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Winter skin

Published January 31st, 2015

With falling temperatures come ski vacations and travels to chilly locales: crisp white snow, the smell of firewood burning, and dry, chapped, painful skin. Coming in from the cold and facing blasting heat doesn't help, either.  Even for those of us in South Florida, the cooler temps can affect our skin.  So what's the best way to keep your epidermis in top shape?

Ban the fragrance. Great smelling soaps mean dry, irritated skin. Look for cleansers that are fragrance free and for sensitive skin, like cetaphil, cerave, or unscented dove.

Turn down the heat - in the shower, that is. Hot water zaps moisture from skin. Much better to take a cooler, shorter shower.

When your skin is still slightly damp from the shower, put on a moisturizing cream - not lotion. Again, no fragrance here either. I like eucerin or cetaphil cream.

Special spots: slather aquaphor on hands and feet before bedtime for extra moisturizing. Glycolic acid creams also help with extra thick rough patches.

And pay attention to clothing, too. Avoid dryer sheets and make sure detergent is also fragrance free. Wool clothing can be irritating to skin.

Remember, even though the weather is cool outside, the sun's rays are still strong. A broad spectrum sunscreen needs to be applied every single day.  No exceptions!  And remember, the sun reflects off the snow (just like with water) and causes even more ultraviolet light exposure.

Stay warm out there - and keep your skin healthy all season long!

My favorite vitamin

Published January 22nd, 2015

People spend their lives searching for the fountain of youth. Maybe if Ponce de Leon knew about vitamin A cream, he would have saved himself some time...

Being more saavy than poor Ponce, you've probably heard of Vitamin A derivatives, known as retinoids. But with so many different names and variations on the market, it can be confusing. Here's the skinny:

Retinoic acid: this topical form of vitamin A is also called tretinoin. It's available by prescription, and is more effective than over the counter forms. In science speak: retinoic acid works to promote cell turnover and collagen production, and has anti-inflammatory effects. It also enhances the penetration of other topical medications/creams. In beauty speak: it helps lighten brown spots, reduces the appearance of fine lines, smooths skin, treats acne blackheads and helps prevent new ones from developing, and improves the overall appearance of skin. Prescription brand names include: Retin-A, Renova, Atralin, Refissa, and Tretin-X.  Retinol: this is the form found in over the counter (nonprescription) products. In order to be effective, retinol needs to be converted to retinoic acid at the cellular level.  It tends to be more gentle than retinoic acid, but is still quite effective.  

Except in pregnant or nursing women, retinoids are an integral part of a good skin care routine. Add in the other essentials: a broad-spectrum sunscreen and an antioxidant/growth factor serum, and the fountain may soon appear!

Give cold sores the cold shoulder

Published January 15th, 2015

We've all seen someone with it.  Or maybe you've got it yourself.  The dreaded cold sore on the corner of the lip.  It warns you it's coming with a tingling and burning feeling, then the painful blisters arrive and often outstay their welcome.  So what's the deal with these cold sores?  Where do they come from?

A virus called herpes simplex virus (HSV) is responsible for causing cold sores, also referred to as fever blisters.  It most commonly occurs in young adults, but can be seen at any age, including infancy.  Many people are infected with the virus and never develop cold sores.  Others may have sores but they aren't painful or symptomatic.  And yet others will have fever, headache, or pain associated with the blisters.

80-90% of herpes infections seen on the lips are caused by HSV type 1, and 10-20% are caused by HSV type 2.  Genital herpes is usually reversed, with 70-90% caused by HSV-2, and 10-30% caused by HSV-1.  But this is not a hard and fast rule; either type can be seen with lips or genitals.

So how is this virus spread?  Usually skin-skin contact is required.  The virus is shed in skin or secretions.  When herpes is seen in wrestlers due to skin-to-skin contact, it's called herpes gladiatorum, and is more common on the head, neck, or shoulder.

Unfortunately, once you've contracted HSV, it's there for life.  (So what happens in Vegas doesn't always stay in Vegas...).  It stays dormant in the nerves and gets reactivated later on.  About 1/3 of people with cold sores on the lips will have a recurrence.  And of these, 1/2 will have at least two recurrences annually.  Usually there is a precipitating factor to bring it out: sunburns/sun exposure, fevers/colds, stress, and altered hormones. 

Before we discuss treatment, let's talk prevention.  Avoid skin-to-skin contact with an area during an outbreak.  The outbreaks are usually treated with oral antiviral medications such as acyclovir, valcyclovir (valtrex), or famciclovir.  If the outbreaks are very frequent, daily suppressive therapy may be used.  There are topical presciption creams, as well, but they are typically not as effective as the pills.  The medications work best if they're used as soon as the tingling/burning feeling comes on.  Although there's no cure, with today's treatments, the discomfort can be minimized and sometimes prevented.

Lovely Legs

Published January 5th, 2015

Children are so wonderful, aren't they?  They truly light up our lives with their shining eyes and smiling faces.  So wonderful, in fact, that we can almost overlook the changes they cause to our bodies.  Loose, sagging skin, stretch marks, and little winding leg veins are a small price to pay for the glory of motherhood, right?  Um, right?

Thankfully, we can improve those (ahem) little issues that occur after the little munchkin is born.  Let's talk about sclerotherapy, which is a procedure performed in the office for small varicose veins on the legs.  After all, this is sizzling south florida, where the dress code is: the less on, the better!

Sclerotherapy involves injecting solutions into varicose veins to "close the veins down."  They do this by irritating or damaging the lining of the veins enough to form a small clot, which over time, will be replaced by tissue.  Different agents are injected to acheive this, including: hypertonic saline, sodium tetradecyl sulfate (STS), polidocanol, and glycerin.  Currently, STS and polidocanol (Asclera) are FDA approved for the treatment.  Which solution to use depends on the physician's preference and the size of the vein being injected.

The treatment session usually lasts 30 min-45 min.  There very minimal discomfort during the procedure, which is often dependent on which solution is injected.  At pdmd, we favor Asclera, as it is easily tolerated with no downtime.  Compression stockings are sometimes worn after the treatment.  Usually, 2-3 sessions are recommended for best results, but veins will improve even after the first treatment.  Pregnant or nursing women should not have sclerotherapy.

Having kids doesn't mean you're destined to hide your legs for the rest of your life!

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