In the News

Palm Beacher helps develop melanoma clinic for indigent

April 2016

Migrants who pick vegetables in western Palm Beach County and those who groom horses here during Wellington’s equestrian season are among those most at risk of developing an especially aggressive form of melanoma, the deadliest type of skin cancer.

The difficulty they and other poor residents have navigating the health care system — and their fears about cripplingly high medical bills often keep them from seeking treatment, according to Dr. John Strasswimmer.

"Many die," said Strasswimmer, a Palm Beach resident with a private dermatology practice in Delray Beach.

He’s looking to improve the odds.

Since the mid-2000s, Strasswimmer has provided screenings to low-income residents through the Caridad Center in suburban Boynton Beach. In 2015, he and other volunteer physicians conducted more than 600 skin cancer screenings.

This summer, the nonprofit medical and dental clinic will dedicate its new Melanoma Clinic. For the first time, Strasswimmer and other physician volunteers will be able to perform a full range of services — skin cancer screenings, diagnosis and treatment — on site. The clinic is part of Caridad’s 11,000-square-foot expansion.

The Caridad Center recently honored Strasswimmer for his role in establishing the melanoma clinic, and he will be named one of the Palm Beach County Medical Society’s Heroes in Medicine at a April 15 event at the Kravis Center.

CB Wohl, Caridad’s clinic director, calls Strasswimmer a model physician volunteer who expertly follows the center’s holistic approach to health care. That approach involves taking into account patients’ living and working conditions, economic status and mental health, Wohl said.

“He’s a consummate professional, he’s an expert in his field, and he is committed to raising the bar of delivering quality care to the indigent in our county,” she said.

Knowledge of risk is low

Earlier this month, the center launched an education program to teach its clients about their specific risks for developing skin cancer.

"It has been known for at least five years that when people who are poor or have dark skin get melanoma, that melanoma is more likely to be a more aggressive form of melanoma. And we don’t know if that’s because biologically, certain populations are more likely to grow a more aggressive form — or if, more likely, there is a delay in diagnosis," Strasswimmer said.

A $68,000 grant this year from the American Academy of Dermatology and the Pfizer Foundation enabled the center to assess its clients’ sun-protection needs. Of the 175 clients who participated, nearly a quarter said they had never heard of skin cancer, 20.7 percent believed people with dark skin can’t get skin cancer and only 15.8 percent had ever asked a doctor about a suspicious spot on their skin.

Existing awareness programs are geared to people with light complexions, he said. Melanomas looks different on darker skin, and it sometimes develops in different areas than melanomas experienced by people with light skin, he said.

Reggae legend Bob Marley died of melanoma, Strasswimmer said. “His melanoma was on his foot. That’s much more typical for people of African ancestry,” he said.

How to stop damaging your hair

February 2015

In our quest for beautiful hair, we often do things that damage our hair. Damaged hair is fragile, so it tends to break. Hair breakage can leave us with frizzy, unhealthy looking hair. If we continue to damage our hair, we may eventually see thinning hair or even bald spots.

The good news is that simple changes can prevent further hair damage. On this page, you’ll find 10 common hair-care practices that can damage hair and dermatologists’ tips that can help you to stop damaging your hair.

10 hair-care habits that can damage your hair 

  1. Washing your hair by rubbing shampoo into the length of your hair

    Changes that can help prevent hair damage:

    • Gently massage shampoo into your scalp.
    • When you rinse the shampoo from your scalp, let it flow through the length of your hair and resist the temptation to rub it into your hair.

  1. Skipping the conditioner

    Changes that can help prevent hair damage:

    • Use conditioner after every shampoo.

Dermatologists’ recommendations for swimmers

Pool chemicals can be hard on your hair. The following can help protect your hair:

  • Wear a swim cap.
  • Rinse hair immediately after swimming.
  • After rinsing your hair, wash your hair with a specially formulated swimmers’ shampoo and follow with a deep conditioner.

  1. Drying your hair by rubbing it with a towel

    Changes that can help prevent hair damage:

    • Wrap your hair in a towel to absorb the water.
    • Let your hair air dry.

  1. Brushing your hair while it is wet

  2. Changes that can help prevent hair damage:

    • Do you have straight hair? Let your hair dry a bit before you gently comb it with a wide-tooth comb.
    • Do you have textured hair or tight curls? Always comb your hair while it is damp, using a wide-tooth comb.

  1. Using a blow dryer, hot comb, or curling iron

  2. Changes that can help prevent hair damage:

    • Let your hair air dry when possible.
    • Use the lowest heat setting.
    • Limit the time a hot comb or curling iron touches your hair.
    • Use these tools less frequently, aiming for once a week — or even less often.

  1. Applying styling products that offer long-lasting hold

  2. Changes that can help prevent hair damage:

    • Try a hairstyle that does not require this product.

  1. Pulling your hair back tightly, such as in a ponytail, bun, or cornrows

  2. Changes that can help prevent hair damage:

    • Wear hair loosely pulled back.
    • Use covered rubber bands made especially for styling hair.
    • Try a different hairstyle that does not pull on your hair.

  1. Wearing a weave or hair extensions

  2. Changes that can help prevent hair damage:

    • Wear weaves and extensions that are light, so they do not pull.
    • Get weaves and hair extensions at a salon that specializes in these services.
    • Wear a professional weave or hair extension for 2 or 3 months at most. 
    • Keep up your scalp hygiene when wearing a weave or hair extension. 
    • Switch hairstyles, so you don’t always wear a weave or hair extensions.

  1. Coloring, perming, or relaxing your hair

  2. Changes that can help prevent hair damage:

    • Try to add more time between touch-ups, especially when the air is dry. In the winter, try to stretch the time between touch-ups to every 8 to 10 weeks or longer.
    • Have only one service — a coloring, relaxer, or perm. If you want more than one service, perm or relax your hair first, and do it 2 weeks before you color your hair.
    • Use conditioner after each shampoo.
    • When in the sun, protect your hair by using a leave-in conditioner that contains zinc oxide or wearing a wide-brimmed hat.

  1. Brushing your hair 100 strokes a day or tugging on your hair to style it

  2. Changes that can help prevent hair damage:

    • Brush and comb your hair only to style it. Hair never needs 100 brush strokes a day. That’s a myth.
    • Use a wide-tooth comb, and use it gently to comb your hair. 
    • Avoid pulling and tugging on your hair as you brush, comb, or style it.
    • Remove tangles gently, using a moisturizing conditioner if necessary.

When to see a dermatologist

If changing how you care for your hair does not help you see healthier hair, you may want to see a dermatologist. Your hair care may not be the root cause of your problem. Seeing a dermatologist is especially important if you are concerned about thinning hair or hair loss. Most causes can be stopped or treated. The sooner the problem is addressed, the better your results.

Dermatologists' top tips for relieving dry skin

February 2015

Simple changes can soothe dry skin

Following the same skin care routine year round may not work so well when the humidity drops. Without a change in your skin care, dry air can make fine lines and wrinkles more noticeable. Dry skin can itch, flake, crack, and even bleed. 

To help heal dry skin and prevent its return, dermatologists recommend the following.

1. Prevent baths and showers from making dry skin worse. When your skin is dry, be sure to:  

  • Close the bathroom door 
  • Limit your time in the shower or bath to 5 or 10 minutes
  • Use warm rather than hot water 
  • Wash with a gentle, fragrance-free cleanser 
  • Apply enough cleanser to remove dirt and oil, but avoid using so much that you see a thick lather
  • Blot your skin gently dry with a towel
  • Slather on the moisturizer immediately after drying your skin

2. Apply moisturizer immediately after washing. Ointments, creams, and lotions (moisturizers) work by trapping existing moisture in your skin. To trap this much-needed moisture, you need to apply a moisturizer within few minutes of:

  • Drying off after a shower or bath
  • Washing your face or hands

3. Use an ointment or cream rather than a lotion. Ointments and creams are more effective and less irritating than lotions. Look for a cream or ointment that contains an oil such as olive oil or jojoba oil. Shea butter also works well. Other ingredients that help to soothe dry skin include lactic acid, urea, hyaluronic acid, dimethicone, glycerin, lanolin, mineral oil, and petrolatum.

Tip:  Carry a non-greasy hand cream with you, and apply it after each hand washing. This will greatly help relieve dry skin. 4. Wear lip balm. Choose a lip balm that feels good on your lips. Some healing lip balms can irritate your lips. If your lips sting or tingle after you apply the lip balm, switch to one that does not cause this reaction.

5. Use only gentle, unscented skin care products. Some skin care products are too harsh for dry, sensitive skin. When your skin is dry, stop using:

  • Deodorant soaps
  • Skin care products that contain alcohol, fragrance, retinoids, or alpha-hydroxy acid (AHA)
Avoiding these products will help your skin retain its natural oils. 

6. Wear gloves. Our hands are often the first place we notice dry skin. You can reduce dry, raw skin by wearing gloves. Be sure to put gloves on before you:

  • Go outdoors in winter
  • Perform tasks that require you to get your hands wet
  • Get chemicals, greases, and other substances on your hands

7. Choose non-irritating clothes and laundry detergent. When our skin is dry and raw even clothes and laundry detergent can be irritating. To avoid this:

  • Wear cotton or silk under your clothing made of wool or another material that feels rough
  • Use laundry detergent labeled “hypoallergenic”

8. Stay warm without cozying up to a fireplace or other heat source. Sitting in front of an open flame or other heat source can dry your skin. 

9. Add moisture to the air. Plug in a humidifier. If you can check your home heating system, find out if you have a humidifier on the system — and whether it’s working. 

When to see a dermatologist

Your skin should start to feel better quickly. If these changes do not bring relief, you may want to see a dermatologist. Very dry skin can require a prescription ointment or cream. Dry skin also can be a sign of a skin condition that needs treatment. A dermatologist can examine your skin and explain what can help reduce your discomfort.

Acne products: How to avoid rare (but serious) allergic reaction

February 2015

A few people who used a non-prescription acne product have developed a serious allergic reaction. Between 1969 and January 2013, the U.S. Food and Drug Administration (FDA) received 131 such reports. That makes this reaction extremely rare.

All products named in the reports contained either benzoyl peroxide or salicylic acid. The FDA says one of these acne-fighting ingredients may have caused the allergic reaction. It’s also possible that another ingredient caused the reaction.

To protect your health, dermatologists recommend the following:

Seek immediate medical care

You may need immediate medical care if you develop any of the following — regardless of whether you’re using an acne product:

  • Difficulty breathing
  • Tightness in your throat
  • Feeling faint or lightheaded
  • Swollen eyes, face, lips, or tongue
  • Hives or intense itching (common and sometimes requires immediate medical care)

These may indicate a serious and potentially life-threatening allergic reaction.

When to see a dermatologist

You will find it helpful to see a dermatologist if you:

  • Plan to use a non-prescription acne product for the first time — and worry about having a possible allergic reaction.
  • Have had a serious allergic reaction (medicine or product).

At the beginning of this appointment, be sure to explain your concerns. Your dermatologist can talk with you about other options for treating acne. During the appointment, you can also learn how to self-test acne products at home. This will tell you whether your skin reacts. If your skin reacts, you could develop an allergic reaction.

Serious allergic reaction is extremely rare

Few people develop this serious allergic reaction. If you’ve been using non-prescription acne products and never developed a skin reaction, it’s unlikely that you will develop a severe reaction. 

The New Buzz Around Propolis

January 2015

Turns out that honey isn’t the only product coming from bees that makes life a little sweeter. Propolis, a natural product produced by bees to coat their hives, can apparently be used by humans to improve skin conditions, prevent wrinkles, and maybe even stimulate hair growth.

Propolis isn’t new—people have been using it for thousands of years—but the science behind the beauty benefits is improving everyday. Bee propolis has been found to inhibit cancer cell growth and have profound anti-inflammatory properties which are important for skin health as well as healthy hair. There are 150 components in propolis—a significant percentage of those proponents being flavonoids, which are great antioxidants.

In terms of wrinkles, propolis works at a fundamental level to help prevent degenerative processes associated with aging such as wrinkles and skin sagging. Propolis can be applied topically or taken as a supplement and is available at many pharmacies and health food stores.

A new study out of Japan shows that propolis may also help to stimulate hair growth. The study, conducted on mice, showed that fur grew back faster when applying propolis topically. The researches in the study pointed out that hair loss is often the result of inflammation, so the anti-inflammatory properties in this nutrient may have a great effect. Further testing still needs to be conducted on humans, but in the meantime, it might be worth it to incorporate propolis into your grooming routine.

Allergies and Hives (Urticaria )

January 2015

Hives, also known as urticaria, are an outbreak of swollen, pale red bumps, patches, or welts on the skin that appear suddenly -- either as a result of allergies, or for other reasons.

Hives usually cause itching, but may also burn or sting. They can appear anywhere on the body, including the face, lips, tongue, throat, or ears. Hives vary in size (from a pencil eraser to a dinner plate), and may join together to form larger areas known as plaques. They can last for hours, or up to several days before fading.

What Causes Hives

Hives  form when, in response to histamine, blood plasma leaks out of small bloodvessels in the skin. Histamine is a chemical released from specialized cells along the skin's blood vessels.

Allergic reactions, chemicals in foods, insect stings, sunlight exposure, or medicines can all cause histamine release. Sometimes, it's impossible to find out exactly why hives have formed.

There are several different types of hives and angioedema, including:

  • Acute urticaria and/or angioedema: Hives or swelling lasting less than six weeks. The most common causes are foods, medicines, latex, or infections.Insect bites and internal disease may also be responsible. The most common foods that cause hives are nuts, chocolatefish, tomatoes, eggs, fresh berries, soy, wheat, and milk. Fresh foods cause hives more often than cooked foods. Certain food additives and preservatives may also be to blame. Medicines that can cause hives and angioedema include aspirin and other nonsteroidal anti-inflammatorymedications (NSAIDs, such as ibuprofen), high blood pressuremedications (ACE inhibitors), or painkillers such as codeine.
  • Chronic urticaria and/or angioedema: Hives or swelling lasting more than six weeks. The cause of this type of hives is usually more difficult to identify than those causing acute urticaria and/or angioedema. The causes can be similar to those of acute urticaria but can also include autoimmunity, chronic infections, hormonal disorders, and malignancy.
  • Physical urticaria: Hives caused by direct physical stimulation of the skin -- for example, cold, heat, sun exposure, vibration, pressure, sweating, andexercise. The hives usually occur right where the skin was stimulated and rarely appear anywhere else. Most of the hives appear within one hour after exposure.
  • Dermatographism: Hives that form after firmly stroking or scratching the skin. These hives can also occur along with other forms of urticaria.
  • Hereditary angioedema: This is painful swelling of tissue. It is passed on through families.

 In for a manicure, out with an infection

Last week I wrote about nail tips and how people who use them regularly are risking serious fungal infections. This week I’d like to discuss how to get a safe manicure or pedicure at your favorite salon.

First of all, always – and I do mean always – bring your own instruments to the salon. Several states have laws prohibiting the use of manicure implements that others have used, but just in case, the smart thing to do is to always bring your own. This includes nail files, too. I regularly see patients who take their own clippers and nail scissors to salons, yet still end up with nail infections. “Did you bring your file, too?” I ask. The answer is always no.

Paronychia is the medical term for an infection around the nail; symptoms include pain and red, swollen skin. The usual causes? Excessive cutting of the cuticle or the use of an infected manicure instrument, including the stick used to push the cuticle back. Treatment of paronychia depends on whether it is bacterial or fungal; usually it is treated with topical antibiotics, but severe cases may require oral antibiotics or injections into the nail fold (very painful, I’m afraid). People can also get herpetic infections of the skin around the nail, known as whitlows,from infected tools.

Second, even if you are the only person using them, clean your manicure implements with rubbing alcohol after every use.

Third, never trust appearances. No matter how beautiful, expensive or clean a salon appears,it’s no guarantee that its facilities and instruments are free of fungi and bacteria. If the manicurist beckons you to a newly vacated pedicure chair where the basin has not been cleaned with bleach, do not sit there. A swish of water and soap will not do; only bleach kills bacteria and fungi.

Pedicures present their own challenges. Never, ever let the manicurist use a razor or a callus remover that slices dead skin. Those are dangerous to use, because it is very easy to cut too deep and slice into flesh, leaving the area vulnerable to infection. Buffers and pumice stones are safer, but should not be used too enthusiastically. It’s actually better to use a pumice stone or file regularly on your feet at home, rather than have it done to excess every few weeks at a nail salon.

On a different, but important, note about nail salons, I’m regularly asked if the ultraviolet drying lamps will age skin as much as sunlight. The answer is yes, especially if you have manicures regularly. Letting nails dry naturally may take longer, but you are not exposing your hands to damaging rays.

