SKIN CANCER IN SKIN OF COLOR

True/False? I do not sunburn easily therefore I do not need to get my skin checked regularly.  

True/False?  I have darkly pigmented skin so I cannot get skin cancer.

All of the above are FALSE statements!

You may not hear as much about skin cancer in patients with darker skin types but many skin cancers are, in fact, MORE common in skin of color.  Also many diagnoses are made at a later stage of the cancer making it harder to treat/cure.  This is due to many reasons.  

The typical patient who asks for a full skin exam is a patient with fair skin who has had many bad sunburns over their lifetime.  Don’t get me wrong, that type of patient is at significantly higher risk for skin cancers than patients who have never had burns.  However, if we only worry about those who have had bad sunburns we miss a large portion of people who could present with a treatable skin cancer.  

Many patients with skin of color are not aware of the types of skin cancers that they are at an increased risk for thus unaware that full skin exams could benefit them.  

I hope to educate on skin cancer in skin of color and save some lives in the following paragraphs by bringing more attention to what skin changes need attention.  If you or a friend or loved one has something like this on their skin, encourage them to see their board certified dermatologist. 

Basal Cell Carcinoma (BCC)

The MOST common skin cancer in caucasians but less common in patients with darker skin types like African Americans, Hispanic, Asian populations.  It often is described as a pink, pearly, shiny bump, BUT in darker skin types it can be a shiny DARK bump(a pigmented Basal cell carcinoma).

Squamous Cell Carcinoma (SCC)

The SECOND most common skin cancer in caucasians but more common than BCC in African Americans/Asians/Hispanic patients.  This can present as a crusted bump, often tender, and can grow slowly or quickly.  Sometimes HPV Human Papilloma Virus is found to be the cause of the cancer. Other risk factors are burns, radiation, old scars. Squamous cell carcinoma can be deadly if not treated especially if on the lip or ear.  It can also be found on a finger or around a nail and get mistaken for a fungus or other rash for a long time before being accurately diagnosed.  So if you have a crusted bump on your leg that is tender or a single finger with redness and scaling skin, you should call your board certified dermatologist to be checked.

Melanoma

Melanoma is the most life threatening of the skin cancers mentioned so far.  Though the number of new cases is higher for caucasians than patients of color, the prognosis is often worse for skin of color patients because the diagnosis is not made early enough.  Melanoma can be a dark expanding mole anywhere on the body.  It can occur where the sun has never shined.  It can occur beneath underwear, beneath a bra, on the palm/sole skin, or in a nail.  If you have a new dark band on a single nail you should call to have it checked.  Some patients with more skin pigment can have pigmented bands on multiple nails and this can be normal, but still worthwhile to get it evaluated.

Cutaneous T Cell Lymphoma (CTCL)

Overall this is rare but this skin lymphoma is more common in African Americans than in Caucasians.  It appears as subtle scaling patches around the hips.  It can be asymptomatic especially at this early stage.  It can be hypo pigmented (meaning slightly lighter than your skin color)  Anyone with scaling patches around the midsection, especially if you are >50 years old, should be evaluated.

Kaposi’s Sarcoma

Again, African Americans have a higher rate of this skin sarcoma than caucasians.  It can be endemic to patients from African/Middle eastern countries.  It can be related to HIV/AIDS and in general is seen more often in immunosuppressed patients.  Similar to CTCL(lymphoma above) it can be asymptomatic and present as dark patches of skin especially on the lower legs/feet that never resolve.  If you have dark patches that remain on your legs/feet you need to be seen by a dermatologist.

Dermatofibroma sarcoma protuberans (DFSP)

This represents 10% of skin cancers in African Americans.  It often presents as an enlarging deep, firm bump.  If you have any atypical appearing “keloids-esque” lesions in non-traumatized areas these should be evaluated.  It can be very difficult to get clear margins during surgical treatment.  Please get your skin checked.

In summary, please do not hesitate to ask for a full skin exam.  Even if you have more concerns than can be addressed in a single visit, make that next appointment to be checked from head to foot.  The same sun precautions apply to all skin types.  

Perform routine self skin examinations so you can know your own skin.

Wear Sunscreen SPF 30+ and reapply every 2 hours

Avoid sun between hours 10am-2pm when possible

Wear UV absorbing sunglasses(you can get ocular melanoma)

Avoid tanning beds

 

Written by Andrea LaTorre MD

a board certified dermatologist at Central Ohio Skin & Cancer

WHEN A ‘CYST’ ISN’T A CYST!

WHEN A ‘CYST’ ISN’T A CYST!
 
Most people have not heard of the term Merkel Cell Carcinoma before. It was first described in 1972, which isn’t all that long ago, and is an uncommon, aggressive tumor. Merkel cells are found in the basal/lower layer of the epidermis in normal skin.  They are thought to function as part of our touch receptors. However, when they grow as irregular masses they can be deadly.
 
Most Merkel cell carcinomas are found on the head and neck with extremities being next most common. This dangerous tumor often presents as a bump beneath the skin that seems cyst-like. The high predisposition for head and neck leads us to believe that the highly sun-damaged skin is most vulnerable. Approximately 400 cases are diagnosed each year in the United States. Most of these 400 cases are found in men in their 60’s-70’s. However, it rarely has occurred as young as 7 years old and some studies have found more equal male:female ratio. Patients with a history of basal cell carcinoma, squamous cell carcinoma, or melanoma are more at risk for Merkel cell carcinoma than someone with no history of a prior skin malignancy. Immunosuppression also increases the risk. 
 
