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Monday, May 14, 2012

Tanorexia

By Debra Jaliman, MD

Woman in Tanning Booth

For the past couple of weeks, the local newspapers have been covering the case of Patricia Krentcil, a New Jersey mother who was arrested April 24 after allegedly taking her five-year-old daughter with her to a tanning salon. The next day the child went to school with burns so severe, her kindergarten teacher reported the case to the authorities.

Krentcil denies the charges and insists the child got sunburned at an outing. But she cheerfully admits to going to tanning salons 20 times a month — and it shows in her face. The photos in the newspapers are downright scary. Her face is an eerie dark orange, and the obvious sun damage is so bad she looks at least a couple of decades older than her real age.

Krentcil is an avowed “tanorexic,” a person who has become addicted to tanning. It’s not a made-up addiction — MRI studies have shown that tanning beds can stimulate the same receptors in the brain that respond to cocaine and other drugs, according to an August, 2011 article in the Journal of Addiction Biology. The problem with this addiction is that it is still legal, and anybody who has the money can go to a tanning salon and bake their skin.

More and more states have passed legislation regulating access to tanning salons for minors. Several states bar salons from admitting anybody under age 18. New Jersey isn’t one of them; it bans minors under 14, but allows teenagers 15-17 to use tanning beds if they have written permission from their parents. Teenagers, unfortunately, are some of the most enthusiastic patrons of tanning salons, and the tanning industry has resisted efforts to make the nation-wide minimum age for admission 21 or even 18.

The Centers for Disease Control (CDC) came out this week with an alarming study on how young people continue to court sun damage. According to the CDC, around half of the nation’s young people, aged 18-29, reported having at least one bad sunburn in the past 12 months, whether from outdoor activities or tanning salons. Meanwhile, the incidence of skin cancer continues to rise.

Parents who willfully and knowingly place a small child in a tanning bed should be criminally charged, in my view. It doesn’t just border on child abuse, it is child abuse. In my practice, I’ve noticed a disturbing trend: a growing number of children and teenagers with skin cancers. How any parent can take a child to a tanning salon is beyond me. But then, as I’ve said before, I think tanning salons should be made illegal.

Photo: Stockbyte

Posted by: Debra Jaliman, MD at 11:28 am

Wednesday, May 9, 2012

Plasma Flashlights and Insect Bites

By Debra Jaliman, MD

Going through medical journals this week, two recent studies caught my eye. One was about a novel way of getting rid of bacteria on the skin; the other confirmed what I’ve long thought about insect bite remedies.

Hand sanitizer gels and wipes seem to be everywhere, but scientists are increasingly concerned that their overuse might lead to resistant bacteria. The best way to get rid of germs on your skin is by using good old soap and water and rubbing your hands long enough under the flow of water to scrub the bacteria off. But not everybody takes the time to wash their hands, leading to a perpetual health care problem.

Now researchers in Australia and China have come up with a new concept: the plasma flashlight, which emits a plasma jet that kills all skin bacteria in an instant. It can be transported anywhere and can be used at any temperature. It’s not commercially available yet, and I have my doubts about how practical a home version would be. After all, who would want to trust a six-year-old with a plasma zapper?

But in other settings, this could be a real breakthrough. Hospital infections are carried from patient to patient via hand contact, because most people, even doctors and nurses, don’t wash their hands often enough. But a one-second zap with the plasma flashlight before touching patients might be enough to significantly lower hospital mortality rates. Wouldn’t it be great if doctors could carry a plasma flashlight in the pocket of their white coats?

The second study, done in the U.K., concluded that most remedies for the usual insect bites of summer — midges, gnats, mosquitoes, and fleas — do not work. That includes most of the insect remedies sold in drugstores, from cortisone creams to antihistamine pills. The itch and redness associated with minor insect bites are usually self-limiting, and will go away on their own even if you do nothing. The one thing that researchers found that actually did work to relieve the discomfort from minor insect bites was cold-water compresses. I would add, from personal experience, that ice cubes are also effective.

