Ask Jodi

What to do about an inflamed, raised, hard scar

Posted on by Jodi LoGerfo

Question: I had an injury to my shoulder earlier this year and while the wound has mostly healed and is no longer scabby, the resulting scar is still painful, raised, hard and lumpy. It's bigger and uglier than the original wound. What can I do? 

Keloid scar

Answer:

There are two types of scars that resemble what you describe and there's a lot we can do in the dermatologists office to help them look and feel better. 

This type of scarring is usually after local skin trauma (e.g., laceration, tattoo, burn, vaccination or surgery) or as a result of an inflammatory skin disorder (e.g., acne, bites or abscesses). 

Scars are composed of new connective tissue that replaces lost tissue in the dermis or deeper parts of the skin, as a result of injury. Their size and shape are determined by the form of the previous wound. The process of scarring is characteristic of certain inflammatory processes. A resulting scar can be thin (atrophic) or thickened, fibrous and overgrown. Some individuals and some areas of the body (e.g., anterior chest) are especially prone to scarring. Scars may be smooth or rough, pliable or firm, they can be pink or violaceous or become white. They can also be hyperpigmented (darkened). Scars are persistent and normally become less noticeable in the course of time. 

Keloids & Hypertrophic Scars 

At times though, and in certain anatomical locations (e.g., shoulders, sternum, mandible and arms) they can grow thick, tough and corded forming a hypertrophic scar or keloid. Under normal circumstances,  wound healing takes place through the rapid and repeated reproduction of fibroblasts (the most common cells of connective tissue) at the wound site. But when fibroblast activity continues unchecked and excessive collagen (protein found in connective tissue) is deposited at the site of injury, the scar gets too big and a hypertrophic scar or keloid is formed. 

A Hypertrophic Scar remains confined to the borders of the original wound and most of the time, retains its shape. It is characterized by hardness, redness and irritation compared to the surrounding skin and can take the form of a firm papule or nodule. 

Conversely, a Keloid is an overgrowth of dense fibrous tissue that you'll notice extending beyond the borders of the original wound. Like a hypertrophic scar, a keloid can be hardened, raised and often darkly discolored. Keloids do not regress, appear to get better or shrink over time on their own. Instead they grow in a pseudo tumor fashion and distort the size and shape of the original lesion. If you know you have a hereditary predisposition toward keloid scarring, mention that to your dermatologist because then we will not try to surgically remove them (called excision) because keloids tend to recur. 

The differences… A hypertrophic scar can occur at an any age and usually stays within the borders of the original wound, whereas a keloid commonly occurs in the third decade and enlarges beyond the area of the initial wounding with web-like extensions. Keloidal growth can also be triggered by pregnancy and compared with hypertrophic scars, a keloid can often be painful and super-sensitive. 

How we treat stubborn keloids and hypertrophic scarring 

We often use a 3-step process in the office to attack raised, hardened scars as soon as we notice a scar is exhibiting signs of hardening, as early as one month-post op, in the case of a scar due to surgery.  The earlier you treat a keloid or hypertrophic scar, the better your results will be. 

We inject  5-fluorouracil "5-FU" (used primarily as an anti-cancer drug but also used for the prevention of scars in glaucoma surgery for at least 15 years) combined with a specific low-dose corticosteroid (to reduce further inflammation and any pain) along with Pulsed Dye Laser treatments. 

5-FU works to reduce skin's metabolism rate and inhibits the over-production of the fibroblasts building up on and around the wound. We combine that with Kenalog (triamcinolone), the low-dose corticosteroid, and perform injections one to three times per week, at regular intervals such as Monday, Wednesday and Friday, depending on how red, hardened and inflamed the scar is. Once the scar softens, injections can be reduced to two times per week, once a week and then every other week, monthly and finally, every six months. The Pulsed Dye Laser is used to decrease any redness, to normalize the wound surface and improve skin texture at the scar and to further blend scar into surrounding skin and we perform those treatments in intervals of four to eight months apart. 

While any keloid or hypertrophic scar can be treated with this technique,  you'll get the best results the younger the scar is. The more inflamed and symptomatic the scar, the better the response to treatment. Older scars that have been hardened for many years and are not inflamed, red, itchy or painful, will not respond as quickly or as thoroughly. Hypertrophic scars respond better than keloids, which frequently recur, although small isolated keloids (less than 2 cm in diameter) usually completely resolve with this technique without recurrence. 

