Suffer from dry eyes? There is help! See below for some useful tips: Artificial Tears are beneficial for the stinging or burning associated with dry eyes. Made of ingredients that temporarily restore moisture to eyes (e.g., glycerin and oils), you can use one or two drops in each eye when they feel uncomfortable. If you need to use more than 3 or 4 times a day, see your ophthalmologist; and if you use drops frequently, try switching to preservative-free drops. Omega 3’s help reduce the inflammation that can contribute to dry-eye syndrome (DES). Studies have shown that patients who take daily supplements of omega-3 fish-oil supplements plus flaxseed oil produce more tears. You can increase your intake byadding a few servings of salmon to your weekly diet or by taking fish-oil and flaxseed supplements after discussing them with your practitioner. There are prescription medications for treating chronic DES. Restasis® is a prescription eye drop that contains cyclosporine, which can help increase natural tear production. Use it twice a day as directed by your ophthalmologist. Warm Compresses are helpful for when your eyes just don’t have enough tears! Tears are your eyes’ lubrication and are made up of water and oil. The oil is produced by glands along the eyelid; if the cells in the glands harden and the openings of the glands become plugged, the oil in the tears may be reduced. Without the oil, the water in tears evaporates too quickly, leaving your eyes feeling dry. Warm compresses can liquefy the plugs so the oil can flow into the tears. Eyelid Washes are helpful when dry eyes have accompanying flaking along the eyelids (a sign of blepharitis--“dandruff” and inflammation of the eyelash follicles). Because of the overproduction of oil (the same concept as dandruff on the scalp), cells near and around the eyelids stick together, causing inflammation. Too much oil can clog the glands and cause tears to evaporate too rapidly. An OTC eye wash contains mild cleansing agents to dissolve the oil and remove the flakes (as well as irritants and allergens). If the symptoms persist for more than 2-3 days, see an ophthalmologist. Eye Inserts are a new treatment option that can be used when all other remedies fail. Available only by prescription, Lacrisert®ophthalmic inserts are tiny cellulose beads that you place within the pouch of your lower lids. These beads dissolve slowly and mix with your own tears and provide ongoing lubrication throughout the day. Use once or twice a day as directed by your ophthalmologist.
As healthcare professionals, we are expected to do a thorough review of systems, assess your medication, evaluate your past medical and family history, equip you with health maintenance and, of course, conduct a physical exam. Examining the skin is the focus in dermatology, but this kind of exam should be part of any internal medicine visit. Often people ask me, how do you do an effective skin exam and identify a mole that is suspicious? When I examine a patient’s skin, I am very methodical, often starting at the head and working my way down a person’s body. Additionally, I am always looking out for the “ugly duckling”--the mole that stands out and looks different from the rest. Don’t forget the ABCDE’s: Asymmetry--is there a lack of symmetry in the color or shape of the lesion? Border--is the edge irregular or jagged? Color--what color is the lesion? Is it brown, black, gray, blue, red or a mixture? Diameter--is the lesion larger than the size of a pencil eraser (> 6mm) or changing in size? Evolving--is the lesion new, growing, spreading or changing? Can you affirm for its changelessness? Most moles on an individual have a pattern, a “look”. The patterns or arrangement of moles on an individual’s skin are good; they serve as an example or point of reference when examining a patient’s skin. When a mole doesn’t fit the pattern, it deserves further investigation (e.g., biopsy, etc.). When a patient says that a lesion is changing, I believe them, even if I am not alarmed by the way it looks. After all, you see your body every day. If you notice something is different, if some aspect about the mole seems to be evolving, say something. Get it checked. And always question an inflamed lesion, with or without pigment. My rule of thumb is one month. If something you notice does not resolve within a month, if the mole looks different and those changes last one month, get yourself to a dermatologist for a full skin check-up and have the lesion examined. If you live in an area where access to a dermatologist is restricted, get to your primary care giver or internist, who may be able to do a biopsy or refer you to a surgeon who can. As part of health maintenance (this goes for everyone), you should have a full skin exam by a dermatologic practitioner yearly. If you have more than 50 moles, have had skin cancer or pre-cancerous/suspicious moles or growths, have a family history of atypical moles or melanoma, you should have a skin exam performed more frequently.
