RejuvaDERM Cosmetic Dermatology & Laser Centre Blog

With such hot weather right now in Grande Prairie, I just want to remind all my patients to be careful in the sun and to avoid sunburn.  Sit in the shade as much as you can, try to avoid the peak hours of the sun’s rays from 10am-4pm, wear your hat, wear sun-protective clothes, and don’t forget your sunscreen. 

Researchers have now learned what goes on in your cells when you get a sunburn.  According to a study published July 8 in the online edition of Nature Medicine: ‘The red and painful burn is an immune response triggered by this altered genetic material to remove sun-damaged cells’.  More specifically, ‘using human skin cells and a mouse model, the investigators found that ultraviolet B radiation fractures and tangles elements of a special type of RNA that doesn’t directly make proteins, known as non-coding micro-RNA. When skin cells are exposed to radiation, they release this altered RNA.’

In my Skin Cancer Clinic, I saw a patient who had laser for a spot on the face (laser done by a technician at another laser clinic in Grande Prairie).  I took one look at it and told this patient it was a skin cancer.  Please be aware that laser is not an appropriate treatment for skin cancer.  This is another example of the danger of technicians with no medical training using lasers to treat spots and not being able to recognize that the spot is really skin cancer and that laser is totally inappropriate and harmful for this condition.

I would like to remind my patients of the danger of having a technician with no medical experience laser a mole.  This stems upon a case I saw last week of a laser technician at another laser clinic in Grande Prairie who was performing laser on ‘supposedly a mole’.  First, skin cancer and melanoma can mimic moles.  The reason why you see a Dermatologist is we’ve spent 9 years of medical training to become a Dermatologist.  Not all brown spots are moles – there are lots of other conditions they can be.  When a brown or black spot is treated with laser, there is no pathology sent.  Laser is totally inappropriate for skin cancer, melanoma, atypical moles, certain other types of moles, and various other skin conditions that can look like moles.  Melanoma can be deadly – please don’t take a chance with these important things.

Another very busy month at Rejuvaderm.  Renovatations are ongoing at our new clinic site.  We can’t wait to be in our new clinic soon.

Latisse

There have been a few changes to Latisse this past month.  First, the price of the 3ml bottle has been reduced to $120.  Second, a new 5ml bottle size is now available for $190.  For further information on Latisse, please see our website. 

Cosmetic Dermatology

In cosmetic news, Dr. Wong and I were some of the first medical doctors in Alberta trained by Allergan in using the newest technique for injecting Juvederm & Voluma fillers including Juvederm.  This technique involves using only 1 small injection site and a cannula ‘ tube-like’ instrument to minimize bruising.  We look forward to using this technique for some of our patients.

Medical Dermatology     

I have seen a lot of sun burns in my clinic this past week.  I’m posting a website put out by Alberta Health Services that provides further info on tanning and its risks.

Wart Clinic – Videos May Reduce Preschoolers’ Anxiety About Wart Removal

A study of 35 children in the Archives of Dermatology published this month showed preschoolers who watched a favourite TV show or movie prior to having warts removed through cryotherapy (liquid nitrogen) were less anxious about the procedure and the procedure took fewer minutes when distracted compared to without them.  From now on, I will encourage all of the children I see in my wart clinic to watch videos.

Dermatology in the News

Spray Tan Substance May Be Harmful When Inhaled.

DHA or dihydroxyacetone, the component in spray tans can damage DNA and cause tumors if inhaled.  Various news sites covered this story.

ABC World News reported, “We all know the risks of sun bathing and tanning beds, and that has led many to try chemical spray tans as a safer alternative. With the help of a hidden camera, ABC’s consumer watchdog, Mark Greenblatt, has discovered that those spray tans may have come with new risks we didn’t know about.”

UK’s Daily Mail reports, “Spray tans, used by many as a safer alternative to sunbeds, may create serious health problems including cancer, scientists warned. Those seeking a bronzed skin tone without exposing themselves to harmful radiation could instead be at risk from the main ingredient in sprays, which is potentially harmful if inhaled. The substance – known as dihydroxyacetone, or DHA – enters the lungs and is then absorbed into the bloodstream where it could damage DNA and cause tumours,” according to Lynn Goldman, MD, dean of the School of Public Health and Health Services at George Washington University.

