Tuesday, September 13, 2016

Dairy and acne

This is not new news, but we now have more evidence in the dermatology literature confirming that skim milk and fat free milk gives more acne!

Low fat and whole milk do not have as solid links to acne as skim or fat free.  There are theories about the skim/fat free milk having more lactose or being more hormonal but that still needs to be figured out.  

Online Dermatology Consults: Azova

Telemedicine is sweeping the country and represents the new horizon in healthcare.  It began as a way for urban physicians to offer healthcare to rural patients or to those who were too far away to come in person to a family doctor or specialist.  With telemedicine, a physician can conduct a consult with a patient via live video.  There are already a handful of Telemedicine systems that are being incorporated into hospitals and clinics, but none of them offer the diversity in services as Azova.

Ask your doctors when they will be getting Azova Telehealth in their practice.

While I still encourage my patients to come in to the office if possible, if that is difficult you can try getting an online video or messaging consult with me via Azova on www.alpineskin.com

The most commonly missed cause of ACNE!

It is time I made a public service announcement about this skin truth.  I see it almost every day in my dermatology practice.  I have had dreams that it should be taught in secondary school, maybe in health class.  I also plan to teach my colleagues who practice dermatology because I have seen even experienced dermatologists miss this.  It is too common to ignore.

It might surprise you to hear that one of the most common causes of acne is a form of bad hygiene, or at least misguided or improper hygiene.  I will not totally blame it on hygiene though, because stress and hormones may underlie this type of acne.  Hopefully you are still reading with excitement as this is going to blow your mind.

DANDRUFF, yes those flakes on the scalp, even a case from a year ago, can cause ACNE!!

Here is the story...and it begins with the sebaceous oil and normal yeast flora of the scalp.
We all have sebaceous oil in our scalp and we all have a yeast on our skin that thrives in this oil called Pityrosporum ovale/malassezia furfur and will overgrow with oil and humidity.  Dermatologists now believe that dandruff in the scalp (seborrhea) may be entirely caused by this yeast overgrowing.  Therefore, dandruff is NOT a problem with dry scalp, but the opposite, oily scalp.  Any condition that increases scalp oil production may result in more dandruff.

Causes of excess scalp oil, or yeast overgrowth,  and more dandruff:
1.  Inadequate washing/shampooing of the scalp
2.  Hormone changes such as those of pregnancy
3.  Stress
4.  Taking oral antibiotics which kills some healthy bacteria that may be keeping the pityrosporum in check.
5.  Hereditary excess scalp oil
6.  pH changes in the skin

If the dandruff is neglected long enough the pityrosporum yeast can find their way to the face, neck and chest.   Often it will be worse by the hairline and go from there.  Some people or even doctors wrongly diagnose it as pomade (greasy hair product) acne.  While pomade acne exists, it is surely overdiagnosed.

I call this yeast acne "Pityrosporum Acne or Follculitis".  It may respond to over-the-counter dandruff shampoos, but you will have to let the shampoo sit on the affected skin for extra minutes and do it daily for at least two weeks.  I usually prescibe my patients an antiyeast lotion or pill when I see them in the clinic.

PITYROSPORUM ACNE has a certain look to it.  It is usually pink or skin-toned, very fine bumps 1-2 mm or less that appear on the face, chest and back.  They will often cluster on the forehead, and hairline.  

Friday, March 20, 2015

What can be done about jowls?

I would like to highlight and discuss my take on some effective non-surgical modes of improving jowls.  For those of you who need to clarify what is meant by "jowls," I am referring to the saggy and sometimes fat pouches of skinon either side of our chin that worsen with age.

Filler treatment to the jawline with Radiesse or a similar sturdy filler ( Voluma ) or multiple treatments with Sculptra can significantly diminish saggy jowls and rejuvenate the jawline.  This can be catered for either men or women, with the goal of maybe giving a more defined strong jawline for men, and a youthful, soft jawline in women.

Laser resurfacing - ablative or non-ablative - have been shown to smooth jawlines and lift jowls, and could be combined with treatment with Lipo Dissolve or a similar product to chemically dissolve fat.
This treatment is not always recommended for darker or melasma-prone skin types.

Radiofrequency heating, either subcutaneous or fractionated and applied to the top of the skin is very effective at smoothing wrinkles and skin tightening.  Treatments may need to be repeated and full results may not be seen for 3-6 months.

As far as which treatment is best for you, it is important to discuss the options with your dermatologist.  Some people, especially when there is both excess fat and skin laxity, do best with a combined approach and treatment with more than one modality.