If a Merkel Cell Carcinoma is suspected and/or a biopsy is performed on a suspicious growth, a dermatopathologist will evaluate the lesion under a microscope. Merkel cells have certain diagnostic markers that aid in making the diagnosis.
 
Frequently, the diagnosis is made when a patient already has metastatic disease present. Survival is 58-79%. Merkel Cell Carcinoma is the deadliest skin cancer with a higher fatality rate than melanoma. Certain risk factors are associated with a lower cure rate: head/neck location, male gender, over 10+ mitoses(dividing cells) per high power field, and blood or lymphatic invasion.
 
This informative post is meant to increase awareness that not all ‘cyst’-like bumps are benign. Though this is a rare tumor, I want to stress these take-home points.
 
-It is ALWAYS okay to get a presumed cyst checked by a dermatologist.
-NEW cyst-like bumps in MEN in their 60-70’s should ALWAYS be checked!
-Any bump that is changing or causing symptoms(pain, itch etc) should be checked
 
Written by Andrea LaTorre MD, a board certified dermatologist at Central Ohio Skin & Cancer

Retinol Fact vs Myth

Sunscreen and Retinol: 

The MOST Essential Ingredients in any skincare regimen

Sunscreen should be a no-brainer at this point.  Everyone has heard that the sun’s UV radiation causes sunburns, skin cancer, and photoaging.  Sunscreen is an essential morning skincare routine to implement if you have not already.  Do not spend hundreds of dollars on neurotoxins(Botox, Dysport), lasers, and fillers if you are not prepared to also wear sunscreen.  The sun breaks down our collagen causing more sagging, yellowing skin over the years.  Lasers and microneedling can encourage your own body to make new collagen to recover from the sun’s damage, but prevention with sunscreen is essential.  Fillers rejuvenate by adding volume and contouring where our aging depletes volume.  Bone structure, facial fat pads, and collagen loss all happen with each passing birthday but the sun speeds up these aging changes.

As mentioned above, sunscreen is vital, but my absolute favorite thing to talk about is probably retinol with my patients.  Retinol is an under-appreciated addition to a skincare routine.  Retinoids are synthetic derivatives of vitamin A. The retinoids that have been designed in a laboratory are adapalene, tazarotene, and retinoic acid(tretinoin, retin-A).  These laboratory derived retinoids are more stable than the over-the-counter retinoids.  

What can Retinol do for me?  Retinoids regulate growth of epithelial cells, suppress tumor promotion, inhibit breakdown of collagen, stimulate skin cells(fibroblasts) to increase collagen synthesis, improve acne, diminish pores, remove blackheads/whiteheads, improve mottled hyperpigmentation, improve tactile roughness, and improve fine lines/wrinkles.  In summary, it helps facial concerns from age 12-100+years old, in men and women.  It begins by being useful in treating acne and then it becomes helpful for preventing aging changes on the face as the years go by.  I try to encourage all young patients to continue on their retinoid regimen even after their acne is improved.  Insurance often does not cover prescription retinoids after teens/20’s because they are viewed as anti-aging.  Our office has all strengths of retinoids for approximately $70-95.  Just a single tube of Rx strength tretinoin can last 6-12 months depending on how often it is used so it is a crucial, small investment for the payoff…. beautiful skin!

So how do retinoids differ? Why can’t I use something I find at the grocery store that says anti-wrinkle or retinol on it? Over-the-counter ‘anti-aging serums’ or ‘brown spot correctors’ often ONLY have sunscreen in them.  I feel I need to say that again……Over-the-counter ‘anti-aging serums’ or ‘brown spot correctors’ often ONLY have sunscreen in them!!  Sometimes patients bring in serums they have paid $30-$100+ for only to find out their only active ingredient is sunscreen.  The reason these can be marketed for anti-aging is because the sun causes aging, so if you wear a sunscreen routinely you will have better looking skin than if you did not.  Additionally, over-the-counter retinoids often have ingredients such as retinyl palmitate and retinaldehyde.  These have less efficacy due to decreased penetration in to the skin.  Only prescription retinoids like tretinoin are approved by FDA to treat photoaged skin, not the over-the-counter retinoids.  

Formulation considerations include what type of packaging the retinoid contained in.  Retinol must be manufactured and packaged properly to avoid oxidation and loss of potency.  It should be in an aluminum tube with a small mouth.  If air and light have access to your topical retinoid it will NOT remain effective!  

Rx Tretinoin is becoming a vital component in the regimen for my patients with pre-cancers and skin cancers as well.  It has shown to remodel skin and cause increased cell turnover which allows DNA damage and pre-cancers to be sloughed off at such a fast rate that my patients develop less of these dangerous growths.  

Lastly, a common myth is that retinol causes photosensitivity and that you will need to stop it during the summertime.  Animal studies in the past showed poor stability upon UV light exposure so retinoids are best applied at night as some(not all) do have less efficacy if applied during a morning skincare regimen.  However, retinoids are now known not to have photosensitizing or phototoxic properties and may actually prevent the skin from dangerous DNA changes and damage from UV sun exposure.  So, someone who wears their retinoid all summer may develop less damage than someone who does not.  Keep this in mind as spring/summer approaches and talk to your dermatologist about which retinoid is right for you.

