The Whole Story: Accutane

 Some rights reserved by perry_marco

So you have acne. Your acne is very bad and you’re thinking only Accutane will cure it.

You may want to think a little harder about this decision. Accutane is very effective for treating acne, but also very powerful and potentially dangerous. In this blog post, I’ll outline some of the effective uses for the drug, as well as when you should take it – and if you should take it.

1.    See a dermatologist.

Acne is a medical problem. If you have a virus, you would go see a doctor, and acne is not different. If you have tried some of the over-the-counter washes and creams, it may be time to check out medical-grade treatments. But only a licensed dermatologist can provide you with the proper skin care you need to overcome your acne.

2.    Work with your dermatologist to evaluate your acne.

Although approximately 80 percent of teens and pre-teens have acne, most cases are not severe enough to warrant major treatment. Usually, some regimen of topical creams, medications and/or washes will do the trick. Your dermatologist can recommend which regimen will work best for you, and can make changes as needed.

3.    Exhaust all possible avenues.

There are hundreds of medical treatment options available to treat acne, so I would never recommend making Accutane your first choice. If you can use something gentler, milder or safer – do. Accutane really should be a last resort for particularly tough or persistent cases of acne.

4.    Discuss the pros and cons of Accutane.

Accutane works by reducing oil production in the body’s glands. As clogged pores are the primary reason for breakouts, Accutane is effective in reducing or eliminating acne for most people.

Although it can be very effective, Accutane can also be dangerous if not taken correctly or if precautions are not taken. Risks include:

• Serious birth defects if taken while pregnant
• Depression or other psychological side effects
• Liver problems related to fatty buildup

While taking Accutane, patients should not give blood, drink multiple alcoholic drinks at one time, have laser procedures or wax regularly.

5.    Educate yourself on the iPLEDGE program.

As a result of so many serious risks associated with Accutane, the drug is now only available through the iPLEDGE program. The program is designed to prevent Accutane-related birth defects. The program requires:

• Two forms of effective birth control (acceptable forms are spelled out by the program)
• For women - A negative pregnancy test 30 days prior to starting medication and every month prior to filling the prescription
• Monthly questionnaires to remind patients of the rules and risks associated with Accutane

6.    Take precautions.

Although Accutane-related birth defects are one of the biggest risks associated with the drug, it is important to consider others.

• Accutane patients should not drink, as the drug itself can cause fatty buildup in the liver. It can also replicate the effects of long-term drinking, like cirrhosis of the liver. Drinking multiple alcoholic drinks at once while taking Accutane can exacerbate potential liver problems.
• Patients will be required to undergo regular blood tests prior to fulfilling their prescriptions each month. This ensures (for women) that there is no pregnancy and for all patients that the liver is functioning normally.
• Family members and friends should watch Accutane patients for signs of depression and other psychological side effects. While these side effects rarely last beyond the final pill, they should be monitored during the Accutane regimen.
• Patients should not wax, have laser treatments or exfoliate heavily during their Accutane regimen. Because the drug dries out the skin, it is more susceptible to ripping or tearing, and waxing may leave permanent scarring. 

7.    Prepare to prevent future breakouts.

Accutane works very well for many people who use it correctly. Although it is risky, it is one of the most effective acne drugs on the market. Due to its risks, most patients should not take Accutane for longer than six months at a time.

Although this is plenty of treatment time for many patients, it may not be the final cure for everyone. Acne is not just a teenage problem, and it is important to maintain a facial cleansing regimen and to keep your dermatologist updated on the state of your skin.

If you have questions about whether Accutane is right for you, make an appointment with a dermatologist. Have general questions I didn’t address in this post? Leave them in the comments and I’ll answer them there.              

The Hair Loss Conundrum

Hair loss is a common problem. Often associated with genetics or disease, it occurs for a variety of reasons. Most people lose between 50 and 100 hairs per day. You may have noticed it in the shower or when brushing your hair. Although this type of regular hair loss is not cause for concern, there are some conditions that may require a visit to the dermatologist.

