Top 5 Reasons to See a Dermatologist

Top 5 Reasons to See a Dermatologist

It's September 5 -- Labor Day has come and gone, the kids are back in school, and all the parents are sighing a collective sigh of relief! Back to routine!

This is a time of year when many parents are able to find a few extra hours in the week to catch up with dental appointments, doctor's visits, hair appointments, etc. We have been seeing an increase in appointment requests for these top 5 skin issues:

1. Skin Cancer

Have a changing mole or new lump or bump on your skin? Skin cancer affects 1 in 4 Americans over their lifetime. Here at Traceside we have had many new diagnoses of basal cells, squamous cells, and unfortunately melanomas over the past few months. If you are concerned you damaged your skin over the summer or have a new lump or bump that won't go away, please call and let us take a look.

2. Sun Damage

Summer is over and many of us are now seeing in the mirror the after-effects of too much sun. Brown spots, uneven skin texture, new lines and wrinkles are all issues that we can help address -- usually with a combination of recommending a personalized skin care regimen, plus possibly chemical peels, botox, fillers, and other cosmetic procedures.

3. Rashes

Sometimes an unintentional consequence of trying to revamp your skincare at home (without the help of a professional!) produces skin irritation, redness, itching, and other problems. We see a lot of patients who have developed an allergy to their skin or hair care products. If you are dealing with a rash on your face, eyelids, neck, or hands that just won't go away, we are here to help. Through a combination of medical treatments and testing, we can help fix this problem!

4. Cysts

Dr. Pimple Popper has put cysts on the radar of many Americans. And yes, cysts for some reason seem to flare during the warm weather months. Dr. Valet has removed many cysts this summer. If you have a bump or lesion under your skin that is swelling and bothering you, we can help.

5. Acne and Rosacea

The heat, sweat, and sunlight that is a natural part of a Southern summer can contribute to acne and rosacea flares in the summer and early fall. We can help clear up these common skin issues with a combination of skincare advice and prescription medications. Don't continue to suffer with acne and rosacea unnecessarily when help is available!

Allergy Season Arrives--Story at 10!


With the arrival of March, spring allergy season is officially underway. You have likely noticed the first of the trees starting to green up; maple, red cedar, and a few others are typically the first to start blooming, sometimes as early as the end of February in Nashville.

Every year allergists are asked how this season compares to prior years. I have done many local news interviews over the years, that typically go something like this:

News anchor: "How bad is the pollen season this year?" (looking at me hopefully)

Me: "It's bad!"

News anchor: (nodding) "Back to you Jim."

The better answer is, it depends (the local news doesn't really like to lead with "it depends--story at 10"). So far, this appears to be a somewhat warm, early spring. Whether that means the trees will flower and continue to flower vigorously because of warm weather, or whether a late cold snap might kill off their early growth and lead to a light tree pollen season because they started growing too early, remains to be seen. Also, all the rain we've had tends to lower pollen counts by removing pollen grains from the air, but conversely, a good moist spring may favor vigorous tree, grass, and weed growth. Additionally, for other patients who are mold allergic, all the moisture will favor mold activity, and hard rains can stir mold and other allergens from the ground into the air (so called "thunderstorm asthma," named for the phenomenon of allergic asthmatic patients reacting following storms). Finally, the spring weather itself (e.g. changing temperature and moisture levels) can act as an irritant trigger, causing nasal symptoms in many patients.

As all of this suggests, at the end of the day, what matters is what you are allergic to, and whether it ends up in your nose. If you usually have a bad spring with allergies or sinus issues, we can help. Getting allergy tested to determine your triggers, and starting an appropriate treatment plan (which may include medications chosen based on your triggers, avoidance measures, and for highly allergic patients, desensitization with allergy shots) can make all the difference. The local news may not like it, but the goal is for anyone asked how their spring allergy season is going to be able to say, "No big deal!"

Is it a Cold . . . or Allergies?

In this article published on StyleBlueprint, Dr. Robert Valet discusses how you can tell the difference between a viral cold and allergies. Interested? Read more by following this link:

Happy Valentine's Day, Spring Allergy Sufferers!

Valentine’s Day…when a young man’s fancy turns to…nose sprays. At least, it should, if he has springtime allergies!

The spring allergy season in Nashville begins in earnest in March, when trees begin pollinating. Because of the very large amount of pollen produced during a short time window (trees typically are done producing pollen for the year in April), early spring is a highly symptomatic time for many allergy sufferers.

If your symptoms have been out of control during previous springs, if you were to pick one medicine that is most likely to be helpful, it would be a nasal steroid spray. Over the counter examples include Flonase, Nasacort, and Nasonex. Nasal steroids have consistently outperformed other types of allergy medication (for example, antihistamine pills) in a variety of studies. However, they do not work overnight and are not good for as needed use. Typically, they require 2 or more weeks of continuous usage to reach full benefit. Given that tree pollen is out by early March in our area, this means starting a nose spray by mid-February in order for it to be fully on board by the time spring allergy season begins.

