SkinCare Physicians Blog offers insights on the latest in medical and surgical dermatology, cosmetic and laser medicine, as well as aesthetics. All of our internationally recognized physicians and some members of our staff contribute to the Skincare Physicians Blog.
Over the last 2 decades, SkinCare Physicians’ Dr. Jeff Sobell has experienced a progression in innovative therapies for psoriasis. Now, with the recent approval of Skyrizi (rizankizumab-rkaa), a biologic indicated for the treatment of moderate-to-severe plaque psoriasis, this progress continues.
Skyrizi belongs to an exciting new class of medications called IL-23 inhibitors. These medications, given by subcutaneous injection, have gained in popularity as they offer patients the chance for high efficacy with favorable tolerability.
In clinical trials with Skyrizi, the average patient’s psoriasis improved by over 50% after 1 dose, and over 90% after 2 doses. At one year after 4 doses, with one injection every 3 months, the average patient’s psoriasis was 95% clear. Not only did Skyrizi address the redness, scale and thick appearance of psoriasis, but it also relieved the symptoms of itching, burning and pain frequently associated with the skin disease.
Before & After Photos Plaque Psoriasis Treated with Skyrizi
Before Skyrizi treatment
At 4 weeks of treatment
At 16 weeks of treatment
Overall the medication was well tolerated by patients in the investigational studies. Common side effects included upper respiratory tract infections, headache and fatigue. As with most biologic therapies, testing for past exposure to tuberculosis is required before starting therapy.
If you suffer from psoriasis, it’s time to contact SkinCare Physicians’ Psoriasis Treatment Center. Skyrizi is an example of the innovative and effective treatments available at our practice. Our dermatologists are proud to provide our psoriasis patients with the very best care possible.
Close to 10 years ago CoolSculpting by Zeltiq revolutionized our approach to body contouring, using a controlled form of cooling to selectively and permanently reduce unwanted areas of local fat. Today, truSculpt iD by Cutera adds a new non-surgical fat reduction procedure to our dermatologists’ toolbox.
truSculpt iD is an innovative technique, recently approved by the FDA, that uses radiofrequency to permanently reduce fat. Instead of the selective cold fat damage produced by CoolSculpting, the radiofrequency used by truSculpt iD converts to heat, permanently melting fat in localized areas. Here are the main benefits of the procedure:
Tailored: Because of the shape and size of the truSculpt iD applicators, our dermatologists can further customize our fat reduction treatments to patients’ specific body shape.
Versatile: We can treat both large and small areas of unwanted fat. The six handpieces can be applied at once to treat a fairly large area such as the abdomen and flanks quickly. Areas that are too small for the CoolSculpting applicators, such as small bulges over women’s and men’s love handles, or pockets around the belly button or a scar, do beautifully with truSculpt iD.
Quick: The procedure can be done in a remarkably short, 15-minute treatment session.
Painless with no downtime: truSculpt iD produces results similar to those of CoolSculpting with even less discomfort and virtually no downtime.
Like CoolSculpting, truSculpt iD is not a weight-loss program, but a treatment to reduce localized areas of fat on the abdomen and love handles, inner thighs, arms and axillary puffs. With the addition of truSculpt iD, SkinCare Physicians’ dermatologists have a more comprehensive and versatile approach to fat reduction. We can now use either cold or radiofrequency-induced heat to produce permanent, pleasing, and natural results for our patients.
Extended, unprotected exposure to the sun can harm the skin for a myriad of reasons such as skin cancer and aging, but photodermatoses, or “sun poisoning”, is a slightly less common but still dangerous effect of sun exposure. Many patients use the term “sun poisoning”, but what does it really mean? We asked dermatologist Dr. Robin Travers to explain the skin condition and its symptoms.
Sun Poisoning Variations
Sun poisoning is similar to severe sunburn, which can lead to patient confusion if symptoms go beyond those they may usually get from a day in the sun. Here are five different forms of the condition and their respective symptoms.
