Category Archives: Articles

Driving with the top down & why this Drives Dermatologists crazy.

Ask these 7 questions prior to a cosmetic procedure!

Rash Guards are smart and sexy, learn why your Dermatologist loves them and why you need to get one!

Spa treatments: Dr. P’s 5 tips for what you want, and what you don’t want to go home with.

Who doesn’t want to have a relaxing and refreshing Spa visit now and again to recharge your battery and feel pampered for a moment. It is important that we do indulge in these luxurious treatments for our skin and nails, but we must proceed with caution.

I recently was in a large shopping mall, and was quickly pulled in by a kiosk worker who started to buff my 1 fingernail before I could say yes or no to his administration. After I walked away, I was preoccupied with the thought that the very same emery board had been used on countless other people, and I could potentially develop a wart on that finger now! Sometimes the more you know, the worse off you are. However, this is just an example of how you can pick up a skin virus or infection without even knowing, and it is delayed often and will not present itself for weeks oftentimes. A similar incident once occurred during a massage when the masseuse began to use a cactus bristle brush against my skin as part of her routine, and the entire time I was concerned about the reuse of the tool, and was too polite to request that she not use it.

It may seem paranoid and I may be overthinking things, but this only comes to my attention because of what I see regularly in the practice of dermatology, I have many patients that have acquired warts from nail salons, the gym, and even from facials or waxing. Poor young women who have tiny warts disseminated over the face or body, and they will commonly have a history of frequenting a spa or salons. When you are using instruments on patients and not properly sterilizing them it can lead to the transmission of diseases, though not life threatening in the cases I have presented they are none the less difficult to treat and unpleasant.
Tips.

1. Seek out a salon or spa that uses a heat autoclave to sterilize their instruments.
You can ask directly if the instruments are autoclaved and they should be able to answer this question. Establishments that use autoclaves will often have their instruments in sealed bags. Other spas or salons will use an alcohol based solution to clean their instruments, this can be helpful, but is inferior to heat autoclaving. Autoclaving entails placing instruments inside a machine which under intense pressure and high heat destroys all organisms on tools and is the gold standard for sterilizing even medical and surgical instruments.

2. Don’t soak your feet in the foot bath in the nail salon.

Unless a disposable liner is being used for each customer, I cannot think of a dirtier place to soak your feet, as appealing as a nice warm soak might sound…I have seen some terrible infections that were picked up at nail salons. One such customer had suffered an amputation of one of her toes due to a salon acquired infection. The issue is that you never know who is going to pick up an infection. The vast majority of people who have these services have no such serious complication, but very commonly will develop a wart or athletes foot.

3. Bring your own nail filers/emery boards, and/or other nail tools if you desire.
When in doubt, you cannot go wrong by being prepared and bringing in your own supplies. You may get a few looks by other customers, and cause the employees to talk a little, but is it worth it to have fewer worries about your health, absolutely! It is not uncommon for many salon goers these days to come prepared with their own trusted equipment.

4. Do not permit the use of any reusable instruments that are not sterilized.
For example: getting a massage and being scrubbed with a brush that is used on other customers. Do not be shy, and don’t let anyone use something that has not been properly sterilized. A nice way of avoiding this awkward moment is to actually be up front and direct with your question before having a service.

5. If you do pick up what appears to be a wart, nail fungus, or another skin infection, do not delay seeking dermatological care, the earlier you start treating the easier it is to fully resolve.

There are so many great treatments to treat warts, and skin or nail fungus, that it makes no sense to waste time before getting treated. In additions, holding off treatment can result in the development of more warts and spreading warts or fungus to your loved ones at home.

Who hasn’t had a pimple emergency at one point in their life, if you are lucky and haven’t had to deal with this…then that is just unfair, but maybe take some notes for your friends and family!

 First treat the pimple, then camouflage it. 