If your allergies typically get out of control this time of year, we can help. Allergy testing is very helpful to determine which allergens are driving your symptoms, which guides avoidance advice and opens the option for allergy shots to retrain your immune system to tolerate your triggers. In other cases, patients with prominent springtime symptoms are not sensitized to allergens, but rather have vasomotor rhinitis, meaning that their symptoms are triggered by air quality, scents, shifting weather patterns, and other non-allergic triggers. Treatment for this is somewhat different, and again, testing is key in order to determine what are your most important triggers.

Having an enjoyable spring, without uncontrolled nose and eye symptoms or severe sinus
infections, should be an achievable goal for everyone. We would be happy to work with you to help you feel your best this time of year. In the meantime, show your nose some love this Valentine’s Day, and start that nose spray!

Addressing Sun Damage in the Winter . . . Great Summer Skin Starts Here!

Addressing Sun Damage in the Winter . . . Great Summer Skin Starts Here!

Here in the middle of January, most of us are doing our best to make it through the cold months and flu season. It's cold outside, it gets dark early, and we are looking forward to spring. Because most of our time is spent indoors, many people neglect their skin care and sunscreen routines in the winter.

But did you know that the winter season is the best time to address sun damage and pigmentation changes in the skin? Don't stop your skin care routine now!! If sun damage has resulted in uneven pigmentation, melasma, sun spots, or other areas of sun damage now is the best time to start doing something about it. The lack of direct sunlight during this season makes it an ideal time to begin working on skin care.

First, start with the basics. Make sure you are wearing spf 30+ on your face, every day, rain or shine. Treating sun damage is like treating high blood pressure or high cholesterol. It will always be with you, and to keep the effects under control, daily maintenance is required. Hyperpigmentation, sun spots, and melasma can be particularly troublesome. The damage to the skin is always there, lurking beneath the surface. Sunlight will bring the damage to light by causing the pigmentation to "blossom." Keep it at bay by blocking the sun's harmful UV rays.

Second, use targeted medical-grade skin care specific to your skin's needs. The more progress you can make towards reducing the appearance of your hyperpigmentation now, the better off you will be when sunny season starts. Choosing a targeted medical grade product can be tricky and appropriate selection begins with assessing your particular needs, in addition to any underlying sensitivities or special considerations you may have. At Traceside, we have had good success treating our patients with a combination of antioxidant serums such as CE Ferulic and/or Resveratrol, prescription creams such as Finacea and Retin-a, and topical skin brighteners.

Third, if you are considering aesthetic procedures to target your skin's sun damage, tone, and texture, now is the time to start. The best results are seen after a series of treatments, which takes time. A great place to start is with chemical peels. A series of glycolic, citric, retinol, and/or TCA peels over time will exfoliate the skin, reduce hyperpigmentation, reduce the apperance of fine lines and wrinkles, and overall improve skin's tone and clarity. Because the effects are gradual, chemical peels are ideal for patients who are new to aesthetic services. The downtime is minimal with most peels and can be completed in a matter of minutes during an office visit.

Fourth, keep your  skin moisturized. The dry air so prevalent this time of year can really do a number on your skin! For combination skin, we recommend CeraVe PM; sensitive skin will do well with Vanicream Lite Lotion. Mature skin that is very dry does well with SkinCeuticals Triple Lipid Restore.

If you have questions about how to get started on achieving your best skin, call us today to schedule a cosmetic consultation. We can help!

Winterize Your Allergies with Traceside Dermatology & Allergy

Winterize Your Allergies with Traceside Dermatology & Allergy

In late fall, we are all busy raking leaves, tuning our heaters, and otherwise preparing our homes for winter. But wait, winterizing is not just for houses; this is a great time of year to get your allergies in good shape for winter and the coming spring!

For many people who suffer from recurring sinus infections, the winter season is tough. Respiratory viruses, dry air, and increased indoor allergen exposure make this the time when most patients' sinuses are at their worst. If this has been your experience, it is likely you have underlying chronic rhinitis. Because your nose and sinuses are partially swelled at baseline, it is harder to shrug off colds and flu without progressing into a bacterial sinus infection. At Traceside, we can help by identifying what is triggering your baseline swelling and implementing an avoidance and treatment plan to help you stay healthy and feel your best.

This isn't just time to prepare for winter; it is also a great opportunity for those with spring, summer, and fall seasonal allergies to get a jump on the season. First, since most plants have been killed by frost, many patients find this the easiest time of year to stop antihistamines for allergy testing, to identify their triggers. Secondly, to feel your best during the springtime, you will need to have a plan in place before the season starts to stay ahead of spring pollen. Finally, for patients who want to consider allergen immunotherapy (allergy shots), which in many cases permanently retrains your immune system to tolerate what you are allergic to, this is a great time to start, complete buildup, and allow maximum time for your allergies to improve, before the trees start blooming in March!

