Dr. Katie Beleznay

Vancouver Skin Care Specialist

Dr. Katie Beleznay is a leading dermatologist specializing in the latest treatments to repair and rejuvenate the skin

Summer Sunscreen Tips

When it comes to sunscreen the most important thing is that you use it! However, even when people are diligent about wearing sunscreen they may still be putting their skin at risk. I wanted to address a few things that everyone needs to know to ensure maximum protection for your skin.

The most common mistake people make when using sunscreen is not using enough and not applying it frequently enough. Sunscreen should form a film on the skin when initially applied. A good rule of thumb is to use 1 oz of sunscreen to cover your body (though obviously this needs to be adjusted based on your body type). Sunscreen should be applied at least 20 minutes before going out in the sun and reapplied every two hours, no matter what SPF.

Sunscreens should be a minimum of 30 SPF but I always suggest the higher (SPF) the better. In the morning we recommend that sunscreen go on after moisturizers or other creams, but before makeup. Always reapply sunscreen after swimming or sweating and apply it on dry skin. 

We recommend using sunscreen daily all year round as the sun’s rays reflect off surfaces such as snow, sand and even concrete, so be sure to protect your skin. In addition to sunscreen it is recommended to wear photo-protective clothing and always wear a hat when spending any extended time in the sun. Beyond the risk of skin cancer, the sun can also lead to signs of premature aging like wrinkles and brown spots. If your skin is already sun damaged it is important to do regular skin checks.

The weather is heating up and I know everyone is excited to get out in the sun. If you follow the advice above your skin (and your dermatologist) will thank you!

May is Skin Cancer Awareness Month

For the month of May the goal is to increase awareness around skin cancer.  Skin cancer is the most common type of cancer, but also one of the most preventable forms of cancer. So by raising awareness of the dangers of unprotected sun exposure and encouraging sun-safe habits, the goal is to help prevent skin cancer in the first place and also review how to screen your skin and find any worrisome spots early.

I had an opportunity to share some thoughts on the topic with CBC News in Vancouver:

Below is more detailed information on types of skin cancer, how to detect it, and how to prevent it.

 What is skin cancer?

Basal cell carcinoma is the most common form and accounts for 90% of all skin cancers. It is caused by long-term exposure to sunlight. It is the most easily treated.

Squamous cell carcinoma (SCC) is the second most common type. It is easily treated when found early, but in a small percentage of cases, this cancer spreads to other parts of the body.

Melanoma is the most serious type of skin cancer and is responsible for the most deaths. However, it can be cured if it is diagnosed and removed early. Melanoma can develop from a pre-existing mole that appeared normal but changes, or as an irregular appearing new spot. Over 7,000 people were diagnosed in Canada with Melanoma in 2017. Melanoma causes more than 1200 deaths in Canada every year. Melanoma is also one of the most common and deadly types of cancer in young adults 15 to 30 years old. Early diagnosis is the key to positive outcomes. 

How common is skin cancer?

Skin cancer is the most common type of cancer. Over 80,000 cases of skin cancer are diagnosed in Canada each year, It is also one of the most preventable because the most common contributor to skin cancer is overexposure to ultraviolet radiation such as from sun and artificial tanning beds. The rates have been steadily increasing over the previous years. In fact Canadians born in the 1990s have 2-3x higher lifetime risk of getting skin cancer (1 in 6) than those born in the 1960s which is about 1 in 20. Today approximately 1 in 5 people will develop skin cancer.

What does melanoma look like?

Melanoma can start as a new, brown or black spot on the skin's surface. It can also begin as a change in the shape or colour of an existing mole or coloured spot. Melanomas tend to be dark in colour — browns and blacks — although some are a mixture of colours including red, blue and white. They will typically grow and change, so the key is to look for change

What causes melanoma?

There are various factors that contribute to the development of melanoma, but excessive exposure to ultraviolet radiation, so sunlight and tanning beds is the main reason for the development of this type of skin cancer. Severe, blistering sunburns especially in childhood are thought to play an initiating role. However, sunburns at any time during life can also increase the risk. Indoor tanning is also a known risk of melanoma.

Who is at highest risk?

Fair skinned people (so those with freckles, blond, red hair, blue eyes) with skin that burns rather than tans are more likely to get this disease. Those with many moles (more than 50), or moles with an unusual colour or shape, or with large moles, have an increased risk. A close family history of melanoma is another risk factor. However, people with no risk factors at all may still get melanoma.

Where does it often appear?

Melanoma appears most commonly on the backs of men and legs of women. However, it can appear anywhere on the skin surface or in the mouth or eyes or palms and soles.