Bottom line: Take charge of your experience at your nail salon – always bring your own implements and decrease your chances of infection.

Smoothies: Overrated or a Nutritious Must?

December 2014

After plenty of research, we recently made the leap and purchased a high-powered blender. I like that I can now add good stuff like apple and celery, and smoothies will still come out smooth. And I love being able to make ice cream and sorbet with frozen fruit.

But before you shell out the money for an appliance that could run hundreds of dollars, consider the pros and cons of joining the smoothie revolution.


  • Smoothies are a great way to fill nutrition gaps, especially in kids or adults who shy away from fruits and veggies. And unlike juices, smoothies include the whole fruit and veggie, so you get the nutrients and fiber in the pulp.
  • Smoothies are a great way for naysayers to see veggies in a new, tasty light. But avoid the temptation to hide veggies in a smoothie from kids (and adults) who are wary of greens — if you hide them and they find out, you may only confirm their reluctance.


  • Some people may rely on smoothies so much that they stop eating fruits and vegetables in their native form. This is a disservice for kids, because they need to be exposed to a variety of foods, including fruits and vegetables.
  • Another drawback, especially if smoothies are used as meal replacements, is that they may not be as filling as a regular meal. That’s because at least part of feeling full and satisfied comes from chewing food. Bottom line: Use smoothies as a convenient way to boost nutrition, but avoid overusing them.

So, what goes into a fruit-and-veggie smoothie? Here are the main components:

Liquid: Smoothies need some liquid such as water, juice, milk, or milk alternatives (soy milk, almond milk, etc.)

Fruit and Veggie: Some smoothies can be more fruit-based and others more veggie-based; but in general, equal parts of fruits and veggies are good. Of course, if you’re not a big veggie fan, you may want to start with more fruit and work your way up to more veggies. Fruits with strong colors, like blueberries and strawberries, can keep the smoothie from turning green. With high-powered blenders you have more choices, like apples with the skin, celery, and carrots.

Ice: If you are using frozen fruit or veggies, ice isn’t needed. If you’re using mostly fresh produce, then throw a cupful of ice into the mix.

Other add-ins: You can add some healthy fats like nut butter or avocado, some protein powder, flax meal, sweetener of choice, or yogurt.

Here’s a recipe for a chocolate peanut butter smoothie that my 5-year old son and I both enjoy. Just put ingredients in a blender. It makes 3 cups.

1 small banana (or half of a large one)

1/2 cup frozen blueberries

1/2 apple or pear

1 cup spinach

1 celery stalk, chopped

2 Tbsp. all-natural peanut butter

1 Tbsp. unsweetened cocoa powder

1 cup milk

1/2 cup ice

Do you make smoothies at home? And if so, what's your favorite concoction?

Fighting Back Against Dry Skin

December 2014

Skin Care for Dry Skin

Got dry skin? There are many things you can do to make it smooth and supple.  In many cases, all it takes is making a few adjustments to your daily skin care routine.

Care Strategies for Dry Skin When You Wash

Try these tips for the bath or shower:

  • Skip long, hot showers. Hot water strips oils from the skin faster than warm water. Long showers or baths actually dry out your skin. Limit yourself to a single 5- or 10-minute warm shower or bath a day.
  • Use a gentle cleanser or shower gel with moisturizer. Instead of harsh cleansers, go for unscented, soap-free, or mild soap cleansers.
  • Moisturize while skin is still moist. Pat your skin with a towel after you shower or wash your face or hands, leaving it damp. Apply a moisturizer within three to five minutes of washing to lock moisture in. 

What to Look for in a Moisturizer

You don't have to pay a fortune for a good, rich moisturizer. Read the label. Ingredients that may be helpful for dry skin include:

  • Ceramides. Ceramides help the skin hold water and soothe dry skin. Synthetic ceramides may mimic the natural substances in the outermost layer of skin that help keep moisture in.
  • Dimethicone and glycerin. These draw water to the skin and keep it there.
  • Hyaluronic acid. Like ceramides, hyaluronic acid helps skin hold water.
  • Lanolin, mineral oil, and petroleum jelly (petrolatum). These help skin hold on to water absorbed during bathing.

Be sure to apply sunscreen to areas of your body that are exposed to the sun during the day. Look for a sunscreen with an SPF of 30 or more that says "broad spectrum" on the label.

5 Lifestyle Tips for Relieving Dry Skin

These strategies can also help make your skin supple and smooth:

  • Plug in a humidifier at home to help keep skin hydrated during winter months when indoor air is dry.
  • Wear cotton and other natural fibers. Wool, synthetics, or other fabrics can be scratchy and irritating.
  • Drink plenty of water.
  • Eat omega-3 foods. Essential fatty acids can help fortify the skin’s natural oil-retaining barriers. Foods rich in omega-3 include cold-water fish (salmon, halibut, sardines), flax, walnuts, and safflower oil.
  • For redness or inflammation, apply a cool compress or an over-the-counter hydrocortisone cream on the area for a week. If these don’t provide relief, talk to your doctor.


Laser Treatment for Psoriasis


If you're living with psoriasis, you know how uncomfortable and embarrassing the red, itchy, scaly skin can be. Treatment options for psoriasis include steroid cream or other medicated creams, oral medications, and light therapy.

All of these treatments work well, but medications can have side effects and light therapy requires a regimen of three sessions a week for two to three months.

Today, there is another option for treating psoriasis: excimer lasers, which deliver ultraviolet light to localized areas of the skin. This treatment uses intense, focused doses of laser light to help control areas of mild to moderate psoriasis without harming healthy skin around them. Targeted laser therapy is similar in effectiveness to traditional light therapy, but it works in fewer sessions with stronger doses of light that can reach deeper into the affected skin. The handheld laser wands are also good for reaching psoriasis in hard-to-treat areas, such as the elbows, knees, palms of the hands, soles of the feet, and scalp.

How do laser treatments for psoriasis work? Can they really clear up your skin? Here's what the research shows about this new treatment for psoriasis.

Psoriasis Laser Treatment: How It Works

December 2014

Psoriasis Laser Treatment: How It Works

Excimer laser treatments are performed in the dermatologist's office. Each session takes only a few minutes. During the treatment, the doctor aims the laser directly at patches of psoriasis. You might feel some warmth at the site or a snapping sensation against the skin.

Laser treatments for psoriasis use one of two types of lasers: a pulsed dye laser (PDL) or an excimer laser.

Pulsed dye lasers create a concentrated beam of yellow light. When the light hits the skin, it converts to heat. The heat destroys the extra blood vessels in the skin that contribute to psoriasis, without harming nearby skin. 

Excimer lasers aim a high intensity ultraviolet B (UVB) light dose of a very specific wavelength -- 308 nanometers -- directly at the psoriasis plaques. Because the laser light never touches the surrounding skin, it reduces the risk of UV radiation exposure. Excimer lasers are used to treat mild-to-moderate psoriasis. 

With excimer laser therapy, patients usually have two treatments lasting 15-30 minutes each week for three or more weeks, with at least a 48-hour break between treatments. With pulsed dye laser therapy, sessions go for 15-30 minutes every three weeks.

Your doctor will determine your dose of laser light based on the thickness of your psoriasis plaques and your skin color (a lower dose is used on lighter skin). During the procedure, you will be given dark goggles to protect your eyes.

Menopause and Dry Skin: The Hormone Connection

September 2014

Dealing with dry, itchy skin at menopause? Find out why -- and get simple tips for smoother skin.

Every woman in menopause knows about the infamous hot flashes. Most are familiar with the night sweats. But dry skin at menopause, too? How did that happen?

The answer is simple: Hormones, specifically estrogen. It turns out that the same hormone behind so many of your body's changes may be responsible for dry skin problems at menopause, too.

What's Happening: Dry Skin and Menopause

Somewhere between the ages of 40 and 58 most women enter menopause. This is when the ovaries stop releasing eggs, periods come to an end, and the production of estrogen begins to decline.

Estrogen is a powerhouse hormone. It stimulates maturation of a girl's body at puberty. It helps keep a woman's bones strong.

Another thing estrogen does is stimulate the formation of skin-smoothing collagen and oils. That's why, as menopause approaches and estrogen production diminishes, dry, itchy skin becomes very common, says Elizabeth Tanzi, MD, co-director of the Washington Institute of Dermatologic Laser Surgery.

That reduction of estrogen, and the changing ratios of hormones in your body, don't just slow down your body's oil production, they also reduce your body's ability to retain moisture.

While a parched t-zone or flakey elbows may be the first places you notice the changes, "it really is a whole-body phenomenon," says Tanzi, with dry skin appearing just about anywhere, from the oil-gland-dense face, back, and chest, to elbows, legs, genitals -- even nails.

The changes to your skin can start as early as perimenopause, and they're permanent, Tanzi says. Fortunately, easing the itch and combating the dry skin associated with menopause is largely in your hands.

5 Tips for Dry Skin Care During Menopause

To help turn dry, problem skin into smoother, fresher skin, experts offer these quick tips for women in menopause.

  • Focus on smart fats: Essential fatty acids -- like the omega-3s found in salmon, walnuts, fortified eggs, or algae oils -- help produce your skin's oil barrier, vital in keeping skin hydrated. A diet short of these body-boosting fats can leave skin dry, itchy, and prone to acne. Most of us have a diet low in omega-3s, which are also found in sardines, soy, safflower oil, and flax.
  • Smooth on that sunscreen: Keep skin healthy with "a broad spectrum sunblock with an SPF of 15 or higher," says Andrea Cambio, MD, FAAD, a board-certified dermatologist practicing in Cape Coral, Fla.
  • Dry skin, wrinkles, moles, and skin cancers can all result from too much sun, so add a sunscreen with UVA and UVB protection to your line of defense. Aim for about an ounce to cover all sun-exposed skin.
  • And if you think an overcast day means you don't need sunscreen, think again. Skin-damaging ultraviolet light can penetrate clouds, fog, even snow.
  • Stop those steamy showers: Piping-hot baths and showers may feel fabulous, but "hot water ... can be very harsh to the skin and dry it out miserably," Cambio tells WebMD. Stop stripping your skin of its natural oils. Take shorter showers and use warm water.

18 Common Rosacea Triggers

September 2014

You've probably noticed that certain foods, temperatures, activities, emotions -- or something else entirely -- will trigger your rosacea to flare up. Here are some common rosacea triggers.

Foods and drinks that cause rosacea:

  • Alcohol
  • Spicy foods
  • Hot drinks
  • Hot foods (in temperature)

Activities that cause rosacea:

  • Exercise or heavy exertion
  • Hot baths or saunas

Weather conditions that cause rosacea:

  • Hot weather
  • Cold weather
  • Humid weather
  • Wind
  • Sunlight

Emotions that cause rosacea:

  • Stress or anxiety
  • Sudden change in emotion, like feeling embarrassed or bursting out laughing

Medical conditions that cause rosacea:

  • Menopause
  • Chronic cough
  • Caffeine withdrawal syndrome

Other rosacea triggers:

  • Skin products
  • Medications, such as topical steroids, some blood pressure drugs, and some opiate painkillers

Keep in mind that not all of these things will trigger your rosacea. Everybody is different. The important thing is to learn what causes your own rosacea symptoms. You can use a diary to keep track.

Why Do Triggers Make Rosacea Worse?

Doctors still aren't sure what causes rosacea, but in a lot of people, things that make your face flush also make rosacea worse.

When you flush, blood rushes to your face, making it red and warmer. So avoiding activities, products, or emotions that cause flushing can reduce your rosacea symptoms.

Avoiding Rosacea Triggers

Once you've figured out what your rosacea triggers are, find ways to avoid them.

Food and drinks. Don't eat foods that cause rosacea symptoms. You could also try some simple substitutions. For instance, in the morning, replace that steaming mug of coffee with iced coffee.

Exercise. Unfortunately, working out can worsen your rosacea. But you still need to be physically active. So change your routine. Instead of one long workout, try splitting it into several shorter segments. Try longer, low-intensity workouts instead of more demanding ones. And stay cool. Don't exercise outside when it's too hot. If you're inside, use a fan or air conditioner. During your workout, drink plenty of water. Afterward, cover your face with a cool cloth.

Weather. You should always wear a hat and use sunscreen to protect your skin while outside. Also, do the obvious: dress warmly on cold days and lightly on hot ones.

Emotional stress. Learn ways to calm yourself before stress results in a rosacea flare-up. You might try deep breathing exercises or yoga.

Medication. If you think a medicine may be a trigger, talk to your doctor. See if you could take a different drug.

Winter Skin Care From Sea to Sea

September 2014

Get skin care tips for your region of the U.S.

Winter, with its cold air and drying heat, can be tough on your skin. And no matter where you live, there are certain basic skin-care things you need to do:

  • Moisturize often.
  • Take shorter, warm (not hot) showers and baths.
  • Keep the humidity level up indoors.

But winter in chilly New England is different than winter in California or the Pacific Northwest. Dermatologists from seven U.S. regions share their best skin-care tips so you can baby your skin in whatever state you find yourself settled in for the winter.

Winter Skin Care: East Coast

Dermatologist Robert Greenberg, MD, says wintry temperatures on the East Coast can mean the humidity dips indoors when the heat is turned on and stays on. "The air is very dry and we lose water from our skin to the dry air," he says. Some people use wood stoves for heat, and that dries the indoor air even more.

Greenberg says he’s had to dissuade his patients from shaking off the chill with a hot shower when they scramble from bed. "A long, hot shower in the morning is not a good idea," he says. It's too drying.

Greenberg tells residents to avoid harsh soaps, use gentle moisturizers, and mild laundry soaps to prevent skin irritation, especially when it gets drier as the winter goes on. He also says to humidify the indoor air as much as possible.

Winter sports such as snowmobiling can take an extra toll on the skin, especially if it's windy. Sports-loving people should apply moisturizer and protect their facial skin and other exposed areas when active.

Winter Skin Care: Southeast

"In the Southeast, we can experience extreme shifts in temperature on a daily basis," dermatologist Andrea Cambio, MD, says. ”It is not uncommon for it to go from the 50s to the 90s in the same day. Added to the equation are very strong ultraviolet rays from the sun."

In addition to the typical winter skin care advice -- shorter, warm showers, use of a gentle fragrance-free cleanser, and use of moisturizer -- she stresses sun protection year round. Sunscreen, protective clothing, and hats are a must. Her advice is especially important for visitors who may be so thrilled to be warm that they forget about sun protection.

Winter Skin Care: South

The Southern states may be the kindest on the skin during winter. "Southern winters are kind of benign," University of Alabama dermatologic surgeon Conway C. Huang, MD, says.

The air in the south doesn't get as dry as in other regions, he says, and humidity remains relatively high.

For winter skin care, Huang suggests using a cream moisturizer -- not a watery lotion -- and keeping showers and baths at a warm temperature, not hot. "Use a gentle soap, or no soap," he says.

Winter Skin Care: Midwest

Chicago dermatologist Mary Massa, MD, says Midwest winters can be cold, snowy, and windy, especially in Chicago, which has earned its "Windy City" nickname.

The heat gets turned up inside when temperatures drop, stripping indoor air of humidity. Plus, windy days can present special problems, she says. "It increases the dryness and adds irritation."

Moisturizing every day can help. Massa tells patients to pick a product based on their skin’s dryness. Consider a heavier, cream-based moisturizer for extremely dry skin. If it’s mildly dry, a lotion moisturizer is probably OK.

For patients who don’t like heavy creams, Massa suggests using a lighter lotion in the morning because it absorbs faster and won't stain clothes as much. Reserve the heavier moisturizer for bedtime use.

Winter Skin Care: Southwest

States in the Southwest, including Arizona, have low humidity year round, Scottsdale dermatologist Bill Halmi, MD, says. "It's exacerbated in the winter," he says. "People do turn on the heat once in a while." Halmi says, "In the Southwest desert area, it's a constant battle against dry skin. In the winter, we need to double our efforts."

Besides the low humidity, there are a lot of hard water issues, Halmi says. "If water is hard, and you use bar soap, it won't come off easily," he says. His advice is to either use liquid soap, such as a moisturizing body wash, for face and body or treat the water with a water softener.

He also reminds Southwest residents to continue using sunscreen even when the temperatures decline in the winter months.

Winter Skin Care: West

Winter skin care advice for those on the West Coast depends on the region they live in, Sacramento dermatologist April Armstrong, MD, says.

"San Francisco has milder winters and the air is often less drying than inland weather," she says. On the coast, there tends to be more moisture than inland. San Francisco's well-known fog is also good for the skin, she says, because of its high humidity.

Central California can turn cold and dry in winter, so people there should moisturize their skin more.

Sunscreen is key to keeping skin healthy in states like California and Hawaii since they get more sunshine than other states during the winter.