No matter what, keep all scars out of the sun for best healing, at least until the “pink” of new skin is gone because exposure to the sun only makes scars darker. 

-Jodi              

If you get a sore or scar on your scalp does it always cause permanent hair loss?

Posted on by Jodi LoGerfo

Question:  I've noticed more hair fall out than usual recently, so, upon looking at my scalp and feeling around more closely, I've found several different areas with  around my scalp where there is no hair. Some areas of hair loss feel smooth with no hair in them and some are sensitive and painful, as if a sore is there or has healed. HELP!

Answer: Clinically, we call that cicatricial alopecia which is the medical term for hair loss due to scarring. Since scars, sores or inflammation  occur due to many different causes, you should head directly to your dermatologist so you can have your scalp examined and a diagnosis made.

The sooner you figure out the the source, the sooner you can begin treatment to cure any lesions (sores) so they don't scar and cause permanent hair loss.

Once hair loss occurs, hair does not usually grow back because the scar tissue has killed the hair follicle. 

How we diagnose cicatrical alopecia, or scarring alopecia 

It's a process that starts with many questions. We will ask you about any recent illnesses, injuries, allergies, your lifestyle, medications and your haircare regimen. We will closely examine your scalp using a magnifying glass and a special light to determine if the lesions have bacterial or fungal causes. We will feel your entire scalp and any lesions feeling for inflammation, sores or scales to determine the exact nature of the lesions and how they appear at different stages and locations. We will also document any hair loss that has occurred and take pictures for future reference. Often, we will take a biopsy of the sore or scarred area to determine the exact cause (if bacterial or fungal) and also to examine the health of the hair follicles to ascertain the severity of the condition. (We use a 4mm punch biopsy to provide an adequate specimen from an active lesion. Sometimes we will also take another sample from an unscarred area.)

Any type of scalp reaction or injury resulting in a lesion that causes a scar can cause death to the hair follicles and permanent hair loss and we call that scarring alopecia. Lesions that cause scars and hair loss can be caused by any of the following conditions and diseases: 

UNKNOWN ORIGIN & AUTOIMMUNE

  • Discoid lupus erythematosus (DLE): A chronic skin condition characterized by inflamed sores that begin as  a red, inflamed patch with a scaly and/or crusty look and feel. The patches leave noticeably discolored, raised scars. Hair follicles are damaged first by the sores and then the resulting scar tissue causes permanent hair loss.
  • Lichen planopilaris: Also called follicular lichen planus, this a rare inflammatory condition results in patchy progressive permanent hair loss. Initially you may notice some small or spiny red bumps around involved follicles which may or may not be itchy. This eventually forms larger reddish lesions (resembling a lichen pattern) and scar tissue which damages hair follicles and causes hair to fall out and not grow back. Additionally, Frontal Fibrosing
  • Alopecia: appears to be a variant of lichen planopilaris. This occurs in mostly older women and appears in a band-like pattern in the frontal and temporal areas of the scalp. Often, a patient's eyebrows are also affected.
  • Sarcoidosis: This disease, also with unknown origin,  causes collections of mixed inflammatory cells (granulomas) which form lesions resulting in scarring at many different parts of the body, including the scalp.

FUNGAL

  • Seborrheic dermatitis: We believe this condition is an inflammatory reaction related to an over-abundance of a normal  yeast species  found on the scalp called M. globosa. It produces toxic substances that irritate the scalp causing a scaly rash.
  • Ringworm (tinea capitis): On the scalp, this common fungal infection characterized by itchy red rings can result in scaling and hair loss  in children, and can progress to folliculitis, too (see below).

BACTERIAL

  • Folliculitis decalvans: Simple folliculitis is any bacterial infection of the hair follicles. But when hair loss is caused by  redness, swelling and pustules surrounding hair follicles that appears to be spreading, it is called folliculitis decalvans. Another type of scarring alopecia, hairs shed as follicles are completely destroyed by the inflammation. A resulting scar is left behind where hair will no longer grow.  Simple folliculitis (one sore) can stem  from a bug bite or a scratch and flare-up or spread if infected with the bacteria Staphylococcus Aureus but recently we have found Methicillin Resistant Staphylococcus Aureus (MRSA) in some lesions and boils, so we always want to take a culture in any open lesions on the scalp, especially those that are spreading. In addition, a variant of folliculitis decalvans occurs in African Americans who present with ingrown hairs of the beard (pseudofolliculitis), acne keloidalis (a destructive folliculitis of the back of the scalp) and scarring alopecia.

