Springtime and New Year’s — these are times when people often look to make changes in their lives by improving health and appearance. With spring around the corner, taking care of skin issues should not be put off any longer.
For some, the issue is sunspots developed while working outdoors or just sitting at the beach. For others, the problem may be the forehead furrows created while debating things with family and friends around the Thanksgiving table. Or maybe it’s both.
Regardless of what you want to take care of, you know that looks matter. As we start a new job, or enter the dating pool, or any number of other things, our appearance is scrutinized and the pressure to repair skin-flaws intensifies. It’s never too late to initiate good protective skin habits, and the much-recommended, but still underutilized sunscreen remains the best tool. But if the damage is done, and you’re seeking to repair and erase, advancements in cosmetic dermatology are here to help. And so is Mount Sinai Dermatology, which offers an impressive array of treatments. Let’s narrow them down to the most effective, most popular and most worth the cost.
Also known as Botox®, Dysport® or Xeomin®, injectable neurotoxins are used to safely fade crow’s feet or other lines between the eyebrows or on the forehead. They take care of deep creases formed by constant muscle movement. Even fiercely needle-shy patients tolerate the small injections and typically no downtime is needed. Patients with complaints of excessive sweating in the underarms or hands, a condition known as hyperhidrosis, may also consider this treatment to reduce sweating and improve quality of life.
Fillers, including Restylane® and Juvéderm®, are increasingly popular methods of replacing the volume loss that occurs through aging. They are injectable gels that may help correct facial wrinkles and folds of varying severity, and can be placed in the lines around your mouth and nose among other areas. These, and others fillers that Mount Sinai Dermatology offers, may also have the added benefit of stimulating the production of your own natural collagen.
Laser hair removal
With the onset of the polar vortex keeping us so cold, all our excess body hair is safely hiding under layers of winter clothing. But, happily, that will change soon. Laser hair removal is an increasingly popular method of permanently removing hair from unwanted areas, and through recent advances is offered with minimal discomfort. This treatment requires several sessions, but typically hair is noticeably thinner and the number of hairs lessened after the first visit.
Laser spot removal
Lasers have dramatically changed the specialty of dermatology, allowing doctors to treat specific conditions with little to no damage to surrounding tissue. Spots developed through excessive sun exposure, or even common red spots called cherry angiomas, can be targeted with specialized lasers. Even smaller blood vessels of the legs or face can now be treated by PDL, or the pulsed-dye laser. Patients with a condition known as rosacea, with notable redness of the nose and face, may also benefit from treatment with the pulsed-dye laser.
These are just a few of the many treatment options offered by dermatologists. Most of the procedures offered through Mount Sinai’s Cosmetic Clinic can be done any weekday, or even during our Saturday morning office hours, but patients are urged to schedule a consultation session to discuss their areas of concern. Thankfully, most of these services require little to no downtime — because even if you’ve decided to take care of your skin issues, everyone doesn’t need to know.
Rachel Nazarian, MD
Clinical Instructor, Dermatology
Doctor’s Faculty Practice
5 East 98th Street
New York, NY 10029
For appointments, call (212) 241-9728
or visit www.MountSinaiDermatology.com
Appointments available with Dr. Nazarian at the cosmetic clinic on Saturdays.
At New York Hospital Queens, expert vascular and endovascular surgeons can treat circulatory conditions, from silent killers, such as aortic aneurysms, to non-life-threatening issues, such as varicose veins.
Minimally invasive treatment options may lead to shorter hospital stays, faster recovery times and fewer infections. Below are some of the most common conditions that the hospital’s experts screen for and treat.
Aortic Aneurysms form when the aorta develops a bulge. The aorta is our body’s largest artery; it carries blood from the heart throughout the body. Left untreated, this bulge in the aorta can grow and eventually rupture. Ruptures cause internal bleeding and death. Aortic aneurysms are known as “silent killers” because individuals may not show symptoms until the aneurysm has ruptured.
