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Dear Patients and Friends,
It has been nearly a year since much of the US entered coronavirus-related lockdowns and life as we knew it was being fundamentally altered from how it had been. It seemed like yesterday when the work-from-home era began and empty streets and bare grocery store shelves and the absence of rush-hour traffic all seemed like post-apocalyptic scenes. Perhaps, the hardest part was to accept the fact that things that we often took for granted, like hugs, seeing friends at conferences and parties, dinners out together and lunches with colleagues, were no longer considered safe and harmless as they had before. I seek solace in being connected with you throughout the year. I realize how important it is for us to remember what we love more than ourselves, our focus, in our heart of hearts and our true north.
Despite the heartbreaks and chaos, there has been tremendous progress in science and medicine in the last year. We now have three effective vaccines for COVID-19. There are new diagnostic tools using artificial intelligence (AI) and targeted therapeutics in the field of dermatology in the pipeline which I am excited to share with you!
Regardless of the uncertainties we may still face together, along with the rest of the world, I want to remind all of us to take good care of ourselves and each other. (Hence, this newsletter is longer than usual, with my recommendations for self-care.)
Sometimes, the little things that we do make the most difference. I felt so moved to receive this beautiful mask, hand made with love, by one of my treasured patients. Thank you all for everything that you do and for every gesture of thoughtfulness, kindness, compassion and love. You give me hope and a sense of normalcy every day.
Sincerely,
Alison Young, MD PhD
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Dr. Young's mask handmade with embroidery from a wonderful patient.
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The Use of Dermoscopy in Skin Cancer Screening and Diagnosis
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Recent expert opinion states that dermoscopy can aid melanoma screening. Healio (2/16, Burba) reports, “Dermoscopy allows for thorough observation of morphologic features not visible to the naked eye in melanoma screening, according to a speaker at the South Beach Symposium Medical Dermatology Summit.” David J. Goldberg, MD, JD, of Skin Laser & Surgery Specialists of New York and New Jersey and Icahn School of Medicine at Mount Sinai, said dermoscopy “does differentiate between melanocytic and non-melanocytic lesions as well as benign or malignant neoplasms. The most widely used dermatoscope, because there are plenty on the market, has a tenfold magnification.”
Since the first use of skin microscopy in 1663, dermoscopic imaging has evolved from the use of a liquid medium to utilizing polarized light, and more recently, to digital dermoscopy. To date, white light has been used to illuminate, magnify and visualize the subsurface structures of skin lesions. However, white light imaging has its limitations. I am excited to introduce Barco’s digital skin imaging platform, Demetra® to my practice. Based on multi-spectral imaging that uses different wavelengths of light to illuminate the lesion, this new technology can reveal more details of skin lesions and specific skin structures such as pigment distribution and blood vessels (vasculature). I am excited about the potential of this new technology in the early diagnosis of melanoma and other skin cancers, via the implementation of machine learning AI algorithms in the near future.
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The Latest News on the Association Between Diet and Acne
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A recent review of 53 articles on the association between diet and acne published over the past 10 years showed that acne-promoting factors include high glycemic (sugar) index (GI)/glycemic load (GL) foods, dairy products, high-fat foods, and chocolate. Foods that seem to protect against acne include fatty acids (e.g., avocado, fish, nuts, flaxseed oil, canola oil, olive oil) as well as fruit and vegetables.
Many studies have confirmed that consumption of large amounts of foods with high GI/GL is a major factor in the promotion and exacerbation of acne. Hyperglycemia and hyperinsulinemia resulting from eating high GI/GL foods increase insulin-like growth factor 1, which in turn result in an increase in androgens (male hormone) that contribute to acne.
Milk probably contributes to acne due to its content in hormonal components or other bioactive molecules like steroids or growth factor stimulating hormones rather than its content in fat compounds (e.g., skim milk is consistently associated with acne). While milk has a low GI, the hormonal components increase glycemic and insulinemic levels, with effects similar to high GI/GL foods.
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Dr. Young is excited to partner with Fullscript to give her patients access to high quality supplementations from the safety of their own homes. Look out for the Cyber Monday sale coming soon.
Fullscript is a smart, easy way to access supplements and meet wellness goals – from anywhere. You can pick your favourite supplements from your preferred device, and supplements get shipped right to your front door. Plus, getting started is completely free! It’s that simple.
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Dr. Young's Tip of the Month
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CORONAVIRUS: IS HANDWASHING DRYING YOUR SKIN?
While washing your hands is critical to slow the spread of coronavirus, frequent handwashing and the increased use of alcohol-based hand sanitizers can cause dry skin that flake, itch, crack and even bleed, without proper precautions and skin care. This results in disruption of our skin barrier and the open wounds in the skin can allow in surface bacteria and increase your risk of skin infection.