TRAUMA

  • Central Centrifugal Cicatricial Alopecia (CCCA): Usually seen in African American women, this type of scarring alopecia usually develops on the crown and spreads peripherally to form a large oval of hair loss on the scalp. Originally, this type of hair loss was thought to be caused by hair straightening with a hot comb or due to the hot petrolatum used with the iron; however, was also found to take place in patients without the use of hot combs or straightening methods.

How we aggressively treat lesions that cause scars…

Once we know what may be causing the lesions, we can treat them to minimize spreading, scarring and any resulting hair loss, using any of the following treatments or combinations of treatments:  

    • Oral and intra-lesional steroids
    • Topical corticosteroids
    • Oral retinoids (isotretinoin)
    • Antimalarials (hydroxychloroquine)
    • Antibiotics (tetracycline, doxycycline, minocycline)
    • Antifungals (itraconazole)
    • pioglitazone
    • Immunosuppressants (cyclosporine, mycophenolate mofetil)
    • DHT blockers (dutasteride internally and minxoidil topically to -induce hair growth if follicles are alive.)

I have found that most patients experience hair loss very gradually (and cannot see the back and top of their head) and the prolonged course of the disease may cause a lack of necessary action. You need to know that the progressive destruction of hairs will result in ever-expanding areas of permanent hair loss. So, no matter what, go see a dermatologist as soon as you feel any sores, pimples, pustules, pain, itchiness, scaliness or inflammation on your scalp, whether or not they have already caused hair loss, because they need to be treated ASAP and aggressively as possible. 

-Jodi  

Can babies go in the sun?

Posted on by Jodi LoGerfo

Question:  I’ve heard conflicting opinions about what age babies can go in the sun. Is there a sun exposure rule for healthy skin for babies? Always have baby wear a had to shade her face in addition to sunscreen in babies over 6 months

Answer: 

I second the advice of the The American Academy of Pediatrics, the U.S. Food and Drug Administration and the American Cancer Society:

Keep babies under 6 months old out of the sun entirely and do not apply sunscreen on babies younger than 6 months. 

Babies who are 6 months or older should be protected with clothing, hats, a broad-spectrum sunscreen and shade. Look for broad-spectrum formulations specifically for babies and toddlers who have more sensitive skin than adults. The time that they spend in the sun should be very limited.

Did you know? More than half of a person’s lifetime sun exposure occurs before age 20.

Remember, skin keeps impeccable records, so every minute spent in the sun adds up as skin damage and possibly skin cancer. More than one million Americans develop skin cancer every year mostly from long-term exposure to ultraviolet radiation from the sun. UV exposure makes you look old before your time and causes:

  • Wrinkling
  • Blotching
  • Drying
  • Leathering of the skin

Beginning with babies 6 months and older, limit time in the sun and protect skin with sunscreen and protective hats and clothing whenever exposed.

-Jodi

What good is coconut oil for hair and skin?

Posted on by Jodi LoGerfo

Question: I've been reading more and more about using coconut oil for hair and skin. Do you think this is a good idea? Can you tell me how to buy coconut oil and how to use it properly?

 As a solid its an ointment or balm, warmed to a liquid a liquid its a moisturizing, conditioning oil

Answer:

I love coconut oil as an added treat for hair and skin (as long as you are not allergic to nuts or coconut). But, I only recommend buying organic unrefined expeller-pressed virgin coconut oil (also called VCO).

VCO is a great addition to any hair and skin routine because:

  • It has no preservatives, additives or color.
  • It's available at any local health food store or online.
  • It's affordable at $9 for a small 14 ounce jar.
  • It's a multi-use beauty product
  • That smell is like being on a desert island (refined VCO  does not retain its natural coconut aroma).

