Hot Topics
A collection of our current Skin Hot Topics by Dr. Landow are available on this page.
While proponents of radiofrequency therapies claim they reliably produce collagen tightening and fewer wrinkles, the technology seems primitive and unlikely to restore a youthful appearing skin. Unfortunately many patients succumb to the marketing lure of Thermage and spend thousands of dollars for little if any noticeable benefit.
Excessive Sweating
Injections of Botox provide unsurpassed improvement for those suffering from excessive perspiration. Not only does the therapy dry the underarms but it also relieves uncontrollable sweating on the palms, soles and forehead. Botox also dramatically aids those with embarrassing wetness in the groin and about the anus.
And Another Use For Botox
Drooling in children and adults often results from neurologic disease. Among the frequent culprits are Parkinson's disease, stroke, cerebral palsy and mental retardation. Injection of Botox into the Parotid or submandibular salivary glands often alleviates this added burden more safely than any of the other available therapies.
Laser Hair Removal
Excessive and annoying dark hair may be successfully reduced by laser therapy. However the results may be less impressive and shorter in duration than once believed. Adding a topical prescription agent, Vaniqua, may significantly boost the outcome and hasten disappearance of unwanted hair.
Contour Thread
In our never ending uncritical embrace of beauty treatments, a number of people turn to "facial lifting" with barbed suture. Supposedly this minimally invasive therapy suspends the sagging tissues with a suture embedded under the skin. Unfortunately no long term safety data exist. When complications arise, significant facial asymmetry may result without a simple method of correcting the deformity.
Psoriasis
Individual responses to treatment with the expensive biologics such as Enbrel, Raptiva or Remicade vary significantly. For some the psoriasis miraculously disappears while inexplicably for others the skin's appearance remains unaltered. To some degree these differences involve genetic variations lurking silently in the DNA.
Melanoma
Current estimates suggest 2007 will bring slightly fewer than 60,000 new cases of invasive malignant melanoma with another 50,000 non-invasive tumors. While these numbers indicate a slight fall from the 2006 numbers, the death toll will continue to rise.
Screening routinely fails to improve the prognosis of this potentially fatal condition.
Screening for Melanoma
Reports indicate yearly melanoma screening may not be effective for the general population. Instead limiting evaluations to those at highest risk appears as a more prudent use of resources. Those most likely to benefit include men, those past age 50, people with a history of melanoma or a changing mole and individuals lacking a dermatologist.
Eyelash Lengthening
One of the newest fads includes a series of newly available cosmetic agents that promise to lengthen and thicken eyelashes. Most of these over-the-counter products contain a relative of the drops prescribed to lower the eye pressure in patients with glaucoma. While the compounds might be effective, persistent discoloration of the skin and eye frequently appear as unwanted side effects.
Sunscreens
In spite of public fascination with sunscreens as a simple and safe method of avoiding cancer and premature skin aging, our love remains unrequited. A recent petition filed by the Attorney General of Connecticut demands the FDA declare an end to the "false and misleading" advertising of these products by their manufacturers. Proof of benefit remains elusive.
Sunscreens II
A recent report from Australia may be the first to show that regular application of sunscreens might be of some benefit in the war against a limited variety of skin cancers. No conclusive evidence even hints that these products reduce the incidence of the two most well known skin cancers: melanomas or basal cell carcinomas. Sunscreens may possibly help protect against squamous cell carcinomas.
Accutane and Inflammatory Bowel Disease
Televised advertisements beckon former Accutane users suffering from colitis referred to as IBD to call for legal assistance. While initial reports hinted the much maligned acne drug might indeed be related to bowel problems, a more recent evaluation of the data questions whether the initial assessment grossly over-exaggerated the purported association.
Blood Thinners
Doctors routinely advise patients to discontinue blood thinners several days prior to surgical procedures. Accumulating evidence indicates this may be unnecessary for the vast majority of operations. Caution still may be appropriate for those beyond age 67, but for most others aspirin, coumadin and Plavix do not pose a great risk.