Written by

Andrea LaTorre MD, a board-certified dermatologist at Central Ohio Skin & Cancer

PMLE, CAD, AKs, NMSC… these are just a few acronyms that Dermatologists learn about. The sun can cause so much more than a sunburn.

sun

Dermatologists are medical doctors who spend 4 years after medical school learning about general internal medicine in a hospital and then follow that year up with 3 additional years specializing in dermatology only.  Given the vast amount of skin disorders that are possible and the complex terminology for naming them, dermatologists have created acronyms to abbreviate many.

Everyone knows the sun can cause a sunburn.  Even my small children know the sun’s power since I am repeatedly using that word ‘sunburn’ around them shamelessly to create a little bit of fear. Young children often hear about burns from candles, fire, ovens, stovetops, boiling water, coffee etc and they learn to have a fear of burning themselves.  I use this to my dermatologist-mom advantage and so far they haven’t had a sunburn (knock on wood!)

However, interestingly, the sun can cause so many other reactions.  Your dermatologist is the person to determine what type you may have.  That is what we spent 3 additional years learning.  Some reactions are due to an oral medication making someone more susceptible to a sunburn.  Another type of reaction involves an allergic response when the sun and certain types of oral medications are combined.  One of my favorites of a phytophoto response where certain plant based products on the body cause a blistering reaction when in sunlight.  Children can get an eruption on their ears from sun and rarely genetic disorders can cause blisters and scabs when in the sun.  Chronic actinic dermatitis plaques older patients after way too many years of sun damage. It is extremely itchy!

So, if you develop a rash as you are enjoying your summer family time, make sure you bring your whole medication list as well as sunscreen or beauty products applied to your skin.  Take a photo and save to show your dermatologist if the reaction doesn’t last long after sun exposure.

Most importantly, wear your sunscreen, hats, sunglasses, and sun protective clothing!

Written by Andrea LaTorre MD, a board certified dermatologist at Central Ohio Skin & Cancer

New Supplement Prevents Cancer! Should you begin a new vitamin?

skin pic

How could the following benefit you…..Niacinamide, zinc, ascorbic acid, kojic acid, glycolic acid and more! These vitamins and fruit/plant derived acids are useful for many dermatology related concerns. Every year more and more research is being done to discover all the benefits of compounds that are naturally found in the environment or our bodies. It is an exciting time for dermatologists and skin care. We see so many skin cancers: primarily Basal cell carcinoma, Squamous cell carcinoma, and Melanoma. As physicians, we wish we could prevent a patient from developing dozens of skin cancers over their lifetime. Additionally, many patients ask what they can do to prevent their skin cancers when it seems as though every office visit ends with a biopsy of a new skin cancer.   Well, now there are topicals and supplements that have been proven to decrease skin cancer and pre-cancer formation! There are supplements that can help inflammatory acne! There are topical plant/nature derived acids that can lighten brown spots and melasma!

Do you have acne?  Have you felt like all things you have tried don’t work?

Have you had so many skin cancers you cannot keep track of them anymore?  Looking to prevent more?

Have brown spots or melasma that don’t seem to face in the winter?

Come visit one of our board certified dermatologists to learn more!

 

Written by Andrea LaTorre MD, board certified dermatologist at Central Ohio Skin &

11’s, crows feet, persistent “angry/concentrated face”, forehead lines…..

beautifulskin

 

 

….if these bother you then Botox might be exactly what you are looking for. But first, let me calm a few of your fears. Botox has gotten a bad name from Hollywood, but this is misleading. These are some of the facts you should know:

 

  1. Botox is a brand name and there are multiple other types including Dysport and Xeomin brands. All are botulinum toxin and paralyze facial muscles so that wrinkles become minimal or absent over time. All brands work similarly. Often people will just call any type of toxin “botox” because of the name recognition. So I will use the name Botox when describing all the products as well.
  2. Botox lasts for about 3 or more months. This is good because if you find Botox is not for you, then at least the effects will disappear. However, most love Botox so much they continue to plan every 3-4 month office visits on an ongoing basis.
  3. Mild side effects include a small bruise, bleeding at an injection site.
  4. A Very rare side effect is drooping of an eyelid. This is a higher risk if too much quantity of Botox is injected too close to the eye, but is so rare I have never seen it happen.

 

Most importantly, the #1 question or concern I hear is…. “WILL I LOOK FAKE OR OVERDONE LIKE THE HOLLYWOOD STARS?” The answer is 100% NO! NO! NO!

Why? Well, first of all, the Hollywood stars are getting their lips over-injected with filler, getting filler in their cheeks, or face lifts as well. This leads to a unnatural look. So, yes they may also have Botox but that is by far not causing their artificial look when done in moderation.

I always tell patients that I personally start low and can always add more if they are someone who has stronger facial muscles. The goal is to feel more confidence, look younger, and have family/husband/wife/friends ask what your secret is rather than be able to tell you have had Botox.

 

Here are some things patients have told me:

Some comments my patients have heard over the years:  I have heard husbands say “You look happier, you look more relaxed, did you change your hair?” I have heard friends say “What facial routine/skin care line are you using? “ Co-workers have said “You look like you are getting more sleep, Did you lose weight?”