The real beauty of VCO for skin and hair is its natural, molecular composition

Not only does VCO have a high saturated fat content-composed of 90% saturated triglycerides, but its low molecular weight and straight linear chain (called a medium-chain fatty acid, in contrast to other saturated fats comprised of long chain fatty acids which make them larger molecules), it is able to permeate the hair shaft  and skin surface rather than just sitting on top. That's what makes it so effective. If you use it at room temperature (when it is solid) it is the perfect ointment to relieve dehydrated, chapped, scaly and itchy skin and it can even improve symptoms of psoriasis and excema. But if you place the jar in warm water, it melts into a liquid oil perfect for massaging, baths, a moisturizer or a hair mask.

The medical literature supports my own observations of VCO as a healthful skin conditioner and moisturizer. Studies have shown that  VCO use may improve skin barrier function (protecting skin from bacteria and fungal intrusion) and  decrease trans-epidermal water loss (skin's ability to retain moisture). Animal studies have shown that coconut oil use can improve wound healing and increase collagen production, too. For hair, in addition to its high absorbability, VCO contains a high percentage of the saturated fat, lauric acid, which also is highly attracted to the protein in hair. Because VCO actually absorbs through the hair shaft, it has positive effects on the strength of hair while it prevents hair damage and protein loss from styling, brushing and even chemical treatments.  

A little coconut oil on your skin and hair goes a long way:

  • As a daily body moisturizer, after shower or bath
  • As a bath oil
  • As a skin exfoliator for skin and to help control dandruff in hair
  • As a cuticle conditioner
  • As a lip balm
  • As an intensive hair mask, from scalp to ends
  • As a scalp or body massage oil

Coconut oil can be greasy if applied too heavily, but don't worry, it absorbs in a few minutes leaving behind that beachy smell and softer, healthier, smoother skin. It can be applied on wet or dry skin. But only apply to dry hair because water limits the VCO from coating the hair properly and permeating the hair shaft. To remove VCO from hair, do not wet first. Simply lather up shampoo in your hands and apply directly and completely over hair and scalp, from roots to ends, then rinse thoroughly.

VCO can be applied in the same way to children and adults. Just be sure that you don't use coconut oil at all if you are allergic to nuts or to coconut.

Have you tried virgin coconut oil yet? What's your favorite way to use it? -Jodi  

Should I be using a retinoid?

Posted on by Jodi LoGerfo

Question:  As I've moved through my thirties and into my forties, I've noticed a marked change in my facial skin. I have some dark spots and discolorations and my face seems thinner overall and a little more sallow. I've heard about using a Retin-A cream but I thought that is for acne or wrinkles. Is it for me? 

Answer:  Actually Retin A is not just for acne or wrinkles. It is a simple, inexpensive topical cure-all for all pre-mature aging and photo-aging (skin damage caused by sun exposure). How your skin looks and feels as you age is influenced by many factors such as genetics, environmental exposure (sun, medication, mechanical stress), hormonal changes and metabolic processes. All of these factors, some of which have to do with your lifestyle and some  you have no control over, cause a change in skin structure, function, and appearance as you age. Although, we dermatologists have studied and seen first-hand that solar UV radiation (sun exposure) is the single major factor responsible for  the unwelcome, premature  effects of skin aging on face, neck or back of  hands such as:

  • Coarser, rougher skin feel and appearance
  • Sallowness
  • Wrinkles
  • Irregular coloration and discolored spots or patches
  • Discolored brown spots called lentigines
  • Telangiectasias (little red visible blood vessels)
  • Benign neoplasms (abnormal, yet non-cancerous, masses of discolored or raised tissue)
  • Pre-cancerous lesions called actinic keratoses and lentigo maligna
  • Cancerous lesions such as basal and squamous cell carcinomas and malignant melanomas.