Nashville Dermatologist -- Winter Skincare Advice

Nashville Dermatologist -- Winter Skincare Advice

Happy Halloween, everyone! We hope you all had a great time enjoying the festivities of the evening!

Since we are solidly in the middle of fall, why are we talking about winter skincare over here on our blog? Well, as the weather changes and the temperatures drop, dermatologists all over the country start to see a rash (no pun intended!) of patients coming to the office for itchy, dry skin. By making a few adjustments to your skincare, you can avoid a trip to the doctor and keep your skin symptom-free all season long.

What are the most common causes of dry, itchy skin this time of year? Typically, the causes can be reduce to one or more of the following: dry air, hot water, and harsh soaps.

The air outside during the cold weather months is very dry, causing your skin's natural moisture to evaporate more quickly. In addition, when we turn on our heaters in our homes, the air becomes even drier still. To combat this, you need to regularly apply a good, simple moisturizer. Our office favorites are Eucerin, Vanicream (great for sensitive skin!), and sometimes even just plain petrolatum!

Because we are cold this time of year, many patients take long, hot showers and baths. Nothing could be worse for your already dry skin. The heat of the water strips your skin of its natural oils, leaving it without protection when you face the dry cool air both inside and outside of your home. To minimize the drying effects of a hot shower, turn the temperature down and reduce the length of your shower. And though we hate to say it, keep the long soaking baths to a minimum. If you just HAVE to take a long soak, moisturize immediately after getting out of the tub!

Harsh soaps are another common problem. Ivory soap, though a favorite of many, is actually one of the worst soaps to use during the winter months. A true soap, it removes all of your skins natural oils. Harsh antibacterial soaps are another common offender, as are strongly scented soaps. Stick to something mild and gentle -- the Dove moisturizing bar is a great place to start, or consider Vanicream's bar soap or gentle liquid cleanser.

If you are following all of these tips, and still can't get your skin under control, it may be time to see a board-certified dermatologist to make sure something else isn't going on. If you need us, we are always happy to help! And otherwise, stay warm and enjoy the festivities of the season!

Nashville Allergist -- Fall Seasonal Allergies Explained

Nashville Allergist -- Fall Seasonal Allergies Explained

Are your allergy symptoms flaring up lately? If you are one of many Nashvillians with runny, stuffy nose this time of year, it is likely you are either allergic, or you aren't! Or maybe both of those! What?

We evaluate many patients with nasal symptoms that flare significantly this time of year. Until we get several good frosts, all of the plants that have been producing pollen since late spring are still active. These include grasses (northern turf grasses like Kentucky bluegrass and fescue, and southern grasses like Bermuda, bahia, and johnson) and weeds, including plantains (see earlier post for pictures!), lamb's quarter, pigweed, kochia, and many others.

However, a spike in nasal/sinus symptoms in fall, when related to pollen allergy, is usually due to ragweed. Ragweeds (Ambrosia genus) are highly allergenic plants native to the Americas. They are among the most common plants to be allergic to (depending on the study, among those with allergic rhinitis, up to 80% may be sensitized to ragweed), and also contribute significantly to asthma symptoms. In our area, we have abundant short ragweed and giant ragweed. Ragweeds are short day plants, meaning that they wait for the days to shorten again before they start to flower, and so they begin flowering in much of the US beginning around the middle of August. If you have fall allergies ragweed may well be an important allergen for you. We can complete skin testing and get you an answer in about a half hour. If you are allergic, this opens additional options including allergy shots and ragweed sublingual immunotherapy (for which there is a FDA approved product, Ragwitek).

Many patients who flare this time of year have negative skin testing to common aeroallergens, known as vasomotor or non-allergic rhinitis. These patients have much the same nasal/sinus symptoms, but are reacting to the changing weather and air quality patterns that occur rapidly in the fall, rather than to pollen in the air. This is another situation where skin testing is very helpful, because it can tell you that you may be able to stop medicines, including Singulair and oral antihistamines, that are unlikely to benefit you if you don't have allergic triggers for your nasal symptoms.

Finally, some patients have allergy by skin testing, but clearly also have non-allergic triggers (for example their fall flare isn't explained by what they are allergic to, or by history they also react around non-allergic triggers like perfumes/strong scents). These "mixed rhinitis" patients can benefit greatly from a combination of therapies targeting both allergic and non-allergic triggers.

If you aren't feeling well this fall, let us review your history and find our what is driving your symptoms, to help get you on the right treatments to feel your best!

