Can Diet Cure Skin Issues?

Posted by & filed under Acne, Anti-aging vitamins and creams, General, skin cancer.

I am often asked by patients, “Can diet cure skin issues?” The answer is yes and no!  Improving your diet alone will not cure acne, psoriasis or eczema. And, it will not prevent future skin cancers. But I can say that changing your diet and developing a healthier lifestyle, combined with the dermatologist’s recommended treatment plan will help.

Can diet cure skin issues such as acne, aging skin, skin cancer, psoriasis or eczema?

Acne and Diet:

Scientific evidence points to an association between diet and acne. High glycemic foods (foods high in sugar and carbohydrates) increase the body’s insulin which, in turn, increases oil production in the skin. This can worsen acne.  There is also evidence the hormones in milk may play a role in causing acne, especially in teenage boys. Can diet cure skin issues such as acne? Try this in addition to medications recommended by a dermatologist.

  • Decrease intake of sugar and high carb foodsslices of salmon
  • Increase foods high in Omega 3 such as salmon and walnuts or take a supplement
  • Consume dairy products from cows not treated with hormones

Aging Skin and Diet:

The science on aging skin and diet is evolving.  There are few large scale studies supporting any particular food or supplement. The advice below is supported by scientific evidence:

Here are some proven skin aging fighters:

  • Coffee and green tea: both contain polyphenols which supply a large number of anti-oxidants. Both have been shown to reduce photo aging changes such as brown spots.

More research is needed:

  • One study showed that an oral supplement containing collagen peptides, the building blocks of collagen reduced wrinkles, improved skin elasticity and improved moisture.

Super CollagenMy colleague, dietitian Jeanne Peters,  recommends “Supercollagen” available at Whole Foods. She states that her skin, hair and nails are noticeably improved.  I plan to try it myself!  Can diet cure skin issues such as aging skin?  These suggestions combined with fanatic sun protection may help!

Skin cancer and diet:

It’s no secret that the major cause of skin cancer is UV rays from the sun or tanning beds. The UV exposure causes free radicals which damage the skin’s DNA, resulting in skin cancer.

LifeExtension Vitamin B3 NiacinVitamin supplementation with B3 and skin cancer:

Recent clinical trials of oral Vitamin B3 or niacinamide,  have shown promising results  High risk patients with a history of 2 or more basal or squamous cells showed a 23% reduction in new skin cancers after taking niacinamide 500 mg twice daily for a year.  I recommend this to all of my skin cancer patients!

Certain foods have anti-oxidant properties that may be helpful in skin cancer prevention:

  • Lycopene: The red pigment in tomatoes
  • Polyphenols in Tea:  It takes at least 4 cups of fresh brewed green tea to reduce skin cancer risk
  • Omega-3 Fatty Acids:  found in salmon, tuna, and walnuts
  • Eating lots of colorful fruits and vegetables

Taking B3 and improving your diet will help your skin health. But, the most important skin cancer prevention is using proper sun precautions.

Psoriasis and Diet:

Psoriasis is known to be linked to obesity or higher body mass index (BMI). Several studies have shown increased severity of psoriasis in patients who have higher BMIs. Can diet cure skin issues such as psoriasis? These diet interventions, combined with medications prescribed by a dermatologist will help more than medication alone.

  • diet cure skin issuesDecrease intake of alcoholic beverages
  • Reduce carbohydrate and sugar intake
  • Increase Omega Fatty Acids either with supplements or foods such as salmon, tuna and walnuts
  • Increase intake of fruits and vegetables.

Skin Health and Vegan Diets:

Vegan diets, without supplementation, may be deficient in B12, iron, calcium, omega 3 fatty acids, zinc and vitamin D. Dry skin, increased paleness, brittle hair and nails may be signs of nutritional deficiency in vegans. Can diet cure skin issues due to nutritional deficiencies? Yes! Check with a registered dietitian for recommendations.

A famous quote by Hippocrates states, “Let food be thy medicine and medicine be thy food.” Since the skin is a mirror of your overall health, a well-balanced, healthy diet is critical to combating skin disease. Try some of these specific measures if you are at risk for aging skin, skin cancer, acne, or psoriasis.

using mobile apps to self-diagnose

Posted by & filed under General.

Recently I have seen some bad outcomes from patients using search engines or mobile apps to self-diagnose and treat their skin conditions.

A young woman with a minor dermatitis used search engines to diagnosis her condition. When she presented to the office she was sure she had psoriasis and wanted to know if Humira, a biologic medication, was right for her. She had spent several hours coming up with her online diagnosis. In the process, she had become very anxious about the prospect of having psoriasis, a lifetime condition. I prescribed a steroid cream for her rash, which is likely to clear it up in a week or two.

