One of the most common questions we hear at the beginning of the summer is, “Which sunscreen should I use”? The short answer is, anything you will use consistently that meets the following criteria:
The sun protective factor (SPF) rates how effective the sunscreen is in preventing sunburn caused by UVB rays. If you’d normally burn in 10 minutes, SPF 15 multiplies that by a factor of 15, meaning you could go 150 minutes before burning. An SPF of 15 filters 93% of the UVB rays whereas SPF 30 filters 97% UVB rays. Unfortunately as of right now, SPF only measures UVB. We know UVA rays also contribute to skin cancer and are more likely to cause UV related aging. Therefore it is important to have a broad spectrum sunscreen that also covers UVA.
The decision then comes down to personal preference more than anything. Creams are best for dry skin and the face. Gels are good for hairy areas such as the scalp and trunk of males. Sticks are good around the eyes. Sprays are good for bald scalps and to quickly cover arms and legs. While sprays are convenient, it is important not to inhale or apply near heat, open flame or while smoking. There are even sunscreen powder options now which provide a good alternative for the face, head, neck and chest areas.
While choosing sunscreen is important, how you apply it is probably the most important part of the equation. Most people only apply 25-50% of the recommended amount of sunscreen. One ounce of sunscreen, about the size of a shot glass, is enough to cover most exposed areas. Sunscreen should be re-applied every 2 hours and sooner if in the water. If re-applying sunscreen that often seems impractical, then you are relying too much on sunscreen. Sunscreens are limited in their ability to protect and can sometimes give a false reassurance because you are no longer burning. Sunscreen is just one tool for avoiding the UV radiation. Wearing protective clothing has become a more reasonable alternative and doesn’t require re-application. Seek shade when appropriate and remember that the strongest rays are between 10 AM and 2 PM. As a general rule, if your shadow is shorter than you then seek shade. Use extra caution near water, snow, and sand which reflect the rays and can double your exposure.
“Melanoma Monday” is May 4, and the entire month of May is Melanoma and Skin Cancer Awareness Month. In 2015, the American Cancer Society estimates that there will be over 70,000 new melanomas diagnosed. While this is less than 2% of skin cancer cases, melanoma will cause the majority of skin cancer-related deaths (almost 10,000 people are expected to die of melanoma in 2015) and is one of the most common cancers in young adults, especially young women. It’s important to remember, though, that most cases of melanoma are caught early, and, when treated at early stages, are curable with relatively minor surgery.
What is melanoma?
Melanoma is a cancer that develops from the pigment-producing cells in the skin and other organs (melanocytes). It can lead to serious illness and even death, because melanoma has the potential to spread to other parts of the body (metastasize). Fortunately, most melanomas arise on the skin, where they are easier to see. So patients are often the first to identify their own melanomas.
While most people have at least a few moles (“nevi”), the vast majority of moles present on most of our bodies do not pose any threat of being or becoming melanoma. In fact, melanoma may not occur in a pre-existing mole. Rather, it may appear on previously normal skin. So what does that mean? Regularly examining your skin from head to toe, including the “hidden places” is the only way to be sure that your moles are not changing and that there are no new or suspicious moles. Your doctor is your partner in this endeavor, but can not possibly replace the importance of self-skin examinations.
What should you be looking for?
There are warning signs (known commonly as the “ABCDE’s”) that make a mole more likely to be one that you should be concerned about:
A – Asymmetry: Look for one half of the mole being different from the other half.
B – Border irregularity : The mole has uneven or notched borders (edges) which are not smooth.
C – Color : The mole has more than one color in an irregular pattern, or is a very different color than the rest of your moles.
D – Diameter : The mole is larger than the size of pencil eraser (6mm) (although there are melanomas diagnosed much smaller than that!)
E – Evolving : The mole is changing in size, shape, border or color, or has started to bleed.
What raises your risk for melanoma?