Have you (yes, YOU!) had your cancer screenings? I feel like my dog means business when he gives me THAT face, so I thought it would be appropriate for today’s blog on cancer screenings. I know we all become somewhat lax about taking care of ourselves and I am no exception. Sometimes we need a gentle reminder... Cancer Screenings
- yearly mammograms starting at age 40 - clinical breast exams during routine check-ups beginning around age 20
- ★Colon and Rectum
- age 50 for both males and females
- digital rectal exam (DRE) and prostate-specific antigen (PSA) should be done annually for men at age 50 - men at high risk, particularly African American men, should begin testing at age 45
- screening should begin about 3 years after a woman starts having vaginal intercourse - screening should begin in the abstinent by age 2 ...remember (I often need a aide-mémoire myself...) early detection means early cure...so, don’t delay and start screening! - Jodi
In many cases we are not able to say exactly why someone gets cancer. I often find myself wondering...why this person or why that person? Unfortunately, right now, no one can provide a list of things you can do that will guarantee you can avoid getting cancer. However, we do have a list of certain habits both good (to be taken up) and bad (to be avoided) that can help. We all know there are risk factors that you cannot change--your genetics and family history are part of the hand you’re dealt in this game of life. There are, though, dangers we can avoid...they include smoking tobacco, being physically idle and overweight, eating [poorly] too many unhealthy fats and sugars, and exposing your body to excessive doses of ultraviolet light. Some suggestions, then, to help decrease your risk of cancer: -Avoid smoking, and if you currently smoke, quit. The sooner you quit, the better you will feel. -If you are overweight, lose weight. Cutting out the bad stuff isn’t an easy task for any of us, but remember, this isn’t a race: slow and steady makes you a winner. -Get some sort of physical activity--at least 30 minutes a day. -Try to eat healthy as much as possible. Of course we all like to indulge now and then, but try to balance your meals with healthy portions of protein and veggies. -Restrict your time in the sun and use sunscreen. -Keep up with routine cancer screenings and physical exams. These include screenings for breast, colon, rectal, uterine and cervical cancer. The bonus is that in addition to helping you decrease your risk of cancer, making lifestyle changes can also reduce your risk of heart disease and diabetes. If you have a family history of a certain disease, screening for a condition earlier may be appropriate. Remember to talk to your practitioner about all lifestyle modifications you embark on. Ask questions! Most importantly, don’t be afraid...early detection means early cure.
Wow...today is the inaugural blog...I don’t really know what to say. I guess, Welcome! Welcome to my blog! I will certainly try to give you my honest opinion, feedback and of course, answers to your skin care concerns and questions. Anything having to do with skin, hair and nails are up for grabs here...so ask away! Additionally, I will try and keep you up to date with the latest news and media reports on dermatology. I hope you enjoy it all! BTW...today is National Croissant Day! In addition to being a skin care guru, I’m also a foodie. At our office, we love to celebrate anything having to do with food. No food holiday goes unnoticed!
Answer: Well, that sounds like follicular lichen planus, also known as lichen planopilaris, attacking your hair follicles. But you need to head straight to a dermatologist for an accurate diagnosis, which could be many other things. We also call this condition you describe, scarring alopecia because unlike the smooth bald patches of alopecia areata or pattern baldness, these bald patches have raised and discolored scar tissue in them initially caused by the immune system attack on your hair follicles. We do know that lichen planus is not contagious. It can also attack the mucous membranes in the genitals or mouth (called oral or mucosal lichen planus), finger or toe nails, or anywhere on the skin especially hairy areas like eyebrows (called cutaneous lichen planus). Many times attacks are on both the head and body at the same time or several locations at once. The exact reason for this attack is unknown, but reddish or brownish raised outbreaks resembling the "lichen" shape (flat round-ish moss common on tree trunks) can be triggered by:
- Allergies to any substance or food
- A viral infection such as hepatitis
- Specific vaccines and many medications
It is also clear that lichen planus attacks 4 times more females than males and most commonly appears in middle age, between the ages of 30 and 70. How lichen planus appears on the scalp Initially you may notice some small or spiny red bumps around involved follicles which may or may not be itchy. This eventually forms scar tissue which damages hair follicles and causes hair to fall out and not grow back. You may also notice unaffected tufts of normal- hair within the scarred areas, which still may appear raised and/or discolored. Gradually hair is lost and replaced with smooth skin, with loss of follicular markings because at this point, hair loss is permanent (we call this Pseudopelade of Brocq if a cause such as lichen planus or alopecia areata is not the cause and the cause is unknown.) How we treat lichen planus If outbreaks are linked to an allergy or drug, identifying and avoiding that substance can help resolve the problem and avoid additional outbreaks. But many times oral lichen planus is a chronic auto-immune condition in which flare-ups continue to come and go over a long period of time, with lesions lasting for days, weeks or even months. Some cases may resolve in 2 years, although approximately 1 in 5 people will have a second outbreak. Since there is no known cure for lichen planus, treatment focuses on alleviating discomfort and promoting the healing of lesions before scar tissue has a chance to form and destroy hair follicles. We like to prescribe steroid medication initially to see if we can halt the reaction, which does help immediately resolve inflamed, scarring tissue. But steroid treatment is a short-term solution only, not to be continued for the long-term because oral and injected steroids increase the risk for osteoporosis, diabetes, high blood pressure and high cholesterol. The bad news: Once steroid treatment is halted, lesions may return. So, because there is no known treatment protocol that works for everybody, we alternate and try all the treatments below to see if we can mitigate the scarring and preserve hair your follicles:
- Antihistamines: Internal medication to help alleviate itching so you don't scratch and cause scars
- Topical corticosteroid: A topical medication in cream or ointment form used to reduce swelling, itching and redness.