A young man made the self-diagnosis of athlete’s foot. He then searched for “natural cures” and came up with using bleach wipes and vinegar soaks. By the time he came in to see me, his localized foot rash had spread to involve his entire leg up to the knee with a red blistering rash. At that point, the reaction to the bleach and vinegar made it difficult to diagnose the original problem. Note of caution: online diagnosis and mobile apps may help you determine if you have a condition that needs medical attention. If you try an over the counter treatment that worsens the condition, stop immediately and see a doctor.

In both of these cases, the use of online diagnosis for their skin condition made the patient worse by causing unnecessary anxiety or by recommending an ineffective treatment. Here’s a summary of the latest information regarding mobile apps and online diagnosis.

Can I use “symptom search” mobile apps to self-diagnose skin conditions?

In January of 2016 Google rolled out a feature called symptom search. This app shows a description of the problem, options for self-treatment and suggestions on whether or not to see a doctor. The company got help from experts at Mayo Clinic and Harvard Medical School. WebMD, Symtomate and others already offer symptom checking apps. A recent review of online symptom checkers was conducted by Harvard Medical School and published in the British Medical Journal. Online diagnosis by symptom checking apps was accurate a mere 34% of the time. About half the time, the correct diagnosis was one of the top three options. While these apps may be helpful for patients deciding whether or not to make an immediate doctor appointment, users should be cautious. In the study, the more accurate symptom checking mobile apps were those provided by medical schools or government agencies.

Can I trust Skin Cancer Mobile Apps to self-diagnose melanoma?

Skin cancer apps are an attempt to help patients monitor their moles for worrisome changes. Typically, the app requires that a user photographs their moles with a smartphone and then enter information about moles such as size, color and recent change. The mobile apps then determines the risk of the melanoma as: low, medium or high. The FTC has found that claims by some of the companies, Mole Detective and MelApp, to accurately detect melanoma risk, were not backed up by evidence. JAMA Dermatology published a study in 2013 evaluating how accurately the skin cancer apps detected melanoma risk. Three of the four apps incorrectly classified melanoma as benign in 30-93% of cases. If you notice a change in a mole, make an appointment with a dermatologist, don’t rely on skin cancer mobile apps to self-diagnose.

Is there Bias in Artificial Intelligence used in mobile apps or search engines?

There is existing bias in healthcare data, creating a risk that AI could exacerbate, rather than eliminate bias. Clinical trials are highly selective in choosing their subjects. Many trials exclude the elderly, those with multiple medical conditions and may disfavor women. Pregnant women are almost always excluded from trials. Patients who are poor and do not have access to high quality healthcare are often excluded. Therefore, medical  data may disproportionately favor white men. Women are more likely to have medication side effects and may have different heart attack symptoms than men. Because AI uses medical data which has inherent biases, symptom checker mobile apps and online searches may be less accurate if you are not a white male!

The internet can be an excellent source of information. I think search engines are best used after a medical visit to learn more. Some of the best online sites for dermatology are: www.skincancer.org and  https://www.aad.org (the American Academy of Dermatology) as well as disease specific sites sponsored by patient advocacy groups such as www.psoriasis.org and nationaleczema.org

If you are concerned about symptoms you are experiencing, see your doctor. The mobile apps may not be helpful!

holiday cosmetic procedures

Posted by & filed under Anti-Aging Treatments, Botox, dermal fillers, General, laser treatments, Non-invasive cosmetic treatments.

While it may seem a bit early to prep for the holidays in October, some procedures have a healing period, so it is necessary to plan ahead. Here are my top four recommended holiday cosmetic procedures to look your best this holiday season.

  • CO2 laser resurfacing -2 months ahead to prep for the holidays:

If you are noticing fine lines around the eyes and mouth and age spots, CO2 laser can erase the changes due to age and too much sun in one easy procedure.  Here’s why you need 2 months to prep for the holidays with this procedure. First, you will need to schedule a consultation to learn if this procedure is right for you.  If you have darker skin, the doctor may recommend 2-3 weeks of pre-treatment with a skin brightener containing hydroquinone to block excess pigmentation post procedure.  You will need a week off to heal, which may require some advanced planning with your job or family responsibilities. The latest fractional CO2 laser procedures are done in the office with topical anesthesia plus some additional pain management. The skin heals in a week allowing you to go back to work with makeup on. However, your skin may be pinker than normal for up to 4 hours. So plan ahead if you are considering CO2 laser resurfacing to prep for the holidays this year.

  • Erbium laser resurfacing (AKA Fraxel laser): 1-3 months ahead:

This laser treatment is done in 4 stages, 3 weeks apart. The healing time for most patients is 3-4 days. This laser is an excellent treatment for acne scars and mild hyper-pigmentation (brown spots)  as well as early signs of aging. Schedule a consultation now, if you are considering this treatment to prep for the holidays.