Nashville Dermatologist -- Should I get this checked? A guide to skin cancer awareness

Nashville Dermatologist -- Should I get this checked? A guide to skin cancer awareness

One of the most common questions we get asked is, "How do I know if my mole is cancerous?"

Here in the Southeastern United States, we are all exposed to the damaging effects of UV rays Every. Single. Day. Rain or shine, winter or summer, the sun is always out and most of us experience the damaging effects of UV radiation. And we know for a fact that 1 in 5 Americans will be diagnosed with skin cancer in their lifetime.

So, what are the warning signs that you may be developing a skin cancer?

The pnemonic "ABCDE" is helpful in evaluating whether that new mole is worrisome or not. If your mole meets one or more of the following criteria, you ought to have your mole checked:

A = asymmetry -- when the two sides of your mole don't match

B = border -- if the border or edge of your mole is irregular

C = color -- if the mole is multiple colors or changing colors

D = diameter -- if the mole is growing in size or is larger than 6mm (the size of a pencil eraser)

E = evolution -- if the mole is changing

And in general, we find it most helpful to evaluate by the "new or changing" criteria - which means if you have a mole that is new or changing, you ought to have it looked at -- particularly if it has irregularities in color, shape, or border or has become symptomatic such as itching or bleeding.

And don't be fooled if the mole isn't brown! Although melanoma often has pigment with it, it can be pink and other skin cancers such as basal cell carcinoma and squamous cell carcinoma are often pink.

When in doubt, get it checked!

Nashville Dermatologist -- Skin Care 101 -- a regimen for prevention

Nashville Dermatologist -- Skin Care 101 -- a regimen for prevention

So we have defined that there are a lot of great skin care products out there and discussed how it is important to choose products that are designed for you and your skin type. Because if you have acne-prone skin but use a product that is heavy and intended for very dry skin, you might make your acne worse! It is so important to be very picky when it comes to choosing products -- one size DOES NOT fit all in the skincare world!

Today, we are going to talk about a very common skin type that I see in the office all the time. The 30-something female patient with mild sun damage and combination skin who wants to start a good regimen to preserve her skin and prevent additional damage.

Here is what I typically recommend:

In the morning

 This patient needs a good gentle cleanser. Products to consider are the SkinCeuticals LHA Cleansing Gel (which we carry), or OTC Cetaphil Gentle Skin Cleanser.

After her moisturizer, she needs a good sunscreen that is designed for use on the face. If her skin tends towards blemishes, I always recommend Elta MD UV Clear. If her skin tends towards dryness, I recommend Elta MD UV Daily. At the drugstore, a good brand is Aveeno.

Next, I recommend a Vitamin C serum. My favorite for this age-group is SkinCeuticals Phloretin CF. It is applied every other day in the morning and works to provide additional protection against environmental damage and also helps to repair past damage.

After that, this patient should apply her favorite makeup and her morning skincare routine is done!

In the evening

It is critical to remove makeup at night and use a cleansing regimen that also exfoliates. Here I recommend using the same morning cleanser (SkinCeuticals LHA cleansing gel or Cetaphil Gentle Skin Cleanser) with a Clarisonic face brush. Clarisonics are amazing. They gently exfoliate, which allows your skin to absorb any products that you use and also clarify the complexion, leaving the skin less dull. I use mine every night.

After cleansing, apply a topical retinoid. I usually recommend patients start with OTC Differin 0.1% gel if the skin tends to be sensitive. If the patient has been using a retinoid for awhile, she can probably tolerate tretinoin 0.05% cream (retin-a). If the patient is pregnant or trying to become pregnant, prescription Finacea gel or foam is the best. Use these products every other night to start, and gradually increase to nightly usage.

If the skin tends to be dry, I recommend an light moisturizer after the retinoid -- at the drugstore, a great moisturizer is Vanicream Lite Lotion.

This is a simple skin care regimen that provides all the protection an average 30- year-old female with combination skin needs to exfoliate, protect, and restore!


Nashville Dermatologist -- Skin Care 101, Part Two

Nashville Dermatologist -- Skin Care 101, Part Two

In June, we talked about how important it is to understand your skin and what problems you are trying to correct when you go about picking a skincare regimen. Today, let's go into greater detail about common types of skincare products so that you can better understand what is available to you today.

In the world of skincare, there are many different categories of products. Here are the major categories (clearly, this is why this can be so confusing!):

  1. Cleansers
  2. Toners
  3. Exfoliators
  4. Sunscreens
  5. Antioxidants
  6. Moisturizers
  7. Acne Products
  8. Rosacea Products
  9. Hyperpigmentation Products
  10. Anti-Aging Products
  11. Skin Soothers
  12. Eye Creams
  13. Neck Creams

What of the above do you need? Why would you choose one type of product over another? Let's start with the top and work our way down.