Botox is performed on patients in their 20’s-60’s typically. Horizontal forehead lines, crows feet, and vertical frown lines are the three areas typically targeted.

Dr. Andrea LaTorre, Dr. Jennifer Nash, Dr. Maralyn Seavolt, & Dr. Amy Gosnell all perform these procedures at Central Ohio Skin & Cancer.

Call (614) 898-7546 for an appointment

 

 

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

 

Dry, rough, calloused feet? Have you exfoliated? Now imagine a product that truly gives you baby soft feet….. I found the answer!

If You Have Ever Wanted Soft, Smooth Baby Skin You Have Got To Try This!

There is a product called the Baby Foot Exfoliation Foot Peel and can be found online. It is truly amazing and effective! (I receive nothing from Baby Foot Peel and have no conflicts of interest. I am just sharing my personal experience)

Here is how the process works and what to expect.

Step 1: Purchase the product

Step 2: Put the two pre-packaged plastic booties full of the exfoliating cream onto clean feet and place socks over them so they stay in place.

Step 3: Wait 60 minutes

Step 4: Rinse off your feet

The first week I felt as though my feet were slightly more smooth but didn’t have any peeling myself. At first I wondered if this meant that the product doesn’t work well. I was in for a big surprise because the second full week my feet lost an indescribable amount of peeling skin! So, after two weeks I had amazingly, baby soft feet and it continued for more than 4 weeks afterwards.

The main active ingredients are: lactic acid, glycolic acid, citric acid, malic acid, salicylic acid among many other ingredients including extracts, oils, and other botanicals so if you have any sensitivities read the whole ingredient list prior to using.

I would advise my patients to consider this product prior to a major event like a wedding, prom, summer vacation, or all summer long! (anywhere your feet will be on display)

There are two major considerations to factor in though.

  1. My initial toenail polish seemed to almost peel off when I did it so I would NOT advise doing the Baby Foot Peel right after a fancy pedicure.  I am not sure if it would damage the polish.
  2. I would NOT do this less than 2 weeks prior to an important event because you could be caught mid week 2 when you have so much peeling skin you would feel your feet looked worse than before!

Enjoy those baby feet!

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

THE KEY TO AGELESS SKIN IS ON YOUR PLATE….

cleanface

I LOVE COOKIES…..I really do, it is my biggest weakness! I am well aware of what the food pyramid says I should be eating, but everyone knows its harder in practice to eat healthy all the time. I have recently been reading more scientific articles detailing how diet affects the skin and its health and it has made me more aware of what I an ingesting.

In general, to sum it all up, a healthy diet can impact not just the age you look but also acne, psoriasis, eczema, itchiness, rosacea, and more!(stay tuned for other blog posts on these other dermatology disorders) Low glycemic diets help the skin look more youthful. Low Glycemic diet means limiting any processed food, avoiding potatoes, crackers, chips, bread(especially white bread), pasta, and sugar. Diets containing beans, vegetables, fruits, nuts, oatmeal, flaxseed etc …are the gold standard! I found it helpful to think about what the certain types of food were doing inside my body by grouping them into a few categories like vitamins, fiber, antioxidants, beverages, and fat.

PREVENT VITAMIN DEFICIENCIES

Believe it or not, Americans can actually have some vitamin deficiencies! This is because the typical American diet isn’t extremely well-rounded or plant/natural food based. It contains so much processed food, heavily salted, or sugar additives. You could encorporate vitamin C and E for antioxidants or vitamin D and calcium(especially if you are a woman for bone strength) or biotin for hair/nail benefits. However, I am not suggesting you do that via supplements. In fact, all these vitamins and more are found in food. Think of your fruits, vegetables and dairy products as providing an excellent baseline level of these important vitamins. Each time you pick up an orange or eat a leafy green salad with kale/spinach greens consider it part of your vitamin intake. Having some minor deficiencies of vitamins can make skin more rough, scaly, and easily irritated. Theoretically, with excellent diets, perhaps less individuals would be prone to itchy skin, vague dermatitis conditions, or dry flaking skin.

FLUSH IT OUT

Think of fiber as the way you can flush your body of the toxins. Whether the “toxinS” are the very unhealthy meals you had on vacation or the alcohol you consumed last weekend during a family celebration… or just bits of processed foods, red meat, sugar etc that you ate as part of your regular diet. Fiber helps food move more quickly through your digestive track. This means any harmful material does not have as much time to contact your intestines.

REVERSE AGING

Antioxidants are a way to reverse the damage you have done!!! Antioxidants can repair DNA damage caused by unhealthy behaviors like tanning/sunburns, unhealthy eating, the aging process and more! Each time you pick up fruits and vegetables or drink a cup of green tea think about your body repairing any past assault from the environment.

PLUMP IT UP

Water, Water, Water! It can be sparkling water or distilled water but water will be #1 on the list of beverages you need to be consuming. Try to drink a minimum of 8 glasses a day. Think of the water as plumping all the cells on your face as you take a sip. When the cells are plump and full your facial skin will look more healthy, glowing, and youthful. Water also helps to moisturize the rest of your skin and keep it from getting irritated by outside factors like cold weather, low humidity, and allergens. If you drink anything else regularly it really should only be green tea and coffee or red wine(but in moderation).