That's especially true for winter skiers who can get an extra dose of UV radiation when the sun reflects off the snow.

Winter Skin Care: Pacific Northwest

The Pacific Northwest can get a lot of rain and some snow. Never mind that the moisture level outside is 100% thanks to all that weather. "When you heat indoor air, the relative humidity is very low," Seattle dermatologist Paul Nghiem, MD, PhD, says.

"You are more likely to need moisturizer in the indoor heated air for sure," he says.

He favors moisturizers that contain glycerin, and he says most people don’t put on enough moisturizer. Nghiem advises applying a layer of moisturizer thick enough that it doesn't absorb for about 30 seconds.

Effects of Stress on Your Skin

September 2014

Stress can affect your whole body, including your skin, hair, and nails.

Your emotions have a powerful effect on your skin. Since stress is a part of life, what matters is how you handle it.

How Stress Affects Skin

Stress causes a chemical response in your body that makes skin more sensitive and reactive. It can also make it harder for skin problems to heal.

Have you ever noticed that when you are stressed, you break out more? This is because stress causes your body to produce cortisol and other hormones, which tells your sebaceous glands to produce more oil. Oily skin is more prone to acne and other skin problems.

Stress can also:

Worsen skin problems. For example, stress can worsen psoriasis, rosacea, and eczema. Stress can also cause hives and other types of skin rashes and trigger a flare-up of fever blisters.

Interfere with daily skin care. If you are stressed, you might skimp on your skin care, which can aggravate skin problems.

Skin problems can also be stressful. Some people are so embarrassed by their skin that they keep to themselves, which adds more stress, worsening the problem.

If you have a skin problem that doesn't heal or keeps coming back, rethink how you handle stress.

8 Ways to Reduce the Effects of Stress on Your Skin

Although it's impossible to avoid stress completely, there are ways to handle it better. Try these approaches:

1. Don't neglect your skin. Take care of your skin, even if you're tired or stressed.
2. Get regular exercise. It's good for your skin and the rest of your body.
3. Take time for yourself to do something you enjoy, even if you only have ten minutes. Take a bath or read an article.
4. Take a walk around the block.
5. Practice stress management techniques, such as breathing exercises, yoga, meditation, or visual imagery.
6. Get enough sleep. Seven to eight hours each night is ideal.
7. Say no. It's OK to set limits and boundaries to lower your stress.
8. Talk to someone. Seek support from a friend or a professional therapist.

Common Pains as You Age: Feel Better

August 2014
By Kara Mayer Robinson

An ache here, a cramp there. As your body ages, you may have more and new pains. There are things you can do to feel better.

10 Daily Habits to Reduce Chronic Pain

In Your 30's

Headaches. Your 30s can be a hectic time of life. Stress at work and home is common at this age -- and can lead to headaches.

Sitting at a computer all day with your head in one position can strain your neck and cause your head to hurt, says Paul B. Langevin, MD, an anesthesiologist at Hahnemann University Hospital in Philadelphia.

The Fix. To relieve stress, try deep breathing exercises. Treat yourself to a gentle massage or a warm bath.

To ease head pain from sitting at a computer, "try stretching your neck muscles by turning your head to the right, then left," suggests Allen Towfigh, MD, a neurologist at New York-Presbyterian Hospital, "then gently trying to touch your ear to your shoulder in each direction."

A hot compress or over-the-counter pain medicine may also bring relief.

Carpal Tunnel Syndrome. Pain in your wrists and hands caused by pressure on the nerves in your wrist.

Your genes and past injuries can make you more likely to get carpal tunnel syndrome, but so can typing on keyboards, cell phones, tablets, and computer games, Langevin says.

The Fix. If you can, take a break from making the same motions over and over, like typing or texting.

Make sure your workspace is set up correctly. For example, while typing at a keyboard:

  • Sit against the back of the chair with your shoulders relaxed.
  • Keep your elbows at your side and your wrists straight.
  • Plant your feet flat on the floor or on a footrest.

Also, try using a wrist brace. Physical therapy and exercises that build up hand and arm muscles can also help. See a doctor if it doesn’t improve. Some people need surgery for this problem.

In Your 40s and 50s

Back Pain. As you age, stress on the spine from bad posture, a poor workplace set-up, and the wrong sleeping habits can all bring on lower back pain.

The Fix. Pay attention to your posture and how you lift things. "Ideally people should not lift more than 25% of their body weight without assistance," Langevin says. Look at your workplace arrangement. Is your chair the right height? Is your computer screen where it needs to be? Make adjustments if needed, says Jacob Teitelbaum, MD, author of From Fatigued to Fantastic! Does your back ache in the morning? Consider buying a new mattress, or trying a new position for sleeping.

Over-the-counter medications like aspirin, acetaminophen, ibuprofen, and naproxen can help relieve pain and reduce swelling. Try physical or chiropractic therapy, or exercise like Pilates or yoga. If you still don’t feel relief, talk with your doctor.

Are You Getting Enough Vitamin D and Calcium?

August 2014
By Amanda Gardner

Getting enough vitamin D and calcium are two of the best things you can do to keep your bones healthy.

These two nutrients work together to make you less likely to break a bone or get osteoporosis, a disease that weakens them.

"If we have adequate amounts of calcium and vitamin D, it really can help with keeping bones strong," says Heather Miller, PharmD, assistant professor of pharmacy practice at the Texas A&M Health Science Center.

How Much Vitamin D and Calcium Do You Need?

Vitamin D is measured in international units (IU). The Institute of Medicine recommends getting this much vitamin D every day:

  • Adults ages 19-70: 600 IU daily
  • Adults older than 70: 800 IU daily

Some experts recommend taking more vitamin D. But the Institute of Medicine (IOM) says that higher levels haven't been shown to be better. The IOM is a nonprofit organization that gives expert, evidence-based advice on public health issues to policy makers and health professionals.

For calcium, the daily recommendations vary by age and gender:

  • Newborns to 6 months: 200 milligrams
  • Babies 7-12 months: 260 milligrams
  • Kids 1-3: 700 milligrams
  • Kids 4-8: 1,000 milligrams
  • Kids and teens 9-18: 1,300 milligrams
  • Adults 19-50: 1,000 milligrams
  • Adult men 51-70: 1,000 milligrams
  • Adult women 51-70: 1,200 milligrams
  • All adults 71 and older: 1,200 milligrams
  • Pregnant/breastfeeding women: 1,000 milligrams
  • Pregnant teens: 1,300 milligrams

How Can You Get Vitamin D and Calcium?

You can get calcium from dairy foods such as milk, cheese, and yogurt. Calcium is also naturally found in plant foods including broccoli, kale, and Chinese cabbage. Some foods have added calcium, like orange juice and breakfast cereals.

Most adults can get the recommended 1000 mgs over the course of a day by eating a packet of fortified oatmeal, a cup of calcium-fortified orange juice, a cup of yogurt and half a cup of cooked spinach.

Many foods have vitamin D, including:

  • Salmon, tuna, sardines, mackerel, and shrimp
  • Egg yolks
  • Beef liver
  • Mushrooms
  • Cod and fish liver oils
  • Foods with added vitamin D, such as milk and some cereals, yogurts, and orange juices

The average adult would get more than a day’s recommended vitamin D by eating just one small can of pink salmon.

Another source of vitamin D is the sun. Your body makes vitamin D from sunlight. But you need to wear sunscreen to protect your skin, and that blocks your body from making vitamin D. Also, it can be hard to make enough vitamin D from the winter sun, depending on where you live.

If you're not getting all the vitamin D and calcium you need from food, talk with your doctor about taking a multivitamin or supplements, says JoAnn Manson, MD, DrPH, a professor of medicine at Harvard Medical School.

Skin Testing for Allergies

August 2014

Skin testing for allergies is used to identify the substances that are causing your allergy symptoms. It is often performed by applying an extract of an allergen to your skin, scratching or pricking the skin to allow exposure, and then evaluating the skin's reaction. It may also be done by injecting the allergen under the skin, or by applying it to a patch that is worn on the skin for a specified period of time.

What Happens During the Allergy Skin Test?

The procedure varies depending on what type of allergy skin test you are having. The three main types of skin tests are the scratch test, intradermal test, and the patch test.

  • Scratch test (also known as a puncture or prick test). First, a doctor or nurse will examine the skin on your forearm or back and clean it with alcohol. Areas on the skin are then marked with a pen to identify each allergen that will be tested. A drop of extract for each potential allergen -- such as pollen, animal dander, or insect venom -- is placed on the corresponding mark. A small disposable pricking device is then used so the extract can enter into the outer layer of the skin, called the epidermis. The skin prick is not a shot and doesn't cause bleeding.
  • Intradermal test. After examining and cleaning the skin, a small amount of the allergen is injected just under the skin, similar to a tuberculosis test.
  • Patch test. Another method is to apply an allergen to a patch, which is then placed on the skin. This may be done to pinpoint a trigger of allergic contact dermatitis. If there are allergic antibodies in your system, your skin will become irritated and may itch, much like a mosquito bite. This reaction means you are allergic to that substance.

How Long Does an Allergy Skin Test Take?

If you're having an allergy skin test, plan to spend about an hour for the entire appointment. For the scratch and intradermal skin tests, the allergen placement part of the test takes about 5 to 10 minutes. Then you will have to wait about 15 minutes to see how your skin reacts.

Patch tests take longer, as you must wear the patch for about 48 hours to determine if there is a delayed reaction. During this time, bathing and swimming should be avoided. You will return to the doctor after the specified period of time to have the area(s) checked.

How Should I Prepare for an Allergy Skin Test?

Inform the health care provider who is going to perform your allergy skin test about all medicines you are taking, including over-the-counter drugs.

Since allergy medicines, including over-the-counter antihistamines, stop allergic reactions, you should not take them for a few days before the test. Talk to your doctor about discontinuing your allergy medicines prior to the test.

Your doctor will give you a list of medicines to avoid before the test, because there are other drugs that can interfere with the results. Since you may not be able to discontinue certain medicines, the doctor or nurse may perform a separate "control" test to determine if that particular drug will interfere with the scratch test.

How to kiss age spots, freckles, and uneven skin tone goodbye
by Alyssa Kolsky Hertzig

July 2014

Why Do We Get These Spots, Anyway?

Surprise: Age spots aren't caused by getting older. Instead, you can blame them (and nearly every other form of unwanted pigmentation) on what's become the 21st century's public enemy number one: the sun. "Sunshine is an attack on the skin, and one way the skin defends itself is to make pigment," explains Ranella Hirsch, M.D., a cosmetic dermatologist in Cambridge, MA, and president-elect of the American Society of Cosmetic Dermatology & Aesthetic Surgery. If a patient is skeptical about her spots being solar related, Dr. Hirsch asks her to move her bra over a quarter of an inch to expose the skin that the sun never hits. "And then she sees what I mean," she says. "If these changes really came from aging, you'd have them all over."

There's one way in which age spots are truly associated with passing years: The older most people get, the greater the amount of sun damage they've accumulated, so the spots are more numerous and more visible. "That's why sunscreen and sun avoidance are key to any therapy you try," says Debra Wattenberg, M.D., assistant clinical professor of dermatology at Mount Sinai Medical Center in New York City.

Why Don't All Spots Look the Same?

Even though most spots are caused — or exacerbated — by the sun, they take different forms. See a dermatologist if a new kind of skin change shows up (to rule out anything dangerous such as melanoma), but here's a guide to help you determine what's what.

Freckles: These are small tannish spots that are usually less than half a centimeter. They may come and go, fading in the winter and darkening in the summertime.

Lentigines: Known as age or liver spots, these small-to-medium brown areas multiply as you get older, popping up most often on the face, hands, and chest — all places with maximum exposure to sun.

Uneven skin tone: Rather than a few specific spots, this involves larger areas of pigmentation that make your skin look darker in some areas, lighter in others.

Post-inflammatory hyperpigmentation: These are dark spots that develop after pimples, bug bites, or other flare-ups, and then stubbornly remain long after the initial inflammation has healed.

Melasma: More patchy than spotty, these brown outbreaks are hormone related, so they are likeliest to appear (on the cheeks, forehead, and around the lips) when a woman is pregnant or taking hormone replacement or birth control pills.

How Can I Treat Spots at Home?

Try hydroquinone. This bleaching agent, available in department and drugstores or by prescription, works by interfering with an enzyme that helps your skin produce melanin, the brown pigment that shows up as spots. (Dr. Hirsch recommends using hydroquinone in conjunction with a prescription-strength retinoid, such as Renova or Tazorac, which helps lighten by exfoliating the skin.) "Hydroquinone is the gold standard for pigmentary disorders," says Rebat Halder, M.D., professor and chairman of the department of dermatology at Howard University. Look for it over the counter in concentrations up to 2 percent; prescription versions will usually have 4 percent.

Beauty 411: Retin-A vs. Retinol
Reviewed by Emmy M. Graber, MD

July 2014

What's the difference between Retin-A and retinol?

Both are retinoids. They're both made from vitamin A and promote faster skin cell turnover. And they're some of the most proven, effective, and powerful options for treating skin issues ranging from acne to signs of aging.

Retinoids come in prescription form and in a range of over-the-counter products. Prescription-level retinoids fall into these groups:
  • Tretinoin, including the brands Atralin, Retin-A, Retin-A Micro, and Renova
  • Tazarotene, such as the brand Tazorac
  • Adapalene, such as the brand Differin

All three groups prevent the buildup of dead cells in the skin's pores and follicles, and all three promote the growth of healthy cells. Common side effects include dryness, redness, irritation, and skin peeling as well as making skin more sensitive to the sun.

Retinol is found in many products that don't require a prescription. Retinols are much weaker than prescription retinoids. Unless vitamin A is listed as one of the top five ingredients and the product is packaged in an airtight opaque bottle, what you're getting might not be all that effective. Neither retinoids nor retinols should be used by breastfeeding or pregnant women.

Consumer Reports Recommends 7 of 20 Sunscreens
by Kathleen Doheny
Reviewed by Arefa Cassoobhoy, MD, MPH

July 2014

Only 2 of 20 sunscreens tested provide the promised level of SPF protection after being in water, according to Consumer Reports’ annual sunscreen test. Only seven of 20 products earned a recommendation.

"Consumers just need to be careful when they buy sunscreen, that they are looking at the labels and questioning the information they are reading,” says Trisha Calvo, Consumer Reports deputy editor.

Shoppers should remember that "only three claims are regulated by the FDA -- SPF, broad spectrum, and water resistance," Calvo says.

The report is published in the July issue of Consumer Reports.

2014 Top Sunscreens

"We tested popular sunscreens from top manufacturers as well as some from small manufacturers," Calvo says. All had to have an SPF claim of at least 30, be broad spectrum (protect against both UVA and UVB rays), and be water-resistant.

UVB rays can cause both sunburn and skin cancer. UVA rays are responsible for aging the skin, and they contribute to skin cancer, including the most deadly form known as melanoma. Experts measured the products' SPF (sun protection factor), or how well it guards against UVB rays, after the testers went in the water.

They also considered cost.

The seven sunscreens that earned recommendations are:

  • Banana Boat's Ultra Defense Max Skin Protect SPF 110 spray, at $1.75 an ounce.
  • BullFrog Water Armor Sport InstaCool SPF 50+ spray, at $1.67 an ounce. This was one of the two screens that lived up to its SPF claim.
  • Coppertone Water Babies SPF 50, at $1.38 an ounce.
  • Neutrogena Ultimate Sport SPF 70+ lotion, at $2.75 an ounce.
  • Target's Up & Up Spray Sport SPF 50 spray, at $0.80 an ounce.
  • Walgreens' Well Sport SPF 50 spray, at $1.58 an ounce
  • Walmart's Equate Ultra Protection SPF 50, at $0.56 an ounce.

These 13 did not earn recommended ratings:

  • Alba Botanica Very Emollient Sport SPF 45, at $2.75 an ounce.
  • Banana Boat Kids SPF 50, at $1.25 an ounce.
  • Banana Boat Sport Performance CoolZone SPF 30 spray, at $1.42 an ounce.
  • Beyond Coastal Natural SPF 30, at $4 an ounce.
  • California Baby Super Sensitive SPF 30+, at $6.90 an ounce.
  • Coppertone Sensitive Skin SPF 50, at $1.67 an ounce. This sunscreen lived up to its SPF claim, but only earned a “fair” rating for UVA protection.
  • Coppertone Sport High Performance SPF 30 spray, at $1.67 an ounce.
  • Coppertone Water Babies Pure & Simple SPF 50, at $1.31 an ounce.
  • CVS Sheer Mist SPF 30 spray, at $1.80 an ounce.
  • Neutrogena Ultra Sheer Body Mist SPF 30 spray, at $1.90 an ounce.
  • No-Ad Sport SPF 50, at $0.63 an ounce.
  • Target's Up & Up Kids SPF 50, at $0.64 an ounce.
  • Walgreens' Well Baby SPF 50, at $0.80 an ounce.ld be used by breastfeeding or pregnant women.

