Last week we examined the physiology and causes of acne, an affliction from which as many as 50 million Americans suffer. This week we will examine in detail various options for treating acne and acne scarring. Continue reading What you should know about acne – Part #2
It seems like just about every major celebrity has had Botox injected at some point to “soften” their wrinkles. But just how often is a Botox injection needed in your face to keep those pesky fine lines and wrinkles away? Continue reading How Long Does A Botox Treatment Last?
Tanning isn’t the smartest thing you can do for your skin, but burning is far worse. Now there are smartphone apps that can help you enjoy the sun while minimizing the inevitable damage to your skin.
By Lauren Cahn
Ah, that golden glow of a suntan. It makes us look and feel more attractive, but suntanning comes at a hefty price: irreversible damage to your skin. Even if you manage to avoid burning, you’re still in for premature wrinkling, sagging, and blotching, and you’re significantly raising your risk of skin cancer, including the deadly kind, melanoma. If only there were a hack of sorts for sunbathing—some way to get that beautiful bronzed look without the problems associated with sun exposure.
Well there’s good news and bad news. The good news is that if you’ve got a smartphone, you can download any number of apps that purport to make a science out of how long and under which circumstances you can bask safely in the sun while minimizing the damage to your skin. We’ll get to them just as soon as we let you in on the bad news, which is that we polled dermatologists from all over the country, and they agreed unanimously: There’s simply no such thing as a safe suntan. We may perceive it as attractive, but a suntan is nothing more than “your body’s defense system against the sun, and more specifically, the UV radiation that the sun emits,” according to Charles E. Crutchfield III, MD, Clinical Professor of Dermatology at the University of Minnesota Medical School and Medical Director of Minnesota’s Crutchfield Dermatology.
UV radiation, commonly known as “UV rays,” represent about 10 percent of the total light emitted from the sun, according to Fraye L. Frey, MD, a board certified dermatologist located in West Nyack, New York, and can be further broken down as follows:
UVC: These rays gets filtered out by the earth’s ozone layer (and are therefore not of immediate concern)
UVB: These rays cause sunburns but are also a natural source of vitamin D, which is crucial to good health (although Dr. Crutchfield points out that Vitamin D can be sourced naturally from tuna, salmon, eggs, cheese, D-fortified foods, and D vitamin supplements)
UVA: These rays penetrate the skin deeply, can fracture DNA, and are associated with premature skin aging, dark patches, wrinkles and skin cancer
“The intensity of UV light can be measured with a variety of instruments that are commercially available,” says Dr. Frey. Specifically, what is measured is the amount of UV radiation in any given locale at any given time, according to Jerome Potozkin, MD, a board certified dermatologist in Danville, California. That measurement is placed on an international index scale known as UVI, and forms the basis for the smartphone apps that purport to help you strategize your sunbathing. “The scale goes from 0 to 10, with the high number meaning the greater risk of sunburn from UV exposure,” adds Carolyn M. Kassabian, MD, a board licensed dermatologist with the Providence Holy Cross Medical Center in Mission Hills, California. “When the UVI is 6, it’s twice as easy to burn than if the UVI were 3.”
So what does that mean in terms of how long you can stay in the sun on any given day and with what level of protection? These smartphone apps were designed to crunch the numbers for you:
iTanSmart uses your phone’s GPS to determine your location, space satellites to measure the UVI in your location, and information that you input about yourself and your environment to tell you exactly how long you can be in the sun without burning. Except for the GPS and the space satellites, all of the information is self-reported, so you’ll need to be honest when inputting your eye color, hair color, tendency to burn, blister, tan, or freckle. You’ll also need to describe where you are (beach? mountain? city?) admit your goal (avoid sunburn versus get a savage tan). If you’re looking to use iTanSmart to develop a tan, you’ll have to pay an extra fee of $1.99, and whether it’s worth it will depend upon many factors, not the least of which is whether you’re prepared to accept the damage you’re doing to your skin in the process (which iTanSmart is fully transparent about reminding you).
