as Tom’s of Maine which relies on botanicals such as aloe, sage and lemongrass to soothe skin and inhibit odor and irritation. Sometimes it’s the formula that causes the itching due to the drying nature of increased alcohol in a liquid spray, roll-on or clear versus a dry solid. Look for aluminum-free, alcohol-free and fragrance-free products.

2. Shave armpits at night. And don’t apply any antiperspirant/deodorant afterwards. Let skin breathe.

3. Go au naturel at the beach. Don’t apply any underarm products if you will be at the beach or swimming as excessive skin rubbing, sweating and salt, sand or chlorine can all further irritate sensitive underarm skin.

4. Switch laundry detergent, too. Try a dye- and fragrance-free laundry detergent to reduce exposure to irritants to your underarm area. Steer clear of chlorine bleach on T-shirts.

5. See your dermatologist if rash doesn’t clear.  If you notice bumps, rash or pustules that do not resolve within a few days, see your dermatologist as folliculitis or other bacterial or fungal infection could be at play.

 

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!