HPV and Cancer
Proteins produced by certain variants of the wart virus may predispose to cancer. Nowhere does this seem more clearly established than cancer of the cervix. Evidence now links betapapillomavirus, a subgroup of HPV, as a potentially commanding partner in non-melanoma skin cancer formation. Currently the strongest association appears to be with Actinic Keratoses, a forerunner of Squamous Cell Carcinoma.
All In Your Head?
Many individuals experience an undeniable desire to pick, scratch and gouge their skin to the point of mutilation. The underlying condition often appears to be a psychiatric malady known as Neurotic or Psychogenic Excoriations. Rather than suffering a primary disease of the skin, these individuals do best under the care of a mental health provider. Other commonly occurring conditions include depression, anxiety and impulse control disorder.
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A collection of our current Skin Hot Topics by Dr. Landow are available on this page.
August
Volume V, Number 8
Medical commentary on dermatology related subjects.
While proponents of radiofrequency therapies claim they reliably produce collagen tightening and fewer wrinkles, the technology seems primitive and unlikely to restore a youthful appearing skin. Unfortunately many patients succumb to the marketing lure of Thermage and spend thousands of dollars for little if any noticeable benefit.
Excessive Sweating
Injections of Botox provide unsurpassed improvement for those suffering from excessive perspiration. Not only does the therapy dry the underarms but it also relieves uncontrollable sweating on the palms, soles and forehead. Botox also dramatically aids those with embarrassing wetness in the groin and about the anus.
And Another Use For Botox
Drooling in children and adults often results from neurologic disease. Among the frequent culprits are Parkinson's disease, stroke, cerebral palsy and mental retardation. Injection of Botox into the Parotid or submandibular salivary glands often alleviates this added burden more safely than any of the other available therapies.
Laser Hair Removal
Excessive and annoying dark hair may be successfully reduced by laser therapy. However the results may be less impressive and shorter in duration than once believed. Adding a topical prescription agent, Vaniqua, may significantly boost the outcome and hasten disappearance of unwanted hair.
Contour Thread
In our never ending uncritical embrace of beauty treatments, a number of people turn to "facial lifting" with barbed suture. Supposedly this minimally invasive therapy suspends the sagging tissues with a suture embedded under the skin. Unfortunately no long term safety data exist. When complications arise, significant facial asymmetry may result without a simple method of correcting the deformity.
Psoriasis
Individual responses to treatment with the expensive biologics such as Enbrel, Raptiva or Remicade vary significantly. For some the psoriasis miraculously disappears while inexplicably for others the skin's appearance remains unaltered. To some degree these differences involve genetic variations lurking silently in the DNA.
Melanoma
Current estimates suggest 2007 will bring slightly fewer than 60,000 new cases of invasive malignant melanoma with another 50,000 non-invasive tumors. While these numbers indicate a slight fall from the 2006 numbers, the death toll will continue to rise.
Screening routinely fails to improve the prognosis of this potentially fatal condition.
Screening for Melanoma
Reports indicate yearly melanoma screening may not be effective for the general population. Instead limiting evaluations to those at highest risk appears as a more prudent use of resources. Those most likely to benefit include men, those past age 50, people with a history of melanoma or a changing mole and individuals lacking a dermatologist.
One of the newest fads includes a series of newly available cosmetic agents that promise to lengthen and thicken eyelashes. Most of these over-the-counter products contain a relative of the drops prescribed to lower the eye pressure in patients with glaucoma. While the compounds might be effective, persistent discoloration of the skin and eye frequently appear as unwanted side effects.
Sunscreens
In spite of public fascination with sunscreens as a simple and safe method of avoiding cancer and premature skin aging, our love remains unrequited. A recent petition filed by the Attorney General of Connecticut demands the FDA declare an end to the "false and misleading" advertising of these products by their manufacturers. Proof of benefit remains elusive.