Some people are at a higher risk for aortic aneurysms. Dr. Rajeev Dayal, chief, Section of Vascular Surgery, and his colleagues Dr. Andy Lee and Dr. Ankur Chawla, recommend screenings for individuals who:
• Are age 60 or older
• Have a family history of aortic aneurysm
• Have smoked
• Have high blood pressure, atherosclerosis, or chronic lung disease
Aortic aneurysms larger than 5 centimeters usually require repair. Most aortic aneurysms can be treated minimally invasively using stents. Stents are small devices placed within the aneurysm to support it and keep it from expanding. The procedure is performed via small incisions in the groin and frequently, the procedure does not require general anesthesia.
Patients with aortic aneurysms close to the kidneys or other arteries may require a graft, which acts like a bridge for blood flow, instead of a stent.
Peripheral arterial disease (PAD) is a condition where plaque builds up in the arteries of the leg and slows blood flow. Plaque is a waxy substance made up of fat, cholesterol, calcium and other substances in the blood.
One common symptom that indicates the beginnings of peripheral arterial disease is when people get pain in their legs when they walk. When at rest, the pain lessens, but when walking continues, the pain starts again. To diagnose PAD, doctors can measure blood pressure in the leg and compare it with blood pressure in the arm. Lower pressure in the leg may be a sign of PAD. An ultrasound, an MRI or a CT scan can show the degree of blockage from plaque.
Depending on the blockage, people with PAD may require a stent or bypass surgery to reroute blood past the blockage with a blood vessel from another part of your body.
Varicose veins are dilated veins in the legs that you can see under the skin, and are more common in women (especially after pregnancy). Weakened or damaged valves that help keep blood flowing toward your heart can cause varicose veins. As blood backs up and begins to pool, the veins bulge and swell.
Many factors can increase an individual’s risk for varicose veins, including family history, older age, gender, pregnancy, being overweight or obese, and lack of movement. People with varicose veins may not always have symptoms, aside from the bulging appearance, but the veins do need to be checked by a physician. Some people with varicose veins may notice pain, weakness in the legs, and ankle swelling or itchiness.
Treatment for people with these symptoms is typically covered by insurance. The first-line treatment option uses lasers to remove “bad” veins. Other treatment options include removing the veins surgically or closing veins with injections in a procedure called sclerotherapy. Insurance does not typically cover the sclerotherapy procedure as it is considered cosmetic.
Posted in Queenswide, Health on Thursday, February 6, 2014 10:30 am. Updated: 12:28 pm. | Tags: New York Hospital Queens , Rajeev Dayal, Md , Andy Lee, Md , Ankur Chawla, Md , Section Of Vascular Surgery Comments (0)
Eczema or atopic dermatitis (AD) is the most common chronic inflammatory skin disease. The prevalence has been increasing worldwide. People with eczema experience severe itching, skin redness and dryness, weeping and scarring. Eczema tends to flare and then subside. Eczema affects daily activities and results in tremendous medical expenditures; the national burden was reported to range from $364 million to $3.8 billion.
Who gets eczema?
Eczema could develop in any age group, but is most common in infants and young adults. The estimated prevalence of eczema is approximately 10 to 30 percent in children and 2 to 10 percent in adults.
There are three subsets of eczema based on age of onset;
1) Early-onset type starts in the first 2 years of life. Most children outgrow it by the age of 10, but others continue to have problem on and off throughout life. Notably, East Asian infants are at increased risk of eczema.
2) Late-onset type begins after puberty.
3) Senile-onset type starts after 60 years of age.
What causes eczema?
Although the exact cause is not known yet, it is thought to be a complex disease where multiple factors including genetic components, epidermal barrier dysfunction and immunologic mechanisms play a role. It has been well-known that eczema is more common in families with a history of eczema, asthma or allergic rhinitis. In addition, candidate genes have been identified and are under investigation. It has been postulated that those genetically susceptible individuals may be sensitized to environmental factors such as irritants or allergens. When they encounter certain substances or conditions (rough materials, soap or detergent, respiratory infections or colds, stress), people may experience a flare-up because of an overactive immune reaction causing epidermal barrier dysfunction.
How is eczema diagnosed?
Dermatologists are specialists trained to recognize and treat eczema. Most often, it can be diagnosed by visual examination along with review of a patient’s history and/or family history of eczema. Although there are blood tests that can support the diagnosis of eczema, the diagnosis can’t be made by the blood test alone.
Can food cause eczema flare-ups?