 Treat the Pimple

• Ice it: Wrap an ice cube in a soft cloth and apply gently to the affected area for 20-30 seconds, rest for a minute and apply again. Cold reduces blood flow to the area and may reduce swelling and inflammation. Don’t press hard and don’t leave the ice on too long or you may irritate the skin.
• Apply an over-the-counter acne preparation that contains benzoyl peroxide or salicylic acid which kill the bacteria that cause pimples. These creams and lotions also help shed layers of dead cells, leaving skin fresher and rejuvenated. A 2.5% concentration of benzoyl peroxide is sufficient and is less irritating than stronger formulations. Overusing acne preparations will irritate the skin; follow directions precisely.
• Apply an over-the-counter hydrocortisone cream that contains 1% hydrocortisone. This medication provides pain relief, and can help to reduce swelling and redness in the area of the pimple. This should not be used every day, or for acne prevention, if used all over the face every day it can actually promote acne.

Camouflage the Pimple

• Eye drops that are formulated to reduce redness in the eyes can also be effective in reducing the redness and irritation of acne. (Tetrahydrozoline hydrochloride is the ingredient to look for.) Apply to the area with a cotton swab. Or combine with cold by soaking the cotton swab with eye drop solution, freezing for an hour or so, then applying to the pimple.
• Conceal the blemish with a heavy-duty cosmetic concealer. Consider blending two shades to avoid using one that’s either too light or too dark, which will accentuate the pimple. Blend carefully into the surrounding area.

What NOT To Do

• Don’t pick, pop, squeeze or scratch an inflamed pimple. It will take longer to heal, will be more likely to leave a scar and will be harder to camouflage. Try to keep your hands away from your face entirely.
• Don’t use aspirin, toothpaste or other home remedies that aren’t formulated for the skin. They may actually trigger acne or cause irritation.
• Don’t expect a facial, chemical peel or other spa treatment to provide a quick fix. While they may ultimately have beneficial effects, in the short term they are likely to leave the skin red and irritated. 
• Don’t overuse astringents, if used appropriately this can help the skin to contract and may shrink the pimple while also reducing the size of your pores. Pharmaceutical astringents that contain benzoyl peroxide or salicylic acid also fight pimple-causing bacteria. Natural astringents include: witch hazel (choose one without alcohol); lemon juice (dilute lemon juice with water and dab with a cotton swab over the area); and green tea (steep a tea bag in hot water, drain and apply directly).
• Don’t apply undiluted tea tree oil, an antibacterial essential oil with anti-inflammatory properties, if used directly this may be irritating to the skin. There hasn’t been much research on its effectiveness but it’s safe to use in diluted form. Dilute with coconut oil or argan oil and dab it on with a cotton swab.

General skin care advice won’t help in an emergency but good skin hygiene will help you avoid those emergencies, In a true pimple emergency call your dermatologist and see if you can be seen that same day, a dermatologist can inject the pimple with low potency cortisone which dramatically helps to resolve the break-out. For prevention, start by washing your face twice a day with a gentle facial cleanser; follow with moisturizer. Pat your face dry with a soft towel; don’t rub. Drink plenty of water. Exercise regularly and shower after exercising to remove excess perspiration from your skin. You can’t completely prevent your skin from acting up but you can reduce the likelihood of it happening at an inopportune moment and be prepared if it does.

Décolletage, “the scoop” —

Looking to prevent or treat a leathery appearing chest? Read here…

So maybe you yourself have, or maybe you know somebody who has the telltale sign of aging on the chest…you know: age spots, sun spots, red blotchy patches, and a crinkled appearance to the skin on the chest extending down into the cleavage, the so-called “décolletage.” Well, if this has become an area your are beginning to notice more, especially when you are wearing more summery attire or dresses and lower cut shirts, you are not alone. I am treating this routinely for women who come in seeking rejuvenation to this area. I am able to accomplish this very simply with laser treatments and careful assessment of the topical regimens that are being used. I am using the Fraxel dual laser for resurfacing of the crepiness and discoloration and brown spots, I use the Ulthera to tighten lax skin and also firm crepiness, and I use Pulse Dye Lasers to assist in reversing damage to blood vessels and eliminate red blotchy patches if they are present. For some patients I am able to use a combination of these laser treatments when all 3 are necessary, and the results are phenomenal.

