Monthly Archives: August 2015

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Could Indoor Tanning Lead to Risky Behavior?


Two new studies on teen behavior relative to sun tanning present some surprising results:

The good news is that the percentage of teens who tan indoors has receded  from 25.45% to 20.9% from 2009 to 2011.

Even among the most frequent users, non Hispanic white females age 16 and up, the percentage has decreased from 37% to 29%.

The bad news: among the frequent tanners, risky behavior such as binge drinking, sexual intercourse and illicit drug use are common for about 1/3 of female frequent tanners and less than 10% of male frequent tanners.

Studies in mice have shown that  ultraviolet damage to the skin induce secretion of a complex hormone by the pituitary gland. Half of it stimulate pigmentation of the skin. The other half, beta endorphin,  whose actions are similar to morphine, produce an emotional “high”.

For teens who admit to frequent tanning, it may be advisable to discuss the effects of not only tanning, but also of  other possible risky behaviors.

What’s Ahead for Your Forehead?



A recent article in the journal “DERMATOLOGIC SURGERY” reports good results following “Focused Cold Treatment” for forehead wrinkles.
It consists of disabling, temporarily, fragments of the frontal nerve by freezing and reviewing the results at days 7-30-60-90.
Good results were seen in the majority of patients.
We shall .follow this story further to assess the effectiveness, longevity and safety of the technique.
For the time being, we are not offering this procedure

Strangely Beautiful Illustrations of 19th-Century Patients With Skin Diseases

By Rebecca Onion,  Slate

“Scarlatine Normale” (scarlet fever). Courtesy The Lilly Library, Indiana University, Bloomington, Indiana

These plates come from an 1833 book by French dermatologist Jean-Louis-Marie Alibert with a classically unwieldy 19th-century title: Clinic of the Saint Louis Hospital, or, Complete Treatise of the Diseases of the Skin, Containing the Descriptions of These Diseases and of the Best Ways to Treat Them.

As part of the first generation of color illustrations of pathological skin conditions, the plates show the patient’s whole face in loving detail. While recording the details of skin maladies, the illustrations also note locks of hair, rumpled bedding, and, in the case of one patient with scarlet fever, an intricate ruffled bonnet.

Alibert directed Hôpital Saint-Louis, located north of Paris and, after 1801, dedicated to the treatment of chronic dermatological disease. The hospital treated about 600 people at once on an in-patient basis and drew patients with rare afflictions who had been unable to find help elsewhere.

Alibert had scientific ambitions and became a noted lecturer and teacher. He worked with artists to produce his large and lavishly illustrated books on cutaneous diseases, including the Complete Treatise.

These plates, depicting patients afflicted with strains of scarlet fever, pellagra, and smallpox, represent a new direction in medical illustration in the late 18th and early 19th centuries: a reliance on extremely naturalistic visual representation. Doctors who commissioned such illustrations hoped, as historian Katherine Ott says, that such illustration might “capture what they saw so that others might learn from it.”


“Erythème Pèlagreux” (erythema caused by pellagra). Courtesy the Lilly Library, Indiana University, Bloomington, Indiana.


"Variole Confluente" (smallpox with a confluent rash). Courtesy the Lilly Library, Indiana University, Bloomington, Indiana.

“Variole Confluente” (smallpox with a confluent rash). Courtesy the Lilly Library, Indiana University, Bloomington, Indiana.



Here’s the Wild New “Trend” That Has Young Women Botoxing Their Heads

By Theresa Avila July 10, 2015


The latest solution to sweaty post-gym hair isn’t a cool spray of dry shampoo or anything else you can buy in the drugstore. In fact, you’ll need the trained hands of a licensed dermatologist to do the trick.

That’s because it involves getting injections of Botox into your scalp. It’s been dubbed “Blotox” by some, and the practice has been discussed in dermatology circles and on beauty sites in recent months, according to dermatologists interviewed by Mic.

Botox, commonly used to reduce wrinkling of the skin, has also been used to help stop the production of sweat in the armpits, palms and feet, Dr. Steven Dayan, a dermatologist and author or of the book, Subliminally Exposed, told Mic.

That’s where “Blotox” comes in. The treatment involves more than 100 injections into the scalp to interrupt the sweat glands from producing perspiration, according to Shape. The effects of the treatment could last up six months, Dayan said.

