Ask Jodi

Active? Watch out for a mucocele

Posted on by Jodi LoGerfo

Question:  Help – what is this bluish, clear very noticeable round lump on my lower lip?

Any face-first fall can cause a mucoceleAnswer: I had a young patient come into the office this week with just that:  A clear, bluish-tinted  bump on her lower lip. It was more than just a "fat lip." I immediately suspected a mucocele because of the bluish tint, roundness and the lower lip placement, so I asked the mom if her daughter had hit or bumped her lip in some way. Yes, she had been riding her bike and fell, hitting that portion of her lip against her teeth.

But a mucocele is not just a child's occurrence…it can happen to anyone who bumps their lower lip on anything which can be common in active adults when skiing, kayaking, climbing, mountain biking or other activities.

Luckily, a mucocele is easy to treat. Usually, just one soft, round, painless lesion (lump) appears noticeably on the lower lip, which may be anywhere from 2-10 mm in diameter. It may look clear or bluish and the bluish tint represents a bruising to the mucous duct from the trauma.The exact cause of the lump is a rupture of a minor salivary (mucous) duct, which causes a leaking of mucous into cystic spaces combined with inflammation from the trauma. 

As new connective tissue is formed, scarring may form. That's why I always drain the mucocele (cyst) of its excess fluid to allow the healing process to begin before any more damage to surrounding tissue occurs. A quick, tiny incision to the cyst releases the thick fluid. If scar tissue forms we may treat it using cryotherapy (freezing) or a laser resurfacing treatment.

I also recommend rinsing the mouth thoroughly with a mixture of one tablespoon of salt to one cup of warm water four to six times per day to help it heal.

A cyst like this can occur elsewhere in your mouth. Musicians who play wind instruments may develop a mucocele opposite the upper second molar on the inside of the cheek (called the buccal mucosa) from the repeated pressure on the mucous duct there.

A mucocele can also form anywhere in the mouth when there is a true blockage of a salivary duct (which may turn painful), so always see a dermatologist or dentist immediately if you see or feel a bump in your mouth.

-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  

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

What moms must know about teens and indoor tanning

Posted on by Jodi LoGerfo

We now know that intense UVA exposure causes dangerous types of skin cancer and that the earlier the use, the higher the risk of melanoma

Question:  My teenage daughters love using tanning beds, especially now that its winter. Tell me once and for all, is this a dangerous practice leading to skin cancer or a safe way to get some color? I’ve read conflicting reports online... 

Answer:  Did you know that 36 states currently restrict indoor tanning use by minors, and in October, 2011 California became the first state  to prohibit the use of indoor tanning devices for all children and adolescents under the age of 18? Also, in 2011, the American Academy of Pediatrics called for a ban on youth tanning and the American Academy of Dermatology  supports this ban. As a mom and a dermatology practitioner knowing what I know and seeing what I see every day in the office, I support this ban. But when teens want to do something its hard to persuade them of future danger as a reason not to do it...in this case, indoor tanning. You can only tell them the truth. 

The use of tanning bed safety has been in debate since the first tanning bed came into use in the 1980’s. Since then there has been much research into the types of Ultraviolet (UV) rays emitted by tanning beds, in what concentrations as well as how they cause skin cell DNA mutations that lead to cancer. Currently, approximately 90 percent of all skin cancers are associated with exposure to UV radiation mostly from the sun. 

But, in 2009, a group of 20 scientists from around the world convened for the International Agency for Research on Cancer (IARC), part of the World Health Organization, and added UV radiation from tanning beds to the IARC’s Group I list of the most carcinogenic (cancer-causing) forms of radiation. 

The reason for the debate on tanning bed safety is that tanning devices use fluorescent lamps which emit mostly UVA rays (UVB rays represent less than 5 percent of the lamp’s output) to induce a quick tan. And, by the end of the 1980’s, scientists had documented the carcinogenic properties of UVB rays: That they caused pre-cancerous DNA cell mutations in skin, triggered growth of squamous cell carcinomas in rodents and that UVB rays were the primary cause of sunburn.  There was no proof yet of any link between UVA exposure and skin cancer. With only a low amount of UVB emitted from a tanning bed, tanning salons could argue that tanning bed use was safe (or even safer than outdoor sun exposure) when obtained in a salon. 

Since then, data has mounted and strengthened the evidence for a causal relationship between high doses of UVA exposure, indoor tanning and skin cancer, especially melanoma of the skin and eyes.  Be wary of any safety or health claims made by indoor tanning salons, the American Suntanning Association or the Indoor Tanning Association:

  • No scientific evidence supports a claim of a protective effect from tanning bed use against future sun damage (getting a "base tan"), as you may have heard.
  • There is no such thing as a "safe" tan because a tan, and especially a sunburn, is skin's reaction to damage caused by UV radiation (whether from the sun or a tanning bed) and it causes DNA changes in the skin cells.
  • The tanning industry jumped all over the news that Vitamin D from sun exposure is necessary for health, and that it was safer to get that Vitamin D from a tanning salon rather than outdoors. It is not.