Men’s Skincare: How to Treat Your Face

July 2014

Some say women are the more sensitive than men, and it’s definitely true when it comes to your face.

Dee Anna Glaser, MD, professor of dermatology at Saint Louis University, says, “Men’s facial skin is typically thicker than women’s and less likely to be sensitive to ingredients in facial cleansers and moisturizers.” Skincare is also usually a simpler routine since men typically don’t wear makeup.

But shaving is another story. For men with heavy beards or curly or kinky hair, irritation and razor bumps can be a big problem. With proper face care, though, those hazards can be made a thing of the past and a clean, smooth face can become a welcome daily occurrence.

Bar Soap or Liquid Cleansers for Men

Most men prefer bars to liquid cleansers. That’s fine as long as you have normal or oily skin. But bar soap tends to dry skin out more than liquid cleansers. “If your skin feels tight or a little itchy after you wash your face, try switching to a liquid cleanser,” Glaser says.

  • If you insist on bar soap, look for moisturizing soaps with emollients such as glycerin. Many are made with vitamin E oil, olive oil, or jojoba oil.

You may experience problems with acne if you have very oily skin. Acne is caused by excess oil production that clogs pores, causing inflammation.

Look for soaps or liquid cleansers that contain salicylic acid, glycolic acid, or benzyl peroxide. All three of these exfoliating agents remove the upper layers of dead skin and allow for deeper cleaning of pores. They also have antibacterial properties.

Moisturizers for Men

Some soaps are laced with moisturizer, and for some men they work just fine. But the surest way to moisten your skin after washing it is to apply a moisturizer.

  • For dry skin, choose a cream, which is the thickest formulation.
  • For normal skin, reach for a lotion, which is lighter and less oily.
  • For oily skin, choose a skin toner or gel.

If you have problems with acne, moisturizers that contain glycolic acid or salicylic acid will help remove dead skin and keep your pores from clogging, dermatologist Carolyn Jacob, MD, says.

Sunscreen Protection for Men

Lots of facial moisturizers promise to keep your face young, but not all of them deliver.

"A lot of products these days tout the fact that they contain antioxidants," Glaser says. "Theoretically, they should help. Sunlight and pollution cause oxidative damage to skin. But so far, we don’t have any scientific evidence one way or the other that says antioxidants at the level contained in skin products really help."

Prescription-strength products with retinol (Retin-A) do smooth out fine lines and wrinkles and even reverse signs of aging at the cellular level. But the lower levels of retinol found in over-the-counter products may not be high enough to do much good.

Do You Really Need Eye Cream?

June 2014

How special lotions help that delicate skin.

By Sonya Collins

Reviewed by Mohiba Tareen, MD

WebMD Magazine - Feature

You've heard the promises: Eye creams reduce or even erase the signs of aging: fine lines, wrinkles, and dark circles. But aren't eye creams just more-expensive moisturizers in a smaller package?

Not necessarily, eye creams are formulated specifically for the delicate skin around the eye, so they tend to be thicker. They contain more oil than a regular facial lotion, and they have a lot of active ingredients aimed at the problems we see around the eyes.

The skin around the eyes is more fragile, more prone to dryness, and quicker to show age and fatigue. Squinting and constant movement of the eyes also hasten the appearance of lines and wrinkles, and fluids collect under the eyes and cause puffiness and dark circles. Eye creams can address some of these issues.

Fine lines and wrinkles come from both sun damage and your skin making less collagen as you age. Collagen helps maintain skin's elasticity. Vitamin C, peptides, and retinol have boosted collagen production, studies of skin creams show. Ceramide and hyaluronic acid also help; these are moisturizers that help prevent water loss in the skin and improve elasticity.

Dark circles under the eyes come from genes, sun damage, age, and blood build-up. Sodium ascorbate, or vitamin C, can thicken the skin and help conceal dark circles after about 6 months. Niacinamide, or vitamin B3, and kojic acid can lighten dark circles.

Puffiness is a buildup of fluid and blood under the eyes. Some studies show that caffeine can help circulation, which could reduce puffiness. Other studies show that cold temperatures are just as effective to treat puffiness. That's why some people refrigerate their eye creams.

Eczema Symptoms and Diagnosis

June 2014

Could your itchy rash be a symptom of eczema? Perhaps. Eczema, also called dermatitis, is a term that covers many types of inflammatory skin problems. The rashes tend to come and go, and often run in families. Some experts estimate that eczema affects a third of the world's people at some time in their lives. The best way to know for sure if you have eczema is to see a doctor. Until you make that appointment, however, check out this list of common eczema symptoms.

Common Eczema Symptoms

Symptoms of eczema often begin in babies. But children and adults can have eczema. No two people have exactly the same eczema symptoms. The severity of eczema symptoms also varies from person to person. In general, eczema symptoms often appear as skin patches that can be:

  • Very itchy
  • Red
  • Dry
  • Swollen
  • Sore

With time, an eczema rash often becomes crusty and scaly. Some types of eczema can also blister, weep, crack, or peel. An infection or too much scratching can make eczema symptoms worse. Over time, scratching can even make the skin become thick and leathery.

You can have eczema anywhere and everywhere, but eczema often appears as a rash on the:

  • Insides of elbows
  • Backs of knees
  • Face, often on the cheeks
  • Behind the ears
  • Buttocks
  • Hands and feet

Sometimes, you may have other skin changes along with eczema, such as small raised bumps or hives. Or, there may be an extra fold of skin under the eyes.

Possible Eczema Complications

Scratching too much can cause a break in the skin. This allows bacteria or viruses to enter and can lead to infection. Sometimes, long-term use of medications to control eczema can also cause complications.

Although eczema symptoms tend to subside as babies grow into children, people who had eczema as infants are at higher risk for other skin problems throughout life. These might include easily irritated skin, skin infections, or eyelid dermatitis.

Diagnosing Eczema

The best way to diagnose eczema is for a doctor to take thorough medical and family histories. To confirm an eczema diagnosis, the doctor may ask about:

  • A history of asthma or allergic reactions, such as to pollen, pets, or certain foods
  • Substances that irritate the skin such as soaps or cosmetics
  • Any recent extra stress
  • Where and when the symptoms appeared
  • Any treatment used for other skin conditions

The doctor can sometimes tell by looking at the rash whether or not it is eczema. But it may take more than one visit to rule out other problems. The doctor might also refer you to a specialist such as a dermatologist or allergist. Although there is no test for eczema, allergy testing can help pinpoint any allergic triggers. Other common triggers include irritants, heat, or emotions.

Questions to Ask the Doctor About Eczema

When you talk with the doctor, be sure to get your questions about eczema answered. Here are some to get you started:

  • What is the cause of my eczema?
  • What's the best way to treat eczema?
  • Do I need a prescription for medication?
  • Is there anything new that might work better than what I've tried in the past?
  • Can I prevent a new outbreak of eczema?
  • When should I call you?

How Are Cold Sores Diagnosed?

June 2014

To see if you have the herpes simplex virus (HSV), which causes cold sores, your doctor may simply examine the cold sore or may take a culture from it.

The doctor may also test blood for antibodies to the virus.

Understanding Cold Sores

Find out more about cold sores:




A positive antibody test only proves that you have the virus; it does not indicate whether or not the virus is active or when you may have acquired it.

What Are the Treatments for Cold Sores?

You can't cure HSV or a cold sore, but you can alleviate the pain it causes by avoiding spicy or acidic foods, applying ice, and using over-the-counter remedies. Look for medicines that contain numbing agents such as phenol and menthol to reduce cracking and soften scabs. Abreva is an over-the-counter topical remedy used to help speed healing and minimize pain from a cold sore. It must be used many times a day to speed the healing.

If your cold sore is especially painful or irritating, your doctor may prescribe an anesthetic gel to alleviate pain or an antiviral oral medication to speed healing or prevent recurrence. The antiviral medicines available for treatment include acyclovir (Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex). These oral medications are more effective when started within the first 48 hours of the outbreak. Valacyclovir is more expensive, but is better absorbed in the digestive tract and therefore more reliable.

Cold sores can become complicated by a bacterial infection, so it is also important to keep them clean by washing gently with soap and water as needed.

How Can I Prevent Cold Sores?

  • Wash your hands after touching a cold sore.
  • Don't rub your eyes after touching your cold sore; you could develop an ocular herpes infection, which may lead to blindness if left untreated.
  • Don't touch your genitals after touching your cold sore; you could develop genital herpes.
  • Replace your toothbrush.
  • Don't kiss someone who has a cold sore or use that person's utensils, towels, or razors.
  • Apply sunscreen to the face and lips before prolonged exposure to the sun.

What Is Hair Loss?

June 2014

Hair grows everywhere on the human skin except on the palms of our hands and the soles of our feet, but many hairs are so fine they're virtually invisible. Hair is made up of a protein called keratin that is produced in hair follicles in the outer layer of skin. As follicles produce new hair cells, old cells are being pushed out through the surface of the skin at the rate of about six inches a year. The hair you can see is actually a string of dead keratin cells. The average adult head has about 100,000 to 150,000 hairs and loses up to 100 of them a day; finding a few stray hairs on your hairbrush is not necessarily cause for alarm.

At any one time, about 90% of the hair on a person's scalp is growing. Each follicle has its own life cycle that can be influenced by age, disease, and a wide variety of other factors. This life cycle is divided into three phases:

Understanding Hair Loss

Find out more about hair loss:





  • Anagen -- active hair growth that lasts between two to six years
  • Catagen -- transitional hair growth that lasts two to three weeks
  • Telogen -- resting phase that lasts about two to three months; at the end of the resting phase the hair is shed and a new hair replaces it and the growing cycle starts again.

As people age, their rate of hair growth slows.

There are many types of hair loss, also called alopecia:

  • Involutional alopecia is a natural condition in which the hair gradually thins with age. More hair follicles go into the resting phase, and the remaining hairs become shorter and fewer in number.
  • Androgenic alopecia is a genetic condition that can affect both men and women. Men with this condition, called male pattern baldness, can begin suffering hair loss as early as their teens or early 20s. It's characterized by a receding hairline and gradual disappearance of hair from the crown and frontal scalp. Women with this condition, called female pattern baldness, don't experience noticeable thinning until their 40s or later. Women experience a general thinning over the entire scalp, with the most extensive hair loss at the crown.
  • Alopecia areata often starts suddenly and causes patchy hair loss in children and young adults. This condition may result in complete baldness (alopecia totalis). But in about 90% of people with the condition, the hair returns within a few years.
  • Alopecia universalis causes all body hair to fall out, including the eyebrows, eyelashes, and pubic hair.
  • Trichotillomania, seen most frequently in children, is a psychological disorder in which a person pulls out one's own hair.
  • Telogen effluvium is temporary hair thinning over the scalp that occurs because of changes in the growth cycle of hair. A large number of hairs enter the resting phase at the same time, causing hair shedding and subsequent thinning.

Don't wait until it's too late: Learn how to SPOT Skin Cancer ™

May 2014

It is estimated that one in five Americans will be diagnosed with skin cancer in the course of their lifetime, and one person dies from melanoma – the deadliest form of skin cancer – every hour.

In recognition of Melanoma/Skin Cancer Detection and Prevention Month ® in May and Melanoma Monday ®, observed on May 5, the American Academy of Dermatology (Academy) is encouraging the public to learn how to SPOT Skin Cancer ™. The campaign aims to save lives by emphasizing the importance of early detection.

"When caught early, skin cancer is highly treatable," said board-certified Dermatology Associates of the Palm Beaches skin cancer surgeon, John M. Strasswimmer, MD, FAAD, PhD. "Despite this, many people don’t know how to be their own detective when it comes to skin cancer, including what to look for on their skin or when they should see a dermatologist."

To increase people's chances of spotting skin cancer early, Dr. Strasswimmer recommends everyone learn the ABCDE rule, which outlines the warning signs of melanoma:

  • A – is for Asymmetry: One half of the mole does not match the other half
  • B – is for Border irregularity: The edges are ragged, notched or blurred.
  • C – is for Color that varies from one area to another.
  • D – is for Diameter: While melanomas are usually greater than 6mm (the size of a pencil eraser) when diagnosed, they can be smaller.
  • E – is for Evolving: A mole or skin lesion that looks different from the rest or is changing in size, shape or color.

"Although skin cancer is more common among people with light or fair skin, everyone is at risk of getting this life-threatening disease," said Dr. Strasswimmer. "SPOT Skin Cancer™ encourages people to invest in their health and spot skin cancer early, when it is most treatable. If you see anything on your skin that is changing, itching or bleeding, you should make an appointment to see a board-certified Dermatology Associates of the Palm Beaches physician."

UV nail salon lamps and risk of skin cancer

May 2014

Researchers studying the use of higher-wattage ultra violet (UV) lamps at nail salons to dry and cure polish was associated with more UV-A radiation being emitted, but the brief exposure after a manicure would require multiple visits for potential DNA damage. The researchers concluded the risk for cancer remains small.

The use of lamps that emit UV radiation in nail salons has raised some concern about the risk of cancer, but previous studies have lacked a sampling of lights from salons.

The authors tested 17 light units from 16 salons with a wide range of bulbs, wattage and irradiance emitted by each device for their research letter.

Higher-wattage light sources were correlated with higher UV-A irradiance emitted.

The study's authors said, "Our data suggest that, even with numerous exposures, the risk for carcinogensis, remains small. That said, we concur with previous authors in recommending use of physical blocking sunscreens or UV-A protective gloves to limit the risk of carcinogenesis and photoaging."

The research is published in JAMA Dermatology.

Established dermatologists improve early self-detection of melanoma

May 2014

Results of a new study suggest that having an established dermatologist can make a big difference for patients with self-detected primary melanoma.

According to research headed by Michelle Y. Cheng, a medical student with the University of Pittsburgh School of Medicine, patients with self-detected primary melanoma who have an established dermatologist are more likely to have thinner lesions at the time of diagnosis than those who don’t have an established dermatologist.

The researchers sought to determine whether three factors — having had a previous dermatologic examination (an established dermatologist), how recent it was, and the wait time for the appointment — were associated with melanoma invasiveness and depth. They conducted a retrospective cross-sectional study of 388 patients with primary melanoma to assess the association between the characteristics of dermatologic care and melanoma depth at diagnosis.

The researchers found that patients with an established dermatologist, compared with those without an established dermatologist, were more likely to receive a diagnosis of melanoma in situ (63.6 versus 44.5 percent) and have thinner invasive melanoma (0.48 mm versus 0.61 mm). These patterns were observed for patients with self-detected, but not dermatologist-detected, melanoma. Self-detected melanomas were in situ for 59 percent of patients with an established dermatologist, compared with 37 percent of those without.

The researchers also found that melanoma invasiveness and depth were unrelated to how recent the last dermatologic examination was or to the wait time for an appointment.

"Education obtained at the dermatology appointment may improve early self-detection of melanoma, and having an established dermatologist may facilitate earlier evaluation of concerning lesions," the authors concluded.

"This study is no surprise to the Dermatology Associates of the Palm Beaches physicians," said Howard A. Green, MD, FAAD. "For years, we have understood that our patients are self-detecting skin cancer in significant numbers. We believe that educating patients during appointments increases awareness. The result is early detection. Most of our patients understand that when they see any change in their skin, it's time for an appointment."

The study was published in the May issue of the Journal of the American Academy of Dermatology.

The key to a long, happy life is not diet or exercise, but strong social connections.

May 2014

According to most of the research of the past thirty years, the key to a long, happy life is not diet or exercise but strong social connections -- that is friendships. Loneliness accelerates age-related declines in cognition and motor function, while a single good friend has been shown to make as much as a 10-year difference in overall life expectancy. In one 2010 study published in the Journal of Clinical Oncology, social well-being, including friendship, turned out to be the number one predictor of survival. In numerous studies over the past thirty years, John T. Cacioppo, a professor of psychology at the University of Chicago and the pioneer of the biological study of loneliness, has found that lonely people have chronically elevated levels of the stress and fear hormones cortisol and epinephrine.

If you are a married man don't think that you are immune because of the great relationship that you have with your wife. Research has found that by the time married women hit 45 or so, they demote their husbands from first to second place among their most important relationships, typically in favor of a daughter or a younger female friend.

So how many friends do we really need?