A person’s risk for developing a melanoma is increased by genetic factors (such as fair skin, light hair and/or light-colored eyes, close blood relatives with melanoma, the presence of many moles (>100), large, irregular or funny looking (“atypical”) moles), a history of UV exposure (such as sunburns, chronic sun exposure, tanning bed usage and a history of other skin cancers such as basal cell carcinoma or squamous cell carcinoma.
If you use tanning beds and/or like to “lay out” to get a dark tan….STOP!!! If you “must” be tan, try a sunless tanning solution (they’ve really improved!). Just remember this does not protect you from sunburns.
If you don’t use sunscreen and sun-protective clothing….START!!! Use broad-spectrum sunscreens which protect from UVA and UVB. Modern sun protection is vastly superior to older sunscreens, but still requires that you liberally and often (every two hours). Limit your exposure to UV light by avoiding being outdoors in direct sunlight too long. This is particularly important between the hours of 10 am and 2 pm, when UV light is strongest.
Screen yourself regularly by doing self-skin exams. We generally recommend examining your skin once a month from head-to-toe. To learn how, go to http://www.skincancer.org/skin-cancer-information/early-detection/step-by-step-self-examination
If you are at risk, get screened as recommended by your dermatologist or qualified healthcare professional.
Skin cancer prevention and early detection is an important aspect of ensuring the health and vitality of your skin throughout your life.
As the weather gets warmer and we start wearing shorts, bathing suits, summer skirts and dresses, we may notice little red and blue spider veins around the knees, thighs, and ankles. The cause of spider veins is not well understood, although there appears to be a definite genetic component. Most women who seek treatment for these veins report their occurrence in family members. Other common contributing factors include pregnancy, birth control pills, estrogen replacement therapy, increased weight, and injury such as bone fractures or muscle sprains.
Spider veins refer to the patches of small red and blue blood vessels that can appear anywhere on the thighs or lower legs. Larger blue or purple blood vessels, often distributed on the inner thighs, knees and lower legs, are slightly raised above the skin surface and are true varicose veins. Most women (and men) who have varicosities also have spider veins over and around the larger vessels and often some degree of leg discomfort and swelling.
Although spider veins cannot be prevented, there is an effective method of eliminating them with a procedure called sclerotherapy. This technique has been used for the treatment of spider veins since the 1930s and involves injecting a solution directly into these small vessels with a very fine needle. The solution irritates the lining of the vessel causing it to scar and slowly fade. Multiple vessels are treated this way in a single session, but several sessions are routinely needed, as some vessels may have to be treated more than once for an optimal response.
Larger varicose veins may be treated with injections but many require more complicated techniques such as using an endovascular laser, surgical removal or ligation, or radiofrequency destruction. Whether treating spider veins alone or deeper varicosities, wearing compression hose for one to two weeks after the procedure is mandatory.
After several sessions of sclerotherapy most patients can expect an 80-90% improvement. This does not, however, ensure that new vessels will stop appearing. Potential side effects of treatment may include stinging at the injection site, slight swelling of the ankles or feet, red, raised, hive-like areas at the sites of injection, and brown lines or spots on the skin at the sites of the treated blood vessels. The brown spots fade within months; the other reactions disappear within days. Optimum results are usually seen 10-12 weeks after therapy. Because the fading of the treated vessels takes this long, most patients seeking sclerotherapy are advised to schedule appointments in the late fall or winter months. Insurance rarely covers the treatment of spider veins as they view this to be a cosmetic procedure, even if patients have symptoms of aching or swelling. Treatment of larger and varicose veins is often covered if symptoms and complications are adequately documented.
Even though newer techniques and technologies have evolved recently, sclerotherapy remains the “gold standard” for the treatment of spider veins on the lower extremities.
One of the most common cosmetic requests I receive is to help improve the skin surrounding the eye (known as “periorbital skin”). This can sometimes present a challenge, because periorbital skin is distinct from other facial skin, and can even appear to age faster and more dramatically than the rest of the face.
In particular, periorbital skin is susceptible to:
* xerosis (dryness) due to the fact that the skin around has fewer sebaceous (oil) glands than other facial skin.