Polymorphous Light Eruption (PMLE): This condition is fairly common and triggered by both UVA and UVB rays. PLME typically occurs only after the first few bouts of sun exposure for the year, since people develop a tolerance to the sun as time progresses. For example, people might develop symptoms after a February trip to a sunny climate, or after those first few sunny warm days in May. Symptoms include a rash that is intensely itchy on forearms, tops of hands, thighs, sides of the face and the v-neck area of the chest.
Photoallergic Reactions: Photoallergies occur when people have become sensitized or allergic to oral medications or topical products (including some ingredients in sunscreens). UVA light triggers these reactions more often than UVB. UVA rays are equally as strong in the winter as in the summer, so these reactions may occur in the wintertime as well as summer.
Phototoxic Reactions: These reactions are fairly common and are similar to acute sunburn. They occur as a response to tetracycline derivatives and sun exposure and can leave severe redness, swelling and blistering, especially on the tops of hands. Other phototoxic reactions include phytophotodermatitis, which is a response to topical agents on the skin. One common example of this is a reaction to furocoumarin, a chemical in many plants such as limes that can cause intense symptoms. Many patients develop this reaction after squeezing lime into a drink while vacationing in a tropical location.
Solar Urticaria: This rare condition is potentially the most severe of the varieties of sun poisoning. Solar urticaria can be triggered by any type of UV light, though UVA is the most common culprit. Hives occur after a short time in the sun and may lead to anaphylactic shock after full body exposure to sunlight.
Contact Dermatitis: Eczema sufferers are not necessarily at a higher risk for sun poisoning, but they, and people with other inflammatory skin conditions, can develop photoallergic contact dermatitis.
All these conditions take the moniker “sun poisoning,” which can make a diagnosis difficult—a physical exam, biopsy and sometimes patch testing may be necessary to reach a precise diagnosis.
Prevention and Treatment
Sun protection is key to prevent these conditions. Patients should reach for a high SPF broad spectrum sunscreen in order to protect from both UVA and UVB light. Sun protective clothing lines exist to specifically prevent UV exposure and are particularly helpful for patients who find it difficult to apply and reapply sunscreens. Patients can also find relief by eliminating any specific irritants or allergens that may be causing their reactions.
If the damage has already been done, hydration and ibuprofen can help with sunburn-like symptoms. Application of hydrocortisone ointment, along with cool baths, compresses and soothing anesthetic gels can provide temporary relief until the eruption resolves.
When in doubt regarding sunburn vs. sun poisoning, always contact your dermatologist.
Many of our patients at SkinCare Physicians ask if they should change their diet to help improve their acne. Fortunately, there have been many studies looking at possible links between diet and acne. SkinCare Physicians’ Dr. Tania Phillips sheds some light on which foods to avoid and which foods can help.
Foods to avoid
High glycemic foods – sugar, white bread, white pasta, and other simple carbohydrates: A study published in July 2018 in the Journal of the American Academy of Dermatology found that diets containing a lot of foods with a high glycemic foods were strongly linked to acne. Scientists aren’t sure why, but one reason may be that high glycemic foods can cause the release of various hormones, such as growth hormone insulin and IGF-I, which can make acne worse. Highly processed and refined carbohydrates turn to have a little or no fiber, and generally could cause blood sugar levels to spike.
Low-fat dairy products: A link exists between dairy products and acne development. In particular low-fat dairy products are associated with acne. Why milk may worsen acne is however still a bit of a mystery. One theory is that some of the hormones in milk cause inflammation inside the body. It is possible that these hormones become more concentrated when the fat is removed. No studies have found that milk products such as yogurt or cheese lead to more breakouts.
Foods possibly helping
Foods with high levels of polyphenols can help to decrease inflammation and may also possibly help acne. Polyphenols are natural micronutrients packed with antioxidant molecules. Polyphenols are found in many plant-based foods including nuts, berries, fruits, green vegetables, dark chocolate, extra virgin olive oil, wine and green tea. Polyphenols have anti-microbial and anti-inflammatory properties and can be used for reducing sebum production in the skin and for treatment of acne.