Sunscreens II
A recent report from Australia may be the first to show that regular application of sunscreens might be of some benefit in the war against a limited variety of skin cancers. No conclusive evidence even hints that these products reduce the incidence of the two most well known skin cancers: melanomas or basal cell carcinomas. Sunscreens may possibly help protect against squamous cell carcinomas.
Accutane and Inflammatory Bowel Disease
Televised advertisements beckon former Accutane users suffering from colitis referred to as IBD to call for legal assistance. While initial reports hinted the much maligned acne drug might indeed be related to bowel problems, a more recent evaluation of the data questions whether the initial assessment grossly over-exaggerated the purported association.
Blood Thinners
Doctors routinely advise patients to discontinue blood thinners several days prior to surgical procedures. Accumulating evidence indicates this may be unnecessary for the vast majority of operations. Caution still may be appropriate for those beyond age 67, but for most others aspirin, coumadin and Plavix do not pose a great risk.
HPV and Cancer
Proteins produced by certain variants of the wart virus may predispose to cancer. Nowhere does this seem more clearly established than cancer of the cervix. Evidence now links betapapillomavirus, a subgroup of HPV, as a potentially commanding partner in non-melanoma skin cancer formation. Currently the strongest association appears to be with Actinic Keratoses, a forerunner of Squamous Cell Carcinoma.
All In Your Head?
Many individuals experience an undeniable desire to pick, scratch and gouge their skin to the point of mutilation. The underlying condition often appears to be a psychiatric malady known as Neurotic or Psychogenic Excoriations. Rather than suffering a primary disease of the skin, these individuals do best under the care of a mental health provider. Other commonly occurring conditions include depression, anxiety and impulse control disorder.
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Dermatology Hot Topics August 2010 Chins and Botox It truly appears that Botox improves a lot more than just unwanted wrinkles, lines and furrows around the eyes, forehead and crow's feet. For those with a strong mentalis muscle, a smile or frown may be met by a dimpled appearance or golf ball-like craters on the chin. This condition rapidly resolves with a small amount of Botox placed directly into the central portion of the chin. Under Eye Bags Shifting fat deposits under the skin result in those under eye "bags" that create the appearance of old age. While in the past the standard therapy involved surgically removing the excess skin and fat, this typically left the area hollow and unnatural looking. Now rather than this often outdated remedy, doctors currently inject a filler such as Juvederm to recreate a more natural appearance to the area. Diet and Acne Studies continue to appear attempting to link dietary carbohydrates and milk consumption to worsening acne. Although the subject lends itself to journalistic sensationalism, the science behind the claims seems extraordinarily tenuous and at best inconclusive. A careful reading of the current "evidence" fails to convince any unbiased observer that dietary changes will improve acne. Blisters During the hot summer months, outdoor exercising often leads to blisters on the feet. While these generally tend to be mere nuisances, they may alter the gait and at times lead to infection. Prevention remains the best option. During the summer, the feet should be kept dry which surprisingly means avoiding cotton socks in favor of material such as Coolmax or Smartwool that wicks moisture away from the skin. Intact blisters resist infection which means evacuating the contents predisposes to problems. Shoe Contact Allergy Foot eczema results from a number of different causes however one of the most frequent culprits involves allergic reactions to materials used in the manufacturing of foot-wear. Making the diagnosis somewhat confusing, the rash also routinely targets other areas of the body with the hands being a common site. Among the usual culprits are glues, rubber accelerators and chromate. Patch testing generally identifies the specific allergen and offers the potential for avoidance. Skin Lighteners Unwanted brown discoloration resulting from injury, acne or excessive sun remains a complaint difficult to adequately address. Over-the-counter topical lighteners rarely provide sufficient potency to improve the skin's color, while prescription agents also remain relatively feeble in this regard. As a result many consumers turn to "natural" products containing herbal remedies available through the internet or in so-called health stores. Unfortunately these materials which not uncommonly originate in Pakistan, India, China or Taiwan often contain toxic mercury which may be harmful to the kidneys. Psoriasis and Heart Disease In spite of much chatter in the media about the elevated risk psoriasis supposedly imparts with regard to heart attacks, careful reading of the studies casts more than a shadow of doubt regarding whether any association exists. Skeptics might point out the presence of considerable drug company money in establishing the supposed link tarnishes the idea that psoriasis plays even a tiny part in the overall story of cardiovascular disease. |