Fats can be healthy if they come from nuts, flaxseed, healthy fish sources. Fatty acids are in every cell of your body and if you don’t have enough fats you are more prone to inflammation, skin infections, water loss. Fatty acids also keep your skin plump and ageless.

In summary, I found it helpful to rather than focus on eliminating something I love like cookies to focus on the positives. So as I ate a 1/2cup of peas and an apple for a snack today, I was thinking about how the protein, fiber, and vitamins were going to help keep me healthy from the inside all the way to the outside (i.e. skin). With any luck, my skin will be glowing tomorrow morning and I will look 10 years younger…… oh well. Bon Appetit!

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

What May Make My Dermatologist Ask Me To See An Eye Doctor and Dentist Each Time I Visit?

Anyone who has had a melanoma skin cancer or who has a first degree relative with a history of melanoma is often asked to see an eye doctor and dentist. This is because the eye and the mouth have pigment producing cells too. Only eye doctors can see that a patient has a mole on their retina and follow it for changes. You would not even be aware that it was there or be able to evaluate the mole for any changes over time. Melanoma can occur anywhere on the body. It can be in a highly sun damaged area of skin or it can be beneath the undergarments where sunlight have never reached. It can be in the mouth, in the eye, or on the sole of the foot.

So please remember to share your family history with your dermatologist so they can recommend any additional specialists you need to see to keep you healthy. Also, protect your eyes with UV blocking sunglasses worn every day especially while driving. If you don’t have UV chapstick available then make sure you are dabbing some sunscreen on your lips every 1-2 hours as well.

Lastly, though melanoma is the most common reason I ask someone to see an eye doctor or dentist regularly, there are other dermatology conditions that surprisingly can have eye manifestations or dental/oral manifestations as well. Our dermatology textbooks have lengthy chapters devoted to genetic conditions that affect the mouth/eye/skin, as well as a whole chapter on just oral diseases that a dermatologist needs to be educated on.

So though, we may ask to look at your fingernails when you come in for a scalp rash, or ask to have you slip off a shoe when you come in for a unilateral hand rash, or ask you about your eyes if you come in for a melanoma follow-up, it is all for good reason. We are gathering information on related areas of the body to try to precisely diagnose your original complaint.

 

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

 

 

 

Dry, rough feet? Painful fissures in your heel? Here is what you can do to be summer ready.

 

foot

 

Everything from genetics to choice of footwear to level/type of physical activity can contribute to dry, cracked feet. While sometimes it can strictly be a cosmetic problem leading to embarrassment during sandal season, often it’s uncomfortable as well. Large callouses are very ridged, thickened, and often have discolored flaking skin. Additionally, some people have recurrent painful fissures in the heels. This can lead to soreness with each step of their foot!

 

First and most importantly, moisturizing feet is important. This can be done by applying a thick emollient like aquaphor or Vaseline on the feet just prior to bedtime. Wearing shoes outdoors can help keep the feet from being abused by sticks, gravel, cement etc in the yard. Many also keep an exfoliating file or brush in their shower to file down the few areas on their feet that develop a callous. This is most effective at the end of the shower when the foot skin is very well hydrated from the water.

 

There are a few additional methods to help smooth. Lotions with Alpha-hydroxy-acids (AHA) or urea are helpful ways to smooth lower leg or foot skin. AHAs are glycolic or lactic acid and are safe for all patients, including pregnant or nursing patients. They are available online or in stores. Urea is also available online or via prescription.

 

For a delightful treat for your feet, give the brand ‘Baby Foot Peel’ a try. It is available online and can lead to dramatic results for your feet. Done regularly, about once a month, it can help keep your feet looking and feeling ready for summer.

 

Lastly, those deep, painful fissures can be improved with all of the above, but keep in the mind that in the moment when acutely painful, you can put a small amount of super glue into the fissure. It helps immensely with the pain while you work on healing the skin.

 

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

Bumps on your arms keeping you from baring them in cute summer dresses or tanktops?

KP

KERATOSIS PILARIS

Chances are you have a family member with this condition so please continue reading….

Spring and summer will be approaching soon.  With the change in seasons we have many patients asking about brown spots, redness on their faces, aging skin and also bumpiness on their arms!  Keratosis Pilaris! They are preparing for bathing suit weather and are sick and tired of the texture of their upper arms, not to mention the redness and sometimes itchiness.

Keratosis pilaris primarily affects the upper arms but can also affect the thighs. It can appear even in young children and more frequently affects the face as well as arms and thighs. Keratosis pilaris is a common condition which consists of rough feeling bumps that can be mistaken for goosebumps or small pimples. However, it is actually plugs of dead skin cells.

There is no danger to a patient with keratosis pilaris. However, many people seek treatment from their dermatologist due to embarrassment by the bumps or the redness to their skin.

First rule of thumb is to use a moisturizer at least once or twice a day to the affected areas on upper arms and thighs. I personally love creams rather than lotions because they hydrate the skin better and burn less on irritated skin.

My favorite over-the-counter treatments for keratosis pilaris are alpha-hydroxy acids which are lactic and glycolic acids. They are pregnancy category B so studies have not shown any cause for concern in pregnant or breast-feeding women. They are available online, at local drug stores/supermarkets, or at many dermatologists offices. They require consistent use to help smooth the bumpy texture of keratosis pilaris.  Some of my patients really like a special compounded prescription I often write for severely dry winter skin, keratosis pilaris, rough knees/elbows, dry heel skin, eczema, or ichthyosis patients.  So if the over-the-counter creams do not seem to be helping, don’t give up.  Instead make an appointment to see your doctor for other options!

