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Author: Ironwood Dermatology
One of the most common problems my patients have is sun-damaged skin. Over the years ultraviolet radiation from the sun causes dyspigmentation (abnormal color), atrophy (thinning), and rhytids (wrinkles).
While there are many medications, products, and procedures that can help improve the appearance of sun-damaged skin, the best way to have beautiful skin is to prevent the damage from ever occurring. I know that here in Arizona it is extremely difficult to completely avoid the sun, but there are several things you can do to significantly reduce your exposure, and thereby limit the damage to your skin and the need for restorative treatment.
The first step is to minimize your outdoor activities during the peak daylight hours (11:00 a.m. to 2:00p.m. in the winter and 9:00 a.m. to 4:00p.m. in the summer). The second step is protective clothing, including long sleeves, pants, and a broad-brimmed hat, which are more effective than sunscreens since clothing can block the sun’s rays, provided the weave of the cloth is tight enough. The last layer of protection is sunscreen. Obviously, here in Arizona this is what most of us depend on for our protection against the sun since we are outside frequently during the day, and the normal attire is shorts and a short sleeved shirt.
There are a few keys to using sunscreen appropriately that I would like to emphasize. The main key is to use enough of the sunscreen. Studies have shown that most of us use approximately 25% of the recommended amount, which manufacturers use to determine SPF (sun protection factor). What this means is that even if you have a sunscreen that is SPF 65, it becomes an SPF of 2.8 when you use one quarter of the normal amount. The other key is to use sunscreen daily. If you apply sunscreen to the same area every day, the SPF factor increases significantly because the skin retains a portion of it for several days. It will also protect you during those times that you find yourself outside when you didn’t expect to be there.
If you follow these simple guidelines you can keep your skin beautiful longer, minimize the amount of restorative treatment, and reduce your risk of skin cancer.
By Dr. Colin Trout
Many people complain of dry, itchy skin that worsens in the winter. It can frequently progress to a diffuse, red, scaly rash that is so itchy that people can’t sleep at night and have difficulty focusing on their normal daily routine. The usual cause of this is xerotic dermatitis, which some people call “winter itch”. This is extremely common in southern Arizona because the climate is generally very dry and during the winter we are inside with heaters that lower the humidity even further. This causes the skin to lose moisture and results in a disruption of the normal barrier of the skin. Once this occurs, there is an inflammatory response (dermatitis) that is very itchy. Over time, with sun exposure and aging, the skin loses its ability to hold in moisture and this condition becomes even more prevalent.
The key to prevention and treatment of this condition is moisture. There are several ways to protect and replenish the barrier of the skin. The most important step is to use moisturizing creams daily. We recommend creams instead of lotions because they hold in more moisture and last longer than lotions. Some people do not like the greasy feeling of creams, but it is a small price to pay to prevent the development of xerotic dermatitis. Another helpful practice is to use soap-free cleansers in the bath or shower, because soap strips the skin of the components that create the barrier and contributes to dryness. Reducing the frequency of water exposure (baths, showers, pools, spa, etc.) and applying the moisturizing cream immediately after drying off will also help prevent flaring of this condition.
If you are disciplined about moisturizing and protecting your skin you can significantly reduce or prevent winter itch. If you have this problem and it is not controlled by the above guidelines, see your dermatologist for an evaluation. They may prescribe a topical steroid to get the condition under control in conjunction with daily moisturizers.
By Colin R. Trout, M.D.
Rosacea (pronounced roh-ZAY-sha) is a common disorder of the facial skin that afflicts an estimated 14 million Americans, many of whom do not know they have it. It affects mostly adults, usually people with fair skin, between the ages of 30 and 60. Rosacea is an inflammatory condition characterized most typically by facial redness and/or acne-like eruptions of the nose, cheeks, chin and forehead. Rosacea can also manifest as watery, irritated eyes or as small visible blood vessels on the face. Although rosacea is not harmful in and of itself, it is often progressive, and if left untreated can significantly impact one’s personal appearance. Surveys indicate that nearly 70 percent of rosacea patients report lowered self-esteem and difficulties with social and professional interactions.
