By: Shannon Homolka – health enews, a news service from Advocate Health Care

It’s mid-November, and if you are participating in “No Shave November,” the finish line is in sight. After a month of not shaving, you will probably be ready to trade your bearded look for a fresh, shaven appearance, but the look of a fresh shave can quickly disappear due to razor burn. This skin irritation appears as a red rash and causes a burning sensation that can be itchy and swollen. Dr. Keith Lopatka, a dermatologist with  Lakeview Dermatology in Chicago offers the following advice to avoid razor burn:

• Avoid using a dull razor by replacing a razor after five uses.
• Shave in the direction of the hair growth (with the grain).
• Use short strokes.
• Shave in the shower. Take a hot shower and shave after being in the shower for a few minutes; the heat and moisture will soften your hairs.
• Never dry shave. Always use a shaving aid such as shaving cream or gel.
• Be sure to clean the razor thoroughly. Rinse your razor after every pass you take.

If you follow these tips and still end up with razor burn, Dr. Lopatka suggests using Aloe Vera on the irritated area after shaving. Lotions containing salicylic acid or glycolic acid can also help. If you have razor burn often you can also use an antibiotic ointment on the area when you finish shaving. Applying ice packs and avoiding shaving until the burn disappears can also be helpful. Most of all, Dr. Lopatka warns patients to stay away from products containing alcohol. “Alcohol tends to dry the skin and clogs pores,” he says. If your razor burn becomes a major concern, check with your physician for additional hair removal options and treatments.

To learn more about men’s dermatology issues, visit lakeviewderm.com. On the site, men can make appointments, find helpful tips and screening information and also find a doctor.

Certain risks invite careful prescribing considerations

By Louise Gagnon – Dermatology Times

The most common hormonal therapy prescribed to treat acne are oral contraceptives, but clinicians need to consider other factors, such as age, before prescribing oral contraceptive agents to acne patients, according to the director of the Dermatology and Skin Care Center of Birmingham in Birmingham, Ala.

“We have a tendency as dermatologists to talk about acne that flares at certain times of the month as being hormonal, or acne that occurs in women as being hormonal, or acne that occurs on the lower part of the face as being hormonal,” explains Julie Harper, M.D., who spoke at an acne guidelines workshop during the annual meeting of the American Academy of Dermatology (AAD).

“All of that may be true, but, really, all acne is hormonal to a certain extent because androgens play a role, both by promoting plugging of the follicle, which is a crucial part of acne development, and in stimulating the sebaceous gland,” she says.

Almost any woman can benefit from taking oral contraceptives, four of which are approved by the FDA for the treatment of acne, in terms of improving this chronic condition, Dr. Harper says.

Studies have not shown that any one particular oral contraceptive is better than another in treating acne, she notes.

“All combinations of pills that combine estrogen and progestin appear to make acne better,” she says. In particular, a Cochrane meta-analysis found no consistent differences among oral contraceptives in decreasing acne.

OC risks

Oral contraceptives, however, do present risks. The most serious is venous thromboembolism (VTE). Taking OCs doubles the risk of VTEs and, depending on the content of the pills, they may triple the risk, Dr. Harper says. She adds that it is important to note that formulations of OCs have been modified over the years.

“The overall risk [of VTES] has decreased due to the fact that the estrogen dose [in oral contraceptives] has decreased over time,” Dr. Harper says.

Newer progestins have been developed and may be present in more recent formulations of oral contraceptives, and some of these progestins carry their own risk, explains Dr. Harper. The FDA conducted its own study, which found the risk of VTE in drospirenone-containing oral contraceptives to be higher than in OCs that contain other progestins. To put this into perspective, levonorgestrel-containing OCs are associated with about six VTEs per 10,000 woman-years, while drospirenone-containing OCs are associated with about 10 VTEs per 10,000 woman-years.²

“There does appear to be some increased risk of VTE with drospirenone-containing pills,” Dr. Harper says, explaining that drospirenone is an anti-androgen and an analog of spironolactone.

