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: Help – what is this bluish, clear very noticeable round lump on my lower lip?
Answer: 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.
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?
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
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!
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?
Answer: Those brown spotted areas on your face are called melasma, and the discoloration is caused and worsened primarily by sun exposure. The result can be a mask-like, spotted or confetti-like appearance that generally involves cheeks, forehead, upper lip, nose, jaw line or chin. Melasma occurs more frequently in Fitzpatrick Skin Scale types III, IV and V, (which I described in my last post about post-inflammatory hyperpigmentation), and 63% of all cases of melasma are in darker-skinned Caucasians. Melasma doesn't cause any other skin symptoms aside from the unwelcome skin discoloration which is usually (unhappily) matching on both sides of the face.
The hormonal influence…it’s a woman thing
Female hormonal triggers play a large role so the condition generally affects women. In fact, melasma occurs in 50%-70% of pregnant women, usually during the 2nd or 3rd trimester, and is called chloasma or, “the mask of pregnancy.” In women who use oral contraceptives, we see melasma on the upper lip, both sides of the forehead and jaw line. We also see melasma form on post-menopausal women when hormone replacement therapy includes progestational hormones.
How sun exposure (UV radiation) stimulates melasma formation:
- Skin cells which produce melanin (skin pigment) are stimulated by UV exposure
- This causes a rapid onset of melasma and speeds up formation once a hormonal trigger is in place
3-Step Rx for melasma
Good news: Melasma is usually treatable when it occurs in the epidermal (outer) layers of the skin, which is 70%-90% of cases. Here’s how we get rid of epidermal melasma:
- Sun Protection: Avoiding sun (UV radiation) exposure is the first line of defense for treating melasma now and avoiding melasma in the future. Wear sunscreen on your face daily and use additional protection such as a hat to protect your skin from further discoloration.
- Use a 4% hydroquinone cream: Considered the gold standard in skin discoloration treatment, this ingredient inhibits the enzyme activity responsible for melanosome formation (melanin-containing cells) and the conversion of tyrosine to melanin which forms the dark spots. Treatment is usually 20 weeks.
- Use a retinoid cream in addition: Retinoids (vitamin A derivatives) increase the rate of epidermal skin cell turn-over so the excess pigmentation is carried out of the skin where it can be sloughed off. Retinoid treatment is also 20 weeks.
A new topical cream we are using is called Tri-Luma® Cream because it contains a combination of 4% hyrdroquinone, a retinoid and an anti-inflammatory all-in-one. In studies, 29% of patients experienced complete clearing of skin when used for only 8 weeks of treatment.
For those with an allergy to hydroquinone, alternative ingredients include kojic acid and azalea acid, although considered weaker hyperpigmentation agents. They are also often used in conjunction with other topical medications. For more severe cases, peeling agents or laser treatments may be indicated but must be balanced against the risk of post-inflammatory hyperpigmentation afterwards.
Basically, if you don’t want melasma, don’t give the sun any face time!
Have you ever noticed spots the sun has left on your face?
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:
- 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.
- 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.
- 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.
- 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.
- 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!
Question: I recently went out for a day on a boat with friends and even though I used SPF 50 sunscreen all day, I still got burned. What did I do wrong? Answer: There's a lot of news in sunscreen ingredients and thinking these days so lets update how you buy, use and apply sunscreen so you don't get burned again (or needlessly exposed to the rays that cause aging, wrinkles and skin cancer): Mistake: Not applying enough sunscreen The current guideline is to apply a shot glass-worth, one full ounce, of sunscreen to your body when spending the day in the dun. And, the most important part, you should reapply this amount of sunscreen every two hours regardless of the SPF noted on the bottle, so you could go through half of an eight-ounce bottle in one day in the sun! Mistake: Believing that sunscreens are "water-proof" The FDA, in its new labeling guidelines, has declared that the use of the term "water-proof" misleading and banned brands from using it. The word will need to be removed from labels by December 2012. Now, the guideline is that sunscreen is "water-resistant" and only for a tested time limit of 40 or 80 minutes when spending time in the water, after which the product will need to be re-applied. Mistake: Applying the sunscreen when you get there The best way to allow sunscreen to do it's work is to apply it a full 30 minutes before going into the sun, so it has time to bond to skin, instead of getting immediately rubbed off by a towel you lay on or washed off by jumping directly into the water. Mistake: Not protecting your skin from UVA rays It used to be that sunscreens only protected against UVB (the burning rays) but now a slew of new chemicals can absorb UVA rays (the ones that penetrate deeper to cause aging, wrinkles and skin cancer). Choose a sunscreen with the new designation "broad spectrum" because these have been tested by the FDA to provide protection against both UVB and UVA rays. Consumer Reports recently tested and rated sunscreens according to the new FDA labeling requirements and found these three top-rated choices:
- All Terrain AquaSport SPF 30 (for athletes and outdoor workers)
- Coppertone Sport High Performance Ultra Sweatproof SPF 30 (for athletes and outdoor workers)
- No-Ad with Aloe and Vitamin E SPF 45 (for the budget minded, every-day body user)
Mistake: Thinking the higher the SPF, the better the protection… According to Consumer Report's recent ratings, top-rated sunscreens are between SPF 30-45. The new thinking is that higher SPF does not really not afford more protection. Here's why: an SPF 15 filters out approximately 93% of all incoming UVB rays, SPF 30 filters out approximately 97% and SPF 50 filters out approximately 98%. No sunscreen can block out 100% (which is why the FDA has also banned the use of the word "sunblock" on labels) of all UV rays so after an SPF 30, you can see the difference in filtering is negligible. The old thinking: If your skin starts reddening in 20 minutes when exposed unprotected to sunlight, using an SPF 15 should prevent your skin from turning red for 15 times longer (approximately 5 hours). The new thinking: No sunscreen protection lasts more than 2 hours. Choose an SPF 30-45 and reapply one ounce every two hours for real protection. Mistake: Ignoring your scalp Most people protect their eyes with sunglasses and slather on the sunscreen but completely ignore their scalp. This is very dangerous, especially if you have any hair loss or thinning issues. Apply sunscreen to any areas experiencing hair loss (a widening part-line, bald spot or receding hair line) and definitely wear a hat! Mistake: Believing that the sun does not affect your face every day I advise everybody to apply a basic "broad-spectrum" sunscreen every day to face, underneath makeup or in makeup for women, especially to protect against photo-aging and skin cancer that you cannot see happening. One that I personally recommend, that was also recommended by the Consumer Reports Ratings, is La Roche-Posey Anthelios 40 with Mexoryl SX SPF 40. Have you made any of the mistakes on this list recently? Tell us your worst sunburn story in the comments!