The cause of rosacea is unknown, and there is no cure. However, medical intervention can control the signs and symptoms of this potentially life-disruptive disorder. Doctors often prescribe topical and/or oral antibiotics to treat rosacea, more for their anti-inflammatory properties than to kill bacteria. Azelaic acid, which reduces redness and inflammation, is another commonly prescribed topical medication. Because symptoms may recur when medications are discontinued, long-term treatment is often necessary.
With long-standing rosacea, the characteristic enlarged blood vessels and facial redness can become permanent. In these cases, laser surgery may be a more suitable treatment. Treatment with a vascular laser can significantly reduce the visibility of blood vessels, decrease redness and improve overall appearance.
By Robyn E. Glaesser, M.D.
Skin cancer is the most prevalent of all cancers with over one million Americans developing skin cancer this year. It has been in the media as of late with the news that the First Lady recently had a squamous cell carcinoma removed from her leg. Skin cancer is a very common occurrence here in the southwest and some statistics have indicated that the Tucson area has the second highest incidence of skin cancer in the world.
Basal cell carcinoma
- Most common skin cancer
- Appears as a pearly bump, nodule or red plaque
- Grows slowly over months
- Generally occurs on sun-exposed areas
- They can occur in areas that are not frequently exposed to the sun
- When untreated, will often bleed, crust over, heal, and then repeat the cycle.
Basal cell carcinomas rarely metastasize
- They can cause significant local damage
- Squamous cell carcinoma
- Second most common type of skin cancer
- Usually occurs on sun-exposed areas, including the ears, face (including the lips), neck and arms
- Typically appear as red, scaly plaques that may bleed and never heal
- Can metastasize to other areas of the body
- It is important to have them treated early.
- The most dangerous type of skin cancer
- It is estimated that 8,000 Americans will die from it this year
- Usually pigmented (dark in color)
- Frequently have an irregular shape
- Uneven borders
- Variations in color.
- May be larger than average nevi (moles)
- They often change in shape and/or color
- They can occasionally bleed, or be itchy or painful
- May develop in a pre-existing nevus or start as a new, dark lesion.
Prevention is the best defense against skin cancer. While sun avoidance it the best prevention, it is hard to completely avoid the sun here in the southwest. Sun protection is our next level of defense. The cowboys had it right by wearing wide-brimmed hats, long-sleeved shirts made of dense fabric, and pants. That is not the usual attire in Tucson, especially during the summer, so high SPF broad spectrum sunscreen, hats that cover the ears, and clothing designed for sun protection are recommended daily.
Skin cancer is highly curable with early detection and treatment. We recommend that patients perform a self-assessment skin exam monthly and be seen by a dermatologist at least once a year for a complete skin exam. If you have a lesion you are concerned about, have it checked by a dermatologist as soon as possible.
By Dr. Colin R. Trout, M.D. Dermatologist. Tucson Arizona.
A wide variety of temporary and permanent fillers are now available. They can be used to restore youthful facial contours by eliminating frown or smile lines, crows feet and scars and they can be used to augment specific facial features such as lips, chin, and cheeks.
Over time, these products have become safer, easier to use and more accessible to the patient. The number of products also allows physicians to treat a broad scope of problems in various ways, leading to much greater flexibility in treatment and optimum results.
The temporary fillers include collagen, hyaluronic acid, calcium hydroxylapatite and poly-L-lactic acid. With all fillers, short-term redness, swelling and tenderness at the injection sites can occur.
- Collagen has been used for over twenty years as a filler and is the gold standard that all other fillers are compared to. Collagen can be obtained from cow hide or from manufactured human skin. A skin test with the cow derived collagen is required prior to the treatment to determine whether the patient is allergic to the implant. The effect of collagen usually lasts two to four months and can be used to treat lines and wrinkles in the lower half of the face as well as lip enhancement.