This blog will give you The Skinny on several common types of hair loss, including when to see a doctor.

Hereditary Hair Loss

Male or Female Pattern Baldness (Androgenetic Alopecia)

This is the most common form of hair loss, often starting with a receding hairline. Many men also see bald patches on the back or top of their heads.

In women, hereditary pattern baldness often results in an overall thinning of the hair. Some women see receding hairlines or bald patches, although this is rare.

There are a variety of treatments available, which include methods of preventing and reversing hereditary hair loss. These include:

• Corticosteroids – can be used to treat patchy hair loss
• Finasteride and Minoxidil – the only FDA-approved drug treatments for hair loss
• Hair transplants – minor surgery under local anesthetic performed by a dermatologist

Hormone-Related Hair Loss

Giving Birth

Many women experience noticeable hair loss after giving birth. This type of hair loss is temporary and related to changes in the body’s estrogen levels. Within a few months, the hair will grow back.

Menopause

It is also common for women to experience hair loss during menopause. This is also related to changing hormone levels. Although it is temporary, women ages 40 and older should not expect to have their hair grow back as fully as it previously was.

Stress

Traumatic events often have physical effects, and hair loss is often one of them. As with other hormone-related hair loss, this is temporary.

Disease-Related Hair Loss

Cancer treatments

Some cancer treatments, including radiation and chemotherapy, can cause hair loss. This is temporary, and the hair will grow back after treatment is finished.

Underlying medical condition

There are several diseases that cause hair loss. These include thyroid disease, anemia and others for which hair loss is a symptom of a larger problem. This type of hair loss can often be stopped or reversed by treating the disease.

Trichotollomania

This is a psychiatric condition in which a person feels compelled to pull out hair from his or her scalp or other parts of the body. There is no dermatological treatment for this, and sufferers should seek psychiatric help.

Disorder-Related Hair Loss

Alopecia areata

Believed to be an autoimmune disease, people with alopecia areata are often otherwise healthy. The disorder causes the body to attack its own hair, causing smooth, round patches of hair loss. Many people with this condition experience complete re-growth, although it can last a significant period of time. Dermatological treatment can help the hair grow back more quickly.

Cicatricial (scarring) alopecia

Like alopecia areata, cicatricial alopecia develops in otherwise healthy people. It is a rare disorder in which the body actually destroys hair follicles. Scar tissue grows in its place and the hair cannot grow back. Although treatment is available, it is only to stop inflammation from destroying the hair follicles.

If you have hair loss that may require a visit to the dermatologist, call our office today and we will be happy to schedule an appointment.

Have more questions about hair loss not answered here? Leave a comment and we’ll be glad to answer it. 

The Mohs Surgery Solution

              

This article on Mohs surgery by Dr. Patel appeared in the January 2013 issue of DeSoto Magazine. It addresses skin cancer and the most effective surgery available to treat it. If you have questions about the procedure, call Advanced Dermatology & Skin Cancer Associates at 901-759-2322 or leave a comment on this post. 

Skin cancer is the most common form of cancer in the United States, with more than 3.5 million cases diagnosed and treated each year. On average, one in five Americans will develop some form of skin cancer in their lifetimes – despite the fact that many types of skin cancer are preventable!

Although not the most common, melanoma is the most dangerous form of skin cancer, accounting for fewer than 5 percent of skin cancer cases but the vast majority of deaths. The incidence of melanoma increased by 800 percent for women and 400 percent for men from 1970 to 2009. This makes it the only cancer of the seven most common with an increasing incidence.

Luckily, like other skin cancers, melanoma is treatable and preventable. About 86 percent of melanomas can be attributed to exposure to ultraviolet radiation, and a person’s risk for the cancer doubles after he or she suffers five sunburns at any age. The best way to avoid skin cancer and, specifically melanoma, is to wear sunscreen with at least 30 SPF every day – even in the winter! It’s also important to consider long sleeves, hats or other protective clothing.