Yes. Food allergies can cause eczema flare primarily in infants and children with severe eczema. Eggs are most often linked to eczema exacerbation among common food allergens such as milk, eggs, peanuts, soy and wheat. Identification of culprit allergens should be carefully determined based on clinical history and provocation tests. Although avoidance of food allergens could prevent flare-ups in a subset of patients, this must be balanced with the potential nutritional deprivation from unnecessary restrictive diets.
How is eczema treated?
Eczema greatly affects the quality of life due to the intense itching, sleep disturbances, psychological distress, disrupted family dynamics and impaired function at school or work. Thus, it is important to diagnose and treat eczema appropriately.
Although there is no cure, most people can effectively manage their disease with medical treatment. The goals of treatment are to reduce inflammation and itching and to prevent future flare-ups.
Currently, avoidance of triggering factors and skin care are recommended for all cases of eczema. Triggering factors include allergens (pollen, dust mites, animal dander), sweating, harsh soaps, wool or other rough fabrics, cigarette smoke and emotional stress.
For skin care, the following self-care treatments could be tried.
• Lubricate skin with moisturizing cream or ointment frequently.
• Avoid scratching as much as possible; trim nails and wear gloves especially at night.
• Water must be lukewarm not hot. Avoid long baths or showers.
• Choose mild soaps and cleansers.
• Wear cool, smooth-textured cotton clothing. Avoid closely fitting garments or clothing that is made from wool or pure synthetic fabrics.
Further treatments are decided based on the severity of the disease.
• Mild cases can be controlled by continuous use of emollients and intermittent use of topical corticosteroids for flare-ups.
• Moderate eczema requires proactive maintenance with anti-inflammatory agents.
• For severe and refractory cases, the use of phototherapy and systemic drugs may need to control the disease.
Soo Jung Kim, MD, PhD
Clinical Instructor, Dermatology
Director of the Mount Sinai Dermatology
168 Centre Street, Suite 3M
New York, NY 10013
For appointments, please call (212) 731-3610
or visit www.MountSinaiDermatology.com
While rare in childhood, skin cancer does not only affect adults and the incidence of melanoma among children and adolescents has been increasing over the past several decades. A recent study published in the Journal of Pediatrics found that between 1973 and 2009, the incidence of melanoma in children and adolescents increased by 2 percent per year. Thus, it is extremely important that we increase awareness and encourage good sun-protection behavior starting at even a young age.
Many parents have questions about how they can best protect their children from the sun. Often questions arise about what sunscreen to use and how to apply it. There are new U.S. Food and Drug Administration sunscreen labeling rules. Understanding what to look for on the sunscreen label is important.
Some frequently asked questions are:
What sunscreen should I use?
Sunscreens are divided into those that are chemical blockers and those that are physical blockers. Chemical blockers contain ingredients such as benzones and absorb ultraviolet radiation from the sun. The main ingredients in most physical blockers are zinc oxide and titanium oxide which reflect or scatter UV radiation.
Although physical blockers leave more of a white milky film on the skin, these are preferred in infants and children with sensitive skin. You want to look for sunscreens that have a sun protective factor (SPF) of 30 or higher. Make sure the sunscreen says it provides “broad spectrum” coverage against both UVA and UVB radiation.
Can I use a sunscreen spray?
The safety and efficacy of sunscreen sprays is still being investigated by the FDA. You may not be applying enough sunscreen when using a spray. There are also concerns about the potential side effects if it were to be inhaled. Avoidance of sunscreen sprays is recommended until further information is available.
How often do I need to apply sunscreen during the day?
Sunscreen should be reapplied every 2 hours. It should also be reapplied after swimming. Sunscreens are no longer able to state that they are “waterproof.”
I have a three-month-old infant.
Can I use sunscreen on my child’s skin?
Sunscreens are not advised in infants younger than 6 months of age. Infants in this age group should be kept out of the sun and in sun-protective clothing and hats.
What else I can do to protect my child from the sun?
In addition to the use of sunscreen, children should also wear wide-brimmed hats, sunglasses and sun-protective clothing. More and more companies are now making sun-protective clothing so it is easier to find. One should stay in the shade as much as possible and avoid the sun midday, during its peak hours of intensity.
What about tanning salons?