Photo-Aging It makes sense to suggest the amount of time spent in the sun parallels the degree of photo-aging that ultimately develops. Unfortunately new understanding of the MC1R gene throws a monkey-wrench into all past assumptions. It appears the presence of certain variants or alleles of this gene may determine an individual's intensity of photo-aging. This counter-intuitive finding may mean that a person's level of sun damage may be genetically determined rather than resulting simply from lifetime exposure to solar irradiation. Moisturizers Advertising often engenders confusion rather than providing enlightenment. In the case of moisturizers, some praise oil-free preparations while others condemn them in favor of brands containing oils. Actually both offer advantages depending on the underlying type of skin. In the harsh desert environment, oil based moisturizers with petrolatum restrict water loss. For more oily skin, oil-free creams with dimethicone soften the skin and reduce the greasy feel of excess sebum. Sunscreen Allergy Whether sunscreens provide adequate protection against harmful ultraviolet rays remains the subject of intense debate. Although common "wisdom" supports application of these products to reduce sun damage, they probably only prevent sunburns and allow most if not all of the cancer causing rays to penetrate the skin. Now it seems one of the most common ingredients in sunscreens relatively frequently causes allergic reactions especially during exposure to the sun. Octocrylene belongs in the cinnamate family and appears to be the culprit. Moisturizers Advertising often engenders confusion rather than providing enlightenment. In the case of moisturizers, some praise oil-free preparations while others condemn them in favor of brands containing oils. Actually both offer advantages depending on the underlying type of skin. In the harsh desert environment, oil based moisturizers with petrolatum restrict water loss. For more oily skin, oil-free creams with dimethicone soften the skin and reduce the greasy feel of excess sebum. Skin Cancer Mohs surgery for skin cancer seems more frequently performed than necessary. This relatively expensive procedure appears appropriate for complicated non-melanoma basal cell and squamous cell carcinomas, however much less involved techniques quickly and conveniently remove typical malignancies. In fact many tumors respond to nothing more invasive than merely scraping them with a curette and "burning" the remaining tissue. This simple technique may cure more than 95% of low risk tumors. Skin Screening and Melanoma Does annual skin cancer screening reduce the likelihood of death from melanoma or does it merely begin a journey to unnecessary intervention and anxiety? A recent survey finds that screening fails to reduce the incidence of death but clearly detects a type of "pre-melanoma" referred to as melanoma-in-situ. Whether untreated this lesion would eventually deteriorate into an invasive melanoma remains the subject of fierce debate. It seems likely that detection often leads to overtreatment rather than cure of important disease. Rosacea Several subdivisions of rosacea exist with relatively little similarity between the different types. In young women manifestations generally involve flushing and redness while among middle aged men an acne-like eruption appears more common. In spite of reports suggesting a link exists between the disease and sun exposure, solar irradiation probably has little to do with the condition. Heat appears a much more likely explanation. Hair Loss Affecting as many as 1 in 50 individuals, alopecia areata represents the most common autoimmune disease known to scientists. In this condition one or more patchy areas of total hair loss rapidly develop. Although each spot tends to be relatively small, about the size of a quarter or half dollar, at times the disorder causes loss involving more extensive regions. Recent investigations pinpoint the cause as gene expression on the hair follicle that beckons some of the body's protective white blood cells to attack the hair producing cells. Hopefully knowing at least one of the causes will allow more directed and successful therapy. |