At Atrium Dermatology^® we are constantly on the lookout for articles we believe are of interest to our patients. Clicking on underlined text will connect you directly to the referenced article.  

Couch Potatoes Live Shorter Lives

On Jan 20, 2040 the New York Times reported that "couch potatoes live shorter lives." Researchers "followed 8,800 adults ages 25 and older for six and a half years and found that each daily hour of television viewing was associated with an 18 percent increase in deaths from heart disease and an 11 percent increase in overall mortality." Notably, "those who watched television four hours or more per day were 80 percent more likely to die of cardiovascular disease than those who watched two hours or less," whether or not they "were overweight, according to the study, which appeared Jan. 11 in the online edition of Circulation: Journal of the American Heart Association."

The Virtues of Washing Hands with Soap and Water

The Wall Street Journal recently focused on hand hygiene.  Under the caption “Fighting Disease with Soap and Water,” the Journal noted that “the list of infections that can spread via unwashed hands reads like the Biblical plagues!” I’m not sure I fully agree with that assessment, but the sampling of diseases quoted in the article caught my attention.

After reviewing the unglamorous history of the importance of hand washing (in 1847 a Viennese doctor named Ignaz Semmelweis instituted hand-cleaning after linking fatalities in his maternity ward to medical students treating his patients after working on cadavers), the article opined that hand washing is “the most effective way to stay healthy”.  However, the writer bemoaned, “Many people don't do it often enough, or long enough, to be effective.”

Quoting Health columnist Melinda Beck, the Journal then offered a guide to “the best way to wash off germs and protect against sickness”.

When to do it.

·        Every time after you use the bathroom, (every surface presents an opportunity for germs to spread)

·        whenever you change a diaper, pick up animal waste, sneeze, cough or blow your nose;

·         when you take public transportation,

·        when you insert or remove contact lenses,

·        when you prepare food,

·        when you handle garbage and

·        before eating.  Ironically, she points out, even at a food hygiene convention she attended everybody shook hands after the talk, and then ran straight for the food line. Nobody washed their hands!

How to do it.

Simple soap and water!  In one study it was found that soap and water removed slightly more virus than three alcohol-based hand rubs. When volunteers didn't clean their hands, most of the virus was still present an hour after exposure. As to technique, the article notes that “it's the mechanical process of washing that's so effective. Soap molecules surround and lift the germs, friction from rubbing your hands loosens them, and water rinses them down the drain.”

Experts recommend

·        using warm water, and

·        enough liquid soap to build a lather

Technique.

·        Lace your fingers together to cover all the surfaces.

·        Rub the fingertips of one hand into the palm of the other, then

·        Rub the fingertips of one hand into the palm of the other (i.e.: reverse!).

·        Keep rubbing for as long as it takes to sing "Happy Birthday" twice.

·        Rinse thoroughly.

The article suggests that one “leaves the water on while you grab a paper towel and use it to shut off the faucet. Take the towel with you to use on the door handle as well.” In fact, I would suggest that you might want to hold on to that towel throughout the day, in case you have to shake hands with someone before your next bathroom trip! A little extreme, perhaps, but it makes sense! 

Antibacterial soaps are no more effective than regular soap. In fact, suggests the article, “some antibacterial ingredients like triclosan leave a residue on the skin that continues killing some bacteria. Critics worry that the remaining bacteria could become resistant, not only to soap but also to antibiotics.” Also, the writer concludes, antibacterial soap gives people a false sense of security.

Drying.

The Journal advocates using paper towels over those awful air dryers –which it observes, can blow remaining germs as far as six feet away!

How to Check for Skin Cancer

After noting that over one million new cases of skin cancer are diagnosed every year in the United States, Wikipedia, in an on-line “how to” article, points out that if you spend any time exposed to UV rays, whether it's from the sun or from tanning beds, you are at risk. The danger exists no matter where you live or how dark your skin is.

The Wikipedia article includes instruction on how to conduct a self examination.  At Atrium Dermatology^® we couldn't agree more that, along with taking preventative measures, the best way to minimize the threat of skin cancer is to check yourself regularly, and detect it early on.  Plan to give yourself a skin exam once a month, in addition to your annual check-up with Dr. Gumpertz.  If you are concerned about what you see (or feel) on your self examination, call us at (440) 646-1600 or email us at AtriumDerm@aol.com to set up an appointment.

A Lesser Considered Hazard of Sunburn

It’s hard to laugh about sunburn, but we found this Bud Light Commercial rather amusing!