In summary to help improve your acne, try the following dietary changes:
Avoid starchy or sugary foods that have a high glycemic index.
Avoid low-fat dairy foods and beverages, if you eat dairy products.
Eat plenty of colorful plants and produce.
Keeping a food and acne diary for a few weeks may help you to identify which foods affect your acne. Also, remember that other factors such as stress may trigger or worsen acne.
While some evidence suggests that diet can possibly affect acne, diet changes alone may not prevent or clear breakouts. If your acne persists, the dermatologists at SkinCare Physicians recommend to seek a medical treatment.
Improving skin color and texture is an important goal for many of our patients, including those who cannot afford to have much down time after a laser procedure. But, can one laser really improve both skin discoloration and texture with minimal down time? The answer is YES and the treatment is called PicoToning.
What can PicoToning accomplish?
With the specialized Focus Array setting on the PicoSure laser, one device can target multiple cosmetic concerns utilizing gentle pressure on a cellular level. This treatment improves the appearance of sun damage and brown age spots by breaking up pigment. At the same time, the treatment improves the texture and tone of the skin by stimulating collagen production. That’s why PicoToning is also effective in the treatment of fine lines and helps to smooth divots and depressions. It is safe in many skin types and may also be an excellent choice for people who simply feel as if their skin has lost its luster.
Can PicoToning be used for melasma?
Yes, PicoToning offers another tool in our dermatologists’ arsenal for the improvement of melasma. Melasma is one of the most difficult problems that dermatologists encounter in their patients. It is a skin condition that causes discolored brown patches, usually on the face, that worsen with sun exposure. It is also frequently seen in pregnancy. We often start treatment protocols with topical brighteners and bleaching creams, but for many patients this does not lead to sufficient improvement. Because PicoToning is gentle on the skin, there is less risk of exacerbating melasma compared to some other laser treatments.
Is PicoToning effective for acne scarring?
Yes, the PicoSure laser with Focus Lens Array is FDA-approved for the treatment of acne scarring. At least one study demonstrated a >24% improvement in acne scar volume after a series of treatments. PicoToning may be a good treatment option for mild to moderate acne scarring in patients who are looking for minimal down time or have darker skin types.
A quick, comfortable laser treatment with minimal downtime
Following a comfortable, 15-20 minute PicoToning treatment, the skin remains pink only for up to 1-2 days, allowing patients to return to their regular activities quickly. Best results are seen after a series of 3-6 sessions. PicoToning is uniquely suited for individuals with busy schedules who still want to look their best by simultaneously improving brown spots, skin texture and stubborn acne scars.
PicoToning has multiple applications due to its benefit for both skin color and texture. SkinCare Physicians’ dermatologists are excited with the results they have had with the procedure. To find out if PicoToning is right for you, schedule a consultation with one of our physicians near Boston.
We hear about culture, read about it, and strive to somehow capture it. But what exactly is it? Is it worth our focus? Does culture really matter? At SkinCare Physicians the response is a resounding yes! And the cornerstone of our dermatology practice’s service culture is our CARE for both patients and employees.
Our physician founders and original management leaders established the ideals for which we strive and initiated SkinCare Physicians’ early culture. Over time, we designed and developed behavioral standards, customer service concepts, employee hiring and training programs consistent with our core values, and our culture of caring was framed. We believe our culture’s strength is powerful because it has evolved naturally and genuinely.
“SkinCare Physicians CARES” is meant to convey our collective purpose. Since our early days in 2000, we CARE for people. We are about fostering a culture, and creating an environment in which we care for both our patients and employees.
How do we stay true to and aligned with our culture of caring, and provide a workplace where people want to work together and support each other? By encouraging honest and open dialogue from every member of the SkinCare Physicians team like we do with every patient; by training, ongoing education, job shadowing exercises, and counseling sessions. Everyone at SkinCare Physicians supports practice growth and collaboration, and everyone works consistently as a team to remedy traits that might hinder advancement.
