Viewing entries tagged
Traceside Dermatology and Allergy

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!

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.

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.).