Resources

Seborrheic Keratoses (SKs),are common benign growths that may be seen on most parts of the body as one matures. According to one study, 83 million Americans have SKs making it as common as acne, rosacea, and psoriasis combined. They are typically described as wart like with a rough, scaly texture and can vary greatly in color, size, and shape. SKs may resemble other benign and malignant skin growths. In this regard, skin lesions with an unusual appearance should always be evaluated by a dermatologist. SKs can be treated with various modalities including cryotherapy (freezing), electrodessication (cautery), curettage (scraping) and scalpel shave removal. A new FDA approved product for the treatment of SKs, called ESKATA, will be available this spring. This hydrogen peroxide based solution is applied to SKs in a dermatologist’s office. The benefit of this treatment compared to other methods is that it doesn’t significantly discolor or scar the underlying skin. If you’d like more information about SKs and or ESKATA, please schedule a consultation with your dermatologist. Call 310.626.4631, ext 227

Cleansers work by removing impurities, skincare products, and makeup from the surface of the skin. Some cleansers can enhance the penetration and therapeutic effect of topically applied medications. Many different types of cleansers are available and it's important to select a product that is best for your particular skin. For example, foaming cleansers containing sodium laurel sulfate work well for individuals with oily complexions and can enhance the penetration of other skincare products and medications. These type of cleansers are too harsh for dry or sensitive skin. Alpha hydroxy acid-based cleansers gently exfoliate while moisturizing the skin and work well for dry and acne-prone skin. They help the latter by lowering the pH of the skin thereby creating an environment that is hostile to the bacteria that play a role in acne. The exfoliating effect enhances penetration of medications applied after cleansing. Salycylic acid-based cleansers penetrate the oil (lipid) layer of the skin and are the most effective for unplugging pores. They are ideal for patients with oily skin and acne, rosacea, and seborrheic dermatitis but are generally too irritating for those with dry/sensitive skin. Antibacterial cleansers contain one of several active ingredients. For example, benzoyl peroxide-containing cleansers are helpful for acne patients with the caveat that they are not well tolerated by patients with dry skin.

Appreciation of beauty and human aesthetics in particular dates back to antiquity. While ideas on beauty vary with personal preferences and cultural standards, there is a general agreement on the features that constitute human beauty.Researchers from Boston University School of Medicine and Harvard Medical School recently published a study that compared standards of beauty in People Magazine from 1990 to 2017. To test their hypothesis that standards of beauty had not changed over that time period, they compared the Worlds Most Beautiful list in the first issue (1990) with that in the 2017 issue. They evaluated the following: age at the time of the issue, sex, race, skin type, hair color, eye color, and visible dermatologic conditions. The results of the study were contrary to their hypothesis and found an increased inclusion of people with a wider variety of skin color and increased representation of older age groups. They point out that a recent consumer report from the American Society for Dermatologic Surgery found that 60% were considering a cosmetic procedure, and the top 3 reasons were to increase confidence, increase attractiveness, and look as young as they feel.The authors state that “ideals of beauty are particular to the beholder and determined by the norms of a society, culture, or historical period” and conclude that their findings suggest that standards of beauty are evolving as people integrate the effects of media with exposure to new cultures and different norms.

Blotchy, discoloration is a common cosmetic problem that can be pronounced in people with darker skin color. Recently, intravenous glutathione injections have been promoted and administered in certain medi-spas as a treatment to diminish skin blotches and generally lighten skin color. Glutathione is an antioxidant found naturally in human cells. It may cause the skin to lighten by deactivating tyrosinase, the enzyme that helps produce melanin, the skin pigment.Intravenous glutathione is being promoted as an alternative to bleach creams that have limited benefits and potential side effects. There are no large-scale studies on the use of intravenous glutathione for skin lightening or its long term side effects. Evidence for its effectiveness comes from individual case reports or anecdotal experience. Unfortunately, a growing number of women around the world have been using this unproven treatment to reduce blemishes and for skin lightening. It’s wise to stay clear of this treatment that lacks evidence-based proof of safety and effectiveness.

ATOPIC DERMATITIS (AD) is the most common form of eczema and appears as an itchy skin rash that can vary in appearance. It commonly waxes and wanes and may clear for long periods. AD usually develops in early childhood but may occur at any age. While there is no cure for AD, it is typically managed by avoiding irritation of the skin from harsh soaps and fragrances, moisturizing the skin especially after showers or baths, and applications of medicated creams and ointments.Recently, two new breakthrough medications have become available for the treatment of AD. Eucrisa (crisaborole) is a steroid-free ointment for people with mild-to-moderate eczema and can be used on all skin areas, for adults and children as young as 2 years old. It blocks an inflammatory enzyme that is present in increased concentration in AD. Dupixent (dupilumab) is an injection treatment indicated for the treatment of adult patients with moderate to severe AD whose disease is not adequately controlled with topical prescription therapies and works by blocking the underlying inflammation in AD. These medications are important additions to our therapeutic options for treating AD.