Dermatologists Doubt Value Of Some UV-Protective Wares.

The New York Times reports on “whole new categories of chemically treated products that purport to block ultraviolet light,” ranging from makeup to sun-protective clothing items and even special laundry detergents. So far, “consumers and dermatologists have their doubts.” Consumers don’t know what to make of such products. Dermatologists, meanwhile, are afraid that such products may lull users “into a false sense of security.” The article goes on to explain which products work and which products are probably a waste of money.

Dermatologist Skeptical Of Value Of Bee Venom For Smoothing Wrinkles.

The Wall Street Journal reports that cosmetics are now adding bee venom, claiming that the substance appears to smooth skin by stimulating elastin and collagen production.  Dermatologist David Leffell of the Yale School of Medicine, expressed skepticism, cautioning readers, “I couldn’t find any legitimate scientific studies of the benefit of bee venom either topical or injected.” Dr. Leffell did point out, however, that honey contained in some cosmetics may act as a beneficial moisturizer.

Study Shows Melanoma Rates Up Across The Board.

ABC News reported, ‘Melanoma rates are up across the board, but especially among women under 40, according to a new study by the Mayo Clinic. In fact, women under 40 are eight times more likely to get skin cancer now than they were in 1970.’  The article went on to discuss skin-cancer facts and myths.

New Research

In Mapping Melanoma Genome, Researchers Find Link To Breast Cancer.

HealthDay reports that according to research published online in the journal Nature, “scientists describe sequencing 25 human metastatic melanomas…and finding a common thread between melanomas and breast cancer, plus evidence that the rate of mutation in melanoma varies with the level of ultraviolet light.” Notably, “the authors found PREX2, a gene associated with breast cancer, in about 14 percent of the melanoma tumors.”

Women With Psoriasis May Have Increased Risk For Crohn’s Disease.

MedPage Today reports, “Women with psoriasis had a four-fold increase in the risk of Crohn’s disease, according to data from two large cohort studies” presented at the Society for Investigative Dermatology meeting.

Women Who Exercise Vigorously May Reduce Their Psoriasis Risk.

HealthDay reports, “Women who exercise vigorously may be reducing their risk of psoriasis,” according to a study published online in the Archives of Dermatology. After examining “data on nearly 867,000 women who took part in the US Nurses’ Health Study II,” researchers found that the “most physically active women had a significantly lower risk of psoriasis, compared to women who exercised the least.”

Psoriasis May Independently Raise Risk Of Type 2 Diabetes.

MedPage Today reports, “Psoriasis, particularly more severe cases, may independently raise the risk of developing diabetes,” according to a study published online June 18 in the Archives of Dermatology. In “108,132 adults with psoriasis and 430,716 patients without psoriasis,” researchers found that “incident diabetes was a modest but significant 14% more likely among individuals with the skin disease after adjusting for a range of other factors.” While “severe psoriasis raised the risk most — with a hazard ratio of 1.46 (95% CI 1.30 to 1.65)…the risk was also statistically significant among mild cases,” researchers reported.

Smoking Associated With Increased Cutaneous Squamous Cell Carcinoma Risk.

HealthDay reports that according to a meta-analysis of six studies published online June 18 in the Archives of Dermatology, smoking is “associated with a 52 percent increased risk of cutaneous squamous cell carcinoma skin cancer.”

A new survey from the American Academy of Dermatology found that only about half of US adults (53 percent) know how to look for skin cancer signs.  In addition, the survey of some 1,151 adults revealed that ‘74 percent of people didn’t know that skin cancer is the most common cancer in the US, and 30 percent were unaware or weren’t sure about how easy it is to treat skin cancer if it’s found early on.’ 

Likewise in Canada, skin cancer is the most common cancer.  Last year in Canada, there were an estimated 75 500 new cases of skin cancer and 5300 new melanoma cases in Canada.  Dermatologists like me specialize in the diagnosis and management of skin cancer.