Why are people doing this? Vanity. One extreme example is a patient who complained to dermatologist Dr. Dendy Engelman that her blow-dried hairstyle did not withstand her spin class because she was sweating so profusely, according to Byrdie.

That conversation led to the idea of injecting Botox into the scalp. The procedure worked and thus began a trend, Engelman told Byrdie.

“Since then, a flurry of patients have come to me requesting the scalp treatment, and some others have decided to do it when I offer it as a solution,” Engelman told Byrdie.

The birth of a trend. The practice has picked up steam in recent months, Dr. Snehal Amin, a dermatologist working with Engelman at Manhattan Dermatology and Cosmetic Surgery in New York, told Mic. On average, the center he works at sees a couple of patients for the procedure every month.

Recent months, though, have shown a spike in the number of patients, Amin said. “Now, every dermatologist is talking about it,” he added. While Amin and Dayan were hesitant to call it a “trend,” other dermatologists and media outlets haven’t shied from the term.

“It’s definitely a trend. There’s no question about it,” Julie Russak, a New York City-based dermatologist told Shape in June. ABC 7 in New York also called the practice a “trend” in a segment, and Latina introduced it as the “Botox trend taking over.”

This is not an official treatment.  “Blotox” is not advertised, because it’s an off-label use of Botox, Amin said. While the FDA has approved Botox for sweat reduction in the palms and armpits, usage of it in other places earns the term “off-label,” Amin said.

But that doesn’t mean off-label uses are atypical in dermatology. For instance, Botox is FDA-approved for wrinkle-reduction but using it on the neck or chest, or to help relieve tension headaches are also deemed off-label uses, he explained.

“Dermatologists tend to be creative and apply medical principles to different problems all over the body,” Amin said. Applying Botox to the scalp is just another example of that practice, he added.

The cost:  A single session costs $1,200-$2,000 and is good for a solid three to six months, Amin said. That prohibitive cost could limit the trend’s popularity and ultimately lead to its demise. “To actually do it enough to make it work, you have to spend a lot of money,” Dayan said. “And there’s just not a market of people who are going to do that.”

The procedure itself may be simple enough, but the treatment is more of a “media sizzle story,” Dayan said.

SoulCycle and Drybar don’t mix: The growing interest in the practice, though, can perhaps be traced to women who regularly spend time in beauty salons getting expensive blowouts, only to have them come undone after a gym session. That’s the case, at least, with Alina Gonzalez, a writer for Byrdie, who in June wrote about how she’s a devotee of Drybar, where she regularly spends $50 a blowout session.

“And so when I’ve gotten a blowout — which I need to do for my self-esteem and legitimate viability in the world, because I look like an eccentric and electrocuted scientist without a blowout just because of my hair type — I basically have to decide between throwing my $50 down the drain by sweating in a hard-core fitness class/the gym or not. I always choose the latter, at least for the first few days of a blowout.”

Given those conditions, it’s no wonder Gonzalez has such an enthusiastic response to the procedure. And, needless to say, women shouldn’t have to choose between the going to the gym or getting a blowout so they feel confident. Even so, we have a feeling we’ll be writing about the death of this “trend” before it really ever takes off.

The dangers of sunscreen – A dermatologist’s perspective.

by Jackie Dosal, MD


Is my sunscreen going to kill me? Perform a search on sunscreen safety and some scary stuff shows up! Retinyl palmitate causes skin cancer. Oxybenzone causes estrogen-like effects on the body. I have seen these statements repeated over and over again all over social media and in real life. I recently heard from a patient, “I was using Neutrogena but then stopped because I heard it wasn’t so good for you.” How do we protect ourselves and our families from skin cancer without any nasty side effects?

I’d like to offer up my take — from a organic-loving, Whole-Foods-shopping, yoga-practicing, green-tea-drinking MD (dermatologist), with an eye for interpreting both media and science…

For those not able to read the whole post (we are all busy, I know!), here’s the quick summary of my findings. You can read on for more info too!

Sunscreen won’t cause hormonal disruption — it would take 200 years of application to even reach questionable levels of exposure.

Sunscreen won’t cause skin cancer — the use of sunscreen is directly correlated to the prevention of skin cancer. Retinyl palmitate is an anti-oxidant that occurs naturally in the skin.

Nanosize sunscreens are safe for use, as they clump in real life, preventing them from being absorbed.

