Treating skin of color

First of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column and the two that follow will consider these problems and their treatments.

Skin tones
Variations in human skin tone

Variations in skin color

Skin color is determined by cells called melanocytes. Melanocytes are specialized cells within the skin that produce a pigment known as melanin. Melanin is produced and stored within special structures known as melanosomes, contained in the melanocytes.

The melanocytes make up only a small percentage of overall skin cells. In fact, only two to three percent of all skin cells are melanocytes. The variation in skin color we see across all people is determined by the type and amount of melanin produced by the melanocytes.

All people inherently have the same number of melanocytes. A recent theory indicates that the differences in skin color are really a reflection of the skin’s ability to protect against ultraviolet radiation.

Persons living closer to the equator produce more melanin because the ultraviolet radiation is more intense and ultraviolet protection is required by the human body. Groups of people living further away from the equator produce less melanin, resulting in lighter skin color.

One reason treating pigmented skin can be somewhat tricky is that traditional textbooks have had only black and white photographs. Additionally, many lesions have been described as red, pink, salmon, or fawn-colored. This certainly is true in Caucasian skin; indeed, many of the textbooks that were written had this as the majority patient type.

However, in tan, brown, or dark-brown skin, inflammation can look grey, copper, or violaceous in color. Additionally, certain conditions will have a slightly different presentation in pigmented skin.

Post-inflammatory hyperpigmentation and hypopigmentation

Melanocytes can either stop producing color or produce excessive color in cases of inflammation. Generally, in children, the cells stop producing color, especially in irritation of the diaper area. (I explain to parents that the cells tend to go to sleep.)

It is very common for a child of color to have a very light area of post-inflammatory hypopigmentation. This is where the inflammation of diaper irritation causes the melanocytes to stop producing color, leaving light or white patches.

With the appropriate treatment, the color almost always returns to normal within a few weeks. In older patients, inflammation can lead to post-inflammatory hyperpigmentation. This is most commonly seen in areas where acne blemishes heal, leaving a dark spot behind. These, too, will fade with time; however, it can be quite persistent.

Vitiligo

Vitiligo is a skin condition that occurs in all people, but it is most noticeable in patients with tan, brown, or dark-brown skin. I believe that vitiligo is really the end stage of several different disorders.

In some disorders, the melanocytes are attacked by the immune system, and they die. In other conditions, the melanocytes are pre-programmed to die early. No matter what the cause, ultimately, patches of vitiligo are white spots devoid of melanin.

Because these areas lack natural protection, vitiliginous patients must wear sunscreens to prevent ultraviolet radiation exposure and subsequent cancer later in life. In the majority of cases, vitiligo is probably the result of an auto-immune or inflammatory attack on melanocytes.

In these cases, topical anti-inflammatories and phototherapy, most notably narrow-band ultraviolet B, tend to be most effective. We have a success rate of approximately 75 percent in our clinic. In the remaining cases, these are probably related to a genetic program in the melanocytes where they die prematurely. Usually, with the appropriate treatment, signs of vitiligo can be reversed in one to two months.

Pityriasis alba

Pityriasis alba is a condition where white patches occur on the arms, trunk and, most notably, on the face. This is a widespread condition seen primarily in adolescent patients of color. It is a result of very mild irritation and/or eczema leading to post-inflammatory hypopigmentation where the melanocytes temporarily stop producing color.

Gentle topical anti-inflammatory lotions, mild cleansing bars, and ultra- moisturizing lotions can be used to treat pityriasis alba. The loss of color in this condition is usually only temporary and is most notably seen on the cheeks of adolescents.

Dermatosis papulosa nigra

This most commonly occurs in African American patients. Some people call them “flesh moles,” “Bill Cosby spots,” “Morgan Freeman spots,” and, more recently, “Condoleezza Rice spots.”

It tends to occur slightly more frequently in women than in men. These are tan to brown to black, raised papules that can occur on the forehead, cheeks, and neck. Under the microscope, they resemble other benign growths known as seborrheic keratoses.

We use a unique surgical technique in our clinic that can achieve excellent results in treating dermatosis papulosa nigra. Indications for treatment can be pain, itching, irritation, and cosmetic reasons.

Treating skin of color: part three

Conclusion of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column completes our consideration of these problems and their treatment in this series.