Any spot or mole that changes, bleeds, or scabs could be skin cancer.  If you are concerned about any spot or mole, show your doctor and he/she may then refer you to a Dermatologist for assessment and treatment.  For further information on skin cancer and my Skin Cancer Clinic please visit my Skin Cancer Clinic webpage.

I am often asked if sunless self-tanning lotions are safe.  At the present time, sunless self-tanning products are considered safe but make sure you continue to use sunscreen with it.  I’ve included a video ‘Self-tanner: How to apply’.  This is the first video in the Dermatology A to Z: Video Series by the American Academy of Dermatology is which offers videos that demonstrate tips people can use to properly care for their skin, hair, and nails.  A new video in the series will be posted to the Academy’s website and YouTube channel every month.  Have a wonderful long-weekend.

Unfortunately I see quite a few tanned young adults (and older adults) in my Dermatology practice.  To follow-up with my last blog, there have been some recent articles trying to address how best to counsel young people to minimize UV ray exposure.  I find this interesting and from now on in my practice will try to first discuss with young adults the cosmetic effects on our skin that the sun and tanning-beds have before moving on to the risks of skin cancer and melanoma.

• The Wall Street Journal (5/8, Landro) ‘Health Blog’ reports that, according to a recommendation made by the United States Preventive Services Task Force (USPSTF) and published online May 7 in the Annals of Internal Medicine, physicians should take time to tell youngsters, teens and adults in their early to mid-twenties that they should minimize their exposure to ultraviolet (UV) rays.
• The CNN (5/8, Hellerman) ‘The Chart’ blog points out, ‘For adults older than 24, there is not enough evidence to say whether counseling about sun exposure makes a difference, according to the Task Force.’ As for youngsters under 10, ‘counseling on sun exposure should be directed towards parents, said Dr. David Grossman, a member of the Task Force.’ Grossman also explained that ‘patients age 10 to 24 should be told to wear sunscreen with an SPF of 15 or above, to cover exposed areas of skin, stay out of the sun between 10 a.m. and 3 p.m. and to shun indoor tanning booths.’
• ‘But rather than focus on skin cancer, discussions with young patients should center on how ultraviolet-ray exposure can damage the way their skin looks, the task force advised,’ HealthDay (5/8, Reinberg) reports. HealthDay quotes USPSTF chair Virginia Moyer, MD, MPH, who stated, ‘We are not saying to young people to avoid sun exposure and indoor tanning to prevent skin cancer, because that message doesn’t work.’ She added, ‘That is the goal, but the message that works is to use appearance-based counseling.’
• WebMD (5/8, Doheny) reports that physicians should warn their fair-skinned young patients ‘of the ill effects of too much sun on their appearance.’ WebMD explains, “A doctor may show a patient photos taken with a UV camera, for instance, to demonstrate how much ultraviolet rays can damage the skin, even of a young person.’ Reuters (5/8, Pittman) also covers the story.

Study Shows Many Young Adults Unaware Of Tanning-Bed Dangers

The Holland (MI) Sentinel (5/15) reports, ‘Results of a survey…conducted by the American Academy of Dermatology shows that young adults are not aware of the dangers of tanning beds and how to properly protect their skin from sun damage.’ For example, ‘nearly one-quarter of young adults were either unaware or unsure that tanning beds are not safer than the sun,’ and just ‘35 percent of young adult respondents ages 18-29 knew that a base tan is not a healthy way to protect skin from sun damage.’

And so I would like to add a few more links on the risks of tanning beds and that tanning beds cause skin cancer and melanoma:

