The Skin We’re In

 



Whew.That wasn’t bad at all.


All the intimidating stories I’d heard about a full-body exam at the dermatologist’s office had me expeting the worst. One friend told me she was completely naked in a brightly lit room in front of the doctor and assistant, clipboards in hand, who took notes as they examined every inch of her embarrassed self. Yikes. That sounds more like an alien abduction than a doctor visit, if you ask me.


Fortunately, I was in much kinder hands.


When I got this assignment, I decided I should take it seriously. Because I was writing about skin, why not go for a dermatology exam myself? Especially since I’ve never been checked and have lived in “sun country” for most of my life.


I made an appointment with Ashley Cauthen, M.D., at MidState Skin in Ocala. Dr. Cauthen’s casual yet competent approach took away any anxiety I had. There was no standing naked under bright lights in front of a stranger. Instead, I wore a robe and the entire exam was painlessly over in just a few minutes.


Considering I’m an outdoor person and have had a lot of sun exposure over the years, I was pleasantly surprised that Dr. Cauthen found only one actinic keratosis (“sun spot”) on my hand, which required attention. A quick zap with liquid nitrogen and it was taken care of. No need to worry about it progressing to skin cancer.


She explained that if she had found something that had the potential of being cancerous, she’d have done a biopsy and sent the sample to a lab for analysis. If it came back positive, a minor outpatient surgery might be all that was needed to remove the spot. If it was advanced, a more aggressive treatment protocol would be in order.


During an exam, the dermatologist also looks for moles and any type of lesion that ulcerates, bleeds or is reluctant to heal. If nothing is found, you’re typically good to go for another year.


Skin Cancer Cases Climb.


“Patients are often more concerned about skin issues than internal things like high blood pressure or diabetes,” notes Dr. Cauthen, “because you can’t hide dermatological issues. You are wearing your disease.”


Raised in Ocala, Dr. Cauthen is well-versed in the damage that skin incurs with constant exposure to sun. She encourages Florida residents (and those in other sun-drenched regions) to plan their initial visit to a dermatologist much earlier than persons who live where they see a lot less sunshine.



“When you start annual exams really depends on your sun exposure. If you haven’t had a history of blistering 
sunburns or chronic sun exposure while growing up, you can wait to start annual exams in your 30s or 40s,” she notes. “But for people who’ve lived in Florida, we suggest they start getting checked once a year in their 20s, as early as age 21.”


All that time in the sun may not catch up with you until middle age, but catch up it will. Wrinkles and sun spots will eventually result, and in some cases, skin cancer rears its ugly head.


Another major cause for concern is the prevalence of tanning bed use. That “healthy” golden glow is actually anything but.


“Tanning beds really age you,” says Dr. Cauthen bluntly. “The latest studies have found that women exposed to UV radiation from indoor tanning at any time in life are at a 75 percent increased risk of getting melanoma. The incidence of melanoma has gone up tremendously and is secondary to the use of tanning beds, which are now considered as carcinogenic as cigarettes. The highest rate of melanoma is now found in women between the ages of 25 and 35, and most of that is due to tanning beds.”


As she explains, all tanning is dangerous. A tanning bed exposes you to both UVB and UVA rays, but so does natural sunlight. However, in a tanning bed, the UVA rays are intensified, which definitely accelerates the aging process.


Many of us enjoy the look of a tan, and Dr. Cauthen says that’s fine, so long as you achieve that color by using a self-tanner or getting a “spray tan” either at a salon or by doing it yourself. Just don’t make the mistake of thinking that being tan will actually protect you from the sun.


“People may think they’re more protected and won’t burn as easily if their skin looks more brown, but it doesn’t offer any form of protection,” she notes. “People with naturally darker skin are more protected but not totally. Bob Marley was black, but he died from a form of melanoma that was first found between his toes.”


The Fight Against Aging.


Everything changes as we age, and our skin is no exception. It becomes thinner, drier and less elastic. The No. 1 thing to slow aging is to use sunscreen religiously. Use of a retinoid cream at night will also help with cell turnover, as well as fine lines and wrinkles.


Faces are one of those body parts that benefit from fat, and the older we get, the less of that we have in the facial area.


“Think of a baby with that nice, rounded face. When we’re young, we have a layer of subcutaneous fat under the skin, but the body absorbs that fat, and over time, we lose more and more of it,” says Dr. Cauthen.


Ahh, but that’s where we can access the latest advances in the field of dermatology… fillers and botulinum toxin. (Botox is just one trade name.)


“Botulinum toxin is useful for relaxing the muscles that contract and cause wrinkles. It helps diminish the appearance of dynamic muscles, the ones you use when making expressions. People hear the term and it sounds alarming, but used in the dermatological setting, it’s very safe,” says Dr. Cauthen.



Cosmetic use has become widespread. Injected under the skin, the substance temporarily paralyzes muscles, with effects usually lasting three to four months. Some younger women are even requesting it for prophylactic use to keep wrinkles from forming in the first place.


Dermal fillers are used to do just that: fill the void in areas under the skin that were once plumped up with subcutaneous fat. They can be injected under the skin to plump up lips, enhance contours and soften creases and wrinkles. Fillers are routinely used to aid in the appearance of marionette lines and nasolabial folds (those frown-like “parentheses” around the mouth and lips that can be so aging).


A recent survey by the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) revealed that 55 percent of filler injections are performed on patients between the ages of 35 and 50. Fillers are sometimes referred to as “liquid facelifts” because they can help restore a youthful fullness without the pain and downtime of surgery. The downside is that they don’t have the lasting effect of surgery; the newest fillers last as long as 12 to 18 months but certainly not years.