Tips: Key to prevention is Sunscreen and minimizing sun exposure to these areas. Using a topical retinoid can help with the appearance and help prevent signs of aging. Keeping the skin hydrated with a delicate moisturizer will also help plump up skin cells and create a smoother firmer look to the skin.

How to both reverse and prevent age spots on hands!

How did these get here? You may be wondering. Well, it may not be from your vacation over the winter, or even what you did last summer, these “age spots” or solar lentigos are really a product of sun exposure and possible sun burns that occurred from childhood and young adulthood. To prevent further development and help fade the spots present daily sunscreen with minimum SPF 30 uva/uvb spectrum is necessary. Using a retinoid topically can long-term prevent the formation and help to fade marks that are already present. In my practice I am using the Fraxel to help treat these “sun spots” on the face, neck, chest, arms, shoulders, upper back, and backs of the hands. The Fraxel is a resurfacing laser with minimal downtime, and patients have the ability to cover the areas treated with make-up shortly after a treatment. This laser takes 2-5 sessions depending on the extent of sun damage present, but the results are incomparable to any other laser that I have seen.

Tips: Keep sunscreen in your car, possibly a spray for the backs of your hands, or you can invest in a pair of SPF driving gloves that you keep in the car. When we are driving the windshield does not eliminate all the harmful rays from the sun so protect your hands. And if you are active with outdoor sports (tennis, jogging, etc.) apply sunscreen to the backs of your hands and reapply every 2 hours. At night put a small amount of retinoic acid containing cream to the backs of your hands, neck and chest and face to help rejuvenate the skin.

For a lip you can bite into. All the information you need to know about getting fuller lips!

It seems these days that everyone is talking about lips, I get many patients who request “Kim Kardashian’s lips”.  I find that there is really a balance, between improving the shape, contour and volume of the lips, and at the same time maintaining a natural look that does not look fake. Indeed with the use of fillers women can now have lips that they never had, and help to regain lips that they lost with aging and sun damage. When filling the lips if the cupids bow or philtrum is weak, recreating this feature can help attain a beautiful look. The lower lip is usually fuller naturally than the upper lip, so we try to maintain these proportions when correcting lips with fillers. The lips are a very sensitive and delicate area, they tend to swell after fillers for 1-2 days, but this does go down and can be sped up with cool compresses. For most patients I will apply topical numbing ointment prior to starting, or even applying an ice pack to the area can help for the discomfort of the injections. But overall, most people do just fine with lip fillers, and the fillers often have numbing medication already premixed so the areas become numb. There are instances when people may be tempted to overfill the lips, but at the hand of an experienced injector this can be avoided. Overall, I enjoy rejuvenating and volumizing lips with fillers and highly recommend it for anyone interested in improving their lips.

Now you can finally banish those fine lines and “smoker’s lines” around the mouth!

I am seeing more and more patients who want the lines around their mouths treated. Many of these patients have never been smokers, and are confused about why they are developing wrinkles. The answer is that there are many factors that contribute to the development of “smokers lines”: genetics, sun damage, repetitive drinking from water bottles and drinking from straws are all contributing factors.

To prevent the formation of lines daily sunscreen use is important with a minimum SPF of 30, and regular application of a topical retinoid can help stimulate collagen production in your skin, you also want to avoid drinking from straws and water bottles. In addition if we can help prevent the perioral muscles from contracting strongly with Botox we can help soften the lines and even prevent lines from becoming deeper.

Fillers such as Belotero, Restylane, and Juvederm Ultra are all helpful for treating lines around the lips. My personal product of choice out of the fillers for the fine lines around the mouth is Belotero. Belotero is a great product because it is specialized to treat very fine lines and is safe to use very superficially in the skin and really looks seamless, and lasts around 6 – 9 months depending on the patient.