Seeking both patient and employee engagement is a concept tasked to every member of the SkinCare Physicians team. We build patient engagement into our daily routines by hearing them, observing touchpoints, and conducting patient satisfaction surveys. We also value employee engagement by listening to one another and through our on-the-spot rewards, entertainment committee, and peer recognition programs, among other initiatives.
Our service standards
SkinCare Physicians’ service design originates from a thoughtful and extensive understanding of our practice’s purpose, laying the groundwork from which all our other service choices were launched including our common purpose statement: C A R E S. It should not come as a surprise then that our five quality standards guiding our service delivery are:
C – Confidence
A – Accuracy
R – Respect
E – Empathy
S – Safety
These standards are applied at every patient and employee touchpoint, preserving an environment where people feel connected and are recognized as being an important part of something uniquely special.
At SkinCare Physicians we have created a happy, positive work environment where people are naturally motivated and even better, motivate each other. Our culture guides all of our choices. It helps us respond to unprecedented service requests. It helps us understand and exceed patient’s expectations. It encourages us to share new ideas with our management team. It inspires us to join a committee. It contributes to job satisfaction and employee happiness. It enables us to provide heartfelt patient experiences. In that environment, employees confidently make hundreds of decisions on their own every day, and the SkinCare Physicians culture of caring acts as their guide. SkinCare Physicians CARES.
Microneedling has been around for over 2 decades, but only recently has there been sufficient data to make it clear that it actually is a useful procedure to improve wrinkles and scars. Learn from a renowned Boston dermatologist why having your face poked with hundreds of tiny needles improve its appearance.
The premise behind microneedling
It was originally postulated that inducing micro wounds to the skin would initiate healing and encourage connective tissue augmentation. Others later described a similar method, inserting needles parallel to the skin, as “percutaneous collagen induction”. Indeed, after penetration of these small needles into skin, a wound healing cascade is initiated. This starts with mild inflammation and release of growth factors, followed shortly by proliferation and the initiation of collagen production and finally, remodeling, which goes on for many months.
How Microneedling works
Microneedling uses pen-shaped roller devices armed with very fine needles which make miniscule evenly-spaced punctures in the skin. These tiny wounds sometimes allow a small pinprick of blood to rise to the surface. Microneedling is a type of fractional treatment, in which only a fraction of the surface of the skin is affected, leaving normal skin surrounding each microwound, hence the rapid healing and little downtime. The procedure is associated with very few adverse side effects compared to some other therapies, is helpful and well tolerated by skin of any color. Its principal use has been for the treatment of fine lines and wrinkles, particularly those surrounding the mouth. It is also helpful for thin scars on the face, such as acne scarring. It has potential use for some pigmentation disorders such as melasma and for stretch marks.
Going a step further with microneedling
When needles penetrate through the skin they create small holes known as microconduits. If substances are applied to the skin right away they then can penetrate through the otherwise impermeable outer layers of the skin to induce useful effects. If some soft tissue augmentation agents or fillers are applied immediately after microneedling, they can filter through the channels leading to diffuse induction of collagen and elastic formation and dimunition of lines, wrinkles and scarring. Platelet-rich plasma (PRP) can be instilled into the skin in this fashion. As well, if photosensitizing chemicals are applied after microneedling and the skin is later irradiated with relevant wavelengths of light, precancerous lesions such as actinic keratoses can be successfully treated. This represents a benign way of penetrating through the tough epidermis, but there is a caution: applying potentially toxic substances to microneedled skin can lead to systemic absorption, as well as adverse and allergic reactions, so it is important to use only agents specifically advised for treatment.
From at-home to in-office devices
There are many microneedling devices available. While home devices are handheld, cylindrical rollers with multiple arrays of needles, most devices used in physicians’ offices are battery or electrically operated units with up to almost 200 needles. The tips of these microneedles are the same size as very small needles used for injection into the skin. The depth of injection may be from tenths of a millimeter up to 3 millimeters.