Of course, allergic reactions to insect bites are another matter, requiring antihistamines and, in extreme cases, the immediate use of epinephrine injections and trips to the emergency room. But this summer, if you or your child get bitten, reach for cold water or an ice cube, not creams or pills.

Posted by: Debra Jaliman, MD at 9:00 am

Tuesday, May 1, 2012

Acne Treatments

By Debra Jaliman, MD

skincare

I’m often asked which treatment is best for acne. The honest answer is there is no one best treatment, for what works best is a combination of treatments.

Acne, especially severe acne, has to be attacked simultaneously from different angles. Dermatologists try to treat pimples, cysts, blackheads, inflammation, and redness — all of which are part of the complete acne picture — at the same time. For example, we have creams that combine tretinoin (Retin-A) and clindamycin, because tretinoin works on the clogged pores that lead to acne, while clindamycin, an antibiotic, treats the skin infection.

The same thing goes for creams that combine benzoyl peroxide, which kills bacteria and increases oxygen to the affected area to speed healing, and antibiotics. And of course, dermatologists often prescribe a combination of creams and oral medications that contain time-released antibiotics. For acne sufferers, time-released oral antibiotics are a great idea because they use lower doses that are constantly attacking the pimples as they form.

For many people, it’s the redness and inflammation associated with acne that bothers them most, and it’s certainly something that should be treated at the same time. One of the most effective treatments is 5% dapsone gel, which can be used alone or in combination with a product that contains salicylic acid.

I’m always bothered by dermatologists who prescribe the same acne treatment over and over for every patient. Acne treatments should be tailored to the individual patient, because the combo treatment that works for one patient will not work for another. Good dermatologists vary acne treatments endlessly, working with their patients until they find the right combination. By the way, acne treatments work best when combined with extraction of blackheads done in a dermatologist’s office, and in cases of cystic acne, cortisone injections into cysts.

Be aware that over time skin can also change in its reactions to acne treatments, so what worked so well six months ago may suddenly cause irritation or fail to prevent outbreaks. When this happens, schedule another appointment with your dermatologist, as you may need a new treatment regimen.

Photo: Hemera

Posted by: Debra Jaliman, MD at 1:50 pm

Wednesday, April 25, 2012

Skin Care Travel Tips

By Debra Jaliman MD

Cosmetics Bag

I just came back from a 10-day trip to North Africa and Europe, where I had a marvelous time. It also reminded me that many of you will probably be traveling soon, so I thought I’d share some travel tips on how to protect your skin, no matter where you go or how you travel.

1) Never wear makeup on a long flight, because it essentially means sleeping in your makeup. And that, as we all know, is a no-no. The only exception I would make is lipstick, as long as it is the moisturizing kind.

2) Cabin air is very dry, so bring lip balm, moisturizer, and a small mister. Misting your face before applying more moisturizer really helps the water molecules to bind to the surface of your skin. Make sure everything is in containers small enough (less than three ounces) to pass through security.

3) Drink plenty of water on the plane. Avoid alcohol throughout the flight, because it is dehydrating.

4) Try to get out of your seat and walk up and down the aisle every hour or so to prevent blood clots. I know, I know — not a skin care tip, but I am a doctor, after all, and blood clots are a real possibility on long flights.

5) Dry, gritty, bloodshot eyes during the flight and upon arrival can be avoided if you have preservative-free lubricating eye drops with you. You want the kind that mimics real tears, not the drops that promise to take the red out of your eyes.

6) Pack a bottle of your favorite mild cleanser in your suitcase and make sure to have a small bottle of your cleanser, plus some cotton squares, in your bag with you at all times. Getting separated from your luggage is a real possibility, and using unfamiliar products can lead to dryness or allergic reactions. I have had so many patients call frantically from Europe with allergic reactions after they used complementary hotel products (which are usually highly fragranced) that I now have a network of dermatologists in major European capitals to which I can refer them. So, be careful with those cute little hotel soaps and creams!