Here are 5 strong findings from June 2009 IARC monograph that put tanning beds in the classification of most carcinogenic forms of radiation:

  1. UVA causes similar but deeper skin damage: The cancer-causing mechanisms of UVB differ, but often overlap those of UVA rays. Sun exposure causes a specific cell mutation pattern that was thought to be caused by UVB rays, but researchers have now tested and found the same pattern in the skin of UVA-exposed mice (the Tp53 gene of UVA or UVB-induced skin tumors of hairless mice and the TP53 gene in human actinic keratoses -precancerous sun spots- and malignant skin tumors). UVA rays actually penetrate the skin more deeply than UVB and can damage cells (including melanocytes, those that produce the skin pigment in a "tan") deep in the dermis whereas UVB rays cause damage to the epidermis, skin’s outermost layer.  UVB rays cause DNA mutations directly and UVA rays cause more indirect damage. For example, recent evidence found that the body’s repair and removal of damaged DNA is impaired when caused by UVA rays.
  2. Time span of  tanning bed use increases melanoma risk: Experiments in human volunteers show that tanning lamps produce the types of skin DNA damage associated with sun exposure but that the excess UV exposure in the stronger tanning beds used more often than routine sun exposure, over time, can weaken the immune system and increase vulnerability to cancer and other diseases.
  3. Intensity of  tanning beds increases melanoma risk:  We now know  that tanning bed units may be 10-15 times stronger than midday sunlight on the Mediterranean Sea, which subjects indoor tanners to UVA doses above those experienced during daily life or even when specifically tanning or active outdoors. Reviews of epidemiological (specific population) studies provide strong evidence that the intermittent, intense sun exposure (the type from outdoor weekend activities or sunny vacations) which leads to sunburn, is the main environmental risk factor for melanoma (the most dangerous form of spreading skin cancer) and that this pattern of over-exposure is simulated by indoor tanning bed use designed to induce a quick tan.
  4. Youth tanning bed use increases melanoma risk: Tanning beds have greater potential to cause melanoma at younger ages than even chronic sun exposure. Currently, 30 million people tan indoors every year in the U.S. and 2.3 million of them are teenagers, like yours. Also, melanoma is now the most common form of cancer for young adults aged  25-29. Although epidemiological studies have not consistently shown that tanning bed use is always a risk factor for melanoma that starts in the skin, a 2006 IARC meta-analysis (review of many studies) found a significant increase in melanoma risk (40-228% increase) when indoor tanning bed use started as a teen or young adult. An overall 75% increase in melanoma risk was found when indoor tanning bed use began before age 35.
  5. Not just skin cancer, but dangerous eye cancer, too:  Even scarier, 4 case-controlled studies consistently reported an increased risk for ocular (eye) melanoma with a clear causal relationship among indoor UV tanners and an even greater risk for subjects who started indoor tanning before age 20. Eye cancer is a risk even with goggle use because the rays can get in around the goggles.

All the recent research on UV rays substantiated a role for both UVA and UVB in human skin cancer development and especially melanoma, the most dangerous form of cancer that starts in the skin and can spread. So, the entire UV spectrum and UV-emitting tanning devices were classified as carcinogenic to humans. 

It's true that teenagers think they are impervious to danger. But at least you can provide them with the current scientific facts...and a reason to check their bodies for any suspicious, new or changing freckles, moles or scabs or spots that could be pre-cancerous or more. 

If anyone has found a way to get their teens to stop indoor tanning, please share it here!

Kids starting camp? Choose sunscreen wisely…

Posted on by Jodi LoGerfo

Question: My son goes to camp all day and I need a good sunscreen because he has sensitive skin and is very fair. I've also heard that there is a certain chemical that kids should not be exposed to because it causes cancer. And, are the sprays as effective as the lotion? Help!

Answer: I know just how you feel and I send my  three-year old Annabelle outside wearing a hat at all times, so send your sun to camp wearing at least a baseball cap to shield his face, or even a broader-rimmed fishing hat to protect his face and back of his neck and ears, if possible. Also, you mentioned he is very fair-skinned, so you might consider having him wear a t-shirt when swimming to help deflect the sun's rays and provide extra protection.

Sunscreen chemicals to avoid:  Recently available data from an FDA study indicate that a form of vitamin A commonly found in sunscreens, retinyl palmitate, may speed skin tumor development when applied to skin in the sun and requires further testing. In addition, according to the Environmental Working Group (EWG), a consumer environmental and health watchdog group, some 65 sunscreens advertised for babies and kids contain oxybenzone, a synthetic chemical that absorbs the sun’s rays but also readily penetrates the skin, more so in children, and can disrupt the body’s natural hormones and also cause allergic reactions. Also, look for glycerol PABA, padimate A and padimate O instead of the original staining, reaction-forming PABA, or para-aminobenzoic acid.

Safer active ingredients include Mexoryl SX (ecamsule),  Parsol 1789, also called avobenzone, and titanium dioxide and zinc oxide, which physically block ultraviolet radiation. Although these sunscreen formulas may go on thicker and appear "whiter,"  they also stay on longer and are gentler to sensitive skins which is a good thing at camp!

Simply make a list of ingredients to avoid and to look for and take it with you to the store. Read labels to make the best choice.

Sunscreen recommendations:  Consumer Reports recently rated sunscreens according to the new FDA labeling requirements and reported that two for kids completely failed  tests so do not choose Alba Botanica and Banana Boat Kids, whose labels claimed broad-spectrum protection and failed the wavelength test. Banana Boat Kids was also poor against UVA rays. Do choose All-Terrain AquaSport Sunscreen Lotion, SPF 30,  recommended by both the EWG and Consumer Reports ratings. I also like the chemical-free Neutrogena Pure & Free Baby, especially for sensitive skins.

You might also speak to camp counselors about how they reapply sunscreens for outdoor activities because sunscreens need to be re-applied after swimming or sweating, or every two hours.

What about spray-on sunscreen?  Stick to the lotions with an SPF between 30-50. Currently, the FDA has requested additional data to establish effectiveness of spray-on sunscreen and to determine whether there is safety hazard if  unintentionally inhaled by children.

Check out the infographic below from EWG which gives a great picture of what to avoid when looking for sunscreen for your child...

Sunscreen Infographic