The most important thing I like to impress upon all of my patients is that most skin cancer is 100% preventable because it is simply caused by repeated exposure to the sun’s UV rays over time. Even though a tan fades, the damage to your skin cells is done, and not only does this make you more prone to developing skin cancer but also skin that is aged, leathery, blotchy, wrinkly and sagging. The second thing I like all my patients to know is that at least 90% of all skin cancers are completely curable, especially if those cancers are detected early.
What is skin cancer?
Skin cancer begins with excessive growth of abnormal cells in the skin. If it is allowed to continue growing uncontrolled, a tumor will form and you will notice some type of change to the skin. The vast majority of skin cancers are basal cell carcinomas and squamous cell carcinomas. Although they are malignant, they are unlikely to spread to other parts of the body if discovered early. However, they can be locally disfiguring if not treated promptly.
Will I get skin cancer?
Basal cell carcinoma (BCC) is the most common form of non-melanoma skin cancer and is so called because it begins in the deepest layer of the epidermis, the skin’s basal cells. This cancer often looks like an open sore, red patch, pink growth or shiny bump; is very slow-growing and most often caused by cumulative (building up over time) and intense exposure to the sun. Basal cell carcinomas rarely metastasize (spread) beyond the borders, so these skin cancers are very treatable.
A squamous cell carcinoma (SCC) is caused by uncontrolled growth of abnormal cells in the squamous cells, which comprise the skin’s upper layers (epidermis). SCCs often look like scaly red patches, open sores or elevated growths with a central depression. They may crust or bleed and may become disfiguring and sometimes deadly if allowed to grow.
The most dangerous form of skin cancer is malignant melanoma, which forms in the melanocytes of the skin (those cells which turn your skin tan to protect the deeper layers of the skin when exposed to the sun). These cancerous growths are caused by damage to the DNA of skin cells, often by ultraviolet radiation from the sun or even from tanning beds. Intense, occasional UV exposure frequently leads to sunburn, especially in those who are genetically predisposed. UV can trigger changes or defects that lead to those skin cells rapidly multiplying and creating malignant tumors. Melanomas can develop from pre-existing moles and the majority are black or brown, but they can also be skin colored, pink, red, purple, blue or white. If melanoma is recognized and treated immediately, it is almost always curable, but if it is not addressed, the cancer can spread to other parts of the body, where it becomes hard to treat and can be fatal. Although it is not the most common skin cancer, it causes the most deaths.
Anyone can get skin cancer, especially those who spend or have spent a lot of time in the sun. However, having fair skin and freckles, light eyes and blonde, red or light-brown hair means your skin burns more easily in the sun and also makes you more susceptible to skin cancer. Additionally, people who have a family history of skin cancer are also more likely to develop skin cancer.
How do I know if I have skin cancer?
Check your own skin regularly and have a dermatologist do so once a year. If you notice any difference in your skin including any raised patches, redness, scaliness, a sore that does not heal or strange moles, head to the dermatologist to have it checked out. Any skin lesion that lingers longer than a month warrants a trip to the dermatologist. Here are the ABC’s of skin changes you should look out for:
•Asymmetry: Any mole that has irregular shape and jagged edges.
•Bleeding: Any mole that bleeds and does not heal.
•Color: Any mole with a variety of colors in the one mole.
•Diameter: Any mole that is larger than the size of a pencil eraser.
•Evolving: Any mole that changes in some way, whether in size, shape, or color.
When you come in for a skin check we will examine your skin and any growths or skin changes in question. If we suspect any type of cancerous lesion, we will take a biopsy (a small piece of the skin) to test it in the laboratory to determine if the growth is benign, pre-cancerous or cancerous.
How to protect yourself from the sun’s damaging rays
Never go into the sun without protecting yourself with a broad-spectrum sunscreen (these protect against both UVA and UVB rays). UVA rays penetrate deep into the dermis, the skin's thickest layer and unprotected exposure can lead to premature aging and wrinkling. UVB rays will usually burn the superficial layers of your skin. It plays a key role in the development of skin cancer.
The Skin Cancer Foundation grants its Seal of Recommendation to sunscreen products greater than SPF 15, so you know they meet the highest safety and effectiveness standards. You can also look for this seal when purchasing UV-protective automobile and residential window film, sunglasses, UV-protective laundry additives and sun-protective clothing and hats.