The skin redness is much more complicated to treat but laser is an option at your dermatologist’s office.

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

 

Do You Cringe When You Hear The Word ‘Eczema’? If so, read this…

 

Eczema, also known as atopic dermatitis, is very common in children. It develops between 6 months-5 years of age. When its all said and done, about 20% of children have eczema. That is A LOT! No wonder it makes parents want to pull their hair out sometimes. In fact, back in the mid 1900’s eczema was much less common, maybe only 3% of the population was affected. Why, you ask?

There are multiple theories as to why eczema is getting more common and all the details have yet to be figured out. However, it is known that eczema is more common in families with asthma or seasonal allergies, in urban areas, in smaller families and in higher socioeconomic classes. The reason this may be true is the lack of early exposure to many allergens aka ‘dirt or stuff in our world’ in the 21st century.   I am by no means an expert but this is why when my children stick their fingers in mud, roll on the grass, or eat food off the floor(in our home only!) I secretly am a little too happy about it. I think to myself…. “Yes! more allergen exposure to their little immune systems!”

Experts think that people keep their homes a little too clean now. Imagine how a century or more ago, things were so different. There was much more farm/rural living; homes were not extremely clean. I don’t mean dirty like our homes are dirty with childrens toys, old unsorted mail, unfolded laundry etc… I am talking soil from outdoors, plant debris, soot from fireplaces, remnants of livestock fur from outdoors.

But, back to the topic of eczema and how to treat it. Eczema patients have a couple components contributing to their itchy skin. Their immune systems are overly sensitive to environmental things as well as poor barrier function. Itchy children have a lack of ceramides in their skin. Imagine a brick and mortar wall, but with eczema the mortar isn’t holding the bricks together well. With all the cracks in the brick wall, allergens from the environment can gain access to their body which triggers their immune system.

Basics of Eczema Care

  • Daily Bath
  • Soapless, fragrance-free cleanser
  • Prescribed medicine, if needed, to flared eczema areas only
  • Moisturizer within 3 minutes to whole body (+Ceramides in it ideally)

There are misconceptions about some of these Basics of Eczema Care. A daily bath is good though many people incorrectly believe a daily bath is bad for the skin. Bathing is good because it removes pollens, ragweed, grass, sweat, cat/dog dander, dust mites and more. Baths prevent these irritants from irritating the skin all night long. Soap is useful in the bath but really only to scalp/hair and groin. When kids are older, armpits too. Soap on non-dirty skin only removes protective oils. Baths rehydrate the skin, only if you follow the bath with locking in the moisture with emollients/creams. Personally, I like emollients(moisturizers) that have oil-base to them, not water-based. The water-based lotions have been proven not as helpful for eczema patients. Lotions are in pump bottles and I tell patients to avoid pump bottles and instead get jars of creams or ointments.(the ones that have lids to unscrew)

I am a firm believer in cortisone creams when needed to help children’s brains and bodies grow as they should. If eczema is severe children are usually eating less, lower body weight, and not getting enough restful sleep due to itching. This prevents them from learning and growing their best. But longer discussions on prescriptions and their risks should be done with your dermatologist.

There are other options including wet wraps, antibiotics, bleach baths, antihistamines, prescription cortisone creams and others but depend on the severity and the age of the patient so see your dermatologist if you are not sure whether your child has the diagnosis of eczema and what treatment might be appropriate for the age/severity.

Keep in mind eczema children are more at risk for staph bacterial infections and molluscum(see prior blog post on Molluscum). This can make their eczema look much worse suddenly so definitely see your dermatologist if the eczema isn’t responding to your usual treatment.

Dr. Andrea LaTorre is a practicing dermatologist in Columbus, OH at Central Ohio Skin & Cancer

Embarrassed by Facial Redness? Bothered by acne breakouts as an adult? There may be a simple solution for you!

 

Could I have Rosacea?

Common concerns among dermatology patients are continuing “acne” in the adult years as well as issues with facial redness. Most of us go through episodes of an occasional facial blemish or some redness of the face with exercise or embarrassment. How does one know if these symptoms might be indicative of rosacea?

Rosacea is a common skin disorder that is characterized by background redness of the face, small dilated blood vessels, bumpy enlarged oil glands and inflammatory skin lesions resembling acne. The National Rosacea Society has estimated that 16 million Americans suffer with this condition.

This common skin disorder has 4 different subsets which can be overlapping. The first is the vascular type. This simply describes background redness of the face, occasionally with associated flushing and often with dilated surface blood vessels. The second subtype is inflammatory acne-like rosacea. This is the type that resembles acne with scattered red bumps and occasional pustules. The third variation is called phymatous rosacea. This subtype has small flesh colored bumps or thickening of the skin surface with possible enlargement of the nose. These features are caused by enlargement of the sebaceous glands. Lastly, rosacea can have eye manifestations. Sometime simple redness of the eyelid margins or lining is the only finding. Occasionally cysts of the lubricating glands of the eyes can develop, called chalazion cysts.