1. Cleansers -- designed to remove excess oil, dirt, and make-up off at the end of the day; everyone needs one of these!

2. Toners -- an alcohol-based solution designed for acne patients to remove excess oil; we generally do not recommend using a toner; unless your skin is excessively oily, this is just going to dry and irritate your skin

3. Exfoliators -- mild acid-based solutions, scrubs, or mechanical devices designed to remove excess skin; this is a must, but the choice of which product depends on your skin type

4. Sunscreens -- designed to protect your skin from the sun; another MUST! 

5. Antioxidant -- designed to be used in addition to sunscreen to protect from UV and environmental agents that age your skin; another MUST!

6. Moisturizer -- designed to combat skin dryness

7. Acne Products -- over-the-counter versions include salicylic acid and benzoyl peroxide; many presription products are available; all designed to help treat, control, and reverse acne

8. Rosacea products -- both over-the-counter and prescription products used to correct and reverse the various aspects of rosacea

9. Hyperpigmentation products -- OTC and prescription lighteners and brighteners; hydroquinone is the most common, but kojic acid, azelaic acid, and others are also available

10. Anti-Aging products -- vitamin-A derivatives that are either OTC ( retinols) or prescriptoin (retinoids) that have a myriad of benefits including exfoliation, reduction in hyperpigmentation, building collagen, and unplugging pores 

11. Skin Soothers -- often botanicals and/or products containing caffeine to reduce redness and inflammation in the skin

12. Eye Creams -- products with a variety of ingredients to reduce the appearance of fine lines, wrinkles, and puffiness around the eyes

13. Neck Creams -- products with intense moisturizers and collagen builders to reduce the appearance of crepey skin on the neck


Whew! That was a lot. The next series of posts will address the most common skin types we see in the office and what types of products from the list above are generally best for these skin types.


Nashville Dermatologist -- Kybella available now!

We are excited that we are now offering Kybella® at Traceside!

What exactly is Kybella®, you might ask? It is a new injectable medication that targets sub-mental fullness, or "double-chin," and it is a first-in-class medication to address this difficult-to-treat area.

One of the most exciting things about Kybella® is that it is non-surgical -- no need to undergo surgery or aggressive laser procedures, if you are unhappy with this particular area. Prior to Kybella®, patients who wanted to address their sub-mental fullness needed to undergo liposuction or other invasive procedures. 

Kybella is performed as a series of 2-4 treatments, each 4-6 weeks apart. After the skin is properly cleansed, numbed, and marked, Dr. Valet injects very small amounts of the medication directly into the fat pad, where it works to slowly dissolve the unwanted fat over time.

If you are interested in Kybella, call our office to set up a consultation. And for a limited time, we are able to offer a $400 rebate through Brilliant Distinctions for our patients who purchase their first two treatments of Kybella® as a package.

Enroll in Brilliant Distinctions for free today and start earning points towards future treatments!

Nashville Allergist -- Summertime Allergies in Nashville: What's Itching You

If you have nasal and/or eye allergy symptoms, or your asthma is flaring this time of year, you may have wondered what you are reacting to. Below are some pictures taken today and fun facts about common allergenic plants in the Nashville area this time of year.

Grasses are prominent allergens in Nashville from late spring until fall frost. These include Northern pasture grasses (Kentucky blue grass, fescue, Timothy, and others), as well as more heat-loving grasses like Bermuda grass, Johnson grass, and Bahia grass. This is one of the reasons I point out when asked why allergies are so bad in Nashville; we are on the border between Northern and Southern grasses and consequently have both!

 Johnson grass is instantly recognizable this time of year. It looks like regular grass, just scaled up. Here is a nice stand, some of which is over 6 ft tall. It is in the same genus as sorghum (as in sorghum syrup) and is also closely related, as its appearance suggests, to corn and sugarcane. It spreads by runners and quickly establishes itself in unmowed areas.

Johnson grass is instantly recognizable this time of year. It looks like regular grass, just scaled up. Here is a nice stand, some of which is over 6 ft tall. It is in the same genus as sorghum (as in sorghum syrup) and is also closely related, as its appearance suggests, to corn and sugarcane. It spreads by runners and quickly establishes itself in unmowed areas.

The other prominent group of summertime allergens apart from grass is weeds (by which allergists mean non-grass, non-tree plants that are important causes of allergy). We are not into ragweed season yet (more to come on this when it starts pollenating in August!), but a number of other weeds are contributing to allergy symptoms this time of year. Below are pictures of two of the most common weeds, English plantain and black seed plantain. These closely related plants grow very well in disturbed soil, and consequently are found close to us in our yards, gardens, and mowed fields.

 English plantain (center of the picture) in its natural environment--nestled among other plants in a lawn. Its fondness for disturbed soil makes it a marker for human activity, and the remains of its pollen in sediments is used as evidence of ancient human agricultural activity. The fact that it grows well near to us contributes to its importance as an aeroallergen.