If you are at risk or if you have developed melanoma or another skin cancer already, it can be treated quite effectively. Unlike other cancers, skin cancer does not often require multiple rounds of chemotherapy or radiation. In fact, it can often be removed if caught early through a simple outpatient procedure known as Mohs surgery.

Developed by Dr. Frederic Mohs, Mohs micrographic surgery is the most advanced and effective treatment procedure for skin cancer available today. The procedure is performed by specially trained surgeons. Mohs surgeons complete at least one additional year of fellowship training with a Mohs College member in addition to a three-year dermatology residency and a one-year medicine residency. With the Mohs technique, surgeons are able to see beyond the visible disease to precisely identify and remove entire tumors layer by layer, leaving surrounding healthy tissue intact and unharmed. As the most exact and precise method of tumor removal, it minimizes the chance of re-growth and lessens the potential for scarring or disfigurement.

Because Mohs surgeons are specially trained in surgery, pathology and reconstruction, Mohs surgery has the highest success rate of all treatments for skin cancer − up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas, as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots.

“The increase in skin cancers is alarming,” said Dr. Purvisha Patel, physician and owner of Advanced Dermatology & Skin Cancer Associates. “But our advances in treating these cancers are promising. Mohs surgery is constantly evolving and improving, and we are able to treat a variety of skin cancers very effectively.”

The Simple Science of Aging

Aging is one of life’s great mysteries. In elementary school, everyone learns about Ponce de Leon’s quest for the fountain of youth. Unfortunately, he never found it, but dermatology has come a long way in the hundreds of years since. This post will explain the aging process and how to slow down its physical manifestations. Have questions? Leave them in the comments, and I’ll answer them there.

Collagen and Elastin

Skin is the largest organ in the human body. For that reason, it manifests changes that occur on the outside and inside over time. Collagen and elastin are integral parts of the skin, as they provide its supportive structure and elasticity. As we age, collagen starts to break down and it becomes more difficult for our skin to build it back up. Elastin also starts to break down, giving the skin the inability to bounce back once stretched.

Fat…is important!

Aging skin begins to lose fat under the surface, which makes the skin much thinner and gives it a wrinkled appearance. That means that if you get a cut or an ulcer, your skin will take longer to heal than it did before. The skin can rip or bruise more easily than it did after minimal trauma. Sun damage and the release of free radicals (from smoking for example) accelerate this process.

Subcutaneous Tissue

OK, you probably aren’t very familiar with this term. Bear with me. The loss of subcutaneous tissue can also change the appearance of skin by altering skin structures such as pores, follicles and oil glands, making them look bigger or more prominent. These skin structures also become less efficient, meaning that we sweat less with time. Some people notice that their skin is more fragile – meaning that it's more sensitive to light, heat and extreme temperatures.

Combined Natural Effects

With all the combined effects of tissue loss and skin structure break down, the signs of photo-aging, such as sun freckles, moles and liver spots, become more noticeable. The incidence of skin cancer also significantly rises with age. This is especially true after the age of 50 or if you've had years of prolonged sun exposure or a genetic condition that predisposes you to skin cancer. Skin can also show signs of internal illness that become more pronounced over time. Regular skin exams are recommended, at least every year, to evaluate the skin and all of the changes that occur with age.

So how do you avoid or slow the process?

Check out the rest of our blog posts or leave a comment here. Here are a few quick tips:

• Wear sunscreen of at least 30 SPF every day to avoid damaging sun exposure.
• Moisturize! Even if you have oily skin, moisturizing helps your skin keep its elasticity longer, which prevents wrinkles and other signs of aging.
• Eat right. Check out this blog post on the best foods for skin health for a few tips.
• Choose your makeup wisely and, if it’s too late to prevent, cover up your signs of aging. This blog post will help you determine which products are right for you. 