* wrinkling (including “Crow’s feet”) — due to the fact that this is some of the thinnest skin on the entire body and is subject to frequent eye movement and squinting. In addition, chronic UV damage is a significant contributor to this problem.
* puffiness and dark circles, largely due to the dense vascular network in the periorbital area, which can become more evident with trauma (as in chronic rubbing of the eyes), certain inflammatory conditions (such as rosacea) and as we age.
* “bagginess” which can be a result of abnormal fat pads around the eyes. The youthful appearance of the eye is dependent upon the distribution of adipose tissue in “fat pads” around the eye, which atrophy (decrease in size) and change position (including bulging and drooping) as we age.
* ptosis (drooping or sagging), which, while a normal part of aging, can also be accelerated by genetics, rapid weight loss and chronic UV damage. This can be very difficult to manage with conservative methods, and may require surgical management.
* skin lesions — such as tags, seborrheic keratoses, xanthelasma, milia, syringomas (to name a few) and of course skin cancers. These require evaluation by a dermatologist or other physician or health care provider for diagnosis and management, if needed.
These general steps may improve the skin around the eyes:
For specific issues which require professional treatment (such as Crow’s feet and skin laxity), you should consult with your physician and/or medical aesthetician to help formulate a plan addressing your specific concerns. This may include products specially formulated for eyelid skin, Botox (to decrease deep Crow’s feet), skin tightening procedures or recommendations for surgical evaluation.
Dr. Angela Hutcheson is a physician at Carolina Dermatology. She is a fellowship trained Mohs surgeon, and board-certified Dermatologist with a specialization in Cosmetic Dermatology.
Microdermabrasion, also known as Microderm, is an effective, non-surgical way to minimize acne scars, fine wrinkles and sunspots by exfoliating the top layers of the skin. No chemicals or laser beams are applied, only aluminum oxide micro crystals or a diamond tipped wand is used. Treatments are performed in salons, spas and dermatologist offices by trained professionals. Microderm should not be confused with Dermabrasion which is a surgical, invasive procedure that typically requires a local anesthetic. Dermabrasion involves a deeper abrasion with stronger abrasive devices which can cause minor skin bleeding.
There are many benefits of Microderm treatments. The most common, expected and visible results a client will see after treatments are a deep exfoliation that leaves the skin healthier and more refreshed. The loosening and removal of this dead skin makes room for newer and more vital skin cells to reveal themselves. The client may also see tighter skin, reduction in T-zone oiliness and temporary pore size reduction. These treatments can also help control and lessen acne outbreaks. Microderm removes those older, outer layers of skin and oil and dirt that may be clogging the pores, allowing medicated acne creams or lotions to penetrate the skin more easily. The microderm machine can be adjusted to skin types and conditions so that even people with sensitive skin are able to receive treatment.
Microdermabrasion was originally developed in the early 1980’s. The first Microderm machines involved vacuuming fine aluminum oxide crystals through a hand piece. As the crystals moved through the system, striking the skin, they exfoliated and then returned to the enclosed disposal canister. The more recent and common method relies on microdermabrasion tips covered in tiny diamonds to perform skin exfoliation. When the diamond tip makes contact with the skin it abrades against the top layer pulling those cells off. The microdermabrasion machine then suctions the loose dead skin cells away from the face.
There is no down time for the skin to recover from a microderm treatment. After a treatment the skin may be a little dry and may even peel slightly. This is normal. Using gentle skincare products and a sunscreen is very important following treatment for 3 days since the skin will be more sensitive than normal. Products that contain active ingredients such as glycolic, lactic or salicylic acid or retinol should be avoided for several days as they may irritate the skin.
For best results, it is generally recommended to get a series of treatments each 4-6 weeks apart. Microderm may be performed on the face, neck, back, chest and hands. The Medical Aestheticians at Carolina Aesthetics are trained and experienced in Microdermabrasion treatments. Our skin care consultations are always free of charge and designed to customize a care regimen for your particular skin.