Pseudofolliculitis barbae

This condition is also known as “razor bumps.” Hair is made of a protein called keratin, and it can be extremely inflammatory to the skin. It is called “pseudo” folliculitis because the hair can actually come out of the follicular opening and penetrate nearby skin, causing it to look like inflammation, or folliculitis, of that pore.

However, because it is just nearby the actual follicle, it is “pseudo” folliculitis. This is most often seen in persons with curly hair or hair that grows at an oblique angle to the skin.

Sometimes, if curly hair is cut extremely close, it never even exits the skin surface, instead penetrating the sidewall of the follicle (known as transfollicular penetration), or it comes out of the follicle and pokes the skin (known as extrafollicular penetration). The results are the same: The keratin invades the skin, producing a brisk inflammatory reaction that causes itching and the formation of pustules.

When pseudofolliculitis is mild to moderate, many topical treatments can be implemented, including a very gentle oatmeal-based shaving cream, and a non-electric razor with a safety guard, so the hairs are not cut too short. Shaving after a shower is also recommended when the hair is hydrated, so the final tip is soft as opposed to sharp.

Also, using a soft-bristle toothbrush to make circular motions in the beard area before bedtime can prevent the hair from penetrating as it grows throughout the night. Topical anti-inflammatory aftershave lotions and oral anti-inflammatories can also be used if necessary. In the majority of cases, this can provide satisfactory relief.

However, in certain instances in which relief is not achieved through these means, the best treatment is to remove the offending agent. In this case, I recommend laser hair removal.

Pseudofolliculitis barbae has been a vexing problem throughout history and can even interfere with occupations that require a clean-shaven face, such as military officers, peace officers and firefighters. Thankfully, this condition can be addressed by implementing appropriate treatments and techniques.

Tinea capitis

Tinea capitis, also known as ringworm, is endemic in African American children. Any child with a scaling, itching scalp should be thoroughly investigated for tinea capitis.

One of the clues to this is enlarged lymph nodes in the nape of the neck. I recommend a topical anti-itch anti-inflammatory lotion in addition to an oral antifungal agent. No matter what agent is used, it is essential that treatment occurs for at least eight weeks at a somewhat high dose, as advised by a board-certified dermatologist.

It is also recommended that all objects that touch the hair, such as combs, barrettes, rubber bands and pillowcases, be replaced or treated to prevent re-infection. I also advise all members of the household to use an anti-fungal shampoo throughout the treatment period for two months.

This is a prevalent yet easily treatable condition in young children. I believe that as people get older, the milieu of their scalp sebum changes, preventing an active infection. However, many adults can be carriers and pass it to their children, who are prone to the infection.

Melanonychia striata

This is a condition where brown to black longitudinal bands occur in many, if not all, the fingernails and toenails. This is a common, benign condition that is often seen in multiple family members. However, if one band should occur spontaneously without a family history, this should be evaluated for an underlying mole or melanocytic malignancy.

Voigt or Futcher lines

These are lines seen most commonly on the upper arms and sometimes thighs and are normal variations. They were named after a physician and anatomist who first described these near the turn of the century. They are harmless.

Melasma

Melasma is a common and vexing problem that I see on a regular basis in our clinic. It presents as hyperpigmented patches occurring on the cheeks, upper lip, forehead, and sometimes dorsal forearms. It can be extremely challenging to treat, and I inform patients that 25 percent of the time there’s not much we can do about it.

I also tell patients that it is a lifelong battle and something that we’ll always have to treat and use preventive measures to keep from coming back. It’s usually a result of hormones, genetics, and sun exposure. Commonly the hormones can include the initiation of oral contraceptives and/or pregnancy and childbirth.

I often tell patients that it’s a very rapid, uneven suntan occurring in the areas described. It’s exacerbated by sun exposure and, we discovered recently, heat exposure. So, people who enjoy saunas, hot showers, steam baths, and warm climates should know these can exacerbate the condition.

I had one patient who we had difficulty treating, and I asked if heat might be a potential factor in his melisma. He looked at me with a frown and said, “I’m a chef. I’m over a hot stove and opening ovens all the time.”

So, patients with melisma must consider meticulous sun protection and heat avoidance. I tell patients that they need to apply sun protection before they leave the house. Any amount of sunlight that touches their skin while walking from a car across a parking lot into a building, even on a cloudy day, is enough to trigger its occurrence.