• Sunburns & Tanning Beds are Two of the Greatest Risk Factors for Melanoma.  The News Herald (5/7) points out, ‘Melanoma is most often found in people with fair skin and those who experience a lot of sun exposure.  Sunburns and tanning beds are two of the greatest risk factors for melanoma.’ The article points out the seriousness of melanoma, which causes ‘about 75 % of all skin cancer fatalities.’
• Skin Cancer Foundation Urges Young Women To Avoid Tanning Salons.  The Longview (TX) News-Journal (5/9) reported, ‘The Skin Cancer Foundation encourages young women who are prom planning to steer clear of tanning salons and embrace their natural skin tones, as ultraviolet radiation from tanning beds can lead to skin cancer.’ The piece adds, ‘The risks of indoor tanning are real — those who make just four visits to a tanning salon per year can increase their risk for melanoma by 11 percent, and their risk for the two most common forms of skin cancer, basal cell carcinoma and squamous cell carcinoma, by 15 percent.’
• Dermatologists Weigh In On Tanning Dangers. The Taunton (MA) Gazette /GateHouse News Service (5/1, Browning) reports that dermatologist Carolyn Jacob, MD, ‘said there’s nothing safe about a tan whether it’s developed outdoors or indoors.’ She pointed out, ‘There’s actually research that shows that tanning booths, which are comprised primarily of UVA (ultraviolet A) rays, increase your risk of developing melanoma, which is the deadliest form of (skin) cancer, by 75 percent.’ Dermatologist Elizabeth Strow, MD, ‘said she is against tanning in general and tanning beds in particular, because of the increased risk of melanoma, squamous cell carcinoma and basal cell carcinoma shown in studies on tanning beds.’
• Statistics About UV-Related Health Risks Not Deterring Young Adults From Tanning. The Record (NJ) (5/5, Yorio) reported, ‘The health risks posed by the ultraviolet lights used in indoor booths and beds are well-documented, but the fact that tanning salons are a multibillion-dollar business proves that statistics have yet to act as a real deterrent’ to teens and young adults. In addition to the Mayo Clinic study cited above, ‘skincancer.org…reports that people who use UV tanning beds are 74 percent more likely to develop melanoma than those who have never tanned indoors, 2 1/2 times more likely to develop squamous cell carcinoma and 1 1/2 times more likely to develop basal cell carcinoma.

There has been so much in the news lately on the dangers of tanning and especially with this being Melanoma May (and the nicest day of the year yet in Grande Prairie!), I would like to include some of these links below:

USA Today (5/11, Hellmich) reports, “Experts have been warning for years that exposure to ultraviolet radiation from the sun and from indoor tanning equipment increases the risk of skin cancer.” Currently, “skin cancer is the most common form of cancer in the USA, and melanoma is the most deadly type of skin cancer, the CDC says.” Daniel Siegel, MD, president of the American Academy of Dermatology, stated, “We are in the midst of a skin cancer epidemic right now, and young people are ignoring all the warnings about the dangers of tanning salons.”

The Washington Post (5/11) “The Checkup” blog reported, “In one study, the CDC and the National Cancer Institute looked at self-reported sun-exposure data for 5,000 people age 18 to 29 collected through the National Health Interview Survey (NHIS) for the years 2000, 2003, 2005, 2008 and 2010. Of those participating in the most recent survey, a whopping 50.1 percent of all adults reported having had at least one sunburn during the preceding 12 months.” A second CDC/NCI study found that “among white women ages 18 to 21, nearly 32 percent had tanned indoors; close to 30 percent of women ages 22 to 25 had done so,” many for multiple times during the year, even though indoor tanning significantly raises a young adult’s risk of getting melanoma.

The NPR (5/11, Hensley) “Shots” blog focuses on the dangers revealed by the tanning booth study. “Overall, in 2010 about 5.6 percent of adults used a tanning bed, or other device that blasts UV rays at skin to darken it.” However, many are unaware that “indoor tanning equipment that exposes a person to UV rays (not tanning spray) carries the risk of skin cancer. The frequent tanning sessions found in the survey increase the risk.” According to Allan Halpern, MD, of the Memorial Sloan-Kettering Cancer Center, “what tanning beds are doing is concentrating the same kind of rays that we get from the sun; so, you’re getting a much bigger dose” than from a similar amount of time spent outside.

The Huffington Post (5/11, Chan) points out, “According to the American Academy of Dermatology, 36 states have restrictions on minors’ use of tanning beds. California has a completely prohibition of tanning-bed use by people younger than 18.” Many states are currently considering legislation to ban or partly ban tanning-bed use by minors.