6) Pack an over-the-counter cortisone cream in your suitcase for hives and insect bites.

7) A small tube of Aquaphor healing ointment in your handbag is very useful when traveling to protect lips and hands, and to keep minor cuts and scrapes hydrated to lessen scarring.

8) Bring some moleskin patches for the blisters so many people get after walking through museum after museum.

9) Don’t forget your favorite sunscreen. Believe me, even on cloudy days in London you are getting the same ultraviolet rays that damage your skin back home.

Photo: Bananastock

Posted by: Debra Jaliman, MD at 9:27 am

Wednesday, April 4, 2012

A Few of My Least Favorite Things

By Debra Jaliman, MD

Lipstick

Dermatologists know that there are wonderful, truly effective skincare products being sold in drugstores and department stores. By the same token, we also know that there are some items that, for reasons that mystify me, continue to sell year after year, despite being either useless or downright harmful. Here, in no particular order, are products that I would never encourage my patients to buy:

1) Peel-off strips and masks. Manufacturers promise that these will pull out blackheads and eliminate dead skin, especially around the nose area. What they never mention is these products also damage healthy skin and break blood vessels. If you have any of these strips and masks at home, do yourself a favor and toss them. To get rid of blackheads, use a product with 1-2% salicylic acid every night. You can alternate this with a retinol-containing cream or serum, because retinol encourages skin cell turnover, which means blackheads are less likely to form. It’s best to use any product with retinol or salicylic acid at night, because they increase sun sensitivity. Don’t forget to use sunscreen during the day.

2) Abrasive facial puffs. These are much too harsh for facial skin, which is more sensitive than the rest of the body and should be treated gently. Using these puffs often leads to skin irritation and broken blood vessels, the last thing anybody wants on the face.

3) Nail strengtheners with formaldehyde. The European Union has banned formaldehyde from all nail products, and I wish FDA would do the same. The more upscale nail polishes do not use formaldehyde, but many cheaper brands do, especially in nail-hardening formulations. Formaldehyde is a carcinogen which can cause irritation and allergies, sometimes severe. If your nail polish contains formaldehyde or toluene sulfonamide-formaldehyde resin, just get rid of it.

4) Long-wearing lipsticks. Yes, I understand the attraction of a lipstick that stays on for hours, but most long-wearing lipsticks tend to dry lips and make them peel. In short, you’re not doing your lips any favors by using these.

5) Deodorant soaps. I’ve said it before and I will say it again: deodorant soaps are a terrible idea, since they dry out the skin and cause irritation. Mild soaps or body washes are always best.

6) Waterproof mascara. I see many models and actresses in my practice, so I’ve observed the effects of waterproof mascaras many times. These mascaras tend to dry out the lashes. Eyelashes, by the way, are quite fragile, and when dry, they break easily.

7) Highly fragranced makeup and skin care products. Not everybody reacts to them, but a growing number of people do. I’ve never understood the appeal of perfumed lipsticks and facial cleansers. Keep in mind that even if you are not allergic, you can easily develop sensitivity to fragrances.

8) Topical steroid creams used as facial moisturizer. I’m serious about this, hard as it is to believe. Every week in my practice I see patients who use over-the-counter cortisone creams to reduce redness or rough patches. The creams are safe enough for occasional use on the face, such as for insect bites. But facial skin is very delicate. Regular use of cortisone creams leads to irreversible thinning of the skin, as well as broken blood vessels and white spots. Cortisone creams should only be used under a physician’s supervision.

Bottom line: With so many good options out there, why use products that can harm your skin?

Photo: Pixland

Posted by: Debra Jaliman, MD at 9:44 am

Wednesday, March 28, 2012

New Treatment for Actinic Keratosis

By Debra Jaliman, MD

Skin Cream

Actinic keratosis is the most common precursor to skin cancer. These lesions are most typically found in fair-skinned individuals, and they can appear anywhere on the body or face, even on bald scalps. They are caused by sun exposure and severe sunburns, but they can take years to become apparent. They look like red, scaly patches, and they feel like sandpaper.