There are multiple treatments available for rosacea. There is evidence that early treatment of rosacea may lessen the severity over time. Some involve modification of factors that may trigger the condition. Some of these include sun protection, avoidance of skin irritants and diet modification.

Medically there have been several advances in the treatment of rosacea. These medications include topical blood vessel constrictors that can minimize the background redness. These medicines coupled with selective laser therapy offer a great option for patients with the vascular form of rosacea.  Our office at Central Ohio Skin & Cancer offers the latest lasers that can offer dramatic treatments results to patients with unwanted facial redness.

Treatments for the acne-like variant of rosacea are numerous and include topical antibiotics and anti-inflammatory medications. Oral antibiotics can also be used in short bursts or in very low doses for a more extended period. Although many of the medications for this type of rosacea can be classified as antibiotics, rosacea is not an infection. These medications are used because of their anti-inflammatory properties and work very well.

So, if you are concerned about a possible diagnosis of rosacea contact our Central Ohio Skin & Cancer office and schedule an appointment with one of our board certified dermatologists!

Also, Central Ohio Skin & Cancer participates in clinical trials for various skin problems. There currently is an ongoing study of a new medication for the topical treatment of rosacea. If you or anyone you know would be interested in participating, let your COSC dermatologist know. Study participants receive free medication and are reimbursed for their time.

Written by Jess DeMaria, MD, a board-certified dermatologist at Central Ohio Skin & Cancer

 

Looking to improve the appearance your yellow, thickened toenails? Home Treatment for Toenail Fungus

toenail fungus

 

Apple Cider Vinegar has been around for quite some time but we are learning more and more ways we can use it to help our skin.  One way to treat toenail fungus is apple cider vinegar soaks.  Some of the oral anti-fungal medications have serious risks to the liver.  This is a very rare risk, but nonetheless it causes many people to avoid oral antifungals  in place of safer home remedies.  Toenails infected with fungus are very thick and make treatment with any topical medication difficult, however there are prescription topicals as well as home remedies.  Discuss the options with your doctor before deciding which is right for you and make sure you indeed have toenail fungus and not another nail ailment.

Here’s what you do:

Get a large bowl or basin to soak your foot/feet in.  Make a 50:50 mixture of water and apple cider vinegar.  Soak for about 20 minutes each day.  The acidic combination inhibits fungal growth which likes alkaline environments.

For extra benefits, you can add 1/3 cup Epsom salt and mix into the water/vinegar.  Soaking with Epsom salts with help exfoliate your feet making them baby soft!

Remember, despite doing all this, fungus is difficult to treat so you still may need a prescription from your doctor.  Also, avoid walking around barefoot in dirt or leaving feet in wet/sweaty socks/shoes for too long as fungus loves to thrive in these environments.

Written by: Andrea LaTorre MD, board certified dermatologist at Central Ohio Skin & Cancer

Why “Retinol” Should Be On Your Mind and On Your Face!

Aside from sunscreen every morning (not just sunny days) truly 365 days per year, there are few things I feel more strongly about than Retinol for anti-aging. I could go on and on about it AND I DO every time a patient asks me about aging concerns.

Because I want to stress that there are so many benefits to Retinol that need to be considered before throwing too much money at weaker, less effective products I want to tell you in bullet points.

  • BUILDS UP COLLAGEN (broken down by UV radiation/sunlight and aging)
  • REDUCES FINE LINES AND WRINKLES (also caused by UV radiation and aging, smoking, and not taking good care of your face)
  • SMOOTHES THE SKIN (improves skin texture and helps makeup glide over skin when applied)
  • REDUCES BROWN SPOTS (subtle spots from sun exposure are in the very top layer of skin and can be encouraged to slough off more quickly when retinol is used along with sunscreen)
  • HELPS IMPROVE ACNE (retinol or Retin-A is a very commonly used acne prescription, however often insurance doesn’t cover it for adults over 30 years old since it is such a powerful anti-aging medication)

Retinol is Pregnancy Category C so there are no studies showing it is safe in humans while pregnant. Therefore we recommend women do NOT USE retinol, neither over-the-counter nor prescription strength, while pregnant. Otherwise, I tell all women to begin using it as a teenager for acne and to try to never stop for the rest of their life.

Written by Andrea LaTorre MD, a board-certified dermatologist at Central Ohio Skin & Cancer.

Nighttime Routine? Find Out What You Should Be Doing For Your Skin.

cleanface

Washing your face is important in the evening but its not just to rinse off makeup like you may think. Rinsing off all the invisible traces of makeup, viruses, bacteria, allergens etc…. from your face nightly is important.

This is true for all ages and genders. For example, it is good practice for children to have their hands and faces washed when they get home from school or play dates. It can help keep them from getting sick as often when any germs they encountered from another child are rinsed off before it amounts to pinkeye, a runny nose, or strep throat infection.

Adults are not immune from viruses or bacteria either. Whether at work, the grocery store, or at home we encounter other people that can pass illnesses to us through touch or sneezing/coughing. But enough about avoiding sickness, lets get back to beauty and skin care.

By rinsing off makeup with a gentle cleanser and then applying moisturizer you can ensure a clean, hydrated face. Dry, parched skin leads to a much more wrinkled appearance. Plus dryness makes skin more vulnerable to irritants. A good moisturized barrier can avoid eczema flares, flaking skin, irritant dermatitis, and keep the face looking youthful.