One last reminder: Did you realize that water, snow, or ice can reflect as much as 90% of the sun’s rays upwards and sideways, which greatly increases your exposure? Don’t ignore the need for sunscreen when working or playing on these surfaces, even on cloudy days as 70% to 80% of the sun’s damaging rays can penetrate through the clouds and haze.
It seems as if the universe is conspiring against us to make us look older and more tired than we are, doesn't it? As we age, many changes occur that lead to thinning facial skin, sagging wrinkles and hollowing where there used to be plump, firm skin. If you're interested in using facial fillers to solve these problems, you've probably heard about Juvéderm Vollure XC and that's because treatment with this injectable facial filler lasts up to 50% longer than any dermal filler before.
Part of the problem with using injectable fillers is that you have to repeat the treatment at regular intervals; some every 6 months and some every year or so, to keep up the desired results. Last month, however, Allergan, the company that makes Juvéderm announced that Juvéderm Vollure XC has been approved by the U.S. Food and Drug Administration (FDA) to correct facial lines and wrinkles such as those folds between your nose and mouth (called nasolabial folds) that can sink into the moderate to severe category.
The exciting news is that in the Juvéderm Vollure XC clinical trial, nearly 60% of patients experienced improvement in nasolabial folds for up to 18 months. This formula was studied and tested for treatment of the nasolabial folds because that is the most common treatment area for wrinkles. The majority of patients (82%) in the trial said they were satisfied with their results at 6 months and 68% were still satisfied at 18 months. Now that's long lasting!
How does Juvéderm Vollure XC work differently than other fillers?
Most facial fillers today rely on a substance called hyaluronic acid, or HA for short, which is naturally occurring in our own connective tissues and cartilage. Since hyaluronic acid is not derived from animal sources or a synthetic compound, it is compatible with the human body, which makes it a filler of choice. It's the viscosity of the filler that determines where it is best used. Soft, thin fillers are best for small areas where precision is very important, such as lips and tear troughs (the under eye area). Thicker fillers fill in hollowness or can add volume and enhance cheekbones. We use a variety of fillers to achieve many different results for our patients, including diminishing the depressed area under your eyes and improve the appearance of deep or sagging wrinkles around the mouth. Fillers can also plump your thin lips or your sunken cheeks and can even facial inconsistencies.
Juvéderm Vollure XC features new Vycross technology, which means it is a much smoother and natural looking hyaluronic acid filler. It has a a more stable consistency and provides longer lasting results and we are using it to treat those nasolabial folds, the marionette lines and the corners of the mouth. The clinical study was based on an average of 1.8 syringes per treatment, so we've found 1-2 syringes treats most patient's nasolabial folds. One of the best things about Juvéderm Vollure XC is the new cohesive gel makes it more malleable than other fillers making it soft enough to move with facial expressions which gives the patient a natural look.
The most common side effects are temporary responses at the injection site such as tenderness, bruising and redness; most of these resolve within a week.
Overall, Juvéderm Vollure XC is a great addition to our filler arsenal giving us long lasting results to correct facial lines and wrinkles with minimal swelling and downtime. Give it a try!
If you’ve got a “double chin” or are concerned about fat or fullness directly under your chin, you’ll be thrilled to hear about Kybella®, an injectable treatment that actually dissolves fat cells under your chin permanently. You may have heard of it as ATX-101 when it was in clinical trials, but now it is FDA approved to treat submental fullness.
This procedure is a God-send to both men and women who may have a hereditary disposition towards under-chin fullness which does not respond to any fat-reducing diet or exercise. It’s the perfect treatment for patients who want a discreet, quick, non-surgical alternative to liposuction. Now you can finally lose that beard, go scarfless and throw out your turtle neck sweaters!
How does Kybella work?
The active ingredient in Kybella® is called deoxycholic acid which naturally occurs in the body to help dissolve fat from your diet. When it’s injected in the fat under your chin, it destroys those the fat cells completely. Once destroyed, they cannot grow back, which is how these injections provide a permanent fat-shrinking effect in the under-chin area. Even if you gain weight, you will usually not gain it where you have had Kybella injections because you will have less fat cells there after treatment.
What does Kybella treatment entail?