Many people shrug it off, thinking it are just a mild cosmetic problem, but actinic keratosis should be treated promptly, because the kesions can turn into squamous cell skin cancer at any moment. The usual treatment is cryosurgery, which uses liquid nitrogen to freeze the lesions, which then typically scab and fall off in a couple of days. Most cases require two sessions of cryotherapy, spaced two weeks apart. It’s a mostly painless procedure, although it may burn a bit.

Topical treatments with prescription creams that patients apply at home are another alternative and are especially useful when there are multiple sites to treat. One of them, 5-FU (5-fluorouracil), is a heavy-duty cream that is actually considered a topical chemotherapy. It’s effective, but it must be applied for several weeks. A common side effect is red and swollen skin, and many people report a burning sensation. Aldara (Imiquimod) is an immune-response modifier which basically stimulates the immune system to kill pre-cancerous cells. It irritates the skin less than 5-FU, but it also takes several weeks. To lessen the chances of irritating the skin, some doctors prefer intermittent Aldara therapy, where patients use it two week on, two weeks off for three cycles. Aldara is frequently used in conjunction with cryotherapy to cover all bases and make sure the lesions are completely eradicated.

All these treatments work, but they do take time—so much time that patients often fail to complete them. Now a new gel may work far faster. I’m proud to say that researchers at Mount Sinai School of Medicine, where I have taught for more than 25 years, have just published a study showing that ingenol mebutate topical gel can take just two or three days, as opposed to weeks, to clear these pre-malignant skin lesions. The interesting thing is that ingenol mebutate is derived from a weed commonly found in Europe and Asia, where it is a traditional folk remedy for skin lesions.

This new topical gel has been approved by the FDA and is sold as Picato, a prescription only medication. Even though some people with multiple lesions may have to use it for a week instead of a couple of days, it seems to irritate the skin far less than Aldara and 5-FU. All in all, it’s an exciting development in dermatology.

Bottom line: A new topical gel may make it far easier to treat actinic keratosis, so don’t put off that visit to your dermatologist.

Photo: Hemera

Posted by: Debra Jaliman, MD at 1:52 pm

Wednesday, March 21, 2012

Fruits, Vegetables, Honey and Your Skin

By Debra Jaliman, MD

Healthy Food

Tired of that gray cast to your complexion? Want to improve your skin tone? The answer may lie in your local farmers’ market.

We all know that eating fruits and vegetables benefits our health. Now a recent study published in the American Journal of Public Health appears to show that eating more fresh veggies and fruits can change the appearance of the skin in just a matter of weeks. British researchers found that adding two extra portions of fruits and vegetables a day for six weeks led to a golden healthy glow, a perceptible improvement seen in participants of all ethnicities.

There’s no doubt that what we eat dramatically impacts our health and appearance. The carotenoids and other flavonoids in fruits and vegetables really can make a difference in the skin. Now that spring is around the corner, it would be a good idea to go to the local greenmarket and start buying fresh produce, organic if possible. Frozen organic fruits and vegetables are an excellent alternative. Use them to make smoothies with water and honey for a quick and refreshing way of getting your daily dose of carotenoids.

Speaking of honey, researchers are increasingly studying its use in wound care. All honey has antibacterial properties, but manuka honey from New Zealand and Australia can be exceptionally healing, depending on its origin and processing. For those who have never tried it, manuka honey is dark and has a strong, distinctive taste that can take some getting used to. Antibacterial activity is measured in an index called the Unique Manuka Factor (UMF). The higher the UMF, the more effective the honey is supposed to be – and also the more expensive, because pure manuka honey is always pricey. I recommend a manuka honey with a UMF of 16 or higher.

High UMF manuka honey works both to prevent skin infections and to clear chronic skin infections. A recent study showed that it is effective on streptococcus, pseudomonas, and staphylococcus bacteria, even on antibiotic-resistant bacterial infections. There are even manuka honey bandages on the market.

