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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

MAY IS SKIN CANCER AWARENESS MONTH

According to the Skin Cancer Foundation, over 5 million cases of skin cancer are diagnosed each year making it the most common cancer in America. Fortunately, skin cancer is one of the most preventable cancers. In addition to seeing your dermatologist periodically for a full body skin exam, you should check your skin head to toe for new, changing, unusual appearing, and non-healing growths. During spring and summer UV radiation exposure peaks between 10 am and 4 pm so it's best to engage in outdoor activities early or later in the day. -Consider the following additional sun protection recommendations from the Skin Cancer Foundation:

• Sunscreen: There are many formulations available for every skin type. It's important to find one you will apply every day. Ideally, the product should be broad spectrum with UVA/UVB protection and water resistant. The later is important especially if you perspire heavily or are engaging in water activities. Apply liberally and repeat application every 2 hours you're outdoors. Make sure the product hasn't past it's expiration date.
• Wear a hat with UPF 50+ and a broad rim for added protection of your ears and face. While hair helps shield from UV rays, your scalp is susceptible where the hair is parted or thin.
• Clothing is often the simplest way to protect your skin and unlike sunscreen it doesn't have to be replace. Plus it is cost effective! Many companies manufacture clothing with breathable, sweat-wicking, and UPF containing fabrics.
• Protect your eyes with sunglasses with lenses that block 100% of UV radiation and choose frames that wrap around or completely cover your eyes.

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

Have you looked in mirror and thought that you appeared older than you feel? Many of the signs of aging are secondary to sun damage from ultraviolet rays that also cause skin cancer. While shielding your skin from the sun starting in childhood is best, it’s never too late to start. Prominent manifestations of sun damage include wrinkles (compare sun exposed skin to unexposed buttocks and breast skin), “broken” blood vessels, freckles, larger brown spots “age spots, liver spots”, blotchy light and dark skin, melasma, blackheads of temples and cheeks, and persistent redness of the sides of the neck and central chest. Prevent further sun damage by applying a broad spectrum sunscreen with an SPF 30 or greater year round. Wearing hats, long sleeves/protective clothing, sunglasses and seeking shade when possible are also advised. UV rays are strongest in spring and summer between 10am and 4pm so it’s best to schedule outdoor activities with that in mind. Remember that UV rays penetrate clouds so even when you don’t feel the heat of the sun it’s important to protect your skin. Beneficial skin care products including vitamin C serums or gels to help stimulate new collagen can be applied during the day under sunscreen. Retinol or tretinoin containing creams applied at night can also stimulate new collagen, improve discolored skin and reduce fine lines. Various office procedures including microneedling, and the Fraxel Laser can improve wrinkles. Photorejuvenation with BBL and Fraxel can be used to improved brown spots and blotchy discoloration, The VBeam Laser is valuable for treating unwanted blood vessels and redness, and gentle chemical peels can improve melasma. (Adapted from The Skin Cancer Foundation Journal 2022)If you have questions regarding prevention and/or treatment of sun damaged skin please schedule an appointment with your dermatologist: 310-626-4631

We’ve periodically reported on topics related to hair growth treatments including the use of low dose oral minoxidil, alopecia, and platelet rich plasma, PRP. Many patients ask about the purported benefits of nutritional supplements for hair loss. An extensive review of multiple studies published in JAMA Dermatology in November 2022 concluded that a wide range of products have potential but definitive evidence of safety and effectiveness were lacking due to factors such as the small size of the study groups, the mix of various types of hair loss, and the lack of control groups.Supplements could have a positive role in hair growth, and might be considered in selected situations, but better studies are needed. While certain deficiencies such as vitamin D and zinc may cause hair loss there are many other factors to consider. When experiencing hair loss, it’s best to consult your dermatologist for evaluation which typically includes taking a thorough history and selected blood tests. A scalp biopsy might be performed when indicated.If you’re losing hair call 310-626-4631 to schedule a consultation with your dermatologist.

There is hope for improving surgical scars, biopsy scars, traumatic scars, hypertrophic scars, and keloidal scars! The redness and texture of most scars can be improved with laser treatments. At Dermatology Associates Medical Group, we treat scars with a combination of different lasers for optimal results. Typically, we use the Vbeam laser and the Fraxel laser at the same session to address redness and texture, respectively.The Vbeam laser reduces redness by targeting blood vessels that contribute to the scar’s red color.The Fraxel laser helps create collagen within the scar, improving its texture to help it blend with the surrounding skin. We use topical numbing cream to minimize any discomfort, and the treatment takes only a few minutes. For best results, several treatments may be necessary.If you have scars that concern you, ask your dermatologist about Vbeam and Fraxel laser treatments at your next dermatology appointment or call us to schedule a consultation with Dr. Aria.

Many patients are interested in cosmetic procedures but have valid concerns about the results appearing overdone, or worse, grotesque. They may have friends or family who, as a result of too much cosmetic intervention, no longer look like themselves. When appropriate treatments are selected and performed properly the results are natural. Specifically, dynamic frown lines can be significantly diminished with botulinum toxins (eg, Botox, Dysport), loss of facial volume and deep lines improved with fillers (eg, Juvederm, Restylane) and discolored, sun damaged skin and wrinkles softened with laser and light treatments (eg BBL Photorejuvenation, Fraxel Laser).We have many years of experience with cosmetic treatments and strive to achieve an outcome that makes you look like your best you.If you’d like to learn more about cosmetic options, call 310-626-4631 to schedule a consultation with your dermatologist.

Fraxel® is a non-surgical laser treatment that improves tone, texture and radiance for aging, sun-damaged or scarred skin.Fraxel® is for people who want to look younger without dramatic changes or extended downtime. The device generates microscopic laser columns that penetrate the skin and treat a fraction of tissue at a time leaving surrounding tissue intact and stimulating new collagen formation with rapid healing.The face, eyelids, neck, chest, and back of the hands can be treated. Fraxel® is effective for:

• Fine lines and wrinkles
• Surface scars including acne scars and surgical scars
• Age spots
• Sun damage including Actinic Keratoses (precancerous sunspots)

Aria Vazirnia, M.D. ("Dr. Aria") is a board-certified dermatologist with the American Society for Laser Medicine & Surgery. Following his dermatology residency at UCSD, Dr. Aria completed a laser and cosmetic dermatology fellowship at Harvard Medical School, Massachusetts General Hospital and the Wellman Center for Photomedicine in Boston where the majority of laser technologies are invented.Call 310-626-4631 to schedule a Fraxel® consultation with Dr. Aria.