Can we cure melasma? An update on melasma treatment

Unfortunately, a cure for melasma still remains elusive in the year 2015.  The newest, latest treatments including:  Tranexamic acid oral medication, and QS-Lasers and other lasers, may improve and clear melasma but only temporarily.   The majority of people get a recurrence of their melasma even with only mild sun exposure.   Some physicians are trying (off-label) tranexamic acid orally long term in their patients because recurrence of melasma is certain within two months of stopping the medication.    Tranexamic acid is not recommended in people who have a history of a clotting or blood disorder, are pregnant or nursing, or take aspirin.  

Monday, February 16, 2015

Shrinking those pores

While using a clinical strength topical retinoid can shrink pores, they'll come right back if you stop using it.

To shrink the pores on the face, longer term, I prefer treatment with fractional radiofrequency or a combination device that does fractional radiofrequency (RF) with microneedling simultaneously.  I am seeing lasting pore shrinkage for at least six months or more and still counting.  Multiple treatments are sometimes necessary, like 2-3 depending on the device and severity of the pore problem, but I am seeing modest improvement with even a single treatment with my Endymed Intensif device that combines the RF with microneedling.

A study from Korea, published 9/2014, had patients with large pores, treated with a fractional radiofrequency device and they were followed for three months after their last treatment and improvement was sustained.   I would like to see longer follow up to know more formally how lasting the pore shrinkage really is, but I am hopeful that it is at least six months and possibly longer.

Wednesday, January 28, 2015

Preventing aging in your skin with antioxidants

Hopefully, by now you know that sun avoidance is paramount to delaying the aging changes of the skin.  I would add (tobacco) smoking avoidance to that list too.  Aging of the skin is primarily due to oxidation which can also be delayed or lessened with the application of topical antioxidants found in skin serums and creams.  Many cosmeceutical lines now contain antioxidants.  It is best to use a line that has published good data on the efficacy of their antioxidant product.  For some ideas, see www.skincreamguide.com

Thursday, December 18, 2014

High Altitude and your Skin

This is my husband!  in the Dolomites in Italy.  He is a mountaineering guide based in Utah, as well as a physician and web developer.

He is pretty good at reapplying sunblock which is crucial when he is on the job.  Most sunblocks last only a couple hours and need reapplication.  He also tries to where a brim on his hat or helmet to protect his eyes and skin.  I check his face, neck and ears monthly for any odd skin lesions just in case.  His climbing buddies tend to get problems with pre-cancers on their neck and ears.

Tuesday, December 16, 2014

My Take on Bio-Oil

Many of my patients ask me about Bio-Oil.  It is a skin product that has been very effectively marketed to the point where some people describe it as practically magic.  It is even sold at Costco.

I would like to look together at the ingredients and tell you my thoughts.  You can see that there are multiple fragrances, many of which are known contact dermatitis allergens, which I would recommend avoiding if you have sensitive, eczema-prone, or allergic skin problems.  So, I would not recommend Bio-Oil for my patients with sensitive skin problems.  The botanical oils are calming, anti-inflammatory so for other people they not only moisturize but can be soothing to the skin.  Other than these calming and moisturizing oils which are found in many good skin products, the Bio-Oil product is not that unique or special in my opinion.  If I bought Bio-Oil I would use it for dry skin or dry hair, and avoid acne-prone areas.

In addition, the claims that are made about Bio-Oil being helpful for scars, stretch marks are unsubstantiated by controlled scientific studies.  However, botanical oils and other moisturizers will temporarily diminish the appearance of skin texture irregularities including scars and stretch marks. In addition, studies have shown that massaging scars and striae with an emollient can result in modest improvement, though it is unclear if it is the product alone or the massage/rubbing that is most effective or both.

Here are the published ingredients which I found on the company's website:


Calendula Officinalis Flower Extract (Calendula Oil)
Lavandula Angustifolia Oil (Lavender Oil)
Rosmarinus Officinalis Leaf Oil (Rosemary Oil)
Anthemis Nobilis Flower Oil (Chamomile Oil)


Retinyl Palmitate (Vitamin A)
Tocopheryl Acetate (Vitamin E)

Oil base

Mineral Oil (Paraffinum Liquidum)
Cetearyl Ethylhexanoate
Isopropyl Myristate
Glycine Soja Oil
Helianthus Annuus Seed Oil

Fragrance (Rose)

Alpha-Isomethyl Ionone
Amyl Cinnamal
Benzyl Salicylate
Hydroxyisohexyl 3-Cyclohexene Carboxaldehyde

Color (Orange)

D&C Red No.17 (CI26100)

Friday, December 5, 2014

Vanquish vs. CoolSculpting

I have been asked now and then which is better.  I offer both treatments in my office and can say first-hand that they are both effective for small pinchable (squeezable) pockets of fat.  If you have more than a few inches to pinch and really want drama faster, then I prefer tumescent liposuction.  As far as how to choose between the two (Vanquish and CoolSculpting), we price them similar and will use a few criteria to distinguish which patient would do best with which.