Indoor tanning should be avoided. Like natural sunlight, the ultraviolet radiation from indoor tanning devices, such as tanning beds, is harmful to your skin and increases your risk of developing skin cancer.
According to the American Academy of Dermatology, “studies have found a 75 percent increase in the risk of melanoma in those who have been exposed to UV radiation from indoor tanning.”
Children, like adults, should have periodic skin examinations by a dermatologist, especially if there is a family history of dysplastic (atypical) moles, melanoma, or other skin cancers such as squamous cell carcinoma or basal cell carcinoma.
Parents should also periodically look at their child’s skin at home and call their dermatologist if they notice any changes.
Lauren Geller, M.D.
Instructor, Dermatology and Pediatrics
Director of Pediatric Dermatology
The Icahn School of Medicine at Mount Sinai
5 East 98th St., 5th floor
New York, NY 10029-6189
Tel: (212) 241-9728
Dermatologists and skin cancer experts, especially before and during the summer months, write articles and give speeches on the harmful effects of sun exposure on the skin: the risk for melanoma and other skin cancers and premature aging of the skin. Despite all efforts, beaches are filled with people tanning in the midday sun, streets are filled with people with a pink-red burnt or bronze skin and tanning salons are filled with clients. Why can’t we deliver our message? Tanning is harmful to our skin just like smoking is harmful to our lungs.
Melanoma is the deadliest form of skin cancer. One person dies every hour from melanoma in the U.S. There are more than 76,250 estimated new cases of invasive melanoma in the U.S. annually resulting in over 9,180 deaths per year. It is the fifth and sixth most common cancer in men and women, respectively. If melanoma is diagnosed early, it is typically cured with surgery. However, advanced disease has a poor outcome and can lead to death.
Warning signs of melanoma. Melanomas often resemble moles; some develop from moles. The majority of melanomas are black or brown, but they can also be skin-colored, pink, red, purple, blue or white. The ABCDE rule of melanoma indicates that melanomas are typically asymmetric, have irregular borders, irregular color, a diameter greater than 6 mm, and evolve. However, not all melanomas follow this rule and have all of these characteristics.
What are the risk factors for melanoma? Everyone is at some risk for melanoma. However, increased risk depends on several factors: fair skin, increased sun exposure, increased number of moles, dysplastic or atypical moles (benign moles with special features), large moles from birth, having had melanoma and other persons in the family with melanoma.
Melanoma as a genetic disease. Cancer results from an accumulation of genetic changes in the DNA that leads to uncontrolled growth of cells. Thus, melanoma is a genetic disorder. Even though melanomas can look similar on the skin (usually brown or black and irregular), recent studies show that genetic changes in one melanoma can be quite different than the other. These findings imply that there are many different types of melanomas. The future requires genetic characterization of a person’s melanoma and treating the patient based on these findings.
The link between melanoma and sun exposure. The majority of melanomas develop on the skin (~95 percent). Rare forms are present such as those that develop in the eye, mouth, gut and the genitalia. Clinical studies that were carried out in the past decades suggested sun exposure (ultraviolet radiation) as a critical factor in promoting melanoma development of the skin. Recent genetic studies examining changes in the DNA now provide evidence that melanoma of the skin is closely related to ultraviolet-related damage. One exception, however, is the sun-protected sites of the skin, such as palms and soles, for which the reason of their development is beyond sun exposure. These recent scientific studies confirm sun exposure as a critical element in the majority of melanomas of the skin.
Tanning and indoor tanning (tanning booths or beds) increase one’s risk for melanoma. Indoor tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors. Those who tan indoors only four times a year increase their risk of developing melanoma by 11 percent. There is an alarming increase of melanoma among young women possibly due to increased use of indoor tanning in this age group.
These studies provide further evidence linking sun exposure to melanoma. One can avoid harmful sun exposure by avoiding the midday sun (11 a.m.-4 p.m.), using protective clothing and by frequent sun block (SPF>30) application. Indoor tanning should never be used. More importantly, one can enjoy the summer months without being subjected to significant levels of ultraviolet radiation by using these measures.