In spring and summer months, we often see vague rashes on eyelids, cheeks, neck, braline or waistband. This can give us hints that a patient is developing a contact dermatitis. Often airborne allergens like pollen or ragweed settle on delicate skin like eyelids, necks or get trapped between skin and clothing at the bra or waistband. Rinsing off in the evening whether it be just your face or a quick rinse in the shower can prevent many rashes due to outdoor allergens. Going to bed with clean skin instead of having irritating pollen on your skin all night long can make a world of difference in some cases.

So, in summary, washing your skin nightly can not only be relaxing and help with preserving luminous well-hydrated skin, but it can diminish contact dermatitis rashes and rinse off germs.

Written by: Andrea LaTorre MD, a board certified dermatologist at Central Ohio Skin & Cancer in Westerville, Ohio.

Do You Have The ‘Mask Of Pregnancy’?

pregnancy2

 

Though it sounds exotic, it is actually quite common. What is the “Mask of Pregnancy”

Brown Spots aka Melasma (the “Mask of Pregnancy”)

Melasma is very common in pregnancy or if taking oral contraceptive pills. It occurs, most commonly, as brown patches on the upper lip, cheek bones, or forehead.

Most importantly, every woman, especially while pregnant should be wearing sunscreen to prevent this blotchy discoloration from popping up. Since pregnancy lasts 40 weeks or about 9+ months chances are in any state/country/climate the pregnancy will overlap with a season where the sun is particularly strong. Melasma can fade gradually after giving birth but often women need more to make it completely go away. Strict sun protection over SPF 30 every day, sunglasses, and even hats are essential to make any treatment worthwhile.

Hydroquinone is often very effective for melasma but needs to be prescription strength given by your doctor. Tretinoin (Retin-A) when combined with hydroquinine, helps the hydroquinone penetrate the epidermis and work better and faster. Chemical peels or laser are other options to increase cell turnover and give the skin an even appearance again. Hydroquinone, tretinoin and some chemical peels may not be recommended by your doctor if you are nursing though. So, best to ask before trying these or potentially wait to treat melasma until after done nursing.

 

Andrea LaTorre MD is a board certified dermatologist at Central Ohio Skin & Cancer

Acne During Pregnancy: Is there anything safe to use?

 

acne

 

“Help! I never had acne before pregnancy!” This is a common concern. Some women have worsening of acne during pregnancy, yet others seem to actually have improvement in their acne. Unfortunately, most acne medications are not approved for use during pregnancy. There are some medicines that are Category X, meaning they cause birth defects but the majority of acne topical creams are Category C, meaning they have not been studied, or at least not in humans. Therefore scientists and doctors cannot say for sure that they do not cause any birth defects in humans. Given this uncertainty of pregnancy Category C acne medications, most women and their physicians avoid them throughout pregnancy. Some category C medicines include salicyclic acid which is over-the-counter. So please go over your at-home beauty routines with your doctor before assuming that over-the-counter or online bought creams are safe.

Helpful in any situation is to continue to wash your face twice daily with a gentle cleanser and moisturize with an oil-free moisturizer as well as use SPF in the morning. Your OB/GYN or dermatologist can help in choosing over-the-counter or prescription products for acne that are Pregnancy Category B which would be safe to use.

 

Andrea LaTorre MD is a board certified dermatologist at Central Ohio Skin & Cancer

Are Spider Veins Avoidable?!?

 

Varicose Veins

Again, unfortunately varicose veins are partly genetic. If your mother , father, or grandmother etc have significant varicosities chances are you may have that in your future as well.  Some common causes of varicose veins are age, pregnancy, female gender, obesity, and sitting/standing for long periods of time.

Veins pump blood back to the heart and with age valves allow more back flow of the blood.  This causes the blood to pool in the legs.  Pregnancy and being of the female gender leads to higher levels of certain hormones in the circulation which contribute to relaxed vein walls.  Additionally, during pregnancy the increased blood volume and heaviness of baby growing in the uterus presses against all the veins in the lower half tof the body.  Similarly, obesity also puts added pressure on the veins in the lower part of the body.  Luckily, pregnancy related varicose veins can improve, but may not disappear, within a year after pregnancy.

The best thing you can do for varicose vein prevention is to wear compression stockings. They make knee-high, thigh-high, and full maternity/up past belly compression stockings. Standing on your feet in one position for long periods of time and crossing your legs can make someone even more likely to get varicose veins.  However, movement/exercise and leg elevation or compression(working AGAINST gravity) can help prevent varicose veins.

For small varicosities, your dermatologist can help.  Though it may not be covered by insurance, it can be affordable.  Insurance considers superficial spider veins and many varicose veins cosmetic, so in the majority of cases they won’t pay.  Two common treatment methods are injection of hypertonic saline into the veins or laser light used to clamp down the dilated vessels.  Both are uncomfortable during the treatment but results can be remarkable.  Two important post-care rules are to wear compression stockings for weeks afterwards so the vessels don’t re-dilate right away while healing.  Also make sure to use strict sun protection or get treatment during the winter months.  Sunlight after most cosmetic procedures including varicose vein treatment can lead to paradoxical darkening that takes a long time to fade!

Andrea LaTorre MD is a board certified dermatologist at Central Ohio Skin & Cancer