I’ve become a big fan of manuka honey. Last year I had a patient with a bad staph skin infection and open wounds all over her body. I tried everything, including the usual antibiotics, and nothing seemed to work. Finally I ordered gauze impregnated with manuka honey and had her use them every day. In two weeks, her infection had cleared up with no scarring.

So it may be worth keeping a jar of UMF 16 manuka honey in your cupboard. Like all honey, it will keep indefinitely, so what do you have to lose?

Bottom line: Fruits, vegetables, and manuka honey can all be powerful allies to your skin.

Photo: iStockphoto

Posted by: Debra Jaliman, MD at 2:41 pm

Wednesday, March 14, 2012

Back to Basics

By Debra Jaliman, MD

Skin Rules Cover

“Good skin is in the details.” That’s what I always tell my patients before I start asking about their skin care routine. How you clean your face, when you apply moisturizer, the kind of sunscreen you use are all factors that impact your appearance and often your health.

Take skin cleansing, for instance. In my new book, Skin Rules: Trade Secrets from a Top New York Dermatologist (St. Martin’s Press), which comes out this week, I go over the right way to cleanse your face. Hint: no matter what cleanser you use, your fingers are not enough. In my book, I recommend using disposable cotton squares to gently rub, not scour, the cleanser into the skin before rinsing with lukewarm water. Pay particular attention to the areas around the nostrils and lips, where dirt and makeup tend to accumulate. If you’ve always used your fingers, try using cotton rounds next time and let me know the result. And yes, you can use a washcloth to get the same exfoliating effect. The problem is, cleanliness is everything when it comes to skin care, and that applies to washcloths and towels. You’d have to use a clean washcloth every time, which is not practical for most people. Disposable cotton rounds are much easier.

If you really want to see a difference, invest in a skin cleansing machine. In my book, I recommend specific brands, but here I’ll just say this: there’s a reason why dermatologists sell the most expensive brand of sonic cleansing machines in their offices, and that’s because it’s the best. Just a couple of weeks using it and patients can really see a difference. Because it exfoliates the skin so effectively, skin looks better and moisturizers and serums penetrate deeper. But it does cost more than a hundred dollars, which not everybody can afford. Don’t despair, because the skin cleansing machines sold in most drugstores also do an effective job. You may not see the outstanding results you’d get with the expensive version, but you will definitely see an improvement.

Pay attention to your cleanser. Forget buying expensive cleansers, because they’re just a waste of money. Go to your drugstore for your cleansers, not the department store. There is such a range of good, inexpensive cleanser on drugstore shelves that everybody can find one for their skin type.  I don’t like bar cleansers because they tend to be very drying, or heavily fragranced liquid cleansers, because they increase the chances of an allergic reaction. In general, when it comes to cleansers, gentle is better. People with oily skin can use exfoliating cleansers or, if their oily skin is sensitive, one with salicylic acid. Most of that salicylic acid is going to be washed down the drain, but it’s been my experience that it helps to remove surface oil.

Bottom line: Good basic cleansing can improve skin and give it a glow.

Posted by: Debra Jaliman, MD at 3:22 pm

Wednesday, March 7, 2012

Wound Care and Scars

By Debra Jaliman, MD

Scar

Everybody has scars: from childhood injuries, from surgeries, from accidents. They are an inevitable part of life, since we don’t live in a safe bubble. But what most people don’t realize is that scars can be minimized, often to the point of near invisibility.

There are two basic types of scars: hypertrophic, which follow the line of injury, and keloidal, where the scarring spreads to the surrounding tissue, forming large bumps and ridges.

Scars are caused by hyperproliferation of collagen. Some people are more prone to scar formation, for reasons that are not altogether clear. People of African American and Caribbean ancestry tend to develop keloids more than other ethnic groups, but the truth is that no ethnicity is immune to keloids. Some areas of the body are more likely to develop keloids: the chest, the back, the shoulders, and the earlobes, probably because the collagen there is thicker to begin with.