So, what's a "retinoid?" First, a little science lesson.  You may hear or read about a lot of terms that all have "retin" in them. That's because the retinoid family comprises vitamin A (retinol) and its natural derivatives such as retinaldehyde, retinoic acid and retinyl esters, plus many other synthetic derivatives. Vitamin A cannot be synthesized by our bodies, so it needs to be supplied and is naturally present in foods as the compound beta-carotene. Retinoids are required for a vast number of biological processes inside the body such as embryo development, reproduction, vision, growth, inflammation and cell differentiation, proliferation and apoptosis (naturally occurring cell death for normal cell growth stages). Retin-A (tretinoin) is the most popular retinoid for facial skin and is also the retinoid most studied for the treatment of chronological or photo-aging. I have tracked numerous studies which have repeatedly shown clinical improvement in photo-damage with tretinoin treatment, as well as with some other topically applied retinols such as isotretinoin and retinaldehyde (which are not my favorites because they are not as potent or stable.) Longer-term studies (6-12 months) on tretinoin were carried out once short-term studies showed that patients' skin condition continued to improve in appearance over time. Additionally, most of these studies compared the use of the various strengths of tretinoin to arrive at the optimal concentration for the treatment of skin aging. 

How do retinoids work? Retinoids are known to speed up the cellular processes such as cellular growth and differentiation. Retinoids work on the skin surface by prompting surface skin cells to grow and die quicker and slough off faster, making way for new cell growth underneath. In this way, they cause discolorations and spots to lighten and they hamper the breakdown of collagen and thicken the deeper layer of skin where wrinkles start. Interestingly, current studies have found that the mechanism by which collagen and elastin are lost after skin is exposed to UV radiation may be blocked when topical tretinoin is applied before sun exposure. More studies are ongoing. 

What about side effects? The most common and frequent adverse effect of topical retinoids is called the "retinoid reaction" which you may or may not experience as burning, peeling, reddened or inflamed skin at the sites of application or in skin folds such as around the nose or lips where additional product might be deposited by accident. It's this reddening and peeling that occurs within the first two weeks of use which cause many patients to give up therapy before realizing any of the benefits which can take two to three months or longer to see and feel. What most people don't know (or wait for) is that the skin builds up tolerance to the retinoid treatment and side effects eventually subside. Also, you can reduce application amount and days or try a lower potency formula to start if you experience these side effects. 

The most important factor in success with tretinoin is to follow the entire course of treatment not to give up! 

The other side effect associated with tretinoin therapy is photo-sensitization (you will be more sensitive to the sun's rays and burn easier), which normally occurs at the beginning of treatment. I always advise patients on tretinoin therapy to avoid excessive sun exposure and use a broad-spectrum sunscreen of at least SPF 30 (and a hat).  Your skin’s response to UV radiation should also return to normal after a few months of treatment. We love combination creams I have found that the way to counter the side effects is to use a retinoid combination cream containing a corticosteroid to reduce inflammatory response and if discoloration or brown spots is one of your problems, you might want to add 4% hydroquinone (a known skin bleaching agent). We think that this combination may be even more effective than the individual components alone. Has tretinoin worked for you? How long did it take?  

UV rays and location, location, location…

Posted on by Jodi LoGerfo

Question:  Is it true that the sun’s UV rays are stronger in the South?

 That big line on the globe is the equator - Do you live near it on either side?

Answer: Yes, this is true. The closer your location is  to the equator (the line that is equally distant from the South Pole and the North Pole which also separates the Northern Hemisphere from the Southern Hemisphere on a map or globe), the more potent the sun’s rays. This is because they hit the earth more directly for a greater part of the year which accounts for the higher skin cancer rates in  “sun belt” locations. People who live or vacation in the Southern United States  or in Central and parts of South America and Africa should be especially aware and diligant of the need for sunscreen, hats and protective clothing and eye glasses whenever outside.

You may see lots of tanner people in these locations and that’s because they are exposed so much more to the UV rays from the sun. Remember, there is no such thing as a healthy tan (no matter what society would lead us to believe) because tanning is the skin’s response to the sun’s damaging rays.

If you're unsure how close you are to the equator, check this global equator map.

-Jodi

Want to be 25% less likely to get age spots?

Posted on by Jodi LoGerfo

Well, I've been saying this to my patients for years:  Daily sunscreen use prevents the ugly results of photo-aging (spots, roughness and wrinkles caused by years of cumulative sun exposure which speeds up your skin's natural aging process)  and finally a study published in a June issue of the Annals of Internal Medicine entitled, "Sunscreen and Prevention of Skin Aging," has proven this to be true. 