How do you prevent skin cancer?

Avoid the sun from 10 am to 4 pm (or during the most intense times of sun exposure) and protect yourself if you are outside during these times by seeking shade, covering up with clothing and wearing a wide brimmed hats.  Also don’t forget to use a protective lip balm with SPF.

Wear a broad-spectrum sunscreen with a minimum SPF of 30. Apply before you leave the house and reapply every two hours or more frequently during strenuous exercise or after swimming.

You can also look for the Canadian Dermatology Association logo on sunscreen products to ensure the product you are using is safe and effective.

Avoiding the use of indoor tanning beds will also reduce your risk of melanoma

Regular skin checks are important.  Have someone help check areas like your back and scalp.  Skin cancer can show up on parts of your bodies that are not always exposed to the sun, so even be sure to check the bottoms of your feet. Examining your skin on a regular basis can lead to early detection, treatment and in most cases, positive outcomes. 

Why should people check their own skin?

People are very successful at detecting melanoma on their own skin or that of a family member. Research shows that >half of melanomas are discovered by the patients themselves and a further 17% by their family members.

Checking your skin and detecting melanoma early can lead to a 90% cure rate. Melanoma has one of the highest cure rates if found early.

A skin self-exam is simple and takes only 10 or 15 minutes once per month.

Recent research shows those at risk for melanoma who had a friend or family member help with checking the skin found the disease at a much earlier stage and had a 63% lower death rate compared to those who did not check their skin.
 

What do you look for when examining your skin for melanoma? A-B-C-D-E

Asymmetry:

The first way to check a mole is by its shape. If you were to draw a line down the middle of your mole, and one side looks different than the other, you should ask your doctor to check it as it is asymmetrical

Border:

Another way to detect an abnormal mole is to look at its borders. If the borders of a mole are uneven and not smooth this is more suspicious.

Colour:

Healthy moles tend to be one uniform colour.  Having a mole with a variety of colors is a potential warning signal. A number of different shades of brown, tan or black could appear. A melanoma may also become red, white or blue.

Diameter:

The diameter (or size) of a mole can also signal you to ask your doctor to check it. A general rule is if the mole is larger than a pencil eraser (which is about 6 mm) there is a higher chance it is suspicious.

Evolution:

Evolution means to watch for changes to the mole over time. Moles sometimes change in size, colour, or shape. There may be other symptoms of change like itching, tenderness or bleeding. So if something is evolving or changing, it’s time to get it checked.

“The Ugly Duckling Rule” is another good rule to look for. You are looking for a change in a specific mole, but also how it compares to the moles around it.  Essentially you are looking for ‘outliers’ spots that are bigger, darker or irregular in any way compared to other spots”

Trends in Dermatology for 2018

As we start off the New Year I wanted to share a few emerging trends in dermatology. In my practice I treat patients for both medical and cosmetic concerns so I will highlight some developments in both areas.

On the medical side there are a number of exciting new treatments emerging for the treatment of psoriasis, eczema and acne just to name a few!

Eczema – This chronic condition can be challenging to treat, particularly since, to date, we have had limited effective systemic medications. Dupilumab is a new biologic that was approved by the FDA in 2017 and has been approved by Health Canada for roll out in 2018. Dupilumab is a human monoclonal antibody that is designed to inhibit overactive signaling of two key proteins (IL-4 and IL-13) that are believed to be major drivers of the underlying inflammation in atopic dermatitis (eczema). We dermatologists (and our patients) have all been awaiting the approval of this new medication as the data suggests it is quite effective and safe. A number of other biologics and topicals (including non-steroid options) are also in the pipeline, promising even more options to treat this condition.

Psoriasis – There are a number of new biologics being introduced for the treatment of psoriasis as well. New IL-17 inhibitors and IL-23 inhibitors, including risankizumab, guselkumab, tildrakizumab, ixekizumab and brodalumab (all a bit of a mouthful to say J), are either recently approved or in the final stages of gaining approval to be marketed in the US and Canada. If you suffer from psoriasis you can ask your dermatologist whether any of these new medications may be right for you. Topicals in newer formulations, such as spray foam (enstilar), also continue to gain popularity for treating mild to moderate psoriasis where a high-powered biologic medicine is not called for.

Acne – In terms of acne treatments there is new evidence that certain combination treatments, such as adapalene and benzoyl peroxide (TactuPump Forte) can help treat acne, including more severe acne, and can also prevent and treat acne scarring. There are number of new topicals in the pipeline for acne treatment as well, including topical sebum inhibitors that could act to reduce “oily skin” that may drive acne in some patients.

Moving on to cosmetic treatments, there are a number of themes influencing the way we treat patients.  