SunZapp provides the same functions as iTanSmart but also assesses the sun protection you are getting from the clothes you tell the app you’re wearing. The results it spits out after you answer all its questions and does its UVI reading are easy to parse. In addition, even without all the warnings that iTanSmart provides, SunZapp’s vibe seems to lean more toward protecting your skin from the sun and away from getting tan.
My Tan Expert does essentially what iTanSmart and Sunzapp do, but slightly more complicated. MyTanExpert not only asks the usual battery of questions about your skin, hair, and eyes, but it also asks you to take a photo of your skin beside a white napkin. You provide the white napkin, and getting your skin and the napkin to fit into their respective outlines while taking the photo yourself, one-handed, is no easy task. Once you complete it, however, it’s difficult to understand what the recommendations mean. For example, it tells me, a very pale, freckly, redheaded, blue-eyed person that my skin can take “another 90 percent of the daily dose of ultraviolet radiation.” What?
It seems, however, that with a minimal understanding of UV rays, the following apps, which do little more than provide a UVI reading and a short and simple sun-protection recommendation, could also help you plan a sun-safe strategy every day:
UV Meter tells you the UVI at your current location and offers practical recommendations for sun protection (including not only sunscreen but also protective clothing) as well predictions on how long it will take before you get sunburned.
The EPA’s SunWise UV Index also tells you the UVI at your current location, offers practical recommendations for sun protection (including not only sunscreen but also protective clothing), including the recommendation to “seek shade.” Plus, the app was designed by the United States Environmental Protection Agency, which is an excellent source of hard-hitting information about the current state of the ozone layer, which may have an impact on the way our skin is affected by UVCs.
Ultraviolet UV Index very simply and quite beautifully shows the current UVI for your locale as well as any other location in the world. In addition, it provides simple, easy-to-understand instructions on how to expose yourself to that day’s rays as safely as possible.
QSun has functions similar to those described for these other apps, but it adds further value by making sunscreen recommendations, including using your own weight and height to tell you exactly how much sunscreen to apply in order to maximize the sunscreen’s effectiveness.
Regardless of the UVI, Dr. Kassabian tells her patients to apply sunscreen with an SPF of between 30 and 50 every single day. “This gets them in the habit of applying regularly, and they are less likely to forget and consequently, less likely to burn.” She also recommends practicing sun avoidance measures, such as wearing a hat and a long-sleeved shirt, and seeking shade whenever possible. These are the sunscreens dermatologists use on themselves.
Dr. Crutchfield adds that your SPF of 30 or higher should provide not only UVB protection, but also broad spectrum protection so that it blocks the UVA rays as well. “Apply sunscreen 30 minutes before sun exposure,” he advises, “and reapply every one to two hours, and more often if perspiring or swimming.”
You can still sport a bronzed look this summer if you want—if you get it from a bottle. As Dr. Potozkin says, “The only safe tan is one involving the application of self-tanner.”
Dr. Crutchfield recognized as a ‘skin care expert’ in In Style magazine. Discussing the latest trends in beauty products. Download & own InStyle’s May 2015 issue today on Itunes.
Subscribe to our monthly newsletter & receive news & specials only available in our newsletter.
Sunscreen still isn’t worn daily
Despite the fact that sun protection is necessary daily, not every American wears sunscreen every day of the year, which is another reason for the influx of skin discoloration. “The increased social and cultural trend of tanning is another reason why hyperpigmentation is on the rise,” says Minneapolis, MN, dermatologist Charles E. Crutchfield III, MD.
What Happens to Untreated Pigment?
Hyperpigmentation is more of a cosmetic problem than a skin health condition according to Dr. Narukar. In most cases, hyperpigmentation will eventually resolve on its own if it is not treated. “But, the question is, how long it will take to lighten up? There’s no way to know and a lot of people just don’t want to deal with discoloration because makeup can hide it so much.” If you skin is prone to pigmentation, always take preventative measures, especially with sunscreen. Dr. Crutchfield points out that failing to protect pigmented skin from sun can cause discolored areas to become even more pigmented.