Studies have already proven that sunscreen prevents skin cancer, but previous studies on photo-aging had always been done on mice so this new study performed on over 900 white people in Australia under the age of 55 and measured over 4 years just confirms what we dermatologists have been saying to our patients: 

"If you want to keep spots and wrinkles at bay,  use sunscreen every day." 

Initially, the researchers weren't sure exactly what effect regular comprehensive use of sunscreen would have on skin aging caused by the sun over the years and they were also curious about the effect of taking dietary antioxidants such as β-carotene supplements to delay skin aging so they tested both. 

The study was broken randomly into 4 sunscreen use groups:

  1. Specific daily use of broad-spectrum (protects against both UVA & UVB rays) sunscreen of SPF 15 applied to head, neck, arms, and hands each morning and after bathing, after spending more than a few hours in the sun, or after sweating heavily and 30 mg of β-carotene.
  2. Specific daily use (as described above) of the broad-spectrum SPF 15 sunscreen and placebo.
  3. Use of broad-spectrum SPF 15 sunscreen at the discretion of the participant and 30 mg of β-carotene.
  4. Use broad-spectrum SPF 15 sunscreen at the discretion of the participant and placebo.

Photos were taken of the backs of participants’ hands at the beginning of the study and 4.5 years later and were examined for microscopic changes of skin aging by researchers without the knowledge of  which study groups the participants had been assigned. 

The sunscreen use findings: 

Interestingly, not all of those in the daily use group applied their sunscreen daily as directed. But more participants assigned to the daily sunscreen use group reported applying sunscreen at least 3 to 4 days each week compared to the participants in the discretionary-use group. Those in the daily-use group were 24% less likely to have increased skin aging after 4.5 years than were those in the discretionary-use group. 

No overall effect of taking β-carotene supplements on skin aging was found.

My advice:  If you want to prevent discolorations, spots and wrinkles from forming due to cumulative exposure to the sun's rays as you age, use a broad-spectrum sunscreen (and make sure it specifies so on the label) daily of at least SPF 15 whenever you are outside and exposed to the sun.  Also,  seek the shade whenever possible and wear a broad-brimmed floppy hat and sun glasses to protect facial skin and your eyes! 

-Jodi

Allergic to sunscreen? Read labels!

Posted on by Jodi LoGerfo

Question:  My daughter is apparently allergic to many of the sunscreens I have tried on her and gets an itchy, burning rash. What is it in the sunscreens that is causing this reaction? 

Answer: There could be many different chemicals causing a skin reaction.Read those sunscreen labels!

Most commonly, allergic reactions to sunscreens are caused by one of the original UVB sunscreen protection ingredients called para-aminobenzoid acid  or PABA. 

Read sunscreen labels and look for refined and newer ingredients called PABA esters (such as glycerol PABA, padimate A and padimate O) instead of the original staining, reaction-forming PABA. 

New "broad spectrum" sunscreen ingredients 

This year,  the FDA requires sunscreens to protect against both UVB and UVA rays (labeled "broad-spectrum"), so new sunscreen ingredients have been developed and included such as include Mexoryl SX (ecamsule) and  Parsol 1789 (avobenzone) which protect against UVA rays. 

Physical sunscreens including  titanium dioxide and zinc oxide have been around for decades. Remember Zinc Oxide on the noses of lifeguards back in the day? These ingredients physically block and scatter UV rays. These singular sunscreen formulas have no other chemical ingredients and so may be a better choice for sensitive skins. They also go on thicker and appear “whiter,”  but they also stay on longer and are gentler to sensitive skins. 

Despite advances in technology, formulating products with these ingredients without the skin-whitening effect has proven difficult.  Zinc oxide has recently been approved by the FDA, like titanium dioxide, in microsized or ultrafine grades as  an allowable active ingredient in sunscreen products with the ability to provide more full-spectrum protection. Zinc oxide is less whitening in this form than titanium dioxide and provides better UV protection. You  can now find sunscreen products that contain these ingredients in combination with other sunscreen ingredients to increase their stability in water and sun and decrease unwanted "whiteness." 

But remember sunscreen protection is all in the proper application.  And, a lot has changed in how we recommend sunscreen to be purchased and used, so it pays to stay up on the news about sunscreen so you don't get burned (literally!) 

