Psoriasis

Psoriasis: More than just a skin problem

Many people think of psoriasis as a cosmetic problem.  However, psoriasis is an inflammatory condition and patients with psoriasis have an increased risk of diabetes, heart disease, and obesity.  Skin lesions can also affect activities of daily life and can contribute to depression. It is important to live a healthy lifestyle if psoriasis is diagnosed.  My Dermatologist can help you manage your disease.    

Psoriasis is a genetic condition in which inflammatory factors are released into the skin and cause skin cells to hyperproliferate (grow quickly) to form plaques and silvery scale.  These lesions can occur anywhere on the body, or can be local to certain areas of the skin.  They can also be specific to scalp, nails, or hands and feet.  It is important though to realize that psoriasis affects more than just the skin, and should be treated and thought of in this way.  In patients with psoriasis, many inflammatory factors are released into the skin.  However, this inflammation can affect other parts of our body as well.  In patients with psoriasis, there is an increased rate of heart disease, metabolic syndrome, depression, high cholesterol, and obesity.  Psoriasis is considered a risk factor for heart disease just like high blood pressure is.  In studies where a PET scan is performed of the entire body in patients with psoriasis, inflammation can be seen in the liver, aorta/femoral arteries, skin plaques, and in many patient’s knees and ankles.  Because of this, it is important to have regular checkups by your primary care provider.  Eating fruits, vegetables, a diet high in fiber and low in fat and cholesterol and following general healthy eating guidelines is important for overall health and decreasing these risk factors of disease.  Exercising regularly and maintaining a healthy weight also helps psoriasis.

Skin disease in patients can also be debilitating to daily activities, sports, employment, and relationships.  Depression and alcoholism are increased in the psoriasis population.  If skin lesions or flakiness are affecting work, activities, relationships or your mood, it is important to seek help in treatment of the disease and contributing factors to improve quality of life.

Psoriatic arthritis can also accompany skin psoriasis.  While psoriatic arthritis can happen at any time, age 30-50 is most common with an average of 10 years after onset of skin psoriasis.  About 30% of patients with psoriasis will develop some level of psoriatic arthritis.  Some signs of psoriatic arthritis are morning stiffness, swollen/tender joints, nail pitting, pain in heel/bottom of foot or other tendons, and fatigue.  If these symptoms are experienced, it is important to get them evaluated and to not dismiss them as osteoarthritis of aging as there are treatments available to alleviate these symptoms.

There are many treatments for psoriasis depending on the individual patient and involvement of the disease. These range from topical creams and light therapy, to oral pills and injections that modulate your immune system.  Dermatologists may work closely with rheumatologists or primary care doctors to help with other symptoms of the disease in addition to the skin to create the best outcome for the individual patient.  If you have concerns about psoriasis you would like to discuss, contact My Dermatologist so we can help you manage the disease and become the best you!

Sources: National Psoriasis Foundation, Bolognia

Skin Care

What is the best Skin Care Regimen? 

Many patients wonder what are the best creams or lotions to use for youthful healthy skin and for prevention of aging skin.

SUNCREEN

In the morning the most important topical to use is sunscreen.  Use at least an SPF 30 sunscreen that covers UVA and UVB light.  The best sunscreen is one you like to use every day.  It should not be irritation or cause itching.  You should like the feel of the product and for some it may need to be more moisturizing and for others more light-feeling.  Sunscreens help prevent UV damage to the skin.

OTHER PRODUCTS

The second most common topical recommended for aging skin is Vitamin A products that are typically used at night time.  Retinol or retinoids are another type of Vitamin A.  These are drying or irritating to some and may need to be used sparingly, infrequently and with a moisturizer. Vitamin A is used to help with wrinkles, fine lines, age spots, texture changes and build collagen in the skin.  

The third topical recommended is topical Vitamin C which produces similar results to Vitamin A.  Some Vitamin C products are more moisturizing and others are more drying. The antioxidant effects of Vitamin C help to prevent skin damage that can lead to skin cancer.

There are many, many other topical anti-aging compounds on the market and more coming every year.  These 3 topicals - sunscreen, Vitamin A and Vitamin C - are the foundation for great skin care. Other topical products may be added for specific skin conditions.

For your personalized skin care regiment, please contact My Dermatologist to set up an evaluation at

appointments@mydermtc.com

612-621-8888.

Dry Skin

What do I do for Dry Skin?

Dry skin in the winter can get very frustrating. Remember to keep your skin hydrated and to liberally apply a gentle moisturizer over the whole body at least daily to help repair and protect your skin from the harsh winter cold and dryness. Avoid scratching dry skin as this can further damage the skin and continue the cycle of dryness and itchiness.  Don’t forget to wear a moisturizer with a SPF of at least 30 to protect your face from winter dryness and winter rays!  