Treatments include topical lightening agents, deep skin peels, and newer laser treatments. In three-quarters of patients, we certainly can see satisfactory results, although it’s one of the most challenging conditions that I treat. I see it almost on a daily basis in my practice.

Treating skin of color part 2

Second of a three-part series

Most skin diseases occur in people of all nationalities, regardless of their skin color. Particular problems encountered in the skin are more common in people with different hues of skin, and sometimes a disorder seems more prominent because it affects skin color. This column continues from last week our consideration of these problems and their treatments.

Acne

When treating persons of color, post-inflammatory hyperpigmentation (brown spots after the acne blemishes have healed) and active acne need to be differentiated. It is important to note that when one is treating acne, the brown spots that occur afterward are only residual effects, not active acne.

SEE ALSO: Treating skin of color Part 1

I usually employ a combination therapy when I am treating acne to achieve optimal results. This usually involves topical treatments, oral treatments, laser treatments and, in persons of color, topical lightening agents. These can include retinol, anti-inflammatory agents, and the bleaching agents kogic acid and hydroquinone.

I also discuss with patients the difference between active inflammatory, bumps, and the flat, brown spots left behind.

Dry or “ashy” skin

This is a problem seen in all patients, but when one has tan, brown, or dark-brown skin, dry skin tends to turn silvery white. This phenomenon is often referred to as having “ashy” skin.

I believe the most important component of any skin care program is a gentle, non-detergent cleanser and an ultra-moisturizing lotion. I recommend the lotion be applied immediately after patting the skin dry after a bath or shower.

This seals in the moisture achieved from the shower, and the appropriate moisturizing lotion can provide continuous moisture and protection throughout the day. Often, two or three days of this program can completely reverse dry or “ashy” skin.

Keloids

keloids

Throughout evolution, our skin has become quite skillful at repairing any sites of injury or damage. Once the integrity of the skin barrier has been interrupted, invaders such as bacteria, fungus and virus can penetrate the skin and essential bodily fluids can leak out. As a result, the skin’s repair system is rapid and complete.

Cells known as fibroblasts migrate into the area and produce protein to fill in the hole. The primary component of the repair product is collagen, and that is what makes up a scar.

Unfortunately, in some cases, and commonly in African Americans, the fibroblasts receive the signal to come in and repair the defect, but they do not get the message to turn off. As a result, too much collagen is produced, and the scar can become thick and hard.

When the collagen presses on nearby sensory nerves, the keloidal scar can also produce tenderness, pain, and extreme itching. The difference between hypertrophic and keloidal scars is that hypertrophic scars usually stay right at the site of injury, whereas keloids can actually spread and invade normal surrounding skin.

In our clinic, we use an aggressive six-month program to treat keloids effectively. It is one thing to remove a keloid surgically, yet it is another thing to keep it from coming back. Remember, the development of a keloid is a response to injury. By surgically removing a keloid, the skin is being re-injured — and that area has already shown it can form a keloid.

We perform regular treatments every two to four weeks over six months, including anti-inflammatory injections, topical silicone-based preparations, pressure dressings, and laser treatments to prevent the return of keloids.

Acne keloidalis nuchae

neck treatment

This condition is also known as folliculitis keloidalis nuchae, where small, very itchy bumps can occur at the nape of the neck. This is most commonly seen in African American patients, but to a lesser degree it can affect all patients.

It is most commonly seen in men, but can also be seen in women. Many male patients believe this is a result of a barbershop treatment where the barber had unclean clippers. This is entirely untrue, and I have seen many cases that develop without any previous haircuts.

One theory is that this condition is a result of a deep fungal infection. However, in my experience, I have performed many biopsies and analyzed cultures for fungus and special histology stains, but I have not yet identified a fungus infection. I believe this condition is just an anatomic and genetic variant, with itchy bumps developing from very mild irritation in this particular anatomic location.

Smaller bumps can be treated very effectively with a combination of topical and oral anti-inflammatory medication. In many cases, a short course can provide long-term results. Often a surgical approach is required if the lesions are too large. Nevertheless, the condition can be managed quite well.

What you should know about acne – Part #1

The medical term for acne is “acne vulgaris.” Acne is the most common skin disorder in the United States and the number-one reason patients visit a dermatologist.