Other buzz words for sensitive skin 

You will notice  lots of colorful kids' sunscreen products on store shelves you might want to stay away from. Try to  avoid any sunscreen products containing dyes or perfumes, which are known allergens. And, for acne-prone or oily sensitive skins, definitely check for specific products labeled, "non-comedogenic" or "won't clog pores." 

I cannot stress enough how important it is to be aware of sunscreen ingredients, especially when allergic reactions are concerned, and take the time to stand in the store aisles and read those labels! 

-Jodi

Black Salve no skin cancer salvation!

Posted on by Jodi LoGerfo

Question: I've read many accounts online about an alternative therapy of using an herbal "Black Salve" to treat skin cancer, but then I also saw many scary photographs and read many scary stories of disfiguring skin damage from the treatment. What's your opinion?Just say “NO” to Black Salve and alternative cures you see online as skin cancer cures! Just say "NO" to Black Salve and alternative cures you see online as skin cancer cures!

Answer: My opinion is firm: When it comes to any type of skin cancer, medical treatment has more than a 90 percent cure rate when lesions are caught early and removed and conventional medicine has an excellent track record in successfully treating skin cancer and restoring health. 

In fact, while there may be a genetic predisposition (family history or skin type) to skin cancer, statistics show that 90 percent of all skin cancers are caused by long-term, unprotected exposure to the sun's UV rays. Those at highest risk are people with fair skin, blond or red hair, and those with blue, green or grey eyes and workers in outdoor occupations.  So skin cancer prevention falls on you for keeping unprotected sun exposure to a minimum and in checking your own skin for suspicious growths and actively having them checked at least once per year by a dermatologic practitioner. 

The skin cancer fear factor… 

Once cancer is diagnosed, patients can get scared and can fall prey to online cure scams and alternative therapies that can do more harm than good, according to a 2009 FDA release entitled, "Beware of Online Cancer Fraud."  "Anyone who suffers from cancer, or knows someone who does, understands the fear and desperation that can set in," said Gary Coody, R.Ph., the National Health Fraud Coordinator and a Consumer Safety Officer with the Food and Drug Administration's (FDA) Office of Regulatory Affairs. "There can be a great temptation to jump at anything that appears to offer a chance for a cure." 

Black Salve on the FDA list of Fake Cancer Cures 

From what I've read, Black Salve is the most the most widely known alternative therapy you will find online. It is an herbal topical treatment classified as an escharotic which is a substance applied to the skin that causes tissue to die and fall off.  The types of Black Salve available on the internet today can be made from ingredients such as zinc chloride, chapparal (larrea tridentata) or bloodroot which are all caustic (or escharotic) to the skin. 

The FDA release outlines how the salves are sold online despite being illegal and how they are sold with false promises that they will cure cancer by "drawing out" the disease from beneath the skin. "However, there is no scientific evidence that black salves are effective," says Janet Woodcock, Director of FDA's Center for Drug Evaluation and Research (CDER). "Even worse, black salves can cause direct harm to the patient." The corrosive, oily salves "essentially burn off layers of the skin and surrounding normal tissue," says Woodcock. "This is not a simple, painless process. There are documented cases of these salves destroying large parts of people's skin and underlying tissue, leaving terrible scars." 

Black Salve does not distinguish diseased from healthy skin. 

If you are questioning an alternative cancer cure you see online, check the FDA list, "187 Fake Cancer Cures Consumers Should Avoid."

That being said, I would not recommend desperate attempts at using Black Salve or other alternative therapies once skin cancer has already taken hold, especially since Melanoma is dangerous and can spread. Here's why:

  • Alternative therapies have not been medically and scientifically tested for efficacy and safety .
  • The use and sale of alternative therapies online is completely unregulated so you cannot be sure the purity or concentration of ingredients you are putting on your skin.
  • Alternative therapies can contain unknown compounds with questionable benefit and the potential for great harm and they are promoted on the internet illegally without full consideration or information about potential toxicity.
  • With alternative therapies instead of surgical procedures and medically researched treatments, there is a large risk of incomplete tumor removal and tumor growth and metastases (spreading).
  • Alternative therapies untested on healthy skin leaves unwary patients open to damage of surrounding healthy tissues and marked scarring with poor cosmetic outcomes

If you think you have a lesion, spot or growth that could be skin cancer, go directly to the dermatologist who will test the tissue via a biopsy and advise you whether the tumor needs to be removed.  In cases such as skin cancer, when medical treatment has a high success rate, don't look elsewhere at alternative therapies. 