According to Oxford University anthropologist Robin Dunbar, most people are capable of maintaining stable relationships with about 150 others. According to Dunbar, "Healthy people maintain a 10 - 15 member "sympathy group" and three to five close friends who can be relied upon in times of trouble. If your friend count falls within that range, you're doing fine. Unfortunately, according to the University of Chicago, most of us only have two personal confidants. If that describes you, it's time to find some additional friends.

Dermatology Associates’ Physician Recognized as a 2014 Hero In Medicine

April 2014

John M. Strasswimmer, MD, PhD, a Dermatology Associates’ physician seeing patients in our North Delray Beach office has been recognized by the Palm Beach County Medical Society as a Hero in Medicine. Each year the Palm Beach County Medical Society recognizes extraordinary physicians and organizations who have made outstanding contributions to society. For 2014, Dr. Strasswimmer has been recognized for the medical missions he performed by treating albino patients in Africa and skin cancer patients in the Caribbean. He also provided education services for physicians and allied health care providers during those missions.

Dr. Strasswimmer will be honored at the Palm Beach County Medical Association’s Heroes in Medicine luncheon on Thursday, May 8th at the Kravis Center Cohen Pavilion in West Palm Beach.

Drinking Linked to Higher Risk of Melanoma

April 2014

Drinking alchohol regularly may increase the risk of developing melanoma by up to 55 percent, according to a new study.

Researchers from Italy, Sweden, the United States, Iran and France conducted a meta-analysis of the results of more than 6,200 cases of melanoma from 16 previous investigations, according to a news release. The researchers found that moderate-to-heavy alchohol use, defined as more than 12.5 grams of ethanol per day, increases the risk of melanoma by 20 percent. Little research has been done on the melanoma risks of heavy drinking-defined as more than 50 g of ethanol per day-but researchers found that the risk increased proportionately with the amount of alchohol consumed, which led to the estimated 55 percent greater risk of melanoma.

Dermatology Associates’ physicians believe it’s important to keep well informed on the latest research and potential risk factors relating to skin cancer so that they can pass on this information to their patients.

"Prevention is better than cure, and understanding how to minimize risk is very important," says Richard Krathen, M.D., F.A.A.D. Dr. Krathen sees patients in the Dermatology Associates’ Palm Beach Gardens and Palm City offices.

Past studies have shown that alchohol use can increase the severity of sunburn-a major risk factor for all kinds of skin cancer, including melanoma. Alchohol can also affect behavior, which can lead to staying out in the sun too long or failure to apply sun screen.

Source: British Journal of Dermatology

Focus on Aging Prompts Teen Sunscreen Use

April 2014

Educational videos focused on premature aging caused by sun exposure were more likely to improve teens’ sunscreen use than videos focused on skin cancer risk, a recent study suggests.

Researchers with the University of California, Davis, and University of Colorado, Denver, conducted a randomized, controlled study of 50 high school students from February to March 2012. Students viewed either a video focused on appearance --showing UV-induced premature aging -- or a video that explained the skin cancer risk associated with UV exposure.

The students who viewed the health-based video had a nonstatistically significant increase in sunscreen use, while the group that viewed the appearance-focused video showed a statistically significant increase in sunscreen use.

Source: Journal of the American Academy of Dermatology

Dermatology Associates Develops World’s First Web and Mobile App for Communication, Education and Discussion Among Dermatologists

April 2014 is the world’s first professionally guided tool connecting dermatologists around the world to enable communication, discussion and education. Dermatologists world-wide can now collaborate, contribute to the dermatology knowledge base, educate, discuss and learn in real-time with colleagues from around the globe. This free website and/or mobile app is available on the iOS app store. DermGrandRounds uses the collective intelligence of a credentialed Professional Board of Advisors , potentially including all the worlds’ dermatologists, dermatology residents, and physician extenders. Participants are able to submit skin photos for identification.

Dermatologists are able to submit photos of the skin to challenge peers, identify skin photos submitted by others, and review and edit the wikiskinatlas, the exclusive online user-generated encyclopedia for dermatology.

With Botox, Experience Counts Most

March 2014

Botox Cosmetic is a prescription medicine that is injected into muscles to temporarily treat frown lines of the forehead, between the brows and around the eyes of adults. It works by blocking nerve impulses to the injected muscles. This reduces muscle activity which is the cause of the frown lines.

Why you should consider Botox Cosmetic.

Years of squinting, concentrating, or frowning can cause your skin to furrow and crease. As time passes, your skin becomes less elastic and the frown lines between your brows remain. The frown lines between your brows may make you look angry and unapproachable.

Botox Cosmetic can give you a real, noticeable result. Botox treatment will not radically change your facial appearance or make you look as if you've "had work done." The muscle activity that causes those frown lines between the brows is temporarily reduced. So you can still frown and look surprised without the wrinkles and creases between your brows.

How quickly will you see a difference?

You'll notice a softening in the appearance of your frown lines between the brows within 24 to 48 hours. The area may continue to improve for up to a month. Results have been shown to last up to four months.

Botox injection is a medical procedure that should be performed in a controlled medical environment, by experienced practitioners.

There is always a risk of an adverse reaction or side effect, so patients need to be in a medical setting for Botox treatment. That's why Dermatology Associates' physicians are so insistent about counseling patients concerning the importance of experience of the practitioner and of being in a medical setting for Botox injections.

At Dermatology Associates, our practitioners are exceptionally well-trained and highly experienced. Botox treatment is both an art and a science. Dermatology Associates' practitioners have a very developed eye for skin abnormalities and an artistic eye for what appears natural when performing Botox treatment.

Migraine Headache and Rosacea May Be Linked In Older Female Patients

October 2013

Women 50 years or older who experience severe migraines may have a slightly higher risk of having rosacea, according to a study published in the May 2013 Journal of the American Academy of Dermatology.

Investigators with the University of Basil, Switzerland, and University Hospital Basel, evaluated via a case-control study the link between migraine or triptan exposure and rosacea risk in patients in the United Kingdom. Researchers culled data from the General Practice Research Database in the U.K. to pinpoint patients with incident rosacea from 1995 to 2009 (cases); one rosacea-free control was added to each case.

Prevalence of diagnosed migraine and triptan exposure before the first-time rosacea diagnosis was compared between cases and controls with multivariate conditional logistic regression.There were 53,927 cases and the same number of controls. There was a slight overall link between rosacea and migraine in women; no link was found in men.

Source: Journal of the American Academy of Dermatology

Nevada Bans Minors From Tanning Beds

October 2013

Nevada is the latest state to prohibit minors from using indoor tanning beds, joining California, Vermont and New Jersey to block adolescents from using the devices. Nevada Gov. Brian Sandoval signed into law a bill that was sponsored by Sen. Joyce Woodhouse, D-Las Vegas, and had the backing of the American Academy of Dermatology Association, the American Society for Dermatologic Surgery Association, the Dermatology Nurses Association and several other groups, according to a news release. The ban follows a recent recommendation by the Food and Drug Administration that indoor tanning beds include warning labels that describe the risk of skin cancer associated with using the devices. The FDA is accepting comments on that proposal, which would reclassify tanning beds from class 1 to class 2, for 90 days. Nevada’s tanning bed restrictions went into effect July 1.

Source: Dermatology Times

Melanoma Detectable Through Skin Odor?

October 2013

Results of a recent study indicate that an odor emitted by melanoma through skin cells may allow the disease to be detected noninvasively.

Researchers from the Monell Chemical Senses Center, Philadelphia, and colleagues used sampling and analytical techniques to identify volatile organic compounds (VOCs), which are chemical molecules that give off an odor. The VOCs were identified in three stages of melanoma and in normal melanocytes, according to a news release.

Using an absorbent device, researchers collected chemical compounds from the air and housed them in containers that held the various types of cells. Investigators used gas chromophotography-mass spectometry techniques to analyze compounds and identify various profiles of VOCs emitted by both cancer and normal cells.

The melanoma cells emitted compounds different than those of normal cells. The different types of melanoma cells were also distinguishable by the type of chemical compounds they released.

To make this discovery useful in the clinical setting, investigators began analyzing VOCs from the cells with a nanosensor made of nano-sized tubes that were coated with DNA strands. The portable nanosensor device proved useful for deciphering differences in VOCs from cancerous cells versus those from normal melanocytes.

"This study demonstrates the usefulness of examining VOCs from diseases for rapid and noninvasive diagnostic purposes," said A.T.Charlie Johnson, Ph.D., professor of physics, University of Pennsylvania, who helped develop the nanosensor.
Source: Dermatology Times

Congress Forms Caucus On Skin Cancer

October 2013

A bipartisan caucus comprised of congressional leaders and dermatology groups will focus on addressing the epidemic of skin cancer in the United States.

The Congressional Skin Cancer Caucus was established by Reps. Jim Cooper (D-Tenn.), Carolyn Maloney (D-N.Y.), Peter Roskam (R-Ill.) and Charlie Dent (R-PA.) with the help of the American College of Mohs Surgery (ACMS) and support from the American Academy of Dermatology Association (AADA).

The caucus will support legislative activities and public policies that are aimed at raising skin cancer awareness, promoting skin cancer screening and early detection of the disease, and improving access to skin cancer treatment.

"We are delighted to see this new caucus come to fruition," said Dirk M. Elston, M.D., president of the AADA. "This bipartisan group has the potential to not only save lives but decrease skin cancer-related healthcare costs in the future."

Brent Moody, M.D., chairman of the ACMS, said, “Mohs surgeons are excited to see the skin cancer epidemic taking a more prominent place in the eyes of our federal policymakers. The Mohs College, in partnership with the AADA and other advocates, including federal agencies, will work with the caucus to identify opportunities to further the mission of this new organization.”

Source: Dermatology Times

Virus Targets Melanoma In Mice

October 2013

A virus injected into mice with melanoma proved effective for prompting an immune system response that killed the virus and the tumor, a recent study demonstrated.

Researchers with The Yale School of Medicine and Yale Cancer Center, New Haven, Conn., injected the vesicular stomatitis virus into mice, and determined that the fast-acting virus bypassed healthy melanocytes but found 19 melanoma tumors.

In 70 percent of the tumors that investigators tested, the disease was destroyed, while the remainder demonstrated a limited response to the virus.The immune system’s response in attacking the virus may also allow it to target and destroy the tumor cells, according to the report. Researchers said the study results merit further study of the virus "for its oncolytic and vaccine potential."

Source: Dermatology Times

Comorbidities Accompany Alopecia Areata

October 2013

Comorbidities such as autoimmune disease and mental health problems are common in patients with alopecia areata.

Researchers from Brigham and Women’s Hospital, Boston, reviewed the medical files of 350 randomly selected patients with alopecia areata who were part of the Partners Health System in Boston.

Common comorbid conditions among the patients were autoimmune diagnoses such as thyroid disease in 14.6 percent, diabetes mellitus in 11.1 percent, inflammatory bowel disease in 6.3 percent, systemic lupus erythematosus in 4.3 percent and rheumatoid arthritis in 3.9 percent. Additionally, psoriasis and psoriatic arthritis were found in 2 percent of the patients. Mental health problems such as anxiety and depression were in 25.5 percent.

In the patients with alopecia areata, researchers also noted a high prevalence of hyperlipidemia (24.5 percent), hypertension (21.9 percent) and gastroesophageal reflux

Source: Dermatology Times

Dermatology Associates' Surgeon, John M. Strasswimmer, MD, PhD, Introduces New Surgical Technique for Skin Cancer Treatment

August 2013

Washington, DC - During the Master's Session of the American College of Mohs Surgery annual meeting, John M. Strasswimmer, MD, PhD, introduced an advanced surgical technique using barbed absorbable sutures to close the large wounds that are often associated with skin cancer treatment. This technique is reported in the July issue of JAMA Dermatology, the peer-reviewed journal of the American Medical Association for Dermatology.

Using barbed, absorbable sutures, Dr. Strasswimmer is able to close large wounds with a spiral suturing technique that eliminates knotting of sutures for a much faster wound closing than is possible with conventional surgical techniques. Because knots are not used, there are no stitches to remove. And all the sutures are below the surface of the skin. The results have shown that the new technique avoids the added costs of additional surgeries. Additionally, patients recover faster and the technique is safer for patients on blood thinners. Dr. Strasswimmer has used the new technique on more than 500 patients with excellent results.

For several years, three Dermatology Associates' physicians, Richard Krathen, MD, Howard A. Green, MD and John M. Strasswimmer, MD, PhD, have been recognized in South Florida for excellence in treating skin cancer with Mohs micrographic surgery. All three physicians were fellowship-trained in Mohs micrographic surgery and reconstructive surgery. Dermatology Associates' physicians regularly conduct research to advance their profession.

Read the full JAMA article here

The Vaccine for Shingles (Herpes Zoster) is Recommended for Everyone 50 and Older

August 2013

Anyone who has had chickenpox can get shingles. After the chickenpox clears, the virus stays in the body. If the virus reactivates (wakes up), the result is shingles — a painful, blistering rash.

Shingles is most common in older adults. A vaccine, which may prevent shingles, is available to people ages 50 and older. Dermatology Associates' physicians recommend this vaccine for everyone 50 and older.

If you get shingles, an anti-viral medicine can make symptoms milder and shorter. The medicine may even prevent long-lasting nerve pain. Anti-viral medicine is most effective when started within 3 days of seeing the rash.

Shingles: Signs and symptoms

Shingles tends to cause more pain and less itching than chickenpox. Common signs (what you see) and symptoms (what you feel) are:

  • The warning: An area of skin may burn, itch, tingle, or feel very sensitive. This usually occurs in a small area on 1 side of the body. These symptoms can come and go or be constant. Most people experience this for 1 to 3 days. It can last longer.
  • Rash: A red rash then appears in the same area.
  • Blisters: The rash soon turns into groups of clear blisters. The blisters turn yellow or bloody before they crust over (scab) and heal. The blisters tend to last 2 to 3 weeks.
  • Pain: It is uncommon to have blisters without pain. Often the pain is bad enough for a doctor to prescribe painkillers. Once the blisters heal, the pain tends to lessen. The pain can last for months after the blisters clear.
  • Flu-like symptoms: The person may get a fever or headache with the rash. "If you are over 50 you should get the shingles vaccine," says Brett S. Dock, MD, a Dermatology Associates' physician seeing patients in our Atlantis office.

Plantar and Palmer Warts

August 2013

Plantar and Palmer warts are common, especially in children. These warts are named for where they appear on the body. Palmer warts occur on the hands, and plantar warts on the bottom of the foot. Virtually everyone will have a wart (or several) someplace at some time in their lives.

What Are Plantar and Palmer Warts?

Plantar warts and palmer warts are noncancerous skin growths, caused by a viral infection in the top layer of the skin. The culprit is a strain of virus called human papillomavirus or HPV. Many strains of the virus exist, and those that cause common warts on the hands and feet are not the same strains of HPV that cause genital warts.

What Do Plantar and Palmer Warts Look Like?

On average plantar warts and palmer warts are small, about the size of a pencil eraser. But some warts grow bigger. Sometimes plantar warts can grow in clusters; those are called mosaic warts.

Sometimes corns or calluses are mistaken for a palmer or plantar wart. In some warts, little black dots appear, leading people to call them "seed" warts. Actually the black dots are little blood vessels that have grown up into the wart. Warts don’t really have “seeds.”

How Do You Get a Plantar or Palmer Wart?

Warts are spread from person to person. The transmission can be indirect. For instance, a child with a wart on his hand may touch a playground surface that is then touched by another child and the wart spreads. Or a person with a plantar wart uses a shower without wearing shower shoes and another person then uses it and develops a wart.

A person's risk of getting a wart varies. Children or adults with a weakened immune system are more susceptible. But anyone can develop warts.

What Are Treatments for Plantar and Palmer Warts?

Plantar and palmer warts can be irritating, aesthetically unpleasing, and a potential source of infection. Doctor's treatments include freezing the wart with liquid nitrogen, cutting off the wart, or applying or injecting medicines to strengthen the immune system so it can clear your body of the virus.

Treatment may be prolonged. Multiple treatments are often necessary since the virus lives deeply in the skin. If a wart is bothering you, please schedule an appointment with a Dermatology Associates' physician.

Source: Skin Care Foundation

FDA Approves Two Drugs, Companion Diagnostic Test for Advanced Skin Cancer

August 2013

The U.S. Food and Drug Administration today approved two new drugs, Tafinlar (dabrafenib) and Mekinist (trametinib), for patients with advanced (metastatic) or unresectable (cannot be removed by surgery) melanoma, the most dangerous type of skin cancer.

Melanoma is the leading cause of death from skin disease. The National Cancer Institute estimates 76,690 Americans will be diagnosed with melanoma and 9,480 will die from the disease in 2013.

