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Thursday, June 30, 2011

Leg Road Map

Children are so wonderful, aren't they?  They truly light up our lives with their shining eyes and smiling faces.  So wonderful, in fact, that we can almost overlook the changes they cause to our bodies.  Loose, sagging skin, stretch marks, and little winding leg veins are a small price to pay for the glory of motherhood, right?  Um, right?

Thankfully, we can improve those (ahem) little issues that occur after Junior is born.  Let's talk about sclerotherapy, which is a procedure performed in the dermatologist's office for small varicose veins on the legs.  After all, it's summer, and time to wear shorts and skirts!

Sclerotherapy involves injecting solutions into varicose veins to "close the veins down."  They do this by irritating or damaging the lining of the veins enough to form a small clot, which over time, will be replaced by tissue.  Different agents are injected to acheive this, including: hypertonic saline, sodium tetradecyl sulfate (STS), polidocanol, and glycerin.  Currently, STS and polidocanol (Asclera) are FDA approved for the treatment.  Which solution to use depends on the physician's preference and the size of the vein being injected.

The treatment session usually lasts 30 min-45 min.  There very minimal discomfort during the procedure, which is often dependent on which solution is injected.  Asclera tends to be more comfortable than hypertonic saline.  Compression stockings are sometimes worn after the treatment.  Usually, 2-3 sessions are recommended for best results, but veins will improve even afte the first treatment.  Pregnant or nursing women should not have sclerotherapy.

Having kids doesn't mean you're destined to hide your legs for the rest of your life.  Like I always say, "Ain't nothing vain about treating veins!"

Tuesday, June 28, 2011

Sweating is the Pits

Summer and 4th of July!  Hot dogs, ice cream, pools, fireworks, and for some, shirts with soaked underarms?  There's nothing fun about having to avoid wearing certain fabrics, or colors, or styles of shirts because you just know that in an hour there will be large dark circles under your arms.  And in the south Florida heat, sweating is a given.

But there are solutions for severe underarm sweating.  Both over-the-counter and prescription topical solutions, usually consisting of aluminum chloride, are often prescribed.  But when they fail, it's Botox to the rescue.

"But Doc," you may say, "isn't Botox for wrinkles?"  Yes, it is.  And it's also FDA approved for primary axillary hyperhidrosis (ie severe underarm sweating).  Dermatologists inject small amounts under the skin in the underarms.  Significant improvement and reduction of sweating is usually seen within 1 month of treatment; often sooner.  And results last approximately 6 months. 

Now, that's worth raising an arm about!

Monday, June 27, 2011

Saving face

I was looking at old pictures of my daughter the other day.  Even though she is only 17 months old, her face is already starting to transform from baby to young girl.  She is losing the chubbiness of her cheeks, the roundness of her face.  Tear - my baby is growing up!

Our face is constantly changing as we age.  But the transitions are more complex than just getting wrinkled.  Have you ever seen a person in their 50s or 60s with perfectly smooth skin, yet somehow they still look old?  The reason is because the structure of our face changes dramatically with time, not just the surface of our skin.  So what happens to our faces?

The bones of our face act as a foundation.  Just as a house sags where the foundation is weak, so does our face (nice, right?).  With time, the bones around our eye sockets receede, contributing to the hollows around our eyes.  Our temples become hollow.  Our upper and lower jaw bones atrophy, decreasing the size of our lower face, and making jowls appear.  Our chins get smaller.  This skeletal resporption changes the proportion of our face, making us look older.  Enter scrulptra and radiesse, two fillers available right now, approved by the FDA for naso-labial folds.  They are used off-label for full facial volumization, injected to help replace the bone loss.  When used properly, they can change the shape of the lower face, allowing a more youthful look.

Above our bones, we have fat.  These fat pads form our cheeks.  When they atrophy, our cheeks become hollow, making our naso-labial folds (the lines on the sides of our mouths) look deeper.  The hollows make us look tired.  Scultpra and radiesse can be used here to restore our cheekbones to their previous glory, in addition to the hylauronic acid fillers: juvederm, restylane, and perlane (all off-label uses).  Hyaluronic acid fillers also work well to fill finer lines and lips (again, off label).  I'll blog more about these separately. 

In addition to the structure of our face, there are surface changes as well.  With time, we lose collagen and make more elastin (think rubber bands....stretchy, saggy).  The more sun exposure you've had in your lifetime, the more loose your skin will be, and the less it "snaps back."  Add in lines from movement, and it equals crow's feet, pucker lines around the upper lip/lower lips, glabellar lines ("eleven lines" between the eyebrows), and forehead lines.  These are corrected with botox and dysport (although they are only FDA- approved to treat glabellar lines; all other uses are off-label).  Plus, the sun causes brown spots on the face and dilated blood vessels, especially around the nose.  For these, often a combination of lasers (like the Fraxel or Active FX, peels, and cosmeceutical creams help.  For saggy areas, Thermage, a radiofrequency device, tightens by using heat to stimulate collagen formation.   

Aging is inevitable.  I see it daily at both home and in my office.  But luckily, modern medicine can help us acheive a natural, healthy look: a volumized face and skin (almost) as soft as a baby's bottom!

