Krauss Dermatology

Madeline Krauss, MD

1 Washington Street, Suite 401, Wellesley Hills, MA 02481 | Tel: 781.416.3500

Archive for March, 2011

Here Comes the Sun

Monday, March 21st, 2011

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Summer is coming sooner than you think!

Here in Massachusetts, we are in a great mood. The temperature is rising. The mounds of gray ice and snow have melted, and the days are longer. Daylight savings time has caused a rush of after work joggers to compete with traffic outside our office window, directly on the route of the Boston Marathon. This is the time of year I start to obsess about one thing: sun protection.
April and May are surprisingly huge months for sunburns. There is still a slight chill in the air, so most people don’t bother with sunscreens. Teens on doxycycline and minocycline antibiotics for acne have forgotten the warnings that they are extremely sensitive to the sun on these medications. The follicularly challenged men (also known as balding) neglect to wear their baseball caps. They have already forgotten the discomfort of my liquid nitrogen treatment of their precancerous scalp spots last year. The runners forget they need a waterproof sunscreen that resists sweating. And the walk-a-thons! So many painful, red, swollen noses and forearms.
There is no question that ultraviolet light contributes to the development of skin cancer, just as cigarettes contribute to lung cancer. It has also been proven that protecting from the sun reduces the incidence of skin cancer. Furthermore, and many of my patients will heed this warning more, ultraviolet light makes you look old before your time. Wrinkles, brown spots, big pores, yellowish bumps, a sallow tone, these are the harvest of the sun worshiper. By protecting, you will look younger, period. One recent article tells the story best. A study showed facial photos (sun exposed area) of people in their 20s, 30s, 40s, 50s. 60s and 70s to a group of observers, and asked them to rate the age of the people in the photos. The same photo subjects also had their sun protected buttock skin photographed and the same observers rated the age of the buttocks. You would think that observers could correctly identify a 20 year old buttock from a 70 year old one. The ages of the facial photo subjects were correctly determined 90-100% of the time, whereas the ages of the buttock photo subjects were correctly identified about 20% of the time. Sun exposure is much more aging than time and gravity! This is supported by earlier data that sun exposed skin of the forearm produces 50% less Collagen type I than does sun protected (buttock) skin. Want collagen? Protect your skin from the sun.
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This hat from Wallaroo has a wide brim to protect your face.

We dermatologists do not expect you to hide in a cave all summer. There are great ways to protect from the damaging UVA and UVB waves. Common sense is the rule. Wear a hat. When I am asked what is the most cost effective cosmetic treatment, I instantly respond, “A hat.” A hat prevents skin cancer, wrinkles, brown spots, broken capillaries, fine lines, crinkly skin texture. The trick is to find one that you will actually put on your head and wear. Even in front of other people. Do not spend $100 on a tube of cream and only $10 on a hat. Buy a beauty. And wear it. Adding sun glasses will make you more chic, and protected.
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Quicksilver rash guard protects from UV rays and looks great

Other forms of non-sunscreen sun protection are also extraordinarily helpful in preventing sunburn, chronic sun damage and eventually skin cancer. The swim shirt or rashguard is a close fitting shirt that goes over your bathing suit and protects from the sun as well as from abrasions (from surfing, windsurfing etc.). Getting your kids used to wearing these is a great way to limit their lifetime exposure. Some of the most attractive swim shirts are available through surfer brands such as Quicksilver, and high quality versions for kids area available from many catalogs including Coolibar’s. And don’t forget the umbrella. Whether using a portable one for your day excursion, or taking advantage of a resort’s cabanas, staying in the shade can keep you from getting fried during a long day at the beach. In addition, a long lunch break in the shade, removing you from the sun’s rays during the peak hours (about 11:30 a.m. to 1:30 p.m. in the northeast) will save your skin from damage, and your kids from painful sunburns.
Use sunscreen. SPF or sun protection factor rates how well a sunscreen shields you from UVB rays. Find an SPF 30 or above product that also states “broad spectrum” or UVA/UVB protection, as protection from UVA rays is not part of the SPF rating. Ratings of higher than 30 do not mean that the product works much better than one that states 30. Because of the way the ratings are calculated, there is a much greater difference between SPF 15 and 30 than there is between 30 and 45 or 45 and 60. The higher numbers give you a false sense of security. In fact, Australian sunscreens can only be labelled up to 30+ to avoid this misconception in the skin cancer capital of the world down under.

Elta UV Pure is a safe and effective sun block.

Many patients ask how safe the chemicals in sunscreen really are. All sunscreen chemicals have been approved by the FDA, but there are some limits to how high a percentage may be used

Top Rated Sunscreen by the EWG/Skin Deep Cosmetic Safety Database! Received a #1 Rating for “Best Moisturizer with SPF”

in sunscreens. The safest and least likely to cause an allergic reaction on your skin are the “physical” sun blocks, Zinc and Titanium. An additional advantage is that Zinc and Titanium work immediately to protect you.  Suntegrity is a line of sunscreens without chemical sunblocks, and no artificial preservatives (like parabens or formaldehyde releasing chemicals). Another great physical sunblock without chemical sunscreen ingredients is very water resistant Elta UV Pure .  This product does not have any parabens or formaldehyde releasing preservatives. Elta and Suntegrity rate among the most safe sunscreens by the Environmental Working Group.  Both Suntegrity and Elta UV Pure are available in our office or over the internet.   The physical sunblock Aveeno Mineral Block, available in your local pharmacy, also contains Zinc and Titanium, but its variety of chemical preservatives make Suntegrity and Elta UV Pure better choices for those wishing to use less allergenic and artificial products.  However, among the choices at your neighborhood drug store, Aveeno Mineral Block is a good option.