What to expect
Microneedling treatments are safe and well tolerated by all skin phototypes. The procedure is uncomfortable, so a topical anesthetic is applied for 20-30 minutes prior to treatment. Following the procedure there is transient redness and occasionally a bit of swelling. The redness usually lasts 1 to 3 days.
Microneedling is relatively inexpensive and can be performed at the same time as other facial treatments, such as botulinum toxins, fillers, peels or dermatologic lasers. It is important to understand that microneedling is not a “quick fix”. Most people need a series of treatments, typically at least 2-3, but potentially as many as 6 usually spaced 4-6 weeks apart. Microneedling won’t likely produce dramatic results, but mild to moderate improvement that will appear slowly. It is an effective treatment for a variety of textural abnormalities and for all skin types. Benefits can last up to 12 months and when used synergistically along with other treatments it provides a variety of useful approaches to treatment.
In winter time and early spring everyone’s skin is dry, cracked and flaky. Because of this “xerosis”, fine lines and wrinkles look more noticeable. The skin is your body’s largest organ and it represents the first line of defense against bacteria, viruses, and irritants. If that skin barrier function is disrupted, even by simple dry skin, that puts our patients at risk for infection and dermatitis.
Knowing how your skin become dry and how moisturizers work to retain water will help you to keep your skin well hydrated year long.
How does our skin become dry?
We all lose up to a pint of water through our skin’s surface every day. This is called trans-epidermal water loss (TEWL). Some factors that increase the rate of trans-epidermal water loss include low humidity, sunburn, excessive exfoliation, exposure to irritants such as harsh soaps, alcohols or solvents, and exposure to highly chlorinated water. Common skin diseases like atopic dermatitis, psoriasis or ichthyosis can also increase trans-epidermal water loss. When the skin’s moisture level is less than 10%, it is technically considered dry skin.
There are 3 strategies to keep the skin well-hydrated:
1- Avoid excessive exposure to irritants which can strip the skin’s superficial layers and oils
2- Moisturize, moisturize, moisturize to help seal water in the skin
3- Use a humidifier to keep home humidity levels between 30-50%
How do moisturizing ingredients work?
Moisturizing ingredients work via three different mechanisms, and many moisturizing products combine these occlusive, emollient or humectant ingredients for better effect than any single ingredient can offer.
Occlusives create a barrier over the skin’s surface to stop transepidermal water loss. Examples of occlusives include petroleum jelly, Aquaphor ointment, shea butter, mineral oil, or coconut oil. These simple oils and waxes simply sit on the very surface layer of the skin, the stratum corneum, and create a barrier to prevent transepidermal water loss. Occlusives are very effective moisturizers, but users often cite stickiness and messiness as an impediment to using them.
Emollients are creams, lotions or ointments which are able to penetrate beyond the stratum corneum into the deeper layers of the skin. They can help support and bind together the proteins that help hold the skin’s cells together, filling in the gaps between the cells and holding water deeper in the skin.
Humectants work a bit differently: instead of focusing on simply holding water in the skin, these ingredients work by drawing moisture in from the outside. Humectants penetrate the outer layer of the skin, pulling water molecules along with them. These ingredients increase the total amount of water that the skin can hold. Humectant ingredients include hyaluronic acid, glycolic acid, and urea. Special naturally occurring molecules within the skin such as ceramides, filaggrin, and pyrrolidone carboxylic acid (PCA) form the skin’s Natural Moisturizing Factor (NMF). These powerful humectants have been incorporated into commercially-available moisturizers to good effect.
Humectants can be a double-edged sword: when the humidity is low in the surrounding air (such as in the wintertime), they can draw water molecules up from the deep dermis. If this deep dermal moisture is not replenished, the skin’s stratum corneum may be superficially hydrated in the short term, but ultimately may become more dry. Look for moisturizers that combine humectant ingredients with occlusive ingredients to solve this problem.