Tafinlar, a BRAF inhibitor, is approved to treat patients with melanoma whose tumors express the BRAF V600E gene mutation. Mekinist, a MEK inhibitor, is approved to treat patients whose tumors express the BRAF V600E or V600K gene mutations. Approximately half of melanomas arising in the skin have a BRAF gene mutation. Tafinlar and Mekinist are being approved as single agents, not as a combination treatment.

The FDA approved Tafinlar and Mekinist with a genetic test called the THxID BRAF test, a companion diagnostic that will help determine if a patient’s melanoma cells have the V600E or V600K mutation in the BRAF gene.

“Advancements in our understanding of the biological pathways of a disease have allowed for the development of Tafinlar and Mekinist, the third and fourth drugs the FDA has approved for treating metastatic melanoma in the past two years,” said Richard Pazdur, M.D., director of the Office of Hematology and Oncology Products in the FDA’s Center for Drug Evaluation and Research.

Zelboraf (vemurafenib) and Yervoy (ipilimumab) were approved in 2011 for the treatment of metastatic or unresectable melanoma.

“The co-approval of Tafinlar and Mekinist and the second companion diagnostic for BRAF mutation detection demonstrates the commitment of pharmaceutical and diagnostic partners to develop products that detect and target the molecular drivers of cancer,” said Alberto Gutierrez, Ph.D., director of the Office of In Vitro Diagnostic Devices and Radiological Health in the FDA’s Center for Devices and Radiological Health.

The FDA’s approval of the THxID BRAF test is based on data from clinical studies that support the Tafinlar and Mekinist approvals. Samples of patients’ melanoma tissue were collected to test for the mutation.

Tafinlar was studied in 250 patients with BRAF V600E gene mutation-positive metastatic or unresectable melanoma. Patients were randomly assigned to receive Tafinlar or the chemotherapy drug dacarbazine. Patients who took Tafinlar had a delay in tumor growth that was 2.4 months later than those receiving dacarbazine.

The most serious side effects reported in patients receiving Tafinlar included an increased risk of skin cancer (cutaneous squamous cell carcinoma), fevers that may be complicated by hypotension (low blood pressure), severe rigors (shaking chills), dehydration, kidney failure and increased blood sugar levels requiring changes in diabetes medication or the need to start medicines to control diabetes.

The most common side effects reported in patients receiving Tafinlar included thickening of the skin (hyperkeratosis), headache, fever, joint pain, non-cancerous skin tumors, hair loss and hand-foot syndrome.

Mekinist was studied in 322 patients with metastatic or unresectable melanoma with the BRAF V600E or V600K gene mutation. Patients were randomly assigned to receive either Mekinist or chemotherapy. Patients receiving Mekinist had a delay in tumor growth that was 3.3 months later than those on chemotherapy. Patients who previously used Tafinlar or other inhibitors of BRAF did not appear to benefit from Mekinist.

The most serious side effects reported in patients receiving Mekinist included heart failure, lung inflammation, skin infections and loss of vision. Common side effects included rash, diarrhea, tissue swelling (peripheral edema) and skin breakouts that resemble acne.

Women of child bearing years should be advised that Tafinlar and Mekinist carry the potential to cause fetal harm. Men and women should also be advised that Tafinlar and Mekinist carry the potential to cause infertility.

Tafinlar and Mekinist are marketed by GlaxoSmithKline, based in Research Triangle Park, N.C. The THxID BRAF Kit is manufactured by bioMérieux of Grenoble, France. Yervoy is marketed by New York City-based Bristol-Myers Squibb, and Zelboraf is marketed by South San Francisco-based Genentech, a member of the Roche Group.

Clothing is the Single Most Effective Form of Sun Protection

August 2013

It is our first line of defense against the sun's harmful ultraviolet rays.

Nearly 3.7 million skin cancers are diagnosed in the US annually, and the vast majority of them are caused by solar UV radiation (UVR). UVR also causes up to 90 percent of the visible changes commonly attributed to aging, such as wrinkles, brown spots, and sagging skin. Fortunately, clothing can absorb or block much of this radiation.

You probably already have clothes that offer excellent UV protection. When choosing the ideal attire for sun safety, consider the following factors:

Tightness of Weave or Knit: Tightly woven or closely knitted fabrics, such as denim and wool, literally have smaller holes between the threads. They keep out more UVR than fabrics with a loose or open weave, like lace. However, clothes should not feel tight on your body: snug-fitting garments can stretch, exposing more skin to the sun.

Type of Fiber: Synthetic and semi-synthetic fibers (such as polyester and rayon) offer the greatest sun protection. Refined and bleached cottons or crepe offer the least. And glossy fabrics, such as satin, reflect more UVR away from the skin than do matte fabrics, like linen.

Thickness or Density: Thin, lightweight materials, including some silks and bleached cottons, let in more UV light than do heavier, denser fabrics such as corduroy.

Color: Dark or bright colors, like black or red, absorb more UVR than white or pastel shades, stopping the rays before they reach the skin. The more intense the hue, the better the UV defense.

An Ultraviolet Protection Factor (UPF) label: A UPF label will help you identify sun-protective garments; the number on the label indicates what fraction of the sun’s rays can penetrate the fabric.

You can mix and match the different kinds of fabrics with UV-screening features to achieve effective sun protection.

While clothes made of UV-screening fabrics go a long way towards protecting your skin, the face and neck receive the most sun exposure and are particularly susceptible to the two most common forms of skin cancer, basal and squamous cell carcinoma. Furthermore, people with melanoma (the deadliest skin cancer) of the head and neck are almost twice as likely to die from the disease as patients with melanomas on other parts of the body.

Hats are the head’s first line of defense. The Skin Cancer Foundation advises everyone to wear hats with a brim that extends three inches or more all the way around to shade the face, neck, ears, and even the top of the shoulders.

Sunglasses are also essential. Over time, solar UVR can cause or contribute to conditions ranging from cataracts and macular degeneration to ocular melanomas and other skin cancers. Five to 10 percent of all skin cancers, in fact, arise on the eyelids.

Look for sunglasses that cover the eyes, eyelids, and as much of the surrounding areas as possible. They should come with a tag verifying that they block 99-100 percent of all UV radiation.

Put your knowledge of dressing for sun success to use every day by following these guidelines:

As with sunglasses and hats, the more skin you cover, the better. Long-sleeved shirts and long pants simply provide more protection than T-shirts and shorts. Many sportswear manufacturers offer fashionable, high-UPF staples such as cargo shorts, polo shirts, and summer dresses designed to keep you cool, dry, and sun-safe during exercise.

Dressing sun-safely is a year-round activity. But in certain seasonal locales even greater precautions must be taken.

When you’re at the beach on a clear summer day, be aware that certain surfaces reflect the sun’s UV rays, allowing them to hit your skin and eyes twice. Sand reflects an extra 15 percent of UV light, and water, up to 10 percent.

Loose-fitting tunics and sarongs help shield the arms and legs; scarves and wraps can cover the neck, upper chest, and shoulder area.

Look for high-UPF swimwear, and choose styles that cover more skin, like one-piece suits and long trunks. For extended stays in the water, full-body wetsuits are an option. Normally, wet clothing allows much more UV to penetrate; for example, the UPF of a white summer cotton T-shirt decreases to only 3 to 4 when the fabric gets wet.

Many people forget about sun protection in cold weather venues. But ice and snow reflect about 80 percent of the sun’s UV light, almost doubling the intensity of exposure. Both snow and strong wind can wear away sunscreen, reducing its effectiveness.

Again, hats are important, and knitted winter hats made of high-tech, man-made materials will keep you comfortable as well as sun-protected. Wraparound sunglasses with UV-protective side shields will cut glare and block the most UVR.

Clothing, sunscreen, and sunglasses are all essential parts of a comprehensive sun protection program. Following these simple tips will enable you to maximize sun safety year-round, without sacrificing style or comfort.

Many manufacturers today identify their sun-protective garments with an ultraviolet protection factor (UPF) label, which indicates what fraction of the sun’s ultraviolet rays can penetrate the fabric. A shirt with a UPF of 50, for example, lets just 1/50th of the sun’s UVR reach the skin, compared to, say, an everyday white cotton T-shirt, which has a UPF of only about 5.

National criteria have been developed for UPF testing; a UPF label may state that the item meets the standards of the American Society for Testing and Materials.

In addition, sun protection products that pass the review of a volunteer Photobiology Committee may receive the Seal of Recommendation, The Skin Cancer Foundation’s stamp of safety and efficacy. Eligible clothing must have a UPF of 30 or higher, and acceptable test results according to the American Association of Textile Chemists and Colorists method or AS/NZS Standard. For hats, a minimum brim width of 3 inches is required.

You can increase your clothes’ UPF by washing a laundry additive like Sun Guard’s Rit® into them. The product’s active ingredient, the sunscreen Tinosorb®, increases clothes’ sun-protective abilities for up to 20 washings. A laundry additive can raise the UPF of an everyday white cotton T-shirt to about 30.

Source: Skin Cancer Foundation

Melanoma Soars Among Young Adults

August 2013

A new Mayo Clinic study has revealed an alarming rise in melanoma among people aged 18 to 39: over the past 40 years, rates of this potentially deadly skin cancer grew by 800 percent among young women and 400 percent among young men. Researchers examined data on the 256 young adults in Olmstead County, MN, who were diagnosed with melanoma between 1970 and 2009. Between 1970 and 1979, just 16 new cases, or 4.8 cases per 100,000 people, were diagnosed. But in the decade ending December 31, 2009, 129 cases were recorded, an incidence rate of 30.8 cases per 100,000 people — an enormous jump from the 1970’s.

Although lifetime risk of melanoma is about 1.5 times greater in males than in females, among young people this pattern is reversed, as this Mayo Clinic Proceedings study demonstrated. The authors observed that Indoor ultraviolet (UV) tanning, which is much more popular among young women than young men, may account for the disproportionate increase in incidence among young women. UV rays emitted by tanning machines are cancer-causing, and Indoor ultraviolet (UV) tanners are 74 percent more likely to develop melanoma than those who have never tanned indoors; those who tan indoors just four times a year increase their risk of developing melanoma by 11 percent. Indoor tanners are also 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma.

While the skyrocketing incidence figures are cause for major concern, the authors noted that death from the disease among young people is actually decreasing, due to earlier diagnosis; with more people aware of changes in their skin, and better diagnostic methods, melanomas are more frequently discovered at earlier stages, when they are easiest to treat.

"Early diagnosis and treatment is when skin cancers are easiest to cure. If you see any change in your skin, it's time to see a Dermatology Associates' physician," says Howard A. Green, MD, a Dermatology Associates' physician seeing patients in our Palm Beach Gardens and West Palm Beach offices.

Texas becomes fifth state to ban indoor tanning for minors under 18

July 2013

Texas has joined California, Vermont, Oregon, and Nevada by passing legislation that prohibits minors under the age of 18 from indoor tanning. This announcement comes shortly after the U.S. Food and Drug Administration proposed stricter regulations on indoor tanning beds, as well as a strong recommendation against the use of tanning beds by minors under the age of 18.

“The American Academy of Dermatology Association is proud to have supported this legislation and commends the state of Texas for joining the fight against skin cancer, including melanoma, the deadliest form of skin cancer,” said board-certified dermatologist Dirk M. Elston, M.D., F.A.A.D., president of the American Academy of Dermatology Association. “Melanoma incidence rates have been increasing for the last 30 years, with the most rapid increases occurring among young, white women, the most common users of indoor tanning beds. Prohibiting minors’ access to indoor tanning stops this behavior before it can become a habit that continues into adulthood.”

John M. Strasswimmer, M.D., F.A.A.D., a Dermatology Associates' Mohs micrographic surgeon says, "We need to talk to our state representatives and have them pass the same legislation in Florida. I see far too many patients requiring skin cancer surgery."

Legislation prohibiting the use of indoor tanning beds by minors under 18 passed both the Texas Senate and House in May. Governor Rick Perry did not sign or veto the bill within the 20-day period. Therefore, the bill automatically became law. The ban will go into effect on Sept. 1, 2013.

Support for the ban was provided by the American Academy of Dermatology Association, the Texas Dermatological Society, the Texas Pediatric Society, AIM at Melanoma, the American Society for Dermatologic Surgery, the American Cancer Society Cancer Action Network, the Dermatology Nurses Association, and the Joanna M. Nicolay Melanoma Foundation.

More than 3.5 million skin cancers in more than 2 million people are diagnosed annually. It is estimated that one in five Americans will develop skin cancer in their lifetime. The risk of developing melanoma increases by 75 percent for individuals who have been exposed to UV radiation from indoor tanning, and the risk increases with each use. Since 2.3 million teens tan indoors in the United States annually, restricting teens’ access to indoor tanning is critical to preventing skin cancer.

Source: American Academy of Dermatology

Five Important Things to Do Everyday

July 2013

#1: Wash Your Hands!

Keeping our hands clean may be one of the most powerful tools we have against germs. Think about all the surfaces you touch during the day, everything from doorknobs to toilets to other peoples' hands. If you increase the number of times you wash your hands to seven times a day, you could reduce your number of yearly colds by about 40 percent.

It's important to wash your hands correctly, and that's not just a quick rinse. According to the Centers for Disease Control and Prevention the proper way to wash is to wet your hands with warm water, lather up with soap and rub your hands together for at least 20 seconds -- the time it takes to sing Happy Birthday to yourself. Don't forget to clean under your fingernails where germs can hide.

#2: Use Hand Sanitizer

While sanitizers aren't meant to replace a good scrub with soap and water, alcohol-based hand sanitizers, usually foams or gels, don't require water to use and are a convenient way to keep your hands germ-free when you're on the go.

Be sure you're using a disinfectant that gets the job done; choose a product that contains at least 60 percent alcohol to be sure it has the power to kill bacteria and viruses. Use about 1/2 teaspoon of sanitizer (or enough to get your hands wet) and rub hands together until they feel dry, which should take at least 10 to 15 seconds according to the Centers for Disease Control and Prevention.

#3: Clean Your Kitchen Sponges

Something as innocuous as a kitchen sponge could be the breeding ground for your family's next cold. Kitchen sponges have been found to carry more than 134,000 bacteria per square inch, including Salmonella and Campylobacter, both of which cause foodborne illness.

What can you do? Replace sponges every week or give them frequent and thorough cleanings. Disinfect sponges in the dishwasher or soak them in a one-part bleach to nine-parts water solution. Or, microwave them: In a study done at the University of Florida, researchers found that 99 percent of bacteria, viruses, parasites and spores living in a kitchen sponge could be killed with a two-minute, full-power disinfection in the microwave.

#4: Stay Hydrated

One simple way to build a barrier against germs is to drink water. Good hydration keeps mucous membranes moist. Mucous membranes are protective linings inside places such as our eyes, sinuses, nose and mouth; when they're kept moist they help to block germs from entering your body. Allowed to dry out, these membranes can leave your body open to germ invasion.

Not all beverages are created equal though. Alcohol, coffee, and soda may actually have an opposite dehydrating effect, so sip water throughout the day to keep the bugs away.

#5: Disinfect Strategically

While many of us think a clean house is a germ-free house, it turns out we don't need to scrub from floor to ceiling to keep the microbes away. Instead, aim to spot clean the germ havens in your home once a week or more. Handles of all sorts are germ factories. A Hygiene Council survey found that kitchen and bathroom faucet handles carried more than 13,000 bacteria per square inch in the kitchen, and about 6,000 in the bathroom.

You don't need to be obsessive, but a good suggestion is to clean everything you use regularly with disinfectant sprays or wipes. A few examples: Phones, remote controls, light switches, computer keyboards and handles (including faucets, toilets, cabinets, doorknobs and the refrigerator). Don't forget the trash can!

Source: Discover

Skin can show first signs of some internal diseases

July 2013

For years, dermatologists have known that the skin offers a window to what is going on inside the body, and changes to the skin may signal a more serious health problem. The key is knowing how to spot these early warning signs so the internal disease can be successfully treated before it becomes a bigger problem.

Common signs spell internal trouble

Richard A. Krathen, M.D., F.A.A.D., a Dermatology Associates' physician says, "In some cases, the skin can show signs of an internal disease before the disease advances and becomes more serious; in other cases, a sign is noticeable on the skin long after the disease begins causing damage internally. There are hundreds of nuances of the skin that could spell trouble, but a handful of general skin changes commonly signal an internal disease."