Body Sculpting - Each year the American Society for Dermatologic Surgery (ASDS) surveys consumers to understand their views on cosmetic treatments. For the fourth consecutive year the treatment of excess fat ranked as the #1 thing that bothered people about their appearance. This has given rise to the popularity of treatments such as CoolSculpting. A number of new and faster CoolSculpting applicators have recently become available and I believe this treatment will continue to increase in popularity. In addition, Belkyra (Kybella in the US), which was originally approved as a treatment for double chins, is now being used (off-label) on different body sites as well to help treat stubborn fat.

Combination treatments – Increasingly you will find different cosmetic treatments, such as neuromodulators like botox, being used in combination with fillers, and lasers, for more effective results. We have moved away from simply treating a line or wrinkle to thinking of the face in 3-dimensions and focusing not only on the skin, but thinking about the underlying structures as well. The aging process is complex and while a patient may be bothered by one thing, we may approach this concern with a combination of treatments to address related concerns. Often a combination approach may provide the most effective and longest lasting improvement. 

Natural looking outcomes – While this is not a new theme, it is definitely one that continues to be important. The desire to ensure a natural look has led to the rise in treatments like microneedling and thermage, skinboosters, and the use of more frequent, but smaller treatments with filler and neuromodulators such as botox. This also aligns with the goal of prevention and using cosmetic treatments to help preserve skin elasticity and collagen, so that your skin can stay looking healthy and vibrant longer.

Focus on men - Men have always represented a smaller proportion of the cosmetic patient population but they continue to grow each year. While men make up only about 10% of the total patient population for popular procedures like botox, the number of men seeking cosmetic treatments has increased dramatically over that past several years. Understanding the unique needs of men and developing customized treatment plans to emphasize masculine features continues to be a focus.


These trends will continue to play a big role in my practice in 2018 and beyond. I will continue to keep up-to-date on the latest in both cosmetic and medical dermatology. If you have any questions or want to book a consultation, please feel free to contact us.

 

Make Yourself “No Makeup” Beautiful

This post was originally published on the Carruthers & Humphrey blog.

---------------------------------------------------------------------------------

During this year’s “awards season” it became clear that the new beauty trend among Hollywood celebrities is to achieve a natural look with minimal makeup. Meanwhile the hashtag #nomakeup has been trending across social media, with everyone from Cindy Crawford to Kim Kardashian to Beyonce posting selfies to show off their makeup-free looks. The move toward less makeup, or no makeup at all, is refreshing to see.

A key message from this movement is to embrace your natural beauty without the need to alter your appearance. Of course many people wonder if they can pull it off and may want to improve their skin tone and complexion before going makeup-free.

At Carruthers & Humphrey, we strive to deliver natural looking results that give our patients greaterconfidence in the appearance of their skin. While every patient receives a customized treatment plan, for those looking to go makeup-free there are a few common treatments that may be utilized to help create that effortless look.

  1. Skin care – A proper skin care routine is vital to keeping skin looking refreshed. There are a number of products that can help give your skin a healthy glow, but I will highlight a few. Topical vitamin A, known as retinol, can be helpful to minimize fine lines, reduce brown spots and improve acne. Specific formulations of topical vitamin C can act as potent antioxidants and can protect the skin against damage from UV. Sunscreen daily and sun protection strategies are also essential to maintaining healthy skin.  It is important to get into a routine with skin care to protect the skin, prevent those signs of aging and help you get that makeup free look.
  2. Lasers and light-based therapies: There are a few different options that can help you achieve your no-make up look. Clear + Brilliant is a non-ablative laser that is helpful for reducing unwanted pigmentation, while also improving pore size and skin texture. Excel V is a different laser that is commonly used to reduce redness and the appearance of blood vessels. Intense Pulsed Light (IPL) also known as a photofacial can reduce pigment, redness, even out the skin town and help to create that healthy glow. These treatments all tend to have minimal downtime. There can be some immediate redness and swelling following the procedure, but this typically subsides within a day or two up to a week or so. Once this subsides the skin will appear smoother and clearer.
  3. Skin Tightening: There are now some great non-invasive options to lift and tighten the skin. Ultherapy utilizes ultrasound while Thermage relies on radiofrequency, but both achieve similar outcomes by triggering a natural process known as neocollagenesis that strengthens existing collagen and stimulates new collagen production that is essential for healthy skin. The results are generally seen over 2-3 months as the process of neocollagenesis takes effect. The results can be long-lasting  Both of these procedures are popular due to minimal patient downtime.

By taking both corrective and preventative actions for your skin you can have the confidence to go #nomakeup.