I’ve researched the issues of sunscreen safety personally, and WOW! It’s confusing and contradictory. I’ll at least say this— we always need to critically and scientifically analyze the sunscreen ingredients we use for both efficacy and safety. And just as important, let’s not perpetuate myths that are based on unsound science. If you are interested in sorting through the muddy waters of sunscreen information — read on!

Environmental Working Group’s Rankings of Sunscreens.

Most of the information about safety stems from the Environmental Working Group’s sunscreen rankings. The Environmental Working Group is a not-for-profit organization that searches to identify harmful chemicals in our environment. While I applaud the intentions of the EWG to find safe and environmentally responsible materials, we need to be fair and look at these issues seriously, and not just solely how presented by the EWG.

Do sunscreens cause hormonal disruption?

The EWG advises avoiding any products with oxybenzone (an excellent UVA and UVB blocker) as it may cause effects similar to estrogen. The concern comes from a study performed in rats, where the rats were fed supratherapeutic doses of sunscreen (let me say that again, the rats ATE sunscreen at megadoses), and the size of their uterus enlarged.

Edited graph from PMID 11333184

There is a monstrous difference between eating super high doses of sunscreen and applying it to your skin daily — and concluding that topical use in human sunscreen causes estrogenic effects is an unrealistic stretch. A study in 2011 in JAMA Dermatology showed that it would take 200 years of daily sunscreen application to reach the same amount exposure as the rats in this study. To the author’s credit, their word-for-word conclusion in the abstract was: “Our findings indicate that UV screens should be tested for endocrine activity…” The authors do not say that the UV screens cause hormone activity in humans… they can’t. In order to substantiate their EWG’s claim, you would need to show hormone disruption in real live humans.

Luckily, such a study was performed. Human patients applied more than 3 times the real-life quantity of a high percentage oxybenzone sunscreen (10% oxybenzone, compared to the commercially available 6% oxybenzone) to their whole body daily for one week. Oxybenzone was in fact detected in the urine of the volunteers (as have some other sunscreen agents). Sound the alarm bells! — this is concerning. It indicates that there is some absorption from topical use (medications that are applied directly to the surface of the skin). However, the body quickly excreted it through the urine (which is a good thing). Much can be said about the fact that it was absorbed, but the take-home message was that the researchers were UNABLE to show a hormone disruption despite this absorption (again, this was at 3 times real-life dosage). There was no accumulation of the ingredients over time.

So we have a study in humans of real-life sunscreen use that shows no hormonal effect, or a study where rats ate sunscreen — which do you believe?

To be fair, when researching this blog post, I did come across an alarming number of lab and animal studies showing absorption of various sunscreen agents, with some experiments suggesting hormonal disruption. There were almost as many that showed no absorption nor hormone disruption. A good summary of those studies can be found here. But we have to look at what’s important… no human studies have shown hormonal disruption, and that is what counts.

Of note, it is important to mention that oxybenzone can cause allergic skin reaction in a fair percentage of people, so there should be some caution with its use.

And by the way, soy is weakly estrogenic. Where are the cries for banning or avoiding soy milk because of hormonal activity? There are many natural skin care products on the market containing soy, several of which I recommend and are excellent. A little perspective is important, and we need to remember that topical use is very different from ingestion.

Let’s move on to sunscreen and skin cancer.

Does my sunscreen increase my risk of skin cancer?

 A few years ago there was media buzz about a toxicology study that suggested that retinal palmitate, a common inactive ingredient in sunscreens, may actually increase your risk for skin cancer by increasing oxidative damage, or reactive oxidative species (ROS). Oxidative damage is like rust on metal — it corrodes our body and makes us more prone to inflammation and cancer. Let’s dive into this deeper.

Retinyl palmitate is an interchangeable form of retinol that is present naturally in our skin, and this should already be a clue that it’s not dangerous. Retinyl palmitate is not just in sunscreens; is approved by the FDA for use in prescription and over the counter medications, as well as a food additive in dairy products and cereals. It was selected for testing due to its prevalent use in common agents, not for any concerns of safety up to that point.

Once again, we have to look at the details of the study that created the buzz. It was never published in a peer-reviewed journal (the standard for medical literature — data needs to be vetted by people in-the-know), and was not performed in humans (also a huge red flag). It was performed in hairless mice, known to have an already increased risk of skin cancer, and these mice were burned with and without retinyl palmitate (RP). The studies showed the production of oxidative damage and increased risk of malignancy. However, these studies take RP out of human context, which is a very complex interactive antioxidant system. According to Dr. Steven Wang, the lead investigator in the study, “when a sunscreen with retinyl palmitate is applied to the skin, a number of antioxidants work together to alleviate the risk of free radical formation seen in these in vitro experiments. If studied on its own — outside of this environment — its antioxidant properties can rapidly be exhausted, allowing the production of oxygen radicals. In these non-human studies, retinyl palmitate was the only compound studied — making the biological relevance of these findings to humans unclear.” Even the lead investigator is not ready to recommend avoiding retinyl palmitate.