Most chemical sunscreens require at least 30 minutes on your skin to become active, so you are relatively unprotected when you first apply. For chemical sunscreens, it is important to apply early, and not to wait until you are about to go out in the sun.  Combinations of physical and chemical sun blocks work very well and are easy to apply. We love Elta UV Shield SPF 45 particularly for acne or rosacea prone skin.  Coppertone Kids Sunscreen Lotion combines physical and chemical sunblocks in a waterproof formula. If you are using a traditional sunscreen off the shelf that does not contain zinc or titanium, just make sure it is SPF 30 or above, broad spectrum, apply an adequate amount, and leave 30 minutes between application and sun exposure.
Enjoy your summer and beach vacations! Improving your sun protection habits is easy. Your good behavior will inspire your family to do the same. Feel free to cheat using bronzers and self tanners (these are not harmful) or treat yourself to a professional spray tan (try the fabulous Blush in Wellesley). Never, never using a tanning booth. Look good, stay beautiful, and decrease your chance of skin cancer. Finally, and I apologize for repeating myself, get a hat!
Madeline Krauss, M.D.

 

Age Spots: Barnacles on the Ship of Life

Tuesday, March 15th, 2011

Barnacles on a ship.

The most common lesions dermatologists see are not pimples, moles (also called nevi), or freckles.  They are seborrheic keratoses.  What?  You have never heard of them?  In the confusing and archaic world of dermatology terms, seborrheic keratosis ranks high in difficult spelling and pronunciation.  An easier synonym is “age spot” or “barnacle”.  It is pretty tough on a younger patient to hear they have an “age spot” the first time.  Many dermatologists use pleasant euphemisms, “knowledge spot”, “wisdom mark”.  Older patients may use the term “liver spots.”  You don’t have to be ancient to have them, but their prevalence increases dramatically with the years.

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A classic seborrheic keratosis

“Seb Kers” as we fondly call them, are raised velvety or warty looking spots that can be a variety of colors from white to black with yellows and many shades of brown in between.  Often they appear “stuck on” or “pasted on” to the skin.  They can occur almost anywhere on the body. They have absolutely nothing to do with sun exposure, and almost everything to do with genetics.  You are somehow programmed that at a certain age, you will begin to get them.  Some people will get a few, some literally hundreds.  Unfortunately there is no cream or medication that can prevent or eradicate these growths.  The good news is they are completely benign and don’t evolve into anything cancerous.

In the doctor’s office there are some procedures that can remove seborrheic keratoses.  The most common methods of removal are liquid nitrogen treatment (cryotherapy) or surgical removal with a scalpel or a sharp circular blade called a curette.  Cryotherapy does not require an injection of local anesthetic, so is easier to perform and more popular with doctors and patients.  The risk of both of these procedures is a discoloration or lightening of the treated area, or an area of texture change or scar.  This occurs more often when seborrheic keratoses on the legs or back are treated.

Seborrheic keratoses can get red, swollen and crusty.  These inflamed lesions can be itchy or tender.  Many insurances cover removal of inflamed lesions.  Treatment of asymptomatic, noninflamed age spots is considered to be cosmetic.  Most practices will perform removal of multiple seb kers for a reasonable fee.  Post freezing of the lesions, application of petroleum jelly, or of the ointment Aquaphor to the treated area 2 to 3 times per day will speed up the healing process.  Earlier, smaller, flatter lesions are a lot easier to remove than large, thick ones.  For a better cosmetic outcome, have them treated with liquid nitrogen periodically at the dermatologists office.

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Seborrheic keratosis (left lower corner) resembling an abnormal mole

One big problem with seb kers is they make self skin exam difficult.  We have been instructing our patients for years to monitor their skin for changing moles, and the “A, B, C, D, E”s of melanoma.  When you have many brown spots, and all appear irregular, different colors, and changing, identification of worrisome moles and melanomas becomes difficult.  Moles (nevi) tend to be smoother in texture than a seb ker, but that is sometimes difficult to judge.  In fact, every dermatologist has sent in biopsies over the years to the lab asking them to identify whether the growth in question was an innocent seborrheic keratosis or a dangerous mole or melanoma.  For that reason, it is important for patients with many spots and changing lesions to be monitored by their dermatologist or primary care doctor.

Most of us would like to grow old.  We can’t always do that without a few barnacles to show for it.  No need to panic if an evenly tan or brown, velvety spot appears on the face, back of the hands, or other location on the trunk or extremities.  If the presence of an age spot is getting you down and you want to eradicate it, see a dermatologist.  If it is irregular and you are not sure what it is, see a dermatologist.  He or she will be very impressed when you say that 8 syllable tongue twister “seborrheic keratosis“.

Madeline Krauss, M.D.