2016 AAD Updates

I recently returned from the 2016 American Academy of Dermatology Conference in Washington D.C., where I had an opportunity to share some of my research and get updates on all the latest in the field of dermatology. It was a wonderful meeting with over 18,000 in attendance! 

Once again there was much discussion of psoriasis and the new biologics available for treatment, as well as the importance of screening for other medical conditions such as high blood pressure and heart disease in these patients. Counseling psoriasis patients to stop smoking, minimize alcohol consumption and maintain a healthy weight was emphasized.

Another interesting topic was a review of treatment of pre-cancerous lesions such as actinic keratoses with topical chemotherapy creams. This can be combined with therapies such as liquid nitrogen for improved outcomes. Photodynamic therapy is another way to treat these lesions for both a medical and cosmetic improvement. As the population ages and there is an accumulation of sun damage, treatment strategies for both pre-cancerous lesions and skin cancers will become even more important.

On the cosmetic side there was a focus on combination therapy for rejuvenation of the aging skin and discussion on complications from treatments. I had the opportunity to present on facial vascular anatomy and strategies to prevent and treat vascular complications including blindness from filler.  I also was invited to teach in a hands-on workshop where I educated other dermatologists how to inject filler in various areas of the face to get the best cosmetic result. Participants were able to practice injecting directly into a training model to practice their skills.

Overall it was a great meeting with lots of pearls shared. I'm looking forward to next year's meeting in Orlando.  

5 Winter Weather Skin Tips

The seasons have changed and the holidays are upon us. To add to all the year-end excitement (or stress) of visiting family, office holiday parties, and crowds at the mall, many people are also dealing with increased skin issues due in part to colder weather. 

If you want to protect and rejuvenate your skin this winter here are my top 5 tips along with products I recommend to my patients, especially this time of year.

1.    Stay hydrated. This is important year-round but often as temperatures drop people forget to continue drinking water and instead increase their intake of coffee, which can dehydrate the body and dry out your skin and lips. Wine and salty foods, which tend to be consumed in larger amounts throughout the holiday season, also have a dehydrating effect. So be sure to drink plenty of water.

2.    Increased hand washing = increased moisturizer. Tis the season for colds and the flu. In order to keep your health in tip-top shape, prevention is key with hand washing and/or use of a hand sanitizer regularly. It's actually a misconception that hand sanitizers are more drying. Studies have shown that soap and water can dehydrate your hands even more. Either way, after cleansing your hands, it is important to rehydrate using a thick moisturizer. Carry them in your purse or pocket if you can.  

3.    Switch to Creams and Balms. Lightweight moisturizers should be substituted for heavier creams and balms that provide deeper nourishment for the skin. Generally I recommend maintaining your daytime routine and switching to something heavier at night. Vaseline also works wonders on dry, cracked skin on hands and feet.

4.    Always Remember SPF. No dermatologist’s list would be complete without a reminder to protect your skin from the sun, no matter what time of year. Especially if you are a winter sports person, remember that the sun reflects off the snow, amplifying the effects. Using suncreen or lotion with SPF year-round will help maintain your skin over the long run. And don’t forget to use lip balm with SPF too.

5.    Humidify. Using a humidifier is a good way to replenish your skin’s moisture. If you don’t have one you can also get a humidifier-like experience by closing the bathroom door when you shower to create a more humid environment.  However, long, hot showers will work against your skin so limit showers to 5-10 minutes and keep the water warm but not hot.

Some of my favorite products to protect against harsh winter weather are:

• Hand moisturizers: Norwegian formula hand cream, Cetaphil hand barrier cream. Consider putting thick moisturizer like Vaseline in a cotton glove for better penetration. 
• Body moisturizers: CeraVe Cream, La Roche Posay Lipikar Baume, Aveeno eczema cream.
• Sunscreen: La Roche Posay Anthelios (SPF 30, 45, or 60), Neutrogena Ultra Sheer (SPF 30, 45 or 60). There are many other good brands out there and the most important thing is to be sure that whatever sunscreen you use has broad spectrum coverage.

Understanding chronic urticaria (hives) and how to treat it

One of the most frustrating skin conditions to have (and treat) is chronic urticaria. Urticaria, commonly known as hives, can be classified as either acute (an episode lasting less than 6 weeks) or chronic (symptoms daily or almost daily for more than 6 weeks). Specific triggers (e.g. pressure, cold) may induce symptoms of urticaria, but often there is no specific external trigger for chronic urticaria. In Canada and the U.S. this chronic condition is labeled Chronic Idiopathic Urticaria (CIU) while the rest of the world refers to it as Chronic Spontaneous Urticaria (CSU). Despite the different terminology it is the same disease.

It is estimated that CIU affects up to 1% of the population at any given time, with peak incidence in patients between 20-40 years of age. CIU generally persists in patients for 1-5 years, with 50% of cases resolving within 6 months of onset and only about 5% lasting more than 10 years.

One of the most serious adverse effects of CIU is impairment of quality of life. Diagnosis and treatment is key to helping improve quality of life for patients.

The diagnosis of CIU is a two-step process. The first step is to gather relevant history from the patient regarding time of disease onset and frequency / duration of symptoms. The second step is a physical examination and diagnostic provocation test. Following diagnosis, your doctor will likely assess the severity using the Urticaria Activity Score (UAS), looking at the number of hives and itch intensity over a 7-day period (UAS7).

The goal in treating CIU is rapid and complete symptom control. The first line of treatment is the use of H1 antihistamines. These are over the counter drugs like Claritin, Allegra and Aerius. If symptoms persist after two weeks the second line treatment is to increase the dosage of antihistamines up to four times. If symptoms are still unresolved then third line treatments include cyclosporine and montelukast (Singulair). Most recently omalizumab (Xolair) was added to the treatment arsenal.

Omalizumab was approved in Canada for treatment of moderate to severe CIU in August 2014, following approval in the US and EU earlier last year. Omalizumab is very well tolerated and has been shown to lead to rapid and sustained improvement in UAS7.

If you or someone you know is dealing with chronic urticaria and are unable to control it with the recommended dosage of antihistamines, you should speak to your doctor to review other options.

New Treatment to Get Rid of Your Double Chin

You may have heard that there is a new injectable treatment to eliminate the dreaded “double chin.” The product is known as KYBELLA in the U.S. and BELKYRA here in Canada. BELKYRA was recently approved by Health Canada for the treatment of submental fullness, or fat below the chin.

This is the only FDA and Health Canada approved non-surgical treatment to reduce submental fat. The active ingredient in BELKYRA is deoxycholic acid, which is a naturally occurring molecule in the body that helps with the breakdown and absorption of fat. When injected, it causes the destruction of fat cells so that those cells can no longer store fat.

Because BELKYRA destroys fat cells, once the desired aesthetic appearance is achieved it is not expected that any re-treatment will be needed. However, the initial treatment regimen will be tailored based on your profile and the desired contouring of the chin. It may require up to six treatments each one-month apart, though results have been seen in as few as two treatments.

Many adults, both men and women, have expressed unhappiness with the appearance of a double chin. That is why it is very exciting to be able to offer a non-invasive treatment that can provide patients with significant results in a short amount of time. The procedure has minimal patient downtime and common side effects are similar to other injectables, including possible swelling, bruising and pain at the site of injection.

I am thrilled to be a part of the practice at Carruthers & Humphrey, which will be the first practice in Vancouver to offer BELKYRA (available in late August or September 2015). If you are interested in a consultation for BELKYRA or other cosmetic procedures please contact the office.