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05/Oct/2019

You may have heard that the actor Hugh Jackman was recently diagnosed with skin cancer. Apparently it was his wife who prompted him to get the spot checked out. Fortunately, it was caught early and easily treated. But if he’s like many men, skin cancer isn’t top of mind. After all, the popular press tends to focus on women’s skin care and sun protection.

In fact, men over 50 are at double the risk to die from skin cancer when compared to women. They’re also at substantially increased risk for squamous cell skin cancer and basal cell skin cancer.

Although anyone’s skin can be damaged by the sun, men tend to spend more time outdoors, use less sun protection, and visit the doctor less often. All of that leads to an increased risk of cancer and larger cancers that can be disfiguring and even deadly. As with all skin cancer, prevention and early detection are the keys for men living in sunny climates like Austin.

Many skin care products and sunscreens are marketed to women which sometimes means they have a scent or creamy feel that men don’t like. It can also be difficult to get creamy sunscreens through to the skin if you have a lot of hair on your arms and chest. A broad-brimmed hat (such as a cowboy hat or Tilley hat) is a quick way to protect your face and neck. Although a ball cap will help somewhat, it doesn’t protect your ears, neck, and the sides of your face.

At Evans Dermatology Partners, we carry several sunscreens particularly because they appeal to men. The one I like best is the Solbar 30 Gel Sunscreen. It’s alcohol-based (like a hand sanitizer) which means that  it doesn’t leave a residue on the skin. Many men also like the Elta UV Aero, a non-greasy spray.  Also, it’s common for sunscreen to be ineffective because too little is applied. A good rule of thumb is to use a golf-ball sized amount (1 oz.) to cover the face and body.

It’s important to remember to use sun protection not only when working or playing outdoors but for driving as well. About 60% of skin cancer in men is on the left side of the body due to exposure through car glass. If you’re balding on top, remember to apply sunscreen there (gel is great for the scalp since it doesn’t leave the hair feeling greasy). And wear your hat – the balding scalp is a common skin cancer site for men.

Keeping sunscreen easily accessible helps make it part of your routine. Have several bottles which you can put in your golf bag, with your lawnmower or outdoor tools, or with sporting equipment. This simple reminder helps make it easy to reapply every two hours when outside.

Men are less likely to visit the dermatologist or perform self-skin exams than women, which helps account for the higher death rate from melanoma in men. Early detection is the key to surviving melanoma, so set an alarm on your phone or calendar to remind you to examine your skin before your shower on the first day of every month.

For our skin checks at Evans Dermatology, we have paper shorts to help us examine your skin completely – avoiding those sometimes embarrassing hospital-style gowns.

Sometimes it helps to think about your skin and your health like you would think about your car. You would never drive your car for years without getting the oil changed, checking your tire tread, and following maintenance guidelines and if you noticed something wrong you would get it checked out. Although you might get away with ignoring maintenance for a while, you would eventually have a breakdown.

Of course, you can always get a new car, but your health is irreplaceable. So protect yourself with a brimmed hat and sunscreen (SPF 30 or higher), see your dermatologist for regular skin checks, and keep a regular eye on your skin. Taking good care of your skin now will save you time, money, and maybe your life.


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05/Oct/2019

Ultraviolet (UV) light makes up a small portion of the sun’s rays and is the major cause of skin damage. Exposure to UV rays causes damage to DNA in skin cells, increases the risk of skin cancer, and accelerates signs of aging (fine lines, deep wrinkles, dark spots, etc).  There are three types of UV light: UVA, UVB and UVC. Let’s look at their differences and how they affect the appearance and health of your skin.

UV rays and skin cancer

UVA:  UVA light is not absorbed by the ozone layer and is able to penetrate the dermis in humans, which is the deepest layer of skin. UVA rays cause many effects on the skin including immediate skin redness and darkness, formation of fine lines, wrinkles and age spots. UVA plays a minor role in the development of skin cancer because it causes formation of free radicals in the skin. It is able to penetrate glass (windows), which is why wearing sunscreen on a daily basis is recommended, even if you don’t go outdoors.  A great example of the advanced skin aging that can be seen with daily exposure to UVA can be seen in the photo below that was published in the New England Journal of Medicine.  The man in this photo was a truck driver for 25 years and you can easily see that the left side of his face has thicker skin and deeper wrinkles.

Remember, UVA = Aging

UV rays and cosmetic dermatology

UVB: UVB is another form of UV light and not all UVB reaches the earth because some rays are absorbed by the ozone layer. Because UVB rays are shorter and have a higher frequency, they are more damaging to skin as they penetrate the epidermis (top layer of skin). UVB radiation causes sunburns and delayed tanning. It plays a major role in the development of all types of skin cancers causing DNA damage to skin cells and the immune system. UVB is also important in the synthesis of Vitamin D3.

Remember, UVB = Bad Burns

UVC: UVC rays are too short to get through the Earth’s atmosphere. Although UVC is the most dangerous form of UV radiation, it is completely absorbed by the ozone layer and does not normally cause skin cancer.