Approximately 50 million Americans suffer from acne. Over 80 percent of all teenagers battle acne. Continue reading What you should know about acne – Part #1

Dermatologist Charles E. Crutchfield III M.D. Announces Platelet Rich Plasma to Treat Hair Loss (Alopecia)

Charles Crutchfield III M.D., a nationally recognized Board Certified Dermatologist and Clinical Professor of Dermatology, offers Platelet Rich Plasma (PRP) therapy for hair loss and thinning hair.

Charles Crutchfield III M.D., a nationally recognized Board Certified Dermatologist and Clinical Professor of Dermatology, offers Platelet Rich Plasma (PRP) therapy for hair loss and thinning hair.

There is new evidence showing the effectiveness of PRP Therapy as a non-surgical medical procedure to treat hair loss and thinning hair. Charles E. Crutchfield III M.D. has seen significant results in patients seeking treatment for hair loss (Alopecia). “Using the patient’s own blood, we create a concentration of Platelet Rich Plasma to promote hair growth and rejuvenation.” Charles E. Crutchfield III M.D. explains the treatment and its benefits: “PRP therapy uses the patient’s blood to create the ideal formula of Platelet Rich Plasma. We start by drawing a blood sample and spinning the blood to separate its components: red blood cells, plasma, and platelet-rich plasma. Injecting the enriched platelet-rich plasma, (containing concentrated amounts of growth factors, cytokines, and platelets), into the treatment area. This PRP treatment stimulates the inactive hair follicles into an active growth phase.”

Dr. Crutchfield has years of experience treating hair loss (alopecia) with success. He is excited about new developments that have made platelet-rich plasma therapy a viable option in treating Alopecia. “When we inject PRP into the area of hair loss, it causes a mild irritation that triggers your body to heal, explains Dr. Crutchfield. “When the platelets are in the clot, enzymes are released that begin a tissue response to attract stem cells to heal and repair the damaged area. The results are an amplification of the body’s regularly occurring wound healing system.”

Dr. Crutchfield has seen a significant increase in the number of patients inquiring about this therapy. Estimates are that nearly 100 million Americans suffer from hair loss. PRP for Hair Loss Therapy is a breakthrough treatment option because it is a safe, reliable treatment that is short and non-surgical. The recovery period is fast, and the results look natural.

“In our experience, although PRP is not yet FDA approved for alopecia, we have a success rate of approximately 75%. I tell patients if they do not notice any regrowth after 2-3 treatments, not to continue. I define success as patients report that they see a significant amount of hair regrowth. I recommend a series of injections to be done monthly, for 4-6 months. Once patients achieve the level of hair regrowth that they are happy with, we will recommend a topical treatment program to maintain and extend the PRP treatment success and recommend a PRP treatment every 6 or 12 months for maintenance. “

The PRP treatment works well for both men and women. It is primarily designed to treat androgenetic alopecia, but we have had success in alopecia areata and hair loss associated with stress (telogen effluvium), too.

Dr. Crutchfield can review your specific case and help to develop a hair re-growth plan.

About Charles E. Crutchfield III, MD:
Charles E. Crutchfield III, M.D. is a graduate of the Mayo Clinic Medical School and a Clinical Professor of Dermatology at the University of Minnesota Medical School. Dr. Crutchfield is an annual selection in the “Top Doctors” issue of Mpls. St. Paul magazine. He is the only dermatologist to have been selected as a “Best Doctor for Women” by Minnesota Monthly magazine since the inception of the survey. Dr. Crutchfield has been selected as one of the “Best Doctors in America,” an honor awarded to only 4% of all practicing physicians. Dr. Crutchfield is the co-author of a children’s book on sun protection and dermatology textbook. He is a member of the AΩA National Medical Honor Society, an expert consultant for WebMD and CNN, and a recipient of the Karis Humanitarian Award from the Mayo Clinic School of Medicine. Dr. Crutchfield was also given “first a physician” award, Helathcare Hero, 100 most influential, and one of the Top 100 African –American Newsmakers in the United States by theGrio, an affiliate of NBC News. https://en.wikipedia.org/wiki/Grio_Awards

Crutchfield Dermatology is a proud member of Doctors for the Practice of Safe and Ethical Aesthetic Medicine (DPSEAM). http://www.SafeAndEthicalDoctors.org

Free Bowling & Pizza for Kids with Alopecia Areata – Annual Bowling Social 2018

When: March 24th, 4pm – 7pm

Where: Goldy’s Gameroom, Coffman Memorial Union, University of Minnesota, 300 Washington Ave SE, Minneapolis, MN 55455

What: The Dermatology Interest Group from the University of Minnesota Medical School, along with Dr. Hordinsky, Dr. Farah, and Dr. Goldfarb invite kids and teens with alopecia areata for FREE bowling and pizza!