English plantain (center of the picture) in its natural environment--nestled among other plants in a lawn. Its fondness for disturbed soil makes it a marker for human activity, and the remains of its pollen in sediments is used as evidence of ancient human agricultural activity. The fact that it grows well near to us contributes to its importance as an aeroallergen.

 Black seed plantain, also nestled in a lawn. This native of North America is one of the most common weeds in our lawns and also a contributor to summertime allergies.

Black seed plantain, also nestled in a lawn. This native of North America is one of the most common weeds in our lawns and also a contributor to summertime allergies.

Nashville Allergist -- Alpha-gal Allergy: It's Un-American!

We hope everyone has had a happy Memorial Day! For those of us who connect the summertime holidays with firing up the barbecue, let's talk about a medical condition we hope you never develop: alpha-gal allergy.

In this unusual food allergy, patients become sensitized to the carbohydrate group galactose-alpha-1,3-galactose ("alpha-gal") due to bites from lone star ticks (the tick has the carbohydrate in its gut and introduces it into the skin of those it bites). Because alpha gal is also found in red meat, patients can then develop allergic reactions after eating red meat. 

Symptoms can include hives, swelling, respiratory difficultly, and GI upset, typically 3-6 hours following red meat consumption. Because this unusual allergy is to a carbohydrate that has slow and variable GI absorption, sometimes symptoms may not occur with small amounts of red meat consumption, making diagnosis more challenging. I enjoy caring for patients with this condition and have been featured in local and national media for my expertise (google "Robert Valet MD alpha gal allergy"), and would be happy to evaluate you if you are concerned about this condition.

Once diagnosed, treatment consists of avoidance of red meat, and more importantly, of additional lone star tick bites, which increase levels of antibodies to alpha gal and may help this allergy to persist. Ticks like to hang out on tall brush and drop off onto passing animals and people, so be careful in brush and inspect for ticks immediately upon returning indoors. 

 An allergy to holiday barbecue can become reality for those who have been bitten by lone star ticks

An allergy to holiday barbecue can become reality for those who have been bitten by lone star ticks

Nashville Dermatologist -- Skin Care 101, Part One

One of the THE most common questions I get from patients is, "What skincare products should I use?" I get it -- it is completely, 100% overwhelming trying to figure out what we should and shouldn't be using on our skin. For starters, the shelves in the drugstore are full of different brands. And that's just the drugstore! Then there are the department store counters, the specialty skincare stores, and now the online vendors. How in the world do you choose?

In a series of posts, I am going to break down skincare. This series is going to take awhile, so hang in there -- but know that everyone will be able to learn something useful from this series.

The first, absolute, number one thing you need to figure out first is your skin. This can actually be fairly complex. You need to start paying attention -- is your skin oily? dry? a combination? Are you prone to developing acne? Do you have rosacea, even in a mild form? Is your skin really sensitive? Is your skin easily irritated? Do you have any history of eczema? 

And secondly, what are your problem areas? Do you have a lot of sun damage and brown spots/uneven pigmentation that you are trying to correct? Are you concerned about fine lines and wrinkles? Are you concerned about skin laxity? Is loose skin around the eye an area of concern for you? Are you concerned about pore size? Blackheads? Are you losing volume or plumpness to your skin? Do you have hormone-induced changes to your skin such as hyperpigmentation?

Once you have a sense of the answers to these questions, you can start to pick the right products. Because ultimately, there are a lot of amazing skincare products out there, but if you aren't picking products that are targeting your skin type and your problem areas, you will not be getting the results that you want and you MAY even be making your skin worse in the process.

For example, I have sensitive, acne-prone skin, which is a tough combination. There is a popular prescription retinoid (retin-a type product) that is designed for anti-aging and is also designed to be moisturizing, which I thought might be great for me since my skin is so sensitive. However, when I tried it on my face, I got CYSTIC ACNE. It was simply much too moisturizing for my acne-prone skin. It is still a great product -- but just not for me

And that is the crux of choosing skincare -- choosing the right products for you.

Dr. Robert Valet in the News

Dr. Robert Valet in the News

Some of you may have heard about a new allergy that develops from a lone star tick bite, resulting in a serious allergy to red meat. It's called alpha gal. Read about it here in this interview with Dr. Valet from 2014 in the Vanderbilt Reporter:


And here again in Dr. Valet's interview with The Today Show:


Dr. Valet has a blog post planned on this very topic later this weekend!


 CDC public image gallery

CDC public image gallery

Nashville Allergist -- It's Poison Ivy Season!

It's been a wet growing season in Nashville and plant growth is lush, including undesirables! I noticed a nice crop of poison ivy at the edges of the grass at the baseball fields this past weekend, featured in the attached video. See if you can hear our son closely paying attention to my points on recognizing poison ivy!