To decrease scarring, proper wound care is essential. Any wound, large or small, has to be kept moist. That’s why my first aid kit at home contains antiobiotic ointment, rather than cream, because ointments keep moisture in. Another useful item to have around is a big jar of Aquaphor Healing Ointment, a petrolatum-based product that is both inexpensive and effective at keeping wounds moist. Clean the wound, apply the ointment, then a bandage. This goes for children’s scratches and grazes, too.

Surgical scars should be treated as soon as the sutures are out. People facing elective surgery or who have scheduled c-sections should buy silicone bandages, which change the temperature of the wound area, decrease oxygen, and improve skin hydration. Silicone bandages must usually be used for at least a couple of months, but the results are worth it. Many doctors also use steroid pills or injections to decrease collagen production. People who know they are prone to keloid formation should absolutely discuss this possibility with their doctor before having any procedure.

Once scars have formed, treatment is still possible. Non-ablative lasers, such as the Medlite and Genesis lasers, do a good job of improving the appearance of scars. It does take several treatments, though, and will cost at least a few hundred dollars. Some doctors use cryotherapy, freezing the scar with liquid nitrogen. But since it may affect the color of the skin, it’s not recommended for those with dark skin. Deep scars may require surgery, where the scar is cut out; the resulting scar is usually smaller and less noticeable.

Aldara (imiquimod) cream also appears to discourage scarring after surgery, so it may be worth asking your surgeon for a prescription before you have the procedure. On the other hand, I’m sorry to say that the vitamin E oil so many people apply to their scars is useless; it won’t make scars worse, but it won’t make them better, either, so don’t waste your money. And finally, radiation treatment should only be used as a last resort, since it carries with it the risk of skin cancer.

Bottom line: Meticulous wound care can result in significantly less scarring.

Photo: iStockphoto

Posted by: Debra Jaliman, MD at 9:28 am

Wednesday, February 29, 2012

Leg Hair Transplants and Enzymes in Skin Care

By Debra Jaliman, MD

Hair Loss

A couple of weeks ago I wrote about hair loss and effective treatments for it. I mentioned hair transplants as a method that is rapidly evolving, giving most patients truly natural-looking hair. Until now, hair follicles were usually taken from the back of the head and transplanted to other areas of the scalp. According to a new study out of California, leg hair may work just as well, if not better, in cases of male pattern baldness. One of the problems with hair transplants is that people with hair loss often have limited donor sites. Leg hair transplants may resolve this problem.

In an interview with the New York Times, Dr. Sanusi Umar, author of the report, said his results on two different male patients showed that leg hair transplants made for softer, more natural hairlines, since leg hair is finer than the coarser hair on the back of the head. Harvesting and transplanting the hair follicles is quite a lengthy process–about eight hours under local anesthesia, with breaks for doctor and patient. And any procedure that takes up so much time is certain to be costly. This technique is new and has only been tried on a small number of patients, so I wouldn’t rush out to get it just yet. But it would certainly seem to hold promise, especially for males. For women, there is very little information, because Dr. Umar has only performed this procedure on one woman.

Enzymes in skin care are also in the news. Enzyme supplements are usually sold in health food stores as digestive aids, but lately they’ve also been turning up in creams and serums, too. I personally like products that contain enzymes, because enzymes seem to work well as gentle exfoliants, digesting dead skin cells and revealing a more glowing, youthful skin.

In a way, they’re an old idea that is new again, thanks to modern technology. Pineapple and papaya enzymes are excellent meat tenderizers, as good cooks have known for generations. But fruit enzymes are also good for the skin. In past centuries, women put crushed pineapple or strawberries on their faces, and the fruit enzymes went to work, clearing their complexions. Nowadays, skin care products contain stabilized enzymes that work far more effectively than the homemade fruit remedies our great-grandmothers used.

Bottom line: Enzymes improve skin texture and add radiance, while leg hair, unwanted or not, may hold promise for hair transplants.

Posted by: Debra Jaliman, MD at 8:48 am

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