Vitamin D is a fat soluble vitamin known for its role in calcium absorption and bone health. Over the last fifteen years, studies began to show that vitamin D
also plays important roles in the immune system by its ability to stimulate antimicrobial peptides. In addition, vitamin D may even have a role in preventing cancer. Studies in mice lacking a Vitamin D receptor showed higher cancer rates. In a study of women given either vitamin D or placebo for several years, the vitamin D group had lower cancer rates.
Vitamin D can be obtained through dietary means such as fish, fortified milk, shiitake mushrooms, or supplements. Also, vitamin D is easily produced within your body through exposure to sunlight, specifically UVB. UVB converts 7-dehydrocholesterol in your body into Vitamin D3. One study showed that 3-8 minutes of mid-day summertime sun exposure to 25% of the body generated 400 international units (IU) of vitamin D. Thus, most individuals in the summer are generating a significant level of vitamin D just from incidental exposure going about their daily lives. However, since UVB also causes skin cancer, I cannot at this time recommend even a short amount of sun as a safe option for obtaining vitamin D. The good news: Most individuals who have a balanced diet, take a vitamin D supplement (600 IU per day), and experience several minutes of incidental daily sun exposure (even if wearing sunscreen), will not be deficient in vitamin D. So, it is not recommended that you sunbathe with the purpose of producing vitamin D. Even if sunbathing for prolonged periods were somehow safe, usable vitamin D is only produced within the first 15 minutes of sun exposure.
There are individuals who are at especially high risk of vitamin D deficiency. Vitamin D deficiency is associated with darker skin, higher BMI, increasing age (>70 years old), and increased distance from the equator. Everyone is more vulnerable to vitamin D deficiency in the winter. If you are in one of the at-risk groups for vitamin D deficiency, discuss the option of supplementation with your Internal Medicine or Family Medicine physician. There may be a risk of kidney stones with Vitamin D supplementation.
1) UVB produces vitamin D but also leads to skin cancer.
2) Continue to protect yourself from the sun to prevent skin cancer.
3) Most individuals will benefit from 600 IU of oral vitamin D, especially in the winter.
4) Most individuals will have normal serum vitamin D levels, especially in the summer.
5) Discuss measuring serum vitamin D with your primary care physician (PCP)
6) If you’ve had kidney stones, only start vitamin D supplementation if approved by your PCP Miller J, Gallo RL. Vitamin D and innate immunity. Dermatol Ther. 2010 Jan-Feb;23(1):13-22  Zinser GM, Sundberg JP, Welsh J. Vitamin D(3) receptor ablation sensitizes skin to chemically induced tumorigenesis. Carcinogenesis. 2002 Dec;23(12):2103-9.  Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr. 2007 Jun;85(6):1586-91.  Terushkin et al. Estimated equivalency of vitamin D production from natural sun exposure versus oral vitamin D supplementation across seasons at two US latitudes, J Am Acad Dermatol 2010  Tang JY, Fu T, Lau C, Oh DH, Bikle DD, Asgari MM. Vitamin D in cutaneous carcinogenesis: part I and II. J Am Acad Dermatol. 2012 Nov
Winter officially begins December 21st, but your skin has probably been feeling the effects of winter long before this. The texture of your skin usually starts to change and become more dry and itchy when the indoor heat turns on. Winter can be particularly hard on your skin if you have an underlying skin condition like eczema or psoriasis. The dry air of the indoor heat will often rob your skin of necessary moisture. The amount of ambient sunlight also decreases over the winter, which can cause certain skin conditions to flare. There are a few simple things you can do to keep your skin in good shape this winter.
Despite the best winter skin care, some people still require additional treatment. There are several prescription strength moisturizers and steroid creams/ointments that can be helpful if you are still experiencing dryness and itching.
At Carolina Aesthetics, we offer numerous moisturizers for the face and/or the body. All skin care consultations are free of charge so we can help you determine which moisturizer is best suited to your skin.