5 ways to protect against skin cancer

·         Watch your shadow.  If it's shorter than you are, the sun's rays are strong. Go inside or seek shade.

·         Wear sunglasses.  Look for lenses with 99% to 100% UV absorption. They provide the best protection for your eyes and surrounding skin.

·         Choose your clothes.  Cute or not, a sundress can't protect your skin as well as clothing with more coverage. Choose outfits made of tightly woven materials that you can't see through when held up to the light.

·         Wear a hat.  Look for a wide brim, which will shade your neck, ears and face. Baseball cap-wearers: Slather sunscreen onto your neck and ears.

·         Sunscreen. Sunscreen. Sunscreen.  Oh, yes, and sunscreen. Use one with an SPF of at least 15 and reapply more often than you probably think you need to, even on hazy or cloudy days.

Consumer Education: Sunscreen - The SPF Factor: What it means

On May 21, 2009 the Houston Chronicle addressed the issue of SPF (“sun protection factor”) numbers. Referencing a Food and Drug Administration report, the article noted that sunscreen labeled “SPF 15” does not mean that the wearer can stay in the sun 15 times longer than if no sunscreen had been applied.  Rather, SPF numbers are simply a gauge indicating the amount of harmful ultraviolet light making its way to the skin.

SPF 15 blocks about 93 percent of UVB (ultraviolet B) rays that cause sunburns, while SPF 30 absorbs nearly 97 percent.  SPF 50 will stop nearly 98 percent of these UVB rays.

But any sunscreen's effectiveness will depend on a number of variables, including the amount used, the time of day when the user is exposed to the sun, the time of year, and how much the user sweats.

We recommend

·      covering up as much as possible,

·      wearing a wide brimmed hat, and

·       applying at least one ounce of sunscreen to exposed areas of your body (about as much as would fill a shot glass)

·       . . . at least every two hours.

The Burning SPF Question:  Is Bigger Better?

In an article on sunscreen protection on June 22, 2009, the Wall Street Journal supported the idea that cheaper sunscreens may be just as effective as their more expensive counterparts. According to the American Academy of Dermatology, sunscreens should be water resistant, have an SPF of at least 15, provide broad-spectrum coverage against UVA and UVB light, and must contain the proper ingredients.  Although the article fails to mention what these ingredients are, it suggests that these would include avobenzone (also called Parsol 1789), titanium dioxide or zinc oxide.

However, protection doesn't increase proportionately with a bigger SPF number; SPF 15 blocks 93% of UVB rays, SPF 30 blocks 97% of UVB rays.   

The Journal notes that since SPF only applies to UVB rays (the Food and Drug Administration does not offer UVA ratings), sunscreens which claim broad-spectrum protection may not actually be delivering fully on their promise.

But perhaps the soundest advice offered in the Journal is that to be effective one must reapply a one-ounce amount frequently.

Other News of Interest to Atrium Dermatology^®

Patients

Online Health Quizzes allow pharmaceutical companies to market their drugs:  

On March 26, 2009, the New York Times reported that one of the most popular tests on the Internet is really a marketing source for pharmaceutical companies. The website suggests that, based on your responses to a questionnaire, it can supply products that will make you look young.  An on-line test asks about 150 questions about lifestyle and family history and,  based upon “how young or old your habits make you" it then assigns a biological age.  The website then makes recommendations on how to “get younger”.

In reality, the website makes its money by allowing pharmaceutical companies, including Pfizer, Novartis, and GlaxoSmithKline to use almost any combination of answers from individual tests to find people to market to.  The data released from responses to the seemingly innocuous questionaire includes whether the respondent is taking antidepressants, how sexually active they are, and even if their marriage is happy.       -Be warned!

Partners may help in conducting skin self-exams:

On February 14, 2009 the Tampa Tribune reported that, according to the American Academy of Dermatology (AAD), Valentine's Day was "the perfect time to 'Screen the One You Love' for skin cancer." Dermatologist and AAD president C. William Hanke, M.D., stated, "In my practice, oftentimes patients tell me that their partner urged them to get an unusual-looking mole checked -- and in some cases these moles turn out to be skin cancer." A 2007 study in the Journal of the American Academy of Dermatology found that people who are assisted by a partner in performing skin self-exams are more likely to follow a regular detection routine than those who rely solely on themselves for motivation."  