Skin in the winter can get very dry, itchy, and irritated. Dry skin is also called xerosis. Xerotic skin can be dry, flaky, rough, cracked, and in dark skin appear gray and ashy. People who are constantly in dry environments, need to wash their skin frequently, have a history of eczema, and the elderly are more predisposed to xerosis. Daily skin care is especially important in the winter to prevent cracking and irritation of the skin. Cold air carries less moisture and as a result, our skin has less moisture in it as well. Dry skin is not a good barrier to outside irritants.  These outside irritants entering our skin can promote itchiness and can initiate an inflammatory response in our skin.  People with a history of eczema are already predisposed for this barrier dysfunction.  As a result of cold weather, irritants, and itching, our skin can become very cracked, red, or open. Hands can become cracked and bleed and can be very painful and debilitating.  This is why it is very important to keep your skin hydrated in the winter.  

We recommend daily showers with warm water and a gentle fragrance free soap. A gentle moisturizer should be applied afterwards and throughout the day.  Lotions and creams with an ingredient called ceramides help restore the skins natural lipids and pH to allow the skin to function more optimally as a barrier.  Ingredients petrolatum or lanolin help seal moisture into the skin.  Urea and lactic acid help the skin hold water, but these ingredients may be irritating to some. We recommend gentle moisturizers such as Cetaphil cream, Cerave cream, and Vanicream for especially sensitive skin.  

For very dry and cracked hands, we recommend applying hand cream after every hand washing.  One we like is Neutrogena Hand Cream.  Frequent hand washing can strip the skin of natural lipids that protect the skin.  If frequent hand washings are needed, gentle soap is recommended.  3M Avagard hand sanitizer is an option that works well and is not over drying.

For dry cracked lips, application of Vaseline or Aquaphor is recommended.  Licking of the lips can further aggravate this delicate skin and avoidance of this is best.  

It is important to try not to scratch dry itchy skin.  Scratching can further abrade the skin, break down its barrier, and cause even more inflammation.  For itchiness that persists, daily allergy medications such as Claritin, Zyrtec or Allegra in the morning and Benadryl at night can help reduce the need to scratch.  Generic versions of these can be just as helpful.  It is important to follow the directions on these over the counter medications for safety.

When skin becomes very dry and cracked, germs can get into the skin.  Red sore spots can be a sign of infection.  It is important to get this treated.  Uncontrollable dryness, itch, or breakdown of the skin may be a sign of a more persistent dermatitis or other skin disease.  It is important to get this type of skin examined.  My Dermatologist can help as prescription creams such as steroids may be needed to break the cycle in these cases. We can also help with recommending a skin care regimen and other treatments as necessary to get you to feeling your best.  Remember to keep your skin hydrated and don’t forget to wear daily moisturizers for your face with at least an SPF of 30.  Make an appointment today if you are concerned about your dry winter skin.  

Sources:  Bolognia, Moore and Saxena, AAD

Sunscreen and Sunblock

What are sunscreens and sunblocks? 

Sunscreens have one of several chemical compounds that absorb either UVB or UVA light.  There are some individuals who are allergic to these compounds. Helioplex is a specific compound made by Neutrogena that has avobenzone and oxybenzone that covers UVA and UVB light. 

Sunblocks use one of the physical light blockers such as titanium and zinc and block all light.  There is very low risk of allergy to these. 

Tanning lotions are not recommended; these are low SPF lotions that allow the skin to darken with ultraviolet injury. 

Self-tanners contain dihydroxyacetone (DHA) which darkens the skin by staining the skin. It offers a safer alternative to ultraviolet darkening of the skin.  Self- tanners do not protect against sunburns and sunscreens/sunblocks are still needed.

What is SPF?

SPF stands for sun protection factor from UVB light only.  A SPF of 15 will increase the time it takes to burn 15 times.  So if someone with type one skin burns in 10 minutes without sunscreen, with a SPF 15 sunscreen, it would take 150 minutes to burn.  Check the labels to make sure it covers UVA and UVB light. 

A sunscreen or sunblock of at least SPF 30 is recommended for daily use.  Make sure the label states that it covers UVB and UVA light.  If you are planning on being outdoors for long periods of time, use at least an SPF of 30 and reapply every 2 hours.  The higher the SPF rating, the longer it will work but dermatologists still recommend reapplying your sunscreen every 2 hours and sooner after sweating or swimming.  Use an ounce of sunscreen to cover an adult body.

What else can I do?

Sunscreen should not be the only sun protection used.  It is recommended that you avoid the sun’s rays between 10am and 4pm, seek shade and wear sun-protective clothing and hats. Wear sunglasses to protect your eyes.