The Spotty Child: Rashes and When to Worry

A red spot on your child’s skin could be any number of things. These rashes that occur during childhood are very common and usually can be cured with tender loving care and time. However, medical care may be necessary. Here’s the skinny of five of the most common childhood rashes. If you find anything concerning, making an appointment with a dermatologist is the best thing to do. 

Chickenpox (Varicella)

If you’ve had chickenpox, you probably remember your friends or siblings having it too. That is because it is one of the most contagious diseases. In the United States alone, about 3.9 million people a year contract chickenpox. It is easily spread when an infected person touches, sneezes, coughs or shares food or drink.

Symptoms 

The first symptoms often are fever, headache, sore throat and sometimes drowsiness or loss of appetite. After a couple of days, an itchy rash and red spots or blisters will appear all over the body, although some children get the chickenpox rash without having the early symptoms. The skin irritations go through four stages over a one- to two-day period: blistering, bursting, drying and crusting. This lasts about 10 days after the first symptoms start.

Treatment

Contact and/or visit your doctor when symptoms start. For regular cases, home treatment is all your child needs. This includes a lot of rest, taking medicine to reduce fever and itching and avoiding contact with others. A popular home remedy is to soak in an oatmeal bath to help fight the itching.

Risk

As with all infections, special care or medicine may be necessary for children and adults with long-term diseases or immune system problems.

Prevention

A vaccine is available for children ages 12 months and older and adults who have not had the chickenpox.

Hand-Foot-Mouth Disease

This is an infectious disease caused by the coxsackie virus. It occurs most often in children younger than 10 years old. It is a contagious disease that can be spread through saliva, fluid from blisters or the stool of an infected person.

Symptoms

As the name implies, it is characterized by blisters on the palms of the hands, soles of the feet and in the mouth. Additional symptoms include fever, sore throat and headache. The infection usually last about seven to 10 days.

Treatment 

There is no medical treatment for hand-foot-mouth disease. Pain relievers and saltwater mouth rinses can be used to ease pain.

Risk

Complications are VERY RARE, but can happen. Viral meningitis, inflammation of the brain, and fingernail and toenail loss have been connected to the disease.

Prevention

No vaccine is available. Just remind your child to take everyday precautions such as washing their hands and avoiding contact with a child that might be infected.

Roseola Infantum (Sixth Disease)

This is a common, but harmless, disease for children ages six months to 2 years old. As you may have guessed by the name, its main feature is a rosy-pink rash on the skin. It is caused by two common viruses that are spread by fluid from the nose or throat.

Symptoms

The first symptom is a high fever that can last anywhere from two to eight days. After the fever subsides, a non-itchy rash may appear. The rash most often presents on a child’s torso, neck or arms. Sore throat, stomachache, loss of appetite, vomiting and diarrhea may occur in rare cases.

Treatment

The rash will go away without any medical treatment. Pain relievers and sponge baths can be used to ease the pain.

Prevention

No vaccine is available. Just remind your child to take everyday precautions such as washing their hands and avoiding contact with a child that might be infected.

Contact Dermatitis

The most common form of dermatitis is an allergic reaction to contact with poison ivy, poison oak or sumac. These plants have sap oil called urushiol, which triggers the allergic reaction. Estimates show that about 75 percent of people in the United States have some degree of sensitivity to urushiol.

Symptoms

Mild skin redness or a rash of small red bumps will form on any skin that has been in contact with the sap oil. In severe cases swelling, redness and large blisters can occur. The rash usually lasts for five to 21 days.

Treatment

Washing with cold water immediately after contact can help reduce the rash. After about an hour, it won’t be as effective. DO NOT jump into a hot shower. This can cause the rash to spread. Most treatments are directed to help control the itching, such as Benadryl or cortisone creams. Calamine lotion, oatmeal baths and cool compresses also are common.

Prevention

Warn your children to avoid the poisonous plants! Easier said then done, right? Common phrases to help remember are “leaves of three, let it be” for poison ivy and “berries white, a poisonous sight” for poison oak and sumac.