Of course, the amount of UV light that reaches a person at any given time and place is dependent on many factors including the time of day, time of the year, elevation, and cloud cover. The UV Index (ranges from 1-11+) is something one can refer to see how intense the UV light is in the area. A higher number means greater exposure of UV rays and a higher risk of sunburn and skin damage. For the daily UV index in Austin, click here.

 

What’s the difference between a tanning booth and phototherapy treatment?

I often have patients ask me this question because dermatologists make a big deal about avoiding outdoor sun exposure and tanning booths at all costs. “Why shouldn’t I use a tanning booth if you have a tanning booth in your office?” Tanning booths and phototherapy booths are very different. Here are the facts:

Tanning booths:

  • Most tanning booths give off primarily UVA rays
  • 20 minutes spent in an indoor tanning booth equals about 2-3 hours in the noontime sun
  • People who first use a tanning bed before age 35 increase their risk for melanoma by 75%
  • People who use tanning beds are 2.5 times more likely to develop squamous cell carcinoma and 1.5 times more likely to develop basal cell carcinoma
  • The Federal Trade Commission has ruled against claiming health benefits for indoor tanning

Phototherapy booths:

  • Phototherapy is light therapy that is prescribed and administered by a dermatologist in their office. Treatment involves exposing the skin to an artificial UV light source for a set length of time on a regular schedule.
  • Nowadays, the most common type of phototherapy used is called narrowband UVB; ”narrowband” refers to a specific wavelength of UV radiation that is safe for the skin.
  • Narrowband UVB has anti-inflammatory effects on the skin and is used to treat many skin conditions such as psoriasis, eczema, vitiligo and even some types of skin lymphomas.
  • There is no evidence to suggest that broadband or narrowband UVB treatments increase the risk of skin cancer.

 

What about Vitamin D?

While it is true that exposure to sunlight (specifically UVB) helps to produce Vitamin D3 in your body, the amount of sunlight that you actually need for adequate levels of Vitamin D is minimal. About 5-10 minutes of exposure to the arms and legs OR hands, arms and face 2-3 times per week is sufficient for healthy Vitamin D levels. This is especially true if you eat foods that are high in Vitamin D (i.e. fish, mushrooms, tofu/soy, dairy, eggs) and/or take oral Vitamin D supplements. Because it is not uncommon for some people to have low Vitamin D levels, especially in areas of the country that tend to be overcast during most of the year, most physicians now recommend daily oral supplementation. This is especially important for women who are at increased risk of developing osteomalacia/osteoporosis. Currently the recommended dose of Vitamin D for the general population is 600 IU for those 1-70 years of age and pregnant or breastfeeding women, and 800 IU for those over 71 years of age.

 

What can I do to protect myself?

The lesson to learn here is that sunlight is not the enemy but rather the conduit of an unavoidable exposure (UV radiation) that we must learn to control. I myself love being active outdoors on a nice sunny afternoon. On days such as these when we venture out to enjoy nature we can protect our skin by trying to linger in shaded areas, wearing sunscreen on exposed areas of the skin (minimum SPF of 30, reapplying every 1-2 hours) and wearing photoprotective clothing (wide brimmed hats, sunglasses, breathable long sleeved shirts, etc).

For everyday protection I recommend using a moisturizer with sunscreen on the face, neck and chest. Minimizing exposure to UV radiation through these measures is one of the best things we can do for our skin in order to decelerate the signs of aging and prevent skin cancer.


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05/Oct/2019

Our society increasingly relies on family and friends as caregivers for those who can no longer care for themselves. If you’re doing the hard work of a part- or full-time caregiver, these tips may help you care for your loved one’s skin as part of their overall health.

Skin plays a very practical role as a barrier to germs and diseases and also helps keep our temperature and blood chemistry where it should be. When someone is not able to move and bathe normally, the risk of skin problems increases, including non-healing wounds that can become infected and even dangerous. And even conditions that are generally non-life threatening, such as uncontrolled itching or lower extremity swelling, can make life very difficult.

In addition, the condition of the skin, hair and nails is important to quality of life. Identity and self-image can be significantly affected, and that can contribute to social isolation. Of course, it is important to take into account the individual’s perspective – something that may cause one person to feel disfigured may be seen by someone else as a normal part of aging.

We hope these skincare tips for caregivers help you support your loved one in the best way you can.

 

Bathing

Keeping the skin clean is the first step in decreasing the risk of wounds, ulcers, and rashes. However, regular bathing can be difficult, and sometimes frightening, for someone who is in a wheelchair or who has limited mobility. Setting up a safe bathing area, with non-skid surfaces and grab rails, can help significantly. Since hot water contributes to dry skin, a moderate temperature is best.

A gentle soap, such a Dove for Sensitive Skin or Cetaphil Gentle Cleanser, is the best option. Make sure to help rinse well with fresh water. Pat completely dry with towels and avoid rubbing to prevent irritation. It is particularly important to ensure that any folds in the skin (for example, under the breasts) are cleaned and carefully dried. These are common areas for skin infections.

