Bottom's Up

Those little baby tushies.  They’re so adorable, aren’t they?  Dimpled and sweet… but there’s nothing cute about getting red and raw from the dreaded diaper rash.  Even the most easy-going baby will fuss, cry, and try to torpedo off the changing table when it’s time to change their diaper. 

Most babies will develop a rash in the diaper area at some point in their infancy.  It’s usually caused excessive wetness and friction.  Feces, urine, fragrances, wipes, and infections with bacteria or yeast are often culprits.

Rashes can be avoided by changing diapers frequently.  The more contact the skin has with urine and feces, the more irritated it becomes.  Exposing the skin to air helps to keep it dry, and gentle cleansing with cotton balls dipped in warm water, or fragrance free wipes for sensitive skin can be used.  Protective creams like Desitin, Vaseline, and A&D ointment protect the skin barrier and help to heal the skin.  Pediatricians and dermatologists may recommend oral or topical antibiotics if there is a bacterial infection.  Yeast infections can be treated with prescription topical anti-yeast creams.  Occasionally, a mild cortisone cream is recommended for severe inflammation, but these must be used under physician’s supervision.  When the diaper occludes/covers the skin, the effects of the cortisone cream are increased.  The skin in that area is already very sensitive, and too much cortisone can cause problems. 

When is a diaper rash not a diaper rash?  Other conditions, such as psoriasis, seborrheic dermatitis, nutritional deficiencies including zinc, and other more rare conditions can present in the diaper area.  Any rash not responding to treatment needs to be evaluated by a pediatrician or dermatologist.  

We love our babies’ bottoms.  Let’s keep them dry, clean, and rash free!    

Hot Beef Fat Injection

Recently, a woman in Illinois went to the hospital complaining a burning sensation to her face.  She had injected fat into her face that she obtained after boiling beef in her house.  And reportedly, had done it several times before.  Although the autopsy ruled another finding as the cause of death, the story brings up the question - do you know what you're injecting?

Injecting foreign substances is not a new thing.  Cases of paraffinoma, where paraffin, cottonseed or sesame oil, and beeswax are injected into the skin have all been reported.  Ulcerations or red bumps can envelop these foreign substances and can show up months to years after the inital injection.  Liquid silicone has been used for the correction of scars, wrinkles, and plumping up hollowed areas of skin.  Skin reactions can include red bumps and nodules, and swelling.  While medical grade silicone (Silikon) is still used, it should be injected in very small amounts, usually as microdroplets, to avoid an inflammatory response.  Injections of mercury into the skin have been reported in the past.  It can cause red, inflamed tissue or fat necrosis (death).  Systemic toxicity can result in death. 

The intoduction of fillers to volumize the face has revolutionized the beauty industry.  With many choices of filler products, dermatologists have the opportunity to really rejuvinate and revolumize faces.  But it's so extremely important to have a board-certified physician inject FDA approved materials.  I've seen people who have received injections of unknown substances by "friends" at "house parties," or other locations.  When complications arise, the injectors have no idea what to do, or they've suddenly disappeared, and patients come to our office for treatment.  While fillers are safe and effective if injected properly, complications such as nodules, swelling, infections, and tissue necrosis may occur, and the risks increase tremendously with untrained injectors and unapproved substances. 

An article in the September issue of Journal of the American Academy of Dermatology highlighted the danger of counterfeit filler available on the internet.  The authors ordered a "permanent" filler online.  The filler was branded as Aotisei, which is a recalled product, as the producing company went out of business in 2007.  The filler was in a seemingly sterile pouch labelled with the words "STERISE" and "Deel at Comer," likely meaning "sterile" and "peel at corner."  There were Chinese symbols on the pouch.  There are also illegal, unliscensed botulinum toxin products available on the internet - on 34 different sites.  Even more sites sell unliscensed dermal fillers.

The FDA has strict regulations regarding botulinum toxins and fillers, and only FDA-approved products should be used.  Please be sure you see a board certified dermatologist or plastic surgeon experienced in cosmetic treatments.  You only have one face, and it's precious! 

Dr D's favorite things

Raindrops on roses and whiskers on kittens, botox in foreheads and aquaphor with mittens; Boxes of restylane tied up with string, these are a few of my favorite things!  I'm no Oprah, but I can still share some of my favorites...

My fav sunscreens: MD Solar Science - love the texture, the tint for the facial sunscreen, that it's chemical free, and that it's gentle on sensitive skin and those prone to acne/rosacea.  La Roche Posay Anthelios has a light texture and works well as a moisturizer, too.  SkinMedica's Enviromental Defense sunscreen is a perfect post-laser and procedure sunscreen. 