Friday, June 24, 2011

Emergency!

Almost weekly, I will get a call in the office for a patient that needs to be seen for a skin emergency.  Jerry Seinfeld would joke, "What, an emergent pimple?"  (Remember the pimple popper, MD episode?)  In a word, yes.  Usually, the patient is coming in for an infected sebaceous cyst that has become an abscess.  By the time they're seeing me, it's usually because it's grown in size and become extremely painful, and they need treatment, stat!

What is a sebaceous (epidermal) cyst?  It's a closed sac under the surface of the skin that contains material called keratin, which looks like a white, cheesy material.  They can be located almost anywhere: the face, neck, trunk, and groin area are usually the most common.  They are usually caused by genetics, damage to hair follicles, and ruptured sebaceous (oil) glands, commonly seen in acne.  In general, sebaceous cysts are benign growths, and usually, don't need to be treated.

But sometimes, because of the cyst location, or trauma, or other factors, the cyst becomes inflamed: red and tender.  If it's a small cyst, and doesn't look infected, the dermatologist may treat with with a steroid injection.  But if it looks infected, then it will need to be drained.  A small opening is made in the abscess and the infection will drain out.  Often, antibiotics will be given as well for treatment.  It's very important to have an abscess treated by a dermatologist, or the infection will fester and could possibly spread into the blood. Because drained cysts tend to recur, surgical removal of the cyst may be planned once the infection has been treated.

I should point out that other things, such as skin cancers, can look like lumps or bumps under the skin.  Any growths should be checked by a dermatologist.  But Jerry Seinfeld already knew that. 

Thursday, June 23, 2011

Beautiful Girls

Halle Berry.  Michelle Pfeifer.  Megan Fox.  Chances are, when you hear these names, you think of the word beauty.  But what makes us label these women as beautiful?  Many people will say that symmetry is what makes people look beautiful.  To a certain extent, this is true.  Our eye is automatically drawn to what is abnormal, or "stands out" on someone's face.  An imperfection or asymmetry on one side of the face is often considered less appealing.  Think of Austin Powers, where Mike Myers can't stop focusing on the "moley moley moley mole."  Or when you have a large pimple on your face and you feel like everyone in the world is staring right at it.  But symmetry is not the whole answer.  If you cut a photo of someone's face in half and superimpose one half on the other, you'll see that even the most "beautiful" people's faces are not perfectly symmetric.  Conversely, if you computer generate a person with both sides of their face in perfect symmetry, they actually just look...wierd.

Often we consider certain features to be more attractive.  High cheekbones, wide eyes, full lips, white, even teeth.  But what about people whose features don't conform to that?  Think of Lauren Hutton's gap in her top teeth, or Angelina Jolie's large lips, or Brooke Shield's thick, heavy eyebrows.  All considered beautiful women.

So what else?  Proportion plays a large role in shaping our perception of beauty.  Dr. Stephen Marquardt talks about the "Golden Ratio," a certain proportion found in nature (1.618:1) that describes the proportions seen in the ideal, or beautiful face.  He says that this ratio is constant in beautiful faces, regardless of culture, race, or era.  The distance between the eyes, between the nose and the upper lip, and the size of the upper lip to the lower lip have all been measured and described as what is the "ideal" distance.

I personally think that the concept of beauty is too complicated to explain with a single number, or a single answer.  I think it's a combination of facial symmetry, facial volume, proportion of features, shape of individual features, clarity and texture of skin and hair, brights of the eyes, etc.  And one important feature that can't be fixed with botox, fillers, lasers, or peels: personality!       

Wednesday, June 22, 2011

Best Sunscreen for Kids

Before we go any further: the best sunscreen for kids is the one you can actually get them to stay still for you to put on them!  But assuming you have a cooperative little one, what sunscreen should you choose?  An ideal sunscreen for kids should protect against both UVA and UVB rays, be gentle and non-irritating, stays on the skin, and be easy to apply. 

Both chemical and physical sunblocks (and a combination of the two) are available on the market.  There's a lot of controversy about chemical sunscreens and the possible association of cancer, particularly with oxybenzone and retinyl palmitate.  Although there is no conclusive evidence of this, I personally recommend using a chemical-free sunscreen on kids, for a few reasons.  First, as a mom, I think the less chemicals kids are exposed to, the better.  Second, many chemicals (like PABA) are irritating and cause rashes - especially for kids with sensitive skin or eczema, which many have.  And finally, chemical sunscreens need to be applied 30 minutes before going outside because they have to be absorbed by the skin to work, whereas physical blockers sit on top of the skin and start working immediately.  With any sunscreen, make sure you reapply frequently, especially when swimming or sweating.

So which do I recommend?  One brand I love is the Skinceuticals physical UV defense.  My other current favorite is the MD Solar Science line.  They carry a physical gel sunblock, and a physical cream sunblock - with and without tint.  They also carry a spray and stick sunscreen (which are great as well - especially for men who hate putting creams on), but these are not chemical-free.  Their products are recommended by The Skin Cancer Foundation. The website is http://mdsolarsciences.com/  And in case you're wondering, I do not work for the company and they are not paying me to write this! 