A hair dryer on “cool” setting can also help gently dry the skin to avoid chafing.

 

Moisturizing

Many elderly people have very dry skin that is more prone to splits or tears. Using a fragrance-free moisturizer like Aveeno Active Naturals Daily Moisturizing Lotion or Cetaphil Cream can help soften the skin and reduce itching. There are tools, such as ReachMate+, that can make it easier for older adults to apply moisturizer themselves. Take care to avoid making the feet slippery when applying moisturizers, and immediately clean any that falls on the floor.

 

Reducing Prolonged Sitting

Many disabled patients spend hours in a chair or wheelchair since walking is difficult. Sitting for too long in one position can reduce blood flow to the skin of the buttocks. This can lead to a painful red area (“hot spot”) which can eventually lead to an ulcer. Ulcers like this can be very difficult to heal and also lead to infection in the body.

Using a donut-style cushion and repositioning regularly will help. Use a kitchen timer to remind the patient to shift positions frequently – ideally every 15-20 minutes, and every two hours at a minimum. If the person can walk safely, get up and walk regularly. Cushions or mattresses should be soft (like an egg crate). For completely immobile patients, special beds to prevent ulcers are available through your doctor or social worker. See you doctor immediately for any concerns about possible ulcers forming, especially on the bottom or legs.

 

Incontinence

Some people with serious medical problems have trouble controlling their bowels or bladder. In these cases it is important to keep the person clean and dry and use an adult diaper that is soft and absorbent.

Soft toilet paper with Cetaphil Gentle Cleanser can be used to clean the area (it does not have to be washed off) followed by a protective ointment like Triple Paste or A&D Ointment. For sleeping, disposable pads are available to protect sheets and the bed. Consult your doctor to help look for the cause if someone has new or worsening incontinence.

 

Swelling and Constrictions

Swelling in the lower legs is a common concern among older adults. Properly fitting compression stockings can help considerably. The Comfort Store here in Austin specializes in fitting these garments, though a doctor’s prescription may be needed for high compression levels.

Avoid anything that constricts the arm or leg, unless using support hose under the care of a doctor. A tight-fitting watch band, socks, or garments can restrict blood flow. Over time, this constriction can cause uncomfortable swelling, damage the skin, and increase the risk for deep vein thrombosis which can be life threatening.

 

Bruising

Older adults and their caregivers are often concerned by large areas of bruising, particularly on the hands and forearms. Most commonly, this is caused by “senile purpura” which is a benign condition caused by increasing fragility of the skin and blood vessels as the body ages. Though senile purpura is not dangerous, it can be cosmetically troubling. This kind of bruising is very difficult to prevent, since it results from everyday activities. Over-the-counter creams containing arnica (for example, DerMend) may help somewhat. Of course, sudden unexplained bruising should be discussed with a doctor as it could be a sign of trauma or another underlying condition.

 

Signs of Skin Cancer

You probably know that older adults are at a significantly increased risk of skin cancer, especially when the patient has a history of previous skin cancers. At the same time, self-monitoring the skin can become more difficult. It is common for older patients to have a large number of lesions on their skin, so noticing a specific spot that is new or changing can be very difficult for a layperson. As a result, it is important to seek the care of a board certified dermatologist when there is a concern about the skin.

When caught early, skin cancer is very treatable even in older patients. When in doubt, have the spot checked out. Even the less dangerous forms of skin cancer can cause significant disfigurement and impairment if left untreated.

 

Signs of Infection

Even with gentle care, many elderly or disabled people get small cuts, bruises, or ulcers from daily life. Any wound that has redness around it or where the skin is hot, tender, or weeping fluid should be seen immediately by a doctor. If it is at night or on the weekend, go to the nearest emergency room or call 911. Skin infections can worsen rapidly and cause further disability or even death if not treated quickly.

 

Getting Help

Many social services are available, through insurance and the government, to support disabled patients and their caregivers. Ask your doctor for a referral for services or for a social worker who can help. In Austin, you can also dial 211 to connect to the United Way and over 10,000 healthcare and other services. Being a caregiver for a chronically ill person can be difficult for anyone. Do not be afraid to ask for help for yourself or the person you care for.

Caregiving is very important but also can be very difficult and draining. Don’t try to go it alone but make sure you have support from your family, your doctor, and local social services to help you do the best job you can.


Find Dr. Mahvish Aftab Khan at the following locations

Rawal General and Dental Hospital Lehtrar Road near Khanna Pul
Mon to Thursday and Saturday
Timings 10 am to 1:30 pm

 
 
 

Ahmed Medical Complex
Sadiqabad Rd, 70-C Block C Satellite Town, Rawalpindi,
Tuesday Thursday & Saturday
Timings 6:30 pm to 8:30 pm

 
 
 

Skinsmith
06 Lord Trade Center, 1st Floor, F-11 Markaz, Islamabad
Monday Wednesday Friday 4pm to 8pm
Tuesday Thursday and Saturday 3pm to 6 pm

Copyright by Dr Mahvish Aftab Khan 2017. All rights reserved.

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