The difference between dry winter skin and eczema:  In the February 15, 2009 edition of New York's Newsday a Mayo Clinic dermatologist wrote that while "ordinary winter dry skin and eczema might look similar...the conditions are unrelated, with different causes. Eczema will likely require a trip to see a dermatologist...to discuss treatment options," and to check for "signs of infection in the eczematous skin. Antibiotics will be necessary if the skin is infected." Also known as atopic dermatitis, eczema "is a skin disorder that's related to an immune system sensitivity" in which "patches of inflamed skin...can be very itchy, weepy and crusty." To treat the condition, "nonprescription anti-itch creams can provide relief," but "a doctor also might recommend corticosteroid creams" or "another class of ointment medications, called immunomodulators," which "help reduce flare-ups." Still, "it's wise to see a dermatologist," because "other skin disorders, such as psoriasis or even malignancies, also can appear as small areas that are dry, flaky, red, cracked or sore."

Artificial Tanning Booths and Cancer:  redOrbit Knowledge Network, an online community for those with an interest in science, space, health and technology, recently reported the results of a study conducted by Mark Purdue of the National Cancer Institute.  Dr. Purdue examined melanoma incidence between 1973 and 2004, and found that the rate had jumped by 50 percent since 1980 for women between the ages of 15 and 39. For men of the same age, the rate remained stable.

Purdue concludes that the disturbing result stems from a combination of excessive sun exposure and the possible overuse of tanning salons, which tend to cater more to women than to men. Tanning beds emit ultraviolet rays that can damage the skin the same way that the sun can.

Long-term exposure to artificial sources of ultraviolet rays like tanning beds (or to the sun's natural rays) increases both men and women's risk of developing skin cancer. In addition, exposure to tanning salon rays increases damage caused by sunlight because ultraviolet light actually thins the skin, making it less able to heal. Women who use tanning beds more than once a month are 55 percent more likely to develop malignant melanoma, the most deadly form of skin cancer.

According to the National Cancer Institute, more than one million people are diagnosed with non-melanoma skin cancer in the United States every year. In fact, non-melanoma skin cancer is the most common type of cancer in the country. Forty to 50 percent of Americans who live to age 65 will have this form of skin cancer at least once. These are startling statistics for a cancer that can, for the most part, be prevented.

WHO IS AT RISK? Almost everyone who frequents a tanning salon or exposes themselves to the sun is putting themselves at risk for skin cancer. The risk is greatest for people with fair skin; blonde, red, or light hair; and blue, green, or gray eyes. Artificial tanning can also be more dangerous for those who burn easily, have already been treated for skin cancer, or have a family member who has had skin cancer. In addition, women have a higher risk of contracting skin cancer on their legs, and men have a higher risk of getting it on their backs.

CAN IT BE PREVENTED? There are various things than one can do to prevent their exposure to artificial sources of ultraviolet rays:

·         Avoid tanning beds and booths.

·         Instead of going to a tanning salon, try tanning sprays. In fact, some salons now provide only tanning spray services.

·         Regardless of your exposure to natural or artificial UV rays, conduct a monthly skin self-exam looking for any abnormalities (like bumps or sores that don't heal) or moles that have changed size, color or shape. Be sure to check all areas. Have a friend or family member check your back.

·         Make an appointment to visit Dr. Esti Gumpertz to get an annual exam. If caught early skin cancer is now almost 100 percent curable.

Long-term exposure to artificial (or natural) sources of ultraviolet rays increases one's risk of developing skin cancer. However there are alternatives one can take to minimize the risk associated with artificial rays such as using sunless tanning lotions or sprays in concert with regular skin checks by your physician or dermatologist. 

Interaction of Sunscreen and Bug Control Products

On March 2, 2009 the Seattle Times addressed an important issue faced by those of us who enjoy the great outdoors once the weather warms up. The article questioned whether there is a product containing both sunscreen and bug control (deet) on the market?  Of perhaps more practical concern was the effect of interaction of the two products if applied independently to avoid both sunburn and mosquito bites.

The Times reported that several combination products with both insect repellent and sunscreen are available, but cautioned that The Centers for Disease Control and Prevention does not recommend their use.  This is because while deet should be used sparingly, sunscreen requires frequent applications.

Recent research reported in the British Journal of Dermatology shows another problem with such combination products: mixing oxybenzone (a common sunscreen ingredient) with deet dramatically increases absorption of both chemicals through the skin. 

In addition, The Lancet reports that deet can reduce the effectiveness of sunscreen applied at the same time.

The conclusion: apply sunscreen first and allow it to dry before putting on insect repellent.  Although this reduces deet absorption, it may increase the passage of oxybenzone through the skin. 