To reduce your risk of dry, cracked skin from handwashing:
1. Wash your hands for at least 20 seconds in lukewarm water Even if your hands are dry, use a gentle, fragrance-free soap, and wash every part of your hands, including between your fingers and around your nails. Washing helps prevent illness by removing harmful bacteria and viruses.
2. Dry your hands with a clean towel but leave them slightly damp
While your hands are slightly damp, apply your hand cream or ointment. When skin is moist, it can better protect you from germs.
3. Keep your skin hydrated
Applying a fragrance-free hand cream or ointment immediately after handwashing and will keep your skin hydrated.(Our favorites include Aquaphor, Eucerin Advanced Repair Hand Cream, CeraVe Therapeutic Hand Cream, Vivier Ultra Hydrating Mask).
4. Allow hand sanitizer to dry. Then apply moisturizer.The Centers for Disease Control (CDC) recommend using a hand sanitizer that contains at least 60% alcohol to kill germs, which can be very drying. There is no evidence that using a hand sanitizer makes it easier to pick up germs. It is dry skin that increases your risk of picking up germs. If you have dry skin from using hand sanitizer, apply moisturizer immediately after your hand sanitizer dries.
5. Wear gloves at night
Wearing cotton or polyvinyl gloves after generously applying your favorite hand cream before bedtime helps to decrease transepidermal water loss which is increased at bedtime. Avoid wearing latex gloves as that may sensitize you to latex allergies in the future.
CORONAVIRUS: WEARING A MASK CAN BE HARD ON YOUR SKIN
While masks play a vital role in reducing the spread of the coronavirus, they can also cause problems ranging from acne and peeling skin to rashes and itchiness.
To help prevent skin problems from developing under your mask:
1. Clean and moisturize your skin daily
Use a mild, gentle, fragrance-free cleanser to wash your face. (Our favorites are CeraVe Hydrating Cleanser, Cetaphil Daily Facial Cleanser, La Roche Posay Toleriane Hydrating Gentle Cleanser, Vivier Hexam Cleanser). Apply a moisturizer containing ceramides, hyaluronic acid and dimethicone immediately after washing your face. (Our favorites are CeraVe AM and PM facial lotion, La Roche Posay Toleriane Double Repair Moisturizer, Elta MD Barrier Renewal Complex, Vivier Lexxel Moisturizing Cream). Apply a moisturizer before and after wearing a mask.
2. Protect your lips by applying Aquaphor® or Vaseline® to prevent dry, chapped lips
3. Skip the makeup when wearing a mask
Makeup is more likely to clog your pores and lead to breakouts beneath a mask. If makeup is necessary, use only products tested and labeled “non-comedogenic” or “won't clog pores.”
4. Avoid trying new skin care products that can irritate your skin
Wearing a mask for even a short time can make your skin more sensitive. To reduce skin problems, avoid trying harsh products, such as a chemical peel, exfoliant, or retinoid, for the first time.
5. Use less of certain skin care products if your face becomes irritated.
When you cover your face with a mask, some skin care products that you have used in the past such as salicylic acid, AHA/BHA, glycolic acid, lactic acid, retinoids, aftershave, may irritate your skin.
6. Wear the right mask
To reduce skin problems, look for masks that offer the following:
- A snug, but comfortable fit
- At least two layers of fabric
- Soft, natural, and breathable fabric, such as cotton, on the inside layer that rests against your skin
If the mask feels too tight or slides around on your face, it can irritate your skin. You are also more likely to adjust a poorly fitting mask. When you touch your mask, you can transfer germs to your mask and your face. The fabric is also important. Avoid synthetic fabrics, such as nylon, polyester, and rayon on the layer that rests against your skin. These are more likely to irritate your skin and cause breakouts.
7. Stop behind-the-ear soreness
Find masks with different types of ties and ear loops and wear a different type each day.
8. Take a 15-minute mask break every 4 hours
Health care workers on the frontlines of the coronavirus pandemic have found that this helps save their skin. Of course, only remove your mask when it is safe to do so and after washing your hands.
Safe places to remove your mask include:
- Outdoors, when you can stay at least six feet away from people
- Inside your car when you are alone
- At home
9. Wash your cloth masks
Many health care organizations now recommend that you wash a cloth mask after each use. Washing it also removes oils and skin cells that collect inside the mask, which could lead to a skin problem.
You can wash a cloth mask in a washing machine or by hand. Both ways remove germs and other particles. Just be sure to:
- Follow the washing instructions on each mask.
- Wash the masks in hot water unless the instructions say otherwise.
- Use a fragrance-free, hypoallergenic laundry detergent.
After washing your mask, check its shape. If a mask no longer fits snugly (and comfortably), it is less protective.
10. Continue the treatment plan that your dermatologist created for you
If you have a skin condition, such as acne or rosacea, it is especially important to follow your treatment plan. This can help keep the condition under control.
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