The Great Hydroquinone Debate
Hydroqinone, a chemical ingredient in lightening products, may be the go-to for hyperpigmentation. It stops about 90 percent of tyrosinase activity, but it has its disadvantages. “We almost always treated spots with hydroquinone but patients want natural alternatives, which is why there are so many options,” says Dr. Narurkar.
by Frederick Lowe
Gregory Cooper, a slender 26 year old, sometimes wears a scraggly beard that detracts from his good looks because he can’t shave every day.
When he does shave with a blade, his face becomes inflamed with razor bumps caused by his naturally curly hair becoming imbedded in his face.
“Eight hours after shaving with a razor blade, my face breaks out in whiteheads,” he says. Continue reading Razor Bumps
National report — When treating patients with skin of color, dermatologists face a number of challenges, and they must choose products and therapies carefully.
Diagnosis is the first challenge; common dermatological conditions may have a slightly different appearance in skin of color, depending on the hue of a patient’s skin, says Charles Crutchfield III, M.D.
“If you’re used to something looking pink or red and then you see it in brown skin, it looks completely different,” says Dr. Crutchfield, clinical professor of dermatology, University of Minnesota Medical School, Minneapolis/St. Paul, and medical director of Crutchfield Dermatology, Eagan, Minn.
Furthermore, dermatologists will encounter a number of conditions more commonly found in patients with skin of color, such as papular pityriasis rosea, razor bumps and keloids, he explains.
“One of the most significant things is the postinflammatory discoloration, both lighter and darker, that you see in skin of color,” Dr. Crutchfield says. “Any time there is inflammation or injury you can have dramatic change in skin color — usually darker, but sometimes lighter, that has to be managed. Sometimes it can take months to correct.”
To help prevent postinflammatory hyperpigmentation, it’s important to choose the right skincare products, says Zoe Draelos, M.D. Preparations that are recommended in white patients may not be suitable for patients with skin of color.
“The most important concern that’s different from Caucasian skin is that you have to be sure that the products that you recommend, whether they’re prescription or over-the-counter … cause absolutely no irritation of the skin at all,” says Dr. Draelos, consulting professor of dermatology, Duke University School of Medicine, Durham, N.C., who is also in private practice in High Point, N.C.
For example, Dr. Draelos says, over-the-counter acne products containing benzoyl peroxide can be irritating in Asian, Latino and African-American patients and ultimately darken the skin. In addition, exfoliants containing glycolic acid or scrubs containing granules or beads also can irritate the skin, resulting in postinflammatory hyperpigmentation, she says.
In patients with acne, Dr. Crutchfield explains to them that postinflammatory changes can be a particular problem with skin of color. Therefore, they need to understand that he must address the inflammatory papules and pustules as well as the postinflammatory hyperpigmented macules that remain after acne heals. Unfortunately, patients with these macules often believe their acne has returned.
In addition to relying on products that are not irritating, Dr. Crutchfield uses anti-inflammatory products to prevent irritation. To manage dyspigmentation, he uses a combination of alpha hydroxy acids and high-dose hydroquinone or hydroquinone metabolites. He also uses a product compounded by his pharmacist that contains hydroquinone, vitamin C, retinol, kojic acid and a steroid.
A number of new products are being used to manage dyspigmentation of the skin. “Many companies are trying to get away from hydroquinone because of the safety issues that have been raised,” Dr. Draelos says. Therefore, physicians are turning to products such as arbutin and deoxyArbutin, kojic acid, lignin peroxidase (Elure, Syneron/Candela), and licorice extract products such as glycyrrhizic acid, she says.
“Sometimes, people will use a bearberry extract if they’re looking for something in the botanical realm,” she adds.
To address concerns in this population, Dr. Draelos says, cosmetic companies are testing products in people with skin of color before they go on the market. “Usually when we test a new cosmetic, we use a broad, multiethnic panel,” she says.
Furthermore, companies work to formulate products with ingredients that have a low potential for irritation and may include an anti-inflammatory to prevent irritation before it occurs, she adds.