HealthDay (5/11, Reinberg) reports that AAD president Daniel Siegel “said the numbers weren’t unexpected. ‘I am not surprised we are seeing lots of people tanning. It’s just like smoking and other risky habits; you’re young and you think you are immortal,’ he said.” He added that tanning “is one more bad habit people need to change.” Also covering the story are the Time (5/11, Sifferlin) “Healthland” blog, MedPage Today (5/11, Smith) and WebMD (5/11, Nierenberg).

Dermatologists from across Canada are urging high school students to have a Tan-Free Grad/Prom.  Especially since May is Melanoma Month, I’d like to take this opportunity to discuss the dangers of tanning.

Please also see the following link on Tan-Free Grad/Prom.

Dangers of Tanning

• Melanoma
• Skin cancer
• Damaging effect on the skin’s immune system
• Damages the DNA in the skin cells
• Premature aging of skin
• Wrinkled, leathery skin
• Sun spots, brown spots & white spots
• Eye damage including cataracts & ocular melanoma

Tanning Increases Risk of Melanoma

The two types of ultraviolet radiation are Ultraviolet A (UVA) and Ultraviolet B (UVB).  UVB has long been associated with sunburn and UVA has been recognized as a deeper-penetrating radiation that causes more damage.  We now know that UVA is also associated with melanoma, the most serious, potentially deadly type of skin cancer of skin cancer.  Despite what the tanning agency would have you believe, there have been many studies that show increased risk of melanoma with tanning.  A large study back in 2009 showed that regular use of indoor tanning starting prior to the age of 30, increases the risk for developing malignant melanoma by 75%.

Tanning Increases Risk of Skin Cancer

Tanning increases the risk of all types of skin cancer including Basal Cell Cancer, Squamous Cell Cancer, and Melanoma.  Contrary to popular belief, skin cancers are not all easily curable.  Melanoma, with a suspected link to UVA exposure, is fatal if not detected early. 

Is There A Safe Way to Tan?

There is no safe way to tan.  A tan damages the skin.  Tanning occurs when UV rays penetrate the epidermis, the skin’s outer layer, causing the production of melanin as a response to the injury.  Long term exposure to UV light, results in a change in the skin’s texture, causing wrinkling and age spots.  Thus, tanning to improve appearance is ultimately self-defeating.  Every time you tan, you damage your skin and this damage accumulates over time.  This accumulated damage, in addition to accelerating the aging process, also increases your risk for all types of skin cancer.

Does the Skin of Young People Show Harmful Effects of Tanning?

Skin aging and cancer are often delayed effects that show up many years after the exposure.  Unfortunately, because the damage is not immediately visible, young people often are unaware of the dangers of tanning.  It is estimated that cases of skin cancer will continue to increase as people who are tanning in their teens and 20s reach middle age.  In some cases, as mentioned in the above article, the effects can show up earlier.  In some patients that tan, I often see skin cancer appearing in young adulthood.

Are Tanning Beds Safer Than Natural Sunlight?

No.  Most tanning beds emit mainly UVA radiation; these so-called “tanning rays” are less likely to cause a sunburn than the UVB radiation from sunlight.  Contrary to the claims of some tanning salons, that does not make them safe, in fact, they cause deeper skin damage.  Studies have demonstrated that exposure to UV radiation during indoor tanning damages the DNA in the skin cells.  Also, excessive exposure to indoor tanning leads to skin again, immune suppression, skin cancers including melanoma, eye damage including cataracts and ocular melanoma.

Is Sun Good for Your Health?

People have long associated a suntan with good health and vitality.  Vitamin D is necessary, but just a small amount of sunlight is needed for the body to manufacture it.  It does not require a suntan!  The Canadian Dermatology Association recommends at least 1000 IU of Vitamin D daily which can easily be obtained by a Vitamin D supplement.  It is safer to take the supplement than expose your skin to the sun.  The tanning agency would have you believe that tanning is important for making Vitamin D but this is not true.  Tanning in sun-tan booths is predominately UVA and it is the UVB rays not UVA this is responsible for making Vitamin D. 

Are Sunless Self-Tanners Safe?

At the present time, sunless self-tanning products are considered safe but continue to use sunscreen with them.  These are the safe alternative for patients wanting a ‘tanned’ look.