Recognizing Poison Ivy Traceside Dermatology and Allergy Robert Valet MD

Apart from usual ways of being exposed (walking through brush, pulling weeds), two particularly bad exposures include weed wacking (and spraying your legs with poison ivy juice) and fires (even in winter; poison ivy vines also contain the oil and can be present on logs that you may be burning). If you are exposed, washing with soap and water right away can help remove the oils before you react to them.

If you are among the 90% of us who react to poison ivy, the small bumpy itchy red rash can be soothed somewhat with OTC topicals including cortisone and calamine, but for more severe cases, long courses of systemic steroids are needed. Another case of prevention being the best cure!

Nashville Dermatologist -- Picking a Sunscreen, Part Two

Nashville Dermatologist -- Picking a Sunscreen, Part Two

OK. So we know we need a sunscreen with SPF 30+ and it needs broad-spectrum coverage. But we all know that when we walk into the drugstore or up to the cosmetics counter, there seem to be a BA-JILLION different sunscreens, and they all have different price points. How do you even start to choose?

Here are a few pointers that we have picked up along the way.

1. First, with sunscreen, you generally get what you pay for. You don't want to pick a sunscreen from the dollar store, nor do you want to buy the absolute cheapest sunscreen at the pharmacy. Generally speaking, we have found that the brand-name sunscreens are less irritating and more effective than the off-brand or store-brands. Aveeno, Neutrogena, Vanicream, La Roche Posay, and California Baby Super Sensitive are all easily available brands with great track records for performance.

2. Second, the mid-range sunscreens generally all do a great job at exactly what they are supposed to do -- block the sun's harmful rays. However, they may not be cosmetically elegant or they may not be appropriate for certain special situations.

3. At the higher price points, sunscreens are being designed to solve a specific problem for a special situation. They are cosmetically more elegant and therefore are more appealing for everyday use. They may be designed for sensitive skin, or acne-prone skin, or for children. So although the mid-priced sunscreens and higher-priced sunscreens generally have the same efficacy (are equally effective at blocking the sun), the specialty brands often offer particular advantages for special situations. 

4. And then of course you have to choose whether you want a lotion, a cream, a spray, a sport stick, etc.

So, what should you pick? And the answer, of course, is that it depends. You need to choose your sunscreen based on how you are going to use it. Here are a few common scenarios:

You are going on a beach vacation. You don't have any particular concerns (no allergies or sensitivities, for example), but you need something that is water-resistant that you can reapply frequently throughout the day.

We would recommend an SPF 50 or higher in this situation, as the sun at the beach can be particularly intense. Choose a broad-spectrum sunscreen and choose a large quantity. Each person needs 1 ounce for each application for full-body coverage. For one person spending 8 hours at the beach, you need approximately a 6 ounce bottle! Look for water-resistance and consider whether a lotion or a spray will be easier for you to apply. (Sprays should not be used on young children). In this situation, a Neutrogena Sport or Coppertone Sport would be a great choice, as would Blue Lizard.

You have acne-prone skin but you know you need a sunscreen to wear every day on your face, neck, and hands. You are a working professional, so you don't want something greasy or something that smells like coconut. You also are approaching mid-life so anti-aging is a concern.

This is a scenario in which it would be worth considering a higher-end sunscreen that has a smooth, dry finish, won't clog your pores, has a pleasing fragrance, layers well under make-up, and has anti-aging properties as well. Our favorite skincare lines have answered this particular need well -- EltaMD is a skincare line with many elegant sunscreens that are perfect for blemish-prone and sensitive skin. They also contain niacinamide for its calming properties.

You have really sensitive skin and you cannot tolerate chemical sunscreens -- in fact, you have broken out in an itchy rash that lasted for days the last time you tried a drugstore sunscreen. But you have fair skin and blue eyes and know you need good protection. What are your options?

Thankfully, there are many sunscreens available for people with sensitive skin. Blue Lizard is a sunscreen brand out of Australia that uses physical blockers and is great for people with sensitive skin who are on vacation or who exercise outdoors and need reliable, consistent protection. For patients who need a product for every day usage, SkinCeuticals Physical Fusion and EltaMD Pure are two great options. Vanicream and California Baby Super Sensitive are two drugstore options that are great for children with sensitive skin.

You know you need to wear sunscreen on your face every day, but you hate skincare products. You want to apply one thing only to your skin every morning. What is one product that will take care of everything?

You need a BB Cream! While we prefer that patients apply a dedicated sunscreen first, then apply their cosmetic coverage, we understand "product fatigue" and the need to simplify our daily routines. In this situation, we recommend EltaMD Elements or EltaMD UV Daily Tinted. Both of these products have excellent spf, are tinted, and provide great coverage. You can then set the product with a mineral powder and you are ready to go!

