There is NO reason to re-excise a moderately-atypical nevus

To those who are patients and those who follow my posts, you know that I am adamant that there has been an over-treatment of these atypical nevi for decades. In short, the data just does not support the removal of these lesions–PERIOD!

Another study was just completed at Emory University (Atlanta) and Atlanta Veterans Administration Medical Center. Here are their conclusions:

Re-excisions are not needed when clinically excised moderately dysplastic nevi have positive histologic margins, based on results of a retrospective study of 438 patients who were treated at nine academic medical centers in the United States. Not a single patient in the study developed melanoma at the excision site after an average follow-up of 6.9 years, and at least 3 years in all cases.     [SOURCE: Kim CC et al. IID 2018, Abstract 571.]

So when your Dermatologist or the Dermatopathologist (on their pathology report) states that your moderately atypical nevus should be removed, ask Why!

 

Most Cosmetics Do Not Work

Study Suggests Most Claims Reported on a Beauty Product Are Not Considered Truthful.

CBS News (7/29) reports on its website that “a new study found fewer than one out of five” beauty product “claims was considered truthful by a panel of readers – and ads that used scientific language to describe the benefits were even less persuasive.” The study that was cited was published in the Journal of Global Fashion Marketing: Bridging Fashion and Marketing.

This comes as no surprise as most companies do not perform studies on their products to prove that they actually work. Others “perform” poorly constructed studies, that would never be published in a peer-reviewed medical journal, using photographs as “evidence” of effect. Photographs alone prove nothing unless they are standardized (same exact lighting, same exact positioning, etc) so when one looks at photographic claims, one should be wary–is the lighting the same, is the person smiling in one picture and not in another.  I never base proof on photographs alone, unless used in a well-performed trial.

Many companies will put the same “active ingredient” in their product and use the claims from other products. Well, while that may sound fine, it is not. While an active ingredient may be essential to achieving a desired result, it is the other ingredients that allow it to penetrate the skin and work. These other ingredients differ, thus changing the result. The active ingredient itself may be different–not as pure or a different percentage. In short, there are many variables.

Therefore, one should be very skeptical regarding claims that are made. Additionally, the same holds true for many products that are sold in Spas, Plastic Surgeon’s offices, and Dermatologist’s offices. Many of the products that I have found on the shelves in these offices were not tested, but based their claims on studies performed on other products from other companies.

FL – Vaccine for all starts soon!

Governor Ron DeSantis announced new eligibility guidelines for COVID-19 vaccinations in Florida this week.  Beginning Monday, March 29, all individuals age 40 and older will be eligible to receive the COVID-19 vaccine. Beginning the following Monday, April 5, all individuals age 18 and older will be eligible to receive the vaccine.  Floridians are encouraged to pre-register at www.myvaccine.fl.gov. Once pre-registered, they’ll be contacted when the vaccine is available in their area. Floridians can also call the vaccine preregistration phone number for their county, listed here. Vaccines are also available at 150 CVS locations, 125 Wal-Mart and Sam’s Club locations, more than 70 Winn Dixie locations, soon-to-be over 600 Walgreens pharmacies, and every single one of the 730 Publix pharmacies across the state.

New Acne Medications: Are they worth it?

With over one thousand medications available, how do we choose which to use? There are newer medications that come out every few years with some benefits and usually one major disadvantage–cost!

Trifarotene: A new topical retinoid to help with clogged pores. This topical product works much faster than other products, which is the major advantage. It also if approved for use on the trunk, although the other retinoids can be used there as well. In as little as 2 weeks patients can see improvement. Unfortunately, this comes with a hefty price tag of over $500 for a 45 gram tube. Is it worth it? Well, you decide. Differin gel costs about $28 ($5 coupons are often found at CVS to further lower the cost) and has been available for over 2 decades, is stable, and works well.

Sarecycline: A new “narrow spectrum” tetracycline class antibiotic, which is more specific for the bacteria that causes acne with less resistance. It has a once a day dosing and a side effect profile that is somewhat similar to other medications in its class. Unfortunately, it has up to 3% risk of vulvovaginal yeast infections. What is the cost? As of now it is about $1000 for a 30 day supply. Is it worth it? You decide if it is worth the price tag compared to about $15 to $20 for a 90 day supply of generic doxycycline.

Tazarotene Lotion and Tretinoin Lotion: Two new formulations of older products. Tazarotene lotion is less irritating than the cream, but less irritating. These two products are far more expensive than Differin gel, which is available without a prescription.

Minocycline Foam: A new topical antibiotic that has the advantage of little to no resistance. The foam is flammable so one must keep away from open flames. It is a once a day formulation and costs around $500. In comparison one can get a clindamycin/benzoyl peroxide for less than $50 with a coupon. Is it worth it? It appears to be well tolerated and very effective, but you decide if it is worth the higher price tag.

Clascoterone: a new topical anti-androgen. This can be used in patients 12 years of age and older, is well tolerated, and should not be used on large areas. This product works differently than other medications as it is thought to decrease the production of oils, which the bacteria feed on.

There are a few “improved” products that may be available in the future.

In summary, there are some newer products available that appear to be safe and effective. Like all new medications, these are associated with a high price tag. In most cases, I do not believe that the significantly higher cost is worth the added benefit for most patients, as this will greatly increase the cost of care. For some patients, these newer options may be worth trying, but as always, one must weigh the cost to benefit to side-effect ratios to determine if it is feasible.

Retinol burn: how to prevent and treat

Tretinol, the active ingredient in Retin A is irritating to the skin. Retinol, an over-the-counter medication gets absorbed into the skin and then converted into this active compound that works as tretinol. In general, Retinol products are less irritating than tretinol.

The benefits of these products is well known. They reduce fine lines and wrinkles, even out skin tones, and reduce acne. Unfortunately, many suffer from the irritation that they can cause.

How can I avoid the Retinol Burn?

1. Apply the smallest amount of product possible. For an entire face, a pea-sized amount is all that should be used. The more you use, the more irritation it will cause.
2. When starting these products, use them only twice a week. Let your skin get acclimated to it and increase slowly over a few weeks to every night.
3. Only use gentle products when starting these products. Do not use acne cleansers, scrubs, alcohol, mechanical brushes, or any other products that irritate the skin. If you break down the skin’s natural barrier, you are more at risk for irritation.
4. Moisturize your skin! Keeping your skin barrier well-lubricated will reduce your chances of irritation.

What can I do if I get irritated from Retinol or Retin A?

1. Stop using the product until all of the irritation resolves.
2. Moisturize the skin with a thin coat of Vaseline daily until the irritation resolves. You can use a gentle moisturizing cream, but Vaseline is safer and works better. An alternative is Aquaphor Ointment.
3. You can use 1% hydrocortisone OINTMENT twice day for one week then once a day for one week if needed. Do not use near the eyes. This works great and definitely get the ointment and not the cream.
4. If recommended or given by your Dermatologist, give them a call and ask for their advice.

What’s best for anti-aging?

We all know that eating healthy is important to combat the effects of aging, but what else should we be doing? Every day I get asked about fillers to plump up lines and other procedures to make one look better. People tend to forget about what else they should be doing to better their overall health and combat the effects of aging.

STRENGTH TRAINING

Many are intimidated by just the thought of strength training, but the benefits are well known and well worth the effort. Muscle mass drops by about 4% each decade after the age of 30. That is a lot of muscle loss! Strength training is the best way to reduce this loss in addition to keeping you fit and functional. In fact, many believe that strength training is actually more important than aerobic exercise to slow the aging process. Common sense tells us that the more strength that we have, the more things that we will be able to do. In short, strength matters.

Are you still not sold on the benefits of strength training? Let’s look a little deeper into this.

1. Strength training burns calories and boosts your metabolism.

The more muscle that you have, the more calories you burn.

2. Strength training strengthens muscles and reduces the risk of osteoporosis.

This is especially important for women, who are most at risk of having brittle bones. Lifting heavy weights stimulates bone production. People often confuse weight lifting with heavy weight lifting. What is the difference? Doing squats with a weight in which one can only do 12 reps if very different than using a weight where one can do 30 reps.

3. The stronger one is the lower the risk of falls or injury

As we lose muscle, the risk of falls or injury increases. In addition, if we are stronger we maintain better balance, further reducing the risk of falls.

4. A lower body fat percentage lower the risk of heart disease and diabetes.

Get rid of that belly fat and you will be healthier. Period. You don’t even have to pick up a weight to enjoy these benefits. You can perform exercises without a single weight such as squats, deadlifts, lunges, push-ups, pull-ups, and tricep dips.

OTC Antihistamine helpful for those with Alopecia Areata

Taking an over-the-counter antihistamine, such as Allegra, daily was shown to be helpful in the treatment of alopecia areata, when used with other treatments. At his medication is very safe, it should be considered as an “additional” treatment for patients suffering from this condition.

Had Cosmetic Fillers? You CAN get the COVID-19 Vaccine!

In rare cases, cosmetic fillers can swell slightly after a vaccine. This has been recently reported with the COVID vaccine. This reaction is temporary and usually resolves within 24-48 hours and can be treated. None of the reported cases were serious, life-threatening, or had long-term complications. For this reason, one who has a history of having fillers may get the COVID-19 vaccine.

Freckles

Freckles are brown spots that commonly occur in sun-exposed areas on the skin that are harmless. As one gets sun exposure, the spots darken. When one avoids the sun or UV exposure, the spots lighten. The face is the most common area affected, but the arms and legs are common sites as well. It is most common for one to have many of these lesions in an area, and not one or a few.

Freckles can be confused with “age spots” or moles (nevi), which do not get darker and lighter the way that freckles do.

Any lesion that has multiple colors, is larger than 4-mm, is asymmetrical, and/or has irregular borders should be checked by a board-certified Dermatologist.

PREVENTION

As Sun-exposure, natural and/or artificial, makes them darker, avoidance is paramount. One should avoid midday Sun, wear protective clothing (i.e. wide brimmed hats and shirts), and use a broad-spectrum sunscreen that contains titanium dioxide and/or zinc oxide in high concentrations. Topical Vitamin C preparations can help prevent new spots and lighten existing spots.

We carry many sunscreens that afford superior protection. Click here to see our Sunscreens.

TREATMENT

Prescription creams can be used to lighten these spots and are extremely effective. We use a prescription that must be compounded (mixed by a pharmacist) that is extremely effective. Over-the-counter preparations containing hydroquinone, Kojic acid, and/or Vitamin C are all helpful to lighten these spots. We have two products that work well to lighten the spots:

FADE 1 2 3 which contains 2% hydroquinone and should be used until the desired color is seen. SPOT TREAT ONLY as it will lighten any skin that it is applied to

Cerum which contains Vitamin C and Ferrulic Acid, which prevents further damage and lightens brown spots. This works great to prevent darkening and helps lighten as well.

How to Get Rid of Dark Circles Under Your Eyes

No one likes the look of dark circles under their eyes, which can make one look tired. Unfortunately, treatment of this common complaint can be difficult as several factors play a role in their appearance.

What causes dark circles under the eyes

• Genetics. This is the most common cause of dark circles. In darker skinned individuals, too much pigment or too much skin can cause dark circles. In lighter skinned persons, thin skin can reveal blood vessels below, giving the skin a blue-purple hue.
• Tear trough or bulging fat pad. There is a natural transition from where the eyelid meets the cheek, which is apparent in everyone. For some this gets hollowed out and forms a deep groove. For others, the skin just below the eyelid bulges outward, thus forming a deep groove below. This occurs due to natural aging and some are more prone due their genetics.
• Aging. With age, the skin thins. Underlying blood vessels become apparent, the skin develops fine lines, and their is a change is texture and tone. As the skin loses its elasticity, it tends to bunch up, which makes it appear dark.
• Seasonal Allergies. Hay fever and other allergens can result in the dilation of blood vessels under the eyes. This causes the skin to appear dark due to the increased blood flow. The released histamine can result in puffiness as well.
• Not enough sleep. Although, most blame a lack of sleep to having dark circles, it is not common. If one does not get enough sleep puffiness can develop under the eyes.

How to treat dark circles under the eyes

While we cannot treat one’s genes, we can do things that reduce the appearance of dark circles.

Eye creams

Certain active ingredients in eye creams, such as retinol and peptides, increase collagan and elastin, reducing fine lines and “bunching” of the skin.  Retinol also reduces pigment, as do other ingredients such as vitamin C, kojic acid, and niacinamide. Topically applied caffeine constricts blood vessels, making dark circles appear lighter.

Dermal fillers

Restylane can be injected into the hollows or grooves under the eyes to reduce their appearance. This safe and effective procedure has results that last approximately six months or longer.

Chemical peels

Chemical peels have been used for centuries to tighten and lighten the skin. While still a good option, newer modalities have given other options, often with faster recovery, than chemical peels.

Microneedling

Microneedling is safe for all skin types, but by itself is minimally effective. When microneedling is combined with radiofrequency, significant improvement can be seen with minimal to no downtime. More than one treatment session is required for optimal results.

Fractional laser resurfacing

Laser skin resurfacing is extremely effective tool used to tighten the skin and stimulate collagen production by creating hundreds and hundreds of tiny round wounds that takes well over a week to heal. For those with fine lines and skin laxity, this is a great option for those who can have at least a week of downtime and several weeks of pinkness on the areas treated.

How do I get the best result

For most, there is not one treatment that will work to reduce the dark circles, but several. For skin laxity and fine lines, creams containing retinol can help, while chemical peeling, laser resurfacing, or surgery may be needed for moderate to severe laxity. For hyperpigmentation, actual increased pigment that is not due to laxity can be treated with creams containing retinol, Vitamin C, kojic acid, niaciniamide, and/or caffeine. Stronger prescription agents containing hydroquinone can be used for moderate cases. For severe cases, chemical peeling and/or laser resurfacing can be used. For puffiness caused by a visible fat pad, Restylane can be injected into the tear trough, or hollow under the eye, to reduce the appearance of the “bag” or surgery can be performed to remove the bag itself in some cases.

In short, for most creams and Restylane injections can very helpful at reducing the appearance of bags or darkness under the eyes.

Covid-19 Facts

The entire world has become affected by Covid-19, formally known as SARS-CoV-2. This virus originated in China. Most current data suggest that this virus, or more likely a predecessor of it, had a bat host. The horseshoe bat has been theorized as one potential host. From there we have several opinions as to what happened. One opinion is that it affected humans, but was not a real pathogen (caused no harm). The virus would have evolved/changed into its current form. The second opinion is that there was an intermediate host–another animal that got the virus from the bat. In this other animal the virus mutated into its current form and then infected humans.

In any case, this new virus is extremely contagious by respiratory droplets. For that reason, social distancing is required at this time. It has been well studied that sneezing and coughing spreads respiratory droplets up to 6 feet in most cases. There are studies showing spread of respiratory droplets as far as 27 feet, but it is not known whether spread of a virus can occur at this distance as the particles are very small and carry a minuscule viral load at best. For this reason, six feet apart from others is considered to be reasonable and fairly safe.

The most common cause of spread of Covid-19 is from one’s contaminated hands to their own face. I cannot stress this enough.  If you are in a potentially contaminated situation, DO NOT TOUCH YOUR FACE until you have washed them with soap and water for at least 20 seconds. If washing is not feasible, use an alcohol-based disinfectant that has at least 60% alcohol (i.e. Purell) What are some potentially contaminated situations: public elevators, public stairs, supermarkets, and basically anywhere outside of the safety of your own home.  Your home is safe if, and only if, when anyone returns to the home they immediately wash their hands before touching anything AND everyone entering the home does not have Covid-19.  The home should be your safe place. There should be no visitors. Only those who reside in the home should be there. If a household member is suspected of having Covid-19, he or she should be isolated within the home and all recent contacts, and members of the home, should be quarantined for at least 2 weeks.

What does quarantine mean? It means that the person who is in quarantine has NO direct exposure to any other person if at all possible. If some contact is required (i.e. sharing a single bathroom), the infected person MUST wear a mask and all other persons who come in contact with that person MUST wear a mask as well. The uninfected individuals must be cognizant of the potentially contaminated areas and be extremely cautious–Disinfect the area prior to use (Lysol spray, bleach wipes, etc.)–clean all potentially contaminated surfaces prior to using the space. Do not ever touch your face in those areas and immediately wash your hands after leaving the space. Wearing a mask helps to remind one not to touch their face and is helpful.

If you must go out: social distance, wipe down areas with bleach wipes (or similar disinfectant) if contact with them is required, cover your face (somewhat controversial, but the good likely outweighs the bad, if any), and wash your hands when you can. Be safe!

For those who do cover their faces, understand that the outside surface of the masks can become contaminated (dirty). If you put the mask down on a surface, you can contaminate the surface. For washable masks, wear them after use. For surgical masks that you intend to reuse, put the mask in clean, new bag after each use. Do not put it on a counter-top of other surface that you can contaminate.

Get out and exercise!  Walk, jog, or run if you can. Do other exercises in the home such as push-ups, pull-ups, crunches, etc.  Eat healthy.

When going out for groceries, try to order online and get curbside pickup. Another great alternative is to order groceries, supplies, and medications from an online store that delivers.  Understand that contamination of the bags is possible. Items that are not perishable can be left out for 3 or more hours to reduce the risk of contamination or one can spray them with a disinfectant. Perishable items can be washed with soap and water or sprayed with a non-toxic disinfectant if one desires. Anywhere that the bags were placed should be considered contaminated and should be cleaned. And, of course, wash your hands once you are done putting things away!

Social distance, but do not socially isolate yourself! Communicate with friends and family via phone, Facetime, or another means of electronic communication. Join an online social group, take an online class, or learn a new language. There are more opportunities than ever to have online interactions and there is no better time than now to do so. Think about others that might be alone and contact them regularly.

To summarize:

1. Stay home and only go out when absolutely necessary or to exercise.
2. Do not have visitors in your home and do not go visit others in their homes.
3. Always practice social distancing. Always!
4. Never touch your face, unless you are in a safe place (i.e. home) and you have washed your hands before doing so.
5. If one is in quarantine, please follow the quarantine rules to keep yourself and those around you safe.
6. Cover your face when you expect to come in contact with others.
7. When things are brought into the home (i.e. shopping bags), consider them contaminated and treat them as such.
8. Do not socially isolate yourself–talk to others, join a social group, or take an online class

Skin tightening with minimal downtime!

Finally a treatment that tightens the skin, reduces the appearance of scars, and reduces the appearance of stretch marks with little to no downtime!

Secret RF is here. This technology uses microneedling with radiofrequency. It is the Radiofrequency that generates heat to tighten the skin. Do not confuse this treatment with microneedling alone as there is no comparison.