New rash

  • Unusual rash, or a rash that does not respond to treatment or is accompanied by fever, joint pain, muscle aches, or other symptoms could indicate an internal problem or infection.
  • A rash occurring on the tops of the feet and lower legs that does not respond to topical steroids or antifungals can be a sign of hepatitis C infection.
  • Occasionally, people will develop a rash from an allergy to a new medicine. However, it is important to monitor the rash carefully because it could be a sign of a more serious condition known as DRESS syndrome, which stands for Drug Reaction (or Rash) with Eosinophilia and Systemic Symptoms.
  • This condition can occur weeks to months after the start of a new medication, making it very difficult to diagnose. This is a potentially serious medical condition that could involve inflammation of the liver, heart, lungs, or thyroid. It is important to see a Dermatology Associates' physician for proper diagnosis if a rash is accompanied by swelling of the face or lymph nodes, fever, and/or feeling of illness.
  • Dermatomyositis is an inflammatory muscle disease with notable skin changes and is associated, in up to 20 percent of cases, with a wide variety of internal cancers (ovarian cancer being the most common in women). Signs on the skin include a violet-colored rash on the upper eyelids and in areas that are exposed to sunlight, and raised, scaly bumps on the knuckles. Other skin changes can be seen on the nail folds with visible blood vessels and ragged-looking cuticles that appear thicker and separate from the nail.

New growths

  • Any new growths should be checked thoroughly by a Dermatology Associates' board-certified dermatologist because they could be skin cancer. Rarely, new growths can represent a metastasis or spread of an internal cancer to the skin. Also, certain tumors of the skin can be a sign of internal disease or a genetic syndrome.
  • In one example, yellow or waxy looking bumps on the arms, legs, or trunk (eruptive xanthomas) could indicate high triglyceride levels. In this instance, a biopsy in conjunction with laboratory testing can lead to diagnosis and treatment, hopefully reducing the cardiovascular risk from this condition.

Skin discoloration

  • Skin color changes can be a sign of internal disease. In the most common example, yellowing of the skin can indicate liver disease. However, other skin color changes can be important signs as well, including darkening of the skin.
  • Noticeable darkening of creases in the skin, sun-exposed areas, joints, and old scars could be a sign of adrenal disease, such as Addison’s disease.
  • Bronzing of the skin in a patient with diabetes can be a sign of an inherited defect in iron metabolism that leads to liver failure known as hemochromatosis.

Change in texture

  • Any unusual softening or hardening of the skin could indicate an underlying medical problem.
  • Systemic sclerosis is an autoimmune disease in which one of the early signs is swelling, followed by hardening of the skin. In more severe cases, it could result in hardening of internal organs, such as the lungs or heart.
  • Acanthosis nigricans is a common condition seen in overweight patients that results in darkened, velvety skin occurring in skin folds and often on the back of the neck. The appearance of this textural change in the skin could indicate the presence of early diabetes. In some cases this skin change may be a sign of a cancerous tumor in an internal organ.

People can be their own best detective in noticing unusual changes in their skin. You should see a Dermatology Associates' physician as soon as possible in these instances:

If you notice an unusual rash that can’t be attributed to a specific cause.

If a rash is diagnosed and not responding to the prescribed treatment.

If a rash is accompanied by fever, muscle aches or other unusual symptoms.

“When examining a patient’s skin for signs of skin cancer or any type of skin condition, we are always mindful of unusual markings on the skin that could indicate another medical problem,” said Dr. Krathen. “Dermatology Associates' physicians have the training and expertise to know when signs on the skin are more than a skin problem, which is why it is important to see a board-certified dermatologist if you notice any skin changes. Doing so can ensure proper diagnosis and in some cases stop the progression of a more serious medical condition.”

Source: American Academy of Dermatology

It’s a guy thing: Cosmetic procedures surge among men

July 2013

In today’s fiercely competitive job market, research shows an increased demand for cosmetic procedures among men hoping that a fresh look will improve their chances of advancing their careers. While men are seeking the same treatments women have long embraced, Dermatology Associates' physicians find the distinct differences between men’s and women’s skin biology, facial anatomy and aging process play a role as to why genders have different rejuvenation needs.

Beyond shaving cream and aftershave

From overall concerns about looking tired to specific complaints about deep expression lines, uneven complexions, excessive hair, hair loss, shaving rashes, sweating, and age spots, men are becoming more interested in achieving greater results than at-home skin care can offer. The following treatment options specifically address some common concerns among men:

  • Volume loss is one of the most noticeable characteristics of aging in men, and dermal fillers are great tools to restore a youthful appearance.
  • Skin resurfacing — done with chemical peels, microdermabrasion or laser devices — is used to improve fine wrinkles, uneven skin tone, age spots, and acne scarring.
  • Neurotoxins, such as botulinum toxin type A, are used to soften facial expression lines and treat localized sweating.
  • Laser hair removal is one of the most common nonsurgical cosmetic procedures performed for men, with the most common treatment areas being the neck (which is prone to ingrown hairs) and the back.
  • Laser devices also are used to treat facial blood vessels.

Men should not look for a “one size fits all” approach to skin care. Rather, they should consult a board-certified dermatologist about establishing a skin-care routine based on their individual skin type and their goals for slowing the aging process. However, the following are some basic skin care tips that all men can incorporate into their routine:

  • Apply a broad-spectrum sunscreen with an SPF of 30 or more as part of your daily skin care regimen.
  • Wash your face daily and after working out using a mild cleanser.
  • Moisturize daily. This practice is often neglected by men, especially those with acne; however, this is an important step in skin care.

“The best way to slow the skin aging process is to protect your skin daily from the sun, because sun exposure causes wrinkles, age spots, and also can increase your risk of skin cancer,” says Brett S. Dock, M.D., F.A.A.D. “In addition to a basic at-home skin care routine, there is a full spectrum of options that men can consider and discuss with a Dermatology Associates' physician to determine the best treatments to reduce the signs of aging.”

Fact or Myth?
All wrinkles form by age 25 -- they just start to show later.
Answer: Myth

July 2013

This is known to be a myth largely because activities after 25 -- like spending more time out in the sun -- can lead to an increase in wrinkles.

"If you get a lot of sun exposure, you're definitely going to get more wrinkles," said Cristina Lampuri, M.D., F.A.A.D., a Dermatology Associates' physician seeing patients in our West Palm Beach and Atlantis offices. "Wrinkles are the result of a loss of collagen, the main structural protein of the skin. As you age, the body begins to produce less of it, which keeps skin from being as firm as it was when you were younger."

But while that decline in collagen happens to everyone, and wrinkles will form along the lines that are moved in facial expressions, sun exposure breaks down collagen even more, leading to wrinkles that otherwise might never have happened.

Squamous cell skin cancers deadly for some patients

July 2013

Cutaneous squamous cell carcinomas typically are easily cured with surgery or ablation, but in certain patients with disease risk factors, the cancer can result in death, according to study findings.

Investigators with Harvard University, Cambridge, Mass., reviewed cases of 1,832 squamous cell carcinoma tumors among 985 patients in a 10-year retrospective study. Among the patients, 3.7 percent developed nodal metastases and 2.1 percent died as a result of the disease, according to the study abstract.

The independent predictors for nodal metastasis and disease-specific death included a tumor diameter of at least 2 cm, invasion beyond fat, and ear or temple location. Perineural invasion also was associated with disease-specific death. Study authors noted that knowledge of associated risk factors could help to select an appropriate treatment in earlier disease stages.

"Squamous cell carcinoma can be more aggressive than some types of melanoma. Because it is so common, and usually readily treated, it is often not given the respect it deserves" said John M. Strasswimmer, M.D., Ph.D., who served on the Faculty of Harvard Medical School at Massachusetts General Hospital prior to joining Dermatology Associates, P.A. of the Palm Beaches. "The key is to have not a good dermatologist, but a great one who can direct the care of squamous cell carcinoma, whether by a straightforward process in the office or more advanced procedures such as Mohs surgery."

Source: JAMA Dermatology

How to decrease skin cancer risk among outdoor athletes

July 2013

Outdoor athletes have a particularly high risk of developing skin cancer. That's because they spend so much time in the sun, training and competing, with much of their skin exposed to ultraviolet (UV) rays, starting at an early age. UV radiation is linked to about 90 percent of nonmelanoma skin cancers and 86 percent of melanomas. Research has also shown that sweat decreases the time it takes for outdoor athletes to burn by as much as 40 percent. Sunburns raise a person's risk for melanoma. Just one blistering sunburn in childhood or adolescence, or five sunburns by any age, doubles the risk of developing melanoma.

Here are the risk factors for outdoor athletes.

1. Cumulative ultraviolet (UV) radiation exposure since early childhood.
2. Exposure to UV radiation during the peak hours of intensity (10AM to 4PM).
3.Lack of sunscreen or shade in the sporting event.
4. Uniforms that leave significant amounts of skin exposed to UV radiation.
5. Reflection of UV radiation by playing surfaces.
6. Increased UV radiation effects due to sweat.

A simple skin cancer prevention method is to use sunscreen. That is true for not only outdoor athletes, but for all of us.

Get creative!

July 2013

Trying to find a creative solution to a difficult problem? Instead of sleeping on it, take a long walk. A study of 52 backpackers found they scored 50% better on a creativity test after spending four days in nature, disconnected from electronic devices. It's not clear whether the wilderness or the lack of cellphones was responsible. Researchers say it might be a bit of both. You can get some of the same benefits without camping in Alaska or Colorado. Experts suggest starting with a 10- to 15- minute walk in a park or on the beach 5 days a week.

Remember to use your sunscreen before you start the walk.

Source: PLoS One, WebMD

What do you know about rosacea?

July 2013

What affects an estimated 16 million Americans, more commonly occurs in women and tends to appear after age 30? If you didn’t guess “rosacea,” you’re not alone – 78% of Americans don’t know what this condition is despite the fact that it’s very common. Rosacea appears on the skin as redness, unpredictable blushing, pimples, bumps and can even affect the eyes, causing itchiness and irritation. Unlike the more commonly known skin issue – acne, rosacea isn’t caused by bacteria: inflammation is the culprit, and it can be exacerbated by internal factors such as stress, anger, embarrassment or by external triggers, including spicy foods, alcohol and hot beverages.

Hot temperatures and sunny weather can also trigger rosacea, so summertime, particularly with long days at the beach and outdoor events, has many of the elements that contribute to rosacea flare-ups.

"The good news is that rosacea can be treated by making simple changes to your skincare routine," says Howard A. Green, M.D., F.A.A.D., a Dermatology Associates' physician seeing patients in our West Palm Beach and Palm Beach Gardens offices. "Certain foods and drinks can also impact rosacea, so being conscious about what you’re eating and drinking can also help."

Dr. Green recommends the following tips for skin with rosacea:

* Tip #1: Especially in warm weather when rosacea flare-ups can be at their worst, talk to a Dermatology Associates' physician about your symptoms. While there is no cure for rosacea, proper treatment can make it manageable. There are several Food and Drug Administration (FDA) approved treatments available to help reduce the inflammatory lesions of rosacea.

* Tip #2: Always wear a broad-spectrum (UVA and UVB protection) sunscreen with an SPF of 30 or higher for sensitive skin, regardless of your skin color or the time of year.

* Tip #3: Try to use make-up that is hypo-allergenic, fragrance-free and does not contain peppermint, menthol or alcohol, as these ingredients can be too harsh for skin with rosacea.

* Tip #4: Make sure you use mild skincare products that don't strip moisture from your skin and aren't abrasive or irritating. Remember, because rosacea can affect the eyes, it is important to remove all your eye make-up at night with a gentle make-up remover.


Can Sun Lower Your Blood Pressure?

June 2013

Is sunlight the new antihypertensive medicine? A new study in the Journal of Investigative Dermatology suggests ultraviolet rays may lower your blood pressure.

Researchers in the United Kingdom had 24 volunteers sit below tanning lamps under two conditions - one time receiving UV rays and the other with the rays blocked - for 20 minutes. The UV group saw a blood pressure drop for 50 minutes afterward, while the group receiving just the heat saw no effect.

But don't head for the sunshine just yet. The researchers claim that UV rays activate nitric oxide - a compound found to lower blood pressure. However, numerous foods that are polyphenol-rich (dark chocolate and tea to name a few) produce an increase in nitric oxide as well - and they don't require you to torch your skin.

While sunlight might seem like a great free solution to lowering blood pressure, unblocked UV rays could cause serious stress on your largest organ, the skin.

Along with other natural pressure release valves that don't affect the rest of your body, consider this: men with metabolic syndrome ( a set of conditions that can lead to heart disease) who ate powder equivalent to 2 cups of grapes daily for a month reduced their systolic blood pressure by 6 points, according to a recent study from The Journal of Nutrition. The polyphenols in grapes seemingly help relax blood vessels and improve their function, say researchers from the University of Connecticut.

How to take care of your beautiful nails

June 2013

Having beautiful nails is less a matter of luck and more a matter of caring for them correctly. Fortunately, there are simple steps people can take to properly care for their nails.

"Nails need to be moisturized, especially after removing nail polish, so be sure to apply a cream regularly," said Dermatology Associates' physician J. John Goodman, MD, FAAD. "Always protect your cuticles. Never cut or forcefully push back your cuticles as doing so could lead to an infection. If you must push them back, only do so gently after a shower or bath."

Dr. Goodman shares more top manicure and pedicure tips:

  1. While most nail salons follow strict cleanliness and disinfection guidelines, look for the following when visiting a salon:
    • Does your nail technician have the necessary experience and/or license, if required?
    • Are the stations clean?
    • Does the nail technician wash her hands between clients?
    • Are there dirty tools lying around?
    • In addition, do not hesitate to ask how they clean their tools.
  2. Shave your lower legs after getting a pedicure, not before. That means not shaving your lower legs for at least 24 hours before you get a pedicure. If you nick yourself while shaving, a pedicure could put you at risk for an infection.
  3. If you get frequent manicures and pedicures, consider purchasing your own tools to be used at the salon.
  4. In addition, check that the pedicure footbaths are thoroughly disinfected before you use them. If they are improperly cleaned, they can harbor bacteria and fungus. If the salon does not appear clean, then choose another one.
  5. While some people beg to differ, there is no scientific evidence that immersing nails in gelatin makes them stronger. Polishes that contain strengthening ingredients increase nail stiffness, which may make nails break more frequently.
  6. Do not wear artificial nails to cover up nail problems as they may make them worse. Artificial nails are not recommended for people who are prone to fungal infections or have brittle nails. For people with healthy nails, artificial nails can be fine as long as they are not worn continuously.

"If you wear artificial nails, know what products are used as the ingredients can cause an allergic reaction in some people," said Dr. Goodman. "If you develop a rash or other reaction, this information will be important to your doctor. If you have any questions or concerns about caring for your nails, make an appointment to see a board-certified Dermatology Associates' physician at any of our conveniently located offices from Boca Raton to Palm City."

FDA moves to safeguard the public from the dangers of tanning beds

June 2013

The U.S. Food and Drug Administration (FDA) has proposed changes to its regulation of tanning beds, including a strong recommendation against the use of tanning beds by minors under the age of 18.

In recognition of the dangers associated with tanning devices, the FDA announced today that it is proposing to raise the classification for sunlamps and tanning beds to a Class II level which institutes stricter regulations to protect public health. Currently, indoor tanning devices are Class I, the category for items that have minimal potential to cause harm to individuals, such as adhesive bandages and tongue depressors.

"Dermatology Associates physicians support the reclassification of indoor tanning devices and the placement of additional restrictions on indoor tanning. We applaud the FDA for taking this important first step,” said board-certified dermatologist Howard A. Green, MD, FAAD. “We also recognize that there is still more work to be done to protect the public from these dangerous devices. We urge the FDA to prohibit the use and sale of indoor tanning devices for minors under the age of 18."

In 2010, the FDA convened an Advisory Panel hearing to examine the current classification and regulations of tanning beds. Representatives from the American Academy of Dermatology , leading dermatologists, and researchers testified before the panel highlighting the risks associated with indoor tanning and the need to protect the public from these dangers. Following the hearing, the American Academy of Dermatology has been working closely with the FDA, and both state and federal legislatures to protect minors from the dangers of indoor tanning.

With a reclassification, tanning bed and lamp manufacturers will be required to show that their products have met certain performance testing requirements. In addition, they will also be required to label the devices so that they:

  • clearly inform consumers about the risks of using tanning beds
  • warn frequent users of sunlamps to be regularly screened for skin cancer
  • alert users that tanning lamps are not recommended for people under 18 years old

Under the proposed changes, manufacturers should provide updated labeling for all products on the market within one year of the FDA’s final order.

"The risk of developing melanoma increases by 75 percent for individuals who have been exposed to UV radiation from indoor tanning and the risk increases with each use.,” said Dr. Green. “We believe that restricting teens’ access to indoor tanning is critical to preventing skin cancer. As medical doctors who diagnose and treat skin cancer, all of us at Dermatology Associates are committed to reducing its incidence and saving lives."

Wart prevention should focus on family transmission

June 2013

According to a study published in the April issue of Pediatrics, warts in school children are spread most commonly at home and at school, and preventative measures should be focused on limiting human papillomaviris (HPV) transmission in families.