Other things to keep in mind: sunscreen is not recommended for babies under 6 months of age.  And even with older kids, the best defense against sunburn is limiting sun exposure during peak hours.  Remember to put hats and sun protective clothing on your kids.  One brand I love is Coolibar, but there are lots of great ones out there.  Have a fun summer, but be sun safe!

Those Pesky Mollusks

Ah, summer.  Time for kids to run around outside, swim at the pool, share toys and good times with friends, and - wait, what's that little white bump on Junior's cute little belly?  Hold on, what are ALL those little bumps on his belly, and armpit, and arm?

The dermatologist confirms it: Junior has molluscum contagiosum.  Moll-what?!

Molluscum contagiosum is a common condition caused by a type of virus called a poxvirus.  As the name implies, it's contagious.  Kids pass it on to each other by direct skin-to-skin contact.  Swimming pools are often associated with infection.  While any child can get it, kids with eczema or atopic dermatitis are at higher risk, and the mollusum often shows up in the same areas affected by eczema.

How is it treated?  Well, sometimes they're not treated at all.  Molluscum will often go away on their own, but it may take up to two years.  Applying surgical tape daily to the spots has been reported as a successful treatment in some.  Other treatments include topical retinoids, scraping (curettage) the lesions, freezing with liquid nitrogen, and applying a topical cream called imiquinod.  An often successful treatment is applying cantharadin liquid in the doctor's office, that is then washed off after 4-6 hours.  It causes blistering of the molluscum and then resolution.  It's up to the doctor and the parents to decide which treatment plan would be best. 

Oh, look, Junior's smiling again.  Oh, he's laughing, how cute.  Wait, what's on the roof of his mouth?  Hand, foot, and what?!

Tuesday, June 21, 2011

The Skinny on Skin Care

One of the questions I often get asked is "What should I be using as a daily routine?"  You maintain your body, your home, your car, your life - and your skin is no different.  It needs to be on a regimen to look and feel its best.  But with all those products out on the market, where do you start?

The number one most important thing you should use in your skin care is SUNSCREEN.  Wait, did I write that big enough?  Let me repeat it.  SUNSCREEEEEN!  And I don't mean a tiny little dab on each cheek so that your face can still get "a little color."  You need to coat your face (use an amount the size of a teaspoon).  The sunscreen should be at least an SPF 30, and should be labeled "broad spectrum," which means it blocks UVA (rays that cause cancer) and UVB (rays that make you sunburn).  It can contain chemicals, like oxybenzone, or physical blockers, like titanium or zinc, or both.  Some brands I like are MD Solar Science, La Roche Posay Anthelios, Skinceuticals, Neutrogena Ultrasheer with helioplex, and Cetaphil.  And for those of you who still don't believe in sunscreen or sun protection, swing by my office and I'll be happy to show you some gory skin cancer photos.   

Second, I always recommend a great moisturizer chock full of antioxidants.  Antioxidants help repair damaged tissue by blocking free radicals. Look for creams that contain vitamin C, vitamin E, coffeeberry, polyphenols (found in green tea), resveratrol (found in red wine), niacin, and coenzyme Q10.  Some brands I love are NIA24, Revale Skin, Oil of Olay ProX, and SkinMedica.  SkinMedica's TNS Essential Serum combines antioxidants with growth factors for even more anti-aging power.

Thirdly, I am a big believer in retinoids.  Retinoids are derived from vitamin A and have lots of science proving their efficacy in skin repair.  Topical retinoids diminish fine lines by stimulating collagen formation, help to even discoloration and skin tone, and unclog pores (blackheads).  Retinoids are often prescibed in pill form to treat psoriasis, prevent skin cancers in patients with weakened immune systems, and to treat severe acne (accutane).  Using a retinoid at night helps to round out a strong skin care regimen.   For people with sensitive skin, it may be too irritating to use a retinoid product every night.  And pregnant or breastfeeding women should never use retinoids.  Renova is a presciption strength retinoid; RoC Retinol Correxion Deep WrinkleNight Cream is a good over-the-counter alternative.

Before starting a regimen, see a dermatologist to fine tune products for your specific skin type to get maximum results.  It's never too early - or too late - to start taking care of your face!

Monday, June 20, 2011

Welcome

Welcome, friends.  The skin is our largest organ, and it's an amazing one at that.  Think of all it does - it encases and protects our internal organs, regulates our temperature, and protects us against harmful bacteria and viruses.  It heals when cut, stretches to different lengths, withstands heat and cold, and is constantly renewing itself.  And it withstands our abuses- sunburns, smoking, exposure to chemicals, poor diet- although often, not without consequences.  Lines, spots, blotches, hollows, rashes, bumps and lumps all seem to creep up over time, and that's where I come in. 

I love what I do.  To me, dermatology is so interesting, and in the fast paced world of medicine, there is always more information, newer technology and innovative techniques.  I decided to start this blog to share knowledge and here and there, sprinkle in my two cents on life in general.  Let's have some fun!