Nashville Dermatologist -- Picking a Sunscreen, Part One

Nashville Dermatologist -- Picking a Sunscreen, Part One

So last week we talked about common-sense ways to protect your skin from the sun and we learned that sunscreen is preferably your last line of defense against sun damage.

BUT . . . we all go outside and we all need sunscreen, so let's talk about how to pick the best one for you.

Before we go on, we need to mention that this blog is intended for educational purposes only and cannot nor should not replace the recommendations of your own personal physician. There are many factors that affect which sunscreen you choose, and we are going to try to simplify that process for you.

First things first, sunscreen is meant to protect you from the sun's damaging rays. How does it do that? Well, sunscreen utilizes either chemical blockers (which absorb the damaging rays) OR physical blockers (which reflect the damaging rays), OR a combination of both. These days, most effective sunscreens use a combination.

Chemical blockers that are commonly used include avobenzone, octinoxate, oxybenzone, octisalate, octocrylene, homosalate, and mexoryl.

Zinc dioxide and titanium dioxide are the two physical blockers that are used. Because zinc and titanium do not rub in and instead leave a white, chalky paste sitting on the surface of your skin, often these particles are "micronized" or basically are made super, super tiny so that they do not leave a chalky coating on your skin.

So how do you know whether you want a physical sunscreen, a chemical sunscreen, or both -- and when you are reading the label of ingredients, how do you know if your chosen sunscreen is effective?

There are two things you really need to know regarding the efficacy of your sunscreen -- first is the SPF, or sun protection factor, and second is the spectrum (is it "broad spectrum" or not).

SPF is the numerical rating that describes the relative strength of the sunscreen at blocking UVB rays. Dermatologists generally agree that you want to choose an SPF 30 or higher. SPF DOES NOT imply the duration that a sunscreen will last, but rather the amount of UVB rays that it will block. So choosing a higher SPF DOES NOT mean that you can reapply less frequently. Above SPF 50, the increase in sun protection is small, however for people who have a history of melanoma or are particularly prone to burning, an SPF higher than 50 is often a good choice. At Traceside, our family members are wearing an SPF 70 at the beach.

The SPECTRUM of the sunscreen indicates whether it covers both UVA and UVB rays. As we discussed above, the SPF tells you how well the sunscreen blocks UVB. But what about UVA? The sunscreeen also needs a UVA blocker. The physical blockers will both block UVA. The chemical sunscreen Mexoryl also blocks UVA.

So, in summary, when you are reading the label on a sunscreen you want to choose a sunscreen with:

1. SPF 30 or higher

2. Broad-spectrum (UVA and UVB) coverage

3. to achieve that, you need to either have picked:

* a completely physical sunscreen (zinc and titanium only)

* a chemical sunscreen that contains Mexoryl

* or a chemical sunscreen that ALSO has at least one of the physical blockers


Stay tuned! On our next post we will cover choosing the actual brand and special considerations for people with specific concerns (aka an allergy, sensitive skin, acne-prone skin, etc.).


Nashville Dermatologist -- Sun Protection 101

Nashville Dermatologist -- Sun Protection 101

School's almost out here in Nashville and naturally we are all turning our eyes towards summer -- days at the pool, weekends at the lake, afternoons at the ball park, and perhaps a little work around the yard.

Given that our active lifestyles keep many of us outdoors, what are the smartest ways to protect your skin? And did you know that sunscreen is actually your last line of defense against sun damage? Follow these four simple rules to enjoy the outdoors and minimize sun damage.

1. Avoid Sun Exposure Between 10 and 2

The sun's rays are at the most intense during the middle of the day. It is best to stay indoors during these hot hours with direct overhead sunlight. Work on a project, run some errands, eat lunch with the kids, read a book -- it's your choice, but try to not be outdoors during these hours.

2. Wear Sun-Protective Clothing

Clothing is a GREAT way to protect your skin from the sun! Did you know that there are many comfortable, lightweight, cool, and even attractive options for sun-protective wear? Dr. Valet's personal favorite is Coolibar, a company out of Australia (find them at  Most people are familiar with rash guards, but did you know you can find swim tights as well as surf-style suits? Don't forget the little ones who need sun protection and also, don't forget your scalp and eyes! Hats and sunglassses are critical.

3. Actively Seek Shade

When you have to be outside during sunny hours, try to sit in the shade -- the shade of a tree, an umbrella, a porch awning (you get the idea!). Any shade you can find will protect your skin from the sun's most intense rays.

4. And Lastly . . . Wear Sunscreen on Exposed Skin

You knew we would recommend it. Most dermatologists recommend an spf of 30 or higher re-applied every 60-90 minutes during active sun exposure. Stay tuned for another blog post soon on HOW to choose a sunscreen. (It can be overwhelming, we know).

Until then, enjoy the last days of school and stay cool!