Although warts are common in school-age children, the way human papillomaviris is transmitted is not well known. Researchers at Leiden University Medical Center, Leiden, Netherlands, inspected the hands and feet of more than 1,000 children ages 4 to 12 from three schools. Investigators noted the presence of warts at baseline and after 11 and 18 months of follow-up.

Researchers also distributed questionnaires that sought information about pre-existing warts, warts in the family, prevalence of warts at baseline and use of public places such as swimming pools, in an effort to collect data about the degree of HPV exposure.

Based on the study, the authors recommend focusing preventive measures on limiting HPV transmission in families and school classes, rather than in public places.

How Should You Apply Sunscreen

June 2013

Cristina Lampuri, M.D., a board certified dermatologist seeing patients in our West Palm Beach and Atlantis offices, recommends people follow these tips when applying sunscreen. In Florida, it's especially important to know how to effectively use sunscreen because we are exposed to the sun's harmful UVA and UVB rays year round.

  1. Choose sunscreen that has an SPF of 30 or higher, is water resistant, and provides broad-spectrum coverage, which means it protects you from UVA and UVB rays.
  2. Apply sunscreen generously before going outdoors. It takes approximately 15 minutes for your skin to absorb the sunscreen and protect you. If you wait until you are in the sun to apply sunscreen, your skin is unprotected and can burn.
  3. Use enough sunscreen. Most adults need at least one ounce of sunscreen. That's about the amount that you can hold in your palm, to fully cover all exposed areas of your body. You should rub the sunscreen thoroughly into your skin.
  4. Apply sunscreen to all bare skin. Remember, your neck, face, ears, tops of your feet and legs. For hard-to-reach areas like your back, ask someone to help you or use a spray sunscreen. If you have thinning hair, either apply sunscreen to your scalp or wear a wide-brimmed hat. To protect your lips, apply a lip balm with an SPF of at least 15.
  5. Reapply sunscreen at least every two hours to remain protected, or immediately after swimming or excessive sweating.

"Your skin is exposed to the sun's harmful rays every time you go outside, even on cloudy days and in the winter, so remember to always use sunscreen when outdoors. If you have questions about what type of sunscreen to use come by a Dermatology Associates' office and we'll help you choose an excellent sunscreen," says Dr. Lampuri.

If you have not had a recent skin screening, now is the time. Make an appointment at your nearest Dermatology Associates' office.

Inflammatory Bowel Disease Raises Skin Cancer Risk

June 2013

Besides diarrhea, rectal bleeding and abdominal cramping, Inflammatory Bowel Disease (IBD) is associated with a 37% increased risk for melanoma, according to new research by the Mayo Clinic.

Melanoma - the most serious type of skin cancer - suppresses the body's immune system, allowing tumors to grow and spread. According to Mayo Clinic researchers, because IBD causes the body's immune system to attack itself, it may leave the body ill-equipped to fight off wayward cells that could lead to cancer.

In addition, patients with IBD are often treated with medications that suppress the body's immune system, which could further contribute to melanoma risk.

To lower skin cancer risk, Brett S. Dock, M.D., a Dermatology Associates' physician seeing patients in our Atlantis, Wellington and West Palm Beach offices, recommends following these simple suggestions:

"Wear hats, sun glasses and use sunscreen with an SPF of 30 or higher this summer. Anyone with Inflammatory Bowel Disease should get an annual skin check now - which all of us should be doing anyway. If you see any atypical moles on your body, or any changes in your skin, be sure to have a Dermatology Associates' physician inspect them as soon as possible to rule out cancer."


June 2013

Think a nightcap will help you get a better night's sleep? Think again. A review study found that while alcohol does allow healthy people to fall asleep more quickly and sleep more deeply for some time, it reduces rapid eye movement sleep in the second half of the night. That can rob you of needed zzz's, leading to daytime drowsiness and poor concentration. And the more you drink before bed, the stronger these effects. One to two drinks seem to have no effect on sleep, but more than that and you're risking a bleary-eyed morning, experts say.

Source: Alcoholism: Clinical and Experimental Research, WebMD

In the Fast Lane

June 2013

A shorter, faster paced workout may cut your risk of heart disease and diabetes more than strolling for an hour a day.

In a study of 10,000 Danish adults, fast joggers and walkers who exercised two to four hours a week were up to 50% less likely to develop metabolic syndrome, a cluster of risk factors - including high blood pressure, high blood sugar, and belly fat - that can lead to diabetes and heart disease. Walking at a casual pace for an hour a day made no difference in peoples' risk for the syndrome.

Source: BMJ Open, WebMD

Berry, Berry Good

June 2013

Could a handful of berries a day keep the cardiologist away? A study shows that women who eat blueberries and strawberries most days of the week reduce their risk of heart attack. Researchers followed 93,000 young and middle-aged women for 18 years. Those who ate more than three half-cup servings of blueberries and strawberries a week were 32% less likely to have heart attacks in later years. The health benefits may come from anthocyanins, antioxidants that create the red, blue and purple color in strawberries, blueberries, and other fruits and vegetables. Women who ate more berries also reported other healthy habits, such as exercising and refraining from smoking.

Source: Circulation and WebMD

Vitamin See

June 2013

Oranges, lemons, and grapefruits are some of the many citrus fruits that researchers believe originated in South and Southeast Asia. In the 18th century, people ate citrus to ward off scurvy: it took another 200 years for scientists to discover that scurvy comes from a vitamin C deficiency, which is why eating C-rich citrus prevents it. Now researchers know that the potassium in citrus fruit can also help maintain healthy blood pressure levels. Other health benefits of these sometimes sweet, sometimes sour fruits: One raw navel orange has about 70 calories, 83 mg of vitamin C, no fat, and a host of other essential nutrients, including folate. In the kitchen, you can eat citrus fresh, pressed for juice, or preserved as marmalade. The fruit's zest, or outer skin, adds flavor to cooking.

Source: WebMD

New System for High Quality Research Developed
by John Strasswimmer, M.D., Ph.D

May 2013

For years dermatologic surgeons have recognized the need for a system to execute high quality research quickly and efficiently. For that reason, Dr. John Strasswimmer, a Dermatology Associates, P.A. of the Palm Beaches dermatologist and Mohs surgery specialist, developed the DermBase dermatologic medical data system - an online system that facilitates collaborative research conducted in both academic and private practice centers. "It was created to answer the most pressing research questions in dermatology and surgical dermatology," said Dr. Strasswimmer.

In the process of creating the DermBase system, Dr. Strasswimmer worked closely with Murad Alam, M.D., M.S.C.I. With their expanding network of academic-minded dermatologists and Mohs surgeons, they conducted two powerful studies to demonstrate the utility of DermBase. Dr. Alam is the principal investigator of both studies.

The firs study was "the largest prospective study of patients ever treated with Mohs micrographic surgery - nearly 20,000 in all, Dr. Alam said. That's a vast increase over the next largest study. Dr. Strasswimmer and Dr. Alam contacted doctors seeking their participation while others found out via word of mouth. In the end, 31 doctors took part, from all over the United States, north and south, academic medical centers and a mix of high volume and low volume private practices.

The second study is the largest prospective study of cosmetic fillers: nearly 7,0iates at Dermatology Assoc00 patients in less than six months. "While the study focused in on a cosmetic procedure, we developed additional methodology to safely and practicably conduct cosmetic studies," said Dr. Strasswimmer.

In the coming weeks, results of these studies will be made public. When they are, we will publish them in this venue.

Dr. Strasswimmer, along with his Dermatology Associates, P.A. of the Palm Beaches colleagues, Howard A. Green, M.D. and Richard Krathen, M.D. are all three of the few fellowship trained Mohs surgeons and reconstructive surgeons in South Florida.

ABCDs Of Melanoma

May 2013

ABCDs of Melanoma

A sudden or continuous change in the appearance of a mole is a sign that you should see a Dermatology Associates physician. The ABCDs rule can help you remember the symptoms of melanoma.

A for Asymmetry
One half of the mole is different than the other half

B is for border irregularity
The edges are notched, uneven or blurred.

C is for color
The color is uneven. Shades of brown, tan and black are present.

D is for diameter
Diameter is greater than 6 millimeters.

Other warning signs:
  • The appearance of a new bump or nodule
  • Color spreads into surrounding skin
  • Redness or swelling beyond the mole
  • Pain
  • Tenderness
  • Itching
  • Bleeding
  • Oozing
  • Scaly appearance

Psoriasis Puts Patients at an Increased Risk for Serious Medical Conditions

May 2013

Psoriasis is a chronic skin condition that usually develops before age 35 and is characterized by thick, red, scaly patches that itch and bleed. Nearly 7 million Americans are living with this skin condition. Both genetic and environmental factors contribute to the development of this disease.

A related condition, psoriatic arthritis, is a chronic disease characterized by stiffness, pain, swelling and tenderness of the joints, surrounding ligaments and tendons. Nearly 85 percent of psoriatic arthritis patients develop psoriasis first. It generally takes about seven to 10 years for psoriasis patients to develop psoriatic arthritis and most commonly develops between the ages of 30 and 50.

“It is important for psoriasis patients to seek treatment for psoriatic arthritis early and to discuss any warning signs of this potentially debilitating condition with their dermatologist,” says Ronald L. Moy, M.D., president of the American Academy of Dermatology. “If left untreated, psoriatic arthritis can result in persistent inflammation, joint inflammation, joint damage, severe physical limitations and even disability in some patients.

Although psoriasis was previously thought to be a disease affecting primarily the skin and the joints, a growing body of research suggests that psoriasis patients are at an increased risk of developing serious medical conditions, including heart disease, type 2 diabetes, lymphoma and obesity. These medical conditions associated with psoriasis are troubling in that, if left unchecked, they can lead to serious health consequences for psoriasis patients. In fact, recent evidence suggests an overall increased risk of mortality in patients with severe psoriasis, especially those who have autoimmune and cardiovascular diseases.

“Regular health screenings and continual monitoring by their dermatologist can help psoriasis patients with the early detection of many of the associated medical conditions,” said Dr. Moy. “Dermatologists can work together with patients and other specialist physicians to determine appropriate preventive steps and treatments based on a patient’s medical history and known risk factors.”

In addition, dermatologists recognize that complying with psoriasis treatment – particularly when using topical medications that often require daily application – remains a major issue for many patients. For that reason, dermatologists may alter treatments based on the strength of therapies to achieve a favorable response and long-term management of the condition.

Patients play a key role in improving outcomes of their individual treatment plans. Dermatologists encourage psoriasis patients to adhere to their treatment plans and discuss any concerns with them. Patients should ask questions to ensure that they understand how to follow their treatment plan, avoid common triggers such as stress, smoking and consuming alcohol, and monitor their health for signs of associated medical conditions.

Dermatology Associates physicians have years of experience treating both psoriasis and psoriatic arthritis.

Important Facts About Sunburn and Skin Cancer

May 2013

Sunburns. According to a survey of white adults in Florida, 37.7 percent had at least one sunburn in the past year.
Sunburns are a significant risk factor for the development of skin cancer.
New Cases of Melanoma. An estimated 4,920 state residents were diagnosed with melanoma in 2009.
Melanoma is responsible for about 75% of all skin cancer deaths. Since 1981, the rate of new melanoma diagnoses among white males has increased by 74% and by 43% among white females. However, the percentage of advanced stage melanoma increased for white females and decreased for white males.
Deaths from Melanoma. About 626 people in Florida die of melanoma every year. Since 1975, the death rate among residents over the age of 50 in Florida has almost doubled.
In 2009, more than 1 million people were diagnosed with skin cancer, making it the most common of all cancers. More people were diagnosed with skin cancer in 2009 than with breast, prostate, lung, and colon cancer combined. About 1 in 5 Americans will develop skin cancer during their lifetime.
  • One American dies of melanoma almost every hour.
  • Melanoma is the second most common form of cancer for adolescents and young adults (15-29 years old).
  • For people born in 2006, 1 in 53 will be diagnosed with melanoma—nearly 30 times the rate for people born in 1930.

An Ounce of Prevention

  • Unprotected exposure to ultraviolet light—a known human carcinogen—is the most preventable risk factor for skin cancer. Taking simple steps as early in life as possible can reduce one’s risk.
  • Early detection of melanoma can save one’s life. Skin examinations may be the best way to detect skin cancer early.
  • The CDC found evidence that education and policy approaches in primary schools (for children) and in recreational or tourism settings (for adults) can improve sun safety behaviors.
  • Student self-reported data—collected as part of the U.S. EPA’s SunWise Program—showed that teachers using the SunWise Tool Kit for 1-2 hours yearly can spur increases in students’ sun safety knowledge and attitudes and small to modest improvements in short-term sun safety behaviors.
  • Using the data mentioned above, published modeling results show SunWise teaching between 1999 and 2015 could prevent more than 50 premature deaths and 11,000 future cases of skin cancer, saving the country more than $30 million in medical costs and productivity losses

Dr. Strasswimmer to Participate in "Run From the Rays" 5k Race

May 2013

Renowned Delray Beach Mohs surgeon, John M. Strasswimmer, M.D., is excited to participate in the Run from the Rays 5K Race to benefit the Melanoma Foundation of New England.

Run from the Rays is a 5K race which will be held on April 21, 2013, to benefit the Melanoma Foundation of New England and other non-profit organizations dedicated to the prevention and treatment of skin cancer. Start time is 7am from the Countess de Hoernie Park in Boca Raton, Florida. The course is a USATF certified 5K course. Finisher medals will go to all participants with special awards provided in 5-year age groups starting with 10 and under up to 70+, along with the top 3 overall male/female and the top male/female masters. After the race, participants are invited to a post-run pancake breakfast and refreshments. Participants may register at Registration is $25. Kids under 8 may participate in the Kids Fun Run for free which starts at 8am.

The Melanoma Foundation of New England is a non-profit organization that was founded in 1999 with the mission of reducing the incidence of melanoma in the New England region. They offer a variety of educational programs designed to aid in the prevention and early detection of skin cancer and melanoma in children and adults. The Foundation also provides support groups, educational programs and one-on-one patient advocacy and support programs for patients and their caregivers.

Dr. Strasswimmer is a board-certified Mohs surgeon who is one of the few Southeast Florida fellowship trained surgeons for Mohs skin cancer surgery and reconstructive surgery. Additional fellowship trained Mohs surgeons and reconstructive surgeons in the Dermatology Associates, P.A. of the Palm Beaches group include Howard A. Green, M.D. and Richard Krathen, M.D. They are all well-known for their exceptional credentials and excellence in both Mohs surgery and reconstructive surgery. They have extensive experience in diagnosing, treating and removing skin cancers of all kinds. Dermatology Associates physicians treat all diseases of the skin, hair and nails. In addition, they provide advanced aesthetic procedures and skin care products to help patients achieve the younger, radiant appearance they desire.

Dr. Strasswimmer received his Medical Degree and Ph.D. from Tufts University. He performed an internship at Harvard Medical School and his residency in dermatology at Yale Medical School. He performed a one year fellowship in Mohs Micrographic Surgery at the American College of Mohs Surgery. He is in private practice in Delray Beach, Florida, where he is passionate about providing his patients with personalized service and unparalleled results.

To contact Dr. Strasswimmer, go to or call 561.819.5822.

Drivers Fail to Use Sunscreen

May 2013

Researchers from Stony Brook University, Stony Brook, N.Y., and colleagues conducted a retrospective survey of patients who had been seen at a Mohs micrographic surgery clinic, according to the study abstract. Fewer patients reported wearing sunscreen while in a car (52 percent) compared with general daily sunscreen use (27 percent). Researchers noted there was a "significant left-sided predominance" of nonmelanoma skin cancers except in patients who rode in vehicles with tinted windows.

"Our results reveal poor patient awareness of and compliance with sun protection measures while in a automobile," study authors concluded. Investigators also noted the survey was not a randomized, controlled trial, and that additional limitations included selection bias and small sample size.

Skin Cancer Detection Habits Low

May 2013

The study, conducted by Harris Interactive on behalf of MELA Sciences, asked 2,109 adults aged 18 and over about their perceptions on risk of skin cancer and detection habits.

Researchers found that even though most Americans understood that moles are precursors of melanoma, less than a quarter (23 percent) perform monthly self-checks on moles and 20 percent believe them to be only beauty marks. More than a third (37 percent) don't believe they are at risk for skin cancer.

The survey also found:

  • Adults are more likely to have a physical exam than a skin cancer screening by a dermatologist.
  • Younger adults a likely than the older generation to have a skin cancer screening despite the fact that melanoma is more common in people younger than 30.
  • Women are slightly more likely than men to be screened by a dermatologist.