- Corticosteroid: Internal medication (such as prednisone) or shots to alleviate a serious attack of swelling, pain or many lesions at one time.
- PUVA light therapy: A type of light treatment used for eczema and psoriasis conditions that may help clear the skin of scarring lesions.
- Retinoic acid: Topical or internal medication to help clear lesions.
- Tacrolimus ointment or pimecrolimus cream: A topical medication that is not a steroid (so it can be used for longer duration) used for severe eczema cases that may help clear lesions.
The most important thing is not to give up and keep alternating and trying the different medications to stop the scarring and the hair loss and save your hair. -Jodi
Question: Can I be causing my own hair loss problem? I have a habit of tugging and twisting on individual hairs every day and even pulling some out and I've noticed some spots where my hair seems to be thinning. What should I do?
This is actually a hair loss disease, but it is psychological in nature rather than physical. The disease is pronounced: trik- oh-till-oh-may-nee-ah. People also call it ‘Trich’ or TTM for short. I can tell if a patient is suffering from this disease rather than something physical such as pattern baldness or auto-immune such as alopecia areata because if I feel stubble in the bald spots, it tells me that hair is growing back normally, although it might have been removed. Bald patches of alopecia areata feel smooth and so do pattern baldness spots because hair is not growing back normally and the growth cycle is disrupted for a physical reason. I suggest a visit to a dermatologist to get an accurate diagnosis. It's a compulsion to pull your hair out…literally. If you feel a strong compulsion to pull out hairs, as you said, you may very well be causing your hair loss. In some patients, the compulsion to pull at hairs is so strong, they feel they can't stop, but others can learn to control it through awareness or will power. Trich does not affect everyone who suffers from it the same way or to the same degree. Some pull hair deliberately and some pull hair out unconsciously and some people pull only scalp hair while others may pull facial hair such as eyelashes and eyebrows or body hair on legs and arms. Some patients pull any and all hair. Some Trich patients just pick up hairs and roll them between fingers. Hair loss can become permanent The longer the hair pulling and twisting habit goes on, the more severe the hair loss may be. In extreme cases, hair loss can become permanent because hair follicles can become damaged to the point of death. In milder cases, hair keeps re-growing, although eyelashes and eyebrows take a notoriously long time to grow back. A dermatologist can confirm the health of hair follicles and a prognosis for hair re-growth.
- What's the prognosis and treatment for Trich? Researchers are unsure how the compulsion to pull out hair starts.
- Past statistics on the disease show that Trich can strike happy, well-adjusted people as often as emotionally disturbed or depressed people. these same statistics show that Trich behavior usually starts in early adolescence and that 90 percent of sufferers are women.
- I think that the statistics may be a little more skewed towards women because Trich is a less satisfying compulsion and less noticeable in men with short hair and male pattern baldness and maybe less men seek medical attention for such a habit. Current research on Trich shows that similar brain chemical imbalances that cause depression or bulimia can cause Trich behavior and treatment with anti-depressant medications may help curb the compulsion to pull at hairs and allow hair to grow back. A Psychologist can help you determine your best course of action once a diagnosis is made.