RSVP Required: fengx358@umn.edu

Funding provided by: UMN Medical School Student Council

When it comes to medications, one size does not fit all

New advances will help patients respond better to medicines

Next time you find yourself in a crowd, take a look around. Notice that people come in all sizes, shapes and colors. These differences can be determined by genetic differences in all of us, and are cemented in our DNA and genes.

dna sequence

Genes can determine everything from eye and skin color to height. These same genes can also affect how we react to many medications. Doctors have long known that some medicines work great for some people and not so great for others.

In some circumstances, patients develop a serious side effect or complication from a medication, whereas many people who take the same medicine do not have the same bad experience and do very well. In fact, almost one million people per year in the U.S. experience adverse medication reactions, and it is estimated that close to 100,000 people die from adverse medication reactions. This is alarming.

pretty pills

To be fair, a person’s response to a particular medicine is also based on multiple factors including age, weight, gender, sex, health status, other current medications being taken, tobacco use, alcohol consumption, and environmental exposures. However, the major influence on how anyone responds to medications lives deep in their genes.

For example, if you have enzymes that break a medicine down quickly, there may not be enough of the medicine available to provide adequate help. In these cases, the medicine may be downright useless, or the patient may require larger doses for good effect.

Alternatively, if your genes produce enzymes that break medicines down slowly, too much may accumulate and cause unwanted or even toxic results. Also, these variations can have devastating results on babies who are being nursed by their mothers taking certain medications.

In fact, 10 percent of people receiving traditional pain medications don’t get any appreciable relief. This 10 percent figure holds true for most all medicines. Of the approximate 1,200 FDA-approved medications, approximately 125 (about 10 percent) will have widely varying effects based, in part, on a person’s individual genetics.

pills brain

These medications are broad-spectrum and are used, in part, to treat the following conditions:

Pain
Depression
Heart disease
Cancer
HIV
Bleeding disorders
Addiction disorders
Asthma
Migraine
Arthritis
Osteoporosis
Alzheimer’s
Psychiatric

The good news is that doctors and researchers have gained a great deal of information and insight on how a person’s genetic makeup can affect the way they respond to specific medications. This field of research (examining how drugs are affected by a person’s genes) is called pharmacogenetics.

Now, with a simple test (either a swab of the inside of the cheek or a blood sample), doctors can look at key genes that code the enzymes that process and affect different medications in the body. This will allow physicians to determine how patients will respond to over 240 different medicines, and the number is growing monthly.

By selecting the correct medicines based on the test, your doctor will then have the ability to limit many adverse drug reactions, avoid medicines that don’t work for you, and avoid any unintentional interactions between the many drugs you may be taking or drugs you may take in the future.

The bad news is that the tests are new and not generally covered by insurance, but that should change over time. Paying out of pocket, the test will cost around $250-$300. That price, too, may come down over time. Two leading companies that perform the tests are OneOme and MilleniumHealth.

Clearly, doctors recognize that when it comes to medicines for their patients, one size does not fit all. The field of recommending the best medication for a patient based on their personal genetics is part of what doctors are calling “precision medicine” and will have a significant impact on the future practice of medicine.

If you are taking multiple medications, have a history of adverse medication reactions, have taken medicines that have not worked, have a complex health history, are being treated with medications from the list of medical conditions listed above, or just want good health information and peace of mind, be sure to have a discussion with your physician about taking a precision pharmacogenetic test.

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.

How do they “lift” faces?