When treating dyspigmentation, Dr. Draelos educates patients about the importance of using sunscreens. “If the sun is darkening the skin and you’re using these products to try to lighten the skin, you find that you end up nowhere,” she says. “So sunscreen is very, very important, and sun avoidance is very important also.”
To maintain skin quality and health, Dr. Crutchfield also suggests moisturization and hydration. “I recommend a good moisturizing lotion that contains ceramides at least twice a day, but especially after bathing,” he says. “That goes a long way to correct dermatitis associated with dry skin.”
He suggests a combination of CeraVe Moisturizing Cream (Coria) and Vanicream Cleansing Bar (Pharmaceutical Specialties), which doesn’t strip away the skin’s natural oils.
Dr. Draelos says she finds that patients with skin of color often want to try other products.
“So I tell them to put a very, very small amount in front of their ear for five nights in a row, and if they have no trouble there, then they can use it broadly over their face.”
Following this course can sometimes prevent overall facial problems. “Predicting a problem before it occurs is always the best way to deal with it,” she says.
Disclosures: Drs. Crutchfield and Draelos report no relevant financial interests.
When stressed or dry skin needs relief (ASAP!), slather this on- “especially in the winter,” says Eagan, Minn., dermatologist Charles Crutchfield.
The non greasy, fragrance-free formula works year-round, “hydrating delicate areas and tough spots alike,” says N.Y.C. dermatologist Francesca Fusco.
$13 at Walgreens.
Also, call Dr. Crutchfield’s office today to schedule your skin care exam and treatments. 651-209-3600
Dr. Crutchfield is a dad of 11- and 5-year-old daughters and an 8-year-old son, a board-certified dermatologist, a clinical professor of dermatology at the University of Minnesota Medical School, and the medical director of Crutchfield Dermatology.
What was the biggest challenge you faced while your wife was pregnant, and how did you overcome it? The biggest challenge that I faced was being exquisitely in tune with my wife’s needs. I can’t imagine being pregnant. I had to check to make sure that her needs were being met by doing this on a daily basis. As with most things for me, this became a habit after about 21 days!
What’s the most surprising thing being a dad has taught you? That you can absolutely love another human being so much that the depth of the love defies the ability to put it into words.
What’s the one bit of advice about fatherhood you wish someone had given you much earlier? Spend time with your kids. Those are moments that you will never get back. Also, when you say you will do something, do it. Remember, the parents are in charge, not the kids. I see too many people begging their kids to behave. I can’t count how many times people have come up to us in restaurants or on airplanes and commented on how well-behaved our children are. It’s for a reason. I rarely have to discipline them. (Although I am the enforcer: I often hear my wife ask, ”Do you want me to get your father in here?”) I simply sit them down and tell them that if they continue their behavior, they’ll be in trouble and get punished. If they stop and apologize and refrain from doing it anymore, we can move on. It’s completely their choice! They almost always choose to behave, and we move on. If they don’t behave, then I will punish them to make sure they understand I will honor my word.
What’s the one thing about being a new dad that shouldn’t be missed? Being there at the delivery!
What’s the most overrated thing about fatherhood? Nothing.
What’s the most underrated thing about fatherhood? How important being a father is. Your job is not necessarily to be the child’s best friend, but being friends is desirable and great. Your job is to teach the child right from wrong, good from bad, so someday when you’re not there, they’ll make the right decisions.
Why are fathers important? They provide stability, a role model, and a support system for the child.
Career, marriage, kids … how does a guy stay sane? Easy: Have a great wife!
Dr. Crutchfield’s Q&A
In Minnesota, when someone says the name Dr. Crutchfield, most people — especially African Americans from Minneapolis, St. Paul and surrounding areas — assume they mean the legendary obstetrician and gynecologist Dr. Charles E. Crutchfield, Jr., a doctor known for the delivery of at least 10,000 Minnesota babies in the Land of 10,000 Lakes over the last 45 years.
But in 1994 another Dr. Crutchfield arrived on the scene in Eagan, Minnesota. He too goes by the name of Dr. Charles E. Crutchfield, but he is known as the third (III) and is the son of Dr. Crutchfield, Jr, who he calls Dad.