The final and probably most convincing evidence of the safety of retinyl palmitate comes from real life use in humans. We often use the family of retinoids (of which retinyl palmitate is a member), as a pill for the prevention of skin cancers in those most at risk (immunosuppressed organ transplant patients). We also have decades of experience using retinoids in acne medications; and topical retinoids are one of the best anti-aging creams on the market — I personally use one (Retin-A) every night. Undeniable human research shows it can reverse oxidative damage and signs of aging, keeping the skin healthy and youthful.

If you are interested in more, I encourage you to read this study by the Journal of the American Academy of Dermatology detailing the properties of retinyl palmitate and discussing its safety.

What are nano particles, and are they safe?

Nanoparticles are molecules that have been divided into nanometers (one billionth of a meter). By making the molecules small, it makes sunscreens more cosmetically acceptable and elegant, thus making it more attractive for people to use (i.e. not thick, sticky, or opaque like the old sunscreens found on lifeguards’ noses).

Concerns arose that these molecules might be small enough to penetrate through the skin into the bloodstream. Time and time again, human studies have shown that these particles are unable to penetrate through the skin because, in nature, these nanoparticles aggregate into clumps that are too large to penetrate the skin. There was also some thought that these ingredients could increase reactive oxidative species (ROS). We now know that this is meaningless if tested outside of the complex human antioxidative system. With this in mind, we should all embrace these new technologies that makes sunscreens less opaque, pastey, and more consumer friendly!

Nanoparticles clump on the skin. Photo credit: PMID: 22123418

Be Cautious of Media Sound Bites

The EWG extrapolates data (usually from animal studies, not humans), and uses scare tactics to make us feel like we are hurting our children if we use certain products. What I don’t like is that they ignore actual sound studies that show safety in humans. Their sound bites are alarming and catchy for headlines. I’ve actually seen website titles citing the EWG reading: “The Most Dangerous Sunscreens For Kids (And They’re Probably Hiding in Your Beach Bag).” Talk about mommy guilt!

I love this story which explains why we need to critically interpret how the media presents headlines: Chocolate Causes Weight Loss!

Background: A scientist wanted to show just how easy it was to convince the media to pick up a poorly designed faux scientific experiment that was catchy for headlines. It was a completely fake, but intriguing idea — eating chocolate can help loose weight. It turns out, it was really easy to get experienced journalists to pick up the headline! Read here: I Fooled Millions into Thinking Chocolate Helps Weight Loss. A critical eye is really needed in these days of rapid information sharing.

What does this all mean?

I don’t agree with the EWG rankings. Many of the poorly ranking sunscreens are very reputable and excellent brands. You can’t take the data from one animal or lab study and ignore other science and human experiments that are in disagreement. That’s not how science works. That’s the reason why thousands of drugs that work in animals never get to the market — because animal studies and in vitro studies often don’t translate into efficacy in the complex environment of the human body.

While in general, I’m in favor of the organic movement, real foods, and responsible farming practices, I often laugh when I see websites recommending chemical-free everything, including sunscreens. Chemicals are in everything, and there is no such thing as a purely chemical-free susncreen. Of course, live in moderation — extreme use of any susbtance can lead to some bad effects, but to say that normal day-to-day use of products causes the same effect seen with extreme use or oral ingestion doesn’t make any sense.

The dose is the poison, not the chemical itself. Almost any substance, including natural or beneficial substances, can be toxic under certain conditions, such as high temperatures, pH, concentrations, or when in the presence of other chemicals. Even too much Vitamin C can be lethal to skin cells at certain doses. The age-old mantra still holds true — everything in moderation.

Let’s thank the EWG for their laudable efforts in keeping us safe, but ask them not to demonize valuable products when the science shows otherwise. I completely agree that more testing needs to be done on household and cosmetic ingredients, but I wish they were a little more unbiased when it came to promotion of their agenda. And the media perpetuates these news snippets with negligible investigation into the validity of the EWG claims. It serves our society poorly.