Cosmetic Update

Quite recently AOL offered skin tips to computer surfers, many of which were based on recent research results (though much of the proffered information seemed to segue into a recommendation for a specific commercial product).  Below are selections from their offering

1. Drinking milk may aggravate teenage acne

If you battle breakouts, milk could be adding to your troubles. Three large studies have found that drinking milk made teens’ acne worse. Researchers say hormones that occur naturally in cows may be the reason, and they believe women in their twenties and thirties could also be susceptible. "If you're a big milk drinker and zits are a problem, you may benefit from cutting back," says Clement Adebamowo, M.D., an oncologist and lead researcher on these studies. He recommended milk substitutes, like soy, instead.

2. Health benefits of Tomatoes

A recent British study found that subjects who ate five tablespoons of tomato paste every day suffered milder sunburns than those who didn't. Researchers think lycopene, a powerful natural antioxidant found in tomatoes, provides the sun-shielding bene­fits.

3. Effects of Stress

Stress can adversely affect your complexion. Researchers at England's University of Manchester took pre- and post-presentation snips of skin from the butt cheeks of participants and then compared the cellular activity. The tense skin showed a 16.4 percent decrease in immune-system-regulating cells. Another study reported that stress caused acne to worsen.

4. low-glycemic diet benefits acne patients

Researchers recently put 23 people with acne on a high-protein, low-glycemic diet for 12 weeks -- and found that their skin got much better. Testers had 21.9 percent fewer blemishes, versus 13.8 percent fewer for a control group that followed a high-carb diet. While the researchers recognized the positive benefit of the incidental weight loss,  the study suggests that the dietary changes helped improve the acne.

5. Showering after a Workout

Sweating produces sebum, an oily pore-clogging secretion.  Since bacteria love to feast on sweat and oil, not showering after a workout will almost inevitably result in breakouts. After any sweat-inducing activity, rinse off under cool water with a shower wash containing oil-clearing glycolic or salicylic acid.

6. Economy Cleansers

"There's no need to buy an expensive cleanser loaded with fancy ingredients," says photobiologist Daniel B. Yarosh, Ph.D., author of The New Science of Perfect Skin. "They're on your skin for less than a minute, so they don't have time to really do anything." In fact, he says, some ingredients,  such as peppermint and eucalyptus, can actually cause irritation.  To be effective, cleansers need only remove dirt, oil, and dead skin cells without stripping away your skin's natural (and necessary) oils.

7. Lip Balm

Your lips have some of the thinnest skin on your body, so they need extra shielding lip balm with UV protection. A survey by a member of the American Society for Dermatologic Surgery found that only 47 percent of respondents used lip protection containing UV blockers. That's bad news, because "when skin cancer originates from the lips, it's especially aggressive and has a higher risk of spreading," says Erin Welch, M.D., assistant professor of dermatology at the University of Texas Southwestern Medical Center.

8. Health Benefits of Vegetables

Research conclusively shows that fruits and vegetables protect and restore the skin. Highly recommended and packed with vitamins A and C (both are antioxidants) are leafy greens, cantaloupe, citrus fruits (especially oranges), blueberries, strawberries, and bell peppers.

9. Recommendation to use Retinoids from an Early Age

Retinoids, which contain vitamin A, are one of the most potent agents for preventing and reversing sun damage and signs of aging. "Even women in their twenties should be using a topical retinoid -- unless they're pregnant or nursing," says Francesca Fusco, M.D., assistant clinical professor of dermatology at Mount Sinai School of Medicine in New York City. Retinoids speed skin renewal by shedding dull, pore-clogging cells and increase collagen production to prevent wrinkles.

10. Moisturizers

"Lock in the benefits of a product's active ingredients by following up with a moisturizer," says Ranella Hirsch, M.D., president of the American Society of Cosmetic Dermatology and Aesthetic Surgery. Look for lotions containing hyaluronic acid or glycerin to keep skin supple.

11. Painless Hair Removal

Studies have shown that Eflornithine HCl, a prescription cream sold under the name Vaniqa reduced hair on the chin and upper lip for nearly 60 percent of women tested. And in two separate studies, using the cream with laser hair removal was more effective than either treatment alone.

12. Effect of Aspirin in Reducing Skin Cancer Risk

A study from the Queensland (Australia) Institute of Medical Research found that people who regularly took some over-the-counter pain relievers, including aspirin, have a lower risk of developing squamous-cell carcinoma, a common form of skin cancer.

13. Reducing Rosacea Irritation

Researchers have found that when rosacea sufferers wash their faces with a sonic skin-care brush their skin calms down. The theory is that the gentle exfoliation allows skin treatments to be absorbed more effectively.