- Hyaluronic acid is also available from an animal (rooster comb) or a non-animal source. Allergy testing is not required prior to using the animal derived product but there may be a low incidence of allergic reactions. HA is often used for lip enhancement but can also be used for filling facial lines and contouring. The animal derived HA usually lasts between three and six months and the other slightly longer.
- Calcium hydroxylapatite not only replaces volume to folds and wrinkles but also stimulates the body to produce new collagen. As a result, this product can last more than a year. Poly-L-lactic acid is used primarily to sculpt or repair facial defects and is not recommended for lip augmentation or treatment of superficial lines and/or wrinkles. Skin testing is not required for either calcium hydroxylapatite or poly-L-lactic acid.
Semi-permanent to permanent implants such as fat injections, and physical implants can be effective for deeper lines, furrows and folds as well as lip and cheek enhancement. Placement of these can be more complex and time consuming but relatively safe.
Filler technology is rapidly expanding and there are many more cosmetic options on the horizon. This is an exciting time in the field of cosmetic rejuvenation!
One of the most common reasons for seeking dermatologic care is for the evaluation and management of acne. Although primarily a disease of adolescence, acne can afflict infants, young adults and people in their forties and fifties. In simple terms, acne results from the action of hormones and other substances on the sebaceous (oil) glands and hair follicles. The sebaceous glands make an oily material called sebum that normally empties onto the surface of the skin via openings in the hair follicles (pores). Oil and cells that line the follicle (keratinocytes) can plug the opening. This, in turn, allows bacteria that live on the skin surface to grow and produce chemicals that attract inflammatory cells. The wall of the hair follicle can then rupture, spilling sebum, keratinocytes and bacteria into the surrounding skin. This results in the formation of “pimples”.
There are several types of acne. Comedones are plugged follicles without associated inflammation. Papules are small inflamed acne lesions that are red and tender. Nodules and cysts are deeper, painful inflammatory lesions that can lead to scarring.
The cause of acne is unknown and probably multifactorial; nevertheless, there are many myths on the subject. Chocolate and greasy foods do not cause acne, nor does dirt on the skin. However, there are things that can exacerbate acne in those with the disease: changing hormones (in adolescence or before menstrual periods), stress, oil in skin products, pressure from sports helmets, squeezing acne lesions and scrubbing of the skin.
Just as there are multiple types of acne, many treatments exist. There are over-the-counter and prescription medications that are very effective in treating acne. Depending on the type and severity of the condition, your doctor may recommend topical therapies, oral medications or both. The mainstays of therapy are topical retinoids (vitamin A derivatives) to unclog pores and topical or oral anti-inflammatory medications and antibiotics. For girls and women with acne, oral contraceptives and other medications that regulate hormones are used. The treatment of choice for scarring acne is isotretinoin (Accutane), and use of this very effective medication must be monitored closely by a dermatologist.
In addition to medications, there are cosmetic procedures which can improve acne. Chemical peels with exfoliating substances such as glycolic acid can be quite beneficial as an adjuvant to traditional acne therapy. Some relatively new, innovative treatments for acne using certain wavelengths of light and lasers are becoming more popular.
About the author
Doctor Robyn E. Glaesser is a practicing Dermatologist at Ironwood Dermatology located at 1735 E. Skyline Drive • Tucson, AZ 85718 • 520-618-1630 • Fax: 520-618-1636
There are three major types of skin cancer: basal cell carcinoma, squamous cell carcinoma and malignant melanoma. With an estimated annual incidence in the United States of 900,000, the most common type of skin cancer (and all cancer, for that matter) is basal cell carcinoma (BCC). The lifetime risk of developing BCC for Caucasian people is about 35% in men and 25% in women. BCC is thought to arise from hair follicle stem cells that lie below the surface of the skin. It typically occurs in areas of chronic sun exposure and often has as a waxy or pearly appearance. Although BCC is usually slow growing and very rarely spreads (metastasizes) to other organs of the body, if left untreated, it can be quite disfiguring. Fortunately, the prognosis is excellent with proper therapy. Treatment typically involves either surgical excision or removal via electrodessication and curettage (a simple “scrape and burn” technique).