Other risks associated with OCs include myocardial infarction (MI), with many being attributable to cigarette smoking in patients who took OCs, according to one study.³

“Smoking and taking OCs is a bad combination,” Dr. Harper says. “Make sure you ask patients if they smoke. I won’t write a prescription [for OCs] even if they smoke one cigarette per day.”

Dr. Harper prefers that parents take part in the discussion about OCs as a strategy to manage acne in her younger female patients, who should all have achieved menarche before they are prescribed OCs to treat their acne.

Prescribing considerations

“In a dermatology clinic, they are being prescribed for acne,” Dr. Harper says. “I would want parents to be part of the decision about oral contraceptives being used. Parents may say they don’t want their child on oral contraceptives regardless if they are FDA-approved [for acne]. You can [encounter] moral and ethical issues.”

An important consideration with the prescription of OCs for acne is that the treatment “does not have an easy endpoint,” Dr. Harper says.

“If they get better with it, and it is stopped, it has a tendency to recur and may come back worse than it was when you started the therapy,” explains Dr. Harper.

Other considerations in prescribing OCs in teenagers is that there is a risk of inducing premature closure of growth plates and preventing the laying down of maximum bone, Dr. Harper says, suggesting that OCs should not be a first choice in very young female patients.

In older female patients, particularly those who have had a hysterectomy, spironolactone is often a therapy that Dr. Harper prescribes. The most recent evidence indicates that it does not require monitoring of potassium.

The AAD will be releasing new acne treatment guidelines this year.

The Food and Drug Administration has just approved a new drug (T-VEC) that uses a safe herpes virus in association with an immunologic attack on the malignant melanoma metastases. This is the first time  a combination of an “Oncolytic” (cancer melting) agent, in this case a modified virus and an immunologic substance (Granulocyte- Macrophage Colony Stimulating Factor) has been used.
In fact, the immunologic agent is secreted by the same virus that melts the tumor.
The drug is administered by injection directly into the skin metastases which gradually disappear. Remarkably, it has shown to also melt  internal metastases. The survival rate in cases of metastatic melanoma treated with this agent alone, is 54% at one year and 52% at 2 years.

SOURCE: U.S. Food and Drug Administration, news release, Oct. 27, 2015
http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm469571.htm

By Lisette Hilton – Dermatology Times

What’s more frightful than Halloween? What the makeup and costumes can do to children’s and adult’s skin. Dermatologists weigh in with their top tips to help patients avoid post-Halloween skin horrors.

Tip 1: Test before applying

Elizabeth Tanzi, M.D., founder and director, Capital Laser and Skin Care, and clinical professor of dermatology at the George Washington Medical Center, recommends that patients do a skin test on the neck or forearm to see if a product they plan to put all over their faces and even their bodies will cause an aller

“Halloween makeup is notorious for containing irritating dyes and chemicals, so be very careful about what you use. Also, some of these products come from China where lead has been an issue, so as a parent, I would think twice about applying inexpensive Halloween makeup to large areas on children,” Dr. Tanzi says. “The best bet is to find professional theater makeup, if an elaborate face painting job is required, for the costume. It’s more expensive, but at least the likelihood of irritation or toxicity is decreased.”

Tip 2: Unclogging what’s clogged

S. Manjula Jegasothy, M.D. founder of the Miami Skin Institute and clinical associate professor of dermatology, University of Miami Miller School of Medicine, Miami. Fla., says Halloween parties can result in long exposures to costume makeup paste and gels.

“These can cause clogging of the pores and [acne] eruptions. These issues are best treated with OTC salicylic acid cleansers and spot treatments, or benzoyl peroxide spot treatments,” Dr. Jegasothy says.

Dermatologists should let their patients know that they should make appointments to address skin issues that persist for more than a week after costume-makeup application.

Tip 4: Costume dangers

Halloween costumes can be allergies waiting to happen, Dr. Prystowsky says.