15. Special Creams

Investing in special creams for specific body part actually does make sense. For example, since skin around eyes is delicate eye creams contain lower levels of potentially irritating ingredients, such as retinol, AHAs, and glycolic acid, than products designed for the face.

16. Effective Sunscreening

"To get a decent amount of UV protection on your face, you'd need to coat your skin with at least a tablespoonful of sunscreen that has an SPF of at least 30," says Sandra Marchese Johnson, M.D., a dermatologist in Fort Smith, Arkansas. She suggests applying a coat of sunscreen followed by a foundation infused with sunscreen or a mineral powder containing titanium or zinc oxide, both natural barriers to UV rays.

17. Healthy Legs

"Cuts, scratches, and scrapes below the knee take a long time to heal and can be prone to infection, since they're an easy entry point for germs," says Doris Day, M.D., clinical assistant professor of dermatology at the New York University Medical Center. Prevent the little cracks that allow bacteria to enter your skin by smoothing on a moisturizing cream every night; to prevent nicks, use a razor with built-in moisture strips, and don't shave your legs for two or three days before a pedicure because salon whirlpool footbaths can be a breeding ground for bacteria.

18. Skin Care Routine

To prevent ingredient overload and reduce irritation, Zoe Diana Draelos, M.D., editor-in-chief of the Journal of Cosmetic Dermatology, advises limiting your skin-care routine to only those items that contain no more than 10 ingredients apiece. According to Draelos, the fewer ingredients there are in a product, the less likely it is to cause a problem. "And to avoid diluting the effects of the previous application always wait at least five minutes between applying another product.

19. Laundering Tip

When you sleep, lotions, hair gels, and oils sweat off of your body and onto your linens. Kenneth Beer, M.D., clinical instructor in dermatology at the University of Miami, advises washing your sheets weekly. At the very least, put on a fresh pillowcase to keep the gunk (and the bacteria that eat the gunk) from clogging your pores.

20. Tanning Advice

For the first eight hours or so after you apply a self-tanner your skin is especially susceptible to free-radical damage from sunlight, according to a 2007 German study. Forty minutes after researchers treated skin samples with the bronzing ingredient in self-tanners, dihydroxyacetone (DHA), elevated levels of free radicals (180 percent more than untreated skin!) formed during sun exposure. Another self-tanner ingredient, erythulose, produced a similar response. Researchers suspect that when the bronzer interacts with the skin, a chemical forms that generates free radicals when exposed to UV light. The safe way to get a tan is to avoid excessive sun exposure for at least 12 hours after applying a self-tanner.

21. Sunscreen Protection

An SPF of 15 blocks 94 percent of burning UVB rays; jump to SPF 30 and you'll get 98 percent coverage. Going to 50 adds just 1 percent more coverage. A smarter choice is a broad-spectrum sunscreen with zinc oxide and stabilizing ingredients that prevent UV blockers from breaking down in sunlight.

22. Overnight Treatments

Hormonal surges during sleep cause your sebaceous glands to pump oil. Those cursed with oily skin and breakouts can fight acne and grease slicks before they strike with an overnight treatment.

23. Smoking Danger

A 2007 study found that smoking ages the skin on your body that the sun doesn't even see. Researchers found that smokers had more pronounced wrinkles than non-puffers on areas of the body usually untouched by UV rays, like the inner arms. "It seems that smoking accelerates the aging process," says Yolanda Rosi Helfrich, M.D., assistant professor of dermatology at the University of Michigan and lead researcher on the study.

24. Benefits of Dark Chocolate

Studies show that nibbling on dark chocolate will arm your skin with additional flavonols, protective nutrients that researchers believe absorb UV light and increase blood flow to the skin, improving its appearance. In one German study, women had flavonoid­enriched cocoa every day for 12 weeks, and afterward their skin was softer, less irritated, and up to 25 percent less sensitive to sun damage when exposed to ultraviolet light.

25. Visit Dr. Gumpertz Regularly

Dermatologists really are the best at knowing which growths are worrisome and which are harmless. A survey in the Journal of General Internal Medicine found that dermatologists had significantly higher accuracy in identifying abnormal skin growths than primary care physicians. In fact, more than 90 percent of dermatologic surgeons have seen one or more patients in the past year with a skin cancer that had been overlooked or misdiagnosed by a non-dermatologist. Melanoma, the most serious form of skin cancer, is the third most common cancer in women ages 20 to 39.