Feel good about protecting your family — and apply that sunscreen this summer!

Why patients should buy skincare products from their Dermatologist

By: LESLIE S. BAUMANN, M.D. | June 16, 2015F_33088


The Internet has changed many facets of modern life, and the practice of medicine has not gone untouched. Consider, for better or worse, the reliance of many patients on WebMD and various other sites for self-diagnosis before consulting with a physician. Even before the Internet, patients would self-diagnose their skin type (more than 80% of them get it wrong). The Internet allows them access to most cosmeceutical brands, the misuse of which leads to unintended consequences that can affect skin health. Clearly, patients who receive advice from a trained medical professional have better outcomes. One reason for this is that the doctor (or aesthetician) spends time with the patient, explaining what products to use and in which order to use them, and follows up with the patient to assess the outcome and adjust the regimen as needed. The problem arises when these patients decide to purchase the products from a source other than their treating physician. Only about 30% of patients buy refills from their doctor for second purchases, and just 15% purchase products from their doctor the third time around. Why is this? It is likely the convenience and the low cost that drive patients to purchase from sources other than their physician or aesthetician. This desire to save money carries significant risks. Many the products online are expired or counterfeit, or are old containers refilled with a different formulation. Patients should be cautioned to only buy products from a source they trust.

I have had dozens of patients bringing in counterfeit products in the last few months. It seems that the problem is becoming more common. I interviewed several companies about this to see whether others were experiencing the same trend. This is what I found: Some companies report that they have seen their samples and trade size containers being sold on eBay. Joe Ragosta of Topix Pharmaceuticals reports that when his company has asked such sellers if they are obtaining these products – marked as samples – from the company, they hear a range of defensive responses, including: “I got it at a show” or “My doctor gave me samples, and I decided to sell them” and “I work at a doctor’s office, and they let me take products as needed.” Make sure that no one on your staff is taking samples and selling them online.

One example: NeoStrata is concerned about the fraudulent use of their products. They recommend that patients purchase their products only from a known physician, ideally from the physician’s office rather than the website. The company understands that customers may want to save money wherever they can and might prefer to buy products online. NeoStrata urges customers who opt to buy online to make such purchases through physician-affiliated websites, where the doctor is clearly identified. At the very least, the company urges patients to choose only sites where they can contact someone and obtain the name of a physician. Further, they strongly discourage using eBay or other auction sites, which do not vouch for the safety and authenticity of products sold through their services.

Other potential problems with skin care products sold online include the following.

Counterfeit products

Several reports have indicated that counterfeit skin products originating in other countries have made their way into the United States and, according to the article published on the website Fact Based Skin Care, pharmaceuticals and personal care products, including cosmetics, are among the top five types of products seized by U.S. Customs and Border Patrol agents (Coy, C. Dangers of Counterfeit Cosmetics, Aug. 4, 2014). Such products include old bottles refilled with inexpensive imitation creams or bottles made to look like legitimate products that in fact contain imitation creams. I once had a patient present with an adverse reaction to a retinol product, which she brought with her to the visit. I sent the bottle to the company, which confirmed my suspicion that the product was counterfeit – a different bottle with a similar label.

In February 2014, CBS New York ran a segment on the potential inclusion of carcinogenic and other harmful ingredients found in online personal care products touted for their low prices (CBS New York. Counterfeit Cosmetics May Be Harmful To Your Health. Feb. 27, 2014). Not even 2 weeks later, CNN reported on the arrest of two brothers in New York alleged to have masterminded a multimillion-dollar counterfeit health and beauty product ring (CNN. Zulueta A. Massive Fake Health and Beauty Supplies Ring Busted. March 9, 2014). ABC’s Good Morning America followed suit with a segment in April 2014 that exposed aspects of the use of knock-off cosmetic products (ABC News, Good Morning America. Online Beauty Bargains: Is It the Real Deal? April 3, 2014).

The Federal Bureau of Investigation has posted memos concerning counterfeit and potentially compromised and hazardous cosmetics and fragrances, offering tips aimed at readily identifying or avoiding unauthorized products.

Torie Hardee of EltaMD summarized that counterfeit products can sometimes be identified by lack of an expiration date on the bottle, discoloration or slightly different fonts on bottles and packaging, and the manufacturer’s address on the bottle.