Ringworm

Myth – ringworm is caused by contact with worms. It is a skin infection caused by fungus that lives off of dead skin, hair and nail tissue. It is very contagious and can be spread by contact with an infected person or animal or towels, clothing or sports gear. Ringworm grows best in warm, moist areas such as locker rooms and swimming pools.

Symptoms

A very itchy rash that usually is in a round shape, like a ring. If infected on the hand, the skin will get thick, dry and scaly.

Treatment

The most common treatment is using over-the-counter or prescription creams, depending on the severity of the infection. If untreated, the skin can become infected with bacteria and will need antibiotics.

Prevention

Avoiding an infected person, animal or item is the No. 1 prevention method. Other tips include having your child wear sandals in locker rooms and around public pools, showering after playing sports and changing their underwear and socks at least once a day.

If you notice an abnormal rash or marking on your child’s skin, or have any questions about skin irritations, call us at 901-759-2322. We will be glad to answer any questions or set up an appointment to assess your child’s situation.

Home Remedies: Puffy Eyes

Chances are, you’ve woken up at some point with puffy or “tired” eyes, which is a fast-track way to make you look worse than you feel. The good news is there are some things you can do at home to get rid of them. Here are a few tips for soothing away your puffy eyes before your next early morning meeting.

Everyday Treatments
There are several at-home remedies that can help dissipate those puffy eye problems without having to resort to a visit to the doctor. These include:

• A chilled tea bag – The cold and ingredients in the tea will help reduce swelling and help you look more awake.
• Egg whites – Whip an egg white or two until they’re stiff, then brush it under your eyes. This will help tighten your skin.
• Cold cucumber slices – Not just for the movies, these slices help the puffiness fade.
• Cold strawberries – Avoid this treatment if you’re allergic to strawberries. Otherwise these fruit slices can help relieve swelling.
• Cotton balls soaked in cold milk – A few minutes with these on each eye will work wonders for that tired look.
• Chilled spoons – If you prefer to avoid turning your face into a salad bar, a couple of spoons chilled in the refrigerator and allowed to rest on each eye work just as well.
• Splashes of cool water – If you’re in a rush, a few splashes of cold water to your face can help. The cold blast will help reduce swelling as well as provide a chilly wake up call!

Long-Term Changes

If puffy eyes are a persistent problem, long-term changes may be necessary. Consider the following:

• Sleep – It isn’t called “beauty sleep” without good reason! If you aren’t sleeping enough or you’re getting poor quality sleep, it’s going to show. Strive to get eight hours of good quality, uninterrupted sleep to help keep puffy eyes at bay.
• Elevate your head while sleeping – Try keeping an extra pillow under your head to keep it elevated while you sleep. Just like an injury, keeping your head elevated will help keep down any swelling.
• Reduce your sodium intake – As you’ve likely heard from numerous doctors, consuming too much salt can lead to a number of health issues. Overconsumption will make you retain water, even in your face, leading to those puffy eyes.
• Drink more water – By drinking more water, your body will stop retaining water, and you should feel better by flushing all the other toxins from your body. Drink 64 ounces per day to make puffiness no more!
• Take a break from the screen – It’s highly likely that you work and/or play with a computer, tablet, smart phone or other device for hours each day. This can contribute to puffy eyes, not to mention eye fatigue. For every hour you are on a computer, take a five to 10 minute break and rest your eyes, or even get up and walk around for a minute. Your eyes and body will thank you for it.

Have questions about puffy eyes not answered in this post? Leave them in the comments, and I’ll answer them there!

Exfoliation Education: Do's and Don'ts for a happy face

Exfoliation is essential for keeping skin young and fresh-looking. Exfoliation can be done either through a manual process or a chemical process. Exfoliating manually consists of using a scrub, a brush or loofah, or a method like microdermabrasion. Chemical exfoliations use acids like glycolic or salicylic acid, among others, or even going so far as a laser peel. Here are some dos and don’ts when it comes to exfoliating.