As in other cancers, prevention strategies are of utmost importance. Routine skin cancer screenings and close surveillance of individuals at high risk for melanoma lead to early recognition, treatment and cure. May is Skin Cancer Awareness Month. In May, free skin cancer screenings are offered by dermatologists throughout the U.S. The Mount Sinai Department of Dermatology will be conducting a free Melanoma Cancer Screening on Thursday, May 23. We are encouraging everyone to take this potentially lifesaving step by coming in to obtain a total body skin examination. This free screening will be held between 3-5 p.m. We will be accepting all walk-ins. No appointment is necessary. Have skin cancer screenings and save your life.
Tanning not only predisposes individuals for melanoma, but for other skin cancers and for premature skin aging: wrinkles, sagging of the skin, brown and red spots. Do you still want to tan? Do you still want to ignore skin cancer screenings? Wake up America!
According to the Skin Cancer Foundation, one person dies from skin cancer every hour in the United States — a good reason why everyone should schedule regular skin examinations. But you may ask, how do dermatologists know when a skin growth or mole needs to be removed?
In the past, every worrisome skin lesion required a biopsy, meaning a small piece of tissue was surgically removed and sent to a pathology laboratory. If the biopsy showed cancer, additional surgery was needed. Even today, surgical biopsy and removal continues to be the standard of care for skin cancer. Fortunately, we have newer techniques that enable us to not only catch skin cancers earlier but also to help us prevent unnecessary biopsies. Total body photography, digital dermoscopy mole monitoring as well as handheld dermoscopy lesion evaluation are some examples of this vital technology. Dr. Orit Markowitz speaks around the globe on these topics and each year directs the Mount Sinai Greater NY Dermoscopy course for dermatologists in the New York and New Jersey area who are trying to hone in on these new important diagnostic tools.
How we approach skin biopsies and cancer surgery is therefore changing for the better. There are even newer devices being developed each year and Dr. Markowitz is at the forefront. An example of the most recent laser tool is called Optical Coherence Tomography (OCT). Dr. Markowitz, a pioneer in OCT research, recognizes its potential to eliminate the need for surgery in many cases. Dr. Markowitz is the Director of Pigmented Lesions and Skin Cancer at Mount Sinai, and she is also the newly appointed President of the International Optical Coherence Tomography Society.
“An important component of OCT is the laser’s ability to take live black and white pictures of deeper skin layers. By combining this technology with other lasers, I am discovering successful ways to both diagnose and treat skin cancer bloodlessly,” said Dr. Markowitz. The earlier a skin cancer is caught, the better the prognosis and outcome. Dr. Markowitz, through the use of non-ablative lasers, has been able to successfully treat — without cutting — both early and even more advanced non-melanoma skin cancers. Non-melanoma skin cancers are not as deadly as melanoma but they are the most common type of cancer and frequently occur in cosmetically sensitive areas such as the face. The possibility of using noninvasive lasers to both diagnose and treat without cutting is very appealing.
Among the advantages of OCT are improved comfort, greater convenience and less scarring. Dr. Markowitz’s research has enabled Mount Sinai to become the country’s leading center for the development and use of OCT.
According to Dr. Markowitz, “I’ve also found OCT to be useful for benign skin growths, thus preventing the need for unnecessary biopsies.” She notes some examples: harmless moles, warts, hemangiomas, seborrheic and actinic keratoses and cysts. Other dermatological diseases that can be diagnosed with OCT include psoriasis, scabies, and blistering diseases.
Dr. Markowitz currently offers OCT and other noninvasive diagnostic techniques to patients at the Mount Sinai Doctors Faculty Practice.
For more helpful tips from Mount Sinai dermatologists, visit the Faculty Practice website:
http://www.mountsinaifpa.org/patient-care/practices/dermatology and view the seasonable Skin Health Newsletter publication.
It is very easy to forget about taking care of oneself during the busy months of fall and winter. With the holidays, cold weather and short days, it’s no wonder that as many as 9 percent of the U.S. population suffers from the winter blues, known as seasonal affective disorder in the medical community. One way a dermatologist can help you with the winter blues is by making you look better.
In fact, botulinum toxins (BotoxÆ or Dysport Æ) have been shown to improve depression symptoms. In a recent study, patients who received botulinum toxin in the forehead reported nearly 50 percent fewer depression symptoms on the Hamilton Depression Rating Scale. I have certainly seen this effect in my patients. It makes perfect sense that if one looks better, he or she feels better. But there is more to this story — experts believe that a relative change in facial expression from angry, sad, and fearful to happy and can produce emotional well-being beyond the cosmetic benefit.