Moisturizers that combine all three types of ingredients are often the most effective. But as important as the ingredient list might be, it is even more important that the moisturizer feel good on the skin! A moisturizer that is easy to apply, glides onto the skin, and penetrates swiftly is one that is going to be easier to use every day. As long as you have no sensitivities, choosing a moisturizer with a fragrance you like can make applying your daily moisturizer something to look forward to instead of a chore! And consistency is the real key to hydrating the skin well.
If needed, your dermatologist can recommend a moisturizer that will work best for your skin type.
A lot of our patients at SkinCare Physicians are experiencing dry itchy skin at this time of year. This infographic shows in 6 easy steps what you can do to minimize your symptoms and moisturize your skin more effectively.
Step 1: Take short warm showers. It’s always tempting to take a long hot shower in winter, but this will make your skin’s dryness and itching worse.
Step 2: Use a mild unscented soap or soap free cleanser, such as Dove or Cetaphil. Harsh soaps can dry out your skin. Harsh soaps can dry out your skin.
Step 3: Only use soap where needed. Soap is not really required all over the body every day!
Step 4: Don’t dry your skin completely after showering; just pat dry with a towel.
Step 5: Apply moisturizer immediately to damp skin. Look for unscented moisturizers that contain lactic acid or urea; they can be effective for extremely dry itchy skin. Ointments such as Aquaphor or Vaseline can be greasy, but trap moisture better than lotions.
Step 6: Turn on humidifiers in your house; they can help make the air less dry, which will benefit your skin. If you don’t have one, place bowls of water on top of radiators.
The good news is that once spring arrives, the ambient air is moister, and skin dryness and itch tend to improve.
If these simple measures do not help, see your dermatologist or contact us. You may need a prescription medication to relieve your symptoms.
Editor’s note: This updated blog was originally published on March 25, 2013.
Have you ever heard a story about someone with head lice and then felt itchy for the rest of the day? There is a reason for this “contagious itching”! Researchers at Temple University* used functional magnetic resonance imaging (fMRI) to get some answers. fMRI offers a way to measure brain activity by detecting changes associated with cerebral blood flow. In patients who were chronically itchy (such as those with atopic dermatitis, or eczema) who were shown a video of people scratching, their brains lit up in the supplemental motor areas, an area that can prompt people to action, such as scratching. And these patients also reported feeling itchier overall.
We all know that scratching itchy skin may produce a satisfying and pleasurable feeling. Why does something so damaging to the skin feel so good? And why do we sometimes feel even MORE itchy after scratching?
The same Temple University researchers also looked at this, using cowhage applied to patients’ forearms. Cowhage is an irritant that is a major component of practical joker’s itching powder! In chronically itchy patients who scratched the application sites, fMRI showed that certain parts of the brain associated with the reward circuit (striatum, cingulate cortex, caudate nucleus and orbitofrontal cortex) lit up. Among patients who did not suffer from chronic itching, these reward areas did not light up nearly as much. So, your brain is actually perceiving scratching as a reward, even though it can actually damage the skin!
Hopefully, understanding the neurologic basis of itching will lead to better treatments in the long run. Until then, patients and dermatologists work together to treat the underlying problems that are causing the itch, such as eczema, psoriasis, or allergy.
Scratching the skin produces a temporary sensation of relief, but in the long run, the sensation of itching may return and may be even stronger. Scratching the skin produces low level damage to the skin’s surface, and when repeated over time the damage to the skin’s barrier function may lead to infection. In addition, long term scratching or rubbing the skin can produce a skin condition called lichen simplex chronicus, or lichenification. This is a well-circumscribed area of thickened, darkened, hyperlinear skin that is persistently itchy. Dermatologists can offer treatments such as emollients, detection of specific contact allergens, and topical or systemic anti-inflammatory medications that treat the underlying cause of the itching.
* Journal reference: Hideki Mochizuki, Alexandru D P Papoiu, Leigh A Nattkemper, Andrew C Lin, Robert A Kraft, Robert C Coghill, Gil Yosipovitch. Scratching Induces Overactivity in Motor-Related Regions and Reward System in Chronic Itch Patients. Journal of Investigative Dermatology, 2015; DOI: 10.1038/jid.2015.223