  • Injectable fillers- 2 weeks ahead:

If you want to have luscious lips or a more youthful facial contour, fillers can help achieve that. There are now specific fillers for lip enhancement, Restylane Silk or Volbella for a natural result. Most people lose volume in the mid face with aging.  Using specific volume enhancing fillers such as Voluma, Sculptra or Radiesse in the mid face results in subtle but noticeable improvement. If you are considering laser and fillers, I recommend doing the laser treatment first followed by filler treatment 1-2 weeks later. Since all fillers can result in temporary bruising or swelling, schedule your holiday filler appointment 2 weeks before that special event.

  • Botox- 2 weeks ahead:

Botox is the #1 non-surgical treatment for lines in the upper half of the face such as crow’s feet, forehead and between the eyebrows. It reduces wrinkles by relaxing the underlying facial muscles. Optimal benefit from Botox takes 10-14 days. Good Botox can also be used, off label, for wrinkles around the mouth, enhancing results from fillers. And, it can reduce “platysma bands” in the neck. Treatment with Botox can be done on the same day as fillers. If you are considering “holiday Botox” schedule your appointment in mid-November.

Schedule your holiday cosmetic procedures TODAY

If you think one or more of these holiday cosmetic procedures may help you look and feel your best for the holiday festivities, don’t hesitate to contact us today! And, don’t forget to compliment the results with top-notch medical grade skin care products!

Doctor and patient discuss Shingles vaccine

Posted by & filed under General, medical dermatology.

I get a lot of questions about shingles.  Many of you know it is very common and very painful condition.  To illustrate, I spoke with one of my longtime patients, Gregg, who recently recovered from this skin infection. He shares his story below.

Gregg shares:

“My problem started with pain on the right lower side of my back. The pain was a dull pain that went around to my lower ribs and stomach on the same side. At first, I thought it was a sports injury. It was hard to sleep. I was scheduled to see an orthopedist.  But then my wife noticed a rash that looked like small red, bumps. She suggested I see a dermatologist. Dr. Goodlerner recognized it immediately as shingles and prescribed valcylovir, an antiviral medication) and Gabapentin (a non–narcotic medication for nerve related pain). I had a shingles vaccine more than 10 years ago but evidently, I was not completely immune. I take some immune-suppressive medications (including Prednisone) which my Dr. G says made me more at risk to acquire the infection and have severe symptoms. After several weeks, it still hurt a lot, so Dr Goodlerner referred me to a pain management specialist,who prescribed a more potent version of Gabapentin , Horizontal,  plus Tramadol  and Lidocaine patches. These helped, but it took over a month for the pain to go away. I was somewhat fortunate that my skin didn’t blister and that it didn’t spread all over me. But it did feel like there was a river of pain going through my body for the first few weeks. If you  can avoid shingles…DO IT!”

What causes Shingles?

The rash is caused by the varicella zoster virus, the same virus that causes chicken pox. After recovering from chicken pox, the virus stays in the body in an inactive state.  It may reactivate years later, due to a stress to the body such as surgery, a severe illness, immunosuppressive medications or cancer. Sometimes the cause is for unknown reasons.

Who is at risk?

Shingles is common; one in three people in the United States will develop shingles in their lifetime. Anyone who has had chicken pox can develop shingles. However, the risk is higher after age 60. More than half of all cases occur in people older than 60. Normally people who have had shingles develop immunity and do not get it again. The vaccine also confers immunity; but may need to be repeated, as my patient described above learned.

What are the signs and symptoms?

shingles FAQShingles is a painful rash that is always on one side of the face or body. It usually occurs in a single stripe or area. Although it may start as bumps or redness, the rash then progresses to blisters. Before the rash develops, there may be pain for a few days in that area. The blisters dry up and heal in about 10-14 days. In more severe cases there may be a headache, fever, chills or tiredness.

What are the complications?

The most common complication is persistent pain after the rash heals which is called Post Herpetic Neuralgia. It usually resolves in a few weeks but rarely can last for years. Post herpetic neuralgia is more common in people over 60 years of age.

You can also get shingles on the nose or eyelid may also spread to the eye and cause serious complications. Individuals with shingles anywhere near the eye should be evaluated by an ophthalmologist right away. Vision impairment can occur if shingles in the eye is not treated.

Other rare complications include pneumonia, hearing loss, and brain inflammation.

Who should get the shingles vaccine?

The CDC recommends that individuals 60 and over get the  vaccine, AKA Zostavax. It has been used in the US for more than 10 years. “It reduces the risk of shingles vaccinegetting shingles by 51% and post herpetic neuralgia by 67%” , according to the CDC.  The vaccine is a live vaccine and is not recommended in patients who are immunosuppressed.  A new vaccine is anticipated within the next year that will be safe even for those with weakened immune systems. It is much needed, as this group is at greatest risk of contracting a severe case of shingles. If you are over 60, ask your doctor or pharmacist about the shingles vaccine.

And, keep in mind the telltale sign of a painful, one sided rash. Seek medical attention right away if you think you may have shingles.