“Keep latex allergies in mind as well for masks, prosthetics and other accessories. If your patients plan to reuse old clothes that have been sitting in their attic, you may want to suggest they give them a heavy clean. Dust and mites can cause allergic reactions if the clothes aren’t carefully cleaned,” Dr. Prystowsky said. “Storing clothes in suboptimal conditions could also expose them to mold. Many costumes have metal pieces, like buttons, crowns, jewelry or shields. Tell your patients to make sure these pieces don’t contain nickel.”

Julia Tzu, M.D., of Wall Street Dermatology in Manhattan, New York City, said she recommends patients wear looser, well aerated costumes to avoid skin issues.

According to Dr. Tzu, 100% cotton fabric is gentlest on the skin.

Tip 5: Where not to buy makeup

Suggest your patients avoid buying their Halloween makeup from the dollar store type retailers or Halloween pop-up shops, according to Jessica J. Krant, M.D., M.P.H., a New York City-based dermatologist surgeon.

“Most of this makeup is poorly regulated and often sells only once per year, so some of it may be pretty old. Since it is not well regulated, it may not contain quality preservatives that are meant to prevent bacterial buildup, increasing the risk for infections,” Dr. Krant says.

Tip 6: Take it off… as soon as possible

Dermatologists should recommend their patients remove all Halloween makeup before going to bed, according to Dallas, Texas, dermatologist Kristel Polder, M.D.

“… thicker foundations can clog pores and contribute to acne,” Dr. Polder says.

She also tells patients to rinse off body paint or sprays with gentle soap and water to avoid irritating the skin and to apply a mild hydrocortisone cream immediately after removing anything that itches or burns.

Tip 7: Accessory hazards

Certain mainstays of Halloween costumes can be particularly hazardous to the skin, according to dermatologist and cosmetic surgeon Joel Schlessinger, M.D., A few examples: the red dye in a petroleum base in fake blood can wreak havoc on the skin. Patients can try, instead, to make their own blood look-alike with corn syrup, flour and food coloring, according to Dr. Schlessinger, who is president of LovelySkin.com.

“Certain false nails are more harmful than others. The chemicals used to apply acrylic nails, for example, include resins and formaldehyde, which are known to cause cancer. Over time, these chemicals can also damage the nail matrix, causing the entire nail to fall off,” Dr. Schlessinger wrote in a recent blog. “Glue-on nails pose less of a threat to your nail health, as long as you remove them properly. However, these are still hard on your natural nail and not recommended. It’s better to paint your nails with regular nail polish.”

Los Angeles-based dermatologist Tsippora Shainhouse, M.D., clinical instructor of pediatric dermatology at the University of Southern California, says that, while fake eyelashes can make a costume a pop, eyelash glues (especially cheap ones) can cause severe contact dermatitis.

“Even reputable brands contain potential contact allergens, such as formaldehyde, cyanoacrylates, latex and rosins,” Dr. Shainhouse says.

She recommends patients test patch the adhesive on their inner arm before applying the lashes to eyes.

Other tips: be careful the glue does not drip beyond the edge of the false lash strip, and keep in mind that tape strips on fake moustaches, sideburns and beards can cause a contact dermatitis. Patients should consider wearing wigs and strap-on beards with elastic ties, according to Shainhouse.

A recent article in the journal “Infection” July 4 2015, reports that in a study done on Veterans in Atlanta, Georgia, the incidence of  MRSA (Methicillin Resistant Staph Aureus ) infection in Vitamin D deficient patients was nearly double that of patients with adequate Vitamin D levels.
Vitamin D  has been known for some time to contribute to immune defenses.

MRSA colonies on blood agar plate

Methicillin-resistant Staphylococcus Aureus (MRSA) infection is caused by a strain of staph bacteria that’s become resistant to the antibiotics commonly used to treat ordinary staph infections.

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.

4.1.1

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

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.

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.