You will need anywhere from 1 to 4 treatment sessions consisting of multiple injections throughout the area of the under-chin fat or fullness.
For comfort, ice is applied 10-15 minutes before the injections are administered. Swelling is an expected side effect and can last anywhere from just two days to as long as a few weeks depending on the amount of fat treated and the dose we administered.
The other common side effects of Kybella® include bruising, pain, numbness, redness and possibly small areas of hardness in the treated area. Older patients with loose skin may notice swelling takes a bit longer to resolve than younger patients with firmer skin.
Once the swelling subsides, you should notice a skin tightening effect along with the fat dissolving.
I usually recommend the treatments be repeated every 4-6 weeks until the desired result is achieved.
For all subsequent treatments, you will notice less injections because there is less fat to treat.
Who does Kybella® work best for?
I’ve had men lining up for it, but it works equally well for both men and women who are concerned specifically with the small amount of fat directly under their chin. Although some skin tightening can be seen as a result of treatment, it does work best in younger patients with firmer skin that is not already sagging.
Kybella® does not help the “turkey neck” or sagging jowls (we have other treatments for that!) so chin, neck and jowl sagging would still be noticeable and need to be treated with other methods.
Is Kybella® expensive?
You may have heard that Kybella® is almost as expensive as liposuction for ridding the under-chin area of fat and fullness. However, it has it's advantages, which include being a non-invasive, non-surgical alternative to liposuction surgery or its after-effects which include pain, swelling and incision-site scarring.
It is definitely the more discreet and the less invasive of the options.
I’m excited to be able to treat my patients who have hated their lifelong double-chin...the difference it makes is amazing!
Just remember, your chin is attached to the rest of your face and your neck, so we have to take all of that into consideration when choosing the best treatment to achieve the look you want.
What I love about being involved in dermatological research is when new disease pathways are found and existing drugs can be applied to them. This is true for a new drug called Soolantra® for treating rosacea. There have been many theories about what caused the redness, large pustules, papules and broken blood vessels that characterize rosacea.
We typically treat rosacea with topical medications including drugs such as metronidazole, azelaic acid and sulfacetamide. Often, we add an oral course of antibiotics including doxycycline, tetracycline, minocycline and clarithromycin to kick start a faster response from the inside out. If that doesn't work, we moved on to topical retinoids such as Retin-A® and for really stubborn, disfiguring rosacea we try isotretinoin. We found that another topical gel formulation of the alpha2 agonist brimonidine called Mirvaso® helps decrease the facial swelling and redness, but doesn't help with the pustules and papules that are so disturbing to patients. Further, we often have to rely on lasers and light treatments to treat any broken blood vessels (we call telangiectasia) that often accompany the pimples and pustules of rosacea. After all is said and done, none of these drugs are perfect, so it is nice to have another option to add to anti-rosacea arsenal.
What can Soolantra® do that is different?
The FDA has approved a 1% cream of the anti-parasitic drug ivermectin (Soolantra®) for the topical treatment of rosacea. You may have heard of this drug as an anti-parasitic medication primarily used in the treatment of onchocerciasis (river blindness) in humans. It is also used in some epidermal parasitic skin infections, such as scabies. Researchers have now determined that Demodex, a microscopic mite that is a normal inhabitant of human facial skin is a powerful culprit in rosacea.
The results of the clinical studies may have you running to the dermatologist to try Soolantra® if you have rosacea:
Two 12-week, randomized, double-blind trials compared a once-daily application of ivermectin cream compared to a similar cream without ivermectin in a total of 1371 patients. In both trials, a complete or almost complete clearing of lesions occurred in significantly more patients treated with ivermectin cream (38.4% and 40.1%) than without the ivermectin (11.6% and 18.8%).
The ivermectin cream decreased the number of inflammatory lesions from the baseline by 76% and 75% compared to reductions of 50% using the cream without ivermectin alone.
Both trials were extended to 40 weeks of treatment with ivermectin cream which significantly boosted the percentages of patients with complete or almost complete clearing of lesions from 38.4% and 40.1% in the initial trial to 71.1% and 76% respectively in the extended trial. That's some increase.