Jan Marini Company representative Stuart Mohr noted that their company has received returns of products that they had not manufactured, as well as their own current or discontinued products returned years after the expiration date. The Jan Marini Co., and most other companies, will not guarantee any product purchased via nonauthorized resellers, because the authenticity and safety of such products cannot be verified.

“These unauthorized resellers are sophisticated, often even working in rings, and find it easy to hide their real identity,” said Mr. Mohr. “Addresses are often hidden or vague; emails are not linked to any specific person; and it’s easy to use false names. If a person is caught in an unauthorized online transaction, it’s easy to change the email address or name and start again,” he added.
FBI’s tips for spotting counterfeit cosmetics and fragrances

• The product is a sample size.

• The packaging differs slightly from the authentic brand (different color or font).

• The product’s wrapping appears haphazard.

• The product is being advertised as a “limited edition” even though the authentic manufacturer doesn’t offer it as a limited edition.

• The product is not listed on the manufacturer’s website.

• The price is drastically lower than the MSRP.

• The product’s consistency or texture doesn’t feel or look like the authentic brand.

• For fragrances, something seems off about the scent, and the color of the fluid in the bottle might be different than the original.

• They are being sold at nonauthorized retailers, including flea markets and discount stores.

• The label does not contain lot number, bar code, manufacturer’s address, or expiration date.

Expired products

Unscrupulous online retailers may slash prices on expired products and remove the expiration date from the package. In my practice, a patient experiencing an erythematous reaction brought in the “SkinMedica” product bottle, which looked suspicious to me. The packaging that the product was in had been discontinued 8 years earlier. It is important to remember that ingredients, particularly retinol, degrade with exposure to air, sun, and heat, and over time. This is most likely what caused my patient’s adverse reaction, and her initial savings from the product caused her several weeks of irritated skin.

Diverted products

SkinMedica reports that diverted products are a trickier issue than counterfeit products, because their packaging and formulas are sufficiently complex to make counterfeiting too difficult to be profitable. Instead, their products have been sold on the so-called gray market below the manufacturer suggested retail price (MSRP), typically online. In these cases, the company cannot help patients with returns or complaints because they cannot verify the chain of custody of the purchased product. They are addressing this problem, though, with an awareness campaign called “Authentic and Authorized.” Its goal is to alert patients and the physicians who dispense their products of the benefits of a physician-dispensed model of skin care, with best outcomes achieved when doctors are prescribing a skin care regimen. SkinMedica emphasizes that no website can guarantee outcomes comparable to a skin care professional and product quality and safety can only be enforced when dispensed through authorized channels.

Potentially illegal or toxic ingredients

Several products that have entered the United States marketed as skin lighteners, antiaging agents, and acne treatment products have been found to contain mercury, according to a consumer update from the FDA. Arsenic, lead, beryllium, and other harmful toxins as well as allergy-inducing fragrances or preservatives not approved as safe in the U.S. may also be found in such products of dubious origin.

Improper storage

Products purveyed online are often stored in hot warehouses. As mentioned above, heat degrades and alters ingredients, rendering compounds such as retinol, benzoyl peroxide, peptides, and ascorbic acid worthless. Extreme cold can also damage the chemical integrity of products. Notably, organic products are more vulnerable because they lack preservatives to gird them against temperature variations and microbes that grow in hot, damp environments.

Lookalike imposters

Generic formulations are packaged to piggyback onto the success of well-known products. Such products found in drugstores may be packaged to look like Cetaphil or Aveeno items, but cost less, and deliver less. While the ingredients on the copycats are identical to those found in the branded preparations, the order in which ingredients are added, the temperature, pH, and even when and how fast ingredients are stirred are part of the proprietary recipe of the company and play a significant role in the potential of the end product and the actions the product exerts on the skin.


Whether or not you sell skin care products in your office, there is much you can do to educate your patients about skin care product safety. Namely, the farther a consumer gets from the source of the product or from reliable endorsers of products, the greater the opportunity for encountering fraudulent or counterfeit products. Patients are best served by sources they can trust, such as their dermatologist. If you sell products in your office, encourage your patients to buy refills from you so they can be assured of the proper formulations. Finally, encourage your patients not to skimp when it comes to the health of their skin, reminding them that it may cost them much more in terms of time, skin irritation, improper treatment, and all related expenses to buy products cheaply from unreliable sources.

Give your patients a copy of this article so that they will understand the enormity of the problem.

Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). She has contributed to the Cosmeceutical Critique column in Dermatology News since January 2001. Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever.