125_Years
of Experience in Dermatology

As part of our comprehensive dermatology offerings, we're excited to offer facials performed by our new aesthetician, Gloria!A facial is a non-invasive, non-surgical treatment that targets various skin concerns, from acne and hyperpigmentation to fine lines and dryness. Our aesthetician uses a combination of techniques, including gentle exfoliation, extractions, and nourishing masks, to leave your skin feeling refreshed, revitalized, and radiant.But did you know that facials are more than just a pampering treat? They also have real medical benefits! By deep cleansing pores and removing dead skin cells, facials can help prevent clogged pores and reduce the appearance of fine lines and wrinkles. They can also improve skin tone and texture, reduce inflammation, and even help manage skin conditions like acne and rosacea. Plus, our aesthetician works closely with our dermatologists to customize each facial to your unique skin concerns and needs.Contact us today to schedule your appointment and start glowing from the inside out!

Acne can affect both teens and adults alike. The relationship between diet and acne is confusing. There is evidence to suggest that certain dietary factors may influence acne; however, the exact mechanisms and specific dietary recommendations are still being elucidated. Some studies suggest that consuming high glycemic index (GI) foods, like sugary snacks and refined carbohydrates, can lead to increased insulin levels, exacerbating acne by boosting sebum production and inflammation.Additionally, certain dairy products, particularly skim milk, may influence acne development due to hormones and growth factors. Protein powders that contain milk-derived whey protein can also exacerbate acne. Diets high in omega-6 fatty acids, found in processed foods and some vegetable oils, may promote inflammation, while omega-3 fatty acids, found in sources like fatty fish, may have anti-inflammatory effects beneficial for acne-prone skin.We always recommend incorporating antioxidant-rich foods such as fruits and vegetables, as well as staying hydrated, to best support skin health. However, individual responses to dietary changes vary, so consulting with your dermatologist for personalized advice is recommended.

While sun protection is our main weapon against skin cancer, recent research offers another layer of defense: nicotinamide, a form of vitamin B3. Available as an oral supplement, nicotinamide, has shown impressive results in reducing the development of both skin cancers and actinic keratoses, precancerous lesions that often progress to cancer. Studies have found it can decrease the incidence of common skin cancers like basal cell carcinoma and squamous cell carcinoma by up to 23%, and reduce actinic keratoses by 15%. This translates to a powerful tool in our arsenal for protecting your skin from the sun's long-term damage.How does it work? Nicotinamide supports DNA repair after sun exposure, boosting your skin's natural defenses against UV damage. It also helps maintain a healthy immune response, another key factor in preventing skin cancer. While sun protection remains crucial, nicotinamide could be a valuable tool for high-risk individuals, such as those with a history of skin cancer or extensive sun exposure.While sun protection remains the cornerstone of skin cancer prevention, nicotinamide offers an additional layer of defense for individuals at high risk, such as those with a history of skin cancer or frequent sun exposure. We're excited to discuss this promising development with you at your next appointment and explore if it might be a good fit for your individual skin health needs.

Have you noticed rough, wart-like growths popping up on your skin? While they might be concerning, the good news is they're likely just seborrheic keratoses, and not something to fret about.What are Seborrheic Keratoses?These common skin growths are completely harmless, and incredibly common, especially as we age. They typically appear as small, raised bumps with a waxy or scaly surface. Colors can range from brown and black to tan and yellow, and they often have a rough, stuck-on appearance. While they can appear anywhere on the body, they favor the chest, back, shoulders, and face.Why See a Dermatologist?While seborrheic keratoses are harmless, it's important to have them checked by a dermatologist, especially if they're new, changing, or causing you any discomfort. This is because they can sometimes resemble other, more concerning skin conditions like skin cancer. A quick examination by a trained professional can give you peace of mind, and rule out any underlying issues.Schedule Your Skin Exam Today!

Winter can bring about a variety of skin challenges, with one common issue being "winter itch" or dry skin. Cold temperatures, low humidity, and indoor heating can strip your skin of its natural moisture, leading to dryness, itching, and discomfort. Here are some tips to help you care for your skin during the winter.

1. Hydrate from the Inside Out:
   • Drink plenty of water to stay hydrated.
   • Consume foods rich in omega-3 fatty acids, like fish, flaxseeds, and walnuts.
2. Moisturize Regularly:
   • Use a thick, emollient moisturizer immediately after bathing.
   • Apply moisturizer at least twice a day, focusing on areas prone to dryness.
   • Look for moisturizers containing ingredients like hyaluronic acid, glycerin, or shea butter.
3. Gentle Cleansing:
   • Use a mild, fragrance-free cleanser to avoid further irritation.
   • Avoid hot water, as it can strip your skin of natural oils. Opt for lukewarm water instead.
4. Shorter, Lukewarm Baths or Showers:
   • Limit your bath or shower time to 10-15 minutes.
   • Use lukewarm water instead of hot water, as hot water can worsen dryness.
5. Humidify Your Home:
   • Use a humidifier to add moisture to the air, especially in bedrooms.
   • Aim for a humidity level between 30-50%.
6. Choose Winter-Friendly Fabrics:
   • Wear breathable, natural fabrics like cotton to prevent skin irritation.
   • Layer clothing to stay warm without overheating.
7. Protect Your Skin Outdoors:
   • Wear gloves, scarves, and hats to shield your skin from harsh winds and cold temperatures.
   • Apply a broad-spectrum sunscreen to exposed skin, as winter sun can still cause damage.
8. Avoid Irritants:
   • Choose fragrance-free and hypoallergenic products to minimize the risk of irritation.
   • Be mindful of harsh soaps, as they can exacerbate dryness.
9. Use Ointments for Severe Dryness:
   • For extremely dry areas, consider using an ointment rather than a lotion, as ointments are thicker and provide more protection.
10. Consult a Professional:
    • If your skin condition persists or worsens, consider a consult for personalized advice and treatment options.

Finger tip fissures, commonly known as cracked or split skin of the fingertips, can be both painful and cause functional impairment. Simple tasks such as grasping objects or buttoning a shirt may be difficult. Many people suffer from fingertip fissures during cool dry winter weather. Other potential aggravating factors include excessive water exposure (especially hot water), chemicals in household cleaning products, and underlying skin conditions, including eczema and psoriasis.Treatment involves avoiding exposure to aggravating factors, wearing gloves when washing dishes and other wet exposure work, and moisturizing frequently with products that are occlusive and contain dimethicone, such as Aveeno Therapy Itch Relief Balm. For deeper fissures, liquid bandage products, such as NuSkin or Bactine applied once or twice daily are often helpful.Finally, if the above measures are inadequate, your dermatologist may prescribe a potent topical steroid and/or topical antibiotic ointment.

Dry skin is sometimes only a cosmetic issue, but many patients with dry skin complain of irritation and itching. Some develop cracks and fissures that can lead to skin infections. There is a common misconception that dry skin is due to decreased oil production, but it's actually a result of water loss due to changes in the skin that occur as we age. That’s why there’s a plethora of creams and lotions promoted as “moisturizers”. Most of these products contain oil in water to add moisture and keep it on the skin. The key ingredients to look for in an effective moisturizer include:

1. Occlusives: These ingredients prevent water loss by blocking evaporation, eg: petrolatum, lanolin, mineral oil, silicones
2. Humectants: Pull water into the top layer of skin (stratum corneum), eg: Hyaluronic Acid (see last month’s blog), glycerin, urea, panthenol
3. Emollients: Make the skin feel soft and smooth, eg: dimethicone, cyclomethicone, jojoba oil

The ingredients are listed on the products package label in decreasing order of concentration and those noted above should be near the top. Here are some additional tips for dealing with dry skin:

• Take shorter showers or baths with warm water. Avoid long exposure to hot water that can strip your skin of oils.
• Use soap primarily on areas of the body that require it and minimize it’s use elsewhere. Moisturizing soaps, eg, Dove, Oil of Olay or soap free cleansers, eg, Cetaphil, Ceravé are good choices. Avoid deodorant soaps and products with fragrance.
• Wash with your hands instead of wash cloths, brushes, and sponges or use them lightly to avoid irritation and blot skin dry gently when toweling.
• Apply a moisturizer immediately after shower or bath to lock in moisture.
• Consider using a humidifier in your bedroom during winter time.

Hyaluronic acid (HA) is a natural substance found in the skin that helps retain moisture, keeping it plump and hydrated. Over time, the production of hyaluronic acid (along with collagen and elastin) decreases. Consequently, our skin loses volume and moisture.When used in skincare products, HA acts as a powerful humectant, attracting and holding water in the skin. Its ability to maintain skin hydration is especially beneficial for individuals with dry or aging skin, as it replenishes moisture and revitalizes the skin's texture.Allergic reactions or irritation of sensitive skin isn’t common with HA. It’s safe to use on the skin during pregnancy and while breastfeeding, making it a versatile ingredient in skincare formulations.It’s important to understand that topical HA contains molecules that are large and provide hydration on a surface level, not deep within the skin. In order to add volume and diminish wrinkles, dermal fillers that contain HA are available for injection into the skin. These products work by lifting and filling areas such as the cheeks, the folds around the mouth and chin, and the lips as well as other areas.

A recently published New York Times article discusses the benefits of over the counter Retinol products for the skin. For those who have tried retinol containing products and would like to try something stronger, prescription products like tretinoin (Retin A) or tazarotene (Tazorac) should be considered.These FDA approved medications have been shown to improve the texture and color of the skin and fade fine lines when used consistently over time. The end result is smoother, younger appearing skin. Side effects include potential skin irritation and sun sensitivity so it’s important to apply sunscreen on a daily basis. Waxing for hair removal should be avoided or the product must be held for at least a week before waxing. Retinoids should not be used by pregnant or nursing women.These products are generally applied nightly but should initially be applied 2-3 times weekly at night to minimize the risk of irritation then gradually increased to nightly as tolerated. If you’d like to try one of these medications please schedule an appointment with your dermatologist.

We continue last month’s theme with a brief discussion of additional common itchy skin conditions that are prevalent this time of year.

1. Bug bites: TICKS: Some may carry Lyme disease. It’s important to cover with protective clothing when spending time in a woodsy or grassy location where Lyme disease is prevalent and to check your skin for ticks after spending time outside. BEES, WASPS, YELLOW JACKETS: May inflict painful stings. Important to have oral antihistamines available. High potency topical steroid creams (prescription) are also very helpful. EPI Pens (prescription) should be on hand for those with history of severe allergies to stings. MOSQUITOES AND OTHERS: Use repellents such as deet or natural essential oil containing repellents. Treat itchy bites with high potency topical steroid creams to prevent scratching and scars.
2. Swimmers itch: Caused by microscopic parasites present in ponds, lakes, and the ocean. Itching occurs after the skin dries from swimming with pimples or hives developing. Prevented by staying out of infested water (signs often posted). Also a brisk rub down with a clean towel after emerging from the water can prevent the parasites from burrowing into the skin.
3. Seabather’s eruption: Caused by “sea lice” which are actually just hatched jelly fish or sea anemone larva common in the waters of eastern Florida or the Caribbean. The creatures have stingers and can get caught between bathing suit and skin.
4. Margarita burn (phytophotodermatitis): Occurs when sunlight and a plant compound combine to cause prominent streaks on the skin, often the back of the hands and around the mouth/chin. Lime juice is a common cause so wash areas that come in contact when out in the sun. Buttercups, carrots, bergamot oranges, and others with similar compounds can cause the condition.
5. Prickly heat or heat rash (miliaria) presents as tiny itchy bumps typically on the trunk usually after significant sweating. The sweat dries and clogs the pores creating the eruption. Prevent by exercising during the cooler part of the day (when outside) and wear light weight, loose fitting clothing. Cool showers can help.

With summer’s warm weather, various irritating skin rashes occur with increase frequency. Five of the more common eruptions are noted below with brief suggestions on prevention and treatment.

1. Tinea pedis (athlete’s foot): Heat and moisture create the perfect environment for fungus to proliferate between toes and on the feet.
   • PREVENTION: Dry thoroughly after showers (try using a hair dryer on a cool setting after towel). Talc free powder after showers are helpful for individuals who perspire heavily.
   • TREATMENT: anti-fungal creams, powders and anti-fungal oral medications in more severe cases.
2. Intertrigo: An itchy rash that typically develops in skin folds due to heat, moisture, and friction/rubbing. The groin and the area beneath the breasts are commonly affected.
   • PREVENTION: Keep the area dry (see tinea pedis above).
   • TREATMENT: antifungal creams and low potency prescription steroid creams.
3. Folliculitis: Infected hair follicles that appear like pimples. Often occur in areas of friction, under tight clothing, and in hairy areas.
   • PREVENTION: Shower promptly after workouts and change out of tight fitting workout clothes. Wear loose fitting clothing during hot humid weather. Avoid hot tubs if you’re unsure whether the acid and chlorine levels are properly controlled to prevent “hot tub folliculitis”.
   • TREATMENT: Wash affected areas in shower with benzoyl peroxide containing soap or cleanser. Sometimes requires topical or oral antibiotic prescription.
4. Rhus dermatitis (poison oak, ivy, sumac): Intensely itchy eruption occurs due to allergy to urushiol, a substance found in these plants. Generally presents on exposed areas of skin but may be spread to other areas by touching.
   • PREVENTION: Learn to recognize and avoid contact with these plants before hiking and gardening. Wear long pants and long sleeve shirts when hiking and gardening(also offers sun protection!)
   • TREATMENT: Generally requires prescription high potency topical steroids for mild/localized eruptions and oral steroids for widespread/severe cases.
5. Sunburn: The sun’s ultraviolet rays (UV) are strong this time of year and most intense between 10 am- 4 pm. The UV is present even on overcast days when it’s not hot and some of the worst sunburns occur under these circumstances.
   • PREVENTION: Minimize outdoor activity between peak UV hours. Liberally apply a broad spectrum sunscreen with minimal SPF 30 and reapply ever 2 hours and following water exposure. Wear hats, sunglasses with UV protection, and sun protective clothing.
   • TREATMENT: Cool compresses, aloe Vera gel, anti-inflammatory medications, eg, aspirin, ibuprofen.

Most men experience significant thinning of scalp hair by age 50 and two-thirds will notice hair loss by age 35. Women represent 40 percent of those with hair loss. In addition to the potential psychological impact, less hair coverage makes the scalp more susceptible to the damaging effects of ultraviolet (UV) light exposure from the sun.The manifestations of chronic sun exposure of the skin include redness, flaky patches, and a rough, sandpaper like texture. These findings often indicate the presence of precancerous actinic keratoses (AKs) which can sometimes cover the entire surface of the exposed scalp. AKs may be tender, painful and bleed easily. Five to 10 percent of AKs evolve into skin cancers which can become aggressive. Squamous cell carcinoma is the most common skin cancer on the scalp but basal cell carcinoma and melanoma may also occur.Sun protection measures are critical to protect the scalp and prevent the development of skin cancers. While sunscreens with SPF 30 or greater are helpful, they must be applied every 2 hours so hats with a tightly woven fabric and broad brim to protect your ears and back of the neck are a better option. Many companies make UPF (ultraviolet protection factor) rated hats with those rated UPF 50+ the best option. If you have AKs and/or you’ve had a skin cancer of the scalp, you can decrease your risk of future skin cancers with treatments including cryotherapy, topical chemotherapy creams, photodynamic therapy (PDT), and oral nicotinamide (vitamin B3). Existing skin cancers must be treated, however, typically with surgery. If you have concerns about sun damage of your scalp schedule an evaluation with your dermatologist. (Adapted from The Skin Cancer Foundation Journal, Vol.XLI, 2023)If it’s been a while since your last skin cancer screening, look yourself over and schedule an exam with your dermatologist: 310-626-4631