Another 16-week randomized trial in 962 patients with moderate to severe papulopustular rosacea showed that using ivermectin 1% cream once per day was significantly more effective than metronidazole 0.75% twice a day in decreasing the number of inflammatory lesions from baseline (83% versus 73.7%) and in clearing or almost clearing lesions (84.9% versus. 75.4%).
This is such great, exciting news for those suffering rosacea
The treatment is simple, apply a pea-sized amount of prescription Soolantra® in a thin layer to any affected area of the face once a day. I would suggest my patients stay on Soolantra® until lesions have cleared which might be anywhere from 16-40 weeks (because there were virtually no side effects in the trials) depending on your specific rosacea condition.
I can't wait to see these results in my patients with rosacea...
Recently, the United States surgeon general issued a call to action to prevent skin cancer, calling it a major public health problem that requires immediate action.
Nearly 5 million people are treated for skin cancer each year. According to the American Cancer Society, more cases of skin cancer are diagnosed annually than breast, prostate, lung and colon cancer cases combined and skin cancer rates are increasing.
“We all need to take an active role to prevent skin cancer by protecting our skin outdoors and avoiding intentional sun exposure and indoor tanning,” said acting Surgeon General Boris D. Lushniak, MD, MPH.
I say this all the time, but it bears repeating as often as possible:
“Most skin cancer is 100 percent preventable.”
Most cases of melanoma – as many as 90 percent – are believed to be caused by cumulative exposure to UV rays. UV rays are also a major risk factor for the most common curable forms of skin cancer, basal and squamous cell skin cancers. Exposure to UV rays comes from the sun and other sources like tanning beds and sunlamps. The U.S. Food and Drug Administration (FDA) now requires that tanning beds and sunlamps carry a warning stating people under 18 should not use them. Lushniak said there is a flawed perception in the US that tanned skin looks healthy, and that needs to change. I always say,
“Tanned skin is damaged skin.”
According to the Melanoma Education Foundation, One blistering sunburn before age 20 doubles your lifetime risk of melanoma. Three or more blistering sunburns before age 20 multiplies your lifetime risk by five.
Reduce your risk of skin cancer for yourself and your children:
- Whenever spending time in the sun, always wear a sunscreen that blocks both UVA and UVB rays of SPF 30 or higher.
- Reapply sunscreen to dry skin every time you come out of the water and reapply at least every 2 hours regardless of SPF.
- Use a full 1 ounce of sunscreen (that’s a shot glass full) to cover your body. Don't forget to apply sunscreen to your neck and ears, face and tops of feet. If you have thinning hair, be sure to apply sunscreen to your scalp!
- Wear a hat to protect eyes and face by wearing sunglasses and a hat-seek shade often.
- Remember, babies under 6 months old should never spend any prolonged time in the sun.
-Jodi, proud owner of a lily white complexion.
Question: I found that during the holidays, both my acne and my rosacea flare up...at the same time. Why is that and what can I do about it?
Answer: Most people realize that rushing around fretting, shopping and baking for holiday parties and family gatherings can be stressful, but there's more going on behind the scenes that can cause skin problems to flare during the holidays. Here are some common reasons why your skin condition may flare up and what you can do to calm it down during and after the holidays.
1. You've let prescription regimens lapse. I know sometimes you feel that you just can't get to the pharmacy to pick up your prescription or you don't have time for the 3-step process of your topical skin prescription. If you suffer from acne or rosacea or any skin problem for which you have a usual regimen or you are taking or using a prescription medication, oral or topical, now is not the time to let the prescription lapse or be lax about using it exactly as recommended. Skin conditions under treatment with medication need to be used as prescribed to control flares caused by the physical, emotional and financial pressures of the holidays. Keep control of your skin conditions by paying special attention to keeping your regimen and skincare routines intact.
2. You're not protecting your skin. With the colder, windier weather this time of year, you may not be doing enough to protect skin from exposure to the elements. Always protect your face with a scarf on blustery days and switch up moisturizer at this time of year to a more emollient (thicker, soothing, smoothing) one, especially when venturing outside and to protect from the over-drying heat inside. Don't let sunscreen use lapse just because it is winter. Always wear sunscreen to safeguard your skin from ultraviolet light damage daily, especially if spending time outdoors for winter sports and activities.