Squamous cell carcinoma (SCC), the second most common type of skin cancer, afflicts about 200,000 Americans per year. It arises from the epidermis, the outermost layer of the skin, and like BCC, tends to occur on sun-exposed areas. The rim of the ear and the lower lip are particularly vulnerable to development of SCC. These cancers often present as wart-like growth that crust and occasionally bleed. Although most are diagnosed early enough to successfully treat with surgical excision or electrodessication and curettage, untreated SCC can metastasize to distant tissues and can be fatal.
Malignant melanoma is the most serious type of skin cancer. Over 50,000 new cases are reported each year, and the incidence is rising more rapidly than any other type of cancer. The tumor originates in melanocytes, the cells that give skin, hair and eyes their pigment. Therefore, most melanomas are black or brown in color, but they can rarely be pink, purple, red or skin-colored. They tend to be flat, with irregularly-shaped borders. If diagnosed and surgically removed early, the cure rate approaches 100%. As the cancer advances, the risk of metastasis to other organs increases dramatically. Once this occurs, treatment is difficult, and many cases result in death.
The most important thing you can do to limit your risk of developing one of these types of skin cancer is to protect your skin from the sun by avoiding sun exposure from 10:00 am to 4:00 pm, wearing sun protective clothing and using sunscreen routinely. It is also important to examine your skin monthly for any suspicious growths and new or changing moles. If you notice anything unusual, see your dermatologist for an evaluation. If you do in fact have a skin cancer, it will in all likelihood, be completely curable.
About the author
Doctor Robyn E. Glaesser is a practicing Dermatologist at Ironwood Dermatology located at 1735 E. Skyline Drive • Tucson, AZ 85718 • 520-618-1630 • Fax: 520-618-1636
Help your skin survive the desert winters
I am often asked by my patients “My skin gets so dry in this desert climate during the winter months. How can I keep it moisturized and healthy?” Here’s what I tell my patients who ask me this question.
The Sonoran Desert climate can be tough on your skin, especially in the winter months. The combination of dry air and lots of sunny days creates a challenge to keeping your skin looking and feeling good. Minimize the number of baths and/or showers you take daily and use a mild, moisturizing cleanser. Use warm to cool water only as very hot water can aggravate dry skin. Afterwards, lightly pat your skin dry and immediately apply a thin moisturizing CREAM to your skin. Reapply the cream several times daily as needed and before going to bed. Also remember to keep yourself hydrated with fluids throughout the day – your body, including your skin, will thank you!
Sun protection is another way to keep your skin in top form. Winter sun exposure can still cause significant damage and can lead to skin cancers in the future. Sun avoidance between about ten o’clock and two o’clock is ideal. Other sun protective measures include protective clothing (wide brimmed hat, long sleeves and long pants) and sunblock. Your sunblock should be at least SPF 30, contain zinc oxide or titanium dioxide, and should be applied every three to four hours for optimum results. Moisturizing and oil-free sunblocks are available, depending on your skin type. The lips are especially sensitive to the sun and to dry climates so use a moisturizing lip sunblock often. Finally, annual skin checks by a dermatologist are important for skin cancer screening.
The winter season is a wonderful time in the desert. These simple tips will keep you and your skin healthy for many desert winters to come!
About the author…
Doctor Fiona D. Behr is a practicing Dermatologist at Ironwood Dermatology located at
1735 E. Skyline Drive • Tucson, AZ 85718 • 520-618-1630 • Fax: 520-618-1636