A report from the Pew Research Center revealed that 38 percent of millennials have at least one tattoo and 23 percent have a piercing somewhere other than an earlobe. There are, however, potential health and social implications that should be considered before acquiring a tattoo or body piercing. The American Academy of Pediatrics stresses the importance of hygienic practices in piercing and tattoo parlors, including making sure practitioners use new disposable gloves, needles from a sealed, sterile container, and fresh unused ink poured into a new disposable container with each client. Fortunately, in California, standards are set for sterilization, sanitation and safety for both tattooing and body piercing. Practitioners have to register with the state health department and are required to submit proof of hepatitis vaccination as well as take a yearly course in blood borne diseases and infection control. While infection is rare, concern about infectious diseases such as HIV, hepatitis and skin infections caused by Staphylococcus aureus (staph) bacteria remain.Finally, one should carefully consider the social implications of tattoos on highly visible areas such as the hands, fingers, neck, and face. Certain professions are still very conservative regarding tattoos. Keep in mind that tattoo removal by laser is painful, difficult, expensive and only partially effective.

Pubic hair removal has become more common in recent years. This is likely due to cosmetic concerns as well as the misconception that hair removal is more hygienic. A recent survey study published in JAMA Dermatology reported on the incidence and types of injuries sustained from removing pubic hair. The survey was sent to 7,570 adults, ages 18-65. Almost half of the people contacted declined to take part in the survey. Of the 52.5% who did take part:

• 66.5% of men said they had groomed their pubic hair, and 23.7% said they'd been injured while doing it.
• 85.3% of women had groomed their public hair and 27.1% had been injured.

The most common problems were:

• cuts (61.2%)
• burns (23.0%)
• rash (12.2%)
• infection (9.3%)

This may reflect the types of hair removal methods used. Shaving with a non-electric razor was the most common method (47.5%), followed by electric razor (26.9%), scissors (18.4%) and waxing (2.6%).For women, those who reported waxing as their main method of hair removal were less likely to have repeated frequent injuries. For men (who were less likely to wax) the type of hair removal method made no difference to injury rate.Pubic hair grooming frequency and degree of grooming (ie, removing all pubic hair) were independent risk factors for injury. Most of the reported injuries were minor with only 1.4% requiring medical attention.The study has limitations but suggests that pubic hair removal is not without risk and that development of guidelines for safe practices to minimize the risk of injury are needed.

Some of our patients continue to express concerns regarding the safety of chemical based sunscreens. We addressed this issue in a tip of the month a few years ago (reprinted below). The information and the message remain the same: sunscreens including chemical based sunscreens are safe and effective!Here are the facts on sunscreens:

1. Regular application of a broad spectrum sunscreen protects the skin from the damaging effects of ultraviolet light exposure. This reduces your risk of premature aging of the skin and skin cancer. For outdoor activity, it's best to use a sunscreen with an SPF of 30 or greater.
2. The FDA regulates sunscreens. The ingredients in sunscreens must be shown to be safe and effective before being approved.
3. Concerns have been raised about several ingredients found in certain sunscreens:
   • Oxybenzone: Protects skin from harmful UVA and UVB rays. Approved in 1978 by the FDA. No data shows it causes hormonal abnormalities or any significant health problem in humans.
   • Retinyl Palmitate: Protects skin from premature aging. Naturally found in our skin. There is no evidence it increases the risk of skin cancer in humans.
   • Nanotechnology: Prevents active sunscreen ingredients from leaving a white residue on the skin. This leads to better coverage and improved protection from UV radiation. Nanoparticles do not enter the body through healthy or sunburned skin.
4. In addition to the application of a broad spectrum sunscreen, wearing UV rated clothing, hats, and sunglasses are additional worthwhile protective measures. Finally, limiting midday outdoor activities (between 10 am and 4 pm in spring and summer) also reduces UV exposure.

Last month we discussed microneedling treatments for skin rejuvenation, acne scars, dyschromia (skin discoloration) and hair loss. This month, we address PRP, a form of enriched blood obtained from routine venipuncture. The blood is centrifuged to separate a component that has a high concentration of platelets (cells involved in clotting) and growth factors that enhance healing. As a result, PRP has been used in maxillofacial surgery, orthopedics, cardiovascular surgery, and to treat soft tissue ulcers. It is being used alone and in combination with microneedling to enhance regenerative effects for skin rejuvenation, treatment of acne scars, and to treat genetic hair loss (androgenetic alopecia). Studies to date that demonstrate the benefits of PRP for dermatologic conditions are limited but promising. Stay tuned for updates on PRP!Please call 310-626-4631 ext. 227 to schedule a consultation with one of our physicians!