My fave face night creams: SkinMedica TNS Essential Serum is one of the best -  the Mercedes of creams.  Antioxidants and growth factors in a silky serum to help combat damage from the sun and aging.  I also love NIA 24's Intensive Recovery Complex with 5% pro-niacin to repair sun damage, brighten skin tone, and smooth fine lines.

My fave anti-aging product: Renova cream.  Available by presciption only, renova is a vitamin A cream that is applied nightly and helps improve fine lines and the texture of the skin.  With years of reseach and science behind them, vitamin A derivatives are a tried and true trick of the anti-aging trade.

My fave eye creams: Revale Eye Therapy with 1% CoffeBerry - a potent antioxidant.  The caffeine in it helps to tighten and reduce puffiness, too.  SkinMedica's Illuminating Eye Cream is great for rejuvinating the underye area.

My fave fillers: with so many options, it's hard to decide!  I love Restylane and Juvederm for lips, parentheses lines around the mouth (nasolabial folds), and hollows under the eyes; Perlane and Radiesse for cheekbones and "marionette lines" (lost volume under the corners of the lips and jaw); Sculptra for overall thin and hollowed faces; Radiesse and Sculptra for hand rejuvination; and Sculptra for wrinkled chests.  All of above fillers are only FDA approved to treat nasolabial folds.

Botox and Dysport are like your kids - they are a bit different but you still love them equally.  I use them both and think each is very effective and safe for wrinkles caused by movement.

Finally, lasers: Fraxel Dual Re:Store is amazing for brown spots and sun damage, and stimulates collagen growth.  Intense Pulsed Light treatments treats brown spots as well as blood vessels from sun and conditions like rosacea.  The Active FX/Deep FX laser dramatically improves sun damaged, wrinkled skin as well as texture and pigment irregularities.  Thermage uses radiofrequency to tighten loose skin and stimulate collagen.

When the kids cry, when the food burns, when I'm feeling sad, I simply remember to put on my creams, and then I don't feel so bad!

Stress and the skin - just say ohm

A collective sigh of relief came across the country last week.  Was it the rebounding stock market?  The avoidance of disaster from Irene?  Or the fact that Kim Kardashian is finally married?  Alas, no.  Parents everywhere are rejoicing that school has started.  And with one less thing to stress and worry about, everyone should now have clear skin. 

"What do you mean, Doc?" you may say.  "Stress can affect skin?"  You betcha!

When we're stressed, our bodies produce more of a hormone called cortisol.  We need that hormone in stressful situations- if we're in danger, about to be attacked, our body responds by saying "run!  escape!" and that cortisol kicks us into high gear.  But when constant low levels of cortisol are released, it is not a good thing. 

Stress can:
increase hair loss
make psoriasis worse
flare acne and rosacea
cause hives
precipitate a shingles outbreak
bring out cold sores
weaken the immune system, making it harder to fight infections
worsen eczema
lead to picking and pulling of skin/nails/hair

But there are ways to manage stress in our lives.  Exercising daily and eating a well balanced diet full of fruits, vegetables, and whole grains combats fatigue and stress, and increases energy levels.  Yoga, breathing exercises, and a few minutes of mediation daily help to lower cortisol levels.  Limiting alcohol and not smoking are important to keeping a healthy glow to the skin.  Spending time with family, friends, and pets builds connections and a strong emotional support system.  Hobbies, like gardening, or painting, are soothing and calming.  Find something you enjoy and look forward to, and make time for it.

As a mom, wife, daughter, friend, sister, and physician, I know how hard it is to try to balance it all.  It's important to take a moment for yourself and create calm in your day.  Stress is impossible to avoid all together - but reducing and managing it is key for a healthy mind, body, and complexion!

the dreaded "i" word

Recently, I saw a little boy for a rash on his face.  His mother, impeccably dressed and coiffed, turned to me and said, "Doctor, is it-" she paused, looked around to make sure no one was around, and continued in a hushed voice, "impetigo?!"  Her eyes were filled with horror. 

Oh, the dreaded "i" word.  It strikes fear in the hearts of parents everywhere, who know that their child will swiftly be sent home from school/daycare/camp/etc if those contagious honey crusts show up on their little angel's face.  Okay, so maybe that's a little bit of a dramatization...

What is impetigo?  It's a superficial infection of the skin caused primarily by two types of bacteria: staphylococcus aureus, streptococcus pyogenes, or both.  It tends to affect preschool children and young adults.  Usually it starts as red areas on the skin that become little blisters filled with fluid, which then burst and dry as golden, honey yellow crusts.  Sometimes kids can have fever and enlarged lymph nodes, but more often, they feel fine.  Often the face is involved, but arms, legs, buttocks, fingertips, and toes can be involved as well.