Have you been tempted by Black Salve? Did the online photos scare you away?

How to get rid of age spots, sun spots, liver spots

Posted on by Jodi LoGerfo

Question:  I have a dark brown oval-shaped spot on my forehead and a cluster of them on my upper chest. I've heard them called age spots, sun spots and liver spots. What are they and how can I get rid of them?

Answer: These spots are medically called solar lentigines because they resemble the shape and color of a lentil bean and are flat (not elevated or depressed). It's a discolored oval spot. Usually, they are caused by sun exposure and the incidence is age-related (hence the term “age spots”) because the older you get, the more you’ve been exposed to the sun, the more likely they are to become visible. 

They closely resemble freckles, but are usually larger and darker than freckles (remember the lentil?) Freckles are usually genetically determined whereas, unfortunately, solar lentigines are often a mark of photo (sun)-damage.

It's important to remember that this type of hyper-pigmentation can be a mark of malignant melanoma or other type of skin cancer such as a basal cell carcinoma or a squamous cell carcinoma and they may be accompanied by other chronic  degenerative changes in the skin caused by sun damage.  Early lesions of lentigo maligna (melanoma in situ) may be light to medium brown and mimic solar lentigines.  Lentigo maligna, benign solar lentigo and pigmented actinic keratosis all occur on sun-damaged skin and multiple lesions of different types in the same area are common.Always see a dermatologic practitioner when a brown spot appears or changes, as a biopsy may be appropriate (remember the ABC's of spots?)

That said, we have many means of removing them and normalizing the discoloration, depending on where they are located and how many you have there:

Cryotherapy:  Melanocytes (pigmented skin cells that cause the darkened spot) are very sensitive to cold temperatures and can actually be destroyed at -4°C to -7°C, therefore we effectively use liquid nitrogen cryotherapy  applied to a singular spot for 5-10 seconds. The brown spot will turn white and crusty and new skin will emerge underneath in about a month. For one simple spot that is not on your face, cryotherapy is a great and inexpensive option.

Chemical peels: Medium depth chemical peels such as Trichloroacetic acid (TCA), for example, have been studied and had a fair response, but we use them cautiously because of irritation and redness. A chemical peel can be a good choice for a larger area  or cluster of spots such as on the upper chest, but may need to be repeated to achieve desired results because you are only removing the outer-most layers of the skin each time.

Laser therapy: Of all the lasers available, some are more pigment-specific and attract the discoloration and act on it better than others. I have found Argon, Q-switched ruby and Er:Yag lasers are all effective on solar lentigines. We also use Intense pulsed light idepending on skin type, location and other variables.  I also love  fractionated laser technology for solar lentigines such as the Fraxel DUAL 1550/1927 or the Deka DOT Laser.  I usually use fractionated lasers to treat the whole face, arms, legs or chest because it works so well for larger clusters of spots, although it is the most expensive option. Complications such as post-inflammatory pigment  alterations (discoloration) can occur afterwards, so sun protection after laser is a must.

Topical treatments:  The use of topical prescription retinoid preparations definitely takes longer, but they are an effective and certainly less expensive alternative to laser therapies for both a large cluster of spots or one spot, no matter where it is located. In studies comparing 0.1% tretinoin versus placebo, after the initial 10 months of treatment, there was an 83% improvement versus 29% in the placebo group and the upper extremities responded as did the face. After an additional 6 months of treatment, the lesions that had resolved during initial treatment did not recur during the 6 month follow-up period and patients continued to Improve. The major side effect: redness and irritation. Bleaching creams containing 4-5% hydroquinone used over a period of several months will lighten solar lentigines but possibly only temporarily. We have found that a combination of the tretinoin and 4% hydroquinone plus a corticosteroid may be even more effective for your specific spots than the individual components alone, although tretinoin alone does work beautifully on Asian skin.

No matter what your age, if you never want to see solar lentigines pop up on your skin, always use sunscreen labelled "broad spectrum" that blocks both UVA and UVB rays.

Have you successfully gotten rid of age-spots and solar lentigines? Share what worked best for you!

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