Don’t worry about exfoliating if you’re in your 20s or younger. Your skin is turning over at a healthy rate, and adding exfoliation won’t make much of a difference.

Do exfoliate if you’re in your 30s or older. Your skin’s natural exfoliation process has begun to slow, so adding exfoliation will make a difference to the appearance of your skin.

Don’t exfoliate often if you have dry or sensitive skin and already use the gentlest products available. Either method (manual or chemical) can potentially do more damage. DON’T exfoliate visibly damaged skin at all.

Do exfoliate if you have oily skin. This will help clear out your pores.

Don’t exfoliate before you cleanse, otherwise you’ll just skim the surface and the product won’t do its job.

Do remove all makeup before exfoliating. This way you get the deep cleansing you’re looking for.

Don’t use too much pressure. This is your skin were talking about. You aren’t buffing a car.

Do use mild to moderate pressure and allow the product to do the job. Gentle pressure is better than harsh in order to avoid skin damage.

Don’t mix waxing with other procedures. While it is an excellent hair remover, waxing exfoliates skin, as well. Don’t exfoliate skin before or after waxing.

Do use proper moisturizers and sunscreen to protect the newly revealed layer of skin.

Don’t have intensive procedures like chemical peels or microdermabrasion done more than two times per year, unless recommended by a medical professional.

Do use a mild or moderate exfoliating product as needed. Usually, one time per week to as often as twice daily is appropriate. I usually recommend something like a toner applied with a cotton pad, depending on your skin type and skin care needs.

Do let your skin tell you when to exfoliate, how often to exfoliate and what products to use.

Do use the proper exfoliating products on the proper part of your body. Exfoliating products meant for your feet will be much more harsh than an exfoliate meant for your lips. Again, only use one product on each part of your body.

Do be careful with sensitive areas of your body, especially around the eyes, décolletage and the bikini area.

Do remember that pink and tingling skin after exfoliation is good, but red, peeling, burning or painful skin after exfoliation is bad. Seek medical attention if necessary.

If you have any other questions about exfoliating that weren’t answered in this post, leave them in the comments below!

The ABCDE of Melanoma

Photo by Texas Institute of Dermatology

Everyone has heard of melanoma. It’s not as common as other types of skin cancer, but it is much more dangerous, accounting for about 75 percent of skin cancer-related deaths each year.

Melanoma is most often caused by genetic predisposition and/or prolonged exposure to the sun or sun-like UV light, such as a tanning bed. Even if you wear sunscreen daily, it’s important to regularly examine any suspicious spots on your skin, and to see a dermatologist if you are concerned. The good news is that if it’s caught early, melanoma can be treated. At Advanced Dermatology & Skin Cancer Associates, we perform a procedure called Mohs surgery, which offers a 99 percent cure rate for skin cancers and leaves little or no scarring.

The trick is to catch these cancers early. When examining a spot, keep an eye out for these common signs of melanoma. Dermatologists refer to this as the “ABCDE of Melanoma,” and if all signs are present, you should visit a doctor as soon as possible.

A – Asymmetry

Unlike benign moles, melanoma almost always has an asymmetrical, or irregular, shape. You should look for uneven edges or a spot that has two distinctly different sides.

B – Borders

Benign moles or freckles usually have smooth, even borders and present as a circle. Melanoma, on the other hand, will typically have irregular borders that don’t look like a regular shape.

C – Color

A benign mole or freckle is usually a single shade of brown. If you have a spot that shows multiple colors, it could be a melanoma. Colors that often present in melanoma spots include blue, black, brown and tan.

D – Diameter

Melanoma will often present as a larger spot than a benign mole. A melanoma lesion is usually 6 millimeters or larger in diameter, or at least the size of a pencil eraser.

E – Evolving

Keep an eye on your moles or other spots. Even if you don’t have melanoma, knowing how these types of spots evolve on your skin under normal circumstances may help you spot a problem later. If a mole changes color and size, visit a dermatologist as soon as possible.