Rosacea is a chronic disorder primarily of the facial skin that is characterized by redness, flushing and acne bumps. Hot liquids, spicy food, alcoholic beverages and stress can make rosacea symptoms worse. Several treatments can alleviate rosacea symptoms. These include V-beam laser treatment, chemical peels and blue light/photodynamic therapy.
The V-beam is a laser used to treat vascular abnormalities, such as redness of acne and rosacea. The laser works by dispensing an intense but gentle burst of light that selectively destroys the blood vessels without damaging the surrounding skin and tissues. Cosmetically sensitive areas, such as the face, neck, and the V of the chest can be easily treated. Pain is usually minor, and use of a topical anesthetic prior to treatment decreases discomfort as much as possible. More than one session is usually necessary to achieve optimal results.
A trichloroacetic acid (TCA) peel gently lifts and removes the surface skin layer preventing clogged pores, acne bumps and fine wrinkles and lines. The effects of a TCA peel may also extend beyond the skin surface — TCA stimulates the underlying dermal tissues to regenerate and strengthen collagen fibers. This results in fewer rosacea breakouts, smoother skin surface, removal of wrinkles and an overall more youthful complexion.
Photodynamic therapy (PDT) with blue light is a noninvasive method used to treat rosacea. A special light-sensitive medication called aminolevulinic acid (ALA) is applied to the affected area and allowed to remain there for 1 to 3 hours. Then the blue light is directed to the skin. For some patients, simply being exposed to blue light can help with rosacea. This treatment improves acne bumps, decreases pore size and improves the overall appearance of the skin.
Fillers are another way to improve one’s appearance. Fillers can be used to lift the creases that extend from the nose to the corners of the mouth (nasolabial folds) and marionette lines, rebuild the cheeks, fill hollows around the temples and improve the appearance of aging hands. Injection of fillers into the lips can decrease the appearance of lines around the mouth and increase the fullness of the lips. A “liquid facelift” combines injections of filler agents into several areas to restore the more rounded, youthful and full contour of the face. This approach is ideal for a younger patient, as well as an older patient who is seeking an alternative to facelift surgery. The entire procedure can be performed in the office with the aid of topical numbing cream.
Some of the popular fillers include RestylaneÆ and JuvÈdermÆ — composed of hyaluronic acid, which is naturally found in the body — and provide volume and fullness to the skin. The duration of effect from the hyaluronic acid fillers ranges from six months to one year in most cases. The volume enhancing effect is created by layering the filler in a series of fine tunnels within the undersurface of the skin.
Sculptra AestheticÆ is another injectable filler that is made from poly-L-lactic acid, which works to restore the structure and contour of the face. Sculptra stimulates the skin to produce collagen, filling and contouring the face over time. This often gives a more natural look than a surgical facelift. Sculptra is best used in combination with hyaluronic acid fillers and botulinum toxins.
The “look good, feel better” motto is an important aspect of dermatology practice. By taking the time to improve your appearance, you can beat the winter blues this year, and every year. Ask your dermatologist what you can do to improve your appearance during your next visit.
Rosacea is a skin condition in which your face tends to appear red and inflamed with periods of worsening and improvement over months to years. Individuals with rosacea may flush easily or develop what looks like acne breakouts. It can occur in all ages or ethnicities but tends to be most common in white, middle-aged adults.
Rosacea is extremely common with an estimated 14 million Americans suffering from the condition. Some notable sufferers include former President Bill Clinton, J.P. Morgan, W.C. Fields, Rembrandt and Rosie O’Donnell — not to mention Santa Claus and, most likely, Rudolph!
Dermatologists are trained to recognize and treat patients with rosacea. There are four recognized types of rosacea that have different clinical features. These include:
acne rosacea (breakouts, pimples, redness)
vascular rosacea (enlarged facial blood vessels)
ocular rosacea (dry eyes, red eyes, eyelid swelling, multiple styes)
rhinophyma (thickening of the skin, especially the nose, enlarged pores)
You may have just one or several types of rosacea concurrently. If you believe you may have symptoms of rosacea, you should make an appointment to see a dermatologist.