3. You're keeping the house (and you're skin) too hot. Most people do not realize the effects of cooking over a hot stove and sticking your face in the hot oven, along with prolonged exposure to dry, heated indoor air during winter months on your skin. When things heat up in the kitchen, facial redness, breakouts and rosacea flares can occur. Furthermore, when the heat goes on in the house, humidity is sucked out of the air and consequently your skin. Crack a window when you sleep to prevent the bedroom from becoming overheated and use a humidifier to help replace some of your skin's moisture loss while you sleep, especially if you notice skin feels tight and looks flaky, red or cracked. If you are cooking, use a cool (clean!) wash cloth to wipe your face throughout the meal preparation and take a break when you can to a cooler part of the house or go outside.
4. You're wearing way too much makeup (and not washing it off)! Everyone tends to be a little more concerned during the holiday season with how they look for office gatherings, parties and family affairs. The temptation to wear heavier layers of primer, foundation and powder along with water-proof eye makeup and mascaras that hold up to partying to the wee hours can really block pores and cause irritation. If you do not wash it all off completely every time before going to bed, or worse, scrub too hard in trying to get it all off, your skin can become angry and inflamed; acne can flare. Never go to bed without taking off your makeup. Period.
5. You're indulging too much. Watch what you eat and drink. Certain foods and alcohol can trigger allergic reactions. When you indulge in foods and drinks you don't normally eat or drink, your body can overreact causing eczema/atopic dermatitis, itching, hives or even more severe anaphylaxis. Let's not forget the sallow, pale, splotchy and wrinkled look of a hangover. Take care to avoid the foods you know you are sensitive to. Furthermore, many foods such as red wine, steaming foods or drinks and spicy foods may trigger reddening in conditions such as rosacea. Be sure to know your personal skin triggers and take care to avoid those accordingly. Also try to maintain your body's hydration levels with lots of purified water whenever possible to flush out allergens, alcohol, stress hormones and other environmental pollutants in the body.
I know, I know - easier said than done!
Maybe you already have your goals and resolutions in place for the beginning of 2015, but none will be easier to kick off and have a greater effect than those to help improve your skin, nails and hair. Check our list and just pick one or two. You can get started right now improving your skin's health and reducing your chances of premature aging, as well as decreasing your risk of diseases of the skin and hair. Go ahead...get going...
1. I will apply sunscreen in the morning every day, whether or not it is cloudy or cold. The sun emits harmful ultraviolet (UV) rays year round and even on cloudy days, up to 80% of the sun’s harmful UV rays can penetrate your skin. Snow, sand, and water all reflect the sun’s rays and increase the need for sunscreen. One of the most valuable things you can do for your skin, is the regular, daily application of sunscreen. We know when applied every day, sunscreen use protects against photoaging-wrinkling, spotting and loss of elasticity caused by exposure to the sun's UV radiation. Furthermore, skin cancer rates are on the rise and sunscreen has been proven to decrease the risk of skin cancer. So, why not use it? Keep your sunscreen next to your toothbrush-when you brush your teeth in the morning, reach for the sunscreen. In twenty years you will be glad you did!
2. I will stop smoking. Period. Isn't it time? Beyond its known links to cancer, lung and heart disease, smoking is now known to be associated with premature skin aging, delayed wound healing, as well as other skin disorders. Moreover, we know smoking makes you look way older than you actually are and that is enough of a reason to kick the habit once and for all.
3. I will use a humidifier in my living quarters to combat winter dryness. A humidifier can be your best friend in the cold, dry winter months, helping your skin stay hydrated and supple.
4. I will increase my water intake and decrease my intake of soda, coffee and alcohol. Water is the best option to reach for when you want a drink. Being dehydrated makes your skin look more dry and wrinkled which can be improved with proper hydration. But...why water? The concept of sugary drinks and aging is really not new. Sugar can be implicated in heart disease, negative effects on brain health and can be associated with immune system suppression. Recent research has suggested that drinking even one sugary soda a day may speed up the rate at which your body ages. Our other favorite vices, coffee and alcohol can also wreck your skin. Both act like a diuretic and prevent your body from holding onto water. The result? Your skin can look dry, wrinkled, and washed out. Make a commitment to yourself, when you feel the need to indulge (and we all know we will), keep yourself hydrated. It may save your skin!
5. I will get a good night's sleep. Your lack of sleep is written all over your face. Your tired skin sags, bags and loses its luster. Lack of sleep causes blood vessels to dilate, causing dark circles under your eyes. Not enough sleep can also make you be more tense and stressed, which definitely makes you look older. When you get a good night's sleep, your body and skin go into repair mode. Skin cells grow and replace older ones...skin becomes renewed and regenerated. A good slumber helps your skin restore and rebalance after the harsh elements of the day. Skin recovers quickly, so get to bed...get that beauty sleep; everyone will notice your fresh face tomorrow.
6. I will practice head to toe monthly self exams on my skin, so I can find any new or changing lesions that may be cancerous or pre-cancerous. I will make an appointment at the dermatologist's office immediately if I notice a new skin growth or change in a mole or growth I have had for a long time. Skin cancers found and removed early are almost always curable, so look yourself over. If you spot it, you can almost always stop it.
These simple skin care resolutions are easy ways to make a big impact on the condition of your skin (and your health). To make it easier to remember to make any of these actions part of your daily habit (or to stop the the detrimental ones from being part of your daily habit), try leaving post-it notes on all your mirrors or nightstand or set up Smartphone alerts using a free calendar app or a free reminder app such as Water Your Body. Start incorporating these changes and we're sure you will see the results. Be sure to check back the whole month of January for more skin resolutions. Remember...it is never too late!
Question: I am a young woman in my twenties and I have noticed a few dark hairs sprouting along my cheek and they are definitely not part of my hairline. What could be causing this and is it normal? How can I get rid of them?
Answer: Clinically, whenever we see a woman who has any dark hair anywhere on her face or body where hair is normally not present, we call it hirsutism. Of course, Conchita Wurst (at left), who won the Eurovision Song Contest earlier this year is in drag, so her manly hormones, mainly testosterone, are the cause of that dark hair growth on her face, where most women do not want or have hair.
How hirsutism happens...
If you've noticed some hairs growing where they shouldn't be, you may have a benign (not dangerous) condition of slightly elevated levels of serum androgens (male hormones) in your body. In women, excess androgen production stimulates (fine) vellus facial hairs to develop into long, coarse, pigmented terminal hairs (like a man's) in most areas of the body except the scalp, where normal estrogen would inhibit that hair growth. That's why women do not normally have facial hair and chest hair, for example. On the scalp, the opposite happens in a woman with too much testosterone in the bloodstream, the long, dark terminal scalp hairs are converted to vellus hairs, eventually resulting in hair thinning.
Sometimes, the condition is part of a larger problem and can be associated with polycystic ovary syndrome (PCOS) which can affect a woman's hormone levels causing the abnormal hair growth. Rarely, ovarian or adrenal tumors can also cause endocrine (hormone) problems that result in excess hair growth and other unwanted signs of masculinization in women. For this reason, it is important to see both your dermatologist and your OB/GYN if you notice any abnormal, hair growth so you can get an accurate diagnosis.
A blood test will give a more clear indication of the origin of the androgens which could simply be testosterone secreted by the ovaries. If testosterone levels are normal, other androgens may be secreted by your adrenal glands. The results will give your doctors a clearer picture of the diagnosis for the unwanted hair growth and the treatment necessary to get it under control. Sometimes, you may be further referred to an endocrinologist for further hormonal testing if necessary.
How we treat simple hirsutism, or abnormal hair growth in women
While there is no cure for hirsutism, in women with mild, isolated hair growth, we can usually get the unwanted hair growth under control in a variety of ways. The first-line therapeutic approach is to decrease the rate of androgen production and secretion which can be done simply and effectively with oral contraceptives (birth control pills). We can further inhibit the androgen action with other medications such as spironolactone (Aldactone), which we use off-label to block the androgen receptors while also suppressing testosterone production. No matter how we try to control the hormones, it usually takes six months to one year for even partial clinical improvement. Once the excess hair is under control, the medications must be continued to limit hormonal production and the unwanted hair growth.
During treatment with the medications, you can physically remove the unwanted hairs by tweezing, shaving, waxing or using depilatories, but the excess male hormones should still be treated. Permanent physical methods to remove hair such as laser hair removal (electrolysis) are great options for treating hirsutism, but for best results the hormonal aspect should still be addressed simultaneously.
Bottom line for weird hairs where they don't belong? See your dermatologist and your OB/GYN ASAP!