When talking about cosmetic procedures, most people assume that IPL treatments are considered Laser treatments. IPL and Laser machines are similar in that they both use energy from light to perform the treatments. IPL is classified as a Cosmetic Laser, but the energy source, the energy manufactured and the way that energy is disbursed is different in an IPL machine than in a true laser.
IPL stands for Intense Pulsed Light but is also known as BBL (Broad Band Light). IPL is powered by flash lamps which create energy and, when pulsed, create a light energy of many wavelengths at the same time, which is a Broad Band Spectrum Light. IPL machines then filter these wavelengths so that those that treat specific skin conditions remain. One type of broad band wavelength targets pigment in the skin, another targets vessels while another targets the roots of hair in the skin. These targets are at different depths in the skin and need broad band wavelengths to reach them. The most popular treatment associated with IPL is called a Photofacial, which treats “photo damage” or the visible evidence of sun damage that appears as sunspots and broken capillaries. This treatment effectively evens out the discoloration of the skin and has been shown to help calm Rosacea. Another popular IPL treatment is Permanent Hair Reduction.
Cosmetic Laser machines can produce energy from a variety of energy sources such as crystals or elements. When the energy source is stimulated, it produces a precisely calibrated light energy that has a very narrow, specific wavelength, known as a Laser Beam. This concentrated beam has only one specific target. The energy source defines what that target is and thus the treatment type. There are many types of lasers on the market that are designed to treat different conditions.
Carolina Aesthetics offers a non-ablative fractional resurfacing laser. This Fractional Laser, generated by erbium, penetrates deeper into the skin than an IPL treatment. The target of this laser is water in the skin. Since skin cells are 99% water, when exposed to the laser beam, they turn into steam so fast that it removes those cells in the tiny columns where the laser penetrates. The body begins to heal these areas and in turn, accelerates the production of collagen resulting in the formation of new, tighter skin. Other types of laser treatments are available at Carolina Dermatology that treat cosmetic concerns (skin aging, skin tightening, tattoo removal, pigmented and vascular lesion removal) and medical conditions (including psoriasis and sun damage). Ask your dermatologist about these services.
If you are considering an IPL or laser treatment of any kind, it is important for you to speak with your doctor or someone trained and licensed to perform such treatments. These procedures have risks associated with them and need to be performed by a licensed professional. The dermatologists at Carolina Dermatology and the medical aestheticians at Carolina Aesthetics are trained and experienced in the IPL and lasers offered in their respective offices.
Many skin rejuvenation products containing emollients, humectants, ceremides, and antioxidants have begun to add “peptides” to their basic formulation. What are peptides, and what is their purpose in the overall rejuvenation process geared to achieve more healthy
and attractive skin?
Chemically, peptides are compounds composed of a series of amino acids bound together for a particular purpose. Amino acids such as lysine, proline, tryptophan and cysteine are molecules that are the basic building blocks of proteins found in all living things. Peptides are used as medication in a variety of settings. Some have antibacterial, antiviral, antitumor, antioxidants and analgesic effects, and although many are found in nature, peptides can by synthesized for medical and commercial use in the laboratory.
Peptides were first used on the skin in wound care treatments where they were found to facilitate more rapid healing of both deep and superficial skin ulcers and burns. It was thus recognized that some of these peptides had the ability to encourage the normal growth of structural components in skin such as collagen, elastin and hyaluronic acid, and to have antioxidant effects. One particular peptide, palmitoyl tripeptide-5 has a very similar structure to naturally occurring growth factors, and has the ability to block an enzyme in skin (matrix metaloproteinae) responsible for sun induced collagen destruction. For these and other reasons, peptides began to be incorporated in topical skin care products formulated for skin rejuvenation and health.
Numerous products sold at Carolina Aesthetics contain various peptides shown to have real effects on skin. All of the Revision products including sunscreens, for example, contain peptides. We recommend these compounds as part of a normal, everyday healthy skin care regimen.
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