Massive research efforts have identified several abnormalities in inflammatory pathways in the skin that are linked to the development of rosacea. It is now believed that patients with rosacea have an exuberant inflammatory response to environmental stimuli leading to rosacea. Essentially, rosacea skin overreacts to normal stimuli leading to redness, flushing and inflammatory bumps. A mite that lives on everyone’s skin, demodex, may play a role in increasing inflammation in the skin and is more numerous in patients with rosacea. Rosacea tends to run in families and therefore patients often have affected family members.
No. In fact, many over-the-counter acne medications will worsen rosacea. The diagnosis of rosacea is best made by a dermatologist.
No. For centuries a bulbous, enlarged and red nose was interpreted as a sign of alcoholism. We now know that rhinophyma, gross enlargement of the oil glands in the nose, is a common feature of rosacea. Patients with rosacea are no more likely than the general public to suffer from alcoholism. While alcohol may lead to flushing directly following consumption, this is because alcohol can trigger rosacea in an individual who is already susceptible to the development of rosacea. Alcohol itself is never the sole cause of rosacea.
There is no cure for rosacea. Medical and surgical therapies are available for patients in order to suppress rosacea flares. Treatments most commonly include topical and sometimes oral antibiotics. Patients with enlarged blood vessels, or telangiectasias, typically respond very well to laser treatments. Rhinophyma, thickening of the nasal skin, may be amendable to surgical correction. Treatment by a dermatologist is best initiated early since once rosacea progresses it can be difficult to control.
The most important factor in preventing a flare in rosacea is sun protection. Patients with rosacea have sensitive skin that most commonly flares following sun exposure. Following exposure the skin tends to stay red much longer than would be expected from a typical sunburn. The use of zinc oxide containing sunscreen with a minimum of SPF 30 must be used 365 days a year. Regular use will limit flares and disease progression in all types of rosacea.
Other common triggers include stress and certain foods and beverages. Patients should learn what precipitates their rosacea and avoid the known triggers.
While there is no cure, several steps can be taken at home to reduce the frequency and severity of rosacea flares such as identifying triggers and regular sunscreen use.
Infants: Seborrheic dermatitis, or “cradle cap,” is very common in infants. While the condition will generally pass with use of gentle cleansers, in severe cases a prescription medication may be necessary. It is also important not to confuse run-of-the mill cradle cap with a true fungal infection.
Infants also may have different lesions, like congenital nevi (generally called “birth marks”) that may appear normal, but it is important for a trained dermatologist to evaluate these. While some birth marks need to simply be observed, others may need to be sampled or even removed.
Toddlers: Although eczema can first appear in newborns, it is also common for it to occur around age two. Parents are usually most concerned about the distressing itch that their children experience as well as how unsightly eczema can look. While thorough moisturization is the most common relief of very mild eczema, it is often prescription medications, including topical steroids, that keep flares under control.
Adolescents: This is a very active time for changes in the skin as hormones are changing rapidly during this time. Acne is usually the number one skin complaint for teenagers. Often by the time they reach the dermatologist they have already tried many over-the-counter agents and it is time for something stronger. Early treatment of acne with topical retinoids and sometimes oral antibiotics can help to prevent long-term scarring and pigmentary changes.
Adults: Even after we have passed through teenage hormonal changes, there are still common problems that can occur. Many adults still struggle with adult acne well into their forties. At that point, acne may have transitioned into a different condition known as rosacea which will often require different treatments than for teenage acne. Also, many adults notice new “growths.” These generally fall into a few common categories. First, there are seborrheic keratoses, which are harmless growths that can appear almost anywhere. These are often referred to as “age spots.” In darker-skinned patients, these growths my be centered on the face and are referred to as dermatosis papulosa nigra. Although harmless, they can be of considerable cosmetic concern for patients.
There are several different treatment options for these, if desired. Changes in the hair can also be a huge concern as we age. Men and women lose hair in different patterns as they age. Depending on how much hair has been lost and the causes of hair loss, oral medications can be used for men (such as PropeciaÆ) or topical for women (such as Minoxidil).