Question: Is there such a thing as sweating too much? What can I do about it if I’m constantly soaking through my clothes? It’s so embarrassing, especially at work!
Answer: Yes, the condition definitely heats up during the summer months but can plague sufferers all year long with overly sweaty armpits, palms and even on soles of the feet. It is called hyperhidrosis which just means “excessive sweating.”
Hyperhidrosis is simply abnormally heavy perspiration. Sweating is a normal bodily function, but some people may have overactive sweat glands that produce more sweat beyond what is required for regulation of body temperature. It can be most noticeable at the armpits because sweat can soak through clothing and become obviously embarrassing. Or you may also be aware your palms are often sweaty so you avoid shaking hands with others. Hyperhidrosis can occur in many parts of the body whether exposed to triggers such as heat, physical activity or exertion, embarrassment, stress or not.
How do we treat excessive sweating?
First, we’ll evaluate your excessive sweating for any potential causes of secondary hyperhidrosis (for example, an underlying disease that causes excessive sweating such as hyperthyroidism).
To gauge your sweating problem, we will try you on stronger prescription-grade antiperspirants which can also help block sweat glands to reduce sweating. Typical over-the-counter antiperspirants are 1-2% aluminum chloride but prescription products can contain up to a 20% solution of aluminum chloride hexahydrate or similar aluminum salts. While these can be irritating in those with sensitive skin and sweat glands, they do reduce perspiration, however they require continuous usage.
After a few weeks of trial, if the prescription products do not reduce your sweating problem well enough, we can now use Botox® (onabotulinumtoxinA), which is FDA approved for the treatment of excessive sweating of armpits. We also use Myobloc® (rimabotulinumtoxinB) or Dysport® (abobotulinumtoxinA) off-label as an alternative, especially for those who have excessive sweating on palms and soles of feet.
These injections work to temporarily de-nerve the sweat gland and results in a local reduction in sweating where injections have been administered for up 5 months. Injections must be repeated at regular intervals to keep excessive sweating at bay and you may still need to use an antiperspirant.
Question: I’ve seen plenty of products in the drug store skincare aisle that contain retinol and say they reduce the appearance of fine lines while balancing an uneven complexion. Is this the same as the Retin-A products I can get by prescription?
Answer: While they are both derivatives of Vitamin A, called “retinoids,” and used to promote faster skin cell turnover, they are not the same.
All retinoids have been well-studied, tested and been proven effective and powerful for treating skin issues ranging from acne to many signs of aging, including sun damage.But there is a marked difference between retinoid products you get only by prescription and the retinol products you see on drug-store shelves.
Retinoid products are prescription-only skincare products containing the most commonly-known natural vitamin A derivative, tretinoin which comes in name brands such as Atralin, Retin-A (and Micro) among others. These proven prescription products increase the rate of cell turnover to uncover healthier skin-whether it’s reducing fine lines or evening out the texture or color of your skin. Common side effects include dryness, redness, cracking, irritation and skin peeling. There are two other prescription strength (lesser known) prescription retinoids-tazarotene (Tazorac) and adapalene (Differin).
If you find, during the dead of winter, that dryness, peeling, redness and cracking are more pronounced, simply reduce the usage of your prescription retinoid to just once per day, or every other day or even every two or three days until side effects are diminished. By the way, winter weather and drier indoor heat may be exacerbating your already winter-dry skin, if you need to use them less don’t worry, the powerful retinoids still do their job!
Retinol products don’t require a prescription so you can buy them over-the-counter at the drug store or grocery store, without a prescription. Retinols are simply a synthetic, weaker version of a retionid and as such, they act more slowly than a retinoid. However, these products can be useful if you find prescription retinoid products too strong for your skin. They are also a good beginning step to starting your skin on a topical retinoid.
When choosing a drug store retinol product, check the ingredients list to make sure vitamin A is listed toward the top of the ingredients list. Also, in terms of packaging, look for an air-tight bottle that keeps the light out (exposure to light makes the products less stable and effective and more susceptible to bacteria growth.)
Other skin tips:
- Reduce your skin’s exposure to hot-hot water.
- Add a humidifier to rooms where you spend a lot of time.
- Use an emollient (thick) cream to counter peeling and cracking skin.
- Always wear sunscreen.