Fillers and botulinum toxin are often used in conjunction, and because neither is permanent, they must be repeated periodically to experience continued results.


Some women shy away from cosmetic injections after hearing stories of treatments gone wrong, but such incidences typically happen because of inexperience and/or incorrect application.


“You should only have these things done by a dermatologist or plastic surgeon because they have extensive training in it,” warns Dr. Cauthen. “The drive to be aesthetically appealing is strong, and women try to find cheaper alternatives. You get what you pay for, and you’re not just paying for the product but the experience of the person doing the injections,” she says. “I saw one woman who had construction-grade silicone injected into her buttocks as an enhancement. She turned septic and required surgery to remove it. Another woman tried to bleach out sun spots using actual bleach and ended up with a rash much worse than the spots.”


Shining The Light On Laser Treatments.


“Whatever condition you are looking to correct, lasers may be the key,” says Miranda Whitmer, M.D. of Gainesville Dermatology Aesthetic Center.


Those conditions include everything from unwanted hair, aging skin, sun damage, redness and dilated blood vessels, and even tattoo removal.



“Fraxel laser is a revolutionary laser system that can offer the results of more invasive lasers without the side effects or significant down time. In addition to being the only FDA-approved procedure for treating acne scarring and melasma, Fraxel is the ultimate laser system for skin rejuvenation, correcting pigmentation, laxity and fine lines and wrinkles,” notes Dr. Whitmer. She adds that this laser is most commonly used for the face, neck, chest and hands but can be used on any skin surface. Although improvement is seen with each treatment, you’ll get the best results with three to six treatments performed one month apart.


Other laser systems are used to treat redness and dilated blood vessels on the skin that are often the result of rosacea, sun damage or even vascular birthmarks. Depending on the severity of the condition, you may need one, two or more treatments.


That tattoo you wished you’d never gotten? There’s a laser for that.


“The Q-switched Alexandrite laser is specifically designed for tattoo removal and is effective for tattoos of all colors,” notes Dr. Whitmer. “Red and black inks tend to respond the quickest. Treatments are done monthly and typically require around six to 12 sessions. Each session takes only minutes to perform, and prices are based on the size of the tattoo.”


Lasers have also become popular as a non-invasive method of reducing and eliminating unwanted body hair.


“Precisely controlled pulses of energy are directed deep into the skin to destroy unwanted hair follicles,” Dr. Whitmer explains. “Because each session targets only those hairs in the active growing phase, four to six treatments scheduled six weeks apart are recommended for optimum results. Most clients will achieve excellent results requiring minimal touch-up treatments once or twice a year.”


Because laser hair removal has become so popular, make sure you know that the person doing your treatment is appropriately trained, she adds.


“Be sure to verify your technician’s credentials and the safety of the laser for your particular skin type.” 


As with any skin treatment, lasers may result in temporary increased susceptibility to UV rays, so appropriate sun protection should be used after any laser treatment session. 

Arm Yourself Against Adult Acne.


It seems particularly unfair that a “teenage problem” can strike long after you’ve left the teen years behind. Unfortunately, though, it happens. And adult acne is not the same as acne that afflicts the young.


“Teenage acne is usually more bacteria driven, while adult acne is primarily more of an inflammatory hormonal response. A bump is not just a bump. Teenage acne has whiteheads, because the white blood cells are fighting bacteria, but with adult acne there’s no bacteria to fight, so you don’t get whiteheads,” explains Ray Shulstad, DNP, ARNP, of the Center for Dermatology and Skin in Spring Hill.


Just because you never had acne as a teen doesn’t mean you’ll escape it as an adult, and to add to the “unfairness” factor, it affects women almost exclusively.


“Women seem to get the short end of the stick when it comes to adult acne because hormonal changes can cause breakouts,” notes Shulstad, who has worked in the field of dermatology since 2001. “In the 20s, hormones are changing as the body gets ready for childbirth, and the mid-30s are another time when breakouts are common, because the hormones are transitioning out of the optimal time for childbirth. It can also occur during perimenopause, early to mid-40s, and when someone has stress in their life.”


Facial hair, which is also hormonally driven, may accompany adult acne. Although teenage acne often affects the entire face, adults usually break out around the mouth area, chin and jaw.


“The best treatments are low-dose antibiotics, not to fight bacterial infections, but because of the anti-inflammatory properties of the antibiotics,” says Shulstad. “We don’t like to use steroids on the face, because, while they can help for a short period of time, they can make it worse in the long run.”


Some women suffer from polycystic ovary syndrome (PCOS), a common endocrine disorder in which the woman has high levels of masculinizing hormones, such as testosterone.


“Additionally, spironolactone, a diuretic that blocks testosterone, can be useful in the right patients,” Shulstad notes. “Some new medications for treating adult acne include non-steroidal anti-inflammatory topical gels and creams.”


Birth control pills are often used to treat teenage acne, but he says they don’t tend to be as effective for combating adult acne.


He cautions against using over-the-counter treatments meant to open the pores. Scrubbing with such products can worsen the problem by causing even more inflammation.


The good news is that adult acne is much easier to control than teenage acne.


“Usually, after a few weeks on medication, you can start tapering off, but it really depends on the individual,” says Shulstad. “If it’s stress-related, it’s usually short term until the hormones regulate themselves. Certain conditions, like rosacea, can make it worse and require longer treatment.


“The quicker you get to a dermatologist, the less damage you’ll do to your skin,” he adds. “The quicker you get it under control, the sooner you’ll quit breaking out. Treating it properly can also prevent scarring.”

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