Skin cancer is also much more common as we age. Although the majority of the lesions that patients are concerned about tend to be normal, particularly if you have an area that is bleeding, burning, itching or nonhealing, there may be cause for concern. Also, what sometimes looks like a normal sun spot may require a dermatologist’s attention.
Establishing a relationship with a dermatologist can provide medical care, as well as comfort and preventative ease of mind, to you and your family.
Your skin changes as you get older. Many factors influence this change, including sun exposure, genetics, age, and your choice of skin care.
Skin Cancer: The most serious growths that occur as one gets older are skin cancers. The most common skin cancer is basal cell carcinoma. It occurs most frequently on the face, ears, neck, scalp, shoulders and back and can look like a skin-colored or open sore. Squamous cell carcinoma is the second most common type of skin cancer. It is usually seen on sun-exposed skin and looks like scaly red bumps that may bleed. Melanoma is the most deadly type of skin cancer and can look like dark brown, black, blue or tan spots that may bleed or grow rapidly.
Actinic keratoses: These are precancerous growths that are caused by long-term UV exposure. These growths can become squamous cell carcinoma and may be associated with basal cell carcinoma. They are usually seen on sun-exposed skin and look like scaly patches or bumps, can have the shape of an animal’s horn, or can bleed easily. Treatment of these lesions is needed to prevent formation of skin cancer and can be accomplished by freezing (cryosurgery) or topical creams.
Seborrheic keratoses: These growths usually appear after the age of 30 and increase in number as one ages. They look like brown, black or pale-colored growths and have a waxy, scaly, slightly elevated appearance. Sometimes, these growths can peel off or crust off and then come back. These lesions can be surgically removed if irritated or can be removed for cosmetic reasons.
Sebaceous Hyperplasia: This is a common condition in which oil glands become enlarged and appear as yellow, shiny bumps on the face. These lesions can be easily removed for aesthetic reasons.
Cherry angioma: These growths are thought to be genetic and look like cherry-colored bumps. They can become quite large and may bleed when traumatized. The number of these lesions usually increases as one ages. These lesions can be removed by excision or laser surgery.
Skin tags: These growths are small accumulations of skin that may have a stalk and are most common on the eyelids, neck, armpits, upper chest, and groin. They can become irritated and very often are removed for practical and cosmetic reasons.
Xerosis (dry skin): The skin tends to dry out as one ages. Besides age other factors that influence this condition include your skin care style. It’s important to not use very hot water in the shower or bath, as this tends to make the skin drier. It’s also important to use a moisturizing wash, and not harsh soap. Pat yourself dry and apply a moisturizer right away.
I strongly advise my patients (young and old) to have a yearly full-body skin screening which allows me to catch early stages of skin cancer by having suspicious moles biopsied or simply monitored for changes. Concerning the aesthetic aspects of aging skin, your dermatologist will select the right treatment which will result in a younger, healthier skin appearance. Sun tanning is a big no-no since it only accelerates premature skin aging and it is a known cause of skin cancer. However, cryotherapy, laser therapy, chemical peels, dermabrasion or microdermabrasion are some of the available treatments that when administered by a qualified dermatologist can reverse or slow down skin aging.
Gary Goldenberg, M.D.
Assistant Professor of Dermatology and Pathology
Medical Director, Dermatology Faculty Practice
Mount Sinai Medical Center
5 East 98th St., 5th floor
New York, NY 10029-6189
Tel: (212) 241-9728
Posted in Central, Health on Friday, June 8, 2012 1:00 pm. Updated: 12:08 pm. | Tags: Anatomical Pathology , Plastic Surgery , Skin Cancer , Health_medical_pharma , Skin Neoplasm , Melanoma , Basal-cell Carcinoma , Actinic Keratosis , Squamous Cell Carcinoma , Basal Cell Carcinoma , Melanocytic Nevus , Skin , Seborrheic Keratosis , Sunburn , Acrochordon , Sebaceous Hyperplasia , Ultraviolet , Skin Cancers , Cancer , Common Skin Cancer , Human Skin , Actinic Keratoses , Health , Seborrheic Keratoses , Laser , Oil Glands , Cherry Angioma , Laser Surgery , Chemical Peels , Laser Therapy , Cryotherapy , Dermabrasion Comments (0)