Swayed by the high esteem in which youthful minds and youthful bodies are held these days, many people are turning to cosmetic surgery to smooth their furrowed brows and lift their sagging jowls. Although face lifts were first performed in Europe and the United States at the turn of the century, the process remained cloaked in secrecy, deemed unrespectable because it catered to vanity and often fostered quackery. Today, this difficult and complex surgery is considered an art, for the surgeon must not only solve the problem of wrinkles but restore the face without changing its character in the process. In short, the procedure, technically known as a rhytidoplasty or rhytidectomy, is this: a surgeon incises and detaches the skin of the face and neck, lifts and tightens the skin, trims off the excess skin, and closes the incisions. Continue reading How do they “lift” faces?

How close are we to finding the ‘Fountain of Youth’? – Part 2

Conclusion of a two-part column

Dear Dr. Crutchfield: According to your article “Good news: We are winning the war on cancer” (MSR April 7, 2016), we have made significant advances in the treatment of many forms of cancer. What’s going on with respect to increasing the length of life?

Last week’s column reviewed two of four areas of research into longevity — “Cell Energy Research” and “Increasing the lifespan of our cells” — that hold the promise of arresting the disorders of aging. This week’s column examines two additional such research areas: “Anti-Oxidant Research” and “Ultraviolet Protection.”

Antioxidant Research

During the normal biochemical processes in our bodies, during the breakdown of medications, and from environmental pollutants, molecules are formed called “free radicals.”  Free radicals are extremely damaging to our cells and bodies by a process called oxidation.

When metal oxidizes, it turns to rust. The same changing and damaging effects occur in our cells when they are exposed to oxidizing agents. Oxidation is believed to be a major factor in the deterioration and aging of our cells.

Fortunately, nature has made a group of tiny protective shields called “antioxidants” that protect our cells from the damaging effects of free radicals. They act like free radical magnets, soaking up free radicals like tiny sponges and preventing them from damaging our cells.

Antioxidants include vitamins A, C and E, lycopene (found in guava, watermelon, tomatoes, papaya, grapefruit, red and green peppers, asparagus, red and purple cabbage, mangos and carrots), some minerals (such as selenium and selenium-containing proteins), and certain plant components called flavonoids. Flavinoids are found in cranberries, blueberries, strawberries, cherries, bananas, pears, peaches, raspberries, almonds, cantaloupes, apples, lemons, peaches, plums, onions, beans, teas and turnip greens.

You can also buy antioxidant supplements. There is no one supplement that does everything, so the best source of vitamins and antioxidants should come from a healthy, well-balanced diet. A general rule-of-thumb for getting the most antioxidants is to have as many different colored fruits and vegetables as possible on your plate.

Ultraviolet Protection

Many of the changes associated with aging in our skin are a result of damage from ultraviolet radiation that we are exposed to from the sun. Specifically, ultraviolet-A damage causes wrinkles, discoloration and skin cancer. Ultraviolet-B radiation produces sunburn.

Protection from ultraviolet radiation is key to preserving the general youthfulness and health of the skin. The key is to use a sunscreen with an SPF factor of 30 with broad-spectrum ultraviolet-A protection. It needs to be applied 30 minutes before sun exposure and frequently reapplied to maintain an effective protective barrier.

Additionally, I recommend using specially designed sun protective clothing that has a tight weave to block the sun, but a lightweight and vented fabric for comfort. Coolibar.com is an excellent resource for such protective clothing. Additionally, the same ultraviolet light that damages the skin will affect our eyes. So, just like sunscreen, UV protective sunglasses should be worn starting with children.

We have not yet discovered the fountain of youth, but science has shown us many ways to maintain, improve and optimize our health. Be sure to review my previous column on general health: “Eat well and live well — it’s never too late to start!” (MSR Sept. 15, 2016; http://spokesman-recorder.com/2016/09/15/eat-well-live-well-never-late-start/).

Charles E. Crutchfield III, MD is a board certified dermatologist and Clinical Professor of Dermatology at the University of Minnesota Medical School. He also has a private practice in Eagan, MN. He received his M.D. and Master’s Degree in Molecular Biology and Genomics from the Mayo Clinic. He has been selected as one of the top 10 dermatologists in the United States by Black Enterprise magazine. Dr. Crutchfield was recognized by Minnesota Medicine as one of the 100 Most Influential Healthcare Leaders in Minnesota. He is the team dermatologist for the Minnesota Twins, Vikings, Timberwolves, Wild and Lynx. Dr. Crutchfield is an active member of both the American and National Medical Associations.