If you have excess fat on the abdomen, waist and back that continues pretty circumferentially, then I prefer the Vanquish.

If it is difficult for you to come once a week for four weeks in a row for an 45 minute long treatment with Vanquish, then you may prefer the CoolSculpting which can be done in one to two treatment sessions.

If you have lots of skin laxity in the abdomen or thighs, I may prefer Vanquish because there is more data to support collagen stimulation from heat than cold.

Both CoolSculpting and Vanquish can be done on the thighs.  CoolSculpting can be done off-label on the arms and chest (man-boobs).  Vanquish can wrap around almost 2/3 of the thigh circumference per treatment where as the CoolSculpting applicators are much smaller.  So if your thighs are large, Vanquish may be better.

Thursday, November 20, 2014

Article from Racked on tallow in skin creams

Click on the link (or copy the link and paste in your browser) below to see my take on tallow-based skin creams.


Monday, November 17, 2014

Aesthetic Blueprint with Kent Remington, M.D.

My partners and I just returned from the Aesthetic Blueprint Conference with Dr. Kent Remington in Dana Point, California.
I am now armed with my aesthetic calipers so I can measure everyone's intercanthal distances and verify that they have properly place brow peaks and cheek apices.

Wednesday, November 12, 2014

Tightening Saggy Skin

For years we have not had good treatment options for improving lax, saggy skin from the neck down other than surgical excision.  Many people will develop saggy skin after weight loss, hormone changes, pregnancy in women, sun damage and simply aging.  Non-ablative lasers, ultrasound and radiofrequency devices are capable of some modest skin tightening and stretch mark improvement but only after multiple treatments - three to ten depending on the device.  In addition, ultrasound (Ultherapy) is infamous for being very painful, yet no more effective than some of the radiofrequency devices.  Recently, subcutaneous radiofrequency treatment has been introduced as a more effective skin tightening option.

Subcutaneous radiofrequency skin tightening is known by the brand name ThermiTight or ThermiRF. It can be done for saggy skin of the jowls, lower face, neck, arms, abdomen, back, neck, and legs (buttock, thighs).  The procedure is done one time, outpatient, with local anesthesia and light or no sedation.  It takes one hour to a few hours depending on the size or treatment area.  Results after just one treatment are exciting and equivalent or much better to multiple treatments with the laser and device treatments I described earlier.

Results after any procedure designed to stimulate new collagen and elastin via heat ( as in laser, ultrasound, and radiofrequency) may take 3-6 months to see the full improvement.

Tuesday, October 28, 2014

Trick or Treat: Sodas, sugar, aging and acne

It's the sugar in sodas that a recent study found causes faster aging via shortening DNA telomeres.  There are other studies that show how sugar binds to collagen in the skin via glycation, stiffening the collagen so it cannot function properly and accounting for some wrinkles and saggy skin.  In addition, a high sugar (high glycemic) diet has been linked (in multiple dermatologic studies) to acne.

Hmmm....bad news for Halloween weekend.

Friday, October 24, 2014

CoolSculpting my office staff

We just CoolSculpted on of my medical assistants last week.  CoolSculpting is cryolipolysis, where fat is frozen underneath the skin.  She is a beautiful girl and she is getting married next summer, so really wanted to look her best.  She is only 24, and has stubborn pockets of fat that we treated below her belly button, and on her hips.  She did fine this week, and just had a little sensitivity in her waist.  One or two days she had some nerve pain beginning on day 4 after the procedure but that has since subsided by day 7.  She took a medication called Gabapentin which helped with that.  We were told this side effect is transient and rare, <10% of people who CoolSculpt.  Her new hourglass figure should be visible at the earliest 30 days and latest three months.  Sometimes a second treatment is needed for larger fat pockets.  Today we are treating a man for "man boobs."  I will try to post pictures in another month of my assistant.