Why does this happen?  These two bacteria can live on the skin and in the nostrils of the patient and/or the patient's family members.  The bacteria then overgrow in certain areas of the skin, causing the rash and blisters. 

A dermatologist will usually culture the skin or the nose or throat, and will treat with both topical and oral antibiotics.  All the family members should be treated as well, because they may be carriers of the bacteria.  Since impetigo tends to recur, prevention with antibacterial washes can help, too.  Treatment with antibiotics is almost always sufficient.  In very rare of strep impetigo, kidney infections or scarlet fever can occur, so it's important to see a dermatologist or pediatrician for treatment.

Junior did not have impetigo.  For now, at least... 

 

the pimple that's not a pimple

It seems like a pimple on the nose.  Only it's been there for 3 months.  And sometimes it bleeds.  And when squeezed, nothing seems to come out of it.  What's up with this wierd pimple?

This "pimple" has a funny name.  It's called basal cell carcinoma.  And it's not a pimple; it's a skin cancer.  The most common type of skin cancer, in fact.  According to the Skin Cancer Foundation, an estimated 2.8 million are diagnosed annually in the US (check out http://www.skincancer.org/Skin-Cancer-Facts/ for some great info).  It tends to show up on sun exposed areas, like the nose, ears, and chest.  Although it almost always is limited to the skin, basal cell carcinoma can be locally destructive if not treated. 

Depending on the type and location of the basal cell carcinoma, different treatment options can be used.  Superficial basal cells may be treated with a cream called imiquimod that is applied 5 times a week for 6 weeks.  Or, a scraping procedure called electrodessication and curettage (ed&c) can be performed in the dermatologist's office.  Larger or infiltrative basal cells can be excised in the office under local anesthesia by the dermatologist.  Very large basal cells, or ones located on the nose, lips, ears, or close to the eyes, where there is not a lot of tissue available, may be removed by the Mohs procedure.  This is a special type of skin cancer surgery where tissue is removed and checked under the microscope while the patient is still in the office.  Once the Mohs surgeon has determined that all the skin cancer has been removed, the area is stitched up.  Mohs surgery has a very high cure rate.  Usually dermatologists who perform this procedure have an additional year of training after residency to become experts in Mohs.      

Once someone has had one basal cell carcinoma, they are 50% more likely to develop a second one.  As this type of skin cancer is directly related to sun exposure, protecting your skin from the sun is a great way to prevent their development.  Proper sunscreen use of a broad spectrum UVA/UVB sunblock is essential.  Clothing, such as hats and shirts, that are specially treated to have a UPF (ultraviolet protection factor) of 50+ can really help protect your skin from the sun.  See my recent interview on NBC6 on sunprotective clothing on our website, www.southbeachdermatology.biz for more information. 

Any "pimple" that doesn't go away, bleeds, itches, crusts, or grows needs to be seen by a dermatologist to make sure it's not a skin cancer ASAP.  Remember, one in five Americans will develop skin cancer in the course of a lifetime.  Stay on top of your skin - it's the only one you have!

Wrinkles and lines and creams?! - oh my!

Some new things are happening, and it's nothing to furrow your brows at.  A novel fighter in the war against forehead wrinkles is about to come on the market.  And studies are promising for a topical (read: CREAM) to treat forehead wrinkles.

There's Botox, there's Dysport, and now there's... Xeomin.  It was approved by the FDA in July 2010 for the treatment of blepharospasm (eyelid spasm) and cervical dystonia, but hasn't received the approval for cosmetic use just yet.  One of the main differences between Xeomin and the other two neurotoxins is that it's a "naked" toxin.  This means it doesn't have any stabilizing proteins around the toxin molecule.  Does this matter?  Maybe, maybe not.  On one hand, the less proteins, the less chance a person will develop antibodies that may make the treatment less effective.  On the other hand, studies have shown that once the powder that the toxin comes in is mixed with saline to form a liquid, 85% of the proteins separate from the toxin (before it is even injected into the patient). 

But this is America, and competition is always good.  Once Xeomin receives it's cosmetic FDA approval, it will be a welcome addition to our tool box.  But what about people that don't want injections?  Is there an option for them, too?

Currently, phase 2 trials are being conducted where a neurotoxin gel called Revance is being applied to crow's feet, and the results are promising.  In one of the studies, results lasted for 115 days.  The current plan is for the gel to be applied in doctor's offices.

The great thing about medicine is that it's constantly changing.  New products, new procedures, and new techniques are always emerging.  We're getting closer and closer to outsmarting aging.